Effect of Continuous Double-Lumen Irrigation Drainage at Constant Temperature on the Control of Abdominal Infection After Surgery

Objective:To investigate the effect of continuous double-lumen irrigation drainage at constant temperature on the control of abdominal infection after surgery,providing a reference for clinical treatment.Methods:From December 2022 to August 2023,100 patients with abdominal infections after surgery were selected from Wendeng People's Hospital in Weihai.They were randomly divided into a control group(50 cases,using conventional single-hole rubber irrigation drainage)and an observation group(50 cases,using continuous double-lumen irrigation drainage at constant temperature).The inflammatory and immune indicators of the two groups were compared after different interventions,and the specific conditions of abdominal infection were statistically analyzed.Results:There was no significant difference in inflammatory indicators between the two groups before intervention(P>0.05).After the intervention,the inflammatory indicators of the observation group were significantly lower(P<0.05).There was no significant difference in immune function indicators between the two groups before intervention(P>0.05).After intervention,the immune function indicators of the observation group showed significant improvement(P<0.05).The control of abdominal infection in the observation group was better than in the control group(P<0.05).Conclusion:Continuous double-lumen rrigation drainage at constant temperature has a better effect on controlling abdominal infection after surgery,improving the infection condition,and enhancing the immune function of patients.

A Giant Granuloma of the Vocal Process after Double-Lumen Bronchial Catheter Insertion: A Rare Case Report and Literature Review

Background: Double-lumen endotracheal (DLT) is commonly used for one-lung ventilation and lung separation during thoracic surgery. There are case reports of medically induced laryngeal granulomas, mainly in patients after single-lumen endotracheal (SLT) tube intubation and tracheotomy, and giant granulomas of the vocal cords due to double-lumen bronchial tube insertion have rarely been reported. Case presentation: A 49-year-old female patient underwent single-port thoracoscopy after DLT intubation as well as a wedge resection of the lower lobe of the left lung, which caused giant vocal process granulomas (VPGs) postoperatively. Based on a retrospective analysis of the general condition, current medical history, past medical history, and visual laryngoscopic observation of the vocal folds tissue, which ruled out preoperative vocal fold granuloma formation, we hypothesized that double-lumen bronchial catheter intubation may have been the primary cause of her vocal fold granuloma formation. Conclusions: Giant granuloma of the vocal folds after DLT insertion is a rare postoperative complication;therefore, if DLT intubation is to be performed, the anesthesiologist should choose an appropriate intubation plan and deal with it promptly to avoid the risk factors to ensure that the patient’s perioperative period is safe and smooth. In addition, if postoperative complications are encountered, they should be followed up and observed on time.

A New Type of Double-Lumen Catheter to Replace Current One in RCA

Objective: To replace the peripheral venous puncture for blood sampling with taking blood samples extracorporally from arterial line before predilution during RCA-CRRT performed. Methods: A new type of double-lumen femoral catheter was used instead of the current tubes. The new type of double-lumen tube had a greater distance from the inner venous ports to the inner arterial ports than current tubes. The minimum distance from the venous port to the arterial port was greatly lengthened. Replacement solution contained citrate, zero Ca2+, zero bicarbonate, low Na+. Blood samples were synchronously collected from the arterial line before the infusion of citrate replacement fluid and from the peripheral vein. The iCa concentration data of two groups were analyzed to observe the difference between iCa concentration levels in the arterial line and in peripheral vein;the anticoagulant effect of RCA and possible complications were observed, such as bleeding, clottings and hypocalcaemia. Results: 28 times of RCA-CRRT were performed on17 AKI and CRF patients with active bleeding or at the high risk of bleeding;336 blood samples were collected. Statistics showed that the difference of iCa concentration between arterial line group and the peripheral vein group was not significant (P = 0.9), there is a high degree of similarity between the iCa concentration of arterial line blood and the peripheral venous blood. None of the patients developed citrate toxicity or metabolic alkalosis. None induced bleeding, or bleeding aggravated. No obvious clotting occurred. Systemic calcium concentration was achieved in the ideal range. Conclusion: In clinical practice, the data of iCa concentration from arterial line can be used to replace that from peripheral vein when the new type of double-lumen femoral catheter is placed in femoral vein. RCA-CRRT therapy is safe and effective.

