两种吸痰方式对颈髓损伤患者呼吸循环参数对比分析研究

[目的]探讨两种不同吸痰方式对颈髓损伤患者吸痰时心率、血压、呼吸频率、血氧饱和度、气道洁净度、吸痰间隔时间等指标的影响,并进行对比分析研究,以选取吸痰效果好,对患者生理指标影响小的吸痰方法.[方法]将54例颈椎损伤并气管切开患者随机分为两组,分别依据医疗护理技术操作常规[1-2],采用自下慢慢上提方法,和依据颈髓损伤后呼吸改变[3]而研究改革的自上而下吸引的两种不同吸痰方式进行吸痰,并对患者心率、血压、呼吸频率、血氧饱和度、气道洁净度、吸痰间隔时间等指标进行对照研究.[结果]改革后的吸痰方式对颈髓损伤患者生理指标影响小,每次吸后气道的洁净度好,且吸痰间隔时间长,两种方法比较,差异有统计学意义(P＜0.05).[结论]在颈髓损伤这个特定的患者群中采用研究改革的自上而下吸引的吸痰方式进行吸痰明显优于常规方法.     

手足口病机械通气患儿密闭式浅层吸痰效果观察

目的探讨密闭式浅层吸痰在手足口病机械通气患儿中的应用效果。方法将62例手足口病机械通气患儿采用随机数字表法分为对照组和观察组各31例。对照组采用传统开放式吸痰,观察组采用密闭式吸痰管结合浅层吸痰。比较两组吸痰前后心率、血氧饱和度、平均气道压及血氧饱和度上升时间、日吸痰次数、吸痰间隔时间、并发症发生情况。结果两组吸痰后心率、血氧饱和度、平均气道压比较,差异有统计学意义(均P0.01);观察组血氧饱和度上升时间较对照组短,烦躁、呛咳、黏膜损伤发生率较对照组低(均P0.01)。结论密闭式浅层吸痰用于手足口病机械通气患儿,可维持机械通气的持续性,保持较稳定的气道压力,降低机体的应激反应。     

胸壁挤压吸痰法用于感染性多发性神经根炎患儿效果观察

目的探讨胸壁挤压法在感染性多发性神经根炎气管切开并机械通气患儿排痰中的应用及效果。方法将49例感染性多发性神经根炎需气管切开并机械通气的患儿，按住院先后单号分为干预组（25例），双号分为对照组（24例），两组接受相同的常规治疗，均雾化吸入氟霉松和肝素钠，均于体位引流后吸痰，吸痰前后大流量吸氧3～5min。干预组在此基础上吸痰前予以胸壁挤压。结果干预组患儿排痰后的血氧饱和度上升幅度、肺部听诊结果，并发症及刺激性咳嗽发生率与对照组比较，差异有统计学意义（P〈0．05，P〈0．01）。结论胸壁挤压吸痰法用于感染性多发性神经根炎机械通气患儿，可提高吸痰效果。     

黏膜麻醉用于颈髓损伤患者吸痰效果探讨

目的提高颈髓损伤患者吸痰效果和舒适性。方法将68例颈髓损伤后发生呼吸道痰液潴留患者按入院顺序分为干预组和对照组各34例,对照组使用传统方法吸痰,干预组采用2%利多卡因行黏膜麻醉后吸痰。结果吸痰后干预组血氧饱和度显著高于对照组(P<0.01),黏膜损伤发生率、呼吸道并发症发生率显著低于对照组(均P<0.05)。结论黏膜麻醉吸痰法用于颈髓损伤吸痰可提高吸痰效果和患者舒适性。     

支气管镜吸痰灌洗治疗颈脊髓损伤并发呼吸道梗阻

目的讨论纤维支气管镜吸痰灌洗对颈脊髓损伤患者合并呼吸道梗阻的疗效。方法对28例（32例次）颈脊髓损伤合并呼吸道梗阻患者使用纤维支气管镜吸痰和灌洗治疗。结果所有患者于治疗后呼吸困难均有明显改善,监测血氧饱和度（SaO2）及动脉血氧分压（PaO2）明显回升,术后根据痰培养药敏试验结果予以抗生素治疗,痰量明显减少,肺部感染控制满意。结论对颈脊髓损伤合并呼吸道梗阻的患者行纤维支气管镜吸痰及灌洗术,指导抗生素的选择应用,有较明显的治疗效果,且安全、便捷,为解决颈脊髓损伤患者并发的呼吸道问题提供了一个较好的治疗方法。     

