重症破伤风的抢救

重症破伤风的抢救成功与否 ,和患者的存活休戚相关。采用伤口扩创处理、应用抗毒血清中和血液中的游离毒素、控制并解除痉挛抽搐、保持呼吸道通畅、合理应用抗生素以及全身支持疗法等六原则抢救 ,使 1例重症破伤风患者痊愈出院     

新生儿重型破伤风气管插管的护理21例

1997年 1月～ 2 0 0 1年 12月我院对 2 1例新生儿重型破伤风在其他治疗原则不变的情况下给予早期气管插管 ,治疗效果满意 ,现报告如下。1　临床资料1 1　一般资料本组共 2 1例 ,男 12例 ,女 9例。发病时间为产后 5～ 10d。全部病例来自农村 ,均为旧法接生 ,有断脐消毒不严史和拒奶、牙关紧闭、苦笑面容、阵发性肌痉挛等临床表现。1 2　方法插管前先给予面罩吸氧 ,然后按医嘱将肌松剂安定针 0 .75～ 1.0 0mg/kg体重 +生理盐水 5ml稀释后缓慢静脉注射 ,待抽搐停止并出现中枢性肌松时 ,经鼻气管插管 ,吸氧或连接呼吸机辅助呼吸。1 3　结果治愈 …     

Management of Primary Hyperparathyroidism With Severe Hypercalcemia During the COVID-19 Pandemic

PurposeIn patients with primary hyperparathyroidism (PHPT) and severe hypercalcemia, parathyroidectomy remains the only curative therapy. During the coronavirus disease 2019 (COVID-19) pandemic, when many hospital visits are suspended and surgeries cannot be performed, the management of these patients represents a challenging clinical situation. This article presents a literature review and discussion of the pharmacologic management of PHPT and severe hypercalcemia, which can be used as a temporary measure during the COVID-19 pandemic until parathyroidectomy can be performed safely.MethodsThis narrative review was conducted by searching literature on the PubMed, Medline, and Google Scholar databases using the terms primary hyperparathyroidism, hypercalcemia, cinacalcet, bisphosphonates, denosumab, vitamin D, raloxifene, hormone replacement therapy, coronavirus, and COVID-19.FindingsAppropriate monitoring and remote medical follow-up of these patients are essential until the resolution of the pandemic. Cinacalcet is the drug of choice for controlling hypercalcemia, whereas bisphosphonate or denosumab is the drug for improving bone mineral density. Combined therapy with cinacalcet and bisphosphonates or cinacalcet and denosumab should be considered when the effects on serum calcium and bone mineral density are simultaneously desired.ImplicationsMedical management of PHPT and severe hypercalcemia presents a reasonable alternative for parathyroid surgery during the COVID-19 outbreak and should be instituted until the pandemic ends and surgery can be performed safely.     

利多卡因治疗重症新生儿破伤风疗效观察

目的:探讨利多卡因对重症新生儿破伤风的治疗效果。方法:按照单盲、随机、对照的研究方法,对49例重症破伤风的新生儿随机分为治疗组21例,对照组28例,其中对照组采用常规治疗方案,治疗组在常规治疗方法的基础上加用利多卡因治疗,观察疗效及安全性。结果:治疗组总有效率为95.24％,与对照组总有效率67.86％比较,差异有显著性(P<0.05)。结论:利多卡因的止痉作用显著,对重症新生儿破伤风的持续性抽搐有较好的疗效,安全性高。     

Haemodynamic Changes During Craniotomy Monitored By A Bioimpedance Plethysmographic Noninvasive Cardiac Output Monitor

Background  Profound cardiovascular changes may occur at various stages during a craniotomy. These changes require a detailed haemodynamic analysis including cardiac output. In the present study, we used a monitor based on electrical bioimpedance method for noninvasive cardiac output measurement. Methods  In 17 ASA I and II patients undergoing elective craniotomies for supratentorial tumours, the following haemodynamic parameters were measured noninvasively: heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR). Haemodynamic changes in response to the following events were studied: (a) induction of anaesthesia with thiopentone, (b) 15 min of air–O₂–isoflurane anaesthesia, (c) infiltration of the scalp with lidocaine adrenaline mixture, and (d) change of inspired gas mixture to N₂O–O₂–isoflurane. Results  HR increased (P < 0.001) and SV decreased (P < 0.001) while CO remained unchanged, one min after administration of thiopentone. After 15 min of isoflurane anaesthesia, HR increased (P < 0.001) and, SBP (P = 0.02), DBP (P = 0.002) and SV (P = 0.003) decreased significantly without change in CO. Three minutes after infiltration of the scalp with lidocaine–adrenaline mixture, there was an increase in SBP (P = 0.001), DBP (P = 0.007), SV (P = 0.007) and CO (P = 0.001) and a decrease in SVR (P < 0.001). Addition of nitrous oxide (60%) to the inspired gas mixture decreased SBP (P = 0.003) and DBP (P = 0.001) with a trend for decrease in CO (P < 0.1). The changes recorded in the present study conform to those that have been documented earlier by using invasive monitoring. Conclusion  Bioimpedance plethysmography is a useful noninvasive technique for monitoring and detailed analysis of the rapidly changing systemic haemodynamics during a craniotomy. The device could be useful for investigating important haemodynamic changes in specific neurosurgical settings. Ali Z, Umamaheswara Rao GS, Jaganath A. Haemodynamic changes during craniotomy monitored by a bioimpedance plethysmographic noninvasive cardiac output monitor.     

