外科危重病人静息能量消耗测定及评价

采用开放式间接测热法对５８例严重感染或创伤病人进行静息能量消耗（ＲＥＥ）测定，以同期外科非应激状态病人为对照组。结果示危重病人组ＭＲＥＥ平均为６９８３±８１２ｋＪ／ｄ，比对照组５２７２±４６９ｋＪ／ｄ增高３０．２％（Ｐ＜０．００１），也明显高于按Ｈａｒｉｓ－Ｂｅｎｅｄｉｃｔ公式估算的基础能量消耗值（ＢＥＥ）（５７９９±６２３ｋＪ／ｄ），ＲＥＥ与ＢＥＥ的平均比值为１．２４±０．１２，每千克体重的ＲＥＥ值平均为１２４．３±１０．５ｋＪ／ｄ，危重病人每分钟通气量、Ｏ２耗量及ＣＯ２产生量均明显高于对照组；而呼吸商明显低于对照组。危重病人ＡＰＡＣＨＥⅡ评分平均值为１９．４±５．３，与ＲＥＥ之间有显著相关（Ｐ＜０．０５）。     

儿童体操运动员的能量消耗

用双标水方法测定了１２名６～８岁体操运动员（男女各６名）的总能量消耗（ＴＥＥ）。同时用开放式间接测热法检测了他们的基础代谢率（ＢＭＲ）。根据总能量消耗与基础代谢率的比值推算出每日体力活动水平（ＰＡＬ），用ＴＥＥ－（ＢＭＲ＋０．１ＴＥＥ）表示其在体力活动上的能量消耗（ＥＣＰＡ）。结果表明：儿童体操运动员的总能量消耗平均为８．３９±１．０８ＭＪ／ｄ（男：８．６７±１．４２ＭＪ／ｄ；女：８．１１±０．５９ＭＪ／ｄ，Ｐ＞０．０５），分别高于ＷＨＯ和我国推荐的每日能量需要量标准的３６％（Ｐ＜０．００１）和１３％（Ｐ＜０．０１）。基础代谢率平均为４．２２±０．３６ＭＪ／ｄ（男：４．４５±０．３４ＭＪ／ｄ；女：３．９９±０．２１ＭＪ／ｄ，Ｐ＜０．０５）。体力活动水平平均为１．９８±０．２９（男：１．９６±０．３５；女：２．０４±０．１５，Ｐ＞０．０５）；体力活动的能量消耗平均为３．３４±１．００ＭＪ／ｄ（男：３．３５±１．３９ＭＪ／ｄ；女：３．３２±０．５０ＭＪ／ｄ，Ｐ＞０．０５）。儿童体操运动员的总能量消耗高于ＲＤＡ，与其每日从事运动训练时消耗大量能量有关。     

异基因外周血造血干细胞移植治疗白血病

探讨用 Ｈ Ｌ Ａ 相合的同胞异基因外周血干细胞移植治疗急性髓细胞白血病及 Ａ Ｂ Ｏ 血型不合的 Ｐ Ｂ Ｓ Ｃ Ｔ 的情况,采用 Ｃ Ｔ Ｘ６０ｍｇ／ｋｇ ×２ ＋ Ｔ Ｂ Ｉ７０ ～７５ Ｇｙ 直线加速器照射＋ Ｃ Ｃ Ｎ Ｕ５０ｍｇ／ｋｇ ×１ ± Ｖ Ｐ１６３０ｍｇ／ｋｇ ×１ 对受者作预处理,供者经 Ｇ－ Ｃ Ｓ Ｆ６μｇ／ｋｇ ×５ｄ 动员后,用血细胞分离机（ Ｂａｘｔｅｒ Ｃ Ｓ３０００ｐｌｕｓ） 分离采集干细胞去除红细胞。对 Ａ Ｂ Ｏ 血型不合的 Ｐ Ｂ Ｓ Ｃ,强化移植物抗宿主病（ Ｇ Ｖ Ｈ Ｄ） 预防方案中 Ｍ Ｔ Ｘ 用量及次数;选输合适血制品。结果３ 例病人输注单个核细胞数分别为４０ 、１００ 、５０ ×１０８／ｋｇ , Ｃ Ｄ３４ ＋ 细胞分别为３６ 、１９０ 、２０ ×１０６／ｋｇ ;干细胞悬液中红细胞残存量分别为２３ｍｌ、１４ｍｌ、２６ ｍｌ,红细胞残存率分别为４ ％ 、３ ％ 、５３ ％ 。移植后造血重建迅速。例１ 于＋ ３４ｄ 染色体完全转变为供者型;例２ 于＋ ４０ｄ 血型完全转变为供者型,＋ ４５ｄ 染色体完全转变为供者型,例３ ＋ ５５ｄ 血型完全转变为供者型。没有输血溶血和免疫溶血发生。例２ 为主,次要 Ａ Ｂ Ｏ 均不合,则早期     

