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121.
Comparison of the haemodynamic effects of intermittent positive pressure ventilation with high frequency jet ventilation 总被引:1,自引:0,他引:1
The cardiorespiratory effects of intermittent positive pressure ventilation and high frequency jet ventilation with and without positive end expiratory pressure were compared in patients following valvular heart surgery (mitral and/or aortic). Twenty patients received intermittent positive pressure ventilation and high frequency jet ventilation with 0, 0.5 and 1.0 kPa positive end expiratory pressure. High frequency jet ventilation was well tolerated. The addition of 1.0 kPa positive end expiratory pressure was associated with preservation of the arterial oxygen tension without any increase in shunt or significant adverse haemodynamic effect. The results are discussed and compared with a previous study of high frequency jet ventilation following aortocoronary bypass graft surgery. 相似文献
122.
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
123.
无创正压通气不同压力支持水平对正常人呼吸做功的影响 总被引:2,自引:0,他引:2
目的 :观察无创正压通气 (NIPPV)不同压力水平对正常人呼吸做功的影响 ,为临床合理地应用NIPPV提供理论依据。方法 :选择 9例正常人行NIPPV并寻找出“最舒适”的吸气压力水平 (IPAP) ,在此压力基础上增加或减少 2 5 %的压力 ,构成低IPAP、最舒适IPAP和高IPAP三个压力水平 ,每一IPAP水平通气 15min以上 ,比较不同压力水平呼吸做功改变。结果 :受试者认为“最舒适”的IPAP为 (11.33± 3.2 0 )cmH2 O ,EPAP为 (4 .5 6± 0 .88)cmH2 O[相当于PSV水平为 (6 .77± 3.2 0 )cmH2 O]。与自主呼吸相比 ,NIPPV增加VE的同时 ,总的呼吸做功(Wtot)明显增加 (P <0 .0 5 ) ,而受试者吸气肌做功占总的吸气做功的百分比 (Wi,p/Wi)明显减少 (P <0 .0 5 )。在最舒适IPAP时 ,Wi,p/Wi降低到基础值的 14 %± 9%。这种变化趋势与IPAP的水平相关。结论 :NIPPV可以显著降低吸气肌肉做功。吸气肌做功减少的比例与IPAP的水平相关。研究的结果为NIPPV时PSV的参数设定提供了生理学的依据。 相似文献
124.
O. Pranevicius K. Bertasius M. Pranevicius E. Jarzemskas 《Acta neurologica Scandinavica》1992,86(5):512-516
The dynamics of the speed of transcranial propagation of ultrasonic impulses has been established in humans. The possibility of detecting the changes in mechanical state of intracranial structures by dynamic measurement of the time of transcranial propagation of ultrasonic impulses (TUPT) has been ascertained for 10 healthy persons and 11 patients with different neurological pathology. The cerebrospinal fluid pressure (CSFP) was simultaneously monitored for 4 of the patients. Spontaneous fluctuations in TUPT and the changes caused by jugular veins, inferior vena cava compression, hyperventilation and temporary retention of breathing were detected for all investigated subjects. Spontaneous TUPT changes in the range of 0.25-0.85 x 10(-4) of initial mean value, which are related with cardiac and respiratory cycles, have been found in healthy persons while in patients they ranged from 0.07 x 10(-4) to 4.5 x 10(-4) of mean time. In healthy persons bilateral jugular vein compression leads to a decrease in TUPT by 1.8-3.0 x 10(-4), while the compression of inferior vena cava gives an increase in TUPT by 1.6-2.6 x 10(-4). Changes in TUPT during these maneuvers in neurological patients were found to be of different amplitude and direction. The rise of CSFP by 8.4-20.2 mmHg (mean 12.4 mmHg) was observed in 4 investigated patients during the compression of jugular veins or during the inferior vena cava compression, while the changes in TUPT obtained during each of such maneuvers were of opposite character. The results suggest that dynamic evaluation of acoustic impedance of intracranial system reflects the changes in the mechanical state of brain parenchyma. 相似文献
125.
