Objective To investigate the application of sequential noninvasive ventilation (NIV) in weaning patients off mechanical ventilation after coronary artery bypass grafting (CABG). Methods From July 2007 to July 2009, 52 patients who underwent CABG with mechanical ventilation for no less than 24 hours and P/F Ratio lower than 150 mm Hg were divided into two groups with random number table. In the sequential NIV group (SNIV group), there were 19 patients including 16 males and 3 females whose ages were 69.26±8.10 years. In the prolonged mechanical ventilation group (PMV group), there were 33 patients including 28 males and 5 females whose ages were 70.06±7.09 years. Clinical data of these two groups were compared and the influence of NIV on the circulation and respiration of the patients were observed. Results The SNIV group weaned off mechanical ventilation earlier than the PMV group (26.46±3.66 h vs. 38.65±9.12 h, P=0.013). The SNIV group held shorter total ventilation time (29.26±21.56 h vs.54.45±86.57 h,P=0.016), ICU stay time (2.44±2.99 d vs. 4.89±7.42 d, P=0.028) and postoperative hospital time (10.82±4.31 d vs. 14.01±19.30 d, P=0.039) than the PMV group. Furthermore, the SNIV group had lower pneumonia rate (5.26% vs. 30.30%, P=0.033) and total postoperative complication rate (10.53% vs.45.45%, P=0.030) than the PMV group. However, there was no significant difference (Pgt;0.05) between the two groups in the successful weaning rate, repeated tracheal intubation rate, tracheotomy rate and mortality 30 days after operation. After NIV, SNIV group had no significant change in heart rate, central vein 〖CM(1585mm〗pressure, pulmonary arterial pressure and pulmonary arterial wedge pressure than the baseline value, while systolic pressure (129.66±19.11 mm Hg vs. 119.01±20.31 mm Hg, P=0.031), cardiacindex ［3.01±0.30 L/(min.m2) vs. 2.78±0.36 L/(min.m2), P=0.043］ and P/F Ratio (205.95±27.40 mm Hg vs. 141.33±9.98 mm Hg, P=0.001) were obviously elevated. Conclusion Sequential NIV is a effective and safe method to wean CABG patients off mechanical ventilation.
Acute respiratory distress syndrome following plastic operation of the abdominal wall with the purpose to reduce over-weight of the body in 3 case was reported. They all recovered following effective and appropriate treatment. The criteria for the diagnosis of ARDS were diseussed and the method of treatment was introduced and the importance of early diagnosis was emphasized.
ObjectiveTo explore the clinical significance of prone position in the treatment of patients with acute respiratory distress syndrome (ARDS) caused by pulmonary contusion.MethodsA retrospective analysis was conducted on pulmonary contusion patients in the Intensive Care Medicine (ICU) from January 2017 to April 2021. The patients were divided into a prone position group (n=121) and a control group (n=117) after screening. The patients' basic conditions, occurrence of ARDS (P/F<150 mm Hg), changes in vital signs, laboratory examinations, lung compliance and other changes after treatment, mechanical ventilation time, staying in ICU, complications, and mortality were recorded and conpared between the two groups.ResultsWhen ARDS [oxygenation index (P/F)<150 mm Hg] occurred, compared with 1 day later, the P/F [(125.7±15.3) vs. (209.5±22.4) mm Hg , P<0.05] and lung compliance [(64.6±4.8) vs. (76.0±5.4) mL/cm H2O, P<0.05] increased in the prone position group. Compare with the control group after 1 day of treatment ARDS (P/F<150 mm Hg), P/F [(209.5±22.4) vs. (126.1±19.5) mm Hg, P<0.05] and lung compliance [(76.0±5.4) vs. (63.5±5.5) mL/cm H2O, P<0.05] increased in the prone position group (P<0.05). Compare with the control group, the prone position group had shortened mechanical ventilation time and ICU stay time, less atelectasis, lower mortality (P<0.05), lower occurrence of pneumothorax (P>0.05).ConclusionProne position treatment for patients with pulmonary contusion after ARDS (P/F<150 mm Hg) can correct hypoxemia faster, improve lung compliance, reduce atelectasis, shorten mechanical ventilation time and stay time of ICU, and reduce mortality, hence it has clinical value.
单肺通气技术( OLV) 广泛应用于开胸手术, 该技术使手术侧肺萎陷, 非手术侧单肺通气, 目的是防止手术侧肺分泌物或血液流入健侧肺, 确保气道通畅, 防止交叉感染, 避免手术侧肺膨胀, 使肺保持安静以利于手术操作, 减轻对肺实质的损伤。随着手术日益走向微创时代, 对该技术的需求大量增加。
Objective To investigate the efficacy of low-dose inhaled nitric oxide (iNO) in the treatment of severe hypoxemia after Sun’s operation. Methods The clinical data of patients undergoing Sun’s operation for acute Type A aortic dissection in our hospital from January 2020 to June 2022 were retrospectively analyzed. Patients who received conventional treatment before November 2021 were enrolled as a control group. After November 2021, iNO was used in our hospital, and the patients who received iNO as an iNO group. The preoperative clinical baseline data, perioperative clinical data and oxygenation index were compared between the two groups. Results A total of 54 patients were included in the control group, including 45 males and 9 females, with an average age of 53.0±10.9 years. A total of 27 patients were included in the iNO group, including 21 males and 6 females, with an average age of 52.0±10.6 years. The preoperative body mass index of the two groups was greater than 25 kg/m2, white blood cell count, C-reactive protein were significantly higher than normal level, but there was no statistical difference between the groups (P＞0.05). There were no statistical differences in intraoperative data between the two groups (P＞0.05). The iNO group had significantly shorter duration of mechanical ventilation, postoperative ICU stay, and postoperative hospital stay than the control group (P<0.001). After 12 h of iNO treatment, hypoxic condition improved obviously, oxygenation indices in 12 h, 24 h, 36 h,48 h, 60 h and 72 h in the iNO group were significantly higher than those in the control group (P<0.05). Conclusion The treatment of severe hypoxemia after Sun’s surgery with low-dose of iNO is safe and effective, can significantly improve oxygenation function, and has significant advantages in shortening ventilator use time, postoperative ICU stay and postoperative hospital stay, but it is not significant in changing postoperative mortality.
