舒芬太尼联合瑞芬太尼在腹腔镜胆囊手术中的应用

目的：观察舒芬太尼诱导，瑞芬太尼维持应用于腹腔镜胆囊切除术中的临床效果。方法：ASAⅠ～Ⅱ级择期行腹腔镜胆囊切除手术的病人60例，随机分为瑞芬太尼组（R组）和舒芬太尼-瑞芬太尼组（SR组），每组30例。麻醉诱导分别采用瑞芬太尼1μg／kg、舒芬太尼O．5μg／kg，麻醉维持两组均为瑞芬太尼0．1μg／kg／min和异丙酚4—6mg／kg／h。比较两组的麻醉效果和术后恢复情况及不良反应等。结果：R组与SF组气管插管和术中均能维持良好的血流动力学；苏醒期SR组血流动力学稳定，VRS和躁动均低于R组（P〈0．05）。结论：舒芬太尼诱导复合瑞芬太尼持续静脉输注维持麻醉方式适宜腹腔镜胆囊切除手术，能满足手术麻醉深度，保证围术期血流动力学稳定，术后又能迅速恢复并可减轻瑞芬太尼麻醉术后的急性疼痛。     

瑞芬太尼复合异丙酚用于剖宫产术的临床研究

目的探讨瑞芬太尼复合异丙酚对剖宫产术产妇全麻的临床疗效。方法选择对硬膜外麻醉有禁忌证的剖宫产产妇40例,将40例产妇随机分入瑞芬太尼组及标准全麻组,每组20例。瑞芬太尼组给予瑞芬太尼1．0μg／kg、异丙酚1．5mg／kg麻醉诱导。标准全麻组给予硫喷妥钠4～5mg／kg,司可林1．5mg／kg。观察两组麻醉前、插管即刻、切皮即刻、拔管时产妇血流动力学改变,术中知晓情况、苏醒时间及新生儿1 min、5 min及10 min Apgar评分。结果瑞芬太尼组产妇各时点血流动力学稳定,苏醒时间快,与标准全麻组插管即刻及切皮即刻比较,差异有统计学意义;两组均无术中知晓发生;两组新生儿1min、5min及10min Apgar评分比较,差异无统计学意义。结论瑞芬太尼复合异丙酚对剖宫产术产妇全麻效果理想,产妇血流动力学稳定,对新生儿无不良影响。     

不同剂量瑞芬太尼喉罩通气麻醉对老年患者全髋关节置换术的影响

目的 观察并比较老年患者双腔型喉罩麻醉下行全髋关节置换术中应用不同剂量瑞芬太尼的临床效果.方法 选择择期行全髋关节置换术的老年患者60例,ASA分级Ⅰ～Ⅱ级,根据瑞芬太尼的不同剂量,分为0.2μg/(kg·min)组、0.3μg/(kg·min)组与0.4μg/(kg·min)组,每组20例.记录三组患者麻醉诱导前、麻醉诱导后即刻、置喉罩后即刻、手术开始、术中15 min、停麻醉药的平均动脉压(MAP)和心率,以及术中用药、体动发生率与苏醒时间.结果 所有患者均顺利完成手术,无术中知晓发生.0.2μg/(kg·min)组术中心率、MAP波动大,体动发生率高(45.0％,9/20),丙泊酚使用量最多[(82.4±21.6)mg];0.3μg/(kg·min)组术中心率、MAP波动较小,术后患者苏醒较快;0.4μg/(kg·min)组术中心率、MAP抑制作用明显,麻黄碱使用量最大[(5.2±4.3) mg],术后拔喉罩时间长[(5.2±1.3) min].结论 0.3 μg/(kg·min)瑞芬太尼复合丙泊酚行双腔型喉罩通气可用于全髋关节置换术老年患者的全凭静脉麻醉,血流动力学稳定,并发症少,通气可靠.     

舒芬太尼复合瑞芬太尼应用全麻临床观察

目的:对比分析舒芬太尼复合瑞芬太尼应用全麻临床效果。方法:选择某医院择期进行下颌骨骨折切开复位手术的患者120例,随机分为瑞芬太尼组、舒芬太尼组、舒芬太尼复合瑞芬太尼组,每组40例。麻醉常规配药,术中泵注给药:瑞芬太尼组,加3μg/(kg.min)瑞芬太尼;舒芬太尼组,0.7μg/(kg.min)舒芬太尼;复合组,0.2μg/(kg.min)舒芬太尼,0.4μg/(kg.min)瑞芬太尼持续泵注。观察术后疼痛级别。结果:各实验组疼痛级别差异有统计学意义。舒芬太尼复合瑞芬太尼组疼痛评分明显低于前两组。结论:舒芬太尼复合瑞芬太尼应用于全麻镇痛效果显著。     

瑞芬太尼与芬太尼在小儿麻醉中的应用比较

本文比较瑞芬太尼和芬太尼在小儿手术麻醉中的安全性和有效性。将40例择期耳鼻喉手术患儿，随机分为A组(瑞芬太尼组)和B组(芬太尼组)，每组20例。麻醉诱导采用静脉注射异丙酚、维库溴铵、咪唑安定，以及瑞芬太尼或芬太尼。麻醉维持采用吸入异氟醚以及持续静脉泵注瑞芬太尼或芬太尼。观察诱导前、诱导后1min、气管插管后2min、5min的血流动力学变化，同时观察麻醉效果、麻醉苏醒及不良反应等情况。结果表明，使用瑞芬太尼的患儿术中血流动力学更稳定，术后苏醒快且副反应少，认为在小儿麻醉中瑞芬太尼的麻醉效果和安全性优于芬太尼。     

