影响多导睡眠监测的相关因素与护理干预

目的:了解影响多导睡眠监测(PSG)效果的相关因素及监测过程中行有效的护理干预对PSG检测结果的影响.方法: 比较2004年5月～2005年8月1100例PSG检测结果与2005年9月～2008年3月2017例行有效护理干预后PSG检测结果.结果:进行有效护理干预后有47例(2.3%)监测失败, PSG检测失败率显著减少(P<0.001).结论:多导睡眠监测过程中行有效的护理干预能提高检测结果的准确性,从而为患者的诊断和治疗提供保证.     

阻塞性睡眠呼吸暂停低通气综合征女性患者呼吸事件与睡眠时相的关系

目的:探讨女性不同程度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的临床特征以及呼吸事件与睡眠时相的关系。方法:主诉睡眠打鼾的女性患者56例,根据夜间多导睡眠图(PSG)监测结果分为4组,即单纯性鼾症组(AHI<5次/h)、轻度、中度和重度OSAHS组。对症状、绝经与否、合并症、Epworth嗜睡量表(ESS)评分、颈围、体重指数(BMI)以及PSG监测指标进行比较;自行设计程序,计算并比较睡眠时相中呼吸事件发生的频率和持续时间以及微觉醒指数。结果:①4组间平均年龄、打鼾病史、BMI、颈围、症状、ESS评分、绝经者所占百分率及合并症出现比率差异无显著性(P>0.05)。②各组总睡眠时间、S1、S2、S3以及快速眼动相(REM期)占总睡眠时间的百分比差异无显著性(P>0.05)。③轻、中度组睡眠不同时相的呼吸事件发生的频率、微觉醒指数及REM明显高于非快速眼动相(NREM期)(P<0.05)。呼吸事件持续时间,重度组REM期明显长于NREM期(P<0.01)。结论:①目前临床诊断和评估的指标不能或不能完全提示女性OSAHS患者的轻重程度;②女性患者呼吸事件主要发生在REM期,该期可能具有重要意义,这一推断有助于对相应的治疗进行进一步探讨。     

46例睡眠呼吸监测的效果观察与护理

目的:提高多导睡眠图(PSG)监测仪检测的准确率及安全性。方法:应用PSG监测仪对睡眠打鼾者46例进行整夜睡眠监测。结果:42例(91.3%)检测成功,4例(8.7%)检测失败,且失败者多为症状较轻患者。结论:PSG检测需要护患双方密切配合,做好导线连接与其中的各项护理措施是提高检测成功率的重要环节。     

无人值守整夜多导睡眠图评估睡眠呼吸暂停低通气综合征患者300例

目的探讨无人值守整夜多导睡眠图监测睡眠呼吸暂停低通气综合征的可行性。方法选择2001-06/2003-12建湖县人民医院呼吸科门诊及住院的疑似睡眠呼吸暂停综合征患者300例,男271例,女29例。均知情同意。采用SRM-9601多导睡眠呼吸监测系统进行无人值守整夜睡眠呼吸暂停低通气综合征监测。回顾性总结多导睡眠图监测成功率。结果纳入对象300例中一次监测成功291例,成功率97.00%。经多导睡眠图诊断为睡眠呼吸暂停低通气综合征255例(85.0%)。结论无人值守整夜多导睡眠图监测一次成功率及确诊率均较高。     

阻塞性睡眠呼吸暂停综合征行多导睡眠呼吸监测56例临床护理

目的:探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者行多导睡眠呼吸监测(PSG)的临床护理方法。方法:对56例打鼾患者行PSG,并给予精心监测前、监测中、监测后护理。结果:本组确诊OSAS患者52例,3例因环境陌生或身体导联多而无法入睡,1例因夜尿频繁影响睡眠。结论:护士在监测前准备、监测中的正确操作和病情观察以及监测后的护理,对整个监测结果的准确性和确保操作的成功具有重要意义。     

