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Objective To explore the impact of pre positioned nasopharyngeal airway combined with high head pre inhalation of oxygen on lung oxygenation and blood gas analysis indicators in morbid obese patients undergoing laparoscopic weight loss surgery.Methods 100 morbid obesity patients from January 2020 to April 2022 planned to undergo elective laparoscopic weight loss surgery were selected as the study subjects.All the patients were divided into two groups according to the random number table method:group A with a head height of 25° and a pre installed nasopharyngeal airway;group B with a head height of 25° and no pre installed nasopharyngeal airway,with 50 patients in each group.Two groups were pre oxygenated for 3 min before undergoing intravenous anesthesia to induce tracheal intubation.Observe and record the pH value,partial pressure of oxygen in arterial blood(PaO2),partial pressure of carbon dioxide(PCO2),partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen(PaO2/FiO2)as well as the ratio of arterial pressure to alveolar oxygen partial pressure(a/APO2)of the two groups of patients who breathed air(T0)after entering the room,ventilated with mask positive pressure for 3 min(T1),and intubated with trachea for 3 min(T2).Record plateau pressure(Pplat),peak airway pressure(Ppeak),and dynamic lung compliance(Cdyn)at T1,T2,and 5 min after pneumoperitoneum(T3).Record the time for percutaneous arterial oxygen saturation(SpO2)to decrease to 92.0%under different artificial ventilation after tracheal intubation,the time for SpO2 to recover to 96.0%after resumption of ventilation,and the occurrence of adverse reactions.Results Compared with Group B,at time point T1,Group A showed a decrease in PCO2 and an increase in PaO2,with statistically significant differences(all P<0.05);Compared with T0,at time points T1 and T2,PaO2/FiO2 and PCO2 in the two groups were increased,while a/APO2 decreased(all P<0.05).At T1 time point,Pplat and Ppeak in Group A were lower than those in Group B,while Cdyn was higher than that in Group B,with statistical significance(P<0.05);Compared with T1 time point,at T2 and T3 time point,Pplat and Ppeak in Group A increased,while Cdyn decreased,with statistically significant differences(all P<0.05);Compared with T1,Ppeak increased in B groups at T2 time point(P<0.05),while Pplat and Ppeak increased in T3 time point,and Cdyn decreased in B group,with statistical significance(all P<0.05).Compared with Group B,Group A had a longer time for SpO2 to decrease to 92.0%and a shorter time for SpO2 to recover to 96.0%(P<0.01).Conclusion The combination of pre positioned nasopharyngeal airway and high head pre inhalation of oxygen can effectively improve acute respiratory obstruction during induction of general anesthesia insertion in morbid obesity patients,and extend the duration of no ventilation.
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@#Objective To investigate the treatment of neonatal respiratory distress syndrome by less invasive surfactant administration(LISA)clinical efficacy,complications and influence on blood gas analysis.Methods A total of 100 cases of neonatal respiratory distress syndrome requiring pulmonary surfactant(PS)tracheal injection therapy and admitted to the Jinhua Central Hospital between December 1st 2019 and August 1st 2022 were randomly assigned into treatment group(50 cases)and control group(50 cases).The treatment group of children received PS treatment using LISA technology,while the control group of children received PS treatment using tracheal intubation tracheal instillation PS extubation followed by intubation-surfactant-extubation technology.The clinical treatment effect,blood gas analysis,non-invasive ventilation time,length of hospitalization,and incidence of complications were compared between the two groups.Results The total effective rate of treatment in the treatment group was higher than that in the control group;After 1 hour of PS treatment,the oxygen partial pressure and blood oxygen saturation of the treatment group were higher than those of the control group,while the carbon dioxide partial pressure was lower than that of the control group.The non-invasive assisted ventilation time of the treatment group was shorter than that of the control group.The incidence of bronchopulmonary dysplasia was lower than that of the control group.Their difference were statistically significant(P<0.05).Conclusion The use of LISA technology for PS treatment of NRDS can improve blood gas indicators,shorten non-invasive ventilation time,improve diagnostic and therapeutic effects,reduce the risk of bronchopulmonary dysplasia,and do not increase the incidence of complications such as tracheal mucosal injury and pulmonary hemorrhage in children.
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AIM: To explore the correlation between neonatal retinal hemorrhage(RH)and changes in umbilical artery blood gas analysis.METHODS: A total of 312 full-term neonates born in our obstetrics department from January 2019 to December 2021 were selected as the study subjects. According to the RetCam III fundus examination results, 245 neonates who did not experience RH were included in the control group, while 67 cases with RH were found to be included in the RH group. In addition, neonates were grouped into I degree group(n=20), II degree group(n=29), and III degree group(n=18)based on the degree of RH. General clinical data and umbilical artery blood gas analysis indicators between the RH group and the control group were compared; the levels of umbilical artery blood gas analysis indicators in neonates with different degrees of RH, the relationship between pH and RH degree, and the influencing factors of neonatal RH were analyzed.RESULTS: There was no obvious difference in maternal age, average gestational week, fetal gender, parity, gestational diabetes, fetal birth weight, and amniotic fluid between the RH group and the control group(all P>0.05), while there were obvious differences in delivery methods, gestational hypertension, forceps assisted delivery, neonatal asphyxia, and umbilical cord around the neck(all P<0.05). The pH value, arterial blood sample partial pressure(PaO2)and base excess(BE)values of the RH group were obviously lower than those of the control group(all P<0.01), while the arterial carbon dioxide partial pressure(PaCO2)was obviously higher than that of the control group(P<0.01). There were obvious differences in umbilical artery blood gas analysis indicators among children with different degrees of RH(P<0.05), and with the increase of the degree of RH, pH value, PaO2 and BE gradually decreased(P<0.05), and PaCO2 gradually increased(P<0.05). There was a negative correlation between the degree of RH and the pH of umbilical artery blood gas analysis(rs=-0.593, P<0.05). The results of multivariate Logistic regression analysis showed that delivery method, gestational hypertension, forceps assisted delivery, neonatal asphyxia, umbilical cord entanglement, pH, PaO2, PaCO2, and BE were all influencing factors for the occurrence of neonatal RH.CONCLUSION: There is a close correlation between neonatal RH and changes in umbilical artery blood gas analysis, and umbilical artery blood gas analysis can be used for the diagnosis of neonatal RH, which can be used to guide clinical treatment.
