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Objective:To investigate the effect of continuous intracranial pressure (ICP) and brain oxygen partial pressure (PbtO 2) monitoring and guiding treatment after the application of standard large bone flap decompression and microhematoma removal in patients with severe traumatic brain injury (TBI). Methods:A retrospective analysis was done of 41 patients with TBI in Department of Neurosurgery in the Inner Mongolia People's Hospital from January 2018 to May 2020. Patients with Glasgow coma scale (GCS)<8 points were treatesd with microscopical removal of hematoma and contusion brain tissue and standard large bone flap decompression. Intraoperative intracranial pressure and brain tissue oxygen partial pressure monitoring probes were placed. Postoperatively, continuous intracranial pressure monitoring and partial oxygen pressure monitoring of brain tissue were performed, and target-based treatment under ICP and PbtO 2 monitoring was performed. According to the Glasgow Outcome (GOS) score after six months, patients were divided into a good outcome group (4-5 scores) and a poor outcome group (1-3 scores). There were 26 cases in good prognosis group and 15 cases in poor prognosis group. Linear regression analysis was used to further evaluate the relationship between PbtO 2, ICP and GOS score. The measurement data of normal distribution were compared by independent sample t-test. The counting data were expressed in cases (%), and the comparison between groups was adopted χ 2 inspection. The general linear bivariate Pearson correlation test was used. Results:The mean value of PbtO 2 (17.42±5.34) mmHg in the poor prognosis group was lower than that in the good prognosis group (24.65±5.61) mmHg, with statistical significance ( t=4.04, P<0.001). The mean value of ICP (22.32±3.45) mmHg in the poor prognosis group was higher than that (17.32±3.23) mmHg in the good prognosis group, with statistical significance ( t=4.15, P<0.001). Using PbtO 2 and ICP as independent variables and GOS score after 6 months as dependent variable, a regression equation was established ( Y=4.040 X+7.497; Y=-2.549 X+28.63). The mean value of PbtO 2 was positively correlated with GOS scores after 6 months in patients with severe head injury ( r=0.75, P<0.001). The mean value of ICP was negatively correlated with the prognosis of patients with severe head injury ( r=-0.87, P<0.001). Conclusion:The treatment guided by ICP combined with PbtO 2 monitoring is valuable in improving the prognosis of patients with severe traumatic brain injury after standard decompressive craniectomy, and may improve the prognosis 6 months after the injury.
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OBJECTIVES@#To evaluate the accuracy and safety of measurements of transcutaneous carbon dioxide partial pressure (TcPCO@*METHODS@#A total of 45 very low birth weight infants were enrolled. TcPCO@*RESULTS@#There was no significant difference in TcPCO@*CONCLUSIONS@#Lower electrode temperatures (38-41℃) can accurately measure blood carbon dioxide partial pressure in very low birth weight infants, and thus can be used to replace the electrode temperature of 42°C. Transcutaneous measurements at the lower electrode temperatures may be helpful for understanding the changing trend of blood oxygen partial pressure.
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Humans , Infant , Infant, Newborn , Blood Gas Monitoring, Transcutaneous , Carbon Dioxide , Electrodes , Infant, Very Low Birth Weight , Oxygen , Partial Pressure , TemperatureABSTRACT
【Objective】 To explore the protective effects of hemoglobin base on oxygen carries (HBOCs) with different oxygen affinity on isolated rat hearts. 【Methods】 Using Langendorff isolated heart perfusion model, 45 adult male SD rats (SPF grade), perfused with 30 min KH solution baseline, were randomly divided into sham operation group and control group: St. Thomas (STS) solution perfusion volume was 3mL/100g body weight; high P50 HBOCs group: [STS + high P50 HBOCs (P50=35.0 mmHg, 2.5 mg/100 g) product] perfusion volume was 3mL/100g body weight; medium P50 HBOCs group: [STS + medium P50HBOCs (P50=26.5.0 mmHg, 2.5 mg/100 g) product] perfusion volume was 3 mL/100 g body weight; low P50 HBOCs group: [STS + low P50 HBOCs (P50=11.0 mmHg, 2.5 mg/100 g) product] perfusion volume was 3mL/100g body weight, and the heart was arrested and placed in a 37℃ water bath to make the heart ischemic for 35 minutes, and then reperfused for 2 hours. The left ventricular development pressure (LVDevP), left ventricular end diastolic pressure (LVEDP), the rate of change of left ventricular pressure (LVPCR) and heart rate (HR) in the rat heart during reperfusion were observed and recorded. 1 min perfusion fluid from each rat in the basic and reperfusion phase was taken, and blood gas analyzer was used to measure the blood gas indexes of rats, and the myocardial injury marker enzymes [cardiac enzyme creatine kinase (CK-MB), lactate dehydrogenase (LDH) and the release of α-hydroxybutyrate dehydrogenase (α-HBDH)] were measured by ELISA kit. 【Results】 The cardiac function and the release of myocardial enzymes in the 5 groups of rats in the basal cardiac perfusion stage were similar (P>0.05). However, in the reperfusion stage, except for the insignificant changes in HR (P>0.05), the heart LVDevP (mmHg) of the three P50 HBOCs groups and the control group were 10.69±3.65 vs 8.50±2.88, 23.26 ±5.62 vs 8.50±2.88, 35.60±3.82 vs 8.50±2.88, LVEDP (mmHg) were 43.34±8.08 vs 54.64±7.42, 39.43±8.30 vs 54.64±7.42, 31.46±4.11 vs 54.64±7.42, dp/dt were 12.09±9.96 vs 6.09±0.98, 25.65±8.87 vs 6.08±0.98, 35.32±9.33 vs 6.09±0.98, -dp/dt were 17.53±11.28 vs 11.39±2.16, 28.80±13.70 vs 11.39±2.16, 43.36±3.83 vs 11.39±2.16, respectively (all P<0.05); the rebound situation and the release of CK-MB, LDH, and α-HBDH in the three P50 HBOCs groups were better than those in the control group (P<0.05). Among the three P50HBOCs products, the low P50HBOCs group had the best cardiac function indexes. The myocardial enzyme indexes of the high, medium and low HBOCs groups were CK-MB (ng/mL): 110.47±4.04, 90.2±2.46, 77.1±3.51; LDH (U/L): 162.23±7.71, 135.13±23.69, 92.20±4.21; a-HBDH (U/L): 228.00±8.03, 172.30±8.99, 131.00±2.02. 【Conclusion】 STS solution containing HBOCs products can improve the function of the reperfused heart at normal temperature ischemia for 35 min and 2 h reperfusion, and reduce heart damage. The STS solution containing low P50 HBOCs has the most obvious protective effect in rat isolated heart perfusion.
