输入性恶性疟疾2例流行病学及临床分析

目的探讨输入性恶性疟疾的流行病学和临床特征。方法对2010年10月至2012年7月收治住院的2例输入性恶性疟疾患者的流行病学资料、临床表现、实验室检查、诊治情况进行回顾性分析。结果 1例患者为非洲劳务回国的中年男性,另1例患者是曾去上海世博会旅游的青年男性,均有贫血、脾大、肝功能异常,1例白细胞减少,1例血小板减少。经抗疟治疗后,2例均在短期(1～2周)内治愈出院。结论输入性恶性疟疾患者临床表现复杂,对输入性恶性疟疾患者应及时进行外周血涂片,认真查找疟原虫,明确诊断,抗疟治疗,避免凶险型疟疾的发生。     

输入性疟疾17例分析

目的探讨输入性疟疾的临床特征及治疗。方法回顾性分析17例输入性疟疾的临床资料。结果 17例出现畏寒、发热、头痛、肌肉酸痛、腹泻、黄疸、少尿、贫血、肺部感染及意识改变等不同临床表现。实验室检查有PLT下降、肝肾功异常,B超示肝脾肿大。16例应用双氢青蒿素哌喹片,1例应用蒿甲醚治疗均治愈。结论输入性疟疾临床表现及实验室检查均呈现多样化,临床医师要有充分认识。青蒿素及其衍生物治疗效果好,可作为首选。     

输入性恶性疟疾37例流行病学及临床特点分析

目的探讨输入性恶性疟疾的流行病学及临床特点。方法收集2007年1月至2013年12月浙江大学医学院附属第一医院及浦江县人民医院收治的输入性恶性疟疾患者共37例,对其流行病学资料、临床表现、实验室检查、诊治情况等进行回顾性分析。结果输入性疟疾病例全年散发,无明显季节性。37例患者均有疟疾流行区居住史,以男性为主（36例）。所有患者均有发热,以中高热为主,伴有消化道反应（7例）、意识改变（5例）、皮肤巩膜黄染（10例）、贫血（12例）、肝肿大（2例）、脾肿大（4例）、腹水（1例）等表现。实验室检查：白细胞计数异常20例,血小板下降30例,C反应蛋白（CRP）升高25例,肝肾功能异常。明确诊断后均予抗疟及综合治疗。在治疗48-96 h后患者体温均恢复正常;血小板下降者在治疗后第3天均开始回升,第7天时恢复正常者28例（93.3%）;所有患者均治愈出院。结论有疟疾流行区居住史的发热患者,尤其是血小板减少、CRP增高者应高度怀疑恶性疟疾,动态检测血小板的变化对其早期诊断及疗效判断具有重要意义。     

三例输入性卵形疟的实验室诊断

目的分析3例输入性疟疾的实验室诊断,减少卵形疟的误诊与漏诊。方法采用形态学检查、巢氏聚合酶链反应(PCR)及序列分析等方法确诊3例输入性疟疾病例。结果 3例患者形态学检查结果分别是未检出疟原虫(实验室初次检查)、检出卵形与恶性疟原虫和检出卵形疟原虫;巢氏PCR检测结果依次是卵形疟原虫感染、卵形与恶性疟原虫混合感染和卵形与间日疟原虫混合感染。结论需加强疟疾消除地区疟原虫形态学检查技术的培训和推广。应用分子生物学检查技术可减少输入性卵形疟的误诊与漏诊。     

北京地区境外输入性恶性疟疾临床分析——附99例报告

目的:探讨北京地区输入性恶性疟疾的临床特点及其诊断与治疗.方法:时99例输入性恶性疟疾患者的临床资料进行数理分析.结果:99例均有疟疾流行区居住史,临床表现复杂多样,其中发热99例(100%)、畏寒90例(90%)、头痛28例、呕吐25例、肌肉疼痛23例、腹泻21例、烦躁不安17例、贫血13例、肝肿大10例、脾肿大43例(43%)、双下肢水肿8例.21例早期误诊,误诊率为21%(21/99).43例给予氯喹治疗,其中16例经治疗无效,加用蒿甲醚治疗;41例应用双氢青蒿素加蒿甲醚治疗;15例应用蒿甲醚加双氢青蒿素哌喹治疗.99例全部治愈,治愈率为100%.3例出现再燃(3%).结论:恶性疟疾早期临床表现复杂,易误诊,临床上遇见有恶性疟疫区居住史的发热患者,应及时行血涂片或骨髓穿刺检查,以免延误诊治.使用青蒿素衍生物治疗恶性疟疾效果好,可作为首选药物.     

