右美托咪定对实施无创正压通气的慢性阻塞性肺疾病急性加重患者镇静的研究

目的探讨右美托咪定对实施无创正压通气(NPPV)的慢性阻塞性肺疾病急性加重(AECOPD)患者镇静的有效性及安全性。方法将2011年11月至2014年6月收入急诊ICU的共68例需NPPV的AECOPD患者随机分为镇静组及对照组,每组34例。两组患者均给予药物治疗及NPPV,镇静组在上述治疗的基础上给予右美托咪定首剂0.5μg/kg的负荷量于10 min静脉推完,然后给予0.1~0.4μg/(kg·h)的维持量,镇静目标为Ramsay评分2~4分。观察两组患者治疗前及治疗后24h的动脉血气分析指标、生理参数[呼吸频率(RR)、心率(HR)及平均动脉压(MAP)]的变化,观察两组患者呼吸机设定条件[吸入氧浓度(FiO2)、吸气相气道正压(IPAP)、呼气相气道正压(EPAP)]的变化及插管有创通气率。结果两组患者治疗前及治疗后24h相比动脉血气指标、RR、HR均明显好转(P0.05),镇静组以上监测指标较对照组改善更明显(P0.05)。两组患者治疗前后相比,MAP均有下降(P0.05),但两组间相比差异无统计学意义(P0.05)。呼吸机设定条件(FiO2、IPAP、EPAP)镇静组较对照组下降(P0.05)。镇静组插管有创通气率(10.5%)明显低于对照组(38.1%),差异有统计学意义(P0.05)。结论右美托咪定镇静改善AECOPD患者NPPV的依存性及疗效,减少有创通气率。     

无创机械通气治疗COPD合并OSAHS重叠综合征患者的临床研究

目的 探讨昼夜选择不同无创呼吸机通气参数治疗慢性阻塞性肺疾病(COPD)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)重叠综合征患者的临床意义。方法 选择COPD合并OSAHS重叠综合征患者52例,随机分为实验组和对照组,对照组患者压力参数设置为：白天与夜间的吸气相压力(IPAP)及呼气相压力(EPAP)保持不变,实验组患者设置为白天与夜间的IPAP保持不变,夜间的EPAP在白天的基础上上调3 cmH₂O。比较两组患者在进行白天通气模式及夜间通气模式前后,血气分析中的氧分压(PaO₂)、二氧化碳分压(PaCO₂)以及嗜睡主观评价Epworth量表(ESS)评分的变化。结果 治疗后,实验组的PaO₂高于治疗前,ESS评分低于治疗前,差异均有统计学意义(t分别=3.14、-6.13,P均<0.05),治疗前后的PaCO₂比较,差异无统计学意义(t=1.17,P>0.05);且实验组治疗后PaO₂高于对照组治疗后,PaCO₂和...     

呼气末正压对右心室Tei指数的影响

目的 探讨呼气末正压(PEEP)对右心室Tei指数的影响。方法 选择2021年6月至2022年1月收治的52例机械通气的危重症患者,使用容量控制的通气模式,分别设置PEEP为4、8和12 cm H₂O,比较改变PEEP后血氧饱和度、心率(HR)、平均动脉压(MAP)、血乳酸及肺静态顺应性(Clst)的变化。对患者进行超声心动图检查,测量右心室心肌做功指数(Tei指数)、心输出量,进行前后对比。结果 纳入52例患者,PEEP为4、8和12 cm H₂O时,血氧饱和度、心率、平均动脉压及乳酸无明显变化;Clst分别为50.72(43.61,57.85)、45.60(42.21,51.22)及37.39(31.64,41.20),各组之间差异有统计学意义(P<0.05);Tei指数分别为0.41(0.31, 0.46)、0.44(0.36, 0.52)和0.57(0.49, 0.72),各组之间差异有统计学意义(P<0.05)。然而,左心室心输出量未出现明显变化,分别为4.72(4.37,5.21)L/min, 4.72(4.23,5....     

