江门市乡镇集中式供水卫生现状分析

为加强乡镇集中式供水卫生管理，进一步普及与提高农村的改水工作，我们按统一的调查方案，于１９９４￣１９９５年在全国范围内开展乡镇自来水厂调查登记和水质监测工作。据统计全市建成投产乡镇水厂６８座，普及率７７．３％，受益人口１４９．０９万，占农村总人口６２．５％，调查结果显示，水源总污染率为８．８２％，在监测项目中主查细菌学指标合格率不高，丰、枯水期水源水平均合格率分别为４０．０％和８８．９％，而出厂水     

术中皮质体感诱发电位与电刺激术定位脑功能区

目的探讨脑功能区手术中利用脑皮质体感诱发电位(SEP)及直接皮质电刺激定位脑功能区的方法及意义。方法对10例脑功能区病变病人在唤醒麻醉下进行手术，利用皮质SEP及皮质直接电刺激定位感觉区、运动区及语占区，住保护脑功能区的前提下，手术切除病变。结果7例病人利用SEP及皮质电刺激确定出运动感觉区，其中4例利用SEP位相倒置确定出中央沟，3例病变位于左侧额颞叶的病人通过皮质直接电刺激确定出语言区?术后功能均较术前明显好转。结论术中SEP及直接皮质电刺激可准确、实时确定脑功能区，最大程度地保护功能，切除病变。     

儿童地高辛血药浓度的回顾性分析

目的 :探讨血药浓度监测对个体化、合理化用药的重要作用。方法 :荧光偏振免疫法 (FPIA)和通过近十年住院病人地高辛用药的回顾性分析。结果 :地高辛血药浓度监测结果分三个范围 :低值小于 0 .8μg/ L,中值 0 .8～ 2 .2 μg/ L,高值大于 2 .2μg/ L。对实验数据进行统计 ,得出有效浓度范围内的病人占 4 0 %左右 ,低值平均约 >5 0 % ,高值平均为 6 .1%。结论 :通过对地高辛用药的监测回顾 ,说明地高辛的药物代谢过程受许多因素如吸收、分布、代谢、排泄、药物间的相互作用等的影响。所以临床在用药过程中 ,药物浓度的监测对实施个体化、合理化用药 ,减少药物中毒的发生起着重要作用     

基层药品不良反应监测体系建设的实践和探讨

目的 探讨基层药品不良反应监测网络建设模式,为药品不良反应监测组织体系的完善提供参考.方法 通过建立山东省基层药品不良反应监测网络的实践,研究、分析基层药品不良反应监测网络的建设模式.结果 建立了高效、快捷的三级药品不良反应监测网络,促进了山东省药品不良反应监测工作的全面发展.结论 建立健全机构设施完备、职责明确、运作规范的基层监测网络,有利于完善我国药品不良反应监测组织体系,推动药品不良反应监测工作的深入开展.     

Anaesthesia monitoring: the human factors component of technology transfer

Resistance to change in monitoring practices from within the anaesthesiology community is a formidable obstacle, and coercive and exhortatory solutions are likely to be unsuccessful in some situations. An analysis of publications about technology transfer and professional obsolescence, and application of this data to the practice of anaesthesia, reveals various stresses that technology transfer from research areas to the workplace may induce in vulnerable anaesthesiologists and account for their attitudes. It is suggested that the invaluable pronouncements of high profile anaesthesiologist groups must be supplemented by supportive behaviour by physicians and administrators at an institutional level. The human factors issues to be addressed include: (i) Monitored data acquisition skills. (ii) Possibility of acting on monitored data. (iii) Assistance for personal insight into attitudinal difficulties that may be encountered. (iv) Data supporting the value of the device. (v) Ergonomically effective integration of the monitor into the work station.Alternatively the perceptions of potential users may accurately reflect changes in their status in the new work situation created by monitors, and decision making aids that may or may not be derived from them. Thus, plans to present job satisfaction in related clinical areas or to associate the proposed new system with evaluation of its effect on patient outcome will be necessary. In this way the clinician becomes involved in clinical research, a quality of personal and quality care development.     

