Should we perform decompressive laparotomy during severe acute pancreatitis with intra-abdominal hypertension below 25 mmHg:Only the gut knows

We suggest that during severe acute pancreatitis(SAP)with intra-abdominal hypertension,practitioners should consider decompressive laparotomy,even with intra-abdominal pressure(IAP)below 25 mmHg.Indeed,in this setting,non-occlusive mesenteric ischemia(NOMI)may occur even with IAP below this cutoff and lead to transmural necrosis if abdominal perfusion pressure is not promptly restored.We report our experience of 18 critically ill patients with SAP having undergone decompressive laparotomy of which one third had NOMI while IAP was mostly below 25 mmHg.

Ultrasound-Guided Superior Gluteal Nerve Hydrodissection in the Treatment of Deep Gluteal Syndrome

Background: Deep gluteal syndrome is a common cause of posterior hip pain. It results from peripheral nerves, such as the sciatic or superior gluteal nerve, being compressed in the deep gluteal space. Hydrodissection is a novel technique for the treatment of nerve pain due to entrapment. The use of hydrodissection for the treatment of deep gluteal syndrome has not been reported. Methods: A case report involved a 42-year-old female presenting with deep gluteal syndrome. Case report: We report, with patient consent, an ultrasound-guided superior gluteal nerve hydrodissection method used for treating the deep gluteal syndrome. A previously healthy 42-year-old female patient sought medical attention due to persistent left gluteal pain. Trials of joint injections, physiotherapy, and epidural blocks were unsuccessful. Hydrodissection under ultrasound-guidance allowed separation of the fascial plane in areas with significant neural innervation. We targeted the superior gluteal nerve with hydrodissection offering the patient immediate and persistent relief from her symptoms. Conclusion: Ultrasound-guided hydrodissection of the superior gluteal nerve offers an effective and novel diagnostic and treatment option for deep gluteal syndrome.

Surgical decompression for the management of abdominal compartment syndrome with severe acute pancreatitis: A narrative review

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome(ACS)play a pivotal role in the pathophysiology of severe acute pancreatitis(SAP)and contribute to new-onset and persistent organ failure.The optimal management of ACS involves a multi-disciplinary approach,from its early recognition to measures aiming at an urgent reduction of intra-abdominal pressure(IAP).A targeted literature search from January 1,2000,to November 30,2022,revealed 20 studies and data was analyzed on the type and country of the study,patient demographics,IAP,type and timing of surgical procedure performed,post-operative wound management,and outcomes of patients with ACS.There was no randomized controlled trial published on the topic.Decom-pressive laparotomy is effective in rapidly reducing IAP(standardized mean difference=2.68,95%confidence interval:1.19-1.47,P<0.001;4 studies).The morbidity and complications of an open abdomen after decompressive laparotomy should be weighed against the inadequately treated but,potentially lethal ACS.Disease-specific patient selection and the role of less-invasive decompressive measures,like subcutaneous linea alba fasciotomy or component separation techniques,is lacking in the 2013 consensus management guidelines by the Abdominal Compartment Society on IAH and ACS.This narrative review focuses on the current evidence regarding surgical decompression techniques for managing ACS in patients with SAP.However,there is a lack of high-quality evidence on patient selection,timing,and modality of surgical decompression.Large prospective trials are needed to identify triggers and effective and safe surgical decompression methods in SAP patients with ACS.

The effect of increased intra-abdominal pressure on orbital subarachnoid space width and intraocular pressure

