飞行人员用药安全与监测研究现状（摘要）

本文针对飞行员用药安全与监测进行了悉心的文献阅读与整理,就各国对飞行员如何带药飞行的研究做一综述。文中涉及到飞行员目前所用六大类药物,如抗抑郁药物、心血管药物、糖尿病药物、呼吸系统药物、抗组胺药物、中草药等。通过总结各国最新文献以阐述各国目前对飞行员安全带药的最新研究成果。作者亦对各国所做的飞行事故毒物检测结果进行了总结。     

Intercomparison experiments of systems for the measurement of xenon radionuclides in the atmosphere

Radioactive xenon monitoring is one of the main technologies used for the detection of underground nuclear explosions. Precise and reliable measurements of ^131mXe, ^133gXe, ^133mXe, and ^135gXe are required as part of the International Monitoring System for compliance with the Comprehensive Nuclear-Test-Ban Treaty (CTBT). For the first time, simultaneous testing of four highly sensitive and automated fieldable radioxenon measurement systems has been performed and compared to established laboratory techniques. In addition to an intercomparison of radioxenon monitoring equipment of different design, this paper also presents a set of more than 2000 measurements of activity concentrations of radioactive xenon made in the city of Freiburg, Germany in 2000. The intercomparison experiment showed, that the results from the newly developed systems agree with each other and the equipment fulfills the fundamental requirements for their use in the verification regime of the CTBT. For 24-h measurements, concentrations as low as 0.1 mBq m⁻³ were measured for atmospheric samples ranging in size from 10 to 80 m³. The ¹³³Xe activity concentrations detected in the ambient air ranged from below 1 mBq m⁻³ to above 100 mBq m⁻³.     

36例歼击机飞行员24h动态心电图分析

为了解中国歼击机赠心电活动特点，分析了３６例歼击机飞行员２４ｈ动态心电图（ＤＣＧ），并与５５例正常人ＤＣＧ比较。结果显示：房性心律失常多于室性，房性或室性心律失常均高于正常组，ＳＴ段下移检出率亦高于正常组。     

飞行人员胆囊结石的空中B超观察

旨在观察飞行中胆囊结石有无位移及能否诱发空中突然失能。采用日本SDL－32型B超诊断仪，对16名飞行人员胆囊结石患者进行了地面及空中观察。结果表明，地面观察未见胆囊结石有明显位移；跟班飞行观察，从飞机爬升经巡航到下滑几个阶段内，胆囊结石保持原位不动者9例（共有块状结石7枚，泥沙状结石3堆），其中结石位于胆囊颈部3例、胆囊体部6例，为滞留型；结石发生了位移者7例（共有块状结石13枚），其中结石由胆囊颈部降到胆囊体部者4例、由胆囊体部落到胆囊底部者2例，在胆囊体部前后壁间横向移位者1例，为游移型。游移型结石有可能速入胆道，引起突然失能，危及飞行安全，应密切观察。     

直接X线成像受检者照射剂量及图像质量的实时监测

目的 探讨利用直接X线成像(DR)图像DICOM头文件中的剂量信息实现对DR受检者照射剂量和图像质量实时监控的可行性.方法 TO.16模体进行曝光,管电流从0.5 mAs开始逐渐增加至125 mAs,分别记录TO.16模体中模拟病变A(直径11.1 mm)、D(直径4.0 mm)、J(直径0.7 mm)的显示个数,计算检测系数(H_T).设计DR受检者照射剂量及图像质量实时管理系统软件,DR摄片完成后,实时发送到工作站,实时读出每幅图像DICOM头文件中的剂量面积值(DAP)信息作为照射剂量与图像质量控制指标,设立上限值、下限值与75%分点值,当超过该部位设定的限值时,系统发出提示,及时查找原因作相应处理.结果 TO.16模体A点在低于10 mAs时、D与J在低于16 mAs,H_T随mAs增加而增加;A点在10-100 mAs、D、J点在16～100 mAs时HT没有增加.DR受检者照射剂量及图像质量实时管理系统软件共计实时监测曝光5120次,发现DAP值超过设定限值引起的提示66次,提示率为1.3%.其中超过上限值21次,包括7次为技师手动设置曝光量过高;4次自动曝光控制(AEC)点选择错误引起的剂量超标;9次为技师人为增大照射野;1次原因未明,推测可能与AEC短时不稳定有关.45次低于下限值,图像质量下降,主要是摄影部位偏离AEC探测点所致.结论 DR具有较高的曝光宽容度.此方法能及时发现人为或设备问题导致的不适当照射剂量及图像质量受损,实现DR受检者照射剂量及图像质量自动实时管理.     

