Statistical modelling for effect of mix-parameters on properties of high-flowing sand-concrete

The high-flowing sand-concrete （HFSC） containing natural sands as aggregate was carried out. The high fluidity and stability of HFSC can be achieved by tailoring the mix design parameters, such as fine to coarse sand ratio, dosage of additions, water to binder ratio and dosage of admixtures. Mini-cone slump test, v-fl.mnel time test and viscosity model parameters were used to characterize the behaviour of HFSC in fresh state. The mechanical compressive strength in 28 d was also determined. A factorial design approach was used to establish models highlighting the effect of each mix-parameter on measured properties of HFSC. The derived models are valid for mixtures made with 0 to 0.3 of dune sand to total sand ratio, 82 to 418 kg/m3 of marble powder, 0.42 to 0.46 of water/binder ratio and 1.3% to 1.9% of superplasticizer high water-reducer. The results show that the derived models constitute very efficient means for understanding the influence of key mix-parameters on HFSC properties and are useful in selecting the optimum mix proportions, by simulating their impact on fluidity, stability and compressive strength.

High-flow nasal cannula oxygen therapy and noninvasive ventilation for preventing extubation failure during weaning from mechanical ventilation assessed by lung ultrasound score: A single-center randomized study

BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comparison with standard care among patients in the intensive care unit(ICU) who undergo successful weaning to decrease the incidence of extubation failure at both 48 hours and seven days.METHODS: During the study period, 98 patients were enrolled in the study, including 49 in the control group and 49 in the treatment group. Patients in the control group and patients with an LUS score <14 points(at low risk of extubation failure) in the treatment group were extubated and received standard preventive care without NIV or HFNCO_(2). Patients with an LUS score ≥14 points(at high risk of extubation failure) in the treatment group were extubated with a second review of the therapeutic optimization to identify and address any persisting risk factors for postextubation respiratory distress;patients received HFNCO2 therapy combined with sessions of preventive NIV(4-8 hours per day for 4-8 sessions total) for the first 48 hours after extubation.RESULTS: In the control group, 13 patients had the LUS scores ≥14 points, while 36 patients had scores <14 points. In the treatment group, 16 patients had the LUS scores ≥14 points, while 33 patients had scores <14 points. Among patients with the LUS score ≥14 points, the extubation failure rate within 48 hours was 30.8% in the control group and 12.5% in the treatment group, constituting a statistically significant difference(P<0.05). Conversely, among patients with an LUS score <14 points, 13.9% in the control group and 9.1% in the treatment group experienced extubation failure(P=0.61). The length of ICU stay(9.4±3.1 days vs. 7.2±2.4 days) was significantly different and the re-intubation rate(at 48 hours: 18.4% vs. 10.2%;seven days: 22.4% vs. 12.2%) significantly varied between the two groups(P<0.05). There was no significant difference in the 28-day mortality rate(6.1% vs. 8.2%) between the control and treatment groups.CONCLUSIONS: Among high-risk adults being weaned from mechanical ventilation and assessed by LUS, the NIV+HFNCO_(2) protocol does not lessen the mortality rate but reduce the length of ICU stay, the rate of extubation failure at both 48 hours and seven days.

Influence of fly ash on early-age cracking behavior of high-flowing concrete

The effects of quality and content of fly ash on the early-age cracking behavior of high-flowing concrete （HFC） were investigated. The early-age cracking behavior of the HFC was analyzed by combining the tests of evaporation capacity and electrical resistivity of the HFC. In these tests, a modified flat-type specimen was adopted. The results show that the HFC will have a lower evaporation capacity when it is mixed with fine fly ash, while it will have a higher evaporation capacity when grade II! fly ash is used as mineral admixture. And the electrical resistivity rate of HFC reduces with the increase of the content of fly ash. A nonlinear relationship exists between the cracking time of HFC and the minimum electrical resistivity. The early-age cracking behavior of HFC with fly ash can be enhanced by appropriately increasing the fine particle content and MgO, K2O, and SO3 contents of fly ash. The optimal content of fly ash, which makes a satisfied early-age cracking behavior of HFC, is obtained. And when the content of fly ash exceeds a critical value, the early-age cracking behavior of HFC will rapidly decrease.