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ABSTRACT Introduction: hemorrhagic shock is a significant cause of trauma-related deaths in Brazil and worldwide. This study aims to compare BE and lactate values at ICU admission and twenty-four hours after in identifying tissue hypoperfusion and mortality. Methods: examines a historical cohort of trauma patients over eitheen years old submittet to damage control resuscitation approch upon hospital admission and were then admitted to the ICU. We collected and analyzed ISS, mechanism and type of trauma, need for renal replacement therapy, massive transfusion. BE, lactate, pH, bicarbonate at ICU admission and twenty-four hours later, and mortality data. The patients were grouped based on their BE values (≥-6 and <-6mmol/L), which were previously identified in the literature as predictors of severity. They were subsequently redivided using the most accurate values found in this sample. In addition to performing multivariate binary logistic regression. The data were compared using several statistical tests due to diversity and according to the indication for each variable. Results: there were significant changes in perfusion upon admission to the Intensive Care Unit. BE is a statistically significant value for predicting mortality, as determined by using values from previous literature and from this study. Conclusion: the results demonstrate the importance of monitoring BE levels in the prediction of ICU mortality. BE proves to be a valuable bedside marker with quick results and wide availability.
RESUMO Introdução: o choque hemorrágico é a principal causa reversível de morte no trauma no Brasil e no mundo. Objetivo: comparar o valor de BE ao do lactato na admissão da UTI e vinte e quatro horas após o internamento na identificação de hipoperfusão tecidual e predição de mortalidade Método: coorte histórica de pacientes traumatizados, maiores de dezoito anos, submetidos à estratégia de controle de danos na admissão hospitalar, seguido de internamento em UTI. Foram coletados e analisados ISS, mecanismo e tipo de trauma, necessidade de terapia de substituição renal e transfusão maciça; BE, lactato, pH e bicarbonato coletados na admissão da UTI e vinte e quatro horas após, e a mortalidade. Os pacientes foram divididos em grupos conforme valores de BE (≥-6 e <-6mmol/L) já descritos na literatura como preditores de gravidade, e após redivididos de acordo com os valores de melhor acurácia encontrados nesta amostra, além de realização de regressão logística binária multivariada. Os dados foram comparados através de diversos testes estatísticos devido a diversidade e conforme a indicação para cada variável. Resultados: houve alterações perfusionais impactantes já na admissão da UTI. BE manteve-se com valor estatisticamente significativo para predição de mortalidade tanto quando utilizado os valores já conhecidos da literatura como quando aplicados os valores neste estudo identificados. Conclusão: valores de BE e de lactato foram capazes de predizer hipoperfusão tecidual e mortalidade nos dois momentos estudados, quando comparados, o BE tem boa performance como preditor de mortalidade, com rápido resultado e ampla disponibilidade.
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Abstract Understanding the physiological concepts of oxygen delivery is essential to discern the mechanisms that influence its increase, reduction or maintenance in the body. This text explores the different mechanisms that help maintain oxygen delivery even in the face of reduced hemoglobin levels. Adequate oxygen delivery ensures tissue and metabolic balance, which is crucial to avoid harmful consequences such as metabolic acidosis and cellular dysoxia. The complex interaction between variables such as cardiac output, hemoglobin and heart rate (HR) plays a fundamental role in maintaining oxygen delivery, allowing the body to temporarily adjust to situations of anemia or high metabolic demand. It is important to emphasize that blood transfusions should not be based on fixed values, but rather on individual metabolic needs. Strategies to reduce myocardial consumption and monitor macro and micro hemodynamics help in making rational decisions. Individualizing treatment and considering factors such as blood viscosity in relation to the benefits of transfusion are increasingly relevant to optimize therapy and minimize risks, especially in complex clinical scenarios, such as neurocritical patients and trauma victims.
