膝关节镜术后注入关节腔小剂量吗啡复合布比卡因镇痛的临床应用

目的比较布比卡因、吗啡、小剂量吗啡联合布比卡因用于关节腔内注射对关节镜手术患者的术后镇痛效应。方法80例腰硬联合麻醉行膝关节手术患者（ASAⅠ～Ⅱ级）,随机分为4组（n=20）,术后向关节腔注入了不同的药物。M组：吗啡4mg;Rl组：布比卡因75mg;R2组：布比卡因150mg;MR组;吗啡1mg＋布比卡因75mg。记录术后第8、16、24、32、48小时患者屈膝90度的视察模拟评分（VAS）和不良反应。结果在术后第8小时,各组VAS评分相当,在术后第16、24、32、40小时MR组VAS评分明显小于其它组;在48h各组VAS评分差异无统计学意义（P〉0．05）。各组均无不良反应发生。结论膝关节镜手术后,关节腔内注入吗啡1mg和布比卡因75mg,其效果优于两者单独应用,可安全有效地用于关节镜手术术后的镇痛治疗。     

小剂量吗啡-布比卡因硬膜外麻醉复合静脉泵注丙泊酚在剖宫产术中的应用

目的观察小剂量吗啡一布比卡因硬膜外麻醉复合静脉泵注丙泊酚在剖宫产术中的麻醉效果。方法选择连续硬膜外麻醉下行子宫下段剖宫产术的产妇128例,ASA分级Ⅰ～Ⅱ级,随机分为布比卡因（A）组、丙泊酚复合布比卡因（B）组、小剂量吗啡一布比卡因（C）组及丙泊酚复合小剂量吗啡．布比卡因（D）组,每组各32例。硬膜外腔注入2％利多卡因5ml,待麻醉平面出现后,A、B组硬膜外腔分别注入0．5％布比卡因10～15ml,C、D组硬膜外腔分别注入吗啡2mg加0．5％布比卡因lO一15ml,B、D组均同时静脉泵注丙泊酚0．5～1．0mg／kg,之后3～5mg／（kg．h）持续静脉泵注。观察并记录新生儿娩出时丙泊酚用量、新生儿娩出1min及5min时Apgar评分、产妇术中生命体征变化、产妇术中舒适度评分（BCS）、术后镇痛视觉模拟评分及术后BCS、术后恶心呕吐、皮肤瘙痒及呼吸抑制等不良反应。结果新生儿娩出时丙泊酚用量B组为（2．10±0．12）mg／kg,D组为（1．40±0．08）mg／kg,B组明显高于D组（P〈0．05）;术中BCSB、D组高于A、C组（P〈0．01或〈0．05）。新生儿Apgar评分（1min及5min）B组显著低于A、C、D组（P〈0．05）。产妇术后6～18h镇痛效果C、D组明显优于A、B组（P〈0．01或〈0．05）。A、B、C、D组产妇术后恶心呕吐发生率分别为9．4％、0、21．9％及12．5％,组间比较差异有统计学意义（P〈0．01或〈0．05）;皮肤瘙痒发生率分别为0、0、12．5％及9．4％,C、D组明显高于A、B组（P〈0．01）。四组术后均未见明显的呼吸抑制。结论小剂量吗啡．布比卡因硬膜外麻醉复合静脉泵注丙泊酚可安全有效地应用于剖宫产术中,并可产生良好的镇痛效应。     

膝关节镜术后关节腔内联合用药对患者术后疼痛及关节肿胀的影响

目的研究关节镜术后关节腔内联合用药对患者术后疼痛、关节积液的影响。方法 80例患者分为两组:A组:术后关节腔内注射0.5%罗哌卡因2ml+玻璃酸钠2.5ml+得宝松1ml,B组:术后关节腔内注射0.5%罗哌卡因2ml。记录术后第4、8、12、24、36、48h患者屈膝90度的视觉模拟评分(VAS)和不良反应,并评价膝关节腔积液情况(浮髌实验)。结果在4、8h,各组VAS评分相当;在12、24、36、48h,A组VAS评分小于B组;两组均无不良反应发生。A组关节浮髌实验阳性率较B组明显低。结论膝关节镜手术后,关节腔内注入罗哌卡因75mg+玻璃酸钠2.5ml+得宝松1ml,在有效镇痛的同时可明显缓解患者术后疼痛,并可减轻关节腔的渗出,利于早期的功能康复。     

硬膜外吗啡术后镇痛更优模式的探讨

目的　观察比较硬膜外不同浓度布比卡因、氟哌利多、新斯的明和小剂量吗啡协同用药以减少吗啡传统用药引起的副作用。方法　 80例患者随机分成 4组并使用不同剂量吗啡和不同浓度布比卡因进行对比观察。结果　协同用药各组副作用发生率远较吗啡传统用药低 ,差异有显著性 ;0 .2 %布比卡因协同组与 0 .375 %布比卡因协同组镇痛与副作用相似 ,组间比较差异无显著性。结论　低浓度 (0 .2 % )布比卡因与氟哌利多、新斯的明协同小剂量吗啡 (1.0mg)用于术后镇痛为更优良的方法。     

