急性一氧化碳中毒患者血清细胞间黏附分子-1和超氧化物歧化酶的变化及临床意义

目的研究急性一氧化碳中毒(ACOP)患者血清细胞间黏附分子-1(ICAM-1)和超氧化物歧化酶(SOD)的变化及其临床意义。方法采用酶联免疫法和放射免疫法测定了84例ACOP患者血清ICAM-1和SOD水平,并与24例健康人对照比较。结果ICAM-1水平:轻度中毒者(362．40±82．80)ng/mL,中度中毒者(396．46±57．28)ng/mL,重度中毒者(624．67±50．18) ng/mL,明显高于健康对照者[(198．28±46．46)ng/mL,P＜0．05]。SOD水平:轻度中毒者(408．28±162．26)ng/mL,中度中毒者(386．64±215．63)ng/mL,重度中毒者(346．82±56．38)ng/ mL,明显低于健康对照者[(476．86±168．52)ng/mL,P＜0．05]。ICAM-1水平与病情程度呈正相关(r=0．48,P＜0．05),SOD水平与病情程度呈负相关(r=-0．54,P＜0．05)。结论ICAM-1和SOD与病情程度密切相关,ICAM-1和SOD可作为一氧化碳中毒患者病情的主要监测指标之一。     

床旁快速检测对急性冠脉综合征的诊断和预后的影响

目的 对比床旁快速检测与传统实验室方法检测心肌损伤标志物对急性冠脉综合征(ACS)的诊断及预后的影响.方法 回顾性分析2006年1月1日至2010年6月30日首都医科大学附属北京朝阳医院急诊科收治已确诊的3467例急性冠脉综合征的患者,记录患者的年龄、性别、既往病史和吸烟史等基本人口资料,以及心肌损伤标志物(CTNI CKMB MYO)、D二聚体、NTproBNP、心脏彩超EF等实验室指标,采用统计学方法比较应用床旁快速检测与实验室检测心肌损伤标志物的患者,在急诊滞留时间(急诊就诊到接受介入或保守治疗之间用时)、入院到住院期间的心血管事件(心衰、室颤、脑血管病)的发生率和28 d病死率的不同.结果 床旁快速检测组的急诊滞留时间、心血管事件发生率和28 d病死率均低于常规实验室检测组(p=0.000),且急诊滞留时间越长,早期肌红蛋白和D二聚体测定值越高,EF测定值越低,28 d死亡风险越高.结论 床旁快速检测比常规实验室检测能缩短ACS患者的急诊滞留时间,降低心血管事件发生率并能明显改善预后.     

Comparison of free and anonymous testing for HIV and sexually transmitted infections between the University Hospital and Health Center

We gathered data regarding age, sex, and positivity rates for human immunodeficiency virus (HIV), syphilis, gonococcus, and chlamydia from individuals who underwent free and anonymous sexually transmitted infection (STI) testing conducted at the Jikei University School of Medicine Hospital (our hospital). These data were compared to results of subjects who underwent similar testing at the Minato Health Center and several private facilities of urologists and gynecologists belonging to the Minato Ward Medical Association. The positivity rate of chlamydia was found to be high in female subjects, particularly at the Minato Health Center, with 15 of 194 subjects (7.73 %) testing positive. In our hospital, we only detected 3 of 133 subjects (2.26 %) who were gonococcus positive. On the other hand, at the doctor’s facilities, 10 of 188 male subjects (5.32 %) were syphilis positive, and 8 of 185 male subjects (4.32 %) were chlamydia positive, thus showing high positivity rates for both infections. At our hospital, 1 of 231 subjects was positive for gonococcus and 4 of 230 subjects (1.74 %) were positive for chlamydia, thus showing lower positivity rates for both infections. HIV-positive subjects were, however, only confirmed at our hospital, with 2 of 243 subjects (0.82 %) being positive. We were able to diagnose infected patients using free and anonymous STI testing at hospitals, and the same as at doctors’ facilities. This result suggests that the hospitals that have many opportunities to diagnose HIV patients may become potential candidates for the development of new consultation facilities, establishment of testing facilities, and enhancement of consultation processes that include STI prevention.     

