目的 评价围术期优化麻醉策略对乳腺癌患者术后全身免疫炎症指数(systemic immune-inflammation index,SII)的影响.方法 选择拟全身麻醉下行单侧乳腺癌改良根治术的女性患者60例,采用随机数字表法分为优化麻醉组(P组)和常规全麻组(R组),每组30例.P组患者进行优化麻醉管理,R组则采用传统的经验式麻醉管理.记录术中瑞芬太尼和丙泊酚用量及术后48h镇痛泵有效按压次数;测量术前(T0)、术后1h、24h、48h(T1-3)时静脉血白细胞介素-4(interleukin-4,IL-4)及干扰素-γ(interferon-γ,INF-γ)浓度;计算T0-3时SII,随访术后1年内乳腺癌复发情况.结果 与R组比较,P组术中丙泊酚和瑞芬太尼用量减少及镇痛泵按压次数减少,P组在T1、T2、T3时点INF-γ及INF-γ/IL-4比值升高,SII下降(P<0.05);与T0比较,R组及P组在T1、T2及T3时点INF-γ浓度及INF-γ/IL-4下降,SII升高(P<0.05);两组1年内肿瘤分别复发7例及5例.结论 优化麻醉策略可减少乳腺癌患者围术期SII变化程度,减轻免疫功能抑制程度.

目的 探究靶控输注依托咪酯在脑血管介入手术中的应用效果.方法 选取2017年3月至2020年3月于本院行脑血管介入手术的50例患者作为研究对象,按照抽签法分为两组,每组25例.对照组采用靶控输注丙泊酚,观察组采用靶控输注依托咪酯,比较两组应用效果.结果 对照组不同时间段的血压水平波动较大,且观察组在气管插管前(T1)、气管插管后5 min(T2)、手术开始时(T3)、停药时(T4)的SBP、DBP水平均高于对照组(P<0.05);麻醉后,对照组的心输出量(CO)、外周血管阻力(SVR)、每博输出量(SV)等指标均低于麻醉前(P<0.05),观察组CO、SVR指标低于麻醉前(P<0.05);两组CO、SVR指标比较差异无统计学意义,观察组SV水平高于对照组(P<0.05);观察组麻醉复苏期躁动率明显低于对照组(P<0.05).结论 在脑血管介入手术中行靶控输注依托咪酯,患者的血压水平、血流动力学较稳定,且麻醉复苏期的躁动率较低.

目的 探讨右美托咪定对在体大鼠心脏心肌缺血再灌注损伤的影响,为今后的实验研究与临床工作提供可靠的参考依据.方法 将50只健康雄性SD大鼠分成5组,每组10只,分别定义为心肌缺血再灌注损伤组(IR组)、右美托咪定组(DP组)、右美托咪定+育亨宾组(DY组)、育亨宾组(YP组)与假实验手术组(CS组).经左冠状动脉结扎方式,使冠状动脉闭塞,造成心脏心肌缺血大鼠模型,在造模后30 min,对心电图波形变化、大鼠心脏心肌组织颜色变化进行持续监测观察,直至达到标准后造模成果.DP、YP、DY组大鼠腹腔内推注药物溶液,IR组推注登记量0.9％氯化钠溶液,CS组只穿线,不结扎,腹腔注射0.9％氯化钠溶液.120 min实施再灌注诱导,对各组大鼠实验过程中的心率、平均动脉压变化情况、大鼠心脏心肌梗死面积情况进行统计分析.结果 再灌注30 min,DP组与DY组大鼠出现心率显著降低情况,且随着实验的继续,心率逐渐降低,再灌注120 min,DP组大鼠心率回升,与IR组比较,DP组各个时间段的心率均明显降低(P<0.05),与CS组比较,IR、DY、YP组再灌注30 min后,平均动脉压水平显著降低(P<0.05).与CS组比较,各组大鼠心肌梗死面积均明显增大(P<0.05),与IR组比较,DP组梗死面积明显更低(P<0.05),与DP组比较,DY、YP组梗死面积升高(P<0.05).结论 在体大鼠经右美托咪定预处理后,心脏血流动力学改变减少,可减轻心肌梗死程度,能够在一定程度上保护心肌,值得临床关注.

