Carbon dioxide recruitment threshold as a predictor of successful weaning in chronic obstructive pulmonary disease patients: A pilot study

Abstract Several methods have been used to predict successful weaning and extubation among chronic obstructive pulmonary disease (COPD) patients. The objective of this study is to determine whether carbon dioxide recruitment threshold (PCO₂RT) can be used as adjunct to conventional weaning parameters to predict early weaning and successful extubation. Twelve COPD patients who were ready to be extubated based on conventional weaning parameters were divided into group A ( n = 7) and group B ( n = 5). Group A were those patients with better weaning parameters and hence a higher probability of successful extubation as compared to group B. Carbon dioxide apnoeic threshold (PCO₂AT) was obtained by hyperventilating the patient using an increment of two breaths per min until apnoea occurs. At this point, the PCO₂AT or the PaCO₂ during said apnoeic period was recorded. A dead space of 150 cc is then added to the circuit until the patient starts to breathe as evidenced by the sensitivity trigger indicator. The PCO₂ obtained at this period is termed PCO₂RT. After weaning for 30 min on a T-tube, another arterial blood gas is determined and this is called the PCO₂SB or the CO₂ level after 30 min on spontaneous breathing. If the PCO₂SB-PCO₂RT difference is high with a sensitivity of 85.71% and specificity of 100% vs sensitivity of 57.14% and specificity of 60% using the conventional weaning parameters. Thus an increase in PCO₂SB at 30 min T-tube is indicative of impending respiratory pump failure and that other causes of failure to wean must be investigated.     

低能量氦—氖激光局部加穴位照射治疗肺结核空洞

目的探讨低能量氦－氖激先局部加穴位照射对肺结核空洞的治疗作用机理。方法９１例初治Ⅲ型肺结核（肺部有空洞）随机分为实验组４６例，对照组４５例，均用６个月短程化疗方案．实验组加氦－氖激光局部、双肺俞穴位照射治疗３个疗程，观察空洞闭合及痰菌阴转情况，以Ｘ２检验分析组间治疗结果的差异．结果实验组治疗２、３个月空洞闭合分别为５８．３％、７０．８％；对照组为３５４％、４７９％，二者均有显著性差异（Ｐ＜０．０５），实验组痰菌阴转、肺部病灶吸收、临床症状改善均高于对照组。结论低能量氦－氖激光局部加双肺俞穴位照射，可加速肺结核空洞的闭合及临床症状的改善     

Interruption of pulmonary arterial flow with inadequate ventilation leads to pulmonary infarction

We examined the effect of interruption of pulmonary arterial flow and inadequate ventilation on the development of pulmonary infarction in rats. Pulmonary arterial flow was blocked by the injection of agar into the inferior vena cava and inadequate ventilation was produced by obstructing the left main bronchus with a polypropylene tip. Histological and angiographic examination of the lung demonstrated that: pulmonary artery embolism alone does not induce pulmonary infarction; obstruction of a bronchus does not induce significant changes, but that pulmonary infarction develops when pulmonary artery embolism and obstruction of a bronchus occur simultaneously. It has been thought that pulmonary infarction is caused by acute obstruction of a pulmonary artery, however, the alveolar walls are supplied with oxygen by both the pulmonary circulation and by ventilation. Interruption of pulmonary arterial flow alone is probably not sufficient to induce pulmonary infarction, which is probably caused by deficiency of oxygen supply to the alveolar walls by a synergy between interruption of pulmonary arterial flow and inadequate ventilation.     

