丙泊酚靶控输注诱导气管插管对腹腔镜手术患者脑氧平衡及代谢的影响

目的 探讨丙泊酚靶控输注诱导气管插管对腹腔镜手术患者脑氧平衡及代谢的影响.方法 选取2012年1月至2013年10月择期行妇科腹腔镜手术患者96例,所有患者均在丙泊酚靶控输注麻醉诱导下行颈内静脉逆行穿刺置管至右侧颈内静脉球部,行桡动脉置管.根据丙泊酚靶控输注的目标浓度分为A组32例、B组33例和C组31例,浓度分别为3,5,7μg/ml.监测患者手术过程中血流动力学及Nacotrend指数（NI）变化,分别于诱导前（T0）、插管即刻（T1）、插管后30 min（T2）、术毕（T3）收集患者颈内静脉和桡动脉血进行血气分析,比较三组患者不同时间点的动脉血氧分压（PaO2）、动脉血氧含量（CaO2）、颈内静脉球部血氧饱和度（SjvO2）、颈内静脉球部血氧分压（PjvO2）,计算三组动脉-颈内静脉球部血氧差（Da-jvO2）、脑氧摄取率（CEO2）、乳酸含量差（Da-jvL）.结果 三组患者收缩压、心率和NI在T1和T2时均明显低于To,差异有统计学意义（P＜0.05）,而三组患者T1、T2时的NI比较差异有统计学意义（P＜0.05）.与To比较,三组患者的PaO2、PjvO2、SjvO2和CaO2在T1～T3明显升高（P＜0.05）,且三组数值均以C组最高,B组次之,A组最低.在丙泊酚靶控输注过程中,Da-jvO2、CEO2和Da-jvL均呈现逐渐下降的趋势,其中以Da-jvL下降趋势最为明显,差异有统计学意义（P＜0.05）.结论 丙泊酚靶控输注诱导气管插管可降低腹腔镜手术患者的脑氧代谢速度,增加脑组织对缺血缺氧的耐受性,但并不会导致患者出现脑氧供需失衡,其中以7μg/ml丙泊酚浓度的麻醉效果最佳.     

右美托咪定对颅脑手术患者围手术期炎性细胞因子的影响

目的 研究右美托咪定(Dex),对颅脑手术患者围手术期炎性反应的影响.方法 择期颅脑手术患者40例随机分为对照组和试验组(右美托咪定组),每组20例,试验组在手术开始前30 min以右美托咪定0.5μg/kg微泵10 min静脉注射,后持续静脉泵注0.2 μg/(kg·h)维持至术毕前30 min;两组均采用静吸复合全麻,分别于麻醉诱导前、术毕、术后4h和术后24h抽取动脉血,测定血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)和肿瘤坏死因子a(TNF-a)水平.结果 试验组术毕、术后4h和术后24 h的TNF-a为(25.3±6.5、30.3±7.5、29.3±6.9)pg/ml,IL-6为(27.1±7.4、31.3±8.5、26.3±6.2)pg/ml,IL-8为(10.3±5.5、11.2±5.8、17.4±6.9)pg/ml;较对照组术毕、术后4h和术后24 h的TNF-a(30.9±7.7、37.3±8.9、35.3±8.2)pg/ml,IL-6(33.3±8.5、36.3±9.5、31.2±8.1)pg/ml,IL-8(14.3±6.3、15.3±6.5、25.5±8.5)pg/ml,IL-10(31.3±11.5、36.3±13.5、42.3±13.5)pg/ml均明显降低;而IL-10(41.3±12.4、48.3±14.6、55.3±14.8)pg/ml,较对照组IL-10(31.3±11.5、36.3±13.5、42.3±13.7)pg/ml显著升高,两组差异有统计学意义(P＜0.01或P＜0.05).结论 右美托咪定能减轻颅脑手术患者围手术期炎性反应,在减轻全身炎症反应的同时,也能抑制颅脑手术后促炎性细胞因子的过度诱导,对颅脑手术患者具有脑保护作用.     

