CT引导下脉冲射频胸背根神经节治疗老年带状疱疹后遗神经痛

目的：评价CT引导下脉冲射频胸背根神经节治疗老年带状疱疹后遗神经痛的疗效和安全性。方法收集2014年4月－2015年8月就诊的老年带状疱疹后遗神经痛患者33例,男性18例,女性15例,年龄（73±10）岁（60～86岁）,疼痛范围位于T2～T11,受损节段1～4节,病程3～18月。视觉模拟评分（VAS）≥4分,行CT引导下脉冲射频胸背根神经节治疗,3d后重复1次。采用VAS对术后1,7,30,90d进行疼痛评分;采用匹兹堡睡眠质量指数量表（PSQI）、SF‐36简明健康调查问卷行术后1,3月的睡眠和生活质量评估。结果与术前1 d比较,治疗后各时点的VAS评分及PSQI分值均降低,而SF‐36量表中各参数均升高（P＜0．05）。患者治疗后均无血、气胸和肺部感染等并发症发生。结论 CT引导下行脉冲射频胸背根神经节定位准确,安全高,近期疗效佳。     

卫生行政干预对肺结核病人转诊追踪影响分析

落实转诊和追踪工作是实施肺结核病人归口管理的关键环节,是实施现代结核病控制DOTS策略的基础[1].长阳县为了探索提高肺结核病人转诊和追踪到位率的方法,自2009年9月起在全县实施卫生行政干预,促进了综合医院、乡镇卫生院对肺结核/疑似肺结核病人网报、转诊及结防机构对转诊未到位病人的追踪工作,取得明显效果.     

阿托品在无痛肠镜检查的应用价值

目的观察在无痛肠镜检查中伍用阿托品的安全性、可行性和不良反应情况。方法 80例ASAⅠ～Ⅱ级拟行无痛肠镜检查的患者,随机均分为两组：实验组（A组：异丙酚＋芬太尼＋阿托品组）,对照组（C组：生理盐水＋异丙酚＋芬太尼组）,观察两组各时期麻醉效果,平均动脉压（MBP）、心率（HR）、呼吸频率（RR）、SpO2变化;不良反应情况和内镜医师的满意度。结果两组患者麻醉效果（诱导时间、清醒时间、体动发生率）差异无统计学意义。与诱导前相比,C组患者给药诱导后SBP明显下降,HR减慢,RR变慢变浅,SpO2下降,差异有统计学意义（P〈0.05）;A组无显著差别;与C组比较,A组不良反应少,内镜医师满意度高。结论在无痛肠镜检查中伍用阿托品能提供满意的麻醉效果,且不良反应少,内镜医师满意度高,值得推广应用。     

异地感染急性血吸虫病1例误诊原因分析

一、临床资料患者，男，20岁，系长阳县航运公司水手，在长江中下游从事货物运输，工龄1年余。患者于1月前不明原因突起发热，体温多在39．5℃以上，呈猪留热型，伴消瘦、乏力，精神、食欲极差。于3日前出现腹痛、腹泻，呈钝痛，以左下腹为主，大便初为稀便，继为粘液脓血便，量少，伴里急后重，伴做咳，少痰，无血丝，否认近期有皮炎及尊麻疹史。在当地治疗无效，于1996年9月5日来我站就诊。既往有“肺结核”病史。体格检查：T39．8℃，R24次份，P113欢呼，邱14用KPa。神志清楚，轻度贫血貌，双肺呼吸音稍粗，腹软，左下腹轻压病，无反跳…     

