重症监护室发生急性精神障碍2例

1病例报告例1患者男,89岁。因反复咳嗽、咳痰伴憋喘30余年,加重3天后入院。既往有慢性阻塞性肺病、肺源性心脏病、冠心病、脑梗死等病史。查体：体温36.5℃,脉搏62/min,呼吸19次/min,血压128/76mmHg,轻度嗜睡,可唤醒,双肺呼吸音粗,可闻及大量湿啰音,散在哮鸣音,血脑钠肽836ng/ml,降钙素原0.05ng/ml。给予抗感染、止咳化痰、解痉平喘、改善心功能等治疗,患者病情无好转,并逐渐加重,     

正常人呼吸肌疲劳的产生和锻炼

正常人呼吸肌疲劳的产生和锻炼李燕玉纪树国在许多导致高碳酸血症的生理紊乱中，呼吸肌疲劳起着重要作用。已有证据表明对呼吸肌施以特殊的训练能提高其强度和耐力［１］。然而正常人在特定条件下也可以产生呼吸肌疲劳。尤其从事某些特殊职业的人群，如运动员、飞行员、潜...     

不同麻醉方法对慢性阻塞性肺疾病患者呼吸肌肌力的影响

COPD患者全身麻醉术后肺部并发症的发生率高,是麻醉医生面临的棘手问题之一。主动的术前干预、正确的麻醉管理术后适当镇痛及有效的呼吸道管理均有助于降低人肺部并发症的发生率[1,2]。本研究采用前瞻性的科研设计,比较不同麻醉方法对慢性阻塞性肺疾病患者呼吸肌肌力的影响。     

外科重症监护室医院感染监测与暴发控制

目的针对某外科重症监护室（SICU）频繁发生医院感染的情况,开展目标性监测,以了解其感染情况和危险因素,提出控制措施。方法对一个月内SICU所有住院患者进行前瞻性监测。医院感染病例根据国家卫生部《医院感染诊断标准（试行）》进行确定。监测护士严密观察出入ICU患者情况,填写《ICU病人日志与月报表》。发现医院感染病例,均应按要求填写《医院感染病例登记表》。监测结束后对数据进行统计学处理。结果所有患者均进行了留置导尿管、使用动静脉插管和呼吸机等介人性操作。22例患者医院感染发病率为22．7％,医院感染例次发病率为40．9％,日医院感染发病率为43．8‰;侵人性操作相关的泌尿道感染、血液感染、肺部感染的日发病率分别为26．8‰、9．5‰、65．8‰。其中一个病例同时有肺部感染、泌尿道感染和菌血症。从患者标本分离的致病菌包括嗜麦芽窄食单胞菌、草绿色链球菌、表皮葡萄球菌、铜绿色假单胞菌、大肠杆菌、金黄色葡萄球菌、木糖氧化无色杆菌及热带念珠菌等,同时对这些致病菌进行了药敏试验。监测期间对一起感染暴发进行了控制。结论SICU是医院感染的高发科室,应采取综合措施和严格的管理以预防感染的发生。     

舒适护理在儿童重症监护室护理中的价值分析

目的 探析在儿童重症监护室护理中应用舒适护理的效果.方法 随机选择重症监护室接受治疗的患儿其中120例参与研究,随机平均分成两组,对照组60例利用常规护理方式对患儿实施护理,观察组60例选择舒适护理方式对患儿实施护理,比较两组效果.结果 观察组护理后无痛、轻微、中度和重度疼痛患儿分别有25%、45%、16.67%、3.33%,对照组分别有23.33%、33.33%、30%、13.33%;观察组护理满意度为98.33%,对照组护理满意度为80%.结论 舒适护理用于儿童重症监护室护理中能够提升护理有效性,值得广泛应用.     

