戊二醛与酸性氧化电位水对支气管镜的消毒效果比较

摘要 目的比较戊二醛与酸性氧化电位水对支气管镜的消毒效果。方法 选取支气管镜160个,随机分为2组,试验组和对照组各 80个,分别采用20 g/L戊二醛与酸性氧化电位水进行五槽法使用前现场高水平消毒及使用后消毒。20 g/L戊二醛浸泡消毒30 min,总计清洗消毒时间为35～45 min;酸性氧化电位水浸泡消毒10 min,总计清洗消毒时间为25 min。消毒后分别采样进行细菌学检测。结果 试验组对支气管镜的现场消毒与使用后的消毒合格率为100%;对照组对支气管镜的现场消毒合格率为100%,使用后的消毒合格率为94%,两组比较,差异有统计学意义（P<0.05）。结论 20 g/L戊二醛对支气管镜的消毒效果肯定,但使用过程中,要注意做好个人防护。     

酸性氧化电位水与戊二醛对临床内镜消毒效果及人体危害性调查

为了解酸性氧化电位水和戊二醛对临床使用中内镜消毒效果,采用现场采样检测方法进行了监测比较。结果,采用酸性氧化电位水清洗消毒胃镜和肠镜3 m in,对自然菌消除率为99.3%~99.95%;清洗消毒作用5 m in,未检出存活菌。用20 g/L戊二醛对胃镜和肠镜清洗消毒作用5 m in,对自然菌消除率为90.38%~93.04%;清洗消毒作用10 m in,对自然菌消除率为99.92%~99.96%。结论,酸性氧化电位水对临床使用中胃镜和肠镜清洗消毒效果比戊二醛作用快速,容易冲洗且无刺激性气味。     

机械通气患者呼吸道的护理

目的：探讨对机械通气患者进行呼吸道的护理的意义。方法：对20例机械通气患者呼吸道进行护理。认真观察呼吸机工作是否正常，并给予雾化吸入后选择合适的吸痰管吸痰，严格执行消毒隔离制度。控制医原性感染。结论：对机械通气患者进行呼吸道的护理是抢救治疗机械通气患者的关键。总结：20例机械通气患者呼吸道的护理，认为加强机械通气患者呼吸道的护理很关键。     

戊二醛的临床消毒应用研究进展

戊二醛是一种高效消毒剂和灭菌剂，广泛用于石油开采、医药卫生、生物化学、食品化妆品的防腐等方面，对其杀菌作用的研究文献报道较多。戊二醛作为灭菌剂适用于手术器械、内窥镜、口腔器械、妇科器械、持物钳和其它的对热敏感的医疗器械的灭菌处理，许多国家将其载入国家药典。戊二醛在取得良好的灭菌作用的同时，其影响因素及产生的不良影响亦被广泛关注，现就这些问题研究情况简述如下。     

呼吸机通气管道的几种消毒方法临床分析

目的：研究消毒呼吸机通气管道的最佳方法,方法：对比戊二醛、甲醛和洗必泰3种方法的消毒效果,结果：消毒60min时,3种方法均达到标准,但戊二醛的消毒效果与甲醛、洗必泰差异有显性（P,0.05),消毒90min。3种消毒效果无差异,但洗必泰对呼吸机通气管道有腐蚀,甲醛有难闻的气味。结论：戊二醛与95%乙醇配合消毒迅速彻底,消毒效果优于甲醛和洗必泰。     

戊二醛对气管内套管的消毒效果分析

戊二醛具有广谱、高效、快速、无毒、稳定、方便的特点,在临床上广泛应用,为探讨对气管内套管的消毒效果,我科自1997年10月以来,采用强化戊二醛（由浓缩戊二醛加强化增效剂配制而成）消毒气管内套管代替原来的煮沸消毒法,经临床应用和观察,效果满意。现报告如下。     

戊二醛用于胃镜消毒方法的改进

目的 :保证用戊二醛进行胃镜消毒的有效浓度 ,确保消毒效果。方法 :制剂室用碘量法测定每批戊二醛的初始浓度共8次 ,感染科和胃镜室用戊二醛浓度指示卡测试使用中戊二醛浓度 2 63次。结果 :戊二醛原液浓度均合格 ;使用中戊二醛浓度合格率为 37.63 % ,原因与胃镜消毒槽设计不合理 ,清洗方法不当 ,使用次数过多等有关。经改进水槽设计 ,纠正不当清洗方法 ,限制使用次数 ,每日测试浓度 ,复查使用中浓度合格率为 90 .0 0 % ,使用次数≤ 2 0人次时浓度合格率为 97.42 %。结论 :戊二醛溶液用于胃镜消毒时 ,每日监测其浓度 ,每批配制液以使用不超过 2 0人次为宜 ,能确保戊二醛溶液的浓度不低于 1 .8%。     

