无创呼吸机治疗呼吸衰竭疗效观察

目的探讨双水平无创通气治疗慢性阻塞性肺病合并Ⅱ型呼吸衰竭的临床疗效。方法106例慢性阻塞性肺病合并Ⅱ型呼吸衰竭的患者，分为对照组和无创呼吸机治疗组。两组患者均给予氧疗、抗感染、祛痰、支气管扩张剂、糖皮质激素、呼吸兴奋剂、纠正水电解质酸碱失衡等常规治疗；无创呼吸机治疗组上述常规治疗基础上加BiPAP无创呼吸机治疗。比较两组治疗前后24h心率、呼吸频率、动脉血气变化。结果两组患者治疗后临床症状、心率、呼吸频率、动脉血气均较治疗前显著改善．而无创呼吸机治疗组治疗效果显著优于对照组。结论使用无创呼吸机可有效改善慢性阻塞性肺病合并Ⅱ型呼吸衰竭患者的生命体征及血气．值得临床推广应用。     

无创正压通气在COPD合并Ⅱ型呼吸衰竭的临床疗效观察

慢性阻塞性肺病（Chronic obstructive pulmonary disease,COPD）患者常常合并Ⅱ型呼吸衰竭,无创机械通气治疗效果肯定。回顾2004—04～2007—03使用双水平无创正压通气（BiPAP）的40例COPD合并Ⅱ型呼吸衰竭患者,疗效满意。     

无创正压通气治疗慢性阻塞性肺疾病并Ⅱ呼吸衰竭52例床分析

目的：探讨无创正压通气治疗慢性阻塞性肺疾病并Ⅱ型呼吸衰竭的临床疗效.方法：选择2002年1月至2009年12月住院治疗的慢性阻塞性肺疾病合并Ⅱ呼吸衰竭52例,观察给予无创正压通气治疗前、后的血气分析值,血氧饱和度、呼吸频率、心率情况.结果：给予无创正压通气治疗两小时后患者血氧饱和度、血氧分压明善提高,血二氧化碳分压明显下降.结论：无创正压通气对轻中度Ⅱ型呼吸衰竭患者疗效肯定值得推广.     

无创正压通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的疗效观察

目的探讨无创正压通气(NIPPV)治疗慢性阻塞性肺疾病(COPD)急性加重合并Ⅱ型呼吸衰竭的临床治疗作用。方法将COPD合并Ⅱ型呼吸衰竭患者58例,随机分为治疗组30例,对照组28例,两组均行常规抗感染、激素、平喘、祛痰、呼吸兴奋剂和持续低流量吸氧等治疗。治疗组在此基础上进行NIPPV治疗,观察两组的临床疗效。结果两组患者治疗前的基本情况差异无统计学意义(P>0.05),治疗组NIPPV治疗前、后(6 h)PaCO2、PaO2、心率和呼吸频率指标明显改善,平均住院日、气管插管率和住院病死率明显减低,同对照组比较差异有统计学意义(P<0.05)。结论NIPPV治疗COPD急性加重合并Ⅱ型呼吸衰竭疗效肯定,可明显缩短住院时间,降低插管率、病死率,值得推广应用。     

BiPAP联合特布他林-氨溴索雾化吸入治疗AECOPD合并Ⅱ型呼吸衰竭患者的疗效观察

目的观察双水平气道正压通气(BiPAP)联合特布他林-氨溴索雾化吸入对AECOPD合并Ⅱ型呼吸衰竭的临床疗效。方法选取我院2008年10月—2011年10月间AECOPD合并Ⅱ型呼吸衰竭84例,分成A组(43例)、B组(41例),进行临床分析。两组均常规给予吸氧、祛痰、平喘、抗感染等治疗,A组同时给予BiPAP通气;B组给予BiPAP通气联合特布他林-氨溴索雾化吸入。观察患者治疗前后血气分析、心率、呼吸频率改变及平均住院天数、气管插管率、病死率的情况。结果两组在治疗后血气分析、HR、RR情况较治疗前均显著改善(P<0.01),而B组在治疗前后改善情况明显优于A组,具有显著统计学差异(P<0.05);两组总有效率比较,无统计学差异(P>0.05),其中显效率B组高于A组,有统计学差异(P<0.05);而在平均住院天数方面,B组明显优于A组(P<0.05)。结论对于AECOPD合并Ⅱ型呼吸衰竭患者采用BiPAP通气联合特布他林-氨溴索雾化吸入治疗,其疗效优于单一采用BiPAP治疗。     

