新生儿重度窒息12例救治体会

目的探讨新生儿重度窒息抢救的措施。方法对我科自2003年6月￣2006年10月从阴道分娩的3928个新生儿中出现的12例重度窒息患儿进行抢救并分析。结果12例患儿经过医护人员的积极抢救治疗,11例抢救成功,1例死亡。结论临床护理人员对新生儿重度窒息的抢救应在熟悉其病因、正确熟练掌握各种处理方法的基础上争分夺秒地进行,才能达到有效的目的。     

新生儿窒息的护理

目的 探讨新生儿窒息的护理方法 .方法 对13例窒息的新生儿进行复苏的抢救,复苏后的护理.预防了新生儿窒息的并发症发生.结果 治疗过程中有一例合并缺血缺氧性脑病.其余无并发症发生.结论 新生儿窒息通过恰当的护理可预防避免新生儿窒息的并发症发生,提高治疗效果.     

新生儿窒息的复苏抢救与护理讨论

目的：观察新生儿窒息的复苏抢救与护理中的效果、分析临床价值。方法选择2013年4月~2014年5月的病儿74例，对窒息的新生儿实施包含清净呼吸道黏液、建立呼吸通气、维持正常循环和心搏出量、药物治疗及评价效果等五方面的新发复苏术ABCDE方案，进行抢救和复苏后治疗护理。结果比较评估治疗前后的差异，在74例病儿中，轻度窒息53例，重度窒息21例，先天性疾病死亡3例；需用药物复苏7例；抢救成功71例；总成活率达95.9%，复苏抢救后患儿未见有后遗症出现。结论实施新发复苏术ABCDE方案和护理后，新生儿窒息的下降率、抢救成功率幅度显著大于实施前，有助于减少因新生时窒息所致的死亡率和后遗症，值得临床推广。     

高血压脑出血急诊护理干预

目的：分析高血压脑出血急诊护理措施和护理效果。方法收集我院2011年9月~2013年9月诊治的高血压脑出血急诊患者70例作为研究对象,采用回顾性的方式分析患者的临床资料。结果研究结果显示,本组患者中有3例患者死亡;5例窒息,;试验组中显效19例,有效18例,无效3例,总有效率为92.5%;另外62例患者均抢救成功。结论高血压脑出血需要积极进行抢救,对患者实施急诊护理干预有助于提高抢救效果,降低窒息和死亡率。     

盐酸钠洛酮治疗新生儿重度窒息的临床分析

新生儿窒息可危及新生儿的生命，且影响预后。其抢救治疗必须及时、有效、分秒必争。我科于1992年5月-1994年12月用盐酸钠洛酮抢救重度窒息儿21例。取得了满意效果。现总结如下。     

25例严重多发伤患者的急救护理体会

目的：探讨对严重多发伤患者的正确急救护理措施,为患者赢得抢救时间,提高急救成功率。方法选取自2012年1月~2013年12月抢救的25例严重多发伤患者作为研究对象,采用规范合理的急救护理程序对严重多发伤患者进行抢救。结果25例患者经抢救,19例(76.0%)患者治愈出院;5例(20.0%)患者病情好转、病情基本稳定;1例(4.0%)患者伤势较重,经抢救无效死亡;抢救治疗总有效率为96.0%。结论严重多发伤患者经规范、科学的急救护理措施,得到及时、有效、准确的急救治疗,为患者争取急诊手术的时间,护士的积极配合对抢救工作起到重要作用,为后期的治疗奠定了良好的基础。     

新生儿上消化道出血的相关因素及早期干预

目的探讨新生儿上消化道出血的高危因素及防治措施。方法对76例住院的上消化道出血新生儿的原发病及治疗措施进行分析研究。结果新生儿窒息、新生儿缺氧缺血性脑病、早产儿、低出生体重儿、硬肿症等为新生儿上消化道出血的主要原因。早期积极有效的治疗可有助于上消化道出血的控制。结论应尽早去除应激因素,积极治疗原发病,纠正窒息缺氧状态,对新生儿上消化道出血者早期给予制酸、止血治疗多预后良好。     

