不同时段泵注右美托咪啶对开颅手术麻醉苏醒质量的影响

目的探讨术前、术中、术毕不同时段泵注右美托咪啶对开颅手术麻醉苏醒质量的影响。方法将我院2012-12—2013-12入院的120例进行开颅手术的患者随机分成对照组、术前组、术中组和术后组,每组30例。给予相应的干预处理后,观察患者的心率、Ramsay镇静评分变化,并比较恶心呕吐、心动过缓和呼吸抑制等不良反应。结果拔管时及拔管后5、10、15、30和60min时间点,术后组患者镇静评分显著高于对照组(P0.05)。与术前组和术中组比较,差异也有统计学意义(P0.05)。术后组患者的拔管时间平均为(48.7±4.5)min,显著长于对照组、术前组和术中组的(22.3±3.2)min、(14.9±2.8)min和(16.9±2.9)min,差异具有统计学意义(P0.05)。不良反应发生率各组比较无差异。结论围术期应用右美托咪啶镇静效果突出,可以防止气管拔管引起的HR加快,且不增加不良反应,值得在临床中推广使用。     

右美托咪定对颅内动脉瘤全麻下介入术后拔管期血流动力学的影响

目的 观察右美托咪定对全麻下颅内动脉瘤介入术后拔管期血流动力学的影响。方法 回顾性分析2016年1月至2018年12月全麻下介入治疗的66例颅内动脉瘤的临床资料,其中33例术后应用右美托咪定治疗（观察组）,33例未应用右美托咪定治疗（对照组）。记录拔除气管插管前（T1）、拔管时（T2）、拔管后5 min（T3）、拔管后30 min（T4）和拔管后1 h（T5）心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）。采用Minogue评分评价拔管时呛咳反应;应用镇静和躁动量表（SAS）评分评估躁动情况;采用Ramsay镇静评分评估镇静情况。结果 T1,两组MAP、HR无统计学差异（P>0.05）;T2~T5,观察组HR、MAP明显低于对照组（P<0.05）。T1~T5,两组SpO2均无统计学差异（P>0.05）。观察组拔管时Minogue评分、SAS评分均明显低于对照组（P<0.05）,而拔管后30 min的Ramsay镇静评分明显高于对照组（P<0.05）。结论 颅内动脉瘤全麻下介入术后应用右美托咪定可维持拔管期血流动力学平稳,可有效抑制围手术期的应激反应,无呼吸抑制。     

神经外科手术全麻术后躁动的不同预防方式对比

目的观察右美托咪定持续静脉泵注和手术结束前30min单次静注舒芬太尼对神经外科手术全麻术后躁动的影响。方法全麻下神经外科手术患者60例,随机分为右美组、舒芬组和对照组各20例。全麻诱导及术中维持相同,其中右美组诱导后持续静脉泵注右美托咪定0.5μg/(kg·h)至手术结束前30min停药。舒芬组手术结束前30min单次静注舒芬太尼0.15μg/kg。对照组诱导后持续静脉泵注生理盐水10mL/h至手术结束前30min停药。记录不同时间点MAP、HR、SpO2及术毕自主呼吸恢复时间、呼之睁眼时间、拔管时间、拔管后5min躁动程度、躁动发生率。结果与对照组比较,右美组和舒芬组拔管即刻及拔管后5min的血压明显降低,心率明显减慢,术后躁动程度及发生率明显降低,差异均有统计学意义(P0.05)。结论右美托咪定持续静脉泵注和舒芬太尼手术结束前30min单次静注均能稳定全麻苏醒期患者血压、心率,降低躁动发生率,且不延长自主呼吸恢复时间、呼之睁眼时间、拔管时间,无明显不良反应,可有效预防神经外科手术全麻术后躁动。     

