经人工气道吸入气体增温湿化效果观察

目的 探讨对经人工气道吸入气体增温湿化的有效性,解决患者经人工气道直接吸入氧气导致的气道干燥、痰栓形成阻塞气道、肺部感染等问题.方法 将38例人工气道非使用呼吸机辅助呼吸期间直接经导管、漏斗吸氧的患者随机分为对照组和观察组各19例.对照组采用常规方法,吸入的氧气应用普通湿化瓶蒸馏水常温(18～22℃)湿化;观察组吸入的...     

重症非人工气道患者痰液湿化效果观察

目的观察重症非人工气道患者痰液湿化的效果。方法将128例非人工气道患者随机分为观察组和对照组各64例。对照组予常规湿化法；观察组予生理盐水100ml加α-糜蛋白酶2万U向口咽部滴入，其滴入量、间隔时间根据痰液的粘稠度而定。结果两组痰液粘稠度比较，差异有显著性意义（P〈0．01）；两组低氧血症发生率和气管切开率比较，差异有显著性意义（均P〈0．05）。结论口咽部滴入湿化液用于重症非人工气道患者的气道管理，能保持气道门户（口咽部）处于湿化状态，使痰液易于吸出或咳出，减少并发症的发生。     

重症非人工气道患者痰液湿化效果观察

目的 观察重症非人工气道患者痰液湿化的效果.方法 将128例非人工气道患者随机分为观察组和对照组各64例.对照组予常规湿化法;观察组予生理盐水100 ml加a-糜蛋白酶2万U向口咽部滴入,其滴入量、间隔时间根据痰液的粘稠度而定.结果 两组痰液粘稠度比较,差异有显著性意义(P＜0.01);两组低氧血症发生率和气管切开率比较,差异有显著性意义(均P＜0.05).结论 口咽部滴入湿化液用于重症非人工气道患者的气道管理,能保持气道门户(口咽部)处于湿化状态,使痰液易于吸出或咳出,减少并发症的发生.     

输液泵控制持续湿化对建立人工气道患者呼吸功能的影响

目的:探讨输液泵控制持续湿化对建立人工气道患者呼吸功能的影响.方法:40例因急性脑血管疾病导致通气功能严重障碍而建立人工气道的患者随机分为A、B两组,每组各20例,分别应用输液泵控制进行持续气道湿化、常规气道湿化,记录并比较两组日平均吸痰次数、平均吸痰时间、经皮血氧饱和度、经皮氧分压.结果:A组日平均吸痰次数、日平均吸痰时间均低于B组,差异有高度统计学意义(P均＜0.01)；而经皮血氧饱和度、经皮氧分压(包括吸痰即刻和吸痰后5min)均高于B组,差异有统计学意义(P均＜0.05).结论:应用输液泵控制对建立人工气道患者进行持续气道湿化,对患者呼吸功能的不利影响较小,优于常规湿化法,值得临床推广.     

组合药液对人工气道湿化的影响

人工气道(包括气管插管、气管切开)是临床抢救和治疗呼吸道梗阻患者的重要措施。正常情况下,鼻咽、呼吸道对吸入气体有加温和湿化作用[1]。由于人工气道的建立,使呼吸道正常的湿化、加温、过滤及咳嗽功能消失,防御功能减弱,如加上机械呼吸,通气量增加,则呼吸道失水严重。由于湿化不足,分泌物干结潴留,更为感染创造条件[2]。实验证明肺部感染随气道湿化程度降低而升高[3]。近几年来,人工气道的湿化问题越来越受到人们的重视。2003年5月～2005年5月,我科104例人工气道患者均采用了组合药液湿化,收到了显著的效果,现报告如下:1资料与方法1.1一…     

人工气道湿化在机械通气病人中的疗效观察

目的:探讨人工气道湿化对机械通气病人的疗效观察.方法:对56例机械通气病人进行回顾,对照分析.结果:通过56例病人在痰液的性状,颜色,以及在玻璃接头内壁的附着情况等各项指标对比的百分率.结论:机械通气病人使用人工气道湿化后能使气道湿润,痰液利于吸出.     

机械通气呼吸湿化器湿化研究进展

为提高机械通气患者气道湿化质量,保障人工气道管理安全,从机械通气呼吸湿化器的湿化类型、湿化方式、湿化液选择、湿化温度、湿化效果与判断等方面综述机械通气呼吸湿化器湿化的研究现状.提出机械通气人工气道湿度主要靠呼吸湿化器的主动湿化来达到最佳湿化,需加强人工气道湿化效果与最佳温度及湿度监测的研究.     

