急性呼吸窘迫综合征的肺保护性机械通气治疗策略

急性呼吸窘迫综合征(ARDS)是以低氧血症、X线上双肺浸润和不伴左房压升高为特征的综合征。它与许多肺和肺外危险因素有关,往往伴有很高的死亡率。预后不良的因素包括支气管肺泡灌注和血浆细胞因子水平增加、脓毒血症及多器官功能的衰竭。治疗措施多为支持疗法,机械通气是主要的治疗手段。     

13例单肺通气时低氧血症发生原因分析及处理

目的:分析开胸手术中应用双腔插管在单肺通气(OLV)时,低氧血症的发生原因及处理措施.方法:选择需开胸手术的食管癌病人和肺癌病人共80例.在快速诱导下行双腔支气管导管插管.连续监测双肺和单肺通气时,双肺隔离是否完全及低氧血症发生时的原因和处理措施.结果:80例患者中发生低氧血症有13例,占16.25%;其中因导管定位不准确导致者8例(61.5%);导管阻塞,分泌物阻塞导致者3例(23.1%);其它因素导致者2例(15.4%).结论:提高插管技术,做好呼吸管理,保证肺的充足供氧,选择恰当的通气方法调整肺的血流,能保证单肺通气时SPO2的稳定,确保手术的顺利完成和病人的安全.     

血红蛋白下降、吸烟对肺一氧化碳弥散功能的影响

肺是气体交换的主要器官 ,肺泡及其周围的毛细血管构成气体交换的单位。影响气体交换的因素有通气是否充分、肺内气体和血流灌注是否均匀以及呼吸膜的通透膜的厚度等。肺内气体交换障碍是造成肺部疾患低氧血症和高碳酸血症最常见的原因 ,严重时可发生呼吸衰竭甚至致死1　资料与     

开放肺的概念

开放肺概念是急性肺损伤(ALI)和急性呼吸窘迫综合征(ARDS)现代治疗策略的一部分,主要内容包括重新开放无通气功能肺泡,并使通气肺泡和再开放肺泡及相连的气道保持开放。     

什么是慢性阻塞性肺病的最佳PEEP?

严重慢性阻塞性肺病(COPD)患者常因急性呼吸衰竭(ARF)而需机械通气治疗。死腔样通气、通气/血流比例失调和低通气肺泡区血流增加引起高碳酸、低氧和呼吸性酸中毒,从而影响气体交换;肺机械异常增加吸气肌负荷,进一步加重了呼吸性酸中毒。因此,无论采用侵入性和非侵人性方法,机械通气必须保证足够的气体交换,减轻吸气肌负荷。     

急性肺损伤中呼吸机相关性全身炎症反应

急性肺损伤(ALI)和急性成人呼吸窘迫综合征(ARDS)是由于肺内皮和上皮细胞损伤所致,伴随有中性粒细胞性肺泡炎、炎症介质的释放、血管和肺泡通透性增加、间质和/或肺泡水肿以及由此引起的肺泡塌陷和动脉低氧血症。常需要用呼吸机来改善气体交换,而机械通气又不可避免地造成肺损伤,包括气胸、肺泡水肿和破裂。除了机械性肺损伤外,许多研究在动物模型和ALI及ARDS患者均证实,采用高潮气量     

胸腔镜下肺癌中转手术的麻醉因素分析

目的 分析胸腔镜下肺癌中转手术的麻醉因素.方法 胸腔镜下肺癌手术102例均经静脉快速诱导插入双腔支气管导管进行间歇通气(IPPV),单肺通气时采用IPPV加呼气末正压呼吸(PEEP)及萎陷肺持续正压通气(CPAP),并调整呼吸参数.插入的双腔支气管导管均经纤维支气管镜定位.结果 102例定位良好,肺萎陷较好.SpO2、PETCO2维持正常范围.共5例术中改为开胸手术,其中2例因肺广泛粘连,2例因肺功能差而不能长时间耐受单肺通气引起的低氧血症,1例因解剖异常,定位差,难以单肺通气.结论 肺广泛粘连、重度肺功能障碍及气管解剖异常应视为胸腔镜下长时间单肺通气的相对禁忌症.     

