大剂量盐酸氨溴索对肺外型急性呼吸窘迫综合征患者血管外肺水及氧合功能的影响

目的 研究大剂量盐酸氨溴索对肺外型急性呼吸窘迫综合征（ARDS）患者血管外肺水（ELWI）及氧合功能的影响.方法 将68例符合ARDS诊断标准的患者分为治疗组（35例）与对照组（33例）.治疗组予以盐酸氨溴索1005 mg/d静脉注入,3h完成,对照组予以等容量的生理盐水静脉滴注3h,连续治疗7d.比较两组患者治疗前、治疗后3、5、7d动脉氧分压和氧饱和度（SaO2）,氧合指数、心脏指数（CI）、血管外肺水指数（ELWI）和血管通透性指数（PVPI）的变化以及机械通气时间、停留ICU时间、住院时间.结果 两组患者治疗后动脉氧分压、SaO2以及氧合指数均有不同程度的升高,ELWI、PVPI均有下降,且治疗组在治疗后5、7d较对照组改善更为明显（P均＜0.05）.此外,治疗组患者机械通气时间、停留ICU时间以及住院时间均比对照组显著降低（P均＜0.05）.结论 大剂量盐酸氨溴索可以降低ARDS患者肺血管通透性及血管外肺水,改善氧合功能,降低机械通气时间和住院时间.     

全身麻醉术中肺保护性通气对肥胖患者肺顺应性及氧合指数的影响

目的 观察全身麻醉术中肺保护性通气（LPVS）对肥胖患者肺顺应性及氧合指数（OI）的影响。方法 选择2016年10月~2019年8月于我院择期行全身麻醉下腹腔镜手术的68例肥胖患者,随机分为对照组与观察组,各34例。对照组接受常规模式机械通气,观察组实施LPVS策略。比较气管插管后10 min（T1）、手术开始后60 min（T2）两组肺顺应性（CL）及氧合功能、血压（DBP、SBP）、心率（HR）及术前术后肺功能。结果 T1时两组CL、OI、PaO2比较,差异无统计学意义（P＞0.05）;T2时观察组CL、OI、PaO2分别为（288.49±30.18）ml/cmH2O、（40.53±8.14）、（422.19±57.40）mmHg,均高于对照组的（221.54±28.67）ml/cmH2O、（31.68±6.70）、（331.74±36.59）mmHg,差异有统计学意义（P＜0.05）;T2时两组DBP、SBP、HR比较,差异无统计学意义（P＞0.05）;手术后观察组FEV1、FVC、FEV1/FVC分别为（1.37±0.43）L、（1.68±0.63）L、（81.29±11.76）%,均高于对照组的（1.06±0.32）L、（1.39±0.47）L、（74.83±12.50）%,差异有统计学意义（P＜0.05）。结论 肥胖患者腹腔镜手术全身麻醉时进行肺保护性通气可降低患者肺泡塌陷,改善氧合功能,增加肺顺应性,有助于保护肺功能,且对循环系统影响较小。     

无创机械通气用于重症监护室急性肺损伤患者的临床观察

目的:观察急性肺损伤患者早期给予无创正压机械通气治疗的临床效果。方法:选择31例早期急性肺损伤患者,给予无创正压机械通气治疗,S/T通气模式,呼吸机参数设置为EPAP3-8cmH2O,IPAP不超过18 cmH2O,潮气量6～8ml/kg,连续动态监测生命体征,采取不同时间段的动脉血气,计算氧合指数并记录。结果:26例急性肺损伤患者临床症状明显改善,并逐渐试脱机成功;5例改行有创机械通气治疗。结论:无创正压机械通气治疗早期急性肺损伤患者临床效果肯定。     

