手足口病患者接诊流程和消毒隔离的分析

手足口病(HFMD)是婴幼儿及学龄前儿童的常见疾病,是肠道病毒引起的一种常见传染属隐性传染病,常呈爆发性流行。引起本病的肠道病毒达20余种,以柯萨奇A型和肠道EV71型最常见。本病通过唾液、飞沫经呼吸道传播,或由手及污染物经口传播。由于本病的传染性强,传播速度快,短时间内可以在学校、幼儿园社区等人口密集的地区引起大流行。我院作为传染病专科医院,自2011年4     

疑似或确诊新型冠状病毒肺炎患者气道管理专家建议

正新型冠状病毒肺炎(coronavirus disease 2019, COVID-19)已纳入《中华人民共和国传染病防治法》规定的乙类传染病,按照甲类传染病管理[1-2],经呼吸道飞沫和密切接触传播是主要的传播途径,也可经气溶胶传播[3]。疫情期间疑似或确诊COVID-19患者的急诊和限期手术需在全麻下完成,而气管插管和拔管可能会导致病毒医源性传播。现将相关文献综合整理并解读,以供临床麻醉科医师参考。1 感染防控全麻气管插管和拔     

腹腔镜下阑尾切除术的配合体会

患者入手术室前，洗手护士和巡回护士共同准备腹腔镜手术专用器械、摄像机、监视器、冷光源、电刀、冲洗吸引设备、CO2气体，检测瓶中CO2压力，并准备中转开腹阑尾切除器械。准备70℃以上的热生理盐水，查对并接患者进手术室。     

超临界CO2萃取枸杞籽油数值模拟及工艺优化

利用现有的超临界流体萃取实验装置,以CO2为萃取剂,考察了萃取压力、温度、CO2流量及原料颗粒大小等因素对枸杞籽油萃取率的影响,并由此确定了较佳的萃取工艺条件：萃取压力25-30MPa,操作温度318-323K,枸杞籽颗粒度40-50目,CO2流量0.3-0.4m^3/h,此时枸杞籽油萃取率最高,可达15.5%。并基于萃取器微分单元和固态原料颗粒微分单元质量守恒原理,建立了微分方程,利用直线推动力近似理论拟合总传质推动力及平衡吸收常数,化简方程,对实验结果进行了数值模拟,优化了实验条件。     

经冠状动脉内移植骨髓间充质干细胞在体示踪及体内再分布的实验研究

目的探讨利用心脏磁共振成像（MRI）对经冠状动脉内注射的超顺磁性氧化铁颗粒（SPIO）标记的骨髓间充质干细胞（bone marrow mesenchymal stem cells，BMMScs）进行在体示踪的可行性，观察移植细胞在体内的再分布情况。方法从猪的髂骨处抽取骨髓，分离、培养BMMSCs。用SPIO和CM—DiI（Cell Tracker^TM C-7001，Molecular Probe）对细胞进行双重标记。通过导管将标记的细胞注射到冠状动脉左前降支内，分别在细胞移植后当天、移植后1周、3周通过MRI检查对移植细胞进行在体示踪；并分别取不同器官的组织标本进行组织病理学检查。结果冠状动脉内注射的SPIO标记的BMMSCs可在心脏MRI上显影，表现为散在分布的点状信号缺失或低密度影像，并可持续3周。病理检查发现移植细胞较为均匀的分布在移植冠状动脉相关的心肌组织内，在移植后1周可见细胞进入冠状静脉系统内。移植细胞在体内能分布至肺、脾和肾，而在肝组织中很少见。结论用MRI技术可对经冠状动脉内注射的SPIO标记的BMMSCs进行在体示踪；移植细胞在体内有向非靶器官再分布的情况，相关器官组织形态学未见明显的改变。     

Pectinex SMASH 在香蕉汁澄清过程中的作用

对PectinexSMASH在香蕉汁澄清过程中澄清度和粘度的变化、还原糖与自由羧基的释放、悬浮颗粒中果胶质及蛋白质含量、悬浮颗粒的Zeta 电位和粒度分布变化等进行了研究.结果表明,香蕉汁悬浮颗粒含有17.68%的蛋白质和24.43%的总果胶质;Zeta 电位测定结果表明,在pH4.76的香蕉汁中,悬浮颗粒表面带负电荷.一些带正电的胶体如明胶和酪蛋白可与悬浮颗粒作用而部分地澄清香蕉果汁,而带负电的胶体如CMC、海藻酸钠和阿拉伯胶可部分地阻止果汁的澄清.PectinexSMASH澄清香蕉汁的过程可分为3个阶段:(1)悬浮颗粒被部分水解,香蕉汁粘度快速下降;(2)部分水解的悬浮颗粒相互聚集并出现絮凝;(3)逐渐长大的颗粒沉淀下来.     