脑血管病与睡眠呼吸障碍的相关性

目的 探讨脑血管病(CVD)与睡眠呼吸障碍(SDB)的相关性.方法 利用多导睡眠图(PSG)对40例急性脑血管病患者进行睡眠全程监测,并选择年龄、性别和体重指数(BMI)相当的健康体检者32例作为正常时照组.结果 研究组睡眠结构紊乱,表现为睡眠效率降低、深睡期和快速眼动(REM)睡眠时间减少、浅睡时间延长,与正常对照组比较,差异均有统计学意义(P<0.01);同时与正常对照组比较,研究组呼吸暂停时间和睡眠呼吸暂停/低通气指数(AHI)明显增高(P<0.01),动脉氧饱和度(SaO2)明显降低(P<0.01),34例(85%)诊断为睡眠呼吸暂停综合征.其中阻塞型睡眠障碍20例(58.8%)(OSA).结论 睡眠呼吸障碍,尤其是OSA与脑血管病的关系密切,既是其发病的独立危险因素,又受其影响加重.     

中重度阻塞性睡眠呼吸暂停低通气综合征患儿睡眠问题的调查分析

目的 调查中重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患儿的睡眠问题及影响.方法 通过问卷调查与多导睡眠监测(Polysomnagraphy,PSG)对近两年来我院睡眠呼吸监测室进行整夜睡眠监测的124例腺样体肥大患儿的睡眠问题进行调查分析,并根据PSG结果中呼吸暂停低通气指数(Apnea hypopnea index,AHI),分为中重度OSAHS合并腺样体肥大组(AHI＞10)和单纯腺样体肥大组(AHI＜5),比较两组患儿睡眠相关问题.结果 试验组主要睡眠相关问题有:睡眠中张口呼吸,反复翻身,脾气急躁、易怒、任性,晨起口唇咽部发干,因憋气醒来,肥胖,有睡眠问题家族史等,发生率高于对照组,差异有统计学意义.中重度OSAHS患儿PSG显示,睡眠中存在Ⅰ期睡眠比例增加,快速动眼睡眠期比例减少,最低血氧饱和度下降至90%以下的人数,发生率高于对照组,差异有统计学意义(P＜0.05).结论 中重度OSAHS合并腺样体肥患儿比单纯腺样体肥大患儿存在的睡眠问题多、发生率高,耳鼻喉科、睡眠门诊及睡眠呼吸监测室的护理人员应给予患儿及家长充分的健康教育及护理指导,提醒家长尽早为患儿行PSG检查.     

儿童阻塞性睡眠呼吸暂停低通气综合征的诊治

【目的】探讨儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床特点和早期诊断及治疗的方法。【方法】分析经鼻咽侧位X线摄片、纤维鼻咽镜检查及多道睡眠监测(polysomnography,PSG)确诊为OSAHS的86例患儿的临床症状和体征的特点,并对其中72例扁桃体、腺样体肥大的患儿进行了手术治疗。【结果】OS AHS患儿的主要症状是睡眠时有打鼾、呼吸不畅、呼吸暂停、听力下降。术后69例患儿临床症状明显缓解,占95.8%。术后2~4个月内,对60例患儿复查PSG,发现睡眠呼吸低通气指数、夜间血氧饱和度低于0.90的时间所占睡眠时间的百分比、最长呼吸暂停时间较术前均明显改善,且差异有显著性(P<0.05)。【结论】扁桃体和腺样体是儿童OSAHS的主要病因,PSG是诊断的依据,手术切除是其主要的治疗手段。     

中度睡眠呼吸暂停低通气综合征患者行舌托治疗后代谢当量及呼吸睡眠监测联合观察

目的:探讨呼吸睡眠监测(PSG)及心电图运动平板试验联合观察评估中度睡眠呼吸暂停低通气综合征(OSAHS)患者行舌托治疗的可能性。方法:对2002年11月至2006年5月间41例愿接受舌托治疗的中度OSAHS患者行舌托治疗,对比观察治疗前及治疗后6个月、1年PSG[呼吸暂停低通气指数(AHI)、最低血氧饱和度]与代谢当量(METs)的变化。结果:41例患者经舌托治疗后1年治愈率17%(7/41),显效率39%(16/41),有效率34%(14/41),无效率10%(4/41)。舌托治疗前后AHI、最低血氧饱和度、METs的变化有统计学意义(P<0.05),舌托治疗后6、12个月AHI、最低血氧饱和度间差异无显著性(P>0.05)。结论:PSG和METs试验联合观察可作为中度OSAHS患者的疗效评价参数组合之一。舌托作为一种非创治疗方式可作为中度OSAHS患者首选方式之一。     

