依托咪酯和咪唑安定对不停跳冠状动脉旁路搭桥手术气管插管期间心率和血压影响的比较(英文)

Objective To compare the effect of etomidate and midazolam on heart rate and blood pressure during tracheal intubation in off-pump coronary artery bypass graft. Methods Sixty patients scheduled for coronary artery bypass graft surgery without cardiopulmonary bypass shunt were randomly and double-blindly divided into etomidate group (Group E,n=30) and midazolam group (Group M,n=30) based on the anesthetic used for induction.Electrocardiogram,systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR) and pulse oximetry saturation (SpO2) were measured and recorded continuously,as well as the value of rate-pressure product (RPP).The time used for tracheal intubation was also recorded.Results In Group M,compared with pre-tracheal intubation,the SBP and DBP of all patients decreased remarkably at the beginning of tracheal intubation (P<0.05).At 1 minute post-trachealintubation,the SBP,DBP and HR increased remarkably (P<0.01);meanwhile,the values of RPP were increased significantly than those at the beginning of tracheal intubation and pre-tracheal intubation (P<0.01).Compared with the values in Group E,at the beginning of tracheal intubation,the values of SBP and DBP in Group M were significantly decreased (P<0.05 and P<0.01,respectively),while the values of SBP,DBP and RPP at 1 minute after tracheal intubation were significantly increased (P<0.05 and P<0.01,respectively). Conclusions Compared with midazolam,etomidate used in anesthetic induction for coronary artery bypass graft surgery without cardiopulmonary bypass shunt may more effectively alleviate the cardiovascular responses to tracheal intubation.     

咳嗽训练促进颈脊髓损伤伴不全瘫患者排痰

【 abstract 】 objective To explore the effects of cough training on intercostals muscles strength and sputum excretion ability in acute cervical spinal cord injury patients with incomplete paralysis. Methods 127 acute cervical spinal cord injury with incomplete paralysis cases treated in changzheng hospital from January 2012 to December 2015 were admitted into study. They had been divided into experimental group and control group randomly by the method of throwing a coin.Experimental group started cough training from 1 d postoperative and the control group only treated by routine sputum nursing measures.The effect of sputum excretion ability, intercostals muscles strength and the rate of sputum suction,lung infection and atelectasis had been compared 8 days after surgery.Results The sputum excretion ability and intercostals muscles strength of the experimental group were significantly better than the control group 8 days after surgery.The rate of sputum suction,lung infection and atelectasis in experimental group was significantly lower than the control group.There were no complications of early cervical fixation turning up in both groups.Conclusion The cough training can strengthen intercostals muscles of CSCI patients with incomplete paralysis, promote their sputum excretion ability .Futhermore ,It can reduce the rate of sputum suction and the incidence of respiratory complications such as lung infection, atelectasis.     

供氧吸痰管与普通吸痰管临床应用效果比较

目的 探讨供氧吸痰管的安全性和有效性.方法 对40例气管插管或气管切开需供氧吸痰的患者采用自身对比观察,分别使用供氧吸痰管和普通吸痰管吸痰,观察吸痰前、吸痰后血氧饱和度和心率的变化.结果 供氧吸痰管吸痰后血氧饱和度无下降,与吸痰前对比无显著差异;普通吸痰管吸痰后血氧饱和度下降,与吸痰前对比有显著差异;供氧吸痰管与普通吸痰管,吸痰前和吸痰后心率变化对比有显著差异.结论 供氧吸痰管在吸痰同时供给氧气,能减轻低氧血症,增强吸痰的安全性.

Abstract：

Objective To investigate the safety and effectiveness of ventilation sputum-aspirating tube. Methods Forty patients with lifesaver or incision of trachea used sputum-aspirating tubes with ventilation and with normal tubes for self-contrasted observation.Then, the heart rate and saturation of blood oxygen before and after suctioning were observed. Results There was no remarkable difference in the value of saturation of blood oxygen in patients who used ventilation sputum-aspirating tube before and after administration.However, there was significant difference in the value of saturation of blood oxygen in the normal sputum-aspirating tube group.Furthermore, there was significant difference in the value of heart rate in both tubes. Conclusions Ventilation sputum-aspirating tube may supply oxygen to lighten hypoxemia.This method may enhance the safety of aspiration.     

