熏眼与按摩治疗干眼症的持续护理改进对策

目的探讨熏眼与按摩治疗干眼症的持续护理改进对策。方法选择2018年6月—2019年6月于我院接受中药熏眼与睑板腺按摩治疗的干眼症患者196例,以随机数字表法将其随机分为两组,其中对照组与研究组各98例。对照组患者接受常规护理,研究组在此基础上应用持续护理改进对策。评价两组患者的治疗效果、干眼症的复发情况,以及护理满意度。结果研究组治疗的总有效率为97.96%高于对照组90.80%(P<0.05)。研究组复发率3.06%低于对照组12.24%(P<0.05)。研究组护理满意率98.98%高于对照组90.82%(P<0.05)。结论持续护理改进对策能够保证熏眼与按摩治疗干眼症的效果,抑制疾病复发,并增强了患者对护理服务的满意度。     

呼吸机持续气道正压通气联合枸橼酸咖啡因治疗早产儿呼吸暂停给药时间与临床疗效的关系

目的:观察呼吸机持续气道正压通气支持下的不同枸橼酸咖啡因给药时间对早产儿呼吸暂停(AOP)疗效的影响。方法:选取91例出生胎龄<32周的原发性呼吸暂停患儿,按照枸橼酸咖啡因给药时间的不同将患儿分为早期组(51例,出生24 h内在呼吸机持续气道正压通气下完成枸橼酸咖啡因给药)和常规组(40例,72 h内在呼吸机持续气道正压通气下给予枸橼酸咖啡因治疗)。比较两组患儿的呼吸机应用时间、给药时间、吸氧天数以及呼吸暂停改善情况,记录呼吸指标变化和不良反应发生情况。结果:早期组呼吸机使用时间、给药时间、吸氧天数、3 d后呼吸暂停次数及住院时间均明显低于常规组,差异有统计学意义(t=5.561,t=2.901,t=2.821,t=3.180,t=2.987;P<0.05)。经枸橼酸咖啡因治疗3 d后,两组患儿β-内啡肽水平及二氧化碳分压较治疗前均有显著降低,且早期组较常规组下降更为明显(t=0.408,t=3.294;P<0.05);氧分压及血氧饱和度均较治疗前有显著回升,早期组较常规组升高更显著(t=6.4758,t=2.121,t=2.409;P<0.05)。早期组的治疗有效率为86.2%(44/51),常规组为72.5%(29/40),两组比较差异具有统计学意义(Z=-2.149,P<0.05)。早期组不良反应事件发生率为13.7%(7/51),常规组为15.0%(6/40),两组比较差异无统计学意义。结论:呼吸机持续气道正压通气可以改善患儿呼吸功能,有助于患儿更好的渡过呼吸暂停危险期,早期给予枸橼酸咖啡因可促进患儿更快的恢复,显著缩短治疗时间,但不会增加不良事件的发生。     

运动对骨骼－肌腱界面愈合组织的影响

利用纽西兰兔作体内实验，来分析手术后石膏固定，笼内活动，连续被动性活动三种不同的复健方法对肌腱－骨骼间界面愈合组织的影响。结果显示在术后第１５天愈合组织所能承受的最大张力，笼内活动组为０．８７５ｋｇ，石膏固定组为２．０１４ｋｇ，是笼内活动组的２３１．５２％，而连续被动性活动组为２．６３８ｋｇ，是笼内活动组的２６１．３５％。石膏固定组虽有很高的张力，但关节内粘连也较多。     

腰椎穿刺蛛网膜下腔置管持续引流防治脑血管痉挛的初步观察

目的：探讨腰椎蛛网膜下腔置管持续引流对蛛网膜下腔出血（SAH）后脑血管痉挛的预防与治疗效果。方法：对88例颅内动脉瘤性SAH患,在超早期行电解可脱卸弹簧圈（GDC）栓塞术后,实施腰椎蛛网膜下腔置管持续引流,通过临床症状、经颅多普勒超声（TCD）及脑血管造影、ECT判断血管痉挛的发生率及严重程度。结果：11例出现症状性脑血管痉挛,平均随访11个月,恢复良好10例,中度致残1例。无引流相关并发症。结论：腰椎蛛网膜下腔置管持续引流可以清除蛛网膜下腔积血、引流血管收缩物质,预防血管痉挛的发生及缓解痉挛程度。     

Epidural anaesthesia for elective Caesarean section does not influence fetal umbilical artery blood flow indices

This prospective study was completed to determine the influence of epidural anaesthesia on the fetoplacental circulation of normal subjects. Thirty-seven normal pregnant patients at term, undergoing elective Caesarean section, had Doppler measurements of the fetal umbilical artery blood flow velocity before and after epidural anaesthesia using lidocaine 2% without epinephrine. There were no differences in systolic/diastolic, resistance or pulsality indices following epidural anaesthesia. These results suggest that this technique has no adverse effect on fetoplacental circulation in normal non-labouring subjects. Cette étude prospective a pour but de déterminer l’influence de l’anesthésie épidurale sur la circulation foeto-placentaire dans le contexte d’une grossesse normale. Des indices de vélocité du flot de l’artère ombilicale foetale ont été mesurés par Doppler chez trentesept patientes gravides à terme, sans complications, programmées pour une césarienne élective, avant et après une anesthèsie épidurale utilisant la lidocaine 2% sans épinéphrine. Les indices de rapport systole/diastole, de résistance et de pulsatilité sont demeurés inchangés après l’induction de l’anesthésie épidurale. Ces constatations suggèrent que l’anesthésie épidurale n’a pas d’influence sur la circulation foetoplacentaire chez des patientes enceintes normales à terme qui ne sont pas en travail.     