影响儿童多导睡眠监测的相关因素分析及护理对策

儿童阻塞性睡眠呼吸暂停综合征(OSAS)在儿童中发病率很高,据保守估计为1%～3%[1].多导睡眠图(PSG)用于诊断儿童睡眠呼吸障碍性疾病,其准确性和可靠性直接影响临床治疗方案的选择[2].多导睡眠图是一种可以在整夜睡眠过程中,根据需要连续并同步监测与记录多项生理指标的检查方法,患儿需在睡眠实验室进行通宵(不少于7 h)的PSG监测[3].患儿年龄小,不配合,对PSG监测工作带来极大挑战.作者对影响儿童行PSG监测效果的因素进行分析,总结护理对策,现报告如下.     

电视辅助胸腔镜外科

１概述 电视辅助胸腔镜外科（Ｖｉｄｅｏ—ａｓｓｉｓｔｅｄ ＴｈｏｒａｃｉｃＳｕｒｇｅｒｙ,ＶＡＴＳ）是内镜外科在设备和手术器械不断发展的基础上产生的“微侵入”外科技术。如腹腔镜技术在外科的应用一样,９０年代以来,ＶＡＴＳ在胸外科领域也得到蓬勃发展。 ＶＡＴＳ的出现改变了胸腔内镜技术的面貌。早在１９１０年,瑞士内科医师Ｊａｃｏｂｅｕｓ首先把膀胱镜技术移植到胸腔内,用于诊断胸膜病灶以及应用到治疗肺结核的胸膜粘连术和肺萎陷疗法。开辟了内镜诊断、治疗胸部疾病的先例［１］。以后,在２０世纪三四十年代,逐渐发…     

Alpha(4)beta(7)/alpha(4)beta(1) dual integrin antagonists block alpha(4)beta(7)-dependent adhesion under shear flow

The alpha(4) integrin, alpha(4)beta(7), plays an important role in recruiting circulating lymphocytes to the gastrointestinal tract, where its ligand mucosal addressin cell adhesion molecule-1 (MAdCAM-1) is preferentially expressed on high endothelial venules (HEVs). Dual antagonists of alpha(4)beta(1) and alpha(4)beta(7), N-(2,6-dichlorobenzoyl)-(L)-4-(2',6'-bis-methoxyphenyl)phenylalanine (TR14035) and N-(N-[(3,5-dichlorobenzene)sulfonyl]-2-(R)-methylpropyl)-(D)-phenylalanine (compound 1), were tested for their ability to block the binding of alpha(4)beta(7)-expressing cells to soluble ligand in suspension and under in vitro and in vivo shear flow. Compound 1 and TR14035 blocked the binding of human alpha(4)beta(7) to an (125)I-MAdCAM-Ig fusion protein with IC(50) values of 2.93 and 0.75 nM, respectively. Both compounds inhibited binding of soluble ligands to alpha(4)beta(1) or alpha(4)beta(7) on cells of human or rodent origin with similar potency. Under shear flow in vitro, TR14035 and compound 1 blocked binding of human alpha(4)beta(7)-expressing RPMI-8866 cells or murine mesenteric lymph node lymphocytes to MAdCAM-Ig with IC(50) values of 0.1 and 1 microM, respectively. Intravital microscopy was used to quantitate alpha(4)-dependent adhesion of fluorescent murine lymphocytes in Peyer's patch HEVs. When cells were prestimulated with 2 mM Mn(2+) to activate alpha(4)beta(7) binding to ligand, anti-alpha(4) monoclonal antibody (mAb) [10 mg/kg (mpk) i.v.] blocked adhesion by 95%, and anti-beta(1) mAb did not block adhesion, demonstrating that this interaction was dependent on alpha(4)beta(7). TR14035 blocked adhesion to HEVs [ED(50) of 0.01-0.1 mpk i.v.], and compound 1 blocked adhesion by 47% at 10 mpk i.v. Thus, alpha(4)beta(7)/alpha(4)beta(1) antagonists blocked alpha(4)beta(7)-dependent adhesion of lymphocytes to HEVs under both in vitro and in vivo shear flow.     

