右美托咪啶联合地佐辛用于宫颈癌根治手术中对心率、平均动脉压及脑电双频指数评分的影响

目的探讨右美托咪啶联合地佐辛用于宫颈癌根治手术中对心率(HR)、平均动脉压(MAP)、脑电双频指数(BIS)及Ramsay镇静评分的影响。方法选取2016年8月-2018年8月在台州市肿瘤医院行宫颈癌根治手术的患者60例为研究对象,随机分为观察组和对照组,每组各30例。观察组患者给予右美托咪啶联合地佐辛麻醉,对照组患者给予丙泊酚联合地佐辛麻醉。统计分析两组患者不同时间点的HR、MAP、BIS、Ramsay镇静评分、苏醒时间和拔管时间及术中术后不良反应发生情况。结果观察组患者T1、T2、T3、T4、T5时的HR、MAP、BIS水平均显著低于T0时,差异均有统计学意义(均P0.05),Ramsay镇静评分显著高于T0时,差异有统计学意义(P0.05);但T0、T6时的HR、MAP、BIS、Ramsay镇静评分比较,差异均无统计学意义(均P0.05)。T1、T2、T3、T4、T5时观察组患者的HR、MAP和Ramsay镇痛评分均显著高于对照组,BIS水平均显著低于对照组,差异均有统计学意义(均P0.05); T0、T6时两组患者的HR、MAP、BIS、Ramsay镇静评分比较,差异均无统计学意义(均P0.05)。观察组患者的苏醒时间、拔管时间均显著短于对照组,差异均有统计学意义(均P0.05)。观察组患者注射痛、低血压、呼吸抑制发生率均显著低于对照组,心动过缓发生率显著高于对照组,差异均有统计学意义(均P0.05)。结论右美托咪啶联合地佐辛用于宫颈癌根治手术中较丙泊酚联合地佐辛对HR、MAP、BIS、Ramsay镇静评分的影响小。     

右美托咪啶与咪唑安定全身麻醉镇静效果比较

目的探讨右美托咪啶与咪唑安定在妇科腹腔镜手术中的镇静效果及安全性。方法选取东丽区东丽医院妇科拟行腹腔镜手术治疗的患者140例为研究对象,随机分成观察组和对照组各70例。所有患者应用瑞芬太尼复合丙泊酚进行麻醉诱导及维持,观察组采用右美托咪啶镇静,对照组采用咪唑安定镇静。比较两组患者在用药后不同时间段内Ramsay评分的变化、复苏时Riker镇静和躁动评分(SAS)、呼吸恢复时间、意识恢复时间、拔管时间和不良反应发生情况。结果观察组用药后10、30 min Ramsay评分均高于对照组,差异有统计学意义(P0.05);观察组拔管时间短于对照组,观察组复苏时SAS评分和不良反应总体发生率均低于对照组,差异有统计学意义(P0.05)。结论妇科腹腔镜手术中应用右美托咪啶镇静程度优于咪唑安定,并能有效地减少拔管时间、降低苏醒期躁动和不良反应发生率。     

右美托咪定和咪达唑仑用于下肢手术术中的镇静效果观察

目的比较右美托咪定和咪达唑仑用于下肢手术术中的镇静效果。方法选择2015年12月—2016年12月在本院骨科择期行下肢手术的患者160例,随机分成右美托咪定组(D组)和咪达唑仑组(M组),每组80例。在手术开始前10 min,D组给予右美托咪定0.5μg/kg泵注10 min,然后以0.4μg·kg~(-1)·h~(-1)泵注至手术结束;M组给予咪达唑仑0.05 mg/kg静脉注射,然后以0.05 mg·kg~(-1)·h~(-1)泵注至手术结束。观察比较两组患者入室时(t_1)、Ramsay镇静评分3分时(t_2)、术中30 min(t_3)、术中60 min(t_4)、术毕时(t_5)时刻的MAP、HR、SpO_2、起效时间、苏醒时间以及术中躁动、低血压、心动过缓、呼吸抑制等并发症的发生情况。结果与M组相比,D组t_2、t_3、t_4、t_5时刻的MAP、HR降低,差异具有统计学意义(P<0.05);D组苏醒时间和起效时间均较M组延长(P<0.05);两组并发症比较,差异无统计学意义(P>0.05)。结论右美托咪定用于硬膜外麻醉辅助镇静效果满意,安全性高,但是苏醒时间较长,应注意密切监护。     

右美托咪定喷鼻用于小儿核磁共振检查镇静效果的观察

目的:探讨右美托咪定喷鼻用于小儿核磁共振检查镇静效果。方法:选择MRI检查的患儿40例,随机分为两组,每组20例:水合氯醛组(A组)和右美托嘧啶组(B组)。A组患儿以10%水合氯醛50~80 mg/kg灌肠,B组以1.5μg/kg右美托咪定喷鼻。监测并比较两组患儿用药前与用药后的心率(HR)、血氧饱和度(SpO2)、呼吸频率(RR);观察镇静效果,并进行Ramsay镇静评分并记录不良反应。结果:两组患儿用药后均能完成检查,但B组的镇静效果优于A组且未发生不良反应;A组不能配合给药3例,发生轻度恶心1例。结论:右美托咪定喷鼻用于小儿核磁共振检查镇静时,药物起效快、效果确切、不良反应少,值得在临床上推广应用。     

