呼吸机在ICU应用的质量管理

现代通气技术的快速发展,使呼吸机在临床得到广泛应用,医护人员在重视使用技术的同时,还应做好使用前后及使用过程中的安全维护和管理,才能使其安全地发挥出最大效益.     

Type II pneumocytes modulate surfactant production in response to cigarette smoke constituents: Restoration by vitamins A and E

This study was to evaluate the effects of cigarette smoke constituents upon type II pneumocyte surfactant production in vitro, and how vitamins A and E may alter the response. Freshly isolated type II pneumocytes from Sprague–Dawley rats were incubated 20 h in medium with fetal bovine serum that was or was not treated with cigarette smoke. The number of adherent cells was inversely related to the dose of smoke or benzo(a)pyrene. Despite the decreased number of treated cells, the total amount of surfactant per culture well was unchanged, whereas surfactant production per cell was significantly increased (P < 0.05). Vitamin A concentration was significantly (P < 0.05) lower in the smoke-treated serum compared with untreated serum. When vitamin A or E was added to the cigarette smoke-treated serum, cell adherence and surfactant production returned to control values. In conclusion, cigarette smoke constituents or benzo(a)pyrene alone decreased the number of adherent type II pneumocytes, but did not alter surfactant amounts because of an increased production of surfactant per cell. Type II pneumocytes seem to adjust surfactant production dependent upon the number of type II pneumocytes to produce it and vitamin A or E enhance cell attachment in the presence of the smoke toxins.     

某电厂25 MW煤气发电工程职业病危害因素水平调查

目的 了解该项目主要职业病危害因素的种类、分布以及浓度和强度，提出防护措施，以达到减少职业病危害因素对人体健康的影响。方法 通过职业卫生学调查和现场测试对该项目职业病危害控制效果进行评价。结果 噪声、粉尘、一氧化碳、二氧化碳及二氧化硫化学毒物合格率为100％。结论 该建设项目生产工艺与设备先进，自动化程度较高，职业卫生防护设施基本齐全，防毒、防噪和防高温效果好，是优质环保工程。     

人工晶体植入术后复视

目的:本文报道7例人工晶体植入术后复视病例,并初步探讨其原因及预防。方法:随访60例单侧白内障摘除及人工晶体植入术连续病例。复视病例,检查复视类型、眼位、眼球活动度、屈光状态、瞳孔及眼底,并散瞳检查人工晶体位置。结果:本文报告白内障摘除及人工晶体植入术后复视发生率为11.67％。术前存在斜视,双眼融合功能障碍,局麻药物对眼外肌的毒性作用,人工晶体中心偏移,黄斑部病变及晶体后囊不均匀混浊等与术后复视有关。结论:复视是白内障摘除及人工晶体植入术后一个重要的并发症。其治疗往往较困难,根据复视的可能原因,采取预防措施对减少术后复视有帮助。眼科学报1997;13:210—212。     

大肠癌手术后肝转移的诊断与治疗

目的：探讨大肠癌手术后肝转移的诊断与治疗。方法：对35例大肠癌手术后肝转移的诊治效果进行回顾性分析。结果：所有的病例均得到CEA、B超和（或）CT检查证实，其1年和3年生存率在根治性手术切除组明显高于其他治疗组。结论：肝转移癌的早期诊断是提高生存率的关键，手术切除及选择性肝动脉栓塞化疗是改善其预后的选择。     

中央沟上段及其邻近沟回的体表定位及其临床意义

目的：探讨在MRI和CT图像上观测中央沟上段及其邻近沟回的特征，进行精确体表定位。方法：30例成人头颅和扫描无颅恼器质性病变10份CT，100份MRI片，在头颅正中欠状面上观测头颅外形和平行于耳眦线平而以上100mm内的前后正巾线的中点及中垂线。在横位图像上观测中央沟上段及其邻近沟回的特征和二维坐标参数。结果：成人头颅近似标准球形。住82％头颅卜平行耳眦线平面的正中点的的投影在垂直耳眦线过外耳道的直线卜，另外18％偏离基线面中垂线小于7mm。上段中央沟在耳眦线平面上70～95mm。84％额上沟与中央前沟相交呈倒T字征，交点住前后中线旁24～27mm，耳眦线平面的中垂线前2～6mm。中央沟上段起点前后中线旁1～15mm，耳眦线平而的中垂线后12～28mm，手结征98％。中央后沟在中央沟之后8～13mm与其平行。结论：每人上段中央沟及其邻近沟回的特征能被MRI精确体表定位。     

The significance of a rapid cold hemagglutination test for detecting mycoplasma infections in children with asthma exacerbation.

BACKGROUND AND PURPOSE: Mycoplasma pneumoniae infection is a frequent cause of community-acquired respiratory infections in children and adults. However, standardized, rapid, specific methods for its diagnosis are lacking. The relationship between M. pneumoniae infection and asthma exacerbation has been recently discussed in the literature. We investigated the accuracy of rapid detection of mycoplasma infection by cold hemagglutination test compared to conventional enzyme immunoassays. The clinical characteristics of mycoplasma infection seen during emergent visits in asthmatic children were reviewed. METHODS: We retrospectively reviewed medical records of patients with asthma exacerbation visiting the Department of Pediatric Emergency, National Taiwan University Hospital, over a 12-month period. Subjects 2-18 years of age diagnosed with asthma at our outpatient clinic were included in this study. Patients with immunodeficiency, congenital anomalies, neurological diseases and irregular follow-up were excluded. RESULTS: A total of 269 children (174 males and 95 females) with a mean (+/- standard deviation) age of 6.15 +/- 3.08 years were included. The prevalence of asthma exacerbation in regular follow-up patients was 13.4%, and as many as 19.6% of cases (74/378 person-times) required hospitalization. Asthma attacks were most prevalent during December. 126 patients had both rapid cold hemagglutination testing and mycoplasma immunoglobulin M titers determined using acute blood samples drawn in the emergency room; 46 (36.5%) of these patients demonstrated mycoplasma infection. Sensitivity and specificity of the rapid cold hemagglutination test was 78.3% and 41.3%, respectively. The positive predictive value was 43.4%. Comparison of patients with or without mycoplasma infection revealed no differences in gender, age, chest X-ray findings, and most symptoms/signs and laboratory data, except that more signs of fever and auscultatory rales were seen in the non-mycoplasma infection group. CONCLUSIONS: Mycoplasma infections could be an exacerbating factor for asthma, and the rapid cold hemagglutination test should not be a guideline for prescribing macrolides in the emergency room.