两种全身麻醉方法对老年患者术后认知功能的影响

目的比较异氟醚静吸复合麻醉与持续输注丙泊酚静脉麻醉对老年患者术后认知功能的影响。方法择期全身麻醉下行腹部手术老年患者40例,分为两组：异氟醚组（I组）和丙泊酚组（Ⅱ组）;I组术中吸入1-2 MAC异氟醚维持麻醉;Ⅱ组术中静脉输注丙泊酚0.06-0.2 mg/（kg.min）^-1维持麻醉,采用简易精神状态量表（MMSE）于术前1 d、术后1 h,4 h,24 h及术后4 d对患者进行评分,记录老年患者围术期的认知功能变化情况。结果两组患者认知功能评分在术后1 h时均有明显下降,且异氟醚组下降较丙泊酚组明显;术后4 h时异氟醚组患者认知功能较术前仍有下降,而丙泊酚组患者认知功能基本恢复至术前水平;两组患者术后24 h、术后4 d时认知功能比较无明显差异。结论异氟醚及丙泊酚对老年患者术后认知功能在短期内均有一定影响,异氟醚麻醉的影响程度较大,持续时间也较长。     

小剂量异丙酚用于老年机械通气患者镇静效果的临床观察

目的　探讨小剂量异丙酚在老年危重病人机械通气时的应用。方法　对 32例术后需呼吸机辅助通气的老年患者随机分两组 :对照组 (异丙酚常规用量 ) 1 8例 ,研究组 (小剂量异丙酚 ) 1 4例 ,分别在镇静前给一定的异丙酚负荷量。对照组给异丙酚 40～ 1 0 0 mg,研究组给异丙酚 2 0～60 mg,均在 5～ 1 0 min内推注完 ,随后对照组以异丙酚 1～ 5mg/ kg· h- 1 ,研究组以异丙酚 0 .3～ 1 .5mg/ kg· h- 1分别采用微量泵持续泵入。结果　静注后两组镇静效果达到 Ramsay氏 ～ 级所需时间 :对照组 (1 5± 5) s,研究组 (2 0± 9) s,两组比较无差异 (P>0 .0 5) ;停药后神志恢复时间 :对照组 6～ 1 5min,研究组 35s～ 6min,两组比较有显著差异 (P<0 .0 5) ;两组病人用药前后 BP、HR、R、Sa O2 、Pa O2 、Pa CO2 和 CVP等均有明显改善 (P<0 .0 5) ,但组间差异无显著意义 ,两组病人用药后血压无明显差异 (P>0 .0 5)。结论　异丙酚以 0 .3～ 1 .5mg/ kg· h- 1滴注 ,用于 ICU老年危重患者可达到理想的镇静效果。     

Systematic review and meta-analysis of Saccharomyces boulardii in adult patients

This article reviews the evidence for efficacy and safety of Saccharomyces boulardii(S.boulardii) for various disease indications in adults based on the peerreviewed,randomized clinical trials and pre-clinical studies from the published medical literature(Medline,Clinical Trial websites and meeting abstracts) between 1976 and 2009.For meta-analysis,only randomized,blinded controlled trials unrestricted by language were included.Pre-clinical studies,volunteer studies and uncontrolled studies were excluded fr...     

Investigation into cases of hepatitis of unknown aetiology among young children,Scotland, 1 January 2022 to 12 April 2022

On 31 March 2022, Public Health Scotland was alerted to five children aged 3–5 years admitted to hospital with severe hepatitis of unknown aetiology. Retrospective investigation identified eight additional cases aged 10 years and younger since 1 January 2022. Two pairs of cases have epidemiological links. Common viral hepatitis causes were excluded in those with available results. Five children were adenovirus PCR-positive. Other childhood viruses, including SARS-CoV-2, have been isolated. Investigations are ongoing, with new cases still presenting.     

基于循证的危重患者院内转运审查指标的制订及障碍因素分析

目的 了解危重患者院内转运证据临床应用现状,分析障碍因素,为证据的临床转化提供参考.方法 通过证据总结,纳入49条最佳证据,制订22条审查指标进行临床审查,根据审查结果分析障碍因素及促进因素,制订行动策略.结果22条审查指标临床执行率为0～100％,其中7条指标执行率均为0.障碍因素主要为危重患者院内转运流程不完善、实...     

