The expression of bone morphogenetic protein 4 and its effects in ischemia-anoxemia induced white matter injury model / 中国小儿急救医学

Objective To investigate the ultrastructural alteration in brain tissues as well as the expression of bone morphogenetic protein(BMP) 4 and its effects on regulating myelination in the process of white matter injury development.Methods A total of 152 Sprague-Dawley newborn rats(3 days old) were randomly divided into white matter injury group(n=76) or control group(n=76).The white matter injury model was established by ligation of the right common carotid artery and hypoxic exposure(8% O2 and 92%N2),and samples were collected at 3d,7d,14d and 21d after operation.Morphological changes of the brain tissues were observed under a light microscope,while myelination was analyzed using a transmission electron microscope.The expression and location of BMP4 and myelin basic protein(MBP),a marker for myelination,was detected by immunohistochemistry staining,expression levels of BMP4 and MBP proteins were analyzed by Western blotting,and BMP4 mRNA expression was measured by real-time PCR.Results Observed under the light microscope,the cellular structure was clear,fibers arranged closely and orderly in the white matter of the control group.Whereas in the white matter injury group,sparse cells,loose mesh shaped white matter,and disorderly oriented fibers were observed.In the control group,myelin sheath had regular morphology,uniform density,and same thickness,observed using the transmission electron microscope.While in the white matter injury group,the myelin sheath was loosened,thinned,lamellar separated,and boundary obscured.Using immunohistochemistry staining,Western blot,and real-time PCR analyses,it was found that the protein and mRNA expression of BMP4 had no significant change with the increase of age in the control group,while it was rapidly increased with the extending of ischemic time in the white matter injury group.Comparing with the control group,the expression of BMP4 was significantly increased since 3d after operation in the white matter injury group(P<0.05),and the difference between two groups became more significant with the extending of ischemic time.The expression of MBP protein was analyzed by immunohistochemistry staining and Western blot,and a gradual increase was found in both groups with the increase of age.However,the expression of MBP protein was significantly decreased on 14d and 21d after operation in the white matter injury group compared with the control group(P<0.05).Conclusion Myelination disorders exists in white matter injury induced by ischemia-anoxemia.Meanwhile,the expression of BMP4 is significantly increased in the white matter injury group,indicating a possibility that BMP4 involves in the regulation of myelination disorders in white matter injury.

Helmet delivered continuous positive airway pressure for hypoxemia treatment in airway extubated patients after cardiac surgery / 中华胸心血管外科杂志

Objective To evaluate the efficacy and safety of helmet delivered continuous positive airway pressure (Helmet-CPAP)for hypoxemia in airway extubated patients after cardiac surgery.Methods 120 adult patients in ICU from March 2014 to July 2015,who were after cardiac surgery,were enrolled.These patients who suffered hypoxemia within 48 hours after extubation,defined as that PaO2/FiO2 with oxygen mask could not reach 200,were divided into two groups.In the control group high concentration oxygen therapy with mask was delivered,while helmet-CPAP was delivered in the experimental group.Treatment duration was 6 hours.Results Helmet-CPAP significantly improved PaO2/FiO2 (144.35 ± 24.43 vs.201.35 ± 52.97,P ＜ 0.05) and left ventricular ejection fractions(0.5383 ± 0.0844 vs.0.5540 ± 0.0844,P ＜ 0.05).Breathing rate (22.60±5.08 vs.18.53 ±4.13,P＜0.05),heart rate(102.72±17.9 vs.95.15 ±13.79,P＜0.05)and shock index (0.85 ± 0.35 vs.0.75 ± 0.15,P ＜ 0.05) were significantly lower.The rate of using mechanical ventilation (6.67％ vs.28.33％,P ＜ 0.05) and length of ICU stay[41.0(25.0,67.5) hours vs.49.5 (32.5,90.8) hours,P ＜ 0.05] was significantly less than control group.Conclusion Helmet delivered continuous positive airway pressure is an effective and safe treatment for hypoxemia in airway extubated patients after cardiac surgery.

Exploración neuropsicológica en un caso de sufrimiento fetal agudo: diagnóstico e intervención / Neuropsychological exploration in a acute fetal distress case: diagnosis and intervention

En el presente artículo se muestran los resultados del proceso de corrección de una niña de edad escolar que presento sufrimiento fetal agudo a los 6 meses de gestación. Se describe el proceso de evaluación y la interpretación de los resultados a la luz de la teoría neuropsicológica de Luria y la psicología histórico-cultural de Vigotsky. Se presenta la propuesta de un programa de corrección neuropsicológica, el cual tiene como objetivo lograr un mejor funcionamiento de los mecanismos de regulación y control y de análisis y síntesis espacial simultanea. Finalmente, se exponen y contrastan los resultados de la evaluación aplicada después del programa de corrección con el estado inicial de la menor...

