温度对手工制备富血小板血浆质量影响的探讨

目的探讨温度对手工制备富血小板血浆质量的影响。方法选取南部战区总医院血液中心2020年5月10日～9月10日无偿健康献血员捐献的外周血60mL/人份,共120份。将每人份全血在随机分为3等份,各20mL,共360份,分别分为9(A_1、A_2、A_3、B_1、B_2、B_3、C_1、C_2、C_3)组,每组40份,其中A组:PRP制备环境温度设为4±2℃,PRP制备及离心仓内温度分别为A_1组:4±2℃,A_2组24±2℃,A_3组:30±2℃,B组:PRP制备环境温度设为24±2℃,PRP制备及离心仓内温度分别为B_1组:4±2℃,B_2组:24±2℃,B_3组:30±2℃,C组:PRP制备环境温度设为30±2℃,PRP制备及离心仓内温度分别为C_1组:4±2℃,C_2组:24±2℃,C_330±2℃组。使用富浆法分离制备浓缩血小板,并计算各组血小板回收率,显微镜下血小板形态,应用酶联免疫吸附试验法定量检测血小板源性生长因子(PDGF-BB)、转化生长因子β(TGF-β)、血管内皮生长因子(VEGF)的浓度。结果血小板计数及血小板回收率比较:A_1、A_2、A_3、B_1、B_2、B_3、C_1、C_2、C_3,9组中,A_3 B_3 C_3三组的结果为(489.2±21.47)x10~9/L、(57.4±2.3)%,(495.7±23.2)x10~9/L、(54.9±1.3)%,(489.4±17.1)x10~9/L、(50.7±2.3)%,均出现血小板聚集现象,分别与A_1、A_2,B_1、B_2和C_1、C_2比较,差异具有统计学意义(P<0.05)。显微镜下观察:A_1、A_2、B_1、B_2、C_1、C_26组,收集的PRP中,血小板细胞大小均匀,无聚集。A_3、B_3、C_33组,收集的PRP中,均有部分血小板聚集成团。生长因子含量检测:未聚集组与聚集组中TGF-β的含量(ng/L)分别为375.0±119.1、183.67±106.2(P<0.05),PDGF-BB的含量(ng/L)分别为933.0±273.0、656±113.0(P<0.05)差异具有统计学意义;VEGF的含量(ng/L)分别为217.5±93.5、155.3±103.4(P>0.05),差异无统计学意义。结论外界环境温度对手工制备PRP制备,离心机机舱的温度保持在24±2℃为佳。     

经鼻高流量氧气湿化治疗老年慢性阻塞性肺疾病急性加重合并呼吸衰竭的可行性研究

ObjectiveTo investigate the feasibility of transnasal heated humidified high flow nasal cannula oxygen therapy (HFNC) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with respiratory failure in elderly patients. MethodsA total of 176 elderly patients with AECOPD complicated with respiratory failure who were hospitalized at Peking University Shougang Hospital from December 2016 to January 2022 were enrolled, including 82 patients in an HFNC group and 94 patients in an NPPV group. After treatment, pulse oxygen saturation (SPO₂), arterial partial pressure of carbon dioxide (PaCO₂), oxygenation index (OI), respiratory rate (RR), heart rate (HR), mean arterial pressure (MAP), comfort score, discharge rate, rate of endotracheal intubation, rate of transfer to intensive care unit (ICU), and mortality were compared between the two groups. The independent sample t-test was used for comparison between the two groups. Statistical data are expressed in percentage or number of cases and the χ² test was used for their comparisons. ResultsThe SPO₂ values at 30 min, 1 h, and 6 h were significantly higher in the HFNC group than in the NPPV group (t=-2.049,-2.618, and -3.314, P=0.043, 0.010, and 0.001, respectively). SPO₂ before discharge was significantly lower than that of the NPPV group (t=2.162, P=0.033), but OI at each time point and before discharge had no statistical significance (P＞0.05). MAP at 6 h was significantly higher in the HFNC group than in the NPPV group (t=-2.209, P=0.029), but within the normal range. HRs at 2 h and 3 h in the HFNC group were significantly higher than those of the NPPV group (t=-2.199 and -2.336, P=0.030 and 0.021, respectively). There were no significant differences in RR, HR, or MAP between the two groups at other time points and before discharge (P＞0.05). There was no significant difference in PaCO2 between the two groups (P＞0.05). Comfort score in the HFNC group was significantly higher than that of the NPPV group (t=-46.807, P＜0.001). There were no significant differences in discharge rate, ICU transfer rate, endotracheal intubation rate, and mortality between the two groups (P＞0.05). ConclusionHFNC is as effective as NPPV in treating elderly patients with AECOPD complicated with type Ⅰ or mild type Ⅱ respiratory failure, and HFNC is more comfortable than NPPV.     