Design and Experiment-Based Optimization of High-Flow Hydraulic One-Way Valves

High-flow hydraulic one-way valves in water pipes are typically used to mitigate conditions,which would otherwise cause vibration and cavitation erosion after long-term operation.To prevent cavitation and enhance the performance of hydraulic one-way valves,in the present work a dedicated experimental study has been conducted.The structural parameters relating to the pilot valve core,the main valve core,and the through-flow section of the considered flow channel have been changed to analyse reverse impact,and cavitation,characteristics.The results show that the control pressure has a weak effect on the cavitation characteristics,while changes in the structural parameters can significantly affect them.In particular,the cavitation index,representing the extent of cavitation,has been found to display a linear correlation with the inlet pressure,but,not with the inlet flow rate.Most importantly,a stepped throttling structure can reduce the pressure oscillation,improve the response speed,enhance the impact characteristics,and decrease the likelihood and severity of cavitation.The larger the flow passage area,the shorter the unloading time.Cavitation mainly occurs when the pilot valve core is fully opened.The stepped main valve core throttling structure has been found to be an optimal option.

Dynamic characteristics of the high-flow water three-way valve

Operating principle of water three-way valve with high flow for individual hydraulic prop in coal was presented in this paper, its strict and precise mathematical model was established, its flow field was simulated numerically by software Fluent, and its dynamic characteristics were analyzed during the work process such as raising leg, loading and overflow, the influence of the related parameters on high-flow water three-way valve was determined. The results as follows： during the raising leg stage and early raising leg stage, when the damping ratio increases, the overshoot of system decreases and the setting time reduces, and the dynamic response performance has a significant improvement. During the loading stage and the overflow stage, the pressure in plunger chamber of single hydraulic prop, the output flow and the displacement of the high-flow water three-way valve decrease with the decreasing of the external load. The spring stiffness of the safety valve directs the flow and the spool＇s displacement of the safety valve, and it can be used to control the high-flow three-way valve＇s sensitivity.

Sleep Quality for Patients Receiving Noninvasive Positive Pressure Ventilation and Nasal High-Flow Oxygen Therapy in an ICU: Two Case Studies

Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.

Efficacy of high-flow nasal cannula on acute exacerbation of chronic obstructive pulmonary disease: A meta-analysis

Objective:To systematically evaluate the efficacy and feasibility of high-flow nasal cannula(HFNC)on patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:Systematic searches on PubMed,Web of Science,the Cochrane Library,Embase,CBM(Chinese Biomedicine Database),CNKI(China National Knowledge Infrastructure),Wanfang Database and VIP were performed for randomized controlled trials(RCTs)which explored the effects of HFNC on patients with AECOPD.The retrieval time was from the establishment of each database to July 2019.RevMan5.3 software was used for statistical analysis.Results:A total of 12 articles were included,involving 812 patients.The results showed that:(1)Compared with conventional oxygen therapy,HFNC could improve patients'arterial partial oxygen pressure(PaO2)(MD=12.70,95%CI(7.00,18.40),Z=4.37,P<0.0001),reduce partial arterial blood carbon dioxide(PaCO2)(MD=-10.99,95%CI(-14.42,-7.55),Z=6.26,P<0.00001)and reduce endotracheal intubation rate(OR=0.19,95%CI(0.04,0.93),Z=2.05,P=0.04),shorten the hospitalization time(SMD=-0.74,95%CI(-1.11,-0.37),Z=3.95,P<0.0001).(2)Compared with non-invasive positive pressure ventilation,it has fewer adverse reactions(OR=0.18,95%CI(0.09,0.35),Z=5.08,P<0.00001)and shorter hospital stay(SMD=-0.57,95%CI(-0.90,-0.23),Z=3.33,P=0.0009).Conclusion:HFNC can improve the patients’hypoxia symptoms and CO2 retention,reduce the rate of tracheal intubation,and alleviate adverse reactions.However,Limited by the quality and region of the included studies,more high-quality are needed to test it.