Tetanus and the aged

Tetanus is primarily a disease of the aged. Even though the overall number of cases of tetanus has decreased since 1955, the number of cases of tetanus in people 50 years of age and older has remained constant. The national Center for Disease Control attributes the cases of tetanus in the aged to inadequate immunization levels. Tetanus is preventable and, theoretically, could be eradicated if the population was at an adequate immunization level. There are many reasons why older people are not adequately immunized. These reasons may include the inability to get to a health care facility due to physical disability or lack of transportation, ignorance of the importance of seeking health care for minor injuries, financial constraints and a knowledge deficit on the part of health care providers regarding the immunization needs of the aged. Health care providers can prevent tetanus in the aged through vigilance. All aged clients should be routinely assessed and immunizations updated as necessary. Tetanus will never be eliminated until universal active immunization has been achieved.     

Mechanisms of Abnormal Glucose Metabolism During the Treatment of Acute Severe Asthma

Twenty-five patients with acute severe asthma were treated withoxygen, corticosteroids and either salbutamol or aminophyllineby intravenous infusion. Blood glucose, plasma insulin and glucagonwere measured during the first 24 hours of treatment. Salbutamoland aminophylline rapidly caused hyperglycaemia, accompaniedby a rise in insulin and a fall in plasma glucagon. At firstthe increase in plasma insulin was insufficient to restore normoglycaemia,but by 24 hours homeostasis was restored. The early submaximalinsulin response was attributed to the fasting caused by breathlessness.There was no evidence of an increase in hormone secretion causedby direct ß₂-adrenergic stimulation of the pancreaticislets. The effect of corticosteroids on blood glucose overthe period of study was considerably less than the contributionof either salbutamol, or aminophylline.     

悬雍垂腭咽成形术围术期的麻醉处理

[目的]探讨悬雍垂腭咽成形术(UPPP)围术期适宜的插管和麻醉方法。[方法]对40例行UPPP病人围术期采用不同的插管方法,其中16例采用静脉快诱导经鼻明视气管内插管,12例术前行预防性气管切开,12例采用清醒镇静表麻下经鼻盲探气管内插管．比较插管时情况。其中非静脉诱导插管24例病人根据插管前是否泵入异舒吉分为异舒吉组和对照组,观察插管前后血压变化。[结果]经鼻明视气管内插管4例插管不顺利,2例插管期间SPO2下降明显;清醒镇静表麻下经鼻盲探气管内插管成功率100％,插管期间SPO2无明显变化,4例插管后无呛咳反应。插管前后异舒吉组血压无明显变化,对照组插管后血压明显升高。[结论]清醒镇静表麻下经鼻盲探气管内插管为UPPP首选;合适的麻醉深度加血管活性药物可维持稳定的血流动力学状态。     

血液透析中发生消化道大出血1例

１病例介绍病人,男,３８岁,因头晕、乏力半年余,加重伴嗜睡１０余天于１９９７年４月２８日收入我院肾内科,诊断为慢性肾炎、肾功能不全（尿毒症期）。住院期间行胃镜检查示慢性浅表性胃炎,血红蛋白７６ｇ／Ｌ～８５ｇ／Ｌ,给予规律血液透析,每周３次,纠正贫血等...     

Management of Bipolar Disorder During the Perinatal Period

Bipolar disorder (BPD) is a lifelong mental health condition characterized by symptoms of mania, depression, and often anxiety. BPD can have detrimental consequences for individuals during pregnancy and the postpartum period, as well as for their offspring. This is often due to underdiagnosis and/or misdiagnosis as unipolar depression. There is a high incidence of first episodes of BPD in pregnant and postpartum persons. Perinatal care providers need to routinely screen for BPD and assess for relapse among those with a previous diagnosis during the pregnancy and postpartum periods. Medication management is complex and must be considered in the context of an individual’s risk factors and perceptions about treatment as well as the limited evidence regarding fetal safety, using a shared decision-making model. Collaboration, consultation, and/or referral to mental health care providers are essential for managing acute and chronic BPD symptoms.     

Fatigue of the His-Purkinje System During Routine Electrophysiologic Studies

In this report we describe fatigue of the His-Purkinje system during retrograde stimulation of the His bundle by ventricular programmed stimulation. The patient underwent electrophysiologic evaluation for syncope. Antegrade conduction and supraventricular studies were normal with the exception of baseline left bundle branch block. During programmed ventricular stimulation, the patient developed intra-Hisian and infra-Hisian block with symptomatic 3:1 atrioventricular heart block requiring insertion of a permanent pacemaker. This case demonstrates the need for careful study of both antegrade and retrograde conduction properties of the His bundle and atrioventricular node when performing standard His bundle studies in evaluation of syncope.     