三种新型防噪声耳塞声衰减值的测定

本文采用Ｍ×４１／ＡＲ型缓冲垫的ＴＤＨ３９型耳机，对噪声作业人员等，用自己配戴耳塞的方法，测定了美国Ｃａｂｏｔ公司的蘑菇状耳塞、松树状耳塞和柱状耳塞在０．１２５～８ｋＨｚ之间１０个音频上的声衰减值，结果如下：①三种耳塞的平均声衰减值在２５～２８ｄＢ之间，三者无差别。它们都是对中高频特别是对高频的衰减效果好，且三种耳塞在各频率上的平均声衰减值（ｄＢ）与其频率（ｋＨｚ）呈直线相关，其回归方程分别为：ｙ＝１８．５＋２．５ｘ，ｙ＝２１．０５＋２．５１ｘ，ｙ＝１５．１＋３．７ｘ。②由于测试的方法不同，本次的实测值较厂家的理论值平均低７～１７ｄＢ（相当于６０～８０％），尤其是柱状耳塞和磨菇状耳塞及其在１２５Ｈｚ～２ｋＨｚ的差别更大。③与国产护耳器中较好的ＸＸ型泡沫塑料耳塞的平均实际声衰减值比较高５～１０ｄＢ，④三种耳塞的ＮＲＲ值分别为１１ｄＢ、８ｄＢ和４ｄＢ，仅为厂家的１４～４４％。同时也说明，要想提高噪声的个人防护效果，不但要重视耳塞的选择，还要重视耳塞的佩戴方法。本次的测定结果仅供参考。     

SOMATOM CR全身CT扫描控制系统故障维修2例

故障１机器扫描有时中断 ,ＰＲＯＪＥＣＴＩＯＮＳＲＥＣＥＶＥＲＥＤ３６０ ,ＵＳ００８０ＴＩＭＯＵＴＭＥＡＳＵ ＭＥＮＴ等不能进行连续扫描 ,非要按ＲＥＳＥＴ按钮多次或重新启动。处理ＢＳＰ及ＤＡＳ数据传输程序检查通过 ,用ＴＩＭ４、５程序测试机架旋转速度 ,发现旋转速度在下限值 ,而最小脉宽间隔≤８．７ｍｓ。调整机架旋转速度 ,确保最小脉宽 ,在各种ＴＩＭ测试模式中均≥８．７ｍｓ。ＢＳＰ接收数据恢复正常 ,无曝光中断现象 ,但偶尔还会出现正方向扫描结束 ,ＴＵＢ反方向启动失败情况 ,利用ＴＳＯ４ 程序做ＧＡＮＣＯ检查机架…     

车间复合噪声对听觉系统的损伤

研究车间复合（脉冲＋稳态）噪声对听觉系统的损伤。将１、２、３组豚鼠（每组１０只）分别暴露于复合噪声〔９５ｄＢ（Ａ）＋１２５ｄＢ（ＳＰＬ峰值）〕、脉冲噪声〔１２６ｄＢ（ＳＰＬ峰值）〕和稳态噪声〔９９．４ｄＢ（Ａ）〕中（３组能量相等）,暴露５天（每天７ｈ）,第４组为对照组。暴露结束后于立即、１天和１０天,测其听力损失（ＮＩＨＬ）。结果显示：复合噪声组（１组）和脉冲噪声组（２组）均产生永久性阈移〔ＰＴＳ,分别为（５．２８±１．８）ｄＢ和（８±０．８５）ｄＢ〕。复合噪声组与脉冲噪声组的渐近线阈移〔ＡＴＳ,分别为（３０．４０±２．１）ｄＢ,（３６．６０±１．４５）ｄＢ〕明显高于稳态噪声组〔（２４．２２±１．２１）ｄＢ〕。提示低于１４０ｄＢ（峰值）时脉冲噪声和复合噪声可能引起比等能量的稳态噪声更高的危害     

