葶苈子对急性呼吸窘迫综合征患者血管外肺水及氧合影响的研究

目的观察葶苈子对急性呼吸窘迫综合征（ARDS）患者血管外肺水和氧合的影响。方法选择符合ARDS诊断标准的患者45例作为研究对象,随机分为研究组（A组23例）与对照组（B组22例）。2组患者给均予对症治疗,A组患者予以葶苈子30 g水煎液鼻饲,每日3次,连续6 d;B组患者作为空白对照组。观察2组患者治疗前及治疗后30 min、3 d、6 d的心脏指数（CI）、血管外肺水（EVWL）和肺血管通透性指数（PVPI）、动脉血氧分压（PaO_2）、氧合指数（PaO_2/FiO_2）的变化;比较2组患者的机械通气时间、住院天数及死亡率。结果治疗前2组CI、EVWL和PVPI和PaO_2/FiO_2比较差异无统计学意义（P〉0.05）。与治疗前比较,A组患者治疗3 d、6 d后的CI、EVLW、PVPI、PaO_2/FiO_2均有明显改善（P〈0.05或P〈0.01）;B组患者需治疗6 d后才有明显改善（P〈0.05）。A、B 2组间治疗6 d后比较差异均有统计学意义（P〈0.05）。A组患者机械通气时间、住院天数和死亡率均比B组明显减少（P〈0.05）。结论葶苈子可改善ARDS患者心脏功能,降低患者EVLW,改善肺血管上皮功能屏障,改善氧合,减少机械通气和住院时间,降低死亡率。     

支气管肺泡灌洗对重症肺部感染患者呼吸力学指标及氧合指数的影响

目的探讨支气管肺泡灌洗对重症肺部感染患者呼吸力学指标及氧合指数的影响。方法选取该院2016年4月至2018年6月收治的92例重症肺部感染患者,利用随机数表法分为两组,各46例。对照组采取常规肺泡灌洗及吸痰治疗,观察组在此基础上采取支气管肺泡灌洗治疗,对比两组临床疗效、呼吸力学指标及血气分析指标。结果与对照组治疗总有效率比较,观察组更高(P 0.05);治疗后,两组气道阻力(Raw)、气道峰值压(PIP)、呼吸做功量(WOB)水平均较治疗前降低,且观察组低于对照组(P 0.05);治疗后,两组动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)及氧合指数(OI)水平均改善,且观察组PaO_2、OI水平较对照组高,PaCO_2水平较对照组低(P 0.05)。结论支气管肺泡灌洗治疗重症肺部感染患者可有效提升临床疗效,改善呼吸力学指标及氧合指数。     

侧卧位单肺通气1∶1吸呼比对老年患者呼吸动力学及氧合的影响

目的:探讨侧卧位单肺容量控制通气时,吸呼比1∶1对老年患者呼吸动力学及氧合的影响。方法:选择56例老年开胸患者分成两组,实施容量控制单肺通气吸呼比为1∶1(A组)和1∶2(B组),分别在双肺通气后15 min,单肺通气后30 min及60 min,恢复双肺通气后15 min,记录动静脉血气分析结果和呼吸参数。结果:与B组相比,单肺通气期间A组的气道峰压和气道平台压(cm H2O)的标准差明显偏低(P0.01);动脉-呼气末二氧化碳分压差明显偏低(P0.01);而单肺通气期间的动脉氧分压PaO2无明显差异。结论:侧卧位单肺容量控制通气时1∶1吸呼比与1∶2相比能降低气道峰压和气道平台压,改善动态顺应性和肺泡通气效率,但不能实质改善动脉氧合。     

