0.5%罗哌卡因切口浸润麻醉对全麻开颅术中血流动力学及血糖的影响

目的 探讨0.5%罗哌卡因切口浸润麻醉对异氟醚吸入全麻开颅术中血流动力学及血糖的影响.方法 采用随机、双盲、对照设计,将24例大脑半球胶质瘤择期手术患者分为罗哌卡因组(A组)和生理盐水对照组(B组),每组12例.静脉注射咪达唑仑0.05 mg/kg,芬太尼4μg/kg,丙泊酚2 mg/kg,维库溴铵0.1 mg/kg诱导行气管插管.吸人异氟醚1.0 MAC维持麻醉.切皮前10 min,A组用0.5%罗哌卡因40ml头皮切口浸润麻醉,B组用生理盐水40ml切口浸润,两组溶液均加入1∶200 000肾上腺素.记录手术前、气管插管后、切口浸润即刻及其后5、10 min、切皮即刻及其后5、10 min、钻颅骨、切开硬脑膜、缝合硬脑膜、缝合皮下组织、缝合皮肤、手术完毕时的平均动脉压(MAP)、心率(HR)、异氟醚吸入浓度,并于术前、气管插管后、切皮后10 min、术毕时抽取动脉血测定血糖.结果 A组切口浸润后10 min至缝合硬脑膜时MAP、HR均低于B组(P＜0.05);缝合皮下组织至术毕时A组的异氟醚浓度低于B组(P＜0.05);B组血糖随切皮刺激强度增高而逐渐升高(P＜0.05).结论 0.5%罗哌卡因切口浸润麻醉,有效地预防了全麻开、关颅时血流动力学的升高,有利于神经外科麻醉.     

阴茎背神经阻滞用于小儿包皮环扎术的临床观察

目的观察七氟醚吸入复合小剂量氯胺酮静注联合罗哌卡因阴茎背神经阻滞在小儿包皮环扎术的麻醉效果。方法选取2012年1月至2013年12月在广东省佛山市顺德妇幼保健院择期行包皮环扎术患儿50例,随机分为实验组和对照组,每组各25例。实验组患儿在吸入七氟醚复合静注氯胺酮的基础上选择罗哌卡因行阴茎背神经阻滞,对照组患儿仅在吸入七氟醚复合静注氯胺酮下完成手术,比较两组患儿在手术期的各项重要指标：不同时间点的平均动脉压、心率、血氧饱和度、氯胺酮用量、苏醒时间及苏醒期间躁动情况。结果手术开始后lOmin,实验组平均动脉压及心率均比对照组平稳（t值分别为3．452和4．418,均P〈0．05）;实验组氯胺酮用量为（40±12）mg,少于对照组的（70±15）mg（t=7．812,P〈0．05）;实验组苏醒时间为（6±4）min,短于对照组的（15±6）min（t=3．753,P〈0．05）;实验组苏醒期间有4例疼痛躁动,少于对照组的15例（t=6．472,P〈0．05）。结论应用七氟醚吸入复合小剂量氯胺酮静注联合罗哌卡因阴茎背神经阻滞的技术为小儿包皮环扎术提供了一种更为安全、有效、满意的麻醉方法,．     

缩血管药对全麻复合硬膜外阻滞时脑电双频指数的不同影响

目的 观察七氟醚全麻复合岁哌卡因硬膜外阻滞时使用麻黄素和去氧肾上腺素对脑电双频指数的影响。方法52例ASAⅠ～Ⅱ级全麻复合硬膜外阻滞下行腹部手术的患者,硬膜外穿刺置管（T9～L2）成功后,给予0．5％罗哌卡因5ml,然后以8ml／h持续硬膜外注射,气管插管后以09％七氟醚（呼气未）维持麻醉,以气管插管后10min的心率、平均动脉压和脑电双频指数值为基础值,与麻醉前的血压比较,平均动脉压下降〈30％者分人对照组,下降≥30％者随机分人麻黄素组（0．1mg／kg）或去氧肾上腺素组（2μg／kg）。后二组给予缩血管药物后观察腑电双频指数变化10min,每2min记录一次。若腑电双频指数〉60,则增加七氟醚浓度0．25％,若腩电双频指数〈60则降低匕氟醚浓度0．25％。每隔2．5min测血压和心率、结果 脑电双频指数变化期间麻黄素组的心率明显高于对照组和去氧肾上腺素组,差异有统计学意义（P〈0．05）;与基础值比较,第10分钟时对照组和去氧肾上腺素组腩电双频指数值碌著升高（P〈0．05）,但均〈60;第2～10分钟麻黄素组腑电双频指数值均显著升高（P〈0．05）．其中有10个患者的脑电双频指数值〉60,与对照组和去氧肾上腺素组比较差异显著（P〈0．05）;与对照组和去氧肾上腺素组比较,第8分钟和第10分钟时麻黄素组脑电双频指数值显著升高（P〈0．05）。结论 麻黄素使七氟醚全麻复合罗哌卡因硬膜外阻滞时的BIS值升高,而去氧肾上腺素无此作用。     

