【摘要】 目的 分析护理干预对纤维支气管镜检查患者的心理影响。方法 2008年1月—12月，通过对100例患者的问卷调查及临床观察,总结分析其心理特点及所采取的护理干预措施的影响。结果 纤维支气管镜检查患者的心理特点有:恐惧心理、紧张心理、消极心理等；相应的护理干预:教育性干预、行为训练、情感支持、药物干预等。结论 正确评估患者的心理特点,采取有效的护理干预,改善患者的心理状况,有利于提高患者的依从性,从而提高检查的成功率。【摘要】 目的 分析护理干预对纤维支气管镜检查患者的心理影响。方法 2008年1月—12月，通过对100例患者的问卷调查及临床观察,总结分析其心理特点及所采取的护理干预措施的影响。结果 纤维支气管镜检查患者的心理特点有:恐惧心理、紧张心理、消极心理等；相应的护理干预:教育性干预、行为训练、情感支持、药物干预等。结论 正确评估患者的心理特点,采取有效的护理干预,改善患者的心理状况,有利于提高患者的依从性,从而提高检查的成功率。
【摘要】 目的 比较喉罩和气管内插管吸入七氟烷全麻用于小儿无痛苦纤支镜检查的麻醉效果、苏醒时间、苏醒质量。 方法 将2008年3月-2009年3月40例行纤支镜检查的患儿随机分为喉罩组（L组，21例）和气管内插管组（T组，19例）。两组均采用逐渐诱导法吸入七氟烷，静脉给予芬太尼1 μg/kg；L组置入喉罩，T组气管插管后控制呼吸。手术中，两组均吸入2%～5%七氟烷维持麻醉。分别记录麻醉前（T0）、麻醉后纤支镜进入前（T1）、进镜至咽部（T2）、声门部（T3）、气管内（T4）及第15 min（T5）时的血压（BP）、心率（HR）、MAP和动脉血氧饱和度（SPO2）。观察纤支镜检查期间有无呛咳、气道痉挛或体动；记录停药至拔管的时间，苏醒后是否再入睡及麻醉满意度。 结果 两组HR在T1、T3、T4时升高，与T0时比较，有统计学意义（Plt;0.05）；其中HR在T1时T组高于L组，组间比较有统计学意义（Plt;0.05）；MAP在T1、T2、T3、T4时，T组低于L组，组间比较有统计学意义（Plt;0.05）。两组患儿镜检期间均无呛咳、气道痉挛或体动；L组苏醒时间短于T组（Plt;0.05），苏醒后再入睡率低于T组（Plt;0.05），麻醉满意度高于T组（Plt;0.05）。 结论 喉罩吸入七氟烷全麻用于小儿无痛苦纤支镜检查，能保证稳定的血流动力学状态，苏醒快速，效果满意。【Abstract】 Objective To assess the feasibility and safety of Laryngeal mask combined with sevoflurane in painless fiberoptic bronchoscopy anesthesia in children. Methods Forty children from March 2008 to March 2009 were randomized divided into laryngeal mask airway group (group L) and endotracheal intubation group (group T). Anaesthesia was induced and maintenanced with 2%-5% sevoflurane and fentanyl 1 μg/kg. The blood pressure (BR), heart rate (HR) and oxygen saturation by pulse oximeter (SPO2)were recorded before anaesthesia (T0), immediately after anaesthesia induction (T1), when FOB at the level of pharynx(T2), vocal cords (T3), trachea (T4) and in 15 min of the FOB (T5). Extubation time, recovery quality and anesthesia effects were also analyzed. Results Compared with T0, there were significant increases in HR at T1、T3 and T4 (Plt;0.05), and HR was significantly higher in the group T than that in the group L at T1 (Plt;0.05). MAP was significantly lower in group T than that in group L at T1、T2、T3 and T4, respectively(Plt;0.05). Recovery time was significantly shorter in group L than that in group T. Incidence of sleep after recovery was lower in group L than that in group T. Anesthesia satisfaction was higher in the group L than that in the group T. Conclusions Laryngeal mask combined with Sevoflurane provide satisfactory anesthesia for painless fiberoptic bronchoscopy in children.
