目的在围麻醉期和危重患者的通气中，高浓度氧吸入可引起肺泡不张，肺内分流率增加，长时间应用可引起肺实质损害。研究观察术后麻醉恢复期不同吸入氧浓度通气对拔管前氧储备和肺换气功能的影响，为通气选择合适的吸入氧浓度提供依据。...目的在围麻醉期和危重患者的通气中，高浓度氧吸入可引起肺泡不张，肺内分流率增加，长时间应用可引起肺实质损害。研究观察术后麻醉恢复期不同吸入氧浓度通气对拔管前氧储备和肺换气功能的影响，为通气选择合适的吸入氧浓度提供依据。方法152例不吸烟的全麻择期手术患者，进入麻醉恢复室（post anesthesia care unit，PACU）后接呼吸机，通气模式为同步间歇指令通气，调节吸入氧浓度为35％，进行肺活量膨肺的肺复原操作，操作结束后，呼吸机调回同步间歇指令通气模式。根据完全随机的原则分为4组（每组38例）：0．35吸入氧浓度（fraction of inspired oxygen in nitrogen，FiO2）组，0．50FiO2组，0．75FiO2组，1．0FiO2组。通气5min，停止通气。当血氧饱和度下降至90％，接上呼吸机。穿刺抽取足背动脉血，并根据公式计算肺内分流率（Qs／Qt）和氧合指数（PaO2/FiO2）。结果0．35FiO2组0．50Fi02组，0．75FiO2组和1．0FiO2组的无通气时限分别为（129±42）、（178±61）、（340±152）、（421±153）S（P〈0．001）。1．0FiO2组的无通气时限高于0．75F102组，但差异无统计学意义。1．0FiO2组的无通气时限明显高于0．35FiO2组和0．50FiO2组（P〈0．005）；0．75FiO2组的无通气时限非常明显高于0．35F1O2组和0．50FiO2组（P〈0．005）。0．50FiO2组的无通气时限高于0．35F1O2组，但差异无统计学意义。0．35FiO2组0．50FiO2组，0．75FiO2组的肺内分流率分别为（4．1±1．1）、（4．6±1．3）、（5．1±2．5）％，均明显低于1．0FiO2组（13．1±4．5）％（P〈0．001）。0．35FiO2组，0．50FiO2组和0．75FiO2组氧合指数分别为（494±75）、（523±70）、（536±80），明显高于1．0FiO2组（423±94，P〈0．005）。结论吸人0．75的氧能够改善肺换气功能，但无通气时限减少。展开更多
在全身麻醉过程中,特别是在气管插管和拔管之前,使用较高的FiO2是一种常见做法。近年来,对围手术期是否应该使用高浓度氧的争议越来越大。文章综述了高浓度氧在围手术期使用的利弊,围绕围手术期使用高浓度氧的不利影响,即活性氧(reactiv...在全身麻醉过程中,特别是在气管插管和拔管之前,使用较高的FiO2是一种常见做法。近年来,对围手术期是否应该使用高浓度氧的争议越来越大。文章综述了高浓度氧在围手术期使用的利弊,围绕围手术期使用高浓度氧的不利影响,即活性氧(reactive oxygen species,ROS)引起的氧化应激增加、导致组织氧合受损的高氧性血管收缩和吸收性肺不张等,分别从高氧病理生理机制及临床研究数据两个方面展开讨论;也探讨了使用高浓度氧的益处,包括减少外科手术部位感染(surgical site infection,SSI)与术后恶心呕吐(postoperative nausea and vomiting,PONV)的发生,增加术中紧急情况下的缺氧耐受时间。展开更多
Background: Results from experimental and clinical studies have shown that mechanical ventilation or/and hyperoxia may aggravate a pre-existing lung injury or even cause lung injury in healthy lungs by affecting the e...Background: Results from experimental and clinical studies have shown that mechanical ventilation or/and hyperoxia may aggravate a pre-existing lung injury or even cause lung injury in healthy lungs by affecting the expression of MMP-9, but the MMP-9 effects are controversial. How are MMP-9 regulated when multicausative factors of injury such as different FiO2, PIP, and respiratory time (RT) impose simultaneously on lungs? Methods: Newborn New Zealand white rabbits were randomly allocated to an unventilated air control group or to one of the 2 × 3 × 3 ventilation strategies by using a factorial design, with different FiO2, PIP, and RT. Then, lung wet-to-dry ratio (W/D), lung histopathology scores, transmission electron microscope, and cells in BALF were analyzed in these different groups. MMP-9 levels were studied by immunohistochemistry and ELISA. Results: MMP-9 levels were significantly different among 3 PIP ventilation regimes (F = 7.215) and MPIP group was the highest among 3 PIP groups. The lung histopathology score in 100% oxygen was significantly higher than in 45% oxygen group (F = 9.037) and MPIP group was the lowest among 3 PIP groups (F = 57.515) and RT 6 h was more serious than RT 1 h. MMP-9 positively correlated with monocytes, but negatively correlated with neutrophils and lung injury histopathology scores. Conclusions: Different PIP and FiO2 exert simultaneously on newborn lung in newborn rabbits ventilation, only mechanical stretch stimulation affects MMP-9 synthesis. Advisable mechanical stretch can promote MMP-9 expression and has protective role in lung in VILI. HPIP causes barotraumas and LPIP induces atelectrauma.展开更多
