咪达唑仑复合芬太尼辅助经鼻胃镜检查的探讨

目的观察咪达唑仑复合芬太尼辅助经鼻胃镜检查的效果。方法将行经鼻胃镜检查的患者588例随机分为观察组（298例）和对照组（290例）。观察组在检查前静脉注射咪达唑仑和芬太尼,行警觉／镇静评分（OAA／S）,至OAA／S达Ⅲ级后检查;对照组直接按常规行经鼻胃镜检查。比较检查前、中、后两组血压、心率、呼吸、血氧饱和度（SpO2）及检查操作时间、患者感受和不良反应。结果观察组检查中的血压、心率及检查操作时间、患者感受和不良反应与对照组比较均有显著差异（P〈0．05）。结论咪达唑仑复合芬太尼辅助经鼻胃镜检查,能消除患者的焦虑和恐惧,有效抑制咽部反应和胃肠道反应引起的不良反应,且操作简便,效果确切,安全性高。     

经鼻胃镜上消化道检查的安全性和耐受性评估

目的通过比较非镇静经口、经鼻途径超细内镜（经鼻胃镜）检查前、检查中和检查结束时受检者血压、脉搏、血压×脉搏/100的动态变化和受检者的恶心反应程度,以评价经鼻胃镜检查的安全性和耐受性。方法对胃镜检查途径无选择意向者212例,随机分为经口和经鼻检查组各106例。分别监测检查前、检查中2min和检查结束时受检者的血压和脉搏,并评估受检者的恶心反应。结果经鼻检查组的血压、脉搏、血压×脉搏/100变化低于经口检查组（P〈0.05）;两组胃镜检查完成时间无明显差异（P〉0.05）;经鼻检查组的恶心反应低于经口检查组（P〈0.05）。结论经鼻检查组的血压、脉搏、血压×脉搏/100升高幅度和受检者的恶心反应均较小,受检者具有较高的安全性和较好的耐受性。     

丙泊酚静脉全麻辅助老年患者肠镜检查效果观察

目的：观察丙泊酚静脉全麻辅助老年患者肠镜检查效果。方法：将行肠镜检查老年患者158例随机分为观察组82例和对照组76例,观察组鼻导管低流量吸氧,保持呼吸道通畅,缓慢静脉推注丙泊酚,达到镇静效果后进镜;对照组按常规方法行肠镜检查。观察比较两组血压、心率、呼吸、氧饱和度、感受、操作时间、丙泊酚总用量和不良反应。结果：观察组感受、操作时间和检查成功率与对照组比较,差异显著（P〈0.05）;血压、心率、呼吸和血氧饱和度有一过性降低,1～1.5min内可自行恢复。结论：丙泊酚静脉全麻辅助老年患者肠镜检查舒适和安全。     

脉搏血氧饱和度监测在全麻术后的应用

对全麻术后麻醉未清醒或呼吸功能未完全恢复的患者 ,应用无创性脉搏血氧饱和度 (ＳＰＯ2 )监测 ,为患者合理给氧提供了科学客观的指标。同时对早期发现病情变化 ,预防并发症的发生起到了重要的指导作用。无创性脉搏血氧饱和度仪可连续监测血氧饱和度和脉搏容积图 ,其原理是通过置于手指末端 ,耳垂等处的红外光传感器来测量氧合血红蛋白的含量。所测的经皮血氧饱和度和动脉血气血氧饱和度的相关性很好 ,其绝对值十分接近[1] 。1　ＳＰＯ2 的监测意义动脉血氧饱和度是指血红蛋白 (Ｈｂ)的氧合程度的百分比 ,ＳＰＯ2 =Ｈｂ氧含量Ｈｂ氧容量 × …     

地佐辛预防高原地区全麻患者苏醒期躁动的观察

目的：观察地佐辛在高原地区对全麻患者苏醒期血压、脉搏血氧饱和度、心率的影响及术后躁动的治疗效果。方法：选择ASA（Ⅰ~Ⅱ）级择期手术患者100例,随机分为观察组（地佐辛组）和对照组,每组50例。观察组患者于手术结束前20min给予静脉注射地佐辛注射液0.1mg/kg,对照组患者不行静脉注射地佐辛。结果：观察组呼吸恢复时间长于对照组（P〈0.01）,但拔管时间无显著性差异（P〉0.05）。观察组脉搏血氧饱和度在拔管即刻较对照组稳定（P〈0.01）、心率在拔管即刻和拔管后5min较对照组稳定（P〈0.01）,血压在拔管即刻和拔管后5min、15min及30min均较对照组稳定（P〈0.01）;对照组患者躁动的发生率高于地佐辛组（P〈0.01）。结论：地佐辛在高原地区用于全麻患者苏醒期,血压、心率较对照组稳定,术后躁动发生率低,尤其是脉搏血氧饱和度值稳定,适用于高原低氧环境。     

