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Mechanical ventilation is an advanced life support treatment for patients with acute respiratory failure. While stabilizing respiratory function, it also acts as an injury factor to exacerbate or lead to lung injury, that is, ventilation-induced lung injury (VILI). There may be a more subtle form of damage to VILI known as "biotrauma". However, the mechanism of biotrauma in VILI is still unclear. This article intends to review the mechanism of biotrauma of VILI from the aspects of inflammatory response, oxidative stress and complement activation, in order to provide a new strategy for clinical prevention and treatment of biotrauma caused by VILI.
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OBJECTIVE To explorethe correlation betweenhypoxiaand insulin resistance bythe blood gas index in high-fat diets-induced obese rat model. METHODS 36％ of high-fat diets were fed to SD male rats for 12 weeks. The model group was divided into IR group and non-IR group with the HOMA-IR index of the 12th week,and the abdominal aorta blood was taken for blood gas analysis. RESULTS The HOMA-IR index,Hct,ctHb and ctO2in IR group were significantly higher than those in normal group andnon-IR group(P>0.05),simultaneously no significant difference in pO2,pCO2and sO2 between tree groups.CONCLUSION Circulating blood of obese rat with insulin resistance is normoxia,accompanied by higher Hct,tHb and ctO2,which may be due to the higher blood viscositand the self-regulation of chronic hypoxia in the body.
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Objective To investigate the clinical efficacies of Milrinone on cardiac function and blood-gas analytic indices in elderly patients with chronic heart failure.Methods During January 2013 to December 2016,50 elderly patients with chronic congestive heart failure admitted into the First People's Hospital of Qingdao Economic and Technological Development Zone were randomly selected and divided into the observation group (n=25) and the control group (n=25).The control group was given conventional treatment including diuretics,ACEI/ARBs,vasodilators,β-adrenergic receptor inhibitors and digitalis drugs,as well as anti-infection,fluid intake treatment and inhibiting the excessive activation of nerve-endocrine system.And Milrinone was taken as add-on to the therapy of control group in observation group.The changes in cardiac function,blood-gas analysis indices and adverse reactions were compared between the two groups.Results The total improvement rate of cardiac function was significantly higher in the observation group than in control group (92.0％ vs.76.0 ％,x2 =5.446,P＜ 0.05).The cardiac function indices,blood-gas analysis index and the level of CRP were significantly improved after treatment versus before treatment in both groups (all P＜0.05).And these improvements were significantly more superior in observation group than in control group (P＜0.05).Conclusions Milrinone can significantly improve the clinical efficacies in elderly patients with chronic heart failure.It can also improve the blood-gas indices and alleviate clinical symptoms,which seems to deserve more clinical application and promotion.
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Objective To investigate the effects of different ventilation modes on PaCO 2 and PaO 2 during laparoscopic surgery in the Trendelenburg position.Methods Forty cases of laparoscopic resection of rectal cancer were randomly divided into group A (n =20)and group B (n =20).Under general anesthesia,all the cases were in volume-controlled ventilation mode (VCV,tidal volume=10 ml/kg)before pneumoperitoneum.After ventilating in VCV mode for 20 minutes with a lower tidal volume (8 ml/kg),group A was converted to PCV mode for 20 minutes and then back to the VCV mode for 20 minutes again.Next we switched to PCV combined with PEEP (5 cm H 2 O)mode (PCV+PEEP)for 20 minutes.In group B,we only alternated PCV with PCV combined with PEEP.Arte-rial blood-gas analysis was obtained at each time when ventilating mode changed.Results In both group A and B,PaO 2 in VCV mode was less than that in PCV mode and PCV+PEEP mode (P <0.05),PaO 2 in PCV mode was also less than that in mode PCV+PEEP mode (P <0.05).PaCO 2 in PCV and PCV combined with PEEP mode was less than that in VCV mode (P <0.05 ),and there was no difference of PaCO 2 in PCV mode and PCV+PEEP mode.The pH value in VCV mode was less than that in PCV mode and PCV+PEEP mode (P < 0.05).There was no difference in pH value between PCV mode and PCV+PEEP mode.Conclusion PCV combined PEEP mode is beneficial ei-ther in increasing or decreasing of PaCO 2 during laparoscopic surgery in the Trendelenburg position comparing with single VCV mode or PCV mode.
