抢救危重病人的心血管循环反馈治疗仪及动物实验

目的 国内外医疗仪器的发展正朝着自动化、智能化、模块化方向发展，但主要集中于诊断方面，用于治疗仪器极少，设计原理及工作程序 心血管循环反馈治疗仅是综合临床上的丰富成功经验设计研制的，其程序结合实验中的数学模型汇编而成，通过在线闭环自动检测，直接、快速、连续、高密度地采集血压，肺毛细血管契压（PCW）、心率等重要生理参数，经压力传感器、A/D转换卡实时连续地输入计算机，通过用户界面人机对话，由医生选择药物，经数学模型及程序的运算，D/A转换器输出指令经输液器来控制给药量，而药物在机体的反应又及时、迅速地经在线闭环自动检测系统反馈回计算机，计算机不断更新计算结果，以此调节给药的速率及剂量，此外该系统还具有监控、报警、故障白诊断、智能化运行等特点。实验结果 通过八只犬的实验表明，计算机取样及时、准确、快速，可以避免一些人为的误差以及取样间隔时间过长的不足，实验中给药结果证明能按照预期设计要求达到治疗目的，因此实用性强，高科技含量高，可以预测将来应用于临床抢救危重病人，可靠性、精确性将大大高于传统方法。讨论 传统的临床治疗方法从收集病人数据到决定准确的给药量反馈过程太长，还有不少人为及计算的干扰和误差，因此抢救成功率极低，动物试验中发现该系统从获取血压变化到多次反馈调整给药整个周期短（2-5min）、计算准确，疗效可靠。当某药无效则可以及时提示医生换药，为临床争取了时间，是一个很有发展前景的抢救危重病人的系统与仪器，目前该系统及仪器仍待进入临床评价。     

抢救危重病人的心血管循环反馈治疗仪及动物实验

目的国内外医疗仪器的发展正朝着自动化、智能化、模块化方向发展, 但主要集中于诊断方面,用于治疗仪器极少.设计原理及工作程序心血管循环反馈治疗仪是综合临床上的丰富成功经验设计研制的,其程序结合实验中的数学模型汇编而成,通过在线闭环自动检测,直接、快速、连续、高密度地采集血压, 肺毛细血管契压(PCW)、心率等重要生理参数,经压力传感器、A/D转换卡实时连续地输入计算机.通过用户界面人机对话,由医生选择药物,经数学模型及程序的运算,D/A转换器输出指令经输液器来控制给药量,而药物在机体的反应又及时、迅速地经在线闭环自动检测系统反馈回计算机,计算机不断更新计算结果,以此调节给药的速率及剂量.此外该系统还具有监控、报警、故障自诊断、智能化运行等特点.实验结果通过八只犬的实验表明,计算机取样及时、准确、快速,可以避免一些人为的误差以及取样间隔时间过长的不足.实验中给药结果证明能按照预期设计要求达到治疗目的.因此实用性强,高科技含量高,可以预测将来应用于临床抢救危重病人,可靠性、精确性将大大高于传统方法.讨论传统的临床治疗方法从收集病人数据到决定准确的给药量反馈过程太长,还有不少人为及计算的干扰和误差,因此抢救成功率极低.动物试验中发现该系统从获取血压变化到多次反馈调整给药整个周期短(2～5min)、计算准确,疗效可靠.当某药无效则可以及时提示医生换药,为临床争取了时间.是一个很有发展前景的抢救危重病人的系统与仪器,目前该系统及仪器仍待进入临床评价.     

闭环在线检测自动反馈控制系统医学模型研究

目的:抢救病人有一个给药量及速度问题,病人对药物反应反馈到医生或计算机分析系统,后者(控制器)做出调整用药及给药速率的决定与指令,从而获得最好治疗效果。原理:人体血压调节是一个具有负反馈的闭环控制系统,特点是系统被控对象的输出(被控制量)会反送回来影响调节器的输出,形成一个或多个闭环。这里调节器的传递函数采用PID。则函数方程为AS=KSt/t τ。结果与讨论:实际中采用应用最为广泛的调节器控制规律为比例、积分、微分控制,简称PID调节。其结构简单、稳定性好、工作可靠、按以上理论设计的仪器动物试验中发现该系统从获取血压变化到多次反馈调整给药整个周期短、计算准确,疗效可靠为临床争取了时间,是一个很有发展前景的抢救危重病人的系统。     

