纤维支气管镜支气管肺泡灌洗治疗对ICU机械通气患者呼吸力学和预后的影响研究

目的;探讨应用纤维支气管镜（bronchofibroscope,BFS）行支气管肺泡灌洗（bronchoalveolar Lavage,BAL）治疗呼吸机相关性肺炎（ventilator associated pneunonia,YAP）对患者呼吸力学和预后的影响。方法：应用BFS对综合ICU内92例VAP患者行BAL治疗。监测患者生命体征、动脉血气分析、呼吸力学指标,对灌洗前后各项监测指标及临床情况进行对比分析。于灌洗前、灌洗后第48h、7d拍摄床旁X线胸片,计算X线胸片改善率。记录确诊VAP后MV时间和统计脱机成功率、死亡率。结果：88．04％（81／92）患者灌洗完毕后双肺痰鸣音立即消失,临床上患者气短喘息等症状得到明显缓解：55．43％（51／92）体温逐渐下降,78．26％（72／92）术后24h至48h外周血自细胞下降至正常;48h后X线胸片病灶吸收率57．60％（53／92）。Pa02／FiO2于灌洗后1h就开始改善,并持续升高;同时在灌洗后1h患者气道峰压（PIP）、呼吸功（WOBvent）和吸气阻力（RAW）开始持续降低,肺动态顺应性（Cdyn）开始持续增加（P〈0．05）。灌洗后4h患者PIP、WOBven和RAW较灌洗后1h有显著性差异（P〈0．05）。7d后X线胸片改善率94．57％（87／92）;60．87％（56／92）患者能在5d至7d内脱机;最终成功脱机率85．87％（79／92）;死亡率14．13％（13／92）。结论：对VAP进行BFS行床旁BAL治疗,能有效改善患者呼吸症状,提高机体通气换气功能,提高感染控制效能,缩短VAP脱机时间,降低死亡率,为综合治疗VAP提供了一条有效新途径。     

Highly predictable execution support for critical applications with HARETICK kernel

In this paper, the problem of providing a fully predictable execution environment for critical and hard real-time applications on embedded and DSP-based platforms is studied from the viewpoint of system architecture and operation.We introduce a set of homogenous models for time, signals and tasks, which will further serve as a basis for describing the architecture and operation of a particular hard real-time kernel – “HARETICK”. The kernel provides support for concurrent operation of hard real-time tasks (the HRT execution environment), using non-preemptive scheduling algorithms, along with soft real-time tasks (the SRT environment), using classical, preemptive, priority-based scheduling algorithms.A set of applications has been developed to test the correct operation of the HARETICK kernel according to the theoretical models and to evaluate its abilities to provide high predictability of execution for critical applications. Some of the main testing results are also discussed in the paper.     

X射线聚焦望远镜的支撑结构设计与力学实验分析

掠入射X射线聚焦望远镜的支撑框架结构设计是望远镜研制的关键技术之一。国内规划中的XTP卫星低能聚焦望远镜拟采用基于超薄玻璃的X射线聚焦望远镜方案,针对望远镜样机严苛的光学和力学性能要求,经过结构选型优化,设计了一种一体化的六边形桶式望远镜支撑结构。利用有限元软件对支撑结构进行了模态分析和频率响应分析,并与力学实验进行了对比验证。结果表明,该支撑结构具有较大的结构刚度,望远镜结构在发射环境下不会发生破坏性改变,满足力学性能要求。该支撑框架结构简洁、装配精度高,具有良好的工艺性,为望远镜的研制提供了参考。     

胸腺五肽对产科危重症患者免疫调理治疗的随机对照研究

目的：研究产科危重病人CD3^＋、CD4^＋,CD8^＋、NK细胞记数、CD4^＋／CD8^＋、α白细胞介紊-6（IL-6）和肿瘤坏死因子α（TNF—α）的变化,探讨胸腺五肽（Thymopentin,TP-5）对产科重症病人的免疫调理作用。方法．2005年1月至2007年12月71例收住重庆医科大学附属第一医院中心ICU的产科重症病人随机分为对照组和治疗组,两组分别于治疗后1、5、10d检测CD3^＋、CD4^＋、CD8^＋和NK细胞数;于治疗前和治疗后1、5d测定病人血清IL-6和TNF—α的动态变化。结果：TP-5免疫调理治疗后两组病人T淋巴细胞总数和亚群在第5d开始有显著性差异,治疗组CD8^＋低于对照组,CD4^＋、NK细胞和CD4^＋／CD8^＋比值高于对照组（P〈0．05）。第10d治疗组CD3^＋、CD4^＋、NK细胞和CD4^＋／CD8^＋比值高于对照组,CD8^＋细胞低于对照组（P〈0．05）。治疗组血清IL-6在第5d下降（P〈0．05）。TNF—α在第1d开始低于对照组（P〈0．03）,下降在第5d显著下降（P〈0．05）。结论：TP-5能明显调节产科危重病人免疫功能,使之趋于平衡,并最终获得改善预后的效果。且副反应少,可作为良好免疫调节剂用于产科危重病人综合治疗。     

