溶血剂对白细胞形态的影响

探讨血细胞计数仪溶血剂对白细胞形态的影响。使用透射电子微镜观察加入溶血剂３０秒时白细胞的形态改变。中性粒细胞体积较正常粒细胞大，细胞轻度变形，细胞膜“增厚”疏松，并明显分为三层。此外，膜表面尚有一电子密度增大的环。部分膜内陷，层次模糊，有缺口。在血细胞计数仪上观察，溶血剂的浓度和溶血时间对ＷＢＣ分类和直方图有明显影响。     

溶血剂对白细胞形态的影响及作用机理初探

溶血剂是血细胞计数仪试剂中的主要试剂。它能将红细胞膜溶解，并能使WBC的体积发生规律性变化．从而使WBC分类成为可能。然而．有关溶血剂对血细胞的作用机制．至今仍研究甚少，还未形成一套完整的解释。我们从血细胞的超微结构和仪器分析等方面，研究了溶血剂对血细胞的作用，探讨了溶血剂的作用机理。     

溶血时间对白细胞分类计数的影响

F-820血液分析仪（CBC）是一种较为新颖的计数仪，其结构紧凑，使用方便，可检测17个项目。对白细胞可作三分类，分别为WS％（小型细胞也即淋巴细胞）、WM％（中型细胞也即单核细胞），WL％（大型细胞也即粒细胞）。使用过程中，笔者发现溶血剂的用量、溶血温度和溶血时间三者对白细胞分类都有影响。为此，笔者就溶血时间对白细胞分类的影响作了如下试验。现将结果报告如下：1.材料与方法1.1血样：随机抽取37份非血液病病人静脉血，用EDTA-Na2抗凝。1.2仪器：F-820血球计数仪，日本东亚产品。配套试剂中国代理商浙江杭州华邦公司提供…     

血细胞计数仪白细胞分类与手工分类的比较

血细胞计数仪白细胞分类与手工分类的比较王虹，王正，袁慧茹，秦晓光笔者采用美国雅培公司ＣＤ－１６００型血细胞计数仪对２７０名住院病人进行粒细胞、淋巴细胞、中间型（Ｍｉｄｄｌｅ）细胞三项分类与手工分类比较。将仪器分类过程中有报警与无报警的分别与手工分类进...     

介绍一种快速稳定的溶血剂

近年来,随着血细胞计数仪的不断更新,许多血细胞计数仪都能用一份标本同时计数白细胞和血红蛋白。因此,对溶血剂的要求越来越高,它既要保证白细胞的完整性,又要完全破坏红细胞。十六烷基三甲基溴化胺不但满足上述条件,而且溶血时间短。现已广泛用于各医院的实验室。但因配方不统一,溶血效果及计数     

溶血剂用量对自动白细胞分类计数的影响

探讨了溶血剂用量对Ｈｅｍａｌａｓｅｒ３血液分析仪白细胞分类计数的影响，随着溶血剂用量的增加，白细胞总数和血红蛋白测定值基本保持恒定，但白细胞三分类结果发生明显改变，淋巴细胞和中间细胞分别升高１４．６％和２３３．３％，粒细胞降低２４．９％，结果表明，调整溶血剂用量是校正仪器白细胞分类计数结果的一种有效方法。     

使用全自动血细胞计数仪时中值细胞变化的初探

全自动血细胞计数仪的广泛应用，给临床诊断治疗提供了更多的参考，同时解放了检验人员的劳动力。2a来我科在使用美国产CD-1800三分类15项全自动血细胞计数仪进行常规检测中，WBC（白细胞）分类中包括（Mid）中值细胞、（Gran）中性粒细胞、（Lymph）淋巴细胞，本文对Mid变化进行初步探讨。     

ABX MICROS-60型血细胞分析仪白细胞分类异常原因分析与处理

ABX M ICROS-60型血细胞分析仪具有测定参数多,分析速度快,结果准确,重复性好,性能相对稳定等优点。但在细胞分类方面存在一些问题,现将我科几年来使用中的体会综合如下,供同行参考。1分类系统存在问题该分析仪是从细胞体积,细胞核特征,颗粒等性能方面综合分析进行细胞分类,在此分类系统中,造成白细胞不分类或分类异常的原因有以下几个方面:1.1试剂温度说明书中要求18℃~22℃,但实践证明最佳温度20℃左右,由于此温度下溶血剂中的表面活性剂与细胞膜脂质作用,破坏膜的双层脂质结构,使两层脂质之间距离加大,结构疏松,肿胀,脂质层断裂,在细…     

血细胞分析中存在问题与建议

近些年来，血细胞分析仪技术进展迅速，血细胞计数仪在不经意间被称为血细胞分析仪。白细胞由最初的白细胞计数，逐步发展为两分类、三分类直至五分类。分析指标越来越多，实验室人员过分依赖分析仪而忽视显微镜形态检查越来越严重，给临床造成严重的漏诊误诊。在这里笔者对这一现象做一分析并提出解决方案。     

异常红细胞形态的鉴定方法和临床意义

血细胞形态学的确立是随着显微镜的发明和细胞染色技术的不断完善而发展的。末稍静脉血的血液细胞学检查，随着全自动血细胞计数仪和自动白细胞分类机能特别是白细胞5分类仪器异常白细胞检出率大大提高，有些已可以代替人工显微镜目视法。但是红细胞形态是否异常通过自动分析仪的电流阻抗和流式细胞仪分析就不十分敏感。现阶段还主要靠人工经过染色通过显微镜观察诊断。     

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.     

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.     

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.     

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.