肺功能中度减退的肺癌患者术后并发症分析

背景与目的:随着肺癌开胸手术的深入开展,术前肺功能状况对手术的影响越来越受重视。本研究分析肺通气功能中度减退的肺癌患者术后并发症发生情况,探讨与并发症发生的相关因素。方法:同步对照分析肺通气功能中度减退(31例)与肺功能正常(62例)两组病例并发症的发生情况,进行t检验及卡方检验作比较,行logistic回归分析影响并发症出现的有关因素。结果:肺通气功能中度减退患者术后常见低氧血症(41.9%),心律失常或心功能不全(25.8%),肺部感染(25.8%)等一般并发症,呼吸衰竭、心力衰竭等严重并发症的发生率为9.2%,院内死亡率为3.2%;而对照组此4类并发症发生率分别为:16.1%、8.1%、9.6%及3.2%,无院内死亡。回归分析显示年龄、手术切除范围与并发症的发生相关。结论:肺通气功能中度减退的肺癌患者术后出现低氧血症等一般并发症几率较正常组明显增高,手术范围较局限的患者,严重并发症及院内死亡率并无明显增高,年龄越大、手术切除范围越大者并发症发生几率越大。     

强化肺康复锻炼在重度肺通气功能障碍肺癌患者围手术期中的应用

目的探讨强化肺康复锻炼在重度肺通气功能障碍肺癌患者围手术期中的应用价值。方法选取2011年12月至2015年12月间江苏省无锡市第四人民医院收治的126例重度肺通气功能障碍肺癌患者,采用随机数字表法分为观察组和对照组,每组63例。观察组患者在常规护理的基础上联用强化肺康复锻炼,对照组患者采用围手术期常规护理,于治疗前后行肺功能检测,比较两组患者临床疗效及并发症情况。结果两组患者治疗后肺功能指标(第1秒用力呼气量、用力肺活量、最大通气量、一氧化碳弥散总量、千克摄氧量、氧脉搏、动脉血二氧化碳分压、呼气峰流速)较治疗前增加,且观察组高于对照组,差异有统计学意义(P<0.05)。两组患者治疗后肺功能指标(残气量、功能残气量、潮气量、呼吸频率)较治疗前降低,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组患者机械通气时间、术后氧疗时间、引流管留置时间、术后住院时间少于对照组,差异有统计学意义(P<0.05)。观察组患者并发症发生率(肺部感染、肺不张、呼吸衰竭)低于对照组,差异有统计学意义(P<0.05)。结论强化肺康复锻炼可显著改善重度肺通气功能障碍肺癌患者的肺功能,疗效显著且安全性高,值得临床推广应用。     

低潮气量联合低呼气末正压通气用于食管癌根治术患者单肺通气的临床观察

目的 观察低潮气量联合低呼气末正压通气用于食管癌根治术患者单肺通气的临床效果.方法 32例ASA Ⅰ或Ⅱ级择期行食管癌(中段)根治术患者随机均分为 A、B两组.A组为低潮气量联合低呼气末正压通气组:VT=6ml*kg-1,f=16次/min-1,加5cm H2O PEEP;B组为传统单肺通气组:VT=10ml*kg-1,f=12次/min.观察气管插管后切皮前(T1)、单肺通气后60min(T2)、恢复双肺通气后15min(T3)、拔管后30min(T4)的动脉氧分压(PaO2)、动脉二氧化碳分压( PaCO2)、呼气末二氧化碳分压(PETCO2)、氧合指数(PaO2/FiO2)、平均动脉压(MAP)及术中的气道峰压(Ppeak)、气道平台压力(Pplat)、气道压力(Paw).结果 T2时A组的Ppeak、Pplat及Paw明显低于B组(P<0.05); T2,3,4时A组的Pa02、Pa02/Fi02明显高于B组(P<0.05);两组各时点PaCO2、PETCO2及MAP差异无统计学意义(P>0.05).结论 食管癌根治术中应用低潮气量联合低呼气末正压通气能有效改善患者术中低氧血症,减少肺部并发症,有利于患者呼吸功能的恢复,对血流动力学无明显影响,是食管癌根治手术全麻安全、有效的通气方法.     

Selenium, lycopene, alpha-tocopherol, beta-carotene, retinol, and subsequent bladder cancer

To examine the association between serum nutrients and the development of bladder cancer we measured selenium, alpha-tocopherol, lycopene, beta-carotene, retinol, and retinol-binding protein in serum collected from 25,802 persons in Washington County, MD, in 1974. Serum samples were kept frozen at -70 degrees C. In the subsequent 12-year period, 35 cases of bladder cancer developed among participants. Comparisons of serum levels in 1974 among cases and two matched controls for each case showed that selenium was significantly lower among cases than controls (P = 0.03), lycopene was lower among cases at a borderline level of significance (P = 0.07), and alpha-tocopherol was nonsignificantly lower (P = 0.13). For selenium there was a nearly linear increase in risk with decreasing serum levels (P = 0.03). When examined by tertiles, the odds ratio associated with the lowest tertile of selenium compared to the highest tertile was 2.06. Serum levels of retinol, retinol-binding protein, and beta-carotene were similar among cases and controls. These results support a role for selenium in the prevention of bladder cancer.     

