篇一：术前血液稀释的研究进展
术前血液稀释的研究进展
李 莉 张 卫 艾艳秋
郑州大学第一附属医院麻醉科，450052
术前血液稀释（HD）是血液保护的主要方法之一，HD有三种形式：①急性等容量血液稀释（ANH）；②急性高容量血液稀释（AHH）；③ 急性非等容量血液稀释（ANIH）。有关术前血液稀释方法的应用已有大量的临床研究和报道，本文就其新的研究进展和应用分述如下。
1． 急性等容量血液稀释
ANH是在麻醉诱导后手术前或体外循环前采集病人血液600～800ml，同时补充适量的晶体液和胶体液以保持病人总的血容量基本不变，之后再根据术中失血情况将采集的血液回输给病人。ANH的稀释程度一般以大血管内HCT来表示，HCT在0.45~0.3为轻度稀释，0.3~0.2为中度稀释，0.2~0.1为重度稀释。HCT究竟稀释到何种程度才不危及组织氧合，曾是研究争议的问题之一。临床应用中血液稀释界值是HCT20％，HB6～7g.dl－1，一般将HCT控制在25％～30％之间，即中度血液稀释。
合并冠心病曾被认为是实施ANH的相对禁忌症，Licker等[1，2] 在连续食道超声心动图监测下对合并冠心病的病人行ANH，结果发现麻醉后实施中度ANH（HCT 28％,HB 8.6 g.dl－1左右）并不削弱冠心病病人左心室的收缩和舒张功能，冠心病病人可良好的耐受，为ANH用于冠心病病人提供了参考。ANH用于何种情况其节约用血的作用才能有效地发挥一直是临床探讨的热点， 一项针对根治性前列腺切除病人的回顾性研究表明通过数学模型计算，术中异源血输入减少与ANH的实施无关，且在大出血情况下ANH节约用血的作用有限，建议重新考虑ANH的适应症以提高其效能[3]。然而多项研究表明ANH可减少术中异源血输入[4，5]，关于ANH的有效性尚需进一步研究。
2． 急性高容量血液稀释
ANH需要放血储血，实施过程较为复杂、费时，且可能增加血液污染的机会[6]，国外有学者提出了AHH技术，即术前不采集自体血，仅快速输注一定量的胶体或（和）晶体液，使循环血容量超过正常生理水平，术中的出血量以等量胶体液补充，而尿液及术野蒸发的水分以等量晶体液来补充。与ANH相比，AHH操作简便、省时，而且由于术前不放血，不降低机体的最大输氧能力，机体对血氧含量减少的代偿能力比ANH好。
为避免实施AHH时一过性的循环超负荷，临床上采用的方法有：麻醉诱导后实施，全麻复合硬膜外麻醉，AHH与控制性降压联合应用等。而老年患者由于心血管系统多存在结构与功能的衰老性减退,能否耐受血液稀释及其引起的血流动力学变化的顾虑,一度限制了AHH在老年患者的应用。随着AHH临床研究的深入, 在老年人行AHH方面积累了一定的经验，王婷[7]等用6%HES按15ml/Kg对老年择期肝脏手术患者行AHH,并与青年扩容组比较,发现两组SV,CO,SVR及CVP变化幅度无显著差异,且反映心肌收缩力的指标血流加速度(ACC)在AHH后亦无明显变化，认为年龄并不是影响AHH实施的因素,与Van Daele[8]等的结论一致。
3．急性非等容血液稀释
由于ANH操作不便、费用高，AHH扩容能力有限的缺点，上世纪九十年代末，有学者提出了急性非等容量血液稀释的概念。即术前采血，采血后快速补充2～2.5倍于采血量的等效胶体或（和）晶体液，以扩充血容量，降低HCT，术中根据失血情况将采集的血液回输给病人。Habler等[9]对124例预计失血较多的口腔颌面科手术病人实施ANIH，于全麻诱导后采血900ml，同时输入6% HES 130/0.4 500ml和晶体1500ml，术中达输血指征时先回输自体血，必要时输入异体血，发现可使89％的病人完全避免输注异体血，认为该方法安全实用，经济。
目前有关ANIH的基础及临床研究尚不多,有关它的安全性及患者能否耐受，其对机体重要器官的影响及节约用血的有效性等问题尚需进一步研究。实施ANIH注意事项：①选择合适病人：ASA为Ⅰ～Ⅱ级，无明显心、肺、肾及凝血功能障碍，且术前HCT>35％；②麻醉深、浅适宜并持续高浓度（40％）氧通气，术后将HCT提升至30％左右，避免组织器官缺氧；③实施时补液速度不宜过快（一般<50ml/min），以免短时间内循环负荷过重而引起心、肺功能紊乱。④术中密切监测循环功能和出入液量；⑤对术前有低血容量、贫血（HB<100g/L）、凝血功能异常、心肺功能障碍及微血管病的病人不宜行ANIH。
4． 血液保护措施在小儿的应用
尽管各种血液保护措施在成人的应用已经较为成熟，但是却不能照搬到小儿中，因为小儿实施血液稀释技术上难度比成人大，另外小儿对氧输送削弱的生理代偿能力有限。大多数节约用血技术对1岁以内的婴儿仅有有限的益处，不提倡应用。1岁小儿如预计失血量达血容量的20％仍适合采用术中血液回收。术前自体供血因需要小儿和家属的理解和配合且有一定的技术要求，主要用于学龄儿童和青少年。急性等容量血液稀释和控制性降压联合应用仅可用于心血管代偿功能良好的年龄组。为减少小儿术中异体血输入，血液稀释技术可以和其他措施如：术前应用促红细胞生成素、铁离子制剂、术中确切止血等联合应用，以达到血液保护的目的[10]。
