变速变负荷运动训练联合玻璃酸钠治疗膝关节骨性关节炎的成本-效果研究

目的:探讨变速变负荷(VVR)运动训练联合玻璃酸钠(SH)治疗膝关节骨性关节炎(OA)患者的成本-效果。方法:90例OA患者随机分为3组各30例,观察组膝关节SH注射和变速变负荷(VVR)下肢肌力测定训练系统进行膝关节运动训练;理疗组膝关节给予石蜡疗法、脉冲磁场、药物离子导入及高频电微波治疗;对照组仅行膝关节SH注射治疗。治疗前后分别采集3组患者康复介入时至康复治疗5周后的直接医疗费用,以及各费用的详细构成。结果:治疗5周后,疼痛目测类比评分法(VAS)评分,3组与治疗前比较均下降;Lysholm膝关节功能量表(LKSS)和VVR下肢肌力评定均有提高,与理疗组和对照组比较,观察组表现更突出(P0.05),理疗组与对照组比较差异无统计学意义。观察组治疗后各项指标每改善1分所耗费的相关成本费用明显低于理疗组和对照组(P0.05)。结论:应用VVR运动训练联合SH局部注射治疗OA是经济、有效的治疗方案。     

运动训练结合玻璃酸钠治疗膝关节骨性关节炎患者关节功能改善分析

目的：评价膝关节功能训练联合玻璃酸钠注射液（施沛特）对膝关节骨性关节炎患者关节功能改善的状况。方法：选择92例膝关节骨性关节炎患者,随机分为2组,一组接受玻璃酸钠注射液膝关节内注射治疗,每周1次,连续5次为1疗程。另一组同样完成1疗程的玻璃酸钠注射液膝关节内注射治疗,但在完成第2次玻璃酸钠注射液关节内注射时开始膝关节功能训练,功能训练持续6个月,评价两组患者膝关节功能改善的差异。结果：膝关节内注射玻璃酸钠注射液联合膝关节功能训练组在改善膝关节功能方面优于单纯膝关节内注射玻璃酸钠注射液组。结论：膝关节内注射玻璃酸钠注射液联合膝关节功能训练能够对膝关节骨性关节炎起到温和持久的关节功能改善作用。     

腓骨沉降术配合玻璃酸钠关节腔注射对膝关节内侧间室骨性关节炎的临床研究

【】 目的：研究腓骨沉降术配合玻璃酸钠关节腔注射对膝关节内侧间室骨性关节炎的临床疗效。方法：将40例膝关节内侧间室骨性关节炎的患者随机分为两组,实验组(腓骨沉降术配合玻璃酸钠关节腔注射组)20例,对照组(玻璃酸钠关节腔注射组)20例,比较实验组和对照组在治疗后1周、2周、3周的视觉模拟疼痛评分变化(visual analog scale,VAS)、膝关节活动度(range of motion ,ROM)。结果：实验组患者在治疗后1周、2周、3周的VAS评分和对照组比较差异具有统计学意义(P ＜ 0．05);实验组患者在治疗后1周、2周、3周的ROM与对照组比较差异有统计学意义(P ＜ 0．05)。结论：腓骨沉降术配合玻璃酸钠关节腔注射对膝关节内侧间室骨性关节炎的临床疗效优于玻璃酸钠关节腔注射。     

玻璃酸钠关节腔内注射在治疗膝关节骨性关节炎中的临床应用

目的探讨玻璃酸钠关节腔内注射在治疗膝关节骨性关节炎中的临床应用价值。方法将166例膝关节骨性关节炎患者随机分为研究组86例和对照组80例。研究组患者近1周内未服用任何消炎止痛药物及激素等对骨关节炎有治疗作用的药物,能够接受玻璃酸钠关节腔内注射的研究方案而不配合其他治疗;而对照组患者给予理疗、关节功能保护及口服非甾体类抗炎药等。治疗3个月后,采用日本整形外科学会的《膝关节功能评定表》对两组患者膝关节功能进行评测,统计两组患者的疗效情况,并进行比较。结果研究组患者膝关节功能综合评分明显高于对照组;研究组疗效优良的百分率为87.21%,而对照组疗效优良的百分率为67.50%,两组比较,差异均有非常显著性意义(P0.01)。结论两种治疗方法对膝关节骨性关节炎疼痛均有缓解效果,但玻璃酸钠关节腔内注射的镇痛效果更持久,疗效更佳,更能明显地改善膝关节功能。     

