煤工尘肺合并低氧血症42例患者脑干听觉诱发电位检测报告

目的:分析煤矿工人尘肺合并低氧血症患者脑干听觉诱发电位(BAEP)的改变及特点,研究这些患者长期慢性脑部缺氧对脑干功能的影响。方法:对42例煤矿工人尘肺合并低氧血症患者与对照组进行BAEP测试,测定Ⅰ、Ⅲ、Ⅴ各波潜伏期(PL)、峰间潜伏期(IPL)、两耳间PL或IPL之差(ILD),Ⅰ-Ⅲ/Ⅲ-Ⅴ之IPL比,同侧Ⅴ/Ⅰ波幅比等数值。结果:病例组IPL明显延长,与对照组比较差异非常显著(P<0.01)。结论:BAEP能敏感反映煤矿工人尘肺合并低氧血症患者脑干的功能障碍,其对早期了解肺性脑病脑干功能有一定价值。     

Metabolic consequences of reduced frequency breathing during submaximal exercise at moderate altitude

Summary The intention of this study was to determine the metabolic consequences of reduced frequency breathing (RFB) at total lung capacity (TLC) in competitive cyclists during submaximal exercise at moderate altitude (1520 m; barometric pressure, P _B=84.6 kPa; 635 mm Hg). Nine trained males performed an RFB exercise test (10 breaths · min ^–1) and a normal breathing exercise test at 75–85% of the ventilatory threshold intensity for 6 min on separate days. RFB exercise induced significant (P<0.05) decreases in ventilation (V _E), carbon dioxide production (VCO₂), respiratory exchange ratio. (RER), ventilatory equivalent for O₂ consumption (V _E/VO₂), arterial O₂ saturation and increases in heart rate and venous lactate concentration, while maintaining a similar OZ consumption (VO₂). During recovery from RFB exercise (spontaneous breathing) a significant (P< 0.05) decrease in blood pH was detected along with increases in V _E, VO₂, VCO₂, RER, and venous partial pressure of carbon dioxide. The results indicate that voluntary hypoventilation at TLC, during submaximal cycling exercise at moderate altitude, elicits systemic hypercapnia, arterial hypoxemia, tissue hypoxia and acidosis. These data suggest that RFB exercise at moderate altitude causes an increase in energy production from glycolytic pathways above that which occurs with normal breathing.     

小儿腭裂修补术围拔管期血氧饱和度值变化分析

目的 观察小儿腭裂手术围拔管期血氧饱和度（SPO2）变化,并分析原因。方法 30例先天性腭裂患儿,择气管插管静脉复合全麻,记录停静脉麻醉时、拔管即刻、拔管后5min、10min、20min及30min时SPO2值,SPO2<90%示低氧血症,SPO2<85%为严重低氧血症。结果 拔管后5min有13例患儿有明显低氧血症,占43.33%,其中严重低氧血症2例;拔管后10min有低氧血症7例,占23.33%;拔管后20min、30min仅2例和1例。结论 全麻下腭裂修补术,于拔管后30min内易发生低氧血症,尤其20min内最为明显,应予以吸O2和呼吸管理,避免意外发生。     

内镜专用口咽通气道在无痛胃镜中的应用

目的观察内镜专用口咽通气道作为一种新型配套咬口与口咽通道的联合体在无痛胃镜应用中的安全性和有效性。方法选择行无痛胃镜检查患者200例,男89例,女111例,年龄22～64岁,BMI 16～30 kg/m~2,ASAⅠ或Ⅱ级,随机分为两组:传统胃镜咬口组(C组)和内镜专用口咽通气道组(K组),每组100例。C组从传统胃镜咬口置入胃镜,K组从内镜专用口咽通气道配套咬口内置入口咽通气道,通过其置入胃镜。术中如有体动或呛咳时,则追加丙泊酚0.2～0.4 mg/kg。记录检查前、胃镜达幽门时和苏醒时MAP、HR、SpO_2;记录进镜时间、检查时间、苏醒时间、PACU停留时间、胃镜置入一次成功例数、胃镜置入难易度,记录患者舒适度、镜检医师满意度和不良反应发生情况。结果与C组比较,胃镜达幽门时K组SpO_2明显增高(P0.05)。与检查前比较,胃镜达幽门、苏醒时两组MAP明显降低、HR明显减慢,胃镜达幽门时C组SpO_2明显降低(P0.05)。与C组比较,K组胃镜一次置入成功率明显升高、胃镜进镜时间和PACU停留时间明显缩短、丙泊酚维持剂量明显减少、低血压发生率明显降低、患者舒适度和镜检医师满意度明显升高(P0.05)。结论内镜专用口咽通气道可作为无痛胃镜的有效气道辅助装置,增加通气效率,降低麻醉药用量,加速无痛胃镜的实施,既确保了无痛胃镜的安全,也提高了无痛胃镜的效率。     

