Objective To analyze the complications occurring during the induction,maintenance,and recovery phases of anesthesia and the perioperative period in neonates and infants undergoing emergency gastrointestinal surgery.Methods A ret-rospective analysis was conducted on the clinical data of 196 neonates and infants who underwent surgery for acute abdomen at our hospital.These patients were divided into neonatal group(group N,age ≤30 days,115 cases)and infant group(group Ⅰ,age 30 days to 6 months,81 cases).Data on general information,disease distribution,and intraoperative and postoperative complications were collected for both groups.Results There were significant differences between the two groups in body mass(t=-8.517,P＜0.05),proportions of low body mass infants(x2=64.909,P＜0.05)and proportions of premature infants(x2=10.657,P＜0.05),concurrent congenital heart disease(x2=5.210,P＜0.05),and concurrent septic shock and metabolic acidosis(x2=8.728,P＜0.05).Children in group N were more prone to hypoxemia(x2=4.123,P＜0.05),hypothermia(x2=8.792,P＜0.05),and hypoglycemia(x2=4.074,P＜0.05)during the anesthesia maintenance period.In addition,group N exhibited a significantly grea-ter need for respiratory support(x2=5.474,P＜0.05),a significantly higher incidence of multiple organ failure(x2=5.474,P＜0.05),and a significantly extended length of hospital stay(t=4.636,P＜0.05)compared with group Ⅰ.Conclusion The risks associated with perioperative anesthesia are high for neonates and infants undergoing emergency gastrointestinal surgery.Specifical-ly,the risks of hypoxemia,hypoglycemia,hypothermia,and apnea are significantly higher in neonates than in infants.Special at-tention must be given to the respiratory risks during anesthesia management in neonatal emergency surgery.

海上综合手术组或专科手术组是海军常见的机动卫勤保障力量，麻醉军医是手术组中的重要成员。海军卫勤保障任务对麻醉军医的数量需求增多，能力要求提高。笔者结合海军基层军医工作能力现状，介绍了海军卫勤保障兼职麻醉军医培训的做法经验和取得的成效，探讨了以手术室外麻醉理念进一步优化兼职麻醉军医培训方案的思考建议。

目的 调查赴远海执行任务的某舰官兵的睡眠质量及影响因素.方法 随机抽取执行远海任务的100名官兵,采用一般资料收集表和匹兹堡睡眠质量指数(PQSI)量表进行调查.结果 共回收有效问卷92份.全体官兵PSQI总平均分为(8.03±3.63)分,其中PSQI总分≥7分共60例,即65.22％的官兵存在睡眠障碍.在各因子得分≥2分的例数中共筛选出主观睡眠质量40例,占43.48％;入睡时间57例,占61.96％;睡眠时间39例,占42.39％;睡眠效率29例,占31.52％;睡眠障碍13例,占14.13％;催眠药物1例,占1.09％;日间功能障碍38例,占41.30％.亚类别的分析发现,年龄≥25岁官兵的评分明显高于<25岁官兵的评分,差异具有统计学意义(P<0.01).不同部门官兵的PSQI评分差异具有统计学意义(P<0.05),进一步两两比较显示,船务部门官兵的PSQI评分与其他4个部门相比明显偏低(P<0.05).累计出海时间>2年的官兵PSQI评分与出海时间少的官兵相比明显偏高,差异具有统计学意义(P<0.05).结论 赴远海执行任务时,官兵存在较为严重的睡眠质量问题,且缺乏系统、多元、有效的改善方案.

目的 探讨多模式镇痛模式在达芬奇膀胱全切联合原位回肠膀胱术患者中的应用效果.方法 将61例实施达芬奇膀胱全切联合原位回肠膀胱术患者的临床资料依据镇痛方式的不同分为观察组(n = 31,实施多模式镇痛)与对照组(n = 30,实施传统模式镇痛),比较两组手术时间、术后不同时段疼痛评分、镇痛不良反应及追加用药情况.结果 两组手术时间对比,差异无统计学意义(P＞0.05);观察组术后2,6,12,24,48 h疼痛评分均低于对照组,不良反应发生率低于对照组,追加用药占比低于对照组(P＜0.05).结论 多模式镇痛在达芬奇膀胱全切联合原位回肠膀胱术患者中应用效果较好,可有效缓解患者术后疼痛感,降低镇痛不良反应发生率,控制止痛药及止呕药的使用.

