Severe hypoxemia after radiofrequency ablation for atrial fibrillation in palliatively repaired tetralogy of Fallot: A case report

BACKGROUND Patients with tetralogy of Fallot(TOF)often have arrhythmias,commonly being atrial fibrillation(AF).Radiofrequency ablation is an effective treatment for AF and does not usually cause severe postoperative hypoxemia,but the risk of complications may increase in patients with conditions such as TOF.CASE SUMMARY We report a young male patient with a history of TOF repair who developed severe hypoxemia after radiofrequency ablation for AF and was ultimately confirmed to have a new right-to-left shunt.The patient subsequently underwent atrial septal occlusion and eventually recovered.CONCLUSION Radiofrequency ablation may cause iatrogenic atrial septal injury;thus possible complications should be predicted in order to ensure successful treatment and patient safety.

Incidence and Management of Early Postoperative Hypoxemia after Abdominal Surgery at Teaching Hospital

Background: Oxygen saturation refers to the quantity of oxygenated hemoglobin in the blood, that is to say the level of oxygen measurable in the red blood cells when they have passed through the lungs. The aim of this study was to describe the management of early postoperative hypoxemia after abdominal surgery at the Yaounde General Hospital (YGH). Method: This is a quantitative, observational study, with a descriptive aim, which took place in the anesthesiology department of the YGH, over a period of 2 months from August 1st to October 1st, 2023. The study included all the patients ≥18 years, of both sexes who had abdominal surgery under general anesthesia and were willing to participate during the time of data collection. The variables studied were the sociodemographic and clinical characteristics, risk factors for oxygen desaturation, postoperative variations in SPO2 and therapeutic tools. Results: We collected 30 patients among whom 11 presented with early postoperative hypoxemia i.e. a frequency of 36.7%. The age of the patients ranged from 18 to 63 years and the mean was 42.47 ± 13.5 years on average. The sex ratio was 0.5. Hysterectomy was the most commonly performed surgery (23.3%). The most common comorbidity was high blood pressure (30%). Half of the patients had midline incision. Supra-umbilical surgery predominated (56.7%), intraoperative blood loss ≥500 ml in 46.7% of cases. Upper abdominal surgery with, subcostal incision and blood loss ≥500 ml are statistically significant risk factors for the occurrence of early postoperative hypoxemia (P Conclusion: Hypoxemia is the result of impaired respiratory function favored by the conditions encountered during the early postoperative period.

Venopulmonary ECMO Improved Hypoxemia and Supported the Right Ventricle in a Patient with Decompensated Eisenmenger Syndrome

Mechanical circulatory and/or respiratory assistance with extracorporeal membrane oxygenation (ECMO) has become a standard of care for patients with circulatory (venoarterial) and/or respiratory (venovenous) failure refractory to standard therapies. Adult patients with congenital heart disease are an increasingly recognized and growing population and include various groups, such as undiagnosed cases in childhood and palliated and/or corrected cases, which require subsequent care because of residual lesions, cardiac arrest/insufficiency, and arrhythmias, among other conditions. In addition, these patients are prone to developing pathologies that are typical of adulthood with a generally increased risk of morbidity and mortality because of their low reserves and organic damage associated with the underlying heart disease, which makes them candidates for ECMO. These patients represent an additional challenge in this therapy because malformations and the presence of a shunt can generally affect the usual cannulation methods and hemodynamic and oximetry monitoring. Thus, the configuration decision must be made on a case-by-case basis. Here, we present a cannulation method, venopulmonary artery ECMO, which provides hemodynamic and respiratory support, and may be ideal for patients with shunts and/or right ventricular dysfunction. To our knowledge, this is the first report of this configuration in patients with congenital heart diseases.

