玻璃体切除术后硅油对眼底损害的临床观察

目的探讨玻璃体切除联合硅油注入术后眼底损害的原因。方法回顾分析51例（51眼）行玻璃体切除联合硅油注入术后发生眼底损害的临床资料,其中糖尿病视网膜病变31例、视网膜脱离12例、眼内异物8例。术前或术中均见视盘颜色红润,视网膜血管正管无白鞘,术前、术中无视盘颜色变淡或视网膜血管异常的记载。51例均采用标准三切口经睫状体平坦部玻璃体切除手术,术终均注入硅油。手术后随访6～43月,平均随访21月。结果51例在术后1～28月均发生视盘颜色变淡,视网膜血管变细有自鞘,视野有不同程度的损害。28例（54．90％）跟压有高于正常史,余23例眼压一直在正常范围。取出硅油后眼底改变无改善,视力低于无眼底改变者。结论玻璃体切除联合硅油注入术后视盘颜色变淡,视网膜血管变细有白鞘及视野的改变均与硅油有关,提示临床上应提高手术技术,在使用硅油时应慎重,不要为了保证视网膜复位,而牺牲原可挽救的有用视功能。     

玻璃体切除术后惰性气体对眼底的损害

目的探讨玻璃体切除联合注气术后眼底病变的原因。方法回顾分析了玻璃体切除联合惰性气体SF6或C3F8注入术后发生视网膜中央或视网膜分枝血管变细,有白鞘,视盘颜色变淡的13例（13眼）。其中眼外伤8例,糖尿病视网膜病变3例,孔源性视网膜脱离2例,手术前视盘颜色红润,边界清,视网膜动、静脉均正常。13例均为标准三通道闭合式玻璃体切除联合20％C3F8或50％SF。注入术。手术过程顺利,术后观察视力、眼压、前房反应、眼底改变及视野。结果13例在手术后5～32d发现视网膜中央血管或视网膜侧枝血管变细,有白鞘,视盘颜色变淡。结论玻璃体切除联合注气术后发生视网膜中央或视网膜侧枝血管变细,有白鞘,视盘颜色变淡的原因是多方面的,其中惰性气体的毒性作用的可能性更大,提示在临床上使用惰性气体时应慎重。     

强化胃残余量控制对呼吸机相关性肺炎的预防效果研究

目的 探讨强化胃残余量控制对预防肠内营养患者呼吸机相关性肺炎的作用.方法 分析96例机械通气超过48 h的患者,随机分成病例组和对照组各48例.分别采用强化胃残余量控制和普通控制.比较2组呼吸机相关肺炎的发生率、病死率、机械通气时间及住院时间.结果 病例组呼吸机相关性肺炎发生率为20.83%、病死率18.75%、机械通气时间(15.21±2.36)d、住院时间(22.38±12.34)d;对照组呼吸机相关性肺炎发生率为39.58%、病死率39.58%、机械通气时间(19.85±4.58)d、住院时间(29.46±15.24)d.2组各项指标比较差异显著.结论 强化胃残余量控制可减少呼吸机相关性肺炎的发生,缩短机械通气和住院时间.     

N-乙酰半胱氨酸联合阿奇霉素在急性呼吸窘迫综合征(ARDS)中对患者肺功能及炎症因子的影响

目的 分析N-乙酰半胱氨酸(NAC)联合阿奇霉素对急性呼吸窘迫综合征(ARDS)患者肺功能及炎症因子水平的影响.方法 选取2018年6月～2019年10月我院收治的106例ARDS患者,对照组给予阿奇霉素,研究组此基础上联合NAC治疗.比较两组患者的肺功能指标、炎症指标及不良反应发生情况.结果 治疗后,两组患者的FEV...     

ICU患者家属的心理状态分析及护理对策

随着医学模式的发展，ICU护士的职责不单是做好危重病患者的抢救与监测，还包括对患者家属的心理护理。因此，了解ICU患者家属的心理需求和焦虑因素，有针对性对患者家属实施有效的心理护理，帮助患者家属正确的面对，建立起对护士的信任与尊重，主动配合护理工作，促进患者的康复。     

冠心病患者经皮冠状动脉腔内成形术后的康复指导

笔报道对126例经皮冠状动脉腔内成形术后的冠心病患实施康复指导方案，采用设置健康保健卡、个别指导、开设学习班等方法，通过心理指导、用药指导及生活指导等综合指导，使患及其家属充分认识到术后康复治疗的重要性，积极配合医务人员进行康复治疗，树立战胜疾病的信心，增强适应环境和社会的能力，提高生活质量，最终达到康复的目的。     

胎膜早破对母儿的影响

目的为探索胎膜早破对母儿的影响。方法对258例头位胎膜早破患者的处理和预后进行回顾性总结。结果胎膜早破对母体影响主要为感染;而对于胎儿本身来说,胎膜早破的危害则主要是引起早产和围产儿死亡率增加。结论胎膜早破是难产的信号之一,需加以重视,予以适当处理,积极防治母儿并发症。     

A combined anti-thrombotic therapy for thrombosis of mitral prosthetic valves

Background For patients with prosthetic heart valves, thrombosis of the valves is dangerous. A second surgery for re-replacing the thrombosed valve is quite traumatic. There have been some researches on noninvasive therapies for thrombosis of prosthetic heart valves. But the combined anti-thrombotic therapy including anti-coagulants and anti-platelet agents was seldom studied. Methods Fourteen patients suffered from thrombosis of the mitral prosthetic valve with stable hemodynamics were studied retrospectively. Thrombosis of the valves was demonstrated by transesophageal echocardiography. All the patients were given a combined antithrombotic therapy with clopidogrel and warfarin during the whole treatment with close monitoring. Low molecular weight heparin (LMWH) was given twice a day during the first 5 days of further treatment in four inpatients. Transthoracic echocardiography was performed repeatedly to observe the function of the mitral prosthetic valves and changes of the thrombus. Results This study included 4 males and 10 females. In these patients, 13 suffered from thrombosis of the mechanical mitral valves, and one patient had thrombosis of the bioprosthetic mitral valve. After an average of 32.0 ± 20.4 days’ treatment, eleven (78.6%) patients’ thrombi disappeared thoroughly with normalized valvular function, only three (21.4%) patients’ thrombi still existed, but no deterioration of valvular functions. For the patients with successful treatment , sizes of the left atriums decreased after treatment (P = 0.01). No significant changes of other chambers and left ventricular ejection fraction were observed (P > 0.05). None experienced major bleeding except for two cases of mild subcutaneous hemorrhage. Conclusions The combined anti-thrombotic therapy based on clopidogrel and warfarin (plus LMWH) is a feasible treatment of thrombosis of prosthetic heart valves under a close monitoring , for both inpatients and outpatients.     

消毒供应中心工作人员职业安全防护的研究

加强消毒供应室工作人员自我防护意识,降低职业危害.从物理、化学、生物、环境、生理等方面阐述消毒供应室工作人员面临的职业危害产生的原因和防护中存在的问题,提出可行性的防范措施.