舒芬太尼联合右美托咪定对腹腔镜手术患者术后镇痛效果的观察

目的 探讨舒芬太尼联合右美托咪定对腹腔镜手术术后的镇痛效果及不良反应的影响.方法 将本院各科室2014年2月-2014年7月行腹腔镜手术的患者180例随机分成两组:舒芬太尼单独用药的对照组和舒芬太尼联合右美托咪定用药的试验组.每组患者90例.采用术后患者的视觉模拟疼痛评分、Rasmay镇静评分对两组患者术后6、12、24、48 h的镇痛效果进行评估,同时观察记录两组患者的不良反应以评价不同镇痛方法的安全性.结果 两组患者术后镇痛效果的比较发现术后6、12、24、48h试验组组的VAS评分均低于对照组的VAS评分,差异具有统计学意义(P＜0.05),试验组各时点的Ramsay评分均高于对照组的Ramsay评分,差异具有统计学意义(P＜0.05).两组患者术后均有心动过缓、恶心、呕吐和皮肤瘙痒等不良反应发生,但相比尚无统计学意义.结论 舒芬太尼联合右美托咪定对腹腔镜手术后患者具有较好的镇痛镇静作用,值得临床推广应用.     

右美托咪定联合舒芬太尼在肛肠手术术后镇痛中的应用

目的:分析和研究右美托咪定联合舒芬太尼在肛肠手术术后自控镇痛中的应用效果。方法:选取我院在2016年1月—6月的80例混合痔手术患者,术中行单次腰麻,术后采用患者自控静脉镇痛(PCIA),随机分为舒芬太尼组(C组)即参照组和右美托咪定联合舒芬太尼组(D组)即研究组,各40例,观察和比较两组患者采用PCIA后6h、8h、12h、24h、48h的舒芬太尼消耗量、VAS评分、不良反应的情况,以及患者满意度。结果:腰麻消退后,D组对舒芬太尼的消耗量低于C组,镇痛效果也优于C组,P0.05,差异有统计学意义;两组均未发生呼吸抑制,D组恶心呕吐的发生较C组明显减少,P0.05,差异有统计学意义。结论:在肛肠手术术后自控镇痛中联合应用右美托咪定和舒芬太尼,镇痛效果较好,舒芬太尼用量减少,能降低恶心呕吐的发生率,提高患者满意度。     

舒芬太尼联合右美托咪啶用于子宫切除术后静脉自控镇痛的临床观察

目的观察盐酸右美托咪定联合舒芬太尼在开腹子宫全切术后患者静脉自控镇痛中的镇痛效果。方法 40例择期在腰硬联合麻醉下行腹式子宫全切手术患者随机分为两组:舒芬太尼组(SF组)和舒芬太尼+盐酸右美托咪啶组(SD组)。SF组镇痛方法为舒芬太尼2.5μg/kg生理盐水稀释至100 m L,SD组为盐酸右美托咪啶1.5μg/kg+舒芬太尼2.5μg/kg,生理盐水稀释至100 m L,两组患者手术结束后行静脉自控镇痛48 h。分别记录镇痛2 h、4 h、8 h、24 h患者的镇痛VAS评分和镇静Ramsay评分;记录镇痛后24 h PCA有效按压次数和舒芬太尼总用量并记录不良反应。结果与SF组相比,SD组在镇痛后4 h、8 h VAS评分降低,两组比较有显著性差异(P<0.05),SF组PCA有效按压次数与舒芬太尼总用量明显增多(P<0.05),两组各时段Ramsay评分无明显差异;SF组术后的恶心、呕吐等不良反应的发生率高。结论舒芬太尼联合盐酸右美托咪啶术后镇痛可明显提高静脉自控镇痛效果,减少镇痛期间不良反应,增加患者术后镇痛舒适度。     

右美托咪定联合舒芬太尼术前镇痛对腹腔镜手术患者应激反应影响

目的有效的术前镇痛有利于缓解患者术后疼痛,减轻术后应激反应。本研究观察腹腔镜手术患者应用右美托咪定联合舒芬太尼术前镇痛的效果。方法选取2016-01-03-12-03光山县中医院收治的行腹腔镜手术患者88例作为研究对象,根据术前镇痛方式的不同将患者分为对照组和观察组,各44例。对照组给予舒芬太尼行术前镇痛,观察组给予右美托咪定联合舒芬太尼行术前镇痛。比较两组镇痛效果及手术前后应激反应的变化情况。结果两组术前醛固酮(aldosterone,ALD)、皮质醇(cortisol,Cor)以及促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)水平对比,差异无统计学意义,均P0.05;观察组和对照组术后ALD分别为(121.52±10.28)和(151.25±12.41)pg/mL,t=12.238,P0.001;Cor分别为(208.69±18.58)和(232.36±22.52)ng/mL,t=5.378,P0.001;ACTH分别为(19.25±1.34)和(25.41±2.01)ng/L,t=16.915,P0.001,差异均有统计学意义。术后1h,两组VAS评分比较差异无统计学意义,P0.05。术后24h,观察组VAS评分为(0.62±0.41)分,低于对照组的(1.33±0.67)分,差异有统计学意义,t=5.996,P0.05。结论腹腔镜手术患者应用右美托咪定联合舒芬太尼术前镇痛效果理想,利于减轻患者术后应激反应,缓解疼痛。     