临床心血管反馈控制程序逻辑设计

心血管循环反馈程序通过在线闭环检测自动反馈控制程序系统并具有监控、报警、故障自诊断、智能化运行等特点.当前我们设计研制的程序是综合临床上的丰富成功经验,结合实验中的模型为数据汇编成程序.该程序既吸取了临床上已被证实了的最好经验,又可以利用计算机取样及时、准确、快速、精确等特点,同时还可以避免一些人为的误差,以及取样间隔时间过长等不足.其实用性强,高科技含量高,用它来抢救危重病人,可靠性、精确性均大大高于传统方法.     

采用腹膜透析术抢救流行性出血热的观察与护理

我院内科1998年收治流行性出血热17例,首次采用腹膜透析术抢救危重病人2例,成功1例,现将抢救成功1例的护理经验总结报告如下。 一、临床资料 患者,女,63岁,于1998年1月23入院,主诉:发热、头痛、腰痛、恶心、周身不适,在家抽搐一次入院,心率90次/分,血压4/OkPa。医嘱给予扩容,升压药静滴,血压9/6.6kPa,病情仍然危重,24、25日病人血压不稳(4.5～11.7)/(0～5.0)kPa,在升压药同用的情况下,血压仍不稳定,24日25日输入4000ml液体,     

颈外静脉套管针穿刺的临床应用

静脉输液及静脉给药是医院临床抢救和治疗病人的重要措施之一。如何及时、准确地为病人建立静脉通路是医务人员重要技术操作之一。在临床中采用颈外静脉套管针穿刺置管的方法，由于穿刺的方法容易掌握，穿刺成功率较高，既可减轻病人反复多次穿刺的痛苦，又能使输液更为方便快捷，减轻了医务人员的重复劳动，受到医务人员及患者的认可。     

静脉留置针常见并发症的分析及对策

静脉输液是临床常见的操作技术及重要的给药途径．脉留置针等于保留一条开放的静脉通路，可保护血管，对抢救危重病人有重要意义．然而，静脉留置针若使用不当，会发生渗液、静脉炎以及堵管等并发症．     

临床使用静脉留置针的护理体会

静脉留置针又称套管针,由于其操作简单,减轻了反复穿刺给病人造成的痛苦,广泛应用于临床,尤其用于抢救危重病人和一日多次静脉给药的病人,我科于2006．2到2007．2应用212例,取得了满意效果。     

静脉留置针在急危重病人中的应用及护理体会

外周静脉留置针又称套管针,其导管柔软,管径粗,作为头皮针的换代产品,已于40年前在欧美国家普及使用,15年前亚洲一些比较发达的国家地区也已取代头皮针.近几年来,国内一些医院已相继在临床治疗中广泛应用,既解决了患者反复穿刺的痛苦,又减轻了护士的护理工作量,尤其对于急危重病人的抢救,静脉留置针的使用,使迅速、准确的用药成为抢救病人生命不可代替的关键所在.当患者烦躁或变换体位时,静脉留置针不易滑脱和损伤血管,而且同延长管和三通相连接时,方便了给药,给急危重患者的抢救和休克病人输血补液提供了有效的治疗通道;为患者提供了中期至长期的静脉治疗通道.现将临床使用的体会和经验总结如下:     

儿科静脉留置针的操作技巧

静脉输液是儿科护理中最常见_的给药方式及护理技术操作,留置针作为头皮针的换代产品,静脉留置针操作简单方便,安全,减少了病人由于反复穿刺而造成的痛苦,减轻病人经济负担,成功保留留置针,有利于临床用药和紧急抢救,对于危重患儿的抢救具有重要意义.     