术前口服5％葡萄糖及0.9％氯化钠对食管癌患者围麻醉期血糖和胰岛素抵抗的影响

目的 探讨术前口服5％葡萄糖及0.9％氯化钠(简称糖盐水)对食管癌患者围麻醉期血糖和胰岛素抵抗的影响.方法 50例拟行择期食管癌根治术患者按随机数字表法分为两组,每组25例,对照组常规禁食、禁饮,试验组术前2h口服糖盐水300 ml,采用静脉复合全身麻醉.分别观察两组患者术前1d、麻醉前、术毕的血糖、胰岛素浓度和胰岛素抵抗指数.结果 两组麻醉前血糖、胰岛素浓度和胰岛素抵抗指数与术前1d比较差异无统计学意义(P＞0.05);两组术毕血糖、胰岛素浓度和胰岛素抵抗指数均较术前1d显著增高[对照组:(10.82±1.23) mmol/L比(5.21±0.32)mmol/L、(51.36 ± 13.68) mU/L比(9.65±1.82)mU/L、24.70±7.47比2.24±0.26;试验组:(9.36±1.35)mmol/L比(5.12±0.21) mmol/L、(32.13±9.71) mU/L比(9.66±1.49) mU/L、13.37±5.82比2.20±0.14](P＜ 0.05);对照组术毕血糖、胰岛素浓度和胰岛素抵抗指数均较试验组高(P＜0.05).结论 术前口服糖盐水不影响食管癌患者围麻醉期血糖水平,并减轻胰岛素抵抗.     

麻醉诱导前静脉预防性给予地佐辛对抑制全身麻醉手术患者诱导期呛咳的效果分析

目的探讨麻醉诱导前静脉预防性给予地佐辛对抑制全身麻醉手术患者诱导期呛咳的效果。方法选取2020年11月至2021年5月在浙江省台州医院行全身麻醉气管插管外科手术患者92例, 按随机数字表法分为对照组和观察组, 每组46例。对照组麻醉诱导前静脉注射0.9%氯化钠5 ml, 观察组静脉注射0.1 mg/kg地佐辛, 10 min后两组行麻醉诱导。记录两组麻醉诱导前(T0)、诱导后气管插管前1 min(T1)、插管后1 min(T2)、气管插管后5 min(T3)时的心率(HR)、收缩压(SBP)、舒张压(DBP), 并检测儿茶酚胺、白细胞介素-6(IL-6)水平, 比较两组呛咳发生率、拔管后躁动评分、视觉模拟量表(VAS)评分、Ramsay镇静评分以及不良反应发生率。结果两组T0、T1、T2、T3时点HR、SBP、DBP水平比较差异无统计学意义(P>0.05)。对照组T2时点儿茶酚胺、IL-6水平高于观察组[(120.49 ± 15.13) ng/L比(113.53 ± 17.14) ng/L、(16.80 ± 2.61) ng/L比(13.46 ± 1.55) ng/L], 差异有...     

全凭静脉及静吸复合麻醉对脊柱神经外科手术患者血糖和皮质醇的影响

目的 探讨静吸复合麻醉和全凭静脉麻醉对脊柱神经外科手术患者血糖和皮质醇的影响.方法 将44例择期行脊柱神经外科手术患者根据计算机产生的随机表分为两组:普鲁泊福复合瑞芬太尼全凭静脉麻醉组(PR组)、七氟烷复合瑞芬太尼静吸复合麻醉组(SR组),每组22例.两组均以普鲁泊福、舒芬太尼、罗库溴铵诱导麻醉,SR组以七氟烷吸入维持麻醉,PR组以普鲁泊福维持麻醉,使脑电双频指数稳定于45～55.观察两组患者不同时间点血糖、皮质醇及血流动力学变化情况.结果 诱导后PR组平均动脉压(MAP)高于SR组(P＜0.05);PR组诱导后60min MAP低于诱导前(P＜0.05).PR组和SR组诱导后60、120min心率(HR)均低于诱导前(P＜0.05);诱导后5min PR组HR低于SR组(P＜0.05).两组间及两组内各时间点血糖水平、两组间各时间点皮质醇水平比较,差异均无统计学意义(P＞0.05).PR组诱导后120min皮质醇水平[(40.6±18.3)μg/L]较诱导前[(129.7±36.7)μg/L]显著降低(P＜0.05),术毕24 h[(93.6±19.8)μg/L]恢复至诱导前水平;SR组诱导后120 min皮质醇水平[(51.6±16.8)μg/L]较诱导前[(130.5±32.1)μg/L]显著降低(P＜0.05),并持续至术毕24 h[(75.9±18.2)μg/L].结论 两种方法均可用于脊柱神经外科手术的麻醉维持,围手术期血糖水平无明显波动,但是七氟烷对皮质醇的抑制时间可能更长.     

