浅谈特种医疗设备的管理工作

安全运行是贯穿整个特种医疗设备生命周期的主线。本文从四个方面粗略地谈了特种医疗设备的安全管理工作。     

Determination of the median effective dose (ED50) of bupivacaine and ropivacaine unilateral spinal anesthesia

Background

Unilateral spinal anesthesia (USpA) has been reported to potentiate spinal anaesthesia and is used in geriatric patients. The purpose of this study was to determine the median effective dose (ED₅₀) of 0.5% hypobaric bupivacaine and 0.5% hypobaric ropivacaine USpA for geriatric patients (age ≥ 70 years) undergoing elective hip replacement surgery.

Methods

A total of 60 geriatric patients (age ≥ 70 years) undergoing elective hip replacement surgery were enrolled in this study. The patients were randomized into 2 groups to receive either intrathecal 0.5% hypobaric bupivacaine USpA (group B) or 0.5% hypobaric ropivacaine USpA (group R). Effective anesthesia was defined as a T10 sensory blockade level maintained for more than 60 min, and a Bromage score of 3 on the operation side within 10 min after injection with no additional epidural anesthetic required during surgery. The ED₅₀ of 0.5% hypobaric bupivacaine and 0.5% hypobaric ropivacaine was calculated using the Dixon and Massey formula.

Results

No significant differences were found between the two groups in terms of demographic data. The ED₅₀ of 0.5% hypobaric bupivacaine USpA was 4.66 mg (95% confidence interval CI 4.69–4.63 mg) mg and that of 0.5% hypobaric ropivacaine USpA was 6.43 mg (95% CI 6.47–6.39 mg) for geriatric patients undergoing hip replacement surgery.

Conclusion

We find the ED₅₀ were lower, and the ED50 of 0.5% hypobaric bupivacaine and ropivacaine was 4.66 mg (95% CI 4.69–4.63 mg) and 6.43 mg (95% CI 6.47–6.39 mg), respectively, for USpA in geriatric patients (age ≥ 70 years) undergoing elective hip replacement surgery.

     

老年骨质疏松症对人工髋关节置换影响的实验研究

目的从生物力学角度探讨老年骨质疏松者对人工髋关节置换的影响及其治疗对策。方法采集30具新鲜股骨标本,DEXA骨密度仪测试每个标本干骺端、颈部、Ward三角区及大转子区的骨密度,将骨质疏松标本进行骨水泥和非骨水泥假体安装,测定其生物力学性能变化。结果老年骨质疏松程度的增加,假体置换后股骨上方应变呈增加的趋势。随着骨密度的增加,假体近端和远端微动随之减少,关节假体的初始稳定性显著增加。结论老年骨质疏松对人工关节假体的置换影响是明显的。老年骨质疏松患者采用骨水泥固定假体其松动率可下降30％～40％,临床上要求假体安装须精确匹配,骨水泥调制合理、厚度适中,以减少松动的发生率。     

中西医结合治疗胆石病并急性胆管炎临床观察

目的：观察胆石病并急性胆管炎行胆道引流术后中西医结合治疗对患者分泌胆汁量及肝功能指标改变的影响。方法：将同期诊断为胆石病并急性胆管炎的患者30例随机分为中西医结合组（实验组）、西医组（对照组）两组，（1）观察记录两组病人术后1、3、5、7天经T管引流的胆汁量。（2）两组病人术前和术后1、3、5、7天采空腹静脉血标本，测定血清总胆红素（TBIL），谷丙转氨酶（ALT）及碱性磷酸酶（ALP）的量。结果：实验组与对照组在术后第1天T管引流胆汁量、第1、3天肝功能改变无显著性差异（p〉0．05）；实验组在术后第3、5、7天T管引流胆汁量，第5、7天TBIL、ALT和ALP与对照组相比较有显著性差异（p〈0．05）。结论：胆石病并急性胆管炎患者在手术治疗的基础上，辅以利胆通腑中药辨证施治一中西医结合治疗有明显增加胆汁分泌，促进患者黄疸消退，改善肝功能的功效。     

隆鼻术中各种充填材料的比较

鼻位于脸部的中央,它有制约五官的作用,稍有缺陷就对容貌影响极大。黄种人的鼻子较扁,中国人颜面较纤巧,额骨鼻突一般较低平,鼻梁以小巧细窄为美;额骨鼻突至鼻尖,男性近似直线,女性微具凹弧,鼻端微翘较为柔和好看。低鼻,俗称“塌鼻梁”多由外伤、感染引起,也见于先天性发育形成     

