Removal of biofilm is essential for long-term ventilation tuberetention

BACKGROUND Although long-term retention of a ventilation tube is required in many ear diseases,spontaneous removal of conventional ventilation tube is observed in patients within 3 to 12 mo.To address this issue,we aimed to determine a new method for long-term retention of the ventilation tube.AIM To explore the value of removing the biofilm for long-term retention of tympanostomy ventilation tubes.METHODS A case-control study design was used to evaluate the safety and effectiveness of long-term tube retention by directly removing the biofilm(via surgical exfoliation)in patients who underwent myringotomy with ventilation tube placement.The patients were randomly divided into two groups:Control group and treatment group.Patients in the treatment group underwent regular biofilm exfoliation surgery in the clinic,whereas those in the control group did not have their biofilm removed.Only conventional ventilation tubes were placed in this study.Outcome measures were tube position and patency.Tube retention time and any complications were documented.RESULTS Eight patients with biofilm removal and eight patients without biofilm removal as a control group were enrolled in the study.The tympanostomy tube retention time was significantly longer in the treatment group(43.5±26.4 mo)than in the control group(9.5±6.9 mo)(P=0.003).More tympanostomy tubes were found to be patent and in correct position in the treatment group during the follow-up intervals than in the control group(P=0.01).CONCLUSION Despite the use of short-term ventilation tubes,direct biofilm removal can be a well-tolerated and effective treatment for long-term tube retention of tympanostomy ventilation tubes in patients who underwent myringotomy.

Refractory Tubes with Innovative Liner Technology for Flow Control and Clean Steel Applications

Ladle shrouds(LS)and submerged entry nozzles(SEN)are flow control products used in continuous casting which transfer the liquid steel from the ladle to the tundish and further to the mould.Due to the strongly different and quickly changing temperature conditions before and during steel casting,highly thermal shock resistant refractory materials are required which simultaneously save steel process energy.A new technology embeds a special liner into the refractory body inner surface to reduce the heat transfer through the LS/SEN wall.To better understand the function of this insulation layer a mathematical model was applied.Temperature measurements carried out in the steel plant were compared with the simulation results.The research results indicate potential heat loss reduction and performance improvements in the steelmaking process.

A Comparison of Arterial Oxygenation between 60% O2 CPAP and 100% O2 CPAP during One-Lung Ventilation: A Prospective Randomized Controlled Study

Background: One-lung ventilation (OLV) is generally adopted for thoracic surgery. The systemic application of a high fraction of inspiratory oxygen (F1O2) and continuous positive airway pressure (CPAP) to the non-ventilated lung is useful for preventing arterial oxygen desaturation. The adverse effects of elevated F1O2 include oxidative lung injury, resorption atelectasis and coronary and peripheral vasoconstriction. It is preferable to avoid hyperoxemia in patients with complications such as chronic obstructive pulmonary disease, idiopathic pneumonia, and bleomycin-treated lungs. We aimed to determine whether the application of 60% O2 CPAP to the non-ventilated lung is sufficient to provide adequate oxygenation with 60% O2 to the ventilated lung. Methods: A total of 70 patients scheduled to receive elective thoracic surgery requiring OLV were recruited. Left double-lumen tubes were applicable in all surgeries. Patients were randomly allocated to one of two groups, to receive either 60% O2 CPAP (60% CPAP group, n = 35), or 100% O2 CPAP (100% CPAP group, n = 35) at a setting of 2 - 3 cmH2O, applied to the non-ventilated lung. Arterial blood gas analyses were obtained at the following stages: RA, spontaneous breathing under room air (RA);TLV, during total lung ventilation (TLV) prior to the initiation of OLV;T5, 5 min after the initiation of OLV;T15, 15 min after the initiation of OLV;T30, 30 min after the initiation of OLV. Results: The PaO2 value in 60% CPAP group vs. 100% CPAP group at each measurement were as follows: RA (mean [standard deviation: SD], 89.7 [8.2] mmHg vs. 85.8 [11.9] mmHg);TLV (277.9 [52.9] mmHg vs. 269.2 [44.0] mmHg);T5 (191.4 [67.9] mmHg vs. 192.3 [66.0] mmHg);T15 (143.2 [67.3] mmHg vs. 154.7 [60.8] mmHg) and T30 (95.6 [32.0] mmHg vs. 112.5 [36.5] mmHg), respectively. Among the five measurement points, T30 was the only time point at which the 100% CPAP group showed a significantly greater PaO2 value than the 60% CPAP group (p = 0.0495). The SaO2 at T30 in the 100% CPAP group (97.4 [2.0]%) was also significantly greater than that in the 60% CPAP group (96.3 [2.2]%, p = 0.039). No differences were found between the groups regarding changes to the overall PaO2 values (p = 0.44) and SaO2 values (p = 0.23) during the study period. Conclusions: Oxygenation could be safely maintained in relatively healthy patients with 60% O2 OLV and 60% O2 CPAP. The application of 60% O2 CPAP during OLV for patients who are not suited to exposure to high F1O2 may be an alternative form of respiratory management.

