膈肌电活动的监测与应用

膈肌是最主要的呼吸肌,大约70％的呼吸功由膈肌承担。在危重病和慢性阻塞性肺疾病等慢性疾病患者中,常发生膈肌功能障碍,从而导致呼吸窘迫、呼吸衰竭、机械通气时间延长、呼吸肌依赖及撤机失败。监测膈肌电活动可用于评价膈肌功能及神经肌肉疾病的诊断与治疗。因此,了解膈肌电活动的监测及应用具有重要意义。     

脂多糖作用于气道上皮细胞后对prdx1表达的影响分析

目的分析脂多糖(LPS)作用于气道上皮细胞后对prdx1表达的影响。方法在DMEM/F12培养基(含10%胎牛血清)中培养正常人的气道上皮细胞株(BEAS-2B),将培养的细胞收集起来计数后分别在6孔培养板中或培养皿中铺板,待细胞贴壁12 h后再将浓度不同但体积相同的LPS分别作用于气道上皮细胞。将体积相同的磷酸盐缓冲液(PBS)加入对照组。12 h、24 h后收集细胞,提取细胞RNA、蛋白。结果 1 mg/L LPS 12 h组、10 mg/L LPS 12 h组、1mg/L LPS 24 h组、10 mg/L LPS 24 h组气道上皮细胞prdx1 mRNA表达均显著高于对照组(P 0. 05),而在气道上皮细胞prdx1 mRNA表达方面,10 mg/L LPS 24 h组1 mg/L LPS 24 h组1 mg/L LPS 12 h组10 mg/L LPS 12 h组(P 0. 05)。0. 1 mg/L LPS 12 h组、0. 5 mg/L LPS 12 h组、1 mg/L LPS 12 h组、5 mg/L LPS 12 h组、10 mg/L LPS 12 h组气道上皮细胞prdx1蛋白表达均显著高于对照组(P 0. 05),而在气道上皮细胞prdx1蛋白表达方面,0. 1 mg/L LPS 12 h组0. 5 mg/L LPS 12 h组1 mg/L LPS 12 h组10 mg/L LPS 12 h组5 mg/L LPS 12 h组(P 0. 05)。结论 10 mg/L LPS作用于气道上皮细胞12 h后会提升prdx1基因与蛋白表达。     

评价膈肌功能指导慢性阻塞性肺疾病患者撤机的可行性研究

Objective To evaluate the predictive performance of neuro-mechanical coupling (NMC) and neuro-ventilatory coupling (NVC) in the weaning outcome in patients with chronic obstructive pulmonary disease (COPD). Methods Sixteen patients were enrolled when the criteria for their first spontaneous breathing trial (SBT) was met. A 30-minute SBT was attempted, with the measurement of electrical activity of the diaphragm (Edi) , NMC, NVC, NVC ×NMC, index of rapid shallow breathing (f/Vt) , airway occlusion pressure (P0.1) and f/Vt ×P0.1 at 0, 5 and 30 min. The receiver operating characteristic (ROC) curve was calculated to evaluate the predictive performance of each index. Results Successful weaning(S group) was observed in 6 patients while weaning failure(F group) in 10 patients. (1)The predictive capacity of Edi: at 30 min of SBT, Edi showed higher values in the F group (P ＜ 0. 05), the area under the ROC curves(AUC) was 0. 817(P ＜0. 05). (2) The predictive capacity of NVC and NMC:at 5, 30 min of SBT, NVC and NMC showed higher values in the S group (P ＜0. 05); at 30 min of SBT NVC presented the largest AUC than any other time of SBT (0. 822, P ＜ 0. 05), while the AUC of NMC was 0. 800 (P ＞ 0. 05). (3) The predictive capacity of NVC × NMC: at 30 min of SBT, the AUC of NVC × NMC was larger than NVC (0. 864, P ＜ 0. 05) , showing greater sensitivity (100. 0%) and specificity (83. 3%) .(4) The predictive capacity of f/Vt and P0.1: f/Vt and f/Vt × P0.1 presented poor predictive performance in the failed patients. Conclusions Edi, NVC and NVC × NMC were good predictor for the weaning outcome in patients with COPD.     

