不同体位二氧化碳气腹对呼吸参数的影响

目的 观察不同体位下腹腔镜手术二氧化碳气腹对患者呼气末二氧化碳分压(PETCO2)、气道峰压(Ppeak) 及气道平台压(PLAT)的影响.方法 A组:女性腹腔镜胆囊切除术60例,术中取头高足低20°~30°;B组:女性腹腔镜子宫切除术60例,术中取头低足高20°~30°.监测气腹前(T0)、气腹后体位改变前(T1)、体位改变后10 min(T2)、20 min(T3)及30 min(T4)时的PETCO2、Ppeak、PLAT.结果 T1、T2、T3、T4时与T0时比较两组PETCO2、Ppeak、PLAT明显升高(P<0.05);B组T2、T3、T4时的PETCO2、Ppeak、PLAT明显高于A组(P<0.05).结论 气腹与体位均使患者呼吸参数发生改变,特别是头低足高位呼气末二氧化碳分压、气道峰压及气道平台压升高更为明显.     

不同气腹压力及截石位改变速度对妇科腹腔镜手术患者的影响

目的:探讨不同气腹压力及截石位改变速度对妇科腹腔镜手术患者血流动力学的影响。方法:将我院2014年6~12月收治的128例妇科腹腔镜患者随机等分为对照组和试验组,对照组患者CO2气腹压力12 mm Hg,变换体位速度8 s;试验组气腹压力13 mm Hg,体位改变速度大于30 s。比较两组患者实施气腹后平均动脉压、收缩压、舒张压、心率。结果:试验组患者在实施气腹前后的平均动脉压、收缩压、舒张压、心率改变幅度小于对照组(P0.05)。结论:气腹压力13 mm Hg,体位改变速度大于30 s能够达到手术所需的膨腹作用,患者血压、心率改变幅度较小,保证手术患者安全。     

截石位改变速度在妇科腹腔镜手术患者中的应用

目的探讨截石位改变速度在妇科腹腔镜手术患者中的应用。方法将收治的120例妇科腹腔镜手术患者随机分为观察组和对照组各60例,2组气腹压力均为11 mm Hg,对照组截石位改变速度6 s内,观察组30 s,比较2组的血流动力学及血气指标的变化。结果 2组患者气腹后的SBP、DBP均较气腹前增加(P0.05);观察组在气腹后的SBP、DBP增加幅度小于对照组(P0.05);观察组的呼气末二氧化碳分压(PETCO2)在气腹后与气腹前无统计学意义(P0.05);对照组在气腹后的PETCO2高于气腹前,差异有统计学意义(P0.05)。观察组与对照组的气道压力在气腹后均有上升趋势,两组之间无统计学意义(P0.05)。结论延长截石位时体位改变的时间,可减少体位改变给妇科腹腔镜手术患者带来的血流动力学影响,更有利于肺功能恢复。     

达芬奇机器人手术中不同CO2气腹压对患者呼吸系统的影响

目的：探讨不同气腹压力对应用达芬奇机器人行腹部手术患者术中呼吸、术后并发症的影响。方法将2013年6～9月行机器人手术的90例患者随机分为三组,实验组1：气腹压力10 mmHg ;实验组2：气腹压力12 mmHg ;实验组3：气腹压力14 mmHg。观察三组患者在气腹前、气腹后即刻、气腹后0．5 h、1 h、1．5 h、2 h、4 h、6 h不同时间点的潮气末CO2（ETCO2）、气道压峰值（PEAK）的数值变化及并发症。结果三组患者ETCO2在气腹后均呈现逐渐增加趋势,实验1组ETCO2在气腹后增加幅度最小,差异有统计学意义（P＜0．05）;三组患者气道峰压在气腹后增加幅度较大,但差异无统计学意义（P＞0．05）;三组患者在高碳酸血症、苏醒时间方面差异均有统计学意义（P＜0．05）。结论在保证安全操作和不影响手术视野的情况下,调低CO2气腹压,可减少对病人呼吸系统的影响,降低ETCO2和气道峰压,减少并发症的发生。     

全凭静脉麻醉下喉罩与气管插管在妇科腹腔镜手术中应用观察

目的:比较全凭静脉麻醉下喉罩、气管插管2种通气方法在妇科腹腔镜手术中应用的安全性、可靠性.方法:ASA Ⅰ～Ⅱ级行妇科腹腔镜手术患者220例,随机分为A,B组,每组各110例.A组采取喉罩下全凭静脉麻醉,B组为气管插管下全凭静脉麻醉,监测记录插管前后心率、血压,气腹前、气腹后5 min平均气道压力、呼气末二氧化碳分压,记录术中及术后腹胀,咽喉痛等并发症.结果:A组置入喉罩前后心率、血压比较差异无统计学意义(P>0.05),B组插管后心率,血压高于插管前(P<0.05);气腹后A、B组平均气道压力和呼气末二氧化碳分压均高于气腹前(P<0.05),2组气腹前、气腹后5 min平均气道压力和呼气末二氧化碳分压比较差异无统计学意义(P>0.05).B组并发症发生率高于A组(P<0.05).结论:腹腔镜手术中使用喉罩下全凭静脉麻醉安全性好,血流动力学平稳,并发症少.     

