气管套管防尘加湿罩的制作和临床应用

气管切开在危重患者的抢救过程中有时起到决定性作用。术后护理时，一般常在气管套管上盖双层湿纱布，一是为防止灰尘吸人造成呼吸道感染；二是增加吸入空气的湿度。但是，棉线吸水后膨胀变粗，致湿纱布的网眼面积明显缩小，使气道阻力增加，导致呼吸费力。针对新问题，我们设计了一种气管套管防尘加湿罩，临床使用后效果满意，介绍如下。     

气管切开179例气管套管应用体会

气管切开是一常用手术,适应证广泛。由于呼吸机的使用,提高了对多种疾病的抢救能力。我们自2000年以来对179例危重患者行气管切开术,积累了部分对预防气管套管相关并发症的经验,现总结如下。     

重度吸入性损伤气管切开的护理体会

目的总结重度吸入性损伤气管切开的护理措施和体会。方法对我院收治的38例重度吸入性损伤患者气管切开的护理措施进行回顾性分析。结果38例患者中31例抢救成功,顺利拔管,7例死亡,成功率81．6％。结论对重度吸入性损伤气管切开后行有效的气道湿化、及时地吸痰、能减少并发症的发生,缩短原发病治愈时间。     

气管切开术后的护理体会

气管切开是一种抢救危重病人的急诊手术,也是解除呼吸道梗阻,抢救病人生命的重要措施之一。如果护理不当,就会发生感染,甚至危及生命,影响康复,因此,做好气管切开的护理,往往对患者有极为重要的作用。     

"V"领后开襟上衣在气管切开患者中的护理体会

目的 探讨"V"领后开襟上衣在气管切开患者中的护理体会.方法 2009年10月-2010年12月我科收住气管切开患者455例,全部使用"V"领后开襟上衣.结果 使用自制上衣后患者农领卡在气管切开套管以下,原有的阻碍呼吸、造成污染,及不便于气管切开处换药、吸痰等护理操作的情况得到有效改善.结论 穿着自制"V"领后开襟上衣可有效减少气管切开患者感染或过度暴露受凉导致的病情加重.     

"V"领后开襟上衣在气管切开患者中的护理体会

目的 探讨"V"领后开襟上衣在气管切开患者中的护理体会.方法 2009年10月-2010年12月我科收住气管切开患者455例,全部使用"V"领后开襟上衣.结果 使用自制上衣后患者农领卡在气管切开套管以下,原有的阻碍呼吸、造成污染,及不便于气管切开处换药、吸痰等护理操作的情况得到有效改善.结论 穿着自制"V"领后开襟上衣...     

一种供气管切开患者在高压氧舱内吸氧的装置

气管切开的患者不能按常规戴面罩吸氧，同时大部分自主呼吸力量较弱。因此，此类患者在高气压下吸纯氧就要有特殊的、安全的装置。目前国内气管切开患者在高压舱内吸氧，大致有以下３种方法：１．将气管套管的气囊内注入生理盐水４～５ｍｌ，堵塞气管套管开口，然后戴面罩...     

一种多型号气切套管外径连接件的研制

高压氧越来越广泛地应用于各种缺血缺氧性疾病的治疗。气管切开的患者因金属套管口径各不相同,至今尚无完善的金属套管专用供氧装置或连接件。因此对于佩戴金属套管的气管切开患者,高压氧治疗的开展一直受到限制。本设计为一种多型号套管外径连接件,可与各种型号的塑料及金属套管外径紧密连接,作为气管切开患者高压氧治疗时的供氧工具连接件。...     

