Effects of unilateral superimposed high-frequency jet ventilation on porcine hemodynamics and gas exchange during one-lung flooding

BACKGROUND Superimposed high-frequency jet ventilation(SHFJV)is suitable for respiratory motion reduction and essential for effective lung tumor ablation.Fluid filling of the target lung wing one-lung flooding(OLF)is necessary for therapeutic ultrasound applications.However,whether unilateral SHFJV allows adequate hemodynamics and gas exchange is unclear.AIM To compared SHFJV with pressure-controlled ventilation(PCV)during OLF by assessing hemodynamics and gas exchange in different animal positions.METHODS SHFJV or PCV was used alternatingly to ventilate the non-flooded lungs of the 12 anesthetized pigs during OLF.The animal positions were changed from left lateral position to supine position(SP)to right lateral position(RLP)every 30 min.In each position,ventilation was maintained for 15 min in both modalities.Hemodynamic variables and arterial blood gas levels were repeatedly measured.RESULTS Unilateral SHFJV led to lower carbon dioxide removal than PCV without abnormally elevated carbon dioxide levels.SHFJV slightly decreased oxygenation in SP and RLP compared with PCV;the lowest values of PaO_(2) and PaO_(2)/FiO_(2) ratio were found in SP[13.0;interquartile range(IQR):12.6-5.6 and 32.5(IQR:31.5-38.9)kPa].Conversely,during SHFJV,the shunt fraction was higher in all animal positions(highest in the RLP:0.30).CONCLUSION In porcine model,unilateral SHFJV may provide adequate ventilation in different animal positions during OLF.Lower oxygenation and CO_(2) removal rates compared to PCV did not lead to hypoxia or hypercapnia.SHFJV can be safely used for lung tumor ablation to minimize ventilation-induced lung motion.

A Comparison of Arterial Oxygenation between 60% O2 CPAP and 100% O2 CPAP during One-Lung Ventilation: A Prospective Randomized Controlled Study

Background: One-lung ventilation (OLV) is generally adopted for thoracic surgery. The systemic application of a high fraction of inspiratory oxygen (F1O2) and continuous positive airway pressure (CPAP) to the non-ventilated lung is useful for preventing arterial oxygen desaturation. The adverse effects of elevated F1O2 include oxidative lung injury, resorption atelectasis and coronary and peripheral vasoconstriction. It is preferable to avoid hyperoxemia in patients with complications such as chronic obstructive pulmonary disease, idiopathic pneumonia, and bleomycin-treated lungs. We aimed to determine whether the application of 60% O2 CPAP to the non-ventilated lung is sufficient to provide adequate oxygenation with 60% O2 to the ventilated lung. Methods: A total of 70 patients scheduled to receive elective thoracic surgery requiring OLV were recruited. Left double-lumen tubes were applicable in all surgeries. Patients were randomly allocated to one of two groups, to receive either 60% O2 CPAP (60% CPAP group, n = 35), or 100% O2 CPAP (100% CPAP group, n = 35) at a setting of 2 - 3 cmH2O, applied to the non-ventilated lung. Arterial blood gas analyses were obtained at the following stages: RA, spontaneous breathing under room air (RA);TLV, during total lung ventilation (TLV) prior to the initiation of OLV;T5, 5 min after the initiation of OLV;T15, 15 min after the initiation of OLV;T30, 30 min after the initiation of OLV. Results: The PaO2 value in 60% CPAP group vs. 100% CPAP group at each measurement were as follows: RA (mean [standard deviation: SD], 89.7 [8.2] mmHg vs. 85.8 [11.9] mmHg);TLV (277.9 [52.9] mmHg vs. 269.2 [44.0] mmHg);T5 (191.4 [67.9] mmHg vs. 192.3 [66.0] mmHg);T15 (143.2 [67.3] mmHg vs. 154.7 [60.8] mmHg) and T30 (95.6 [32.0] mmHg vs. 112.5 [36.5] mmHg), respectively. Among the five measurement points, T30 was the only time point at which the 100% CPAP group showed a significantly greater PaO2 value than the 60% CPAP group (p = 0.0495). The SaO2 at T30 in the 100% CPAP group (97.4 [2.0]%) was also significantly greater than that in the 60% CPAP group (96.3 [2.2]%, p = 0.039). No differences were found between the groups regarding changes to the overall PaO2 values (p = 0.44) and SaO2 values (p = 0.23) during the study period. Conclusions: Oxygenation could be safely maintained in relatively healthy patients with 60% O2 OLV and 60% O2 CPAP. The application of 60% O2 CPAP during OLV for patients who are not suited to exposure to high F1O2 may be an alternative form of respiratory management.

