新生儿期生长发育及影响因素调查

对370例新生儿的生长发育进行了监测,本组新生儿出生体重平均为3277g,平均身长49.9cm,低体重儿(<2500g)的发生率为1.6%,出生后8～14d生长最快,28d平均累计增重981g、增长6cm、母乳喂养儿的身长和体重的增长速度和幅度均优于其他喂养方式。并对母乳喂养年龄,妊娠周数,出生体重等影响生长发育的因素进行了分析。     

Twenty-four hour ambulatory monitoring of tremor,sweating, skin temperature and locomotor activity in the alcohol withdrawal syndrome

An ambulatory monitor has been used to determine the characteristic patterns of tremor, sweating, skin temperature and locomotor activity in subjects undergoing alcohol withdrawal. Twenty-four hour records were obtained from six male subjects who had been consuming an average of 345 g of alcohol per day prior to cessation and from a group of agematched controls. Consistent with earlier research and clinical observation, tremor, sweating and locomotor activity were elevated in withdrawal subjects. Sweating was greatest in the period from approximately 00.00 h to 06.00 h, as was skin temperature. Tremor and activity levels decreased during this period, but were considerably higher in withdrawal subjects. The data suggest that 24-h monitoring of alcohol withdrawal using objective methods provides a more sensitive assessment technique than the standard clinical approaches. The technique may be of value in other dysautonomic states.     

气功改善心气虚型高血压病患者心功能和微循环作用观察

120例老年受试者作超声心动图测定,结果发现老年高血压患者(80例)左心功能低于无高血压老年人(40名),而心气虚高血压患者(46例)明显低于无心气虚高血压患者(34例)。气功治疗1年后,心输出量增加,总周围阻力降低,EF、EFV、Mvcf 均趋向于增加,提示气功有纠正血液动力学失调和增进左心功能作用。120例老年受试者甲皱微循环检测发现高血压有加剧微循环障碍作用,心气虚高血压患者微循环障碍发生率为73.91%,气功锻炼1年后为39.13%(P<0.01)。提示气功有改善微循环的作用。以上结果表明气功能益心气通血脉。     

Dual-channel audio monitor for distinguishing action potentials from two different sources

An audio-monitor design is described which allows action potentials from two different input channels to be heard and distinguished from each other. Two other more conventional modes of operation have also been incorporated into the design, making the device a versatile instrument for monitoring neurophysiological events. The dual-channel mode of operation is most useful in detecting the relationship of activity between the two sources.     

实时超声显象检测卵泡预告排卵期的临床意义

本文叙述了超声检测卵泡的方法、声象图表现。通过对30例月经周期正常妇女超声检测卵泡的研究结果表明,自月经周期第10天开始,超声可显示直径7mm的卵泡,排卵前卵泡直径为21±0.5mm。排卵前5～6天内,卵泡平均每天增长1.8±0.5mm,以卵泡直径20mm做为成熟卵泡,预测排卵时间为1.42±1.16天。并就超声检测预告排卵的临床价值等问题进行了讨论。     

Waste gas monitor reduces wasted volatile anesthetic

Objective. The increasing focus on health care costs requires that all physicians evaluate practice behaviors. The primary emphasis in anesthesia has been limiting the use of expensive medications and interventions. Reducing waste is another approach, and volatile anesthetics are an appropriate target in that simple reduction of fresh gas flow (FGF) rates is effective. A monitor that measures and displays the cost of wasted volatile anesthetic was developed and used to determine if real-time display of the cost would result in decreased FGF rates, which, in turn, would decrease wasted anesthetic. Methods. The waste gas monitor (WGM) measures flow rate at the anesthesia machine's scavenger port, integrates this with agent concentration, and displays the calculated cost, real-time, on a portable computer screen. The WGM equipment was attached to the anesthesia machine in the gynecologic surgery operating room (OR) and those cases performed under general endotracheal anesthesia and lasting longer than one hour were eligible for inclusion. First year anesthesiology residents assigned to the study OR as part of a non-specialty rotation, were the subjects of the study. For each resident, after data were collected from at least two eligible baseline cases (Baseline Phase, WGM not visible and resident unaware of its presence), the monitor was introduced and data collection continued for at least three more eligible cases (Visible Phase). Results. Nine residents were initially enrolled, but due to scheduling difficulties only five residents completed the protocol. Data from cases using the WGM demonstrated a 50% decrease (3.58 ± 1.34 l/min vs. 1.78 ± 0.51 l/min (p = 0.009)) in the scavenger flow rates, which resulted in a 48% ($5.28 ± 0.68 vs. $2.72 ± 0.80 (p = 0.002)) decrease in hourly cost of wasted volatile anesthetic. There was no difference between the Baseline and Visible phases with regard to use of nitrous oxide or intravenous anesthetic agents. Conclusions. The WGM decreased wasted volatile anesthetic by encouraging decreased FGF rates.     

The effect of chart speed on fetal monitor interpretation

Objective: Electronic fetal heart monitor chart speeds vary between countries, and it is unclear whether differing chart speeds affect physician tracing interpretation.

