抑郁症的多导睡眠脑电图研究

目的探讨抑郁症患者的多导睡眠图异常改变，与正常对照组之间的差异。方法采用多导睡眠仪（PSG）对20例抑郁症患者进行整夜睡眠描记，并与对照组比较。结果抑郁症组与正常组比较：睡眠潜伏期延长，慢波睡眠减少，维持率低；REM潜伏期缩短，密度增加。结论我们认为抑郁症患者存在入睡困难、易醒、早醒及浅睡为主的睡眠障碍，多导睡眠图特征性变化是以快动眼睡眠过度活跃为特征，表现为REM潜伏期（RL）缩短，REM密度增加，原因可能与5-羟色胺／去甲肾上腺素（5-HT/NE）能神经传递减少及／或胆碱能传递增加有关。笔者认为抑郁症患者REM睡眠的特征性改变对抑郁症的诊断及鉴别诊断有一定临床意义。     

抑郁症患者睡眠生理的特征改变

目的：探讨抑郁症患者睡眠生理结构的变化，并与正常人比较。方法：抑郁症组为2002—01／2004—12广州市精神病医院门诊抑郁症患者42例，正常对照组为广州市精神病医院部分职工和广州医学院部分学生，共选择30人。使用英国Oxford工厂生产的Medilog多导睡眠图记录仪进行多导睡眠图检查．记录整夜的脑电图信号。主要观察①睡眠进程：包括总记录时间，睡眠总时间．睡眠潜伏期，快速眼动睡眠潜伏等。②睡眠结构：包括各阶段（非快速眼动S1、S2、S3、S4、快速眼动）睡眠的时间和百分比，快速眼动活动度、密度和强度，睡后觉醒的次数、时间和百分比。③睡眠片断的平均时程。对此项检查获患者及家属全面知情同意。结果：抑郁症组及正常对照组均完成多导睡眠图的检查，全部进入结果分析。①睡眠进程分析：总记录时间两组无差异，抑郁症组睡眠总时间比正常对照组少，睡眠潜伏期比正常对照组长，快速眼动睡眠潜伏期比正常对照组短，差异均有显著性（P〈0．05），抑郁症组睡眠效率和维持率低。②睡眠结构分析：抑郁症组非快速眼动S1时间比正常对照组长，但无统计学意义；非快速眼动S2时间比正常对照组短，[（212．72&;#177;92．9），（224．63&;#177;8．1）min，F=9．388，P=-0．004]；而非快速眼动（S3＋S4）时间比正常组短，但无统计学意义，不少患者的整个慢波睡眠（S3＋S4）缺失。抑郁症组快速眼动活动度、密度和强度均显著高于正常对照组，睡后觉醒时间长。（爹抑郁症组睡眠片断的平均时程低于正常对照组[（81.90&;#177;7．2），（96.73&;#177;8．6）min，P=0．818]。结论：抑郁症组睡眠潜伏期长、睡后觉醒时间长，睡眠效率和维持率低，快速眼动潜伏期缩短，S1睡眠延长，S3，S4睡眠缩短，部分患者的整个慢波睡眠（S3＋S4）缺失。提示抑郁症患者与正常人有不同的睡眠模式，其睡眠障碍模式以快速眼动睡眠过度活跃为特征。     

