不监测胃残留量对ICU行肠内营养患者影响的系统评价

目的探讨不监测胃残留量对ICU行肠内营养患者的影响,为临床开展肠内营养护理提供循证依据。方法计算机检索有关不监测胃残留量对ICU行肠内营养患者影响的随机对照试验(RCT)文献,按Cochrane协作网的系统评价方法筛选文献、评价纳入文献质量,使用RevMan5.3软件进行统计分析。结果共纳入5篇RCT,878例研究对象。Meta分析结果显示,不监测胃残留量患者呕吐、腹胀发生率显著高于常规监测胃残留量患者,而喂养不耐受发生率显著降低(均P0.01);不监测胃残留量对肺炎、腹泻、误吸发生率及机械通气时间、住院时间等无影响(均P0.05),对营养摄入量有影响。结论ICU行肠内营养患者不监测胃残留量对其肺炎、误吸及腹泻发生率无明显影响,其呕吐和腹胀发生风险增加,喂养不耐受发生率降低,营养摄入量得到保障。受纳入研究数量和质量限制,研究结果尚需进行大样本、高质量、多中心的RCT加以论证。     

亚甲蓝在机械通气患者胃反流误吸监测中的应用

目的探讨亚甲蓝标记法在诊断机械通气患者胃反流误吸中的可行性和实用性。方法将亚甲蓝注入200例机械通气患者的鼻饲营养液内标记染色;遵循按需吸痰原则,吸出患者气道分泌物后,分别进行痰液颜色的肉眼观察和胃蛋白酶检测,判断患者是否发生胃反流误吸。比较两种方法检测效果,对亚甲蓝标记法的敏感度、特异度进行分析。结果两种检测方法阳性率比较,差异无统计学意义(P0.05);亚甲蓝标记法观察胃反流误吸敏感度为100%,特异度为98.26%。结论亚甲蓝标记法可用于机械通气患者胃反流误吸的诊断。     

两种气管导管预防机械通气患者呼吸机相关性肺炎效果比较

目的探讨圆柱形与锥形气囊气管导管对机械通气患者微误吸致呼吸机相关性肺炎(VAP)的预防效果。方法将机械通气≥48h的气管插管患者64例随机分为A组32例,采用圆柱形气囊气管导管;B组32例,采用锥形气囊气管导管。将机械通气≥48h的气管切开患者72例随机分为C组36例,采用圆柱形气囊气管导管;D组36例,采用锥形气囊气管导管。观察并记录四组患者VAP发生率和时间、机械通气时间、痰液变化量、声门下分泌物变化量、脱机成功率。结果 B、D组VAP发生率显著低于A、C组;痰液变化量和声门下分泌物变化量显著多于A、C组(P0.05,P0.01)。四组机械通气时间、7d内脱机成功率、14d内脱机成功率差异无统计学意义(均P0.05)。结论使用锥形气囊的气管导管可以更好地预防微误吸的发生,从而预防VAP的发生。     

骨科术后机械通气患者ICU谵妄发生率及危险因素调查

目的探讨骨科术后机械通气患者谵妄发生率及相关危险因素,为护理人员采取有效的预防措施提供参考。方法选择ICU骨科术后机械通气患者142例,每日2次使用ICU意识模糊评估法评估患者是否发生ICU谵妄并收集相关危险因素。结果骨科术后机械通气患者谵妄发生率为40.8%,89.7%在入ICU 5d内发生。Logistic回归分析显示,APACHEⅡ评分、疼痛、机械通气时间和低钙血症是谵妄的独立危险因素(P0.05,P0.01)。结论骨科术后机械通气患者谵妄发生率较高,ICU护理人员应重点关注病情严重、机械通气时间长的患者,采取积极的措施缓解疼痛和纠正低钙血症,以降低ICU谵妄发生的风险。     

危重症患者肠内营养液间歇泵入效果观察

目的观察危重症患者接受肠内营养治疗的最佳输注方式,减轻反流、误吸风险。方法将60例ICUEN患者随机分为对照组和观察组各30例。对照组采用持续泵入输注（16h）,观察组采用间歇泵入输注,即榆注90min暂停150min,4＆／d。结果两组胃残留液、胃液pH值,营养液反流入口、胃管内营养液反流发生率比较,差异有统计学意义（P〈0．05,P〈0．01）。结论肠内营养间歇泵入输注方法可减少患者胃残留液量和降低胃液pH值,有效减少反流、误吸发生率,是ICU患者较理想的鼻饲方法。     

