飞行员强迫性神经症伴换气过度综合征1例

1 临床资料 患者,男性,23岁,歼-6飞行员,飞行时间260h。1998年7月由飞行基础学院毕业分配至我部。5000m以下歼教-6飞行12h。该员在未使用氧气面罩(按规定昼间4000m以上飞行必须戴氧气面罩)时,未出现异常。同年8月6日在飞行高度9000m时,出现头晕、恶心、胸闷、腹胀。落地后航医发现该员面色苍白、多汗,测量血压、脉搏、体温正常。问其原因,自述系戴     

飞行员通气过度训练方法的建立

旨在建立体验通气过度症状的训练方法，并与缺氧训练相结合，使飞行员区分该两类症状和掌握正确的处理方法。受训者为３０名歼机飞行员。采用以肺阻抗通气图为主的呼吸强度宣控制技术，使呼吸频率和潮气量分别控制在４０次／ｍｉｎ和１．２Ｌ／次，实验６００ｓ通气过度训练，并记录脑电图、脑血流图、心电图、血压、呼气末ＣＯ２分压、ｆ、ＴＶ。     

移居高原人过度换气、屏气前后的脑血流动力学改变及其吸氧的效应

为观察高原环境下低PaO_2、低PaCO_2及低通气量对脑血流动力学的影响及其吸氧效应,我们于1992年应用经颅多普勒超声在海拔3700m高原现场采取过度换气、屏气方法进行了本项研究。1 对象与方法1.1 实验对象:均为进驻海拔3700m40d的男性青年官兵,平均年龄20.8岁,身体健康,24人为首次进入高原,其余12人虽曾多次进入过高原地区,但已在平原生活1年以上。1.2 实验方法:①TCD仪为TC2000智能化机型;②应用4MHz探头置于锁骨上缘胸锁乳突肌内侧,探测头颈总动脉（CCA）的平均流速（Vm）,收缩峰     

飞行员通气过度训练方法的建立

目的旨在建立体验通气过度症状的训练方法，并与缺氧训练相结合，使飞行员区分该两类症状和掌握正确的处理方法。方法受训者为30名歼击机飞行员。采用以肺阻抗通气图为主的呼吸强度定量控制技术，使呼吸频率（f）和潮气侵（TV）分别控制在40次／min和1．2L／次，实施600s通气过度训练，并记录脑电图、脑血流图、心电图、血压、呼气未CO2分压（PETCO2）、f、TV。5－10min后进行常规缺氧训练。结果29例于259±155s出现通气过度症状。PETCO2与时间的变化曲线呈指数式下降（P＜0．01）、心率加快、脑电α波幅升高，脑血流量下降（P＜0．01）。26例体验到通气过度与缺氧症状的差异，其特点是通气过度以四肢、躯体麻木感为主（P＜0．05），缺氧以头晕、眼花、心悸为主（P＜0．05）。结论该训练方法安全，效果可信，飞行员易接受，可达到训练目的。     

飞行员空中通气过度和缺氧症状的调查

飞行员空中通气过度和缺氧症状的调查周亚军彭国祥【关键词】（Ｋｅｙｗｏｒｄｓ）缺氧症（Ｈｙｐｏｘｉａ）通气过度（Ｈｙｐｅｒｖｅｎｔｉｌａｔｉｏｎ）飞行疲劳（Ｆｌｉｇｈｔｆａｔｉｇｕｅ）【中国图书资料分类法分类号】Ｒ８５２．１１飞行员在飞行中受不利因素的...     

早期过度换气治疗GCS≤5分颅脑损伤的疗效评价

目的 评价早期过度换气疗法在治疗格拉斯哥昏迷评分（GCS）≤5分颅脑损伤的效果。方法 将72例≤5分颅脑损伤病人随机分成过度换气治疗组（n=36)和对照组（n=36)，观察过度换气治疗组治疗前后血气值变化，记录两组病例的存活数，死亡数，存活时间。结果 过度换气能降低动脉血二氧化碳分压（P＜0．01），提高动脉血氧分压（P＜0．01）。过度换气治疗组和对照组的病死率在统计学上无显著性差异（P＞0．05）。结论 早期过度换气能延长GCS≤5分病人的生存时间，但不能降低其病死率。     

胸腹部CT扫描呼吸方法的探讨--过度换气呼气末屏气与平静呼吸吸气末屏气的比较

目的通过平静呼吸吸气末屏气(组)A与过度换气呼气末屏气(组)B的比较,找出既能增加屏气时间,又能减少层面差异的方法。方法选胸腹部CT检查的病人(志愿者),进行呼吸训练,用秒表测量A组与B组的屏气时间;两组病例均做常规螺旋CT扫描,选取一定层面做一次扫描,记录其与螺旋CT扫描图像中相同层面的床位差为层面差。结果两组屏气时间男性有显著差异(P<0.001,t=6.317),女性亦有显著差异(P<0.001,t=12.98)。层面差异测量,两组比较胸部有显著差异(P<0.001,t=5.662),上中腹部有显著差异(P<0.001,t=5.548)A组胸部和上中腹部之间无显著差异(P>0.2,t=1.073)B组。,胸部和上中腹部之间无显著差(P>0.5,t=0.4979)。结论B组屏气时间比A组明显增加,两组屏气的时间男性大于女性,两组屏气时间增加率男性小于女性。同层扫描可重复性的呼吸控制方法,组优于A组。B     