101例尿毒症相关性肺水肿的特殊护理措施

目的 探讨尿毒症相关性肺水肿的特殊护理措施。方法 对尿毒症相关性肺水肿的护理除常规护理措施外，应做到以下几点特殊护理：①密切观察血压、血氧饱和度、近期尿量变化；②有效控制血压；③采取不同的透析方式适时适量透析超滤、加强透析中的护理；④改善全身营养状况，防止肺部感染；⑤牢记护理程序体位-吸氧-血管扩张药-血液透析；⑥严格控制入量。结果 101例病人中抢救成功84例，死亡13例，自动出院3例。结论 采取治疗和特殊护理对抢救尿毒症相关性肺水肿患者有较好效果。     

Inhibition of Expression of Hypoxia-inducible Factor-1α mRNA by Nitric Oxide in Hypoxic Pulmonary Hypertension Rats

Hypoxiaisadirectfactorcausinghypoxicpul monaryhypertension (HPH) .hypoxiainduciblefac tor 1α (HIF 1α)isfoundtobethemostcrucialfactorsofarwhichmediatesthecellularresponsetohypoxi a[1] .OurpreviousstudyrevealedthatoverexpressionofHIF 1andendothelin 1(ET 1…     

慢性阻塞性肺疾病前驱性呼吸衰竭患者呼吸驱动的改变

目的探讨慢性阻塞性肺疾病(COPD)和COPD前驱性呼吸衰竭(前驱呼衰)患者中枢呼吸驱动的改变;评价界定COPD前驱性呼吸衰竭的临床意义.方法试验对象为COPD前驱性呼吸衰竭、COPD尚未达前驱性呼吸衰竭的患者和健康对照者各30名.所有受试者均进行如下参数的测定:动脉血气分析;常规肺功能,主要以第1秒用力呼气容积(FEV1)占预计值的百分比(FEV1%)来评价;中枢呼吸驱动水平,以0.1 s口腔阻断压(P0.1)、校正中枢呼吸驱动(以每分通气量来校正,即P0.1/MV)和吸气阻抗P0.1/VT/Ti)等来评价.结果P0.1和P0.1/MV在COPD前驱呼衰组明显高于正常对照组和未达前驱呼衰组,P0.1/VT/Ti在COPD前驱呼衰组和未达前驱呼衰组明显高于正常对照组(P=0.002);P0.1,P0.1/MV,P0.1/VT/Ti与PaO2,FEV1%呈显著负相关(rs=-0.769,-0.495,-0.543;-0.747,-0.480,-0.526,P均＜0.01);与PaCO2呈显著正相关(rs=0.270,0.312,0.369,P分别为＜0.05,＜0.01,＜0.01).结论COPD前驱呼衰患者呼吸储备能力减低,呼吸效率下降;P0.1,P0.1/MV,P0.1/VT/Ti等参数在推断患者神经-肌力输出水平与呼吸衰竭发生阈值方面具有较大的意义.当COPD进展至前驱呼衰阶段,从血气分析、肺功能检查到呼吸驱动水平都发生了显著的改变,从而提示界定此阶段具有一定的临床意义.     

惠州市结核病控制项目实施效果评价

目的 总结我市结核病控制项目实施效果和经验。方法 根据全市各县(区)上报的结核病报表和有关总结材料进行分析。结果 在项目实施期间发现涂阳病人7522例，治愈了7303例，涂阳病人登记率从1993年的8．2／10万提高到2001年的39．4／10万，初、复治涂阳病人治愈率从1992年的80．0％和81．8％提高到2001年的98．9％和96．2％。结论 我市结核病控制项目实施效果显，项目所取得的成功经验和技术策略对今后结核病控制可持续发展有着重要的指导作用。     

Pericardial effusion following pulmonary resection

Objective Postoperative pericardial effusion commonly occurs after open heart surgery. However, after general thoracotomy such as pulmonary resection, there have been few reports of pericardial effusion. The purpose of this study is to investigate patients with pericardial effusion following pulmonary resection.Methods: Among 2,385 patients with pulmonary resection for lung neoplasm in our institute, eight patients, whose pericardium had never been opened during the operation, developed pericardial effusion. The clinical characteristics of the eight patients were analyzed.Results: Pericardial effusion after pulmonary resection was divided into two subtypes: pericardial effusion in three patients with left thoracotomy occurring within 30 days postoperatively, and pericardial effusion in the remaining five patients with right thoracotomy occurring more than 30 days postoperatively. Pericardiotomy or pericardiocentesis was performed in three symptomatic patients, and the remaining five asymptomatic patients were treated with diuretics. Pericardial effusion disappeared in three of the five patients about 1–3 months after the conservative treatment, while, in the remaining patients, because pericardial effusion had increased gradually, pericardiocentesis was performed.Conclusion: From our experience, the treatment strategy of drainage for early pericardial effusion and diuretics for late pericardial effusion seems to be appropriate. (Jpn J Thorac Cardiovasc Surg 2006; 54:193-198)     

