问题2：无生命迹象和无生命体征的定义是什么？

解答：无生命迹象（no signs of life）是指创伤患者无可测得的血压、呼吸或运动、心脏电活动或瞳孔反应,即临床死亡。无生命体征（no vital signs）是指创伤患者没有明显的血压,但证明有心脏电活动、呼吸运动或瞳孔反应,即有获救可能者。     

基于单模肝超声造影图像的呼吸门控法初步研究

目的:针对单模造影图像的成像特点进行呼吸运动校正方法研究,减小单模肝超声造影图像序列定量分析中呼吸运动的影响。方法:采用图像门控法与模板图像迭代配准法对单模肝造影图像序列配准,在10个肝细胞癌超声造影病例上初步探索,提出呼吸运动校正方法的可行性,并验证该方法的有效性。结果:校正后的肝超声造影图像序列所生成的加权过渡时间和参数图的质量比校正前明显提高,校正后帧选择的图像与模板图像的平均相关系数比校正前平均增加0.26±0.15,校正后的图像序列生成的时间-强度曲线拟合的偏差值比校正前平均减少34.47±10.9。结论:该校正方法能提高单模肝超声造影图像序列定量分析的准确性,从而有助于提高肝肿瘤的鉴别诊断效率。     

呼吸运动对肺癌患者三维适形调强放疗肿瘤靶区体积的影响

目的:探讨肺癌患者采用三维适形调强放疗过程中呼吸运动对肿瘤靶区体积的影响。方法:选择原发性非小细胞肺癌患者30例,均为我院2016年02月至2017年02月收治,行三维适形调强放疗,应用Eclipse 13.6版本治疗计划系统分析呼吸运动对肿瘤靶区体积和位置的影响。结果:对比肿瘤靶区在融合图像下与平静呼吸状态下的体积、融合图像下与诊断图像下的体积、平静呼吸状态下与诊断图像下的体积,不同部位病灶间均具有统计学差异（P＜0.05）。结论:肺癌患者应用三维适形调强放疗方案治疗时,呼吸运动可引发肿瘤靶区体积上的改变,且伴中心坐标移位,对肿瘤靶区进行勾画时,需充分对其影响进行考虑。     

咽部神经肌肉变化与阻塞性睡眠呼吸暂停低通气综合征

阻塞性睡眠呼吸暂停低通气综合征（obstractive Sleep apnea／hypopnea syndrome,OSAHS）是一种睡眠呼吸障碍,它是指每晚7h睡眠中,胸腹呼吸运动存在的情况下,上呼吸道无气流通过超过10s以上,     

应用多普勒超声观察母体Valsalva干预对胎儿的影响

目的 应用超声研究母体Valsalva干预是否能克服胎儿呼吸运动(FBM)并改变胎儿血流动力学.方法 随机选择有FBM胎儿(孕龄为32～36周)100例,分为Valsalva干预组(A1组,50例)、无干预组(A2组,50例).同法选择无FBM胎儿100例,分为Valsalva干预组(B1组,50例)、无干预组(B2组,50例).A1、B1组于Valsalva干预前后应用彩超检测脐动脉、脐静脉、大脑中动脉、静脉导管的血流参数,同时观察15 min内胎儿FBM改变情况;A2、B2组无Valsalva干预,但同样测量上述指标.结果 母体Valsalva干预对有或无FBM胎儿的呼吸次数及持续时间均无显著影响,Valsalva干预前后胎儿脐动脉和大脑中动脉多普勒血流参数、静脉导管S波、D波、a波的血流速度差异无显著性意义(P>0.05);但Valsalva干预前后胎儿静脉导管的PI值、RI值差异有显著性意义(P<0.05).结论 应用母体Valsalva干预克服胎儿FBM,以利于胎儿多普勒超声检查是没有临床依据的,相反会影响静脉导管血流动力学的超声多普勒检测.     

斜坡枕在逆行胰胆管造影术中的应用

在逆行胰胆管造影（ERCP）术中,通常采用俯卧位,头偏向右侧,为了增加病人舒适度,传统做法是在其胸腹部下垫一软枕,但由于软枕面积较大,受压后宜变形,与病人胸腹部接触紧密,从而影响病人的呼吸运动,不利于手术顺利进行.针对此问题,我科设计了斜坡枕用于ERCP术病人,效果良好.现介绍如下.     