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Acidose , Débito CardíacoRESUMO
Objective:To analyze the effect of different lithotomy positions on hemodynamics in patients undergoing laparoscopic total hysterectomy.Methods:A total of 50 patients who underwent laparoscopic total hysterectomy at Zhoushan Women and Children's Hospital between January 2020 and June 2021 were included in this study. The patients were randomly divided into a control group and an observation group using a random number table method, with 25 patients in each group. The control group underwent conventional lithotomy position total laparoscopic hysterectomy, while the observation group underwent high and low lithotomy position total laparoscopic hysterectomy. The general surgical indicators, respiratory function indicators, blood gas analysis indicators, hemodynamic levels, incidence of complications, and clinical efficacy were compared between the two groups.Results:The general surgical indicators and airway peak pressure indicators in the observation group were significantly lower than those in the control group (both P < 0.05). There was no statistically significant difference in partial pressure of end-tidal carbon dioxide (PCO 2) and arterial carbon dioxide partial pressure (PaCO 2) between the two groups (both P < 0.05). At 15 minutes after pneumoperitoneum, the PaCO 2 level increased in each group, and the PaCO 2 level in the observation group was significantly higher than that in the control group (all P < 0.05). At the same time, the HCO 3- level decreased in each group, and the HCO 3- level in the observation group was significantly lower than that in the control group (all P < 0.05). At 5 minutes before recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the control group were (76.52 ± 8.61) beats/minute, (113.52 ± 5.36) mmHg (1 mmHg = 0.133 kPa), and (86.91 ± 4.21) mmHg, respectively. At 5 minutes after recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the control group were (89.52 ± 8.61) beats/minute, (106.85 ± 5.63) mmHg, and (80.96 ± 3.65) mmHg, respectively. At 5 minutes before recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the observation group were (76.36 ± 8.61) beats/minute, (112.79 ± 5.28) mmHg, and (86.89 ± 4.54) mmHg. At 5 minutes after recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the observation group were (75.63 ± 6.86) beats/minute, (111.99 ± 5.51) mmHg, and (85.06 ± 3.21) mmHg, respectively. At 5 minutes after recovery of body position, heart rate in the control group was increased and that in the observation group was decreased compared with heart rate measured at 5 minutes before recovery of body position. At 5 minutes after recovery of body position, heart rate in the observation group was significantly lower than that in the control group. Diastolic blood pressure and systolic blood pressure decreased in each group, and the amplitudes of reductions in diastolic blood pressure and systolic blood pressure in the observation group were significantly lower than those in the control group. ( t = 6.04, 3.26, 4.22, all P < 0.05). There was no statistically significant difference in incidence of adverse reactions between the two groups ( P > 0.05). The overall response rate in the observation group was significantly higher than that in the control group ( P < 0.05). Conclusion:Compared with conventional lithotomy position total laparoscopic hysteretsotomy, high and low lithotomy position total laparoscopic hysterectomy takes a shorter duration for total laparoscopic hysterectomy, leads to a shorter length of hospital stay, results in less blood loss, causes fewer postoperative infections, and results in more stable hemodynamics and a lower incidence of complications.
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Objective:To investigate the effect of penehyclidine hydrochloride on respiratory mechanics, arterial blood gas, and inflammatory factors in patients undergoing one-lung ventilation during thoracoscopic lobectomy.Methods:A total of 100 patients who underwent thoracoscopic lobectomy with one-lung ventilation at Jinhua Central Hospital from January to November 2022 were included in this randomized controlled study. They were divided into groups A and B ( n = 50 per group) using a random digital number table. Patients in group A received an intravenous infusion of 0.02 mg/kg of pentylenethyclidine hydrochloride 30 minutes before surgery, while patients in group B received an equal amount of 0.9% sodium chloride injection 30 minutes before surgery. Clinical indicators, respiratory mechanical indicators (peak airway pressure, lung compliance), arterial blood gas analysis indicators (blood oxygen saturation, arterial pressure of oxygen, oxygenation index), inflammatory factor levels (interleukin-6, interleukin-8, tumor necrosis factor level-α), and pulmonary complications were compared between the two groups. Results:There were no significant differences in mechanical ventilation time or total infusion volume between the two groups (both P > 0.05). At the end of surgery (T1) and 1 day after surgery (T2), peak airway pressure in group A was (17.43 ± 2.69) cm H 2O and (16.81 ± 2.28) cm H 2O (1 cm H 2O = 0.098 kPa), respectively, which were significantly lower than (19.23 ± 3.40) cm H 2O and (18.29 ± 2.06) cm H 2O in group B, respectively ( t = 2.94, 3.41, P = 0.002, < 0.001). At T1 and T2, lung compliance in group A was (34.67 ± 2.93) cm H 2O and (36.26 ± 3.11) cm H 2O, respectively, which were significantly higher than (32.23 ± 2.85) cm H 2O and (33.84 ± 2.87) cm H 2O in group B, respectively ( t = 4.22, 4.04, P = 0.000, < 0.001). At T1 and T2, blood oxygen saturation, arterial partial pressure of oxygen, and oxygenation index in group A were significantly higher than those in group B ( t = 8.12, 3.07, 10.47, 3.16, 3.81, 4.15, all P < 0.05). At T1 and T2, interleukin-6, interleukin-8, and tumor necrosis factor-α levels in group A were significantly lower than those in group B ( t = 11.67, 13.55, 9.60, 15.71, 6.13, 11.50, all P < 0.001). The incidence of complications in group A was 4% (2/50), which was significantly lower than 16% (8/50) in group B ( χ2 = 4.00, P < 0.05). Conclusion:Penehyclidine hydrochloride has a good effect on respiratory mechanics, arterial blood gas, and inflammatory factors in patients undergoing thoracoscopic lobectomy with one-lung ventilation and thereby deserves clinical promotion.