Two modes of error processing in reaching

Several processes are devoted to error reduction for the production of purposeful actions. When motor responses deviate from their goal, online corrections can be performed either under voluntary control with additional sub-movements or under fast automatic control with smooth velocity profiles. When errors cannot be corrected online and are repeated over trials, subsequent responses can be improved iteratively through adaptation, a progressive adjustment of motor commands that acts to reduce the magnitude of error. It has been argued that reaching adaptation results essentially from a conflict between actual sensory feedback and expected sensory feedback. Here, we specifically compare two innovative hand-reaching paradigms that provide the subject with undistorted hand sensory feedback. Both paradigms induce motor planning errors unknown to the subjects. Experiment 1 yields a continuous retinal and visuomotor feedback which allows fast and complete automatic online corrections. In experiment 2, all visual feedback is eliminated during movement execution. This prevents online correction and provides information on hand-to-target visual error at movement end only. Despite a reiterated motor planning error and an automatic online correction of the whole error, experiment 1 shows a complete lack of adaptation. In contrast, experiment 2 which yields the same motor planning error exhibits a robust and generalized adaptation, although devoid of limb inter-sensory mismatch. These results demonstrate independence between the induced motor adaptation and automatic online correction, both characterized by the lack of any cognitive interference. Despite these quite different processes acting upon either motor planning or motor control, the general structure of the movement kinematics remains unaltered. A putative visuomotor cerebro-cerebellar network accounting for our results is proposed.     

Predictive information processing in the brain: errors and response monitoring

The monitoring of one's own actions is essential for adjusting behavior. In particular, response errors are important events that require behavioral adjustments. Correct and incorrect responses, as well as feedback to responses, are followed by brain activity originating mainly in the anterior cingulate, which can be measured with fMRI and event-related potential (ERP) techniques. After each response a small negativity (Nc or CRN) is elicited in the ERP, which is strongly enhanced in incorrect trials (Ne or ERN). Following feedback stimuli that signal a negative outcome of an action, a similar negativity, the feedback-related negativity (FRN) is elicited. Recently it has been shown that these neurophysiological correlates of response monitoring and evaluation can be classified even on the single-trial level in the EEG and thus could be utilized not only to distinguish between correct and erroneous actions, but also can be used online for a wide range of applications such as prediction of clinical outcomes or brain computer interfaces.     

软组织厚度自动测量器械的设计与实验研究

目的研究自动测量软组织厚度的关键技术,设计一种自动测量组织厚度的器械,通过实验验证其可行性及准确性。方法设计测厚实验系统,采用直流减速编码器电机实现对测量结构的反馈和控制,按照结构内部的传动关系建立主从运动量间的关系式,即电机转轴转动圈数与器械前端所夹组织厚度的关系,从而实现测厚功能。根据实验组与对照组的结果分析测试实验系统的误差与分布情况。结果 9组实验共产生27对厚度数据,其误差平均值为-0.07 mm,方差为0.03 mm2。按实验次数分组,其组内误差波动较小;按厚度值分组,其组内误差波动较大。结论采用该器械测量厚度是可行的,但还存在一定误差;实验批次决定了器械测量的初始位置,对测量结果影响较大;不同厚度值对应器械前端不同的开口角度,对测量结果影响较小。     

Digital thromboelastometer

Conclusions 1. The thromboelastometer saves the investigator from spending time on interpreting time diagrams and completely eliminates the introduction of subjective errors into the measurement results. 2. The digital output of the thromboelastometer is equally acceptable both for visual reading of the measurement results and for automatic documentation or input of data into a diagnostic computer complex. 3. The use of standard elements in the computer logic circuit of the instrument meets the requirements of unification in instrument manufacture and reduces the cost of its manufacture. Dnepropetrovsk Medical Institute. Translated from Meditsinskaya Tekhnika, No. 4, pp. 47–50, July–August, 1970.     

Continuous non-invasive blood pressure monitoring using concentrically interlocking control loops

A new method and apparatus for non-disruptive blood pressure (BP) recording in the finger based on the vascular unloading technique is introduced. The instrument, in contrast to intermittent set point readjustments of the conventional vascular unloading technique, delivers BP without interruptions, thus refining the Penáz' principle. The method is based on concentrically interlocking control loops for correct long-term tracing of finger BP, including automatic set point adaptation, light control and separate inlet and outlet valves for electro-pneumatic control. Examples of long-term BP recordings at rest and during autonomic function tests illustrate the potential of the new instrument.     

