凝血酶雾化吸入治疗支气管扩张咯血的护理

目的 分析凝血酶雾化吸入治疗支气管扩张咯血的护理.方法 选择2013年2月～2015年1月我院收治的550例支气管扩张咯血患者作为研究对象,把550例患者随机均分为两组,一组为对照组采用常规的抗感染和止血敏及止血芳酸、常规护理等方法联合治疗.另一组为观察组,在对照组治疗的基础上增加凝血酶雾化吸入配合雾化吸入护理.对比两组患者临床治疗效果.结果 观察组临床止血效果优于对照组,止血时间对比差异明显,具有统计学意义(P＜0 05).结论 应用凝血酶雾化吸入治疗支气管扩张咯血配合必要的护理措施,可以有效缩短止血时间,建议临床推广应用.     

支气管扩张患者的治疗效果分析

目的观察分析尿激酶雾化吸入在支气管扩张治疗中的治疗效果。方法选取2013年8月~2014年8月到我院进行治疗的支气管扩张患者68例作为研究对象,并将其随机分为观察组和对照组,每组各34例。对照组患者给予α-糜蛋白雾化吸入治疗,观察组患者给予尿激酶雾化吸入治疗,对两组患者治疗后的疗效及治疗前后动脉血气相关指标进行对比分析。结果观察组和对照组治疗总有效率分别为94.12%和82.35%。观察组治疗总有效率明显高于对照组,两组比较差异显著,有统计学意义(P<0.05)。观察组患者治疗前后PaCO2水平和PaO2水平的改善程度均明显好于对照组,两组比较差异显著,有统计学意义(P<0.05)。结论尿激酶雾化吸入疗法比α-糜蛋白雾化吸入疗法在支气管扩张中能取得更显著的临床疗效,有效地缓解患者的临床症状,值得进一步的推广和应用。     

不同雾化吸入在支气管哮喘护理中的效果观察

目的：探讨氧气雾化吸入与超声雾化吸入在支气管哮喘中的效果。方法分析我院2013年1月~2014年1月60例支气管哮喘患者临床资料,将其随机分为两个组别,治疗组患者给予有氧雾化吸入,对照组患者给予超声雾化吸入。对以上两组患者在血氧饱和度上及主要症改善时间上行对比观察。结果氧气雾化吸入组患者气喘、咳嗽及听诊双肺哮鸣音改善时间少于超声雾化吸入组且在血氧饱和度上优于超声雾化吸入组。结论与超声雾化吸入相比,氧气雾化吸入更有利于缓解患者气喘,提高患者的血氧饱和度,降低呼吸道刺激症状,适用于支气管哮喘。     

小儿肺炎采用布地奈德雾化吸入治疗临床体会

目的：探析采用布地奈德雾化吸入治疗小儿肺炎的疗效。方法选择我院于2013年1月~2014年1月收治的90例小儿肺炎患者作为研究对象,采用随机分配的方法将以上患儿分为观察组和对照组。两组患儿首先均给予抗生素并进行止咳和退热治疗,之后对照组给予5ml 0.9%的氯化钠溶液和2000U的糜蛋白酶用于雾化吸入治疗,观察组则使用2~3ml0.9%的氯化钠以及1mg布地奈德进行雾化吸入治疗,两组治疗时间均为7d,比较两组患儿的气促、肺部喘鸣音以及咳嗽等症状及其消失时间,比较治疗有效率。结果观察组28例显效,15例有效,2例无效,总有效率为95.56%;对照组12例显效,19例有效,14例无效,总有效率为68.89%,两组之间的比较有统计学意义(P<0.05)。此外,观察组患者憋喘、咳嗽以及肺部喘鸣音消失所用时间与对照组相比明显缩短,差异明显。结论布地奈德雾化吸入治疗在小儿肺炎患者中的应用可以有效缓解患儿的咳嗽以及喘憋、肺部喘鸣音等临床症状,并且起效快,症状消失所需时间更短,应用效果显著。     

原发性醛固酮增多症围手术期的护理

手术是目前治疗肾上腺疾病的方法之一.提高围手术期的治疗及护理技术对提高手术成功率,减少并发症极为重要.我院自2001年11月至2004年10月共收治原发性醛固酮增多症21例,通过加强对围手术期的治疗和护理疗效满意,报道如下.     

