密闭式吸痰管在机械通气患者治疗中的疗效观察

目的研究更适合机械通气患者气管内吸痰的方式。方法选取外科重症监护病房（SICU）和急诊重症监护病房（EICU）机械通气治疗的61例患者为研究对象，随机选择使用密闭式气管内吸痰（CS）和开放式气管内吸痰（OS）两种吸痰方式，于吸痰前后记录脉搏血氧饱和度（SpO2）的变化并比较两组患者并发症例数。结果吸痰中、吸痰后0．5minOS治疗组各时点SpO2值较吸痰前1min下降明显（P〈0．05），CS治疗组吸痰前后SpO2值无显著差异（P〉0．05）。两组并发症比较无显著差异（P〉0．05）。结论CS对机械通气患者更有利。     

不同高度储血器放置对负压吸引下红细胞损伤的影响

目的探讨不同高度储血器放置对负压吸引下红细胞损伤的影响。方法选择库存时间30~40d、证实被乙肝病毒感染的浓缩红细胞与同血型的血浆混匀(1U∶100ml),每次抽取50ml,共60份,随机均分为三组:H组、N组和L组。依次将每份血液平铺于平底金属弯盘中,通过200mm Hg的吸引负压将弯盘中的血液收集于储血器内。根据储血器放置的高度分为三组,储血器高于弯盘水平30cm(H组);储血器与弯盘同一水平(N组);储血器低于弯盘水平30cm(L组)。比较三组60s内储血器中收集到的血液容量(V收集),比较负压吸引前弯盘内和负压吸引60s后储血器内血液的红细胞畸形率(EDR)以及上清液中的游离血红蛋白含量(FHb)。结果与吸引前比较,三组血液EDR、FHb在负压吸引后均明显升高(P0.05或P0.01);与H组比较,N组和L组V收集明显增加,而EDR和FHb在负压吸引后明显降低(P0.05)。结论负压吸引可引起经过血浆混匀后的库存浓缩红细胞形态改变和发生溶血,这种损伤程度与负压吸引过程中储血器放置的高度有关。其中,储血器放置于吸血平面上方30cm时对红细胞造成的损伤程度要高于放置在同一水平或下方30cm者。     

超声引导下小针刀联合双针穿刺抽吸治疗钙化性冈上肌腱炎的临床观察

目的探讨改良型超声引导下小针刀经皮穿刺联合双针抽吸治疗钙化性冈上肌腱炎的效果及安全性。方法将60例钙化性冈上肌腱炎患者随机分为对照组和观察组,每组各30例。对照组在超声引导下先以小针刀穿刺后再行单针头经皮抽吸治疗;观察组在超声引导下先以小针刀穿刺后再行双针头经皮抽吸治疗。两组分别于治疗前,治疗后3 d、7 d、1个月、6个月采用数字评价量表(NRS)评价患者疼痛程度;采用美国加州大学肩关节评分系统(UCLA)和Constant-Murley肩关节功能评分系统评价患者肩关节功能和活动范围。比较两组患者DR片检查结果及二次、三次治疗比率。同时记录治疗和随访期间不良反应发生情况。结果两组患者治疗前NRS评分比较,差异无统计学意义;治疗后3 d、7 d观察组患者NRS评分均低于对照组,差异均有统计学意义(均P<0.05);治疗后1个月、6个月两组NRS评分比较差异均无统计学意义。两组患者治疗前与治疗后3 d、7 d、1个月、6个月UCLA评分和Constant-Murley评分比较差异均无统计学意义。观察组患者DR片显示,治疗后7 d钙化灶减小或消失。观察组患者二次、三次治疗比率均低于对照组,差异均有统计学意义(均P<0.05)。两组患者治疗期间不良反应发生率比较,差异无统计学意义。结论与传统超声引导下小针刀联合单针头抽吸术比较,超声引导下小针刀联合双针头穿刺抽吸治疗钙化性冈上肌腱炎可在早期缓解患者症状,治疗效果显著,具有较好的安全性。     

Development of normal-suction boundary control method based on inflow cannula pressure waveform for the undulation pump ventricular assist device

It is desirable to obtain the maximum assist without suction in ventricular assist devices (VADs). However, high driving power of a VAD may cause severe ventricle suction that can induce arrhythmia, hemolysis, and pump damage. In this report, an appropriate VAD driving level that maximizes the assist effect without severe systolic suction was explored. The target driving level was set at the boundary between low driving power without suction and high driving power with frequent suction. In the boundary range, intermittent mild suction may occur. Driving power was regulated by the suction occurrence. The normal-suction boundary control method was evaluated in a female goat implanted with an undulation pump ventricular assist device (UPVAD). The UPVAD was driven in a semipulsatile mode with heartbeat synchronization control. Systolic driving power was adjusted using a normal-suction boundary control method developed for this study. We confirmed that driving power could be maintained in the boundary range. Occurrences of suction were evaluated using the suction ratio. We defined this ratio as the number of suction occurrences divided by the number of heartbeats. The suction ratio decreased by 70% when the normal-suction boundary control method was used.     

