Analysis of the Efficacy of Humidified High-Flow Nasal Oxygen Therapy Combined with Alveolar Lavage in the Treatment of Patients with Severe Pneumonia Complicated with Respiratory Failure

Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia complicated with respiratory failure admitted to the Third People’s Hospital of Xining from July 2021 to December 2022 were randomly divided into two groups:group A and group B.The patients in group A were given humidified high-flow nasal oxygen therapy combined with alveolar lavage,whereas those in group B were given humidified high-flow nasal oxygen therapy.The treatment efficacy,blood gas analysis results,and differences in inflammatory mediators were compared between the two groups.Results:The curative effect in group A(96.67%)was significantly higher than that in group B(81.67%),P<0.05;the partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygen saturation(SpO2),and Horowitz index(P/F)of group A were significantly better than group B,P<0.05;the interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),and C-reactive protein(CRP)levels,white blood cell(WBC)count,serum procalcitonin(PCT),and neutrophil(N)percentage of group A were significantly lower than those of group B,P<0.05.Conclusion:For patients with severe pneumonia complicated with respiratory failure,alveolar lavage,on the basis of humidified high-flow oxygen therapy,can inhibit local inflammation,improve blood gas analysis results,promote disease recovery,and improve the clinical treatment effect。

TREATMENT OF 50 CASES OF SENILE DEMENTIA BY ACUPUNCTURE COMBINED WITH INHALATION OF HERBAL DRUGS AND OXYGEN

Clinical DataCase selection: 100 cases who met thediagnostic criteria of senile dementiaformulated by American Association ofPsychiatry in Handbook of Diagnosis andStatistics (DSM-Ⅲ-R, 3rd revised edition)

High-flow nasal cannula oxygen therapy and noninvasive ventilation for preventing extubation failure during weaning from mechanical ventilation assessed by lung ultrasound score: A single-center randomized study

BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comparison with standard care among patients in the intensive care unit(ICU) who undergo successful weaning to decrease the incidence of extubation failure at both 48 hours and seven days.METHODS: During the study period, 98 patients were enrolled in the study, including 49 in the control group and 49 in the treatment group. Patients in the control group and patients with an LUS score <14 points(at low risk of extubation failure) in the treatment group were extubated and received standard preventive care without NIV or HFNCO_(2). Patients with an LUS score ≥14 points(at high risk of extubation failure) in the treatment group were extubated with a second review of the therapeutic optimization to identify and address any persisting risk factors for postextubation respiratory distress;patients received HFNCO2 therapy combined with sessions of preventive NIV(4-8 hours per day for 4-8 sessions total) for the first 48 hours after extubation.RESULTS: In the control group, 13 patients had the LUS scores ≥14 points, while 36 patients had scores <14 points. In the treatment group, 16 patients had the LUS scores ≥14 points, while 33 patients had scores <14 points. Among patients with the LUS score ≥14 points, the extubation failure rate within 48 hours was 30.8% in the control group and 12.5% in the treatment group, constituting a statistically significant difference(P<0.05). Conversely, among patients with an LUS score <14 points, 13.9% in the control group and 9.1% in the treatment group experienced extubation failure(P=0.61). The length of ICU stay(9.4±3.1 days vs. 7.2±2.4 days) was significantly different and the re-intubation rate(at 48 hours: 18.4% vs. 10.2%;seven days: 22.4% vs. 12.2%) significantly varied between the two groups(P<0.05). There was no significant difference in the 28-day mortality rate(6.1% vs. 8.2%) between the control and treatment groups.CONCLUSIONS: Among high-risk adults being weaned from mechanical ventilation and assessed by LUS, the NIV+HFNCO_(2) protocol does not lessen the mortality rate but reduce the length of ICU stay, the rate of extubation failure at both 48 hours and seven days.

Sleep Quality for Patients Receiving Noninvasive Positive Pressure Ventilation and Nasal High-Flow Oxygen Therapy in an ICU: Two Case Studies

Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.

