近红外光谱仪监测窒息新生儿听觉刺激诱发时的脑氧合代谢及脑血流变化

目的了解窒息新生儿在听觉刺激诱发脑神经活动时的脑氧合代谢和脑血流量的改变。 方法1998~2003年北京中日友好医院儿科选择窒息新生儿34例为窒息组，健康新生儿40名为对照组。使用近红外光谱仪，观察听觉刺激试验诱发的脑氧合血红蛋白\[Hb O2\]、还原血红蛋白\[Hb H\]和总血红蛋白\[Hb tot\]浓度的变化，并比较两组脑氧合代谢和脑血流量的改变。根据\[Hb O2\]、\[Hb H\]和\[Hb tot\]不同的变化，将氧合代谢曲线分为A(\[Hb O2\]、\[Hb H\]和\[Hb tot\]均增加)； B(\[Hb O2\]和\[Hb tot\]增加,\[Hb H\]降低)；C(\[Hb O2\]和\[Hb tot\]降低,\[Hb H\]增加)3种曲线类型。 结果窒息组中25例(25/34、73.5%)显示C型变化，对照组中28例(28/40、70.0%)显示A型变化，两组中A、C两型例数比较差异显著(P<0.05)。两组\[Hb O2\]和\[Hb tot\]数值变化幅度比较差异显著(P<0.05)。 结论窒息新生儿听觉刺激诱发相应皮层的神经活动时，显示局部脑血流量下降、氧合代谢降低，重度窒息儿更明显。     

关龙胆地上部分保肝作用研究

目的通过不同毒物引起的肝损伤来研究关龙胆地上部分的保肝作用。方法选用D-半乳糖胺、硫代乙酰胺、四氯化碳等3个肝损伤毒物造肝损伤模型,通过不同机制引起的肝损伤来研究关龙胆地上部分的保肝作用。结果关龙胆地上部分有一定的保肝作用,可降低各种肝损伤模型的ALT,AST,AKP等。结论关龙胆地上部分也有一定的药用价值,用全草取代地下部分入药有一定的可行性。     

清开灵粉针剂雾化吸入治疗老年呼吸系统疾病临床观察

目的 观察清开灵粉针剂雾化吸入治疗老年呼吸系统感染的临床疗效.方法 60例随机分为治疗组和对照组各30例,治疗组采用抗生素 清开灵粉针0.4g～0.6g,加入生理盐水20mL雾化吸入;对照组采用抗生素治疗,观察两组治疗前后临床疗效.结果 治疗组治疗后临床疗效优对照组(P＜0.05).结论 清开灵粉针剂雾化吸入治疗老年人呼吸道感染,疗效确切,未发现明显毒副作用.     

抗菌药物临床应用指导原则（3）各类抗菌药物的适应证和注意事项

1 青霉素类抗生素。本类药物可分为：(1)主要作用于革兰阳性细菌的药物，如青霉素(G)、普鲁卡因青霉素、苄星青霉素、青霉素V(苯氧甲基青霉素)。(2)耐青霉素酶青霉素，如甲氧西林(现仅用于药敏试验)、苯唑西林、氯唑西林等。(3)广谱青霉素．抗菌谱除革兰阳性菌外，还包括：①对部分肠杆菌科细菌有抗菌活性者，如氨苄西林、阿莫西林；②对多数革兰阴性杆菌包括铜绿假单胞菌具抗菌活性者，如哌拉西林、阿洛西林、美洛西林。     

国家级中医药Ⅰ类继续教育推广项目中国针灸学会水针刀三氧消融术尸体解剖提高研修班通知

水针刀三氧消融——融盘微创新技术是由中国骨伤微创分会执行主席、《全国高等院校骨伤教材》副主编、广州中医药大学第二附属医院（广东省中医院）主任导师、张仲景国医学院吴汉卿教授在水针刀疗法的基础上结合三氧技术所研发的微创新技术，已成功举办了170余期培训班，来自国内各地（含台湾、香港）和马来西亚、新加坡、韩国等国家的1万多名医生先后学习掌握了该项技术。为满足广大医师要求，继续开展以下培训：     

Influence of moderate hypothermia on cerebral oxygenation in pigs with intracranial hypertension