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BACKGROUND: Although blood donation by healthy people can relieve the urgent need of clinical blood to some extent, it is impossible to fundamentally solve the problem of blood shortage and blood safety by relying solely on blood donation by healthy people. OBJECTIVE: In combination with the significance of the development of biological oxygen-carrying therapeutics, to expound the unique characteristics of biological oxygen-carrying therapeutics, and to summarize the research status and application progress of biological oxygen-carrying therapeutics in recent years, in order to provide a certain theoretical basis for further research on the role and clinical application of biological oxygen carrying therapeutic agents. METHODS: The authors searched the relevant articles published from January 2015 to August 2019 in the databases of CNKI, Wanfang and PubMed. The keywords were “blood substitute, hemoglobin oxygen carrier, artificial blood, oxygen-carrying therapeutic agent” in English and Chinese. Types of search literature included original research and reviews. Initially 418 articles were included, and finally 46 eligible articles were classified and reviewed. RESULTS AND CONCLUSION: The biological oxygen-carrying therapeutic agent has a good clinical effect. It can maintain blood osmotic pressure, acid-base balance and blood volume, and also has good oxygen-carrying capacity. It can deliver oxygen to local hypoxic tissue for a long time. It is also easy to store and transport. Biological oxygen-carrying therapeutic agents have been widely used in surgery, which are of great help to expand blood volume and accelerate postoperative recovery. Therefore, the development of biological oxygen-carrying therapeutic agents is of great significance for surgical trauma and resuscitation, hemorrhagic shock, malignant anemia, myocardial infarction and other diseases. It shows a good clinical application prospect.
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RESUMEN La afinidad de la hemoglobina (Hb) por oxigeno (O2) es un factor importante que influye en el transporte de este gas, especialmente en hipoxia y en diferentes enfermedades como anemia o fibrosis quística. En la medición de la afinidad se usa la determinación de la curva de disociación Hb:O2. El método presentado para establecer la curva de disociación Hb:O2 (CDO) simplifica los protocolos normalmente utilizados, ya que elimina el requerimiento del equipo específico para equilibrar la sangre con oxígeno en niveles fijos de presión parcial (PO2). Mediante el uso de ecuaciones matemáticas es posible establecer la cinética de saturación de la hemoglobina (SO2) a valores crecientes de PO2. De igual forma, mediante el método se determinan aspectos típicos de la unión Hb: O2 como la dependencia del pH (coeficiente de Bohr) y el tipo de asociación de la proteína con su ligando mediante el diagrama de Hill. En virtud de la simplificación realizada, el método es aplicable en prácticas de laboratorio en población humana y animal, así como en la investigación de diferentes condiciones experimentales.
ABSTRACT The affinity of hemoglobin (Hb) for oxygen (O2) is an important factor influencing the transport of this gas especially in hypoxia and in different diseases such as anemia or cystic fibrosis. By the affinity measurement, the determination of the Hb: O2 dissociation curve is used. The presented method to establish the Hb: O2 oxygen dissociation curve (CDO) simplifies the protocols normally used, since it eliminates the requirement of specific equipment to equilibrate blood with oxygen at fixed levels of oxygen pressure (PO2). By using mathematical equations, it is possible to establish the saturation change of hemoglobin (SO2) at increasing oxygen partial pressure. Similarly, the method determines typical aspects of the Hb: O2 binding as the pH dependence (Bohr coefficient) and the association type of protein with its ligand by the Hill diagram. By this simplification, the method is applicable in laboratory practices in human and animal population, as well as in the investigation of different experimental conditions.
