鼻塞持续气道正压通气治疗新生儿呼吸衰竭临床观察

目的观察经鼻塞持续气道正压通气(N-CPAP)治疗新生儿呼吸衰竭的效果。方法应用STEPHANN-CPAP小儿呼吸机对30例危重新生儿进行经鼻塞持续气道正压通气呼吸支持治疗,观察治疗前后临床症状和血气变化。结果治疗有效25例,无效5例。治疗有效患儿使用N-CPAP时间12~96h,平均(32±4)h。并发症为鼻黏膜损伤,共12例。全部病例均治愈出院。结论N-CPAP治疗新生儿肺炎并呼吸衰竭及早产儿原发性呼吸暂停效果显著,是新生儿科一种简便易行、无创安全、疗效显著的呼吸支持设备。     

A catheter technique in ophthalmic regional anaesthesia. Cadaver experiments

BACKGROUND: Regional anaesthesia for ophthalmic surgery is generally accomplished by peri- or retrobulbar techniques. Depending on the duration of ophthalmic surgery, reblock might become necessary. Our goal was to invent a catheter technique for ophthalmic regional anaesthesia that enables the user to administer local anaesthetics intraoperatively into the peri- or retrobulbar space continuously. METHODS: Twenty-five adult cadaver orbits of normal size and anatomy were used for the experiments. A flexible catheter was introduced transcutaneously or transconjunctivally into the extra- or intraconal space. Methylene blue solution was injected through the catheter. RESULTS: Using the same transcutaneous retro- and peribulbar technique, it was possible to introduce flexible catheters into a proper position of the cadaver orbits. The injected dye was found intra- or extraconally. CONCLUSION: Examining the spread of the dye in the orbit, we concluded that it is possible to provide ophthalmic anaesthesia for surgery through an indwelling catheter. We proved that continuous or intermittent administration of a local anaesthetic agent into the extra- or inraconal space can be achieved and this technique may allow us to maintain anaesthesia as long as it is necessary.     

先天性白内障手术中预防后发障的方法

目的　探讨小儿先天性白内障手术中预防后发障的方法。方法　对 46例 ( 4 6眼 )先天性白内障 ,以白内障超声乳化仪的注吸I/A系统吸净晶状体植入人工晶状体后 ,进行后囊连续环形撕囊及前段玻璃体切除联合手术 (A组 ) ,同期施行的3 2例 ( 3 2眼 )先天性白内障 ,以同样的方法行白内障摘出人工晶状体植入后 ,进行单纯后囊连续环形撕囊术 ,不做前段玻璃体切除 ,作为对照组 (B组 )。术后随访 2年以上。结果　后发障发生的情况 ,A组 2眼 ( 4 4% ) ,B组 7眼 ( 2 1 9% ) ,两组对比差异具有显著性意义 (P <0 0 5 )。两组均未发现眼底并发症。结论　先天性白内障术中行后囊连续环形撕囊联合前段玻璃体切除术 ,是预防后发性白内障的有效方法。     

连续环形撕囊的大小对后囊浑浊的影响

目的　分析不同口径连续环形撕囊对后囊浑浊的影响。方法　回顾 10 1眼分别以囊口直径 4 5～ 5 0mm和 6 0～7 0mm连续环形撕囊 ,行白内障超声乳化联合后房人工晶状体植入术 ,观察术后后囊浑浊的情况。结果　随访 1年 ,A组采用小口径连续环形撕囊 68眼中 1年发生后囊浑浊 2 5眼 ( 3 6 8% ) ,其中 2级 2 1眼 ( 3 0 9% ) ,3级 4眼 ( 5 9% ) ;B组采用大口径连续环形撕囊 3 3眼中 1年发生后囊浑浊 2 6眼 ( 78 8% ) ,其中 2级 18眼 ( 5 4 5 % ) ,3级 8眼 ( 2 4 2 % )。 2组间发生后囊浑浊 2级、3级 ( χ2 =4 2 976,P <0 0 5 ;χ2 =5 5 0 73 ,P <0 0 5 )差异均具有显著意义。结论　小口径截囊者后囊浑浊发生率低于大口径截囊者。     

不同截囊方式所致晶状体后囊破裂的比较

目的　比较开罐式截囊与连续环形撕囊术中后囊破裂的原因和发生率。方法　将作者 4年来手术的 13 3眼白内障按时间顺序分为A组和B组。A组行开罐式截囊 ;B组行连续环形撕囊 ,其它步骤相同。分别统计后囊破裂的例数和原因。结果　后囊破裂共 14眼 ,其中A组 10眼 ,发生率 10 75 % ;B组 4眼 ,发生率 10 0 0 %。两组发生率的差异无显著意义 ( χ2=0 0 16,P >0 5 0 )。结论　后囊破裂与截囊方式无关。     

炼钢连铸混合智能调度方法及其应用

在炼钢连铸生产工艺约束条件下,针对多设备、多工序、以及生产类型复杂的生产环境,目前还难以在合理时间内获得最优调度解,提出了基于规则的专家调度方法、基于规划的两阶段调度方法和基于多级模糊综合评价方法的混合智能调度方法,并在合理时间内得到一个有效的可行解。应用混合智能调度方法建立了智能调度架构,设计并开发了软件系统。该系统应用于国内某大型钢厂的生产调度,在缩短计划编制时间、减少钢水等待时间、提高设备利用率方面获得显著经济效益。     