ObjectiveTo investigate the effect of recruitment maneuver (RM) following fibrobronchoscopy in invasively mechanically ventilated (IMV) patients with excessive airway secretions or foreign body aspiration. MethodsFrom September 2012 to July 2014, 200 eligible patients were randomly assigned to intervention group (n=100) and control group (n=100) . Airway clearance by fibrobronchoscopy was conducted in both the two groups, but RM was subsequently performed only in the intervention group. Outcome measurements included oxygenation index, partial pressure of carbon dioxide (PaCO2), heart rate (HR), air way resistance (Raw) and dynamic lung compliance (Cdyn) before and 2 hours after treatment, and duration of IMV and Intensive Care Unit (ICU) stay were also analyzed. ResultsAfter treatment with fibrobronchoscopy, oxygenation index [intervention vs. control: (291.14±38.49) vs. (241.39± 35.62) mm Hg (1 mm Hg=0.133 kPa)], PaCO2 [(41.65±7.73) vs. (38.87±7.97) mm Hg] and Cdyn [(48.94±11.21) vs. (39.59±10.98) mL/cm H2O (1 cm H2O=0.098 kPa) ] were significantly increased, while HR [(95.41±20.59) , vs. (106.47±19.11) beats/min] and Raw [(17.87±8.32) vs. (23.98±7.88) cm H2O/(L·s)] were significantly decreased in both groups (P ＜ 0.01) . Duration of IMV and ICU stay in the intervention group were (15.72±6.42) and (19.85±8.12) days respectively, while in the control group were (20.49±7.21) and (27.87±10.33) days. Compared with the control group, patients in the intervention group had lower Raw, duration of IMV and ICU stay, and higher Cdyn, oxygenation index, and PaCO2 (P ＜ 0.01) , but no significant difference was found in HR (P ＞ 0.05) . ConclusionIn mechanically ventilated patients with excessive airway secretion or foreign body aspiration, recruitment maneuver following fibrobronchoscopy is of great clinical importance, due to the decrease of the duration of mechanical ventilation and ICU stay by re-inflating the collapsing alveoli, improving pulmonary ventilation and gas exchange, lung compliance and diffusion capacity.
目的 观察右美托咪啶复合丙泊酚靶控静脉麻醉在纤维支气管镜检查术中的麻醉效果。 方法 2010年12月－2012年4月，将60例行纤维支气管镜检查术的患者随机分为丙泊酚麻醉组（对照组）和右美托咪啶复合丙泊酚麻醉组（观察组），每组各30例。观察记录不同时点平均动脉压（MAP）、心率、呼吸次数（RR）、脉搏血氧饱和度（SpO2），镇静评分、手术时间、苏醒时间、丙泊酚总用量、不良反应发生率及患者满意度。 结果 所有患者均能顺利完成操作，诱导入睡后观察组MAP、心率下降（P＜0.05），丙泊酚总用量、不良反应发生率均少于对照组（P＜0.05），镇静评分优于对照组（P＜0.05）；两组RR、SpO2、苏醒时间、手术时间及患者满意度差异无统计学意义（P＞0.05）。 结论 右美托咪定复合丙泊酚靶控输注适用于纤维支气管镜检查术麻醉，是一种更加安全有效的麻醉方法。
Objective To investigate a suspected outbreak of hospital-acquired infections caused by Mycobacterium chelonae related to flexible bronchoscope (hereinafter referred to as “bronchofibroscope”) and apply targeted high-throughput sequencing (tNGS) technology for etiological analysis, providing references for controlling hospital infection outbreaks. Methods A retrospective survey of patients who were detected with Mycobacterium chelonae through tNGS testing of bronchoalveolar lavage fluid (BALF) after bronchofibroscopy at the Zhengdong District, People’s Hospital of Henan University of Chinese Medicine, People’s Hospital of Zhengzhou between May 1, 2018 and March 18, 2024. The causes were investigated through comprehensive measures including on-site epidemiological surveys and environmental health assessments, and intervention measures were developed and evaluated for effectiveness. Results A total of 52 patients were included. Mycobacterium chelonae was detected in 30 patients, nosocomial infection was excluded in all cases. The suspicious contaminated bronchofibroscope lavage fluid and its cleaning and disinfection equipment, environment and other samples were collected. The traditional microbial culture results were negative. The tNGS results showed that Mycobacterium chelonae was detected in bronchofibroscope lavage fluid (sequence number 156), and all the patients with Mycobacterium chelonae detected in BALF used the bronchofibroscope. It was judged that this event was a pseudo-outbreak of nosocomial infection caused by the contamination of bronchofibroscope with the patient’s BALF. After three months of continuous follow-up after the comprehensive control measures were taken, Mycobacterium chelonae was not detected by tNGS in bronchofibroscope lavage fluid or patients’ BALF. All patients in the hospital improved and discharged without any new cases. The pseudo-outbreak of nosocomial infection was effectively controlled. Conclusions There are many links in the reprocessing of bronchofibroscope, which is easy to cause pollution, and the management needs to be strengthened. tNGS detection has the characteristics of high efficiency, few background bacteria and clear pathogen spectrum, which can be used as a supplementary means for the investigation of nosocomial infection outbreaks, and is of great significance for identifying the source of infection and determining the transmission route.