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Objective To summarize the experience of perioperative treatment of lung transplantation for end-stage lung disease. Methods Perioperative clinical data of 7 recipients undergoing lung transplantation were retrospectively analyzed, including 3 cases with bilateral lung transplantation and 4 cases with unilateral lung transplantation. The perioperative status and clinical prognosis of lung transplantation recipients were observed. Results The operation time of 7 lung transplantation recipients was (344±133) min. Cold ischemia time was (236±74) min in 4 cases of single-lung transplantation and (480±120) min in 3 cases of bilateral-lung transplantation. The length of Intensive care unit(ICU) stay was 21 (13-25) d and the length of hospital stay was 101 (64-117) d. In the first 3 d after surgery, the daily fluid output was significantly larger than the fluid input (all P < 0.05). The arterial oxygen partial pressure (PaO2) of lung transplantation recipients in the first 3 d after surgery was significantly elevated than preoperative level (all P < 0.05), whereas the arterial carbon dioxide pressure (PaCO2) did not significantly change (all P > 0.05). All recipients had pulmonary bacterial infection after lung transplantation, including 3 cases complicated with fungal infection. One recipient underwent exploratory thoracotomy for hemostasis due to active thoracic bleeding after operation, 1 recipient suffered from primary graft dysfunction (PGD) and 4 recipients received secondary endotracheal intubation. Two cases died after operation, 1 case died of septicemia caused by multidrug-resistant acinetobacter baumannii, the other case died of rejection reaction after self-terminating use of immunosuppressive agents. The remaining 5 cases were successfully discharged and recovered well. The longest survival period was 3.1 years. Conclusions In the perioperative management of lung transplantation, it has great significance to hold the surgical indications, monitor and manage postoperative refined fluid and hemodynamics, implement the strategy of protective pulmonary ventilation, and early diagnose and treat severe postoperative complications for the recipients of lung transplantation to safety through the perioperative period.
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Objectives@#Study on the accuracy and influencing factors of neonatal intensive care unit (NICU) critically ill newborns different body parts monitoring by percutaneous oxygen partial pressure (TcpO2) and carbon dioxide partial pressure (TcpCO2), in order to provide a basis for non-invasive monitoring of critically ill newborns in ICU.@*Methods@#60 cases of critically ill newborns requiring blood gas analysis were selected as research cases during July 2017 to March 2018 in Wuxi City Maternity and Child Hospital Neonatology. According to the randomized control principle, three groups were divided, chest group (20 cases), abdomen group (20 cases), leg group (20 cases). The chest group placed the electrodes of the transcutaneous gas analyzer on newborns′ anterior chest. The abdomen group placed the electrodes on newborns′ abdomen. And the leg group placed the electrodes on the inner thigh. PaO2 and PaCO2 values were collected from the blood gas results of critically ill newborns. TcpO2 and TcpCO2 values were recorded. And at the same time, the electrode shedding situation was observed as well. Compare transcutaneous data and arterial blood data, and do analysis.@*Result@#The chest group TcpO2 (69.05±9.17) mmHg(1 mmHg=0.133 kPa), TcpCO2 (46.9±10.57) mmHg, PaO2 (76.4±8.64) mmHg, PaCO2 (40.65±4.74) mmHg, the PaO2 and PaCO2 values were obviously different from the blood gas analysis results (t=-2.608, 2.413, P<0.05). The abdomen group and the leg group had no significant differences (P>0.05) . And the electrode sheet shedding rate was 30% in the chest group, 25% in the abdomen group, and 10% in the leg group, the three groups had no significant differences (χ2=2.553, P>0.05) .@*Conclusion@#NICU critically ill newborns thigh skin monitoring by percutaneous oxygen partial pressure and carbon dioxide partial pressure has high accuracy, and the electrode sheet shedding rate is relatively low. Therefore, it is a safe and effective clinical monitoring method, of great significance for monitoring changes in the condition of critically ill newborns.
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Objective@#To investigate the influence of N-acetylcysteine on forced expiratory volume in one second(FEV1), vital capacity(VC), diffusion capacity of lung carbon monoxide(DLCO), arterial oxygen partial pressure(PaO2) in patients with chronic obstructive pulmonary disease(COPD) and pulmonary interstitial fibrosis.@*Methods@#From January 2015 to July 2017, 140 COPD patients complicated with pulmonary interstitial fibrosis in the People's Hospital of Shanxi Province were chosen as study objects, and they were divided into control group and research group according to the digital table, with 70 cases in each group.The control group was treated with routine treatment, while the research group was treated with N-acetylcysteine.After treatment, the treatment effects, VC, FEV1, PaO2, DLCO, TGF-β and VEGF between the two groups were compared.@*Results@#The total effective rate of the research group was 82.86%(58/70), which of the control group was 58.57%(41/70), the difference was statistically significant (χ2=9.968, P<0.05). Before treatment, the pulmonary function between the two groups had no statistically significant difference(t=0.082, 0.028, 0.421, 0.155, all P>0.05). After treatment, the FEV1[(59.03±15.02)% vs.(53.35±13.71)%], VC[(69.95±11.83)% vs.(65.21±11.65)%], DLCO[(68.92±11.56)% vs.(64.01±11.34)%] and PaO2[(68.79±5.38)mmHg vs.(62.37±6.14)mmHg]of the research group were higher than those of the control group, the differences were statistically significant (t=2.337, 2.389, 2.537, 6.580, all P<0.05). Before treatment, the TGF-β and VEGF levels between the two groups had no statistically significant differences(t=1.230, 0.016, all P>0.05). After treatment, the VEGF[(0.32±0.04)ng/L vs.(0.44±0.05)ng/L] and TGF-β[(271.16±35.21)ng/L vs.(345.13±39.08)ng/L] levels of the research group were lower than those of the control group, the differences were statistically significant (t=11.765, 15.680, all P<0.05). There was no statistically significant difference in the incidence rate of adverse reactions between the two groups(1.43% vs 4.28%, χ2=2.323, P>0.05).@*Conclusion@#Large dose of N-acetylcysteine can effectively improve the TGF-β and VEGF levels of COPD patients complicated with pulmonary interstitial fibrosis, and promote its pulmonary function, with good safety.
