Clinical Course of Patients With Worsening Heart Failure With Reduced Ejection Fraction

Background

Epidemiology of patients with worsening heart failure and reduced ejection fraction (HFrEF) in the real-world setting is not well described.

不同剂量舒芬太尼在腹部术后镇痛中的应用

目的探究不同剂量舒芬太尼在腹部手术术后静脉镇痛中的应用。方法择取2018年6月-2019年2月期间本院收治的92例腹部手术患者,随机分为对照组与观察组,每组46例。对照组行小剂量舒芬太尼给药,观察组行大剂量舒芬太尼给药,比较两组患者术后不同时间点疼痛视觉模拟评分(VAS)以及不良反应发生率。结果术后8h两组患者VAS评分差异无统计学意义(P> 0.05);术后12 h、术后24 h以及术后48 h观察组患者VAS评分均低于对照组,不良反应发生率6.52%低于对照组23.91%,差异有统计学意义(P <0.05)。结论腹部手术患者术后静脉镇痛使用大剂量舒芬太尼具有更理想的麻醉镇痛效果,且安全性高。     

不同剂量硬膜外分娩镇痛对产后尿潴留的影响

目的探讨不同剂量下罗哌卡因联合舒芬太尼硬膜外分娩镇痛方案安全性和对产后尿潴留的影响。方法选取2018年5月-2019年5月本院妇产科收治的拟行硬膜外分娩镇痛下自然分娩的初产妇80例,随机分为甲方案组和乙方案组,每组40例,甲方案组产妇采取0.1%罗哌卡因+0.3μg/mL舒芬太尼的硬膜外分娩镇痛方案,乙方案组产妇采取0.075%罗哌卡因+0.5μg/mL舒芬太尼的硬膜外分娩镇痛方案,比较两组产妇的视觉模拟评分(VAS)、尿潴留、其他不良反应和新生儿出生后Apgar评分。结果结果显示,两组的镇痛时间差异无统计学意义;与此同时,在子宫颈开口3 cm时(T0)、分娩镇痛后30 min(T1)、宫颈口开口10 cm时(T2)、分娩即刻(T3)和分娩后2 h时(T4)5个时间点的疼痛评分差异均无统计学意义;但麻醉后的其他时间点的疼痛评分与T0比较,均具有统计学意义。甲方案组尿潴留发生率为5.00%,低于乙方案的20.00%,差异具有统计学意义(χ^2=4.114,P=0.043)。两组产妇分娩的新生儿在出生后l min、5 min和10 min时的Apgar评分差异均无统计学意义(P>0.05)。结论两种剂量的分娩镇痛方案均可有效缓解分娩疼痛,但在0.1%罗哌卡因+0.3μg/mL舒芬太尼剂量下产后尿潴留的发生风险更小。     

2015—2017年天津市津南区咸水沽医院解热镇痛抗炎药品的使用情况分析

目的 调查分析2015-2017年天津市津南区咸水沽医院解热镇痛抗炎药品的应用情况及趋势,为科学管理和合理应用提供参考。方法 采用数据回顾性方法,对天津市津南区咸水沽医院解热镇痛抗炎药品的用药金额、用药数量及构成比、限定日计量（DDD）值、用药频度（DDDs）及日均费用（DDC）等数据进行统计与分析。结果 共有28种解热镇痛抗炎药,涵盖口服、注射、外用3种剂型。口服剂型解热镇痛抗炎药的销售金额逐年上升,注射剂型解热镇痛抗炎药的销售金额逐年下降。洛索洛芬钠分散片的销售金额及构成比稳居首位。2015年注射用氯诺昔康的销售金额居第2位,但2016、2017年,注射用精氨酸阿司匹林跃居第2位。氨咖黄敏口服溶液的DDDs稳居首位。牛痘疫苗接种家兔炎症皮肤提取物片的DDC排名第1位,2017年加巴喷丁胶囊的DDC排名跃居第1位。结论 天津市津南区咸水沽医院解热镇痛抗炎药品的管理比较规范,药物使用大致合理。     

Exponential decay for binary time‐varying covariates in Cox models

Cox models are commonly used in the analysis of time to event data. One advantage of Cox models is the ability to include time‐varying covariates, often a binary covariate that codes for the occurrence of an event that affects an individual subject. A common assumption in this case is that the effect of the event on the outcome of interest is constant and permanent for each subject. In this paper, we propose a modification to the Cox model to allow the influence of an event to exponentially decay over time. Methods for generating data using the inverse cumulative density function for the proposed model are developed. Likelihood ratio tests and AIC are investigated as methods for comparing the proposed model to the commonly used permanent exposure model. A simulation study is performed, and 3 different data sets are presented as examples.     