机械通气患者鼻饲饮食返流的护理

目的:探讨减少机械通气患者鼻饲时误吸的方法,促进患者早日康复。方法:通过改进置管方法、改善鼻饲液注入方法、给予合适的体位、掌握好吸痰时机等方法,改进食管返流患者的护理方法,为患者更好的提供安全的营养支持。结果:80例患者中10例发生返流,经改进护理方法后,患者得到良好的营养支持,愈后好。结论:通过改进护理方法,可有效防止机械通气患者鼻饲返流误吸的发生。     

ICU无创机械通气患者口渴感水平及影响因素分析

目的探讨ICU无创机械通气患者口渴感水平及影响因素。方法应用口渴数字评分量表(NAS)对108例无创机械通气患者不同时间点的口渴感水平进行调查。结果无创机械通气患者口渴程度随着机械通气时间的延长逐渐加重(P0.01);口渴评分6.14±1.26。机械通气时间、呼吸型态、吸入潮气量及漏气量、呼吸频率、是否首次使用无创机械通气、面罩舒适度是患者口渴感的影响因素(P0.05,P0.01)。结论 ICU无创机械通气患者口渴感发生率高,口渴的发生与机械通气时间、是否首次使用无创机械通气及呼吸频率、面罩匹配度等因素有关,需对患者积极实施干预,预防和减轻患者口渴程度,提高治疗依从性。     

品管圈活动降低吞咽障碍老年患者误吸率

目的 降低吞咽障碍老年患者误吸发生率.方法 成立品管圈小组,分析吞咽障碍老年患者误吸的危险因素及发生原因,采取针对性措施防止患者误吸;12个月后评价效果.结果 开展品管圈活动后患者误吸率显著降低（P＜0.05）.结论 品管圈活动可有效降低吞咽障碍老年患者误吸发生率.     

肿瘤细胞减灭术联合腹腔内热灌注化疗术后谵妄发生的危险因素分析

目的筛选肿瘤细胞减灭术联合腹腔内热灌注化疗术后谵妄发生的危险因素。方法全麻下行肿瘤细胞减灭术联合腹腔内热灌注化疗患者150例,年龄18~75岁,性别不限,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级,体重40~70 kg。根据术后72小时内是否发生谵妄分为谵妄组和非谵妄组。记录患者性别、年龄、体重、ASA分级、术前空腹血糖和糖化血红蛋白;既往史包括肿瘤切除术史、化疗和放疗史;合并症包括抑郁症、高血压、冠状动脉粥样硬化性心脏病、慢性主观性头晕、慢性阻塞性肺疾病、腔隙性脑梗死和慢性肾功能衰竭;手术相关因素包括腹腔内热灌注时间、手术时间和术后机械通气时间;术后镇痛补救情况。将组间比较差异有统计学意义的因素进行多因素Logistic回归分析,筛选术后谵妄发生的危险因素。结果 139例患者中42例发生术后谵妄,发生率为30.2%。Logistic回归分析结果显示,年龄≥65岁、术前抑郁、长时间腹腔内热灌注化疗和术后ICU长时间机械通气是肿瘤细胞减灭术联合腹腔内热灌注化疗术后谵妄的独立危险因素。结论年龄≥65岁、术前抑郁、长时间腹腔内热灌注化疗和术后ICU长时间机械通气是肿瘤细胞减灭术联合腹腔内热灌注化疗术后谵妄的独立危险因素。     

ICU成人患者术后发生谵妄的危险因素分析

目的 探讨ICU成人患者术后发生谵妄的危险因素。方法 选取2020-09—2022-09河南省第二人民医院ICU收治的术后发生谵妄的50例成人患者作为观察组，并以1∶1配比选取同期术后未发生谵妄的50例患者作为对照组。收集患者的临床资料，分析影响ICU术后成人患者发生谵妄的相关因素。结果 高血压、糖尿病、冠心病、心律失常、呼吸系统疾病、肝肾功能不全、脑卒中与ICU成人患者术后发生谵妄无明显关联(P>0.05);ASA分级、手术时间、ICU机械通气时间、视觉模拟量表(VAS)评分、术后使用镇痛镇静药、身体约束、急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分是ICU成人患者术后发生谵妄的影响因素(P<0.05)。Logistic回归分析显示，ASA分级≥Ⅲ级、手术时间≥3 h、APACHEⅡ评分>15分、ICU机械通气时间≥24 h、VAS评分>4分、术后使用镇痛镇静药、身体约束是ICU成人患者术后发生谵妄的危险因素(P<0.05)。结论 ICU成人患者术后发生谵妄的影响因素较多，ASA分级≥Ⅲ级、手术时间≥3 h、APACHEⅡ评分>15分、ICU机械...     