Comparison of the TaqMan and LightCycler systems in evaluation of CYP2B6 516G>T polymorphism

Understanding genetically encoded inherited differences in drug metabolism and drug targets offers the promise of minimizing adverse drug reactions and improving therapies. We have compared two real-time PCR-based methods, the TaqMan and LightCycler for the pharmacogenetic evaluation of CYP2B6 516G>T polymorphism. Both methods were found to be suitable for pharmacogenetic testing of CYP2B6 516G>T in the meaning of time consumption, accurate genotype calling, flexible reaction format, simple data analysis, and low cost per assay. The genotype success rate was similar, but the LightCycler procedure was less expensive in terms of cost per sample and shorter running time.     

中心静动脉血二氧化碳分压差联合早期乳酸清除率对感染性休克患者预后的判断价值

目的：探讨中心静动脉血二氧化碳分压差（ Pcv－aCO2）和早期乳酸清除率在评估感染性休克患者预后中的临床意义。方法选取2010－01～2013－10收住我院重症医学科的82例经早期目标导向治疗（ EGDT）达标的感染性休克患者进行前瞻性观察研究,记录入院6 h Pcv－aCO2及患者入院后第一个24 h急性生理学和慢性健康状况评分系统Ⅱ（ acute physiology and chronic health evaluationⅡ,APACHEⅡ）评分和全身性感染相关性器官衰竭（ SOFA）评分;并记录入院时、入院6 h、入院24 h动脉血乳酸,计算早期乳酸清除率;以入院6 h Pcv－aCO2高低分为两组：A组（ Pcv－aCO2＜6 mm Hg）和B组（ Pcv－aCO2≥6 mm Hg）,比较两组患者乳酸清除率、SOFA评分及病死率。以6 h乳酸清除率高低分为两组：C组（乳酸清除率≤10％）和D组（乳酸清除率＞10％）,比较两组患者的28天病死率。根据28天病程转归分为死亡组（32例）和存活组（50例）,比较两组患者不同时间动脉血乳酸浓度、APACHEⅡ评分。结果 B组较A组乳酸清除率低,SOFA评分及病死率高,入院6 h Pcv－aCO2与6 h乳酸清除率存在负相关（ r＝－0.324,P＝0.003）。 D组病死率低于C组（ P＜0.05）。存活组APACHEⅡ评分较死亡组高,而入院时、6 h、24 h动脉血乳酸浓度均低于死亡组（ P＜0.05）。结论6 h Pcv－aCO2和6 h乳酸清除率可作为判断感染性休克患者预后的指标。     

Comparison of muscle and joint pressure-pain thresholds in patients with complex regional pain syndrome and upper limb pain of other origin

Pain localized in the deep tissues occurs frequently in complex regional pain syndrome (CRPS). In addition, hyperalgesia to blunt pressure over muscles is common in CRPS, but it often appears in limb pain of other origin as well. Considering that 3-phase bone scintigraphy (TPBS) reveals periarticular enhanced bone metabolism in CRPS, joint-associated hyperalgesia to blunt pressure might be a more specific finding than hyperalgesia over muscles. In 34 patients with upper limb pain (18 CRPS, 16 non-CRPS; diagnosed in accordance to the Budapest criteria) and in 18 healthy controls, pressure-pain thresholds (PPT) were assessed bilaterally over the thenar (PPT_Thenar), the metacarpophalangeal (PPT_MCP), and the proximal interphalangeal (PPT_PIP) joints using a pressure algometer (Somedic, Sweden). Beforehand, all patients had received TPBS for diagnostic purposes independently of the study. Region-of-interest (ROI) ratios (mineralization phase) for the MCP and PIP, excluding fracture sites, were correlated with the PPT. In CRPS, all ROI ratios were significantly increased and all PPT of the affected hand were decreased compared to non-CRPS (PPT_Thenar: 243 ± 150 kPa vs 358 ± 197 kPa, PPT_MCP: 80 ± 67 kPa vs 159 ± 93 kPa, PPT_PIP: 80 ± 56 kPa vs 184 ± 110 kPa; P < .01) and controls (PPT_Thenar: 478 ± 106 kPa, PPT_MCP: 254 ± 50 kPa, PPT_PIP: 275 ± 76 kPa; P < .01). A PPT_Thenar below 293 kPa revealed 77% sensitivity but only 63% specificity, whereas a PPT_PIP below 102 kPa had 82% sensitivity and 94% specificity to identify CRPS. Only in CRPS were PPT_MCP and PPT_PIP correlated significantly inversely with the ROI ratio (MCP: r = −0.439, PIP: r = −0.447). PPT_PIP shows higher specificity for CRPS type I than PPT_Thenar without loss of sensitivity. Therefore, measurement of joint PPT could be a noninvasive diagnostic tool reflecting increased bone metabolism assessed by TPBS as a sign of bone pathophysiology.     

