高压氧条件下无阻力气管套管给氧对重型颅脑损伤并肺部感染患者的影响

目的比较重型颅脑损伤气管切开并肺部感染患者高压氧治疗与常压下经气管套管口给氧治疗的效果,探讨在大型压缩空气医用氧舱中无舱内呼吸机的条件下,采用自创吸氧连接装置高压氧治疗的可行性及通气情况。方法重型颅脑损伤气管切开并肺部感染患者60例,按年龄、性别、格拉斯哥昏迷（COS）评分分层后,随机分为高压氧组和对照组,每组30例。两组患者均给予降颅压、保护脑组织、手术（或非手术）、敏感抗菌药物、对症支持和氧气治疗等。对照组在常压下经气管套管采用一次性吸氧管给氧治疗,高压氧组采用我科自创吸氧连接装置进行高压氧治疗。对两组患者的体温、咳嗽咳痰、白细胞总数及分类、肺部听诊变化等情况进行比较。结果高压氧组体温恢复正常、咳嗽咳痰好转、白细胞总数及分类正常、肺部呼吸音清晰的时间明显短于对照组,组间比较差异有统计学意义（P〈0．01）。结论自创吸氧连接装置符合呼吸机呼气末正压通气模式,在压缩空气医用氧舱中无呼吸机辅助呼吸的条件下,对重型颅脑损伤气管切开术后并发肺部感染患者行高压氧治疗具有较好的实用价值。     

腹式呼吸治疗冠心病临床疗效观察

目的观察腹式呼吸对社区冠心病(CHD)患者临床症状及心电图ST-T、血清总胆固醇(TC)的影响,探讨其作用机制和临床意义。方法选择30例住院治疗的冠心病患者,随机分为试验组(15例,常规药物治疗加腹式呼吸训练)与对照组(15例,单纯常规药物治疗),观察治疗前后2组患者心绞痛等临床症状计分,静息心电图ST-T,血清TC的变化,并根据临床疗效评定标准对2组临床总疗效进行比较。结果试验组临床总有效率为80%,对照组为67%(P<0.01);实验组静息心电图有效率、心绞痛缓解率分别为(87%,93%),对照组分别为(47%,73%),差异有统计学意义,P均<0.05;实验组血清TC含量由治疗前(5.8±0.6)mmol/L下降至(4.6±0.5)mmol/L(P<0.01),临床症状由治疗前的13.5±1.3下降到3.3±1.5,P<0.05)。结论腹式呼吸治疗冠心病疗效确切,简便易行,是心血管药物治疗冠心病同时、有效的协同疗法,可在社区冠心病防治中推广应用。     

依托咪酯在老年人无痛胃镜中的应用

目的观察老年人无痛胃镜检查中应用依托咪酯静脉麻醉的效果及安全性。方法80例实施无痛胃镜检查的老年患者,随机分成2组,静脉注射A组选用异丙酚＋芬太尼,B组选用依托咪酯＋芬太尼。记录2组患者检查前、中、后的心率、血压、脉搏、血氧饱和度、苏醒时间、不良反应及麻醉满意度。结果A组在检查过程中血压、心率变化最大时与检查前相比较,降低20%～30%左右,B组则变化较小,血压仅降低5%左右,心率降低6%左右。结论在为老年人实施无痛胃镜检查时,应用依托咪酯＋芬太尼静脉麻醉可以达到与异丙酚同样满意的麻醉效果,而且在血流动力学方面存在一定的优势。     

重症哮喘患者呼吸干预的临床疗效观察

目的探索对哮喘患者呼吸干预的方法，为成功救治重症哮喘患者提供可靠依据。方法将2009年18例（对照组）和2011年1-12月22例（干预组）经临床治疗重症哮喘患者的临床资料进行回顾性研究、分析、归纳、整理，并对两组患者呼吸系统临床相关佐证资料及干预手段与治疗效果的相关性进行研究。结果干预组与对照组比较患者血气分析指标好转和症状缓解时段明显缩短（P〈0．05）。结论早期规范的对哮喘患者进行呼吸干预是临床成功治疗重症哮喘患者的关键之一。     

使用无创呼吸机病人的护理体会

目的：探讨无创呼吸机治疗过程中对患者的评估及护理措施。方法：对使用无创呼吸机61例患者进行护理评估，并根据评估结果采取相应的护理措施。结果：61例患者中58例治疗有效，3例无效。结论：对使用无创呼吸机的患者进行评估及护理，能使患者积极配合，提高患者的依从性，增加患者的舒适度，减少并发症的发生，取得较为满意的疗效。     

Cambridge Breathlessness Intervention Service (CBIS)

Abstract

Breathlessness is a common disabling symptom of advanced cardiorespiratory disease both malignant and non-malignant in nature. It is profoundly distressing for both patient and those who care for them, and often leads to disability, social isolation, and depression. It is extremely difficult to palliate successfully and interventions that help breathlessness are still poorly understood. Breathlessness occurs in 90% of patients with advanced chronic obstructive pulmonary disease and lung cancer and is also common in heart failure. The Cambridge Breathlessness Intervention Service was set up to deliver an evidence-based complex intervention for breathlessness and to carry out research to improve its management. The team consists of a palliative care consultant, specialist physiotherapists, a lead occupational therapist: it is part of a palliative care department at an acute hospital but sees patients in the community and carries out ward consultations. The evaluation and modelling of the service (using the Medical Research Council (MRC) methodology for research in complex interventions) has taken 10 years and has shown the value of the fan, using pacing techniques, an individualized exercise programme, breathing exercises, learning anxiety reduction techniques, and support for carers delivered with a rehabilitative approach. Recently, the Phase III evaluation of the service has demonstrated its effectiveness in reducing distress due to breathlessness in patients with lung cancer. The qualitative data also demonstrated the importance not only of the interventions themselves but also the manner in which they were delivered, i.e. that empathy; kindness and active listening were central to effective management.     

