目的:研究低氧性肺動脈高壓大鼠對實驗性紅細胞增多的適應。方法:健康SD大鼠28只,體重200～250 g,隨機分為4組:常氧對照組（N）、單純低氧組（H）、低氧+低劑量人重組促紅細胞生成素（rEPO） 600 u/kg（H+E1）組、低氧+高劑量rEPO 1200 u/kg（H+E2）組,每組7只大鼠。除常氧對照組外各低氧組大鼠均缺氧21 d,每日8 h。其中后兩組每周腹部皮下注射不同劑量的rEPO三次。取血樣測定紅細胞數、全血粘度及紅細胞變形指數；頸外靜脈插管測定平均肺動脈壓力；光鏡觀察反映肺動脈重構程度的形態學參數肺小動脈管壁厚度百分比、肺非肌性小動脈肌化程度。結果:①隨著rEPO注射劑量的增加,紅細胞、全血粘度有不同程度的增高；②全血粘度增高的同時紅細胞變形指數也相應地增加；③隨著rEPO劑量的增加,平均肺動脈壓力逐漸增高,但是肺血管重構程度反而有所緩解。結論:實驗性紅細胞增多通過改變紅細胞變形性和緩解肺血管重構程度來阻遏低氧性肺動脈高壓的進一步發展。
Objective To investigate the safety of thoracic surgery for high-altitude patients in local medical center. MethodsWe retrospectively collected 258 high-altitude patients who received thoracic surgery in West China Hospital, Sichuan University (plain medical center, 54 patients) and People's Hospital of Ganzi Tibetan Autonomous Prefecture (high-altitude medical center, 204 patients) from January 2013 to July 2019. There were 175 males and 83 females with an average age of 43.0±16.8 years. Perioperative indicators, postoperative complications and related risk factors of patients were analyzed. ResultsThe rate of minimally invasive surgery in the high-altitude medical center was statistically lower than that in the plain medical center (11.8% vs. 55.6%, P<0.001). The surgical proportions of tuberculous empyema (41.2% vs. 1.9%, P<0.001) and pulmonary hydatid (15.2% vs. 0.0%, P=0.002) in the high-altitude medical center were statistically higher than those in the plain medical center. There was no statistical difference in perioperative mortality (0.5% vs. 1.9%, P=0.379) or complication rate within 30 days after operation (7.4% vs. 11.1%, P=0.402) between the high-altitude center and the plain medical center. Univariate and multivariate analyses showed that body mass index≥25 kg/m2 (OR=8.647, P<0.001) and esophageal rupture/perforation were independent risk factors for the occurrence of postoperative complications (OR=15.720, P<0.001). ConclusionThoracic surgery in the high-altitude medical center is safe and feasible.
ObjectiveTo discuss the treatment and nursing care for Daocheng tourists with acute altitude sickness, and analyze its related factors. MethodsFrom April to September 2012, 236 Daocheng tourists with acute altitude sickness were given drugs in time, and underwent oxygen inspiration. On the basis of observing the disease, nurses also provided care and health education to the patients. ResultsBy guiding patients' psychology, diet, oxygen uptake, medication and health related education, we cured 234 patients, and the rest 2 with high altitude cerebral edema were cured after being transferred to low-lying areas. ConclusionTourists from low-lying areas are vulnerable to altitude sickness when touring high lands. Preventive medicine before entering highland areas, more rest and less exercise are important factors to prevent the occurrence of altitude sickness. Health education from nursing care providers can effectively guarantee the safety of tourists entering plateau.
