Changes and significance of retinal blood oxygen saturation and oxidative stress indexes in patients with diabetic retinopathy

BACKGROUND Diabetic retinopathy(DR)is a diabetic complication that can severely affect the patients’vision,eventually leading to blindness.DR is the most important manifestation of diabetic micro-vasculopathy and is mainly related to the course of diabetes and the degree of blood glucose control,while the age of diabetes onset,sex,and type of diabetes have little influence on it.AIM To explore the changes in blood oxygen saturation and oxidative stress indices of retinal vessels in patients with DR.METHODS In total,94 patients(94 eyes)with DR(DR group)diagnosed at Jianyang people’s Hospital between March 2019 and June 2020,and 100 volunteers(100 eyes)(control group)without eye diseases,were included in this study.Arterial and venous blood oxygen saturation,retinal arteriovenous vessel diameter,and serum oxidative stress indicators in the two groups were compared.Based on the stage of the disease,the DR group was divided into the simple DR and proliferative DR groups for stratified analysis.RESULTS The oxygen saturation of the retinal vessels in the DR group was significantly higher than that in the control group(P<0.05).The retinal vessel diameters between the DR and control groups were not significantly different.The serum malondialdehyde(MDA)and 8-hydroxydehydroguanosine(8-OHdG)levels in the DR group were significantly higher than those in the control group(P<0.05).The serum superoxide dismutase(SOD)and reduced glutathione(GSH)levels in the DR group were significantly lower than those in the control group (P < 0.05). The oxygensaturation of the retinal vessels in the patients with proliferative DR was significantly higher thanthat in the patients with simple DR (P < 0.05). The retinal vessel diameter in patients with proliferativeDR was not significantly different from that of patients with simple DR (P > 0.05). SerumMDA and 8-OHdG levels in patients with proliferative DR were significantly higher than those inpatients with simple DR (P < 0.05). Serum SOD and GSH levels in patients with proliferative DRwere significantly lower than those in patients with simple DR (P < 0.05).CONCLUSIONIncreased blood oxygen saturation of retinal arteries and veins and increased oxidative stressdamage in patients with DR may be associated with decreased retinal capillary permeability andarterial oxygen dispersion, possibly reflecting the patient’s condition.

Correlation of Blood Lactate and Mixed Venous Oxygen Saturation in Off-Pump CABG

Aim: To evaluate the correlation of blood lactate and mixed venous oxygen saturation to predict outcome in off-pump coronary artery bypass grafting. Method: This is a randomized study including 30 patients. Blood lactate and mixed venous oxygen saturation were measured in 4 groups of patients—number of grafts, presence or absence of left main coronary artery disease, ejection fraction and serum creatinine. Blood samples were taken before induction, after grafting, on intensive care unit admission, 24 hours and 48 hours after surgery. The measured blood lactate and mixed venous oxygen saturation are compared to assess the outcomes in terms of duration of ventilation and intensive care unit stay. Results: The blood lactate and mixed venous oxygen saturation values increased post operatively but no statistically significant difference in three groups— number of grafts, left main coronary artery disease and ejection fraction. In serum creatinine group, the blood lactate value was found to be statistically significant after grafting in patients with creatinine <1.5 mg/dl, however, there was a significant disparity in numbers. Conclusion: Mixed venous oxygen saturation is a better predictor of morbidity than blood lactate in terms of intensive care unit stay in patients undergoing off pump coronary artery bypass grafting.

Effect of blood transfusion therapy on oxygen saturation in brain and intestinal tissues of children with premature anaemia