Methods: Twenty-minute segments of 19 tracings were displayed on both 1 and 3?cm/min strips and interpreted by 14 physicians at the particular speed they were accustomed to reading. Interpretations of tracing characteristics were compared between groups using free margin kappa, a measure of interobserver agreement.

Results: Compared to 3?cm/min tracings, 1?cm/min tracings were significantly more often identified as having absent than minimal variability, and minimal than moderate variability. Accelerations were significantly more often identified in 1 versus 3?cm/min strips. There were no significant differences between groups with respect to baseline fetal heart rate, prolonged or repetitive decelerations, or American College of Obstetricians and Gynecologists tracing category. Neither chart speed had substantial interobserver agreement in tracing variables; however, agreement was consistently higher in 3 versus 1?cm/min tracings (all p?<?0.05).

Conclusions: Tracing interpretation is significantly affected by fetal monitor chart speed with regards to variability, acceleration and deceleration. Further studies are required to determine if differences in chart speed interpretation affect clinical management.     

A comparison of manual versus automated saturation of peripheral oxygenation in the neonatal intensive care unit

Background: It is vital to maintain the saturation of peripheral oxygenation (SpO₂) in a targeted range in extremely premature infants to improve survival without significant morbidities.

Objectives: To compare manual versus automated monitor documentations of daily upper and lower values of SpO₂ in premature infants.

Methods: In a prospective observational study, the highest and lowest daily SpO₂ manually recorded values from electronic medical records were compared with automatically recorded values from bedside cardiorespiratory monitors.

Results: Eighteen infants were monitored for 605 patient days, with a mean birth weight of 859?±?183?g, and gestational age of 26.0?±?1.3?wks. Within the lowest SpO₂ values, manually recorded values were consistently higher than the simultaneous automatically recorded monitor values. The highest SpO₂ point differences in documentation was seen in patients with SpO₂ range?≤?70% (16?±?13 points), followed by 71–80% (10?±?7 points) and 81–90% (7?±?4 points); p?<?0.01.

Conclusions: The difference between manually and automatically recorded SpO₂ is large in lower SpO₂ ranges and small in higher SpO₂ ranges. Automated oxygen administering systems should be considered to reduce potential errors.     

Surgeons' exposure to sevoflurane during paediatric adenoidectomy: a comparison of three airway devices

Although sevoflurane is commonly used in anaesthesia, a threshold value for maximum exposure to personnel does not exist and although anaesthetists are aware of the problem, surgeons rarely focus on it. We used a photo‐acoustic infrared device to measure the exposure of surgeons to sevoflurane during paediatric adenoidectomies. Sixty children were randomly allocated to laryngeal mask, cuffed tracheal tube or uncuffed tracheal tube. The average mean (maximum) sevoflurane concentrations within the surgeons' operating area were 1.05 (10.05) ppm in the laryngeal mask group, 0.33 (1.44) ppm in the cuffed tracheal tube group and 1.79 (18.02) ppm in the uncuffed tracheal tube group, (p < 0.001), laryngeal mask and cuffed tracheal tube groups vs. uncuffed tube group. The presence of sevoflurane was noticed by surgeons in 20% of cases but there were no differences between the groups (p = 0.193). Surgical and anaesthetic complications were similar in all three groups. We conclude that sevoflurane can be safely used during adenoidectomies with all three airway devices, but in order to minimise sevoflurane peak concentrations, cuffed tracheal tubes are preferred.     

Identifying ActiGraph non-wear time in pregnant women with overweight or obesity

ObjectivesNon-wear time algorithms have not been validated in pregnant women with overweight/obesity (PW-OW/OB), potentially leading to misclassification of sedentary/activity data, and inaccurate estimates of how physical activity is associated with pregnancy outcomes. We examined: (1) validity/reliability of non-wear time algorithms in PW-OW/OB by comparing wear time from five algorithms to a self-report criterion and (2) whether these algorithms over- or underestimated sedentary behaviors.DesignPW-OW/OB (N = 19) from the Healthy Mom Zone randomized controlled trial wore an ActiGraph GT3x + for 7 consecutive days between 8–12 weeks gestation.MethodsNon-wear algorithms (i.e., consecutive strings of zero acceleration in 60-second epochs) were tested at 60, 90, 120, 150, and 180-min. The monitor registered sedentary minutes as activity counts 0−99. Women completed daily self-report logs to report wear time.ResultsIntraclass correlation coefficients for each algorithm were 0.96−0.97; Bland–Altman plots revealed no bias; mean absolute percent errors were <10%. Compared to self-report (M = 829.5, SD = 62.1), equivalency testing revealed algorithm wear times (min/day) were equivalent: 60- (M = 816.4, SD = 58.4), 90- (M = 827.5, SD = 61.4), 120- (M = 830.8, SD = 65.2), 150- (M = 833.8, SD = 64.6) and 180-min (M = 837.4, SD = 65.4). Repeated measures ANOVA showed 60- and 90-min algorithms may underestimate sedentary minutes compared to 150- and 180-min algorithms.ConclusionsThe 60, 90, 120, 150, and 180-min algorithms are valid and reliable for estimating wear time in PW-OW/OB. However, implementing algorithms with a higher threshold for consecutive zero counts (i.e., ≥150-min) can avoid the risk of misclassifying sedentary data.