In accordance with the trans-lamina cribrosa pressure difference theory, decreasing the trans-lamina cribrosa pressure difference can re- lieve glaucomatous optic neuropathy. Increased intracranial pressure can also reduce optic nerve damage in glaucoma patients, and a safe, effective and noninvasive way to achieve this is by increasing the intra-abdominal pressure. The purpose of this study was to observe the changes in orbital subarachnoid space width and intraocular pressure at elevated intra-abdominal pressure. An inflatable abdominal belt was tied to each of 15 healthy volunteers, aged 22-30 years （12 females and 3 males）, at the navel level, without applying pressure to the abdomen, before they laid in the magnetic resonance imaging machine. The baseline orbital subarachnoid space width around the optic nerve was measured by magnetic resonance imaging at 1, 3, 9, and 15 mm behind the globe. The abdominal belt was inflated to increase the pressure to 40 mmHg （1 mmHg = 0.133 kPa）, then the orbital subarachnoid space width was measured every 10 minutes for 2 hours. After removal of the pressure, the measurement was repeated 10 and 20 minutes later. In a separate trial, the intraocular pressure was measured for all the subjects at the same time points, before, during and after elevated intra-abdominal pressure. Results showed that the baseline mean orbital subarachnoid space width was 0.88 ＋ 0.1 mm （range： 0.77-1.05 mm）, 0.77 ＋ 0.11 mm （range： 0.60-0.94 mm）, 0.70 ＋ 0.08 mm （range： 0.62-0.80 ram）, and 0.68 _＋ 0.08 mm （range： 0.57-0.77 mm） at 1, 3, 9, and 15 mm behind the globe, respectively. During the elevated intra-abdominal pressure, the orbital subarachnoid space width increased from the baseline and dilation of the optic nerve sheath was significant at 1, 3 and 9 mm behind the globe. After decompression of the abdominal pressure, the orbital subarachnoid space width normalized and returned to the baseline value. There was no significant difference in the intraocular pressure before, during and after the intra-abdominal pressure elevation. These results verified that the increased intra-abdominal pressure widens the orbital subarachnoid space in this acute trial, but does not alter the intraocular pressure, indicating that intraocular pressure is not affected by rapid increased in- tra-abdominal pressure. This study was registered in the Chinese Clinical Trial Registry （registration number： ChiCTR-ONRC-14004947）.

Central Pain Syndrome: Etiological Perspectives from the 3D Default Space Model of Consciousness

In this article, the mechanisms of central pain syndrome (CPS) are examined for the purpose of gaining insight into how a unified conscious experience arises from brain and body interaction. We provide a novel etiology for CPS via implementation of the previously proposed 3D Default Space (3DDS) consciousness model in which consciousness and body schema arise when afferent information is processed by corticothalamic feedback loops and integrated via the thalamus. Further, we propose the mechanisms by which CPS represents deficits in dynamic interactions between afferent and efferent signaling. Modern hypotheses of CPS suggest roles for maladaptive neuroplasticity, a deafferentated somatosensory cortex and/or thalamus, and reorganization along the sensory pathways of the spinothalamic tract in the pathogenesis of the painful sensations. We propose that CPS arises when painful sensory signals originating along the maladapted and/or dysfunctional spinothalamic tract become accentuated by the dominant top down mechanisms of the brain.

A Population Dynamics Approach to the Distribution of Space Debris in Low Earth Orbit

The presence of the debris in the Earth’s orbit poses a significant risk to human activity in outer space.This debris population continues to grow due to ground launches,the loss of external parts from space ships,and uncontrollable collisions between objects.A computationally feasible continuum model for the growth of the debris population and its spatial distribution is therefore critical.Here we propose a diffusion-collision model for the evolution of the debris density in the low-Earth orbit and its dependence on the ground-launch policy.We parametrize this model and test it against data from publicly available object catalogs to examine timescales for the uncontrolled growth.Finally,we consider sensible launch policies and cleanup strategies and how they reduce the future risk of collisions with active satellites or space ships.

Treatment of intractable chronic pelvic pain syndrome by injecting a compound of Bupivacaine and Fentanyl into sacral spinal space

Objective:To investigate the effect of injecting a compound of Bupivacaine and Fentanyl into sacral spinal space to treat chronic pelvic pain syndrome (CPPS). Methods: A total of 36 men with recalcitrant CPPS refractory to multiple prior therapies were treated with the injection of a compound of Bupivacaine and Fentanyl (10 ml of 0. 125% Bupivacaine, 0. 05 mg Fentanyl, 5 mg Dexamethasone, 100 mg Vitamin B1 and 1 mg Vitamin B12) into sacral space once a week for 4 weeks. The National Institute of Health Chronic Proslatitis Symptom Index (NIH-CPSI), maximum and average flow rate were performed at the start and the end of 4 weeks' therapy. Results :Mean NIH-CPSI total score was decreased from 26. 5±1. 6 to 13. 4±2. 0 (P<0. 001). Significant improvement was seen in each subscore domain. A total of 32 patients (89%) had at least 25% improvement on NIH-CPSI and 22 (61 %) had at least 50% improvement. Maximal and average flow rate were increased from 19. 5±3. 8 to 23. 6±4. 2 and 10. 9±2. 6 to 14. 3±2. 4 respectively. Conclusion: Injection of this compound of Bupivacaine, Fentanyl and Dexamethasone into sacral spinal space is an effective and safe approach for recalcitrant CPPS. Further study of the mechanisms and prospective placebo controlled trials are warranted.

