非霍奇金淋巴瘤患儿化疗期间并发水痘的护理

报道了9例非霍奇金淋巴瘤患儿在接受化疗期间并发水痘的护理体会,介绍了处于化疗抑制期患儿感染水痘的临床特点、诊治及转归。在护理上给予隔离,预防交叉感染,密切观察病情,实施心理护理、皮肤黏膜护理、发热护理。经过及时的治疗和精心护理,有效地预防了交叉感染,促进了疱疹愈合,缩短了病程,减轻了患儿痛苦,无继发感染及水痘相关并发症发生,为原发肿瘤的进一步治疗创造了条件。     

非霍奇金淋巴瘤患儿化疗期间并发水痘的护理

报道了9例非霍奇金淋巴瘤患儿在接受化疗期间并发水痘的护理体会,介绍了处于化疗抑制期患儿感染水痘的临床特点、诊治及转归。在护理上给予隔离,预防交叉感染,密切观察病情,实施心理护理、皮肤黏膜护理、发热护理。经过及时的治疗和精心护理,有效地预防了交叉感染,促进了疱疹愈合,缩短了病程,减轻了患儿痛苦,无继发感染及水痘相关并发症发生,为原发肿瘤的进一步治疗创造了条件。     

美罗华治疗非霍奇金淋巴瘤的护理

通过对10例用美罗华治疗非霍奇金淋巴瘤患的护理，总结了此类治疗护理的3个要点：重视用药前的心理护理；熟悉药物的配制方法和滴注要求；用药过程中要密切观察药物的不良反应。     

非霍奇金淋巴瘤患者护理方法探讨

近年来,淋巴瘤的发病率越来越高,尤其是非霍奇金淋巴瘤（non-Hodgkin＇s lymphoma,NHL）侵袭性强,化疗是最常用的方法之一,但是化疗药物在抑制或杀伤肿瘤细胞的同时,也给患者机体带来了较大的不良反应,患者难以承受而中断治疗,而化疗过程中的护理可明显减轻患者的病痛及心理负担,增加化疗依从性,提高其生存质量。     

非霍奇金淋巴瘤化疗护理的体会

非霍奇金淋巴瘤(non hodgin lymphoma,NHL)在临床治疗中首选化学药物治疗,也是国际上公认的标准性经典方案。1998年1月至2003年12月,本院采用CHOP方案,为环磷酰胺、阿霉素、强的松和长春新碱等组成,对43例NHL患者进行治疗,获得较好疗效,现报告如下。     

原发性心脏非霍奇金淋巴瘤1例的护理

总结1例原发性心脏非霍奇金淋巴瘤患者的护理体会。护理重点为严密心电监护,监测血电解质,关注血压和体温变化,做好化疗药物使用的护理,警惕骨髓抑制期感染、发热等的发生,患者出院后定期随访。经过8个疗程的化疗,患者右心房内的肿块完全消失,胸闷、气促症状消失,切口愈合,生活自理。     

非霍奇金淋巴瘤并发新型隐球菌脑膜炎一例

非霍奇金淋巴瘤并发新型隐球菌脑膜炎一例王景霞张力哈桂珍王凤菊张鸿博患者，女，３８岁。因反复发热２个月，体温常达３９℃，体重下降１５ｋｇ，曾用多种抗生素治疗无效，于１９９６年３月２１日入院。查体：体温３８．８℃，皮肤、粘膜无苍白及皮疹；左颈部扪及６枚花...     

美罗华治疗B细胞性非霍奇金淋巴瘤的观察及护理

近年来,单克隆抗体治疗恶性淋巴瘤取得很大进展,利妥昔单抗注射液是一种人鼠嵌合型的抗CD20抗体,是目前世界上治疗B细胞性非霍奇金淋巴瘤的第一种单克隆抗体。美罗华与B细胞表面CD20抗原结合,通过补体依赖性细胞毒性、抗体依赖性的细胞毒性作用达到使B淋巴细胞被清除的目的。CHOP方案不能有效清除NHL的微小残留病灶。R—CHOP能提高疗效而不增加毒性。我科2007年7月～2009年7月应用R—CHOP方案治疗NHL15例61次。现将观察及护理总结如下。     

非霍奇金淋巴瘤并发黑热病1例

患者,男,29岁,石油工作者,居住于甘肃敦煌地区,曾到四川等地旅游居住.患者最初于2006年4月25日劳累后出现午后发热,胸部X线示双肺纹理增多,超声示肝脾肿大,血常规白细胞(WBC)2.5×109/L;生化检查:丙氨酸转氨酶(ALT)421 U/L,天冬氨酸转氨酶(AST)365 U/L,碱性磷酸酶(ALP)716 U/L,γ-谷氨酰转移酶(γ-GT)439 U/L,乳酸脱氢酶(LDH)608 U/L;骨穿示增生性骨髓象.     

