气管切开后气道持续湿化的应用

目的探讨不同的雾化方法对气管切开后气道湿化的作用效果;方法选择我院2006年11月-2009年12月以来的48例气管切开患者,随机分为两组,一组采用压缩雾化吸入机,连接管连接雾化器与气管导管或者气切面罩,对患者进行24h持续雾化吸入,另一组进行间隔雾化吸入,并比较二者的气管切开后气道湿化的效果;结果不同的气管切开后的气道湿化方法对患者出痰次数以及出痰的粘稠度和痰痂数量均造成不同程度的差异。其中,第一组为24h持续雾化吸入湿化,在两周内患者的重度粘痰次数为4次,显著低于第二种间隔雾化的重度粘痰11次（P〈0.01）;持续雾化吸入湿化的中度＋重度粘痰次数也显著低于间隔雾化的次数,二者差异显著（P〈0.05）;同时,第一组重度粘痰次数也显著低于第二组,二者差异显著（P〈0.05）。另外,持续雾化吸入湿化极显著的降低了患者痰痂的数量（P〈0.01）;结论采用压缩雾化吸入机,连接管连接雾化器与气管导管或者气切面罩,对患者进行24小时持续雾化吸入,能够有效地保持切开后气管的湿度,维持气管粘膜正常,有利于患者的呼吸顺畅,减少痰液生成。     

喷射雾化器持续雾化对气管切开气道湿化作用的研究

目的探讨喷射雾化器持续雾化对气管切开气道的湿化作用。方法气管切开患者90例,随机分为实验组及对照组各45例。实验组应用氧气驱动喷射雾化器,在雾化器内加无菌注射用水持续雾化进行气道湿化,对照组应用输液泵将无菌注射用水持续泵入气道进行湿化。结果实验组患者湿化满意度、呼吸音改善优于对照组,湿化不足、肺部感染发生率低于对照组,吸痰间隔时间长于对照组,PaO2、SaO2高于对照组,PaCO2低于对照组,差异均具有显著性。结论利用喷射雾化器持续雾化进行气道湿化,效果良好,并且操作简单、方便吸痰,洗涤消毒彻底,值得临床推广。     

气管切开微泵入低渗盐水湿化气道预防肺部感染的疗效观察

目的研究气管切开微泵人低渗盐水湿化气道预防肺部感染疗效．方法与常规雾化进行对比分析其体温、白细胞计数、肺部罗音及胸片异常的时间．结果治疗组从体温、肺部罗音及胸片异常出现的时间都有优异于常规雾化组，但白细胞计数变化差异不明显．结论气管切开微泵人低渗盐水湿化气道预防肺部感染并发症疗效显著可靠．     

气管切开微泵入低渗盐水湿化气道预防肺部感染的疗效观察

目的研究气管切开微泵入低渗盐水湿化气道预防肺部感染疗效.方法与常规雾化进行对比分析其体温、白细胞计数、肺部罗音及胸片异常的时间.结果治疗组从体温、肺部罗音及胸片异常出现的时间都有优异于常规雾化组,但白细胞计数变化差异不明显.结论气管切开微泵入低渗盐水湿化气道预防肺部感染并发症疗效显著可靠.     

气道持续湿化吸氧在人工气道病人的运用

目的 观察人工气道病人运用气道持续湿化的效果.方法 对64例人工气道开放病人先运用常规吸氧并间断滴入湿化液,24h后运用加温湿化罐进行持续雾化吸氧,对其气道湿化情况前后进行观察统计.结果 运用持续湿化吸氧,可有效的减少痰液的黏稠度与痰痂的形成.结论 道持续湿化能够保证吸入气体得到充分的湿化,减少病人气道水分的丢失,对改善和保持病人呼吸道通畅有明显的结果.     

机械通气患者持续气道湿化中使用盐酸氨溴索的效果观察

目的探讨呼吸机使用期间适宜的气道湿化方法,以降低痰液粘稠度、减少痰痂形成及痰培养细菌阳性率。方法将60例机械通气超过5d的患者分观察组和对照组,对照组仍采用常规呼吸机湿化装置湿化;观察组在对照组基础上使用盐酸氨溴索行持续气道湿化。结果观察组在痰痂形成、刺激性咳嗽、气道粘膜出血、肺部感染均显著低于对照组(<0.05)。结论机械通气患者联合使用盐酸氨溴索行持续气道湿化明显优于传统的方法。     

56例气管切开并发症的处理

气管切开术是临床抢救和治疗呼吸道梗阻患者的重要措施之一。如发生意外情况,处理不当,可产生严重后果,危及生命。因此,不但掌握气管切开后的常规护理,而且应了解和妥善处理气管切开的并发症。我科近10年共行气管切开术56例,现就12例气管切开术后并发症的处理及护理对策报告如下。     

重型颅脑损伤病人气管切开后的护理体会

气管切开是抢救颅脑外伤和其他疾病并发呼吸困难的最有效方法.本文回顾性分析我科2005年5月至2009年5月24例重型颅脑外伤患者的临床资料,总结气管切开术后预防肺内感染的护理体会.现报告如下.     

