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。     

妇产科剖宫产抗菌药物合理使用调查分析

目的：对我院妇产科剖宫产患者使用抗菌药物情况进行分析,以提高该类药物反应的合理性。方法：对我院妇产科１９９９年１月～１９９９年１２月出院的病历进行抗菌药物的反应回顾性抽查。结果：抗菌药物使用率１００％,预防用抗菌药方案为头孢唑啉２．０ｇ静注给药,总有效率９９．２３％。结论：围手术期抗菌物药费用低很,预防感染结果满意。     

妇科围手术期抗菌药物的监督与管理

目的:通过对妇科围手术期抗菌药物的监督与管理,提高合理用药水平。方法:回顾性调查分析2000年经腹子宫肌瘤或子宫肌瘤+附件手术病例,找出临床围手术期预防性应用抗菌药物存在的主要问题,参照国内外有关文献制定妇科围手术期抗菌药物用药指南。依据指南,在2001年进行前瞻性干预研究,2005年随访干预后情况。结果:使用抗菌药物的合理率由干预前的12．5％上升到干预中的88．2％和干预后的96．8％(P<0．01)。平均抗菌药费由干预前的(1 780．58±425．93)元,降到干预中的(833．73±148．73)元(P<0．01)和干预后的(508．71±187．01)元(P<0．01)。干预前妇科围手术期预防性应用抗菌药物存在的主要问题,如抗菌药物品种选择不当,给药时机不当和用药疗程过长等,干预后均得到解决。结论:本研究所采用的合理用药干预措施具有可行性和有效性,对促进安全、有效经济、合理地使用抗菌药物起到了积极的促进作用。     

复方氯霉素滴耳液的制备及临床应用

目的：制备复方氯霉素滴耳剂，观察临床疗效。方法：建立质量控制方法，并进行稳定性及临床疗效观察。结果：制备的滴耳剂质量可靠，疗效确切。结论：本制剂制备工艺合理，质控方法可靠，临床疗效满意。     

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.