PALL和Tyco呼吸过滤器对Ppeak和Pmean影响的模拟研究

目的：了解PALLBB25S和TyroHygroboy呼吸过滤器对呼吸道回路峰压值（Poeak）和气道平均压（Pmean）的影响。方法：模拟研究了PALL和Tyeo呼吸过滤器在应用过程中Ppeak和Pmean的变化特点。结果：（1）随着潮气量的逐步增大（100-800ml／次）,此两种型号呼吸过滤器（成人与儿童）所产生的Ppeak与未用呼吸过滤器时相比无显著差异性;但它们所产生的Pmean则显著提高。（2）与成人型号呼吸过滤器相比,应用Tyc0儿童型号呼吸过滤器时其对呼吸力学的影响仅表现为Pmean显著升高,而Ppeak并未显著升高。结论：此两种型号呼吸过滤器（成人与儿童）对呼吸道阻力的影响表现为显著提高了Pmean。     

不同清洗方式清洗消毒简易呼吸气囊的效果观察

目的：探讨全自动清洗消毒机配合自制简易呼吸气囊清洗架在消毒供应中心集中清洗效果,为实际应用提供参考依据。方法：将2020年10月～2021年10月本院消毒供应中心纯手工清洗与全自动清洗消毒机清洗简易呼吸气囊各65例,分别对各呼气阀、球形气囊抽样检测,对比细菌检测数量。结果：两组简易呼吸气囊在清洗前、后的菌落计数和细菌清除率无差异（P>0.05）。采用全自动清洗工艺,每个可节省5.5min劳动力（约1.66元）。根据三甲医院平均每日使用65个简易呼吸气囊,每日可节省人力支出107.9元。结论：全自动清洗消毒机与纯手工清洗方式具有一致的消毒效果,但是全自动清洗消毒方式解放了人力,降低整体工作量,提升工作效率,节约时间和成本。此外,不需要手工清洗,也降低化学浸泡消毒对员工的伤害,采用全自动清洗机清洗方式具有明显的优势。     

Lung volume recruitment in impending respiratory failure

Lung volume recruitment can improve peak cough flows and respiratory compliance in patients who either do or do not require mechanical ventilation. There are several lung volume recruitment techniques: air stacking, glossopharyngeal breathing and mechanical insufflation-exsufflation with cough assist devices. The principle of lung volume recruitment is based on the insufflation of air in the lungs after maximal inspiration. In air stacking, a manual resuscitation bag is used for insufflation. Glossopharyngeal breathing requires the use of oropharyngeal and laryngeal muscles by the patient. The mechanical cough assist device exsufflates the air after insufflation. These techniques may prevent pulmonary complications, hospital admission and tracheotomy in patients with a reduced ability to cough, a proclivity towards atelectasis and recurrent airway infections. The combination of long-term mechanical ventilation with lung volume recruitment has led to further improvement in the prognosis of chronic respiratory failure. More patients may potentially benefit from lung volume recruitment than only those being converted from short-term to long-term mechanical ventilation.     

动物用力肺通气功能的测定

动物用力肺通气功能指标对于慢性阻塞性肺气肿（COPD）等呼吸疾病的基础医学研究具有非常重要的意义。本文介绍了一种测量动物用力肺通气功能指标的方法,并且研制了一套测量其相关指标的系统,包括硬件部分和计算机软件自动分析部分。     

Social Service Counseling in Cancer Centers Certified by the German Cancer Society

Social workers are an integral part of care provided in cancer centers that are certified according to the requirements of the German Cancer Society. This article reports on the tasks of social workers in German cancer care and on the proportion of patients that receives social service counseling (SSC) in breast, lung, colorectal, skin, gynecological, prostate, pancreas, neurological, and head and neck cancer centers based on data from 367,297 patients treated between 2009 and 2012. The highest proportions of patients (median >75%) are provided with SSC in breast and colorectal cancer centers, whereas the median is below 30% in skin cancer centers. Variation between centers and center types is high.     