Prone position combined with high-flow nasal oxygen could benefit spontaneously breathing, severe COVID-19 patients:A case report

BACKGROUND Since the outbreak of coronavirus disease 2019(COVID-19)in Wuhan,China in December 2019,the overall fatality rate of severe and critical patients with COVID-19 is high and the effective therapy is limited.CASE SUMMARY In this case report,we describe a case of the successful combination of the prone position(PP)and high-flow nasal oxygen(HFNO)therapy in a spontaneously breathing,severe COVID-19 patient who presented with fever,fatigue and hypoxemia and was diagnosed by positive throat swab COVID-19 RNA testing.The therapy significantly improved the patient's clinical symptoms,oxygenation status,and radiological characteristics of lung injury during hospitalization,and the patient showed good tolerance and avoided intubation.Additionally,we did not find that medical staff wearing optimal airborne personal protective equipment(PPE)were infected by the new coronavirus in our institution.CONCLUSION We conclude that the combination of PP and HFNO could benefit spontaneously breathing,severe COVID-19 patients.The therapy does not increase risk of healthcare workers wearing optimal airborne PPE to become infected with virus particles.

Extracorporeal membrane oxygenation and inhaled sedation in coronavirus disease 2019-related acute respiratory distress syndrome

Coronavirus disease 2019(COVID-19)related acute respiratory distress syndrome(ARDS)is a severe complication of infection with severe acute respiratory syndrome coronavirus 2,and the primary cause of death in the current pandemic.Critically ill patients often undergo extracorporeal membrane oxygenation(ECMO)therapy as the last resort over an extended period.ECMO therapy requires sedation of the patient,which is usually achieved by intravenous administration of sedatives.The shortage of intravenous sedative drugs due to the ongoing pandemic,and attempts to improve treatment outcome for COVID-19 patients,drove the application of inhaled sedation as a promising alternative for sedation during ECMO therapy.Administration of volatile anesthetics requires an appropriate delivery.Commercially available ones are the anesthetic gas reflection systems AnaConDa®and MIRUSTM,and each should be combined with a gas scavenging system.In this review,we describe respiratory management in COVID-19 patients and the procedures for inhaled sedation during ECMO therapy of COVID-19 related ARDS.We focus particularly on the technical details of administration of volatile anesthetics.Furthermore,we describe the advantages of inhaled sedation and volatile anesthetics,and we discuss the limitations as well as the requirements for safe application in the clinical setting.

The effect of high-flow oxygen via tracheostomy on respiratory pattern and diaphragmatic function in patients with prolonged mechanical ventilation:A randomized,physiological,crossover study

Background Compared to conventional oxygen devices,high-flow oxygen treatment(HFOT)through the nasal cannulae has demonstrated clinical benefits.Limited data exist on whether such effects are also present in HFOT through tracheostomy.Hence,we aimed to examine the short-term effects of HFOT through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical ventilation.Methods A randomized,crossover,physiological study was conducted in our ICU between December 2020 and April 2021,in patients with tracheostomy and prolonged mechanical ventilation.The patients underwent a 30-min spontaneous breathing trial(SBT)and received oxygen either via T-piece or by HFOT through tracheostomy,followed by a washout period of 15-min breathing through the T-piece and receipt of 30-min oxygen with the other modality in a randomized crossover manner.At the start and end of each session,blood gasses,breathing frequency(f),and tidal volume(VT)via a Wright's spirometer were measured,along with diaphragm ultrasonography including diaphragm excursion and diaphragmatic thickening fraction,which expressed the inspiratory muscle effort.Results Eleven patients were enrolled in whom 19 sessions were uneventfully completed;eight patients were studied twice on two different days with alternate sessions;and three patients were studied once.Patients were randomly assigned to start the SBT with a T-piece(n=10 sessions)or with HFOT(n=9 sessions).With HFOT,VT and minute ventilation(VE)significantly increased during SBT(from[465±119]mL to[549±134]mL,P<0.001 and from[12.4±4.3]L/min to[13.1±4.2]L/min,P<0.05,respectively),but they did not change significantly during SBT with T-piece(from[495±132]mL to[461±123]mL and from[12.8±4.4]mL to[12.0±4.4]mL,respectively);f/VT decreased during HFOT(from[64±31]breaths/(min∙L)to[49±24]breaths/(min∙L),P<0.001),but it did not change significantly during SBT with T-piece(from[59±28]breaths/(min∙L)to[64±33]breaths/(min∙L));partial pressure of arterial oxygen increased during HFOT(from[99±39]mmHg to[132±48]mmHg,P<0.001),but it decreased during SBT with T-piece(from[124±50]mmHg to[83±22]mmHg,P<0.01).In addition,with HFOT,diaphragmatic excursion increased(from[12.9±3.3]mm to[15.7±4.4]mm,P<0.001),but it did not change significantly during SBT with T-piece(from[13.4±3.3]mm to[13.6±3.3]mm).The diaphragmatic thickening fraction did not change during SBT either with T-piece or with HFOT.Conclusion In patients with prolonged mechanical ventilation,HFOT through tracheostomy compared with T-piece improves ventilation,pattern of breathing,and oxygenation without increasing the inspiratory muscle effort.Trial Registration Clinicaltrials.gov ldentifer:NCT04758910.

