Effect of positive end-expiratory pressure ventilation on central venous pressure and intraoperative blood loss in patients undergoing laparoscopic hepatectomy

Objective:Tto investigate the effects of positive end-expiratory pressure(PEEP)ventilation on central venous pressure(CVP)and intraoperative blood loss in patients undergoing laparoscopic hepatectomy.Methods:46 cases of patients undergoing laparoscopic hepatectomy,25 cases of male,female 21 cases,ASAⅠ~Ⅲlevel,were randomly divided into two groups.In group A tidal volume was set to 6 ml/kg(Predicted Body Weight,PBW)and PEEP was set to 0 cmH2O.The tidal volume of group B was set as group A,PEEP was set to 8 cmH2O.CVP,MAP,and Ppeak were recorded in the supine position after intubation(T0),supine position after pneumoperitoneal(T1),anti-trendelenberg position after pneumoperitoneal(T2),supine position after surgery(T3),and Ddyn was calculated.The amount of nitroglycerin and the amount of blood loss were recorded.Results:Compared with group A,the CVP of group B was significantly increased at T1 and T2(P<0.05).Compared to T2 with T1 in group A and group B,CVP was decreased significantly(P<0.05).At T3,Cdyn in group B was significantly higher than that in group A(P<0.05).The amount of nitroglycerin in group B was significantly higher than that in group A(P<0.05).There was no significant difference in intraoperative fluid rehydration and blood loss between the two groups(P>0.05).Conclusion:PEEP with 8cmH2O can improve Ddyn in patients undergoing laparoscopic hepatectomy,but increased CVP.It requires more use of controlled low central venous pressure techniques to reduce intraoperative blood loss.

Role of proning and positive end-expiratory pressure in COVID-19

The novel coronavirus,which was declared a pandemic by the World Health Organization in early 2020 has brought with itself major morbidity and mortality.It has increased hospital occupancy,heralded economic turmoil,and the rapid transmission and community spread have added to the burden of the virus.Most of the patients are admitted to the intensive care unit(ICU)for acute hypoxic respiratory failure often secondary to acute respiratory distress syndrome(ARDS).Based on the limited data available,there have been different opinions about the respiratory mechanics of the ARDS caused by coronavirus disease 2019(COVID-19).Our article provides an insight into COVID-19 pathophysiology and how it differs from typical ARDS.Based on these differences,our article explains the different approach to ventilation in COVID-19 ARDS compared to typical ARDS.We critically analyze the role of positive end-expiratory pressure(PEEP)and proning in the ICU patients.Through the limited data and clinical experience are available,we believe that early proning in COVID-19 patients improves oxygenation and optimal PEEP should be titrated based on individual lung compliance.

Driving pressure in mechanical ventilation:A review

Driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of injury.However,ΔP levels have also been shown to closely impact hard endpoints such as mortality.Considering this,conducting an in-depth review ofΔP as a unique,outcome-impacting therapeutic modality is extremely important.There is a need to understand the subtleties involved in making sureΔP levels are optimized to enhance outcomes and minimize harm.We performed this narrative review to further explore the various uses ofΔP,the different parameters that can affect its use,and how outcomes vary in different patient populations at different pressure levels.To better utilizeΔP in MV-requiring patients,additional large-scale clinical studies are needed.

Effects of positive end-expiratory pressure on intracranial pressure,cerebral perfusion pressure,and brain oxygenation in acute brain injury:Friend or foe?A scoping review