GPS--good practice secondary data analysis. Working Group for the Survey and Utilization of Secondary Data (AGENS) of the German Society for Social Medicine and Prevention (DGSMP)

The scientific use of secondary data, especially of claims data from health insurance funds, has continuously increased in the last years. Therefore the Working Group "Collection and Use of Secondary Data" (AGENS) of the German Society of Social Medicine and Prevention (DGSMP) took the initiative to define quality standards for secondary data analysis. Starting with a review of the Good Epidemiologic Practice (GEP) AGENS adapted the GEP to the specific requirements of secondary data analysis by a multi-stage consensus process. The guideline Good Practice Secondary Date Analysis (GPS) was adopted on January 15 (th), 2005. GPS consists of 10 guidelines which are divided in explaining comments and recommendations. The GPS are targeted to set up standards for secondary data analysis, and they may also be used as a foundation of contracts between data owners and scientists. They are addressed to scientists from health services research and social medicine. AGENS commits itself to revise GPS continuously.     

Shutting down operating theater ventilation when the theater is not in use: infection control and environmental aspects.

OBJECTIVE: In hospital operating rooms (ORs), specially conditioned air is supplied to protect patients from airborne agents that may cause infections. This study investigated whether it is hygienically safe to shut down the air supply at night if measures are taken to ensure a timely restart before surgery is performed. DESIGN: Experimental study. SETTING: Neurosurgical OR of a German university hospital. METHODS: The ventilation system was switched off and restarted after 10 hours. Particles suspended in the air near the operating table were counted, OR temperature was measured, and settle plates were exposed and incubated. RESULTS: In 13 investigations, a median of 1.3 x 10(4) particles 0.5 microm/m3 or greater (range, 5.8 x 10(3) to 1.1 x 10(5)) were documented immediately after restart in the morning. After 10 minutes and subsequently, no test showed a particle count exceeding the threshold limit of 1.0 x 10(4) particles 0.5 microm/m3 or greater recommended by the German Society of Hygiene and Microbiology. Only a few colony-forming units (CFU) were detected per settle plate (median, 0 CFU/60 cm2; range, 0 to 8) and OR temperatures quickly reached normal levels. CONCLUSIONS: Shutting down OR ventilation during off-duty periods does not appear to result in an unacceptably high particle count or microbial contamination of the OR air shortly after the system is restarted. Because substantial energy and cost savings are likely, this should be considered in hygienically safe heating, ventilation, and air conditioning systems. However, normal ventilation should be established at least 30 minutes before surgical activity.     

Extremely deep recreational dives: the risk for carbon dioxide (CO(2)) retention and high pressure neurological syndrome (HPNS)

Clear differences between professional and recreational deep diving are disappearing, at least when taking into account the types of breathing mixtures (oxygen, nitrox, heliox, and trimix) and range of dive parameters (depth and time). Training of recreational deep divers is conducted at depths of 120-150 metres and some divers dive to 180-200 metres using the same diving techniques. Extremely deep recreational divers go to depths of more than 200 metres, at which depths the physical and chemical properties of breathing gases create some physiological restrictions already known from professional deep diving. One risk is carbon dioxide retention due to limitation of lung ventilation caused by the high density of breathing gas mixture at great depths. This effect can be amplified by the introduction of the additional work of breathing if there is significant external resistance caused by a breathing device. The other risk for deep divers is High Pressure Neurological Syndrome (HPNS) caused by a direct compression effect, presumably on the lipid component of cell membranes of the central nervous system. In deep professional diving, divers use a mixture of helium and oxygen to decrease gas density, and nitrogen is used only in some cases for decreasing the signs and symptoms of HPNS. The same approach with decreasing the nitrogen content in the breathing mixture can also be observed nowadays in deep recreational diving. Moreover, in extremely deep professional diving, hydrogen has been used successfully both for decreasing the density of the breathing gas mixture and amelioration of HPNS signs and symptoms. It is fair to assume that the use of hydrogen will be soon "re-invented" by extremely deep recreational divers. So the scope of modern diving medicine for recreational divers should be expanded also to cover these problems, which previously were assigned exclusively to professional and military divers.     

Improving quality of care for depression: the German Action Programme for the implementation of evidence-based guidelines.

