新生儿采用不同吸痰方法效果的研究

目的研究用吸耳球和吸痰管吸痰对新生儿的影响。方法将同期出生足月新生儿120例随机分为对照组和研究组,每组60例。对照组采用吸耳球清理呼吸道,研究组采用一次性吸痰管接负压吸引器清理呼吸道,两组均母婴同室、母乳喂养。记录新生儿体重下降的最低幅度和回升时间、新生儿24h内呕吐次数及第1次排黄便时间。结果研究组体重下降幅度明显低于对照组,体重回升快;24h内呕吐次数明显少于对照组;第1次排黄便时间早于对照组,且差异显著(P<0.01)。结论采用一次性吸痰器吸痰可以减少新生儿呕吐次数,减轻生理性体重下降幅度和缩短胎便的排净时间。     

产后抑郁症相关因素调查研究

目的探讨持续胃肠道低负压引流在抢救经口服急性有机磷农药中毒（AOPP）中的效果。方法将36例AOPP患者随机分成两组。对照组（19例）采用传统洗胃、导泻法；研究组（17例）于常规洗胃、导泻后，行胃肠道间断（4～6h 1次）甘露醇或生理盐水灌洗加持续胃管及肛管低负压吸引。比较两组阿托品及解磷定用量、胆碱酯酶上升至正常50％时间、昏迷时间及腹胀便秘、反跳、中间综合征发生率。结果研究组阿托品及解磷定用量显著少于对照组（均P〈0．05），胆碱酯酶上升时间、患者昏迷时间显著短于对照组（均P〈0．05）。结论持续胃肠道低负压吸引能有效清除AOPP患者胃肠道毒物，有利于患者恢复。     

基层医院治疗肠外瘘12例报告

目的：总结基层医院治疗肠外瘘的经验。 方法：报告本院从１９８９年１２月至１９９７年１２月收治各种肠外瘘１２例的治疗体会，依托脂肪乳注射液，用周围静脉代替经中心静脉行全肠外营养支持；简化肠内营养配方。强调肠外瘘的局部处理－附有滴水管的双腔负压吸引管持续低负压吸引。 结果：除２例死亡外，８例获得瘘自愈的优良效果，１例行肠外瘘闭合手术治愈，１例好转，等待确定性手术治疗。 结论：通过餐周静脉途径行肠外营养     

Neonatal gastric suctioning results in chronic visceral and somatic hyperalgesia: role of corticotropin releasing factor

Abstract Gastric suctioning is common in neonatal intensive care units. Studies suggest that gastric suctioning in premature infants may play a role in the development of visceral hyperalgesia. We hypothesized that repeated orogastric suctioning during the neonatal period results in chronic alterations in visceral and somatic sensation through a corticotropin-releasing factor mediated mechanism. Neonatal male Long Evans rats (n = 13) received daily orogastric suctioning for 10 days starting at postnatal day two (P2). Control rats (n = 15) were handled similarly without orogastric suction. A second study group was subjected to a similar protocol, only with pre-emptive administration of a CRF1 receptor antagonist (antalarmin, 20 mg/kg, IP) (n = 8). The control group received vehicle only (n = 8). An additional group was given antalarmin without suctioning (n = 5). After these rats grew to adulthood (PN 60), a visceromotor response to graded colorectal distension was recorded (10-80 mmHg, 30s, 180s inter-stimulus intervals) to assess changes in visceral sensitivity. Paw withdrawal latency to noxious heat applied to the hind paws was measured to assess changes in cutaneous sensitivity. Orogastric suctioning during the neonatal period results in global chronic somatic and visceral hyperalgesia in adult rats. Visceral hyperalgesia is prevented by pre-emptive administration of the CRF1 receptor antagonist, antalarmin.     

危重婴幼儿呼吸道管理中吸引负压的研究

目的探讨儿科危重症呼吸道管理中吸痰的合适吸引负压。方法选择41例PICU危重婴幼儿，年龄28d-2岁，呼吸道分泌物多，不能自行排痰均进行雾化吸入和拍背吸痰；采用华东负压表厂生产的中心吸引装置，选定1名PICU高年资并获得高级生命支持培训合格证的专科护士进行吸痰操作；吸引负压预设值为12．5kpa（93．75mmHg），当痰液粘稠不能吸出则以2．5kpa为一个吸引负压单位值逐渐增加为原则，进行吸痰负压的调节，以吸净呼吸道分泌物为目的；记录痰液吸出情况和有无痰中带血，同时监测心率、呼吸、血氧饱和度（SpO2）等，确保危重症吸痰过程中的安全。结果①355例次有效吸引，吸痰负压与呼吸道粘膜损伤出血有显著的统计学意义p〈0．01（x^2=43．987），负压在12．5-17．5kpa（93．75-131．25mmHg）是安全的，吸引负压增加，呼吸道粘膜损伤出血亦增加；②355例次有效吸引，吸痰负压与痰液的粘稠度比较有显著的统计学意义p〈0．01（x^2=18．714），与年龄比较无显著相关性p〉0．05。结论危重婴幼儿呼吸道管理中吸引负压安全范围为12．5-17．5kpa（93．75-131．25mmHg），负压吸引的大小与病情有关，与年龄无明显关系；当痰液粘稠时，需通过呼吸道的温湿化稀释痰液和借助拍背震动等物理方法帮助有效清除呼吸道分泌物。     

