Relationship between neonatal respiratory distress syndrome pulmonary ultrasonography and respiratory distress score,oxygenation index,and chest radiography grading

BACKGROUND Accurate condition assessment is critical for improving the prognosis of neonatal respiratory distress syndrome(RDS),but current assessment methods for RDS pose a cumulative risk of harm to neonates.Thus,a less harmful method for assessing the health of neonates with RDS is needed.AIM To analyze the relationships between pulmonary ultrasonography and respiratory distress scores,oxygenation index,and chest X-ray grade of neonatal RDS to identify predictors of neonatal RDS severity.METHODS This retrospective study analyzed the medical information of 73 neonates with RDS admitted to the neonatal intensive care unit of Liupanshui Maternal and Child Care Service Center between April and December 2022.The pulmonary ultrasonography score,respiratory distress score,oxygenation index,and chest Xray grade of each newborn before and after treatment were collected.Spearman correlation analysis was performed to determine the relationships among these values and neonatal RDS severity.RESULTS The pulmonary ultrasonography score,respiratory distress score,oxygenation index,and chest X-ray RDS grade of the neonates were significantly lower after treatment than before treatment(P<0.05).Spearman correlation analysis showed that before and after treatment,the pulmonary ultrasonography score of neonates with RDS was positively correlated with the respiratory distress score,oxygenation index,and chest X-ray grade(ρ=0.429–0.859,P<0.05).Receiver operating characteristic curve analysis indicated that pulmonary ultrasonography screening effectively predicted the severity of neonatal RDS(area under the curve=0.805–1.000,P<0.05).CONCLUSION The pulmonary ultrasonography score was significantly associated with the neonatal RDS score,oxygenation index,and chest X-ray grade.The pulmonary ultrasonography score was an effective predictor of neonatal RDS severity.

Correlation of Inferior Vena Cava Respiratory Variability Index with Central Venous Pressure and Hemodynamic Parameters in Ventilated Pigs with Septic Shock

Septic shock is a common critical condition, for which effective early fluid resuscitation is the therapeutic focus. According to the 2008 international guidelines for management of severe sepsis and septic shock, resuscitation should achieve a central venous pressure （CVP） of 8-12 mmHg within the first 6 h. However, it is still uncertain about the sensitivity and specificity of CVP in reflecting the cardiac preload. Ultrasonography is a simple, rapid, non-invasive, and repeatable method for the measurement of sensitivity and specificity of CVP and has thus gradually attracted the increasing attention of physicians. It was reported that ultrasonography can show the inferior vena cava diameter, respiratory variability index, and blood volume in patients with sepsis or heart failure.

Persistent alterations in gray matter in COVID-19 patients experiencing sleep disturbances:a 3-month longitudinal study

Sleep disturbances are among the most prevalent neuropsychiatric symptoms in individuals who have recovered from severe acute respiratory syndrome coronavirus 2 infections.Previous studies have demonstrated abnormal brain structures in patients with sleep disturbances who have recovered from coronavirus disease 2019(COVID-19).However,neuroimaging studies on sleep disturbances caused by COVID-19 are scarce,and existing studies have primarily focused on the long-term effects of the virus,with minimal acute phase data.As a result,little is known about the pathophysiology of sleep disturbances in the acute phase of COVID-19.To address this issue,we designed a longitudinal study to investigate whether alterations in brain structure occur during the acute phase of infection,and verified the results using 3-month follow-up data.A total of 26 COVID-19 patients with sleep disturbances(aged 51.5±13.57 years,8 women and 18 men),27 COVID-19 patients without sleep disturbances(aged 47.33±15.98 years,9 women and 18 men),and 31 age-and gender-matched healthy controls(aged 49.19±17.51 years,9 women and 22 men)were included in this study.Eleven COVID-19 patients with sleep disturbances were included in a longitudinal analysis.We found that COVID-19 patients with sleep disturbances exhibited brain structural changes in almost all brain lobes.The cortical thicknesses of the left pars opercularis and left precuneus were significantly negatively correlated with Pittsburgh Sleep Quality Index scores.Additionally,we observed changes in the volume of the hippocampus and its subfield regions in COVID-19 patients compared with the healthy controls.The 3-month follow-up data revealed indices of altered cerebral structure(cortical thickness,cortical grey matter volume,and cortical surface area)in the frontal-parietal cortex compared with the baseline in COVID-19 patients with sleep disturbances.Our findings indicate that the sleep disturbances patients had altered morphology in the cortical and hippocampal structures during the acute phase of infection and persistent changes in cortical regions at 3 months post-infection.These data improve our understanding of the pathophysiology of sleep disturbances caused by COVID-19.