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Objective:To investigate the clinical efficacy of alteplase combined with heparin in the treatment of acute moderate- and high-risk pulmonary thromboembolism and its effects on arterial blood gas analysis and myocardial enzyme level.Methods:Seventy-eight patients with acute moderate- and high-risk pulmonary thromboembolism who received treatment in Dongyang People's Hospital from January 2015 to January 2022 were retrospectively included in this study. They were divided into observation ( n = 39) and control ( n = 39) groups according to different treatment methods. The control group was treated with heparin, while the observation group was treated with alteplase based on heparin. All patients were treated for 7 days. Clinical efficacy as well as arterial blood gas analysis, myocardial enzymes, pulmonary artery pressure, and tricuspid annular plane systolic excursion pre- and post-treatment were compared between the two groups. Results:The total response rate in the observation group was significantly higher than that in the control group (94.87% vs. 76.92%, χ2 = 5.18, P < 0.05). After treatment, the partial pressure of carbon dioxide in the observation group was significantly lower than that in the control group [(36.24 ± 5.12) mmHg vs. (44.25 ± 3.78) mmHg, 1 mmHg = 0.133 kPa, t = 7.86, P < 0.05]. After treatment, the partial pressure of oxygen in the observation group was significantly higher than that in the control group [(78.82 ± 5.1) mmHg vs. (71.23 ± 4.89) mmHg, t = 6.66, P < 0.05]. After treatment, lactate dehydrogenase, creatine kinase, and creatine kinase isoenzyme in the observation group were (107.42 ± 15.45) U/L, (37.21 ± 10.84) U/L, and (12.28 ± 3.54) U/L, respectively, which were significantly lower than (189.94 ± 21.20) U/L, (65.42 ± 6.57) U/L, and (19.29 ± 3.08) U/L in the control group ( t = 19.64, 13.89, 9.33, all P < 0.001). After treatment, the pulmonary arterial pressure in the observation group was significantly lower than that in the control group [(32.24 ± 3.86) mmHg vs. (37.79 ± 5.17) mmHg, t = 5.37, P < 0.001]. Tricuspid annular plane systolic excursion in the observation group was significantly higher than that in the control group [(14.07 ± 1.27) mm vs. (12.63 ± 1.16) mm, t = 5.22, P < 0.001]. Conclusion:Ateplase combined with heparin has an obvious effect on acute moderate- and high-risk pulmonary thromboembolism. It can improve arterial blood gas analysis and reduce myocardial enzyme levels.
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Objective:To investigate the clinical efficacy of acupoint application therapy combined with pressing needle therapy in the treatment of acute exacerbation of chronic obstructive pulmonary disease.Methods:Eighty-six patients with acute exacerbation of chronic obstructive pulmonary disease who received treatment at Lishui Hospital of Traditional Chinese Medicine from February 2022 to August 2022 were retrospectively included in this study. They were randomly divided into Group A ( n = 29), group B ( n = 29), and the combined treatment group ( n = 28) according to different treatment methods. All three groups were treated with conventional Western medicine. Based on this, group A was treated with acupoint application therapy, group B was treated with pressing needle therapy and the combined treatment group with treated with acupoint application therapy and pressing needle therapy. Clinical efficacy was compared among the three groups. Traditional Chinese medicine symptom score, pulmonary function index, blood gas index, and quality of life score pre- and post-treatment were compared among the three groups. Results:There was a significant difference in total response rate among group A [75.86% (22/29)], group B [79.31% (23/29)], and the combined treatment group [96.43% (27/28), H = 6.15, P < 0.05]. After treatment, the scores of cough, expectoration, and dyspnea in the three groups were significantly decreased compared with those before treatment (all P < 0.05). After treatment, the scores of cough, expectoration, and dyspnea in the combined treatment group were (1.79 ± 0.48) points, (2.30 ± 0.32) points, and (1.96 ± 0.43) points, respectively, which were significantly lower than those in (2.32 ± 0.41) points, (2.68 ± 0.42) points, and (2.27 ± 0.36) points in group A and (2.17 ± 0.50) points, (2.91 ± 0.43) points, and (2.33 ± 0.43) points in group B ( F = 9.81, 17.38, 6.72, all P < 0.05). After treatment, forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1), and FEV 1/FVC were increased in each group compared with those before treatment (all P < 0.05). After treatment, FVC, FEV 1, and FEV 1/FVC in the combined treatment group were (3.95 ± 0.47) L, (2.01 ± 0.36) L, and (82.91 ± 13.35)%, respectively, which were significantly higher than (3.63 ± 0.59) L, (1.76 ± 0.21) L, and (73.23 ± 10.85)% in group A and (3.89 ± 0.38) L, (1.64 ± 0.37) L and (73.91 ± 7.62)% in group B ( F = 3.49, 9.80, 7.05, all P < 0.05). After treatment, blood gas indicators in each group were significantly increased compared with those before treatment (all P < 0.05). After treatment, blood oxygen partial pressure in the combined treatment group, group A and group B was (85.76 ± 3.21) mmHg, (81.05 ± 4.23) mmHg, and (80.62 ± 4.03) mmHg, respectively. The partial pressure of carbon dioxide in the three groups was (37.74 ± 5.88) mmHg, (44.32 ± 5.59) mmHg, and (43.22 ± 6.41) mmHg, respectively. There were significant differences in blood oxygen partial pressure and partial pressure of carbon dioxide among the three groups ( F = 15.50, 9.88, all P < 0.05). After treatment, the quality of life score in each group was significantly increased compared with that before treatment (all P < 0.05). After treatment, the quality of life score in the combined treatment group, group B, and group A was (43.97 ± 6.34) points, (39.16 ± 4.45) points, and (40.19 ± 4.67) points, respectively, and there was significant difference among the three groups ( F = 4.12, P < 0.001). Conclusion:In the treatment of acute exacerbation of chronic obstructive pulmonary disease, acupoint application therapy combined with pressing needle therapy is highly effective than monotherapy. The combined therapy can better improve traditional Chinese medicine symptoms and blood gas indicators, effectively enhance pulmonary function, and improve quality of life than monotherapy.
