异丙酚不同配伍用于人工流产手术麻醉效果分析

目的 探讨异丙酚联合应用不同药物在人工流产手术的麻醉效果。方法 ASAⅠ～Ⅱ级人工流产患者120例，分为3组各40例，A组单用异丙酚，B组异丙酚配伍氯胺酮．C组异丙酚配伍芬太尼。记录3组异丙酚用量、苏醒时间、恢复正常行走时间及患者麻醉前后的MAP、HR、SpO2。结果B、C组异丙酚用量明显小于A组（P〈0．05）；A、C组麻醉后MAP值显著小于麻醉前（P〈0．05）；A组清醒时间、恢复正常行走时间比B、C组短（P〈0．05）。结论 异丙酚联合氯胺酮用于人工流产手术麻醉可加强镇痛，减少异丙酚用量。     

听觉诱发电位指数监测在无痛宫腔镜术中瑞芬太尼麻醉深度的评价

目的观察应用瑞芬太尼复合丙泊酚麻醉的无痛宫腔镜术中听觉诱发电位指数（AAI）能否反映镇静镇痛水平。方法选择门诊行无痛宫腔镜手术患者60例,随机分成丙泊酚组（Ⅰ组）和瑞芬太尼复合丙泊酚组（Ⅱ组）,均30例。监测给药前（TO）、给药后（T1）、术中1min（T2）、术中3min（T3）、术中5min（T4）、术后1min（T5）、术后5min（T6）、术后7min（T7）的AAI值、手术时间、苏醒时间及质量。结果两组在给药后及整个手术过程中（T1-T4）AAI值明显下降,降至20—30水平,差异均有统计学意义（t分别=23．01、26．73、34．90、28．07、17.41、24.32、26．66、28．77,P均〈0．05）。术后逐渐回升,至手术后7min（T7）AAI值恢复至给药前水平,T5、T6与T0时比较,差异均有统计学意义（t分别=20．78、11．01、12．62、10．40,P均〈0．05）。各时点Ⅰ组与Ⅱ组比较,差异均无统计学意义（t分别=0．76、0．70、0．73、0．87、1．02、0．39,P均〉0．05）。Ⅰ组术中HR增快,Ⅱ组术中体动明显减少,两组比较,差异有统计学意义（x^2分别=14．70,17．78,P均〈0．05）。手术时间、苏醒时间两组比较,差异均无统计学意义（t分别=1．11、1．38,P均〉0．05）。结论AAI能有效地反映丙泊酚麻醉的镇静水平,但AAI不能较好地反映麻醉的镇痛水平,不能预测术中体动的发生。     

异丙酚复合小剂量氯胺酮麻醉用于烧伤切痂植皮手术临床分析

目的：探讨异丙酚复合小剂量氯胺酮静脉麻醉方法在烧伤切痂植皮手术中的可行性及安全性。方法：选取我院2004年6月至2006年6月住院烧伤患者100例，随机分成2组：A组单用氯胺酮静脉麻醉，B组采用异丙酚复合小剂量氯胺酮静脉麻醉。每组50例。分别观察并记录麻醉前、单次静脉给药后2min、4min、10min、取皮单次给药后、植皮20min各时点患者收缩压（SBP）、舒张压（DBP）、心率（HR）及血氧饱和度（SpO2）、呼吸频率（RR）、术中术后患者是否躁动、术野渗血情况及术毕停药后睁眼的时间，将各观察指标进行统计学分析。结果：A组患者麻醉显效后，患者SBP、DBP、HR均有明显升高，SBP升高尤为显著，与术前相比差异显著（P〈0．05）；B组患者SBP、DBP、心HR与术前相比无显著变化（P〉0．05），A组与B组比较组间有显著性差异（P〈0．05），A、B两组Sp02都有所下降，呼吸浅慢。组间无显著性差异（P〉0．05）；A组患耆术中约20例出现不同程度躁动，术后约5例躁动，B组患者未出现躁动，术野渗血较A组少．停药后睁眼应答时间较A组明显缩短，组间有显著性差异（P〈0．05）。结论：异丙酚复合小剂量氯胺酮静脉麻醉用于烧伤切痂植皮术安全可行，比单用氯胺酮静脉麻醉有更大优越性。     