呼吸过滤器对老年患者全身麻醉术后呼吸道感染的预防作用

目的 观察呼吸过滤器（BF）对老年患者全身麻醉插管术后并发呼吸道感染的预防作用.方法 选择全身麻醉插管择期行胃肠肿瘤根治术的老年患者100例,随机分成两组各50例.观察组使用BF,对照组不使用BF.分别对麻醉前后两组气管导管末端、呼吸回路气管端采样进行细菌培养;统计两组术后7d内下呼吸道感染的发生率.结果 术后两组气管导管末端均检测到大量细菌生长.对照组呼吸回路气管端检测到大量细菌生长[（305.2±12.4） CFU/cm2],而观察组[（10.2±2.0）CFU/cm2]几乎无细菌生长,两组比较差异有统计学意义（t=166.077,P＜0.01）;术后随访观察组无病例被确诊为下呼吸道感染,而对照组有5例（10.0％）发生肺部感染,差异有统计学意义（x2=5.263,P＜0.05）.结论 BF可有效滤过呼吸回路细菌,显著降低老年患者全身麻醉插管术后呼吸道感染的发生率.     

A non-invasive technique for evaluation of respiratory efforts in preterm infants during feeding

The aim of this study was to develop a minimally invasive technique to evaluate respiratory patterns in preterm infants during feeding.MethodologyRespiratory flow was obtained with a pneumotachograph coupled initially to a mask and then to a prong, both with a differential pressure transducer. Respiratory plethysmography was used to measure thoraco-abdominal movements. This recording allowed calibration of the preterm infant’s tidal volume prior to feeding experiments. Electromyography was used to monitor oral muscle movements through electrodes attached to the buccinator, masseter and mentalis muscles. A pulse oximeter and cardiac monitor were used for continuous monitoring of vital signs. The infants were positioned vertically in a semi-sitting position in an infant seat.ResultsThe methodology developed here was considered effective in achieving the proposed aims. With the integration of all these systems, it was possible to evaluate the respiratory patterns of preterm infants during cup feeding.ConclusionThis method allows the analysis of respiratory flow, volume, and O₂ saturation during feeding and identification of the moment in which a change in breathing occurs (i.e., pausing or feeding). This method is minimally invasive, providing the preterm infant with an environment that is as close to normal as possible.     

Respiratory Muscle Training Reduces Respiratory Complications and Improves Swallowing Function After Stroke: A Systematic Review and Meta-Analysis

ObjectiveTo investigate whether respiratory muscle training is capable of reducing the occurrence of respiratory complications and improving dysphagia (swallowing or cough function) after stroke.Data SourcesCochrane Library, Excerpta Medical Database (EMBASE), PUBMED, and Web of Science were searched for studies published in English; the China Biology Medicine (CBM), China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI), and Wanfang Database were searched for studies published in Chinese up to August 10, 2021.Study SelectionEleven randomized control trials (RCTs) (N=523) met the inclusion criteria were included in this systematic review.Data ExtractionData and information were extracted by two reviewers independently and disagreements was resolved by consensus with a third coauthor. Primary outcome was the occurrence of respiratory complications, secondary outcomes would be represented by swallowing and cough function. The quality of each included RCT were assessed by Cochrane risk-of-bias criteria and the GRADE evidence profile was provided to present information about the body of evidence and judgments about the certainty of underlying evidence for each outcome.Data SynthesisRespiratory muscle training reduced the risk of respiratory complications (relative risk, 0.51; 95% confidence interval [CI], 0.28-0.93; I²=0%; P=.03; absolute risk difference, 0.068; number need to treat, 14.71) compared with no or sham respiratory intervention. It also decreased the liquid-type Penetration-Aspiration Scale scores by 0.81 (95% CI, –1.19 to –0.43; I²=39%; P<.0001). There was no significant association between respiratory muscle training and Functional Oral Intake Scale (FOIS) scores, cough function: increased FOIS scores by 0.47 (95% CI, –0.45 to 1.39; I²=55%; P=.32), decreased peak expiratory cough flow of voluntary cough by 18.70 L per minute (95% CI, –59.74 to 22.33; I²=19%; P=.37) and increased peak expiratory cough flow of reflex cough by 0.05 L per minute (95% CI, –40.78 to 40.87; I²=0%; P>.99).ConclusionThis meta-analysis provided evidence that respiratory muscle training is effective in reducing the risk of respiratory complications and improving dysphagia by reducing penetration or aspiration during swallowing liquid bolus after stroke. However, there was no sufficient evidence to determine that respiratory muscle training improves cough function. Additional multicenter studies using larger patient cohorts are required to validate and support these findings. Furthermore, long-term follow-up studies should be performed to measure outcomes, while avoiding bias due to confounding factors such as heterogeneity of the etiologies of dysphagia.