8例肩难产的助产与护理体会

目的 探讨临床肩难产的助产与护理方法.方法 对我院2007年3月～2010年7月妇产科阴道分娩的3379例产妇当中的8例肩难产病例的临床资料进行回顾性的分析,并就其肩难产的助产与护理方法予以总结.结果 肩难产通过临床处理,有1例出现产后出血,1例出现新生儿颅内出血,1例新生儿臂丛神经损伤,4例新生儿轻度窒息,2例新生儿重度窒息,且后果比较严重.结论 临床肩难产处理不当可危及胎儿以及产妇的安全,积极采取合理有效的临床助产措施对于肩难产母婴有着极为重要的临床意义.     

新生儿窒息复苏与护理

总结我们对新生儿窒息的预防、复苏、抢救、护理方法和体会。报告在我院住院分娩的63例窒息新生儿的复苏护理。重点：认真做好产前检查,发现母体或胎儿异常给予适当干预;严密观察产程,加强胎儿宫内监测;准备急救药品器械;窒息的复苏及时有效,给予科学的护理,从而降低了围产儿缺血缺氧性脑病的发生及新生儿的病死率。     

新生儿窒息抢救的体会

新生儿窒息是产科常见的新生儿危象,如处理不当可造成新生儿智力障碍、行为异常等后遗症,甚至围产儿死亡。因此,如何迅速及时有效抢救新生儿窒息,已为产科医务人员的重任。对新生儿窒息的抢救应在熟悉其病因,正确熟练掌握各种处理方法的基础上争分夺秒地进行,以达有效之目的。我院从1997年5月至200年11月共分娩4053例。其中窒息儿129例,     

畸变产物耳声发射、新生儿行为神经测定评价新生儿窒息分析

目的为了探讨新生儿窒息所致中枢神经元缺氧性损伤及耳蜗毛细胞功能的损害对新生儿早期听力的影响;和评价DPOAE、NBNA在其中价值。方法对36例新生儿窒息进行畸变产物耳声发射及NBNA评价。结果正常新生儿的耳声发射与NBNA评分中行为能力3项通过时间比较无显著性差异P〉0.05;在正常与窒息新生儿及轻度与重度窒息中,比较NBNA中行为能力3项与耳声发射通过时间均有显著性差异P〈0.001。结论提示正常新生儿耳声发射与NBNA评分中的行为能力3项通过基本同步;新生儿窒息所导致耳蜗毛细胞功能及中枢神经元的损害恢复不同步;窒息越严重,耳蜗毛细胞功能及听觉中枢神经元功能恢复越慢。     

不同季节新生儿硬肿症分析比较及护理对策

目的 了解新生儿硬肿症的发病与季节的关系,寻找不同季节的主要致病因素及护理对策,提高新生儿硬肿症的治愈率;方法 按春、夏、秋、冬四季进行统计,找出各季节主要的致病因素;结果 总体上新生儿硬肿症的发病冬春季多于夏秋季,其比为3:2,早产为主要致病因素,在一年四季中均占有较高比例(65.23%),感染和窒息是夏秋季新生儿硬肿症的主要致病因素之一,夏秋季硬肿症患儿合并感染或窒息的比例明显高于冬春季(P<0.05);结论 寒冷损伤是新生儿硬肿症主要的致病外因,早产、感染和窒息是新生儿硬肿症的重要致病内因;因此,加强孕期保健,提高接生技术,防止早产和窒息以及在护理新生儿时加强保暖和预防感染对预防新生儿硬肿症的发生极为重要。     

