浙江医科大学附二院门诊处方中精神药物使用调查

本文对浙江医科大学附属二院１９９３年７月间３１３７８张合格处方进行统计分析，并用限定日剂量（ＤＤＤ）和药物使用指数（ＤＵＩ）为指标，分析镇静催眠药物使用情况。结果表明苯二氮　类药方２０６７张，占总处方量的６．５９％，巴比妥类药方４９张，占０．１６％，麻醉药方１１１张；占０．３５％。苯二氮　类药方中．女性处方量１２０２张，男性处方量８６５张，男、女组间比较有显著性差异。苯二氮　类药方多分布在神经内科，常用的药有舒乐安定和阿普唑仑。九种常用的苯二氮　类药和麻醉性镇痛药的ＤＵＩ均小于１。提示药物滥用现象少见，该院对这类药物的管理比较严格。麻醉性镇痛药中二氢埃托啡处方占６７．５７％。     

Clinical index to predict bacteraemia caused by staphylococci

Abstract. Objectives. To define risk factors associated with bacteraemia caused by Staphylococcus aureus or coagulase-negative staphylococci; and to use them to define patients in need of empiric anti-staphylococcal antibiotic treatment. Design, Derivation set: observational, prospective study; validation set: retrospective analysis of a prospectively collected database. Setting. Derivation set: Beilinson Medical Centre, Petah Tiqva, Israel—a 900-bed university hospital. Validation set: St Thomas's Hospital, London, UK—an 800-bed teaching hospital. Subjects. All episodes of bacteraemia detected at Beilinson Medical Centre between March 1988 and September 1990 (derivation set, n = 1410), and at St Thomas's Hospital during 1987–1990 (validation set, n = 1040). Interventions. None. Main outcome measures. Percentage of staphylococcal bacteraemia in groups of patients defined by the models. Results. The following factors were associated with Staphylococcus aureus bacteraemia: focus of infection (whether high or low risk), haemodialysis, intravenous drug abuse and infection acquired in the orthopaedic ward. A logistic model was used to divide the derivation set into three groups with percentages of Staphylococcus aureus bacteraemia of 1.8%, 13.2% and 33.7% (P < 0.0001); and the validation group 2.5%, 18.2% and 53.2% (P < 0.0001). Factors associated with coagulase-negative staphylococcal bacteraemia were: central or peripheral intravenous catheter as the focus of infection, a preterm neonate, the presence of a central intravenous catheter, low temperature, and a low white blood cell count. A second model including those factors was used to divide the derivation set into three groups with percentages of coagulase-negative staphylococcal bacteraemia of 1.9%, 22.8%, and 43% (P < 0.0001). In the validation set, the percentages were 2.9%, 22.4% and 31.0% (P < 0.001). Conclusions. The present study defines groups at high risk for staphylococcal bloodstream infection, in which empiric treatment should include an anti-staphylococcal drug.     

高校科研业绩量化评价指标体系及评价方法初探

目的：建立高校科研业绩量化计算公式及评价方法。方法：通过对高校科研业绩的表现形式和特点进行分析，根据高校科研和教学工作实际，提出高校科研业绩量化评价指标选取原则。结果：初步拟定了指标体系和评价指标的计算方式。结论：为高校科研管理部门对科研人员评价提供量化方法。     

踝/肱指数对下肢动脉硬化性闭塞症缺血程度的评价

目的：利用检测下肢动脉硬化性闭塞症患的踝/肱指数对其下肢缺血程度进行评估。方法：采用以色列Flo-link 500T血管多普勒诊断仪对我院50例确诊为下肢动脉硬化性闭塞症患进行了分组踝/肱指数的检测。结果：踝/肱指数在0．5—0．9之间，常提示下肢动脉或近端有单水平阻塞；踝/肱指数在0．45以下常提示患下肢缺血程度严重，为坏疽前期静息痛表现；踝/肱指数在0．30以下多伴有缺血性溃癌或坏死。结论：踝/肱指数的检测可以反映下肢缺血程度，指导临床选择治疗方法，判断愈后及疗效，其无创性、可重复性、价格低康，更易被患接受。     

宫颈腺癌细胞DNA流式细胞光度分析

应用流式细胞计对３０例宫颈腺癌和混合癌细胞的ＤＮＡ指数和细胞增殖周期各时相细胞分布比例进行分析，结果显示非整倍体肿瘤２９例，占９６．７％．流式细胞计在诊断恶性肿瘤方面是有价值的。细胞增殖周期比ＤＮＡ指数对预后的估价更有意义．乳头型腺癌、分化Ｉ级的肿瘤，Ｓ＋Ｇ２Ｍ比率最低，５年生存率最高．     