Potentially fatal electrolyte imbalance caused by severe hydrofluoric acid burns combined with inhalation injury: A case report

BACKGROUND Hydrofluoric acid(HF)is one of the most common causes of chemical burns.HF burns can cause wounds that deepen and progress aggressively.As a result,HF burns are often severe even if they involve a small area of the skin.Published cases of HF burns have mostly reported small HF burn areas.Few cases of HF inhalation injury have been reported to date.CASE SUMMARY A 24-year-old man suffered from extensive hydrofluoric acid burns covering 60%of the total body surface area(TBSA),including deep second degree burns on 47%and third degree burns on 13%of the TBSA,after he fell into a pickling pool containing 15%HF.Comprehensive treatments were carried out after the patient was admitted.Ventricular fibrillation occurred 9 times within the first 2 h,and the lowest serum Ca2+concentration was 0.192 mmol/L.A dose of calcium gluconate(37 g)was intravenously supplied during the first 24 h,and the total amount of calcium gluconate supplementation was 343 g.Extracorporeal membrane oxygenation(ECMO)was applied for 8 d to handle the acute respiratory distress syndrome(ARDS)induced by the HF inhalation injury.The patient was discharged after 99 d of comprehensive treatment,including skin grafting.CONCLUSION Extensive HF burns combined with an inhalation injury led to a potentially fatal electrolyte imbalance and ARDS.Adequate and timely calcium supplementation and ECMO application were the keys to successful treatment of the patient.

Effectiveness of oxygen nebulization at preventing radiotherapy-induced mucositis in patients with nasopharyngeal cancer

Purpose:To evaluate the effectiveness of oxygen nebulization at preventing radiotherapyinduced mucositis in patients with nasopharyngeal cancer.Methods:Sixty patients with nasopharyngeal cancer treated with simultaneous integrated boost intensity-modulated radiotherapy were randomly assigned to oxygen nebulization or ultrasonic nebulization groups;treatment was once daily for 20 minutes.All patients received routine oral care.We compared saliva pH and volume,food intake,and change in oral mucosa during radiotherapy,and dry mouth and sore throat after radiotherapy between the two groups.Results:There were significant differences in the incidence of grade III or IV mucositis,saliva volume and pH,and dry mouth and sore throat between the two groups when the total dose was 33 Gy(p<0.05 or p<0.01).Conclusion:Oxygen nebulization reduces radiotherapy-induced mucositis and relieves symptoms such as dry mouth and sore throat in patients with nasopharyngeal cancer.