Effect of Nalmefene on Delayed Neurocognitive Recovery in Elderly Patients Undergoing Video-assisted Thoracic Surgery with One Lung Ventilation

The intravenous use of nalmefene has been found to exert neuroprotective effect in patients with severe traumatic brain injury and acute cerebral infarction;nonetheless,it is unknown whether nalmefene alleviates delayed neurocognitive recovery.Our purpose of the current research was to clarify the impact of nalmefene on delayed neurocognitive recovery in aged patients experiencing video-assisted thoracic surgery(VATS)with intraoperative use of one lung ventilation(OLV).The present study involved 120 paticents undergoing selective VATS,randomized to accept low-dose nalmefene(N1 group,n=40),high-dose nalmefene(N2 group,1n=40)or equal volume of physiologic saline(control group,1=40).A battery of neuropsychological tests were used to estimate cognitive function I day before surgery(o)and 10 days after surgery or before discharge(t).Regional cerebral oxygen saturation(rSO2)was detected 5 min before induction(t),5 min after induction(1),15 and 60 min after onset of OLV(62 and 13),and 15 min after termination of OLV(4).The plasma values of interleukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-a1 and adiponectin(ADP)were also detected prior to induction of anesthesia(T0),1 h,2 h and 6 h after surgery(TI,T2,T3).On 1,delayed neurocognitive recovery occurred in 5/40(12.5%)patients of NI group,in 5/40(12.5%)patients of N2 group and in 13/40(32.5%)patients of control group(P<0.05).There were no statistical differences in rSO2 among three groups at different time points.At Tl,T2 and T3,IL-1β,IL-6 and TNF-a values significantly increased and ADP value significantly decreased(P<0.05)in control group.In contrast,at TI,T2 and T3,IL-1β,IL-6 and TNF-a values decreased and ADP value decreased less in N1 and N2 groups(P<0.05).At TI,T2 and T3,IL-1β,IL-6 and TNF-a concentrations presented a trend of N2 group<N1 group<control group and ADP presented a trend of N2 group>Nl group>control group(P<0.05).The result of our present research supports the hypothesis that the perioperative intravenous treatment with nalmefene to VATS with OLV ameliorates postoperative cognitive function and decreases the incidence of delayed neurocognitive recovery,most likely by suppression of inflammatory responses.

Univariate Risk Factors for Prolonged Mechanical Ventilation in Patients Undergoing Prosthetic Heart Valves Replacement Surgery

Data from 736 patients undergoing prosthetic heart valve replacement surgery and concomitant surgery （combined surgery） from January 1998 to January 2004 at Union Hospital were retrospectively reviewed. Univariate logistic regression analyses were conducted to identity risk factors for prolonged mechanical ventilation. The results showed that prolonged cardiopulmonary bypass duration, prolonged aortic cross clamp time and low ejection fraction less than 50 percent （50 %） were found to be independent predictors for prolonged mechanical ventilation. Meanwhile age, weight, and preoperative hospital stay （days） were not found to be associated with prolonged mechanical ventilation. It was concluded that. for age and weight, this might be due to the lower number of old age patients （70 years and above） included in our study and genetic body structure of majority Chinese population that favor them to be in normal weight, respectively.

Clinical Study of P_(ET)CO_2 in One-lung Ventilation

Fourty-eight patients (ASA physical status Ⅰ - Ⅱ) undergoing selected thoracotomy and pulmonectomy were studied. They were divided into two groups according to different respiratory modes, two-lung ventilation (TLV) and onelung ventilation (OLV) or TLV and OLV with a Bain cyclic system for CPAP on the side of operated lung. PETCO2 and PaCO2 were measured after 30 min TLV,30 min and 60 min OLV, and repeated TLV (R-TLV) 30 min after pulmonectomy, to evaluate the difference between PETCO2 and PaCO2 in OLV and to observethe effect of abating hypoxemia and discharge of CO2 in OLV with Bain system.Our results showed that the PaCO2 and PETCO2 in different test groups were normal though the measured values in OLV were slightly higher than that in TLV (P<0. 05) , and then they were recovered after R-TLV (P>0. 05). There was nosignificant difference between group 1. and 2. in OLV (P>0. 05). There was aclose correlation between PETCO2 and PaCO2 (P<0. 05). The differences of the calculated P(a-ET)CO2 and radio of PETCO2/PaCO2 in different ventilation modes were not significant. Hypoxemia in OLV was corrected by Bain system, but the discharge of CO2 was not affected. The results showed that measurement of PET CO2 as a non-invasive procedure can be commonly used to monitor OLV.

