长期小剂量吸入糖皮质激素对哮喘儿童血ACTH的影响

为了解长期小剂量吸入糖皮质激素对哮喘儿童肾上腺皮质功能的影响 ,我们检测了 2 0例哮喘患儿血促肾上腺皮质激素(ＡＣＴＨ)水平 ,报告如下。1　资料与方法1.1　病例选择　随机选取 1996年 12月至 1998年 2月 ,我院儿童哮喘专科 ,经丙酸倍氯松 (ＢＤＰ)吸入治疗的缓解期哮喘儿童 2 0例。其中轻度哮喘 3例 ,中度 15例 ,重度 2例 ,诊断和病情分度符合儿童哮喘诊断标准[1] 。男 13例 ,女 7例。年龄 7～12岁 ,平均 9.1岁。首诊前哮喘病程 2～ 8年。全部哮喘患儿均经哮喘门诊专科指导正确有效吸入ＢＤＰ。吸入ＢＤＰ用药时间 6～ 18个月 ,平均疗…     

吸入皮质激素对哮喘患儿肾上腺轴功能影响的动态观察

目的观察长期吸入糖皮质激素对哮喘患儿下丘脑 垂体 肾上腺轴 (HPAA)功能的影响 ,评估长期吸入糖皮质激素的安全性。方法 5 2例中、重度哮喘患儿在快速缓解后吸入不同剂量糖皮质激素 ,其中 2 0例吸入布地奈德 ,32例吸入氟替卡松。每 3个月根据病情做一次剂量调整 ,分别于疗程中的第 3、6、12个月各检测一次 2 4小时尿皮质醇 ;取同期健康儿童 2 0例 2 4小时尿皮质醇做对照。结果在疗程第 3个月时 2 4小时尿皮质醇有一定程度的降低 ,但与正常组对照无显著性差异 (P >0 .0 5 )。在疗程第 6、12个月时 2 4小时尿皮质醇恢复 ,其值与正常对照组无显著性差异 (P >0 .0 5 )。结论长期吸入糖皮质激素对哮喘患儿下丘脑 垂体 肾上腺轴的功能无明显影响 ,仅显示正常的功能性反馈机制 ,吸入糖皮质激素具有较可靠的安全性。     

长期吸入糖皮质激素治疗咳嗽变异性哮喘疗效观察

目的 探讨长期规律和间断吸入糖皮质激素对咳嗽变异性哮喘（CVA）患者肺功能和临床疗效的影响。方法 采用随机配对法将确诊的82例CVA患者分为A、B两组，A组长期规律吸入糖皮质激素，B组间断吸入糖皮质激素；观察两组治疗前及殆疗后1、3、6、12个月一秒种用力呼气量与用力肺活量比值（FEV1％）的改变情况和临床疗效。结果 治疗1个月后，两组患者咳啾症状均消失，FEV1％明显好转．（均为P〈0．01），但两组间比较差异无显著性（P〉0．05）。治疗3、6、12个月后，A组FEV1助均有明显改善（均为P〈0．01），而B组的FEV1％随着复发病例的逐渐增多，曾经改善的肺功能又降至治疗前水平（分别为P〈0．05、P〉0．05和P〉0．05）；两组间FEV1％比较差异均有显著性（P〈0．05或P〈0．01）。A组患者复发病例数明显低于B组（1．00：5．71）。结论 长期规律吸入糖皮质激素治疗CVA，能明显减少症状复发，同时还可改善肺功能，减少典型哮喘的发生。     

布地奈德吸入对咳嗽变异性哮喘患儿的肺功能影响

目的了解吸入皮质激素类药物———布地奈德气雾剂对儿童咳嗽变异性哮喘的作用。方法观察布地奈德吸入治疗 (≤ 4 0 0 μg)前后肺功能的变化。结果用力肺活量 (FVC)、1秒用力呼气容积 (FEV1)、呼气峰流速 (PEFR)测定值接近正常儿童 ,而肺活量最大呼气流速 (FEF) 2 5 %～ 75 %明显低于正常儿童测定值。治疗 6个月后患儿FEF 2 5 %～75 %较治疗前有显著意义的改善 (P <0 .0 1)。结论咳嗽变异性哮喘患儿存在小气道功能障碍 ,应按哮喘常规治疗给予较长时间的皮质激素吸入。     

