高原红细胞增多症16例围术期麻醉管理体会

16例高原红细胞增多症 (简称高红症 )病人 ,在围术期我们针对该类患者其血液成分 ,微循环 ,血液流变学等方面发生的一系列生理或 /和病理性改变。采取了血液稀释和自体输血等相应的对策 ,取得了较好的手术麻醉效果 ,大大降低了高红症病人手术麻醉的危险性     

高原外训军人心理健康、认知因素与急性高山病的相关性

目的:探讨高原外训军人心理健康、认知因素与急性高山病的相关性。方法:采用基本信息问卷、Lake Louise急性高山病评分量表(AMS)、症状自评量表(SCL-90)、焦虑自评量表(SAS)和抑郁自评量表(SDS)对191名急进高原进行高原适应性训练的军人施以团体测验。结果:研究样本SCL-90的躯体化因子显著高于全国正常成人常模(t=5.019,P0.001)。AMS症状阳性组与阴性两组样本在文化程度(t=2.385,P0.05)、社会支持中的倾诉方式(t=2.542,P0.05)、求助方式(t=2.133,P0.05)、对AMS的认知(t=2.423,P0.05)、SCL-90总分(t=-4.936,P0.001)及各因子分均有显著差异。SCL-90总分、对AMS应对策略的认知对预测AMS症状总分有一定的预测作用。结论:高原外训军人心理健康水平、认知因素对AMS有显著的影响,运用合理的心理干预技术,可降低AMS的发生率,增强高原作战部队的战斗力。     

高原地区妇女卵巢激素功能的改变

本文对撒拉、土、回、蒙、藏、汉６种民族２７６６名已婚妇女进行阴道脱落细胞检查。其中对不同民族生育期妇女筛选６００例，ＨＥ·巴氏染色，计数阴道涂片的底层细胞比例，结果提示：卵巢激素功能轻度低落占３８％，中度低落占１４．６６％，高度低落占０．５％，并与地区、民族、年龄分布不同有关。推测高原低氧对卵巢激素功能低落有一定的影响。     

高原地区卵巢早衰病因分析及治疗

目的：探讨高原地区卵巢早衰的病因及中药活血法的疗效。方法：对51例卵巢早衰患者随机分为治疗组和对照组对比疗效并测定两组治疗前后血流变变化。结果：治疗组26例患者症状明显改善，22例月经基本正常，2例恢复正常月经并排卵妊娠，2例不满意。结论：中药活血法配合雌孕激素替代疗法标本兼治，为高寒地区治疗卵巢早衰提供了切实有效的特色疗法。     

Environmental, socio-demographic and behavioural determinants of malaria risk in the western Kenyan highlands: a case–control study

Objective  To identify risk factors for uncomplicated malaria in highland areas of East Africa at higher risk of malaria epidemics, in order to design appropriate interventions.
Methods  Prospective, population-based, case–control study in the Nandi Hills, a highland area of western Kenya, to identify environmental, sociodemographic and behavioural factors associated with clinical malaria. Data were collected using field observation, a structured questionnaire, and a global positioning system device.
Results  We interviewed 488 cases of slide-confirmed malaria and 980 age-matched controls. Multivariate analyses associated higher malaria risk with living <250 m of a forest [OR = 3.3 (95% CI 1.5, 7.1)], <250 m of a swamp [2.8 (1.3, 5.9)], <200 m of maize fields [2.0 (1.2, 3.4)], in the absence of trees <200 m [1.6 (1.2, 2.2)], on flat land [1.6 (1.2, 2.2)], in houses without ceilings [1.5 (1.1, 2.2)], in houses with a separate kitchen building [1.8 (1.4, 2.3)] and in households where the female household head had no education [1.9 (1.1, 3.1)]. Travelling out of the study site [2.2 (1.2, 4.1)] was also associated with increased risk.
Conclusions  In this East African highland area, risk of developing uncomplicated malaria was multifactorial with a risk factor profile similar to that in endemic regions. Households within close proximity to forest and swamp borders are at higher risk of malaria and should be included in indoor residual spraying campaigns.     

