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BACKGROUND: Lung protective ventilation strategies and positive endexpiratory pressure (PEEP) have been widely used as an effective ventilation pattern in clinical practice of administration of acute respiratory distress syndrome (ARDS) in recent years, but there arestill great arguments on the therapeutic effects.OBJECTIVE: To observe the changes of oxygenation index and inflammatory transmitters in peripheral blood and bronchoalveolar lavage fluid(BALF) of different lung areas [superior area of lung (upper lobe), ventral side of inferior lung (heart lobe), and dorsalis inferior lung (diaphragm lobe)] of ARDS dogs caused by pulmonary and extrapulmonary insults under lung protective ventilation treatment.DESIGN: A randomized control animal study.SETTING: Department of Respiratory Medicine, the General Hospital of Chinese PLA.MATERIALS: Twenty-four adult healthy male mongrel dogs were randomly divided into four groups with 6 dogs in each: pulmonary ARDS experimental group, pulmonary ARDS control group, extrapulmonary ARDS experimental group and extrapulmonary ARDS control group.METHODS: Models of extrapulmonary ARDS were induced by intravenous injection of oleic acid (0.1-0.15 mg/kg), and the pulmonary ARDS models were established by intratracheal administration of diocty sulfosuccinate sodium salt. After lung injury, the experimental groups received lung protective ventilation treatment (tidal volume: 8 mL/kg, PEEP: 0.981 kPa)for 3 hours, and the control groups also received ventilation of large tidal volume (tidal volume: 14-17 mL/kg, PEEP: 0 kPa).MAIN OUTCOME MEASURES: ① changes of oxygenation index in each group; ② dynamically observed the changes of the inflammatory transmitters [tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL1β) and interleukin-6 (IL-6)] in pe. Ripheral blood and BALF of different lung areas (upper lobe, heart lobe and diaphragm lobe) of ARDS dogs under lung protective ventilation treatment.RESULTS: All the 24 dogs were involved in the analysis of results. ①After lung injury, the oxygenation indexes were significantly decreased in all the groups, and the oxygenation indexes after lung protective ventilation in the experimental groups were obviously higher than those in the control groups (P ＜ 0.05). At 2 and 3 hours after lung protective ventilation, the oxygenation indexes in the extrapulmonary ARDS experimental group were markedly higher than those in the pulmonary ARDS experimental group (P＜ 0.05). ② After lung injury, the levels of the inflammatory transmitters in peripheral blood were all obviously increased in all the groups, which were decreased to different extent after the lung protective ventilation treatment,but the therapeutic effect in the pulmonary ARDS experimental group was not as good as that in the extrapulmonary ARDS experimental group. ③The levels of inflammatory transmitters in BALF of lung upper lobe and heart lobe were obviously higher in pulmonary ARDS dogs than in extrapulmonary ARDS dogs.CONCLUSION: The ameliorations of the release of inflammatory transmitters and oxygenation index at different areas are obviously different between ARDS dogs caused by pulmonary and extrapulmonary insults, and lung protective ventilation has good effect on extrapulmonary ARDS dogs,but has bad effect on pulmonary ARDS ones.
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BACKGROUND: Although pulmonary diffusion capacity (PDC) has been substantially proved in a declining tendency in age-dependent manner, the effects of such related factors as body mass,sex and height within an age range on pulmonary membrane conductance (Dm) and capillary blood volume(CBV),as well as the correlation of Dm with CBV and PDC deserve further investigation.OBJECTIVE:To study the correlation of Dm and CBV with PDC,age,body mass, height and sex in normaladults.DESIGN: With healthy adults as subjects, multiple factor linear correlation and regression analysis was used to elicit correlation coefficient and regression equation while F-test and Q-test were used for comparing the differences between groups.PARTICIPANTS:We randomly selected 100 healthy adults,50 males and 50 females, who came to the clinic of the General Hospital of Chinese PLA for routine physical examination between April and October 1997.The 100 volunteers were divided into five groups according to their age:20-29, 30-39, 40-49, 50-59 and 60-69 years old groups with 20 in each group, half males and half females.METHODS: PDC and Dm of the healthy adults were examined with Sensormedics 2200 pulmonary function detector. CBV was calculated with the following formula (1/PDC=I/ Dm +1/θCBV, θrefers to the combined velocity of CO with Hb,which was in inverse proportion to the inhaled partial oxygen pressure,Dm and CBV were unaffected by θ).Multiple factor linear correlation and progressive regression analysis was used to elicit correlation coefficient of PDC, Dm and CBV. Meanwhile, regression equation was used to reveal the correlation of age,body mass and height with pulmonary functions.MAIN OUTCOME MEASURES: Correlation ofDm and CBV with PDC and age, body mass, height and sex in normal adults.RESULTS:Data of the 100 healthy adults were processed according to the objective and statistically analyzed.① PDC and Dm were proved to decline in age-dependent manner from the onset of 40 years old in the 100 healthy adults (P＜ 0.05), and CBV also declined after 50 years old (P ＜ 0.05).②Relationship between women's age and pulmonary function:Age was proved to have significant negative correlation with PDC,Dm and CBV (r= -0.646 0 to -0.814 6, P＜ 0.01).By contrast,PDC was found to be positively correlated with Dm,CBV and alveolus ventilation volume (AVV) (r=0.949 7, 0.740 0, 0.735 6, P＜ 0.01), and AVV was found to be positively correlated with PDC, Dm and CBV (r=0.482 1-0.740 6,P＜ 0.01).③ Relationship between men's age and pulmonary function:Age had significant negative correlation with PDC, Dm and CBV (r=-0.712 to -0.830 5, P＜ 0.01). However, PDC was found to be moderately or highly positively correlated with Dm,CBV and AVV(r=0.585 2 to 0.946 0, P＜ 0.01), and AVV had moderately positive correlation with PDC, Dm and CBV (r=0.431 3-0.585 2, P＜ 0.01). ④ Regression analysis revealed that age and height were the main variables of the predicting equation of PDC,Dm and CBV.Body mass could not enter regression equation in females,and it was only proved to be correlated with PDC and CBV in males with the regression coefficient of 0.009 4 and 0.654 3, respectively.CONCLUSION:① PDC and Dm begin to decline from the onset of 40 years old in healthy adults (P＜ 0.05),and CBV declines after 50 years old.② PDC, Dm and CBV of healthy adults are proved to decline in age-dependent manner. ③ PDC increases with the increment of Dm and CBV. ④ Age and/or height are the main variables in the regression equation of PDC, Dm and CBV, but body mass is not the key predictor for Dm and CBV.