暮春话“流脑”

流行性脑脊髓膜炎简称“流脑”,是由脑膜炎双球菌引起的急性呼吸道传染病。具有发病急、变化多、传播快、流行广、危害性大的特点。发病季节一般从冬末或春初开始,4月份达到高峰,5月下旬逐步减少。多见于15岁以下的儿童,特别是2～6岁的儿童更易感染。但近年来青壮年的发病率有增高的趋势。因此,应高度警惕,加强防范。脑膜炎双球菌多寄生在病人或健康带菌者的鼻、咽部粘膜内,当这些人在咳嗽、说话、打喷嚏时,喷射出大量带菌的飞沫,污染空气,健康人一旦吸入这种带菌的空气,在机体免疫力和抵抗力下降或病菌力很强的情况下,脑膜炎双球菌就会经呼吸道进入血液,而后到达颅     

CO_2气腹对炎症环境下巨噬细胞功能影响的实验研究

目的:测定模拟炎症环境下CO2气腹对巨噬细胞超氧阴离子释放和线粒体功能的影响,探讨炎症条件下CO2气腹腹腔镜手术的可行性。方法:将大鼠肺泡巨噬细胞系NR8383细胞株在37℃、5%CO2、95%湿度中培养传代后分为正常对照组、实验对照组及CO2气腹组。用酵母多糖诱发炎症环境,用酶标仪测定各组相应时间的自由基荧光值及450nm波长处线粒体吸光度OD值。结果:两项实验中正常对照组与实验对照组各时段的差异有统计学意义(P0.05)。CO2气腹组与实验对照组在1h、2h、4h及恢复常氧条件培养2h的差异有统计学意义(P0.05),恢复常氧条件培养4h与实验对照组的差异无统计学意义。结论:CO2气腹对巨噬细胞超氧阴离子释放及线粒体功能具有短暂可逆抑制,利于减轻局部炎症反应,保持机体的免疫功能。CO2气腹腹腔镜手术对感染性疾病是安全、有益的。     

CO_2激光烟雾颗粒的粒径测定及元素分析

目的测定超脉冲C02激光治疗时产生的烟雾颗粒大小,并进行元素成分分析。方法超脉冲CO2激光治疗时开启可移动式吸烟机,使用1周的吸烟机过滤芯海绵作为实验组,未经使用的过滤芯为对照组。扫描电镜测量过滤芯内烟雾颗粒大小及分布,X射线光电子能谱仪分析检测烟雾颗粒的组成元素及构成比。结果扫描电镜显示,超脉冲C02激光治疗产生的烟雾颗粒平均直径为3.37μ皿,能谱分析显示激光烟雾主要元素成分为碳和氧,另有微量钠、硫、氯元素。结论超脉冲C02激光的烟雾颗粒与PM 2.5微粒大小相当,属于对肺有损害的微颗粒,建议医学激光治疗时增强医患人员防护意识与措施。     

主动脉弓三分支型移植物在血管模拟装置中的腔内修复实验

目的:研究一体化三分支型主动脉弓腔内移植物在新型血管模拟装置中模拟腔内修复主动脉弓的可行性。方法:设计并制作主动脉弓一体化三分支型覆膜支架,其分支针对主动脉弓上的3个分支动脉;用新型血管模拟装置测试此种移植物,优化移植物的腔内操作,评估移植物在模拟装置内释放的可行性。结果:新型血管模拟装置运作正常,移植物可顺利装载入输送系统并导入血管模拟装置内释放,其主体和分支在位良好。结论:设计制作了新型主动脉弓分支型移植物,其输送系统能顺利将移植物送达靶血管准确位置;新型体外血管模拟装置能模拟人体血管腔内环境并对上述移植物进行体外测试。     

以问题为基础的学习方法在ICU护理查房中的应用

目的：提高ICU护理查房质量和护士综合素质，方法：采用以问题为基础的学习方法（PBL）进行护理查房，并与传统查房模式相比较。结果：PBL模式在查房压力，查房前准备，上网查资料，查房前与病人沟通，关注病人体语，参与科研及前赡性选题方面显著优于传统模式（均P＜0．01），PBL模式以心理学，医学，人文学和知识需求为主，传统模式则以医学，护理学知识需求为主，结论：采用PBL模式查房拓展ICU护士的知识面和知识深度，提高其发现，解决问题的能力，提高查房质量。     

