不同药物复合丙泊酚应用于无痛胃肠镜检查的护理比较

目的 比较芬太尼复合丙泊酚与布托啡诺复合丙泊酚在无痛胃肠镜检查中的应用效果,并总结护理侧重点.方法 将100例接受无痛胃肠镜检查的患者分为两组各50例,芬太尼组为芬太尼复合丙泊酚,布托啡诺组为布托啡诺复合丙泊酚,比较两组麻醉诱导期丙泊酚注射痛及血流动力学变化,观察术中呛咳、躁动,术后呕吐、眩晕等不良反应发生率.结果 两组患者血氧饱和度、平均动脉压和心率比较,差异无统计学意义(P＞0.05),布托啡诺组术后眩晕比芬太尼组的发生率高(P＜0.05),术中呼吸抑制芬太尼组发生率高于布托啡诺组(P＜0.05),芬太尼组注射痛发生率比布托啡诺组高(P＜0.05).结论 芬太尼复合丙泊酚或布托啡诺复合丙泊酚麻醉在护理上各有侧重,前者应做好注射痛和呼吸系统管理,后者需注重麻醉后呕吐和眩晕的护理.     

纳布啡在无痛胃肠镜检查中减轻丙泊酚静脉注射痛的效果

目的 评价纳布啡在无痛胃肠镜检查中减轻丙泊酚静脉注射痛的效果。方法 选择于该院住院，择期行无痛胃肠镜检查的患者100例。其中，男54例，女46例，年龄20～65岁，体重指数（BMI）19～26 kg/m²，美国麻醉医师协会（ASA）分级为Ⅰ级或Ⅱ级，采用随机数表法将患者分为纳布啡复合丙泊酚组（N组，n = 50）和对照组（C组，n = 50）。N组静脉注射纳布啡0.15 mg/kg，C组静脉注射等容量生理盐水，3 min后两组均静脉推注丙泊酚1.50～2.00 mg/kg，待患者睫毛反射消失后行胃肠镜检查，根据患者吞咽反射及体动情况，酌情追加丙泊酚0.50～1.00 mg/kg。比较两组患者丙泊酚注射痛发生率、不同部位丙泊酚注射痛发生率、丙泊酚注射痛的严重程度、苏醒时间、检查时间、丙泊酚用量和相关不良反应发生情况。结果 N组丙泊酚注射痛发生率、手背处静脉注射痛发生率和丙泊酚静脉注射后轻、中度疼痛所占比例均明显低于C组（P < 0.05）；N组苏醒时间短于C组，丙泊酚用量少于C组（P < 0.05）。N组出现1例恶心呕吐，C组出现1例心动过缓。两组均未发生反流误吸、低氧血症、低血压及血栓性静脉炎等不良反应。结论 纳布啡0.15 mg/kg预处理，可以减轻丙泊酚静脉注射引起的疼痛，复合丙泊酚用于无痛胃肠镜检查，可缩短苏醒时间，减少丙泊酚用量，安全有效。     

盐酸纳布啡用于无痛纤维支气管镜对呛咳反应及相关指标的影响

目的 观察丙泊酚复合盐酸纳布啡或舒芬太尼在无痛纤维支气管镜检查中对患者呛咳反应、血流动力学和术中呼吸抑制等的影响。方法 将择期行无痛纤维支气管镜检查的103例患者随机分为纳布啡组（N组）、舒芬太尼组（S组）和纯丙泊酚组（C组）,所有患者操作开始前经外周静脉通道注射丙泊酚复合盐酸纳布啡或舒芬太尼。其中,N组：纳布啡10～20 mg+丙泊酚100～150 mg,S组：舒芬太尼5～10 μg + 丙泊酚100～150 mg,C组：丙泊酚100～150 mg。记录入室时（T₀）、纤维支气管镜进入声门时（T₁）、检查过程中（T₂）、检查完毕（T₃）的平均动脉压（MAP）、心率（HR）、经皮动脉血氧饱和度（SpO₂）以及纤维支气管镜进入声门时呛咳程度、检查全过程托下颌面罩给氧次数等。结果 3组患者各时间点的MAP、HR、SpO₂和检查过程中托下颌次数比较,差异均无统计学意义（P > 0.05）;C组呛咳评分高于N组和S组（P < 0.05）,苏醒时间长于N组和S组（P < 0.05）,但N组和S组比较,差异无统计学意义（P > 0.05）。结论 小剂量盐酸纳布啡或舒芬太尼复合丙泊酚用于无痛纤维支气管镜检查,对血流动力学影响较小,同时可有效抑制操作过程中的呛咳反射,相比于单纯使用丙泊酚,未增加呼吸抑制的发生率。     

