持续射流式雾化吸入麻醉在纤支镜检查中的应用

近年来，我们用射流式雾化器在纤维支气管镜（简称纤支镜）检查前对患者行持续雾化吸入麻醉，效果满意。现报告如下。临床资料：选择2002年8月～2005年8月在我院做纤支镜检查或治疗的患者876例，男572例、女304例，年龄9～84岁、平均60．2岁，其中不明原因咯血107例。将患者随机分为实验组294例、对照A组292例和对照B组290例，三组患者性别、年龄、病情、呼吸频率（RR）、心率（FIR）、指脉血氧饱和度（SpO2）等差异均无统计学意义。     

住院患者抗菌药物使用情况调查

目的 :了解本院住院患者抗菌药物使用情况并进行分析 ,为临床合理用药提供依据。方法 :采用回顾性方法 ,随机调查 2 0 0 1年 1月～ 10月全院 14个临床科室的出院病例 2 90份 ,进行逐一统计分析。结果 :共有 2 4 4例使用抗菌药物 ,占总调查病例数的 84 .14 %。手术科室用药占 92 .94 % ,非手术科室用药占 71.6 7% ,使用频率最高的是青霉素。用药天数为 837d ,用药例次达 89例次。抗菌药物使用合理或基本合理 181例 ,占 74 .18% ,存在问题的有 6 3例 ,占 2 5 .82 %。使用不合理的主要原因是术前、术后预防感染及长疗程用药 (6 3.4 9% )。结论 :本院使用抗菌药物绝大多数是合理的 ,但仍存在着不合理使用的现象 ,还需加强管理。     

小知识（7）

斑釉指数(index of dental fluorosis)评估地区氟斑牙流行程度的指标。氟斑牙以Dean氏分类法为基础,把氟斑牙发生频率与程度结合起来,其公式为:斑釉指数=正常例数×0.5 极轻例数×1 受轻检度查例例数数×2 中度例数×3 重度例数×4以指数评估流行程度的标准为:0~0.4为阴性;0.4~0.6为边缘线;0.6~1为轻微;1~2为中等;2~3为较显著;3~4为显著或极显著。小知识(7)     

功能性内镜鼻窦手术后鼻黏膜纤毛转归的研究

功能性内窥镜鼻窦外科手术(FESS)已经成为治疗慢性鼻窦炎的主要手术方法,但仍需要客观的、特别是量化的证据来证明FESS后鼻黏膜纤毛功能得到恢复。我们对近年来有关FESS后鼻黏膜组织形态学、鼻黏膜纤毛功能转归的研究报道作一综述。     

脑梗死患者组织因子途径抑制物C-399T多态性

组织因子途径抑制物（TFPI）是外源性凝血途径起始步骤的生理性抗凝物质，在调节血栓形成、抑制溶栓后血管再闭塞等方面具有重要作用。近年研究表明TFPIC-399T基因多态性与静脉血栓形成无关，但与动脉血栓性疾病的关系仍有争论，且不同人种TFPIC-399T的分布频率不同。为了研究TFPIC-399T多态性在中国人群中的分布频率及其与脑梗死（Cerebral Infarction，CI）之间的可能联系，我们分析了部分CI患者及正常人的TFPIC-399T等位基因的变异情况及血浆总TFPI抗原浓度，现报道如下。     

不同频率振动应变对成骨细胞增殖及分化能力的影响

目的 观察不同频率振动应变(vibration strain)对体外培养成骨细胞细胞周期、增殖能力及分化的影响,确定最佳振动频率.方法 应用自制复合振动仪,将振动强度0.5g(g为加速度),不同频段3～10、15～30、25～45、50～80和80～100Hz振动应变分别作用于成骨细胞,振动应变加载后分别检测细胞周期、细胞增殖能力(MTT法)及碱性磷酸酶(alkaline phosphatase, ALP)活性的变化.结果 15～30和25～45Hz频段诱导成骨细胞周期循环(P<0.01),促进细胞增殖(P<0.01),增强ALP活性(P<0.01);80～100和3～10Hz频段抑制细胞周期循环(P<0.01);80～100Hz频段抑制细胞增殖(P<0.01);50～80和80～100Hz频段抑制ALP活性(P<0.01).结论 不同频率振动应变对成骨细胞周期、增殖能力、ALP活性均有影响,振动应变促进成骨细胞增殖及分化的最佳频率为15～45Hz.     

