【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.
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.
ObjectiveTo investigate the clinical features and relationship of anthracosis and bronchial anthracofibrosis (BAF).MethodsA retrospective study among 591 patients who did bronchoscopy in this hospital from January 2016 to December 2018 was performed. Of them, 71 patients had anthracosis, including 39 BAF. Their clinical data, bronchoscopic results, CT scan and pulmonary function tests were analyzed and compared.ResultsThe prevalence of anthracosis was 12.0% (71/591), while 54.9% (39/71) of anthrocosis were BAF. BAF patients shared features of old age (77.0±10.4), female domination (59.0%), low smoking ratio (25.6%) and high prevalence of tuberculosis (41.0%). Upper lobe bronchi and right lobe bronchus were the predominant sites of involvement. Right lobe bronchus was the most common site of stenosis or occlusion in BAF. According to CT scan, 69.0% of all anthrocasis cases had enlarged or calcificated lymph node in mediastinal or hilar positions. Paratracheal, parahilar, subcarinal lymph nodes were most frequently involved. Compared BAF with non-BAF patients, BAF patients had significantly more cough and expectoration. There was no statistical differences in age, sex, smoking history, infection with tuberculosis, the distribution of anthracosis and abnormal lymph nodes. Though only 26 of 71 patients performed respiratory function tests, there were significantly more cases of obstructive ventilation function disturbance in BAF than in non-BAF patients.ConclusionsAnthracosis occurs at regular locations in lung, usually accompanied with abnormal mediastinal/hilar lymph nodes and associated with tuberculosis. BAF might be a more severe type of anthracosis.
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.
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.
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 systematically review respiratory muscle training (RMT) on respiratory functions of patients with spinal cord injury (SCI). Methods PubMed, EMbase and The Cochrane Library were electronically searched to collect the randomized controlled trials (RCTs) about RMT on pulmonary functions in patients with SCI from inception to April, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 11 RCTs involving 263 patients were included. The results of meta-analysis showed that, compared with conventional rehabilitation group, RMT effectively improved vital capacity (MD=0.41, 95%CI 0.12 to 0.69, P=0.005), inspiratory capacity (MD=0.35, 95%CI 0.05 to 0.65, P=0.02), maximal inspiratory pressure (MD=7.75, 95%CI 0.11 to 15.39, P=0.05) and maximal voluntary ventilation (MD=17.52, 95%CI 8.11 to 26.93, P=0.000 3). There were significant differences between two groups. Conclusion Current evidence shows that RMT can effectively improve the respiratory function of patients with SCI. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
Objectives To explore the efficacy of humidified and heated high flow oxygen therapy for the critically ill patients in intensive care unit (ICU) after extubation. Methods From January 2014 to December 2016, 487 patients were enrolled. Patients were allocated to two treatment groups randomly, which were humidified and heated high flow oxygen therapy group (236 patients, HFM group, aged 55.3±21.1 years old) and routine oxygen therapy group (251 patients, TO group, aged 58.4±19.3 years old). Blood oxygen saturation, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), fraction of inspired oxygen (FiO2), respiratory frequency, incidence rate of reintubation, ventilator-free days, ICU length of stay, and hospital stay were assessed and compared between the HFM group and the TO group. Results The hospital stay was similar in two groups. There were more ventilator-free days in the HFM group (P<0.05), fewer patients required reintubation (4.2%vs. 10.4%, P<0.05) and less ICU length of stay [(10.5±6.1) dvs. (14.3±8.5) d, P<0.05]. PaO2/FiO2 of the HFM group were better than the TO group after extubation at 2 h, 4 h, 8 h, 24 h, and 48 h (P<0.05). There were no statistically significant differences in respiratory frequency and PaCO2. Conclusions Humidified and heated high flow oxygen therapy can supply a better oxygenation for patients after extubation in ICU. It could be a common therapy in ICU for the critically patients after extubation.