床边纤维支气管镜吸痰及支气管灌洗的护理配合

总结了重度颅脑损伤并发肺部感染应用纤支镜在床边吸痰及支气管灌洗术的护理配合,包括术前准备、术中配合、术后护理等.认为良好的护理配合能明显减轻患者肺部感染,改善肺通气功能,使低氧血症得到纠正,有效提高患者的生活质量.     

大容量全肺灌洗术的护理体会

尘肺病是严重的职业危害之一,是指由于在职业活动中长期吸入生产性粉尘,并在肺内滞留而引起的以肺组织弥漫性纤维化为主的全身性疾病[1].大容量全肺灌洗术(Massive Whole-Lung Lavage,WLL)是针对尘肺病的一种有效治疗方法.     

支气管肺泡灌洗术治疗婴幼儿重症肺炎应用效果观察

ICU肺部严重感染患儿,因其免疫功能和咳嗽反射较差,常合并其它系统的疾病,极易出现肺部感染加重、肺不张等情况,使病情恶化,增加住院时间和费用.纤维支气管镜因可直接冲洗支气管中分泌物、减轻肺不张、缓解肺部急症等优点,目前已广泛应用于成人以及大龄儿童肺部感染,但在婴幼儿重症肺炎中应用及疗效等情况目前报道颇少.     

重症社区获得性肺炎患者行肺泡灌洗联合肺吹气治疗的护理

总结了62例重症社区获得性肺炎患者行肺泡灌洗联合肺吹气治疗的护理措施,包括术前心理护理、术中体位、配合插镜、灌洗、肺吹气护理、术后护理等.认为肺泡灌洗联合肺吹气治疗能使重症肺炎患者炎症病灶完全吸收,配合精心护理,能促进患者早日康复.     

无创通气联合支气管肺泡灌洗对COPD合并肺部感染和Ⅱ型呼吸衰竭患者的疗效

目的:探讨无创通气联合支气管肺泡灌洗对COPD合并肺部感染和Ⅱ型呼吸衰竭患者的疗效.方法:50例不需立即有创机械通气治疗的COPD合并肺部感染和Ⅱ型呼吸衰竭患者,随机分为对照组26例和灌洗组24例.对照组行常规治疗及无创正压通气(NIPPV);灌洗组在对照组治疗基础上行支气管肺泡灌洗(BAL).观察两组在治疗前后各项指标变化及疗效.结果:血气分析同组内治疗前后比较差异有统计学意义(P<0.01),两组间比较差异有显著性(P<0.01);第4天灌洗组WBC、中性粒细胞率、CRP水平较对照组明显降低(P<0.01);灌洗组细菌培养阳性率及观察第7天X线示胸片炎性病变吸收率均明显高于对照组(P<0.01);灌洗组有创通气上机率、住院时间明显低于对照组(P<0.05),治愈率明显高于对照组(P<0.05),两组病死率差异无统计学意义(P＞0.05),两组均无严重并发症.结论:对不需立即行持续有创通气治疗的COPD合并肺部感染和Ⅱ型呼吸衰竭患者,无创通气联合BAL治疗较安全,临床疗效确切,值得临床推广应用.     

简易床边吞水测试在吞咽困难患者中的临床应用及护理

总结了简易床边吞水测试在40例患者中的应用效果,包括制定简易床边吞水测试的排除标准、纳入标准、判断标准及流程,对吞咽障碍患者采取安全进食程序的护理,认为简易床边吞水测试可作为临床上评估患者是否存在吞咽困难的工具;可作为留置鼻胃管患者拔管的指征;可体现"发展专科护理,建立临床专科护理队伍"的现代护理专业发展方向.     

支气管动脉栓塞术治疗大咯血的几例临床护理体会

目的:观察支气管动脉栓塞术治疗肺结核大咯血的临床价值,提高大咯血抢救的成功率.同时通过护理观察及研究,及时发现病情变化,积极对症处理,促进患者康复.     

流程再造在围术期麻醉护理中的应用

目的 探讨流程再造在麻醉护理的应用与效果评价.方法 以"业务流程再造"理论为依据,了解并评估原有工作流程的具体情况,确定流程再造目标及解决方法.结果 实行麻醉护理流程再造以后,手术患者满意率由原来的85%上升到98%,麻醉不良反应明显降低.结论 麻醉护理流程的再造,提高了手术室的服务质量和工作效率,减少了麻醉风险的发生.     