The present article shows the correction process result of a girl in school age who presents acute fetal distress at six month of gestation. Describes the evaluation process and the result of the interpretation at the neuropsychology theory light of Luria and Vigotsky Historic-Cultural psychology. Present the proposal of a Neuropsychological correction program, which has as objective achieved a better regulation and control and analysis and simultaneous spatial synthesis mechanism operation. Finally, exposed and contrasts evaluation results applied after the correction program with the initial state of the minor...

Influence of noninvasive mechanical ventilation therapy on BNP and prognosis in patients with AAMI complicated hypoxemia / 心血管康复医学杂志

Objective:To study dynamic change of brain natriuretic peptide (BNP),left ventricular ejection fraction (LVEF)and prognosis improvement in patients with acute anterior myocardial infarction (AAMI)complicated hy-poxemia after noninvasive mechanical ventilation therapy.Methods:A total of 60 patients with AAMI complicated hypoxemia,who were hospitalized in our hospital from Mar 2011 to Oct 2013,were divided into noninvasive venti-lation group (n=28)and routine treatment group (n=32)according to number table.Dynamic change of BNP, LVEF and prognosis were observed and compared between two groups.Results:After treatment,BNP level and LVEF significantly improved in both groups (P<0.05 all),compared with routine treatment group,there was more significant reduction in BNP level [24h:(263.6±23.3)μmol/L vs.(126.2±21.9)μmol/L]and significant rise in LVEF [(40.6±13.1)% vs.(47.3±14.7)%]in noninvasive ventilation group after treatment (P<0.01 both);af-ter 30d follow-up,there were significant rise in 6min walking distance (percentage of 426~550m,59.3% vs. 75.0%),LVEF [(41.1±11.7)% vs.(49.4±12.5)%]and survival rate (90.6% vs.96.4%),and significant re-duction in rehospitalization rate (12.5% vs.7.1%)in noninvasive ventilation group,P<0.01 all.Conclusion:Ear-ly noninvasive mechanical ventilation therapy can significantly improve cardiac function,exercise tolerance and short-term prognosis in patients with acute anterior myocardial infarction complicated hypoxemia.

Acute type A aortic dissection preoperative hypoxemia clinical analysis / 中华胸心血管外科杂志

ObjectiveAnalyze preoperative clinical relevanted factors of acute type A aortic dissection with hypoxemia according to a group clinical data.MethodsFrom January 2011 to June 2011,we have collected 54 preoperative cases of acute type A aortic dissection,including 42 males,12 females,aged 28-73 years old,onset to treatment time is 0.4-14.0 days.General information:age,gender,time of onset,body mass index,hypertension,diabetes mellitus,smoking,drinking,heart ejection fraction,prothrombin time,quantitative fibrinogen,fibrinogen degradation products,D-dimer,C-reactive protein,procalcitonin,ICU time,length of hospital stay.According to the blood gas analysis of quiet state case without oxygen,with PaO2 ＜ ( 100-age ×0.33 ±5) mm Hg is for the hypoxemia group,equal or higher than this is no-hypoxemia group.ResultsNo-hypoxemia group has 14 cases,11 males,3 females,average aged (51.14 ± 14.24) years old,including 12 operation patients ( no death) and 2 no-operation patients(2 cases death).Hypoxemia group has 40 cases,31 males,9 females,average aged (50.53 ± 9.73 ) years old,including 33 operation patients(2 cases death) and 7 no-operation patients(7 cases death).There is no significant difference in age,gender,time of onset,hypertension,diabetes mellitus,smoking,drinking,cardiac ejection fraction,prothrombin time and fibrinogen.There is statistically significant on body mass index,fibrinogen degradation products,D-dimer,C-reactive protein,procalcitonin,ICU time and length of hospital stay time ( P ＜ 0.05 ).ConclusionPreoperative hypoxemia with acute type A aortic dissection is associated with obesity,excessive inflammation and activation of coagulation and fibrinclytic system,and hypoxemia may prolong the time of operative patients with acute type A aortic dissection in ICU and hospital.

