一次性输液加温器在加温氧疗中的应用

氧气吸入时湿化剂的温度会随着氧疗时间的延长而逐渐下降,而长时间地吸入湿化的冷氧气,易刺激患者气道,使其痉挛,痰液黏稠,甚至形成痰栓阻塞气道加重呼吸困难。为使长时间吸氧的患者能吸入温度适宜的氧气,以提高治疗效果,减少并发症,我们将一次性输液加温器用于氧疗时加温,并探讨在不同氧流量下,将加温器放置在输氧管不同的位置时,吸     

湿化高流量鼻导管氧疗在无痛消化内镜诊疗中的应用

目的 探讨湿化高流量鼻导管氧疗（HHFNC）用于无痛消化内镜诊疗的临床效果和安全性。方法 择期行无痛消化内镜诊疗的患者200例,男111例,女89例,年龄18~80岁,BMI 18~30 kg/m²,ASA Ⅰ—Ⅲ级,根据随机数字表将患者分为两组：普通鼻导管氧疗组（C组）和HHFNC组（H组）。C组通过鼻导管吸入氧气5 L/min。H组通过HHFNC系统（PT101AZ）吸入空氧混合气体50 L/min,FiO₂ 40％。记录术中最低SpO₂、经皮二氧化碳分压（PtcCO₂）、无创呼吸支持;丙泊酚用量、内镜时间和呼之睁眼时间;低氧血症、高血压、低血压、心动过速、心动过缓、恶心呕吐等不良反应情况。结果 与C组比较,H组术中最低SpO₂明显升高（P<0.05）,无创呼吸支持明显减少（P<0.05）,低氧血症发生率明显降低（P<0.05）,心动过缓发生率明显升高（P<0.05）。两组PtcCO₂、丙泊酚用量、内镜时间、呼之睁眼时间、高血压、低血压、心动过速、恶心呕吐差异均无统计学意义。结论 HHFNC用于无痛消化内镜可改善氧合和降低气道干预需求。     

高流量氧疗湿化对干燥综合征继发肺纤维化患者的护理研究

目的：探讨高流量湿化氧疗治疗干燥综合征继发肺间质纤维化的临床临护理措施。方法：回顾性分析我院自 2010年 5 月—2017 年 12 月期间收治的 39 例干燥综合征继发肺间质纤维化患者。其中 2010 年 5 月—2015 年 9 月期间收治的 20例患者给予常规呼吸疾病综合治疗护理设为对照组 20 例。2015 年 10 月—2017 年 12 月期间收治的 19 例患者在常规呼吸疾病综合治疗护理基础上予高流量湿化氧疗护理治疗设为观察组 19 例。回顾性分析两组患者在治疗开始前、开始后 24 h、48 h 呼吸频率、动脉血气分析及痰液黏稠度的改善情况。结果：两组患者年龄、性别、病程等一般情况比较无统计学差异（P>0.05）。两组在治疗开始前呼吸频率、动脉血气分析结果比较差异无统计学意义（P>0.05）；两组在治疗开始后 24 h呼吸频率、pH、PaCO2 无统计学差异（P>0.05），比较 PaO2（86.33±7.23），（90.43±7.56）有统计学差异（P<0.05）。两组在治疗开始后 48 h 呼吸频率比较差异无统计学意义（P>0.05），比较 pH、PaO2、PaCO2 差异有统计学意义（P<0.05）。两组患者组内比较对照组治疗开始前、开始后 24 h、48 h 呼吸频率、pH、PaCO2、PaO2 比较有统计学差异（P<0.05）；观察组治疗开始前、开始后 24 h、48 h 呼吸频率、pH、PaCO2、PaO2 比较有统计学差异（P<0.01）。两组患者在治疗开始前组间比较痰液黏稠度无差异统计学意义（P>0.05），24 h、48 h 后组间比较痰液黏稠度差异有统计学意义（P<0.01）。结论：高流量湿化氧疗结合呼吸道治疗干燥综合征继发肺间质纤维化的患者，疗效肯定，安全可靠，值得推广应用。     

无湿化中低流量吸氧在呼吸系统疾病患者中的应用研究

目的探讨无湿化与湿化两种吸氧模式在呼吸系统疾病患者中的应用效果。方法选取2017年4～9月住院的呼吸系统疾病患者400例,按入住病室分为两组各200例。对照组采用常规湿化中低流量吸氧,观察组采用无湿化中低流量吸氧。比较两组不同吸氧时间的舒适度、湿化瓶细菌污染情况、睡眠质量以及执行两种吸氧模式的操作耗费时间等。结果两组患者不同时间点吸氧舒适度比较差异无统计学意义(均P 0. 05)。两组患者湿化瓶细菌污染率比较:吸氧24 h时差异无统计学意义(P 0. 05),吸氧48 h和72 h时对照组湿化瓶细菌检出阳性率显著高于观察组(P 0. 05,P 0. 01)。观察组患者睡眠质量显著优于对照组(P 0. 01);护士执行无湿化吸氧的操作时间比执行湿化吸氧的操作时间显著缩短(P 0. 01)。结论呼吸系统疾病患者实施无湿化中低流量吸氧可减少湿化瓶细菌污染率,提高患者的睡眠质量,缩短护士的操作时间,且不增加患者呼吸道不适感。     

