超声引导下深静脉穿刺置管技术在围术期小儿患者中的应用

目的：探讨超声引导下深静脉穿刺置管技术在围术期小儿患者中的应用效果。方法选取我院接收的80例择期拟行手术患儿作为本次的研究对象,对其临床资料进行回顾分析。结果观察组患儿的穿刺置管时间、穿刺总成功率、一次穿刺成功率、失败率及并发症发生率与对照组比较均有统计学差异（P ＜0.05）。结论给予择期手术患儿超声引导下深静脉穿刺置管术治疗可提高成功率,减少并发症,具有较高的应用价值,可推广应用。     

儿童外伤性白内障50例临床分析及护理

[目的]通过对儿童外伤性白内障围术期相关护理因素的分析,确定患儿的心理特征及健康需求。[方法]对不同年龄段患儿采用了不同的护理措施。[结果]通过对外伤性白内障患儿的护理,使之能最好的配合手术,50例儿童外伤性白内障手术前后矫正视力比较,差异具有统计学意义(χ2=32.29,P<0.05)。[结论]采用针对性的围术期护理措施,是取得良好治疗效果保障之一。     

Population pharmacokinetics and pharmacodynamics of cefpirome in critically ill patients against Gram-negative bacteria

Objectives To develop a population pharmacokinetics model for cefpirome in ICU patients, to assess pharmacokinetic-pharmacodynamic profiles vs. MIC distribution of likely ICU pathogens, and to assess their expected cumulative fraction of response (CFR). Design and setting Prospective observational study in a multidisciplinary ICU. Measurements and results Twelve patients received 2 g cefpirome intravenously over 12 h. Thirteen blood samples were taken on two occasions. Demographic and creatinine clearance data were collected. Based on the final covariate model obtained using NONMEM, Monte Carlo simulations were undertaken to simulate free-drug concentrations for two administration methods: intermittent bolus administration (IBA) and continuous infusion (CI) with a loading dose of 0.5 g. Concentration-time profiles were evaluated by the probability of achieving free-drug concentrations above the MIC for more than 65% of dosing interval. Using MIC distributions from the EUCAST programme the CFR for each method was evaluated. A three-compartment model with zero-order input best described the concentration-time data. The CFR for Escherichia coli and Klebsiella spp. was greater than 97% in all IBA and CI doses but for Pseudomonas aeruginosa, and Acinetobacter spp. achieved target concentrations of 56% and 46%, respectively. High-dose CI cefpirome (6 g/day) for P. aeruginosa and Acinetobacter spp. was required to achieve CFR of 89%. Conclusion Measured creatinine clearance appears to be a good marker of cefpirome clearance and potentially could be used to individualise cefpirome therapy. When given as IBA or CI for E. coli and Klebsiella spp., cefpirome should be successful. Cefpirome fails to achieve the bactericidal target even when administered at high-doses such as 6 g/day for P. aeruginosa and Acinetobacter spp. Prospective clinical studies are needed to conclusively validate these findings.     

危重病患者血清瘦素表达及营养评价指标的作用

目的　探讨危重患者急性期禁食、全胃肠外营养 (TPN)治疗后血清瘦素的表达 ,以及营养评价指标对营养支持的作用。方法　用放射免疫法测定危重病患者血清瘦素 ,同时检测相关营养评价指标。结果　危重病患者急性期瘦素变化不明显 ,TPN治疗后迅速上升 ,第 3天达高峰 ,治疗后 5d仍高于正常。两组血浆纤维蛋白原、白蛋白、总胆固醇、甘油三脂、血淋巴细胞计数差异均无显著性意义 ,P >0 0 5。结论　危重病患者急性期禁食血清瘦素无显著性改变 ,但对TPN治疗反应迅速 ,血清瘦素有可能用来作为危重病患者急性期营养评价指标。血浆纤维蛋白原、白蛋白、总胆固醇、甘油三脂、淋巴细胞计数对危重病患者急性期营养状况无评价性作用。     

双人更换床单法在外科危重患者中的应用体会

目的总结外科手术后危重和多管道患者最佳更换床单操作的方法。方法制订规范的双人操作卧床患者更换床单的操作流程，并于2005年12月开始对本病区450例患者实施双人更换床单法。结果按此卧床更换床单法进行规范操作，890例患者在此过程中各种管道均通畅、无扭曲及脱落；均描述整个更单过程较舒适，更单时感觉疼痛感无增加或可耐受；未出现因更单而造成的患者病情变化。结论外科危重和多管道患者双人更换床单法比单人操作法安全，提高了患者的舒适度，同时也符合节力原则。     

Maltreatment and Developmental Disabilities in Children

The purpose of this review is to explore the interactive influences of maltreatment and disabilities on children's development, and to provide practical suggestions about what may be done to optimize developmental outcomes. The review briefly describes maltreatment in the general population, noting incidence, proportions of children experiencing different types of maltreatment, and special risk for very young children. The disproportionate vulnerability of children with developmental disabilities is discussed, with emphasis on risk factors for maltreatment. The high incidence of developmental disabilities in maltreated children and reasons for it are described. Studies documenting the developmental consequences of abuse and neglect are reviewed. Specific recommendations, based on review of maltreatment and disability literature, include recognizing subtle forms of maltreatment; routinely screening for developmental problems; referring children for comprehensive multidisciplinary evaluation; identifying caregiver competency; gaining familiarity with intervention resources; and monitoring children's progress with directive guidance.     

儿童意外伤害的特点及预防

综述了儿童意外伤害发生类型、特点、影响因素,并提出了相应的预防策略。     

Care of the critically ill patient

Modern intensive care medicine requires a multidisciplinary approach to look after critically ill patients. Dedicated critical care units offer a variety of facilities to monitor and support organ functions, allowing diagnosis and treatment of life-threatening conditions in a controlled environment. This article describes the main principles of intensive care medicine, giving an overview of a systematic approach to assessment and treatment of organ dysfunction, and highlights some of the complex ethical and organizational challenges.