目的 探究喉罩通气七氟醚吸入全身麻醉在支气管镜检查中的应用效果.方法 选取2018年9月至2019年9月于医院接受支气管镜检查的50例患者作为研究对象,采用数字盲选法分为对照组和试验组,各25例.对照组给予丙泊酚静脉全身麻醉,试验组给予喉罩通气七氟醚吸入全身麻醉,比较两组麻醉效果及并发症发生率.结果 两组苏醒时间比较,差异无统计学意义(P>0.05);试验组麻醉诱导时间长于对照组,手术时间短于对照组,差异均有统计学意义(P<0.05);试验组并发症发生率低于对照组,差异有统计学意义(P<0.05).结论 喉罩通气七氟醚吸入全身麻醉应用于支气管镜检查中,可以缩短手术时间,降低支气管痉挛等并发症发生率.

目的:分析腹腔镜胆囊手术麻醉中食管引流型喉罩的应用效果.方法:选取我院2018年9月1日—2019年9月1日收治的腹腔镜胆囊手术患者50例作为观察对象,根据抓阄结果将其均分为观察组(25例)和对照组(25例).对照组患者使用气管插管方式麻醉,观察组患者使用食管引流型喉罩麻醉,比较两组患者术中血流动力学变化情况、术后并发症发生情况.结果:观察组插管即刻、拔管即刻的平均动脉压及心率变化较小,与对照组相比更具稳定性,差异显著(P<0.05);且观察组患者术后并发症发生率低于对照组,差异显著(P<0.05).结论:腹腔镜胆囊手术麻醉中食管引流型喉罩的应用有利于稳定患者心率及平均动脉压,值得临床推广.

Objective To investigate the clinical application effect of Dexmedetomidine in the inhalation anesthesia of desflurane in elderly patients undergoing orthopaedic surgery. Methods Forty elderly patients with femoral internal fixation treated in our hospital from August 2016 to August 2017 were enrolled in the study. They were divided into group D (dexmedetomidine group) and group C (control group) according to the odd/even sequence, with 20 cases in each group. In the group D, 0.5 μg/kg Dexmedetomidine was used, while in the group C, the same load capacity of normal saline from pumping was applied. The systolic blood pressure, diastolic blood pressure, and heart rate at room awake (T1), intravenous injection of Dexmedetomidine or saline for 10 minutes (T2), immediately after tracheal intubation (T3), beginning of surgery (T4), intravenous injection of Dexmedetomidine or saline for 60 minutes (T5) and immediately after tracheal extubation (T6) were compared between the two groups. The blood glucose at rest (T0), T3, T4, T5 and T6 one day before surgery were recorded. The changes of blood glucose levels, blood pressure, and heart rate at different points-intime were compared between the two groups. Results The differences were statistically significant in systolic blood pressure, diastolic blood pressure and heart rate of patients in group D and group C at T2, T3, T4, T5 and T6 (P<0.05). In the group D, the blood glucose levels at T3, T4, T5, T6 were significantly lower than those in the group C (P<0.05). The agitation score in the group D was lower than that in the group C, with a statistical difference (P<0.05). The total incidence of adverse reactions in the group D was 10.00％, lower than 35.00％ in the group C, with a significant difference (P<0.05). Conclusion Dexmedetomidine has a significant effect on desflurane inhalation anesthesia in elderly patients undergoing orthopedic surgery. It can control blood pressure, blood glucose and heart rate, and reduce adverse reactions, which is worthy of clinical promotion and application.

目的 研究血管内皮生长因子(VEGF)、白细胞分化抗原簇34 (CD34)在药物流产患者血清中的表达情况,并探讨其与药物流产并发症的相互关系.方法 选取2014年9月-2015年8月该院收治的妊娠8周以内自愿要求行药物流产的患者103例为研究对象,采用ELISA法测定患者血清中VEGF和CD34的含量,结合血液流变学的实验结果,分析其与药物流产并发症的相关性.结果 子宫异常出血组及感染组患者的VEGF及CD34表达水平明显高于无并发症组,差异有统计学意义(P＜0.05).子宫异常出血组及感染组患者的全血黏度和血浆黏度均高于元并发症组,差异有统计学意义(P＜0.05).结论 药物流产后并发症的发生与血管生成相关调节因子CD34与VEGF的高表达呈现一定的相关性.

