BIS在晚期肿瘤患者全身热疗麻醉中的应用

目的 评价脑电双频指数(BIS)在晚期肿瘤患者全身热疗麻醉中应用的可行性.方法 46例(ASA Ⅰ～Ⅱ级)晚期肿瘤患者,随机分为观察组(BIS监测)、对照组(常规监测);术中监测心率(HR)、血压(Bp)、围术期血糖变化、术毕意识恢复时间等,并对所得数据进行统计学分析.结果 两组患者,麻醉与热疗全过程为(410±43)min,升温期(223±32)min、恒温期60 min、降温期(72±17)min;升温期和恒温期HR增快,对照组50%的患者发生严重低血压,血压下降幅度＞基础值的30%,体温达41℃后,所有患者均用多巴胺维持血流动力学稳定;观察组血流动力学较平稳,仅有2例发生低血压.结论 围术期BIS值维持在55～60,热疗患者的血流动力学及血糖浓度的变化是稳定的,意识恢复快,麻醉并发症少,保证了手术安全顺利地进行,说明BIS用于全身热疗麻醉中的监测是可行的.     

BIS在晚期肿瘤患者全身热疗麻醉中的应用

目的评价脑电双频指数（BIS）在晚期肿瘤患者全身热疗麻醉中应用的可行性。方法46例（ASAⅠ～Ⅱ级）晚期肿瘤患者，随机分为观察组（BIS监测）、对照组（常规监测）；术中监测心率（HR）、血压（Bp）、围术期血糖变化、术毕意识恢复时间等，并对所得数据进行统计学分析。结果两组患者，麻醉与热疗全过程为（410±43）min，升温期（223±32）min、恒温期60min、降温期（72±17）min；升温期和恒温期HR增快，对照组50％的患者发生严重低血压，血压下降幅度〉基础值的30％，体温达41℃后，所有患者均用多巴胺维持血流动力学稳定；观察组血流动力学较平稳，仅有2例发生低血压。结论围术期BIS值维持在55—60，热疗患者的血流动力学及血糖浓度的变化是稳定的，意识恢复快，麻醉并发症少，保证了手术安全顺利地进行，说明BIS用于全身热疗麻醉中的监测是可行的。     

ET-SPACETM全身热疗系统的治疗温度与测控

ET-SPACE^TM全身热疗系统是利用红外线体表照射对人体进行全身加温的，可以确保人体各部位均匀加热。我科采用的治疗温度是41．8℃，升温时间约需3h，恒温期治疗时间为1h，降温时间约需1h。其测温系统可以同时实时显示各路测温探测器的温度变化曲线；其控温系统对人体的绝对控温精度达到0．1℃，显示分辨率达到0．01℃。     

中深度镇静下全身热疗的麻醉管理

目的探讨肿瘤患者在中深度镇静下行红外线全身热疗的麻醉管理。方法对42例ASAⅠ^Ⅱ级恶性肿瘤患者在中深度镇静下行全身热疗86例次治疗,核心温度(参考肛温)40.0Ⅱ级恶性肿瘤患者在中深度镇静下行全身热疗86例次治疗,核心温度(参考肛温)40.0⁴1.8℃,维持240 min以上。结果患者均顺利完成治疗,且无严重不良反应。其中26例次恒温期使用β2受体阻滞剂艾司洛尔,全部例次使用升压药多巴胺,5例次舌后坠影响通气放置了口咽通气道。无其他并发症。结论深度镇静用于红外线全身热疗简便易行,患者经济舒适,较为安全。     

用国产WRL-4型微波热疗机合并放疗治疗表浅肿瘤

199例浅表性肿瘤患者,用915MHz微波以两种不同的加温方式(升温式与降温式)热疗并联用放疗,作临床疗效比较研究,结果显示降温式热疗加放疗优于升温式热疗加放疗.疗效提高显著,降温组总有效率优于加温组,提示热疗具有增敏作用.     