舒适护理在小儿包皮环切术中的应用

目的 探讨舒适护理应用于小儿包皮环切手术的效果.方法 选择在本院住院的74例包皮环切术患儿,随机分为对照组和实验组,每组各37例,对照组采用传统的治疗护理、健康教育等常规护理,实验组在对照组基础上实施舒适护理,比较2组患儿的平均住院时间.结果 经舒适护理的实验组患儿住院时间明显低于对照组(P<0.05),差异有统计学意义.结论 舒适护理能增加患儿的配合度,减少了术后并发症和麻醉并发症的发生,有利于患儿手术后恢复,缩短了患儿的住院时间.     

106例支气管哮喘急性发作的急救观察与护理体会

目的:探讨支气管哮喘急性发作时的急救和护理措施.方法:对我院2009年2月至2011年2月收治的106例支气管哮喘急性发作患者进行急救和护理,分析急救及护理效果.结果:106例病患中,临床控制89(83.96%)例,显效11(10.38%)例,有效5(4.72%)例,无效1(0.94%)例,临床控制率达到94.34%.结论:积极及时的急救和护理措施,能够有效缓解患者的急性发作症状,对临床控制有显著作用.     

The clinical utility of asbestos body counts in bronchoalveolar lavage fluid

To assess the clinical utility of measuring the number of asbestos bodies (AB) present in bronchoalveolar lavage fluid (BALF), we counted the number of AB in BALF from 119 subjects using light microscopy. The results were analyzed according to occupational histories, radiological findings of asbestos-induced lung and pleural changes, and asbestos-related diseases. The 94 subjects in group 1 had a history of dust exposure, whereas group 2 subjects (n = 25) had no dust exposure. Group 1 was subdivided into subjects with obvious exposure to asbestos (group 1A, n = 61), and subjects with no known exposure to asbestos (group 1B, n = 33). The distribution of AB counts per ml of BALF (means +/- SEM) differed significantly between groups 1 and 2 (38.8 +/- 17.4 vs 0.06 +/- 0.04, p < 0.0001). The AB counts were significantly different between groups 1A and 1B (57.9 +/- 26.6 vs 3.4 +/- 1.2, p = 0.01). Subject, exposed to dust who had radiological evidence of pleural thickening had significantly higher AB counts than subjects in whom pleural thickening was absent (66.0 +/- 31.1 vs 5.1 +/- 4.2, p = 0.03). In group 1, the BALF was positive for AB in 7 of 14 patients with pulmonary fibrosis, 4 of 5 patients with lung cancer, all 6 patients with malignant mesothelioma, and all 4 patients with benign asbestos pleural effusion. We conclude that AB counts in BALF are useful for evaluating both the history of asbestos exposure in a population exposed to dust, as well as patients having asbestos-related diseases.     

Quantification of exercise-induced pulmonary haemorrhage with bronchoalveolar lavage

Primary liposarcoma of the stomach is rare and only seven cases have been described in the English literature. Here we report the eighth case, which occurred in a 68-year-old woman who presented with repeated tarry stools and hematemesis. Endoscopic examination revealed a large ulcerated submucosal mass at the gastric angle. The patient was treated by total gastrectomy. On microscopic examination, the tumor showed the features of a well differentiated sclerosing liposarcoma. Immunohistochemically, many spindle to stellate tumor cells were diffusely positive for vimentin and CD34. Positivity for S-100 protein was found in the adipocytic component, including lipoblasts, in addition to some spindle-shaped tumor cells. On ultrastructural examination, the spindle to stellate cells had features characteristic of fibroblasts. No recurrence or metastasis was seen during 13 months. Liposarcoma of the stomach has to be considered in the differential diagnosis with other submucosal lesions, such as gastric lipoma and gastrointestinal stromal tumor.     

Comparison of bronchoalveolar lavage and catheter lavage to confirm ventilator-associated lower respiratory tract infection

Lower respiratory tract infection (LRTI) is a well recognised complication of artificial ventilation in intensive care units (ICU). Ideally, specimens for microbiological analysis should be obtained during bronchoscopy, but this is not always possible. Therefore, the microbiological diagnosis of lower respiratory tract infection by broncho-alveolar lavage (BAL) obtained during bronchoscopy was compared with catheter lavage (CL) with a balloon-tipped catheter. Adult patients with clinical evidence of lower respiratory tract infection in an adult ICU were randomly assigned to undergo BAL followed by CL or vice versa. Forty ml of normal saline 0.9% were instilled and then aspirated with a flexible bronchoscope to obtain BAL. A similar volume was instilled and aspirated with a 12-gauge Foley balloon-tipped catheter to obtain a CL sample. The number of inflammatory cells, epithelial cells and organisms seen by microscopy were quantified. Culture results were semi-quantified and classified as negative, positive, equivocal or contaminated. Seventy-nine paired specimens were obtained from 66 patients, including specimens from 10 patients taken on two or more occasions. Only 20% of BAL and 16% of CL had one or more epithelial cells and bacteria were seen in 26 BAL and 21 CL specimens, respectively; 35% of BAL and CL specimens were positive and there was a discrepancy in the culture result in only two cases. Staphylococcus aureus was the pathogen isolated most frequently and polymicrobial lower respiratory infection was diagnosed on 10 occasions (15%). CL fluid is as reliable as BAL in diagnosing lower respiratory tract infection in ICU. This approach does not require bronchoscopic expertise and utilises convenient laboratory techniques.     

