麻醉气体吸附器的临床应用

麻醉苏醒的快慢主要取决于吸入麻醉药的血／气溶解度，临床上常用肺泡吸入麻醉药的浓度降低速率来表示麻醉苏醒的快慢。在低流量紧闭式麻醉下，关闭麻醉气体挥发罐后回路内麻醉气体的浓度仍旧很高，传统苏醒方法常采用大流量新鲜气体冲洗法，该法不仅浪费气源，增加麻醉医生工作量，还会引起手术室内气体环境污染。此法同时也降低了呼     

靶控输注异丙酚与吸入异氟醚-笑气复合硬膜外阻滞联合全麻的比较

硬膜外阻滞联合全麻具有明显减少全麻药用量,减轻术中应激反应,苏醒迅速和术后镇痛便利等优点已被临床广泛采用,但全麻药物以吸入麻醉药或静吸联合为主.随着环保意识的不断提高,如何避免或减少吸入麻醉药的环境污染越来越受到麻醉医生的重视.靶控输注(TCl)静脉麻醉药技术的出现弥补了以往静脉麻醉药使用不方便、不易调控麻醉深度的缺点,使静脉麻醉药深浅能象吸入麻醉药用标准挥发罐调节一样简便.本研究旨在比较上腹部手术靶控输注异丙酚与吸入异氟醚-笑气复合硬膜外阻滞的麻醉效果,并结合麻醉深度监测探索上腹部手术中复合硬膜外阻滞时为维持合适麻醉深度所需异丙酚的血药浓度,以供临床应用参考.     

氧流量对七氟醚复合笑气排出的影响及与苏醒期的关系的研究进展

静吸复合全麻患者,麻醉苏醒的快慢主要取决于吸入麻醉药的排出速度.目前常用的方法是在手术结束后给予纯氧对回路内和病人体内的麻醉气体进行冲洗或辅助一些拮抗药加快苏醒,如果吸入纯氧流量不足,回路和病人体内麻醉气体排出速度缓慢,过多残余不仅可能导致病人烦躁、呕吐,甚至抑制呼吸.但一味追求排出麻醉气体速度而无限增大吸入纯氧流量不但会造成大量气源的浪费,而且可能使病人产生低碳酸血症,甚至造成呼吸性碱中毒以及苏醒期躁动和苏醒后再麻醉.本实验旨在寻找一个适当的纯氧流量可使病人既能迅速安全苏醒,又不造成气源的浪费.     

术后呼吸训练对肺癌患者肺功能的影响

呼吸训练目的 是重新建立患者呼吸模式,增加患者膈肌活动度,提高患者肺泡换气量,减少患者呼吸时的能量消耗,缓解患者呼吸困难,改善患者肺癌切除术后肺的功能和生活质量;运用缩唇呼气法可延缓病患的呼气流速,增加气道内压,以抵抗由于气道外压力所产生的动力压迫,防止外周小气道陷闭,便于排空肺泡内气体,从而减少呼气频率和增大患者肺内潮气量.深呼吸法则可增加患者肺泡通气量与肺活量,改善由于吸入气体分布不匀状态以及低氧现象,提高气体交换效能.     

靶控输注异丙酚与吸入异氟醚-笑气复合硬膜外阻滞联合全麻的比

硬膜外阻滞联合全麻具有明显减少全麻药用量 ,减轻术中应激反应 ,苏醒迅速和术后镇痛便利等优点已被临床广泛采用 ,但全麻药物以吸入麻醉药或静吸联合为主。随着环保意识的不断提高 ,如何避免或减少吸入麻醉药的环境污染越来越受到麻醉医生的重视。靶控输注 (TCl)静脉麻醉药技术的出现弥补了以往静脉麻醉药使用不方便、不易调控麻醉深度的缺点 ,使静脉麻醉药深浅能象吸入麻醉药用标准挥发罐调节一样简便。本研究旨在比较上腹部手术靶控输注异丙酚与吸入异氟醚 笑气复合硬膜外阻滞的麻醉效果 ,并结合麻醉深度监测探索上腹部手术中复合硬膜…     

麻醉机的快速检测方法简析

介绍了麻醉机的工作原理和检测方法,对其蒸发罐、回路气密性、快速供氧、氧笑联动等项目进行检查与检测,对潮气量、呼吸频率、呼气末正压、吸入氧浓度等呼吸参数的检测与调节作了说明,特别是对检测中应注意的问题作了重点提示。     

