糖尿病人血液流变学及凝血四项检测的临床意义

目的探讨糖尿病患者血液流变学及凝血四项指标的变化与其并发血管性疾病的关系。方法用LG-R-80自动冲洗血液粘度测试仪测定糖尿病病人与正常人的血液流变学指标及用PK-A(Ⅰ)血凝仪联合检测糖尿病病人与正常人的PT、 APTT、TT、FIB含量,进行统计学处理。结果糖尿病患者的血液流变学指标与正常对照组存在显著差异(P<0．05),其中全血高、低切粘度和血浆粘度这三项指标差异显著(P<0．01);糖尿病患者的凝血四项指标与对照组比较,糖尿病组与正常对照组的PT、APTT都具有显著性差异(P<0．05),FIB差异显著(P<0．01)。结论通过观察糖尿病病人的血液流变学及凝血四项指标的变化有利于控制糖尿病血管性病变的发生发展。     

原发性青光眼患者血液流变学和血浆中内皮素-1的变化及意义

目的：探讨原发性青光眼患者血液流变学指标和血浆中内皮素-1（ET-1）的变化及意义。方法选择84例原发性青光眼患者,根据损伤较严重眼的视野结果分为轻度视野受损组（A 组）、中度视野受损组（B 组）、重度视野受损组（C 组）,同时选择28例老年白内障患者作为对照组（D 组）,比较四组患者的血液流变学指标和 ET-1水平。结果A、B、C 3组患者的血液流变学指标和 ET-1水平均明显高于 D 组（P ＜0．05）。A1、B1、C13组的全血粘度及 ET-1水平均明显高于 A2、B2、C2（P ＜0．05）。A1、B1、C13组的血浆粘度、红细胞压积、纤维蛋白原水平虽然高于 A2、B2、C2,但差异无统计学意义（P ＞0．05）。结论原发性青光眼患者血液流变学指标水平的改变影响了视神经血液供应,而 ET-1水平的增高参与了血管功能失调过程,两者均为原发性青光眼的重要发病机制。     

不同糖化血红蛋白水平的2型糖尿病患者血液流变学检测分析

目的分析糖化血红蛋白（GHbAlc）控制在不同水平的2型糖尿病患者血液流变学的特点,为其治疗及预防提供参考依据。方法选取2型糖尿病病例113例,按GHbAlC不同水平分为：A组（33例,控制良好）、B组（40例,控制一般）、C组（40例,控制不佳）。同时随机抽取健康体检者40例作为对照（D组）。分别检测GHbAlC、血液流变学及生化指标,并进行分析对比。结果单因素方差分析显示,血流变相关指标除血细胞比容在四组之间无统计学意义外（F=0．08,P=0．970）,其他指标在四组之间均存在统计学差异（P〈0．05）;采用LSD-t检验方法分析结果：血流变指标除血细胞比容外A、B、c组均明显高于D组（P〈0．05）;采用sN-K检验方法进行组闯分析：除全血高切、中切黏度、血沉方程K值A、C组比较,差异无统计学意义（P〉0．05）;血浆黏度、RBC刚性指数A、D组间比较,差异无统计学意义（P〉0．05）;RBC变形指数及三酰甘油B、C组间比较,差异无统计学意义（P〉0．05）,余下各指标不同组之间的比较差异均有统计学意义（P〈0．05）。结论2型糖尿病患者存在血液流变学指标异常,不同GHbAlc水平下血液流变学指标有差异。     

