“舰艇汽轮机装置及系统”课程教学改革及实践

课程教学改革是当前实战化教学改革的重要内容和基石。文章针对专业主干核心课程“舰艇汽轮机装置及系统”,分析其课程教学改革的必要性及面临的问题,从课程内容、教学方式、课程保障、课程时空扩展等方面开展教学改革和实践,取得了较好的效果,不仅提高了课程教学效果,同时对于进一步深入推进整个专业实战化教学改革,具有重要意义。     

The significance of troponin T and CK-MB release in coronary artery bypass surgery

Measurement of cardiac markers is an index of care standard in the assessment and diagnosis of cardiovascualr disease. Two of the major cardiac markers are Creatine Kinase isoenzyme CK-MB and Troponin T, which are extensively used in the diagnosis of heart disease. The release of Troponin T and creatine kinase isoenzyme (CK-MB) was investigated in 50 coronary artery bypass surgery patients. Measurement of plasma samples was carried out at five different time points, namely before surgery, 1,6,12,24 hours after surgery. The results indicated that CK-MB level were increased by a factor more than four times compared with the upper limit of baseline (befor surgery). Troponin T concentration showed more than six fold over the upper limit of baseline (before surgert) at 1,6,12,24 hours after surgery. In order to assess the significance of the length of the surgical procedure on the release of Troponin T and CK-MB, the surgery patient were divided into two groups according to the length of the surgical procedure: group I was selected on the basis that the surgical procedure they underwent lasted above 90 minutes and group II with a surgical procedure below 90 minutes. Both Troponin T and CK-MB showed a significant increase in-group I compared to group II. To investigate the likelihood that this effect is party due to myocardial infarction during surgery, the patients were divided into two groups: Group A with some sings of myocardial infarction on Q wave of ECG and group B without any change. The results showed approximately a two-fold increase of these markers in-group A compared to group B. Since these markers reach into blood following damage to myocardial their increase in patients with time course surgery of more than 90 minutes and those with a probability of MI during operation, indicating that these patient fall into a high risk group of repeat (MI) after surgery.     

二维冠状动脉旁路桥的局部形状模型

对于一个二维冠状动脉旁路桥的形状,局部利用扰动技术,导出其局部形状模型及广义形式．     

硫、氯、碱金属元素对工业固废水泥资源化利用的影响及控制技术

固体废物水泥资源化利用必将是我国消纳大部分工业固废的有效途径之一,然而很多工业固废中会含有大量的硫、氯、碱金属等元素,这些物质的超量存在会影响到水泥窑协同处置工艺和水泥成品质量。本文通过综述国内外文献,归纳了典型工业固废中硫、氯、碱金属元素的含量范围,并介绍了它们对水泥资源化利用技术的主要制约因素,进而提出相应的调控措施,为工业固体废物水泥资源化利用提供必要依据。     

Off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting: which is better in patients with chronic obstructive pulmonary disease?

To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.     

300MW汽轮发电机转子现场大修

本文介绍了300MW汽轮发电机转子现场大修的工艺总结。     

创伤应激与环核苷酸的关系

以体外循环手术作为创伤应激模式，采用放射免疫法测定了１６例低温麻醉体外循环手术者围术期７个时段的血浆ｃＡＭＰ、ｃＧＭＰ值，探讨其在应激状态下的变化及临床意义．发现随机体承受创伤刺激，特别是对心脏的手术操作及体外循环转流刺激强度的增减，ｃＡＭＰ及ｃＧＭＰ呈相应的变化．表明在体外循环手术这种特定的创伤模式下，对血浆环核苷酸的动态监察可作为病人机体、特别是心脏应激反应强度的一个综合参考指标     

温血诱停及终末再灌注在冠状动脉搭桥术中的应用

目的：总结温氧合血诱导傅及终末再灌注心肌保护在冠状动脉搭桥术中应用的经验，方法：21例冠心病患者中85．75％为多支冠状动脉病变，8例左室射血分数≤45％，其中3例＜30％，均在中等低温外外循环下CABG。急症CABG1例。常规采用左乳内动脉（LIMA）与左前降支（LAD）搭桥，余均选用大隐静脉桥。人均搭桥2．8支。心肌保护方法为主动脉根部温氧合血顺灌诱导停搏及终末再灌注。4℃冷晶体停搏液间断灌注维持停搏。观察心脏自动复跳率及复苏后心律紊乱情况，术后恢复情况，结果：心脏自动复跳率90．5％，复跳后心律规则、平稳、术后左室顺应性，心功能恢复良好，术后病人心绞痛完全消失，结论：温氧合血诱导停搏及终末再灌注心肌保护效果好，对心功能不全，心肌能贮低下的高危病例应采用温氧合血诱导停搏及终末再灌注并适用于冠状动脉搭桥术。     

Attempting to maintain normoglycemia during cardiopulmonary bypass with insulin may initiate post-operative hypoglycemia

Cardiopulmonary bypass is known to cause alterations in insulin secretion and resistance, resulting in profound hyperglycemia. Aggressive treatment of the resulting hyperglycemia intra-operatively could result in a severe degree of post-operative hypoglycemia. We undertook this prospective non-randomized clinical study to compare the alterations in glucose homeostasis in diabetic (group A, n=50) and non-diabetic (Group B, n=50) patients undergoing moderate hypothermic (30°C) cardiopulmonary bypass for coronary artery bypass grafting (CABG). All patients had a fasting blood sugar level done on the morning of surgery. Blood sugars were monitored intra-operatively and post-operatively at fixed time intervals. Intra-operative hyperglycemia was treated aggressively by a continuous, infusion of injecting plain insulin. Both the groups experienced similar significant increase in blood glucose levels during bypass (‘p’=0.00003). However, the mean blood glucose level upon arrival in the intensive care unit was significantly decreased in group B compared to group A (p=0.0002). 60% of group B and 10% of group A patients required treatment for post-operative hypoglycemia (blood glucose level <60mg/dl). This clinical study reveals that attempting to maintain normoglycemia in this setting with Insulin may initiate post-operative hypoglycemia.     

旁路节流调速实验曲线下凹的原因分析

本从理论上分析了在QCS003B液压实验台上所进行的旁路节流调速实验曲线下凹的原因,实践证明分析是正确的,其结论具有实际意义。