食管癌根治术中应用右美托咪定麻醉对患者术后认知功能的影响

目的探讨右美托咪定对食管癌根治术全麻患者术后认知功能的影响。方法将76例食管癌根治术全麻患者随机分为2组,每组各38例,两组均给予芬太尼持续静脉泵入镇痛,对照组予以力月西麻醉,观察组予以右美托咪定麻醉,比较两组镇静效果,认知功能和不良反应发生率。结果两组镇静效果时间无显著性差异比较(P>0.05);但观察组停药后苏醒时间短于对照组(P<0.05);观察组不良反应发生率低于对照组(P<0.05)。观察组治疗后威斯康辛卡片分类测验(WCST)总应答数、持续性错误数、非持续性错误数显著低于对照组,正确应答数、完全分类数显著多于对照组,差异具有统计学意义(P<0.05)。结论与力月西比较,右美托咪定用于食管癌根治术全麻中的镇静效果好,对患者认知功能影响较小,且不良反应发生率低。     

右美托咪定在小儿脑室-腹腔分流术中的应用

目的观察右美托咪定在小儿脑室-腹腔分流术中对血流动力学、术毕苏醒期躁动的影响以及脑保护作用。方法74例行脑室-腹腔分流术的先天性脑积水患儿,通过随机数表法分为观察组D组(37例)和对照组N组(37例)。观察组先给予1μg/kg的右美托咪定负荷量静脉泵入后再以0.5μg/(kg·h)速度维持给药,对照组使用同容量的生理盐水。比较2组术中MAP和HR的变化,比较2组拔管时间和苏醒时间,测定不同时间点血清中S100β蛋白和神经元特异性烯醇化酶(NSE)的浓度,根据Ramsay评分和FLACC评分评价患儿术后躁动和镇痛情况。结果 D组术中、术后MAP和HR变化均小于对照组N组(P0.05);2组拔管时间、苏醒时间无明显差异(P0.05));N组NSE和S100β蛋白浓度在术后各时间点均高于D组(P0.05);D组Ramsay评分高于N组而FLACC评分低于N组,差异有统计学意义(P0.05)。结论右美托咪定在小儿脑室-腹腔分流术中的应用,可较好地稳定术中患儿的生命体征,减少苏醒期躁动,提高苏醒质量,且有一定的脑保护作用。     

右美托咪定滴鼻对颅内动脉瘤介入治疗全麻拔管期血流动力学的影响

目的 观察右美托咪定滴鼻对颅内动脉瘤介入治疗全麻拔管期血流动力学的影响。方法 选择择期行介入治疗的颅内动脉瘤80例，根据滴鼻药物分为4组（n=20），即对照组（C组）和低、中、高剂量右美托咪定组（D1组、D2组、D3组）。手术结束前30 min，D1、D2、D3组用右美托咪定0.6、1.0、1.4 μg/kg滴鼻，C组用生理盐水滴鼻。记录入室时（T0）、滴鼻前即刻（T1）、手术结束时（T2）、患者苏醒时（T3）、拔管时（T4）、拔管后1 min（T5）、5 min（T6）心率（HR）、平均动脉压（MAP）、收缩压与心率的乘积（RPP）；记录术后恢复指标（包括苏醒时间、拔管时间、拔管质量评分、Ramsay镇静评分）。结果 与C组比较，D1组T3~T5、D2和D3组T2~T6 MAP、RPP、HR均明显降低（P<0.05）；D2组和D3组拔管质量评分均明显降低（P<0.05）、Ramsay评分均明显增高（P<0.05），D3组苏醒时间及拔管时间均明显延长（P<0.05）。与D1组比较，D2和D3组T3~T6 MAP、RPP、HR均明显降低（P<0.05），D3组拔管质量评分明显降低（P<0.05）、RamaSay评分明显增高（P<0.05），苏醒时间及拔管时间均明显延长（P<0.05）。与D2组比较，D3组苏醒时间及拔管时间均明显延长（P<0.05）。D2和D3组HR、MAP、RPP、拔管质量评分、Ramsay镇静评分均无统计学差异（P>0.05）。结论 手术结束前30 min给予右美托咪定1.0 μg/kg滴鼻全麻拔管期血流动力学平稳，同时不影响术后恢复。     