预防神经外科吸入性肺炎护理管理流程的构建与应用

目的建立一套规范实用的预防神经外科患者吸入性肺炎护理管理流程,降低吸入性肺炎发生率。方法将2014年1~12月神经外科患者315例作为干预组,使用神经外科预防误吸高危因素评估表对患者吸入性肺炎危险因素进行预见性及动态评估,制定并落实护理综合管理方案,通过防误吸护理评价单对护理质量进行监控。将2013年1~12月274例神经外科患者作为对照组,使用传统护理方法。比较两组吸入性肺炎发生率及患者满意度。结果干预组吸入性肺炎发生率显著低于对照组,患者及家属满意率显著高于对照组(均P0.01)。结论实施预防吸入性肺炎护理管理流程,针对神经外科患者误吸危险因素实施护理,确保每项护理措施安全有效落实,可有效减少患者吸入性肺炎的发生。     

Fine Needle Aspiration Biopsy of Bone Lesions: Clinical Value

The clinical value of cytological aspiration biopsy in 85 patients with lytic bone lesions was studied. In 71 cases cytology was of diagnostic value, but in 14 cases it was inconclusive or misleading. The method is considered a simple primary diagnostic procedure especially in lytic bone lesions of uncertain nature.     

Tendon Transference for Ulnar and Combined Ulnar-Median Nerve Paralysis

The clinical value of cytological aspiration biopsy in 85 patients with lytic bone lesions was studied. In 71 cases cytology was of diagnostic value, but in 14 cases it was inconclusive or misleading. The method is considered a simple primary diagnostic procedure especially in lytic bone lesions of uncertain nature.     

Diffuse interstitial pneumonitis due to aspiration of gastric contents

Two cases of interstitial pneumonitis are described which developed after the acute phase of aspiration pneumonitis. Open lung biopsy revealed an interstitial, granulomatous foreign body response induced by foodstuff aspiration. Steroid treatment was administered and both cases then showed a favourable course, with the pulmonary lesion healing within 12 days.     

Aspiration during anaesthesia: a review of 133 cases from the Australian Anaesthetic Incident Monitoring Study (AIMS)

Two-hundred and forty incidents of vomiting/regurgitation and aspiration were reported to the Anaesthetic Incident Monitoring Study database consisting of 5000 reports. Of these, 133 cases of aspiration were recorded. Passive regurgitation occurred three times more commonly than active vomiting. Aspiration was reported twice as often in elective compared with emergency surgery, with 56% of incidents taking place during induction of anaesthesia. Anti-aspiration prophylaxis was prescribed in 14% of patients who subsequently aspirated; however, the majority of cases had at least one predisposing factor for regurgitation, vomiting or aspiration evident peri-operatively. While a major immediate physiological disturbance was common, long-term morbidity was not. Death ensued in five cases, all of whom had significant co-morbidities. Factors reported as contributing to the incident included error of judgement and fault of technique, while clinical experience and anaesthetic assistance tended to minimise the incident. Aspiration remains an important anaesthetic-related morbidity. The application of simple guidelines may have prevented the incident in 60% of all cases of aspiration. Ensuring airway security may be as important as chemoprophylaxis in its prevention.     

Scintigraphic method to detect silent aspiration during sleep in postsurgical patients with oral cancer

BACKGROUND: A simple method to detect silent aspiration during sleep has not been established in postsurgical oral cancer patients. METHODS: Radioactive paste consisting of (99m)TcO(4) (-) and carboxylmethylcellulose was prepared and placed in a maxillary prosthesis with a cavity in the palatal space. The patient was requested to wear this appliance during sleep, and the following morning the patient was subjected to scintigraphic scanning. Both the anterior and posterior aspects of the thorax were scanned using a Shimazu Medical gamma camera with window settings adjusted to a low energy collimator at 500 kilocounts per image. RESULTS: Silent aspiration that had not been detected by videofluoroscopic examination was clearly demonstrated by the scintigraphic method, showing aspiration of radioactive paste during sleep in the left thorax of the patient. CONCLUSIONS: The method reported for establishing aspiration is simple and reliable to assess silent aspiration during sleep in patients with oral cancer.     