抑郁症患者睡眠生理的特征改变

目的:探讨抑郁症患者睡眠生理结构的变化,并与正常人比较。方法:抑郁症组为2002-01/2004-12广州市精神病医院门诊抑郁症患者42例,正常对照组为广州市精神病医院部分职工和广州医学院部分学生,共选择30人。使用英国Oxford工厂生产的Medilog多导睡眠图记录仪进行多导睡眠图检查,记录整夜的脑电图信号。主要观察①睡眠进程:包括总记录时间,睡眠总时间,睡眠潜伏期,快速眼动睡眠潜伏等。②睡眠结构:包括各阶段(非快速眼动S1、S2、S3、S4、快速眼动)睡眠的时间和百分比,快速眼动活动度、密度和强度,睡后觉醒的次数、时间和百分比。③睡眠片断的平均时程。对此项检查获患者及家属全面知情同意。结果:抑郁症组及正常对照组均完成多导睡眠图的检查,全部进入结果分析。①睡眠进程分析:总记录时间两组无差异,抑郁症组睡眠总时间比正常对照组少,睡眠潜伏期比正常对照组长,快速眼动睡眠潜伏期比正常对照组短,差异均有显著性(P<0.05),抑郁症组睡眠效率和维持率低。②睡眠结构分析:抑郁症组非快速眼动S1时间比正常对照组长,但无统计学意义;非快速眼动S2时间比正常对照组短,[(212.72±22.9),(224.63±8.1)min,F=9.388,P=0.004];而非快速眼动(S3+S4)时间比正常组短,但无统计学意义,不少患者的整个慢波睡眠(S3+S4)缺失。抑郁症组快速眼动活动度、密度和强度均显著高于正常对照组,睡后觉醒时间长。③抑郁症组睡眠片断的平均时程低于正常对照组(81.90±7.2),(96.73±8.6)min,P=0.818。结论:抑郁症组睡眠潜伏期长、睡后觉醒时间长,睡眠效率和维持率低,快速眼动潜伏期缩短,S1睡眠延长,S3,S4睡眠缩短,部分患者的整个慢波睡眠(S3+S4)缺失。提示抑郁症患者与正常人有不同的睡眠模式,其睡眠障碍模式以快速眼动睡眠过度活跃为特征。     

发作性睡病的临床监测与特征分析

目的探讨多导睡眠图(ploysomnography;PSG)、多次睡眠潜伏期试验(multiplesleeplatencytest;MSLT)在发作性睡病(Narcolepsy;NC)和嗜睡症(lethargy;IH)患者诊断、鉴别诊断中的价值。方法对35例发作性睡病(NC)和30例嗜睡症(IH)进行整夜多导睡眠图(PSG)描记和多次睡眠潜伏期试验(MSLT),分析其睡眠参数异同。结果MSLT结果显示:NC组睡眠潜伏期和快动眼睡眠(REM)潜伏期显著缩短,入睡次数和REM睡眠出现次数明显多于IH组和对照组(P<0.01),睡眠潜伏期<5分钟和ROREMPs≥2次30例(85.7%),与IH组比较差异有统计学意义(P<0.01);整夜PSG结果显示:NC组总睡眠时间和深睡眠(SWS)百分比及REM潜伏期显著低于IH组和对照组,而S1阶段睡眠显著高于IH组,两组比较,差异具有统计学决心义(P<0.01)。结论NC患者具有明显的睡眠潜伏期缩短和反常的REM睡眠特征,MSLT、PSG对NC和IH的诊断和鉴别诊断具有重要参考价值。     

抑郁症与不伴抑郁失眠症患者睡眠模式比较

目的 验证抑郁症和失眠症同源性假说。方法 采用多导睡眠图记录仪,记录并分析30例抑郁症患者和30例失眠症患者整夜的脑电图、眼电图、肌电图等。结果 抑郁症患者快动眼(REM)睡眠明显活跃,各项 REM指标均与失眠症患者有非常显著性差异( P <0.01);失眠症患者以睡眠持续性差、浅睡和觉醒增多以及深睡和REM睡眠明显受抑制为特征,不少患者的整个慢波睡眠(S3+S4)缺失。结论 抑郁症与不伴抑郁情绪的失眠症睡眠模式不同,抑郁症以 REM睡眠过度活跃为特征,而失眠症以非REM睡眠明显紊乱为主要特征。     

多道睡眠图指标评估脑卒中后抑郁的价值

目的：探讨多道睡眠图(polysomnograph，PSG)指标对脑卒中后抑郁(post-stroke depression，PSD)的诊断价值。方法：30例研究对象分为3组进行多道睡眠图检查并分析其结果：病例组为10例PSD患者，根据DSM-Ⅳ诊断标准确诊；对照组为10例脑卒中后无抑郁的患者；正常组为年龄、性别匹配的健康者。结果：与对照组、正常组比较，病例组睡眠结构发生明显变化，表现为睡眠潜伏期延长，快速动眼睡眠与非快速动眼睡眠(REM-NREM)周期次数增加；快速动眼睡眠(rapid eye movements，REM)潜伏期缩短；REM活动度、强度、密度增加；S1阶段睡眠增加，S2和S3 4阶段睡眠减少。总睡眠时间、慢波睡眠时间比正常组少，但与对照组之间无差异；3组之间觉醒时间、睡眠效率无明显差异。结论：PSD患者存在PSG指标变化，这些改变可能有助于PSD的诊断参考。     

