广西各种意外性急性中毒2330例的特点分析

为了探讨广西意外急性中毒特点,调查分析了63家市、县、乡镇医疗单位的2330便意外性急性中毒病历资料。结果显示农村以男性、36岁～60岁、务农与农药类毒物的病例分布率（依序为：55．19％、42．21％、72．81％、40．21％）明显高于城镇（依序为：45．35％、30．95％、3．50％、3．83％）,城镇以女性、20岁～35岁、务工、无职业、化学类毒物的病例分布率（54．65％、38．11％、35．15％、29．69％、56．56％）显著高于农村（44．81％、25．26％、4．59％、11．26％、21.32％）（均为P〈0．005）。另农村农药类毒物以有机磷（占48．28％）最高,城镇化学类毒物以CO（占89．16％）最高;意外中毒病例数平均每年以13．82％的速度在递增。说明广西意外中毒人群结构与毒物种类在城乡间具有明显差别。     

诱导排尿反射对急性酒精性意识障碍患者催醒作用的研究

为了观察以呋塞米注射液诱导排尿反射对急性酒精性意识障碍患者促醒的作用,将30例急性重度酒精中毒患者纳入观察,随机分为2组,每组15例.两组患者均予补液,营养支持,纠正水电解质、酸碱平衡等对症处理.对照组予注射用纳洛酮2mg,加入5％葡萄糖溶液中静滴,纳洛酮日总用量不超过4.0mg.观察组在对照组基础上,加用呋塞米注射液20mg静脉推注,1次/日.对照组治疗后平均苏醒时间为1.85h±0.26h,观察组治疗后平均苏醒时间为1.28h±0.22h,经t检验,t=6.481 7,P＜0.01,提示观察组疗效优于对照组.笔者认为,以呋塞米注射液诱导排尿反射对急性酒精性意识障碍患者有较好的促醒作用,不仅与促进酒精代谢有关,兴奋觉醒中枢亦是其可能的机制.     

胸腺五肽在中毒患者治疗中疗效观察

观察胸腺五肽在中毒患者治疗中的效果.选取ICU中毒患者共40例.分为试验组和对照组,试验组23例,对照组17例.试验组在基础治疗同时加用胸腺五肽,对照组只对症治疗.观察比较两组患者D1、3、5、7天的体温、白细胞计数、中性粒细胞计数、呼吸机辅助呼吸时间、镇静镇痛药物应用时间、C反应蛋白水平、病原学结果.两组D1体温、白细胞计数、中性粒细胞计数和CRP指标比较,差异无统计学意义(P＞0.05);在治疗D3、D5和D7两组白细胞计数比较,在治疗D3和D5两组中性粒细胞计数比较,在治疗D5和D7两组体温比较,在治疗D5两组CRP比较,差异有统计学意义(均P＜0.05).试验组应用呼吸机辅助呼吸时间短于对照组,差异有统计学意义(P＜0.001).试验组发生相关性感染例数少于对照组,差异有统计学意义(P＜0.05).胸腺五肽在中毒患者治疗的应用中,可调节患者细胞免疫功能,减轻炎症活动,联合应用并未增加药物副反应,并能最终改善预后.     

妊娠期急性脂肪肝诊治中的科学思维应用

现代科学思维方法中系统思维及模糊思维方法具有普遍适用意义。妊娠期急性脂肪肝临床上极为罕见,并发症多,病死率极高,1例并发腹部卒中的妊娠期急性脂肪肝患者通过科学诊疗转危为安,及时终止妊娠、对症处理、多学科协作联合治疗,积极预防并发症是确保救治成功的关键。本文尝试介绍科学思维方法在该病诊疗中的一些体会。     

Coping with the threat of severe acute respiratory syndrome: Role of threat appraisals and coping responses in health behaviors

The present study examines the psychological impact of severe acute respiratory syndrome (SARS) by exploring the coping strategies and health behaviors enacted in response to the SARS epidemic. Hierarchical linear regression indicated that the use of wishful thinking in response to the threat of SARS was related to both avoiding public places and avoiding people perceived to be possible carriers of the SARS virus, but was not associated with the use of more adaptive health behaviors, such as using disinfectants and hand washing. Conversely, those who reported engaging in empathic responding in response to the threat of SARS were both less likely to report avoiding people perceived as being at a high risk for SARS and more likely to report engaging in effective health behaviors. Support seeking was not a significant predictor of the health behaviors examined in the present study. Results are discussed in terms of coping with health threats and health promotion.     

