无痛结肠镜检查的效果观察

目的:探讨异丙酚、芬太尼联合静脉麻醉辅助结肠镜检查的效果。方法:将420例患者随机分为两组,自愿接受异丙酚、芬太尼静脉麻醉后行结肠镜检查者220例,未经静脉麻醉接受结肠镜检查者200例,比较两组患者完成结肠镜检查成功率,观察有无腹部疼痛和恶心、呕吐等副反应情况。结果:麻醉组检查成功率100%,均未诉腹部疼痛,恶心者占1.36%;未麻醉组检查成功率为95.5%,主诉腹部疼痛者占98.5%,主诉恶心、呕吐者占24.5%。检查效果有显著性差异,p均小于0.05。结论:异丙酚、芬太尼联合静脉麻醉用于结肠镜检查,能使患者安全、轻松地完成镜检,并减轻患者痛苦。     

脊髓损伤运动员营养与医学护理需求

运用文献综述法将近10余年国内外有关脊髓损伤运动员合理膳食与医学护理的文献加以总结,并提出相应建议。合理膳食部分包括:脊髓损伤运动员能量需求与钙的补充两方面内容。医学护理部分主要包括:脊髓损伤运动员褥疮的防治,泌尿系统疾病的防治,排便障碍与管理,肌肉痉挛的防治等四方面内容。     

足底静脉泵预防脊柱创伤术后DVT的有效性评价

目的：探讨足底静脉泵在预防脊柱创伤术后深静脉血栓形成的有效性和安全性。方法：将2011年6月至2012年7月收治的脊柱损伤患者86例,随机分为观察组和对照组,每组各43例。术后均给予常规药物预防和护理干预,观察组在此基础上增加给予足底静脉泵物理干预。分别于术前和术后7d行下肢彩色多普勒超声检查,比较两组患者DVT发生率、下肢肿胀和D-二聚体含量。结果：术后7d,两组患者下肢肿胀明显缓解,其中观察组下肢周径差值仅为（1．3±0．3）cm,显著小于对照组（P〈0.05）,且D-二聚体含量呈下降趋势,仅为（0．6±0．1）ng／L,显著低于对照组（P〈0．01）。两组患者术后7d深静脉血栓发生率分别为2．3％和18．6％,观察组较低（P〈0．05）,两组在治疗过程中均未出现明显的不良反应。结论：足底静脉泵在预防脊柱创伤术后深静脉血栓形成中具有较好的临床效果且能够安全、够快速缓解腿部肿胀,值得临床推广。     

微泵输注双异丙酚用于全麻诱导插管

观察微量推注泵输注双异丙酚在全麻诱导插管期间脑电双频谱指数(BIS)和血液动力学的变化。把40例择期行腹部手术病人随机分成2组,每组各20例,Ⅰ组为老年人组,Ⅱ组为成年人组。结果表明:两组病例气管插管前及气管插管后BIS、SBP、DBP及RPP均较麻醉诱导前低(P!0.01),两组间气管插管前及气管插管后BIS、SBP、DBP及RPP变化差异无统计学意义;麻醉诱导期间的心率变化各参数差异无统计学意义。微量推注泵静脉输注国产双异丙酚复合咪达唑仑、拘橼酸芬太尼和罗库溴铵用于全麻诱导插管,不论在成年人或老年人均可维持足够的麻醉深度,并可减轻或消除气管插管时心血管的不良反应。     

Lumbar spinal loading during bowling in cricket: a kinetic analysis using a musculoskeletal modelling approach

The objective of the study was to evaluate two types of cricket bowling techniques by comparing the lumbar spinal loading using a musculoskeletal modelling approach. Three-dimensional kinematic data were recorded by a Vicon motion capture system under two cricket bowling conditions: (1) participants bowled at their absolute maximal speeds (max condition), and (2) participants bowled at their absolute maximal speeds while simultaneously forcing their navel down towards their thighs starting just prior to ball release (max-trunk condition). A three-dimensional musculoskeletal model comprised of the pelvis, sacrum, lumbar vertebrae and torso segments, which enabled the motion of the individual lumbar vertebrae in the sagittal, frontal and coronal planes to be actuated by 210 muscle-tendon units, was used to simulate spinal loading based on the recorded kinematic data. The maximal lumbar spine compressive force is 4.89 ± 0.88BW for the max condition and 4.58 ± 0.54BW for the max-trunk condition. Results showed that there was no significant difference between the two techniques in trunk moments and lumbar spine forces. This indicates that the max-trunk technique may not increase lower back injury risks. The method proposed in this study could be served as a tool to evaluate lower back injury risks for cricket bowling as well as other throwing activities.     