人工气道不同湿化方法的应用观察

目的:探讨加温持续湿化气道在气管切开病人中的应用效果.方法:将60例气管切开病人随机分为2组,治疗组30例采用0.9％NS100ml智能输液泵以3ml/h持续恒温泵入,辅以吸痰前气道内注入温生理盐水5-10ml,对照组30例采用0.9％NS250ml应用输液管持续湿化气道.结果:治疗组痰痂形成,肺部感染,气管堵塞及细菌培养例数有显著性差异P＜ 0.05,平均带管时间,平均住院时间缩短,住院费用下降.结论:采用加温持续湿化气道辅以吸痰前滴注温生理盐水效果优于输液管持续湿化气道,符合生理需要,病人舒适.     

静脉输液速度调节器在人工气道湿化护理中的应用观察

目的:观察静脉输液速度调节器应用于人工气道湿化护理的临床效果.方法:将40例行气管插管或气管切开的患者随机分为两组,观察组20例应用静脉输液速度调节器持续滴注湿化法湿化气道,对照组20例采用常规的间断湿化法湿化气道.结果:现察组的气道温化工序、肺部感染、痰液黏稠度、刺激性咳嗽、呼吸道黏膜充血等临床效果优于原常规的间断湿化法.     

呼吸机辅助呼吸采用微量泵持续气道湿化效果观察

目的 探讨呼吸机使用期间适宜的气道湿化方法,以降低痰液黏稠度及痰培养细菌阳性率.方法 将72例人工气道并使用呼吸机超过5 d的患者分为观察组和对照组各36例,对照组采用人工鼻气道湿化;观察组在人工鼻基础上增加微量泵持续气道湿化.连续5 d后评价效果及痰培养细菌阳性率.结果 观察组痰液黏稠度及痰培养细菌阳性率显著低于对照组(P＜0.05,P＜0.01).结论 对呼吸机辅助呼吸患者使用人工鼻联合微量泵持续气道湿化,可有效降低痰液黏稠度及痰培养细菌阳性率.     

Effect of prosthetic airway splint on the growing trachea

Airway splints are now used clinically to treat tracheomalacia and may also have a place in the management of tracheal stenosis. These studies in 5 to 7 Kg piglets were designed to assess the effects of prosthetic airway splints on airway growth and to establish their usefulness in the reconstruction of tracheal defects. Three experimental groups were studied: group I (n = 8). Silastic reinforced Marlex mesh or Vicryl mesh prostheses were placed around 75% of the circumference of a 3 cm segment of trachea. Pigs were sacrificed at 4 months (average weight = 78.9 +/- 9.0 Kg) and the cross-sectional area of trachea was measured. Group II (n = 5). The same prostheses were used to replace the tracheal defect created by excising three rings (50% of tracheal circumference). Tracheas were examined grossly and histologically at sacrifice. Group III (n = 5). Same as Group II except tracheal defect covered by strap muscles. Prostheses placed external to them to prevent airway collapse. Group I had 4% to 14% (mean 8%) decrease from normal cross-sectional area of trachea at site of splint. No airway obstruction and no infection was encountered. Group II, severe airway obstruction, granulation tissue, and infection at site of defect was noted. Group III showed no signs of airway obstruction, no infection, and minimal airway narrowing. Re-epithelialization of the muscle surface in contact with airway occurred in all these animals. Silastic reinforced Marlex or Vicryl splints placed around the intact rapidly growing trachea do not significantly limit its growth. In addition, these synthetic materials appear to be well-tolerated when used to reconstruct tracheal defects if placed over well-vascularized tissue such as muscle.     

Collapsibility of the upper airway at different concentrations of propofol anesthesia

