ICU中机械通气患者胃肠道功能障碍与预后的关系

为了探讨重症加强治疗病房机械通气患者胃肠道功能障碍与预后的关系,回顾性分析了我院中心ICU收治的68例非胃肠道疾病且行有创机械通气治疗超过48h患者的临床资料,并将患者分为胃肠道功能障碍组和非胃肠道功能障碍组,用统计软件分析发生胃肠道功能障碍的相关临床因素及发生胃肠道功能障碍后对病死率的影响.结果显示,统计分析显示胃肠道功能障碍组和非胃肠道功能障碍组在机械通气天数、APACHE Ⅱ评分、MODS的发生率、病死率间存在明显差异.因此,对危重病患者应重视其胃肠道功能障碍的防治.     

ICU呼吸机相关性肺炎临床相关因素分析

为了探讨呼吸机相关性肺炎（VAP）发生的危险因素,回顾性分析我院ICU机械通气的88例患者的临床资料,按诊断标准分为发生VAP组和未发生VAP组,对两组患者的相关因素及预后进行评价。结果显示,发生VAP组机械通气时间明显长于未发生VAP组（P〈0．05）;两组在年龄、APACHE评分、病死率差异显著（P〈0．05）。因此,机械通气时间是影响VAP发生的重要因素,患者年龄越大,APACHE评分越高,越容易发生VAP。VAP是病情危重的一个表现,发生VAP的患者,病死率高,防治VAP的措施是必要的。     

ARDS的常规非机械通气治疗现状

ARDS是重症患者常见的临床问题,病死率较高.ARDS时除机械通气治疗外,非机械通气治疗手段包括液体管理、药物治疗、体外生命支持治疗等也显示出不同的临床疗效,需要临床医生加以关注.     

早期气管切开对非肺部疾病长期机械通气患者的影响

为了评价早期气管切开对非肺部疾病长期机械通气患者的影响,我们回顾性分析158例非肺部疾病长期机械通气患者,根据气管切开时间的早晚（气管插管7天为界）分为早期气管切开组（n=88）和延迟气管切开组（n=70）。比较两组患者的抗生素使用时间、镇静剂和镇痛剂用量、病死率、医院获得性肺炎发生率等。结果显示早期气管切开可以明显缩短患者机械通气时间和ICU住院时间,降低抗生素使用天数、减少镇痛剂的用量,降低总住院费用。所以,非肺部疾病长期机械通气患者可以从早期气管切开中获益。     

早期气管切开对非肺部疾病长期机械通气患者的影响

为了评价早期气管切开对非肺部疾病长期机械通气患者的影响,我们回顾性分析158例非肺部疾病长期机械通气患者,根据气管切开时间的早晚(气管插管7天为界)分为早期气管切开组(n=88)和延迟气管切开组(n=70).比较两组患者的抗生素使用时间、镇静剂和镇痛剂用量、病死率、医院获得性肺炎发生率等.结果显示早期气管切开可以明显缩短患者机械通气时间和ICU住院时间,降低抗生素使用天数、减少镇痛剂的用量,降低总住院费用.所以,非肺部疾病长期机械通气患者可以从早期气管切开中获益.     

镇静与镇痛在ICU机械通气患者中的应用变化

探讨ICU内机械通气患者应用镇痛剂、镇静剂及肌松剂的情况及其对机械通气和预后的影响。回顾性分析我院中心ICU2006年、2007年收治的244例行有创机械通气治疗超过48h患者的临床资料,并将患者分为2006年组和2007年纽,用统计软件分析患者在年龄、性别、入ICU时APACHEⅡ评分、血糖、血浆白蛋白、基础疾病,气管插管时间、机械通气时间、ICU住院天数、镇痛与镇静剂应用的时间、机械通气时是否使用肌松剂、Ramsay评分及病死率方面是否存在差别。统计分析显示2006年组和2007年组在年龄、性剐、入ICU时APACHEⅡ评分、血糖、血浆白蛋白、是否使用肌松剂及基础疾病方面无差别;与2006年组相比2007年组患者气管插管时间、机械通气时间及ICU住院天数均缩短,镇痛与镇静剂应用时间均缩短,Ramsay评分降低,病死率下降。提示对机械通气的危重症患者应合理使用镇痛剂与镇静剂。     

