In order to identify the incidence of nosocomial pulmonary infection in surgical critical care patients in our hospital, we studied 800 patients discharged from surgical intensive care unit between May 1992 to Dec. 1994. One hundred and six episodes of pulmonary infection were found in 96 cases, in which 20 cases had been re-infected. The infection rate was 12.0%. The age of patients, APACHE- Ⅱ score and duration in ICU were closely related to the incidence of pulmonary infection. Tracheal intubation, tracheotomy and mechanical ventilation were the predisposing factors. The prevalent pathogens were pseudomonas aeruginosa, acinetobacter, staphylococcus aureus and candida albicans. 54.7% of cases were infected with more than one pathogens, and 36.8% of cases had fungal infection. The prevention and treatment are also discussed.
Objectives To explore the efficacy of humidified and heated high flow oxygen therapy for the critically ill patients in intensive care unit (ICU) after extubation. Methods From January 2014 to December 2016, 487 patients were enrolled. Patients were allocated to two treatment groups randomly, which were humidified and heated high flow oxygen therapy group (236 patients, HFM group, aged 55.3±21.1 years old) and routine oxygen therapy group (251 patients, TO group, aged 58.4±19.3 years old). Blood oxygen saturation, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), fraction of inspired oxygen (FiO2), respiratory frequency, incidence rate of reintubation, ventilator-free days, ICU length of stay, and hospital stay were assessed and compared between the HFM group and the TO group. Results The hospital stay was similar in two groups. There were more ventilator-free days in the HFM group (P<0.05), fewer patients required reintubation (4.2%vs. 10.4%, P<0.05) and less ICU length of stay [(10.5±6.1) dvs. (14.3±8.5) d, P<0.05]. PaO2/FiO2 of the HFM group were better than the TO group after extubation at 2 h, 4 h, 8 h, 24 h, and 48 h (P<0.05). There were no statistically significant differences in respiratory frequency and PaCO2. Conclusions Humidified and heated high flow oxygen therapy can supply a better oxygenation for patients after extubation in ICU. It could be a common therapy in ICU for the critically patients after extubation.
Forty critical patients with respiratory failure in the intensive care unit were randomly divided into two groups,Group A with administration of parenteral nutritino(PN) and Group B,no parenteral nutrition given.Blood gas analysis and respiratory monitoring showed that the respiratory rate,pH、PaO2、PaCO2 and HCO3- had no marked difference between the two groups.But in Group A there was a slight decrease of Pao2/FiO2 and a marked increase of A-aDO2 and the pulmonary shunt.This study indicates that the content of fat emulsion and hydrocarbon in PN may be the main factor that affects the respiratory function.
創傷、手術、感染、燒傷等極度應激狀況下的危重患者常出現應激性高血糖； 非糖尿病危重患者類似糖尿病的癥狀； 糖尿病危重患者則高血糖程度明顯加重。 創傷后出現不同水平的高血糖，隨著血糖的增高，其死亡危險性也呈階梯樣成倍增長［1，2］……
目的 研究高血壓腦出血患者開始建立腸內營養的時間，以揭示其建立腸內營養的最佳時機。 方法 選取2010年7月－2011年9月收治的高血壓腦出血患者69例，隨機將其分為A、B、C組，A組23例在血流動力學穩定后24 h內采取鼻胃管方式開始建立腸內營養；B組23例在24～48 h內開始腸內營養支持；C組23例在48～72 h開始腸內營養支持，并分別于營養支持前1 d及營養支持后的14 d檢測三組患者三頭肌皮皺厚度、上臂肌圍、血清白蛋白、血紅蛋白水平等相關營養指標的波動情況；監測第3、14天各組患者腹瀉、便秘、應激性潰瘍、肺部感染等臨床并發癥的發生情況。 結果 相關營養指標監測結果研究發現：建立腸內營養支持14 d后，三組患者其三頭肌皮皺厚度及上臂肌圍在營養支持前后差異無統計學意義（P＞0.05）；A、B組患者其血清白蛋白及血紅蛋白水平在營養支持后較前有增高表現，差異有統計學意義（P＜0.05），且B組患者其血清白蛋白及血紅蛋白水平增高程度較A組更為顯著；C組患者其血清白蛋白水平在營養支持后有增高表現，且差異有統計學意義（P＜0.05），但血紅蛋白水平較前比較差異無統計學意義（P＞0.05）。相關臨床并發癥發生率的研究結果如下：給予腸內營養支持3 d后，A、C組患者分別與其余兩組比較發現，其腹瀉、胃潴留、應激性潰瘍、肺部感染發生率較其余兩組比較差異無統計學意義（P＞0.05）；B組患者與其余兩組比較，其應激性潰瘍發生率較其余兩組減低，且差異有統計學意義（P＜0.05）；腹瀉、胃潴留、肺部感染較其余兩組比較無顯著差異；但隨著觀察時間的不斷延長，在腸內營養支持后的14 d，A組患者較其余兩組比較，其腹瀉、胃潴留、應激性潰瘍發生率仍無顯著差異，但其肺部感染的發生率較B組增高，而較C組減低，且差異有統計學意義（P＜0.05）；B組患者較其余兩組比較，其腹瀉、應激性潰瘍、肺部感染的發生率較其余兩組均減低，且差異有統計學意義（P＜0.05），并且其肺部感染發生率減低程度較A組明顯，其胃潴留發生率與其余兩組比較時差異無統計學意義（P＞0.05）；C組患者與其余兩組比較，其應激性潰瘍、肺部感染個例發生率較其余兩組增高，但差異無統計學意義（P＞0.05）。 結論 高血壓腦出血患者于血流動力學穩定后的24～48 h內給予建立腸內營養支持，可利于患者相關營養指標的恢復，減少相關臨床并發癥的發生，可能會在一定程度益于患者的預后。