左旋多巴对帕金森病患者血浆维生素B12浓度及神经传导速度影响

目的 研究应用左旋多巴治疗对帕金森病(Parkinson diease,PD)患者体内维生素B12浓度及神经传导速度的影响.方法 随机选择初次诊断帕金森病患者60例,随机分成3组,每组20例.其中对照组口服安坦,2 mg/次,3次/d.治疗组1服用左旋多巴,0.25 g/次,3次/d.治疗组2服用左旋多巴,0.25 g/次,3次/d,同时服用甲钴胺,500μg/次,2次/d.分别于用药前、治疗12个月后测定维生素B12浓度,并行神经肌电图检查.结果 治疗组1治疗后血浆维生素B12浓度及周围神经传导速度低于对照组和治疗组2(P＜0.05),而治疗组2血浆维生素B12浓度及周围神经传导速度与对照组差异无统计学意义(P＞0.05).结论 左旋多巴可降低血浆维生素B12浓度、减慢周围神经传导速度,同时服用甲钴胺可有效改善血浆维生素B12浓度及周围神经传导速度,减轻左旋多巴对周围神经的影响.     

甲钴胺静注致心律失常临床病例分析

维生素B12（Vitamin B12）是一类含钴的水溶性B族维生素,一般指氰钴胺（cyanocobalamin）。在体内具有辅酶活性的维生素B12为甲钴胺（Mecobalamine）和5′-脱氧腺苷钴胺（5′-deoxyadenosylcobalamin, Cobamamide）。维生素B12参与体内核酸、胆碱、蛋氨酸的合成以及脂肪、糖的代谢。     

甲钴胺对青光眼视神经保护作用的临床研究

青光眼是一种隐匿性致盲性疾病,目前它的发病率和致盲率在世界范围内都呈上升趋势[1].关于青光眼的危害,认为是高眼压状态下对视网膜神经节细胞造成损害.对于青光眼的治疗主要是将眼压降至安全的靶眼压范围.当眼压控制后,如何阻止视网膜神经节细胞的进一步凋亡和挽救被高眼压损害功能的神经节细胞,越来越引起眼科临床医师的重视.甲钴胺（甲基维生素B12）是维生素B12的衍生物,已广泛应用于神经疾病的治疗.国内外的临床观察报道甲钴胺有明显的保护神经的作用.甲钴胺是否对视神经及视网膜神经节细胞有保护作用,我们在临床上选取眼压已经控制的原发性开角型青光眼患者,观察疗效.     

甲钴胺在周围神经病中的康复效果

甲钴胺为存在于血液、脊髓中的辅酶维生素 B12，又名钴宾酰胺，商品名为缩弥可保。与维生素 B12相比，由于分子结构中有一个活性甲基结合在中心的钴分子上，所以对神经组织具有良好的传递性，对神经损伤的康复具有更好的作用。 1药理作用 甲钴胺通过甲基转换反应，促进核酸－蛋白－脂质代谢，修复被损害的神经组织。在大白鼠脑株细胞实验中，甲钴胺在同型半胱氨酸合成蛋胺酸过程中起着辅酶的作用，参与由脱氧尿嘧啶核苷合成胸腺嘧啶核苷，促进 DNA、 RNA的合成。另外，在神经胶质细胞实验中，甲钴胺可促进髓鞘脂质卵磷脂的合成。甲钴胺…     

透刺经筋法联合甲钴胺穴位注射对周围性面瘫患者面神经功能的影响

目的:探究透刺经筋法联合甲钴胺穴位注射对周围性面瘫患者面神经功能的影响。方法:选取周围性面瘫患者102例,根据治疗方案不同分组,各51例。对照组给予常规治疗(改善循环、营养神经、抗病毒等),观察组于对照组基础上加用透刺经筋法、甲钴胺穴位注射,2组均持续治疗1个月。对比2组治疗前后神经功能分级(H-B)评分、面瘫Portmann评分、面部残疾指数(FDI)、面部生物电信号差(提唇上肌、咬肌)、血清Th17细胞表达。结果:治疗后观察组H-B评分较对照组低,Portmann评分较对照组高;治疗后观察组FDIS较对照低,FDIP较对照组高;治疗后观察组提唇上肌、咬肌生物电信号差较对照组低;治疗后观察组血清Th17细胞表达较对照组低,差异均有统计学意义。结论:透刺经筋法、甲钴胺穴位注射联合治疗周围性面瘫患者,可有效改善面神经功能、残疾指数、生物电信号差距,其作用机理可能与降低血清Th17细胞表达有关。     