Intrabronchial airway pressures in intubated patients during bronchoscopy under volume controlled and pressure controlled ventilation

Bronchoscope insertion through an endotracheal tube increases airflow resistance. Constant tidal volume (T(v)) ventilation can be maintained by augmenting the inspiratory pressure, but increased outflow resistance cannot be compensated for. Air trapping distal to the tube may lead to higher airway pressures in volume controlled (VC) mode and reduced T(v) in pressure controlled (PC) mode. Increased end-expiratory airway pressures will not be detected by ventilator pressure sensors. In mechanically ventilated and sedated patients, the effects of bronchoscope insertion on intrabronchial pressures were recorded by a pressure transducer distal to the endoscope. In half of the patients, the ventilator was set in VC mode prior to bronchoscope insertion, keeping the previous T(v) constant. In the other half the ventilator was set in PC mode, keeping previous peak inspiratory pressures constant. All patients underwent sequences of VC-PC-VC or PC-VC-PC ventilation with two-minute intervals between mode-changes. In VC mode, bronchoscope insertion increased peak airway pressure from 29 cmH2O (22 to 43) to 41 cmH2O (36 to 49) (P = 0.012) and end-expiratory airway pressure from 11 cmH2O (6 to 18) to 22.5 cmH2O (15 to 30) (P = 0.012). There were no significant changes in T(v), P(a)CO2 or P(a)O2 after two minutes. In PC mode, peak airway pressure was unchanged and end-expiratory airway pressure increased from 9.5 cmH2O (7 to 10) to 10.5 cmH2O (9 to 18) (P = 0.017). Median T(v) was reduced from 673 ml (585 to 800) to 450 ml (408 to 560) (P = 0.012); median P(a)CO2 increased from 5.7 kPa to 6.5 kPa (P = 0.012). Using distal measurement, positive end-expiratory airway pressure increased markedly in VC mode but only marginally in PC mode after bronchoscope insertion.     

高频喷射通气对吸入性损伤犬呼吸气流与气体交换的影响

目的 观察犬吸入性损伤时呼吸气流对气体交换的影响。方法 用三维粒子动态分析仪测定犬自主呼吸时吸气和呼气流速。将实验动物通入高压蒸气５秒后随机进行五种不同条件高频喷射通气，每种通气方式通气２０分钟，并根据公式Ｒｅ＝Ｖｒｐ／η计算出雷诺数，同时采取动脉血标本，观察Ｐ２－ＣＯ２、ＰａＯ２、ＰＩＰ的变化。结果（１）自主呼吸时吸气为层流，呼气可有为层流，也可能为涡流；（２）高频喷射通气（ＨＦＪＶ）时呼气和吸     

泌尿生殖系统无乳链球菌感染的临床病区分布及耐药性分析

目的分析泌尿生殖系统无乳链球菌感染的临床病区分布及耐药情况,为临床提供治疗依据及合理的用药方案。方法对临床送检的阴道分泌物标本及中段尿标本进行常规培养,检出的无乳链球菌株经由VITEK-2全自动细菌鉴定分析仪进行鉴定和药敏分析。结果 1 563例送检标本发现57例患者有无乳链球菌感染,感染率为3.64%;无乳链球菌的临床病区分布以妇产科最高,其次是神经内科和肾病内科;药敏结果显示所有检出的无乳链球菌对四环素的耐药率高达77.2%,其次是红霉素为49.1%、克林霉素为42.1%、环丙沙星40.4%、左氧氟沙星36.8%。结论国内无乳链球菌的感染率较高,尤其是在妇产科病区,临床上应加强对无乳链球菌的培养检测,及时并合理应用抗菌药物,以降低耐药率。     

开展大隐静脉曲张剥脱术日间病房运营模式的可行性探讨

目的 探讨采用新型运行流程,开展大隐静脉曲张剥脱术日间病房运营模式的可行性和安全性.方法 回顾性分析笔者所在医院2011年内行大隐静脉曲张剥脱术的282例患者的临床资料,根据运营方式不同将其分为日间手术组(n=90)和住院手术组(n=192).对2组患者的临床特征以及医疗运行指标(包括术前等待时间、住院时间以及医疗费用)进行比较分析.结果 2组患者间的基本临床特征差异均无统计学意义(P＞0.05)；日间手术组患者的术前等待时间和住院时间较住院手术组短(P＜0.05),而医疗费用较低(P＜0.05).结论 新型的日间病房运营模式可缩短大隐静脉曲张患者的术前等待时间、住院时间以及医疗费用,同时能够保证其临床治疗的安全性,值得在临床中推广.     