Prone position combined with high-flow nasal oxygen could benefit spontaneously breathing, severe COVID-19 patients:A case report

BACKGROUND Since the outbreak of coronavirus disease 2019(COVID-19)in Wuhan,China in December 2019,the overall fatality rate of severe and critical patients with COVID-19 is high and the effective therapy is limited.CASE SUMMARY In this case report,we describe a case of the successful combination of the prone position(PP)and high-flow nasal oxygen(HFNO)therapy in a spontaneously breathing,severe COVID-19 patient who presented with fever,fatigue and hypoxemia and was diagnosed by positive throat swab COVID-19 RNA testing.The therapy significantly improved the patient's clinical symptoms,oxygenation status,and radiological characteristics of lung injury during hospitalization,and the patient showed good tolerance and avoided intubation.Additionally,we did not find that medical staff wearing optimal airborne personal protective equipment(PPE)were infected by the new coronavirus in our institution.CONCLUSION We conclude that the combination of PP and HFNO could benefit spontaneously breathing,severe COVID-19 patients.The therapy does not increase risk of healthcare workers wearing optimal airborne PPE to become infected with virus particles.

Efficacy and Safety of Treatment of High-flow Priapism with Superselective Transcatheter Embolization

This study is aimed to evaluate the effectiveness and safety of the treatment of highflow priapism with superselective transcatheter embolization.From Sep.1999 to Jan.2013,six patients with high-flow priapism underwent superselective transcatheter embolization of the cavernous artery.Recurrence of priapism,and change in erectile function detected by nocturnal penile tumescence and rigidity(NPTR)test and the International Index of Erectile Function 5-item questionnaire(IIEF-5)were evaluated during a mean follow-up of 12 months.A single superselective transcatheter embolization was sufficient for complete resolution of priapism in the six patients.None of the patients had a relapse of priapism after embolization,and all the patients who had premorbid normal erectile function showed maintained potency with normal results of NPTR and a mean postoperative IIEF-5 score of 23.5(range 23 to 24)during the follow-up period.In conclusion,superselective transcatheter embolization is an effective and safe treatment method for high-flow priapism,and it can ensure a high level of preservation of premorbid erectile function.

Analysis of the Efficacy of Humidified High-Flow Nasal Oxygen Therapy Combined with Alveolar Lavage in the Treatment of Patients with Severe Pneumonia Complicated with Respiratory Failure

Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia complicated with respiratory failure admitted to the Third People’s Hospital of Xining from July 2021 to December 2022 were randomly divided into two groups:group A and group B.The patients in group A were given humidified high-flow nasal oxygen therapy combined with alveolar lavage,whereas those in group B were given humidified high-flow nasal oxygen therapy.The treatment efficacy,blood gas analysis results,and differences in inflammatory mediators were compared between the two groups.Results:The curative effect in group A(96.67%)was significantly higher than that in group B(81.67%),P<0.05;the partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygen saturation(SpO2),and Horowitz index(P/F)of group A were significantly better than group B,P<0.05;the interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),and C-reactive protein(CRP)levels,white blood cell(WBC)count,serum procalcitonin(PCT),and neutrophil(N)percentage of group A were significantly lower than those of group B,P<0.05.Conclusion:For patients with severe pneumonia complicated with respiratory failure,alveolar lavage,on the basis of humidified high-flow oxygen therapy,can inhibit local inflammation,improve blood gas analysis results,promote disease recovery,and improve the clinical treatment effect。

Impact and Management under Extracorporeal Circulation of a Patient with Renal Insufficiency on Dialysis with a High-Flow Arteriovenous Fistula in the Cardiac Surgery Department of the Angers Teaching Hospital about a Case and Review of the Literature

Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.

