新生儿高胆红素血症时心肌酶的改变及临床意义

目的探讨新生儿高胆红素血症时心肌酶的改变及临床意义。方法分别于治疗前、后对64例高胆红素血症新生儿（治疗组），43例正常新生儿进行肝功能和心肌酶谱检测。结果高胆红素血症患儿治疗前心肌酶与对照组心肌酶比较差异有统计学意义（P〈0．01），心肌酶的升高与黄疸程度呈正相关，差异有统计学意义（P〈0．01），治疗后心肌酶与对照组心肌酶比较差异无统计学意义（P〉0．05）。结论新生儿高胆红素血症时心肌酶升高，且与黄疸程度相关，随着高胆红素血症的治愈心肌酶逐渐降至正常，心肌酶可作为高胆红素血症时的监测指标，但不一定造成患儿心肌细胞的不可逆损害。     

新生儿高胆红素血症合并心肌损害102例临床分析

对收治的102例新生儿高胆红素血症患儿的心肌酶谱进行测定,测定项目包括天冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）水平,观察新生儿高胆红素血症对心肌的损害及治疗前后心肌酶活性的变化。102例新生儿高胆红素血症患儿治疗后AST、LDH、CK、CK-MB水平均下降,与治疗前比较,差异具有显著的统计学意义（P〈0.05）。心肌损害是新生儿高胆红素血症常见的并发症,治疗后心肌酶也可恢复正常水平。临床治疗中应加强心肌保护和对心肌损害的治疗,降低永久性心肌损害的发生率。     

血清心肌酶谱、肌钙蛋白和超敏C-反应蛋白在手足口病患儿中的临床意义

目的探讨血清心肌酶谱、肌钙蛋白I（cTnI）和超敏C-反应蛋白（hs-CRP）在手足口病患儿中的临床意义。方法选择86例手足口病患儿,随机分为重症组37例,普通组49例,同时选择40例健康体检儿童作为对照组,分别检测三组儿童血清心肌酶谱、cTnI和hs-CRP水平,观察重症组和普通组治疗前后上述指标的变化情况。结果重症组和普通组血清心肌酶谱、cTnI和hs-CRP水平均明显高于对照组（P〈0.05）;重症组患儿血清心肌酶谱、cTnII〈I和hs—CRP水平均较治疗前显著降低,且有显著性差异（P〈0．05）。结论手足口病患儿在病情发展过程中心肌容易受到侵犯,检测血清心肌酶谱、cTnI和hs—CRP有助于尽早发现心肌损害,并能够判断心肌受损程度。     

血清心肌酶谱及肌钙蛋白检测在新生儿高胆红素血症患者中的临床意义

目的探讨血清心肌酶谱(乳酸脱氢酶,肌酸磷酸激酶,α-羟基丁酸脱氢酶和肌酸磷酸激酶同工酶)与肌钙蛋白I(CTn I)水平变化在新生儿高胆红素血症中的临床意义。方法选择2014年1月至2016年12月我院收治的154例高胆红素血症患儿为研究对象,根据胆红素水平升高程度的不同分为轻度高胆红素组(A组),重度高胆红素组(B组),极重度高胆红素组(C组),并选择同期健康体检新生儿60例为对照组(D组),同时检测并对比四组血清心肌酶谱水平及CTnI。结果 A、B、C组心肌酶谱水平及CTnI均明显高于D组(P0.05),其中心肌酶谱水平及CTnI由高往低依次为C、B、A组(P0.05)。结论心肌酶谱及CTnI的测定,可以作为判定新生儿高胆红素血症患儿严重程度及心肌损害的重要指标,对于早期诊断、治疗、评估预后具有重要的临床意义。     

高胆红素血症对足月新生儿心肌组织的影响

目的探讨高胆红素血症对足月新生儿心肌组织的影响。方法选择46例高胆红素血症患儿为高胆组,30例健康新生儿为对照组,根据治疗方法不同将高胆组分成高胆Ⅰ组和高胆Ⅱ两组。高胆组分别于治疗前后抽取静脉血测定胆红素和心肌酶,所有患儿入院时均行心电图、超声心动图检查。结果高胆组新生儿心肌酶血清磷酸肌酸激酶同工酶(CK-MB)较对照组明显增高,差异有统计学意义(P<0.01);高胆组Ⅱ组患儿治疗前后心肌酶CK-MB比较差异无统计学意义(P>0.05);高胆组和对照组新生儿超声心动图、心电图均无明显异常,也无心肌受损的临床表现和体征。结论新生儿高胆红素血症对心肌无损害,而且无需常规保心肌治疗;临床上诊断新生儿心肌损伤仅依据心肌酶活性增高是不够的,应结合超声心动图、心电图以及临床表现来综合判断。     

婴儿高胆红素血症心肌酶谱测定及其临床意义

目的探讨高胆红素血症心肌酶谱测定对心肌的影响。方法对同期黄疸住院的患儿根据Avery标准分为高胆红素血症组 (观察组 )和非高胆红素血症组 (对照组 ) ,患儿在入院后 1小时内采静脉血 2ml,用日立 7170型全自动生化仪检测心肌酶谱。结果高胆红素血症组AST、CK MB、LDH值明显高于非高胆红素血症组 (P <0 .0 5 ) ,α HBD值的变化则更为显著 (P <0 .0 1)。在高胆红素血症组中 ,感染组CK MB值明显高于非感染组 (P <0 .0 5 )。结论高胆红素血症对心肌有损害作用 ,尤其是感染因素所致的高胆红素血症患儿心肌损害更为明显。     

