山东省县级综合医院绩效考核评价研究

目的全面评估山东省县级综合医院的整体服务与技术水平,进一步落实县级综合医院的功能定位,引导其发展方向。方法以文献研究为基础,综合应用专家咨询法、倍数环比法确定指标构成及权重,并通过TOPSIS法、定量分析与对比分析等方法,研究山东省111家县级综合医院的绩效考核情况。结果山东省县级综合医院发展水平参差不齐,运营效率与持续发展方面存在明显劣势。结论各县级综合医院应根据实际情况调整未来发展重心,加强规范化管理,促进各指标协同发展。同时,政府应继续落实对县级综合医院的扶持政策。     

新生儿个体化发育支持对极低出生体重儿智力和全身运动发育的影响

目的 分析探讨新生儿个体化发育支持对极低出生体重儿智力和全身运动发育的应用效果和作用。 方法 选取2018年12月1日—2019年7月1日期间在湖南省妇幼保健院出生且符合入选标准的极低出生体重儿90例为研究对象,并随机将其分为对照组(n=37)和观察组(即个体化发育支持组,n=53)。收集所有患儿的基本资料,比较两组体质量恢复时间、完全经口喂养时间及胎粪排尽时间,以及两组患儿的全身运动(general movements,GMs)、患儿智力(mental development index,MDI)、心理运动指数(psychomotor development index,PDI)及发育商(development quotient,DQ)情况,评估两组全身运动及智力发育情况。 结果 观察组的体质量恢复时间为(7.86±2.66)d、完全经口喂养时间为(11.77±3.52)d,胎粪排尽时间为(12.19±4.22)d,时间均短于对照组(均P<0.05);观察组体格变化速度情况高于对照组(P<0.05);随访至矫正胎龄12个月后,观察组全身运动情况、智力发育、心理运动发育指数以及发育商评分均优于对照组(均P<0.001)。 结论 新生儿个体化发育支持可以促进极低出生体重儿智力及全身运动的发育,减少异常GMs发生率,可推广应用。     

喉罩全麻通气用于妇产科临床麻醉的麻醉效果及安全性评价

目的:探究妇产科麻醉中采用喉罩全麻通气的麻醉效果与安全性。方法:选取本院收治的妇产科手术患者90例,按照通气方式的不同分为2组,对照组实施气管内插管通气,观察组实施喉罩全麻通气,比较两组患者置管成功率、收缩压、舒张压、平均动脉压、心率的变化。结果:对照组通气后收缩压与舒张压水平高于通气前(P<0.05);观察组通气后收缩压与舒张压水平均低于对照组(P<0.05);对照组通气后平均动脉压与心率水平均比通气前高(P<0.05);观察组通气后平均动脉压与心率水平均比对照组低(P<0.05)。结论:产科麻醉中采用喉罩全麻通气麻醉,麻醉效果与安全性都较高。     

一流期刊建设背景下高校普通科技期刊的价值、发展现状与建议——以河北省高校普通科技期刊为例

【目的】 在培育世界一流期刊的背景下探讨高校普通科技期刊的价值,并分析河北省高校普通科技期刊的发展现状,以期帮助他们看到自身的价值,认清发展现状,开拓思维,发展前进。【方法】 采用文献分析法探讨高校普通科技期刊的价值,通过网络调研法了解河北省高校普通科技期刊的现状。【结果】 高校普通科技期刊在一流科研人才培养、一流科研成果产出、服务区域彰显一流方面具有不可忽视的价值;河北省高校普通科技期刊的出版周期以双月刊为主,办刊历史均有一定的积累,期刊学科类别较全面,但存在刊名同质化、影响力指数分区普遍不高、被知名数据库收录的期刊数量不多、数字出版内容形式单一等方面的不足。应加强向专业化转型、新媒体建设、集群化建设三方面的思考和尝试。【结论】 认识到自身价值,坚定发展信心,同时准确看到自身问题,克服困难、锐意进取是高校普通科技期刊充分发挥自身价值并成长为一流科技期刊的必经之路。     