经鼻(面)罩BiPAP辅助治疗老年急性左心衰患者的疗效观察及护理

BiPAP是无创正压通气(NPPV)中的一种模式,为双水平气道正压通气.近年来我院重症医学科对30例老年急性左心衰患者,在使用抗心衰基础药物治疗的同时,予以经鼻(面)罩BiPAP辅助通气,通过严密观察和加强护理,无并发症发生,取得较满意的效果,现报道如下. 临床资料 1.一般资料.本组急性左心衰患者30例,男21例,女9例,平均年龄65.85岁,其中急性心肌梗死并发心衰6例,缺血性心肌病11例,扩张型心肌病6例,老年性心脏瓣膜病5例,风湿性心脏病2例.合并有慢性阻塞性肺疾病和多种老年性疾病者25例,患者均有不同程度的呼吸困难,端坐呼吸,呼吸频率＞30次/min,明显发绀,SaO2＜ 85％,且无食管反流,血气胸及心包填塞等机械通气禁忌症. 2.方法.在给予常规强心、利尿、扩血管等抗心衰基础药物治疗的同时,用呼吸机辅助通气,采用BiPAP模式.机械通气方法:根据患者面形大小,分泌物多少及能否闭嘴等选择合适的鼻罩或面罩,采用美国伟康公司生产的BiPAP呼吸机(S/T-D/30),经鼻(面)罩正压通气,呼吸模式为自触发定时(S/T),吸气压(IPAP)14～16 cm H2O(1 cm H2O=0.098 kPa),呼气压(EPAP)4～6 cm H2O,氧流量4～8 L/min,持续应用至病情好转,并根据病情适当调整吸气压、呼气压及氧流量.     

无创正压通气治疗老年急性心肌梗死并左心衰竭的临床研究

目的:观察无创正压通气(NPPV)在老年急性心肌梗死合并左心衰竭患者治疗中的作用。方法:将60例符合入选标准的老年急性心肌梗死合并左心衰竭患者分为两组,治疗组30例经口鼻面罩行NPPV,通气模式采用压力支持(PSV)+呼气末正压(PEEP)模式;对照组30例给予高浓度面罩吸氧,两组均给予改善心肌缺血、利尿、扩血管、强心和镇静等治疗。结果:治疗组经NPPV2h后,患者的临床症状、动脉血气指标、心率和呼吸频率均明显改善并明显优于对照组(P<0.05),与对照组比较,治疗组病死率、气管插管率显著降低,住院时间显著缩短,差异均有显著性(均P<0.05)。结论:NPPV是抢救老年急性心肌梗死合并左心衰竭患者的有效措施。     

不同无创正压通气对呼吸窘迫综合征早产儿血气及疗效的影响

目的 比较双水平气道正压通气(BiPAP)和鼻塞式持续气道正压通气(NCPAP)对呼吸窘迫综合征(RDS)早产儿血气及疗效的影响,以评价BiPAP的临床应用价值.方法 对80例RDS早产儿常规使用肺表面活性物质(PS)进行替代治疗后,随机分入BiPAP通气模式组(BiPAP组)和NCPAP通气模式组(NCPAP组),每组各40例.观察两组工作参数(FiO2、PEEW EPAP),血气指标(PaO2、PaO2/FiO2、PaCO2、pH)及治疗成功率.结果 ①两组通气模式工作参数:FiO2、PEEWEPAP随通气时问延长均逐渐降低.0 h(上机时)两组间FiO2、PEEP/EPAP比较差异均无统计学意义(P>0.05),上机后6、12、24、48 h BiPAP组FiO2、PEEP/EPAP均明显低于对应NCPAP组(P<0.05,P<0.01);②两组PaO2、PaO2/FiO2、pH均有上升趋势,PaCO2呈现降低的趋势.0 h时PaO2、PaO2/FiO2、PaCO2、pH两组比较差异均尢统计学意义(P>0.05);PaO2、PaO2/FiO2、pH在上机后6、12、24、48 h BiPAP组均明显高于对应NCPAP组(P<0.05,P<0.01);PaCO2于上机后6、12、24、48 h BiPAP组均明显低于对应NCPAP组(P<0.05);③BiPAP组治疗成功率明显高于NCPAP组(P<0.05).结论 对于RDS早产儿采用BiPAP治疗疗效优于NCPAP,具有无创、高效等优点,值得推广.     

