一次性口咽通气管在急诊洗胃中的应用

目的 探讨一次性口咽通气管在急诊洗胃过程中的应用效果.方法 将72例服毒需急诊洗胃的患者随机分为两组各36例,对照组使用开口器或舌钳协助经口插管,确定置管成功后用注射器和长胶布固定胃管,观察组使用口咽通气管协助插管后用长胶布固定胃管.结果 观察组胃管被咬瘪和脱落发生率显著低于对照组,置管时间和洗胃时间显著短于对照组(均p<0.01).结论 应用口咽通气管协助经口插管后固定胃管,可缩短置管时间和洗胃时间,减少不良反应,减轻病人痛苦,提高护理质量.     

传统置胃管法与改良置胃管法对小儿急性中毒的观察与护理

目的?分析并评价传统置胃管法与改良置胃管法对小儿急性中毒的治疗与护理效果.方法?将该院2009年4月—2012年4月期间收治的急性中毒患儿185例随机分为观察组与对照组,对照组85例应用传统置胃管法,观察组100例应用改良置胃管法,对比分析两组患儿的临床治疗及护理效果.结果?观察组患儿的一次置管成功率、胃管堵塞率、两次及以上置胃管率以及0.5?h内洗胃率与对照组相比(P<0.01或P<0.05),差异有统计学意义;观察组鼻或咽喉出血发生率、恶心呕吐发生率以及胃内容物返流发生率均显著低于对照组,两组比较(P<0.05),有统计学意义;观察组呛咳反应发生率与对照组相比无显著性差异(P>0.05),不存在统计学意义;观察组平均住院时间为(3.59±0.41)d,对照组为(4.11±0.64)d,两组比较差异有统计学意义(P<0.05).结论?应用改良置胃管法能够明显提高急性中毒患儿的一次性置管成功率,缩短住院天数,减少并发症的发生,其洗胃效果令人满意,提倡临床广泛推广.     

食管气管联合导管在急性重症口服中毒洗胃中的应用

将107例急性重症口服中毒病人随机分为两组.观察组用食管气管联合导管(ETC)插管,从食管管腔中插入胃管洗胃;对照组在普通气管插管成功后,从口腔或鼻腔插入胃管洗胃.观察两组插胃管成功所需时间和一次插胃管成功率.结果两组病人插管时间和一次插管成功率比较,均p＜0.05,差异有显著性意义.提示对急性重症口服中毒病人采用食管气管联合导管插管洗胃是较好的抢救方法.     

心里干预在清醒者洗胃配合中的应用

目的:探讨心里干预在清醒患者洗胃配合中的应用.方法:将60例药物中毒清患者随机分成两组,观察组和对照组各30例,观察组在对照组的基础上加上心理干预,并观察置管时间,置管成功率,洗出血性液体等发生率.结果:心理干预组一次性插入胃管的成功率及术中配合程度明显优于对照组(p<0.05).结论:心里干预增加中毒患者对洗胃的依从性,缩短洗胃时间,减轻患者痛苦,在急诊抢救中具有十分重要的临床意义     

呼气末二氧化碳分压监测在昏迷患者留置胃管中的应用

目的 探究呼气末二氧化碳分压（end expiratory carbon dioxide partial pressure,PetCO2）监测在昏迷患者留置胃管中的应用效果。方法 选择2021年6-12月医院收治的62例留置胃管昏迷患者作为研究对象,根据组间性别、年龄、身体质量指数（bodymassindex,BMI）、格拉斯哥昏迷评分（Glasgowcomascale,GCS）等基本资料均衡可比的原则分为两组。对照组30例行常规胃管插管,观察组32例在PetCO2监测下进行胃管插管,对两组一次置管成功率、置管时间、置管不良反应发生情况以及置管期间生命体征指标变化情况进行对比分析。结果 观察组一次置管成功率高于对照组,置管时间短于对照组,差异有统计学意义（P<0.05）;观察组呛咳、恶心呕吐等置管不良反应发生率均低于对照组,差异有统计学意义（P<0.05）;观察组各生命体征指标变化程度均低于对照组,差异有统计学意义（P<0.05）。结论 PetCO2监测在昏迷患者留置胃管中的应用效果较好,值得推广应用。     