抗磷脂抗体阳性先兆流产孕妇的血液流变学变化及临床意义

【目的】探讨抗磷脂抗体（APL）阳性的先兆流产孕妇的血液流变学变化。【方法】选择APL阳性的先兆流产孕妇102例,其中54例既往无不良孕产史者为A组,48例有不良孕产史的抗磷脂综合征（APS）患者为B组。另选择50例APL阴性的正常孕妇为对照组（C组）。用血液粘度仪及动态血沉／压积测试仪测定三组孕妇的血液流变学指标。【结果]B组的全血粘度（Nb）包括高切及低切浓度、血浆粘度（Np）、红细胞压积（HCT）、红细胞聚集指数（VAI）和红细胞刚性指数（IR）均高于A、C两组,而红细胞变形指数（DI）低于A、C两组,差异比较均有统计学意义（P〈0．05）。A组的全血高切及低切粘度高于c组,差异有统计学意义（P〈0．05）,其他血液流变学指标A、C两组比较无统计学意义（P〉0．05）。【结论】APL阳性先兆流产孕妇的血液粘度增高,其中APS孕妇的红细胞聚集性增加和变形能力减弱,可能与自然流产、死胎等不良妊娠结局相关。在APL阳性的先兆流产孕妇中常规进行血液流变学指标检测有助于预测妊娠并发症并予早期治疗。     

低分子肝素治疗短暂性脑缺血发作的疗效观察

目的　探讨凝血酶抑制剂低分子肝素治疗短暂性脑缺血发作患者的血液流变学及部分实验室指标改变及其临床意义。方法　将符合诊断标准的患者随机分为治疗组(A组)19 例,对照组(B组)20 例,检测两组的血液流变学变化及部分实验室指标,并将结果加以比较。结果　A组治疗前后全血粘度,血浆粘度,还原粘度及红细胞聚集指数均降低(P<0 .05),两组间治疗后比较差异有显著性(P<0. 05),实验室检查指标KPTT、PLT、BT、CT、AST、LDH、Cr均无显著变化(P>0. 05),两组间比较差异无显著性(P>0 .05)。结论　TIA的血粘度增高是微血栓形成的重要影响因素。     

妊娠高血压综合征患者血液流变学指标的变化及分析

目的探讨妊娠高血压综合综合征患者血液流变学指标的变化及其临床意义。方法测定50例正常妊娠妇女及 85例妊高征患者(其中轻度妊高征27例,中度28例,重度30例)全血高低切粘度、血浆粘度、高低切还原粘度、红细胞压积、红细胞变形指数、红细胞电泳时间及纤维蛋白原、白蛋白和总蛋白含量等指标并进行比较。结果与正常妊娠组比较,妊高征组中上述血液流变学指标存在明显异常,差异有显著性(P<0．05-0．01);妊高征患者随病情的进展上述指标变化更趋明显,差异有显著性(P<0．05-0．01);而且上述指标在治疗后有明显改善,差异较治疗前亦有显著性(P<0．05-0．01)。结论妊高征患者血液流变性的特点表现为血液浓稠,粘滞性增高,红细胞变形能力降低,聚集性增强,血浆纤维蛋白原含量增加,白蛋白和总蛋白含量降低。为妊高征的诊断、治疗、疗效及预后判定提供了理论依据。     

三种胃管置入方法临床应用的效果比较

目的探讨三种胃管置入方法的临床应用效果。方法分别对传统法(A组)、沙氏导丝内置法(B组)、鼻咽部麻醉联合沙氏导丝内置法(C组)置入胃管的清醒病人的一次性置管成功率、平均置管时间、病人准备时间、恶心呕吐发生率及咽喉不适反应发生率进行比较。结果三组病人中,B、C组一次性置管成功率均为100%,明显高于A组(76·7%);B、C组平均置管时间较A组短,差异有显著性意义(P<0·05);但C组病人准备时间较A、B组长;A组恶心呕吐严重程度发生率较B、C组高,差异有显著性意义(P<0·05);A、B组病人咽喉不适反应发生率无明显差异(P>0·05),C组为43·3%,明显低于A、B组(P<0·05)。结论沙氏导丝内置法与鼻咽部麻醉联合沙氏导丝内置法均能显著提高胃管置入的成功率,沙氏导丝内置法操作简便易行,鼻咽部麻醉联合沙氏导丝内置法能明显减轻病人的痛苦。     