Double-Lumen Needle Follicular Flushing System versus Single-Lumen Aspiration Needle in IVF/ICSI Patients with Poor Ovarian Response: A Meta-Analysis

Background: The present study performed a meta-analysis to comprehensively analyze existing randomized controlled trials (RCT) involving the use of double-lumen needle in patients with poor ovarian response to explore whether double-lumen needle was good for specific patients. Methods: The PubMed, EMBASE, Cochrane Library databases and two randomized controlled trials registration centers were thoroughly searched until April 2017. The clinical outcomes of IVF/ICSI cycles were compared between two groups with double-lumen needle and single-lumen needle. Results: Four RCT studies were included in this present meta-analysis. The oocytes yield was similar in two groups (OR 0.88, 95%CI 0.66 - 1.16;I2 = 4%). The procedure time with double-lumen needle was significantly longer than that with single-lumen needle (IV = 1.98, 95%CI 0.95 - 3.00;I2 = 86%). The fertilization rate with double-lumen needle was lower than that with single-lumen needle (OR 0.66, 95%CI 0.44 - 0.97;I2 = 0%). There was no significant difference of live birth rate in two groups (OR 0.76, 95%CI 0.32 - 1.76;I2 = 41%). Conclusion: Double-lumen needle could not benefit patients with a POR in terms of the number of oocytes retrieved, oocyte recovery rate, normal fertilization rate, clinical pregnancy rate, and live birth rate, compared with single-lumen needle.

经鼻高流量湿化氧疗在慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者中的临床疗效

目的:探讨经鼻高流量湿化氧疗(HFNC)在慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭患者中的临床疗效。方法:将90例AECOPD合并Ⅱ型呼吸衰竭患者随机分为对照组和观察组,每组45例。在抗感染、解痉平喘、祛痰、营养支持等常规治疗基础上,对照组给予无创正压通气(NPPV)、观察组予以HFNC治疗,疗程均为7 d。比较2组患者治疗前、治疗1 d及7 d后动脉血气分析指标(PaO_(2)、PaCO_(2))、氢离子浓度指数(pH)、平均动脉压(MAP)、心率、呼吸频率、C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)、生存质量[圣·乔治医院呼吸疾病调查问卷(SGRQ)评分]、舒适状况量表(GCQ)评分、住院时间及不良反应。结果:治疗1 d、7 d后,2组PaO_(2)、pH值及GCQ评分较治疗前升高,且治疗7 d后高于治疗1 d后,观察组GCQ评分高于对照组(P均<0.05);PaCO_(2)、MAP、心率、呼吸频率及SGRQ评分较治疗前降低,且治疗7 d后低于治疗1 d后,观察组SGRQ评分低于对照组(P均<0.05)。治疗7 d后,观察组心率及呼吸频率低于对照组,2组CRP、IL-6、TNF-α水平较治疗前降低,且观察组低于对照组(P均<0.05)。观察组平均住院时间短于对照组,不耐受、面部压伤、鼻腔出血及胃肠胀气发生率低于对照组(P均<0.05)。结论:HFNC与NPPV均是AECOPD合并Ⅱ型呼吸衰竭呼吸支持治疗的有效方式,但HFNC在改善临床症状、缓解炎性反应及舒适耐受性方面更具优势,可显著提高生存质量,降低不良反应发生率。

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.