右美托咪定联合氟哌利多在卡贝缩宫素诱发剖宫产术不良反应中的预防作用研究

目的探讨右美托咪定联合氟哌利多在卡贝缩宫素诱发剖宫产术不良反应中的预防作用,为临床治疗及预防提供参考依据。方法选择台州市博爱医院2016年12月-2018年10月100例择期剖宫产手术患者,应用右美托咪定联合氟哌利多预防卡贝缩宫素诱发剖宫产术中不良反应作为联合用药组,选择同期行择期剖宫产手术单独用药右美托咪定的100例患者及单独用药氟哌利多的100例患者作为对照组,观察患者的镇痛镇静评分[视觉模拟评分法(VAS)、镇静Ramcy评分]、生命体征监测指标[心率(HR)、平均动脉压(MAP)、动脉血氧饱和度(SpO_2)]及不良反应发生情况。结果联合用药组VAS评分、镇静Ramcy评分均优于右美托咪定组和氟哌利多组,差异有统计学意义(均P<0. 05);麻醉前、胎儿娩出时联合用药组的HR、MAP、SpO_2与右美托咪定组和氟哌利多组比较,差异无统计学意义(均P>0. 05);卡贝缩宫素注射后5 min、手术结束时联合用药组的HR、MAP、SpO_2与右美托咪定组和氟哌利多组比较,差异有统计学意义(均P<0. 05);联合用药组的不良反应发生率为10. 0%,显著低于右美托咪定组和氟哌利多组的20. 0%、23. 0%,差异有统计学意义(均P<0. 05)。结论右美托咪定联合氟哌利多应用于剖宫产手术的患者,具有良好的镇痛镇静效果,可以更好地维持患者生命体征,并且能够有效预防卡贝缩宫素诱发的剖宫产术中不良反应,可以作为优选的麻醉用药方案。     

右美托咪定在乳腺癌乳房再造手术全麻苏醒期的临床应用效果

目的：比较右美托咪定和异丙酚对乳腺癌乳房再造手术患者全身麻醉苏醒期血流动力学及镇静水平的影响,探讨右美托咪定的临床应用效果。方法：将本院2010年1月-2013年1月全麻下择期行乳腺癌乳房再造手术患者30例随机分为两组,盐酸右美托咪定组（D组）和异丙酚组（P组）,每组15例。D组靶控输注右美托咪定和异丙酚,P组单纯靶控输注异丙酚。手术结束后,分别记录麻醉苏醒期患者意识清醒时（T1）、拔管时（T2）、拔管后5 min（T3）、拔管后10 min（T4）的平均动脉压（MAP）、心率（HR）和Ramsay镇静评分;记录两组患者麻醉恢复情况（苏醒时间、拔管时间和躁动例数）。结果：两组患者一般情况比较差异无统计学意义;麻醉苏醒期T1、T2时点的平均动脉压（MAP）、心率（HR）,D组低于P组（P〈0.05）;D组术后躁动例数低于P组（P〈0.05）,两组苏醒时间、拔管时间和Ramsay镇静评分比较差异无统计学意义。结论：右美托咪定能减轻乳腺癌乳房再造术患者全麻苏醒期的血流动力学反应,并提供满意的镇静水平和苏醒质量。     

右美托咪定滴鼻在儿童磁共振成像检查中的应用及安全性分析

目的 分析右美托咪定滴鼻在儿童磁共振成像(MRI)检查中的应用及其安全性。方法 选取2020年1月—2021年1月在浙江大学医学院附属儿童医院行MRI检查的200例患儿为研究对象,根据镇静方式的不同将其分为正常剂量组(63例)、高剂量组(59例)及合剂组(78例),采用的镇静方式分别为右美托咪定滴鼻联合咪达唑仑注射液(右美托咪定剂量为2.0μg/kg)、右美托咪定滴鼻联合咪达唑仑注射液(右美托咪定剂量为3μg/kg)、右美托咪定滴鼻联合咪啡合剂(咪达唑仑0.5 mg/kg,极量10 mg,纳布啡0.2 mg/kg,右美托咪定剂量为2.0μg/kg)。观察各组患儿镇静情况,包括镇静成功率、镇静起效时间、达深度镇静时间、深度镇静维持时间、苏醒区停留时间及Steward苏醒评分;不良反应、药物补偿情况;镇静满意度、镇静UMSS评分;心率、平均动脉压等。结果 高剂量组和合剂组患儿镇静成功率(96.61%、89.74%)高于正常剂量组(82.54%),差异有统计学意义(χ²=0.52,P<0.05);合剂组患儿苏醒时间长、苏醒评分[(71.48±7.03)min、(3...     