Objective: To study the effect of blood transfusion therapy on oxygen saturation in brain and intestinal tissues of children with premature anaemia. Methods: Ninety-five children with premature anaemia in our hospital from August 2016 to July 2018 were selected and divided into three groups according to the different degrees of anemia, namely, mild group (n=30), moderate group (n=30) and severe group (n=35), meanwhile, another 35 premature without anemia were set as control group. Then the basal vital signs, levels of hemoglobin (Hb) and hematocrit (Hct), as well as the oxygen saturation in brain and intestinal tissue were compared among the four groups. Results: The SBP and DBP between the four groups after treatment had no difference. The HR and RR after treatment in the control group and the mild group were significantly higher than those in the severe group. The RR of the mild group was significantly lower than that of the control group, with statistical difference. The Hb in the control group and the mild group was significantly higher than that in the moderate group and the severe group. The Hb in the moderate group was significantly higher than that in the severe group. Hct in the control group and the mild group was significantly higher than that in the severe group. The Hct in the moderate group had no statistic difference with that of the mild group and severe group. The cerebral oxygen saturation after treatment in the control group and the mild group was significantly higher than that in the severe group, meanwhile the intestinal tissue oxygen saturation after treatment of the control group was significantly higher than that in the severe group. Cerebral oxygen saturation after treatment showed no difference between the severe group and the moderate group, and the intestinal tissue oxygen saturation after treatment either had no difference among the severe group, the moderate group and the mild group. Conclusion: Blood transfusion therapy can significantly improve the oxygen saturation of brain and intestinal tissues in children with premature anaemia without affecting blood pressure, and improve the degree of anemia, which can be used reasonably under the strict control of clinical indications.

Blood oxygen level–dependent functional magnetic resonance imaging can evaluate the efficiency of transcatheter arterial chemoembolization in hepatocellular carcinoma

Hepatocellular carcinoma(HCC) is among the most common malignant tumors worldwide, and transcatheter arterial chemoembolization(TACE) technology has become the first-line treatment for advanced HCC. Another important, recently developed technique is blood oxygen level–dependent functional magnetic resonance imaging(BOLD-fMRI), which utilizes hemoglobin as an endogenous contrast agent and measures deoxygenated hemoglobin content by sampling the oxygen content of tissues, thus reflecting the hemodynamics and pathophysiologic changes in body organs. Currently this technology is being used in patients with liver tumors;that is, it serves as an important tool in follow-up after TACE. The present paper summarizes these developments.

Combined APACH Ⅱ score and arterial blood lactate clearance rate to predict the prognosis of ARDS patients

Objective:To explore the easily applicable indicators of practical value to evaluate the prognosis of acute respiratory distress syndrome（ARDS）.Methods:Blood and biochemical tests and bloodgas analyses were performed upon entry into the ICUs,12 h,24 h,48 h and 72 h after that in 72 ARDS patients（who were admitted to the ICUs of our hospital from January 2000 to December 2009）.Then APACHEⅡscores were achieved by combining relevant physiological parameters and laboratory results.Results:There was a statistical difference between the death group and survival group at different time points upon entering the ICUs in terms of APACHEⅡscore, alveolar-arterial oxygen difference and arterial blood lactate clearance rate.PaO2/FiO2 values were recorded to be statistically different between the death group and survival group 24 h,48 h and 72 h,respectively after entry into the ICUs.In addition,registered linear regression existed between APACHEⅡscore,alveolar-arterial oxygen difference or PaO2/FiO2 value and time. APACHEⅡscore 24 h and 72 h after entering ICUs predicted mortality with an area under the ROC curve（AUC） standing respectively at 0.919 and 0.9SS.Arterial blood lactate clearance rate 12 h, 24 h,48 h and 72 h after entering ICUs predicted mortality with an area under the ROC curve （AUC） at 0.918,0.918,0.909 and 0.991,respectively.Conclusions:APACHEⅡscore applied in combination with arterial blood lactate clearance rate is of clinical significance in assessing the prognosis of ARDS patients.

Neuroprotection of hyperbaric oxygen therapy in sub-acute traumatic brain injury:not by immediately improving cerebral oxygen saturation and oxygen partial pressure

Although hyperbaric oxygen （HBO） therapy can promote the recovery of neural function in patients who have suffered traumatic brain injury （TBI）, the underlying mechanism is unclear. We hypothesized that hyperbaric oxygen treatment plays a neuroprotective role in TBI by increasing regional transcranial oxygen saturation （rSO2） and oxygen partial pressure （PaO2）. To test this idea, we compared two groups： a control group with 20 healthy people and a treatment group with 40 TBI patients. The 40 patients were given 100% oxygen of HBO for 90 minutes. Changes in rSO2 were measured. The controls were also examined for rSO2 and PaO2, but received no treatment, rSO2 levels in the patients did not differ significantly after treatment, but levels before and after treatment were significantly lower than those in the control group. PaO2 levels were significantly decreased after the 30-minute HBO treatment. Our findings suggest that there is a disorder of oxygen metabolism in patients with sub-acute TBI. HBO does not immediately affect cerebral oxygen metabolism, and the underlying mechanism still needs to be studied in depth.

