Objective To study the influencing factors for duration of mechanical ventilation in chronic obstructive pulmonary disease ( COPD) patients with type II respiratory failure. Methods Twenty-eight cases of mechanical ventilated COPD patients with type II respiratory failure were enrolled from March 2006 to March 2008 in Beijing Shunyi Hospital. They were divided into two groups based on their duration of ventilation: ≤7 d group as group I, and gt; 7 d as group II. Data of heart rate and blood pressure were recorded before the trachea intubation. Clinical data of blood routine, blood gas analysis and serum biochemistry were collected and analyzed. Previous history, smoking history and subsequent complications were also recorded. Results Heart rate in the group II were significantly higher than which in the group I[ ( 121. 50 ±17. 20) /min vs ( 103. 08 ±19. 97) /min, P lt;0. 05] . The incidences of upper gastrointestinal hemorrhage and blood pressure fall immediately after intubation were 63% and 88% respectively in the group II, which were significantly higher than the group I ( 0 and 25% ) . The levels of albumin, pre-albumin, Na+ , PaO2 were ( 29. 06 ±5. 00) g /L, ( 66. 36 ±17. 72) mg/L,( 138. 45 ±4. 74) mmol /L and ( 49. 06 ±20. 11) mm Hg respectively in the group II. While in the group I, those were ( 37. 11 ±2. 73) g /L, ( 127. 70 ±35. 84) mg/L, ( 143. 29 ±3. 42) mmol /L and ( 72. 25 ±38. 69) mm Hg respectively, which showed significant differences compared with the grouop II. The incidence of previous concomitant cerebral infarction showed significant difference between the group I and group II( 33. 33% vs 0) .Conclusion The levels of albumin, pre-albumin, heart rate before the intubation, upper gastrointestinal hemorrhage and blood pressure fall immediately after the intubation are associated with duration of mechanical ventilation and may indicate the prognosis in COPD patients with type II respiratory failure.
Objective To investigate the effect of intra-abdominal hypertension(IAH) on respiratory function in pigs.Methods Twelve pigs were randomly divided into two groups (n=6 in each group),ie.IAH20 group(intra-abdominal pressure=20 mm Hg) and IAH30 group(intra-abdominal pressure=30 mm Hg).Pig model of IAH was established by intraperitoneally injection of carbon dioxide.The changes in respiratory function parameters including pulmonary dynamic compliance（Cdyn），peak inspiratory pressure(PIP) ,SpO2 and PaCO2 were recorded at different time points.Results Cdyn was significantly decreased at different time points compared with baseline in group IAH30 and group IAH20.PIP significantly increased at different time points compared with baseline in both IAH groups，but group IAH30 was more severe than group IAH20. No significant changes of SpO2 and PaCO2 were found in two IAH groups.Conclusion IAH can impair respiratory function by decreasing lung compliance and increasing inspiratory pressure.
Objective To assess the effect of continuous positive airway pressure ( CPAP) on expiratory flow limitation in severe chronic obstructive pulmonary disease ( COPD) patients during noninvasive ventilation by oscillatory reactance ( Xrs ) . Methods Eight patients with stable COPD and chronic hypercapnic respiratory failure( type II) received noninvasive ventilation with a traditional CPAP ventilator through a nasal mask were enrolled. The CPAP were successively set as 4, 8 and 12 cm H2O respectively. The forecd oscillation( 5 Hz, 2 cm H2O) was imposed into the mask and the flow and nasal pressure were measured at the airway opening. The difference between inspiratory and expiratory Xrs( ΔXrs)were calculated for each breathing cycle and average ΔXrs was calculated at different pressure levels according to the established algorithm. Meanwhile, the oesophageal pressure was also measured by a balloontipped catheter and transpulmonary pressure was calculated. The breathing cycles above were analyzed subsequently and classified as expiratory flow-limited( EFL) and non-EFL breath. In addition, flow and nasal pressure when breathing naturally( CPAP = 0 cmH2O) was also collected for each patient and the EFL breath cycles was identified as baseline. Then, the percentage of EFL breathing cycles and ΔXrs were calculated for each CPAP level and their relationship was analyzed. The threshold value of ΔXrs with maximum sensitivity and specificity to detect EFL and the optimal CPAP to suppress the development of EFL were computed. Results ①CPAP increased from4 to 8 and 12 cm H2O resulted in fall of mean values of ΔXrs from2. 67 to 1. 62 and 1. 31 cm H2O· s- 1 · L- 1 , respectively( ΔXrs at CPAP 0 cm H2O was not detected) , and the decrease of ΔXrs when CPAP up to 8 cm H2O from 4 cm H2 O was significant ( Z = - 2. 68, P = 0. 01) . ②CPAP significantly suppressed the development of EFL, when CPAP increased from0 cm H2O to 4,8 and12 cmH2O resulted in decrease in the percentage of breathing cycle from 29. 8% to 9. 9% , 8. 1% and 4. 4%, respectively( 2 = 15. 6, P = 0. 01) . ③ ΔXrs was related to the degree of EFL and the mean value of ΔXrs in EFL breathing cycles was significantly higher than that in non-EFL’s. When ΔXrs decreased to 1. 83 cm H2O· s- 1 · L- 1, the majority of breath showed non-EFL, with a sensitivity of 94% and specificity of 97% for detecting EFL, respectively. Conclusions ΔXrs is an indicator of the occurrence of EFL. Appropriate CPAP to render the value of ΔXrs equal to or slightly less than 1. 83 cm H2O·s - 1 ·L- 1 may effectively suppress the development of EFL in severe COPD patients during noninvasive ventilation.