Comparison of the Effectiveness of Marked Suction Tubes vs. Plain Suction Tubes in Pediatric Mechanically Ventilated Patients

Introduction: Endotracheal suction plays a crucial role in the management of mechanically ventilated patients. This study aims to evaluate the clinical effectiveness and safety of suction tubes with markings in mechanically ventilated pediatric patients. Materials and Methods: A randomized assignment was carried out on a cohort of 52 pediatric patients who underwent mechanical ventilation in the Pediatric Intensive Care Unit at the Third Affiliated Hospital of Sun Yat-sen University, covering the period from January 2022 to December 2022. These patients were divided into two groups: an improved group (n = 26) utilizing marked suction tubes, and a regular group (n = 26) employing conventional suction tubes. The objective of our study was to evaluate the clinical effectiveness of marked suction tubes. Results: The effects of the improved group on the vital signs of children undergoing mechanical ventilation were small and statistically significant compared with the regular group (p < 0.05). Additionally, the improved group exhibited a reduced frequency of sputum suction, shorter mechanical ventilation duration, and fewer days of hospitalization in the PICU compared to the regular group during the ventilation period. Notably, the difference in the duration of PICU hospitalization was statistically significant (p < 0.05). Moreover, the incidence of adverse reactions in the improved group was notably lower, with statistically significant differences observed in airway mucous membrane damage and irritating cough when compared to the regular group (p < 0.05). Conclusion: The utilization of marked suction tubes provides clinical nurses with clear guidance for performing suctioning with ease, efficiency and safety. Consequently, advocating for the widespread implementation of marked suction tubes in clinical practice is a commendable pursuit.

胸腔内注射凝血酶、引流管悬吊联合治疗难治性气胸的疗效

目的探讨胸腔内注射凝血酶、引流管悬吊联合治疗难治性气胸的临床疗效,并观察该治疗方案对患者漏口闭合时间、发热发生率的影响。方法前瞻性选取2020年6月至2022年6月医院106例难治性气胸患者,依据随机数字表法将其分为对照组53例与研究组53例,对照组采用胸腔内注射凝血酶+常规胸腔闭式引流治疗,研究组采用胸腔内注射凝血酶+引流管悬吊治疗,观察2组临床疗效、留管时间、漏口闭合时间、住院时间、并发症(发热、胸膜粘连、纵隔气肿),对比2组治疗前、后肺功能指标[肺活量(VC)、残气量(RV)、肺一氧化碳弥散量(DLCO)、肺总量(TLC)]、血气分析指标[动脉血氧分压(PaO_(2))、二氧化碳分压(PCO_(2))、氧合指数(PaO_(2)/FiO_(2))、血氧饱和度(SaO_(2))]、6 min行走试验(6MWT)、Borg呼吸困难指数。结果治疗后,研究组总有效率高于对照组(P<0.05);研究组留管时间、漏口闭合时间、住院时间短于对照组(P<0.05);研究组并发症少于对照组(P<0.05);治疗后,2组VC、RV、DLCO、TLC高于治疗前,且与对照组相比,研究组更高(P<0.05);治疗后,2组PaO_(2)、PaO_(2)/FiO_(2)、SaO_(2)高于治疗前,PaCO_(2)、Borg呼吸困难指数低于治疗前,6MWT长于治疗前,且与对照组相比,研究组变化幅度更大(P<0.05)。结论胸腔内注射凝血酶联合引流管悬吊治疗难治性气胸效果显著,可改善患者肺功能指标、血气指标,减轻呼吸困难症状,提高运动耐量,缩短恢复时间,且不会增加并发症。

