支气管肺泡灌洗诊断肺结核护理配合

目的:探讨支气管肺泡灌洗诊断肺结核的可行性及护理方法。方法:对36例疑似肺结核患者进行支气管肺泡灌洗,灌洗液经离心、沉淀,涂片抗酸染色找结核杆菌。结果:36例疑似肺结核患者进行支气管肺泡灌洗,诊断肺结核24例。诊断率66.67%。结论:支气管肺泡灌洗液抗酸染色找结核菌方法快速准确,能使结核患者得以及时诊治。术前做好充分准备与心理护理,消除患者恐惧心理,术中严格执行诊疗常规,严密观察患者生命体征,防止并发症的发生,正确收集灌洗标本,是支气管肺泡灌洗检查的有效保证。     

支气管肺泡灌洗术在误吸患者中的应用与护理

目的探讨纤维支气管镜行支气管肺泡灌洗术在误吸患者中的作用与护理。方法对161例误吸患者应用支气管肺泡灌洗术进行治疗,观察其疗效及不良反应,同时认真做好护理。结果161例误吸患者中96例恢复,59例好转,6例无变化,无1例发生严重心律失常等并发症。结论支气管肺泡灌洗有利于更好地救治误吸患者,而且有效的护理能提高其救治成功率。     

支气管肺泡灌洗在治疗重症哮喘患者中的效果观察及护理

目的 探讨支气管肺泡灌洗在治疗重症哮喘患者中的治疗效果及护理经验.方法 对24例重症哮喘患者在机械通气的基础上采用纤支镜支气管肺泡灌洗治疗,观察和比较支气管肺泡灌洗前后患者动脉血气及气道阻力变化情况和观察灌洗过程中不良反应及并发症发生情况.结果 支气管肺泡灌洗后患者动脉氧分压( PaO2)、血氧饱和度(SaO2)较灌洗前升高,气道峰压(PIP)较灌洗前降低,灌洗前后比较,均P＜0.01,差异具有统计学意义;在灌洗过程中患者未出现严重的并发症.结论 在机械通气的基础上采用纤支镜下支气管肺泡灌洗是治疗重症哮喘有效手段.做好灌洗前后的护理是保证治疗成功的关键.     

支气管肺泡灌洗治疗顽固性肺部感染的护理

目的：总结支气管肺泡灌洗生肺部感染的护理经验。方法：用支气管肺泡灌洗术治疗无罪性肺部感染１４例。结果：疗效显９例,有效４例,无效１例,总有效率９０％,结论：支气管肺泡灌洗治疗顽固性肺部感染安全、有效、可靠。     

支气管肺泡灌洗治疗呼吸衰竭60例的护理

目的 总结呼吸衰竭患者行支气管肺泡灌洗治疗的护理体会.方法 对60例Ⅱ型呼吸衰竭患者行纤维支气管镜肺泡灌洗治疗实施的护理.结果 所有患者行支气管肺泡灌洗后症状明显好转,血气分析较灌洗前明显改善( P＜0.05).结论 Ⅱ型呼吸衰竭患者行支气管肺泡灌洗治疗,充分的术前准备、术中配合、术后的严密观察是提高临床疗效的关键.     

支气管肺泡灌洗在儿童感染性肺不张治疗中的应用及护理

目的探讨经纤维支气管镜行支气管肺泡灌洗术在儿童感染性肺不张治疗中的作用与围术期的护理对策。方法对55例感染性肺不张的住院患儿,应用支气管肺泡灌洗术进行治疗,观察其疗效及不良反应,同时认真做好围术期护理。结果55例感染性肺不张患儿中37例复张,16例好转,2例无变化;无1例发生肺水肿、出血、气胸等并发症。结论支气管肺泡灌洗有利于肺不张的恢复,及时采取恰当的护理措施是支气管肺泡灌洗术治疗感染性肺不张取得良好疗效的保证。     

支气管肺泡灌洗在儿童感染性肺不张治疗中的应用及护理

目的 探讨经纤维支气管镜行支气管肺泡灌洗术在儿童感染性肺不张治疗中的作用与围术期的护理对策.方法 对55例感染性肺不张的住院患儿,应用支气管肺泡灌洗术进行治疗,观察其疗效及不良反应,同时认真做好围术期护理.结果 55例感染性肺不张患儿中37例复张,16例好转,2例无变化;无1例发生肺水肿、出血、气胸等并发症.结论 支气管肺泡灌洗有利于肺不张的恢复,及时采取恰当的护理措施是支气管肺泡灌洗术治疗感染性肺不张取得良好疗效的保证.     

