婴幼儿头皮静脉输液时体位安置分析

目的 探讨婴幼儿头皮静脉输液时切实可行的体位.方法 将240例门诊输液患儿随机分为家长怀抱式输液组、背兜式静脉输液组和自由式输液组各80例.结果 与背兜式静脉输液组和自由式输液组相比,家长怀抱式输液体位更容易被家长接受,患儿输液肿胀、脱针率最低(8.75％),差异均具有统计学意义(P＜0.01).结论 家长怀抱式输液体位优于背兜式静脉输液组和自由式输液组.     

组长负责量化考核模式在儿童输液室中的应用

目的 利用现有人力资源,建立组长负责量化考核模式,减少护理缺陷与护理纠纷,提高儿童输液室护理质量.方法 制订量化考核标准,实施组长负责管理模式,通过考核,将结果进行分析、反馈.结果 实施前后护理质量、患者对护士的满意度、医生对护士的满意度差异有统计学意义（P〈0.05）.结论 组长负责量化考核模式的实施,是保证护理质量,提高患儿及家长满意度的有效措施,值得借鉴.     

秦皇岛市中老年人不同职业高血压患病率及相关因素调查

目的通过对秦皇岛市不同职业中老年人高血压患病率及相关因素调查,探讨中老年人高血压及易患因素的特点及不同职业高血压患病率差别,以便制定合理的防治措施。 方法采用整体随机抽样方法,选择一居民委员会、一所学校、2个自然村及机关、工厂及机关干部,按WHO标准进行血压测量,并对一些相关危险因素进行问卷调查。 结果秦皇岛市中老年高血压患病率为38.45%,其中干部患病率为47.61%,工人为36.30%,教师为28.68%,农民为24.50%。 结论秦皇岛市中老年不同职业患病率有明显差异,患病相关危险因素调查结果与超重、家族史、高血脂、高盐饮食有明显关系。     

止痒乳膏的制备及应用

介绍止痒乳膏的制备、质量控制、用途及疗效。     

移植细胞实现肝脏有效再殖的机制研究

细胞移植是目前代替原位肝移植治疗终末期肝脏疾病最具可行性的方法。然而由于细胞来源、移植细胞植入受体肝脏效率低、增殖缓慢等问题，极大地限制了细胞移植治疗方式在临床上的广泛应用。近年来，通过人为修饰改变移植细胞和宿主肝脏微环境和肝细胞的特性，使得移植细胞再殖肝脏取得了实质性的进展。本文主要综述目前已经成功实现肝脏再殖的研究成果，并探讨移植细胞在不同动物模型中再殖肝脏的潜在机制。     

食管癌术中经鼻气管导管引导胃管插入法

食管癌术中经鼻气管导管引导胃管插入法河南省驻马店市１５９医院麻醉科朱海英，张群法，盛莉我们自１９９３年以来采用气管导管经鼻引导插入胃管４８例，均系食管中上段肿瘤病人。其中男性３６例，女性１２例，年龄最大６７岁，最小２０岁。麻醉用２４～２８号气管导管１...     

小儿阻塞性睡眠呼吸暂停综合征手术的麻醉

<正>阻塞性睡眠呼吸暂停综合征(OSAS)在小儿中发病率为1%～3%,常见原因为扁桃体和腺样体增生肥大引起患儿鼻塞、呼吸道不畅、睡眠打鼾等。睡眠期间表现为间断性上气道部分或完全梗阻为特点的睡眠呼吸紊乱。长期出现睡眠呼吸     

重症卒中患者并发高渗血症的干预与预后研究

目的探讨干预重症卒中并发高渗血症患者的临床价值。方法选择并发高渗血症的重症卒中患者[入院时格拉斯哥昏迷评分(GCS)≤12分]34例,通过控制补液量、利尿药和血糖,动态观察干预前后血浆渗透压及其相关因素的变化,评价干预治疗对预后的影响。结果控制补液量是高渗血症最常用(85.3%)的干预措施,其次为控制渗透性利尿药用量(41.2%)和控制血糖(41.2%)。干预前血浆渗透压(321±10)mmol/L,血钠(146±5)mmol/L,血糖(9.5±2.8)mmol/L;干预后分别为(308±18)、(142±7)和(7.5±3.1)mmol/L。血浆渗透压降至正常者住院期病死率为15.8%,明显低于血浆渗透压未降至正常者的病死率(100%),差异有显著性(P<0.01)。多因素Logistic回归分析显示,影响住院患者病死率的主要危险因素是血浆渗透压增高和APACHE(acutephysiologyandchronichealthevaluation)Ⅱ评分增高。结论降低血浆渗透压可改善重症卒中并发高渗血症患者的预后,降低住院病死率。     