脑内张力性血肿的诊断与治疗体会

目的探讨脑内张力性血肿临床规律及有效治疗方法。方法经CT扫描诊断并为手术证实的脑内张力性血肿共12例,对其头部CT扫描片、临床表现特点、治疗经过等回顾分析。结果所有12例中高血压性脑出血10例,外伤性脑内血肿2例。发病初期血肿量均为20ml以下,均于发病7～10d左右,临床症状加重,CT扫描可见高密度血肿灶周围出现环形低密度改变,并伴有明显占位效应,还是诊断脑内张力性血肿的主要依据。结论如及时施行颅骨钻孔,血肿穿刺抽吸手术,病情则会迅速好转,预后良好。     

Treatment of atelectasis of upper lung lobes. Selective bronchial suctioning with J-shaped catheter tip and guide mark

We developed a technique for blind bronchial suction using a curved-tip catheter with a guide mark, for the treatment of atelectasis of the lower and middle lobes of the lung. Suction of the upper lobe bronchi could not be performed because of the combination of the peculiar anatomy of the upper lobe bronchi with catheter design. We treated successfully two cases of atelectasis of the right upper lobes using a Rusch Metras bronchography catheter with a guide mark which is not readily available. Therefore we devised a J-shape tipped catheter with a guide mark. We have successfully treated 13 episodes of atelectasis of the right upper lobe in 10 patients and one episode in the left upper lobe in one patient with this new catheter.     

Telescopic suction tube for microsurgery

Summary An adjustable telescopic suction tube has been developed for microsurgery. Owing to this innovation, the surgeon can easily set the suction tube to a suitable length by gently pulling the end of the telescopic tube out or in.     

Disposition and effects of flurbiprofen enantiomers in human serum and blister fluid

Aims To investigate the pharmacokinetics of the enantiomers of flurbiprofen and inhibition of prostanoid production in blister fluid and serum. Methods Eleven healthy volunteers received 75 mg R-, 75 mg S-flurbiprofen or no medication in a randomized 3-way cross-over study. Flurbiprofen concentrations were determined by h.p.l.c. TXB₂ and PGE₂ were determined by enzyme immunoassay and chemiluminescence immunoassay respectively. Results S-flurbiprofen produced almost complete (>99%vs baseline) inhibition of thromboxane B₂ (TXB₂ ) in serum in all volunteers and significant inhibition of prostaglandin E₂ (PGE₂ ) generation in blister fluid, but there was a considerable inter-individual variation in the response ranging from −78 to +190% change from control PGE₂ AUC. After administration of R-flurbiprofen, there was a mean maximum TXB₂ inhibition of 65.2±15.0% in serum but no significant changes of PGE₂ levels in blister fluid were observed. The pharmacokinetic parameters in serum and blister fluid were not significantly different between enantiomers. R- to S-inversion did not occur to a clinically relevant extent. For R-flurbiprofen, the complex rate constant of transfer into blister fluid was greater at the u.v.-exposed site (0.110±0.050) than at the control site (0.079±0.026, P<0.05) which corresponded to a higher AUC and C_max of R-flurbiprofen in u.v.-exposed blister as compared with control. For inhibition of TXB₂ generation after administration of S-flurbiprofen, a sigmoidal log-linear concentration–response relationship was established in all subjects (EC₅₀: 0.123±0.092 μg ml⁻¹ ). In contrast, inhibition of PGE₂ production in blister showed no clear concentration-response relationship when correlated with concentrations of S-flurbiprofen in either serum or blister fluid. After administration of R-flurbiprofen, no concentration-effect relationship could be established. Conclusions It is concluded that the blister model may have value for studying the pharmacokinetics and pharmacodynamics of antiinflammatory drugs in humans. Interestingly, inter-individual variation in the pharmacokinetics of flurbiprofen enantiomers could not account for the variability in response observed in the blister model.