目的探讨实时食管压监测指导下设定呼气末正压(positive end expiratory pressure,PEEP)通气参数对肥胖腹腔镜结直肠癌根治术患者的临床价值。方法选择2016年1—12月收治的拟行腹腔镜结直肠癌根治术的肥胖患者90例,男50例,女40例,年龄40...目的探讨实时食管压监测指导下设定呼气末正压(positive end expiratory pressure,PEEP)通气参数对肥胖腹腔镜结直肠癌根治术患者的临床价值。方法选择2016年1—12月收治的拟行腹腔镜结直肠癌根治术的肥胖患者90例,男50例,女40例,年龄40~65岁,BMI>30kg/m2,ASAⅡ或Ⅲ级,采用随机数字表法将患者随机分为三组:P组、PEEP5组和PEEP10组,设置VT8ml/kg,分别在肺复张后给予个体化PEEP(采用实时食管压监测通过计算呼气末跨肺压=0cmH_2O和吸气末跨肺压=25cmH_2O确定最佳PEEP)、PEEP 5cmH_2O和10cmH_2O。观察气腹建立前(T0)、气腹建立后10min(T1)、气腹后头低40.5°足高位20 min(T2)和气腹结束(T3)时的呼吸力学指标。结果T1—T3时P组Ppeak、SBP明显低于,PaO_2/FiO_2明显高于PEEP5组和PEEP10组(P<0.05);T2时P组Pplat、Raw明显低于PEEP5组(P<0.05);T2、T3时P组Cst明显高于PEEP5组(P<0.05);T1、T2时P组DBP明显低于PEEP5组和PEEP10组(P<0.05)。结论实时食管压监测应用于PEEP通气的肥胖腹腔镜结肠癌手术患者,能够有效改善患者呼吸和循环功能。展开更多
目的探讨实时食管压监测对PEEP通气肥胖腹腔镜结肠癌患者呼吸、循环功能的影响。方法选择65例肥胖腹腔镜结肠癌患者,根据随机数字表法,将所有患者分为观察组及对照组。观察组患者采取个性化的PEEP(根据实时食管压监测确定最佳的PEEP),...目的探讨实时食管压监测对PEEP通气肥胖腹腔镜结肠癌患者呼吸、循环功能的影响。方法选择65例肥胖腹腔镜结肠癌患者,根据随机数字表法,将所有患者分为观察组及对照组。观察组患者采取个性化的PEEP(根据实时食管压监测确定最佳的PEEP),对照组患者采取PEEP为10 cm H 2O。对比2组患者T0~T3点的血流动力学指标及呼吸力学指标。结果T1、T2、T3点时,观察组的氧合指数明显高于对照组(P<0.05),观察组的SBP明显低于对照组;T1、T2点时,观察组的DBP明显低于对照组,P<0.05。T1、T2、T3点时,观察组的Ppeak明显低于对照组(P<0.05)。结论对于PEEP通气的肥胖腹腔镜结肠癌患者,采用实时食管压监测方式可显著改善患者的呼吸、循环功能。展开更多
The continuous evaluation of the measured Stand Pipe Pressure(SPP)against a modeled SPP value in real-time involves the automatic detection of undesirable drilling events such as drill string washouts and mud pump fai...The continuous evaluation of the measured Stand Pipe Pressure(SPP)against a modeled SPP value in real-time involves the automatic detection of undesirable drilling events such as drill string washouts and mud pump failures.Numerous theoretical and experimental studies have been established to calculate the friction pressure losses using different rheological models and based on an extension of pipe flow correlations to an annular geometry.However,it would not be feasible to employ these models for real-time applications since they are limited to some conditions and intervals of application and require input parameters that might not be available in real-time on each rig.In this study,The Group Method of Data Handling(GMDH)is applied to develop a trustworthy model that can predict the SPP in real-time as a function of mud flow,well depth,RPM and the Fan VG viscometer reading at 600 and 300 rpm.In order to accomplish the modeling task,3351 data points were collected from two wells from Algerian fields.Graphical and statistical assessment criteria disclosed that the model predictions are in excellent agreement with the experimental data with a coefficient of determination of 0.9666 and an average percent relative error less than 2.401%.Furthermore,another dataset(1594 data points)from well-3 was employed to validate the developed correlation for SPP.The obtained results confirmed that the proposed GMDH-SPP model can be applied in real-time to estimate the SPP with high accuracy.Besides,it was found that the proposed GMDH correlation follows the physically expected trends with respect to the employed input parameters.Lastly,the findings of this study can help for the early detection of downhole problems such as drill string washout,pump failure,and bit balling.展开更多
文摘目的探讨实时食管压监测对PEEP通气肥胖腹腔镜结肠癌患者呼吸、循环功能的影响。方法选择65例肥胖腹腔镜结肠癌患者,根据随机数字表法,将所有患者分为观察组及对照组。观察组患者采取个性化的PEEP(根据实时食管压监测确定最佳的PEEP),对照组患者采取PEEP为10 cm H 2O。对比2组患者T0~T3点的血流动力学指标及呼吸力学指标。结果T1、T2、T3点时,观察组的氧合指数明显高于对照组(P<0.05),观察组的SBP明显低于对照组;T1、T2点时,观察组的DBP明显低于对照组,P<0.05。T1、T2、T3点时,观察组的Ppeak明显低于对照组(P<0.05)。结论对于PEEP通气的肥胖腹腔镜结肠癌患者,采用实时食管压监测方式可显著改善患者的呼吸、循环功能。
基金The authors would like to acknowledge the Petroleum Equipment’s Reliability and Materials Laboratory of the University of Boumerdes for their assistance throughout this study。
文摘The continuous evaluation of the measured Stand Pipe Pressure(SPP)against a modeled SPP value in real-time involves the automatic detection of undesirable drilling events such as drill string washouts and mud pump failures.Numerous theoretical and experimental studies have been established to calculate the friction pressure losses using different rheological models and based on an extension of pipe flow correlations to an annular geometry.However,it would not be feasible to employ these models for real-time applications since they are limited to some conditions and intervals of application and require input parameters that might not be available in real-time on each rig.In this study,The Group Method of Data Handling(GMDH)is applied to develop a trustworthy model that can predict the SPP in real-time as a function of mud flow,well depth,RPM and the Fan VG viscometer reading at 600 and 300 rpm.In order to accomplish the modeling task,3351 data points were collected from two wells from Algerian fields.Graphical and statistical assessment criteria disclosed that the model predictions are in excellent agreement with the experimental data with a coefficient of determination of 0.9666 and an average percent relative error less than 2.401%.Furthermore,another dataset(1594 data points)from well-3 was employed to validate the developed correlation for SPP.The obtained results confirmed that the proposed GMDH-SPP model can be applied in real-time to estimate the SPP with high accuracy.Besides,it was found that the proposed GMDH correlation follows the physically expected trends with respect to the employed input parameters.Lastly,the findings of this study can help for the early detection of downhole problems such as drill string washout,pump failure,and bit balling.