Speed-resolved blood perfusion and oxygen saturation in human skin response to thermal stimulation

The functional status of vessels can be determined by assessing blood perfusion.By integrating diffuse reflectance spectroscopy(DRS)and Laser Doppler Flowmetry(LDF),the speed-resolved blood perfusion and blood oxygen saturation can be measured simultaneously by Enhanced Perfusion and Oxygen Saturation(EPOS).The dataset presented in this descriptor contains EPOS data recorded from a forearm point exposed to different levels of thermal stimulation,the classical LDF at control points,the R-R time series and data regarding the subjects’characteristics.All data were recorded from 60 recruited healthy subjects.Half of the subjects received different levels of thermal stimulation,and half of them were blank controls.We believe that this dataset will lead to the development of local blood perfusion methods that can be used to index vessel function assessments.This publicly available dataset will be beneficial to the microcirculation evaluation.

MEASUREMENTS OF THE BLOOD CAPILLARY PRESSURE AND ARTERIAL ELASTICITY

Describe some new fully automatic instruments for the measurements of the blood capillary pressure (Pcap) and arterial elastic properties in human fingers using a photoelectric plethysmographic technique, With these instruments, the value of Pcap was in good agreement with those reported by other investigators, the arterial elastic properties in human fingers have been successfully measured. The measurements of Pcap and arterial elasticity are now required in clinics because they provide useful and important information for evaluating vascular haemodynamics.

Effects of oxygen concentration and flow rate on cognitive ability and physiological responses in the elderly

The supply of highly concentrated oxygen positively affects cognitive processing in normal young adults. However, there have been few reports on changes in cognitive ability in elderly subjects following highly concentrated oxygen administration. This study investigated changes in cognitive ability, blood oxygen saturation （%）, and heart rate （beats/min） in normal elderly subjects at three different levels of oxygen [21% （1 L/min）, 93% （1 L/min）, and 93% （5 L/min）] administered during a 1-back task. Eight elderly male （75.3 ＋ 4.3 years old） and 10 female （71.1 ＋ 3.9 years old） subjects, who were normal in cognitive ability as shown by a score of more than 24 points in the Mini-Mental State Examination-Korea, participated in the experiment. The experiment consisted of an adaptation phase after the start of oxygen administration （3 minutes）, a control phase to obtain stable baseline measurements of heart rate and blood oxygen saturation before the task （2 minutes） and a task phase during which the 1-back task was performed （2 minutes）. Three levels of oxygen were administered throughout the three phases （7 minutes）. Blood oxygen saturation and heart rate were measured during each phase. Our results show that blood oxygen saturation increased, heart rate decreased, and response time in the 1-back task decreased as the concentration and amount of administered oxygen increased. This shows that administration of sufficient oxygen for optimal cognitive functioning increases blood oxygen saturation and decreases heart rate.

Multispectral imaging of acute wound tissue oxygenation

This paper investigates the appropriate range of values for the transcutaneous blood oxygen saturation(StO2)of granulating tissues and the surrounding tissue that can ensure timely wound recovery.This work has used a multispectral imaging system to collect wound images at wave-lengths ranging between 520 nm and 600 nm with a resolution of 10 nm.As part of this research,a pilot study was conducted on three injured individuals with superfcial wounds of different wound ages at different skin locations.The S_(t)O_(2)value predicted for the examined wounds using the Extended Modified Lambert-Beer model revealed a mean S_(t)O_(2)of 61±10.3%compared to 41.6±6.2%at the surrounding tissues,and 50.1±1.53%for control sites.These preliminary results contribute to the existing knowledge on the possible range and variation of wound bed S_(t)O_(2)that are to be used as indicators of the functioning of the vasomotion system and wound health.This study has concluded that a high S_(t)O_(2)of approximately 60%and a large fuctuation in this value should precede a good progression in wound healing.