不同浓度罗哌卡因胸段硬膜外麻醉复合全麻在上腹部大手术中的应用

目的比较全麻复合不同浓度胸段硬膜外阻滞（TEA）应用于上腹部大手术患者的优缺点,为临床诊疗提供参考。方法选择60例ASAI-Ⅱ级拟行上腹部大手术患者,分为A、B、C组,每组20位患者,术中A组每60分钟硬膜外给予0．5％罗哌卡因＋0．5μg／ml舒芬太尼10ml,B组每60分钟硬膜外给予0．25％的罗哌卡因＋0．5μg/m1舒芬太尼10ml,C组每60分钟硬膜外给予10ml生理盐水。分别监测人手术室基础值、全麻诱导前、麻醉诱导插管后、切皮后、手术结束后、气管拔管后各时刻患者的MAP、HR血流动力学参数,观察各组全麻药用量情况,记录3组手术结束后到气管拔管的时间。结果A、B组病例麻醉效果满意,在气管插管后、切皮后、腹腔探查、气管拔管时段较C组循环波动小（P〈0．05）,血流动力学较稳定,而A、B组之间比较差异无统计学意义（P〉0．05）。在麻醉维持期间,A、B组BP和HR较C组相比在低位运行,但均在正常范围。A、B组较C组全麻用药量明显减少（P〈0．05）,术后苏醒质量高,无烦躁、切口疼痛等不适。结论全麻复合0．5％、0．25％浓度罗哌卡因胸段硬膜外阻滞较单纯全麻能有效减轻围麻醉期的应激反应,保持血流动力学的稳定,麻醉过程平稳,术毕苏醒快,并发症发生率少,术中全麻药用量少,在上腹部大手术中是一种安全、有效的较理想麻醉方法,值得临床推广应用。     

国产罗哌卡因在肌间沟臂丛阻滞麻醉中的效果观察

目的 比较0．5％、0．75％国产罗哌卡因和0．5％布比卡因用于肌间沟臂丛神经阻滞的效果和安全性，评价国产罗哌卡因进行臂丛阻滞麻醉的有效性和安全性。方法 随机选择ASA（美国麻醉学家学会）Ⅰ-Ⅱ级需行肌间沟臂丛阻滞的手指再造手术病人60例，随机双盲分为3组，每组20人，分别采用0．5％罗哌卡因30ml，0．75％罗哌卡因加ml和0．5％布比卡因各30ml，以针尖触及神经出现并传至拇指的触电样异感为注药标准。注药后测定起效时间、阻滞平面，判断上肢活动程度，详细记录术后创口疼痛时间、上肢运动恢复时间及可能发生的不良反应和并发症。结果 3组病人c，～T，阻滞起效时间，均〈5min（P〉0．05），注药20min后3组病人上肢均不能水平举动，3组病例的感觉阻滞时间无差异，0．75％罗哌卡因和0．5％布比卡因组运动阻滞程度差异无统计学意义（P〉0．05），0．5％罗派卡因组运动阻滞时间明显短于另外2组（P〈0．05），3组病例麻醉优艮率均为100％（P〉0．05）。无局麻药毒性反应和严重并发症发生。结论 0．5％和0．75％国产罗哌卡因用于肌间沟臂丛神经阻滞效果和术后持续镇痛作用与0．5％布比卡因相似，0．5％罗哌卡因可用于肌肉松弛程度要求低的上肢手术麻醉，0．75％罗哌卡因适合任何上肢手术的麻醉。     

两种浓度罗哌卡因的麻醉效能比较

目的观察不同浓度罗哌卡因用于蛛网膜下腔阻滞（腰麻）剖宫产术的麻醉效能和母婴安全，以探索罗哌卡因用于蛛网膜下腔阻滞（腰麻）剖宫产术的最佳浓度。方法采用随机双盲法将46例足月单胎初产妇等分为二组：0，5％罗哌卡因组（A组），0．75％罗哌卡因组（B组）。观察项目包括基本指标（HR、BP、SpO。胎心音等）、N阻滞效能（感觉与运动N阻滞）、新生儿1min和5min阿氏（Apgar）评分。结果发现B组感觉阻滞维持时间明显长于A组（p〈0．01），对运动N阻滞强度也大于A纽（P〈0．05），未出现新生儿阿氏（Apgar）评分0～3分的情况，5min时全部达8分以上，二组间在新生儿阿氏（Apgar）评分方面无统计学意义，也未发现产妇有髓鞘损伤的相关症状体征。结论0、75％罗哌卡因用于蛛网膜下腔阻滞（腰麻）剖宫产术时，其麻醉效能强于0．5％罗哌卡因，二者对母婴均具较好的安全性。     

