分娩球配合导乐陪伴分娩在正常分娩产妇中的临床研究

目的探讨分娩球配合导乐陪伴分娩对正常分娩产妇的影响。方法随机选择我院2005年12月~2006年8月住院入产房分娩的68例孕妇作为观察组,孕妇自入产房待产开始,经产科检查后,排除胎先露异常及存在严重妊娠并发症不能下床活动的孕妇。由导乐陪伴,并在宫缩间歇期骑坐在分娩球上,或者通过滚、靠、抱等方式来减轻疼痛。同时,随机抽取我院2005年1~9月入产房分娩的72例孕妇作为对照组。观察两组产妇分娩方式、产后出血、新生儿出生后Apgar评分及分娩并发症等。结果观察组手术产率降低,产后出血减少,新生儿窒息发生率降低,与对照组有统计学意义(P<0.01)。结论分娩球配合导乐陪伴分娩能提高自然分娩率,降低手术产、产后出血及新生儿窒息发生率。     

导叶对轴流泵性能影响的试验

对设计模型轴流泵在无导叶和有导叶时的外特性进行测试,在导叶进出口位置开设测孔,并运用球形五孔探针对导叶进出口流场进行测量,得到绝对速度的周向、轴向及径向速度分量的分布曲线.测量结果表明:轴功率变化曲线在有导叶和无导叶时趋于一致,可忽略导叶对叶轮内流动的影响;在设计最优工况下,导叶出口绝对速度的圆周分量较小,导叶可回收的旋转动能约占叶轮出口总能量的15.7%;无导叶时泵的运行工况点向小流量工况偏移,在设计无导叶轴流泵时应在原有设计参数的基础上进行参数补偿.运用球形五孔探针测量三维流场中速度,具有适用性强、方法简单、测量精度较高的优点.试验结果揭示了导叶对轴流泵性能影响的规律,为进一步研究轴流泵内部流场提供了理论和实际应用参考.     

中国新生儿营养支持临床应用指南

推荐意见强度分级:指南参考美国肠内肠外营养学会2000年指南,依据证据等级强度,将推荐意见分为了A、B、C三个等级(表1)。第一部分肠内营养支持通过胃肠道提供营养,无论是经口喂养还是管饲喂养称为肠内营养(enteralnutrition,EN)。1推荐摄入量1.1能量经肠道喂养达到105～130kcal/(kg·d),大部分新生儿体重增长良好。部分早产儿需提高能量供应量眼约150kcal/(kg·d)演才能达到理想体重增长速度。(B)1.2蛋白质足月儿2～3g/(kg·d),早产儿3～4g/(kg·d)蛋白质:热卡=1g:35～43kcal(2.8～3.1g:110～12kcal)。(B)1.3脂肪5～7g/(kg·d),占总能量…     

Targeted Endodontic Microsurgery: Implications of the Greater Palatine Artery

IntroductionTargeted Endodontic Microsurgery (TEMS) combines trephine burs and 3D-printed guides to make flapless maxillary palatal root-end surgery possible. This study assessed the location of the greater palatine artery (GPA), the relationship of the GPA to maxillary molar root ends, and the feasibility of flapless palatal-approach TEMS.MethodsThree endodontists analyzed 250 cone-beam computed tomographic images of maxillary molars for (1) transition morphology between the hard palate and the alveolar process adjacent to first and second molars as an indication of the most likely location of the GPA, (2) the superior-inferior relationship between the GPA and root ends, and (3) the feasibility of palatal-approach TEMS.ResultsPalatal transition morphology included 20% Spine, 72% Bridge, and 8% Smooth. GPA position as related to palatal root ends was classified as 34% superior, 40% adjacent, and 21% inferior. Five percent of classifications were undefined. TEMS was deemed feasible for 47% of maxillary first molars and 52% of second molars, and was significantly more feasible with GPAs superior to palatal root ends. Reasons for infeasibility included GPA proximity and unfavorable resection angle or level. Maxillary first molar palatal roots were 11.13 ± 2.68 mm from the greater palatine foramen (GPF) and 2.37 ± 1.46 mm from the GPA. Second molar palatal roots were 4.94 ± 2.55 mm from the GPF and 2.53 ± 1.77 mm from the GPA.ConclusionsPalatal transition morphology and GPA position adjacent to maxillary molars, as manifested in cone-beam computed tomographic coronal views, suggested maxillary palatal root TEMS could be accomplished with a 2-mm safety margin in 47% of first molars and 52% of second molars. Historical paradigms that do not consider flapless palatal surgical approaches may need to be revised.     