Comparing two whole task patient simulations for two different dental education topics

We investigated the effect of two types of whole task patient simulations, role-play and web-based, on learning outcomes for two topics, local anesthesia and non-surgical extractions, in a foundational oral maxillofacial surgery course for second year pre-clinical dental students. Using a 2x2 factorial design, we asked which simulation model allows for deeper cognitive engagement that fosters higher learning outcomes for novices practicing complex skills as a professional, a collaborative role-play simulation (Role-Play Sim), or an individually-paced web-based simulation (Web Sim)? In two studies covering two different topics, we compared the effect of these simulations on 50-item multiple-choice knowledge tests. Participants were randomly assigned to one of four groups: No Sim, Web Sim, Role-Play Sim, or Both Sims. For study 1 covering local anesthesia, there was a statistically significant main effect for the Role-Play Sim, F (1, 105) = 103.804, p < 0.001, η_p² = 0.497, but not for the Web Sim, F (1, 105) = 1.655, p = 0.201. Similarly, for study 2 covering extractions, there was a statistically significant main effect for the Role-Play Sim, F (1, 108) = 162.362, p < 0.001, η_p² = 0.601, but not for the Web Sim, F (1, 108) = 0.072, p = 0.798. The interaction term was not statistically significant in either study. Results suggest that role-play simulations achieved a higher level of learning outcomes than the web-based patient simulation.     

麻醉前后插留置导尿管的比较研究

对观察麻醉前后行留置导尿术对病人的不同影响，随机抽取200例腹部手术病人，分成二组，分别于麻醉前及麻醉后5分钟行留置导尿术，发现麻醉后行留置导尿术可明显减轻病人疼痛、排尿困难等症状，取得了较好的临床效果。     

不同麻醉方式介入人工流产术的临床观察

[目的]探讨采取不同麻醉方式对人工流产术的影响 [方法〗将行人工流产术的291例孕妇分为三组:Ⅰ组采用静脉麻醉142例,Ⅱ组采用宫颈局部麻醉并用安定阿托品95例,Ⅲ组为对照组未采用任何药物54例,观察镇痛效果,宫颈松弛情况,术中出血量及并发症发生情况 [结果]Ⅰ、Ⅱ组的镇痛效果及避免并发症的出现明显优于对照组(P<0 01),但宫颈松弛程度、术中出血量与对照组比较无显著性差异(P>0 05) [结论〗静脉麻醉及宫颈局部麻醉结合安定、阿托品的使用镇痛效果确切,可减少人流并发症的发生,对人工流产术是安全、有效的     

RF-II型椎弓根螺钉系统加横突间植骨治疗腰椎滑脱

目　的 :观察RF -Ⅱ型椎弓根螺钉系统加横突间植骨治疗腰椎滑脱的疗效。方法 :自 1998年 2月～ 2 0 0 1年 2月采用RF -Ⅱ型椎弓根螺钉系统复位内固定加横突间植骨术治疗腰椎滑脱症 2 1例 ,男性 15例 ,女性 6例 ,峡部型 17例 ,退变型 3例 ,创伤型 1例 ,Ⅰ度 5例 ,Ⅱ度 12例 ,Ⅲ度 4例 ,滑脱部位L515例 ,L4 6例。结果 :全部病例均获随访平均 3.2年 ( 2 .4～5年 ) ,复位率 90 %～ 10 0 % ,无感染 ,无神经根损伤或神经症状加重 ,术前畸形得以改善 ,19例术前症状消失 ,2 0例 ( 95 % ) 4～ 6个月脊柱融合。结论 :RF -Ⅱ系统强度可靠 ,三维固定方式理想 ,可明显提高横突间植骨的融合率 ,是目前治疗腰椎滑脱的理想方式。     

芬太尼吗啡联合用于罗哌卡因蛛网膜下腔阻滞和术后镇痛

目的随机双盲对照研究比较剖宫产手术中使用芬太尼和吗啡单独或联合进行罗派卡因蛛网蟆下腔阻滞效果差别。方法99例择期在0．75％罗哌卡因7．5mg蛛网膜下腔阻滞行剖宫产手术的产妇随机分配到三组；F组在蛛网膜下腔同时给与芬太尼15^ug，M组给与吗啡0．25mg，FM组给与芬太尼150^ug＋吗啡0．25mg，所有的产妇在手术以后给与病人自控镇痛系统（PCA）进行吗啡术后镇痛。结果各组在术中舒适度、麻黄碱消费量、恶心呕吐、瘙痒和镇静等方面没有显著的差异（p〉0．05）；F组和FM组与M组之间相比取得感觉阻滞效果时间有显著差异（p〈0．05）；F组和M组以及F和FM组之间，吗啡术后镇痛消耗量在4，8，12和24小时有显著的差异（p〈0．01），在2小时点，F组和FM组之间已有显著差异（p〈0．05）。结论与单独使用芬太尼比较，蛛网膜下腔吗啡与芬太尼合用可以提供更加良好的术后镇痛，与单独使用吗啡相比，蛛网膜下腔吗啡与芬太尼合用可以更快的建立阻滞平面；结果表明不同给药途径吗啡单独使用在手术后均能够提供良好的镇痛。