纤维支气管镜肺泡灌洗术对老年COPD患者合并重症肺部感染血氧指标及预后的影响

目的探讨纤维支气管镜肺泡灌洗术对老年慢性阻塞性肺疾病(COPD)合并重症肺部感染患者的临床治疗效果和对血氧指标及预后的影响。方法选择2014年1月-2017年6月医院收治的老年COPD合并重症肺炎患者126例为研究对象,随机分为试验组和对照组,各63例。所有患者均给予常规对症治疗,试验组在此基础上进行纤维支气管镜肺泡灌洗术。对两组患者临床症状消失时间、疗程及对血氧指标[氧分压(PaO2)、二氧化碳分压(PaCO2)、氧合指数(SpO2)、酸碱度(pH)]及预后的影响进行分析,并评价临床疗效。结果试验组咳嗽消失时间、咳痰消失时间、肺部啰音消失时间、抗菌药物使用时间和住院时间分别为(12.71±2.16)、(8.81±2.76)、(5.73±1.25)、(8.54±3.12)和(15.38±3.29)天均短于对照组(P<0.05)。治疗后两组患者PaO2、SpO2均升高,而PaCO2下降,试验组以上指标为(64.28±5.59)mmHg、(95.53±4.35)mmHg、(33.56±5.52)%与对照组比较,差异有统计学意义(P<0.001);两组患者pH差异无统计学意义(P=0.058)。试验组疗效优于对照组(P=0.018)。试验组不良反应和死亡为7.94%(5/63)和4.80%(3/63)与对照组比较差异无统计学意义。试验组真菌定植率为7.94%(5/63)低于对照组20.63%(13/63)(P=0.042)。结论纤维支气管镜肺泡灌洗术治疗老年COPD合并重症肺部感染效果较好,能改善血氧指标和患者预后,具有一定的临床价值。     

纤维支气管镜吸痰联合肺泡灌洗在重症肺部感染患者治疗中的效果观察

目的:观察纤维支气管镜吸痰联合肺泡灌洗在重症肺部感染患者治疗中的效果。方法:抽取2016年2月~2019年2月本院收治的重症肺部感染患者68例作为研究对象,随机将其分为对照组、观察组,每组各34例。对照组采用常规治疗,观察组采用纤维支气管镜吸痰联合肺泡灌洗治疗,对比2组治疗效果。结果:观察组动脉血氧分压、动脉血氧饱和度高于对照组,而动脉二氧化碳分压低于对照组(P<0.05);观察组症状改善时间、住院时间、通气时间短于对照组(P<0.05);观察组治疗总有效率高于对照组(P<0.05)。结论:纤维支气管镜吸痰联合肺泡灌洗用于重症肺部感染治疗,效果显著。     

纤维支气管镜吸痰联合肺泡灌洗在重症肺部感染患者治疗中的效果分析

目的探讨纤维支气管镜吸痰联合肺泡灌洗在重症肺部感染患者中的应用效果及护理措施,给予临床诊治指导。方法选取2012年1月-2014年1月重症肺部感染患者90例,按数学随机方法分为普通组和治疗组,各45例,普通组实施内科常规治疗,治疗组实施纤维支气管镜吸痰联合肺泡灌洗,对比两组患者治疗有效率、血氧分压等临床指标。结果普通组治疗有效率为62.22%,治疗组有效率为82.22%,两组对比差异有统计学意义(χ2=9.218,P<0.05);治疗组血氧分压(PaO2)为(81.44±0.84)mm Hg、二氧化碳分压(PaCO2)为(42.28±0.92)mm Hg、血氧饱和度(SaO2)为(91.88±1.34)%、pH值为7.38±0.06,各项指标改善均优于普通组,对比差异有统计学意义。结论在重症肺部感染患者中应用纤维支气管镜吸痰及灌洗治疗临床效果显著确切,安全性高,值得临床推广应用。     

经纤维支气管镜吸痰联合肺泡灌洗在重症肺部感染治疗中的临床作用

目的分析经纤维支气管镜吸痰联合肺泡灌洗治疗重症肺部感染的临床疗效。方法 2005-2010年治疗的重症肺部感染患者380例,均行纤维支气管镜吸痰及泡灌洗治疗,并与之前行常规内科疗法的重症肺部感染患者的临床资料进行比较,比较两组治疗前后的痰细菌清除率、有效率及住院时间。结果吸痰联合肺泡灌洗观察组总有效率为97.6%,对照组为90.6%;痰细菌培养致病菌清除率观察组达96.7%,对照组为57.1%;观察组平均住院天数(13.4±3.4)d,对照组为(21.6±4.6)d,两组差异均有统计学意义(均P<0.05)。结论应用纤维支气管镜吸痰联合肺泡灌洗治疗重症肺部感染能够显著提高疗效,减少住院时间,具有临床应用价值。     

纤维支气管镜与肺泡灌洗术治疗老年重症肺部感染患者的疗效分析

目的探讨纤维支气管镜与肺泡灌洗术治疗老年重症肺部感染临床疗效,为临床治疗该类疾病提供依据。方法选取2011年1月-2015年1月治疗的老年重症肺部感染患者86例,随机分为观察组和对照组,每组各43例;对照组患者接受常规治疗,观察组患者在常规治疗基础上加用纤维支气管镜肺泡灌洗术治疗;观察记录两组患者治疗效果、临床体征恢复时间及不良反应发生率;数据采用SPSS 19.0软件进行统计分析。结果观察组患者咳嗽消失时间、咳痰消失时间、肺部啰音消失时间和住院时间均少于对照组患者,两组之间差异有统计学意义(P0.05);患者治疗总有效率观察组为90.70%,对照组为65.12%,差异有统计学意义(P0.05);两组患者动脉血气指标氧分压(PaO2)、二氧化碳分压(PaCO2)和血氧饱和度(SpO2)灌洗后有明显改善,差异有统计学意义(P0.05),但观察组改善更为明显,与对照组相比,差异有统计学意义(P0.05)。结论纤维支气管镜和肺泡灌洗术治疗老年重症肺部感染能明显提高疗效,缩短住院时间。     

