摘要:目的: 评价机械通气对胸腔内脉搏氧饱和度的影响。 方法 :以食道、气管和降主动脉作为胸腔内脉搏氧饱和度的监测位点,将改制后的氧饱和度探头分别固定于上述部位,并连接于同一监护仪上。纯氧通气,待上述氧饱和度容积波波形和读数稳定,停止机械通气30s。以录像的方式记录机械通气停止前后30 s内食道、气管和降主动脉SpO2容积波和读数的变化。同时记录舌SpO2。 结果 :机械通气时,食道、气管和降主动脉三个监测位点均可获得异常高大的SpO2容积波;停止通气时,异常高大的氧饱和度波形消失。食道、气管和降主动脉脉搏容积波变异率分别为112%,74%,302%。降主动脉脉搏容积波的变异率明显高于食道和气管( 〖WTBX〗P ＜005)。机械通气停止前后30s内食道、气管和降主动脉的SpO2读数变化无显著差异(〖WTBX〗P ＞005)。 结论 :机械通气对胸腔内食道、气管和降主动脉氧饱和度读数无影响,主要影响是脉搏容积波。且各位点间脉搏氧容积波受呼吸的影响不同。Abstract: Objective: To investigate the impact of mechanical ventilation on pulse oximetry in thoracic cavity. Methods : After dogs anesthesia induction and thoracotomy, pulse oximeters were simultaneously placed at esophagus, trachea, and descending aorta, and connected with the same monitor for SpO2 monitoring. During ventilation with 100% oxygen, the mechanical ventilator was temporarily switched off for 30 seconds after high quality PPG waveforms and SpO2 readings were obtained. SpO2 signals and readings from esophagus (SeO2), trachea (StraO2), descending aorta (SDAO2) shown on the monitoring screen were recorded by the SONY video before and after stopventilation. And StonO2 were also recorded. Results : Abnormally largeamplitude PPG waves were found in normal waves at monitoring sites of esophagus, trachea, and descending aorta in all animals during ventilation; however, they disappeared without ventilator. The variation rate in ventilationinduced PPG amplitude were 112%, 74%, 302% at esophagus, trachea and descending aorta respectively. The PPG amplitude variation rate from SDAO2 was higher than that from SeO2 and StraO2 (〖WTBX〗P ＜005). However, the SpO2 readings obtained from pulse oximetries in all sites were no significantly statistical difference within 30s before and after temporarily stopventilation (〖WTBX〗P ＞005). Conclusion : Abnormally amplitude PPG waveforms from oximetry probe placed at esophagus, trachea, and descending aorta were induced by ventilation. The Variation rate in ventilationinduced PPG amplitude was various at different monitoring sites. The SpO2 readings from esophagus, trachea, and descending aorta were not significantly contaminated by ventilation.
Surgerical treatment has been used for portal hypertension over a hundred years, and has evolved from various portosystemic shunts to devascularizations and selective shunts. Selective shunting, which has the advantages of long-term prevention from recurrent variceal bleeding and maintenance of hepatic portal vein perfusion, has developed from single distal splenorenal shunt to various procedures including distal splenocaval shunt, coronary caval shunt, coronary renal shunt, etc. Selective shunting can also be achieved after reconstruction of spontaneous portosystemic shunt. Preoperative portal venous system CT angiography, intraoperative ultrasound Doppler and portal vein pressure measurements may provide patients with a more reasonable treatment of choice.
ObjectiveTo investigate the effects of esophageal cooling (EC) on lung injury and systemic inflammatory response after cardiopulmonary resuscitation in swine.MethodsThirty-two domestic male white pigs were randomly divided into sham group (S group, n=5), normothermia group (NT group, n=9), surface cooling group (SC group, n=9), and EC group (n=9). The animals in the S group only experienced the animal preparation. The animal model was established by 8 min of ventricular fibrillation and then 5 min of cardiopulmonary resuscitation in the other three groups. A normal temperature of (38.0±0.5)℃ was maintained by surface blanket throughout the experiment in the S and NT groups. At 5 min after resuscitation, therapeutic hypothermia was implemented via surface blanket or EC catheter to reach a target temperature of 33℃, and then maintained until 24 h post resuscitation, and followed by a rewarming rate of 1℃/h for 5 h in the SC and EC groups. At 1, 6, 12, 24 and 30 h after resuscitation, the values of extra-vascular lung water index (ELWI) and pulmonary vascular permeability index (PVPI) were measured, and meanwhile arterial blood samples were collected to measure the values of oxygenation index (OI) and venous blood samples were collected to measure the serum levels of tumor necrosis factor-α (TNF-α) and inerleukin-6 (IL-6). At 30 h after resuscitation, the animals were euthanized, and then the lung tissue contents of TNF-α, IL-6 and malondialdehyde, and the activities of superoxide dismutase (SOD) were detected.ResultsAfter resuscitation, the induction of hypothermia was significantly faster in the EC group than that in the SC group (2.8 vs. 1.5℃/h, P<0.05), and then its maintenance and rewarming were equally achieved in the two groups. The values of ELWI and PVPI significantly decreased and the values of OI significantly increased from 6 h after resuscitation in the EC group and from 