临床医学英语教学课件：Unit 6 ICU

1、Unit 6ICUImportant Combining Forms1. ped(o)-: child2. iatr(o)-: medicine, medical doctor3. lys(o)-: dissolution4. orth(o)-: correction5. vas(o)-: vessel6. brady-: slow7. tachy-: rapid8. pnea, pneo-: respiration9. encephal(o)-: brain10. -spir(o): respiration11. intra-: withinICU发展史ICU始于对呼吸衰竭的集中治疗和护理，

2、广泛应用于心 脏内、外科。在1952年的夏季，丹麦首都哥本哈根发生了脊髓灰白质炎的流行，造成了很多延髓性呼吸麻痹病例，多死于呼吸衰竭。当时病人被集中起来，在内科医生和麻醉医生的共同努力下，通过气管切开保持呼吸道畅通并进行肺部人工通气，使死亡率显著下降。治疗效果的改善，使有关医生认识到加强监护和治疗的重要性。1958年，Zbsen及Kvittingen报道了259例此类病人加 强监护和治疗的经验，又进一步提高了人们对ICU重要性的认识，并开始在临床上推广应用。在英国，50年代初，曾建立许多呼吸重症监护治疗病房(RICU)，它主要是为继发于神经疾病的慢性呼吸衰竭的病人提供呼吸支持而设立的。由此，人

3、们在机械通气的处理方面取得了大量的经验。在美国，对危重病人加强监护和治疗的发展也很快。例如，麻省总医院的RICU于1961年开放后，一年内就治疗400例病人。50年代，体外循环下心内直视手术的成功应用于临床和推广，以及缺血心肌再血管化的开展，为现代ICU的建立提供了客观需要，并显示了蓬勃发展的生机。到60年代，由于临床的需要，分科愈益细致，危重病人亦不断增加，加之电子工业的飞速发展，以及监护仪器和新诊断设备的问世，因而各种ICU相继建立，如冠心病重症监护治疗病房(CCU)、心肺重症监护治疗病房(CPICU)、心脏外科重症监护治疗病房（CSICU）、神经外科重症监护治疗病房（NSICU），婴幼儿

4、重症监护治疗病房（IICU）等。几乎每一个专科均有它们自己的专科重症监护治疗病房。对特殊病人如心脏、肺、心肺移植术后，以及免疫系统病的病人，还建立了“岛式”隔离加强医疗室，除严格隔离外，还采用净化空气进行换气，以减少感染机会，从而改进了各专科对危重病人的抢救、治疗和护理，提高了疗效。 山东大学齐鲁医院ICU科山东大学齐鲁医院综合ICU成立于1991年，是新兴的临床业务科室，也是我省最早成立的综合ICU，创建之初，有床位3张，医护工作人员12人，十五年来，科室发展迅速，目前已拥有对外开放床位16张，医护工作人员增加至30余人次，设备总投资一千万元以上，成为山东省乃至国内有影响的科室之一。 临床工

5、作本科室负责全院危重病人的监护、抢救工作，具备对危重病人进行持续的生命体征监测，及时地反馈治疗，以及对多个脏器进行功能支持的能力。先后在省内率先开展了多项新的诊疗技术，如经皮穿刺气管插管技术，操作简单，手术时间短，病人创伤小，刀口愈合快，代替了传统应用的气管切开方法；胃粘膜PH监测，对指导复苏，预防MODS具有重要的临床价值；持续床旁血液滤过，使不宜搬动或血流动力学不稳定的危重病人也可以接受血液净化治疗。先进的医疗设备，精湛的医疗技术，细心负责的护理队伍，与兄弟科室团结协作的团队精神，使我科危重病人的抢救存活率达到80%以上，多次获得医院危重病例抢救成功奖。正是由于ICU的建立，大大地提高了外