人工气道持续氧雾化湿化的临床应用研究

[目的]观察持续氧雾化人工气道湿化在重型颅脑损伤、脑出血行气管切开病人中的临床应用效果。[方法]将92例重型颅脑损伤、脑出血行气管切开、气管插管病人随机分为观察组和对照组,每组46例,观察组采用持续氧雾化湿化法和对照组采用持续滴注湿化法。观察并比较两组病人气道湿化效果。[结果]观察组病人痰液黏稠度明显低于对照组(P<0.05);观察组气道湿化并发症发生率(包括刺激性咳嗽、痰栓形成、气道黏膜损伤出血、肺部感染)明显低于对照组(P<0.05);与对照组比较,观察组病人血氧分压(PaO2)、血氧饱和度(SaO2)明显升高,心率、呼吸频率明显减慢(P<0.05)。[结论]持续氧雾化人工气道湿化能安全、有效地提高重型颅脑损伤、脑出血行气管切开、气管插管病人的气道湿化效果。

应用HHHFNC预防新生儿拔管失败的临床研究

目的探讨加温湿化高流量鼻导管通气(HHHFNC)预防新生儿拔管失败的效果。方法选取江西省儿童医院2016年6月~2019年6月新生儿重症监护病房接收的211例应用气管插管后需无创辅助通气患儿为研究对象,按照随机数字表法分为经鼻持续气道正压通气(NCPAP)组(102例)和HHHFNC组(109例)。比较两组患儿拔管前平均气道压(MAP)、拔管前吸入氧气浓度(FiO2)、有创呼吸机应用时间和总用氧天数等呼吸参数情况、拔管失败情况、并发症发生情况。结果两组患儿拔管前MAP和有创呼吸机应用时间、拔管前FiO2浓度等呼吸参数情况比较,差异无统计学意义(P>0.05)。HHHFNC组总用氧天数短于NCPAP组,差异有统计学意义(P<0.05)。两组拔管失败率比较,差异无统计学意义(P>0.05)。HHHFNC组患儿不良事件(医院感染、慢性肺疾病)和并发症(腹胀、鼻部损伤)发生率均低于NCPAP组,差异有统计学意义(P<0.05)。结论相比NCPAP方法,HHHFNC的应用更能有效缩短患儿总用氧天数,减少发生并发症、不良反应,对预防新生儿拔管失败更有意义。

PVC气管切开内套管清洗间隔时间与呼吸机相关性肺炎的相关性研究

目的研究PVC气管切开套管内套管清洗时间与呼吸机相关性肺炎的相关性,比较12 h与24 h清洗内套管前后,内套管内壁细菌培养结果的差异性,为预防呼吸机相关性肺炎提供科学依据。方法 2010年1—12月,在我院综合ICU气管切开行机械通气患者共60例,采用抛硬币法随机分为2组,观察组30例,每12 h对内套管进行清洗及浸泡1次;对照组30例,每24 h对内套管清洗及浸泡1次,两组分别在气管切开行机械通气后第3、第5、第7天在清洗内套管前后对两组患者内套管内壁表面用无菌咽拭子涂擦后,送至检验科进行细菌培养及分类。结果观察组清洗前、后内套管管壁细菌菌株数均明显少于对照组(P<0.01),观察组呼吸机相关性肺炎发病率低于对照组(P<0.05),机械通气时间及住院时间两组比较差异无统计学意义(P>0.05)。结论相对于每24 h清洗气管切开内套管1次,每12 h清洗1次,可减少内套管管壁细菌菌株数,降低呼吸机相关性肺炎发病率。

AH Plus根管充填术后反应观察

目的观察AH Plus充填根管的术后反应情况。方法选择236例来我科就诊的需作根管治疗的患牙,随机分成两组,分别采用AH Plus加牙胶尖、氧化锌丁香油糊剂加牙胶尖充填根管。所有患者根管充填后1周复诊,询问其术后反应。结果两组术后反应程度有显著性差异(P<0.01)。结论AH Plus可有效减轻根充术后反应,是提高根管治疗临床疗效的比较理想的根充糊剂。