Hepatopulmonary syndrome: An update

Hepatopulmonary syndrome (HPS) is characterized by defects in oxygenation caused by intra-pulmonary vasodilation occurring because of chronic liver disease, portal hypertension, or congenital portosystemic shunts. Clinical implications of portal hypertension are very well-known, however, awareness of its effect on multiple organs such as the lungs are less known. The presence of HPS in chronic liver disease is associated with increased mortality. Medical therapies available for HPS have not been proven effective and definitive treatment for HPS is mainly liver transplantation (LT). LT improves mortality for patients with HPS drastically. This article provides a review on the definition, clinical presentation, diagnosis, and management of HPS.     

Polysomnographic assessment of respiratory disturbance during deep propofol sedation for endoscopic submucosal dissection of gastric tumors

AIM To investigate that polysomnographic monitoring can accurately evaluate respiratory disturbance incidence during sedation for gastrointestinal endoscopy compare to pulse oximetry alone.METHODS This prospective observational study included 10 elderly patients with early gastric cancer undergoing endoscopic submucosal dissection(ESD) under propofol sedation. Apart from routine cardiorespiratory monitoring, polysomnography measurements were acquired. The primary hypothesis was tested by comparing the apnea hypopnea index(AHI), defined as the number of apnea and hypopnea instances per hour during sedation, with and without hypoxemia; hypoxemia was defined as the reduction in oxygen saturation by ≥ 3% from baseline.RESULTS Polysomnography(PSG) detected 207 respiratory disturbances in the 10 patients. PSG yielded a significantly greater AHI(10.44 ± 5.68/h) compared with pulse oximetry(1.54 ± 1.81/h, P 0.001), thus supporting our hypothesis. Obstructive AHI(9.26 ± 5.44/h) was significantly greater than central AHI(1.19 ± 0.90/h, P 0.001). Compared with pulse oximetry, PSG detected the 25 instances of respiratory disturbances with hypoxemia 107.4 s earlier on average.CONCLUSION Compared with pulse oximetry, PSG can better detect respiratory irregularities and thus provide superior AHI values, leading to avoidance of fatal respiratory complications during ESD under propofol-induced sedation.     

无创呼吸机治疗手术后低氧血症疗效评价

目的评价Knightstar-330无创呼吸机治疗手术后低氧血症患者的疗效。方法将60例符合诊断标准的手术后低氧血症患者随机分成两组,即治疗组(n=30)与对照组(n=30),进行分组治疗。治疗组在常规治疗的基础上,加用Knightstar-330无创呼吸机治疗;对照组只给予常规治疗及鼻导管吸氧。结果治疗组30例中有28例在24小时后病情缓解,2例恶化,改用有创通气;对照组30例中有9例在24小时后病情基本缓解,另21例病情加重,使用有创或无创通气。结论Knightstar-330无创呼吸机治疗手术后低氧血症患者有明显疗效,但亦有其局限性,若对无创通气初期血气分析无改善者,要尽快进行有创通气。     

23例肺栓塞临床特点分析

目的通过对肺栓塞(pulmonary embolism,PE)临床特点分析与总结,提高对PE的认识。方法对23例PE患者的高危因素、临床表现及常见辅助检查结果进行分析。结果 PE患者有高危因素。临床症状中呼吸困难占91.30%,PE三联征仅见13.04%,其他表现包括心悸、胸痛、咯血、晕厥等。血气分析见低氧血症、低碳酸血症。D-二聚体阳性率为91.30%。91.30%心电图和86.95%超声心动图有异常。结论 PE表现缺乏特异性,但是可见低氧血症及右心室高压或右心功能不全相关的症状及辅助检查结果。     

两种气道湿化方法在气管切开患者中的应用比较

目的探讨微量泵控制持续气道湿化在气管切开患者的应用及对其并发症的影响。方法选取气管切开患者120例,随机分为两组,实验组60例应用微量泵控制持续气道湿化,对照组60例应用传统的间断或定时气道湿化法,并进行连续观察。结果实验组的并发症和吸痰次数少于对照组,吸痰时及吸痰后2～5min实验组经皮血氧饱和度均值高于对照组。结论微量泵控制持续气道湿化在气管切开患者的应用效果明显,可以明显减少并发症的发生,减少吸痰次数,减轻吸痰所致低氧血症程度并缩短其持续时间。