目的:探讨循证护理在气管切开术患者呼吸道管理中应用的效果及措施。方法:将104例患者随机分为观察组和对照组各52例。观察组重点从“气道湿化、肺部物理疗法、吸痰、气道感染的预防、口咽部护理”几个方面进行循证,获取最佳证据,指导临床护理,对照组按传统护理法。结果:观察组患者并发症的发生率、死亡率显著低于对照组,患者及家属对护理工作的满意率明显提高。结论:运用循证护理能减少患者并发症的发生,降低病死率,提高生存质量。
The setting and adjustment of ventilator parameters need to rely on a large amount of clinical data and rich experience. This paper explored the problem of difficult decision-making of ventilator parameters due to the time-varying and sudden changes of clinical patient’s state, and proposed an expert knowledge-based strategies for ventilator parameter setting and stepless adaptive adjustment based on fuzzy control rule and neural network. Based on the method and the real-time physiological state of clinical patients, we generated a mechanical ventilation decision-making solution set with continuity and smoothness, and automatically provided explicit parameter adjustment suggestions to medical personnel. This method can solve the problems of low control precision and poor dynamic quality of the ventilator’s stepwise adjustment, handle multi-input control decision problems more rationally, and improve ventilation comfort for patients.
Objective To investigate the prethrombotic state and effect of anticoagulation therapy in patients with chronic obstructive pulmonary disease(COPD) and ventilator-associated pneumonia (VAP)．Methods Forty-six COPD patients were divided into VAP group(25 cases)and non-VAP group (21 cases)．The VAP group were randomly subdivided into two groups：group A(conventional therapy group，n=13)，group B(conventional therapy+anticoagulation therapy group，n=12)．The D-dimer (DD)，fibfinogen(FIB)，pulmonary artery pressure(PAP)and the time of weaning were compared between these groups．Results In the COPD patients，the levels of DD，FIB and PAP were significantly increased in VAP group compared with non-VAP group[(0．50±0．26)mg／L，(3．67 ±0．88) L，(31．71 ± 5．66)mm Hg vs(0．23±0．12)mg／L，(1．56±0．45) L，(15．28 ±2．84)mm Hg，respectively，all Plt; 0．05]．In the COPD patients with VAP，the levels of DD，the content of FIB，PAP and mortality were significantly lower in group B with shorter time of weaning compared with group A[(0．22±0．16)mg／L， (1．56±1．17)g／L，(16．00±2．48)him Hg，8．33％ and(4．00±1．41)d vs(O／41±0．09)mg／L，(3．66± 1．03) L，(28．00±0．85)mm Hg，15．4％ and(10．76±3．35)d，respectively，all Plt;0．05]． Conclusions Prethrombotic state exists in COPD patients with VAP．Aggressive anticoagulation on base of routine therapy，by ameliorating microcireulation，call shorten the time of weaning and reduce the mortalit in these patient
Objective To analyze the causes of missed diagnosis of sleep apnea hypopnea syndrome ( SAHS) . Methods 42 missed diagnosed cases with SAHS from May 2009 to May 2011 were retrospectively analyzed and related literatures were reviewed. Results The SAHS patients often visited the doctors for complications of SAHS such as hypertension, diabetes mellitus, metabolic syndrome, etc. Clinical misdiagnosis rate was very high. Lack of specific symptoms during the day, complicated morbidities, and insufficient knowledge of SAHS led to the high misdiagnosis rate and the poor treatment effect of patients with SAHS. Conclusion Strengthening the educational propaganda of SAHS, detail medical history collection, and polysomnography monitoring ( PSG) as early as possible can help diagnose SAHS more accurately and reduce missed diagnosis.
Objective Can we successfully make diagnosis, treatment and prevention in patients with SARS in the economically undeveloped region? Methods we retrospectively reviewed the whole process of diagnosis, treatment and prevention in three patients with SARS. Results All the three patients recovered with no socomial infection in medical staff and no second-generation patients. Conclusion In the economically undeveloped region, if one attached importance to epidemic crisis inwardly and put all the steps into effect really, and if one took four early steps, started the contingent mechanism up urgently, worked can onically and treated patients actively when the epidemic crisis broke out, the outbreak could be overcome successfully with little cost.
