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Objective To compare the individual effects of three recruitment maneuvers (RM) in children with congenital heart disease complicated by postoperation acute respiratory distress syndrome (ARDS).Methods A prospective single-blind randomized controlled trial was conducted.Thirty-two children with congenital heart disease complicated with ARDS after open-heart surgery undergoing mechanical ventilation were randomized into three groups,to whom three different RM was respectively performed,namely sustained inflation (SI),progressively increased positive end expiratory pressure (IP) and pressure control ventilation (PCV).Blood gas analysis was done every 6 hours,and the lung RM was performed if oxygenation index (OI) ≤ 300 mmHg (1 mmHg =0.133 kPa).The OI,the dynamic lung compliance (Cdyn),as well as the parameters of hemodynamics before,during and after RM for 15,30,and 60 minutes were recorded and analyzed before and after RM.Results During the treatment process,the OI was significantly increased during the process and 15,30 or 60 minutes after RM compared with that before RM,with no statistical difference among groups (F value was 1.027,0.403,0.264,0.172,0.159,and P value was 0.367,0.671,0.769,0.843,0.853).The Cdyn at all time points in each group was also significantly increased,but there was no statistical difference among groups (F value was 0.009,0.015,0.206,0.010,0.389,and P value was 0.991,0.985,0.814,0.990,0.683).In the process of RM,the heart rate (HR) and mean arterial pressure (MAP) of the children were lowered compared with those before RM [HR (bpm):131.67 ± 9.56 vs.138.93 ± 5.22 in SI group,133.27 ± 9.54 vs.140.33 ± 7.74 in IP group,137.13 ± 7.39 vs.142.40 ± 9.18 in PCV group,all P ＜ 0.01;MAP (mmHg):55.07 ± 4.43 vs.65.87 ± 4.46 in SI group,58.82 ± 6.04 vs.64.02 ± 7.65 in IP group,57.89 ± 4.71 vs.65.36 ± 5.37 in PCV group,all P ＜ 0.01],but it recovered immediately.CVP in all three groups was increased during RM [cmH2O (1 cmH2O =0.098 kPa):11.60±0.99 vs.5.53±0.74 in SI group,10.33± 1.35 vs.5.40±0.74 in IP group,10.20±0.94 vs.5.80±0.68 in PCV group,all P ＜ 0.01].There was significant difference in CVP during RM among three groups (F =7.327,P =0.002),and CVP in SI group was higher than that of other two groups (both P ＜ 0.05).CVP returned to the former level in 15 minutes after RM in IP and PCV groups,and recovered in 30 minutes in SI group.Conclusions All of the RM methods can effectively improve oxygenation and pulmonary compliance of the children with complication of ARDS,and they complement the inadequacy of lung protective ventilation.PCV and IP are more effective than SI in the uniform re-expansion of alveoli after RM and recovery of hemodynamics.
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According to the results of quantum chemistry calculation and the present research status in the relationship between the structures and the functions of DT, the E154 in DT catalyzing domain was mutated to aspartic acid and arginine in order to study the effects of the alteration on the biological activities. By means of gene site-direct mutation, two mutated genes were prepared and the high performance expression was obtained in E.coli system. The results of toxcity studies indicated that the acute toxicity in guinea pig and cytotoxicities of mutant E154D increased slightly in compared with those of recombination wild toxin, and contrarily, those of E154R decreased obviously.
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To investigate the effect of bFGF and sucralfate on the improvement of the quality of expanded skin flap, white piglets were employed to establish a continuous tissue expansion model. They were randomly divided into 3 groups: group 1: both bFGF and sucralfate were injected; group 2: both bFGF and normal saline was injected; and group 3(the control group):only normal saline was injected. Three days after completion of the expansion ,normal and expanded skin flaps were created at random to assess flap viability and stretch back .The results showed that the flap survival length in group 1 was significantly larger than that of the control group and normal random flap( P