不同吸痰方法对呼吸衰竭机械通气患者的影响

Objective To evaluate the influence of two sputum suction methods on the mechanical ventilation of respiratory failure patients.Methods A total of 106 respiratory failure patients on mecharical ventilation were randomly divided into two groups:the observational group and the control group,each with 53 cases.Closed suction was used in the observational group,while opened suction was used in the control group.The SpO2,variabilities of heart rate,pulmonary infections,arterial blood gas and the injury of the airway mucosa were mornitored and recorded during the course of suctioning.Results The SpO2 ,pulmonary infections and blood gas were significantly different between the two groups (P ＜0.05) .The cases with the HR decreasing amplitude greater than 20%,and the rate of the airway mucosa injury were significantly higher in the control group than those in the observational groups (P ＜ 0.01) .Conclusions Compared with opened suction,closed suction can maintain better oxygenation state.It also leads to reduction of the airway mucosa injury.In addition,it prevents crossed infections effectively,with a safe manipulability.     

To salvage acute infectious laryngitis with Ⅲ°laryngeal obstruction by tracheal intubation and mechanical ventilation

Objective Discuss the salvage effect of acute infectious laryngitis with Ⅲ°laryngeal obstruction by tracheal intubation and mechanical ventilation. Methods 16 acute infectious laryngitises with Ⅲ°laryngeal obstruction were treated by tracheal intubation using 1-2 smaller than endotracheal tube of corresponding regular age and mechanical ventilation,who had been in hospital from October 2004 to October 2009.Results 16 patients were recovered. Conclusion To salvage acute infectious laryngitis with Ⅲ°laryngeal obstruction by tracheal intubation and mechanical ventilation could avoid incision of trachea and decrease the complication.     

预防高压氧治疗时耳痛方法的比较研究

目的 比较头后仰侧卧45°和头后仰平卧位麻黄碱滴鼻对高压氧(HBO)治疗时耳痛的影响,确定更为合理的麻黄碱滴鼻方法,为预防耳痛提供参考依据.方法 将首次行HBO治疗的患者300例随机分为观察组和对照组各150例,2组患者均采用大型医用空气加压氧舱同舱治疗,HBO治疗的第1～3天进舱前予麻黄碱滴鼻,观察组采用头后仰侧卧45°体位,对照组采用头后仰平卧位,分别在每侧鼻腔内滴1%盐酸麻黄碱滴鼻液3滴,出舱后询问患者有无耳痛,检查鼓膜,并进行比较.结果 观察组耳痛、鼓膜损伤发生率和鼓膜损伤程度均低于对照组,2组比较差异明显.结论 HBO治疗前采用头后仰侧卧45°麻黄碱滴鼻,可减少HBO时耳痛的发生,该方法滴鼻符合咽鼓管的解剖与生理特点,比头后仰平卧位更合理有效,具有较高的实用价值.

Abstract：

Objective This paper aims to find a best position of ephedrine hydrochloride nasal drops by comparing earache occurred in hyperbaric oxygen(HBO )therapy while using ephedrine hydrochloride nasal drops in two positions: laying in lateral position of 45°with head leaning back; laying down flat, so as to supply reference for prevention of earache. Methods We selected 300 cases of HBO patients who were firstly treated by HBO and randomly divided into the observation group and the control group with 150 cases in each group. All these patients were treated by large medical hyperbaric oxygen tank. On the first to third day, ephedrine hydrochloride nasal drops were put into the patients before they were sent into the oxygen tank. Patients in the observation group lay in lateral position of 45°with their head leaning back, and those in the control group were in horizontal position. We put three drops of 1% of ephedrine hydrochloride nasal drops respectively into their nasal cavity. When they came out of the oxygen tank, we asked them if they felt earache and checked their tympanic membrane so as to make a comparison. Results It was found that earache, rate of tympanic membrane injury and the extent of such injury in the observation group was obviously less than that in the control group, there was difference in statistics between these two groups. Conclusions Before HBO treatment, ephedrine hydrochloride nasal drops that put in lateral position of 45°with patients head leaning back can reduce the possibilities of earache occurred in HBO. It was also observed that such position was an ideal one which had anatomical characteristics of Eustachian tube and was safer than laying down flat, so such position is more practical.     

