舰员上舰时间与晕船程度、生活质量的关系研究

目的 了解某部舰员上舰时间与晕船程度、生活质量的关系。方法 采用随机整群抽样法,选取某部舰员568名,应用世界卫生组织生活质量测定量表简表(WHOQOL-BREF)和舰员基本情况调查表进行问卷调查。晕船程度采用国际常用的晕船评分标准,分为不晕船、轻度晕船、中度晕船和重度晕船4个等级。结果 舰员晕船程度的轻重与上舰时间的长短之间存在显著相关（P＜0.01）。舰员生理领域得分(62.91±13.44、62.51±17.06、60.99±14.06、56.67±15.32)与上舰时间长短呈显著负相关(P＜0.01),而心理领域和环境领域得分与上舰时间长短呈显著正相关(P＜0.01)。结论 是否为独生子女、学历、婚姻状况、所在部门、上舰时间和晕船程度等因素对水面舰艇官兵生活质量影响程度较大。上舰时间越长,晕船程度越轻。加强新舰员（上舰时间≤2年）心理教育,关注老舰员（上舰时间＞2年者）生理健康,提高抗晕船能力等措施,有利于提高舰员的生活质量水平。     

实时三维超声心动图评价肺动脉高压患者右心室收缩功能

目的 运用实时三维超声心动图(RT-3DE)评价肺动脉高压患者右心室收缩功能.资料与方法 97例肺动脉高压患者按照肺动脉收缩压分为3组:轻度组30例,中度组35例,重度组32例;选取31名正常成人作为对照.采用RT-3DE检测受试者右心室整体及三节段的舒张末期容积、收缩末期容积、搏出量和射血分数.结果 中、重度组右心室整体收缩末期容积明显大于正常组及轻度组(P＜ 0.05或P＜0.01),右心室射血分数明显低于正常组及轻度组(P＜0.01).三节段研究显示:重度组右心室流入道的收缩末期容积明显大于正常组(P＜0.05)及轻度组(P＜0.01),中度组收缩末期容积大于轻度组(P＜0.05);中、重度组的右心室射血分数均明显低于正常组及轻度组(P＜0.01);小梁部舒张末期容积以中度组增大最为明显(P＜0.05),中、重度组收缩末期容积明显增大(P＜0.05),搏出量和射血分数各组间均无统计学意义(P＞0.05).右心室流出道的右心室收缩功能参数各组间均无统计学意义(P＞0.05).结论 中度以上的肺动脉高压患者存在右心室整体及流入道收缩功能损害.     

颈动脉易损斑块在脑卒中的危害性分析

目的探讨颈动脉易损斑块与脑卒中发生的相关性。方法根据易损斑块形态特征和狭窄程度,受试者被分成9个组,采用χ~2检验比较组间样本率。结果相同狭窄程度的不同易损斑块在引发脑卒中的危害性无明显差别(P0.05)。各种易损斑块在中度狭窄组和重度狭窄组,在引发脑卒中的危害性均大于轻度狭窄组(P0.05)。但中度狭窄组和重度狭窄组之间,在引发脑卒中的危害性无明显差别(P0.05)。结论易损斑块是脑卒中的重要危险因素,易损斑块所致的颈动脉中度狭窄、重度狭窄在引发脑卒中的危害性均大于轻度狭窄,中度狭窄与重度狭窄之间的危害性无明显差别。     

左右颈动脉支架植入术发生颈动脉窦综合征比较

目的 对比分析左右两侧颈内动脉分别行球囊扩张颈动脉支架植入术(CAS)时发生颈动脉窦综合征(CSS)的差异.方法 回顾性分析64例接受CAS术颈动脉狭窄患者,男36例,女28例,平均年龄62.7岁(49～75岁);右侧颈动脉狭窄36处、左侧颈动脉狭窄30处,2例患者为双侧狭窄;重度狭窄(＞70％)37处,狭窄伴溃疡(30％～70％)29处;共植入66枚支架.术中均选用Wallstent自膨式支架.结果 36处接受右侧CAS术治疗颈动脉狭窄中发生重度CSS 5处、中度19处、轻度12处,发生率分别为13.89％、52.78％、33.33％;30处接受左侧CAS术治疗颈动脉狭窄中发生重度CSS 3处,中度10处、轻度17处,发生率分别为10.00％、33.33％、56.67％.两组数据差异有统计学意义(P＜0.05).结论 CSS是CAS术时常见并发症,右侧颈动脉行CAS时CSS发生率高于左侧.     

