无创正压通气治疗在急诊中的应用

正压通气是治疗各种原因导致呼吸衰竭的常规、有效的治疗方法。合理应用正压通气治疗急性呼吸衰竭是关键性问题。通过正压通气维持肺泡的开发，纠正低氧血征，有利于避免肺损伤恶化，改善氧合功能避免继发性多器官损害和挽救患者的生命。     

无创与有创通气在COPD并呼吸衰竭的临床应用比较及护理体会

目的:观察无创通气与有创通气治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的临床疗效以及机械通气的合理护理.方法:80例COPD合并Ⅱ型呼吸衰竭患者,应用分层随机化法分为无创组和有创组各40例,两组均给予常规基础治疗.当患者需要机械通气时,无创组给予无创呼吸辅助,治疗效果不佳时更换为有创通气;有创组给予有创呼吸辅助.结果:治疗后两组血气分析结果均有显著改善,有创组改善程度优于无创组,但差异均无显著性(均P>0.05);两组患者死亡率差异无显著性;无创组插管率、住ICU时间、VAP发生率、住院费用较有创组明显降低,差异有显著性.结论:无创通气治疗COPD合并Ⅱ型呼吸衰竭无创伤、疗效确切,缩短住院治疗时间,降低住院费用和VAP发生率,能使部分患者免于气管插管,值得临床广泛应用.机械通气期间的合理护理干预对治疗结果有重要影响.     

急性左心衰应用无创呼吸机的护理体会

急性左心衰发作是常见心血管急症之一,常表现为呼吸困难、胸闷、发绀、血氧饱和度下降、大汗淋漓等肺循环淤血症状,其起病急,病情重,进展快,死亡率高,须紧急救治.近年来,随着多功能呼吸机的使用,使得急性左心衰的病死率大大降低,取得良好的治疗效果.本文对我院2009年8月～2011年5月间使用无创呼吸机治疗的16例急性左心衰患者的治疗与护理体会作如下总结.     

无创呼吸机辅助通气治疗老年肺性脑病患者的护理

总结了老年肺性脑病患者采用无创辅助通气治疗的合理方法.包括:护理中除加强使用呼吸机常规护理外,还应密切观察患者的病情、生命体征、加强气道护理与并发症的护理,给予营养支持、心理干预、健康宣教等.认为老年肺性脑病患者在无创辅助通气治疗时,护理人员应密切观察病情及各项生命体征,并加强呼吸道的管理,积极防治各种并发症,有利于提高无创辅助通气的治疗效果.     

航空摄影测量技术在露天矿山动态监测中的应用

将航空摄影测量技术应用于露天矿山动态监测中,实践证明该技术具有效率高、成本低、精度高和成图快的优势,在矿山采边坡、资源开采、保有资源储量、矿山土地资源利用现状、矿山生态环境和矿山复垦现状等方面的动态监测中具有良好的应用效果。     

三维扫描技术在矿山储量动态监测中的应用探讨

三维激光扫描技术作为一项新兴测绘技术,有效突破了传统地质测绘数据处理的局限性。目前,矿山储量动态监测工作最常见的外业测量方式是全站仪采集,而内业则通过SD法计算矿产资源的储量。因此,分析三维扫描技术的原理,论述其重要性,研究其应用策略、流程以及领域,能够为矿山储量动态监测的自动化发展提供理论指导。     

GPS技术在矿区动态监测中的应用与数据处理研究

利用GPS定位技术进行矿区工程各监测点位置确认,布设GPS动态监测网,对各期观测数据进行统一基准的采集整理,并进行基线解算,确定GPS动态监测网中相应监测点的三维坐标,从而绘制与工程实际情况贴近的数据图,进而完成对矿区的动态数据监测处理。     

全站仪-RTK联合测量技术在井下动态监测中的应用

针对矿山井下动态监测环境复杂,传统测量精度较低的问题,本文结合矿山应用实际案例,提出了全站仪-实时动态RTK联合测量的方式,并在实际应用中取得了良好的应用效果。通过实践表明：全站仪-实时动态RTK联合测量在巷道掘进动态测量中具有效率高、精度高和安全性高的优势,在井下采空区动态监测中具有作业量小、安全性高和精度高的优势。因此,将该技术广泛的应用于矿山实时动态测量中,具有良好的应用前景,可以推广使用。     

无刷无环起动器在梅钢翻车机电机改造中的应用

采用无刷变阻起动器取代传统、繁琐、多触点元件组成的起动装置,节省了安装空间和二次回路电缆,减少起动装置的功率消耗,节省了电能。     

动态技术在PLC中的应用

介绍了动态技术在PLC系统中的使用,避免了因硬件故障而产生的事故,实现硬件故障倒向安全侧的功能.     