重组人生长激素对机械通气患者氧合的影响

为了探讨重组人生长激素（rhGH）对机械通气治疗危重患者的治疗效果,将31例机械通气治疗的危重患者随机分为rhGH组和对照组,rhCM组每晚皮下注射rhGH8IU,连续记录7d内的各项指标。结果显示,rhGH组机械通气时间明显短于对照组,差异有统计学意义;rhGH组患者APACHEⅡ评分于用药后第5天开始明显低于对照组;对用药不同阶段氧合指标的比较,两组患者氧分压指标的变化差异统计学意义,而应用rhGH组患者呼吸指数和氧合指数于用药后第5天和第7天明显高于对照组,有统计学意义。因此,应用rhGH可以促进机械通气的危重患者自主呼吸功能的恢复。     

重组人生长激素对机械通气患者氧合的影响

为了探讨重组人生长激素(rhGH)对机械通气治疗危重患者的治疗效果,将31例机械通气治疗的危重患者随机分为rhGH组和对照组,rhGH组每晚皮下注射rhGH8IU,连续记录7d内的各项指标.结果显示,rhGH组机械通气时间明显短于对照组,差异有统计学意义;rhGH组患者APACHE Ⅱ评分于用药后第5天开始明显低于对照组;对用药不同阶段氧合指标的比较,两组患者氧分压指标的变化差异统计学意义,而应用rhGH组患者呼吸指数和氧合指数于用药后第5天和第7天明显高于对照组,有统计学意义.因此,应用rhGH可以促进机械通气的危重患者自主呼吸功能的恢复.     

珂立苏、西地那非联合机械通气治疗重度新生儿持续肺动脉高压的临床观察

探讨珂立苏、西地那非联合机械通气治疗重度新生儿持续肺动脉高压临床效果。本研究将47例重度新生儿持续肺动脉高压患儿随机分为观察组和对照组,对照组给予西地那非、常频机械通气等常规治疗,观察组再加用珂立苏治疗,比较两组治疗前后的临床指标和有效率。结果表明,两组肺动脉收缩压、动脉血氧分压、动脉血二氧化碳分压和氧合指数与治疗前相比有统计学意义(P0.05),且观察组改善显著,与对照组相比差异有统计学意义(P0.05);观察组有效率91.67%,对照组有效率73.91%。因此,珂立苏、西地那非联合机械通气治疗重度新生儿持续肺动脉高压效果更显著。     

ICU镇静药物的选择：苯二氮卓还是非苯二氮卓

2013年美国危重症医学会新发布的镇静、镇痛、谵妄治疗指南中指出,苯二氮卓类镇静药物的使用是ICU重症患者谵妄发生的独立危险因素,推荐ICU镇静优先采用非苯二氮卓类镇静药物以改善临床预后.的确,大量的研究表明以右美托咪定为代表的非苯二氮卓类药物相比苯二氮卓类镇静药,能明显缩短重症患者机械通气时间、ICU住院时间、减少ICU费用,并减少ICU谵妄的发生.然而事物总有两面性,ICU镇静不只是单凭药物调整便能顺理成章完成的事情.相比依据指南盲从简单的停用某种药物,建立完整的疼痛、躁动、谵妄评估系统,制定个体化镇静计划,保证机械通气有效性显得更为重要.     

Together – apart: in touch in a time of separation

This paper explores the experience of working as a Jungian analyst through the various phases of the global COVID-19 pandemic, examining the importance of the physical containing space alongside the analyst’s internal mind and how technology can both help and hinder understanding. A number of clinical vignettes illustrate the challenge of communicating over a distance, paying particular attention to the way countertransference phenomena can become re-attuned. Reference is made to mythology and symbols of hope, and consideration given to the meaning and purpose of the pandemic.     

The Possibility of Meaning in Human Evolution

Science undermines the certitude of non-naturalistic answers to the question of whether human life has meaning. I explore whether evolution can provide a naturalistic basis for existential meaning. Using the work of philosopher Daniel Dennett and scientist Ursula Goodenough, I argue that evolution is the locus of the possibility of meaning because it has produced intentionality, the matrix of consciousness. I conclude that the question of the meaning of human life is an existentialist one: existential meaning is a product of the individual and collective tasks human beings undertake.     

