大剂量低频率重组人促红细胞生成素治疗肾性贫血临床观察

[目的]观察大剂量低频率重组人促红细胞生成素(rhEPO)治疗肾性贫血的临床疗效及安全性.[方法]对60例确诊为慢性肾衰竭合并肾性贫血的维持性血透患者,随机分为大剂量低频率rhEPO治疗组与小剂量高频率rhEPO对照组,治疗组应用10000U rhEPO每周1次皮下注射,对照组应用3000U rhEPO每周3次皮下注射,分别观察治疗前及用药后4周、8周及12周患者血红蛋白(Hb)、红细胞压积(Hct)、血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)的变化以及药物不良反应.[结果]治疗组与对照组治疗12周后患者Hb、Hct、SF、TSAT均较治疗前有升高( P <0.01),且治疗组治疗4、8周后患者Hb、Hct水平升高更明显,贫血伴随症状得到明显纠正,与对照组比较有统计学意义( P <0.05).[结论]大剂量低频率rhEPO能快速改善肾性贫血患者贫血情况、不良反应低、安全性良好.     

甲状旁腺激素与血液透析患者促红细胞生成素疗效的关系

目的探讨维持性血液透析患者免疫反应性甲状旁腺激素（iPTH）与贫血和促红细胞生成素（EPO）疗效的关系。方法46例维持性血液透析患者于透析日空腹采血测定血红蛋白（Hb）、红细胞比积（Hct）、血清铁蛋白（SF）、C反应蛋白（CRP）、血清钙（Ca）、磷（P）、钙磷乘积（Ca×P）以及血浆白蛋白（Alb）、肌酐（Scr）和iPTH,记录重组人促红细胞生成素（r-HuEPO）用量,以r-HuEPO用量/Hct比值（EPO/Hct）作为EPO低反应指标。结果46例患者中20例（占43.5%）iPTH升高（iPTH增高组）,26例（占56.5%）正常（iPTH正常组）,iPTH增高组EPO/Hct比值、磷（P）、钙磷乘积（Ca×P）和iPTH水平均高于iPTH正常组,Hct、Hb低于PTH正常组;多因素逐步线性回归分析表明,影响EPO/Hct比值的因素有iPTH、年龄和透析疗程（R2=0.388,P=0.039）。结论继发性甲状旁腺功能亢进是维持性血液透析患者常见并发症之一,甲状旁腺激素升高是影响促红细胞生成素疗效的主要因素之一。     

静脉用蔗糖铁治疗血液透析患者肾性贫血的疗效观察及护理

目的探讨静脉补铁对肾性贫血的疗效及护理。方法 46例维持血液透析的贫血患者分为静脉和口服两组,治疗8周后观察其Hb、RBC等各项指标的变化。结果静脉组治疗前后的Hb为(70.05±16.19)g/L及(86.19±13.04)g/L,RBC为(2.51±0.56)×1012/L及(3.08±0.65)×1012/L,Hct为0.218±0.051及0.274±0.046,SF为(215.43±98.31)μg/L及(510.99±136.96)μg/L,TSAT为(21.03±5.83)%及(33.51±7.47)%,差异具有统计学意义(P均<0.01);且Hb、Hct、SF、TSAT增高幅度明显高于口服组(P<0.05)。口服组治疗前后各指标均无统计学差异。结论静脉补铁治疗血液透析患者肾性贫血疗效优于口服铁剂。     

罗沙司他治疗维持性血液透析患者难治性肾性贫血的疗效观察

目的观察罗沙司他治疗维持性血液透析患者难治性肾性贫血的疗效及安全性。方法选取行维持性血液透析的65例采用重组人促红细胞生成素(rhEPO)联合铁剂治疗肾性贫血不理想的患者为研究对象,随机分为试验组(n=33)与对照组(n=32)。试验组口服罗沙司他胶囊治疗,对照组注射rhEPO治疗, 2组均口服铁剂,治疗6周。比较2组治疗前后的贫血指标[血细胞比容(Hct)、血红蛋白(Hb)]和铁代谢指标[转铁蛋白(TRF)、转铁蛋白饱和度(TSAT)、总铁结合力(TIBC)],并记录2组不良事件发生情况。结果治疗6周后,试验组Hb、Hct、TIBC、TRF水平高于对照组,差异有统计学意义(P0.05), TSAT水平与对照组比较,差异无统计学意义(P0.05)。试验组不良事件发生率低于对照组,差异有统计学意义(P0.05)。结论罗沙司他胶囊治疗维持性血透患者难治性肾性贫血的疗效优于rhEPO,且不良反应较少,口服便利,安全有效。     