1995～2000年度我院地高辛血药浓度监测情况分析

对我院1995～2000年1580份地高辛血药浓度监测的结果进行分析.6年间地高辛血药浓度监测的数量没有明显的变化,且主要集中在心内科、心外科、呼吸内科和高干科等几个科室,约占80%以上.在治疗窗(0.8～2.0μg/L)范围内的占监测总数的48.04%,其中>2.0μg/L的占12.65%,<0.8μg/L的占39.11%,两者合计数为51.76%.本项分析结果提示,应加强个体化给药意识,提高合理用药的水平.     

放化分离α谱分析在钚内照射个人剂量监测应用中的探讨

目的 探讨尿钚放化分离结合α谱分析的监测方法作为职业人员吸入钚所致内照射个人剂量监测的适宜性,为核工业职业卫生管理和钚设施单位开展尿钚监测提供参考。方法 以美国能源局（DOE）核设施单位的钚化合物组成为例,使用模拟计算的方法,分别推导了急性和慢性吸入钚化合物致个人有效剂量分别为1 mSv时的尿钚水平,并与放化分离后α谱分析的典型探测限进行比较,分析尿钚监测用于个人剂量估算的适用性。结果 仅对于吸入M类钚化合物后10 d内使用放化分离α谱分析进行尿钚监测可以满足1 mSv探测限要求。结论 制定人员尿钚内照射个人剂量监测计划,须考虑监测方法的探测限,必要时通过工作场所监测结合受照时间等对工作人员的职业受照进行评价。     

代谢组学技术在精准医疗中的运用

个体差异的存在对复杂的代谢综合征(如糖尿病、肥胖、心血管疾病)和癌症治疗及预防带来了巨大的挑战。精准医疗策略利用高通量的分子监测技术筛选与疾病相关的生物标志物,为疾病发生的病理学机理研究及动态监测提供了新的思路。在精准医疗的分子监测技术中,代谢组学技术分析的结果与疾病发生的相关性最高。本文对代谢组学技术在精准医疗中的运用进行阐述,主要包括代谢组学技术的优点,代谢表型的影响因素和代谢组学在疾病监测中的运用,旨在促进精准医疗策略在人体健康管理中的运用。     

创伤后早期监护的临床意义

创伤后早期监护重点是对血容量及脏器血液灌流做出评估,对创伤性休克的程度做出判断。本文对习用的心率、血压、尿量、中心静脉压等监护参数的临床意义从理论及经验上进行了分析。着重指出老年人创伤后早期循环状态不良的主要原因仍是低血容量,但需要与心功能不全鉴别。     

万古霉素血药浓度监测的临床应用

目的探讨万古霉素血药浓度监测的临床应用,以指导临床合理用药。方法对海军总医院2009年7月～2011年9月住院患者使用万古霉素的79例次血药浓度监测结果进行回顾性分析。结果该院住院患者使用万古霉素的总有效率为61.76%。血液中药物谷浓度在5～10 mg/L的占22.78%;小于5 mg/L有4例次,占5.06%;大于20 mg/L有27例次,占34.18%。结论根据血药浓度制定个体化给药方案,能提高疗效,减少不良反应。     