The approach to the initial diagnosis of pulmonary embolism / 中国医师进修杂志

ObjectiveTo seek the approach to the initial diagnosis of pulmonary embolism through analysis and conclusion of the clinical features of pulmonary embolism.MethodsThe high risk factors,clinical manifestation and results of common auxiliary examinations of 23 patients with pulmonary embolism were analyzed retrospectively.ResultsThere were 91.30％(21/23)patients with high risk factors.The common symptoms were dyspnea (91.30％,21/23) and chest tightness (69.57％,16/23 ),while the triad of pulmonary embolism merely accounted for 13.04％ (3/23).And other symptoms included palpitation,chest pain,hemoptysis and syncope,etc.Blood gas analysis indicated that there were hypoxemia and hypocarbia.The positive rate of D-dimer was 91.30％ (21/23).The abnormal rate of electrocardiogram was 91.30％( 21/23 ) and the abnormal rate of echocardiography was 86.96％(20/23).ConclusionAppropriate approach to the initial prognosis can help to establish the diagnosis of patients with suspected pulmonary embolism as early as possible,as well as differentiate other cardiopulmonary diseases.

Effects of pulmonary resection on perioperative right ventricular function / 中华胸心血管外科杂志

Objective To investigate the changes of perioperative right ventricular function after pulmonary resction. Methods 45 cases of pulmonary resection were divided into four groups.Group Ⅰwas wedge resection(n = 10), GroupⅡ was lobectomy(n = 19), Group Ⅲ was double lobectomy(n=7)and Group Ⅳ was pneumonectomy(n=9). The changes of CVP, PAMP, PEP/ET, Sa, VTIs, RVSP, Ea/Aa, and Tel were evaluated by traditional ultrasonic and tissue Doppler ultrasonic techniques at different time inter- vals (pre-operation, 5-7 days orland 1 month post-operation), Results Compared with the pre-operation CVP, the indexes of all groups have no significant changes post-operatively. Wedge resection didn' t obviously influence right cardiac after load and systolic function/diastolic function. No evidet changes detected in Tei pre-and post-operatively. However, the indexes (PAMP, RVSP and PEP/ET ratio) reflecting right cardiac afterload evidently increased at post-pneumonectomy or lobectomy group5- 7 days post-opera- tive. All these reflect the decrease of Tei, which was more obvious in pneumonectomy than in lobectomy group. Right cardiac after- load, systolic/diastolic function and Tel index recovered to pre-operative level 1 month post-operation in single lobectomy group. But the above indicators, especially the Tel, were still high in double lobectomy and pmeunonectomy groups 1 morth post-operation.Tei index is positively correlated with PAMP and is weakly correlated with PET/ET ratio and Ea/Aa ratio. Conclusion Pulmonary wedge resection doesn't evidently influence right cardiac function. However, right cardiac diastolic function evidently decreases temporarily at lobectomy group. The systolic function and diastolic funetions decrease after double-lobectomy and pneumonectomy and it's more evident in pneumonectomy group. Though the right cardiac afterloads of lobectomy, double lobectomy and pneumonectomy groupa all increase significantly post-operativlye, only the former recover to pre-operative level 1 month after surgery.

Aplicação da ventilação não-invasiva em insuficiência respiratória aguda após cirurgia cardiovascular / Application of noninvasive ventilation in acute respiratory failure after cardiovascular surgery

OBJETIVOS: Verificar as respostas ventilatória, de oxigenação e hemodinâmica de pacientes com insuficiência respiratória aguda (IResp) hipoxêmica submetidos a aplicação de ventilação mecânica não-invasiva (VMNI) no pós-operatório de cirurgia cardiovascular, buscando variáveis preditoras de sucesso, e comparar as diferentes modalidades de VMNI. MÉTODOS: No total, 70 pacientes com IResp hipoxêmica foram randomizados em uma das três modalidades de VMNI: pressão positiva contínua em vias aéreas (CPAP) e ventilação com dois níveis pressóricos (PEEP + PS e BiPAP®). Foram analisadas variáveis ventilatórias, de oxigenação e hemodinâmicas nos períodos pré-aplicação, 3, 6 e 12 horas após iniciado o protocolo. RESULTADOS: Foram excluídos 13 pacientes. Dos pacientes restantes, 31 evoluíram para independência do suporte ventilatório, constituindo o grupo sucesso, e 26 necessitaram de intubação orotraqueal, sendo considerados insucesso. Idade e níveis iniciais de freqüência cardíaca (FC) e de freqüência respiratória (FR) apresentaram valores elevados no grupo insucesso (p = 0,042, 0,029 e 0,002, respectivamente). O grupo insucesso apresentou maior número de intercorrências intra-operatórias (p = 0,025). As variáveis de oxigenação elevaram-se somente no grupo sucesso. Dentre as modalidades de VMNI, evoluíram como sucesso 57,9 por cento dos pacientes no grupo ventilador, 57,9 por cento no bi-nível e 47,3 por cento no CPAP. Variáveis de oxigenação e FR apresentaram melhora somente nos grupos com dois níveis pressóricos. CONCLUSÃO: Pacientes com IResp hipoxêmica no pós-operatório de cirurgia cardiovascular apresentaram melhora da oxigenação, da FR e da FC durante a aplicação de VMNI. Em pacientes mais idosos e com valores iniciais de FR e de FC mais elevados, a VMNI não foi suficiente para reverter o quadro de IResp. Modalidades com dois níveis pressóricos apresentaram resultados superiores.