Susceptibility of Ureaplasma urealyticum to Tetracycline,Doxycycline, Erythromycin,Roxithromycin, Clarithromycin,Azithromycin, Levofloxacin and Moxifloxacin

Abstract

The in vitro activity of tetracycline, doxycycline, erythromycin, roxithromycin, clarithromycin, azithromycin, levofloxacin and moxifloxacin was tested against 63 clinical isolates of Ureaplasma urealyticum. The minimal inhibitory concentrations (MICs) and the minimal bactericidal concentrations (MBCs) were determined by the broth microdilution method in A7 medium. The miC50 and miC90 of the tested agents after 24 h of incubation were as follows: Tetracycline, 0.5 and 2.0 μg/ml; doxycycline, 0.125 and 0.25 μg/ml; erythromycin, 2.0 and 8.0 μg/ml; roxithromycin, 2.0 and 4.0 μg/ml; clarithromycin, 0.25 and 1.0 μg/ml; azithromycin, 2.0 and 4.0 μg/ml; levofloxacin, 1.0 and 2.0 μg/ml; and moxifloxacin, 0.5 and 0.5 μg/ml, respectively. The MIC values after 24 h and 48 h incubation differed by no more than one dilution for all the agents with the exception of doxycycline (two dilution difference for MIC₉₀). Overall, moxifloxacin was the most active agent in vitro against U. Urealyticum, with the narrowest difference between MIC and MBC values, followed closely by levofloxacin. Clarithromycin was the most active macrolide.     

80岁以上合并肠梗阻的结直肠癌患者的外科治疗

目的 探讨80岁以上合并肠梗阻的结直肠癌患者的外科治疗策略。方法 回顾性分析中国医学科学院结直肠外科2007年1月—2018年12月行结直肠癌手术且术前合并肠梗阻的77例80岁以上患者的临床病理资料,按照手术方式分为根治组（n=58）与非根治组（n=19）,比较两组患者临床病理特征、围手术期相关指标和预后。采用Kaplan-Meier法进行生存分析,Log rank检验进行生存时间比较;应用Cox比例风险模型进行多因素分析,对影响预后的因素进行分析。结果 根治组TNM分期为Ⅳ期患者的比例明显低于非根治组（8.6% vs. 57.9%, P<0.001）。根治组患者的5年生存率明显高于非根治组（65.5% vs. 26.3%, P<0.001）。单因素分析显示TNM分期和是否行根治性手术与合并肠梗阻的老年结直肠癌患者预后相关。多因素分析表明是否行根治性手术是影响80岁以上合并肠梗阻的结直肠癌患者预后的独立因素。结论 是否行根治性手术是影响80岁以上合并肠梗阻的结直肠癌患者预后的独立因素。     

Etoposide, dexamethasone, cytarabine, and cisplatin in vincristine, doxorubicin, and dexamethasone-refractory myeloma

Based on remarkable activity in refractory lymphomas, a combination of etoposide, cisplatin (both administered by 4-day continuous infusions), cytarabine (Ara-C), and dexamethasone (EDAP) was evaluated in 20 patients with advanced myeloma refractory to standard melphalan and prednisone (MP) and/or vincristine, Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), and dexamethasone (VAD) and even to high doses of melphalan (HDM) (seven patients). Forty percent of patients responded regardless of previously recognized risk factors (eg, duration of drug resistance, tumor mass, and serum lactic dehydrogenase [LDH] level). While the median survival was only 4.5 months, patients with good performance (Zubrod less than 2) and low or intermediate tumor stage survived more than 14 months compared with only 2 months for the remaining group. EDAP could be readily administered in the outpatient clinic, but neutropenic fever prompted hospital admission in 80% of patients, half of whom developed penumonia and sepsis, a fatal outcome in four patients. Severe myelosuppression was of short duration, so that subsequent cycles could be administered every 3 to 4 weeks. No serious extramedullary toxicity, including renal toxicity, was encountered. Marrow toxicity and hence infectious complications may be reduced by elimination of Ara-C without compromising treatment efficacy. We conclude that the lack of cross-resistance with VAD and even HDM makes EDAP or a similar combination an attractive regiment to be formally explored in an alternating sequence with VAD in high-risk myeloma.