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Objective To explore the value of percutaneous oxygen partial pressure monitoring in prognosis evaluation of patients with acute heart failure (AHF). Methods A total of 91 patients with AHF due to various reasons admitted to the emergency department of the First Affiliated Hospital of China Medical University from July 2017 to June 2018 were enrolled. Dynamic monitoring data of arterial blood gas, percutaneous oxygen partial pressure monitoring and noninvasive cardiac output monitoring (NICOM) of all of the patients at the time of diagnosis (before treatment) and 6 hours after treatment were recorded, including arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), blood lactic acid (Lac), percutaneous oxygen partial pressure (TcPO2), percutaneous carbon dioxide partial pressure (TcPCO2), cardiac output (CO) and stroke volume (SV). The 10-minute oxygen challenge test value (OCT), oxygen and carbon dioxide offsets were calculated. The patients were divided into survival group and non-survival group according to 28-day survival situation, and the differences in above parameters were compared between the two groups. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of percutaneous partial oxygen pressure monitoring for the prognosis of patients with AHF. Results All the 91 patients were enrolled in the analysis, among whom 26 died on 28 days and 65 survived, with a mortality of 28.6%. Before treatment, 10-minute OCT in the non-survival group was significantly lower than that in the survival group [mmHg (1 mmHg = 0.133 kPa):41.0±3.9 vs. 45.6±3.2, P < 0.01], and the carbon dioxide offset was significantly higher than that in the survival group [(0.51±0.11)% vs. (0.37±0.11)%, P < 0.01]. However, there was no statistically significant difference in PaO2, PaCO2, TcPO2, TcPCO2, oxygen offset, CO, SV or Lac between the two groups. After 6 hours of treatment, TcPCO2, oxygen offset and carbon dioxide offset in the non-survival group were significantly higher than those in the survival group [TcPCO2 (mmHg): 36.0±2.8 vs. 33.2±2.8, oxygen offset: (0.25±0.05)% vs. (0.22±0.06)%, carbon dioxide offset: (0.29±0.12)% vs. (0.16±0.13)%, all P < 0.05], TcPO2, 10-minute OCT, CO and SV were significantly lower than those in the survival group [TcPCO2 (mmHg): 36.0±2.8 vs. 33.2±2.8, 10-minute OCT (mmHg): 49.1±4.5 vs. 53.6±5.5, CO (L/min):4.9±0.5 vs. 5.3±0.5, SV (mL): 57.8±3.5 vs. 64.4±4.8, all P < 0.01]. However, there was no statistically significant difference in PaO2, PaCO2 or Lac between the two groups. ROC curve analysis showed that the area under the ROC curve (AUC) of 10-minute OCT onset predicting the 28-day death of patients with AHF was 0.802; when the optimal cut-off value was 43.5 mmHg, the sensitivity and specificity was 77.3% and 68.0%, respectively. The AUC of carbon dioxide offset was 0.812; when the optimal cut-off value was 0.46%, the sensitivity and specificity was 86.4% and 68.0%, respectively. Conclusions Percutaneous oxygen partial pressure monitoring can be used as a reliable indicator for prognosis evaluation of patients with AHF. Increased carbon dioxide offset and decreased 10-minute OCT suggest poor prognosis, and the prognosis of patients with AHF should be evaluated by dynamic monitoring.
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Objectives Study on the accuracy and influencing factors of neonatal intensive care unit (NICU) critically ill newborns different body parts monitoring by percutaneous oxygen partial pressure (TcpO2) and carbon dioxide partial pressure (TcpCO2), in order to provide a basis for non-invasive monitoring of critically ill newborns in ICU. Methods 60 cases of critically ill newborns requiring blood gas analysis were selected as research cases during July 2017 to March 2018 in Wuxi City Maternity and Child Hospital Neonatology. According to the randomized control principle, three groups were divided, chest group (20 cases), abdomen group (20 cases), leg group (20 cases). The chest group placed the electrodes of the transcutaneous gas analyzer on newborns′anterior chest. The abdomen group placed the electrodes on newborns′ abdomen. And the leg group placed the electrodes on the inner thigh. PaO2 and PaCO2 values were collected from the blood gas results of critically ill newborns. TcpO2 and TcpCO2 values were recorded. And at the same time, the electrode shedding situation was observed as well. Compare transcutaneous data and arterial blood data, and do analysis. Result The chest group TcpO2(69.05 ± 9.17)mmHg(1 mmHg=0.133 kPa), TcpCO2( 46.9±10.57)mmHg, PaO(276.4±8.64)mmHg, PaCO(240.65± 4.74)mmHg, the PaO2 and PaCO2 values were obviously different from the blood gas analysis results (t=-2.608, 2.413, P<0.05). The abdomen group and the leg group had no significant differences(P>0.05). And the electrode sheet shedding rate was 30% in the chest group, 25% in the abdomen group, and 10% in the leg group, the three groups had no significant differences(χ2=2.553,P>0.05). Conclusion NICU critically ill newborns thigh skin monitoring by percutaneous oxygen partial pressure and carbon dioxide partial pressure has high accuracy, and the electrode sheet shedding rate is relatively low. Therefore, it is a safe and effective clinical monitoring method, of great significance for monitoring changes in the condition of critically ill newborns.