Lung recruitment maneuver effects on respiratory mechanics and extravascular lung water index in patients with acute respiratory distress syndrome

BACKGROUND：Animal experiments showed that recruitment maneuver （RM） and protective ventilation strategy of the lung could improve oxygenation and reduce extravascular lung water. This study was to investigate the effects of RM on respiratory mechanics and extravascular lung water index （EVLWI） in patients with acute respiratory distress syndrome （ARDS）. METHODS：Thirty patients with ARDS were randomized into a RM group and a non-RM group. In the RM group, after basic mechanical ventilation stabilized for 30 minutes, RM was performed and repeated once every 12 hours for 3 days. In the non-RM group, lung protective strategy was conducted without RM. Oxygenation index （PaO2/FiO2）, peak inspiratory pressure （PIP）, Plateau pressure （Pplat）, static pulmonary compliance （Cst） and EVLWI of patients before treatment and at 12, 24, 48, 72 hours after the treatment were measured and compared between the groups. Hemodynamic changes were observed before and after RM. One-way ANOVA, Student＇s t test and Fisher＇s exact test were used to process the data. RESULTS：The levels of PaO2/FiO2 and Cst increased after treatment in the two groups, but they were higher in the RM group than in the non-RM group （P〈0.05）. The PIP and Pplat decreased after treatment in the two groups, but they were lower in the RM group than in the non-RM group （P〈0.05）. The EVLWI in the two groups showed downward trend after treatment （P〈0.05）, and the differences were signifcant at all time points （P〈0.01）; the EVLWI in the RM group was lower than that in the non-RM group at 12, 24, 48 and 72 hours （P〈0.05 or P〈0.01）. Compared with pre-RM, hemodynamics changes during RM were significantly different （P〈0.01）; compared with pre-RM, the changes were not significantly different at 120 seconds after the end of RM （P〉0.05）. CONCLUSIONS： RM could reduce EVLWI, increase oxygenation and lung compliance. The effect of RM on hemodynamics was transient.

Applications of lung clearance index in monitoring children with cystic fibrosis

A sensitive, reproducible and feasible measure of lung function for monitoring the respiratory health is a prerequisite for the optimization of management of the patients with cystic fibrosis(CF). Spirometry has been considered the method of choice, although it is applicable only in children older than 6 years of age, as good cooperation is necessary for its proper performance. However, over the last15 years, scientific interest in gas dilution techniques and particularly in multiple breath wash out(MBW) method has been revived. The most commonly reported index of MBW is lung clearance index(LCI). The aim of this review is to present the most recent developments in the application of LCI as a monitoring index of respiratory status of CF patients. LCI is a sensitive and reproducible marker of ventilation inhomogeneity. It is more sensitive than spirometry and, unlike spirometry; it can be performed across the whole pediatric age range. Since it is dependent on body size, until at least the age of 6 years, the relative and not the absolute changes are more appropriate for providing clinically meaningful conclusion on ventilation inhomogeneity. Until now, MBW has been mainly used as a research tool. Based on the currently available data LCI cannot safely predict high-resolution computed tomography findings in children with CF, especially in infants. It can be used as an end-point measure for the assessment of beneficial effect of interventions. However, its utility as an outcome measure for the efficacy of therapeutic interventions seems to be dependent on the pathophysiologic mechanisms that underlie each intervention. It seems that more studies,especially longitudinal ones, are required in order to fully clarify the clinical usefulness of LCI, not only in the research setting, but also in every day practice of CF clinic.

Effect of Shenqi Fuzheng Injection and naloxone and BiPAP ventilator on serum inflammatory factors, immune function and blood gas analysis indexes in patients with AECOPD with type Ⅱ respiratory failure