Background Patients with acute brain injury(ABI)are a peculiar population because ABI does not only affect the brain but also other organs such as the lungs,as theorized in brain–lung crosstalk models.ABI patients often require mechanical ventilation(MV)to avoid the complications of impaired respiratory function that can follow ABI;MV should be settled with meticulousness owing to its effects on the intracranial compartment,especially regarding positive end-expiratory pressure(PEEP).This scoping review aimed to(1)describe the physiological basis and mechanisms related to the effects of PEEP in ABI;(2)examine how clinical research is conducted on this topic;(3)identify methods for setting PEEP in ABI;and(4)investigate the impact of the application of PEEP in ABI on the outcome.Methods The five-stage paradigm devised by Peters et al.and expanded by Arksey and O'Malley,Levac et al.,and the Joanna Briggs Institute was used for methodology.We also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)extension criteria.Inclusion criteria:we compiled all scientific data from peer-reviewed journals and studies that discussed the application of PEEP and its impact on intracranial pressure,cerebral perfusion pressure,and brain oxygenation in adult patients with ABI.Exclusion criteria:studies that only examined a pediatric patient group(those under the age of 18),experiments conducted solely on animals;studies without intracranial pressure and/or cerebral perfusion pressure determinations,and studies with incomplete information.Two authors searched and screened for inclusion in papers published up to July 2023 using the PubMed-indexed online database.Data were presented in narrative and tubular form.Results The initial search yielded 330 references on the application of PEEP in ABI,of which 36 met our inclusion criteria.PEEP has recognized beneficial effects on gas exchange,but it produces hemodynamic changes that should be predicted to avoid undesired consequences on cerebral blood flow and intracranial pressure.Moreover,the elastic properties of the lungs influence the transmission of the forces applied by MV over the brain so they should be taken into consideration.Currently,there are no specific tools that can predict the effect of PEEP on the brain,but there is an established need for a comprehensive monitoring approach for these patients,acknowledging the etiology of ABI and the measurable variables to personalize MV.Conclusion PEEP can be safely used in patients with ABI to improve gas exchange keeping in mind its potentially harmful effects,which can be predicted with adequate monitoring supported by bedside non-invasive neuromonitoring tools.

Influence of positive end-expiratory pressure upregulation on the right ventricle in critical patients with acute respiratory distress syndrome:an observational cohort study

Background This study aimed to investigate the influence of positive end-expiratory pressure(PEEP)on the right ventricle(RV)of mechanical ventilation-assisted patients through echocardiography.Methods Seventy-six patients assisted with mechanical ventilation were enrolled in this study.Positive end-expiratory pressure was upregulated by 4 cm H_(2)O to treat acute respiratory distress syndrome,wherein echocardiography was performed before and after this process.Hemodynamic data were also recorded.All variables were compared before and after PEEP upregulation.The effect of PEEP was also evaluated in patients with and without decreased static lung compliance(SLC).Results Positive end-expiratory pressure upregulation significantly affected the RV function.Remarkable differences were observed in the following:Tei index(P=0.027),pulmonary artery pressure(P=0.039),tricuspid annular plane systolic excursion(P=0.014),early wave/atrial wave(P=0.002),diaphragm excursion(P<0.001),inferior vena cava collapsing index(P<0.001),and SLC(P<0.001).There were no significant changes in heart rate,respiratory rate,central venous pressure,mean arterial pressure,and base excess(P>0.05).Furthermore,the cardiac output of the RV was not significantly affected.In patients with decreased SLC(n=41),there were more significant changes in diaphragm excursion(P<0.001),inferior vena cava collapse index(P=0.025),pulmonary artery pressure(P<0.001),and tricuspid annular plane systolic excursion(P=0.007)than in those without decreased SLC(n=35).Conclusion Positive end-expiratory pressure upregulation significantly affected the RV function of critically ill patients with acute respiratory distress syndrome,especially in those with decreased SLC.

