目的 探讨髋关节置换术后超声神经刺激器引导下股神经阻滞麻醉对患者术后镇痛的效果.方法 56例实施髋关节置换术患者,随机分为基础组和干预组,各28例.基础组术后镇痛泵镇痛,干预组术后镇痛泵联合超声神经刺激器引导下股神经阻滞麻醉镇痛.比较两组患者术后疼痛情况、镇痛泵按压次数、曲马多用量.结果 干预组患者术后12、24、72 h疼痛评分分别为(2.6±0.5)、(3.2±0.6)、(2.8±0.4)分,均低于基础组的(3.5±0.9)、(4.2±1.1)、(3.7±0.7)分,差异有统计学意义(P<0.05).干预组镇痛泵按压次数(3.1±1.1)次及曲马多用量(112.3±21.1)mg均少于基础组的(7.2±1.6)次、(252.4±32.6)mg,差异有统计学意义(P<0.05).结论 髋关节置换术后超声神经刺激器引导下股神经阻滞麻醉能减轻患者术后疼痛程度,减少镇痛药物使用量.

目的 探究某企业退休糖尿病患者应用知信行模式(KABP)健康教育的效果.方法 98例某企业退休糖尿病患者,按随机数字表法分为对照组和观察组,各49例.对照组给予常规药物治疗及健康教育,观察组在对照组基础上给予KABP健康教育.比较两组患者并发症发生情况及干预前后空腹血糖(FBG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)水平.结果 干预前,两组FBG、2 h PG及HbA1c比较差异无统计学意义(P>0.05);干预后,观察组FBG(3.47±1.15)mmol/L、2 h PG(9.63±2.27)mmol/L及HbA1c(4.19±1.58)％均低于对照组的(4.79±1.58)mmol/L、(12.14±2.57)mmol/L、(6.17±1.92)％,差异有统计学意义(P<0.05).观察组并发症发生率为8.16％,明显低于对照组的30.61％,差异有统计学意义(P<0.05).结论 对企业退休糖尿病患者应用KABP健康教育能改善其血糖水平,减少并发症出现,值得广泛采用.

Objective: To assess the clinical effect of the combination of traditional Chinese medicine and Western medicine in acute lung injury. Methods: Randomized controlled trials related to the therapy for acute lung injury with the combination of traditional Chinese medicine and Western medicine were searched and select-ed from databases including CNKI,Wanfang Data,Weipu Data,CBM,PubMed,Embase and Cochrane Library. All literature was screened according to the inclusion and exclusion criteria screening and data was extracted by excel software.The Cochrane risk of bias table was used to valuate the study quality,and RevMan 5.3 was used for data analysis. Results: 16 RCTs,involving 756 patients,were included into the study. The Meta-analysis results showed that compared with Western medicine treatment,the combination of traditional Chinese medicine and Western medicine treatment could reduce the mortality risk(RR=0.54,95%CI[0.34,0.87],P=0.01)and the incidence of ARDS(RR=0.41,95%CI[0.25,0.65],P=0.0002)and decrease the concentration of CRP(SMD=-0.49,95%CI[-0.81,-0.17],P=0.002). Conclusion: The combination of traditional Chinese medicine and Western medicinemay has a better effect.However,due to the low methodology and quality and small sample size of included RCTs in this study,more RCTs with a larger sample size are required to further verify the efficacy and safety of the combination of traditional Chinese medicine and Western medicine therapy for ALI.

Objective To explore the effect and mechanism of sulfotanshinone sodium in lung fibrosis in ALI rats by intraperitoneal injection. Method The rats were divided into normal group,model group and sulfotan-shinone sodium group randomly.During the experiment,acute lung injury was induced by oleic acid in rats.Sulfo-tanshinone sodium group was treated by intraperitoneal injection of sulfotanshinone sodium for 14 days consecutively. The 12 rats were sacrificed at 7thand 14thday after last administration.The indexes of weight,arterial partial pres-sure of oxygen(PaO2),oxygenation index(PaO2/FiO2),lung index and wet/dry ratio,IL-1,TNF-α,PCⅢ,TGF-β1 and the lung histopathology of rats were observed. Results There was no difference in rat weight between the groups.The values of PaO2and PaO2/FiO2were increased.The lung index and wet/dry ratio,IL-1,TNF-α,PCⅢ, TGF-β1 and IQA were all reduced. The lung histopathology damage was significantly lightened.as compared with the model group. Conclusion It has treatment effect of sulfotanshinone sodium in lung fibrosis in the ALI rats, which may be related with the adjustment on inflammatory factor.