OBJECTIVE: To examine ventilatory response, oxygenation-related, and hemodynamics of patients with hypoxemic acute respiratory failure (ARF) submitted to noninvasive mechanical ventilation (NIV) during the postoperative phase of cardiovascular surgery in order to identify predictive variables of success, and to compare the different types of NIV. METHODS: Seventy patients with hypoxemic ARF were randomized to one of three modalities of NIV - continuous positive airway pressure (CPAP) and ventilation with two pressure levels (PEEP + SP and BiPAP®). Ventilation, oxygenation-related, and hemodynamics variables were analyzed at pre-application, and 3, 6, and 12 hours after the protocol began. RESULTS: Thirteen patients were excluded. Thirty-one patients progressed to independence from ventilatory support and comprised the success group, and 26 required orotracheal intubation and were considered the nonsuccess group. Age, initial heart rate (HR), and respiratory rate (RR) showed elevated levels in the nonsuccess group (p=0.042, 0.029, and 0.002, respectively). A greater number of intraoperative complications were seen in the nonsuccess group (p=0.025). Oxygenation variables increased only in the success group. Among the NIV types, 57.9 percent of patients in the ventilator group, 57.9 percent in the two-pressure levels group, and 47.3 percent in the CPAP group progressed with success. Oxygenation and RR variables showed improvement only in the groups with two pressure levels. CONCLUSION: Patients with hypoxemic ARF in the postoperative stage after cardiovascular surgery showed better oxygenation, RR, and HR during NIV application. In older patients and those with higher baseline RR and HR values, NIV was not sufficient to reverse ARF. The two-pressure level modes showed better results.

Fisiopatología de la hipertensión asociada al síndrome de apnea obstructiva del sueño: Evidencia de estudios clínicos y modelos animales de hipoxia crónica intermitente / Pathophysiology of obstructive sleep apnea-associated hypertension

There is a well established relationship between the obstructive sleep apnea syndrome and hypertension. Current evidence suggests that the increase in arterial pressure is secondary to an enhanced sympathetic tone through peripheral chemoreflexes triggered by intermittent hypoxic stimulation of the carotid bodies. Chronic intermittent hypoxia would activate renal and systemic vasoactive systems through potentiated hypoxic chemoreflexes. These early changes in autonomic tone can be detected through cardiovascular variability and baroreflex sensitivity analysis. Both are relatively simple and noninvasive techniques. The multiplicity of pathogenic mechanisms in obstructive sleep apnea-associated hypertension emphasizes the need of increasing diagnostic sensitivity to detect and correct this common condition, which significantly increases cardiovascular risk.

Influência do sistema de fornecimento de oxigênio na qualidade de vida de pacientes com hipoxemia crônica / Influence of the oxygen delivery system on the quality of life of patients with chronic hypoxemia