Chronic permanent hypoxemia predisposes to mild elevation of liver stiffness

AIM:To evaluate the impact of long term permanent hypoxemia noticed in patients with non operated congenital cyanogenic cyanotic cardiopathy on liver stiffness.METHODS:We included ten adult patients with non operated inoperate cyanotic cardiopathy and ten matched patients for age and gender admitted to the gastroenterology department for proctologic diseases;Clinical and laboratory data were collected[age,gender,body mass index,oxygen saturation,glutamate oxaloacetate transaminase(GOT),glutamate pyruvate transaminase(GPT),glycemia and cholesterol].Measurement of hepatic stiffness by transient elastography was carried out in all patients using the Fibroscan device.All patients underwent an echocardiography to eliminate congestive heart failure.RESULTS:Among the patients with cyanotic cardiopathy,median liver stiffness 5.9±1.3 kPa was greater than control group(4.7±0.4 kPa)(P=0.008).Median levels of GOT,GPT,gamma-glutamyltransferase,glycemia and cholesterol were comparable in cardiopathy and control group.In regression analysis including age,gender,body mass index,oxygen saturation,GOT,GPT,glycemia,cholesterol showed that only oxygen saturation was related to liver stiffness(r=-0.63 P=0.002).CONCLUSION:Chronic permanent hypoxemia can induce mild increase of liver stiffness,but further studies are needed to explore the histological aspects of liver injury induced by chronic permanent hypoxemia.

Hypoxemia without persistent right-to-left pressure gradient across a patent foramen ovale:A clinical challenge

Patent foramen ovale (PFO) closure for systemic hypoxemia is controversial. The first systematic, albeit retrospective, study was recently presented which showed good procedural and clinical success for PFO closure for this indication. We present a case of acute right to left intra-cardiac shunt across PFO where the shunting is not persistent. Hence making a decision on PFO closure based on the aforementioned promising trial may not have been the right decision for the patient. This case highlights that the decision on PFO closure for such indication needs to be individualized. We also review the sparse literature on PFO closure for this indication and discuss how the decision making for such indication needs to be individualized.

Postoperative secondary aggravation of obstructive sleep apneahypopnea syndrome and hypoxemia with bilateral carotid body tumor:A case report

BACKGROUND Carotid body tumor(CBT)is a chemoreceptor tumor located in the carotid body,accounting for approximately 0.22%of head and neck tumors.Surgery is the main treatment method for the disease.CASE SUMMARY We reviewed the diagnosis and treatment of one patient who had postoperative secondary aggravation of obstructive sleep apnea–hypopnea syndrome(OSAHS)and hypoxia after surgical resection of bilateral CBTs.This patient was admitted,and relevant laboratory and imaging examinations,and polysomnography(PSG)were performed.After the definitive diagnosis,continuous positive airway pressure(CPAP)treatment was given,which achieved good efficacy.CONCLUSION This case suggested that aggravation of OSAHS and hypoxemia is possibly caused by the postoperative complications after bilateral CBTs,and diagnosis by PSG and CPAP treatment are helpful for this patient.

Continuous positive airway pressure for treating hypoxemia due to pulmonary vein injury:A case report

BACKGROUND Vascular injury during thoracoscopic surgery for esophageal cancer is a rare but life-threatening complication that can lead to severe hypotension and hypoxemia.Anesthesiologists need to provide rapid and effective treatment to save patients'lives.CASE SUMMARY A 54-year-old male patient was scheduled to undergo a thoracoscopic-assisted radical resection of esophageal cancer through the upper abdomen and right chest.While dissociating the esophagus from the carina through the right chest,unexpected profuse bleeding occurred from a suspected pulmonary vascular hemorrhage.While the surgeon attempted to achieve hemostasis,the patient developed severe hypoxemia.The anesthesiologist implemented continuous positive airway pressure(CPAP)using a bronchial blocker(BB),which effectively improved the patient’s oxygenation and the operation was completed success-fully.CONCLUSION CPAP using a BB can resolve severe hypoxemia caused by accidental injury of the left inferior pulmonary vein during surgery.

The clinical features of idiopathic pulmonary hypertension with nocturnal hypoxemia

Objective Hypoxemia is one of the main factors of pulmonary hypertension,and it can also be a complication of pulmonary hypertension,and it is a risk factor for many cardiovascular diseases,which increases the adverse prognosis of patients.At present,there are some controversies about the diagnosis and treatment of sleep apnea disorder in patients with pulmonary hypertension.

Phrenic Nerve Injury Is a Differential Diagnosis of Hypoxemia after Video-Assisted Thoracoscopic Thymectomy:2 Cases Report and Literature Review

Hypoxemia after general anesthesia is not uncommon.For patients after thoracotomy,the differential diagnosis is usually difficult.Surgical,anesthetic,and patient-associated factors may contribute to postoperative hypoxemia.We described two patients who underwent videassisted thoracoscopic thymectomy and developed hypoxemia immediately after extubation.Phrenic nerve injury was suspected in both patients.One case recovered spontaneously without intervention.The second case who had been demonstrated as bilateral phrenic nerve injury after the operation was continuously on ventilator after physical therapy and respiratory training for 2 months.