脑钠肽和内皮素对充血性心力衰竭诊断及预后判断的比较

目的探讨脑钠肽（BNP）和内皮素（ET）对充血性心力衰竭（CHF）诊断及预后判断的价值。方法56例CHF患者人院和出院时测定血浆BNP和ET浓度，同时用心脏彩色多普勒测定其左室射血分数（LVEF）；分析CHF患者血浆BNP和ET与LVEF的相关性；并以同期住院治疗的无CHF患者32例为对照。随访CHF患者出院后6个月心脏病意外事件的发生情况。结果CHF患者血浆BNP和ET浓度明显高于非CHF患者（P〈0．01）；BNP和ET浓度随CHF加重而升高（P〈0．01），但ET浓度心功能Ⅲ级和Ⅱ级比较差异却无统计学意义（P〉0．05）；CHF患者BNP和ET与LVEF呈负相关（P〈0．01）。血浆BNP和ET诊断CHF的敏感性分别为93．6％和80．7％，特异性分别为90．8％和75．6％，阴性预测值分别为95．2％和85．3％。发生心脏病意外事件组血浆BNP浓度明显高于未发生事件组，而ET浓度两组比较差异却无统计学意义（P〉0．05）。结论血浆BNP对CHF诊断和预后的判断价值均高于血浆ET。     

缺氧缺血新生鼠脑内血红素氧化酶-1和一氧化碳的变化(英文)

目的研究新生大鼠缺氧缺血时脑内血红素氧化酶-1(HO-1)和内源性一氧化碳(CO)及环化鸟苷酸(cGMP)的变化,探讨锌原卟啉(Znpp)的治疗作用。方法7dSD大鼠随机分为假手术对照组,缺氧缺血组(HI)及缺氧缺血+锌原卟啉组(HI+Znpp)。利用分光光度法测定血COHb含量和脑匀浆HO-1活性;放免法测定脑匀浆cGMP水平,并观察脑病理改变。结果HI组在1,4,12hHO-1、cGMP、CO水平与对照组比明显升高(P<0.01),在12h达到高峰;HI+Znpp组HO-1、cGMP、CO水平在1,4,12h均明显低于HI组(P<0.01),但仍高于对照组(P<0.01)。脑组织病理检查可见HI组呈重度缺氧缺血改变,多数神经元细胞肿胀变性;而Znpp组神经元变性者少。结论HI后脑内HO-1活性明显增高导致内源性CO和cGMP增高,Znpp可阻抑这一病理生理过程,减轻脑损伤。     

Comparison of genotypes of Streptococcus pneumoniae serotypes 6A and 6B before and after the introduction of PCV7 vaccination in Korea

We investigated changes of serotypes in Streptococcus pneumoniae and the characteristics of serotypes 6A and 6B in Korean hospitals after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). PCV7 serotypes decreased significantly from 66.8% in 1996-2001 to 41.3% in 2008-2009 (P<0.001). However, serotype 6B did not decrease during these 2 periods (5.7% to 6.4%). Non-PCV7 serotypes that increased significantly were 3 (3.6% to 9.1%), 6A (3.1% to 8.5%), 13/28 (0 to 3.7%), 15 (2.2% to 6.7%), 16.36.37 (0 to 1.2%), 19A (1.2% to 9.7%), and 23A (0 to 1.5%). Multilocus sequence typing indicated that 9 STs were identified among 36 isolates of serotype 6A and 19 among 35 isolates of serotype 6B. No STs were found both in the 2 serotypes. The increase in serotype 6A was associated mainly with ST81, a Spain-23F clone genotype. The association of serotype 6A and ST81 is unique to Korea. Clones of serotype 6B isolates changed between the 2 periods. ST282, the main clone of serotype 6B in the PCV7 period, was found only in Korea. Our study demonstrates changing characteristics of pneumococcal serotypes 6A and 6B isolates in Korea and suggests selective evolution of certain clones in the era of PCV7 vaccination.     

