静脉复合麻醉在无痛肠镜检查中的应用研究

目的:观察静脉复合应用异丙酚、芬太尼、阿托品在结肠镜检查中的临床效果及安全性。方法:静脉复合麻醉组113例静脉注射异丙酚、芬太尼、阿托品至患者进入3～4级镇静状态后行结肠镜检查,对照组86例按常规进行结肠镜检查,观察两组病人反应,检测血压、心率、氧饱和度的变化。结果:检查过程中麻醉组有一过性氧饱和度降低(P<0.05),对照组血压、心率不同程度增高(P<0.05),麻醉组患者对无痛肠镜技术满意,30min后能安全离院或安返病房。结论:复合应用异丙酚、芬太尼、阿托品于结肠镜检查中安全有效,优势互补,可减少各药物的用量,减少副作用的发生。     

异丙酚联合小剂量咪唑安定在肠镜检查中的应用

目的:研究异丙酚和小剂量咪唑安定在肠镜检查中麻醉效果和患者的满意程度。方法:将进行胃镜检查30例。随机分为对照组(n=15)和麻醉组(n=15),对照组患者常规进行肠镜检查;麻醉组患者静脉注射咪唑安定(1.5～2.0mg)和异丙酚(1.5mg/kg),患者意识消失后,立即进行肠镜检查。两组患者在胃镜检查中均监测血压、心率、氧饱和度的变化,检查后询问患者的满意程度。结果:麻醉组心率和血压与对照组相比均有明显下降(P<0.05);两组氧饱和度差异无统计学意义(P>0.05);麻醉组满意程度高于对照组(P<0.05)。结论:异丙酚联合小剂量咪唑安定进行肠镜检查是一种安全有效、舒适、易被接受的无痛肠镜检查。     

麻醉肠镜检查安全性分析

目的：探讨异丙酚复合芬太尼麻醉进行结肠镜检查的安全性。方法：观察异丙酚复合芬太尼麻醉下进行结肠镜检查的351例患者术中、术后不良反应及并发症的发生率,评估麻醉肠镜检查的安全性。以同期进行常规结肠镜检查的351例患者为实验对照。结果：麻醉肠镜检查完成率高于常规肠镜检查组;检查过程中患者生命体征基本平稳,无严重并发症发生。结论：丙泊酚复合芬太尼麻醉实施无痛苦结肠镜检查安全可行。     

小剂量异丙酚复合芬太尼用于老年人无痛胃镜的临床观察

目的 观察小剂量异丙酚复合芬太尼在老年人无痛胃镜中的临床效果.方法 选取该院2007年5月～2009年10月170例无痛胃镜检查的老年患者,随即分为对照组与治疗组,治疗组给予异丙酚0.6～0.8mg/kg,芬太尼0.5μg/kg;对照组给予咪唑安定0.03～0.04 mg/kkg,异丙酚1~2mg/kg静脉滴注.给药后观察患者1、5、10及15min的血压、心率和血氧饱和度的变化,观察患者有无体动、呕吐、呼吸循环严重抑制等症状产生.结果 治疗组给药前后MAP、HR、SPO2差异无显著性(P>0.05);对照组给药后MAP、SPO2、呈明显下降趋势(P<0.05);治疗组比对照组术后麻醉清醒时间明显缩短(P<0.01).结论 小剂量异丙酚复合芬太尼用于老年人的无痛胃镜的临床观察是安全的,期间呼吸循环稳定.     

咪唑安定、芬太尼和异丙酚用于结肠镜检查

目的：在结肠镜检查中辅以良好的镇静和镇痛，减少患者的痛苦，提高检查成功率。方法：290例患者，随机分为MF（210例，咪唑安定和芬太尼静脉注射）和MP两组（80例，咪唑安定和异丙酚静脉注射），观察记录两组患者的血压、心率、血氧饱和度、操作时间、苏醒时间和不良反应。结果：两组患者给药后血压、心率和血氧饱和度均有不同程度的下降，但在正常范围内；两组检查顺利完成，操作时间无差异，MP组的苏醒时间短于MF组，两组不良反应均较轻微。结论：咪唑安定和芬太尼或咪唑安定和异丙酚均可安全有效地用于结肠镜检查，明显地减轻了患者的痛苦。     

异丙酚联合芬太尼在胃肠镜检查中的应用

目的：研究小剂量异丙酚联合芬太尼静脉麻醉在胃肠镜检查中的安全性.方法：比较胃镜麻醉组、肠镜麻醉组与对照组检查中的反应及检查前、中、后BP、HR及 SpO2的变化.结果：胃镜麻醉组恶心、呕吐、咳嗽、躁动发生率分别为1.2%、3.8%、1.2%,而对照组为97.5%、22.5%、28.8%,P ＜0.001.胃肠镜检查麻醉组耐受性好.结论：小剂量异丙酚联合芬太尼静脉麻醉用于胃肠镜检查,安全有效,耐受性好,有利于病灶的观察.     