飞行中人体的呼吸生理反应

本文系统地回顾了飞行中飞行人员呼吸生理反应的研究进展，包括高性能飞机飞行时的呼吸生理反应，飞行中的附加呼吸阻力及能量消耗问题，飞行人员的通气过度反应等。对每一项呼吸生理反应均讨论了其飞行中的生理监测及军用标准问题，并给出了有代表性的数据资料。文中还讨论了高性能战斗机飞行时的呼吸生理反应及其监测问题。     

Whole-brain vascular reactivity measured by fMRI using hyperventilation and breath-holding tasks: efficacy of 3D prospective acquisition correction (3D-PACE) for head motion

Functional MR imaging (fMRI) study using hyperventilation and breath-holding task has been reported to be one of the non-invasive methods to examine whole-brain vascular reactivity. The purpose of this study was to evaluate the efficacy of a method for 3D prospective detection and correction of head motion (3D-PACE) in a study of whole-brain vascular reactivity using hyperventilation and breath-holding tasks. Eight healthy volunteers were scanned using an fMRI protocol of hyperventilation and breath-holding task blocks at 3 T in separate runs with and without 3D-PACE. In two subjects, two more runs with and without 3D-PACE were repeated. The mean total number of activated voxels ± standard deviation was 26,405.3±1,822.2 in the run with 3D-PACE and 17,329.9±2,766.3 in the run without 3D-PACE (P<0.05), although there is some intersubject variation regarding the effect of 3D-PACE. In the two subjects whose performed two more runs, the number of activated voxels were smaller in the run without 3D-PACE than even in the run with 3D-PACE performed later. We conclude that 3D-PACE is beneficial for fMRI studies of whole-brain vascular reactivity induced by hyperventilation and breath-holding.     

低氧对破骨细胞活性的影响及其机制

目的:观察低氧对乳兔破骨细胞分化、活性的影响,并研究其可能的机制.方法:培养乳兔破骨细胞、成骨细胞,TRAP染色鉴定破骨细胞,比较破骨细胞在常氧(含氧量20％)及低氧(含氧量3％)条件下骨吸收陷窝面积.破骨细胞加入到第3代成骨细胞中分别于常氧和低氧条件下进行共培养,第24、48、72、96 h检测RANK、OPG、RANKL、TRAP及CtsK mRNA的表达.结果:各时间点低氧组RANK、RANKL、CtsK、TRAP mRNA表达均高于常氧组;OPG mRNA的表达低于常氧组组,具有统计学差异(P＜0.05或P＜0.01).结论:低氧可激活破骨细胞TRAP和CtsK基因的上游信号,增强破骨细胞活性.     

The effectiveness of esophageal stethoscopy in a simulated in-flight setting

Purpose: Previous research has confirmed the inability of flight nurses in an airborne BO-105 helicopter to hear breath sounds using normal or amplified transthoracic stethoscopy. The purpose of this study was to determine whether esophageal stethoscopy enabled effective auscultation of breath sounds in a simulated in-flight environment.

Methods: The cabin-sound environment of an in-flight BO-105 was recorded and recreated in an audiology laboratory, where five flight nurses were evaluated listening to taped breath sounds via an esophageal stethoscope. This audiotape model, validated in a previously published study, used a tape consisting of 24 20-second segments. Each segment, the beginning of which was marked with a beep signal, consisted of 20 seconds of silence or breath sounds. The distal (esophageal) end of the esophageal stethoscope was attached to the tape recorder; the intensity level of breath sounds heard at the stethoscope earpiece was calibrated to equate the sound level of actual esophageal breath sounds recorded on a volunteer.

Results: All nurses correctly identified the 24 taped segments as silent or including breath sounds 100% of the time.

Conclusion: In the simulated environment tested, esophageal stethoscopy enabled 100% accuracy in identification of breath sounds, as compared with previously reported 0% efficacy for standard transthoracic auscultation. Study in the actual patient-care environment is indicated to confirm the usefulness of esophageal stethoscopy in the in-flight setting.     

