肺纤维化患者非心胸手术的围术期麻醉管理策略

1肺纤维化概述 肺纤维化（pulmonary fibrosis,PF）是多种间质性肺疾病（ILD）的共同终末期改变,患者起病隐匿,病程中出现进行性加重的气短、干咳、活动耐力严重下降、限制性通气功能障碍和换气功能进行性恶化,最终出现呼吸衰竭、右心功能不全和死亡。PF尚无有效治疗方法 ,氧疗和肺移植能够改善患者的症状,但仍不能确切延长患者生存期。

非心胸手术术后肺部感染的相关危险因素分析

国外有文献报道外科术后肺部感染发生率是2%～20%,术后出现肺部感染的患者住院时间延长,增加了住院费用,理应引起重视,采取措施降低发生率[1]。因此了解导致术后肺部感染的危险因素,

成年人非心胸手术中通气管理的临床实践:一项全国问卷调查研究

目的调查中国麻醉医师在成年人非心胸手术中通气管理的临床实践现状。方法2021年8月至2021年9月,向中国81家大型三甲综合医院麻醉科发出电子调查问卷进行全国调查性研究,分析小潮气量(V_(T))通气、呼气末正压通气(PEEP)及肺复张手法(ARM)的应用情况和“肺保护性通气(LPV)策略”的理论认识情况。对调查结果进行描述性统计分析。结果全国57家调查中心参与调查,调查中心回复率为70%,回收有效问卷1089份。92.7%的麻醉医师术中常规使用小VT通气。77.1%的麻醉医师术中常规设置PEEP,1~5 cmH_(2)O(1 cmH_(2)O=0.098 kPa)是最常采用的PEEP水平。84.6%的麻醉医师术中常规实施ARM。绝大多数麻醉医师(97.9%)认为“LPV策略”是指联合使用“小V_(T)、PEEP及ARM”。64.8%的麻醉医师术中常规联合使用小V_(T)、PEEP及ARM。结论中国大型三甲综合医院的麻醉医师在成年人非心胸手术中通气管理中的临床实践现状存在异质性,LPV策略的临床实践与理论认识存在一定差距。

Establishment of an animal model of non-transthoracic cardiopulmonary bypass in rats

Objective: To establish an animal model of non-transthoracic cardiopulmonary bypass (CPB) in rats. Methods: Ten adult male Sprague-Dawlay rats, weighing 350-500 g, were used in this study. CPB was established in these animals through cannulating the left carotid and right jugular vein for arterial perfusion and venous return. The components of perfusion circuit, especially the miniature oxygenator and cannula, were specially designed and improved. The mean arterial pressure was measured with a blood pressure meter through cannulating the left femoral artery. The hemodynamic and blood gas parameters were also monitored. Results: The rat model of non-transthoracic CPB was established successfully. The hemodynamical parameters were changed within an acceptable region during CPB. The miniature oxygenator was sufficient to meet the standard of satisfactory CPB. Conclusions: The rat model of non-transthoracic CPB established through the carotid and jugular cannulation is feasible, easily operated, safe, reliable, and economic. It is an ideal model for the pathophysiological research of CPB.