连续缝合和间断缝合吻合血管对动静脉内瘘的影响

目的探讨不同血管吻合方式（连续性血管吻合、间断性血管吻合）对动静脉内瘘术成功率的影响。方法将69例终末期慢性肾衰竭患者随机分成3组，连续缝合组、双侧间断缝合组、单侧间断缝合组，按不同的血管吻合方式进行手术，比较各组间内瘘成功率的差异。结果间断缝合组与连续缝合组内瘘成功率比较，差异具有统计学意义（P〈0．05）；双侧间断缝合组与单侧间断缝合组比较，差异无统计学意义（P〉0．05）。结论动静脉内瘘手术中，采取间断缝合法吻合血管比连续缝合法能获得更高的成功率，而双侧间断缝合法与单侧间断缝合法比较并无明显优势。     

气管切开术后气道护理进展

为加强气管切开病人气道管理,从重建生理湿化状态、有效吸痰方法、湿化液选择、气道湿化方法等方面进行了综述。     

气管切开后呼吸道管理的护理进展

介绍了气管切开后呼吸道管理的护理进展.重点阐述了气管切开的适应证,气道湿化的护理管理,吸氧、排痰的护理管理,气囊的护理管理,呼吸道感染的护理.     

Finite-time stabilization control for discontinuous time-delayed networks: New switching design

This paper discusses the finite-time stabilization problem for time-varying delayed neural networks (DNNs) with discontinuous activation functions. By using fixed point theory and set-valued analysis, we establish the existence theorem of equilibrium point. In order to stabilize the states of this class of discontinuous DNNs in finite time, we design two different kinds of switching controllers which are described by discontinuous functions. Under the framework of Filippov solutions, several new and effective criteria are derived to realize finite-time stabilization of discontinuous DNNs based on the famous finite-time stability theory. Besides, the upper bounds of the settling time of stabilization are estimated. Numerical examples are finally provided to illustrate the correctness of the proposed design method and theoretical results.     

非确定性人工气道湿化法降低脑卒中舌后坠患者肺部感染的效果研究

目的探讨脑卒中舌后坠患者非确定性人工气道(口咽通气道下)湿化的方法及临床应用效果。方法选择应用口咽通气道的脑卒中舌后坠呼吸困难患者60例,随机分为观察组和对照组各30例,观察组采取经口咽通气道内径孔道持续湿化法;对照组应用五官科喉头喷雾器间歇湿化法。观察两组患者痰液湿化效果、吸痰次数、痰痂的形成、气道黏膜损伤以及肺部感染情况。结果湿化第3、7天观察组痰液湿化效果满意率优于对照组、肺部感染率低于对照组,差异有统计学意义(P0.05);湿化第7天观察组痰痂的形成、气道黏膜的损伤低于对照组,差异有统计学意义(P0.05);湿化第3、7天观察组吸痰次数明显低于对照组,差异有明显统计学意义(P0.01)。结论脑卒中舌后坠患者采用非确定性人工气道持续湿化法,湿化效果满意,可减少吸痰次数、痰痂的形成以及气道黏膜的损伤,有效降低患者肺部感染的发生率。     

High flow nasal oxygen generates positive airway pressure in adult volunteers

INTRODUCTION: The use of non-invasive ventilation (NIV) as an alternative to intubation in respiratory failure is associated with better outcomes in certain conditions. NIV is often poorly tolerated by patients hence precipitating the need for invasive ventilation. High flow nasal (HFN) oxygen delivery is a potential alternative to NIV as it delivers air and oxygen via a humidified circuit at flows greater than those traditionally used with a nasal interface. BODY: Studies of paediatric patient using high flow nasal oxygen therapy have been shown to have similar efficacy as nasal continuous positive airway pressure (CPAP). Although the degree of positive pressure and the effect of different flow rates on positive pressure generation have not been well defined or studied in the adult intensive care population. St. Vincent's Health Human Research and Ethics Committee granted approval to this study and also awarded a $3000 grant. Volunteers were fitted with the Fisher & Paykel high flow nasal interface (RT034) and pharyngeal pressures were recorded with flows from 0 to 60L/min. Expiratory pressures with the mouth closed were higher than those with the mouth open and this was statistically significant (<0.001). Expiratory pressures were higher with the mouth closed and were statistically different (p<0.001). EPPs were higher amongst female subjects compared to male subjects and were statistically different between genders for both open (p<0.05) and closed (p<0.001) measurements. CONCLUSION: This study has demonstrated that high flow nasal therapy is associated with the generation of significant positive airway pressure in volunteers. In conclusion there is a degree of CPAP generated with the HFN therapy, which is flow dependent and also dependent on whether the person is breathing with mouth open or closed.     