儿童先天性心脏病伴气管支气管狭窄的多层螺旋CT诊断

目的 探讨MSCT后处理技术对儿童先天性心脏病(简称先心病)伴气管支气管狭窄的诊断价值.方法 对34例先心病伴气管支气管狭窄的患儿行MSCT对比增强扫描及MPR、CPR、MinIP和VR重组以显示气管支气管狭窄情况,并与经手术证实的32例共43个狭窄节段行对比分析.采用非参数检验(Mann-Whitney test)比较各种后处理技术对狭窄程度测量与术中测量的差异性.结果 术中测量狭窄累及范围长短不一,其中气管狭窄段4～39 mm;主支气管狭窄段4～33 mm;叶支气管狭窄段3～12 mm.MSCT测量与手术测量相差最大为4 mm(3个节段),其余测量相差均＜3 mm.术中测量狭窄程度,轻度6个节段,中度16个节段,重度21个节段.MPR或CPR测量狭窄(轻度5个节段、中度17个节段、重度21个节段);MinIP测量狭窄(轻度2个节段、中度9个节段、重度32个节段);VR测量狭窄(轻度4个节段、中度11个节段、重度28个节段).MPR或CPR和VR测量狭窄程度与术中测量差异无统计学意义(Z=-0.105和-1.479,P均＞0.05);MinIP与术中测量差异有统计学意义,常过估狭窄程度(Z=-2.484,P=0.013).结论 MSCT扫描及其三维重组技术相互结合能准确评估先心病伴气管、支气管狭窄的程度和范围,为临床制定治疗方案提供重要依据.     

起落单飞对飞行学员心功能影响的性别差异

目的研究歼击机女飞行学员起落单飞对心功能影响的特征。方法同期歼击机飞行学员32名,分成男女两组,每组16人。采用REDCOM-CBS2000心功能血流参数无损伤监测仪进行检测。结果男女飞行学员心功能比较,不飞行时,差异无统计学处理(P>0.05);起落单飞后两组的平均动脉压、心率、心输出量差异有统计学意义(t=2.660～2.711,P<0.05),但心脏指数差异无统计学意义(P>0.05)。两组学员的功能指标变化量差异无统计学意义。结论起落单飞对心功能的影响,歼击机男、女飞行学员之间总体上无明显差异,从而为歼击机女飞行员航卫保障提供科学参考依据。     

睡眠呼吸暂停低通气综合征患者睡眠监测分析

目的:探讨睡眠呼吸暂停低通气综合征(SAHS)睡眠监测与临床多因素的关系.方法:采用美国伟康Stardust睡眠监测系统为患者进行整夜的睡眠监测,回顾性分析105例睡眠呼吸暂停综合征患者的临床资料.结果:Stardust睡眠监测分析出SAHS患者,其中轻度17例,中度48例,重度40例.SAHS患者的体重指数(BMI)、年龄与轻度、中度、重度患者呈正相关,有显著性差异(P＜0.05).SAHS患者的总觉醒次数、呼吸暂停低通气总时间与轻度、中度、重度患者呈正相关,有显著性差异(P＜0.01),SAHS患者的最长氧降时间与轻度、中度、重度患者呈正相关,有显著性差异(P＜0.01).SAHS患者中睡眠时间最低血氧饱和度(SaO2)与轻度、中度、重度患者呈反相关,有显著性差异(P＜0.01.SAHS患者的最长呼吸暂停低通气时间、平均呼吸暂停低通气时间、夜间基础血氧饱和度、夜间基础心率与轻度、中度、重度患者均无相关性,无显著性差异(P＞0.05).SAHS患者并发高血压病者最多为28.57％、其次为脂肪肝、高脂血症、冠心病、2型糖尿病,分别为27.62％、20.00％、14.29％、7.62％.结论:本研究显示SAHS男性多于女性,与年龄、BMI呈正相关,与高血压病、冠心病、高脂血症、2型糖尿病等疾病有相关性.SAHS是一种具有潜在危险的睡眠呼吸障碍疾病,累及多系统病变,应早期诊断并合理治疗,同时积极预防并发症的发生.     

