高压氧联合地塞米松治疗突发性耳聋的疗效及相关影响因素分析

目的 分析高压氧联合地塞米松治疗突发性耳聋（SD）的疗效及相关影响因素。方法 回顾性分析 2014年 1 月—2016 年 12 月我院 200 例采用高压氧联合地塞米松治疗的 SD 患者的临床资料，根据疗效分为有效组（n=182 例）与无效组（n=18 例），比较 2 组性别、年龄、发病至就诊时间、耳别、听力损失、听力曲线类型、伴眩晕情况、伴耳鸣情况、合并疾病（高血压或糖尿病）、血浆黏度及血清 C 反应蛋白（CRP）等指标，并采用 Logistic 回归筛选影响SD 疗效的危险因素。结果 200 例患者经治疗后，总有效 182 例（91.00%），无效 18 例(9.00%）。有效组年龄>50岁、发病至就诊时间>7 d、听力损失≥60 dB、听力曲线类型为高频型或全聋型、伴眩晕、合并高血压、合并糖尿病、血浆黏度≥2 mPa·s、血清 CRP≥20 μmol/L 的比例明显低于无效组（P＜0.05）。Logistic 回归分析显示，年龄（>50 岁）、发病 至就诊时间（>7 d）、听力损失（≥60 dB）、听力曲线类型为高频型或全聋型、伴眩晕、合并高血压、合并糖尿病、血浆黏度（≥2 mPa·s）、血浆 CRP（≥20 μmol/L）为影响 SD 疗效的危险因素（P＜0.05）。结论 高压氧联合地塞米松是治疗SD 的有效方案，但影响其疗效的因素众多，临床治疗时有必要考虑患者临床与病理特征。     

Modified oxygen mask to induce target levels of hyperoxia and hypercarbia during radiotherapy: A more effective alternative to carbogen

Purpose: Carbogen has long been under investigation as an adjuvant to radiotherapy of tumors. A major factor confounding its evaluation is its inconsistency in raising blood partial pressure of CO₂ (pCO₂). We investigated whether a new partial rebreathing method would provide better control of pCO₂ than carbogen.

Methods and materials: We compared the efficacy of each method in 10 healthy volunteers. Volunteers breathed 1.5, 3 and 5% carbogen in 5-min stages via the usual non-rebreathing circuit. All the volunteers then breathed 100% O₂ through a commercial sequential gas delivery (SGD) circuit modified by attaching a reservoir to its exhalation port. Hypercarbia was induced by step reductions in oxygen flow to the SGD circuit. We monitored minute ventilation and end-tidal pCO₂ (ETpCO₂) as a surrogate for its arterial value.

Results: Inhalation of 1.5 and 3% carbogen did not increase ETpCO₂ from baseline (40 ± 1.5 mmHg); 5% carbogen increased ETpCO₂ to 45 ± 1.6 mmHg (p < 0.001). With the SGD circuit, reducing O₂ flow to 4.3 ± 0.7 l/min increased ETpCO₂ in all subjects from 41 ± 2.0 mmHg (baseline) to 46 ± 2.1 mmHg (p < 0.001). Voluntary hyperventilation reduced ETpCO₂ with 5% carbogen but not with SGD (p = 0.379).

Conclusions: We confirm previous observations that carbogen inhalation does not result in a predictable rise in ETpCO₂ and suggest that a precise and stable target ETpCO₂ can instead be induced by simply controlling O₂ flow into a modified SGD circuit. We hoped that the reliable control of pCO₂ will enable studies that address first, the efficacy of raising ETpCO₂ on specific tumor blood flow, and eventually, its benefit as an adjuvant to radiotherapy.     