大剂量盐酸氨溴索联合新型鼻罩持续呼吸道正压通气治疗新生儿呼吸窘迫综合征

目的探讨大剂量盐酸氨溴索(沐舒坦)联合新型鼻罩持续呼吸道正压通气治疗新生儿呼吸窘迫综合征(NRDS)的疗效。方法选择NRDS患儿114例,随机分成治疗组(n=58)和对照组(n=56),两组在相同综合治疗的基础上,对照组予头罩吸氧(氧流量4~6 L/min),治疗组予大剂量沐舒坦30 mg/(kg.d),分2次用5%葡萄糖注射液20 mL稀释后静脉滴注,并联合新型鼻罩持续呼吸道正压通气(NCPAP),其参数设定为流量6~8 L/min,吸入氧浓度(FiO2)0.4~0.6,压力为5~8 cm H2O,观察两组治疗后12及48 h的临床表现及血气变化,比较pa(O2)及pa(CO2)及pa(O2)/FiO2的变化。结果治疗组44例经治疗12 h及48h后,呼吸困难和呻吟明显减轻或消失,血pa(O2)升高,pa(CO2)下降,氧合参数明显增加,其中以胸片RDS分级Ⅰ及Ⅱ级效果较佳,Ⅲ及Ⅳ级效果较差;治疗组总有效率75.8%,而对照组为26.7%,两组疗效及血气、氧合指数比较均有显著性差异。结论大剂量沐舒坦联合新型鼻罩持续呼吸道正压通气能改善通气及氧合,对新生儿RDS有较好的疗效,尤其对胸片RDS分级Ⅰ级及Ⅱ级的患儿,早期应用可避免气管插管,减少机械通气率。     

两种噪声强度测定法用于噪声作业岗位卫生学评价的比较

目的　探讨两种不同方法对工作场所的噪声强度进行测定的效果 ,为噪声作业岗位的卫生学评价提供科学依据。方法　选择有噪声作业的 3个场所 ,且噪声是不连续、非稳态噪声 ,分别用瞬时测定方法和等效连续A声级测定方法对噪声强度进行测定。结果　用瞬时测定方法测得 3个工作场所A、B、C的噪声强度分别是 89 6dB(A)、95 3dB(A)和 92 7dB(A) ,3个工作场所的噪声强度都超过国家职业卫生标准。用等效连续A声级方法测得 3个工作场所的噪声强度分别是 83 8dB(A)、92 5dB(A)和 88 7dB(A) ,根据国家职业卫生标准 ,工作场所A噪声强度未超标 ,工作场所B、C噪声强度超标。结论　对于不连续、非稳态噪声 ,用等效连续A声级方法测定噪声强度比瞬时测定方法更科学合理 ,更客观反映劳动者接触噪声的实际情况     

Interaction of treatment with a continuous variable: simulation study of power for several methods of analysis

In a large simulation study reported in a companion paper, we investigated the significance levels of 21 methods for investigating interactions between binary treatment and a continuous covariate in a randomised controlled trial. Several of the methods were shown to have inflated type 1 errors. In the present paper, we report the second part of the simulation study in which we investigated the power of the interaction procedures for two sample sizes and with two distributions of the covariate (well and badly behaved). We studied several methods involving categorisation and others in which the covariate was kept continuous, including fractional polynomials and splines. We believe that the results provide sufficient evidence to recommend the multivariable fractional polynomial interaction procedure as a suitable approach to investigate interactions of treatment with a continuous variable. If subject‐matter knowledge gives good arguments for a non‐monotone treatment effect function, we propose to use a second‐degree fractional polynomial approach, but otherwise a first‐degree fractional polynomial (FP1) function with added flexibility (FLEX3) is the method of choice. The FP1 class includes the linear function, and the selected functions are simple, understandable, and transferable. Furthermore, software is available. We caution that investigation of interactions in one dataset can only be interpreted in a hypothesis‐generating sense and needs validation in new data. Copyright © 2014 John Wiley & Sons, Ltd.     

A prospective,multicenter phase II study of continuous infusion of FLAG for patients older than 60 yr with resistant acute myeloid leukemia: a comparison with intensive younger patients’ trial

Relapsed or refractory acute myeloid leukemia (R/R AML) in elderly (≥60 yr old) patients were eligible. Induction chemotherapy consisted fludarabine and cytarabine (ARAC) as a 24‐hr CI without idarubicin (C‐FLAG), which was compared with the results of C‐FLAG with idarubicin (CI‐FLAG2) in younger patients’ trial. A total of 33 and 68 patients were enrolled in C‐FLAG and CI‐FLAG2, respectively. CR, CRp, and CRi were achieved in 10 (30.3%), 3 (9.1%), and 2 (6.1%), respectively. When comparing outcomes between C‐FLAG and CI‐FLAG2, there were no difference in terms of CR rate (P = 0.572) and objective response rate (ORR; P = 0.899). Favorable predictors on ORR in C‐FLAG were PB WBC ≤ 20K/uL at salvage (P = 0.024) and early evaluation peripheral BLAST = 0% (P = 0.013) on multivariate analysis. The overall survival of patients who achieve CR/CRp/CRi showed significantly prolonged survival compared with patients who did not in C‐FLAG (P < 0.001) and was a favorable predictor of longer survival by multivariate analysis (P = 0.009). Median overall survival was 3.19 (95% CI, 2.05–4.33) months and similar with that of CI‐FLAG2 (P = 0.841). Attenuated salvage regimen C‐FLGA in elderly patients was as effective as more intensive younger patients’ regimen CI‐FLAG2 in terms of response and survival although elderly patients had more unfavorable clinical characteristics.