不同浓度罗哌卡因用于产科术后镇痛的观察

目的观察比较不同浓度甲磺酸罗哌卡因用于产科术后镇痛的镇痛效果、运动神经阻滞程度及不良反应。方法选择ASA分级Ⅰ～Ⅱ级剖宫产产妇90例,随机分成三组,每组各30例,比较术后A组O．25％罗哌卡因＋0．08mg／ml吗啡、B组0．225％3哌卡因＋0．08mg／ml吗啡、C组0．20％罗哌卡因＋0．08mg／ml吗啡,以2ml／h的速率持续硬膜外镇痛的镇痛效果、运动阻滞情况及并发症发生率。结果A、B组VAS评分显著低于C组（P〈0．05）。Bromage评分A组显著高于B、C组（P〈0．05）。三组并发症的发生率差异无显著性（P〉0．05）。结论0．25％哌卡因用于产科手术镇痛效果显著,但运动神经阻滞相对明显,产妇满意度不是最佳;而0．225％罗哌卡因和0．20％罗哌卡因用于产科术后镇痛均无明显的运动阻滞及不良反应,0．225％罗哌卡因比0．20％罗哌卡因术后镇痛效果更好,病人更满意舒适．所以0．225％罗哌卡因是产科术后镇痛最佳的浓度,更适用于产科术后镇痛。     

病人自控硬膜外镇痛对术后肠功能恢复的影响(附60例报告)

本文按术后镇痛的方式将60例胃肠手术患者随机分为三组，每组2．0例。A组(对照组，肌注哌替啶)，B组(布比卡因)，C组(布比卡因 吗啡组)，观察三种术后镇痛方法对术后肠功能恢复的影响。结果表明，C组用于胃肠手术后镇痛效果良好；与从组比较，术后肠功能恢复无明显影响；B组有促进术后肠功能恢复的效应，但术后镇痛效果差。     

芬太尼与吗啡术后镇痛的效果比较

目的研究对比芬太尼与吗啡用于剖宫产术后病人自控硬膜外镇痛（PCEA）的镇痛效果及不良反应。方法选择120例剖宫产手术患者，ASAⅠ～Ⅱ级，心、肺功能正常，无脊柱畸形。随机分为两组，芬太尼组（A组）、吗啡组（B组）各60例。A组（n=60）应用芬太尼0．251ng＋0.75％布比卡因20ml＋0．9％氯化钠至120ml；B组（n=60）吗啡5mg＋0．75％布比卡因20ml＋0．9％氯化钠至120ml。均采用PCA泵（120ml），以LCP模式（负荷剂量5ml＋维持剂量2．5ml／h＋PCA每次3m1）进行镇痛。PCA后分别12、24、48小时专人巡视，评估疼痛、舒适程度及不良反应。观察BP、HR、IKIK、Sp02、疼痛评分（VAS）、肠功能恢复时间及恶心、呕吐、瘙痒不良反应。结果综合镇痛效果A组与B组无明显差异（P〉0．05）；A组恶心、呕吐、皮肤瘙痒发生率较B组低（P〈0．01），肠功能恢复时间A组较B组早。结论芬太尼、吗啡PCEA用于术后镇痛均可取得满意的效果，但芬太尼比吗啡的不良反应少，更适合于术后镇痛。     

小剂量罗哌卡因复合芬太尼对胃肠手术术后镇痛效果及胃肠功能恢复的影响

目的观察小剂量罗哌卡因复合芬太尼硬膜外持续输注的临床效果及对胃肠道手术病人术后胃肠功能恢复的影响，并与常用浓度的布比卡因进行比较，以指导临床选择用药。方法60例胃肠道手术患者（ASAⅠ～Ⅱ级），随机分为3组，双盲对照观察，R组（n=20），镇痛药为芬太尼0．36mg加0．25％罗哌卡因加地塞米松10mg加NS稀释至150ml；B组（n=20）镇痛药为芬太尼0．36mg加0．15％布比卡因加地塞米松10mg为NS稀释至150ml；C组（n=20），据需要间断肌注度冷丁。R组、B组在镇痛开始时静脉注射格拉司琼5mg。观察术后第一次肛门排气时间．并分别记录术后6、12、24、36、48h的疼痛评分、心率、血压、呼吸进行比较。结果①R、B组排气时间短；②R、B组硬膜外镇痛效果好．对生命体征影响很小，两组闻无显著性差异。结论①局麻药硬膜外镇痛促进胃肠功能恢复；②罗哌卡因与布比卡因相比，在镇痛效果方面没有差剐。因罗哌卡因的中枢神经毒性及心脏毒性作用小于布比卡因，故罗哌卡因在硬膜外镇痛中使用可能更为安全。     

氯胺酮用于上腹部手术后硬膜外镇痛

目的 观察小剂量氯胺酮用于上腹部手术后患者自控硬膜外镇痛（PCEA）的效果.方法 将100例ASA Ⅰ～Ⅱ级、行上腹部手术的患者随机分为两组.Ⅰ组PCEA泵含0.125%左布比卡因＋0.05 mg/ml吗啡.Ⅱ组PCEA泵含0.125%左布比卡因＋0.05 mg/ml吗啡＋0.2 mg/ml氯胺酮.结果 术后第1天和第2天吗啡消耗量Ⅰ组分别为（8.28±2.75） mg、（7.74±1.85） mg,Ⅱ组为（6.71±1.35） mg、（6.15±1.22） mg,尽管Ⅱ组吗啡消耗量明显少于Ⅰ组,但术后6、12、24、48 h VAS评分低于Ⅰ组（P〈0.05）.结论 结果表明,小剂量氯胺酮用于术后硬膜外镇痛效果更好,同时可减少吗啡的用量.     

膝关节镜术后注射玻璃酸钠治疗骨性关节炎疗效观察

目的探讨膝幕节镜术后注射玻璃酸钠（HA）治疗骨性关节炎（OA）的疗效。方法54例膝OA患者的治疗进行回顾性分析。A组单纯膝关节镜手术，B组膝关节镜术后关节腔内注射HA。观察治疗前后病人的疼痛、膝关节活动情况。结果所有病例均获随访，采用HSS评分标准评价疗效：B组优良率大于A组（P〈0．05），有效率差异无统计学意义。结论膝关节镜术后关节腔内注射HA是治疗OA的有效方法。     

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.