低负压间断吸痰减轻患儿呼吸道黏膜损伤

目的探讨低负压间断吸痰对减少患儿呼吸道黏膜机械性损伤的效果。方法将100例需吸痰的患儿随机分为对照组和实验组各50例。对照组采用常规方法吸痰;实验组采用低负压间断吸痰法,即开始吸痰的负压根据患儿年龄及痰液黏稠度设置为13.3～20.0kPa,吸患儿呼吸道深部痰液时调低负压,吸痰过程中听患儿痰鸣音判断吸痰效果及更换导管时间断吸痰。结果实验组吸痰过程中血氧饱和度较对照组稳定,出血发生率显著降低,家长满意度显著提高(P0.05,P0.01)。结论低负压间断吸痰可维持较好的血氧饱和度,减少对呼吸道黏膜的机械性损伤。     

低负压间断吸痰减轻患儿呼吸道黏膜损伤

目的探讨低负压间断吸痰对减少惠儿呼吸道黏膜机械性损伤的效果。方法将100例需吸痰的患儿随机分为对照组和实验组各50例。对照组采用常规方法吸痰;实验组采用低负压间断吸痰法,即开始吸痰的负压根据患儿年龄及痰液黏稠度设置为13．3～20．0kPa,吸患儿呼吸道深部痰液时调低负压,吸痰过程中听患儿痰鸣音判断吸痰效果及更换导管时间断吸痰。结果实验组吸痰过程中血氧饱和度较对照组稳定,出血发生率显著降低,家长满意度显著提高（P〈0．05,P〈0．01）。结论低负压间断吸痰可维持较好的血氧饱和度,减少对呼吸道黏膜的机械性损伤。     

胸壁挤压吸痰法用于感染性多发性神经根炎患儿效果观察

目的 探讨胸壁挤压法在感染性多发性神经根炎气管切开并机械通气患儿排痰中的应用及效果.方法 将49例感染性多发性神经根炎需气管切开并机械通气的患儿,按住院先后单号分为干预组(25例),双号分为对照组(24例),两组接受相同的常规治疗,均雾化吸入氟霉松和肝素钠,均于体位引流后吸痰,吸痰前后大流量吸氧3～5 min.干预组在此基础上吸痰前予以胸壁挤压.结果 干预组患儿排痰后的血氧饱和度上升幅度、肺部听诊结果,并发症及刺激性咳嗽发生率与对照组比较,差异有统计学意义(P<0.05,P<0.01).结论 胸壁挤压吸痰法用于感染性多发性神经根炎机械通气患儿,可提高吸痰效果.     

气管内吸痰对血氧饱和度的影响

气管内吸痰对血氧饱和度的影响张琪霞，黄惠群选择术前脉搏血氧饱和度（ＳｐＯ２）≥９５％的气管插管全麻成年病人２０例。在术毕后，待自主呼吸频率、潮气量均恢复正常，吸入空气１０ｍｈ，使ＳｐＯ２恢复至麻醉前水平，用相当于气管导管内径的吸引管吸痰。吸引负压２０...     

机械通气患者密闭式吸痰前预充氧必要性分析

目的 探讨机械通气患者在密闭式吸痰前是否需要常规给予预充氧。方法 选择27例患者，对每例患者密闭式吸痰前行吸氧（吸氧组）和不吸氧（不吸氧组）自身对照，分别记录患者吸痰前、吸痰后、吸痰后１ min时SpO2、心率和平均动脉压。结果 不同时间两组SpO2、心率、平均动脉压比较，干预效应均P>0.05，时间效应P<0.05、P<0.01；SpO2的交互效应P<0.05，心率、平均动脉压的交互效应均P>0.05。结论 对于SpO2正常患者，密闭式吸痰前不建议常规给予预充氧，吸痰过程需要密切观察患者生理指标变化；吸痰时，对于如心功能不全、气道畸形、支气管哮喘等血氧饱和度有可能显著下降的患者，仍建议密闭式吸痰操作前给予预充氧，以提高氧储备，确保患者安全。     

The influence of upper respiratory tract surgery on respiratory function evaluated by oxygen saturation

To evaluate the influence of upper respiratory tract surgery on respiratory function, we used a pulse oximeter to measure the arterial oxygen saturation in 40 patients (ASA 1 or 2) during surgery under local anesthesia. The patients were divided into four groups: a control group of 10 patients who underwent surgery not involving the upper respiratory tract, and three upper respiratory tract surgery groups of 10 patients each underwent surgery on the nasal cavity alone (group 1), on the oral cavity alone (group 2), and on both the oral and nasal cavities (group 3). Groups 1 and 2 showed little desaturation compared to their baseline levels and the control group, while group 3 showed a mild desaturation even at the beginning of surgery and this gradually turned to a moderate or severe desaturation. This was due to both the extension of the surgical zone to the nasal and oral cavities and to ventilatory distress produced by massive bleeding and aspiration of secretions. Thus, the pulse oximeter is a useful monitor for upper respiratory tract surgery involving both general and local anesthesia. It allows the identification of hypoxia so that remedial therapy can be instituted.(Kinugawa H, Yahagi N, Amakata Y: The influence of upper respiratory tract surgery on respiratory function evaluated by oxygen saturation, J Anesth 5: 327–330, 1991)     

