支气管肺泡灌洗术治疗新生儿胎粪吸入综合征的疗效观察

观察支气管肺泡灌洗术治疗新生儿胎粪吸入综合征的临床疗效。选取胎粪吸入综合征患儿78例,随机分为治疗组(40例)和对照组(38例),对照组给予常规对症支持治疗,治疗组在对照组治疗基础上给予支气管肺泡灌洗术治疗。比较两组治疗效果。治疗组支气管肺泡灌洗术后血气分析p H值(p H)、血氧饱和度(Sp O2)、氧分压(Pa O2)明显上升,二氧化碳分压(Pa CO2)明显下降,与对照组相比有显著差异性(P0.05);治疗组机械通气比例、机械通气时间、氧疗时间、住院时间明显短于对照组(P0.05);治疗组总有效率为92.5%,对照组为84.21%,治疗组疗效明显优于对照组(P0.05)。支气管肺泡灌洗治疗新生儿胎粪吸入综合征疗效显著,治愈率高,值得临床广泛应用。     

气管内冲洗对新生儿胎粪吸入综合征预后的影晌

目的:探讨气管内冲洗对新生儿胎粪吸入综合征(MAS)疗效及预后的影响.方法:将62例胎粪吸入新生儿随机分为两组:气管内冲洗组32例,未进行气管内冲洗组30例,观察两组疗效及预后.结果:进行气管内冲洗者,小节段肺不张或局限性阻塞性肺气肿、肺炎、缺氧缺血性脑病(HIE)、呼吸衰竭、新生儿颅内出血(ICH)的发生率均明显低于未冲洗组(P＜0.05或P＜0.01),病死率及住院天数差异亦有显著意义(P＜0.05),未冲洗组有10例出现严重呼吸衰竭,予机械通气治疗,上机时间平均4 d,其中6例抢救无效死亡,而冲洗组无一例予机械通气治疗.结论:气管内冲洗是治疗胎粪吸入综合征的一种可靠的、有效的急救措施.     

气管内冲洗对新生儿胎粪吸入综合征预后的影响

目的 :探讨气管内冲洗对新生儿胎粪吸入综合征 (MAS)疗效及预后的影响。方法 :将 62例胎粪吸入新生儿随机分为两组 :气管内冲洗组 3 2例 ,未进行气管内冲洗组 3 0例 ,观察两组疗效及预后。结果 :进行气管内冲洗者 ,小节段肺不张或局限性阻塞性肺气肿、肺炎、缺氧缺血性脑病 (HIE)、呼吸衰竭、新生儿颅内出血 (ICH)的发生率均明显低于未冲洗组 (P <0 0 5或P <0 0 1) ,病死率及住院天数差异亦有显著意义 (P <0 0 5) ,未冲洗组有 10例出现严重呼吸衰竭 ,予机械通气治疗 ,上机时间平均 4d ,其中 6例抢救无效死亡 ,而冲洗组无一例予机械通气治疗。结论 :气管内冲洗是治疗胎粪吸入综合征的一种可靠的、有效的急救措施     

纤维支气管镜吸痰联合肺泡灌洗在慢性阻塞性肺疾病呼吸衰竭有创机械通气中的应用

目的:观察纤维支气管镜吸痰联合肺泡灌洗对有创机械通气的慢性阻塞性肺疾病呼吸衰竭的治疗效果。方法:气管插管机械通气的慢性阻塞性肺疾病呼吸衰竭患者41例,随机分为纤维支气管镜吸痰联合肺泡灌洗治疗组(A组)和普通吸痰管吸痰组(B组),比较2组呼吸衰竭纠正时间、出现肺部感染控制窗的时间、有创机械通气时间、机械通气后住院天数、病死率情况。结果:2组病死率比较差异无统计学意义(P>0.05),A组呼吸衰竭纠正时间、出现肺部感染控制窗的时间、有创机械通气时间、机械通气后住院天数等指标均优于B组,差异有统计学意义(P<0.05)。结论:纤维支气管镜吸痰联合肺泡灌洗是治疗有创机械通气的慢性阻塞性肺疾病呼吸衰竭患者的有效手段,能迅速控制感染、缩短有创机械通气时间、减少撤机困难等并发症的发生,还可缩短住院时间,改善预后。     

