舒芬太尼给药模式对妇科腹腔镜手术病人术后麻醉恢复质量比较

目的研究舒芬太尼不同给药模式对妇科腹腔镜病人术后麻醉恢复质量的影响,探讨此类手术舒芬太尼较佳给药模式。方法选择60例妇科择期行腹腔镜手术患者．ASAⅠ～Ⅱ级．根据舒芬太尼给药模式随机分为两组：Ⅰ组为间断推注给药组,Ⅱ组为血浆靶控给药组。所有患者常规连续监测收缩压（SBP）、舒张压（DBP）、心率（HR）、心电图（ECG）、呼末二氧化碳分压（PetCO2）．分别记录两组患者手术时间、舒芬太尼用量、丙泊酚用量、呼吸恢复时间、睁眼时间、拔管时间、出手术时Ramsay镇静评分、VAS评分。结果Ⅰ组与Ⅱ组相比,舒芬太尼用量明显减少（P〈0.05）,丙泊酚用量差异两组无统计学意义（P〉0．05）,患者呼吸恢复时间、睁眼时间、拔管时间Ⅰ组均明显缩短（P〈0．05）,但出手术室时Ⅱ组Ramsay评分较高（P〈0．05）,VAS评分两组无统计学意义（P〉0．05）。结论舒芬太尼两种常用的给药模式均能较好地应用于妇科腹腔镜病人,间断推注给药病人苏醒更快。     

瑞芬太尼复合丙泊酚或地氟烷麻醉用于电视胸腔镜手术患者的临床观察

目的 评价瑞芬太尼复合丙泊酚或地氟烷麻醉在电视胸腔镜手术中的临床效果。方法 将40例经电视胸腔镜治疗自发性气胸的患者，随机分为瑞芬太尼复合丙泊酚静脉麻醉组（P组）和瑞芬太尼复合地氟烷静吸复合麻醉组（D组），每组各20例。对比观察两种麻醉方法术中平均动脉压（MAP）和HR的变化以及术毕停药后呼之睁眼时间、自主呼吸恢复时间、拔管时间及清醒程度（采用拔管后5min镇静评分判断）。结果 D组术中MAP明显低于术前（P〈0．05），D组摆体位后2min、健侧单肺通气（OLV）10min及OLV 30min的MAP低于P组，但两组比较差异无统计学意义；P组患者HR、MAP无明显变化；两组患者拔管时间、拔管后5min镇静评分比较差异均无统计学意义。结论 瑞芬太尼复合丙泊酚或瑞芬太尼复合地氟烷用于电视胸腔镜手术麻醉，术后苏醒迅速，苏醒质量优良；但在血流动力学方面，前者更加平稳。     

瑞芬太尼复合丙泊酚麻醉在双侧同期大容量肺灌洗术中的应用

目的观察瑞芬太尼复合丙泊酚麻醉下双侧同期大容量肺灌洗术在尘肺患者中的应用效果。方法回顾性分析2009—04／10期间人院的尘肺接受双肺同期大容量肺灌洗术40例患者资料,其中早期麻醉采用芬太尼复合丙泊酚20例（A组）,后期采用瑞芬太尼复合丙泊酚的患者20例（B组）,术中常规监测收缩压（SBP）、舒张压（DBP）,心电图（ECG）、心率（HR）和脉搏氧饱和度（SPO2）。观察插管时应激反应情况,记录麻醉苏醒时间,呼吸恢复时间,拔管时间。结果两组患者年龄、体重、每肺灌洗时间、麻醉时间等差异无统计学意义（P〈0．05）。诱导期两组血流动力学相似。B组有2例患者SBP小于80mmHg。插管后1minA组SBP（136±11）mmHg高于B组（117±12）mmHg（P〈0．05）,插管反应大于B组,A组术中呛咳发生率15．3％,B组术中呛咳发生率3．4％,B组患者术后呼吸恢复时间、呼唤睁眼时间、拔管时间与A组相比差异有统计学意义。结论瑞芬太尼复合丙泊酚麻醉安全有效,较芬太尼复合丙泊酚的应激反应轻、苏醒快、定向力恢复好,更适合于双侧同期大容量肺灌洗术。     