从SARS看突发公共卫生事件的政策管理

在调研国外应对突发公共卫生事件政策管理经验的基础上,结合我国应对传染性非典型肺炎的措施,初步探讨了我们在应对突发公共卫生事件政策管理方面的不足,并就改进对策也进行了初步研究。     

Changes in physical activity among coronary and hypertensive patients: A longitudinal study using the Health Action Process Approach

Objectives: Physical activity (PA) is a key factor in cardiovascular disease prevention. Through the Health Action Process Approach (HAPA), the present study investigated the process of change in PA in coronary patients (CPs) and hypertensive patients (HPs).

Design: Longitudinal survey study with two follow-up assessments at 6 and 12 months on 188 CPs and 169 HPs.

Main outcome measures: Intensity and frequency of PA.

Results: A multi-sample analysis indicated the equivalence of almost all the HAPA social cognitive patterns for both patient populations. A latent growth curve model showed strong interrelations among intercepts and slopes of PA, planning and maintenance self-efficacy, but change in planning was not associated with change in PA. Moreover, increase in PA was associated with the value of planning and maintenance self-efficacy reached at the last follow-up

Conclusions: These findings shed light on mechanisms often neglected by the HAPA literature, suggesting reciprocal relationships between PA and its predictors that could define a plausible virtuous circle within the HAPA volitional phase. Moreover, the HAPA social cognitive patterns are essentially identical for patients who had a coronary event (i.e. CPs) and individuals who are at high risk for a coronary event (i.e. HPs).     

2010年我国急性ST段抬高型心肌梗死诊断与治疗指南解读评析

近年来我国急性心肌梗死的发病率一直呈明显上升趋势,已接近国际平均水平。对于STEMI版早期诊断并及时开通梗死相关动脉、增加心肌再灌注、防止心肌进一步坏死,可显著降低心血管事件的发生。本文从STEMI的诊断、早期医疗、再灌注治疗、辅助治疗及二级预防等几个方面对2010年我国急性ST段抬高型心肌梗死的诊断与治疗指南进行了详细解读分析。     

医学对急性呼吸窘迫综合征（ARDS）的认识

ARDS是一个临床综合征,其特征是炎症性肺水肿,严重的低氧血症,僵硬肺和弥漫性内皮和上皮损伤。既往50年中,特别是SARS在全球暴发以来,对ARDS病因、生理学、组织学和管理上有了重大的进展。然而,尽管围绕ARDS的研究显著增加,依然有许多重要问题亟待解决。     

CLIMATE ENGINEERING FROM HINDU‐JAIN PERSPECTIVES

Although Indic perspectives toward nature are now well documented, climate engineering discussions seem to still lack the views from Indic or other non‐Western sources. In this article, I will apply some of the Hindu and Jain concepts such as karma, nonviolence (Ahi?sā), humility (Vinaya), and renunciation (Sa?nyāsa) to analyze the two primary climate geoengineering strategies of solar radiation management (SRM) and carbon dioxide removal (CDR). I suggest that Indic philosophical and religious traditions such as Hinduism, Buddhism, and Jainism offer ethical concepts to call for humility in all acts of climate engineering leading to a favoring of CDR over SRM and a favoring of lifestyle changes (particularly vegetarianism) over both. I demonstrate these concepts by introducing the five great elements from the Hindu philosophy, two Hindu legends from Hindu mythology, the Indic ethical ideas of karma, renunciation, and humility, and the moral authority of Gandhi.