肝蒂阻断联合低中心静脉压技术在肝右叶癌切除术中的应用

目的 探讨肝蒂阻断联合低中心静脉压技术对肝右叶癌切除术中出血量及术后肝肾功能的影响.方法 2006年12月至2008年6月施行肝右叶癌切除术的患者48例,随机分为低中心静脉压(CVP)组(LCVP组,23例)和常规手术组(对照组,25例).LCVP组切肝时经药物处理使CVP<5 mm Hg(1 mm Hg=0.133 kPa)、收缩压≥90 mm Hg,对照组则按常规手术处理.比较两组术中出血量、术后住院时间、术后肝肾功能的变化及术后并发症.结果 LCVP组和对照组术中出血量分别为(326.67±109.13)ml和(538.33±177.07)ml,LCVP组明显低于对照组(P<0.01);LCVP组术后住院时间为(8.52±1.78)d,对照组为(9.40±1.68)d,两组比较差异有统计学意义(P<0.05).结论 在肝右叶癌切除术中,肝蒂阻断联合低CVP技术可以有效地减少术中出血量,缩短术后住院时间,且对患者肝肾功能无损害.     

低中心静脉压用于减少腹腔镜肝叶切除术中的出血量

目的研究控制性低中心静脉压技术能否减少腹腔镜肝叶切除术中的出血量,并评价此技术对肾功能的影响。方法40例行腹腔镜肝叶切除术的患者,随机分为对照组和低中心静脉压(LCVP)组,采用静吸复合全麻。LCVP组通过切肝前控制输液量和微泵静注硝酸甘油将CVP控制<5mmHg。观察两组病人术中失血量、输血量、切肝前输液量、收缩压和术后24h肾功能的变化。结果LCVP组术中失血量、输血量、切肝前输液量和收缩压均低于对照组(P>0.05);术后24h两组患者肾功能的变化无显著性差异(P>0.05)。结论LCVP可明显减少腹腔镜肝叶切除术中的失血量和输血量,对肾功能无明显影响。     

右美托咪定对全麻下老年骨科手术患者苏醒期躁动及认知功能的影响

目的探讨右美托咪定对全麻下老年骨科手术患者苏醒期躁动及认知功能的影响。方法按随机数字表法将于我院行全麻下老年骨科手术的患者80例分为两组,每组各40例,对照组在麻醉前给予0.9%氯化钠注射液,研究组麻醉前给予右美托咪定。比较两组术后苏醒时间、苏醒期躁动发生率及认知功能。结果研究组苏醒时间为(19.64±5.08)min,低于对照组的(34.79±5.86)min(P0.05);研究组苏醒期躁动发生率明显低于对照组(P0.05);研究组简易精神状态评价量表(MMSE)评分高于对照组(P0.05);研究组术后7天认知功能障碍发生率明显低于对照组(P0.05)。结论右美托咪定可缩短全麻下老年骨科手术患者术后苏醒时间,降低苏醒期躁动发生率,减轻认知功能受麻醉的影响。     

全凭静脉麻醉对比吸入麻醉对老年患者术后认知功能的影响

目的:分析全凭静脉麻醉、吸入麻醉对老年患者术后认知功能的影响.方法:本次老年患者从我院2013年5月-2015年12月抽选,按入院编号顺序分成不同麻醉组:44例对照组给予吸入麻醉,44例研究组给予全凭静脉麻醉,统计术后效果.结果:研究组的苏醒时间为(16.10±5.65)min,拔除导管时间为(11.65±4.40)min;对照组的苏醒时间为(30.96±11.42)min,拔除导管时间为(18.49±7.36)min,两组统计有区别,P<0.05.结论:临床给予老年患者全凭静脉麻醉作用突出,可预防并发症,增强认知功能,值得学习.     

全身麻醉和腰硬联合麻醉对老年骨科患者术后短期认知功能的影响

目的:分析全身麻醉比较腰硬联合麻醉应用在老年骨科患者中对术后短期认知功能的影响。方法:择本院2016年10月-201 7年10月收治103例骨科手术老年病患资料,抽签式分研究组(60例),对照组(43例);研究组为腰硬联合的麻醉方式,对照组是全身麻醉的方式,研究两组应用影响。结果:麻醉24h后研究组MMSE为(29.63±0.75)分,比对照组(21.31±0.49)分高(P0.05);苏醒时间比较,对照组(15.36±2.01)min比研究组(4.10±1.64)min长(P0.05)。结论:腰硬联合麻醉比全身麻醉对老年骨科患者术后短期认知功能的影响小,可推广。     

静吸复合麻醉与单纯静脉麻醉对老年子宫肌瘤腹腔镜切除术患者认知功能及应激指标影响

目的:探讨静吸复合麻醉与单纯静脉麻醉对子宫肌瘤腹腔镜切除术对老年患者认知功能及应激指标影响。方法:本院2018年1月30日—2019年5月30日行腹腔镜下子宫肌瘤切除术的100例老年患者,年龄≥65岁,随机数表法分为复合麻醉组(接受静吸复合麻醉)和单纯麻醉组(接受单纯静脉麻醉),每组50例。监测麻醉诱导前即刻(T0)、建立气腹前(T1)、建立气腹后(T2)、术后24h(T3)的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)。观察并比较两组苏醒指标及手术指标、不良反应发生情况。检测两组患者术后24h后外周血SOD、MDA水平。评估患者认知功能。结果:两组患者T0、T1、T2、T3时刻HR、MAP、CVP无差异,苏醒指标(苏醒时间、定向力恢复时间、恢复自主呼吸时间)及手术指标(手术时间、术中出血量)无差异(均P>0.05)。复合麻醉组术后24h SOD水平高于单纯麻醉组,MDA低于单纯麻醉组(P<0.05)。拔管后1h、6h,复合麻醉组认知功能评分高于单纯麻醉组(P<0.05)。两组不良反应发生率(4%、4%)无差异(P>0.05)。结论:静吸复合麻醉可改善腹腔镜老年子宫肌瘤切除术患者认知功能及氧化应激水平,且不影响血流动力学,安全性高。     

