诺迪康胶囊治疗冠状动脉粥样硬化性心脏病的疗效及其对血小板聚集率的影响

目的：评价诺迪康胶囊治疗冠状动脉粥样硬化性心脏病（冠心病）的临床疗效及其对血小板聚集率的影响。方法：４６例冠心病患者随机分２组，分别服用诺迪康胶囊和复方丹参片４周；治疗前后进行心电图和血小板聚集率（ＰＡＲ）检查。结果：３０例患者服诺迪康胶囊前后ＰＡＲ分别为０．７３±０．１５和０．６３±０．１２（Ｐ＜０．０１），与对照组治疗后（０．６９±０．１５）比较有显著性差异（Ｐ＜０．０５），心绞痛临床总有效率为９０．０％，明显高于对照组６２．５％（Ｐ＜０．０５），心电图改善总有效率（６１．５％）高于对照组（５３．９％），但无显著差异。结论：诺迪康胶囊可明显降低ＰＡＲ，改善胸痛症状及心电图ＳＴＴ改变。     

心元胶囊治疗心肾阴虚兼心血瘀阻证的心绞痛临床研究

目的：观察心元胶囊治疗心肾阴虚兼心血瘀阻证的心绞痛临床疗效和安全性。方法：共观察心绞痛１２０例，其中治疗组９０例口服心元胶囊４粒，每日３次，服４周；对照组３０例口服地奥心血康胶囊２粒，每日３次，服４周。结果：心元胶囊治疗心绞痛症状的显效率为７２．２２％，总有效率为９３．３３％，疗效优于对照组的４６．６７％和７６．６７％（Ｐ＜０．０５和Ｐ＜０．０１）；对心电图的改善其显效率及总有效率分别为４８．８９％和７６．６７％，疗效优于对照组的２３．３３％和５３．３３％（Ｐ均＜０．０１）；对中医证候记分的改善好于对照组；具有确切降低胆固醇和甘油三酯、升高高密度脂蛋白胆固醇的作用；其改善血液流变学指标的疗效优于对照组（Ｐ＜０．０５和Ｐ＜０．０１）。结论：心元胶囊治疗心肾阴虚兼心血瘀阻证的心绞痛疗效确切，未发现不良反应     

心元胶囊治疗心肾阴虚兼心血瘀阻证的心绞痛临床研究

目的：观察心元胶囊治疗心肾阴虚兼心血瘀阻证的心绞痛临床疗效和安全性。方法：共观察心绞痛１２０例，其中治疗组９０例口服心元胶囊４粒，每日３次，服４周，对照组３０例口服地奥心血康胶囊２粒，每日３次，服４周。结果：心元胶囊治疗心绞痛症状的显效率为７２．２２％，总有效率为９３．３３％，疗效优于对照组的４６．６７％和７６．６７％（Ｐ〈０．０５和Ｐ〈０．０１），对心电图的改善基显效率及总有效率分别为４８．８９     

联用普恩复胶囊和参麦注射液佐治慢性肺原性心脏病急性发作期疗效观察

目的：探讨应用普恩复（蚓激酶）胶囊联合参麦注射液佐治慢性肺原性心脏病（肺心病）急性发作期的疗效。方法：慢性肺心病急性发作期患者３４例（治疗组）联用普恩复胶囊和参脉注射液治疗，并与复方丹参注射液治疗３２例（对照组）进行疗效比较。结果：治疗４周前后比较，治疗组血液流变学、动脉血气指标均明显改善，有非常显著性差异（Ｐ＜０．０５和Ｐ＜０．０１）。治疗组显效率５５．９％，总有效率９１．２％；对照组显效率３１．３％，总有效率７１．９％；２组疗效有显著性差异（Ｐ＜０．０５）。结论：普恩复胶囊和参麦注射液联用能降低慢性肺心病急性发作期患者血粘度，提高动脉血氧分压，改善心脏功能，缓解临床症状，明显提高了临床疗效。     

“拯心汤”治疗缓慢性心律失常临床研究

目的：评价“拯心汤”治疗缓慢性心律失常的临床疗效。方法：８１例患者随机分为２组，治疗组５６例采用内眼“拯心汤”治疗，对照组２５例以阿托品及相关西药治疗。结果：近期疗效治疗组显著３６例，有效１４例，总有效率８９．２９％，对照组分别为１５例、６例和８４．００％，２组近期疗效比较无显著性差异（Ｐ〉０．０５）；但治疗组在提高心率、改善心电图及血液流变性等方面优于对照组（Ｐ〈０．０５或Ｐ〈０．０１）。远期疗     