双腋下非霍奇金淋巴瘤1例

1病历摘要女,45岁。2004-09-07乳腺健康普查:双乳发育正常,右乳中上可触及3 cm×3 cm的结节样增厚,左乳外上可触及片状增厚,可触及双腋下多个肿大的淋巴结,中等硬度,活动度小无压痛,其他浅表淋巴结未触及。建议乳腺钼靶X线检查2004-09-27进行乳腺钼靶拍片,X线片显示:双腋下淋巴结肿大(多发)。其淋巴结多个增大,边界清楚,密度增高且较均匀,直径1.2~1.5 cm,淋巴门消失,未发现乳腺异常。建议进一步检查,取活体组织检查或相关其他检查、胸片和CT等。随后患者取走钼靶片,先后到两家三甲医院就诊,均告之未发现肿瘤,腋下淋巴结肿大诊断为:单纯反…     

Percutaneous needle cricothyroidotomy with repetitive airway obstruction

To develop a technique for needle cricothyrotomy that mimics the normal respiratory cycle (using repetitive obstruction of the upper airway and relatively low flow oxygen through small catheters), a controlled trial in three anesthestized dogs was performed. Oxygen from a standard bottle and pressure reducer was delivered through the cricothyroid membrane at 0.36 L/kg/min, which is metabolically equivalent to 0.2 L/kg/min in an adult human. The upper airway was obstructed until the chest rose and then was unobstructed to allow exhalation. The animals were ventilated for 5 minutes to allow equilibration. Arterial Pco₂ was measured after 2-minute periods of apnea and 3 minutes of ventilation, each repeated four times. The procedure was repeated in three other dogs at a flow of 0.18 L/kg/min to simulate a 50% air leak. Cricothyroid ventilation at 0.36 L/kg/min lowered the Pco₂ from 65 mm Hg to 43 mm Hg, F = 258, P = .004. All Pco₂s after 25 minutes were in the normal range. Ventilation at 0.18 L/kg/min stabilized the Pco₂ at approximately 1.5 times normal (67 mm Hg versus 79 mm Hg for the preceding apnea, F = 77, P = .013). Flow rates achievable with 18- to 20-gauge catheters and standard oxygen sources are adequate for cricothyroid ventilation when the airway is repetitively obstructed to allow a normal respiratory cycle.     

1例前纵隔淋巴瘤并发严重气道梗阻患儿的护理

总结1例前纵隔淋巴瘤并发严重气道梗阻患儿的抢救和护理体会。包括严密的观察和监测患儿病情,心肺复苏下迅速有效应用体外膜肺氧合进行救治;在体外膜肺运行期间密切观察患儿生命体征,动态评估气道梗阻症状,加强气道管理和监测。经过精心的治疗和护理,体外膜肺机运行70.5 h后成功撤离,患儿于入科第7天病情恢复平稳,转至血液科继续进行专科治疗。     

丙种球蛋白不敏感川崎病合并不完全肠梗阻1例护理

总结1例丙种球蛋白不敏感川崎病合并不完全肠梗阻护理。护理要点:早期识别丙种球蛋白不敏感川崎病;病情监测;高热护理;药物护理;皮肤黏膜护理;胃肠道护理;家属及患者心理护理;出院康复指导。     

RapidRhino herniation causing airway obstruction

Epistaxis is commonly managed with RapidRhino in emergency departments. We report a case of RapidRhino herniation during air inflation in a 99-year-old female, leading to significant airway obstruction. Upon re-inflation of the RapidRhino for persistent epistaxis, our patient suddenly developed acute respiratory distress. Throat examination revealed a large clot-like circular mass occluding the oropharynx. Initially mistaken as a massive blood clot, the mass was identified as the distal end of the RapidRhino. Immediate deflation of the RapidRhino results in spontaneous resolution of the respiratory distress. We hypothesise that the RapidRhino has herniated posteriorly into the oropharynx through excessive air inflation, potentially compounded by a product defect. Our case highlights a fatal consequence of RapidRhino application where emergency physicians should be cautious of, especially among inexperienced users.     

