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Pyloric Stenosis and Nonbilious Vomiting in Infants: Negative Base Excess and Hypercapnia—Two Opposing Points of One Scale a Comparative Case Series
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作者 Ralf-Bodo Tröbs Tomasz Baranski +1 位作者 Andreas Lipphaus Matthias Nissen 《Open Journal of Pediatrics》 CAS 2023年第1期104-112,共9页
Background: Blood pH and bicarbonate estimations are basal acid-base laboratory tests that are performed in infants with infantile hypertrophic pyloric stenosis (IHPS). This study aimed to define the clinical value of... Background: Blood pH and bicarbonate estimations are basal acid-base laboratory tests that are performed in infants with infantile hypertrophic pyloric stenosis (IHPS). This study aimed to define the clinical value of pCO<sub>2</sub> and BE in infants suspected to have IHPS. Methods: We collected data from 80 “surgical” infants younger than 100 days with prolonged nonbilious vomiting who were suspected to have IHPS. In 65 infants, pyloric stenosis was confirmed, and 15 infants had nonsurgical conditions. Capillary blood was tested for standard acid-base parameters and lactate. The two groups were compared. Results: Eighty-eight percent of the IHPS infants had elevated standard bicarbonate levels (st bicarb) > 25 mmol/l, and 60% had BE > 3.5 mmol/l;12% of the infants showed hypercapnia (pCO<sub>2</sub> ≥ 50 mmHg) associated with markedly increased standard bicarbonate and BE. Infants with nonsurgical vomiting were older at admission (p = 0.002), had a longer duration of vomiting (p < 0.001), were older (p = 0.002) and weighted more at admission (p = 0.004), had lower pCO<sub>2</sub> (p = 0.021), lower st bicarb (p < 0.001) and lower BE (p = 0.001). In addition, nonsurgical infants showed a trend to anemia (p = 0.002). Conclusions: In infants with IHPS/nonbilious vomiting, acid-base analysis (ABA) is equivocal or inconclusive. These findings may be misleading and could result in a false clinical decision. Nonsurgical vomiting is associated with a lower degree of alkalosis, normocapnia to slight hypercapnia and a base deficit. However, even infants with IHPS may present with a negative BE. In infants with IHPS and severe alkalosis, hypercapnia carries a risk for respiratory depression. Monitoring the infant’s respiration allows for the early detection of respiratory deterioration. 展开更多
关键词 Pyloric Stenosis Nonbilious Vomiting HYPOVENTILATION Base Excess hypercapnia
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Effects of Endoplasmic Reticulum Stress on Pulmonary Hypertension in Rat Induced by Chronic Hypoxia and Hypercapnia 被引量:1
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作者 Congcong Zhang Jingjing Zhang +3 位作者 Yuanling Wu Yongyue Dai Lei Ying Wantie Wang 《Journal of Biosciences and Medicines》 2018年第6期53-67,共15页
Objective: To observe the pulmonary vascular remodeling in rats with pulmonary hypertension induced by hypoxia and hypercapnia, and to explore the role of endoplasmic reticulum stress in pulmonary hypertension. Method... Objective: To observe the pulmonary vascular remodeling in rats with pulmonary hypertension induced by hypoxia and hypercapnia, and to explore the role of endoplasmic reticulum stress in pulmonary hypertension. Methods: 1) 40 SD rats were randomly divided into four groups: normoxic control group (N), hypoxia hypercapnia group (HH), endoplasmic reticulum stress (ERS) inhibitor 4-phenyl butyric acid group (4-PBA), ERS pathway agonist tunicamycin group (TM). 2) The mean pulmonary arterial pressure (mPAP) and the right ventricular hypertrophy index (RV/(LV + S)) were measured in each group. 3) Identification of pulmonary artery smooth muscle cells (PASMCs) in each group by immunofluorescence α-SMA. 4) Morphological changes of lung tissue and pulmonary artery were observed by electron microscope. 5) The apoptotic index of PASMCs in each group was detected by TUNEL. 6) Reverse transcription polymerase chain reaction (RT-PCR) and Western Blot (WB) were used to detect the expression of ERS related protein and mRNA (GRP78, CHOP, JNK, Caspase-12) in each group. Results: 1) Compared with the N group, the mPAP, RV/(LV + S) and vascular wall area (WA)/total area (TA) value of HH group, 4-PBA group and TM group were increased (P < 0.01), and the vascular lumen area (LA)/TA values, PASMCs apoptosis index were significantly decreased. GRP78, CHOP, JNK, Caspase-12 expression were increased, and the differences were statistically significant. 