硝酸甘油对脊髓损伤雌性大鼠漏尿点压力影响的初步研究

目的初步探讨硝酸甘油对慢性期完全性脊髓损伤雌性大鼠漏尿点压力的影响。方法建立慢性期完全性脊髓损伤雌性大鼠模型,腹腔注射硝酸甘油3mg。观察用药前后大鼠逼尿肌漏尿点压力的变化。结果用药前漏尿点压力(32.27±15.00)cm H₂O(1cm H₂O=98.0665Pa),用药后为(23.29±9.46)cm H₂O(P≤0.01)。结论腹腔注射硝酸甘油可明显降低慢性期完全性脊髓损伤雌性大鼠漏尿点压力。     

无创机械通气治疗COPD合并Ⅱ型呼吸衰竭疗效观察

目的：探讨双水平气道正压无创通气（BiPAP）对慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease,COPD）合并Ⅱ型呼吸衰竭的治疗价值。方法：66例COPD合并Ⅱ型呼衰患者分成通气组和对照组,对照组给予常规抗感染、祛痰、平喘、肾上腺皮质激素、呼吸兴奋剂、低浓度持续吸氧等治疗,通气组除了常规治疗外,加无创机械通气（BiPAP）治疗,采用通气口鼻面罩,设定参数S／T模式,呼吸频率12～18次／min,氧流量3～5L／min,吸气压（IPAP）10～18cmH2O,呼气压（EPAP）3～6cmH2O,最初3日持续使用呼吸机,病情好转后6～20h／d,通气天数为5～12天,观察治疗前后动脉血气分析指标变化。结果：通气组治疗后血气分析中pH值、SaO2、PaO2、PaCO2较治疗前均明显改善（P〈O．01）,其改善幅度明显优于对照组,临床症状亦明显改善。结论：双水平气道正压无创通气治疗COPD合并Ⅱ型呼吸衰竭疗效显著。     

无创通气治疗重叠综合征并发呼吸衰竭5例

目的 :探索简便、临床易于推广应用的重叠综合征治疗手段。方法 :对 5例重叠综合征患者经鼻 (面罩 )持续气道正压通气 (BiPAP)治疗 ,吸气压力 (IPAP)为 12～ 14cmH2 O ,呼气压力 (EPAP) 4～ 5cmH2 O ,每日治疗 6～ 8h ,持续 1周 ,观察症状的改善 ,血气分析指标的变化。结果 :5例重叠综合征病例均取得了较为满意的疗效 ,全部病人临床症状明显好转 ,呼吸衰竭得到了改善。结论 :BiPAP呼吸机使用简便 ,治疗重叠综合征疗效满意 ,并减少了医务人员的工作量 ,节省病员开支 ,具有广阔的临床前景。     

不同通气参数在BiPAP无创正压通气治疗急性心肌梗死泵衰竭患者疗效比较

急性心肌梗死泵衰竭患者分为高水平通气组及低水平通气组,两组常规给予相关治疗措施。两组通气由吸气压(IPAP)8~15cm H2O、呼气压(EPAP)4~6cm H2O开始;其中高水平通气组在患者可耐受情况下每5min增加2cm H2O的压力直到吸气压达到15~20cm H2O,呼气压6~8cm H2O,低水平通气组患者压力不变。结果两组患者一般情况、血气指标、LVEF等较治疗前明显改善(P0.05)。治疗后2h两组患者血压、Pa O2、乳酸、LVEF比较,高水平通气组改善更为明显(P0.05)。高水平通气组在急性心肌梗死泵衰竭治疗初期改善氧合、降低心脏负荷具有更好的效果。     

