双频谱指数在心脏瓣膜置换术中的观察

目的应用脑电双频谱指数(BIS)监测常规经验麻醉下瓣膜置换术病人的麻醉深度(意识水平),观察BIS在伤害性刺激时的变化.方法选择30例瓣膜置换术病人,采用芬太尼、咪唑安定、哌库溴铵及心血管活性药物对病人实施麻醉;术中监测并有专人分别记录入室(基础值)、诱导后、插管后、切皮后、锯胸骨时、缝胸骨时及术毕BIS和MAP,HR各参数值,观察不同阶段各参数的变化.结果诱导后各参数均明显降低,虽然切皮后、锯胸骨及缝胸骨等强刺激后MAP和HR未见统计学意义的显著改变,但BIS却显著增高(P＜0.01);全部病人锯胸骨时BIS均在60(67.28±8.97)以上,缝胸骨时63(68.46±8.70)以上,而无1例低于50者.结论该组瓣膜置换术病人麻醉偏浅,尤以锯胸骨、缝胸骨及术毕等时段为甚,表现为BIS值偏高,有知晓发生;知晓可发生在临床认为满意的麻醉中;应用BIS监测,可更加合理地评价麻醉深度.     

Liver Transplant Recipients Older Than 60 Years Have Lower Survival and Higher Incidence of Malignancy

Older age is not considered a contraindication for liver transplantation, but age-related morbidity may be a cause of mortality. Survival and the incidence of the main post-transplant complications were assessed in 111 adult liver transplant recipients. They were divided in two groups according to their age (patients younger than 60 years, n=54; patients older than 60 years, n=57) and both groups were compared. Older patients were more frequently transplanted for hepatitis C (p= 0.03) and hepatocellular carcinoma (p= 0.05) and their liver disease was less advanced (Child-Pugh and MELD scores were significantly lower; p=0.004 and p=0.05, respectively). After transplantation, older patients had a significantly lower survival (p=0.02). Higher age was independently associated with mortality (hazard ratio for each 10-year increase: 2.1; 95% confidence interval: 1.1- 4.0; p=0.02). The incidence of de novo neoplasia and nonskin neoplasia were higher in older patients (p=0.02 and p =0.007, respectively). Malignancy was the cause of death in one patient younger than 60 years and in 12 patients older than 60 years (p =0.002). In multivariate analysis, a higher age and smoking were independently associated with a higher risk of dying of de novo neoplasia. In conclusion, older liver transplant recipients have a significantly lower survival than younger patients. Malignancy is responsible for this decreased survival.     

急性心肌梗塞错误溶栓治疗12例分析

自1993年12月至1995年8月，对155例急性心肌梗塞（AMI）病人进行溶栓治疗，12例发生误溶(7．7％）。其中早期复极综合征4例，室壁瘤2例，心肌炎1例，心肌病1例，完全性左束支阻滞1例，间歇性左前分支阻滞互例，其它2例。本文分析了误溶病例与AMI的鉴别要点，并提出了减少误溶，提高诊疗水平的措施。     

高血压合并脑梗死患者血浆C-反应蛋白、纤维蛋白原及白细胞变化的研究

目的探讨高血压合并脑梗死患者急性期血浆C-反应蛋白(CRP)、纤维蛋白原(Fib)水平、白细胞(WBC)及分类计数的变化与高血压合并脑梗死的关系。方法将患者分为两组,高血压合并脑梗死组(68例)和单纯高血压组(65例),检测两组患者急性期血浆CRP、Fib和WBC水平。结果高血压合并脑梗死患者急性期CRP、Fib水平、WBC总数、中性粒细胞数均比单纯高血压患者明显增高(P＜0．01)。结论C-反应蛋白、纤维蛋白原和白细胞升高可能与脑梗死的发生和进展相关,抗炎治疗可能是脑梗死治疗的一个选择。     

Understanding the effects of a decentralized budget on physicians' compliance with guidelines for statin prescription – a multilevel methodological approach

Background  

Official guidelines that promote evidence-based and cost-effective prescribing are of main relevance for obvious reasons. However, to what extent these guidelines are followed and their conditioning factors at different levels of the health care system are still insufficiently known.     

