2例气管插管后气管内膜损伤原因分析与护理

气管插管对气管内膜是一种损伤，损伤常与插管时间长短成正比，插管时间越长，损伤率就越高。气管内膜损伤在体外循环术后的发生率大于其它疾病的发生率。现对2例体外循环手术患者气管插管后气管内膜损伤分析讨论如下：     

两种不同气管插管临床教学方法的对比研究

目的 为了提高窒息新生儿气管插管成功率,缩短气管插管成功的时间,减少气管插管损伤.方法 对助产人员进行气管插管教学时,采用死胎和模型两种方法 培训,两组人员均按气管插管操作步骤进行操作,经同一评价标准评价合格后在临床上进行窒息新生儿气管插管,观察插管成功时间、插管成功率及气管插管时造成的气道损伤.结果 研究组的插管成功时间明显低于对照组,而插管成功率明显高于对照组,对气道的损伤明显低于对照组.结论 利用死胎进行气管插管训练的复苏人员可以明显提高气管插管成功率,缩短插管时间,减少插管对气道的损伤.     

重型颅脑损伤院前气管插管的临床分析

目的 探讨院前气管插管对重型颅脑损伤患者预后的影响.方法 将重型颅脑损伤患者根据是否气管插管和插管距受伤的时间分为3组,观察记录各组死亡人数、SpO2及计算氧合指数.结果 插管后SpO2及氧合指数高子插管前,未行气管插管组死亡人数更多.结论 早期气管插管可以改善氧合,防止误吸,控制通气,对重型颅脑损伤患者预后是有利的.     

气管黏膜损伤致呼吸衰竭3例的护理

气管插管使气管黏膜损伤坏落导致呼吸道阻塞,呼吸衰竭,表现为呼吸困难,三凹征明显,咳痰由多变少,哮喘逐渐加重伴有喉鸣音,再次气管插管治愈。1病例报告例1,女,41岁,因间歇性咳血15年,诊断为左肺下叶结核球,2012年4月20日经气管插管静脉复     

早期气管插管对颅脑损伤患者预后的影响分析

目的：观察颅脑损伤早期气管插管对患者预后的影响。方法：回顾性分析和评价我院自2006年6月至2009年6月间收治的68例颅脑损伤患者的临床资料,依据气管插管时间将其分为早期组和常规组。早期组于损伤发生20min内出现早期气管插管绝对指征时行气管插管,常规组以呼吸功能衰竭为指征行气管插管,比较两组死亡率及预后情况。结果：早期气管插管患者预后效果良好,在死亡率和预后良好率方面均明显低于常规插管组,在统计学上有显著性差异（P〈0．05）。结论：早期气管插管可减少并发症的发生,对颅脑损伤患者预后具有良好的影响,能显著降低患者残死率,改善缺氧状态,改善预后。     

医源性气管与支气管损伤4例

手术中气管与支气管损伤是一危及生命的并发症,近20年来医源性气管与支气管损伤的病例明显增多,它们多发生于麻醉中气管插管和气管切开术时.我科近3年来发生的4例医源性气管与支气管损伤,报告如下.     

EuromedicalTM加强型与普通型气管导管用于经鼻气管插管的比较

目的 比较两种气管导管用于经鼻气管插管的优缺点.方法 选择脊柱外科、神经外科择期手术患者60例,分为R、C两组(n=30),均采用经鼻明视下插管,R组导管选择EuromedicalTM 加强型(Oral/Nasal)导管,C组选择EuromedicalTM 普通型(Oral/Nasal)导管;比较两组患者的插管时间、成功率及并发症等.结果 R组插管用时平均(50±6.7)s,C组为(57±10.3)s,差异有统计学意义(P＜0.05);R组插管一次性成功29例,两次成功30例,C组一次性成功27例,两次成功30例,差异无统计学意义(P>0.05);R组鼻黏膜损伤出血4例,无咽部黏膜损伤出血,C组鼻黏膜损伤出血16例,咽后壁黏膜损伤出血7例,均明显较R组多(P＜0.05).结论 EuromedicalTM 加强型(Oral/Nasal)气管导管用于经鼻气管插管引起的鼻咽部损伤少,更适合用于经鼻气管插管.     

纤维支气管镜辅助气管插管用于颈髓损伤病人的麻醉

目的：探讨纤维支气管镜辅助气管插管用于颈髓损伤病人麻醉的可行性。方法：32颈髓损伤病人在清醒，环甲膜表面麻醉下行纤维支气管镜辅助气管插管，观察插管过程中病人的血压，脉搏等变化呛咳，头部制动等情况。结果：32例中成功插入30例，插管过程一般为20s-2min。表面麻醉和插管时大多元剧烈呛咳，血压，脉搏，血氧饱和度无明显变化。插管过程中头部稳定。结论：纤维支气管镜辅助气管插管用于颈髓损伤病人的麻醉，可避免传统气管插管时颈部过伸而引起的颈髓型一步损伤，操作简单，安全。     

