多参数监护仪的测量原理及其使用与维护

多参数监护仪目前已成为医院应用最广泛的仪器之一 ,其使用与保养维护的好坏 ,将影响到临床应用质量及经济收入 ,我们将就目前主流多参数监护仪的测量原理及其使用与维护作了介绍     

Intra-arterial and extra-arterial pH, PCO2 and PO2 monitors

In vitro blood gas analysers inherently limit the frequency of serial blood gas measurements because of blood loss and cost. In vivo blood gas monitors eliminate an inherent cost and blood loss associated with measurement. Optode microsensing is a technology that can be readily adapted to in vivo measurement of pH, PCO₂ and PO₂. Optode-based intra-arterial devices that display continuous values have been developed that are practical for routine use but consistent performance remains a problem; an extra-arterial device that provides intermittent values has been shown to be consistent but is not yet available for routine use. The transfer of blood gas measurements from laboratory analysers to the combination of point-of-care analysers and monitors should have as profound an impact on acute respiratory care as did the introduction of laboratory-based blood gas analysers over 30 years ago. However, we must be sure these devices are reliable, consistent and cost beneficial in order to avoid widespread adoption of yet another technology that provides more data, more cost, and questionable patient benefit.     

Infrequent syncope in a heavy vehicle driver

We present a case study of a truck driver with sinus node dysfunction diagnosed with the help of an implantable loop recorder more than 18 months after implantation. This case emphasizes that cardiogenic syncope may be very infrequent and its diagnosis can be elusive despite extensive testing.     

Repeated sensory contact with aggressive mice rapidly leads to an anticipatory increase in core body temperature and physical activity that precedes the onset of aversive responding

The present study investigated whether the 'psychological threat' induced by sensory contact with an aggressive conspecific would be a sufficient factor in inducing behavioural and physiological disturbances. Repeated sensory contact with an aggressive mouse (social threat) in a partitioned cage was compared with repeated exposure to a novel partitioned cage in male NMRI mice. We first examined parameters of stress responsiveness (body weight, plasma corticosterone levels, frequency of self-grooming and defecation). The temperature and physical activity responses to stress were also recorded during and after the 4 weeks of stress using radiotelemetry. Finally, cognitivo-emotional performance was assessed after acute stress and 2 and 4 weeks of stress by measuring decision making, sequential alternation performance and behaviour in the elevated T-maze. Social threat had a greater impact than novel cage exposure on most parameters of stress responsiveness, although mice did not habituate to either stressor. Social threat rapidly led to an anticipatory rise in core body temperature and physical activity before the scheduled stress sessions. Such anticipation developed within the first week and persisted for 9 days after ending the stress procedure. Some memory impairment in the sequential alternation test was found in stressed mice, independent of the stressor. After 4 weeks of stress, inhibitory avoidance in the elevated T-maze was enhanced in socially stressed mice and reduced in novel cage mice. The sustained anticipation of stress in the social threat group preceded aversive responding. It remains to be established whether anticipation contributes to the development of aversive responses.     

Use of creatinine clearances to monitor the effect of low-dose dopamine in critically ill surgical patients

INTRODUCTION: Despite uncertain evidence of its efficacy, "low-dose dopamine" (2-5 microg/kg/min) has often been used to augment renal perfusion in critically ill surgical patients. The 2-h creatinine clearance (CC) has been shown to be a monitor of renal function in critically ill patients. We therefore studied the use of sequential CC determinations to monitor the effect of low-dose dopamine (LDD) in surgical intensive care unit (SICU) patients. We hypothesized that sequential CC measurements could demonstrate whether individual patients had positive responses in renal function to LDD. METHODS: Data were prospectively collected for patients on LDD in a university SICU. CC were recorded for these patients immediately before and after the institution of LDD or before and after the cessation of LDD. APACHE II scores, gender, urine creatinine, age, blood pressure, heart rate, and urine output (UO) were also recorded for these patients; P < 0.05. RESULTS: Twenty-four pairs of CC values were observed during the study. The mean APACHE II score for the patients was 15.1. In 10 cases after initiation of LDD, the mean CC increased from 52.5 +/- 23.7 ml/min to 68.1 +/- 33.8 ml/min (P = 0.056). UO also increased from 48.0 +/- 27 to 75.9 +/- 49 ml/h (NS). In 14 cases after discontinuation of LDD, CC decreased from 85.6 +/- 36.3 ml/min to 63.6 +/- 45.5 ml/min (P = 0.044) and UO decreased from 105.1 +/- 73.9 to 89.6 +/- 76.7 ml/h (NS). Overall, 13 of the 24 patients had a 25% change or more in CC upon initiation or cessation of LDD. CONCLUSIONS: LDD institution increased CC in individual patients in the SICU population. Because using LDD in the absence of a discernable improvement in renal function is costly and may harbor risks, we recommend following CC in patients on LDD to determine which patients derive benefit from the intervention.     

DATEX OHMEDAS/5型监护仪在围麻醉期的应用

介绍了DATEX OHMEDAS/5型监护仪在围麻醉期的应用体会.对围麻醉期中使用监护仪如何使监测数据做到稳定性、抗干扰进行了说明,分析了可能导致不稳定、被干扰的原因.     

野战医疗队地域电子监控系统的设置

随着国防建设的加强、和平时期救灾意识的强化,医院野战医疗队外出驻训和实战的频次越来越多。野战医疗队在野外展开地域的安全也成为越来越被关注的焦点。野战医疗队现地展开虽然相对集中,但除分类调整哨出口外,仍有很长的地域分界线需要哨兵站岗,使得本身人数不多的野战医疗队人力资源紧张的问题显得尤为突出。本文阐述野战医疗队野外现地展开后安防监控的建设方法。通过合理选择和架设野外监控,填补警戒人员不足的空缺。     

邯郸市2013年初、复治涂阳肺结核患者耐药状况分析

目的了解浙江省台州市肺结核病例的耐药情况,为制定肺结核防控策略提供依据。方法对2015—2017年在台州市耐药监测点连续纳入的267例涂阳病例的痰标本,进行结核分枝杆菌培养、菌群鉴定。采用比例法药敏试验进行9种抗结核药物[异烟肼(INH)、利福平(RFP)、乙胺丁醇(EMB)、链霉素(SM)、卡那霉素(KAM)、氧氟沙星(OFX)、卷曲霉素(CPM)、丙硫异烟胺(PTO)和对氨基水杨酸钠(PAS)]的药物敏感性试验。结果267例病例中,送检培养220例,培养阳性190例(17例鉴定为非结核分枝杆菌感染),培养阴性28例,污染2例。160例有9种抗结核药物的药敏试验结果,总耐药率为22.5%,初治组耐药率为21.4%,复治组耐药率为33.3%,两组差异无统计学意义(P＞0.05)。耐多药率为3.1%,初治组耐多药率为0.7%,复治组耐多药率为26.7%,两组差异有统计学意义(P < 0.01)。9种药物的耐药顺位依次为INH(8.1%)、PTO(8.1%)、SM(6.9%)、RFP(6.3%)、OFX(2.5%)、PAS(2.5%)、EMB(2.5%)、CPM(2.5%)和KAM(2.5%)。不同性别耐药率差异无统计学意义(P>0.05)。不同年龄组耐药率差异无统计学意义(P>0.05)。结论对台州市耐药结核病疫情仍需引起重视,特别是获得性耐多药疫情。须继续完善“三位一体”管理模式,提高临床诊疗质量,强化社区服药管理。