臀肌挛缩症松解术的围手术期护理

报告了10例臀肌挛缩症患儿的围手术期护理，主要护理措施是术前做好心理护理及常规准备，术后做好体住及护理，疼痛护理，功能训练，经过对症护理，有效地预防了伤口裂开出血，恢复了髋关节活动功能。本组患儿均治愈出院。     

硫酸沙丁胺醇雾化吸入治疗支气管哮喘的护理干预

目的：探讨分析硫酸沙丁胺醇雾化吸入治疗支气管哮喘的护理干预方法及效果。方法选取我院2013年1月~12月收治的60例采用硫酸沙丁胺醇雾化吸入治疗的支气管哮喘患者,随机分为观察组和对照组,每组患者各30例。观察组患者给予综合护理干预,对照组给予常规护理干预,观察比较两组的临床疗效和护理满意度。结果在临床疗效和护理满意度方面比较,观察组明显优于对照组,<0.05具有显著性差异,有统计学意义。结论对硫酸沙丁胺醇雾化吸入治疗的支气管哮喘患者进行综合护理干预,可提高临床疗效和护理满意度,值得推广应用。     

中药平喘合剂联合地塞米松雾化吸入治疗支气管哮喘疗效观察

目的：探讨中药平喘合剂联合地塞米松雾化吸入治疗支气管哮喘的临床效果。方法对我院收治的50例支气管哮喘患者在给予地塞米松、庆大霉素、糜蛋白酶等雾化吸入治疗的基础上,再给予中药平喘合剂雾化吸入治疗,观察治疗效果及有无发生不良反应。结果本组患者50例,显效16例,有效28例,总有效率为88%,患者均无不良反应发生。结论中药平喘合剂联合地塞米松雾化吸入治疗支气管哮喘疗效满意,值得推广。     

老年腰椎间盘突出症围手术期处理的进展

随着人类寿命的延长,老年腰椎间盘突出症的发病率也有明显上升的趋势.常见的老年腰腿痛的临床症状,主要是由于椎间盘变性,纤维环破裂,髓核突出刺激或压迫神经根、马尾神经所致.由于长期慢性腰腿痛,严重影响老年人的生活质量,而且常常合并其它慢性疾病,使得手术治疗较为棘手[1].现就近年来60岁以上老年腰椎间盘突出症围手术期的处理进展作一综述.     

支气管扩张症的CT诊断

支气管扩张症（简称支扩）是指由于支气管及附近肺组织的慢性炎症损坏管壁,导致支气管树变形扩张的一种慢性化脓性疾病。可局限于一个肺叶,也可累及一侧肺或双侧肺的多个肺叶。CT技术尤其是高分辨率CT（HRCT）是一种更加可靠和准确的诊断技术,自90年代后期特别是2000年以来,国内各医院已经广泛采用而取代了以往的支气管造影,以此来作为支扩的诊断依据。本文通过对27例支扩CT表现的分析总结,对其CT检查价值及诊断进行初步的评价和探讨。     

雾化吸入加味定喘汤防治实验性大鼠哮喘的初步探讨

目的研究中药雾化对大鼠哮喘模型炎症指标作用及其免疫学机理。方法取8-10周Wistar大鼠,分为中药组(TCM)、地塞米松雾化组(Dex 1)、地塞米松注射组(Dex 2)、哮喘模型对照组(Asthma)和正常对照组(Control),每组为15只。利用OVA及氢氧化铝制作大鼠哮喘模型,在雾化激发期,中药组用杏仁、甘草等中药制成的溶液雾化大鼠,其余几组分别用地塞米松雾化或注射,或用NS代替地塞米松。最后进行BALF中白细胞分类计数,测定血浆OVA特异性IgE抗体。结果TCM组、Dex1组、Dex2组与Asthma组比较BALF中EOS百分比、血清OVA特异性IgE抗体A值水平明显降低,差异有显著性,而TCM组、Dex1组和Dex2组比较差异也有显著性。结论本研究所用中药溶液具有抗炎作用,能明显降低实验大鼠BALF中EOS百分比及OVA特异性IgE水平,同地塞米松雾化效果相当。但本中药溶液降低BALF中EOS百分比及血清OVA特异性IgE水平与地塞米松注射比较,其疗效有一定差异。但本中药溶液具体起作用的成分是什么以及如何将其与中医辨证施治结合起来尚需进一步研究。     

