间歇正压通气和呼气末正压通气对犬眼内压的影响

目的 探讨间歇正压通气(IPPV)和呼气末正压通气(PEEP)对犬眼内压(10P)的影响.方法 实验犬8只,麻醉后分别监测基础条件下和各种机械通气条件下的IOP、CVP、MAP.结果 实施20 ml/kg和30 ml/kg两种不同潮气量的IPPV时IOP差异无统计学意义.实施10、15、20cm H20三种不同压力值的PEEP时IOP均显著升高(P<0.01).结论 IPPV对IOP影响不大,PEEP可使IOP显著升高.     

双相气道内正压呼吸机在老年慢性阻塞性肺疾病康复期和急性肺水肿患者中的临床应用

应用双相气道内正压呼吸机（ＢｉＰＡＰ）对９例慢性阻塞性肺疾病（ＣＯＰＤ）康复期和呼吸衰竭稳定期进行临床观察发现，治疗后动脉血氧分压与治疗前相比显著升高（Ｐ＜０．０１）；肺活量及用力肺活量轻度升高；１例３次发生急性左心衰、急性肺水肿致急性呼衰患者治疗后，病情很快改善；１例阻塞性夜间睡眠呼吸暂停综合征者应用效果满意。该机应用简便、安全，对心率血压无明显影响，为ＣＯＰＤ康复期、急性左心衰兼肺水肿的治疗提供了新途径。     

Nasal septum lesions caused by chromium exposure among chromium electroplating workers

A chromium electroplating worker, suffering from epistaxis during work, was found to have nasal septum perforation. To determine the etiology and prevalence of nasal septum lesions, we conducted a survey of seven chromium electroplating factories and examined 79 workers. Forty workers from three aluminum electroplating factories were also enrolled as the reference group. Subjects were thoroughly examined by an otolaryngologist and each of them provided a blood and urine sample. A questionnaire interview regarding symptoms of the upper respiratory tract, past medical history, life style, and work history was also conducted. Air chromium concentrations were measured by taking area samples for 4–6 hours. Based on field observation and chromium measurements, we divided chromium electroplating into three different exposure zones: workers directly dealing with electroplating tanks (n = 31), other process workers (n = 29), and office workers and drivers (n = 19). Among the 79 chromium electroplating workers, there were 16 cases of nasal septum perforation, and 42 with either scar formation or ulceration; 10 chromium electroplating workers developed skin ulcers after performing chrome plating. No workers from aluminum electroplating factories had any nasal septum or skin abnormalities. There was a consistent trend between the degree of chromium exposure and the signs and symptoms related to the nose, throat, and skin. Immediate improvement of occupational hygiene is warranted.     

吗啡对机械通气病人的应用

为获得病人在接受呼吸机期间充分的镇静、良好的耐管并与呼吸机合拍达到满意的治疗效果，对６０例不同年龄的患者在进行呼吸机支持治疗期间，采用平均０４５ｍｇ／（ｋｇｄ）的吗啡量持续微量泵静脉注入，间断辅助安定的方法．用药后连续２ｈ观察血压、心率、呼吸、意识等变化．结果：在用药期间病人血压、心率、呼吸平稳，保持清醒，安静耐管，解决了病人与呼吸机拮抗的矛盾．结果表明：该法在临床上有广泛使用价值     

Effects of isoflurane on oxygenation during one-lung ventilation in pulmonary emphysema patients

Background: Hypoxic pulmonary vasoconstriction has an important role in human one-lung ventilation (OLV) in the lateral decubitus position under general anesthesia. During OLV, inhalational anesthesia may inhibit hypoxic pulmonary vasoconstriction and the decrease in arterial oxygenation. We studied the effect of isoflurane administration on arterial oxygen tension in chronic obstructive pulmonary disease patients.
Methods: Ten patients who had thoracoscopic laser ablation of bullous emphysema were studied. Patients received 2% isoflurane in oxygen from induction until the first 20 min of OLV in the lateral decubitus position, then were switched to 1% isoflurane lasting 20 min and next were switched to 0.5% isoflurane lasting 20 min. After each 20-min inhalation, pulmonary and hemodynamic parameters were measured. The given concentrations for isoflurane were merely vapor meter concentrations.
Results: PaO₂/FIO₂, Qs/Qt respiratory rate peak inspiratory pressure and PaCO₂ showed no significant changes at each point of isoflurane. Expiratory tidal volume significantly decreased (P<0.05) with 0.5% isoflurane compared to that with 2% isoflurane. Cardiac output, mean arterial pressure, mean pulmonary arterial pressure, systemic vascular resistance and pulmonary vascular resistance showed no significant changes at each point of isoflurane.
Conclusions: In patients with pulmonary emphysema, arterial oxygenation is not affected by low isoflurane concentration during OLV in the lateral decubitus position.     