同剂量罗哌卡因和布比卡因腰硬联合麻醉用于老年妇科手术的临床比较

目的比较老年妇科手术中应用同剂量布比卡因和罗哌卡因实施腰硬联合麻醉的安全性和有效性。方法60例ASA分级Ⅰ～Ⅱ级拟行妇科手术的老年患者，平均年龄（70±8）岁，随机分为两组，布比卡因组（A组）和罗哌卡因组（B组），每组各30例，分别给予同剂量（0．75％药物12mg＋10%，葡萄糖1（ml）的布比卡因和罗哌卡因实施腰硬联合麻醉。结果两组麻醉效能、最高麻醉阻滞平面比较差异无统计学意义。A组给药5min时血压开始下降，且有12例（40．0％）患者需要使用麻黄碱升压（麻黄碱5～10mg静脉注射）；B组血压、心率波动多在正常范围之内，仅有2例（6．7％）需要使用麻黄碱升压，可见A组血压、心率波动较大（P〈0．05）。结论布比卡因与罗哌卡因均可有效地应用于老年妇科手术腰硬联合麻醉，但老年妇女由于机体机能下降和合并症较多，手术及麻醉的耐受性差，围手术期风险较大，为策安全，老年妇科手术麻醉应首选罗哌卡因。     

0．5％罗派卡因硬膜外麻醉乳腺癌根治术的临床观察

目的：探讨0．5％罗哌卡因用于高位硬膜外麻醉的安全性。方法：选择女性乳腺癌手术患者40例，分为两组：I组（罗哌卡因组），0．5％罗哌卡因硬膜外麻醉；Ⅱ组（布比卡因组），0．375％布比卡因硬膜外麻醉。观察麻醉前后呼吸、血流动力学变化。结果：两组麻醉后均可引起HR、RR、SP、DP、SPO2下降（P＜0．01），Ⅱ且明显低于I组（P＜0．05）。观察期间无严重不良反应。结论：0．5％罗哌卡因用于高位硬膜外麻醉，效果良好，无明显不良反应，使用安全。     

不同剂量罗哌卡因蛛网膜下腔阻滞用于老年人下腹部以下部位手术麻醉的临床观察

目的 观察不同剂量罗哌卡因蛛网膜下腔阻滞用于老年人下腹部以下部位手术麻醉的临床效果，对其适宜剂量及安全性进行评估，并与布比卡因比较。方法 80例60～80岁患者，麻醉方法为蛛网膜下腔-硬膜外联合阻滞。根据蛛网膜下腔阻滞麻醉药物配制剂的不同将研究对象随机分成R1组、R2组、R3组及B组，每组20例。蛛网膜下腔阻滞（用局麻药），R1组、R2组及R3组分别为罗哌卡因10、12和14mg，B组为布比卡因10mg。观察感觉阻滞起效时间、运动阻滞起效时间、最高阻滞平面、最大运动阻滞程度、运动恢复时间，并记录蛛网膜下腔阻滞前（T0）及阻滞后3min（T1）、5min（T2）、10min（T3）、15min（T4）及30min（T5）时点的收缩压（SBP）、HR、SpO2。结果 B组感觉阻滞起效时间（38±25）s及运动阻滞起效时间（136±36）s较其他三组均短（P〈0．05），B组最大运动阻滞程度评分（2．35±0．31）分和运动恢复时间（3．1±0．6）h较其他三组均显著增高和延长（P〈0．01）。四组患者麻醉前后SBP及HR比较，R3组麻醉后15min时点SBP较麻醉前显著下降（P〈0．05），B组麻醉后5min及10min时点SBP较麻醉前显著下降（P〈0．05或〈0．01）。结论 罗哌卡因蛛网膜下腔阻滞用于老年人下腹部以下部位手术的麻醉，配制重密度液时，使用12mg的剂量，可满足手术所需的麻醉效果，且安全性好。     

罗哌卡因应用于会阴侧切术的效果分析

目的：探究罗哌卡因应用于会阴侧切术术后的镇痛效果以及母婴状况。方法：选择顺产时需要行会阴侧切手术的孕产妇94例，随机分为两组：试验组给予浓度为0．375％的罗哌卡因15ml，行阴部神经阻滞麻醉；对照组给予浓度为1％的利多卡因15ml，行会阴皮下浸润麻醉。观察和比较术后两组孕产妇出现疼痛的时间、自感疼痛程度以及新生儿Apgar评分。结果：试验组孕产妇术后平均（18．67±4．92）h出现疼痛，与对照组比较，差异有统计学意义（P〈0．05）；试验组孕产妇术后8例疼痛难忍，对照组24例，差异有统计学意义（P〈0．05）；两组术后胎儿Apgar评分情况比较差异无统计学意义（P〉0．05）。结论：罗哌卡因应用于会阴侧切术临床镇痛效果优于利多卡因，适合基层医院应用。     

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.