早发冠心病患者血浆C反应蛋白与临床表型及冠状动脉病变的关系

目的：探讨早发冠心病患者血浆C反应蛋白与临床表型及冠状动脉病变的关系，以期为冠心病早期康复措施介入提供理论依据。方法：采用Judkim法进行冠状动脉造影明确早发冠心病及正常对照组。冠心病诊断系指至少有一支冠状动脉直径减少≥500h，和临床确诊为心肌梗死。应用散射比浊法测定研究对象血浆C反应蛋白。早发冠心病临床表型分为急性心肌梗死、不稳定性心绞痛和稳定性心绞痛；根据冠状动脉狭窄程度计算冠状动脉病变积分；采用病例对照的方法进行对比研究。结果：病例组患者血浆C反应蛋白水平[(7.5&;#177;1．6)mg／L]明显高于对照组[(3．2&;#177;1.3)mg／L](t=7.431．P&;lt;0．01)。病例组C反应蛋白正常的患者中，稳定性心绞痛比例明显多于不稳定性心绞痛和急性心肌梗死；C反应蛋白升高亚组，急性心肌梗死比例最高，稳定性心绞痛的比例最低；冠状动脉病变高积分组C反应蛋白水平明显高于低积分组(P=0．000)。多因素回归分析表明，高C反应蛋白是早发冠心病显著的独立危险因素(OR=10．41；95％CI：2．31～31．24：P=0．1301)。结论：早发冠心病患者血浆C反应蛋白水平明显升高；高c反应蛋白与早发冠心病的临床表型和冠脉病变相关；高C反应蛋白是早发冠心病的独立危险因素。     

冠心病患者肺炎衣原体感染与C反应蛋白、纤维蛋白原相互关系的研究

目的 :了解冠心病患者肺炎衣原体感染与C反应蛋白 (CRP)、纤维蛋白原的相互关系 ,探讨其可能的发病机制。方法∶应用多聚合酶链反应 (PCR)技术检测了 5 4例冠心病患者 (急性心肌梗死 16例 ,不稳定型心绞痛 2 0例 ,稳定型心绞痛 18例 )血清肺炎衣原体DNA ,选 2 0例体检健康者作对照 ,同时用免疫浓度法检测各组血清CRP和血浆纤维蛋白原浓度。结果∶急性心肌梗死组 ,不稳定型心绞痛、稳定型心绞痛组肺炎衣原体DNA阳性率分别为 81.3%、75 %、6 6 .7% ,与对照组 2 5 %相比差异有显著性 (P <0 .0 1) ;稳定型心绞痛组、不稳定型心绞痛组、急性心肌梗死组血清CRP浓度和血浆纤维蛋白原浓度显著高于正常对照组 (P <0 .0 1) ,并且与冠心病的严重程度呈正相关。直线相关分析显示冠心病患者CRP浓度和纤维蛋白原浓度之间存在显著正相关 (r =0 .96 2 ,P <0 .0 1) .结论∶冠心病患者肺炎衣原体感染率明显增高 ,肺炎衣原体可能通过炎症反应和凝血机能增强在冠心病的发生、进展中发挥重要作用     

早发冠心病患者血浆C反应蛋白与临床表型及冠状动脉病变的关系

目的:探讨早发冠心病患者血浆C反应蛋白与临床表型及冠状动脉病变的关系,以期为冠心病早期康复措施介入提供理论依据。方法:采用Judkins法进行冠状动脉造影明确早发冠心病及正常对照组。冠心病诊断系指至少有一支冠状动脉直径减少≥50%和临床确诊为心肌梗死。应用散射比浊法测定研究对象血浆C反应蛋白。早发冠心病临床表型分为急性心肌梗死、不稳定性心绞痛和稳定性心绞痛;根据冠状动脉狭窄程度计算冠状动脉病变积分;采用病例对照的方法进行对比研究。结果:病例组患者血浆C反应蛋白水平犤(7.5±1.6)mg/L犦明显高于对照组犤(3.2±1.3)mg/L犦(t=7.431,P<0.01)。病例组C反应蛋白正常的患者中,稳定性心绞痛比例明显多于不稳定性心绞痛和急性心肌梗死;C反应蛋白升高亚组,急性心肌梗死比例最高,稳定性心绞痛的比例最低;冠状动脉病变高积分组C反应蛋白水平明显高于低积分组(P=0.000)。多因素回归分析表明,高C反应蛋白是早发冠心病显著的独立危险因素(OR=10.41;95%CI:2.31～31.24;P=0.001)。结论:早发冠心病患者血浆C反应蛋白水平明显升高;高C反应蛋白与早发冠心病的临床表型和冠脉病变相关;高C反应蛋白是早发冠心病的独立危险因素。     