无线网络数字化氧气流量计费系统的研制与应用

目的 探讨无线网络数字化氧气流量计费系统的研制及在临床中的应用.方法 根据医嘱将需要吸氧的患者220例随机分为观察组108例和对照组112例,观察组用无线网络数字化氧气流量计费系统,对照组用传统的浮标式氧气流量计.观察比较2组因吸氧收费问题产生的护患纠纷发生率、护士累计观察患者吸氧时间的平均耗时、每桶氧气收回的平均费用.结果 因吸氧收费问题产生的护患纠纷发生率,观察组为0.93%,对照组为75.89%;护士累计观察吸氧时间的平均耗时,观察组为2.03 min,对照组为12.54 min;每桶氧气收回的平均费用,观察组为42.68元,对照组为28.23元,差异显著.结论 无线网络数字化氧气流量计费系统的应用能减少护患纠纷的发生,提高患者满意度,缩短护士累计观察吸氧的时间,提高工作效率,明确氧气收费的合理方法,挽回经济损失.

Abstract：

Objective To investigate the development of the digital wireless network billing system of oxygen flow in clinical application. Methods By random 220 cases of patients who need to absorb oxygen were divided into the observation group(108 cases)and the control group(112 cases), the observation group used the digital wireless network billing system of oxygen flow, and the control group adopted the traditional buoy type oxygen gauge instrument. The following items were compared between the two groups: dispute rates between nurses and patients for different amount of absorbed oxygen, the average time cost for nurses in measuring the duration of oxygen absorbing, total income per barrel for recycling oxygen. Results For the dispute rates between nurses and patients for different amount of absorbed oxygen were 0.93% in the observation group, and 75.89% in the control group. The average time cost for nurses in measuring the duration of oxygen absorbing was 2.03 minutes for the observation group, and 12.54 minutes for the control group; total income per barrel for recycling oxygen was 42.68 yuan per barrel of the observation group, and 28.23 yuan in the control group. The statistical analysis between the two groups was supported by 95% confidential level. Conclusions Using the digital wireless network billing system of oxygen flow in clinical can reduce the dispute rates between the nurses and patients, improve patients' satisfaction degree, reduce the total time cost for nurses in measuring the duration of oxygen absorbing, raise efficiency, build a clear scientific charge system of oxygen flow, and restore economic loss.     

小切口人工全髋关节置换术50例临床疗效分析

Objective To explore the clinical efficacy of lateral mini-incision for total hip arthroplasty.Methods 100 cases who needed total hip arthroplasty were selected from April 2006 to April 2009.they were divided into two groups, control group and observation group. Routine operation for total hip arthroplasty was used to control group,lateral mini-incision for total hip arthroplasty was used to observation group. Operative time、preoperative bleeding、drainage flow 、transfusion volume、incisional lengthwere recorded, and postoperative functional recovery in two groups were observed; and scores of harris was evaluated in two groups before and after operation. Results incisional length、preoperative bleeding、drainage flow 、transfusion volume in two groups existed statistical difference, P<0.05; after operation, scores of Harris in two groups existed no statistical difference,P > 0.05.Conclusion mini-incision for total hip arthroplasty with lateral approach has advantage of minimal invasion、quickly functional recovery, but the Indication of operation should be mastered.     