The effect of high-flow oxygen via tracheostomy on respiratory pattern and diaphragmatic function in patients with prolonged mechanical ventilation:A randomized,physiological,crossover study

Background Compared to conventional oxygen devices,high-flow oxygen treatment(HFOT)through the nasal cannulae has demonstrated clinical benefits.Limited data exist on whether such effects are also present in HFOT through tracheostomy.Hence,we aimed to examine the short-term effects of HFOT through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical ventilation.Methods A randomized,crossover,physiological study was conducted in our ICU between December 2020 and April 2021,in patients with tracheostomy and prolonged mechanical ventilation.The patients underwent a 30-min spontaneous breathing trial(SBT)and received oxygen either via T-piece or by HFOT through tracheostomy,followed by a washout period of 15-min breathing through the T-piece and receipt of 30-min oxygen with the other modality in a randomized crossover manner.At the start and end of each session,blood gasses,breathing frequency(f),and tidal volume(VT)via a Wright's spirometer were measured,along with diaphragm ultrasonography including diaphragm excursion and diaphragmatic thickening fraction,which expressed the inspiratory muscle effort.Results Eleven patients were enrolled in whom 19 sessions were uneventfully completed;eight patients were studied twice on two different days with alternate sessions;and three patients were studied once.Patients were randomly assigned to start the SBT with a T-piece(n=10 sessions)or with HFOT(n=9 sessions).With HFOT,VT and minute ventilation(VE)significantly increased during SBT(from[465±119]mL to[549±134]mL,P<0.001 and from[12.4±4.3]L/min to[13.1±4.2]L/min,P<0.05,respectively),but they did not change significantly during SBT with T-piece(from[495±132]mL to[461±123]mL and from[12.8±4.4]mL to[12.0±4.4]mL,respectively);f/VT decreased during HFOT(from[64±31]breaths/(min∙L)to[49±24]breaths/(min∙L),P<0.001),but it did not change significantly during SBT with T-piece(from[59±28]breaths/(min∙L)to[64±33]breaths/(min∙L));partial pressure of arterial oxygen increased during HFOT(from[99±39]mmHg to[132±48]mmHg,P<0.001),but it decreased during SBT with T-piece(from[124±50]mmHg to[83±22]mmHg,P<0.01).In addition,with HFOT,diaphragmatic excursion increased(from[12.9±3.3]mm to[15.7±4.4]mm,P<0.001),but it did not change significantly during SBT with T-piece(from[13.4±3.3]mm to[13.6±3.3]mm).The diaphragmatic thickening fraction did not change during SBT either with T-piece or with HFOT.Conclusion In patients with prolonged mechanical ventilation,HFOT through tracheostomy compared with T-piece improves ventilation,pattern of breathing,and oxygenation without increasing the inspiratory muscle effort.Trial Registration Clinicaltrials.gov ldentifer:NCT04758910.

High-flow nasal cannula oxygen therapy in acute hypoxemic respiratory failure and COVID-19-related respiratory failure

Although standard oxygen face masks are first-line therapy for patients with acute hypoxemic respiratory failure,high-flow nasal cannula oxygen therapy has gained major popularity in intensive care units.The physiological effects of high-flow oxygen counterbalance the physiological consequences of acute hypoxemic respiratory failure by lessening the deleterious effects of intense and prolonged inspiratory efforts generated by patients.Its simplicity of application for physicians and nurses and its comfort for patients are other arguments for its use in this setting.Although clinical studies have reported a decreased risk of intubation with high-flow oxygen compared with standard oxygen,its survival benefit is uncertain.A more precise definition of acute hypoxemic respiratory failure,including a classification of severity based on oxygenation levels,is needed to better compare the efficiencies of different non-invasive oxygenation support methods(standard oxygen,high-flow oxygen,and non-invasive ventilation).Additionally,the respective role of each non-invasive oxygenation support method needs to be established through further clinical trials in acute hypoxemic respiratory failure,especially in severe forms.