戊二醛配合不同处理对纤维胃镜消毒效果的比较

试验中，以戊二醛配合不同处理对纤维胃镜消毒，并比较其效果。试验时，将绿脓杆菌、大肠杆菌与金黄色葡萄球菌混合液及ＨＢｓＡｇ、ＨＢＶＤＮＡ阳性血清染于胃镜镜身、活检钳、活检管道内表面等部位，经２０ｍｉｎ晾干。然后，用２％戊二醛分别配合下列处理进行消毒：①...     

强化戊二醛对吸痰管消毒的探讨

目的　为了探索一种高效快速、安全实用、价廉的吸痰管消毒方法。方法　将 6 4条使用过的吸痰管 ,分成三个组 ,分别用 2 %强化戊二醛、0 5 %过氧乙酸、2 %消佳净浸泡法进行消毒 ,于浸泡 10、15、2 0、30min后 ,各取样一次做细菌培养。结果　 2 %强化戊二醛与 0 5 %过氧乙酸比较 ,在不同的时间段 ,消毒效果差异无显著意义(P >0 0 5 ) ;2 %强化戊二醛与 2 %消佳净比较 ,各时间段的消毒效果 ,差异有显著意义 (P <0 0 5或 0 0 0 1) ,尤其是浸泡 30min ,差异非常显著。结论　 2 %强化戊二醛具有高效快速、实用安全、价廉的优点 ,是消毒吸痰管的理想消毒剂     

Outcome of older patients receiving mechanical ventilation

Objective To determine the threshold of age that best discriminates the survival of mechanically ventilated patients and to estimate the outcome of mechanically ventilated older patients.Design International prospective cohort study.Setting Three hundred sixty-one intensive care units from 20 countries.Patients and participants Five thousand one hundred eighty-three patients mechanically ventilated for more than 12 h.Interventions None.Measurements and results Recursive partitioning and logistic regression were used and an outcome model was derived and validated using independent subgroups of the cohort. Two age thresholds (43 and 70 years) were found, by partitioning recursive analysis, to be associated with outcome. This study focuses on the analysis of patients older than 43 years of age, divided in two subgroups: between 43 and 70 years (middle age group) and older than 70 years (elderly group). Survival in hospital was 45% (95% C.I.: 43–48) for the elderly group and 55% (53–57) for the middle age group (p<0.001). Advanced age was not associated with prolongation of mechanical ventilation, weaning or length of stay in the ICU and in hospital (p>0.05). Variables associated with mortality in the elderly were: acute renal failure, shock, Simplified Acute Physiology Score II and a ratio of PaO₂ to FIO₂ more than 150.Conclusions Older mechanically ventilated patients (age >70 years) had a lower ICU and hospital survival, but the duration of mechanical ventilation, ICU and hospital stay were similar to younger patients. Factors associated with the highest risk of mortality in patients older than 70 were the development of complications during the course of mechanical ventilation, such as acute renal failure and shock.Electronic Supplementary Material Supplementary material is available in the online version of this article at The authors wrote this paper on behalf of the Mechanical Ventilation International Study Group, whose members are listed in the electronic supplementary material.Supported by grant 98/0233 from the Fondo de Investigación Sanitaria, by the Red GIRA (G03/063 from the Fondo de Investigaciones Sanitarias), by the Red Respira (C03/11 from the Fondo de Investigaciones Sanitarias) and Merit Review Grant from Veterans Administration Research Service.Dr. Ely is funded by the Paul Beeson Faculty Scholar Award for Study of Aging and the National Institute of Aging (#AG01023–01A1)     

Potassium sorbate reduces gastric colonization in patients receiving mechanical ventilation