Bi-level Positive Airway Pressure Support System Use in Acute Congestive Heart Failure: Preliminary Case Series

Objective: To describe the use of a noninvasive bi-level positive airway pressure (PAP) support system for ED patients with acute congestive heart failure (CHF).
Methods: Retrospective case series analysis of ED patients presenting with acute CHF in imminent need of endotracheal intubation (ETI) managed with a bi-level PAP system. The bi-level PAP system was applied at the discretion of the treating emergency physician. Management of the bi-level PAP system, including setting of inspiratory PAP (IPAP) and expiratory PAP (EPAP), weaning, adjunct pharmacologic therapy, and failure of bi-level PAP support, was determined by the treating physician.
Results: Only two (9%) of 22 patient presentations necessitated ETI. The mean duration of bi-level PAP therapy was 7.9 hours. The mean maximum IPAP and EPAP settings were 10.8 and 5.8 cm H₂O, respectively. Mean intensive care unit length of stay (LOS) was 2.4 days, with a median LOS of only 1 day. There were three deaths in the series; none were attributed to the bi-level PAP system. No technical difficulty with the bi-level PAP system was noted.
Conclusion: Noninvasive pressure support ventilation with a bi-level PAP support system may avert ETI in acute CHF patients. This device can be effectively used by ED personnel.     

Acute physiologic effects of nasal and full-face masks during noninvasive positive-pressure ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease

OBJECTIVE: To assess the efficacy of and patient tolerance for nasal and full-face masks during noninvasive positive-pressure ventilation (NPPV) with patients suffering acute exacerbations of chronic obstructive pulmonary disease. SETTING: A respiratory medicine ward of a referral hospital. METHODS: Fourteen patients were randomized to 2 groups. Seven used nasal masks and 7 used full-face masks. We used a portable ventilator and recorded arterial blood gases and indices of respiratory muscle effort before and after 15 min of NPPV. Patient tolerance was scored as follows: no tolerance (mask had to be withdrawn before the study period ended) = 0 points; poor tolerance (patient complained of discomfort from the ventilation devices but nevertheless remained compliant) = 1 point; fair tolerance (patient seemed uncomfortable but did not complain) = 2 points; excellent tolerance (patient felt better than before beginning NPPV) = 3 points. RESULTS: The groups were comparable in clinical and pulmonary function variables at baseline. NPPV improved both arterial blood gases and the indices of respiratory effort, with no significant differences between the groups. During NPPV the group that used full-face mask had a greater decrease in respiratory rate, but no other differences. NPPV was well tolerated in both groups. CONCLUSIONS: In patients suffering acute exacerbations of chronic obstructive pulmonary disease NPPV improves arterial blood gases and respiratory effort indices regardless of the type of mask used.     

Effects of the components of positive airway pressure on work of breathing during bronchospasm

Introduction

Partial assist ventilation reduces work of breathing in patients with bronchospasm; however, it is not clear which components of the ventilatory cycle contribute to this process. Theoretically, expiratory positive airway pressure (EPAP), by reducing expiratory breaking, may be as important as inspiratory positive airway pressure (IPAP) in reducing work of breathing during acute bronchospasm.

Method

We compared the effects of 10 cmH₂O of IPAP, EPAP, and continuous positive airwaypressure (CPAP) on inspiratory work of breathing and end-expiratory lung volume (EELV) in a canine model of methacholine-induced bronchospasm.

Results

Methacholine infusion increased airway resistance and work of breathing. During bronchospasm IPAP and CPAP reduced work of breathing primarily through reductions in transdiaphragmatic pressure per tidal volume (from 69.4 ± 10.8 cmH₂O/l to 45.6 ± 5.9 cmH₂O/l and to 36.9 ± 4.6 cmH₂O/l, respectively; P < 0.05) and in diaphragmatic pressure–time product (from 306 ± 31 to 268 ± 25 and to 224 ± 23, respectively; P < 0.05). Pleural pressure indices of work of breathing were not reduced by IPAP and CPAP. EPAP significantly increased all pleural and transdiaphragmatic work of breathing indices. CPAP and EPAP similarly increased EELV above control by 93 ± 16 ml and 69 ± 12 ml, respectively. The increase in EELV by IPAP of 48 ± 8 ml (P < 0.01) was significantly less than that by CPAP and EPAP.

