持续无水式鼻导管吸氧的临床应用

目的探讨无水式鼻导管吸氧的氧疗效果及其在感染控制方面的作用,为临床实施氧疗护理提供实证依据。方法方便性抽样选取100例进行鼻导管吸氧的患者,采用随机数字表法分为研究组和对照组,分别采取无水式和常规蒸馏水湿化方式吸氧,比较两组患者的呼吸道症状、肺部感染率及吸氧装置染菌情况。结果两组患者在呼吸困难、上呼吸道干燥不适、鼻腔分泌物结痂及充血等方面差异均无统计学意义（均P〉0．05）;研究组患者体温升高、WBC升高及肺部感染的比例均低于对照组,吸氧装置染菌率低于对照组,差异均有统计学意义（P〈O．05或P〈0．01）。结论使用无水式鼻导管吸氧在不增加患者呼吸道不适的前提下,能有效降低肺部感染率,减轻护士工作量,值得临床推广应用。     

持续气管内滴药预防气管切开术后肺部感染疗效观察

目的探讨有效的气管内给药护理方式,降低气管切开术后患者呼吸道感染的发生率,改善预后。方法收集本院ICU及感染内科87例气管切开患者,其中26例给予间歇气管内滴药,34例给予气管内喷雾,27例给予持续气管内滴药。采用检测不同时间点血液中的药物浓度以及痰液细菌学培养的方法,对上述3组方案进行疗效比较。结果持续气管内滴药组在各时间点所测得的血药浓度均显著高于其他组,而该组痰培养阳性例数所占比例也要低于其他2组。结论采用持续气管内滴药的方法,在预防气管切开术后患者的肺部感染、改善预后方面的疗效优于其余2种气道湿化法。     

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。     

人工气道湿化的研究进展

从气道湿化的生理和病理改变、最适温度与湿度、方法和效果方面综述了人工气道湿化的研究现状,提出应加强气道内湿度监测的研究.     

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.     

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.     

氧气湿化瓶清洗消毒过程的细节优化

目的为探索提高重复使用氧气湿化瓶的清洗消毒质量,通过实验比较两种不同浸泡方法以及终末漂洗选择常水与纯水对重复使用氧气湿化瓶清洗消毒效果的影响,寻求最佳清洗消毒流程。方法采用无菌棉拭子涂擦采样和细菌定量检测方法,第1组实验中实验组采用多酶清洗液浸泡后再用84消毒液浸泡消毒,对照组只使用多酶清洗液浸泡。第2组实验中实验组消毒后选择纯水冲洗,对照组选择自来水。对清洗后的每个氧气湿化瓶进行采样,样本送微生物实验室进行细菌培养和菌落计数。结果经多酶清洗液和84消毒液浸泡后的氧气湿化瓶消毒合格率100％,仅经多酶清洗液浸泡的氧气湿化瓶合格率为92％。消毒后使用纯水冲洗的合格率为100％,使用自来水冲洗的合格率为72％。结论由消毒供应中心集中清洗的氧气湿化瓶,其清洗质量能得到保证;氧气湿化瓶在急救时可不经84消毒液消毒;使用纯水终末漂洗其清洗效果明显优于使用自来水。     

医院氧气湿化瓶的细菌污染情况及护理干预

目的调查医院氧气湿化瓶的细菌污染情况,进行相应的护理干预,减少氧气湿化瓶细菌污染引起的医院感染。方法抽查我院各病区患者使用后的氧气湿化瓶（患者使用后组）180只,消毒后已安装但患者未使用的氧气湿化瓶（消毒已安装组）150只,消毒后未安装氧气湿化瓶（消毒未安装组）100只,进行细菌培养和监测。结果患者使用后组氧气湿化瓶细菌污染率为76.6%,消毒已安装组细菌污染率为14.0%,消毒未安装组氧气湿化瓶未培养出细菌,三组氧气湿化瓶细菌污染率间差异有统计学意义（χ2=15.28,P〈0.01）,两两比较差异均有统计学意义（P〈0.01）。两组氧气湿化瓶污染细菌分布间差异无统计学意义（χ2=1.83,P〉0.05）。结论加强氧气湿化瓶消毒后无菌保存,安装过程无菌操作,每次使用后更换湿化液,是降低氧气湿化瓶细菌污染的有效措施,预防交叉感染,降低医院感染率。