气管切开患者的护理体会

临床上许多患者由于呼吸道阻塞、呼吸不畅,需要行气管切开术,而气管切开后加大了患者气管及肺部感染的机率,因而必须要做好气管切开患者的护理,防止气管及肺内感染的发生。我科于2005年1月至2008年1月对收治的97例气管切开术后患者进行了有效的护理,大大减少了肺内感染的发生。     

11例气管切开术后患者的护理体会

气管切开术是抢救危重病人呼吸道梗阻的重要措施之一。气管切开患者依赖气管套管呼吸。因此 ,做好其术后的护理就尤其重要。本文简述 11例患者气管切开术后的护理体会。1　临床资料　　我科自 1994年 9月至 1998年 9月共对 11例危重病人呼吸道梗阻患者行气管切开术。其中有机磷农药中毒伴呼吸衰竭 3例 ,脑血管意外昏迷患者 8例。带管时间最短为 4d,最长为 41d,年龄 2 8～ 6 7岁。具体做法与护理体会如下。1　呼吸道护理1.1　做好呼吸道湿化 :我们采取在气管口覆盖一纱布并固定 ,将针头别在纱布上 ,以每分钟 0 .2～ 0 .4m l的速度将稀化液沿…     

气管切开术后的护理体会

气管切开术是抢救生命的急救手术,有时也适应于喉的机械性阻塞所致的呼吸困难及下呼吸道分泌物阻塞引起的呼吸衰竭。气管切开术后护理是手术成败的主要原因之一。为提高护理质量,现将我院1985～1991年收治气管切开木4例的护理体会总结如下。1 临床资料 本组气管切开术4例均为男性,年龄16～58岁,手术适应证为昏迷并呼吸道阻塞。原发病种为脑干损伤并颅内血肿3例,脑干损伤1例。气管插管时间10～30d,平均18.5d。4例经治疗15～36d后     

老年重症病人气管切开术后长期带管的护理

气管切开术后 ,保持呼吸道通畅及预防并发症是护理工作的一个重要环节 ,特别是长期带管的老年重症病人 ,由于自身抵抗力低 ,更容易发生各种并发症。 10年来我科对各种病因所致严重气道梗阻或呼吸衰竭的老年病人共 7例进行气管切开术 ,其中 3例因病情长期不能拔管 ,带管时间为 3～ 6个月 ,现将 3例老年重症病人气管切开术后长期带管的护理体会介绍如下。1　临床资料　　 3例病人均为男性 ,年龄 72～ 86岁 ,1例为成人呼吸窘迫综合征 ,2例为呼吸衰竭 ,行气管切开术后带管时间为 3～6个月。2　护理体会2 .1　气管切开后呼吸道感染的预防 :1病人…     

21例气管切开术后肺部感染恢复期康复护理体会

气管切开术是抢救危重患者的急救手术,气管切开可增加有效通气量,也便于吸痰、加压吸氧等,是临床上用于抢救呼吸衰竭、中枢神经系统疾病等危重患者的重要手段,但是,气管切开后,容易出现下呼吸道感染。有报道指出：气管切开后下呼吸道感染占93．8％。一旦感染,有效康复护理措施如促进排痰、保证有效通气、争取早期拔管对患者进一步开展康复治疗非常重要。笔者所在科室自2005～2008年收治了21例气管切开术后伴肺部感染恢复期患者,有效的护理和早期的康复介入使所有患者均成功封管,现将康复护理体会报道如下。     

气管切开术后肺部感染的护理对策

气管切开是解除上呼吸道梗阻的有效方法，是临床上用于抢救呼吸衰竭、中枢神经系统疾病等危重病人的重要手段，但是，气管切开后，容易出现下呼吸道感染。有报道指出：气管切开后下呼吸道感染占93．8％。笔者总结我院2006～2007年气管切开术23例病人的护理经验，现就其中几个护理因素进行分析。     

ICU气管切开患者肺部感染原因分析及护理对策

气管切开术是抢救危重患者的急救手术,能解除各种原因引起的呼吸道阻塞,改善呼吸困难,但术后肺部感染的机会较多,有文献报告气管切开术后肺部感染达100%[1].通过总结2008年1月至2009年11月我院ICU 36例行气管切开发生肺部感染患者的痰培养结果,对我院ICU气管切开患者肺部感染病原菌现状分析,建立有效预防ICU院内感染的护理对策.     

气管切开术后呼吸道的护理

目的探讨气管切开术后呼吸道护理体会。方法对64例气管切开术患者给予呼吸道护理,包括体位、排痰、套管护理、呼吸道湿化、口腔护理及针对性心理护理。结果64例气管切开患者除1例死于原基础疾病外,其余均未发生呼吸道感染。结论系统的整体化护理,可以显著降低或预防气管切开术后患者的呼吸道感染。     

探讨气管切开术后医源性感染的影响因素及护理对策

目的探讨分析气管切开术后医源性感染的影响因素,并提出相应的护理对策。方法本文研究对象选取我院2016年4月至2017年4月收治的42例行气管切开手术患者,其中有22例患者在术后发生医源性感染(感染组),20例患者未感染(非感染组),采取单因素分析对气管切开术后发生医源性感染涉及的年龄、抗菌药物使用、机械通气、住院时间、插管保留时间等相关因素进行分析。结果 42例行气管切开术患者有22例发生医源性下呼吸道感染,感染率为52.38%。从单因素分析结果得知,行气管切开术后发生医源性感染和插管保留时间、机械通气、三代头孢使用有着紧密联系。结论在手术治疗中对抗菌药物进行合理使用,控制呼吸辅助器械,只有这样才能降低气管切开术后发生医源性感染几率。与此同时临床护理人员也需要积极学习各项预防和控制感染规章制度,在工作中严格遵守消毒规程,提高医院控制感染意识的同时达到预防医院感染目的。     

早期气管切开对重型脑外伤患者治疗效果及预后的影响

目的 探讨早期气管切开术对重型脑外伤患者治疗效果及预后的影响.方法 回顾性分析2012年1月至2019年12月雅安市人民医院收治的60例重型颅脑外伤患者的临床资料,根据气管切开时间将患者分为早期气管切开组(ET组)和晚期气管切开组(LT组).ET组患者在入院7 d内行气管切开术,LT组患者在入院7 d后行气管切开术,比较不同气管切开时间对重型脑外伤患者治疗效果及预后的影响.结果 与LT组比较,ET组患者入院时合并低氧血症比例明显升高,差异有统计学意义(P<0.05).ET组行气管切开术后肺部感染发生率(21.88％)低于LT组肺部感染发生率(50.00％),差异有统计学意义(P<0.05).ET组ICU住院时间、总住院时间明显少于LT组(P<0.05);ET组肌松剂使用率、呼吸衰竭比例明显低于LT组(P<0.05);两组患者抗生素使用率、镇静剂使用率、出院格拉斯哥预后评分(GOS)、住院死亡率和气管切开并发症发生情况比较,差异无统计学意义(P>0.05).结论 入院时低氧血症可作为重型脑外伤患者行早期气管切开的指标之一.重型脑外伤患者选择早期气管切开术进行治疗,可减少肺部感染及呼吸衰竭发生,缩短IC U住院时间及总住院时间,但不能改善出院GOS评分和住院死亡率.     

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.