Objective To study the clinical feasibility of invasive mechanical ventilation with bilevel positive airway pressure（BiPAP） non-invasive ventilator in the stable patients needing prolonged mechanical ventilation.Methods Eleven patients with respiratory failure admitted in intensive care unit（ICU）of our department，who needed prolonged mechanical ventilation，between Jun 2004 and Nov 2007 were enrolled in the study and followed until death or Jan 2008.The arterial blood gas analysis data，length of stay(LOS)，LOS after changing to BiPAP non-invasive ventilator（Synchrony，Harmony，RESPIRONICS，VPAP III ST-A，RESMED），survival time after discharge(or fulfilled the discharge standards) were reviewed retrospectively.Results The settings of inspiratory pressure，expiratory pressure and respiratory rate of non-invasive ventilation were 21.3 (16-26) cm H2O，4 cm H2O，and 16 min-1，respectively.The LOS (or up to the discharge standard) was (91.5±50.2) days.The LOS (or up to the discharge standard) after changing to BiPAP ventilator was (23.5±12.2) days.The mean survival time after discharge (or up to the discharge standard) was (353.1±296.5) days.Four patients were still alive up to the end of the study.The arterial pH，PaCO2，PaO2，and SaO2 were not significant different before and after changing to BiPAP ventilator.Conclusion The mechanical ventilation with BiPAP non-invasive ventilator via tracheotomy tube is an alternative choice for stable patients needing prolonged mechanical ventilation.
Objective To compare the efficacy and safety of different airway humidification methods in patients with tracheotomy in weaning process. Methods Twelve patients with tracheotomy in the medical intensive care unit ( MICU) of the First Affiliated Hospital of Sue Yat-sen University fromSeptember 2008 to August 2009 were enrolled in which 45 case /times weaning tests in three different humidification ways were performed( 15 cases in each group) . Wet square gauze method was used in group A and traditional intermittent wet fluid drip method was used in group B. In group C, MR850 humidifier device, RT200 Venturi tube and T tube device were used to perform humidification. Comparisons were carried out between the three groups on sputum viscosity, comfort of patients before and after humidification, length of weaning time, frequencies of irritating coughs and phlegm formation during test period. Sputum viscosity was evaluated by airway secretion score ( AWSS) .Results There was no significant difference of sputum viscosity assessed by AWSS in group A before and after humidification( P gt; 0. 05 ) while AWSS was significantly increased in group B and group C ( P lt;0. 01) , implied that sputum viscosity was significantly lower than that of group A ( P lt;0. 05) . The scores of patients’comfortwere 3. 0 ±0. 4, 5. 0 ±1. 2, and 8. 0 ±1. 7 in groups A, B, and C respectively which mean that the patients in group C felt more comfortable than those in group A and group B ( P lt;0. 01) . Cough frequencies of groups A, B and C per hour were 0. 8,2. 6,and 0. 4 times/hour respectively in which the frequency of group B was significantly higher than those of group A and group C ( P lt;0. 01) . The frequency of phlegm formation in group A was 7 times in 15-times offline record, which was significantly higher than those in group B and group C ( P lt;0. 01) . Conclusions For the patients with tracheotomy in weaning process, MR850 humidifier device, RT200 Venturi tube and T tube device for humidification is superior in reducing sputum viscosity and phlegm formation, improving patient comfort, and reducing the occurrence of irritating cough.