一种改良式氧气呼吸器在Ⅰ型呼吸衰竭患者中的应用效果

目的探讨一种改良式氧气呼吸器在Ⅰ型呼吸衰竭患者中的应用效果。方法选取2022年10月至2023年11月在入住山西医科大学第二医院Ⅰ型呼吸衰竭患者的临床资料,按照吸氧面罩的不同种类分为对照组和观察组共88例,对照组48例使用抗生素+普通面罩吸氧治疗,观察组40例使用抗生素+改良式氧气呼吸器治疗。比较2组患者脉搏血氧饱和度(SpO_(2))下降发生率、饮水呛咳发生率、腹胀发生率、患者满意度得分情况。结果2组患者SpO_(2)下降发生率和饮水呛咳发生率分别为21%、15%,差异均有统计学意义;与对照组相比,观察组患者满意度得分有所提升,为2.9分,差异有统计学意义;腹胀发生率降低了4%,差异无统计学意义。结论Ⅰ型呼吸衰竭患者应用改良式氧气呼吸器可降低因暂停吸氧造成的SpO_(2)下降发生率、饮水呛咳发生率,有助于提高患者满意度,患者获益大,可在临床广泛应用。

沙美特罗替卡松联合经鼻高流量湿化氧疗治疗AECOPD并Ⅱ型呼吸衰竭的临床疗效

目的探讨沙美特罗替卡松联合经鼻高流量湿化氧疗(HFNC)治疗慢性阻塞性肺疾病急性发作(AECOPD)并Ⅱ型呼吸衰竭的临床疗效。方法选取2021年1月—2022年8月南方医科大学南方医院白云分院收治的AECOPD并Ⅱ型呼吸衰竭患者共110例,随机分为观察组和对照组,每组55例。对照组给予HFNC治疗,观察组给予沙美特罗替卡松联合HFNC治疗。比较两组肺功能指标[第1秒用力呼气容量(FEV 1)、用力肺活量(FVC)、FEV 1/FVC]、血气分析指标[pH值、血氧饱和度(SaO 2)、氧分压(PaO 2)、二氧化碳分压(PaCO 2)]、炎症指标[白介素-17(IL-17)、超敏C反应蛋白(hs-CRP)、圣乔治呼吸问卷(SGRQ)评分、改良英国医学研究委员会呼吸困难量表(mMRC)评分]及临床疗效。结果治疗后,观察组肺功能指标优于对照组(P<0.05)。观察组pH值、SaO 2、PaO 2较对照组增高,PaCO 2较对照组降低(P<0.05)。观察组血清hs-CRP、IL-17水平较对照组降低(P<0.05)。观察组SGRQ及mMRC评分较对照组降低(P<0.05)。观察组患者的临床疗效优于对照组(P<0.05)。结论沙美特罗替卡松联合HFNC治疗能够改善AECOPD并Ⅱ型呼吸衰竭患者肺功能、呼吸功能及血气分析指标,抑制机体炎症反应。

围术期不同吸入氧浓度与术后肺部并发症的研究进展

围术期吸氧治疗是一种常规的呼吸支持措施,不同的吸入氧浓度(FiO_(2))对患者的影响不同,吸入高浓度氧气可以减轻术后恶心呕吐和预防手术部位感染的观念已逐渐改变,氧气作为一种强氧化剂,其引发的氧化应激反应可对肺部造成氧化损伤,进而增加术后肺部并发症(postoperative pulmonary complications,PPC)的发生率。PPC能显著增加术后早期死亡率、ICU入住率和住院时间。围术期机械通气时不同FiO_(2)的使用与PPC的发生密切相关。通过回顾近期研究,探讨不同FiO_(2)对PPC的影响,为临床医生提供关于围术期氧气管理的科学依据,以通过更加优化的围术期氧气管理策略,减少PPC风险并提高患者术后恢复质量。

