Stephan CPAP呼吸机的使用与维护

Stephan CPAP呼吸机是新生儿专用呼吸机,它和普通呼吸机相比,在设备的操作,使用范围和维护保养上都有很大的区别。为了让医护人员更加了解、熟习这种呼吸机,更好地使用它治病救人,发挥它的最大功效,该文主要介绍了该呼吸机的特点、使用技巧、使用注意事项和维护保养。     

A prospective study of exposure to verotoxin-producing Escherichia coli among Canadian children with haemolytic uraemic syndrome. The CPKDRC co-investigators.

Haemolytic uraemic syndrome (HUS) is a leading cause of acute renal failure in childhood. Although infection with Escherichia coli O 157. H7 has been associated with HUS in North America and Europe, only a limited number of studies have examined the role of other verotoxin-producing E. coli (VTEC) serotypes in this condition. To address this issue, we conducted a comprehensive, prospective microbiological study of patients treated for HUS at eight Canadian hospitals in the summer of 1990. Of the 34 consecutive patients with HUS enrolled over 4 months, E. coli O 157. H7 was isolated from the stools of 26, and other E. coli serotypes were isolated from four patients. In four subjects no pathogenic E. coli serotypes were identified on stool culture. Using oligonucleotide probes specific for VT-1 and VT-2, verotoxin genes were detected in the stool isolates of all patients with E. coli O 157. H7, and from two with other E. coli serotypes. Two other patients had at least a fourfold rise in anti-verotoxin antibodies. Strong evidence of exposure to a verotoxin was present in 30/34 (88%). Patients with E. coli O 157. H7 infection were more likely to develop an antibody response to VT-2 than to VT-1 (22/22 vs 12/22; P = 0.002). These results further strengthen the association of HUS with verotoxin-producing E. coli in North America, and confirm that E. coli serotypes other than O 157.H7 are isolated in a small proportion of summertime HUS episodes.     

便携式呼吸机院前急救转运流程与操作规范研究

目的:研究制定标准化便携式呼吸机院前急救转运流程,提高呼吸机院前急救转运质量,减少不良事件的发生。方法:以2020年Transport型气动电控呼吸机使用为例,针对呼吸机院前急救转运患者的任务评估、转运前准备、途中救治及院际交接等环节,制定标准化呼吸机急救转运流程及操作要点,并与上年度(2019年)呼吸机院前急救转运成功率进行比较。结果:采用标准化呼吸机院前急救转运流程后,2020年呼吸机转运成功率由2019年的98.6%提升至99.5%,有效提高了呼吸机院前急救转运质量,降低了呼吸机转运风险。结论:标准化的呼吸机院前急救转运流程有利于医护人员及时发现转运途中存在的隐患,可有效减少呼吸机院前急救转运不良事件的发生。     

Esprit呼吸机的介绍及常规故障排除

美国伟康Esprit呼吸机可进行有创及无创通气治疗，在不同的呼吸类型条件下可设置不同的通气模式。Esprit呼吸机具有自动诊断功能，本文作者根据五种常规故障的诊断代码分析故障原因，并进行故障排除，同时强调定期维护的重要性。     

医用空气压缩机智能化气源切换装置的加装

目的对配置于SMART呼吸机上的医用空气压缩机进行改进,使呼吸机具备中心供气和空气压缩机供气自动选择、自动切换功能。方法在空气压缩机的气路中加装传感器、控制阀等设备,使用C语言编程,利用呼吸机的单片机对切换装置进行控制。结果当中心供气设备发生故障导致供气压力低于下限时,呼吸机可以在报警的同时自动切换至空气压缩机供气,当中心供气压力恢复正常后,呼吸机又能够智能切换回中心供气。结论加装气源切换装置提升了呼吸机的智能化程度,避免了呼吸机由于气源因素导致的工作异常。     

Intertester reliability of brachial artery flow-mediated vasodilation using upper and lower arm occlusion in healthy subjects

The assessment of endothelial function as brachial artery flow-mediated vasodilatation is a widely used technique that determines the effect of risk factor intervention and may have the potential to predict the clinical benefit of antiatherogenic therapy. Previous studies suggest that flow-mediated dilation is greater using the upper-arm occlusion technique, but no data are available to compare intertester reliability between technicians. This study was undertaken to compare the amount of hyperemia between upper and lower occlusion techniques and to determine reproducibility between testers. Nineteen healthy adults, ages 25 to 50, were included in the study. Brachial artery vasodilatation was measured 1 and 3 minutes post cuff deflation and was compared with the baseline and expressed as a percent change. There was a tester effect in the percent change in diameter across all measurements. The results of this study reveal inconsistencies between testers when using a blood pressure cuff to induce hyperemia for the assessment of endothelial function through brachial artery flow-mediated vasodilation. However, upper arm as compared to lower arm blood pressure cuff occlusion results in significantly greater hyperemia and vasodilatation, even though there was a difference in measurements between testers.     