2) Compared with the HH group, the mPAP, RV/(LV + S) and WA/TA of 4-PBA group were decreased (P < 0.01);the LA/TA value and PASMCs apoptosis index were increased (P < 0.05);and the mRNA and protein expression of CHOP, JNK, Caspase-12 and GRP78 had a significant decrease (P < 0.05). 3) Compared with the HH, the mPAP, RV/(LV + S) and WA/TA of TM group were increased (P P P < 0.01);and? PASMCs apoptotic index was increased (P < 0.01). Meanwhile, the mRNA expression of Caspase-12, CHOP, JNK and GRP78 was increased to varying degrees (P < 0.05), and the protein expression of Caspase-12, CHOP and JNK was also increased significantly (P Conclusion: Hypoxia and hypercapnia induced pulmonary vascular remodeling may be related to the proliferation of PASMCs, and ERS related factors (JNK, Caspase12 and CHOP) are involved in the regulation of hypoxic hypercapnia. 展开更多
关键词 ERS PULMONARY ARTERY HYPERTENSION HYPOXIA hypercapnia RAT
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Different Concentrations of Notoginsenoside Rg1 Attenuate Hypoxic and Hypercapnia Pulmonary Hypertension by Reducing the Expression of ERK in Rat PASMCs 被引量:1
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作者 Congcong Zhang Lixiao Ye +4 位作者 Haizhen Jin Meiping Zhao Mengxiao Zheng Longsheng Song Wantie Wang 《Advances in Biological Chemistry》 2016年第1期12-18,共7页
Pulmonary arterial hypertension (PAH) is a serious disease which is characterized by increased vascular resistance and pressure. We have previously hypothesized that panax notoginseng saponins (PNS) might attenuate pu... Pulmonary arterial hypertension (PAH) is a serious disease which is characterized by increased vascular resistance and pressure. We have previously hypothesized that panax notoginseng saponins (PNS) might attenuate pulmonary vasoconstriction under hypoxia and hypercapnia condition. This study aims to investigate the effect of notoginsenoside R<sub>g1</sub>, a main ingredient of PNS, with various concentrations (8, 40, 100 mg/L, respectively) on extracellular signal regulated kinase (ERK1/2) signaling pathway in pulmonary arterial smooth muscle cells (PASMCs). In addition, PASMCs were randomly divided into six groups: SD rat under normoxic condition as control group (N group), hypoxia hypercapnia group (H group), DMSO control group (HD group), R<sub>g1</sub>-treatment groups (R<sub>gL</sub>R<sub>gM</sub> and R<sub>gH</sub> group). Western-blot and RT-PCR were used to test the expression of p-ERK protein and the expression of ERK1 mRNA and ERK2 mRNA. This study provided the evidence that the expression of p-ERK protein and the expression of ERK1 mRNA and ERK2 mRNA in HD group and H group were obviously higher than that in N group (P < 0.01), Whereas the level of ERK1/2 mRNA in R<sub>g1</sub>-treatment groups was significantly lower than that in HD group and H group (P < 0.01), and the proper concentration of R<sub>g1</sub> is 40 mg/L. These results suggested that notoginsenoside R<sub>g1</sub> can attenuate pulmonary vasoconstriction which may lead to HHPV through reducing the expression of ERK1/2. 展开更多
关键词 Pulmonary Arterial Smooth Muscle Cells Hypoxia hypercapnia ERK1/2 Signal Pathway Notoginsenoside Rg1 Rats
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Study of band 3 protein and intraerythrocytic acid-base regulation under chronic isobaric hypoxia and hypoxia-hypercapnia in rats
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作者 杨晓静 毛宝龄 钱桂生 《Journal of Medical Colleges of PLA(China)》 CAS 1995年第3期213-219,共7页
The changes of the structure and content of the erythrocyte membrane band 3 protein and its function of anion transport and blood gases inside and out of the erythrocytes were observed under isobaric hypoxia and hypox... The changes of the structure and content of the erythrocyte membrane band 3 protein and its function of anion transport and blood gases inside and out of the erythrocytes were observed under isobaric hypoxia and hypoxia-hypercapnia in rats. It was found t 展开更多
关键词 HYPOXIA hypercapnia BAND 3 protein ACID-BASE regulation rat
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BAG3-Related Myofibrillar Myopathy Presenting as Hypercapnia:A Case Report and Literature Review
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作者 Yan Xu Shixuan Liu +7 位作者 Wenbing Xu Jinmei Luo Jingwen Niu Zhi Liu Jinming Gao Jinglan Wang Yi Dai Mengzhao Wang 《Chinese Medical Sciences Journal》 CAS CSCD 2021年第4期265-278,共14页
