透析液钙离子浓度对肾功能衰竭血液透析患者血清钙离子水平及血压的影响

目的 观察不同钙离子浓度的透析液对血液透析患者透析后血清钙离子水平及血压变化的影响，为肾功能衰竭血液透析患者的高钙血症及高血压的防治提供依据。方法 选择不同钙离子浓度的透析液，将维持性血液透析患者分为高钙组（1．75mmol／L）和低钙组（1．25mmol／L），比较患者每次透析前后脉搏、血压，同时抽查患者透析前后血钙及血肌酐浓度的变化。结果透析后两组患者血肌酐浓度均显著下降，透析前后差异均具有统计学意义（P〈0．01）；高钙组患者透析后血钙较透析前升高，差异具有统计学意义（P〈0．01），而低钙组患者血钙比透析前略降低，差异无统计学意义（P〉0．05）。高钙组患者透析后较透析前收缩压、舒张压及平均动脉压都升高，差异均具有统计学意义（P〈0．05），而低钙组患者透析后较透析前收缩压、舒张压及平均动脉压都降低，差异均具有统计学意义（P〈0．05）。透析后两组血钙比较差异具有统计学意义（P〈0．01）；透析后低钙组较高钙组患者的收缩压、舒张压及平均动脉压都降低，三者差异均具有统计学意义（P〈0．01）。结论透析液钙离子浓度与血液透析患者血清钙离子水平及血压呈正相关，低钙透析液透析有助于维持性血液透析患者高血压的控制。     

缬沙坦治疗糖尿病肾病的疗效观察

目的:观察血管紧张素Ⅱ,Ⅰ型受体拮抗剂(AT1Ra)缬沙坦(Valsartan)对伴大量白蛋白尿的临床糖尿病肾病的治疗作用。方法:32例2型糖尿病患者,24h尿白蛋白排泄率(24hUAER)>200μg/min,均伴高血压,维持原糖尿病治疗不变,分组比较应用缬沙坦(80mg/d)或贝那普利(10mg/d)治疗8周前后平均动脉压(MAP)、24hUAER、HbA1c、尿酸(UA)等指标的变化。结果:缬沙坦治疗组和贝那普利治疗组24hUAER分别由703.2±987.9μg/min降至664.2±970.6μg/min(P<0.01)和由778.6±1005.0降至734.9±996.0μg/min(P<0.01)。二者疗效相似,且均与血压变化不相关。结论:AT1Ra缬沙坦可以降低临床糖尿病肾病的蛋白尿,其肾脏保护作用除了与降血压有关,还有不依赖降压效应的其他机制。     

亚低温治疗重型颅脑损伤中脑组织氧分压的临床意义

目的观察亚低温治疗重型颅脑损伤过程中患者颅内压及脑组织氧分压的变化及临床意义。方法将80例急性重型颅脑损伤患者,随机分为亚低温治疗组(40例)和对照组(40例)。亚低温组入院后或术后立即给予亚低温治疗,保持肛温在32~34℃,持续24h~5d;对照组给予常规治疗。两组均观察颅内压(ICP)和脑组织氧分压(PbtO2)变化。结果亚低温组治疗后,ICP明显下降,PbtO2逐渐升高,与对照组相比有显著性差异。结论亚低温治疗能降低脑外伤后增高的ICP,提高PbtO2;伤后24h内持续PbtO2<5mmHg预示患者预后不良。     

社区护理工作绩效评价体系的建立与实践

目的为了探索一套适合我国社区卫生服务机构持续健康发展的护理管理模式，以提高社区护理管理效应。通过专家评定法以及全体护理人员讨论的方法，给予每项护理工作以适当的权重，以此建立社区护理工作绩效量化评价体系，并组织实施。实施后，在社区护理工作方面形成了良好的管理导向，建立了有效的激励机制，提高了护理工作质量、效率和效益。因此，可以认为在社区护理实施工作绩效量化评价体系，是值得推广的一项举措。     

机械压力对人脐静脉内皮细胞ET-1、NO合成的影响和意义

目的探讨压力增高对血管内皮细胞分泌血管活性物质功能的影响及其在门静脉高压症发病机制中的作用。方法用RT-PCR方法半定量研究人脐静脉内皮细胞ET-1、eNOS、i-NOS mRNA的表达;用硝酸还原酶法检测各组细胞培养液中NO代谢产物NO2-/NO3-的含量,免疫荧光标记激光扫描共聚焦显微镜检测培养细胞的ET-1蛋白表达。结果ET-1和eNOS mR-NA在正常培养的内皮细胞中即有表达,iNOS mRNA则几乎无表达。生理水平压力刺激下各组各待测基因mRNA表达与对照组无显著性差异。超生理范围压力刺激后,ET-1 mRNA有显著性升高。eNOS mRNA在40 mm Hg 24 h后才有显著性差异。iNOS mRNA在不同条件下均无显著变化。在细胞培养液中分别加入细胞外钙螯合剂EGTA、PKC抑制剂后,则见ET-1、eNOS mRNA表达下降。结论压力增高可刺激血管内皮细胞合成ET-1、NO,其作用在转录水平,其作用机制分别与PKC信号通路和细胞外钙浓度有关。门静脉压力增高与血管内皮细胞合成ET-1、NO增多之间存在相互作用。     

Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery

The use of vacuum assisted closure (V.A.C.) therapy in postoperative infections after dorsal spinal surgery was studied retrospectively. Successful treatment was defined as a stable healed wound that showed no signs of acute or chronic infection. The treatment of the infected back wounds consisted of repeated debridement, irrigation and open wound treatment with temporary closure by V.A.C. The instrumentation was exchanged or removed if necessary. Fifteen patients with deep subfascial infections after posterior spinal surgery were treated. The implants were exchanged in seven cases, removed completely in five cases and left without changing in one case. In two cases spinal surgery consisted of laminectomy without instrumentation. In two cases only the wound defects were closed by muscle flap, the remaining ones were closed by delayed suturing. Antibiotic treatment was necessary in all cases. Follow up was possible in 14 patients. One patient showed a new infection after treatment. The study illustrates the usefulness of V.A.C. therapy as a new alternative management for wound conditioning of complex back wounds after deep subfascial infection.     

双水平气道正压无创通气用于老年患者全麻恢复期的呼吸支持

目的研究双水平气道正压(BiPAP)通气在老年患者全麻恢复期呼吸支持的可行性。方法30例择期手术的老年患者随机分为BiPAP组与对照组,每组15例。在术前、拔管后、吸氧或无创通气1h后三个时点比较血液动力学、动脉血气分析参数和呼吸动力学指标。结果两组患者血液动力学的各项指标在各时点差异无显著意义;BiPAP组无创通气1h后PaCO2较拔管后降低,与对照组吸氧1h后比PaCO2低;拔管后两组患者PaO2较术前降低,BiPAP组吸氧1h可提高PaO2。BiPAP无创通气1h后,VTi、VE、Cdyn升高,RAWm降低;而对照组吸氧1h后较拔管后无明显改善。结论老年患者短期BiPAP面罩支持无创通气耐受性好,对血液动力学无明显影响,可以改善通气和氧合,降低气道阻力,提高肺顺应性。     

有关医院空调水系统若干问题的探讨

主要阐述空调水系统利用平衡阀调节系统阻力,保持系统水力稳定;利用软启动器实施水泵的平滑软启动;压差旁通阀的作用及选型安装;系统管道热膨胀等问题。     

IS THERE A SPECIFIC LINKAGE BETWEEN OBSTRUCTIVE SLEEP APNEA SYNDROME AND GASTROESOPHAGEAL REFLUX DISEASE?

Obstructive sleep apnea syndrome (OSAS) is a common condition characterized by repetitive sleep‐induced collapse of the upper airways. It is associated with increased risk for hypertension, ischemic heart disease, cerebral stroke, and traffic accidents. In contrast, gastroesophageal reflux disease (GERD) is a very common disorder defined as various symptoms or esophageal mucosal damage generated by the abnormal reflux of gastric contents into the esophagus. Patients with OSAS have been reported to have a high prevalence of gastroesophageal reflux (GER) symptoms. The increase of transdiaphragmatic pressure in parallel with the large negative intrathoracic pressure produced during apnea events may directly lead to GER. In addition, some studies have demonstrated improvement in GERD with the application of continuous positive airway pressure, most consistently effective treatment for OSAS. However, GER dose not occur with every apnea. Moreover, the common conditions observed in patients with OSAS, including obesity or alcohol ingestion, are also predisposing factors for GER. A more recent investigation in over 1000 subjects failed to show a causal link between both diseases. Thus, the potential relationship between OSAS and GERD remains controversial. Inconsistencies in definitions of both diseases or sampling biases may contribute to the confusing results.     

腹内高压对门静脉压、中心静脉压影响的实验研究

目的研究腹内压升高对大鼠中心静脉压和门静脉压的影响。方法将20只成年雄性SD大鼠分别通过颈静脉插管、穿刺门静脉主干法来测定中心静脉压和门静脉压，运用氮气气腹法制作大鼠腹内高压动物模型。建立气腹后分别在0、5、10、15、20、25、30、35、40、45mmHg压力值下测得中心静脉压和门静脉压。结果中心静脉压和腹内压之间的直线回归方程为Y=2．824＋0．045X，相关系数r=0．984（P〈0．01）；门静脉压和腹内压之间的直线回归方程为Y=8．887＋0．939X，相关系数r=0．998（P〈0．01）。结论腹内压与中心静脉压和门静脉压有很好的相关性，可以根据腹内压监测中心静脉压和门静脉压的变化。