惊厥性疾病患儿血浆和脑脊液生长抑素的变化

目的探讨血浆、脑脊液生长抑素(SOM)在惊厥发生中的作用及其临床意义。方法选取惊厥性疾病患儿67例,分别在入院d1、d7采取静脉血,d1采脑脊液(CSF)标本,采用放射免疫分析法检测血浆和CSF中SOM水平。结果1.惊厥组d1、7血浆SOM水平分别为(39.23±11.00)、(29.47±9.40)ng/L,d7较d1显著下降(t=21.530P<0.001);惊厥各组d7与d1自身比较有显著差异(t=16.551,10.968,13.715P均<0.01);脑炎无惊厥组d7(20.57±4.82)ng/L较d1(21.66±5.01)ng/L下降,但无显著差异(t=1.321P>0.05);对照组d1(19.58±6.04)ng/L,惊厥组与脑炎无惊厥组、对照组相比均有显著差异(t=6.847,7.921P均<0.01),惊厥组各组之间也有显著差异(F=56.114P<0.01);2.惊厥组CSF中SOM为(44.14±12.50)ng/L,脑炎无惊厥组为(22.88±5.60)ng/L,对照组为(18.88±5.27)ng/L。惊厥组较脑炎无惊厥组、对照组均显著升高(t=7.406,7.786P均<0.001),惊厥各组之间也有显著差异(F=51.150P<0.01)。3.惊厥发作次数多则血浆和CSF中SOM水平高,经直线相关与回归分析,d1、7血浆SOM水平与d1CSF中SOM水平显著正相关(r=0.956,0.830P均<0.001)。结论惊厥性疾病患儿血浆、CSF中SOM水平均显著增高,但SOM水平在惊厥发生的不同阶段变化不同。血浆SOM水平能间接反映CSF水平,且与惊厥发     

针灸治疗儿科病概况

针灸是儿科疾病的重要治疗方法 ,早在《内经》中已有记载 ,后世不断完善、发展 ,在临床治疗上取得了肯定的疗效。现就近年来有关此方面的临床资料综述如下。1　神经系统　　徐氏[1 ] 针刺治疗小儿脑瘫 90例 ,主穴 :八脉交会穴 (按时取穴 ,采用灵龟八法穴位开合规律选取穴位 )、耳穴脑点或脑干、合谷或足三里 ,并据症配穴 ,以补法为主 ,每日或隔日 1次 ,5 0次为 1疗程 ,每疗程间隔 1周 ,治疗 7疗程 ,显效 2 9例 ,有效 5 6例 ,无效 5例 ,总有效率 94.4% ,疗效优于空白对照组 (ｐ <0 .0 1 ) ,且治疗组康复年龄低于空白对照组 ( ｐ <0 .0 5 )。…     

北京冬季奥林匹克运动会运动员手术的麻醉管理

According to literature reports, the injury rate of the athletes in Olympic Winter Games recent years was as high as 10%-14%. Combined with the background of corona virus disease 2019 (COVID-19), the medical insurance work of the 24th Olympic Winter Games held in Beijing had put forward more complicated requirements and more severe challenges. In order to better optimize anesthesia management, this article summarized the perioperative treatment of athletes in Olympic Winter Games, the safety protection strategy of medical staff under general anesthesia, and the potential impact of peri-operative drugs on athletes. Anesthesiologists, as the core members of the rescue team, should be familiar with the particularity of operative anesthesia of athletes, sum up relevant experience to ensure the safety of perioperative patients. So all kinds of technical measures should be taken in the process of operation to minimize the indoor pollution caused by the patient's cough. For example, all the patients should wear N95 masks from the ward to the operating room, and after the operation, wear the N95 masks back to the ward. Although the International Olympic Committee had banned more than 200 drugs for participants and athletes who had to strictly follow International Olympic Committee requirements during anesthesia, the athletes were no longer participating in this Olympic Winter Games, so opioids (sufentanil and remifentanil) and glucocorticoid (dexamethasone) could be used according to the actual needs of surgery and anesthesia. Five athletes in Yanqing competition area underwent surgical anesthesia in Peking University Third Hospital Yanqing Hospital. All the five patients received general anesthesia, of whom four underwent orthopaedic surgery and one underwent laparoscopic cholecystectomy. General anesthesia with laryngeal mask airway was the first choice in the five patients. And the pain after orthopaedic surgery was severe and nerve block technique could effectively relieve the pain after surgery. Three patients received ultrasound-guided nerve block analgesia, the postoperative analgesia lasted 36 h. After the operation, non-steroidal anti-inflammatory drug (NSAID) was infused intravenously in the ward and all the patients recovered uneventfully. As the core member of the trauma rescue team, anesthesiologists should be familiar with the particularity of the athletes' surgical anesthesia, do a good job in medical security, and summarize relevant experience to ensure the life safety of the perioperative patients.     