高压氧舱内呼吸机联合气管套管治疗重型颅脑损伤术后气管切开患者30例疗效分析CSCD

颅脑损伤后出现昏迷及呼吸障碍的重症患者大多数需行气管切开术,以保证患者机体的氧供.高压氧（hyperbaric oxygen,HBO）治疗能够明显增加患者血氧含量,改善神经系统功能,促进患者神经功能恢复[1].由于大多数颅脑损伤患者病情危重,气管切开后仍要求在高压氧舱内将呼吸机的机械通气与气管套管吸氧结合,因此护理管理质量要求比较高,特别是呼吸道的管理尤为关键,因为气管切开治疗开放了呼吸通道,使外源性病菌容易侵入肺部,增加肺部感染的可能性,且高压氧舱为完全封闭的治疗环境,缺少空气对流,加之持续高浓度氧供,导致患者呼吸道分泌物明显增多.由于颅脑损伤术后患者大部分意识不清,咳嗽、咳痰等条件反射减弱,无法自行排出呼吸道中的分泌物,因此较容易发生痰液潴留,使细菌繁殖增生,引发气管切开和呼吸机相关性肺炎[2].本研究探讨高压氧舱内呼吸机联合气管套管吸氧治疗重型颅脑损伤术后气管切开患者不同的治疗和护理模式对预后的影响.现报道如下.     

药物性气管套管垫的临床研究

气管切开术后,由于呼吸道分泌物等污染切口,引起切口处感染。多年来对气管切开切口处的护理,一直采用套管周围放一消毒纱布套管垫的方法,不能有效地预防、治疗切口感染。1992年我们研制出一种新的气管套管垫,垫中含有一定量的抗生素药物。临床应用证明该套管垫具有预防和治疗气管切口处感染的作用。现介绍如下。 对象与方法     

外生型宫颈浸润癌介入治疗的探讨

目的探讨超选择性子宫动脉化疗栓塞治疗53例外生型宫颈浸润癌的意义。方法常规采用Seld ing's技术,经皮股动脉穿刺插管,髂内动脉造影及子宫动脉化疗栓塞治疗。结果超选择子宫动脉化疗栓塞治疗后突起子宫颈局部肿瘤大部分或全部坏死脱落。结论采用超选择性子宫动脉化疗栓塞是治疗中晚期宫颈癌的一种安全有效的方法。     

自制可回收下腔静脉滤器预防急性肺栓塞的实验研究

目的 探讨一种新型可回收下腔静脉滤器预防急性肺栓塞的有效性、安全性.方法 12只犬制备成髂股深静脉血栓模型,分为滤器组(实验组)与无滤器组(对照组),每组6只.滤器组在深静脉血栓脱落前于对侧股静脉置入下腔静脉滤器,其后使血栓脱落;对照组直接使血栓脱落即形成肺动脉栓塞.通过血栓脱落前后的肺动脉造影、肺动脉测压以及动脉血氧饱和度测定评价滤器的血栓捕获性能.结果 滤器组均成功捕获脱落的深静脉血栓,无一例发生肺动脉栓塞,8 h后滤器均能成功回收;而对照组在推注血栓后均发生了肺动脉栓塞.结论 自制可回收下腔静脉滤器能有效预防下肢深静脉急性血栓脱落引起的肺动脉栓塞,其置入和回收简便.     

Ocular problems in military free fall parachutists

Military free fall parachutists may be unaware of the risk of corneal freezing and desiccation keratitis should their goggles come off during free fall in subfreezing temperatures. We determine the incidence of ocular difficulties in military free fall parachutists and the role freezing temperatures may play in causing these problems. We found that 79% of those who responded to the survey had lost their goggles at least once during free fall and 69% experienced ocular symptoms after goggle loss. Analysis shows a 30-fold increase in the duration of symptoms in subfreezing vs. above-freezing temperatures, with the odds of the ground mission being affected at 7.3 per 100 jumps in the subfreezing group. The rate of goggles coming off per jump is 3.3 times less with >75 jumps. Contact lenses are not protective and photorefractive keratectomy was not detrimental.     

