随着氧疗技术的不断进展,氧气治疗已经成为临床必不可少的基本治疗措施,而近几年经鼻高流量氧疗(high flow nasal cannula oxygen therapy,HFNC)因为其舒适性、持续冲刷鼻咽部生理无效腔,呼气末正压(PEEP)效应、加温加湿等功能已经逐渐取代普通氧疗和部分无创通气,成为临床的第一选择[3].HFNC因为其独特的生理效应使其临床适应证越来越广泛.我们通过查阅国内外相关文献就近年来HFNC在不同疾病中的应用进行综述.

目的：探讨系统化健康教育对类风湿性关节炎治疗依从性和关节功能的影响。方法选取我院2012年11月至2013年12月接诊的160例类风湿关节炎患者的临床资料，将所有接诊患者采用随机数字表法分为对照组和观察组各80例。对照组给予常规健康教育，观察组给予系统性健康教育，比较两组患者的治疗依从性和关节功能变化情况。结果护理12周和24周后，观察组患者的依从优良率明显高于对照组患者，组间差异有统计学意义（ P＜0．05）；患者的关节功能指标如晨僵时间、疼痛指数、肿胀指数以及关节功能指数等均较对照组患者出现了明显改善，组间差异有统计学意义（ P＜0．05）。结论系统化健康教育对类风湿性关节炎患者具有十分重要的意义，可明显改善患者的服药依从性和复诊依从性，促进患者的关节功能恢复，提高患者的生活质量，有利于患者的预后，值得临床应用。

目的：探讨预见性护理对脑出血偏瘫患者的护理效果及对患者肌力、肢体运动功能和神经功能的影响。方法将我院2013年1月至2014年1月收治的110例脑出血偏瘫患者随机均分为观察组和对照组各55例。在采用同样治疗方案的前提下，对照组采用常规护理，观察组给予预见性护理，观察并对比两种护理方式的临床效果，对肌力、肢体运动功能和神经功能的影响。结果两组患者护理后的神经功能缺损评分均较护理前明显降低（ P＜0．05），且观察组护理后的神经功能缺损评分明显低于对照组，差异均具有统计学意义（ P＜0．05）。实施预见性合护理措施后，观察组的Barthel指数和Fugl－Meyer评分均明显高于对照组，差异具有统计学意义（ P＜0．05）。观察组的并发症发生率、死亡率、致残率均明显低于对照组，差异具有统计学意义（ P＜0．05）。结论预见性护理可降低脑出血偏瘫病人的残疾率、死亡率和并发症发生率，对患者肌力、肢体运动功能和神经功能的恢复均有积极意义。

Objective:To explore the application effect of early enteral nutrition in the treatment of patients with acute exacerbated chronic obstructive pulmonary disease(AECOPD) by applying mechanical ventilation.Methods:40 AECOPD patients with mechanical ventilation were randomly divided into nutrition group with nasointestinal tube(group A,n=15) and nutrition group with nasogastric tube(group B,n=14) and control group(group C,n=11).The patients in group A and group B were provided nutrition respectively by nasointestinal tube and nasogastric tube,and the patients in the control group received intravenous nutrition.The length of mechanical ventilation,incidence of complications and improvement of patient's nutrition were observed and compared among the 3 groups after treatment for 2 weeks.Results:The length of mechanical ventilation was shorter in the group A than that in the group B and C(P<0.05);abdominal distension and other complications and the frequency of hyperglycemia were less than the group B and C(P<0.05);the increasing amount of albumin in the group A was more than the group B and C(P<0.01).Conclusion:The application of early nutritional support can effectively reduce complications and improve the nutritional status of AECOPD patients with mechanical ventilation.

Objective To evaluate the feasibility and the efficacy of early extubation and sequential noninvasive mechanical ventilation (MV) switched by procalcitonin window ( PTC window) in chronic obstructive pulmonary disease with exacerbated hyercapnic respiratory failurel.Methods All selected acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with respiratory failure were randomly divided into two groups.Sequential MV group by PIC window were the control group (22 cases),and others (23 cases) were as the experimental group underwent sequential MV by PTC window.The invasive MV duration,days of invasive MV,ventilatorassociated pneumonia ( VAP),days of antibiotic exposure,6-month rate of acute exacerbation and 6-month mortality were measured.Results Compared with sequential MV group by PIC window,sequential MV group by PTC window had shorter duration of invasive MV[(3.8 ± 1.4),(6.5 ± 1.8) d,P =0.000 ],fewer days in ICU[(6.9 ±1.7),( 9.6 ± 1.9) d,P =0.000 ],and fewer days of antibiotic exposure.The 6-month rate of acute exacerbation and 6-month mortality were not significantly different compared to the control group[( 21.7％,22.7％,P =1.000) ; (17.4％,13.6,P=0.450) ].Conclusion Early extubation followed by non-invasive MV initiated at the point of PTC window may decrease the duration of invasive MV and reduce antibiotic prescription.

