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郑毅负压隔离病房建设的4点体会
随着甲型流感的爆发,北京地坛医院受到全国的广泛关注,很多拟建负压隔离病房的医院都纷纷到医院来考察,在此时机,记者采访了北京地坛医院院长助理郑毅,结合北京地坛医院的建设,他谈了自己对于负压隔离病房建设的体会.
关键词: 负压隔离病房 病房建设 Negative Pressure Experience 医院院长 地坛 北京 甲型流感 记者采访 考察 -
封闭式负压引流促进创面愈合的机制
封闭式负压引流(vacuum - assisted closure ,VAC) 疗法也称负压伤口(topical negative pressure wound ,TNP)疗法,是将吸引装置与特殊的伤口敷料连接后,使伤口保持在负压状态,达到治疗目的.
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应用负压治疗伤口的临床实践及进展
负压创面治疗是一种促进急、慢性创面愈合的方法 ,它将负压作用于创面,对特定的伤口有促进愈合或改善基底状态的作用.
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持笔式持续负压细针穿刺器研制及其临床应用
1.针吸标本采集技术的回顾:细针吸取细胞病理学(fine needle aspiration cytopathology,FNAC)是诊断肿瘤、结核及其他疾病一项重要检查方法,产生于20世纪30年代.随着现代微创医学的发展,此项检查在国内外,尤其是在欧美发达国家颇受推崇.但是多年来,针吸标本采集技术存在的一些不足,始终影响着FNAC的普及与提高.长期以来,国内仍采用徒手牵拉针管方式完成针吸穿刺,操作费力、标本不足,影响了此项检查的开展.国外使用Franzén 20世纪50年代发明的注射器把手牵拉针管保持负压穿刺,虽在一定程度上改善了穿刺技术,但此器械较笨重,手感差,并且不利于掌握进针深度及力度,穿刺准确性及效果也不理想.
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负压闭式引流在外科创伤护理中的应用
控制严重创伤所致的大面积软组织撕脱,加快创面愈合,减少全身并发症,促进功能恢复是创伤外科面临的重要课题之一.而传统的外科换药,增加了创面感染的机会,给病人带来了多次的刺激和痛苦,同时也增加了医护人员繁杂的工作量,而病人创伤愈合的结果也很难达到理想的效果[1].负压闭式引流(vacuum gealing drainage,VSD)技术能够彻底祛除腔隙或创面的分泌物和坏死组织、促进伤口愈合,是外科引流换药技术的革新.我院创伤外科于2006年-2009年运用该技术处理复杂创面,取得良好效果.现报道如下.
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负压封闭引流治疗GustiloⅢ度损伤的护理
GustiloⅢ度损伤指软组织损伤,有严重碾压挫伤、创面重度污染、粉碎性骨折并伴有开放性骨折或骨外露的损伤.我院自2007年10月至2009年应用负压封闭引流治疗Gustilo Ⅲ度损伤12例,取得满意疗效.现将其护理报告如下.
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负压封闭引流治疗手足毁损伤病人的护理
手足毁损伤是骨科常见病之一.2008年9月-2009年1月我科应用负压封闭引流技术配合内固定手术治疗手足毁损伤,缩短了创面愈合时间,降低了治疗费用,取得了满意疗效.现将护理体会报道如下.
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吸盘式封闭负压引流病人的护理
封闭式负压引流技术(VSD)是近年用于创面引流的一项新技术,是一种高效、简单、经济且可促进创面愈合的纯物理疗法,而吸盘式封闭负压引流是一种改良新技术.我科利用吸盘式VSD处理了40个创面,获得满意疗效,现报告如下.1临床资料1.1一般资料2009年-2010年收治的40例大面积撕脱伤住院病人,其中男29例,女11例,年龄13岁~67岁(40岁±5岁),创面分布于全身多处.1.2材料一次性专用敷料,主要成分为聚乙烯醇,其早期在医学领域称"人工皮",包含多侧孔引流管以增强引流,提供均衡负压达到全面引流并保持长时间通畅.
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尿管灌肠并负压鼓引流在癌性肠梗阻病人中的应用及护理
肠梗阻是一种常见病,不但可引起肠壁本身解剖与功能上的改变,还可导致全身性生理紊乱,病程复杂多变,病情严重者的病死率相当高[1].癌性不全肠梗阻是腹腔、盆腔内原发性或转移性恶性肿瘤所致,也是晚期癌症病人常见的并发症.此种肠梗阻临床一般称为癌性肠梗阻(CBO),通常无法进行外科手术,病人十分痛苦[2].在采取常规禁食、药物、营养等治疗的基础上,我科采用尿管灌肠并接负压鼓引流,改进了传统的灌肠方法,取得了满意的治疗效果,有效缓解了肠梗阻症状.
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应用人工皮负压封闭引流在低位直肠癌术后的观察和护理
腹会阴联合直肠癌根治术(Miles术)是治疗低位直肠癌的主要手术方式.在手术过程中要切除乙状结肠下部及其系膜和直肠全部、肛管与肛周5 cm直径的皮肤、坐骨直肠窝组织等[1].因切除范围较大,会阴部切口容易出现切口感染、切口裂开、形成窦道等并发症,据国外报道会阴部的并发症发生率达10%~40%[2,3].