Emergency percutaneous tracheostomy in a severely burned patient with upper airway obstruction and circulatory arrest

We report the life-saving use of Griggs percutaneous tracheostomy in an arrested patient with complex upper airway obstruction, as a result of burns, smoke injuries and iterative tracheal intubation attempts. The technique was performed blindly at bedside to treat an acute episode of failed ventilation and intubation and cardiac arrest in a patient with altered neck anatomy. The intervention salvaged the situation, leaving a definitive airway. The feasibility of using an emergency Griggs percutaneous tracheostomy versus cricothyroidotomy is suggested in selected cases.     

中老年气道阻塞患者吸气曲线特征分析

目的:了解国内中老年气道阻塞患者的吸气曲线特征.方法:对120例中老年气道阻塞患者及41例中老年健康志愿者测试并分析其吸气流量曲线特征.结果:所有受试者均能达到30 L/min的吸气峰流量,且其早期吸气流速也均能达到30 L/min.有效吸气容积方面,大部分受试者都很难达到4 L的有效吸气容积.各指标中,敏感度最高的为吸气流量在30 L/min以上时的吸气曲线下面积,特异度最高的为吸入20%用力吸气容积时的吸气流量(IF20%FIVC)及吸气流量峰值,阳性似然比最高的为IF20%FIVC.采用多元逐步回归和主成分分析法建立了预计吸气能力的回归方程.结论:4 L有效吸气容积这一指标并不适用于国人,IF20%FIVC是一反映早期吸气流速的诊断价值较好的指标.     

Continuous positive airway pressure titration in infants with severe upper airway obstruction or bronchopulmonary dysplasia

Abstracta

Introduction

Noninvasive continuous positive airway pressure (CPAP) is recognized as an effective treatment for severe airway obstruction in young children. The aim of the present study was to compare a clinical setting with a physiological setting of noninvasive CPAP in infants with nocturnal alveolar hypoventilation due to severe upper airway obstruction (UAO) or bronchopulmonary dysplasia (BPD).

Methods

The breathing pattern and respiratory muscle output of all consecutive infants due to start CPAP in our noninvasive ventilation unit were retrospectively analysed. CPAP set on clinical noninvasive parameters (clinical CPAP) was compared to CPAP set on the normalization or the maximal reduction of the oesophageal pressure (Poes) and transdiaphragmatic pressure (Pdi) swings (physiological CPAP). Expiratory gastric pressure (Pgas) swing was measured.

Results

The data of 12 infants (mean age 10 ± 8 mo) with UAO (n = 7) or BPD (n = 5) were gathered. The mean clinical CPAP (8 ± 2 cmH₂O) was associated with a significant decrease in Poes and Pdi swings. Indeed, Poes swing decreased from 31 ± 15 cmH₂O during spontaneous breathing to 21 ± 10 cmH₂O during CPAP (P < 0.05). The mean physiological CPAP level was 2 ± 2 cmH₂O higher than the mean clinical CPAP level and was associated with a significantly greater improvement in all indices of respiratory effort (Poes swing 11 ± 5 cm H₂O; P < 0.05 compared to clinical CPAP). Expiratory abdominal activity was present during the clinical CPAP and decreased during physiological CPAP.

Conclusions

A physiological setting of noninvasive CPAP, based on the recording of Poes and Pgas, is superior to a clinical setting, based on clinical noninvasive parameters. Expiratory abdominal activity was present during spontaneous breathing and decreased in the physiological CPAP setting.     

钬激光治疗大气道内新生物的疗效观察与护理

目的 评价支气管镜下应用钬激光技术治疗大气道腔内新生物导致气道阻塞的疗效与护理方法.方法 选择气管、主支气管腔内新生物(良、恶性肿瘤)占位阻塞大气道导致呼吸困难的患者13例,在软质支气管镜下,应用钬激光对病变进行切除,术前做好充分的沟通和准备,术中密切观察与配合,术后细心护理,预防并发症发生.结果 经钬激光治疗后大气道...     

上腔静脉阻塞综合征的护理

目的探讨上腔静脉阻塞综合征的护理方法。方法对20例恶性肿瘤并发上腔静脉阻塞综合征的护理过程进行回顾性分析,总结上腔静脉阻塞综合征的观察要点及护理方法。结果经过积极治疗和系统护理后,16例症状缓解,4例未见缓解。结论对易并发上腔静脉阻塞综合征的肿瘤患者要严密观察病情,及早发现阻塞症状并积极处理,既可缓解症状,又可延长无复发生存期。