巴曲酶对缺血再灌注后凋亡相关基因时效研究

目的:探讨巴曲酶对沙土鼠前脑缺血再灌注损伤后海马CA1区神经元凋亡相关基因Bcl-2、Bax表达的影响及可能的作用机制。方法:分组采用双侧颈总动脉夹闭5min后再通,造成沙土鼠前脑缺血再灌注的损伤模型,在不同时间点腹腔注射巴曲酶对其进行治疗后,运用免疫组织化学方法,检测沙土鼠海马CA1区神经元中的Bcl-2、Bax免疫反应阳性细胞的数量。结果:与对照组相比,治疗组海马CA1区Bet-2表达明显增加,Bax表达降低,尤以缺血再灌注前6h、即刻、缺血再灌注后1h、3h及6h明显(P<0.01)。结论:巴曲酶可减少脑缺血再灌注后神经细胞的凋亡,发挥脑保护作用;其作用存在明显时效关系,机理可能与增强Bcl-2的表达及抑制Bax的表达有关。     

Relationship between polymorphism of DC-SIGN (CD209) gene and the susceptibility to pulmonary tuberculosis in an eastern Chinese population

Dendritic cell-specific intracellular adhesion molecule-3-grabbing nonintegrin (DC-SIGN) is an important receptor for Mycobacterium tuberculosis on human dendritic cells. Previous studies have shown that the variation, especially the -871A/G and -336A/G in DC-SIGN promoter influenced the susceptibility to tuberculosis. We therefore investigated whether polymorphisms in the DC-SIGN gene were associated with susceptibility to tuberculosis in an eastern Chinese population. A total of 237 culture-positive pulmonary tuberculosis case patients and 244 controls were genotyped for -871A/G and -336A/G by pyrosequencing. Our results suggested that the 2 promoter variants of DC-SIGN gene were not associated with susceptibility to tuberculosis in Chinese. Further analysis showed that the allele -336G was associated with a protective effect against fever in pulmonary tuberculosis patients, but not against cavity formation. In addition, we compared the allelic frequencies of -871A/G and -336A/G in African, Caucasian, and Asian groups. The results showed that the tw forms of allelic frequencies detected Chinese individuals in our study were similar to the reported frequencies in other Asian populations but differed significantly from those in the African and Caucasian groups studied.     

改良人巨细胞病毒抗体ELISA试剂盒的研制及质量鉴定

目的建立一种快速、稳定、特异、实用的检测抗人巨细胞病毒（HCMV）IgG、IgM抗体的方法。方法对传统间接酶联免疫吸附试验（ELISA法）进行改良,使用自制的抗原并在试剂液中添加吸附剂、保护剂、稳定剂。结果改良的ELISA试剂具有稳定、敏感、特异性强、重复性好等优点,实验温育时间只需40min;对819例婚前查体妇女进行检测,HCMV—IgM阳性率为2.32％．HCMV—IgG阳性率为95．11％。结论本试剂可用于HCMV抗体的检测。     

图像处理和人工神经网络在肺癌细胞病理诊断中的应用

目的探求基于计算机图像处理和人工神经网络的“肺癌早期细胞病理电脑诊断系统”（lung cancer diagnosing system，LCDS）在肺癌临床细胞病理诊断中的应用价值。方法运用LCDS对512例经皮肺穿刺标本的细胞学涂片进行检测评判和综合分析，并对其中手术治疗的362例进行LCDS细胞病理诊断与术后组织病理诊断对比分析研究。结果LCDS能运用图像处理和专家系统完成对肺部病灶癌细胞和非癌细胞的识别诊断，进而运用人工神经网络能完成肺鳞癌、腺癌、小细胞癌等主要病理类型的细胞病理诊断，与临床组织病理或细胞病理诊断结果对比，总符合率为91．80％。其中362例接受外科手术者以术后组织病理诊断结果为标准，LCDS检测诊断的敏感性为94．79％（291／307例），特异性为90．91％（50／55例），准确性为94．20％（341／362例）。结论LCDS所采用的诊断模型是实用而有效的，具有诊断准确率高、易于操作培训等优势，有可能为肺癌早期细胞病理诊断提供又一实用有效的手段。     

电视胸腔镜手术230例

作者自１９９４年４月至１９９５年１２月共完成电视胸腔镜手术２３０例。病种包括肺大皮包、自发性气胸、肺癌、恶性胸水、脓胸、血胸、纵隔肿瘤等。术后并发症少，手术时间缩短，术后恢复快。实践证明，电视胸腔镜手术是一项很有发展前景的技术。