舒适护理模式对重症监护室内心血管疾病患者负性情绪的影响

目的 分析舒适护理模式对重症监护室(ICU)内心血管疾病患者负性情绪的影响。方法 选取2018年4月-2021年4月接受治疗的心血管疾病患者100例,根据护理方式的不同将其分为观察组(n=50)和对照组(n=50),对照组行常规护理模式,观察组行舒适模式。对比两组负性情绪、舒适度评分,护理效果。结果 干预后,观察组舒适评分、负性情绪评分改善程度优于对照组,两组数据差异有意义(P<0.05)。观察组护理总有效率显著优于对照组,两组数据差异有意义(P<0.05)。结论 将舒适护理模式应用于对ICU心血管疾病患者护理中,有助于缓解患者负性情绪,使患者具有高度的护理舒适度,促进患者病情恢复,具有较好的护理效果,临床应用价值高。     

模拟空战动作期间呼吸肌的疲劳

前言 以前的研究提示,大的周围骨胳肌的疲劳不太可能削弱抗G收紧动作(AGSM)的效能。由于呼吸肌系的性能未获同样的注意,因而用本研究来验证模拟空战动作(SACM)期间会发生呼吸肌疲劳这一假说。方法 6名受试者暴露于一个由+4 Gz变到+7 Gz平段的离心机剖面,直到疲劳得不能坚持。与食管的压力和通气一道,监测了膈肌、斜角肌、脊间肌和     

SBAR沟通模式的一体化急救护理在重症监护室患者急诊抢救中的应用

目的 研究探讨现状-背景-评估-建议(SBAR)沟通模式的一体化急救护理在重症监护室(ICU)患者急诊抢救中的应用效果。方法 选取ICU在2020年1月～2022年1月收治的120例患者为对象,随机抽签法分为对照组、观察组,各60例。对照组以常规护理干预,观察组采用SBAR沟通模式的一体化急救护理干预。评估比较两组患者的急诊抢救效果、不良事件发生率、护理质量、家属满意度等。结果 观察组患者血压、脉搏、呼吸、体温恢复平稳时间、ICU治疗时间、住院时间均低于对照组(P<0.05)。观察组不良时间发生率6.67%(4/60),低于对照组患者为21.67%(13/60)(P<0.05)。观察组护理质量评分包括健康宣教、基础护理、危重症护理、应急处理及总分均高于对照组(P<0.05)。观察组患者家属总满意度为91.67%(55/60),高于对照组患者为76.67%(46/60)(P<0.05)。结论 SBAR沟通模式的一体化急救护理在重症监护室患者急诊抢救中的应用良好,能够提高患者的急诊抢救效果,缩短患者的住院时间,减少不良事件发生率,提高患者的护理质量和患者家属的满意度...     

重症监护病房革兰阴性菌流行分布及耐药性监测

目的分析沈阳军区总医院呼吸内科重症监护室(RICU)革兰阴性菌的流行分布及其对抗菌药耐药的状况。方法对2009年1月—2011年12月RICU收住患者的所有分离菌株进行分析,试验方法严格按照NCCLS最新标准进行。结果 RICU共分离出277株革兰阴性菌,其中铜绿假单胞菌90株(32.49%)、不动杆菌65株(23.47%)、肺炎克雷伯杆菌56株(20.22%),嗜麦芽窄食假单胞菌20株(7.22%),其次为黏质沙雷菌和大肠埃希菌;革兰阴性菌对碳青酶烯类、头孢他啶、头孢哌酮-舒巴坦钠、头孢吡肟、哌拉西林-他唑巴坦和左氧氟沙星仍高度敏感,但不动杆菌的耐药率却不断增高。结论加强革兰阴性菌耐药性的动态监测,对临床医生合理使用抗菌药十分必要。     

综合ICU感染患者的病原菌菌群分布特点及耐药性分析

目的探讨重症监护病房(ICU)感染的主要致病菌分布特点及其耐药情况,为临床治疗提供依据。方法回顾性分析我院ICU 2011年10月—2013年12月各类标本培养结果,分析各系统主要致病菌分布特点及其耐药性。结果 570份阳性标本中,313份来源于下呼吸道,占54.91%;647株分离菌中革兰阴性菌占56.72%(367/647),主要致病菌是铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌和肺炎克雷伯菌;革兰阳性菌占21.33%(138/647),主要是金黄色葡萄球菌;真菌占21.95%(142/647),主要是白假丝酵母菌。主要革兰阴性菌对美罗培南、舒巴坦钠-头孢哌酮钠、美满霉素耐药性较低;糖肽类对主要的革兰阳性球菌仍然是特效药;真菌对氟胞嘧啶、两性霉素B敏感性较高。结论 ICU感染多发生在下呼吸道,病原菌以革兰阴性菌居多,耐药情况较为严重。应加强ICU主要致病菌及其耐药性的监测,合理使用抗菌药物,减少ICU患者院内感染及耐药菌产生。     