支气管肺泡灌洗在儿童感染性肺不张治疗中的应用及护理

目的探讨经纤维支气管镜行支气管肺泡灌洗术在儿童感染性肺不张治疗中的作用与围术期的护理对策。方法对55例感染性肺不张的住院患儿，应用支气管肺泡灌洗术进行治疗，观察其疗效及不良反应，同时认真做好围术期护理。结果55例感染性肺不张患儿中37例复张，16例好转，2例无变化；无1例发生肺水肿、出血、气胸等并发症。结论支气管肺泡灌洗有利于肺不张的恢复，及时采取恰当的护理措施是支气管肺泡灌洗术治疗感染性肺不张取得良好疗效的保证。     

支气管肺泡灌洗治疗迁延性局限性支气管肺感染临床分析

目的:探讨支气管肺泡灌洗在治疗迁延性局限性支气管肺感染的临床价值。方法:将52例患者随机分为2组,治疗组(n=27):在进行抗感染平喘、营养支持治疗基础上行支气管肺泡灌洗治疗;对照组(n=25):单纯行抗感染化痰、解痛及营养支持治疗。结果:治疗组显效17例,有效9例,有效率为96.3%;对照组显效7例,有效11例,有效率为67%。两组比较差异有统计学意义(P<0.05)。结论:支气管肺泡灌洗是治疗迁延性局限性支气管肺感染的有效方法,有较高的实用价值。     

重症肺部感染经支气管镜支气管肺泡灌洗术治疗临床观察

选取我院2009年1月～2012年5月收治的重症肺部感染患者120例,采用随机数字表法分为两组,其中对照组60例,采用抗生素应用、营养支持及持续呼吸机通气等常规治疗措施;支气管肺泡灌洗组60例,在对照组治疗基础上,加用支气管肺泡灌洗术;比较两组患者临床感染改善总有效率,临床症状、体征改善时间,住院时间及治疗前后血气分析指标等。结果对照组与支气管肺泡灌洗组患者临床感染总有效率分别为73.3%和95.0%;支气管肺泡灌洗组患者临床感染改善总有效率明显高于对照组,组间比较差异显著(P<0.05);支气管肺泡灌洗组患者退热时间、咳嗽咳痰时间、白细胞恢复时间及住院时间均明显短于对照组,组间比较差异显著(P<0.05)。经支气管镜支气管肺泡灌洗术治疗重症肺部感染能够有效改善临床症状,缩短病程,加快康复进程,提高肺部通气功能。     

Characteristics and outcome among patients suffering out-of-hospital cardiac arrest due to drowning

AIM: To describe the characteristics and outcome among patients with out-of-hospital cardiac arrest (OHCA) caused by drowning as compared with OHCA caused by a cardiac etiology (outside home). PATIENTS AND METHODS: All the patients included in the Swedish OHCA Registry between 1990 and 2005 which were not crew witnessed, in whom cardio-pulmonary resuscitation (CPR) was attempted, were evaluated for inclusion. Those caused by drowning were compared with those with a cardiac etiology (outside home). RESULTS: Patients with OHCA due to drowning (n=255) differed from patients with OHCA with a cardiac etiology (n=7494) as they were younger, less frequently suffered a witnessed OHCA, more frequently received bystander CPR and less frequently were found in a shockable rhythm. Patients with OHCA due to drowning had a prolonged ambulance response time as compared with patients with OHCA with a cardiac etiology. Patients with OHCA due to drowning had a survival rate to 1 month of 11.5% as compared with 8.8% among patients with OHCA due to a cardiac etiology (NS). Among patients with OHCA due to drowning, only one independent predictor of survival was defined, i.e. time from calling for an ambulance until the arrival of the rescue team, with a much higher survival among patients with a shorter ambulance response time. CONCLUSION: Among patients with OHCA 0.9% were caused by drowning. They had a similar survival rate to 1 month as compared with OHCA outside home with a cardiac etiology. The factor associated with survival was the ambulance response time; a higher survival with a shorter response time.     

