双水平气道正压通气治疗急性左心衰的临床研究

目的评价双水平气道正压通气(BiPAP)无创机械通气对急性左心衰患者的临床疗效。方法将64例急性左心衰患者随机分为两组(BiPAP组和对照组),BiPAP组在常规治疗的基础上,给予BiPAP呼吸机经鼻面罩双水平气道正压通气治疗;对照组在常规药物治疗的基础上,给予面罩高流量吸氧。观察两组治疗前后血气、心率、血压、呼吸等变化。结果BiPAP组治疗后,有效率97.3%。32例患者症状明显改善,血气分析及生命体征参数比较差异均有统计学意义(P<0.05)。对照组总有效率为83.2%。结论BiPAP无创通气治疗急性左心衰能迅速缓解症状,可作为治疗急性左心衰的一种安全、有效的方法。     

喉罩联合高频喷射通气在输尿管软镜钬激光碎石术麻醉中的应用

目的评价喉罩联合高频喷射通气应用于输尿管软镜钬激光碎石术的安全性。方法60例拟行输尿管软镜钬激光碎石患者,丙泊酚靶控输注静脉全麻后置入合适喉罩,联合高频喷射通气,比较通气前后平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）、呼末二氧化碳分压（PET CO2）,动脉氧分压（PaO2）、动脉二氧化碳分压（PaCO2）、气道压（Paw）等参数。结果输尿管软镜钬激光碎石术采用丙泊酚靶控输注静脉全麻,置入喉罩联合高频喷射通气,PETCO2、PaCO2、Paw、分别由高频喷射通气前的（32.01±3.31）mmHg,（40.83±2.68）mm-Hg,（14.7±1.74）cmH2O 下降至通气后的（22.07±3.31）mmHg,（33.3±2.29）mmHg,（4.6±1.59）cmH2O;PaO2由（279.7±51.5）mmHg增至（311.78±46.4）mmHg。结论全凭静脉麻醉,采用喉罩联合高频喷射通气,能安全地应用于输尿管软镜钬激光碎石术。     

Adaptation to different noninvasive ventilation masks in critically ill patients

OBJECTIVE:

To identify which noninvasive ventilation (NIV) masks are most commonly used and the problems related to the adaptation to such masks in critically ill patients admitted to a hospital in the city of São Paulo, Brazil.

METHODS:

An observational study involving patients ≥ 18 years of age admitted to intensive care units and submitted to NIV. The reason for NIV use, type of mask, NIV regimen, adaptation to the mask, and reasons for non-adaptation to the mask were investigated.

RESULTS:

We evaluated 245 patients, with a median age of 82 years. Acute respiratory failure was the most common reason for NIV use (in 71.3%). Total face masks were the most commonly used (in 74.7%), followed by full face masks and near-total face masks (in 24.5% and 0.8%, respectively). Intermittent NIV was used in 82.4% of the patients. Adequate adaptation to the mask was found in 76% of the patients. Masks had to be replaced by another type of mask in 24% of the patients. Adequate adaptation to total face masks and full face masks was found in 75.5% and 80.0% of the patients, respectively. Non-adaptation occurred in the 2 patients using near-total facial masks. The most common reason for non-adaptation was the shape of the face, in 30.5% of the patients.

CONCLUSIONS:

In our sample, acute respiratory failure was the most common reason for NIV use, and total face masks were the most commonly used. The most common reason for non-adaptation to the mask was the shape of the face, which was resolved by changing the type of mask employed.     

Franco-British responses to chemical warfare 1915–8, with special reference to the medical services,casualty statistics and the threat to civilians

This dual-focussed examination will critically compare and contrast the British Royal Army Medical Corps and the French Medical Service’s involvement in the Western Front chemical campaign between 1915 and 1918. Because the Anglophone historiography has tended to marginalise the French contribution to the allied chemical war, this article will attempt to re-balance the historical narrative by emphasising the collective nature and importance of this joint Franco-British enterprise. By interrogating a raft of under-utilised primary evidence in the French and British archives, this investigation will contribute to the ‘alliance literature’ by arguing that when it comes to aspects of the Franco-British chemical war such as the co-operation of the medical services, the appellation ‘together but alone’ does not fully hold. The article will explore avenues of the two national armies evolving process of mutual medical assistance, material exchange and scientific collaboration. The striking similarity of French and British gas casualty statistics is highlighted with reference to the overall congruence of their anti-gas strategies – notwithstanding the problematic nature of these statistics. In addition to enhancing soldiers’ resistance to the poison gas threat on the battlefield, the Medical Services were also responsible for the protection of local civilians in the war zones. With reference mainly to France, this investigation will discuss the significance and implications of the poison gas threat to the home front. Finally, the impact of chemical weapon production upon civilian war workers in France and Britain will be commented upon.     

