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51.
Dr. med. Thorsten Schäfer Heike Vogelsang 《Somnologie - Schlafforschung und Schlafmedizin》2002,6(2):79-84
Summary Question of the study Nasal continuous positive airway pressure (CPAP) prevents collapse of the upper airway during sleep in patients with obstructive sleep apnea provided that a positive transmural pressure can be maintained during inspiration. We examined pressure-flow characteristics in seven CPAP and bilevel devices during spontaneous breathing.
Methods The CPAP devices were set to a pressure level of 9.8 hPa (10 cm H2 O) and adapted to a pneumotachograph using a standard CPAP hose and an outlet valve. We continuously measured flow, volume and pressure during resting ventilation and increasing voluntary hyperventilation and analysed the dependence of the variables on a breath-to-breath basis.
Results Mean CPAP pressures differed between the devices (9.9 – 10.6 hPa) despite the same settings. In all machines pressure fell during inspiration to 8.4 – 9.8 hPa and increased during expiration to 11.1 – 11.7 hPa. This effect increased with higher flow rates. Maximum expiratory pressures rose to 12 – 19 hPa at peak flow rates of 2 l/s, mean expiratory pressures to 9.5 – 16 hPa. Inspiratory pressures dropped to 8.5 – 4.5 hPa (minimum) and 10.5 – 6.0 (mean). Bilevel devices showed a higher stability than CPAP devices. Pressure swings during the respiratory cycle increased the additional work of breathing.
Conclusions Due to differences in mean and effective CPAP levels CPAP devices are not simply exchangeable but should be individually adapted. Patients with higher minute ventilation might benefit from more stable CPAP machines. The impact on patients' compliance remains to be evaluated. 相似文献
Methods The CPAP devices were set to a pressure level of 9.8 hPa (10 cm H
Results Mean CPAP pressures differed between the devices (9.9 – 10.6 hPa) despite the same settings. In all machines pressure fell during inspiration to 8.4 – 9.8 hPa and increased during expiration to 11.1 – 11.7 hPa. This effect increased with higher flow rates. Maximum expiratory pressures rose to 12 – 19 hPa at peak flow rates of 2 l/s, mean expiratory pressures to 9.5 – 16 hPa. Inspiratory pressures dropped to 8.5 – 4.5 hPa (minimum) and 10.5 – 6.0 (mean). Bilevel devices showed a higher stability than CPAP devices. Pressure swings during the respiratory cycle increased the additional work of breathing.
Conclusions Due to differences in mean and effective CPAP levels CPAP devices are not simply exchangeable but should be individually adapted. Patients with higher minute ventilation might benefit from more stable CPAP machines. The impact on patients' compliance remains to be evaluated. 相似文献
52.
53.
The objective of this investigation was to demonstrate the possible interactions of systemic lidocaine (lido) with inhibitory receptors in the spinal cord. In the lumbar dorsal horn of anesthetized and curarized rats, 60 physiologically identified, wide dynamic range (WDR) neurons, were recorded extracellularly. Glutamate, glycine and its selective antagonist, strychnine, were iontophoretically applied onto the neurons either singularly or concurrently. The effects of systemic lido on the drug-induced frequency changes and the interaction with the glycine receptors, using strychnine as a probe, were studied. It was consistently found that (i) lido (3–4 mg/kg) inhibited the excitatory responses to iontophoretic glutamate, (ii) this inhibition was significantly antagonized by concurrent iontophoretic strychnine, (iii) iontophoretic glycine induced comparable glutamate inhibition that was reversed by strychnine. In contrast, no effect on glutamate-induced excitations was observed when lido was applied by micropressure or a different local anesthetic was systemically administered. The results suggest that central inhibitory effects of lido could by mediated by spinal strychnine-sensitive glycine receptors, activated by lido itself or possibly by its glycine residue-bearing metabolites. 相似文献
54.
