两种机械通气方式在兔海水型肺水肿中的应用比较

目的　观察不同通气方式对海水淹溺型肺水肿的救治作用。方法　应用常规机械通气和高频喷射通气对 4 2只海水淹溺型肺水肿兔进行分组救治。不同时间点观察血气分析、呼吸动力学、血流动力学、肺损伤指标 ,并进行病理学检查和观察存活时间。结果　两种通气方式治疗后血氧分压、血氧饱和度、二氧化碳分压均较未治疗组有明显改善 (P <0 .0 1) ,呼吸动力学、血流动力学异常得到一定程度纠正 ,肿瘤坏死因子 α、肺泡灌洗液中性粒细胞计数等肺损伤指标也显示通气治疗后肺损伤情况减轻。两种通气方式之间比较显示常规机械通气较高频喷射通气治疗能更好地改善海水淹溺型肺水肿时的低氧情况。结论　常规机械通气和高频喷射通气治疗海水淹溺型肺水肿时低氧血症均取得满意效果 ,并减轻了肺损伤的程度。     

两种机械通气方式对海水淹溺肺水肿的影响

目的观察两种机械通气方式对海水淹溺肺水肿（pulmonary edema after seawater drowning，PE-SWD）兔的救治作用。方法应用常规机械通气（CMV）和高频喷射通气（HFJV）对PE-SWD兔进行分组救治，在不同时间点观察血气分析、呼吸动力学、血液动力学、肺损伤指标，并进行病理学检查和观察存活时间，从而观察两种机械通气方式治疗PE-SWD的效果。结果两种通气方式治疗后，血氧分压（PaO2）、血氧饱和度（SO2）、二氧化碳分压（PaCO2）均较未治疗组有明显改善（P〈0．01），呼吸动力学、血液动力学异常得到一定程度纠正，TNF-α、肺泡灌洗液中性粒细胞计数等部分肺损伤指标也显示机械通气治疗后肺损伤程度减轻。两种通气方式之间比较显示，CMV较HFJV治疗能更好地改善PE-SWD的低氧情况。结论CMV和HFJV治疗PE-SWD低氧血症均取得满意效果，并减轻了肺损伤的程度。     

呼气末正压通气联合控制性肺膨胀治疗海水淹溺急性肺损伤

目的 探讨呼气末正压通气(PEEP)联合控制性肺膨胀(SI)对海水淹溺致急性肺损伤(SWD-ALI)兔的治疗作用及安全性.方法 应用小潮气量机械通气联合PEEP对42只SWD-ALI兔进行分组救治,通气过程中实施SI,在不同时间点观察血气分析、呼吸力学、血液动力学、肺损伤指标,并进行肺组织学检查,以评价治疗效果及安全性.结果 PEEP联合SI治疗后SWD-ALI兔血氧分压(PaO2)等指标较对照组和PEEP治疗组明显改善(P<0.05),肺顺应性也明显好转(P<0.05),呼吸力学、血液动力学无显著恶化,影像学检查显示肺内渗出明显吸收.结论 在SWD-ALI兔治疗过程中应用PEEP,同时实施SI,能够明显改善氧合,提高肺顺应性,是一种安全有效的治疗SWD-ALI的机械通气手段.     

特布他林对海水淹溺性肺水肿兔的治疗作用

目的观察特布他林对海水淹溺性肺水肿（PE-SWD）的治疗作用。方法将24只新西兰兔制作成海水淹溺性肺水肿机械通气模型，随机分成对照组（C组）和特布他林治疗组（T组）。在不同时间点观察动脉血气分析、呼吸动力学指标。同时检测两组的血管外肺水含量指数（EVLWI）、伊文思兰漏出（ELI）指数、肺泡灌洗液中TNF-α和中性粒细胞计数及肺组织匀浆Na^＋ -K^＋ -ATP酶活性，并进行病理学检查。结果特布他林治疗后PE—SWD兔血氧分压（PaO2）、二氧化碳分压（PaCO2）、呼吸动力学指标等均较对照组有明显改善（P〈0．05）。T组EVLWI、ELI及肺泡灌洗液中TNF-α、中性粒细胞计数均低于C组（P〈0．05），而肺组织匀浆Na^＋ -K^＋ -ATP酶活性明显高于C组。结论特布他林可改善海水淹溺所致的低氧血症，减轻肺水肿。     

高压氧、机械通气对海水淹溺肺水肿兔肺组织学及呼吸功能的影响

目的　观察高压氧 (HBO)、机械通气对海水淹溺肺水肿 (PE- SWD)兔肺组织学及呼吸功能的影响。方法　将 2 4只实验动物随机分为 PE- SWD组、HBO治疗组、机械通气治疗组。在不同时间点观察动脉血气分析、呼吸频率、呼吸动力学指标 ,实验结束后进行肺组织病理学检查。结果　 HBO治疗组、机械通气治疗组各相同时间点 Pa O2 明显高于 PE- SWD组 (P<0 .0 1) ;HBO治疗组除个别时间点外 ,p H、Pa CO2 在整个治疗过程中变化不明显 ;机械通气治疗后 p H的变化规律略与 PE- SWD组相同 ,但治疗结束时仍低于其他组 (P<0 .0 1) ,Pa CO2 始终维持在一个较高的水平 (P<0 .0 1)。两种治疗都减轻了肺损伤程度 ,在降低气道峰压、提高肺顺应性方面两治疗组之间比较 ,差异无显著性意义 (P>0 .0 5 )。结论　 HBO和机械通气治疗可明显纠正 PE- SWD时的低氧血症 ,减轻肺损伤程度 ,改善呼吸功能。     