基层输血科自制室内质控品的方法与可行性探讨

目的探讨如何利用基层输血科现有实验室条件,选则自制质控品对ABO血型正反鉴定、Rh D血型鉴定、不规则抗体筛查和交叉配血试验进行室内质量控制。方法回顾性分析我院输血科2013年7月—2014年7月13次自制质控品的可靠性和特异性,评价自制质控品的临床应用效果。自制单独血浆与红细胞质控品,经亲和力、抗体效价检测、凝集强度和稳定性等验证后,按照自行设计的室内质控模式,进行ABO血型鉴定、Rh D血型、交叉配血试验及不规则抗体筛查等试验。结果各检测项目共有1 780个室内质控结果,其中1次(0.06%)属于"警告",2次(0.11%)属于"失控";失控中随机误差1次(50%),系统误差1次(50%)。随机误差和系统误差各占质控总数的比例为0.06%。结论本院输血科自制的室内质控品,其有效性、特异性、稳定性和可靠性,符合《ISO15189医学实验室认可准则》中对IQC的基本要求,可以有效控制输血差错事故的发生。     

Comparison of the APACHE III, APACHE II and Glasgow Coma Scale in acute head injury for prediction of mortality and functional outcome

Objectives: This study examines the efficacy of the predicting power for hospital mortality and functional outcome of three different scoring systems for head injury in a neurosurgical intensive care unit (NICU). Design: On the day of admission, data were collected from each patient to compute the Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II and III, and Glasgow Coma Scale (GCS) scores. Hospital mortality was defined as the deaths of patients before discharge from hospital. Early mortality was defined as death before the 14th day after admission. Late mortality was defined as death after the 15th day from admission. Functional outcome was evaluated by Index of Independence in Activities of Daily Living (Index of ADL). Setting: An 8-bed NICU in a 1270-bed medical center in Taichung Veterans General Hospital. Patients and participants: Two hundred non-selected patients with acute head injury were included in our study in a consecutive period of 2 years. Patients less than 14 years old were not included. Interventions: None. Measurements and results: Sensitivity, specificity and correct prediction outcome were measured by the chi-square method in three scoring systems. The Youden index was also obtained. The best cut-off point in each scoring system was determined by the Youden index. The difference in Youden index was calculated by Z score. A difference was also considered if the probability value was less than 0.05. The area under Receiver Operating Characteristic (ROC) curve was computed. Then the area under ROC of each scoring system was compared by Z score. There was statistical significance if p was less than 0.05. For prediction of hospital mortality, the best cut-off points are 55 for APACHE III, 17 for APACHE II and 5 for GCS. The correct prediction outcome is 82.4% in APACHE III, 78.4% in APACHE II and 81.9% in the GCS. The Youden index has best cut-off points at 0.68 for APACHE III, 0.59 for APACHE II, and 0.56 for GCS. The area under Receiver Operating Characteristic (ROC) curve is 0.90 in the APACHE III, 0.84 in the APACHE II and 0.86 in the GCS. There are no statistical differences among APACHE III and II, and GCS in terms of correct prediction outcome, Youden Index and the area under the ROC curve. Other physiological variables excluding GCS in APACHE III and II (AP III-GCS, AP II-GCS) have less statistical value in the determination of mortality for acute head injury. For the prediction of late mortality, APACHE III and II yield significantly better results in the area under the ROC curve, correct prediction and Youden index than those of GCS. Other physiological variables (AP III-GCS and AP II-GCS) play an important role in the prediction of late mortality in APACHE scores. For prediction of the functional outcome of surviving patients with acute head injury, the APACHE III yields the best results of correct prediction outcome, Youden index and the area under the ROC curve. Conclusion: The APACHE III and II may not replace the role of GCS in cases of acute head injury for hospital or early mortality assessment. But for prediction of the late mortality, the APACHE III and II have better accuracy than GCS. Other physiological variables excluding GCS in the APACHE system play a crucial contribution for late mortality. GCS is simple, less time-consuming and economical for patients with acute head injury for the prediction of hospital and early mortality. The APACHE III provides better prediction for severe morbidity than GCS and APACHE II. Therefore, the APACHE III provides a good assessment not only for hospital and late mortality, but also for functional outcome. Received: 22 May 1995 Accepted: 2 September 1996     

