Logistic模型和ROC曲线对磷酸钠盐致电解质紊乱的预测分析

目的：应用Logistic模型和ROC曲线探讨磷酸钠盐口服溶液致电解质紊乱的相关危险因素，并进行风险预测。方法：采用回顾性、观察性的研究方法收集使用磷酸钠盐口服溶液患者的病历资料，分析致电解质紊乱的危险因素，建立Logistic模型，绘制风险因素的ROC曲线。结果：共纳入294例（男183例，女111例）患者，78例（占26.5%）患者出现电解质紊乱，其中低钾血症有34例（占11.6%），高氯血症有29例（占9.9%），低钾高氯血症有7例（占2.4%），低钠血症有4例（占1.4%），低钠低氯血症有3例（占1.0%），低钠低氯低钾血症有1例（占0.34%）。单因素方差分析显示年龄、SCr、Ccr 3项指标的差异具有显著性，进一步多因素Logistic模型分析显示CCr分级是发生电解质紊乱的独立危险因素。根据Logistic模型分析结果，用CCr分级构建ROC曲线，曲线下面积0.816。CCr< 60 mL·min^-1时，患者更易发生电解质紊乱，提示CCr是发生电解质紊乱的危险因素。结论：临床医师可根据患者CCr情况选择合适的肠道清洁药物。     

术中按需喷洒与术前口服二甲硅油 在肠镜检查中的作用研究

〔摘 要〕 目的：探讨术中按需喷洒与术前口服二甲硅油在肠镜检查中的应用效果。 方法：选取 2020 年 1 月至 2021 年 6 月于萍乡市人民医院行肠镜检查的无明显症状患者 90 例，按随机数字表法分为两组，对照组和观察组各 45 例。两组均 使用聚乙二醇电解质散清洁肠道，对照组术前口服二甲硅油，观察组术中按需喷洒二甲硅油。比较两组患者肠道清洁分级、 气泡分级、二甲硅油用量、肠镜检查操作时间、结肠息肉检出率及患者满意度。 结果： 两组患者肠道清洁分级相比，差异无 统计学意义（P ＞ 0.05）。观察组患者气泡分级 1 级率为 80.00 %，高于对照组的 62.22 %，差异具有统计学意义（P ＜ 0.05）。 观察组患者二甲硅油用量为（14.58 ± 2.01）mL，少于对照组的（22.35 ± 2.65）mL，进、退镜时间分别为（8.89 ± 1.14）min、 （8.33 ± 1.08）min，短于对照组的（9.76 ± 1.27）min、（10.27 ± 2.04）min，差异有统计学意义（P ＜ 0.05）。观察组患者 结肠息肉检出率、患者满意度为 17.78 %、97.78 %，高于对照组的 4.44 %、82.22 %，差异具有统计学意义（P ＜ 0.05）。 结论：术中按需喷洒二甲硅油在肠镜检查中效果更佳，可减少二甲硅油用量，提高视野清晰度，缩短肠镜检查操作时间， 并利于结肠息肉的检出，提高患者满意度。     

Ion transfer reactions in media of low ionic strength

Facilitated ion transfer (FIT) and simple ion transfer (IT) reactions at the water|1,2-dichloroethane (W|DCE) interface with media of low ionic strength are investigated by employing micro- and nano-pipettes. The model systems chosen for the FIT and IT are K⁺ transfer facilitated by dibenzo-18-crown-6 (DB18C6) and tetramethylammonium (TMA⁺), respectively. For the FIT reaction at micro- and submicro-liquid|liquid interfaces, when the supporting electrolyte concentrations in the organic phase are at micromolar levels, its voltammetric waves are analyzed by the theory for one-electron oxidation of uncharged species in organic solution with little added supporting electrolyte on solid ultramicroelectrodes (UMEs) proposed by Oldham [K.B. Oldham, J. Electroanal. Chem. 250 (1988) 1]. Its chronoamperograms are strongly affected by the externally applied potentials, which is consistent with the theory proposed by Stojek and co-workers [A. Jaworski, M. Donten, Z. Stojek, Anal. Chim. Acta 305 (1995) 106, A. Jaworski, M. Donten, Z. Stojek, J. Electroanal. Chem. 407 (1996) 75, W. Hyk, M. Palys, Z. Stojek, J. Electroanal. Chem. 415 (1996) 13, W. Hyk, Z. Stojek, J. Electroanal. Chem. 422 (1997) 179] for reactions at solid UMEs with different concentrations of supporting electrolyte. In addition, the FIT reaction can exhibit well-defined steady-state waves at the nano-liquid|liquid interface when no supporting electrolyte is added to the organic phase. For the TMA⁺ transfer reaction from the aqueous phase to DCE (or from DCE to the aqueous phase), the magnitude of its steady-state limiting current depends on the concentration of supporting electrolyte in the same phase, and the shape and position of its transfer waves are influenced by the supporting electrolyte concentrations in the adjacent phase. We can observe clearly the migration effect on the transfer reaction of charged species.     

