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。     

第一掌背动脉逆行筋膜皮瓣修复示指软组织缺损

目的 介绍一种新型逆行筋膜皮瓣修复示指皮肤缺损。方法 我院于1997～2003年，采用第一掌背动脉逆行筋膜皮瓣修复示指皮肤缺损9例，该皮瓣以第一掌背动脉在第二掌骨背侧的纵轴为轴线，以筋膜为蒂，蒂部设计在皮瓣的远侧，供血动脉为示指桡侧指动脉。结果 皮瓣全部成活，随访半年以上5例，修复后指腹两点辨别觉为6mm～11mm(平均7．9mm)，外形满意，患均恢复原工作。结论 切取第一掌背动脉逆行岛状筋膜皮瓣修复示指皮肤缺损安全可行，是修复示指皮肤大面积缺损的较理想方法。     

多发伤一期手术处理(附168例病例分析)

目的：从168例多发伤的处理方法、流行病学、创伤指数、并发症及病死率的总结分析，说明多发伤一期手术处理在急诊科的地位。方法；急诊科直接收治多发伤首诊病人，遇有多发伤合并休克，立即抗休克治疗，做好术前准备，反复体检、观察和评估。手术时，如脑胸腹四肢联合伤，一般分两组进行手术。结果：168例共406处伤，手术处理共246例次。总死亡率7．7％，发生两个脏器功能衰竭16例，死亡4例，占25％，三个脏器功能衰竭8例，死亡6例，占75％。平均住院无数：一期手术处理为1．5±6．4，分期为24±4．4（两者有显著差异）。结论：多发伤一期手术处理，在相同创伤指数下，可减少术后并发症，降低死亡率和病残率；缩短住院时间；简化手续，为多发伤病人的抢救赢得MSOF时间，证明多发伤一期手术处理在急诊科中的重要性和必要性。     

Factors affecting the neonatal response to artificial surfactant

Objective : To define the individual neonatal response to the artificial surfactant, Exosurf, and factors that may influence the response.
Methodology : Eighty-two consecutive, preterm neonates with respiratory distress syndrome, who received Exosurf at <12h of age were studied. Their response was categorized from the graphical change in the oxygenation index with postnatal age, for 12h after each of two doses of surfactant and assessed independently by two observers. Clinical factors were analysed for their effect on the four pre-defined categories of response, namely: none; mild; good; relapsed; and good: sustained.
Results : Within the first 12h, 11% of the neonates showed no response, 5% a mild response and 84% a good response, but 34% relapsed. By 24h, 6% still showed no response (all died), 11% showed a mild response and 83% a good response, of whom half relapsed. At 24h, no response was significantly associated with low gestational age and asphyxia mild response with less severe lung disease. According to the response there was a gradation in the risk of death during the first week.
Conclusions : The response to Exosurf can be individually and reproducibly categorized and demonstrated that 83% of neonates had a good response but half relapsed. No response was associated with extreme prematurity and asphyxia     

Relationship between apoptosis and proliferation in secondary tumors of the brain

A correlation between apoptosis and proliferation in astrocytomas and oligodendrogliomas, but not in glioblastomas, has been previously reported. An index for apoptosis and proliferation was established for each tumor in a series of 20 brain metastases, and its correlation was studied using the Spearman rank correlation test. Apoptosis index (AI) ranged between 1 and 78% (mean ± SD: 11.48 ± 16.4). Proliferation index (PI) ranged between 2.4 and 21% (mean ± SD: 8.23 ± 4.8). When the relationship between AI and PI was studied, a clear correlation was found (r: 0.8965, 95% CI: 0.74–0.95; P < 0.0001). Therefore, it is concluded that a clear correlation exists between proliferation and apoptosis in secondary tumors of the brain.     

北京和重庆市育龄期妇女风疹抗体水平调查

目的了解北京和重庆市育龄期妇女风疹抗体水平,为控制先天性风疹综合征(CRS)提供科学依据。方法2006年6~8月随机抽取北京和重庆市各1个区作为调查点,对20~39岁育龄期妇女623人(北京市311人,重庆市312人)进行血清流行病学调查。结果北京和重庆市育龄期妇女风疹抗体阳性率分别为85.21%和78.53%,自然感染获得抗体阳性率分别为85.08%和77.89%;风疹抗体分布与年龄、地区有关,随着年龄的增长抗体阳性率和几何平均浓度有下降的趋势。结论制定科学的风疹疫苗使用策略和免疫程序,提高育龄期妇女的免疫力,是减少CRS发病的有效手段。     

丙氨瑞林治疗子宫内膜癌病人的性激素及有丝分裂指数的变化

目的：观察丙氨瑞林对子宫内膜癌的治疗作用。方法：对诊刮确诊的１７例子宫内膜癌病人，予丙氨瑞林７００μｇ，ｉｍ，ｑｄ×７ｄ，用药前后作性激素测定及组织学检查。结果：绝经妇女用药后血中ＦＳＨ和ＬＨ下降（Ｐ＜０．０１和＜０．０５），雌二醇、孕酮及睾丸酮变化不明显。其中１３例内膜样腺癌用药后有丝分裂指数明显下降（Ｐ＜０．０１），有丝分裂指数变化与癌周内膜之反应有关。呈增生反应癌周内膜癌组织有丝分裂指数下降值明显高于呈萎缩状态癌周内膜。结论：丙氨瑞林治疗子宫内膜癌后能降低ＦＳＨ和ＬＨ水平，对子宫内膜癌尤其是雌激素依赖性内膜癌有一定疗效。     

ROBUST GUARANTEED COST CONTROL OF UNCERTAIN NON-LINEAR ROBOTIC SYSTEM USING MIXED MINIMUM TIME AND QUADRATIC PERFORMANCE INDEX

To provide better transient performance in controlling robots, a mixed minimum time and quadratic performance index is used. For known and uncertain revolute robot manipulators a conventional optimal control and a robust guaranteed cost control are proposed respectively. Asymptotic stability is also discussed based on the Lyapunov direct method. The proposed robust control is continuous and requires no knowledge of the uncertain system except for bounding functions.