声音嘶哑的预防及护理

声音嘶哑（简称声嘶）常见于声带小结、声带息肉。声带小结和声带息肉均属于良性病变，是引起声音嘶哑的最常见原因。声带小结和声带息肉的发生、发展与所伴随的社会压力和心理刺激具有时间或强度的相关性，从身心医学角度重新审视声嘶患者，此病应属于植物神经功能紊乱相关的心身疾病。     

右美托咪啶对原发性高血压病人术后舒芬太尼自控静脉镇痛效果的影响

目的 探讨右美托咪啶对原发性高血压病人术后舒芬太尼自控静脉镇痛效果的影响.方法 择期拟行经腹子宫全切术的原发性高血压病人60例,年龄42～63岁,体重48～72 kG,高血压分级Ⅰ或Ⅱ级,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将病人随机分为3组(n=20):对照组(C组)、不同剂量右美托咪啶组(D1组和D2组).术后24 h内行舒芬太尼PCIA,舒芬太尼100μg+托烷司琼5 mg+生理盐水100ml,背景输注速率2 ml/h,PCIA剂量0.5ml,锁定时间15 min.D1组和D2组在PCIA同时分别以0.2和0.3μg·kg-1·h-1的速率静脉输注右美托咪啶,C组在PCIA同时以0.1 ml·kg-1 的速率静脉输注生理盐水.术后24h内记录总按压次数、舒芬太尼用量和硝苯地平、麻黄碱的使用情况及呼吸抑制和呕吐的发生情况,术后24h时行Ramsay镇静评分.结果 与C组比较,D1组和D2组PCIA总按压次数减少,舒芬太尼用量降低,Ramsay镇静评分升高,硝苯地平使用率、呼吸抑制和呕吐发生率降低,D2组麻黄碱使用率升高(P＜0.05);与D1组比较,D2组PCIA总按压次数减少,舒芬太尼用量降低,Ramsay镇静评分升高,麻黄碱使用率升高(P＜0.05).结论 右美托咪啶不仅可减少原发性高血压病人术后舒芬太尼PCIA的用量,还可预防术后高血压进一步恶化.

Abstract：

Objective To investigate the effect of dexmedetomidine on postoperative patient-controlled intravenous analgesia (PCIA) with sufentanil in patients with essential hypertension. Methods Sixty ASA Ⅱ or Ⅲ patients with essential hypertension aged 42-63 yr weighing 48-72 kg undergoing hysterectomy were randomly divided into 3 groups ( n = 20 each): control group ( group C) and different doses of dexrmedetomidine groups ( group D1.2 ). PCIA was performed with sufentanil 1 μg/ml + tropisetron 5 μg/ml in 100 ml of normal saline within 24 h after operation (background infusion at 2 ml/h with a bolus dose of 0.5 ml and a 15 min lockout interval). Dexmein group C. Ramsay score was recorded. The number of attempts, consumption of sufentanil, the number of patients who needed nifedipine or ephedrine and side effects such as vomiting and respiratory depression were recoded within 24 h after operation. The level of sedation was evaluated with Ramsay sedation score at 24 h after operation.Results Compared with group C, the number of attempts, consumption of sufentanil, the number of patients who needed nifedipine and incidences of vomiting and respiratory depression were significantly decreased, while Ramsay score was significantly increased in D1 and D2 groups, and the number of patients who needed ephedrine was significanlly increased in group D2 ( P ＜ 0.05). The number of attempts and consumption of sufentanil were significantly decreased, and Ramsay score and the number of patients who needed ephedrine were significantly increased in group D2 compared with group D1 ( P ＜ 0.05). Conclusion Dexmedetomidine can not only reduce the consumption of sufentanil for postoperative PCIA, but also prevent postoperative hypertension from deteriorating in patients with essential hypertension.     

冠心病合并不同程度抑郁患者心率变异性分析

目的探讨抑郁对冠心病患者心率变异性(HRV)的影响。方法将临床确诊为冠心病的120例患者应用Zung抑郁自评量表(SDS)评定抑郁状况。抑郁严重度指数<0.5为无抑郁,0.5≤抑郁严重度指数<0.6为轻度抑郁;抑郁严重度指数≥0.6为中重度抑郁,据此分为抑郁组(64例)和非抑郁组(56例),将抑郁组患者再分为轻度抑郁组(40例)和中重度抑郁组(24例)。应用24 h动态心电监测仪记录各组患者的HRV,分析抑郁对冠心病患者HRV时域指标和频域指标的影响。结果冠心病患者合并抑郁组时域指标:指定时间内所有正常窦性R-R间期总体标准差(SDNN)、指定时间内每5 min窦性R-R间期均值标准差(SDANN)、指定时间内每5min窦性R-R间期标准差的均值(SDNNDX)、指定时间内正常连续窦性R-R间期差值均方根(RMSSD)及每两个相邻R-R间期差值>50 ms的个数所占的百分比(PNN50)均显著低于非抑郁组[(83.66±15.71)ms比(111.02±25.56)ms,(77.99±18.46)ms比(89.43±14.12)ms,(45.56±10.72)ms比(53.17±14.71)ms,(37.90±9.28)ms比(44.96±17.92)ms,18.42%±4.68%比23.21%±11.79%,P<0.01或P<0.05];抑郁组频域指标:极低频功率(VLF)及低频功率(LF)显著高于非抑郁组[(160.23±44.27)Hz/ms~2比(141.78±54.19)Hz/ms~2,(353.28±43.41)Hz/ms~2比(292.81±64.63)Hz/ms~2,P<0.01],而高频功率(HF)显著低于非抑郁组(P<0.05)。抑郁严重度指数与SDNN、SDANN、SDNNDX、PNN50均显著负相关(r=-0.536、-0.250、-0.273、-0.185),抑郁严重度指数与LF和LF/HF均呈显著正相关(r=0.207、0.26)。结论合并抑郁的冠心病患者HRV降低,且抑郁程度对HRV具有显著影响。     

手足口病的居家治疗护理指导

目的探讨护理指导在居家治疗手足口病患儿中的应用。方法选择70别手足口病患儿及家属进行护理指导。结果70例患儿均能按时就诊,疗程短,未发生病情加重,均做到有效隔离,控制疫情发展。结论护理指导提高患者及家属的遵医行为,有效控制手足口病的传播,提高治愈率。     

颈动脉斑块的分割和三维图像显示

人体颈动脉和斑块在亮度分布和形态上有一定交叉和重叠，采用普通方式获得的CT或者MRI数据能清晰地反映斑块在颈动脉中的占位在临床上具有重要意义。本研究提出一种新的参数样条定义切割球簇分割得到颈动脉附近体素，并加强颈动脉和斑块的亮度对比和几何尺度放大，以达到与手术解剖颈动脉斑块基本一致的视觉效果。并将该方法与以血管中心线展开拉伸的血管分割方法进行了比较。实验结果表明本文方法可为颈动脉斑块组织分割提供可视的实时显示，可为相关治疗方法和疗效提供视觉分析。