Screening Coarctation of Aorta with Clinical and Echocardiographic Profiles in Infants:A Pilot Study

Aim:To determine the profiles of clinical features including four-limb blood pressure(BP),saturations of peripheral oxygen(SpO2),and echocardiographic features in infants with coarctation of aorta(CoA)to facilitate congenital heart diseases screening.Methods:The charts of infants with CoA were retrospectively reviewed.All in-hospital infants suspected of congenital heart diseases by clinical teams were prospectively measured of four limbs BPs and SpO2 in a regional cardiac transferring center during 2013 and 2019.Echocardiography as a gold standard test was followed within 2 days after suspicion.All infants were divided into non-significant CoA group or significant CoA group based on the difference of BPs between right arm and lower limbs.Predictors of nonsignificant CoA were determined with multivariable logistic regression.Results:One hundred thirty-three infants with CoA were identified.The BPs on upper limbs were higher than those on lower limbs(P=0.001).No statistical difference in SpO2 was found between four limbs.Fifty-three(39.8%)infants presented with significant CoA.Thirty-four infants presented with low SpO2 and 26 of 34 presented with non-significant CoA.Small ascending aorta diameter[0.070(95%CI:0.005–0.136),P=0.036]was an independent risk factors for non-significant CoA.Eighteen(13.5%)infants with CoA didn’t present with any of the BP difference,low SpO2,murmur,or weak femoral pulse.Conclusion:Less than half of the infants with CoA presented with a significant BP difference.Another one fifth presented with low SpO2.Small ascending aorta diameter was an independent factor for non-significant CoA.

Morphological and functional evaluation of chronic kidney disease using magnetic resonance imaging

X-ray computed tomography(CT),ultrasonography(US)and radionuclide scanning are important clinical methods for evaluating morphology of the kidney.These modalities are also applicable for estimating kidney function with time lapse analysis using proper contrastmedia as may be necessary.In the case of US,it can estimate kidney function based on the measurement of blood flow using the Doppler effect.Formerly,magnetic resonance imaging(MRI)was an inappropriate diagnostic imaging technique for abdominal organs because of their respiratory displacements.However,MRI is now actively used for kidney as well as liver or other parenchymal organs,in tandem with the technological advances.Unlike unenhanced X-ray CT,"conventional"MRI can distinguish the border between cortex and medulla in T1 or T2 weighted images.It was known that the border blurred with decreasing kidney function.Moreover,several other particular imaging methods were introduced in recent years,and these could be called"functional"MRI.In this review,the following are discussed:functional MRI for chronic kidney disease,which include blood oxygenation level-dependent MRI for evaluation of hypoxia,diffusion-weighted imagingfor evaluation of fibrosis,diffusion tensor imaging for evaluation of microstructure,and arterial spin labeling to evaluate the amount of organ perfusion,accompanied with several related articles.The ultimate goal of functional MRI is to provide useful in vivo information repeatedly for daily medical treatment non-invasively.

Cerebral autoregulation-directed optimal blood pressure management reduced the risk of delirium in patients with septic shock

Background When resuscitating patients with septic shock,cerebrovascular reactivity parameters are calculated by monitoring regional cerebral oxygen saturation(rSO_(2))using near-infrared spectroscopy to determine the optimal blood pressure.Here,we aimed to analyze the impact of cerebral autoregulation-directed optimal blood pressure management on the incidence of delirium and the prognosis of patients with septic shock.Methods This prospective randomized controlled clinical study was conducted in the Xiangya Hospital of Central South University,China.Fifty-one patients with septic shock(December 2020–May 2022)were enrolled and randomly allocated to the experimental(n=26)or control group(n=25).Using the ICM+software,we monitored the dynamic changes in rSO_(2) and mean arterial pressure(MAP)and calculated the cerebrovascular reactivity parameter tissue oxygen reactivity index to determine the optimal blood pressure to maintain normal cerebral autoregulation function during resuscitation in the experimental group.The control group was treated according to the Surviving Sepsis Campaign Guidelines.Differences in the incidence of delirium and 28-day mortality between the two groups were compared,and the risk factors were analyzed.Results The 51 patients,including 39 male and 12 female,had a mean age of(57.0±14.9)years.The incidence of delirium was 40.1%(23/51),and the 28-day mortality rate was 29.4%(15/51).The mean MAP during the first 24 h of intensive care unit(ICU)admission was higher([84.5±12.2]mmHg vs.[77.4±11.8]mmHg,P=0.040),and the incidence of delirium was lower(30.8%vs.60.0%,P=0.036)in the experimental group than in the control group.The use of cerebral autoregulation-directed optimal blood pressure(odds ratio[OR]=0.090,95%confidence interval[CI]:0.009 to 0.923,P=0.043)and length of ICU stay(OR=1.473,95%CI:1.093 to 1.985,P=0.011)were risk factors for delirium during septic shock.Vasoactive drug dose(OR=8.445,95%CI:1.26 to 56.576,P=0.028)and partial pressure of oxygen(PaO_(2))(OR=0.958,95%CI:0.921 to 0.996,P=0.032)were the risk factors for 28-day mortality.Conclusions The use of cerebral autoregulation-directed optimal blood pressure management during shock resuscitation reduces the incidence of delirium in patients with septic shock.

