郴州地区住院新生儿高胆红素血症临床特点及病因构成分析

目的：分析郴州地区住院新生儿高胆红素血症的临床特点及病因构成。方法选取2012年1~12月该院新生儿高胆素血症患儿534例,收集一般临床资料,检测总胆红素水平、人巨细胞病毒(HCMV)基因、6-磷酸葡萄糖脱氢酶(G-6PD)的酶活性,筛查新生儿溶血病,并进行统计分析。结果新生儿高胆素血症患儿中 G-6PD 酶缺乏症患儿43例,占8.0%;ABO 溶血病患儿98例,占18.4%;HCMV 感染患儿153例,占28.6%;细菌感染患儿149例,占27.9%。结论该地区新生儿高胆红素血症患儿病因以感染性因素为主,加强患儿胆红素水平监测,并对检验结果和病因进行分析,可有效预防和降低高胆红素血症对新生儿的损害。     

新生儿重度高胆红素血症病因及预后分析

目的探讨新生儿重度高胆红素血症的病因及近远期预后。方法对2008年6月至2012年6月在本院治疗的132例重度高胆红素血症患儿(总胆红素>342μmol/L)进行临床资料回顾性分析,通过随访1⁵年后患儿听力、智力、神经系统发育情况,了解重度高胆红素血症的病因及近远期预后。结果感染占新生儿重度高胆红素血症病因的第一位(38.64%),其次是不明原因黄疸(31.06%)和新生儿溶血病(21.21%);132例患儿出院时,127例治愈,3例好转,2例死亡。经15年后患儿听力、智力、神经系统发育情况,了解重度高胆红素血症的病因及近远期预后。结果感染占新生儿重度高胆红素血症病因的第一位(38.64%),其次是不明原因黄疸(31.06%)和新生儿溶血病(21.21%);132例患儿出院时,127例治愈,3例好转,2例死亡。经1⁵年后随访96例患儿,8例有听力损害,2例有神经系统改变,4例有不同程度智力损害,其他患儿预后良好。且其预后与血清胆红素峰值无显著相关性。结论感染为该地区新生儿重度高胆红素血症病因的第一位;胆红素对脑干听觉通路的毒性作用可能是暂时的,若治疗及时,后期可恢复;对新生儿重度高胆红素血症,单凭血清胆红素峰值并不能确切预测远期预后,及早发现和治疗,其近远期预后良好。     

新生儿高胆红素血症150例临床分析

目的探讨新生儿高胆红素血症的病因及相关因素,提高对新生儿高胆红素血症高危因素的认识,为临床提供早诊断早治疗的依据。方法对150例住院的新生儿高胆红素血症患儿临床资料进行分析。结果新生儿高胆红素血症的病因以围产因素为主,占43．3％,葡萄糖-6磷酸脱氢酶（G-6PD）缺乏占18．0％,ABO溶血病占15．3％,感染占14．0％,原因不明占9．4％。其中发病日龄在生后7d内占84．7％。结论加强围产期保健是防治高胆红素血症的关键;对高胆红素血症做出早期诊断,早期治疗,可减少胆红素脑病的发生。     

新生儿高未结合胆红素血症239例分析

目的：探讨包头地区新生儿高未结合胆红素血症的常见病因及临床特点,为预防该病提供依据。方法：对239例新生儿高未结合胆红素血症进行病因分析及临床特点分析。结果：高未结合胆红素血症病因依次为感染因素（26.4%）、围产因素（25.5%）、母乳性黄疸（22.6%）、其他因素（16.7%）、溶血因素（8.8%）。结论：感染因素为首位因素,其次为围产因素,所以预防和控制新生儿感染及强调围产期保健是降低新生儿高未结合胆红素血症发生率的重要途径。     

≥35周新生儿高胆红素血症96例分析

目的 探讨≥35周新生儿高胆红素血症的发病原因及其治疗方法.方法 回顾性分析湖北黄石爱康医院收治的96例≥35周的高胆红素血症患儿的相关临床资料,并且统计分析新生儿高胆红素血症的病因和探讨观察患儿的治疗效果.结果 除其他不明病因外,≥35周新生儿高胆红素血症的主要病因是:感染因素和围产因素.经过辩证施治后,患儿黄疸消退,血胆红素逐渐恢复正常.结论 临床应用蓝光照射和药物治疗等治疗方法治疗新生儿高胆红素血症效果显著.     

新生儿高胆红素血症病因及临床特点分析

目的:分析新生儿高胆红素血症病因及临床特点。方法:对我院74例新生儿高胆红素血症进行回顾性分析。结果:新生儿高胆红素血症病因主要为围产期因素、感染性病症因素、母乳性黄疸因素以及ABO溶血病因素,且新生儿年龄<7 d与≥7 d的高胆红素血症关联性比较,差异有统计学意义(P<0.05)。结论:医护工作人员应准确掌握新生儿高胆红素血症病因及临床特点,多关注新生儿围产期护理指导,尽可能早预防、早发现、早治疗,可有效降低和预防新生儿高胆红素血症的发生。     

新生儿高胆红素血症86例临床分析

目的 总结本地区新生儿高胆红素血症的病因组成及治疗时机等临床特点.方法 收集本院近期86例新生儿高胆红素血症患儿资料,采用回顾性调查方法加以分析.结果 本地区新生儿高胆红素血症病因以围产因素为主,其次为感染因素.结论 加强围产期保健、减少产科因素、积极防治新生儿感染可以降低新生儿高胆红素血症的发生率,减少伤残率.     

新生儿高胆红素血症临床危险因素分析

目的探讨新生儿高胆红素血症的病因及相关因素，为临床防治新生儿高胆红素血症及预后判断提供参考依据。方法回顾性分析922例本院新生儿病房住院的高胆红素血症患儿，要求足月儿为出生14d之内、早产儿为出生1个月之内，研究组为符合高胆红素血症的新生儿，对照组为生理性黄疸的新生儿。应用Logistic回归模型，对临床常见病因如感染、围产因素、早产、ABO或RH溶血等进行分析。结果感染是引起新生儿高胆红素血症的主要因素，其次是围产因素和早产。研究组和对照组比较，围产和早产因素差异有统计学意义。结论感染仍是城市郊区高胆红素血症患儿的主要因素，围产因素已日益成为高胆红素血症的主要发病病因。提高人们对围产期保健的认识，加强围产期监测、随访及宣教，是城市郊区医院产科及围产儿科医务人员的工作者重点。     

新生儿重度高胆红素血症1091例临床分析

【目的】探讨新生儿重度高胆红素血症的病因及胆红素脑病的发生情况。【方法】对2008年11月1日至2009年10月31日在本院住院的新生儿重度高胆红素血症1091例临床资料进行回顾性分析。【结果】原因不明黄疸占新生儿重度高胆红素血症病因的第一位（59．62％）,其次是新生儿溶血病（14．99%）和败血症（13．82％）;不同病因胆红素脑病的发生率差异无显著性（F=5．766,P=0．45）;胆红素脑病病因构成比中原因不明占57．650A;血清总胆红素超过599μmol／L,胆红素脑病的发生率显著增加。【结论】原因不明黄疸占新生儿重度高胆红素血症病因的第一位,原因不明的黄疸可能是重度高胆红素血症研究的重点;血清总胆红素超过599μmol／L时,建议积极换血治疗。     

480例新生儿病理性黄疸临床病因分析

新生儿病理性黄疸是新生儿期最常见的症状之一，可由多种不同病因引起，以黄疸为主诉者占本院新生儿科住院数的首位。现对480例新生儿高胆红素血症的病因及临床特点作一分析。报告如下。     

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.