Reducing Hospital Toxicity: Impact on Patient Outcomes

Background

Circadian rhythms are endogenous 24-hour oscillations in biologic processes that drive nearly all physiologic and behavioral functions. Disruption in circadian rhythms can adversely impact short- and long-term health outcomes. Routine hospital care often causes significant disruption in sleep-wake patterns that is further compounded by loss of personal control of health information and health decisions. We wished to evaluate measures directed at improving circadian rhythm and access to daily health information on hospital outcomes.

N-甲基-D-天门冬氨酸和非N-甲基-D-天门冬氨酸类受体在新生大鼠延髓脑片呼吸节律性放电中的作用

目的 探讨Ｎ－基－Ｄ－天门冬氨酸（Ｎ-methyl-Ｄ-aspartate,ＮＭＤＡ）和非ＮＭＤＡ类受体在基本呼吸节律发生和调 节中的作用。方法 在新生ＳＤ大鼠离休延髓脑片上记录舌下神经的呼吸节律性放电活动,在改良的Krebs液中加入兴 奋性氨基酸类递质及相应的拮抗剂,观察其ＲＲＤＡ的影响。结果 使用非ＮＭＤＡ受体激动剂海人酸（Kainic acid.ＫＡ） 后,可见呼吸周期及呼气时间有所延长, ＮＭＤＡ受体激动剂对呼吸活动则没有明显影响（Ｐ＞０．１）;相应的拮抗剂６－氰基 －７－硝基喹恶啉土卫四（６,７-dinitroquinoxaline-2,3-dione,ＤＮＱＸ）和２－氨基磷酸戊酸（D-２-amino-5-phosphonopentanoic, ＡＰ5）均可使放电频率和积分幅值明显降低吸气时间显著缩短（Ｐ＜０.０１）,ＤＮＱＸ同时可致呼吸周期和呼气时间明显缩短 （Ｐ＜０．０５）。结论 在哺乳动物基本呼吸节律的产生和调节中,ＮＭＤＡ类受体主要对呼吸活动的强度产生调节作用;而非 ＮＭＤＡ类受体不仅可以影响呼吸的强度,同时对呼吸的频率也发挥调节作用。     

孕期睡眠与妊娠期糖尿病关联的研究进展

睡眠参与调节机体的神经内分泌免疫等诸多过程, 越来越多的证据表明, 睡眠可影响血糖代谢。妊娠期女性相较普通人群更容易出现睡眠问题, 因此孕期睡眠与妊娠期糖尿病的关系逐渐引起关注。本文从睡眠质量、睡眠持续时间、睡眠节律及可能的生物学机制对孕期睡眠与妊娠期糖尿病的关联进行综述, 为妊娠期糖尿病防控提供参考。     

胃痛灵汤对胃黏膜保护作用的时间节律研究

目的 研究消炎痛对胃黏膜的损伤以及胃痛灵汤对胃黏膜的保护作用是否存在时间节律性。方法 选取一昼夜中的6：00、12：00、18：00、24：00，4个时间点进行实验，选取小鼠240只，随机分为24组，每组10只，每个时间点包括6组动物。分为胃痛灵汤组（等效量组、2倍量组、4倍量组）、气滞胃痛冲剂组、空白对照组和模型组，除空白对照组外，其余各组均按64mg/kg的剂量灌服消炎痛溶液，取胃检测胃黏膜损伤指数和血清及胃组织匀浆中的超氧化物歧化酶（SOD）活性和丙二醛（MDA）含量。结果 消炎痛对胃黏膜的损伤呈现明显昼夜节律性，明期中段（9：00－15：00)用药对胃黏膜的损伤最严重（P＜0.05），胃痛灵汤各用药组在明期中段表现出最显著的抗胃黏膜损伤作用（P＜0.001），SOD活性与MDA含量的改变提示与机体的氧化作用有关。讨论 胃痛灵汤有显著的抗胃黏膜损伤作用，使消炎痛致胃黏膜损伤的昼夜节律性消失，且可明显提高胃组织和血清中的SOD活性，降低MDA含量，且对节律有调整作用。     

MEG and EEG topography of frontal midline theta rhythm and source localization

Summary In this paper, we report on our study of frontal midline theta (Fm) activity in human subjects, recorded during mental processes such as arithmetic calculation. The Fm is a 6–7 Hz rhythmic wave with a duration of few seconds. The Fm activity is observed in the central region at the front of the head. EEGs and MEGs of Fm were measured simultaneously during mental calculation, and we analyzed these waveforms based on both topographic EEG maps and magnetic fields measurements. A single dipole simulated the EEG topography adequately, but there are many other dipole models which can generate a similar EEG pattern. It is difficult to estimate the source location of the Fm from the EEG topography alone because the EEG technique has a certain ambiguity associated with source estimation. Therefore, we considered the spatial relationships between the sources and the patterns of EEG and MEG that were simulated. Although it is not possible to obtain a unique solution for the source location of Fm from the EEG data alone, the simultaneous recording of MEGs from a large scalp area may result in an unambiguous solution. We therefore conclude that the simultaneous recording of both MEG and EEG data is more useful for accurate localization, than the EEG alone.     