OBJETIVO: Avaliar a qualidade de vida relacionada à saúde de pacientes com doença obstrutiva crônica das vias aéreas recebendo oxigenoterapia domiciliar prolongada (ODP) por meio de cilindros de oxigênio e comparar estes resultados com os obtidos após seis meses de modificação do sistema de fornecimento para concentradores de oxigênio. MÉTODOS: Um total de 45 pacientes, 24 com hipoxemia crônica e 21 sem evidências de hipoxemia, foram avaliados. Os pacientes com hipoxemia crônica estavam recebendo ODP regularmente durante pelo menos os últimos seis meses e foram avaliados no momento basal, em uso de cilindro, e após seis meses de transição para concentradores. Os pacientes não hipoxêmicos foram avaliados no mesmo intervalo de tempo que os pacientes hipoxêmicos. Para avaliar a qualidade de vida foi utilizada a versão validada para língua portuguesa (Brasil) do Questionário Respiratório Saint George (Saint George's Respiratory Questionnaire - SGRQ). RESULTADOS: No momento inicial, os pacientes hipoxêmicos apresentaram maior comprometimento da qualidade de vida, avaliada pelo escore total e pelos escores dos domínios sintomas e impacto do SGRQ, que os pacientes não hipoxêmicos. Após seis meses, houve melhora significativa da qualidade de vida dos pacientes hipoxêmicos e, neste momento, não foi encontrada diferença entre os pacientes com e sem hipoxemia. CONCLUSÃO: Nossos achados mostraram que os pacientes com doença obstrutiva crônica das vias aéreas e hipoxemia crônica apresentam prejuízo da qualidade de vida, que essa qualidade de vida pode ser melhorada com o uso regular de ODP e que o sistema de fornecimento de oxigênio tem influência nessa melhora.

OBJECTIVE: To evaluate the health-related quality of life of patients with chronic obstructive pulmonary disease receiving long-term oxygen therapy (LTOT) at home through oxygen cylinders and compare these results with those obtained six months after the transition from oxygen cylinders to oxygen concentrators. METHODS: A total of 45 patients were evaluated. Of those, 24 had chronic hypoxemia and 21 presented no evidence of hypoxemia. The patients with chronic hypoxemia had been regularly receiving LTOT for at least the last six months and were evaluated at baseline, while using cylinders, and six months after the transition from cylinders to concentrators. The non-hypoxemic patients were evaluated at the same time points as were the hypoxemic patients. In order to evaluate quality of life, a version of the Saint George's Respiratory Questionnaire (SGRQ), translated and validated for use in Brazil, was administered. RESULTS: At baseline, quality of life, as evaluated using the total score and the symptom and impact domain scores of the SGRQ, was more impaired in the hypoxemic patients than in the non-hypoxemic patients. After six months of using the concentrators, the hypoxemic patients presented a significant improvement in the quality of life, and, at that time, no difference was found between the patients with and without hypoxemia. CONCLUSION: Our findings show that quality of life is impaired in patients with chronic obstructive pulmonary disease and chronic hypoxemia, that their quality of life can be improved through regular use of LTOT, and that the oxygen delivery system has an influence on this improvement.

The expressions of ICAM-1 and VCAM-1 in HIE neonatal rabbits / 重庆医科大学学报

Objective:Searching after the effects of the expressions the neonatal rabbits with chronic intrauterine anoxemia give to neutrophil and conglutinated molecule.Method:Choosing 15 Zelanian rabbits that have been in afternoon pregnancy,we divide them into three stochastic contratest groups by chance:the control group,the anoxic group and the group interfered with Chinese traditional medicine.Then,we contrast the expressions and changes of these groups with CD11b/CD18,ICAM-1 and VCAM-1.Results:Contrasting the CD11b/CD18,ICAM-1 and VCAM-1 of the anoxic group and the group interfered with Chinese traditional medicine with chinese traditional medicine with the control group,we have found their expressions all more remarkably strengthened;There is some difference in expression between the anoxic group and the group interfered with Chinese traditional medicine,but it has little statistical significance.Conclusion:In this article,there occurs the mention:the chemotaxis of neutrophil has been strengthened and the endotheliocytosis of cerebrovascular has been conglutinated under anoxemia;as a result,the chemotaxis and endotheliocytosis have marred the brain cell tissue and participated in whole pathological and physiological process.

Ventilação de alta freqüência por oscilação comparada a ventilação mecânica convencional associada a reposição de surfactante em coelhos / High frequency oscillation ventilation compared to conventional mechanical ventilation plus exogenous surfactant replacement in rabbits

