七氟醚和异丙酚麻醉对应激反应及血流动力学的影响

目的 探讨异丙酚和七氟醚麻醉对应激反应及血流动力学的影响,为手术提供一种合理的麻醉方法.方法Ⅰ组20例异丙酚静脉诱导,异丙酚静脉持续泵入4-8μgkg/h维持麻醉;Ⅱ组20例七氟醚诱导,七氟醚持续吸入1%-2%维持麻醉.观测两组病人不同时期的血糖、皮质醇及SBP、DBP、HR、SpO2的变化.结果Ⅰ组术中SBP、DBP比Ⅱ组明显降低（P＜0.05）;术中,术毕Ⅰ组皮质醇明显高于Ⅱ组（P＜0.01）;术毕时Ⅰ组血糖明显高于Ⅱ组（P＜0.01）.结论 七氟醚吸入麻醉比异丙酚静脉麻醉应激反应小,血流动力学变化小,更适合于麻醉的选择.     

七氟醚与异丙酚对先心病患儿应激反应及血流动力学的影响

目的探讨七氟醚与异丙酚麻醉对先心病患儿应激反应及血流动力学的影响。方法选取沈阳242医院收治的118例先天性心脏病患儿,随机分为两组。对照组59例予以异丙酚静脉诱导,并持续泵入6~8μg/(kg·h)维持麻醉,观察组59例采取七氟醚吸入诱导,并持续吸入2%~4%维持麻醉。观察两组患者不同时点血糖、皮质醇及心率(HR)、收缩压(SBP)、舒张压(DBP)、脉搏血氧饱和度(Sp O2)变化。结果两组患儿麻醉后HR、SBP、DBP均有所降低,术中对照组患儿HR、SBP、DBP较观察组明显降低(P0.05),两组患儿插管后血糖。皮质醇均显著降低,且对照组更为明显(P0.05),术毕关胸时对照组血糖、皮质醇明显高于观察组,P0.05。结论七氟醚吸入麻醉用于先心病患儿心脏手术时应激反应小,血流动力学变化稳定,安全性优于异丙酚麻醉。     

七氟醚与依托咪酯麻醉诱导对老年腹部手术患者应激反应及血液流变学的影响

目的比较七氟醚、依托咪酯麻醉诱导对老年腹部手术患者应激反应及血流动力学的影响。方法选择2018年8月至2019年7月择期腹部手术老年患者85例,随机数字表法分为七氟醚组44例、依托咪酯组41例。七氟醚组采用咪达唑仑、舒芬太尼、七氟醚、顺式苯磺酸阿曲库铵麻醉诱导,依托咪酯组采用咪达唑仑、舒芬太尼、依托咪酯脂肪乳、顺式苯磺酸阿曲库铵麻醉诱导。比较麻醉诱导前(T0)、插管1 min(T1)、插管3 min(T2)、插管5 min(T3)、插管10 min(T4)两组应激反应、血流动力学、不良反应。结果 T1～T4时,七氟醚组皮质醇(Cor)、血糖(Glu)低于依托咪酯组(P0.05); T1时,七氟醚组收缩压(SBP)、舒张压(DBP)高于依托咪酯组,心率(HR)低于依托咪酯组,T2～T4时,七氟醚组SBP、DBP、HR均低于依托咪酯组(P0.05);两组恶心呕吐等不良反应比较,差异无统计学意义(P0.05)。结论七氟醚诱导麻醉有助于缓解老年腹部手术患者插管应激反应,维持血流动力学的相对稳定。     