总之，血液稀释作为术中节约用血的有效方法之一，虽已清楚了它的基本原理，和血液稀释病人的麻醉原则，但对ANH能否真正减少围术期的异体输血量及AHH在临床中能否取代ANH等问题尚无统一认识，作为新兴的血液保护方法,ANIH还缺乏足够的理论和实践依据,其实施方法、应用价值、对机体功能的影响等方面有待于进一步的基础和临床研究,因此,进一步研究应致力于：① 在临床实践中不断发展和完善血液稀释的理论基础和科学依据。② 对于不同病人选择不同的血液稀释方法及其有效组合。③ 探索和发展更有效、更安全的血液保护方法，以达到更完善节约用血的目的。
篇二：flexible sensor
文献【1】提出了一种用超薄金纳米线制作可穿戴、高灵敏度的压力传感器的方法。印有叉指式电极的和空白的聚二甲基氧硅烷PDMS基板之间夹入超薄金纳米线编制的薄膜，施加压力后，电极和薄膜之间的导电通道增多，引起电阻的变化，施加合适的电压之后，进而引起电流的变化。撤掉压力之后，各参量恢复原状。基于这种原理制作了压力传感器，并对制作的传感器的动态和静态压力响应性能进行了分析。同时制作了传感器阵列，并进行了实际测试。这种传感器可以测量的动态压力范围在13~50000Pa，并且还可以测量弯曲，扭转和声学振动。
【1】A wearable and highly sensitive pressure sensor with ultrathin gold nanowires
Shu Gong，Willem Schwalb，Yongwei Wang，Yi Chen1，Yue Tang，Jye Si，Bijan Shirinzadeh Wenlong Cheng
图1
文献【2】提出了一种新型的有机场效应晶体管压力测量结构。该结构的关键层电介质层是结构规则的可压缩性橡胶薄膜，使得元件具有高度压力敏感性。输出电流和电介质层电容相关性使得这种器件可以测量压力。
【2】Highly sensitive flexible pressure sensors with microstructured rubber dielectric layers
Stefan C. B. Mannsfeld，Benjamin C-K. Tee，Randall M. Stoltenberg，Christopher V. H-H. Chen
Soumendra Barman，Beinn V. O. Muir，Anatoliy N. Sokolov，Colin Reese and Zhenan Bao2834
文献【3】提出了一种利用纳米纤维可逆连锁效应的柔性应变式传感器，可用于压力、剪切力、扭转力的测量。该传感器是高长径比的镀有Pt膜的聚合物纳米纤维互锁阵列夹在两个聚二甲基硅氧烷薄膜之间构成。当被施加不同的感测刺激，互连的程度变换和传感器的电阻发生可逆变化。
【3】A flexible and highly sensitive strain-gauge sensor using reversible interlocking of nanofibres
Changhyun Pang，Gil-Yong Lee，Tae-il Kim，Sang Moon Kim，Hong Nam Kim，Sung-Hoon Ahn
and Kahp-Yang Suh
图3
文献【4】利用碳黑—硅橡胶的压阻效应设计了三维力传感器，利用碳纤维—PDMS的温度敏感效应设计了温度传感器，并把两种传感器制作在一起。分析了工作原理，构建了温度和压力测量的数学模型，并进行了系数标定，误差分析等工作。
【4】用于机器人皮肤的柔性多功能触觉传感器设计与实验黄英，陆伟，赵小文，廉超，葛运建 文献【5】提出了用伸缩性碳纳米管制作的柔性应力检测传感器。
文献【6】将有机晶体管集成到压力敏感橡胶上，制作了柔性压力传感器阵列。
【6】A large-area, flexible pressure sensor matrix with organic field-effect transistors for artificial
skin applications
Takao Someya，Tsuyoshi Sekitani，Shingo Iba，Yusaku Kat，Hiroshi Kawaguchi，and Takayasu Sakurai
文献【7】利用力敏导电橡胶的压阻效应，研究设计了一种新型的三维力检测传感器。首先分析了体压阻效应和界面压阻效应的原理，并探讨了在传感器测量过程中两种压阻效应主导性。利用压阻效应首先设计介绍了单个传感器的检测原理，然后进行了大规模传感阵列的分析。并对制作的传感器进行实际受力进行数学分析，建模，测试，验证评估了设计的传感器的性能。
【7】一种新型机器人三维力柔性触觉传感器的设计黄英，明小慧，向蓓，仇怀利，葛运建
图7
文献【8】介绍了一种基于柔性触觉传感器的接触压力分布采集系统和利用Matlab 进行系统设计的方法。选择力敏导电橡胶作为传感器系统的敏感单元，并采用聚酰亚胺薄膜作为柔性基底来制备8*8 型阵列柔性传感器阵列，通过硬件采样处理，把测得数据上传至计算机上位机软件，并进行数据分析，绘制对应的压力分布图。文章介绍了系统结构，软件部分地设计思想，数据的后期处理思路，并进行了实际应用的测试分析。。
【8】基于Matlab 的接触压力分布测量系统的设计 张武，黄英，曹广辉，赵小文