The OxyArm: a supplemental oxygen delivery device

Facemasks and nasal cannulae are used to provide supplemental oxygen to patients in the postoperative period after general anesthesia. These devices are associated with several patient complications, including aspiration, hypercarbia, and mechanical trauma. A new device, the OxyArm, is designed to eliminate these problems. It is an "open oxygen" system that does not require physical contact with the patient's face. In this clinical study we evaluated the OxyArm in the immediate postoperative period. Sixty patients received supplemental oxygen via the OxyArm for the first 8 min after tracheal extubation after general anesthesia. Oxygen saturation values were continuously recorded during 3 4-min time periods: 1) while breathing oxygen through an endotracheal tube before tracheal extubation, 2) while breathing oxygen delivered by the OxyArm at 4 L/min 4 min after tracheal extubation, and 3) while breathing oxygen delivered by the OxyArm at 2 L/min 8 min after tracheal extubation. There were no significant differences in oxygen saturation among the three time periods and no patient experienced an oxygen desaturation event less than 88%. Patients and clinicians praised the OxyArm for its comfort and ease of use, allowing nursing facial care without interrupting oxygen therapy. We conclude that the OxyArm delivers adequate levels of oxygen for most patients during the early postoperative period.     

Cardiovascular effects of nasotracheal intubation

Intubation time, arterial pressure, heart rate and arterial oxygen saturation during nasotracheal intubation effected with the Macintosh laryngoscope blade were compared with those during orotracheal intubation. The 60 patients studied received a standardised general anaesthetic and were randomly allocated to one of two groups immediately before tracheal intubation. The mean nasal intubation time (33.2 seconds) was significantly greater than mean oral intubation time (14.8 seconds). The mean arterial pressure changes in the nasal group were significantly greater and more prolonged than in the oral group. The mean heart rate in the nasal group was significantly lower than in the oral group during the first minute after intubation, after which heart rates were similar. There were no significant differences between the two groups with regard to arterial oxygen saturation levels at any stage.     

Spontaneous resolution of massive right-sided pneumothorax occurring during laparoscopic cholecystectomy

Pneumothorax is a rare but potentially serious complication that can occur during laparoscopic surgery. We describe a case of a spontaneous massive right-sided pneumothorax that occurred during laparoscopic cholecystectomy, presumably because of escape of intraperitoneal carbon dioxide under pressure into the pleural cavity through a congenital defect in the diaphragm. During the procedure, arterial oxygen saturation decreased and clinical examination revealed signs of a right-sided pneumothorax. This was confirmed on chest x-ray in the immediate postoperative period. Since the patient was clinically stable without any signs of respiratory distress, a conservative approach was adopted. The patient remained on close clinical observation and continuous monitoring of arterial hemoglobin oxygen saturation by pulse oximetry and repeat chest x-rays and had an uneventful recovery with complete resolution of the pneumothorax 3 hours after surgery and without the need for thoracic aspiration or tube thoracostomy.     

Initial management of massive oral bleeding after midfacial fracture

BACKGROUND: This article reviews initial outcomes of the treatment of massive oral bleeding after midfacial fracture. METHODS: Massive bleeding was defined according to the criteria of Buchanan and Holtmann. The incidence of patients who met these criteria, hematocrit, the type of fracture, time from injury to initial management, source of bleeding, duration of management, and treatment strategy were recorded. RESULTS: We identified massive bleeding in the maxillofacial region in 5 of 521 patients (0.96%). All patients demonstrated profuse bleeding from the nose, and no active source of bleeding was evident in the oral cavity. Bleeding was controlled by nasal packing and temporary reduction in all patients, none of whom required artery ligation or embolization. CONCLUSION: Massive oral bleeding associated with midfacial fractures is frequently derived from the nasal cavity and associated structures. Although the nose may be the cause of the bleeding, the sinuses, skull base, and nasopharynx may also have active bleeding that has cleared through the nasal cavity and nasopharynx into the oral cavity. Control of this massive nasal bleeding during the early stage can therefore improve morbidity associated with severe exsanguination.     

