纤维支气管镜下球囊扩张术治疗26例结核性支气管狭窄的临床分析

目的：探讨经纤维支气管镜球囊扩张治疗结核性支气管狭窄的临床价值。方法：对2005年10月～2006年11月在我院就诊的26名结核性支气管狭窄患者，在内镜直视下进行球囊扩张治疗，并在术前和最后一次球囊扩张治疗后当天对狭窄段气道直径，气促评分和第一秒用力呼气容积（FEV1）进行测定。结果：经纤维支气管镜球囊扩张后临床症状明显缓解，狭窄段直径明显增大（P〈0．01），气促评分明显降低（P〈0．01），术后FEV1明显上升（P〈0．01）。结论：纤维支气管镜下球囊扩张治疗结核性支气管狭窄能明显改善肺通气功能，缓解气促症状，是一种简单、安全、有效的治疗方法。     

鼻饲泵泵入与注射器注入混合奶对昏迷患者大便次数的影响比较

目的探讨昏迷患者用鼻饲泵泵入和用注射器注入混合奶2种进食方法对大便次数的影响。方法对50例术后昏迷留置胃管的患者随机分为实验组和对照组2组,每组各25例。使用上述2种方法进食进行比较。结果鼻饲泵泵入法比用注射器注入法进食的患者的大便次数显著减少。结论对于长期卧床昏迷的患者来说,使用鼻饲泵泵入法进食是既科学又值得推广的方法。     

两种人工气道气囊管理方法的临床效果观察

目的探讨更合适于人工气道气囊管理的方法,提高护理质量。方法将60例机械通气患者随机分为2组,最小封闭压力组采用气囊最小封闭压力,定时放气组采用传统方法:气囊放气-充气1次/4h,并对潮气量、SaO2、PEEP和并发症如痰阻、刺激性咳嗽等指标进行观察。结果最小封闭压力组在维持潮气量和SaO2稳定均优于定时放气组(P<0.05),维持PEEP值和减少刺激性咳嗽发生率均优于定时放气组(P<0.005),痰阻发生率低于定时放气组(P<0.05),采用气囊最小封闭压力无1例气管黏膜损伤。结论使用气囊最小封闭压力管理人工气道气囊,有利于机械通气治疗顺利进行,减少病人不适。     

静脉自控镇痛泵在剖宫产术后的应用及护理

[目的] 观察静脉自控镇痛泵镇痛与肌肉注射镇痛药的镇痛效果、不良反应和剖宫产术后48 h内母乳喂养时间、睡眠时间及第1次排气时间,总结护理对策.[方法] 将180例剖宫产术后产妇随机分为两组,实验组90例,产妇术后用自控镇痛泵镇痛,对照组90例,产妇术后实行肌肉注射镇痛药的方法镇痛,采用相应护理措施.[结果]实验组疼痛明显减轻,与对照组比较差异有统计学意义(P＜0.01);实验组恶心、呕吐、头痛、头晕、尿潴留等不良反应明显少于对照组(P＜0.05);实验组48 h内母乳喂养时间和睡眠时间明显多于对照组(P＜0.01),实验组术后第1次排气时间明显短于对照组(P＜0.01).[结论] 静脉自控镇痛泵镇痛明显优于肌肉注射镇痛法.     

Brazilian Intragastric Balloon Consensus Statement (BIBC): practical guidelines based on experience of over 40,000 cases

Background

Intragastric balloons (IGBs) are a minimally invasive option for obesity treatment, acting as a space-occupying device and leading to weight loss through increased satiety. This device has been growing in popularity owing to its safety profile and good weight loss results. However, there are no published guidelines that standardize the technical aspects of the procedure.

二尖瓣球囊成形术前后心电图PtfV1的改变及意义

目的：研究风湿性心脏病（风心病）二尖瓣狭窄患者二尖瓣球囊成形术（ＰＢＭＶ）前后心电图ＰｔｆＶ１的改变及其与血流动力学、二维超声心动图的相关性。方法：测定２４例风心病患者ＰＢＭＶ前后心电图ＰｔｆＶ１、血流动力学和二维超声心动图参数并作相关分析。结果：ＰｔｆＶ１术后较术前明显降低（Ｐ＝０．０１３），手术前后ＰｔｆＶ１与血流动力学及二维超声心动图参数均无明显相关性。结论：心电图ＰｔｆＶ１可作为术后血流动力学改善的无创性指标之一，ＰｔｆＶ１在风心病二尖瓣狭窄中的异常可能是多种因素共同影响所致     

