呼吸过滤器的研究与使用现状

呼吸过滤器(breathingfilter,BF)也称生物过滤器、热湿交换过滤器、人工鼻等,是一大类在呼吸回路中使用的过滤器,具有不同程度的生物滤过功能和加温保湿作用。近年BF已逐渐在临床推广使用,作为机械通气(mechanicalventilation,MV)期间保护气道、降低呼吸回路微生物污染和控制院     

呼吸过滤器临床应用的安全性探讨及技术创新

近年来,为了减少呼吸回路内微生物的污染,降低患者术后肺部并发症（如呼吸机相关性肺炎和院内感染）发生率,呼吸过滤器在临床上的应用价值越来越大。新型冠状病毒肺炎的出现使呼吸过滤器的应用更加广泛,因此合理规范地使用是当前需解决的重要问题。文章总结了呼吸过滤器的临床应用新进展,对其自投入临床使用以来遇到的各种潜在并发症进行分析...     

热湿交换过滤器在吸入麻醉期间对气道炎症反应的影响

机械通气期间干燥和微生物污染均可导致呼吸道感染发生率增加,热湿交换过滤器(heat and moistureexchange filters,HMEF)具有生物滤过功能和气道加温保湿作用,但在临床中的实际使用效果未能得到充分确证[1~3]。气道炎症反应在肺部损伤和感染的早期出现并在一定程度上呈正相关,为临床提供了一个早期辨识机械通气并发症及其程度的途径。本实验通过支气管肺泡灌洗术直接测定肺炎症细胞和炎症介质水平,观察HMEF对不同人群吸入麻醉期间气道反应水平的影响,评估HMEF的临床使用效果。1资料与方法1.1病例选择2004年8月至2005年8月气管插管吸入…     

论细菌病毒湿热交换呼吸通路过滤器HMEF的选择使用

在手术室环境中，充满潜在的病原体和感染源。已有研究显示。与普通人群相比，医护人员．尤其是呼吸系统的医疗人员。有较高的气道反应性疾病或肺结核。本文拟寻找危险因子的源头，并探讨降低其对患者和医护人员危险性的方法。 使用细菌病毒湿热交换呼吸通路过滤器能降低患者感染的危险性．从而也可能降低医护人员的危险性。     

湿热交换过滤器预防术中病人低体温的临床研究

目的：探讨湿热交换过滤器（heat and moisture exchanger and filter,HMEF）预防术中全麻病人低体温的临床应用价值。方法：择期颅脑手术的成年病人60例，随机分为A、B两组，每组30例。置入直肠温度探测头接Datex Ⅱ型多功能监测仪持续监测体温。观察组（A组）在气管导管与呼吸回路间安置HMEF，对照组（B组）则不放置。将两组间体温的变化进行比较。结果：A组在诱导后、术中于术毕体温也有下降，但组间各期比较无显著差异（P＞0．05）。B组在诱导后60分钟时体温下降最为明显,为2．6℃，与A组（1．4℃）同期比较有非常显著意义（P＜0．01）。术毕寒战发生率两组间相比也有显著差异（P＜0．05）。结论：使用湿热交换过程过滤器的预防术中低体温的作用。     

白细胞过滤器清除浓缩红细胞悬液中肿瘤细胞的效果

术中自体血网输虽然可避免异体输血导致的多种并发症[1-5],但对于肿瘤切除术患者,经自体血液回收机漂洗后的血液中仍存在肿瘤细胞[6],自体血回输可导致肿瘤的血道转移.红细胞直径小、无核且具有变形性,可通过过滤网.漂洗后的回收血经白细胞过滤器过滤能否清除红细胞悬液中肿瘤细胞及对红细胞形态及其细胞膜Na+-K+-ATP酶活性的影响,有待进一步探讨.本研究拟评价白细胞过滤器清除浓缩红细胞悬液中肿瘤细胞的效果,为临床提供参考.     

299例2型糖尿病肾病患者湿热证和血瘀证在不同CKD分期的发生率及其与实验室指标的相关性研究

目的：回顾性分析299例2型糖尿病肾病患者湿热证和血瘀证在不同CKD分期的发生率,同时试图找寻与湿热证和血瘀证相关的实验室指标。方法：将我院肾内科及内分泌科确诊为2型糖尿病的患者,按K/DOQI指南（2002）进行CKD分期,对湿热证和血瘀证临床症状进行流行病学的统计和分析。结果：湿热证和血瘀证在2型糖尿病肾病患者的发生率随着内生肌酐清除率（Ccr）下降而升高;湿热证与2型糖尿病肾病患者血C反应蛋白（CRP）呈显著相关性（P〈0.05）;血瘀证与2型糖尿病肾病患者血纤维蛋白原（Fg）呈显著相关性（P〈0.05）。结论：随着糖尿病肾病的发展,湿热证和血瘀证的发生率上升;血CRP可做为2型糖尿病肾病患者湿热证相关实验室指标,血Fg可做为2型糖尿病肾病患者血瘀证的相关实验室指标。     

慢性肾脏病湿热证研究进展

正慢性肾病以肾脏局部炎症、肾脏固有细胞的功能异化或消失、肾脏纤维化为主。湿热证是指湿热蕴结体内,脏腑经络运行受阻,可见全身湿热症状。吴崐在《医方考》中说:"下焦之病,责于湿热。"肾居下焦,在肾脏疾病中湿热极为普遍,湿热蕴结贯穿其始终,是加重慢性肾病进展的重要因素。因此,及时发现和重视湿热证,早期预防和治疗湿热证显得尤为重要。经过长期的探索和研究,慢性肾脏病湿热证客观化及临床辨治研究均取得较多成果,针对湿热证的各类中药也不断应用于临     