Effect of improving prehospital hypotension and hypoxemia on the prognosis of patients with traumatic brain injury

Objective:to investigate the effect of improving prehospital hypotension and hypoxemia on the prognosis of different subgroups of patients with traumatic brain injury(TBI).Methods:medical staff were trained about the prehospital first aid for 2 months to fully master the methods of improving prehospital hypotension and hypoxemia,then the prognosis of TBI patients pre-and post-training for 12 months was collected and recorded.The prognostic differences of different TBI subgroups were discussed through data analysis.Results:after the training,the proportion of prehospital hypotension and hypoxemia in TBI patients decreased by 77%(8.5%vs.1.9%)and 63%(9.9%vs.3.6%,P<0.05),respectively.However,only the prognosis of moderate and severe TBI patients was improved,the proportion of patients with"good prognosis^increased by 14%(61.4%vs.70.5%,respectively)and 62%(35.6%vs.58%),and no significant effect showed in mild and critical TBI patients.Conclusion:reducing the incidence of prehospital hypoxemia and hypotension can improve the prognosis of moderate and severe TBI patients,while no significant effect on mild and critical TBI patients.

THE EFFECT OF OXYGEN APPLIEDTHROUGH DRID SHIP CONSTANT HEADVESSEL TO DLALYSATE ONDIALYSIS HYPOXEMIA

Thgrough experimental and clinical observation of the effect or oxygensupplyed in grid shape through constant head vessel on the PaO2 and Sao2 or bloodthrough dialyser, the result suggested that supplying oxygen through constant head vessel in grid shape is one good way to treat dialysis hypoxemia.

Sleep-related hypoxemia aggravates systematic inflammation in emphysematous rats

Background Sleep disturbance is common in patients with emphysema. This study aimed to develop a novel model of sleep-related hypoxemia （SRH） in emphysema （SRHIE） with rats, and to explore the inflammatory status of SRHIE in lung, liver, pancreas, carotid artery and whole blood.Methods Seventy-five male Wistar rats were assigned to 5 groups with 15 per group according to the exposure conditions. The protocols varied with the degree of hypoxia exposure and severity of pre-existing emphysema caused by cigarette smoke exposure： （1） SRH control （SRHCtrl） group, sham smoke exposure （smoke exposure, exposed to smoke of 15 cigarettes twice everyday, 16 weeks） and SRH exposure （12.5% O2, 3 hours, SRH exposure, divide total hypoxia time （1.5 hours or 3 hours） into 4 periods evenly （22.5 minutes or 45 minutes） and distribute these hypoxia periods evenly into physiological sleep time of rats identified by electroencephalogram, week 9 to week 16）; （2） Emphysema control （ECtrl） group, smoke exposure and sham SRH exposure （21% O2, 3 hours）; （3） Short SRH in emphysema （SRHShort） group, smoke exposure and short SRH exposure （12.5% O2, 1.5 hours）; （4） Mild SRH in emphysema （SRHMild） group,smoke exposure and mild SRH exposure （15% O2, 3 hours）; （5） Standard SRH in emphysema （SRHStand） group, smoke exposure and SRH exposure （12.5% O2, 3 hours）. ECtrl, SRHShort, SRHMild and SRHStand groups were groups with emphysematous rats. Two days before the end of exposure, 5 rats in each group were randomly selected for arterial blood gas analysis. In the rest 10 rats in each group, we obtained blood samples and bronchoalveolar lavage fluid （BALF）for routine tests. We also obtained tissue blocks of lung, liver, pancreas, and right carotid artery for pathologic scoring and measurements of liver oxidative stress （measuring hepatic oxidative stress enzymes, superoxide dismutase （SOD） activity, catalase （CAT） activity and malondialdehyde （MDA） concentration）.Results Emphysematous groups had higher mean linear intercept （MLI） and mean alveolar number （MAN） values than SRHCtrl group. MLI values in SRHStand group were the highest （ail P 〈0.05）. O2Sat in SRHStand rats when SRH exposure was （83.45±1.76）%. Histological scores of lung, liver, pancreas and right carotid artery were higher in emphysematous groups than SRHCtrl group, and SRHStand group were the highest （all P 〈0.05） （SOD and CAT values were lower and MDA values were higher in groups with emphysema than without and in SRHStand group than in ECtrl group （all P 〈0.05））. MDA values were the highest in SRHStand group （all P 〈0.05）. Total cellular score in BALF and White blood cell （WBC） in whole blood were the highest in SRHStand group （all P 〈0.05）. Lymphocyte ratios were the highest in SRHStand group both in BALF and blood （all P 〈0.05）. Red blood cell （RBC） and hemoglobin in emphysematous groups were higher than that in SRHCtrl group, and SRHStand group were higher than ECtrl group （all P 〈0.05）.Conclusions With a proper novo model of SRHIE with Wistar rats, we have demonstrated SRH may aggravate the degree of emphysematous changes, polycythemia,oxidative stress and systematic inflammation. SRH and emphysema may have a synergistic action in causing systematic damages, and lymphocyte may be playing a central role in this process. Longer duration and more severe extent of SRHIE exposure also seem to result in more serious systematic damages. The mechanisms of all these concerned processes remain to be studied.

