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Severe hypoxemia after radiofrequency ablation for atrial fibrillation in palliatively repaired tetralogy of Fallot: A case report
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作者 Zhi-Hang Li Lian Lou +3 位作者 Yu-Xiao Chen Wen Shi Xuan Zhang Jian Yang 《World Journal of Cardiology》 2024年第3期161-167,共7页
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 h... 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. 展开更多
关键词 Atrial fibrillation Radiofrequency ablation Tetralogy of Fallot Right-to-left shunt hypoxemia Medical decision Case report
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Venopulmonary ECMO Improved Hypoxemia and Supported the Right Ventricle in a Patient with Decompensated Eisenmenger Syndrome
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作者 Daniel Manzur-Sandoval Gian Manuel Jiménez-Rodríguez +5 位作者 Edgar García-Cruz Ramón Espinosa-Soto Erika Yamali Ramirez-Marcano Yessenia Máyory Téllez-López José Luis Elizalde-Silva Gustavo Rojas-Velasco 《World Journal of Cardiovascular Surgery》 2024年第1期7-19,共13页
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 r... 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. 展开更多
关键词 Eisenmenger Syndrome Venopulmonary Artery ECMO Refractory hypoxemia Right Ventricular Dysfunction
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Continuous positive airway pressure for treating hypoxemia due to pulmonary vein injury:A case report 被引量:1
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作者 Chao Zhou Shan Song +4 位作者 Jian-Feng Fu Xue-Lian Zhao Hua-Qin Liu Huan-Shuang Pei Hong-Bo Guo 《World Journal of Clinical Cases》 SCIE 2023年第8期1830-1836,共7页
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 e... 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. 展开更多
关键词 Vascular injury Continuous positive airway pressure hypoxemia Bronchial blocker Esophageal carcinoma resection Case report
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Chronic permanent hypoxemia predisposes to mild elevation of liver stiffness 被引量:5
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作者 Mohamed Tahiri Abdenasser Drighil +7 位作者 Yasmine Jalal Dounia Ghellab Wafaa Hliwa Haddad Fouad Wafaa Badre Ahmad Bellabah Rachida Habbal Rhimou Alaoui 《World Journal of Gastroenterology》 SCIE CAS 2014年第30期10564-10569,共6页
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 ... 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. 展开更多
关键词 Liver CARDIOPATHY hypoxemia Stiffness CYANOTIC
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Hypoxemia without persistent right-to-left pressure gradient across a patent foramen ovale:A clinical challenge 被引量:1
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作者 Sadip Pant Kevin Hayes +1 位作者 Abhishek Deshmukh David L Rutlen 《World Journal of Cardiology》 CAS 2013年第7期254-257,共4页
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 fo... 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. 展开更多