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。

Highly sensitive,sub-microsecond polymer photodetectors for blood oxygen saturation testing

Bottom surface of active layers and interface of indium tin oxide(ITO)electrodes and active layers play a crucial role in determining the performance of polymer photodetectors with photomultiplication(PM-PPDs).The interfacial trapped electron distribution closing to ITO electrodes will determine spectral response range and external quantum efficiency(EQE)of PMPPDs.The bottom interface is more sensitive than top interface when light is coming from the ITO side,and the larger density of generated charge on the bottom interfaces will induce interfacial band more bending for efficient charge tunneling injection.Highly sensitive and sub-microsecond PM-PPDs are achieved with PMBBDT:Y6(100:7,w/w)as active layers under forward bias,yielding EQE of 18,700%at 320 nm,21,700%at 600 nm and 16,400%at 810 nm under a bias of 7 V,respectively,as well as fast response time of 79μs.The high EQE of the PM-PPDs is attributed to efficient hole tunneling injection from ITO electrode under forward bias.The electron traps closing to ITO electrode will be quickly filled up when light is coming from ITO side,leading to interfacial band more bending for hole tunneling injection.Importantly,the PM-PPDs is performed to measure heart rate(HR)and blood oxygen saturation(SpO_(2)),and the measured data by the PM-PPDs are very similar with those obtained by commercial photodetectors.

高流量氧疗联合纳洛酮治疗老年重症急性呼吸衰竭患者的疗效

目的探讨高流量氧疗联合纳洛酮治疗老年重症急性呼吸衰竭(acute respiratory failure,ARF)患者的疗效。方法选取126例老年重症ARF患者作为研究对象,随机分为对照组和观察组,每组63例。对照组给予经鼻高流量氧疗,观察组在对照组治疗的基础上给予纳洛酮治疗,2组均治疗1周。评估2组的临床疗效,比较2组治疗前后的肺功能指标[第1秒用力呼气容积(forced expiratory volume in first second,FEV_(1))、用力肺活量(forced vital capacity,FVC)和FEV_(1)/FVC值]、血气分析指标[动脉血氧分压(partial pressure of oxygen in arterial blood,PaO_(2))、动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO_(2))和血氧饱和度(oxygen saturation,SaO_(2))]、血清生化标志物[C-C趋化因子配体6(C-C motif chemokine ligand 6,CCL6)、肺部活化调节趋化因子/趋化因子配体18(pulmonary activation regulated chemokine/C-C motif chemokine ligand 18,PARC/CCL18)和肺表面活性物质相关蛋白-D(surfactant protein-D,SP-D)]水平的变化,观察并记录2组的预后情况[再插管率、48 h肺部感染率、重症监护室(intensive care unit,ICU)住院时间及28 d病死率]。结果治疗后,观察组的临床总有效率(93.65%)明显高于对照组(77.77%),P<0.05;2组的FEV_(1)、FVC、FEV_(1)/FVC值,PaO_(2)、SaO_(2)较治疗前均显著提高(P<0.05),PaCO_(2)较治疗前显著降低(P<0.05);2组的血清CCL6水平较治疗前显著提高(P<0.05),血清PARC/CCL18及SP-D水平较治疗前显著降低(P<0.05);观察组的以上指标变化幅度均显著高于对照组(P<0.05)。观察组的再插管率为17.46%,显著低于对照组的33.33%,48 h肺部感染率为9.52%,显著低于对照组的23.81%,ICU住院时间显著短于对照组(P<0.05)。2组的28 d病死率比较差异无统计学意义(P>0.05)。结论高流量氧疗联合纳洛酮治疗老年重症ARF患者疗效显著,能明显改善肺功能和血气分析指标,对血清CCL6水平起到上调作用,并能抑制血清PARC/CCL18及SP-D的高水平表达,其能改善机体炎症情况,降低患者的再插管率和48 h肺部感染率,缩短ICU住院时间,改善患者预后情况。