基于康达效应的高速气流推力矢量喷管

基于康达效应设计了一种高速气流推力矢量喷管,利用其对流体的偏转作用实现主流方向控制。喷管由主通道以及外侧八个独立气室和出口处的康达壁面组成,可通过气室外部的开合情况来实现八个偏转方向的控制。本文对所设计的高速气流推力矢量喷管进行了仿真计算,研究了主流速度、气室开合情况及康达壁面曲率三个参数对主流偏转效果的影响。数值模拟结果表明:(1)主流速度在50~160 m/s时,不同的开合组合的偏转效果有较为显著的差异。(2)气室打开数量为奇数时,偏转效果优于偶数。只有一个气室开口时,偏转效果最优。(3)计算得到三维喷管最优康达壁面的曲率是55.26。本文设计的高速气流推力矢量喷管能够达到较好的偏转控制效果,最大偏转角度可达到85.91°。

低负荷血流限制和高强度抗阻运动对男性运动青年大腿微循环功能的影响

背景:微循环作为人体物质能量代谢交换的唯一场所,与人体运动能力密切相关。抗阻运动是提高微循环功能的有效方式,但也有研究指出血流限制训练也能提高微循环功能,且具有负荷小和安全性高等优点。目的:比较6周低负荷血流限制运动、高强度抗阻运动对运动型男性青年大腿微循环功能的影响,并从血管内皮功能角度探讨运动改善微循环功能的可能机制。方法:将湖北民族大学60名体育专业男性大学生按照随机数表法分为对照组、高强度抗阻运动组和低负荷血流限制运动组,每组20人。低负荷血流限制运动组进行6周(每周3次、每次90 min、运动强度为30%1RM)的低负荷血流限制运动;高强度抗阻运动组进行6周(每周3次、每次90 min、运动强度为70%1RM强度)的抗阻训练;对照组该时间段不进行任何形式的运动训练。分别在干预开始的前1 d以及6周干预结束后次日的晨起空腹状态下对3组受试者微血管血流灌注量、经皮氧分压、肌氧饱和度、一氧化氮、内皮型一氧化氮合酶、内皮素1、血管内皮细胞生长因子及大腿围、肌力等指标进行测试。结果与结论:①运动干预后,低负荷血流限制运动组和高强度抗阻运动组的微血管血流灌注量加热值、血细胞移动速度加热值与对照组及运动干预前相比有显著差异(P<0.05);低负荷血流限制运动组微血管血流灌注量加热值、血细胞移动速度加热值与高强度抗阻运动组相比有显著差异(P<0.05);经皮氧分压和肌氧饱和度与干预前相比有显著性差异(P<0.05)。②运动干预后,低负荷血流限制运动组和高强度抗阻运动组一氧化氮、内皮型一氧化氮合酶、内皮素1、血管内皮细胞生长因子与对照组及运动干预前相比有显著差异(P<0.05)。③运动干预后,低负荷血流限制运动组和高强度抗阻运动组大腿围和大腿肌肉力量与运动干预前相比有显著差异(P<0.05)。④上述结果证实,6周低负荷血流限制运动和高强度抗阻运动可能通过调节内皮型一氧化氮合酶、内皮素1、血管内皮细胞生长因子等血管因子的分泌,提高体育专业大学生大腿微循环功能,并增加大腿肌肉的收缩力量,且低负荷血流限制运动对微血管血流灌注量、血细胞移动速度的干预效果更佳,因此低负荷血流限制运动较高强度抗阻运动在提高微循环功能方面更具优势。