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Objective:To analyze statistically the results of potassium, sodium, chlorine tests by blood-gas biochemical analyzer and automatic biochemical analyzer, in order to have a reference data for blood-gas biochemical analyzer in emergency biochemistry examination.Methods: A total of 101 cases were selected in emergency department. Arterial and venous blood samples of these cases were drawn and tested in electrolyte examination by blood-gas biochemical analyzer and automatic biochemical analyzer. The results of both instruments measured were analyzed statistically.Results: The results of potassium, sodium, chloride ion concentrations tested by blood-gas analyzer ABL80 were lower than the results tested by Beckman AU5800 automatic biochemical analyzer. The correlation analysis were performed in each tested item between the two instruments, and the differences were statistically significant(r=0.997,r=0.992,r=0.989;P<0.05).Conclusion: Although there were differences between two instruments in testing potassium, sodium and chloride ion concentration, the correlation was significant in each test item between the two instruments and the testing speed of blood-gas analyzer ABL80 is faster than the other. Therefore, in order to make quick and accurate clinical judgments about patient's condition, it is worth using blood-gas biochemical analyzer for a preliminary reference in clinical application.
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Objective To analyze the comparability of potassium results detected by blood-gas analyzer and dry chemical analy-zer .Methods Dry chemical detection system was used as comparison method (X) ,and blood gas analyzer systems was used as the experimental method (Y ) .Arterial blood samples collected from ICU newborns were detected respectively by the two methods .If SE of medical decision level was less than or equal to 1/2 TEa decided by CLIA′88 ,the results was acceptable .Results There was a linear correlation in potassium concentrations of the two detection systems(r=0 .976 ,P<0 .01) .But among three medical decision levels ,the SE of the two detection systems only acceptable at 3 .0 mmol/L .Conclusion The potassium concentration of blood gas analyzer is lower than that of dry chemistry analyzer .The potassium concentration of dry chemistry analyzer should be taken as a reference to diagnose and clinical treatment .
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Objective: To study the rescue strategy for patients with severe multiple injuries after sudden disaster under field condition. Methods and results: A 53-year-old female patient was referred to us after hit on the pelvis in the China Wenchuan earthquake. Her symptoms included large volume of hematuria, difficult breath, tenderness of the whole abdomen, and bedsore. Portable B ultrasound revealed effusion of abdomen and left chest cavity, and bladder rupture. Portable blood-gas analyzer indicated severe anemia + hypoxemia + hypokalemia + acidosis. Drainage was done through left chest cavity aspiration and bladder aspiration. Abdominal examination found rectal rupture (perforation), which was managed by Harttman + cystostomy followed by anti-infection treatment. The patient recovered 18 days after operation. Conclusion: The rich experience and skillful surgical management, the full play of portable equipment, the help from the local hospital, together with timely anti-infection management, are the keys to successful rescue of patients with severe multiple injuries under field condition.