经鼻胃镜的临床应用价值

目的:观察经鼻胃镜检查时患者的不适反应和生命体征变化,并在检查过程中与患者交谈,询问对检查过程的感受.方法:用直径超细的经鼻胃镜经鼻腔插入至十二指肠,完成胃镜检查.结果:1266例病人中,除8例因双侧鼻夹肥大或小儿因鼻腔太小镜身无法通过而改经口腔检查外,所有病例均顺利完成胃镜检查,少数病人有心率稍降低和鼻腔黏膜轻度损伤,大多数病人无明显的咽反射.结论:直径超细的经鼻胃镜经鼻插入可不接触舌根到达食管和胃,减轻了患者的咽反射,减轻了对迷走神经的刺激,有效地避免恶心反应,减少了患者检查时不适反应,对患者的生命体征影响较小,对那些普通胃镜插管风险较高的有心肺疾患、年老体弱和普通胃镜无法插管的患者是一种安全、有效的检查方法.     

高海拔地区某部官兵吸烟与血氧饱和度和脉搏的关系

目的研究驻高海拔地区某部官兵吸烟行为与血氧饱和度和脉搏的关系。方法使用指夹式脉搏血氧仪,测定驻高海拔地区某部184名官兵的血氧饱和度和脉搏,按照吸烟量的大小分为甲、乙两组（各92名）,比较两组之间血氧饱和度和脉搏的差异;再将不吸烟24名和重度吸烟的21名官兵进行比较,比较两组之间血氧饱和度和脉搏的差异。结果吸烟量大小两组之间的血氧饱和度没有显著差异,但吸烟量大组的脉搏增快;不吸烟与重度吸烟两组之间,血氧饱和度差异不显著,但重度吸烟组脉搏增快。结论高海拔地区吸烟行为不能增加血氧饱和度,减轻高原反应,相反可使心率增快,从而增加心输出量和耗氧量。吸烟有害无利,在高原官兵也是如此,建议戒烟。     

进驻高原军人爬山对即刻血氧饱和度和心率的影响

目的:观察3000米爬山前后即刻对进驻高原军人血氧饱和度和心率的影响.方法:对比观察爬山前后即刻血氧饱和度和心率的变化.结果:爬山后心率较爬山前明显增加.结论:高原爬山即刻即可对心血管系统产生影响.使心率明显加快.     

机械通气在高龄低肺功能食管癌患者术后的临床应用

目的探讨机械通气在高龄肺功能低下食管癌术后的应用价值。方法选取56例术前肺功能(MVV≤50%和FEV1/FVC>45%)低下的食管癌患者,年龄(72.3±4.1)岁。其中术后行呼吸机辅助呼吸的37例为A组;术后常规治疗,未行呼吸机辅助呼吸的19例为B组。观察两组患者血氧饱和度、心律失常、动脉血气以及住院时间等情况。结果两组患者均无死亡病例。A组中脉搏血氧饱和度(97.6±1.4)%,心律失常发生率29.7%(11/37),呼吸机辅助呼吸时间(33.2±5.4)h,术后住院时间(7.6±2.3)d;B组中脉搏血氧饱和度(92.4±1.2)%,心律失常发生率47.4%(9/19),术后住院时间(10.1±3.1)d,其中2例因血氧饱和度降至80%,立刻行呼吸机辅助呼吸;两组术后血气的变化差异有统计学意义。结论对于肺功能低下的食管癌手术患者,应用机械通气辅助呼吸可扩大手术适应证,减少术后并发症。     

阻塞性睡眠呼吸暂停低通气综合征合并心血管疾病患者通气功能和睡眠结构的变化

 目的探讨阻塞性睡眠呼吸暂停低通气综合征(Obstructive sleep apnea/hypopnea syndrome,OSAHS)合并心血管疾病患者通气功能和睡眠结构的变化,观察经鼻持续气道正压通气的治疗效果.方法监测单纯鼾症组,鼾症合并心血管疾病组,OSAHS组,以及OSAHS合并心血管疾病组患者低通气指数、呼吸暂停指数、呼吸暂停低通气指数、最低血氧饱和度、觉醒指数及睡眠分期的变化.随机选择OSAHS合并心血管疾病患者28例实施经鼻持续气道正压通气治疗.结果 OSAHS合并心血管病组的呼吸暂停指数高于单纯OSAHS组(P＜0.05).OSAHS合并心血管疾病组的觉醒指数和3+4期睡眠时间明显小于单纯OSAHS患者(P＜0.01或P＜0.05).OSAHS合并心血管疾病患者经持续气道正压通气治疗后呼吸暂停低通气指数显著降低(P＜0.05),最低氧饱和度明显升高(P＜0.05);重度组2期睡眠明显减少(P＜0.01);重度组3+4期睡眠明显增加(P＜0.05).结论 OSAHS合并心血管疾病患者有明显的通气功能和睡眠结构紊乱,经鼻持续气道正压通气治疗后通气功能和睡眠结构紊乱明显改善.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.