数量化脑电图监测手术切皮时的镇痛强度

为评价数量化脑电图（ＥＥＧ）反映镇痛强度的准确性，作者对６５例ＡＳＡⅠ级腹部手术患者，快速静脉诱导气管插管后，机械通气。麻醉维持：Ｏ２－Ｎ２Ｏ（１：２）－七氟醚吸入，切皮前不追加长效肌松药，监测ＴＯＦ。随机分为三组：七氟醚呼气末浓度分别为１％（Ⅰ组）、１．５％（Ⅱ组）、２％（Ⅲ组），至少维持１５ｍｉｎ。应用数量化脑电图监测手术切皮前、后３分钟脑电图（Ｆｐ１－Ａ１，Ｆｐ２－Ａ２）和平均动脉压（ＭＡＰ）、心率（ＨＲ）的变化以及患者的切皮反应改变。结果显示，切皮前数量化ＥＥＧ随七氟醚呼气末浓度增加，波谱边缘频率（ＳＥＦ）、中频率（ＭＦ）、双谱指数（ＢＩＳ）明显降低（Ｐ＜０．０１），δ波比率（δＲ）明显升高（Ｐ＜０．０１），ＭＡＰ仅Ⅰ组和Ⅲ组之间差异有显著意义（Ｐ＜０．０５），ＨＲ三组之间差异无显著意义。切皮反应者的ＳＥＦ、ＭＦ、ＢＩＳ明显高于无反应者，δＲ明显低于无反应者（Ｐ＜０．０１）。反应者切皮前、后的ＭＡＰ和ＨＲ变化差明显大于无反应者（Ｐ＜０．０１）。作者认为，ＥＥＧ数量化指标ＳＥＦ和ＢＩＳ能较准确地反映切皮前七氟醚镇痛强度，血流动力学与七氟醚呼气末浓度无相关性，因此不能反映切皮前七氟醚镇痛强度。     

颈部硬膜外麻醉的应用

本组对近十年763例颈部硬膜外麻醉进行了回顾性调查研究,分析了不同浓度局麻药对呼吸、循环的影响,以及颈部硬膜外麻醉并发症的原因。认为颈部硬膜外麻醉具有对呼吸、循环抑制轻,成功率较高(98.03％),术中患者清醒可配合手术等优点,比较安全可靠。同时强调:(1)颈部硬膜外穿刺置管操作应轻柔,以免损伤脊神经根造成感觉和运动功能障碍;(2)选用低浓度局麻药以达到主要阻断感觉神经为主的目的,术中应加强对呼吸、循环的监护与管理;(3)严格掌握适应症。但如何消除颈部硬膜外麻醉术中的牵拉反应,尚待进一步研究。     

护士形象的工作效应

所谓形像,就是一个人内在素质在行为方式和精神面貌上的表现,人的素质是人类进步和社会发展的标志.就护士而言,护理人员的素质提高了,用自己的行为塑造崇高形象,所从事的护理工作的护理质量才会提高.     

Use of Different Doses and Administrative Patterns of Vecuronium for Rapid Intubation and Pharmacodyamic Study

ＵｓｅｏｆＤｉｆｆｅｒｅｎｔＤｏｓｅｓａｎｄＡｄｍｉｎｉｓｔｒａｔｉｖｅＰａｔｔｅｒｎｓｏｆＶｅｃｕｒｏｎｉｕｍｆｏｒＲａｐｉｄＩｎｔｕｂａｔｉｏｎａｎｄＰｈａｒｍａｃｏｄｙａｍｉｃ　ＳｔｕｄｙＧｕｏＸｉａｎｇｙａｎｇ；（郭向阳）ＬｕｏＡｉｌｕｎ；（...     

手术室护士的职业危害及防护

手术室内环境的污染确实对人体造成极大的危害，针对危害手术室护士的身体健康因素不断增加的现象。加强防护措施，从而提高手术室护士对职业危害因素的认识，增强自身防护,保证手术室护士身心健康，规范操作，提高医疗护理技术．     

硬性支气管镜在肺叶切除术后气道管理中的应用探讨

介绍硬性支气管镜检查在胸科肺叶切除术后气道管理中的应用方法及其意义。在改膜外及全身麻醉下对3例因肺癌拟行肺叶切除术的患者分别在全麻诱导气管插管后以及关胸后实施了硬性支气管镜检查。结果表明，在全身麻醉下行硬性支气管镜检查可清晰显示气管、支气管内部结构及病变部位。直视下，可彻底清除肺叶切除术后气管、支气管内的分泌物及凝血块。作者认为在肺叶切除术后行支气管镜检查可减少术后肺不张及支气管胸膜疼等并发症发生率。