目的探讨鼻氧管、氧气面罩和氧袋面罩三种吸氧方法治疗重型病毒性肺炎患者的临床效果。方法113例重型病毒性肺炎患者为研究对象,其中,32例接受鼻氧管吸氧氧疗(鼻氧管组),40例接受氧气面罩吸氧氧疗(氧气面罩组),41例接受氧袋面罩吸氧氧疗...目的探讨鼻氧管、氧气面罩和氧袋面罩三种吸氧方法治疗重型病毒性肺炎患者的临床效果。方法113例重型病毒性肺炎患者为研究对象,其中,32例接受鼻氧管吸氧氧疗(鼻氧管组),40例接受氧气面罩吸氧氧疗(氧气面罩组),41例接受氧袋面罩吸氧氧疗(氧袋面罩组)。对比三组患者吸氧治疗前后的血气分析监测结果[pH值、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、氧合指数(OI)、血氧饱和度(SpO_(2))],OI<300 mm Hg(1 mm Hg=0.133 kPa)持续时间、治疗有效率及气管插管率。结果治疗前,三组患者的pH值、PaO_(2)、PaCO_(2)、OI、SpO_(2)对比,差异无统计学意义(P>0.05)。氧袋面罩组治疗48 h后的pH值高于本组治疗前,差异具有统计学意义(P<0.05);氧袋面罩组治疗24、48 h后的PaO_(2)高于本组治疗前,且高于氧气面罩组及鼻氧管组同时点,差异具有统计学意义(P<0.05);氧袋面罩组治疗24、48 h后的OI高于氧气面罩组及鼻氧管组同时点,差异具有统计学意义(P<0.05);三组患者治疗24、48 h后的SpO_(2)均高于本组治疗前,差异具有统计学意义(P<0.05)。氧袋面罩组患者的OI<300 mm Hg持续时间为(8.32±3.82)d、治疗有效率为70.7%、气管插管率为19.5%;氧气面罩组患者的OI<300 mm Hg持续时间为(9.34±4.36)d、治疗有效率为67.5%、气管插管率为22.5%;鼻氧管组患者的OI<300 mm Hg持续时间为(12.35±4.64)d、治疗有效率为56.3%、气管插管率为31.3%。氧袋面罩组及氧气面罩组患者的OI<300 mm Hg持续时间均短于鼻氧管组,差异具有统计学意义(P<0.05);氧袋面罩组及氧气面罩组患者的OI<300 mm Hg持续时间对比,差异无统计学意义(P>0.05);三组患者的治疗有效率及气管插管率两两对比,差异无统计学意义(P>0.05)。结论氧气面罩、氧袋面罩吸氧氧疗应用于重型病毒性肺炎患者较鼻氧管吸氧氧疗可更明显改善患者的血气指标,具有较高的安全性。展开更多
BACKGROUND Emergency surgical resection is a standard treatment for right-sided malignant colonic obstruction; however, the procedure is associated with high rates of mortality and morbidity. Although a bridge to surg...BACKGROUND Emergency surgical resection is a standard treatment for right-sided malignant colonic obstruction; however, the procedure is associated with high rates of mortality and morbidity. Although a bridge to surgery can be created to obviate the need for emergency surgery, its effects on long-term outcomes and the most practical management strategies for right-sided malignant colonic obstruction remain unclear.AIM To determine the appropriate management approach for right-sided malignant colonic obstruction.METHODS Forty patients with right-sided malignant colonic obstruction who underwent curative resection from January 2007 to April 2017 were included in the study.We compared the perioperative and long-term outcomes of patients who received bridges to surgery established using decompression tubes and those created using self-expandable metallic stents(SEMS). The primary outcome was the overall survival duration(OS) and the secondary endpoints were the diseasefree survival(DFS) duration and the preoperative and postoperative morbidity rates. Analysis was performed on an intention-to-treat basis.RESULTS There were 21 patients in the decompression tube group and 19 in the SEMS group. There were no significant differences in the perioperative morbidity rates of the two groups. The OS rate was significantly higher in the decompression tube group than in the SEMS group(5-year OS rate; decompression tube 79.5%,SEMS 32%, P = 0.043). Multivariate analysis revealed that the bridge to surgery using a decompression tube was significantly associated with the OS(hazard ratio, 17.41; P = 0.004). The 3-year DFS rate was significantly higher in thedecompression tube group than in the SEMS group(68.9% vs 45.9%; log-rank test,P = 0.032). A propensity score–adjusted analysis also demonstrated that the prognosis was significantly better in the decompression tube group than in the SEMS group.CONCLUSION The bridge to surgery using trans-nasal and trans-anal decompression tubes for right-sided malignant colonic obstruction is safe and may improve long-term outcomes.展开更多