Objective: To investigate the effect of Shenqi Fuzheng Injection combined with naloxone and BiPAP ventilator on serum inflammatory factors, immune function and blood gas analysis indexes in treatment of AECOPD with type Ⅱ respiratory failure. Methods: A total of 82 patients with AECOPD and type Ⅱ respiratory failure were divided into control group (n=40) and observation group (n=42) according to random data table, patients in the control group received naloxone and BiPAP ventilator therapy, and observation group patients were treated with Shenqi Fuzheng Injection on the basis of control group. The levels of serum inflammatory factors, immune function and blood gas analysis indexes were compared between the two groups before and after treatment. Results: There were no significant difference in levels of CRP, TNF-α, IL-6, CD3+, CD4+, CD8+, CD4+/CD8+, PaO2, PaCO2, SaO2 and pH before and after treatment in the two groups. After treatment, the levels of CRP, TNF-α, IL-6, CD8+and PaCO2 in two groups were significantly lower than those in same group before treatment, moreover observation group was significantly lower than control group;and levels of CRP, TNF-α, IL-6, CD8+ and PaCO2 in the observation group was significantly lower than those of the control group, the difference was statistically significant;When compared with the group before treatment, CD3+, CD4+, CD4+/CD8+, PaO2, SaO2 and pH levels of both groups after treatment were significantly increased, and the level of each index of observation group after treatment were significantly higher than the control group, the difference was statistically significant. Conclusion: The clinical effect of Shenqi Fuzheng Injection Combined with naloxone and BiPAP ventilator in treatment of AECOPD with type II respiratory failure is significant, can effectively reduce the body's inflammatory reaction, improve immune function, regulate blood gas analysis index, with a certain clinical value.

前列腺外周带血流高阻力指数(RI)对前列腺癌的诊断价值

目的 探索彩色多普勒超声的血流指标对前列腺癌的诊断价值。方法 采用彩色多普勒双平面直肠腔内探头检测前列腺 ,重点检测前列腺外周带血流参数指标。结果 前列腺增生 67例 ,前列腺癌 5 8例。前列腺外周带血流 2级以上前列腺增生 5 8% ,前列腺癌 74.13 % ,P <0 .10 ;前列腺增生和前列腺癌的Vmax均值分别是 10 .77cm/s和12 .91cm/s ,RI分别是 0 .71和 0 .82 ,Vmax和RI在两组间有显著统计学差异 (P <0 .0 0 1) ;以RI 0 .75为临界值 ,对前列腺癌诊断的敏感性 87.5 %、特异性 92 .4%、准确性 75 %和阳性预测值 84%。结论 前列腺外周带血流增多 ,RI >0 .75时 ,对前列腺癌的诊断价值明显提高。

RI指数联合超声对孕晚期胎儿肾积水预后预测价值的研究

目的探讨RI指数联合超声对孕晚期胎儿肾积水预后预测的价值．方法选取行超声检查发现的晚孕期肾积水胎儿141例，检测胎儿的肾实质厚度、肾盂前后直径（APD）、肾盂肾盏形态，并给予评分，累计3项指标评分分值；对胎儿行超声检查时测定积水肾脏肾门位置的RI值．将以上检测结果与胎儿出生后1a内行超声检查和临床诊断结果进行对照研究．结果141例胎儿共有170只。肾积水；出生后1a内行超声检查和临床诊断显示，非病理性肾积水121只，病理性49只．随着超声评分值增加，病理性。肾积水风险越高，其中超声评分≤3分均为非病理性肾积水，评分≥8分均为病理性肾积水．病理性肾积水与非病理性肾积水超声评分之间差异具有显著统计学意义（P〈0．01）．超声评分为5分时，为辨别诊断非病理性。肾积水和病理性。肾积水的截断值，特异度为88．61％，灵敏度为95．00％．超声评分≤5分的肾积水胎儿的肾动脉RI值在0．60～0．67，而超声评分〉5分的。肾积水胎儿。肾动脉RI值在0．70～0．78．结论超声评分法联合RI指数评估胎儿肾积水预后客观准确，具有较高实用价值，超声评分5分为诊断胎儿病理性肾积水的最佳截断值．

