神经重症康复病房气管切开术后拔管困难患者的临床特点分析

目的 探讨神经重症康复病房气管切开术后拔管困难患者的临床特点。 方法 回顾性分析2015年1月至2019年5月由淄博市中心医院康复科神经重症康复病房收治的气管切开术后患者122例,根据患者是否成功拔管分为2组,拔管成功组（73例）和拔管困难组（49例）。采用全面无反应性量表（FOUR）和昏迷恢复量表（CRS-R）评定患者的意识状态,采用口腔摄入功能量表（FOIS）评定患者的进食能力,采用纤维内窥喉镜观察气道解剖结构,采用Marianjoy分泌物五分评分量表、Rosenbek渗漏-误吸量表（PAS）行分泌物潴留及吞咽误吸评分。先采用单因素分析,再进行多因素Logistic回归分析,筛选危险因素。 结果 单因素分析显示,年龄、意识状态、吞咽功能、分泌物潴留、误吸和声门开放水平可能是影响神经重症气管切开术后患者拔管的因素(P<0.05)。Logistic回归分析显示,咽喉部分泌物潴留多［OR=9.380,95%CI(3.010,29.231),P<0.05］和声门开放水平差［OR=0.186,95%CI(0.083,0.417),P<0.05］是神经重症气管切开术后患者拔管的危险因素。 结论 咽喉部分泌物潴留多和声门开放水平差是神经重症气管切开术后患者拔管困难的独立危险因素。纤维内窥喉镜在诊治过程中起着十分重要的作用。     

Lasers and light sources for PDT: past, present and future

The more recent use of Photodynamic therapy in Oncology dates to the early 1970’s, when Dr. Thomas J. Dougherty, began his investigations into the mechanisms and clinical uses hematoporphyrin derivative (HpD). Since then the therapy has found its way through the regulatory process in numerous countries throughout the world. In many of these locales as it was in the United States, this was the first drug device approval, for oncology, that had been undertaken and ultimately approved, by the regulatory agencies in the respective countries. Throughout this time changes occurred in the formulation of HpD as well as the development of other photosensitizers. The more difficult aspect, however, of this modality has been the availability of reliable, affordable and appropriate devices for the production and delivery of light to the targeted areas. In the last 10 years, however, there has been a slow yet improving landscape in the development of devices for PDT that ultimately will provide the impetus for greater acceptance of PDT in the medical community.     

Fiberoptic endoscopic examination of swallowing safety: A new procedure

A new procedure for assessing the pharyngeal stage of swallowing in patients with dysphagia is described. Called the fiberoptic endoscopic examination of swallowing safety (FEESS), it is being used to detect aspiration and to determine the safety of oral feeding in patients for whom the traditional videofluoroscopic evaluation may be difficult or impossible to perform. Patients for whom the FEESS procedure is indicated are identified and information obtainable via endoscopy is outlined.     

An integrated fiberoptic–microfluidic device for agglutination detection and blood typing

In this paper, an integrated fiberoptic–microfluidic device for the detection of agglutination for blood type cross-matching has been described. The device consists of a straight microfluidic channel through with a reacted RBC suspension is pumped with the help of a syringe pump. The flow intersects an optical path created by an emitter-received fiber optic pair integrated into the microfluidic device. A 650 nm laser diode is used as the light source and a silicon photodiode is used to detect the light intensity. The spacing between the tips of the two optic fibers can be adjusted. When fiber spacing is large and the concentration of the suspension is high, scattering phenomenon becomes the dominant mechanism for agglutination detection while at low concentrations and small spacing, optointerruption becomes the dominant mechanism. An agglutination strength factor (ASF) is calculated from the data. Studies with a variety of blood types indicate that the sensing method correctly identifies the agglutination reaction in all cases. A disposable integrated device can be designed for future implementation of the method for near-bedside pre-transfusion check.     

纤支镜引导气管插管在急诊的临床应用

目的：评价纤支镜引导气管插管在急诊的应用价值。方法：将30例急诊气管插管病例随机分为两组,即气管内插管（ETT）组和纤支镜引导气管插管（FOB）组,记录插管时间和插管成功率。结果：FOB组插管成功率明显高于ETT组（P〈0．05）,而插管时间两组无显著性差异（P〉0．05）。结论：纤支镜引导气管插管因其快捷、有效,在急诊气管插管中有一定的临床应用价值。