小切口人工全髋关节置换术50例临床疗效分析

Objective To explore the clinical efficacy of lateral mini-incision for total hip arthroplasty.Methods 100 cases who needed total hip arthroplasty were selected from April 2006 to April 2009.they were divided into two groups, control group and observation group. Routine operation for total hip arthroplasty was used to control group,lateral mini-incision for total hip arthroplasty was used to observation group. Operative time、preoperative bleeding、drainage flow 、transfusion volume、incisional lengthwere recorded, and postoperative functional recovery in two groups were observed; and scores of harris was evaluated in two groups before and after operation. Results incisional length、preoperative bleeding、drainage flow 、transfusion volume in two groups existed statistical difference, P<0.05; after operation, scores of Harris in two groups existed no statistical difference,P > 0.05.Conclusion mini-incision for total hip arthroplasty with lateral approach has advantage of minimal invasion、quickly functional recovery, but the Indication of operation should be mastered.     

50%葡萄糖注射液治疗老年难愈合伤口的疗效观察和护理体会

Objective To explore the curative effect and nursing intervention of 50%GS in gerontism with hard agglut wound. Methods 52 patients from the Affiliated Hospital of Guangdong Medical College, be-tween March 2007 and April 2008, were enrolled in this study. They were randomly divided into 2 groups accord-ing to numerical table. Conventional dressing change methods were used in the control group and 50% GS was rated in the observation group. The effectual rate and healing time of the two groups were observed and com-pared. Results The effectual time in control group was (12.8±5.12) days, while (8.65±3.52) days in theobservation group, and the healing rate in the control group was 53.8% and 80.8% in the observation group. The effectual rote and healing time of patients in observation group were better than those of patients in control group, and there were significant differences between them (P<0.05) . Conclusions 50% GS is an effective and con-venient method which can accelerate the curing of hard agglut wound. Therefore, it is highly recommended and popularized.     

脑卒中昏迷患者两种不同吸痰方式的对比研究

目的有效清除脑卒中昏迷患者呼吸道分泌物,减少因反复插管而损伤呼吸道黏膜。方法将62例脑卒中昏迷患者随机分为对照组和实验组,两组年龄、性别、发病时间、病情程度、治疗等方面经统计学检验无显著差异,两组分别采用经口、鼻吸痰与经口咽通气管吸痰,比较两组患者的吸痰量、痰液性状、一次插管成功率及吸痰前后30min血氧饱和度(SaO2)。结果两组吸痰在吸痰量、痰液性状、一次插管成功率、血氧饱和度等方面均存在显著性差异(P<0.05)。经口咽通气管吸痰一次插管成功率高,吸出痰量多、粘稠,且对气道损伤小,吸痰后SaO2明显高于吸痰前及对照组。结论经口咽通气管吸痰能提高一次插管成功率,有利于吸出患者气道深部痰液,防止痰液阻塞气道,对控制感染和改善气道有重要意义。     

浅部吸痰在气管插管机械通气患者中的安全性和有效性的探讨

目的：探讨浅部吸痰在气管插管机械通气患者中的安全性和有效性。方法将本气管插管机械通气的患者60例,随机分为实验组及对照组,每组30例。观察两组患者分别于吸痰前1 min、吸痰后5 min 记录患者的心率、收缩压、指脉血氧饱和度、呼吸频率、潮气量、气道峰压的变化值;两组吸痰前后痰鸣音改善情况、吸痰后患者的舒适度以及患者机械通气时间;记录两组患者吸痰出现刺激性咳嗽、黏膜损伤出血、痰痂堵塞情况、机械通气5d内呼吸机相关性肺炎发生率比较。结果两组患者比较,浅部吸痰组患者心率增加值、收缩压增加值、呼吸频率增加值低于深部吸痰组,组间差异有统计学意义( P<0.05);血氧饱和度增加值、潮气量增加值、气道峰压下降值,两组比较差异无统计学意义( P>0.05);鸣音改善情况和机械通气时间,两组比较差异无统计学意义( P>0.05);浅部吸痰组吸痰前后患者的舒适度好于深部吸痰组,组间差异有统计学意义( P<0.05);浅部吸痰组出现刺激性咳嗽、黏膜损伤出血发生率低于深部吸痰组,组间差异有统计学意义( P<0.05);痰痂堵塞情况、机械通气5 d内呼吸机相关性肺炎发生率比较,两组比较差异无统计学意义( P>0.05)。结论浅部吸痰在气管插管机械通气患者中是一种较为安全有效的吸痰方式。     