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Objective:To investigate the value of short-time transcutaneous carbon dioxide pressure (TcPCO 2) and transcutaneous oxygen pressure (TcPO 2) monitoring in critically ill preterm infants. Methods:From January to December 2018, 62 critically ill neonates receiving respiratory support at Guangzhou Women and Children's Medical Center were retrospectively enrolled. A total of 348 sets of paired data including TcPCO 2/TcPO 2 and arterial carbon dioxide pressure (PaCO 2)/arterial oxygen partial pressure (PaO 2) were analyzed. The patients were divided into different groups based upon birth weight (23 cases>1 000 g-≤1 500 g, 129 sets of paired data; 18 cases≤1 000 g, 130 sets of paired data) and gestational age (16 cases born at ≤28 gestational weeks, 127 sets of paired data; 29 cases born at 28-34 gestational weeks, 159 sets of paired data) and the differences between groups were compared. The correlation and consistency of TcPCO 2/TcPO 2 and PaCO 2/PaO 2 were evaluated using Pearson's correlation and Blan-Altman scatter plots. Receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic efficacy of TcPCO 2 in neonates with hypercapnia. Results:There was a positive correlation between TcPCO 2 and PaCO 2 in all patients ( r=0.913, 95% CI:0.894-0.929, P<0.05). In patients whose birth weight was>1 000 g-≤1 500 g or≤1 000 g, TcPCO 2 and PaCO 2 were positively correlated and the consistency were good ( r=0.909, 95% CI:0.874-0.935; r=0.934, 95% CI:0.908-0.953; both P<0.05), and the same finding was also observed in patients born at≤28 gestational weeks or 28-34 weeks of gestation ( r=0.938, 95% CI:0.913-0.956; r=0.871, 95% CI: 0.827-0.904; both P<0.05). The sensitivity, specificity and area under curve of TcPCO 2 in the diagnosis of hypercapnia were 90.91%, 85.85%, and 0.942, respectively. There was a poor correlation between TcPO 2 and PaO 2 in all patients and those with birth weight >1 000 g-≤1 500 g or gestational age 28-34 weeks (all r<0.75, all P<0.05). There was no correlation between TcPO 2 and PaO 2 in the birth weight ≤1 000 g and gestational age ≤28 weeks groups (both P>0.05). Conclusions:Short-time TcPCO 2 monitoring can accurately assess PaCO 2 in critically ill neonates requiring respiratory support and is of high diagnostic value for hypercapnia. However, TcPO 2 has limitation in evaluating PaO 2 and other indicators may need to be involved.
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OBJECTIVES@#To explore the effects of hypoxic and hypobaric conditions on blood gas and erythrocyte-related indicators in rats.@*METHODS@#SD male rats were exposed to low-pressure hypoxic conditions simulating an altitude of 6500 m in a small or a large experimental cabin. Abdominal aortic blood samples were collected and blood gas indicators, red blood cells (RBCs) count, and hemoglobin (Hb) content were measured. The effects of exposure to different hypoxia times, different hypoxia modes, normal oxygen recovery after hypoxia, and re-hypoxia after hypoxia preconditioning on blood gas indicators, RBCs count and Hb content were investigated.@*RESULTS@#The effect of blood gas indicators was correlated with the length of exposure time of hypoxia and the reoxygenation after leaving the cabin. Hypoxia caused acid-base imbalance and its severity was associated with the duration of hypoxia; hypoxia also led to an increase in RBCs count and Hb content, and the increase was also related to the time exposed to hypoxia. The effects of reoxygenation on acid-base imbalance in rats caged in a small animal cabin were more severe that those in a large experimental cabin. Acetazolamide alleviated the effects of reoxygenation after leaving the cabin. Different hypoxia modes and administration of acetazolamide had little effect on RBCs count and Hb content. Normal oxygen recovery can alleviate the reoxygenation and acid-base imbalance of hypoxic rats after leaving the cabin and improve the increase in red blood cell and hemoglobin content caused by hypoxia. The improvement of hypoxia preconditioning on post hypoxia reoxygenation is not significant, but it can alleviate the acid-base imbalance caused by hypoxia in rats and to some extent improve the increase in red blood cell and hemoglobin content caused by hypoxia.@*CONCLUSIONS@#Due to excessive ventilation and elevated RBCs count and Hb content after hypoxia reoxygenation, oxygen partial pressure and other oxygenation indicators in hypoxic rats are prone to become abnormal, while blood gas acid-base balance indicators are relatively stable, which are more suitable for evaluating the degree of hypoxia injury and related pharmacological effects in rats.
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Ratos , Animais , Masculino , Acetazolamida , Hipóxia , Oxigênio , Eritrócitos , Hemoglobinas , Desequilíbrio Ácido-BaseRESUMO
For patients in ICU under mechanical ventilation, monitoring of percutaneous partial pressure of CO2 and O2 after general anesthesia is crucial as excessive or insufficient ventilation may prove to be fatal. However, the correlation between percutaneous monitoring and arterial blood gas analysis still remains unclear. Here, we studied the application value of monitoring of PtcCO2/PtcO2 for patients in ICU after general anesthesia for better management of patients in ICU on ventilation. A total of 195 eligible patients were selected. After transfer, when PtcCO2 and PtcO2 were stable (10-15 min), they were recorded as transfer-in values. Partial pressure of carbon dioxide (PaCO2), partial pressure of oxygen (PaO2), lactate, PtcO2 and PtcCO2 were recorded. Vital signs and hemodynamics data were also recorded. There were significant positive correlations between PtcCO2 and PtcO2 (r = 0.876), and between PtcO2 and PaCO2 (r = 0.817) (P <0.01). PaO2 was higher than PtcO2 (P <0.01). There were significant positive correlations between PtcCO2/PtcO2 and PaCO2/PaO2 at different time points (T0: upon transfer-in; T1: before extubation; T2: upon transfer-out, P <0.01). At different oxygen inhalation concentrations (21, 40 and 50%), PtcCO2 and PtcO2 were all well linearly correlated. The overall PtcO2/PaO2 was (0.75±0.12). When FIO2 values were 21, 40 and 50%, PtcO2/PaO2 values were similar (P >0.05). PtcCO2 and PtcO2 or PtcO2 and PaCO2 are significantly positively correlated, without significant differences between different time periods or oxygen concentrations. PtcCO2 and PtcO2 can predict the changes of PtcO2 and PaCO2, which is of great significance to the early observation of oxygenation changes, adjustment of ventilator parameters and improvement of prognosis. PtcCO2/PaO2 values are similar at different oxygen concentrations, as an eligible index for the postoperative evaluation of tissue perfusion status and hemodynamic level.