静脉麻醉与吸入麻醉对老年冠状动脉疾病患者术后心脏功能的影响

目的探讨静脉麻醉与吸入麻醉对老年冠状动脉疾病患者术后心脏功能的影响。方法对2016年1月—2016年12月接受手术治疗的老年冠状动脉疾病患者78例,随机分为两组,分别予以静脉麻醉(静脉组39例)和吸入麻醉(吸入组39例),对比两组不良心血管事件发生情况、苏醒时间,采用简易精神量表(Mini-Mental State Examination,MMSE)评价两组认知功能。计数资料比较采用χ~2检验,计量资料比较采用t检验,P0.05为差异有统计学意义。结果吸入组心血管事件发生率7.69%、苏醒时间(19.45±4.03)min低于静脉组[23.08%、(23.57±4.76)min],两组比较差异有统计学意义(均P0.05)。治疗后吸入组的MMSE评分(32.75±2.08)分较静脉组(27.43±2.43)分更高,比较差异有统计学意义(P0.05)。结论吸入麻醉能降低老年冠状动脉疾病患者术后不良心血管事件的发生率,缩短苏醒时间,促进术后认知功能恢复。     

Narcotrend监测下七氟醚为辅佐用于老年患者全麻诱导的临床研究思路

目的：对Narcotrend监测下七氟醚用于老年患者全麻诱导的临床效果进行研究。方法将我院80例ASAI-III级于全麻下进行手术的老年患者分为实验组和对照组,实验组40例,实验组采用Narcotrend监测七氟醚的吸入量,对照组全凭患者吸入。对比两组的麻醉诱导时间、持续时间、苏醒时间,以及麻醉结束后的呼气未稳态、脑电电测指数以及七氟醚用量。结果实验组患者的麻醉诱导时间为（0.79±0.11）min苏醒时间为（31.4±7.90）min,对照组分别为（0.88±0.12）min与（30.8±9.4）min,实验组对照组患者有明显缩短,呼气未稳状态明显低于对照组,脑电监测指数明显高于对照组,七氟醚用量明显少于对照组, P〈0.05,差异具有统计学意义。结论 Narcotrend应用于老年患者全麻诱导过程中能够准确控制七氟醚吸入量,有效减少七氟醚用量,以免出现过度麻醉现象。     

全凭静脉麻醉与静吸复合麻醉对老年患者术后认知功能影响的比较

目的观察和分析全凭静脉麻醉与静吸复合麻醉对老年患者术后认知功能产生的影响。方法选择50例于2012年4月--2013年7月间在我院进行手术治疗的老年患者资料进行研究和分析、将患者分为对照组和观察组两组，每组各有25例患者，对观察组患者进行丙泊酚、瑞芬太尼静脉泵注维持麻醉，对对照组患者进行浓度为1％。2．5％的异氟烷吸人复合芬太尼静脉推注维持麻醉，比较和分析两组患者的麻醉效果。结果对照组患者的术后苏醒时间为（31．2±9．8）min，观察组患者的术后苏醒时间为（17．5±7．9）min，两组患者术后苏醒时间差异具有统计学意义（P〈0．05）。两组患者术前以及术后24hMMSE评分差异不具有统计学意义（P〉0．05），术后1、3、6hMMSE评分差异均具有统计学意义（P〈0．05）。结论对老年患者全凭静脉麻醉能够缩短患者的术后苏醒时间，加快患者认识功能的恢复速度。     

全凭静脉麻醉与静吸复合麻醉对胃肠肿瘤患者术后认知功能的影响

目的探究全凭静脉麻醉与静吸复合麻醉对胃肠肿瘤患者术后认知功能的影响。方法选择2015年11月—2017年1月本院收治的胃肠肿瘤切除手术患者80例作为研究对象,随机分为对照组和观察组各40例。对照组患者给予静吸复合麻醉,观察组予以全凭静脉麻醉,比较两组患者手术前后认知功能及拔管时间、呼吸恢复时间、苏醒时间。计量资料采用t检验,P0.05为差异有统计学意义。结果对照组患者拔管时间、呼吸恢复时间及苏醒时间分别为(21.26±5.67)、(15.64±3.67)、(32.12±10.31)min,观察组分别为(17.64±4.61)、(13.26±3.14)、(18.89±8.64)min,两组相比差异均有统计学意义(均P0.05)。手术结束后1 h,对照组患者注意力、定向力、语言能力及行为能力评分分别为(4.97±0.98)、(4.47±0.32)、(4.61±0.13)、(4.53±0.46)分,均低于观察组的(5.94±0.78)、(5.46±0.67)、(5.34±0.63)、(5.23±0.32)分,差异均有统计学意义(均P0.05)。结论全凭静脉麻醉可有效改善胃肠肿瘤患者术后认知功能障碍,缩短其术后拔管时间、呼吸恢复时间及苏醒时间,提高患者生活质量,值得临床推广与应用。     

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.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

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.     

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.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.