Morphology of the lungs and cellular composition of bronchoalveolar lavage in tuberculomas

Morphology of the lungs and bronchoalveolar lavage (BAL) were studied in 27 patients with tuberculomas. The investigators also determined lymphocytic, macrophagal or neutrophil BAL composition regarding lymphocyte, macrophage or neutrophil dominating infiltration of pulmonary tissue outside the sites of specific inflammation. As a result, the activity of the process was assessed by subpopulation composition of lymphocytes in BAL, by morphology of alveolar macrophages in pulmonary tissue; the pattern of inflammatory reaction in the lesion focus was specified.     

Non-fibrous inorganic particles in bronchoalveolar lavage fluid of pottery workers

AIM: To study the actual exposure of pottery workers to silica particles, as their risk of silicosis is potentially high because of the presence of inhalable crystalline silica particles in the workplace. METHODS: Nine pottery workers underwent bronchoalveolar lavage. The recovered fluid was analysed for cytological and mineralogical content by analytical transmission electron microscopy. The data were compared with those obtained from a control group composed of seven patients with sarcoidosis and six patients with haemoptysis. RESULTS: Cytological results showed a similar profile in exposed workers and controls, whereas in patients with sarcoidosis a lymphocytic alveolitis was found. Microanalysis of the particulate identified the presence of silicates, CRSs, and metals. Pottery workers had higher numbers of total particles and CRSs, and had a higher silicate/metal ratio. In five workers, the presence of zirconium silicate was also detected. Patients with sarcoidosis had the lowest number of particles, and an inverted silicate/metal ratio. CONCLUSION: Microanalysis by transmission electron microscope can provide useful information to assess occupational exposure to dusts.     

Utility of routine testing of bronchoalveolar lavage fluid for cryptococcal antigen

All cryptococcal antigen (CrAg) testing performed at our institution between 1989 and 1994 was reviewed for utility of routinely testing of bronchoalveolar lavage fluid (BAL) for this antigen. Forty-two of 1,506 BAL specimens were positive. Seventeen of these were felt to represent false positives (sensitivity, 71%; positive predictive value, 0.59). The data on CrAg in cerebrospinal fluid and serum and the fungal culture and histological results of BAL specimens did not support continued, routine testing of BALs for CrAg to diagnose cryptococcosis.     

Distribution of asbestos bodies in the human lung as determined by bronchoalveolar lavage

Asbestos-related lung diseases tend to have distinct local distributions, for example, asbestosis first appears and tends to be more severe in the peripheral parts of the lower lung zones. The risk for asbestosis is related to the total asbestos burden of the lung. This suggests that the lower lobes in asbestos-exposed individuals may contain more asbestos than the other lobes. To test whether such topographic differences exist, we compared the number of retrieved asbestos bodies (AB) per ml BAL fluid in three groups of occupationally asbestos-exposed subjects who underwent BAL at different sampling sites. In Group 1 (n = 24) we performed BAL at three sites, namely in a segment of the right upper, right middle, and right lower lobe, to evaluate differences in asbestos body burden from lung apex to basis. There was a distinct increase in BAL asbestos body concentrations from the upper (21.2 +/- 9.1 AB/ml BAL fluid) to the middle (30.4 +/- 12.8 AB/ml BAL fluid) and to the lower lobe (56.0 +/- 20.2 AB/ml BAL fluid), all differences being significant (p < 0.01). In Group 2 (n = 40), we found good interlobar correlations for asbestos body counts between the right middle lobe (21.0 +/- 5.8 AB/ml BAL fluid) and the lingula (22.4 +/- 5.9 AB/ml BAL fluid) (r = 0.941, p < 0.001) and, in Group 3 (n = 15), between the ventral basal segment of the right (41.2 +/- 13.6 AB/ml BAL fluid) and left lung (39.0 +/- 13.6 AB/ml BAL fluid) (r = 0.966, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)