12 h after resuscitation in the SC group compared with the NT group (all P<0.05). Additionally, the values of ELWI and PVPI were significantly lower and the values of OI were significantly higher from 12 h after resuscitation in the EC group than those in the SC group [ELWI: (13.4±3.1) vs. (16.8±2.7) mL/kg at 12 h, (12.4±3.0) vs. (16.0±3.6) mL/kg at 24 h, (11.1±2.4) vs. (13.9±1.9) mL/kg at 30 h; PVPI: 3.7±0.9 vs. 5.0±1.1 at 12 h, 3.4±0.8 vs. 4.6±1.0 at 24 h, 3.1±0.7 vs. 4.2±0.7 at 30 h; OI: (470±41) vs. (417±42) mm Hg (1 mm Hg=0.133 kPa) at 12 h, (462±39) vs. (407±36) mm Hg at 24 h, (438±60) vs. (380±33) mm Hg at 30 h; all P<0.05]. The serum levels of TNF-α and IL-6 significantly decreased from 6 h after resuscitation in the SC and EC groups compared with the NT group (all P<0.05). Additionally, the serum levels of IL-6 from 6 h after resuscitation and the serum levels of TNF-α from 12 h after resuscitation were significantly lower in the EC group than those in the SC group [IL-6: (299±23) vs. (329±30) pg/mL at 6 h, (336±35) vs. (375±30) pg/mL at 12 h, (297±29) vs. (339±36) pg/mL at 24 h, (255±20) vs. (297±33) pg/mL at 30 h; TNF-α: (519±46) vs. (572±49) pg/mL at 12 h, (477±77) vs. (570±64) pg/mL at 24 h, (436±49) vs. (509±51) pg/mL at 30 h; all P<0.05]. The contents of TNF-α, IL-6, and malondialdehyde significantly decreased and the activities of SOD significantly increased in the SC and EC groups compared with the NT group (all P<0.05). Additionally, lung inflammation and oxidative stress were further significantly alleviated in the EC group compared with the SC group [TNF-α: (557±155) vs. (782±154) pg/mg prot; IL-6: (616±134) vs. (868±143) pg/mg prot; malondialdehyde: (4.95±1.53) vs. (7.53±1.77) nmol/mg prot; SOD: (3.18±0.74) vs. (2.14±1.00) U/mg prot; all P<0.05].ConclusionTherapeutic hypothermia could be rapidly induced by EC after resuscitation, and further significantly alleviated post-resuscitation lung injury and systemic inflammatory response compared with conventional surface cooling.
Objective To investigate the prevalence and predisposing factors of gastroesophageal reflux（GER）in patients with chronic obstructive pulmonary disease（COPD）and its impacts on the frequency of COPD exacerbations.Methods 50 patients with acute exacerbation of COPD were enrolled in the study.All patients filled a modified version of clinically validated standardized Mayo Clinic GER questionnaire.Pulmonary function tests（PFT），body mass index（BMI），serum albumin，and medications were recorded.The patients were divided in to GER group（13 patients with GER symptoms longer than one year and diagnosed GER by gastroscope） and non-GER group（37 patients without GER symptoms）.Results There were no significant differences in the BMI，serum albumin，use of inhaled steroids and theophylline between the two groups.Forced expiratory volume in one second as a percentage of the predicted value（FEV1%pred）（37% vs 38.3%，P=0.608.），residual volume % predicted（123.4 % vs 137.8%，P=0.222），and residual volume to total lung capacity（139.4% vs 141.5%，P=0.798） were not significantly different between the two groups.The number of COPD exacerbations per year was significantly higher in patients with GER compared to patients without GER（4.5 vs 1.3，P=0.006）.Conclusions The severity of airflow obstruction and the hyperinflation is unlikely to contribute to the development of GER.Patients with GER experience significantly more exacerbations per year when compared to patients without GER，suggesting more highlight warrant in treatment of GER in COPD patients.
ObjectiveTo observe the efficacy of dense ligation and non-dense ligation in treating severe esophageal varices. MethodsSixty cirrhotic patients with severe esophageal varices treated in our hospital between January 2009 and October 2011 were divided into two groups based on their operative ways.Group A was the dense ligation group including 32 patients,and group B was non-dense ligation group in which there were 28 patients.Six-shooter multi-band ligators were used for endoscopy.If the number of loop ligature collar was larger than six,it was regarded as dense ligation and the rest was regarded as non-dense ligation. ResultsIn group A,one month after first ligature,six patients were basically cured,24 were greatly improved,and two did not respond to the treatment,with a total effective rate of 93.8% and an average ligation of 1.94 times.In group B,one month after first ligature,one patient was basically cured,24 were greatly improved,and three did not respond to the treatment,with a total effective rate of 89.3% and an average ligation of 2.75 times. ConclusionDense ligation is a safe,reliable and effective approach for esophageal varices,which brings about a high disappearance rate of esophageal varices and reduced ligation frequency.