低强度抗阻结合血流限制训练12周青年人体成分、肌肉力量及动脉弹性功能

背景:高强度抗阻训练能有效提高肌肉力量,但动脉硬化风险较高;高强度抗阻训练结合有氧运动可有效降低动脉硬化水平;低强度抗阻结合血流限制训练不需要高负荷力量刺激肌肉,或许是提高肌肉力量、保持动脉弹性的科学训练方法。目的:探讨12周的低强度抗阻训练结合血流限制训练对青年人体成分、肌肉力量及动脉弹性功能的影响,为制定个性化训练方案提供理论支撑。方法:随机招募55名大学生并通过抽签的方式随机分为高强度抗阻训练组、高强度抗阻结合有氧运动组及低强度抗阻结合血流限制训练组,分别进行为期12周的高强度抗阻训练、高强度抗阻训练结合有氧运动、低强度抗阻训练结合血流限制训练,训练结束后进行身体成分、肌肉力量及动脉弹性功能测试。结果与结论:12周的训练干预后,高强度抗阻训练组、低强度抗阻结合血流限制训练组的瘦体质量显著增加(P<0.05),3组的最大重复次数(1RM)和膝关节等速肌力均显著增加(P<0.05),高强度抗阻结合有氧运动组、低强度抗阻结合血流限制训练组的动脉弹性功能显著改善(P<0.05)。结果表明:12周的高强度抗阻训练、低强度抗阻训练结合血流限制训练能显著改善身体成分;3种训练方式均能增加肌肉力量;12周的高强度抗阻训练结合有氧运动、低强度抗阻训练结合血流限制训练均能改善动脉弹性功能,且低强度抗阻训练结合血流限制训练的效果优于高强度抗阻训练结合有氧运动。因此,建议将低强度抗阻训练结合血流限制训练作为首选训练方式,以改善动脉弹性,降低动脉硬化的风险。

欧洲呼吸协会2022版《急性呼吸衰竭患者经鼻高流量氧疗临床实践指南》解读

欧洲呼吸协会于2022年发布了《急性呼吸衰竭患者经鼻高流量氧疗临床实践指南》,该指南旨在为急性低氧性呼吸衰竭、手术患者术后拔管、非手术患者拔管以及高碳酸血症型呼吸衰竭4种情境下的氧疗管理提供指导。涵盖了8个主题,下设相应的推荐意见。尽管该指南的制订方法规范严谨,但需要指出的是,现有的临床证据质量等级并不高,尚需更多研究来进一步支持这些推荐意见的有效性。尽管如此,这份指南仍可帮助急诊医护人员更好地开展急性呼吸衰竭患者的氧疗实践。

经鼻高流量鼻导管湿化氧疗联合氨溴索双途径给药对重症肺炎合并呼吸衰竭患者的疗效

目的分析经鼻高流量鼻导管湿化氧疗(high-flow nasal cannula,HFNC)联合氨溴索双途径给药对重症肺炎合并呼吸衰竭患者动脉血气指标、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、肺表面活性蛋白D(surfactant protein D,SP-D)水平的影响。方法选取收治的重症肺炎合并呼吸衰竭患者92例,用随机数字表法分为观察组和对照组,每组46例。对照组给予氨溴索双途径给药(氨溴索肺泡灌洗和氨溴索雾化)治疗,观察组在对照组治疗的基础上联合应用HFNC。2组均连续治疗7 d。比较2组临床相关指标和临床疗效,治疗前后动脉血气指标和血清hs-CRP、SP-D水平的变化,记录治疗期间2组不良反应的发生情况。结果治疗后,观察组机械通气时间、住院时间均短于对照组,再插管率低于对照组(P<0.05)。观察组的总有效率(89.13%)高于对照组(71.74%),P<0.05。观察组动脉血氧分压(PaO_(2))、动脉血氧饱和度(SaO_(2))均高于对照组(P<0.05),动脉血二氧化碳分压(PaCO_(2))、血清hs-CRP和SP-D均低于对照组(P<0.05)。治疗期间,2组患者均未出现严重不良反应。结论重症肺炎合并呼吸衰竭患者接受HFNC联合氨溴索双途径给药治疗,可有效改善患者的动脉血气指标,减轻炎性反应,提高治疗效果,促进患者病情恢复。