Prediction of outcome from intensive care after gastroenterologic emergency

Prognostic factors determining the outcome from intensive care were studied in 952 patients admitted to 25 Finnish ICUs after gastroenterologic emergency. Logistic regression analysis was used to create predictive models based on the APACHE II–system. The models were constructed by using data from a random two–thirds of the study population and validated in the remaining independent one–third together with the original APACHE II–index. The Acute Physiology Score, age, and a pre–existing liver disease were the three most important determinants of outcome. The inclusion of the TISS score describing the intensity of treatment into a model did not enhance the accuracy of the prediction. Our models were better calibrated than the original APACHE II–equation when tested by the goodness–of–fit –statistics. These statistical models may help the clinicians to predict the outcome for an individual patient by providing them information about the relative impacts of predictive factors or about the probability of death. These probabilities should be interpreted cautiously, taking into acount the limitations of statistical methods. This is especially important when assessing the highrisk patients. Their number in our study was too low for accurate outcome prediction.     

脑卒中患者日常生活能力的评定

采用Ｂａｒｔｈｅｌ指数对１２０例脑卒中住院患者在发病后５￣６周进行日常生活活动（ＡＤＬ）能力的证实。因脑卒中遗留的功能不全，ＡＤＬ的受损率达６６．７％，肢体的Ｂｒｕｎｎｓｔｒｏｍ功能分级与ＡＤＬ积分高度相关，相关性下肢高于上肢；多元逐步回归分析显示，躯体（偏瘫）和心理（认知障碍和抑郁因素）影响ＡＤＬ的能力。认为ＡＤＬ能力的提高，不仅依赖于肢体功能障碍的改善，提高认知功能，改善情感状况，对于脑卒中患     

双频谱指数在心脏瓣膜置换术中的观察

目的应用脑电双频谱指数(BIS)监测常规经验麻醉下瓣膜置换术病人的麻醉深度(意识水平),观察BIS在伤害性刺激时的变化.方法选择30例瓣膜置换术病人,采用芬太尼、咪唑安定、哌库溴铵及心血管活性药物对病人实施麻醉;术中监测并有专人分别记录入室(基础值)、诱导后、插管后、切皮后、锯胸骨时、缝胸骨时及术毕BIS和MAP,HR各参数值,观察不同阶段各参数的变化.结果诱导后各参数均明显降低,虽然切皮后、锯胸骨及缝胸骨等强刺激后MAP和HR未见统计学意义的显著改变,但BIS却显著增高(P＜0.01);全部病人锯胸骨时BIS均在60(67.28±8.97)以上,缝胸骨时63(68.46±8.70)以上,而无1例低于50者.结论该组瓣膜置换术病人麻醉偏浅,尤以锯胸骨、缝胸骨及术毕等时段为甚,表现为BIS值偏高,有知晓发生;知晓可发生在临床认为满意的麻醉中;应用BIS监测,可更加合理地评价麻醉深度.     

Elevated body mass index and mortality risk in the elderly

The purpose of this report was to perform a systematic review and meta-analysis of the studies examining the impact of an elevated body mass index (BMI) on mortality risk in elderly (> or =65 years) men and women. A variance-based method of meta-analysis was used to summarize the relationships from available studies. The summary relative risk of all-cause mortality from the 26 analyses that included a risk estimate for a BMI within the overweight range was 1.00 (95% confidence intervals, 0.97-1.03). The summary relative risk of all-cause mortality for the 28 analyses that included a risk estimate for a BMI within the obese range was 1.10 (1.06-1.13). These calculations indicate that a BMI in the overweight range is not associated with a significantly increased risk of mortality in the elderly, while a BMI in the moderately obese range is only associated with a modest increase in mortality risk.     

脑电双频指数用于门诊无痛内镜检查的临床研究

目的　观察脑电双频指数 (BIS)监测对门诊无痛内镜检查病人麻醉过程及恢复的意义。方法　 12 0例择期在丙泊酚 芬太尼静脉麻醉下行胃镜检查的门诊病人 ,随机分为BIS监测组 (A组 )与常规监测组 (B组 ) ,每组 6 0例。静脉给予芬太尼 1μg/kg、丙泊酚 0 5mg/kg负荷量后 ,丙泊酚的维持量A组根据BIS值 (4 5～ 6 0 )调节 ,B组仅根据临床体征调节。记录丙泊酚用量、术中反应、胃镜检查时间及留观时间等。结果　两组间一般资料及麻醉前MAP、HR、SpO2 、BIS均无显著性差异(P >0 0 5 )。丙泊酚用量A组明显少于B组 ,留观时间A组显著短于B组 (P <0 0 1)。MAP在麻醉诱导入睡后和插镜时两组均有下降 ,但A组降幅低于B组 (P <0 0 1)。不良反应发生率A组明显少于B组 (P <0 0 1)。结论　BIS监测用于门诊麻醉对预防麻醉药用量不足或逾量 ,减轻血液动力学改变 ,避免术中肢动与知晓有重要意义 ,有利于提高麻醉安全 ,减少并发症。