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Objective To measure the oxygen partial pressure (PtO2) within a situation of vacuum sealing drainage (VSD) implement, and to discuss the potential mechanism of VSD alleviating skeletal muscle ischemia reperfusion (I/R) injury in rabbits. Methods Rabbits were randomly(random number) divided into three groups: sham (n=10), I/R (n=10) and I/R+VSD (n=10) groups. In the I/R group, left hind limb ischemia was induced by clamping the femoral artery and vein for 4 h, then released for 6 h, to allow reperfusion of the limb. VSD was only performed in the I/R+VSD group during the reperfusion period. All rabbits were administered a series test of PtO2 in different time points before and after reperfusion, and the left hind limb skeletal muscle and ear vein blood samples were immediately harvested for biochemical analyses, including hypoxia inducible factor 1 alpha (HIF-1α) mRNA and protein, and lactic acid (LA). One-way analysis of variance (ANOVA), Fisher's least significant difference (LSD) test or Tamhane's T2 test was used where appropriate to analyze the experimental results. Results The levels of PtO2 in the I/R and I/R+VSD groups were decreased after ischemia, but no significant difference was noted between the two groups (t=1.322, P=0.296). The PtO2 levels in the I/R+VSD group were less increased than those in the I/R group after reperfusion (t=2.015, P=0.046). The levels of HIF-1α mRNA and protein were increased after I/R injuries (F=10.120, P=0.002; F=36.480, P<0.01; F=6.960, P=0.015, F=4.470, P=0.035), and the levels in the I/R+VSD group were greater than those in the I/R group (t=1.799, P=0.048, t=5.911, P=0.019; t=1.878, P=0.046, t=2.609, P=0.030). The LA levels were significantly increased in the skeletal muscle and blood samples in the I/R and I/R+NPWT groups compared with those in the sham group at the final stage (F=9.540, P=0.002 and F=13.750, P<0.01), but the levels in the I/R+VSD group were less than those in the I/R group (t=2.263, P=0.040 and t=3.617, P=0.027). Conclusions Our results suggested that VSD technique decreased PtO2 in regional ischemic muscles and led to increases in HIF-1α mRNA and protein that subsequent accumulation of less LA in both of regional skeletal muscle and systemic blood circulation, which provided protection effect after I/R injury in rabbits.
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Objective To study the predictive value of evaluation in oxygen partial pressure[p(O2)] and carbon dioxide partial pressure[p(CO2)] of pleural cavity to the closure of visceral pleura in primary spontaneous pneumothroax (PSP) pa-tients. Methods Seventy-six hospitalized pneumothroax patients were divided into two groups:closed pneumothroax group (n=40) and open pneumothroax group (n=36), according to the radiographic information.To collect the expiratory gas by the device which we designed and produced, to collect the gas in the pleural cavity by thoracentesis. To detect the p(O2)and p(CO2)respectively, and the blood gas analysis of radial artery was done at same time. Results There was significantly low-er value of p(O2)of the gas in the pleural cavity in patients of closed pneumothroax than that of open pneumothroax (P 0.05). There was significantly higher value of the expiratory gas/the pleural cavity gas p(O2) and a significantly lower value of p(CO2), in closed pneumothroax group than those of open pneumothroax group (P<0.05). Logistic regression analy-sis showed that values of the expiratory gas/the pleural cavity gas p(O2) and p(CO2) were the effective factors for the closure of visceral pleura. ROC curve showed that the areas under ROC curve (AUC) for the expiratory gas/the pleural cavity gas p(O2) and p(CO2) was 0.985 and 0.867, the sensitivities were 92.5% and 77.8%, the specificities were 100%and 85.0%and the reference values were 1.81 and 0.97. Conclusion To utilize the evaluation of gas partial pressure can predict whether the leakage of the visceral pleura is closed.
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Objective To investigate the clinical effect of nicorandil for treatment of patients with acute respiratory distress syndrome (ARDS).Methods A prospective randomized controlled trial was conducted. A total of 40 cases of patients with ARDS admitted to Department of Critical Care Medicine of Guizhou Provincial People's Hospital from October 2012 to October 2014 were enrolled, and they were randomly divided into two groups, 20 cases in each group. The two groups were treated with routine western medicine after admission. On this basis, the observation group was given nicorandil 10 mg, while the control group was given warm boiled water 10 mL, through gastric tubes 3 times a day, the therapeutic course being consecutive 5 days in both groups. The length of stay in intensive care unit (ICU), duration of mechanical ventilation after treatment, oxygenation index (OI), alveolo-arterial oxygen partial pressure difference (PA-aO2), positive end-expiratory pressure (PEEP), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, Glasgow coma score (GCS) before and after treatment, the predicted death rate (PDR) and 28-day mortality were compared between the two groups. The predicitive factors for 28-day mortality were screened by binary logistic analysis.Results The length of stay in ICU and duration of mechanical ventilation of control group were longer than those of observation group, but the difference was not statistically significant [ICU length of stay (day): 14.55±12.71 vs. 9.15±6.00, duration of mechanical ventilation (day): 13.25±12.27 vs. 7.75±5.32, bothP > 0.05]. After treatment, the GCS was higher than that before treatment in control group and observation group (11.95±3.98 vs. 10.75±4.89, 12.95±3.67 vs. 12.20±4.56), while APACHE Ⅱ score, PDR and PEEP were all lower than those before treatment [APACHE Ⅱ: 21.05±8.58 vs. 24.90±5.63, 18.70±11.21 vs. 26.65±7.67; PDR: (47.71±29.49)% vs. (61.00±23.29)%, (36.79±18.49)% vs. (56.12±18.16)%; PEEP (cmH2O, 1 cmH2O = 0.098 kPa): 4.40±3.14 vs. 5.75±2.59, 3.80±2.55 vs. 7.55±3.32], but there were no statistically significant differences between the two groups before and after treatment (allP > 0.05). After treatment, the OI was significantly higher and the PA-aO2 was significantly lower than those before treatment in the two groups, and the degrees of improvement of the observation group were more remarkable than those of the control group [OI (mmHg, 1 mmHg = 0.133 kPa): 224.72±85.12 vs. 141.37±45.82, PA-aO2 (mmHg): 132.60±46.64 vs. 204.30±121.2, bothP 0.05). Binary logistic regression analyses showed that the PA-aO2 [odds ratio (OR) = 0.958,P = 0.013, 95% confidence interval (95%CI) = 0.927 - 0.991], APACHE Ⅱ score (OR = 0.882,P = 0.010, 95CI = 0.803 - 0.970), GCS (OR = 1.399, P = 0.004, 95%CI = 1.111 - 1.761) and PDR (OR = 0.907,P = 0.002, 95%CI = 0.853 - 0.965) after treatment were the independent predictors of 28-day mortality.Conclusion Nicorandil can significantly improve oxygenation, but cannot reduce 28-day mortality in patients with ARDS.