多功能监护仪操作培训步骤与临床实际操作应用的现状调查分析

目的调查分析护士多功能监护仪操作培训步骤及临床实际操作应用的现状。方法采取方便抽样方法,对2020年9月来自四川、广西、重庆、北京、福建、云南、贵州、河南、江苏、黑龙江等全国20个省(自治区、直辖市)100余家二乙以上医院,参加中华护理学会重症专科护士培训的261名ICU护理人员进行问卷调查。共发放问卷261份,收回有效问卷261份,问卷有效回收率为100.0%。调查护理人员接受监护仪操作培训步骤及临床实际操作步骤情况及护理人员非抢救状态下单人操作心电监护(ECG)、无创血压(BP)监测、血氧饱和度监测(SPO2)耗时情况。结果65.5%的护理人员接受培训的首要步骤是进行ECG监测,24.9%接受培训的首要步骤是进行SPO2监测,9.6%的护理人员接受培训的首要步骤是进行无创BP监测;35.2%的护理人员接受培训步骤的顺序与实际操作步骤不一致;49.4%的护理人员在实际临床操作中是先进行SPO2监测而非ECG监测,且认为不管是培训还是实际操作应先进行SPO2监测。非抢救状态下单人操作ECG监测、无创BP监测、SPO2监测耗时分布比较差异有统计学意义(P<0.05);SPO2监测耗时<20s占比高于与ECG监测、无创BP监测,耗时20~40、41~60、61~80s占比低于ECG监测、无创BP监测,差异有统计学意义(P<0.05)。结论多功能监护仪操作培训主要步骤的先后顺序未规范,培训步骤顺序与临床实际操作存在脱节现象,建议监护仪操作培训流程应先进行SPO2监测,其次是ECG与无创BP监测。

沙滩椅体位及控制性降压下肩关节手术病人脑氧饱和度与脑部血流速度改变及其对术后神经认知的影响

目的分析沙滩椅体位及控制性降压下肩关节手术中脑氧饱和度(rScO_(2))与脑部血流速度的变化,及其对病人术后神经认知的影响。方法选取拟于本院以沙滩椅体位接受肩关节手术治疗的病人60例,均为美国麻醉医师协会(ASA)分级Ⅰ、Ⅱ级,在静脉全身麻醉及控制性降压干预下,于麻醉前、麻醉并转入沙滩椅体位后5 min、手术开始时以及手术开始后每隔20 min直至手术结束进行rScO_(2)、大脑中动脉血流速度(VMCA)和有创血压(心脏水平和耳道水平)的检测,并记录脑氧欠饱和事件(CDE)的发生。同时,于术前和术后24 h对病人进行神经认知能力测试。结果转入沙滩椅体位后所有病人的rScO_(2)和VMCA相比麻醉前都有所下降。经历CDE的病人耳道水平平均动脉压、rScO_(2)和VMCA均显著低于未经历CDE的病人,并且术后24 h时连线测试成绩也更低,组间差异有统计学意义(P<0.05)。结论对于ASA分级Ⅰ、Ⅱ级病人,沙滩椅体位及控制性降压下肩关节手术中部分病人的rScO_(2)和VMCA较麻醉前显著下降并发生CDE,进而对术后神经认知产生不利影响。