Esophageal pulse oximetry is more accurate and detects hypoxemia earlier than conventional pulse oximetry during general anesthesia

The esophagus is perfused directly by prominent arteries and may provide a more consistent tissue source for pulse oximetry.The goal of this study was to evaluate the sensitivity and accuracy of an esophageal pulse oximetry probe on patients during controlled hypoxemia in comparison to measurements obtained with conventional pulse oximetry(SpulseO_(2)).Forty-five ASA Ⅰ-Ⅱ adult patients were included in this prospective observational study.Nellcor digital oximetric probes were placed on finger tips for SpulseO_(2) before anesthesia.After tracheal intubation,an esophageal probe was placed in the lower segment of the esophagus for esophageal oximetric monitoring(SoesO_(2)).All patients were disconnected from the breathing circuit to establish a controlled hypoxemia,and were re-connected to the breathing circuit and ventilated with 100% oxygen immediately when SoesO_(2) dropped to 90%.Matched SoesO_(2) and SpulseO_(2) readings were recorded when SoesO_(2) measurements were at 100%,95%,90% and the lowest reading.The time for SoesO_(2) and SpulseO_(2) to drop from 100% to 95%,90% and return to 100% was recorded.Oxygen saturation from arterial blood samples(SartO_(2))was also measured at each time point respectively.The linear correlation coefficient of the regression analysis between SartO_(2) and SoesO_(2) was 0.954.The mean±2SD of the difference was 0.3%±4.3% for SoesO_(2) vs.SartO_(2) and 6.8%±5.6% for SpulseO_(2) vs.SartO_(2)(P<0.001).The 95% confidence interval for the absolute difference between SoesO_(2) and SartO_(2) was 0.3% to 0.7% and 6.2% to 7.4%between SpulseO_(2) and SartO_(2).The time to reach 90% saturation measured with SoesO_(2) was approximately 94 seconds earlier than the SpulseO_(2)(P<0.001).In conclusion,SoesO_(2) is more accurate and enables earlier detection of hypoxemia when compared to conventional pulse oximetry during hypoxemia for patients undergoing general anesthesia.