氯胺酮复合异丙酚静脉麻醉在小儿斜疝手术中的应用

目的：观察异丙酚联合氯胺酮静脉麻醉在小儿斜疝修补手术中应用的安全性、可行性及优点。方法：选择择期行斜疝修补手术的小儿患者40例,随机分成两组,Ⅰ组（实验组）采用异丙酚复合氯胺酮静脉麻醉,Ⅱ组（对照组）采用氯胺酮加地西泮静脉麻醉。麻醉过程中监测循环呼吸相关参数,同时记录麻醉效果、不良反应、氯胺酮用量及术后苏醒时间。结果：Ⅰ组的氯胺酮用量明显少于Ⅱ组（P〈0．05）,术后苏醒时间明显短于Ⅱ组（P〈0．05）,术后躁动等不良反应少于Ⅱ组。结论：异丙酚复合氯胺酮静脉麻醉用于小儿斜疝修补手术比氯胺酮加地西泮具有更多优点。     

无痛人工流产术80例临床分析

目的观察异丙酚及氯胺酮用于人工流产术的效果。方法观察组采用异丙酚及氯胺酮静脉给药，对照组术前不使用药物。结果观察组在止痛效果、手术时间、并发症发生率等方面均优于对照组（P〈0．05），两组术中出血及术后阴道出血停止时间差异无统计学意识（P〉0．05）。结论异丙酚及氯胺酮用于人工流产术具有镇痛效果好、手术时间短、并发症少等优点，值得临床上推广应用。     

婴儿呼吸道异物取出术不同麻醉方法的比较

目的：比较婴儿呼吸道异物取出术不同麻醉方法的效果。方法：婴儿呼吸道异物120例分三组，每组40例。Ⅰ组为氯胺酮、咪达唑仑和异丙酚麻醉。保留自主呼吸；Ⅱ组为氯胺酮、异丙酚和维库溴铵麻醉；Ⅲ组则以阿曲库铵取代维库溴铵。Ⅱ、Ⅲ组均行人工通气。记录三组患儿麻醉、手术及苏醒时间，统计置镜满意率、并发症发生率。结果：Ⅱ、Ⅲ组患儿麻醉、手术时间、置镜满意率无显著性差异（P〉0．05）；Ⅱ、Ⅲ组与Ⅰ组比较，麻醉、手术及苏醒时间均明显缩短，置镜满意率高于Ⅰ组（P〈0．05），并发症低于Ⅰ组（P〈0．05）。结论：婴儿呼吸道异物取出术麻醉使用肌松剂，能抑制不良反射，保证氧供和肌松。     

小剂量氯胺酮复合异丙酚在口腔小儿门诊手术中的应用

目的观察小剂量氯胺酮复合异丙酚用于口腔小儿门诊手术的临床效果。方法选择我院2005年8月至2006年12月行口腔门诊手术的患者60例，ASAⅠ～Ⅱ级，男38例，女22例，年龄3～8岁，体质量7～18kg，其中舌系带矫正术38例，舌外伤6例，唇外伤8例，唇黏液囊肿4例，补牙术4例。两组患者的年龄、体质量、男女比例及手术时间均差异无统计学意义。将所选病例随机分为2组，每组30例，Ⅰ组：单纯氯胺酮肌注组，以4～8mg／kg氯胺酮肌注诱导麻醉，Ⅱ组：小剂量氯胺酮复合异丙酚组，给予患者开通静脉，以0．5～1mg／kg氯胺酮静脉注入诱导麻醉，以异丙酚维持麻醉。所有患者记录诱导前心率（HR0），给药5min后心率（HR1），手术结束时（HR2）；记录诱导时间（T0）、清醒时间（T1）、离院时间（T2）；记录氯胺酮总用量，呕吐次数。结果Ⅱ组的T0、T1、T2、HR1，氯胺酮总用量，呕吐次数均明显小于Ⅰ组（P〈0．05）。结论小剂量氯胺酮复合异丙酚麻醉用于口腔小儿门诊手术起效快，恢复完全，安全实用，副作用少，其效果明显优于单纯氯胺酮肌注组。     

