昂丹司琼用于预防全麻拔管时恶心呕吐的临床观察及护理

目的观察昂丹司琼用于预防全麻拔管时恶心呕吐的疗效。方法选择50例择期腹腔镜手术全麻插管患者,随机分为A、B两组,每组25例。A组拔管前30min静注昂丹司琼8mg,B组拔管前30min静注胃复安10mg。观察两组拔管前后恶心呕吐程度、发生率。结果A组恶心呕吐程度显著低于B组(P<0.05)。结论昂丹司琼能有效降低腹腔镜手术全麻拔管时恶心呕吐程度及发生率。     

全凭静脉与吸入全身麻醉苏醒期躁动发生率的临床观察

目的比较丙泊酚、地氟烷、七氟烷复合瑞芬太尼全身麻醉苏醒期躁动的发生情况。方法90例ASAⅠ～Ⅱ级择期全身麻醉下行乳腺癌根治术及鼓室成形术。随机分成三组：丙泊酚组、地氟烷组、七氟烷组。观察各组苏醒期躁动发生率和睁眼时间、拔管时间,监测躁动发生前后血压、心率及脉搏血氧饱和度。结果地氟烷组和七氟烷组苏醒期躁动发生率分别为31．03％和33．33％,高于丙泊酚组的3．33％（P〈0．05）;睁眼时间、拔管时间差异不具有显著性意义（P〉0．05）;躁动发生前后血压、脉搏血氧饱和度差异无显著性意义（P〉0．05）,而心率在躁动发生后明显增快（P〈0．05）。结论地氟烷、七氟烷吸入麻醉苏醒期躁动发生率明显高于丙泊酚全身麻醉。     

How we make choices and sacrifices in medical education during the COVID-19 pandemic

Abstract

In this commentary, we highlight some of the pressing choices and sacrifices we must make in medical education during the COVID-19 pandemic.     

二次通用旋转组合法优化黄芪中毛蕊异黄酮苷和芒柄花素的酶解提取工艺

目的采用二次通用旋转组合设计优化黄芪中毛蕊异黄酮苷和芒柄花素的酶解提取工艺。方法在确定酶比例的基础上,选定复合酶用量、酶解时间、加水量和提取时间为考察因素,以毛蕊异黄酮苷、芒柄花素提取量为指标,采用二次通用旋转组合设计优化黄芪酶解提取工艺。结果优化所得黄芪酶解提取的最佳工艺条件:复合酶用量340 mg,酶解时间110min,加水量19倍,提取时间150 min,在此条件下,毛蕊异黄酮苷、芒柄花素提取量分别为0.25 mg/g、67.95μg/g。结论优化所得黄芪酶解提取工艺稳定可行。     

浅析绮石论虚劳之"先天之因"

综考历代相关文献,虚劳之先天成因有以下几个方面:一是早婚早育,肌体稚弱,精气未生,血气未充,肾元亏虚;二是久病、劳逸过度、性生活失调导致父母体质虚弱;三是高龄生育;四是妊娠失养导致子代先天禀赋薄弱,胎儿气血供养不足,出生后体质虚弱,生长发育受到影响,从而形成虚劳的病理基础。     

氯胺酮在高危产妇剖宫产术全麻中对新生儿呼吸的影响

目的:研究氯胺酮在合并有并发症产妇的剖宫产术全麻中应用的安全性和可行性。方法:选择ASA分级Ⅱ~Ⅲ级的产妇40例,随机分为氯胺酮全麻组(Q组)和椎管内麻醉组(Z组)。Q组方案:静注氯胺酮1mg·kg-1、司可林100 mg,气道表面麻醉后行气管插管,手术开始至胎儿娩出前一般无需追加上述药物,若追加氯胺酮其总量不超过1.5 mg·kg-1、司可林总量不超过200 mg,胎儿娩出后立即抽取胎儿脐带血行血气分析并对胎儿进行1min和5 min Apgar评分。观察产妇入室至离室各时间点的血压、心率、脉率血氧饱和度及产妇入室至手术开始所需的时间等指标。并记录两组新生儿出生后3~5 d的新生儿神经行为评分(NBNA)。结果 :在两组血气分析数值中Q组氧分压和血氧饱和度两项值均高于Z组,两组比较有统计学意义(P<0.05),其他指标差异无统计学意义(P>0.05),新生儿1 min和5 min Apgar评分两组差异无统计学意义(P>0.05)。产妇的血压、心率两组间在个别时间点比较有统计学意义(P<0.05),脉率血氧饱和度两组比较无统计学意义(P>0.05),产妇入室至手术开始所需的时间Q组明显短于Z组,两组比较有统计学意义(P<0.05)。两组新生儿NBNA评分差异无统计学意义(P>0.05)。结论:氯胺酮可以安全地用于剖宫产术全麻中,尤其适用于危重或禁用椎管内麻醉的产妇。     