妇科手术后病人静脉输注曲马多与硬膜外自控镇痛的效果比较

[目的 ]寻找妇科病人手术镇痛的最佳方法 ,减少妇科手术后病人的并发症。 [方法 ]将妇科开腹手术病人 10 0例 ,随机分为对照组和实验组各 5 0例 ,对照组在硬膜外麻醉手术后带硬膜外穿刺管入病房维持 48h ,实验组手术后给予曲马多静脉输注并维持 2 4h ,并根据病人的疼痛感调节滴数。运用“0～ 10”疼痛量表对病人术后 12h、2 4h、48h进行镇痛效果评估 ,同时记录镇痛后尿潴留、恶心呕吐、呼吸抑制等并发症的发生率。 [结果 ]两组病人术后镇痛效果无统计学意义。但实验组副反应发生率明显少于对照组。 [结论 ]妇科术后病人运用静脉输注曲马多镇痛效果与PCEA法相似 ,但并发症明显减少 ,有利于术后病人的早期康复     

Pulmonary Valve Opening With Two Rotary Left Ventricular Assist Devices for Biventricular Support

Right ventricular failure is a common complication associated with rotary left ventricular assist device (LVAD) support. Currently, there is no clinically approved long‐term rotary right ventricular assist device (RVAD). Instead, clinicians have implanted a second rotary LVAD as RVAD in biventricular support. To prevent pulmonary hypertension, the RVAD must be operated by either reducing pump speed or banding the outflow graft. These modes differ in hydraulic performance, which may affect the pulmonary valve opening (PVO) and subsequently cause fusion, valvular insufficiency, and thrombus formation. This study aimed to compare PVO with the RVAD operated at reduced speed or with a banded outflow graft. Baseline conditions of systemic normal, hypo, and hypertension with severe biventricular failure were simulated in a mock circulation loop. Biventricular support was provided with two rotary VentrAssist LVADs with cardiac output restored to 5 L/min in banded outflow and reduced speed conditions, and systemic and pulmonary vascular resistances (PVR) were manipulated to determine the range of conditions that allowed PVO without causing left ventricular suction. Finally, RVAD sine wave speed modulation (±550 rpm) strategies (co‐ and counter‐pulsation) were implemented to observe the effect on PVO. For each condition, outflow banding had higher PVR (97 ± 20 dyne/s/cm⁵ higher) for when the pulmonary valve closed compared to reduced speed. In addition, counter‐pulsation demonstrated greater PVO than co‐pulsation and constant speed. For the purpose of reducing the risks of pulmonary valve insufficiency, fusion, and thrombotic event, this study recommends a RVAD with a steeper H‐Q gradient by banding and further exploration of RVAD speed modulation.     

经皮二尖瓣球囊扩张术治疗风湿性二尖瓣狭窄患者长期疗效

目的　评价经皮二尖瓣球囊扩张术 (PBMV)后远期疗效。方法　对 10 7例患者接受PBMV术治疗后进行随访 ,包括超声心动图和临床心功能评价 ,平均随访时间 (5 .3± 1.6 )年。结果　超声心动图的术前、术后 7天内、随诊的二尖瓣面积、左房内径、二尖瓣跨瓣压力阶差分别为 (1.0 4± 0 .2 1)mm2 、(4 6± 6 )mm、(18± 7)mmHg(1mmHg=0 .133kPa) ;(1.73± 0 .2 7)mm2 、(4 4± 8)mm、(8± 4 )mmHg ;(1.6 3± 0 .2 4 )mm2 、(38± 6 )mm、(10± 4 )mmHg。术前与术后 7天内相比P <0 .0 1,术前与随访相比P <0 .0 1,再狭窄率为 10 % ,心功能改善并维持Ⅰ、Ⅱ级有 86 .9%(93例 )。结论　PBMV治疗风心病二尖瓣狭窄的远期效果良好 ,未见严重并发症。     

Percutaneous balloon kyphoplasty for the treatment of very severe osteoporotic vertebral compression fractures: a case-control study

Background Context

Controversy exists regarding percutaneous balloon kyphoplasty (PBK) in patients with a very severe osteoporotic vertebral compression fracture (vsOVCF).