瑞芬太尼辅助颈丛阻滞对甲状腺手术患者镇静和镇痛的影响

目的评价瑞芬太尼辅助颈丛阻滞对甲状腺手术镇静和镇痛效果。方法择期颈丛阻滞麻醉下行甲状腺次全切除术患者60例，ASAⅠ或Ⅱ级，随机分为3组（n=20）：对照组（C组），瑞芬太尼恒速输注组（R组）和瑞芬太尼靶控输注组（TCI组）。颈丛阻滞效果确切后，术前5min，R组持续静脉注射瑞芬太尼2μg／（kg·h）；TCI组靶控输注瑞芬太尼血浆靶浓度1．25ng／ml，C组持续静脉注射生理盐水直到手术结束。观察并记录患者MAP、HR、RR、SpO2，视觉模拟疼痛评分（VAS）、镇静评分（OAA／S评分），不良反应（呼吸抑制、肌肉僵硬、恶心呕吐）及术后患者满意度。结果与T0组比较，C组T2时MAP升高，T1和T2时HR明显增快（P〈0．05）；与C组比较，R组和TCI组T2时MAP降低，T1和T2时HR明显减慢（P〈0．05，P〈0．01）。OAA／S评分比较，R组和TCI组达4分的例数明显多于C组（P〈0．01）。VAS评分比较，R组和TCI组优良的例数明显多于C组（P〈0．01）。与C组比较，R组和TCI组各有2例和1例出现轻微的呼吸抑制，不良反应发生率差异无统计学意义。结论瑞芬太尼辅助颈丛阻滞下行甲状腺手术安全有效，恒速输注与靶控输注法的镇静和镇痛效果相当。     

不同剂量瑞芬太尼对全麻术后气管拔管时的血流动力学影响

目的观察全麻术后应用瑞芬太尼对病人气管拔管血流动力学的影响，寻找瑞芬太尼预防气管拔管心血管反应的最佳剂量。方法选择ASAI-Ⅱ级择期全麻的上腹部手术患者50例，随机等分为5组，即对照组（A）和4个不同剂量的瑞芬太尼组（B、C、D、E），对照组在气管拔管前静脉注射生理盐水10ml，瑞芬太尼组分别在拔管前静脉注射瑞芬太尼（0．25、0．50、0．75、1．00）μg／kg，观察拔管用药前（T1），用药后拔管即刻（T2）和拔管后1min（T3）、3min（T4）、5min（T5）血流动力学变化和拔管后不良反应。结果与拔管前比较，A组拔管后BP升高、HR增加（P〈0．01），B组在T2、T1时点BP升高，但差异无统计学意义（P〉0．05），HR增加（P〈0．05）；C组在各时点BP下降（P〈0．05）、HR平稳；D、E组BP、HR均下降（P〈0．05）。B组在各时点BP、HR与A组比较差异无统计学意义（P〉0．05），C、D、E组拔管后BP、HR均低于A组（P〈0．05）；SpO2在各组间及各组内不同时间点间差异均无统计学意义（P〉0．05）；对照组的呛咳发生率高于瑞芬太尼各组（P〈0．05），随着瑞芬太尼的用量加大，恶心呕吐、嗜睡、心动过缓和呼吸抑制等副作用的发生率逐渐增加。结论拔管前静脉注射瑞芬太尼可预防拔管时血流动力学的变化，气管拔管前用0．5μg／kg瑞芬太尼可能是最恰当的剂量。     

瑞芬太尼和芬太尼用于老年患者麻醉的比较

目的评价瑞芬太尼用于老年患者麻醉的安全性和有效性。方法选择择期行胃癌根治术的老年患者40例，随机分为瑞芬太尼丙泊酚组（PR组）、芬太尼丙泊酚组（PF组），每组20例。患者行全麻诱导，术中分别以瑞芬太尼、芬太尼、丙泊酚和维库溴铵维持麻醉。记录诱导前、诱导后、插管后、切皮时、切皮后5min、手术1h、手术结束时、睁眼时等各时点的SBP、DBP、HR，观察术后呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间、离开麻醉恢复室时间，记录不良反应发生率，术后24h随访患者有无术中知晓及患者满意度。结果两组患者于气管插管后均出现不同程度的血压升高、心率增加（P〈0．05），但PF组插管反应的发生率明显高于PR组（P〈0．05）。PR组切皮时的血压和心率均明显低于麻醉诱导前（P〈0．05），于切皮后5min缓慢升至麻醉诱导前的水平。结论芬太尼和瑞芬太尼用于老年患者手术均能达到满意的麻醉效果，但瑞芬太尼用于老年人麻醉时血流动力学更加平稳，是一种比较理想的老年人麻醉药物。     