食管气管联合导管在急性重症口服中毒洗胃中的应用

将107例急性重症口服中毒病人随机分为两组。观察组用食管气管联合导管（ETC）插管，从食管管腔中插入胃管洗胃；对照组在普通气管插管成功后，从口腔或鼻腔插入胃管洗胃。观察两组插胃管成功所需时间和一次插胃管成功率。结果两组病人插管时间和一次插管成功率比较，均p〈0．05，差异有显著性意义。提示对急性重症口服中毒病人采用食管气管联合导管插管洗胃是较好的抢救方法。     

预防鼻胃管置入所致粘膜损伤的方法探讨

目的：探讨利多卡因和石蜡油滴鼻及口服对胃管置入患者鼻腔、食管黏膜损伤的防护作用。方法：将80例胃管置入患者随机分为实验组和对照组,每组各40例。实验组患者采用利多卡因和石蜡油滴鼻及口服,对照组不采取防护措施,分别观察两组患者的胃管置入不良反应及一次性置管成功率,并通过鼻胃镜观察鼻腔、食管的黏膜损伤程度。结果：实验组仅有3例出现重度胃管置入不良反应,一次性置管成功率达93.3%,鼻胃镜检查仅有3例出现粘膜充血（P〈0.01）。结论：利多卡因和石蜡油滴鼻及口服对胃管置入患者的鼻腔及食管黏膜损伤有防护作用,值得临床推广应用。     

中毒病人口、鼻两种置胃管的对比观察

[目的]对中毒病人口、鼻两种置胃管方法进行对比观察。[方法]选取某院急诊科2008年6月～2009年1月所抢救的急性有机磷中毒、镇定药中毒、其他药物过量等100例病人随机分为鼻插法(50例)和口插法(50例)。[结果]将经鼻置胃管和经口用咽喉镜置胃管从一次成功率,恶心呕吐,鼻出血率进行比较,二者差异有统计学意义(P﹤0.01)。[结论]经口用咽喉镜置胃管效果优于经鼻置胃管洗胃法。     

术前置胃管时机及方式的临床对比研究

目的：探讨全麻下与常规术前对患者行胃管置入术的差异。方法：将60例肝胆手术患者随机分为两组,对照组于术前30min在病房内行胃管置入术．实验组为在手术室全麻下行胃管置入术。观察两组患者胃管置入的成功率及在置胃管过程中有无恶心、呕吐、流泪、呛咳、疼痛反应;置管前、置管后1min、置管后5min血压、心率变化及心肌耗氧率。结果：实验组1次置管成功率均明显高于对照组（P〈0．05）;置管过程中实验组不适反应发生率均明显低于对照组,血压、心率波动范围实验组也明显低于对照组（P〈O．01）,两组比较,全麻下置胃管术优于对照组（P〈0．01）。结论：宜选择全麻后在导丝引导下置入胃管术。     

气管插管伴意识障碍病人插胃管的临床研究

目的对经口行气管插管伴意识障碍病人分别采用新方法和常规方法留置胃管,对比两者首次置管成功率、平均置管时间、并发症,为临床插胃管提供理论依据。方法选择对经口行气管插管伴意识障碍病人插胃管48例,随机分成观察组24例,对照组24例,观察组采用新研制的润滑剂:湿润烧伤膏+利多卡因和新研制了与一次性硅胶胃管各种型号相配的骨水泥头胃管辅助器进行插胃管;对照组采用常规教科书的方法。结果观察组首次置管成功率91·67%,置管平均时间(10·30±3·4)min;对照组首次置管成功率70·33%,置管平均时间(19·52±10·57)min,而且观察组并发症也大大减少,尤其是鼻出血在观察组未发现1例。结论采用新方法对气管插管伴意识障碍病人进行插胃管能提高插胃管成功率,减少并发症,节省护士操作时间,提高工效。     

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.