参麦汤合锌硒宝治疗急性病毒性心肌炎临床观察

目的：探讨参麦汤、锌硒宝对急性病毒性心肌炎的疗效。方法：将106例急性病毒性心肌炎患者随机分为2组，治疗组60例，采用参麦汤、锌硒宝治疗4周。对照组46例，静滴肌酐、辅酶A、VitC治疗2个疗程(15d为1个疗程)。结果：治疗组显效率为88.3％，对照组为55.5％，2组有显著性差异(P＜0.01)。结论：参麦汤、锌硒宝具有增加心肌营养、改善心肌代谢等作用，并可提高机体免疫功能，对急性病毒性心肌炎有显著疗效。     

儿宝颗粒辅助锌硒宝治疗厌食症儿童的效果观察

目的:观察儿宝颗粒辅助锌硒宝治疗厌食症儿童的临床效果。方法:选取我院2017年5月～2018年5月收治的108例厌食症患儿为研究对象,随机分为对照组和观察组各54例。对照组应用锌硒宝治疗,观察组在对照组基础上予以儿宝颗粒辅助治疗。比较两组治疗前后微量元素、免疫功能指标以及食欲调节因子指标变化。结果:治疗前,两组微量元素、免疫功能指标以及食欲调节因子指标比较差异无统计学意义(P0.05);治疗后,观察组Fe、Zn、Mg、Ig A、Ig G、Ig M、NYP、Ghrelin水平明显高于对照组,Leptin水平低于对照组(P0.05)。结论:儿宝颗粒辅助锌硒宝治疗厌食症,可有效促进患儿的食欲,增加营养摄入,提高免疫力。     

两种方法防治小儿反复呼吸道感染的疗效观察

目的 :探索防治小儿反复呼吸道感染 (RRI)的方法。方法 :将 15 0例患儿随机分成A组 (口服锌硒宝组 ) 80例 ,B组 (肌注人血丙种球蛋白组 ) 70例 ,治疗前后分别检测细胞免疫及体液免疫功能。结果 :A组的总有效率明显高于B组 (P <0 .0 1) ,治疗前后A组的细胞免疫及体液免疫功能发生了显著变化 (P <0 .0 5 ) ,而B组治疗前后细胞免疫功能变化无显著性 (P >0 .0 5 )。结论 :口服锌硒宝能明显提高患儿的免疫力 ,用锌硒宝防治小儿RRI具有较好的远期效果     

参麦注射液治疗新生儿缺氧缺血性脑病合并心肌损害30例的疗效观察

目的 :观察参麦注射液治疗新生儿缺氧缺血性脑病 (HIE)合并心肌损害 30例的临床疗效。方法 :治疗组 30例在常规治疗基础上用参麦注射液 2 m L/ (kg·d)加入 10 %葡萄糖溶液 5 0 m L中静滴 ,每日 1次 ,疗程 7～ 10天。对照组 33例 ,仅用常规治疗。结果 :治疗组的显效率 5 3% (16/30 )和总有效率 80 % (2 4 / 30 )均明显高于对照组的 2 1%和 5 5 % (7/ 33和 18/ 33) ,P<0 .0 1和 P<0 .0 5 ;治疗组心率、心电图、心肌酶学恢复时间比对照组显著缩短 (P<0 .0 1) ;治疗组神经系统主要症状和体征消失时间比对照组显著缩短 (P<0 .0 1)。结论 :参麦注射液治疗 HIE合并心肌损害疗效满意。     

参麦注射液对老年血液肿瘤化疗患者的心脏保护作用

目的 :观察参麦注射液对老年血液肿瘤患者化疗期间的心脏保护作用。方法 :44例老年血液肿瘤患者分为参麦组和对照组 ,参麦组 (n =2 3例 )化疗同时应用参麦注射液 40～ 6 0ml/d ,共用 10d ,对照组 (n =2 1例 )不用参麦注射液 ,其它治疗相同。观察化疗前后患者的心肌酶、心律失常及心功能情况。结果 :化疗后参麦组的心肌酶水平比对照组低 (P <0 0 5 ) ,心律失常发生率参麦组亦比对照组低 (P <0 0 5 ) ,而两组心功能比较差异无显著意义 (P >0 0 5 )。结论 :参麦注射液可以减轻化疗药物对老年血液肿瘤患者的心脏毒性作用。     