白鼠活动自动测试系统

本文介绍一种由红外光电传感器阵列和二级计算机网组成的白鼠活动自动测试系统。该系统设计新颖，灵敏度高，响应快，能实时测试几十只白鼠一周的活动规律，并根据对生命节律现象研究要求和中医药特点进行数据处理，输出相应的曲线、表格。本系统还充分考虑了白鼠活动的特点以及喂养方面的要求，采用模块化结构，使拆卸、安装、清洗都非常方便。本系统已应用于北京中医药大学的生命节律研究。     

The Regulation of Blood Pressure Reactions to Taxing Conditions using Pulse Transit Time Feedback and Relaxation

Two experiments are described in which 40 normotensive subjects were trained to reduce blood pressure (BP) both in undistracting conditions and while performing taxing tasks. Biofeedback was compared with relaxation in each case, and BP was continously monitored by the pulse wave velocity method. In Study 1, feedback and relaxation groups produced similar BP reductions when control was attempted in isolation. However, the relaxation group was significantly disturbed during performance of an auditory choice reaction time (RT) task. In contrast, feedback subjects showed identical BP modifications in the two conditions. In Study 2, the differences during the RT task proved to be short lived. However, the feedback group overcame pressor reactions to a mental arithmetic test more rapidly than could relaxation subjects, and the difference between groups persisted during no-feedback trials. In both studies, modifications were more specific in the feedback condition, since alterations in heart rate, respiration and general activity were less prominent. It is suggested that it may be fruitful to use feedback for training people to overcome BP reactions to taxing conditions, rather than trying to modify tonic level alone.     

Computer-assisted hand-held dynamometer: low-cost instrument for muscle function assessment in rehabilitation medicine

In rehabilitation medicine, muscle function is assessed during the physical examination of the patient. Although a simple hand-held instrument improves the assessment of static strength, it is rarely used in clinical practice, where dynamic measurements are preferred. A computer-assisted hand-held dynamometer (CAHNDY) has been developed that enables the clinician to measure dynamic muscle function in a standardised manner, using simple (i.e. portable and low-cost) apparatus. The CAHNDY comprises a force transducer and a movement transducer interfaced to a personal computer. In the study dynamic measurement protocols are used, based on a biomechanical analysis of daily activities. In this way, iso-functional profiles can be established, describing the kinematics of muscle function in its functional context. Using the iso-functional profiles as a basis for standardisation, the double feedback algorithm of the CAHNDY assists the tester in meeting this standard, during maximal muscle function testing. In a multi-centre trial, the CAHNDY is evaluated by physical therapists for knee extensor and flexor function. The CAHNDY enables iso-functional dynamic muscle function testing, although application is limited by the maximal strength of the tester. It is concluded that the CAHNDY is suitable for use in rehabilitation medicine.     

Online and post-trial feedback differentially affect implicit adaptation to a visuomotor rotation

Multiple motor learning processes can be discriminated in visuomotor rotation paradigms. At least four processes have been proposed: Implicit adaptation updates an internal model based on prediction errors. Model-free reinforcement reinforces actions that achieve task success. Use-dependent learning favors repetition of prior movements, and strategic learning uses explicit knowledge about the task. The current experiment tested whether the processes involved in motor learning differ when visual feedback is altered. Specifically, we hypothesized that online and post-trial feedback would cause different amounts of implicit adaptation. Twenty subjects performed drawing movements to targets under a 45° counterclockwise visuomotor rotation while aiming at a clockwise adjacent target. Subjects received visual feedback via a cursor on a screen. One group saw the cursor throughout the movement (online feedback), while the other only saw the final position after movement execution (post-trial feedback). Both groups initially hit the target by applying the strategy. After 80 trials, subjects with online feedback had drifted in clockwise direction [mean direction error: 15.1° (SD 11.2°)], thus overcompensating the rotation. Subjects with post-trial feedback remained accurate [mean: 0.7° (SD 2.0°), TIME × GROUP: F = 3.926, p = 0.003]. We interpret this overcompensation to reflect implicit adaptation isolated from other mechanisms, because it is driven by prediction error rather than task success (model-free reinforcement) or repetition (use-dependent learning). The current findings extend previous work (e.g., Mazzoni and Krakauer in J Neurosci 26:3642–3645, 2006; Hinder et al. in Exp Brain Res 201:191–207, 2010) and suggest that online feedback promotes more implicit adaptation than does post-trial feedback.