丙泊酚复合瑞芬太尼在关节脱位手法复位麻醉中的应用

目的观察丙泊酚复合瑞芬太尼静脉麻醉在关节脱位手法复位手术中的可行性以及安全性。方法选择40例ASA分级Ⅰ～Ⅱ级闭合性关节脱位患者，随机分为两组，每组各20例。对照组为单纯丙泊酚组，试验组为丙泊酚复合瑞芬太尼组。记录两组患者术前、术中、术后的平均动脉压（MAP）、SpO2、HR、呼吸频率（RR）和麻醉起效时间、手术时间、苏醒时间、离院时间、麻醉效果等，并观察患者术中的不良反应以及术后的视觉模拟评分（VAS）。结果试验组的手术时间、苏醒时间、离院时间以及丙泊酚总用量[分别为（4．5±3．0）min、（1．5±0．8）min、（13．1±3．1）min、（2．0±0．5）mg／kg]明显低于对照组[分别为（10．1±4．S）min、（3．4±1．6）min、（21．6士4．1）rain、（3．5±1．2）mg/kg]（P〈0．05）。两组患者术中SpO2、RR较术前均有所下降，但两组比较差异无统计学意义；对照组术中HR较术前升高，而试验组术中HR较术前下降。试验组的麻醉效果明显优于对照组，其中试验组术中几乎无体动，对照组有18例体动（P〈0．05）；术后试验组VAS[（1．2±0．5）分]明显低于对照组[（4．6±1．8）分]。结论丙泊酚复合瑞芬太尼用于关节脱位手法复位手术是安全可行的，且较单纯用丙泊酚更能达到满意的麻醉效果。     

丙泊酚复合瑞芬太尼靶控输注在神经外科手术中的应用

目的评价丙泊酚复合瑞芬太尼靶控输注全静脉麻醉在神经外科手术中应用的可行性、安全性和有效性。方法对120例神经外科择期手术病人，分别采用丙泊酚芬太尼（PF）、丙泊酚瑞芬太尼（PR），每组60例。丙泊酚靶浓度诱导时为5μg/ml，维持时为3μg/ml；芬太尼靶浓度2μg/L；瑞芬太尼靶浓度诱导时为3μg/L，维持时为3.5μg/L。记录患者围麻醉期血流动力学、脑电双频指数（BIS）以及麻醉后恢复情况。结果PF组患者在气管插管后、上头架后及睁眼时，平均动脉压（MAP）及心率（HR）显著高于插管前（P〈0．05），切皮后各指标与插管前比较，差异均无统计学意义（P〉0．05）。PR组患者在各时间点的MAP、HR与插管前比较差异均无统计学意义（P〉0．05）。2组患者麻醉和手术期间各时间点的BIS值差异无统计学意义（P〉0．05）。PR组患者较PF组患者苏醒时间短。结论丙泊酚复合瑞芬太尼靶控输注，术中血流动力学稳定，停药后清醒迅速，更适于神经外科手术，便于对病人的意识和神经功能作出准确评估。     

异丙酚-瑞芬太尼在小儿扁桃体腺样体摘除术中的应用

目的：观察异丙酚复合瑞芬太尼静脉麻醉用于小儿扁桃体、腺样体摘除术的效果。方法：将小儿扁桃体和／或腺样体摘除术30例，随机分为氯胺酮组和瑞芬太尼组，每组15例，监测血流动力学指标，记录患儿麻醉恢复情况。结果：诱导给药后1分钟瑞芬太尼组MAP有所下降，与基础值和氯胺酮组相比P〈0．05，HR两组相比差异无统计学意义。瑞芬太尼组吞咽恢复时间、睁眼时间、拔除气管导管时间明显小于氯胺酮组（P〈0．05）。结论：异丙酚复合瑞芬太尼静脉麻醉应用于小儿扁桃体、腺样体摘除术是较为理想的麻醉方法。     

丙泊酚复合瑞芬太尼用于无痛人流术中的麻醉效果分析

目的观察丙泊酚复合瑞芬太尼麻醉用于无痛人流术中的麻醉效果和安全性。方法将40例在我院自愿终止妊娠行无病人工流产的患者随机分为观察组及对照组，对照组单独使用丙泊酚，观察组使用丙泊酚复合瑞芬太尼。结果麻醉诱导后，观察组的SB、DB、HIK下降明显，与对照组比较，差异有统计学意义（P〈0．05）。观察组的丙泊酚总量、苏醒时间、不良反应及离院时间也明显优于对照组，差异有统计学意义（P〈0．05）。结论综上所述，丙泊酚复合瑞芬太尼用于无痛人流术效果满意，值得推广应用。     

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.