ICU气管插管拔除后经鼻导管湿化高流量吸氧患者的护理

目的探讨ICU气管插管拔除后经鼻导管湿化高流量吸氧患者的护理方法及效果。方法选取2017-01—2018-06间在安钢总医院ICU气管插管已拔除的52例患者,均行经鼻导管湿化高流量吸氧。总结护理方法和效果。结果 52例患者中除1例因呼吸困难进行性加重再次气管插管行机械通气外,其余患者脱机拔管后1、8、24 h的呼吸频率、氧合指数及二氧化碳分压指数均维持在合理范围内。患者气道组织湿化程度为(2.19±0.19)分,舒适度评分为(1.68±0.28)分,耐受程度评分为(1.19±0.17)分。结论对ICU气管插管拔除后经鼻导管湿化高流量吸氧患者做好相关护理,可有效维持合理的呼吸频率、氧合指数及二氧化碳分压指数,提高患者的气道组织湿化水平、舒适度以及耐受程度,降低脱机拔管后再插管的风险。     

红外线测温仪评估压力蒸汽灭菌物品卸载温度的应用效果研究

摘要 目的 研究不同温度检测方法在压力蒸汽灭菌物品卸载温度评估中的效果。方法 采用不同温度测试方法，评估红外线测温仪在检测压力蒸汽灭菌物品包外温度中的应用效果。结果 压力蒸汽灭菌器内物品卸载温度测试时机是在灭菌包冷却30 min后进行。采用手触摸法检测温度合格率为78.89%,红外线测温仪检测温度合格率仅为38.89%。卸载至不锈钢储物台面后，采用手触摸法检测组湿包发生率为28.89%；红外线测温仪检测组湿包发生率为0%。两组测温方式检测结果差异具有显著统计学意义(P＜0.001)。结论 压力蒸汽灭菌器械包冷却后，采用红外线测温仪可精确评估压力蒸汽灭菌物品卸载时的包外温度，能最大限度地避免卸载后湿包的发生。     

参芪扶正注射液联合经鼻高流量加温湿化治疗COPD合并Ⅱ型呼吸衰竭的疗效

目的探讨参芪扶正注射液联合经鼻高流量加温湿化治疗慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭的临床疗效。方法将102例COPD合并Ⅱ型呼吸衰竭患者按随机数表法分为对照组和观察组,每组51例。对照组采用常规治疗,同时采用经鼻高流量加温湿化治疗。观察组在对照组治疗的基础上联合参芪扶正注射液治疗。观察2组治疗前、治疗7 d后血二氧化碳分压（PaCO2）、氧分压（PaO2）、pH值和最大呼气流量（PEF）、第1秒用力呼气容积（FEV1）及临床疗效。结果观察组总有效率为94.12%,高于对照组的80.39%,差异有统计学意义（P<0.05）;观察组治疗7 d后血PaO2、pH和PEF、FEV1值均高于对照组,血PaCO2值低于对照组,差异有统计学意义（P<0.05）。结论参芪扶正注射液联合经鼻高流量加温湿化治疗COPD合并Ⅱ型呼吸衰竭患者可有效提升疗效,显著改善了患者的血气指标和肺功能。