地氟醚和异氟醚对脑电图的影响

目的比较相同MAC浓度的地氟醚和异氟醚对脑电图的影响。方法20例20~50岁,ASAI~II级择期手术的病人,均不用术前药。麻醉诱导以静脉异丙酚2 mg/kg,琥珀胆碱2 mg/kg快速气管插管,单纯吸入地氟醚或异氟醚维持麻醉。控制呼吸,维持呼气末二氧化碳分压(PETCO2)在4.7~6.0kPa。以TOF临测肌松,维持T4/T1<25%。以双导联方式监测脑电变化,观察呼气末麻醉药浓度在0.5、0.8、1.0、1.3和1.5MAC时的脑电边缘频率(SEF)和双谱指数(B I)的改变。结果随MAC的增加SEF和B I逐渐减少,呈负性线性相关关系(r分别为-0.95和-0.99,P<0.01),2组间SEF和B I差异无统计学意义(P>0.05)。结论地氟醚对脑电图的影响与异氟醚相似;EEG对监测麻醉浓度有一定指导意义。     

选择性脊神经后根切断术的麻醉处理

目的:总结选择性脊神经后根切断术的麻醉处理经验.方法:病例12例,男7例,女5例,平均年龄11岁.麻醉诱导均采用咪唑安定0.2 mg/kg,异丙酚2.0 mg/kg,芬太尼3 ug/k,维库溴铵0.1 mg/kg.术中给予异丙酚3～4 mg/kg/h静脉维持,芬太尼、维库溴铵间断静脉注射,辅以0.5～1%异氟醚吸入.控制呼吸,潮气量8～10ml/kg,呼吸频率18～20次/分.术中监测气道压、潮气量、呼气末二氧化碳分压、血压、脉搏、氧饱和度.结果:12例病人神经根测试准确,顺利完成手术,术后恢复良好,无麻醉并发症.结论:该类手术均应选择气管内静脉吸入复合麻醉,术中加强对呼吸、循环功能的监测,避免麻醉期间患儿躁动造成脊髓及脊神经根的损伤.     

浅谈肛肠全身麻醉分析

肛肠科手术均可在局部麻醉或椎管内麻醉下完成,故全身麻醉不是首选的麻醉方法。对肛肠手术全麻适应证患者根据全麻药进入人体的途径不同,全麻可分为吸入麻醉和非吸入麻醉两大类。吸入麻醉有可控性强、较为安全的优点。静脉麻醉是直接将静脉全麻药注入静脉血中,与吸入麻醉相比,具有用药简单便捷,诱导迅速平稳,无呼吸道刺激,患者舒适等优点,所以对一般无须呼吸控制的肛肠手术极为适宜。     

丙泊酚复合瑞芬太尼静脉麻醉在腹腔镜手术中的应用

目的 评价丙泊酚靶控输注复合瑞芬太尼微量泵持续输注全凭静脉麻醉术中血流动力学变化和术后苏醒过程.方法 ASA Ⅰ～Ⅱ级择期腹腔镜手术患者30例,随机分为两组.两组均以咪唑安定0.05 mg/kg、维库溴铵0.1 mg/kg、丙泊酚1.5 mg/kg、瑞芬太尼1.5 μg/kg诱导后气管插管.麻醉维持:全凭静脉麻醉组(A组,n=15)采用丙泊酚靶控输注,设定靶浓度2.0～2.5 μg/ml;静吸复合麻醉组(B组,n=15),吸入七氟烷,维持呼气末浓度为1.3%左右;瑞芬太尼两组输注方法相同,微量泵持续注入0.25 μg/ (kg·min).所有药物术毕停用.记录诱导前、CO2气腹前、CO2气腹后10 min、30min、苏醒期血压、心率.观察术毕停药后患者自主呼吸恢复时间、呼之睁眼时间、拔管时间;术后恶心、呕吐和术中知晓发生率.结果 (1)A组CO2气腹前后相比较及苏醒期与诱导前相比较,血压、心率无显著性变化;B组气腹后10 min SBP、DBP较气腹前有显著升高(P<0.05),苏醒期血压、心率较诱导前有显著升高(P<0.01).(2)两组自主呼吸恢复时间、呼之睁眼时间差异无统计学意义,拔管时间A组显著快于B组(P<0.05).(3)术后恶心、呕吐发生率差异无统计学意义,两组均无术中知晓.结论 与静吸复合麻醉相比,丙泊酚与瑞芬太尼联合输注全凭静脉麻醉血流动力学更稳定、苏醒迅速、苏醒质量更高.     

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.