全自动清洗消毒机集中处理呼吸机附件的效果分析

目的 分析全自动清洗消毒机集中处理呼吸机附件的清洗消毒效果,以有效预防、控制呼吸机相关性肺炎.方法 运用全自动清洗消毒机和配套清洗架,按照标准清洗流程对3003件呼吸机附件进行集中清洗消毒,并用目测法及细菌采样法对消毒后附件进行效果监测及评价.结果 呼吸机附件经全自动清洗消毒机集中清洗消毒处理后,目测法观察3003件附件合格率达99.9％,采样法监测360件附件合格率达100.0％.结论 运用全自动清洗消毒机对呼吸机附件进行集中清洗消毒,能充分保证呼吸机附件的清洗消毒质量,有效降低呼吸机相关性肺炎的发生率,不断提升临床科室对消毒供应中心服务的满意度.     

呼吸机控制理论及其应用技术

本文介绍了呼吸机的发展和基本原理，以气动电控型呼吸机为例，叙述了呼吸机控制理论的发展，说明了呼吸机中常用的两种控制器：PID控制器和模糊控制器的基本原理，以及不同控制方法的优缺点。     

浅谈呼吸机临床上的有效运用

呼吸机越来越广泛地用于治疗各种原因所致的呼吸障碍，抢救了许多危重患者的生命，人们也愈来愈认识到呼吸机给人类带来的好处，但它给患者身心带来的负面影响也不容忽视。本文着重介绍了呼吸机与患者的连接、工作参数的合理设置以及治疗时的护理，使呼吸机在临床上能够得到较好的运用，从而使患者的疾病更快地康复。     

Barriers to STD/HIV prevention on the Internet.

Using the Internet as a mode for health promotion is appealing. There are important methodological considerations to the approach, but there are also important reasons why people will and will not participate in Internet interventions. This is a report on data from 4601 people who completed an online survey of sexual risk behavior in 2000. Most indicated they would visit a website for STD/HIV prevention information (61%), but fewer would open an E-mail (45%) or chat (30%) about the topic. Top reasons for rejecting website, E-mail and chat room education about STD/ HIV are given. Logistic regression results showed men who have sex with men (MSM) and persons with a history of testing for STD are consistently more likely to endorse STD/HIV prevention through chat rooms (MSM 1.8, STD testers 1.3), E-mail (MSM 1.6, STD testers 1.2) and websites (MSM 1.8, STD testers 1.2). The data demonstrate the Internet may facilitate health promotion among MSM who may not be reached in a publicly funded STD prevention setting. The Internet may also act as a good adjunct to STD information obtained in clinic settings among those who seek STD testing.     

无创呼吸机微涡轮研究

本文介绍了无创呼吸机总体组成结构、叶片型式。讨论了不同βb2角(叶片出口的几何角)对无创呼吸机效率、功率以及压力的影响,同时介绍了怎样确定微涡轮的叶片数和在无创呼吸机微涡轮中采用后弯式叶片的优点。     

Maquet Servo-s呼吸机的自检及故障分析与探讨

目的:针对Maquet Servo-s型呼吸机的自检及对应故障进行分析,帮助操作人员掌握其临床检测方法。方法:通过Maquet Servo-s型呼吸机自身检测过程,结合呼吸机质量控制规范,针对常见功能及关键模块实施分析,评估呼吸机性能。结果:呼吸机的定期检测维护,降低了临床使用中的故障几率,保障了呼吸机使用的医疗质量和临床安全。结论:以临床上常见的Maquet Servo-s型呼吸机为例,概括介绍了该型呼吸机的自检内容,并对流程进行了详细说明,为其它型号呼吸机故障的诊断和维护提供借鉴。     

PB840呼吸机的维护与故障排除

医用呼吸机按用途不同分为功能单一的抢救急救呼吸机、辅助治疗呼吸机,高智能、功能齐全的综合型呼吸机。呼吸机是临床重症科室所用重要的治疗设备,也是临床使用高风险的设备之一,呼吸机的维护、使用直接关系到患者的健康与安危。PB840呼吸机是美国泰科公司生产高档呼吸机,是一款高智能的、功能齐全的综合型呼吸机。该呼吸机有操作简单、界面直观、性能稳定等优点,广泛应用于国内各大医院。阐述PB840呼吸机的日常维护,分析与排除两例特殊故障,与同仁们交流学习。     

老年患者应用智能化呼吸机时报警原因分析及对策

目的分析老年患者机械通气时智能化呼吸机的故障,报警原因及对策,减少机械通气并发症的发生率.方法回顾分析10年来老年住院患者机械通气过程中智能化呼吸机故障报警的情况等级以及对患者的影响.结果经气管插管和气管切开进行机械通气800例次,发生呼吸机故障和报警500例次,其中每分钟呼出气量低限报警38.7%,气源报警25.2%,气道压力高限报警13.6%.结论及时发现和正确处置呼吸机故障和报警,可避免各种不良后果的发生,否则可对患者造成危害,甚至危及生命.因此,应加强临床一线医生,护士的培训,提高及时发现和排查呼吸机故障和报警的能力.     