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<p><b>OBJECTIVE</b>To evaluate the effectiveness of a helium-oxygen mixture (79%He- 21%O(2)) as an aerosolizing compressed gas for beta(2)-agonist therapy in patients with an asthma exacerbation.</p><p><b>METHODS</b>Twenty-four patients in the outpatient department with a mild to moderate exacerbation of asthma were enrolled. The patients were randomly divided into an experimental group (13 cases) and a control group (11 cases). The experimental group inhaled Berotec with heliox-driven, and the control group inhaled Berotec with compressed air-driven. Eight hospitalized patients in the respiratory department with severe exacerbation of asthma were enrolled. The patients inhaled Berotec with heliox-driven or compressed air-driven in a random order.</p><p><b>RESULTS</b>The results of spirometric parameters and arterial blood-gas analysis were measured. In the mild to moderate asthma patients, no statistical differences between the two groups for forced vital capacity (FVC), forced expired volume in one second (FEV(1)), and expiratory flow in 50% forced vital capacity (FEF(50)) were presented. But the severe patients showed significant differences between heliox-driven and compressed air-driven for FVC, FEV(1), FEF(50) and partial pressure of oxygen (PaO(2)).</p><p><b>CONCLUSIONS</b>Compared with the traditional inhalation of beta(2)-agonist therapy using compressed air-driven, the method of inhaling beta(2)-agonist with heliox-driven has more obvious benefits for those suffering from severe asthma. This is likely due to the cooperative effects between inhaling heliox on its physical gas properties and improving delivery of beta(2)-agonist in the treatment of exacerbation of severe asthma.</p>
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Agonistas Adrenérgicos beta , Asma , Terapéutica , Broncodilatadores , Fenoterol , Helio , OxígenoRESUMEN
Objective Determination of the specific antibodies of IgG and IgM against SARS virus in serum specimens from convalescent SARS patients. Methods The contents of IgG and IgM antibodies against coronavirus were determined with ELISA in the blood of 22 convalescent SARS patients. At the same time, the sera from 22 healthy people were used as negative control. Results The positive rate of specific IgG was 100.0% in convalescent SARS patients (the minimal OD value was 0.477, the maximal OD value was 1.851, the mean value was 1.163), within 71 days of recovery. The positive rate of specific IgM was 22.73% in convalescent patients (5 in 22 samples), and it became negative in all patients after 65 days. On the contrary, the IgG and IgM antibodies were all negative in all 22 healthy people. Conclusion The results indicated that all patients convalescent from SARS could generate specific IgG antibody, which might last for a long time.
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AIM: To evaluate the response of obstructive sleep apnea hypopnea syndrome (OSAHS) to fluoxetine. METHODS: After a baseline polysomnography (PSG) and Epworth Sleepiness Scale (ESS) documented OSAHS, 10 patients were treated with fluoxetine (20 mg?d -1 ) for four weeks, a repeating PSG and ESS was performed to evaluate the action of fluoxetine. RESULTS: After 4 weeks fluoxetine treatment, the proportion of REM sleep time was decreased by 9.2 %, and the assessment of ESS was significantly decreased (P 0.05 ). The apnea/hypopnea index (AHI) fell in average 24.84 per hour,the mean SaO 2 and minimum SaO 2 significantly increased by 3.2 % and 16.6 %, respectively, and desaturation event index significantly decreased 18.24 per hour (P 0.05 ). The treatment efficiency of fluoxetine to OSAHS was 50%. CONCLUSION: Short term use of fluoxetine in patients with OSAHS is associated with better sleep quality, improvement in oxygenation,and reduction of episodic apneas or hypopneas.