目的 通过对船员健康状况的检测、评估、分析预测,为船员提供具有整体性、连续性的健康管理服务.方法 采用回顾性调查方法,获得海员各类健康风险的疾病.结果 海员年龄结构20岁及30岁年龄组所占人数最高60.1％;BIM＞ 23.9占34.19％;血压偏高占4.89％;血糖偏高(＞6.1 mmol/L)占14.79％;视力下降的占33.4％;听力不同程度下降的占19.31％;轮机占比45.7％;脂肪肝占比5.22％、肝功能异常占比18.22％;泌尿结石占泌尿B超人数6.4％;各种心血管异常占22.68％;血常规、尿常规异常占比22.33％.结论 根据船员群体不同的健康及疾病风险评估,对不同的群体进行个性化健康干预与促进.

Objective:To observe the clinical efficacy of ordinary-days moxibustion and midsummer moxibustion on bronchial asthma with Yang deficiency constitution,as well as their consequent effect on patients' constitution.Methods:A total of 63 patients who had bronchial asthma of Yang deficiency constitution were enrolled and divided into ordinary-days moxibustion group (32) and midsummer moxibustion group (31).Patients were treated respectively on midsummer days and ordinary days,with same moxibustion plaster and at same acupoints.The asthma syndrome score,asthma control test score (ACT) and Yang deficiency transformation score were compared between the two groups.Results:Effectiveness of both the two groups was satisfying,but no significant difference was showed.The asthma syndrome score and ACT of both the groups indicated significant difference before and after the treatment (P ＜ 0.05),but no significant difference was revealed (P ＞ 0.05).Improvements were achieved in both the groups after the treatment for the scores of Yang deficiency transformation (P ＜ 0.05),but better curative result was made in the midsummer group (P ＜ 0.05).Conclusion:Similar curative effect was obtained in both ordinary-days moxibustion and midsummer moxibustion for bronchial asthma with Yang deficiency constitution.Midsummer moxibustion has more significantly efficacy in term of Yang deficiency constitution transformation.

Objective To investigate the safety and effectiveness of propofol combined with parecoxib sodium use in epidural anesthesia for abdominal surgery in the elderly.Methods Eighty elderly patients scheduled for selective lower abdominal surgery,age 65~80 yr,were randomly divided into two groups,pure propofol group(A group) and propofol combined with parecoxib sodium(B group).After the success of the epidural block according to the result,using intravenous drug auxiliary by group,while maintaining the Ramsay sedation score among 3~5points during operation.MAP,HR and SpO2were recorded at the time points of entering operation(T0),cutting skin(T1),10min(T2),30min(T3),60min(T4) after operation and end of surgery(T5).Record the VAS value of incision pain at 1h,3h,6h,12h and 24h postoperatively(0~10 points).The cases of traction reaction classification and postoperative adverse reaction were observed and recorded,and the propofol consumptions,additional cases of fentanyl and the awake time after surgery were recorded also.Results MAP and HR were increased markedly at T0 than at T1~T5(P<0.05);Comparing with group A,group B has much lower in intraoperative traction reaction and additional cases of fentanyl(P<0.05),shorter the awake time after operation,and significant more relieved the VAS value of incision pain each time point after surgery.Conclusion Propofol combined with parecoxib sodium use in epidural anesthesia for abdominal surgery in the elderly is safe and effective,it can effectively reduce intraoperative traction reaction and appear to provide better analgesia effect in 12 hours after surgery.

