食管癌术后冷冻肋间神经镇痛的临床疗效观察

目的：评价食管癌术后应用肋间神经冷冻镇痛的临床效果。方法：选取2010年2月-2012年6月本科收治的157例食管癌患者,按照随机数字表法将其分为三组,肋间神经冷冻组（n=65）：采用术中冷冻肋间神经止痛,每根肋间神经冷冻温度为-57℃左右,冷冻时间为90 s;镇痛泵组（n=51）：术后由麻醉师给予静脉用镇痛泵（舒芬太尼）止痛;对照组（n=41）：临时肌注吗啡。通过视觉模拟疼痛评分法评价术后疼痛程度,比较各组肺部并发症发生率及第1秒用力呼气容积（FEV1）实测值,同时比较各组胃肠道功能恢复时间。结果：肋间神经冷冻组的术后镇痛效果、肺部并发症、胃肠道排气排便情况等方面均明显优于镇痛泵组和对照组,差异均有统计学意义（P〈0.05）。结论：肋间神经冷冻术可明显减轻食管癌患者开胸术后疼痛,且能降低并发症发生率,可作为常规选择替代人工镇痛泵。     

肋间神经冷冻和硬膜外自控镇痛在胸外科术后镇痛中的比较

目的 比较肋间神经冷冻和硬膜外自控镇痛在胸外科术后镇痛中的临床效果.方法 将2006年4月至2008年5月开胸手术治疗的89例患者按照随机数字表法随机分为肋间神经冷冻组(A组,47例)和硬膜外自控镇痛组(B组,42例).比较两种方法在术后疼痛程度评分、术后止痛药物应用次数、术后下床活动时间上的差异.结果 A组患者术后疼痛程度评分为(1.49±0.80)分,B组为(2.43±1.21)分,两组比较差异有统计学意义(P<0.05). A组和B组术后止痛药物应用次数[(1.28±0.62)、(2.02±1.05)次]、术后下床活动时间[(43.15±12.22)、(64.10±14.25)h]比较差异均有统计学意义(P<0.05).结论 肋间神经冷冻在治疗效果上优于硬膜外自控镇痛,肋间神经冷冻在胸外科术后镇痛中可以提供满意的镇痛效果.     

开胸术后肋间神经冷冻与患者自控静脉镇痛效果的临床比较

目的 观察肋间神经冷冻与患者自控静脉镇痛(PCIA)在开胸术后的镇痛效果.方法 150例接受开胸手术的患者按镇痛方法随机分为三组:肋间神经冷冻组(冷冻组,50例)、PCIA组(50例)及临时肌肉注射哌替啶(度冷丁)组(对照组,50例).以视觉模拟疼痛评分法评价疼痛程度,并比较各组术后肺部并发症的发生率和第1秒用力呼气容积(FEV1)实测值.结果 术后第3天冷冻组患者疼痛程度显著弱于PCIA组和对照组,P＜0.05,冷冻组的FEV1(1.89±0.31)较对照组(1.37±0.20)高,P＜0.05,肺部并发症的发生率(14%)也显著低于对照组(36%),P＜0.05.结论 肋间神经冷冻可以显著减轻接受开胸手术患者的疼痛,并可减少肺部并发症的发生.     

肋间神经冷冻术预防开胸术后胸痛的临床观察研究

目的探讨肋间神经冷冻术对预防开胸术后胸痛的效果.方法随机选取行开胸术的患者235例作为实验组(A组),并随机选择同期行开胸手术患者分别作为术后静脉自控镇痛组(B组)及对照组(C组),观察各组患者术后疼痛及止痛药的使用情况;同时对比观察各组术前、术后PaO2、PaCO2的变化.结果A组止痛有效率与B组相比有显著差异(P≤0.01);B组止痛有效率与C组相比有显著差异(P≤0.01).三组之间术后止痛药的使用量有显著差异,其中A组用量最少,C组最多.术后血气分析结果表明,A组可有效改善术后缺氧及二氧化碳潴留状态.结论术中肋间神经阻滞能增强术后镇痛效果,减少术后镇痛药的使用,并有效改善呼吸抑制状态.     

特耐预先镇痛联合肋间神经阻滞在胸腔镜肺叶切除手术中的使用

目的：探讨特耐预先镇痛联合肋间神经阻滞在胸腔镜肺叶切除手术中的使用的镇痛效果。方法：选择60例胸腔镜肺叶切除手术患者,分为观察组和对照组,观察组采用特耐预先镇痛复合肋间神经阻滞镇痛,比较两组患者的术后1,2,4,8,12小时疼痛程度。结果：在术后各时间点,观察组VAS评分均显著低于对照组。观察组患者术后吗啡使用量显著低于对照组。结论：特耐预先镇痛复合肋间神经阻滞可以改善胸腔镜肺叶切除手术术后镇痛。     

改良肋间神经阻滞术后镇痛的临床观察

目的 探讨多微孔硬膜外导管持续肋间神经阻滞镇痛的临床效果与实用价值.方法 40例开胸术后镇痛患者分别施行多微孔硬膜外导管持续肋间神经阻滞镇痛(观察组,20例)与患者自控静脉镇痛(对照组,20例),按Prince-Henry(PH)评分法评估两组患者术后疼痛程度,观察其并发症的发生率.结果 观察组术后2d内PH评分均低于对照组,差异有统计学意义(P＜0.01).观察组术后胸腔引流管留置时间(2.58±0.70)d,明显短于对照组的(3.69±1.01)d,差异有统计学意义(P＜0.01).对照组术后镇痛相关并发症发生率30％(6/20),高于观察组的5％(1/20),差异有统计学意义(P＜0.01).结论 持续肋间神经阻滞镇痛效果极明显,更有助于术后呼吸功能的恢复,减少并发症.     