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Objective To observe the characteristics of changes in tissue oxygen partial pressure in Zusanli (ST36) acupoint and related organs in acute respiratory distress syndrome (ARDS), and to clarify the correlation between oxygenation of local tissue and systemic oxygenation and the correlation between oxygen metabolism of acupoint tissues and related organ tissues.Methods Twenty healthy New Zealand white rabbits were selected and divided into an ARDS model group and a control group, according to random number table method, 10 in each group. Oleic acid (0.08 - 0.1 mL/kg) intravenous injection was used to replicate the ARDS animal model. Only tracheotomy, mechanical ventilation, insertion of arterial/venous catheter, etc other manipulations were conducted, and no oleic acid was injected in the control group. Tissue oximeter was used to determine the fraction of inspired oxygen (FiO2), when FiO2 was 0.21 and 1.00 respectively, the tissue oxygen partial pressure (PtO2) in Zusanli acupoint, stomach and liver was measured. Meanwhile, the blood gas analyses of arterial blood and mixed venous blood were carried out to calculate the oxygen extraction rate (O2ER).Results When FiO2 was equal to 0.21, the levels of PtO2 in Zusanli acupoint, stomach and liver of the ARDS model group were significantly higher than those of the control group in the same period; the partial pressure of oxygen arterial blood (PaO2), partial pressure of oxygen in mixed venous blood (PvO2), arterial oxygen saturation (SaO2), mixed venous oxygen saturation (SvO2) and O2ER of the ARDS model group were significantly lower than those of the control group over the same period. When FiO2 was equal to 1.00, PtO2, PaO2, SaO2 and O2ER in Zusanli acupoint, stomach and liver were increased compared with those when FiO2 was 0.21 in both groups, and the increase of PtO2 and O2ER in Zusanli acupoint, stomach and liver was more significant in the ARDS model group [PtO2 (kPa): Zusanli acupoint: 16.75±2.12 vs. 13.80±1.83, stomach: 16.45±1.33 vs. 13.35±1.25, liver: 16.43±1.45 vs. 13.45±1.36, O2ER: (36.14±0.97)% vs. (30.81±1.01)%]; the increase of PaO2, SaO2 and SvO2 was more significant in the control group [PaO2 (mmHg, 1 mmHg = 0.133 kPa): 682.02±50.32 vs. 159.32±40.17, SaO2: 1.00±0.00 vs. 0.98±0.01, SvO2: 0.69±0.01 vs. 0.63±0.03, allP < 0.05]. The indexes under FiO2 0.21 compared to those under FiO2 1.00 in the same group, it was shown that when FiO2 1.00, PvO2 was increased in the ARDS model group, but decreased in the control group, the difference between the two groups being statistically significant (mmHg: 36.00±2.83 vs. 42.50±1.70,P < 0.05). Besides, PtO2 in Zusanli acupoint was positively correlated to that in stomach (r = 0.963,P < 0.001).Conclusions When ARDS is under the condition of systemic oxygen delivery disorder, the demand of organ tissues for oxygen is significantly increased, but the oxygen utilization is impaired obviously, which is possibly related to the cellular mitochondrial dysfunction. There is good correlation between the tissue oxygen partial pressure of acupoint tissue and related organ tissue. The detection of oxygen in acupoint tissue has important guidance significance for monitoring the oxygen metabolism of related organ tissues.
