呼吸机管路低位摆放联合口鼻腔冲洗干预在肺炎机械通气中的应用效果观察

目的 观察呼吸机管路低位摆放联合口鼻腔冲洗干预在肺炎机械通气中应用效果。方法 选取2019年1月至2022年5月我院收治的需机械通气的肺炎患者60例,采用简单随机法分为正常组和观察组各30例。正常组机械通气中采用口鼻腔冲洗干预,观察组机械通气中采用呼吸机管路低位摆放联合口鼻腔冲洗干预。比较两组患者有创通气时间、ICU住院时间及误拔管、呼吸机相关性肺炎(VAP)、28 d病死发生率,检测两组干预前及干预3、7 d降钙素原(PCT)、白细胞计数(WBC)等炎症因子的变化。结果 观察组有创通气时间、ICU住院时间明显短于正常组,冷凝液倒流和VAP发生率明显低于正常组(P<0.05);两组28 d病死率、累计误拔管发生率、临床总有效率比较,差异无统计学意义(P>0.05);干预3、7 d后两组PCT、WBC、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)明显较干预前下降,且观察组炎症因子指标低于正常组(P<0.05)。结论 呼吸机管路低位摆放联合口鼻腔冲洗干预可降低肺炎机械通气中冷凝液倒流发生率,缩短病程,降低VAP的发生。     

集束化护理在预防呼吸机相关性肺炎中的应用

目的:探讨机械通气集束化护理在预防呼吸机相关性肺炎的作用。方法:选择2011年1~12月机械通气患者225例作为对照组,2012年1~12月机械通气患者262例作为观察组,对照组采用常规的护理方法,观察组采用包括严格手卫生、加强口腔护理、重视气道湿化、定时监测气囊压、持续声门下吸引、每天进行拔管评估、呼吸机管路的护理、半卧位(抬高床头30°~45°)等集束化护理措施,观察两组患者VAP的发病率、入住ICU的时间、机械通气时间、ICU的医疗费用。结果:观察组患者VAP的发病率、入住ICU时间、机械通气时间、ICU的医疗费用均低于对照组(P0.05)。结论:集束化护理可降低机械通气患者VAP发病率,减少机械通气时间和医疗费用,值得临床推广应用。     

呼吸机干预体系对ICU呼吸机辅助通气患者预后的影响

目的:探讨呼吸机干预体系对重症监护病房(ICU)呼吸机辅助通气患者预后的影响。方法:选择2016年6月至2017年6月在我院治疗的80例ICU呼吸机辅助通气患者,将患者随机等分为观察组和对照组,对照组机械通气期间行常规性呼吸机护理干预;观察组实施呼吸机干预体系管理模式。比较两组患者预后情况及并发症发生情况。结果:观察组干预后急性病理生理和慢性健康评分低于对照组(P0.05),观察组呼吸机使用时间、住ICU时间、平均住院时间均短于对照组(P0.05),呼吸机相关性肺炎(VAP)、冷凝液倒流情况、护理投诉发生率方面比较观察组短于对照组(P0.05);患者的满意率高于对照组(P0.05)。结论:呼吸机干预体系能有效降低ICU呼吸机辅助通气患者VAP发生率,改善患者预后,提高患者满意率。     

气囊上滞留物清除术对COPD患者呼吸机相关性肺炎发病的影响

目的 观察气囊上滞留物清除术对降低COPD患者呼吸机相关性肺炎（VAP）的作用.方法 将62例经鼻气管插管机械通气治疗48 h以上患者随机分为观察组和对照组各31例,对照组采用常规气道护理,观察组在此基础上实施气囊上滞留物清除术.观察两组机械通气1周、2周及2周后VAP发生率以及机械通气时间、VAP出现时间、RICU住院时间及死亡例数,并对发生VAP的病人进行CPIS评分.结果 机械通气1周、2周观察组VAP的发生率为12.9％,对照组为31.5％（P＜0.05）;发生VAP患者的机械通气时间观察组为（12.6±9.7）d,对照组为（13.8±12.8）d（P ＜0.05）;两组患者下呼吸道分泌物的致病菌分布均以革兰阴性杆菌为主,主要优势菌为铜绿假单胞菌、鲍曼不动杆菌、白色念珠菌,主要致病菌构成比差异无统计学意义（P＞0.05）.观察组发生VAP者CPIS评分为（8.2±2.3）分,对照组为（9.8±3.2）分（P＜0.05）.结论 气囊上滞留物清除术可降低COPD患者VAP的发生率,延迟机械通气时VAP发生时间,明显降低CPIS评分,降低病死率,缩短机械通气时间及住RICU时间.     

