靶控输注瑞芬太尼行MAC下无痛膀胱镜检查

目的研究靶控输注瑞芬太尼用于无痛膀胱镜检查的可行性和安全性。方法将30位择期行膀胱镜检查患者,美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ～Ⅱ级,分为2组(L和H组),2组均无术前用药。常规监护后进行效应室靶控输注瑞芬太尼,L组浓度为2μg/L,H组浓度为4μg/L,待到达靶浓度后开始手术操作。术中患者主诉疼痛或出现体动时以1μg/L为单位提高瑞芬太尼靶浓度,最高不超过6μg/L。若脉搏血氧饱和度低于90%则给予面罩加压给氧。在麻醉中观察并记录无创血压、心率、脉搏血氧饱和度、视觉模拟评分(visual analogue score,VAS)、脑电双频指数(bispectral index,BIS)、合并症发生率(呼吸抑制、血压下降、恶心、呕吐、咳嗽和躁动)以及瑞芬太尼用药总量、追加次数、最高靶浓度,并在2组间进行比较。结果 2组患者VAS评分均可达2～4分,L和H组平均BIS值分别为89±10和86±13(P>0.05)。2组患者靶控至预定浓度后血压有明显下降,进镜时收缩压、心率与入室时比较差异无统计学意义(P>0.05),L组与H组辅助呼吸发生率为2/15和8/15(P=0.02)。L和H组术中轻微体动的发生率分别为5/15和1/15(P=0.08)。瑞芬太尼总用药量分别为(125.5±77.7)μg和(242.5±72.6)μg。结论本实验中靶控输注瑞芬太尼,对于膀胱镜检能达到足够的麻醉深度,具有安全性和可行性。靶浓度为2～4μg/L时可提供适合的镇痛强度,同时能够减少不良反应。     

基于传感网的无线监护系统中MAC层协议的研究

目的：针对无线监护系统的特点,寻找一种适合应用的无线传感器网络MAC层协议。方法：通过分析无线局域网协议802.11中PCF机制,根据无线监护系统的特点对其提出一些改进。结果：通过动态地改变PCF机制中超帧的长度,从而使节点在保证通讯质量的前提下减少了侦听时间,延长了寿命。结论：实验表明该方法可以有效地提高网络的容量,减少时延,节省能量。     

静注异丙酚对异氟醚肺泡最低有效浓度的影响

评价静脉异丙酚对异氟醚肺泡最低有效浓度的影响。静脉内以10mg.kg~(-1).h~(-1)滴入异丙酚,在21例(男14,女7;年龄32～66岁)手术患者,测定其对异氟醚MAC的影响。异氟醚呼气末浓度监测时间均在静脉异丙酚滴入和异氟醚吸入25分钟后取值。当异氟醚浓度(呼气末)等于或小于0.86vol％时,42.9％病人切皮时“动”,而当异氟醚浓度等于或大于0.86vol1％时,有52.4％病人无“动”反应。此时计算得出异氟醚之MAC为0.76vol％。即静注异丙酚以10mg.kg~(-1).h~(-1)能减少异氟醚MAC 33.9％;约相当于0.34MAC。异丙酚MAC可能为29.5mg.kR~(-1).h~(-1)。     

接触叠氮酸作业工人的健康危害研究

对31名起爆药三硝基间苯二酚与叠氮化铅共沉淀结晶(D.S共晶)作业工人进行了临床检查;测定了生产场所HN_3浓度,多数低于0.5mg/m~2,少数高于10mg/m~3。工人工作2～18年,头痛、多梦、眼和咽刺激及血压降低明显多于对照组,但未见其器官性损害。工人短时间接触高浓度HN_3(12.8mg/m~3)有自觉不适,脱离接触后迅速消失。结合亚慢性HN_3吸入毒性,提出HN_3和NaN_3最高容许浓度各为0.2mg/m~3和0.3mg/m~3。     