丙泊酚联合布托啡诺应用在无痛胃肠镜麻醉中的效果分析

目的 探究无痛胃肠镜麻醉应用丙泊酚与布托啡诺联合方案的临床效果。方法 选取本院诊治72例无痛胃肠镜麻醉患者资料,随机分两组,对照组予以丙泊酚,研究组予以丙泊酚与布托啡诺联合方案,分析两组患者临床相关麻醉效果、生命体征指标及不良事件情况。结果 治疗后,研究组睫毛反射的消失（8.03±0.59）s、检查时间（28.83±2.23）min、丙泊酚量（122.63±15.36）mg及苏醒时间（4.48±1.03）min均低于对照组,差异有统计学意义（P<0.05）;意识消失时,研究组血氧饱和度（96.12±2.12）%、血压（11.08±0.70）KPa均高于对照组（P<0.05）;研究组发生舌根后坠、呼吸暂停等不良事件8.33%均低于对照组的33.33%,差异有统计学意义（P<0.05）。结论 无痛胃肠镜麻醉应用丙泊酚与布托啡诺联合方案,能有效缩短麻醉起效及苏醒时间,降低不良事件发生。     

布托啡诺联合丙泊酚在无痛胃肠镜检查中的应用效果及护理

目的 探讨布托啡诺联合丙泊酚用于无痛胃肠镜检查的效果与护理体会.方法 选择本院2015年5月~2016年5月接受无痛胃肠镜检查的患者192例为研究对象,以随机数字表法分为对照组与观察组,每组96例,观察组采取布托啡诺联合丙泊酚麻醉,对照组采取芬太尼联合丙泊酚麻醉,对两组麻醉诱导血流动力学变化、丙泊酚注射痛程度、不良反应发生率等进行观察.结果 两组患者麻醉前、意识消失时、苏醒时的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)等血流动力学指标均无明显差异(P>0.05);观察组丙泊酚注射液痛0级患者构成比明显高于对照组,对照组疼痛Ⅱ级、Ⅲ级、Ⅳ级患者构成比明显高于观察组,两组差异有统计学意义(P<0.05).观察组术后眩晕发生率明显高于对照组,对照组呼吸抑制、术中呛咳躁动发生率较观察组高,差异均有统计学意义(P<0.05).结论 布托啡诺联合丙泊酚与芬太尼联合丙泊酚应用于无痛胃肠镜检查中均有效、安全,但布托啡诺呼吸抑制轻,麻醉安全与麻醉管理方面更具有优势.在以上两种麻醉方案中,护理应该各有侧重,前者需做好麻醉后眩晕与呕吐的护理,后者需做好呼吸系统与注射痛的护理.     

丙泊酚复合小剂量舒芬太尼用于无痛人流临床观察

目的：评价无痛人流术应用丙泊酚复合常规剂量舒芬太尼麻醉的效果,优化手术麻醉的基础上提高无痛人流术患者的无痛性、安全性。方法：选择本中心的200例无痛人流术患者,随机分为丙泊酚复合小剂量（0.05μg/kg）舒芬太尼的研究组以及丙泊酚复合小剂量（0.15μg/kg）舒芬太尼的对照组。比较两组无痛人流术患者的镇痛效果、不良反应以及生命体征、入睡时间、清醒时间情况。结果：研究组患者术中的HR、SPO2对比对照组更为平稳（P＜0.05）、MAP除外（P＞0.05）,且入睡时间、清醒用时短于对照组（P＜0.05）,丙泊酚总量少于对照组（P＜0.05）。另外,两组无痛人流术患者的镇痛效果以及术中知晓、术后恶心呕吐等不良反应情况比较,差异无显著性（P＞0.05）。结论：丙泊酚复合小剂量舒芬太尼用于无痛人流术中镇痛效果好、安全性高,且患者生命体征平稳,清醒快,是有效的麻醉方案。     

布托啡诺复合罗哌卡因用于产科硬膜外镇痛的观察

[摘要] 目的：比较布托啡诺复合丙泊酚及单用丙泊酚用于人工流产术的效果及不良反应，探讨布托啡诺应用的安全性及有效性。方法：择期行人工流产术患者40 例，随机分为两组：布托啡诺-丙泊酚组（BP组）和丙泊酚组（P组），每组20例。观察两组患者围麻醉期血流动力学及SpO2变化、丙泊酚用量、诱导时间、苏醒时间、恢复正常行走时间、术中及术后镇痛情况，记录术中呼吸抑制、术后嗜睡、恶心呕吐等相关并发症、术中体动反应、术后宫缩痛及患者满意度情况。结果：P组术中MAP显著低于BP组水平（P＜0.01）。BP组丙泊酚用量与P组相比无显著性差异，但诱导时间显著短于P组（P＜0.01）。BP组苏醒时间及恢复正常行走时间较P组有所延长，但无统计学意义。BP组术中及术后镇痛效果均明显优于P组（P＜0.01），丙泊酚注射痛、体动、宫缩痛发生率均明显低于P组，两组呼吸抑制发生率无显著性差异。结论：布托啡诺复合丙泊酚用于人工流产术具有麻醉效果好、麻醉并发症少的优点，可安全用于人工流产术的麻醉，值得临床推广应用。     

