有创无创序贯性机械通气治疗慢性阻塞性肺疾病致严重呼吸衰竭的临床分析

目的探讨有创无创序贯性机械通气治疗慢性阻塞性肺疾病致严重呼吸衰竭的临床疗效。方法 2013年10月至2015年5月期间,从我院随机选取68例慢性阻塞性肺疾病(COPD)致严重呼吸衰竭的患者作为研究对象,并随机分为对照组与研究组,每组各34例。对照组给予有创通气治疗,而研究组则给予有创无创序贯性机械通气治疗。比较两组的临床疗效。结果治疗后,研究组动脉血气指标(PaO_2、PaCO_2、SaO_2)改善程度均明显优于对照组,差异具有统计学意义(P<0.05)。研究组再插管率、住院时间、死亡率均显著小于对照组,差异具有统计学意义(P<0.05)。结论对慢性阻塞性肺疾病致严重呼吸衰竭患者实施有创无创序贯性机械通气治疗,可降低再插管率,缩短住院时间,减少死亡率,促进患者预后康复,值得推广。     

双水平无创正压通气进行序贯脱机治疗的研究

[目的]评价有创无创序贯通气治疗慢性阻塞性肺病(COPD)并重症呼吸衰竭的价值.[方法]采用临床试验收集COPD并重症呼吸衰竭的患者,行气管插管有创通气,当出现肺部感染控制(PIC)窗时,将患者随机分成两组,一组拔管实施BiPAP作为序贯通气组,另一组实施SIMV PSV作为常规通气组.观察两组脱机成功率、呼吸机相关性肺炎(VAP)发生率、再插管率、死亡率、有创通气时间、总通气时间及序贯通气组血气指标、心率、呼吸频率、血压的变化.[结果]序贯通气组VAP发生率、死亡率、有创通气时间、总通气时间少于常规通气组(P<0.05).脱机成功率高于常规通气组(P<0.05),再插管率与常规通气组比较差异无统计学意义(P0.05),序贯通气组pH、氧分压、二氧化碳分压、氧合指数、心率、呼吸频率、血压无明显变化(P0.05).[结论]BiPAP脱机优于SIMV PSV,对于COPD并重症呼吸衰竭患者是一种行之有效脱机方式.     

慢性阻塞性肺疾病合并呼吸衰竭患者无创机械通气的护理体会

目的:探讨对慢性阻塞性肺疾病(COPD)合并呼吸衰竭(ARF)患者使用无创机械通气治疗后的护理方法和体会.为慢性阻塞性肺疾病(COPD)合并呼吸衰竭(ARF)患者使用无创机械通气治疗后的护理提供科学的指导.方法:回顾性分析100例慢性阻塞性肺疾病(COPD)合并呼吸衰竭(ARF)患者的相关临床资料,使用无创机械通气治疗后进行综合性护理,观察患者的治疗效果.结果:在100例慢性阻塞性肺疾病(COPD)合并呼吸衰竭(ARF)患者中,经过治疗和护理有92例患者的临床症状和血常规检查得到明显改善,治疗结束后患者的PaO2含量(84.23±7.31)mmHg显著高于治疗前的(47.29±6.78)mmHg,治疗后的PaCO2含量(41.23±9.22)mmHg显著低于治疗前的(75.23±9.11)mmHg.结论:无创机械通气在治疗慢性阻塞性肺疾病合并呼吸衰竭的患者时有利于改善其呼吸状况,加之以正确的护理干预措施可以明显提高机械通气治疗的成功率,减少术后不良反应和并发症的发生.     

有创-无创序贯机械通气治疗ICU重症COPD合并呼吸衰竭疗效分析

目的:研究有创-无创序贯机械通气治疗ICU重症慢性阻塞性肺疾病合并呼吸衰竭的临床效果。方法:选择山东省荣成市人民医院ICU收治的慢性阻塞性肺疾病合并呼吸衰竭患者46例,采用数字单双号的模式分为对照组(持续有创通气治疗)与观察组(有创—无创序贯机械通气疗法),每组各23例。比较两组ICU住院时间、总通气时间、有创通气时间、脱机成功率、呼吸机相关性肺炎发生率。结果:观察组ICU住院时间、总通气时间、有创通气时间、脱机成功率、呼吸机相关性肺炎发生率均显著优于对照组。结论:针对慢性阻塞性肺疾病合并呼吸衰竭患者,采用有创-无创序贯机械通气方案的临床疗效显著,对患者预后具有重要的促进作用。     

慢性阻塞性肺疾病合并呼吸衰竭的机械通气治疗

目的 观察机械通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床疗效.方法 选择2010年8月--2012年8月在我院呼吸内科住院的42例COPD合并呼吸衰竭患者,随机分为观察组和对照组各21例.对照组患者给予常规治疗,观察组在常规治疗的基础上给予无创呼吸机辅助通气治疗,比较两组治疗效果.结果 治疗后,两组患者各项指标与治疗前相比,均有明显好转(P<0.05),且治疗组PH、PaO2及PaCO2改善均显著优于对照组,差异有统计学意义(P<0.05);观察组治疗有效率显著高于对照组,差异有统计学意义(P<0.05).结论 机械通气治疗慢性阻塞性肺疾病合并呼吸衰竭疗效显著,可有效改善患者临床症状和血气指标,值得在临床上应用和推广.     