不同流量经鼻高流量湿化氧疗对术后低氧血症患者的疗效分析

目的研究经鼻高流量湿化氧疗(high-flow nasal cannula oxygen therapy, HFNC)不同流量对术后低氧血症患者的临床疗效。方法选取2019年12月至2022年6月海军军医大学第一附属医院重症医学科收治的40例应用HFNC的术后低氧血症患者。采用自身前后对照研究方法, 患者接受普通鼻导管氧疗1 h后, 依次进行吸入流量分别为30、45、60 L/min的HFNC各1 h。记录4个氧疗阶段患者的心率、SpO2、呼吸频率、SBP、MAP, 记录4个阶段结束即刻患者血气分析指标(PaO2、PaCO2、pH)、氧合指数(oxygenation index, OI)、舒适度、耐受度。结果与普通鼻导管氧疗比较, 30、45、60 L/min HFNC时患者PaO2、OI升高(P<0.05), 45、60 L/min HFNC时患者呼吸频率降低(P<0.05)、SpO2升高(P<0.05), 60 L/min HFNC时患者舒适度、耐受度降低(P<0.05)。与30 L/min HFNC比较, 45、60 L/min HFNC时患者PaO2、O...     

ICU气管插管拔除后经鼻导管湿化高流量吸氧患者的护理

目的探讨ICU气管插管拔除后经鼻导管湿化高流量吸氧患者的护理方法及效果。方法选取2017-01—2018-06间在安钢总医院ICU气管插管已拔除的52例患者,均行经鼻导管湿化高流量吸氧。总结护理方法和效果。结果 52例患者中除1例因呼吸困难进行性加重再次气管插管行机械通气外,其余患者脱机拔管后1、8、24 h的呼吸频率、氧合指数及二氧化碳分压指数均维持在合理范围内。患者气道组织湿化程度为(2.19±0.19)分,舒适度评分为(1.68±0.28)分,耐受程度评分为(1.19±0.17)分。结论对ICU气管插管拔除后经鼻导管湿化高流量吸氧患者做好相关护理,可有效维持合理的呼吸频率、氧合指数及二氧化碳分压指数,提高患者的气道组织湿化水平、舒适度以及耐受程度,降低脱机拔管后再插管的风险。     

供氧加温湿化联合沐舒坦雾化对COPD急性发作期患者氧疗效果的影响

目的 探讨供氧加温湿化联合沐舒坦雾化治疗慢性阻塞性肺疾病(COPD)急性发作期患者的氧疗效果.方法 将84例COPD急性发作期患者按随机数字表法分为观察组(44例)和对照组(40例).观察组采用多功能氧气湿化器对氧气加温湿化,同时采用氧气驱动式雾化吸入沐舒坦(每天3次);对照组用传统的浮标式氧气吸入器持续吸氧.观察两组患者心率、呼吸、血气分析结果、痰液黏稠度、气喘缓解时间和痰鸣音消失时间.结果 观察组动脉血氧分压显著提高,心率、呼吸和二氧化碳分压显著降低(均P＜0.05);气喘缓解时间、痰鸣音消失时间显著短于对照组,痰液黏稠度显著优于对照组(均P＜0.01).结论 供氧加温湿化联合沐舒坦雾化可提高COPD急性发作期患者的氧疗效果,且患者感觉舒适,痰液稀释容易排出,不易发生刺激性呛咳反应,患者易接受.     

供氧加温湿化联合沐舒坦雾化对COPD急性发作期患者氧疗效果的影响

目的探讨供氧加温湿化联合沐舒坦雾化治疗慢性阻塞性肺疾病（COPD）急性发作期患者的氧疗效果。方法将84例COPD急性发作期患者按随机数字表法分为观察组（44例）和对照组（40例）。观察组采用多功能氧气湿化器对氧气加温湿化,同时采用氧气驱动式雾化吸入沐舒坦（每天3次）;对照组用传统的浮标式氧气吸入器持续吸氧。观察两组患者心率、呼吸、血气分析结果、痰液黏稠度、气喘缓解时间和痰鸣音消失时间。结果观察组动脉血氧分压显著提高,心率、呼吸和二氧化碳分压显著降低（均P＜0．05）;气喘缓解时间、痰鸣音消失时间显著短于对照组,痰液黏稠度显著优于对照组（均P＜O．01）。结论供氧加温湿化联合沐舒坦雾化可提高COPD急性发作期患者的氧疗效果,且患者感觉舒适,痰液稀释容易排出,不易发生刺激性呛咳反应,患者易接受。     