Abdominal compartment syndrome:Often overlooked conditions in medical intensive care units

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.

Intra-abdominal pressure:Time ripe to revise managementguidelines of acute pancreatitis?

AIM: To systematically review evidence on pathophysiology of intra-abdominal pressure(IAP) in acute pancreatitis(AP) with its clinical correlates. METHODS: Systematic review of available evidence in English literature with relevant medical subject heading terms on Pub Med, Medline and Scopus with further search from open access sources on internet as suggested by articles retrieved. RESULTS: Intra-abdominal hypertension(IAH) is increasingly gaining recognition as a point of specific intervention with potential to alter disease outcome and improve mortality in AP. IAH can be expected in at least 17% of patients presenting with diagnosis of AP to a typical tertiary care hospital(prevalence increasing to 50% in those with severe disease). Abdominal compartment syndrome can be expected in at least 15% patients with severe disease. Recent guidelines on management of AP do not acknowledge utility of surveillance for IAP other than those by Japanese Society of Hepato-BiliaryPancreatic Surgery. We further outline pathophysiologic mechanisms of IAH; understanding of which advances our knowledge and helps to coherently align common observed variations in management related conundrums(such as fluid therapy, nutrition and antibiotic prophylaxis) with potential to further individualize treatment in AP. CONCLUSION: We suggest that IAP be given its due place in future practice guidelines and that recommendations be formed with help of a broader panel with inclusion of clinicians experienced in management of IAH.

Study of intra-abdominal hypertension prevalence and awareness level among experienced ICU medical staff

Background:Intra-abdominal hypertension(IAH) is a disease with high morbidity and mortality among critically ill patients.The study's objectives were to explore the prevalence of IAH and physicians' awareness of the 2013 World Society of Abdominal Compartment Syndrome(WSACS) guidelines in Chinese intensive care units(ICUs).Methods:A cross-sectional study of four ICUs in Southwestern China was conducted from June 17 to August 2,2014.Adult patients admitted to the ICU for more than 24 h,with bladder catheter but without obvious intravesical pressure(IVP) measurement contraindications,were recruited.Intensivists with more than 5 years of ICU working experience were also recruited.Epidemiological information,potential IAH risk factors,IVP measurements and questionnaire results were recorded.Results:Forty-one patients were selected.Fifteen(36.59%) had IVP?12mm Hg.SOFA(Sequential Organ Failure Assessment) hepatic and neurological sub-scores were utilized as independent predictors for IAH via logistic backward analysis.Thirty-seven intensivists participated in the survey(response rate:80.43%).The average score of each center was less than 35 points.All physicians believed the IAH prevalence in their departments was no more than 20.00%.A significant negative correlation was observed between the intensivists' awareness of the 2013 WSACS guidelines and the IAH prevalence in each center(r=-0.975,P=0.025).Conclusion:The prevalence and independent predictors of IAH among the surveyed population are similar to the reports in the literature.Intensivists generally have a low awareness of the 2013 WSACS guidelines.A systematic guideline training program is vital for improving the efficiency of the diagnosis and treatment of IAH.

Elevated intra-abdominal pressure:A review of current knowledge

Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deterioration of organ function and the development of multiple organ failure.Raised IAP affects every system and main organ in the human body.Even marginally sustained IAH results in malperfusion and may disrupt the process of recovery.Yet,despite being so common,this potentially lethal condition often goes unnoticed.In 2004,the World Society of the Abdominal Compartment Syndrome,an international multidisciplinary consensus group,was formed to provide unified definitions,improve understanding and promote research in this field.Simple,reliable and nearly costless standardized methods of non-invasive measurement and monitoring of bladder pressure allow early recognition of IAH and timely optimized management.The correct,structured approach to treatment can have a striking effect and fully restore homeostasis.In recent years,significant progress has been made in this area with the contribution of surgeons,internal medicine specialists and anesthesiologists.Our review focuses on recent advances in order to present the complex underlying pathophysiology and guidelines concerning diagnosis,monitoring and treatment of this life-threatening condition.

Abdominal compartment syndrome among surgical patients

Abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compliance,and other factors that exert a constant pressure within the abdominal cavity.Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction.Among surgical and trauma patients,aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS.Other conditions that have also been identified as risk factors are ascites,hemoperitoneum,bowel distention,and large tumors.All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension(IAH).Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery,abdominal aortic aneurysm repair,and liver transplantation among others.Close monitoring of organ function and intra-abdominal pressure(IAP)allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP.Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction.There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.

