机械通气对体外循环术后炎症反应的影响

目的：探讨体外循环（CPB）术后不同肺通气策略对肌体炎症反应的影响。方法：行室间隔缺损修补术的患者30例，随机分为两组，传统通气组（H组）和保护性肺通气组（L组），于麻醉诱导后、CPB前、CPB结束即刻、CPB结束后6小时取静脉血样测IL-6和IL-8。结果：在体外循环前H组与L组在IL-6与IL-8水平无差异，CPB结束即刻两组的IL-6与IL-8水平均明显升高，而两组间亦无差异性。在CPB结束后6小时两组的IL-6与IL-8水平继续升高，H组升高的更明显，L组仅轻度升高。结论：保护性肺通气策略可以降低体外循环术后的全身炎症反应，有利于患者肺功能的恢复。     

法洛四联症根治术后对左肺动脉狭窄影响机理的数值分析

目的 利用计算流体力学(CFD)方法分析法洛四联症(TOF)根治术后不同的左肺动脉狭窄率（50%,20%,0%）模型的局部血流动力学改变。方法 通过对患者CT数据处理,完成3组左肺肺动脉狭窄几何的全三维数字化重构;结合主肺动脉血流量等临床数据,对3组模型中肺动脉分叉区的血液流动速度场、压力、壁面剪切应力等进行记录。结果 在3组模型的非定常模拟中,左肺动脉起始端均存在与狭窄率相关的反流和血流分布,右肺动脉血流分布规则。3组模型的静态压力、压力损失、壁面剪切力等也不同。结论 肺动脉分支的合理扩大在TOF根治术中有重要意义;术后左肺动脉狭窄是造成肺动脉反流的早期和重要因素;通过CFD模拟术后患者的三维模型可以对手术的效果提供早期参考。     

肺部物理治疗在小儿机械通气的临床应用

目的总结婴幼儿持续机械通气下肺部物理治疗的护理经验.方法对50例机械通气患儿的肺部物理治疗进行回顾性总结.结果撤机成功37例,死亡4例,家属放弃治疗3例,肺不张2例,二氧化碳潴留2例,撤机困难2例.结论小儿机械通气下坚持肺部物理治疗,可使撤机时间缩短,提高了撤机成功率,减少并发症和死亡率.     

肺部物理治疗在小儿机械通气的临床应用

目的　总结婴幼儿持续机械通气下肺部物理治疗的护理经验 .方法　对 5 0例机械通气患儿的肺部物理治疗进行回顾性总结 .结果　撤机成功 37例 ,死亡 4例 ,家属放弃治疗 3例 ,肺不张 2例 ,二氧化碳潴留 2例 ,撤机困难 2例 .结论　小儿机械通气下坚持肺部物理治疗 ,可使撤机时间缩短 ,提高了撤机成功率 ,减少并发症和死亡率 .     

小潮气量和传统潮气量机械通气治疗小儿重症肺炎的疗效对比分析

目的：对比分析小潮气量和传统潮气量机械通气治疗小儿重症肺炎的疗效。方法：对2013年6月至2015年6月在我院进行接治的100例小儿重症肺炎进行研究,将患儿随机分为对照组和观察组,各50例,对照组的患儿采用传统潮气量,潮气量为10~12 mL/kg;观察组的患儿采用小潮气量,潮气量为6~8 mL/kg,对治疗过程中两组患儿临床参数的变化进行对比分析。结果：观察组患儿的机械通气时间明显多于对照组(t=11.0770,P=0.0000),观察组患儿的病死率明显高于对照组(χ2=5.4825,P=0.0192),治疗过程中,两组患儿的平均气道压(Paw)、吸入氧浓度(fraction of inspiration O2,FiO2)、高呼吸末正压(positive end expiratory pressure,PEEP)、吸气峰压(peak inflating pressure,PIP)等临床各指标的变化无明显差异(P>0.05),观察组与对照组存活患儿的反复呼吸道感染发生率无明显差异(χ2=0.0624,P=0.8028)。结论：对重症肺炎患儿进行机械通气时,传统潮气量的治疗效果优于小潮气量。     

无创机械通气与有创机械通气治疗急性左心衰竭临床观察

目的 探讨无创机械通气与有创机械通气治疗急性左心衰竭的疗效对比.方法 回顾分析我院重症监护室急性左心衰竭患者105例,在常规强心,利尿,扩血管药物治疗后症状无改善时,应用无创机械通气57例,有创机械通气48例,观察治疗后2h患者心率(HR),收缩压(SBP),呼吸(RR),血气pH值,二氧化碳分压(PCO2),氧分压(PO2)的变化.结果 患者在应用无创与有创机械通气后肺部啰音明显减少,心率,血压,呼吸,血气分析指标与治疗前比较差异显著,抢救成功率分别为93.75和94.73％,,两组间机械通气后指标无明显差异.结论 无创机械通气治疗急性左心衰竭疗效显著,且操作简单,副作用少,能够减轻患者痛苦,值得临床推广.     