关键词 Patent foramen ovale hypoxemia Right-to-left SHUNT SHUNT closure Pulmonary EMBOLISM Atrial SEPTAL defect
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Postoperative secondary aggravation of obstructive sleep apneahypopnea syndrome and hypoxemia with bilateral carotid body tumor:A case report 被引量:2
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作者 Xi Yang Xiao-Guang He +2 位作者 Dong-Hui Jiang Chun Feng Rui Nie 《World Journal of Clinical Cases》 SCIE 2020年第23期6150-6157,共8页
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 rev... 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. 展开更多
关键词 Carotid body tumor Continuous positive airway pressure hypoxemia Obstructive sleep apnea-hypopnea syndrome Head and neck Case report
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The clinical features of idiopathic pulmonary hypertension with nocturnal hypoxemia
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作者 Lu Yan 《中国循环杂志》 CSCD 北大核心 2018年第S01期165-165,共1页
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... 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. 展开更多
关键词 IDIOPATHIC PULMONARY HYPERTENSION NOCTURNAL hypoxemia risk FACTOR
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Phrenic Nerve Injury Is a Differential Diagnosis of Hypoxemia after Video-Assisted Thoracoscopic Thymectomy:2 Cases Report and Literature Review
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作者 Lulu Ma Yuguang Huang 《Chinese Medical Sciences Journal》 CAS CSCD 2020年第2期191-194,共4页
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 hypo... 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. 展开更多
关键词 Phrenic nerve injury hypoxemia video-assisted thoracoscopic surgery
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Effect of improving prehospital hypotension and hypoxemia on the prognosis of patients with traumatic brain injury
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作者 Liang Liang Liwei Wu +3 位作者 Yaowen Hu Xin Li Haiqing Dong Xiaofeng Sun 《Journal of Translational Neuroscience》 2020年第2期34-39,共6页
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 ... 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. 展开更多
关键词 traumatic brain injury(TBI) prehospital hypotension and hypoxemia Glasgow outcome scale(GOS) management guide
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THE EFFECT OF OXYGEN APPLIEDTHROUGH DRID SHIP CONSTANT HEADVESSEL TO DLALYSATE ONDIALYSIS HYPOXEMIA
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作者 Zhenguo Mi, Yusheng Bao,Chun Liu, Xi Cao, Jiasheng Deng, Jin TongDepartment of Urology,First Affiliated Hospital of Shanxi Medical CollegeTaiyuan, 030001, ChinaHui Liang(Clinic of Taiyuan Industrial and Commercial Bank,Taiyuan. 030001,China) 《Chinese Journal of Biomedical Engineering(English Edition)》 1994年第1期35-37,共3页
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 throu... 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. 展开更多
关键词 CONSTANT head VESSEL DIALYSIS hypoxemia.
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俯卧位通气对严重脑功能损伤患者低氧血症的影响