文摘目的探讨鼻氧管、氧气面罩和氧袋面罩三种吸氧方法治疗重型病毒性肺炎患者的临床效果。方法113例重型病毒性肺炎患者为研究对象,其中,32例接受鼻氧管吸氧氧疗(鼻氧管组),40例接受氧气面罩吸氧氧疗(氧气面罩组),41例接受氧袋面罩吸氧氧疗(氧袋面罩组)。对比三组患者吸氧治疗前后的血气分析监测结果[pH值、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、氧合指数(OI)、血氧饱和度(SpO_(2))],OI<300 mm Hg(1 mm Hg=0.133 kPa)持续时间、治疗有效率及气管插管率。结果治疗前,三组患者的pH值、PaO_(2)、PaCO_(2)、OI、SpO_(2)对比,差异无统计学意义(P>0.05)。氧袋面罩组治疗48 h后的pH值高于本组治疗前,差异具有统计学意义(P<0.05);氧袋面罩组治疗24、48 h后的PaO_(2)高于本组治疗前,且高于氧气面罩组及鼻氧管组同时点,差异具有统计学意义(P<0.05);氧袋面罩组治疗24、48 h后的OI高于氧气面罩组及鼻氧管组同时点,差异具有统计学意义(P<0.05);三组患者治疗24、48 h后的SpO_(2)均高于本组治疗前,差异具有统计学意义(P<0.05)。氧袋面罩组患者的OI<300 mm Hg持续时间为(8.32±3.82)d、治疗有效率为70.7%、气管插管率为19.5%;氧气面罩组患者的OI<300 mm Hg持续时间为(9.34±4.36)d、治疗有效率为67.5%、气管插管率为22.5%;鼻氧管组患者的OI<300 mm Hg持续时间为(12.35±4.64)d、治疗有效率为56.3%、气管插管率为31.3%。氧袋面罩组及氧气面罩组患者的OI<300 mm Hg持续时间均短于鼻氧管组,差异具有统计学意义(P<0.05);氧袋面罩组及氧气面罩组患者的OI<300 mm Hg持续时间对比,差异无统计学意义(P>0.05);三组患者的治疗有效率及气管插管率两两对比,差异无统计学意义(P>0.05)。结论氧气面罩、氧袋面罩吸氧氧疗应用于重型病毒性肺炎患者较鼻氧管吸氧氧疗可更明显改善患者的血气指标,具有较高的安全性。
文摘BACKGROUND Emergency surgical resection is a standard treatment for right-sided malignant colonic obstruction; however, the procedure is associated with high rates of mortality and morbidity. Although a bridge to surgery can be created to obviate the need for emergency surgery, its effects on long-term outcomes and the most practical management strategies for right-sided malignant colonic obstruction remain unclear.AIM To determine the appropriate management approach for right-sided malignant colonic obstruction.METHODS Forty patients with right-sided malignant colonic obstruction who underwent curative resection from January 2007 to April 2017 were included in the study.We compared the perioperative and long-term outcomes of patients who received bridges to surgery established using decompression tubes and those created using self-expandable metallic stents(SEMS). The primary outcome was the overall survival duration(OS) and the secondary endpoints were the diseasefree survival(DFS) duration and the preoperative and postoperative morbidity rates. Analysis was performed on an intention-to-treat basis.RESULTS There were 21 patients in the decompression tube group and 19 in the SEMS group. There were no significant differences in the perioperative morbidity rates of the two groups. The OS rate was significantly higher in the decompression tube group than in the SEMS group(5-year OS rate; decompression tube 79.5%,SEMS 32%, P = 0.043). Multivariate analysis revealed that the bridge to surgery using a decompression tube was significantly associated with the OS(hazard ratio, 17.41; P = 0.004). The 3-year DFS rate was significantly higher in thedecompression tube group than in the SEMS group(68.9% vs 45.9%; log-rank test,P = 0.032). A propensity score–adjusted analysis also demonstrated that the prognosis was significantly better in the decompression tube group than in the SEMS group.CONCLUSION The bridge to surgery using trans-nasal and trans-anal decompression tubes for right-sided malignant colonic obstruction is safe and may improve long-term outcomes.