腹腔双套管在肝胆术后患者中的应用和护理

目的探讨肝胆病人术后应用腹腔双套管的观察和护理。方法对159例肝胆术后病人使用腹腔双套管接中心负压吸引进行引流。结果本组病人中有2例术后2小时双套管引出鲜红色不凝血液达到300ml，需再次手术探查止血。有3例病人引出混浊样液体，经冲洗、抗感染等伤口愈合。有15例引流液引出黄褐色胆汁样液体，经充分引流、延长引流时间，伤口也慢慢愈合。无1例病人因护理不当而造成双套管脱出。结论肝胆病人术后使用腹腔双套管进行腹腔引流，可以保持有效的引流，防止管道的堵塞，及时观察患者有无术后出血、胆瘘等并发症的发生有积极的意义。

气管切开内套管并发症的护理干预

目的:探讨气管切开气管内套管并发症的护理干预。方法:气管切开留置套管50例,采用加强气道湿化、保持呼吸道通畅、加强管道的消毒和有效控制感染等护理干预。结果:本组50例中出现呼吸机相关性肺炎1例,气管扩张1例,气管黏膜损伤性出血1例,加强护理后均恢复。结论:气管切开内套管患者整体护理干预,能减少并发症的发生。

含内套管的弯管流量测量装置特性研究

为对一种含内套管的弯管流量测量装置的特性进行研究,采用数值建模的计算方式,对内套管在不同安装位置下的流动状态进行数值分析,结果表明流道发生一定变化未对流量系数可靠性产生影响;运用涡轮流量计标定试验对其流动阻力与流量系数进行研究,得出了不同流量下的流量系数,并由此得出该弯管的流量系数经验公式。结论表明该特殊弯管流量测量装置性能稳定,流量系数误差小,可以满足多数工业现场流量测量要求。

气管切开内套管消毒方法的改进

目的 :总结气管切开内套管的消毒效果。方法 :随机将需行气管切开的患者分为两组 ,甲组内套管用煮沸法 ,乙组用浸泡消毒法。比较两种方法消毒的效果、程序与优缺点。结果 :浸泡消毒法省时、省电、去腥臭 ,达到了灭菌的效果。结论 :浸泡消毒法优于传统的煮沸法 ,能有效地祛除痰的腥臭味 ,省时、省电 ,效果可靠 。

深静脉置管感染相关因素的分析及护理对策

目的 探讨引起深静脉置管感染的相关因素 ,并提出相对应的护理对策。方法 采用回顾性的方法对 82例深静脉置管出现感染情况进行调查 ,分析引起感染的相关因素。结果 有 7项因素与感染有关 :插管过程污染、导管连接部位处理时感染、加入液体操作时污染、导管内血凝块堵塞、股静脉穿刺时污染、病人的易感性、导管留置时间较长。结论 深静脉置管感染的发生是多因素共同作用的结果 ,应加强对这些相关因素的控制 ,操作时严格遵守无菌操作 。

两种氧疗方式治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者的效果

目的探讨经鼻高流量氧疗(HFNC)和传统鼻导管氧疗在慢性阻塞性肺疾病急性加重期(AECOPD)合并Ⅱ型呼吸衰竭患者中的临床疗效。方法将75例AECOPD合并Ⅱ型呼吸衰竭患者分为对照组(n=36)和实验组(n=39)。对照组在常规治疗基础上给予传统鼻导管氧疗,实验组在常规治疗基础上给予HFNC。比较2组的动脉血氧分压[p_(a)(O_(2))]、动脉血二氧化碳分压[p_(a)(CO_(2))]、血氧饱和度(SpO 2)、呼吸频率、心率、第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、痰液黏稠度、痰量的变化。结果治疗后,实验组p_(a)(CO_(2))、呼吸频率、心率、痰液黏稠度、痰量改善程度与对照组比较,差异有统计学意义(P<0.05)。结论HFNC对AECOPD合并Ⅱ型呼吸衰竭患者的治疗效果优于传统鼻导管氧疗,可有效提高通气效率,降低呼吸频率,减少二氧化碳重复吸入。