异氟醚和异丙酚对高血压手术患者血压的影响

目的比较异氟醚和异丙酚麻醉对高血压手术患者麻醉中的安全性和有效性。方法择期行全麻手术的高血压患者60例,ASAⅠ或Ⅱ级,随机分成I组(异丙酚组)和Ⅱ组(异氟醚组),每组30例。诱导麻醉后,Ⅰ组异丙酚TCI维持麻醉,Ⅱ组异氟醚、氧化亚氮低流量吸入维持麻醉。记录诱导前2 min(T0)诱导前(T1)、插管后5 min(T2)、麻醉30 min(T3)、术毕拔管5 min(T4)时收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)的变化。结果两组T1、T2、T3时点与T0时点比较SBP、DBP、MAP、HR都下降,以Ⅰ组下降比较明显(P0.05),但差异无统计学意义(P0.05)。Ⅰ组相对与Ⅱ组而言其苏醒时间稍长,但是其平稳性较好。结论从麻醉效果总体而言,高血压手术麻醉中应用异丙酚静脉麻醉优于异氟醚吸入麻醉。     

老年急性肠梗阻病人的麻醉探讨

目的比较两种麻醉方法硬膜外复合全身麻醉(GE组)和单纯全麻(G组)在老年急性肠梗阻病人术中的应用,指导临床实践。方法本实验选择老年急性肠梗阻病人36例,分为硬膜外复合全身麻醉(GE组)和单纯全麻(G组),每组18例,GE组病人先进行硬膜外穿刺(T10-11),给于2%利多卡因5 ml,测定有效的麻醉平面后,开始常规诱导。两组病人均以芬太尼、维库溴铵、咪唑安定、异丙酚静脉诱导,麻醉维持以持续吸入异氟醚为主,G组辅以单次静注维库溴铵2-4 mg,芬太尼0.05-0.1 mg,GE组术中每1 h硬膜外腔追加0.5%布比卡因5 ml。观测诱导前、插管2 min、探查时、关腹时的SBP、DBP、HR、SPO2,记录催醒药和肌松拮抗药例数和拔管时间。结果插管2 min、探查时,GE组SBP、DBP均比诱导前显著降低(P<0.05),G组SBP、DBP均比诱导前显著升高(P<0.05),两组间比较,GE组SBP、DBP均比G组显著降低(P<0.01),除插管2min时,HR较明显升高外,两组病人各时点的HR、SpO2变化不明显。GE使用催醒药和肌松拮抗药例数明显减少,拔管时间明显缩短。结论硬膜外复合全身麻醉比单纯全麻应激反应小,清醒快,拔管早,不失为老年人急性肠梗阻病人的最佳选择。     

七氟醚与丙泊酚在输尿管腹腔镜手术中的应用比较

目的:通过比较七氟醚与丙泊酚麻醉在输尿管腹腔镜手术中的应用,探讨七氟醚在临床麻醉应用中的特点.方法:将60例ASAⅠ～Ⅱ级行择期腹腔镜下输尿管切开取石手术的患者分为两组,分别行七氟醚(Ⅰ组)及丙泊酚(Ⅱ组)麻醉.比较两组患者从诱导至意识消失时间、插气管导管时间、手术结束至知觉恢复时间、清醒后拔除气管导管时间及两组患者诱导期间MAP、HR和SpO2的变化.结果:(1)两组患者从诱导至意识消失时间、插气管导管时间差异均有非常显著性(P<0.01).手术结束至知觉恢复时间、清醒后拔除气管导管时间差异均无显著性(P>0.05).(2)诱导期间Ⅰ组MAP在插入气管导管时,插管后1 min及插管后3 min与诱导开始前比较差异均有非常显著性(P<0.01).Ⅱ组MAP在插入气管导管时及插入后3 min与诱导开始前比较差异均有非常显著性(P<0.01).Ⅰ组MAP在插管后1 min、3 min及气腹后3 min与Ⅱ组比较差异有显著性(P<0.05),Ⅱ组MAP在气腹后3 min与气腹前比较差异有显著性(P<0.05),而Ⅰ组差异无显著性(P>0.05).Ⅱ组HR在插入气管导管时与诱导开始前比较差异有非常显著性(P<0.01),两组其他各时间点的HR及两组SpO2与诱导开始前比较差异均无显著性(P>0.05).结论:七氟醚吸入麻醉与丙泊酚静脉麻醉均能较好地在输尿管腹腔手术中应用,丙泊酚静脉麻醉诱导更快,而七氟醚吸入麻醉维持更平稳.     