Objective To investigate the effect of the two different nerve block anesthesia on clavicle fracture fixation.Methods 52 cases of clavicular fracture fixation were randomly divided into two groups (n =26):cervical plexus nerve block group (group A),Brachial plexus block group (group B).Non-invasive blood pressure (NIBP),heart rate (HR),oxygen saturation (SpO2) and electrocardiogram (ECG) were observed before anesthesia,incision,and fractures.We analyzed the anesthetic effect in different points time.Results ①Compared with the group B,three time points NIBP and HR of group A were statistically significant(P ＜ 0.05),but there was no significant difference in the SpO2 between group A and group B (P＞ 0.05).②Compared with the group B,the anesthetic effect was statistically significant in group A(P ＜ 0.05).Conclusion The depth and superficial cervical plexus nerve block is a better and feasible anesthetic method in clavicle fracture fixation.

Objective To discuss the feasibility of laryngeal mask airway(LMA) combined with spinal and epidural anesthesia(CSEA) in Laparoscopic cholecystectomy.Methods 80 patients were randomly divided into the laryngeal mask airway combination with spinal and epidural anesthesia group(group A) and the general anesthesia group(group B).Hemodynamic variables of BP and HR were determined in the anesthesia,and also the anesthesia effects and side effects were determined.Results In group B,the amount of anesthesia was larger,the time of awareness was significantly longer,and the degree of awareness was worse than that of group A.Hemodynamic variables of BP and HR were significantly different after anesthesia or pneumpperitoneum from those before anesthesia in group B(p0.05).Side effects were the lowest in group A.Conclusion Laryngeal mask airway in combination with spinal and epidural anesthesia in Laparoscopic cholecystectomy is beneficial for hemodynamics and safe.

Objective: To investigate the effect of Pravastatin on maintenance of sinus rhythm and improving cardiac function in patients with normal blood lipid level complicated with chronic heart failure and paroxysmal atrial fibrillation.Methods: A total of 68 patients with normal blood lipid level complicated with chronic heart failure and paroxysmal atrial fibrillation were divided into treatment group(35 cases) and control group(33 cases).Aminodarone was used in the control group,based on the control group,Pravastatin(20 mg/d) was given in the treatment group.All patients were followed up for 6 months.Results: Compared between the two groups 6 months after treatment,the NYHA functional grade significantly improved(P0.05),LVEF significantly increased in the treatment group(P0.05).The recurrence rate of paroxysmal atrial fibrillatio in the treatment group decreased significantly compared with that in the control group(P0.05).Conclusion: Long-term administration of Pravastatin can inhibit the in flammatory reaction,improve cardiac function and reduce the relapse rate of paroxysmal atrial fibrillation in patients with normal blood lipid level complicated with chronic heart failure and paroxysmal atrial fibrillation.

目的:观察新斯的明在硬膜外麻醉下剖宫产妇胎儿娩出瞬间血压和心率的变化. 方法:选择ASAI～Ⅱ级拟行剖宫产手术的患者100例,随机分为对照组(n=50)和观察组(n=50).所有病人均由L2～3行硬膜外麻醉,对照组经硬膜外腔注射1%利多卡因+0.5罗哌卡因混合液15 mL加生理盐水1.5 mL,观察组经硬膜外腔注射1%利多卡因+0.5罗哌卡因混合液15 mL加新斯的明1.5 mg (1.5 mL),观察胎儿娩出瞬间产妇血压和心率的变化.结果:对照组血压明显下降,心率明显增快,观察组血压变化不明显,心率增快较少.结论:新斯的明对硬膜外麻醉下剖宫产妇胎儿娩出瞬间低血压有预防作用,且有利于心率的稳定.