Objective To evaluate the clinic outcomes of coronary artery bypass grafting （CABG） on patients of coronary artery disease complicated with chronic obstructive pulmonary disease（COPD）. Methods The data of 27 patients of coronary artery diseases complicated with COPD who had received CABG from Jan. 1998 to Dec. 2004, were retrospectively summarized. 18 patients received off-pump CABG （off-pump group）,and 9 cases received on- pump CABG （on-pump group）. All patients accepted the evaluation about clinical respiratory complications, oxygenation index （PaO2/FiO2）, related respiratory function index, plasma intercellular adhesion molecule 1 （ICAM-1） and the amount of neutrophil in pulmono-alveolar perfusion fluid at the different time point including the start of CPB （for off-pump group, the measurement accepted at the start of operation）, end of CPB （end of operation for off-pump group）, and at 2, 6, 12, and 24h after operation. Results There was no operation-related death in two groups. One died of respiratory failure 14 days after operation in the hospital in off-pump group, there were more respiratory complications in on-pump group than that in off-pump group, and PaO2/FiO2 in on-pump group was higher than that in off-pump group at CPB 30min （at the start of operation）, but lower than that in off-pump group postoperative at 6 h, 12 h（P〈0. 05）, the concentration of plasma ICAM-1 had obvious difference between two groups from CPB 30 min （at the start of operation） to post-operative 24 h （P 〈 0. 05）. The neutrophils in bronchoalveolar lavage in on-pump group was higher than that in off-pump group from CPB 30 min （at the start of operation） to 24 h after operation （P〈0. 05）. Conclusion Off-pump CABG seems more suitable than on-pump CABG for coronary artery disease patients with COPD due to less damage on oxygen-exchange capability and less respiratory complication.
【摘要】 目的 分析急性颈脊髓损伤后并发呼吸功能障碍的高危因素，以减少呼吸功能障碍发生，降低死亡率。 方法 对2002年7月-2006年8月收治的48例急性颈脊髓损伤患者，根据瘫痪程度、脊髓损伤平面、吸烟及年龄与呼吸功能障碍发生率的相关性，采用维持有效呼吸、颈部制动、减压复位内固定等相关措施，减少颈脊髓损伤患者术后并发呼吸功能障碍的发生。 结果 22例发生呼吸功能障碍；9例死亡，其中7例死于呼吸衰竭，1例心跳骤停死亡，1例合并脑干损伤死亡。 结论 全瘫、脊髓损伤平面高、吸烟、高龄是急性颈脊髓损伤并发呼吸功能障碍的高危因素，对高危患者气管切开、呼吸机辅助呼吸态度应积极。【Abstract】 Objective To analyze the high risk factors of respiratory obstacle after acute cervical spinal cord injury (SCI) and accept the measure more actively so as to decrease the respiratory obstacle occurrence and reduce the mortality rate. Methods A total of 48 patients from July 2002 to August 2006 were analyzed. According to the correlation among the paralyze degree,smoking, and age with the respiratory obstacle occurrence, we reduce the occurrence of respiratory obstacle in patients with spinal cord injury after the operation via obtaining the effective breath, neck retaining, etc. Results The respiratory obstacle was found in 22 cases; death in 9, in whom 7 died of respiratory failure, 1 of cardiac arrest, and 1 of brain stem hurt. Conclusions The whole palsy, higher level of the spinal cord injury, smoking, and advanced age are the high risk factors of respiratory obstacle after acute cervical SCI. The tracheostomy tube and the adjuvant respiration with the respirator should be accept aggressively for those high risk patients.