阻塞性睡眠呼吸暂停低通气综合征患者脑血管自动调节潜力分析

目的 评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者脑血管的自动调节能力.方法 选择济南市第四人民医院神经科自2007年2月至2009年5月就诊或住院的OSAHS患者76例,根据患者呼吸暂停低通气指数(AHI)和夜间最低血氧饱和度(LSaO2)分为轻、中、重度OSAHS组,选择同期有打鼾史的健康体检者32例作对照组,利用多导睡眠仪监测睡眠相关指标及不同时段血压,通过经颅多普勒超声(TCD)检测结合倾斜实验、屏气实验评价患者脑血管的CO2反应性和自动调节能力.结果 与对照组比较,OSAHS组患者AHI较高、LSaO2较低、微觉醒指数(MI)较高,暂停时收缩压增高,S1占睡眠时间的百分比增高、S3+4占睡眠时间的百分比降低,差异均有统计学意义(P＜0.05).与对照组和轻度OSAHS组比较,中、重度OSAHS组患者呼吸抑制指数(BHI)降低、由卧位至立位平均动脉压恢复90%所用时间(TMAP)增加;与对照组比较,OSAHS组患者血管运动反应性(VMR)降低、由卧位至立位脑血流速度(CBFV)恢复90%所用时间(TCBFV)增加,差异均有统计学意义(P＜0.05).中重度OSAHS患者卧立位时血压、平均CBFV的差异均有统计学意义(P＜0.05),立位血压和平均CBFV之间呈正相关关系(r=0.384,P=0.005).结论 OSAHS患者尤其是中重度患者脑血管调节功能受损,卒中风险可能增加.导致OSAHS患者脑血管调节受损的主要因素为夜间低氧血症、高碳酸血症、血压波动及睡眠结构紊乱.

Abstract：

Objective To evaluate the cerebral autoregulation in patients with obstructive sleep apnea-hypopnea syndrome (OASHS) using transcranial Doppler (TCD)-CO2 test and head-upright tilt test (HUTT) from the aspects of nocturnal hypoxemia/hypercapnia and sleep structure. Methods Seventy-six patients with OSAHS visiting our hospital from February 2007 to May 2009 were chosen in our study and divided into severe OSAHS group (n=26), moderate OSAHS group (n=29) and mild OSAHS group (n=21) according to the apnea-hypopnea index (AHI), and the lowest oxygen saturation (LSaO2); 32 healthy controls, having snore history, were adopted too. Polysomnography monitor was used for night-7-h sleep monitoring and blood pressure monitoring; sleep-related indicators and blood pressure at different times were analyzed. Cerebrovascular reactivity was calculated in terms of the breath-holding index (BHI) and vascular motor reactivity (VMR) by TCD-CO2 test; Changes of cerebral blood flow velocity (CBFV), blood pressure (Bp), and the time from squatting-to-tilt position for the mean arterial pressure (TMAP) and the CBFV (TCBFV) returning to ＞90% of baseline levels were detected by HUTT to assess the cerebral pressure-autoregulation. Results The AHI, microarousal index (MI) and the percentages of S1 in the non-rapid eye movement sleep period in the severe, moderate and mild OSAHS groups were all significantly higher than those in the control group (P＜0.05); the LSaO2 and the percentages of S3+4 in the non-rapid eye movement sleep period in all the OSAHS groups were significantly lower than those in the control group (P＜0.05); no significant difference in blood pressure before apnea was noted between the OSAHS groups and the control group (P＞0.05), however, the systolic blood pressure while apnea in all the OSAHS groups was significantly higher than that in the control group (P＜0.05). As compared with the controls and mild OSAHS group (1.89±0.36, 1.75±0.41), severe and moderate OSAHS groups (0.71 ±0.17, 1.12±0.23, respectively) showed significantly decreased BHI (P＜0.05); As compared with the controls (0.68±0.11), and the mild, moderate and severe OSAHS groups (0.20±0.04, 0.34±0.07 and 0.55±0.17, respectively) showed significantly decreased VMR (P＜0.05); TMAP in the moderate and severe OSAHS groups was significantly longer than that in the controls and mild OSAHS group (P＜0.05); TCBFV in the mild, moderate and severe OSAHS groups was significantly longer than that in the controls (P＜0.05). Significant difference on the levels of Bp and CBFV during tilt was noted between the moderate and severe OSAHS groups (P＜0.05); Pearson analysis showed a linkage between Bp and CBFV changes (r=0.384, P=0.005). Conclusion Cerebrovascular autoregulation is impaired in patients with OSAHS, especially in the moderate and severe groups, which may increase the risk of stroke. The major risk factors for cerebrovascular autoregulation in patients with OSAHS are night hypoxemia, hypercapnia, blood pressure fluctuation and severe sleep disorders.     

营养支持在脑卒中治疗中的重要性

脑卒中患者存在营养不良的风险,尤其在吞咽障碍、严重脑卒中以及老年患者中更为多见.营养不良与脑卒中的不良预后密切相关,美国心脏学会(AHA)和美国卒中学会(ASA)联合发布的<急性缺血性卒中早期处理指南(2005)>[1]指出,与营养恶化相伴随的是肺炎、胃肠道出血和褥疮等并发症的风险增高.推荐应对所有脑卒中患者进行基线营养评定,并采取措施纠正或改善患者的营养状况.但是目前脑卒中治疗过程中患者的营养状况经常被忽略,影响脑卒中患者的康复,因此,加强脑卒中后患者的营养管理,建立营养评估诊断记录和制订营养不良的干预措施.显得尤为重要.