不同麻醉方式用于乳腺癌根治术的对比分析

目的探讨不同麻醉方式用于乳腺癌根治术的临床疗效。方法选取乳腺癌患者120例，根据麻醉方式不同随机分为硬膜外组与全身麻醉（全麻）组各60例，监测两组患者围手术期血压、心率、血氧饱和度等生命体征及去甲肾上腺素、肾上腺素及C反应蛋白等的变化，将两组数据进行对比分析。结果硬膜外组患者术前、术中、术后生命体征及去甲肾上腺素、肾上腺素及C反应蛋白水平无明显变化（均P〈0．01）；全麻组术中生命体征及应激激素水平较术前、术后差异有统计学意义（均P〈0．01）。结论乳腺癌根治术中硬膜外麻醉较全麻具有较轻的手术应激反应，围手术期生命体征亦相对平稳。     

酒剂在《圣济总录》中的应用

酒剂是将药物用白酒或黄酒以一定的方法处理后,使药物有效成分溶于酒中,滤去药滓制成,具有活血通络、易于发散和助长药效的特性,能够增加药物祛风通络和补益作用,可作内服和外用。《圣济总录》为北宋著名方书,其中酒剂应用非常有特色。文章从酒剂的调制方法、服用方法和应用范围3个方面,对书中的酒剂作了系统的归纳总结,对指导临床具有一定意义。     

Development of a method for clinical medication review by a pharmacist in general practice

Medication review of patients on long-term treatment in general practice in the UK has been reported to be inadequate. Proposals followed suggesting that pharmacists could use their expertise to lead such a medication review in conjunction with the general practitioner. This paper describes the concept of clinical medication review by a pharmacist based in general practice. We describe the development of a method for a structured and systematic process for undertaking such a review in clinics conducted by a pharmacist. The method was developed for a nationally funded study in the UK. We provide a definition of clinical medication review and suggests a structure for the process through data gathering, evaluation and implementation.     

GP attitudes to managing drug- and alcohol-dependent patients: a reluctant role

The aim of this study was to determine the experience, confidence and views of GPs in South West Sydney towards managing drug and alcohol dependence and their interest in participating in shared care methadone prescribing. Five hundred and forty-eight GPs were mailed a self complete questionnaire. Non-responders were followed-up by telephone. Seventy-six per cent of GPs responded; 52% considered methadone maintenance to be effective. GPs were more confident managing smoking than alcohol and benzodiazepine dependence and least confident in illicit drug dependence. Fifty per cent reported having no patients on methadone and 40% between one and five patients. GPs in Fairfield and Liverpool reported having most patients; 25% were interested in prescribing methadone for patients in their own practice and 17% for patients referred to them. GPs who had more patients on methadone in their practice (especially those in Fairfield and Liverpool) considered methadone effective and were more likely to be interested in having patients referred to them. The most frequent reasons for not being interested were concerns about patients being demanding or aggressive or the impact on their practice. The most frequently requested support for shared care prescribing was for 24-hour back-up from specialist services, especially requested by those with less experience with patients on methadone. A shared-care approach to facilitating greater GP involvement in prescribing appears feasible, especially among GPs with some previous experience with patients on methadone.     

建立全麻俯卧位头面部压红三级质量控制指标的追踪效果评价

目的探讨针对全麻俯卧位术后面部压红采用预防标准操作流程(SOP)护理后,对建立的压疮三级质量控制指标进行追踪效果评价。方法我科从2014年7月建立全麻俯卧位头面部压红三级质量控制指标,将2014年7月-9月收治的82例全麻俯卧位术后患者作为A组,采用传统的头面部压红护理方法;2015年7月-9月收治的83例全麻俯卧位术后患者作为B组,在A组预防措施基础上采用头面部压红预防标准操作流程(SOP)、头面部压红观察记录单进行监督。比较两组患者术毕翻身后、离室前、入复苏室后和送返病房前的头面部压红发生率,以此评价各阶段的护理质量。结果患者术毕翻身后头面部压红发生率,B组明显低于A组,差异有统计学意义(P0.05);而在离室前、入复苏室后和送返病房前的头面部压红发生率,两组差异不明显(P0.05)。结论全麻俯卧位头面部压红发生率是护理质量控制的过程指标,尤其是术毕翻身后的压红监测,能够有效监控巡回护士的工作质量。应用SOP能有效降低术毕后的压红发生率。追踪发现多数压之褪色的头面部压红在复苏期能够消褪。     

Unfavourable working conditions for female GPs. A comparison between Swedish general practitioners and district nurses

Objective - The aim was to analyse gender and occupational differences in the psychosocial working conditions of general practitioners (GPs) and district nurses (DNs) in Sweden. Design - A stratified random sample of GPs (n = 566) and DNs (n =554) from four county councils in Sweden. The overall participation rate was 83%. Setting - Primary health care. Main outcome measures - A mailed questionnaire comprising 10 items providing demographic data and 36 items on psychosocial working conditions was used. The questionnaire had been tested for validity and reliability. A factor analysis included five items: strains and symptoms, professional content, social support at work, workload and job control. Results - Professional content was the most positively rated aspect, whereas workload was the most negatively rated. GPs perceived a higher workload and lower social support than did the DNs. Female GPs scored significantly more negatively than both male GPs and female DNs did in four out of the five factors. Female GPs reported a high workload, low job control and low social support at work. Female DNs, too, reported a high workload, relatively low job control but fairly strong social support. Conclusion - Female GPs perceived more unfavourable psychosocial working conditions than both male GPs and female DNs did in the same organisational setting.     

全麻诱导不同通气方式对中心静脉压的影响

目的探讨全身麻醉诱导时低潮气量高频率辅助通气与高潮气量低频率辅助通气对中心静脉压的影响,选出对循环血流动力学影响较小的辅助通气方式。方法选择2010年3月～2011年7月于江门市中心医院行全身麻醉的患者120例,随机分为两组,每组60例。Ⅰ组在全麻诱导准备插管前采用低潮气量高频率辅助通气,Ⅱ组在全麻诱导准备插管前采用高潮气量低频率辅助通气,全程监测心率、血氧饱和度、平均动脉压、中心静脉压,分别记录患者在全麻诱导前、全麻诱导时、气管插管后的中心静脉压值（CVP）,比较两组CVP值的变化。结果全麻诱导前及气管插管后两组CVP值差异无统计学意义（P〉0.05）,全麻诱导时Ⅱ组CVP值明显比Ⅰ组低,差异有统计学意义（P〈0.05）。结论全麻诱导时低潮气量高频率辅助通气对CVP的影响小,较高潮气量低频率辅助通气对CVP的影响较大,但持续时间很短,在气管插管后,这种影响即消失