双伺服加温湿化器对张口呼吸病人气道湿化效果研究

[目的]研究双伺服加温湿化器用于张口呼吸病人气道湿化的临床效果。[方法]将100例张口呼吸病人随机分为两组,试验组采用FisherPaykel双伺服加温湿化器(MR850)持续湿化,对照组采用压缩雾化吸入机持续雾化吸入,观察比较24h后口腔黏膜湿化效果、气道评分、痰液黏稠度、气道湿化效果、呼吸、血气分析变化,并观察24h、48h、72h气道不良反应发生情况。[结果]两组口腔黏膜湿化效果、痰液黏稠度、肺部啰音、刺激性咳嗽、PaO2比较差异均有统计学意义(P0.05)。[结论]双伺服加温湿化器对张口呼吸病人气道起到了良好的气道湿化效果,痰液引流通畅,口腔黏膜痰痂形成明显减少,血气分析指标改善,降低了肺部并发症发生的风险,不良反应发生率低。     

两种气道湿化方法对气管切开患者的影响

目的探讨两种气道湿化方法对气管切开患者的影响。方法 2012年1月—2013年12月选择上海市奉贤区奉城医院实施气管切开行人工气道患者80例,分为观察组和对照组各40例。观察组采用输液泵加输液恒温器持续气道湿化,对照组采用输液泵持续常温气道湿化,比较两组患者痰液黏稠度、刺激性咳嗽、气道黏膜出血和肺部感染发生情况,并观察患者的平均氧分压、氧饱和度、心率以及呼吸频率情况。结果观察组的平均痰液黏稠度与对照组比较,差异有统计学意义(P0.05);观察组的刺激性咳嗽、气道黏膜出血和肺部感染发生率较对照组低,平均氧分压、氧饱和度较对照组稳定;心率和呼吸频率变化较小。与对照组比较差异有统计学意义(P0.05)。结论采用输液泵加输液恒温器持续气道湿化能有效促进患者排痰,减少相关并发症的发生,有助于气道切开患者的早日康复。     

Effects of carbon dioxide absorbent cooling and temperature gradient reduction on water condensation in the anaesthesia circuit

BACKGROUND: Large quantities of water condensation occur in the anaesthesia circuit during low-flow anaesthesia. We hypothesized that cooling of the CO2 absorbent would prevent water condensation. METHODS: To cool CO2 absorbent efficiently, we constructed a novel temperature gradient reduction (TGR) canister, which was cooled by a blower. Experiments were divided into three groups: the conventional canister group (control group, n=6), the TGR canister without cooling group (TGR group, n=6), and the TGR canister with cooling group (TGR cooling group, n=6). One kilogramme of CO2 absorbent was placed into the canister. The anaesthetic ventilator was connected to a 3 litre bag and 300 ml min(-1) of CO2 was introduced. About 500 ml min(-1) of oxygen was used as fresh gas. The anaesthetic ventilator was set at a ventilatory frequency of 12 bpm, and tidal volume was adjusted to 700 ml. RESULTS: The longevity of the CO2 absorbent was 437 (sd 7.8) min in the control group, 564 (13.8) min in the TGR group (P<0.001 vs control), and 501 (5.8) min in the TGR cooling group (P<0.001 vs control, TGR). Total water condensation in the anaesthesia circuit was 215 (9.4) mg min(-1) in the control group, 223 (9.7) mg min(-1) in the TGR group, and 47.7 (5.7) mg min(-1) in the TGR cooling group (P<0.001 vs control, TGR). CONCLUSIONS: TGR of CO2 absorbent with cooling is a useful and simple method to reduce water condensation in the anaesthesia circuit in low-flow anaesthesia, with a little increase in the longevity of the CO2 absorbent.     

两种不同气道湿化方法用于脑梗死患者气管切开术后疗效比较

目的比较两种不同气道湿化方法用于脑梗死患者气管切开的疗效。方法60例脑梗死气管切开患者按数字表法随机分为观察组及对照组各30例,观察组采用以输液泵持续滴注0．45％氯化钠溶液气道湿化法,对照组采用以注射器间断滴入0．45％氯化钠注射液气道湿化法,比较两组患者刺激性咳嗽、痰痂形成、气道黏膜出血、肺部感染等发生情况。结果观察组刺激性咳嗽、痰痂形成、气道黏膜出血、肺部感染等发生率明显低于对照组,差异有统计学意义（均P〈0．05）。结论应用输液泵持续滴注0．45％氯化钠溶液气道湿化法能明显减少肺部感染及痰痂形成,预防刺激性咳嗽与气道黏膜出血,值得临床推广应用。     

喉癌术后套管内滴药的量、时间与并发症关系的临床研究

喉癌术后易发生窒息、肺部感染、气道内出血、切口感染等并发症 ,为减少并发症 ,保持气道湿化 ,痰液稀化 ,减少痰量 ,能轻易咳出 ,本科特制了湿化液 ,并以痰粘稠度确定套管内滴入湿化液的量和时间。套管内滴入湿化液的同时 ,针对喉癌患者自身特点 ,鼓励咳痰 ,早期下床活动。对在我院住院的喉癌手术患者 (治疗组 )与采用常规吸痰法 (对照组 )进行比较 ,结果显示 :治疗组中无一例并发症发生 ,平均住院天数缩短 (治疗组 11.12± 2 .0 8天 ,对照组 13 9± 3.2 7天 ) ,抗生素费用降低 (治疗组 10 42± 15 3 ,12元 ,对照组 2 192 80± 318.78元 ) ,P <0 .0 5 ,差异有显著意义 ,说明套管内滴入法的可行性及实用性 ,可作为喉癌术后气道湿化法的发展方向推广。     