俯卧位通气对严重脑功能损伤患者低氧血症的影响

目的观察俯卧位通气(PPV)在改善严重脑功能损伤患者低氧血症中的临床疗效。方法采用回顾性研究方法,选择2O20年8月至2O21年8月收住在浙江大学医学院附属第一医院重症医学科的140例严重脑功能损伤患者作为研究对象。按照纳入和排除标准,对氧合指数≤200mmHg(1mmHg~0.133kPa)并行PPV的20例患者进行统计分析。比较患者PPV前、PPV后12h、恢复仰卧位后12h血气分析相关指标[包括动脉血氧分压(PaO_(2))吸入氧浓度(FiO_(2))氧合指数、动脉血氧饱和度(SaO_(2))、动脉血二氧化碳分压(PaCO_(2))pH值]和呼吸机相关参数[包括气道峰压(PIP)、呼气末正压(PEEP)、潮气量(VT)、肺动态顺应性(Cdyn)等],以及平均动脉压(MAP)心率(HR)的差异,同时记录患者PPV期间的相关并发症。结果患者男性15例,女性5例;平均年龄(46.10±17.22)岁,平均PPV时间(22.20±5.94)h。与PPV前比较,患者PPV后12h和恢复仰卧位后12hPaO_(2)、氧合指数、SaO_(2)、VT、Cdyn均明显升高[PaO_(2)(mmHg):98.35±21.85、98.45±17.90比72.15±10.14,氧合指数(mmHg):198.82±40.51、202.27±46.39比133.20±33.95,SaO_(2):0.97±0.02、0.97±0.01比0.94±0.03,VT(mL):558.42±111.23、580.29±119.44比484.82±123.77,Cdyn(mL/cmH_(2)O):26.11±5.42、27.90±5.80比24.15±6.13,均P<0.05];与PPV后12h比较,患者恢复仰卧位后12hCdyn亦明显升高(P<0.05)。患者PPV前后各时间点FiO_(2)、PaCO_(2)、pH值、PIP、PEEP、HR、MAP比较差异均无统计学意义(均P>0.05)。5例患者在PPV后出现以颜面部为主的皮肤受压处红肿,恢复为仰卧位后逐渐好转。期间未出现导管脱落、恶性心律失常及明显血流动力学不稳等情况。结论PPV对改善严重脑功能损伤患者的低氧血症有一定临床疗效。

Stanford A型主动脉夹层术后低氧血症风险因素分析

目的了解Stanford A型主动脉夹层患者术后低氧血症的独立危险因素,并探讨术后低氧血症对患者预后的影响。方法对2018年12月至2023年6月安徽医科大学第一附属医院心脏大血管外科共计收治的109例Stanford A型主动脉夹层患者进行围术期资料采集,根据患者术后是否并发低氧血症,将其分为低氧血症组和非低氧血症组。首先,对患者术前及术中资料进行单因素分析,单因素分析后,将具有统计学意义的变量资料行Logistic回归分析,最终明确术后低氧血症的独立危险因素。结果术后非低氧血症组患者64例,低氧血症组患者45例,经单因素分析,两组患者性别(P=0.001)、急诊(P=0.015)、体质量(P=0.000)、术前尿素氮浓度(P=0.008)和深低温停循环时间(P=0.042)比较,差异具有统计学意义。5个变量因素经Logistic回归分析后得出体质量(P=0.001)、急诊(P=0.004)和深低温停循环时间(P=0.015)具有统计学意义,为术后低氧血症的独立危险因素。两组患者术后12 h内清醒(P=0.000)、术后二次气管插管(P=0.017)、术后气管切开(P=0.001)、术后透析(P=0.032)、术后严重脏器损伤(P=0.000)、术后7 d内出重症监护病房(P=0.000)、术后四肢活动障碍(P=0.016)和非医嘱离院(P=0.001)比较,差异均具有统计学意义。结论体质量、急诊和深低温停循环时间是Stanford A型主动脉夹层患者术后低氧血症的独立危险因素。围术期对危险因素采取针对性干预策略,有助于改善患者术后低氧血症的发生率并促进良性临床转归。

经鼻咽喷射局麻药表麻联合深度镇静在气管镜检查中的应用

目的探讨经鼻咽通气道气管内表麻联合深度镇静麻醉方法在气管镜检查中的效果、安全性和可行性。方法选择需行支气管镜检查的患者60例。采用随机数字表法将患者分为2组(n=30):环甲膜局部麻醉组(C组)和鼻咽通气道局部麻醉组(E组)。C组患者在患者入室后经环甲膜穿刺气管内表麻,并常规鼻吸氧疗;E组患者在入室后吸气期经鼻咽通气道喷射诱导咳嗽气管内表麻,并经鼻咽通气道吸氧疗。2组均静脉注射丙泊酚和瑞芬太尼,达到镇静深度(Ramsay>4分)时手术医师置入纤支镜。观察的主要结局是2组患者术中低氧血症发生率;次要结局为入室(T0)、环甲膜穿刺后及鼻咽通气道置入后(T1)、至声门(T2)、至隆突(T3)、清醒时(T4)等时间点的平均动脉压、心率、托下颌、退镜、术中利多卡因总量、手术时间、恢复时间、医生和患者满意度、丙泊酚、瑞芬太尼的用量、咳嗽评分以及其他术中并发症包括术后咽痛、恶心、呕吐和鼻出血的发生率。结果主要结局:与C组比较,E组术中发生低氧血症发生率明显降低(P<0.05)。次要结局:2组利多卡因总量无统计学差异(P>0.05);与C组比较,E组托下颌例数、退镜例数明显减少(P<0.05);与C组比较,E组手术时间明显缩短、医患满意度明显增高、瑞芬太尼用量明显减少(P<0.05);两组恢复时间、丙泊酚用量、咳嗽评分及术后并发症差异均无统计学意义(P>0.05)。结论经鼻咽通气道通气联合喷射局麻药诱导咳嗽的局部麻醉方式,可以防止术中发生低氧血症发生率,缩短手术时间,提高手术医师和患者的满意度。

