急性冠状动脉综合征急诊介入治疗中用Diver C.E.血栓抽吸器的临床研究

目的评价在急性冠状动脉综合征(ACS)急诊介入治疗中应用Diver C.E.血栓抽吸器的安全性和有效性。方法2005年7月~2006年9月,共70例接受急诊经皮冠状动脉介入治疗(PCI)的ACS患者纳入研究,其中抽吸器组35例,根据冠状动脉造影及临床情况从同期急诊介入治疗的ACS患者中选取35例条件相匹配者作为对照组。比较两组间的基础资料、造影结果和临床预后。结果抽吸器组支架直接置入率高(P=0.009),远端栓塞发生率低(P=0.046),校正的心肌梗死溶栓试验帧数计数值小(P=0.004),心肌灌注分级3级获得率高(P=0.044);急性ST段抬高型心肌梗死中抽吸器组术后肌酸激酶同工酶和肌钙蛋白T峰值浓度较低,ST段回落幅度大,均明显优于对照组(P<0.05),但两组住院期间和中期随访主要心血管事件发生率差异无显著性意义。结论在血栓负荷较重的ACS患者中,急诊PCI时应用Diver C.E.血栓抽吸器安全可行,可显著改善患者术后即刻的远端心肌血流微灌注,减少心肌酶的释放,但远期疗效还需进一步评价。     

冠脉搭桥机械通气期间膨肺吸痰的作用及监护

目的探讨膨肺吸痰在冠脉搭桥机械通气期间预防并发症的意义。方法对24例冠脉搭桥机械通气期间使用膨肺吸痰93次,观察吸痰前后HR、SaO2、MAP的变化。结果HR、MAP、69次吸痰前SaO2>95%,吸痰前后差异无显著性(P>0.05),24次吸痰前SaO2<95%,吸痰前后有明显差异(P<0.05),氧饱和度有明显上升。结论膨肺吸痰可有效保持呼吸道通畅,减少负压吸引可能引起的肺不张及低氧血症,减少体力消耗及心脏负担,促进心脏手术后病人早日康复。     

中心负压吸引管末端的挂钩固定

吸痰技术是清理呼吸道分泌物，保持气道通畅的重要措施，整个过程要求严格无菌操作，中心负压吸引管末端的固定放置既要保持管道清洁，又要方便操作，而目前在未使用吊塔的ICU病房和普通病区对吸引管末端的固定放置均达不到清洁、方便的要求，若中心负压吸引管未得到妥善放置，易造成吸引管接头脱落污染，     

一次性减压式吸管用于早孕吸宫术的多中心临床观察

目的:观察一次性减压式流产吸管的使用效果和可接收性。方法:采用多中心随机对照研究方法,在5家医院或计划生育服务机构选择600例妊娠35~56天、<40岁健康妇女,随机使用一次性减压吸管或金属吸管进行负压吸宫术,比较两种吸管的使用效果。结果:减压式吸管在疼痛、出血、手术时间以及人工流产综合征的发生率方面略好于金属吸管,但差异无统计学意义(P<0.05);观察对象对减压式吸管的满意度高于金属吸管,差异有统计学意义(P>0.05)。结论:一次性减压式吸管适用于终止孕56天内的早期妊娠;与传统的金属吸管相比,在减少术时人工流产综合征、出血以及术后阴道流血和月经持续时间上具备一定优势,而且为一次性产品,降低了医源性感染的风险,值得临床使用。     

心内吸引减压阀的研制与临床应用

目的为了减轻体外循环心内吸引力过大，所产生的负压对红细胞和心内膜的破坏，将研制的一种心内吸引减压阀我们在临床试用。方法60例室间隔缺损患儿随机分为减压组和对照组，每组30例，减压组体外循环中心内吸引应用减压阀，对照组体外循环中心内吸引不用减压阀。转流中用负压表进行心内吸引管负压测定。分别在转流10min和1h采血2ml，测定血浆游离血红蛋白（FHb）浓度、红细胞比积（Hct）、血红蛋白（Hb）、红细胞计数（RBC）。术中取右心房心内膜活检做病理观察。结果转流1h对照组FHb较减压组显著增高，有统计学意义（P〈0．05）。两组间转流10min、1h的Hct、Hb、RBC差异均无统计学意义（P〉0．05）。对照组发现心内膜病理改变，减压组未见心内膜的损伤。结论心内吸引减压阀可减小体外循环心内吸引管内的负压，减轻红细胞破坏和心内膜伤害，有保护心内膜以及红细胞的作用。     

Gastric Suction in Healthy Newborn Infants Effects on Circulation and Developing Feeding Behaviour

ABSTRACT. Gastric emptying of newborn infants is a procedure performed to prevent aspiration of gastric contents. The present investigation was conducted to study the effects of gastric suction on circulatory and behavioural parameters in 21 healthy newborn children (11 cases, 10 controls). A small elevation in mean arterial blood pressure was observed during gastric suction. The incidence of retching was also increased. In all children spontaneous sucking and rooting movements, as well as state of sleep and wakefulness were recorded. In the control group spontaneous sucking and rooting movements started to occur 15 min after birth and reached a maximum at 45 and 60 min, respectively. The first hand to mouth movement was observed after a mean of 34 min and the infants found the nipple and started to suckle at about 55 min. This sequence of prefeeding behaviour was disrupted in children who had undergone gastric suction. The physiological side-effects induced by gastric suction are minor, but it seemed to be unpleasant for the child and no clear advantages are gained by the procedure.     