肝移植后机械通气50例分析

背景：人工机械通气是肝移植后必须经历的一个阶段,移植后机械通气与多种因素有关。 目的：探讨影响肝移植机械通气撤机的影响因素。 方法：采用回顾性方法分析机械通气时间的长短(24 h)与移植前并发症,移植中氧代谢,移植后肝、肾功能和脱机前、后血气及电解质的关系。 结果与结论：肝移植后机械通气时间的长短与移植前并发症、移植中氧代谢、移植后肝肾功能有关(P < 0.05),而与脱机前后血气及电解质无关(P > 0.05)。说明移植前并发症、移植中氧代谢、移植后肝肾功能可影响肝移植后机械通气时间。     

时间-空间相关成像技术产前诊断胎儿法洛四联症的价值

目的探讨时间-空间相关成像技术在产前诊断胎儿法洛四联症（tetralogy of Fallot,TOF）中的应用价值。方法应用时间-空间相关成像（spatiotemporal image correlation,STIC）技术回顾性分析12例已经明确诊断为TOF的胎儿心脏容积数据,并与其常规胎儿超声心动图表现相比较。结果 11例TOF胎儿获得满意的心脏容积数据,经多种模式分析均发现室间隔缺损,主动脉根部增宽、骑跨于室间隔缺损之上,9例伴肺动脉狭窄。其图像质量与直接采集的二维图像对比无明显差异。结论 STIC技术降低了胎儿心脏检查的操作难度,能够更直观地显示病变部位的立体结构,有助于胎儿TOF的检出。     

机械通气治疗新生儿呼吸衰竭的血气监测结果分析

目的 了解机械通气对呼吸衰竭的治疗效果和不同通气方式的差异。方法 分析47例呼吸衰竭新生儿在机械通气的前后及过程中的625次血气监测结果,结果 机械通气显著改善了患儿的酸中毒和高碳酸血症,为疾病的治疗创造了条件。不同的通气方式下的血气分析结果提示SPONT较A/C、SIMV较少发生过度通气。结论 机械通气是治疗新生儿呼吸衰竭的有效手段。但不能肯定通气方式对通气效果有影响。     

Myocardial fatty dystrophy in patients with Fallot tetralogy

Fatty degeneration (FD) was studied histochemically and ultrastructurally in surgical biopsies from 147 patients aged 22 days to 40 years with Fallot's tetralogy. FD was most pronounced in patients aged 3 to 6 years when the main part of cardiomyocytes completed the program of ontogenetical growth and started growing as hypertrophic mature cells. An increase of FD is considered as manifestation of an initial stage of hypertrophy of mature cardiomyocytes.     

Outcome of adults with repaired tetralogy of Fallot

Outcome of adult patients with repaired tetralogy of Fallot (TOF) was studied with emphasis on postrepair problems. A retrospective review of clinical, echocardiographic, catheterization, and surgical data was performed for 48 patients who underwent corrective repair of TOF after 15 years of age. All patients survived total repair and have been followed up from 3 months to 11 years (median 4.6 years). Postoperatively, 81.3% of patients were in functional class I and 85.4% had normal right ventricular function. One patient (2.1%) died during follow-up. There were 6 reoperations (12.5%) in 5 patients. The indications for reoperation included residual ventricular septal defect (VSD) (n=1), right ventricular outflow obstruction with VSD (n=4), and pulmonary regurgitation (n=1). The 10-year actuarial survival rate was 97.1%, and the 10-year freedom from reoperation was 81.3%. Aortic regurgitation was seen preoperatively in 6 patients (12.5%) and there were 2 newly developed aortic regurgitations after operation, one of which was caused by infective endocarditis. Corrective repair of TOF can be recommended in this patient group since the survival rate, postrepair functional status and hemodynamics are acceptable. Continued close follow-up, however, is essential for early identification and correction of post-repair problems.     

Frontonasal dysplasia associated with tetralogy of Fallot.

Three children with frontonasal dysplasia associated with tetralogy of Fallot are reported. All cases had true hypertelorism and a median nasal groove with absence of the nasal tip. There was no mental deficiency. The facial anomaly is a sporadic, non-genetic interference of the normal development of the face. This is the first report of frontonasal dysplasia associated with a cardiac defect. Multifactorial inheritance of this syndrome is proposed.     

Familial tetralogy of Fallot and glaucoma

All 3 daughters of a mother with glaucoma had a conotruncal abnormality of the heart and glaucoma. The presence of heart and eye anomaly may be coincidental; however, both may be related to abnormal development of neural crest. The pedigree suggests autosomal dominant inheritance in this family.