纤维支气管镜在急危重病人气道管理中的应用 总被引:3,自引:0,他引:3
目的 探讨纤支镜在急危重病人气道管理中的作用。方法 回顾性总结支气管镜对34例重症病人进行气道管理中的清理作用及治疗咯血,肺炎及肺不张等临床经验。结果 10例肺部感染患者,经纤维支气管镜治疗后感染均得到不同程度的控制,其中6例痊愈出院;7例肺不张者,4例行纤支镜1次肺复张,1例行纤支镜2次后复张,余2例配合其它治疗措施后复张;大咯血9例患者,经纤支镜局部应用肾上腺素及凝血酶,6例咯血立即停止,3例明显减轻;机械通气患者4例,2例痰栓致肺不张,其中1例左肺不张纤支镜吸引冲洗后复张2例诊断气管插管球囊滑脱/破裂,指导换管成功。困难气管插管患者均因常规方法失败后经纤支镜引导插管成功。结论 支气管镜是对急危重症病人进行气道管理的极有价值的工具,即可用于协助气管插管,又可胜任气道的清理作用及诊治大咯血,难治性肺部感染及急性肺不张等。 相似文献
55.
Yasunori Cho Satoru Suzuki Masakazu Yokoi Muneaki Shimada Saburo Kuwabara Akira Murayama 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2004,52(10):476-479
Lymphoblastic lymphoma, an aggressive mediastinal mass, is recognized as serious threat to the patient in developing cardiac
tamponade or airway obstruction. Surgical procedure is often required to relieve clinical emergency and to establish prompt
pathological diagnosis. However, in such a patient, acute respiratory occlusion in the spine position can be a life-threatening
complication during general anesthesia. We describe a 17-year-old man whose cardiac tamponade was treated by pericardial-pleural
window through a left anterior thoracotomy in the lateral position. The patient recovered from hemodynamic compromise without
showing respiratory occlusion during general anesthesia and remained in the lateral position until extubation. Pathological
diagnosis was precursor T-lymphoblastic lymphoma. There were no complications attributable to the operative procedure. Further
chemotherapy reduced the mediastinal mass in size after two weeks when the patient developed sepsis and died. Lateral position
prevents respiratory occlusion during surgical procedure under general anesthesia in the patient of huge anterior mediastinal
tumor with airway obstruction. 相似文献
56.
A restricted field of view (rFOV) approach for imaging a dynamic time series of volumes of limited spatial extent within a larger subject is described. The shorter readout with rFOV-MRI can be exploited to either limit image artifacts or increase spatial resolution. To accomplish rFOV imaging of a multislice volume for a dynamic series, an outer volume suppression (OVS) preparation that saturates signal external to a cylinder through the subject is followed by slice-selective excitation and a spiral readout. The pass- and stopband efficiencies of the OVS in an agar gel phantom were 97% (+/-1.5%) and 3% (+/-1%), respectively. Profiles of the temporal signal-to-noise ratio (SNR) were measured in a phantom and an adult brain. The rFOV sequence reduced distortions from off-resonance signal and T2*-induced blurring compared to a conventional sequence. Sequence utility is demonstrated for high-resolution rFOV functional MRI (fMRI) in the visual cortex. The rFOV sequence may prove to be useful for other multislice dynamic and high-resolution imaging applications. 相似文献
57.
Guillaume Duhamel Gottfried Schlaug David C Alsop 《Magnetic resonance in medicine》2006,55(3):514-523
Measurement of the arterial input bolus shape is essential to the quantification of mean transit time and blood flow with dynamic susceptibility contrast (DSC) MRI. Input functions derived from the echoplanar signal intensity within or near arteries are highly nonlinear, yet such input functions are widely used. We employed a physical model for the echoplanar signal intensity from an artery as a function of contrast agent concentration, artery size, and angle to the magnetic field to test approaches for the measurement of the arterial input function. The simulated results confirmed the strong nonlinearity of signal in the neighborhood of vessels. Of the input function measurement methods considered, the simulations suggested that measurement of signal near but not within a large vessel is most accurate, but mean transit times (MTT) calculated with these input functions are highly sensitive to peak bolus concentration. Input functions determined from voxels demonstrating the shortest first moment overestimated the MTT but the measured MTTs were more robust to changes in peak concentration. Characteristics of the measured in vivo input functions were consistent with the simulations. Our results emphasize the important contribution of input function errors to the uncertainty in MTT and blood flow imaging with DSC MRI. 相似文献
58.