术后延长吸氧时间对老年全膝关节置换术病人术后疼痛、炎症因子及免疫功能的影响

目的探讨术后延长吸氧时间对老年全膝关节置换术(TKA)病人术后疼痛、炎症因子及免疫功能的影响。方法选取2022年1月至2023年1月西安交通大学第二附属医院收治的拟行TKA治疗的病人142例,男65例,女77例;年龄(73.35±7.30)岁。采用随机数字表法将病人分为观察组和对照组,每组71例。对照组病人术后给予8 h的常规鼻导管低流量(3 L/min)吸氧,观察组在对照组的基础上延长吸氧时间至术后48 h。观察两组术前和术后8、24、48 h简易精神状态检查量表(MMSE)评分和疼痛视觉模拟量表(VAS)评分,术前和术后8、48 h血清炎症因子和免疫功能指标水平;术前和术后24、48 h脉搏血氧饱和度(SpO_(2))、心率和呼吸频率情况。结果观察组术后24、48 h MMSE评分显著高于对照组(P<0.05),VAS评分显著低于对照组(P<0.05)。两组术后24、48 h VAS评分较术前均显著降低(P<0.05)。对照组术后各时点MMSE评分较术前均显著降低(P<0.05),观察组术后8、24 h MMSE评分显著降低(P<0.05)。观察组术后24、48 h SpO_(2)显著高于对照组(P<0.05),心率、呼吸频率显著低于对照组(P<0.05)。观察组术后48 h白介素-10(IL-10)、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平显著高于对照组(P<0.05),白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平显著低于对照组(P<0.05)。与术前比较,两组术后8、48 h血清IL-6、TNF-α水平均显著升高(P<0.05),CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平均显著降低(P<0.05)。结论术后延长吸氧时间可降低老年TKA病人疼痛,提高病人术后免疫功能,改善炎症因子水平。

麻醉苏醒期间不同吸入氧浓度对腹腔镜胃癌根治术患者术后肺不张的影响

目的探讨麻醉苏醒期间不同吸入氧浓度对腹腔镜胃癌根治术患者术后肺不张的影响。方法选择行择期腹腔镜下胃癌根治术的老年患者68例,随机分为两组:高吸入氧浓度组(C组)和低吸入氧浓度组(L组),每组34例。在麻醉苏醒期间,L组采用40%吸入氧浓度,C组采用100%吸入氧浓度。采用床旁肺超声评估患者12个区域(左肺和右肺各6个区域)的肺超声评分(LUS)。记录入室时(T_(0))、术后30min(T_(4))的LUS评分及术后肺不张的发生率。记录入室(T_(0))、气腹结束时(T_(1))、拔管时(T_(2))、出PACU时(T_(3))的心率(HR)、平均动脉压(MAP),血气分析记录血氧分压(PaO_(2)),计算氧合指数(OI)。记录拔管后在PACU中SpO_(2)<94%事件的发生率。于术前1d(D_(0))和术后1d(D_(1))、3d(D_(2))、5d(D_(3))测定第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、1秒率(FEV_(1)/FVC)。记录术后1d临床肺部感染评分(CPIS)和术后7d肺部并发症的发生情况。结果L组和C组从气腹结束至拔管时间分别为(36.4±5.2)min和(37.3±4.2)min(P>0.05)。与C组相比,L组在T4时的肺超声评分及肺不张发生率明显降低(P<0.05)。L组在T_(3)时,PaO_(2)、OI均明显升高(P<0.05)。在PACU中L组Sp0_(2)<94%事件的发生率低于C组(P<0.05)。与D_(0)时比较,D_(1-3)两组患者的FEV_(1)、FVC、FEV_(1)/FVC均明显降低(P<0.05),与C组比较,L组在D_(1)时FEV_(1)、FVC、FEV_(1)/FVC均明显升高(P<0.05)。术后1dCPIS评分和术后7d肺部并发症发生率两组无明显差异(P>0.05)。结论麻醉苏醒期间低吸入氧浓度能降低老年患者腹腔镜胃癌根治术术后肺不张的发生率及严重程度,改善术后早期肺功能。