目的 观察地佐辛术后镇痛对硬腰联合麻醉下老年患者术后认知功能的影响.方法 择期行下肢骨科手术患者120例,年龄70～ 82岁,ASAⅡ～Ⅲ级,均采用硬腰联合麻醉.患者随机分为3组(n=40),无术后镇痛组(C组)、地佐辛静脉镇痛组(D组)和硬膜外自控镇痛组(E组).C组给予等容量的生理盐水,D组使用地佐辛35mg+托烷司琼5mg+生理盐水至100ml;E组使用舒芬太尼50μg+1％罗哌卡因30ml+生理盐水至100ml.分别于术前1d、术后1d、3d、5d和7d由本院同一心理医生对患者进行一次简易智力状态检测评分(MMSE).结果 术前1d,3组患者的MMSE评分差异无统计学意义(P＞0.05).术后1d和3d,D组和E组与C组比较,评分差异有统计学意义(P＜0.05),D组与E组比较差异无统计学意义(P＞0.05).术后5d和7d,3组评分差异无统计学意义(P＞0.05).结论 地佐辛静脉镇痛可安全用于老年下肢手术患者,且可降低老年患者术后认知功能的发生率.

Post-traumatic stress disorder (PTSD) is a chronic anxiety disorder caused by seeing or experiencing life-threatening traumatic events, with lack of effective treatment. In recent years, stellate ganglion block (SGB) has been used to treat PTSD. This review introduces the diagnostic criteria of PTSD and the indications of SGB, summarizes previous evidence including case reports, retrospective studies and recent randomized controlled trials, which indicates that SGB can improve the subjective feelings and rating scores in PTSD patients, discusses the underlying mechanisms involving the regulation of sympathetic nerve and amygdala as well as the inhibition of nerve growth factor in stellate ganglion, and describes new techniques that can greatly improve SGB safety and effectiveness, so as to provide reference for further clinical and basic research of PTSD.

目的 研究核潜艇远航期间艇员动脉血二氧化碳分压(PaCO2)的变化,寻找吸入二氧化碳浓度(FICO2)和动脉血二氧化碳分压的线性相关关系.方法 某型核潜艇执行远航任务期间,采用改良后的氧烛-氢氧化锂的荆量和比例,在水上航行第3天(T1)、潜航第10天(T2)、第20天(T3)、第30天(T4)4个时间点测定艇员的PaCO2变化,并记录测定时间点的FICO2,利用统计学软件计算两者的相关性.结果 血气分析结果显示,T3与T4时间点的PaCO2明显高于T1扣T2时点,差异有统计学意义(P＜0.05),且艇员FICO2与PaCO2具有线性相关关系.结论 核潜艇远航中及时合理调整氧烛-氢氧化锂剂量和比例有助于维持艇员正常的生理状态.为维护艇员PaCO2生理水平,需将舱室CO2浓度维持到0.39％以下.

剖宫产术后早期泌乳是促进产妇康复和确保母乳喂养的关键[1].血清泌乳素(prolactin, PRL)水平是决定泌乳时间和量的关键因素[2].剖宫产术后疼痛可抑制泌乳素的分泌[3-4].纳布啡是一种阿片受体激动-拮抗剂(κ受体激动、μ受体拮抗),其起效迅速,能够有效抑制内脏痛,可安全用于剖宫产术后镇痛[5].既往研究报道,纳布啡能够增加健康受试者的血清泌乳素水平[6] ,但其对剖宫产产妇术后PRL的影响尚不清楚.本研究旨在探讨纳布啡用于剖宫产术后患者自控静脉镇痛( patient-controlled intravenous analge-sia, PCIA)的效果及对PRL水平的影响,为纳布啡用于剖宫产术后镇痛提供参考.