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作者 叶青青 邵绍鲲 +4 位作者 吕海锋 王飞飞 沈国杰 范伟娜 吴晓梁 《中国中西医结合急救杂志》 CAS CSCD 2024年第1期46-49,共4页
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,... 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。 展开更多
关键词 俯卧位通气 脑功能损伤 低氧血症 急性呼吸窘迫综合征
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Stanford A型主动脉夹层术后低氧血症风险因素分析
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作者 刘海渊 高晴云 +2 位作者 张成鑫 刘愚勇 葛圣林 《岭南心血管病杂志》 CAS 2024年第4期351-357,共7页
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... 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。 展开更多
关键词 主动脉夹层 低氧血症 体质量 急诊 深低温停循环
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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
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作者 姚毅真 唐俊 +2 位作者 胡国强 周婷 徐泽波 《石河子大学学报(自然科学版)》 CAS 北大核心 2024年第4期478-483,共6页
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... 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。 展开更多
关键词 鼻咽通气道 气管内表麻 深度镇静 低氧血症
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肺复张在急性A型主动脉夹层术后低氧血症中的应用
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作者 刘阳春 李奇威 +3 位作者 温建麟 陆海素 莫丽勤 曾晓春 《中国现代医生》 2024年第10期22-27,共6页
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... 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。 展开更多
关键词 主动脉夹层 低氧血症 肺复张 呼气末正压通气
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New therapeutic strategy with extracorporeal membrane oxygenation for refractory hepatopulmonary syndrome after liver transplant: A case report
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作者 Belinda Sánchez Pérez María Pérez Reyes +4 位作者 Jose Aranda Narvaez Julio Santoyo Villalba Jose Antonio Perez Daga Claudia Sanchez-Gonzalez Julio Santoyo-Santoyo 《World Journal of Transplantation》 2024年第1期210-214,共5页
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 w... 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. 展开更多
关键词 Liver transplantation Hepatopulmonary syndrome Refractory hypoxemia TREATMENT Extracorporeal membrane oxygenation Case report
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经鼻高流量湿化氧疗在呼吸衰竭低氧血症患者中的应用及规范化护理研究 被引量:3
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作者 解晓旭 梁丽 《中国标准化》 2024年第8期321-324,共4页
目的:经鼻高流量湿化氧疗在呼吸衰竭低氧血症患者中的应用及规范化护理效果研究。方法:本次研究从山东大学齐鲁医院2022年1月到2023年6月收入的呼吸衰竭低氧血症患者中随机抽取76例,按照随机数表法将其分为了对照组和观察组两组。对照... 目的:经鼻高流量湿化氧疗在呼吸衰竭低氧血症患者中的应用及规范化护理效果研究。方法:本次研究从山东大学齐鲁医院2022年1月到2023年6月收入的呼吸衰竭低氧血症患者中随机抽取76例,按照随机数表法将其分为了对照组和观察组两组。对照组接受常规治疗和护理,观察组接受经鼻高流量湿化氧疗以及规范化护理。结果:对照组综合满意29例(76.32%),观察组综合满意36例(94.74%),观察组综合护理满意率显著高于对照组,差异有统计学意义,(P<0.05);治疗后观察组的血气指标结果优于对照组,(P<0.05),有统计学意义;对照组并发症10例(26.32%),观察组并发症3例(7.89%),观察组并发症显著低于对照组,差异有统计学意义,(P<0.05)。结论:经鼻高流量湿化氧疗联合规范化护理方式可以稳定呼吸衰竭患者的临床体征,改善血气指标,降低并发症发生率,可推广。 展开更多
关键词 经鼻高流量湿化氧疗 呼吸衰竭低氧血症患者 规范化护理
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凡纳滨对虾在低氧环境下存活性状的遗传参数评估
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作者 段毓佳 谭建 +5 位作者 栾生 罗坤 王宏杰 隋娟 孟宪红 孔杰 《渔业科学进展》 CSCD 北大核心 2024年第1期138-147,共10页