文摘目的在围麻醉期和危重患者的通气中，高浓度氧吸入可引起肺泡不张，肺内分流率增加，长时间应用可引起肺实质损害。研究观察术后麻醉恢复期不同吸入氧浓度通气对拔管前氧储备和肺换气功能的影响，为通气选择合适的吸入氧浓度提供依据。方法152例不吸烟的全麻择期手术患者，进入麻醉恢复室（post anesthesia care unit，PACU）后接呼吸机，通气模式为同步间歇指令通气，调节吸入氧浓度为35％，进行肺活量膨肺的肺复原操作，操作结束后，呼吸机调回同步间歇指令通气模式。根据完全随机的原则分为4组（每组38例）：0．35吸入氧浓度（fraction of inspired oxygen in nitrogen，FiO2）组，0．50FiO2组，0．75FiO2组，1．0FiO2组。通气5min，停止通气。当血氧饱和度下降至90％，接上呼吸机。穿刺抽取足背动脉血，并根据公式计算肺内分流率（Qs／Qt）和氧合指数（PaO2/FiO2）。结果0．35FiO2组0．50Fi02组，0．75FiO2组和1．0FiO2组的无通气时限分别为（129±42）、（178±61）、（340±152）、（421±153）S（P〈0．001）。1．0FiO2组的无通气时限高于0．75F102组，但差异无统计学意义。1．0FiO2组的无通气时限明显高于0．35FiO2组和0．50FiO2组（P〈0．005）；0．75FiO2组的无通气时限非常明显高于0．35F1O2组和0．50FiO2组（P〈0．005）。0．50FiO2组的无通气时限高于0．35F1O2组，但差异无统计学意义。0．35FiO2组0．50FiO2组，0．75FiO2组的肺内分流率分别为（4．1±1．1）、（4．6±1．3）、（5．1±2．5）％，均明显低于1．0FiO2组（13．1±4．5）％（P〈0．001）。0．35FiO2组，0．50FiO2组和0．75FiO2组氧合指数分别为（494±75）、（523±70）、（536±80），明显高于1．0FiO2组（423±94，P〈0．005）。结论吸人0．75的氧能够改善肺换气功能，但无通气时限减少。
文摘在全身麻醉过程中,特别是在气管插管和拔管之前,使用较高的FiO2是一种常见做法。近年来,对围手术期是否应该使用高浓度氧的争议越来越大。文章综述了高浓度氧在围手术期使用的利弊,围绕围手术期使用高浓度氧的不利影响,即活性氧(reactive oxygen species,ROS)引起的氧化应激增加、导致组织氧合受损的高氧性血管收缩和吸收性肺不张等,分别从高氧病理生理机制及临床研究数据两个方面展开讨论;也探讨了使用高浓度氧的益处,包括减少外科手术部位感染(surgical site infection,SSI)与术后恶心呕吐(postoperative nausea and vomiting,PONV)的发生,增加术中紧急情况下的缺氧耐受时间。
文摘Background: Results from experimental and clinical studies have shown that mechanical ventilation or/and hyperoxia may aggravate a pre-existing lung injury or even cause lung injury in healthy lungs by affecting the expression of MMP-9, but the MMP-9 effects are controversial. How are MMP-9 regulated when multicausative factors of injury such as different FiO2, PIP, and respiratory time (RT) impose simultaneously on lungs? Methods: Newborn New Zealand white rabbits were randomly allocated to an unventilated air control group or to one of the 2 × 3 × 3 ventilation strategies by using a factorial design, with different FiO2, PIP, and RT. Then, lung wet-to-dry ratio (W/D), lung histopathology scores, transmission electron microscope, and cells in BALF were analyzed in these different groups. MMP-9 levels were studied by immunohistochemistry and ELISA. Results: MMP-9 levels were significantly different among 3 PIP ventilation regimes (F = 7.215) and MPIP group was the highest among 3 PIP groups. The lung histopathology score in 100% oxygen was significantly higher than in 45% oxygen group (F = 9.037) and MPIP group was the lowest among 3 PIP groups (F = 57.515) and RT 6 h was more serious than RT 1 h. MMP-9 positively correlated with monocytes, but negatively correlated with neutrophils and lung injury histopathology scores. Conclusions: Different PIP and FiO2 exert simultaneously on newborn lung in newborn rabbits ventilation, only mechanical stretch stimulation affects MMP-9 synthesis. Advisable mechanical stretch can promote MMP-9 expression and has protective role in lung in VILI. HPIP causes barotraumas and LPIP induces atelectrauma.