OBJECTIVES: Tube feeding might increase gastric burden of pathogenic bacteria and predispose patients to ventilator-associated pneumonia. We sought to determine whether a tube feeding formula acidified using potassium sorbate could reduce gastric burden of potentially pathogenic bacteria. DESIGN: Prospective, randomized, double-blind trial. SETTING: RML Specialty Hospital, a facility with expertise in weaning patients from prolonged mechanical ventilation. PATIENTS: Thirty patients recovering from prolonged mechanical ventilation. INTERVENTION: Patients were randomized to receive either a standard tube feeding formula (n=14) or a formula acidified using potassium sorbate to a pH of 4.25 (n=16). MEASUREMENTS AND RESULTS: Weekly quantitative cultures of gastric aspirates. The number of colony-forming units (CFUs) per patient was higher in the control than in the treatment group (53%+/-11% vs 9%+/-3.4%, threshold of >or=100,000 CFU/mL fluid, P=.003). The number of organisms isolated in each patient per week was higher among patients receiving standard tube feeding formula than among patients receiving acidified formula (0.91 +/- 0.20 vs 0.13 +/- 0.05 organisms per patient per week, threshold of >or=100,000 CFU/mL fluid, P=.0014). There was no difference in the incidence of gastrointestinal bleeding or ventilator-associated pneumonia between study groups. CONCLUSION: Tube feeding formula acidified using potassium sorbate was well tolerated and reduced gastric bacterial burden in patients recovering from prolonged mechanical ventilation.     

封闭式吸痰在急诊机械通气病人的应用体会

目的探讨封闭式吸痰在急诊机械通气病人中的应用。方法将144例机械通气病人随机分为对照组和观察组各72例。观察组采用封闭式吸痰。对照组采用开放式吸痰。观察病人吸痰前后血氧饱和度及心率变化,清醒病人吸痰恐惧感及吸痰耗时情况等。结果封闭式吸痰对患者血氧饱和度、心率改变显著小于对照组(P0.05);吸痰时病人恐惧感发生率对照组明显高于观察组(P0.05);吸痰操作耗时比较,封闭式吸痰法耗时显著少于传统开放式方法(P0.05)。结论封闭式吸痰能有效减轻吸痰对患者心肺功能的影响,减轻患者的心理负担,提高急诊科的工作效率。     

机械通气对CVP的影响

目的探讨机械通气对CVP的影响 ,提高机械通气病人CVP的准确性和可靠性。方法对 40例机械通气病人进行CVP及机械通气有关参数的监测。结果经监测比较发现 ,机械通气使CVP上升。CVP的上升与平均气道压呈正相关。结论CVP的这种变化并不反映相伴随的血液动力学变化。     

机械通气对危重症伴呼吸衰竭患者血浆内皮素水平的影响

目的　探讨呼吸功能不全等危重病患者接受机械通气治疗时血浆内皮素变化的临床意义。方法　 5 8例呼吸功能不全等危重病患者为观察组 ,38例健康体检者为对照组 ,机械通气治疗前后测定血浆内皮素浓度。结果　观察组机械通气前的血浆内皮素平均浓度为 (6 5 79± 2 1 78)pg/mL ,明显高于对照组的(4 8 87± 10 96 )pg/mL ,(P <0 0 1)。观察组机械通气治疗后第 3天 ,血浆内皮素平均浓度为 (36 39±16 39)pg/mL (P <0 0 1)。结论　机械通气是治疗呼吸功能不全、减少内皮素对机体的损害的有效措施。血浆内皮素浓度的变化 ,对危重症伴呼衰患者病情严重程度和转归的判断、疗效评价有一定参考价值。     

单向活瓣通气给氧在机械通气患者撤机中的应用研究

目的探讨在机械通气患者撤机过程中,使用单向活瓣通气给氧的方法对脱机训练的影响。方法选择行机械通气72 h以上患者48例,符合撤机标准,在准备撤机前将患者随机分成观察组和对照组各24例,观察组使用单向活瓣通气给氧的方法对患者进行脱机训练,对照组采用常规氧气管给氧通气的方法,通过观察两组患者的血气分析、呼吸频率、心率、血压变化,并了解患者的耐受性及舒适度改变等指标。结果两组患者在脱机后1 h3、h2、4 h动脉血气分析的血氧分压(PaO2)、动脉血氧饱和度(SaO2)、呼吸次数、心率、血压变化相比较,差异有显著性意义(P<0.05)。观察组患者的耐受性及舒适度明显比对照组好。结论使用单向活瓣通气给氧用于机械通气患者撤机的方法,可以使患者能吸入较精确的足够的氧混合气体,降低导管死腔,减少患者的呼吸做功,增加患者的舒适度,从而能使患者达到快速、顺利脱机的目的。     

不同吸引负压对机械通气患者密闭式吸痰效果的对比

目的比较密闭式吸痰时负压10~20kPa与20~40kPa对机械通气患者吸痰效果的影响。方法2005年9月-2007年3月,选择老年气管切开机械通气患者21例,随机分为2组:低压组(n=10,吸引压力=10~20kPa)和高压组(n=11,吸引压力=20~40kPa),分别采用不同吸引负压密闭式吸痰各7d,比较2组患者吸痰前后动脉血氧饱和度(SPO2)、24h痰量、24h吸痰次数,吸痰间隔时间、气道黏膜损伤情况等。结果和低压组患者比较,高压组患者24h吸痰量少、24h吸痰次数少、吸痰间隔时间长(P<0.05),而吸痰前后2组患者的SPO2、气道黏膜情况无显著性差异(P>0.05)。结论机械通气患者采用高压(20~40kPa)密闭式吸痰的效果好,间隔时间长,可减轻患者的痛苦,提高工作效率。     

