层流洁净手术室空气日常监测方法效果观察

目的探讨层流洁净手术室空气日常监测有效方法。方法对层流洁净手术室百级、千级、万级各1间手术间,分别按《医药卫生洁净室(区)沉降菌的测试方法》GB/T16294-1996、《医药消毒卫生标准》GB/T15982-1995,在相同的温度、湿度下,共计8d,专人定时静态下,采用多点布控法(多点布控组)与常规布控法(常规布控组),分两组不同高度进行空气沉降法采样,30min后进行检测。结果多点布控与常规布控采样,细菌菌落数均未超标;无致病菌检出。多点布控组与常规布控组监测结果经t检验,有显著性差异(P<0.01)。多点布控采样效果优于常规布控组。手术区在0.8m、1.2m高度多点布控采样检测结果无细菌生长;周边区地面上采样与周边高度0.8m处采样监测结果经χ2检验,有显著性差异(P<0.05),多点布控周边区地面上采样阳性率高于周边高度0.8m采样。常规布控0.8m高度采样阳性率高于1.2m高度采样,采样监测结果经χ2检验,无显著性差异(P>0.05)。结论采用多点布控,手术区0.8￣1.2m高度、周边地面上采样进行空气沉降法监测是洁净手术室空气日常监测的有效方法。     

急性有机磷中毒动物血糖及胆碱酯酶活力的动态监测研究

目的：动态监测急性有机磷中毒动物在急性有机磷中毒及解救过程中血浆的乙酰胆碱酯酶活性和血糖值变化，依据此两项指标与中毒程度的相关性，为临床救治提供新的方法以及实验依据。方法：通过耳缘静脉注射5％敌百虫溶液（2mL／kg）先后对12只家兔建立急性有机磷中毒模型，分别在模型动物处于正常、轻、中、重度中毒和救治的时段采血，动态监测血浆乙酰胆碱酯酶活力和血糖两项指标变化。结果：在急性有机磷中毒过程中，血糖值升高与乙酰胆碱酯酶活力降低相比较，血糖浓度动态变化与中毒轻重程度相关性较好，并能体现机体对中毒的应激程度。结论：血糖浓度能较好地反映有机磷中毒深度以及机体应激程度，可作为临床评估危重程度的动态性快速诊断指标。     

Assessment of Rhythm and Rate Control in Patients with Atrial Fibrillation

A recent series of randomized prospective clinical trials that compared rate control with rhythm control in patients with atrial fibrillation (AF) found no significant difference in primary outcome between the two strategies. However, these trials lacked clear criteria for defining "successful" rate or rhythm control. Various measures have been used to gauge the success of antiarrhythmic drug therapy, including time to first recurrence of AF, any AF recurrence, AF burden, and a reduction in symptoms. Determining the success of antiarrhythmic therapy can be relatively straightforward by using how patients feel during therapy as a key endpoint. Most patients are satisfied with a major reduction in symptomatic AF episodes and can live comfortably with occasional episodes of AF. For those who are bothered by even infrequent, brief AF episodes, a treatment regimen that eliminates nearly all AF recurrences is required, although often hard to achieve. Catheter ablation may be necessary to achieve a successful outcome in these patients. Suppression of AF in a patient at high risk of stroke does not, however, remove the need for concomitant warfarin therapy. The endpoints of ventricular rate control are not clear, and the recently published rhythm versus rate control trials lacked standard criteria for judging acceptable rate control. One relatively simple method is to try and achieve a 24-hour heart rate that mimics expected normal sinus rhythm. It is important to achieve good rate control to minimize symptoms and the risk of tachycardia-mediated cardiomyopathy.     

动力髋螺钉治疗股骨转子间骨折

目的 评价动力髋螺钉(DHS)治疗股骨转子间骨折的临床效果。方法 1996年3月～2002年3月用DHS共治疗患者29例．骨折按Evans分型，本组Evans ⅠA2例，Evans ⅠB 10例，Evans ⅡA 3例，Evanslib12例，Evans Ⅲ2例．结果 29例患者均获随访，随访12～48个月，平均26个月，根据Harris髋关节评分：优16例，良9例，中3例，差1例。结论 如能及时手术良好复位，DHS是治疗股骨转子间骨折的较好选择。     

某镍冶炼厂工人指甲镍含量与接镍水平关系的研究

对某镍业公司车间空气中镍浓度和工人指甲镍含量进行了测定。按照生产过程和卫生学特点,将所获数据划分为碎矿压球、电炉转炉和汽车维修三组。空气镍浓度几何均值分别为0.0978、0.0623和0.0202mg/m~3;工人指甲镍几何均值分别为23.04、21.07和4.84μg/g;两者呈现一定的接触水平-反应关系。表明以指甲镍作为职业性接镍人群的生物监测指标有一定的参考价值。     