ICU患者早期集束化气道干预对预防呼吸机相关性肺炎的作用

目的 探讨ICU患者早期集束化气道干预对预防呼吸机相关性肺炎（VAP）的作用.方法 选取入住ICU行有创机械通气的患者128例,随机分为对照组64例和观察组64例.对照组采取常规气道干预,观察组在4h内采取集束化气道干预（及时倾倒呼吸机管路冷凝水、人工气囊的压力保持在20～30 cmH2O、胸部物理治疗每2小时1次、持续声门下吸引、呼吸机采用热湿交换器、每4小时洗必泰口腔冲洗）.观察并记录两组VAP发病率、平均机械通气时间、ICU平均住院时间及28 d的病死率.动态观察确诊VAP患者当天（0）、3、5、7、14 d时临床肺部感染评分（CPIS）、APACHEⅡ评分.结果 观察组与对照组比较,VAP发病率（18.75％与35.94％）、平均机械通气时间（6.26±2.89）d与（10.54±4.36）d、ICU平均住院时间（11.88±3.97）d与（16.55±5.22）d,观察组均较对照组低,且差异有统计学意义（x2=4.758、t=6.546、t=5.697,P＜0.05或P＜0.001）.两组中确诊VAP3、5、7、14 d,CPIS评分分别为（7.01±2.24）、（8.74±2.33）分,（5.67±2.14）、（7.51±2.27）分,（4.36±1.44）、（6.95±2.98）分,（2.75±1.37）、（6.53±2.88）分,观察组的CPIS评分均较对照组低,差异有统计学意义（F组间=27.22,P＜0.001;F组内=29.41,P＜0.001;F交互=4.35,P＜0.01）;APACHEⅡ评分分别为（17.02±7.06）、（22.48 ±7.31）分,（15.01±6.06）、（19.67±7.14）分,（12.40±4.17）、（16.13±5.33）分,（8.40±2.57）、（13.10±4.93）分,观察组的APACHEⅡ评分较对照组低,差异有统计学意义（F组间=47.43,P＜0.001;F组内=45.36,P＜0.001;F交互=4.25,P＜0.01）.结论 早期应用集束化气道干预可降低VAP的发生率,一定程度改善病情及预后.     

集束护理对ICU呼吸机治疗患者临床疗效的影响分析

目的探讨ICU行呼吸机治疗患者实施集束护理的临床疗效,分析对预防呼吸机相关性肺炎(VAP)发生的应用效果。方法选取2017年1月～2018年12月我院行ICU机械通气治疗的患者80例,根据随机数表法分为对照组和观察组各40例。对照组实施ICU常规护理,观察组实施集束护理干预,分析两组患者干预后ICU住院时间、机械通气时间、心率、呼吸频率、VAP发生率。结果观察组ICU住院时间、机械通气时间均短于对照组,差异有统计学意义(P<0.05);干预后,观察组心率、呼吸频率均优于对照组,差异有统计学意义(P<0.05);干预后,观察组VAP发生率低于对照组,差异有统计学意义(P<0.05)。结论 ICU行呼吸机治疗患者实施集束护理可有效预防VAP发生,利于改善患者预后。     

口腔护理配合刷牙预防呼吸机相关性肺炎及其不良事件的临床对照研究CSCD

目的探讨在口腔护理中加入刷牙的步骤,是否能降低呼吸机相关性肺炎(ventilator associated pneumonia,VAP)的发生率及其导致的不良事件。方法便利抽样选取入住第二军医大学长征医院急救科ICU病房并接受气管插管患者122名,随机分配至标准的口腔护理(对照)组与标准口腔护理+刷牙(观察)组,随访28d,观察患者VAP发生率、无需机械通气时间、无需使用抗生素时间以及ICU住院时间及28d内ICU住院病死率。结果对照组VAP发生率为33.3%,观察组为29.0%;对照组无需机械通气时间为(8.9±6.5)d,观察组为(8.5±7.2)d;对照组无需抗生素时间为(8.3±7.2)d,观察组为(7.9±7.3)d;对照组的平均住院时间为(16.3±10.2)d,观察组为(15.8±11.3)d;对照组病死率为35%,观察组为32.3%。以上指标两组相比,差异均无统计学意义(均P>0.05)。结论标准口腔护理加入刷牙步骤不能降低VAP的发生率和28d住院病死率,亦不能缩短使用抗生素时间、机械通气时间以及ICU平均住院天数。     