新生儿腹腔镜手术中两种呼吸模式探讨

目的探讨腹腔镜手术二氧化碳气腹期间采用定压通气（PCV）和定容通气（VCV）对患儿呼吸力学及血流动力学的影响。方法50例择期行腹腔镜手术的新生儿,按照麻醉中机械通气方式分成PCV组（n=25）和VCV组（n=25）,气腹过程中通过调节吸气压力（PCV组）或潮气量（VCV组）使呼气末二氧化碳分压（PETCO2）稳定在（45±1）mmHg。于气腹开始前（T1）、开始后15min（T2）和30min（T3）记录气道峰压（Ppeak）、平均气道压（Pmean）、胸肺顺应性（C）等呼吸力学和血流动力学指标,同时采集动脉血进行血气分析。结果两组在T2、T3时点的C均较气腹前显著下降（P〈0.05）,Ppeak、Pmean及动脉血二氧化碳分压（PaCO2）显著上升（P〈0.05）,两组之间的PaCO2和循环参数差异无统计学意义（P〉0.05）,VCV组Ppeak和Pmean明显高于PCV组（P〈0.05）。结论在新生儿腹腔镜手术气腹期间应用压力控制模式机械通气,能在相对低的气道压力下提供有效的肺通气,在预防患儿产生肺气压伤方面较容量控制模式更有优势。     

截石位改变速率及气腹压力对妇科腹腔镜手术患者的影响

目的探讨截石位改变速率及气腹压力对妇科腹腔镜手术患者的影响。方法选取行妇科腹腔镜手术患者120例,参照术中气腹压力值及截石位的变化速率将患者随机分为4组,每组30例。比较气腹前水平截石体位(T_1)、CO2气腹后1 min(T_2)、头低臀高截石位后1 min(T_3)、气腹消除后1 min(T_4)时患者呼气末CO_2值(ETCO_2)、气道峰压值(Ppeak)、平均动脉压(MAP)以及心率(HR)值等。结果与建立气腹前相比,气腹后4组患者ETCO_2值均显著升高(P 0. 05),T_4时ETCO_2值下降较快,但与T_1时相比无显著差异(P 0. 05)。建立气腹后,4组患者Ppeak值均显著高于T_1时(P 0. 01)。建立气腹后,4组患者MAP、HR值均显著升高(P 0. 05)。结论截石位改变速率及气腹压力对妇科腹腔镜手术患者ETCO_2、Ppeak、MAP、HR有一定影响。     

保护性肺通气对肺功能正常患者呼吸力学的影响

目的:观察肺功能正常的患者术后使用保护性肺通气对呼吸力学的影响.方法:40例ASA Ⅰ或Ⅱ级,择期全麻下耳鼻喉科术后患者使用常规机械通气模式.30 min后随机分为对照组和研究组,每组20例.对照组(C组)维持常规机械通气模式.研究组(P组)改为保护性肺通气模式.30 min后观察呼吸力学参数的改变.结果:与对照组比较,研究组气道峰压升高,气道平均压升高,呼气末二氧化碳升高,呼吸系统总阻力降低,呼吸系统总顺应性升高但无统计学意义.结论:时肺功能正常患者实施保护性肺通气,与常规机械通气模式对比,其气道峰压升高,气道平均压升高,呼气末二氧化碳分压升高,呼吸系统总阻力降低.     

头低臀高体位下行妇科腹腔镜手术时七氟烷对呼吸力学的影响

目的：观察头低臀高体位下行妇科腹腔镜手术时七氟烷吸入麻醉对呼吸力学的影响。方法：选择妇科腹腔镜择期手术患者150例,随机分为七氟烷组、异氟烷组。七氟烷组患者在气管插管全麻下选用七氟烷持续吸入维持麻醉;异氟烷组患者在气管插管全麻下选用异氟烷持续吸入维持麻醉,2组患者术中连续测定气道峰压力、平台压、胸肺顺应性、呼气末CO2分压等指标,分别在插管后5min、气腹后5min、头低臀高位后5min和30min、改平卧位后以及拔管前6个时间点记录相关观察指标的变化。结果：七氟烷组与异氟烷组在头低位5min和头低位30min时的气道峰压力、平台压比较均有显著差异（P〈0.01）;2组胸肺顺应性变化在头低位改平卧后差异有统计学意义（P〈0.05）。2组呼气末CO2分压则随着气腹、头低位、改平卧位呈显著变化,但2组之间差异无统计学意义（P〉0.05）。结论：七氟烷对患者呼吸力学的影响比异氟烷轻,尤以头低位明显,而且停止吸入麻醉药后七氟烷组呼吸力学指标恢复比异氟烷组快,七氟烷吸入麻醉更适用于头低臀高体位下妇科腹腔镜手术。     