放疗中呼吸运动对不同形状射野剂量分布的影响

Objective To evaluate the influence of respiration on the radiation dose distribution within target volume in radiotherapy with film dosimetry. Methods Radiation of 50 MU was delivered by a square, round, ellipse, dumb bell, or female shaped filed to the films within a moving or motionless Respiration Motion Phantom respectively, the dose distributions for the two motion status were measured and compared. In order to further verify the impact of respiration, a plank phantom was used on different shifting value: 0, 0.5, 1.0, 1.5 and 2.0 cm, respectively. A square, round, or eUipse-shaped filed was used for irradiation and the distributions in different status were measured and compared with film dosimetry. Iso-dose line comparison, NAT(Normalized Agreement Tests) and γ comparison were used for the comparison of dose distributions. Fs can be an index to reflect the variability of the areas that surrounded by iso-dose lines. (FS90, FS50, FS25 delegates the ratio of the areas that surrounded by 90 %,50 %,25 % iso-dose hne in different situation respectively). Results (1) Compared with motionless situation, the FS90 in horizontal movement situation became small and the FS25 became large. As the displacement became larger, the FS90 became larger and the FS25 became smaller. FS in vertical movement situation, square and dumb bell fields changed while the others didn't have a change. (2)γ and NAT comparison: In the horizontal movement situation, compared with the static phantom, Pγ < 60 % and PNAT < 75 %. Under vertical movement situation, Pγ were less than 85 % for the square, round, dumb bell and female shaped fileds. In the plank phantom verification, Pγ and PNAT became smaller as the movement became larger. Conclusions The respiration can impact on the dose distribution within the target volume in radiotherapy, leading to a smaller area of higher dose level and an expanded area of lower dose level. The influence will become more significant with larger movement of the target.     

呼吸运动对肺部肿瘤靶区受照剂量分布影响的研究

Objective To investigate the influence of respiratory motion on target dose distribution in radiotherapy for patients with lung tumors. Methods The Big Bore Brilliance CT with bellows system was used to gain the 4DCT sets and respiratory frequency information of the patients. The moving ranges of the tumors in left-right (LR), anterior-posterior (AP) and cranial-caudal (CC) directions were measured from the center coordinate values of gross tumor volume of ten time-phase CT sets in the treatment planning sys-tem. Then a breathing model was used to simulate the tumor motions due to respiration. A 4-dimensional motion table was used to mimic the motion of lung tumor in beams-eye-view (BEV). A 2-dimensional semi-conductor beams measurement system was fixed to the table to measure the 2-dimensional dose distribution of static and dynamic targets using the treatment beams at gantry angle of 0°. Finally, the differences of the dose distribution between the static and moving phantom were compared and analyzed with the statistical soft-ware R. Results When the amplitude (half of the moving rang) in the CC direction was 1 cm, the passing ratio of relative dose difference ≤4% in one beam field was minimal (1.1%), and there was 58% maximal relative dose absence. The 4% passing ratios media in the CC direction were 94.7%, 79.4%, 58.6% and 37.1% in <0.25, 0.25-<0.50, 0.50- <0.75 and ≥0.75 mm amplitude (X<'2>=29.20,P=0.000), but were all similar in the AP and LR directions. The mean value of the relative dose change in the high dose area was smaller than the low dose area in the 89% beam fields. When only the CC direction was consid-ered, the 4% passing ratio of 3.6 s and 8.2 s period was 72% and 60%, respectively. Conclusions The amplitude in the CC direction is a factor impacting the dose distribution of the moving target. The influence of respiratory motion on high dose area is more than that on low dose area. When the other respiratory param-eters are fixed, the motion of long period has more influence on the dose than that of short period. Special at-tention should be paid to the patients with tumor of more than 0.5 cm amplitude in the CC direction when planning the intensity modulated radiotherapy.     

一例多发性肋骨骨折、血气胸的护理体会

我院于2009年2月10日收住一例车祸致左侧多发性肋骨骨折、左肺挫裂伤、血气胸、创伤性湿肺患者,经抢救和精心护理患者痊愈,现将护理体会报告如下.     

呼吸肌锻炼在COPD肺康复治疗中的意义

慢性阻塞性肺疾病（COPD）是一种常见的、严重的呼吸系统疾病,发病率高,死亡率高。近年来。综合的肺康复治疗日益受到重视,其中,针对参与呼吸运动的呼吸肌锻炼起了重要作用。目前临床应用的主要有深慢呼吸、缩唇-腹式呼吸和阻力呼吸锻炼,合适的患者通过正规训练。可以减轻症状,减少残障的发生,从而达到肺康复治疗的目的。