石蜡油口服联合开塞露纳肛对痔PPH患者进行术前肠道准备的效果探讨

为探讨石蜡油口服联合开塞露纳肛对行吻合器痔上黏膜环切术（PPH）治疗的痔患者进行术前肠道准备的效果,将拟行PPH治疗的100例混合痔患者随机分为观察组和对照组,各50例。两组患者采用不同方法进行术前肠道准备,观察组予石蜡油口服加开塞露纳肛,对照组予聚乙二醇电解质散口服,对比两组患者肠道清洁度、不良反应及术后首次排便时间。结果显示,两组患者肠道清洁度比较差异无统计学意义,P〉0.05;但观察组患者疲劳感、肛门坠胀感发生率均明显低于对照组,P〈0.05;而且术后首次排便时间较对照组早,P〈0.05。结果表明,石蜡油口服联合开塞露纳肛对混合痔患者进行术前肠道准备方法简便,经济实惠,效果肯定,不良反应少,值得临床推广应用。     

Effect of large volume replacement with balanced electrolyte solutions on extravascular lung water in surgical patients with sepsis syndrome

We investigated the effect of large volume replacement with balanced electrolyte solutions on extravascular lung water (EVLW) in 16 adult surgical patients with sepsis syndrome. Patients entered the study within the 24 h period following surgical interventions for acute necrotizing pancreatitis, intra-abdominal abscesses, and/or peritonitis. Sequential measurements (n=108) were made at intervals of 6–12 h over a 48 h period. There were no significant differences between initial and final values of thermal-dye EVLW (5.0±1.1 vs. 5.7±1.1 ml/kg), plasma colloid osmotic pressure (COP, 13.3±2.5 vs. 13.2±2.9 mmHg), pulmonary artery wedge pressure (PAWP, 9.2±3.0 vs. 10.8±3.0 mmHg), and COP-PAWP gradient (4.0±3.5 vs. 2.4±3.9 mmHg). All results expressed as (mean±SD). The EVLW did not correlate with plasma COP, PAWP, or COP-PAWP gradient. We conclude that large volume replacement with balanced electrolyte solutions with the secondary decrease in plasma COP and COP-PAWP gradient do not necessarily contribute to a substantial increase in EVLW. This study fails to show any causal relationship between decrease in plasma COP or COP-PAWP gradient and oedema formation in the lung.Supported by the Austrian Govenment, Department of Health     

The development of pediatric fluid resuscitation: an interview with Dr. Frederic A. ‘Fritz’ Berry

Dr. Frederic A. ‘Fritz’ Berry (1935), Professor Emeritus of Anesthesiology and Pediatrics at the University of Virginia, has played a pioneering role in the development of pediatric anesthesiology through training generations of anesthesiologists. He identifies his early advocacy of balanced electrolyte solution for perioperative fluid resuscitation as his defining contribution. Based on his clinical experiences, he pushed to extend the advances in adult fluid resuscitation into pediatric practice. He imparted these and other insights to his colleagues although textbooks, book chapters, original journal publications, and decades of Refresher Course Lectures at the American Society of Anesthesiologists' annual meetings. A model educator, clinician, and researcher, he shaped the careers of hundreds of physicians‐in‐training while advancing the field of pediatric anesthesiology.     

老年人饮食摄入电解质及微量元素与便秘伴随症状的相关性

目的探讨老年人饮食中摄入的电解质及微量元素与便秘伴随症状的相关性。方法选择某于休所中自愿参加的65岁以上老年人，共51人，进行饮食和排便相关情况调查，并留取粪便标本进行电解质及微量元素测定。结果饮食中的钙离子含量与排便全程时间、排便用力指数及排便不净存在显著的正相关；粪便内钙的含量与饮食中钙的含量存在显著的正相关；20位便秘者日均摄入钙离子、钾离子含量显著高于31位非便秘者；且粪便标本中的钙离子含量与排便用力程度及排便时间长存在显著正相关。结论为防治便秘，老年人应摄入平衡饮食，不应过量摄入高钙饮食。     

复方果糖电解质注射液在骨创伤患者中的疗效观察

目的 探讨复方果糖电解质注射液在骨创伤患者中的临床疗效和应用价值。方法 选取2020年1月到2021年6月在我院行骨创伤切开复位内固定术的患者80例,随机分为对照组和试验组,每组各40例。对照组予5％葡萄糖注射液2000ml/日,注射液中添加1.5g氯化钾和1g葡萄糖酸钙,连续补液治疗5天;试验组予复方果糖电解质注射液2000ml/日,连续补液治疗5天,观察两组患者的血糖、肝肾功能、电解质、血液流变学及伤口愈合情况。结果 术后所有患者生命体征平稳。对照组血糖水平明显高于试验组（P ＜0.01）,并且对照组的血糖水平波动幅度较大。两组血液流变学和凝血功能差异具有显著的统计学意义（P ＜0.05）,但两组电解质、肝肾功能无显著差异。结论 复方果糖电解质注射液可以安全应用于骨创伤患者,对患者的血糖、肝肾功能和电解质等影响较小,又可以降低血液粘滞度,相对而言血栓风险更低,补液简洁、方便、安全。