应用肺表面活性物质治疗新生儿胎粪吸入综合征的临床观察及护理

目的探讨应用肺表面活性物质治疗新生儿胎粪吸入综合征的临床疗效及护理对策。方法选取2009年1月~2013年12月入住本院NICU的胎粪吸入综合征重症患儿70例,将患儿随机分为观察组与对照组各35例。对照组采用常规治疗及护理;观察组在常规治疗及护理的同时,加用外源性PS(珂立苏)进行治疗。结果观察组在使用外源性PS后呼吸机参数能较快下调,并且机械通气时间及住院时间均短于对照组,差异均有统计学意义(均P0.05);但治疗费用比较两组相差不大,差异无统计学意义(P0.05)。结论机械通气联合PS的应用,能有效治疗新生儿胎粪吸入综合征。     

机械通气联合支气管肺泡灌洗治疗重症新生儿胎粪吸入综合征

目的:探讨机械通气联合纤维支气管镜下支气管肺泡灌洗(BAL)在治疗新生儿重症胎粪吸入综合征(MAS)中的作用。方法:选择常规机械通气治疗后病情无明显缓解的重症MAS患者15例(治疗组),应用生理盐水经纤支镜行BAL清除呼吸道胎粪和分泌物,并以29例行单纯机械通气治疗的重症MAS患儿作为对照。结果:治疗组与对照组的治愈率和并发症发生率分别为93.3%和65.5%、33.3%和69.0%,两组比较差异有显著性(χ2=4.080,χ2=5.116,P均<0.05)。治疗组与对照组的机械通气时间和住NICU时间分别为(31.76±16.49)h和(66.80±26.21)h、(4.16±1.98)d和(8.52±3.16)d,两组比较差异有显著意义(t=4.703,t=4.849,P均<0.01)。结论:机械通气联合纤支镜下BAL是治疗重症新生儿MAS的有效方法。     

新生儿有创机械通气撤机操作的配合及护理体会

正有创机械通气是新生儿重症监护室(neonatal intensive care unit,NICU)的重要抢救治疗措施。常用于治疗新生儿呼吸窘迫综合征、胎粪吸入综合征、早产儿呼吸暂停、早产儿支气管肺发育不良、新生儿重症肺炎、肺出血等疾病。密切的撤机操作配合及良好的护理措施保证了上述疾病患儿呼吸支持的过渡。现将杭州市妇产科医院NICU在2014年12月至2015年12月实施有创机械通气新生儿撤机操作     

气道灌洗联合鼻塞持续气道正压通气治疗新生儿胎粪吸入综合征79例分析

目的：探讨气道灌洗联合鼻塞持续气道正压通气（ nCPAP）治疗新生儿胎粪吸入综合征（ MAS）的疗效。方法回顾分析我院新生儿科2009年1月至2012年12月收治的79例MAS病例,其中气道灌洗联合nCPAP治疗36例（观察组）,早期单独使用nCPAP治疗43例（对照组）,比较两组nCPAP治疗时间、nCPAP峰值压力、并发PPHN和机械通气例数。结果观察组nCPAP治疗时间短于对照组,nCPAP峰值压力低于对照组,并发PPHN例数和需要机械通气例数也明显低于对照组,差异均有统计学意义（ P＜0.05）。对照组并发肺气漏1例,死亡1例;观察组无肺气漏和死亡病例。结论气道灌洗联合nCPAP较早期单独使用nCPAP能更明显改善MAS病情,预防和减少PPHN发生,减少机械通气,安全高效易行,值得推广。     

重症胎粪吸入综合征23例临床分析

目的:探讨经支气管灌洗及气管滴入肺表面活性物质治疗重症胎粪吸入综合征(MAS),提高抢救成功率。方法:将23例患儿分为两组,对照组13例,常频通气治疗;观察组10例,在使用常频机械通气的基础上,采用支气管灌洗及气管滴入肺表面活性物质。结果:观察组上机时间、住院时间明显短于对照组,氧合指数(OI)及PaO2/FiO2优于对照组。结论:早期及时清理呼吸道是关键,早期应用肺表面活性物质,有利于重症MAS的治疗。     

支气管肺泡灌洗治疗胎粪吸入综合征的观察及护理40例

胎粪吸入综合征(meconium aspiration syndrome,MAS)是新生儿期常见的危重病症[1]。由于胎儿发生宫内窘迫或产时窒息,吸入排出的胎粪后发生肺部病变所引起,发生率占活产婴儿的1.2%~2.2%,病死率高达7.0%~15.2%,是新生儿时期重要的死亡原因之一。为了探讨支气管肺泡灌洗对MAS的疗     

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.     

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.     

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.     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

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.