胸腔内注射凝血酶联合引流管悬吊治疗难治性气胸的临床疗效

目的观察胸腔内注射凝血酶联合引流管悬吊治疗难治性气胸的临床疗效。方法纳入2022年5月—2023年5月医院接受胸腔内注射凝血酶联合引流管悬吊治疗的60例难治性气胸患者,作为观察组,并纳入同时期医院接受持续胸腔闭式引流,辅助以持续负压吸引常规内科治疗的52例难治性气胸患者,作为对照组;治疗3周后比较两组临床疗效、临床指标(炎症发生率、肺部感染情况、肺功能障碍发生情况、刺激性咳嗽)、免疫功能指标[成熟T淋巴细胞(CD_(3)^(+))、指诱导性T细胞/辅助性T细胞(CD_(4)^(+))、抑制性T细胞/细胞毒性T细胞(CD_(8)^(+))]以及药物不良反应的发生情况。结果治疗3周后,观察组和对照组总有效率分别为96.67%(58/60)和82.69%(43/52),差异有统计学意义(P<0.05)。治疗3周后,观察组和对照组的临床指标(炎症发生率、肺部感染情况、肺功能障碍发生情况、刺激性咳嗽)有所好转,且观察组优于对照组,差异具有统计学意义(P<0.05)。治疗3周后,观察组和的对照组的CD_(3)^(+)分别为(1 890.39±172.45)、(860.11±93.64)μL;观察组和的对照组的CD_(4)^(+)分别为(900.63±94.13)、(478.17±50.74)μL;观察组和的对照组的CD_(8)^(+)分别为(800.41±84.35)、(330.42±30.86)μL,差异具有统计学意义(P<0.05)。对照组和观察组治疗期间均无不良反应,差异无统计学意义(P>0.05)。结论胸腔内注射凝血酶联合引流管悬吊治疗难治性气胸有良好的临床疗效,且治愈率较高。

带针胸管胸腔闭式引流术联合高频机械通气治疗新生儿气胸的临床效果

目的:分析带针胸管胸腔闭式引流术联合高频机械通气(HFOV)治疗新生儿气胸的临床效果及安全性。方法:选取2022年1月—2023年12月昆明市第一人民医院收治的新生儿气胸患儿62例为研究对象,随机分为对照组和观察组,各31例。对照组实施传统胸腔闭式引流术联合常频机械通气治疗,观察组实施带针胸管胸腔闭式引流术联合HFOV治疗。比较两组治疗效果、血气分析指标、治疗指标及并发症发生率。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P=0.006);治疗12 h后,两组动脉血氧分压、动脉血二氧化碳分压、氧合指数、吸入氧浓度优于治疗前,观察组优于对照组,差异有统计学意义(P<0.05);观察组操作时间、起效时间、呼吸机参数下调时间、胸部X线恢复正常时间、住院时间短于对照组,伤口直径小于对照组,差异有统计学意义(P<0.05);观察组并发症发生率低于对照组,差异有统计学意义(P=0.005)。结论:带针胸管胸腔闭式引流术联合HFOV治疗新生儿气胸的效果显著,可改善新生儿血气分析指标,缩短病情转归时间,安全性较高。