Imbalance between intraperitoneal coagulation and fibrinolysis during peritonitis of CAPD patients: the role of mesothelial cells

We compared peritoneal dialysis effluents from 18 CAPD patientswho had not suffered from peritonitis during the last 6 months(group 1) with the effluents from five patients with acute peritonitis(group 2), measuring activation markers of coagulation and fibrinolysis.These markers included prothrombin fragment F1+2 (F1+2), thrombin-antithrombinIII complex (TAT), fibrin monomer (FM), and fibrin degradationproducts (FbDP). In the dialysate of group 1 we found remarkablyhigh levels of F1+2, TAT and FM concomitant with a high concentrationof FbDP, indicating a high rate of intraperitoneal fibrin turnover.The balance between peritoneal generation and degradation offibrin was disturbed in untreated patients of group 2, who hadsignificantly higher levels of coagulation markers and a higherratio between FM and FbDP. Seven days after treatment with intraperitonealadministration of antibiotics and heparin, F1+2, TAT, FM andFbDP decreased significantly. To evaluate the role of mesothelial cells (MC) in the high peritonealfibrin turnover we investigated the expression of tissue-typeplasminogen activator (t-PA), urokinase-type plasminogen activator(u-PA), plasminogen activator inhibitor type-1 (PAI-1), andtissue factor in cultured human peritoneal MC under basal conditionsand after exposure to tumour necrosis factor (TNF) interleukin-1(IL-1), or bacterial lipopolysaccharide (LPS). The exposureof MC to TNF or to a lesser extent IL-1 or LPS reduced theirfibrinolytic activity by decreasing t-PA production and increasingPAI-1 synthesis. Furthermore the addition of TNF resulted inactivation of the coagulation cascade by the expression of tissuefactor. These in-vitro findings explain the imbalance betweenintraperitoneal coagulation and fibrinolysis during peritonitisof CAPD patients.     

目前下肢被动运动装置存在的问题和改进原则

本文分析了目前下肢ＣＰＭ装置存在的问题,指出在ＣＰＭ每一运动周期,人体下肢与ＣＰＭ支架之间都将产生有害的相对位移和交替牵拉应力,影响关节功能顺利康复。提出下肢ＣＰＭ的正确使用方法和设计原则。     

高频透热撕囊法在白内障手术中的应用

目的:评价在白内障手术中使用高频透热撕囊仪作连续环形撕囊的效果。方法:在30例(34眼)患者进行白内障囊外摘出联合后房型人工晶体植入术中,先向前房注入透明质酸钠,然后使用高频透热撕囊仪作晶体连续环形撕囊术。结果:有3眼术中出现小的晶体前囊放射状撕裂,所有病例术后角膜无水肿,无其他术后合并症,术后一周31眼矫正视力≥0.5,占91.2％。结论:此法操作简便,易于掌握,是一个安全有效的连续环形撕囊的方法。尤其适用于过熟期白内障,儿童先天性白内障和外伤性白内障的截囊。眼科学报1999;15:121—123。     

Crisnatol mesylate: Phase I dose escalation by extending infusion duration

Summary Crisnatol mesylate is a rationally designed cytotoxic arylmethylamino-propanediol with broad spectrum cytotoxic activity. A phase I study with an unconventional escalation scheme was developed using a constant drug infusion rate (mg/m²/hr) and prolonging the infusion duration from 6 to 96 hours. Sixty-five patients received crisnatol at doses from 18 mg/m² in 6 hrs to 3400 mg/m² in 72 hours. The dose-limiting toxicity in two of five patients at 2700 mg/m² and two of three patients at 3400 mg/m² was neurologic and consisted of a syndrome of confusion, agitation, and disorientation. Phlebitis mandated the use of a central line. The mean terminal phase half-life (T_1/2 ) was 3.3 hours with a total body clearance (CL) of 22.8 L/hr/m² and a volume of distribution (Vd_ss) of 53 L/m². The median steady-state peak plasma concentration (C_ss) at 2700 mg/m²/72 hours was 2.7 g/ml and at 3400 mg/m²/72 hours was 3.8 g/ml. No responses were seen. The maximum tolerated dose (MTD) on this schedule is 2700 mg/m²/72 hours in patients with no liver disease and good performance status.