儿童上呼吸道软组织手术全身麻醉术后拔管期呼吸道不良事件的临床观察

目的:探讨儿童上呼吸道软组织手术全身麻醉术后拔管期呼吸道不良事件的发生情况。方法:选取收治的手术患儿180例,观察组和对照组各90例,两组患儿分别采用不同的全身麻醉手术方法,比较两组患儿呼吸道不良事件发生率及血气分析。结果:观察组患儿呼吸道不良事件发生率显著高于对照组,差异有统计学意义(P<0.05)。结论:儿童上呼吸道软组织手术全身麻醉术后拔管期不良事件的发生率较高,应采取积极有效的应对方法,使患儿平稳渡过拔管期。     

An evaluation of the impact of a tracheostomy weaning protocol on extubation time

Background:  To avoid the possible complications of prolonged intubation, it is necessary and advisable to attempt weaning from the tracheostomy tube at the earliest opportunity. However, while weaning protocols have proven successful in reducing ventilation time of critical care patients, there is little evidence of their use and impact on tracheostomy tube weaning time.
Aims:  This pilot study sought to determine if the introduction of a new tracheostomy weaning protocol would reduce the time to extubation of the tracheostomy.
Method:  A quasi-experimental design used two groups of patients. A retrospective control group of patients ( n  = 20) who had been weaned using standard practice were identified by a search of medical records. A prospective experimental group ( n  = 20) had care planned using a new tracheostomy weaning protocol. Data relating to time to extubation were collected on both groups who were all patients in an eight-bedded Critical Care Unit of a District General Hospital. The same inclusion and exclusion criteria were applied to both groups.
Results:  The results revealed a reduction of 1·35 days from commencement of weaning to extubation in the prospective (experimental) group. This was not statistically significant ( P  = 0·181)
Conclusion:  Although the findings from the study were not statistically significant, they can be seen as clinically significant in terms of patient comfort and reduced dependency in care by a reduction of time with a tracheostomy. It is recommended that a larger scale study be carried out to determine if a tracheostomy weaning protocol does make an impact on length of time to extubation in wider care settings.     

肝癌术后中心静脉置管拔管困难原因分析及对策

目的：探讨肝癌术后患者中心静脉置管拔除困难的原因及对策。方法对6例拔管困难患者,根据不同原因所致拔管困难采取适当的预防与处理措施。结果本组6例拔管困难患者均成功拔管。结论为降低拔管困难的发生率,应充分认识、正确分析拔管困难的原因,评估危险因素,积极寻求有效措施。发生拔管困难的常见原因为血管痉挛和血管收缩、血栓性静脉炎、穿刺损伤、感染。提高置管人员的操作水平,严格执行无菌操作,置管期间正确封管,拔管前,向患者作好解释,发生拔管困难时,暂停拔管,积极处理危险因素,是成功拔管的关键。     

Weaning From Mechanical Ventilation in Paediatrics. State of the Art

Weaning from mechanical ventilation is one of the greatest volume and strength issues in evidence-based medicine in critically ill adults. In these patients, weaning protocols and daily interruption of sedation have been implemented, reducing the duration of mechanical ventilation and associated morbidity. In pediatrics, the information reported is less consistent, so that as yet there are no reliable criteria for weaning and extubation in this patient group. Several indices have been developed to predict the outcome of weaning. However, these have failed to replace clinical judgment, although some additional measurements could facilitate this decision.     

主动呼吸循环技术对机械通气拔管患者自主咳痰能力恢复的效果评价

目的探讨主动呼吸循环技术对拔管患者恢复自主咳痰能力的效果。方法将75例拔管后咳痰无力或无效咳痰患者随机分为两组,对照组35例进行常规治疗,试验组40例在常规治疗基础上进行主动呼吸循环技术功能锻炼,观察两组患者自主咳痰能力、首次排痰时间、排痰量及痰鸣音情况、氧分压(PaO2)、二氧化碳分压(PaCO2)、再次插管率及初次拔管后住院天数等。结果与对照组患者比较,试验组患者在很短时间内恢复自主咳痰能力,首次排痰量明显多于对照组,患者呼吸音改善,肺部感染好转,两组间比较差异有统计学意义(P0.05);对照组患者再次插管率明显高于试验组患者,初次拔管后住院天数明显多于试验组患者,差异有统计学意义(P0.05)。结论主动呼吸循环技术有助于初次拔管患者恢复自主咳痰能力,保持呼吸道通畅,避免CO2潴留,防止分泌物坠积所致肺不张和肺炎,有效降低再次插管率,促进肺功能的恢复。     