不同类型冠心病患者血浆脑钠肽检测的临床意义分析

目的探讨不同类型冠心病患者血浆脑钠肽(BNP)检测的临床意义。方法选择河南省开封市中医院收治的60例冠心病患者,按照发病类型分为稳定型心绞痛、不稳定型心绞痛、急性心肌梗死(AMI)3组,每组20例。同期选择20例健康体检者作为对照组。对比分析4组受试者BNP水平的差异。结果 AMI组BNP水平较不稳定型心绞痛患者明显升高(ng/L:524.34±20.49比189.35±10.33,t=65.228 7,P=0.000 0);不稳定型心绞痛组BNP水平较稳定型心绞痛组明显升高(ng/L:189.35±10.33比31.98±4.96,t=59.465 5,P=0.000 0)。稳定型心绞痛组BNP水平与健康对照组比较差异无统计学意义(ng/L:31.98±4.96比30.46±5.35,t=0.931 8,P=0.357 4)。结论不同类型冠心病患者血浆BNP水平不同,以AMI患者BNP水平最高,不稳定型心绞痛次之,稳定型心绞痛患者与健康者无差异;检测冠心病患者BNP水平有利于辅助诊断不同类型冠心病。     

早发冠心病患者脂蛋白a与临床类型及冠状动脉病变关系的初步研究

目的　探讨早发冠心病患者血浆脂蛋白a[Lp(a) ]水平与冠状动脉病变程度及临床类型的关系。方法　采用Judkins法对 12 6例胸痛或胸部不适患者行冠状动脉造影 ,确诊为早发冠心病患者 ,以Lp(a)水平差异分为两个亚组 ,并与 89例对照者进行比较分析。结果　早发冠心病组血浆Lp(a)为 (2 33± 114 )mg/L明显高于对照组 (190± 78)mg/L(P <0 .0 5 ) ;早发冠心病患者Lp(a)低于 30 0mg/L亚组中 ,心肌梗死、不稳定型心绞痛和稳定型心绞痛比例无明显差异 ;而在Lp(a)异常升高亚组 ,临床表现为不稳定型心绞痛的比例最高 (5 4 % ) ,明显高于另两种临床类型 (P <0 .0 5 )。冠状动脉病变高积分组Lp(a)水平明显高于中等积分组和低积分组 (P <0 .0 1或 0 .0 5 )。结论　早发冠心病患者血浆Lp(a)水平与临床类型及冠状动脉病变程度密切相关     

比索洛尔对冠心病患者血浆C反应蛋白的影响

目的　探讨比索洛尔对冠心病患者血浆C反应蛋白(CRP)的影响。方法　将冠心病稳定型心绞痛患者随机分成A、B、C三组:治疗组(A组)、病例对照组(B组) ,另设正常对照组(C组)。结果　A、B组较C组明显升高(P <0 .0 1) ,A组服用比索洛尔后血浆CRP水平明显降低(P <0 .0 5 )。结论　比索洛尔明显降低冠心病稳定性心绞痛患者血浆CRP浓度。     

不同类型冠心病患者的胰岛素抵抗

目的　探讨不同类型冠心病患者与胰岛素抵抗之间的关系。方法　急性心肌梗死组 2 3例 ,不稳定型心绞痛组 2 9例 ,稳定型心绞痛组 2 6例 ,对照组 5 5例。测定空腹血糖、空腹胰岛素水平、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、肌酐、尿酸水平。评价胰岛素敏感性采用稳态模式评估法 (HOMA)及改良的胰岛素敏感性指数 (ISI)公式计算。结果　急性心肌梗死组、不稳定型心绞痛组与对照组比较 ,存在高胰岛素血症 (P <0 .0 1)和胰岛素敏感性的降低 (P <0 .0 1)。而稳定型心绞痛组与对照组比较 ,胰岛素水平及胰岛素敏感性的差异均无统计学意义 (P >0 .0 5 )。结论　急性心肌梗死及不稳定型心绞痛患者存在高胰岛素血症和胰岛素抵抗 ,胰岛素抵抗在两者的发病中可能发挥一定作用。     