ISSUE: Depressive disorders are of great medical and political significance. The potential inherent in achieving better guideline orientation and a better collaboration between different types of care is clear. Throughout the 1990s, educational initiatives were started for implementing guidelines. Evidence-based guidelines on depression have been formulated in many countries. PURPOSE: This article presents an action programme for structural, educational, and research-related measures to implement evidence-based care of depressive disorders in the German health system. The starting points of the programme are the 'Guidelines Critical Appraisal Reports' of the 'Guideline Clearing House' and measures from the 'Competence Network on Depression and Suicidality' (CNDS) funded by the Federal Ministry of Education and Research. The article gives an overview of the steps achieved as recommended by the Guidelines Critical Appraisal Reports and the ongoing transfer process into the German health care system. RESULTS: The action programme shows that comprehensive interventions to develop and introduce evidence-based guidelines for depression can achieve benefits in the care of depression, e.g. in recognition, management, and clinical outcome. CONCLUSION: It was possible to implement the German Action Programme in selected care settings, and initial evaluation results suggest some improvements. The action programme provides preliminary work, materials, and results for developing a future 'Disease Management Programme' (DMP) for depression.     

多脏器联合超声对机械通气患者撤机的预测价值研究

目的:探讨多脏器联合超声对机械通气患者撤机的预测价值。方法:选取2019年6月至2020年6月某院重症医学科收治的62例机械通气患者,均符合撤机标准进入自主呼吸试验(spontaneous breathing trial,SBT)。所有患者SBT前进行超声检查,记录肺部超声评分(lung ultrasound score,LUS)、舒张早期左房室瓣血流速度/左房室瓣环运动速度(E/e′)、膈肌呼吸浅快指数(diaphragmatic rapid shallow breathing index,DRSBI)。根据能否成功撤机分为成功组和失败组。绘制ROC曲线评估LUS、E/e′、DRSBI及三者联合对撤机失败的预测价值。数据采用SPSS 26.0软件进行统计学分析。结果:62例患者中,撤机成功49例,撤机失败13例。失败组的LUS、E/e′、DRSBI明显高于成功组[(13.23±4.23)分vs(7.32±2.59)分,13.84±1.66 vs 10.67±1.29,1.75±0.26 vs 1.43±0.25],差异均有统计学意义(P<0.001)。LUS≥8.5分时预测撤机失败,敏感度为84.6%、特异度为83.7%,AUC值为0.88;E/e′≥12.7时预测撤机失败,敏感度为84.6%、特异度为91.8%,AUC值为0.93;DRSBI≥1.5时预测撤机失败,敏感度为76.9%、特异度为75.5%,AUC值为0.82;LUS≥8.5分、E/e′≥12.7且DRSBI≥1.5时预测撤机失败,敏感度为100%、特异度为89.8%,AUC值为0.98,高于单项指标检测。结论:多脏器联合超声能有效预测机械通气患者的撤机失败。     

Effects of Sarcopenia on Ventilatory Behavior and the Multidimensional Nature of Dyspnea in Patients With Chronic Obstructive Pulmonary Disease

ObjectivesThis study tested the hypothesis that sarcopenia, a common extrapulmonary feature of chronic obstructive pulmonary disease (COPD), can affect ventilatory behavior, and worsen the multidimensional nature of dyspnea in patients with COPD.DesignCross-sectional survey study.Settingand Participants: Stable outpatients with COPD encountered in general practice and respiratory clinic.MethodSarcopenia was diagnosed according to an appendicular skeletal muscle mass index based on measurements of electrical impedance and handgrip strength. Exertional dyspnea was tested using a 3-minute Step Test and a 6-minute Walk Test. The dimensions of dyspnea were assessed by a multidimensional dyspnea profile.ResultsOf 60 stable patients with COPD, 16 met the criteria for sarcopenia. During the 3-minute Step Test, minute ventilation as a proportion of exercise time, tidal volume as a proportion of inspiratory capacity, the change in inspiratory capacity, and ventilation as a proportion of maximal voluntary ventilation did not differ between patients with and without sarcopenia. Patients with sarcopenia exhibited lower evolution of tidal volume, higher evolution of respiratory frequency versus ventilation and breathing discomfort on the 3-minute Step Test, as well as increased physical breathing effort on the 6-minute Walk Test, compared with those without sarcopenia. In a multivariable model adjusted using inverse probability weighting, sarcopenia was independently associated with breathing discomfort during the 3-minute Step Test and physical breathing effort during the 6-minute Walk Test.Conclusions and ImplicationsSarcopenia may be associated with shallow breathing and diverse sensory and affective components of exertional dyspnea in patients with COPD. The study indicates that improvement of the rapid breathing pattern may offer unique ways to alleviate dyspnea in older patients with COPD and sarcopenia.     