Objective BAG3-related myopathy is a rare condition so far reported in twenty patients worldwide.The purpose of this study was to draw attention to this rare disease and to the fact that BAG3-related myopathy should b... Objective BAG3-related myopathy is a rare condition so far reported in twenty patients worldwide.The purpose of this study was to draw attention to this rare disease and to the fact that BAG3-related myopathy should be considered as a rare differential diagnosis of hypercapnia.Methods We report a sporadic case of a 14-year-old Chinese girl with a de novo p.Pro209 Leu mutation in BAG3 and reviewed the literatures for reported cases related to this mutation.Results We described a 14-year-old Chinese girl who presented with gradually appearing symptoms of hypercapnia that required assisted ventilation.The muscle biopsy and the blood whole-exome sequencing results confirmed the diagnosis of myofibrillar myopathy with a de novo p.Pro209 Leu mutation in BAG3.Totally twentyone patients from twenty families with a confirmed diagnosis of BAG3-related myopathy were reported to date,including this patient and literature review.The male to female ratio was 11:10 and most showed initial symptoms in the first decade of life.Most patients presented toe/clumsy walking or running as the onset symptom,followed by muscle weakness or atrophy.Creatine kinase levels were elevated in fourteen patients and were normal in three.Eighteen patients developed respiratory insufficiency during the disease course and thirteen(one could not tolerate non-invasive assisted ventilation)required non-invasive assisted ventilation for treatment.Except for one not reported,heart involvement was found in seventeen patients during the disease course and seven underwent heart transplantation.Z-disk streaming and aggregation could be observed in most of the patients’muscle histology.In the long-term follow-up,five patients died of cardiac or respiratory failure.Conclusion BAG3-associated myopathy is a rare type of myofibrillar myopathy.It should be considered as a rare differential diagnosis of hypercapnia. 展开更多
关键词 myofibrillar myopathy BAG3 respiratory insufficiency hypercapnia
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Notoginsenoside R<sub>1</sub>Attenuates Hypoxia and Hypercapnia-Induced Vasoconstriction <i>In Vitro</i>by Reducing the Expression of p38
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作者 Congcong Zhang Meiping Zhao +2 位作者 Mengxiao Zheng Longsheng Song Wantie Wang 《Journal of Biosciences and Medicines》 2017年第8期1-10,共10页
Notoginsenoside R1, the main active ingredient of Panax notoginseng saponins (PNS), has been proposed to play fatal roles in the development of hypoxic hypercapnia-induced pulmonary vasoconstriction (HHPV). Subsequent... Notoginsenoside R1, the main active ingredient of Panax notoginseng saponins (PNS), has been proposed to play fatal roles in the development of hypoxic hypercapnia-induced pulmonary vasoconstriction (HHPV). Subsequently, pulmonary arterial smooth muscle cells (PASMCs) lead to pulmonary vascular system remodeling and chronic pulmonary disease in the development of HHPV. Despite considerable studies have contributed to pulmonary disease, the mechanism of how Notoginsenoside R1 affects HHPV remains unclear. In this view, we will discuss the effect of notoginsenoside R1 by investigating the expression of p38 mitogen-activated protein kinase (p38 MAPK) signaling pathway in PASMCs under hypoxia and hypercapnia condition. The third order PASMCs of Sprague Dawley (SD) rats were cultured with various concentrations (8, 40, 100 mg/L, respectively) of Notoginsenoside R1. Our data showed that the protein and mRNA expression levels of p-38 MAPK were higher in hypoxic hypercapnia group compared with hypoxic DMSO and normoxia control groups (p 1 treatment groups, the level of p-p38 MAPK protein and p38 MAPK mRNA were significantly decreased with different degrees (p 1 treatment may contribute to attenuate HHPV via decreasing the protein and mRNA expression levels of p-38 MAPK. 展开更多
关键词 Hypoxic hypercapnia P38 MAPK Notoginsenoside R1 Pulmonary Arterial Smooth Muscle Cells
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Relationship between metabolic syndrome and hypercapnia among obese patients with sleep apnea Relationship between metabolic syndrome and hypercapnia among obese patients with sleep apnea