肺复张在急性A型主动脉夹层术后低氧血症中的应用

目的 探讨肺复张治疗急性A型主动脉夹层(acute type A aortic dissection,ATAAD)术后低氧血症的疗效及安全性。方法 选取2019年11月至2022年5月广西医科大学第一附属医院ATAAD术后低氧血症患者56例,将其随机分为肺复张组(n=36)及常规治疗组(n=20)。常规治疗组患者在肺保护性通气基础上行常规机械通气,肺复张组患者采用呼气末正压通气(positive end expiratory pressure,PEEP)递增法进行肺复张。比较两组患者治疗前后的动脉血气分析、呼吸力学指标、血流动力学指标和血清白细胞介素(interleukin,IL)-6及IL-10水平。结果 治疗后12h、24h,两组患者的动脉血氧分压(arterial partial pressure of oxygen,PaO_(2))、氧合指数(oxygenation index,OI)、肺静态顺应性(C_(stat))及肺动态顺应性(C_(dyn))均显著高于本组治疗前,肺泡动脉氧分压差[PO_(2)(A-a)]、呼吸指数(respiratory index,RI)、气道峰压(P_(peak))及气道平台压(P_(plat))均显著低于本组治疗前(P<0.05);肺复张组患者的PaO_(2)、OI、C_(stat)及C_(dyn)均显著高于常规治疗组,PO_(2)(A-a)、RI、P_(peak)及P_(plat)均显著低于常规治疗组(P<0.05)。肺复张组患者肺复张过程中收缩压及平均动脉压有所下降(P<0.05),中心静脉压有所升高(P<0.05),肺复张结束后均恢复至基线水平。治疗后12h,两组患者的血清IL-6和IL-10水平均显著低于本组治疗前(P<0.05)。结论 PEEP递增法肺复张可改善ATAAD术后低氧血症患者的氧合及肺顺应性,但对血流动力学存在一过性影响,治疗时应进行严密监测。

全麻腹腔镜全子宫切除术患者麻醉苏醒期并发低氧血症相关因素及护理对策

目的:探讨全麻腹腔镜全子宫切除术(LTH)患者麻醉苏醒期并发低氧血症(HXA)的有关因素并提出护理对策。方法:选取2022年3月-2024年1月本院全麻LTH患者280例临床资料进行回顾性分析,采用logistic回归分析LTH患者麻醉苏醒期并发HXA的影响因素。构建回归预测模型并判定模型拟合优度与预测效能。结果:全麻LTH患者麻醉苏醒期HXA发生率为27.1%(76/280)。单因素分析显示,HXA组与无HXA组年龄、体质指数(BMI)、ASA分级、丙泊酚用量、手术时间、麻醉后恢复室(PACU)停留时间比较,有差异(P<0.05)。二元logistic回归分析显示,年龄≥65岁(OR=1.926,95%CI 1.073~3.458)、BMI高(OR=1.824,95%CI 1.485~2.239)、ASA分级Ⅲ级(OR=2.353,95%CI 1.124~4.926)、丙泊酚用量大(OR=1.005,95%CI 1.002~1.008)、手术时间长(OR=1.078,95%CI 1.050~1.107)是全麻LTH患者麻醉苏醒期并发HXA的影响因素(P<0.05)。根据上述影响因素构建预测模型,H-L检验预测模型拟合优度良好,受试者操作特征(ROC)曲线可知,模型对全麻LTH患者麻醉苏醒期并发HXA的预测曲线下面积为0.900,敏感性为80.3%,特异性为87.3%。结论:年龄≥65岁、BMI高、ASA分级Ⅲ级、丙泊酚用量大、手术时间长均可影响全麻LTH患者麻醉苏醒期HXA的发生,且据此建立的预测模型预测效力良好,临床应据此予以针对性预防及护理,以降低麻醉苏醒期HXA发生风险。