乌司他丁联合地塞米松治疗创伤性肺损伤对患者血清一氧化氮及内皮素的影响

目的:观察乌司他丁联合地塞米松治疗创伤性肺损伤对患者血清中一氧化氮(NO)和内皮素(ET-1)的影响。方法:选取2014年1月-2015年1月本院收治的52例创伤所致肺损伤住院患者作为研究对象,采用随机数字表法将其分为观察组与对照组,每组26例,对照组在常规治疗基础上接受地塞米松治疗,观察组在对照组治疗基础上联合乌司他丁治疗。记录并比较两组机械通气使用率、呼吸窘迫综合征(ARDS)发生率,检测比较两组不同时间肺泡-动脉氧分压差(P_(A-a)DO_2)、氧和分数(PaO_2/FiO_2)、动脉氧分压(PaO_2)及患者血清NO、ET-1浓度。结果:观察组ARDS发生率及机械通气使用率均低于对照组,比较差异均有统计学意义(P0.05);治疗第5天,两组P O_2、PaO_2/FiO_2均高于治疗前,而P_(A-a)DO_2及NO、ET-1浓度均低于治疗前,观察组PaO_2、PaO_2/FiO_2、NO及ET-1均优于对照组,比较差异均有统计学意义(P0.05)。结论:乌司他丁联合地塞米松治疗创伤性肺损伤疗效显著,能够有效改善患者氧合状况,降低患者炎症反应发生率以及机械通气使用率。     

胸腔穿刺抽液对肺换气功能影响的研究

本文对30例各种原因单侧、游离性、渗出性胸膜炎病人胸腔抽液前后不同时间血气及肺泡—动脉血氧分压差VA—aDO_2)进行自身对照研究。结果表明:抽液前PaO_2降低、A—aDO_2增大、PaCO_2及HCO_3~-降低、BE负值增大,与正常值比较有显著差异(P<0.001)。术后PaO_2逐渐升高,A—aDO_2相应减小,与术前比较有显著差异(P<0.001),但PaCO_2、HC0z_2~-及BE无明显改变。提示胸腔积液可以导致低氧血症及慢性呼吸性碱中毒,胸腔抽液能改善低氧血症,但不能有效纠正呼吸性碱中毒。     

高频振荡通气法治疗新生儿气胸的临床效果

目的观察高频振荡通气法治疗新生儿气胸的临床效果。方法搜集2011年3月至2017年3月新乡市中心医院145例气胸新生儿的临床资料进行回顾性研究。按照通气方式分为对照组(73例)和观察组(72例),对照组接受常规机械通气法,观察组接受高频振荡通气法。观察两组患儿机械通气时间、吸入高浓度氧时间、用氧总时间、住院时间、pH值、血氧分压(PaO_2)、氧合指数(OI)、动脉血氧分压/肺泡氧分压比值(PaO_2/PAO_2)、二氧化碳分压(PaCO_2),对比两组患儿出院6个月后呼吸频率、每分钟通气量、潮气量、达峰时间比及并发症发生率。结果观察组机械通气时间、吸入高浓度氧时间少于对照组,差异有统计学意义(P<0.05)。观察组用氧总时间、住院时间与对照组比较,差异无统计学意义(P>0.05)。治疗后,两组pH值、PaO_2、PaO_2/PAO_2高于治疗前,观察组pH值、PaO_2、PaO_2/PAO_2高于对照组,差异有统计学意义(P<0.05);治疗后,两组OI、PaCO_2低于治疗前,观察组OI、PaCO_2低于对照组,差异有统计学意义(P<0.05)。出院6个月后复查,观察组呼吸频率、每分钟通气量、潮气量、达峰时间比与对照组比较,差异无统计学意义(P>0.05)。观察组呼吸道感染、肺出血及颅内出血发生率低于对照组,差异有统计学意义(P<0.05)。结论与常规机械通气法比较,高频振荡通气法可缩短气胸新生儿机械通气时间及用氧总时间,改善血气分析指标,稳定肺功能,降低并发症发生率。     