Noninvasive monitoring of intra-abdominal pressure by measuring abdominal wall tension

BACKGROUND: Noninvasive monitoring of intra-abdominal pressure(IAP) by measuring abdominal wall tension(AWT) was effective and feasible in previous postmortem and animal studies. This study aimed to investigate the feasibility of the AWT method for noninvasively monitoring IAP in the intensive care unit(ICU).METHODS: In this prospective study, we observed patients with detained urethral catheters in the ICU of Shanghai Tenth People's Hospital between April 2011 and March 2013. The correlation between AWT and urinary bladder pressure(UBP) was analyzed by linear regression analysis. The effects of respiratory and body position on AWT were evaluated using the paired samples t test, whereas the effects of gender and body mass index(BMI) on baseline AWT(IAP<12 mm Hg) were assessed using one-way analysis of variance.RESULTS: A total of 51 patients were studied. A significant linear correlation was observed between AWT and UBP(R=0.986, P<0.01); the regression equation was Y=–1.369+9.57X(P<0.01). There were signif icant differences among the different respiratory phases and body positions(P<0.01). However, gender and BMI had no signif icant effects on baseline AWT(P=0.457 and 0.313, respectively).CONCLUSIONS: There was a signif icant linear correlation between AWT and UBP and respiratory phase, whereas body position had signif icant effects on AWT but gender and BMI did not. Therefore, AWT could serve as a simple, rapid, accurate, and important method to monitor IAP in critically ill patients.

脑内扩大的血管周围间隙患者运动认知功能减退综合征的临床评估

目的 探究老年脑内扩大的血管周围间隙(EPVS)患者运动认知功能减退综合征(MCR)的患病率及运动和认知功能减退情况。方法 连续纳入2023年3月1日至2023年11月30日在北京朝阳医院神经内科就诊的≥60岁头部磁共振成像显示有EPVS的患者113例,根据是否患有MCR分为MCR组44例和MCR阴性组69例。评估患者认知功能及运动功能,认知功能评估包括蒙特利尔认知量表(MoCA)、简易智能状态检查量表(MMSE)、连线测试(TMT),运动功能评估包括Tinetti量表、简易体能状况量表(SPPB)、8 m步行任务、“起立-行走”计时测试(TUGT)、步行和连续减法任务(WSS)、步行和语义流畅任务(WSF)、TUGT和串行减法任务(TUGSS)。比较2组患者的运动和认知功能,多因素logistic回归分析EPVS患者发生MCR的相关危险因素。结果 与MCR阴性组比较,MCR组MoCA评分、SPPB评分、8 m步行速度降低,TMT-A时间、TMT-B时间、WSS时间、WSF时间、TUGSS时间升高(P<0.05,P<0.01)。多因素logistic回归分析显示,在模型1中(将单因素分析存在差异的变量纳入回归分析),MoCA评分、8 m步行速度、TUGSS时间是EPVS患者发生MCR的影响因素(P<0.05,P<0.01);在模型2中(将单因素分析存在差异的变量纳入回归分析同时调整年龄、性别、教育程度、既往史因素),MoCA评分(OR=0.621,95%CI:0.432~0.929,P=0.010)、8 m步行速度(OR=1.332,95%CI:1.115~1.591,P=0.002)、TUGSS时间(OR=0.393,95%CI:0.232~0.665,P=0.001)仍为EPVS患者发生MCR的影响因素。结论 在老年EPVS患者中,MCR患者认知及运动功能显著减退,MoCA评分、8 m步行速度、TUGSS时间是EPVS患者发生MCR的相关因素。

