舒芬太尼复合罗哌卡因在急诊上肢手术中的应用

[目的]探讨舒芬太尼复合罗哌卡因在急诊上肢手术中臂丛神经阻滞效果。[方法]将65例急诊上肢手术患者随机分为对照组与观察组,给予30例对照组患者0.5%罗哌卡因麻醉,35例观察组患者0.5%罗哌卡因复合舒芬太尼麻醉。比较两组麻醉后感觉、运动阻滞起效时间、感觉、运动阻滞持续时间、镇痛评分。[结果]两组感觉、运动阻滞起效时间未见统计学差异(P﹥0.05);但观察组感觉、运动阻滞持续时间显著长于对照组,差异有统计学意义(P﹤0.05),麻醉后各时点镇痛评分显著低于对照组,差异有统计学意义(P﹤0.05)。[结论]与单纯应用罗哌卡因相比,舒芬太尼复合罗哌卡因在急诊上肢手术中臂丛神经阻滞作用时间长,镇痛效果好。     

罗哌卡因混合舒芬太尼在剖宫产患者硬膜外麻醉中的应用

目的探讨罗哌卡因混合小剂量舒芬太尼用于剖宫产患者硬膜外腔麻醉的临床应用的可行性。方法选择ASAⅠ～Ⅱ级足月、单胎产妇40例,年龄20～36岁,体重60～95kg,随机分为两组,每组20例,R组(0.75%罗哌卡因13ml),RS组(0.75%罗哌卡因13ml 舒芬太尼10μg)。观察感觉阻滞起效时间、感觉阻滞的最高平面、感觉阻滞达到最高平面的时间、感觉阻滞的作用时间、运动阻滞的起效时间、改良Bromage评分、不良反应和新生儿Apgar评分。结果两组患者Bromage评分和不良反应无区别。与R组比较,RS组的感觉阻滞起效时间缩短、感觉阻滞的最高平面增高、达到感觉阻滞最高平面的时间缩短、感觉阻滞作用时间延长及运动阻滞起效时间缩短,新生儿Apgar评分无区别。结论罗哌卡因混合小剂量舒芬太尼硬膜外麻醉用于剖宫产手术,其起效时间缩短,麻醉效果优于单纯罗哌卡因,对新生儿Apgar评分无明显影响,适合临床应用。     

罗哌卡因复合小剂量舒芬太尼在剖宫产手术中的应用

目的 评定剖宫产术中应用罗哌卡因复合小剂量舒芬太尼的麻醉效果.方法 选择40例ASAI～Ⅱ级的剖宫产患者,随机双盲分为R组(O.75%罗哌卡因13ml)和RS组(0.75%罗哌卡因13ml+舒芬太尼10μg),每组20例.观察两组患者感觉阻滞起效时间、感觉阻滞的最高平面、感觉阻滞达到最高平面的时间、感觉阻滞的作用时间、运动阻滞的起效时间、不良反应及麻醉效果等.结果 RS组的感觉阻滞起效时间、感觉阻滞的最高平面、感觉阻滞达到最高平面的时间、感觉阻滞的作用时间、运动阻滞的起效时间与 R 组比较差异均有统计学意义(P＜0.05或＜0.01);麻醉效果RS组明显好于R组.结论 术中应用罗哌卡因复合小剂量舒芬太尼,其感觉、运动阻滞时间均缩短,且作用时间延长,麻醉效果优于单纯应用罗哌卡因,适合于剖宫产手术.     

罗哌卡因复合小剂量舒芬太尼在剖宫产手术中的应用

目的评定剖宫产术中应用罗哌卡因复合小剂量舒芬太尼的麻醉效果。方法选择40例ASAⅠ～Ⅱ级的剖宫产患者，随机双盲分为R组（0．75％罗哌卡因13m1）和RS组（0．75％罗哌卡因13ml＋舒芬太尼10μg），每组20例。观察两组患者感觉阻滞起效时间、感觉阻滞的最高平面、感觉阻滞达到最高平面的时间、感觉阻滞的作用时间、运动阻滞的起效时间、不良反应及麻醉效果等。结果RS组的感觉阻滞起效时间、感觉阻滞的最高平面、感觉阻滞达到最高平面的时间、感觉阻滞的作用时间、运动阻滞的起效时间与R组比较差异均有统计学意义（P〈0．05或〈0．01）；麻醉效果RS组明显好于R组。结论术中应用罗哌卡因复合小剂量舒芬太尼，其感觉、运动阻滞时间均缩短，且作用时间延长，麻醉效果优于单纯应用罗哌卡因，适合于剖宫产手术。     