高流量湿化氧疗的临床应用研究进展

高流量湿化氧疗(humidified high flow nasal cannula, HFNC)在临床中的应用越来越广泛, 因其具有最大流量可达80 L/min、氧气加湿、加热度高达100%等特点, 可以更好地挽救患者生命;但存在临床适应证把握不当造成气管插管延迟、延误治疗的情况。文章从HFNC生理学效应出发, 对近几年来HFNC在不同人群临床治疗及围手术期应用进展做进一步阐述, 以期为临床合理使用HFNC提供更多参考。     

加温器与可调节输液器持续气道恒温湿化氧疗在气管插管非机械通气中的应用

目的:探讨重症肺性脑病经口气管插管脱离呼吸机后应用加温器与可调节输液器持续气道恒温湿化氧疗在人工气道的效果.方法:将行经口气管插管脱离呼吸机后56例患者随机分为加温器与可调节输液器持续恒温氧气湿化气道组28例(治疗组)和超声雾化器雾化组28例(对照组),观察两组患者湿化效果,耐受率,痰痂形成情况,气道黏膜出血,平均刺激性咳,窒息及气管堵塞情况.结果:治疗组湿化效果满意患者舒适度增加易于接受,、吸痰彻底,发生痰痂形成,气道黏膜出血,平均刺激性咳,例数比对照组明显减少,有显著性差异(P＜0.05)结论:持续恒温氧气湿化气道符合生理需要,使用加温器与可调节输液器持续气道恒温湿化氧疗优于超声雾化器雾化,并发症减少,湿化效果好,明显降低护理工作量.     

Effect of heated humidified gases on temperature drop after cardiopulmonary bypass

In an attempt to prevent the decrease in nasopharyngeal temperature (NPT) ("afterdrop") after cardiac surgery, 30 patients undergoing hypothermic cardiopulmonary bypass (CPB) were randomly assigned to receive humidified heated inspired gases at 45 degrees C at the proximal end of the endotracheal tube (group I) or dry gases at room temperature (group II), from the time of termination of CPB. All patients received high flow rates on CPB during the rewarming period with the use of vasodilator drugs when necessary. Both groups were comparable with respect to total bypass time, rewarming time, and temperature at termination of CPB. In addition, the NPT was compared with the tympanic membrane temperature (TMT) in group I to assess the validity of the NPT under these conditions. The results indicate that heating and humidifying inspired gases do not prevent afterdrop and do not falsely increase the nasopharyngeal temperature. The reasons for the ineffectiveness of heated humidified gases may include a large heat deficit at termination of CPB despite a normal NPT, and the very small heat content of heated gases. Monitoring the temperature of a site that reflects the heat deficit, and a more complete rewarming during CPB are suggested as a better approach to the prevention of afterdrop.     

Primary lung cancer surgery after curative chemoradiotherapy for esophageal cancer patients

The safety and perioperative problems of primary lung cancer surgery after curative chemoradiotherapy (CRT) for thoracic esophageal cancer (EC) are controversial. We retrospectively evaluated six patients who had received curative CRT for EC from 2003 to 2009, in whom the lung nodule was identified as a primary lung cancer and who subsequently underwent pulmonary resection. The treatment for EC consisted of chemotherapy with cisplatin and 5-fluorouracil with concurrent curative thoracic radiotherapy (60 Gy). The median age at the surgery was 75 years (range 69-80 years). The median time from radiation to pulmonary resection was 26 months (range 7-70 months). All patients had a predicted postoperative forced expiratory volume in 1 s (FEV(1))% of >40% before lung surgery. The surgical difficulty involves mediastinal lymph node dissection following tissue fibrotic changes after thoracic radiation. Postoperative complications occurred in two patients, and included arrhythmia and empyema. The patient who developed empyema had a massive pericardial effusion after CRT and underwent pericardial fenestration at the time of pulmonary resection. There was no operative mortality. Lung cancer surgery after curative CRT for EC is feasible in carefully evaluated and selected patients.     

Long-term survival after multimodality therapy including surgery for metastatic esophageal cancer

Background and objectives: Esophageal cancer (EC) remains an aggressive disease with a poor survival. Management of metastatic EC is limited to palliative chemotherapy (CT). Scientific contributions regarding the role of surgery are scarce and controversial. We analysed outcome of surgically treated metastatic EC patients.