基于平板电脑的距离自适应视功能自测方案的研究

目的构建基于平板电脑的距离自适应视功能自测系统,并分析其精确性。方法基于配有摄像头的平板电脑,使用ArUco技术识别2 m范围内的二维码以进行实时测距,构建距离自适应的集视力(普通视标视力和不同对比度高通视标视力)、调节幅度和中心5°视野测定一体化的视觉功能检测系统。共纳入健康受试者22例(44眼)完成视功能检查,其中6名受试者在四种距离(1 m、1.25 m、1.6 m、2 m)分别完成视力测试,并在足矫和–3.00D欠矫模拟调节不足状态下分别完成调节幅度测试。比较程序读数距离和空间中二维码距平板屏幕实际距离;比较在不同距离的同种视标的视力测试结果一致性;分析足矫及欠矫状态下调节幅度的变化,并使用ICC法评估其可重复性;分析视野测试结果的对比敏感度阈值及有效性。结果实际距离与程序读数距离具有良好的一致性水平。相同对比度高通视标视力测试在不同距离的测试结果无显著差异(P>0.05),100%普通视标视力在0.9~1.1m距离范围内与其他距离结果存在显著差异(P<0.001)。测量3次调节幅度的ICC值为0.861(P<0.001);欠矫状态下的调节幅度较足矫状态更低,变化具有统计学差异(P<0.05)。双眼视野对比度阈值的上边缘值均值为16.92%,程序能正确识别视野缺损。结论本研究构建了一种基于平板电脑的距离自适应视功能自测系统,可在2 m内实时精准测距,根据距离自动调节初始视标的大小以精确呈现视标,进行视力、调节幅度及中心5°视野检测。该系统不受固定距离限制并且具有更高的检验效能,可应用于空间狭小且不能固定距离的空间站的视功能检测。

中医证的时空观

“天人合一”的古代哲学思想体系是时空观的基础,深刻影响人类政治、经济、文化、医学等诸多领域。《黄帝内经》(简称《内经》)的“天人合一”思想渗透于中医理论、临床诊疗的各个方面,为“证”作为中医特色辨证论治理论提供依据。因此,以《内经》中“天人合一”理论为基础,对时空性深刻内涵进行深度挖掘,探讨“证”的时空性,对提高临床诊疗水平大有裨益。

基于CiteSpace的脏腑辨证知识图谱可视化分析

目的基于Citespace的文献计量学分析脏腑辨证研究热点及前沿。方法检索中国知网从建库至2021年6月1日的所有关于脏腑辨证领域的文献。使用TXT文档保存,采用Excel 2013对年发文量趋势分析,用CiteSpace5.6.R2软件对作者合作、机构合作、关键词以及聚类进行可视化分析。结果共检索到1217篇相关文献。年发文量一直处于上升趋势。研究作者主要为国医大师周仲瑛以及合作人,总体而言单位合作相对密切,这与中医诊断学继承发展相关。关键词聚类分析结果为#0八纲辨证、#1肝肾阴虚、#2辨证论治、#3学术思想、#4体质、#5知识讲座、#6张珍玉、#7针灸治疗、#8中脏腑、#9中医证候、#10三参数、#11态基。可以看出脏腑辨证涵盖了中医药、体质学说、针灸治疗以及现代智能化研究。近5年的研究主要注重在以下方面:经验2016-2019、失眠2016-2021、数据挖掘2016-2021、经络2016-2017、不寐2016-2021、名医经验2017-2021、针灸2017-2021、治疗2018-2019、《黄帝内经》2018-2019、针刺2018-2019、易水学派2018-2021、病机2018-2021、脾胃病2018-2021、脏腑辨证2019-2021。通过观察近5年的前沿动态,不难发现基于数据挖掘某种疾病或者名老中医经验治疗某种疾病的脏腑辨证的证候是继续研究的方向。结论脏腑辨证领域正处于蓬勃发展时期,有继承、有创新,通过图谱初步直观展现了脏腑辨证领域发展脉络、研究热点及前沿趋势,为中医诊断、辨证学研究提供研究方向。

Positive end expiratory pressure titrated by transpulmonary pressure improved oxygenation and respiratory mechanics in acute respiratory distress syndrome patients with intra-abdominal hypertension

