Tourniquet pain in a volunteer study: effect of changes in cuff width and pressure

This study examines the relationship between pneumatic tourniquet cuff size, occlusion pressure and the resulting pain. Two tourniquet cuff widths were used, a wide (14 cm) and a narrow cuff (7 cm). Twenty volunteers were divided into two groups for tourniquet application: a pressure group in which the tourniquet was inflated to a pressure equal to the systolic pressure + 100 mmHg, and a saturation group in which the tourniquet was inflated to 10 mmHg above the loss of arterial pulse, as indicated by cessation of pulse waveform on an oximeter. According to a randomised cross-over protocol, subjects were studied using wide and narrow cuffs simultaneously and/or successively on both arms. Pain was assessed by subjects by means of a visual analogue score (0-10 cm). Occlusion pressures were similar for all volunteers in the pressure group and significantly higher than those in the saturation group with both the wide and narrow tourniquets. The wide cuff data turned out to be significantly lower than the narrow cuff results. Subjects in the pressure group could tolerate pain with the narrow cuff for significantly longer than with the wide cuff. However, in the saturation group, volunteers tolerated the wide cuff for longer. Pain intensity increased more rapidly in those in the pressure group with the wide cuff than with the narrow cuff. In contrast, volunteers in the saturation group found the narrow cuff to be more painful than the wide cuff. In conclusion, this study has shown that a wide tourniquet cuff is less painful than a narrow cuff if inflated at lower pressures and at these lower pressures it is still effective at occluding blood flow.     

浅析现代化医院设备管理的新趋势

从医院设备管理的发展历史出发，结合现代化医院设备管理科学的发展和信息化的时代要求，对设备管理、维护、修理趋势进行分析，在此基础上提出现代化医院设备管理科学化的发展方向。     

山西省磁共振成像发展概况

目的　分析山西省磁共振成像 (MRI)发展概况 ,为制定大型医用设备政策提供科学依据。方法　用描述性统计方法研究山西省所有 2 1台MRI的基本情况以及MRI与各地区经济、医院等级间的关系 ,并参照国家政策和部分国家MRI发展情况进行分析。结果　 1.山西省MRI发展水平与当地经济发展水平相一致 ;条件好的医院MRI发展较快 ,设备档次较高。 2 .山西省MRI拥有量、MRI的档次不仅远低于发达国家 ,甚至低于一些发展中国家。但是 ,山西省和太原市MRI的拥有量水平均高于国家制定的MRI配置标准。结论　 1.仅从部分国家 ,包括发展中国家的MRI发展状况相比较的角度看 ,山西省MRI发展水平较低 ,与快速发展的经济不相适应 ,应加快其发展步伐。 2 .由于山西省和太原市在我国经济发展中处于较低水平 ,MRI发展已超过国家标准 ,旧的标准不再适合新的发展 ,应考虑修定MRI发展标准     

贝叶斯分层模型在医疗器械临床试验中的应用

贝叶斯方法是基于贝叶斯定理而发展起来的,用于系统阐述和解决统计问题的方法.贝叶斯方法的核心在于参数随机化,在先验概率的基础上通过参数的后验概率进行统计推断.医疗器械往往具备优良的先验信息,贝叶斯方法在器械临床试验中的应用贯穿试验设计和数据分析的各个阶段,贝叶斯方法在正确应用的前提下,临床试验的成本会比频率学派更小.贝叶斯分层模型与经典贝叶斯方法相比,对先验信息的可交换性要求更低,更为灵活的借取“部分”先验信息.本文以一项冠脉支架临床试验为例,应用贝叶斯分层模型方法,对实际结果与传统频率学派方法获得的结果进行比较,并进行相应的讨论.     