Objetivos: a) avaliar o efeito na oxigenação e ventilação de coelhos artificialmente depletados de surfactante quando submetidos à ventilação mecânica convencional associada à reposição parcial de surfactante exógeno; b) comparar a evolução deste grupo com outro grupo submetido à ventilação de alta freqüência por oscilação (HFO) sem reposição associada de surfactante. Métodos: Vinte coelhos brancos da raça New Zealand, peso de + 3 kg, foram anestesiados e artificialmente induzidos à depleção de surfactante endógeno através de sucessivas lavagens pulmonares com alíquotas (25 ml/kg) de solução fisiológica, até atingir uma PaO2 menor que 100 mmHg, quando ventilados via traqueostomia no modo de pressão controlada objetivando um volume corrente de 10ml/kg, com PEEP de 5cm H2O, FiO2 de 100%, freqüência respiratória de 30 mpm, e tempo inspiratório de 0,65 s. Posteriormente, os coelhos foram divididos em (a) grupo CMV+S, submetido à ventilação convencional associada com reposição parcial de surfactante exógeno; (b) grupo HFO submetido à ventilação de alta freqüência por oscilação. Gasometrias arteriais foram coletadas antes da lavagem pulmonar, após a lavagem pulmonar, 15, 60 e 120 minutos após iniciado o tratamento. Os grupos foram comparados utilizando-se o teste t de Student. Resultados: Em ambos grupos a PaO2 (pós lavagem pulmonar) era inferior a 50mmHg (p=0,154), subindo aos15 minutos de tratamento para 254 mmHg (CMV+S) e 288 mmHg (HFO, p=0,626). Aos 60 e 120 minutos, a PaO2 foi maior (p=0,001) no grupo HFO (431 e 431 mmHg) quando comparado com o grupo CMV+S, que apresentou queda progressiva (148 e 126 mmHg). Aos 60 minutos a PaCO2 era significativamente menor no grupo do CMV+S (29 versus 41 mmHg). Conclusões: Em modelo animal com SARA a estratégia de ventilação protetora como a HFO, isoladamente, promove uma rápida e persistente melhora na oxigenação, inclusive, com níveis superiores aos obtidos pelos animais submetidos à ventilação mecânica convencional associada à reposição de surfactante.

Objectives: (a) to evaluate the effect on oxygenation and ventilation of rabbits with induced surfactant depletion when they are submitted to a conventional mechanical ventilation, plus a small dose of exogenous surfactant; (b) to compare this group with another group submitted to a High Frequency Oscillation (HFO) without exogenous surfactant administration. Methods: Twenty New Zealand White rabbits weighing (+ 3 kg) were anaesthetized and artificially induced to a endogenous surfactant depletion by successively lung lavage with normal saline (aliquots of 25 ml/kg) until to reach a persistent PaO2 less than 100 mmHg when submitted to a mechanical ventilation in a pressure control mode with a target tidal volume of 10ml/kg, PEEP of 5cm H2O, FiO2 1.0, respiratory rate 30/min, and inspiratory time of 0.65 s. Then the rabbits were divided in (a) CMV+S group, submitted to a conventional mechanical ventilation plus exogenous surfactant replacement; (b) HFO group, submitted to a High Frequency Oscillation Ventilation. Arterial blood gases were measured at control period, post lung lavage, 15, 16 and 120 minutes after treatment started. The groups were compared using Student t test. Results: The post lung lavage PaO2 in both groups was lower than 50mmHg (p=0.154), increasing after 15 min of treatment to 254 mmHg (CMV+S) and 288 mmHg (HFO, p=0.626). The PaO2 at 60 and 120 minutes were higher (p=0.001) in the HFO group (431 e 431 mmHg) when compared with the CMV+S group, which showed a progressive fall (148 e 126 mmHg). At 60 minutes of treatment, the PaCO2 was lower (p=0.008) in the CMV+S group (29 versus 41 mmHg). Conclusions: In ARDS animal model a protect mechanical ventilation strategy as HFO by itself promotes a fast and persistent increase in the oxygenation, with superior levels than those observed in animals treated with conventional mechanical ventilation plus exogenous surfactant replacement.

Anestesia regional y saturación de oxígeno posoperatorio en el paciente geriátrico / It anesthetizes regional and saturation of oxygen posoperatorio in the patient geriatric