舒利迭治疗儿童中重度哮喘121例疗效观察

目的观察舒利迭治疗儿童中、重度哮喘的疗效和安全性。方法将121例3～14岁中、重度哮喘息儿随机分为治疗组和对照组。治疗组吸入糖皮质激素与长效B：受体激动剂舒利迭,1挣／次,2次／d;急性发作期间,同时吸入普米克令舒1mg／2ml＋博利康尼雾化液5mg／2ml,1～2次／d,疗程2～6d,病情控制后停用（即肺部听诊哮鸣音消失）。按常规阶梯治疗方案,吸入3个月,评价患儿临床表现、FEV,后降级治疗,改1挣／次,1次／d;3个月后再次评价,进入临床缓解期后,1揿／次,隔日1次,维持治疗;治疗期间监测最大呼气流量（PEF）或第1秒末用力呼气量（FEV,）,疗程结束时对两组进行临床疗效判定。结果治疗组肺功能有明显改善（P〈0．01）。FEV,均值治疗2d后即显著上升;治疗后2～6dFEV。改善率为98．5％。对照组为87．8％。两组比较,差异无统计学意义（P〉0．01）。结论舒利迭治疗中、重度哮喘起效迅速,肺功能改善明显,无严重不良反应,患儿依从性好。     

支气管哮喘患儿吸入糖皮质激素治疗依从性的影响因素分析

目的探讨支气管哮喘患儿吸入糖皮质激素治疗依从性的影响因素。方法回顾本院2016年5月至2018年5月60例采取糖皮质激素吸入治疗的支气管哮喘患儿为研究对象,分析其吸入药物治疗依从性、哮喘临床症状评分、肺功能、吸入治疗中存在的问题。结果本组患儿中治疗依从性良好28例,一般17例,差15例。经多因素logistic回归分析,哮喘临床症状评分高、第1 s用力呼气容积(FEV1)占预计值百分比、气道阻力(Raw)占预计值百分比、肺活量(VC)、面罩过紧、吸入时间过长是影响支气管哮喘患儿吸入糖皮质激素治疗依从性的独立危险因素(P 0. 05);最大通气量(MVV)占预计值百分比、体位不当、口咽部气溶胶沉积过多是其混杂因素(P 0. 05)。结论掌握影响患儿吸入糖皮质激素治疗依从性的主要因素,采取针对性干预措施,提高患儿治疗依从性。     

中低剂量吸入糖皮质激素治疗儿童中重度哮喘

目的:为了探讨既能控制哮喘病情又能尽最大可能避免全身副作用的吸入糖皮质激素剂量。方法:回顾性地总结了中低剂量吸入糖皮质激素治疗儿童中重度哮喘的效果。53例年龄4～14岁中重度哮喘患儿中,16例接受丙酸倍氯松(BDP)、丁地去炎松(BUD)每日500～600μg或氟替卡松(FP)每日250μg(中等剂量)吸入;37例接受BDP、BUD每日400μg或FP每日200μg(低剂量)吸入治疗。所有患儿均未使用白三烯受体拮抗剂或茶碱类药物。随访3个月,观察患儿哮喘发作次数及程度,40例在治疗前、治疗后2～4周及12周检查肺功能或使用峰流速仪检测峰流速值(PEF),记录PEF与平均预计值的比率(PEFR%)。结果:除1例重度患儿使用BDP600μg有一次轻度发作外,其余52例患儿使用中低剂量吸入糖皮质激素治疗后12周内均无哮喘发作。40例患儿吸入治疗后2～4周绝大部分患儿PEFR%恢复正常,治疗后12周PEFR%明显高于治疗前,其中低剂量吸入糖皮质激素组与中等剂量组无明显差异。结论:对儿童中重度哮喘给予“安全剂量”(每日400μgBDP或BUD,200μgFP)吸入糖皮质激素能够控制哮喘发作,恢复肺功能。安全剂量能最大程...     

