高血压是我国重点防治的心血管疾病, 血压的控制率备受关注。在一些血压控制不良的患者中睡眠呼吸暂停是导致顽固性高血压的重要原因。以睡眠过程中反复、频繁出现呼吸暂停和低通气为特点的睡眠呼吸暂停低通气综合征( sleep apneahypopnea syndrome, SAHS) 自20 世纪80 年代以来也受到广泛关注, 临床和基础研究取得了迅速发展。目前, 多项临床、流行病学和基础研究证实SAHS可以导致和/ 或加重高血压, 与高血压的发生发展密切相关。
目的:分析长期机械通气患者脱机成败原因,提高脱机成功率。方法:针对本院2003年5月至2008年10月近6年ICU172例长期机械通气患者成败原因进行分析。结果:总脱机成功率90.69%。脱机失败率 9.31%。结论:长期机械通气患者多存在多种因素的共同参与,如营养不良、全身衰弱、呼吸功能不全、通气泵衰竭和心理因素等,增加了脱机的难度,进而出现撤机困难。
In order to guide diagnosis and treatment in children with sleep disordered breathing aged 1 to 23 months, the European Respiratory Society(ERS) summarized the evidence and released the European Respiratory Society statement based on clinical experience in 2016. This article aims to interpret the ERS statement. Children with apparent upper airway obstruction during wakefulness and those with SDB symptoms and complex conditions requires treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions. Obstructive SDB in children aged 1 to 23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities.
Objective To determine the usefulness of serial measurements of the rapid shallow breathing index ( f/VT , RSBI) as a predictor for successfully weaning of patients undergoing prolonged mechanical ventilation ( gt; 72 hours) . Methods 76 mechanically ventilated patients were prospectively analyzed. 120-min spontaneous breathing trial was conducted after the patients having fullfiled the traditional weaning criteria, and RSBI were continuously monitored by the ventilator at five time points ( 5, 15, 30,60, and 120 min) . A repeated measure of general linear model in SPSS 15.0 was conducted to analyze the data. Results 62 patients completed 120-minute spontaneous breath trial and in which 20 patients failed weaning. There was no significant difference of RSBI at five time points during weaning ( P gt;0. 05) . But thevariation trends of RSBI during weaning time were significant different between the successful weaning patients and the failed weaning patients ( P lt; 0. 05) . Conclusions In patients undergoing prolonged mechanical ventilation, the variation trend of RSBI is more valuable than single RSBI in the prediction ofsuccessful weaning.
Objective To analyze different characteristics of extra-vascular lung water ( EVLW) in the patients with acute respiratory distress syndrome( ARDS) , and examine its prognostic value. Methods 23 patients with ARDS admitted between November 2010 and December 2011 were divided into a survival group( n=13) and a dead group( n =10) according to the outcome. The hemodynamic status including extravascular lung water index( EVLWI) was measured in 3 consecutive days, and the relationship between EVLWI and the prognosis of patients was analyzed. Results On the first day of diagnosis, the EVLWI was higher in both groups in comparison with normal value. It was ( 13. 9 ±3. 45) mL/kg in the survival group and ( 14. 87 ±5. 75) mL/kg in the dead group( P gt;0. 05) . However, on the second day, the EVLWI in the survival group dropped significantly after intensive intervention, but the patients in the dead group did not respond well to the treatment and the EVLWI declined slightly. The EVLWI of both groups began to diverge significantly fromeach other, showing average value of ( 11. 07 ±2. 51) mL/kg and ( 15.63 ±5. 05) mL/kg, respectively( P lt; 0. 05) . On the third day, this difference between two groups was still more remarkable, resulting in ( 10.32 ±1.57) mL/kg vs. ( 16. 6 ±4. 33) mL/kg( P lt; 0. 01) . Conclusions The changes of EVLWI can be used to evaluate the effectiveness of treatment and predict the prognosis of patients with ARDS. EVLWI would likely be an indicator to evaluate the pulmonary capillary leakage.