加强急救ICU护理队伍建设的措施与效果

目的探讨ICU护理队伍建设的有效途径。方法强化护理人员的服务意识和服务技能;采用多种方法提高护理人员业务素质;实施人性化管理。结果护理人员服务水平和业务素质大大提高。结论灵活运用各种培训方法,进一步完善任用机制,是加强急救ICU护理队伍建设的有效途径。     

砷快速检测盒与原子荧光法测定水砷含量结果对比

目的　比较水砷快速检测试剂盒(速测法)和氢化物发生-原子荧光光谱法(HG-AFS)测定饮水中砷含量的可靠性和应用价值。方法　用速测法和HG-AFS测定水样747份,将2种方法检测结果进行对比,数据处理应用SPSS 10.0软件进行配对设计的秩和检验。结果　2种方法测得的结果总体差异无统计学意义(u=1.32,P0.05),但速测法结果在0.03～0.05 mg/L 之间与HG-AFS结果差异有统计学意义(u=2.42,P0.05)。结论　HG-AFS稳定可靠,速测法操作简单,可以在现场应用。用速测法初步筛选,用HG-AFS对速测法结果含砷定量分析,既可减少工作量,又能保证分析结果的可靠性,完全能满足地方性砷中毒工作的需求。     

二维血流显像技术与彩色多普勒在颈动脉疾病诊断中的应用比较

目的比较二维血流显像技术（B-Flow）与彩色多普勒血流显像（CDFI）和能量多普勒（PDI）在颈动脉疾病诊断中的应用价值。方法对160例颈动脉疾病患者分别进行CDFI、PDI及B-Flow技术检查,对比分析。其中41例患者进行了数字减影血管造影（DSA）检查。结果B-Flow技术是一种新型血管疾病影像学检查方法,具有更高帧频、高分辨率和全景显像功能,能同时显示血流和背景组织结构,B-Flow与CDFI、PDI结合使用,可提高异常图像显示率;对于颈动脉狭窄和闭塞的判断与DSA结果比较,B-Flow技术与DSA相关性明显高于后两者。结论B-Flow显像技术较CDFI及PDI显像在颈动脉疾病中的应用范围更广,可以弥补CDFI、PDI显像上的不足。     

急性一氧化碳中毒患者血浆神经元特异性烯醇酶的动态变化及评估预后的意义

目的探讨急性一氧化碳中毒患者血浆神经元特异性烯醇酶(neuron-specific enolase,NSE)的动态变化及评估预后的意义。方法收集急性一氧化碳中毒患者71例,分别于中毒后24h(71例)、第3天(69例)、第7天(68例)和第14天(68例)采集血标本,应用酶联免疫吸附法测定血浆NSE水平,检测结果与40例正常对照者比较,并探讨急性一氧化碳中毒患者血浆NSE水平的动态变化及其与临床神经功能改变的相关性。结果中毒后24h、第3天血浆NSE水平明显高于对照组(t值分别为10.29、6.64,均P<0.001),24h的变化较为显著;预后不良组血浆NSE水平在中毒后24h(11例)、第3天(9例)、第7天(8例)各时间点明显高于预后良好组(60例)(t值分别为5.86、3.78、2.16,均P<0.05)。存活的68例急性一氧化碳中毒患者中毒后第14天神经功能缺损评分减少值与24h、第3天血浆NSE水平呈负相关,相关系数分别为-0.40(P<0.001)和-0.36(P<0.01)。结论急性一氧化碳中毒患者早期血浆NSE水平明显升高,血浆NSE的动态变化可反映中毒的严重程度并对预后评估有重要意义。     

Reproducibility of the ABILOCO Questionnaire and Comparison Between Self-Reported and Observed Locomotion Ability in Adult Patients With Stroke

Caty GD, Theunissen E, Lejeune TM. Reproducibility of the ABILOCO questionnaire and comparison between self-reported and observed locomotion ability in adult patients with stroke.