高血压病人药物治疗期间动态血压变化 总被引:49,自引:0,他引:49
目的评价高血压病人药物治疗期间24h动态血压变化。方法26例住院的高血压病人经药物治疗4周连续3d随测血压,血压正常后进入本研究。治疗前后进行24h动态血压监测。结果患者随测血压(8~9AM,3~4PM)血压恢复到正常水平,但动态血压显示在一段时间内(6~8AM,6~11PM)平均收缩和舒张压仍明显高于正常人平均水平(P<0.01),而该时间段易被临床医生忽视。结论随测血压不能实际全面反映高血压病人药物治疗的疗效,24h动态血压的监测可以正确评价高血压病人药物治疗的效果并根据高血压分布的时间来调整降压药的种类和剂量。 相似文献
126.
Purpose. To obtained rate constants from weight-averaged (Mw) or z-averaged (Mz) molecular weights for polymers of Schule-Flory distribution and undergoing random scission. These constants were compared with those obtained by parallel 1HNMR studies.
Methods. The hydrolysis of two poly(ortho ester)s were followed by 1HNMR and gel permeation chromatography (GPC).
Results. Equations to convert number-averaged (Mn), Mw and Mz into fraction of backbone remaining (fc) were derived. First-order hydrolytic rate constants of two poly(ortho ester)s; DETOSU-HD and DETOSU-CDM were calculated using these relationships. The rate constants calculated from 1HNMR, Mz and Mw were 0.215, 0.218 and 0.182 hr–1, respectively, for DETOSU-CDM and 0.152, 0.086 and 0.038 hr–l for DETOSU-HD. The large discrepancy in the rates determined by 1HNMR and GPC in the latter case was attributed to that the detector response (refractive index) of the monomers was lower than that of the high molecular weight polymer. The difference is small in the case of DETOSU-CDM, and the rates calculated from GPC data were comparable or nearly identical to that obtained from 1HNMR data.
Conclusions. Although GPC can yield rapid and valuable kinetic data for the degradation of biodegradable polymers, the system, however, must be carefully calibrated to account for the variations in Mark-Houwink coefficients and in the response of the mass detector between the high and low MW polymers. 相似文献
127.
Yoshio Takesue Takashi Yokoyama Takashi Kodama Yoshiaki Murakami Yuji Imamura Yuichiro Matsuura 《Surgery today》1997,27(5):392-397
This study was designed to determine the influence of ileal pouch capacity and anal sphincteric function on the clinical outcome
after ileal pouch-anal anastomosis. A total of 24 patients who had undergone ileal pouch-anal anastomosis (J pouch) for ulcerative
colitis were studied. The 24-hour stool frequency was found to be inversely correlated with the sensitivity threshold volume
(STV), maximal tolerance volume (MTV), and distensibility, but was independent of the maximal resting pressure and maximal
squeeze pressure. Patients experiencing nocturnal fecal incontinence had maximal resting pressures that were significantly
lower than those of nocturnally continent patients. Among the patients with fecal incontinence, those with frequent soiling
had lower resting pressures, STV, and distensibility than the patients with intermittent spotting. In addition, the STV in
patients needing nocturnal evacuation were lower than those of patients who did not evacuate after falling asleep. The conclusions
are as follows. Both stool frequency and the need for nocturnal pouch evacuation correlated directly with pouch volume. Anal
incontinence was more common in patients with low internal sphincteric function. In addition, frequent and gross nocturnal
incontinent patients demonstrate a worse function in both the anal sphincter and reservoir than those with intermittent spotting. 相似文献
128.
129.
130.
It is shown that a repetitive pulse sequence consisting of two 90° pulses and gradients in a 1:2 ratio around the second 90° pulse generates interscan shifted stimulated echoes (SSTEs) and intrascan multiple spin echoes (MSEs). Separation of these two types of signals is accomplished using specific gradient crusher schemes. The intensity of the SSTEs is an order of magnitude larger than that of the MSEs and determines the signal contrast if both effects are selected simultaneously. The SSTE sequence generates improved contrast between gray and white matter, even at high field, which is explained in terms of increased inverse T1-weighting for the interscan echo. The MSE image has low signal to noise and no detectable contrast. The effect of interscan diffusion weighting is also discussed. 相似文献