右美托咪定复合舒芬太尼对妇科恶性肿瘤患者术后镇痛及细胞免疫功能的影响

目的探讨右美托咪定复合舒芬太尼对妇科恶性肿瘤患者术后镇痛及细胞免疫功能的影响。方法选取2015年12月-2018年6月在本院行手术治疗的162例妇科恶性肿瘤患者,其中对照组(81例)给予舒芬太尼,观察组(81例)给予右美托咪定复合舒芬太尼。比较2组患者视觉模拟评分(VAS)、Ramsay评分、细胞免疫功能指标及不良反应的发生情况。结果观察组术后4 h、8 h、24 h及48 h的VAS评分均低于对照组,而各时间点的Ramsay评分均高于对照组(P0.05)。观察组术后24 h、48 h的CD3~+和CD4~+T淋巴细胞、CD4~+/CD8~+比值以及NK细胞水平均高于对照组(P0.05)。2组患者术后48 h内呼吸抑制、心动过缓的发生率差异无统计学意义(P0.05),但观察组术后48 h内寒战、恶心呕吐和不良反应总发生率均低于对照组,上述差异均有统计学意义(P0.05)。结论妇科恶性肿瘤患者术后应用右美托咪定复合舒芬太尼具有良好的镇痛镇静效果,可促进患者术后免疫功能恢复。     

右美托咪定对瑞芬太尼复合全麻术后舒芬太尼自控镇痛效果的影响

目的评价右美托咪定对瑞芬太尼复合麻醉患者术后舒芬太尼静脉自控镇痛效果的影响。方法择期行腹腔镜肠癌切除术成年患者60例,随机分为右美托咪啶组(D组)和对照组(C组),各30例。D组诱导前静脉予右美托咪定负荷量1μg/kg,并以0.3μg/(kg·h)维持至术毕,C组为空白对照组。两组术后接镇痛泵,行舒芬太尼PCIA。记录患者定向力恢复时(Ta)、接泵后1 h(Tb)、3 h(Tc)、6 h(Td)、12 h(Te)、24 h(Tf)的VAS和BCS评分;记录术后24 h的PCA总按压次数及舒芬太尼总用量;记录术后恶心、呕吐、寒颤、呼吸抑制的发生情况。结果Ta、Tb时,D组患者VAS评分低于C组(p<0.05),D组BCS评分高于C组(p<0.05);D组术后24 h舒芬太尼用量和PCA按压次数少于C组(p<0.05);D组恶心、呕吐、寒颤的发生率少于C组(p<0.05)。结论右美托咪定1 ug/kg负荷剂量麻醉前给予和0.3 ug/(kg·h)持续维持,能减轻患者瑞芬太尼麻醉苏醒后早期的术后疼痛,减少术后自控镇痛舒芬太尼用量及术后恶心、呕吐、寒颤等不良反应的发生。     

右美托咪定联合舒芬太尼对剖宫产术后镇痛效果影响

目的观察右美托咪定辅助舒芬太尼应用于剖宫产手术术后镇痛的效果。方法选择ASAⅠ或Ⅱ级择期剖宫产手术患者90例,随机均分为三组:Ⅰ组术后镇痛给予舒芬太尼1.5μg·kg-1,Ⅱ组舒芬太尼1.0μg·kg-1,Ⅲ组舒芬太尼1.0μg·kg-1+右美托咪定1.0μg·kg-1。术毕均给予负荷剂量3 m L,镇痛泵设置为2 m L/h,锁定时间间隔15 min,单次负荷剂量2 m L。采用BCS评价疼痛程度,Ramsay评分评估镇静程度,记录三组术毕(T1)及术后6 h(T2)、12 h(T3)、24 h(T4)与48 h(T5)的疼痛程度和镇静评分,记录各时间段自控镇痛有效按压次数,记录不良反应发生率以及MAP、HR、Sp O2。结果 T2~T5时Ⅲ组BCS评分显著高于Ⅰ、Ⅱ组(P<0.05);Ⅱ组自控有效按压次数明显多于Ⅰ、Ⅲ组(P<0.05)。Ⅰ组恶心、呕吐、皮肤瘙痒发生率高于Ⅱ、Ⅲ组(P<0.05)。Ⅲ组HR显低于Ⅰ、Ⅱ组(P<0.05),Ramsay评分明显高于Ⅰ、Ⅱ组(P<0.05)。结论右美托咪定用于剖宫产手术术后镇痛可减少舒芬太尼用量,提高舒适度,同时降低恶心、呕吐、皮肤瘙痒的发生率,但心动过缓发生率增高。     