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Objective To observe the effect of nasal continuous positive airway pressure (nCPAP) and Biphase positive airway pressure (BIPAP) on the oxygen exchange indexes in newborns with mild to moderate neonatal respiratory distress syndrome (NRDS).Methods After infusion of pulmonary suffactant into lung bilaterally,116 cases with mild to moderate NRDS were treated with nCPAP(nCPAP group,n =75) and BIPAP(BIPAP group,n =41) respectively.Oxygen exchange indexes including arterial partial pressure of oxygen [pa (O2)],modified oxygenation index (P/F),alveolar-arterial oxygen tension difference (A-aDO2),respiratory index (RI),artery/alveolar oxygen partial pressure ratio[pa (O2)/pA (O2)] and pulmonary shunt fraction (Qs/Qt) were measured or calculated at 0 (before treatment),2,8 and 24 h after being treated with nCPAP or BIPAP.Results Six different oxygen exchange indexes of Pa (O2),P/F,A-aDO2,RI,pa (O2)/pA(O2) and Qs/Qt in both groups didn't show statistical significance at 0 hour:pa(O2) (kPa) (6.1 ±0.6 vs 6.1 ±0.6,t =0.11,P ＞0.05),P/F(kPa) (15.59 ± 1.45 vs 15.71 ± 1.45,t =1.59,P ＞ 0.05),A-aDO2(kPa)(6.04 ±0.64 vs 6.24 ±0.69,t =1.59,P ＞0.05),RI(6.0 ± 1.0 vs 6.2 ± 1.1,t =1.35,P ＞ 0.05),p,(O2)/pA(O2) (0.24 ±0.02 vs 0.25 ±0.03,t =1.63,P ＞0.05)and Qs/Qt(％)(11.9±1.6 vs 11.6 ± 1.6,t =1.10,P ＞ 0.05).A-aDO2,RI,pa (O2)/pA (O2) and Qs/Qt of BIPAP group had more improvement than those of nCPAP at 2 and 24 h,and oxygen exchange indexes at 2 h of BIPAP group and those of nCPAP group were:A-aDO2 (kPa) (3.83 ±0.49 vs 4.24 ± 0.67,t =18.26,P ＜ 0.05),RI(2.7 ± 0.5 vs 3.3 ±0.7,t =20.59,P ＜ 0.05),p,(O2)/pA(O2) (0.35 ±0.03 vs 0.32 ±0.04,t =15.35,P ＜0.05) and Qs/Qt(％) (8.8 ± 1.6 vs 9.8 ±2.0,t =7.68,P ＜ 0.05) ; 24 h indexes in BIPAP group and the indexes of nCPAP group were:A-aDO2 (kPa) (2.29 ± 1.19 vs 3.07 ± 1.67,t=18.43,P ＜0.05),RI(1.4 ±1.4 vs 2.3 ± 1.6,t=25.02,P ＜0.05),pa(O2)/pA(O2) (0.49 ±0.10 vs 0.42 ±0.11,t =14.96,P ＜0.05) and Qs/Qt(％) (6.5 ±3.0 vs 8.5 ±4.4,t =9.59,P ＜0.05).pa(O2) and P/F of both groups didn't show statistical difference significantly [Pa (O2)(kPa) (12.6 ± 1.0 vs 12.7 ± 1.0,t =3.76,P ＞ 0.05),P/F(28.49 ± 3.17 vs 31.85 ± 2.85,t =3.76.P ＞ 0.05)].Nineteen cases in nCPAP group needed invasive mechanical ventilation,and only 3 cases in BIPAP group underwent the procedure;there was a significant difference (x2 =4.01,P ＜ 0.05).Oxygen exchange indexes in both groups were gradually improved from 2 h,8 h to 24 h,but 22 deteriorated cases showed no improvement,who underwent invasive ventilation.Positive end-expiratory pressure (PEEP) positive airway pressure (EPAP) was (0.42 ± 0.19) kPa in BIPAP group,and (0.56 ± 0.23) kPa in nCPAP group (t =3.45,P ＜ 0.01).Conclusions 1.BIPAP and nCPAP can improve the ability of oxygen exchange in newborns with mild to moderate NRDS,but BIPAP is more effective than nCPAP,which can shorten the possibility of invasive ventilation and reduce the PEEP level.2.p,(O2),P/F,pa (O2)/pA (O2) and RI may be more suitable for evaluating oxygen exchange for neonatal NRDS.
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BACKGROUND: Negative-pressure wound therapy (NPWT) is believed to accelerate wound healing by altering wound microvascular blood flow. Although many studies using laser Doppler have found that NPWT increases perfusion, recent work using other modalities has demonstrated that perfusion is reduced. The purpose of this study was to investigate the influence of NPWT on tissue oxygenation of the foot, which is the most sensitive region of the body to ischemia. METHODS: Transcutaneous partial pressure of oxygen (TcpO2) was used to determine perfusion beneath NPWT dressings of 10 healthy feet. The sensor was placed on the tarso-metatarsal area of the foot and the NPWT dressing was placed above the sensor. TcpO2 was measured until it reached a steady plateau state. The readings obtained at the suction-on period were compared with the initial baseline (pre-suction) readings. RESULTS: TcpO2 decreased significantly immediately after applying NPWT, but gradually increased over time until reaching a steady plateau state. The decrease in TcpO2 from baseline to the steady state was 2.9 to 13.9 mm Hg (mean, 9.3+/-3.6 mm Hg; 13.5+/-5.8%; P<0.01). All feet reached a plateau within 20 to 65 minutes after suction was applied. CONCLUSIONS: NPWT significantly decrease tissue oxygenation of the foot by 2.9 to 13.9 mm Hg. NPWT should be used with caution on feet that do not have adequate tissue oxygenation for wound healing.