开胸术后排痰困难患者吸痰方法的研究

目的探讨经口咽通气管吸痰在开胸手术后患者排痰困难中的应用效果。方法随机将96例开胸手术后排痰困难患者分成观察组和对照组各48例,观察组采用口咽通气管吸痰,对照组采用常规经口鼻腔吸痰,比较两组吸痰前后心率、血压、氧分压、血氧饱和度以及两组的吸痰效果、吸痰时间、一次插管成功、肺部相关并发症等情况。结果两组患者吸痰后血氧饱和度、氧分压、吸痰操作时间、吸痰效果、一次插管成功、患者接受度、相关并发症的比较,差异有统计学意义（t分别为11．16,11．15,15．20,8．18,6．10,6．56,16．70,4．89;X。分别为5．76,4．44;P〈0．05）;心率、血压差异无统计学意义（P〉0．05）。结论经口咽通气管吸痰的方法对畅通呼吸道、改善呼吸、缓解缺氧都具有明显满意的临床效果。     

不同吸引负压在老年患者经鼻腔吸痰中的应用效果分析

目的 比较采用不同负压（15～25 kPa与25～40 kPa）吸痰对老年经鼻腔负压吸痰患者吸痰效果的影响.方法 2009年7月至2010年10月,选择未建立人工气道或已拔出人工气道的老年患者37例,随机分为两组：观察组（n=19,吸引压力=15～25 kPa）和对照组（n=18,吸引压力=25～40 kPa）,分别采用不同吸引负压经鼻腔吸痰各10 d,比较两组患者吸痰时的耐受度,吸痰前后心率、血压、脉氧饱和度、吸痰间隔时间、吸痰量的多少及气道黏膜损伤情况等.结果 与对照组患者比较,观察组患者吸痰间隔时间长、24 h吸痰量多、吸痰更彻底,对气道黏膜损害更小,组间比较差异具有统计学意义（P〈0.05）.而吸痰时两组的耐受度以及吸痰前后两组患者的心率、血压、脉氧饱和度变化.组间比较差异无统计学意义（P〉0.05）.结论 老年患者采用低压（15～25 kPa）经鼻腔吸痰的效果好,间隔时间长,吸引更彻底,可减轻患者的痛苦,提高工作效率.     

两种声门下吸引法对气道黏膜损伤的比较研究

目的比较两种声门下吸引法对气道黏膜损伤的影响。方法将监护病房气管插管行机械通气的100例患者按人科顺序分观察组和对照组各50例。观察组采用间歇声门下吸引,对照组采用持续声门下吸引,比较两组每天声门下分泌物的吸引量及声门下分泌物隐血试验阳性率。结果两组声门下分泌物吸引量差异比较无统计学意义;观察组声门下分泌物隐血试验阳性率显著低于对照组,差异比较有统计学意义。结论两种声门下吸引法的效果相似,但持续声门下吸引存在声门下与气囊上方呼吸道黏膜损伤出血的风险。     

开放声门深部吸痰方案在AECOPD呼吸衰竭无创通气无力排痰患者中的应用

目的比较开放声门深部吸痰方案与常规吸痰法两种不同吸痰方式在慢性阻塞性肺病急性加重期（AECOPD）呼吸衰竭无创通气无力排痰患者中的效果。方法将AECOPD呼吸衰竭无创通气无力排痰的62例患者按随机数字表法随机分为观察组和对照组各31例,分别采用开放声门深部吸痰方案（观察组）和常规吸痰法（对照组）吸痰。比较两种方法的吸痰效果、气道损伤及肺部感染等并发症的发生率以及对患者血氧饱和度的影响。结果观察组患者吸痰效果显效者18例,发生气道损伤者1例;对照组吸痰效果显效者10例,发生气道损伤者8例,两组比较差异均有统计学意义（P均〈0．05）。吸痰前两组血氧饱和度差异无统计学意义（P〉0．05）,观察组吸痰后血氧饱和度（98．03±1．42）％高于对照组的（96．22±1．62）％,差异有统计学意义（t=4．649,P〈0．05）。观察组发生肺部感染者2例,对照组发生肺部感染者5例,两组比较差异无统计学意义（χ^2=0．64,P〉0．05）。结论开放声门深部吸痰方案比常规吸痰法更能提高吸痰的有效率,减少并发症的发生,减轻患者的痛苦,提高护理质量。     