Correlation between oxygen status measures during neonatal air transport

Introduction: The purpose of this study was to determine the strength of the relationship between arterial oxygen tension (Pao₂) and transcutaneous oxygen (Ptco₂), and arterial carbon dioxide tension (Paco₂) and transcutaneous carbon dioxide (Ptcco₂) of premature neonates during fixed-wing air transport.Method: The study admitted 37 randomly selected intubated or nonintubated neonates who received oxygen by mechanical ventilation or face mask and required at least a 1-hour fixed-wing flight. Arterial blood gas samples were taken from the umbilical artery catheter at the end of three 15-minute intervals and stored in an ice slurry for analysis (Radiometer ABL300) on arrival at the receiving hospital. Transcutaneous monitor readings (Radiometer Tina 3) were recorded with each arterial sample.Results: A correlation of 0.88 (p <.001) between Pao₂ and Ptco₂ and 0.86 (p <.001) between Paco₂ and Ptcco₂ existed.Conclusion: Despite strong correlation, the range of difference between the individual transcutaneous values and actual blood oxygen values were from 0 to 31. This difference was not due to change in cabin pressure. Considering the flight environment (cabin temperature, pressure changes, and weather), these values are remarkably stable.     

？ICCO与Swan—Ganz导管在血流动力学监测中的应用比较

目的对比PICCO与Swan—Ganz导管在重症血流动力学监测中的应用。方法30例患者采用PICCO法,32例患者采用Swan—Ganz导管．比较两组患者直接由穿刺及置管本身导致的并发症、ICU住院天数、住院费用、死亡率有无统计学意义。结果PICCO组患者在ICU住院天数、住院费用均少于Swan—Ganz导管组（P〈0．05）,死亡率及穿刺并发症的发生率二者无统计学意义（P〉0．05）。结论使用PICCO进行血流动力学监测在临床更经济、高效,具有更广泛的使用价值。     

出血性脑卒中术后颅内压监测及临床意义的研究

 目的 探讨持续动态颅内压(ICP)监测在出血性脑卒中术后治疗中的意义.方法 对出血性脑卒中60例术后进行回顾性分析,随机分为监护组(30例)和对照组(30例).监护组根据持续ICP的变化分为＜20 mmHg、20～30 mmHg、＞30 mmHg,并随时调整治疗.对照组根据常规经验进行术后治疗.结果 监护组ICP＞20 mmHg者占60%,＞30 mmHg者占20%.在甘露醇的应用和并发症发生率方面均低于对照组,两组差异有统计学意义(P＜0.01和P＜0.05).预后情况监护组优于对照组(P＜0.05),且不同ICP之间预后差异有统计学意义(P＜0.05).结论 对于出血性脑卒中术后患者进行ICP监护有利于指导和及时调整治疗方案,减少并发症,改善预后.     

创伤性休克监测指标及意义

创伤性休克为急诊室常见病,病理生理基础是有效循环血量锐减,微循环灌注不足,较单纯失血性休克更加复杂。休克发生后引起机体血压下降、心率增快等一系列代偿或失代偿变化,最终导致组织灌注不良而引发严重后果。在此过程中,如何对患者的状态进行有效的监测,对指导急诊救治有十分重要的意义。本文主要介绍了创伤性休克传统监测指标以及近年来研究应用的一些新的监测指标。     

爱婴医院消毒效果监测分析与评价

目的:分析爱婴医院空气、物体表面、医护人员手及使用中消毒液在消毒效果监测中的存在问题及寻求解决方式.方法:于2001年、2002年每月对我院各科室的空气、物体表面、医护人员手及使用中消毒液的消毒效果进行监测和对比评价.结果:2001年、2002年各类消毒效果监测总合格率分别为96.4%、97.9%,两者比较差异有显著性(P＜0.05),其中2001年空气质量监测合格率91.0%,2002年合格率96.7%,两者比较差异有非常显著性(P＜0.01),2001年物体表面、医护人员手及使用中消毒液质量监测合格率与2002年比较差异无显著性(P＞0.05).结论:严格执行消毒隔离制度;合理布局病室;有条件的可安装纯动态消毒机等是提高空气消毒质量的有效办法.     