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Bandages , Blood Gas Monitoring, Transcutaneous , Foot , Ischemia , Negative-Pressure Wound Therapy , Oxygen , Partial Pressure , Perfusion , Reading , Suction , Wound Healing , Wounds and InjuriesABSTRACT
ObjectiveTo investigate the effect of vacuum sealing drainage (VSD) with different negative pressures on variation of oxygen partial pressure (PtO2 ) and wound healing in the rabbits.MethodsTwelve rabbit wound models were made and randomly (random number) divided into two groups, namely vacuum group ( n =6 )in which rabbits were treated with VSD by different negative pressures ( - 75 mmHg,- 125 mmHg,- 225 mmHg and - 350 mmHg) for 7 days, and routine treatment group ( n =6). At each interval of measurement, variation of PtO2 was measured by oxygen partial pressure admeasuring device, and area of VSD dressing and surface of wound were measured by vernier caliper, and growth of anaerobic bacteria was detected by bacterial culture, and morphological change and the course of wound healing were observed under by light microscope after HE tissue staining. Meanwhile anther two groups (n =6, in each) were set for comparing, including normal group, sham operation group. ResultsAverage PtO2 value of vacuum group was in the range of ( 1.87 +0. 19) kPa to ( 1.54 ±0. 21 ) kPa which was decreased gradually in 7 days under different negative pressures. Average PtO2 value of routine treatment group and normal group were ( 2. 82 ± 0. 37 ) kPa and ( 5.79 + 0. 50 ) kPa, respectively which weresignificant higher than that in vacuum group ( P ＜ 0. 01 ). PtO2 was fell to 80. 94％ of its original value after VSD for 5 seconds, and continued the downward trend with the increasing of negative pressure at the same interval of measuring. Area of VSD dressing significantly decreased to 65. 36％ of its original area after VDS for5 minutes (P＜0.01). Surface of wound was minimized to 62. 82％ of its original area after VSD for 7 days ( P ＜ 0. 01 ), and variations of those in - 350 mmHg group were significant greater than those in other groups ( P ＜ 0. 01 ). There was no evidence of anaerobic bacteria growth in vacuum group during this experiment. ConclusionsPtO2 could be down-regulated by VSD significantly without growth of anaerobic bacteria, and minimization of VSD dressing at - 350 mmHg was significantly helpful to reduce the area of wound for promoting the healing.
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Objective To observe changes of the partial oxygen pressure in the deep tissues along the Large Intestine Meridian (LIM) during acupuncture stimulation,so as to reveal the characteristics of energy metabolism in the tissues along the LIM. Methods Thirty-one healthy volunteer subjects were enlisted in the present study. Partial oxygen pressure (POP) in the tissues (at a depth of about 1.5 cm) of acupoints Binao (LI 14),Shouwuli (LI 13),Shousanli (LI 10),2 non-acupoints [the midpoints between Quchi (LI 11) and LI 14,and between Yangxi (LI 5) and LI 11) of the LIM,and 10 non-meridian points,1.5-2.0 cm lateral and medial to each of the tested points of the LIM was detected before,during and after electroacupuncture (EA) stimulation of Hegu (LI 4) by using a tissue oxygen tension needle-like sensor. Results In normal condition,the POP values in the deep tissues along the LIM were significantly higher than those of the non-meridian control points on its bilateral sides. During and after EA of Hegu (LI 4),the POP levels decreased significantly in the deep tissues along the LIM in comparison with pre-EA (P0.05). Conclusion POP is significantly higher in the deep tissues along the LIM of healthy subjects under normal conditions,which can be downregulated by EA of Hegu (LI 4),suggesting an increase of both the utilization rate of oxygen and energy metabolism after EA.
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The effects of oxygen partial pressure on cryopreservation of the cells with organ preservation solution were explored. Hypoxic UW solution was made by purging the UW solution with argon. The pig proximal tubule epithelial cells (LLC-PK1 cells) were cryopreserved in hypoxic UW solution (Ar-UW group) or standard UW solution (UW group) at 4℃ for 48 h. Trypan blue staining and LDH detection were performed to evaluate the injury of the cells. The results showed that the oxygen partial pressure in Ar-UW group was significantly declined from 242±6 mmHg to 83±10 mmHg. After cryopreservation at 4℃ for 48 h, LDH leakage rate and Trypan blue-stained rate in Ar-UW group were (11.3±3.4)% and (10.5±4.7)%, respectively, which were significantly lower than in UW group [(49.5±6.9)% and (47.6±9.3)% respectively, both P＜0.01]. It was concluded that lower oxygen partial pressure of UW solution was more beneficial to the cryopreservation of LLC.
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In order to explore the method to prepare hypoxia UW solution and the stability and preservation of hypoxia UW solution, UW solution was purged by argon or air for 15 min or 60 at a flow rate of 0.8 or 2 L/min, and the oxygen partial pressure of UW solution was detected. The hy-poxia UW solution was exposed to the air or sealed up to preserve by using different methods, and the changes of oxygen partial pressure was tested. The results showed that oxygen partial pressure of 50 mL UW solution, purged by argon for 15 min at a flow rate of 2 L/min, was declined from 242±6 mmHg to 83±10 mmHg. After exposure to the air, oxygen partial pressure of hypoxia UW solution was gradually increased to 160±7 mmHg at 48 h. After sealed up by the centrifuge tube and plastic bad filled with argon, oxygen partial pressure of hypoxia UW solution was stable, about 88±13 mmHg at 72 h. It was concluded that oxygen of UW solution could be purged by argon efficiently. Sealed up by the centrifuge tube and plastic bag filled with argon, oxygen partial pressure of UW so- lution could be stabilized.