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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 
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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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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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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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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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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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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
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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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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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允许性高碳酸血症在临床中的应用进展
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作者 王玲 钟毅 单热爱 《赣南医学院学报》 2024年第4期404-408,共5页
允许性高碳酸血症在临床上已不仅局限于肺保护的应用,还具有多器官保护作用。本文就允许性高碳酸血症的多器官保护作用及机制进行综述,文献复习结果发现允许性高碳酸血症能够通过抗炎、抗氧化应激减少细胞凋亡、改善组织氧合,对肺、脑... 允许性高碳酸血症在临床上已不仅局限于肺保护的应用,还具有多器官保护作用。本文就允许性高碳酸血症的多器官保护作用及机制进行综述,文献复习结果发现允许性高碳酸血症能够通过抗炎、抗氧化应激减少细胞凋亡、改善组织氧合,对肺、脑产生保护作用;此外还能通过改善线粒体结构、改善心肌缺血再灌注损伤等对脑、心脏具有保护作用,这些发现将为允许性高碳酸血症的后期研究及不同的临床应用提供参考。 展开更多
关键词 允许性高碳酸血症 多器官保护 肺保护
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肺康复护理在慢性阻塞性肺疾病急性加重期伴高碳酸血症患者中的应用效果
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作者 陈苏 陈碧 +3 位作者 嵇桂娟 李玉珍 陈帅 胡霞 《中外医学研究》 2023年第27期87-91,共5页
目的:探究肺康复护理在慢性阻塞性肺疾病(COPD)急性加重期伴高碳酸血症患者中的应用效果。方法:选取2022年2—12月阜宁县人民医院呼吸与危重症医学科收治的80例COPD急性加重期伴高碳酸血症患者。根据随机数表法将其分为对照组和观察组,... 目的:探究肺康复护理在慢性阻塞性肺疾病(COPD)急性加重期伴高碳酸血症患者中的应用效果。方法:选取2022年2—12月阜宁县人民医院呼吸与危重症医学科收治的80例COPD急性加重期伴高碳酸血症患者。根据随机数表法将其分为对照组和观察组,各40例。对照组给予常规护理,观察组在对照组基础上给予肺康复护理。比较两组护理前后呼吸困难情况、日常生活活动能力、心理状态、肺功能、营养状况及诊治效果。结果:护理后,观察组改良版英国医学研究委员会呼吸困难(mMRC)评分低于对照组,Barthel指数评分高于对照组,差异有统计学意义(P<0.05)。护理后,观察组焦虑自评量表(SAS)和抑郁自评量表(SDS)评分均低于对照组,差异有统计学意义(P<0.05)。护理后,观察组第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)及FEV_(1)/FVC%均高于对照组,差异有统计学意义(P<0.05)。护理后,观察组营养状况显著优于对照组,差异有统计学意义(P<0.05)。观察组诊治效果优于对照组,总有效率高于对照组,差异有统计学意义(P<0.05)。结论:针对COPD急性加重期伴高碳酸血症患者使用肺康复护理,一方面有利于改善患者呼吸功能、提高患者日常生活活动能力;另一方面可改善患者心理状态、提高患者营养情况及诊治总有效率。 展开更多
关键词 慢性阻塞性肺疾病急性加重期 高碳酸血症 肺康复护理 常规护理
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体外二氧化碳清除技术的临床应用进展
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作者 张凌 李明鹏 《西南医科大学学报》 2023年第5期369-373,共5页
体外二氧化碳清除技术(extracorporeal carbon dioxide removal,ECCO_(2)R)旨在去除血液中二氧化碳,以缓解高碳酸血症和相关酸中毒的不良影响,为保护性甚至超保护性机械通气提供条件,有助于减少有创呼吸机使用,缩短呼吸机带机时间。近年... 体外二氧化碳清除技术(extracorporeal carbon dioxide removal,ECCO_(2)R)旨在去除血液中二氧化碳,以缓解高碳酸血症和相关酸中毒的不良影响,为保护性甚至超保护性机械通气提供条件,有助于减少有创呼吸机使用,缩短呼吸机带机时间。近年来,该技术在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)、慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)、新冠肺炎及等待肺移植手术等患者中发挥了重要作用。本文就近年来国内外ECCO_(2)R的临床应用进展做一述评,以供临床进一步推广提供参考与借鉴。 展开更多