改良预先单肺通气加快胸腔镜手术肺萎陷的效果及安全性评价

目的评价改良预先单肺通气(OLV)在胸腔镜手术中加快术侧肺萎陷的效果及安全性。方法将2019年5月至2021年10月甘肃省肿瘤医院择期行肺楔形切除、肺叶切除术102例病人,按随机数字表法分配至常规OLV(C组)、预先OLV(P组)、改良预先OLV组(M组),每组34例。分别采用相应肺萎陷方法监测并记录病人胸腔开放后获得满意肺萎陷所需时间,胸腔开放后1、5、10、20、30 min肺萎陷评分,诱导前(T_(0))、插管后/膨肺前(T_(1))、侧卧前/膨肺末(T_(2))、侧卧后/膨肺后1 min(T_(3))、胸腔开放即刻(T_(4))、获得满意肺萎陷时刻(T_(5))的平均动脉压(MAP)、心率,T_(0)、T_(3)、T_(4)、T_(5)的脉搏血氧饱和度(SpO_(2))、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2)),以及病人术中低氧血症发生、血管活性药物使用、术后肺部并发症及住院天数等情况。结果排除1例困难插管及7例胸腔粘连病人,最终94例病人研究数据被纳入分析。与C组[(14.8±2.8)min]及P组[(9.3±1.6)min]相比,M组[(6.8±1.3)min]病人胸腔开放后获得满意肺塌陷时间更短(均P<0.01);胸腔开放后1、5、10 min肺萎陷评分更高(均P<0.01)。M组病人各时间SpO_(2)、PaO_(2)、PaCO_(2)与P组相比差异无统计学意义(均P>0.05)。M组病人T_(2) MAP、心率较T_(1)、T_(3)短暂降低(均P<0.05)。三组病人无术中低氧血症发生;术中血管活性药物使用率、术后肺部并发症发生率、重症监护病房(ICU)转入率及术后住院天数组间比较均差异无统计学意义(均P>0.05)。结论改良预先OLV能更明显地加快胸腔镜手术双腔插管病人术侧肺萎陷,且对病人安全没有明显影响。

Degradation of refractory pollutants by hydrodynamic cavitation: Key parameters to degradation rates

Degradations of refractory pollutants by hydrodynamic cavitation were experimentally carried out in a self-developed hydrodynamic cavitation reactor with Venturi tubes, multi-orifice plates and their combinations. Effects of hydraulic elements of cavitation due to the Venturi tube on degradation of refractory hydrophobic pollutant were studied, and an optimal throat length corresponding to the maximum degradation rate was obtained. Effects of cavitation due to number, size and distribution of orifice for the multi-orifice plates on degradation of refractory hydrophilic pollutant were investigated, and comparisons and analyses were made. Effects of cavitation due to different combinations of the Venturi tubes with the triangular multi-orifice plates on degradation of hydrophilic and hydrophobic mixtures were studied, and an appropriate combination was determined. Also, effects of cavitation duration, pH value and initial concentration on the refractory pollutants were explored.

鼻空肠管与鼻胃管肠内营养支持在急诊ICU机械通气患者中的应用效果对比

目的对比鼻空肠管与鼻胃管肠内营养支持在急诊ICU机械通气患者中的应用效果。方法70例急诊ICU机械通气患者随机分为两组。对照组留置鼻胃管进行肠内营养支持,观察组留置鼻空肠管进行肠内营养支持。比较两组的营养状况和并发症。结果观察组的达目标喂养量所需时间短于对照组(P<0.05)。干预后,观察组的HB、PAB和ALB水平均高于对照组(P<0.05)。观察组的胃肠道并发症总发生率为5.71%,低于对照组的28.57%(P<0.05)。结论与鼻胃管肠内营养支持相比,鼻空肠管肠内营养支持能够快速改善急诊ICU机械通气患者的营养状况,减少胃肠道并发症的发生。