Considerations of single-lung ventilation in neonatal thoracoscopic surgery with cardiac arrest caused by bilateral pneumothorax:A case report

BACKGROUND Tension pneumothorax of the contralateral lung during single-lung ventilation(SLV)combined with artificial pneumothorax can cause cardiac arrest due to bilateral pneumothorax.If not rapidly diagnosed and managed,this condition can lead to sudden death.We describe the emergency handling procedures and rapid diagnostic methods for this critical emergency situation.CASE SUMMARY We report a case of bilateral pneumothorax in a neonatal patient who underwent thoracoscopic esophageal atresia and tracheoesophageal fistula repair under the combined application of SLV and artificial pneumothorax.The patient suffered sudden cardiac arrest and received emergency treatment to revive her.The recognition of dangerous vital sign parameters,rapid evacuation of the artificial pneumothorax,and initiation of lateral position cardiopulmonary resuscitation while simultaneously removing the endotracheal tube to the main airway are critically important.Moreover,even though the sinus rhythm was restored,the patient’s continued tachycardia,reduced pulse pressure,and depressed pulse oximeter waveform were worrisome.We should highly suspect the possibility of pneumothorax and use rapid diagnostic methods to make judgment calls.Sometimes thoracoscopy can be used for rapid examination;if the mediastinum is observed to be shifted to the right,it may indicate tension pneumothorax.This condition can be immediately relieved by needle thoracentesis,ultimately allowing the safe completion of the surgical procedure.CONCLUSION Bilateral pneumothorax during SLV combined with artificial pneumothorax is rare but can occur at any time in neonatal thoracoscopic surgery.Therefore,anesthesiologists should consider this possibility,be alert,and address this rare but critical complication in a timely manner.

Effect of sevoflurane pretreatment combined with propofol on cerebral oxygen metabolism and inflammatory response during one-lung ventilation

Objective:To study the effect of sevoflurane pretreatment combined with propofol on cerebral oxygen metabolism and inflammatory response during one-lung ventilation.Methods:A total of 92 patients who accepted pulmonary lobectomy under one-lung ventilation in Changzheng Hospital Affiliated to Second Military Medical University between August 2014 and March 2016 were selected and divided into sevoflurane group and control group. Before one-lung ventilation (T1), 30 min after one-lung ventilation (T2) and 60 min after one-lung ventilation (T3), cerebral oxygen metabolism indexes and serum inflammation indexes were determined;after surgical resection, the lung tissue was collected to determine the expression of inflammatory signaling molecules and hypoxia injury molecules.Results: CjvO2 and ajdDCO2 levels as well as serum ICAM-1, IL-1β and TNF-α contents were not significantly different between two groups of patients at T1;CjvO2 levels as well as serum ICAM-1, IL-1β and TNF-α contents of sevoflurane group at T2 and T3 were significantly lower than those of control group while ajdDCO2 levels were significantly higher than those of control group;after surgical resection, TLR4, NF-kB, AQP-4, p38MAPK, HO-1, GLUT-1, HIF-1毩 and CHOP protein expression in lung tissue of sevoflurane group were significantly lower than those of control group.Conclusion:Sevoflurane pretreatment combined with propofol can improve the cerebral oxygen metabolism and inhibit the inflammatory response during one-lung ventilation.

Effect of sevoflurane pretreatment on alveolar oxygenation function and systemic inflammatory response activation during one-lung ventilation

Objective:To study the effect of sevoflurane pretreatment before one-lung ventilation on pulmonary compliance, oxygenation function and systemic inflammatory response.Methods:104 patients who accepted one-lung ventilation operation in Mianyang Central Hospital between April 2014 and December 2015 were selected and randomly divided into the sevoflurane group who accepted sevoflurane pretreatment combined with routine anesthesia and the control group who accepted routine anesthesia, and the pulmonary compliance and oxygenation function parameters during one-lung ventilation as well as the contents of inflammatory mediators in serum and the contents of inflammation regulation molecules in alveolar lavage fluid were determined.Results: At T1, T2 and T3, Cdyn and PaO2/FiO2 levels of sevoflurane group were significantly higher than those of control group, and serum ICAM-1, IL-6, IL-8 and TNF-α contents were significantly lower than those of control group while IL-10 contents were significantly higher than those of control group;after operation, AQP-1, p38MAPK, TLR4 and NF-κB contents in collapsed alveolar lavage fluid of sevoflurane group were significantly lower than those of control group.Conclusion: Sevoflurane pretreatment before one-lung ventilation can improve the pulmonary compliance and oxygenation function, and inhibit the activation of inflammatory response.

