ABSTRACT
Objective To explore the effects of bed side painless fiberoptic bronchoscopy for bronchoalveolar lavage (BAL) under chest computed tomography (CT) guidance and mechanical ventilation in the patients with severe pulmonary infection (SPI).Methods A total of 131 cases of SPI undermechanical ventilation support were randomly (random number) divided into CT group (C group),chest Xray examination group (X group) and without radiological examination group (N group).The bronchoalveolar lavage (BAL) by using painless fiberoptic bronchoscopy with invasive mechanical ventilation was carried out in patients of these three groups.Vital signs and variables of respiratory mechanics ofpatients were monitored before and 1 h,2 h,and 4 h after BAL and the time consumed for BAL was simultaneous recorded.Meanwhile,infection related biomarkers on the 3rd d and 5thd after BAL,positive detection rate of pathogenic bacteria,the time of invasive mechanical ventilation used during BAL and total duration of mechanical ventilation support were measured.Results During BAL and at 10 min after BAL,heart rate and respiratory rate of C group and X group were lower than those of N group (P ＜ 0.05),however,there was no significant difference in SBP and DBP among groups (P ＞ 0.05).One and two hours after BAL,peak inspiratory pressure (PIP),work of breathing ventilation (WOBvent) and airway resistance (RAW) in C group and X group were lower than those in N group,therefore,dynamic compliance (Cdyn) in C and X groups was better than that in N group (P ＜0.05).Four hours after BAL.Cdyn in C group and X group was better than that in N group (P ＜ 0.05),But there were no significant differences in PIP,WOBvent and RAW among groups (P ＞ 0.05).BAL time (BAL-t) in C group (16.81 ±2.62) min was shorter than that in X group (20.12 ± 3.81) min and N group (23.69 ± 2.76) min,(P ＜ 0.05).Three and five days after BAL,core body temperature,WBC and procalcitonin (PCT) in C and X group were lower than those in N group (P ＜0.05),and those in C group was lower than those in X group (P ＜0.05).Pathogenic micro-organism detection rate in C group (80.55％,29/36) was higher than that in X group (72.09％,31/43) and N group (59.65％,34/57) (P ＜ 0.05).Total mechanical ventilation time (MV-t) in C group (114.36 ± 38.39) h was shorter than that in X group (132.07 ± 42.51) h and N group (165.28 ± 67.28) h (P ＜ 0.05).Conclusions BAL by using painless fiberoptic bronchoscopy under chest CT guidance can effectively reduce the stress on patients with severe pulmonary infection supported with mechanical ventilation,decrease airway hyper-reactivity,shorten the BAL time,ICU stay and duration of mechanical ventilation,facilitate drainage of lung infection exudates and pathogen detection rate and improve efficacy of comprehensive treatment.
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Objective To investigate the clinical effect of digital multifunction trauma rinser(DMTR) on wound cleaning .Meth-ods 278 trauma patients from 6 hospitals were divided into groups by hand washing and DMTR .The cleaning time ,the amount of cleaning fluid and the effects of wound cleaning and bacterial clearance and healing were compared between the two groups .Results DMTR save time ,reduced the amount of cleaning fluid ,reduced residual bacteria ,and had better wound healing in patients with large wound area .Conclusion DMTR ,which is worthy of clinical application ,has better effect on cleaning large wounds than the traditional manual debridement w ay .
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Objective To observe and compare the operation ,short-term therapeutic effect and long-term therapeutic effect be-tween painless gastrostomy under endoscopy and nasal-jejunal catheterization as well as to explore their clinical feasibility and clini-cal application .Methods 81 cases of patients with severe acute pancreatitis in the hospital ICU from May 2012 to September 2013 , were divided into gastrostomy jejunostomy group(43 cases)and nasojejunal feeding group(38 cases) .The operation time ,gastroin-testinal nutrition tube inner curvature ,removal rateetc were observed to calculate the success rate .Contrast ratio ,plugging rate and catheter related infection rate and several indexes were observed to evaluate the therapeutic effect of two groups of short-term infec-tion ofincision .long-term calculation of two groups with tube ,comfort score and nutritional indexes to evaluate the therapeutic effect index .Results The operation time ,the digestive tract inside area rate ,nutrition tube removal ,catheter related pulmonary infection rate ,average indwelling catheter time ,comfort ,nutrition index of the two groups had statistically significant (P0 .05) .Conclusion With fewer complications and longer tube time , painless gastrostomy under endoscopy is safe ,simple and feasible ,which is easily accepted by patients .
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Objective To analyze the causes of misdiagnosis of aorta diseases for simple inferior limb artery thrombo-embolism,and summarize the clinical experience. Methods Retrospective analysis was made on clinical data of 9 eases misdiagnosed aorta disease,including clinical manifestation,misdiagnosis,improper treatment and final definite diagnosis. Results All 9 cases were misdiagnosed as simple inferior limb thrombo-embolism at first.Three cases were treated with emergent thrombectomy using Fogarty catheter.The correct diagnosis Was achieved by 3-dimensional CT angiography (3DCTA) after operation,and the eitiology of other 6 cases were also pmved as aortic disease by 3DCTA before operation.Among 5 cases of acute aorta dissection with iliac-femoral artery involved,2 cases abandoned surgery with one dying the next day and the other lost to follow-up after being discharged.The other 3 cases were treated with endovascular therapy successfully.One case of abdominal aorta anurysm with mural thrombosis defluxion were treated by aneurysm resection.The other 3 caBes of Leriche syndrome with acute aorta terminal filament thrombosis formation were cured by aortoiliac bypass.The limbs ischemia were improved in all cases without perioperative death.Conclusion Aorta diseases can sometimes lead to acute inferior limb ischemia,mimicking limb artery thrombo-embolism.Preoperative imaging especially 3 DCTA helps to establish correct preoperative diagnosis for a successful treatment.
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As a kind of service trade,medicine needs humane service.The best way to construct harmonious relationship between hospitals and patients is humane service.Humane service should consider that the service's target is patients,the weakness of human nature,the difference of humanity and the mentality of self-defend.Five key elements should be possessed in humane service: reliability,assurance,tangibility,empathy and responsiveness.