Factors causing differences in voiding parameters between conventional and ambulatory urodynamics

Voiding parameter values measured with ambulatory urodynamic monitoring (AM) are generally found to be different from those measured with conventional cystometry (CMG). The reason for this is unclear, but might be related to differences in the voided volume. To verify this hypothesis, we compared voidings from female patients at an initial bladder volume that was close to the modal volume (that is, the volume most often voided by the patient as derived from frequency/volume charts) with voidings at maximum cystometric capacity during a routine video urodynamic examination. A first group of 35 patients voided at the modal volume before they did at capacity. The order was reversed in a second group of 12 patients. The dependence of the voiding parameters on the voided volume and the order of the measurements were examined. It was found that the maximum flow rate depended significantly on the voided volume, but the associated detrusor pressure did not. Urethral resistance and bladder contraction strength were not volume dependent either. It was concluded that the differences between AM and CMG cannot be explained from possible differences in the voided volume. Received: 23 August 1999 / Accepted: 16 December 1999     

Infection control and paediatric tuberculosis: A practical guide for the practicing paediatrician

Tuberculosis (TB) in children requires close attention to infection control to prevent transmission to other patients and health care workers. Although many children with TB are not infectious, appropriate airborne precautions must be maintained until conditions that increase the risk of transmission have been ruled out and accompanying adults, who may also be infectious, have been screened. Concurrent strategies to prevent TB transmission should be implemented, including administrative, engineering and personal protective measures. The most important measure is maintaining a high clinical index of suspicion for TB in patients with compatible symptoms and epidemiological risk factors. Comprehensive tuberculin skin test programmes and the use of N 95 masks can reduce the risk of transmission within health care settings. Current standards of practice should be followed to prevent transmission from patients with active TB disease.     

脑卒中急性期血压变化规律

目的:探讨脑卒中急性期血压变化规律。方法:对108例脑卒中患者在发病48h内进行动态血压监测,分析24h总血压负荷及血压昼夜节律等参数;且对所有患者进行连续7d的血压测量。结果:脑卒中患者急性期(尤其在发病48h内)血压处于较高水平,血压昼夜节律减弱或消失,89%的患者血压两周内降至正常或发病前水平。结论:脑卒中急性期血压存在先升后降的变化规律,降压药物的使用应该慎重。     

可行走分娩镇痛应用于潜伏期的临床研究

目的评价可行走分娩镇痛在潜伏期应用的临床效果。研究宫口开张不同大小应用分娩镇痛后的产程进展，对子宫收缩力的影响及新生儿Apgar评分情况。方法确认已临产无内科合并症的初产妇共75例，随机分为三组。Ⅰ组：宫口开张1cm左右；组：宫口开张2～3cm；Ⅲ组为正常对照组未采用分娩镇痛。观察镇痛起效时间、子宫收缩力的变化、总产程、产后出血量、分娩结局及新生儿Apgar评分。结果Ⅰ组与Ⅲ组比较总产程差异无统计学意义。Ⅰ组与Ⅱ组第一产程比较时间延长，差异有统计学意义（P〈0．05），Ⅱ组与Ⅲ组比较子宫收缩力无明显降低，第一产程中Ⅰ组与Ⅲ组比较子宫收缩力显著降低，P（0．05，Ⅰ组催产素使用率为100％。三组间产后出血、新生儿Apgar评分各组间差异无统计学意义。结论舒芬太尼合并低浓度的罗哌卡因引导下无痛分娩，从潜伏期应用，有明显的分娩镇痛作用，不增加产后出血量，对新生儿的Apgar评分无影响。     

治疗前动态血压监测对高血压病患者左室重塑类型的预测

目的:探讨原发性高血压(EH)患者动态血压对左室重塑类型的预测价值。方法:84名EH患者按动态血压值分为两组,分别进行心脏超声检测,比较左室重量指数(LVMI)及左室重塑的特点。结果:平均血压值较高的B组LVMI、左室肥厚与向心性肥厚的发生率均高于平均血压值低的A组(均P<0.01),正常构型发生率低于A组(P=0.01)。LVMI与平均收缩压、平均舒张压均呈显著的正相关关系(均P<0.05)。结论:动态血压值高的EH患者LVMI较大,左室肥厚与向心性肥厚的发生率较高。动态血压对EH患者左室重塑的类型有强烈的预测价值。     

老年高血压患者血压昼夜节律对左室肥厚的影响

【摘要】 目的 研究老年高血压患者的血压昼夜节律变化对左室肥厚的影响。方法 选取我院126例高血压患者,根据心脏彩超提示左室肥厚情况分为肥厚组（n=52例）和非肥厚组（n=74例）。比较两组动态血压指标及血压变异性,进行多因素分析探讨血压变异性对左室肥厚的影响。 结果 高血压肥厚组24h平均收缩压（24hSBP）、白天平均收缩压（dSBP）、夜间平均收缩压（nSBP）、24h收缩压标准差（24hSSD）、24h舒张压标准差（24hDSD）、白天收缩压标准差（dSSD）、夜间收缩压标准差（nSSD）均高于非肥厚组,差异有统计学意义（P＜005）。Logistic回归分析显示,24h SBP 与dSSD、nSSD为左室肥厚的独立危险因素（P＜005）。结论 老年高血压患者的24h SBP 与dSSD、nSSD是影响左室肥厚的独立危险因素,平稳控制血压对防止左室肥厚的发生有一定影响。     

Daytime Ambulatory Blood Pressure Correlates Strongly with the Echocardiographic Diameter of Aortic Coarctation

Objective - To relate the echocardiographic aortic arch-diameter to ambulatory and clinic blood pressure (BP) in patients with aortic coarctation. Design - Eighteen adult patients (50% men) were recruited from the coarctation registry of the Linkoping Heart Centre. Biplane-trans-oesophageal echocardiography (TEE) was performed with Acuson XP 128/10, ambulatory BP was recorded with Spacelab models 90202/90205. Results - Systolic clinic and ambulatory BP levels were higher in patients than in the 36 controls (clinic BP: 146 &#45 25 mmHg vs 119 &#45 10 mmHg, p = 0.0009, ambulatory BP: 140 &#45 18 mmHg vs 124 &#45 11 mmHg, p = 0.009). The differences in diastolic BP levels were less obvious (clinic BP: 87 &#45 16 mmHg vs 76 &#45 8 mmHg, p = 0.02, ambulatory BP: 84 &#45 13 mmHg vs 77 &#45 9 mmHg, p = 0.052). Daytime ambulatory BP was more strongly related than clinic BP to the coarctation diameter (AD) (systolic BP r = -0.73, p = 0.0006 and r = -0.61, p = 0.007, respectively). In surgically corrected patients ( n = 14) only the correlations between ambulatory systolic daytime ( r = -0.61, p = 0.02) and night-time ( r = -0.58, p = 0.03) BP to AD was statistically significant. Conclusion - Ambulatory BP correlates strongly with aortic coarctation measured by TEE and would thus be the preferred technique for evaluating BP in this patient category.