高通量血液透析联合促红细胞生成素治疗维持性肾性贫血的临床评价

目的探讨高通量血液透析联合促红细胞生成素(EPO)治疗维持性肾性贫血的临床效果。方法肾性贫血患者30例,随机分为治疗组和对照组各15例,分别用高通量血液透析联合EPO治疗和低通量血液透析联合EPO治疗,疗程1年,观察两组的疗效。结果治疗组的不良反应率小于对照组(6.4%vs 66.7%,P0.05);治疗后与对照组比较,治疗组的尿素氮(BUN)、血细胞比容(Hct)明显下降,分别为(2.1±0.5)mmol/L vs(1.1±0.2)mmol/L(P0.01)及(152.6±119.1)%vs(38.8±17.2)%(P0.01),而与对照组比较,治疗组的多效蛋白(PTN)和血红蛋白(Hb)明显升高,分别为(100.6±3.8)mg/L vs(57.0±1.5)mg/L(P0.05)及(31.1±0.5)g/L vs(18.7±0.5)g/L(P0.01)。结论高通量血液透析联合EPO治疗维持性肾性贫血临床效果好、安全高。     

高通量血液透析对维持性血液透析患者微炎症及肾性贫血的影响

目的观察比较采用高通量血液透析(HFHD)和低通量血液透析(LFHD)对维持性血液透析(MHD)患者微炎症状态及肾性贫血的影响。方法选择合肥市第二人民医院2013年1月至2014年1月的MHD患者共100例,随访12个月,其中HFHD组50例,LFHD组50例,测定两组患者基线和治疗1、6、12个月的高敏C反应蛋白(hs CRP)、白细胞介素6(IL-6)、血红蛋白(Hb)、红细胞压积(Hct)。并记录留取静脉血前4周重组人红细胞生成素(r-Hu EPO)的应用总量,以每周应用r-Hu EPO与Hct的比值(EPO/Hct)作为评价r-Hu EPO低反应的指标。采用t检验、卡方检验等方法,分析比较两组之间炎症因子、Hb、Hct、EPO/Hct之间的差异。结果 (1)HFHD组患者治疗6、12个月后hs CRP[(5.52±2.36)mmol/L、(5.06±2.13)mmol/L]、IL-6[(35.17±15.06)ng/L、(28.74±13.56)]、EPO/Hct[(2.15±1.03)×104 U、(2.08±1.34)×104 U]水平明显低于透析前,而其体内Hb[(86.92±10.33)g/L、(90.36±11.57)g/L]、Hct(27.49%±5.05%、29.95%±6.14%)含量则明显提高,差异有统计学意义(均P<0.05);(2)LFHD组治疗6、12个月后,hs CRP、IL-6、EPO/Hct、Hb、Hct较治疗前无明显变化(均P>0.05);(3)HFHD组和LFHD组在治疗1个月时,hs CRP、IL-6、EPO/Hct、Hb、Hct均较治疗前无明显变化(均P>0.05);(4)治疗6、12个月结束时,HFHD组患者Hb、Hct较LFHD组差异无统计学意义(均P>0.05),而EPO/Hct[(2.15±1.03)×104 U、(2.08±1.34)×104 U]、hs CRP[(5.52±2.36)mmol/L、(5.06±2.13)mmol/L]、IL-6[(35.17±15.06)ng/L、(28.74±13.56)ng/L]较LFHD组明显减低(均P<0.05)。结论采用HFHD的MHD患者在治疗一段时间后能降低微炎症状态,进而减轻EPO抵抗,改善肾性贫血。     