纤维支气管镜肺泡灌洗吸痰术治疗ICU患者肺部感染临床效果分析

目的探讨纤维支气管镜肺泡灌洗吸痰术治疗ICU患者肺部感染的临床效果,以提高疗效率。方法将2012年11月-2013年10月84例ICU肺部感染患者分为两组,对照组41例给予常规治疗,试验组43例于常规治疗基础上给予纤维支气管镜肺泡灌洗吸痰术治疗。结果试验组、对照组总有效率分别为93.02%、68.29%,与对照组相比,试验组总有效率较高,肺部啰音缓解时间、发热缓解时间、咳嗽缓解时间、抗菌药物应用时间、机械通气时间及ICU住院时间均比较短,两组差异有统计学意义(P<0.05)。结论纤维支气管镜肺泡灌洗吸痰术治疗ICU患者肺部感染,疗效高,症状缓解时间短,药物应用、机械通气及ICU住院时间较短,值得推广。     

注射用头孢哌酮钠舒巴坦钠联合支气管镜肺泡灌洗在支气管扩张合并感染患者中的应用效果

目的 分析支气管扩张合并感染患者接受注射用头孢哌酮钠舒巴坦钠联合支气管镜下肺泡灌洗治疗的效果。方法 选取2021年9月至2022年12月医院收治的80例支气管扩张合并感染患者，以随机数字表法分成对照组与试验组，各40例。对照组给予注射用头孢哌酮钠舒巴坦钠治疗，试验组在对照组基础上给予支气管镜肺泡灌洗治疗，比较两组疗效、动脉血氧饱和度(SaO₂)、血氧分压(PaO₂)及二氧化碳分压(PaCO₂)、白细胞计数(WBC)、C反应蛋白(CRP)及降钙素原(PCT)水平、咳痰量。结果 治疗后，试验组总有效率、SaO₂、PaO₂水平高于对照组，差异有统计学意义(P<0.05)；试验组PaCO₂、WBC、CRP、PCT水平、咳痰量均低于对照组，差异有统计学意义(P<0.05)。结论 支气管扩张合并感染患者采用注射用头孢哌酮钠舒巴坦钠联合支气管镜肺泡灌洗治疗效果理想，能改善患者血气指标，缓解炎症反应，减少咳痰量。     

床旁纤维支气管镜吸痰支气管灌洗治疗气管插管患者肺部感染临床分析

目的探讨气管插管患者并肺部感染纤维支气管镜治疗的效果。方法回顾性分析经纤维支气管镜吸痰+灌洗治疗肺部感染62例。观察对比治疗前后呼吸、心率及血气分析中血氧饱和度等变化。结果 62例治疗前后呼吸、心率及血气分析中血氧饱和度等各项指标均明显好转(P<0.05)。结论纤维支气管镜吸痰+灌洗治疗气管插管患者肺部感染疗效肯定。     

纤支镜下肺泡灌洗吸痰术对ICU肺部感染患者临床症状及血气指标的影响

目的探究纤支镜(纤维支气管镜)下肺泡灌洗吸痰术对ICU肺部感染患者临床症状及血气指标的影响。方法选择2013年1月至2016年9月在本院ICU诊治的肺部感染患者90例,根据患者入院顺序分为2组,每组45例。对照组患者实施常规治疗,观察组患者在常规治疗的基础上实施纤支镜下肺泡灌洗吸痰术治疗。比较2组患者临床疗效、临床症状消失时间、治疗前后血气指标。结果观察组患者临床疗效优于对照组患者(P<0.05);观察组患者肺部音、咳嗽、发热等消失时间明显低于对照组患者(P<0.05);2组患者治疗前PaCO_2、PaO_2、pH值、SaO_2差异(P>0.05);治疗后观察组患者PaO_2、pH值、SaO_2高于对照组患者。结论对ICU肺部感染患者实施纤支镜下肺泡灌洗吸痰术治疗能提高患者临床疗效,缩短症状缓解时间,改善血气指标,利于患者恢复。     

纤维支气管镜治疗矽肺合并重症肺部感染的疗效

目的 探讨经纤维支气管镜对矽肺患者肺部局部感染病灶(参照肺部CT影像定位)行支气管肺泡灌洗加全身抗感染治疗矽肺合并重症肺部感染患者的疗效.方法 将广西壮族自治区职业病防治研究院2009-2011年收治的32例矽肺合并重症肺部感染患者随机分为2组,观察组(16例)给予纤维支气管镜行支气管肺泡灌洗及局部用药,每周期2次,并全身抗感染及支持对症治疗,根据药敏结果选用抗生素;对照组(16例)单用抗生素全身抗感染及对症支持治疗.结果 观察组16例治疗后的血气分析指标均较治疗前改善(均P＜0.01),其显效率为75.0％,总有效率为93.8％;对照组16例,显效率为37.5％,总有效率为75.0％,治疗组显效率明显高于对照组(x2=4.571,P＜0.05).结论 经支气管镜行支气管肺泡灌洗治疗,能及时清除气道分泌物,改善肺通气功能,可明显提高矽肺重症肺部感染患者的治愈率,是一种治疗重症肺部感染行之有效的治疗方法,值得临床进一步研究推广.     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.