New therapeutic strategy with extracorporeal membrane oxygenation for refractory hepatopulmonary syndrome after liver transplant: A case report

BACKGROUND Due to the lack of published literature about treatment of refractory hepatopulmonary syndrome(HPS)after liver transplant(LT),this case adds information and experience on this issue along with a treatment with positive outcomes.HPS is a complication of end-stage liver disease,with a 10%-30%incidence in cirrhotic patients.LT can reverse the physiopathology of this process and restore normal oxygenation.However,in some cases,refractory hypoxemia persists,and extracorporeal membrane oxygenation(ECMO)can be used as a rescue therapy with good results.CASE SUMMARY A 59-year-old patient with alcohol-related liver cirrhosis and portal hypertension was included in the LT waiting list for HPS.He had good liver function(Model for End-Stage Liver Disease score 12,Child-Pugh class B7).He had pulmonary fibrosis and a mild restrictive respiratory pattern with a basal oxygen saturation of 82%.The macroaggregated albumin test result was>30.Spirometry demonstrated a forced expiratory volume in one second(FEV1)of 78%,forced vital capacity(FVC)of 74%,FEV1/FVC ratio of 81%,diffusion capacity for carbon monoxide of 42%,and carbon monoxide transfer coefficient of 57%.He required domiciliary oxygen at 2 L/min(16 h/d).The patient was admitted to the intensive care unit(ICU)and extubated in the first 24 h,needing high-flow therapy and non-invasive ventilation and inhaled nitric oxide afterwards.Reintubation was needed after 72 h.Due to the non-response to supportive therapies,installation of ECMO was decided with progressive recovery after 9 d.Extubation was possible on the tenth day,maintaining a high-flow nasal cannula and de-escalating to conventional oxygen therapy after 48 h.He was discharged from ICU on postoperative day(POD)20 with a 90%-92%oxygen saturation.Steroid recycling was needed twice for acute rejection.The patient was discharged from hospital on POD 27 with no symptoms,with an 89%-90%oxygen saturation.CONCLUSION Due to the favorable results observed,ECMO could become the central axis of treatment of HPS and refractory hypoxemia after LT.

凡纳滨对虾在低氧环境下存活性状的遗传参数评估

在水产养殖中,尤其是高密度养殖情况下,缺氧会短期内造成个体的大量死亡,从而影响生产效益。本研究以凡纳滨对虾(Litopenaeus vannamei)高抗和快大2个品系作为研究对象,利用高致死溶解氧(DO)胁迫的方式,对2个品系各41个家系共计6560尾幼虾进行低氧耐受性测试,统计高致死溶解氧水平下幼虾的存活性状,分析不同品系间及同一品系不同家系间耐低氧性状的差异,评估其遗传参数;对耐受性有显著差异的家系个体的鳃、肌肉、肝胰腺组织进行组织学观察,并比较其细胞水平上的差异。结果显示,在0.3mg/L低氧条件下,高抗品系和快大品系的家系半致死存活率SS50均表现出显著差异(P<0.05),高抗品系SS50为49.30%,快大品系SS50为42.52%;家系间存活时间的变异系数分别为60%和45%。利用阈值性状动物模型,以半致死时的个体存活状态作为观测值(存活为1,死亡为0)估算的遗传参数为(0.345±0.031)~(0.378±0.029),经过转换后在连续变化的观测值尺度上的遗传力为(0.219±0.031)~(0.237±0.029),表现为中等遗传力水平。高抗品系中低氧耐受家系和低氧敏感家系的鳃、肌肉和肝胰腺组织均出现不同程度的损伤,但不同的家系间表现出不同程度的抗逆生理特征差异,这可能与高抗不同家系抗逆耐受力强弱有关。不同家系间在低氧胁迫下的存活时间、生理特性差异以及各品系遗传力估算结果表明,凡纳滨对虾对高致死溶解氧水平的耐受性状存在丰富的遗传变异,具有选育的可行性。