Swimming, a gene-specific arrhythmogenic trigger for inherited long QT syndrome

OBJECTIVE: To determine the genetic basis for long QT syndrome (LQTS) in a cohort of patients with a personal history or an extended family history of a swimming-triggered cardiac event. PATIENTS AND METHODS: After review of the Mayo Clinic unit medical record system, blood samples or archived autopsy tissue samples were obtained from a retrospective cohort of 35 cases diagnosed as having autosomal dominant LQTS. Exon-specific amplification by polymerase chain reaction and direct sequence analyses were performed on the entire KVLQT1 gene. RESULTS: Six cases had a personal history or an extended family history of a near drowning or drowning. In all 6 cases, LQTS-causing mutations in KVLQT1 gene were identified: 3 deletion mutations, 2 donor splice site mutations, and 1 missense mutation. One of the mutations, a novel donor splicing defect, was determined by postmortem molecular analysis of a paraffin-embedded tissue block from a 12-year-old girl who died in 1976. Distinct KVLQT1 mutations were demonstrated in 3 of the remaining 29 cases. The overall frequency of KVLQT1 defects in LQTS was 100% (6/6) in those with and 10% (3/29) in those without a personal history or an extended family history of drowning or near drowning (P<.001). CONCLUSION: Swimming appears to be a gene-specific (KVLQT1) arrhythmogenic trigger for LQTS. This study provides proof of principle that an unexplained drowning or near drowning may have a genetic basis.     

Systematic review of definitions for drowning incidents

OBJECTIVES: In preparation for the World Congress on Drowning uniform reporting consensus document of drowning incidents we reviewed systematically the medical literature for the terms and definitions used to describe drowning incidents to assess the uniformity of these terms in the medical literature. METHODS: The search strategy included a literature search of PubMed, MEDLINE and the Cochrane Database from 1966 to April 2002, as well as a review of reference lists of identified studies and a hand search of relevant textbooks and reference works. Search terms used included drowning, near-drowning, submersion, immersion, suffocation, asphyxiation, water injuries, and aspiration. Any article with drowning as a primary focus and containing a definition of drowning was included. Study designs included experimental studies, observational studies, case control studies, reviews, letters, and editorials. RESULTS: The search identified approximately 6000 articles. Of these 650 were reviewed and 43 articles addressing the definition of drowning were identified. We found a total of 33 different definitions to describe drowning incidents, 20 for drowning and 13 for near-drowning; along with another 13 related terms. There were at least 20 different outcome measures for drowning incidents reported. CONCLUSIONS: A review of existing drowning literature demonstrates a lack of a standard definition of drowning and a lack of agreement on measures of outcome. This variability in definitions and outcomes makes it very difficult to assess and analyze studies both individually and as a whole and draw conclusions that will influence practice. These objective findings support the need for the drowning Utstein focus on one definition of drowning and validated measures of functional and neurological outcome.     

臭氧液阴道冲洗在治疗念珠菌阴道炎中的效果观察

[目的]研究臭氧液进行阴道冲洗在治疗念珠菌阴道炎中的效果.[方法]将300例念珠菌阴道炎病人随机分成实验组和对照组.实验组用臭氧液冲洗阴道并同时给予克霉唑泡腾片阴道塞药,每天1次,7 d为1个疗程;对照组不用臭氧液冲洗,余同实验组,两组病人治疗后停药5 d复查.[结果]实验组总有效率98.67%高于对照组94.67%.[结论]臭氧阴道冲洗辅助克霉唑泡腾片阴道塞药治疗念珠菌阴道炎效果好、疗效快.     

Pathology of the lung in near-drowning

In order to study the initial pathological changes that occur in drowning, the authors developed an experimental model that closely simulates the actual changes in the nearly drowned patient. Adult male rabbits were anesthetized and intubated, and 6 ml/kg of fresh or salt water was instilled directly into the endotracheal tube. The animals were killed after 29 minutes, and the heart and lungs were then examined microscopically. The authors found that in the first 30 minutes, the brunt of the damage is borne by the vascular endothelium and not the alveolar cells.     

微创手术治疗中耳炎

目的：探讨在耳内窥镜直视下,进行中耳微创手术对慢性化脓性中耳炎的疗效。方法：在耳内窥镜直视下,扩大小的鼓膜穿孔,清除中耳肉芽,清除胆脂瘤并加以冲洗和负压吸引治疗慢性化脓性中耳炎单纯型54例,骨疡型6例,胆脂瘤型7例。结果：54例,单纯型中耳炎,治疗组30例中获得干耳28例,有效率为93．3％;对照组24例中获得干耳9例有效率为37．5％;治疗组30例中,纯音听力检查较治疗前平均提高10db者124例,有效率为80％;对照组24例中音听力检查较治疗前平均提高10db者4例,有效率为44．4％,骨疡型6例中获得干耳4例,胆脂瘤型7例中获得干耳6例。结论：使用耳内窥镜作为一种辅助工具,进行微创手术治疗加上冲洗和负压吸引治疗部分慢性化脓性中耳炎是有效和可靠的。     

