用头俯屈位插管处理困难气管插管的研究

目的：探索用头俯屈位插管技术处理困难气管插管的效果。方法：对临床所见１０例困难气管插管患者，先采用头后伸位进行插管，２次以上试行插管失败后，则改用头俯屈位进行气管插管。结果：采用头后伸位插管全部未插入，而改用头饰屈位后全部插入。结论：采用头俯屈位插管可以提高困难气管插管的成功率。     

前房形态动态裂隙摄像测量系统的研制

目的 :设计制作一种前房形态动态裂隙摄像测量系统,对其精密度及可重复性进行检测 ,并应用其定量分析浅前房者在暗室俯卧试验过程中前房形态的变化。方法 :自行设计制作了前房形态动态裂隙摄像测量系统 ,然后用同一摄像系统拍摄标准米尺1张 ,测量计算其精密度。通过同一人对同一眼连续摄像测量10次及同一人对同一前房图像连续测量10次计算其可重复性。选取浅前房22例22只眼在暗室俯卧试验前后用本前房形态动态摄像测量系统摄像 ,并测量计算试验前后的前房深度及虹膜曲率半径。结果 :本摄像测量系统的精密度为0.035mm。变异系数为1.21%～3.69 %。22只浅前房眼在暗室俯卧后的前房深度小于暗室俯卧前 ,有统计学显著性差异 (P<0.01) ,试验后虹膜曲率半径小于试验前 ,差异有统计学显著性 (P<0.01)。结论 :本装置具备检测暗卧过程中晶体虹膜隔前移量及瞳孔阻滞力增加引起的虹膜膨隆程度改变量的能力 ,可为进一步研究瞳孔阻滞性闭角型青光眼的发病机制提供线索和依据     

Prone position may increase temperature around the head of the infant

Recommendations to adopt the supine position were followed by a dramatic decrease of SIDS. But no explanation has been given for the association between SIDS and the prone position nor for its decrease in the supine position. We report data on an infant and a mannequin demonstrating an increase in temperature around the head in the prone position. A 4-month-old boy presented an acute life-threatening event related to temperature after febrile otitis despite treatment: 40.5°C, heart rate 280 bpm with circulatory failure and cardiorespiratory arrest requiring resuscitation. There were no seizures. Blood and CSF cultures were negative. The course under antibiotics was favourable. On d 3, we measured temperature at several sites on and around the heat. Temperatures were higher in the prone than in the supine position in pericephalic areas: + 1°C (supracephalic), +2.5°C (peritemporal), and +3.5°C (submandibular). In a thermoregulated room, we used a mechanically ventilated mannequin of an infant. The prone position was also associated with an increase in temperature around the head: +3.3°C (supracephalic), +1.8°C (peritemporal), and +1.1°C (submandibular). Changing from the supine to prone position thus increased temperature around the head (infant and mannequin). To our knowledge, this has not been reported before. SIDS is related to factors modifying temperature status and environment. Furthermore, evacuation of heat is mandatory for an infant. We think the increase in temperature around the head in the prone position is due to the absence of convective fluxes, and speculate it could impair thermolysis.     

Effects of prone and supine positions on sleep state and stress responses in mechanically ventilated preterm infants during the first postnatal week

BACKGROUND/RATIONALE: Preterm infants in mechanical ventilation are vulnerable and may manifest physiological instability and a disorganized behavioural state when responding to external stimuli. Adequate positioning strategies may play an important role in protecting infants from environmental stressor and assisting quality of sleep. However, no study has examined effects of prone and supine positions on behavioural state and stress signs including startle, tremor, and twitch responses for ventilated preterm infants during the critical first week postbirth. AIM OF THE STUDY: The purpose of this study was to compare effects of prone and supine positions on behavioural state and stress responses in mechanically ventilated preterm infants. DESIGN/METHODS: The infants were aged 25-36 weeks of gestation, < or = 7 days of age, and without sedation or congenital abnormalities. Using a crossover design, 28 infants were randomly assigned to supine/prone or prone/supine position sequence. Infants were placed in each position for 2 hours. A stabilization period of 10 minutes before observation of each position was allowed. During the protocol, care procedures were kept minimal and ventilator settings remained unchanged. Behavioural state and frequencies of stress signs including startle, tremor, and twitch were systemically recorded and analysed with repeated measures analysis of variance. FINDINGS: Infants when prone compared with supine had (a) less crying, less active sleep, and more quiet sleep states, and (b) fewer stress responses of startle, tremor, and twitch. CONCLUSION: Results indicate that prone positioning improves the quality of sleep and decreases stress for ventilated preterm infants during the first week postbirth. These may conserve energy and assist infants' extrauterine adaptation.     