水胶体敷料防治患儿气管插管皮肤损伤的效果观察

目的:探讨水胶体敷料在重症患儿气管插管固定中防治面颊部皮肤损伤的方法和效果.方法:将儿科重症监护病房气管插管超过72 h的126例患儿按入院时间分为对照组57例和观察组69例,对照组直接使用3M黏着性棉布伸缩包带进行气管插管的固定,观察组先采用水胶体敷料对患儿脸颊部进行保护,再用3M黏着性棉布伸缩包带进行固定.评价2组患儿气管插管固定效果、脸部皮肤受损及破溃情况、气管插管护理所用时间.结果:2组在气管插管固定效果上差异无统计学意义(P>0.05).在气管插管护理上,对照组皮肤不同程度受损率22.81%,观察组皮肤完好无破损,观察组每天的气管插管护理时间明显少于对照组(P<0.01).结论:采用3M黏着性棉布伸缩包带对患儿气管插管进行固定易发生皮肤的破损,水胶体敷料能很好地防治皮肤损伤发生.     

重度颅脑损伤手术后病人气管插管的护理

目的探讨重度颅脑损伤病人术后气管插管的护理措施。方法对200例重度颅脑损伤病人气管插管的护理经验进行回顾性分析。结果采用综合护理措施后患者均取得较为满意的临床效果。结论重度颅脑损伤病人气管插管采用综合护理可以减少并发症,有利于病情好转。     

四肢急性血管损伤诊治(附73例报告)

诊治四肢急性血管的损伤,如何才能收到良好的效果,目前仍然是一重要的课题。作者从1977年1月～1991年5月的73例中,发现了一些有关重要问题。指出在诊断时动脉搏动的存在不能排除血管损伤,尤其上肢血管损伤伴有较高的神经损伤发生率,血管造影并无必要;术中应对受伤的血管及软组织进行彻底的清创,选择恰当的血管修复方法,不要遗漏对复合伤的处理,注意神经损伤应早期修复。     

Skateboard injuries

The recent increase in skateboard injuries is causing concern. Over a 30-month period there were 80 admissions (69 children) to Westmead Hospital because of skateboard injuries. Among children most injuries were minor, involving fractures to the upper limbs (47) or minor head injuries (8). The only serious injuries were a ruptured urethra and a closed head injury. Over the same time period skateboard riding caused five deaths in New South Wales. These all involved head injuries and in four instances collisions with cars. The data strongly support other studies that show skateboard riding is particularly dangerous near traffic and should be proscribed. However, in parkland and around the home the skateboard is an enjoyable toy with an acceptable risk of minor injury. Helmets should be worn and would have prevented all the head injury admissions in this series. Children under 10 have a higher risk of fractures and head injuries due to insufficient motor development to control the boards and the resultant falls. Skateboard injuries are an example of injuries caused by a "fad epidemic". To cope with these types of periodic events up-to-date data collection is needed, followed rapidly by an intervention programme so that serious injuries can be kept to a minimum.     

Bile duct injuries in open and laparoscopic cholecystectomy: Apples and oranges

Bile duct injuries are potentially devastating for the patient and the surgeon. Most bile duct injuries probably occur during the initial 12-15 cases of laparoscopic cholecystectomy done by any one surgeon^(8,15). It is imperative therefore that surgeons in training or who are new to this technique are adequately supervised during this period. There seems to be an increased incidence of bile duct injury with the laparoscopic technique (0.6% compared with 0.2%). Laparoscopic bile duct injuries however, may be more common but less serious compared with the open approach. A high proportion of laparoscopic injuries are injures in continuity, which may be managed without recourse to laparotomy. The incidence of severe injury requiring a hepaticoenterostomy does not seem to have increased, though as yet we cannot comment on the incidence of late duct strictures from the laparoscopic approach. Laser and diathermy injuries are also more common with the laparoscopic procedure and the high reported incidence of bile leaks must be carefully analysed. It has been suggested that large scale audit is more likely to reflect the true incidence of bile duct injury due to under-reporting of a relatively uncommon problem in published series⁽⁴³⁾. Analysis of bile duct injuries should therefore take into account different rates in reported and audit series, bile leaks, probable increased primary diagnosis at the original laparoscopic cholecystectomy, and the learning curve as well as new mechanisms of diathermy or laser injury. With comparative analysis and experience the long term incidence of bile duct injuries may be similar to that after the open procedure, and indeed may even be less in some centres⁽⁵⁰⁾.     

35例高校篮球运动员膝部损伤分析

目的 探讨大学生运动员膝部损伤的机制及损伤原因，提出预防损伤的措施。方法 对锦州市三所高校35例篮球运动员进行问卷调查。结果 内侧副韧带损伤9例(25．71％)，半月板损伤10例(28．57％)，髌骨劳损8例(22．86％)。结论 膝关节损伤同篮球运动的特殊技术要求有密切关系，训练应有针对性，加强医务监督。     

Nordic (cross-country) skiing injuries in Australia

A retrospective study of 88 nordic skiing injuries from the 1984 and 1985 skiing seasons in Australia is presented. To our knowledge, this is the largest study to date of such injuries. These injuries are compared with alpine skiing injuries from the same medical clinic for the 1985 skiing season. There was a much lower incidence of injury from nordic skiing; however, when injuries did occur, they tended to be more serious than those of alpine skiing and frequently required immediate evacuation to hospital for treatment. As the nordic skier is relatively isolated from medical services, these findings need to be considered in the future planning of rescue services for such skiers.     