Positive End-expiratory Pressure Titration after Alveolar Flecruitment Directed by Electrical Impedance Tomography

Background： Electrical impedance tomography （EIT） is a real-time bedside monitoring tool, which can reflect dynamic regional lung ventilation. The aim of the present study was to monitor regional gas distribution in patients with acute respiratory distress syndrome （ARDS） during positive-end-expiratory pressure （PEEP） titration using EIT. Methods： Eighteen ARDS patients under mechanical ventilation in Department of Critical Care Medicine of Peking Union Medical College Hospital from January to April in 2014 were included in this prospective observational study. After recruitment maneuvers （RMs）, decremental PEEP titration was performed from 20 cmH20 to 5 cmH20 in steps of 3 cmH20 every 5-10 min. Regional over-distension and recruitment were monitored with EIT. Results： After RMs, patient with arterial blood oxygen partial pressure （PaO2） ＋ carbon dioxide partial pressure （PaCO2） 〉400 mmHg with 100% of fractional inspired oxygen concentration were defined as RM responders. Thirteen ARDS patients was diagnosed as responders whose PaO2 ＋ PaCO2, were higher than nonresponders （419 ± 44 mmHg vs. 170 ±73 mmHg, P 〈 0.0001）. In responders, PEEP mainly increased-recruited pixels in dependent regions and over-distended pixels in nondependent regions. PEEP alleviated global inhomogeneity of tidal volume and end-expiratory lung volume. PEEP levels without significant alveolar derecruitment and over-distension were identified individually. Conclusions： After RMs, PEEP titration significantly affected regional gas distribution in lung, which could be monitored with EIT. EIT has the potential to optimize PEEP titration.

Effects of different levels of end-expiratory positive pressure on lung recruitment and protection in patients with acute respiratory distress syndrome

Background It is still controversial as to the implementation of higher positive end-expiratory pressure （PEEP） in patients with acute respiratory distress syndrome （ARDS）. This study was conducted to compare the lower and higher PEEP in patients with ARDS ventilated with low tidal volume, to investigate the relationship between the recruited lung volume by higher PEEP and relevant independent variables and to provide a bedside estimate of the percentage of potentially recruitable lung by higher PEEP. Methods Twenty-four patients with ARDS were studied. A lung recruiting maneuver was performed, then each patient was ventilated with PEEP of 8 cmH20 for 4 hours and subsequently with PEEP of 16 cmH20 for 4 hours. At the end of each PEEP level period, gas exchange, hemodynamic data, lung mechanics, stress index ＂b＂ of the dynamic pressure-time curve, intrinsic PEEP and recruited volume by PEEP were measured. Results Fourteen patients were recruiters whose alveolar recruited volumes induced by PEEP 16 cmH20 were （425_＋65） ml and 10 patients were non-recruiters. Compared with the PEEP 8 cmH20 period, after the application of the PEEP 16 cmH20, the PaO2/FiO2 ratio and static lung compliance both remained unchanged in non-recruiters, whereas they increased significantly in recruiters. Changes in PaO2/FiO2 and static lung compliance after PEEP increase were independently associated with the alveolar recruitment. Analyzing the relationship between recruiting maneuver （RM）-induced change in end-expiratory lung volume and the alveolar recruitment induced by PEEP, we found a notable correlation. Conclusions The results of this study indicated that the potential for alveolar recruitment might vary among the ARDS population and the higher PEEP levels should be limited to recruiters. Improving in PaO2/FiO2, static lung compliance after PEEP increase and the shape of the pressure-time curve could be helpful for PEEP application.

Alveolar stability under different combinations of positive end-expiratory pressure and tidal volume： alveolar microscopy in isolated injured rat lungs

Background High positive end-expiratory pressure （PEEP） and low tidal volume （VT） ventilation is thought to be a protective ventilation strategy. It is hypothesized that the stabilization of collapsible alveoli during expiration contributes to lung protection. However, this hypothesis came from analysis of indirect indices like the analysis of the pressure-volume curve of the lung. The purpose of this study was to investigate isolated healthy and injured rat lungs by means of alveolar microscopy, in which combination of PEEP and VT is beneficial with respect to alveolar stability （I-E%）. Methods Alveolar stability was investigated in isolated, non-perfused mechanically ventilated rat lungs. Injured lungs were compared with normal lungs. For both groups three PEEP settings （5, 10, 20 cmH20） were combined with three VT settings （6, 10, 15 ml/kg） resulting in nine PEEP-VT combinations per group. Analysis was performed by alveolar microscopy. Results In normal lungs alveolar stability persisted in all PEEP-VT combinations （I-E% （3.2±11.0）%）. There was no significant difference using different settings （P 〉0.01）. In contrast, alveoli in injured lungs were extremely instable at PEEP levels of 5 cmH20 （mean I-E% 100%） and 10 cmH2O （mean I-E% （30.7±16.8）%）; only at a PEEP of 20 cmH20 were alveoli stabilized （mean I-E% of （0.2±9.3）%）. Conclusions In isolated healthy lungs alveolar stability is almost unaffected by different settings of PEEP and VT. In isolated injured lungs only a high PEEP level of 20 cmH2O resulted in stabilized alveoli whereas lower PEEP levels are associated with alveolar instability.

