多普勒超声对兔动脉硬化的血流动力学与流变学研究

目的通过研究兔颈总动脉粥样硬化血液流变学与动力学的变化规律,探求其早期诊断的敏感指标.方法选24只大耳白兔随机分成2组:A组为正常饲料组(6只),B组为高脂饲料喂养组(18只),各分成3个亚组,分别喂养4周、8周、12周.观察颈总动脉Vs、PI、RI及血液流变学特性的变化,用病理结果进行验证.结果在兔AS不同阶段,B组家兔颈总动脉PI、RI逐渐增高(P＜0.01或P＜0.05),Vs无显著变化;血液流变学指标中全血黏度、红细胞聚集指数在4周以后出现进行性增高(P＜0.01或P＜0.05),并与PI、RI呈正相关;红细胞变形指数逐渐降低(P＜0.01或P＜0.05),与PI、RI呈负相关.结论血流动力学与血液流变学变化相结合可以早期定性、定量检测AS,动态观察其病变进展情况.     

高频超声检测兔腹主动脉粥样硬化的实验研究

目的用高频超声检测动脉粥样硬化(AS)兔模型腹主动脉病变进展的动态过程,评价超声检测的可行性、可靠性及应用价值.方法24只国产纯种大耳白兔随机分成4组:1组为正常对照组,基础颗粒饲料喂养;2、3、4组分别为高脂饲料喂养4、8、12周的动脉粥样硬化模型组.分别测定兔血脂浓度,彩超测量腹主动脉内膜-中层厚度(IMT)、血管内径(D)、IMT/D比值.将超声测量值与病理测量值作对比分析.血流频谱指标包括:收缩期峰值流速(Vs)、搏动指数(PI)、阻力指数(RI).结果模型组家兔腹主动脉IMT明显增厚(P＜0.01),并逐渐发展为动脉硬化斑块.病变早期血管内径代偿性扩张,而后逐渐狭窄.IMT/D比值呈逐渐增高趋势.PI、RI值显著增高(P＜0.01),Vs值差异无显著性意义(P＞0.05).结论彩超可准确评价AS病变,其中IMT、D、IMT/D比值以及PI、RI为超声检测AS可靠的观测指标.     

血液稀释疗法对小型猪严重烧伤后血液流变学特性的影响

目的：通过中国实验用小型猪严重烧伤后应用血液稀释疗法，探讨其对血液流变学特性的影响，为血液稀释疗法的临床应用提供理论依据。方法：严格选择20只中国实验用小型猪制作严重烧伤动物模型，随机分为对照组及实验组，按烧伤前、伤后6，8，16，24，48h，6个时相分别检测全血黏度、血细胞比容、红细胞变形指数、红细胞聚集指数等指标。结果：实验组全血黏度、血细胞比容、红细胞聚集指数等血液流变学指标与对照组相比明显降低，红细胞变形指数明显增加。结论：在烧伤休克期及围手术期应用血稀疗法可明显减轻烧伤休克期血液浓缩、红细胞聚集与黏滞，提高红细胞变形能力，有效改善血容量。血液稀释疗法在烧伤休克期及围手术期是一种可行有效的治疗措施，对大面积烧伤早期修复及临床治愈率提高有重要的指导意义。     

阳江地区体检人群的群体血液流变学差异

目的 对阳江地区体检人群血液流变学结果进行统计分析,了解不同群体的各项指标有无性别及年龄差异.方法 测定体检人群的血液流变指标,再用SPSS软件系统对测定结果进行统计分析.结果 血液流变学指数存在性别差异(P<0.05),男性组的全血黏度、红细胞聚集指数、红细胞刚性指数、红细胞变形指数、红细胞电泳指数、压积的异常均高于女性组.全血黏度和压积,30～39岁组分别与50～59岁组、≥60岁组比较差异有统计学意义(P<0.05);≥60岁组与20～29岁组、30～39岁组、40～49岁组比较,其红细胞沉降率方程K值、红细胞沉降率、红细胞变形指数指标差异有统计学意义(P<0.05),且50岁以上组的异常率较其他年龄组高.结论 (1)全血黏度的异常正逐渐年轻化;(2)血液流变指标在性别上差异有统计学意义,年龄上也存在一定的差异,根据群体差异建立不同年龄段和性别的参考值尤为重要.     

150例高血压病患者血液流变学指标变化及其临床意义的研究

目的：探讨高血压病患者血液流变学指标变化及其临床意义。方法应用北京赛科希德生产的SA-6000型全自动血液流变仪测定150例高血压病患者与80名健康成人的全血黏度、血浆黏度、红细胞压积、红细胞聚集指数、红细胞刚性指数及红细胞变形指数并进行比较。结果与健康者相比,高血压病患者全血黏度、红细胞压积、红细胞聚集指数、红细胞刚性指数及红细胞变形指数均增高（P＜0.05或P＜0.01）,其中男性高血压病患者血浆黏度亦增高（P＜0.05）。结论高血压病患者血液呈高黏滞状态。血液流变学指标检测对于了解高血压病临床病理变化和指导治疗具有重要意义。     