丙泊酚复合不同镇痛药静脉麻醉用于三叉神经半月节射频热凝术

目的观察丙泊酚分别复合芬太尼、瑞芬太尼、布托啡诺用于三叉神经半月节射频热凝术的麻醉效果。方法 60例三叉神经痛行半月神经节射频热凝术的患者,随机均分为3组(每组20例),丙泊酚分别复合芬太尼(A组)、瑞芬太尼(B组)、布托啡诺(C组)进行静脉麻醉。观察并记录不同时点MAP、HR及SpO2的变化,丙泊酚总用量、术后苏醒时间及术中体动、呼吸抑制和心动过缓的发生率,术后随访恶心呕吐的发生率、患者和术者的满意度。结果 3组患者在麻醉诱导后、治疗中MAP均有明显降低(P均<0.05),B组降幅大于A、C组(P均<0.05),术后3组均恢复至接近麻醉前水平。丙泊酚总用量、术后苏醒时间及术中体动发生率B组低于A、C组(P均<0.05),术中呼吸抑制和心动过缓的发生率由高到低依次为B组、A组和C组,但3组间差异无统计学意义(P>0.05)。结论丙泊酚复合不同阿片类药物用于半月节射频热凝术均安全有效,复合瑞芬太尼组术后苏醒快,复合布托啡诺组术中不良反应较少。     

纳布啡和舒芬太尼分别复合丙泊酚用于门诊无痛胃肠镜检查的临床观察

目的比较丙泊酚分别复合舒芬太尼和两种剂量的纳布啡用于无痛胃肠镜检查的临床效果,并探讨纳布啡用于胃肠镜检查的最适剂量。方法选2016年1~3月于北京友谊医院行无痛胃肠镜的患者90例进行前瞻性研究,随机数法分为3组:舒芬太尼组(S组)、低剂量纳布啡组(N1组)、高剂量纳布啡组(N2组),每组各30例。S组静脉注射舒芬太尼0.1μg/kg,N1组静脉注射盐酸纳布啡0.1 mg/kg,N2组静脉注射盐酸纳布啡0.2 mg/kg。各组均静脉注射丙泊酚1.5~2.0 mg/kg,行胃镜加肠镜检查,术中酌情追加丙泊酚0.5~1.0 mg/kg,观察3组患者术中呼吸及生命体征变化程度、苏醒时间、视觉模拟评分(VAS)及术中体动情况。结果与N1组和N2组比较,S组术中呼吸频率减少最明显(P0.05),3组在VAS评分和苏醒时间上差异无统计学意义(P0.05)。结论盐酸纳布啡适宜在无痛胃肠镜检查中使用,0.1 mg/kg的剂量能够满足胃肠镜检查的要求且具有良好的安全性。     

舒芬太尼联合布托啡诺用于腹腔镜胆囊切除术后自控静脉镇痛的效果观察

目的：观察腹腔镜胆囊切除术后患者自控静脉镇痛中应用舒芬太尼与布托啡诺的临床效果。方法：将2017年11月至2019年11月入选的90例拟行腹腔镜胆囊切除术的患者随机分为舒芬太尼组30例、布托啡诺组30例和联合组30例,三组术后分别采用舒芬太尼、布托啡诺、舒芬太尼+布托啡诺静脉自控镇痛。比较三组术后疼痛评分、Ramsay镇静评分、术后躁动发生率及镇痛相关不良反应发生情况。结果：舒芬太尼组和联合组术后各时间点疼痛评分均低于布托啡诺组（P<0.05）;舒芬太尼组和联合组各时间点疼痛评分比较,无显著性差异（P>0.05）;舒芬太尼组和联合组术后4 h Ramsay评分低于布托啡诺组（P<0.05）。三组术后躁动发生率比较,差异有统计学意义（P<0.05）,其中联合组躁动发生率低于布托啡诺组（P<0.05）。三组恶心呕吐发生率、不良反应总发生率比较,差异有统计学意义（P<0.05）,布托啡诺组和联合组不良反应总发生率均低于舒芬太尼组（P<0.05）。结论：腹腔镜胆囊切除术患者术后自控静脉镇痛采用舒芬太尼联合布托啡诺,可减少舒芬太尼用量,在保证镇痛效果的同...     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.