Methods: We retrospectively identified surgically treated metastatic EC patients from our esophagectomy database. The aim of this study was to evaluate surgical complications, pathological response, oncological outcome and mean survival of these aggressively treated stage IV cancer patients.

Results: Twelve stage IV patients with disease presentation limited to outfield lymph node (LN) and/or liver metastasis were treated with an aggressive multimodality treatment including surgery. Mean age was 58 years (75% male, 75% Adenocarcinomas). Median postoperative hospital stay was 15 d. Radiological anastomotic leakage occurred in one patient. In hospital, mortality was nil. Complete resection was achieved in all but one. Metastatic recurrence occurred in 64% of R0 resected patients. At date of censoring, after a median follow-up of 22 months, 50% of the surgical resected patients are still alive and 33% are free of disease recurrence. Kaplan–Meier curves show a possibility to long-term survival after aggressive multimodality therapy including surgery.

Conclusions: In selected metastatic EC patients, multimodality treatment including surgery has an acceptable surgical outcome with a potentially long-term survival.     

食管癌根治术患者麻醉诱导后预置鼻咽通气道的效果

目的 评价鼻咽通气道用于食管癌手术患者麻醉苏醒期气道管理的效果。方法 将96例择期接受全身麻醉的食管癌根治术患者,随机分为研究组和对照组各48例。对照组转入PACU给予3 L/min面罩吸氧;研究组在麻醉诱导后置入鼻咽通气道,术毕转入PACU经鼻咽通气道给予3 L/min吸氧。观察并记录患者入手术室（T0）、入PACU时（T1）、拔除气管导管时（T2）、拔除气管导管后10 min （T3）、拔除气管导管后30 min （T4）、转出PACU时 （T5）脉搏氧饱和度,T0、T3、T5时患者动脉血气分析结果,PACU内患者躁动、恶心呕吐和喉痉挛等并发症。结果 两组血氧饱和度、氧分压和二氧化碳分压组间效应、时间效应、交互效应显著（均P＜0.05）,研究组T3、T4、T5血氧饱和度显著高于对照组,T3、T5的氧分压显著高于对照组,二氧化碳分压显著低于对照组(均P<0.05)。结论 食管癌根治术患者预置鼻咽通气道能降低麻醉恢复期低氧血症发生率,改善患者上呼吸道通气效果。     

食管癌术后肠内营养患者胃潴留的影响因素分析

目的探讨食管癌术后肠内营养患者胃潴留的影响因素。方法观察165例食管癌术后肠内营养患者胃潴留的发生情况,分析其影响因素。结果胃潴留发生率22.42%,高血糖、低血压、低血钾、便秘、肺部感染为其影响因素(均P0.01)。结论食管癌术后肠内营养的患者发生胃潴留与多重因素相关,尤其是伴高血糖、低血压、低血钾、便秘、肺部感染患者,需采取措施积极处理,预防胃潴留的发生。     

Prospective, case-matched study of heated and humidified carbon dioxide insufflation in laparoscopic colorectal surgery

PURPOSE: Laparoscopic colorectal surgery is often prolonged and may cause hypothermia. It is uncertain if heated and humidified carbon dioxide (CO(2)) in laparoscopic colorectal surgery is beneficial. This is a prospective case-matched study on the use of heated and humidified CO(2) in patients undergoing laparoscopic colorectal surgery. METHOD: Twenty consecutive patients undergoing laparoscopic colorectal surgery with heated (36 degrees C) and humidified (95%) CO(2) were compared with 20 consecutive patients using standard CO(2) (30.2 degrees C). All procedures were performed by a single surgeon in an institution. The changes in core temperature during surgery, visual quality of images and the short-term clinical outcome were documented. RESULTS: The core temperature fell during surgery in both groups. Although the fall of core temperature was more in the control group, it was not statistically significant (P > 0.05). The passage of flatus was more delayed in heated and humidified group (P = 0.004), but it did not affect the hospital discharge. All the other parameters, including the quality of visual images and the postoperative pain, were similar in both groups. CONCLUSIONS: Despite better temperature maintenance (nonsignificant), pneumoperitoneum using heated and humidified CO(2) gas did not appear to have any clinical benefits in laparoscopic colorectal surgery.     

全息刮痧疗法对胃癌术后患者早期肠内营养耐受性的影响

目的 探讨全息刮痧疗法对胃癌术后患者早期肠内营养耐受性的影响.方法 将胃癌根治术后行肠内营养患者100例按随机数字表法分为观察组和对照组各50例.对照组按常规行肠内营养护理,观察组在肠内营养常规护理基础上,于每日首次输注肠内营养前30 min实施全息刮痧疗法.比较两组肠内营养耐受性评分、肠内营养输注达目标量时间和首次肛...