无创正压通气治疗老年人COPD合并Ⅱ型呼吸衰竭的临床观察

目的研究无创正压通气治疗老年人慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭的治疗效果。方法选择96例COPD合并呼吸衰竭的老年患者,应用鼻罩行辅助通气治疗2h,对比治疗前后动脉血气分析,并观察神志、发绀、血压和心率等的变化。结果使用呼吸机2h后血氧分压、血氧饱和度明硅增高,与联机前比较差异有品著统计学意义（P〈0．01）,血二氧化碳分压明显降低（P〈0．01）;发绀减退或消退,呼吸频率、心率减慢,气促减轻,但血压无明硅变化。结论鼻罩BiPAP呼吸机辅助通气对COPD合并呼吸衰竭有肯定疗效。     

Microbiological safety and cost-effectiveness of weekly breathing circuit changes in combination with heat moisture exchange filters: a prospective longitudinal clinical survey

Aim: To assess the safety and cost effectiveness of a usage for seven days of breathing circuit systems (BCSs) in combination with heat moisture exchanger filters (HMEF) in operation room anesthesia. Method: In a prospective longitudinal clinical study, the contamination on high-risk surfaces (HMEF together with inner and outer surface of BCS) was monitored over 1, 2, 5, and 7 days. Results of endogenous respiratory patient flora and contamination flora of BCS, HMEF and bag were compared. Costs of prolonged use of BCS together with HMEF up to 7 days were calculated. Results: Neither physiological respiratory flora nor colonizing pathogens of the oropharynx of the ventilated patients were transmitted through the filters at any time. None of the included patients developed a postoperative pneumonia. Using the BCS for 24 hours provides a cost savings of up to 40% versus single use. Extending the change interval from 24 hours to 48 hours saved over 50% compared to change after each patient, and an additional 19% compared to change after 24 hours. In combination with a HMEF BCS can be used up to 7 days without clinical risk on multiple patients in operation room settings.Conclusion: Expanding the usage of berating in combination with usage of moist exchange filters is feasible, microbiologically safe and cost effective, as 41% of material costs per ventilation may be saved. Further research is needed to confirm these results.     

Anaesthesia and severe pulmonary disease

The key to the management of anaesthesia in patients with severe pulmonary disease lies in predicting the requirement for support of ventilation and/or oxygenation in the postoperative period, and the provision of effective pain relief in such a way as to allow the patient to maintain adequate spontaneous ventilation. This in turn depends on understanding the influence of the relevant surgical intervention on the patient's ability to sustain his normal breathing requirements, to breathe deeply, and to cough.     

Women and sex-specific health research in the German Society for Social Medicine and Prevention

Since the 1970s women's health research has put gender-specific topics on the agenda of health research and practice. Based on a social science approach, it focuses on social conditions of the maintenance of women's health and of their needs in prevention, health promotion, medical treatment, and rehabilitation. Besides an analysis of woman-specific topics (such as sexual violence or drug abuse) women's health research addresses questions of gender bias in health research. In Germany, guidelines are lacking that ensure appropriate attention to gender issues for health research. The section "Woman-specific and gender-specific health research" of the German Society for Social Medicine and Prevention (DGSMP) intends to intensify the discussion on the gaps in health research and prevention and on the development of guidelines to detect gender bias. The main goal is to implement the concept of gender mainstreaming in public health.     

