严重脓毒症患者应用呼吸机集束干预策略的效果观察

目的:探讨严重脓毒症患者实施呼吸机集束干预策略的效果.方法:选取37例自2009年4月-2010年3月在本科室住院的严重脓毒症进行呼吸机辅助通气的患者为对照组,采用常规的护理方法;39例2010年4月-2011年3月在本科室住院的严重脓毒症进行呼吸机辅助通气的患者为实验组,采用呼吸机集束干预策略.比较两组患者呼吸机相关性肺炎(Ventilator Associated Pneumonia,VAP)发生率和呼吸机辅助呼吸时间.结果:实验组患者VAP发生率和辅助呼吸的时间均低于对照组.VAP发生率两组比较,经统计学分析,P＜0.05,差异具有统计学意义.结论:严重脓毒症患者实施呼吸机集束干预策略可减少VAP的发生率.     

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.     

集束化护理对严重脓毒症患者早期脱机的影响

目的 探讨集束化护理对严重脓毒症患者早期脱机的影响.方法 将2010年收住ICU18岁以上的严重脓毒症患者设为实验组,其采用集束化护理的方法,把2009年收住ICU18岁以上的严重脓毒症患者设为对照组,其采用常规护理方法.观察2组患者28d内机械通气时间及脱机再次应用呼吸机的情况,2组比较采用χ2检验.结果 实验组28d内机械通气时间较对照组缩短,实验组脱机后再次应用呼吸机的人数比对照组少,差异具有统计学意义(P＜0.05).结论 集束化护理能明显缩短脓毒症患者的机械通气时间,减少再次使用呼吸机,提高护理质量,缩短住ICU时间.     

机械通气患者气管插管的护理

随着危重症医学的不断发展及多功能呼吸机的广泛应用,使得气管插管行机械通气治疗成为内外科及重症领域重要的治疗环节.我院自2010年3月以来,应用机械通气治疗的病人达150例.现以经口气管插管为例将我们对机械通气管插管病人的护理体会如下.     

不同体位护理对呼吸机相关性肺炎的影响

目的 探讨不同体位护理对呼吸机相关性肺炎发病率和临床预后的影响.方法 对2007年9月～2010年9月36例ICU呼吸机通气患者进行研究,分为转动体位护理组、半卧位护理组和常规护理组,统计分析3组患者呼吸机相关性肺炎患病及未患病人数、应用呼吸机时间和住ICU天数.结果 转动体位护理组、半卧位护理组和常规护理组的患病率分别为8.3%、41.7%和83.3%;转动体位护理组的患病率、应用呼吸机时间和住ICU天数低于半卧位护理组和常规护理组,半卧位护理组的患病率、应用呼吸机时间和住ICU天数低于常规护理组,p值均<0.05,差异具有统计学意义.结论 转动体位护理优于半卧位护理和常规护理,半卧位护理优于常规护理.转动体位护理和半卧位护理可以较好地预防呼吸机相关性肺炎(VAP),减少应用呼吸机时间和住ICU天数,是值得推广的护理技术.     

新生儿机械通气的护理

总结了目前新生儿机械通气的护理有关问题,包括:严密监测生命体征、呼吸机管理、气管插管护理、口腔护理和预防并发症等几个方面.认为对新生儿机构通气进行科学管理,能有效提高护理质量和抢救成功率.     

探讨呼吸机相关性肺炎临床诊治与分析

呼吸机相关性肺炎(VAP)是指原无肺部感染或原有肺部感染经呼吸机治疗后而发生的与呼吸机相关的感染,病原学常见为耐药菌与真菌等.在气管插管机械通气治疗后48 h或原有肺部感染用呼吸机48 h后发生新的感染,并经病原学证实.     

改良气管插管固定带在ICU中的应用

目的 探讨改良气管插管降低气管插管病人脱管的发生率及其口角损伤发生率的效果.方法 将223例气管插管病人随机分为观察组与对照组.观察组115例,使用改良气管插管固定带;对照组108例,使用传统白扁带固定.比较2种方法气管插管脱出及口角损伤发生率.结果 观察组病人气管插管脱出率、口角损伤发生率显著低于对照组(p<0.01).结论 改良气管插管固定带能有效降低气管插管脱管及口角损伤,值得在临床中推广.     

舒适护理在经口气管插管机械通气清醒病人中的应用

总结了舒适护理在经口气管插管机械通气清醒病人中的应用,包括:舒适的心理护理、气管插管导管的舒适护理、机械通气的舒适护理、吸痰的舒适护理、口干、口渴的舒适护理、体位的舒适护理、沟通障碍的舒适护理、睡眠的舒适护理.认为对病人行机械通气时,应加强满足病人舒适的需求,严密做好各方面的护理,才能达到良好的治疗效果.     

肠内营养持续泵入配合床头抬高对降低呼吸机相关性肺炎发生的影响

目的 探讨肠内营养持续泵入配合床头抬高30°～45°以上对预防胃内容物反流、降低呼吸机相关性肺炎(VAP)发生的影响.方法选择2007年4月～2010年12月收住内科ICU行机械通气治疗7～10d的100例患者,采用随机数字法随机分成试验组和对照组,试验组52例,采用肠内营养持续泵入配合床头抬高30°～45°以上,对照组48例采用肠内营养持续泵入床头抬高不受限.比较2组的体温、血白细胞、痰培养、胸片结果.结果试验组8例(16%)发生VAP,对照组17例(35%)发生VAP,试验组体温、血白细胞、痰培养,结果优于对照组,差异有统计学意义(P<0.05).结论肠内营养持续泵入配合床头抬高30°～45°以上,预防胃内容物反流、降低呼吸机相关性肺炎发生效果显著.     

