术中保温对低体温创伤患者麻醉恢复期的影响

目的观察保温对低体温创伤手术患者麻醉恢复期的影响。方法选择创伤严重度评分介于16~40分之间,且肛温〈36℃需进行手术的创伤患者80例,随机分为保温组和对照组,每组40例。两组均在室温下手术,保温组采用各种措施保持肛温≥36℃,对照组体温未施加干预。记录两组气管拔管时间、苏醒时间、心律失常、寒战及躁动的发生情况。结果与对照组比较,保温组气管拔管时间、苏醒时间缩短（P〈0.01）,心律失常、寒战及躁动的发生率低（P〈0.05）。结论术中采取保温措施可以明显缩短低体温创伤患者麻醉恢复期,减少各种并发症的发生,使患者平稳度过麻醉恢复期。     

围术期心理支持疗法对气管插管全身麻醉患者苏醒期的影响

目的:观察围术期心理支持疗法对气管插管全身麻醉患者苏醒期的影响。方法:54例择期全身麻醉下行腹部手术的患者分为两组,对照组常规术前访视,观察组术前访视时接受围术期心理支持疗法。记录术毕、拔管时、拔管后5min的血压及心率、苏醒时间、躁动评分。结果:两组患者躁动评分比较,P<0.05;观察组苏醒时间短于对照组,但两组比较无明显统计学意义;两组患者拔管时、拔管后5min的血压、心率与术毕时相比均有升高,观察组升高的幅度低于对照组。结论:围术期心理支持疗法可明显降低气管插管全身麻醉患者苏醒期躁动的发生率,使循环相对平稳,但对苏醒时间无明显影响。     

老年人腹部手术术中保温对术后苏醒的影响及护理

目的观察术中保温对老年患者术后苏醒的影响。方法选择全麻开腹手术患者60例(美国麻醉医师协会的分级标准I~Ⅱ级),按照随机数字表法分为常规组和保温组各30例。常规组行常规护理,术中未采取任何保温措施;保温组术中注意保温,室内温度维持在23~28℃,使用Warm Touch TM充气式保温装置及电子液体加温仪,冲洗液用水温浴箱加温至37℃。比较两组患者术前、术中及术后血压、心率、体温的变化及拔管时间、清醒时间、寒战和躁动的发生率。结果(1)常规组患者术中及术后血压、心率、体温与术前相比均存在统计学差异,而保温组患者无明显变化;(2)与保温组患者相比,常规组患者术后血压升高、心率增快、苏醒延迟、寒战及躁动发生率高(P<0.05)。结论术中低体温可影响神经、内分泌和循环系统,延缓患者的术后恢复,增加不良反应发生率;术中应监测体温变化,对输液液体及冲洗液加温,下半身使用保温毯保暖,并保持手术间温度,以缩短患者术后苏醒时间,降低不良反应的发生率。     

不同保温措施对全身麻醉肺癌手术病人麻醉恢复期的影响

[目的]探讨不同保温措施对全身麻醉肺癌手术病人麻醉恢复期的影响。[方法]开胸手术病人80例,采用随机数字表法随机分为4组各20例,各组均在室温下进行手术,常温组(C组)不做特殊处理;电子液体加温组(L组)输液、输血采用电子液体加温仪保温;风热毯保温组(W组)采用风热毯覆盖非手术区,以鼓风机鼓43℃热风保温;综合组(B组)采用电子液体加温和风热毯机保温。观察各组病人血压、心电图、鼻咽温、尿量、引流量等的变化,并记录麻醉苏醒期血压异常、心律失常、苏醒延迟、寒战、躁动等发生情况。[结果]4组病人苏醒期并发症发生率比较有统计学意义(P<0.01或P<0.05),B组并发症发生率明显低于其他3组。[结论]肺癌手术病人采取综合保温措施可缩短麻醉恢复期,减少各种并发症的发生率。     

不同保温措施对全身麻醉肺癌手术病人麻醉恢复期的影响

[目的]探讨不同保温措施对全身麻醉肺癌手术病人麻醉恢复期的影响。[方法]开胸手术病人80例，采用随机数字表法随机分为4组各20例，各组均在室温下进行手术，常温组（C组）不做特殊处理；电子液体加温组（L组）输液、输血采用电子液体加温仪保温；风热毯保温组（W组）采用风热毯覆盖非手术区。以鼓风机鼓43℃热风保温；综合组（B组）采用电子液体加温和风热毯机保温。观察各组病人血压、心电图、鼻咽温、尿量、引流量等的变化，并记录麻醉苏醒期血压异常、心律失常、苏醒延迟、寒战、躁动等发生情况。[结果]4组病人苏醒期并发症发生率比较有统计学意义（P〈0．01或P〈0．05），B组并发症发生率明显低于其他3组。[结论]肺癌手术病人采取综合保温措施可缩短麻醉恢复期，减少各种并发症的发生率。     