经尿道前列腺切除(TURP)术后大出血的原因和处理

目的：探讨经尿道前列腺切除(TURP)术后大出血的原因和防治对策。方法：对本院2001年9月～2004年1月行TURP术的215例患者临床资料进行回顾性分析。结果：215例患者中，12例术后大出血，其中术后早期出血4例，迟发性出血8例。9例经保守治疗治愈，2例经再次开放手术止血，1例经电切镜止血。结论：术中止血确切及术后保证引流通畅是预防TURP术后大出血的关键；术后及时发现出血并正确处理可避免再次手术之苦；对膀胱内已充满血块不能吸出者需再次手术；电切镜下止血是一种安全而有效的方法。     

The Hospital Management of Severe Migrainous Headache

In a two year period, 47 patients with migraine were hospitalized for the management of severe headache; 18 had acute migraine (duration less than 72 hours), 17 had status migrainosus (duration by definition more than 72 hours), and 12 had chronic daily headaches qualitatively of a migraine type. Treatment in all comprised cessation of all previous medication, plus one of the following: intravenous DHE, intravenous lidocaine, a combination of lidocaine + DHE, or subcutaneous sumatriptan. Improvement from DHE, lidocaine, or both was slow and often incomplete. Sumatriptan was not used in patients with chronic daily headaches; in the 8 cases of acute migraine or status migrainosus in which it was used, improvement was rapid and complete in seven.     

舒适护理在重度子痫前期行剖宫产术产妇中的应用

目的探讨舒适护理在重度子痫前期行剖宫产手术患者中的应用效果。方法对2007年3月～2008年10月期间的35例重度子痫前期行剖宫产手术的患者（观察组）实行舒适护理,对2006年月－2007年2月收治的33例产妇（对照组）实行常规护理。比较2组的手术时间、出血量、并发症、术后满意度及新生儿Apgar评分。结果观察组产妇的手术时间缩短,术中出血、疼痛等情况均优于对照组（P〈0．05）。结论对重度子痫前期剖宫产产妇实施舒适护理,减少了术中并发症,提高了护理质量。     

Studies in Cognitive Processing During Worry

Three experiments were conducted to examine the cognitive processing biases during worry or positive imagery. Participants were classified as worriers or non-worriers on the basis of normative data for the Penn State Worry Questionnaire (PSWQ). Experiment 1 was a directed forgetting task using threat and non-threat words. Experiment 2 was a Stroop task, and Experiment 3 was a dot-probe task, also using threat and non-threat words as targets. Across all three experiments, worriers exhibited lower cognitive bias during positive imagery compared to during worry, whereas non-worriers did not show a difference in memory or response latency for all three experiments. A fourth experiment was conducted to determine whether there was a differential rate of catastrophic thinking or positive imagery in association with worry level. It was found that worriers catastrophized more rapidly when instructed, and more slowly engaged in positive imagery. Collectively, these results suggest that positive imagery reduces cognitive bias among worriers, and additional research is warranted to determine how this may contribute to treatment of worry-based conditions.     

Use of the King LTS-D During Medication-Assisted Airway Management

Objective. This case series evaluated provider use of the King LTS-D as a primary airway in patients requiring rapid-sequence intubation (RSI). Methods. Twenty-seven paramedics completed a one-hour training session on the use of the device. All patients meeting the service's standard criteria for medication-assisted airway management were included in the study. Following each insertion, paramedics contacted a research hotline to complete data collection. The primary endpoint was successful insertion, with secondary endpoints including time from succinylcholine administration to successful ventilation, pre- and post-insertion vital signs (oxygen saturation [SaO₂], pulse rate, and systolic and diastolic blood pressure), and end-tidal carbon dioxide [ETCO₂] value 2 minutes after insertion. Analysis between pre- and postinsertion variables was completed using the Wilcoxon signed-rank test. Results. A total of 11 patients met the enrollment criteria and were treated with the device by nine of the 27 paramedics enrolled in the study. All 11 insertions (100%) were successful, with 10 of the 11 (91%) successes achieved on the first insertion attempt. No significant difference existed between pre- and post-insertion pulse rate or blood pressure measures. A significant difference in SaO₂ values was present (p = 0.007). Median ETCO₂ for the study sample was 40 mmHg (interquartile range [IQR] = 33–46 mmHg). Seventy-three percent (8/11) of patients had a time interval of succinylcholine administration to first ventilation of 1 minute or less (range = 1–3 minutes). One case of aspiration was noted on hospital chart review. Conclusion. In this case series, paramedics were able to successfully place and use the King LTS-D in patients meeting our emergency medical services (EMS) system indications for RSI.