甘肃省平凉市崆峒区人群盲和低视力现况调查

目的:探讨与了解甘肃省平凉市崆峒区人群盲与低视力的患病率及致病原因。方法:应用横断面研究的流行病学调查方法,以村(社区)为基础,采用随机整群抽样原则抽取6个乡镇2个街道办事处作为调查地点。采用世界卫生组织制定的盲与低视力标准,对全区按0.719%抽样比例抽取样本进行盲与低视力的流行病学调查。结果:检录3235例中,受检人数为2801例,受检率为86.58%,双眼盲21例,盲率为0.75%(男0.59%,女0.91%);双眼低视力125例,低视力患病率为4.46%(男3.73%,女5.16%),≥60岁以上盲与低视力患者的患病率明显增高。致盲病因前三位的眼病依次为白内障(47.62%)、角膜病(14.29%)、青光眼(14.29%)。结论:崆峒区人群中盲和低视力的眼病以白内障居首位,因此手术治疗白内障仍是今后防盲治盲工作的首要任务。     

Changes in B-mode Ultrasound Echo Intensity Following Injection of Bupivacaine Hydrochloride to Rat Hind Limb Muscles in Relation to Histologic Changes

This study tested the hypothesis that infiltration of inflammatory cells in muscle fibers would increase echo intensity (image brightness) of B-mode ultrasound images. Bupivacaine hydrochloride (BPVC) or saline solution (SAL) was injected to the tibialis anterior (TA) muscles of 14- to 23-wk-old male Wistar rats. Ultrasound images were taken from the muscles before and at 0, 2, 4, 6, 9, 12, 24, 48, 72, 120, 168 and 336 h after the injection and analyzed for the echo intensity (echogenicity) expressed as the mean value of image pixel value of a region-of-interest. Changes in the echo intensity were compared between BPVC-injected and control or SAL-injected muscles. In the subsequent study, rats (n = 2 per time point) were sacrificed after taking ultrasound image at 0, 2, 6, 12, 24, 48 and 168 h after BPVC injection to the right TA and SAL injection to the left TA to observe histologic changes under a light microscope and the relationship between echo intensity and inflammatory cells was assessed. No significant changes in echo intensity were observed for the control, but BPVC induced significant (p < 0.05) increases in the echo intensity peaking 0 to 24 h postinjection. SAL also increased echo intensity immediately after injection but returned to the baseline by 24 h postinjection. The time course of changes in the echo intensity did not match with the time course of increases in inflammatory cells in the muscle. It is concluded that infiltration of inflammatory cells is not a direct cause of the increased echo intensity. (E-mail: k.nosaka@ecu.edu.au)     

门诊输液区的护理风险管理

目的探讨如何预防并降低门诊输液区护理风险,减少投诉和纠纷。方法将2005年1月至2006年12月护理风险管理干预前设为A组,将2007年1月至2008年12月风险管理干预后设为B组,投诉与纠纷的风险（差错与事故的风险）在医生环节、药房环节、收费环节、护士环节、病人或陪人环节、环境因素A组与B组比较研究。结果护理风险管理干预后10028例患者中发生5例纠纷,与护理风险管理干预前9365例患者中发生33例纠纷相比,有显著差异（χ^2=22．661,P〈0．01）。结论护理风险管理干预后门诊输液区护理风险降低,投诉与纠纷明显减少。     

Effects of experimental pain on jaw muscle activity during goal-directed jaw movements in humans

To study the effects of masseter muscle pain on jaw muscle electromyographic (EMG) activity during goal-directed tasks. Mandibular movement was tracked and EMG activity was recorded from bilateral masseter, and right posterior temporalis, anterior digastric, and inferior head of lateral pterygoid muscles in 22 asymptomatic subjects at postural jaw position, and during three tasks: (a) protrusion, (b) contralateral (left), (c) open jaw movement. Tasks were performed during three conditions: control (no infusion), test 1 [continuous infusion into right masseter of 4.5% hypertonic saline to achieve 30–60 mm pain intensity on 100-mm visual analog scale (VAS)], and test 2 (isotonic saline infusion; in 16 subjects only); the sequence of hypertonic and isotonic saline was randomized. The average EMG root-mean-square values at 0.5 mm increments of mid-incisor-point displacement were analysed using linear mixed effects model statistics (significance: P < 0.05). Right masseter hypertonic saline infusion resulted in significantly (P < 0.0005) more pain (mean ± SD VAS 47.3 ± 14.3 mm) than isotonic infusion (12.2 ± 17.3 mm). Although there was evidence of inter-subject variation, the principal EMG findings were that the significant effects of hypertonic saline-induced pain on EMG activity varied with the task in which the muscle participated irrespective of whether the muscle was an agonist or an antagonist in the tasks. The direction of the hypertonic saline-induced pain effect on EMG activity (i.e., whether the hypertonic saline-induced EMG activity was less than or greater than control EMG activity) could change with the magnitude of jaw displacement. Hypertonic saline infusion had no significant effect on postural EMG activity in any of the recorded jaw muscles. The data suggest that under constrained goal-directed tasks, the pattern of pain-induced changes in jaw muscle EMG activity is not clear cut, but can vary with the task performed, jaw displacement magnitude, and the subject being studied.     