雾化吸入肺表面活性物质治疗新生儿呼吸窘迫综合征的临床研究

目的:观察雾化吸入肺表面活性物质(Pulmonary surfactant,PS)治疗新生儿呼吸窘迫综合征(Neonatal respir-atory distress syndrome,NRDS)的临床效果。方法:44例NRDS患儿分为3组,分别雾化吸入PS(雾化组)16例,用气道内滴入PS(气内组)16例以及单纯应用呼吸机治疗(单纯组)12例。观察3组患儿不同方法治疗后的临床症状,动脉血气分析,上机时间以及并发症情况。结果:雾化组中,治疗后仅3例需要机械通气,上机时间0～52h,平均上机时间(45.3±8.33)h,治疗后动脉血气(PH、PO2、PCO2、a/APO2)结果均有改善,显效12例,有效4例,并发肺部感染2例;气内组中有9例需机械通气,平均上机时间(76±8)h,显效13例,有效3例,并发肺部感染10例,肺不张2例;单纯组12例中,均需应用呼吸机辅助通气,平均上机时间(105±15)h,显效6例,有效5例,无效1例,并发肺部感染11例,气胸1例,肺不张2例。结论:雾化吸入PS能在较短时间有效改善肺换气和弥散功能,促进氧合,改善临床症状,减少并发症,减少上呼吸机时间。     

Late versus early testing of HIV--16 Sites,United States, 2000-2003

Knowledge of human immunodeficiency virus (HIV) serostatus has been an important element of HIV-prevention and -treatment efforts. In 2000, among the estimated 850,000-950,000 persons living with HIV in the United States, approximately one fourth (180,000-280,000) were unaware that they were HIV infected. In addition, many persons with HIV are tested late in the course of infection, usually as a result of illness. During 1994-1999, among persons who had HIV diagnosed, 43% were tested late in the infection (i.e., had acquired immunodeficiency syndrome [AIDS] diagnosed within one year of HIV diagnosis). Late testing results in missed opportunities for prevention and treatment of HIV. To characterize HIV-testing patterns among HIV-infected persons, CDC analyzed data from a multisite interview project. During May 2000-February 2003, persons at 16 U.S. sites who were tested early in the course of HIV disease (early testers) were compared with persons who were tested late in the course of HIV disease (late testers). This report summarizes the results of the analysis, which indicate that late testers were more likely than early testers to be black or Hispanic, less educated, and exposed to HIV through heterosexual contact. Reducing the incidence of both new infections and HIV-associated morbidity and mortality will require earlier testing and improved access to prevention and care services for persons infected with HIV. A new CDC initiative, "Advancing HIV Prevention: New Strategies for a Changing Epidemic," is aimed at reducing barriers to early diagnosis of HIV infection and increasing access to quality medical care, treatment, and ongoing prevention services.     

根本原因分析法在提高呼吸机维修效率中的应用

目的:分析基于根本原因分析(RCA)法在呼吸机日常维修中的应用效果,以提高呼吸机的维修效率。方法:通过故障树模型对呼吸机维修的相关数据进行RCA,逐层寻找出呼吸机的故障原因为器械因素、人为因素和环境因素,其根本原因为无常备易损配件和工程师专业技能不足;针对器械因素和人为因素制定呼吸机维修效率提升措施。结果:通过按需库存常用配件、重视工程师培训考核以及利用维修数据寻找维修短板的方法,提高呼吸机维修效率,实施RCA法后呼吸机的1日修复率由实施前的68%提高至84%。结论:RCA法可找出影响呼吸机维修效率的根本原因,延长呼吸机使用寿命,提高呼吸机的安全性。     

基于ActiveX控件呼吸机检测装置的软件设计

目的:研制新型呼吸机检测仪,对呼吸机的流量、压力、通气性能等主要信号进行检测和综合评价.方法:以PCI04为硬件平台,嵌入WinXP操作系统,使用VC++设计一个波形显示控件,成功应用于呼吸机检测装置软件中.结果:本呼吸机检测仪装置可对呼吸机的通气性能进行综合评价,对呼吸机做出准确、可靠的测试和评估,从而对呼吸机的使用进行很好的质量控制.结论:该设计方法高效、简便,可移植性强.     

灵智呼吸机的工作原理与维护

呼吸机是目前各大医院的常规医疗装备,对于灵智呼吸机的工作原理、呼吸机结构可从气路和电路两个部分去了解。气路部分是由进气系统、吸气系统、呼气系统、安全系统、检测系统、氧气监测系统及雾化器系统（雾化器阀sol4）等组成;电路部分由电源模块、直流电源、电源板、传感器板、主板、图像处理板、LCD用户界面显示器、前面板、Web接口电路板等组成。为尽可能避免呼吸机在使用过程中发生故障,造成对患者的伤害,定期对呼吸机进行安全性能检测是保证设备正常运行的有效措施。在日常维护方面要求定期对呼吸机进行自检和定标,排除可能造成的安全隐患。