改良深部吸痰法在重型颅脑损伤气管切开患者中的应用

目的探讨改良深部吸痰法在重型颅脑损伤后气管切开患者中的应用效果。方法采用便利抽样法选择2013年6-10月解放军第309医院神经外科ICU收治的重型颅脑损伤后气管切开早期非机械通气患者40例,采用随机数字表法分为对照组和研究组。对照组采用常规吸痰法;研究组采取改良深部吸痰法,即在吸痰管尖端超过套管末端0.5cm时减慢插入速度,直至患者出现呛咳反射或感觉到气管隆凸阻力时吸痰。观察两组患者气道黏膜损伤情况、吸痰时患者屏气时间、人工气道通畅程度及临床肺部感染积分(clinical pulmonary infection score,CPIS)。结果两组患者气管切开后3、7d时的CPIS均高于气管切开前,差异有统计学意义(P0.05);但3个时间点的组间比较差异无统计学意义(均P0.05)。研究组吸痰时患者屏气时间短于对照组,气道黏膜损伤发生率低于对照组,差异均有统计学意义(P0.01);两组患者人工气道通畅率差异无统计学意义(P0.05)。结论改良深部吸痰法可以降低传统气管切开吸痰造成气管黏膜损伤的发生率,缩短吸痰时屏气时间,能够达到预防和减少肺内感染、保持呼吸道通畅的目的。     

片状或负压引流在43例腮腺术后应用的疗效观察

目的观察片状或闭式引流在腮腺术后应用的临床效果。方法选取本院2008年2月~2011年11月43例腮腺手术患者,将住院号尾数为奇数的17人分为A组,术后使用片状引流,尾数为偶数的26人分为B组,术后使用负压引流。从皮瓣贴合情况、引流量的变化情况、涎漏发生率和术创对加压包扎的要求等几个方面,观察2种引流方式对术创愈合的促进情况。结果 A组皮片引流创口术后皮瓣早期贴合欠佳,平均引流放置时间为5.8 d,涎漏发生率11.8%,对加压包扎依赖,术创平均加压时间11.2 d;而B组负压引流创口术后皮瓣即已贴合,平均引流放置时间为3.9 d,涎漏发生率3.8%,对加压包扎不依赖,术创平均加压时间4.9 d。结论负压引流对腮腺术创的愈合促进作用优于片状引流。     

Diagnostic ability of EUS-FNA for pancreatic solid lesions with conventional 22-gauge needle using the slow pull technique: a prospective study

Abstract

Objective. Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) using the slow pull technique (SP-FNA) has recently attracted attention as an effective tissue acquisition technique. However, efficacy of SP-FNA with a 22-gauge conventional needle remains unclear. The aim of this study is to evaluate the diagnostic ability of SP-FNA with a 22-gauge needle. Material and methods. Patients with a pancreatic solid lesion were prospectively enrolled in this study. SP-FNA was performed at two needle passes with a 22-gauge needle. One dedicated pathologist evaluated the obtained samples in terms of quantity (Grade 0: scant; Grade 1: inadequate; Grade 2: adequate), quality (Grade 0: poor; Grade 1: moderate; Grade 2: good), and blood contamination (Grade 0: significant; Grade 1: moderate; Grade 2: low), and provided a pathological diagnosis. Additional EUS-FNA was performed by applying suction (SA-FNA). The evaluation points were as follows: diagnostic accuracy of SP-FNA compared with that of SA-FNA, and the quantity, quality, and blood contamination level of SP-FNA-obtained samples. Results. We enrolled 40 cases. The diagnostic accuracy of SP-FNA was 90% (36/40). There was no significant difference in the accuracy between SP-FNA and SA-FNA (90% vs. 90%, p = 1.000). The samples obtained using SP-FNA were assessed as Grade 2 for quantity in 29 cases (73%), quality in 31 (78%), and blood contamination in 25 (63%). Conclusions. Adequate, high-quality, and unsubstantially blood-contaminated samples could be obtained using SP-FNA. The diagnostic ability of SP-FNA was 90%, which appeared to be similar to that of SA-FNA.     

Gastric Biopsy in Peptic Ulcer: A Follow-up Study

Fundal biopsy was performed in 155 peptic ulcer patients (GU 65, DU 90) and antral in 43 (GU 17, DU 26) of the 155 patients. In GU fundal gastritis was found in 74 and antral in 94 % of the cases. In DU the percentages were 16 and 65 respectively. In a short-term follow-up of 30 patients (GU 15, DU 15) the state of the fundal macosa remained essentially unchanged in 19, became worse in 6, and possibly showed an improvement in 5. In a 1–6 year follow-up of 58 patients (GU 28, DU 30) the same type of mucosal structure was preserved in 40, worsening of the changes in 13, and some improvement in 5.     

Influence of Dissolving Fe–Nb–B–Dy Alloys in Zirconium on Phase Structure,Microstructure and Magnetic Properties

This paper refers to the structural and magnetic properties of [(Fe₈₀Nb₆B₁₄)_0.88Dy_0.12]_1−xZr_x (x = 0; 0.01; 0.02; 0.05; 0.1; 0.2; 0.3; 0.5) alloys obtained by the vacuum mold suction casting method. The analysis of the phase contribution indicated a change in the compositions of the alloys. For x < 0.05, occurrence of the dominant Dy₂Fe₁₄B phase was observed, while a further increase in the Zr content led to the increasing contribution of the Fe–Zr compounds and, simultaneously, separation of crystalline Dy. The dilution of (Fe₈₀Nb₆B₁₄)_0.88Dy_0.12 in Zr strongly influenced the magnetization processes of the examined alloys. Generally, with the increasing x parameter, we observed a decrease in coercivity; however, the unexpected increase in magnetic saturation and remanence for x = 0.2 and x = 0.3 was shown and discussed.     