165例脑出血患者的临床护理体会

脑出血是脑血管病中比较常见的也是最严重的类型之一,主要是指小动脉、毛细血管破裂等原因引起的原发性而非外伤性的脑实质出血.由于其出血多发生在基底节、内囊和丘脑附近,具有发病率高,病死率高的特点,多数突然发病,病情进展迅速,严重时数分钟或数小时内恶化,并发症较多,除应及时诊断和抢救治疗外,护理工作也是至关重要的.因此,做好脑出血患者护理,对预防出血、减少复发、控制并发症十分重要.     

Prognostic factors in spontaneous intracerebral hemorrhage

The introduction of etiological, diagnostic and therapeutical factors have modified the knowledge on the evolutive behaviour of spontaneous intracerebral hemorrhages (ICH). Mortality and morbidity associated to spontaneous ICH were assessed using as independent variables clinical and neuroimage factors obtained upon admission of the patients. We studied 228 patients with spontaneous ICH selected from a data bank of 277 patients with non-traumatic ICH. During the first 24 hours, we assessed several clinical factors (arterial hypertension, Glasgows Neurological Scale and Barthels Scale) and TC images (size, location, extension of bleeding to ventricles, edema and atrophy). Thirty-one per cent of the patients died during the first 2 months. The multiple linear regression study showed that mortality was related to variables of the Glasgows Neurological Scale upon admission, extension to ventricles, size of ICH and perilesional edema, whereas the morbidity was only related to the size of the hemorrhage. Severity of the clinical affection, extension of the bleeding to ventricles, size of the hemorrhage and presence of perilesional edema, but not arterial hypertension, were the main factors affecting mortality at two months of spontaneous ICH.     

Liver dysfunction in spontaneous intracerebral hemorrhage

The purpose of this study was to investigate the relationship between mild degrees of liver dysfunction and spontaneous intracerebral hemorrhage (ICH) from the hemostatic standpoint. A detailed study of hemostatic systems was made in 462 patients with ICH. To compare ICH with the other cerebrovascular diseases, data from 120 patients with subarachnoid hemorrhage and 114 others with cerebral infarction were reviewed. At admission, the medical histories of the patients, including information about previous alcohol consumption, was taken, and blood samples were collected to perform the following studies: platelet count, fibrinogen level, prothrombin time, activated partial thromboplastin time, antithrombin III, plasminogen and alpha 2-antiplasmin activity, platelet aggregability, and liver function tests. The incidence of liver dysfunction and alcohol consumption in patients with ICH was significantly (P < 0.05) higher than in patients with subarachnoid hemorrhage and in those with cerebral infarction. Hematoma volume, mortality rate, and past alcohol consumption in patients with ICH significantly increased with worsening severity of liver dysfunction. Although almost all hemostatic parameters became worse with increasing severity of liver dysfunction, they changed within the normal limits. Platelet aggregability and alpha 2-antiplasmin activity in patients with liver dysfunction were remarkably deteriorated beyond normal limits. In conclusion, liver dysfunction associated with alcohol consumption appears to be an important factor in the deterioration of the clinical status of patients with ICH and may be one of the causative factors in the development of ICH. Although mildly impaired hemostatic systems may be partially responsible for these adverse effects of liver dysfunction on ICH, it seems probable that nonhemostatic mechanisms are attributed to the effects.     

C-type hepatitis in spontaneous intracerebral hemorrhage

The prevalence of hepatitis C virus (HCV) in 139 cases of spontaneous intracerebral hemorrhage (ICH) was investigated with regard to a diagnosis of hypertension. Patients under 30 and over 79 years of age were omitted from this study, and those with complicating malignancies and undergoing anti-coagulation or antiplatelet therapy were also excluded. The prevalence of HCV was significantly higher among the ICH group as a whole (19 out of 139 cases, p < 0.05) especially in the non-hypertensive group (7 out of 29 cases, p < 0.01), compared to the control group (7 out of 140 cases without ICH). The non-hypertensive HCV-positive group (7 cases) had significantly higher GOT and GPT levels, prolonged PT and a-PTT values, and lower platelet counts, compared to the hypertensive HCV-negative group (74 cases). The HCV antibody titers did not differ among the HCV-positive groups. The results suggest that chronic hepatitis due to HCV infection is a major risk factor for spontaneous intracerebral hemorrhage, especially in non-hypertensive patients.     