Numerosos estudios plantean la necesidad de suministrar oxígeno suplementario a pacientes geriátricos en el período posoperatorio (PO), después de anestesia regional como profilaxis de hipoxemia. Teniendo en cuenta lo anterior, se decidió comprobar cómo se comporta la saturación de oxígeno (STO2) en el PO en los pacientes geriátricos que se asistieron con el uso de esta técnica. Previa autorización del consejo científico se seleccionaron al azar 50 pacientes ASA I-II-II (F = 30, K = 20) intervenidos de hemiabdomen inferior y miembros inferiores. Preoperatoriamente se registraron variables demográficas, antecedentes patológicos personales (APP) y (STO2). Se realizó anestesia subaracnoidea (SA) o peridural (PE). En el PO se realizaron 6 mediciones de la STO2 (cada 10 min durante 1 h) a la salida del salón de operaciones. Se procesaron estadísticamente los resultados (comparación de medias). Edad promedio 76 ± 6 años, anestesia PE 20, SA 30, Hb media 10,5 g/L STO2 preoperatorio 94 por ciento ± 1,5. Mediciones en el PO 1ra. 95 por ciento ± 1,8; 2da. 94 por ciento ± 1,3; 3ra. 93 por ciento ± 2,1; 4ta. 95 por ciento ± 1,9; 5ta. 94 por ciento ± 1,5; 6ta. 93 por ciento ± 1,7. No se hallaron diferencias estadísticamente significativas entre estas mediciones, ni en relación con la SOT2 preoperatorias con el uso de esta técnica anestésica en la población geriátrica(AU)

Many studies state the need to administer supplementary oxygen to elderly patients in the postoperative period (POP) after regional anesthesia as a prophylaxis of hipoxemia. Bearing in mind the above mentioned, we decided to confirm the behaviour of oxygen saturation (O2S) in the POP of these aged patients that were assisted with this technique. Having cosulted the Scientifc Council, we proceed to a random selection of 50 ASA I-II-III patients (F = 30, K = 20) that underwent an operation of inferior hemiabdomen and lower limbs. Demographic variables, personal pathologic histories (PPH) and 02S were obtained before the operation. Subarachnoid (SA) or peridural (PE) anesthesia was administered. 6 measurements of O2S were made (every 10 min. during l hour) on leaving the operating room.The results were statistically processed (comparison of means). Average age was 76 ± 6 years, PE 20 , SA 30, mean Hb 10.5 g/L, preoperative O2S 94 percent ± 1.5. The following measurements were made during the POP: lst, 95 percent ± 1.8; 2nd, 94 percent ± l.3; 3rd, 93 percent ± 2.1; 4th, 95 percent ± 1.9; 5th, 94 percent ± l.5; 6th, 93 percent ± l.7(AU)

Hyperoxia solution improves oxygenation in patients with hypoxemia after orthotopic liver transplantation / 解放军医学杂志

Objective Post-operative hypoxemia occurred frequently after extubation in patients who underwent orthotopic liver transplantation (OLT) in ICU. This study is to investigate the efficiency of hyperoxia solution in improving oxygenation. Methods Ten OLT cases, who post-operatively manifested hypoxemia after extubation, were enrolled in this study. Hyperoxia Ringer's solution (500ml) prepared by Jing-Shu-Yang (an apparatus of oxygen supply, Vanform Co., Shandong) was infused at a rate of 200ml/hr. Hemodynamic parameters, blood gas, and blood lactate were determined at the beginning, end of infusion, and 1 hour after the infusion, with recording of the following data: heart rate (HR), mean arterial pressure (MAP), pulmonary arterial pressure (PAP), and pulmonary capillaries wedged pressure (PCWP). Results Compared with the levels at the beginning of infusion, SpO2 and SvO2 increased significantly at the end of the infusion of 500 ml hyperoxia Ringer's solution, and they returned to the baselines 1 hour later, although regular Ringer′s solution was coutinuously given by the same infusion rate. HR, MAP and PCWP were kept stable with the solution infusion. Notably, PAP was decreased markedly at the end of infusion, and blood lactate level remained unchanged after the intervention. Conclusion Hyperoxia Ringer's solution infusion improved oxygenation in OLT patients who suffered from acute lung injury with hypoxemia postoperatively. PAP decreased markedly as hypoxemia was corrected.

Central executive dysfunction in patients with obstructive sleep apnea syndrome: an event-related potential topographic study / 中华神经科杂志

Objective To evaluate the early effect of hypoxemia on central executive function of working memory.Methods 24 patients with obstructive sleep apnea syndrome (OSAS) and 20 healthy matching controls were studied in probe retrieval task.Results In control group,both the low and high conflict identification tasks elicited the N270 component with right prefrontal [F4,(2.2?2.7) ?V]and posterior [P3,(7.0?3.0) ?V; P4,(6.9 ? 3.1) ?V] distribution. N430 was elicited in high conflict condition with right hemispheric lateralization. The positive component,P300( 300～400 ms) distributed remarkably at parietal scalp[P3,(7.0?3.0) ?V; P4,(6.9?3.1) ?V]was elicited only in identity identification task. The N270 was significantly decreased in the frontal regions in mild OSAS patients [F4,(5.0 ? 4.5) ?V]; F3,(6.0?4.5) ?V] in comparison with the controls( P

