困难撤机

本文讨论国际上困难撤机的时间界定及困难撤机的原因,讨论了困难撤机的常见问题,困难撤机患者脱机模式的管理方法。在近代机械通气撤离新理念方面的发展趋势,尽管机械通气应用水平有很大发展,但在诸多环节上仍存在很多问题,撤机仍需经验,需多学科合作。     

The perils of intimacy: Closeness and distance in feeding and weaning

This paper is based on work in the baby clinic of a general practice, with examples from infant observation, and ideas from recent research. It is something of an interdisciplinary paper.     

Dominance and age-related changes in the play fighting of intact and post-weaning castrated male rats (Rattus norvegicus)

The play fighting behaviour of male rats (Rattus norvegicus) castrated at weaning was compared to that of intact controls during the juvenile and post-pubertal phases of development. Following puberty, both the castrated and intact animals exhibited an age-related change in their play fighting; the frequency of initiating play fighting decreased and juvenile patterns of playful defense were replaced by more adult-like patterns. As these changes occurred even in the absence of the pubertal surge of gonadal hormones, they were more likely to result from the organizational effects of gonadal hormones in the perinatal period than the activational effects of these hormones at puberty. Although the castrated animals exhibited the age-related changes in behaviour, they did not exhibit the asymmetries in play associated with dominance relationships. As demonstrated in previous studies, in pairs of intact rats, the animal that attacks the most and uses more juvenile defenses during play fighting and weighs the least is typically the subordinate. In the castrates, asymmetries in weight and playful defense are not related to play frequency, indicating the absence of a dominance relationship. Although the characteristic changes in male play fighting at puberty are independent of the activational effects of gonadal hormones, dominance relationships and their associated changes in play fighting are dependent on these hormones. Therefore, in the perinatal period gonadal hormones most likely organize the age-related changes in play behaviour, whereas post-pubertally gonadal hormones activate dominance relationships and thus, indirectly modify play fighting by affecting dominance-associated assymetries in behaviour. © 1996 Wiley-Liss, Inc.     

呼吸机依赖患者撤机失败原因及对策

机械通气是近年来抢救呼吸衰竭患者的重要生命支持手段,但使用呼吸机的时间超过2周可导致撤机困难。本文详细分析了诸如心理障碍、营养不良、心肺功能不全以及撤机方法不当等各种可导致困难撤机的原因,并针对各个原因提出相应的治疗及护理对策,从而降低临床上困难撤机的发生率。     

Agonistic behaviour and bite wound patterns in wild water voles (Arvicola terrestris L.)

Intra‐specific aggression was investigated in a wild colony of Water voles between 1999 and 2004 in South Wales, UK. The occurrence and location (i.e. on the head, neck, body or tail) of bite wounds were recorded for adult and juvenile male and female voles. The greatest (33%) incidence of bite wounds were recorded on juvenile females and the lowest (18%) in adult females. Seasonal analysis of wound data in adults revealed that females were more likely to be bitten during the breeding season whereas bite patterns in males did not vary seasonally. Analysis of bite pattern topography revealed that most Water voles seemingly attempt to bite vulnerable target areas of the body (namely the head and tail). This is in contrast with studies on rats and mice where competitive forms of attack (particularly involving males) largely avoid these areas of the attacked animal's body. Targeting vulnerable areas is normally a characteristic of defensive modes of attack. Patterns of bite topography and agonistic behaviour in this species seem to reflect competitive interactions between individuals, particularly between territorial females and their female offspring, over access to essential resources. Aggr. Behav. 32:599–603. 2006. © 2006 Wiley‐Liss, Inc.     

ICU长期机械通气患者撤机困难的因素分析

为探讨ICU长期机械通气患者撤机困难的原因,回顾性分析大连医科大学附属第一医院重症医学科的62例长期机械通气患者的临床资料,回顾撤机过程,分析其撤机成功或失败的原因。结果显示,62例长期机械通气患者,34例成功撤机;10例死亡;18例因各种原因出现撤机困难,其中运动神经元病1例,脑外术后2例,间质性肺病4例,慢性阻塞性...     

呼吸机的撤离

呼吸机的脱机和撤离过程是一个重要的临床问题。呼吸机撤离是呼吸机由全部同期支持转为自主呼吸过程。在脱机过程中不必要的延迟会增加机械通气的复杂性,如肺炎或气道损伤,同时增加治疗的费用。撤机分为脱机和撤离人工气道,撤机参数对撤机后果预测的准确率不高,本文论述了对自主呼吸试验失败原因及实施自主呼吸方法以及完整呼吸机撤离过程。