血浆置换联合血液滤过在脓毒性休克患者中的疗效观察

目的探讨血浆置换联合血液滤过能否改善早期脓毒性休克患者临床表现及预后。方法回顾性分析2017年12月至2020年12月福建医科大学附属闽东医院ICU收治的55例脓毒性休克患者。根据入科是否使用血浆置换联合血液滤过技术分为血液净化组(n=29)及常规治疗组(n=26)。两组患者均按2016年拯救脓毒症运动指南进行治疗。常规治疗组均不行血液滤过或(和)血浆置换治疗。血液净化组24 h内完成一次血浆置换后立即行血液滤过治疗。监测治疗前及治疗24 h后炎症指标、血流动力学指标、器官功能评分及记录28 d生存状况。计数资料采用χ2检验, 计量资料采用t检验, 采用Kaplan-Meier曲线评估28 d生存状况。结果 (1)入组时两组性别、年龄、基础疾病、APACHEⅡ及SOFA评分差异无统计学意义。(2)入组时两组PCT、CRP及IL-6差异无统计学意义;治疗后, 与常规治疗组相比, 血液净化组PCT、CRP及IL-6均下降[PCT(ng/mL):(50.07±14.54)vs.(57.93±13.42), P=0.043;CRP(mg/L):(85.71±46.05)vs.(115.10±4...     

危重病人实施肠内营养过程的护理安全管理

肠内营养是危重病病人重要支持治疗手段。与肠外相比,肠内营养能减少肠道菌群易位,降低感染率,保护胃肠道黏膜的结构和功能[1]、改善预后、减少感染、缩短入住重症监护病房(ICU)的时间和住院时间[2]。但在危重症病人实施肠内营养的过程中可能会出现错误连接、非计划性拔管、皮肤烫伤、误吸、堵     

乌司他丁治疗脓毒症急性肾损伤的临床疗效分析

目的：探讨乌司他丁（UTI）治疗脓毒症急性肾损伤的临床疗效。方法：回顾性分析2017年6月~2019年12月在ICU治疗的84例脓毒症急性肾损伤患者临床资料,根据是否使用乌司他丁分成对照组和UTI组,各42例。比较两组急性生理学及慢性健康状况评分Ⅱ及序贯器官功能衰竭评分、生化指标、炎症介质以及24 h尿量、肾损伤生物标志物水平。结果：治疗7 d后,UTI组24 h尿量明显多于对照组,急性生理学及慢性健康状况评分Ⅱ及序贯器官功能衰竭评分明显低于对照组,差异有统计学意义（P＜0.05）。UTI组生化指标、炎症介质以及肾损伤生物标志物水平均明显低于对照组,差异有统计学意义（P＜0.05）。结论：UTI能够降低脓毒症急性肾损伤患者炎症介质水平,减轻肾脏损伤,起到一定的保护肾脏、改善病情的作用。     

评价膈肌功能指导慢性阻塞性肺疾病患者撤机的可行性研究

Objective To evaluate the predictive performance of neuro-mechanical coupling (NMC) and neuro-ventilatory coupling (NVC) in the weaning outcome in patients with chronic obstructive pulmonary disease (COPD). Methods Sixteen patients were enrolled when the criteria for their first spontaneous breathing trial (SBT) was met. A 30-minute SBT was attempted, with the measurement of electrical activity of the diaphragm (Edi) , NMC, NVC, NVC ×NMC, index of rapid shallow breathing (f/Vt) , airway occlusion pressure (P0.1) and f/Vt ×P0.1 at 0, 5 and 30 min. The receiver operating characteristic (ROC) curve was calculated to evaluate the predictive performance of each index. Results Successful weaning(S group) was observed in 6 patients while weaning failure(F group) in 10 patients. (1)The predictive capacity of Edi: at 30 min of SBT, Edi showed higher values in the F group (P ＜ 0. 05), the area under the ROC curves(AUC) was 0. 817(P ＜0. 05). (2) The predictive capacity of NVC and NMC:at 5, 30 min of SBT, NVC and NMC showed higher values in the S group (P ＜0. 05); at 30 min of SBT NVC presented the largest AUC than any other time of SBT (0. 822, P ＜ 0. 05), while the AUC of NMC was 0. 800 (P ＞ 0. 05). (3) The predictive capacity of NVC × NMC: at 30 min of SBT, the AUC of NVC × NMC was larger than NVC (0. 864, P ＜ 0. 05) , showing greater sensitivity (100. 0%) and specificity (83. 3%) .(4) The predictive capacity of f/Vt and P0.1: f/Vt and f/Vt × P0.1 presented poor predictive performance in the failed patients. Conclusions Edi, NVC and NVC × NMC were good predictor for the weaning outcome in patients with COPD.     