乌针漱口液口腔护理预防ICU患者呼吸机相关性肺炎的效果观察

摘要：目的 观察乌针漱口液口腔护理预防ICU患者呼吸机相关性肺炎（VAP）的防治效果。方法 选取2019年4月至2020年6月在广西中医药大学附属瑞康医院ICU收治的92例经口气管插管机械通气治疗的患者,采用随机数字法分为观察组和对照组,每组46例。观察组采用乌针漱口液进行口腔护理,对照组采用生理盐水进行口腔护理,比较两组患者护理后的临床肺部感染评分(CPIS)、机械通气时间、口腔评估指南（0AG）评分、口咽及气管内定植菌发生率、VAP发生率、满意度的情况。结果 护理后,观察组的CPIS评分、机械通气时间均明显低于对照组,差异有统计学意义(P＜0.05);观察组的口腔黏膜、牙龈、唾液、口腔异味、吞咽功能和0AG总分明显均优于对照组,差异有统计学意义(P＜0.05);观察组的口咽及气管内定植菌发生率、VAP发生率均明显低于对照组,差异有统计学意义(P＜0.05);观察组口满意度明显高于对照组,差异有统计学意义(P＜0.05)。结论 乌针漱口液口腔护理能更好地降低ICU机械通气患者VAP的发生率,减少机械通气时间,改善口腔健康情况,患者满意度较高。     

品管圈活动在ICU预防呼吸机相关性肺炎的应用

目的探讨品管圈(QCC)活动在ICU预防呼吸机相关性肺炎(VAP)中的应用效果。方法以本院ICU于2015年1月至2015年12月期间收治的102例机械通气时间大于48 h患者作为本组研究对象,QCC活动于7月开始启动,按时间顺序1~6月收治的机械通气时间大于48 h的患者为对照组,7~12月收治的机械通气时间大于48 h的患者为观察组,对照组与观察组各51例,对照组未实施QCC活动,观察组实施QCC活动。比较两组VAP的发生率、病死率、机械通气时间、ICU住院时间。结果观察组VAP发生率和病死率较对照组显著降低(P0.05);机械通气时间和住院时间较对照组明显缩短,差异具有统计学意义(P0.05)。结论品管圈活动在ICU预防VAP的应用可以增进护士的团队精神,充分发挥其工作积极性,可以明显降低VAP的发生率和病死率,缩短机械通气时间和患者住院时间,提高护理品质。     

气管导管改造和护理改良对ICU人工机械通气患者呼吸机相关性肺炎的预防效果

目的探讨气管导管改造和护理改良对重症监护病房(ICU)人工机械通气患者呼吸机相关性肺炎(VAP)的预防效果。方法2017年6月至2018年6月选取滨州市中心医院(ICU)收治的呼吸机机械通气患者110例,根据随机数字表分为观察组及对照组,各55例。对照组行常规呼吸道管理,观察组在对照组基础上进行气管导管改造及护理改良。比较两组患者使用呼吸机3 d后痰液黏稠度、痰痂形成、刺激性咳嗽次数、VAP发生率、肺部湿罗音消失时间、机械通气时间、入住ICU时间、平均住院时间及患者治疗满意率。结果观察组痰液黏稠度较对照组明显降低,痰痂形成率、VAP发生率均明显低于对照组,患者的治疗满意率明显高于对照组,差异均有统计学意义(均P<0.05)。观察组肺部湿罗音消失时间、机械通气时间、入住ICU时间、平均住院时间均明显短对照组,差异有统计学意义(均P<0.05)。结论气管导管改造和护理改良能有效促进ICU人工机械通气患者痰液排出,降低患者的VAP发生率,有利于患者预后,提高患者治疗的满意率。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.