BiPAP呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的疗效观察

目的分析研究COPD(慢性阻塞性肺疾病)合并呼吸衰竭采取Bi PAP呼吸机治疗的临床效果。方法选取2011年2月~2013年1月接收的患有COPD伴有呼吸衰竭的病人70例,随机分为观察组、对照组,对照组对病人实施常规临床治疗模式,观察组对病人采取常规治疗联合Bi PAP治疗,对观察组与对照组治疗效果给予对比研究。结果观察组临床治疗总体有效率要明显比对照组高,两组临床效果差异具有明显的统计学意义(P<0.05);观察组血氧分压显著增加,二氧化碳分压、呼吸以及心率频率明显降低,和对照组相比差异具有明显的统计学意义(P<0.05)。结论慢性阻塞性肺疾病合并呼吸衰竭采取Bi PAP呼吸机治疗,可以使呼吸衰竭症状得到明显改善,具有临床推广价值。     

无创正压辅助通气治疗老年AECOPD合并Ⅱ型、呼吸衰竭伴意识障碍的临床疗效评价

目的：探讨无创正压辅助通气治疗老年慢性阻塞性肺疾病急性加重期（acute exacerbation of chronic obstructive pulmonary disease,AECOPD）合并Ⅱ型呼吸衰竭伴意识障碍患者的临床疗效。方法收集老年AECOPD合并Ⅱ型呼吸衰竭伴有意识障碍的患者43例,均为65岁以上的老年患者,在常规治疗基础上,应用德国万曼多功能无创呼吸机（VENTImotion）进行无创正压辅助通气治疗,观察治疗前后患者心率、呼吸频率、意识状态及动脉血气指标变化。结果43例老年患者均成功接受无创正压辅助通气治疗,与治疗前相比,治疗2 h后,pH值和PaCO2均改善（P＜0.05）,治疗12 h后意识状态好转,格拉斯哥昏迷指数评分（Glasgow coma scale,GCS）增高（P＜0.01）,心率及呼吸频率下降,PaO2升高（P＜0.05）,治疗48 h后意识状态明显改善,动脉血气指标基本恢复正常。结论无创正压辅助通气救治老年AECOPD合并Ⅱ型呼吸衰竭伴有意识障碍患者的临床疗效显著。     

BiPAP呼吸机治疗Ⅱ型呼吸衰竭的疗效观察

慢性阻塞性肺病（COPD）患者常并发Ⅱ型呼吸衰竭,临床上常给予鼻塞低流量吸氧及解痉、呼吸兴奋剂等治疗,但难以取得满意效果。近年来,无创通气方法越来越多地用于临床,为治疗COPD并发Ⅱ型呼衰提供了一种新方法。我科自2005年以来,对临床上确诊COPD并发Ⅱ型呼衰的患者,用双水平气道正压力通气（Bi-level positive airway pressure,BiPAP）呼吸机经口鼻面罩气道正压通气治疗,取得了较好的效果,现报告如下。     

双水平气道正压通气治疗重叠综合征伴呼吸衰竭25例疗效分析

目的 探讨双水平气道正压通气(Bi-PAP)呼吸机治疗重叠综合征伴呼吸衰竭患者的疗效.方法 25例患重叠综合征伴呼吸衰竭的老年患者,在常规治疗基础上,使用Bi-PAP呼吸机治疗,观察治疗前后动脉血气指标变化及睡眠呼吸暂停低通气指数(AHI)变化.结果 25例患者使用Bi-PAP呼吸机治疗后,20例(80.0%)血气指标明显改善,AHI指数明显纠正.结论 使用Bi-PAP呼吸机治疗重叠综合征伴呼吸衰竭,可有效地减轻患者上气道阻塞,消除低氧血症,降低患者的反复感染率,显著改善预后.     

无创双水平正压通气治疗慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭的护理

无创双水平正压通气是慢性阻塞性肺疾病（COPD）伴Ⅱ型呼吸衰竭治疗的重要手段,无创呼吸治疗能为COPD伴Ⅱ型呼吸衰竭患者提供一种安全、有效的呼吸支持,且能有效地降低气道插管率,提高患者的舒适程度,减少并发症的发生,但无创正压双水平正通气操作的正规性以及与患者充分的交流、严密的床旁监护、不良反应的预防和无创呼吸机的正规消毒是进行无创双水平正压通气治疗效果的有效保证。     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.