文献【9】借助MEMS 工艺研发了一种聚酰亚胺基底的Ni 薄膜热敏传感器阵列。该方法利用Ni
材料高电
阻温度系数及聚酰亚胺柔性的特点, 提高了传感器的灵敏度, 并使阵列结构实现了全柔性化。基于金属的电阻温度效应，通过分析比较选择了金属Ni作为传感器敏感材料，利用溅射、光刻、刻蚀等MEMS微加工工艺, 在柔性聚酰亚胺上制备Ni薄膜热敏电阻，并通过实验对制的的器件进行参数的测量标定，以及性能的测试。
【9】基于MEMS 技术的柔性Ni 基热敏传感器阵列研制 徐延光，马炳和，邓进军
文献【10】研制了基于压阻检测技术为基础的三维微力传感器，建立传感器的数学模型并用有限元分析软件对敏感弹性元件进行分析。利用悬臂梁受力弯曲变形的原理结合显微视觉技术, 实现对传感器的标定, 并给出了传感器的信号处理方法。该传感器采用MEMS工艺, 在单晶硅上使用深度反应离子刻蚀( DRIE )技术结合离子注入工艺制作而成，并通过实验证明了该传感器的合理性和有效性。
【10】基于MEMS技术的微操作三维力传感器研究 荣伟彬，王家畴，赵玉龙，陈立国，孙立宁
文献【11】设计了一种基于嵌入式光电元件的柔性剪切应力传感器。其基本设计思想是在PDMS上下两层放置垂直腔面发射激光器(VCSEL)和对应的光电二极管，在PDMS受剪切力发生形变时，光电二极管接收到的功率发生变化，输出电流进而发生变化，从而把力的变化转换为电流的变化。
【11】Flexible Shear Sensor Based on Embedded Optoelectronic Components Jeroen Missinne， Erwin Bosman，Bram Van Hoe，Geert Van Steenberge，Sandeep Kalathimekkad，Peter Van Daele，and Jan Vanfleteren
图11
文献【12】提出了一种用普通白纸作基底，利用石墨材料的压阻效应制作的柔性压力传感器。具有设计新颖，结构简单，制作成本低廉等特点。文章首先讲解了设计思路，以及单个传感器的制作方法。之后对传感器的机械性能和电气性能进行了简单分析，然后对受力时电阻的变化进行系数标定。同时设计制作的基于这种传感器的质量测试系统。但是由于基底的纸质材料的特殊性，这种传感器在具体的实用性层面还需要继续的探索，但无疑提出的新创意值得进一步开发。
【12】PAPER-BASED PIEZORESISTIVE MEMS FORCE SENSORS X.Y. Liu，M. O’Brien， M. Mwangi，X.J. Li，
and G.M. Whitesides
图 12
文献【13】通过薄膜转移技术在可变形的绝缘层两侧放置配对的方形铜板电极，受力后，由于绝缘层发生形变，对应的铜板电极之间电容随之改变，进而把力的变化转换为电容的变化。分别设计制作了以玻璃和聚酰亚胺作为绝缘介质的3*3传感器阵列。
【13】Fabrication and characterization of flexible pressuresensor arrays made by film transfer technologyT.H.N Dinh，P-Y. Joubert，E. Martincic，E. Dufour-Gergam
图13
文献【14】提出了一种光电压力传感器的设计制作方法。在PCB基板上放置成对的LED和光电二极管，然后再每对LED和光电二极管正上方放置一个硅结构体，而这个硅结构体在受力时会发生形变。当受力时硅结构体的形变，向下遮挡了一部分的光路，进而导致光电二极管接收到的光量发生变化，进而将力的变化转化为光电二极管输出电压的变化。基于这种原理，分别开发了两种光电压力传感器。通过改变硅结构体的物理形状，进一步的改善该传感器的测量效果。并讨论了制作的传感器在医学上相关应用。
【14】A Flexible Sensor Technology for the Distributed Measurement of Interaction Pressure
Marco Donati，icola Vitiello，Stefano Marco Maria De Rossi，Tommaso Lenzi，Simona Crea，Alessandro Persichetti，Francesco Giovacchini，Bram Koopman，Janez Podobnik，Marko Munih，and Maria Chiara Carrozza
图
14
篇三：三类完形短篇文档
根据我校三轮静悟需要和考试说明要求，结合我校学情，特设以下三类完形：
1. 另类“完形”2. 自编完形3. (各地)交流完形 供晨读或课堂灵活搭配使用
另类“完形”（1） Emma shines in her new role
“Stunning” is the best word to describe Emma Watson’s performance in her new movie, Noah(《诺亚方舟：创世之旅》).The movie is b______ on the famous Bible story of Noah’s Ark(诺亚方舟).