二氮嗪预处理联合低温对大鼠海马神经元缺氧复氧时Bcl-2和Bax表达的影响

Objective To investigate the effects of diazoxide preconditioning combined with hypothermia on the expression of Bcl-2 and Bax during anoxia-reoxygenation in rat hippocampal neurons. Methods The hippocampal neurons isolated from newborn SD rats ( < 24 h, weighing 5-6 g) were inoculated in the culture dish or 96 well plates. The hippocampal neurons were randomly assigned into 8 groups and each group contained 36 wells or 12 dishes of neurons: normal temperature .group (group NT), diazoxide preconditioning (DP) + NT group (group DP+ NT), mild hypothermia group (group MiH) , DP + MiH group (group DP + MiH) , moderate hypothermia group (group MoH), DP + MoH group (group DP + MoH), deep hypothermia group (group DeH) and DP+DeH group (group DP+ DeH). In group DP + NT, DP + MiH, DP+ MoH and DP + DeH, diazoxide was added to the culture media, the final concentration was 100 μmol/L,and the neurons were incubated for 1 h once a day for 2 d, and then subjected to 4 h of hypoxia at 37, 34, 30 and 22℃ , respectively, followed by 48 h of reoxygenation at 37℃ . The neuronal viability, apoptotic rates and expression of Bcl-2 and Bax were determined and the ratio of Bcl-2/Bax was calculated. Results The neuronal viability was significantly higher, apoptotic rate lower, Bcl-2 expression higher, Bax expression lower and Bcl-2/Bax ratio higher in group DP + NT, MiH, MoH and DeH than in group NT ( P < 0.05). The neuronal viability was significantly higher, early apoptotic rate lower, Bcl-2 expression higher, Bax expression lower and Bcl-2/Bax ratio higher in group DP + MiH, DP + MoH and DP+ DeH than in group DP + NT ( P < 0.05), but there was no significant difference in the late apoptotic rate between group DP + MiH, DP + MoH, DP + DeH and DP + NT ( P > 0.05). The neuronal viability was significantly higher, early apoptotic rate lower, Bcl-2 expression higher, Bax expression lower and Bcl-2/Bax ratio higher in group DP+ MiH and DeH than in group MiH (P < 0.05), but there was no significant difference in the late apoptotic rate between group DP + MiH, DeH and MiH, and no significant difference in the above indices between group MoH and MiH (P > 0.05) . The neuronal viability was significantly higher, early apoptotic rate lower, Bcl-2 expression higher, Bax expression lower and Bcl-2/Bax ratio higher in group DP+ DeH than in group DP+ MiH ( P < 0.05). Conclusion Diazoxide preconditioning combined with hypothermia can attenuate the anoxia-reoxygenation injury in rat hippocampal neurons possibly through correcting the imbalance of Bcl-2 and Bax and inhibiting the early apoptosis of hippocampal neurons.     

二氮嗪预处理联合低温对大鼠海马神经元缺氧复氧时Bcl-2和Bax表达的影响

Objective To investigate the effects of diazoxide preconditioning combined with hypothermia on the expression of Bcl-2 and Bax during anoxia-reoxygenation in rat hippocampal neurons. Methods The hippocampal neurons isolated from newborn SD rats ( < 24 h, weighing 5-6 g) were inoculated in the culture dish or 96 well plates. The hippocampal neurons were randomly assigned into 8 groups and each group contained 36 wells or 12 dishes of neurons: normal temperature .group (group NT), diazoxide preconditioning (DP) + NT group (group DP+ NT), mild hypothermia group (group MiH) , DP + MiH group (group DP + MiH) , moderate hypothermia group (group MoH), DP + MoH group (group DP + MoH), deep hypothermia group (group DeH) and DP+DeH group (group DP+ DeH). In group DP + NT, DP + MiH, DP+ MoH and DP + DeH, diazoxide was added to the culture media, the final concentration was 100 μmol/L,and the neurons were incubated for 1 h once a day for 2 d, and then subjected to 4 h of hypoxia at 37, 34, 30 and 22℃ , respectively, followed by 48 h of reoxygenation at 37℃ . The neuronal viability, apoptotic rates and expression of Bcl-2 and Bax were determined and the ratio of Bcl-2/Bax was calculated. Results The neuronal viability was significantly higher, apoptotic rate lower, Bcl-2 expression higher, Bax expression lower and Bcl-2/Bax ratio higher in group DP + NT, MiH, MoH and DeH than in group NT ( P < 0.05). The neuronal viability was significantly higher, early apoptotic rate lower, Bcl-2 expression higher, Bax expression lower and Bcl-2/Bax ratio higher in group DP + MiH, DP + MoH and DP+ DeH than in group DP + NT ( P < 0.05), but there was no significant difference in the late apoptotic rate between group DP + MiH, DP + MoH, DP + DeH and DP + NT ( P > 0.05). The neuronal viability was significantly higher, early apoptotic rate lower, Bcl-2 expression higher, Bax expression lower and Bcl-2/Bax ratio higher in group DP+ MiH and DeH than in group MiH (P < 0.05), but there was no significant difference in the late apoptotic rate between group DP + MiH, DeH and MiH, and no significant difference in the above indices between group MoH and MiH (P > 0.05) . The neuronal viability was significantly higher, early apoptotic rate lower, Bcl-2 expression higher, Bax expression lower and Bcl-2/Bax ratio higher in group DP+ DeH than in group DP+ MiH ( P < 0.05). Conclusion Diazoxide preconditioning combined with hypothermia can attenuate the anoxia-reoxygenation injury in rat hippocampal neurons possibly through correcting the imbalance of Bcl-2 and Bax and inhibiting the early apoptosis of hippocampal neurons.     