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作者 Yuka Kimura Takatoshi Kasai +5 位作者 Yasuhiro Tomita Satoshi Kasagi Hisashi Takaya Mitsue Kato Fusae Kawana Koji Narui 《World Journal of Respirology》 2020年第1期1-10,共10页
BACKGROUND In the obese patient population,some patients have severe obstructive sleep apnea(OSA)with daytime hypoventilation.Such patients are generally identified on the basis of the presence or absence of daytime h... BACKGROUND In the obese patient population,some patients have severe obstructive sleep apnea(OSA)with daytime hypoventilation.Such patients are generally identified on the basis of the presence or absence of daytime hypercapnia,and the condition is called obesity hypoventilation syndrome.However,mechanisms for such daytime hypoventilation remain unclear.AIM To investigate metabolic syndrome and daytime hypercapnia association based on hypercapnia prevalence in obese OSA patients in a nested case-control study.METHODS Consecutive obese patients(body mass index≥30 kg/m2)who underwent polysomnography due to suspected OSA were included.Among them,patients with severe OSA(apnea hypopnea index≥30/h)were divided into two groups according to the presence or absence of hypercapnia during wakefulness(arterial partial pressure of carbon dioxide≥or<45 Torr,respectively).The characteristics and clinical features of these two groups were compared.RESULTS Among 97 eligible patients,25 patients(25.8%)had daytime hypercapnia.There were no significant differences in age,gender,body mass index,apnea-hypopnea index,and Epworth Sleepiness Scale scores between the two groups.However,patients with hypercapnia had a significantly lower arterial partial pressure of oxygen level(75.8±8.2 torr vs 79.9±8.7 torr,P=0.042)and higher arterial partial pressure of carbon dioxide level(46.6±2.5 torr vs 41.0±2.9 torr,P<0.001).Additionally,patients with hypercapnia were more likely to have metabolic syndrome(72.0%vs 48.6%,P=0.043)and a higher metabolic score(the number of satisfied criteria of metabolic syndrome).In multivariate logistic regression analysis,the presence of metabolic syndrome was associated with the presence of hypercapnia(OR=2.85,95%CI:1.04-7.84,P=0.042).CONCLUSION Among obese patients with severe OSA,26%of patients had hypercapnia during wakefulness.The presence of metabolic syndrome was independently correlated with the presence of daytime hypercapnia. 展开更多
关键词 Arterial partial pressure of carbon dioxide hypercapnia Metabolic syndrome Obesity hypoventilation syndrome Obstructive sleep apnea Sleep disordered breathing
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经鼻高流量氧疗对稳定期慢性阻塞性肺疾病合并高碳酸血症的疗效分析
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作者 叶青 田瑞雪 +1 位作者 侯洪颜 颜卫峰 《实用临床医药杂志》 CAS 2024年第14期67-71,76,共6页
目的分析经鼻高流量氧疗(HFNC)对稳定期慢性阻塞性肺疾病(COPD)合并高碳酸血症患者的干预效果。方法选取45例需长期氧疗的稳定期COPD合并高碳酸血症患者作为研究对象,根据不同呼吸支持模式分为长期家庭氧疗(LTOT)组、无创通气(NIV)组、H... 目的分析经鼻高流量氧疗(HFNC)对稳定期慢性阻塞性肺疾病(COPD)合并高碳酸血症患者的干预效果。方法选取45例需长期氧疗的稳定期COPD合并高碳酸血症患者作为研究对象,根据不同呼吸支持模式分为长期家庭氧疗(LTOT)组、无创通气(NIV)组、HFNC组,每组15例。比较3组患者出院后一般情况、血气指标、肺功能指标、呼吸状况、生活质量及步行试验结果。结果随访期内,HFNC组、NIV组住院次数、急性加重次数均少于LTOT组,差异有统计学意义(P<0.05);出院后6、12个月,3组动脉血二氧化碳分压[p_(a)(CO_(2))]低于出院前,动脉血氧分压[p_(a)(O_(2))]、脉搏血氧饱和度(SpO_(2))、用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))高于出院前,且HFNC组上述指标变化程度大于NIV组、LTOT组,差异有统计学意义(P<0.05);出院后1、3、6、12个月,3组英国医学研究委员会呼吸困难量表(mMRC)评分、圣乔治呼吸问卷(SGRQ)评分均逐渐降低,6 min步行距离(6MWD)均逐渐增加,且HFNC组上述指标变化程度大于NIV组、LTOT组,差异有统计学意义(P<0.05)。结论HFNC可有效减轻稳定期COPD合并高碳酸血症患者呼吸困难症状,改善肺功能,促进血气指标恢复正常,还可提升生活质量和运动耐力,降低再入院率。 展开更多
关键词 慢性阻塞性肺疾病 高碳酸血症 家庭氧疗 无创通气 经鼻高流量氧疗 肺功能
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Increased CO2 Levels during the First Half of Incubation at High Altitude Modifies Embryonic Development of Fertile Leghorn Breeder Eggs
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作者 Marco A. Juárez-Estrada Erik I. López-Ruiz +2 位作者 Sonia López-Cordova Guillermo Tellez-Isaias Omar F. Prado-Rebolledo 《Food and Nutrition Sciences》 CAS 2024年第7期524-547,共24页