Pneumonia due to aspiration of povidone-iodine during anesthesia--a case report]

We report a case of pneumonia secondary to aspiration of povidone-iodine, which was used as an oral antiseptic. The patient was 17 y.o. female (body weight: 70 kg) who underwent a transsphenoidal resection of pituitary adenoma. Although she had a history of asthma during her childhood, no asthmatic attacks occurred for the past 10 yrs. After satisfactory anesthesia induction and tracheal intubation, 60 ml of 0.7% povidone-iodine solution was used to clean the oral cavity by a surgeon. Insufficient sealing by the cuff occurred after suturing the tube, which had made a needle hole in the cuff. Arterial oxygen saturation dropped to 90% and an increased resistance in the lungs was noted. The trachea was reintubated and she was transferred to the ICU. Her chest X-ray revealed signs of pneumonia and atelectasis in the right upper lobe. Mechanical ventilation with PEEP and periodical bronchial toilet were performed during her stay in the ICU for 42 hrs. A week was needed for the improvement of her X-ray findings. Although povidone-iodine is thought to be safe and affective antiseptics, severe complications from its aspiration may occur in patients whose airways are sensitive as observed in this case.     

EFFECTS OF SEDATION PRODUCED BY THIOPENTONE ON RESPONSES TO NASAL OCCLUSION IN FEMALE ADULTS

To test the hypothesis that full wakefulness is an importantfactor in the control of the route of breathing in adult humans,we have studied the responses to nasal occlusion before andduring sedation with thiopentone in 14 female subjects. A tightlyfitting partitioned face mask separated the nasal and oral breathingroutes. Nasal and oral breathing were identified from changesin carbon dioxide concentration and airway pressure in the differentcompartments of the face mask. Arterial oxygen saturation (S_po2)was monitored simultaneously. Eleven of 14 subjects breathedonly through the nose (nasal breathers) both before and duringsedation. In these subjects, the time required to initiate oralbreathing in response to nasal occlusion during sedation wassignificantly longer than that before sedation (mean 37.7 (SD15.5) s vs 3.2 (1.3) s(P <0.01)).Also, there was a significantdifference (P <0.01) in the smallest values of S_po2 attainedduring nasal occlusion before (98.0 (0.8) %) and after (89.3(4.3) %) sedation. In adult humans the ability to maintain adequateventilation by switching from the nasal to the oral route inresponse to nasal occlusion is greatly impaired during sedation,probably because of the impairment of conscious influence onthe control of the palatal muscles.     

Clinical assessment of oxygen conserving devices in chronic bronchitis and emphysema.

We have studied the efficacy of three devices designed to conserve oxygen delivered to patients with hypoxic chronic bronchitis and emphysema. Devices A and B are valve systems, which deliver oxygen only during inspiration. Device C is a modified nasal prongs system incorporating a "moustache reservoir" (Oxymizer, Chad Therapeutics Inc, Woodland Hills, California), which is claimed to produce a higher arterial oxygen saturation (SaO2) from a given flow of oxygen than does continuous delivery through nasal prongs. Devices A and B were found to give the same oxygen saturation as continuous flow oxygen, but only device B reduced the flow of oxygen significantly (p less than 0.01). The flow characteristics of device A were likely to be the cause of this failure to conserve oxygen. Device C produced a higher mean rise in SaO2 than did standard nasal prongs at all oxygen flow rates, and was able to achieve the same rise in SaO2 as standard nasal prongs with a small (25-33%) saving in oxygen delivery. There was, however, considerable variation between patients in the oxygen saving efficiency of device C, with little or no oxygen saving in seven of the 12 patients studied.     

Blood oxygen saturation levels during conscious sedation with midazolam. A report of 16 cases

In a double-blind randomized study on 16 healthy individuals, two groups of subjects (8 in each group) received either midazolam (Dormicum; Roche) 0.1 mg/kg or placebo intravenously for conscious sedation during oral surgical procedures. Oxygen saturation of the blood was measured at different stages. Ten minutes after administration of the drug, the percentage oxygen saturation was significantly lower (P less than 0.05) in the midazolam group than in the placebo group.     

利用鼻中隔粘骨膜复合瓣修复半侧鼻下部衬里缺损的临床研究

目的:探讨一种半侧鼻下部全层缺损衬里修复的手术方法.方法:根据衬里缺损的面积,设计对侧相应大小鼻中隔粘膜软骨膜复合组织瓣,通过鼻中隔背部跨越鼻中隔软骨,将血运良好的复合组织瓣固定在缺损周边的骨膜上.对8例半侧鼻下部全层缺损患者采用此方法修复衬里,其中3例男性,5例女性,并同时运用局部皮瓣或额部皮瓣修复外层,耳软骨或肋软骨重建支架,随访6～12个月,了解鼻衬里恢复情况.结果:本组8例患者再造鼻衬里均血运良好,鼻腔大小及通气正常,鼻中隔形态正常,供区呼吸性上皮覆盖,无穿孔、感染或偏曲.结论:在半侧鼻下部全层缺损的衬里再造中,应用此方法进行衬里修复,组织性质最接近,血运好且薄,柔软且挛缩程度小,同时为软骨支架提供良好血供,保持了鼻部组织的完整及自然形态,是一种良好的鼻部衬里修复方式.