Effect of sevoflurane pretreatment on cerebral oxygen saturation, pulmonary compliance and systemic stress response in patients with one-lung ventilation

Objective:To investigate the effect of sevoflurane pretreatment on cerebral oxygen saturation, pulmonary compliance and systemic stress response in patients with one-lung ventilation. Methods:A total of 70 patients with lung cancer who accepted the selective pulmonary lobectomy in our hospital between January 2012 and December 2015 were collected and divided into observation group and control group (n=35) according to the single-blind randomized control method. After general anesthesia induction, the control group received air/oxygen mixed ventilation, and the observation group received sevoflurane pretreatment for 30 min and received one-lung ventilation after that. Immediately after anesthesia induction (T0), 30 min after sevoflurane pretreatment (T1), 60 min after sevoflurane pretreatment (T2) and at chest wall suture after operation (T3), the cerebral oxygen saturation monitor was used to determine the left and right regional cerebral oxygen saturation (rSO2);end-expiratory airway blocking method and related indexes were used to calculate the contralateral pulmonary static compliance (Cst) and pulmonary dynamic compliance (Cdyn);the RIA method was used to determine serum stress hormone levels.Results:At T0, differences in cerebral oxygen saturation, pulmonary compliance and systemic stress response were not statistically significant between two groups of patients;at T1, T2 and T3, left and right rSO2 levels of observation group were higher than those of control group, Cst and Cdyn levels were significantly higher than those of control group, and serum epinephrine (E), norepinephrine (NE), cortisol (Cor) and angiotensinⅡ (AngⅡ) levels were lower than those of control group.Conclusion:Sevoflurane pretreatment can promote the intraoperative cerebral oxygen saturation and pulmonary compliance, and reduce systemic stress response in patients with one-lung ventilation.

Oxygenation,inflammatory response and lung injury during one lung ventilation in rabbits using inspired oxygen fraction of 0.6 vs.1.0

Maintaining adequate oxygenation during one-lung ventilation（OLV） requires high inspired oxygen fraction（FiO_2）.However,high FiO_2 also causes inflammatory response and lung injury.Therefore,it remains a great interest to clinicians and scientists to optimize the care of patients undergoing OLV.The aim of this study was to determine and compare oxygenation,inflammatory response and lung injury during OLV in rabbits using FiO_2 of 0.6 vs.1.0.After 30 minutes of two-lung ventilation（TLV） as baseline,30 rabbits were randomly assigned to three groups receiving mechanical ventilation for 3 hours：the sham group,receiving TLV with 0.6 FiO_2;the 1.0 FiO_2 group,receiving OLV with 1.0 FiO_2;the 0.6 FiO_2 group,receiving OLV with 0.6 FiO_2.Pulse oximetry was continuously monitored and arterial blood gas analysis was intermittently conducted.Histopathologic study of lung tissues was performed and inflammatory cytokines and the mRNA and protein of nuclear factor kappa B（NF-κB） p65 were determined.Three of the 10 rabbits in the 0.6 FiO_2 group suffered hypoxemia,defined by pulse oximetric saturation（SpO_2） less than 90%.Partial pressure of oxygen（PaO_2）,acute lung injury（ALI） score,myeloperoxidase（MPO）,tumor necrosis factor-a（TNF-α）,interleukin-6（IL-6）,mRNA and protein of NF-kB p65 were lower in the 0.6 FiO_2group than in the 1.0 FiO_2 group.In conclusion,during OLV,if FiO_2 of 0.6 can be tolerated,lung injury associated with high FiO_2 can be minimized.Further study is needed to validate this finding in human subjects.

The Effect of Dexmedetomidine on Oxygenation and Intrapulmonary Shunt during One Lung Ventilation

Background: The effect of intravenously administered dexmedetomidine on oxygenation during one-lung ventilation has not been studied. The hypothesis of this prospective, randomized study was that dexmedetomidine would be associated with an improvement in oxygenation during one-lung ventilation. The secondary outcome was the change in the intrapulmonary shunt. Materials and Methods: Thirty patients undergoing one-lung ventilation were included. Patients in Group D (n = 15) received a bolus dose of 1 μg·kg-1 dexmedetomidine at 10 min after induction of anaesthesia followed by an infusion of 0.4 μg·kg-1·hr-1 that was stopped at the end of the surgery, and those in the control group(Group C, n = 15) were given saline at the same dosage. Vital signs, PaO2, and pulmonary shunting (Qs/Qt) were compared. Results: During one-lung ventilation, the PaO2 in Group D increased significantly and Qs/Qt significantly decreased compared to Group C (PaO2, 203.7 ± 42.3 mmHg vs. 173 ± 37.6 mmHg [P = 0.04] and Qs/Qt 19.8% ± 4.5% vs. 31% ± 2.4% [P < 0.0001], Group D and Group C, respectively). Conclusion: Intravenous administration of dexmedetomidine achieved an improvement in oxygenation during one-lung ventilation. This was associated with a decrease in pulmonary shunt. Use of intraoperative dexmedetomidine during thoracic surgery can be suggested.