报告用巯基棉(SCF)吸附富集分离──催化动力学法,测定了包头市区400名18~55岁健康成年人发硒值。结果显示:发硒值的中位数(M)为0.76mg/kg。男女分组分析,男性的M为0.69mg/kg,女性M为0.80mg/kg,男女两组间的差异无显著意义(P>0.05)。 相似文献
59.
In order to investigate the K~+ channels and their effects on resting membrane potential(Em) and excitability in rat bronchial smooth muscle cells (BSMCs), the components of outward K~+channel currents and the effects of K~+ channels on Em and tension in rat bronchial smooth musclewere observed by using standard whole-cell recording of patch clamp and isometric tension recordingtechniques. The results showed that under resting conditions, total outward K~+ channel currents infreshly isolated BSMCs were unaffected by ATP-sensitive K~+ channel blocker. There were two typesof K~+ currents: voltage-dependent delayed rectifier K~+ channel (Kv) and large conductance calcium-activated K~+ channel (BK_(Ca)) currents. 1 mmol/L 4-aminopyridine (4-AP, an inhibitor of Kv)caused a significant depolarization (from — 8.7±5.9mV to —25.4±3.1mV, n=18, P<0.001).In contrast, 1 mmol/L tetraethylammonium (TEA, an inhibitor of BK_(Ca)) had no significant effect onEm (from —37.6±4.8 mV to —36.8±4.1 mV, n=12, P>0.05). 4 相似文献
60.
双水平压力调节通气与反比通气对健康及急性肺损伤犬心肺功能影响的比较研究 总被引:12,自引:2,他引:10
目的 :比较双水平压力调节 (BIPAP)通气和反比通气 (IRV)对心肺功能的影响。方法 :在两种通气模式 0、0 .5和 1.0 k Pa呼气末压 (EEP)时 ,分别测定健康犬及油酸诱发急性肺损伤犬的呼吸力学、血流动力学及血气分析各参数。结果 :无论有无急性肺损伤 ,BIPAP通气时平均气道压 (m Paw )均明显低于 IRV时(P均 <0 .0 5 )。给健康犬用 IRV通气时 ,上述 3种 EEP水平的 m Paw分别为 (0 .437± 0 .10 3) k Pa、(0 .811±0 .0 93) k Pa和 (1.36 0± 0 .119) k Pa;用 BIPAP通气时则分别降为 (0 .2 2 5± 0 .0 71) k Pa、(0 .6 11± 0 .10 5 ) k Pa和(1.10 7± 0 .0 89) k Pa。油酸诱发急性肺损伤后 ,m Paw分别由 IRV时 (0 .72 5± 0 .2 2 2 ) k Pa、(1.186± 0 .2 98) k Pa和 (1.6 0 0± 0 .10 0 ) k Pa降至 BIPAP时 (0 .35 0± 0 .12 9) k Pa、(0 .6 2 5± 0 .15 0 ) k Pa和 (1.12 5± 0 .0 96 ) k Pa;但两种通气模式中气道峰压、心排血量并无明显差异。另外 ,急性肺损伤时 ,BIPAP通气的动脉血氧分压 (Pa O2 )分别为 (9.10± 1.79) k Pa、(11.43± 1.80 ) k Pa和 (13.40± 3.2 0 ) k Pa,较 IRV时 Pa O2 (7.87± 2 .33) k Pa、(9.0 7±3.0 5 ) k Pa和 (9.71± 1.85 ) k Pa增高 (EEP 1.0 k Pa时 ,P <0 .0 5 )。结论 : 相似文献