麻醉诱导前给予右美托咪定对脊柱侧弯矫形术患者的影响

探讨麻醉诱导前给予右美托咪定对脊柱侧弯矫形术患者唤醒时间、镇痛效应及血流动力学的影响。方法 选取2021年1月～2021年12月间于我院行脊柱侧弯矫形术的患者113例为研究对象,按照简单随机法分为观察组（n=57）和对照组（n=56）,观察组在麻醉诱导前给予0.8 μg/kg的右美托咪定10 min内静脉泵注体内,对照组在相同时间内泵入等量的生理盐水,而后两组患者均行全身麻醉,比较两组麻醉插管前（T0）、插管后10 min（T1）、唤醒前10 min（T2）、唤醒期间（T3）、唤醒后5 min（T4）、加深麻醉后10 min血流动力学指标［心率（HR）、平均动脉压（MAP）、血氧饱和度(SpO2)］变化,术后唤醒时间、唤醒质量、唤醒时躁动发生率,拔管即刻、术后2、6、24 h镇痛效果［视觉模拟评分法（VAS）］,麻醉前、术后2 h及6 h应激反应［血清皮质醇（Cor）、醛固酮（ALD）、血糖（Glu）］水平及药物安全性。结果 HR、MAP组间、时间点、组间×时间点比较,差异均有统计学意义（P＜0.05）,观察组T3、T4时间段HR、MAP比较差异有统计学意义（P＜0.05）,SpO2组间、时间点、组间×时间点比较差异均无统计学意义（P＞0.05）。观察组唤醒质量显著高于对照组（P＜0.05）,唤醒时躁动发生率显著低于对照组（P＜0.05）,两组唤醒时间比较差异无统计学意义（P＞0.05）。VAS评分组间、时间点、组间×时间点比较,差异均有统计学意义（P＜0.05）,组内各时间段比较差异均有统计学意义（P＜0.05）,观察组术后2、6 h VAS评分显著低于对照组（P＜0.05）。Cor、ALD、Glu组间、时间点、组间×时间点比较,差异均有统计学意义（P＜0.05）,组内各时间段内外周血Cor、ALD、Glu水平均依次递增（P＜0.05）,且观察组术后2、6 h外周血Cor、ALD、Glu水平均显著高于对照组（P＜0.05）。观察组与对照组不良反应率比较,差异无统计学意义（2=0.154,P=0.694）。结论 脊柱侧弯矫形术麻醉诱导前给予右美托咪定有利于提高术中唤醒质量,降低术中血流动力学波动,改善术后疼痛及应激反应,具有良好的应用价值     

Relationship between self-rating and polygraphic sleep parameters — analysis of compiled data from 12 young Japanese adults —

An examination of the relationship of the self-rating sleep score to polygraphic sleep parameters was conducted. The self-rating sleep questionnaire, OSA, includes five sleep quality factors: sleepiness (Fl), sleep maintenance without interruption (F2), worry about daily life or poor emotional condition (F3), integrated or perceived sleep feeling (F4) and sleep initiation or induction (F5). Polygraphic sleep parameters including each sleep stage in minutes were used. If intercorrelation coefficients exceeded 0.8, only one of the related parameters was selected for multivariate analysis. Twelve male students slept a total of 88 nights, among which the first night was not included, in an experimental room. When absolute values of Spearman’s rank correlation coefficient of not less than 0.4 were tentatively selected, the following pairs were extracted: F2 score and S1 (-0.423) or S3+S4 (0.409), F5 score and sleep latency (-0.439). Deeper sleep was closely associated with sleep maintenance without interruption. Agreement between self-rating and a polygraphic sleep parameter was recognized between the F5 score and sleep latency. Each OSA factor score was predicted by other polygraphic sleep parameters using multiple regression analysis. MT significantly contributed to the Fl, F3 and F4 scores. The number of stage shifts per night significantly contributed to the Fl and F3 scores, and the number of sleep spindles significantly contributed to the F5 score. Though prediction of sleep quality by polygraphic sleep parameters is limited, the association between concrete subjective and objective sleep parameters was clarified as mentioned above, and their practical meaning was partially elucidated.     