实习护生锐器伤发生情况调查分析

目的了解实习护生锐器损伤的现状,为开展锐器伤防范知识和技能的培养及采取职业防护措施提供科学依据。方法采用问卷法调查100名实习护生锐器伤的发生率。结果100％实习护生发生过锐器伤,其中锐器伤以针刺伤占首位（58．67％）;发生锐器伤的相关操作主要为开安瓿（35．56％）、处理废物（30．22％）;发生锐器伤场所主要在治疗室（56．89％）;锐器伤的发生率与实习时间成正比、与实习护生的学历无关,并且锐器伤后处理方法不规范。结论实习护生缺乏锐器伤的防护意识,要加强锐器伤防护知识的培训,充分认识其重要性,增强防护意识,同时要加大职业防护的管理．以减少锐器伤的危害。     

40例严重胸腹伤急症手术治疗体会

胸腹伤系胸腹多脏器复合损伤,其伤势重,休克发生率高。通过40例严重胸腹伤急症手术治疗,作者认为,迅速补液输血纠正低血容量,改善微循环;胸伤的处理以简单有效为原则,重点在于改善呼吸功能,一般不需开胸手术;腹伤多为肝脾破裂,且易导致休克,应积极施行手术探查。     

Limiting the use of routine radiography for acute ankle injuries.

In the diagnosis of ankle injuries routine radiography is often productive. An international survey of the average number of radiographs made of injured ankles suggested that two projections are adequate to detect fractures. This was confirmed in a prospective study of 242 patients coming to a hospital emergency department with recent ankle injuries. All the fractures could be identified on an anteroposterior or a lateral projection, although some were more obvious on an oblique view. As well, all the fractures were associated with malleolar soft-tissue swelling. Thus, radiography for acute ankle injuries could safely be restricted to patients with soft-tissue swelling, and fractures could be diagnosed using only two routine projections, though for management purposes additional projections might be needed. With a policy of limiting the use of radiography substantial cost reductions are possible.     

Reconstruction of urethral injuries

OBJECTIVES: To highlight the complexity of urethral injuries and to emphasise their prevention. DESIGN: A retrospective study. SETTING: Coast Province General Hospital, Mombasa, Kenya. SUBJECTS: Twenty two male patients operated between 1997 and 2007. RESULTS: Surgery for urethral injuries was done on 22 patients; 16 were of the posterior urethra, five bulbar urethra and one proximal penile urethra. The posterior urethral injuries were due to: pelvic fracture in 14, penetrating stick in one, and one animal injury by a buffalo. The bulbar urethral injuries were due to straddle injuries in four and one gunshot injury. The penile urethral injury was by compression of the subject by a motor vehicle against a wall. Anastomotic urethroplasty was performed in 20 patients, of whom 16 had complete recovery. Surgery for all bulbar and the penile urethral injuries was successful. Failure of repair with restenosis occurred in four patients with posterior urethral injuries. Bouginage was done in one patient who subsequently required no further treatment. Eventual total obliteration occurred in three patients. Reoperation was done in two of these with complete recovery in one and failure in the other who had two further urethroplasties, optical urethrotomy and is currently on clean intermittent self catheterisation. The fourth patient awaits reoperation. Sutureless membranous urethroplasty was done in two patients with posterior urethral injuries in whom sutures could not be inserted into the proximal prostatic urethra. One developed stenosis a year later, had optical urethrotomy and commenced on clean intermittent self catheterisation for a while, without further trouble. The other developed total obliteration. At repeat surgery enhanced scarring with urethral shortening were found and the operation was abandoned. The Mitrofanoff principle was applied with an appendicovesicostomy; one form of urinary diversion with a continent catheterisable conduit. On follow up, now nine years, the diversion is continent, has no catheterisation difficulties, and no urinary calculi. CONCLUSION: Urethral injuries are difficult to manage. A two pronged approach is advanced; prevention and competent repair. Surgeons managing these injuries are encouraged to acquire the needed reconstruction skills. Emphasis on prevention is paramount. Appropriate road, industrial and occupational safety measures should be enforced. Iatrogenic injuries can be avoided by due care during catheterisation and urethral instrumentation.     

168例急性重型颅脑外伤的心电图分析

目的：为探讨急性重型颅脑外伤病人的心电图(ECG)变化、特征及临床意义。方法：回顾性分析168例急性重型颅脑外伤的常规心电图。结果：急性重型颅脑外伤病人常出现心电图异常，本组异常者143例(占85％)。其中以心肌复极异常为主，心律失常次之。结论：急性重型颅脑外伤的心电图异常占大多数，且变化复杂，一般为应激反应，是暂时的，可逆的，提示其心电图变化与病情及预后存在着平行关系，故对此类病人尤其在手术前进行常规心电图检查是必要的。急性重型颅脑外伤病人进行心电图监测对诊断、治疗及判断预后具有重要价值。