呼吸衰竭患者不同吸痰方式吸痰效果的比较

目的探讨不同吸痰方式对呼吸衰竭机械通气患者吸痰前后呼吸循环参数的影响。方法将40例呼吸衰竭使用呼吸机的患者随机分为对照组和观察组,各20例。观察组采用密闭式吸痰,对照组采用传统的开放式吸痰,采取受试者自身前后对照的方法,观察患者吸痰前后呼吸循环参数的变化。结果密闭式吸痰前后患者呼吸循环参数差异无统计学意义（P〉0．05）,开放式吸痰前后心率、SpO2、Ppeak、Pplat参数差异有统计学意义（P〈0.01）,收缩压、RR、PaO2参数差异有统计学意义（P〈0.05）,Vt、PaCO2参数差异无统计学意义（P〉0.05）。结论呼吸衰竭患者使用密闭式吸痰方法较开放式吸痰方法安全有效。     

机械通气患者呼气末正压对膀胱压的影响

目的：探讨机械通气患者呼气末正压（PEEP）对膀胱压的影响。方法选取我院重症医学科机械通气且监测膀胱压的患者40例,将膀胱压正常＜1．47 kPa（15 cmH2 O）的患者23例作为A组,膀胱压增高≥1．47 kPa （15 cm H2 O ）的患者17例作为 B 组,采用自身对照法,观察患者在断开呼吸机及使用呼气末正压0 kPa （0 cmH2O）、0．294 kPa （3 cmH2O）、0．490 kPa（5 cmH2O）、0．981 kPa（10 cmH2O）和1．47 kPa（15 cmH2O）时的膀胱压变化。结果A组患者在不同呼气末正压时膀胱压的变化差异无统计学意义（P＞0．05）。B组患者在呼气末正压＞0．294 kPa（3 cmH2 O）时随着呼气末正压的增高膀胱压也会随之增高,差异有统计学意义（P＜0．05）,呼气末正压为≤0．294 kPa（3 cmH2 O）时与断开呼吸机时测得的膀胱压比较,差异无统计学意义（P＞0．05）。结论膀胱压＜1．47 kPa（15 cm H2 O ）时,可保持呼吸机的呼气末正压正常调整,以保证患者的氧合,保障患者的安全。膀胱压≥1．47 kPa（15 cmH2 O）时,应保持呼吸机的呼气末正压≤0．294 kPa（3 cmH2 O）的水平,以保证患者的氧合,保障患者的安全。     

Pain assessment in turning procedures for patients with invasive mechanical ventilation

Background: The assessment of pain is particularly difficult in critical patients unable to self‐report or with cognitive impairment. In such cases, the use of scales which evaluate pain through patient behaviour is important. Aims: To compare the behavioural responses to pain, measured on the Critical‐Care Pain Observation Tool (CPOT) scale, and the physiological responses prior to, during and after the positioning procedure in patients with invasive mechanical ventilation. We also sought to analyse whether there are differences in the CPOT scores between medical and surgical patients, and between conscious and unconscious patients. Method: Pain scores were evaluated in 96 patients. The data gathering was carried out 1 min before, during and 10 min after the turning by means of the CPOT scale which includes four behavioural indicators, each indicator scored from 0 to 2. Likewise, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and arterial oxygen saturation (SpO₂) were recorded. Results: The total mean score on the CPOT scale prior to the positioning procedure was 0·27; during turning it was 1·93 and 0·10 after the procedure (p < 0·05). Facial expression was the indicator that increased most with reference to the baseline situation, followed by body movements; compliance with the ventilator, and finally, muscle tension. There were also slight variations in these physiological variables during the turning procedure (p < 0·05). The total mean score on the CPOT scale during the turning of surgical patients was 2·02 and 1·80 for medical patients (p = 0·162). Conclusions: The observation of the patient's behaviour during the turning and the physiological changes produced allow professionals to objectify pain in critical patients with verbal communication difficulties. Moreover, our results also highlight the need to administer of additional analgesia before a painful procedure, particularly in post‐surgical patients. Relevance to clinical practice: The good measurement qualities of the CPOT scale obtained during a painful procedure recommend its use in intensive care units (ICUs) for adult patients with artificial ventilation.