体感诱发电位在椎管内占位显微手术中的监测

目的　评价体感诱发电位 (SEP)在神经外科脊髓疾病显微手术中的监测作用 ,避免或减少医源性脊髓损伤。方法　 2 8例病人行术前、术中SEP全程监测 ,包括脊髓SEP(SSEP)及皮层SEP(CSEP) ,术中及时把监测信息反馈给术者。并将术中监测结果与术后疗效对照分析。结果　椎管内占位手术在行髓内肿瘤切除时最易引发SEP波幅降低及潜时延长。术中监测按Frankel分级D、E级患者波幅较基准电位下降不超过 50 % ,潜伏期延长不超过7% ;B、C级患者波幅较基准电位下降不超过 40 % ,潜伏期延长不超过 5 %。术后不会引起脊髓功能不可逆损害。结论　脊髓手术时行SSEP和CSEP联合监测可及时反映出脊髓功能的变化 ,提高术者术中操作的安全性 ,避免或减少术后并发症     

模糊数学方法用于职业危害因素的综合评价

模糊数学方法用于职业危害因素的综合评价徐新云（湖南省劳动卫生职业病研究所，长沙４１０００７）用模糊数学方法进行综合评价时，首先要确定评判等级，各评判因素在不同等级中的取值，以及各评判因素的权重系数三方面内容。本文将评判等级定为优、良、一般、差、很差５...     

Compartment syndrome. Exclusively the result of increased pressure in the muscular compartment?

Summary The compartment syndrome (cs) is characterized by an increased tissue pressure in a limited space. Pathophysiologically, it is a multifactorial disease that is potentially induced by an initial trauma and develops according to the existence of cofactors. Cofactors are, for instance, the circulation of the patient and the initial treatment of the impending cs. In particular, the microcirculation is altered with endothelial destruction, development of a capillary leak, protein loss from intravasal space and the development of an interstitial and intracellular third space. An impaired drainage of the lymphatic and venous system causes a venous infarction. An arterial infarction results if the tissue pressure exceeds the arteriolar pressure. An accompanying ischemia reperfusion mechanism increases the trauma load. In disadvantageous cases, the patients are in danger of developing a multi-organ deficiency syndrome (MODS) by an uncontrolled inflammatory reaction, by intravasal volume loss and by a myonephropathic systemic reaction. Clinically, the patients suffer a disproportionate amount of pain, followed by neurological signs. Especially in noncompliant patients, tissue pressure measurement is useful. Resuscitation of the circulation as well as splitting of casts is important. In case of a manifest cs, dermatofasciotomy has to be performed as an emergency operation. Even if cs is diagnosed early and fasciotomy is carried out early, the development of sequellae cannot be avoided in every single case.      

Toluene in blood as a marker of choice for low-level exposure to toluene

The validity of two new biological exposure markers of toluene in blood (TOL-B) and toluene in urine (TOL-U) was examined in comparison with that of the traditional marker of hippuric acid in urine (HA-U) in 294 male workers exposed to toluene in workroom air (TOL-A), mostly at low levels. The exposure was such that the geometric mean for toluene was 2.3 ppm with a maximum of 132 ppm; the workers were also exposed to other solvents such as hexane, ethyl acetate, styrene, and methanol, but at lower levels. The chance of cutaneous absorption was remote. Higher correlation with TOL-A and better sensitivity in separating the exposed workers from the nonexposed subjects were taken as selection criteria. When workers exposed to TOL-A at lower concentrations (< 50 ppm, < 10 ppm, < 2 ppm, etc.) were selected and correlation with TOL-A was examined, TOL-B showed the largest correlation coefficient which was significant even at TOL-A of < 1 ppm, whereas correlation of HA-U was no longer significant when TOL-A was < 10 ppm. TOL-U was between the two extremes. The sensitivities of TOL-B and TOL-U were comparable; HA-U showed the lowest sensitivity. Thus, it was concluded that TOL-B is the indicator of choice for detecting toluene exposure at low levels.     

声音振动刺激试验在临床上的应用

应用声振仪对１９９２年２个月～１９９３年６个月单胎３６～４３周妊娠孕妇１５０例进行了声音振动刺激试验（ＶＡＳ－Ｔ）并与无负荷试验（ＮＳＴ）对照。对此结果ＶＡＳ－Ｔ（＋）１４６例，（－）４例，ＮＳＴ反应型９６例，无反应型５４例。ＮＳＴ无反应型预测价值８％，假阴性率９２％。ＮＳＴ无反应型经声音刺激后５０例成ＶＡＳ－Ｔ（＋）。ＶＡＳ－Ｔ预测价值９９．３％。ＮＳＴ有效率６６％，ＶＡＳ－Ｔ有效率９９％。ＮＳＴ至少需做２０ｍｉｎ，ＶＡＳ－Ｔ９５％在３ｍｉｎ内达到标准，最长１５ｍｉｎ。为避免ＮＳＴ假无反应型，应进行ＶＡＳ－Ｔ。