Pilot randomised controlled trial of face-down positioning following macular hole surgery

Objective

This was a pilot randomised controlled trial (RCT) to investigate the effect of post-operative face-down positioning on the outcome of macular hole surgery and to inform the design of a larger definitive study.

Methods

In all, 30 phakic eyes of 30 subjects with idiopathic full-thickness macular holes underwent vitrectomy with dye-assisted peeling of the ILM and 14% perfluoropropane gas. Subjects were randomly allocated to posture face down for 10 days (posturing group) or to avoid a face-up position only (non-posturing group). The primary outcome was anatomical hole closure.

Results

Macular holes closed in 14 of 15 eyes (93.3% 95% confidence interval (CI) 68–100%) in the posturing group and in 9 of 15 (60% 95% CI 32–84%) in the non-posturing group. In a subgroup analysis of outcome according to macular hole size, all holes smaller than 400 μm closed regardless of posturing (100%). In contrast, holes larger than 400 μm closed in 10 of 11 eyes (91% 95% CI 58–99%) in the posturing group and in only 4 of 10 eyes (40% 95% CI 12–74%) in the non-posturing group (Fisher''s exact test P=0.02).

Conclusion

Post-operative face-down positioning may improve the likelihood of macular hole closure, particularly for holes larger than 400 μm. These results support the case for a RCT.     

Hypotensive and Prophylactic Effects of Angiotensin II Subtype 1 Receptor Antagonist,Irbesartan, in Stroke‐Prone Spontaneously Hypertensive Rats

We determined the acute hypotensive effect of a single administration and the prophylactic effect of chronic treatment with Irbesartan, an angiotensin II receptor antagonist, on the development of end‐organ damage in stroke‐prone spontaneously hypertensive rats (SHRSP). The acute hypotensive effect was determined by a telemetrical method in SHRSP fed a normal diet. The prophylactic effect was examined by biochemical, histopathological and immunohistochemical methods in SHRSP fed a high‐salt and low‐protein diet. Irbesartan (3, 10, 30 and 100 mg/kg) reduced blood pressure in a dose‐dependent manner without affecting heart rate. Irbesartan (3, 10 and 30 mg/kg) increased the survival rate in SHRSP fed a high‐salt and low‐protein diet. Furthermore, Irbesartan ameliorated the appearance of stroke symptoms in dose‐dependent manner showing association with the prevention of microscopic lesions. Irbesartan ameliorated the increases in urinary protein excretion and N‐acetyl‐D‐glucosamidase activity by preventing nephrosclerosis, as judged by microscopic observations, and ameliorated the increases in the expression of collagen IV and fibronectin in the kidney. These findings demonstrate that Irbesartan is a potent antihypertensive drug offering a protective effect on the development of hypertension‐induced end‐organ damages in SHRSP. Thus, Irbesartan is useful for the therapy of hypertension with end‐organ damage.     

