急诊PCI使用抽吸导管的临床体会

目的探讨抽吸导管在急性心肌梗死急诊经皮冠状动脉介入治疗（PCI）中的应用。方法将我院78例急性心肌梗死患者随机分为两组：血栓抽吸组32例（抽吸导管抽吸冠脉内血栓,然后置入支架）和对照组46例（按常规PCI进行）。治疗后观察病变血管血流及心肌灌注情况,比较两组住院期间及术后随访6个月期间主要心脏不良事件（MACE）的发生率。结果血栓抽吸导管组的疗效明显优于对照组。结论抽吸导管用于急诊PCI效果显著。     

血栓抽吸联合替罗非班和维拉帕米预防急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗无复流的临床疗效研究

目的 观察血栓抽吸联合冠状动脉内推注替罗非班、维拉帕米预防急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗（PCI）无复流的疗效及安全性.方法 将我院收治的65例急性ST段抬高型心肌梗死患者随机分为联合治疗组34例和标准PCI组31例.联合治疗组：在Diver CE导管抽吸后经冠状动脉直接推注维拉帕米和替罗非班,再根据具体情况予以球囊扩张和/或支架术;标准PCI组：术前静脉推注替罗非班,然后静脉泵入替罗非班,维持24～48 h,术中如出现＂慢血流＂或＂无复流＂使用维拉帕米,予以球囊扩张和/或支架术.观察住院期间出血并发症及主要心血管事件.结果 住院期间联合治疗组恶性心律失常和心脏破裂发生率均低于标准PCI组（P＜0.05）;两组均未发生严重出血并发症.结论 血栓抽吸联合冠状动脉内推注替罗非班、维拉帕米预防急性ST段抬高型心肌梗死患者直接PCI无复流有效、安全.     

Banding of nipples as an augmentation of the suction correction of flat or inverted nipples

Summary Banding the nipples with a split and stretched rubber band or by the use of plaster is supplementary to the suction method for correction of flat or inverted nipples and effectively reduces the number and durations of such suction sessions, substantially improving the results. These procedures are an ideal solution for this condition.     

Simplified wound care and earlier wound recovery without closed suction drainage in elective total hip arthroplasty. A prospective randomized trial in 100 operations

Introduction Evidence to support or refute closed suction drainage (CSD) in primary total hip replacement (THR) is not conclusive. Our anecdotical experience was that persistent ooze from the drainage hole often delayed wound recovery. We hypothesized that, without CSD, wound care would be simplified without short or long term disadvantage. Materials and methods Hundred patients scheduled for primary THR were randomly assigned for CSD or non-drainage. Drains were withdrawn at day 2. Pain, wound hematoma, number of dressing changes, time of persistent discharge from the operation site (skin incision and drain hole), total blood loss and number of blood transfusions were prospectively recorded. Hip function, presence of heterotopic ossifications (HTO) and complications were recorded at a follow visit 1 year after surgery. Results Wound sites managed without CSD needed significantly less wound dressings (P < 0.001) and were dry at an earlier time (P < 001). Despite a significant bigger subfascial hematoma in the non-drained group (P < 0.05), in terms of pain, thigh swelling, total blood loss, number of transfusions needed, hip function and HTO no difference was recorded between the groups (P = 0.2–0.82). Conclusion To omit CSD in primary THR results in simplified and more rapid wound management without any disadvantage at short and long term.     

Benefits and harms of normal saline instillation before endotracheal suctioning in mechanically ventilated adult patients in intensive care units: A systematic literature review and meta-analysis

ObjectivesThis systematic review aimed to identify the effects of normal saline instillation before endotracheal suctioning on clinical outcomes in critically ill patients on a mechanical ventilator.Research MethodologyThis review was based on the guidelines of the National Evidence-based Healthcare Collaborating Agency in Korea and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Six electronic databases were searched for relevant literature. Other sources were also searched, including the reference lists of identified reports and previous systematic reviews. After the initial literature search, a two-step retrieval process was performed to select eligible studies. Then, data were collected using a newly developed form, and the risk of bias was assessed using the checklists of the Joanna Briggs Institute. Data were analyzed using both narrative syntheses and meta-analyses.ResultsIn total, 16 studies: 13 randomized controlled trials and three quasi-experimental studies, were included. From the narrative syntheses, instilling normal saline before endotracheal suctioning was associated with a decrease in oxygen saturation, prolonged time for oxygen saturation to recover to baseline, decreased arterial pH, increased secretion amount, reduced incidence of ventilator-associated pneumonia, increased heart rate, and increased systolic blood pressure. Meta-analyses showed a significant difference in heart rate at five minutes after suctioning but no significant differences in oxygen saturation at two and five minutes after suctioning and heart rate at two minutes after suctioning.ConclusionThis systematic review indicated that instilling normal saline before performing endotracheal suctioning has more harmful effects than benefits.Implications for Clinical PracticeAs recommended in the current guidelines, it is necessary to refrain from routine normal saline instillation before endotracheal suctioning.     