Chest roentgenology in the intensive care unit: an overview

Chest roentgenology in the intensive care unit is a real challenge for the general radiologist. Beyond the basic disease, the critically ill is at risk for developing specific cardiopulmonary disorders, all presenting as chest opacities, their diagnosis often being impossible if based only on the radiological aspect. To make things harder, their appearance can vary with the subject's position and the mechanical ventilation. Patients require a continuous monitoring of the vital functions and their mechanical and pharmacological support, for which they are connected to different instruments. The radiologist should know the normal position of these devices, and promptly recognize when they are misplaced or when complications from their insertion occurred. Our aim is to suggest for each of the above-mentioned conditions a guideline of interpretation based not only on the radiological aspect and distribution of the lesions, but also on the physiopathological and clinical grounds. Received 19 August 1996; Revision received 28 November 1996; Accepted: 6 January 1997     

重症监护病房医院感染目标性监测探讨

目的分析我院重症监护病房（ICU）患者医院感染的发生情况及危险因素,探讨降低感染率的途径。方法采用目标性监测方法对我院2011年1月~2012年7月收治ICU的患者进行监测,建立医院感染监测日志并根据患者临床病情予以分级评定,同时对3种侵入性操作的相关性感染进行分析。结果 239例ICU住院患者中发生医院感染22例（9.21%）,33例次（13.81%）,日医院感染发病率为23.81‰,日医院感染例次率为35.71‰,患者病情平均严重程度3.54分,经ASIS法调整后,日医院感染发病率为6.73‰,日医院感染例次率为10.09‰;3种侵入性操作中使用呼吸机相关的日感染率（44.03‰）居首位,留置尿管相关日感染率（10.93‰）次之;医院感染部位以下呼吸道为主（57.58%）,医院感染的细菌主要为革兰氏阴性菌（61.22%）,真菌感染率（34.69%）也逐渐升高。结论 ICU医院感染发病率高,进行目标性监测可及时准确获得ICU医院感染资料,掌握ICU院感特点和发展规律,有效控制宿主和医源性两方面的危险因素,可降低医院感染率,减少耐药菌株的产生。     

Multidetector row CT pulmonary angiography and indirect venography for the diagnosis of venous thromboembolic disease in intensive care unit patients

RATIONALE AND OBJECTIVES: To determine the diagnostic quality, performance characteristics and interreader reliability of computed tomography pulmonary angiography (CTPA) and venography (CTV) in intensive care unit (ICU) patients with suspected venous thromboembolism (VTE). MATERIALS AND METHODS: A total of 100 consecutive ICU patient CT examinations performed for clinically suspected VTE on a four-row CT scanner were reviewed. Three readers rated the diagnostic quality of each CTPA and CTV examination as excellent, acceptable, or nondiagnostic. Readers scored the overall determination for pulmonary embolism (PE) and deep venous thrombosis (DVT) using a 5-point scale, and scored the determination for PE by anatomic level. Receiver operator characteristic (ROC) analysis was performed for each reader and the original clinical report, using consensus interpretation as the reference standard. Interobserver variability for PE and DVT was determined using kappa analysis, and was stratified by examination quality. RESULTS: A total of 25% of CTPA examinations were nondiagnostic, most commonly because of motion artifact and poor contrast opacification. A total of 24% of CTV examinations were nondiagnostic, most commonly because of poor contrast opacification and metallic hardware. Using receiver operating characteristic analysis, the areas under the curve (Az) for PE diagnosis were 0.875, 0.923, 0.888, and 0.674 for the three readers and clinical reading, respectively, and for DVT diagnosis were 0.842, 0.859, 0.952 and 0.669. Interobserver agreement for detection of PE was moderate at the supralobar level (kappa = 0.55), very good at the lobar level (kappa = 0.69), and moderate for segmental (kappa = 0.54) and subsegmental arteries (kappa = 0.44). Overall reader agreement was good for excellent/good quality CTPA examinations (kappa = 0.52-0.56), and poor when examination quality was poor (kappa = 0.06). CONCLUSIONS: CTPA and CTV are sufficiently accurate and reliable techniques for evaluating VTE in ICU patients, particularly in light of patient complexity.     