炎症及营养指标对RICU下呼吸道感染患者临床转归预测分析

目的探讨炎症及营养指标对严重下呼吸道感染患者临床转归的预测价值。方法运用受试者工作特征曲线(ROC曲线)计算曲线下面积(AUC),分析143例呼吸重症监护病区(RICU)下呼吸道感染患者入院时血清降钙素原(PCT)、超敏C反应蛋白(Hs-CRP),清蛋白(Alb)、前清蛋白(PA)、尿素氮(BUN)、肌酐(Cr)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血红蛋白(Hb)水平和淋巴细胞计数(LY)等指标对于入院25 d死亡及实施机械通气的预测价值,进行炎症与营养指标的相关性分析。结果 ROC曲线对于25 d死亡预测分析中,PCT的AUC值最高(>0.70),其余指标AUC均>0.50。25 d死亡组与非死亡组间各指标比较,LY、PCT、Alb及PA的差异有统计学意义(P<0.05或P<0.01)。各指标预测实施机械通气ROC曲线分析中,LY的AUC值最高,除PA和Cr外,各指标AUC均>0.50。实施机械通气与未实施机械通气组间比较,LY、PCT、Hb及HDL-C的差异有统计学意义(P<0.05)。患者PCT与Hb、PA、Alb、TC、HDL-C及LDL-C水平呈负相关(P<0.05或P<0.01),与BUN及Cr水平呈正相关(P<0.01);Hs-CRP与PA、Alb水平呈负相关(P<0.01)。结论 PCT、LY对于严重下呼吸道感染患者近期死亡及实施机械通气独立预测价值相对较高,且PCT水平与营养状况有密切关系。

基于改进RI方法的文本聚类

旨在通过考虑特征词汇的潜在语义和自身的重要性来提高文本聚类效果,研究基于RI方法的文本向量表示方法。首先,对基于RI方法构建的特征词汇随机索引向量中+1和-1向量元素出现位置进行约束,以避免在构建特征词汇上下文向量时可能造成该特征词汇潜在语义丢失现象;其次,在生成文本向量时考虑特征词汇自身重要性来改进权值的计算;最后,在测试数据上对基于RI方法的文本向量表示进行聚类效果测试与对比分析,结果表明采用基于RI方法能提高文本聚类效果。

基于索引调制的RIS辅助SIMO通信系统信号检测算法

面对未来无线移动通信对通信质量和频谱效率的更高要求,该文融合索引调制(IM)与可重构智能表面(RIS)技术,建立基于IM的RIS辅助单输入多输出(SIMO)通信系统架构,并提出一种基于变分贝叶斯推断(VBI)的信号检测算法。首先,在该系统中,RIS单元被划分为若干子块,利用RIS子块的激活状态传递附加信息;接着,利用VBI给出激活RIS子块对应的相移矢量与待检测信号的近似后验分布;最后,利用RIS相移矢量近似后验分布的对数零梯度值结合正交匹配追踪算法(OMP)恢复出索引信息比特,进而利用待检测信号对数零梯度值,恢复出发送信号。同时,从理论上推导了基于IM的RIS辅助SIMO系统平均速率。仿真结果表明,与传统RIS辅助的SIMO通信系统相比,基于IM的RIS辅助SIMO系统具有更高的系统平均速率;并且与现有算法相比,该文算法具有更低的误比特率。

RIT与AHI指数对阻塞性睡眠呼吸暂停低通气综合征评估作用的比较

目的:研究睡眠呼吸紊乱时间指数(respiratory impair time index,RIT)在阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者病情评估中的作用。方法:对98例OSAHS患者的多导睡眠图(polysomnography,PSG)进行回顾性分析,将分别发生于快速眼动睡眠期(rapid eye movement stage,REM)和非快速眼动睡眠期(non-rapideyemovementstage,NREM)的呼吸暂停低通气指数(apneahypopneaindex,AHI)、RIT指数以及最低血氧饱和度进行对比分析和相关性分析,了解AHI和RIT与患者不同睡眠时相及缺氧严重程度之间的关系。结果:①重度患者RIT指数在NREM期(23.4±9.8)与REM期(28.3±9.2)具有显著差异,与患者最低血氧饱和度的变化相一致,而AHI指数在NREM期与REM期无统计学差异;②RIT与LSaO2的相关系数(r)为-0.67;AHI与LSaO2的相关系数(r)为-0.45,RIT与患者最低血氧饱和度更具相关性。结论:RIT随患者不同睡眠时相而变化。

