气管切开术的并发症(附213例病例分析)

本文报道了气管切开术各种并发症的发病率,并对术中或术后并发症的病的病因、发病机理、治疗和预防进行了讨论。     

气管切开与呼吸机机械通气抢救有机磷农药中毒致呼吸肌麻痹6例

目的：探讨气管切开与呼吸机机械通气抢救重度有机磷农药中毒（ＡＯＰＰ）致呼吸肌麻痹的疗效。方法：对６例重度ＡＯＰＰ致呼吸肌麻痹患者在综合治疗基础上，及时予气管切开，并使用全能呼吸机机械通气。结果：治愈５例，死亡１例。抢救成功率达８３．３％。结论：对重度ＡＯＰＰ患者及时行气管切开，并使用全能呼吸机机械通气，抢救效果良好。     

Conditioned and unconditioned forelimb reflex systems in the cat: involvement of the intermediate cerebellum

 Temporary inactivation of the cerebellar interposed nuclei was used to assess the role of the intermediate cerebellum in the performance of forelimb cutaneo-muscular reflexes in the cat. The following types of reflexive responses were evaluated: the classically conditioned and unconditioned forelimb withdrawal responses and the forelimb tactile placing, hopping and magnet responses. The experiments tested the hypothesis that the intermediate cerebellum is involved in the performance of all the above forelimb reflexes. The forelimb withdrawal reflex was classically conditioned in a newly developed paradigm in which animals were first operantly conditioned to stand on four elevated platforms. Trained animals were microinjected with a γ-aminobutyric acid (GABA) agonist, muscimol, in the interposed nuclei, and the effects of inactivation of the intermediate cerebellar output on the forelimb reflexes were examined. The main findings of these experiments are that unilateral muscimol inactivation of the interposed nuclei in the cat abolished the expression of the classically conditioned limb flexion reflex, suppressed the performance of the unconditioned withdrawal reflex and, in parallel, downregulated the tactile placing, hopping and magnet postural responses in the ipsilateral forelimb. These observations are inconsistent with concepts indicating exclusive involvement of the intermediate cerebellum in the classically conditioned reflexes elicited by aversive stimuli. On the contrary, they support the hypothesis of a more global involvement of this structure in learned and unlearned defensive flexion reflexes and in automatic postural response systems. Received: 29 July 1996 / Accepted: 26 September 1996     

经皮扩张性气管切开术的临床应用

目的：探讨经皮扩张性气管切开术行气管切开及气道套管插入的方法与效果。方法：在内科ICU病房内，采用一步性扩张气管切开术，对35例患者进行气管切开，同时采用纤维支气管镜对其中l0例患者进行气道内检查。结果：按照操作规程，均完成了气管切开及气管套管的插入，平均操作时间为5．4min．所有患者在带管过程中及拔管后，未发现有气道狭窄的发生，无瘘管或瘘道形成，且创口愈合良好。结论：经皮扩张性气管切开术操作简便易行，值得临床推广使用。     

41例气管切开手术后护理体会

目的:总结气管切开术后护理体会.方法:探讨41例气管切开术后患者的心理护理、并发症的防范和护理要点.结果:2例死于各自原发病,39例患者在术后8～128天内顺利拔管.结论:规范的术后护理对保证气管切开术后效果起着至关重要的作用.     

Cerebellar cortex and eyeblink conditioning: bilateral regulation of conditioned responses

We examined the role of the cerebellum in classical conditioning of the nictitating membrane response (NMR) of rabbits by comparing the effects of unilateral and bilateral cerebellar cortical lesions. Using extended preoperative conditioning to ensure high levels of learning, we confirmed that unilateral lesions of lobules HVI and ansiform lobe impaired conditioned responses (CRs) previously established to an auditory conditioned stimulus, but did not prevent some relearning with post-operative retraining. Bilateral lesions of HVI and ansiform lobe produced similar impairments of CRs, but also prevented subsequent relearning. Unilateral cortical lesions produced significant enhancement of unconditioned response (UR) amplitudes to periorbital electrical stimulation. Bilateral cortical lesions enhanced UR amplitudes to a lesser extent. Because there was no correlation between the degree of CR impairment and UR enhancement across the unilateral and bilateral lesion groups, the suggestion that the lesions impaired CRs due to general effects upon performance, rather than due to losses of learning, is not supported. Both sides of the cerebellar cortex contribute towards learning a unilaterally trained CR. This finding is important for the re-interpretation of unilateral, reversible inactivation studies that have found no involvement of the cerebellar deep nuclei in the acquisition of NMR conditioning. In addition, we found conditioning-dependent modifications of unconditioned responses that were particularly apparent at low intensities of periorbital electrical stimulation. This finding is important for the re-interpretation of studies that have found apparent changes in the UR of conditioned subjects after cerebellar lesions.     

