Objective To evaluate the effects of midazolam intravenous drip combined with lidocaine via nebulization on patients during mechanical ventilation in intensive care unit ( ICU) . Methods 60 thoracic patients required postoperative mechanical ventilation in ICUwere randomized into 2 groups. The patients in therapeutic group received lidocaine 1 mg/kg via nebulization and midazolam intravenous drip 0. 1 mg·kg- 1·h- 1 . The patients in control group received 0. 9% NaCl 1 mg/kg via nebulization andmidazolam0. 1 mg·kg- 1 ·h- 1 . According to the scale of Ramsay, the additional midazolam and fentanyl were injected to maintain sedation and inhibit cough in both groups. During ventilation, calm score, the number and the severity of cough, the mean arterial pressure ( MAP) , heart rate ( HR) , and the consumption of midazolam and fentanyl were record. Results The number and severity of cough, the scale of MAP and HR in the therapeutic group were all significant lower than those in the control group ( P lt; 0. 05) . Theconsumption of midazolam and fentanyl in the therapeutic group were also significantly lower than that in the control group ( P lt; 0. 05) .Conclusion Midazolam intravenous drip combined with lidocaine via nebulization can reduce the side effects and requirement of sedative and opioids drug in ICU patients undergoing mechanical ventilation.
ObjectiveTo explore the influence of general anesthesia with laryngeal mask and preoperative inhalation of budesonide aerosol on the incidence of respiratory adverse events during pediatric anesthesia recovery. MethodsA total of 100 child patients scheduled to undergoing inguinal hernia repair between December 2012 and February 2014 were randomly divided into two groups (group A and B) with 50 in each. All the patients underwent general anesthesia with laryngeal mask, while patients in group B inhaled budesonide aerosol before anesthesia. Then, we observed the incidence of adverse events in both groups, including laryngospasm, respiratory tract infection, and pulmonary complications. ResultsCompared with group A, patients in group B had a lower incidence of adverse events (P<0.05). ConclusionPreoperative application of budesonide aerosol inhalation can significantly reduce adverse events in the process of anesthesia recovery in children.
目的:评价足量布地奈德溶液雾化治疗重度慢性阻塞性肺疾病急性加重期患者的临床应用价值。方法: 90例30%≤FEV1lt;50%的重度COPD急性加重期患者随机分为3组: 布地奈德组给予布地奈德溶液雾化吸入2mg/次,每8小时1次;甲泼尼龙组给予口服甲泼尼龙片24mg /次,1/日;对照组不使用任何糖皮质激素。疗程10d,观察3组患者治疗后肺功能,动脉血气和呼吸困难评分变化,以及糖皮质激素主要不良反应。结果: 与对照组相比,吸入布地奈德组和口服甲泼尼龙组在FEV1,PaO2,PaCO2和呼吸困难评分改善值方面,有显著差异性(Plt;005);吸入布地奈德组和口服甲泼尼龙组两组各项指标改善程度相似(Pgt;005);吸入布地奈德组和对照组的不良反应少于口服甲泼尼龙组 (Plt;005)。〖HTH〗结论:〖HTSS〗足量布地奈德溶液雾化治疗与口服糖皮质激素疗效相近,全身副作用小,安全性好,是重度COPD急性加重期糖皮质激素的有效选择。
Objective To evaluate therapeutic efficacy and safety of recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) inhalation in patients with recurrent pulmonarv alveolar proteinosis (PAP). Methods Three cases of recurrent PAP were treated by GM-CSF inhalation after whole lung lavage. The clinical data of the pulmonary function and SpO 2, the clinical symptoms and pulmonary lesions were compared before and after treatment. Results The pulmonary function and manifestations were improved obviously after GM-CSF inhalation. Also the ground-glass opacity was improved in high-resolution CT. The pulmonary function and SpO 2 increased obviously after received GM-CSF inhalation. There were no any adverse reactions in 3 cases. Conclusion GM-CSF inhalation therapy is effective and safe in recurrent PAP, but the long-term effect remains to be seen.
ObjectiveTo evaluate the effectiveness and safety of nebulized amikacin for the treatment of ventilator-associated pneumonia (VAP) caused by gram-negative bacilli. MethodsFrom January 2010 to December 2013,a total of 120 patients with VAP due to gram-negative bacilli were randomised to a nebulized group (60 patients) and a control group (60 patients) in Shanghai Fifth People's Hospital. On the basis of similar routine treatment and systemic antibiotics based on the physicians' decision according to guidelines,the patients received 400 mg nebulized amikacin diluted in 5 mL normal saline in the nebulized group or 5 mL normal saline in the control group twice daily for 7 days. The rate of clinical cure and bacterial eradication,mortality,weaning rate and adverse events were recorded. ResultsAt the end of nebulized treatment,the rate of clinical cure in the nebulized group was significantly higher than that in the control group (75.0% vs. 53.3%,P=0.013). So was the rate of bacterial eradication (75.0% vs. 44.4%,P=0.008). But the crude mortality and weaning rate were similar between two groups (P>0.05). The adverse events in two groups were similar too (P>0.05). When followed-up to the 28th day,the weaning rate in the nebulized group was significantly higher than that in the control group (71.7% vs. 51.7%,P=0.024),but the crude mortality was not different (P>0.05). ConclusionNebulized amikacin as an adjunctive therapy for the treatment of VAP,which do not demonstrate obviously adverse events,can help improve rate of clinical cure and bacterial eradication and long-term weaning rate,but can not reduce patients' crude mortality.
