高频电刀的漏电烧伤及电器安全

高频电刀是一种医用外科手术仪器，能利用切开和电凝肌体组织，使切断的毛细血管表面凝固而止血。高频电刀从电路结构上分为火花式高频振荡、电子管式或半导体式高频振荡电刀，后者向小型化、大功率和智能化发展。设备的发展必然带来一些如漏电、电刀烧伤、电器安全等问题，导致医院手术室时而出现医疗事故。因此，其电器安全问题已经为广大设备管理部门所重视。简要分析了高频电刀的漏电烧伤、实例检测及设备的电器安全。     

Determination of chorionicity in twin gestations by high-frequency abdominal ultrasonography: Counting the layers of the dividing membrane

OBJECTIVE: Our aim was to determine whether chorionicity in twin gestations can be diagnosed by use of high-frequency ultrasonography to count the layers of intraamniotic membrane. STUDY DESIGN: This prospective study of 66 twin pregnancies between 13 and 38 weeks' gestation used transabdominal ultrasonography at 10 MHz. The pregnancy was classified as monochorionic when two layers were counted and as dichorionic when three or four layers were counted. The findings of the examiner, who had no other information about chorionicity, were compared with those of the histopathologic examination of the placenta. RESULTS: Ultrasonography allowed chorionicity to be determined correctly in 60 of 63 cases (95%; 100% in the second trimester and 92% in the third). The predictive value for dichorionicity was 100% (48/48) and the sensitivity 94% (48/51). The 12 monochorionic diamniotic pregnancies in which the membrane was visualized were all correctly diagnosed. In a thirteenth case, with severe oligohydramnios, the membrane could not be seen. Two patients were lost to follow-up. In 95% of the cases (63/66) only one examination was required to diagnose chorionicity. Intraobserver variability was 0% (0/26). Interobserver variability, tested by photographs, was 3% (2/65). CONCLUSIONS: This technique should be the first-line method for determining chorionicity in the second and third trimesters because it is the most effective. Its excellent reproducibility may be attributable to the use of high-frequency ultrasonography. (Am J Obstet Gynecol 1996;175:1529-33.)     

Pulmonary infection control window in treatment of severe respiratory failure of chronic obstructive pulmonary diseases: a prospective, randomized controlled, multi-centred study

Background Early withdraw from invasive mechanical ventilation (MV) followed by noninvasive MV is a new strategy for changing modes of treatment. This study was conducted to estimate the feasibility and the efficacy of early extubation and sequential noninvasive MV commenced at beginning of pulmonary infection control window in patients with exacerbated hypercapnic respiratory failure caused by chronic obstructive pulmonary diseases (COPD). Methods A prospective, randomized controlled study was conducted in eleven teaching hospitals’ respiratory or medical intensive care units in China. Ninety intubated COPD patients with severe hypercapnic respiratory failure triggered by pulmonary infection (pneumonia or purulent bronchitis) were involved in the study. When the pulmonary infection had been controlled by antibiotics and comprehensive therapy, the 'pulmonary infection control window (PIC window)' has been reached. Each case was randomly assigned to study group (extubation and noninvasive MV via facial mask immediately) or control group (invasive MV was received continuously after PIC window by using conventional weaning technique).Results Study group (n=47) and control group (n=43) had similar clinical characteristics initially and at the time of PIC window. Compared with control group, study group had shorter duration of invasive MV ［(6.4±4.4) days vs (11.3±6.2) days, P=0.000］, lower rate of ventilator associated pneumonia (VAP) (3/47 vs 12/43, P=0.014), fewer days in ICU ［(12±8) days vs (16±11) days, P=0.047］ and lower hospital mortality (1/47 vs 7/43, P=0.025).Conclusions In COPD patients requiring intubation and invasive MV for hypercapnic respiratory failure, which is exacerbated by pulmonary infection, early extubation followed by noninvasive MV initiated at the start of PIC window may decrease significantly the duration of invasive MV, the risk of VAP and hospital mortality.     

Performance characteristics of 10 home mechanical ventilators in pressure-support mode: a comparative bench study

OBJECTIVE: Inspiratory pressure (Pi) support delivered by a bilevel device has become the technique of choice for noninvasive home ventilation. Considerable progress has been made in the performance and functionality of these devices. The present bench study was designed to compare the various characteristics of 10 recently developed bilevel Pi devices under different conditions of respiratory mechanics. DESIGN: Bench model study. SETTING: Research laboratory, university hospital. MEASUREMENTS: Ventilators were connected to a lung model, the mechanics of which were set to normal, restrictive, and obstructive, that was driven by an ICU ventilator to mimic patient effort. Pressure support levels of 10 and 15 cm H(2)O, and maximum were tested, with "patient" inspiratory efforts of 5, 10, 15, 20, and 25 cm H(2)O. Tests were conducted in the absence and presence of leaks in the system. Trigger delay, trigger-associated inspiratory workload, pressurization capabilities, and cycling were analyzed. RESULTS: All devices had very short trigger delays and triggering workload. Pressurization capability varied widely among the machines, with some bilevel devices lagging behind when faced with a high inspiratory demand. Cycling was usually not synchronous with patient inspiratory time when the default settings were used, but was considerably improved by modifying cycling settings, when that option was available. CONCLUSIONS: A better knowledge of the technical performance of bilevel devices (ie, pressurization capabilities and cycling profile) may prove to be useful in choosing the machine that is best suited for a patient's respiratory mechanics and inspiratory demand. Clinical algorithms to help set cycling criteria for improving patient-ventilator synchrony and patient comfort should now be developed.     