远航期间任务人员晕船反应调查及原因分析

目的:研究和平方舟医院船上任务人员在远航期间晕船反应发生情况,分析晕船反应发生的原因,为今后医院船合理配置任务人员及降低任务人员晕船反应发生率提供参考依据。方法:根据自愿原则,采用自制问卷对和平方舟医院船上260名任务人员进行问卷调查,问卷内容主要包括两部分,第一部分基本情况调查,包括性别、年龄、体质量、吸烟史等;第二部分影响晕船反应发生的因素调查,包括出海次数、人员类别、住舱所在甲板位置、登船前是否每日进行体育锻炼、登船后是否每日进行体育锻炼等信息。回收有效问卷251份。采用SPSS 19.0统计软件及Empower Stats软件对数据进行统计分析。结果:单因素分析发现晕船反应发生与性别、体质量、是否抽烟、既往是否执行过出海任务、住舱所在甲板位置、人员类别之间明显相关( P<0.05)。多元回归分析表明,女性及既往未执行过出海任务是晕船反应发生的危险因素( P<0.05)。阈值饱和效应分析显示,从第2个航段开始,每经历1个航段,任务人员晕船反应发生率降低0.51%。 结论:医院船在配置任务人员时应综合评估任务人员基本情况,在安排住舱位置时,应将晕船人员尽量安排在靠近船体中部底层。任务人员平时应注重身体锻炼,保持营养摄入平衡,增强抗晕船适应性训练。     

256层CT评估Stanford B型主动脉夹层升主动脉弹性与冠状动脉狭窄的相关性

【摘要】目的：探讨256层CT心电门控扫描评估Stanford B型主动脉夹层升主动脉弹性的价值及其与冠状动脉狭窄的相关性。方法：搜集2018年12月-2020年10月本院诊断为Stanford B型主动脉夹层并行256层CT心电门控扫描患者中图像质量较好且无明显呼吸、心脏搏动伪影的56例纳为研究对象（男37例,女19例）,分为冠状动脉狭窄阳性组（n=35）和冠状动脉狭窄阴性组（n=21）,并根据狭窄程度将冠状动脉狭窄阳性组分为轻度、中度、重度狭窄3组。将原始数据间隔5％ R-R间期进行多期相重建,测量并计算升主动脉的4个弹性指标：膨胀性(AoD)、顺应性(AoC)、僵硬度(AoSI)及相对直径变化率(%Ao),并参照Gensini标准行冠状动脉狭窄评分。结果：Stanford B型主动脉夹层升主动脉各弹性指标在冠状动脉狭窄阳性组与狭窄阴性组间差异具有统计学意义（P＜0.05）。冠状动脉轻度狭窄组与中度狭窄组间除僵硬度外,其余各项弹性指标差异均无统计学意义。轻度狭窄组与重度狭窄组、中度狭窄组与重度狭窄组间各项指标差异均具有统计学意义（P＜0.05）。冠状动脉狭窄评分（参照Gensini标准）与升主动脉各弹性指标具有显著相关性（P＜0.01）。结论：运用256层CT心电门控扫描评估Stanford B型主动脉夹层动脉弹性及其与冠状动脉狭窄的相关性具有一定的可行性,且Stanford B型主动脉夹层的升主动脉弹性指标与冠状动脉狭窄程度存在相关性。     

潜艇艇员远航期间睡眠特点的跟踪研究

目的 探讨潜艇艇员远航期间的睡眠特点,为艇员远航睡眠保障提供科学依据.方法 以执行某远航任务的潜艇艇员作为研究对象,于远航前及每个航段前后采用睡眠状况自评量表(SRSS)跟踪调查艇员的睡眠状况并进行评分.分析不同任务类型艇员在执行航段任务前后、海上休整前后的睡眠变化,对艇员和水面舰舰员第二航段的睡眠分数进行比较,并对每个航段有睡眠问题艇员的人数进行比较.结果 由整体结果 看,艇员在执行完航段任务后,睡眠状况明显差于航段任务前和出海前(P<0.01),第三航段任务前的睡眠情况明显差于出海前(P<0.05).航段任务前艇员海上休整,睡眠状况平稳,与出海前差异无统计学意义(P>0.05).完成航段任务、艇员海上休整结束后的睡眠情况明显好于休整前(P<0.05或P<0.01).完成一个航段后经过海上休整,艇员的睡眠分数恢复至出海前水平(P>0.05).连续完成两个航段任务后经过海上休整,艇员睡眠分数的变化不明显(P>0.05).艇员经海上休整后睡眠状况明显好于同期、同次任务的水面舰舰员(P<0.05),但艇员在执行完航段任务后,睡眠明显差于海上休整艇员(P<0.01)及水面舰舰员(P<0.05).各航段中,出现睡眠问题人数的比例在海上休整艇员中明显低于执行航段任务的艇员(P<0.001或P<0.05).第一航段任务后未休整的艇员和靠港休整的艇员出现睡眠问题的比例比较差异不明显(P>0.05),但第二航段靠港休整的艇员中出现睡眠问题的比例明显高于前者(P<0.05).海上休整期间,第二、第三航段艇员中出现睡眠问题的比例明显高于第一航段(P<0.05,P<0.01),第三航段任务艇员中出现睡眠问题的比例明显高于第一航段(P<0.01)和第二航段(P<0.01).结论 整体上,远航艇员执行完航段任务后睡眠质量明显下降,且睡眠问题可累加,随连续长航时间的增加睡眠质量越来越差,但经过海上休整,艇员的睡眠状况明显好转,提示海上休整是艇员执行远航任务时有效的睡眠保障方式.     

