目的 探讨经鼻高流量氧疗治疗Ⅰ型呼吸衰竭患者的临床疗效及对患者血流动力学、血气分析指标的影响.方法 根据随机数字表法将成都市龙泉驿区第一人民医院2019年8月至2020年12月收治的100例Ⅰ型呼吸衰竭患者分为对照组和观察组,各50例.对照组患者进行无创辅助通气治疗,观察组患者进行经鼻高流量氧疗治疗.比较两组患者治疗48 h后的临床疗效,治疗前与治疗48 h后的血流动力学指标、血气指标,治疗前后的疲劳量表(Borg)、舒适度评分(BCS).结果 治疗48 h后观察组患者的临床总有效率高于对照组;与治疗前比,治疗48 h后两组患者心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、动脉血二氧化碳分压(PaCO2)水平及治疗后Borg评分均降低,且观察组均低于对照组;两组患者动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)水平及治疗后BCS均升高,且观察组均高于对照组(均P<0.05).结论 经鼻高流量氧疗治疗Ⅰ型呼吸衰竭疗效确切,可有效改善患者临床症状,降低患者的各项血流动力学指标,提升舒适度.

目的 探讨失效模式与效应分析(failure mode and effect analysis,FMEA)联合PDCA循环在重症监护病房(intensive care unit,ICU)多重耐药菌院内感染防控中的临床效果,为ICU制定预防多重耐药菌院内感染控制措施提供有利依据.方法 2020年1月开始,成都市龙泉驿区第一人民医院重症医学科组建风险评估小组分析ICU多重耐药菌感染的可能风险点,通过FMEA进行风险评估,筛选出优先风险数值较高的失效模式用以评价多重耐药菌感染的高风险点;根据筛选出的高风险点进行真因分析,通过PDCA循环管理模式制定改进措施并予以风险控制.收集并比较2018年1月-2019年12月干预措施实施前与2020年1月-2021年6月干预措施后ICU多重耐药菌院内感染发生率、高风险事件失效改善情况、医护满意度.结果 筛选出的6项高风险事件分别为多重耐药隔离措施单一、床单元消毒不到位、不合理使用抗菌药物、新入人员感染防控意识薄弱、病原菌送检意识薄弱、消毒不及时.干预前后患者的多重耐药总发生率分别为2.72％(49/1800)和1.71％(31/1808),差异有统计学意义(x2=4.224,P=0.040);干预前后病原菌送检率分别为56.67％(1020/1800)和61.23％(1 107/1808),差异有统计学意义(x2=7.755,P=0.005);干预前后医护满意度分别为75.0％(30/40)和95.0％(38/40),差异有统计学意义(x2=6.275,P=0.012).结论 FMEA能有效发现ICU中多重耐药菌感染防治的薄弱点,而PDCA模式能有效针对薄弱点制定改进措施予以风险控制,两者联合应用为ICU多重耐药菌院内感染合理防治提供了科学有效保证.

重症患者是营养不良和并发营养风险的高危人群,其营养不良发生率约为40％[1].营养不良可影响患者临床结局,如增加感染风险、延长患者住院时间、增加重症患者的病死率[2].营养支持治疗前需对患者进行营养风险评估,评估的方法众多,但缺乏金标准,尤其是针对重症患者[3].可视化技术为重症医师直接掌握患者的营养状态提供了基础.评估肌肉的厚度、横截面积、回声强度等指标有助于预测、评价患者的营养不良及预后.但各研究中具体测量部位、方法等还存在差异,对于使用哪种肌肉作为预测指标及阈值等未达成共识[4].

目的 了解成都市周边县级公立医院重症医学科(ICU)医护人员对镇痛镇静集束化策略(CSAS)的认知情况及现状.方法 采用分层随机抽样方法,对成都市周边13家县级医院执行CSAS现状进行无记名问卷调查,分析不同特征医护人员对CSAS的认知及临床实践应用情况.结果 成都市周边县级公立医院ICU医护人员对CSAS的知晓率为70.2％,不同性别、不同工作年限的ICU医护人员对CSAS的知晓率不同(P＜0.05);ICU医护人员中具有“无镇痛不镇静”理念的为56.2％,“无镇痛不镇静”理念在不同性别、学历、职业类别和职称中的分布差异有统计学意义(P＜0.05).结论 目前成都市周边县级公立医院ICU对CSAS的认知和现状与相关循证策略要求存在一定的差距.

目的:笔者此论文旨在分析无创呼吸机在AHFRF治疗中的临床效果.方法:选择2015年3月至2017年3月在我院住院治疗的一百三十位AHFRF患者作为研究对象.其中使用常规治疗以及无创呼吸机辅助通气治疗的AHFRF患者共计七十八位,剩余的五十二位患者则使用的是本院的常规疗法.我们称前者为实验组,后者为对照组,然后将两个组的患者的治疗效果进行详细的对比分析,此外,还要观察两组患者在我院进行治疗二十四小时之前的B型尿钠肽(BNP)、平均动脉压(MAP)、心率(HR)、氧分压(PaO2)、二氧化碳分压(PaCO2)等五个指标的水平.结果:治疗前两组患者的五个观察指标之间的差异不具备统计学意义即P值大于零点零五.在经过治疗后,实验组的这五个观察指标值均小于对照组,P值小于零点零五,两组之间的差异有统计学意义.换言之,实验组治疗的总有效率明显比对照组好.结论:在AHFRF患者的治疗中运用无创呼吸机治疗可以有效缓解病人的呼吸困难症状,患者血气指标改善非常确切,这对于患者临床疗效的提升大有裨益,有助于患者病情的康复治疗.

