紧急意外化学物质损伤救护模拟训练研究

目的改善意外化学物质损伤救护训练方法,提高意外化学物质损伤救护的能力。方法将化学损伤救护技术与计算机模拟仿真技术结合起来,开发出支持化学物质损伤事故救护的化学损伤救护模拟训练系统。结果化学损伤救护模拟系统可提供交互式训练,改进传统训练方法,提高医护人员业务能力,提升保障机构和人员在紧急化学物质损伤时应急响应能力。结论模拟训练是一项简捷、高效的训练方法,对提高卫勤教学质量及部队卫勤保障能力具有一定的现实意义,提升信息化条件下卫勤训练的信息化水平。     

恶性肿瘤家族史与肺癌发生危险的系统评价

目的探讨恶性肿瘤家族史与肺癌发生的关系。方法通过计算机检索PubMed、CENTRAL、中国生物医学文献数据库系统(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP),收集国内外在1988—2009年间公开发表的恶性肿瘤家族史与肺癌关系的病例-对照研究。采用系统评价方法对各研究结果进行分析,计算其合并优势比(OR)和95%可信区间(CI)。结果纳入合并分析的文章共17篇(10490例病例),结果表明,恶性肿瘤家族史与一级亲属肺癌的发生有关(OR=1.58,95%CI:1.31～1.91,P0.0001)。分层分析表明,一级亲属患恶性肿瘤与非吸烟者肺癌的发生有关(OR=1.46,95%CI:1.08～1.97,P=0.01);一级亲属患肺癌与肺癌的发生有关(OR=1.71,95%CI:1.49～1.95,P0.0001);一级亲属中父亲、母亲及兄弟姐妹(包括同父异母和同母异父者)患恶性肿瘤与肺癌的发生有关[OR值分别为1.43(95%CI:1.10～1.84,P=0.007)、1.36(95%CI:0.99～1.87,P=0.06)和1.51(95%CI:1.35～1.69,P0.0001)]。结论恶性肿瘤家族史明显增加一级亲属患肺癌的风险。     

Pain control in first-trimester surgical abortion: a systematic review of randomized controlled trials

Background

First-trimester abortions especially cervical dilation and suction aspiration are associated with pain despite various methods of pain control.

Study Design

Following the guidelines for a Cochrane review, we systematically searched for and reviewed randomized controlled trials comparing methods of pain control in first-trimester surgical abortion at less than 14 weeks gestational age using electric or manual suction aspiration. Outcomes included intra- and postoperative pain, side effects, recovery measures and satisfaction.

Results

We included 40 trials with 5131 participants. Because of heterogeneity, we divided studies into seven groups:Local anesthesia: Data were insufficient to show a clear benefit of a paracervical block (PCB) compared to no PCB. Reported mean pain scores (10-point scale) during dilation and aspiration were improved with carbonated lidocaine [weighted mean difference (WMD), −0.80; 95% confidence interval (CI), −0.89 to −0.71; WMD, −0.96; 95% CI, −1.67 to −0.25], deep injection (WMD, −1.64; 95% CI, −3.21 to −0.08; WMD, 1.00; 95% CI, 1.09 to 0.91), and with adding a 4% intrauterine lidocaine infusion (WMD, −2.0; 95% CI, −3.29 to −0.71; WMD, −2.8; 95% CI, −3.95 to −1.65).PCB with premedication: Ibuprofen and naproxen resulted in small reduction of intra- and postoperative pain.Conscious sedation: The addition of conscious intravenous sedation using diazepam and fentanyl to PCB decreased procedural pain.General anesthesia: Conscious sedation increased intraoperative but decreased postoperative pain compared to general anesthesia (GA) [Peto odds ratio (Peto OR) 14.77 (95%, CI 4.91-44.38) and Peto OR 7.47 (95% CI, 2.2-25.36) for dilation and aspiration, respectively, and WMD −1.00 (95% CI, −1.77 to −0.23) postoperatively). Inhalation anesthetics are associated with increased blood loss (p<0.001).GA with premedication: The cyclooxygenase (COX)-2 inhibitor etoricoxib; the nonselective COX inhibitors lornoxicam, diclofenac and ketorolac IM; and the opioid nalbuphine improved postoperative pain.Nonpharmacological intervention: Listening to music decreased procedural pain.No major complication was observed.

Conclusions

Conscious sedation, GA and some nonpharmacological interventions decreased procedural and postoperative pain, while being safe and satisfactory to patients. Data on the widely used PCB are inadequate to support its use, and it needs to be further studied to determine any benefit.     

胚胎宫内生长受限42例临床分析

目的:探讨孕早期胚胎宫内生长受限存在的临床依据及其发病相关因素和临床意义。方法:对42例孕早期月经龄与胚胎生长发育不相符病例的临床资料进行回顾性分析(研究组),与同期随机抽取的1956例正常孕妇作对照(对照组),对年龄、婚龄、不孕不育病史、不良孕史、宫内操作史、盆腔感染性疾病史,孕中、晚期并发症发生情况、分娩期情况及新生儿情况进行分析。产后随访1年,记录新生儿及婴儿生长发育、智力发育情况。结果:孕早期胚胎宫内生长受限发病的相关危险因素两组比较,差异有统计学意义,年龄(P<0.05)、婚龄(P<0.05)、不孕不育病史(P<0.01)、不良孕史(P<0.01)、宫内操作史(P<0.01)、盆腔感染性疾病史(P<0.01)、前置胎盘(P<0.01)、胎盘异常(P<0.01)、胎盘粘连及植入(P<0.01)、产后出血(P<0.05)。结论:孕早期存在胚胎宫内生长受限,其发病相关因素有遗传、免疫因素;盆腔感染性疾病史;受精卵滋养层发育迟缓等。     