经喉罩全凭七氟醚吸入麻醉在小儿腹股沟疝手术中的应用

目的：观察经喉罩全凭七氟醚吸入麻醉在小儿腹股沟疝手术中的临床应用效果。方法：60例ASAⅠ-Ⅱ级择期行腹股沟疝囊高位结扎术的患儿随机分成喉罩-七氟醚组（实验组）和氯胺酮组（对照组）。实验组以七氟醚诱导后置入喉罩，经喉罩全凭七氟醚吸入维持麻醉，对照组以氯胺酮和异丙酚诱导和维持麻醉。比较两组血流动力学、呼气末CO2分压（PetCO2）、手术时间、苏醒时间、出室时间（在恢复室内停留时间）。记录术中和术后不良反应如体动反应、嗜睡、恶心呕吐等发生情况。结果：对照组在T3、T4、T5时点HR、BP均明显高于实验组相应时点（P〈0．05）。实验组患儿苏醒时间和出室时间均明显低于对照组（P〈O．05）。对照组体动反应和嗜睡发生率明显高于实验组（P〈0．05）。实验组术后恶心发生率明显高于对照组（P〈O．05）。结论：经喉罩全凭七氟醚吸入麻醉用于小儿腹股沟疝手术，术中经过更平稳，麻醉恢复更快，术中及术后不良反应少。     

无痛胃镜术中给氧模式探讨

目的探讨无痛胃镜检查中的最佳呼吸管理模式。方法200例无痛胃镜病人，采用芬太尼与异丙酚复合静脉镇痛，依给氧方式不同随机分为4组。每组50例。Ⅰ组，不给氧；Ⅱ组，鼻导管给氧；Ⅲ组，面罩给氧；Ⅳ组，高频喷射通气。记录病人麻醉前，麻醉后2、4、6、8、10min时的呼吸次数及SpO2。结果麻醉后所有病人呼吸频率均较麻醉前显著降低（P〈0．05）。8min后呼吸频率逐渐恢复至麻醉前水平。Ⅱ组SpO2麻醉后2min有一明显降低（P〈0．05），其中9例需行面罩给氧。Ⅰ组SpO2在8min内均较麻醉前明显降低（P〈0．05），其中有23例病人因SpO2低于93％而需面罩给氧。Ⅲ、Ⅳ组病人麻醉前后SpO2差异无显著性（P〉0．05）。结论无痛胃镜检查，用麻醉机面罩给氧或进行高频喷射通气给氧都是安全有效的方法。     

心理干预及硬膜外自控镇痛对胸部手术后应激反应的影响

目的：观察心理干预联合患者自控镇痛对胸部手术患者术后应激反应的影响。方法：选择择期开胸手术患者60例,随机分为Ⅰ组为对照组,术后根据需要间断肌注哌替啶;Ⅱ组为观察组,围手术期进行心理干预,术后行硬膜外自控镇痛。结果：Ⅰ组HR、SBP有不同程度的增高（P〈0．05）而Ⅱ组则较稳定;Ⅰ组术后应激激素水平明显增高（P〈0．01）;Ⅱ组虽有增高趋势但差异无显著性（P〉0．05）;两组各时点组间比较差异有显著性（P〈0．05）;Ⅰ组术后RR浅快,SpO2有不同程度的降低（P〈0．05）,与Ⅱ组比较差异有显著性（P〈0．05）;Ⅱ组患者镇痛效果明显优于Ⅰ组（P〈0．05）。结论：心理干预联合硬膜外自控镇痛能提供完善的止痛效果,能更有效地控制术后应激反应,并有改善呼吸和稳定循环之功效。     

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.     

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.     

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.     

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."