BACKGROUND: This study investigated the effect of varying concentrations of propofol on upper airway collapsibility and the mechanisms responsible for it. METHODS: Upper airway collapsibility was determined from pressure-flow relations at three concentrations of propofol anesthesia (effect site concentration = 2.5, 4.0, and 6.0 mug/ml) in 12 subjects spontaneously breathing on continuous positive airway pressure. At each level of anesthesia, mask pressure was transiently reduced from a pressure sufficient to abolish inspiratory flow limitation (maintenance pressure = 12 +/- 1 cm H2O) to pressures resulting in variable degrees of flow limitation. The relation between mask pressure and maximal inspiratory flow was determined, and the critical pressure at which the airway occluded was recorded. Electromyographic activity of the genioglossus muscle (EMGgg) was obtained via intramuscular electrodes in 8 subjects. RESULTS: With increasing depth of anesthesia, (1) critical closing pressure progressively increased (-0.3 +/- 3.5, 0.5 +/- 3.7, and 1.4 +/- 3.5 cm H2O at propofol concentrations of 2.5, 4.0, and 6.0 microg/ml respectively; P < 0.05 between each level), indicating a more collapsible upper airway; (2) inspiratory flow at the maintenance pressure significantly decreased; and (3) respiration-related phasic changes in EMGgg at the maintenance pressure decreased from 7.3 +/- 9.9% of maximum at 2.5 microg/ml to 0.8 +/- 0.5% of maximum at 6.0 microg/ml, whereas tonic EMGgg was unchanged. Relative to the levels of phasic and tonic EMGgg at the maintenance pressure immediately before a decrease in mask pressure, tonic activity tended to increase over the course of five flow-limited breaths at a propofol concentration of 2.5 microg/ml but not at propofol concentrations of 4.0 and 6.0 microg/ml, whereas phasic EMGgg was unchanged. CONCLUSIONS: Increasing depth of propofol anesthesia is associated with increased collapsibility of the upper airway. This was associated with profound inhibition of genioglossus muscle activity. This dose-related inhibition seems to be the combined result of depression of central respiratory output to upper airway dilator muscles and of upper airway reflexes.     

血清浓度对脂肪成体干细胞向软骨细胞分化的影响

[目的]比较不同浓度的血清,在转化生长因子-β1(TGF-β1)存在的条件下,对脂肪成体干细胞(ad-ipose-derived adult stem cells,ADASCs)向软骨细胞分化的影响,探讨较为合适的血清浓度。[方法]取成年新西兰兔颈部脂肪组织,剪碎后通过Ⅰ型胶原酶消化,得到脂肪成体干细胞;稳定传代后,分别用含1?S和10?S的软骨诱导液干预ADASCs 2周,采用MTT检测方法对细胞增殖活性进行比较,应用甲苯胺蓝染色及Ⅱ型胶原免疫组化染色进行软骨细胞鉴定,利用Leica病理图像软件分析两组间Ⅱ型胶原免疫组化染色后的灰度,比较两组细胞分化的效果。[结果]MTT检测显示10?S组细胞增殖活性高于1?S组(P<0.05),两组细胞的甲苯胺蓝染色及Ⅱ型胶原免疫组化染色均为阳性,并以10?S组更为显著;灰度分析提示10?S组Ⅱ型胶原表达量高于1?S组(P<0.05)。[结论]体外研究表明,含10?S的软骨诱导液更有利于脂肪成体干细胞向软骨细胞方向增殖和分化,这将为作者采用这种新型的干细胞修复软骨缺损做好前期的准备。     

Dimethylsulfoxide enhances the absorption of chemotherapeutic drug instilled into the bladder

Summary We examined the effect of dimethylsulfoxide (DMSO) on the absorption of a chemotherapeutic drug instilled into the bladder. Female Wistar rats with bladder tumors underwent intravesical instillation of normal saline (S group) or 50% DMSO (D group) prior to the administration of pirarubicin (tetrahydropyranyl-Adriamycin). The absorption of pirarubicin was estimated histologically by observing its fluorescence. In the S group, fluorescence of pirarubicin was observed only in the epithelial layer of normal or hyperplastic regions and in the cells of superficial layers of the tumor. In the D group fluorescence was observed in the entire bladder wall of normal or hyperplastic regions and extended to deeper regions of the tumors than in the S group. These findings indicate enhancement of the absorption of pirarubicin by pretreatment with DMSO.     

Usefulness of continuous oxygen insufflation into trachea for management of upper airway obstruction during anesthesia

BACKGROUND: Severe complications associated with upper airway obstruction often occur during the perioperative period. Development of a simple and reliable technique for reversing the impaired airway patency may improve airway management. The purpose of the current study is to evaluate the usefulness of transtracheal oxygen insufflation (TTI) for management of upper airway obstruction during anesthesia and to explore the mechanisms of TTI in detail. METHODS: During propofol anesthesia in eight spontaneously breathing patients, the upper airway cross-sectional area and pressure-flow measurements during neck flexion with TTI were compared with those during triple airway maneuvers (TAM) without TTI. Blood gas analyses assessed efficacy of CO2 elimination during TTI in an additional nine patients. RESULTS: TTI achieved adequate PaCO2 and PaO2 levels equivalent to those during TAM. In addition to a significantly smaller cross-sectional area during TTI, the location and slope of the pressure-flow relation during TTI completely differed from those during TAM, indicating that upper airway resistance was much higher during TTI. Notably, minute ventilation during TTI was significantly smaller than that during TAM, suggesting reduced dead space or other mechanisms for CO2 elimination. CONCLUSIONS: TTI is capable of maintaining adequate blood gases through mechanisms different from those of conventional airway support in anesthetized subjects with upper airway obstruction.     

