Respiratory failure complicating the course of diabetic ketoacidosis(DKA)is a source of increased morbidity and mortality.Detection of respiratory failure in DKA requires focused clinical monitoring,careful interpreta...Respiratory failure complicating the course of diabetic ketoacidosis(DKA)is a source of increased morbidity and mortality.Detection of respiratory failure in DKA requires focused clinical monitoring,careful interpretation of arterial blood gases,and investigation for conditions that can affect adversely the respiration.Conditions that compromise respiratory function caused by DKA can be detected at presentation but are usually more prevalent during treatment.These conditions include deficits of potassium,magnesium and phosphate and hydrostatic or non-hydrostatic pulmonary edema.Conditions not caused by DKA that can worsen respiratory function under the added stress of DKA include infections of the respiratory system,pre-existing respiratory or neuromuscular disease and miscellaneous other conditions.Prompt recognition and management of the conditions that can lead to respiratory failure in DKA may prevent respiratory failure and improve mortality from DKA.展开更多
Although respiratory failure commonly occurs during the course of myasthenia gravis (MG),it is rarely described as the first presentation in patients with previously unrecognized MG.Here we reported one case of MG in ...Although respiratory failure commonly occurs during the course of myasthenia gravis (MG),it is rarely described as the first presentation in patients with previously unrecognized MG.Here we reported one case of MG in a 76-year-old man with the isolated respiratory failure as the first symptom.As illustrated by this case,it is important to consider neuromuscular disorders in cases of unexplained respiratory failure.展开更多
目的 对神经肌肉疾病合并呼吸衰竭患者的机械通气策略进行研究.方法 57例神经肌肉疾病合并呼吸衰竭患者分为小潮气量通气组（A组27例）和常规潮气量通气组（B组30例）,观察2组患者机械通气后血气和气道压力的变化,支气管肺泡灌洗液（BAL...目的 对神经肌肉疾病合并呼吸衰竭患者的机械通气策略进行研究.方法 57例神经肌肉疾病合并呼吸衰竭患者分为小潮气量通气组（A组27例）和常规潮气量通气组（B组30例）,观察2组患者机械通气后血气和气道压力的变化,支气管肺泡灌洗液（BALF）中TNF、IL-6、IL-8的变化;14 d存活率和14d脱机成功率.结果 机械通气后0.5、24 h A组患者动脉血气pH值分别为7.30±0.08、7.40±0.06,明显低于同时点B组的7.39±0.06、7.47±0.04（P均＜0.05）;机械通气后0.5、24 h A组患者动脉血气PaCO2水平分别为（60.4±16.9）、（38.2±7.3）mm Hg,明显高于同时点B组的（46.6±8.1）、（29.2±6.9）mm Hg（P均＜0.05）;机械通气后0.5、24 hA组患者气道峰压分别为（21.5±4.5）、（18.6±3.8）cmH2O,明显低于同时点B组的（29.4±5.1）、（31.3±4.7）cm H2O（P均＜0.05）;机械通气后24、48 h A组患者BALF中TNF水平分别为（1385±341）、（1345±411）ng/L,明显低于同时点B组的（1914±501）、（2214±544）ng/L（P均＜0.01）;机械通气后24、48 h A组患者BALF中IL-6水平分别为（249±64）、（209±49）ng/L,明显低于同时点B组的（324±79）、（343±60）ng/L（P均＜0.01）;机械通气后24、48 h A组患者BALF中IL-8水平分别为（79.4±23.6）、（92.7±32.5）ng/L,明显低于同时点B组的（143±36）、（162±49）ng/L（P均＜0.01）;A、B组患者14 d存活率分别为100.0%、96.7%,差异无统计学意义（P＞0.05）;A组患者14 d脱机成功率为59.3%,明显高于B组的33.3%（x2=3.85,P＜0.05）.结论 对于神经肌肉疾病合并呼吸衰竭患者,选用小潮气量进行机械通气,可以减轻机械牵拉诱发的细胞因子释放,减轻机械通气相关性肺损伤,提高脱机成功率.展开更多
文摘Respiratory failure complicating the course of diabetic ketoacidosis(DKA)is a source of increased morbidity and mortality.Detection of respiratory failure in DKA requires focused clinical monitoring,careful interpretation of arterial blood gases,and investigation for conditions that can affect adversely the respiration.Conditions that compromise respiratory function caused by DKA can be detected at presentation but are usually more prevalent during treatment.These conditions include deficits of potassium,magnesium and phosphate and hydrostatic or non-hydrostatic pulmonary edema.Conditions not caused by DKA that can worsen respiratory function under the added stress of DKA include infections of the respiratory system,pre-existing respiratory or neuromuscular disease and miscellaneous other conditions.Prompt recognition and management of the conditions that can lead to respiratory failure in DKA may prevent respiratory failure and improve mortality from DKA.
文摘Although respiratory failure commonly occurs during the course of myasthenia gravis (MG),it is rarely described as the first presentation in patients with previously unrecognized MG.Here we reported one case of MG in a 76-year-old man with the isolated respiratory failure as the first symptom.As illustrated by this case,it is important to consider neuromuscular disorders in cases of unexplained respiratory failure.
文摘目的 对神经肌肉疾病合并呼吸衰竭患者的机械通气策略进行研究.方法 57例神经肌肉疾病合并呼吸衰竭患者分为小潮气量通气组（A组27例）和常规潮气量通气组（B组30例）,观察2组患者机械通气后血气和气道压力的变化,支气管肺泡灌洗液（BALF）中TNF、IL-6、IL-8的变化;14 d存活率和14d脱机成功率.结果 机械通气后0.5、24 h A组患者动脉血气pH值分别为7.30±0.08、7.40±0.06,明显低于同时点B组的7.39±0.06、7.47±0.04（P均＜0.05）;机械通气后0.5、24 h A组患者动脉血气PaCO2水平分别为（60.4±16.9）、（38.2±7.3）mm Hg,明显高于同时点B组的（46.6±8.1）、（29.2±6.9）mm Hg（P均＜0.05）;机械通气后0.5、24 hA组患者气道峰压分别为（21.5±4.5）、（18.6±3.8）cmH2O,明显低于同时点B组的（29.4±5.1）、（31.3±4.7）cm H2O（P均＜0.05）;机械通气后24、48 h A组患者BALF中TNF水平分别为（1385±341）、（1345±411）ng/L,明显低于同时点B组的（1914±501）、（2214±544）ng/L（P均＜0.01）;机械通气后24、48 h A组患者BALF中IL-6水平分别为（249±64）、（209±49）ng/L,明显低于同时点B组的（324±79）、（343±60）ng/L（P均＜0.01）;机械通气后24、48 h A组患者BALF中IL-8水平分别为（79.4±23.6）、（92.7±32.5）ng/L,明显低于同时点B组的（143±36）、（162±49）ng/L（P均＜0.01）;A、B组患者14 d存活率分别为100.0%、96.7%,差异无统计学意义（P＞0.05）;A组患者14 d脱机成功率为59.3%,明显高于B组的33.3%（x2=3.85,P＜0.05）.结论 对于神经肌肉疾病合并呼吸衰竭患者,选用小潮气量进行机械通气,可以减轻机械牵拉诱发的细胞因子释放,减轻机械通气相关性肺损伤,提高脱机成功率.