颌面头颈外科术后气道管理困难的手术因素分析

目的: 探讨影响颌面头颈外科手术术后发生气道管理困难的手术因素。 方法: 对我院2015年1月—12月间的180例颌面头颈外科术后带人工气道入SICU患者进行回顾分析。根据手术类型分为3组,即肿瘤切除术组（60例）、先天性畸形矫正术组（60例）和创伤手术组（60例）。使用SPSS 13.0软件包对各组围术期资料进行χ²检验和t检验,筛选差异指标。 结果: 肿瘤切除术组手术和麻醉时间较另外2组长（P<0.05）,需行清醒气管插管比例高（P<0.05）,术中出血量多（P<0.05）,术后带管时间较长（P<0.05）。创伤手术组镇静不足、躁动发生率较另外2组高（P<0.05）。 结论: 颌面头颈外科手术患者因局部解剖结构改变,出血、水肿压迫气道等原因,气道梗阻风险较高,给予适度的镇静、镇痛,保留气管插管并延迟拔管,可以避免发生严重并发症。     

ICU气管插管患者非计划拔管危险因素的Meta分析

目的明确ICU气管插管患者非计划拔管的危险因素。方法检索Web of Science、Embase、PubMed、中国知网、中国生物医学文献数据库、万方和维普等数据库2010年1月1日-2020年12月31日有关ICU气管插管非计划拔管危险因素的队列研究或病例对照研究,由两名研究人员独立进行文献筛选、资料提取以及文献质量评价。使用RevMan 5.3统计软件对纳入文献进行Meta分析。结果共纳入文献12篇,样本量为5 372例。Meta分析结果显示,年龄较小(WMD=-6.37)、男性(OR= 2.21)、镇静不足(OR=4.54)、RASS评分>-2分(OR=10.37)、Ramsay评级一二级(WMD=-1.05)、未使用身体约束(OR=5.35)、夜班(OR=3.31)、患有呼吸系统疾病和充血性心力衰竭(OR=2.34)、谵妄(OR=7.19)、更高的GCS评分(WMD=1.42)、心率过快（＞100次/分）(SMD=0.45)和机械通气时长(WMD=-2.31)等是ICU气管插管患者非计划拔管危险因素。结论通过Meta分析结果,可以构建ICU气管插管患者UEE风险预测模型,对患者进行危险因素分级,识别并管理高危患者,从而科学管理管路。     

Effects of landiolol on the cardiovascular response during tracheal extubation

The objective of this study was to investigate the effect of landiolol on the cardiovascular responses to emergence from anesthesia and tracheal extubation. Fifty-nine patients without cardiovascular disorders who were scheduled for tympanoplasty were randomly allocated to receive a loading dose of landiolol at 0.125 mg x kg(-1) x min(-1) for 1 min, followed by an infusion at 0.01 mg x kg(-1) x min(-1) (group L1), 0.02 mg x kg(-1) x min(-1) (group L2), 0.03 mg x kg(-1) x min(-1) (group L3), or 0.04 mg x kg(-1) x min(-1) (group L4). At the end of surgery, sevoflurane and nitrous oxide were discontinued, and landiolol was started. The mean arterial pressure (MAP), heart rate (HR), and rate pressure product (RPP) in the four groups were compared before anesthesia induction, just after extubation, 5 min after extubation, 10 min after extubation, and at discharge from the operating room. Just after extubation compared with the baseline, the MAP increased significantly in all groups; the HR increased in groups L1 and L2; and the RPP increased in all groups, except for group L4. Continuous administration of landiolol, at 0.03 or 0.04 mg x kg(-1) x min(-1), may prevent the increases in HR and RPP, respectively, that occur at the emergence from anesthesia and tracheal extubation.     

艾司洛尔对拔管期血流动力学的影响

目的 :观察艾司洛尔不同给药方式对拔管期血流动力学的影响。方法 :将 45例ASAI～Ⅱ级择期全麻手术病人随机分成三组 (每组 15例 )。A组在拔管前 12 .8± 4.5min开始用微量泵持续给予艾司洛尔 2 0 0 μg/kg/min。B组在拔管前2min静注艾司洛尔 1.5mg/kg。C组为对照组。 结果 :A、B两组用艾司洛尔后与C组比较HR、SBP、RPP均有明显降低 (P <0 .0 5 )。而B组在停麻药到拔管各指标变化与C组相似 (P >0 .0 5 )。结论 :持续给予艾司洛尔更能有效保持拔管期血流动力学的稳定