临床路径在输入性疟疾患者临床健康教育中的应用效果分析

目的探讨基于输入性疟疾临床路径的健康教育方法及其实施效果。方法针对例输入性疟疾制定标划的基于临床路径的程序化健康教育模式,入组45例输入性疟疾患者,分析患者满意度、临床路径实施前后的平均住院日、住院费用和药占比等数据。结果凡进入临床路径管理的疟疾患者满意度达到100%,平均住院日为7.24 d,较2011年同期住院疟疾患者平均住院日8.65 d,缩短了16.3%。疟疾出院患者次均总费用较临床路径实施前降低了13.45%,药占比疟疾由临床路径实施前的17.79%减至13.80%。结论采用基于临床路径的健康教育模式更有利于输入性疟疾患者的医疗救治和健康康复。     

2014～2017年山东省泰安地区输入性疟疾患者临床及实验室相关指标分析

目的 分析2014～2017年山东泰安地区输入性疟疾患者临床及实验室相关指标特征,以提高对输入性疟疾的诊治水平。方法 回顾性分析泰安市中心医院2014～2017年58例输入性疟疾患者的临床资料,对患者体征、血细胞检测、肝功能进行统计分析。结果 58例患者以发热为首发症状者最多,占82.8%; 感染疟原虫类型以恶性疟居多,为56.90%; 血细胞检测中,疟疾组白细胞计数(WBC)和中性粒细胞百分比(N%)均高于对照组且差异具有统计学意义(WBC:t=5.371,P<0.05,N%:χ²=9.592,P<0.05),血小板(PLT)计数低于对照组且差异具有统计学意义(t=7.239,P<0.05),恶性疟患者血小板(PLT)计数低于其他三种疟疾患者,且差异均具有统计学意义(q=4.221～6.778,均P<0.05),三日疟患者白细胞计数(WBC)和中性粒细胞百分比(N%)均低于其他三种疟疾患者,且差异具有统计学意义(WBC:q=3.523～6.818,均P<0.05,N%:χ²=58.19～63.23,均P<0.05); 肝功能检查中,疟疾组患者谷氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)和直接胆红素(DBIL)均高于正常对照组,且差异有统计学意义(t=2.131～8.922,均P<0.05),恶性疟患者TBIL高于三日疟,且差异具有统计学意义(q=4.983,P<0.05); 疟疾组患者经治疗后,PLT和AST变化最为明显,患者PLT逐渐上升,AST逐渐下降,在出院前可恢复正常。结论 输入性疟疾患者实验室指标有明显特点,且不同类型疟原虫的感染实验室指标有差异,在工作中应加以重视,提高疟疾的诊治水平。     

2015-2019年山东省泰安市输入性疟疾的流行病学分析

目的 分析2015-2019年山东省泰安市输入性疟疾病例疫情特征,为巩固消除疟疾成果提供参考.方法 通过"中国疾病预防控制信息系统"和"中国寄生虫病防治信息管理系统",采用统计学方法对2015-2019年泰安市输入性疟疾病例监测和疫情报告资料进行流行病学分析.结果 2015-2019年泰安市共报告输入性疟疾病例122例...     

成人恶性脑型疟疾2例临床分析并相关文献复习

目的初步探讨成人恶性脑型疟疾的临床特征、诊断及治疗。方法回顾性分析2例确诊成人恶性脑型疟疾患者的流行病学特征、临床表现、实验室检查、治疗经过及其预后,并复习相关文献。结果 2例成人恶性脑型疟疾患者均有非洲工作或生活史,同时均为急性起病,表现为高热、头昏头痛,意识障碍,同时伴有肝功能异常,累及两系以上血象异常,C-反应蛋白明显升高,外周血涂片均找到恶性疟原虫;予以青蒿琥酯等治疗患者痊愈,其中1例出院后因未服用伯安喹而引起复燃,再次治疗有效。结论成人恶性脑型疟疾在我国多为输入性感染,临床易误诊,有必要反复血涂片找疟原虫以便于确诊;该病起病迅速,病情进展快,及时有效抗疟疾治疗病情恢复快,治疗效果好。     

18例输入性疟疾的护理

【目的】总结输入性疟疾患者的护理经验。【方法】回顾性分析本科诊治的18例输入性疟疾的临床表现与治疗方法,针对患者临床特点、并发症采取相应的护理干预。【结果】18例患者治愈17例（94．4％）;死亡1例（5．6％）。9例并发中毒性肝炎,5例溶血性尿毒症综合征,4例出现意识障碍,4例急性肾功能衰竭,1例继发癫痫,1例出院3周后发生再燃。【结论】提供全方位综合护理干预是提高恶性疟疾救治成功率、促进康复的有力保障。     

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.