Greater Resistance to Extinction of Electrodermal Responses Conditioned to Potentially Phobic CSs: A Noncognitive Process?

Previous results have suggested that electrodermal responses classically conditioned to potentially phobic CSs (e.g., pictures of snakes or spiders) are highly resistant to extinction and occur largely independently of cognitive expectancies. In order to test stringently for these possibilities, 144 college student subjects were administered differential classical conditioning acquisition and extinction paradigms while expectancies of the shock UCS were closely monitored. Half the subjects had potentially phobic CSs, whereas the other half had neutral CSs. Regardless of type of CS, during acquisition no evidence of electrodermal conditioning was found among subjects unaware of the CS?UCS contingency, nor was conditioning found on the pre-aware trials of subjects who became aware. During extinction, there was significantly greater resistance to extinction of electrodermal responses conditioned to potentially phobic CSs as well as a similar trend with expectancies of the UCS. However, when expectancies were equated, there was no greater resistance to extinction of electrodermal responses conditioned to potentially phobic CSs. Thus, while electrodermal responses conditioned to potentially phobic CSs did exhibit greater resistance to extinction, this conditioning was no more independent of expectancies than is conditioning with neutral CSs.     

Effects of signaled and unsignaled stressor on ECG T-wave amplitude

Thirty-six human subjects were exposed to noise (noxious US) under one of the following signal (CS) conditions: signaled stressor (SS), unsignaled stressor (NS) and a truly random control group (RS). Changes in ECG T-wave amplitude were used to index the stress response and the greatest change in amplitude occurred in the SS group. T-wave amplitude change was compared to HR change as an index of sympathetic stimulation and the former proved the more sensitive. The increased sympathetic responding in the SS condition suggests that a reliable signal may serve a physiologically adaptive purpose.     

The ventral hippocampus and fear conditioning in rats. Different anterograde amnesias of fear after tetrodotoxin inactivation and infusion of the GABA(A) agonist muscimol

Studies on the involvement of the rat hippocampus in classical fear conditioning have focused mainly on the dorsal hippocampus and conditioning to a context. However, the ventral hippocampus has intimate connections with the amygdala and the nucleus accumbens, which are involved in classical fear conditioning to explicit and contextual cues. Consistently, a few recent lesion studies have indicated a role for the ventral hippocampus in classical fear conditioning to explicit and contextual cues. The present study examined whether neuronal activity within the ventral hippocampus is important for the formation of fear memory to explicit and contextual cues by classical fear conditioning. Tetrodotoxin (TTX; 10 ng/side), which completely blocks neuronal activity, or muscimol (1 microg/side), which increases GABA(A) receptor-mediated inhibition, were bilaterally infused into the ventral hippocampus of Wistar rats before the conditioning session of a classical fear-conditioning experiment. Conditioning to a tone and the context were assessed using freezing as a measure of conditioned fear. TTX blocked fear conditioning to both tone and context. Muscimol only blocked fear conditioning to the context. The data of the present study indicate that activity of neurons in the ventral hippocampus is necessary for the formation of fear memory to both explicit and contextual cues and that neurons in the ventral hippocampus that bear the GABA(A) receptor are important for the formation of fear conditioning to a context. In addition, both bilateral muscimol (0.5 microg/side and 1 microg/side) and TTX (5 ng/side and 10 ng/side) infusion into the ventral hippocampus dose-dependently decreased locomotor activity in an open-field experiment.     

Conditioned taste aversion using four different means to deliver sucrose to rats

A solution of sucrose either to be drunk from a drinking tube-self-drinking procedure (SD)-or perfused intraorally as a consequence of nose-pokes-self-administration procedure (SA)-or perfused as a consequence of licking an empty tube (LA)-was paired with an LiCl-induced malaise in rats. The effects were compared to those of a procedure consisting of intraoral administration (IO) of sucrose not contingent to any specific action of the rat. Similar levels of conditioned taste aversion (CTA) were obtained but extinction in the IO procedure was quicker than in the SA procedure, which was itself quicker than in the SD procedure. Extinctions in the IO and LA procedures resembled one another and were quicker than in the SD procedure. A step towards deciding between several explanatory hypotheses of these differences was made by conducting two more experiments. The third experiment was based on reinstatement, or not, of the conditioning procedure for the test after standard IO extinction. CTA was produced only when SD was used both at conditioning and test. A fourth experiment was based on latent inhibition where the procedure was changed, or not, between preexposure and conditioning. Latent inhibition was absent only when the rats had been preexposed to sucrose with the SA procedure and conditioned with the SD procedure.