吸入糖皮质激素对哮喘患儿肺功能及钙磷代谢影响的临床观察

支气管哮喘是当前世界威胁公众尤其是儿童健康的慢性疾病 ,许多国家已将吸入糖皮质激素作为治疗哮喘的首选方法。本文对长期吸入小剂量糖皮质激素的患儿进行观察 ,了解其疗效及副作用 ,报告如下。一、资料与方法1.临床病例　 2 6例均为我院 1997年儿童哮喘专科 3岁以上的哮喘患儿 ,符合儿童哮喘 (中度 )诊断标准[1 ] ,病程 1 5～ 3年 ,既往无长期使用激素史 ,并排除内分泌代谢性疾病。激素的使用 :持续吸入二丙酸倍氯米松 (必可酮 ) 2 0 0～ 30 0 μｇ/ｄ ,疗程 1 5～ 2年 ,症状加重时短期加用 β2 受体激动剂或氨茶碱 (<3天 )及抗感染治疗…     

哮喘儿童吸入糖皮质激素对骨密度的影响

目的观察吸入糖皮质激素普米克气雾剂（BUD）对哮喘儿童骨密度（BMD）的影响。方法对70例初诊哮喘患儿（A组）和60例经储雾罐吸入BUD治疗6～30个月的复诊哮喘患儿（B组），应用美国XR-46双能X-线快速全身骨密度诊断仪测量股骨BMD，其中9例患儿进行治疗前后自身BMD比较。结果BUD吸入治疗后哮喘息儿股骨（包括股骨头、大转子、三角区）各部位BMD无显著变化（P〉0．05）。结论经储雾罐吸入BUD治疗小儿哮喘不会使BMD明显下降，是一种安全有效的儿童哮喘治疗方法，值得临床推广应用。     

激发因素问卷调查在儿童哮喘阶梯吸入治疗中的作用

目的：分析哮喘激发因素问卷调查对儿童支气管哮喘阶梯吸入治疗效果的影响。 方法：调查于2003-06／2005—06在青岛大学医学院附属医院儿科哮喘中心完成，选择支气管哮喘患儿237例，监护人均知情同意。随机分为2组，对照组110例，问卷调查组127例。对照组在采用阶梯吸入治疗方案之前先行过敏原检测；问卷调查组在对照组治疗的基础上，进行激发因素调查并给予相应预防指导。过敏原检测采用皮肤点刺试验，依据华东地区常见过敏原特点，选取吸入性过敏原17种，食物过敏原9种。问卷调查内容包括常见的哮喘激发因素30个问题。6个月后进行临床疗效评价：①症状评价采用日间、夜间临床哮喘症状评分法（0～3分，0分无症状；3分影响活动，夜间经常憋醒）。②调查患儿治疗依从率、缓解期激素吸入量和哮喘发作次数。（固肺功能检查采用MasterScope肺功能仪，检测指标为第1秒用力呼气容积和最大呼气峰流速。 结果：患儿237例全部进入结果分析，无脱落。①治疗6个月后两组患儿治疗依从性、症状评分、缓解期激素吸入量和哮喘发作次数比较：问卷调查组患儿系统治疗的依从率显著高于对照组[76．8％，53．8％（P〈0．01）]；问卷调查组患儿的哮喘症状评分（0．8&;#177;0．10，1．2&;#177;0．15）、急性发作次数（2．7&;#177;1．43，4．0&;#177;1．67）、激素用量（340&;#177;160，400&;#177;200）均显著低于对照组（P〈0．01）。②治疗6个月后两组患儿肺功能比较：治疗后问卷调查组患儿的肺功能指标最大呼气流速和第1秒最大呼气容积均显著高于治疗前及对照组（P〈0．05～0．01）。 结论：通过过敏原检测及激发因素问卷调查并给予预防指导，可以减少患儿药物用量．改善肺功能，减少复发，提高其治疗效果，在儿童支气管哮喘长期治疗中具有重要意义。     

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.