右美托咪啶应用于功能神经外科手术麻醉的效果探讨

目的探讨右美托咪啶应用于功能神经外科手术麻醉的效果。方法收集我院收治的功能神经外科手术患者214例,随机分为观察组与对照组各107例。2组均予以七氟醚吸入全屏静脉麻醉,观察组加用右美托咪啶,对照组加用等剂量生理盐水,比较2组麻醉效果。结果观察组的镇静效应显著优于对照组,瑞芬太尼与丙泊酚用量显著低于对照组,Ramesay评分显著高于对照组,OAA/S评分显著低于对照组(P0.05);2组恢复自主呼吸时间、苏醒时间以及清醒拔管时间无明显差异(P0.05)。结论右美托咪啶应用于功能神经外科手术麻醉有利于提高麻醉镇静效果,降低麻醉药物用量,具有较好的安全性,值得推广应用。     

右美托咪啶对颅内动脉瘤手术患者全麻苏醒期躁动的影响研究

目的观察右美托咪定对颅内动脉瘤夹闭术患者,全麻苏醒期躁动的影响。方法选53例Hunt-Hess分级Ⅰ或Ⅱ级颅内动脉瘤患者行择期手术。随机分为右美托咪定组(治疗组)和生理盐水组(对照组)。治疗组手术结束前30 min微量泵静脉输注右美托咪定1μg/kg,持续泵入约20 min;对照组持续泵入生理盐水。记录两组患者手术结束拔管前(T1)、拔管时(T2)和拔管后5 min(T3)、平均动脉压(MAP)、血压(HR)和血氧饱和度(Sp O2),并对两组患者的术后唤醒、呼吸恢复和拔管时间进行记录对比,记录两组患者拔管后5 min、30 min、60 min、120 min躁动情况、躁动程度、镇痛、镇静状况,采取Riker sedation and agitation score (SAS)镇静、躁动评分,进行评估。结果两组患者在各时间点Sp O2差异无显著性统计学意义,在T2、T3两个时间点,治疗组患者MAP明显降低,HR明显减慢,差异有显著性统计学意义(P 0. 01)。对两组患者自主呼吸恢复时间、呼唤睁眼时间、拔管时间比较无明显差异(P 0. 05),无统计学意义。治疗组患者术后躁动程度及发生率,明显低于对照组(P 0. 05),差异有统计学意义。结论右美托咪定能明显抑制颅内动脉瘤手术患者,全麻苏醒期的应激反应,降低躁动程度,有利于血流动力学的稳定。     

右美托咪定用于脑膜瘤切除术患者的麻醉效果及安全性分析

目的观察右美托咪定用于脑膜瘤切除术患者中的麻醉效果,分析右美托咪定在脑膜瘤切除术中的应用价值及安全性。方法选取2015-01—2016-01郑州大学人民医院诊断治疗的脑膜瘤患者65例为研究对象,随机分为实验组和对照组,2组患者术前采取相同的常规麻醉诱导,实验组麻醉诱导前注射右美托咪定,对照组麻醉诱导前注射生理盐水,观察并对比2组患者入手术室时、切皮时及拔管时的收缩压(SBP)、舒张压(DBP)及心率(HR)等指标,同时对比2组患者麻醉时间、自主呼吸恢复时间、定向力恢复时间及苏醒期不良反应发生率等,分析右美托咪定在脑膜瘤切除术中的麻醉效果及安全性。结果 2组患者入手术室时的SBP、DBP及HR无明显差异(P0.05),切皮时和拔管时的SBP、DBP及HR比较差异有统计学意义(P0.05);2组患者的麻醉时间和定向力恢复时间无明显差异(P0.05),实验组患者的自主呼吸恢复时间明显小于对照组,差异具有统计学意义(P0.05);实验组患者苏醒期恶心呕吐、呛咳、躁动及呼吸抑制的发生率分别为17.1%、37.1%、22.9%及0,对照组分别为40.0%、66.7%、46.7%及16.7%,2组差异均具有统计学意义(P0.05)。结论右美托咪定用于脑膜瘤切除术患者中麻醉效果显著,不良反应发生率低,安全性高,具有一定的临床应用价值。     