一次性静脉输液针在婴儿吸痰中的应用

[目的]观察一次性静脉输液针在婴儿吸痰中的效果。[方法]将360例需要吸痰患儿随机分成两组,对照组178例采用常规吸痰法,试验组182例采用一次性静脉输液针吸痰,对比吸痰前后的血氧饱和度、鼻黏膜损伤例数、阻塞堵管例数。[结果]对照组吸痰后有效311次,无效78次,试验组有效384次,无效17次;两组有效率差异有统计学意义（χ^2=42.22,P〈0.05）。[结论]婴儿肺炎在常规治疗基础上用一次性静脉输液针吸痰效果优于常规吸痰方法,可缩短婴儿肺炎的病程。     

经鼻气管插管吸痰方法的临床研究

目的探讨吸痰方法对经鼻气管插管气道护理的影响，提高经鼻气管插管气道护理质量。方法对120例经鼻气管插管病人根据吸痰方法随机分组为规范组58例和常规组62例，规范组要求：控制吸痰管插入深度，随吸痰管插入深度调节负压，适时吸痰，加强气道湿化，吸痰管金霉素眼膏润滑，加强口腔护理等；常规组按临床一般吸痰方法吸痰。比较观察两组病人痰液性状、痰量、痰痂、痰细菌培养、肺部感染等变化。结果常规吸痰组病人黄色粘稠痰者占69．35％，痰量〉80ml占70．97％，痰痂形成占61．29％．细菌培养阳性占64．52％．肺部感染占51．61％．而规范组病人分别为31．03％，25．86％，5.17％，20．69％，22．41％，P〈0．005。结论规范吸痰，可有效改善痰液性状、减少痰量及痰痂、减少肺部感染发生。     

利多卡因在神志清醒患者吸痰中的应用

目的观察利多卡因在清醒患者吸痰中的应用。方法选取本院2009年6月至2010年6月需吸痰的清醒患者83例,随机分为观察组42例,对照组41例。观察组患者在吸引前沿气管内缓慢注入2％的利多卡因0．5—1ml,2—3min后行气道内吸引;对照组采用常规方法进行气道内吸引。结果两组患者咳嗽、疼痛、躁动、气管痉挛、低氧血症、心律异常、恶心等发生情况比较,差异有统计学意义（P〈0．01）;吸痰后出血发生情况比较,差异无统计学意义（P〉0．05）;两组患者吸痰过程中、吸痰后2min、吸痰后5min的血氧饱和度检测情况比较,差异有统计学意义（P〈0．01）。结论利多卡因能够减轻清醒患者吸痰中的机体反应,降低气管的敏感性,减轻患者痛苦,值得临床推广使用。     

两种吸痰方式在经口腔无创吸痰中的对比研究

目的观察比较两种不同吸痰方式在无创吸痰中的效果。方法将行无创吸痰的32例患者随机分为观察组和对照组,分别采用经口咽通气管吸痰法（观察组）和经鼻腔/口直接吸痰法（对照组）吸痰。比较两种方法的吸痰效果、吸痰次数和总量、并发症的发生以及吸痰方法对血氧饱和度的影响。结果观察组的吸痰效果、吸痰次数和总量、并发症的发生以及吸痰方法对血氧饱和度的影响与对照组相比均有显著性差异（P〈0.05）。结论经口咽通气管吸痰法比经口直接吸痰法更能减轻患者的痛苦,减少临床护理工作量,提高护理质量。