目的 观察急性左心衰患者采用无创呼吸机治疗的临床价值及安全性.方法 将120例急性左心衰患者随机分为观察组(予以无创呼吸机治疗,n=60)和对照组(予以常规治疗,n=60),对比两组患者的临床治疗效果、不同时间动脉血气水平变化情况、并发症发生情况及生活质量评分等.结果 观察组患者的临床总疗效(96.67%)及动脉血气水平的变化情况明显优于对照组,组间差异均有统计学意义(P<0.05);观察组患者的各项并发症发生率及生活质量评分明显优于对照组,组间差异有统计学意义(P<0.05).结论 无创呼吸机治疗急性左心衰的临床效果显著,有效提高了治疗的安全性和可靠性,值得推广.

Objective To observe the effect of using noninvasive ventilation in severe asthma patients.Methods Extract from October 2013 to October 2013 treated 82 cases of patients with severe asthma,named after the observation group and control group,control group given conventional western medicine treatment,the observation group in the control group treated with noninvasive ventilation on the basis of treatment,compared two groups of therapeutic effect.Results The results showed that the group using noninvasive ventilation after treatment,the blood gas analysis index to improve the situation is better than the control group ( <0.05);Observation group and control group total effective rate were 87.80%,87.80%,total effective observation group was obviously higher than that of control group,the group data contrast differences between apparent,was statistically significant( <0.05).Conclusion The treatment of severe asthma to noninvasive ventilation,to obtain the treatment effect of ideal,can effectively improve the clinical indexes.

Objective:To discuss the action of APACHE Ⅱscore , blood lactate clearance rate on com-parison prognosis of critically ill patients .Method:146 cases of critically ill patients were selected and di-vided into group A, B, C according to the level of APACHE Ⅱscore , each group were assessed blood lac-tate clearance rate , APACHE Ⅱscore ;patients were divided into groups of death and survival group , and then assess blood lactate clearance rate , APACHE Ⅱscore.Result:23 cases of 146 cases of death in criti-cally ill patients (15.8%), 123 cases survived (84.2%).Blood lactic acid level two groups B , C was higher than that in group A , the blood lactate clearance rate was significantly lower than that in group A , P<0.01, has statistical significance;group C blood lactate levels were significantly higher than that of group B , the blood lactic acid clearance rate was significantly lower in group B (P<0.05), with statistical significance;group A, B, C blood lactate levels with 24h the instant blood lactic acid level was low , P<0.05, with statis-tical significance;increase the APACHE II score of patients with blood lactate clearance rate decreases , P<0.05, with statistical significance;the death group APACHE II score was significantly higher than the surviv-al group, P<0.05, has statistical significance;24h blood lactic acid levels in the two groups than the instant blood lactic acid level is low , P<0.05, the statistical significance .Conclusion:By detecting the blood lactic acid level and APACHE II score well able to assess the prevalence of critically ill patients to the doctor , treatment of patients , so as to reduce the mortality of patients .

Objective To explore the risk factors of nursing accident for neurological critical illness patients and observe the efficacy of nursing intervention on them .Methods A total of 275 cases of neurological pa‐tients were enrolled in author's hospital from May 2012 to May 2014 ,and the basic information on these pa‐tients were documented and the accident risk factors were investigated .Among them ,137 patients (male 86 cases ,female 51 cases) were admitted to hospital as a control group before May 2013 ,and treated with routine care ;while other 138 cases (male 92 cases ,female 46 cases) were admitted as the experimental group after May 2013 ,and received specific treatments for the risk factors basis on the routine care .The occurrence of the accident was observed to determine nursing intervention in neurological critical patients . Results Risk factors on nursing accidents for neurological critical patients were activity of daily living (OR= 3 .54 ,P= 0 .000 < 0 .01) ,the state of consciousness (OR = 6 .12 ,P = 0 .000 < 0 .01) ,swallowing ability (OR = 4 .82 ,P= 0 .016 < 0 .05) ,intracranial pressure (OR = 2 .36 ,P= 0 .024 < 0 .05) ,respectively ;the in‐cidence rate of nursing accidents in the experimental group was obviously decreased than that in the control group .Conclusion It is play an important role on controlling infection to carry out nursing intervention on capacity for action ,state of consciousness ,swallowing ability and intracranial pressure for neurological critical patients .

Objective To observe the clinical therapeutic effect of hemoperfusion for patients with acute phase complication of severe organophosphate poisoning.Methods Clinical data of 40 cases of severe organophosphate poisoning admitted during the period of August,2005 to July,2007 were retrospectively reviewed.The patients accepted hemoperfusion besides routine therapeutic methods.The incidence rates of acute respiratory failure,intermediate syndrome and poison rebound were statistically analyzed.Results In 40 cases of severe organophosphate poisoning,the incidence rates of acute respiratory failure,intermediate syndrome and poison rebound are 7.5%,12.5%,and 15.0% respectively.Conclusion Hemoperfusion can reduce the incidence rate of acute respiratory failure,but its effect for prevention of intermediate syndrome and poison rebound is not significant.