舒芬太尼或芬太尼联合利多卡因对全麻气管插管时血流动力学的影响

目的:观察舒芬太尼或芬太尼与利多卡因联合用于全麻诱导插管时对血流动力学的影响。方法:择期全麻手术病例60例,按诱导药物不同平均分为利多卡因组(Ⅰ组)、芬太尼联合利多卡因组(Ⅱ组)、舒芬太尼合用利多卡因组(Ⅲ组)3组。分别记录诱导前(T0)、插管前(T1),插管后即刻(T2),插管后1min(T3)、3min(T4)、5min(T5)各时点的舒张压(SBP)、收缩压(DBP)、心率(HR)。结果:诱导后T1时点3组SBP、DBP、HR显著低于T0(P<0.05或P<0.01);插管后Ⅲ组SBP、DBP、HR与T0比较差异无显著性(P>0.05),在T2、T3、T4、T5时SBP、DBP及HR在T2、T3时均显著低于Ⅰ组(P<0.01或P<0.05),在T2、T3时SBP、DBP、HR明显低于Ⅱ组(P<0.05);Ⅱ组在T2、T3与T0比较SBP、DBP明显升高(P<0.05),HR在T4、T5时与T0比明显下降(P<0.05),与Ⅰ组比较SBP、DBP、HR低于Ⅰ组(P<0.05);Ⅰ组SBP、DBP、HR明显高于T0时点(P<0.05或P<0.01)。结论:舒芬太尼或芬太尼与利多卡因联合能较好地抑制气管插管时的应激反应,舒芬太尼在维持血流动力学方面更有优势。     

七氟醚用于腹腔镜胆囊切除术的麻醉效果观察

目的探讨七氟醚用于腹腔镜胆囊切除术的麻醉效果。方法将行腹腔镜胆囊切除术130例患者分为七氟醚组、异丙酚组、雷米芬太尼组3组,观察3组气管插管1 min、建立人工气腹前、气腹后7 min、拔出气管导管时收缩压(SBP)、心率(HR)、舒张压(DBP),自主恢复时间、拔管时间及止痛时间,并评价3组不良反应发生情况。结果七氟醚组气管插管1 min、建立人工气腹前、气腹后7 min、拔出气管导管时SBP、HR及DBP均显著低于异丙酚组和雷米芬太尼组(P<0.05);七氟醚组自主恢复时间、拔管时间及止痛时间较雷米芬太尼组显著缩短(P<0.05);七氟醚组不良反应发生率显著低于雷米芬太尼组(P<0.05)。结论腹腔镜胆囊切除术中在麻醉效果相同的情况下,七氟醚麻醉效果好,对人体循环系统影响最小,维持生命体征最为平稳,安全性最高,值得临床推广应用。     

异丙酚和七氟醚对老年乳腺癌患者术中应激反应和术后认知功能的影响

目的 探讨异丙酚和七氟醚麻醉对老年患者术中应激反应及术后认知功能的影响.方法 乳腺癌手术老年患者60 例,分别接受异丙酚(30 例)和七氟烷(30 例)麻醉,比较两组术中应激反应、术后简易精神状态量表评分、术后认知功能障碍发生率.结果 丙泊酚组在麻醉诱导后3 min皮质醇浓度明显低于入室后(t=2.15,P＜0.05);七氟醚组在麻醉诱导后3 min、插管后1 min、切皮后2 min、关腹后及拔管后皮质醇浓度均高于入室后(t分别=2.25、2.13、1.98、2.99、3.15,P均＜0.05);七氟醚组各时间点的血液中皮质醇浓度均高于丙泊酚组(t分别=3.21、2.95、3.42、3.55、3.54,P均＜0.05);丙泊酚组术后认知功能障碍发生率为6.70%,七氟醚组为13.30%,两组比较,差异有统计学意义(χ2=50.28,P＜0.05).结论 丙泊酚能有效抑制全麻术中应激反应,两组均可引起老年患者术后早期短暂的认知功能下降,但异丙酚较七氟烷能减少认知功能障碍的发生率.     

