气管插管全麻术中预防气道感染的临床研究

目的观察一次性病毒/细菌过滤器在气管插管全麻术中预防气道感染的应用价值,为临床预防策略的制定提供参考。方法选择2011年3月-2013年3月接受气管插管全麻手术的患者76例,按照随机数字表法将其分为观察组和对照组各38例;观察组应用一次性病毒/细菌过滤器,而对照组则未用,分别在麻醉前和手术结束时用无菌棉签采集麻醉机呼气端、吸气端表面标本行细菌学检测;在手术结束时收集钠石灰罐底部10g钠石灰行细菌学检测,对比两组患者的检测结果和术后24h内气道感染发生率。结果两组患者在麻醉开始前麻醉机呼气端、吸气端细菌学培养结果均为阴性;手术结束时,麻醉机吸气端、呼气端和钠石灰的细菌学培养阳性率均为0,对照组分别为5.26%、42.11%和15.79%,观察组细菌培养阳性率均显著低于对照组,差异有统计学意义(P<0.05);术后24h内气道感染发生率观察组为2.63%,显著低于对照组的18.62%,差异有统计学意义(P<0.05)。结论麻醉机气管插管全麻可增加患者气道感染的机会,通过一次性病毒/细菌过滤器、及时更换钠石灰等措施,可有效预防气道感染的发生。     

Understanding and improving airway management in companion animals - part 1

Airway Management, briefly taught within the veterinary nursing curriculum, is performed many times a day and a vital part of the anaesthesia process. Students are shown how to place an endotracheal tube, taught little about dead-space and airway resistance but, although there are many publications on the pitfalls of intubation, it is often sub-optimally managed in a busy clinic. To provide excellent, safe airway management for our patients, we must understand the history, mechanics and pitfalls about the process: It is only then can we truly apply better techniques in order to improve both care and safety to our patients.     

机械通气患者气管内吸痰的研究进展

随着医学技术的发展,应用呼吸机机械通气进行生命支持、治疗呼吸衰竭已成为一种常规手段。人工气道的建立使下呼吸道直接与外界相通,咳嗽反射受抑制,咳痰能力丧失,因此气管内吸痰成为清除气道内分泌物的重要方法。但呼吸机相关并发症逐渐引起医护人员的重视,其中最常见的是呼     

Major complications of airway management: a prospective multicentre observational study

We conducted an observational study of serious airway complications, using similar methods to the fourth UK National Audit Project (NAP4) over a period of 1 year across four hospitals in one region in the UK. We also conducted an activity survey over a week, using NAP4 methods to yield an estimate for relevant denominators to help interpret the primary data. There were 17 serious airway complications, defined as: failed airway management leading to cancellation of surgery (eight); airway management in recovery (five); unplanned intensive care admission (three); and unplanned emergency front of neck access (one). There were no reports of death or brain damage. This was an estimate of 0.028% (1 in 3600) complications using the denominator of 61,000 general anaesthetics per year in the region. Complications in patients with ‘predicted easy’ airways were rare (approximately 1 in 14,200), but 45 times more common in those with ‘predicted difficult’ airways (approximately 1 in 315). Airway management in both groups was similar (induction of anaesthesia followed by supraglottic airway or tracheal tube). Use of awake/sedation intubation, videolaryngoscopy and high-flow nasal oxygenation were uncommon even in the predicted difficult airway patients (in 2.7%, 32.4% and 9.5% of patients, respectively). We conclude that the incidence of serious airway complications is at least as high as it was during NAP4. Despite airway prediction being used, this is not informing subsequent management.     