妊娠合并梅毒的产前超声监测价值

目的探讨妊娠合并梅毒胎儿超声特征及产前超声监测的价值。方法将82例妊娠合并梅毒患者分为治疗组和未治疗组,同时按孕周又将其随机分组,通过产前超声监测,比较各组胎儿的异常超声表现、先天梅毒儿的发生情况。结果早孕治疗组超声监测未发现异常超声表现;中、晚孕治疗组、未治疗组胎儿畸形发生率分别为:6.06%,33.33%,70.83%。治疗组产前超声监测明显超声异常,如胎儿畸形等行引产26例,有效防止先天梅毒儿出生;未治疗组未行产前超声监测出生先天梅毒儿17例。结论产前超声监测有助于先天梅毒的诊断和抗梅疗效的观察,是及早发现胎传梅毒,适时终止妊娠,减少先天梅毒儿出生的一个可靠的监测手段,有较高的临床应用价值。     

失血性休克复苏及监测指标研究进展

创伤、失血性休克是一古老的临床研究课题。不仅在平时常见，更重要的是与战伤救治密切相关。尽管近10年来取得了一些进展，但复苏时机、复苏目标、液体种类的选择、复苏后继续生命支持以及监测技术等仍是临床以及研究人员面临的重大挑战。本文将就近年来有关上述问题的最新研究进展进行分析和讨论，以期提高对该复杂综合征的认识，为今后的研究提供帮助。     

Monitoring the swimmer’s training load: A narrative review of monitoring strategies applied in research

The high incidence of injury during swim training and the increasing demands of the sports make monitoring of the swimmer's training load a key concept requiring further investigation. Research has previously introduced numerous methods for the purposes of monitoring the swimmer's training load, but a narrative review discussing the strengths and limitations of each method is lacking. Consequently, this narrative review aims to summarize the monitoring strategies that have been applied in research on competitive swimmers. This knowledge can assist professionals in the field in choosing which method is appropriate in their particular setting. The results from this study showed that external training load was predominantly obtained through real-life observation of the swimmers’ training volume. However, research has investigated a number of internal load monitoring tools, including blood lactate, training heart rate, and perceived effort of training. To date, blood lactate markers are still considered most accurate and especially recommended at higher levels of competitive swimming or for those at greater risk of injury. Further, mood state profiling has been suggested as an early indicator of overtraining and may be applied at the lower competitive levels of swimming. Professionals in the field should consider the individual, the aim of the current training phase, and additional logistical issues when determining the appropriate monitoring strategy in their setting.     

Duplex Doppler ultrasound in carcinoid metastases

In a prospective study, the role of duplex Doppler ultrasound in monitoring interferon treatment-related changes in carcinoid metastases was evaluated. The Doppler findings from the tumours were correlated to the clinical and laboratory status of the patients to test the hypothesis that successful treatment results in increased vascular resistance. The patients were divided into 4 groups: untreated (n = 10), progressive disease (n = 17), stable disease (n = 20) and objective response (n = 18). In 7 cases Doppler evaluation was made before and after treatment. No significant difference in Doppler values were found between the groups, and at present duplex Doppler ultrasound does not seem to play a role in the evaluation of tumour therapy in carcinoid patients. Offprint request to: A. Elvin     

超声监测氯米芬治疗不孕症的应用价值

目的　探讨氯米芬 (克罗米芬 )诱导排卵障碍性不孕症妇女排卵时B超监测卵泡发育的临床价值。方法　对 48例用克罗米芬及HMG促卵泡发育的排卵障碍性不孕患者 ,月经第 9天开始观察 ,直至排卵期结束。结果　 48例患者经诱导排卵 ,卵泡发育成熟 .排卵者 3 4例 ,占70 %,其中受孕者 17例。结论　用B超监测药物诱导排卵在排卵障碍不孕症治疗中有重要的指导意义 ,可为准确预报排卵时间 ,指导患者掌握受孕机会 ,并在治疗中选择有效剂量 ,提供可靠的科学依据。