The exchange of oxygen (O2) and carbon dioxide (CO2) within an incubator has a significant impact on embryonic development (ED) and hatching processes. This study examines the influence of non-ventilation (NV) conditi... The exchange of oxygen (O2) and carbon dioxide (CO2) within an incubator has a significant impact on embryonic development (ED) and hatching processes. This study examines the influence of non-ventilation (NV) conditions during the first ten days of incubation at high altitudes on Leghorn hens hatching eggs. Five hundred four hatching eggs were equally divided into three treatment groups and placed in twelve incubators (R = 4). The first group was subjected to standard ventilated conditions (V) during the setting phase. The ventilation inlet holes of the remaining incubators in the NV treatments were closed with either micropore (M) or polypropylene (P) tape, referred to as NVM and NVP groups, respectively. These two different airtight settings were intended to allow for a gradual rise in CO2 naturally generated by the embryos. Results indicate that carbon dioxide concentration gradually increased during the first half of incubation, reaching 1.42% in the NVM group and 1.20% in the NVP group, while the V condition group remained at 0.15%. From 10 days of incubation onwards, normal V conditions were restored in all incubators. The highest hatchability of fertile eggs (HFE) was shown by the NVP group (55.7%), followed by the V (52.6%) and NVM (38.6%) groups. The NVP group showed a greater yolk-free body mass (YFBM) from 10 days of incubation until the hatch basket transfer. NV conditions during the first 10 days of incubation at high altitude produced higher YFBM with gradually decreasing yolk sac mass. In comparison to the NVM and V conditions, the particular NVP condition showed a beneficial impact on the quality of hatched chicks. Sustaining NVP condition (1.2% of CO2) throughout the first half of incubation at high altitude generated the optimal environment in the incubator ensuring the best hatchability results. This study highlights how important it is for hatchery managers to recognize the influence of low O2 and high levels of CO2 on the development trajectories of Leghorn embryos during early incubation at high altitudes. 展开更多
关键词 Non-Ventilation hypercapnia Hypoxia Egg Mass Loss HATCHABILITY Embryonic Mortality Hatchling Chick Quality
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允许性高碳酸血症对老年糖尿病患者术后认知功能的影响
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作者 张静 张婧 +2 位作者 韩霜 李建立 容俊芳 《临床麻醉学杂志》 CAS CSCD 北大核心 2024年第1期30-35,共6页
目的探讨允许性高碳酸血症对老年糖尿病患者术后认知功能的影响。方法选择全麻下行腹腔镜上腹部手术的老年糖尿病患者60例,将患者随机分为两组:允许性高碳酸血症通气糖尿病组(DH组)和常规通气糖尿病组(DR组),每组30例。另选择全麻下行... 目的探讨允许性高碳酸血症对老年糖尿病患者术后认知功能的影响。方法选择全麻下行腹腔镜上腹部手术的老年糖尿病患者60例,将患者随机分为两组:允许性高碳酸血症通气糖尿病组(DH组)和常规通气糖尿病组(DR组),每组30例。另选择全麻下行腹腔镜上腹部手术非糖尿病老年患者60例,将患者随机分为两组:允许性高碳酸血症通气非糖尿病组(NH组)和常规通气非糖尿病组(NR组),每组30例。麻醉诱导后行机械通气,调控呼吸参数使DH组和NH组维持PaCO_(2)45~65 mmHg,DR组和NR组维持PaCO_(2)35~45 mmHg。记录气腹前5 min及气腹后5、15、30 min的PETCO_(2),并采集以上时点桡动脉、颈内静脉血样行血气分析,记录pH值、PaCO_(2),计算动脉-颈内静脉血氧含量差(Da-jvO_(2))和脑氧摄取率(CERO_(2))。检测麻醉诱导前及术后3 d的血清S100β蛋白浓度。记录术前1 d和术后1、3、7 d的蒙特利尔认知评估量表(MoCA)评分和术后认知功能障碍(POCD)的发生情况。结果与气腹前5 min比较,四组气腹后5、15、30 min时PETCO_(2)和PaCO_(2)明显升高,pH值、Da-jvO_(2)和CERO_(2)明显降低(P<0.05)。与麻醉诱导前比较,四组术后3 d血清S100β蛋白浓度均明显升高(P<0.05)。与术前1 d比较,四组术后1、3 d MoCA评分均明显降低(P<0.05)。与DR组比较,DH组气腹前5 min及气腹后5、15、30 min时PETCO_(2)明显升高,pH值、Da-jvO_(2)和CERO_(2)明显降低,术后3 d血清S100β蛋白浓度明显降低,术后1、3 d MoCA评分明显升高,POCD发生率明显降低(P<0.05)。与NR组比较,NH组气腹前5 min及气腹后5、15、30 min时PETCO_(2)明显升高,pH值、Da-jvO_(2)和CERO_(2)明显降低,术后3 d血清S100β蛋白浓度明显降低,术后1、3 d MoCA评分明显升高,POCD发生率明显降低(P<0.05)。与NH组比较,DH组气腹前5 min及气腹后5、15、30 min时Da-jvO_(2)和CERO_(2)明显升高,术后3 d血清S100β蛋白浓度明显升高,术后1、3 d MoCA评分明显降低(P<0.05)。结论允许性高碳酸血症可改善老年糖尿病患者术中脑氧代谢,降低术后血清S100β蛋白浓度,降低术后认知功能障碍的发生率。 展开更多
关键词 老年 高碳酸血症 术后认知功能障碍 糖尿病 S100Β蛋白
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允许性高碳酸血症对腹腔镜胆囊切除术老年患者颈动脉血流和早期认知功能的影响
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作者 腾香芹 柳胜安 +2 位作者 李青 茆庆洪 史宏伟 《生物医学工程与临床》 CAS 2024年第5期673-682,共10页
目的观察腹腔镜胆囊切除术(LC)建立气腹后给予允许性高碳酸血症(PHC)通气策略对老年患者颈动脉血流和早期认知功能的影响。方法选择全身麻醉下行LC的老年患者90例,其中男性45例,女性45例;年龄65~80岁,平均年龄71.00岁(标准差6.71岁);身... 目的观察腹腔镜胆囊切除术(LC)建立气腹后给予允许性高碳酸血症(PHC)通气策略对老年患者颈动脉血流和早期认知功能的影响。方法选择全身麻醉下行LC的老年患者90例,其中男性45例,女性45例;年龄65~80岁,平均年龄71.00岁(标准差6.71岁);身高150~185 cm,平均身高163.77 cm(标准差9.35 cm);体质量46~90 kg,平均体质量66.98 kg(标准差9.60 kg);美国麻醉医师协会(ASA)分级Ⅱ级73例,Ⅲ级17例;美国纽约心脏病协会(NYHA)分级Ⅱ级79例,Ⅲ级11例;文化程度小学20例,中学60例,大学10例。随机分为PHC组(H组,n=45)和常规通气组(C组,n=45)。所有患者在手术开始之前均采用常规通气模式,在建立气腹后,C组调整动脉血二氧化碳分压(PaCO_(2))为35~45 mmHg,H组调整PaCO_(2)在46~55 mmHg。记录所有患者麻醉诱导前(T0)、麻醉诱导后手术前(T1)、气腹后稳定目标值15 min(T2)、气腹后稳定目标值30 min(T3)、缝皮结束(T4)5个时间点的局部脑氧饱和度(rSO_(2))、右颈内动脉收缩期峰值流速(PSV-RICA)、舒张末期峰值流速(EDV-RICA)、右颈内动脉平均流速(VM-RICA)、右颈内动脉流量(Q-RICA)、左颈内动脉流量(Q-LICA)、右颈总动脉收缩期峰值流速(PSV-RCCA)、心率(HR)、平均动脉压(MAP)、心输出量(CO)、鼻咽温度、动脉血气,PaCO_(2)、动脉血氧分压(PaO_(2))、乳酸(Lac)、血糖(Glu),血红蛋白(Hb);并于术前1 d、术后12 h、术后1 d、出院前对患者进行简易精神状态评价量表(MMSE)评分和认知功能筛查量表(CASI)评分。结果(1)与C组比较,H组手术后住院时间较短[(4.60±0.65)d vs(5.17±0.84)d。