Objectives

To test the reproducibility of the ABILOCO questionnaire. To validate the patient self-reporting method and the third-party assessment of the stroke patients' locomotion ability by a treating physical therapist.

Design

Prospective study.

Setting

University hospital.

Participants

Adult stroke patients (N=28; 59±13y). The time since stroke ranged from 3 to 253 weeks.

Interventions

Not applicable.

Main Outcome Measure

The ABILOCO questionnaire.

Results

The results of patient self-assessment and the results of the third-party assessments by the physiotherapists at a 2-week interval were highly correlated (intraclass correlation coefficient [ICC]=.77 and ICC=.89, respectively). The results of the patient self-assessment and the third-party assessment by the physical therapist were both well correlated to assessment by an independent medical examiner who observed the patient during the 13 ABILOCO activities (ICC=.69 and ICC=.87, respectively).

Conclusions

The use of ABILOCO as a self-reporting questionnaire is a valid and reproducible method for assessing locomotion ability in patients with stroke in daily clinical practice and research.     

An investigation of thrust,depth and the impedance cardiogram as measures of cardiopulmonary resuscitation efficacy in a porcine model of cardiac arrest

ObjectiveOptimising the depth and rate of applied chest compressions following out of hospital cardiac arrest is crucial in maintaining end organ perfusion and improving survival. The impedance cardiogram (ICG) measured via defibrillator pads produces a characteristic waveform during chest compressions with the potential to provide feedback on cardiopulmonary resuscitation (CPR) and enhance performance. The objective of this pre-clinical study was to investigate the relationship between mechanical and physiological markers of CPR efficacy in a porcine model and examine the strength of correlation between the ICG amplitude, compression depth and end-tidal CO₂ (ETCO₂).MethodsTwo experiments were performed using 24 swine (12 per experiment). For experiment 1, ventricular fibrillation (VF) was induced and mechanical CPR commenced at varying thrusts (0–60 kg) for 2 min intervals. Chest compression depth was recorded using a Philips QCPR device with additional recording of invasive physiological parameters: systolic blood pressure, ETCO2, cardiac output and carotid flow. For experiment 2, VF was induced and mechanical CPR commenced at varying depths (0–5 cm) for 2 min intervals. The ICG was recorded via defibrillator pads attached to the animal's sternum and connected to a Heartsine 500P defibrillator. ICG amplitude, chest compression depth, systolic blood pressure and ETCO₂ were recorded during each cycle. In both experiments the within-animal correlation between the measured parameters was assessed using a mixed effect model.ResultsIn experiment 1 moderate within-animal correlations were observed between physiological parameters and compression depth (r = 0.69–0.77) and thrust (r = 0.66–0.82). A moderate correlation was observed between compression depth and thrust (r = 0.75). In experiment 2 a strong within-animal correlation and moderate overall correlations were observed between ICG amplitude and compression depth (r = 0.89, r = 0.79) and ETCO₂ (r = 0.85, r = 0.64).ConclusionIn this porcine model of induced cardiac arrest moderate within animal correlations were observed between mechanical and physiological markers of chest compression efficacy demonstrating the challenge in utilising a single mechanical metric to quantify chest compression efficacy. ICG amplitude demonstrated strong within animal correlations with compression depth and ETCO₂ suggesting its potential utility to provide CPR feedback in the out of hospital setting to improve performance.     