(E)-5-(2-bromovinyl)-2'-deoxyuridine (BVDU)

(E)-5-(2-bromovinyl)-2'-deoxyuridine (BVDU, Brivudin, Zostex, Zerpex, Zonavir), now more than 20 years after its discovery, still stands out as a highly potent and selective inhibitor of herpes simplex virus type 1 (HSV-1) and varicella-zoster virus (VZV) infections. It has been used in the topical treatment of herpetic keratitis and recurrent herpes labialis and the systemic (oral) treatment of herpes zoster (zona, shingles). The high selectivity of BVDU towards HSV-1 and VZV depends primarily on a specific phosphorylation of BVDU to its 5'-diphosphate (DP) by the virus-encoded thymidine kinase (TK). After further phosphorylation (by cellular enzymes), to the 5'-triphosphate (TP), the compound interferes as a competitive inhibitor/alternate substrate with the viral DNA polymerase. The specific phosphorylation by the HSV- and VZV-induced TK also explains the marked cytostatic activity of BVDU against tumor cells that have been transduced by the viral TK genes. This finding offers considerable potential in a combined gene therapy/chemotherapy approach for cancer. To the extent that BVDU or its analogues (i.e., BVaraU) are degraded (by thymidine phosphorylase) to (E)-5-(2-bromovinyl)uracil (BVU), they may potentiate the anticancer potency, as well as toxicity, of 5-fluorouracil. This ensues from the direct inactivating effect of BVU on dihydropyrimidine dehydrogenase, the enzyme that initiates the degradative pathway of 5-fluorouracil. The prime determinant in the unique behavior of BVDU is its (E)-5-(2-bromovinyl) substituent. Numerous BVDU analogues have been described that, when equipped with this particular pharmacophore, demonstrate an activity spectrum characteristic of BVDU, including selective anti-VZV activity.     

真空负压吸引在乳腺癌改良根治术后应用的研究

目的 ：探讨Drainobag真空负压引流瓶在乳腺癌根治术后的应用效果。方法：对66 例在我科施行乳腺癌改良根治术的患者,术后随机分为两组,对照组(33 例)选择持续墙式中心负压吸引引流,改进组(33例)应用Drainobag真空负压引流瓶引流,对两组术后第一天引流量、置管时间、皮下积液、皮瓣坏死和术后住院时间进行比较。结果：改进组术后第一天引流量、置管时间、皮下积液、皮瓣坏死率和术后住院时间均明显低于对照组(Ｐ＜0.05)。结论：应用Drainobag真空负压引流瓶引流效果好,能有效预防术后并发症的发生,缩短了住院时间,增强了病人的自信心。     

Morphological Distinction of Cyanodermatium (Hydrococcaceae) and Radaisia (Hyellaceae) of Chroococcales (Cyanoprokaryota)

Radaisia gomontiana Sauvageau has been studied for their morphology from the material collected from natural habitat and from cultures. The continuous collections of the organism from nature did not show any sign of baeocyte formation. However, in the seventeenth collection, after 2 months growth in a water body, it did reveal the formation of baeocytes only for 2 days, whereas under culture conditions, stages of baeocyte and monocyte formation were recorded as distinct features. The organism is identified as Radaisia (Hyellaceae) when baeocytes are observed. Its vegetative stage which is recognized as Cyanodermatium (Hydrococcaceae).