有创与无创序贯性机械通气治疗COPD的体会

慢性阻塞性肺疾病(COPD)患者终末期常合并严重呼吸衰竭(呼衰),而机械通气是治疗呼衰的重要措施,其中有创机械通气使用较普遍,而有创机械通气治疗容易引起呼吸机相关性肺炎(VAP)、呼吸机相关肺损伤(VILI)及脱机困难。如处理不当,不仅延长患者的住院时间和增加费用。甚至容易产生许多严重并发症导致最后死亡,无创机械通气用于COPD患者脱机过程,受到了越来越多的关注,我科于2003     

序贯机械通气在慢性阻塞性肺疾病危重呼吸衰竭患者中的应用价值

目的 探讨序贯机械通气在慢性阻塞性肺疾病(COPD)危重呼吸衰竭患者中的应用价值.方法 对32例COPD危重呼吸衰竭患者实施有创机械通气,当肺部感染基本控制时随机分为两组.对照组16例,继续行有创机械通气,以压力支持通气(PSV)方式逐渐至脱机;序贯组16例,改为面罩Bi-PAP无创正压通气后逐渐至脱机.两组同时进行监护,记录两组患者血气分析,比较两组呼吸机相关性肺炎(VAP)发生例数、死亡例数、机械通气时间及总住院时间.结果 与对照组比较,序贯组VAP发生率较对照组低(6.25%比56.25%),有创机械通气时间短[(137±38)h比(362±160)h,],差异有统计学意义(P＜0.01).两组病死率与总机械通气时间比较差异无统计学意义.结论 COPD危重呼吸衰竭患者,当肺部感染基本控制时,实施有创一无创序贯机械通气,可以降低VAP发生率,缩短有创机械通气时间,改善预后.     

经鼻气管插管机械通气在抢救慢性阻塞性肺疾病呼吸衰竭中的应用

目的探讨经鼻气管插管机械通气在抢救慢性阻塞性肺病呼吸衰竭中的应用。方法对重症慢性阻塞性肺疾病呼吸衰竭患者58例进行有创机械通气,其中经鼻插管33例,气管切开25例,以了解经鼻气管插管在抢救呼吸衰竭的优越性。结果经鼻插管33例,抢救成功31例,顺利脱机拔管,死亡2例,抢救成功率93．93％,气管切开25例,抢救成功22例,顺利脱机拔管,死亡3例,抢救成功率88％。结论经鼻气管插管相对痛苦小,可反复进行,适用于慢性阻塞性肺疾病呼吸衰竭反复发作者,另外根据结果显示经鼻气管插管组使用呼吸机时间及平均住院时间均短于气管切开组。     

探讨慢性阻塞性肺疾病并2型呼吸衰竭患者两种不同通气方式的临床效果

目的:对分析有创和无创机械通气对慢性阻塞性肺疾病合并2型呼吸衰竭患者的临床使用效果。方法:根据2010年1月至2015年10月我院的COPD合并2型呼吸衰竭老年患者80例来进行分析,分成轻度呼吸衰竭组和重度呼吸衰竭组,均有40例。两组都接受了抗感染、祛痰、解痉平喘等常规治疗。轻度组再分成两组,第一组使用无创呼吸机通气,第二组使用气管插管呼吸机通气。对比各组患者的呼吸通气指标。结果:轻度呼吸衰竭两组患者通气3、12、24、48 h后的各项指标均有所改善,前后结果存在统计学差异性(P0.05),组间结果无统计学差异性(P0.05)。中毒呼吸衰竭组患者有8例因病重转为有创通气,其余患者在通气3、12、24、48 h后各指标和之前有差异性(P0.05);重度呼吸衰竭患者的无创通气时间比有创通气时间长(P0.05),有创通气组的有效率比无创通气组高(P0.05)。结论:慢性阻塞性肺疾病合并2型呼吸衰竭患者,轻度呼吸衰竭可以使用无创机械通气,重度呼吸衰竭患者应该使用有创机械通气。     

无创正压通气治疗老年慢性阻塞性肺疾病合并重症呼吸衰竭临床应用

目的：评价在老年慢性阻塞性肺疾病合并重症呼吸衰竭患者的临床治疗中运用无创正压通气治疗的效果。方法：选取我院2014-2015年收治的慢性阻塞性肺疾病合并重症呼吸衰竭患者86例作为本次研究对象,对照组运用常规慢性阻塞性肺疾病治疗方法,观察组在对照组治疗的基础上实施无创正压通气治疗。比较两组治疗效果。结果：治疗后观察组患者的各项呼吸指标改善情况明显优于对照组并且呼吸功能恢复正常的时间短于对照组,差异有统计学意义（P<0.05)。结论：对老年慢性阻塞性肺疾病合并重症呼吸衰竭患者使用无创高压通气治疗能显著改善患者各项呼吸指标,缩短患者呼吸功能恢复正常的时间,临床治疗效果理想。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.