骨质疏松症信息管理系统的建立及应用——附8102例报告

目的 应用计算机数据管理系统对骨质疏松患者进行系统化、标准化管理,为骨质疏松症及其并发症的临床监控、发病机制研究提供重要的科学依据和研究手段.方法 采用Borland公司的可视化软件开发工具Delphi,研究设计的骨质疏松症信息管理系统(osteoporosis information managementsystem,OIMS),结合我科8102例骨质疏松患者的实际应用情况,对该系统做一综合评价.结果 1)OIMS以多种形式动态地显示了患者长期的临床指标变化,实现了患者个体病情的监控,减少或延缓并发症的发生,提高了医疗质量,增加了患者的依从性;2)OIMS可有效地解决门诊病史管理混乱的问题,实现病史资料的标准化管理,提高了工作效率;3)OIMS的资料存贮、查询、管理功能为医学研究者提供强大的统计支持;4)与社区卫生服务相结合,加强社区慢性病的管理力度.结论 OIMS可有效解决骨质疏松症及其并发症的计算机标准化信息管理,实现人工操作环节中较难完成的管理和分析工作,提高工作效率,使骨质疏松患者的病情得到更好监控.     

血管外科实验研究方向思考:从系统生物学研究到转化医学

血管外科的蓬勃发展,离不开血管疾病机制的实验研究,科学的实验研究成果也是临床开拓诊治新途径、开发新技术、开创新理念的不竭之源.血管疾病绝大多数是复杂性疾病,血管组织细胞和其功能调节亦是多网络多层次的,单一的基因、蛋白质、信号传导通路等的传统研究已不能满足复杂机体的研究需要,不能有效转化到临床应用.随着现代生物医学步入"组"生物学、系统生物学的后基因组时代,血管外科实验研究主流亦趋于系统化、网络化和数字化.另一方面,如何将研究成果更好地应用于临床,同样是现代生物医学的巨大挑战.从实验室到临床,再从临床到实验室,转化医学已经成为世界医学生物学研究的模式和共识,是血管外科实验研究的必由之路.现对血管外科系统生物学和转化医学的研究进展作一述评.     

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BackgroundAbsenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).MethodsWe measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization’s Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.ResultsIn total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).ConclusionAmong employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.     

The German emergency and disaster medicine and management systemdhistory and present

As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach.     

肝内胆管囊腺瘤和囊腺癌的CT、MRI及病理表现

目的探讨肝内胆管囊腺瘤和囊腺癌的CT、MRI和病理特点。方法回顾性分析经手术病理证实的6例肝内胆管囊腺瘤和2例肝内胆管囊腺癌的影像及临床病理资料，将病变的影像表现与其病理大体形态及组织学表现作对照分析。结果6例肝内胆管囊腺瘤，女4例、男2例；2例肝内胆管囊腺癌均为女性病人；8例病人平均年龄55岁。所有病灶均表现为多房囊性肿块，肿瘤囊腔各分房内常为多种液体成分，在CT上可表现为不同密度、在MRI上可表现为不同信号强度。囊内出现多发大小不等的壁结节在胆管囊腺癌内更常见，囊内有分隔但无壁结节只见于胆管囊腺瘤。在7例CT扫描中，4例胆管囊腺瘤和1例胆管囊腺癌可见囊壁或分隔上钙化，囊壁、囊内分隔及囊内结节均为轻、中度延迟增强。肿瘤中出现卵巢样间质见于3例胆管囊腺瘤和1例胆管囊腺癌，且均为女性病人。结论肝内胆管囊腺瘤和囊腺癌是肝脏不常见的囊性肿瘤，影像上多房、囊内有分隔且各分房囊内密度或信号不一致，高度提示肝内胆管囊腺瘤或囊腺癌的诊断，如囊内伴有多发大小不等的结节，则进一步提示囊腺癌的可能。但影像学表现不能区分肿瘤中有无卵巢样间质。     

Differences in Osteocyte Density and Bone Histomorphometry Between Men and Women and Between Healthy and Osteoporotic Subjects

Bone defects related to osteoporosis develop with increasing age and differ between males and females. It is currently thought that the bone remodeling process is supervised by osteocytes in a strain-dependent manner. We have shown an altered response of osteocytes from osteoporotic patients to mechanical loading, and osteocyte density is reduced in osteoporotic patients, which might relate to imperfect bone remodeling, leading to lack of bone mass and strength. Hence, information on osteocyte density will contribute to a better understanding of bone biology in males and females and to the assessment of osteoporosis. Osteocyte density as well as conventional histomorphometric parameters of trabecular bone were determined in cancellous iliac crest bone of healthy postmenopausal women and men and of osteoporotic women and men. Osteocyte density was higher in healthy females than in healthy males and lower in osteoporotic females than in healthy females. Bone mass was reduced in osteoporotic patients, both male and female. In females, trabecular number was reduced, whereas in males, trabecular thickness was reduced and eroded surface was increased. There were no correlations between the parameter groups bone architecture, bone formation, bone resorption, and osteocyte density. These results are consistent with impaired osteoblast function in osteoporotic patients and with a different mechanism of bone loss between men and women, in which osteocyte density might play a role. The reduced osteocyte numbers in female osteoporotic patients might relate to imperfect bone remodeling leading to lack of bone mass and strength. M. G. Mullender and S. D. Tan contributed equally to this work.