Background Intra-abdominal hypertension （IAH） is common in acute respiratory distress syndrome （ARDS） patients and when resulting in decrease of chest wall compliance will weaken the effect of positive end expiratory pressure （PEEP）. We investigated the effect of PEEP titrated by transpulmonary pressure （Ptp） on oxygenation and respiratory mechanics in ARDS patients with IAH compared with PEEP titrated by ARDSnet protocol. Methods ARDS patients admitted to the intensive care unit （ICU） of the Zhongda Hospital were enrolled. Patients were ventilated with volume control mode with tidal volume of 6 ml/kg under two different PEEP levels titrated by Ptp method and ARDSnet protocol. Respiratory mechanics, gas exchange and haemodynamics were measured after 30 minutes of ventilation in each round. IAH was defined as intra-abdominal pressure of 12 mmHg or more, Results Seven ARDS patients with IAH and 8 ARDS patients without IAH were enrolled. PEEP titrated by Ptp were significant higher than PEEP titrated by ARDSnet protocol in both ARDS patients with IAH （（17.3±2.6）cmH20 vs. （6.3±1.6） cmH2O and without IAH （（9.5±2.1） cmH2O vs. （7.8±1.9） cmH2O）. Arterial pressure of O2/fraction of inspired oxygen （PaO2/ FiO2） was much higher under PEEP titrated by Ptp when compared with PEEP titrated by ARDSnet protocol in ARDS patients with IAH （（27.2±4.0） cmHg vs. （20.9± 5.0） cmHg. But no significant difference of PaO2/FiO2 between the two methods was found in ARDS patients without IAH. In ARDS patients with IAH, static compliance of lung and respiratory system were higher under PEEP titrated by Ptp than by ARDSnet protocol. In ARDS patients with IAH, central venous pressure （CVP） was higher during PEEP titrated by Ptp than by ARDSnet protocol. Conclusion Positive end expiratory pressure titrated by transpulmonary pressure was higher than PEEP titrated by ARDSnet protocol and improved oxygenation and respiratory mechanics in ARDS patients with IAH.

基于CiteSpace的中医痰证诊断标准知识图谱可视化分析

目的:从历史、现状问题、未来发展趋势三大方面分析中医痰证证候诊断标准研究。方法:检索中国知网数据库(CNKI)中关于痰证诊断标准的相关文献。将文献记录以Refworks的格式导出,利用CiteSpaceV软件对文献的作者、研究机构和关键词三方面进行共现图谱分析。结果:纳入文献418篇,可视化分析后发现,关于痰证证候诊断标准的研究中包含核心作者13人,组成了2个高产团队。研究的主要力量集中在河南中医学院第一附属医院、河南中医学院老年医学研究所以及北京中医药大学,主要研究方向为痰证证候诊断标准的制定以及诊断标准的相关临床试验研究。高频关键词形成7个聚类群,提示高血压和冠心病成为受关注较多的疾病。结论:近30年痰证诊断标准研究可概括为“三多三少”:机构多,合作少;研究多,整合少;病种多,深入少。预测发展趋势是针对临床高发代谢类疾病深入病证结合研究,运用代谢组学技术,进一步挖掘临床客观指标在痰证诊断中的价值。

改良式俯仰交替卧位改善急性呼吸窘迫综合征机械通气患者肺功能临床效果评估

目的:评估改良式俯仰交替卧位改善急性呼吸窘迫综合征(ARDS)机械通气患者肺功能的临床效果。方法:选择医院收治的80例拟行机械通气的ARDS患者,根据随机数表法将其分为对照组和观察组,每组40例。两组均进行俯卧位机械通气(PPV)治疗,其中对照组患者采取俯卧位2 h+仰卧位3 h的循环体位;观察组患者采取改良式俯仰交替卧位(俯卧位4 h+仰卧位1 h循环),比较两组患者年龄、性别、体质量指数(BMI)、呼吸频率(R)、心率(HR)、急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分、肺损伤预测评分(LIPS)等临床资料。并分别比较两组治疗前后患者的血气分析指标、血流动力学指标、死腔分数生理死腔(VD)与潮气量(VT)的比值(VD/VT)及呼吸动力学指标。结果:两组患者治疗前后平均动脉压(MAP)、中心静脉压(CVP)、心脏指数(CI)、每搏输出量(SV)及每搏输出量变异率(SVV)水平比较,差异无统计学意义;同时间点两组患者MAP、CVP、CI、SV及SVV水平比较,差异无统计学意义。观察组患者治疗后VD/VT水平明显低于对照组,差异有统计学意义(t=2.380,P<0.05)。两组患者治疗后动脉血氧分压(PaO_(2))、氧合指数水平均明显高于治疗前,动脉血二氧化碳分压(PaCO_(2))、pH值水平均明显低于同组治疗前;观察组患者治疗后氧合指数水平明显高于对照组,差异具有统计学意义(t=2.397,P<0.05)。两组患者治疗后气道阻力水平均明显高于治疗前;观察组患者治疗后气道阻力水平明显高于对照组,差异具有统计学意义(t=2.201,P<0.05)。结论:PPV可有效改善ARDS患者临床症状,其中治疗期间采取改良式俯仰交替卧位对改善患者氧合指数及VD/VT方面具有一定帮助。