烧伤合并吸入性损伤机械通气第24小时的氧合指数对患者预后的影响

目的探讨烧伤合并吸入性损伤患者行机械通气第24小时的氧合指数(OI)对患者预后的影响。方法142例烧伤合并吸入性损伤行机械通气患者,根据第24小时的OI值分为A组[OI≤200 mm Hg(1 mm Hg=0.133 kPa),36例]、B组(200 mm Hg<OI≤300 mm Hg,46例)、C组(OI>300 mm Hg,60例)。比较三组一般资料及预后情况;依据预后情况将患者分为预后不良组(86例)与预后良好组(56例)。采用单因素和多因素Logistic回归分析烧伤合并吸入性损伤机械通气患者预后不良的危险因素。结果三组年龄、烧伤总面积(TBSA)、机械通气前氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))及预后情况比较,差异具有统计学意义(P<0.05)。C组年龄(40.07±21.20)岁小于A组的(54.64±17.83)岁和B组的(51.72±17.99)岁(P<0.05);B组TBSA(60.43±29.04)%和C组TBSA(62.89±24.85)%小于A组的(74.14±21.90)%,预后不良率54.3%、48.3%低于A组的88.9%(P<0.05)。机械通气前,A组和B组PaO_(2)水平显著低于C组,PaCO_(2)高于C组(P<0.05);B和C组SaO_(2)高于A组(P<0.05)。三组机械通气开始时间、三度烧伤面积及入院延迟复苏情况比较差异无统计学意义(P>0.05)。预后不良组与预后良好组患者的年龄、TBSA、机械通气后第24小时OI比较差异具有统计学意义(P<0.05);预后不良组与预后良好组患者的机械通气开始时间、机械通气时间及机械通气前PaO_(2)、PaCO_(2)、SaO_(2)比较差异无统计学意义(P>0.05)。将筛选出P<0.05的因素纳入多元Logistic回归分析,排除混杂因素后,结果显示:机械通气后第24小时OI≤200 mm Hg、TBSA大、老年是烧伤合并吸入性损伤行机械通气患者预后不良的独立危险因素(OR=5.551、1.046、10.187,P<0.05)。结论机械通气第24小时OI≤200 mm Hg的烧伤合并吸入性损伤患者预后不良,TBSA越大,机械通气前PaO_(2)及SaO_(2)越低,通气后第24小时的OI可能越低。

全程细致化护理模式对小儿慢性哮喘急性发作行雾化吸入治疗患儿症状、氧合指数及哮喘控制水平的影响

目的 探讨全程细致化护理模式对小儿慢性哮喘急性发作行雾化吸入治疗患儿症状、氧合指数及哮喘控制水平的影响。方法 选取2019年3月至2022年3月本院儿科收治的80例小儿慢性哮喘急性发作行雾化吸入治疗的患儿为研究对象,按照随机数字表法将其分为对照组(40例,常规护理)和观察组(40例,在常规护理基础上增加全程细致化护理)。比较两组的干预效果。结果 干预后,观察组的症状积分低于对照组,氧合指数、哮喘控制水平高于对照组(P<0.05)。干预后,观察组的用力肺活量(FVC)、呼吸流速峰值(PEFR)、第1秒用力呼气容积(FEV_(1))高于对照组(P<0.05)。观察组的治疗总依从率高于对照组(P<0.05);干预后,观察组的汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分低于对照组(P<0.05)。结论全程细致化护理在小儿慢性哮喘急性发作行雾化吸入治疗患儿中的应用效果明显,可有效缓解患儿症状,改善肺功能指标及负性情绪,提升治疗依从性。

疫情防控期间术后面罩吸氧患儿佩戴口罩的安全性研究

目的探讨新型冠状病毒感染疫情防控期间术后面罩吸氧患儿佩戴口罩的安全性。方法选择2021年4—8月于浙江省台州医院进行手术治疗的60例患儿为研究对象,采用随机数字表法分为试验组和对照组,每组30例。试验组术后拔除气管插管并立即佩戴一次性医用儿童口罩,对照组患儿不佩戴口罩。患儿转移至麻醉后恢复室并使用普通吸氧面罩进行氧疗,比较两组0、5、10、15、30、45 min时心率(HR)、氧饱和度(SPO_(2))、呼气末二氧化碳分压(ETCO_(2))和呼吸频率(RR)水平。结果两组HR、SPO_(2)的时间效应、组别效应和时间×组别交互效应比较,差异均无统计学意义(P>0.05)。两组RR和ETCO_(2)水平比较,存在时间效应,差异有统计学意义(P<0.05),但组别效应和时间×组别交互效应比较,差异均无统计学意义(P>0.05)。结论患儿术后氧气面罩吸氧期间佩戴医用口罩不会引起呼吸参数的不良变化。