Objective To compare the clinical efficacy of intravenous polymyxin B alone and intravenous drip combined with nebulized inhaled polymyxin B in treatment of patients with carbapenem-resistant organism (CRO) pneumonia. Methods The clinical data of 85 patients with CRO pneumonia admitted to the Intensive Care Unit of Nanjing Drum Tower Hospital from September 2020 to June 2023 were collected using a retrospective study. According to the different ways of administration of polymyxin B, the patients receiving polymyxin B intravenous drip therapy alone were included in group A, and the patients receiving polymyxin B intravenous drip therapy combined with nebulized inhalation therapy were included in group B. The therapeutic effective rate, bacterial clearance rate, 30-day all-cause mortality and the level of infection indexes before and after the use of medication were compared between the two groups. The occurrence of acute kidney injury during the use of drugs in the two groups was observed and recorded. Results The pathogenicity culture results showed that there was no statistically significant difference between the two groups (P=0.144). Serum procalcitonin and C-reactive protein were significantly lower in the two groups after drug administration compared with those before drug administration (both P<0.05). The therapeutic efficiency and bacterial clearance rate in group B were higher than those in group A (both P<0.05). There was no statistically significant difference in 30-day all-cause mortality between the two groups (P=0.664). And there was no statistically significant difference in the incidence of adverse reactions between the two groups (P=0.650). Conclusion When polymyxin B is used to treat patients with CRO pneumonia, the intravenous drip combined with nebulized inhalation regimen is superior to intravenous drip therapy alone and does not increase the risk of developing nephrotoxicity.
Objective To investigate the pollution status of ultrasonic atomization fumigation and washing machine of traditional Chinese medicine and the effect of precision disinfection intervention, and to provide scientific basis for strengthening the cleaning and disinfection work of ultrasonic atomization fumigation and washing machine of traditional Chinese medicine. Methods From January to February 2024, samples were collected from the surface of seven ultrasonic atomization fumigation and washing machines of traditional Chinese medicine that could be used normally in the Department of Traditional Chinese Proctology of the First People’s Hospital of Longquanyi District, Chengdu. Samples were collected from four points, namely the nozzle, the front edge of the hip bath cover, the rear edge of the hip bath cover, and the outer edge of the hip bath cover, and at four times, namely before use, after use, after pre-intervention routine disinfection, and after post-intervention precision disinfection (including training of personnel, solidification of disinfection process, and improvement of disinfection supplies), to compare the pollution status and disinfection effect of the object surface at different points and sampling times, and analyze the microbial detection. Results In terms of different times, the qualified rate of specimens was 28.6% before use, which decreased to 14.3% after use; the qualified rate of specimens was 39.3% after pre-intervention routine disinfection, which increased to 92.9% after post-intervention precision disinfection, with a statistically significant difference (χ2=17.923, P<0.001). A total of 158 strains of bacteria were detected from unqualified specimens, including 121 strains of Gram-positive bacteria (accounting for 76.58%) and 37 strains of Gram-negative bacteria (accounting for 23.42%). The detected bacteria were mainly common environmental bacteria. The top three were Kocuria rhizophila, Dermacoccus nishinomurai, and Microbacterium aureum. The main pathogenic bacteria of common nosocomial infections were Staphylococcus epidermidis and Escherichia coli, and no multi-drug resistant strains were detected. Conclusion Targeted cleaning and disinfection measures should be taken to ensure the disinfection effect and reduce the risk of nosocomial infection for special medical instruments such as ultrasonic atomization fumigation and washing machine of traditional Chinese medicine.
Objective To evaluate the therapeutic effects of different airway management strategies early used for patients after abdominal surgery in general anesthesia. Methods According to gender, age,and operation location,200 patients after abdominal surgery in general anesthesia were randomly assigned to four groups, ie. a conventional treatment group ( Group A) , an incentive spirometry ( IS) therapy group ( Group B) , an aerosol inhalation group ( Group C) , a combination of inhalation and IS therapy group ( Group D) . Inhalation drugs included Budesonide, Terbutaline, and Ambroxol. The index of pulmonary function test ( FVC, FEV1 , PEF) and arterial blood gases analysis ( ABG) were measured, and the effect of secretions clearance and the improvement of respiratory symptoms were evaluated at 0.5 h,24 h, 48 h after extubation.Intratracheal intubation of the patients after leaving ICUwas followed up. Results FVC, FEV1 , PEF, ABG,sputumvolume, the effect of secretions clearance, clinical efficacy, and intratracheal intubation rate in group B, C and D were improved more significantly than those in group A. And the therapeutic effect was best in group D ( P lt;0. 05) . The secretions clearance was improved more better in group C and D, especially in those high-risk patients with advanced age, smoking history, and pulmonary cormobidities ( P lt; 0. 05) .Conclusions The combined use of IS training and inhalation therapy can improve airway secretions clearance and pulmonary function particularly for those patients after abdominal surgery in general anesthesia, especially for those high-risk patients.