吸入麻醉药七氟烷复合丙泊酚用于动脉瘤介入栓塞手术控制性降压的效果评价

目的：探讨吸入麻醉药七氟烷复合丙泊酚用于动脉瘤介入栓塞手术控制性降压的应用效果。方法：选择择期行动脉瘤实施介入栓塞手术的患者55例,分为单纯使用七氟烷组（S组35例）和七氟烷复合丙泊酚组（SP组20例）。控制性降压过程中,平均动脉压（MAP）控制在65 mm Hg左右。监测并记录达到目标血压的时间以及麻醉前、麻醉中、控制性降压中、手术结束后的HR、MAP、SpO2;观察控制性降压过程中心电图的变化;记录控制性降压过程中意识恢复时间、拔管时间以及术后躁动发生率。同步采集桡动脉血和颈内静脉血行血气分析,测定动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）、颈内静脉血氧分压（PjvO2）、颈内静脉血氧饱和度（SjvO2）、血红蛋白（Hb）,并计算动脉血氧含量（CaO2）、颈内静脉血氧含量（CjvO2）、动静脉血氧含量差（Da-jvO2）及脑氧摄取率（CERO2）。结果：两组在麻醉及手术各时点的HR、MAP和SpO2比较差异均无统计学意义（P〉0.05）,但SP组吸入七氟烷浓度低于S组（P〈0.05）。两组均未有患者出现心电图改变及心率失常发生。两组意识恢复时间及拔管时间比较差异均无统计学意义（P〈0.05）。S组拔除喉罩后出现心动过缓、躁动情况均明显高于SP组,差异有统计学意义（P〈0.05）。两组中PaO2、SaO2和SjvO2在降压前、降压中、降压后均明显高于麻醉前（P〈0.05）,但两组间差异无统计学意义（P〉0.05）;降压前、降压中、降压后的CjvO2均显著低于麻醉前（P〈0.05）,但两组间差异无统计学意义（P〉0.05）;降压前、降压中、降压后的Da-jvO2和CERO2均显著低于麻醉前（P〈0.05）,且SP组明显低于S组（P〈0.05）。结论：七氟烷复合丙泊酚麻醉在需控制血压的动脉瘤介入栓塞手术中优于单纯七氟烷吸入麻醉,七氟烷用量减少,停药后不会?     

超前硬膜外镇痛对开胸手术患者应激反应的影响

目的 比较超前硬膜外镇痛和术后硬膜外镇痛对开胸手术患者应激反应的影响.方法 选择择期全身麻醉下拟行开胸手术患者30例,ASA分级Ⅰ或Ⅱ级,按随机数字表法分为术后硬膜外镇痛组(C组)和超前硬膜外镇痛组(P组),每组15例.两组均于T10 ～ T11间隙行硬膜外穿刺并置管.P组切皮前20min时硬膜外注射0.5 μg/ml舒芬太尼+0.15％罗哌卡因混合液15ml,30 min后接镇痛泵以5ml/h的速率硬膜外输注250ml.C组术后待患者清醒、自主呼吸恢复后,拔除气管导管,硬膜外注射0.5μg/ml舒芬太尼+0.15％罗哌卡因混合液15 ml,30 min后接镇痛泵以5ml/h的速率硬膜外输注250ml.两组于硬膜外穿刺前(T0)、术后2 h(T1)和术后18 h(T2)分别采集静脉血6ml,测定血浆促肾上腺皮质激素(ACTH)、血清皮质醇(Cor)和C反应蛋白(CRP)浓度.结果 与T0时比较,两组T1和T2时血清Cor、CRP浓度和血浆ACTH浓度均升高(P＜0.05);P组T1和T2时血清Cor、CRP浓度和血浆ACTH浓度[T1:(401±84) nmol/L、(12.5±5.8) mg/L、(51±84) ng/L;T2:(482±70) nmol/L、(20.4±6.2) mg/L、(72±11) ng/L]均低于C组同时间点[T1:(502±91) nmol/L、(16.3±3.6) mg/L、(70±21) ng/L;T2:(566±77) nmol/L、(27.2±8.5) mg/L、(86±17) ng/L] (P＜0.05).结论 与术后硬膜外镇痛相比,超前硬膜外镇痛可更好地抑制开胸手术患者术后应激反应.     

