头部低温治疗高血压性脑出血高热的最佳疗程的研究

目的 探讨头部低温对高血压性脑出血（HIH）高热降温最佳治疗时间。方法 176例HIH高热病人随机分为四组，A组43例，为体温恢复后（≤37．5℃）即停止头部低温治疗者；B组44例，为体温恢复后头部低温继续治疗1～2d者；C组51例，为3～4d者；D组38例，为5～6d者。结果 四组比较，头部低温启始时间、体温恢复时间及3天体温恢复率均无显著性差异（P〉0．05）；体温再发率以A、B两组最高（P〈0．05）；治疗前后神经功能缺损评分（NDS）、日常生活质量评分（ADL）比较，以C、D组效果最佳（P〈0．05）。结论 头部低温降温治疗时间为体温恢复后继续治疗3～4d者最佳。     

不同启始时间头部低温对大面积脑梗死并中枢性高热降温效果比较

目的观察不同启始时间头部低温对大面积脑梗死(LCI)合并中枢性高热的降温效果。方法将154例中枢性高热LCI病人按入院时间顺序分为4组,A组34例,为高热后≤3 h行头部低温降温;B组35例,为高热后4-6 h行头部低温降温;C组45例,为7-9 h行头部低温降温;D组40例,为10-12 h行头部低温降温。结果 4组比较,头部低温治疗时间无显著性差异(均P>0．05),3 d体温恢复率无显著性差异(均P>0．05),体温再发率以A、B两组最低(均P<0．05),生存者治疗前后神经功能缺损程度评分(NDS)、日常生活能力评定(ADL)以A、B两组效果最佳(均P<0．05),肺部感染以 C、D发生率为高(均P<0．05)。结论 LCI中枢高热者6 h内应用头部低温治疗可达到治疗及降温双重作用。     

头部低温治疗高血压性脑出血高热的最佳疗程的研究

目的探讨头部低温对高血压性脑出血(HIH)高热降温最佳治疗时间.方法 176例HIH高热病人随机分为四组,A组43例,为体温恢复后(≤37.5℃)即停止头部低温治疗者;B组44例,为体温恢复后头部低温继续治疗1～2 d者;C组51例,为3～4 d者;D组38例,为5～6 d者.结果四组比较,头部低温启始时间、体温恢复时间及3天体温恢复率均无显著性差异(P＞0.05);体温再发率以A、B两组最高(P＜0.05);治疗前后神经功能缺损评分(NDS)、日常生活质量评分(ADL)比较,以C、D组效果最佳(P＜0.05).结论头部低温降温治疗时间为体温恢复后继续治疗3～4 d者最佳.     

不同方法对大面积脑梗死高热降温的效果比较

目的：探讨3种不同方法对大面积脑梗死高热病人的降温效果。方法：将105例大面积脑梗死高热病人随机分为颅脑降温治疗仪组、冰袋组和酒精擦浴组，以3组病人30min内体温恢复率、体温反复率、3天以内体温恢复率、病死率、生存者治疗前后神经功能缺损评分与日常生活质量评分等指标进行对照观察。结果：30min内体温恢复率以酒精擦浴为佳（P〈0．01）；体温反复者以颅脑降温治疗仪最低（P〈0．01）；3天以内体温恢复率以颅脑降温治疗仪最高（P〈0．05）；生存者治疗前后神经功能缺损评分、日常生活质量评分比较以颅脑降温治疗仪组效果最佳（P〈0．05，P〈0．01）；病死率颅脑降温治疗仪组最低（P〈0．05）。结论：颅脑降温治疗仪不但降温效果较佳，而且对减少病死率及提高病人愈后生活质量起到积极的作用。     

不同方法对高血压性脑出血脑疝高热降温效果比较

目的：探讨三种不同方法对高血压性脑出血脑疝（HCHCH）高热病人的降温效果。方法：将96例HCHCH高热病人，随机分为颅脑降温治疗仪（HTI）组，冰袋组和酒精擦浴组，以三组病人30min内体温恢复率，体温反复率，3天以内体温恢复率，病死率，生存者治疗前后神经功能缺损评分（NDS）与日常生活质量（ADL）等指标进行对照观察，结果：三组比较30min内体温恢复率以酒精擦浴为佳（P＜0．01），体温反复者以HTI最低（P＜0．01），3天以内体温恢复率以HTI最高（P＜0．05），生存者治疗前后NDS，ADL比较以HTI组效果最佳（P＜0．05，P＜0．01）；病死率HTI组最低（P＜0．05），结论：HTI不但降温效果较佳，而且对减少病死率及提高病人愈后生活质量起到积极的作用。     