目的 调查核潜艇远航期间艇员心理健康状况,并分析相关影响因素.方法 对三次执行核潜艇长航任务的126名艇员在远航前封舱期和返航后采用症状自评量表(SCL-90)和艾森克个性问卷(EPQ)进行测评和结果比较.结果 核潜艇长航后SCL-90量表中,除人际关系敏感、偏执及精神病性外,其他因子分与中国军人常模相比,差异有统计学意义(P＜0.05).核潜艇远航后EPQ精神质(P)分、神经质(N)分明显高于封舱期(P＜0.05),内外向(E)分和掩饰(L)分远航前后无明显差异(P＞0.05).结论 核潜艇远航特殊的生活和作业环境造成了艇员心理健康水平的下降,针对核潜艇远航特点应给与必要的心理干预.

目的 探讨潜艇艇员在远航过程中空腹血糖和生命体征的变化情况.方法 对50名潜艇艇员远航前,远航前期、中期和后期,远航后的空腹血糖、呼吸、脉搏、平均动脉压进行检测.结果 远航前期、中期、后期和远航后的空腹血糖均较远航前明显升高(P＜0.01,P＜0.05);远航前期和后期的呼吸次数均较远航前明显增加(P＜0.05);远航前期脉搏较远航前、远航中期和远航后均明显增加(P＜0.05);远航前期和远航后期的平均动脉压均较远航前明显增加(P＜0.05).结论 远航会导致潜艇艇员血糖、呼吸、脉搏和血压升高,特别是在远航期更为明显.

目的 探讨个性化健康教育模式在潜艇部队新兵训练伤健康教育中的实施效果.方法 以海军某潜艇训练基地1146名新兵为研究对象,随机分为A组(个性化健康教育组)和B组(传统教育模式组),对两组新兵开展军事训练伤健康教育,并比较两组新兵接受教育后的“知、信、行”(knowledge,attitude,belief,practice,KABP)问卷调查结果,进行效果评价.结果 健康教育后,A组军训伤KABP得分均高于B组,差异有统计学意义(P＜0.01).结论 个性化健康教育模式应用于潜艇新兵军事训练伤,较传统教育模式可显著提高教育效果.

目的 利用GEM3000血气分析仪研究长航核潜艇艇员血气变化.方法 采用GEM3000血气分析仪对某长航核潜艇20名艇员进行实地血气分析.结果 与水上航行期比较:下潜航行期pH从T1时点开始呈逐渐下降趋势,T4时点降为最低,与T1时相比有统计学差异(P＜0.05);PaCO2在T2时点下降,T3时点升高,与T2时点比较有统计学差异(P＜0.05),T4时点达到最高,与T1、T2时点比较有统计学差异(P＜0.05);PaO2在T2时点降低,与T1时点比较有统计学差异(P＜0.05),从T3时点升高,T4时点升至最高,与T2、T3时点比较有统计学差异(P＜0.05);Na离子在T2时点升高,与T1时点比较有统计学差异(P＜0.05),T3时点开始下降,与T2时点比较有统计学差异(P＜0.05);K离子从T2时点下降,T2、T3、T4时点分别与T1时点比较有统计学差异(P＜0.05);钙离子在T1、T2、T3时点基本持平,T4时点升高,并且分别与T1、T2、T3比较有统计学差异(P＜0.05);HCO3-、Hb、Hct各时点比较均无统计学差异(P＞0.05).结论 长航潜艇环境对官兵机体正常生理代谢水平存在一定影响.

Hyperbaric oxygen has been widely used in the treatment of many diseases and in some special circumstances such as deepwater diving, and it plays an irreplaceable role. But oxygen toxicity is an important complication, especially in diving medicine. Due to the characteristics of lung itself and the differences in dry/wet environment, the pathological mechanism of pulmonary oxygen toxicity is very complicated. With the advances in the experimental techniques and expansion of the research ideas, the studies on pulmonary oxygen toxicity have no longer limited to the level of tissue morphology and pathological strata, more and more studies that focused on cellular and sub-cellular levels have been carried out. The present review will focus mainly on the clinical manifestations, pathophysiology, pathogenesis and progresses in monitoring and treatment of pulmonary oxygen toxicity over recent years. DOI: 10.11855/j.issn.0577-7402.2016.03.17

开胸手术创伤大,手术时间相对较长,全麻苏醒期患者常出现血压上升,心率加快、呛咳,躁动等一系列反应[1,2],临床麻醉中通常使用麻醉性镇痛药及负性心血管活性药物来减少不良反应.维持全麻苏醒期拔管血流动力学平稳、减少苏醒期躁动是麻醉管理的重要环节.本研究旨在探讨帕瑞昔布钠超前镇痛对开胸患者苏醒期的影响.