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RESUMO Embora a PaO2/FiO2 derivada da gasometria arterial continue sendo o padrão-ouro do diagnóstico de insuficiência respiratória aguda, a SpO2/FiO2 tem sido investigada como potencial substituta. Esta revisão narrativa apresenta o estado da literatura pré-clínica e clínica sobre a SpO2/FiO2 como possível substituta da PaO2/FiO2 e para uso como marcador diagnóstico e prognóstico; ainda, é fornecida uma visão geral da oximetria de pulso e suas limitações, além da avaliação da utilidade da SpO2/ FiO2 como substituta da PaO2/FiO2 em pacientes com COVID-19. Ao todo, foram encontrados 49 estudos comparando SpO2/FiO2 e PaO2/ FiO2 com base em uma estratégia de pesquisa mínima. A maioria dos estudos foi realizada em recémnascidos, alguns foram realizados em adultos com síndrome do desconforto respiratório agudo, e outros foram realizados em outros cenários clínicos (incluindo poucos em pacientes com COVID-19). Há certa evidência de que os critérios de SpO2/FiO2 podem substituir a PaO2/FiO2 em diferentes cenários clínicos. Isso é reforçado pelo fato de que devem ser evitados procedimentos invasivos desnecessários em pacientes com insuficiência respiratória aguda. É inegável que os oxímetros de pulso estão cada vez mais difundidos e podem proporcionar um monitoramento sem custos. Portanto, substituir a PaO2/FiO2 pela SpO2/FiO2 pode permitir que instalações com recursos limitados diagnostiquem a insuficiência respiratória aguda de maneira objetiva.
ABSTRACT Although the PaO 2/FiO 2 derived from arterial blood gas analysis remains the gold standard for the diagnosis of acute respiratory failure, the SpO2/FiO2 has been investigated as a potential substitute. The current narrative review presents the state of the preclinical and clinical literature on the SpO2/FiO2 as a possible substitute for PaO2/FiO2 and for use as a diagnostic and prognostic marker; provides an overview of pulse oximetry and its limitations, and assesses the utility of SpO2/ FiO2 as a surrogate for PaO2/FiO2 in COVID-19 patients. Overall, 49 studies comparing SpO2/FiO2 and PaO2/FiO2 were found according to a minimal search strategy. Most were conducted on neonates, some were conducted on adults with acute respiratory distress syndrome, and a few were conducted in other clinical scenarios (including a very few on COVID-19 patients). There is some evidence that the SpO2/ FiO2 criteria can be a surrogate for PaO2/FiO2 in different clinical scenarios. This is reinforced by the fact that unnecessary invasive procedures should be avoided in patients with acute respiratory failure. It is undeniable that pulse oximeters are becoming increasingly widespread and can provide costless monitoring. Hence, replacing PaO2/FiO2 with SpO2/FiO2may allow resourcelimited facilities to objectively diagnose acute respiratory failure.
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Objective:To investigate the clinical efficacy of Qianjin Weijing Decoction in the treatment of severe pneumonia with the accumulation of phlegm and heat in the lung. Methods:Eighty patients with severe pneumonia with the accumulation of phlegm and heat in the lung received treatment in Wenzhou Hospital of Traditional Chinese Medicine from December 2018 to December 2020. They were randomly allocated to undergo routine treatments (control group, n = 40) or routine treatments combined with Qianjin Weijing Decoction (observation group, n = 40) for 7 days. Clinical efficacy, blood gas analysis, oxygenation index, inflammatory factors (C-reactive protein and procalcitonin), and sequential organ failure score were compared between the two groups. Results:Total response rate in the observation group was significantly higher than that in the control group [87.50% (35/40) vs. 65.00% (26/40), χ2 = 5.59, P < 0.05]. Partial pressure of carbon dioxide (PaCO 2) post-treatment was significantly lower in the observation group than that in the control group [(30.24 ± 2.68) mmHg vs. (39.95 ± 3.27) mmHg, t = 14.52, P < 0.05]. The partial pressure of blood oxygen (PaO 2) and oxygenation index (PaO 2/FiO 2) in the observation group were (76.85 ± 4.56) mmHg and (326.84 ± 8.49) mmHg, respectively, which were significantly higher than those in the control group [(68.39 ± 4.12) mmHg, (284.16 ± 15.56) mmHg, t = -8.70, -15.22, both P < 0.05). Serum levels of C-reactive protein and procalcitonin post-treatment in the observation group were (23.12 ± 6.56) mg/L and (0.31 ± 0.08) μg/L, respectively, which were significantly lower than those in the control group [(38.92 ± 5.62) mg/L, (0.78 ± 0.20) μg/L, t = 11.56, 13.80, both P < 0.05]. Sequential organ failure score was significantly lower in the observation group than in the control group [(2.31 ± 0.46) points vs. (5.12 ± 1.25) points, t = 13.34, P < 0.05)]. Conclusion:Qianjin Weijing Decoction has a good therapeutic effect on severe pneumonia with the accumulation of phlegm and heat in the lung. The treatment can improve blood gas analysis and decrease inflammatory factor levels with a good prognosis.