局部浸润麻醉在急腹症患者全麻手术苏醒期的疗效观察

目的研究局部浸润麻醉在急腹症患者全麻手术苏醒期的疗效。方法将我院80例急腹症患者随机分为观察组与对照组各40例。两组手术前均采取相同的气管内插管全麻。观察组手术结束前给予罗哌卡因手术切口皮下局部浸润麻醉,对照组不给予局麻。对比两组麻醉效果、苏醒期疼痛、烦燥情况。结果观察组苏醒时的VAS评分明显低于麻醉前(p<0.001),也显著低于同期对照组评分(p<0.001)。观察组麻醉优良率高于对照组,差异有统计学意义(95.0%vs 75.00%,p<0.05)。观察组苏醒时疼痛、烦躁等不良反应发生率明显低于对照组,差异有统计学意义(p<0.05)。结论在急腹症患者全麻手术结束前追加局部浸润麻醉,麻醉效果更好,苏醒期更加平稳和安全。     

集束化激励式心理干预在急诊重症监护室机械通气清醒患者撤机中的应用

目的：分析急诊重症监护室机械通气患者清醒撤机时辅以集束化激励式心理干预的临床应用价值。方法：选取2018年1月至2019年1月我院重症监护室收治94例机械通气患者为研究对象，对照组单纯辅以常规护理干预，观察组辅以集束化激励式心理干预，比较护理效果。结果：观察组患者一次拔管成功率明显高于对照组，再插管率、病死率均明显低于对照组(P＜0.05)。另外，观察组患者机械通气时间（4.21±1.14）d、住ICU病房时间（8.42±0.24）d均较对照组相比更短(P＜0.05)。结论：重症ICU病房内机械通气患者清醒后撤机时辅以集束化激励式心理干预效果更佳，可提高一次拔管成功率，降低病死率。     

Effects of childhood trauma on HPA-axis reactivity in women free of lifetime psychopathology

Exposure to childhood trauma may induce persistent changes in Hypothalamic-Pituitary-Adrenal (HPA)-axis functioning even in the absence of current psychopathology. Because previous studies did not systematically exclude subjects with lifetime psychiatric morbidity, prevalent psychopathology may have confounded the association. In this study we investigated whether women exposed to childhood trauma, but without a history of psychiatric disorders, show alterations in HPA-axis functioning. We included 10 women exposed to significant childhood trauma and 12 non-exposed women. All women were between 29 and 64 years old, mentally and physically healthy, and without current or lifetime psychopathology. HPA-axis functioning was assessed as 1) basal activity with salivary cortisol patterns over 8 time points on two consecutive sampling days and 2) plasma cortisol and adrenocorticotropic hormone (ACTH) reactivity over 7 time points after the combined dexamethasone/corticotropin-releasing hormone (dex/CRH) challenge test. Basal salivary cortisol output did not differ between trauma-exposed compared to non-exposed women. Significantly blunted plasma cortisol and ACTH responses in response to dex/CRH administration were found in the trauma-exposed compared to the non-exposed women (F(1,20) = 5.08, p = 0.04 and F(1,20) = 5.23, p = 0.03 respectively). Adjusting for age, body mass index (BMI), oral contraceptive use, and menopausal status, somewhat weakened the associations for cortisol as well as ACTH (F(1,16) = 3.30, p = 0.09) and F(1,16) = 2.17, p = 0.16 respectively), but for cortisol absolute differences in point estimates were largely unaffected. Although basal cortisol patterns were similar in the two groups, exposure to childhood trauma seemed to be related to a blunted HPA-axis reactivity in women who were free of current or lifetime psychopathology.     

Salivary 3‐methoxy‐4‐hydroxyphenylglycol increases after awakening in healthy young adults

Levels of 3‐methoxy‐4‐hydroxyphenylglycol (MHPG) may reflect central noradrenergic activity. In this study, we investigated salivary MHPG changes after awakening, and explored their relationships with cortisol and peripheral autonomic activity. The participants were 25 college students. Saliva samples were collected on awakening and 30 min after awakening to determine MHPG and cortisol. Ambulatory electrocardiograms were obtained to assess heart rate, cardiac sympathetic index (CSI), and cardiac vagal index (CVI) before and after awakening. MHPG levels increased significantly during the first 30 min after awakening. Similarly, cortisol, heart rate, and CSI increased during the 30 min after awakening, but changes in MHPG did not correlate with changes in cortisol, heart rate, CSI, and CVI during that period. This study demonstrated that salivary MHPG levels increase after awakening, in common with cortisol, heart rate, and cardiac sympathetic activity.     