甲钴胺治疗面神经炎疗效观察

目的：探讨甲钴胺治疗面神经炎的有效性。方法：观察40例,甲钴胺组（A）21例,普通维生素B12组（B）19例,分别治疗2周与4周后评判其治愈率及总有效率。结果：甲钴胺组2周的治愈率19.0%,总有效率66.7%;4周的治愈率76.2%,总有效率95.2%。维生素B12组2周的治愈率0%,总有效率26.3%;4周的治愈率10.5%,总有效率63.1%。两者比较有统计学意义（P〈0.05）。结论：甲钴胺治疗面神经炎是简单、易行且有效的一种方法。     

甲钴胺联合前列地尔治疗糖尿病周围神经病变的疗效观察

目的：观察比较甲钴胺联合前列地尔,单用甲钴胺及单用维生素B12治疗糖尿病周围神经病变的疗效。方法：将60例糖尿病周围神经病变患者随机分为3组,治疗组1（20例）给予甲钴胺0.5mg肌内注射,每天1次,同时给予前列地尔10μg＋0.9%氯化钠液10mL静脉推注,每天1次,连续2周;治疗组2（20例）给予甲钴胺0.5mg肌内注射,每天1次,连续2周;对照组（20例）用维生素B120.5mg肌内注射,每天1次,连续2周。每组均辅以丹参针剂静脉滴注治疗。结果：治疗组1、治疗组2患者症状和体征、各项神经传导速度与对照组相比均显著改善,而治疗组1与治疗组2之间临床疗效差异有统计学意义,且各组均无明显不良反应。结论：甲钴胺联合前列地尔治疗糖尿病周围神经病变疗效更好。     

子痫前期伴高同型半胱氨酸血症70例临床护理

目的:探讨子痫前期伴高同型半胱氨酸血症的护理方法.方法:测定266例子痫前期患者(A组)和266例正常妊娠孕妇(B组)血浆同型半胱氨酸(tHey)水平和血清叶酸、维生素B12水平,并对子痫前期伴高同型半胱氨酸血症患者应用叶酸联合甲钴胺进行治疗,测定治疗前后患者血浆tHey水平和血清叶酸、维生素B12水平.结果:血浆tHey水平A组高于B组,血清叶酸、维生素B12水平A组低于B组,两组比较均有极显著性差异(P<0.01).A组中70例伴高同型半胱氨酸血症患者经叶酸联合甲钴胺进行治疗4周后,血浆tHey水平下降(P<0.01),血清叶酸、维生素B12水平上升(P<0.01).结论:子痫前期患者血浆tHey水平上升,血清叶酸、维生素B12水平下降,叶酸联合甲钴胺进行治疗能使子痫前期伴高同型半胱氨酸血症患者血浆tHey水平下降.     

甲钴胺治疗特发性面神经麻痹的疗效观察

目的:探讨甲钴胺治疗特发性面神经麻痹的疗效.方法:将116 例患者分为对照组(58 例)和治疗组(58 例),在常规治疗的基础上,对照组给予维生素B12治疗,治疗组给予甲钴胺治疗.结果:(1)治疗4 周后,治疗组患者综合疗效明显优于对照组(χ2 ＝ 5.609,P ＝ 0.018).(2)治疗4 周后,治疗组神经传导速度、波幅均高于对照组,差异均有统计学意义(t ＝ 7.669,P ＝ 0.000;t ＝ 3.095,P ＝ 0.002).结论:甲钴胺治疗面神经炎疗效良好.     

2型糖尿病合并痛性神经病变患者应用甲钴胺不同 用药方式治疗的疗效及神经传导机制分析

目的:探讨2型糖尿病合并痛性神经病变患者应用甲钴胺不同用药方式治疗的疗效及对神经传导机制的影响。方法:选取2015年3月至2016年3月在我院接受治疗的2型糖尿病合并痛性神经病变患者135例,根据甲钴胺不同给药方式分为3组,A组45例给予甲钴胺肌内注射,B组45例给予甲钴胺静脉滴注,C组45例给予甲钴胺椎管内注射,3组患者均给予常规治疗。比较治疗前后3组患者的神经传导变化,包括运动神经传导速度(MCV)和感觉神经传导速度(SCV);血浆Hcy;采用神经病变自觉症状问卷(TSS)评定的神经症状;疗效及不良反应。结果:3组患者治疗前正中神经及腓神经MCV和SCV比较差异无统计学意义(P>0.05),治疗后均明显增加,且C组最快,B组快于A组(P均<0.05);治疗后,3组患者血浆Hcy及TSS评分都有所下降,且C组最低,B组低于A组(P均<0.05);治疗后,A、B、C组患者总有效率分别为77.78%、84.44%和97.78%,差异有统计学意义(P<0.05)。结论:甲钴胺不同给药方式都能够显著改善患者的神经病变,静脉滴注与椎管内注射的治疗效果优于肌内注射,椎管内注射效果最显著。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.