分腿位与截石位腹腔镜子宫切除术对患者血流动力学、呼吸功能及体位相关并发症的影响

目的探析分腿位与截石位腹腔镜子宫切除术对患者血流动力学及呼吸功能的影响,并比较不同体位下患者体位改变后相关并发症的变化。方法前瞻性纳入2017年1月至2020年1月在四川大学华西第二医院行腹腔镜子宫切除术104例患者为观察对象,以随机数字表法将其分为试验组(52例)与对照组(52例)。对照组予以传统截石位,试验组则给予患者实施分腿位。比较2组患者体位改变1 h后的血流动力学指标(舒张压、收缩压、心率以及中心静脉压),呼吸功能指标(呼气末CO_2分压、气道峰压以及动脉CO_2分压);观察比较2组患者术后体位相关并发症(肩痛、肩部皮肤损伤以及眼睑水肿)的发生情况。结果体位改变1 h后,2组患者的舒张压、呼气末CO_2分压、收缩压、心率及动脉CO_2分压对比差异均无统计学意义(P> 0.05);但试验组的中心静脉压与气道峰压为(10.31±0.87) mmHg、(22.31±2.20 cm H_2O),均显著低于对照组[(14.46±1.54) mmHg、(29.73±3.45) cm H_2O],差异有统计学意义(P <0.05)。试验组患者的肩痛、肩部皮肤损伤以及眼睑水肿发生率分别为3.85%、0、1.92%,均明显低于对照组(19.23%、17.31%、17.31%),差异有统计学意义(P <0.05)。结论分腿位运用于腹腔镜子宫切除术,能够显著减轻对机体血流动力学与呼吸功能影响,同时术野较好,可减少体位相关并发症的发生,相较传统截石位更适于推广与应用。     

Cardiac pathology in various in various pathogenetic subtypes of ischemic stroke

Heart pathology was studied in various pathogenetic subtypes of ischemic stroke. A total of 330 stroke patients were divided into 4 groups. Group 1 consisted of 104 (31.5%) patients with cardioembolic stroke, group 2--of 72 (21.8%) with hemodynamic, group 3--of 71 (21.5%) patients with atherothrombotic and group 4--of 83 (25.2%) patients with lacunar stroke. Cardiac pathology was found in all patients of group 1 (ischemic heart disease-50.0%, inflammatory-infectious lesions-27.9%, other lesions-22.1%), in 49 (68.1%) patients of group 2, 36 (50.7%) of group 3 and 31 (37.3%) of group 4. Ischemic heart disease was prevalent (85.7, 86.1, 83.9% vs group 1). Potential sources of cardiogenic cerebral embolia were found in patients of all the groups: 100, 62.5, 43.7 and 33.7%, respectively. Thus, most patients with ischemic stroke have different heart defects related to the subtype of ischemic stroke. Potential causes of cardiocerebral embolism can be detected in any subtype of ischemic stroke.     

Comparative analysis of low-back loading on chiropractors using various workstation table heights and performing various tasks

BACKGROUND: There is epidemiologic evidence that chiropractors are a high-risk group for low-back disorders. However, to date there are no known biomechanical studies to determine whether their workstations may be a contributing factor. OBJECTIVE: To investigate whether chiropractors' workstation table height or the tasks they perform make them susceptible to low-back strain. As well as investigating low-back strain, a screening was performed to determine whether chiropractors' upper extremities were at risk for undue strain as workstation table height was varied. Study Design: Experimental pilot study. SETTING: A university ergonomic laboratory. METHODS: An adjustable manipulation table was set at 3 different heights: 465 mm, 665 mm and 845 mm.Each of the 7 volunteer chiropractors were fitted with a triaxial electrogoniometer and were videotaped and photographed for analysis while performing spinal manipulation to the cervical, thoracic, and lumbar spine of a volunteer patient at each workstation table height. Two biomechanical models, one static and one dynamic, were used to record the dependent variables. A screening of various upper extremity variables was also performed with the static model. RESULTS: For the subjects under study, a significant difference was found for the variables maximum sagittal flexion, disk compression force, and ligament strain as table height was varied. For the lumbar and thoracic manipulation tasks, the medium table height (655 mm) was found to create the least low-back strain. For the cervical manipulation task, the high table height (845 mm) was found to be the least straining on the low-back. The low height table (465 mm) was the most straining for all tasks. Upper extremities were not significantly affected by changes to table height. Significant differences were found for the task performed for axial rotational velocity, disk compression force, ligament strain, maximum sagittal flexion, dominant (right) elbow moment, and dominant (right) shoulder moment variables. There was no significant interaction between table height and task performed. CONCLUSION: Workstation table height was found to have a significant effect on low-back load of subjects under study. The results of this study demonstrate an overall unacceptably high amount of sagittal flexion, ligament strain, and disk compression force on the chiropractor subjects in the tasks performed.