Objective To investigate the relationship of prenatal health care and pregnancy outcome.Methods All 2100 cases of maternal inpatients from March 2009 to March 2011 were selected in our hospital.Among them 1067 cases achieving the maternal antennal systemic health care were selected as observation group,but not fully implemented health care during pregnancy in 1033 cases of pregnant women as controls.Maternal antenatal visits,delivery mode,third labor time,amount of bleeding,uterine atony,puerperal infection,and pregnancy-induced hypertension,diabetes complications of two groups were compared,and the obtained data were statistically analyzed.Results The observation group compared with the control group,antenatal visits,delivery mode of two groups had significant difference(P0.05);The third labor time,amount of bleeding and complication rate of observation group were significantly lower than those of the control group,and two groups had significant difference(P0.05).Conclusion Antenatal systemic health care during pregnancy is one of the important factors to ensure good pregnancy outcomes.Maternal antenatal examination and related health education should be strengthened,to reduce the incidence rate of adverse pregnancy outcome,and to improve maternal quality of life.

目的：观察在乳腺肿瘤切除术中不同剂量右美托咪定(DEX)对喉罩置入时所需丙泊酚的半数有效血浆靶控浓度（EC50）及其对呼吸、循环的影响。方法选择ASAⅠ~Ⅱ级，年龄18~60岁，Mallampati分级Ⅰ~Ⅱ级，拟在全麻加喉罩通气下行择期乳腺肿瘤切除术的患者。根据随机数字表将其分成4组：对照组（A组）生理盐水组、试验组（B1~3组）不同剂量DEX组分别静脉泵注生理盐水20mL、DEX0.2、0.5、0.8μg/kg（20mL），泵注时间15min，随后靶控输注异丙酚，待丙泊酚血浆浓度与效应室浓度达平衡1min后行喉罩置入。采用改良上下序贯法根据患者的体动反应增加或减少下一个患者丙泊酚（0.3μg/mL）血浆靶浓度测定出50%的患者对喉罩置入无反应时所需的丙泊酚血浆浓度及其95%可信区间（95%CI）。监测给药前、后患者的SBP、DBP、HR、RR、SpO2及OAA/S评分，并记录不良反应的发生情况。结果4组患者的年龄、身高、体质量、麻醉诱导前SBP、DBP、HR、RR、SpO2及OAA/S评分比较均无统计学差异（P>0.05)，4组患者诱导后与诱导前比较SBP、DBP、HR、RR及OAA/S评分均有明显下降（P<0.05)，但4组间比较并无统计学差异（P>0.05)。4组患者于喉罩置入时丙泊酚EC50及EC50的95%可信区间分别为：A组6.325（5.9205~6.7552）μg/mL；B1组5.673（5.5558~5.7936）μg/mL；B2组4.623（4.4548~4.7992）μg/mL；B3组4.083(3.9609~4.7666)μg/mL。与A组比较，其他3组在喉罩置入时丙泊酚EC50明显降低（P<0.05）；且B1组至B3组的EC50逐渐减少。术中A组有5例患者出现呼吸抑制多于其他3组（P<0.05）。结论右美托咪定在一定范围内可呈剂量依赖性地减少乳腺肿瘤切除术患者丙泊酚的半数有效血浆靶控浓度。

思想政治工作是我们党的政治优势和优良传统,随着医改的不断深入,公立医院思想政治工作面临环境、任务、内容、渠道和对象的深刻变化。因此,要思想政治工作要努力适应医改的新形势、新变化、新要求,重点从增强党政领导班子的战斗力、增强中层干部的执行力,增强全体职工的向心力,增强医院的服务力,增强医院的发展力等"五个力"上下功夫,以提高思想政治工作的针对性和实效性。

目的:了解基层医务人员掌握和应用中医药知识技能的内容和程度,对中医药知识的需求方向和接受培训的方式,探讨适应基层中医药知识技能培训的有效方式.方法:采用全而调查与抽样样本调查相结合,问卷调查和实地访谈相结合.结果:基层医务人员有一定的中医药知识技能基础,接受培训方式以参加培训班进行常见病、多发病的辨证施治培训为主.结论:开展突出重点,分层次的中医药知识技能培训是符合基层实际的有效培训方式.