Conclusion

The reduction in work of breathing during bronchospasm is primarily induced by the IPAP component, and that for the same reduction in work of breathing by CPAP, EELV increases more.     

钙库操纵性钙通道蛋白在环磷酰胺诱导的膀胱过度活动症大鼠模型膀胱组织中的表达

目的 制备膀胱过度活动症(overactive bladder,OAB)大鼠模型,探讨钙库操纵性钙通道蛋白在OAB大鼠膀胱组织中的表达.方法 30只健康雌性SD大鼠,随机分为模型组和对照组各15只.模型组单次腹腔注射环磷酰胺200 mg/kg制备OAB模型,对照组腹腔注射等量生理盐水.2组腹腔注射后24 h行尿流动力学...     

机械通气对改良腹腔高压液体动物模型腹腔压力-容量关系的影响

目的探讨机械通气对腹腔高压液体动物模型腹腔压力-容量关系的影响。 方法以12只实验猪为研究对象，采用随机数字表法随机分为A组(机械通气组)和B组(非机械通气组)，各6只。两组均采用全身麻醉，A组行气管插管后接机械通气，模式为容量控制通气(VCV)，设定潮气量(VT)10 ml/kg，呼吸频率16次/min，吸入氧浓度(FiO₂)0.40，高呼气末正压通气(PEEP)5 cmH₂O(1 cmH₂O＝0.098 kPa)。按照水囊法制作腹腔高压液体动物模型，每注入生理盐水10 ml，测压1次，记录腹腔内注入总液体量，同步记录腹腔压力(IAP)，绘制腹腔压力-增容量曲线，并在IAP为0，10，20，30，40，50 cmH₂O时(0是指腹腔压力升高的0界点)记录注液量。腹内压维持在35 cmH₂O，观察4 h后处死实验动物，切取心脏、肺脏，用10%甲醛溶液固定24 h后常规石蜡包埋，切片，苏木精-伊红(HE)染色，生物光学显微镜下观察。 结果12只家猪均制模成功，无一发生气压伤和死亡。A组腹腔压力-增容量曲线为不规则的"S"形双函数曲线，IAP在22 cmH₂O为节点，IAP<22 cmH₂O，IAP与增容量存在线性相关关系(r²＝0.78，P<0.05)，IAP>22 cmH₂O，IAP与增容量存在线性相关关系(r²＝0.96，P<0.01)；B组腹腔压力-增容量曲线为单函数曲线，IAP与增容量存在正相关关系(r²＝0.87，P<0.01)。A组在IAP为0，10，20，30，40，50 cmH₂O时注液量[(2 018.22±108.66)ml，(2 032.60±114.42)ml，(2 038.54±112.60)ml，(2 080.88±118.44)ml，(2 162.38±118.86)ml，(2 310.78±124.20)ml]均低于B组[(2 890.40±164.50)ml, (3 000.58±176.22)ml, (3 060.24±178.24)，(3 098.50±183.40)ml，(3 120.00±184.20)ml, (3 145.80±188.60)ml]，均差异有统计学意义(t＝4.42，4.61，4.85，4.66，4.37，5.35；均P<0.01)。心脏标本病理检查：A组心脏心肌纤维玻璃样变性，横纹明显减少，部分心肌纤维萎缩；B组心脏心肌纤维部分萎缩，部分肥大，心肌纤维玻璃样变性，心肌间动脉扩张充血。肺脏病理检查：A组肺脏可见大小不一的肺泡腔，部分肺泡融合，肺泡腔扩张，肺组织间可见出血、慢性炎细胞浸润及炎性渗出，细支气管周围平滑肌增生；B组肺脏肺泡融合，形成较大的肺泡囊，肺泡内皮细胞中度增生，可见心衰细胞，间质淋巴管扩张，管内充满淋巴液，支气管动脉扩张充血，管腔内大量红细胞聚集。 结论腹腔高压可引起心脏和肺脏出现明显的细胞学损伤，机械通气使腹腔间隔室综合征(ACS)发生代偿的空间缩小，腹腔压力与容积关系曲线发生改变，并对心和肺损伤起到一定程度的保护作用。     

