不同吸引负压对小儿吸痰效果的影响

吸痰是临床上常用的护理操作技术，吸痰的目的是吸出呼吸道分泌物，保持呼吸道通畅，维持有效通气，吸痰常用的吸引负压为成人300～400mmHg（40．0～53．3kPa），小儿〈300mmHg（40．0kPa）,由于吸痰是一种侵入性操作，吸引负压太大容易损伤口鼻腔粘膜，吸引负压太小，痰液吸不干净，达不到治疗效果。在临床实践中，我们通过对小儿不同年龄阶段设置不同的吸引负压范围，既达到彻底吸净痰液又可减少患儿粘膜损伤。现将结果报道如下。     

气管内吸痰的压力选择

当气道内有分泌物(痰液)积聚时，会阻碍气道的正常通气，因此必须将分泌物从气道内排出，以保持呼吸道通畅。人工气道建立后，病人出现咳嗽反射障碍甚至消失，自行排痰障碍，必须采取人工吸痰。吸痰是清理呼吸道内分泌物，维持呼吸道通畅的重要措施，是通过合适的负压吸引的方法将患者呼吸道内潴留的分泌物吸出。吸痰对维持呼吸道通畅，改善通气，防治感染具有重要作用。临床上一些气管切开后分泌物较多的病人，经反复负压吸痰时有肺不张的发生。我们发现吸痰负压过大可致肺泡萎陷。为此，我们利用简易呼吸器在每次吸痰后膨肺3～5次，     

电动吸引器改良后的临床应用

吸痰是临床救治工作中保持呼吸道通畅的一种治疗方法。电动吸引器吸痰是利用负压吸引的原理,将呼吸道的分泌物或误人的呕吐物吸出,保持呼吸道通畅。我院使用的YB．DX230D01A型电动吸引器的构造主要由主机、负压瓶和吸引瓶各一个、导管3根（其中连接吸引瓶的1根导管较长）、电源线一根以及脚踏板一个组成。     

改良型密闭式吸痰器在患儿吸痰留标本中的应用

目的探讨改良型密闭式吸痰器在小儿呼吸道感染取痰标本中的应用效果。方法采用由2根管加1个密闭储液器组成的改良一次性婴儿型吸痰管,前段为吸痰管与密闭储液器相连,后段由储液器与负压吸引器连接形成密闭回路。雾化吸入稀释痰液10~15分钟,家长拍背5~10分钟。吸痰管闭合负压不超过100 mmHg,吸痰管插入深度由目测鼻尖至耳垂的距离再加2~3 cm。吸痰先用吸痰管刺激会厌部引起咳嗽,然后将吸痰管插入到气管。结果住院3~15天,平均住院（7.33±2.14）天。患儿吸痰留取标本成功实施102例。结论采用改良型密闭式吸痰器在患儿吸痰留取标本中收到良好效果。     

长期应用人工气道患者呼吸道感染的预防

保持气道通畅，预防肺部并发症患者气管切开术后的吸痰是保持呼吸道通畅的重要措施。插入吸痰管时，先用止血钳夹住或反折吸痰管，暂时阻断负压，待吸痰管到达吸引部位后，再开放吸引。吸痰时动作要轻柔，将吸痰管插入气管深部，然后边提拉边旋转，以保证有效地吸出分泌物...     

自制气管滴喉液防止气管切开导致呼吸道阻塞的经验

自制气管滴喉液防止气管切开导致呼吸道阻塞的经验第三临床学院耳鼻喉科袁焕女气管切开术后，最重要的护理是预防呼吸道阻塞。以往我们采取吸痰法，但是气管切开术后病人及喉癌术后病人，气管内分泌物较多粘稠不易吸出，甚至形成痰痂、血痂，很难吸出。为解决这个难题，我...     

慢性呼吸衰竭的护理体会

1病情观察及护理 （1）保持呼吸道通畅：绝对卧床休息，可采取坐位或半坐位，昏迷病人应采取平卧位，头偏向一侧，有利于呼吸分泌物排出。鼓励病人尽量咳嗽使痰液排出，对不能咳出的病人，定时帮助病人翻身，1-2小时1次。为使痰液易于排出，帮助病人拍背和胸部，使痰液易于排出；仍不能排出者，口服祛痰剂或超声雾化吸入治疗；对昏迷病人采取吸引器吸痰，压力要小，吸痰前后均应充分吸氧，以防吸痰时缺氧加重或发生窒息。必要时做好气管插管或气管切开的准备。     

诱发性排痰在胸科手术后的应用及效果

胸科手术后患者因麻醉、手术创伤及机械通气等原因，使呼吸道分泌物增多，由于患者不能很好地运行自主排痰方法，或因害怕疼痛不敢用力咳嗽而无法清除呼吸道分泌物。常规的电动吸引器负压吸痰往往只吸出大气道的痰液，且有不少副作用，如低氧血压、气管痉挛、气道粘膜受损、心律失常等，甚至危及生命的病例也有报道。而且此项操作属侵入性操作，会增     

兼有吸引功能的心肺复苏器

0引言兼有吸引功能的心肺复苏器是一种能促使心跳、呼吸骤停患者复苏并兼有吸除阻塞呼吸道痰液类异物功能的人工胸外按压器具．该发明1997－05获得国家专利证书，专利号：ZL96214470．3．1结构组成和性能该器具由复苏吸盘与吸引器两部分组成．最大直径105mm，高度60mm，硬度（50土5）邵氏单位．与吸盘固联的吸引器真空值范围：一6．65kPa—一39．9kPa．吸痰量：500mL／min。2适用对象和使用方法2．及适用对象①主要用于院外心跳、呼吸骤停的抢救；②重病患者痰液阻塞上呼吸道时及时进行吸痰抢救；③长期卧床患者，用其击胸拍背，促使痰液…     

机械通气下床旁支气管镜吸痰护理

我院2003年5月-2007年5月收治长时间使用呼吸机通气的呼吸衰竭患者27例.在机械通气过程中,因患者痰液粘稠,位置较深用普通吸痰管难以吸出,因此我们采用纤维支气管镜(FB)直视下吸痰,彻底清除呼吸道尤其是下呼吸道分泌物,保证小气道通畅效果显著,现将吸痰的护理体会报告如下.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.