亚甲蓝对感染性休克犬肠道灌注和氧合的影响

目的　研究鸟苷酸环化酶抑制药亚甲蓝对感染性休克犬肠道灌注和氧合的影响。方法　静脉注入内毒素诱导的 7只感染性休克犬模型 ,输注 0 9%氯化钠复苏后 15分钟内注入亚甲蓝2mg/kg。血流量仪测定基础、休克 1小时后、复苏后和亚甲蓝注入后 30分钟肠系膜上动脉血流量。分析动脉和肠系膜上静脉血气 ,计算肠道氧合。结果　犬感染性休克后 ,肠系膜上动脉 (肠道 )血流减少 6 1 8% (P <0 0 1) ,氧输送 (DO2 )减少 6 2 1% (P <0 0 1) ,氧摄取 (O2 extr)增加 2 3 5 %。复苏至肺动脉嵌压为 (12 1± 1 4 )mmHg后 ,肠道血流增加 5 4 6 % (P <0 0 1) ,DO2 增加 12 8% (P <0 0 1) ,O2 extr增加 2 0 9%。亚甲蓝注入后 ,肠道血流增加 19 4 % (P <0 0 1) ,DO2 则无明显变化 (P >0 0 5 ) ,O2 extr增加 14 8%。结论　感染性休克后肠道血流灌注减少 ,氧耗增加 ;液体复苏仅部分恢复肠道灌注 ;亚甲蓝增加肠道灌注和氧摄取     

IV. Forum

Zusammenfassung 38 Gasödem-Patienten wurden kombiniert mit chirurgischer Intervention, hyperbarer Oxygenation und Antibiotica, behandelt. 14 starben unmittelbar am Gasodem, 5 an mittelbaren Komplikationen. Bei 15 der 19 Überlebenden mußten Gliedmaßen amputiert werden. Nacb den eigenen Erfahrungen an 118 mit der Verdachtsdiagnose Gasödem zugewiesenen Patienten ist eine primäre chirurgische Intervention für Diagnostik und Therapie unerläßlich. Mit der hyperbaren Oxygenation allein kann ein fortgeschrittenes Gasödem nicht beherrscht werden.     

特高海拔现场高压氧治疗对肺水肿病人肺动脉压的影响

目的　观察特高海拔地区现场高压氧 (HBO)治疗对高原肺水肿 (HAPE)病人肺动脉压的影响 ;评价HBO对HAPE的疗效 ;探讨肺动脉高压 (PH)与HAPE的关系 ;强调现场就地治疗的重要性。方法　在 4636米特高海拔 (气压 5 7.41kPa,氧分压 1 2 .OkPa)现场治疗来自海拔 4636～ 5 1 30米 (气压5 7.41～ 5 3.2 8kPa/431 .6～ 40 0 .6mmHg,氧分压 1 2 .0～ 1 1 .6kPa/90 .0～ 87.0mmHg)的HAPE 32例。治疗前后对其临床症状、X光胸片、血氧饱和度 (SaO2 )、平均肺动脉压 (MPAP)进行自身对照。结果　治疗前后 32例HAPE临床症状、体征及MPAP等各项观测指标显著改善 ,P <0 .0 0 1。结论　特高海拔现场HBO救治HAPE效果肯定 ,它能使显著增高的肺动脉压降低 ,全部病例病情迅速改善 ,其中 1 1例 ( 34.3% )基本治愈。为下送进一步治疗创造了条件。HAPE患者均有PH ,而PH者未必一定发生HAPE ;PH是机体适应缺氧环境的正常代偿 ,PH失代偿的阈值确有必要探讨     

Reconstruction of Liver Tissue In Vitro: Geometry of Characteristic Flat Bed, Hollow Fiber, and Spouted Bed Bioreactors with Reference to the In Vivo Liver