人工气道应用微量注射泵持续湿化的效果分析

目的探索人工气道应用微量注射泵持续湿化的效果.方法随机将70例气道切开患者分为2组,实验组35例采用微量注射泵持续推注湿化气道,对照组35例采用传统的气道内定时、间断滴注湿化法,并进行连续观察、对比分析.结果实验组形成痰痂、发生刺激性咳嗽、气道出血的例数均明显少于对照组,肺部感染发生率亦低于对照组,同时减少护理工作量.结论人工气道应用微量注射泵持续推注湿化法明显优于传统气道内定时、间断滴注湿化法.     

盐酸氨溴索联合碳酸氢钠用于吸入性损伤气管切开病人气道湿化的临床观察

[目的]观察盐酸氨溴索联合碳酸氢钠用于吸入性损伤气管切开病人气道湿化的效果。[方法]将2013年6月—2016年5月烧伤科70例因吸入性损伤行气管切开的成人病人按随机数字表法分为对照组和观察组各35例,对照组在气管切开的常规护理基础上采用传统的糜蛋白酶、硫酸庆大霉素、地塞米松磷酸钠及生理盐水作为气道湿化液,使用持续微量注射泵滴入气道湿化法,观察组在气管切开的常规护理基础上采用盐酸氨溴索+1.25%碳酸氢钠作为湿化液,使用持续微量注射泵滴入气道湿化法。比较两组病人并发症发生情况、气道湿化效果。[结果]观察组病人痰痂形成、呼吸道感染、刺激性咳嗽、气道黏膜损伤和出血等并发症发生率低于对照组(P0.05),湿化效果优于对照组(P0.05)。[结论]盐酸氨溴索联合碳酸氢钠用于吸入性损伤气管切开术后病人气道湿化的效果明显,并发症发生率低,效果优于传统的糜蛋白酶、硫酸庆大霉素、地塞米松磷酸钠及生理盐水作为气道湿化液。     

两种呼吸道湿化法用于大面积烧伤合并中、重度吸入性损伤患者的护理比较

[目的]探讨两种呼吸道湿化法用于大面积烧伤合并中、重度吸人性损伤患者呼吸道湿化的临床效果.[方法]选择2007年1月-2009年12月我科大面积烧伤患者120例,随机分为对照组和实验组,每组60例.实验组采用呼吸道输液泵持续湿化法,对照组采用呼吸道间断推注湿化法,比较两组患者痰痂形成、发生刺激性咳嗽、呼吸道粘膜出血及肺部感染情况.[结果]实验组痰痂形成、发生刺激性咳嗽、呼吸道粘膜出血的例数明显低于对照组（P〈0.05）,肺部感染发生率亦低于对照组（P〈0.01）.[结论]呼吸道输液泵持续湿化法可以明显减少痰痂形成、刺激性咳嗽、呼吸道粘膜出血及肺部感染发生率,减少了护理人员工作量,提高了人工呼吸道护理质量.     

颅脑外伤气管切开患者气道湿化不佳的相关因素分析及护理

目的:探究颅脑外伤气管切开患者气道湿化不佳的相关因素,进一步找出最适合的护理方法.方法:对我院收治的需要进行气管切开的20 例颅脑外伤患者分为两组,分别做气道湿化不足以及气道湿化过度两种情况,再对两组分别再进行分组做对比试验.结果:气道湿化不足患者中:传统组出现痰痂3例、血痂1例、气管堵塞1例;雾化组出现痰痂1例、血痂1例;两组比较差异具有统计学意义(P<0.05).气道湿化过度的患者,低浓度组出现痰液粘稠的1例、刺激性咳嗽1例;正常浓度组出现痰液粘稠2例、刺激性咳嗽2 例、气道粘膜出血1例;两组比较差异具有统计学意义(P<0.05).结论:对于颅脑外伤患者而言,气管切开是保证其呼吸道畅通的关键,而做好气管切开湿化护理又是相当重要的,能确保呼吸道通畅,为脑部提供充足的氧,改善脑外伤预后.