Objective To explore the effectiveness and safety of self-made washable endotracheal tube for subglottic secretion drainage. Methods Ordinary endotracheal tube and sputum aspirating tubes were used to make washable endotracheal tube for subglottic secretion drainage in our hospital. The self-made tubes were compared with washable endotracheal tube available on the market. The suction resistance, the cases of obstruction in the tubes, the average daily drainage, and the cases of infection of incisional wound were compared between the two kinds of tubes, and their safety was evaluated. Results After three days of application, the suction resistance of endotracheal tube available on the market increased, with six cases of the blockage of the lumen ( 85% ) , while that of self-made endotracheal tube did not change, with no cases of blockage ( 0% ) . There was significant difference between these two kinds of tubes ( P lt;0. 01) . The average daily drainage in the former was ( 16. 55 ±8. 66) mL/d; while that in the latter was ( 40. 12 ±25. 48) mL/d. There was no significant statistical difference between the two kinds of tubes ( P gt;0. 05) . The incidence ofinfection of incisional wound in the ordinary endotracheal tube was 50% ( 5 cases) ; that in the tubes available on the market was 28% ( 2 cases) ; that in the self-made tubes was 15% ( 2 cases) . There was significant difference among the three groups. When tube cuffs were inflated, the distance between the back edge of suction tubes and tube cuffs was was 2-4 mm. Conclusion Self-made washable endotracheal tubes are effective for subglottic secretion drainage with good safety and low price.
目的 探讨ICU床旁行气管切开术中意外发现甲状腺肿大的简易处理方法。方法 对我院ICU 48例床旁气管切开术中意外发现甲状腺肿大的处理方法进行回顾性分析，观察术中出血量、术后出血和切口感染情况。结果 48例患者术中出血量无明显增多，术后无继续出血，均未发生切口感染。结论 ICU床旁行气管切开术中，意外发现的甲状腺肿大并不少见，掌握简易有效的处理方法具有积极的临床意义。
ObjectiveTo explore the effects of metoprolol on hemodynamics of early septic shock patients with myocardial injury. MethodsWe prospectively recruited 22 septic shock patients with myocardial injury, who were admitted to the ICU of Xiaolan Hospital during March 2014 and February 2015.The metoprolol was injected through central venous catheter to reduce heart rate by 20% from baseline and maintain for 6h.Hemodynamic and oxygen metabolic parameters were collected to establish database. ResultsHeart rate decreased significantly to (98±18), (95±16) and (92±18) beat/min respectively at 1h, 3h and 6h post-dosing, compared with (125±28) beat/min at pre-dosing (P < 0.05).Cardiac index decreased significantly to (3.2±1.5), (3.3±1.9) and (3.3±1.6) L·min-1·m-2 respectively at 1h, 3h and 6h post-dosing, compared with (3.9±2.5) L·min-1·m-2 at pre-dosing (P < 0.05).The mean blood pressure, central venous pressure, pulmonary artery wedge pressure, pulmonary vascular resistance index, systemic vascular resistance index and stroke volume index showed no significant changes between pre-dosing and post-dosing (all P > 0.05). Lactate concentration decreased significantly to (9.8±4.1) and (8.1±3.6)mmol/L respectively at 3h and 6h post-dosing, compared with (13.4±5.2)mmol/L at pre-dosing (all P < 0.05), but mixed venous oxygen saturation showed no significant changes (P > 0.05). ConclusionMetoprolol may reduce heart rate and cardiac output in septic shock patients with myocardial injury, without obvious adverse effects on circulatory function and systemic perfusion.
Objective To explore the influence of different withdrawal time of trachea cannula on percutaneous dilational tracheostomy (PDT) in critically ill patients. Methods In this study, we retrospectively analyzed the clinical data of 185 critically ill patients experienced PDT, who had been admitted to the adult mixed ICU of Xiaolan Hospital of Southern Medical University from January 2015 to July 2017. The patients were divided into an early PDT group (EPDT group) and a delayed PDT group (DPDT group) according to the timing of withdrawing trachea cannula. Operation information such as operation time, blood loss and the incidence of complications were collected and compared between the two groups. Results Between the EPDT group and the DPDT group, there were no obvious differences in operation time (minutes: 6.5±2.6 vs. 7.3±3.5), amount of blood loss (ml: 5.2±2.8 vs. 6.0±3.4) or conversion to traditional operation (1.9% vs. 2.4%) (all P>0.05). Compared with the EPDT group, the DPDT group patients experienced more fluctuation of intraoperative vital signs, used more dose of sedative and analgesic drugs, and experienced higher occurrence of aspiration (18.3%vs. 5.6%), balloon burst (13.4% vs. 2.9%), guide-wire placing difficulty (11.0% vs. 1.9%) and tracheostomy cannula placing difficulty (14.6% vs. 2.9%) (all P<0.05). There were no statistical significances in postoperative complications such as postoperative-hemorrhage, pneumothorax, pneumoderm, the posterior tracheal injury or incision infection between the two groups (allP<0.05). More patients acquired postoperative pulmonary infection in the DPDT group than the EDPD group (12.2%vs. 5.8%, P>0.05), and there was no statistical significances in mechanical ventilation time between the two groups (days: 5.5±3.0vs. 6.0±2.5, P>0.05). Conclusions The operation and complications of PDT in critically ill patients are influenced by the timing of withdrawing trachea cannula. The standard procedure of withdrawing trachea cannula preoperatively may offer better clinical operability and lower technical risk.