两种剂量右美托咪定用于神经外科手术麻醉的临床比较

目的评价两种剂量右美托咪定用于神经外科手术麻醉的效果。方法选取择期全身麻醉下行神经外科手术患者90例,随机分为右美托咪定0.5μg·kg~(-1)·h~(-1)(D1组)、右美托咪定0.2μg·kg~(-1)·h~(-1)(D2组)和对照组(C组)每组各30例。D1组和D2组分别于麻醉诱导前10min静注右美托咪定负荷剂量0.7μg/kg,随后分别以0.5μg·kg~(-1)·h~(-1)和0.2μg·kg~(-1)·h~(-1)维持至硬膜关闭完全,C组给予等容量的生理盐水。记录入室(T_0)、气管插管时(T_1)、手术开始时(T_2)、钻颅骨时(T_3)、手术结束时(T_4)、拔管时(T_5)、拔管后5min(T_6)的平均动脉压(MAP)、心率(HR);记录异丙酚和瑞芬太尼用量;记录自主呼吸恢复时间、拔管时间和不良反应发生情况。结果 D1组的平均动脉压、心率与T0比较波动范围小,与D2组、C组比较血流动力学较平稳,差异有统计学意义(P0.05);与C组和D2组比较,D1组异丙酚和瑞芬太尼用量减少,苏醒期恶心呕吐、呛咳及躁动的发生率降低,差异有统计学意义(P0.05);3组间自主呼吸恢复时间和拔管时间比较差异无统计学意义(P0.05)。结论诱导前静注右美托咪定0.7μg/kg,继之以0.5μg·kg~(-1)·h~(-1)维持,血流动力学稳定,有效抑制插管和拔管时的应激反应且不影响拔管时间,减少异丙酚和瑞芬太尼用量,降低苏醒期不良反应的发生率。     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

广西农村壮族妇女精神分裂症患者生活质量状况调查

目的研究农村壮族妇女精神分裂症患者的生活质量及影响因素。方法前瞻性的队列研究。采用随机分层抽样法分为农村壮族妇女精神分裂症组、农村汉族妇女精神分裂症组、农村正常妇女对照组,应用“世界卫生组织生存质量测定报告”(WHOQOL-100)及PANSS量表调查其生活质量和疾病的严重程度。结果农村壮族妇女精神分裂症患者生活质量明显低于农村汉族妇女精神分裂症患者,影响其生活质量的相关因素是生活环境及精神支柱/个人信仰。结论经济贫困、环境条件、缺乏有效的医疗服务和社会保障是农村壮族妇女精神分裂症患者生活质量低的关键。因此,建立农村壮族社区精神卫生服务网络势在必行。     

《绵阳市社会心理服务工作管理办法》解读

2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

The origins of innervation of the esophagus of the dog

This study defined the origins of extrinsic efferent and afferent innervation of the normal canine esophagus. When all the layers of the wall of the 3 esophageal regions (cervical, thoracic and abdominal) were injected with horseradish peroxidase (HRP), labeled nerve cells were found in the nucleus ambiguus (NA) and parasympathetic nucleus of X (PX) of the brainstem. Most labeled cells in the NA were located in the compact column (retrofacial nucleus) while labeled cells in the PX were located in separate rostral and caudal areas. There was no somatotopic organization in either the NA or PX. Labeled sympathetic postganglionic neurons were found in the cranial cervical, middle cervical, cervicothoracic, thoracic sympathetic trunk and celiacomesenteric ganglia. The HRP injection of the esophageal wall labeled sensory cell bodies in the glossopharyngeal, proximal and distal vagal, and C2-T6 spinal ganglia. There was no discernible pattern of distribution of labeled cells in the autonomic or sensory ganglia. When the HRP injections were confined to the mucosa-submucosa layers of the thoracic esophagus, a small number of labeled cells were identified in the NA; however, no labeled cells were found in the NA when injections were confined to the mucosa-submucosa of either the cervical or abdominal esophageal regions. With these confined injections, the labeled nerve cells appeared in the rostral part of the PX. Thus, it appeared that the internal tunics of the esophagus (i.e., the mucosa and submucosa) were innervated by neurons in the rostral PX while the muscular tunic was innervated by neurons in the caudal PX and the rostral NA. After mucosa-submucosa injections, labeled sympathetic neurons appeared in the same ganglia that were identified after whole wall injections and these had a similar random distribution. These injections also labeled neurons in the glossopharyngeal, proximal vagal, and distal vagal ganglia, but unlike the whole wall injections there was no labeling in the spinal ganglia. This suggested that the labeled cells of the spinal ganglia seen after whole wall injections conveyed impulses from the tunica muscularis and serosa.     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.