Objective To analyze the risk factors of treatment failure by noninvasive positive pressure ventilation (NPPV) in patients with acute respiratory failure (ARF) due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and explore the best time that NPPV be replaced by invasive ventilation when NPPV failure occurs. Methods The data of patients with ARF due to AECOPD who were treated with NPPV from January 2013 to December 2015 were retrospectively collected. The patients were divided into two groups: the NPPV success group and the NPPV failure group (individuals who required endotracheal intubation or tracheotomy at any time). The Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score was analyzed; the Glasgow Coma Scale score, respiratory rate (RR), pH value, partial pressure of oxygen (PaO2), PaO2/fraction of inspired oxygen (FiO2) ratio, and partial pressure of carbon dioxide were also analyzed at admission, after 2 hours of NPPV, and after 24 hours of NPPV. Results A total of 185 patients with ARF due to AECOPD were included. NPPV failed in 35.1% of the patients (65/185). Multivariate analysis identified the following factors to be independently associated with NPPV failure: APACHEⅡscore≥30 [odds ratio (OR)=20.603, 95% confidence interval (CI) (5.309, 80.525), P<0.001], RR at admission≥35 per minute [OR=3.723, 95%CI (1.197, 11.037), P=0.020], pH value after 2 hours of NPPV<7.25 [OR=2.517, 95%CI (0.905, 7.028), P=0.070], PaO2 after 2 hours of NPPV<60 mm Hg (1 mm Hg=0.133 kPa) [OR=3.915, 95%CI (1.374, 11.508), P=0.010], and PaO2/FiO2 after 2 hours of NPPV<200 mm Hg [OR=4.024, 95%CI (1.542, 11.004), P=0.010]. Conclusion When patients with ARF due to AECOPD have a higher severity score, have a rapid RR at admission, or fail to improve in terms of pH and oxygenation after 2 hours of NPPV, the risk of NPPV failure is higher.
Objective To determine the usefulness of serial measurements of the rapid shallow breathing index ( f/VT , RSBI) as a predictor for successfully weaning of patients undergoing prolonged mechanical ventilation ( gt; 72 hours) . Methods 76 mechanically ventilated patients were prospectively analyzed. 120-min spontaneous breathing trial was conducted after the patients having fullfiled the traditional weaning criteria, and RSBI were continuously monitored by the ventilator at five time points ( 5, 15, 30,60, and 120 min) . A repeated measure of general linear model in SPSS 15.0 was conducted to analyze the data. Results 62 patients completed 120-minute spontaneous breath trial and in which 20 patients failed weaning. There was no significant difference of RSBI at five time points during weaning ( P gt;0. 05) . But thevariation trends of RSBI during weaning time were significant different between the successful weaning patients and the failed weaning patients ( P lt; 0. 05) . Conclusions In patients undergoing prolonged mechanical ventilation, the variation trend of RSBI is more valuable than single RSBI in the prediction ofsuccessful weaning.
【Abstract】 Objective To analyze the lung pathological features of type A H1N1 influenza and respiratory failure. Methods The data of imaging and aspiration lung biopsy of five patients with type A H1N1 influenza and respiratory filure since October 2009 were retrospectively analyzed. Results Common clinical manifestations of patients with type A H1N1 influenza and respiratory failure were rapid progress of illness after common cold-like symptoms with high fever, dyspnea, severe hypoxemia, large amounts of bloody sputum, wet rales over both lungs, and with other organs involved or even septic shock. Early lung pathological features were inflammatory exudate in alveoli and lung interstitium, infiltration of inflammatory cells, and extensive hemorrhage. Middle and late pathological features were hyperplasia of alveolar epithelial,disconnection of alveolar septa, replaced of alveolar spaces by fibrosis. Conclusions The pathology of patients with type A H1N1 influenza and respiratory failure is similiar with ARDS. Development of treatment strategies targeted to pathological characteristics of ARDS caused by type A H1N1 influenza is of greatsignificance for effective and timely treatment.