内镜保胆取石术与腹腔镜胆囊切除术治疗胆囊结石围手术期安全性的Meta分析

目的 系统评价内镜保胆取石术（EGPC）和腹腔镜胆囊切除术（LC）治疗胆囊结石的有效性及安全性。方法 计算机检索中国知网、万方数据、维普、PubMed、Embase、Web of Science和The Cochrane Library等,收集2000年1月－2022年6月关于EGPC和LC治疗胆囊结石的随机对照试验（RCT）,检索语言仅限于中文和英文。对获得的文献进行筛选、数据提取和质量评价,运用RevMan 5.4软件进行统计学分析。结果 22篇中文文献被纳入研究,共1 888例患者。与LC组比较,EGPC组术中出血量更少（MD = -12.88,95%CI：-16.29～-9.47,P = 0.000）,术后肛门排气时间更短（MD = -6.05,95%CI：-8.17～-3.93,P = 0.000）,术后下床活动时间更短（MD = -4.76,95%CI：-5.89～-3.62,P = 0.000）,术后并发症发生率更低（OR＾ = 0.25,95%CI：0.17～0.36,P = 0.000）,两组患者手术时间（MD = 1.79,95%CI：-5.02～8.59,P = 0.610）和住院时间（MD = -0.68,95%CI：-1.48～0.12,P = 0.100）比较,差异无统计学意义。结论 EGPC对于满足保胆取石指征的患者,具有一定的临床运用价值,但由于研究纳入文献质量较低,结论还不足以支持EGPC在治疗胆囊结石方面优于LC,有待下一步纳入高质量的RCT进行验证。     

基于单元的综合安全项目在复发性卵巢癌化疗患者安全用药中的应用

目的 探讨基于单元的综合安全项目在复发性卵巢癌化疗患者安全用药中的应用效果。方法 选取安徽省某三级甲等医院2个妇科病区,实施基于单元的综合安全项目指导下的复发性卵巢癌化疗药物安全用药管理,实施前后使用医院安全文化调查问卷、安全用药知信行水平调查问卷、复发性卵巢癌化疗药物理论知识考核和复发性卵巢癌化疗患者药物不良反应发生率进行效果评价。结果 实施后医院安全文化调查问卷中待改进区域的积极反应率较干预前有所改善（P<0.05）;实施后医护人员的安全用药知识、态度和行为水平以及理论知识考核得分均高于实施前（P<0.05）;实施后复发性卵巢癌化疗患者药物不良反应的发生率较实施前明显下降（P<0.05）。结论 基于单元的综合安全项目指导下的复发性卵巢癌化疗患者安全用药管理,有利于建立病区安全文化,提高医护人员安全用药水平,减少化疗药物不良反应的发生率。     

Staying awake – a genetic region that hinders α2 adrenergic receptor agonist‐induced sleep

How external stimuli prevent the onset of sleep has been little studied. This is usually considered to be a non‐specific type of phenomenon. However, the hypnotic drug dexmedetomidine, an agonist at α₂ adrenergic receptors, has unusual properties that make it useful for investigating this question. Dexmedetomidine is considered to produce an ‘arousable’ sleep‐like state, so that patients or animals given dexmedetomidine become alert following modest stimulation. We hypothesized that it might be more difficult to make mice unconscious with dexmedetomidine if there was a sufficient external stimulus. Employing a motorized rotating cylinder, which provided a continuous and controlled arousal stimulus, we quantitatively measured the ability of such a stimulus to prevent dexmedetomidine loss of righting reflex in two inbred strains of mice (C57BL/6 and 129X1). We found that whereas the C57BL/6 strain required a strong stimulus to prevent dexmedetomidine‐induced hypnosis, the 129X1 strain stayed awake even with minimal stimuli. Remarkably, this could be calibrated as a simple threshold trait, i.e. a binary ‘yes–no’ response, which after crossing the two mouse strains behaved as a dominant‐like trait. We carried out a genome‐wide linkage analysis on the F₂ progeny to determine if the ability of a stimulus to prevent dexmedetomidine hypnosis could be mapped to one or more chromosomal regions. We identified a locus on chromosome 4 with an associated Logarithm of Odds score exceeding the pre‐established threshold level. These results show that complex traits, such as the ability of a stimulus to reverse drug‐induced hypnosis, may have precise genetic determinants.     