心理护理对普外科手术患者术前焦虑影响的临床分析

目的选取临床病例验证心理护理是降低普外科术前患者术前焦虑恐惧心理的有效方法。方法随机选取适合病例作为实验组(90人)和对照组(90人)。首先对两组进行入院后焦虑自评(SAS)的测试,记录数据。而后,实验组除了给予普通术前护理外,还给予特殊心理护理,而对照组只给与普通术前护理。最后,在术前1天再一次对两组进行焦虑自评(SAS)的测试,记录数据。而后利用SPSS 13.0对数据进行横向和纵向对比分析。结果实验组和对照组在实验前在焦虑程度上无明显差异(P>0.05),对照组实验前后两次测评亦无明显差异(P>0.05),而实验组实验前后患者的焦虑情况却有明显的差异(P<0.05)。结论特殊的心理护理是降低普外科术前患者术前焦虑、恐惧的有效方法。     

柳氮磺胺吡啶联合培菲康治疗溃疡性结肠炎的临床研究

目的探讨柳氮磺胺吡啶联合培菲康治疗溃疡性结肠炎患者的临床疗效。方法将52例溃疡性结肠炎患者随机分成两组。治疗组采用柳氮磺胺吡啶联合培菲康治疗（n=27）;对照组单纯采用柳氮磺胺吡啶治疗（n=25）,观察两组患者治疗后临床活动指数及临床综合疗效。结果两组治疗前临床活动指数：治疗组为7.85±2.93,对照组为7.68±2.88,两组差别无统计学意义（P〉0.05）,治疗后临床活动指数治疗组为1.56±1.78,对照组为3.64±2.50,两组均较治疗前下降了（P〈0.001）,但治疗组临床活动指数的改善优于对照组（P〈0.05）;治疗后两组临床综合疗效比较,治疗组完全缓解20例,有效5例,无效2例,总有效率92.6%,对照组完全缓解11名,有效6例,无效8例,总有效率68%,治疗组临床综合疗效也优于与对照组,两组完全缓解率和总有效率有显著差别（P〈0.05）。结论柳氮磺胺吡啶联合培菲康治疗溃疡性结肠炎患者有利于临床症状的好转,提高临床疗效。     

Total failure of spinal anesthesia for cesarean delivery,associated factors,and outcomes: A retrospective case–control study

Spinal anesthesia is the anesthetic technique of choice for patients undergoing cesarean delivery. In the present study, total spinal anesthesia failure was defined as a case when an absent blockade or inadequate surgery required general anesthesia administration with an endotracheal tube. This study aimed to investigate factors related to this condition and report its maternal and neonatal outcomes.This retrospective matched case–control study was conducted by recruiting 110 patients with failed spinal anesthesia and 330 control patients from September 1, 2016, to April 30, 2020, in the largest university hospital, Thailand.Of 12,914 cesarean deliveries, 12,001 patients received single-shot spinal anesthesia (92.9%) during the study period. Total spinal anesthesia failure was experienced by 110/12,001 patients, giving an incidence of 0.9%. Factors related to the failures were a patient body mass index (BMI) ≤29.5 kg/m² (adjusted odds ratio 1.9; 95% confidence interval 1.2–3.1; P = .010) and a third-year resident (the most senior trainee) performing the spinal block (adjusted odds ratio 2.4; 95% confidence interval 1.5–3.7; P < .001). In the group with failed spinal anesthesia, neonatal Apgar scores at 1 and 5 minutes were lower than those of the control group (both P < .001). Two patients in the failed spinal anesthesia group (2/110; 1.8%) had difficult airways and desaturation.Independent factors associated with total spinal anesthesia failure were a BMI of ≤29.5 kg/m² and a third-year resident performing the spinal block. Although the incidence of total failure was infrequent, there were negative consequences for the mothers and neonates. Adjusting the dose of bupivacaine according to the weight and height of a patient is recommended, with a higher dose appropriate for patients with a lower BMI.     

中山-西渡教学模式开展的实践和体会

目的：探讨中山-西渡教学模式开展8个月来的教学实践和体会,摸索适合在郊区社区开展的特色教学模式。方法：从2015年5月开始,西渡社区卫生服务中心开展“中山-西渡教学模式”,共有19名医生参与,其中中心师资学员2名,每6个月轮换一次;其他学员包括规培生8名、新乡村医生4名、低年资医师5名,每3个月轮换一次。每周三上午由复旦大学中山医院副主任医师带教,学员参与,学员在学习期满时接受临床理论和接诊技能考核。同时,对2015年5月—12月该模式教学接诊的233例患者进行满意度问卷调查,其中初诊患者156例。结果：学员结束培训时,考核全部达到优良。学员经带教后临床思维缜密,均能独立完成患者接诊和初步处理,初诊患者非常满意率达98%。结论：中山-西渡教学模式能起到医患双赢的成效,可作为郊区社区卫生服务中心的教学模板。