经鼻加温湿化高流量氧疗对重症肺炎患儿血气指标、MMP-9及TNF-α的影响

目的 探讨经鼻加温湿化高流量氧疗(HFNC)治疗小儿重症肺炎的疗效及对血气指标、基质金属蛋白酶9(MMP-9)、肿瘤坏死因子α(TNF-α)的影响。方法 选取2018年5月—2020年8月河北省人民医院收治的123例重症肺炎患儿作为研究对象,按照随机抽样法分为观察组(HFNC治疗,n=62)与对照组(面罩吸氧治疗,n=61)。对比两组临床症状、动脉血二氧化碳分压(PaCO_(2))、血氧分压(PaO_(2))、TNF-α、MMP-9、血氧饱和度/吸入氧浓度与呼吸频率的比值(ROX指数)。结果 观察组的退热时间、体征消失时间、咳嗽咳痰消失时间、住院时间分别为(5.21±1.02)d、(10.02±1.32)d、(7.41±0.96)d、(9.02±2.69)d,均短于对照组(t=5.688、10.332、10.253、2.180,P<0.05)。观察组治疗后2、6、12、24 h的ROX指数分别为(6.31±1.62)、(9.85±1.96)、(11.65±2.39)、(13.46±3.25),均高于对照组(t=2.467、3.380、4.251、4.902,P<0.05);治疗后,观察组的PaCO_(2)(35.69±5.21)mmHg低于对照组,而PaO_(2)(87.52±18.69)mmHg高于对照组(t=2.379、4.647,P<0.05);治疗后,观察组的MMP-9、TNF-α分别为(6.32±1.05)pg/mL、(10.40±1.30)pg/mL,低于对照组(t=13.425、13.060,P<0.05)。结论 HFNC用于重症肺炎患儿中具有显著效果,有利于改善患儿血气指标,降低MMP-9、TNF-α水平。

无创通气间歇期经鼻高流量湿化氧疗治疗慢性阻塞性肺疾病急性加重临床效果及对患者气管插管率、血气指标的影响

目的:分析无创通气(NIV)间歇期经鼻高流量湿化氧疗(HFNC)治疗慢性阻塞性肺疾病急性加重(AECOPD)临床效果及对气管插管率、血气指标的影响。方法:回顾性收治的105例AECOPD患者资料,将患者分为对照组52例[接受无创通气(NIV)治疗与常规氧疗]和观察组53例(接受NIV联合HFNC治疗),比较两组患者临床指标、血气指标、治疗失败原因及不良反应。结果:观察组呼吸支持时间、NIV间歇歇息次数、NIV每日平均使用时间、ICU住院时间均短(小)于对照组(均P<0.05),两组气管插管率比较差异无统计学意义(P>0.05);治疗后两组动脉血氧分压(PaO_(2))比治疗前明显升高,动脉血二氧化碳分压(PaCO_(2))比治疗前明显降低(P<0.05),但两组治疗后PaO_(2)、PaCO_(2)水平比较差异无统计学意义(均P>0.05);观察组患者呼吸困难加重率、治疗不耐受率均低于对照组(均P<0.05),两组CO_(2)潴留加重率、低氧血症加重率比较差异无统计学意义(均P>0.05);观察组不良反应发生率显著低于对照组(P<0.05)。结论:NIV间歇期给予HFNC治疗AECOPD患者对气管插管率及血气指标的影响与常规氧疗差异不显著,但可改善患者其他临床指标,减少治疗失败情况及不良反应。