镀银气管导管对呼吸机相关性肺炎影响的荟萃分析

目的 评价镀银气管导管,对预防机械通气患者呼吸机相关性肺炎(VAP)的效果.方法 电子检索Cochrane图书馆、PubMed、EMbase、ScienceDirect、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库等,各数据库检索时间均从创建到2011年8月；纳入镀银气管导管对预防机械通气患者VAP效果的随机对照试验(RCT);采用RevMan5软件进行荟萃分析,对于无法转换合并的数据,采用描述性分析.结果 共纳入3个RCT、2127例患者,文献异质性较小；荟萃分析结果表明,镀银气管导管可显著降低VAP的发生率[固定效应模型,OR=0.59,95 ％CI(0.41,0.84),P=0.005]、死亡率和负面事件等方面两组差异无统计学意义;住院时间、住ICU时间、气管插管时间、临床肺感染指数及呼吸道细菌浓度等指标,由于数据难以转换及难以获取完整数据等原因未能做荟萃分析,只进行描述性分析,显示两组在上述指标方面差异无统计学意义.结论 与标准非镀银气管导管相比,镀银气管导管能显著降低机械通气患者VAP的发生率,而对患者死亡率及负面事件发生率等指标无明显改善；需要进行更多设计严格的、多中心、大样本随机对照试验,对镀银气管导管的综合效果进行验证.     

Prospective randomized controlled trial evaluating cap-assisted colonoscopy vs standard colonoscopy

AIM: To study the significance of cap-fitted colonoscopy in improving cecal intubation time and polyp detection rate. METHODS: This study was a prospective randomized controlled trial conducted from March 2008 to February 2009 in a tertiary referral hospital at Sydney. The primary end point was cecal intubation time and the secondary endpoint was polyp detection rate. Consecutive cases of total colonoscopy over a 1-year period were recruited. Randomization into either standard colonoscopy (SC) or cap-assist...     

可视喉镜联合纤维支气管镜在声门显露困难患者双腔支气管插管中的应用

目的探讨GlideScope可视喉镜联合纤维支气管镜引导在声门显露困难患者双腔支气管插管中的应用。方法选择择期行胸科手术患者40例,男24例,女16例,年龄24~78岁,ASAⅠ或Ⅱ级,MallampatiⅢ或Ⅳ级,随机分为GlideScope可视喉镜组(GF组)和Macintosh喉镜组(M组),每组20例。GF组运用可视喉镜联合纤维支气管镜引导进行支气管插管及对位;M组运用传统方法(先用Macintosh喉镜插管,再使用纤维支气管镜对位)。记录患者喉镜下声门显露程度Cormack-Lehane分级、插管时间、插管一次成功率、需喉部按压的患者例数以及术后48h内的声音嘶哑及咽痛情况。结果GF组Cormack-Lehane分级明显低于M组(P0.01)。GF组插管时间明显短于M组[(104.3±11.1)s vs.(138.6±33.0)s](P0.01),一次插管成功率明显高于M组(90%vs.55%)(P0.05),需要喉部按压患者比例明显低于M组(20%vs.90%)(P0.01),术后声音嘶哑和咽痛的发生率明显低于M组(5%vs.35%,25%vs.75%)(P0.05)。结论与传统方法比较,可视喉镜联合纤维支气管镜引导用于声门显露困难患者可以提高插管的成功率,减少插管时的应激反应,降低声嘶和咽痛的发生率。     

经股动脉插管超选择肾动脉栓塞治疗顽固性血尿（附13例报告）

目的：探讨经股动脉超选择插管动脉栓塞术治疗各种原因引起的顽固性血尿临床疗效。方法回顾性分析13例经内科药物治疗无效的顽固性血尿患者经股动脉超选择插管肾动脉或髂内动脉栓塞（或同时化疗药灌注）的临床资料。结果13例患者中5例晚期未手术膀胱癌,2例膀胱癌术后,2例经皮肾镜取石,2例晚期肾癌（后证实为1例肾结核）,1例移植肾出血,1例阴茎海绵体血管瘤伴动脉畸形出血;术后1～3 d完全或基本止血,2例无效（1例通过抗结核4d止血1例膀胱全切双肾造瘘尿道残端出血未能止血）。结论经股动脉插管行动脉栓塞术治疗各种顽固性血尿有显著疗效。