TVCDS与RI指数联合血清CA125、CA199水平检测对卵巢癌患者诊断效能的影响

目的探究经阴道彩色多普勒超声（TVCDS）与多普勒超声阻力指数（RI指数）联合血清糖类抗原125（CA125）、糖类抗原199（CA199）水平检测对卵巢癌患者诊断效能的影响。方法选取2014年1月至2017年2月本院卵巢癌早期患者44例（A组），卵巢良性肿瘤患者38例（B组），均经术后病理学证实，另选取同期健康体检者40例（C组）。均行TVCDS检查，以化学发光免疫分析法测定血清CA125、CA199水平。比较三组血清CA125、CA199水平及A组、B组TVCDS血流参数[收缩期峰值流速（PSV）、舒张末期流速（EDV）、RI指数1，分析TVCDS（RI）、血清CA125、CA125水平单独及联合诊断早期卵巢癌敏感度、特异度、准确度、漏诊率、误诊率。结果经单因素方差分析，三组间血清CA125、CA199水平比较，差异有统计学意义（P〈0．05），A组血清CA125、CA199水平明显高于B组、C组，差异有统计学意义（P〈0．05）；A组PSV、EDV高于B组，RI低于B组，差异具有统计学意义（P〈0．05）；联合检测早期卵巢癌敏感度93．18％（41，44）、特异度97．37％（37／38）、准确度95．12％（78／82），均高于TVCDs（RI）、血清CA125、CA199水平单独检测，差异具有统计学意义（P〈0．05）；联合检测漏诊率6．82％（3／44）、误诊率2．63％（1／38），均低于TVCDS（RI）、血清CA125、CA199水平单独检测，差异具有统计学意义（P〈0．05）。结论TVCDS与RI指数联合血清CA125、CA199水平检测卵巢癌患者，能及早发现恶性肿瘤，具有较高诊断价值，且能减少漏诊、误诊情况，值得临床推广应用。

全身免疫炎症指数、EGRIS评分对吉兰-巴雷综合征病人发生呼吸衰竭的预测价值

目的探讨全身免疫炎症指数(SII)、Erasmus GBS呼吸功能不全评分(EGRIS)对吉兰-巴雷综合征(GBS)病人呼吸衰竭发生的预测价值。方法收集2018年5月至2021年5月在郴州市第一人民医院接受治疗的123例GBS病人的临床资料。根据是否发生呼吸衰竭分为呼吸衰竭组、非呼吸衰竭组。对比两组病人的EGRIS评分、SII;运用多因素logistic回归分析探究可能影响GBS病人呼吸衰竭的危险因素;使用受试者操作特征(ROC)曲线评估EGRIS、SII对GBS病人发生呼吸衰竭的预测价值。结果两组病人发病到住院时间[(5.3±0.6)d比(9.2±1.1)d]、EGRIS评分[(5.5±0.2)分比(2.8±0.3)分]及SII[(1683.6±64.3)分比(603.4±25.2分)]比较,差异有统计学意义(P<0.05)。EGRIS及SII是GBS病人发生呼吸衰竭的危险因素(OR值分别为1.43、5.26,均P<0.01)。EGRIS、SII及两者联合预测呼吸衰竭的曲线下面积分别为0.75、0.89、0.93,灵敏度分别为82.01%、96.67%、95.33%,特异度分别为69.01%、67.61%、78.87%。结论EGRIS、SII是预测GBS病人发生呼吸衰竭的指标,两者联合可准确预测呼吸衰竭风险。

心电图Morris、Macruz指数与经皮球囊二尖瓣成形术疗效的相关性分析

分析32例经皮球囊二尖瓣成形术(PBMV)前、后的心电图Morris指数(PTFv_1)和Macruz指数(Ⅱ导联P/P-R段比值),探讨心电图对判定PBMV疗效的价值。结果Morris指数术前—0.061±0.005mm·s,术后—0.038±0.003mm·s,Macruz指数术前2.54±0.12,术后2.02±0.15,均有极显著性差异(P<0.001)。将两指数分别与多项血流动力学和超声心动图测值比较,术前,后均有较好的相关。认为Morris指数和Macruz指数可作为PBMV后疗效判定及心功能随访的一种可靠而简便的方法。

食管癌患者血清NGAL、Hcy、sTNF-RI、白介素及食管动力学指标的变化观察

目的分析食管癌患者的血清NGAL、Hcy、sTNF-RI、白介素及食管动力学指标的变化情况。方法选取本院收治的66例食管癌患者为观察组,并选取同时间段的66名体检健康人员为对照组,然后将2组的血清NGAL、Hcy、sTNF-RI、白介素及食管动力学指标进行检测与比较,然后将观察组中不同食管癌分期者的检测指标进行比较。结果观察组的血清IL-2低于对照组,血清NGAL、Hcy、sTNF-RI及IL-6、IL-8、IL-18则均高于对照组,另外食管收缩压、蠕动性收缩比及食管括约肌松弛率低于对照组,且观察组中食管癌分期较高者的变化大于食管癌分期较低的患者,差异均有统计学意义(P<0.05)。结论食管癌患者的血清NGAL、Hcy、sTNF-RI、白介素及食管动力学指标呈现异常的状态,且其检测水平受疾病分期的影响较大。