Bronchiectasis and deteriorating lung function in agammaglobulinaemia despite immunoglobulin replacement therapy

Immunoglobulin replacement therapy enhances survival and reduces infection risk in patients with agammaglobulinaemia. We hypothesized that despite regular immunoglobulin therapy, some patients will experience ongoing respiratory infections and develop progressive bronchiectasis with deteriorating lung function. One hundred and thirty‐nine (70%) of 199 patients aged 1–80 years from nine cities in the United Kingdom with agammaglobulinaemia currently listed on the UK Primary Immune Deficiency (UKPID) registry were recruited into this retrospective case study and their clinical and laboratory features analysed; 94% were male, 78% of whom had Bruton tyrosine kinase (BTK) gene mutations. All patients were on immunoglobulin replacement therapy and 52% had commenced therapy by the time they were 2 years old. Sixty per cent were also taking prophylactic oral antibiotics; 56% of patients had radiological evidence of bronchiectasis, which developed between the ages of 7 and 45 years. Multivariate analysis showed that three factors were associated significantly with bronchiectasis: reaching 18 years old [relative risk (RR) = 14·2, 95% confidence interval (CI) = 2·7–74·6], history of pneumonia (RR = 3·9, 95% CI = 1·1–13·8) and intravenous immunoglobulin (IVIG) rather than subcutaneous immunoglobulin (SCIG) = (RR = 3·5, 95% CI = 1·2–10·1), while starting immunoglobulin replacement after reaching 2 years of age, gender and recent serum IgG concentration were not associated significantly. Independent of age, patients with bronchiectasis had significantly poorer lung function [predicted forced expiratory volume in 1 s 74% (50–91)] than those without this complication [92% (84–101)] (P < 0·001). We conclude that despite immunoglobulin replacement therapy, many patients with agammaglobulinaemia can develop chronic lung disease and progressive impairment of lung function.     

Effect of surfactant inhalation on allergic bronchoconstriction in guinea pigs

Background In the small airway, surfactant reduces surface tension, prevents liquid filling of bronchioles, thereby maintaining patency in the small airways. Recent reports demonstrated that surfactant dysfunction develops in experimental asthma in immunized guinea pigs. However, there are few reports concerning surfactant and lung function in an experimental asthma model. Objective To examine whether inhaled surfactant improves lung mechanics in antigen-induced bronchoconstriction in guinea pigs. Method We developed a passively immunized guinea pig model for allergic bronchoconstriction induced by antigen inhalation. Using this model, we investigated the effect of inhaled exogenous surfactant, surfactant TA. on the airway opening pressure (Pao) after antigen challenge. Results Aerosol antigen challenge produced a gradual and long-lasting increase in Pao. Twenty minutes after antigen challenge, aerosolized surfactant TA, 20 mg/ml. was inhaled for 90 s, and it significantly reduced the Pao by 32.8% in 12 min, while a 10.2% reduction was observed in a control group in the same period. When surfactant TA was administered by 90-s inhalation before antigen challenge, it inhibited the Pao increase in a dose-dependent manner: mean inhibitory rates of Pao were 33.6% in surfactant TA 10 mg/ml and 61.9% in surfactant TA 20 mg/mI, respectively. Conclusion Inhaled surfactant showed preventive and recovery effects on antigeninduced bronchoconstriction in an immunized guinea pig model.     