硬膜外腔注射生理盐水对腰-硬联合麻醉的影响

腰-硬联合麻醉（CSEA）具有起效快、作用完善、可控性强、便于术后镇痛等优点，现已广泛应用于剖宫产手术的麻醉。但由于产妇的特殊生理改变，脊麻时易发生广泛阻滞；另外，产妇孕期血液高凝，为减少深静脉血栓的形成，术后应尽快恢复活动，因此应尽可能缩短CSEA运动神经阻滞的时间。我们通过向硬膜外腔注射生理盐水，观察其对CSEA麻醉的影响，探讨其临床应用价值。     

放置Swan-Ganz导管致右心耳穿孔一例

患者女，53岁，体重98kg，因突发性胸痛、胸闷4个月于2004年10月8日入院。既往有高血压病10年，糖尿病4个月，4个月前有心肌梗死发作。心电图（ECG）：窦性心率，房早并短暂阵发性房速，异常Q波。冠状动脉造影：冠状动脉粥样硬化性心脏病，累及前降支、回旋支和右冠状动脉。射血分数：70％。B超：节段性室壁运动功能减弱。诊断：冠心病、陈旧性下壁心肌梗死、劳累型心绞痛、高血压病。     

七氟醚与氯胺酮在婴幼儿门诊手术麻醉中的比较

近几年随着手术和麻醉的发展，小儿门诊手术日趋增多，如何高质量地实施麻醉成为麻醉医师关注的问题。本研究拟观察七氟醚（sevoflurane）吸入麻醉在婴幼儿门诊短小手术应用的可行性和安全性，并与氯胺酮（ketanmine）静脉麻醉进行比较，以期为小儿麻醉提供新方法。     

二氮嗪预处理联合低温对大鼠海马神经元缺氧复氧时Bcl-2和Bax表达的影响

Objective To investigate the effects of diazoxide preconditioning combined with hypothermia on the expression of Bcl-2 and Bax during anoxia-reoxygenation in rat hippocampal neurons. Methods The hippocampal neurons isolated from newborn SD rats ( < 24 h, weighing 5-6 g) were inoculated in the culture dish or 96 well plates. The hippocampal neurons were randomly assigned into 8 groups and each group contained 36 wells or 12 dishes of neurons: normal temperature .group (group NT), diazoxide preconditioning (DP) + NT group (group DP+ NT), mild hypothermia group (group MiH) , DP + MiH group (group DP + MiH) , moderate hypothermia group (group MoH), DP + MoH group (group DP + MoH), deep hypothermia group (group DeH) and DP+DeH group (group DP+ DeH). In group DP + NT, DP + MiH, DP+ MoH and DP + DeH, diazoxide was added to the culture media, the final concentration was 100 μmol/L,and the neurons were incubated for 1 h once a day for 2 d, and then subjected to 4 h of hypoxia at 37, 34, 30 and 22℃ , respectively, followed by 48 h of reoxygenation at 37℃ . The neuronal viability, apoptotic rates and expression of Bcl-2 and Bax were determined and the ratio of Bcl-2/Bax was calculated. Results The neuronal viability was significantly higher, apoptotic rate lower, Bcl-2 expression higher, Bax expression lower and Bcl-2/Bax ratio higher in group DP + NT, MiH, MoH and DeH than in group NT ( P < 0.05). The neuronal viability was significantly higher, early apoptotic rate lower, Bcl-2 expression higher, Bax expression lower and Bcl-2/Bax ratio higher in group DP + MiH, DP + MoH and DP+ DeH than in group DP + NT ( P < 0.05), but there was no significant difference in the late apoptotic rate between group DP + MiH, DP + MoH, DP + DeH and DP + NT ( P > 0.05). The neuronal viability was significantly higher, early apoptotic rate lower, Bcl-2 expression higher, Bax expression lower and Bcl-2/Bax ratio higher in group DP+ MiH and DeH than in group MiH (P < 0.05), but there was no significant difference in the late apoptotic rate between group DP + MiH, DeH and MiH, and no significant difference in the above indices between group MoH and MiH (P > 0.05) . The neuronal viability was significantly higher, early apoptotic rate lower, Bcl-2 expression higher, Bax expression lower and Bcl-2/Bax ratio higher in group DP+ DeH than in group DP+ MiH ( P < 0.05). Conclusion Diazoxide preconditioning combined with hypothermia can attenuate the anoxia-reoxygenation injury in rat hippocampal neurons possibly through correcting the imbalance of Bcl-2 and Bax and inhibiting the early apoptosis of hippocampal neurons.