Effect of Oxygen Therapy by Venturi Mask versus Non Invasive Ventillation on the Outcome of Patients Who Devolope Hypoxia after Open Heart Surgery

Background: Cardiothoracic surgery is a common cause of acute respiratory failure and is associated with increased morbidity and mortality. We aimed to compare the outcomes of open heart surgery patients treated using oxygen delivery devices with patients who receive NIV as a first-line therapy for hypoxemic respiratory failure. Materials and Methods: 40 patients who developed acute hypoxemic respiratory failure after open heart surgery and admitted to cardiothoracic ICU 20 patients received NIV and 20 patient received oxygen by venture mask. For all patients the following measurements were performed before and after CPAP AND Venture use: CBC, blood urea, serum creatinine body temperature, chest X-ray, Arterial blood gases (arterial pH, sodium bicarbonate, pcO2, SpO2 and PaO2-to-FiO2 ratio). Results: Mean PO2 and SO2 have increased after using of both venture and Cpap, increase in both PCO2 and HCO3 levels after using Venturi mask, CPAP mask was superior to venturi mask in avoiding the need of intubation, decreasing The ICU stay median length and also median length of hospitalization, all were lower in CPAP group than venture group. Also the mortality rate was lower in CPAP group than the venturi group. Conclusion: Using CPAP mask in severe AHRF following open heart surgery can avoid intubation, decreases the levels of tachypnea and arterial hypoxemia, decreases ICU stay, the length of hospitalization and also decreases the mortality rate compared with patients receiving high-concentration oxygen therapy with venture mask.

Effect of preoperative inspiratory muscle training on postoperative outcomes in patients undergoing cardiac surgery:A systematic review and meta-analysis

BACKGROUND Cardiovascular disease is the most prevalent disease worldwide and places a great burden on the health and economic welfare of patients.Cardiac surgery is an important way to treat cardiovascular disease,but it can prolong mechanical ventilation time,intensive care unit(ICU)stay,and postoperative hospitalization for patients.Previous studies have demonstrated that preoperative inspiratory muscle training could decrease the incidence of postoperative pulmonary complications.AIM To explore the effect of preoperative inspiratory muscle training on mechanical ventilation time,length of ICU stay,and duration of postoperative hospitalization after cardiac surgery.METHODS A literature search of PubMed,Web of Science,Cochrane Library,EMBASE,China National Knowledge Infrastructure,WanFang,and the China Science and Technology journal VIP database was performed on April 13,2022.The data was independently extracted by two authors.The inclusion criteria were:(1)Randomized controlled trial;(2)Accessible as a full paper;(3)Patients who received cardiac surgery;(4)Preoperative inspiratory muscle training was implemented in these patients;(5)The study reported at least one of the following:Mechanical ventilation time,length of ICU stay,and/or duration of postoperative hospitalization;and(6)In English language.RESULTS We analyzed six randomized controlled trials with a total of 925 participants.The pooled mean difference of mechanical ventilation time was-0.45 h[95%confidence interval(CI):-1.59-0.69],which was not statistically significant between the intervention group and the control group.The pooled mean difference of length of ICU stay was 0.44 h(95%CI:-0.58-1.45).The pooled mean difference of postoperative hospitalization was-1.77 d in the intervention group vs the control group[95%CI:-2.41-(-1.12)].CONCLUSION Preoperative inspiratory muscle training may decrease the duration of postoperative hospitalization for patients undergoing cardiac surgery.More high-quality studies are needed to confirm our conclusion.

Non-Invasive Pressure Support Ventilation in Major Lung Resection for High Risk Patients: Does It Matter?