医院船海外医疗服务期间重症监护病房的感染控制与管理

目的总结参加"和谐使命-2014"海外医疗服务的经验,探索加强医院船重症监护病房感染控制的有效途径和管理措施。方法对医院船重症监护病房存在的感染控制方面问题进行分析,针对性制定出相应的感染控制措施,并在"和谐使命-2014"任务执行过程中付诸实施。结果整个任务期间,医院船重症监护病房收治患者共计119例;其中,1例为艾滋病、梅毒、丙型病毒性肝炎三重感染患者,1例为严重产后感染患者,1例为急性重症胃肠炎患者,2例为肺部感染患者。整个治疗过程顺利,没有出现任何院内感染或感染播散病例。结论对医院船重症监护病房存在的感染控制问题,可通过成立感染控制小组、建立相对隔离措施、加强管理防护等措施加以改进。     

Cumulative radiation exposure from diagnostic imaging in intensive care unit patients

AIM:To quantify cumulative effective dose of intensive care unit(ICU)patients attributable to diagnostic imaging.METHODS:This was a prospective,interdisciplinary study conducted in the ICU of a large tertiary referral and level 1 trauma center.Demographic and clinical data including age,gender,date of ICU admission,primary reason for ICU admission,APACHE Ⅱ score,length of stay,number of days intubated,date of death or discharge,and re-admission data was collected on all patients admitted over a 1-year period.The overall radiation exposure was quantified by the cumulative effective radiation dose(CED)in millisieverts(mS v)and calculated using reference effective doses published by the United Kingdom National Radiation Protection Board.Pediatric patients were selected for subgroupanalysis.RESULTS:A total of 2737 studies were performedin 421 patients.The total CED was 1704 m Sv with a median CED of 1.5 mS v(IQR 0.04-6.6 mS v).Total CED in pediatric patients was 74.6 mS v with a median CED of 0.07 mS v(IQR 0.01-4.7 mS v).Chest radiography was the most commonly performed examination accounting for 83% of all studies but only 2.7% of total CED.Computed tomography(CT)accounted for 16% of all studies performed and contributed 97% of total CED.Trauma patients received a statistically significant higher dose [median CED 7.7 mS v(IQR 3.5-13.8 mS v)] than medical [median CED 1.4 m Sv(IQR 0.05-5.4 m Sv)] and surgical [median CED 1.6 mS v(IQR 0.04-7.5 mS v)] patients.Length of stay in ICU [OR = 1.12(95%CI:1.079-1.157)] was identified as an independent predictor of receiving a CED greater than 15 mS v.CONCLUSION:Trauma patients and patients with extended ICU admission times are at increased risk of higher CEDs.CED should be minimized where feasible,especially in young patients.     

从营养支持看重症医学医师角色

目的探讨适于基层医疗单位重症医学科的角色。方法以营养支持治疗为例,比较普通模式和协作小组模式下营养方式、费用、并发症、营养目标达标率等方面的差异。结果与普通模式相比,协作小组模式下,肠外营养比例降低,肠内营养给予率提高,并发症降低,营养目标达标率提高,ICU费用未增加。结论应建立"协作小组"抢救模式完成对危重患者抢救,重症医学是应扮演一个协调、整合各专业的角色。     

Role of high resolution ultrasonography in diagnosing septic hip arthritis in premature neonates admitted to the neonatal intensive care unit

Aim

The aim of this study is to evaluate the role of high resolution ultrasonography (HRUS) of the hip in premature neonates admitted to the neonatal intensive care unit (NICU) in diagnosis of septic hip arthritis.