Objective To study the effect of different regulation modes of the air in cabin on the arterial blood gas of mariners during a prolonged voyage in a nuclear submarine. Methods During three long distance voyages of the same nuclear submarine, the same air-regeneration device was adopted. According to the different doses and percentages of the oxygen-lithium hydroxide absorbers, the mariners of three voyages were divided by sequence of voyages into control group (C), observation group 1 (A), and observation group 2 (B). The change in arterial blood PaO2 and PaCO2 of mariners in the three groups were detected on the third day of surface navigation (T1), 10th day (T2), 12nd day (T3), 13th day (T4) of submarine navigation, and the day before returning (T5). Result There was no difference between the three groups in T1 and T2 (P>0.05). There was a significant difference in PaO2 and PaCO2 between the two observation groups and the control group on T3, T4 and T5 (P<0.05). Conclusions Different amount and percentage of the oxygenlithium hydroxide showed an influence on PaO2 and PaCO2 of the mariners. Optimal amount and percentage of the oxygen-lithium hydroxide is very important in keeping normal physiological status of mariners in a nuclear submarine. DOI: 10.11855/j.issn.0577-7402.2015.03.14

Objective To investigate the changes in cellular immune function and biochemical indicators of conventional submarine crew both before and after prolonged deployment at sea.Methods Sixtytwo submariners were recruited as the subjects of our study.Detections were made on T lymphocyte subpopulation and NK cell (CD3 + , CD4 + , CD8 + , CD4 +/CD8 + and NK cells) , heptorenal function as well as 13 biochemical indicators [blood glucose (Glu), aspartate amninotransferase (AST), alanine aminotransferase (ALT), AST/ALT, UREA, creatinine (CREA), potassium (K), sodium (Na) and chlorine (Cl), calcium (Ca), magnesium (Mg), phosphorus (P) and iron (Fe)].Results As compared with those before prolonged deployment at sea, CD3 + levels in the T lymphocyte subpopulation after prolonged deployment at sea (67.02％ ± 7.30％ and 68.91％ ± 8.15％ respectively) , CD4 + levels(33.59％ ± 5.61％ and 36.87％ ± 3.65 ％ respectively) , and CD4 +/CD8 + levels (1.22 ± 0.45, 1.46 ± 0.52 respectively) , were all significantly increased (P ＜-0.05).However, CD8 + levels were obviously decreased(27.32％ ± 8.21％ ,25.25％ ± 4.38％) (P ＜ 0.05).Blood glucose levels were obviously increased [(3.68 ± 0.85) mmol/L and (4.38 ± 1.15) mmol/L respectively] (P ＜ 0.05).Ca levels were also elevated [(2.48 ± 0.11) mmol/L and (2.54 ± 0.12) mmol/L respectively] (P ＜ 0.05).Na levels were respectively [(141.08 ± 5.75) mmol/L,(138.08 ± 2.86)mmol/L] , C1 levels were obviously decreased, which were respectively [(103.12 ± 3.09)mmol/L and(98.89 ±4.28)mmol/L] (P ＜0.01), and Fe levels were also obviously decreased, which were [(23.14 ± 6.75) μmol/L and (21.54 ± 7.34) μmol/L] respectively (P ＜ 0.05).Though biochemical indicators of heptorenal function were elevated to various extents, no statistical differences could be noticed (P ＞ 0.05).Conclusions The immune response of the conventional submariners during this prolonged deployment at sea was enhanced, the blood glucose and Ca levels were elevated, but Fe, Na and Cl levels were decreased, indicating that nutritional components should be adjusted in future submarine deployments at sea,and attention should be paid to the changes in blood glucose, so as to ensure the mental health of the submariners.