青年腹股沟疝临床特点及腹腔镜手术治疗疗效分析

目的分析青年腹股沟疝病人的临床特点,探讨腹腔镜手术治疗策略及疗效。方法对2001年1月至2018年12月间在上海交通大学医学院附属瑞金医院普外科行腹腔镜腹股沟疝修补术(LIHR)6220例(7415侧)病人进行回顾性同期非随机对照研究。其中,青年组(18～44岁)804例(860侧),中年组(45～64岁)1976例(2323侧),老年组(≥65岁)3440例(4232侧)。结果与中老年组相比,青年组病人的病程时间长、女性比例高、单侧疝比例高、腹部手术史少、体重指数低(P=0.000)。青年组的斜疝比例高,直疝、复合疝、复发疝、IV型疝比例低(P=0.000)。青年组的经腹腹膜前修补术(TAPP)和轻量大网孔补片比例高(P=0.000)。青年组的手术时间长(P=0.000),术后住院时间短(P=0.000)。青年组和中老年组在术后第1天疼痛分数、术后2周恢复非限制性活动方面差异无统计学意义(P>0.05)。青年组有1例复发,中老年组有13例复发,差异无统计学意义(P>0.05)。青年组无严重并发症(需要手术干预)发生,尿潴留发生率低(P=0.000),其他普通并发症(如血清...     

Is D2 laparoscopic gastrectomy essential for elderly patients with advanced gastric cancer? A propensity score matched analysis

BackgroundThe necessity of the standard D2 gastrectomy for elderly patients with advanced gastric cancer (GC) is controversial because only limited data are available to demonstrate its oncological benefit for them. Our aim was to compare the outcomes of D2 and Non-D2 and to evaluate the survival benefit of D2 laparoscopic gastrectomy (LG) in elderly patients.MethodsWe retrospectively identified 865 patients with GC who underwent radical LG at our hospital between 2011 and 2017. Patients aged ≥75 years who were diagnosed with clinical T1N+ or clinical T2-4 were eligible. The primary outcome was the 3-year overall survival (OS) rate. The confounding factors were minimized using propensity score matching.ResultsThis study included 119 patients (63 D2 LG and 56 Non-D2 LG), and 52 patients (26 each for D2 LG and Non-D2 LG) were analyzed after matching. Although no significant difference was found in overall major complications (P=1.00), complications tended to occur in the D2 group (D2 vs. Non-D2 =3.9% vs. 0%). No differences in the 3-year OS were noted between the two groups (68.8% vs. 68.8%; HR 1.53, 95% CI: 0.56–3.19).ConclusionsThis study demonstrated the possible association between D2 LG and increased complication rate and no survival benefit of D2 LG in elderly patients.     

应用针刺夹脊穴联合半夏厚朴汤治疗海洛因依赖者稽延性戒断症状的效果及对患者TESS评分的影响

目的:探讨应用针刺夹脊穴联合半夏厚朴汤治疗海洛因依赖者稽延性戒断症状的效果及对患者副反应量表(Treatment Emergent Symptom Scale,TESS)评分的影响.方法:选取2018年8月-2019年8月陕西省某戒毒所进行强制脱毒治疗三个月以上,再次自愿进行康复治疗的海洛因依赖稽延性戒断症患者18例作...     

荧光定量PCR检测不孕不育患者解脲支原体和沙眼衣原体

随着社会的发展,不孕不育症患者不断增多,使之不仅是一个医学问题,同时也成为一个社会问题。研究表明,衣原体、支原体的泌尿生殖系感染是造成男女不孕不育的因素之一。为了解我国不孕不育患者泌尿生殖道解脲支原体(UU)和沙眼衣原体(CT)的感染情况,我们采用荧光定量PCR(FQ—PCR)     

心理疏导联合精神护理在ICU谵妄患者中的效果

目的 探讨心理疏导联合精神护理在重症加强护理病房(ICU)谵妄患者中的应用效果.方法 将东莞市第五人民医院ICU于2017年1月-2018年9月收治的70例患者按照随机数字表法分为对照组和观察组各35例.对照组给予常规护理,观察组在常规护理的基础上给予心理疏导联合精神护理,比较两组患者的护理效果、谵妄及生活质量评分.结...