Ultrasound-Guided Fine Needle Aspiration Biopsy Update 1998

Abstract: Breast ultrasound using a high-resolution, realtime, hand-held probe was performed on 19, 714 patients. Ultrasound-guided fine needle aspiration biopsy was done on 2,453 solid masses. We report on 2,075 of these lesions, 629 malignant and 1,446 benign, confirmed either by excisional biopsy or adequate follow-up. Of the cancers, 597 (95%) had either malignant or suspicious cytology with 1 false positive case and 32 false negative cytologic results. The diagnosis of cancer was delayed in four patients because of benign appearances on imaging and cytology. Surgery was performed promptly after the first imaging follow-up in each case. There was no delay in diagnosis in the remaining 11 patients because of the suspicious appearance of the masses on mammogram. Mammography missed 147 (23%) of the 629 cancers, 102 of which were clinically palpable. Forty-five cancers were both nonpalpable and not seen by mammogram (incidental cancers). A correct cytologic diagnosis, either fibroadenoma or nonspecific benign, was made in 1,339 of the 1,446 benign masses. The sensitivity of this technique in the diagnosis of solid breast lesions was 95%, the specificity was 93%, and the overall accuracy was 93%. We conclude that real-time, ultra sound-guided fine needle aspiration cytology is a valuable adjunct to the clinical, mammographic, and sonographic assessment of solid breast lesions.     

Breast cyst recurrence after postaspiration injection of air

Breast cysts are a common cause of breast pain, lumps, and patient anxiety. Older studies incidentally reported a decrease in cyst recurrence when air was injected for diagnostic purposes after aspiration. The purpose of this study was to determine the incidence of cyst recurrence after ultrasound-guided aspiration and injection of air for therapeutic purposes. In this study, we retrospectively reviewed 113 cysts aspirated in 90 women; 88 had air injected for therapeutic purposes after aspiration, and 25 did not. Subsequent mammograms and sonograms were reviewed (mean follow-up 21 months, range of 8–36 months) to assess for recurrence. Demographic and imaging features were not different between the two study groups. Of the 88 cysts that had air injected after aspiration, 14 recurred (16%) compared with 20 of 25 cysts (80%) that did not have air injected following aspiration. Cyst recurrence correlated with air injection, but did not correlate with cyst size, menopausal status, or use of hormone replacement therapy. Only one patient complained of pain, and no complications occurred. The injection of air into cysts following aspiration may be useful for therapeutic purposes.     

Nondiagnostic fine-needle aspirations of the thyroid: is the risk of malignancy higher?

Background

Nondiagnostic fine-needle aspirations (FNAs) pose a dilemma in the management of patients with thyroid nodules. In most cases, these patients undergo either repeat FNA or surgical resection. However, a significant number of patients will only be observed, assuming that the risk of malignancy is low. Therefore, the purpose of this study was to determine whether the risk of malignancy is higher in patients with thyroid nodules and nondiagnostic FNAs.

Methods

We reviewed reports from 4286 consecutive FNA biopsies performed on patients with thyroid nodules at our institution between 2002 and 2010. We divided FNAs into two categories: diagnostic and nondiagnostic. We collected demographic, follow-up, and pathology data from both groups and then analyzed them with analysis of variance and chi-square tests.

Results

Of the 4286 FNAs, 259 were classified as nondiagnostic (6%). We saw no significant differences in age or gender between patients with diagnostic versus nondiagnostic FNAs. Of the patients with nondiagnostic FNAs, 62 underwent diagnostic thyroidectomy (24%), 74 had a repeat FNA (29%), and 123 had observation only (47%); thus, 136 patients had a cytologic or pathologic diagnosis. Patients with nondiagnostic FNAs had a significantly higher rate of all types of thyroid cancer, compared with those with diagnostic FNAs (12% versus 5%, respectively; P < 0.001). Impressively, the chance of papillary thyroid cancer was twofold higher in patients with nondiagnostic FNAs.

Conclusions

The percentage of nondiagnostic FNA at our institution during this period (6%) was relatively low. However, the incidence of malignancy in these patients was significantly higher. Therefore, we recommend that patients with thyroid nodules and nondiagnostic FNAs undergo either repeat biopsy or diagnostic thyroidectomy.