目的 比较经皮扩张气管切开术（PDT）和开放式气管切开术（OT）在成批吸入性损伤患者中的应用效果。 方法 采用前瞻性随机性研究方法，将2006年1月－2010年12月收入三峡大学人民医院重症医学科的4批34例吸入性损伤患者，分为PDT组（n=17）和OT组（n=17），比较两组的手术时间、出血量、并发症，观察手术前后的平均动脉压（MAP）、心率（HR）、呼吸频率（R）、动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）。 结果 PDT组与OT组手术时间分别为（7.0 ± 1.9）、（18.0 ± 11.4）min，差异有统计学意义（P=0.000）；PDT组与OT组出血量分别为（7.0 ± 4.4）、（19.0 ± 12.1）mL，差异有统计学意义（P=0.001）；两组患者气管切开前及切开后的MAP、HR、R、PaO2和PaCO2差异无统计学意义（P＞0.05）；PDT组发生出血并发症1例，OT组发生出血、皮下气肿、纵隔气肿及切口感染等并发症共6例，PDT组并发症发生率低于OT组，差异有统计学意义（P=0.034）。 结论 PDT在救治成批吸入性损伤患者时比OT更快地建立人工气道，而出血量、并发症发生率均低于OT，值得推广应用。
【摘要】 目的 探讨吸入性损伤气管切开置管，导管脱出的原因及正确的护理方法，提高护士对患者的预见性护理能力。 方法 对2005年1月-2011年3月收治的158例吸入性损伤气管切开患者，其中9例术后发生导管脱出的原因及护理对策进行回顾性总结。 结果 9例患者发生导管脱出的主要原因有导管选用不当、剧烈咳嗽、系带过松、气囊充气不足或气囊破裂、切口过大，以及自行拔出。9例发生脱管时间不一，最短于气管切开术后第1天，最长于术后15 d，8例经予以紧急处理而尚未影响后续治疗，1例因缺氧时间太长而死亡。 结论 充分认识吸入性损伤患者气管切开脱管原因，并采取预见性的观察及护理措施，可减少脱管发生，确保患者安全。【Abstract】 Objective To explore the reasons and correct nursing methods of placing endotracheal tubes and tubes prolapsing after incision of trachea for inhalation injury. Methods The clinical data of nine patients with endotracheal tubes prolapse after incision of trachea out of 158 patients suffering from incision of trachea for inhalation injury from January 2005 to March 2011 were retrospectively analyzed. Results The reasons of nine patients suffering from endotracheal tubes prolapse included tubes incongruity, severe cough, too slack bridles, insufficiency and break of aerocysts, too large incision and extraction by themselves. The prolapse time of nine patients was different. The shortest time was postoperative one day, the longest one was postoperative 15 days. Eight patients were treated emergently and healed normally. One patient died of long oxygen deficiency. Conclusions The reasons of endotracheal tubes prolapse after incision of trachea are sufficiently recognized. Predictable observing and nursing methods may decrease the incidence rate of tubes prolapse.
【摘要】 目的 分析急性颈脊髓损伤后并发呼吸功能障碍的高危因素，以减少呼吸功能障碍发生，降低死亡率。 方法 对2002年7月-2006年8月收治的48例急性颈脊髓损伤患者，根据瘫痪程度、脊髓损伤平面、吸烟及年龄与呼吸功能障碍发生率的相关性，采用维持有效呼吸、颈部制动、减压复位内固定等相关措施，减少颈脊髓损伤患者术后并发呼吸功能障碍的发生。 结果 22例发生呼吸功能障碍；9例死亡，其中7例死于呼吸衰竭，1例心跳骤停死亡，1例合并脑干损伤死亡。 结论 全瘫、脊髓损伤平面高、吸烟、高龄是急性颈脊髓损伤并发呼吸功能障碍的高危因素，对高危患者气管切开、呼吸机辅助呼吸态度应积极。【Abstract】 Objective To analyze the high risk factors of respiratory obstacle after acute cervical spinal cord injury (SCI) and accept the measure more actively so as to decrease the respiratory obstacle occurrence and reduce the mortality rate. Methods A total of 48 patients from July 2002 to August 2006 were analyzed. According to the correlation among the paralyze degree,smoking, and age with the respiratory obstacle occurrence, we reduce the occurrence of respiratory obstacle in patients with spinal cord injury after the operation via obtaining the effective breath, neck retaining, etc. Results The respiratory obstacle was found in 22 cases; death in 9, in whom 7 died of respiratory failure, 1 of cardiac arrest, and 1 of brain stem hurt. Conclusions The whole palsy, higher level of the spinal cord injury, smoking, and advanced age are the high risk factors of respiratory obstacle after acute cervical SCI. The tracheostomy tube and the adjuvant respiration with the respirator should be accept aggressively for those high risk patients.