In the film, Emma plays Ila, the wife of Noah’s eldest son. She endures(忍受) heavy rain, floods and wild animals, and has to fight for
her s_______ in the movie.
Playing such a role was a real challenge for the
young actress. T_______ to the training she received
when she shot the Harry Potter film s______, she was
able to perform well in her first big-budget post-Potter
movie.
“All those Harry Potter movies had really prepared me
well for this r_______in Noah, the challenge of
hunting animals and working with many famous actors and a_______,” said Emma. It’s hard to believe that the e__________(=seasoned) actress is only 23 years old, and she has been working in the movie i__________ since the age of nine. She gained worldwide f_______ for her role as Hermione Granger(赫敏·格兰杰), a smart girl who is Harry Potter’s best friend.
Now, because of her great per__________ in this new movie, Emma has successfully elevated (=lifted)her career to a new h________(高度).
1. based2. survival 3. Thanks 4. series5. role6. actresses7. experienced
8. industry9. performance 10. height
各地交流完形（1）济南
第二节 完形填空(11至20题，每小题1分)阅读下面短文，从短文后所给各题的四个选项(A、
B、C和D)中，选出可以填入空白处的最佳选项。
As Prime Minister, David Cameron is one of the most successful people in the country. But he has admitted that he still has ___11___ about his academic record at school. He was a “late developer” when it came to academics, ___12___ in his early years with physics and chemistry.
___13___what advice he would give his young self, he said it would be “ to keep on with science subjects because understanding of science will be so ___14____ in your future life.”
In an interview with The Spectator, the Prime Minister said that he would tell the young Cameron he should be hitting the ___15___ harder. “ A little ___16___ on physics and chemistry, please, David,” he said.
Mr Cameron is not the first Prime Minister to realize the ____17____ of science in leadership. Margaret Thatcher had a degree in ____18___ from Oxford and, when working as a young chemist in 1950 she was part of a team which helped ___19___ the first soft-serve ice cream. Margaret Thatcher used her training as a chemist to ___20___ politics with the mind of a scientist.