t=2.915,P<0.05];H组在T1、T2、T3、T4时间点CO均高于C组(均P<0.05);H组PSV-RICA、PSV-RCCA、双侧颈内动脉流量(Q-ICA)在T2、T3、T4时间点均高于C组(P<0.05);H组脑循环阻力(C-SVR)值在T2、T3时间点均低于C组(P<0.05)。(2)与C组比较,T2、T3、T4时H组rSO_(2)、PaCO_(2)、Lac明显升高(P<0.05)。(3)与C组比较,MSE评分在术后12 h和出院前较高(P<0.05),H组CASI评分在术后12 h、术后1 d和出院前较高(P<0.05)。C组和H组MMSE评分和CASI评分在术后12 h、术后1 d均低于术前(P<0.05),且C组MMSE评分和CASI评分在出院前低于术前(P<0.05)。(4)在PHC下,T1时PSV-RICA与rSO_(2)为正相关(P<0.05),相关性大小为0.261。T2时PSV-RICA、PSV-RCCA、Q-RICA与rSO_(2)均具有相关性,相关性大小分别为0.303、0.578、0.350。T3时PSV-RICA、PSV-RCCA、Q-RICA与rSO_(2)均具有相关性,相关性大小分别为0.259、0809、0.419。T4时PSVRICA、PSV-RCCA、Q-RICA与rSO_(2)均具有相关性,相关性大小分别为0.387、0.785、0.263。在PHC下,T1、T2、T4时,PSVRICA与CO呈正相关(R=0.265、0.422、0.405);PSV-RICA、Q-RICA与rSO_(2)呈正相关;在T3时Q-RICA与CO(R=0.301)呈正相关。结论PHC可以增加LC老年患者的颈内动脉血流量及收缩期流速,提高其脑灌注,维持脑氧供需平衡,从而发挥脑保护作用,也可能有利于改善患者手术后早期认知功能的恢复。 展开更多
关键词 允许性高碳酸血症 腹腔镜胆囊切除术 老年患者 脑氧饱和度 颈动脉血流 认知功能
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Effects of therapeutic hypercapnia on inflammation and apoptosis after hepatic ischemia-reperfusion injury in rats 被引量:13
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作者 LI Ai-min QUAN Yan GUO Yue-ping LI Wen-zhi CUI Xiao-guang 《Chinese Medical Journal》 SCIE CAS CSCD 2010年第16期2254-2258,共5页
Background Therapeutic hypercapnia (TH) has been demonstrated to protect several organs ischemia-reperfusion injury.The study aimed to investigate the effects of therapeutic hypercapnia on hepatic ischemia-reperfusi... Background Therapeutic hypercapnia (TH) has been demonstrated to protect several organs ischemia-reperfusion injury.The study aimed to investigate the effects of therapeutic hypercapnia on hepatic ischemia-reperfusion injury (HIRI).Methods Thirty adult male Wistar rats weighing (250 ± 20) g were randomized into 3 groups (n=10 in each), group C (control group), group A (hypercapnia group) and group B (CO2 preconditioning group).A segmental ischemia of the liver was induced by interrupting the blood vessels including the bile duct to the median and left lateral lobes for 60 minutes and all the animals were sacrificed after 240 minutes observation period of reperfusion.Mean arterial pressure (MAP)and the blood gases were measured before ischemia (baseline) and at 30, 60, 120, 180 and 240 minutes after reperfusion.Arterial blood samples were obtained for determination of serum levels of TNF-α, IL-10, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT).The histopathology of liver tissues was evaluated by light microscopy.The NF-κB expression and apoptotic hepatocytes were respectively determined by immunohistochemistry and TUNEL assay.Results The serum levels of liver enzymes and TNF-α were significantly decreased while the IL-10 level was significantly increased in groups A and B than in group C (P 〈0.05), and group B surpassed group A (P 〈0.05).The histopathological scores, the NF-κB immunohistochemical score (IHS) and apoptotic index were significantly lower in groups A and B than in group C (P 〈0.05), and the decrease in group B was more obvious than in group A (P〈0.05).Conclusion Therapeutic hypercapnia attenuates ischemia-reperfusion injury to the liver.Moreover, the effects of CO2preconditioning are outstandingly notable. 展开更多
关键词 hypercapnia CO2 preconditioning LIVER ischemia-reperfusion injury
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Intermittent hypoxia with or without hypercapnia is associated with tumorigenesis by decreasing the expression of brain derived neurotrophic factor and miR-34a in rats 被引量:7
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作者 Zhang Jing Guo Xu +2 位作者 Shi Yanwei Ma Jing Wang Guangfa 《Chinese Medical Journal》 SCIE CAS CSCD 2014年第1期43-47,共5页
Background Very recent studies revealed that obstructive sleep apnoea (OSA) is a contributor of the increased incidence and mortality of cancer in humans,but mechanisms of how OSA promotes tumorigenesis remains larg... Background Very recent studies revealed that obstructive sleep apnoea (OSA) is a contributor of the increased incidence and mortality of cancer in humans,but mechanisms of how OSA promotes tumorigenesis remains largely unknown.We investigated whether intermittent hypoxia with and without hypercapnia plays a role in tumorigenesis.Methods First,Sprague-Dawley (SD) male rats (12 weeks old) were subjected to different hypoxia exposures:intermittent hypoxia and intermittent hypoxia with hypercapnia; continuous hypoxia and normal air.The systemic application of chronic fast rate hypoxia with or without