丙泊酚复合艾司氯胺酮麻醉对妇科腹腔镜手术患者血流动力学及苏醒质量影响

目的：探讨妇科腹腔镜手术丙泊酚复合艾司氯胺酮麻醉对患者血流动力学及苏醒质量的影响。方法：将2021年1月-2023年1月在本院妇科收治的100例腹腔镜手术患者随机分成对照组与观察组各50例,均行全麻,对照组采取丙泊酚麻醉诱导,观察组采用丙泊酚复合艾司氯胺酮麻醉诱导,其他麻醉方法相同。观察麻醉诱导前(T0)、气管插管后5min(T1)、建立二氧化碳气腹后30min(T2)、关闭二氧化碳气腹后5min(T4)血流动力学、苏醒质量、炎性因子水平以及不良反应。结果：T1～T3两组平均动脉压、心率均降低但观察组高于对照组;观察组自主呼吸恢复时间(2.26±1.02 min)、呼之睁眼时间(5.53±1.38 min)、定向力恢复时间(6.56±1.49 min)均短于对照组(4.15±1.19 min、7.11±1.55 min、8.54±2.01 min);术后1d两组血清白介素-6、肿瘤坏死因子-α水平均升高但观察组(148.78±24.92 ng/L、26.16±5.63 ng/L)低于对照组(213.83±32.43 ng/L、33.28±6.45 ng/L);不良反应发生率观察组(6....     

脑氧代谢监测在脑外伤术中过度通气时的价值

目的观察术中过度通气对急性颅脑外伤患者氧代谢的影响,探讨脑氧代谢监测的价值。方法 36例急性颅脑外伤患者,手术中分别于正常通气（PETCO25.0 Kpa）、轻度（PETCO25.0~4.0 Kpa）、中度（PETCO23.5 Kpa）、重度（PETCO23.0 Kpa）过度通气并稳定20 min后同步采集外周动脉和颈静脉球部血样行血气分析,监测SjvO2并计算Da-jvO2。结果随着PETCO2的降低,SjvO2下降,Da-jvO2增加,在中度过度通气时均在安全范围,但至重度过度通气时,有10例SjvO2低于50%,24例Da-jvO2高于9 ml%,显示部分患者脑缺氧。结论脑氧代谢监测可指导脑外伤患者术中过度通气,重度过度通气时可导致脑氧供需失衡,故在颅脑手术麻醉中应避免重度过度通气。     

臂丛神经阻滞复合喉罩麻醉在老年患者上肢手术中的应用

目的 观察臂丛神经阻滞复合喉罩麻醉在老年患者上肢手术中的临床效果.方法 选择择期行上肢切开复位内固定术的老年患者50例,按随机数字表法分为臂丛神经阻滞复合气管插管麻醉组(A组)与臂丛神经阻滞复合喉罩麻醉组(B组),每组25例.观察两组患者麻醉诱导前(T0)、麻醉诱导后即刻(T1)、插管或置喉罩后即刻(T2)、手术开始时(T3)、术中15 min(T4)、停麻醉药时(T5)的平均动脉压(MAP)、心率(HR),同时记录两组患者术中丙泊酚用量、苏醒时间及术后躁动发生率.结果 所有患者均顺利完成手术,无术中知晓.B组血流动力学较为稳定.两组患者在T1时MAP、HR均显著低于T0,差异有统计学意义(P＜0.01).A组患者T2、T3时MAP、HR均高于T1,差异有统计学意义(P＜0.05),其余各时间点间比较差异均无统计学意义(P＞0.05).B组患者MAP、HR在T1后各时间点间比较差异均无统计学意义(P＞0.05).B组在T2时MAP、HR及术后躁动发生率均低于A组[(85.9±8.3) mm Hg(1 mm Hg=0.133 kPa)比(102.5±9.0) mm Hg、(84.5±15.0)次/min比(94.2±14.3)次/min、12.0％ (3/25)比36.0％ (9/25),P＜0.05],丙泊酚用量、苏醒时间少于A组[(321.7±47.2) mg比(382.4±52.6)mg、(7.3±2.9) min比(13.2±3.7) min,P＜ 0.05].结论 臂丛神经阻滞复合喉罩麻醉能安全有效地应用于行上肢切开复位内固定术的老年患者.     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.