严重烧伤气管切开后气管套管堵塞原因分析及对策

目的分析重度、特重度烧伤患者气管切开后通气不畅、易发生气管套管堵塞且较以前增多的原因,解决和预防的方法。方法回顾分析1992年至2000年和2001年至2009年两个时间段共计207例烧伤患者行气管切开术的病因、治疗方法、护理措施、一次性气管套管的使用及治疗环境对呼吸系统的影响。结果 1992年至2000年122例患者,平均住院日56d,4人发生堵管,堵管率为3.279%,死亡65例,死亡率53%。2001年至2009年85例患者,平均住院日35d,5人发生堵管,堵管率为5.882%,死亡29例,死亡率34%。结论重度、特重度烧伤合并吸入性损伤这一特殊的致病因素,是造成气管切开后通气不畅易发生套管堵塞的主要原因,补液的时间及补液的方法不同、护理措施是否有效、一次性气管套管的使用以及高温治疗环境（各种烧伤治疗机）均是术后气管套管通气不畅易发生套管堵塞重要因素。充分认识烧伤补液、治疗环境的重要性,同时高度重视术后气管套管的护理,才能达到气管切开目的 。     

经皮穿刺气管切开术与常规气管切开术术式比较

目的：比较经皮气管切开术（percutaneoustracheotomy,PT）与常规气管切开术（conventionaltracheotomy,CT）的优缺点。方法：本组行PT44例,CT86例,将两种手术方式、手术场所及手术并发症进行观察对比。结果：PT床边操作20例（45％）,术中出血量5～10ml,手术时间5～10min,皮下气肿5例,术后拔管颈部疤痕长度1～1．5cm,同CT比较（P〈0．0131）。结论：PT操作简单、时间短、手术安全可靠,明显优于CT,值得推广。     

持续加热湿化法在机械通气患者中的应用及分析

目的探讨呼吸机加热湿化管道系统对建立人工气道机械通气患者湿化效果的影响。方法收集建立人工气道机械通气48h以上患者200例,随机分为A、B组各100例。A组使用Drarermedical（吸气与呼气管路均无加热）湿化管道系统;B组使用同类型Dragermedical（吸气管路带加热而呼气管路无加热）湿化管道系统;两组湿化液均使用灭菌注射用水。对两组分泌物粘稠度、管道痰痴形成及气道痉挛情况进行比较。结果两组患者在气道分泌物粘稠度、管道痰痂形成、气道痉挛等方面的比较,差异有统计学意义（P〈0．01）;B组无管道痰痴形成,亦无气道痉挛发生。结论机械通气患者呼吸道湿化效果与呼吸机管道湿化系统的管道是否加热有关,加热湿化系统管道,有利于改善气道湿化效果。     

持续气道正压无创呼吸机控制系统的研制

提出一种用于治疗睡眠呼吸暂停综合症的持续气道正压呼吸机控制系统解决方案.系统主要由控制核心高速Soc单片机C8051F005、压力发生装置无刷直流电机/风机装配体和压力传感器组成.介绍系统控制器的结构、硬件电路原理、软件设计流程和实现持续气道正压自动控制的PID算法处理模块,并利用气流分析仪和噪声计测试样机性能.选择6名志愿者对样机进行临床试用.实验结果表明,主要技术参数符合ISO 17510-1睡眠呼吸暂停治疗设备标准所规定的要求,具有噪声低、可靠性高、使用舒适性好等优点.     

Inflammatory Processes and Effects of Continuous Positive Airway Pressure (CPAP) in Overlap Syndrome

We aimed to compare serum levels of the inflammatory mediators including C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and asymmetric dimethylarginine (ADMA) in chronic obstructive pulmonary disease (COPD), obstructive sleep apnea syndrome (OSAS), and their coexistence called overlap syndrome (OVS). In addition, we planned to investigate changes of these mediators with the treatment of continuous positive airway pressure (CPAP) in OSAS and OVS. CRP, TNF-α, and ADMA levels were analyzed by ELISA method from blood samples withdrawn from patients with COPD (N?=?25), OVS (N?=?25), and moderate- to severe-stage OSAS (N?=?25). First blood samples were taken in the morning after polysomnography application, and second blood samples were taken from OSAS and OVS patients who underwent regular CPAP treatment. In comparison of three groups prior to CPAP treatment, ADMA level in OSAS were significantly lower than in COPD (p?=?0.009), but CRP and TNF-α were similar among groups. When we compared the parameters before and after CPAP treatment, the level of CRP in both OSAS and OVS decreased significantly (p?=?0.02, p?=?0.04), whereas TNF-α and ADMA levels did not display any significant differences. A decrease of serum CRP level in OVS and OSAS groups following effective CPAP treatment shows that CPAP is an effective treatment method for systemic inflammation.     