新生儿急性呼吸衰竭呼吸机撤离时的呼吸力学研究

目的 探讨新生儿机械通气撤机时呼吸力学指标的范围及临床意义.方法 测定32例机械通气撤机时,新生儿在持续气道正压(CPAP)模式、脱机拔管前及拔管后20min等条件下的呼吸力学指标范围.根据拔管48h内是否重新插管,将以上病例分为撤机成功组与失败组.结果 成功组的呼吸力学范围:平均气道阻力(Rawmean)为(93.7±14.3)cmH2O/(L·S)(1cmH2O=98.07Pa)、呼吸系统顺应性(Crs)为(0.65±0.09)ml/(cmH2O·kg)、呼吸功(WOBp)为(1589±133.2)g·cm/(min·kg);失败组:Rawmean为(98.6±15.5)cmH2O/(L·S)、Crs为(0.57±0.08)ml/(cm H2O·kg)、WOBp为(1782±148.6)g·cm/(min·kg).Crs与WOBp两组差异有显著意义(P＜0.05),脱机成功率为95.4%.结论 呼吸力学的检测对新生儿呼吸机的撤离有指导作用,特别是对呼吸系统顺应性和呼吸功的检测,更具有实际意义.     

60例ET-SPACE-Ⅰ全身热疗系统治疗恶性肿瘤护理分析

目的探讨并分析ET-SPACE-Ⅰ全身热疗系统治疗恶性肿瘤护理。方法选择我院2009年1月至2011年1月收治的60例晚期恶性肿瘤患者的临床资料,ET-SPACE-Ⅰ全身热疗系统治疗前行常规检查、心理护理等,术中紧对患者生命体征、肝肾功能、意识等进行监测,术后检测患者病情情况及身体各项机能,发现异常症况给予积极处理。结果全部患者经治疗、护理后痊愈出院,术后3d有3例病人发生腹泻,29例患者出现不同程度皮肤灼伤,7例患者出现血低血压,1例患者出现肺水肿,1例患者术后出现谵妄,给予对应处理后,全部好转。结论 ET-SPACE-Ⅰ全身热疗系统作为一项新技术,其护理工作应注意对患者病情变化情况的严密观察,给予积极的处理,此项工作仍需临床医护人员的不断探索与总结。     

长托宁与东莨菪碱在全身热化疗术中的应用比较

目的比较分析长托宁与东莨菪碱在全身热化疗术中对全身热疗的升温时间影响及热疗过程中患者心率的影响。方法选择23例病人,共做30次高温麻醉,分为长托宁组(A组)及东莨菪碱组(B组),前15次术中适时适量地给予长托宁,后15次适时适量的给予东莨菪碱。在全身麻醉方式不变和热疗仪仓内环境相对恒定的情况下,比较从基础体温上升到41℃时所需时间长短的变化以及在升温过程中患者的心率变化。结果A组从基础体温上升到41℃所需时间明显短于B组,A组在升温、恒温过程中心率变化小于B组。在高温过程中,患者心率超过120次/分钟时,适时适量地给予β-受体阻滞剂控制心率。结论在高温麻醉下通过全身热疗术中适时适量地给予长托宁可更明显缩短加热时间,在此过程中更有利于控制心率及循环稳定。     

