食管癌外科治疗近期疗效的影响因素分析

目的探讨食管癌患者年龄、吻合位置与术后并发症发生率和死亡率的关系,以及新辅助化疗对食管癌手术切除率的影响。方法回顾性分析西安交通大学医学院第一医院肿瘤外科自1997年~2003年首诊收治、资料完整587例食管癌患者资料。结果不同年龄组手术切除率分别为91.2%、95.9%和97.7%(P>0.05);>70岁年龄组术后吻合口瘘发生率和术后死亡率均较其它组高(P<0.05)。胸膜顶部吻合口瘘发生率为16.67%,较其它位置吻合口瘘发生率明显高(颈部2.17%、弓上1.09%、弓后2.60%、弓下0),具有显著性差异(P=0.019)。III期食管癌患者行术前新辅助化疗组与未化疗组的手术切除率分别为96.92%和78.85%,具有显著差异(P<0.05),而术后吻合口瘘发生率和术后死亡率无明显差异(P=1.000)。结论术前新辅助化疗可提高食管癌手术的切除率并不增加术后并发症。年龄大并不完全是手术禁忌,高龄患者的手术应充分考虑患者的生理年龄。     

深度镇静麻醉胃镜检查术后不良反应的影响因素研究

目的探讨丙泊酚联合芬太尼深度静脉麻醉胃镜检查术后患者不适的影响因素。方法随机抽取2010年9月-2010年10月某院深度镇静麻醉胃镜检查术受检者270名,术前采用自制问卷调查,记录受检者术中术后多项指标,分析深度镇静麻醉胃镜检查术术后患者不适的主要影响因素。采用描述性统计分析、χ2检验、单因素非条件logistic回归分析。结果术后不适的影响因素有年龄、BMI、是否患有冠心病、是否曾经做过胃镜检查、术前心理是否紧张、术中是否出现呛咳和躁动、麻醉药物起效时间、术后清醒时间。结论对于年龄较大、肥胖、患有冠心病、以往从未做过胃镜检查、术前紧张、术中出现呛咳躁动、麻醉药物起效时间长的受检者应在术中密切观察其呼吸、循环受抑制情况,并在术后延长观察时间。     

术后谵妄的研究进展

谵妄是一种以急性意识和认知功能障碍为特征的脑综合症。手术后患者出现谵妄不仅会增加术后并发症及医疗费用、延长住院时间,还会增加远、近期死亡率,且一旦发生谵妄,其术后长期认知功能也显著下降。对术后谵妄的诊断、预防和治疗是外科围手术期的重要内容。近年来,在手术后谵妄发生、发展及诊治方面有较多的研究且也取得了一定的进展。该文就术后谵妄发生的病理生理学机制、危险因素、诊断、预防以及治疗等方面的研究进展进行综述。     

芬太尼、罗比卡因配伍用于直肠癌术后硬膜外镇痛的临床观察

[目的]研究芬太尼、罗比卡因配伍用于硬膜外术后镇痛的临床效果及不良反应。[方法]ASAI-Ⅱ级择期直肠癌切除术患者60例,按术后硬膜外用药的不同随机分为两组,每组30例、Ⅰ级(观察组)术后硬膜外用药为2ml/h微量止痛泵加入0.2％罗比卡因100ml、芬太尼0.2mg,Ⅱ组(对照组)术后硬膜外用药为2ml/h微量止痛泵中入0.25％布比卡因100ml、芬太尼0.2mg术后行视觉模拟评分(VAS)(Visual analogue scale),BCS(bruggrmann comfort scale)舒适评分并观察不良反应发生情况。[结果]Ⅰ组VAS评分明显低于对照组(P<0.05或P<0.01)。BCS评分明显高于对照组(P<0.05或P<0.01)。两组均无术后不良反应发生。[结论]芬太尼、罗比卡因配伍硬膜持续应用可获得良好的术后镇痛效果。     

Teaching and learning the concept of chemical bonding

Chemical bonding is one of the key and basic concepts in chemistry. The learning of many of the concepts taught in chemistry, in both secondary schools as well as in the colleges, is dependent upon understanding fundamental ideas related to chemical bonding. Nevertheless, the concept is perceived by teachers, as well as by learners, as difficult, with teaching commonly leading to students developing misconceptions. Many of these misconceptions result from over‐simplified models used in text books, by the use of traditional pedagogy that presents a rather limited and sometimes incorrect picture of the issues related to chemical bonding and by assessments of students' achievement that influence the way the topic is taught. In addition, there are discrepancies between scientists regarding key definitions in the topic and the most appropriate models to teach it. In particular, teaching models that are intended to have transitional epistemological value in introducing abstract ideas are often instead understood by students as accounts of ontological reality. In this review paper we provide science educators, curricula developers and pre‐service and in‐service professional development providers an up‐to‐date picture regarding research and developments in teaching about chemical bonding. We review the external and internal variables that might lead to misconceptions and the problematic issue of using limited teaching/learning models. Finally, we review the approaches to teaching the concept that might overcome some of these misconceptions.     