核黄素缺乏大鼠红细胞维生素E水平的变化及脂质过氧化关系的研究

对两组大鼠分别喂饲核黄素缺乏（ＲＤ）膳和核黄素添加（Ｒ８，２２ｍｇ／ｋｇ饲料）膳８周后，测定了两组大鼠的红细胞维生素Ｅ（ＲＢＬＶｅ）、红细胞超氧化物歧化酶（ＳＯＤ）和红细胞丙二醛（ＭＤＡ）的水平。结果发现：ＲＤ组ＲＢＣＶｅ水平（４．７１７３±０．７７１０ｍｇ／ｇ蛋白质）显著低于ＲＳ组（５。３８６８±１．１５３７ｍｇ／ｇ蛋白质，Ｐ＜０．０５）。而ＲＤ组的ＲＢＣＳＯＤ（７７４５．２±６１０．１ｕ／ｇ蛋白质）和ＭＤＡ（０．６８６８±０．１３７２μｇ／ｇ蛋白质）则分别显著低于和高于ＲＳ组（８２６８．５±３０１．０ｎｕ／ｇ蛋白质，０．５５４８±０．０９８０，Ｐ＜０．０５）。研究提示，核黄素缺乏引起细胞膜脂质过氧化加重可能ＲＢＣＶｅ消耗增加。     

宾阳县食品从业人员HBsAg阳性情况分析

１９９８年我们对宾阳县食品从业人员体检资料进行ＨＢｓＡｇ阳性分析。１材料与方法资料来源于宾阳县１９９８年食品从业人员健康体检资料;试剂由上海荣盛生物技术有限公司提供,以样品ＯＤ值ＥＬＩＳＡ法检测ＨＢｓＡｇ,≥２．１阴性对照平均ＯＤ值判为阳性。２结果２．１ＨＢｓＡｇ感染情况接受检查的食品从业人员５７１２人,ＨＢｓＡｇ阳性３２４人,阳性率为５．６７%,其中男性阳性率为５．８１%（１２４／２１３４）;女性阳性率为５．５９%（２００／３５７８）。２．２ＨＢｓＡｇ阳性与行业分布见表１。２．３年龄分布见表２。表１各行…     

锌在豚鼠卡那霉素中毒性耳聋中的作用

应用给豚鼠注射硫酸锌的方法，观察了锌对豚鼠卡那霉素中毒性耳聋的影响。通过观察给药组和对照组动物的耳廊反射（ＰＲ）阈，脑干听觉诱发电位（ＢＡＥＰｓ）阈变化及耳蜗底回外毛细胞缺失率，发现硫酸锌注射组和对照组豚鼠的４、６、８ＫＨｚＰＲ阈在处死时分别升高１４．５６±３．１２ｄＢ，１５．８８±３．３８ｄＢ，１８．１２±２．７０ｄＢ和１７．１２±３．５６ｄＢ，１６．１５±２．５８ｄＢ，１９．２５±３．０１ｄＢ（Ｐ＞０．０５）。实验结果说明补充锌对卡那霉素中毒性耳损害无明显对抗作用     

CT多幅相机开机后不能正常进行自检故障一例

故障现象：开机后照相机无任何反应,不能自检,不能装载。故障检修：本着由简到繁的原则,首先检查了直流电压和全部保险丝。（１）;保险丝全部正常。（２）：电压＋８．５Ｖ、一８．５Ｖ、＋５５Ｖ、＋１８．５Ｖ、一１８．５Ｖ、＋２４Ｖ均都在正常工作范围内。观察２Ｊ４、２Ｊ５电路板上的ＬＥＤ的状态,也未见明显变化。在正常工作时开机后,装载暗盒的Ｘ——平台和Ｙ——平台得到Ｊ４板（ＰＯＳＩＴＩＯＮＧＥＮＥＲＡＴＯＲＢＯＡＲＤ位置发生器控制板）发给２Ｊ２板（ＶＥＲＩＴＣＡＬＳＴＥＰＰＩＮＧＭＯＴＯＲＬＯＧＩＣＢＯＡ…     