不同吸痰管在心外科ICU术后机械通气患者中应用的效果比较

目的比较应用密闭式吸痰管和开放式吸痰管对成人心外科术后感染预防和控制效果的影响。方法选择心外科术后行机械通气患者159例,随机分为密闭式吸痰组（n=77）和开放式吸痰组（n=82）,比较两组患者术后当天及术后第1,2,3天的白细胞计数,拔管前痰培养阳性率及总机械通气时间。结果密闭式吸痰组与开放式吸痰组的白细胞计数在术后当天[（10．42±3．81）×10^9／L比（9．44±3．36）×10^9／L]和第1天[（12．03±3．87）×10^9／L比（11．32±3．59）×10^9／L]差异无统计学意义（t分别为-1．718,-1．188;P〉0．05）;而密闭式吸痰组白细胞计数术后第2天[（16．14±5．78）×10^9／L比（14．81±3．68）×10^9／L]、第3天[（15．09±5．91）×10^9／L比（12．65±3．18）×10^9／L]高于开放式吸痰组,差异有统计学意义（t分别为-2．044,-2．409;P〈0．05）。密闭式吸痰组痰标本细菌培养阳性率高于开放式吸痰组（12．2％比10．4％）,但差异无统计学意义（χ2=0．129,P=0．72）,总机械通气时间长于开放式吸痰组[（14．48±4．71）h比（12．15±4．47）h],差异有统计学意义（t=2．994,P=0．003）。结论密闭式吸痰管的吸痰效果不及开放式吸痰管,由于吸痰不彻底导致的细菌定植发生率较高,从而导致肺部感染率增加。而且对于心外科术后短期带管的患者来说,密闭式吸痰装置的费用较高。     

开放声门深部吸痰方案在AECOPD呼吸衰竭无创通气无力排痰患者中的应用

目的比较开放声门深部吸痰方案与常规吸痰法两种不同吸痰方式在慢性阻塞性肺病急性加重期（AECOPD）呼吸衰竭无创通气无力排痰患者中的效果。方法将AECOPD呼吸衰竭无创通气无力排痰的62例患者按随机数字表法随机分为观察组和对照组各31例,分别采用开放声门深部吸痰方案（观察组）和常规吸痰法（对照组）吸痰。比较两种方法的吸痰效果、气道损伤及肺部感染等并发症的发生率以及对患者血氧饱和度的影响。结果观察组患者吸痰效果显效者18例,发生气道损伤者1例;对照组吸痰效果显效者10例,发生气道损伤者8例,两组比较差异均有统计学意义（P均〈0．05）。吸痰前两组血氧饱和度差异无统计学意义（P〉0．05）,观察组吸痰后血氧饱和度（98．03±1．42）％高于对照组的（96．22±1．62）％,差异有统计学意义（t=4．649,P〈0．05）。观察组发生肺部感染者2例,对照组发生肺部感染者5例,两组比较差异无统计学意义（χ^2=0．64,P〉0．05）。结论开放声门深部吸痰方案比常规吸痰法更能提高吸痰的有效率,减少并发症的发生,减轻患者的痛苦,提高护理质量。     

不同吸痰负压对重型颅脑损伤气管切开术后病人的效果研究

目的:探讨不同吸引负压对重型颅脑损伤病人气管切开术后的影响。方法:选择神经外科监护病房65例重型颅脑损伤并行气管切开术后病人为研究对象,随机分为A、B、C三组,分别采取90～120 mmHg、121～150 mmHg、151～180 mmHg压力进行气管内吸痰,分析3组病人吸痰前后ICP数值变化、吸痰频率、吸痰间隔、吸痰彻底评分以及7 d内气道黏膜损伤的发生率。结果:A组ICP的影响最小,达到的峰值最低,恢复至基线的时间最短,24 h吸痰频率最高,吸痰间隔最短,但吸痰效果最不理想。B组在吸痰后ICP升高,但平均ICP峰值较A组升高,并在2min左右恢复基线,24 h吸痰频率较低,吸痰间隔较长,吸痰效果较理想。C组对ICP的影响最大,达到的峰值最高,恢复至基线的时间最长,24 h吸痰频率最低,吸痰间隔最长,但吸痰效果最理想。3组吸痰负压7 d内气道黏膜损伤的发生率的比较有统计学意义(P<0.05)。结论:重型颅脑损伤病人气管切开术后宜采用121～150 mmHg负压进行气管内吸痰,较为安全有效。     

连接负压拔管术在气管导管拔出中的应用

目的观察全身麻醉后气管导管拔除时气管导管连接负压直接拔管的可行性、安全性及效果。方法选择无呼吸系统疾病史、无困难气道和通气困难、ASAⅠ-Ⅱ级（无或有轻度系统性疾病,但对日常工作和生活无影响）、18-65岁择期气管内全身麻醉患者86例,随机分成A、B2组各43例。拔管前A组：不用吸痰管,直接连接负压于气管导管体外端;B组：用吸痰管插入气管导管内吸引。观察2组拔管前后MAP、HR、ECG、SpO2,记录拔管后咳嗽咳痰情况及心电图和并发症发生情况。结果与自身拔管前比较A组拔管后MAP、HR稍有升高,SpO2稍有下降,ECG无异常,但无显著差异;B组拔管后MAP、HR、SpO2较自身拔管前比较有显著差异,且与同期A组比较也有显著差异。结论连接负压拔管能有效减轻心血管反应,避免缺氧,减少气管、支气管损伤及肺部并发症,实用性强,是气管导管拔除法中值得推荐的一种好方法。