p38 MAPK Inhibitor (SB203580) and Metformin Reduces Aortic Protein Carbonyl and Inflammation in Non-obese Type 2 Diabetic Rats

Microvascular and macrovascular diseases are the main causes of morbidity in type 2 diabetes patients through chronic hyperglycaemic condition via oxidative stress and inflammation. Reactive oxygen species (ROS) activate p38 MAPK phosphorylation and inflammation which enhances protein modification by carbonylation. The use of metformin and a p38 MAPK inhibitor is hypothesised to reduce ROS production and inflammation but effects of metformin and p38 MAPK inhibitor (SB203580) on ROS production and inflammation in vascular type 2 diabetes mellitus non-obese (T2DM) have not been investigated. The Goto-Kakizaki rat T2DM model was divided into three groups as T2DM, T2DM treated with 15 mg/kg bw metformin and T2DM treated with 2 mg/kg bw SB203580 for 4 weeks. Rat aortas were isolated and protein carbonyl (PC) contents were measured by spectrophotometric DNPH assay. Aortic IL-1ß level was determined by ELISA. Results showed that aortic PC contents in the T2DM group were significantly higher than in non-diabetic rats. Treatment with metformin or SB203580 significantly reduced PC contents while only metformin significantly reduced IL-1ß levels. Findings indicated that metformin reduced ROS production and inflammation in diabetic vessels and possibly reduce vascular complications in non-obese T2DM.     

全麻手术病人应用医用水凝胶护眼贴效果分析

目的：探讨全麻手术需特殊体位病人在应用医用水凝胶护眼贴后对预防眼睑水肿、结膜红肿等眼部并发症的效果。方法选择120例脊柱手术俯卧位全麻病人和食管癌手术侧卧位全麻病人,将其随机分为两组,各60例。试验组60例直接使用医用水凝胶护眼贴保护双眼,对照组60例采用金霉素眼膏结合3M 透明敷料贴保护双眼。观察术后24小时眼部并发症发生情况。结果术后24小时回访,试验组术后患者眼睑水肿2例、结膜红肿2例、视物模糊3例、畏光3例、黏滞感2例、异物感4例;对照组术后患者眼睑水肿9例、结膜红肿13例、视物模糊13例、畏光11例、黏滞感9例、异物感17例。两组间差异有统计学意义。结论特殊手术体位全麻病人术中使用护眼贴能更有效保护双眼,预防眼部并发症的发生。     

鼻内镜下上颌窦囊肿手术45例分析

分析鼻内镜手术技术治疗上颌窦囊肿的临床效果。方法对我科2005年6月—2009年6月收治的90例上颌窦囊肿患者根据入院顺序,随机分为鼻内镜组和对照组各45例,其中对照组行传统柯—陆氏上颌窦囊肿摘除术。观察比较两组手术的效果及术后并发症发生的情况。结果鼻内镜组的手术操作简单,术后反应小,并发症少,效果满意。经统计学处理,差异有统计学意义,P〈0.05或P〈0.01。结论在治疗上颌窦囊肿中,鼻内镜手术摘除上颌窦囊肿是首选术式,值得临床推广和应用。     

静脉留置技术常见并发症及处理

对静脉留置技术中的导管阻塞、导管脱出、气胸、胸导管损伤等并发症的原因、处理及预防措施进行了综述,为医护人员在临床工作中更有效的使用静脉留置针,减少并发症提出对策,为静脉留置技术在临床上得到更广泛运用提供依据。     

"进与退中的彷徨,达观和无常与俱"--试论辛弃疾世界观的矛盾

作为南宋爱国的英雄词人,辛弃疾的人品和词作被后世广为推崇。他一生以爱国志士自居,故一方面爱国主义是其世界观的核心;而另一方面,辛弃疾的世界观也同时呈现出矛盾性和复杂性,这也体现了人性的丰富性和复杂性。因此,在分析他的世界观时,我们应辨证全面地看问题,切不可偏颇。其世界观的矛盾主要表现在两个方面。