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BACKGROUND: The extrauterine fetal incubation system must meet stable blood gas exchange and sufficient oxygen supply to provide the physiologic oxygen consumption of the fetus. In the fetus, blood gas exchange is totally sustained by the placental circulation. The placenta can be regarded as an extracorporeal organ, and the basic structure of placental circulation comprises arteriovenous (AV) bypass. To mimic this mode of circulation, we used AV ECMO (extracorporeal membrane oxygenation) in the goat fetus, and attempted to achieve stable blood gas exchange and oxygen supply to the fetus. METHODS: Pregnant goats, weighting 30 - 35 kg, were anesthetized with N2O-O2-enflurane. We performed a cesarean section with a midline incision, and cannulated via the umbilical vessels after a hysterotomy, and connected the fetuses to an ECMO circuit. The fetus was transferred to an incubator containing normal saline mixed with antibiotics. Blood samples were obtained every 4 to 6 hours from the circuit for electrolytes, hemoglobin and blood gas analysis and arterial blood pressure and heart rate were monitored through the umbilical artery. Oxygen delivery and consumption were calculated from the measured parameters. Microscopic examinations of the liver, kidney and lung were performed 24 hours after ECMO to know the effect of AV ECMO on the circulation of the organ. RESULTS: AV ECMO was done for 24 hours in the six goat fetuses and the main cause of death was circulatory failure. Heart rates and blood pressure were stable during ECMO. Sodium bicarbonate was injected when mild acidosis occurred and blood gas exchange was maintained stable. Mean pump flow rate was 156 +/- 62 ml/min/kg and oxygen extraction ratio was 30.4%. The liver function tests were sustained within normal limits both before and 24 hours after ECMO, but BUN and creatininincreased beyond upper normal limits 24 hours after ECMO. Microscopic features of the liver and kidney showed congestion 24 hours after ECMO. The fetal lung after 24 hours of ECMO especially showed an increase of mature capillaries in the septum and wall of alveoli compared with the twin fetal lung. CONCLUSIONS: These results indicate that the extrauterine fetal incubation model used for this study was suitable to blood gas exchange and utility of oxygen for goat fetuses.
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Feminino , Humanos , Gravidez , Acidose , Antibacterianos , Pressão Arterial , Gasometria , Pressão Sanguínea , Capilares , Causas de Morte , Cesárea , Eletrólitos , Estrogênios Conjugados (USP) , Oxigenação por Membrana Extracorpórea , Feto , Cabras , Frequência Cardíaca , Hemodinâmica , Histerotomia , Incubadoras , Rim , Fígado , Testes de Função Hepática , Pulmão , Membranas , Oxigênio , Consumo de Oxigênio , Placenta , Circulação Placentária , Choque , Bicarbonato de Sódio , Gêmeos , Artérias UmbilicaisRESUMO
0.05). Conclusion: The domestic enflurane's solubilities in different solutions and stability in soda lime is same as the imported enflurane's.
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Studies were made to ascertain the relationship between arterial and end-tidal carbon dioxide tension in 19 patients during caesarean section under general anesthesia(Group 2). 27 nonpregnant patients scheduled for abdominal hysterectomy were also performed as a control group(Group I). 15 and 30 minutes after the induction of anesthesia in group I, and just before uterine incision, 15 minutes following induction in group 2, arterial blood was sampled for PaCO analysis and PETCO2(end-tidal CO2 tension) determined at the same time. In group 1, there was a statistically significant differences between PaCO2 and PETCO2 but in group 2, no differences between them were shown. The highly significant correlations between PaCO2 and PETCO2 in both groups were found. On the basis of the above results, we recommend that non-invasive measurement of PETCO2 can be used reliably in stead of measuring PaO2 to evaluate the ventilatory status during anesthesia in patients for caesarean section.
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Feminino , Humanos , Gravidez , Anestesia , Anestesia Geral , Capnografia , Dióxido de Carbono , Carbono , Cesárea , HisterectomiaRESUMO
Studies were made to ascertain the relationship between arterial and end-tidal carbon dioxide tension in 19 patients during caesarean section under general anesthesia(Group 2). 27 nonpregnant patients scheduled for abdominal hysterectomy were also performed as a control group(Group I). 15 and 30 minutes after the induction of anesthesia in group I, and just before uterine incision, 15 minutes following induction in group 2, arterial blood was sampled for PaCO analysis and PETCO2(end-tidal CO2 tension) determined at the same time. In group 1, there was a statistically significant differences between PaCO2 and PETCO2 but in group 2, no differences between them were shown. The highly significant correlations between PaCO2 and PETCO2 in both groups were found. On the basis of the above results, we recommend that non-invasive measurement of PETCO2 can be used reliably in stead of measuring PaO2 to evaluate the ventilatory status during anesthesia in patients for caesarean section.