运动单位数目估计和传统肌电图技术在神经肌肉疾病中的应用比较

目的比较运动单位数目估计（MUNE）法和传统肌电图（EMG）在神经肌肉疾病中的诊断价值。方法应用肌电图仪中的MUNE程序和定量运动单位电位分析（QMUP）程序检测53例神经肌肉疾病患者的趾短伸肌、鱼际肌或小鱼际肌。结果8例肌萎缩性侧索硬化患者在针电极EMG检测中均为巨大电位,在MUNE检测中计数均显著减少。45例周围神经疾病患者,2例在EMG检查中无法确诊,但MUNE计数减少;2例在EMG检查中仅有自发电活动,而无肯定运动单位电位变化,MUNE计数也在正常范围内;其余41例EMG均明确显示神经源性损害,同时MUNE计数也减少。结论MUNE和传统EMG各有优缺点,两者相结合有助于提高诊断。     

Comparison of ventilation and cardiac compressions using the Impact Model 730 automatic transport ventilator compared to a conventional bag valve with a facemask in a model of adult cardiopulmonary arrest

PURPOSE: To determine the performance of two person CPR on an instrumented manikin by registered nurses using conventional bag valve mask (BVM) ventilation or the Impact Model 730 automatic transport ventilator (Impact 730, Impact Instrumentation, Inc., West Caldwell, NJ) in CPR mode using a face mask. DESIGN: Randomized crossover quasi-experimental. SETTING: Laboratory simulation. SUBJECTS: Twenty-eight registered nurses trained in performing adult cardiopulmonary resuscitation (CPR). INTERVENTIONS: Basic Life Support was provided by subjects using a conventional bag valve mask (BVM) ventilation or mask ventilation with an automatic transport ventilator, the Impact 730, which incorporates a metronome to facilitate chest compression timing. Subjects alternated performing 4min of CPR using the BVM or Impact 730 to deliver breaths with a mask while the other subject performed compressions. MEASUREMENTS AND MAIN RESULTS: Flow, volume and pressure were measured using a pneumotachograph and pressure transducer, and ease of use was measured using a 10cm visual analogue scale. There was no statistical or clinical difference between the actual and recommended tidal lung volume (mean+/-S.D.) delivered by the Impact 730 (-120.4+/-91.5ml) versus the BVM (-119.8+/-187.3+/-ml). Ventilation with the BVM resulted in more (137.7+/-143.9ml) air per breath passing through the simulated lower esophageal sphincter compared to the Impact 730 (14.0+/-16.8ml, p<0.05). The reduced mask leak per breath with the Impact 730 (176.1+/-98.3ml) compared to the BVM (367.6+/-337.7ml, p<0.05) is likely to have resulted from the subject being able to manage the mask with two rather than one hand and is reflected in the higher ease of use score on a 10cm visual analogue scale with the Impact 730 (8.06+/-1.35cm) versus the BVM (6.46+/-2.46cm, p<0.05). Subjects tended to deliver slightly more compressions and breaths when using the BVM. CONCLUSION: Compared to the BVM, the Impact 730 is as effective, easier to use and limits the amount of gas entering the stomach when used during adult CPR in a simulated setting.     

急性呼吸窘迫综合征患者侧卧位通气与俯卧位通气的临床疗效观察

目的 评价侧卧位通气和俯卧位通气对急性呼吸窘迫综合征（ARDS）患者的临床疗效。并对两种体位通气方法进行对比观察。方法 将ICU2005年收治的23例ARDS患者随机分为两组，分别施行侧卧位通气（15例）和俯卧住通气（8例），监测仰卧位时，体位改变后1、2、4h及转复为仰卧位后1h的呼吸循环指标，并分别进行比较。结果 体位改变后1、2、4h及转复为仰卧住后1h，两组患者动脉血氧分压、氧舍指数均较仰卧位时升高（P〈0．05），心率、平均动脉压、气道峰压及动脉血二氧化碳分压与仰卧位时比较差异无统计学意义（P〉0．05）。以氧分压升高10mmHg为有效标准。治疗有效率侧卧位组73．3％，俯卧位组66．7％，两组比较差异无统计学意义（P〉0．05）。结论 作为ARDS机械通气治疗手段，侧卧位通气与俯卧位通气治疗的有效率接近。但侧卧位实施更容易，护理更方便。并发症少，值得临床进一步探讨。