【摘要】 目的 探討高原地區腹腔鏡膽囊切除術（laparoscopic cholecystectomy，LC）患者的特點，以便更好地進行圍手術期處理。 方法 對2009年2月-2010年5月收治的長期生活在西藏高原地區的患者（高原組）367例和非高原地區患者（非高原地區組）167例的一般資料、術前診斷、合并癥情況進行回顧性分析，兩組患者性別、年齡及病程比較，差異無統計學意義（Pgt;0.05），有可比性。兩組患者診斷均以膽囊結石為主，其次為膽囊息肉，診斷構成比較，差異無統計學意義（Pgt;0.05）；兩組患者合并癥比較，高原組患者高血壓、冠心病、血紅蛋白增多癥及竇性心動過緩的發生率高于非高原地區組（Plt;0.05）；肺部疾病、肝硬化、糖尿病及腦梗死的發生率兩組患者比較差異無統計學意義（Pgt;0.05）。兩組患者均采用常規LC進行治療，對兩組患者術后臨床結果、并發癥等進行統計學分析。 結果 高原組患者手術中轉開腹率（7.1%）高于非高原地區組（2.4%）患者（Plt;0.05）；高原組患者較非高原地區組患者住院時間長、手術時間長、術中出血量多（Plt;0.05）；術后并發癥比較差異無統計學意義（Pgt;0.05）。 結論 高原地區LC患者宜及時中轉開腹，其圍手術期處理得當將有助于減少術后并發癥的發生。【Abstract】 Objective To explore the characteristics of patients undergoing laparoscopic cholecystectomy in highland area, in order to carry out better perioperative management. Methods We collected and analyzed the general information, preoperative diagnosis and complications of 367 patients living in highland area and 167 patients living in inland between February 2009 and May 2010. There was no significant difference between the two groups in sex, age and course of disease (Pgt;0.05). Cholecystolithiasis was the main disease followed by gallbladder polyps, and there was no difference between them in the kind of diseases (Pgt;0.05). The incidence of hypertension, coronary heart disease, hereditary persistence of fetal hemoglobin and sinus bradycardia was higher in patients in highland area than that in patients in non-highland area (Plt;0.05). There was no significant difference in the incidence of lung disease, liver cirrhosis, diabetes mellitus and cerebral infarction between the two groups (Pgt;0.05). Conventional laparoscopic cholecystectomy was conducted in both two groups. Comparative analysis of treatment outcome and postoperative complications was done. Results The rate of conversion from laparoscopic surgery to laparotomy in Tibetan patients (7.1%) was higher than that in patients in non-highland area (2.4%) (Plt;0.05). Hospitalization time, operation time and blood loss in Tibetan patients were significantly higher than those in patients in non-highland area (Plt;0.05), but there was no significant difference in postoperative complications between the two groups of patients (Pgt;0.05). Conclusions Laparoscopic cholecystectomy for patients in highlardarea should be converted to laparotomy when necessary. Appropriate perioperative management is helpful in reducing the incidence of postoperative complications.
【摘要】 目的 探討高原地區橈神經損傷的治療效果，并總結影響療效的因素。 方法 回顧性分析2005年6月-2010年6月收治的橈神經損傷并有完整隨訪資料的54例患者，其中男40例，女14例；年齡8～69歲，平均32.6歲。開放性損傷5例，閉合性損傷49例；左側26例，右側28例。受傷原因:刀傷5例，醫源性損傷（手術牽拉傷、被鋼板擠壓傷）10例，肱骨干骨折合并橈神經損傷39例。神經損傷類型:橈神經完全斷裂12例；大部分斷裂15例；挫傷27例，挫傷長度1.5~4.5 cm。所有患者均有典型的感覺及運動功能障。采用神經吻合修復27 例，神經松解減壓27例。骨折均用鋼板內固定。 結果 所有患者手術均順利，術后切口均I期愈合，無手術相關并發癥發生。54例均獲隨訪16~24個月，平均18個月。骨折于術后8～14個月達臨床愈合。末次隨訪時根據中華醫學會手外科上肢周圍神經功能評定標準，神經吻合的27例中，獲優14例，良8例，差5例；神經松解減壓術治療的27例均獲優。總優良率為91%。 結論 上臂橈神經損傷宜早期手術修復，神經吻合的療效較神經松解減壓術差。【Abstract】 Objective To explore the therapeutic effect on radial nerve injuries in plateau area, and to analyze the influencing factors. Methods The clinical data of 54 patients with radial nerve injuries who were treated between June 2005 and June 2010 were retrospectively analyzed. The patients included 40 males and 14 females and aged 8-69 years (averaged 32.6 years old). Of these 54 patients, 5 were open injuries, 49 were closed injuries; 26 were on the left side, and 28 were on the right sides. Causes of injuries included: 5 direct cut injuries, 10 iatrogenic injuries (including traction injuries and crush injuries by steel plates), and 39 humeral shaft fracture and radial nerve injuries. Types of nerve injuries included: 12 complete radial neurotmesis, 15 partial radial neurotmesis, and 27 radial contusions (with contusion length ranged 1.5-4.5 cm). All patients had radial nerve injuries experienced significant motor dysfunctions. Among these patients, 27 underwent nerve anastomosis, the remaining 27 were treated by nerve decompression; all fractures were treated with internal fixation with steel plates. Results During the average follow-up of 18 months (16-24 months), all 54 patients completely recovered from radial nerve injuries without any complications. The time for fracture healing ranged 8-14 months. According to the evaluation standards for radial nerve functional recovery, developed by the Chinese Medical Association, among the 27 cases treated by nerve anastomosis, 14 were “optimal”, 8 were “fair”, and 5 were “bad”; and all 27 cases treated by nerve decompression were “optimal”. Conclusion It is suggested to have early surgical treatment for the upper arm radical nerve injuries. The nerve decompression had better curative effects than the nerve anastomosis does.