Background and purpose: Patients with severely impaired pulmonary function have an increased operative risk for major lung resection. The clinical benefits of pre- and perioperative, non-invasive pressure support ventilation (NIPSV) have up to now not been extensively evaluated. Patients with severely reduced pulmonary function were investigated in this prospective and randomised single centre clinical trial. Methods: Standard pulmonary evaluation was performed in all patients before major lung resection. To predict postoperative pulmonary function, a lung perfusion-ventilation scan was carried out. All patients enrolled in the study were instructed preoperatively on how to use a NIPSV respirator. Af-ter lung resection patients were randomised either for continuation of NIPSV or for standard treatment. Results: Of the 52 patients assessed, 21 patients met the inclusion criteria for the study protocol. Predicted mean postoperative FEV1 was 1.10 L (range 0.92 - 1.27 L). Lobectomy was performed in 14 patients, pneumonectomy in 6 patients and a segmentectomy in 1 patient. No inhospital deaths occurred. Pulmonary complications (reintubation, pneumonia) were more frequent in the NIPSV group than in the control group (3 patients versus 1 patient), without statistical significance (p = 0.31). Conclusions: We observed no mortality and a low morbidity in this high risk group. Postoperative continuation of NIPSV had no beneficial effect on the clinical outcome. Preoperative conditioning with NIPSV, however, seems to be a suitable tool for patients with severely impaired pulmonary function. This study may serve therefore as basis for further investigations for the potential clinical benefits of prophylactic NIPSV in major lung surgery.

预先单肺通气联合呼吸暂停对支气管封堵器用于胸腔镜手术单肺通气时肺萎陷的影响

目的 探讨预先单肺通气(OLV)联合呼吸暂停对支气管封堵器(BB)用于胸腔镜手术行OLV时肺萎陷的影响。方法 选择择期行胸腔镜下左肺段或肺叶切除术的患者75例,随机分为预先OLV组(A组)、呼吸暂停组(B组)和预先OLV联合呼吸暂停组(C组),每组25例。记录3组打开胸膜到肺完全萎陷的时间、外科医生满意度、进胸前准备时间、OLV时间、手术时间和OLV开始至胸膜打开后20 min内低氧血症[经皮动脉血氧饱和度(SpO_(2))<90%]的发生情况;记录3组胸膜腔开放即刻(T_0)、胸膜腔开放后1 min (T_1)、5 min (T_2)、10 min (T_3)和20 min (T_4)的肺萎陷评分(LCS)。结果 与A组和B组比较,C组肺完全萎陷时间明显缩短,外科医生满意度明显提高,差异均有统计学意义(P <0.05),A组和B组肺完全萎陷时间和外科医生满意度比较,差异均无统计学意义(P> 0.05);与A组比较,B组T0时点LCS低于A组,而在T_1时点,则明显高于A组,C组T_(1)、T_(2)、T_(3)和T_(4)时点LCS明显高于A组和B组,差异均有统计学意义(P <0.05);C组T2时点SpO_(2)明显低于A组和B组,差异有统计学意义(P <0.05)。结论 对于用BB行OLV的胸腔镜手术患者,预先使用OLV联合呼吸暂停,可以改善非通气侧肺的肺萎陷效果,缩短了肺完全萎陷时间,提高了外科医生满意度,且OLV的早期LCS更高,但仍需监测OLV期间的SpO_(2)。

鼻腔扩容术联合腭咽成形术治疗伴鼻塞症状阻塞性睡眠呼吸暂停低通气综合征的疗效

目的:探讨鼻腔扩容术联合腭咽成形术治疗伴鼻塞症状阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法:选取80例伴鼻塞症状OSAHS患者为研究对象,根据手术方式不同分为对照组和观察组,每组各40例。对照组患者实施单纯腭咽成形术治疗;观察组患者实施鼻腔扩容术联合腭咽成形术治疗,术后随访6个月。比较两组患者临床疗效、鼻腔通气功能[鼻腔阻力、鼾声指数及鼻呼吸总量]、睡眠呼吸指标[呼吸暂停低通气指数(AHI)、最低动脉血氧饱和度(LSaO_(2))、血氧饱和度(SpO_(2))、深睡眠比例及觉醒指数、Epwoeth嗜睡量表(ESS)评分]及生活质量[魁北克睡眠问卷(QSQ)评分]。结果:观察组患者临床总有效率高于对照组(92.50%vs.75.00%,P<0.05)。治疗后6个月,两组患者鼻腔阻力、鼾声指数、AHI、觉醒指数及ESS评分均降低(P<0.05),且观察组低于对照组(P<0.05);鼻呼吸总量、LSaO_(2)、SpO_(2)、深睡眠比例、QSQ各维度评分及总分均升高(P<0.05),且观察组高于对照组(P<0.05)。结论:鼻腔扩容术联合腭咽成形术是一种治疗伴鼻塞症状OSAHS的有效方式,可改善患者鼻腔通气功能及睡眠呼吸参数,提升生活质量。