前列腺摘除术后不同温度冲洗液对膀胱痉挛的影响

目的 :探讨前列腺摘除术后不同温度冲洗液冲洗膀胱对膀胱痉挛的影响。方法 :随机将 5 3例前列腺摘除术后患者分为两组 ,分别应用低温和等温冲洗液冲洗膀胱 ,监测对膀胱痉挛的影响。结果 :低温和等温冲洗液冲洗膀胱每日膀胱痉挛的次数分别为 19 5± 8 2次与 6 8± 2 1次 (P <0 0 0 1) ;每次膀胱痉挛的持续时间分别为 2 3± 0 8min与 1 0± 0 3min (P <0 0 0 1) ;持续天数分别为 5 0± 2 0d ,2 5± 1 0d (P <0 0 0 1)。结论 :等温冲洗液冲洗膀胱可减少膀胱痉挛的次数 ,缩短膀胱痉挛的持续时间和天数 ,降低患者术后疼痛 ,提高患者的舒适度     

Our experience in the use of a Russian preparation of pulmonary surfactant in the treatment of acute respiratory distress syndrome and severe pneumonia in children]

Six critical patients aged 2 months to 13 years with lung diseases were treated by pulmonary surfactant preparation. Three of these children developed the acute respiratory distress syndrome in the presence of grave pneumonia (1 case), asphyxial drowing (1 case), and small-small intestinal invagination (1 case), three others developed acute bilateral large focal pneumonia with or without repeated atelectases. The drug Surfactant-BL was administered in a dose of 400 micrograms/m2 by instillations (2 cases) or by inhalation aerosols. The drug improved blood gases, lung compliance, x-ray picture, and clinical status of all patients, permitting a decrease in IMV/SIMV parameters within 12-48 h after the last administration and discontinuation of IMV/SIMV in 3 patients within 24 h after 1 or two administrations. Five children survived, 1 (with asphyxial drowning) died with brain edema and wedging syndrome. Surfactant-BL is a safe and effective drug; administration through alveolar nebulisers should be preferred.     

Drowning related out-of-hospital cardiac arrests: Characteristics and outcomes

Aim

There are few studies on drowning-related out-of-hospital cardiac arrest (OHCA) in which patients are followed from the scene through to hospital discharge. This study aims to describe this population and their outcomes in the state of Victoria (Australia).

Methods

The Victorian Ambulance Cardiac Arrest Registry was searched for all cases of OHCA with a precipitating event of drowning attended by emergency medical services (EMS) between October 1999 and December 2011.

Results

EMS attended 336 drowning-related OHCA during the study period. Cases frequently occurred in summer (45%) and the majority of patients were male (70%) and adult (77%). EMS resuscitation was attempted on 154 (46%) patients. Of these patients, 41 (27%) survived to hospital arrival and 12 (8%) survived to hospital discharge (5 adults [6%] and 7 [12%] children). Few patients were found in a shockable rhythm (6%), with the majority presenting in asystole (79%) or pulse-less electrical activity (13%). An initial shockable rhythm was found to positively predict survival (AOR 48.70, 95% CI: 3.80–624.86) while increased EMS response time (AOR 0.73, 95% CI: 0.54–0.98) and salt water drowning (AOR 0.69, 95% CI: 0.01–0.84) were found to negatively predict survival.

Conclusions

Rates of survival in OHCA caused by drowning are comparable to other OHCA causes. Patients were more likely to survive if they did not drown in salt water, had a quick EMS response and they were found in a shockable rhythm. Prevention efforts and reducing EMS response time are likely to improve survival of drowning patients.     

球帽附着体种植覆盖总义齿即刻负载修复低平下颌无牙颌13例:随访24个月

目的:无牙颌种植修复是目前口腔种植关注的热点,如何做到简单、快捷、经济是正在努力探索的问题.观察使用2颗ITI球帽附着体种植覆盖总义齿即刻负载对低平下颌无牙颌的修复效果.方法:纳入下颌牙槽骨萎缩低平义齿固位差的患者13例,分别于下颌置入种植体2颗,正畸牵引圈保存球帽基台与球帽阴型间缓冲空间,制作下颌球帽附着体种植覆盖总义齿,即刻负载修复,随访24个月.结果:所有种植体无松动,无明显骨吸收,义齿咀嚼及固位满意.3例出现种植体周围牙龈轻度红肿,对症处理后痊愈.结论:2颗ITI球帽附着体种植覆盖总义齿即刻负重修复低平下颌无牙颌是简单、快捷、经济、可行的手段.