血栓抽吸导管联合替罗非班在急性ST段抬高性心肌梗死介入治疗中的应用

目的观察急性sT段抬高性心肌梗死（ST—EMI）患者行急诊冠状动脉介入治疗（PCI）过程中及术后,DIVERTM CE血栓抽吸导管与血小板糖蛋白Ⅱb／Ⅲa受体拮抗剂替罗非班（冠状动脉内推注后静脉滴注维持）联合应用的临床疗效及安全性。方法选择2008年4月至2011年3月间符合PCI治疗条件的急性sT段抬高性心肌梗死患者共60例。按入院顺序将患者随机归为两组：32例（A组）患者给予替罗非班;28例患者（B组）给予DIVER TM CE血栓抽吸导管与替罗非班联合应用。比较两组患者手术前后的心肌梗死血管（TIMI）血流变化、出血性并发症和住院期间主要心脏不良事件（MACE）的发生率。结果B组术后即刻TIMI血流改善效果明显优于A组,在住院期间MACE的发生率低于A组（25．0％vs3．6％,P〈0．05）,两组均无致命性出血并发症。结论在急性sT段抬高性心肌梗死PCI中应用DIVER TM CE血栓抽吸导管与替罗非班（冠状动脉内推注后静脉滴注维持）能够明显减少冠状动脉内血栓,减少无复流现象,降低住院期间心血管事件发生率,亦无致命性出血并发症,是一种安全有效的治疗方法。     

Peak blistering point: influence on fluid levels of 5-MOP in human skin in vivo after systemic administration

Summary The concentration of 5-methoxypsoralen (5-MOP) in suction blister fluid (SBF) after oral intake was determined in relation to the peak blistering point. Interstitial fluid was obtained from nine healthy male volunteers by applying mild suction (300–350 mmHg) to the skin of the volar aspect of the forearm. Blisters were raised at three different times: 18 h prior to drug administration (group I); 2 h prior to drug administration (group II); and during drug ingestion (group III). SBF levels of 5-MOP were determined in each group of blisters 2 h after oral administration of 1.2 mg/kg micronized 5-MOP. The results showed a statistically significant difference in the concentrations of 5-MOP between each group of blisters. The highest concentration of 5-MOP in the SBF was found in group III and the lowest in group II blisters. These findings suggest that the point of peak blistering in relation to drug administration needs to be known in each pharmacological study using suction blisters.     

异丙酚静脉麻醉人工流产的临床研究

目的 :评价异丙酚静脉麻醉人工流产的效应。方法 :16 0 0例ASAⅠ～Ⅱ、妊娠 1～ 3月孕妇 ,80 0例自愿实行全麻人工流产者为治疗组 ,另 80 0例自愿无麻醉人工流产者为对照组。治疗组采用两次推注给药法 ,首次给药至深镇静 ,1 5～ 2分钟后再次追加 5 0 %诱导量。观察诱导剂量、诱导过程术中HR、BP、SpO2 变化、恢复时间、副作用、患者满意程度及对照组VAS评分。结果 :两组平均手术时间为 5 2 8～ 5 44分钟 ,治疗组异丙酚用量 187 40± 32 18mg ;治疗组术中MAP下降大于 2 0 %的患者为 13 % ,对照组为 39% ;治疗组HR减慢超过 2 0 %为 7 9% ,对照组为 39% ;治疗组恶心和呕吐率分别为 2 1%和 1 9% ,对照组为 2 3 9%和 6 1% ,均有非常显著差异 (P <0 0 1)。对照组 80 1%患者出现人流综合症 ,VAS评分 7 1分 ,而治疗组满意率为 99 4% ,无不满意者 ,麻醉后清醒和定向力恢复迅速。结论 :异丙酚可满足人工流产手术的需要。异丙酚静脉麻醉用于人工流产明显减低副作用 ,患者满意率提高     

Benefits and harms of normal saline instillation before endotracheal suctioning in mechanically ventilated adult patients in intensive care units: A systematic literature review and meta-analysis

ObjectivesThis systematic review aimed to identify the effects of normal saline instillation before endotracheal suctioning on clinical outcomes in critically ill patients on a mechanical ventilator.Research MethodologyThis review was based on the guidelines of the National Evidence-based Healthcare Collaborating Agency in Korea and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Six electronic databases were searched for relevant literature. Other sources were also searched, including the reference lists of identified reports and previous systematic reviews. After the initial literature search, a two-step retrieval process was performed to select eligible studies. Then, data were collected using a newly developed form, and the risk of bias was assessed using the checklists of the Joanna Briggs Institute. Data were analyzed using both narrative syntheses and meta-analyses.ResultsIn total, 16 studies: 13 randomized controlled trials and three quasi-experimental studies, were included. From the narrative syntheses, instilling normal saline before endotracheal suctioning was associated with a decrease in oxygen saturation, prolonged time for oxygen saturation to recover to baseline, decreased arterial pH, increased secretion amount, reduced incidence of ventilator-associated pneumonia, increased heart rate, and increased systolic blood pressure. Meta-analyses showed a significant difference in heart rate at five minutes after suctioning but no significant differences in oxygen saturation at two and five minutes after suctioning and heart rate at two minutes after suctioning.ConclusionThis systematic review indicated that instilling normal saline before performing endotracheal suctioning has more harmful effects than benefits.Implications for Clinical PracticeAs recommended in the current guidelines, it is necessary to refrain from routine normal saline instillation before endotracheal suctioning.     

羊水胎粪污染新生儿复苏的前世今生：过去60年中美两国的演变史

出生于羊水胎粪污染的新生儿可发生新生儿胎粪吸入综合征、持续性肺动脉高压等并发症，甚至死亡。在过去的几十年里，羊水胎粪污染新生儿复苏已发生了几次重要的变革。最初，对于羊水胎粪污染新生儿，通常在其出生后立即采用喉镜直视下吸引声门下胎粪。自2015年起，美国儿科学会新生儿复苏指南不再推荐对羊水胎粪污染无活力新生儿“常规”给予气管插管吸引胎粪，但建议立即给予气囊面罩正压通气复苏。然而，最新版2021年中国新生儿复苏指南仍保留对无活力新生儿进行胎粪吸引的建议。该文旨在探讨过去60年中美两国新生儿复苏指南在羊水胎粪污染新生儿复苏方法中的差异及其原因。