不同氧流量经鼻高流量湿化氧疗治疗慢性阻塞性肺疾病急性加重期患者临床疗效及短期预后影响因素分析

目的探讨不同氧流量经鼻高流量湿化氧疗(HFNC)治疗慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床疗效,并筛选氧流量设置为60 L/min的HFNC治疗患者短期预后的影响因素。方法选取自2022年6月至2023年6月崇州市人民医院收治的150例AECOPD患者为研究对象,采用随机数字表法将患者分为低流量组、中流量组、高流量组,每组各50例。3组均给予HFNC治疗,其中,低流量组氧流量为30 L/min,中流量组氧流量为40 L/min,高流量组氧流量为60 L/min,持续治疗7 d。比较3组患者治疗后24 h短期疗效。治疗前、治疗后,比较3组动脉血气指标[二氧化碳分压(PaCO_(2))、氧分压(PaO_(2))]、肺功能[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、呼气峰值流量(PEF)],以及症状严重程度[慢性阻塞性肺疾病评估测试(CAT)、呼吸困难指数(mMRC)评分]。高流量组患者在经HFNC治疗后随访28 d,根据28 d疾病转归情况分为预后良好组(n=32)与预后不良组(n=18),分析氧流量设置为60 L/min的HFNC治疗患者短期预后影响因素。结果治疗后,3组PaCO_(2)低于治疗前,PaO_(2)、FVC、FEV1、PEF水平高于治疗前,差异有统计学意义(P<0.05)。治疗后,高流量组、中流量组PaCO_(2)低于低流量组,且高流量组低于中流量组;高流量组、中流量组PaO_(2)、FVC、FEV1、PEF水平高于低流量组,且高流量组高于中流量组,差异有统计学意义(P<0.05)。治疗后,3组患者CAT评分、mMRC评分低于治疗前,差异有统计学意义(P<0.05)。治疗后,高流量组、中流量组CAT评分、mMRC评分低于低流量组,且高流量组低于中流量组,差异有统计学意义(P<0.05)。高流量组、中流量组总有效率高于低流量组,且高流量组总有效率高于中流量组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄、吸烟史、急性生理学与慢性健康评分、C反应蛋白、降钙素原、PaCO_(2)、PaO_(2)、CAT评分、mMRC评分、HFNC短期疗效是影响高流量HFNC治疗AECOPD短期预后的独立危险因素(P<0.05)。结论高流量HFNC可更好地改善AECOPD患者动脉血气、肺功能,提高短期疗效,但仍有部分患者受年龄、吸烟史、急性生理学与慢性健康评分、C反应蛋白、降钙素原、PaCO_(2)、PaO_(2)、CAT评分、mMRC评分、HFNC短期疗效等因素影响,预后不佳,临床中可根据上述危险因素早期制定相关措施以改善短期预后。

艾司氯胺酮复合丙泊酚麻醉诱导在无痛胃肠镜检查中的应用效果

目的:观察艾司氯胺酮复合丙泊酚麻醉诱导在无痛胃肠镜检查中的应用效果。方法:回顾性分析2023年1—12月于该院行无痛胃肠镜检查者94名的临床资料,按照麻醉诱导方式不同将其分为观察组与对照组各47名。对照组采用丙泊酚麻醉诱导,观察组采用艾司氯胺酮复合丙泊酚麻醉诱导,比较两组麻醉起效时间、恢复室停留时间、离院时麻醉后出院评分量表(PADSS)评分、不同时间[麻醉诱导前(T_(0))、麻醉诱导注药后即刻(T_(1))、入镜至回肠末端(T_(2))、苏醒即刻(T_(3))]体征指标[平均动脉压(MAP)、心率、血氧饱和度(SpO_(2))]水平,以及不良反应发生率。结果:观察组麻醉起效时间短于对照组,差异有统计学意义(P<0.05);T_(1)、T_(2)时,两组MAP、心率均低于T_(0)时,但观察组高于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为8.51%,明显低于对照组的23.40%,差异有统计学意义(P<0.05);两组恢复室停留时间、离院时PADSS评分以及不同时间(T_(0)、T_(1)、T_(2)、T_(3))SpO_(2)水平比较,差异均无统计学意义(P>0.05)。结论:艾司氯胺酮复合丙泊酚麻醉诱导应用于无痛胃肠镜检查可缩短麻醉起效时间,提高MAP和心率水平,以及降低不良反应发生率,效果优于单纯丙泊酚麻醉诱导。