水飞蓟宾对快速老化小鼠学习记忆影响

目的探讨水飞蓟宾对快速老化小鼠（SAMP8）学习记忆及氧化应激因子表达影响。方法以SAMP8小鼠为模型,采用新物体辨别、Y迷宫及Morris水迷宫进行学习记忆能力评价,酶联免疫实验检测氧化应激相关指标。结果与对照组比较,模型组小鼠优先指数（0.45±0.07）、自发交替反应率[（0.58±0.06）%]明显下降,逃避潜伏期[（50.62±11.24）s]明显延长（P<0.01）,小鼠海马组织中谷胱甘肽（GSH）、超氧化物歧化酶（SOD）水平[分别为（21.13±6.17）mg/mL、（15.21±0.09）μg/mL]降低,丙二醛含量[（4.02±0.12）nmol/mL]升高（P<0.05）;与模型组比较,水飞蓟宾200 mg/kg组小鼠优先指数（0.68±0.09）、自发交替反应率[（0.70±0.09）%]升高,逃避潜伏期[（23.45±11.94）s]明显缩短（P<0.01）,小鼠海马组织中GSH、SOD水平[分别为（42.37±12.08）mg/mL、（32.24±0.24）μg/mL]升高,丙二醛含量[（2.54±0.21）nmol/mL]明显降低（P<0.05）。结论水飞蓟宾可改善快速老化小鼠学习记忆障碍,其机制可能与提高小鼠抗氧化应激能力有关。     

Transient left bundle branch block after posture change to the prone position during general anesthesia: A case report

Rationale:The prone position is commonly used in spinal surgery. There have been many studies on hemodynamic changes in the prone position during general anesthesia. We report a rare case of transient left bundle branch block (LBBB) in a prone position.Patient concern:Electrocardiogram (ECG) of a 64-year-old man scheduled for spinal surgery showed normal sinus rhythm change to LBBB after posture change to the prone position.Diagnosis:Twelve lead ECG revealed LBBB. His coronary angio-computed tomography results showed right coronary artery with 30% to 40% stenosis and left circumflex artery with 40% to 50% stenosis. The patient was diagnosed with stable angina and second-degree atrioventricular block of Mobitz type II.Intervention:Nitroglycerin was administered intravenously during surgery. Adequate oxygen was supplied to the patient. After surgery, the patient was prescribed clopidogrel, statins, angiotensin II receptor blocker, and a permanent pacemaker was inserted.Outcome:Surgery was completed without complications. After surgery, the transient LBBB changed to a normal sinus rhythm. The patient did not complain of chest pain or dyspnea.Lesson:The prone position causes significant hemodynamic changes. A high risk of cardiovascular disease may cause ischemic heart disease and ECG changes. Therefore, careful management is necessary.     

斜卧体位与俯卧体位在微创经皮肾镜取石手术中的比较

目的: 比较斜卧位、俯卧位在微创经皮肾镜取石术中应用的安全性和疗效。方法: 2组上尿路结石患者共62例, 其中斜卧位27例, 俯卧位35例, 术前2组患者在年龄、性别、合并症等方面比较,差异均无统计学意义(P>0.05),记录手术时间、出血量、围手术期并发症及术后住院天数等,并进行统计学分析。结果: 2组共62例手术均获成功,无穿刺失败和中转开放手术者。斜卧位组手术时间(85.1±25.3) min;术中出血量为(117.5±49.7) mL;未发生严重的并发症。俯卧位组手术时间为(97.2±30.6) min;术中出血量为(149.3±53.1) mL;术中发现气胸1例,术后发生大出血2例。2组病人在术中出血量、手术并发症及术后住院天数等方面比较,差异均有统计学意义(P<0.05)。结论: 改良斜卧位经皮肾镜取石术疗效与俯卧位相似, 但改良斜卧位手术患者较易耐受,且并发症少,安全性高,在临床上有良好的推广前景。     

清开灵注射液治疗SHR_(SP)出血性中风病的研究

实验结果显示，清开灵注射液能延长ＳＨＲＳＰ生存期和卒中后的存活时间，降低脑系数，减轻脑水肿，增强脑出血灶的吸收，促进肉芽组织增生，有利于病灶的修复；亦能使海马ＣＡ１区神经元损伤减轻脱失减少；神经元计数清开灵组较病理组明显增加（Ｐ＜０．０１）。提示清开灵对出血性中风的治疗作用机制是通过改善脑水肿，促进出血病灶的吸收修复，保护神经细胞而实现的。