Effect of noise on the vestibular system - Vestibular evoked potential studies in rats

Studies have shown that in order for sound to affect the vestibular end organs in the inner ear, very high intensities are required. Furthermore, in patients with noise induced hearing loss, vestibular signs, if present, are subclinical. In order to study possible auditory-vestibular interactions in a more controlled fashion, using physiological sound intensities, the present study used short latency vestibular evoked potentials (VsEPs) to impulses of angular (15,000 degrees /sec(2), risetime 1.5 msec) and linear (3-5 g, risetime 1.5 msec) acceleration were used to study the possible effects of sound on peripheral vestibular function in rats. Four different paradigms were used: a - an intense (135 dB pe SPL) click stimulus was presented 5 msec before the linear acceleration impulse and the VsEP to 128 stimuli were recorded with and without this click stimulus. There was no effect of the preceding intense click on the first wave (reflecting end organ activity) of the linear VsEP. b - 113 dB SPL white noise "masking" was presented while the VsEPs were elicited. A 10-20% reduction in the amplitude of the first VsEP wave was seen during the noise exposure, but 5 minutes after this exposure, there was almost complete recovery to pre-exposure amplitude. c - 113 dB SPL noise was presented for one hour and VsEPs were recorded within 15 minutes of cessation of the noise. The auditory nerve-brainstem-evoked response showed a temporary threshold shift while there was no effect on the VsEP. d - 113 dB SPL white noise was presented for 12 hours per day for 21 consecutive days. Auditory nerve-brainstem-evoked responses and vestibular (VsEPs) function were studied one week after the conclusion of the noise exposure. Auditory function was severely permanently depressed (40 dB threshold elevation and clear histological damage) while the amplitude of wave 1 of the VsEP was not affected. It seems therefore that even though intense noise clearly affects the cochlea and may have a "masking" effect on the vestibular end organs, the intensities used in this study (113 dB SPL) are not able to produce a long-term noise induced vestibular disorder in the initially normal ear. These differences between the response of the cochlear and vestibular end organs to noise may be due to dissimilarities in their acoustic impedances and/or their electrical resting potential.     

Evaluation of Transient and Distortion Product Otoacoustic Emissions before and after shooting practice

Firearms are a common source of impulse noise that may potentially damage a hearing organ. It is not easy to predict soldiers' personal susceptibility to noise exposure. The purpose of this study was to evaluate of the transient evoked otoacoustic emission (TEOAE) and distortion-product otoacoustic emission (DPOAE) before and after shooting and compare it with conventional pure tone audiometry. Standard pure tone audiometry, tympanometry, TEOAE and DPOAE measurements were recorded before and 10-15 minutes after shooting. Ten male soldiers (20 ears) were exposed to impulse noise from automatic gunfire (15 single rounds of live ammunition). They did not use any earplugs. The reduction in amplitude of the TEOAE after shooting was 3.1 and 5.1 as SPL for 3 and 4 kHz respectively for the right ear and 4.3 dB SPL for 1 kHz and 0.6 dB SPL at 2 kHz for the left ear. The greatest reduction in DPOAE occurred at frequencies of 1.0 kHz (3.8dB SPL) and 3.0 kHz (2.9 dB SPL) for the left ear. There were no differences in the audiometric thresholds before and after shooting. Emissions appear to be more sensitive for monitoring early cochlear changes after shooting, than pure tone audiometry.     

Influence of leisure-time noise on outer hair cell activity in medical students

Objective: Noise exceeding a certain level can damage outer hair cells and thus cause hearing loss. In the past, noise-induced hearing loss was mainly caused by occupational noise. Leisure-time noise may be a promoting factor, particularly in young adults. The purpose of this study was to investigate whether transient evoked otoacoustic emissions (TEOAE) can be used to evaluate outer hair cell damage in young adults with no history of hearing complaints. The data obtained from the measurement of TEOAE were correlated with the participants’ listening habits and exposure to leisure-time noise. Methods: Eighty-eight young adults (47 women, 41 men; age 22.9±2.9 years) were examined. TEOAE were measured using standard ILO 88 equipment. All participants had normal hearing (hearing thresholds better than 20 dB HL; frequency range 0.125–10 kHz). None of the participants suffered from permanent tinnitus. All participants answered a questionnaire concerning their listening habits. Results: On average, the participants frequented a discotheque 1.4 times a month; 25% had never visited a discotheque, 35% visited once a month and 32% twice or three times a month. Sixteen per cent reported transient tinnitus after every visit to a discotheque and 58% after nearly every visit. Eight per cent suffered from transient hearing loss after every visit to a disco and 37% after nearly every visit. Three per cent (4%) reported tinnitus (nearly) every morning after visiting a discotheque. The TEOAE level was above 6 dB in all participants [9.2±3.6 dB (mean ± SD)] and reproducibility was above 60% (90±9%). All values matched pass criteria for normal TEOAE under clinical conditions. However, TEOAE levels and reproducibility decreased significantly with an increased number of visits to discotheques. Conclusion: Outer hair cell damage could be measured using TEOAE in individuals exposed to leisure-time noise, although these individuals exhibited no measurable puretone hearing loss.     