放疗前后鼓室置管治疗鼻咽癌伴分泌性中耳炎的疗效对比观察

目的评估放疗前后鼓室置管对行放疗的鼻咽癌伴分泌性中耳炎(OME)患者的治疗价值。方法回顾性分析2017年7月~2022年2月重庆大学附属涪陵医院确诊的鼻咽癌伴OME行放疗的49例患者,根据鼓室置管时机的不同将纳入病例分为观察组和对照组。观察组(n=21例)在放疗前即行鼓室置管,对照组(n=28例)在放疗后再行鼓室置管,对比分析两组患者的治疗效果、生活质量及远期并发症等因素。生活质量评估指标主要包括:听力改善(纯音听阈气导AC提升值)、耳鸣改善(THI耳鸣残疾评估量表得分)及咽鼓管功能(ETDQ-7咽鼓管功能障碍评分)。结果随访时间超过1年,观察组总有效率为81.0%(17/21),对照组总有效率为75.0%(21/28),差异无统计学意义(χ^(2)=0.022,P>0.05);观察组AC提升值为17.57±8.483,对照组AC提升值为19.86±5.848,差异无统计学意义(t=-1.117,P>0.05);观察组治疗后THI得分0.95±3.390,对照组THI得分为2.50±4.948,差异无统计学意义(t=-1.180,P>0.05);观察组治疗后ETDQ-7得分为9.86±6.027,对照组ETDQ-7得分为9.36±2.947,差异无统计学意义(t=0.383,P>0.05);远期并发症如化脓性中耳炎、鼓膜穿孔、耳道溢液等,观察组的发生率为19.1%(4/21),对照组发生率为25.0%(7/28),差异无统计学意义(χ^(2)=0.022,P>0.05)。结论鼻咽癌伴OME在放疗前或放疗后行鼓室置管治疗效果均较好,并有效改善患者听力、耳鸣和咽鼓管功能,但两组无明显差异且均有不低的远期并发症发生,因此放疗前不宜行不必要的鼓室置管。

Blindly inserted nasogastric feeding tubes and thoracic complications in intensive care

Purpose of review: This article reviews the thoracic complications from malpositioned blindly inserted nasogastric feeding tubes in mechanically ventilated patients in intensive care and the methods to check the position and promote safe placement of the feeding tubes. Recent findings: Malpositioned feeding tubes are not included in risk management databases. The reported incidence is 1-3% and more than half occur in mechanically ventilated patients. Eighty three mechanically ventilated patients were reported with malpositioned nasogastric tubes and 66% of them developed serious thoracic complications. Pneumothoraces accounted for 80% of thoracic complications that were evenly distributed between tubes with and without stylet. Repeated misplacements appear to increase the risk. Non-radiological confirmation of the position of the tube has suboptimal performance. Protocols to place feeding tubes and new technology are promising candidates. Summary: Malpositioned nasogastric feeding tubes are underreported and associated with serious thoracic complications in mechanically ventilated patients. We need more data to answer whether we can afford to prevent them.

Perianesthesia emergency repair of a cut endotracheal tube’s inflatable tube:A case report

BACKGROUND During the perianesthesia period,emergency situations threatening the life and safety of patients can occur at any time.When dealing with some emergencies,occasional confusion is inevitable.CASE SUMMARY This case report describes the rare situation wherein a surgeon inadvertently detached the inflatable tube of an endotracheal tube during a tonsillectomy,and positive pressure ventilation could not be provided.While reintubation may increase the risk of respiratory tract infection and aspiration,patients with a difficult airway might die due to apnea.The best treatment method is to optimize the damaged tracheal tube junction to avoid secondary intubation and ensure patient safety.An intravenous needle and cannula were used to repair the damaged gap in the current case.Following the repair,the anesthesia machine showed no indication of low tidal volume,and there was no deflation of the endotracheal tube cuff.Subsequently,the patient was transferred to the postanesthesia recovery room,and the tracheal tube was removed with satisfactory results.CONCLUSION Using an intravenous needle to repair a break in the inflatable tube surrounding an endotracheal tube is safe and reliable.