关键词 体外二氧化碳清除 高碳酸血症 急性呼吸窘迫综合征 慢性阻塞性肺疾病 肺移植
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允许性高碳酸血症对老年胸腔镜食管癌根治术患者术后谵妄的影响 被引量:1
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作者 邵艳梅 宋洁 +3 位作者 杨梦思 黄孝慈 汤昕宇 胡宪文 《天津医药》 CAS 北大核心 2023年第3期282-285,共4页
目的探讨允许性高碳酸血症(PHY)对老年胸腔镜食管癌根治术患者术后谵妄(POD)的影响。方法纳入择期行胸腔镜食管癌根治术的老年(≥65岁)患者92例,用随机数字表法将患者分为正常范围动脉血二氧化碳分压[p(CO_(2))控制在35~45 mmHg]组(N组... 目的探讨允许性高碳酸血症(PHY)对老年胸腔镜食管癌根治术患者术后谵妄(POD)的影响。方法纳入择期行胸腔镜食管癌根治术的老年(≥65岁)患者92例,用随机数字表法将患者分为正常范围动脉血二氧化碳分压[p(CO_(2))控制在35~45 mmHg]组(N组)和轻度PHY[p(CO_(2))控制在46~55 mmHg]组(H组),各46例。记录2组患者清醒时(T_(0))、插管后(T_(1))、气胸0.5 h(T_(2))、气胸1 h(T_(3))、放气10 min(T_(4))时的平均动脉压(MAP)、心率(HR)和脑氧饱和度(rSO_(2));记录2组患者术中输液量、尿量、出血量、麻黄素用量;术后连续3 d记录疼痛视觉模拟评分(VAS),采用谵妄诊断量表(CAM)评估是否发生POD。结果与T_(0)比较,N组和H组患者的MAP、HR及r SO_(2)在T_(1)~T_(4)时均下降(P<0.05);与N组比较,H组患者的MAP和rSO_(2)在T_(2)~T_(4)时较高(P<0.05)。2组患者T_(2)~T_(4)时rSO_(2)与p(CO_(2))呈正相关(rs分别为0.438、0.646、0.554,均P<0.01)。2组患者术中的输液量、尿量及出血量差异无统计学意义(P>0.05);与N组比较,H组患者术中的麻黄素用量减少[(5.8±3.2)mg vs.(4.0±2.5)mg,t=3.014,P<0.01]。2组患者术后3 d VAS评分均逐步降低(P<0.05),2组间VAS评分差异无统计学意义(P>0.05)。H组患者的POD发生率低于N组(8.7%vs.23.9%,χ^(2)=3.903,P<0.05)。结论老年胸腔镜食管癌根治术中采用PHY通气策略有助于优化脑氧供需平衡,提升rSO_(2),降低POD的发生率。 展开更多
关键词 胸腔镜检查 食管肿瘤 谵妄 手术后并发症 高碳酸血 允许性高碳酸血症
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儿童阻塞性睡眠呼吸暂停低通气综合征治疗的研究进展 被引量:4
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作者 董世佳 余静 《临床医学研究与实践》 2023年第2期186-189,194,共5页
儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是儿科一种常见的疾病,其特征是儿童在睡眠过程中频繁发生完全或不完全的上气道阻塞,扰乱儿童正常通气和睡眠结构而引起睡眠中断、低氧血症、高碳酸血症等睡眠障碍。儿童OSAHS是一种异质性和... 儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是儿科一种常见的疾病,其特征是儿童在睡眠过程中频繁发生完全或不完全的上气道阻塞,扰乱儿童正常通气和睡眠结构而引起睡眠中断、低氧血症、高碳酸血症等睡眠障碍。儿童OSAHS是一种异质性和动态的疾病,涉及多学科,具有多种治疗方案。本文回顾了儿童OSAHS治疗方案及其适应证的科学进展,介绍该病的治疗和研究现状。 展开更多
关键词 阻塞性睡眠呼吸暂停低通气综合征 儿童 治疗现状 睡眠中断 低氧血症 高碳酸血症
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PHV在新生儿高碳酸血症患儿治疗中的应用
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作者 晁小云 陈捷 +4 位作者 陈丽萍 喻聪 李琳 陶荔 刘红霞 《中国医学创新》 CAS 2023年第20期132-137,共6页
目的:评估允许性高碳酸血症通气法(PHV)在新生儿高碳酸血症治疗中的应用效果。方法:选取2019年1月—2022年10月江西省儿童医院新生儿重症监护室(NICU)收治的60例呼吸衰竭并发新生儿高碳酸血症为研究对象,根据随机数字表法将其分为对照... 目的:评估允许性高碳酸血症通气法(PHV)在新生儿高碳酸血症治疗中的应用效果。方法:选取2019年1月—2022年10月江西省儿童医院新生儿重症监护室(NICU)收治的60例呼吸衰竭并发新生儿高碳酸血症为研究对象,根据随机数字表法将其分为对照组、试验A组和试验B组,各20例。对照组使用常规通气策略,试验A组和试验B组使用PHV,试验A组pH范围7.30~7.40,PaCO_(2)维持范围45~55 mmHg;试验B组pH范围7.35~7.45,PaCO_(2)维持范围55~65 mmHg。比较三组患儿治疗后临床情况、振幅整合脑电图(aEEG)监测结果、头颅磁共振成像(MRI)异常结果、血流动力学指标及并发症。结果:试验A组和试验B组机械通气时间、住院天数均明显少于对照组,差异均有统计学意义(P<0.05)。出院前,试验A组和试验B组呼吸机相关性肺损伤发生率均明显低于对照组,差异有统计学意义(P<0.05);三组患儿氧疗时间、aEEG监测结果、头颅MRI异常结果、血流动力学指标、气胸、气管插管和动脉导管开放发生率比较,差异均无统计学意义(P>0.05);试验A组和试验B组机械通气时间、氧疗时间、住院天数、aEEG监测结果、头颅MRI异常结果、血流动力学指标和并发症发生率比较,差异均无统计学意义(P>0.05)。结论:安全范围内PHV在新生儿高碳酸血症治疗中安全可靠,且PHV可有效缩短机械通气时间,降低呼吸机相关性肺损伤风险。 展开更多
关键词 新生儿高碳酸血症 允许性高碳酸血症通气法 振幅整合脑电图 头颅磁共振成像 头颅彩超
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