小剂量罗哌卡因复合芬太尼或舒芬太尼腰硬联合麻醉行阴式子宫切除术

目的比较腰硬联合麻醉低剂量的罗哌卡因与芬太尼或舒芬太尼联合应用于阴式子宫切除术的麻醉效果。方法将45例行阴式子宫切除术的病人随机分为L、F和S三组,每组15例。L组腰麻用药为罗哌卡因15mg,F组腰麻用药为罗哌卡因7.5mg与芬太尼25μg,S组罗哌卡因7.5mg与舒芬太尼5μg。观察感觉阻滞起效时间,痛觉阻滞持续时间,最高阻滞平面、三组最大运动阻滞Bromage评分及血液动力学的变化。结果 F组和S组的感觉阻滞起效时间均短于L组（P〈0.05）;感觉阻滞持续时间F组和S组均明显长于L组（P〈0.05）,且S组明显长于F组（P〈0.05）。L组的感觉阻滞最高平面稍高于F组和S组,但差异无统计学意义（P〉0.05）。F组和S组最大运动阻滞Bromage评分均明显小于L组（P〈0.05）。L组患者麻醉后5～10minMAP明显降低,与麻醉前相比P〈0.05。L组有三例患者出现恶心,F组有两例患者出现恶心,S组未出现这种情况。结论实施阴式子宫切除术,小剂量罗哌卡因与25μg芬太尼或舒芬太尼5μg联合使用行腰硬联合麻醉能提供有效的麻醉,且舒芬太尼优于芬太尼。     

氯普鲁卡因混合罗哌卡因用于子宫切除术的麻醉效果观察

目的:探讨子宫切除术患者氯普鲁卡因混合罗哌卡因用于硬膜外麻醉的效果。方法:拟行子宫切除术患者60例,随机分为3组(n=20)。硬膜外麻醉配液Ⅰ组:0.75%罗哌卡因;Ⅱ组:1%氯普鲁卡因+0.5%罗哌卡因;Ⅲ组:1.5%氯普鲁卡因+0.5%罗哌卡因。记录感觉阻滞最高平面、运动阻滞分级及感觉、运动阻滞起效时间、持续时间、术中辅助用药及不良反应。结果:与Ⅰ组比较,其他两组感觉阻滞的起效时间、达最高平面时间、BromageⅠ、Ⅱ级的起效时间均缩短,Ⅱ、Ⅲ两组感觉阻滞持续时间、运动阻滞的持续时间缩短,Ⅱ组Bromage Ⅲ级的起效时间缩短。结论:子宫切除术患者1%或1.5%氯普鲁卡因可增强0.5%罗哌卡因硬膜外麻醉的效果。     

氯胺酮对剖宫产病人罗哌卡因硬膜外麻醉效果的影响

目的观察氯胺酮静脉或硬膜外给药对剖宫产病人罗哌卡因硬膜外麻醉效果的影响。方法剖宫产病人60例(ASAⅠ～Ⅱ级),随机分为三组(n=20):硬膜外罗哌卡因组(R组)、硬膜外罗哌卡因复合氯胺酮组(RK组)、硬膜外罗哌卡因复合静脉氯胺酮组(RIK组)。三组均分两次硬膜外注入1%利多卡因加0.375%罗哌卡因混合液15ml(即5ml和10ml);RK组在局麻药中混入氯胺酮20mg;RIK组切皮前静脉注入氯胺酮20mg。观察感觉阻滞起效时间、感觉阻滞达到的最高平面和时间、感觉阻滞持续时间、运动阻滞起效和持续时间、腹肌松弛程度、麻醉效果及不良反应。结果三组间运动阻滞起效时间、持续时间和Bromage评分差异无统计学意义。R组出现腹膜牵拉反射几率大。RK组感觉阻滞起效时间及达到最高平面的时间缩短,持续时间延长,最高平面升高,未见腹膜牵拉反射,且病人均处于清醒状态。RIK组也能预防腹膜牵拉反射,但对病人意识状态影响明显。结论硬膜外给予小剂量氯胺酮可增强剖宫产病人罗哌卡因硬膜外麻醉效果,且不增加不良反应。     