160例米非司酮配伍米索前列醇不同给药方式在终止孕早期妊娠临床应用

目的:探讨米非司酮配伍米索前列醇不同给药方式在孕6～13周早孕引产中的应用效果。方法:回顾分析2006年1月～2009年10月要求终止妊娠患者160例。分析米非司酮配伍米索前列醇早孕引产的临床疗法及安全性,米非司酮总剂量为150mg,根据不同服药方法分为两日服法和3日服法;根据米索前列醇不同给药方式分为口服给药和阴道给药;将160例实验对象分为4组:A组米非司酮3日服法,第3日晨顿服米索前列醇500mg;B组米非司酮服法同A组,第3天晨阴道置入米索列醇500mg;C组米非司酮两日服法,第3天空腹顿服米索前列醇500mg;D组米非司酮服法同C组,第3天晨阴道置入米索前列醇500mg。结果:米非司酮配伍米索前列醇引产4组成功率均令人满意。相同剂量的药物,相同的给药途径引产效果差异无统计学意义(P>0.05),而不同的给药途径引产效果差异有统计学意义(P<0.05)。结论:非米司酮两日服法,即75mg每天1次顿服共2天,配伍米索前列醇500mg阴道给药的早期引产方法更为简便、安全、有效、痛苦小,值得临床推广应用。     

Buccal misoprostol for cervical ripening prior to first trimester abortion

Background

Cervical priming prior to uterine suction evacuation softens the cervix and lessens the force needed for dilation, thereby potentially reducing the probability of procedural complications. The use of buccal misoprostol has been shown to be an adequate cervical primer in second trimester surgical procedures, but its use in first trimester aspiration procedures is not well documented. Our objective was to assess the necessity of manual dilation of the cervix when buccal misoprostol is used for cervical priming prior to first trimester uterine aspiration procedures.

Study Design

Retrospective case review of 685 patients who underwent a first trimester aspiration abortion with buccal misoprostol cervical priming from August 24, 2006, to February 23, 2007. All procedures were performed by three experienced physicians.

Results

Adequate dilatation of the cervix was achieved in 44.2% patients. The proportion of patients with adequate dilation decreased with increasing gestational age. Patients requiring additional mechanical dilatation differed significantly between those who were parous (51.0%) and those who were nulliparous (72.4%) (p<.001).

Conclusion

Buccal misoprostol appeared to decrease our need for manual dilation prior to first trimester aspiration abortion. Earlier gestations and parous patients showed less need for manual dilitation than later gestations or nulliparous women. A larger study with a control group is needed to confirm the benefit of the use of buccal misoprostol in first trimester aspiration abortion.     

分层次开展急救培训提高部队官兵急救能力的探索

目的探索依托军队中心医院为部队官兵开展分层次急救知识培训,提高其急救能力。方法选择基层部队的19名军医、34名卫生士官和2 300名普通官兵,针对三种对象采取不同的急救知识培训方式,于培训前后进行急救理论与技能的考核。结果培训前后所有参训学员的理论与技能考核成绩有显著差异。结论对基层部队官兵分层次针对性地进行急救知识培训,可有效提高培训效率,使不同层次的官兵掌握相应的急救技能,提高部队的整体急救水平。     

Hallux rigidus: Joint preserving alternatives to arthrodesis - a review of the literature

Hallux rigidus describes the osteoarthritis of the first metatarsophalangeal joint. It was first mentioned in 1887. Since then a multitude of terms have been introduced referring to the same disease. The main complaints are pain especially during movement and a limited range of motion. Radiographically the typical signs of osteoarthritis can be observed starting at the dorsal portion of the joint. Numerous classifications make the comparison of the different studies difficult. If non-operative treatment fails to resolve the symptoms operative treatment is indicated. The most studied procedure with reproducible results is the arthrodesis. Nevertheless, many patients refuse this treatment option, favouring a procedure preserving motion. Different motion preserving and joint sacrificing operations such as arthroplasty are available. In this review we focus on motion and joint preserving procedures. Numerous joint preserving osteotomies have been described. Most of them try to relocate the viable plantar cartilage more dorsally, to decompress the joint and to increase dorsiflexion of the first metatarsal bone. Multiple studies are available investigating these procedures. Most of them suffer from low quality, short follow up and small patient numbers. Consequently the grade of recommendation is low. Nonetheless, joint preserving procedures are appealing because if they fail to relief the symptoms an arthrodesis or arthroplasty can still be performed thereafter.     

Cribado precoz de diabetes gestacional y macrosomía

Gestational diabetes (GD), which has a prevalence of 9%, is associated with high maternal and perinatal morbidity. Early diagnosis and treatment of maternal hyperglycemia reduce the risk of macrosomia and the associated intrapartum complications. Risk factors for GD can be identified in the first trimester from maternal history (age, obesity, previous macrosomia or GD, family history of diabetes), biochemical markers (adiponectin, sex hormone-binding globuline and others), and biophysical markers (arteriography, visceral adiposity). Risk factors for macrosomia include obesity and diabetes in the maternal history, pregnancy associated plasma protein-A and free β subunit of human chorionic gonadotropin as biochemical markers, and nuchal translucency and uterine artery Doppler as biophysical markers. Prediction models combining maternal history, biochemical and biophysical markers can achieve a detection rate of 65% and 35% for GD and macrosomia, respectively, with a false positive rate of 10%.