A breathing lung phantom for 81mKr lung ventilation studies its use in dosimetry and quality control

The construction of a breathing lung phantom that can be used to measure the amount of radioactive gas in the lungs as well as to determine the absorbed dose is described. For a lung ventilation study that consists of 6 views of 300 kents each, an effective dose equivalent of 50 Sv was calculated. The phantom is also suitable for comparison of different generator systems.     

不同机械通气方式联合猪肺磷脂注射液治疗新生儿呼吸衰竭疗效比较

目的 比较常频机械通气(CMV)、猪肺磷脂注射液联合CMV、猪肺磷脂注射液联合高频振荡通气(HFOV)治疗新生儿呼吸衰竭的疗效。方法 选择2019年1月至2020年12月南阳市中心医院收治的133例呼吸衰竭新生儿为研究对象,根据治疗方式将患儿分为对照组(n=41)、观察组A(n=45)和观察组B(n=47)。对照组患儿给予单纯CMV治疗,观察组A患儿给予猪肺磷脂注射液联合HFOV治疗,观察组B患儿给予猪肺磷脂注射液联合CMV治疗。比较3组患儿机械通气时间、用氧时间、治疗前后的呼吸力学指标[动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)、氧合指数(OI)、呼吸指数(RI)]和血清内皮素-1(ET-1)、肌酸激酶同工酶(CK-MB)、Ⅱ型肺泡表面抗原-6(KL-6)、Clara细胞蛋白16(CC16)水平及不良反应发生情况。结果 3组患儿的机械通气时间和用氧时间比较差异有统计学意义(F=12.658、26.196,P<0.05);观察组A和观察组B患儿的机械通气时间和用氧时间显著短于对照组(P<0.05),观察组A患儿的机...     

急性加重期慢性阻塞性肺疾病患者有创机械通气期间营养风险及影响因素分析

目的 探究慢性阻塞性肺疾病急性加重期(AECOPD)有创机械通气患者营养风险及影响因素分析。方法 选取2020年2月—2022年2月入住中国医科大学附属盛京医院重症监护病房(ICU)需要有创机械通气支持的AECOPD患者126例,根据营养风险筛查量表(NRS)2002将患者分为有营养风险组(86例)和无营养风险组(40例)。收集患者动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)、第1秒用力呼气容积占用力肺活量百分比(FEV₁/FVC)、残气量(RV)、白蛋白(ALB)、前白蛋白(PA)等临床资料。采用多因素一般Logistic回归分析有创机械通气AECOPD患者发生营养风险的危险因素,绘制受试者工作特性(ROC)曲线评价上述指标对有创机械通气AECOPD患者营养风险的诊断价值。结果 有营养风险组PaO₂<60 mmHg、PaCO₂≥50 mmHg、FEV₁/FVC<50%、ALB<30.00 g/L、PA<145.00 ...     

Blockade of pulmonary stretch receptors reinforces diaphragmatic activity during high-frequency oscillatory ventilation

During apneic periods elicited by high-frequency oscillatory ventilation (HFOV) a tonic diaphragmatic activity was observed, contrasting with the absence of diaphragmatic activity during apnea induced by lung inflation. To clarify the mechanism underlying the persistence of the diaphragmatic activity during HFOV-induced arrest of breathing the reflex responses to short periods of HFOV, and to periods of lung inflation with airway pressure (P _aw) equal to the meanP _aw and/or to maximalP _aw during HFOV were examined both before and after the blockade of slowly adapting stretch receptors (SR) by inhalation of sulphur dioxide (SO₂) in anaesthetized rabbits. In animals with intact SR, the HFOV-induced reflex apnea lasted longer than that induced by lung inflation, the associated diaphragmatic activity being in the most cases higher than the diaphragmatic activity during quiet expiration; inflation, however, completely inhibited diaphragmatic activity. After blockade of SR, spontaneous breathing continued during periods of lung inflation, i.e., the Hering-Breuer inflation reflex was abolished, whereas HFOV still led to a cessation of spontaneous breathing, the associated diaphragmatic activity even exceeding the level observed during quiet inspiration. From these results we conclude that only one part of the reflex response to HFOV is due to SR-stimulation and that in addition other vagal pulmonary receptors (irritant-and/or C-fibre-receptors) are involved. The stimulation of the latter counterbalances the concomitant stimulation of SR, giving rise to the tonic activity of the diaphragm.