TEOAE和ABR联合应用于高危新生儿听力筛查的分析

目的:瞬态耳声发射(TEOAE)及听性脑干反应(ABR)联合应用于高危新生儿听力筛查的敏感性和准确性分析.方法:对120名高危新生儿(240耳),采用TEOAE及ABR技术对其进行听力筛查.结果:240耳经TEOAE检测,82耳(34%)未通过筛查,在未通过TEOAE的耳中有53耳通过ABR筛查.而在通过TEOAE的158耳(66%)中有27耳未通过ABR.两种筛查方法相比,ABR筛查的通过率高于TEOAE筛查,其差异有显著的统计学意义(P＜0.01).结论:联合采用TEOAE和ABR听力筛查技术,可以减少单纯用TEOAE进行筛查的假阳性和假阴性,从而提高高危新生儿听力筛查的敏感性和精确性.     

较短时间声暴露后永久性听力损失的预测方法

50只豚鼠分为1个对照组和4个暴露组,分别暴露于1kHz纯音115,120,125和130dB(SPL)0.5h,观察暴露后的皮层听区电反应阀、琥珀酸脱氢酶(SDH)活性和毛细胞缺失率的变化。不同强度声暴露后0.5h内的平均听力损失<50dB者,不发生永久性听力损失,而>50dB者,则都有永久性听力损失。就单耳来说,大多数都符合这一关系。这一结果可为预测暴露后是否产生永久性听力损失提供参考依据。毛细胞SDH活性和表面形态无明显改变时,听力损失是暂时性的,酶活性下降明显但细胞形态尚属正常时,多数耳有永久性听力损失,当二者均有明显改变时,则几乎所有耳都留有永久性听力损失。     

应用纯音测听诊断职业性噪声聋的可靠性和有效性

对6年以上工龄的青年织布女工108人(216耳)连续二次纯音测听的资料表明:第一次和第二次的听阈均值差除个别频率(8KHz左耳为3.5dB)外,其余各频率都在-0.3～0.5dB范围内;最大标准差于2KHz处为17.4dB,在3KHz和8KHz处分别为18.5dB、20.1dB。据此认为一次纯音测听的记录可作为职业性噪声聋诊断和评价听力损失程度的初步依据,必要时可用阻抗计测试镫骨肌反射阈和听觉脑干诱发反应测听以排除中耳疾患和非器质性聋。2例女工脱离噪声环境疗养2周,每隔一周复查听力一次,结果三次测听的语频均值出现21.7和13.3dB的差值,考虑系暂时性阈移的恢复。作者们对1980年卫生部门颁发的“噪声性聋调查方法”提出了改进意见。     