西宁地区汉族人群胃组织内MDA含量与SOD活力变化与高原慢性胃炎发病的关系

目的：探讨高原地区慢性胃炎高发病率发病机制。方法：检测平原地区与高原地区汉族人群慢性胃炎胃组织内MDA（丙二醛）含量与SOD（超氧化物歧化酶）活力。结果：高原地区与平原地区世居汉族人群胃黏膜组织中的MDA含量相同,无明显差异,但是高原地区世居汉族人群胃黏膜组织中的SOD活力显著高于平原地区世居汉族人群的的SOD活力。高原地区移居汉族胃黏膜内MDA含量与SOD活力均高于平原地区世居汉族人群。相同海拔高度高原地区世居与移居汉族人群胃黏膜内MDA含量与SOD活力无明显差异。结论：高原地区慢性胃炎胃组织内存在氧自由基代谢失衡,而且是高原地区慢性胃炎高发的重要原因之一。     

Influence of osmolarity of contrast medium and saline flush on computed tomography angiography: Comparison of monomeric and dimeric iodinated contrast media with different iodine concentrations at an identical iodine delivery rate

Purpose

To evaluate the influence of osmolarity of iodinated contrast media and saline flush on the contrast effect in thoracic computed tomography angiography (CTA) at an identical iodine delivery rate (IDR).

Materials and methods

Seven beagles were used in a cross-over experiment. The contrast media used were iohexol 350 mgI/ml (IOH350; osmolarity 844 mmol/kg) and iodixanol 320 mgI/ml (IDX320; osmolarity 290 mmol/kg). Each contrast medium was administered to groups with and without saline flush at 40.0 mgI/kg/s for all experiments. Dynamic CT scanning was performed at the ninth thoracic vertebra level. The peak value, area under the curve (AUC), and time to peak (TTP) were calculated from the time attenuation curves of the pulmonary artery and aorta.

Results

There was no significant difference between IOH350 and IDX320 with or without saline flush in the peak values for the pulmonary artery and aorta. AUC was significantly higher in groups with saline flush for both contrast media and arteries (p < 0.05) with no significant difference between contrast media. TTP was significantly longer in groups with saline flush than without saline flush for both contrast media and arteries (p < 0.05), with no significant difference between contrast media.

Conclusions

There were no significant differences in the contrast effects of monomeric IOH350 and dimeric IDX320 in thoracic CTA when used at an identical IDR. Moreover, saline flush prolonged the peak duration at 600 mgI/kg.     

Effect of different saline chaser volumes and flow rates on intravascular contrast enhancement in CT using a circulation phantom

Purpose

To evaluate the influence of different saline chaser volumes and different saline chaser flow rates on the intravascular contrast enhancement in MDCT.

Materials and methods

In a physiological flow phantom contrast medium (120 ml, 300 mgI/ml, Ultravist 300) was administered at a flow rate of 6 ml/s followed by different saline chaser volumes (0, 30, 60 and 90 ml) at the same injection rate or followed by a 30-ml saline chaser at different injection rates (2, 4, 6 and 8 ml/s). Serial CT-scans at a level covering the pulmonary artery, the ascending and the descending aorta replica were obtained. Time-enhancement curves were computed and both pulmonary and aortic peak enhancement and peak time were determined.