腹式呼吸对妇科盆腔肿瘤患者术后排气时间的效果观察

目的：探讨腹式呼吸训练对妇科肿瘤手术患者术后排气时间的影响。方法：选择妇科肿瘤手术患者60例，随机分为试验组和对照组，每组各30例，试验组患者术后麻醉清醒后指导腹式呼吸，每4h听一次患者的肠蠕动次数，术后12h、24h、48h记录。对照组麻醉清醒后鼓励床上活动，6h后予以半卧位，鼓励床上运动逐渐过度到下床活动。结果：试验组患者术后肠蠕动出现的时间、出现排气的时间、出现排便的时间均早于对照组，其差异有统计学意义（P<0.05）。结论：腹式呼吸训练可作为妇科肿瘤手术患者术后尽快恢复肠功能的护理措施。     

呼吸、心率的雷达式非接触检测系统设计与研究

介绍了呼吸,心率的雷达式非接触检测系统的硬,软件设计思想和方法,研究了其非接触检测技术,在探测信号功率P＜1mW,探测距离S＜10m,检测对象着各类衣服的情况下,较高的检测出人体呼吸及心动信号,结果表明：该技术方法和系统检测灵敏度高,是一种可行的,很有前景的呼吸,心率非接触检测方法和系统。     

某加酸超标岗位局部排风系统改造

目的通过分析某加酸岗位盐酸超标原因，提出通风设施改造方案，使改造后的岗位空气中盐酸浓度达到国家卫生标准。方法对某加酸现场进行监测，结合现场调查，分析盐酸超标原因，改进其作业方式，改变其排风系统通风方式，并对吸气罩、风道及风机进行改造。结果由于作业方式的不合理，同时通风系统方式不合理，导致岗位空气中盐酸超标20倍。在改进作业方式、改造局部排风系统后，该岗位空气中盐酸浓度降至〈0．55mg／m^3。结论为该加酸超标岗位局部排风系统设计的改造方案切实可行，达到预期目标。     

Effects of He-O2 breathing during experimental decompression sickness following air dives

The effects of ventilation with He-O2 during decompression sickness (DCS) and venous air embolism were studied. Fifteen anesthetized dogs were mechanically ventilated and subjected to repeated air dives until pulmonary artery pressure at least doubled within 10 min postdive. At 30 min postdive, ventilation was either continued with air (controls, n = 7) or changed to He-O2 (n = 8) for an additional 90 min. All animals developed pulmonary hypertension, systemic hypotension, hemoconcentration, hypoxemia, hypercarbia, and pulmonary edema. Breathing air or He-O2 postdive did not alter these responses, but He-O2 breathing produced an 11% increase in pulmonary vascular resistance (PVR). In 3 other anesthetized dogs that were not subjected to dives, ventilation was changed to He-O2 at various times during an intravenous infusion of air; He-O2 breathing caused a 22% increase in PVR. We conclude that breathing He-O2 during DCS resulting from air dive can intensify pulmonary vascular obstruction.     

Reproducibility of the German and Slovakian Versions of the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN)

Purpose. The aim of this study was to assess the reproducibility and reliability of the KomPAN questionnaire among two groups of university students from Germany and Slovakia. Methods. A total of 422 individuals (mean age 21.4 years, SD 4.0), including 197 from Slovakia (men 26.2%) and 225 from Germany (men 22.3%), were tested using the self-administered (SA-Q) version of the KomPAN questionnaire and then retested two weeks later. A cross-classification analysis, kappa coefficients, Cronbach’s ɑ coefficients, and a test-retest result comparison were conducted separately for each group of students to assess the reproducibility and reliability of the questionnaire. Results. The cross-classification values were higher than 46.2% among the German students and higher than 55.8% among the Slovakian students. The kappa coefficients ranged from 0.21 to 0.90 in the German students and from 0.38 to 0.94 in the Slovakian students. Cronbach’s ɑ ranged from 0.58 to 0.78. Conclusion. The questionnaire displayed a moderate to very good reproducibility, which was slightly higher in the Slovakian group than in the German group. Therefore, the questionnaire can be recommended for further analysis and comparison of the dietary habits among Germans and Slovakians on a larger scale.