冠心病患者血中白介素-6和白介素-10浓度的变化--附46例检测报告

目的 :探讨细胞因子白介素 6、白介素 10在冠心病心绞痛患者血中的变化规律。方法 :检测 2 2例不稳定型心绞痛、 2 4例稳定型心绞痛患者及 2 0名正常对照者血中白介素 6、白介素 10浓度并进行比较。结果 :不稳定型心绞痛组、稳定型心绞痛组及正常对照组血中白介素 6分别为 (2 2± 5 )ng/L ,(8± 3)ng/L ,(4± 2 )ng/L ;不稳定型心绞痛组分别高于稳定型心绞痛组及正常对照组 ,差异均有统计学意义 (均为P <0 0 0 1)。不稳定型心绞痛组、稳定型心绞痛组及正常对照组血中白介素 10分别为 (7 4±2 9)ng/L ,(4 1± 1 9)ng/L ,(1 9± 0 7)ng/L ,不稳定型心绞痛组分别高于稳定型心绞痛组 (P =0 0 4 8)及正常对照组 (P =0 0 0 8)。结论 :冠心病患者血清细胞因子白介素 6、白介素 10的浓度升高。     

冠心病患者血浆胆固醇与内皮素-1 C-反应蛋白及血小板可溶性P选择素相关性研究--附56例报告

目的 :了解冠状动脉粥样硬化性心脏病 (冠心病 )患者血浆胆固醇与内皮素 1、C反应蛋白 (C reactiveprotein ,CRP)及血小板可溶性P选择素 (solubleP selectin ,sP selectin)的关系。方法 :检测5 6例急性冠状动脉综合征 (acutecoronarysyndrome,ACS)、 2 3例慢性稳定型心绞痛 (chronicstableangina ,CSA)患者和对照组 10名正常人血浆总胆固醇、LDL C、内皮素 1、CRP和血小板sP selectin水平。结果 :ACS组血浆内皮素 1[(5 2± 10 )ng/L]、CRP水平 [(2 0± 9)mg/L]与CSA组 [(4 3± 4 )ng/L ,(13± 5 )mg/L]和正常对照组 [(36± 10 )ng/L ,(8± 2 )mg/L]比较差异均有统计学意义 ,均为P <0 0 1。血浆sP selectin水平ACS组 [(15 9± 5 8) μg/L]与CSA组 [(12 9± 1 9) μg/L]比较、CSA组与正常对照组[(6 7± 2 9) μg/L]比较 ,差异均有统计学意义 ,均为P <0 0 1。ACS组血浆总胆固醇、LDL C分别与内皮素 1、CRP、sP selectin呈正相关 [(r=0 2 9,P <0 0 5 ;r=0 5 6 ,P <0 0 1) ,(r=0 4 9,r =0 5 0 ,均为P<0 0 1) ,(r=0 30 ,P <0 0 5 ;r=0 5 4 ,P <0 0 1) ];CSA组血浆LDL C与CRP呈正相关 (r =0 4 7,P <0 0 5 )。结论 :ACS患者的血浆胆固醇可能有加重内皮功能障碍、刺激血管炎症反应和激活血     

血清高敏C反应蛋白与冠心病斑块稳定性的相关性研究

目的　研究血清高敏C反应蛋白 (hs CRP)水平与冠心病斑块稳定程度的相关性。方法　用酶联免疫吸附法 (ELISA)检测了 138例冠心病患者 (2 8例急性心肌梗死 ,6 6例不稳定型心绞痛 ,4 4例稳定型心绞痛 )及 2 8例非冠心病对照组的hs CRP的水平 ,并对冠心病患者进行冠状动脉造影病变形态学分析 ,比较不同类型的冠心病及不同形态斑块的hs CRP水平。结果　血清hs CRP在急性心肌梗死组 (16 .2 5± 1.2 7)mg/L和不稳定型心绞痛组 (11.4 1±4 .89)mg/L明显高于稳定型心绞痛组 (4 .82± 3.94 )mg/L和非冠心病组 (2 .70± 1.95 )mg/L(P均 <0 .0 5 )。血清hs CRP在Ⅱ型斑块组中的水平 (14 .5 0± 4 .6 6 )mg/L明显高于其他型斑块组 (6 .82± 5 .6 3)mg/L及非冠心病组 (2 .70± 1.95 )mg/L(P <0 .0 1)。结论　血清hs CRP水平与冠心病斑块稳定性有关。冠状动脉造影斑块分型结合hs CRP水平 ,可较好地估价斑块的稳定性     

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.