成人心脏术后高危患者撤机后使用高流量吸氧及无创通气的临床预后疗效研究

目的探讨成人心脏术后高危患者撤机后使用高流量吸氧及无创通气的临床预后疗效。方法选取2020年6月—2022年6月贵州省人民医院收治的86例接受心脏外科手术后的患者作为研究对象。按照干预方式差异分为常规组和联合组,每组43例。常规组患者给予高流量氧疗技术,联合组给予高流量氧疗技术联合无创呼吸机辅助通气治疗。比较两组干预治疗前后血气指标、再插管率、呼吸衰竭发生率和呼吸困难评分。结果治疗后,联合组的动脉血氧分压、血氧饱和度、氧合指数、pH值高于常规组,差异有统计学意义(P均<0.05)。联合组在拔管后48 h、72 h、7 d的再插管率低于常规组,差异有统计学意义(P均<0.05)。联合组的呼吸衰竭率(4.65%)低于常规组(20.93%),差异有统计学意义(χ^(2)=5.108,P<0.05)。治疗24、48 h后,联合组的呼吸困难评分低于常规组,差异有统计学意义(P均<0.05)。结论成人心脏术后高危患者撤机后使用高流量氧疗技术与无创式呼吸机相结合干预效果显著,可有效改善患者呼吸困难症状和血气指标,可减少患者再插管和呼吸衰竭发生,有助于患者早日康复。

瑞芬太尼联合咪达唑仑在小儿先心术后机械通气中镇痛镇静的效果分析

目的探讨瑞芬太尼联合咪达唑仑在小儿先心术后机械通气中镇痛镇静的效果。方法便利选取2020年4月—2023年12月南通大学附属常州市儿童医院收治的107例小儿先心术患儿为研究对象,根据不同镇痛镇静方法分为两组,观察组(54例)接受瑞芬太尼联合咪达唑仑微泵维持持续镇静镇痛,对照组(53例)接受咪哒唑仑镇静加间断芬太尼镇痛。对比两组镇静效果、疼痛程度、不良反应发生率、生命体征。结果用药后,观察组镇静效果评分为(2.38±0.67)分,较对照组的(1.56±0.31)分高,差异有统计学意义(t=8.099,P<0.05)。用药前和用药时,两组疼痛程度对比,差异无统计学意义(P均>0.05),用药完毕后6 h,观察组疼痛程度较低,差异有统计学意义(P<0.05)。用药完毕后6 h,观察组心率和收缩压低于对照组,差异有统计学意义(P均<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论瑞芬太尼联合咪达唑仑在小儿先心术后机械通气中的镇静效果较好,患儿疼痛程度较低,且不良反应较少。

婴儿心脏术后肌钙蛋白T水平对机械通气时间延长的影响

目的探讨肌钙蛋白T对婴儿心脏术后机械通气时间延长的影响。方法回顾性选取2019年1月至4月在南方医科大学附属广东省人民医院心外科行体外循环下心内直视术的192例先天性心脏病婴儿,按术后即刻肌钙蛋白T水平分为肌钙蛋白T高值组(3798.0~10000.0 ng/L)、中值组(1827.0~3709.0 ng/L)和低值组(316.2~1801.0 ng/L),各64例。低值组中,女28例,男36例,日龄203.00(129.75,274.50)d;中值组中,女30例,男34例,日龄118.00(76.50,173.75)d;高值组中,女24例,男40例,日龄168.50(78.00,219.25)d。采用方差分析、秩和检验、χ^(2)检验进行统计分析,通过单因素和多因素logistic回归模型分析术后肌钙蛋白T水平与术后机械通气时间延长的相关性,通过单因素和多因素线性回归模型分析术后肌钙蛋白T水平与重症监护停留时间及术后住院天数的相关性。结果术前日龄越小、手术体外循环时间越长、主动脉阻断时间越长,术后肌钙蛋白T水平越高(均P<0.05)。在校正了性别、日龄、胎龄、术前血红蛋白、术前血清肌酐、体外循环时间、主动脉阻断时间、先天性心脏病手术风险调整评分(RACHS-1)等因素后,多因素回归模型发现,肌钙蛋白T水平升高是机械通气时间延长的独立危险因素[OR=1.2(1.1,1.3),P<0.001]。结论肌钙蛋白T水平升高与婴儿先天性心脏病术后机械通气时间延长有关。