经鼻持续气道正压通气对重症肺炎合并呼吸衰竭患儿血气及氧代谢指标的影响

目的探究经鼻持续气道正压通气对重症肺炎合并呼吸衰竭患儿血气及氧代谢指标的影响。方法选取2015年3月—2016年12月收治的重症肺炎合并呼吸衰竭患儿68例为研究对象,按照随机数表法将其分为两组,每组34例。两组患儿均行常规治疗,对照组行常规鼻导管吸氧治疗,观察组行经鼻持续气道正压通气治疗。比较两组:血气指标,包括PH值、动脉血二氧化碳、动脉血氧分压指标;氧代谢指标,包括血氧饱和度、氧消耗、氧输送、动脉血氧含量;治疗前后心率及呼吸频率。计量资料比较采用t检验,P0.05为差异有统计学意义。结果对照组p H值(7.28±0.15)、动脉血氧分压(7.16±0.82)k Pa均比观察组[(7.37±0.13)、(7.68±0.83)]k Pa低,对照组动脉血二氧化碳[(5.98±0.66)k Pa]比观察组[(5.46±0.62)k Pa]高,差异有统计学意义(P0.05);对照组血氧饱和度(91.62±2.39)%、氧输送(575.68±64.27)ml/(min·m2)、动脉血氧含量(161.58±19.64)m L/L比观察组[(96.75±1.84)%、(609.78±74.53)ml/(min·m2)、(178.65±20.18)m L/L]低,对照组氧消耗(137.87±20.16)ml/(min·m2)比观察组[(124.74±17.85)ml/(min·m2)]高,差异有统计学意义(P0.05);对照组治疗后心率频率(146.43±8.24)次/min及呼吸频率(44.58±5.87)次/min均比观察组[(131.63±7.56)次/min、(131.63±7.56)次/min]高,差异有统计学意义(P0.05)。结论经鼻持续气道正压通气可有效改善重症肺炎合并呼吸衰竭患者的低氧症状及血气指标,降低心率和呼吸频率,提高呼吸功能。     

右美托咪定对颅脑手术患者围手术期炎性细胞因子的影响

目的 研究右美托咪定(Dex),对颅脑手术患者围手术期炎性反应的影响.方法 择期颅脑手术患者40例随机分为对照组和试验组(右美托咪定组),每组20例,试验组在手术开始前30 min以右美托咪定0.5μg/kg微泵10 min静脉注射,后持续静脉泵注0.2 μg/(kg·h)维持至术毕前30 min;两组均采用静吸复合全麻,分别于麻醉诱导前、术毕、术后4h和术后24h抽取动脉血,测定血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)和肿瘤坏死因子a(TNF-a)水平.结果 试验组术毕、术后4h和术后24 h的TNF-a为(25.3±6.5、30.3±7.5、29.3±6.9)pg/ml,IL-6为(27.1±7.4、31.3±8.5、26.3±6.2)pg/ml,IL-8为(10.3±5.5、11.2±5.8、17.4±6.9)pg/ml;较对照组术毕、术后4h和术后24 h的TNF-a(30.9±7.7、37.3±8.9、35.3±8.2)pg/ml,IL-6(33.3±8.5、36.3±9.5、31.2±8.1)pg/ml,IL-8(14.3±6.3、15.3±6.5、25.5±8.5)pg/ml,IL-10(31.3±11.5、36.3±13.5、42.3±13.5)pg/ml均明显降低;而IL-10(41.3±12.4、48.3±14.6、55.3±14.8)pg/ml,较对照组IL-10(31.3±11.5、36.3±13.5、42.3±13.7)pg/ml显著升高,两组差异有统计学意义(P＜0.01或P＜0.05).结论 右美托咪定能减轻颅脑手术患者围手术期炎性反应,在减轻全身炎症反应的同时,也能抑制颅脑手术后促炎性细胞因子的过度诱导,对颅脑手术患者具有脑保护作用.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Hydrazine inhalation hepatotoxicity

Abstract Hydrazine is a hazardous chemical commonly used as a reactant in rocket and jet fuel cells. Animal studies have demonstrated hepatic changes after hydrazine inhalation. Human case reports of hydrazine inhalation hepatotoxicity are rare. We report a case of mild hepatotoxicity following brief hydrazine vapour inhalation in a healthy young man, which resolved completely on expectant management.     

Fitness standards in airline staff

Employers have a legal duty to manage safety and to meet this duty it is necessary to control risks arising from pre-existing medical conditions. Such conditions can be identified at the time of job placement, but there is little published information about the approach to fitness standards by most airlines. This review is therefore limited to the practice of one major airline. It is illustrated by reference to various occupations within the airline, with the associated rationale.