开胸术后肋间神经冷冻与患者自控静脉镇痛效果的临床比较

目的 观察肋间神经冷冻与患者自控静脉镇痛(PCIA)在开胸术后的镇痛效果及其对血浆白细胞介素(IL)-6、C反应蛋白(CRP)的影响.方法 选择行常规开胸肺癌根治术患者120例,按随机数字表法分为三组:肋间神经冷冻组、PCIA组及临时肌肉注射哌替啶组,每组40例.视觉模拟疼痛量表评分(VAS)法评价疼痛程度,比较各组术前、术后相应时间点IL-6及CRP水平,并观察比较各组术后并发症发生率.结果 术后48 h,肋间神经冷冻组[95.0％ (38/40)]、PCIA组[90.0％(36/40)]镇痛有效率显著高于临时肌肉注射哌替啶组[35.0％(14/40)],差异有统计学意义(P＜0.01).三组术前1 d IL-6水平比较差异无统计学意义(P＞0.05).肋间神经冷冻组术后6h时IL-6水平显著低于同期PCIA组[(13.82±4.42) ng/L比(17.94±5.16) ng/L],差异有统计学意义(P＜0.05).三组患者术前ld及术后2h时CRP水平比较差异均无统计学意义(P＞0.05).肋间神经冷冻组术后24 h时CRP水平显著低于同期PCIA组[(112.6±14.0) mg/L比(125.5±17.9) mg/L],差异有统计学意义(P＜0.05).临时肌肉注射哌替啶组、肋间神经冷冻组和PCIA组术后并发症发生率分别为22.5％(9/40)、5.0％(2/40)、12.5％(5/40),三组间比较差异无统计学意义(P＞0.05).结论 肋间神经冷冻可以显著减轻开胸术后患者的疼痛,降低术后炎性反应程度.     

右美托咪定复合氢吗啡酮用于老年患者胸腔镜术后静脉自控镇痛的效果

目的探讨右美托咪定复合氢吗啡酮用于老年患者胸腔镜术后静脉自控镇痛的效果。方法本次研究选取我院2018年1月—2019年4月行胸腔镜手术的60例老年患者为观察对象,随机分成A组和B组,每组30例,全部患者术后均给予氢吗啡酮静脉自控镇痛(patient-controlled intravenous analgesia,PCIA),B组在PCIA泵注氢吗啡酮基础上加用恒速静脉注射右美托咪定,比较术后4 h、8 h、12 h、24 h及48 h静息疼痛视觉模拟评分(VAS)及镇静评分(Ramsay),术后不良反应发生状况,患者满意度,以及术后48 h内氢吗啡酮用量和住院时间。结果(1)VAS和Ramsay评分比较,B组均明显优于A组(P<0.05)。(2)对比两组不良反应发生率,B组(6.67%)明显低于A组(26.67%)(P<0.05)。(3)对比两组患者总满意率,B组(93.33%)明显高于A组(70.00%)(P<0.05);(4)两组氢吗啡酮使用量比较,组间差异不明显(P>0.05);(5)两组住院时间比较,B组明显短于A组,两组差异显著(P<0.05)。结论老年患者胸腔镜术后静脉自控镇痛中,在使用氢吗啡酮基础上复合使用右美托咪定,可增加对患者的镇痛、镇静效果,降低不良反应发生率,加快患者恢复,缩短住院时间,利于提升治疗安全性和患者满意度。     

肋间神经冷冻止痛术对开胸手术后患者肺功能影响

目的：为研究探讨肋间神经冷冻止痛术在开胸手术后的止痛效果及对患者术后肺功能的影响。方法：选用10例开胸手术患者用肋间神经冷冻术防切口疼痛，观察对肺功能的影响，同时用20例开胸手术患者作对照，对照组全部患者术后早期面用杜冷丁止痛，而冷冻组均未使用任何止痛药物。结果：两组患者在术后早期，肺功能变化幅度均较大，且与时间密切相关（P＜0．05），但两组之间差异仍无显著性（P＞0．05）。结论：肋间神经冷冻止痛术后止痛效果确切，维持时间长，可替代止痛药物。     

肋间神经冷冻止痛的研究现状

开胸术后镇痛对于手术患者的临床预后和康复具有重要意义。它能够有效地减轻手术患者的切口疼痛和由手术创伤引起的神经内分泌反应。因此,有效控制术后疼痛不仅仅是患者的基本医疗要求,也是治疗的措施之一。近年来,随着冷冻医学的发展以及冷冻探针的研发和改进,肋间神经冷冻止痛在临床上逐渐得以推广应用,并且取得了令人满意的止痛效果。作为一项新兴的技术,肋间神经冷冻止痛的临床应用尚处于探索阶段,现对其实验及临床研究综述如下。一、冷冻止痛的发展简况冷冻止痛具有非常悠久的历史,1931年Jones就报道了希腊医生Hippocrates(公元前460…     

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.