Clinical study on the effect of different antalgic modes on postoperative arterial oxygenation in elderly patients / 中华老年医学杂志

Objective To observe the degree of arterial oxygenation and the incidence of hypoxaemia by different antalgic modes in elderly patients postoperatively, and to investigate the way of prophylaxis and treatment. Methods Sixty elderly patients by different postoperative antalgic modes were randomly divided into three groups with 20 in each: patient-controlled epidural analgesia group, continuously intravenous infusion analgesia group and intramuscular injection analgesia group. The oxygen saturation was monitored during 24 hours and the arterial blood gases were measured immediately before and 4, 24 and 48 hour after operation. Results The rates of hypoxaemia occurring once or more in patient-controlled epidural analgesia group, continuously intravenous infusion analgesia group and intramuscular injection analgesia group were 21%, 36% and 32% respectively . There were no significant differences in PaO 2 (arterial PO 2) and PaCO 2 (arterial PCO 2) between postoperative 48 hour and immediately before operation in patient-controlled epidural analgesia group. PaO 2 and PaCO 2 at 4 and 24 hour after operation were significantly lower than those immediately before operation, and all were over 70 mmHg. Conclusions Patient-controlled epidural analgesia may improve the degree of arterial oxygenation and lower the incidence of hypoxaemia after operation in elderly patients.

Effects of chronic cigarette smoking on hypoxic pulmonary vasoconstriction in rats——role of prostaglandins and leukotrienes / 中国病理生理杂志

Investigation of the roles of prostaglandins(PGs) and leukotrienes(LTs) inthe changes of hemodynamics and hypoxic pulmonary vasoconstriction(HPV) induced bychronic cigarette smoking in Wistar rats.After exposure to either smoke or room air, rats were anesthetized, the changes ofhemodynamics and hypoxic pulmonary vasoconstriction were measured. Blood samplesdrawn through the carotid arterial cannula were analyzed with radioimmunoassay(RIA)for PGs and bioassay for LTs in plasma. The results showed that cigarette smoking for onemonth did not change the pulmonary arterial pressure nor the pulmonary vascularresistance(PVR) in rats, while the pressure response of pulmonary vessels to hypoxiawas reduced significantly, which could be abolished by indomethacin. Cigarette smokingcould increase the concentration of 6-Keto-PGF_1?but not that of TXB_2, in arterial plasma,during hypoxia and it reduced the plasma level of LTs as well. These results suggestedthat chronic cigarette smoking might have reduced HPV by two ways: i. e. increasing theptoduction of vasodilative PGs, especially PGI_2, and reducing LTs production duringhypoxia.

Changes of cardiac ventricles and myocardial and lymphocytic ?-adrenoceptors during and after chronic hypoxia in rabbits / 第三军医大学学报

The dynamic changes of the functions and the weight index of the 2 ventricles and the density of ?-adrenoceptors in the myocardium were observed and the correlation between the changes of ?-adrenoceptors of the myocardium and.the peripheral lymphocytes was investigated during and after intermittent chronic hypbxia in rabbits.The fingings were as follows.(1)Chronic hypoxia resulted in an increase of systolic pressure,dp/dtmas and weight index of the right ventricle.25 days after the restoration of normal oxygen supply,systolic pressure and dp/dtomas of the right ventricle became normal but its weight index remained increased.(2)The density of ?-adrenoceptors of the 2 ventricles was reduced on the 7th,15th and 30th day of hypoxia as compared with that of the control.25 days after the restoration of oxygen supply,the density of ?-adrenoceptors became normal in the left ventricle but remained decreased in the right ventricle.(3)There was a positive correlation between the changes of ?-adrenoceptors in the 2 ventricles and peripheral lymphocytes.The findings suggest that hypoxia-induced hypertrophy of the right ventricle is usually accompanied with a decreased density of its ?-adrenoceptors and thedensity of ?-adrenoceptors of peripheral lymphocytes can reflect the changes of ?-adrenoceptors in the myocardium.

Analysis to the perioperative hypoxemia of acute Stanford type A aortic dissection / 解放军医学杂志

0.05). While the significant differences existed between postoperative hypoxemia group and non-hypoxemia group (P