目的 观察芬太尼复合氯胺酮用于腹部手术患者术后静脉自控镇痛(PCIA)的效果和安全性. 方法 ASAⅠ-Ⅱ级腹部手术患者100例,随机分为A、B两组,A组为芬太尼0.5-0.8mg、氯胺酮100-200mg、地塞米松5mg加生理盐水稀释到100ml入泵静脉镇痛.B组为吗啡5mg、0.75%布比卡因150mg、地塞米松5mg 加生理盐水稀释到100ml入泵硬膜外镇痛.记录术后6h、12h、24h、48h 的镇痛评分(VAS)、镇静评分(Ramsay)及不良反应. 结果 术后两组镇痛评分差异无统计学意义.A组镇静评分及不良反应发生率低于B组(P＜0.05).结论 芬太尼复合氯胺酮用于腹部手术病人术后静脉自控镇痛的效果良好,且能减少芬太尼的用量,降低不良反应的发生.

Objective To investigate the effect of Lidocaine on heart rate variability in epidural block anesthesia,and judge the relationship between the functional status of autonomic nerve and epidural block anesthesia.Methods By Fourier analysis transfer principle and heart rate variability power spectrum analysis(HRV-PSA),the power spectrum was analyzed in 60 minutes before and after Lidocaine being injected into epidural space to investigate the sympathetic activity.Results 3 minutes after Lidocaine being injected into epidural space,parts of sympathetic nerve was restrained,twelve minutes after epidural block,the plane was fixed basically.Conclusions Heart rate variability can reflect the effect of epidural block,and be used as a reference index of judging epidural anesthesia effect.

目的:探讨气管损伤的急诊麻醉和手术处理。方法:清醒条件下应用气管插管或气管切开的方法,在利用气道伤口插入气管导管或气管套管。结果:无病例死亡,术后3个月内呼吸功能正常。结论:及时正确的围术期治疗不仅能挽救伤者的生命,还可避免严重并发症的发生。

目的:观察胃复安对饱胃孕妇急诊剖宫产麻醉反流误吸的预防作用。方法:200例ASAⅠ～Ⅱ级饱胃足月孕临产妇硬膜外麻醉下行急诊剖宫产手术,患者随机分为胃复安组和对照组(各100例)。胃复安组术前30min静脉注射甲氧氯普胺0.2mg/kg,对照组术前不用药。术中分别记录恶心呕吐和反流误吸例数,比较两组恶心呕吐发生率。结果:胃复安组恶心呕吐、反流误吸发生率明显少于对照组(P<0.01)。结论:胃复安对饱胃孕妇急诊剖宫产麻醉反流误吸有一定的预防作用。

目的探讨新的护理模式下产科护理的发展方向。方法选择2006年全年在我科住院分娩、自然临产或催产素方法的无妊娠并发症的初产妇,采用陪伴分娩和无人陪伴下分娩两种方法,随机分成观察组和对照组进行观察。结果两组比较第一产程、第二产程、第三产程、产后2h的出血量均有显著性差异,新生儿出生后窒息发生率有显著性差异,产后哺乳姿势和婴儿含接姿势正确率有显著性差异。讨论陪伴分娩不仅有助于减少产后出血,降低新生儿死亡率和剖宫产率,

目的研究利多卡因用于硬膜外阻滞麻醉时对心率变异性的改变,从而判断植物神经功能状态与硬膜外阻滞麻醉的关系。方法应用付立叶分析转换原理和功率谱分析技术对利多卡因硬膜外注药前后60min内心率功率谱进行分析,反映交感神经活性。结果硬膜外注入利多卡因3min后部分交感神经即受到抑制,硬膜外阻滞开始12min后交感神经阻滞平面基本固定。结论心率变异性能反映硬膜外阻滞效果,可作为判断硬膜外麻醉是否成功的参考指标。

目的研究如何减少硬膜外麻醉中阻滞不全的问题。方法选择上腹部手术40例,B组应用氟哌利多伍用哌替啶,A组应用咪唑安定配伍芬大尼复合硬膜外麻醉,观察其镇静遗忘效果及对内脏牵拉反应的影响。结果A组的镇静、遗忘效果显著优于B组,其抗内脏牵拉反应效果良好,且对呼吸循环抑制轻。结论咪唑安定伍用芬太尼作为硬膜外阻滞辅助用药安全、有效,对紧张、恐惧、焦虑病人尤为适用。