清醒俯卧位通气在急性呼吸窘迫综合征患者中的应用进展

清醒俯卧位通气是在意识清醒患者中使用的一种辅助体位通气方式。清醒俯卧位通气能够显著改善急性呼吸窘迫综合征患者的氧合指数,降低气管插管率、病死率等。该文介绍了清醒俯卧位通气的定义、适应证、禁忌证、启动与终止时机、重点监测内容、并发症的预防与处理,并对应用过程中存在的护理难点进行总结并提出建议,以期为清醒俯卧位通气患者的护理提供参考依据,改善患者临床结局。     

Sural sensory nerve action potential,epidermal nerve fiber density,and quantitative sudomotor axon reflex in the healthy elderly

Introduction: Polyneuropathy evaluation in older patients is often challenging due to conflicting data regarding normative values for peripheral nerve testing. Methods: We characterized the results of sural nerve conduction studies, intraepidermal nerve fiber density (IENFD), and quantitative sudomotor axon reflex testing (QSART) in a prospective study of 50 healthy subjects aged ≥60 years. Results: Of the 50 subjects, 48 (96%) had an obtainable sural sensory nerve action potential (SNAP). Using quantile regression, we estimated the lower limit of normal (LLN) for sural amplitudes to be 3 μV for patients 60–70 years, 1 μV for those 70–74 years, and <1 μV (absent) for those ≥75 years of age. IENFD and QSART volume were reduced with advancing age, although IENFD was lower in men and QSART volume was lower in women. Conclusions: We propose that an absent sural SNAP in patients up to 75 years of age should be considered abnormal. Our findings also support age‐ and gender‐stratified normative data for IENFD and QSART. Muscle Nerve 49:564–569, 2014     

CRRT人力资源配置与使用现状调查

目的了解肾内科CRRT护理人力资源配置现状,为CRRT护士的合理配置提供依据。方法采用跟班实测的方法对肾内科连续性肾脏替代治疗(CRRT)护理小组护士进行责任岗位工时测量,计算护理工时、护士人数及工作量饱和度。结果 CRRT护理小组每周工时数665h;以14名护士(11名在岗,3名在他科轮转或延后到岗)计算工作量饱和度为83.4%,日常工作饱和度为85.8%。结论肾内科CRRT护士岗位设置合理,工作量饱满,护士人力暂时缺编2.5人,另3人应尽快到位,以缓解全体CRRT护士的工作压力。     

Changes of adiponectin and its receptors in rats following chronic renal failure

Objective: To investigate changes of adiponectin and its receptors (Adipo R) in rats following chronic renal failure. Methods: Male SD rats were randomly divided into two groups: control group and chronic renal failure (CRF) group. The CRF group were gavaged with adenine (300?mg/kg/d) for 4 weeks and the control group with drinking water. All rats were anesthetized at 2nd or 4th week and blood and urine samples were collected for detection of renal function, 24?h urine protein and adiponectin concentration. Renal tissues were also collected for HE staining, immunohistochemistry and RT-PCR screening. Results: Compared with control group, the serum concentrations of urea and creatinine, 24?h urine protein excretion in the CRF group were significantly higher at 2nd week and further increased at 4th week (p?0.05). The adiponectin levels in serum and urine in the CRF group were significantly higher than those of control group (p?0.01). The renal expressions of Adipo R1 and Adipo R2 in CRF group were also significantly increased compared to control group (p?0.01). The increased expressions of Adipo R1 and Adipo R2 were positively related to the adiponectin levels in serum, urine, and 24?h urine protein. Conclusion: The significant changes in expression of adiponectin and its receptors in rat CRF model could be an adaptive response that may provide the basis to understand pathological changes in chronic kidney disease.     

战(创)伤失血复合氰化物中毒对大鼠心功能的影响

目的观察战(创)伤失血复合氰化物中毒对大鼠心功能的影响。方法将成年SD大鼠随机分为假手术组、失血性休克组、氰化钾中毒组和失血性休克复合氰化钾中毒组,观察各组大鼠心肌线粒体超氧化物歧化酶(SOD)、丙二醛(MDA)和谷胱甘肽过氧化物酶(GSH-Px)活力的变化,采用生理信号采集系统记录大鼠心率(HR)、左心室收缩压峰值(mLVSP)和左心室压力上升最大速率(+dp/dtmax),采用生化分析法检测大鼠心肌酶谱天冬氨酸转氨酶、乳酸脱氢酶、肌酸激酶、肌酸激酶同工酶(AST、LDH、CK和CKMB)的活力变化。结果与氰化钾中毒组比较,失血复合氰化钾中毒组大鼠心肌中线粒体SOD、GSH-Px活力明显降低,MDA含量升高;大鼠心脏HR、mLVSP、+dp/dtmax和心肌酶谱活力变化明显异常。结论战(创)伤失血条件下氰化物对大鼠心脏功能的影响更为严重,需要进一步探索相应的防治措施。