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影响负压封闭引流通畅的原因分析及对策
负压封闭引流技术(vacuum sealing drainage,VSD)是一种处理各种复杂创面和用于深部引流的新方法,可有效改善局部血流、减轻组织水肿、减少细菌数量、促进肉芽组织生长[1].目前此项技术已广泛应用于骨科领域治疗软组织缺损和感染性创面,而引流通畅与否直接关系到治疗效果.现对我院2009年2月-2010年1月69例VSD手术病人的引流情况进行观察和分析,并给予相应的护理干预.现报道如下.使用的引流管材质比较软,给予一定的负压后引起管道塌陷,影响引流效果,将负压调整,给予较低值,虽然管道塌陷情况得到改善,但是负压压力不够,虽未引起堵塞,但引流效果不够理想.
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自制负压引流装置在头颈部恶性肿瘤颈清扫术中的应用
头颈部恶性肿瘤切除范围大,颈部血管丰富,渗出物较多,术后需要用负压较大的引流装置引出渗液,以利于颈部皮瓣贴合,减少术区无效腔形成,加速创面愈合<'[1]>.目前各种引流装置很多,负压引流袋负压小(120 mmHg~160 mmHg,1 mmHg=0.133 kPa),易形成血肿压迫气管引起呼吸困难甚至窒息;且不可调节,引流管过长,引流液一部分存于引流管和负压球内,计量不准确,对颈清扫术而言,由于颈部皮瓣剥离面较大,若负压太小,创腔内残液不能充分引出,造成创腔感染影响疗效.我科2007年以来使用自制负压引流装置,引流效果较好.
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Effects of Dynamic Wall Properties on Blood Flow in Stenotic Arteries
High grade stenoses may cause critical flow and mechanical conditions such as negative pressure, flow separation,high shear stress and wall compression in arteries which may be related to platelet aggregation, thrombus formation, atherosclerosis growth and plaque cap rupture which leads directly to stroke and heart attack. The exact mechanism of these events and the conditions causing them are not well understood. Blood flow is highly pulsatile.
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Intracystic negative pressure may promote bone formation around jaw cysts
The growth and enlargement of jaw cysts are associated with raised intracystic pressure and bone resorption surrounding the cysts. The major bone-resorbing cells are the osteoclasts. They are acting under the influence of local bone-resorbing factors: prostaglandins, proteinases and cytokines. It was found that positive pressure enhanced the expression of IL-1αmRNA and protein in epithelial cells of odontogenic keratocyst, and increased the secretion of matrix metalloproteinase and PGE<,2> in a co-culture of odontogenic keratocyst fibroblasts and epithelial cells. However, the signal intensities for IL-1α mRNA and protein in the epithelium were significantly decreased after marsupialization which relived intracystic pressure. Experimental study indicated that intermittent negative pressure could promote osteogenesis in human bone marrow-derived stroma cells (BMSCs) in vitro. We propose a hypothesis that bone formation around the cyst of the jaws would be stimulated by intracystic negative pressure.
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无创正压通气在非急救医学中的临床应用
无创机械通气是指不建立人工气道,采用面罩或鼻罩等进行呼吸支持的机械通气技术.无创通气分为无创负压通气(noninvasive negative pressure ventilation,NNPV)和无创正压通气(noninvasive positive pressure ventilation,NNPV),临床应用多为无创正压通气.新一代无创呼吸机在吸氧浓度调节、气道湿化、同步性能等方面以及与其配套的鼻、面罩的密闭性、舒适性、减少重复呼吸等方面都有了很大的改善,因此其适应证有逐渐扩大的趋势.随着患者对生命质量要求的提高,能保留进食与语言功能的无创通气方式在我国临床应用会逐渐增多.无创通气的适应证选择国内外都在探索之中,目前在急救医学中应用于COPD急性加重期、急性肺水肿、重症哮喘、农药中毒等.而在非急救医学中目前认为对于以下几种情况无创通气可以发挥满意的疗效.
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负压创面治疗技术的研究进展
负压创面治疗技术 (negative pressure woundtherapy,NPWT)是近十几年来提出并开展的新方法,它包括1993年德国外科医师Fleischmann等[1]先提出的封闭负压引流(vacuum sealing drainage,VSD)及1997年美国外科医师Argenta和Morykwas[2]首创的封闭负压辅助闭合(vacuum-assisted closure,VAC)两项关键技术.
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Objective: To observe pressure changes in the spinal canal of the vertebrarium subjected to impact. From the point of view of impact, pressure changes and spinal cord injuries, the relationship between the type of spinal fracture and the severity of spinal cord injuries were analyzed and some experimental data were provided for early evaluation of severity of spinal cord injuries. Methods: An experimental model of spinal burst fracture was made with Type BIM-I bio-impact machine and techniques of high velocity vertical loading in static pattern and stress shielding were adopted. Vertebral sections T10-L4 taken from fresh cadavers were impacted and pressure changes in the spinal canal were observed. The types and severity of spinal fracture were studied with gross and radiography examination. Results: Great positive pressure wave (wave A) in the spinal canal of the 4 vertebral specimens with burst fracture was recorded. The peak value of pressure was correlated with the severity of posterior column injuries. Generally, the peak value of pressure was low in the samples with posterior column injuries, but high in the samples without injuries. The predominant features of fractures were burst fractures of vertebral body and severe destruction of the skeletal and fiber structure of the spinal canal. Positive and negative pressure waves (wave B) were recorded in 2 vertebral samples in which no significant abnormal changes were found by radiography examination, however, a little liquid effusion in the vertebral body was found by gross examination. Conclusions: The type of pressure wave in the spinal canal is related to the deformation or the destruction of the spinal canal structure. The peak value of the pressure is non-linearly related to the obstruction in the spinal canal, but related to posterior column injuries.