Objective:To explore the clinical effects of high flow nasal cannula (HighFlow) on patients with traumatic flail chest after removing mechanical ventilation.Methods:A retrospective analysis was carried out on 80 traumatic flail chest patients with mechanical ventilation, admitted to the ICU of Department of Emergency and Critical Care Medicine of Shanghai Changzheng Hospital from October 2016 to December 2019, who were divided into the HighFlow group and the conventional oxygen therapy (COT) group. The clinical effects of high flow nasal cannula on PaO 2/FiO 2 ratio, ventilation-free days, re-intubation case number, length of stay in ICU, incidence of ventilation associated pneumonia (VAP), and ICU mortality were analyzed. Results:The time point of extubation of the HighFlow group was (4.6±2.1) d, while that of the COT group was (4.3±2.2) d ( P>0.05). At the time point of extubation, the differences of the ventilation oxygenation indexes, i. e. arterial blood gas pH, PaO 2, and PaCO 2, heart rate (HR), and mean arterial pressure (MAP), between the two groups were not statistically significant ( P>0.05). PaO 2/FiO 2 and PaCO 2 at 2 h after extubation in the HighFlow group were significantly improved as compared with in the COT group; the re-intubation rate of the HighFlow group was significantly lower than that of the COT group; the time of ventilation-free of the HighFlow group was significantly longer than that of the COT group; the length of stay in ICU of the HighFlow group was significantly shorter than that of the COT group; the incidence of VAP of the HighFlow group was obviously lower than that of the COT group; all differences were statistically significant ( P<0.05). Conclusion:For traumatic flail chest patients with mechanical ventilation, high flow oxygen therapy can help them wean from mechanical ventilation earlier and reduce the incidence of VAP, which is worthy of popularization and application in clinic.

Objective:To explore the clinical effects of high flow nasal cannula (HighFlow) on patients with traumatic flail chest after removing mechanical ventilation.Methods:A retrospective analysis was carried out on 80 traumatic flail chest patients with mechanical ventilation, admitted to the ICU of Department of Emergency and Critical Care Medicine of Shanghai Changzheng Hospital from October 2016 to December 2019, who were divided into the HighFlow group and the conventional oxygen therapy (COT) group. The clinical effects of high flow nasal cannula on PaO 2/FiO 2 ratio, ventilation-free days, re-intubation case number, length of stay in ICU, incidence of ventilation associated pneumonia (VAP), and ICU mortality were analyzed. Results:The time point of extubation of the HighFlow group was (4.6±2.1) d, while that of the COT group was (4.3±2.2) d ( P>0.05). At the time point of extubation, the differences of the ventilation oxygenation indexes, i. e. arterial blood gas pH, PaO 2, and PaCO 2, heart rate (HR), and mean arterial pressure (MAP), between the two groups were not statistically significant ( P>0.05). PaO 2/FiO 2 and PaCO 2 at 2 h after extubation in the HighFlow group were significantly improved as compared with in the COT group; the re-intubation rate of the HighFlow group was significantly lower than that of the COT group; the time of ventilation-free of the HighFlow group was significantly longer than that of the COT group; the length of stay in ICU of the HighFlow group was significantly shorter than that of the COT group; the incidence of VAP of the HighFlow group was obviously lower than that of the COT group; all differences were statistically significant ( P<0.05). Conclusion:For traumatic flail chest patients with mechanical ventilation, high flow oxygen therapy can help them wean from mechanical ventilation earlier and reduce the incidence of VAP, which is worthy of popularization and application in clinic.

Objective To analyze and compare the curative effect of thoracic laparoscopy combined with resection of esophageal carcinoma and conventional three incision resection of esophageal carcinoma .Methods From January 2012 to January 2016,sixty-two patients received esophageal cancer resection in Shanxi Provincial Cancer Hospital were selected in the research.The patients were divided into laparoscopic group (28 cases) and traditional group(34 cases) according to surgical methods ,and they were treaded with thoracic laparoscopy combined with resection of esophageal carcinoma and three incision resection of esophageal carcinoma ,respectively.The amount of blood loss , the number of lymph node dissection ,the postoperative 1d flow,the ventilator use of 24h and the number of tracheotomy were recorded.The time of hospitalization,the time of closed drainage and the incidence of postoperative complications were recorded and compared between the two groups at discharge time.Results The operative time,amount of blood loss,drainage volume,drainage time and hospitalization time of the laparoscopic group were (3.22 ±0.64)h,(218.20 ± 45.42)mL,(235.67 ±42.15)mL,(3.32 ±1.81)d,(14.28 ±2.53)d,respectively,which were significantly lower than those of the traditional group [(4.52 ±1.11)h,(407.42 ±50.06)mL,(321.71 ±37.82)mL,(5.16 ±1.78)d, (17.35 ±4.38)d,t＝5.764,15.438,8.465,4.020,3.448,all P＜0.05].The incidence rates of pulmonary infection and atelectasis in the laparoscopic group were 3.57% and 0.00%,respectively,which were significantly lower than those in the traditional group (23.53% and 17.65%,χ2＝4.929,5.471,all P＜0.05).The ventilator -assisted breathing rate and postoperative tracheotomy rate of the laparoscopic group were both 0.00%,which were significantly lower than those of the traditional group (23.53%and 14.71%,χ2＝7.564,4.479,all P＜0.05).Conclusion It is safe and reliable to complete lymph node dissection and surgical treatment of thoracic laparoscopy combined with resection of esophageal carcinoma,and compared with conventional three incision resection of esophageal carcinoma it has the advantages of small trauma,low incidence rate of complication and fast recovery,which is worthy of further promotion.

Objective To study the antimicrobial susceptiblity,clinical and bacteriological characteristics of enterobacter cloacae infection in ICU. Methods 83 cases of ICU infected with enterobacter cloacae were analyzed retrospectively. Results The elderly, hypoproteinemia,invasive operation,long-term hospitalization and the abuse of broad-spectrum antibiotics were the risk factors of infection with enterobacter cloacae. Besides highly sensitive to imipenem, the bacterium was resistant to most antibiotics, many of whose drug resistance ratio is over 50%. Conclusion The patients in ICU should be avoided the long-term abuse of broad-spectrum antibiotics and invasive operation.Bacterial culture and antibiotic susceptibility test should be carried out promptly. They could reduce the incidence of enterobacter cloacae infection.