腓骨沉降术配合玻璃酸钠关节腔注射治疗膝关节内侧间室骨性关节炎的临床研究

目的:研究腓骨沉降术配合玻璃酸钠关节腔注射治疗膝关节内侧间室骨性关节炎的临床疗效。方法:将40例膝关节内侧间室骨性关节炎的患者随机分为两组:实验组(腓骨沉降术配合玻璃酸钠关节腔注射组)20例和对照组(玻璃酸钠关节腔注射组)20例,比较两组在治疗1周、2周、3周后的视觉模拟疼痛评分变化(VAS)、膝关节活动度(ROM)。结果:实验组在治疗1周、2周、3周后的VAS评分和ROM与对照组比较,差异均具有统计学意义,P0.05。结论:腓骨沉降术配合玻璃酸钠关节腔注射治疗膝关节内侧间室骨性关节炎的临床疗效优于玻璃酸钠关节腔注射,值得临床推广应用。     

中药药熨结合玻璃酸钠治疗膝关节骨性关节炎的观察与护理

目的：探讨中药药熨疗法治疗膝关节骨性关节炎的临床疗效。方法：随机将122例膝关节骨性关节炎患者分为观察组（62例）和对照组（60例）,观察组采用中药药熨疗法和关节腔内注射玻璃酸钠;对照组用单纯关节腔内注射玻璃酸钠。结果：观察组的疗效优于对照组。结论：中药药熨结合玻璃酸钠治疗膝关节骨性关节炎有较好的临床疗效。     

中西医结合治疗膝关节骨性关节炎73例疗效观察

目的为探讨中药内服、熏洗配合玻璃酸钠关节内注射治疗膝关节骨性关节炎的临床疗效。方法将73例膝关节骨性关节炎患者分为两组：治疗组（补益肝肾中药内服、通经活络洗方熏洗配合玻璃酸钠关节内注射）43例,对照组（玻璃酸钠关节内注射）30例,分别观察并比较其临床疗效和改善关节功能的疗效。结果显示治疗组临床疗效及镇痛和改善关节功能的效果均优于对照组（JP〈0．05）。结论表明中药内服外洗配合玻璃酸钠关节内注射治疗膝关节骨性关节炎,具有较好的临床疗效及缓解疼痛和改善关节功能的作用。     

熏洗方联合玻璃酸钠关节腔内注射治疗膝骨性关节炎临床疗效观察

目的:观察熏洗方联合玻璃酸钠注射治疗膝骨性关节炎的临床疗效。方法:选取轻中度膝骨性关节炎患者60例,随机分为实验组和对照组各30例。实验组采用名老中医丁锷的经验方熏洗方外用联合玻璃酸钠注射液关节腔内注射治疗,对照组30例采用单纯玻璃酸钠注射液关节腔注射治疗,5周为1个疗程。通过观察2组患者膝关节治疗前后的疼痛视觉模拟评分(VAS)、Lysholm评分变化及临床疗效。结果:实验组治疗后的VAS评分显著低于对照组,Lysholm评分显著高于对照组;实验组的有效率显著高于对照组,差异有统计学意义。结论:熏洗方可以显著改善膝骨性关节炎患者的临床症状,提高患者生活质量,改善患者膝关节功能,值得临床推广使用。     

丹参注射液联合玻璃酸钠腔内注射治疗膝骨性关节炎

目的:观察丹参注射液联合玻璃酸钠腔内注射治疗膝骨性关节炎的疗效。方法:选取我院收治的120例膝骨性关节炎患者为研究对象,随机分为研究组和对照组各60例。研究组给予丹参注射液+玻璃酸钠注射液治疗,对照组给予玻璃酸钠注射液治疗,观察两组临床治疗优良率,比较两组治疗前及随访1年后膝关节功能、生活质量。结果:研究组临床治疗优良率高于对照组(P<0.05);治疗前两组膝关节功能及生活质量比较无明显差异(P>0.05),治疗后两组均有所改善,且研究组改善程度优于对照组(P<0.05)。结论:丹参注射液联合玻璃酸钠腔内注射治疗膝骨性关节炎疗效显著,可有效改善患者生活质量,促进早期恢复,预后良好。     

电针结合玻璃酸钠关节内注射治疗膝骨性关节炎

目的探讨电针结合玻璃酸钠关节内注射治疗膝骨性关节炎的临床疗效。方法将确诊患者随机分为治疗组55例和对照组54例。前者接受电针结合玻璃酸钠关节内注射综合疗法,后者仅行玻璃酸钠关节内注射治疗。治疗前、后分别测定膝关节运动功能,计算治疗有效率并对生活质量进行评估。结果治疗后,两组膝关节运动功能评分均显著提高,治疗组高于对照组(P<0.001)。治疗后5周,治疗组的有效率高于对照组(P<0.05),两组患者的生活质量均显著改善(P<0.001)。其中,治疗组的生活质量明显优于对照组(P<0.001)。结论电针配合玻璃酸钠关节内注射是一种治疗膝骨性关节炎的有效方法。     

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.     

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.