Use of Intravenous Polymyxin B During Continuous Venovenous Hemodialysis

Described here is the case of a 23-year-old male with Acinetobacter baumannii sepsis and acute renal failure requiring continuous venovenous hemodialysis treated successfully with intravenous polymyxin B. The drug was administered as a loading dose of 2.5 mg/kg, followed by 2 doses of 1 mg/kg on days 4 and 8, then 0.8 mg/kg daily to complete a 24-day course. A discussion of dosing recommendations for polymyxins in dialysis is presented.     

Effects of Continuous Positive Airway Pressure on Sleep State Misperception in Patients With Obstructive Sleep Apnea

BackgroundLittle is known regarding the effects of continuous positive airway pressure (CPAP) on sleep misperception in obstructive sleep apnea (OSA).MethodsSleep state perception was measured by subtracting the objective total sleep time from the subjective sleep duration. Sleep underestimation and overestimation were defined as ± 60 minutes sleep perception. Insomnia and depressive symptoms were assessed using questionnaires. Finally, nonparametric statistical analyses were performed.ResultsOf the 339 patients with OSA included in the study, 90 (26.5%) and 45 (13.3%) showed sleep underestimation and overestimation, respectively. Overall, a significant underestimation of sleep was noted during CPAP titration comparing to a diagnostic PSG (P < 0.001). OSA patients with insomnia or depressive symptoms did not show any changes in sleep perception between diagnostic and CPAP titration studies, whereas those without insomnia or depressed mood showed significantly underestimated sleep duration during CPAP titration. Patients with OSA and either underestimated or overestimated misperception showed perceptual improvements during CPAP titration regardless of the presence of insomnia or depressive symptoms. However, of 204 patients with normal sleep perception, 138 (67.6%) and 10 (4.9%) had underestimation and overestimation of sleep during CPAP titration.ConclusionCPAP titration may improve sleep perception with moderate to severe OSA who have sleep misperception. However, CPAP titration may result in sleep misperception especially underestimation of sleep in those who have normal sleep perception.     

Effect of Continuous Positive Airway Pressure on Sleep Structure in Heart Failure Patients with Central Sleep Apnea

Study Objectives:

At termination of obstructive apneas, arousal is a protective mechanism that facilitates restoration of upper airway patency and airflow. Treating obstructive sleep apnea (OSA) by continuous positive airway pressure (CPAP) reduces arousal frequency indicating that such arousals are caused by OSA. In heart failure (HF) patients with central sleep apnea (CSA), however, arousals frequently occur several breaths after apnea termination, and there is uncertainty as to whether arousals from sleep are a consequence of CSA. If so, they should diminish in frequency when CSA is attenuated. We therefore sought to determine whether attenuation of CSA by CPAP reduces arousal frequency.

Design:

Randomized controlled clinical trial.

Patients and Setting:

We examined data from 205 HF patients with CSA (apnea-hypopnea index [AHI] ≥ 15, > 50% were central) randomized to CPAP or control who had polysomnograms performed at baseline and 3 months later.

Measurements and Results:

In the control group, there was no change in AHI or frequency of arousals. In the CPAP-treated group, the AHI decreased significantly (from [mean ± SD] 38.9 ± 15.0 to 17.6 ± 16.3, P < 0.001) but neither the frequency of arousals nor sleep structure changed significantly.

Conclusion:

These data suggest that attenuation of CSA by CPAP does not reduce arousal frequency in HF patients. We conclude that arousals were not mainly a consequence of CSA, and may not have been acting as a defense mechanism to terminate apneas in the same way they do in OSA.

Citation:

Ruttanaumpawan P; Logan AG; Floras JS; Bradley TD. Effect of Continuous Positive Airway Pressure on Sleep Structure in Heart Failure Patients with Central Sleep Apnea. SLEEP 2009;32(1):91-98.     

持续正压通气对阻塞性睡眠呼吸暂停低通气综合征患者血栓前状态的影响

探讨持续正压通气（CPAP）对阻塞性睡眠呼吸暂停低通气综合征（OSAS）患者血栓前状态（PTS）的影响。对49例OSAS患者治疗前及经CPAP治疗30d后血小板聚集率（PAG）、P-选择素、内皮素-1（ET-1）及血清血友病因子（vWF）进行了放免或酶免测定,并与42名健康对照组的检测结果进行了比较。结果显示,OSAS患者治疗前PAG、P-选择素、ET-1、vWF均高于治疗后及正常对照组（P〈0.01）,经CPAP治疗30d后,上述患者检测结果与对照组无明显差异（P〉0.05）。结论：OSAS患者治疗前多存在PTS,用CPAP治疗可纠正血小板活化,有利内皮细胞修复,对于减轻患者临床症状起到一定的作用。