复脉汤治疗缓慢性心律失常64例疗效观察

目的 :观察复脉汤治疗缓慢性心律失常的疗效。方法 :94例缓慢性心律失常患者 ,随机分为2组 ,治疗组 64例 ,采用自拟复脉汤治疗 ;对照组 3 0例 ,口服心宝治疗 ,均 3 0d为 1疗程。结果 :治疗组有效率为 78.1 % ,对照组为 46.7% ,经统计学处理 ,P <0 .0 5,2组有效率比较有显著差异 ,治疗组优于对照组。     

联用消心痛和参麦注射液治疗慢性阻塞性肺疾病急性加重期合并心肌损害的疗效观察

目的 :观察联用消心痛和参麦注射液在治疗慢性阻塞性肺疾病 (COPD)急性加重期合并心肌损害的疗效。方法 :将 1999年 4月— 2 0 0 3年 4月收治的 6 3例 COPD急性加重期 (AECOPD)合并心肌损害患者随机分为对照组 (按常规治疗 )及观察组 (联用消心痛和参麦注射液 7～ 10 d) ,比较两组症状、体征、心电图和心肌酶学恢复时间。结果 :观察组主要症状、体征的改善时间及心率、心电图、心肌酶的恢复时间均较对照组显著缩短(P均 <0 .0 1) ,观察组显效率 5 3.3% (16 /30 )和总有效率 80 .0 % (2 4 /30 )也均明显高于对照组〔分别为 2 1.2 %(7/33)和 5 4 .5 % (18/33) ,P<0 .0 5和 P<0 .0 1〕。结论 :联用消心痛和参麦注射液对 AECOPD合并心脏损害患者疗效满意     

龙胆参麦止痉汤治疗带状疱疹后遗神经痛32例

目的:观察龙胆参麦止痉汤治疗带状疱疹后遗神经痛的临床疗效。方法:将我院2016年8月~2017年5月辨证为肝经湿热、气阴两虚、气滞血瘀型的64例带状疱疹后神经痛患者,按随机数字法分为治疗组与对照组各32例。对照组予以西药治疗,治疗组在对照组的基础上加用龙胆参麦止痉汤治疗,两组均以2周为1个疗程,治疗2个疗程,对比两组临床疗效。结果:总有效率治疗组为(84.4%)明显优于对照组(62.5%),差异有统计学意义(P0.05)。结论:龙胆参麦止痉汤治疗肝经湿热、气阴两虚、气滞血瘀型带状疱疹后遗神经痛疗效显著。     

参麦注射液治疗肺心病合并心衰34例

目的 :观察参麦注射液对肺心病合并心衰的临床疗效。方法 :随机将 64例肺心病合并心衰患者分为西药对照组 3 0例和参麦注射液治疗组 3 4例。对照组予抗感染、解痉、化痰、扩管、利尿等处理 ,治疗组加用参麦注射液静脉滴注 ,疗程均为 1 4d。结果 :治疗组有效率为 91 .2 % ,对照组有效率为 70 .0 % ,2组相比差异显著 (P <0 .0 5) ;治疗组治疗后血液动力学各项指标及血液流变学的多项指标均较疗前明显改善 (P <0 .0 5或P <0 .0 1 )。结论 :加用参麦注射液治疗肺心病合并心衰 ,疗效高于单纯西药治疗。     

布拉酵母菌散联合锌硒宝治疗小儿迁延性腹泻效果

目的本文就布拉酵母菌散联合锌硒宝治疗小儿迁延性腹泻的临床效果进行研究。方法选取某院儿科在2016年6月至2017年6月收治的94例迁延性腹泻患儿,采用随机数表法将其分为实验组(n=47)与对照组(n=47),对照组采用布拉酵母菌散治疗,实验组则予以布拉酵母菌散联合锌硒宝治疗,比较两组患儿的治疗总有效率、止泻时间及免疫指标。结果实验组的治疗总有效率显著高于对照组(95.74%VS 76.60%),实验组的止泻时间快于对照组,实验组的CD_4~+细胞分数、CD_8~+细胞分数、CD_4~+/CD_8~+比值的改善程度对比对照组更为显著,组间比较,P0.05。结论为迁延性腹泻患儿采用布拉酵母菌散联合锌硒宝进行治疗,可获得显著疗效,并有助于改善患儿的免疫功能。     

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.