鼻内窥镜微创技术在难治性鼻泪管阻塞治疗中的应用

目的探讨应用鼻内窥镜微创技术治疗难治性鼻泪管阻塞的可行性，并探讨其临床意义。方法难治性鼻泪管阻塞56例（65眼）在鼻内窥镜直视下进行泪囊鼻腔造瘘术联合环形人工泪小管植人术，对合并上泪道狭窄或阻塞者，术中于鼻内窥镜直视下，采用WZC-Ⅲ高频电泪道浚通仪进行上泪道浚通术。5眼合并鼻中隔重度偏曲者，同期行鼻内窥镜下鼻中隔偏曲矫形术。术后常规处理，3个月后拔除人工泪小管，随访观察1-3个月。结果术后仅极少数患者存在轻度溢泪及眼内眦部充血，无人工泪小管脱落及其他不适。65眼中53眼溢泪、溢脓等症状消失，治愈率81．5％（53／65）；7眼存在轻度溢泪，无溢脓，有效率10．8％（7／65），5眼症状无改善，无效率7．7％（5／65）。结论鼻内窥镜微创技术为难治性鼻泪管阻塞提供了一种理想的治疗手段，它具有微创、直视下操作、疗效可靠、并发症少、无颜面部瘢痕等优点。     

咪唑安定用于慢性阻塞性肺部疾病患者机械通气时的效果观察

目的观察咪唑安定用于慢性阻塞性肺部疾病(COPD)患者机械通气时改善人机对抗的临床效果。方法对56例机械通气时发生人机对抗COPD患者应用咪唑安定治疗,观察用药前和用药后1、4、12h时患者的呼吸(RR)、心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、酸碱度(pH)、二氧化碳分压(PCO2)、氧分压(PO2)的变化和评估镇静效果。结果咪唑安定应用于COPD患者机械通气改善人机对抗,82.14%患者的Ramsay镇静评分达2～4分,用药后患者RR、HR、MAP、SpO2、pH、PCO2、PO2均有明显改善(P<0.05,P<0.01),但对血压有一定影响。结论咪唑安定对机械通气中的人机对抗疗效好,患者的通气状况可明显改善,但应加强对循环的监测和管理。     

Effects of Epigallocatechin-3-gallate on lead-induced oxidative damage

Recent studies have shown that lead (Pb) could disrupt the prooxidant/antioxidant balance of tissue which leads to biochemical and physiological dysfunction. Epigallocatechin-3-gallate (EGCG), a catechin polyphenols component, is found to be an effective antioxidant. The present study investigated whether EGCG administration could reverse the changes on redox states in rat hippocampus caused by lead exposure. The association between redox status changes and long-term potentiation (LTP) in CA1 area of hippocampus were also examined. Wistar rats exposed to lead from postnatal day 1 were followed by 10 days of EGCG (10, 25 and 50 mg/kg) administration through intraperitoneally (ip), and the rats were sacrificed for experiments at the age of 21–23 days. The experimental results showed that glutathione (GSH) and superoxide dismutase (SOD) activity decreased accompanied with LTP amplitude decrease in CA1 area of hippocampus in the lead-exposed group. EGCG supplementation following lead intoxication resulted in increases in the GSH and SOD levels and increases in the LTP amplitude. Malondialdehyde (MDA) levels, a major lipid peroxidation byproduct, increased following lead exposure and decreased following EGCG treatment. In hippocampal neuron culture model, lead exposure (20 μM) significantly inhibited the viability of neurons which was followed by an accumulation of ROS and a decrease of mitochondrial membrane potential (ΔΨ_m). Treatment by EGCG (10–50 μM) effectively increased cell viability, decreased ROS formation and improved ΔΨ_m in hippocampal neurons exposed to lead. These observations suggest that EGCG is a potential complementary agent in the treatment of chronic lead intoxication through its antioxidative character.     

“零缺陷”在呼吸机日常管理中的应用

本文重点探讨了呼吸机管理应用中存在的问题和缺陷,以及"零缺陷"管理在呼吸机临床应用每一个过程中实施"零缺陷"的方法。重点对呼吸机的管理方式,呼吸机使用前的安全性能测试及维护保养等方面的质量控制进行探讨。通过对呼吸机采用集中管理模式,建立完善的制度,规范日常操作。有效降低了故障率,确保了呼吸机的完好率在100%。     

基于脉冲反相技术的医用高频超声组织谐波信息提取技术的研究

本文在所研制的高频超声数字编码发射和宽带接收系统的基础上,利用基频为20 MHz、35 MHz和50 MHz的宽带超声换能器,进行了脉冲反相技术高频超声谐波提取方法的实验研究.结果表明.采用本方法,可有效地抑制基波的影响.同时能有效提高高频谐波信号的幅度,较传统的RF滤波法分离谐波具有明显的优势.     

