电切镜术中纵隔气肿两例

<正>例1,患者,男,63岁,64kg。因"前列腺电切术(TURP)后2周血尿"入院,术前诊断为:TURP术后;膀胱内血凝块;尿潴留。急诊入手术室拟行电镜下血肿清除术。入室BP180/110mm Hg,HR 130次/分,SpO297%,静注咪达唑仑2mg、芬太尼0.15mg、顺式阿曲库铵9mg、丙泊酚160mg行麻醉诱导,经口明视下插入ID 7.0气管导管,固定深度距门齿22cm,听诊双肺呼吸音清,双侧对称,插管顺利,行机控通气,RR 12次/分,VT500ml,I∶E为1∶1.5,气道峰压为19mm Hg,PETCO232mm Hg,术中间断给予芬太尼、顺式阿曲     

呼吸运动对肺部肿瘤靶区受照剂量分布影响的研究

Objective To investigate the influence of respiratory motion on target dose distribution in radiotherapy for patients with lung tumors. Methods The Big Bore Brilliance CT with bellows system was used to gain the 4DCT sets and respiratory frequency information of the patients. The moving ranges of the tumors in left-right (LR), anterior-posterior (AP) and cranial-caudal (CC) directions were measured from the center coordinate values of gross tumor volume of ten time-phase CT sets in the treatment planning sys-tem. Then a breathing model was used to simulate the tumor motions due to respiration. A 4-dimensional motion table was used to mimic the motion of lung tumor in beams-eye-view (BEV). A 2-dimensional semi-conductor beams measurement system was fixed to the table to measure the 2-dimensional dose distribution of static and dynamic targets using the treatment beams at gantry angle of 0°. Finally, the differences of the dose distribution between the static and moving phantom were compared and analyzed with the statistical soft-ware R. Results When the amplitude (half of the moving rang) in the CC direction was 1 cm, the passing ratio of relative dose difference ≤4% in one beam field was minimal (1.1%), and there was 58% maximal relative dose absence. The 4% passing ratios media in the CC direction were 94.7%, 79.4%, 58.6% and 37.1% in <0.25, 0.25-<0.50, 0.50- <0.75 and ≥0.75 mm amplitude (X<'2>=29.20,P=0.000), but were all similar in the AP and LR directions. The mean value of the relative dose change in the high dose area was smaller than the low dose area in the 89% beam fields. When only the CC direction was consid-ered, the 4% passing ratio of 3.6 s and 8.2 s period was 72% and 60%, respectively. Conclusions The amplitude in the CC direction is a factor impacting the dose distribution of the moving target. The influence of respiratory motion on high dose area is more than that on low dose area. When the other respiratory param-eters are fixed, the motion of long period has more influence on the dose than that of short period. Special at-tention should be paid to the patients with tumor of more than 0.5 cm amplitude in the CC direction when planning the intensity modulated radiotherapy.     

阿米卡星不良反应

阿米卡星为氨基糖苷类抗生素，具广谱抗菌活性，临床应用很广。近年来国内有文献报道其不良反应．现综述如下。     

帕金森病疾病经济负担及相关因素的调查研究

帕金森病（Parkinson disease,PD）主要发生于65岁以上老年人群,近期的一项调查显示我国65岁以上人群PD患病率接近1.7%,与西方国家接近,但由于我国绝对人口众多,因此在我国至少有约200万PD患者,远远超过欧美主要国家PD患者人数的总和.由于PD目前尚无法根治,需要长期的药物治疗,并且随着病程还会出现不同程度的并发症,因此不仅给患者本人的健康带来了严重的危害,也给其家庭乃至整个社会带来了沉重的经济负担.然而迄今我国还未见关于PD经济负担的报道.为了更准确地了解我国PD经济负担的现状,为制定相关卫生经济政策和疾病防治策略提供基础依据,我们对上海市201例PD患者的经济负担情况进行了调查研究.     

六味安消治疗糖尿病胃轻瘫33例的疗效观察

目的 观察六味安消治疗糖尿病胃轻瘫的临床疗效及护理体会.方法 将我院收治的糖尿病胃轻瘫患者33例作为观察对象,给予六味安消口服,4周后观察.结果 显效24例,有效6例,无效3例,总有效率90.9%.结论 六味安消治疗糖尿病胃轻瘫疗效显著且用药安全.     

麻醉诱导药物用于支撑喉镜下声带息肉摘除262例

目的 观察复合应用静脉麻醉药在声带息肉摘除术中的协同作用。方法 选择262例支撑喉镜下声带息肉摘除术的完整病例进行分析。结果 起效迅速．心血管反应较轻，苏醒快，术后无知晓存在。结论 咪唑安定复合芬太尼、异丙酚、氯化琥珀胆碱用于支撑喉镜下声带息肉摘除术，是一种安全、经济、有效的麻醉方法。     

糖尿病性视网膜病变

长期以来，由于胰岛素的发现和应用、各种降血糖药物的陆续问世、以及广泛使用各种抗生素，糖尿病因急性并发症和合并感染而死亡的人数大大减少，患者的寿命得以延长，但糖尿病慢性并发症的发病率相应增加。糖尿病性视网膜病变（Diabetic Ratinopathy，DR）是糖尿病最常见并发症之一，是致盲的主要原因。本文就糖尿病性视网膜病变的发病机理、临床特点、诊断及鉴别诊断阐述如下。     

护理硕士专业学位研究生教育质量评价框架的构建及权重分析

目的:构建护理硕士专业学位（MNS）研究生教育质量评价框架并确定各指标权重。方法:以学生发展理论为研究框架，通过文献回顾、半结构化访谈、小组讨论及专家函询构建MNS研究生教育质量评价框架；运用层次分析法对MNS研究生教育质量评价框架进行指标权重分析。结果:2轮专家函询问卷有效回收率分别为92.31%和100.00%，专家个人权威系数为0.775～0.875，群体权威系数分别为0.817和0.825；专家函询肯德尔协调系数为0.244～0.369（均P<0.05）。最终形成的MNS研究生教育质量评价框架中，应届毕业生版包括3个一级指标、6个二级指标、18个三级指标；往届毕业生版包括4个一级指标、8个二级指标、25个三级指标。MNS研究生教育质量评价框架中应届毕业生版一级指标中相对权重最高的是“过程质量”（0.608 0），其次为“输出质量”（0.272 1），“输入质量”最低（0.119 9）。结论:构建的MNS研究生教育质量评价框架具有科学性，其内容系统、全面，可为MNS研究生教育质量评价提供新思路。