Five-year survival rates for implants placed using digitally-designed static surgical guides: a systematic review

Digitally-designed static surgical guides provide an acceptable level of accuracy and predictability for the placement of dental implants. However, to our knowledge, few published studies have compared the long-term survival of implants placed in this way with those placed using other methods. A systematic search of electronic databases using a population, intervention, comparison, and outcome (PICO) framework was conducted of Medline and EMBASE, as well as grey literature and hand searches, to obtain all relevant work pertaining to the survival of dental implants placed by guided surgery. The studies were required to have at least 10 patients with a follow up of at least five years. A total of 621 titles were screened. Four studies met the inclusion criteria for quantitative analysis, and they all reported the exclusive use of Nobel Biocare implants and the NobelGuide system (Nobel Biocare Services). Cumulative survival rates ranged from 94.5% to 100% over five years. The survival rates of implants placed using digitally-designed static surgical guides are comparable to the estimated overall survival rate (95.6% over five years), despite the complex nature of the treatments done with guided surgery. Clinicians who do these operations should, however, have the experience and ability to revert to conventional freehand techniques if complications arise.     

集中示教结合视频指导模式在心肺复苏技能培训中的应用

目的探索适用于临床护士的心肺复苏术（CPR）技能培训模式。方法将2011年参加心肺复苏培训护理人员600人纳入本研究,按随机数字法分为传统教师授课模式、视频指导自学模式、集中示教结合视频指导模式3组,每组200人,授课1周后分别采用CPR操作技能评分表及运用心肺复苏训练模拟人对护士进行考核。结果集中示教结合视频指导模式组心肺复苏操作的各项要点考核得分：病情评估（19．21±1．43）分、胸外按压（19．14±2．18）分、开通气道（10．36±0．96）分、人工呼吸（10．32±1．63）分、效果评估（3．68±0．51）分、综合评价（8．90±1．10）分及考核均值（91．33±5．00）分、操作合格率（94．5％）均明显高于传统教师授课模式组[（18．73±2．01）分,（17．00±3．09）分,（9．06±1．10）分,（9．84±1．48）分,（3．35±0．71）分,（7．34±1．44）分,（86．56±6．84）分,89．5％]和视频指导自学模式组[（18．50±2．34）分,（16．84±3．19）分,（8．96±1．14）分,（9．77±1．57）分,（3．29±0．75）分,（7．27±1．48）分,（86．00±7．40）分,88．5％],集中示教结合视频指导模式组与其他两组比较,差异具有统计学意义（P〈0．05）;而传统教师授课模式组与视频指导自学模式组相比较,差异无统计学意义（P〉0．05）。结论集中示教结合视频指导模式能够有效增强培训效果。     

颈椎病的中医康复治疗

目的：探讨颈椎病的中医康复治疗方法。方法：结果：治愈60％;好转37．5％;无效2．5％。总有效率为97．5％。观和康复预防观,疗效肯定,并发症少,安全无不良反应。采用颈椎牵引,辨证用药和康复训练指导等方法,并观察其效果。结论：通过牵引,充分利用中医康复学的辨证康复观,功能康复     

外科手术计算机辅助导航技术

外科手术计算机辅助导航即利用计算机图形图像技术对放射影像学资料进行处理 ,重建二维或三维的医学图像模型 ,同时结合各种空间定位技术 ,在医师的双眼、手术工具及患者的头部之间建立一个实时的环路 ,实现手术过程中器械位置的实时或准实时显示。我们综述了外科手术计算机辅助导航系统的发展历史和研究现状 (重点阐述了其系统结构和关键技术 ,包括空间定位技术、图像处理与显示技术、系统配准技术、头部定位技术等 (最后给出了手术导航系统的发展趋势     

细针引导腰麻针径路的解剖特点与临床应用

目的：评价细针引导腰麻针穿刺径路的解剖特点与其临床应用效果。方法：经尿道微创腔镜手术30例,用9号穿刺针置于皮下引导,25GWhitacre腰穿针通过9号穿刺针孔进行蛛网膜下腔穿刺,成功后拔出内芯,可见脑脊液外流,注入0.5%布比卡因2～3ml退针,立即平卧位。观察病人麻醉平面、血压变化及麻醉效果。结果：穿刺操作简单,全部病例完成腰麻,麻醉效果好,一次腰麻能够完成手术。术后随访无任何异常。结论：掌握正确的解剖要领作细针引导下腰麻穿刺可降低病人的损伤,是一种可行、安全及有效的麻醉方法。