Ulinastatin for acute lung injury and acute respiratory distress syndrome: A systematic review and meta-analysis

AIM: To investigate the efficacy and safety of ulinastatin for patients with acute lung injury(ALI) and those with acute respiratory distress syndrome(ARDS).METHODS: A systematic review of randomized controlled trials(RCTs) of ulinastatin for ALI/ARDS was conducted. Oxygenation index, mortality rate [intensive care unit(ICU) mortality rate, 28-d mortality rate] and length of ICU stay were compared between ulinastatin group and conventional therapy group. Meta-analysis was performed by using Rev Man 5.1.RESULTS: Twenty-nine RCTs with 1726 participants were totally included, the basic conditions of which were similar. No studies discussed adverse effect. Oxygenation index was reported in twenty-six studies(1552 patients). Ulinastatin had a significant effect in improving oxygenation [standard mean difference(SMD) = 1.85, 95%CI: 1.42-2.29, P < 0.00001, I2 = 92%]. ICUmortality and 28-d mortality were respectively reported in eighteen studies(987 patients) and three studies(196 patients). We found that ulinastatin significantly decreased the ICU mortality [I2 = 0%, RR = 0.48, 95%CI: 0.38-0.59, number needed to treat(NNT) = 5.06, P < 0.00001], while the 28-d mortality was not significantly affected(I2 = 0%, RR = 0.78, 95%CI: 0.51-1.19, NNT = 12.66, P = 0.24). The length of ICU stay(six studies, 364 patients) in the ulinastatin group was significantly lower than that in the control group(SMD =-0.97, 95%CI:-1.20--0.75, P < 0.00001, I2 = 86%). CONCLUSION: Ulinastatin seems to be effective for ALI and ARDS though most trials included were of poor quality and no information on safety was provided.

Effect of High Frequency Oscillatory Ventilation on EVLW and Lung Capillary Permeability of Piglets with Acute Respiratory Distress Syndrome Caused by Pulmonary and Extrapulmonary Insults

The effect of high frequency oscillatory ventilation（HFOV） at early stage on hemodynamic parameters, extravascular lung water（EVLW）, lung capillary permeability, CC16 and s ICAM-1 in piglets with pulmonary or extrapulmonary acute respiratory distress syndrome（ARDS） was explored. Central vein pressure（CVP） and pulse indicator continuous cardiac output（Pi CCO） were monitored in 12 anesthetized and intubated healthy piglets. Pulmonary ARDS（ARDSp） and extrapulmonary ARDS（ARDSexp） models were respectively established by lung lavage of saline solution and intravenous injection of oleic acid. Then the piglets received HFOV for 4 h. EVLW index（EVLWI）, EVLW/intratroracic blood volume（ITBV） and pulmonary vascular permeability index（PVPI） were measured before and after modeling（T0 and T1）, and T2（1 h）, T3（2 h）, T4（3 h） and T5（4 h） after HFOV. CC16 and s ICAM-1 were also detected at T1 and T5. Results showed at T1, T3, T4 and T5, EVLWI was increased more significantly in ARDSp group than in ARDSexp group（P〈0.05）. The EVLWI in ARDSp group was increased at T1（P=0.008）, and sustained continuously within 2 h（P=0.679, P=0.216）, but decreased at T4（P=0.007） and T5（P=0.037）. The EVLWI in ARDSexp group was also increased at T1（P=0.003）, but significantly decreased at T3（P=0.002） and T4（P=0.019）. PVPI was increased after modeling in both two groups（P=0.004, P=0.012）, but there was no significant change within 4 h（T5） under HFOV in ARDSp group, while PVPI showed the increasing trends at first, then decreased in ARDSexp group after HFOV. The changes of EVLW/ITBV were similar to those of PVPI. No significant differences were found in ΔEVLWI（P=0.13）, ΔPVPI（P=0.28） and ΔEVLW/ITBV between the two groups（P=0.63）. The significant decreases in both CC16 and s ICAM-1 were found in both two groups 4 h after HFOV, but there was no significant difference between the two groups. It was concluded that EVLWI and lung capillary permeability were markedly increased in ARDSp and ARDSexp groups. EVLW could be decreased 4 h after the HFOV treatment. HFOV, EVLW/ITBV and PVPI were increased slightly at first, and then decreased in ARDSexp group, while in ARDSp group no significant difference was found after modeling. No significant differences were found in the decreases in EVLW and lung capillary permeability 4 h after HFOV.