11.A. doubts B regrets C. memories D. opinions
12.A. experimenting B. completingC. struggling D. wandering
13.A. AskedB. Told C. Warned D. Informed
14.A. interesting B. important C. challenging D. difficult
15.A. school B. recordsC. degreeD. books
16.A. moreB. easier C. lessD. slower
17.A. history B. value C. truth D. advance
18.A. biologyB. physicsC. politicsD. chemistry
19.A. discover B. taste C. developD. serve
20.A. approach B. discussC. learnD. imagine
11—15 ＢＣＡＢＤ １６――２０ＡＢＤＣＡ
各地交流完形 （2）淄博
第二节完形填空(两篇共30小题；满分40分。A篇10小题：每题1分，满分10分)
阅读下面短文，从短文后各题所给的四个选项(A、B、C、D)中，选出最佳选项。
A
Getting back to nature is good for your mental health，according to new research．
in middle-and high-income countries live in cities，worry is a major public health concern．Parks，．
but researchers have not confirmed a cause and effect link．So Mathew R. White and colleagues to try to pin it down．
They the metal health of hundreds of Britons who had moved from a grey city neighborhood to a greener one withwho had moved oppositely．
Looking at the data over the of five years，they found that people who had moved to a greener area were happier—and stayed happier—after their move．
In a report in the journal Environmental Science & Technology,the researchers，“Environmental policies to increase urban green space may have continuable public health benefits．”
11．A．population
12．A．whichB．workers C．employees B．that
B．spaces C．where
D．folk D．when D．matters D．suggested D．hobby D．into D．explained D．those D．effort D．doubt 13．A．energies14．A．advised15．A．game16．A．from C．climatesB．discussed C．submitted B．happiness C．time B．byC．with l7．A．experimented18．A．others 19．A．course B．combined C．compared B．onesC．all B．distance C．historyB．imagine C．conclude 20．A．calculate
11—15 ACBDB 16—20 A CDAC
“萌娃”小王子乔治随父母展开“尿布外交”之旅。
另类“完形”（2）Prince George charms the world on first tour Task:介词填空 Britain’s Prince George has become the U.K.’s youngest ambassador as the baby prince goes o_____ his very first official tour to New
Zealand and Australia along w______ his parents, the Duke
and Duchess of Cambridge.
The19-day mission, which will end o______ April 25 in
Canberra, Australia, is called a “diaper diplomacy(尿布外
交)”tour. It is carried o_____ to strengthen ties with the two
Commonwealth(英联邦)countries. And although he is not
even nine months old, George has proved to be a little
prince charming(白马王子).
The baby prince attracted tons of attention from a_______ the world on Day Three of the tour. He performed his first royal duty—joining ten other babies on a play date(玩伴聚会) in Wellington, the capital o_____ New Zealand.
On the “most watched play date ever,” George was seen crawling on the floor, playing with toys and interacting w______ other babies. He even a____ one point grabbed a toy from a little girl, who cried but was comforted by her mother and by George’s mother, Kate. Later, another baby grabbed a toy f______ George but he didn’t seem to mind.
George’s father visited Australia, too, with his parents a_____ a similar age. Prince Charles and the late (已故的)Princess Diana brought Prince William o____ the trip in1983 when he was just nine months old. That was the first such exercise in diaper diplomacy.
１—5onwith on out around 6—11 ofwithat fromaton
各地交流完形（3）菏泽
第二节完形填空(两篇共30小题；满分40分。A篇10小题：每题1分，满分10分)
阅读下面短文，从短文后各题所给的四个选项(A、B、C、D)中，选出最佳选项。
A
Xinxin, a 12-year-old student from Beijing, enjoyed his winter vacation with his father in Singapore. During their visit, he even had the chance to some of Singapore's sights by himself his father was busy with other things.
Xinxin’s first adventure in Singapore was at a water park near their hotel. He enjoyed swimming and into the water by himself, and then returned to the hotel before a time in the evening that was by his father.
The boy also made a trip to Universal Studios Singapore a guardian. He had already been to the park with his father two times during the trip. Xinxin volunteered to make his trip by himself. His father gave him some pocket money to buy lunch, and then Xinxin rode the shuttle from their hotel to the studios. He spent a whole day there and had a time.
In an interview with Beijing Evening News, Xinxin’s father said that he was too busy to spend all his time with his son, he decided to give him the opportunity to develop a sense of Had Xinxin’s mother been there, she would not have let Xinxin out of her sight, the father commented.
11. A. study
12. A. while
13. A. along B. explore B. untilC. test C. beforeC. alone D. measure D. unless D. lonely
D. diving
D. asked
D. without
D. fourth
D. flexible
D. when
D. diligence B. alive14. A. floating 15. A. made16. A. under17. A. firstB. surfingB. set C. driving C. decided C. with C. thirdB. behind B. second B.miserable B. sinceB. daring 18. A.terrible 19. A. though C. fantasticC. if C. pride 20. A. independence
11—15 BACDB 16—20 DCCBA
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