Independent lung ventilation: Implementation strategies and review of literature

Independent lung ventilation,though infrequently used in the critical care setting,has been reported as a rescue strategy for patients in respiratory failure resulting from severe unilateral lung pathology.This involves isolating and ventilating the right and left lung differently,using separate ventilators.Here,we describe our experience with independent lung ventilation in a patient with unilateral diffuse alveolar hemorrhage,who presented with severe hypoxemic respiratory failure despite maximal ventilatory support.Conventional ventilation in this scenario leads to preferential distribution of tidal volume to the nondiseased lung causing over distension and inadvertent volume trauma.Since each lung has a different compliance and respiratory mechanics,instituting separate ventilation strategies to each lung could potentially minimize lung injury.Based on review of literature,we provide a detailed description of indications and procedures for establishing independent lung ventilation,and also provide an algorithm for management and weaning a patient from independent lung ventilation.

Improvised technique for measuring tracheal tube cuff pressure

We agree with the editorial published by Feng et al concerning the insufficient routine monitoring of tracheal tube cuff pressure(TTCP) by anesthesiologists, and propose an improvised technique that can facilitate and promote such routine monitoring by intensive care staff who attend to patients receiving mechanical ventilation. Insufficient monitoring of tracheal cuff pressure has also been documented for intensive care unit nurses. Measurements of cuff pressure are beneficial when used in management of air leakage around an endotracheal tube, and can be easily obtained with the aid of a personalized and simple technique performed using materials that are readily available in all hospitals. Other investigators have previously demonstrated the usefulness of employing an improvised technique. We considered that possible disadvantages are similar to those encountered when using standardized equipment. With our improvised technique, we seek to promote among the nursing staff the determination of the TTCP in intubated patients to reduce the risk of related medical complications.

重症卒中患者早期不同气道开放方式对肺部感染及气管插管的影响

目的 研究重症卒中患者早期应用口咽通气管或鼻咽通气管的临床应用效果。方法 连续纳入2020年6月—2022年6月首都医科大学附属北京天坛医院急诊抢救室收治的重症卒中患者,根据患者留置口咽通气管、鼻咽通气管、未留置口/鼻咽通气管分为口咽通气管组、鼻咽通气管组、对照组,对其临床资料进行回顾性分析。比较各组间临床特征、入院7 d内肺部感染发生情况、序贯气管插管转化率及转化时间。结果 共纳入213例重症卒中患者,男性123例,脑出血119例,脑梗死94例。鼻咽通气管组79例,口咽通气管组68例,对照组66例。鼻咽通气管组入院7 d内误吸发生率低于对照组(10.13%vs. 19.70%,P=0.034)及口咽通气管组(10.13%vs. 22.06%,P=0.021)。鼻咽通气管组入院7 d内肺部感染发生率低于对照组(32.91%vs. 59.09%,P=0.018)与口咽通气管组(32.91%vs. 45.59%,P=0.023)。鼻咽通气管组、口咽通气管组、对照组三组7 d院内全因死亡率(30.38%vs. 32.35%vs. 34.84%,P=0.660)整体差异无统计学意义。鼻咽通气管组7 d内气管插管转化率低于口咽通气管组(12.66%vs. 44.12%,P=0.022)与对照组(12.66%vs. 43.94%,P=0.031)。鼻咽通气管组气管插管转化时间较口咽通气管组[(6.72±2.15)d vs.(4.12±1.23)d,P=0.022]、对照组[(6.72±2.15)d vs.(3.12±1.33)d,P=0.011]延长。入院7 d血气分析可见鼻咽通气管组[(83.56±8.31)mmHg vs.(76.34±8.63)mmHg,P=0.007]及口咽通气管组[(84.56±5.84)mmHg vs.(76.34±8.63)mmHg,P=0.003]血氧分压高于对照组,而鼻咽通气管组[(37.67±11.22)mmHg vs.(48.56±9.62)mmHg,P=0.012]及口咽通气管组[(36.45±17.53)mmHg vs.(48.56±9.62)mmHg,P=0.009]二氧化碳分压低于对照组。结论 重症卒中早期给予口咽通气管或鼻咽通气管开放气道能改善呼吸道不畅,提高血氧分压、降低二氧化碳潴留。但鼻咽通气管与口咽通气管相比,可减少卒中后误吸的发生,降低肺部感染概率,延缓气管插管转化时间,降低气管插管转化率,缩短住院时间。

