老年手术患者应用丙泊酚复合瑞芬太尼喉罩麻醉的临床效果观察

目的：探讨靶控输注丙泊酚复合瑞芬太尼喉罩麻醉在老年手术患者中的临床应用效果,为临床麻醉提供参考。方法：选取127例老年手术患者作为研究对象,随机分为A、B、C3组,A组43例（采用瑞芬太尼复合丙泊酚麻醉,喉罩通气）、B组42例（采用丙泊酚麻醉,喉罩通气）,C组42例（采用瑞芬太尼复合丙泊酚麻醉,面罩通气）,均采用靶控输注静脉麻醉法。观察麻醉诱导时间、术中反应、麻醉效果、镇静效果评分、苏醒时间、认知功能以及不良反应发生率等指标。结果：丙泊酚总用量：A组为（335．2±56．4）mg,B组为（466．5±64．8）mg,C组为（334．8±59．7）mg,经方差分析,差异有统计学意义,F=6．513,P〈0．05;Ramsay评分：A组6分的例数为37例（86．0％）,B组为30（71．4％）,C组为34（81．0％）,经卡方检验,差异有统计学意义,X^2=5．832,P〈0．05;不良反应发生率：A组为5例（11．6％）,B组为15例（35．7％）,C组为7例（16．7％）,经卡方检验,差异有统计学意义,X^2=7．546,P〈0．05。结论：老年手术患者应用丙泊酚复合瑞芬太尼喉罩麻醉效果显著,安全有效。     

喉罩通气下七氟醚全凭吸入麻醉在小儿先天性心脏病介入手术的临床麻醉效果

目的:探讨喉罩通气下七氟醚全凭吸入麻醉在小儿先天性心脏病介入手术的临床麻醉效果。方法:选取2017年4月～2019年5月期间我院收治的行先天性心脏病介入手术患儿98例,根据随机数字表法将其分为对照组(n=49)和研究组(n=49)。对照组给予氯胺酮诱导,全凭丙泊酚维持,面罩吸氧;研究组给予全凭七氟醚诱导、维持,喉罩通气。比较两组患儿麻醉前(T0)、切皮前(T1)、切皮后1 min(T2)、切皮后30 min(T3)、术后(T4)的血流动力学指标[平均动脉压(MAP)、心率(HR)]及应激反应指标[血糖、皮质醇],记录两组患儿手术时间、麻醉诱导时间、术后苏醒时间等围术期指标情况。记录两组围术期不良反应发生情况。结果:研究组手术时间、麻醉诱导时间、术后苏醒时间均短于对照组(P0.05)。两组T0时间点血糖、MAP、皮质醇、HR比较差异无统计学意义(P0.05);对照组T1～T4时间点MAP、血糖、皮质醇、HR均较T0升高(P0.05);研究组T1～T4时间点血糖、MAP、皮质醇、HR与T0时间点比较无差异(P0.05);研究组T1～T4时间点血糖、MAP、皮质醇、HR低于对照组(P0.05)。两组不良反应发生率比较无差异(P0.05)。结论:小儿先天性心脏病介入手术中应用喉罩通气下七氟醚全凭吸入麻醉,诱导迅速且安全、术后苏醒快、手术时间短,可有效维持血流动力学稳定,减少应激反应。     

神经内科硕士研究生临床和科研能力的培养

临床医学硕士研究生阶段是培养临床和科研思维能力的重要阶段,从某种意义上说是人生和医疗生涯的关键时期。神经内科硕士研究生不仅应该具有一定的临床工作能力,还应具有一定的科研能力。临床工作能力培养包括临床基本功的培训,基本理论的加强和基本技能的培养,临床思维能力的培养及医患沟通能力的培养等多个方面。科研能力包括文献阅读能力、科研思维能力和论文写作能力等。这样,硕士研究生毕业后不仅能够诊治神经内科常见病和多发病,会思考临床工作中的问题,更重要的是能想办法探索和解决这些问题。这也是硕士研究生和本科生的本质区别。因此,研究生阶段是医学生涯一个重要的里程碑,临床和科研能力的培养对个人未来的发展具有十分重要的意义。     

Novel Vitamin and Gold-Loaded Nanofiber Facial Mask for Topical Delivery

l-ascorbic acid has been widely used in cosmetic and dermatological products because of its ability to scavenge free radicals and destroy oxidizing agents. However, it is chemically unstable and can easily be oxidized. The current cosmetic facial masks available in the market are pre-moistened, which means that the aqueous fluid content of the mask may oxidize some of the unstable active ingredients such as ascorbic acid. This work presents an anti-wrinkle nanofiber face mask containing ascorbic acid, retinoic acid, gold nanoparticles, and collagen. This novel face mask will only be wetted when applied to the skin, thus enhancing product stability. Once moistened, the content of the mask will gradually dissolve and release the active ingredients and ensure maximum skin penetration. The high surface area-to-volume ratio of the nanofiber mask will ensure maximum contact with the skin surface and help to enhance the skin permeation to restore its healthy appearance. Electrospun fiber mats may provide an attractive alternative to the commercial facial cotton masks.     