Evaluation of a new simple treatment for positional sleep apnoea patients

Obstructive sleep apnoea syndrome is a common clinical problem. Positional sleep apnoea syndrome, defined as having a supine apnoea-hypopnoea index of twice or more compared to the apnoea-hypopnoea index in the other positions, occurs in 56% of obstructive sleep apnoea patients. A limited number of studies focus on decreasing the severity of sleep apnoea by influencing sleep position. In these studies an object was strapped to the back (tennis balls, squash balls, special vests), preventing patients from sleeping in the supine position. Frequently, this was not successful due to arousals while turning from one lateral position to the other, thereby disturbing sleep architecture and sleep quality. We developed a new neck-worn device which influences sleep position by offering a vibration when in supine position, without significantly reducing total sleep time. Thirty patients with positional sleep apnoea were included in this study. No side effects were reported. The mean apnoea-hypopnoea index dropped from 27.7 ± 2.4 to 12.8 ± 2.2. Seven patients developed an overall apnoea-hypopnoea index below 5 when using the device in ON modus. We expect that positional therapy with such a device can be applied as a single treatment in many patients with mild to moderate position-dependent obstructive sleep apnoea, while in patients with a more severe obstructive sleep apnoea such a device could be used in combination with other treatment modalities.     

New tracheal sound feature for apnoea analysis

Sleep apnoea syndrome is common in the general population and is currently underdiagnosed. The aim of the present work was to develop a new tracheal sound feature for separation of apnoea events from non-apnoea time. Ten overnight recordings from apnoea patients containing 1,107 visually scored apnoea events totalling 7 h in duration and 72 h of non-apnoea time were included in the study. The feature was designed to describe the local spectral content of the sound signal. The median, maximum and mean smoothing of different time scales were compared in the feature extraction. The feature was designed to range from 0 to 1 irrespective of tracheal sound amplitudes. This constant range could offer application of the feature without patient-specific adjustments. The overall separation of feature values during apnoea events from non-apnoea time across all patients was good, reaching 80.8%. Due to the individual differences in tracheal sound signal amplitudes, developing amplitude-independent means for screening apnoea events is beneficial.     

Schlafapnoe bei Niereninsuffizienz

There is a high comorbidity of renal insufficiency and sleep apnoea. The prevalence of sleep apnoea increases inversely with declining kidney function. In patients with renal diseases typical risk factors for sleep apnoea do not apply. Sleep apnoea seems to be more a direct consequence of the pathophysiological changes associated with renal insufficiency. Diagnosis of sleep apnoea is also often delayed because the symptoms are typically masked by the renal insufficiency. Preliminary studies indicated that sleep apnoea is also associated with higher cardiovascular risk in patients with end-stage kidney diseases. Quality of life which is reduced in patients with renal insufficiency may be worsened by sleep apnoea. Diagnosis and therapy of sleep apnoea should receive more attention in patients with renal insufficiency.     

微循环及氧自由基改变在窒息幼兔脑损伤中的作用

将健康幼兔２２只随机分为对照组和窒息组。与对照组相比，窒息组耳廓微循环指标加权积分值、血清脂质过氧化物（ＬＰＯ）含量明显增高，脑水含量增多，红细胞超氧化物歧化酶（ＳＯＤ）和全血谷胱甘肽过氧化物酶（ＧＳＨ－Ｐｘ）活力明显下降，且脑组织形态学改变显著。窒息组血ＬＰＯ与脑水含量、微循环加权积分值与脑水含量、血ＬＰＯ与微循环加权积分值间均呈正相关关系。结果提示，窒息时氧自由基的产生与微循环障碍互为因果，共同促使脑损伤发生。     

应用NCPAP治疗继发性新生儿呼吸暂停疗效观察

目的探讨NCPAP治疗继发性新生儿呼吸暂停的疗效。方法总结我院2007.01～2008.08新生儿科及ICU收治的继发性呼吸暂停病例81例（不包括继发于呼吸窘迫综合征病例15例）,分NCPAP治疗组25例、机械通气治疗组16例、氨茶碱一般治疗组40例三组治疗,回顾性分析疗效情况。结果NCPAP组好转时间短于一般治疗组,t=4.13,P〈0.01,差异有显著性,疗效优于一般治疗组;NCPAP组与气管插管组比较,t=0.9,P〉0.05,差异无显著性,疗效相似。结论应用NCPAP可有效治疗新生儿呼吸暂停,减少气管插管机会。     