6、科手术成功率，使本来极为危重的患者也能成功的获得新生。教学与科研科室承担着多项教学任务，为山东大学研究生学院开设了危重病医学课程，30学时/年（1.5学分），山东大学临床医学七年制教学任务12学时/年，山东大学危重病医学选修课20学时/年，山东大学护理学院40学时/年，以及全院业务讲座及轮转医师的教学任务。自2002年开始举办山东省危重病医学继续教育学习班，每年一届，普及危重病医学知识。参编全国统编教材急救护理学，主编呼吸机临床应用指南。曾获山东省科委科技进步二等奖一项，山东卫生厅科技进步三等奖一项，目前承担国家自然科学基金项目一项，省科委课题2项。学术交流重视与省内外、国内外的学术交流活动，

7、于1998年组织成立了山东危重病医学专业委员会，是全国成立最早的省份，并在青岛、烟台、聊城等地成立了分会，每两年组织一次学术交流活动，目前我省ICU普及情况走在国内前列。于2002年成功主办了第五届全国危重病医学学术会议。学术活动频繁举行，极大地推动了危重病医学在我省的普及和推广。2005年组织成立了山东省医学会重症医学分会。科室负责人为中国危重病医学专业委员会副主任委员、山东危重病医学专业委员会主任委员、山东省医学会重症医学分会主任委员，是山东危重病医学的学科带头人，为普及、发展ICU作了卓有成效的工作。 ICU OverviewDefinition An intensive care un

8、it, or ICU, is a specialized section of a hospital that provides comprehensive and continuous care for persons who are critically ill and who can benefit from treatment.Purpose The purpose of the intensive care unit (ICU) is simple even though the practice is complex. Healthcare professionals who wo

9、rk in the ICU or rotate through it during their training provide around-the-clock intensive monitoring and treatment of patients seven days a week. Patients are generally admitted to an ICU if they are likely to benefit from the level of care provided. Intensive care has been shown to benefit patien

10、ts who are severely ill and medically unstablethat is, they have a potentially life-threatening disease or disorder. ICU care requires a multidisciplinary team that consists of but is not limited to intensivists (clinicians who specialize in critical illness care); pharmacists and nurses; respirator

11、y care therapists; and other medical consultants from a broad range of specialties including surgery, pediatrics, and anesthesiology. The ideal ICU will have a team representing as many as 31 different health care professionals and practitioners who assist in patient evaluation and treatment. The in

12、tensivist will provide treatment management, diagnosis, interventions, and individualized care for each patient recovering from severe illness.Description ICUs are highly regulated departments, typically limiting the number of visitors to the patients immediate family even during visiting hours. The

13、 patient usually has several monitors attached to various parts of his or her body for real-time evaluation of medical stability. The intensivist will make periodic assessments of the patients cardiac status, breathing rate, urinary output, and blood levels for nutritional and hormonal problems that

14、 may arise and require urgent attention or treatment. Patients who are admitted to the ICU for observation after surgery may have special requirements for monitoring. These patients may have catheters placed to detect hemodynamic (blood pressure) changes, or require endotracheal intubation to help t

15、heir breathing, with the breathing tube connected to a mechanical ventilator.In addition to the intensivists role in direct patient care, he or she is usually the lead physician when multiple consultants are involved in an intensive care program. The intensivist coordinates the care provided by the

16、consultants, which allows for an integrated treatment approach to the patient.Nursing care has an important role in an intensive care unit. The nurses role usually includes clinical assessment, diagnosis, and an individualized plan of expected treatment outcomes for each patient (implementation of t

17、reatment and patient evaluation of results). The ICU pharmacist evaluates all drug therapy, including dosage, route of administration, and monitoring for signs of allergic reactions. In addition to checking and supervising all levels of medication administration, the ICU pharmacist is also responsib

18、le for enteral and parenteral nutrition (tube feeding) for patients who cannot eat on their own. ICUs also have respiratory care therapists with specialized training in cardiorespiratory (heart and lung) care for critically ill patients. Respiratory therapists generally provide medications to help patients breathe as well as the care and support of mechanical ventilators. Respiratory therapists also evaluate all respiratory therapy procedures to maximize efficiency and cost-effectiveness.Large medical centers may have more than one ICU. These specialized i