Results

Compared to contrast medium injection without a saline chaser the pushing with a saline chaser (30, 60, and 90 ml) resulted in a statistically significant increased pulmonary peak enhancement (all p = 0.008) and prolonged peak time (p = 0.032, p = 0.024 and p = 0.008, respectively). Highest aortic peak enhancement values were detected for a saline chaser volume of 30 ml. A saline chaser flow rate of 8 ml/s resulted in the highest pulmonary peak enhancement values compared to flow rates of 2, 4 and 6 ml/s (all p = 0.008). Aortic peak enhancement showed the highest values for a flow rate of 6 ml/s.

Conclusion

A saline chaser volume of 30 ml and an injection rate of 6 ml/s are sufficient to best improve vascular contrast enhancement in the pulmonary artery and the aorta in MDCT.     

联合应用大剂量呋塞米、小剂量多巴胺及高渗盐水治疗顽固性心功能衰竭的疗效观察

目的探讨高渗盐水联合大剂量呋塞米、小剂量多巴胺持续静脉注射在顽固性心衰治疗中的实际应用价值。方法选择已经接受常规利尿、扩血管等治疗效果不显著的顽固性心衰患者32例,实施高渗盐水联合大剂量呋塞米、小剂量多巴胺持续静脉注射治疗方案,常规口服螺内酯,低钾血症患者静脉补钾。结果治疗后患者体质量明显减轻,血钠、钾、氯浓度明显升高,呼吸困难均较前减轻,水肿明显消退。结论联合应用大剂量呋塞米、小剂量多巴胺及高渗盐水治疗顽固性心衰疗效显著,值得,临床应用。     

滴注NaCl湿化液对机械通气新生儿吸痰效果及心肺功能的影响

目的探讨机械通气新生儿吸痰前气道内滴注不同容量、浓度的NaCl湿化液对痰量和心肺功能的影响。方法选择20例有创机械通气新生儿,分别给予气道内滴注不同容量、浓度的NaCl湿化液,记录滴注湿化液后和吸痰后1,2,10min的痰量和外周血氧饱和度（SpO2）、气道峰压（PIP）、心率（HR）、收缩压（SBP）和舒张压（DBP）。结果滴注0.5ml湿化液组的痰液排出量（1.27±0.77）ml与不滴注湿化液组的痰液排出量（0.74±0.55）ml比较,差异有统计学意义（P=0.006）,但与滴注1ml湿化液组的痰液排出量（0.99±0.66）ml比较,差异无统计学意义（P=0.072）。在气管内吸痰前滴注不同浓度（0.9%和0.45%）、不同容量（0.5ml和1ml）NaCl湿化液对痰液排出量的影响无统计学差异（P＞0.05）。不同浓度和容量的NaCl湿化液对SpO2、HR、PIP、SBP和DBP均无影响（P＞0.05）,但SpO2、HR和SBP在吸痰前后均有随时间变化的趋势（F值分别为41.567,39.688,6.715,P＜0.05）。吸痰后2,10min的SpO2高于滴注湿化液后和吸痰后1min;吸痰后1,2min的HR快于滴注湿化液后;吸痰后1,2min的SBP较滴注湿化液后增高;PIP和DBP在吸痰前后没有随时间变化的趋势。结论机械通气新生儿吸痰前气道内滴注0.5ml、0.9%NaCl湿化液,可以增加痰量,对心肺功能无明显不良影响。     

生理盐水喷雾辅助治疗婴儿鼻塞及对其睡眠质量的影响

目的 分析生理盐水喷雾辅助治疗鼻塞的婴儿及对其睡眠质量的临床影响和治疗情况。方法 选取2017年3月~2018年3月我科收治的鼻塞患儿86例,随机分为对照组和观察组,每组43例。对照组给予常规治疗,观察组在对照组基础上加用生理盐水喷雾辅助治疗。对比两组患儿的鼻塞症状消失的时间及治疗前后鼻塞以及睡眠质量的评分情况。结果 治疗后,观察组鼻塞评分低于对照组[（1.40±0.49）分 vs（2.14±0.46）分],差异有统计学意义（P＜0.05）。观察组鼻塞症状消失时间短于对照组[（5.95±1.02）d vs （10.95±1.77）d],差异有统计学意义（P＜0.05）。观察组睡眠质量评分低于对照组[（1.41±0.59）分 vs （2.07±0.63）分],差异有统计学意义（P＜0.05）。观察组治疗总有效率高于对照组（95.35% vs 72.09%）,差异有统计学意义（P＜0.05）。结论 应用生理盐水喷雾辅助治疗鼻塞的婴儿,能够有效缩短病程,消除鼻塞症状,改善睡眠治疗,提高临床治疗效果。