两种子宫输卵管造影方法发生对比剂逆流的比较

目的:探讨子宫输卵管造影(HSG)检查使用宫颈塞法和双腔球囊导管法发生逆流的差别。方法:我院HSG检查457例,其中宫颈塞法210例,占46%,双腔球囊导管法247例,占54%。结果:两种方法发生逆流的比率为11.4%和18.2%,组间差异有显著性意义(P<0.05)。两种造影方法中逆流的类型比较,淋巴逆流、静脉逆流、混合逆流发生比率为25.0%、20.8%、54.2%和26.7%、20.0%、53.3%,组间差异无显著性意义(P>0.05)。结论:两种方法发生逆流的比率有显著性差异,发生的类型比率无明显差异,双腔球囊导管法操作方法不恰当会增加发生逆流的机会。     

皮肤切开套管针静脉穿刺置管在烧伤休克期的应用

目的：解决大面积烧伤休克期静脉反复穿刺失败的难题。方法：采用皮肤切开套管针静脉穿刺置管代替静脉切开。结果：本组24例穿刺成功率100％，比静脉切开节时省力，有效地保护了静脉的重复使用，无1例发生静脉炎，静脉栓塞及套管脱出等静脉置管并发症。结论：皮肤切开套管针静脉穿刺置管适合于烧伤复苏治疗，利于反复穿刺。     

Technical innovation: wire guided ductography

To introduce an easy and improved technique for performing ductography using inexpensive easily available intravenous cannula. Guide wire: Prolene/Surgipro 3-0 (Polypropylene mono filament non-absorbable surgical suture). A plastic 26 G intravenous cannula. Disposable syringe 2 ml. Non-ionic contrast (low density like Omnipaque 240 mg I/I). The guide wire (Prolene 3-0) is introduced into the orifice of the duct heaving discharge and 26 G intravenous plastic cannula is then passed over the guide wire. The cannula is advanced in the duct over guide wire by spinning around it. When the cannula is in place the guide wire is removed. Any air bubbles present in the hub of the cannula can be displaced by filling the hub from bottom upwards with needle attached to contrast filled syringe. 0.2-0.4 ml non-ionic contrast is gently injected. Injection is stopped if the patient has pain or burning. Magnified cranio-caudal view is obtained with cannula tapped in place and gentle compression is applied with the patient sitting. If duct filling is satisfactory a 90* lateral view is obtained. A successful adaptation of the technique for performing ductography is presented. The materials required for the technique are easily available in most radiology departments and are inexpensive, thus making the procedure comfortable for the patient and radiologist with considerable cost effectiveness.     

Cutaneous application of local anaesthetic–a useful help in galactography

Galactography is an important step in the diagnostic workup of abnormal nipple discharge. At times it is impossible to insert the cannula in the secreting duct and galactography cannot be performed. In such cases we tried applying local anaesthetic spray (LA) cutaneously to the nipple followed by a further insertion attempt. LA has enabled us to insert the galactography cannula in all patients so far. We concluded that after previous unsuccessful attempts, the presented technique may relax the duct orifice and therefore permit insertion of the galactography cannula into the secreting duct.     

Guide-wire reinforcement and lengthening with coaxial locking guide wires: the crimping technique

The authors developed a technique to increase the size of a guide wire and permit single-step placement of catheters and large sheath systems over previously inserted small-caliber guide wires. The technique involves compression of metal cannula against a smaller in-dwelling wire or inner cannula. It has been used successfully during laser-assisted balloon angioplasty and percutaneous nephrolithotomy.     

Percutaneous nephropyelostomy using a fine-needle puncture set.

The authors describe an improved method of percutaneous nephropyelostomy using a long, fine, flexible needle combined with a wider and shorter cannula. The needle facilitates atraumatic puncture of the renal collecting system and antegrade pyelography and subsequently serves as a guide over which the nephrostomy cannula is inserted. This technique was successful in 105 of 115 procedures (93 patients) over a period of 15 months and has replaced operative nephrostomy in the author's hospital.     

Cannula-Assisted and Transabdominal Ultrasound-Guided Hepatic Venous Recanalization in Budd Chiari Syndrome: A Novel Technique to Avoid Percutaneous Transabdominal Access

We describe a technique for facilitating recanalization of hepatic veins via the transjugular approach in patients with Budd Chiari syndrome, where a transjugular liver biopsy cannula provides support to the catheter–glidewire combination and transabdominal ultrasound helps in positioning the tip of the cannula at the hepatic venous ostium.