胎心电子监护网络对产时胎儿的监护及出生评价

目的：探讨分娩时胎儿在宫内的安危及分娩后新生儿的结果,方法：选择1998年2至3月本院369名使用胎心监护网络分娩的产妇与应用单机监护分娩的产妇比较,观察两组宫内窘迫符合率、剖宫产、阴道助产发生率及新生儿窒息发生率．结果：网络监测组宫内窘迫符合率、剖宫产及阴道助产发生率明显高于对照组（P＜0.05）;而新生儿窒息发生率,尤其重度窒息发生率明显低于对照组（P均＜0．01）．通过对低危病人的监测,发现低危病人转为高危病人,两组分别为16．7％和19.2％,说明低危病人也应行常规监测．提示：使用网络监护能较早、更准确了解胎儿宫内安危,明显提高监测诊断水平．     

Systematic comparison of different algorithms for apnoea detection based on electrocardiogram recordings

Sleep apnoea is a common disorder that is usually diagnosed through expensive studies conducted in sleep laboratories. Sleep apnoea is accompanied by a characteristic cyclic variation in heart rate or other changes in the waveform of the electrocardiogram (ECG). If sleep apnoea could be diagnosed using only the ECG, it could be possible to diagnose sleep apnoea automatically and inexpensively from ECG recordings acquired in the patient's home. This study had two parts. The first was to assess the ability of an overnight ECG recording to distinguish between patients with and without apnoea. The second was to assess whether the ECG could detect apnoea during each minute of the recording. An expert, who used additional physiological signals, assessed each of the recordings for apnoea. Research groups were invited to access data via the world-wide web and submit algorithm results to an international challenge linked to a conference. A training set of 35 recordings was made available for algorithm development, and results from a test set of 35 different recordings were made available for independent scoring. Thirteen algorithms were compared. The best algorithms made use of frequency-domain features to estimate changes in heart rate and the effect of respiration on the ECG waveform. Four of these algorithms achieved perfect scores of 100% in the first part of the study, and two achieved an accuracy of over 90% in the second part of the study.     

Increased sodium-proton antiporter activity in patients with obstructive sleep apnoea

Cytosolic pH (pH(i)) and the activity of the sodium-proton antiporter (Na(+)/H(+) antiporter) were measured in lymphocytes from 22 patients with obstructive sleep apnoea and from 24 age-matched healthy subjects (Controls). The cellular Na(+)/H(+) antiporter was measured spectrophotometrically using a pH-sensitive fluorescent dye after intracellular acidification using sodium propionate. Resting pHi was similar in lymphocytes from patients with obstructive sleep apnoea and from controls (7.36 +/- 0.20, n=22; vs. 7.35 +/- 0.19, n=24; mean +/- SD). The Na(+)/H(+) antiporter activity was significantly higher in patients with obstructive sleep apnoea than in controls (11.87 +/- 3.26 x 10(-3) pH(i)/s vs. 4.38 +/- 1.40 x 10(-3) pH(i)/s; P < 0. 0001). The apparent affinity of the Na+/H+ antiporter was not significantly different between the groups (6.90 +/- 0.23 vs. 6.87 +/- 0.20). In patients with obstructive sleep apnoea the activity of the Na(+)/H(+) antiporter remained stable during the night. The activity of the Na(+)/H(+) antiporter was 13.49 +/- 4.80 x 10(-3) pH(i)/s at 20.00 and 13.26 +/- 6.13 x 10(-3) pH(i)/s at 02.00. From the present results it is concluded that an increased cellular Na(+)/H(+) antiporter activity may be a genetic marker for patients who are predisposed to obstructive sleep apnoea.