肺癌术后发生呼吸衰竭(RI)的常见危险因素分析

目的探析肺癌术后发生呼吸衰竭的常见因素。方法选取该院2011年1月—2015年1月收治的89例肺癌术后发生呼吸衰竭的患者为研究的对象,并同时选取同期手术治疗的178例肺癌术后未发生呼吸衰竭的患者,作为对照组,采取Logistic回归分析危险因素。结果研究组患者的平均年龄、平均吸烟量均显著多于对照组,差异有统计学意义(P<0.05),研究组血浆白蛋白量为(36.5±4.3)g/L,对照组血浆白蛋白量为(35.4±3.3)g/L两者差异无统计学意义(P<0.05),研究组具有既往呼吸系统疾病史患者占(29/89)32.58%较对照组(5/178)2.81%差异有统计学意义(x^2=16.785,P<0.05);研究组FEV1/FVC、FEF50%(<70%)的比例显著高于对照组,差异有统计学意义(P<0.05),研究组MVV(<50%)、FIF50%、ERV、IC(<70%)较对照组比较,差异有统计学意义(P<0.05)。研究组患者术中输液量、术后当天输液量、术后当天进入量均显著高于对照组,差异有统计学意义(P<0.05)。Logistic回归分析,患者年龄、既往呼吸系统疾病史、手术方式、FVC、FEV1及术后当天进入量是肺癌术后发生呼吸功能衰竭的常见危险因素。结论肺癌术后发生呼吸衰竭的常见因素中,年龄、既往呼吸道疾病史、手术方式、FVC、FEV1及术后当天进入量是其主要危险因素。

Effects of high-volume hemofiltration on alveolar- arterial oxygen exchange in patients with refractory septic shock

BACKGROUND：High-volume hemofiltration （HVHF） is technically possible in severe acute pancreatitis （SAP） patients complicated with multiple organ dysfunction syndrome （MODS）. Continuous HVHF is expected to become a beneficial adjunct therapy for SAP complicated with MODS. In this study, we aimed to explore the effects of fluid resuscitation and HVHF on alveolar- arterial oxygen exchange, the Acute Physiology and Chronic Health Evaluation II （APACHE II） score in patients with refractory septic shock. METHODS：A total of 89 refractory septic shock patients, who were admitted to ICU, the Provincial Hospital affiliated to Shandong University from August 2006 to December 2009, were enrolled in this retrospective study. The patients were randomly divided into two groups： fluid resuscitation （group A, n=41）, and fluid resuscitation plus high-volume hemofiltration （group B, n=48）, The levels of O2 content of central venous blood （CcvO2）, arterial oxygen content （CaO2）, alveolar-arterial oxygen pressure difference P（A-a）DO2, ratio of arterial oxygen pressure/alveolar oxygen pressure （PaO2/ PAO2）, respiratory index （RI） and oxygenation index （OI） were determined. The oxygen exchange levels of the two groups were examined based on the arterial blood gas analysis at different times （0, 24, 72 hours and 7 days of treatment） in the two groups. The APACHE II score was calculated before and after 7-day treatment in the two groups. The levels of CcvO2, CaO2 on day 7 in group A were significantly lower than those in group B （CcvO2：0.60±0.24 vs, 0.72±0.28, P〈0.05; CaO2：0.84±0.43 vs. 0.94±0.46, P〈0.05）. The level of oxygen extraction rate （O2ER） in group A on the 7th day was significantly higher than that in group B （ 28.7±2.4 vs. 21.7±3.4, P〈0.01）. The levels of P（A-a）DO2 and RI in group B on the 7th day were significantly lower than those in group A. The levels of PaO2/PAO2 and OI in group B on 7th day were significantly higher than those in group A （P〈0.05 or P〈0.01）. The APACHE II score in the two groups reduced gradually after 7-day treatment, and the APACHE II score on the 7th day in group B was significantly lower than that in group A （8.2±3.8 vs. 17.2±6.8, P〈0.01）. HVHF combined with fluid resuscitation can improve alveolar- arterial-oxygen exchange, decrease the APACHE II score in patients with refractory septic shock, and thus it increases the survival rate of patients.