BACKGROUND: Moderate hypothermia is one of the effective therapeutic methods for head injury in recent years, there are many mechanisms of moderate hypothermia for brain protection, and its influence on cerebral oxygenation is also one of them. OBJECTIVE: To observe the influence of moderate hypothermia on cerebral oxygenation of animals with acute intracranial hypertension, and further investigate the protective mechanism of moderate hypothermia. DESIGN: A randomized controlled trial. SETTING: Department of Neurosurgery, Renji Hospital affiliated to the Medical College of Shanghai Jiao Tong University. MATERIALS: Twenty healthy little pigs, either male or female, weighing 4.5–5.5 kg, were used. Neurotrend-typed multiparameter monitoring system (Diametrics Company, British); CMA/100 micro-injection pump (Carnegie Company, Sweden). METHODS: The experiment was conducted in the Changzheng Hospital affiliated to the Second Military Medical University of Chinese PLA in November, 2001. The pigs were randomized into two groups: the normothermia group (control group, n =10) and moderate hypothermia group (n =10). ① Bilateral femoral arteries were separated, one was connected to pressometer for monitoring mean arterial pressure (MEP), and the other for analysis of blood gases [including peripheral blood pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of carbon dioxide (PaCO2), HCO3–]. ② Rectal temperature was monitored with mercurial thermometer. ③ Intracranial pressure was monitored using Camino optic ICP probe placed in the subdural space. ④ Neurotrend multiparameter monitoring sensor was inserted into the white matter for about 4 cm to determine cerebral perfusion pressure (CPP, CPP=MAP(ICP), brain tissue partial oxygen pressure (PO2), partial pressure of carbon dioxide (PCO2), HCO3– and brain temperature. The rectal temperature of animals in the moderate hypothermia group was lowered to 34 ℃ using ice bags, and the body temperature was maintained at 33–35 ℃ for 2 hours. The changes of the parameters were observed continuously, and the pigs in the normothermia group were not treated with cooling. MAIN OUTCOME MEASURES: ① MAP, ICP, rectal temperature, CCP; Indexes of cerebral oxygenation detected with Neurotrend-typed multiparameter monitoring system; ② Results of blood gases analysis in the moderate hypothermia group. RESULTS: All the 20 pigs were involved in the analysis of results. ① MAP, ICP, rectal temperature, CCP and indexes of cerebral oxygenation: In the moderate hypothermia group, the ICP after cooling was obviously lower than that before cooling [(3.31±1.19), (5.33±0.95) kPa, P < 0.05], CCP was higher, brain tissue PCO2 [(12.03±1.73), (10.59±2.01) kPa, P < 0.05], and brain tissue pH value was higher [(7.03±1.63), (9.40±1.30) kPa, P < 0.05], whereas the brain temperature was decreased as compared with that before cooling [(34.9±0.3), (37.2±0.2) ℃, P < 0.05]. ② Results of blood gases analysis in the moderate hypothermia group: There were no significant differences in the parameters of peripheral arterial blood gases analysis before and after cooling in the moderate hypothermia group (P > 0.05) CONCLUSION: Moderate hypothermia will not impair the cerebral oxygenation, and it can reduce brain tissue CO2 and decrease brain tissue acidosis.     

氧气雾化吸入在治疗慢性阻塞性肺疾病中的护理

目的:介绍氧气雾化吸入在治疗慢性阻塞性肺疾病中的护理方法.方法:结合78例慢性阻塞性肺疾病患者的护理经验,针对患者病情轻重采取抗感染、吸氧、平喘等综合雾化吸入治疗.结论:氧气雾化吸入可使慢性阻塞性肺疾病患者咳嗽、咳痰、气喘等症状得到明显改善.     

食管切除病人术后雾化吸入方式改进的临床观察

目的:探讨适用于食管切除术后病人更理想的雾化吸入方案,以促进病人有效排痰,预防术后肺部并发症.方法:选择重庆医科大学附属第一医院胸心外科2008年1月～6月行全麻开胸食管切除食管胃弓上吻合病人60例,随机分为2组,实验组采用0.45%氯化钠作为湿化剂持续24 h氧气雾化吸入,对照组采用0.9%氯化钠作为湿化剂行氧气雾化吸入4次/d.15min/次,并根据痰液的黏稠度增加雾化吸入次数.结果:两组病人在使用氧气雾化吸入后血气分析结果提示pH、PO2、PCO2值之间差异无统计学意义(P>0.05),实验组湿化适中例数多于对照组有统计学差异(P<0.01),湿化不足例数小于对照组有统计学差异(P<0.01),湿化过度例数无统计学差异(P>0.05).结论:食管切除术后病人采用0.45%氯化钠早期、持续氧气雾化吸入不仅降低痰液的黏弹性.还可维持血中氧分压的稳定.