Abstract: Bioreactors currently being developed for hybrid artificial livers vary greatly with respect to their microenvironment. The specific architecture modifies the relationship parenchymal and nonparenchymal cells have with the exchange surfaces of the bioreactor. Most designs are either based on hollow fiber, spouted bed, or flat bed devices. This diversity is contrasted by the uniform and unique organization of the in vivo liver. The liver cells are arranged as plates and both sinusoidal surfaces of the hepatocytes are enclosed within the matrix of the space of Disse. In this study we intended to define the in vivo liver tissue characteristics in a manner useful for an organotypical approach to hepatic tissue engineering. Transmission electron microscopy of an in vivo liver was utilized to describe these ratios. The ratios defined in this study are based on the constant hepatocellular expression of two sinusoidal surfaces. A relationship is established between the expression of the sinusoidal surfaces and their use as attachment and exchange surfaces inside a bioreactor. The presence of biliary surfaces and nonparenchymal cell surfaces is compared. The functional relevance of an in vivo like extracellular matrix geometry for oxidative biotransformation of primary hepatocytes in vitro was studied using the two model drugs cyclosporin and rapamycin. The generation of the hydroxylated cyclosporin metabolites AM 9 and AM 1 and four rapamycin metabolites was analyzed by high performance liquid chromatography (HPLC). It is shown that the cell–specific biotransformation rates at 1 week in culture in matrix overlayed hepatocytes was 5–10 times that of hepatocytes without matrix overlay. Bilaminar membrane (BLM) bioreactors were used to reconstruct extracellular matrix geometry, three–dimensional cell plates, and sinusoidal analogs in between cell plates.     

Clinical observation on acupuncture combined with hyperbaric oxygenation in treating patients with cervical spondylosis of nerve root type in acute phase

Objective: To observe the therapeutic efficacy of acupuncture combined with hyperbaric oxygenation for cervical spondylosis of nerve root type in acute phase. Methods: One hundred cases with cervical spondylosis of nerve root type in acute phase were randomly divided into two groups, with 50 patients in each group. The patients in the treatment group were treated by acupuncture combined with hyperbaric oxygenation, and those in the control group only received the same acupuncture therapy as the treatment group. The therapeutic efficacy was evaluated after 2 courses of treatment. Results: In the treatment group, 27 cases were cured, 9 cases showed markedly effective, and 4 cases were invalid, and the recovery rate was 67.5%, the total effective rate was 90.0%; in the control group, 18 cases were cured, 17 cases showed markedly effective, 15 cases were invalid, and the recovery rate was 36.0%, the total effective rate was 70.0%. There were statistically significant differences between two groups in the recovery rate and the total effective rate(both P0.05). The average cure time of the treatment group was(15.56±7.13) d, and that of the control group was(22.13±7.78) d, which also had significant difference between the two groups(P0.05). Conclusion: Acupuncture combined with hyperbaric oxygenation has rapid and reliable effects for cervical spondylosis of nerve root type in acute phase.     

丙泊酚镇静对严重脓毒症及脓毒症休克患者呼吸力学及氧合的影响

目的观察丙泊酚镇静对严重脓毒症及脓毒症休克患者呼吸力学及氧合的影响。方法42例实施机械通气的严重脓毒症及脓毒症休克患者随机分为丙泊酚（P）组（镇静诱导和维持用丙泊酚）和咪唑安定（M）组（镇静诱导和维持用咪唑安定）。根据Ramsay氏分级标准调整2组用药量。记录2组患者镇静诱导前即刻（T0）、镇静诱导后1h（T1）．12h（T2）,24h（T3）．48h（T4）各时点气道峰压（PIP）,平台压（Pplat）,肺动态顺应性（Cdyn）及气道阻力（Raw）,同时采集上述各时点中心静脉血,桡动脉血测定血气,计算肺内静动脉分流率（Qs／Qt）和氧合指数（OI）。结果（1）与T0时比较,T1-T4时2组患者呼吸参数均有改善（P〈0．05）;（2）与M组比较,T4时P组Qs／Qt下降、OI升高（P〈0．05）。结论丙泊酚镇静有利于改善机械通气时严重脓毒症及脓毒症休克患者氧合,可为其病因治疗赢得时间。