首次通过肺灌注显像对瓣膜性心脏病合并肺动脉高压的临床价值

目的　探讨首次通过肺灌注显像 (FPPPI)联合肺灌注显像 (PPI)对瓣膜性心脏病合并肺动脉高压 (PH)的临床价值。方法　以二尖瓣病变为主的瓣膜病患者 116例 ,术前均行右心导管、FPPPI及PPI、超声心动图检查。其中 10 5例患者术后 5～ 14d再次行FPPPI及PPI,33例患者于术后 3～ 11个月进行第 3次FPPPI及PPI复查。按右心导管测得的平均肺动脉压力 (MPAP)水平分为正常、轻度升高、中度升高、重度升高组。结果　① 116例患者FPPPI法所测肺平衡时间 (LET)、上肺野与下肺野比值 (S L)及超声心动图所测肺动脉压力 (EPAP)与右心导管所测肺动脉收缩压 (SPAP)的r值分别为0 85 6 ,0 5 0 3及 0 5 72 (P <0 0 1)。②以MPAP为标准 ,FPPPI、PPI及FPPPI PPI测定肺动脉压力的灵敏度分别为 94 7%、78 8%及 96 4 % ,特异性分别为 6 8 3%、5 2 8%及 72 7% ,准确性分别为 85 3%、70 7%及 89 7%。③ 10 5例患者术前与术后 5～ 14dLET分别为 (2 7 71± 10 85 )s和 (2 0 96± 6 2 5 )s(P <0 0 0 1) ;S L分别为 1 4 3± 0 4 1和 1 30± 0 35 (P <0 0 0 1)。④LET在MPAP轻度、中度、重度升高组的完全改善率分别为 4 7 6 %、34 5 %及 1 4例 ;部分改善率分别为 4 0 5 %、6 2 1%及 3 4例 (P <0 0 0 1)。S L在各组完     

家兔急性周围型肺栓塞影像模型的制备

目的探讨用可吸收性明胶海绵制作家兔急性肺栓塞(PE)影像模型的可行性。方法20只实验组家兔随机分成5组,采用明胶海绵栓子经股静脉插管制成急性PE的动物模型。栓塞后行肺动脉造影检查,栓塞后2h、24h、3d、7d、14d(A、B、C、D、E组)分批处死家兔,解剖肺动脉并观察栓塞区肺组织病理变化。对照组2只注入生理盐水,分别于第7天,14天处死。结果20只实验组家兔1只麻醉意外死亡,19只制备模型后成活,模型制备成功率95%。肺动脉造影显示46支叶及段肺动脉栓塞。肺动脉解剖共发现栓子65个,栓塞动脉50支。A组肺体积肿胀,色深红,镜下观察见肺组织充血。B组、C组、D组、E组中15只家兔肺表面呈苍白色、暗红色、黑色或苍白色区内见黑色坏死区,另外1只仅见肺体积肿大,肺颜色无变化,E组1只第3天左侧发生气胸,肺萎缩;光镜下观察肺组织水肿、淤血、出血、坏死,炎性细胞浸润,肺泡含气减少,肺泡支架结构破坏,E组2例栓塞区见肺组织机化,栓子周围有血小板血栓和/或混合血栓形成。对照组2只家兔肺部仅见少量炎性细胞浸润。结论用明胶海绵作为栓塞物制备家兔急性肺栓塞模型,其方法简便、成功率高,为肺栓塞影像学研究提供了一种较好的实验模型。