Carbon dioxide pneumoperitoneum causes severe peritoneal acidosis,unaltered by heating,humidification, or bicarbonate in a porcine model

Background Carbon dioxide (CO₂) is the most common gas used for insufflation in laparoscopy, but its effects on peritoneal physiology are poorly understood. This study looks at the changes in peritoneal and bowel serosal pH during CO₂ pneumoperitoneum, and whether heating and humidification with or without bicarbonate alters the outcomes.Methods Twenty-one pigs divided into four groups as follows: (1) standard (STD) laparoscopy (n = 5); (2) heated and humidified (HH) laparoscopy (n = 6); (3) heated and humidified with bicarbonate (HHBI) laparoscopy (n = 5); and (4) laparotomy (n = 5). Peritoneal pH, bowel serosal pH, and arterial blood gas (ABG) were obtained at 15-min intervals for 3 h.Results Severe peritoneal acidosis (pH range 6.59–6.74) was observed in all laparoscopy groups, and this was unaltered by heating and humidification or the addition of bicarbonate. Bowel serosal acidosis was observed in all laparoscopy groups with onset of pneumoperitoneum, but it recovered after 45 minutes. No significant changes in peritoneal or bowel serosal pH were observed in the laparotomy group.Conclusion CO₂ pneumoperitoneum resulted in severe peritoneal acidosis that was unaltered by heating and humidification with or without bicarbonate. Alteration in peritoneal pH may conceivably be responsible for providing an environment favorable for tumor-cell implantation during laparoscopy.     

The effect of gas flow on the filtration performance of breathing system filters

When tested according to the European standard, the performance of breathing system filters is determined at a flow of 15 or 30 l.min-1 for filters intended for use with paediatric or adult patients, respectively. However, higher flows of gas may pass through a filter in some circumstances. The penetration of sodium chloride particles through seven different breathing system filters (three pleated hydrophobic and four electrostatic) was measured at five different flows ranging from 15 to 75 l.min-1. Penetration varied from 0.004% to 24.4% for the various filters at the different flows. Penetration increased by between 2 and 40 times for the different filters as the flow increased by a factor of five but this did not markedly alter the rank order of the filters in terms of performance. Testing to the standard provides a useful indication of relative performance at any flow.     

常用生物黏附性高分子材料物理性质的比较试验

 目的　考察聚卡波菲等11种常用生物黏附性高分子材料的吸水性、黏附力等与制剂学有关的物理性质,为筛选处方提供可靠的依据。方法　采用离心沉降法以溶胀度为指标测定生物黏附性高分子材料的吸水性能,并且考察了高湿条件下它们的吸湿性;评价了生物黏附性高分子材料在水中分散后的流变学性质;采用简便称重法测定体外条件下不同生物黏附性高分子材料的切向黏附力和垂直方向黏附力。结果　考察的11种生物黏附性高分子材料中,溶胀度、吸湿性、黏度、黏附力均以聚卡波菲最大,同浓度下黏附力排列顺序为聚卡波菲、黄原胶、卡波沫(Carbopol 1342P)、卡波沫(Carbopol 974P)、甲壳素、卡波沫(Carbopol971P)、羟丙基甲基纤维素(Methacel K100M)、羧甲基纤维素钠、羟丙基甲基纤维素 (MethacelK15M)、明胶和阿拉伯胶。结论　吸水性、吸湿性、黏度及黏附力具有一定的相关性,可以用来筛选处方工艺。     

微量注射泵湿化对人工气道效果的观察

目的观察微量注射泵与传统湿化方法的效果，使之临床应用。方法选择150例机械通气患者，随机分为两组，统一表格记录，进行连续观察，将获得资料进行统计分析。结果微量注射泵组无发生刺激性咳嗽及痰阻、痰痂形成1例、气道粘膜损伤出血2例、肺部感染5例：传统组刺激性咳嗽67例、气道粘膜损伤出血10例、痰痂形成21例、痰阻16例、肺部感染26例。结论微量注射泵湿化是一种简单、安全、稳定、有效的方法，减少流程、提高效率。     

0．45％氯化钠溶液与灭菌注射用水在机械通气患者气道湿化中的对照研究

目的观察两种不同湿化液在建立人工气道机械通气患者气道湿化中的作用。方法将我院2009年1-4月心脏外科接受心脏手术治疗后行机械通气的患者40例,利用随机数字表随机分为A组和B组各20例,A组给予0．45％氯化钠溶液100ml加沐舒坦15mg气道湿化液,B组给予灭菌注射用水100ml加沐舒坦15mg作为气道湿化液,观察2组患者吸出痰液的量、颜色、黏稠度、患者的体温、肺部的听诊以及x线胸片情况。结果机械通气后4、8、16、24h及l～2、3～5、6．7d2组患者痰液的量、颜色、黏稠度、患者的体温以及x线胸片情况比较无显著差异,2组患者机械通气后4、16、24h,1-2、3-5、6-7d患者的肺部听诊隋况无显著差异,机械通气后8h的肺部的听诊情况B组优于A组。结论没有足够的依据认为0．45％氯化钠溶液100ml加沐舒坦15mg和灭菌注射用水100ml加沐舒坦15mg作为气道湿化液在机械通气患者气道湿化中的作用效果不同。