Posture and isobaric subarachnoid anasthesia

Twenty-five patients had subarachnoid anaesthesia induced with 3.0 ml 0.5% bupivacaine plain. A study of the spread of analgesia demonstrated a small (2-3 segments) but significant (p less than 0.001) rise in analgesic levels when the patients were turned from a lateral to the supine position, and from the supine to prone positions.     

Lever press responding as a measure of ethanol preference in rats

Preference for ethanol in rats, overcoming the problem of a position habit, was assessed in a one-lever and two-liquid chamber. Performance in lever pressing for ethanol of different concentrations (2.5%, 5.0%, and 15.0%) and for water, as well as the amount of liquid intake, were recorded. Evidence of ethanol preference was observed by both the lever press and consumption measures when the concentration was 2.5%. Water preference was evident at higher concentrations. The present method proved to be a useful method for studying ethanol preference in rats.     

斜卧位微创经皮肾镜治疗上尿路结石

目的探讨斜卧位微创经皮肾镜碎石术（minimally invasive percutaneous nephrolithotomy,MPCNL）治疗上尿路结石的可行性。方法 2009年8月-2010年10月,采用斜卧45°体位行MPCNL治疗上尿路结石57例,包括肾结石49例,输尿管上段结石8例。结果 57例均Ⅰ期建立经皮肾通道成功,无穿刺失败或中转开放手术。平均手术时间85 min（45-120min）。一期结石清除率100%（57/57）。肾造瘘管留置时间1-3 d,平均住院时间6 d（4-7 d）。未出现严重并发症。结论斜卧位施行MPCNL手术治疗上尿路结石具有安全、高效、微创的特点,患者体位舒适,便于术中麻醉监测,术中碎石易排出,值得临床推广应用。     

两种鼻腔滴药方法治疗儿童鼻窦炎疗效及舒适度的观察

目的：比较两种鼻腔滴药方法对儿童鼻窦炎疗效的影响。方法：将200例上颌窦积液的患儿随机分成观察组和对照组。分别采用侧卧垂头位及仰卧垂头位两种鼻腔滴药方法。2周后统计两种鼻腔滴药体位对鼻窦炎患儿疗效的影响及患儿滴药时的舒适度有何差异。结果：观察组有效率与舒适度均高于对照组,P〈0．05。结论：侧卧垂头位鼻腔滴药法可以准确地将药液滴人中鼻道,达到使中鼻道黏膜减轻充血和上颌窦积液彻底引流的目的,提高治疗效果,患儿乐于接受。     

Distortions of perceived auditory and visual space following adaptation to motion

Adaptation to visual motion can induce marked distortions of the perceived spatial location of subsequently viewed stationary objects. These positional shifts are direction specific and exhibit tuning for the speed of the adapting stimulus. In this study, we sought to establish whether comparable motion-induced distortions of space can be induced in the auditory domain. Using individually measured head related transfer functions (HRTFs) we created auditory stimuli that moved either leftward or rightward in the horizontal plane. Participants adapted to unidirectional auditory motion presented at a range of speeds and then judged the spatial location of a brief stationary test stimulus. All participants displayed direction-dependent and speed-tuned shifts in perceived auditory position relative to a ‘no adaptation’ baseline measure. To permit direct comparison between effects in different sensory domains, measurements of visual motion-induced distortions of perceived position were also made using stimuli equated in positional sensitivity for each participant. Both the overall magnitude of the observed positional shifts, and the nature of their tuning with respect to adaptor speed were similar in each case. A third experiment was carried out where participants adapted to visual motion prior to making auditory position judgements. Similar to the previous experiments, shifts in the direction opposite to that of the adapting motion were observed. These results add to a growing body of evidence suggesting that the neural mechanisms that encode visual and auditory motion are more similar than previously thought.     

左三叉神经根微血管减压术两种体位的比较研究

目的探讨三又神经根微血管减压术摆置侧俯卧位时对腋神经的压迫程度以及术后对患者造成手臂酸麻等症状的情况,为神经外科施行三叉神经根微血管减压术时选择合适的侧俯卧位提供依据。方法将44例实施三叉神经根微血管减压术的患者随机分成观察组与对照组各22例,观察2组患者在摆侧俯卧位时右手臂不同放置位置时对于术后患者的手臂功能的影响程度。结果手术完毕患者清醒后2组患者的手臂感觉、对疼痛的反应、上肢肿胀情况及活动灵活度比较差异显著。结论对于三叉神经根微血管减压术的侧俯卧位摆置需将患者的头部往前移,使右上肢脱离床体进行低位置固定,可以防止右上肢受压严重而造成神经受损或手臂功能受损。     