一氧化碳与炎症的研究进展

一氧化碳具有重要的抗炎作用.一氧化碳释放分子作为CO的一种新的供体,广泛地应用于生物学研究.本文对CO的抗炎作用和CORM的研究进展进行综述.     

Flow Distribution During Cardiopulmonary Bypass in Dependency on the Outflow Cannula Positioning

Oxygen deficiency in the right brain is a common problem during cardiopulmonary bypass (CPB). This is linked to an insufficient perfusion of the carotid and vertebral artery. The flow to these vessels is strongly influenced by the outflow cannula position, which is traditionally located in the ascending aorta. Another approach however is to return blood via the right subclavian artery. A computational fluid dynamics (CFD) study was performed for both methods and validated by particle image velocimetry (PIV). A 3‐dimensional computer aided design model of the cardiovascular (CV) system was generated from realtime computed tomography and magnetic resonance imaging data. Mesh generation (CFD) and rapid prototyping (PIV) were used for the further model creation. The simulations were performed assuming usual CPB conditions, and the same boundary conditions were applied for the PIV validation. The flow distribution was analyzed for 55 cannula positions inside the aorta and in relation to the distance between the cannula tip and the vertebral artery branch for subclavian cannulation. The study reveals that the Venturi effect due to the cannula jet appears to be the main reason for the loss in cerebral perfusion seen clinically. It provides a PIV‐validated CFD method of analyzing the flow distribution in the CV system and can be transferred to other applications.     

Comparative study of acute tissue damage induced by the CO2 laser versus microelectrodes in cordectomies

OBJECTIVE: This study compared the acute tissue damage produced by a CO2 laser and microelectrodes in samples of vocal cords from patients undergoing laryngeal endoscopic surgery for stage T1 squamous cell carcinoma. STUDY DESIGN AND SETTING: Based on prior surgical experience with the CO2 laser and microelectrodes, the study protocol used hematoxylin-eosin staining of vocal cords treated with a CO2 laser (n=20) or microelectrode (n=20). RESULTS AND CONCLUSION: The acute tissue damage produced by the CO2 laser was similar to that induced by microelectrodes in cutting mode. The tissue damage resulting from the use of the microelectrode in coagulation mode was comparatively greater.     

High frequency ventilation. Study of the mechanisms of action

Dried lungs and isolated bronchial trees dissected from large animals were submitted to high-frequency oscillation and jet-ventilation. The pattern of intrapulmonary pressure distribution and CO2 diffusion were measured through transalveolar chambers fixed to the perforated pleural surfaces and through airbags pasted on the isolated bronchial trees. Under oscillating conditions, the pressure profiles in different lung and bronchial compartments were inhomogeneous and frequency dependent; the pressure-wave amplitude was proportional to the oscillation frequency. On the other hand, the inhomogeneities found with jet-ventilation were mostly dependent on the airflow direction and position of the intratracheal cannula. Since these inhomogeneities were similar on dissected lungs as well as on isolated bronchial trees, it was concluded that they were essentially dependent on endobronchial aerodynamic effects. But the absence of the in vivo pulmonary and bronchial elastic recoil certainly modified the effects of these ventilation modes with respect to accepted clinical findings. Also results were shown to vary between individuals and within individuals, probably explaining the divergent results obtained by different authors.     

Effects of CO2 laser beam on cortical bone

Sixteen bone blocks from two freshly amputated legs were used to study the effect of CO2 laser on cortical bone. They were divided into two groups. In Group I, the blocks were treated with CO2 laser using 1 mm spot (focused mode). In Group II, they were treated with CO2 laser using 3 mm spot (defocused mode). Two other variables were investigated: the power and time of exposure. Three histologic zones were observed: a superficial zone with black particle deposits (carbonization), an intermediate zone with fibrillations and enlarged empty lacunae, and a deep zone with normal appearing bone. The bony changes in the first two zones combined were superficial in all specimens and did not exceed 200 microns. Increased energy, a focused beam, and time of exposure were all associated with increased matrix changes. CO2 laser can be applied to cortical bone in vitro with minimal residual thermal damage.