仪表飞行条件下飞行错觉与仪表注视的相关分析

目的 分析仪表飞行条件下飞行错觉发生情况与仪表注视的相互关系。方法 对45名飞行员进行仪表飞行试验,记录其飞行错觉情况、仪表扫视情况及眼动情况,并对以上指标进行偏相关分析。结果 飞行员仪表飞行错觉水平与飞行错觉后反应（r=0.620,P=0.000）、升降速表注视时间（r=0.372,P=0.014）呈显著正相关;与高度表反应正确率（r=-0.304,P=0.047）、地平仪反应正确率（r=-0.311,P=0.042）呈现显著负相关。结论 飞行员仪表飞行错觉的发生与高度表、地平仪及升降速表的正确判读具有一定关联,视觉搜索效率较低可能是飞行错觉发生的重要原因或重要中介因素。     

低氧环境下粘附因子与动脉粥样硬化相关关系的研究

目的：检测血清可溶性ICAM-1、VCAM-1、E-选择素、P-选择素表达水平与高原地区动脉粥样硬化形成的相关性。方法：利用酶联吸附免疫法对西宁、玉树和果洛地区动脉粥样硬化患者（动脉粥样硬化组42例）及健康对照者（对照组40例）进行血清可溶性ICAM-1、VCAM-1、E-选择素、P-选择素表达水平的检测。结果：ICAM-1、VCAM-1、E-选择素及P-选择素表达与西宁、玉树或果洛动脉粥样硬化患者患病具有明显相关性;但是ICAM-1、VCAM-1、E-选择素及P-选择素各因子表达在西宁、玉树或果洛高海拔正常对照组、动脉粥样硬化患者组之间无明显差异性。结论：血清可溶性ICAM-1、VCAM-1、E-选择素及P-选择素与高原动脉粥样硬化的形成无关。     

三级生物安全实验室对环境潜在影响及对策研究

三级生物实验室(BSL-3实验室)的研究对象都是对个人和环境有高度危险性的致病微生物。如何避免其对环境的影响，成为各国政府、环境保护和相关科研人员高度关注的一个问题。本文将重点阐述三级生物实验室对环境危害的重要因素和防范对策。主要研究了其对环境潜在危害的影响因素和造成危害的基本要素，对实验室的设施建设、安全设备要求、防护性能检测验证以及管理软件建设进行了探讨，以最终实现BSL-3实验室的感染性三废(固体、液体和气体)“零排放”的目标。     

医疗安全风险预警机制系统的设计与实现

目的：本研究旨在建立医疗安全风险预警机制信息化平台模型。方法：通过文献复习、调研学习、专家咨询及借鉴软件系统开发相关的原理确定预警系统模型。结果：开发了医疗安全风险预警系统,实现了机制运行的信息化。结论：医疗安全风险预警机制的信息化提高了机制运行的准确性与效率性。     

Tumor uptake of radiolabeled acetate reflects the expression of cytosolic acetyl-CoA synthetase: implications for the mechanism of acetate PET

Introduction[1-¹¹C]Acetate positron emission tomography (PET) is used for myocardial studies. In the myocardium, mitochondrial acetyl-CoA synthetase (ACSS1) mainly contributes to the radiopharmaceutical uptake. [1-¹¹C]Acetate PET is also used for tumor diagnosis; however, the uptake mechanism of radiolabeled acetate in tumors remains unclear. Our previous study reported that cytosolic acetyl-CoA synthetase (ACSS2) was expressed in tumor cells and up-regulated under hypoxia, whereas expression of ACSS1 was negligible regardless of the oxygen conditions. We also indicated that ACSS2 is a bidirectional enzyme that controls acetyl-CoA/acetate metabolism in tumor cells. In this study, to elucidate the basic mechanism of tumor acetate uptake, we focused on ACSS2 and investigated the role of ACSS2 in the uptake of radiolabeled acetate in tumor cells.Methods[1-¹⁴C]Acetate uptake and ACSS2 expression were examined in four tumor cell lines under normoxia or hypoxia. An ACSS2 knockdown study was also performed.Results[1-¹⁴C]Acetate uptake was increased in the tumor cells under hypoxia. This pattern followed that of ACSS2 expression. The incorporated ¹⁴C was mostly distributed in the lipid-soluble fractions, and this tendency increased under hypoxia. ACSS2 knockdown led to a corresponding reduction in [1-¹⁴C]acetate uptake in all tumor cell lines examined under normoxia and hypoxia.ConclusionsACSS2 plays an important role in the uptake of radiolabeled acetate in tumor cells, which is different from that in the myocardium, which mainly involves ACSS1. The uptake of radiolabeled acetate in tumors increased under hypoxia along with up-regulation of ACSS2 expression. This suggests a possible mechanism for acetate PET for tumors.     

外部性脑积水CT诊断及与新生儿窒息的关系

本文报道34例CT诊断外部性脑积水,临床均有新生儿窒息史,探索二者之间的关系,分析表明外部性脑积水与围产期窒息有关。并对本病的发病机制和CT表现进行了讨论。     

PET乏氧显像在预测肿瘤乏氧及指导临床治疗中的应用进展

放射性核素标记的乏氧显像是评估肿瘤乏氧程度的重要方法, 乏氧显像剂可以选择性地滞留于乏氧组织内, 直观反映乏氧的部位和乏氧的程度, 对肿瘤诊断、分期、疗效监测及预后评估等有指导意义, 同时也为临床选择及调整肿瘤治疗方案提供了客观依据。笔者主要对肿瘤乏氧PET显像近年来在临床研究中的进展及与肿瘤乏氧相关的治疗进展进行综述。