局部正压通风方法解决采面低氧问题的试验及模拟研究

针对浅埋近距离煤层群工作面易产生低氧现象的难题,以山西某矿3105工作面低氧问题为研究背景,采用理论分析、相似模拟及数值模拟方法进行了研究。分析得出煤层地质条件、工作面通风方式、大气压力变化和自然风压是工作面产生低氧现象的主要原因,并探究了采用局部正压通风方法解决采面低氧问题的可行性。结果表明:采用负压通风时,增加风速不能明显提高工作面上隅角区域的氧气体积分数,仍低于20%;采用局部正压通风时,采场内20%氧气体积分数等值线在通风风速达到1.6 m/s时,与工作面呈平行状态,增加风速能有效提高采面上隅角的氧气体积分数;采用局部正压通风回风巷增阻时,相较于单一的局部正压通风能够在更小的风速条件下解决采面低氧的问题,且一定程度上有利于防范采空区遗煤自然发火。利用COMSOL仿真软件,建立工作面采场气体运移模型,开展了不同通风方法、不同风速条件下的采空区氧气体积分数分布及运移规律研究,数值模拟结果与试验测定结果基本一致。3105工作面现场实践表明,采用局部正压通风回风巷增阻的技术措施能够有效解决工作面低氧问题,工作面上隅角及回风流的氧气体积分数由15%上升到20%以上,并始终保持正常水平,确保了工作面的安全生产。

Effect of neurally adjusted ventilatory assist on trigger of mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease patients with intrinsic positive end-expiratory pressure

Objective To compare the trigger delay and work of trigger between neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) in acute exacerbation of chronic obstructive pulmonary disease(AECOPD) patients with intrinsic positive end-expiratory pressure (PEEP) during mechanical ventilation.

亚低温下呼气末正压通气对成人急性呼吸窘迫综合征氧代谢情况及预后结局的影响研究

目的:观察亚低温下呼气末正压通气(PEEP)对改善成人急性呼吸窘迫综合征(ARDS)氧代谢情况及预后结局的影响。方法:选取2021年5月—2022年5月在南阳市第一人民医院接受持续正压通气治疗的126例ARDS患者作为研究对象。采用抽签法将患者分为两组,每组各63例。对照组予以常规体温下PEEP治疗。观察组予以亚低温下PEEP治疗。比较两组患者治疗前后的肺部炎症指标、氧代谢指标变化情况以及两组患者的治疗情况、预后结局。结果:治疗后,观察组患者的肺部局部白细胞介素-6(IL-6)、血清降钙素原(PCT)、C-反应蛋白(CRP)水平均低于对照组,差异有统计学意义(t=4.973、6.714、4.442,P<0.05);观察组患者的氧分指数(P/F)、混合静脉血氧饱和度(SvO2)高于对照组、血清乳酸水平(LAC)水平低于对照组,差异有统计学意义(t=2.901、2.974、10.809、P<0.05);观察组的肺顺应性高于对照组,ICU住院时长、机械通气时长均低于对照组,差异有统计学意义(t=9.476、6.907、3.530,P<0.05);观察组患者并发症发生率(7.94%)低于对照组(19.05%)、病死率(4.76%)低于对照组(15.87%),差异有统计学意义(χ^(2)=5.287、6.671,P<0.05)。结论:采用亚低温技术配合PEEP可促进ARDS患者的肺部炎症反应及氧代谢情况恢复,可增加患者临床获益并改善预后结局。