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Objective:To make Excel spreadsheet of arterial blood gas analysis to judge the types of acid-base imbalance quickly and accurately, and guide the clinical treatment of acid-base disorders.Methods:According to the Henderson-Hasselbalch equation, the compensation formula of acid-base imbalance prediction, the theory of acid-base balance and the related research progress, the analysis process of acid-base balance disorder was settled, and the IF function in Microsoft Office Excel 2003 was used to edit the formula to make Excel spreadsheet for arterial blood gas analysis.Once the pH value, artery blood carbon dioxide pressure (PaCO 2), actual bicarbonate (HCO 3-), sodiumion (Na + ), chlorineion (Cl -) and compensatory time-limited parameters were input, the types of acid-base imbalance can be shown.Arterial blood gas analysis of 185 cases from intensive care unit at Xuzhou Central Hospital was determined by Excel spreadsheet group and manual group respectively, the results and time of judging the type of acid-base imbalance were compared between two groups for statistical analysis. Results:The results of acid-base imbalance between two groups were compared, and 42 cases were normal and simple acid-base and the consistent rate was 100%, double acid-base imbalances of 107 cases with the consistent rate of 97.20%, triple acid-base imbalances of 36 cases with the consistent rate of 91.67%.After Kappa consistency test (Kappa value=0.944) and Pair chi-square Test (McNemar-Bowker Test)( P=0.223), the results of two groups were consistent.It took less time to judge the results of normal or simple acid-base imbalance[(32.32±4.26)s vs.(75.88±19.22)s], double acid-base imbalance[(31.28±5.31)s vs.(137.56±37.64)s] and triple acid-base imbalance[(32.98±4.23)s vs.(315.09±89.37)s] by the Excel spreadsheet group compared with the manual group, and the differences were statistically significant ( P<0.01). Conclusion:The automatic judging of Excel spreadsheet for arterial blood gas analysis can quickly and accurately determine the types of acid-base imbalance in arterial blood gas analysis and has more advantages for triple acid and base imbalance especially with simple interface and simple operation.And it can avoid the missing judgment of acid and base imbalance when pH is 7.35 to 7.45.
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Objective:To observe the clinical efficacy of sacubitril-valsartan combined with Haikun Shenxi in the treatment of chronic left heart failure with renal insufficiency.Methods:A total of 80 patients with chronic left heart failure and renal insufficiency who were admitted to Dalian Municipal Central Hospital from October 2019 to October 2020 were selected as the research objects. They were divided into two groups by random digits table method, 40 cases in each group. The control group was treated with sacubitril-valsartan. The observation group was based on the control group plus Haikun Shenxi Capsule, and N-terminal pro-brain natriuretic peptide (NT-proBNP), heart function indexes, kidney function indexes, blood gas indexes and quality of life in two groups were compared.Results:NT-proBNP, serum creatinine and blood urea nitrogen in the observation group were significantly lower than those in the control group after treatment: (1 034.27 ± 87.33) μg/L vs. (1 421.46 ± 105.54) μg/L, (240.53 ± 45.26) μmol/L vs. (284.52 ± 52.47) μmol/L, (12.05 ± 1.87) mmol/L vs. (15.79 ± 1.87) mmol/L, the difference was statistically significant ( t = 17.88, 4.01 and 8.62; P<0.01); left ventricular end-diastolic dimension (LVEDD) after treatment in the observation group was significantly lower than that in the control group: (46.12 ± 1.05) mm vs. (48.81 ± 1.74) mm, left ventricular ejection fraction (LVEF) and cardiac index (CI) were significantly higher than those in the control group: (49.95 ± 2.17)% vs. (45.24 ± 3.22)%, (2.98 ± 0.55) L/(min·m 2) vs. (2.45 ± 0.73) L/(min·m 2), the difference was statistically significant ( t = 7.67, 8.38 and 3.66; P<0.01); the blood gas index arterial partial pressure of carbon dioxide (PaCO 2) in the observation group after treatment was significantly lower than that in the control group: (46.34 ± 3.52) mmHg (1 mmHg = 0.133 kPa) vs. (51.63 ± 4.25) mmHg, arterial partial pressure of oxygen (PaO 2), oxygen saturation of haemoglobin (SO 2), pH, HCO 3-, base excess (BE) were significantly higher than the control group: (69.35 ± 5.12) mmHg vs. (62.45 ± 4.86) mmHg, (90.46 ± 4.02)% vs. (85.36 ± 4.32)%, 7.32 ± 0.12 vs. 7.22 ± 0.15, (23.1 ± 2.0) mmol/L vs. (21.5 ± 1.9) mmol/L, (-1.57 ± 0.67) mmol/L vs. (-2.15 ± 0.85) mmol/ L, the differences were statistically significant ( t = 6.06, 6.18, 5.47, 3.33, 3.67 and 3.39; P<0.01); the quality of life scores PD, ED, OD and TS in the observation group after treatment were lower than those in the control group: (17.80 ± 3.11) scores vs. (22.35 ± 2.72) scores, (12.28 ± 2.10) scores vs. (15.74 ± 1.73) scores, (18.27 ± 1.69) scores vs. (25.54 ± 2.33) scores, (46.68 ± 3.15) scores vs. (62.17 ± 3.63) scores, the differences was statistically significant ( t = 6.97, 8.05, 15.30 and 20.38; P<0.01). Conclusions:The sacubitril-valsartan combined with Haikun Shenxi in the treatment of chronic left heart failure with renal insufficiency has a significant clinical effect. It could effectively improve the patient's heart and kidney function and blood gas indicators, and further improve the patient's quality of life.