曲马多应用于全身麻醉的临床观察

目的 评估曲马多应用于全身麻醉的临床效果。方法 选择ASAI－Ⅱ级子宫手术患者60例,采用曲马多4mg/kg（T组,n＝30）或芬太尼4μg/kg（F组,n－30）,丙泊酚2．5mg/kg和维库溴铵0．1mg/kg诱导插管,术中以维库溴铵、丙泊酚（0．1－0．2）mg.kg^-1.min^-1持续静滴,曲马多（50－100）mg/h或芬太尼（0．05－0．1）mg/h维持麻醉。监测麻醉前、插管前后、切皮前及之后5、15、30、60、90min的MAP和HR,拔除气管导管后呼吸空气5、10、15、30min的SpO2,评估麻醉满意度。结果 术中麻醉效果均满意。T组在诱导插管时MAP改变不明显,而F组明显下降（P＜0．001）,两组间比较差异有显著性意义（P＜0．05）。术毕拔管后15min内呼吸空气时SpO2T组明显高于F组（P＜0．05）。结论 曲马多应用地全身麻醉效果确切,而且麻醉诱导时血流动力学改变不明显,术后呼吸抑制程度较轻。     

异丙酚用于预防全麻插管及拔管期心血管应激反应的研究

目的：观察异丙酚对全麻插管及拔管期心血管反应的预防作用。方法：选择ASAI－Ⅱ级无明显高血压病、拟在全麻下行胸腹部择期手术的病人24例,随机分为异丙酚组和对照组。麻醉：异丙酚组静注异丙酚、芬太尼和肌松剂诱导插管,并于术毕拔管前静注异丙酚1mg/kg;对照组静注安定、芬太尼和肌松剂诱导插管,拔管前不给药。对比两组在插管及拔管时的血压和心率变化。结果：插管时两组血压、心率均有所上升,但无统计学差异;拔管时对照组血压、心率明显升高有显著性差异（P＜0．05）异丙酚组则无明显改变。结论：拔管前静注异丙酚能有效抑制拔管时的心血管应激反应。     

Apnoeic oxygenation in paediatric anaesthesia: a narrative review

Apnoeic oxygenation refers to oxygenation in the absence of any patient or ventilator effort to move the lungs. This phenomenon was first described in humans in the mid-20th century but has seen renewed interest in the last decade following the demonstration of apnoeic oxygenation with low-flow, and subsequently high-flow, nasal oxygen. This narrative review summarises our understanding of apnoeic oxygenation in the paediatric population. We examine the evidence supporting oxygenation via tracheal tube, modified laryngoscopes and nasal cannulae. The evidence for prolongation of safe apnoea time at induction of anaesthesia is also appraised. We explore the capacity for carbon dioxide clearance, flow rate selection with high-flow nasal oxygen and complications associated with the technique. It remains uncertain whether apnoeic oxygenation in paediatric patients results in a meaningful clinical benefit compared with standard care for outcomes such as the number of tracheal intubation attempts or the incidence of hypoxaemia. In particular, the role of apnoeic oxygenation in paediatric difficult airway management is unclear as this has not been the targeted focus of any published research to date.     

Incidence of accidental awareness during general anaesthesia in obstetrics: a multicentre,prospective cohort study

General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30 days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/probable or possible awareness, an incidence of 1 in 256 (95%CI 149–500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122–417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25–30 kg.m^-2); low BMI (<18.5 kg.m^-2); out-of-hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30 days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7–52.0 [2–56]) than in patients without awareness 3 (1–9 [0–64]), p = 0.010. Four patients had a provisional diagnosis of post-traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow-up.     

Update on ENT anaesthesia in children

This article is an update of anaesthesia for common paediatric ear, nose and throat (ENT) procedures. ENT pathology is the most common indication for surgery in children. An increasing proportion are performed as day cases, even in the presence of comorbidities such as obstructive sleep apnoea (OSA), so judicious selection of suitable children remains important. Considerations include severity of disease, known difficult airway, complex comorbidities, and the surgical centre. The anaesthetic management of frequently performed paediatric ENT procedures will be discussed, including recent advances in ENT surgery that have an impact on the anaesthetist.