加温加湿经鼻高流量氧疗对老年脑梗死合并肺部感染患者的效果研究

目的探讨加温加湿经鼻高流量氧疗对老年脑梗死合并肺部感染患者的临床疗效。方法选取2018-01—2020-01郑州大学第二附属医院收治的60例老年脑梗死合并肺部感染患者,随机分为对照组和观察组各30例,对照组给予传统的吸氧面罩方式给氧,观察组采用加温加湿经鼻高流量氧疗,观察2组临床效果。结果治疗72 h后观察组PaO2(101.3±5.86)mmHg,PaCO2(35.96±2.55)mmHg,SaO2(93.50±4.58)%,心率(70.6±3.556)次/min,呼吸频率(18.6±1.028)次/min,均明显优于对照组的PaO2(95.12±5.11)mmHg,PaCO2(40.89±3.36)mmHg,SaO2(89.36±3.77)%,心率(83.12±1.18)次/min和呼吸频率(22.9±0.944)次/min(P<0.05)。治疗1周后观察组痰液黏稠度Ⅰ度占比70%,Ⅱ度占比30%,Ⅲ度占比0,明显低于对照组的Ⅰ度占比26.67%,Ⅱ度占比60%,Ⅲ度占比13.33%(P<0.05)。治疗72 h后观察组口鼻腔黏膜干燥者舒适度(3.29±1.07)明显优于对照组(5.99±1.23)(P<0.05),咽喉疼痛者舒适度(4.77±0.89)明显优于对照组(7.78±1.12)(P<0.05)。结论加温加湿经鼻高流量氧疗对老年脑梗死合并肺部感染患者的疗效显著,能够有效改善患者的动脉血气指标,降低心率和呼吸频率,降低痰液黏稠度,增加患者氧气吸入的舒适性和耐受性。     

人工气道持续氧雾化湿化的临床应用研究

[目的]观察持续氧雾化人工气道湿化在重型颅脑损伤、脑出血行气管切开病人中的临床应用效果。[方法]将92例重型颅脑损伤、脑出血行气管切开、气管插管病人随机分为观察组和对照组,每组46例,观察组采用持续氧雾化温化法和对照组采用持续滴注湿化法。观察并比较两组病人气道湿化效果。[结果]观察组病人痰液黏稠度明显低于对照组（P〈0．05）;观察组气道湿化并发症发生率（包括刺激性咳嗽、痰栓形成、气道黏膜损伤出血、肺部感染）明显低于对照组（P〈0．05）;与对照组比较,观察组病人血氧分压（PaO2）、血氧饱和度（SaO2）明显升高,心率、呼吸频率明显减慢（P〈0．05）。[结论]持续氧雾化人工气道湿化能安全、有效地提高重型颅脑损伤、脑出血行气管切开、气管插管病人的气道湿化效果。     

气管切开术后微量输液泵持续滴注法湿化人工气道的效果观察

[目的]探讨气管切开术后微量输液泵持续滴注法湿化人工气道的效果。[方法]将102例气管切开病人随机分为两组,实验组采用输液泵持续向人工气道滴注湿化液,对照组采用传统的间断气管内滴注法湿化气道。[结果]实验组并发症发生率低于对照组（P〈0．05）,湿化效果优于对照组（P〈0．05）,差异具有统计学意义。[结论]输液泵持续向人工气道滴注湿化液优于传统的间断气管内滴注法。     

Perforated synapses on double-headed dendritic spines: a possible structural substrate of synaptic plasticity

Examination of axospinous synapses in serial sections obtained from the middle molecular layer of the rat dentate gyrus has revealed that some of them involve double-healed dendritic spines. Each spine head is apposed by a separate axon terminal with which it always forms a perforated synaptic contact distinguished by a discontinuous postsynaptic density. The number of perforated synapses on double-headed spines was estimated as a synapse-to-neuron ratio with the aid of the disector technique and found to be significantly increased in rats kindled via medial perforant path stimulation. These results support the notion that perforated synapses involving double-headed dendritic spines represent a structural modification related to enhanced synaptic efficacy.     

A comparison of five heat and moisture exchangers

Five heat and moisture exchangers were investigated to compare their efficiency of humidification, their ability to filter bacterial spores and their various physical properties. The results are presented and the various mechanisms of heat and moisture exchange are reviewed. The Pall Ultipor BB50, because of its hydrophobic properties, has a slightly different action from heat and moisture exchangers already in use, The place of the Pall Ultipor BB50 in clinical practice is discussed.     