100例糖尿病患者血液流变学变化及分析

作者对１００例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）惠者和４５例健康人对照，观察了红细胞变形指数、红细胞聚集指数、全血高切还原粘度、全血低切还原粘度、血浆比粘度．显示高血糖状态组、高脂血症组与对照组比较上述指标均有显著性差异（Ｐ＜０．０５），有血管病变组与对照组比较差异更显著（Ｐ＜０．０１）．结论：糖尿病（ＤＭ）患者高血糖状态、高血脂影响血液流变学，监测血液流变学改变，采取相应措施，对减少ＤＭ血管并发症的发生是有意义的．     

糖尿病不同病程与血液流变性的关系

目的 研究糖尿病不同病程的血液流变学特征,并结合分子水平分析其形成的病理生理学基础.方法 根据糖尿病诊断标准选择研究对象101例,按病程分为糖尿病组（DM组）32例,血糖稳定机制损害组（IGH组）34例,正常糖耐量组（NGT组）35例,对各组进行血液流变学检测,结果进行分析.结果 三组间比较,参数均有意义（P＜0.01）;IGH组与NGT组比较,高切血粘度、红细胞刚性指数及红细胞电泳时间增高（ P＜0.05）,红细胞变形指数下降（P＜0.05）;DM组分别与IGH组和NGT组比较,红细胞变形指数进行性下降（ P＜0.05或P＜0.01）,红细胞刚性指数进行性升高（ P＜0.05或P＜0.01）,其他各参数增高显著（ P＜0.01）.结论 糖尿病随病程进展,红细胞变形性进行性下降,而聚集性逐渐增强.糖尿病血液流变学的特征既是糖尿病病理生理的基础之一,也是效应之一,两者互为因果.     

血液流变学检测对非小细胞肺癌的诊断价值分析

目的 探讨血液流变学检测对非小细胞肺癌(N S C L C)的诊断价值.方法 选取2017年10月至2019年12月该院收治的307例N S C L C患者(其中腺癌161例、鳞癌146例)作为N S C L C组,另选取同期在该院的300例健康体检者作为对照组,收集两组详细临床资料信息,检测两组血液流变学指标的变化.结果 NSCLC组全血高、中、低切黏度,血浆黏度及红细胞聚集指数均明显高于对照组,差异均有统计学意义(P<0.05);单因素Logistic回归分析显示,年龄、吸烟史、全血黏度、血浆黏度及红细胞聚集指数均与NSCLC的发生和发展相关;进一步多因素Logistic回归分析显示,年龄、吸烟史、全血黏度、血浆黏度及红细胞聚集指数是NSCLC的危险因素.结论 血液流变学检测简单方便、经济无创,对NSCLC的诊断、治疗及预后评价均有一定临床应用价值.     

三七总皂苷联合银杏黄酮对高脂血症大鼠血液流变性的影响

目的研究三七总皂苷联合银杏黄酮对高脂血症大鼠脂代谢和血液流变学特性的影响及其意义的探讨。方法24只大鼠,随机分为对照组（8只）和高脂喂养组（16只）,高脂血症组通过高脂、高胆固醇饮食建立高脂血症大鼠模型;8周后,高脂喂养组又随机分为高脂血症组和给药组,给药组继续给予高脂饮食的同时予以三七总皂苷（100mg／kg／d）和银杏黄酮（48mg／kg／d）灌胃8周;之后分别检测各组动物体重、血脂水平、全血粘度、血浆粘度、血浆纤维蛋白原（Fib）、红细胞变形、红细胞聚集、红细胞压积以及部分活化凝血酶原时间（APTT）、活化部分凝血酶时间（PT）的变化并进行全血细胞分析。结果高脂血症组大鼠体重、血浆甘油三酯、胆固醇含量、全血粘度、血浆粘度、血浆纤维蛋白原含量、红细胞聚集指数较对照组明显升高（P〈0．05或P〈O．01）,而红细胞变形性明显低于正常对照组（P〈0．01）而给药组与高脂血症组比较显示：三七总皂苷联合银杏黄酮能够有效降低高脂大鼠血浆甘油三酯、胆固醇含量、降低全血粘度、血浆粘度、红细胞聚集指数以及血浆Fib的含量（P〈0．05或P〈O．01）,升高红细胞变形指数（P〈0．05）。结论三七总皂苷联合银杏黄酮给药能有效地降低高脂血症大鼠的血脂水平,改善高脂血症大鼠血液流变学性质。     

荷Lewis肺癌小鼠血液流变学指标的改变

目的 从整体动物水平观察荷Lewis自发肺转移癌小鼠的血液流变学指标的改变.方法 将C57BL/6小鼠皮下接种Lewis肺癌,21d后处死小鼠,观察其肿瘤转移和血液流变学指标变化.结果 模型组小鼠血液红细胞电泳速率慢于正常,电泳时间延长;高、低切变率下,模型组红细胞变形指数和取向指数均较正常组显著降低;模型组全血黏度显著增高.作用于血液系统的药物阿司匹林和活血化淤中药三七提取成分总皂苷(TSPN)分别给药后,小鼠红细胞电泳速率和电泳时间有所改善,与模型组相比有显著性差异.阿司匹林组和TSPN组高、低切变率下全血黏度均较模型组显著降低.结论 Lewis荷瘤小鼠血液流变学指标发生显著改变;阿司匹林和TSPN对荷瘤小鼠血液黏度和红细胞表面电荷有一定的改善作用.     

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.