Objective To analyze the current situation and demand of emergency and critical care training for medical staff in plateau areas, and to provide a reference for further emergency and critical care training for medical staff in plateau areas. Methods From July 1, 2018 to July 30, 2020, medical staff (including physicians, nursing staff, and other medical staff) from hospitals in various regions of Tibet were surveyed anonymously, to investigate the content and demand of medical staff in plateau areas receiving emergency and critical care training. The content and demand of medical staff from different levels of hospitals receiving emergency and critical care training were further compared. Results A total of 45 questionnaires were distributed in this study, and a total of 43 valid questionnaires were collected, with an effective response rate of 95.6%. The average age of medical staff was (35.67±9.17) years old, with a male to female ratio of 1∶1.5. The proportion of tertiary, secondary, and lower level hospitals to which medical staff belong were 23.3%, 27.9%, and 48.8%, respectively. The number and proportion of medical staff receiving training on chest pain, heart failure, stroke, gastrointestinal bleeding, respiratory failure, metabolic crisis, and sepsis diseases were 25 (58.1%), 25 (58.1%), 24 (55.8%), 23 (53.5%), 20 (46.5%), 14 (32.6%), and 12 (27.9%), respectively. The number and proportion of medical staff who believed that training in the heart failure, respiratory failure, metabolic diseases, stroke, gastrointestinal bleeding, chest pain, and sepsis needed to be strengthened were 38 (88.4%), 36 (83.7%), 35 (81.4%), 34 (79.1%), 34 (79.1%), 33 (76.7%), and 29 (67.4%), respectively. Thirteen medical staff (30.2%) hoped to acquire knowledge and skills through teaching. There were no statistically significant differences in gender, age, job type, professional title, and department type among medical staff from tertiary, secondary, and lower level hospitals participating in the survey (P>0.05). The proportion of medical staff in hospitals below secondary receiving training on chest pain was lower than that in second level hospitals (38.1% vs. 91.7%). The proportion of medical staff in hospitals below secondary receiving training on heart failure was lower than that in secondary and tertiary hospitals (38.1% vs. 75.0% vs. 80.0%). The proportion of medical staff in hospitals below secondary receiving training on respiratory failure was lower than that in tertiary hospitals (28.6% vs. 80.0%). The demand for sepsis training among medical staff in hospitals below secondary was higher than that in tertiary hospitals (85.7% vs. 30.0%). There was no statistically significant difference in the other training contents and demands (P>0.05). Conclusion The content of critical care training for medical staff in plateau areas cannot meet their demands, especially for medical staff in hospitals below secondary. In the future, it is necessary to strengthen training support, allocate advantageous resources to different levels of hospitals, expand the scope of training coverage, and enrich training methods to better improve the ability of medical personnel in plateau areas to diagnose and treat related diseases.
短期進入高原從事高強度工作所致高原反應是值得探討的問題,查閱文獻,探討其病因及發病機理、臨床表現,總結國內外在診斷、預防及治療方面的經驗,探索一套可行、有效的預防及治療措施,具有重要的臨床意義。