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... 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。 展开更多
关键词 凡纳滨对虾 低溶解氧 遗传力 组织损伤 选育
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急性Standford A型主动脉夹层术前低氧血症对术后消化道出血的影响分析
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作者 李嘉骏 张宇聪 +2 位作者 王靖 周永智 胡敏 《中国医学前沿杂志(电子版)》 CSCD 北大核心 2024年第7期80-86,共7页
目的探讨急性A型主动脉夹层(acute type A aortic dissection,ATAAD)患者术前低氧血症与术后消化道出血(gastrointestinal bleeding,GIB)的相关性,为ATAAD术后GIB的预测及诊治提供一定的参考。方法通过回顾性队列研究分析123例ATAAD患... 目的探讨急性A型主动脉夹层(acute type A aortic dissection,ATAAD)患者术前低氧血症与术后消化道出血(gastrointestinal bleeding,GIB)的相关性,为ATAAD术后GIB的预测及诊治提供一定的参考。方法通过回顾性队列研究分析123例ATAAD患者围手术期临床资料。通过Logistic回归分析,探讨术前低氧血症与术后出现GIB之间的相关性。基于围手术期指标建立了预测ATAAD患者术后出现GIB的预测模型,通过计算受试者操作特征曲线(receiver op-erator characteristic curve,ROC曲线)曲线下面积(area under the curve,AUC)来评估模型的预测能力。结果纳入的ATAAD患者中,术前低氧血症发生率为26.0%(32/123),术后GIB发生率为8.1%(10/123)。单因素Logistic回归分析结果显示,ATAAD术前低氧血症(P=0.004)、C反应蛋白水平(P=0.021)、白细胞介素-6水平(P=0.020)及术中深低温停循环时间(P=0.001)与术后发生GIB的显著相关。多因素Logistic回归分析结果显示,术前低氧血症(P=0.024)和术中深低温停循环时间(P=0.010)是ATAAD患者术后出现GIB的独立危险因素。基于术前是否合并低氧血症、夹层是否累及肠系膜动脉及术中深低温停循环时间建立的临床预测模型可以很好地预测术后GIB的发生风险(AUC=0.913)。结论本研究发现ATAAD患者术前合并低氧血症与术中深低温停循环时间是术后GIB的独立危险因素。 展开更多
关键词 急性A型主动脉夹层 消化道出血 低氧血症 危险因素 临床预测模型
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成人体外循环下心血管术后重度低氧血症现状及影响因素分析
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作者 张林浩 向玉萍 +1 位作者 罗天会 曾玲 《临床外科杂志》 2024年第8期822-825,共4页
目的探讨成人体外循环下心血管术后重度低氧血症的危险因素。方法2021年1月~2021年12月成人体外循环下心血管术后病人395例。采用电子病历系统收集病人社会人口学资料、疾病相关资料、术前检验结果、术中资料、术后6小时内检验指标及术... 目的探讨成人体外循环下心血管术后重度低氧血症的危险因素。方法2021年1月~2021年12月成人体外循环下心血管术后病人395例。采用电子病历系统收集病人社会人口学资料、疾病相关资料、术前检验结果、术中资料、术后6小时内检验指标及术后72小时内氧合指数;氧合指数≤100 mmHg为重度低氧血症组(20例),氧合指数>100 mmHg为非重度低氧血症组(375例),比较两组病人的围术期临床资料。多因素logistic回归分析成人体外循环下心血管术后重度低氧血症的危险因素。结果395例病人术后重度低氧血症发生率为5.06%(20/395),多因素logistic回归分析显示,体质量指数(BMI,OR=3.713,95%CI 1.946~7.083,P<0.001),术前中性粒细胞计数(OR=1.164,95%CI 1.034~1.312,P<0.012),主动脉阻断时间(OR=1.009,95%CI 1.001~1.018,P=0.030)是成人体外循环下心血管术后重度低氧血症的独立危险因素。术后重度低氧血症组有创通气时间、ICU住院时间、总住院时间延长,再次气管插管率更高(P<0.05)。结论BMI、术前中性粒细胞计数、主动脉阻断时间是成人体外循环下心血管术后重度低氧血症的独立危险因素,术后重度低氧血症病人预后更差。 展开更多
关键词 体外循环 心血管手术 重度低氧血症 危险因素
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幕上深部肿瘤患者术后脱氧失败的影响因素及列线图模型的构建
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作者 齐良 刘雪娇 +4 位作者 朱静文 李鹏 陈亚兰 张安琪 杜文文 《浙江医学》 CAS 2024年第16期1706-1710,1718,共6页
目的探讨幕上深部肿瘤患者全身麻醉术后脱氧失败的影响因素,构建列线图模型并对其进行验证。方法回顾性选择2016年1月至2021年12月在温州医科大学附属第一医院择期全身麻醉下行幕上深部肿瘤切除手术的患者364例,根据麻醉复苏室(PACU)是... 目的探讨幕上深部肿瘤患者全身麻醉术后脱氧失败的影响因素,构建列线图模型并对其进行验证。方法回顾性选择2016年1月至2021年12月在温州医科大学附属第一医院择期全身麻醉下行幕上深部肿瘤切除手术的患者364例,根据麻醉复苏室(PACU)是否脱氧成功,将患者分为脱氧失败组105例和脱氧成功组259例。收集两组患者的一般资料、术中情况及两组患者的麻醉医生工作情况。采用简单随机分组法按8∶2将患者分为训练集291例和验证集73例。对训练集采用单因素和多因素logistic回归分析PACU脱氧失败的危险因素,并构建列线图模型,评估预测效能。结果多因素logistic回归分析发现患者年龄、BMI、地佐辛、输血、麻醉医生交接班是术后脱氧失败的独立危险因素(均P<0.05)。以此构建的列线图预测模型在验证集中的AUC为0.831,灵敏度为0.946,特异度为0.444。结论基于logistic回归分析建立的列线图模型预测效能较好,有助于医务人员预测和预防幕上深部肿瘤患者全身麻醉术后脱氧失败。 展开更多
关键词 幕上深部肿瘤 低氧血症 影响因素 列线图
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