右美托咪定对鼻内镜手术患者血流动力学及苏醒期的影响

探讨鼻内镜手术时应用右美托咪定对其血流动力学及苏醒期的影响。选择100例行鼻内镜的择期手术患者,随机分为两组,右美托咪定组（D组）,持续泵入右美托咪定0.4μg·kg-1·h-1从麻醉诱导开始到拔管结束;对照组（C组）,持续泵入相同剂量的生理盐水。诱导药物均为依托咪酯0.3mg/kg,舒芬太尼0.4μg/kg,罗库溴铵0.6mg/kg,术中以丙泊酚6mg·kg-1·h-1、瑞芬太尼0.1μg·kg-1·min-1维持。观察并记录诱导前5min,手术开始后10min及30min,手术结束时,拔管时及拔管后2min的MAP及HR;记录术野质量和术中出血量、手术时间和拔管时间、拔管时躁动的发生率、呛咳评分、拔管后患者的Ramsay镇静评分。结果 D组在拔管时及拔管后2min血压和心率与C组相比降低（P〈0.05）;D组的术野质量优于C组（P〈0.05）,术中出血量D组少于C组（P〈0.05）;两组的手术时间和拔管时间差异无统计学意义;拔管时躁动的发生率及呛咳评分D组低于C组（P〈0.05）;D组拔管后患者的Ramsay镇静评分高于C组（P〈0.05）。术中应用右美托咪定,可使鼻内镜手术患者术中血流动力学更稳定,苏醒期更为平稳。     

药物不良反应侵权诉讼问题研究

药物不良反应侵权诉讼是一种特殊的民事侵权诉讼。药品的生产者、药品经营者以及医疗机构都可能成为诉讼中的被告。药物不良反应侵权诉讼中的许多案件事实实行举证倒置。主要举证倒置事实有:药品缺陷、因果关系、免责事由、医疗过错等。     

胸腔镜外科的发展、现状与思考

胸腔镜手术已经有近100年的历史,经历了传统胸腔镜外科,电视胸腔镜外科,机器人辅助胸腔镜外科,远程机器人手术等阶段,目前已成为许多胸部疾病的首选治疗手段。但胸腔镜外科的发展并不一帆风顺,经历了兴起、衰落、振兴的过程。我国现处于电视胸腔镜阶段。胸腔镜外科的发展历程是生产力水平和社会需求两个要素综合作用的典型范例,随着21世纪的到来,胸腔镜外科的明天更辉煌。     

The Influence of the Premedication Consult and Preparatory Information about Anesthesia on Anxiety among Patients Undergoing Cardiac Surgery

The present study examines the impact of patients' subjective evaluation of the premedication consult and of preparatory information about anesthesia on preoperative anxiety among patients undergoing cardiac surgery ( N = 93). The preparatory information concerned a flyer that contained information about treatment options, risks of surgery and expected outcomes with respect to anesthesiology. The data did not support the beneficial effect of the information on patients' anxiety levels above the standard procedure in which patients were solely visited by their anesthesiologist for a premedication consult. Anxiety reduction was related, however, to the perceived quality of the premedication consult. The more positively the interaction with the anesthesiologist was evaluated, the stronger the patients' anxiety reduction. In addition, the moderating impact of monitoring/blunting on preoperative anxiety was examined. High levels of monitoring and low blunting were associated with stronger anxiety reduction, regardless of whether patients received additional preparatory information or solely an oral consult. The implications of these findings for clinical practice are discussed.     

不同5-HT3受体拮抗剂预防腹腔镜术后恶心呕吐的临床观察

观察使用不同5-HT3受体拮抗剂预防全麻下腹腔镜手术术后恶心呕吐的临床效果。选择160例气管内插管全身麻醉下腹腔镜手术,随机分四组,每组40例,手术结束前30min分别静脉注射昂丹司琼4mg（A组）;托烷司琼2mg（B组）;格拉司琼3mg（C组）;D组为对照组。记录术后2h、6h、12h、24h患者恶心、呕吐出现的例数。结果四组患者术后恶心呕吐的发生率是一个逐渐下降的趋势,A、B、C三组与D组相比较有显著性差异（P〈0．05）;术后2h、6h、12hB组与A组、C组相比较有显著性差异（P〈0．05）;而术后24hA、B、C三组差异无统计学意义,A、B、C三组抑制恶心呕吐的有效率分别为67．5％、87．5％和70．0％,与对照组比较差异有统计学意义（P〈0．05）,随访患者24h内无与药物相关的不良反应。结论：三种药物都能有效地预防术后恶心呕吐,但12h内托烷司琼的有效性更为明显。     

从医学整合的角度谈现代肺癌的防治

肺癌是严重影响群众健康的常见恶性肿瘤,当前肺癌防治工作中面临一系列由于分科过细、欠缺协作等导致的问题。加强肺癌防治领域中学科、技术、资源的整合,才能够有效应对越来越严峻的肺癌防治形势。建立以疾病为中心的肺癌整体防治模式,对于其他单一重大疾病的防治也有重要参考意义。     

Plumbing the Depths: A Recovery of Natural Law and Natural Wisdom in the Context of Debates about Evolutionary Purpose

I argue that the theological traditions of natural law and wisdom offer helpful meeting points in discussions about evolutionary “purpose” and contingency in relation to theological purpose, and serve to form the basis for a theology of nature. Natural law offers a way of describing the ordered action of God toward complexity in a contingent world without using the language of either “design” or “progress.” The theological tradition of wisdom as implicit in the natural world, learned in the human community, and received as gift of grace offers a further means of interconnecting biological reality with spiritual experience, while retaining distinctions. Wisdom and natural law intersect inasmuch as natural law is participation in Eternal Wisdom, although the latter makes sense only from the prior perspective of faith.     

浅述空肠弯曲菌诱发格林-巴利综合征的机制和防控

弯曲菌是全球范围流行的细菌性肠道病原菌之一,对人致病的主要是空肠弯曲菌,HS:19等特定血清型空肠弯曲菌感染是诱发人格林-巴利综合征(GBS)的重要前驱因子。本文浅述了空肠弯曲菌诱发格林-巴利综合征的可能机制,并提出了防控的几点建议。     

浅谈现代普通外科观念的变更

随着自然科学和社会科学的发展,特别是现代医学模式的转变,普通外科的观念与传统观念有了很大不同。人本主义观念是普通外科的所有医疗活动的指导原则,循证观念成为解决临床问题的有效手段,微创观念将引导现代普通外科的发展方向,置换观念是社会和自然科学发展的必然,整体观念体现着现代医学对立统一的思想,而新的健康观念更符合人类文明进步的要求,协作观念则是提高医疗质量的保障。     

青少年道德判断能力的研究

德国道德心理学家林德提出“道德行为与发展的双面理论”,并设计了著名的“道德判断测验”,在20多年的研究中取得了很多重要成果。我们以中文版的“道德判断测验”为测量工具,以724名12-27岁青少年学生为被试进行实证研究,研究结果表明:学生的C分数随年级提高而有所提高,但不同年级之间有一定波动,说明学校教育有助于提高学生的道德判断能力,但存在不稳定因素。男女生C分数不存在显著差异,学校内部各年级之间也不存在显著差异,不同性质的学生之间不存在显著差异;