围全麻期患者体温下降的原因分析及护理

目的探讨围全麻期患者体温下降的原因。方法选取90例全麻手术患者,随机分为对照组和试验组。对照组(n=45)术中室温22~24℃,不做保温处理;试验组(n=45)术中注意保暖,室温维持在24~26℃,输入的液体、冲洗液行加温处理。观察两组术前、术中、术后血压、心率、体温、复苏时间、尿量、引流量、寒颤和躁动发生率。结果与试验组相比,对照组患者血压正常、心率增快、苏醒延迟、引流量多、寒颤和躁动发生率高。结论术中进行体温监测,实施有效的保温措施,保持体温的恒定对手术的成功和病人的恢复至关重要。     

术中低体温对患者麻醉恢复期的影响及护理干预

目的 :观察术中低体温对患者麻醉恢复期的影响。方法 :选择全麻开腹手术患者 6 0例 ,ASAⅠ～Ⅱ级。按照随机表法随机分为两组 ,常规组 30例 ,行常规手术 ,术中肛温 34.2～ 35 .5℃ ;保暖组 30例 ,术中注意保暖 ,室内温度维持在 2 8～ 30℃ ,使用电子液体加温仪输液及输血 ,冲洗液用水温浴箱加温至 37℃ ,术中肛温 35 .6～ 36 .5℃。观察两组术前、术中及术后血压、心率、肛温、拔管时间、清醒时间、尿量、引流量、寒颤及躁动的发生率。结果 :与保温组相比 ,常规组患者血压升高 ,心率增快 ,清醒延迟 ,引流量增多 ,寒颤、躁动发生率高。结论 :术中低体温使术后氧耗增加 ,术后潜在并发症的发生机会增多。术中应监测体温 ,输液液体及冲洗液应加温 ,注意保持手术间温度 ,以降低上述反应的发生率。     

围手术期不同体温对婴幼儿患者康复的影响

目的观察围手术期不同体温对婴幼儿患者术后康复的影响。方法将120例行腹部手术患儿随机分三组，A组为提高室温组，将室温提高至26℃，术中肛温〈36℃；B组采取液体加温法，肛温维持在36．2士0．2℃；c组采取综合保温措施，肛温维持在37±0．5℃。观察三组术前、术中、术后血压、心率、肛温、拔除气管时间、尿量、引流量、麻醉复苏期间寒战及躁动的发生率。结果三组中，A组患儿术中，术后体温降低明显，血压升高、心率增快明显，术后引流量增多，寒战、躁动发生率最高，拔管时间明显延长。C组寒战、躁动发生率最低，拔管时间最短。B组在术后引流量、拔管时间、寒颤、躁动发生频率上也有明显高于C组。结论低体温使术后潜在并发症发生率增多，术中采取保温措施，肛温维持在37±0.5℃，更有利于婴幼儿手术后的康复。     

全麻复合椎管内麻醉在高龄患者腹上区手术中的应用

目的：评价全麻复合硬膜外麻醉用于高龄患者胆囊切除手术的麻醉效果。方法：择期行胆囊切除手术患者100例，随机分两组，每组50例。A组：全麻复合椎管内麻醉；B组：全麻。观察两组异丙酚、瑞芬、维库溴铵用量及手术时间，监测血压（BP）、心率（HR）、心电图（ECG）、血氧饱和度（SpO2）、呼气末CO2、术毕苏醒情况。结果：两组的手术时间无差异，B组在全麻插管时、切皮时、术中探查时及术毕拔管时无创动脉压（MAP）、HR明显高于A组，也高于术前（P〈0．05）：A组苏醒时间明显短于B组（P〈0．05）；B组在术毕苏醒期有躁动和精神障碍发生，而A组无。结论：全麻复合椎管内麻醉比全麻更适合高龄患者腹上区手术的麻醉。     

单纯全麻和全麻复合硬膜外阻滞用于乳癌根治并即时乳房再造术的比较

【目的】比较全身麻醉及全麻复合硬膜外阻滞用于乳癌根治并即时应用带蒂背阔肌皮瓣进行乳房再造术的应用效果、安全性和实用性。【方法】24例择期行乳腺切除＋乳房再造术患者,年龄32～61岁ASAⅠ～Ⅱ级,随机分为：Ⅰ组：单纯全麻组（n=12）。Ⅱ组：全麻复合硬膜外阻滞组（n=12）。观察记录两组麻醉前、全麻诱导时、气管插管时、体位变换时、拔管前后的SBP、DBP、HR、SPO2变化。记录两组患者全麻药用量、术毕至拔管时间、拔管时躁动、苏醒后再入睡及并发症发生等情况。【结果】Ⅱ组气管插管及术毕拔管时的循环波动明显小于Ⅰ组（P〈O．05）,Ⅱ组全麻药用量、术毕苏醒时间、拔管躁动和再入睡例数与Ⅰ组相比有显著差异（P〈O．01）。【结论】全麻复合硬膜外阻滞较单纯全麻术中循环功能稳定,麻醉苏醒较快,苏醒后再入睡发生率低,有利于术后呼吸管理,提高麻醉安全性。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."