人体外耳道口及鼓膜处声压值的测量与比较

目的　测量和比较稳态噪声环境下外耳道口和鼓膜处的声压值 ,观察外耳道声学效应最大的频率范围 ,为个体噪声计量仪的设计及研究环境噪声对人体的影响提供精确的数据 ,为噪声暴露声压值的校正提供参考。方法　在 5 0dBSPL稳态窄频带噪声声压下 ,分别于 0 .2 5～ 8.0 0kHz用AudioScanRM5 0 0测量 30人 ( 6 0耳 )外耳道口及鼓膜处的声压值 ,比较各个频率段外耳道口和鼓膜处声压差值的差异。结果　在相同频率段 ,不同受试者双耳之间及男女之间外耳道口的声压值小于( 0 .2± 1.8)dBSPL ,鼓膜处的声压值小于 ( 0 .6± 2 .6 )dBSPL ,差异均无显著性 (P >0 .0 5 ) ,故将相同频率段外耳道口及鼓膜处的声压值结果合并统计。在 1.5 0kHz以上频率段 (含 1.5 0kHz)外耳道口和鼓膜处的声压差值的差异有显著性 (P <0 .0 1)。在 2 .0 0kHz处其差值最大 ,为 ( 10 .5± 3.4 )dBSPL。在0 .5 0kHz处其差值最小 ,为 ( 0 .5± 6 .2 )dBSPL。结论　对中心频率为 1.5 0kHz(含 1.5 0kHz)以上的噪声 ,在评价环境噪声及使用噪声个体计量仪时应考虑外耳道的增压作用     

Effects of stimulus intensity on sound localization in the horizontal and upper-hemispheric median plane.

Sound lateralization ability with headphones is known to be affected by stimulus intensity. However, there have been few studies on sound localization with loudspeakers in free field from the standpoint of stimulus intensity. The aim of this study is to obtain basic data for the tests with normal hearing and hearing-impaired subjects, and for the fitting of a hearing aid. The author investigated the relationship between stimulus intensities and sound localization ability of the broadband noise and pure tone bursts delivered in the horizontal and upper-hemispheric median planes. Subjects were ten volunteers, 5 males and 5 females, at the age of 18-19 years, with normal hearing. The results showed well how subjects perceived directions at all stimulus intensities. The percentage of correct response (%correct) for broadband noise stimuli was maximum at the intensity from 40 to 70 dB SPL (sound pressure level), and was minimum at 0 to 20 dB SPL in both the horizontal plane and the upper-hemispheric median plane. At lower stimulus intensity, examinee could not judge the direction, even if they could hear the stimuli. For pure tone bursts stimuli in the upper-hemispheric median plane, %correct was low irrespective of stimulus intensity.     

Agreement between hearing thresholds measured in non-soundproof work environments and a soundproof booth

Aims: To study the agreement between audiometric test results measured in non-soundproof environments at the worksite, and in a soundproof booth.

Methods: In a cross sectional prevalence study on noise induced hearing loss, 885 transport workers whose hearing thresholds were measured by a standard audiometric test method in non-soundproof environments at the worksite were identified to have some hearing loss (>25 dB), and were retested in a soundproof booth.

Results: At 4–8 KHz, the mean of the absolute differences in hearing threshold obtained by these two methods was 2 dB or less. When the proportions of hearing loss (30 dB for any frequencies at 3–8 KHz, or 90 dB for three low frequencies at 0.5–2 KHz, or 90 dB for three high frequencies at 3–6 KHz) were compared, considerable differences existed. A much better agreement was obtained when the criteria for hearing loss as measured in the field test under non-soundproof conditions were relaxed by 5 dB. At 4 KHz, the difference between the proportion of subjects with hearing loss as measured in the field and that as measured in the booth was the smallest. The kappa statistic was highest at 3 and 4 KHz.

Conclusions: Audiometric test results conducted in non-soundproof environments in the field are comparable to those obtained in a soundproof environment among transport workers with a hearing loss of >25 dB. The hearing threshold at 4 KHz appears suitable for the estimation of the prevalence of hearing loss when appropriate adjustments are made in the diagnostic criteria.

     

Comparing changes in transient-evoked otoacoustic emission and pure-tone audiometry following short exposure to industrial noise

It has been suggested that otoacoustic emissions, particularly transient-evoked otoacoustic emissions (TEOAE), might be more sensitive in assessment of changes to the cochlea caused by noise than pure-tone audiometry (PTA). The aim of the study was to compare temporary threshold shifts with the changes in TEOAE following a six-hour exposure to industrial noise at the intensity of 85-97 dB (A). Thirty two male employees of a metal factory were screened. TEOAE, PTA and tympanometry were included in the hearing test battery. Both, PTA and TEOAE showed significant reduction due to noise exposure, but no correlation between temporary threshold shifts and decreases in either the overall TOAE level or the level of otoacoustic emission in the frequency bands was found. Our results confirm the high sensitivity of TEOAE to short exposure to industrial noise. This study may recommend this measurement as a method of evaluation for TTS conditions for hearing conservation programme purposes, in addition to pure-tone audiometry.