变速牵引提高牵引成骨效率的实验研究

目的:观察变换速度牵引兔下颌骨15mm后新骨生成的质量,探讨提高牵引成骨效率的方法。方法:新西兰白兔5只,单侧下颌骨截开。延迟5d后,以0.75mm/次、2次/d的速率牵引6d,共9mm;再以0.5mm/次、2次/d的速率牵引6d,共6mm;固定15周,新骨分别行大体、放射学和组织学观察。结果:牵引结束后新骨逐渐成熟,到固定15周时,牵引区新骨与正常骨接近。结论:变速牵引成骨能够保证新骨的良好生成,缩短牵引时间,提高应用效率。     

变速牵引成骨对兔下牙槽神经的影响

目的　研究变速牵引兔下颌骨15mm对下牙槽神经的影响。方法　5只新西兰白兔单侧下颌骨截开。延迟5d ,以每天1 5mm ,每天2次牵引9mm ,然后继续以每天1mm ,每天2次牵引6mm ,完成牵引后固定15周,分别行肉眼及组织学观察和电生理学检查。结果　下颌骨延长15mm ,新骨生成良好。下牙槽神经牵长2 1. 99% ,牵引结束时神经变性明显,感觉神经动作电位波幅下降为术前的9. 70 % ,潜伏期较术前有所延长,随后出现恢复趋势,到固定15周时,波幅恢复到术前的33. 85 % ,潜伏期基本恢复正常。结论　下颌骨变速牵引15mm后,下牙槽神经受到明显的影响,到15周时,下牙槽神经的功能有恢复的趋势,但恢复尚不完全。     

Stability criteria for continuous‐time systems with additive time‐varying delays

This paper studies the problem of stability analysis for continuous‐time systems with two additive time‐varying delay components. By taking the independence and the variation of the additive delay components into consideration, more general type of Lyapunov functionals are defined. Together with a tighter estimation of the upper bound of the cross‐product terms derived from the derivatives of the Lyapunov functionals, less conservative delay‐dependent stability criteria are established in terms of LMIs. Combining with a reciprocally convex combination technique, the newly obtained stability conditions are also less complex. Two numerical examples are given to illustrate the effectiveness and the significant improvement of the proposed method. Copyright © 2013 John Wiley & Sons, Ltd.     

53例糖尿病酮症酸中毒临床分析

目的：探讨糖尿病酮症酸中毒的临床特点,总结治疗经验,提高诊疗水平,降低死亡率。方法回顾性分析我院2008年1月～2013年12月收治的53例糖尿病酮症酸中毒患者的临床资料。本组53例均采用小剂量胰岛素静脉泵入及补液、补钾、抗感染等综合治疗。结果治愈及好转出院48例,未愈5例,其中死亡2例。结论DKA临床表现复杂多样,积极寻找病因,早发现、早治疗,预后良好;一旦确诊,积极补液改善循环,小剂量胰岛素,适当补钾及去除诱因等综合治疗是抢救成功的关键。     

Improved delay‐partitioning approach to robust stability analysis for discrete‐time systems with time‐varying delays and randomly occurring parameter uncertainties

This paper is concerned with the robust stability problem for uncertain discrete‐time systems with interval time‐varying delays and randomly occurring parameter uncertainties. By construction of a suitable Lyapunov–Krasovskii functional and utilization of new zero equalities with delay‐partitioning approach, improved delay‐dependent criteria for the robust stability of the systems are derived in terms of linear matrix inequalities for guaranteeing the asymptotic stability of the concerned systems. The effectiveness and reduction of conservatism of the derived results are demonstrated by three numerical examples. Copyright © 2014 John Wiley & Sons, Ltd.