转炉炉壳热应力分析

根据实际转炉建立实体模型。以有限元为手段,考虑了炉衬和炉壳材料的物性参数随温度变化的特点和炉衬与炉壳之间膨胀间隙,计算了转炉炉壳在温度载荷和炉衬膨胀压力同时作用下的热应力。所得结果可为转炉炉壳设计提供依据。     

Results of treatment of cancer of the cardia

Cancer of the cardia is traditionally discussed with cardiac cancer of the lower portion of the esophagus and upper gastric cancer invading the esophagus, and the specific characteristics of cancer of the cardia have never been clearly defined. We reviewed the outcome of 172 patients with adenocarcinoma of the cardia who had undergone radical surgery between 1949 and 1994 in the Division of Gastrointestinal Surgery of the Cancer Institute Hospital. The centers of the tumors were located within 2 cm above and below the boundary between the esophagus and the stomach, and their longitudinal diameter was less than 8 cm. We divided the patients into an early period (1949-1979; n = 79) and a late period (1980-1994; n = 93), and focused on the historical transition. There were no differences in patient gender or histology between the two periods. However, the late period was associated with fewer cases of esophageal invasion and shorter longitudinal diameter, as the age of the population advanced. The number of advanced cancers such as the localized and infiltrative type had decreased, and early cancer and early clinical stage had become more common, but despite the fact that the number of early cancers had increased, extended dissection, such as thoracic and paraaortic lymph node dissection, was performed more frequently. By clinical stage, the long-term outcome markedly improved in Stage I patient in the late period, and tended to improve in Stage II and III patients. This appears to have been attributable to the prevention of micrometastasis by extended dissection, although the number of early cancers is another major potential cause. There were no differences in the outcome of Stage IV patients between the two periods, and further advances in multimodality therapy must be awaited. The range of resection is basically proximal gastrectomy, and if there are adequate indications, the prognosis is favorable. In view of the status of lymphatic flow and lymph node metastasis, and long-term results, lateroaortic lymph node dissection is important. Since the number of early cancer patients has been increasing, if intraabdominal recurrence is prevented, intrathoracic lymph node dissection will contribute greatly to the outcome of such patients.     

焦炭热性能指标意义浅析

通过对焦炭在高炉内的历程及其变化规律的剖析,阐述焦炭热性能指标的意义,形象地把焦炭在高炉内的损耗分为三部分(M1,M2,M3)。指出M2对焦比及焦炭价格有一定的指导作用。     

The effect of amount of possession of the trait of hostility on accuracy of perception of hostility in others.

Some theories of personality hold that an individual's perception of others is influenced by his own personality characteristics; more specifically, that a trait of low social value will be projected more into others, and that insight into the possession of these characteristics reduces this distortion. These 2 hypotheses were tested by having a group of college students rate each other (including themselves) on degree of friendliness or hostility. Agreement with group rating about self yielded the insight score. In general, the hypotheses were supported; the "friendly" Ss were most accurate in their perception of others, and insight was positively associated with accurate perception. From Psyc Abstracts 36:04:4HL16M. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of rates of infection of two methods of emergency ventricular drainage

The rates of infection of two methods of external ventricular drainage in use at Atkinson Morley's Hospital--namely, (a) percutaneous drainage with Rickham reservoirs and (b) tunnelled ventriculostomies--were compared in this retrospective review. Percutaneous drainage of CSF with Rickham reservoirs was associated with a 27% rate of infection as identified by positive microbiological cultures; tunnelled ventriculostomy catheters had a 10% infection rate. The difference in the infection rate between the two methods was statistically significant (P < 0.015). Other variables examined, including the age and sex of the patients and the reasons for ventricular drainage, were not associated with an increased rate of infection. Most infections from either method were caused by a coagulase negative staphylococcus. The average duration of ventricular drainage before identification of positive cultures was 5.7 days for Rickham reservoirs and 6.0 days for ventriculostomies.     

浅析《野草》的版画特征

鲁迅先生一生热爱美术作品,对版画中木刻兴趣尤甚.<野草>作为其"写心之作",亦呈现出一些与木刻版画一致的审美特征:一是具有木刻版画的色彩特征,多对比、多冷色,有阴郁的美感;二是具有木刻版画的力度特征,环境描写、人物刻画处处刀锋毕现,遒劲有力,有一种"力之美".     

四辊破碎机车刀架的改造

针对四辊破碎机车刀架车削中存在的几个问题,详细介绍了电动车刀架的结构和工作原理,建立主要设计参数的数学表达式,并进行适当的分析。改造后,这种电动车刀架运行平稳、可靠、方便、省力,取得了预期的效果。     

Effect of antibiotics of chemotaxis of human leukocytes

The effect of 20 different antibiotics on chemotaxis by human neutrophils was studied. Human leukocytes incubated with chloramphenicol, rifampin, sodium fusidate, and tetracyclines in vitro showed markedly depressed migration. The mechanisms by which these antibiotics affect leukotaxis are discussed.