不同麻醉药物配伍在结肠镜检查中的应用

目的探讨两种麻醉药物配伍在结肠镜检查中的可行性和安全性。方法入选900例,2002年8月￣2003年5月在该科接受无痛结肠镜检查的380例为A组,给予咪唑安定0.1mg/kg,芬太尼0.05￣0.10mg/例;2003年6月￣2005年5月520例为B组,给予咪唑安定0.04mg/kg,芬太尼0.02￣0.05mg/例,异丙酚0.3￣3.0mg/kg。观察两组的药物起效时间、苏醒时间、镜检满意度、药物的用量及血压、心率及血氧饱和度的变化。结果两组患者都能顺利完成结肠镜检查,没有严重不良反应的发生。B组中药物起效时间、苏醒时间、镜检满意度都明显优于A组(P<0.05);咪唑安定和芬太尼的累计剂量都少于A组;对血压、心率和血氧饱和度的影响B组明显低于A组(P<0.05)。结论在结肠镜检查中两种麻醉药物配伍都是安全、有效的镇静麻醉方法,其中后者更适合门诊患者使用。     

咪唑安定联合芬太尼/异丙酚在结肠镜检查中的应用探讨

目的　使结肠镜检查更加顺利 ;比较两种方法的优缺点 ,使镇静镇痛技术在结肠镜检查中更有选择性。方法　共 30 2人进行了结肠镜检查 ,分为MF组 (咪唑安定 +芬太尼n =90 ) ,MP组 (咪唑安定 +异丙酚n =16 2 ) ,普通对照 (n =5 0 )。MF组镜检前予咪唑安定 1～ 2mgiV ,芬太尼 5 0mgim ;MF组镜检前予咪唑安定 1～ 1.5mgiV ,异丙酚 0 .5～ 2 .0mg/KgiV (Range 2 5～ 14 5mg) ,直到患者进入浅睡眠状态 ,睫毛反射消失 ,呼吸平稳后 ,开始进行肠镜检查或治疗 ;对照组未给予任何药物。检查时均给予吸氧。结果　MF组、MP组均取得了良好的镇静镇痛效果 ,MP组作用更显著 (P <0 .0 0 1) ;MF组记忆缺失率明显低于异丙酚组 ;MP组与其他两组相比 ,其对脉搏的影响有显著差异 (P <0 .0 5 ) ,对血压的影响有显著差异 (P <0 .0 0 1) ,影响血压严重改变发生率有显著差异 (P <0 .0 0 1)。三组之间对SPO2 的影响无差别。MF组与对照组相比 ,对Bp、P、SPO2 的影响无差别。结论　咪唑安定联合芬太尼 /异丙酚均有良好的镇静镇痛效果。咪唑安定联合芬太尼更适用于有心血管疾患的病人 ;咪唑安定联合异丙酚对于高度紧张的患者不失为理想的选择     

异丙酚联合芬太尼麻醉用于结肠镜检查的临床观察

目的观察异丙酚联合芬太尼应用于结肠镜检查的麻醉效果。方法选择100例行结肠镜检查的病人,随机分为PF组(异丙酚 芬太尼n=50)和P组(异丙酚n=50)。PF组在镜检前静注芬太尼1 μg/kg、异丙酚1 mg/kg, 异丙酚30 ml/h静脉泵注;P组镜检前异丙酚1.5 mg/kg静脉注射,异丙酚30 ml/h静脉泵注。直到患者进入浅睡眠状态,睫毛反射消失后,开始进行肠镜检查。检查时均予以吸氧。结果PF组镇痛效果优于P组(P<0.05),BP、HR、SpO2、操作时间、苏醒时间、离院时间及不良反应两组相比差异无显著性。结论异丙酚联合芬太尼麻醉技术,起效快、镇痛完善、苏醒迅速、不良反应较少,可安全有效地应用于结肠镜检查中。     

异丙酚+氯诺昔康+氯胺酮静脉复合麻醉行无痛消化内镜诊疗术的临床研究

目的 探讨静脉复合麻醉在无痛消化内镜中的疗效.方法 将460例进行消化内镜术的患者按随机数字表法分为观察组230例和对照组230例.观察组用异丙酚+氯诺昔康+氯胺酮静脉复合麻醉进行无痛胃肠镜检查治疗;对照组患者只采用异丙酚进行无痛胃肠镜检查治疗.观察2组患者检查前(T0)、内镜到达检查终点时(T1)、内镜退出患者时(T2)、患者苏醒时(T3)4个时间点的血氧饱和度、心率及呼吸频率变化.结果 在T1,T2时间点,观察组患者血氧饱和度、心率及呼吸频率均高于对照组(P＜0.05).在T0、T3时间点,治疗组患者血氧饱和度、心率及呼吸频率与对照组相比差异无统计学意义(P＞0.05).结论 异丙酚+氯诺昔康+氯胺酮静脉复合麻醉行无痛消化道内镜检查治疗是一种安全有效的麻醉方式.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Trust and distrust between patient and doctor

To trust someone is to have expectations of their behaviour; distrust often involves disappointed expectations. But healthy trust and distrust require a good understanding of which expectations are reasonable, and which are not. In this paper, I discuss the limits of trustworthiness by drawing on recent studies of trust in the context of defensive medicine, biobanking and cardiopulmonary resuscitation decisions.     

妊娠合并血小板减少症与心、肝、肾脏器损伤

目的探讨妊娠合并血小板减少症伴随重要脏器的损伤情况。方法前瞻性研究我院及北华大学附属医院2004年10月至2005年5月妊娠合并血小板减少症的临床资料，对41例妊娠合并血小板减少症者尿素氮（BUN）、肌酐（CREA）、谷丙转氨酶（ALT）、乳酸脱氢酶（LDH）的测定及妊娠期高血压疾病与血小板计数（PLT），血小板平均体积（MPV）和血小板体积分布宽度（PDW）参数的测定进行对比分析。结果妊娠合并血小板减少症患者心、肝、肾等重要脏器均有不同程度的改变，且随着血小板计数降低，损害程度加剧，差异具有显著性（P〈0．01）。妊娠期高血压疾病，随着疾病程度的加重，血小板计数较正常孕妇明显减少，MPV、PDW明显升高，有显著性差异（P〈0．01）。结论血小板参数是判断疾病的重要参考指标，肝、肾、心脏器损伤程度与血小板计数具有相关性。