Establishment of BALB/C mouse models of influenza A H1N1 aerosol inhalation

Influenza A (H1N1) is a rapidly spreading acute respiratory illness that remains a worldwide burden on public health. To simulate natural infection routes, BALB/C mice were challenged with the H1N1 virus by aerosol and intranasal instillation routes. We compared the weight change and survival of the mice for 14 consecutive days after infection. The infected mice were euthanized at days 3, 5, 7, and 9 to perform necropsies, lung pathological analyses, viral titers measurement, and lung cytokines examination. The aerosol-treated mice showed clinical symptoms on day 4, obvious lung lesions on day 5, rapid weight loss on day 7, peak virus replication in the lungs on days 7 to 9, and bronchial epithelial hyperplasia on day 9. However, after intranasal instillation, the mice exhibited clinical signs on day 2, rapid weight loss and obvious lung lesions on day 3, and peak virus replication in the lungs on days 3 to 5; no bronchial epithelial hyperplasia was detected. High levels of proinflammatory cytokines and chemokines were detected in the lungs of infected mice by both two routes. Disease and lung lesion progressions were slower in the mice that inhaled H1N1-containing aerosols than in those treated by intranasal instillation, and lung lesions were homogeneous in the aerosol group and heterogeneous in the intranasal group. In this study, BALB/C mouse models of H1N1 virus aerosol inhalation were successfully established and compared with mouse models of intranasal inoculation, aerosol mouse models had an infection route and lung pathology characteristics that more closely resembled those observed in humans.     

围手术期抗菌药物使用情况的调查与分析

目的调查和分析医院围手术期抗菌药物使用情况。方法回顾性调查分析某医院2005年1月至12月600例围手术期患者抗菌药物使用情况。结果600例病例中,有532例病例使用了抗菌药物,其中,预防性用药443例,治疗性用药89例,抗菌药物使用率88.8%;两联以上使用的为294例,占55.2%;抗菌药物使用合理36例,占6.8%;不合理使用抗菌药物496例,占93.2%。手术预防用药时间统计为0-27 d,其中用药时间≥4 d的有299例,占67.5%。抗菌药物使用种类依次为头孢菌素类三代、硝基咪唑类、青霉素类＋β-内酰胺酶抑制剂、青霉素类、氟喹诺酮类等。结论围手术期抗菌药物选择不合理,围手术期用药时间、用药途径、用法不当,联合用药不合理,用药时间持续过长等较为普遍,围手术期预防性用抗菌药物应适当控制。     

Steam inhalation therapy: severe scalds as an adverse side effect

Background

Steam inhalation therapy is often recommended in the treatment of a common cold. However, it has no proven benefit and may in fact have serious adverse side effects in terms of burn injuries.

Aim

To quantify the human and economic costs of steam inhalation therapy in terms of burn injury.

Design and setting

A prospective database study of all patients admitted to the burn centres (Beverwijk, Groningen, Rotterdam) and the hospital emergency departments in the Netherlands.

Method

Number and extent of burn injuries as a result of steam inhalation therapy were analysed, as well as an approximation made of the direct costs for their medical treatment.

Results

Annually, on average three people are admitted to in one of the Dutch burn centres for burns resulting from steam inhalation therapy. Most victims were children, and they needed skin grafting more often than adults. The total direct medical costs for burn centre and emergency department treatment were €115 500 (£93 000), emotional costs are not reflected.

Conclusion

As steam inhalation therapy has no proven benefit and the number and extent of complications of this therapy in terms of burn injury are significant, especially in children, steam inhalation therapy should be considered a dangerous procedure and not recommended anymore in professional guidelines and patient brochures.     