新生儿高胆红素血症心肌酶活性及C-反应蛋白变化的临床分析

目的 通过检测高胆红素血症新生儿心肌酶活性、C-反应蛋白（CRP）水平变化,分析高胆红素血症与心肌细胞活性、CRP之间的关系,为更全面地认识新生儿高胆红素血症提供一定的理论依据.方法 选取高胆红素血症患儿89例,据血清胆红素值分为轻度、重度两组,采用全自动血生化分析仪及免疫比浊法分别于治疗前及治疗后第3天测定血清心肌酶活性及CRP水平,并与无高胆红素血症的新生儿做对照研究.结果 重度高胆红素血症组与对照组相比,所有心肌酶指标活性均显著性增高,轻度组激酸肌酶（CK）、天门冬氨酸氨基转移酶（AST）、激酸肌酶同工酶（CK-MB）等部分指标活性明显升高,CRP水平各组间比较差异无统计学意义.治疗3 d后,黄疸明显减退,复测心肌酶活性基本恢复至正常水平.结论 高胆红素血症患儿心肌酶活性显著性增高,随黄疸加重,心肌酶活性相应增高.高胆红素血症患儿CRP水平未见显著性变化.     

肺炎支原体肺炎新生儿心肌酶谱动态变化及意义

目的探讨肺炎支原体肺炎新生儿心肌酶谱动态变化及意义。方法选取普通细菌感染及肺炎支原体感染肺炎患儿分别54、40例,在发病后第5天、第10天及2周进行急性期血清心肌酶谱测定,与36例正常健康新生儿进行对比并进行相互比较。结果发病后第5天MP组、N-MP组患儿肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）、α-羟丁酸脱氢酶（α-HBDH）均高于健康对照组,且N-MP组心肌酶谱均高于MP组,差异有统计学意义（P〈0．05）。第10天MP组、N-MP组心肌酶谱明显高于对照组,差异有高度统计学意义（P〈0．01）;但MP组高于N—MP组,差异有统计学意义（P〈0．05）.第2周N-MP组心肌酶谱基本降至正常,与健康对照组比较,差异无统计学意义（P〉0．05）;但MP组心肌酶谱仍明显高于MMP组及健康对照组,差异均有统计学意义（P〈0．05,P〈0．01）。结论肺炎支原体肺炎新生儿血清心肌酶谱水平升高出现迟、程度重、恢复慢;对新生儿肺炎支原体肺炎患儿,高度重视心肌损伤方面的监测,常规不同时段反复检测心肌酶谱,以了解其心肌损害情况,以便得到及时有效地治疗,避免延误病情。     

高胆红素血症对新生儿心肌酶谱及血清丙二醛、超氧化物歧化酶的影响

目的:研究高胆红素血症对新生儿心肌酶谱及血清丙二醛(MDA)、超氧化物歧化酶(SOD)的影响.方法:筛选高间接胆红素血症新生儿40例作为研究对象,足月健康新生儿30例作为对照组,使用德国产奥林巴斯2700全自动生化分析仪检测心肌酶谱,采用化学比色法检测血清MDA浓度及SOD活性.结果:高胆红素血症新生儿胆红素、心肌酶谱及MDA浓度均明显高于对照组,SOD活性明显低于对照组,且随着胆红素的降低.心肌酶谱及MDA浓度亦减低,SOD活性随之增高,差异均有统计学意义(均P＜0.01).结论:新生儿高胆红素血症可致心肌酶增高,造成心肌损伤,且随着胆红素下降,损伤减轻,其机制可能与体内存在脂质过氧化损害、血清抗氧化酶活性减低有关.     

早产窒息新生儿同型半胱氨酸联合心肌酶测定的临床价值

目的探讨同型半胱氨酸(Hcy)联合心肌酶谱检测在早产窒息新生儿中的临床价值,为临床鉴别诊断及治疗早产患儿提供科学依据。方法选取2011年1月至2014年5月在该院住院的早产新生儿高胆红素血症患儿150例,并分为轻度窒息组和重度窒息组,同时选取新生儿生理性黄疸患儿100例设为对照组,分别检测血清总胆红素(TBIL)、同型半胱氨酸(Hcy)及心肌酶谱各指标水平,并进行比较分析。结果轻度窒息组及重度窒息组患儿Hcy、TBIL及各项心肌酶谱指标水平均高于对照组,差异均有统计学意义(P0.05)。结合临床资料及彩色多普勒超声检测结果,早产窒息高胆红素血症患儿中有3例诊断为心肌炎,29例诊断为亚临床心肌炎,46例诊断为疑似心肌炎。结论早产高胆红素血症患儿心肌细胞存在不同程度损伤,常规测定Hcy及心肌酶谱对临床诊断新生儿心肌炎及亚临床心肌炎有积极意义。     

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.