目的:探讨早期肠内营养在慢性阻塞性肺疾病急性加重期(AECOPD)机械通气患者中的应用效果.方法:将40例AECOPD机械通气患者随机分为鼻肠管组(A组)15例,鼻胃管组(B组)14例,对照组(C组)11例.A组、B组分别给予鼻肠管、鼻胃管鼻饲营养,对照组给予静脉营养,治疗2周后观察、比较三组机械通气时间、并发症发生情况及营养改善情况.结果:A组机械通气时间短于B组、C组(P<0.05),腹胀等并发症、高血糖发生次数均少于B组、C组(P<0.05);白蛋白增加量大于B组、C组(P<0.01).结论:AECOPD机械通气患者早期应用鼻肠管营养支持可缩短机械通气时间,且并发症少,营养改善佳.

目的 探讨低分子肝素钠的剂量对ALI/ARDS预后的影响及可能的作用机制.方法 42名ALI/ARDS患者随机分为3组,A组为对照组12人;B组为小剂量低分子肝素组14人;C组为大剂量低分子肝素组16人.治疗7天观察氧合指数、血浆中IL-6和PAI-1的浓度、APACHE Ⅱ、死亡率.结果 通过治疗(1)各组氧合指数均较治疗前有所改善,小剂量抗凝与对照组比较无差异,P=0.054;大剂量抗凝优于对照组,P=0.001;(2)各组血浆中IL-6的含量较治疗前均有所下降,抗凝组优于非抗凝组,且大剂量抗凝优于小剂量,P=0.015;(3)各组血浆中PAI-1的含量较治疗前均有所下降,小剂量抗凝与对照组比较无差异,P=0.395;大剂量抗凝优于对照组,P=0.003;(4)各组患者APACHE Ⅱ较治疗前均有所好转,小剂量抗凝与对照组比较无差异,P=0.018;大剂量抗凝优于对照组,P=0.016;(5)氧合指数与血浆PAI-1呈负相关,r=-0.648,P=0.04;IL-6与APACHEⅡ评分呈负相关,r=-0.737,P=0.002;各组死亡率分别为41.7%,35.7%,25%,组间比较差异有统计学意义,P<0.05.结论 应用低分子肝素治疗ALI/ARDS,能够激活纤溶系统改善氧合;可能通过抑制IL-6等炎症介质的释放,降低全身炎症反应,从而降低患者的死亡率;大剂量的效果优于小剂量.

目的探讨低分子肝素钠对急性肺损伤（ALI）/急性呼吸窘迫综合征（ARDS）患者凝血活化、炎症反应及纤溶抑制的影响,以及其作用机制。方法将42例ALI/ARDS患者随机分为对照组（常规治疗）12例,治疗A组（常规治疗+低分子肝素钠2 500 U）14例,治疗B组（常规治疗+低分子肝素钠5 000 U）16例,均治疗7 d;观察三组治疗前后氧合指数（OI）、血浆IL-6、纤溶酶原活化剂抑制物-1（PAI-1）、急性生理学与慢性健康状况Ⅱ（A-PACHEⅡ）评分、活化部分凝血酶原时间（APTT）及PLT。结果与对照组比较,两治疗组OI改善明显,血浆IL-6、PAI-1明显下降,APACHEⅡ评分明显好转;治疗B组各指标改善情况均优于治疗A组（P均＜0.01）。三组治疗前后血浆APTT和PLT均无统计学差异（P＞0.05）,无出血增加情况。OI与血浆PAI-1呈负相关,IL-6与APACHEⅡ评分呈负相关（P均＜0.01）。对照组、治疗A组、治疗B组病死率分别为41.7%、35.7%、25.0%,组间比较有统计学差异（P＜0.05）。结论不同剂量低分子肝素钠均能改善ALI/ARDS患者的预后,但以5 000 U剂量者疗效明显。低分子肝素钠可能通过抑制IL-6等炎症介质释放,降低全身炎症反应,从而降低患者的病死率。

为探讨康复新液联合红外线照射治疗压疮的效果,将20例重症监护室压疮患者随机分为实验组12例和对照组8例。实验组应用康复新液喷洒创面联合红外线照射治疗,对照组应用庆大霉素外敷常规方法治疗。结果实验组有效率高于对照组(P<0.01),愈合时间短于对照组(P<0.01)。认为康复新液联合红外线照射治疗压疮的临床效果显著,优于传统的庆大霉素外敷常规方法。