腰硬联合镇痛及患者自控镇痛对产程及分娩结局的影响

目的 探讨腰硬联合(CSEA)及患者自控镇痛(PCEA)对产程及分娩结局的影响。方法 随机选取2014年1~12月足月待产、无妊娠合并症和并发症初产妇996例,其中503例产妇于活跃期实施CSEA+PCEA镇痛(分娩镇痛组),493例未行分娩镇痛(对照组),分别记录并比较两组产妇各产程时间、子宫收缩、镇痛效果、运动神经阻滞程度、产程中缩宫素的使用率、产后出血率、羊水Ⅲ度污染率、新生儿Apgar评分、产钳助产和剖宫产率。结果 分娩镇痛组第一产程、第二产程较对照组有所延长,差异有统计学意义(P<0.05);第三产程无明显改变;子宫收缩力减弱;分娩镇痛组较对照组镇痛效果显著,差异有统计学意义(P<0.05);运动阻滞程度低;缩宫素使用率、产后出血率、羊水Ⅲ度污染率、及新生儿Apgar评分及产钳助产和剖宫产率两组比较,差异均无统计学意义(P>0.05)。结论 腰硬联合分娩镇痛可能会使第一产程、第二产程延长,对子宫收缩力有一定的影响,但并未增加缩宫素的使用率及产钳助产和剖宫产率,其镇痛效果显著,运动阻滞程度低,对分娩结局无不良影响。     

Relation between energy expenditure and body composition in man: specific energy expenditure in vivo of fat and fat-free tissue

The relationship between energy expenditure and body composition, in terms of fat and fat-free masses, has previously been described by a variety of predictive regression equations with parameters devoid of physiological content. We present here results obtained by calculating the specific energy expenditure, ie, the energy expenditure per unit of mass, of fat and fat-free tissue on the basis of measurements of the total energy expenditure (EE), the masses of fat (FM), and fat-free (FFM) tissue using the following simple model: EE = k1.FM + k2.FFM where k1 and k2 are the specific energy expenditures of fat and fat-free tissue, respectively. The results of observations on 104 women at rest yielded values for k1 and k2 of 0.31 and 1.35 watts/kg of fat and fat-free mass, respectively, with standard errors of estimate of 0.074 and 0.052 watts/kg, respectively. Analysis of several series of measurements, from other sources and on smaller samples of subjects, yielded similar values at rest but with larger standard errors of estimate. Data from subjects performing varying amounts of work in 24-h measurements showed, as expected, larger values for both tissues. The results explain to a very large extent the well-established relation between resting metabolic rate and body weight, ie, a linear relation with a non-zero intercept. The results also offer a clear-cut explanation for the well known difference in energy expenditure between men and women with the same body weight.     

5339例创伤患者创伤及死亡特点分析

目的　探讨创伤患者创伤及死亡特点。方法　回顾性分析 1996年 1月至 2 0 0 0年 12月我院收治 5 3 3 9例创伤患者的临床资料。结果　 5 3 3 9例创伤患者中男性 3 910例 ,女性 14 2 9例 ,平均受伤年龄 (3 5 3± 3 3 7)岁 ,2 0～ 2 9岁占 64 19%。治愈好转5 168例 ,死亡 47例 ,3 1例死于重型、特重型颅脑损伤。结论　创伤的高危人群为青壮年 ,且男性多于女性 ,交通事故是本组创伤的第一位原因。把创伤的预防与控制作为一项政府工程 ,加强宣传和教育 ,改善交通状况等均对创伤的预防与控制有重要意义     

Myelinated fiber regeneration after crush injury is retarded in sciatic nerves of aging mice

To compare nerve regeneration in young adult and aging mice, the right sciatic nerves of 6- and 24-month-old mice were crushed at the sciatic notch. Two weeks later, both groups of mice were perfused with an aldehyde solution, and, after additional fixation, the sciatic nerves were processed so that the transverse sections of each nerve subsequently studied by light and electron microscopy included the entire posterior tibial fascicle 5 mm distal to the crush site. The same level was sectioned in unoperated contralateral nerves; these nerves served as controls. Electron micrographs and the Bioquant Image Analysis System IV were used to measure areas of posterior tibial fascicles and count the number of myelinated axons, the number of unmyelinated axons, and their frequency in Schwann cell units. In aging mice, the total number of regenerating myelinated axons was significantly reduced, but totals of regenerating unmyelinated axons in aging and young adults did not differ significantly. In aging mice, the frequency of Schwann cells that contained a single unmyelinated axon was greater, suggesting that before myelination began, Schwann cell ensheathment of axons also was slowed. After axotomy by a crush injury, the area of the posterior tibial fascicle was less than that in young adults and the distal disintegration of myelin sheath remnants also appeared to be retarded. The results indicate that responses of neurons, axons, and Schwann cells could be important in slowing the regeneration of myelinated fibers found in sciatic nerves from aging mice.     

High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults

Background contextBack problems (BPs), with their cost and disability, are a substantial burden for individuals, employers, and society.PurposeThis systematic review of controlled trials evaluates the effectiveness of interventions to prevent BP episodes in working age adults.Data sourcesWe searched MEDLINE/EMBASE through May 2007, and COCHRANE/Trials Registry through August 22, 2008 using search terms of back pain, back injuries or sciatica, linked to prevention, control, workplace interventions, or ergonomics and searched article bibliographies.Study selectionFor systematic review inclusion, articles had to describe prospective controlled trials of interventions to prevent BPs in working-age adults, with intervention assignment either to individual participants or preexisting groups. Of 185 articles identified as potentially relevant, 20 trials (11%) met inclusion criteria.Data extractionResearchers extracted relevant information from controlled trials and graded methodological quality. Because of heterogeneity of trials, meta-analysis was not performed.ResultsOnly exercise was found effective for preventing self-reported BPs in seven of eight trials (effect size 0.39 to >0.69). Other interventions were not found to reduce either incidence or severity of BP episodes compared with controls. Negative trials included five trials of education, four of lumbar supports, two of shoe inserts, and four of reduced lifting programs.ConclusionsTwenty high-quality controlled trials found strong, consistent evidence to guide prevention of BP episodes in working-age adults. Trials found exercise interventions effective and other interventions not effective, including stress management, shoe inserts, back supports, ergonomic/back education, and reduced lifting programs. The varied successful exercise approaches suggest possible benefits beyond their intended physiologic goals.Level of evidenceSystematic review Level I evidence.     

浅谈基层医院如何掌握胆囊息肉样病变手术指征

胆囊息肉病变(PLG)临床并不少见,手术是根治的主要方法,但并非所有胆囊息肉都需手术治疗。因其病变类型不同,大小不一,疾病转归亦不尽相同,因此其手术适应证各家医院掌握也不一致。我院自1996年1月至2006年6月共收治胆囊息肉病人128例,其中手术切除胆囊119例,具体分析如下。     

Varicose vein surgery using a pneumatic tourniquet: reduced blood loss and improved cosmesis.

A prospective controlled randomised study has been performed of 100 consecutive patients undergoing varicose vein surgery. One group underwent saphenofemoral flush ligation and multiple lower leg avulsions with the leg exsanguinated with a Rhys-Davies cuff, and ischaemia maintained with a pneumatic tourniquet. The other group underwent identical surgery but with a 30 degree head down tilt only. Blood loss was significantly less (13.5 +/- 12 ml vs 133 +/- 78 ml; P less than 0.01) and postoperative cosmesis was significantly improved in patients in the tourniquet group. Operating time was similar (27 +/- 11 min vs 30 +/- 13 min) in the two groups.