冠心病患者血清促红细胞生成素与血液流变学及血细胞参数的关系

目的：探讨冠心病患者促红细胞生成素(Erythropoietin，Epo)与血液流变学指标及血细胞参数之间的关系，为临床康复干预措施的实施提供理论依据。方法：选取急性心肌梗死29例，不稳定心绞痛37例共66例冠心病患者进行血液流变学和血细胞参数及血清Epo含量检测并与正常对照组进行比较。结果：患者组血液流变学指标、血红蛋白浓度、白细胞计数、红细胞计数及血清Epo显著高于对照组(P=0．05～0．01)，平均红细胞体积和平均血红蛋白含量显著低于对照组(P=0．05～0．01)，平均红细胞血红蛋白浓度与对照组比较差异无显著性意义(P&;gt;0．05)。结论：血液流变学及血细胞参数异常与冠心病的发生有关，而Epo的增高极有可能是导致细胞参数异常进而促使血液流变学异常的直接原因。     

清热解毒凉血化瘀治疗温病湿热证的实验研究

目的 :探讨清热解毒、凉血化瘀对温病湿热证的作用 ,并从微观角度探讨温病湿热证血瘀的客观性。方法 :采用复合因素复制新西兰兔温病湿热证模型 ,设立黄连解毒汤组 (A组 ) ,黄连解毒汤加丹参、赤芍组(B组 ) ,王氏连朴饮组 (C组 ) ,王氏连朴饮加丹参、赤芍组 (D组 ) ,湿热证模型组和正常对照组 ,观察各组症状及体温变化 ,同时检测血浆内毒素 (ET)、肿瘤坏死因子 (TNF)、白介素 1(IL 1)、血液流变学、血小板、凝血功能、血栓素 B2 (TXB2 )、6酮前列腺素 F1α(6 keto PGF1α)等指标变化。结果 :药物 B组症状表现较轻 ;药物A组和 B组体温升高较小。药物治疗各组 ET、TNF和 IL 1均较模型组显著降低 (P<0 .0 5或 P<0 .0 1) ,A组和 B组 ET、IL 1的含量均低于 C组 (P均 <0 .0 5 )。湿热模型组血液流变学各参数、血小板计数及聚集率、凝血指标、TXB2 、6 keto PGF1α与正常对照组比较均有显著性差异 (P均 <0 .0 1)。药物 B组和 D组改善上述指标效果较好 ,优于 A组和 C组 (P<0 .0 5或 P<0 .0 1)。结论 :清热解毒对于温病湿热证具有较好的治疗作用。温病湿热证存在传统四诊不易察觉的微观血瘀 ,治疗时加入凉血化瘀之品 ,可获佳效。     

回收式自体输血对骨科患者血液流变学和免疫功能的影响

目的评估回收式自体输血对骨科患者血液流变学和免疫功能的影响及相应护理干预的效果。方法选择骨科就诊的患者67例,分为异体输血组（A组）和自体输血组（B组）,分别为31例和36例。A组采用异体输血并常规护理,B组采用回收式自体输血加用预见性护理。输血前及输血后分别检查两组患者的血液流变学、免疫功能及护理效果。结果两组输血后红细胞计数、血细胞比客较输血前明显下降,差异有统计学意义（P〈0．05）。比较输血后红细胞聚集性、红细胞刚性,两组输血后与输血前差异均无统计学意义（P〉0．05）,但B组红细胞聚集性较A组表现出下降趋势。A组异体输血后CD4＋、cD4＋／CD8＋、NK细胞较术前明显下降,差异有统计学意义（P〈0．05）,CD8＋较输血前明显增加,差异有统计学意义（P〈0．05）。B组输血后与输血前无明显变化,差异无统计学意义（P〉0．05）。比较两组输血后免疫功能变化,B组CD4＋、CD4＋／CD8＋、NK细胞较A组明显增高（P〈0．05）,CD8＋明显下降,差异有统计学意义（P〈0．05）。B组采用循证护理及预见性护理后,术后并发症发生率明显降低,两组发生率差异有统计学意义（P〈0．05）。结论回收式自体输血可维持血液流变学的稳定并维持正常免疫功能,配合预见性护理可减少并发症的发生。     

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.