我国复合手术室配置与临床应用的思考

随着医学装备技术的融合发展,复合手术室在国内应运而生并快速发展。作为一项新技术、新产品,复合手术室在设备使用和管理方面存在诸多争议,针对其建设和发展中面临的困惑,本研究从复合手术室的发展历程、临床使用情况出发,对复合手术室的定义、分类、建设和使用进行深入的分析和研究,提出加强复合手术室建设和发展的思考。     

数字摄影有效照射野控制与影像切割

目的:应用DR图像切割技术,探讨降低患者吸收剂量、节省存储空间、提高影像质量的途径。方法:选用不同大小的FPD照射野进行曝光,对诊断区外的影像切割后进行存储,在患者剂量、存储空间、影像质量等方面比较其与最大射野时的差异。结果:FPD受照面积分别为8×10英寸、10×12英寸、14×17英寸时,对应的与射野等大的存储文件大小分别为3.96MB、8.58MB、15MB,切割后存储文件最小分别可达2.1MB、5.2MB、7.5MB;与板等大照射野吸收剂量分别是2.16 dGy、10.61 dGy、2.78 dGy,与诊断区等大照射野吸收剂量分别为1.64 dGy、6.71 dGy、1.61 dGy。结论:在应用DR进行摄影时,缩小照射野至诊断区大小,并对图像进行切割,可以降低患者吸收剂量,节省存储空间,并提高影像质量。     

X射线行李包安检设备辐射泄漏量的MCNP模拟

目的 模拟计算地铁站所使用的X射线行李包安检设备辐射泄漏量的大小。方法 采用MCNP4C程序来模拟X射线安检设备在使用过程中X射线的泄漏量。结果 人体接受到的最大辐射剂量为8.26μSv/a,但如果能保持安检设备铅帘的完整性人体受到的辐射剂量仅为0.0727μSv/a。结论 当行李进出安检机并导致铅帘产生缝隙时,辐射泄漏量会显著增大;人体所受到的最大辐射量仍低于《电离辐射防护与辐射源安全基本标准》(GB18871-2002)中规定的10μSv/a的豁免标准。     

论现代医疗设备管理

本文以作者多年从事医疗设备管理经验出发,综述了现代医疗设备管理的主要问题。本文将从设备购入管理,设备安装,设备使用管理,设备评估四方面分析医院高科技设备管理中应注意的一些问题,并在最后,提出了自己关于改进设备管理的建议。     

Effects of Mini‐Volume Priming During Cardiopulmonary Bypass on Clinical Outcomes in Low‐Bodyweight Neonates: Less Transfusion and Postoperative Extracorporeal Membrane Oxygenation Support

Mixing of autologous blood with priming volume has relatively significant effects on blood composition, especially in low‐bodyweight neonates. In an effort to reduce these effects, mini‐volume priming (MP) has been applied in cardiopulmonary bypass (CPB). The present study was designed to examine the effect of MP on clinical outcomes of low‐bodyweight neonates undergoing open heart surgery.We retrospectively reviewed medical records of low‐bodyweight (2.5 kg or less) neonates who underwent open heart surgery in our center from January 2000 to December 2014. A total of 64 patients were included. MP was introduced in 2007, and became a routine protocol in 2009. Preoperative and intraoperative characteristics included age, bodyweight, RACHS‐1, priming volume, CPB time, and aortic cross‐clamp time, transfusion, and hematocrit during CPB. Clinical outcomes included 30‐day mortality, postoperative extracorporeal membrane oxygenation (ECMO) support, open sternum status, prolonged mechanical ventilation care (>7 days), and acute renal failure. MP was utilized in 39 patients and conventional priming (CP) was used in 25 patients. The priming volume decreased to 126.0 mL in the MP group compared with 321.6 mL in the CP group. Transfusion volume during CPB was 87.3 mL in the MP group versus 226.8 mL in the CP group, and the difference was statistically significant (P < 0.001). Hematocrit at the end of the CPB and maximal decrease of hematocrit during CPB were not significantly different between the two groups. The 30‐day mortality rate was 12.8% in the MP group versus 20.0% in the CP group. Postoperative ECMO support was performed in 5.1% of patients in the MP group versus 17.4% of patients in the CP group. Open sternum status was required in 20.8% of patients in the MP group versus 10.3% of patients in the CP group, and prolonged ventilator care was required in 54.2% of patients in the MP group versus 38.5% of patients in the CP group. However, no statistical significance was measured in any of the clinical outcome measures. Larger priming volume and higher RACHS‐1 were significant risk factors of postoperative ECMO support in univariate and multivariate analysis. The results of the present study suggest that MP may be beneficial in avoiding transfusion without having a significant effect on the hematocrit. Clinical outcomes did not differ between the two groups. However, larger priming volume was a significant risk factor for postoperative ECMO support with RACHS‐1 category.