Humidification devices

Humidification is concerned with the addition of water vapour to a gas and can be measured as either absolute or relative. Adequate humidification is a vital consideration in anaesthesia given that the anatomical source of natural gas humidification (the nasopharynx) is generally bypassed, which can lead to complications including hypothermia, thickening of respiratory secretions, mucus plugging and airway keratinization. Humidification may be passive or active. Equipment involved in passive humidification includes HME filters, soda lime and cold water baths, with these devices able to achieve varying efficiencies without extrinsic energy input. Active humidification devices (including hot water baths) are capable of delivering a higher relative humidity but are associated with higher cost and potential hazards. While not strictly classed as true humidification devices, nebulizers are considered in this article as they add water droplets into a gas flow using a Venturi system, spinning discs or ultrasound vibration technology.     

文丘里空氧混合阀联合面罩温湿化给氧在脑卒中患者的应用

目的探讨文丘里空氧混合阀联合面罩持续温湿化在脑卒中患者中的应用效果。方法将60例脑卒中患者按照入院时间分为对照组与观察组各30例,对照组使用扶舒清鼻导管或面罩给氧,观察组使用文丘里空氧混合阀联合面罩温湿化给氧,观察两组血氧饱和度、痰液黏稠度、痰痂形成、痰培养结果及开放气道时间。结果观察组血氧饱和度、痰液黏稠度、痰痂形成、气道开放时间显著优于对照组,痰培养阳性率显著低于对照组(P0.05,P0.01)。结论文丘里空氧混合阀联合面罩湿化给氧可有效提高患者氧疗效果,湿化患者气道,缩短患者气道开放时间,降低肺部感染发生率。     

High-flow insufflation

Summary

Within the last decade, laparoscopy has developed from mainly a diagnostic technique to an extensive therapeutical procedure. This development has led, among others, to new or extended requirements for intra-abdominal insufflation. These requirements are outlined and analysed. A new generation insufflator, developed and manufactured by Karl Storz, is presented and evaluated. This instrument fulfills these requirements to a large extent by providing high-flow insufflation with up to 30 l/min average flow, further improved pressure control and optional gas heating to body temperature. Further, additional security functions are provided such as monitoring of the correct Veress needle placement, monitoring of the insufflation line status, active venting, good vision during smoke generation (CO₂ laser, electrocautery) by semi-continuous insufflation or display of selected functional parameters in the videoendoscopic image. Finally, an optional CO₂ gas humidification system is also provided.     

0．45％盐水氧气射流雾化在气管切开患者中的应用

目的探讨0．45％盐水氧气射流雾化用于气管切开患者的临床效果。方法将60例气管切开患者随机分为观察组和对照组各30例，对照组用0．9％氯化钠注射液500ml加庆大霉素8万U、α-糜蛋白酶5mg、地塞米松10mg进行气管内间断滴入湿化，3～5ml／次，每2小时1次；观察组用0．45％盐水氧气射流雾化，每2小时1次，每次15～20min。两组均连续湿化15d。结果观察组痰液黏稠度、痰液活菌比例、肺部感染发生率、气道湿化效果、氧合状态显著优于对照组（均P〈0．01）。结论0．45％盐水氧气射流雾化用于气管切开患者可更好地保持呼吸道通畅，维持适当肺通气、氧合作用，降低肺部感染。     

泰利福氧气驱动持续气道加温湿化装置的改良应用

目的：探讨改良泰利福氧气驱动持续气道加温湿化装置的应用效果。方法对29例人工气道脱机患者采用改良式持续气道加温湿化方法：以空气驱动加温湿化装置，关闭文丘里空氧混合阀。呼吸螺纹管接“Y”型三通连接人工气道，氧气单独从氧气流量表供给，从“Y”型三通的另一开口插入人工气道，保证湿化和吸氧同时进行。结果采用改良式持续气道加温湿化方法后，装置存在的噪音得到解决，保证病人安全吸氧，充分湿化，并减少了高流量氧气驱动湿化水，节约成本。29例病人气道湿化效果满意，无气道阻塞、出血、痰痂形成。结论改良式气道加温湿化装置可以解决泰利福氧气驱动持续气道加温湿化装置存在的噪音问题，同时可满足病人吸氧需求和节约成本。