8种子宫腔吸引管清洗方法的效果比较

目的:为了掌握使用后的子宫腔吸引管的最佳清洗方法。方法:将使用后的子宫腔吸引管240件采用清水法浸泡,另240件采用加酶法浸泡,然后分别随机分为A、B、C、D 4组,各60件。A组采用超声清洗机清洗,B组采用高压喷枪冲洗,C组采用流水下手工擦洗加超声清洗机清洗,D组采用流水下手工擦洗加高压喷枪冲洗。比较清水浸泡法和加酶浸泡法各组的清洗效果,同时比较加酶浸泡法4组清洗前后子宫腔吸引管内壁带菌情况。结果:加酶浸泡法A、B、C、D组清洗合格率显著优于清水浸泡法(χ2=6.39、5.36、3.98、4.69,均P<0.05)。加酶浸泡法D组合格率显著高于A、B、C组(χ2=26.76、7.79、4.69,P<0.01、P<0.05)。加酶法D组吸引管内壁带菌率显著低于A、B组(χ2=10.10、6.67,均P<0.01)。结论:使用后的子宫腔吸引管,加酶浸泡后流水下手工擦洗,再用高压喷枪冲洗能有效清除吸引管壁的有机残留物。笔者认为此法值得临床推广应用。     

简易负压封闭吸引治疗Ⅳ期压疮患者的护理

我科根据VSD和VAC治疗的原理,自行设计一种简易负压封闭吸引治疗方法,用于临床治疗Ⅳ期压疮患者9例11处伤口取得较为满意的效果,现报告如下。     

诱导性主动咳嗽在胸部术后护理中的应用研究

目的探讨胸科术后患者最佳诱导性咳嗽方法及最佳诱导患者主动咳嗽的时机。方法将120例患者随机分成常规组、气管按压组、吸痰管刺激组3组,每组40例。3组患者均在手术清醒后2,6,18h实施诱导方法,观察不同方法应用前后患者的SPO2、有效咳嗽咳疾情况、诱导前后的感受情况及有无肺不张的发生。结果①术后6h和18h诱导咳嗽前后血氧饱和度变化ASPO23组间差异有统计学意义（P〈0．05）,气管按压组和吸痰管刺激组在术后6h的aSPO2与常规对照组差异均有统计学意义（P〈0．05）,吸痰管刺激组在术后18h的ASPO2变化情况与常规对照组差异有统计学意义（P〈0．05）。②有效咳嗽率、有效咳痰率均为气管按压组〉吸痰管刺激组〉常规组。结论 胸科术后6h实施气管按压法诱导患者主动咳嗽能够取得较好的效果。     

重型颅脑损伤后并消化道出血的预防与治疗体会

目的：探讨重型颅脑损伤患者早期管饲营养素预防和治疗上消化道出血的效果。方法：对69例重型颅脑损伤并昏迷病人常规早期置留胃管鼻饲，及观察消化道出血情况。结果：69例中，有8例发生消化道出血，无1例死于消化道大出血。结论：重型颅脑损伤后尽早营养素管饲，可以预防并发上消化道出血，而胃液监测有助于消化道出血的预防和治疗。     

吸注套扎疗法与缚扎固定法治疗混合痔临床分析

目的:探讨吸注套扎疗法与缚扎固定法治疗混合痔的临床效果,探寻方便快捷、疗效更佳的治疗手段。方法:选取我科2009年1月～2010年1月间收治的混合痔患者200例,随机分为观察组与对照组各100例,观察组采用吸注套扎疗法治疗,对照组采用缚扎固定法治疗。对比两组患者术后疼痛、水肿程度,术中出血量、术后48hVAS评分及并发症发生情况。结果:观察组术后疼痛、水肿程度明显轻于对照组,术中出血量及术后48hVAS评分均低于对照组,观察组患者痊愈率为96%,对照组痊愈率为70%,组间对比差异显著(P<0.05)。结论:吸注套扎疗法治疗混合痔较缚扎固定法治疗术后并发症少,疼痛、水肿轻,且治疗愈高、疗效确切,临床应广泛应用。