载脂蛋白A1、B基因多态性对非创伤性股骨头坏死发生的影响

目的:探讨载脂蛋白A1、B基因多态性对非刨伤性股骨头坏死(avascular necrosis of the femoral head,ANFH)发生的影响.方法:应用聚合酶链反应对中国北方汉族143例ANFH患者和92例正常人分别扩增含Apo AI基因启动子-75 bp和第一内舍子 83 bp及Apo B基因Eco RI、XbaI和3-VNTR的DNA片段,限制性内切酶酶切扩增产物,琼脂糖凝胶电泳分离基因多态性.结果:Apo A1基因启动子-75 bp处,ANFH患者中A/A基因型频率明显高于正常组(P＜0.01),而G/A基因型频率明显低于正常组(P＜0.01).Apo AI内舍子 83 bp位点,Apo B基因Eco RI、Xba I位点和3-VNTR区域ANFH患者组和正常组基因型及等位基因频率分布无统计学差异.结论:Apo A1基因启动子区域-75bp位点A/A型可能是非创伤性股骨头坏死易感基因之一,但未能发现Apo A1第一内舍子 83 bp位点及Apo B基因Eco RI、XbaI和3-VNTR位点多态性与非创伤性股骨头坏死发生有明显的关系.     

连台手术病人的安全护理

护理安全是指在实施护理的全过程中,患者不发生法律和法定的规章制度允许范围以外的心理、机体结构或功能上的损害、障碍或死亡[1].手术室护理安全是护理管理的重点,是护理质量的重要标志之一.随着现代手术室的使用,连台手术频率和手术强度也有随之增加.紧张繁忙的护理工作中,存在着诸多安全隐患,稍有不慎,就有可能造成严重后果.为加强管理,防止或减少护理纠纷的发生,我院结合实际情况,分析了连台手术所存在的各种风险因素,并制定相应的护理对策,现总结如下:     

Evaluating therapeutic outcome in epileptic patients using the changes of interval and duration

BACKGROUND: Seizure frequency is in abnormal distribution, and it is not enough to express the trend of concentration using means, and its median loses a lot of information, thus it lacks of a standard for evaluating the therapeutic effects based on seizure frequency. OBJECTIVE: To establish a method for evaluating the therapeutic effects on anti-epileptic drugs using changes of interval and duration of seizure. DESIGN: A prospective cohort study. SETTING: Zhumadian Psychiatric Hospital. PARTICIPANTS: Outpatients and inpatients suffering from epilepsy attending firstly visited Zhumadian Psychiatric Hospital from June 2001 to June 2002 were enrolled. They were diagnosed as epileptic according to the International Classification of Epileptic Seizure by International League Against Epilepsy (1981) based on the clinical history, physical examination, and investigations. The interval time was no more than 6 months. Informed consent was obtained from all the subjects, and the study was approved by the hospital ethical committee. METHODS: ① For the first visit and each follow-up, the following data were recorded, including general demographic information, seizure type, the date and time of ictus, the duration of ictus, and inducement or situation related, according to which the following indexes could be calculated, including seizure styles, interval, duration, cluster frequency and cluster duration. The information from the first review was noted as annals A. The second interview was taken at the end of the evaluating period; the information from the second review was noted as annals B. The third interview was taken within two weeks after the second one; the information from the third review was noted as annals C. The annals B or the annals C were respectively compared with the annals A in the light of the same types or the same styles of the same patient. Summation of the scores of interval change and duration change of the same type or the same style and 5 of basic score was the score of a corresponding seizure type or a corresponding style of one patient. In order to test its reliability and validity, the score of change of frequency or duration plus 5 scores respectively was the score of frequency or duration. ② Reliability and validity were tested by calculating corresponding correlation coefficient with SPSS 11.0. ROC curve was used for developing diagnostic criterion of predicting therapeutic effects with SPSS 11.0. MAIN OUTCOME MEASURES: ① Reliability and validity; ② Diagnostic criterion for predicting therapeutic effects one year later. RESULTS: Totally 28 patients were involved in the final analysis of results. ① Reliability and validity were high: rinter-rater=0.98, rtest-retest=0.99, rconstruct validity=0.83. ② A total score > 6 was the optimal diagnostic criteria for predicting therapeutic effects one year later, in other words, a patient who scored more than 6 at the evaluating period may be seizure-free one year later. CONCLUSION: It is a potential tool for evaluating epileptic therapeutic outcome, and it can be diffusely used in interrelated fields after being further validated.