半导体激光血管内照射联合针刺疗法对重度颅脑损伤昏迷的催醒作用

目的探讨半导体激光血管内照射联合针刺疗法对重度颅脑损伤昏迷患者的催醒作用。方法1998年至2000年稳定期重度颅脑损伤昏迷患者76例,随机分为2组,各38例。对照组行常规治疗。治疗组低强度半导体激光血管内照射同时行针刺治疗;激光功率2～3.5mW,照射时间50～60min;针刺取穴关中、风府、风池、内关、神门、劳宫、十宣、三阴交、涌泉;激光照射及针刺同时进行,每日1次,15次为一疗程。2组患者治疗后格拉斯哥迷量表(GCS)评分≥9为清醒。结果治疗后第25天,治疗组清醒33例,对照组清醒27例,差异有显著意义(P<0.05)结论激光血管内照射加针刺疗法可显著缩短重度颅脑损伤稳定期昏迷患者的昏迷时间。     

Awakening as an operant behavior: preliminary results.

Albino laboratory rats, surgically implanted for polygraphic recording, were monitored electrophysiologically and behaviorally and subjected to programs of food reinforcement contingent on particular sleep parameters. It was found that rats could learn, in 4 to 8 days, to wake up before 10 sec of sleep had elapsed to receive drops of food upon awakening; randomly reinforced control rats did not exhibit this pattern. Rats required to decrease latency to sleep onset, while failing to do so, did show enhanced sleep preparatory behavior as indicated by decreased neck muscle EMG levels. A possible model of sleep as a sequence of discrete, theoretically conditionable behaviors is presented.     

无痛胃肠镜术后不同年龄患者苏醒与认知恢复调查

目的:研究不同年龄患者接受门诊无痛电子胃肠镜术后麻醉苏醒和认知功能恢复情况。方法:门诊无痛电子胃镜检查的青、中、老年患者接受术前及术后1 h内每15 min简明精神状态评分(minimal mental status examination,MMSE),计算出术后认知恢复程度百分比,并记录苏醒过程。结果:老年组的完全苏醒时间为(12.7±4.3)min,明显比青、中年组长(9.3±4.1)min,(9.8±3.6)min。术后15 min、30 min、45 min和60 min老年组的MMSE分值分别为术前基线的75.29%、77.19%、86.31%、92.40%,均明显低于青年组和中年组(85.23%、92.95%、98.99%、99.66%和86.82%、92.23%、97.64%、99.32%)。术后认知功能恢复时间明显长于苏醒时间。结论:门诊无痛胃镜患者术后的麻醉苏醒比认知功能恢复快,老年患者的认知恢复和苏醒均明显慢于中、青年患者,但并无严重的认知功能障碍发生。提示对门诊患者,尤其是老年患者应该给予更长时间的观察。     

Psychosocial factors at home and at work and levels of salivary cortisol

BACKGROUND: Salivary cortisol as a physiological measure of stress has attracted great interest in recent years. METHOD: A 55 women and 28 men, all healthy volunteers, were included in a study on psychosocial factors at work and at home and salivary cortisol. General linear models, univariate and repeated measures, respectively, were used to evaluate the associations between psychosocial factors and cortisol excretion measured six times during a working day. Age, physical activity, tobacco use and the time of the first saliva sample were used as covariates. RESULTS: In the women, high degrees of time pressure, effort and effort reward imbalance were significantly associated with higher levels of cortisol. In the men, high degrees of effort, effort reward imbalance and overcommitment were significantly associated with higher levels of cortisol. CONCLUSION: Psychosocial factors are of significance to the level of salivary cortisol. The study emphasises the benefits of taking physiological measurements of stress in epidemiological studies.