神经调节辅助通气对急性呼吸窘迫综合征兔呼吸机相关性膈肌功能障碍的影响

Objective To evaluate the effect of neurally adjusted ventilatory assist (NAVA) on prevention of ventilator-induced diaphragmatic dysfunction (VIDD) in ARDS rabbits.Methods Twenty New Zealand white rabbits were randomly divided into 4 groups: ( 1 ) control group ( n = 5 ); ( 2 ) Volume control (VC) group ( n = 5 ); ( 3 ) Pressure support ( PSV ) group ( n = 5 ); (4) NAVA group ( n = 5 ).In VC, PSV and NAVA groups, the rabbits were killed and the diaphragm was removed after 4 hours of ventilation.Animals in the control group were not mechanically ventilated, and the diaphragm was also removed immediately after anesthetizing.In all rabbits, malondialdehyde ( MDA), superoxide disrmutase (SOD) and glutathione(GSH) of diaphragm were measured.Structure of diaphragm was observed by light microscope, electron microscope, constituent ratio and mean cross-sectional area (CSA) of diaphragm fiber.Results (1)MDA: Compared with the control [(0.15 ±0.06)nmol/mg], PSV group[(0.30 ±0.11)nmol/mg], there was no significant difference in MDA of diaphragm in NAVA group [( 0.28 ± 0.19 )nmol/mg] (F = 2.730, P ＞ 0.05).MDA in VC group [(0.40 ±0.16)nmol/mg] was significantly higher than the control group (P＜0.05).(2) SOD: Compared with control [( 111 ± 12) U/mg], PSV group [(93 ± 4) U/mg], there was no significant difference in SOD of diaphragm in NAVA group [( 94 ± 9 )U/mg] (F=4.422,P ＞0.05).SOD in VC group [(80 ±21 )U/mg] was significantly lower than the control group(P ＜0.05).(3)GSH: Compared with control [(5.3 ± 1.0)mg/g] and PSV group [(4.5 ±1.2)mg/g], there was no significant difference in GSH of diaphragm in NAVA group [(5.6 ± 1.0) mg/g](F =3.001 ,P ＞ 0.05 ).GSH in VC group [(3.3 ± 1.7)mg/g] is significantly lower than control and NAVA groups ( P ＜ 0.05 ).( 4 ) Light microscope: In VC group, many changes were observed in the muscle, such as myofibrosis, necrosis, and some of muscle fibers became atrophy, but these were no obvious changes of pathological structure in control, PSV or NAVA groups.(5)Electron microscope: In control, PSV and NAVA groups, the ultrastructure of diaphragm was normal Different from the above 3 groups, some abnormal ultrastructure was observed in VC group, including disrupted myofibrils, swollen mitochondria.(6)CSA of diaphragm fiber: Compared with control and PSV group, there was no significant difference in CSA of diaphragm fiber in NAVA group ( P ＞ 0.05 ); The CSA of type Ⅱ fibers in VC group was markedly lower than control group ( P ＜ 0.05 ) .Conclusions Compared with volume control ventilation, NAVA may mitigate diaphragmatic oxidative stress, atrophy and injury, and prevent VIDD better than VC.     

机械通气时间对机械通气撤机患者膈肌功能的影响分析

目的 探讨机械通气时间对机械通气患者膈肌功能的影响.方法 以2008年12月至2009年12月入住东南大学附属中大医院ICU行机械通气超过24 h,且准备撤机的患者为研究对象,根据机械通气时间分为机械通气≤3d组(A组)及机械通气＞3d组(B组).行自主呼吸实验(SBT)30 min,监测SBT 0、5及30 min时膈肌电位(Edi)、神经肌肉强度指数(NMS)、神经机械耦连指数(NMC)及神经通气耦连指数(NVC)等膈肌功能指标.结果 44例患者纳入研究,A组患者25例(56.8％),B组患者19例(43.2％).①SBT 0 min时A、B两组患者间Edi、NMS、NMC及NVC差异均无统计学意义.②SBT 5 min时B组患者Edi和NMS显著高于A组.③SBT 30 min时B组患者Edi显著高于A组[(23±11)μV比(15±8)μV,P＜0.05];与A组患者NMS相比,B组患者NMS显著增高[(598±309)μV· cpm比(363±224)μV·cpm](P＜0.05),而B组患者NVC则明显低于A组.结论 SBT 30 min时机械通气＞3 d的患者膈肌收缩能力、耐力均下降;提示机械通气时间增加可能是导致膈肌功能下降的重要原因.