舒芬太尼和芬太尼分别联合咪唑安定对烧伤植皮术后的镇痛镇静疗效及其对多器官功能的影响

目的：比较舒芬太尼和芬太尼分别联合咪唑安定对烧伤植皮术后患者镇痛镇静的临床疗效及其对多器官功能的影响。方法：将60例烧伤植皮术后患者随机分入舒芬太尼联合咪唑安定组和芬太尼联合咪唑安定组。两组患者均分别采用舒芬太尼和芬太尼联合咪唑安定进行术后镇静镇痛治疗。比较两种治疗方案的镇静镇痛临床疗效、不良反应和对患者肝肾功能、心功能和呼吸功能变化。结果镇痛治疗后6h和12h时,舒芬太尼组的VAS评分显著低于芬太尼组;其中12h时,舒芬太尼组的RSS分值亦显著低于芬太尼组,差异均具有统计学意义（P〈0．05）。且芬太尼组出现恶心、呕吐和嗜睡的发生率明显高于舒芬太尼组（P〈0．05）。此外,两组患者的心、肝、肺功能指标比较无明显差异（P〉0．05）,而舒芬太尼联合咪唑安定对于改善肾功能相关指标的效果则优于芬太尼（P〈0．05）。结论舒芬太尼联合咪唑安定方案对烧伤植皮术后患者进行镇静镇痛的临床疗效和肾功能恢复方面由于芬太尼联合咪唑安定方案。     

物理因子在老年骨性关节炎中的临床应用及研究

目的：本研究旨在探讨物理因子在老年骨性关节炎（OA）中的综合效应,解除患者痛苦。方法：近5年来我们采用单物理因子或2种、2种以上物理因子治疗大量的老年0A患者,现对其理疗诊治记录进行回顾性总结,对其症状、体征及结果：进行列表统计分析。结果：7100例;老年OA患者,选择单物理因子治疗3540例,总治愈、显效率达66．88％;选择多物理因子联合治疗3560例,总治愈、显效率达92.52％。结论：物理因子联合应用治疗老年OA,疗效显著。     

The installation and support of internationally distributed equipment for people with dementia

This paper describes the evaluation and support of assistive technology designed to increase the independence of people with dementia. Devices were evaluated by people with dementia in their own homes. Working with and supporting people with dementia requires relational skills not normally needed by installers and technical supporters.     

Design and application of a generic clinical decision support system for multiscale data

Medical research and clinical practice are currently being redefined by the constantly increasing amounts of multiscale patient data. New methods are needed to translate them into knowledge that is applicable in healthcare. Multiscale modeling has emerged as a way to describe systems that are the source of experimental data. Usually, a multiscale model is built by combining distinct models of several scales, integrating, e.g., genetic, molecular, structural, and neuropsychological models into a composite representation. We present a novel generic clinical decision support system, which models a patient's disease state statistically from heterogeneous multiscale data. Its goal is to aid in diagnostic work by analyzing all available patient data and highlighting the relevant information to the clinician. The system is evaluated by applying it to several medical datasets and demonstrated by implementing a novel clinical decision support tool for early prediction of Alzheimer's disease.     

延伸护理对脑卒中吞咽障碍患者康复的影响

目的:观察延伸护理对脑卒中吞咽障碍患者吞咽功能恢复的影响.方法:对100例脑卒中吞咽障碍患者,随机分为实验组和对照组,各50例.两组住院期间均接受分级吞咽功能训练.出院后,对照组按常规定期复查,实验组由责任护士定期复诊指导和电话随访的形式进行延伸护理.比较延伸护理前后两组患者吞咽能力改善状况.结果;经护理干预,两组患者吞咽能力均有改善,但实验组患者的指标明显优于对照组,差异有统计学意义(P＜0.01).结论:延伸护理可促进脑卒中吞咽障碍患者出院后吞咽能力的改善,提高其吞咽功能.     

局部糖皮质激素联合氦氖激光对急性化脓性中耳炎的疗效观察

目的:观察局部糖皮质激素联合氦氖激光治疗急性化脓性中耳炎的临床疗效。方法:将临床确诊的81例(81耳)急性化脓性中耳炎患者随机分成实验组和对照组。其中,实验组(40例)在给予左氧氟沙星滴耳液5ml+与布地奈德混悬液2ml混合均匀后滴耳的同时配合氦氖激光局部照射及全身抗生素治疗;对照组(41例)则仅给予左氧氟沙星滴耳液滴耳并联合氦氖激光局部照射及全身抗生素(同实验组)治疗。10日为一疗程,观察两组疗效。结果:1、实验组总有效率为95%,对照组总有效率为82.8%,两组间有统计学意义。2、两组治愈时间分别是7.6±1.5天和10.6±1.6天,经统计学分析,两组间有统计学意义(P0.05)。结论:局部糖皮质激素联合氦氖激光治疗急性化脓性中耳炎较常规治疗方法有更好的疗效,且可明显缩短病程。该治疗方法简单可行,疗效高,值得推广和应用。