大面积脑梗死并高热老年患者的亚低温治疗疗效观察

目的 观察亚低温治疗对大面积脑梗死并高热老年患者生命体征的影响及其临床疗效。方法 46例发病2。1h内入院的老年大面积脑梗死并高热患者随机分为亚低温组和对照组各23例。亚低温组给予33℃～35℃的低温治疗，对照组给予常规降温治疗，10d后评定两组患者的体温、心率等，并根据死亡率及神经功能缺损评分评估患者的预后。结果 10d后。亚低温组患者的体温、心率均低于对照组。死亡率亦低于对照组，神经功能改善（P〈0．05），预后较好。结论 亚低温治疗老年大面积脑梗死并高热患者安全有效。     

肛指温差值与高热病儿降温效果关系的研究

目的 研究肛指温差值与高热病儿降温效果的关系。方法 将120例高热病儿随机分两组，一组采用药物降温，另一组采用药物加物理降温。降温前测量肛指温差值，观察降温措施后30min、60min、120min、180min体温下降情况及伴随症状。结果 两组高热病儿肛指温差值〈6℃的体温下降较肛指温差值〉6℃明显（P〈0．05）；肛指温差值〈6℃的高热病儿在降温后30min、60min两个时间段，药物联合物理降温组体温下降优于单用药物降温组（P〈0．05）；肛指温差值〉6℃的高热病儿在药物联合物理降温后30min、60min两个时间段，体温下降不如单用药物降温组（P〈0．05），且伴随症状在30min后有增加。结论 肛指温差值是判断高热病儿降温效果及能否进行物理降温的一个好指标。     

降温毯不同预设温度降温效果观察

[目的]探讨降温毯不同预设温度降温效果、并发症发生率，以及护理人员使用降温毯的注意事项。[方法]选取肛温超过39℃，传统物理降温效果不佳的危重病人125例。按照病人应用降温毯前肛温。采用分层随机化法分为5组（A组、B组、C组、D组、E组），降温毯预设温度分别设为10℃～15℃、15℃-20℃、20℃～25℃、25℃～30℃、30℃～35℃，观察应用6h后腋温、肛温、肛温与腋温之差、动脉血乳酸浓度及并发症发生率。[结果]各组腋温均接近降温毯预设温度；肛温较应用前明显下降（P〈0．05）；D组、E组温差、动脉血乳酸浓度与A组、B组、C组比较差异显著（P〈0．05）；A组并发症发生率明显高于其他组（P〈0．05），其余各组间比较差异不明显（P〉0．05）。[结论]对持续高热的病人，应尽早使用降温毯降温，降温毯预设温度以25℃～35℃为宜。     

头部低温对高血压脑出血患者血清炎性细胞因子含量的影响

目的观察高血压脑出血（HIH）患者白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF—α）含量的变化及头部低温对其的影响。方法124例HIH患者根据是否加用头部低温治疗分为头部低温组（63例）和对照组（61例）。采用酶联免疫吸附法（ELISA）和放射免疫法测定两组患者治疗前及治疗后8d血清IL-6、TNF—α含量。并与正常组（40例）进行比较。同时，对两组患者中存活者生活质量进行比较。结果头部低温组和对照组治疗前IL-6、TNF—α明显升高，与正常组比较差异均有显著性（P均〈0．01）；治疗前头部低温组和对照组间IL-6和TNF—α差异均无显著性（P均〉0．05）；治疗后8d，头部低温组IL-6、TNF—α较治疗前明显降低（P均〈0．05），对照组降低不明显（P均〉0．05），头部低温组与对照组比较差异均有显著性（P均〈0．01）。头部低温组较对照组存活者预后的生活质量明显提高（P〈0．05）。结论HIH早期血清IL-6、TNF—α含量明显升高，头部低温可有效降低其含量，提高存活者预后生活质量。     

应用半导体制冷仪行亚低温治疗大面积脑梗死病人的疗效观察

[目的]观察亚低温疗法时大面积脑梗死病人的临床治疗效果。[方法]把92例大面积脑梗死并发高热的病人随机分为亚低温组和对照组各46例。亚低温组给予医用半导体制冷仪行亚低温治疗，对照组给予常规物理扣药物降温治疗。10d后评定2组病人的体温、心率等指标；1个月后根据死亡率及神经功能缺损评分评估病人的预后。[结果]亚低温组病人的体温、心率均低于对照组，病死率亦低于对照组，神经功能改善（P〈0.05），预后较好。[结论]头颅局部亚低温疗法治疗大面积脑梗死病人安全有效，能够改善病人预后。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.