Perioperative Doses of Ondansetron or Dolasetron Do Not Lengthen the QT Interval

ObjectiveTo test the primary hypothesis that ondansetron or dolasetron extends the rate-corrected QT electrocardiographic interval (QTc) greater than 60 milliseconds or increases the fraction of patients with QTc greater than 500 milliseconds in patients having noncardiac surgery, and the secondary hypothesis that QTc prolongation is worse in diabetic patients.Patients and MethodsWe extracted data from the Cleveland Clinic's Perioperative Health Documentation System between March 25, 2006, and September 30, 2010, and additional perioperative medications from Cleveland Clinic pharmacy's Epic Cost of Goods Sold (COGS) system. We searched for patients who had a preoperative electrocardiogram within 1 month of surgery and postoperatively within 2 hours. We excluded patients given an antiemetic drug other than ondansetron or dolasetron perioperatively, and those given amiodarone.ResultsA total of 1429 patients given serotonin-3 receptor (5HT3R) antagonists and 1022 controls met the enrollment criteria. Seventeen percent of patients given 5HT3R antagonists (n=242) and 22% of controls (n=220) had postoperative QTc exceeding 500 milliseconds. Mean ± SD presurgical and postsurgical QTc, respectively, were 438±37 milliseconds and 464±41 milliseconds for 5HT3R antagonist patients and 443±40 milliseconds and 469±47 milliseconds for control patients. Univariable mean ± SD perioperative increases in QTc were 26±39 and 26±48 milliseconds in the 2 groups. After adjusting for confounding variables, there were no differences in the mean increase in QTc in patients who were and were not given 5HT3R antagonists: –0.1 milliseconds (97.5% CI, –5.2 to 5.0 milliseconds; multivariable P=.97). The QTc was prolonged, but not significantly, in diabetic patients given 5HT3R antagonists (P=.16).ConclusionsThe average QTc prolongation from baseline was only 6%. Perioperative use of ondansetron or dolasetron was not associated with extended QT prolongation, and these results did not vary by diabetic status. Perioperative use of 5HT3R antagonists does not produce potentially dangerous perioperative electrocardiographic changes and does not seem to warrant a drug safety warning from the Food and Drug Administration.     

News in Brief

Disseminated Mycobacterium avium complex (MAC) infection is a severe complication of advanced HIV/AIDS disease. Disseminated infection due to MAC appeared later in the natural history of HIV disease and was an independent predictor of mortality in patients before the extended use of highly active antiretroviral therapy (HAART). The use of combination schemes, including three or four antimicrobial agents followed by secondary prophylaxis and HAARTs, improved the survival and reduced mortality rates. However, subjects who ignore their serological status for HIV, or who are not receiving or do not tolerate HAART, are at high risk of developing disseminated MAC disease. In addition, patients who show a good immunological and virological response to HAART can develop episodes of immune reconstitution inflammatory syndrome associated with MAC, including supurative lymphadenitis and subcutaneous or soft-tissue abscesses. In this article, we describe the epidemiological, clinical, immunological, therapeutic and preventive aspects of MAC infection in HIV-seropositive patients in the pre- and post-HAART era.     

广州市区早产儿上臂围、上臂围/头围测定及其意义探讨

本文测量出生后第三天早产儿171例上臂围、上臂围/头围比数值分别为8.35±0.61cm,0.27+0.017。与体重直线相关系数(r)分别是0.661,0.364,均有极显著性(P<0.01),呈线性增长。经主成分分析,提示早产儿主要因素是上臂围和体重的不足。     

车间空气中氯化锌（烟）卫生标准研究

飘扬较系统的动物试验结果和职业人群的流行病不调查，参考国外标准，结合我国实际，为使对职业接触氯化锌（烟）工人的呼吸道刺激和对肺的毒性减少到最小为依据，推荐时间国权平均容许浓度１ｍｇ／ｍ＾３，最高容许浓度２ｍｇ／ｍ＾３。     

MMPI subtypes and antisocial behaviors in adolescent alcohol and drug abusers

Relationships between psychopathology and alcohol, drug abuse, and other deviant behaviors were studied in a sample of 60 adolescents with exaggerated drug use patterns. Modal Minnesota Multiphasic Personality Inventory (MMPI) profile subtypes were identified using multivariate analyses, and adolescents defined by profile type were compared on background and antisocial history variables derived from retrospective self-reports. Data were collected reflecting a variety of drug categories, including alcohol and opiates. Three distinct patterns were found, with 97% of adolescents meeting criteria for profile type assignment. Adolescent subtypes were characterized by significant differences in degree and type of psychopathology but not in antisocial features. Adolescent alcohol and illicit drug use were associated with marked antisocial features, but the more exclusively antisocial drug-using adolescents tended to be involved in earlier and more extensive types of alcohol and drug activities.