支扩大咯血病人的心理状况及对止血治疗的影响

目的 :了解支气管扩张大咯血病人的心理状况 ,探讨心理因素对止血治疗的影响。方法 :采用SCL -90调查大咯血病人的心理状况 ,并分组治疗 ,比较治疗组与对照组止血效果 ,分析心理因素对临床止血治疗的影响。结果 :在两组 6 2例大咯血病人中 ,83 87%有焦虑情绪 ,6 6 13%呈恐惧反应。心理因素引起血压升高者占 32 2 6 % ,影响垂体后叶素使用者占 2 0 97%。咯血持续时间 :治疗组平均 5天 ,对照组 7天。结论 :支扩大咯血病人多有短期性心理反应 ,主要表现为焦虑及恐怖性倾向。心理因素可使血压升高 ,在血管破裂的基础上加重咯血 ,并使垂体后叶素使用受限 ,多方面均影响止血效果。故对大咯血病人在止血治疗的同时 ,应加强心理治疗 ,不仅有益于心身健康 ,且可缩短咯血时间     

Impacts of Asthma in Patients With Bronchiectasis: Findings From the KMBARC Registry

PurposeAlthough the coexistence of asthma and bronchiectasis is common, the impacts of asthma on bronchiectastic patients (BE) have not been well evaluated because this issue using bronchiectasis cohorts has been investigated in only a few studies.MethodsIn the present study, 598 patients who were prospectively enrolled in the Korean bronchiectasis registry were evaluated. The clinical characteristics between BE with asthma and those without asthma were compared.ResultsAsthma was found in 22.4% of BE. BE with asthma had a higher body mass index (BMI) (P = 0.020), more dyspnea (P < 0.001), larger sputum volume (P = 0.015), and lower forced expiratory volume in 1 second (FEV1) (P < 0.001) than those without asthma. BE with asthma had a higher rate of previous pneumonia (P = 0.017) or measles (P = 0.037) than those without asthma. Regarding treatment, BE with asthma used inhaled corticosteroids, long-acting muscarinic antagonists, and leukotriene receptor antagonists more frequently than those without asthma. Although intergroup differences were not observed in disease severity of bronchiectasis (P = 0.230 for Bronchiectasis Severity Index and P = 0.089 for FACED), the Bronchiectasis Health Questionnaire (BHQ) scores indicating the quality of life, were significantly lower in BE with asthma than in those without asthma (61.6 vs. 64.8, P < 0.001). In a multivariable model adjusting for age, sex, body mass index, forced expiratory volume in 1 second %predicted, sputum volume, modified Medical Research Council dyspnea scale ≥ 2, and the number of involved lobes, asthma was associated with lower BHQ scores (β-coefficient = −2.579, P = 0.014).ConclusionsBE with asthma have more respiratory symptoms, worse lung function, and poorer quality of life than those without asthma. A better understanding of the impacts of asthma in BE will guide appropriate management in this population.     

预防性使用抗生素在205例直肠癌围手术期的应用分析

目的 探讨围手术期预防直肠癌术后感染的用药方案.方法 对近10年来205例直肠癌患者围手术期的抗生素应用进行回顾性分析.病例分为三组,A组118例为1991年5月至1993年2月典型的全程应用抗生素病例;B组57例为1996年3月至1997年2月短期应用抗生素病例;C组30例为2000年3月至9月短期肠道准备病例.结果 三组病例术后第三天体温、白细胞总数、切口愈合情况、感染率和肠液培养、血培养阳性率等均无显著差别;C组病例术前服用抗生素用量明显减少(P＜0.01);B组、C组病例抗生素用量较A组明显减少(P＜0.01).结论 直肠癌围手术期短期预防性应用抗生素的方法安全、经济、可靠,有明显的临床应用价值.     

围术期轻度低体温的并发症及防治措施

围术期低体温会明显增加并发症,包括心脏事件、凝血障碍、伤口感染和术后恢复延迟等,因此有必要在除治疗性低体温以外维持手术患者的核心体温高于36℃。再分布性低体温是椎管内麻醉和全麻后第一个小时内低体温的主要原因。防止围术期体温降低有很多方法,被动隔热可减少皮肤失热30%(一层)到50%(三层),但多数患者需要主动加温来维持体温正常;充气温毯和电热毯是目前最有效的无创加温方法;静脉输液的加温能力虽然有限,但当需要输入大量液体时,应该为输入的液体加温。