不同浓度氧气对脂多糖诱导的肺泡Ⅱ型上皮细胞炎性反应的影响

目的 观察不同浓度氧气对脂多糖(LPS)诱导的大鼠肺泡Ⅱ型上皮细胞(AT-Ⅱ)分泌炎性因子的影响并探讨其机制.方法 原代培养的AT-Ⅱ随机分为5组(n=6):A、B、C、D组,E组分别置于无菌培养箱:A箱37℃、21％O2、5％ CO2,B箱37℃、21％O2、5％ CO2,C箱37℃、40％O2、55％N2、5％ CO2,D箱37℃、60％O2、35％N2、5％ CO2,E箱37℃、90％O2、5％ N2、5％CO2;24 h后酶联免疫吸附试验(ELISA)检测各组细胞白细胞介素-8(IL-8)含量,反转录-聚合酶链反应(PT-PCR)及Western blot检测各组细胞p38丝裂原活化蛋白激酶(p38MAPK) mRNA及蛋白表达水平.结果 A、B、C、D、E组IL-8含量分别为(40.22 ±7.25)、(109.35±10.19)、(213.98±30.51)、(369.71 ±21.73)、(489.32 ±42.35) ng/L;p38MAPK mRNA表达水平分别为0.066± 0.010、0.163±0.008、0.228 ±0.027、0.268 ±0.016、0.292±0.010;p38 MAPK蛋白表达水平分别为0.055±0.005、0.124 ±0.006、0.182±0.009、0.227±0.013、0.303±0.010.与A组比较B、C、D、E组IL-8含量、p38MAPK mRNA和蛋白表达水平明显升高,差异有统计学意义(P＜0.05);与B组比较C、D、E组IL-8含量、p38MAPK mRNA和蛋白表达水平逐渐升高,差异有统计学意义(P＜0.05);C、D、E组间两两比较IL-8含量、p38MAPK mRNA和蛋白表达水平逐渐升高,差异有统计学意义(P＜0.05).结论 40％～90％的氧气可使LPS诱导的AT-Ⅱ分泌IL-8呈浓度依赖性增加,其机制可能与胞内p38MAPK表达上调有关.     

不同浓度地西他滨对破骨细胞分化的影响

目的：探讨不同浓度梯度地西他滨对破骨细胞形成、活性及吸收功能的影响。方法不同浓度地西他滨（0、0.1、0.25和0.5μmol/L）处理单核巨噬（RAW264.7）细胞。通过4’,6?联眯?2?苯基吲哚（4,6?Diamidino?2?phenylindole dihydrochloride, DAPI）染色和微丝绿色荧光探针（F?actin?Trakcer Green）染色后观察F?actin环的形成即破骨细胞轮廓;抗酒石酸酸性磷酸酶检测试剂盒检测细胞上清中的抗酒石酸酸性磷酸酶活性,骨板吸收实验检测破骨细胞的骨吸收能力;Q?PCR实验检测破骨细胞标志基因抗酒石酸酸性磷酸酶（tartrate?resistant acid phosphatase, TRAP）、组织蛋白酶K（cathepsin K, CK）和脊髓基质金属蛋白酶?9（matrix metalloproteinase?9, MMP?9）的mRNA表达。结果不同浓度地西他滨抑制核因子NF?κB配体激活因子（receptor activator of NF?κB ligand, RANKL）诱导RAW264.7细胞形成F?actin环,降低了破骨细胞的TRAP酶活性,抑制了破骨细胞的骨吸收能力,同时也下调了破骨细胞标志基因TRAP、CK和MMP?9的mRNA表达。且随着药物浓度的增高,上述的抑制作用越明显。结论地西他滨抑制破骨细胞形成、活性和骨吸收能力,且这种抑制作用随着药物浓度的增加而逐渐增强。