高温复合滤筒除尘器输灰方案探讨

随着高温复合滤筒除尘器的引入,与之配套的输灰系统也面临着新的挑战。本文以乾县农林生物质焚烧发电项目为例,对仓泵式气力输灰系统和机械集中(冷却)+低正压连续气力输送系统两种不同的输灰方式从技术、经济角度进行比较,最终提出了高温复合滤筒除尘器下可行的输灰方式,供同行借鉴。

Expiratory flow-limitation in mechanically ventilated patients: A risk for ventilator-induced lung injury?

Expiratory flow limitation(EFL), that is the inability of expiratory flow to increase in spite of an increase of the driving pressure, is a common and unrecognized occurrence during mechanical ventilation in a variety of intensive care unit conditions. Recent evidence suggests that the presence of EFL is associated with an increase in mortality, at least in acute respiratory distress syndrome(ARDS) patients, and in pulmonary complications in patients undergoing surgery. EFL is a major cause of intrinsic positive end-expiratory pressure(PEEPi), which in ARDS patients is heterogeneously distributed, with a consequent increase of ventilation/perfusion mismatch and reduction of arterial oxygenation. Airway collapse is frequently concomitant to the presence of EFL.When airways close and reopen during tidal ventilation, abnormally high stresses are generated that can damage the bronchiolar epithelium and uncouple small airways from the alveolar septa, possibly generating the small airways abnormalities detected at autopsy in ARDS. Finally, the high stresses and airway distortion generated downstream the choke points may contribute to parenchymal injury, but this possibility is still unproven. PEEP application can abolish EFL, decrease PEEPi heterogeneity, and limit recruitment/derecruitment.Whether increasing PEEP up to EFL disappearance is a useful criterion for PEEP titration can only be determined by future studies.

Low power linear actuator for direct drive electrohydraulic valves

This paper presents a bi-directional permanent-magnet linear actuator for directly driving electrohydraulic valves with low power consumption. Its static and dynamic performances were analyzed using the 2D finite element method,taking into account the nonlinear characterization and the eddy current loss of the magnetic material. The experiment and simulation results agree well and show that the prototype actuator can produce a force of ±100 N with the maximum power being 7 W and has linear characteristics with a positive magnetic stiffness within a stroke of ±1 mm. Its non-linearity is less than 1.5% and the hysteresis less than 1.5%. The actuator's frequency response(-3 dB) of the displacement reaches about 15 Hz,and the most significant factor affecting the dynamic performance is identified as the eddy current loss of the magnetic material.

Neurally adjusted ventilator assist in very low birth weight infants:Current status