Phenotypic plasticity and archetype: a response to common objections to the biological theory of archetype and instinct

Since Jung’s death in 1961, scholars have attempted to integrate growing biological science data into Jungian concepts such as the collective unconscious, instincts and the archetypes. This enterprise has been challenging due to persistent false dichotomies of gene and environment occasionally arising. Recent works by Roesler (2022a, 2022b) for example, have raised objections to the biological theory of archetypes, but the objections are plagued by such dichotomies. The concept of phenotypic plasticity, however, helps to both avoid this problem as well as bridge the gap between competing theories into a more integrated model with solid biological foundations.     

When is it time to stop? When good enough becomes bad enough

This article draws on Winnicott’s concept of the good enough mother to discuss how to know whether a therapeutic situation is good enough to continue or bad enough to end. This dilemma is explored in terms of clinical syndromes, such as anorexia and pathological gambling, but focuses mainly on analyst-initiated endings, which are termed the ‘Casablanca dilemma’, based on an amplification of the ending of the film Casablanca. The author goes on to discuss such one-sided endings, drawing on interviews with 40 analysts and therapists about their clinical experience. A typology of bad enough endings is presented. The psychological differences between a good enough analysis as opposed to a bad enough one are explored through the ideas of Winnicott and Neumann.     

Kann Es Ein Argument Für Den Skeptizismus Geben? Das Epistemische Problem Der Irrtumsmöglichkeit

Summary  Is there any argument for scepticism? The epistemic problem of the possibility of error. Arguments for scepticism rest on the assumption that knowledge claims are fallible. For this reason the concept of knowledge appears to be questionable. Since it is necessary to distinguish doubts from possible doubts, the arguments for scepticism appear to be unconvincing. If we take it into account that we know something that is immune to doubt, we should draw the conclusion that, contrary to scepticism, knowledge claims have to be compatible with being fallible. Thus any knowledge claim is capable of being doubted.     

The transcendent function in Spitteler’s Prometheus and Epimetheus

In August 2020, John Beebe and Steve Myers met via Zoom to discuss their differing interpretations of psychological typology and the different sources within Jung’s writings that influenced their books: Integrity in Depth: Energies and Patterns in Psychological Type (Beebe), and Myers-Briggs Typology vs Jungian Individuation (Myers). The discussion centred on Spitteler’s epic poem Prometheus und Epimetheus, which forms the basis of chapter V of Psychological Types. This is both the largest chapter and one of two chapters that Jung highlighted in the Argentine foreword as containing the essence of the book. Jung’s book is primarily about the transformation of personality rather than the categorization of people. Although it contains a critical psychology that deconstructs the nature of consciousness, that is only one half of the book and a stepping-stone to the other half, which is the reconciliation of opposites with particular emphasis on the relation of consciousness and the unconscious. Jung assumed that readers were already familiar with Prometheus und Epimetheus, an understanding of which sheds light on the nature of the transformation that Jung described – the development of a new attitude towards attitude itself.     

Chapter 6: Biblical Foundations for a Practical Theology of Aging

SUMMARY

This article reviews Biblical sources pertaining to the elderly, particularly the frail elderly. Founded on these sources, implications for elderly with Alzheimer's Disease and other forms of dementia are addressed through a personal perspective informed by writings of Christian mystics.     

Seeing in the Dark: A View into Dissociation and Healing

In this paper, I will explore the role of art-making, the experience of trauma and dissociation, and the process of working with self-states from an analytic and creative frame. Relevant literature on dissociation, trauma, and the use of art will be discussed. A case involving my work with an adolescent girl who had experienced sexual abuse from a family member will be shared, with an emphasis on the meaningful role images played during the therapeutic process. Both Jungian and psychoanalytic models of conceptualizing and working with dissociation are included, following Donald Kalsched’s (2013) recommendation for a “binocular stance” to treatment, including both a focus on the inner, intrapsychic world and the interpersonal, relational realm, and how art images both illuminated and expressed these realms. Within the therapeutic process, art images allowed the therapist a view into the client’s unconscious process, and created a meeting ground for dissociative barriers to be gradually seen, felt and known, by both therapist and client. The experience of dissociation, in images and in session, provided a reference point for myself and my client, Taylor, to develop a shared understanding and a framework for growth.