双水平气道正压无创通气对重症心力衰竭患者血气指标和血流动力学及心功能的影响

目的探讨双水平气道正压(BiPAP)无创通气对重症心力衰竭(HF)患者血气指标和血流动力学及心功能的影响。方法选取2018年5月至2021年6月于贵州省人民医院治疗的90例重症HF患者作为研究对象,依据治疗方式不同分为对照组与观察组,每组45例。对照组给予常规药物联合面罩吸氧治疗,观察组给予药物联合BiPAP无创通气治疗,比较两组治疗前后血气指标、血流动力学指标及心功能指标。结果治疗2h后,两组动脉血氧分压(PaO_(2))均高于治疗前,动脉血二氧化碳分压(PaCO_(2))均低于治疗前,且观察组PaO_(2)高于对照组,Pa-CO_(2)低于对照组,差异有统计学意义(P<0.05)。治疗2h后,两组右心房平均压(RAMP)、肺动脉平均压(PAMP)及肺动脉楔压(PCWP)均低于治疗前,而观察组RAMP、PAMP均高于对照组,PCWP低于对照组,差异有统计学意义(P<0.05)。治疗48h后,两组每搏输出量(SV)均大于治疗前,左心室射血分数(LVEF)高于治疗前,N末端B型脑钠肽前体(NT-proBNP)水平低于治疗前,且观察组SV、LVEF均高于对照组,NT-proBNP水平低于对照组,差异有统计学意义(P<0.05)。结论BiPAP无创通气治疗重症HF的效果理想,能有效改善患者血气、血流动力学指标及心功能,值得临床推广应用。

双黄连氧气驱动雾化吸入联合NCPAP治疗对MP合并呼吸衰竭患儿的影响

目的探讨采取双黄连氧气驱动雾化吸入联合经鼻持续气道正压通气(NCPAP)治疗儿童重症支原体肺炎(MP)合并呼吸衰竭的效果及对血清瘦蛋白(Leptin)、白细胞介素⁃17(IL⁃17)及白细胞介素⁃33(IL⁃33)水平的影响。方法选取82例患儿并随机分成观察组42例与对照组40例,对照组采取常规吸氧、止咳及NCPAP治疗,观察组则是在对照组的基础上加用双黄连氧气驱动雾化吸入治疗,比较2组治疗效果。结果观察组患儿各症状消退时间明显比对照组短(P<0.05);治疗后2组血氧饱和度(SaO_(2))、血氧分压(PaO_(2))较治疗前提高,二氧化碳分压(PaCO_(2))较治疗前降低,而观察组指标变化幅度较对照组显著(P<0.05);治疗后2组血清Leptin、IL⁃17、IL⁃33均较治疗前降低,观察组各指标显著低于对照组(P<0.05)。结论双黄连氧气驱动雾化吸入联合NCPAP治疗儿童重症MP合并呼吸衰竭,可显著改善患儿血气功能指标,降低血清炎症因子水平,促进患儿症状的改善。

高流量吸氧在高原性肺水肿治疗运用体会

目的 探究针对于高原性肺水肿采用高流量吸氧治疗的运用体会。方法 选取该院收治的50例高原性肺水肿患者作为此次实验对象,选取时间范围在2020年8月—2022年8月期间。按照随机抽签的方式分为对照组25例采取鼻导管吸氧方式,观察组25例则采取高流量吸氧方式,对比两组患者治疗效果、生命体征相关指标变化情况、并发症发生情况以及患者舒适度情况。结果 观察组治疗疗效在92%显著高于对照组68%(P<0.05);观察组患者在肺部啰音消失时间、胸片阴影消失时间、住院时间指标上均短于对照组(P<0.05);观察组并发症发生率8%显著低于对照组32%(P<0.05);治疗前两组的舒适度对比(P>0.05),治疗后观察组各项指标均高于对照组(P<0.05)。结论 针对于高原性肺水肿患者采取高流量吸氧进行治疗能够有效提高患者的疗效和舒适度,缩短肺部啰音、胸片阴影消失时间、住院时间以及减少治疗后续的并发症,比以往使用的鼻导管吸氧治疗效果更加明显,因此此种治疗方式值得临床广泛应用和推广。