Radiology as seen by medical students

Purpose

To determine the impact of exposing medical students to medical imaging during the first year of the second cycle of medical school (DCEM1) on their perception of this medical specialty and the acquisition of its basic concepts.

Materials and methods

All students in the 2007-2008 graduation class entering into the first year of the second cycle of medical school were anonymously enrolled into this project that included pre-rotation and post-rotation questionnaires, theory classes followed by clinical rotations with clearly predetermined objectives.

Results

A total of 108 students were enrolled, with 70% being females. The parents of the students had a medical or paramedical profession in 46.3% of cases. Before the rotation, 61.6% of students perceived a difference between a hospital-based practice and private practice. Fifty-two percent of students had a clear idea of their professional future prior to the rotation. Five students (4.7%) believed prior to the rotation that it might have an impact on their professional future, versus 63% after the rotation (P < 0.0001). The students whose parents work in the medical or paramedical field do not have a better defined idea of their professional future; on the other hand, they have more interest for radiology (73.6% with high or very high interest versus 52.8%, P = 0.03). After the rotation, there was a significant increase in the number of students with high or very high interest for radiology (77.8% versus 66.7%, P = 0.023). A student noted that he would redirect his career to radiology. There was also a significant increase in the number of students perceiving a difference between a hospital-based practice and private practice (82.2% versus 61.6%, P = 0.003). With regards to radiology knowledge before and after the rotation, there was a significant increase of mean scores (P < 0.001). Eighty-eight percent of students were satisfied or very satisfied with the radiology rotation. Overall, the students believe that 70% of the objectives were achieved. The only criticism from the students was that the clinical instructors were overworked.

Conclusion

Early exposure of medical students to radiology increases their level of interest for the specialty and increases the perception of differences between a hospital-based practice and private practice. The overall knowledge of students about radiology was improved, but the workload of clinical instructors impaired the quality of the rotation.     

Chest radiograph interpretation by medical students

AIM: To assess the ability of final year medical students to interpret conventional chest radiographs. MATERIALS AND METHODS: Ten conventional chest radiographs were selected from a teaching hospital radiology department library that were good radiological examples of common conditions. All were conditions that a medical student should be expected to recognize by the end of their training. One normal radiograph was included. The radiographs were shown to 52 final year medical students who were asked to describe their findings. RESULTS: The median score achieved was 12.5 out of 20 (range 6-18). There was no difference between the median scores of male and female students (12.5 and 12.3, respectively, p=0.82) but male students were more likely to be certain of their answers than female students (median certainty scores 23.0 and 14.0, respectively). The overall degree of certainty was low. On no radiograph were more than 25% of students definite about their answer. Students had received little formal radiology teaching (2-42 h, median 21) and few expressed an interest in radiology as a career. Only two (3.8%) students thought they were good at interpreting chest radiographs, 17 (32.7%) thought they were bad or awful. CONCLUSION: Medical students reaching the end of their training do not perform well at interpreting simple chest radiographs. They lack confidence and have received little formal radiological tuition. Perhaps as a result, few are interested in radiology as a career, which is a matter for concern in view of the current shortage of radiologists in the UK.     

Teaching radiology to military nursing students

OBJECTIVES: To assess the students' perceptions and evaluations of radiology lectures and to determine the factors correlating with performance on examinations. METHODS: Sixty-three nursing students were asked to submit their opinions regarding the lecture at the end of each lecture, and they were asked to evaluate the lectures as a whole at the end of the course. Relationships between each of the survey items (student curiosity, overall understanding, usefulness of the lecture, difficulty level, incentive to study, and total number of opinions regarding the lecture) and the final examination score were examined with Spearman correlation analysis. RESULTS: Statistically significant positive correlations were found between student curiosity and the final examination score (n = 62, rs = 0.281, p < 0.028) and between the total number of opinions and the final examination score (n = 63, rs = 0.273, p < 0.032). However, the other variables did not reach statistical significance. CONCLUSIONS: Our results suggest that lectures enhancing student curiosity and eliciting feedback from students may be related to high performance on examinations.     

Teaching students using incremental skill format

The format of mandatory and free selections on a check-off list was found to be an ineffective learning tool for radiation therapy technology students. Changing to an incremental skill development format resulted in students with enhanced technical ability and a well-rounded clinical education. This study presents first and second level objectives for weekly incremental skill development.