加速康复外科在老年肝移植受者围手术期临床应用中的效果

目的探索加速康复外科(ERAS)指导下的围手术干预策略在老年肝移植受者中的应用价值。方法回顾性分析405例肝移植受者的临床资料,根据年龄分为老年组(≥60岁,122例)和非老年组(<60岁,283例),所有患者均进行ERAS指导下的围手术期干预处理,分析两组受者术中、术后相关指标,并发症发生情况及出院情况。结果两组受者麻醉时间,手术时间,无肝期,出血量,输血量,关腹前乳酸水平,呼吸机辅助时间,重症监护室(ICU)入住时间,Caprini评分,CHIPPS评分,胃管、尿管、引流管拔除时间,首次饮水时间,首次下地活动时间和首次肛门排气时间差异均无统计学意义(均为P>0.05),老年组首次进食时间晚于非老年组(P<0.05)。两组受者发热、腹腔积液、肺部感染、胃排空障碍、出血、非活动性静脉血栓发生率差异均无统计学意义(均为P>0.05)。两组受者出院前天冬氨酸转氨酶、总胆红素、直接胆红素、血清肌酐水平及总住院时间差异均无统计学意义(均为P>0.05);老年组受者丙氨酸转氨酶值比非老年组低,差异有统计学意义(P<0.05)。非老年组与老年组受者术后30 d内均无非计划再次手术发生,出院后30 d内再入院率差异无统计学意义(P>0.05)。结论ERAS干预策略有助于老年肝移植受者围手术期的恢复,达到与非老年肝移植受者同等的术后恢复水平。

重症超声评估流程在机械通气撤机拔管中的应用价值

目的探讨重症超声评估流程在机械通气撤机拔管中的应用价值。方法选取2021年1至10月于英德市人民医院重症医学科(ICU)采用机械通气的208例患者作为研究对象,按时间段将其分为对照组102例与研究组106例,其中2021年1至5月患者作为对照组,2021年6至10月患者作为研究组。对照组经治疗在撤离呼吸机拔除气管插管前,根据主管医生对患者体格检查、影像学及实验室检查结果评估,决定是否拔管。研究组在对照组的基础上,采用自行设计程序化重症超声评估流程,对机械通气患者心功能、肺部影像状况、膈肌功能及吞咽功能量化评估,决定是否拔管。比较两组患者机械通气时间、ICU平均住院时间、ICU气管插管拔管后48 h内再插管率、ICU转出后48 h内重返率。结果研究组患者的机械通气时间和ICU平均住院时间均短于对照组,差异有统计学意义(P<0.05)。研究组患者的ICU气管插管拔管后48 h内再插管率和ICU转出后48 h内重返率均低于对照组,差异有统计学意义(P<0.05)。结论自行设计程序化重症超声评估流程决定是否拔出气管插管,能缩短患者机械通气时间和ICU平均住院时间,降低ICU气管插管拔管后48 h内再插管率和ICU转出后48 h内重返率。

分析BiPAP无创通气治疗重症难治性哮喘的临床价值

目的分析对重症难治性哮喘患者通过采用双水平气道正压通气呼吸机(bilevel positive airway pressure ventilator,BiPAP)无创通气的治疗价值。方法方便选取2020年1月—2022年5月新疆维吾尔自治区人民医院呼吸与危重症医学科确诊为重症难治性哮喘患者72例,按照随机数表法分为对照组和观察组,各36例。对照组为常规治疗,观察组联合应用BiPAP无创通气治疗,对比两组治疗效果、血气分析指标、肺功能指标及生命体征指标。结果治疗后,观察组PaO_(2)、SaO_(2)、FEV1、PEF指标均较对照组更高,差异有统计学意义(P<0.05);治疗后,观察组PaCO_(2)、RR、HR、SBP较对照组更低,差异有统计学意义(P<0.05);观察组治疗总有效率为97.22%高于对照组的77.78%,差异有统计学意义(χ^(2)=4.571,P<0.05)。结论重症难治性哮喘患者应用BiPAP无创通气后其血气指标更优,肺功能均得以改善。