麝香保心丸与复方丹参片治疗冠状动脉粥样硬化性心脏病心绞痛疗效比较

目的：比较麝香保心丸与复方丹参片治疗冠状动脉粥样硬化性心脏病（冠心病）心绞痛的临床疗效。方法：冠心病心绞痛患者６４例，其中３２例（治疗组）采用麝香保心丸口服治疗，并与用复方丹参片治疗的３２例（对照组）作疗效比较，２组疗程均为４周。结果：治疗组心绞痛及心电图的总有效率分别为９０．６％和７１．９％，均显著高于对照组（５３．１％和４３．８％，Ｐ均＜０．０１）；治疗组在减少心绞痛发作次数、持续时间及硝酸甘油用量、改善心肌缺血的范围和程度、降低心肌耗氧量及降低ＬＰＯ含量及提高ＳＯＤ活性等方面亦显著优于对照组（Ｐ＜０．０５或Ｐ＜０．０１）。结论：麝香保心丸治疗冠心病心绞痛疗效显著，优于复方丹参片     

复方丹参滴丸治疗冠心病心绞痛疗效观察

目的：为进一步验证复方丹参滴丸治疗冠心病心绞痛的临床疗效。方法：运用复方丹参滴丸与消心痛随机对照治疗冠心病心绞痛患者１４９例，其中治疗组１０１例，对照组４８例。结果：治疗组心绞痛速效止痛总有效率为８４．１６％，对照组总有效率为８７．５０％，两组立刻含药后半小时查心电图，其心电图总有效率治疗组为４６．５３％，对照组为４３．７５％（Ｐ均＞０．０５）；两组患者分别以常规用量（即前组每次１０粒，后组每次１０ｍｇ）均每日３次含服，连续治疗４周后，观察心绞痛症状和休息状态下心电图，治疗组心绞痛症状缓解总有效率为９５．０５％，心电图总有效率为６０．４０％，对照组则分别为７９．１７％和３７．５０％，两组分别对照比较，Ｐ均＜０．０５。结论：复方丹参滴丸对冠心病心绞痛具有长效治疗作用，其心绞痛症状与心电图疗效均明显优于消心痛。     

降粘胶囊治疗高粘滞血症的临床研究

目的：观察降粘胶囊治疗高粘滞血症的疗效。方法：高粘滞血症患者３９４例随机分为治疗组１９８例和对照组１９６例。将口服降粘胶囊治疗组和口服茶色素胶囊对照组作比较。结果：治疗组治疗后血液流变学指标较治疗前明显改善（Ｐ＜０．０５～０．０１）。治疗组总有效率为９４．９％，对照组为８５．２％，治疗组疗效明显优于对照组（Ｐ＜０．０５）；治疗组治疗后总胆固醇、甘油三酯和血糖较治疗前明显下降（Ｐ均＜０．０１），高密度脂蛋白则明显上升（Ｐ＜０．０１）。结论：降粘胶囊具有降低血脂、血糖、血液粘稠度及改善微循环、防止动脉硬化等作用，是预防和治疗高粘滞血症的有效药物。     

中西医结合治疗急性缺血性脑血管病临床疗效分析

报告９７例急性缺血性脑血管病中西医结合治疗（中西医组），与同期单用脉通液静滴治疗的８９例（对照组）进行临床疗效对比分析。结果：中西医组总有效率为８３．５％；对照组总有效率为６４．０％（Ｐ＜０．０５），差异有显著性。中西医组重型患者总有效率为８３．６％；对照组重型患者总有效率为４８．３％，Ｐ＜０．０ｌ，差异有非常显著性。     

氦—氖激光照射耳穴治疗痤疮370例

目的：对痤疮进行氦－氖激光治疗，评价其疗效，并探讨治疗作用，为该病的临床治疗提供参考。方法：将４１０例痤疮患分成激光组（３７０例）与药物组（４０例），分别采用氦－氖激光照射耳穴及药物治疗进行对比分析。结果：激光组总有效率（９９．２％）与药物组总有效率（９０．０％）差异无显性（Ｐ〉０．０５）。激光治疗后，耳穴皮温明显升高（Ｐ〈０．０５），免疫球蛋白ＩｇＧ显下降（Ｐ〈０．０５）。结论：激光治疗痤     

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.