Continuous improvements in perinatal care have resultedin increased survival of premature infants.Their immature lungs are prone to injury with mechanical ventilation and this may develop into chronic lung disease(CLD) or bronchopulmonary dysplasia.Strategies to minimize the risk of lung injury have been developed and include improved antenatal management(education,regionalization,steroids,and antibiotics),exogenous surfactant administration and reduction of barotrauma by using exclusive or early noninvasive ventilatory support.The most frequently used mode of assisted ventilation is pressure support ventilation that may lead to patientventilator asynchrony that is associated with poor outcome.Ventilator-induced diaphragmatic dysfunction or disuse atrophy of diaphragm fibers may also occur.This has led to the development of new ventilation modes including neurally adjusted ventilatory assist(NAVA).This ventilation mode is controlled by electrodes embedded within a nasogastric catheter which detect the electrical diaphragmatic activity(Edi) and transmit it to trigger the ventilator in synchrony with the patient's own respiratory efforts.This permits the patient to control peak inspiratory pressure,mean airway pressure and tidal volume.Back up pressure control(PC) is provided when there is no Edi signal and no pneumatic trigger.Compared with standard conventional ventilation,NAVA improves blood gas regulation with lower peak inspiratory pressure and oxygen requirements in preterm infants.NAVA is safe mode of ventilation.The majority of studies have shown no significant adverse events in neonates ventilated with NAVA nor a difference in the rate of intraventricular hemorrhage,pneumothorax,or necrotizing enterocolitis when compared to conventional ventilation.Future large size randomized controlled trials should be established to compare NAVA with volume targeted and pressure controlled ventilation in newborns with mature respiratory drive.Most previous studies and trials were not sufficiently large and did not include longterm patient oriented outcomes.Multicenter,randomized,outcome trials are needed to determine whether NAVA is effective in avoiding intubation,facilitating extubation,decreasing time of ventilation,reducing the incidence ofCLD,decreasing length of stay,and improving long-term outcomes such as the duration of ventilation,length of hospital stay,rate of pneumothorax,CLD and other major complications of prematurity.In order to prevent barotrauma,next generations of NAVA equipment for neonatal use should enable automatic setting of ventilator parameters in the backup PC mode based on the values generated by NAVA.They should also include an upper limit to the inspiratory time as in conventional ventilation.The manufacturers of Edi catheters should produce smaller sizes available for extreme low birth weight infants.Newly developed ventilators should also include leak compensation and high frequency ventilation.A peripheral flow sensor is also essential to the proper delivery of all modes of conventional ventilation as well as NAVA.

某660MW超超临界汽轮机低压内缸加工工艺研究

文章根据某660 MW超超临界汽轮机低压内缸结构特点和设计要求,制定了能有效保证加工精度、低成本、高效率的工艺方案。针对工件刚性差、易变形、内孔隔板定位面和中分面密封要求严等加工难点,提出了保证加工精度的工艺措施。

兰新高铁大风区低风压正馈线受力特性

为抑制兰新高铁大风区正馈线舞动,保证列车安全运行,首先,设计新型低风压正馈线,仿真获取常规正馈线和低风压正馈线在不同风载荷下的气动力参数和舞动幅值,并进行对比分析;其次,对防舞效果较佳的3种低风压正馈线建立三维有限元模型,并施加拉伸载荷,模拟正馈线舞动时的受力情况;最后,分析低风压正馈线形变及应力变化.结果表明:低风压正馈线自由端形变量远大于固定端,铝股线形变量大于钢股线,且越往外层,股线形变量越大;在绞线制造时可以考虑将钢层和铝层交替绞合,以平衡绞线的导电性和刚性.在股线相互接触的位置出现了应力集中,应力集中位置与股线绞合方向相同;在绞线制造时,可以考虑在股线表面覆缓冲层,以减缓正馈线舞动时股线之间的振荡冲击,并延长正馈线的使用寿命;低风压正馈线模型的凹槽小圆弧半径与常规正馈线半径的比值越大,最外层铝股线的形变越大,正馈线舞动时越容易断股;在低风压正馈线选型时应该综合考虑,平衡防舞有效性与使用寿命.