海水淹溺致急性肺损伤兔模型的建立

目的 通过向兔气管插管内灌入海水,建立海水淹溺致急性肺损伤模型.方法 观察不等量海水灌入气管插管兔肺内后症状学、血气分析、血流动力学、肺损伤指标、组织学等变化,寻找符合急性肺损伤诊断标准的合适的灌入海水量.结果 2～3 ml/kg的海水灌入兔肺内后,氧合指数、影像学等指标显示符合国际公认的急性肺损伤动物模型.结论 向兔肺内灌入适量海水,成功复制出既符合海水淹溺的实际情况,又符合国内外急性肺损伤诊断标准的海水淹溺致急性肺损伤动物模型.     

水下冲击伤后肺与血气的变化及其意义

目的 观察水下冲击伤后肺损伤程度及血气指标的动态变化与动物伤情的关系。方法 38只成年犬,用TNT炸药致不同程度的水下冲击伤,现场死亡动物和存活动物分别于死后即刻和伤后6h进行大体解剖观察,利用便携式手持血气分析仪测定伤前、伤后30min和6h的动脉血气。结果 水下冲击伤肺损伤主要表现为不同程度的肺出血、肺水肿;冲击波正向冲量与肺损伤程度和动物死亡密切相关;呼吸频率、血氧分压以及二氧化碳分压的变化可反映肺损伤程度。结论 严重的肺损伤导致的低氧血症可能是水下冲击伤动物早期死亡的主要原因,伤情的严重程度与水下冲击波的正向冲量密切相关。     

连续性静脉-静脉血液滤过联合机械通气治疗的高原肺水肿临床观察

目的:观察连续性静脉-静脉血液滤过(CVVH)联合机械通气治疗高原肺水肿患者的临床疗效。方法:选择入住ICU符合高原肺水肿诊断标准的患者56例,随机分为2组:A组27例,采用常规治疗 机械通气;B组29例,采用常规治疗 机械通气 CVVH。分别观察2组患者在氧合指数、吸入氧浓度、动脉血氧分压、PEEP水平、心率、血压及病死率等方面的差别。结果:B组患者加用CV-VH后,各项指标经统计学处理显示:病死率,B组与A组比较,差别有显著性意义(P<0.05):其他指标B组与A组比较,差别均有高度显著性意义(P<0.01)。结论:CVVH疗法可有效清除高原肺水肿患者血管外肺水和各种应激激素、致炎介质,明显改善了高原肺水肿患者肺部氧合功能及血流动力学指标,提高抢救成功率。     

高原地区双水平气道正压无创机械通气治疗急性左心功能衰竭的疗效观察

目的:观察高原地区双水平气道正压(Bi-level positive airway pressure,BiPAP)无创机械通气对急性左心功能衰竭患者的疗效。方法:78例来自海拔2260m～3500m的急性左心功能衰竭患者随机分成两组,治疗组39例和对照组39例,对照组给予常规利尿、扩血管、强心和鼻导管高浓度吸氧,治疗组除常规治疗外,加无创机械通气S/T模式治疗,分别记录两组患者治疗前及治疗后30分钟和60分钟的呼吸、血压、血气分析及症状和体征的变化。结果:无创机械通气治疗组30分钟血pH值、动脉血二氧化碳分压、呼吸频率和心率与常规治疗组有显著性差别,治疗60分钟的血氧分压和呼吸频率较常规治疗组明显改善(P<0.05)。结论:高原地区双水平气道正压无创机械通气能迅速改善急性左心功能衰竭患者的缺氧情况,并显著降低心率、减慢呼吸频率,是治疗急性左心功能衰竭的重要手段。     

机械通气在胸部开放伤后海水灌入胸腔致急性肺损伤救治中的应用

目的探讨机械通气在胸部开放伤后海水灌入胸腔致急性肺损伤（ALI）救治中的应用。方法锐器致胸部开放伤后胸腔内灌注海水（35ml／kg）制备ALI成年杂交犬动物模型，随机分为未救治组、普通救治组、机械通气组，每组6只。未救治组在ALI出现后不实施任何救治措施，普通救治组给以鼻导管吸氧、胸腔闭式引流、静脉输入5％葡萄糖液等，机械通气组将普通救治组鼻导管吸氧改为机械通气。动态观察血气分析、血流动力学变化，检测外周血中炎症介质的变化。结果胸部开放伤后海水灌入胸腔可导致ALI，普通救治组PaO2虽有所升高但仍显著低于正常，机械通气能快速纠正低氧血症，两组在纠正高渗、高钠、高氯血症和改善血流动力学方面无显著差异。结论胸部开放伤后海水灌入胸腔引起严重ALI，机械通气具有良好的治疗效果。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.