近端/远端复合肌肉动作电位振幅比率在术后面神经功能评估上的价值

目的 探讨近端/远端复合肌肉动作电位振幅比率在术后面神经肿瘤侵犯段功能评估上的价值和对早期面神经修复的指导意义。方法 比较术末面神经近端/远端复合肌肉动作电位振幅比率和术后2周、6个月患侧面神经功能的H-B分级之间的关系。结果 术后6个月面神经H-B分级恢复到Ⅰ-Ⅱ级者,术末近端/远端复合肌肉动作电位振幅比率均>0.3。结论 术末面神经近端/远端复合肌肉动作电位振幅比率是判断术后面神经远期功能,特别是肿瘤侵犯段功能的重要指标,为术中直接修复面神经提供了指导依据。     

术中电生理检测在肘管综合征的应用

目的 :探讨术中电生理监测在肘管综合征手术中的临床应用价值。方法 :对25例肘管综合征手术患者进行尺神经松解前后的电生理术中监测。结果 :术中尺神经肘管松解前后 ,传导速度提高50% ,潜伏期缩短30%,其中传导速度的改善有显著意义(P<0.05)。结论 :传导速度是较敏感的术中监测参数。肘管综合征术中应用电生理检测有一定临床意义。     

双源CT低剂量前瞻性心电触发序列扫描在冠状动脉血管成像的应用

Objective To evaluate low-dose CT coronary angiography with prospective electrocardiogram (ECG)-triggering using dual-source CT scanner.Methods Sixty-eight patients who underwent coronary CT angiography using a dual-source CT scanner were divided into 2 groups: group A (38 cases) and group B (30 cases).Prospective ECG-triggering sequence scan mode was employed for group A.Inclusion criteria included: heart rate <70 bpm, sinus rhythm, and heart rate fluctuation less than 10 bpm.Data acquisition was set at 70% of the RR-interval.Retrospective ECG-gating helical scan was performed for group B.Inclusion criteria included heart rates < 70 bpm and sinus rhythm.The exclusion criteria included heart failure and serious arrhythmias.In both groups, patients with a BMI≥24 kg/m2 were examined with a tube voltage of 120 kV, whereas patients with a BMI <24 kg/m2 were examined with a tube voltage of 100 kV.All images were transferred to a workstation for further processing and analysis.The imaging quality was evaluated.The imaging quality of coronary artery segments were compared with rank sum test between the two groups, and the radiation dose were compared with t test.Results A total of 476 coronary artery segments were evaluated in group A and 372 segments were evaluated in group B.The mean score of imaging quality for coronary artery segments in group A was 3.48±0.59 and that in group B was 3.53±0.58.There was no statistical difference in imaging quality between the two groups (Z=-1.432, P=0.187).The effective dose was on average (2.51±0.54) mSv (range 1.3--3.3 mSv) in group A, whereas on average (14.55±3.54) rosy (range 7.1--20.2 mSv) in group B.There was a statistical difference between the two groups (t=18.484, P=0.000).Conclusions Low-dose prospective ECG-triggering sequence scan in dual-source CT coronary angiography is feasible in patients with low heart rate and regular cardiac rhythm.This scan mode can substantially reduce radiation doses while preserving good diagnostic image quality.     

急性重型脑损伤患者脑组织氧代谢监测及意义

目的　探讨对急性重型脑损伤患者行脑组织氧代谢监测的临床意义。　方法对2 8例急性重型脑损伤患者 (均在全麻下急诊行血肿清除术和 (或 )去骨瓣减压术 )术中及术后持续进行脑组织氧代谢监测 ,观察脑组织氧分压 (PbtO2 )、二氧化碳分压 (PbtCO2 )和pH值 (pHbt)的变化。　结果　 (1) 2 8例脑外伤患者在剪开硬脑膜后PbtO2 、pHbt分别从 (13± 4 )mmHg、(6 .96± 0 .15 )增加至 (2 1± 5 )mmHg、7.0 5± 0 .12 (P <0 .0 5 ) ,PbtCO2 从 (6 1± 6 )mmHg下降至 (5 3± 5 )mmHg(P <0 .0 5 )。(2 )其中 2 4例脑外伤患者在血肿清除后 ,PbtO2 、pHbt值分别从 (2 1± 4 )mmHg、7.0 5± 0 .11增加至 (2 8± 6 )mmHg、7.15± 0 .10 (P <0 .0 5 ) ,PbtCO2 从 (5 2± 6 )mmHg下降至 (4 5± 4 )mmHg(P <0 .0 5 )。 (3)PbtO2 <10mmHg持续 30min以上的患者预后差。　结论　 (1)脑组织氧代谢监测是一种安全、可靠的监测手段 ,能直接动态反映脑组织的病理生理变化 ,及时发现脑组织缺血缺氧 ,以指导治疗。 (2 )持续进行脑组织氧代谢监测可判断重型脑外伤患者的预后。