Objective To observe the effects of dexmedetomidine on hemodynamics of the patients with intracranial aneurysm under going transcatheter embolization in induction period of general anesthesia. Methods The Admitted in author's hospital the 60 patients with intracranial aneurysm (ASAⅠ-Ⅱ) under going transcatheter embolization were randomly divided into control group (C) and dexmedetomidine group (D),30 cases for each. Before the induction,the patients in the two groups received dexmedetomidine 0.4 μg/kg or equivalent normal saline with in 15 minutes,respectively. All the patients got the same anesthetics for induction. The parameters of systolic blood pressure (SBP),diastolic pressure (DBP),mean arterial pressure (MAP),heart rate (HR) of every patient were recorded at the following time-points:before anesthesia induction (T0),before and immediately endotracheal intubation (T1 and T2),1,3and 5 minutes after intubation (T3,T4 and T5). Results Compared with group C,all parameters were lower at T0. All paremeters of all patients rised. But the extent of rise in group C was obvious(P<0.05). There was no significant difference at T5(P>0.05). Conclusion Infusion of DEX is efficient to control the fluctuation of haemodynamics of induction perios in the patients under going transcatheter embolization for intracranial aneurysm. Accordingly the risk of aneurysm ruptured decreased.

2011年至2013年期间，笔者所在医院奉命随海军某型核潜艇先后执行了4次战备远航卫勤保障任务，累计航程×××××海里、航行时间长×××d，其中水下潜航×××d。通过数次远航卫勤保障工作的开展，笔者对艰苦、恶劣环境下，特别是核潜艇远航期间卫勤工作展开有了更深的了解与体会，现将其特点及经验做法介绍如下。

Study Objective: A novel pressure bladder indicator was developed, and this study aimed to evaluate the clinical application of the pressure bladder indicator by measuring the epidural space pressure and bladder working pressure on patients undergoing lumbar epidural puncture.Design: Randomized, prospective, double-blinded studyPatients: 130 patientsSetting: The Second Hospital of Shandong UniversityInterventions: In this study, 60 patients undergoing surgical procedures under lumbar epidural anesthesia were enrolled to detect epidural pressure, and other 70 patients who were undergoing lumbar epidural anesthesia or combined spinal-epidural anesthesia were enrolled to evaluate the pressure bladder indicator.Measurements: After successful breakthrough of ligamentum flavum by traditional methods, a pressure transducer was connected to an epidural needle tail and a monitor to measure the epidural pressure at L1-L5 in 60 patients. The working pressure of the bladder was also measured by a transducer. Then lumbar epidural puncture was performed with the pressure bladder indicator in other 70 patients.Main Results: The lumbar epidural pressure of the 60 patients was 9.8 +/- 4.3 mm Hg, and the bladder working pressure of the pressure bladder indicator was 122 +/- 15 mm Hg. All these 70 patients were confirmed with successful bladder indication and lumbar epidural puncture. Thus, the coincidence ratio was 100%.Conclusions: The novel developed pressure bladder indicator was a reliable and useful technique to conduct successful lumbar epidural puncture. (C) 2015 Elsevier Inc. All rights reserved.

Objective To study the effects of synthesized intervention measures on improving the level of serum electrolyte in nuclear submariner during submerged voyage,so as to provide scientific basis for working out measures of health security. Methods The submariners were divided into two groups: intervention group,and non-intervention group. The intervention group was given some synthesized intervention measures such as taking electrolyte enriched food,multivitamin 29,calcium carbonate D3,and fluorescent lamp shining,etc. The level of serum Na+,K+,Ca2 +was examined before sailing,and on the 3rd d,10th d,20th d,and 30th d of sailing. Results( 1) The incidence of hypokalemia in non-intervention group,and intervention group was 35%,and 5% respectively( P 0.05); that of hypocalcemia 37. 5%,and 10% respectively( P 0. 05).( 2) The level of serun K+in non-intervention group on the 10th d 〔( 3. 52 ± 0. 21) mmol /L〕,20th d 〔( 3. 55 ± 0. 23) mmol /L〕,and 30th d 〔( 3. 6 ± 0. 17)mmol /L〕was lower than that before sailing,as well as on the 3rd d〔( 4. 05 ± 0. 84),( 3. 80 ± 0. 23) mmol /L respectively〕( P 0. 05).( 3) The levels of serum K+,Ca2 +during submerged voyage in intervention group were not significantly different from those before voyage( P 0. 05),but were lower than those at the corresponding time in non-intervention group( P 0. 05). Conclusion The synthesized intervention mesures could reduce the incidence of hypokalemia and hypocalcemia in the submariners during submerged voyage.