蔗糖铁注射液治疗维持性血液透析肾性贫血疗效分析

目的分析蔗糖铁注射液治疗维持性血液透析肾性贫血的临床疗效。方法将收治的维持性血液透析后发生肾性贫血的120例患者纳入研究,随机分组。在促红细胞生成素基础上对照组口服铁剂治疗,试验组静脉注射蔗糖铁治疗。连续治疗8w,对比两组患者Hb、Hct、SF、TSAT等指标的变化和不良反应的差异。结果与治疗前对比,治疗后患者Hb、Hct、SF、TSAT等指标均有所上升,其中试验组各指标上升幅度明显大于对照组,组间差异有统计学意义(P0.05)。与对照组对比,试验组患者治疗期间不良反应发生率较低,组间差异有统计学意义(P0.05)。结论采用蔗糖铁注射液治疗维持性血液透析肾性贫血,可明显改善贫血症状,且不良反应轻微,可在临床推广应用。     

小剂量促红细胞生成素治疗老年人慢性疾病性贫血的疗效

目的:观察小剂量重组人促红细胞生成素(rhEPO)治疗老年人慢性疾病性贫血(ACD)的疗效.方法:对南京军区南京总医院老年科住院患者中96例确诊为ACD的患者按发病原因分成感染组和肿瘤组,再将每组分成常规组和rhEPO组,所有患者均积极治疗原发疾病,适当输血、补充铁剂、维生素B12、叶酸等,但rhEPO组在基础治疗上根据贫血程度的不同,应用rhEPO 3 000 U或10 000 U,皮下注射,每周2次,观察其纠正贫血、改善基础病变疗效及安全性.结果:感染组中rhEPO组和常规组基础Hb水平分别为(71±9)g/L和(70±10)g/L,贫血程度轻度30例、中度16例.肿瘤组中rhEPO组和常规组基础Hb水平分别为(72±9)g/L和(71±9)g/L,贫血程度轻度29例、中度18例、重度3例.治疗2周后所有患者Hb水平呈持续稳步上升趋势,感染和肿瘤组Hb分别为(83 ±11)g/L和(75 ±12)g/L;至8周时感染组中的rhEPO组和常规组Hb分别上升至(121 ±11)g/L和(100 ±9)g/L.肿瘤组Hb分别上升至(106±11)g/L和(92±9)g/L),两组差异均有显著统计学意义(P＜0.01).但肿瘤组较感染组Hb水平增长速度慢.结论:根据患者贫血程度,应用不同小剂量rhEPO能平稳有效纠正老年人ACD,且安全耐受性好.并发症的治疗对纠正ACD具有同样的重要性.     

甲状旁腺切除术对维持性血液透析病人生活质量的影响

[目的]探讨甲状旁腺切除术对维持性血液透析病人生活质量的影响。[方法]选取23例维持性血液透析并继发性甲状旁腺功能亢进病人,采用医疗结局研究量表健康调查简表(MOS SF-36)测评甲状旁腺切除手术前及术后1年尿毒症合并甲状旁腺功能亢进病人生活质量,并对手术前后血钙、磷及血免疫反应甲状旁腺激素(iPTH)进行检测。[结果]术后1年病人血钙、血磷及iPTH等指标与术前比较明显下降(P0.05),病人骨痛情况改善;SF-36各维度评分与术前比较差异均有统计学意义(P0.05)。[结论]甲状旁腺切除术有助于改善尿毒症合并甲状旁腺功能亢进行维持性血液透析病人的生活质量。     

超声引导下PTC针穿刺无水乙醇注射治疗继发性甲状旁腺功能亢进的临床观察

目的观察终末期肾衰竭患者继发性甲状旁腺功能亢进使用超声引导下PTC针穿刺无水乙醇注射治疗的疗效。方法选择28例维持性血液透析继发性甲状旁腺功能亢进(iPTH≥44 pmol/mL)的患者,在超声引导下使用PTC针进行甲状旁腺穿刺,无水乙醇注射治疗,观察注射前后iPTH、碱性磷酸酶、血清钙、磷及多普勒超声甲状旁腺血流的变化。结果 PEITP治疗前后对比iPTH明显下降,皮肤瘙痒明显缓解,骨关节痛减轻,甲状旁腺增生腺体的血流明显减少。有明显统计学差异。结论 PEITP技术目前在开展甲状旁腺切除(PTX)条件不够的单位依然是治疗难治性SHPT的有效方法。     

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.