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Objective:To investigate the efficacy of Kechuanning combined with western medicine on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and its effects on serum amyloid A, interleukin 1β and procalcitonin levels. Methods:A total of 104 patients with AECOPD who received treatment in Yongkang Hospital of Traditional Chinese Medicine from January 2019 to December 2020 were included in this study. They were randomly assigned to receive either symptomatic treatment with western medicine alone ( n = 52, control group) or symptomatic treatment with western medicine combined with Kechuanning ( n = 52, observation group). Therapeutic effects, latency to clinical symptom relief, pre- and post-treatment pulmonary function, serum inflammatory factor levels, and blood gas analysis indexes were compared between the two groups. Results:Total response rate in the observation group was significantly higher than that in the control group [86.54% (45/52) vs. 67.31%(35/52), χ2 = 4.99, P < 0.05]. Latency to rale disappearance, latency to cough disappearance, length of hospital stay in the observation group were (8.25 ± 1.38) days, (10.05 ± 1.53) days, and (12.65 ± 2.28) days, which were significantly shorter than those in the control group [(9.41 ± 1.46) days, (12.19 ± 1.61) days, (14.36 ± 2.14) days, t = 4.16, 6.98, 3.61, all P < 0.05]. After treatment, forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1), and FEV 1/FVC value in the observation group were (1.88 ± 0.5) L, (64.13 ± 5.72)%pred, (59.43 ± 5.57)%, respectively, which were significantly higher than those in the control group [(1.65 ± 0.51) L, (60.22 ± 5.60)% pred, (54.16 ± 5.19)%, t = 2.17, 3.52, 4.99, all P < 0.05]. Arterial partial pressure of oxygen (PaO 2) and blood oxygen saturation (SpO 2) in the observation group were (9.18 ± 0.89) kPa and (96.26 ± 2.13)%, respectively, which were significantly higher than those in the control group [(8.74 ± 0.76) kPa, (94.07 ± 2.08)%, t = 2.71, 5.305, both P < 0.05]. Partial pressure of carbon dioxide (PaCO 2) in the observation group was significantly lower than that in the control group [(7.32 ± 0.27) kPa vs. (7.63 ± 0.32) kPa, t = 5.34, P < 0.05]. Serum amyloid protein, interleukin-1β and procalcitonin levels in the observation group were (43.84 ± 6.15) mg/L, (3.24 ± 0.51) μg/L, (1.55 ± 0.37) ng/L, respectively, which were significantly lower than those in the control group [(55.26 ± 3.46) mg/L, (4.19 ± 0.56) μg/L, (2.03 ± 0.46) ng/L, t = 9.23, 9.04, 5.86, all P < 0.05]. Conclusion:Kechuanning as an adjuvant therapy for AECOPD can greatly improve lung function and hypoxia, alleviate clinical symptoms, reduce inflammatory reactions, and have a definite clinical effect. The study is innovative and scientific and is worthy of clinical reference.
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Objective:To investigate the clinical efficacy of sequential invasive-noninvasive mechanical ventilation for chronic obstructive pulmonary disease complicated by type II respiratory failure.Methods:Eighty-four patients with chronic obstructive pulmonary disease complicated by type II respiratory failure who received treatment in The First Affiliated Hospital of University of Science and Technology of China from January 2017 to December 2019 were included in this study. Patients were selected to withdraw the ventilator for performing a spontaneous breathing test according to recovery status. Patients who underwent invasive mechanical ventilation were included in the control group ( n = 42). Patients who underwent sequential invasive-noninvasive mechanical ventilation based on the pulmonary infection control window were included in the observation group. Mortality rate, reintubation rate, total ventilation time, length of hospital stay, heart rate, and blood gas analysis were compared between the two groups. Results:The length of hospital stay and total ventilation time in the observation group were (9.69 ± 1.94) days and (7.49 ± 1.53) days, respectively, which were significantly shorter than those in the control group ( t = 8.87, 5.10, both P < 0.05). Reintubation rate and mortality rate in the observation group were 4.76% (2/42) and 2.38% (1/42), respectively, which were significantly lower than those in the control group ( χ2 = 5.13, 3.90, both P < 0.05). In each group, heart rate, partial pressure of carbon dioxide and partial pressure of oxygen measured after treatment were superior to those measured before treatment (all P < 0.05). Conclusion:Based on pulmonary infection control window, invasive-noninvasive sequential ventilation for chronic obstructive pulmonary disease complicated by type II respiratory failure can not only reduce total ventilation time and length of hospital stay, remarkably improve clinical manifestations, but also effectively reduce reintubation rate and mortality rate.
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Objective:To analyze the factors influencing pH value in umbilical arterial blood gas (UABG) analysis in preterm infants.Methods:A retrospective study was conducted on live singleton preterm infants ( n=573) who received UABG analysis in Peking University Third Hospital from January 2017 to February 2019. Analysis of variance, independent sample t-test, Spearman's or Pearson's correlation analysis, or linear regression analysis was used to analyze the influencing factors. Results:There was no significant difference in UABG pH value between preterm infants of different gestational ages (F=1.74, P=0.077). Spearman's correlation analysis found no correlation between gestational age and UABG pH value in premature infants ( r=0.003, P=0.940), and neither did Pearson's correlation between birth weight and pH value ( r=0.025, P=0.548). UABG pH value in preterm infants was linearly correlated with vaginal delivery ( t=－5.72, P<0.001), gestational hypertension ( t=－3.99, P<0.001) and placental abruption ( t=－4.52, P<0.001). Conclusions:Preterm infants at different gestational ages show a similar pH value in UABG. For those born to mothers with gestational hypertension or placental abruption, when vaginal delivery is pending, close monitoring and full preparation for resuscitation are necessary.