Issues in cardiopulmonary transition at birth

The transition from fetal to newborn life involves a complex series of physiological events that commences with lung aeration, which is thought to involve 3 mechanisms. Two mechanisms occur during labour, Na⁺ reabsorption and fetal postural changes, and one occurs after birth due to pressure gradients generated by inspiration. However, only one of these mechanisms, fetal postural changes, involves the loss of liquid from the respiratory system. Both other mechanisms involve liquid being reabsorbed from the airways into lung tissue. While this stimulates an increase in pulmonary blood flow (PBF), in large quantities this liquid can adversely affect postnatal respiratory function. The increase in PBF (i) facilitates the onset of pulmonary gas exchange and (ii) allows pulmonary venous return to take over the role of providing preload for the left ventricle, a role played by umbilical venous return during fetal life. Thus, aerating the lung and increasing PBF before umbilical cord clamping (known as physiological based cord clamping), can avoid the loss of preload and reduction in cardiac output that normally accompanies immediate cord clamping.     

机械通气对中心静脉压影响的研究进展

随着医学科学的发展,机械通气在抢救危重病患者中发挥了越来越大的作用。机械通气可致中心静脉压(CVP)升高,不同的通气模式致CVF升高的程度不同。作者就机械通气模式对CVP影响的程度及如何在机械通气状态下测得较准确的CVP值作一综述。     

高浓度有机废水好氧曝气池泡沫物理控制

以垃圾渗沥液好氧曝气处理为例,结合工程设计初期到工程实施及生产运行,对好氧池的泡沫积存问题采用物理消除措施进行改进和创新,实践证明采用多种物理措施相结合控制泡沫的方法效果较为理想。     

Preservation of the mastoid aeration and prevention of mastoid dimpling in chronic otitis media with cholesteatoma surgery using hyaluronate-based bioresorbable membrane (Seprafilm)

During mastoidectomy a hollow-cavity is formed within the mastoid bone after its cortex and air cells are removed. Postoperatively, the aerated cavity is usually filled with soft tissues. Also it is not so uncommon to see cases with retraction of the mastoid area skin into the cavity causing a cosmetic problem termed as mastoid dimpling. In order to achieve an aerated mastoid cavity and minimizing the mastoid dimpling, an adhesion barrier was utilized to prevent fibrous tissue formation within the cavity. Twenty-one patients with middle ear and/or mastoid cholesteatoma, who underwent tympanoplasty with mastoidectomy (canal wall-up) with staged procedures, were included in the study. The mastoid cavity was tented and covered with an adhesion barrier (hyaluranic acid and carboxymethylcellulose, Seprafilm, (Seprafilm, GENZYME Inc., Cambridge, MA, USA) at the end of the surgery. Postoperatively, in two cases serohemorrhagic fluid collected between the adhesion barrier membrane and the subcutaneous tissues requiring drainage. Second stages were performed 4–6 months after the first stage. Two residual cholesteatoma cases were present. Patients were followed for a minimum of 2 years after the second stage. Mean follow-up was 2 years and 5 months. No wound infection was encountered postoperatively. Late follow-up of minimum 2 years after the second surgery revealed cosmetically acceptable retroauricular area with no dimpling. Mild retraction in two cases and two micro-central perforations in the neotympanic membrane were found. CT scans obtained both prior to the second stage and at the end of the second year of second stage revealed fully aerated mastoid cavities covered with periosteum in its natural position. Mastoid cortex plasty with seprafilm offers a rapid and effective solution to the preservation of mastoid space and the preservation of the contours of the mastoid bone.     

机械通气病人手势语言的建立及应用

目的满足病人机械通气期间语言沟通障碍的身心需求.方法将100例心脏手术病人分为观察组与对照组各50例,两组术前由责任护士给予常规心脏外科术前指导;观察组另由责任护士教给简单、规范的手势语言,于术前3～5 d进行训练.结果机械通气期间观察组护理满意度、遵医行为显著优于对照组(均P＜0.01).结论手势语言达到了护患沟通的目的,较好地满足了病人机械通气期间的身心需求.     

内置蜂窝陶瓷的气升式内循环生物反应器II.固定化Achromobacter sp.降解氯酚和苯酚

蜂窝陶瓷固定化细胞气升式内循环生物反应器(IAL-CHS)降解氯酚和苯酚.对该反应器进行了批式和连续流降解实验,固定于陶瓷载体上的微生物经过短时间适应后,能有效地降解氯酚和苯酚,表现出较好的稳定性和抵抗冲击负荷性能,在350h的连续流处理过程中,氯酚的降解率越来越高,达到98%以上.     

某医院病理科空气污染现状及解决方法初探

[目的]探讨降低病理科化学试剂空气污染的有效方法. [方法]在同等条件下,关闭门窗12h后(A组)、通风排气30min后(B组)、应用空气净化装置加通风排气30min后(C组)3种情况下测定取材室甲醛浓度、技术室二甲苯浓度. [结果]A、B、C3种情况下取材室甲醛检测浓度分别为(4.35±0.28)、(0.46±0.06)、(0.39±0.02)mg/m3,技术室二甲苯浓度分别为(5.18±0.08)、(0.60±0.04)、(0.07±0.01)mg/m3. [结论]病理科常用化学试剂严重污染工作环境,通风是减少病理科污染程度的最方便、最直接、较有效方法,但有一定的局限性;空气净化装置加通风排气的应用是目前降低病理科化学试剂污染程度较为有效的方法之一.     

Factors affecting recovery of mastoid aeration after ear surgery

Fifty-six patients after tympanomastoid surgery were examined to determine recovery of mastoid aeration and various pre- and intraoperative factors such as eustachian tube (ET) function, how the mastoid mucosa had been treated during surgery and whether or not a large silastic sheet had been placed in the middle ear or a ventilation tube used. Mastoid aeration recovery was confirmed by computed tomography in 27 of the 57 cases (47%) within 12 months of surgery. Among the factors examined, preservation of the epitympanic mucosa was found to be most important in mastoid aeration recovery. Use of a large silastic sheet to cover the area from the bony ET and tympanic cavity to epitympanum, aditus ad antrum or antrum was found to be of some help in recovery mastoid aeration after complete resection of the mucosa and mastoid air cells. Preoperative ET function, anterior tympanotomy and use of a ventilation tube did not influence recovery. Received: 12 August 1997 / Accepted: 9 September 1998     

COPD患者应用机械通气的舒适护理

目的：探讨COPD病人机械通气时应用舒适护理的临床意义。方法：对52例COPD病人实施舒适护理进行临床观察和分析。结果：实施舒适护理病人通气顺应性好，机械通气时间缩短。结论：对COPD病人实施机械通气时，应重点满足其舒适的需求，加强各方面的护理，才能达到良好的治疗效果。