hypercapnia mimicked severe OSA patients with apnoea/hypopnea index equivalent to 60 events per hour.Then routine blood tests were performed and the levels of brain derived neurotrophic factor (BDNF) and miR-34a were examined.Results In contrast to intermittent hypoxia with hypercapnia,both intermittent hypoxia and continuous hypoxia treatments caused significantly higher levels of haematology parameters than normoxia treatments.Compared to normoxia,intermittent hypoxia with hypercapnia exposure resulted in substantial decrease of serum BDNF and,miR-34a in the lower brainstem,while less pronounced results were found in intermittent hypoxia and continuous hypoxia exposure.Conclusions The exposure of intermittent hypoxia with or without hypercapnia,mimicking the situations in severe OSA patients,was associated with,or even promoted tumorigenesis. 展开更多
关键词 intermittent hypoxia hypercapnia sleep apnoea TUMORIGENESIS brain derived neurotrophic factor MIR-34A
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无创机械通气治疗慢性阻塞性肺疾病急性加重期合并高碳酸血症临床疗效及对血气分析炎性因子的影响 被引量:1
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作者 关文霞 靳建峰 马小军 《河北医学》 CAS 2024年第4期593-597,共5页
目的:分析无创机械通气(NIV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并高碳酸血症的临床疗效及对血气分析、炎性因子的影响。方法:回顾性分析我院2022年4月至2023年4月治疗的118例AECOPD合并高碳酸血症患者进行研究,根据治疗的差异... 目的:分析无创机械通气(NIV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并高碳酸血症的临床疗效及对血气分析、炎性因子的影响。方法:回顾性分析我院2022年4月至2023年4月治疗的118例AECOPD合并高碳酸血症患者进行研究,根据治疗的差异将其分为对照组58例(采用氧疗与常规药物治疗)和观察组60例(采用NIV治疗)。对比两组临床疗效、血气指标[酸碱度(pH)、动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))]、炎性因子[白介素-6(IL-6)、白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)]以及T淋巴细胞亚群[CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)]。结果:对照组(63.79%)的总有效率低于观察组(81.67%)(P<0.05);两组治疗前的PaO_(2)、pH、PaCO_(2)比较,差异无统计学意义(P>0.05)。两组治疗前后PaO_(2)、pH、PaCO_(2)差值比较(P>0.05);两组治疗前IL-6、IL-10、TNF-α水平比较(P>0.05);观察组治疗前后IL-6、IL-10、TNF-α差值大于对照组(P<0.05);两组治疗前CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平比较(P>0.05);观察组治疗前后CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)差值大于对照组(P<0.05)。结论:采用NIV治疗可提高AECOPD合并高碳酸血症患者的临床治疗疗效,有效改善炎性因子指标与T淋巴细胞亚群,有助于促进患者全面康复。 展开更多
关键词 无创机械通气 慢性阻塞性肺疾病急性加重期 高碳酸血症 血气分析
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多沙普仑联合经鼻高流量氧疗在COPD合并轻度高碳酸血症治疗中的效果 被引量:1
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作者 朱伟 鲁青芳 崔文旺 《新疆医科大学学报》 CAS 2024年第8期1124-1128,共5页
目的探讨多沙普仑联合经鼻高流量氧疗在慢性阻塞性肺疾病(COPD)合并轻度高碳酸血症治疗中的效果。方法选取2023年1月至2023年7月本院收治的COPD合并轻度高碳酸血症患者96例,采用随机数表法将其分为对照组和研究组,每组各48例。两组均给... 目的探讨多沙普仑联合经鼻高流量氧疗在慢性阻塞性肺疾病(COPD)合并轻度高碳酸血症治疗中的效果。方法选取2023年1月至2023年7月本院收治的COPD合并轻度高碳酸血症患者96例,采用随机数表法将其分为对照组和研究组,每组各48例。两组均给予基础治疗,对照组另给予经鼻高流量氧疗,研究组另给予多沙普仑联合经鼻高流量氧疗治疗。对比两组患者肺功能、血气指标及临床疗效。对比两组患者肺表面活性蛋白(SP-D)、Clara细胞分泌蛋白(CC16)水平及Bathel指数(BI)评分。对比两组患者不良反应发生情况。结果治疗后研究组第1秒用力呼气容积(FEV1)[(1.28±0.25)L vs(1.12±0.21)L]、用力肺活量(FVC)[(2.28±0.3)L vs(2.07±0.35)L]及FEV1/FVC[(56.14±5.12)%vs(54.11±4.78)%]均高于对照组(P<0.05)。治疗后研究组动脉血氧分压(PaO:-2)[(67.21±8.16)mmHg vs(58.43±7.65)mmHg]、血氧饱和度(SpO:-2)[(90.62±8.65)%vs(86.74±7.92)%]均高于对照组(P<0.05),动脉二氧化碳分压(PaCO:-2)[(40.53±2.70)mmHg vs(42.85±2.86)mmHg]低于对照组(P<0.05)。研究组治疗总有效率(93.75%vs 79.17%)高于对照组(χ^(2)=4.360,P=0.037)。两组治疗后SP-D水平[(38.12±9.53)mg/mL vs(40.18±9.85)mg/mL]、CC16水平[(86.14±9.25)ng/mL vs(84.33±9.07)ng/mL]差异无统计学意义(t=1.095、0.968,P=0.276、0.336)。治疗后研究组BI评分[(73.88±6.16)分vs(71.23±5.94)分]高于对照组(t=2.145,P=0.034)。两组患者不良反应总发生率(14.58%vs 10.42%)相近(χ^(2)=0.381,P=0.537)。结论多沙普仑联合经鼻高流量氧疗治疗COPD合并轻度高碳酸血症可提高患者肺功能,改善血气指标,提高临床疗效,提高患者生活质量,且安全可靠。 展开更多
关键词 慢性阻塞性肺疾病 轻度高碳酸血症 多沙普仑 经鼻高流量氧疗 临床疗效 肺功能
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允许性高碳酸血症联合远端缺血预处理对肺癌手术患者脑氧饱和度和术后认知功能障碍的影响
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作者 陆微 朱丹艳 +2 位作者 姜小峰 饶效 彭文勇 《中国现代医生》 2024年第14期19-23,共5页
目的探究允许性高碳酸血症(permissive hypercapnia,PHC)联合远端缺血预处理(remote ischemic preconditioning,RIPC)对胸腔镜肺癌手术患者脑氧饱和度和术后认知功能的影响。方法收集择期胸腔镜肺癌手术患者64例,按随机数字表法分为对... 目的探究允许性高碳酸血症(permissive hypercapnia,PHC)联合远端缺血预处理(remote ischemic preconditioning,RIPC)对胸腔镜肺癌手术患者脑氧饱和度和术后认知功能的影响。方法收集择期胸腔镜肺癌手术患者64例,按随机数字表法分为对照组和联合组,各32例。对照组术中正常通气,联合组给予允许PHC并进行RIPC,PaCO_(2)保持在45~50mmHg(1mmHg=0.133kPa)。记录术前(T_(0))、单肺通气后10min(T_(1))、单肺通气后30min(T_(2))、肺复张后10min(T_(3))及手术结束时(T_(4))5个时间点的局部脑氧饱和度(regional cerebral oxygenregional oxygen saturation,rSO_(2)),颈内静脉血氧饱和度(oxygen saturation of jugular venous blood,SjvO_(2))、计算脑氧摄取率(cerebral oxygen extraction rate,CERO_(2))和脑动静脉血氧含量差值(CaO_(2)-CjvO_(2))。监测上述5个时间点心率(heart rate,HR)及平均动脉压(mean arterial pressure,MAP),记录术前1d和术后1d、3d认知功能评分;术前、术后24h及术后48h检测血清中神经元特异性烯醇化酶(neuronspecific enolase,NSE)、β淀粉样蛋白(beta-amyloid,Aβ)及S100β蛋白(S100β);比较两组患者手术相关指标及术后不良反应情况。结果T_(1)至T_(4)时刻联合组患者rSO_(2)、SjvO_(2)高于对照组而CaO_(2)-CjvO_(2)及CERO_(2)低于对照组。两组患者T0至T_(4)时刻MAP及HR差异无统计学意义。术后1d联合组患者的简易智能精神状态检查量表(mini-mental state examination,MMSE)评分比对照组明显增高,术后24h及术后48h联合组患者血清中NSE、Aβ及S100β水平较对照组降低(P<0.05)。两组患者不良反应发生率及手术相关情况差异无统计学意义(P>0.05)。结论PHC联合RIPC可提高胸腔镜肺癌手术患者的脑氧饱和度,改善脑氧代谢水平,降低血清中神经元特异性烯醇化酶、β淀粉样蛋白及S100β蛋白水平,减轻术后认知功能障碍。 展开更多