高海拔地区海拔高度与剧烈运动对血液流变性的影响

目的：探讨两个不同海拔地区剧烈运动前后血液流变性的变化。方法：对４０名平原健康青年在海捷拔３８００和５３００米两地区进行５公里越野跑前后血液流变学１０项指标检测。结果：在海拔３８００和５３００米越野跑后较前血液粘度增加,ＴＫ（红细胞变形系数）及 ＩＲ（红细胞刚性指数）减弱,ＨＣＴ（红细胞压积）和ＰＦＣ（纤维蛋白原）及 ＶＡＩ（血细胞聚集）增加。越野前在海拔５３００米较３８００米的血液粘度增加,ＴＫ、ＩＲ无显著性差异,ＰＦＣ增加显著（Ｐ＜０．０５）。其余指标升高。剧烈运动后海拔５３００较３８００米,ＩＲ一项无统计学意义,９项指标增加。结论：高原血液流变学指标的变化与高尺低氧低气压、海拔高度及剧烈运动有关。     

Spatial clustering of malaria and associated risk factors during an epidemic in a highland area of western Kenya

The epidemiology of malaria over small areas remains poorly understood, and this is particularly true for malaria during epidemics in highland areas of Africa, where transmission intensity is low and characterized by acute within and between year variations. We report an analysis of the spatial distribution of clinical malaria during an epidemic and investigate putative risk factors. Active case surveillance was undertaken in three schools in Nandi District, Western Kenya for 10 weeks during a malaria outbreak in May-July 2002. Household surveys of cases and age-matched controls were conducted to collect information on household construction, exposure factors and socio-economic status. Household geographical location and altitude were determined using a hand-held geographical positioning system and landcover types were determined using high spatial resolution satellite sensor data. Among 129 cases identified during the surveillance, which were matched to 155 controls, we identified significant spatial clusters of malaria cases as determined using the spatial scan statistic. Conditional multiple logistic regression analysis showed that the risk of malaria was higher in children who were underweight, who lived at lower altitudes, and who lived in households where drugs were not kept at home.     

Meteorologic influences on Plasmodium falciparum malaria in the Highland Tea Estates of Kericho,Western Kenya

Recent epidemics of Plasmodium falciparum malaria have been observed in high-altitude areas of East Africa. Increased malaria incidence in these areas of unstable malaria transmission has been attributed to a variety of changes including global warming. To determine whether the reemergence of malaria in western Kenya could be attributed to changes in meteorologic conditions, we tested for trends in a continuous 30-year monthly malaria incidence dataset (1966-1995) obtained from complete hospital registers at a Kenyan tea plantation. Contemporary monthly meteorologic data (1966-1995) that originated from the tea estate meteorologic station and from global climatology records were also tested for trends. We found that total hospital admissions (malaria and nonmalaria) remained unchanged while malaria admissions increased significantly during the period. We also found that all meteorologic variables showed no trends for significance, even when combined into a monthly suitability index for malaria transmission. We conclude that climate changes have not caused the highland malaria resurgence in western Kenya.     

药物对进驻高原青年睡眠剥夺及运动时心功能指数的影响

目的 :探讨红景天与乙酰唑胺对进驻高原青年睡眠剥夺及运动时心功能指数的影响。方法 :将进驻海拔 370 0m一个月的 2 4名健康青年随机分为 3组 ,每组 8人。让受试者做坐位踏车运动。计算每位受试者的心功能指数。第二次实验为2 4h睡眠剥夺后 ;第三次实验为 3组受试者分别口服三普红景天、乙酰唑胺和安慰剂 2 0d后 ;第四次实验为服药后 2 4h睡眠剥夺后 ,实验方法与第一次相同。结果 :红景天组和乙酰唑胺组心功能指数服药后与服药后睡眠剥夺后较服药前、睡眠剥夺后及对照组明显增高 ,差异显著 (P <0 0 5 ) ,但乙酰唑胺对人体有不良反应。结论 :三普红景天与乙酰唑胺均能改善高原移居青年的心功能及提高做功效率 ,三普红景天优于乙酰唑胺