罗哌卡因复合舒芬太尼用于妇科手术硬膜外麻醉的临床观察

目的:观察硬膜外罗哌卡因复合舒芬太尼在妇科手术中的麻醉效果。方法:40例ASAI~II级的子宫切除术患者随机分为两组:罗哌卡因复合舒芬太尼组(S组,n=20)和罗哌卡因组(R组,n=20)。于L1.2间隙行硬膜外穿刺后分别给予0.75%罗哌卡因10 m l,S组复合舒芬太尼10μg,R组复合生理盐水1 m l,观察起效时间、无痛平面时间、镇痛持续时间、运动阻滞镇静程度及不良反应等。结果:与R组相比S组的起效时间、无痛平面时间缩短,镇痛持续时间延长(P<0.05);两组的镇痛效果,运动阻滞及镇静程度差异无显著性(P>0.05),无不良反应发生。结论:罗哌卡因复合小剂量舒芬太尼可以显著增强罗哌卡因的硬膜外麻醉效果。     

左旋布比卡因复合等效剂量芬太尼或舒芬太尼用于妇科硬膜外麻醉效果比较

目的比较左旋布比卡因复合等效剂量的芬太尼或舒芬太尼用于妇科硬膜外麻醉的效果。方法择期妇科手术60例,年龄20～65岁,ASAⅠ～Ⅱ级,随机分为3组(n=20):单纯左旋布比卡因组(L组),复合芬太尼组(F组),复合舒芬太尼组(S组)。L组:0.75%左旋布比卡因10ml+生理盐水2ml,F组:0.75%左旋布比卡因10ml+芬太尼50μg+生理盐水共12ml,S组:0.75%左旋布比卡因10ml+舒芬太尼7.5μg+生理盐水共12ml。记录感觉阻滞起效时间、阻滞达最高平面时间、最高阻滞平面、镇痛持续时间、运动阻滞起效时间及持续时间、术中麻醉效果及不良反应。结果芬太尼或舒芬太尼都能增强左旋布比卡因的硬膜外麻醉效果。与L组相比,F组和S组的感觉阻滞起效时间、达最高平面时间缩短,镇痛维持时间延长(P0.05),F组与S组相比,S组的麻醉效果较F组更好(P0.05),运动阻滞起效时间、持续时间、不良反应三组间差异均无统计学意义(P0.05)。结论妇科手术硬膜外麻醉中左旋布比卡因复合等效剂量芬太尼或舒芬太尼都能增强麻醉效果,复合舒芬太尼的麻醉效果要优于复合芬太尼。     

罗哌卡因复合舒芬太尼腰麻在剖宫产术中应用的效果

目的 研究罗哌卡因复合舒芬太尼腰麻在剖宫产术中应用的效果.方法 选择择期剖宫产患者80例,按麻醉用药不同分2组,每组40例,两组均取右侧卧位于L3-4穿刺,穿刺成功后,罗哌卡因组（R组）蛛网膜下腔注入0.75%罗哌卡因2.0 ml＋10%葡萄糖1.0 ml,罗哌卡因复合舒芬太尼组（RS组）蛛网膜下腔注入0.75%罗哌卡因2.0 ml＋10%葡萄糖0.9 ml＋舒芬太尼5μg（0.1 ml）.观察并记录感觉阻滞起效时间、作用时间;运动阻滞起效时间、作用时间;术中低血压、心动过缓、恶心、呕吐及皮肤瘙痒发生情况;评价2组患者麻醉效果和肌松效果.结果 RS组感觉阻滞起效时间及作用时间优于R组（P＜0.05）.两组运动阻滞起效时间、作用时间及不良反应比较差异均无统计学意义（P＞0.05）.RS组皮肤瘙痒明显多于R组（P＜0.05）.RS组麻醉效果评级为优的患者明显多于R组（P＜0.05）,两组肌松情况比较,差异无统计学意义（P＞0.05）.结论 小剂量舒芬太尼可以延长罗哌卡因腰麻的感觉阻滞作用时间,能增强麻醉效果,不影响其肌松效果,也不增加不良反应,较单纯罗哌卡因腰麻更具有优越性.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.