七氟醚与丙泊酚用于新生儿麻醉效果的实验研究

目的研究七氟醚和丙泊酚应用于新生儿麻醉的效果。方法60例新生儿随机均分为两组,七氟醚组和丙泊酚组,每组30例。七氟醚组经面罩吸入七氟醚与氧气的混合气体,根据患儿体动反应调节七氟醚的浓度,丙泊酚组静脉注射丙泊酚2.5mg/kg,意识消失后行气管插管。取右侧卧位从骶裂孔注入0.25%罗哌卡因1.0ml/kg。七氟醚组术中持续吸入七氟醚,丙泊酚组静脉持续泵注丙泊酚1.0-1.5mg/(kg.h),保留自主呼吸,间断辅助呼吸维持麻醉。术中连续监测SPO2、HR、BP、RR,记录两组患儿麻醉中意识消失时间、气管插管时间、插管时发生体动、呛咳例数、自主呼吸恢复时间、术中呼吸抑制例数。同时比较患儿术后苏醒时间及质量。结果两组患儿麻醉前SBP、DBP、HR组间比较差异无显著性。诱导期SBP、DBP、HR较麻醉前明显下降(P0.05)。插管后SBP、DBP、HR较麻醉前明显下降(P0.05)。丙泊酚组诱导期及插管后SBP、DBP、HR较七氟醚组明显下降(P0.05)。七氟醚组患儿意识消失时间、气管插管时间均较丙泊酚组明显延长(P0.05)。七氟醚组患儿恢复自主呼吸时间较丙泊酚组明显缩短(P0.05)。七氟醚组患儿呼吸抑制发生率较丙泊酚组明显减少(P0.05)。两组气管插管期间呛咳、体动的发生率无显著性差异(P0.05)。七氟醚组患儿苏醒时间较丙泊酚组明显缩短(P0.05)。两组苏醒质量无显著性差异(P0.05)。结论丙泊酚与七氟醚均可安全有效地应用于新生儿患者。七氟醚更易保证患儿心血管系统及呼吸系统的稳定,值得在新生儿手术中推广应用。     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

通用设计原则与产品研发策略

本文介绍了通用设计的概念和设计原则,并阐述了根据此原则实施通用设计的产品研发策略。通用设计惠及的不仅是残疾人,也惠及了包括普通公众在内的广泛人群,以及企业。应将通用设计的原理应融入政府相关政策和未来发展的规划中,为残疾人以及更多人群提供合理便利的通用设计产品。     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

胃癌DNA含量与E-cad、EGFR表达的关系及其意义

目的　探讨胃癌组织DNA含量与E cad、EGFR表达的关系 ,评价其在浸润、转移潜能及预后判断中的作用。方法　应用图像分析仪及SP免疫组化法检测 30例正常胃黏膜上皮、30例不典型增生和 5 0例胃癌组织DNA含量与E cad、EGFR蛋白表达情况。结果　①正常胃黏膜上皮、Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌组的DI、PI、S %、>5c %逐渐增高 ,与胃癌分期、淋巴结转移显著相关 (P <0 0 1)。②E cad在正常胃黏膜上皮阳性表达率 10 0 % ,EGFR呈阴性表达 ;Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌E cad阳性表达率逐渐降低 ,EGFR的阳性表达率逐渐升高 ,且差异显著 (P <0 0 5 ) ;E cad表达减弱、EGFR表达升高与胃癌分化差、淋巴结转移显著相关 (P <0 0 1)。③E cad表达阴性的胃癌DNA指数及EGFR表达水平显著高于E cad阳性 (P <0 0 1)。结论　检测DNA含量及E cad、EGFR蛋白表达有助于胃癌的早期诊断及转移潜能和预后的判断。