Chronic Paroxysmal Hemicrania: Dissociation of the Pain and Autonomic Features

The case of a woman suffering from chronic paroxysmal hemicrania is presented. Most attacks were unilateral and recurred on the same side. On a few occasions, attacks were observed on the contralateral side. In addition, the patient reported some incomplete attacks on the usually symptomatic side with autonomic phenomena, but without pain. That "partial" attacks would exist has been suspected on theoretical ground. This is, however, the first time such attacks have been reported by a patient. Therefore, a double dissociation of the symptomatology seemed to exist: (1) a side shift of attacks, and (2) incomplete("partial") attacks. These unexpected findings occurred after two indomethacin treatment withdrawals. A possible central and "midline" origin of attacks or an indomethacin after-effect or both are discussed as a likely explanation for such a dissociation of symptoms and signs.     

高血糖对非胰岛素依赖型糖尿病患者红细胞（Ca~（2＋）－Mg~（2＋））－ATP酶的影响

为了解高血糖对非胰岛素依赖型糖尿病（ＮＩＤＤＭ）患者红细胞膜（Ｃａ２＋－Ｍｇ２＋）－Ａｒｐ酶的影响，采用改良的Ｈａｎａｈａｎ和Ｌｕｔｈｒａ法测定了红细胞膜（Ｃａ２＋－Ｍｇ２＋）－ＡＴＰ酶活性。结果表明，ＮＩＤＤＭ患者红细胞膜（Ｃａ２＋－Ｍｇ２＋）－ＡＴＰ酶活性降低，且与空腹血糖、糖化血红蛋白、果糖胺及红细胞变形指数呈负相关，后者与红细胞内Ｃａ２＋浓度呈正相关。说明（Ｃａ２＋－Ｍｇ２＋）－ＡＴＰ酶活性下降时，红细胞变形能力降低，可能与患者红细胞膜蛋白的过度糖化及细胞内Ｃａ２＋浓度的增高有关。     

Untersuchung zur Morbidität der indigenen Volksgruppen der Chiquitanos im südlichen Amazonasgebiet

The Chiquitano-tribe lives in the southern Amazonas region in Bolivia, remote from larger towns. A study (n=1514) on morbidity over an one year period (April 1995 till March 1996) and its relation to general and social medicine is given. Most frequently, childreh under 15 years and women in parity age (15–45 years) sought consultation (34,1 %, 42,7 %). Gastrointestinal, respiratoral and gynecological-obstetric diseases were predominant (22,4 %, 16,2 % and 15,7 %). In the dry season, common colds and respiratoral infections represented the major health problem. In the rainy season, infectious diarrhea diseases caused by polluted water as a consequence of extended floods were most frequent. Typical tropical diseases (malaria, Dengue fever, Chagas’ disease, leprosy a.o.) and socially caused diseases (AIDS, dependencies on drugs and alcohol, consequencies of crime) were rarely seen. With respect to severity, 55,8 % of the patients showed mild disorders. More serious diseases were observed in 39, 8 %. 4,6 % of the patients were diagnosed severly ill and needed hospitalization. Epidemiological data on general and social medicine of minorities in developing countries and their actual degree of medical care are important in a shrinking world. The data are useful to estimate medical needs and plan improvements to the health care system especially in rural areas.     

响洪甸放射性废物坑放射卫生学调查及评价

本文调查了一个铀水冶厂放射性废物坑的污染情况,发现该坑周围农田及坑附近淠史杭大灌渠水、泥等均受到不同程度污染。这表明,即使处理小型铀水冶厂的放射性废物,在选址、掩埋等各个环节也都应严格做到科学、合理,并且还要做好掩埋后的管理工作。