Animal Model for Evaluating Bone Repair with and without Adjunctive Hyperbaric Oxygen Therapy (HBO): Comparing Dose Schedules

The effect of hyperbaric oxygen (HBO) on the healing of standardized metaphyseal defects in the cortices of rat femurs was studied. The question was whether a known total amount of HBO given twice a day (BID) would have a different effect than once a day (QD) treatments. A microvascular casting technique was developed whereby vessel ingrowth at the repair site could be monitored using scanning electron microscopy (SEM). Bone repair morphology was evaluated by light microscopy (LM) and various tissue components were quantified by histomorphometry (HM). Animals were sacrificed I, 2, 3, or 5 weeks postoperatively. SEM revealed that endosteal bone ingrowth was totally responsible for the repair of the cortical defects. Moreover, endosteal vessel ingrowth did not differ between controls and either group of HBO treated animals. LM displayed enchondral ossification in controls and BID treated animals and a pronounced osteoclastic activity in the latter group throughout the repair process. By contrast the QD treated group healed by primary ossification. Judged by the HM data, QD treatment appeared to accelerate bone repair and vessel ingrowth compared to controls, while BID treatment seemed to retard these processes.     

Pyoderma gangrenosum: A case report of bilateral dorsal hand lesions and literature review of management

Pyoderma gangrenosum is a great masquerader in wound diagnosis and management. Frequently misdiagnosed as a necrotizing infection, the elusive nature of its etiology and pathogenesis has thwarted the establishment of a standardized management algorithm, leaving immunosuppressant therapies as the mainstay of treatment. The present report describes a 61-year-old woman presenting with temporally discrete bilateral dorsal hand lesions successfully managed with distinctive multimodality therapies. The initial lesion was managed under the auspices of a necrotizing process using a combination of hyperbaric oxygen therapy and skin grafting with a negative-pressure dressing, both individually demonstrated to be effective for prompt wound stabilization and coverage. A subsequent contralateral hand lesion was similarly managed as a necrotizing infection before a diagnosis of pyoderma gangrenosum was considered. Stabilization and eventual resolution was achieved using intravenous and topical steroids followed by hyperbaric oxygen therapy, again highlighting the benefits of multimodality therapy in the setting of pyoderma gangrenosum.     

一例体外膜肺氧合成功抢救碘帕醇对比剂致过敏性休克的护理体会

体外膜肺氧合（Extra corporeal membrane oxygenation,ECMO）又称体外生命支持系统,是指将患者的静脉血引流至体外,经人工肺（氧合器）氧合后再输回患者动脉或静脉的中短期心肺辅助治疗,使心肺得到充分休息,为心肺功能的恢复赢得时间[1]。而非离子型造影剂因其渗透压低,没有阳离子的生物学作用,不良反应少,具有良好的血管内皮和神经系统的耐受性,已广泛用于影像检查及介入治疗。     

A case report of acquired methemoglobinemia rescued by veno-venous extracorporeal membrane oxygenation

Rationale:Severe methemoglobinemia (Met-Hb) is rare. The delayed diagnosis and treatment often cause further damage. The management of cellular hypoxemia is challenging and the use of extra-corporeal membrane oxygenation (ECMO) has never been reported.Patient concerns:The young patient, healthy with unremarkable past medical history, was sent to emergency room with out-of-hospital circulatory arrest (OHCA) and severe generalized cyanosis. His family reported he ingested sodium nitrite accidentally.Diagnoses:After successful resuscitation and return of spontaneous circulation (ROSC), the paradoxically normal arterial blood gas (ABG) with the unusual brownish blood led to the suspicion of Met-Hb. The lab test confirmed it and showed a very high level of 80%.Interventions:Because of recovered and normal cardiac function, we placed veno-venous extracorporeal membrane oxygenation (VV-ECMO) for tissue hypoxemia in addition to exchange transfusion, vitamin C, and methylene blue.Outcomes:Met-Hb blood level dropped rapidly. After vigorous rehabilitation for weeks, the patient was able to be discharged home without major neurological sequela.Lessons:VV-ECMO can hyper-oxygenate the hypoxemic tissue regardless the etiology and minimize hypoxemia-reperfusion injury while awaiting the definite diagnosis and therapy.