超声在乳腺癌诊断中的应用价值

近年来,乳腺癌的发病率有逐年上升的趋势。由于超声没有电离辐射,在长时间工作状态下不会对医务人员和患者的身体产生损伤,而且简便易行,具有可重复性,因此超声检查已经成为乳腺癌筛查、诊断的主要手段。乳腺癌的超声诊断方法经历了几次重大的革新,从灰阶实时超声、彩色多普勒血流显像、彩色能量多普勒到超声引导下穿刺活检、超声造影以及三维超声。     

Acceptability of suction curettage and mifepristone abortion in the United States: a prospective comparison study

OBJECTIVE: We sought to compare the acceptability of suction curettage abortion with that of medical abortion with mifepristone and misoprostol in American women. STUDY DESIGN: We performed a prospective, serially enrolled, cohort analysis. The study population consisted of 152 subjects receiving mifepristone and misoprostol and 174 subjects undergoing suction curettage abortion aged > or =18 years with intrauterine pregnancies of up to 63 days' estimated gestation. Questionnaires regarding expectations and experiences were administered before the abortion and at the 2-week follow-up visit. RESULTS: Subjects undergoing medical abortions reported significantly greater satisfaction than those undergoing surgical abortions (mean rank, 121 vs 149; P <.01) but were no more likely to recommend the method they had just experienced to a friend (97% vs 93.3%). If a future abortion was required, however, 41.7% of subjects undergoing surgical abortions indicated they would opt for a medical abortion, whereas only 8.6% of subjects receiving medical abortions would choose a surgical abortion (P <.001). Failure of the abortion decreased satisfaction in the medical group and increased the likelihood of choosing a surgical abortion for a subsequent procedure (P <.001). Surgical subjects who experienced more anxiety than expected during the abortion were more likely to choose a medical procedure for a subsequent abortion (P <.01). CONCLUSION: Women receiving mifepristone and misoprostol were more satisfied with their method and more likely to choose the same method again than were subjects undergoing surgical abortion. Failure of a medical abortion and increased anxiety during surgical abortion were associated with preference for the alternative technique in a future procedure.     

Osteomyelitis after Operative Fracture Treatment: A Report of 62 Cases Treated with Radical Surgery and Lincomycin (Lincocin®)

During the years 1967-1975 a total of 62 patients were treated for postoperative osteomyelitis. The lower extremities had been fractured in 89 per cent of the cases and 54 per cent were closed injuries. The fractures, mostly caused by traffic accidents and falls, had been immobilized by plates in 30 and by intramedullary nails or pins in 25 patients.

Staphylococcus aureus was cultured in 80 per cent, 68 per cent of them were resistant to penicillin, but in 84 per cent the organisms were highly lincomycin sensitive and only three patients with four osteomyelitic lesions presented lincomycin resistance.

The treatment consisted chiefly of sequestrectomies and saucerizations supported by 3-12 months of lincomycin treatment. In 30 operations a closed irrigation-suction technique was used, perfusing the wound with lincomycin solution. Stable implants should be left in place until the fracture is clinically solid whereas unstable osteosyntheses should be replaced by rigid internal or extraskeletal fixation.

At follow-up, the results were judged as good in 74 per cent, fair 8 per cent and poor 18 per cent. The amputation rate was 13 per cent.

Plates should not be used in the treatment of comminuted tibial fractures with considerable soft tissue damage.     

Human subcutaneous tissue distribution of fluconazole: comparison of microdialysis and suction blister techniques

AIMS: To investigate uptake of fluconazole into the interstitial fluid of human subcutaneous tissue using the microdialysis and suction blister techniques. METHODS: A sterile microdialysis probe (CMA/60) was inserted subcutaneously into the upper arm of five healthy volunteers following an overnight fast. Blisters were induced on the lower arm using gentle suction prior to ingestion of a single oral dose of fluconazole (200 mg). Microdialysate, blister fluid and blood were sampled over 8 h. Fluconazole concentrations were determined in each sample using a validated HPLC assay. In vivo recovery of fluconazole from the microdialysis probe was determined in each subject by perfusing the probe with fluconazole solution at the end of the 8 h sampling period. Individual in vivo recovery was used to calculate fluconazole concentrations in subcutaneous interstitial fluid. A physiologically based pharmacokinetic (PBPK) model was used to predict fluconazole concentrations in human subcutaneous interstitial fluid. RESULTS: There was a lag-time (approximately 0.5 h) between detection of fluconazole in microdialysate compared with plasma in each subject. The in vivo recovery of fluconazole from the microdialysis probe ranged from 57.0 to 67.2%. The subcutaneous interstitial fluid concentrations obtained by microdialysis were very similar to the unbound concentrations of fluconazole in plasma with maximum concentration of 4.29 +/- 1.19 microg ml(-1) in subcutaneous interstitial fluid and 3.58 +/- 0.14 microg ml(-1) in plasma. Subcutaneous interstitial fluid-to-plasma partition coefficient (Kp) of fluconazole was 1.16 +/- 0.22 (95% CI 0.96, 1.35). By contrast, fluconazole concentrations in blister fluid were significantly lower (P < 0.05, paired t-test) than unbound plasma concentrations over the first 3 h and maximum concentrations in blister fluid had not been achieved at the end of the sampling period. There was good agreement between fluconazole concentrations derived from microdialysis sampling and those estimated using a blood flow-limited PBPK model. CONCLUSIONS: Microdialysis and suction blister techniques did not yield comparable results. It appears that microdialysis is a more appropriate technique for studying the rate of uptake of fluconazole into subcutaneous tissue. PBPK model simulation suggested that the distribution of fluconazole into subcutaneous interstitial fluid is dependent on tissue blood flow.