新型冠状病毒肺炎疫情期间居民使用口罩和消毒产品的影响因素

目的  了解新型冠状病毒肺炎（corona virus disease 2019,COVID-19,简称新冠肺炎）疫情期间居民口罩和消毒产品使用情况及其影响因素,为进一步做好疫情防控提供科学依据。 方法  采用Cronbach's α系数和KMO值对问卷的信度和效度进行评价。2020年3月4日至5日,通过网络调查居民的人口学特征、口罩和消毒产品使用情况,并分析居民口罩和消毒产品使用的影响因素。 结果  共回收有效问卷1 713份,其中男性492人（28.72%）,有382人（24.12%）认为戴多层口罩会更安全,有269人（15.70%）认为口罩可以经过蒸煮后再用,有265人（15.47%）认为口罩可以经过喷酒精后再用。有1 529人（89.26%）近一个月使用消毒产品对门把手/开关/按钮（84.96%）、地面（71.88%）和马桶/便池（70.70%）进行消毒。多因素结果显示文化程度越高、年龄越大、月收入越高和企业人员更多使用口罩和消毒产品。 结论  COVID-19流行期间,居民戴口罩和使用消毒产品的比例较高,但依旧存在误区,文化程度、年龄、职业和月收入对戴口罩和使用消毒产品有影响,应进行针对性的宣传教育。     

面罩与鼻导管在极早产儿稳定期辅助通气中的应用效果比较

目的 比较面罩和鼻导管在极早产儿稳定期辅助通气中的应用效果.方法 接受辅助通气治疗的极早产儿80例,采用序贯入组的方法分为鼻导管组与面罩组,各40例.鼻导管组患儿出生后使用单侧鼻导管进行辅助通气,面罩组患儿出生后使用面罩进行辅助通气,采用呼吸监测仪对患儿的辅助通气压力峰值(PIP)、呼气末正压(PEEP)通气、潮气量、辅助通气呼吸次数、漏气量、大量漏气次数、气道阻塞次数进行测量,并记录出生后第1、5 分钟Apgar 评分、气管插管患儿数、住院期间死亡患儿数,出生第5 分钟心率和氧饱和度.结果 鼻导管组与面罩组患儿呼吸指标比较,PIP,PEEP,平均辅助通气呼吸次数,出生后第1、5 分钟Apgar评分,气管插管患儿数,住院期间患儿死亡率,出生后第1、5 分钟的心率与氧饱和度差异均无统计学意义(P>0.05);鼻导管组患儿平均大量漏气次数为425.11±20.92显著高于面罩组的321.67±17.26,平均漏气量百分比(30.58±9.26)%显著高于面罩组的(14.15±6.76)%,平均气道阻塞次数112.53±13.91显著高于面罩组的46.62±13.04,鼻导管组患儿的平均实际呼气潮气量为(4.62±2.40)mL·kg-1显著低于面罩组的(7.31±2.76)mL·kg-1,均差异有统计学意义(P<0.05).结论 采用面罩进行辅助通气比鼻导管能获得更好的辅助通气指标.其使用方法简单,易于掌握,值得在临床上推广.     

1例人工气道气囊多次破裂的急救与护理

总结1例重症患者人工气道气囊多次破裂的急救与护理。从准确识别气囊破裂、气囊多次破裂急救与护理配合、取出断裂气管软骨后并发症的观察与护理等3个方面总结护理经验。经过积极的治疗与护理,患者住院32 d后,好转出院。     

深麻醉下拔除气管导管辅以SLIPA喉罩替代通气对肺功能异常患者心功能及循环系统的影响

[目的]探讨深麻醉下拔除气管导管辅以SLIPA喉罩替代通气对肺功能异常患者心功能及循环系统的影响.[方法]本院择期行上腹部手术的84例肺功能异常患者,随机分为A、B两组,每组42例,A组保留气管导管通气,清醒后拔管;B组深麻醉下拔管,并予以SLIPA喉罩替代通气,比较两组麻醉诱导前(T0)、切皮时(T1)、拔管或拔除喉罩即刻(T2)、5 min(T3)、10 min(T4)患者心率(HR)、平均动脉压(MAP)、呼吸指数(RI)的变化;血管紧张素Ⅱ(AngⅡ)、皮质醇(Cor)水平及苏醒期并发症发生率.[结果]①T1、T2、T3点B组MAP变化幅度低于A组(P＜0.05),T1、T2点A组RI上升,B组T1点上升、T2点降低,与A组相比较差异有显著性(P＜0.05);B组T1、T2、T3、T4点HR变化幅度低于A组(P＜0.05);②T1点,两组Cor上升、AngⅡ降低,与T0比较差异有显著性(P＜0.05),T2、T3点,A、B组AngⅡ、Cor均上升,B组上升幅度均低于A组(P＜0.05);③B组中度呛咳、苏醒期躁动发生率低于A组(P＜0.05).[结论]肺功能异常上腹部手术患者深麻醉下拔管辅以SLIPA喉罩替代通气,可减轻拔管应激反应,稳定患者循环系统及心功能.