术前超声引导下星状神经节阻滞对胸腔镜手术患者的肺保护作用及机制

目的探讨术前超声引导下星状神经节阻滞(SGB)对胸腔镜手术单肺通气(OLV)患者的肺保护作用及机制。方法选择2021年1月至2022年4月于南京医科大学附属苏州医院行胸腔镜下OLV肺叶切除术的84例患者为研究对象,按照随机数字表法将患者分为观察组和对照组,每组42例。观察组患者麻醉诱导前实施超声引导下SGB;对照组患者不做穿刺操作。2组患者采用相同的麻醉诱导和维持方案。记录患者入手术室后(T_(0))、OLV开始前(T_(1))、OLV开始后30 min(T_(2))、OLV开始后60 min(T_(3))、术毕(T_(4))、拔管后30 min(T_(5))时血流动力学、呼吸力学参数和动脉血气指标。比较各时间点2组患者氧合指数(OI)和肺内分流率(Qs/Qt)以及pH值。分别于T_(0)、T_(3)、T_(5)时,抽取2组患者静脉血,应用酶联免疫吸附法检测血清中肺表面活性物质相关蛋白-A(SP-A)、超氧化物歧化酶(SOD)、丙二醛(MDA)、白细胞介素(IL)-6及IL-10水平,记录患者术后SGB相关并发症及术后72 h内肺部并发症发生情况。结果2组患者T_(1)、T_(2)、T_(3)时的平均动脉压(MAP)和心率(HR)显著低于T_(0)时(P<0.05);T_(4)和T_(5)时的MAP和HR与T_(0)时比较差异无统计学意义(P>0.05),2组患者其他时间点间的MAP和HR比较差异无统计学意义(P>0.05)。T_(1)、T_(2)、T_(3)时,观察组患者的MAP显著低于对照组(P<0.05);T_(2)、T_(3)时,观察组患者的HR显著低于对照组(P<0.05);其他时间点,2组患者的MAP和HR比较差异无统计学意义(P>0.05)。T_(0)~T_(5)各时间点2组患者的脉搏氧饱和度(SpO_(2))比较差异无统计学意义(P>0.05)。2组患者T_(2)、T_(3)时的气道峰压(Ppeak)、呼吸频率(RR)显著高于T_(1)和T_(4)时,潮气量(TV)显著低于T_(1)和T_(4)时(P<0.05);T_(2)、T_(3)时,观察组患者的Ppeak、TV显著低于对照组(P<0.05);T_(1)、T_(4)时,2组患者的Ppeak、TV比较差异无统计学意义(P>0.05);T_(1)~T_(4)时,2组患者的RR、呼气末二氧化碳分压(PetCO_(2))比较差异无统计学意义(P>0.05)。T_(0)~T_(5)时,2组患者的pH比较差异无统计学意义(P>0.05)。2组患者T_(1)与T_(0)时的OI比较差异无统计学意义(P>0.05);2组患者T_(2)~T_(5)的OI显著低于T_(0)和T_(1)时(P<0.05);T_(2)~T_(5)时,观察组患者的OI值显著高于对照组(P<0.05)。2组患者T_(2)~T_(5)时的Qs/Qt值显著高于T_(0)、T_(1)时(P<0.05);T_(2)~T_(5)时,观察组患者的Qs/Qt显著低于对照组(P<0.05)。2组患者T_(3)和T_(5)时的血清SP-A、IL-6水平显著高于T_(0)时(P<0.05);T_(3)、T_(5)时,观察组患者的SP-A、IL-6水平显著低于对照组(P<0.05)。对照组患者T_(3)和T_(5)时血清IL-10水平低于T_(0)时,观察组患者T_(3)和T_(5)时的血清IL-10水平高于T_(0)时(P<0.05);T_(3)、T_(5)时,观察组患者的血清IL-10水平显著高于对照组(P<0.05)。对照组患者T_(3)和T_(5)时血清MDA水平显著高于T_(0)时(P<0.05);观察组患者T_(3)和T_(5)时血清MDA水平与T_(0)时比较差异无统计学意义(P>0.05);T_(3)、T_(5)时,观察组患者血清MDA水平显著低于对照组(P<0.05)。T_(3)、T_(5)时,对照组患者血清SOD水平显著低于T_(0)时,观察组患者血清SOD水平显著高于T_(0)时(P<0.05);T_(3)、T_(5)时,观察组患者血清SOD水平显著高于对照组(P<0.05)。观察组患者中4例出现单侧喉返神经阻滞症状,1例患者出现臂丛神经阻滞,均于术后24 h内好转,术后随访未见其他不良反应。术后72 h内对照组有1例患者出现低氧血症。结论术前超声引导下SGB可以显著改善胸腔镜手术OLV患者的OI,减少肺内分流,抑制炎症反应和氧化应激,从而发挥肺保护作用。