PB-840呼吸机气路系统工作原理

PB-840呼吸机在国内外医院广泛使用,本文详细介绍了 PB840的气路系统的结构及工作原理.     

美国熊牌1000III型呼吸机故障检修与保养

本文主要对美国熊牌1000I I I呼吸机的故障原因进行了分析,并就此提出了解决方法和几点保养方案。     

幼儿室间隔缺损术后两种机械通气撤机方法的效果比较

目的比较幼儿室间隔缺损修补术后同步间歇指令通气(SIMV)模式撤机法与直接撤机法的效果。方法将50例室间隔缺损修补术后行机械通气的患儿随机分为两组,观察组30例,予SIMV模式过渡撤机,对照组20例,采用直接撤机法。比较两种撤机方法的效果。结果两组撤机时间比较差异有统计学意义(P<0.01),观察组所需的时间更短,并且呼吸机相关性肺炎(VAP)的发生率更低(P<0.05);两组再置管率比较无统计学差异(P>0.05);撤机前后的心率、呼吸及血压的变化值比较均有统计学意义(P<0.01),观察组变化幅度较小;两组撤机前后的PaO2、PaCO2及pH值的比较均无统计学差异(P>0.05)。结论在幼儿室间隔缺损修补术后,应用SIMV法撤机能够缩短呼吸机辅助的时间和降低VAP的发生率,所以效果优于直接撤机法。     

High frequency oscillation in newborn infants with respiratory failure

Objective: To report ventilation strategies, survival and complications in 39 outborn infants treated with high frequency oscillatory ventilation (HFOV).
Methodology Data were collected prospectively between 1 May 1992 and 31 December 1993 on all infants treated with HFOV who had severe respiratory failure despite optimal conventional ventilation.
Results Twenty-eight out of 39 (72%) survived. Of the 15 infants with birthweights <1500g, eight survived. Best survival rates were for infants with pulmonary interstitial emphysema with air leak (4/5) and for infants of birthweight >1500g with hyaline membrane disease (8/8), and meconium aspiration syndrome (7/7). Three infants deteriorated while on HFOV and required extracorporeal membrane oxygenation. Complications were: (i) development of pulmonary interstitial emphysema (1); (ii) recurrence of pneumothorax (3); (iii) hypotension (2); and (iv) bronchopulmonary dysplasia (9). One of the eight infants weighing <1500g who received HFOV in the first week of life developed periventricular haemorrhage.
Conclusion The initial results of HFOV for severe respiratory failure were encouraging although a learning curve was encountered with its introduction.     

High-frequency oscillatory ventilation combined with intermittent mandatory ventilation in critically ill neonates: 3 years of experience

A heterogeneous group of 45 neonates with severe pulmonary disease and inadequate gas exchange on conventional intermittent mandatory ventilation (IMV) was treated with a high-frequency oscillator combined with an IMV (HFO-IMV) system (Emerson Airway Vibrator connected to a BABYBird 1 ventilator). The mean gestational age was 33 weeks (25.5–43) and mean birth weight 2.02 kg (0.66–4.24). Primary diagnoses included respiratory distress syndrome (RDS; 23), pneumonia (12), persistent fetal circulation (PFC; 6), diaphragmatic hernia/hypoplastic lungs (4). The IMV rate was reduced from 78 to 29 BPM (P0.0005), while maintaining lower partial pressure of carbon dioxide (PaCO₂) (P<0.005) and higher partial pressure of oxygen (PaO₂) (P0.0025). Active air leaks were present in 20 infants and these infants responded most favourably to HFO-IMV. HFO-IMV failed to improve ventilation in neonates with diaphragmatic hernia/hypoplastic lungs. Complications during HFO-IMV were increased pulmonary secretions (11), worsening or recurrence of pre-existing air leaks (11), or occurrence of new air leaks (10). In 4 patients death was related to major air leak complications. Twenty-four infants died, 18 of them of a respiratory cause. Twenty-one infants finally survived. We assembled a well-tolerated system to provide HFO-IMV and to successfully ventilate neonates with severe respiratory disease, who failed to respond to conventional IMV. Initiation of HFO-IMV earlier in the course of the disease in this type of infant may improve survival.Abbreviations BPM breaths per minute - FiO₂ fraction of inspired oxygen - HFI high-frequency flow interrupter - HFJ(V) high-frequency jet (ventilation) - HFO high-frequency oscillation - HFO-IMV high-frequency oscillation combined with intermittent mandatory ventilation - HFPP(V) high-frequency positive pressure (ventilation) - IMV intermittent mandatory ventilation - P(a)CO₂ partial pressure of (arterial) carbon dioxide - P(a)O₂ partial pressure of (arterial) oxygen - Paw mean airway pressure - PFC persistent fetal circulation - PIE pulmonary interstitial emphysema - PIP peak inspiratory pressure - RDS (infant) respiratory distress syndrome