气管切开术50例手术和护理体会

在临床中,气管切开是一种急救手术,用于抢救喉阻塞和下呼吸道分泌物阻塞引起呼吸困难的患者,能够迅速达到呼吸畅通的目的。但是要注意的是,切管切开术是对操作者的技术要求较高的一种术式,操作者必须熟练了解人体颈部解剖结构,手术细心谨慎,才能达到好的效果。本文就对本院实施的气管切开术50例的相关体会进行分析。     

累及心脏瓣膜的肺阿米巴病一例

患者男性,40岁.入院时咳嗽,气急不能平卧,痰血呈果酱色,低热.无腹痛腹泻.胸片示两肺浓密渗出阴影.强心利尿和激素治疗无效.无化学品接触和心脏病史.发病前2个月曾回家乡(苏北农村).体检:唇绀,心率120次/min,胸前心尖区收缩期杂音.呼吸浅速,32次/min,左肺湿性啰音.     

鼻内镜鼻腔框架结构重塑治疗常年性变应性鼻炎98例

目的:探讨鼻内镜下鼻腔框架结构重塑治疗变应性鼻炎的疗效.方法:对98例变应性鼻炎并鼻腔结构异常的患者施行鼻内镜下鼻中隔矫正术、下鼻甲部分切除术、纠正异常中鼻甲.所有患者随访1年以上,评价其临床效果.结果:术后3个月总有效率95.9%,术后半年总有效率81.6%,术后1年总有效率65.3%,术后2年总有效率60.2%.结论:该手术安全有效,有助于变应性鼻炎的治疗.     

以颈部肿块为惟一临床表现的隐性鼻咽癌1例

颈部肿块的处理有时极具挑战性,一是体现在对肿块性质的判定,二是体现在对原发灶的搜寻,三是体现在能否有效的切除,后两者有时更具挑战性.在临床医疗活动中我们不时会遇到棘手的病例,在施治措施经讨论又难以统一的情况下,"施治策略"的制定的确是一大难题.     

急性心肌梗死病人的护理

急性心肌梗死(AMI)是由于冠状动脉急性闭塞,导致相应的心肌因严重持久的缺血所致的局部坏死,表现为剧烈而持久的胸骨后疼痛、休克、心力衰竭、心律失常、有恐惧及濒死感,严密的观察和护理是提高治愈率、降低死亡率的关键.现将临床护理经验总结如下.     

吸入溴化异丙托品和沙丁胺醇治疗慢性阻塞性肺病的疗效及安全性评价

慢性阻塞性肺病(COPD)是呼吸系统常见疾病,其主要特征是慢性气流阻塞,并呈进行性发展。缓解气流阻塞,改善基础肺功能是应用支气管扩张剂的主要治疗目的。合理选择支气管扩张剂可以显著提高治疗效果。临床常用的两类支气管扩张剂是β_2激动剂和抗     

非索伪麻缓释胶囊治疗变应性鼻炎疗效与安全性的多中心临床研究

［摘要］目的观察非索伪麻缓释胶囊治疗变应性鼻炎的疗效和安全性。方法变应性鼻炎患者240例,采用随机、双盲双模拟、多中心、平行对照的方法,随机分为治疗组和对照组各120例,分别采用非索伪麻缓释胶囊,每次1粒,bid,po;或氯雷他定伪麻黄碱缓释片,每次1片,bid,po,连续用药7～14 d。疗程结束时以综合疗效改善百分率、症状体征总积分下降值来评估其临床疗效,以不良事件、实验室检查等来评估其安全性。结果共有224例患者纳入疗效分析,治疗组（113例）及对照组（111例）的综合疗效改善百分率分别为92.92%和95.50%（P＞0.05）。29例患者发生45例次不良反应（治疗组13例21例次,对照组16例24例次）,主要表现为口干、头晕、嗜睡、乏力等。两组间不良反应发生率差异无显著性（P＞0.05）。无一例严重不良事件发生。结论非索伪麻缓释胶囊可有效控制变应性鼻炎症状,疗效显著,安全性好。     

不同年龄人群自发性气胸的病因和治疗特点分析

目的探讨青年和中老年人群自发性气胸的病因和治疗特点。方法回顾性分析同济大学附属肺科医院急诊科收治的113例自发性气胸患者的发病基础、治疗时间、预后等情况。结果收治的自发性气胸人数占同期急诊人数（124／4538）2．7％,占同期急诊住院人数（113／805）14％。113例气胸中,手术治愈25例,胸腔闭式引流／胸膜黏连治愈83例,未愈出院5例。复发病例44例。年龄〈40岁的青年组共40例,平均年龄（24．25±6．63）岁,扁平胸27例。有明确发病诱因31例。临床症状以胸闷为主,25例胸CT提示肺大疱。胸腔闭式引流28例,平均引流时间（3．54±2．85）d。手术治疗12例。年龄≥40岁的中老年组患者共73例,平均年龄（65．78±13．79）岁,桶状胸57例。有明确发病诱因11例。临床症状以胸闷和咳嗽为主,胸腔闭式引流55例,平均引流时间（6．65±10．2）d。手术治疗13例,未愈5例。结论青年人群气胸的发生和扁平胸有关联,发病诱因明确;肺气肿是中老年气胸的主要病因。无法手术的中老年难治性气胸,是气胸临床治疗的难点。     