病理学专业学位研究生临床与科研能力培养模式初探

病理学是研究疾病的发病、病变机理及在疾病发展过程中各组织器官形态特征与功能变化的一门学科,被称作是联系基础与临床的桥梁和纽带。据统计我国现阶段临床病理医生的需求量很大,而高水平临床病理诊断医师尤为欠缺。近年来,病理学专业学位研究生的培养应运而生,旨在为国家培养高质量的病理学人才。然而由于我国传统的病理学研究生的培养仍存在种种弊端,毕业的研究生难以获得临床与科研二者综合能力的提升,因而限制了其自身在病理学事业方面的发展。本文依据我科室专业学位研究生的培养经验,探讨病理学专业学位研究生的培养模式以及如何培养高层次病理学人才,促进其科学研究与外科病理诊断的有机结合,为推动我国病理学事业的蓬勃发展打好坚实基础。     

Effective Linkages of Continuum of Care for Improving Neonatal,Perinatal, and Maternal Mortality: A Systematic Review and Meta-Analysis

Background

Continuum of care has the potential to improve maternal, newborn, and child health (MNCH) by ensuring care for mothers and children. Continuum of care in MNCH is widely accepted as comprising sequential time (from pre-pregnancy to motherhood and childhood) and space dimensions (from community-family care to clinical care). However, it is unclear which linkages of care could have a greater effect on MNCH outcomes. The objective of the present study is to assess the effectiveness of different continuum of care linkages for reducing neonatal, perinatal, and maternal mortality in low- and middle-income countries.

Methods

We searched for randomized and quasi-randomized controlled trials that addressed two or more linkages of continuum of care and attempted to increase mothers’ uptake of antenatal care, skilled birth attendance, and postnatal care. The outcome variables were neonatal, perinatal, and maternal mortality.

Results

Out of the 7,142 retrieved articles, we selected 19 as eligible for the final analysis. Of these studies, 13 used packages of intervention that linked antenatal care, skilled birth attendance, and postnatal care. One study each used packages that linked antenatal care and skilled birth attendance or skilled birth attendance and postnatal care. Four studies used an intervention package that linked antenatal care and postnatal care. Among the packages that linked antenatal care, skilled birth attendance, and postnatal care, a significant reduction was observed in combined neonatal, perinatal, and maternal mortality risks (RR 0.83; 95% CI 0.77 to 0.89, I² 79%). Furthermore, this linkage reduced combined neonatal, perinatal, and maternal mortality when integrating the continuum of care space dimension (RR 0.85; 95% CI 0.77 to 0.93, I² 81%).

Conclusions

Our review suggests that continuous uptake of antenatal care, skilled birth attendance, and postnatal care is necessary to improve MNCH outcomes in low- and middle-income countries. The review was conclusive for the reduction of neonatal and perinatal deaths. Although maternal deaths were not significantly reduced, composite measures of all mortality were. Thus, the evidence is sufficient to scale up this intervention package for the improvement of MNCH outcomes.     

变蛋袋料液配方的研究

变蛋袋浸渍料液中NaOH浓度是决定变蛋凝固性的关键因子。在一定范围内 ,其浓度每增减 0 .65% ,始凝日期可增减一天。其中料液重 1 1 g、NaOH浓度 7.76%、始凝日期 1 1天组为最适配比。     

Bag culture: a method for root-root co-culture

A method named "bag culture" was developed for coculturing of Linum persicum (section Syllinum) and L. austriacum (section Linum) hairy roots. For this propose L. austriacum and L. persicum hairy root cultures were established using Agrobacterium rhizogenes in McCown medium. L. persicum hairy roots in bags (1 mm2 mesh) were successfully grown together with L. austriacum hairy roots. The amounts of podophyllotoxin (PTOX) and 6-methoxypodophyllotoxin (MPTOX) produced by L. persicum hairy root cultures were detected using HPLC. The results indicated that the amounts of both lignans and growth indexes of the two hairy roots decreased, that may be partly due to a competition between the two types of culture in using precursors of biosynthetic metabolites and the amount of culture medium which is available for each hairy root. However, MPTOX (0.17 g/100 g DW) and PTOX (0.02 g/100 g DW) levels of the L. persicum single culture in bag were significantly higher than of the other cultures which may be due to the immobilization effect of the bag.     