ICU医护人员ARDS肺保护通气策略依从性的现状调查

目的通过调查分析重症监护病房(ICU)医护人员对急性呼吸窘迫综合征(ARDS)肺保护通气策略(LPVS)应用的依从性,以改进临床ARDS LPVS的规范实施。方法回顾性调查2021年1月至2022年12月入住江苏省内8家医院ICU进行有创机械通气ARDS患者的临床资料,通过自制的ARDS LPVS实施监测量表,收集患者性别、年龄、身高、理想体质量(IBW),以及机械通气6 h的呼吸机参数〔模式、潮气量(VT)、呼气末正压(PEEP)、吸入氧浓度(FiO2)〕等相关指标。根据ARDS患者机械通气是否按照目标VT≤6 mL/kg(IBW),以及PEEP设置水平是否符合ARDS临床研究网络(ARDSnet)推荐FiO2-PEEP对应量表作为评价ARDS LPVS的标准,评估不同级别医院ICU医护人员对ARDS LPVS临床实施的依从性。结果纳入调查的357例ARDS机械通气患者中,VT设置均值为(6.17±1.02)mL/kg,其中204例患者按照VT≤6 mL/kg(IBW)设置,依从性为57.14%;三级医院VT设置低于二级医院(mL/kg:6.06±1.05比6.33±0.97,P<0.05),三级医院VT设置的依从性较二级医院更好〔61.84%(128/207)比50.67%(76/150),P<0.05〕。PEEP设置区间在3~16 cmH_(2)O(1 cmH_(2)O≈0.098 kPa),PEEP均值为(6.52±2.53)cmH_(2)O,其中199例患者的PEEP设置符合ARDSnet推荐的FiO2-PEEP对应量表,依从性占比为55.74%;三级医院PEEP设置高于二级医院(cmH_(2)O:6.95±2.13比5.94±2.91,P<0.05);三级医院PEEP设置的依从性高于二级医院〔67.63%(140/207)比39.33%(59/150),P<0.05〕。更为明显的是,在PEEP设置<5 cmH_(2)O的38例患者中,二级医院占94.74%(36例),其PEEP设置的不规范程度远高于三级医院〔60.67%(91/150)比32.37%(67/207),P<0.05〕。结论小潮气量(LVT)及合适PEEP的设置是规范实施ARDS LPVS的基础,是预防和减少呼吸机相关肺损伤(VILI)的关键。但从本次调查的情况来看,临床依从性并不乐观,尤其是二级医院在ARDS LPVS临床实施中与三级医院相比存在较大的差距。因此,需要重视ICU医护人员ARDS LPVS的治疗理念,提高整体认知水平,建议采取医护一体化的联合管理模式,建立相应的督查机制,以提高ICU医护人员ARDS LPVS的依从性。

Erroneous presentation of respiratory-hemodynamic disturbances and postsurgical inflammatory responses in patients having undergone abdominal cavity cancer surgery

In this letter to the editor,the authors discuss the findings and shortcomings of a published retrospective study,including 120 patients undergoing surgery for gastric or colon cancer under general anesthesia.The study focused on perioperative dynamic respiratory and hemodynamic disturbances and early postsurgical inflammatory responses.

两种不同体位固定技术对食管癌放疗的摆位误差临床比较分析

目的探究在食管癌患者的放射治疗中采取不同的体位固定技术对摆位误差的影响,为临床提高患者放疗的准确性和治疗效果提供依据。方法选取2020年2月至2022年2月于上海市杨浦区市东医院肿瘤放疗科接受放疗治疗的56例食管癌患者进行回顾性分析,根据放疗中体位固定技术的不同分为对照组(28例,低温热塑膜固定)和研究组(28例,真空负压垫和翼型板联合固定),分析两组患者X轴(左右方向)、Y轴(上下方向)、Z轴(前后方向)的摆位误差的差异。结果研究组X轴、Y轴及Z轴的线性摆位误差分别为(1.87±0.45)mm、(2.31±0.89)mm、(1.56±0.58)mm,均明显小于对照组X轴、Y轴及Z轴的摆位误差(2.20±0.67)mm、(2.90±0.93)mm、(2.77±0.82)mm,差异有统计学意义(t=2.164、2.425、6.375,P=0.036、0.019、0.000);研究组X轴、Y轴及Z轴的旋转误差分别为(0.82±0.52)°、(0.63±0.34)°、(0.65±0.39)°,小于对照组X轴、Y轴及Z轴的摆位误差(0.83±0.49)°、(0.72±0.43)°、(0.73±0.46)°,差异无统计学意义(t=0.074、0.869、0.702,P=0.941、0.389、0.486)。结论在食管癌患者放疗过程中应用真空负压垫和翼型板联合固定的方式,可以进一步减少摆位误差,从而提高患者放疗的准确性和治疗效果,可考虑作为食管癌患者放疗治疗中的一种可靠体位固定技术。