Blood gas analysis in management of flail chest injuries

Six cases of flail chest injury were studied for changes in blood gases and acid-base status before and during respiratory management. Metabolic acidosis and mild to severe hypoxemia were found in most patients with flail chest at the time of admission, and there was a relationship between manifestation of paradoxical respiration and hypercarbia. Serial blood gas determinations are extremely important in assessment of the adequacy of the therapy, particularly in management of flail chest with continuous IPPB therapy.     

1002例4岁以下小儿潮气呼吸流速-容量环正常值的研究

目的测定健康小儿潮气呼吸肺功能正常值。方法用潮气呼吸方法测定1002例1~47个月小儿流速-容量曲线并计算其衍生参数。结果流速-容量环在健康婴幼儿呈不典型椭圆型,随年龄增长渐趋光滑。4岁以下小儿各项肺功能测定值主要与身高、体重、月龄相关,以前两者尤其是身高关系更为明显。有关参数显示小儿肺容量的增加大于流速的增长,小气道的发育快于大气道,代谢率随着年龄的增长而降低,达峰时间比(TPTEF/TE),达峰容积比(VPEF/VE)在各年龄组间差异存在,其数值的变化可反映小气道的阻塞情况。结论小儿肺功能与身高、体重、月龄相关,尤与身高相关更为显著;潮气呼吸肺功能测定简便、准确、重复性好,可作为4岁以下小儿检测肺功能的首选。     

Blood pressure analysis

SUMMARY  Arterial blood pressure is influenced by sleep-related breathing disorders. As cardiovascular consequences can be diagnosed by an accurate recording and analysis of blood pressure, new recording methodologies and an approach to analysis are presented here. Invasive continuous blood pressure recording is the common reference for all methodologies. As blood pressure varies rapidly in parallel with sleep-related breathing disorders it is indispensible to record blood pressure continuously. To introduce non-invasive methodology the Finapres system was used during sleep studies; a validation study showed severe limitations. This study was followed by the validation of an improved system called Portapres, which is portable, has two finger cuffs and a hydrostatic height compensation.
Analysis of continuous blood pressure in patients with sleep apnoea is carried out to detect mechanisms which influence the cardiovascular risk. Spectrum analysis of systolic blood pressure showed two different major oscillations present in patients with obstructive sleep apnoea. One oscillation (<0.06 Hz) occurs in parallel with each apnoeic episode and the other oscillation (0.2-0.4 Hz) occurs in parallel with the obstructive efforts during each apnoea and in parallel with respiration during periods of snoring. These two oscillations were so specific that the use of non-invasive continuous blood pressure recording allowed an estimation of the extent of underlying breathing disorders, and assessment of cardiovascular risk in a patient with obstructive apnoea in terms of hypertension and on the basis of ambulatory monitoring.     

综合防治中老年桡骨远端骨折并发症效果观察

目的：探讨综合防治桡骨远端骨折并发手肩综合症及骨折畸形的效果.方法：采用带功手法整复、小夹板固定、自我锻炼功法、内服外用药物等综合方法治疗桡骨远端骨折180例.结果：优171例,良9例,差0例,优良率达100％.结论：综合治疗桡骨远端骨折能有效防治手肩综合症及骨折畸形,提高临床疗效,促进伤肢康复.     

Measurement of dyspnea: word labeled visual analog scale vs. verbal ordinal scale

We previously used a verbal ordinal rating scale to measure dyspnea. That scale was easy for subjects to use and the words provided consistency in ratings. We have recently developed a word labeled visual analog scale (LVAS) with labels placed by the subjects, retaining the advantages of a verbal scale while offering a continuous scale that generates parametric data. In a retrospective meta-analysis of data from 43 subjects, individuals differed little in their placement of words on the 100 mm LVAS (mean+/-S.D. for slight=20+/-2.5 mm, moderate=50+/-5 mm and severe=80+/-6 mm) and ratings were distributed uniformly along the scale. A significant stimulus-response correlation was obtained for both the LVAS (r(2)=0.98) and for the verbal ordinal scale (Spearman r=0.94). The resolution of the two scales differed only slightly. With meaningful verbal anchors, well-defined end-points, and clear instructions about the specific sensation to be rated, both scales provide valid measures of dyspnea.