Efficacy of a heated passover humidifier during noninvasive ventilation: a bench study

BACKGROUND: Noninvasive positive-pressure ventilation (NPPV) delivers air at a high flow, which is associated with airway mucosal drying and impaired airway functioning. OBJECTIVES: To examine the effects of mechanical ventilation parameters on relative humidity and absolute humidity during NPPV, and to evaluate the effect of a heated passover humidifier on relative humidity, absolute humidity, and ventilator performance during NPPV. METHODS: We performed a bench study to assess the effects of inspiratory positive airway pressure (IPAP) of 10 cm H(2)O, 15 cm H(2)O, and 20 cm H(2)O, respiratory rates of 12 breaths/min and 24 breaths/min, and inspiratory-expiratory ratios of 1:2 and 1:3 on relative and absolute humidity. The measurements were obtained on room air and with a heated humidifier at medium and maximum heater settings. RESULTS: Without humidification, the relative humidity in the NPPV circuit (range 16.3-26.5%) was substantially lower than the ambient relative humidity (27.6-31.5%) at all ventilatory settings. Increasing the IPAP decreased the relative humidity (Spearman's rho = 0.67, p < 0.001). Changing the respiratory rate or inspiratory-expiratory ratio had no significant effect. Both relative and absolute humidity increased with humidification, and the air was fully saturated at the maximum heater setting. Delivered IPAP was reduced by 0.5-1 cm H(2)O during humidification. CONCLUSIONS: NPPV delivers air with a low relative humidity, especially with high inspiratory pressure. Addition of a heated humidifier increases the relative and absolute humidity to levels acceptable for nonintubated patients, with minimal effect on delivered pressure. Consideration should be given to heated humidification during NPPV, especially when airway drying and secretion retention are of concern.     

Noninvasive positive-pressure ventilation with different interfaces in patients with respiratory failure after abdominal surgery: a matched-control study

BACKGROUND: Acute respiratory failure (ARF) is a relatively common complication after abdominal surgery. METHODS: We compared the efficacy of noninvasive positive-pressure ventilation (NPPV) delivered via helmet versus via face mask in patients with ARF after abdominal surgery in 2 intensive care units (31 beds) in the hospital affiliated with the Catholic University of Rome. Twenty-five patients with ARF after abdominal surgery were treated with NPPV via helmet, and the data from those patients were matched with 25 controls chosen from a historical group of 151 patients treated with face mask during the previous 2 years for respiratory complications after abdominal surgery. The matching was done according to age, Simplified Acute Physiology Score II, and the ratio of P(aO(2)) to fraction of inspired oxygen (P(aO(2))/F(IO(2))). NPPV was delivered in pressure support, starting with 10 cm H(2)O, and positive end-expiratory pressure (PEEP) was increased in steps of 2-3 cm H(2)O, up to a maximum of 12 cm H(2)O, in order to maintain an arterial oxygen saturation over 90% with the lowest possible F(IO(2)). RESULTS: NPPV significantly improved P(aO(2))/F(IO(2)) in both groups. Five of 25 helmet patients (20%) and 12 of 25 mask patients (48%) were intubated (p < 0.036). The main cause for NPPV failure in both groups was intolerance (mask 32% vs helmet 12%, p = 0.6). Heart rate, systolic blood pressure, respiratory rate, duration of NPPV, level of pressure support, and PEEP presented no differences between the 2 groups, nor did intensive-care-unit or hospital mortality. Both the helmet and mask interfaces were effective in improving gas exchange and respiratory rate. The global rate of NPPV complications (mask intolerance, major leaks that caused ventilator malfunction, and ventilator-associated pneumonia) was significantly higher in the mask group than in the helmet group (19 patients vs 4 patients, p < 0.03). CONCLUSIONS: NPPV can be an alternative to conventional ventilation in patients with ARF after major abdominal surgery, and helmet use is associated with a better tolerance and a lower rate of complications.     