Auditory and somatosensory evoked potentials in coma following spontaneous cerebral hemorrhage: early prognosis and outcome

Hereditary hemorrhagic telangiectasia (HHT), or Rendu-Osler-Weber disease, is an autosomal dominant disorder of localized angiodysplasia, although it is sometimes mistakenly identified as a hemostatic disorder due to its associated characteristic bleeding. The vascular lesions that develop consist of direct arteriovenous connections without an intervening capillary bed. Germline mutations in one of two different genes, endoglin or ALK-1, can cause HHT. Both are members of the transforming growth factor (TGF)-beta receptor family of proteins, and are expressed primarily on the surface of endothelial cells. They are associated together in a receptor complex on the cell surface. Biochemical studies suggest that endoglin modulates TGF-beta signaling through ALK-1 and the type I TGF-beta receptor. Most mutations identified in endoglin and ALK-1 create null alleles, which lead to reduced message or protein levels. A model of haploinsufficiency is proposed, in which inheritance of a mutation predisposes an individual to develop HHT-associated vascular lesions. The factors that initiate lesion formation are unknown, but disruption of these genes in mice should provide animal models to address these and other important questions about the pathogenesis of HHT.     

无创辅助通气治疗人机对抗的原因分析及护理干预

目的:寻找有效的护理干预方法来减少无创辅助通气治疗中的人机对抗.方法:根据92例慢性阻塞性肺疾病急性加重期合并呼吸衰竭行无创辅助通气治疗的患者共出现的228次人机对抗的临床资料,分析了产生人机对抗的原因,并根据不同的原因,提出了护理干预的方法.结果:发现相关的护理干预方法能有效的减少人机对抗,提高治疗效果.     

Prevalence of risk factors in spontaneous intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage

OBJECTIVE: To evaluate whether differences exist in the occurrence of modifiable risk factors between aneurysmal subarachnoid hemorrhage and spontaneous intracerebral hemorrhage, since these stroke subtypes have frequently been combined in epidemiological studies and labeled hemorrhagic stroke. DESIGN: Cross-sectional survey. SETTING: Helsinki University Central Hospital in Helsinki, Finland. PATIENTS: One hundred fifty-six consecutive patients with spontaneous intracerebral hemorrhage aged 16 to 60 years (96 males and 60 females) and 281 patients with aneurysmal subarachnoid hemorrhage (145 males and 136 females) who were admitted to an emergency department. MAIN OUTCOME MEASURES: Prevalence of several health habits, previous diseases, and medication of patients with spontaneous intracerebral hemorrhage were compared with that of patients with subarachnoid hemorrhage using multiple logistic regression. RESULTS: Hypertension (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.6-4.3), diabetes mellitus (OR, 26.4; 95% CI, 3.1-221.6), alcohol intake within the preceding week (for 1-150 g of alcohol: OR, 2.0; 95% CI, 1.1-3.6; for 151-300 g of alcohol: OR, 1.7; 95% CI, 0.8-3.8; and for > 300 g of alcohol: OR, 4.4; 95% CI, 2.1-9.1), and anticoagulant treatment (OR, 21.8; 95% CI, 2.3-207.3) were all significantly more common, but current cigarette smoking (OR, 0.3; 95% CI, 0.2-0.5) was less common in patients with intracerebral hemorrhage than in those with subarachnoid hemorrhage simultaneously after adjustment for sex, age, and body mass index. In males, hypertension (OR, 2.3; 95% CI, 1.1-4.5) and alcohol intake (for > 300 g/wk: OR, 5.8; 95% CI, 2.2-15.7) were more common, but current smoking (OR, 0.2; 95% CI, 0.1-0.4) was less common in patients with intracerebral hemorrhage than in those with subarachnoid hemorrhage after adjustment for age, body mass index, and diabetes mellitus. In females, hypertension (OR, 2.9; 95% CI, 1.4-5.8) and anticoagulant treatment (OR, 10.0; 95% CI, 1.0-100.2) were more common in patients with intracerebral hemorrhage after adjustment for age and body mass index. In univariate statistics, patients with intracerebral hemorrhage were also older, more often had previous symptoms of cerebral ischemia, and had higher values for body mass index and gamma-glutamyltransferase than did those with subarachnoid hemorrhage. CONCLUSIONS: Hypertension, diabetes mellitus, anticoagulant treatment, and amount of alcohol taken within 1 week seem more commonly to be associated with intracerebral hemorrhage than with subarachnoid hemorrhage, which is, however, associated more frequently with cigarette smoking.     

舒适护理在肺癌化疗患者中的应用

对142例肺癌化疗患者从生理、心理、环境等方面提供舒适护理,结果增强了患者与护士之间的亲密关系,为患者顺利进行化疗提供了保障.     

脑梗塞患者的心理干预及社区护理体会

目的:通过对84例脑梗塞患者实施心理护理尝试,促进社区护理发展.方法:在患者住院期间有所准备,出院时进行指导,出院后定期访视以及家属密切配合,解决康复期间所有身心问题.结果:84例患者意识清晰,无并发症发生,心理调适好,改变了不良行为习惯,建立了正确的生活方式.护士增强了工作责任心,进一步改善了在群众中的形象.结论:开展社区护理势在必行.