Deficits in upper limb position sense of children with Spastic Hemiparetic Cerebral Palsy are distance-dependent

This study examined the arm position sense in children with Spastic Hemiparetic Cerebral Palsy (SHCP) and typically developing children (TD) by means of a contralateral matching task. This task required participants to match the position of one arm with the position of the other arm for different target distances and from different starting positions. Results showed that children with SHCP exhibited with both arms larger matching errors than the TD group, but only when the distance between the arms at the start of the movement was large. In addition, the difference in errors between the less-impaired and the impaired limb changed as a function of the distance in the SHCP group whereas no interlimb differences were found in the TD group. Finally, spasticity and restricted range of motion in children with SHCP were not related to the proportion of undershoot and size of absolute error. This suggests that SHCP could be associated with sensory problems in conjunction with their motor problems. In conclusion, the current study showed that accurate matching of the arms is greatly impaired in SHCP when compared to TD children, irrespective of which arm is used. Moreover, this deficit is particularly present for large movement amplitudes.     

全膝关节置换术后不同体位和引流方法的失血量比较

目的探讨全膝关节置换术后不同体位和引流方法对减少失血量的影响。方法选择30例全膝关节置换术后患者,按随机数字表分为A组、B组和C组各10例。A组术后患肢踝后垫枕,膝关节伸直位,留置负压引流袋引流;B组术后患肢踝后垫枕,膝关节伸直位,留置非负压引流袋引流;C组术后患肢抬高30°、屈膝45°,留置非负压引流袋引流。比较3组术后24h切口引流量、术前和术后总蛋白及血红蛋白差值、总输血量。结果 A、B、C 3组术后24h切口引流量分别为(970.00±79.54)ml、(719.00±83.91)ml和(419.00±38.74)ml,经比较,F=15.36,P<0.05;C组患者术后总蛋白和血红蛋白减少较小、总输血量较少,与A、B组比较,差异有统计学意义。结论全膝关节置换术后患膝放置于屈曲抬高体位和应用非负压引流,能有效减少术后失血量。     

Sleep positions in children with Down syndrome and obstructive sleep apnea

ObjectivesTo assess sleep positions in children with both Down syndrome (DS) and obstructive sleep apnea (OSA) and determine if there is a preferred sleep position by severity of apnea.MethodsA single-center retrospective review of patients with both DS and OSA was performed. Caregivers reported sleep position utilized greater than 50% of observed sleep time. Accuracy of this report was confirmed through review of hypnograms from polysomnography studies.ResultsEighty-two patients met inclusion criteria. Median body mass index (BMI) was 26.6 and 56% of patients had a prior tonsillectomy and/or adenoidectomy. The mean obstructive AHI (OAHI) was 25.33 with 90.4% having severe OSA, 9.6% having moderate OSA, and no patients having mild OSA. Reported sleep positions were skewed towards lateral/decubitus (82.9%) compared to prone (11.0%) and supine (6.1%). This was consistent with hypnogram data where 71% of total sleep time in lateral/decubitus positions compared to prone (13%) and supine (6%). The median changes in sleep position per patient was 5 (IQR: 3–6). Lower BMI (p < 0.001, 95% CI: 0.32–1.13) and tonsillectomy (p < 0.001, 95% CI: 7.7–18.19) were associated with lower OAHI. Sleep position was not associated with age (p = 0.19), sex (p = 0.66), race (p = 0.10), ethnicity (p = 0.68) nor history of tonsillectomy (p = 0.34). Preferred sleep position was not correlated with OAHI (p = 0.78, r = 0.03) or OSA severity (p = 0.72, r = 0.03).ConclusionsThis study highlights the possibility that children with DS may have preferential sleep positions that cater to optimized airflow in the context of OSA although further prospective study is needed.     

侧卧牵引位行肩关节镜手术患者的体位护理

目的 探讨侧卧牵引位行肩关节镜手术患者术中因特殊体位所出现的护理问题及相应的护理措施，探讨解决侧卧牵引位在全身麻醉下可能出现的问题及解决方法。方法 回顾性分析54例侧卧牵引位行肩关节镜手术患者在摆放体位中可能出现的护理问题，加强护理干预。结果 无一例患者术后出现因体位摆放出现的手术并发症。结论 术前的充分准备，术中仔细配合，加强护理干预，能有效避免侧卧牵引位体位摆放出现的手术并发症，提高病人的满意度。