目的:探讨循证护理在气管切开术患者呼吸道管理中应用的效果及措施。方法:将104例患者随机分为观察组和对照组各52例。观察组重点从“气道湿化、肺部物理疗法、吸痰、气道感染的预防、口咽部护理”几个方面进行循证,获取最佳证据,指导临床护理,对照组按传统护理法。结果:观察组患者并发症的发生率、死亡率显著低于对照组,患者及家属对护理工作的满意率明显提高。结论:运用循证护理能减少患者并发症的发生,降低病死率,提高生存质量。
Objective The risk factors of noninvasive positive pressure ventilation (NPPV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with failure of respiratory failure were identified by meta-analysis, so as to provide a basis for early clinical prevention and treatment failure and early intervention. Methods PubMed, The Cochrane Library, EMbase, China National Knowledge Infrastructure, Wanfang, VIP and CBM Data were searched to collect studies about risk factors about failure of noninvasive positive pressure ventilation in AECOPD and respiratory failure published from January 2000 to January 2021. Two researchers independently conducted literature screening, literature data extraction and quality assessment. Meta-analysis was performed on the final literature obtained using RevMan 5.3 software. Results Totally 19 studies involving 3418 patients were recruited. The statistically significant risk factors included Acute Physiology and Chronic Health Evaluation (APACHEⅡ) score, pre-treatment PCO2, pre-treatment pH, Glasgow Coma Scale (GCS), respiratory rate (RR) before treatment, body mass index (BMI), age, C-reactive protein (CRP), renal insufficiency, sputum disturbance, aspiration of vomit. Conclusions High APACHE-Ⅱ score, high PCO2 before treatment, low pH value before treatment, low GCS score, high RR before treatment, low BMI, advanced age, low albumin, high CRP, renal insufficiency, sputum disturbance, and vomit aspiration were the risk factors for failure of respiratory failure in patients with COPD treated by NIPPV. Failure of non-invasive positive pressure ventilation in COPD patients with respiratory failure is affected by a variety of risk factors, and early identification and control of risk factors is particularly important to reduce the rate of treatment failure.
Objective To study the clinical feasibility of invasive mechanical ventilation with bilevel positive airway pressure（BiPAP） non-invasive ventilator in the stable patients needing prolonged mechanical ventilation.Methods Eleven patients with respiratory failure admitted in intensive care unit（ICU）of our department，who needed prolonged mechanical ventilation，between Jun 2004 and Nov 2007 were enrolled in the study and followed until death or Jan 2008.The arterial blood gas analysis data，length of stay(LOS)，LOS after changing to BiPAP non-invasive ventilator（Synchrony，Harmony，RESPIRONICS，VPAP III ST-A，RESMED），survival time after discharge(or fulfilled the discharge standards) were reviewed retrospectively.Results The settings of inspiratory pressure，expiratory pressure and respiratory rate of non-invasive ventilation were 21.3 (16-26) cm H2O，4 cm H2O，and 16 min-1，respectively.The LOS (or up to the discharge standard) was (91.5±50.2) days.The LOS (or up to the discharge standard) after changing to BiPAP ventilator was (23.5±12.2) days.The mean survival time after discharge (or up to the discharge standard) was (353.1±296.5) days.Four patients were still alive up to the end of the study.The arterial pH，PaCO2，PaO2，and SaO2 were not significant different before and after changing to BiPAP ventilator.Conclusion The mechanical ventilation with BiPAP non-invasive ventilator via tracheotomy tube is an alternative choice for stable patients needing prolonged mechanical ventilation.
Objective To investigate the correlation between serum level of visfatin and obesity in patients with obstructive sleep apnea hypopnea syndrome ( OSAHS) . Methods Forty-seven patients with OSAHS and 20 healthy controls were recruited in this study. Polysomnography was performed in all subjects to detect apnea-hypopnea index ( AHI) . The serumlevels of cisfatin, C-reactive protein ( CRP) , TNF-α, and IL-6 were measured by enzyme linked immunosorbent assay. The body mass inex ( BMI) was calculated.The level of cisfatin was compared between the OSAHS patients with different severity and the controls, and its relationship with the levels of AHI, BMI, CRP, TNF-α, and IL-6 was analyzed. Results The serumlevel of visfatin in the OSAHS patients was higher significantly than that in the controls ( P lt;0. 01) and increased by the severity of OSAHS. There were positive correlations between the serum level of visfatin and AHI,BMI, CRP, TNF-α, IL-6 in the OSAHS patients ( P lt;0. 05) . Conclusion The expression of visfatin may play an important role in the pathogenesis of OSAHS.