右美托咪定联合瑞芬太尼辅助颈丛阻滞甲状腺手术的临床观察

目的:观察右美托咪定联合瑞芬太尼辅助颈丛阻滞甲状腺手术中应用的效果。方法:ASAⅠ-Ⅱ级甲状腺次切除术的患者66例,随机分为对照组(瑞芬太尼组,n=32)和实验组(右美托咪定联合瑞芬太尼组,n=34)。分别观察两组患者麻醉手术前后BP、HR、SPO2的变化,观察术中镇静和镇痛评分并进行比较。结果:患者术中合作度评级试验组明显优于对照组(P<0.05)。结论:右美托咪定联合瑞芬太尼用于甲状腺手术镇静、镇痛效果明显,安全有效,值得临床广泛应用。     

右美托咪定联合舒芬太尼静脉自控镇痛分娩效果

目的:评价右美托咪定复合舒芬太尼静脉自控镇痛(PCA)用于分娩效果。方法:选择2017年3月—2017年12月本院分娩产妇122例,按照用药方案不同分为观察组与对照组各61例,均应用静脉PCA技术,对照组仅给予舒芬太尼,观察组在对照组基础上复合右美托咪定,比较两组舒芬太尼用量、PCA键按压次数、血流动力学变化、疼痛视觉模拟评分(VAS)、Ramsay镇静评分(RSS)以及不良反应。结果:观察组舒芬太尼用量(78.5±8.2 ml)及PCA键按压次数(19.0±2.6次)低于对照组(121.4±14.1 ml、27.4±4.2次)(均P0.05);两组平均动脉压(MAP)与血氧饱和度(SpO2)比较无差异(P0.05);术后6h、12h、24h时观察组VAS评分低于对照组,RSS评分高于对照组(均P0.05);观察组总不良反应发生率(9.8%)低于对照组(31.2%),总满意度(95.1%)高于对照组(80.3%)(均P0.05)。结论:右美托咪定联合舒芬太尼用于静脉PCA分娩镇痛,可明显降低舒芬太尼用量,提高镇痛镇静效果,不良反应较少,满意度较高。     

卵巢癌手术后右美托咪定复合舒芬太尼术镇痛对患者睡眠及血清BDNF水平影响

目的:分析右美托咪定复合舒芬太尼术后镇痛对卵巢癌手术患者睡眠质量及血清脑源性神经营养因子(BDNF)水平的影响。方法:将2015年5月-2018年9月本院择期行卵巢癌根治术患者95例随机分为观察组48例和对照组47例。两组术中麻醉方式相同,术后镇痛观察组采用舒芬太尼+托烷司琼+右美托咪定,对照组采用舒芬太尼+托烷司琼。视觉模拟评分法(VAS)和RSS镇静评分评估患者术后疼痛和镇静效果,于术前晚(T1)、术后当晚(T2)和术后第2晚(T3)监测患者睡眠情况,酶联免疫法检测患者术前及术后血清BDNF水平,记录术后24h舒芬太尼累计消耗量及不良反应。结果:术后6h、12h、24h、48h VAS评分观察组均低于对照组,术后1h、6h RSS评分观察组低于对照组(均P0.05),术后12h、24h、48h RSS评分两组无差异(P0.05);与T1时比较,T2和T3时两组入睡时间均延长,睡眠效率下降,自主睡眠质量评分降低,且观察组入睡时间短于对照组,睡眠效率高于对照组,自主睡眠质量评分高于对照组(均P0.05);与术前比较,两组术后12h、48h、72h血清BDNF水平均降低,且观察组低于对照组(均P0.05);血清BDNF水平与患者自主睡眠质量评分呈负相关关系(r=-0.582,P=0.037);术后24h舒芬太尼累计消耗量和不良反应发生率观察组均低于对照组(P0.05)。结论:右美托咪定复合舒芬太尼术后镇痛可更有效改善卵巢癌患者术后睡眠质量,降低血清BDNF水平,睡眠质量改善作用优于单纯应用舒芬太尼。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.