预防性应用抗生素对气胸患者胸管定植菌的影响

目的 研究气胸患者闭式引流术后胸管定植菌的病原学特点以及预防性抗生素应用在减少病原菌定植方面的意义.方法 入组120例急诊留观的需接受胸腔闭式引流术治疗的气胸患者,随机(随机数字法)分为抗生素组(A组,n=60)和对照组(B组,n=60)完成胸腔置管术,术后A组给予甲磺酸左氧氟沙星氯化钠注射液0.6 g/200 mL·d-1静脉滴注,B组给予0.9%氯化钠注射液200 mL/d静脉滴注直至拔管后24 h.拔管后将胸管前端2 cm剪下行细菌培养.两组数据比较采用χ2检验或Fisher精确概率法.结果 两组120例有49例导管培养阳性,共检出病原菌57株,位于前四位的病原菌分别是凝固酶阴性葡萄球菌(57.9%)、白色假丝酵母菌(10.5%)、金黄色葡萄球菌(7%)和鲍曼不动杆菌(7%),所有细菌对β-内酰胺类抗生素都具有较高的耐药率.有基础疾病的患者的导管细菌检出率(50%)高于单纯气胸患者的31%,两者差异具有统计学意义(P＜0.05).置管时间超过14 d的患者的导管细菌检出率(70%)明显高于置管14 d以内的35%,两者差异具有统计学意义(P＜0.01).置管小于7 d时,A组导管的细菌检出率(8.3%)明显低于B组(52.9%),两者差异有统计学意义(P＜0.01);置管7～14 d时,A组导管的细菌检出率(21.4%)低于B组(68.8%),两者差异有统计学意义(P＜0.05);置管大于14 d时,两组导管的细菌检出率皆为70%,两者差异无统计学意义(P＞0.05).两组患者在疾病转归和住院天数上差异无统计学意义(P＞0.05).结论 气胸患者闭式引流术后常见的胸管定植菌为条件致病菌,细菌耐药现象十分严重.置管时间的延长、患者合并基础疾病都会增加感染的风险.预防性的应用抗菌药物有利于减少短期置管(小于14 d)患者的导管细菌检出率,降低感染的风险,但在缩短住院天数、影响疾病转归方面未证明有益.

Abstract：

Objective To investigate the feature of the microorganisms colonization of the thoracic catheter-related infection and evaluate the clinical significance of prophylactic antibiotics administration in patients with pneumothorax treated with closed thoracic drainage. Method A total of 120 patients with pneumothorax treated with closed thoracic dramage in emergency department wore enrolled. The patients were randomized (random number) into group A (n =60) and group B (n =60). In group A, the patients received levofloxacin mesylate injection and in group B, patients received physiological saline injection instead after closed thoracic drainage. The tip of catheter was cut off to get a 2-cm long segment after catheter removal and this segment was dipped into a bottle filled with liquid culture medium for microorganism culture. Statistical analysis carried out by using χ2 test or Fisher exact test. Results Of all 120 patients, microorganisms were found in 49 segments of catheter and 57 strains of microorganisms were found. The four most common microorganisms were Coagulase-negative staphylococci (57.9%), Candida albicans (10. 5%),Staphylococcus aureus (7%) and Acinetobacter baumanii (7%). All of them were highly drug-resistant to β-1actam antibiotics. The difference in the positive rate of microorganism culture was distinct in pneumothorax patients with underlying diseases (50%) in comparison to the patients without underlying diseases (31%) (P ＜ 0.05). The positive rate of microorganism culture increased significantly as the duration of drainage was longer than 14 days (P ＜ 0.01). The positive rate of culture in group A was lower than that in group B if the duration of drainage was less than 7 days (8.3% vs 52.9%, P ＜ 0.01). The positive rate of culture after drainage for 7 days was 21.4% in group A and 68.8% in group B (P ＜0.05), and that after drainage for over 14 days was 70% in both groups (P ＞ 0.05). There were no significant differences in outcome and days of hospital stay between two groups (P ＞ 0. 05). Conclusions The common colonized microorganisms of thoracic catheter-related infection are conditional pathogens and highly resistant to antibiotics. Lengthening the duration of drainage and having underlying diseases increase the risk of infection. Although prophylactic antibiotics administration is beneficial to decrease the risk of thoracic catheter-related infection, it has no effects on shortening hospital stay and outcome of disease.