视网膜静脉阻塞患眼振荡电位的频域和时域分析

目的：探讨视网膜静脉分支阻塞和中央静脉阻塞患眼振荡电位的频域和时域参数及其临床应用。方法：测定了ＢＲＶＯ９例９只眼,ＣＲＶＯ９例９只眼和４０只正常眼的ＯＰＳ,并经快速富里叶变换昨到ＯＰＳ的频谱。对ＢＲＶＯ、ＣＲＶ患眼和正常眼的ＯＰＳ频域和时域各参数进行了比较。结果：与正常对照眼比较ＢＲＶＯ患眼的ＯＰＳ在１１０－２５０ＨＺ频率范围内主频率显著下降;平均频谱的幅度、总功率、最大振幅和最大功率无显著改变     

定压控制通气模式下有创呼吸机峰值压力差异对重症患者的潜在风险分析

目的：通过测试分析不同品牌型号的有创呼吸机在定压控制通气模式下的气道峰压,揭示其气道峰压的差异以及由此可能对重症患者造成的潜在威胁。方法：利用呼吸阻力和顺应性可调的成人模拟肺作为有创呼吸机的负载,测试各品牌型号呼吸机在定压控制通气模式下的气道峰压。结果：通过分析发现,各品牌型号有创呼吸机其气道峰压在定压控制通气模式下存在差异。结论：对重症患者而言,如果忽视各品牌型号有创呼吸机之间的气道峰压差异,将有可能对重症患者造成潜在威胁。     

呼吸机治疗慢性阻塞性肺疾病的临床观察及护理方法分析

目的：探讨鼻罩无创正压通气呼吸机辅助治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床疗效。方法：选取我院2006年7月-2009年9月收治的120例慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者的资料,随机分为双水平无创正压呼吸机辅助治疗组（60例,治疗组）和常规治疗组（60例,对照组）,治疗组患者应用无创正压呼吸机辅助治疗,常规治疗组患者采用常规抗感染、吸氧、营养支持等基础治疗。结果：治疗组患者抢救成功55例,抢救成功率91．67％,对照组患者抢救成功49例,抢救成功率81．67％。结论：无创正压通气呼吸机辅助治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭,临床疗效满意,实行有效、全面的护理是治疗成功的重要保证,值得在临床推广。     

BIPAP呼吸机治疗COPD合并呼吸衰竭的护理

目的观察BIPAP呼吸机治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭的临床效果,探讨最佳的护理措施。方法将90例COPD合并呼吸衰竭患者随机分为观察组和对照组,对照组45例患者采用常规治疗和护理,观察组则在对照组的基础上加用BIPAP呼吸机辅助治疗并进行相应的护理措施,观察治疗前后两组患者的动脉血PH值、氧分压(PaO2)、二氧化碳分压(PaCO2)、血氧饱和度(SaO2)、呼吸频率(RR)、心率(HR)等指标的变化情况。结果治疗5～10 d后,两组患者的PH、PaO2、PaCO2、SaO2、RR、HR的变化均较治疗前明显改善,且观察组比对照组变化更明显,差异有统计学意义(p<0.05)。结论应用BIPAP呼吸机能明显提高COPD合并呼吸衰竭的临床疗效,易操作,易被患者接受,避免了气管插管,是一种既安全又有效的方法。而治疗前的准备、治疗过程中护理干预、保持通畅的呼吸道及并发症的预防是护理工作中的重点。     

老年呼吸机相关肺炎患者死亡的危险因素

目的分析老年呼吸机相关肺炎(VAP)患者死亡的危险因素。方法调查2011年4月—2017年2月某院年龄≥60岁且发生VAP的患者,收集患者的临床资料,包括基本情况、感染情况、预后等,并对其死亡的危险因素进行分析。结果共有老年VAP患者682例,198例患者死亡,病死率为29.03%。APACHEⅡ评分15分(OR=2.482,95%CI=1.473~4.183)、机械通气时间15 d(OR=2.526,95%CI=1.661~3.840)、多重耐药菌感染(OR=3.379,95%CI=2.008~5.686)、真菌感染(OR=3.414,95%CI=1.830~6.370)、使用糖皮质激素(OR=2.075,95%CI=1.265~3.403)、血清清蛋白浓度35 g/L(OR=2.129,95%CI=1.386~3.268)、器官损伤数目≥3个(OR=3.438,95%CI=2.165~5.459)、血糖≥10 mmol/L(OR=1.744,95%CI=1.106~2.751)等8个因素均为老年VAP患者死亡的独立危险因素。结论老年VAP患者死亡与多种因素有关,临床应采取以干预主要危险因素为主的综合防控措施,降低其病死率。     

Ventilation modalities in infants with congenital diaphragmatic hernia

Neonates with congenital diaphragmatic hernia are among the more complex patients to support with mechanical ventilation. They have particular features that add to the difficulties already present in the neonatal patient. A ventilation strategy tailored to the patient’s underlying physiology rather than mode of ventilation is a crucial issue for clinicians treating these delicate patients.