不同药物用于人工流产术麻醉的比较

目的 观察异丙酚分别伍用芬太尼、氯胺酮、曲吗多、瑞芬太尼在人工流产术麻醉时的-临床效果及对呼吸循环的影响.方法 150例人工流产孕妇,随机分为单纯异丙酚组(I组)、复合芬太尼组(Ⅱ组)、复合氯胺酮组(Ⅲ组)、复合曲吗多组(Ⅳ组)、复合瑞芬太尼组(V组),Ⅱ、Ⅲ、Ⅳ、Ⅴ组于异丙酚静注前分别给予芬太尼0.8μg/kg、氯胺酮0.4mg/kg、曲吗多1.5mg/kg、瑞芬太尼0.4μg/kg,观察异丙酚用量、麻醉效果及对呼吸循环的影响.结果 Ⅰ组用药1分钟后血压、心率明显下降(P＜O.01),Ⅱ、Ⅲ、Ⅳ、Ⅴ组异丙酚用量明显较Ⅰ组减少(P＜0.01),且麻醉效果优于Ⅰ组.无人工流产综合征病例发生,各组出血量及宫颈松弛度比较均无显著差异.结论 芬太尼、氯胺酮、曲吗多、瑞芬太尼均可提高异丙酚的麻醉效能,减少异丙酚的用量,可防止人工流产综合征的发生.     

丙泊酚复合瑞芬太尼全凭静脉麻醉在老年上腹部手术中的应用分析

目的观察分析丙泊酚复合瑞芬太尼全凭静脉麻醉在老年上腹部手术中的应用效果。方法选取我院40例60岁以上将进行上腹部手术的患者分成观察组和对照组,每组各20例患者,在常规麻醉诱导后,观察组以使用瑞芬太尼0.4～0.6 mg(kg.min)和丙泊酚6 mg/(kg.h)全凭静脉麻醉,对照组使用瑞芬太尼0.4μg(kg.h)和丙泊酚6 mg/(kg.h)全凭静脉麻醉。结果观察组术后的心率(HR)、收缩压(SBP)均高于对照组,并且术后的苏醒时间、拔管时间也相对较快,术后呛咳、呕吐发生率均明显低于对照组,P均<0.05,具有统计学意义。结论瑞芬太尼复合丙泊酚全凭静脉麻醉对于老年上腹部手术麻醉效果理想,适用于老年上腹部手术麻醉。     

异丙酚联合瑞芬太尼在老年高血压患者手术麻醉中的应用效果

目的探讨异丙酚联合瑞芬太尼应用于老年高血压患者手术麻醉中的效果。方法选择我院2009年7月至2012年7月行胆囊切除术的老年高血压患者100例,随机分为观察组和对照组各50例,观察组采用异丙酚联合瑞芬太尼麻醉维持,对照组采用异丙酚麻醉维持,比较两组的麻醉效果。结果观察组麻醉优良率98.0%(49/50),显著高于对照组的84.0%(42/50),拔管时间和苏醒评分均显著高于对照组,差异均具有统计学意义(均P<0.05)。结论异丙酚联合瑞芬太尼应用于老年高血压患者手术麻醉中效果确切。     

氟比洛芬酯用于瑞芬太尼麻醉术后镇痛的临床研究

目的 评估氟比洛芬酯用于瑞芬太尼麻醉术后镇痛的临床效果.方法 60例接受腹部大手术的患者被随机分组,每组15例,分别接受:(1)术中瑞芬太尼0.05μg/(kg·min)(L组).(2)术中瑞芬太尼0.40μg/(kg·min)(H组).(3)麻醉诱导前静脉注射氟比洛芬酯100 mg,术中瑞芬太尼0.05μg/(kg·min)(LF组).(4)麻醉诱导前静脉注射氟比洛芬酯100 mg,术中瑞芬太尼0.40μg/(kg·min)(HF组).记录四组患者拔除气管导管后的口述疼痛评分,拔管后1、2、3、12、24h的视觉疼痛模拟评分(VAS)和48 h的吗啡用量.结果 四组间拔管后的口述疼痛评分差异无统计学意义;H组术后1、2、3h的VAS分别为(4.90±0.74)分、(4.80±0.92)分、(4.50±0.85)分,较其他三组明显升高,同时H组48 h吗啡需要量为(7.30±1.64)mg,较其他三组明显增大(P＜0.05).结论 在手术中相对大剂量应用瑞芬太尼会诱发术后痛觉过敏,非甾体抗炎药氟比洛芬酯对瑞芬太尼麻醉术后疼痛具有明显的抑制作用.     

瑞芬太尼与芬太尼静脉麻醉在老年患者手术麻醉中的效果对比分析

目的比较瑞芬太尼与芬太尼静脉麻醉在老年患者手术麻醉中的效果.方法选择该院80例拟行腹部手术的老年患者,随机分成瑞芬太尼组和芬太尼组各40例,均采用静吸复合全麻,气管内插管,比较两组患者的麻醉效果.结果瑞芬太尼组自主呼吸恢复时间、苏醒时间、定向力恢复时间均显著短于芬太尼组,丙泊酚总量也明显少于芬太尼组,P<0.05.结论瑞芬太尼在老年患者麻醉维持中比芬太尼效果和安全更好,值得临床推广.     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.