探讨右美托咪啶对扁桃体腺样体摘除术患儿全麻苏醒期的影响

目的观察微量泵输注右美托咪啶对全凭七氟醚麻醉行扁桃体腺样体摘除术患儿苏醒期的影响。方法选择全身麻醉下行扁桃体腺样体摘除术的患儿60例,年龄4~11岁,体重13~38kg,ASAⅠ~Ⅱ级,随机分为Ⅰ、Ⅱ、Ⅲ三组(n=20):Ⅰ组(对照组)输入林格试液10ml,Ⅱ、Ⅲ组在麻醉诱导前10min分别输注右美托咪啶0.3ug?kg-1和0.5ug?kg-1。给药结束后采用8%七氟醚和6L?min-1O2诱导后气管插管,麻醉维持采用2~3%七氟醚和O22L?min-1。记录患儿各时点MBP、HR和R,苏醒时间、躁动情况和Ramsay镇静评分。结果Ⅲ组MBP、HR、R和Ⅱ组HR在T1~T4时点明显低于Ⅰ组;燥动评分Ⅲ组T1~T4时点和Ⅱ组T2~T4时点明显低于Ⅰ组,Ramsay镇静评分Ⅲ组T1~T4时点、Ⅱ组T2~T3时点明显高于Ⅰ组,且Ⅱ、Ⅲ组苏醒期燥动例数和躁动持续时间大于15min发生率明显低于Ⅰ组(P0.05)。结论右美托咪啶为扁桃体腺样体切除术患儿麻醉苏醒期提供了良好的镇静效应,并较好的抑制了患儿苏醒期燥动,稳定了血流动力学。     

盐酸右美托嘧啶在膝关节表面置换手术中的临床应用

目的观察盐酸右美托咪啶在临床膝关节表面置换术中的临床应用。方法 40例术前ASA分级Ⅰ^Ⅱ级择期膝关节表面置换手术患者,分为右美托咪啶组(D组,n=20)和对照组(C组,n=20),行腰硬联合麻醉,D组入室开放静脉通道后即按照0.6Ⅱ级择期膝关节表面置换手术患者,分为右美托咪啶组(D组,n=20)和对照组(C组,n=20),行腰硬联合麻醉,D组入室开放静脉通道后即按照0.6⁰.8μg/kg剂量给予4μg/mL的盐酸右美托咪啶注射液静脉泵注诱导,10分钟后改为0.30.8μg/kg剂量给予4μg/mL的盐酸右美托咪啶注射液静脉泵注诱导,10分钟后改为0.3⁰.5μg·kg-1·h-1维持,直至术毕前15分钟停药,C组则相同的方式静脉泵注生理盐水。监测并记录观察麻醉前(T0),止血带充气前(T1),松止血带前1分钟(T2),松止血带后5分钟(T3)及术后6小时(T4)各个时点的平均动脉压(MAP)、HR、SpO2、Ramsay评分、VAS评分,记录术中恶心、呕吐、寒战等不良反应。结果与D组及T0时段相比,C组在T2MAP、HR明显升高(P<0.05),与C组及T0相比,D组在T1、T2、T3时段心率明显减慢(P<0.05),与C组及T0相比,D组在T1、T2、T3Ramsay评分明显升高(P<0.05),T2、T4VAS评分明显降低(P<0.05),与D组比较,C组术中的恶心、呕吐、烦躁、寒战等不良反应的发生率高(P<0.05)。结论盐酸右美托咪啶应用在膝关节表面置换手术中,具有满意的镇静效果,并能减轻止血带反应,维持术中血流动力学稳定,减少术中恶心、呕吐和寒战的发生,无呼吸抑制等明显不良反应。     

七氟醚复合右美托咪定全身麻醉用于腹腔镜子宫全切术效果及安全性

目的：探讨七氟醚复合右美托咪定全身麻醉用于腹腔镜子宫全切术的麻醉效果及安全性。方法：选取2018年1月—2021年2月在本中心择期腹腔镜子宫全切术的患者100例,随机分为观察组和对照组各50例,分别采用静脉输注右美托咪定或给予等量生理盐水,两组均复合吸入七氟醚全身麻醉。观察两组术后苏醒时间、拔管时间、七氟醚肾上腺素能反应的最低肺泡浓度(MACBAR)值、拔管后Ramsay镇静评分等指标;比较静脉输注右美托咪定前(T0)、输注右美托咪定5min(T1)、建立气腹时(T2)、手术30min(T3)、术毕(T4)两组心率(HR)、平均动脉压(MAP)及七氟醚浓度,两组麻醉期不良反应。结果：观察组与对照组苏醒时间(6.84±1.61min比9.19±2.07min)、拔管时间(10.83±2.16min比13.80±2.94min)、七氟醚MACBAR值(2.49±0.85)%比(4.64±0.97)%、拔管Ramsay评分(3.43±0.80分比2.26±0.63分)均有差异(P<0.05)。T0时两组HR、MAP均无差异(P>0.05),T1、T2、T3、T4时观察组HR、MA...     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.