目的 总结9例儿童肺移植患儿术后监护治疗期的多学科团队护理经验.方法 组建多学科团队,落实精准用药、精准容量管理、术后感染控制、营养护理、心理干预、气道管理、个性化镇痛镇静等护理措施.结果 9例患儿ICU住院2～21 d,中位数4 d,均顺利转出ICU;病房住院13～149 d,中位数16 d.患儿均康复出院,随访期间无一例死亡.结论 基于多学科团队的护理,可以提高肺移植患儿术后护理水平,提高肺移植患儿长期生存率.

ABCA3基因缺陷可致先天性肺表面活性物质代谢障碍,是一种罕见遗传病,SHULENIN 等[1]于2004年首次发现ABCA3基因变异可致肺部疾病.目前,已有200多种ABCA3基因变异被报道[2].由其导致的间质性肺病(interstitial lung disease,ILD)尚缺乏特异性治疗方法,且预后差,5岁存活率低于20％,大部分患儿在5岁前死亡或必须接受肺移植手术[3].我国儿童肺移植起步晚,加上小儿供体稀缺,目前国内仅有6个移植中心开展了18例儿童肺移植手术,年龄最小的受者为5岁[4].2020年9月本院肺移植中心收治1例ABCA3基因缺陷ILD患儿并行肺移植术,术后患儿出现了重度原发性移植物失功( primary graft dysfunction , PGD )以及严重感染、高热、脱机困难等并发症,经过ICU治疗和护理,顺利转入移植病房,现将该例患儿移植术后护理情况报道如下.

临床上很多患者需要肠内营养支持治疗,然而腹泻一直是困扰临床治疗中最常见的不良反应,不仅导致患者延迟治疗,甚至需要终止肠内营养支持,影响患者康复与预后.近年来发现越来越多的研究强调肠黏膜屏障及肠道通透性对健康和疾病的重要作用.作者就黏膜屏障及其在疾病预防和治疗中的作用进行论述,并提出肠壁通透性“阈值”降低可能是导致肠内营养性腹泻原因之一,为进一步治疗肠内营养性腹泻提供可借鉴的方法.

[目的]探讨中医“益气健脾法”在老年肠内营养性腹泻患者中治疗作用,探索相关的机制,为防治此类疾病提供思路.[方法]27例符合老年肠内营养性腹泻患者随机分为中药组和西药组,同时选取行肠内营养治疗无腹泻患者作为“正常对照”研究,测量治疗前后肠道屏障功能指标“内毒素、二胺氧化酶、人肠脂肪酸结合蛋白”的变化.[结果]肠内营养性腹泻患者中药组治疗后血清内毒素水平明显下降,二胺氧化酶(DAO)、人肠脂肪酸结合蛋白(I-FABP)水平经过治疗后有下降,但差异无统计学意义.[结论]研究结果显示中药益气健脾法可以有效治疗肠内营养性腹泻、减轻症状、改善肠道功能,机制可能与改善肠道屏障功能有关.西药益生菌治疗具有一定疗效和安全性.

目的:探讨呼吸机应用中3种不同废气处理方式对病室内菌落数的影响.方法:选取应用呼吸机患者150例,采用3种不同废气排放方式,分析空气平均菌落数目标性检测结果.结果:通过连接螺纹管进行呼吸机废气处理,所得空气菌落数总数明显低于对照组,差异有统计学意义(P<0.05).结论:通过连接螺纹管将废气排放至空气净化系统入风口,在7 d内造成室内菌落数总量均在合格范围内,可见此方法有助于提高ICU病室空气质量,能降低多重耐药菌发生率和血流相关性感染发生率,处理方法安全有效且成本低.

随着人口老龄化,老年患者逐渐增多,由于味蕾减少、咀嚼功能减退、胃肠功能减弱等种种原因导致老年人消化吸收营养减少,造成营养不良,甚至导致疾病的发生及进展.肠内营养适用于有胃肠功能或有部分胃肠功能而不能或不愿吃足够数量的食物来满足机体营养需求的需要肠内 营 养 治 疗 的 病 人[1].但 腹 泻 是 肠 内 营 养 常 见 并发症,发病率高达 20％ ～ 40％[2].本 文 笔 者 运 用 参 苓 白 术 散 益 气 健 脾、渗 湿 止 泻之功效治疗老年肠内营养相关性腹泻 8 例,取得满意疗效,故报道如下.

Objective:To observe the relevant indexes and symptoms of hemoptysis of patients with bronchiectasis,analyze the possible causes and treatment strategies of Chinese medicine in treating hemopty sis of patients. Methods:Total 48 patients with bronchiectasis(20 patients with hemoptysis and 28 patients without hemoptysis) were analyzed and the similarities and differences of the clinical symptoms,syndrome differentiation and treatment were compared. Results:The inflammatory index in patients with bronchiectasis was high and the patients with hemoptysis had no obvious infectious symptoms. The syndrome differentiation was mostly heat syndrome,mainly treated by cooling blood for hemostasis. Conclusion:The hemoptysis of pa-tients with bronchiectasis may have no obvious infections,cough and overstrain maybe are the possible causes. Traditional Chinese medicine has obvious therapeutic effects on hemoptysis.

Objective To investigate the efficacy and safety of citrate anticoagulation for continuous renal placement therapy (CRRT) in patients at high risk of bleeding. Methods Forty-seven patients who needed to CRRT and were admitted into the department of critical care medicine from January 2015 to October 2016 were enrolled in this study. According to the patient′s actual condition, they were divided into citrate groups (24 cases) and saline group (23 cases). Patients in saline group were given saline wash. The efficacy and safety were compared between the two groups. The filter lifetime, after treatment the activated partial thromboplastin time (APTT), hemoglobin (Hb), blood gas indexes were compared between the two groups. Results The citrate group used 76 filters while the 0.9% sodium chloride group used 87 filters. The average filter lifetime in citrate group was (22.4 ± 12.7) h which was longer than (8.6±3.3) h in 0.9%sodium chloride group (t=9.79, P<0.01). The incidence of coagulation in extracorporeal circulation was 3.9%(3/76) which was lower than 16.1%(14/87) in 0.9%sodium chloride group(χ2=5.20, P<0.05). Conclusions Regional citrate anticoagulation is a safe and effective option for CRRT in patients at high risk of bleeding.

Objective To study the therapeutic effect of Shenling Baizhu powder in the treatment of enternal nutrition related diarrhea in the elderly. Methods 58 patients with eternal nutrition were randomly divided into observation group (n=30) and control group (n=28). In the case of conventional drug treatment, the observation group added to shenling Baizhu power, the control group was treated with probiotics, diarrhea and EN reach the target time were observed. Results The total effective rate of the observation group was 96.7% and the total effective rate of the control group was 89.3%, the difference of target nutrition time between the two groups was statistically significant. Conclusion Shenling Baizhu powder in the treatment of enternal nutrition related diarrhea in the elderly can promote intestinal absorption of water and relieve diarrhea

Chronic cough is presenting symptom of atopic cough( AC), which has no clinical sign. AC has normal pulmonary imageology and pulmonary function, which has no airway hyperreactivity. AC is associated with atopic constitution, but no eosinophils are found in bronchoalveolar lavage fluid. So, it is defined as AC. Cause and onset of the disease are not clear. In recent years, the pathogenesis and diagnosis strategy as well as treatment of the patients with AC have many progresses. This article reviews cognition of AC in recent years.

急性左心衰系因急性的严重心肌损害或突然加重的负荷使心功能正常或处于代偿期的心脏在短时间内发生衰竭或使慢性心力衰竭急剧恶化.