The mechanism of blood pressure variability: Study in patients with fixed ventricular pacemaker rhythm

Background: Several studies have shown that heart rate variabilityplays an anti-oscillatory role in the regulation of blood pressurevariability in humans. We tested whether systolic blood pressurevariability in patients with a fixed ventricular pacemaker rhythmdiffers from that in patients with sinus rhythm. Methods and Results: In 18 patients with a fixed ventricularpacemaker rhythm and in ten age-matched patients with sinusrhythm the systolic blood pressure oscillation and the low andhigh-frequency spectral components of systolic blood pressurewere studied in the resting supine position during spontaneousbreathing and during forced deep ventilation of 6 cycles. min^–1.Patients with a pacemaker had a higher amplitude of systolicblood pressure oscillation than control subjects during spontaneousbreathing (13.5 ± 2.0 mmHg vs 6.4 ± 1.6 mmHg,P=0.035), and a slight but not significant difference also persistedduring forced deep ventilation (19.0 ± 2.3 mmHg vs 15.0± 2.3 mmHg, P=0.18). The increment in systolic bloodpressure fluctuation from spontaneous breathing to forced deepventilation was less marked in the pacemaker group than in thecontrol subjects (40% vs 130%, P=0.43). Although all the systolicblood pressure spectral components of the pacemaker patientswere higher during both spontaneous breathing and forced deepventilation, the differences between the two groups did notreach statistical significance. Conclusions: Our observations in patients with a fixed ventricularpacemaker rhythm suggest that the mechanical effects on theintrathoracic vessels and the consecutive stroke volume changesare responsible for respiration-related systolic blood pressureoscillation and reflex systolic blood pressure changes.     

冠心病患者QT离散度与心率,心率变异性的时晨变化及相关性

目的：探讨冠心病（ＣＨＤ） 患者ＱＴ 离散度（ＱＴｄ） 与心率变异性（ ＨＲＶ） 的时晨变化及相关性。方法：ＣＨＤ 患者２８ 例,采取自身对照方法进行每４ｈ 时段的ＱＴｄ 比较与ＨＲＶ 时晨变化的相关性研究。结果：ＣＨＤ 患者ＱＴｄ 平均值５９－７６ ±１０－５３ ｍｓ,各时段无显著差异,Ｆ＝ １－７３ ,Ｐ＞ ０－０５ ,但８∶００（５３－５７ ±１８－２ｍｓ） 比２０∶００（６５－１８ ±１８－０８ ｍｓ） ,Ｐ＜ ０－０５ 。心率（ＨＲ） 与ＨＲＶＩ比,Ｐ＜ ０－０１ ,有显著负相关性,ＨＲ 与能谱密度（ＰＳＤ） 比,ｒ ＝ ０－６２ ,Ｐ＜ ０－１ ,正相关。ＨＲ、ＨＲＶＩ、ＰＳＤ 和Ｒ－ Ｒ 间期标准差（ＳＤ） 与ＱＴｄ 比,Ｐ＞ ０－０５ ,无相关性。结论：ＱＴｄ 有明显时晨节律变化,与ＨＲ、ＨＲＶ 无统计学相关性。提示自主神经影响并非主要原因,ＱＴｄ 变化与其它因素,尤其缺血心肌局部电不稳定性有关。     

国医大师夏桂成调治PCOS的理念与方法

介绍了国医大师夏桂成调治多囊卵巢综合征（PCOS）的理念与方法。以易学太极中阴阳消长转化的观点,分析女性生殖轴的圆运动生物钟节律,提出心肾交济,平衡阴阳为主,协调肝脾气血为辅的理念,燮理月经周期的变化,治疗月经紊乱。认为生殖周期圆运动节律的紊乱是PCOS病发之源。核心脏腑功能失调是PCOS病发之关键,具体包括:癸水缺乏使生精无源;心肾失交,节律紊乱;肝阴不充,阴虚阳亢;中焦脾胃,病酿痰脂。奇恒之腑藏泻的失司是PCOS月经失调的表观因素。      

癫癎发作生物节律的研究进展

随着对癫癎研究的不断深入,癫癎发作的时相性越来越受到关注。癫癎发作存在生物节律,同一类型的癫癎在不同时间段、不同状态(睡眠/觉醒、昼夜更替)发作频率不同。癫癎生物节律的分子机制、内分泌机制相当复杂,目前存在多种假说。明确癫癎发作的生物节律,根据其发作节律予以预防及治疗,既可以有效控制癫癎发作,也可以减少药物不良反应。癫癎发作生物节律的研究将为癫癎治疗提供新的思路。     

模拟人体生物钟镇静用于ICU机械通气患者的临床研究

目的探讨模拟人体生物钟镇静方案对ICU机械通气患者谵妄及其他临床结局的影响。方法将110例ICU有创机械通气≥12h患者根据是否应用模拟人体生物钟镇静方案分为模拟人体生物钟组(研究组,55例)与非模拟人体生物钟组(对照组,55例),两组再根据使用镇静药物的不同分为右美托咪定组(各15例)、丙泊酚组(各20例)、右美托咪定+丙泊酚组(联合镇静组,各20例)。应用重症监护疼痛观察工具(CPOT)及Richmond躁动-镇静评分(RASS)对镇痛镇静深度进行量化控制,使研究组RASS评分白天维持在0~1分、夜间维持在-1~-2分;对照组昼夜均维持在-1~-2分。记录患者谵妄、呼吸机相关性肺炎等并发症或不良事件发生率,以及机械通气时间、住ICU时间、拔管时间、镇痛镇静药物用量。结果研究组谵妄、呼吸机相关性肺炎、严重低血压及心动过缓发生率显著低于对照组(P0.05,P0.01);与同种镇静药的对照组比较,研究组机械通气时间、拔管时间、住ICU时间显著缩短,镇痛镇静药物剂量显著减少(均P0.05)。结论模拟人体生物钟镇静有助于降低ICU机械通气患者不良反应发生率,缩短机械通气时间、拔管时间及住ICU时间,减少镇静镇痛药物用量,可提高临床疗效。