阿尔兹海默病患者睡眠脑电图分析

目的:观察阿尔兹海默病(AD)患者夜间睡眠的临床特征。方法:对53例AD患者(AD组)和25例年龄、性别相匹配的健康体检者(对照组)进行夜间睡眠脑电图检测;同时将AD组患者进行MMSE评分,根据评分将AD组患者分为轻、中、重度痴呆,分析快速眼动(REM)睡眠时间减少程度与MMSE评分的相关性。结果:与对照组相比,AD组患者总觉醒时间增加,睡眠效率、睡眠潜伏期减少,REM睡眠比例下降,差异有统计学意义(P0.05);AD患者痴呆程度越重,REM睡眠减少越显著。结论:AD患者睡眠指标和睡眠结构发生改变,表现为觉醒时间增加,睡眠效率、睡眠潜伏期减少,REM睡眠减少;痴呆程度越重,REM睡眠减少越显著。     

多道睡眠图指标评估脑卒中后抑郁的价值

目的探讨多道睡眠图 ( polysomnograph,PSG)指标对脑卒中后抑郁 (post-stroke depression,PSD)的诊断价值. 方法 30例研究对象分为 3组进行多道睡眠图检查并分析其结果病例组为 10例 PSD患者,根据 DSM-Ⅳ诊断标准确诊;对照组为 10例脑卒中后无抑郁的患者;正常组为年龄、性别匹配的健康者. 结果与对照组、正常组比较,病例组睡眠结构发生明显变化,表现为睡眠潜伏期延长,快速动眼睡眠与非快速动眼睡眠( REM-NREM)周期次数增加;快速动眼睡眠( rapid eye movements,REM)潜伏期缩短; REM活动度、强度、密度增加; S1阶段睡眠增加, S2和 S3+ 4阶段睡眠减少.总睡眠时间、慢波睡眠时间比正常组少,但与对照组之间无差异. 3组之间觉醒时间、睡眠效率无明显差异. 结论 PSD患者存在 PSG指标变化,这些改变可能有助于 PSD的诊断参考.     

抑郁症患者REM睡眠脑电图的研究

目的 探讨抑郁症患者睡眠脑电图的特点。方法 对50例抑郁症患者和50例正常对照者进行睡眠脑电图检测，并进行对照。结果 抑郁症患者REM睡眠密度增加、潜伏期缩短、时间缩短、周期减少。结论 抑郁症患者睡眠脑电图中的REM指标，可作为抑郁症临床诊断的参考指标。     

舒眠胶囊联合黛力新治疗原发性失眠疗效观察

目的 观察舒眠胶囊联合黛力新治疗原发性失眠的疗效.方法 采用随机、对照方法,将120例原发性失眠患者随机分为治疗组、对照组,每组各60例,治疗组给予舒眠胶囊联合黛力新治疗,对照组给予舒眠胶囊治疗,两组疗程均为12W,治疗后采用多导睡眠图描记技术评价疗效.结果 治疗后治疗组与对照组比较,睡眠潜伏期明显缩短,总睡眠时间及睡眠效率明显提高,觉醒次数和时间明显减少;睡眠结构分析浅睡较前减少,尤其Ⅰ期睡眠明显,而深睡(Ⅲ,Ⅳ期)明显增加,快速眼动睡眠相(REM)睡眠比例有所增加.对照组睡眠潜伏期缩短,总睡眠时间延长,觉醒时间和次数减少,睡眠效率无明显变化;睡眠结构分析,浅睡(Ⅱ期睡眠)增加,而深睡(Ⅲ,Ⅳ期睡眠)减少,REM潜伏期延长.结论 舒眠胶囊联合黛力新治疗原发性失眠的疗效确切.     

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.