The influence of positive end-expiratory pressure on pulmonary blood volume changes in adult respiratory distress syndrome

Pathophysiologic changes associated with the Adult Respiratory Distress Syndrome (ARDS), such as the presence of pulmonary vascular occlusions, decreased vascular compressibility, or inceased intrapulmonary shunting, could limit the effect of positive end-expiratory pressure (PEEP) upon pulmonary blood volume (PBV). Accordingly, we determined the effect of 5 and 15 cm H₂O PEEP upon the PBV changes of normal volunteers (n = 9) and patients with moderate or severe ARDS associated with acute pulmonary hypertension (n = 10). Changes of PBV were estimated from equilibrium blood pool scans using Technetium-99m-labeled erythrocytes. The change of PBV induced by PEEP was assessed by measuring the count density over a region of the left lung during 0, 5, and 15 cm H₂O continuous positive airway pressure in the volunteers and during mechanic ventilation with 5 and 15 cm H₂O PEEP in the ARDS patients. Biventricular ejection fractions using gated blood pool angiocardiography and central hemodynamics were also measured in the ARDS patients. In volunteers, 5 and 15 cm H₂O continuous positive airway pressure decreased pulmonary activity by 10% ± 4% and 24% ± 9%, respectively (mean ± SD, P = .0001). In ARDS patients, PBV appeared to be unaffected by decreasing PEEP from 15 to 5 cm H₂O, despite an increased stroke volume, biventricular end-diastolic volume, and venous admixture. Pulmonary vascular resistance and right and left ventricular ejection fraction were unchanged. The ability of PEEP to reduce PBV appears to be decreased during acute lung injury.     

Noninvasive ventilation in neuromuscular disease: equipment and application

Noninvasive support of ventilation is commonly needed in patients with neuromuscular disease. Body ventilators, which are used rarely, function by applying intermittent negative pressure to the thorax or abdomen. More commonly, noninvasive positive-pressure ventilation (NPPV) is used. This therapy can be applied with a variety of interfaces, ventilators, and ventilator settings. The patient interface has a major impact on comfort during NPPV. The most commonly used interfaces are nasal masks and oronasal masks. Other interfaces include nasal pillows, total face masks, helmets, and mouthpieces. Theoretically, any ventilator can be attached to a mask rather than an artificial airway. Portable pressure ventilators (bi-level positive airway pressure) are available specifically to provide NPPV and are commonly used to provide this therapy. Selection of NPPV settings in patients with neuromuscular disease is often done empirically and is symptom-based. Selection of settings can also be based on the results of physiologic studies or sleep studies. The use of NPPV in this patient population is likely to expand, particularly with increasing evidence that it is life-prolonging in patients with diseases such as amyotrophic lateral sclerosis. Appropriate selection of equipment and settings for NPPV is paramount to the success of this therapy.     

环保实用型气管造口防护罩的研制与临床应用

目的探讨环保实用型气管造口防护罩的临床应用效果。方法选择2017年1月至2018年12月我院收治的100例头颈部肿瘤气管切开术后患者,随机等分为试验组与对照组,试验组使用环保实用型气管造口防护罩,对照组常规使用双层生理盐水纱布覆盖气管套管口,比较两组患者舒适度和周围环境清洁度。结果试验组患者舒适度、周围环境清洁度均高于对照组(P<0.05),差异有统计学意义。结论环保实用型气管造口防护罩可有效提高气管切开舒适度和周围环境清洁度,值得推广。