通气策略对腹腔镜手术病人肺内分流及氧合的影响

目的：观察不同潮气量（VT）、呼吸频率（F）、吸呼比（I：E）等通气参数对腹腔镜手术病人肺内分流及氧合情况的影响。方法：25例ASAⅠ～Ⅱ级全麻下择期腹腔镜手术患者随机分为3组,麻醉诱导药物相同,呼吸机参数VT=8ml／kg,F=15次／min,I：E=1：2。气腹后通气参数设定分别为A组VT=10ml／kg。F=12次／min,I：E=1：3;B组VT=6ml／kg,F=20次／min,I：E=1：2;C组同气腹前。分别于气腹前、后测定混合静脉血和动脉血血气,计算各组气腹前后的肺泡气动脉血氧分压差[P（A-a）O2]、呼吸指数（RI）、肺内分流（QS／QT）及氧摄取率（ERO2）。结果：气腹后C组RI增加（P〈0.05）,A、C两组的P（A-a）O2升高（P〈0．05）,ERO2下降（P〈0．05）,而QS／QT增加（P〈0．05）,尤以A组QS／QT,增加显著（P〈0.01）。但各组数据组间比较,差异无统计学意义（P〉0．05）。结论：A、B、C3种通气策略对腹腔镜手术病人的P（A-a）O2、QS／QT、ERO2和RI等方面的影响无大差别。     

血气分析及其结果的判断

<正> 近20年来,血气分析在临床的应用,已成为急诊抢救、呼吸与代谢疾病主要的监护指标。对观察病情的发展、指导治疗及预后的估计意义很大。血气分析不但可直接或间接反映呼吸的通气与换气功能,并可了解体内酸碱与电解质的平衡状态。一、血氧(O_2)分析的判断血O_2分析常用动脉血氧分压(PaO_2),氧饱和度(SaO_2)及氧含量(CaO_2)三个指标。氧离曲线是在一定的PaO_2下血红蛋白(Hb)与O_2结合的程度(即SaO_2)。此曲线呈S形,在SaO_2接近正常时,PaO_2的测定比SaO_2更为敏感。如SaO_2自97.6%降至96.5%,即仅降低1.1%     

Bain呼吸环路防治单肺通气犬肺内分流量增加的实验研究

对15条单肺通气(OLV)犬模型进行实验,观察手术侧肺加用或不用Bain环路对犬肺分流量和氧合的影响。结果提示:与双肺通气(TLV)相比,不用Bain的OLV犬,动、静脉氧分压(PAO_2、P(?)O_2),动、静脉血氧饱和度(SaO_2、S(?)O_2)分别降低了49％、11％、8％、14％;肺泡气与动脉血氧分压差(_(A-a)DO_2),肺毛细血管-动脉血氧含量差(C_cO_2-CaO_2),肺毛细血管-静脉血氧含量差(C_cO_2-C(?)O_2)和肺分流量(Q_(?)/Q_t),分别增加了39％、350％、50％和190％(均为P<0.01)。提示低氧血症与OLV时严重肺内分流、静脉血掺杂有关。而使用Bain的OLV犬氧合良好,PaO_2、P(?)O_2稍有增高,~(A-a)DO_2和Q_(?)/Q-t分别降低了19.3％和8％(均为P>0.05)。Bain环路能将氧气以一定的压力和流速持续吹入肺泡,使其扩张并行气体交换,达到改善术侧肺功能和防治肺内分流量增加的目的。     

有创-无创序贯机械通气治疗重症肺炎疗效及对肺泡氧合功能、血清炎症因子水平的影响

目的观察有创-无创序贯机械通气治疗重症肺炎疗效及对肺泡氧合功能、血清炎症因子水平的影响。方法对我院62例重症肺炎患者临床资料进行回顾性分析,根据其通气治疗方式差异分为有创-无创序贯机械通气治疗组(研究组,n=36)和有创通气治疗组(对照组,n=26)。观察两组治疗情况[有创通气时间、呼吸机相关性肺炎(VAP)发生率、ICU住院时间、病死率],记录治疗前(T1)、治疗7 d后(T2)两组患者肺氧合指数(OI)、动脉血气分析指标[氧分压(PaO_2)、氧饱和度(SaO_2)]及血清炎症因子[肿瘤坏死因子-α(TNF-α)、白介素-1(IL-1)、IL-6]水平检测结果。结果研究组有创通气时间、VAP发生率、ICU住院时间、病死率均小于对照组(P0.05)。T2时,两组OI、PaO_2、SaO_2均较T1时升高,且研究组高于对照组(P均0.05);血清TNF-α、IL-1、IL-6水平均较T1时降低,且研究组低于对照组(P均0.05)。结论有创-无创序贯机械通气治疗重症肺炎疗效确切,对改善患者肺氧合功能、减轻炎症反应有一定帮助,于促进患者疾病恢复有利。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.