家兔肠缺血再灌注对膈肌电生理特性的影响

目的:观察家兔肠缺血再灌注对膈肌电生理特性的影响.方法:取家兔12只,随机分对照组、模型组,每组6只.复制家兔肠系膜动脉缺血再灌注损伤动物模型,测定缺血前、缺血1 h及再灌注1 h、2 h膈肌肌电图(EMGdi),经计算机MedLab 采样、数字化,快速富利叶转换(FFT)分析,计算高频/低频(H/L)比值和中心频率(Fc),数据作方差分析q检验.结果:实验组在肠缺血再灌注后1 h 和2 h 时 Fc明显降低(P＜0.01).结论:肠缺血再灌注可降低膈肌肌电的Fc.     

体外膈肌起搏联合体位改变对脑卒中 气管切开卧床者肺部感染的影响

目的:探讨体外膈肌起搏(EDP)联合体位改变对脑卒中气管切开卧床患者肺部感染的治疗效果。方法:选取2018年6月至2020年6月深圳市第二人民医院收治的脑卒中气管切开合并肺部感染的患者60例,随机分成观察组和对照组两组,每组各30例。两组均给予常规治疗,观察组在常规治疗基础上增加两项治疗:(1)EDP治疗;(2)体位改变。治疗3周后比较两组下列指标:(1)每组患者治疗后的前3日排痰量,第1、2周平均每日排痰量;(2)两组患者体温恢复正常所需时间;(3)两组患者抗菌药物使用天数;(4)每组患者治疗前后平静呼吸时膈肌活动度。结果:(1)与治疗前比较,两组患者治疗后第1天、第2天、第3天排痰量均无明显变化(P>0.05)。观察组第1周、第2周每日平均排痰量减少(P<0.05)。对照组第1周每日平均排痰量无明显变化(P>0.05),第2周每日平均排痰量减少(P<0.05)。与对照组同时间比较,观察组治疗第2周每日平均排痰量明显减少,差异具有统计学意义(P<0.05)。(2)与对照组比较,观察组体温恢复正常的时间及抗菌药物使用天数明显更短,差异具有统计学意义(P<0.01)。(3)治疗3周后,观察组膈肌活动度显著较治疗前增加,差异具有统计学意义(P<0.01),对照组膈肌活动度与治疗前比较,差异无统计学意义(P>0.05)。与对照组治疗后比较,观察组膈肌活动度显著增加,差异有统计学意义(P<0.01)。结论:EDP联合体位改变治疗可改善脑卒中气管切开卧床患者膈肌活动度,减少痰量,缩短肺部感染者发热时间,促进肺部感染的恢复,减少抗菌药物使用。     

The Neonatal Diaphragmatic Crura Are Hypertrophied

OBJECTIVE: To sonographically show that the neonatal crura are markedly hypertrophied. METHODS: Fifty patients in each of 2 groups, ages 0 to 2 months and 18 to 40 years, were randomly chosen from patients who recently underwent abdominal sonography. A single longitudinal plane of a section was used to measure both the anteroposterior diameter of the aorta and the diaphragmatic crus. The ratios of these were compared in the 2 groups. RESULTS: A significant difference was shown between the sizes of the diaphragmatic crura of the neonate and the adult when the aorta was used as an internal standard of size variability. The mean ratio of the aorta to the right crus in neonates was 2.95, and in young adults it was 1.04 (P < .0001). CONCLUSIONS: The neonatal crura are hypertrophied at birth, likely to allow the markedly atelectatic and fluid-filled lungs to fully expand in relatively few breaths.     

Phrenic Nerve Stimulation for Central Ventilatory Failure with Bipolar and Four-Pole Electrode Systems

A multi-channel phrenic nerve stimulator developed in Tampere has been implanted into seven patients with C2-tetraplegia and into three patients with central sleep apneas. Six bipolar cuff electrodes were implanted bilaterally into the neck. Two four-pole cuff and 14 four-pole noncuff electrodes were used in seven patients and to replace one bipolar electrode. Four-pole electrodes were implanted within the thorax. Seven patients achieved total independence from conventional ventilators within 4 months of implantation, and one for 18 hours each day. Two patients died 12 days and 3 months after implantation and two patients after having achieved independence from mechanical ventilators from causes unrelated to the stimulators. Reoperations were necessary because of dislocation of receivers, electrodes, electrode lesions, nerve injuries, and technical failures in seven patients. Most of the problems appeared in two patients with obesity and in three patients with very thin phrenic nerves. Single unit prototypes failed technically more frequently than units of prototype serial fabrication. New electrode design, progress in the manufacture of receivers, and improved implantation technique should help to diminish failures in future.     

体外膈肌起搏在肺心病呼吸衰竭治疗中的应用

本文报告30例肺心病所致呼吸衰竭患者,经体外膈肌起博治疗后,呼吸衰竭症状改善,PaCO_2明显下降,PaO_2上升,提示体外膈肌起博在急慢性呼衰治疗中,具有降低高碳酸血症和提高氧分压疗效。并具有无创性,操作简易等优点,为呼吸乐统疾病提供一个新的治疗手段。