暂时性腹腔关闭联合腹腔双套管负压引流术在腹腔严重感染治疗中的应用

目的探讨暂时性腹腔关闭(TAC)联合腹腔双套管持续负压引流技术在腹腔严重感染治疗中的应用效果。方法回顾性分析2012年7月至2017年9月解放军联勤保障部队第九○八医院收治的31例腹腔严重感染患者的临床资料,其中17例应用TAC联合腹腔双套管持续负压引流技术进行治疗(联合治疗组),14例采用传统引流方法及直接关闭腹腔进行治疗(常规治疗组),分析2组的治疗方法和效果。结果联合治疗组中14例患者腹腔感染得到有效控制,2例患者术后分别出现肠瘘、肠间隙脓肿等并发症,1例患者术后继发多器官功能衰竭而死亡。常规治疗组中有8例患者术后出现腹部并发症,2例死亡。联合治疗组较常规治疗组在术后腹部并发症发生率(17.6%vs57.1%)、体温([37.6±0.5)℃ vs(38.1±0.5)℃]、心率([88.7±10.7)次/min vs(99.3±13.4)次/min)]、腹内压([17.2±4.0)mmHg vs(25.1±4.0)mmHg]、APACHEⅡ评分([15.6±4.9)分vs(19.8±5.2)分)]、ICU住院时间([7.6±2.2)d vs(11.0±1.9)d)]、总住院时间([23.9±10.3)d vs(36.7±15.8)d)]等方面均显著降低(P<0.05)。结论TAC联合腹腔双套管持续负压引流技术在严重腹腔感染的治疗中疗效显著,引流效果好,可显著降低腹内压及腹部并发症发生率,值得临床推广应用。

加温湿化高流量鼻导管通气治疗Ⅰ期新生儿呼吸窘迫综合征的临床疗效分析

目的加温湿化高流量鼻导管通气(HHHFNC)治疗Ⅰ期新生儿呼吸窘迫综合征的临床疗效分析。方法选取2018年1月至2019年12月广州市番禺区中心医院收治的Ⅰ期新生儿呼吸窘迫综合征患儿60例,采用随机数字表法分为A组18例、B组20例和C组22例。A组患儿给予经湿化瓶头罩给氧治疗,B组患儿给予HHHFNC治疗,C组患儿给予经鼻持续气道正压通气。3组患儿均连续治疗2小时、24小时,比较3组患儿治疗前、治疗后2小时和治疗后24小时血气分析指标,气促缓解时间和住院时间,并观察B、C组鼻部损伤、腹胀和发生气漏情况。结果治疗前3组患儿血氧分压(PaO2)、血二氧化碳分压(PaCO2)比较,差异无统计学意义。治疗后B、C组患儿PO2值高于A组,PCO2值低于A组。B、C组气促缓解时间、住院日短于A组。B组鼻部损伤、腹胀以及发生气漏小于C组。结论 HHHFNC治疗轻度新生儿呼吸窘迫综合征临床疗效确切,副损伤少。HHHFNC操作简单,方便护理,安全性高,适合在基层医院推广应用。

Formation of granulation tissue on bilateral vocal cords after doublelumen endotracheal intubation:A case report

BACKGROUND Most case reports on laryngeal granuloma formation have described patients after tracheotomy and single-lumen endotracheal intubation.Few studies have investigated vocal cord granuloma formation after double-lumen endotracheal(DLT)intubation.CASE SUMMARY We report granulation tissue formation on the bilateral vocal cords after DLT intubation in a 45-year-old,153-cm-tall female patient.Previous imaging reports showed no formation of vocal cord granuloma before DLT intubation.Therefore,we inferred that DLT intubation may have been the main reason for the postoperative granulation tissue formation on her bilateral vocal cords,based on the patient’s history of DLT intubation,persistent hoarseness after thoracic surgery,and fibrolaryngoscopic and pathological reports during 12 mo follow-up.CONCLUSION Thirty-two Fr DLT tubes should be utilized for thoracic surgery on female patients who are shorter than 153 cm in height.

钻孔灌注桩断桩再生可行性分析

在有关的教科书、施工手册等书籍中介绍的是钻孔灌注桩断桩产生的原因及避免断桩发生的方法。本文将从断桩后但桩还没有死时,谈谈再生的方法。