ObjectiveImpaired breathing during and following seizures is an important cause of sudden unexpected death in epilepsy (SUDEP), but the network mechanisms by which seizures impair breathing have not been thoroughly investigated. Progress would be greatly facilitated by a model in which breathing could be investigated during seizures in a controlled setting. MethodRecent work with an acute Long-Evans rat model of limbic seizures has demonstrated that depression of brainstem arousal systems may be critical for impaired consciousness during and after seizures. We now utilize the same rat model to investigate breathing during partial seizures with secondary generalization. ResultBreathing is markedly impaired during seizures(P < 0.05;n=21), and that the severity of breathing impairment is strongly correlated with the extent of seizure propagation (Pearson R=-0.73;P < 0.001;n=30). ConclusionSeizure propagation could increase the severity of breathing impairment caused by seizures. Based on these results, we suggest that this animal model would help us to improve understanding of pathways involved in impairment of breathing caused by seizures and this is an important initial step in addressing this significant cause of SUDEP in people living with epilepsy.
ObjectiveTo explore the influence of respiratory function training on pulmonary function of patients with pneumoconiosis. MethodsOne hundred patients with pneumoconiosis hospitalized in our department between June 2011 and September 2012 were chosen as the research subjects. According to the method of random digits table, they were equally and randomly divided into contrast group and observation group. Patients in both the two groups were given routine treatment and nursing and health education, while patients in the observation group adopted respiratory training with lung functional exerciser in addition. Then we observed the forced expiratory volume in one second (FEV1), vital capacity, maximal voluntary ventilation, forced vital capacity, classification of conscious shortness of breath and shortness of breath as well as classification of activities of daily living in the patients before and after training in both the two groups. ResultsAfter 6 months, lung function index, classification of conscious shortness of breath and shortness of breath as well as classification of activities of daily living of patients in the observation group improved a lot, which was significantly better than that in the contrast group (P<0.05). Compared with the contrast group, the FEV1 [(2.75±0.43) L], vital capacity [(3.29± 0.45)L] of patients in the observation group were significantly higher (P<0.05). Compared with the contrast group, classification of conscious shortness of breath and shortness of breath (2.10±0.67), classification of activities of daily living (2.19±0.66) were also significantly different (P<0.05). ConclusionRespiratory function training with lung functional exerciser can improve lung function of patients with pneumoconiosis, alleviate the degree of dyspnea, and enhance the quality of life.
ObjectiveTo investigate the application value of modified gastric tube in surgery for mid- and lowerthoracic esophageal cancer compared with gastric tube. MethodsA total of 221 patients with mid- and lower-thoracic esophageal cancer who underwent esophagectomy between October 2009 and June 2013 in our hospital were recruited in the study. They were randomly divided into a modified gastric tube group (n=108) and a gastric tube group (n=113). There were 67 males and 41 females at age of 63.50±6.75 years (ranged 47-73 years) in the modified gastric tube group, including 62 cases of middle esophageal cancer and 46 cases of lower esophageal cancer. There were 69 males and 44 females at age of 63.38±7.21 years (ranged 49 to 76 years) in the gastric tube group, including 68 cases of middle esophageal cancer and 45 cases of lower esophageal cancer. The results of surgery and morbidities were recorded. The respiratory functions were recorded at 3 days before surgery, 1 week and 4 weeks after surgery, respectively. ResultsAll surgeries were successfully performed in two groups. There was 1 case of death and 1 case of anastomotic leakage in the gastric tube group. There was no death or anastomotic leakage occurred in the modified gastric tube group. There was statistical difference in the operation time between the modified gastric tube group and the gastric tube group (150.65±11.88 min vs. 174.58±11.99 min, P<0.05). There were no statistical differences in the amount of bleeding during operation or the length of hospital stay between two groups (P>0.05). There were no statistical differences in respiratory function between two groups at 1 week or 4 weeks after surgery (P>0.05). ConclusionFor patients with mid- and lower-thoracic esophageal cancer, modified gastric tube has a good clinical application value compared with gastric tube. It is easy and safe, and can decrease the operation time without aggravation of pulmonary function after operation. It is a better esophagus reconstruction method in esophagectomy for mid- and lower-thoracic esophageal cancer in primary hospitals.