Improving the Quality of Maternal and Neonatal Care: the Role of Standard Based Participatory Assessments

Background

Gaps in quality of care are seriously affecting maternal and neonatal health globally but reports of successful quality improvement cycles implemented at large scale are scanty. We report the results of a nation-wide program to improve quality of maternal and neonatal hospital care in a lower-middle income country focusing on the role played by standard-based participatory assessments.

Methods

Improvements in the quality of maternal and neonatal care following an action-oriented participatory assessment of 19 areas covering the whole continuum from admission to discharge were measured after an average period of 10 months in four busy referral maternity hospitals in Uzbekistan. Information was collected by a multidisciplinary national team with international supervision through visit to hospital services, examination of medical records, direct observation of cases and interviews with staff and mothers. Scores (range 0 to 3) attributed to over 400 items and combined in average scores for each area were compared with the baseline assessment.

Results

Between the first and the second assessment, all four hospitals improved their overall score by an average 0.7 points out of 3 (range 0.4 to 1), i.e. by 22%. The improvements occurred in all main areas of care and were greater in the care of normal labor and delivery (+0.9), monitoring, infection control and mother and baby friendly care (+0.8) the role of the participatory action-oriented approach in determining the observed changes was estimated crucial in 6 out of 19 areas and contributory in other 8. Ongoing implementation of referral system and new classification of neonatal deaths impede the improved process of care to be reflected in current statistics.

Conclusions

Important improvements in the quality of hospital care provided to mothers and newborn babies can be achieved through a standard-based action-oriented and participatory assessment and reassessment process.     

气囊面罩联合气管插管通气救治对急诊心肺复苏患者动脉血气指标及预后的影响

摘要 目的：观察气囊面罩联合气管插管通气救治对急诊心肺复苏患者动脉血气指标及预后的影响。方法：选取中国人民解放军联勤保障部队第九四〇医院2020年4月-2022年10月期间收治的急诊心肺复苏患者86例作为研究对象。根据通气方式的不同将患者分为A组（n=41,常规气管插管通气救治）和B组（n=45,气囊面罩联合气管插管通气救治）。对比两组临床指征、急性生理与慢性健康评分（APACHEⅡ）、血气指标[二氧化碳分压（PCO2）、实际碳酸氢根（AB）、氧分压（PO₂）、二氧化碳总量（TCO₂）]、复苏成功率、格拉斯哥昏迷评分（GCS）、6个月存活率。结果：与A组相比,B组的自主呼吸恢复时间、心跳恢复时间、气道开放时间、意识恢复时间更短（P<0.05）。治疗后B组AB、TCO₂、PCO₂低于A组,PO₂高于A组（P<0.05）。治疗后B组APACHEⅡ评分低于A组,GCS高于A组（P<0.05）。B组的复苏成功率、6个月存活率高于A组（P<0.05）。结论：急诊心肺复苏患者使用气囊面罩联合气管插管通气救治,患者的临床指征、动脉血气指标均得到显著改善,且预后良好。     

高频振荡呼吸机治疗呼吸窘迫综合征致呼吸机相关性肺损伤的疗效观察

目的:观察高频振荡呼吸机在治疗呼吸窘迫综合征(NRDS)致呼吸机相关性肺损伤(VALI)患儿的临床疗效。方法:选择我院2012年6月~2014年10月收治的NRDS致VALI患儿83例为研究对象,采用随机数字表法将患者随机分为研究组(45例)和对照组(38例)。两组均进行一般治疗,在此基础上对照组采用常规机械通气,研究组采用高频振荡呼吸机行高频通气。观察两组患者治疗24 h后p H值、二氧化碳分压(Pa CO2)、氧分压(Pa O2)、血压(BP)、心率(HR)及并发症情况。结果:两组患者治疗24 h后p H值、Pa CO2、Pa O2及BP比较,差异均无统计学意义(P0.05),研究组HR心率低于对照组,差异存在统计学意义(P0.05);研究组纵膈气肿、肺损伤、间质气肿及气胸的发生率均低于对照组,差异有统计学意义(P0.05)。结论:高频振荡呼吸机治疗NRDS致VALI患儿能够明显改善其症状及减少并发症的发生率,是治疗NRDS致VALI的有效的方式。