ObjectiveTo summarize the experience and lessons of right ventricular decompression in children with pulmonary atresia and intact ventricular septum (PA/IVS) and to reflect on the strategies of right ventricular decompression.MethodsThe clinical data of 12 children with PA/IVS who underwent right ventricular decompression in our hospital from March 2015 to December 2019 were reviewed retrospectively. There were 10 males and 2 females with a median age at the time of surgery was 5 d (range, 1-627 d). Correlation analysis between the pulmonary valve transvalvular pressure gradient and changes in Z score of tricuspid valves after decompression was performed.ResultsOne patient died of refractory hypoxemia due to circulatory shunt postoperatively and family members gave up treatment. There were 2 (16.67%) patients received postoperative intervention. The pulmonary transvalvular gradient after decompression was 31.95±21.75 mm Hg. Mild pulmonary regurgitation was found in 7 patients, moderate in 2 patients, and massive in 1 patient. The median time of mechanical ventilation was 30.50 h (range, 6.00-270.50 h), and the average duration of ICU stay was 164.06±87.74 h. The average postoperative follow-up time was 354.82±331.37 d. At the last follow-up, the average Z score of tricuspid valves was 1.32±0.71, the median pressure gradient between right ventricle and main pulmonary artery was 41.75 mm Hg (range, 21-146 mm Hg) and the average percutaneous oxygen saturation was 92.78%±3.73%. Two children underwent percutaneous balloon pulmonary valvoplasty at 6 and 10 months after surgery, respectively, with the rate of reintervention-free of 81.8%. There was no significant correlation between pulmonary transvalvular gradients after decompression and changes in Z score of tricuspid valves (r=–0.506, P=0.201).ConclusionFor children with PA/IVS, the simple pursuit of adequate decompression during right ventricular decompression may lead to severe pulmonary dysfunction, increase the risk of ineffective circular shunt, and induce refractory hypoxemia. The staged decompression can ensure the safety and effectiveness for initial surgery and reduce the risk of postoperative death.
Objective To investigate the prevalence and risk factors of isolated nocturnal oxygen desaturation (INOD) in pre-discharge inpatients with chronic obstructive pulmonary disease (COPD). Methods Totally 431 inpatients with COPD in this department were screened during January to June in 2017, in which pre-discharge inpatients without daytime hypoxia were enrolled in this study. Portable and wearable oximeter was used to record whole night oxygen saturation, pulse, hand movement of the inpatients within two days before being discharged. The clinical characters and symptoms, resting daytime artery gas analysis results, spirometry results, Epworth Sleepiness Score (ESS), Pittsburgh Sleep Quality Index (PSQI) were recorded and compared between INOD and non-INOD patients. Moreover, these data were furtherly compared between patients with or without suspected COPD-SAHS overlap syndrome (OS) to reveal the differences in clinical features. Logistics regression was used to find out independent predictors. Results One hundred and six pre-discharge inpatients without daytime hypoxia were screened out and out of them, 44 patients (41.5%) were proven with INOD. Patients with INOD presented lower daytime SaO2 [(91.8±1.1)% vs. (94.4±1.5)%, P<0.05], moreover, the patients with suspected OS had a higher yearly exacerbation frequency (2.1±0.6 per yearvs. 1.4±0.4 per year, P<0.05), higher ESS score (10.5±2.7vs. 5.1±2.5, P<0.05) and PSQI (12.8±4.4vs. 7.4±3.1, P<0.05). Conclusions Even in pre-discharge COPD inpatients without daytime hypoxia, there is 41.5% of them suffering from unrevealed INOD. Lower daytime oxygen saturation and higher ESS indicate probable INOD and with higher exacerbation risk in OS patients. To screen out INOD in pre-discharge COPD is of clinical value and in need of attention.
在过去二十年间，麻醉技术和手术技术的改进使肺部恶性肿瘤患者的手术死亡率大大降低，但术后并发症仍是主要问题。肺切除术后的常见并发症是肺部并发症[1]，主要表现是低氧血症，尤其在肺功能减退的肺切除患者中发病率更高[2]。目前国内对低氧血症的诊断缺乏统一的诊断标准，一些作者采用Russell等[3]提出的标准，吸空气氧的情况下，患者动脉血氧饱和度（SpO2）≤92%，大于30 s就可诊断为术后低氧血症。也有作者建议[4]将一次或以上血气检查PaO2lt;8 kPa或PaO2/FiO2lt;300 mm Hg（1 mm Hg=0.133 kPa）作为诊断低氧血症的标准。30%~50%的术后患者可发生低氧血症，一般认为这样的低氧血症是一过性的，对大多数患者是无害的[5]。但如果合并心脑或其他器官动脉硬化或其他原因的血管阻塞，这种低氧血症就是很危险的[6]。常见低氧血症的原因是肺萎陷不张和误吸、心源性肺水肿、静脉输入液体过量、通气血流比例失调和急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）[7]，其中ALI/ARDS是肺切除术后患者死亡的主要原因[8-10]。