关键词 允许性高碳酸血症 远端缺血预处理 肺癌 术后认知功能障碍
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Effects of hypercapnia on nuclear factor-κB and tumor necrosis factor-α in acute lung injury models 被引量:8
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作者 杨丽丽 戢新平 刘志 《Chinese Medical Journal》 SCIE CAS CSCD 2004年第12期1859-1861,共3页
关键词 hypercapnia · acute lung injury · mechanical ventilation · carbon dioxide · nuclear factor-κB · tumor necrosis factor-α
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低血流量体外循环二氧化碳清除效率及其影响因素
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作者 胡臻 李川 +8 位作者 余蓓蕾 古晓燕 孔凌 董建华 杨茜 黄力 吴边 葛永纯 龚德华 《肾脏病与透析肾移植杂志》 CAS CSCD 2024年第2期114-120,共7页
目的:通过猪高碳酸血症模型,研究低流量体外循环二氧化碳清除(ECCO_(2)R)装置的二氧化碳(CO_(2))清除效率及其影响因素。方法:采用控制性低潮气量建立高碳酸血症模型后,6头实验猪接受基于连续性肾脏替代治疗(CRRT)平台进行的ECCO_(2)R... 目的:通过猪高碳酸血症模型,研究低流量体外循环二氧化碳清除(ECCO_(2)R)装置的二氧化碳(CO_(2))清除效率及其影响因素。方法:采用控制性低潮气量建立高碳酸血症模型后,6头实验猪接受基于连续性肾脏替代治疗(CRRT)平台进行的ECCO_(2)R治疗。在治疗的前2 h内,交替采用面积为0.8 m^(2)、1.2 m^(2)的2种膜装置,在气体流量12 L/min情况下,每15 min调整一次,观察血流量(BF)100 mL/min、250 mL/min及400 mL/min时CO_(2)清除量(VCO_(2))的变化;后续2 h则采用0.8 m^(2)面积的装置及BF 400 mL/min情况下,每15 min调整一次,观察气体流量4 L/min、8 L/min及12 L/min时VCO_(2)的变化;在第3个2 h,膜装置不变及固定12 L/min气体流量情况下,同样调整潮气量以改变膜前CO_(2)分压(PCO_(2)pre),观察BF 100 mL/min、250 mL/min及400 mL/min情况下VCO_(2)的变化;在后续时间继续使用原膜装置,固定BF 400 mL/min、气体流量12 L/min及PCO_(2)pre 70 mmHg左右条件持续治疗24 h,观察血气指标随治疗而变化情况。结果:6头猪共5头完成实验,其中一头因膜装置严重凝血而中断治疗。相同BF情况下2种面积的膜装置校正VCO_(2)无显著差异;气体流量变化对VCO_(2)亦无显著影响;而随着BF增大及PCO_(2)pre升高VCO_(2)则显著增加,三者之间的关系可采用下述拟合方程表示:VCO_(2)(mL/min)=0.18×BF(mL/min)+1.21×PCO_(2)pre(mmHg)-59.89(P<0.0001,条件R 2=0.82)。持续24 h治疗中,VCO_(2)基线时最高,达119.33±23.16 mL/min,后续呈缓慢下降并逐渐稳定在60~70 mL/min。动脉CO_(2)分压(PaCO_(2))第1 h由基线59.22±5.22 mmHg降至48.36±5.02 mmHg,pH值由7.30±0.05升至7.39±0.02(P<0.05)。后续治疗中,PaCO_(2)维持在较平稳状态,24 h时为51.04±3.98mmHg(P<0.05);pH值略有回落,24 h时为7.34±0.03(P>0.05)。结论:低流量的ECCO_(2)R的CO_(2)清除效率主要与BF相关,也受到血CO_(2)分压(PCO_(2))的影响。而0.8 m^(2)或1.2 m^(2)膜面积及4~12 L/min的气体流量对CO_(2)清除效率无明显影响。借助于CRRT平台的低流量持续ECCO_(2)R可有效降低PaCO_(2)。 展开更多
关键词 高碳酸血症 连续性肾脏替代治疗 低血流量 体外循环二氧化碳清除
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体外二氧化碳清除治疗Ⅱ型呼吸衰竭的临床初探
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作者 万静怡 鲁杨 +3 位作者 户俊凯 马旭 闫国胜 张宏涛 《中国血液净化》 CSCD 2024年第4期245-249,共5页
目的探讨体外二氧化碳清除(extracorporeal carbon dioxide removal,ECCO_(2)R)治疗接受连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)合并Ⅱ型呼吸衰竭患者的临床疗效。方法回顾性分析2020年12月—2022年7月就诊于... 目的探讨体外二氧化碳清除(extracorporeal carbon dioxide removal,ECCO_(2)R)治疗接受连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)合并Ⅱ型呼吸衰竭患者的临床疗效。方法回顾性分析2020年12月—2022年7月就诊于重症监护室(intensive care unit,ICU)应用ECCO_(2)R治疗合并Ⅱ型呼吸衰竭的CRRT患者(干预组)11例和同期未应用ECCO_(2)R治疗的合并Ⅱ型呼吸衰竭的CRRT患者(对照组)11例,收集患者开始治疗前和治疗24小时后的血气分析结果,比较患者治疗前后动脉血二氧化碳分压(PaCO_(2))、pH值、动脉血氧分压(PaO_(2))、碱剩余(BE)、碳酸氢根(HCO_(3)^(-))、乳酸(Lac)等指标的变化。结果与对照组相比,应用ECCO_(2)R治疗前干预组PaCO_(2)较高(Z=2.988,P=0.002),治疗后差异无统计学意义(Z=-0.230,P=0.847);应用ECCO_(2)R治疗24小时后干预组pH值(t=-3.656,P=0.002)、BE(t=3.185,P=0.001)、HCO_(3)^(-)(t=2.791,P=0.004)、Lac(Z=-2.397,P=0.016)较对照组高。干预组应用ECCO_(2)R治疗后,pH值较治疗前升高(t=-2.948,P=0.008),PaCO_(2)较治疗前下降(Z=-3.447,P<0.001)。结论EC-CO_(2)R可纠正合并Ⅱ型呼吸衰竭CRRT患者的高碳酸血症,但能否改善预后尚需大样本临床研究。 展开更多
关键词 体外二氧化碳清除 连续性肾脏替代治疗 Ⅱ型呼吸衰竭 高碳酸血症
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经鼻高流量氧疗与传统氧疗在伴轻度高碳酸血症慢性阻塞性肺疾病急性加重期的临床应用分析
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作者 王莉 杨礼波 张伟男 《中外医疗》 2024年第28期43-46,共4页
目的分析在伴轻度高碳酸血症慢性阻塞性肺疾病急性加重期患者的临床治疗中,经鼻高流量氧疗和传统氧疗的治疗效果。方法方便选取2021年1月—2022年7月宿迁第三医院收治的85例慢性阻塞性肺疾病急性加重期患者作为研究对象,根据不同治疗方... 目的分析在伴轻度高碳酸血症慢性阻塞性肺疾病急性加重期患者的临床治疗中,经鼻高流量氧疗和传统氧疗的治疗效果。方法方便选取2021年1月—2022年7月宿迁第三医院收治的85例慢性阻塞性肺疾病急性加重期患者作为研究对象,根据不同治疗方法将其分为对照组(42例,实施传统氧疗)和观察组(43例,实施经鼻高流量氧疗),对比两组临床疗效、血气指标水平、肺功能水平、血液嗜酸性粒细胞(eosinophils,EOS)水平。结果观察组治疗总有效率[97.67%(42/43)]高于对照组[80.95%(34/42)],差异有统计学意义(χ^(2)=4.634,P=0.031)。治疗前,两组血气指标水平、肺功能比较,差异无统计学意义(P均>0.05);治疗后,观察组血气指标水平、肺功能优于对照组,差异有统计学意义(P均<0.05)。治疗前,两组EOS水平比较,差异无统计学意义(P>0.05);治疗后,观察组EOS百分比和绝对值均低于对照组,差异有统计学意义(P均<0.05)。结论在伴有轻度高碳酸血症慢性阻塞性肺疾病且处于急性加重期的患者治疗中,经鼻高流量氧疗效果显著。 展开更多
关键词 经鼻高流量氧疗 传统氧疗 轻度高碳酸血症 慢性阻塞性肺疾病 急性加重期
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