目的探讨经鼻高流量氧疗(HNFC)在颈椎损伤伴高位截瘫患者术后脱机中的价值。方法回顾性分析2016年9月至2018年3月中一家大学附属三级甲等综合性医院急诊ICU颈椎损伤伴高位截瘫并进行手术患者,术后在符合常规的脱机拔管程序基础上进行脱...目的探讨经鼻高流量氧疗(HNFC)在颈椎损伤伴高位截瘫患者术后脱机中的价值。方法回顾性分析2016年9月至2018年3月中一家大学附属三级甲等综合性医院急诊ICU颈椎损伤伴高位截瘫并进行手术患者,术后在符合常规的脱机拔管程序基础上进行脱机拔管,比较使用高流量氧疗(HNFC)组和常规氧疗组(COT组)对患者拔管后72 h再插管率、ICU住院时间及拔管后6、24、72 h患者呼吸频率、心率、平均动脉压(MAP)氧饱和度(SaO2)、氧合指数(PaO2/FiO2)及二氧化碳分压(PaCO2)。结果共纳入符合入组标准的患者38例,其中HFNC组16例,COT组22例;脱机拔管后6 h HFNC组患者呼吸频率、氧饱和度(SaO2)、氧合指数(PaO2/FiO2)均优于COT组(P<0.05),患者心率、平均动脉压(MAP)、血气分析中二氧化碳分压(PaCO2)两组差异无统计学意义(P=0.39);脱机拔管后24 h、72 h HFNC组PaO2/FiO2优于COT组(P<0.05),HFNC组患者PaCO2值显著小于COT组(P<0.05),脱机拔管后24h血氧饱和度(SaO2)HFNC组优于COT组(P<0.05),但72 h血氧饱和度(SaO2)两组差异无统计学意义(P=0.21)、呼吸频率、心率及平均动脉压(MAP)两组两个时间点差异无统计学意义。HNFC组中拔管后72 h内有3例患者重新插管(18.8%),COT组有6例患者重新插管(27.3%),两组再插管率比较差异有统计学意义(P<0.05);两组患者ICU住院时间比较:(15.5±3.4) d vs (16.6±5.2) d,差异无统计学意义。结论针对基于颈椎损伤伴高位截瘫患者术后脱机拔管患者中,使用经鼻高流量氧疗较常规氧疗可以改善拔管后患者的呼吸及氧合情况,降低拔管患者24、72 h的PaCO2,明显降低患者重新插管率,但并不减少ICU的住院时间。展开更多
<strong>Objective:</strong> Explore the rule of autonomic nervous dysfunction in the patients with urination disorder after high level spinal cord injury, and seek a safe, objective and accurate method to ...<strong>Objective:</strong> Explore the rule of autonomic nervous dysfunction in the patients with urination disorder after high level spinal cord injury, and seek a safe, objective and accurate method to evaluate autonomic nervous function. <strong>Patients and Method:</strong> 48 patients with dysuria after cervicothoracic SCI were selected. Before, during and after imaging urodynamic examination with slow filling in supine position, blood pressure and ECG were monitored simultaneously. The symptoms of sweating, shivering, headache, flushing and chills were observed and recorded. The study of the relationship among the changes of blood pressure, heart rate and urodynamic indexes and the above symptoms was analyzed. <strong>Results:</strong> They were divided into three groups: group A (no obvious abnormality), group B (hyperactivity) and group C (hypoactivity) according to their BP, HR and existing the symptoms or not. <strong>Conclusion:</strong> The incidence of autonomic dysfunction in the high level SCI patients with dysuria was very high (79.17%), most of them were hyperactivity, and a few were low function. The changes of SBP and DBP in the hypoactivity group all appeared an increasing and then declining trend, while the change of HR in the low function one was lower than normal and decreased continuously. The main inducements of AD are neurogenic detrusor overactivity, detrusor sphincter dyssynergia, elevated abdominal pressure and abnormal bladder sensitivity. The asymptomatic patients had a higher occurrence rate (43.75%). Only by imaging urodynamic examination with slow filling and synchronous blood pressure monitoring, can autonomic nervous function of the patients be evaluated safely, objectively, early and accurately.展开更多
文摘目的探讨经鼻高流量氧疗(HNFC)在颈椎损伤伴高位截瘫患者术后脱机中的价值。方法回顾性分析2016年9月至2018年3月中一家大学附属三级甲等综合性医院急诊ICU颈椎损伤伴高位截瘫并进行手术患者,术后在符合常规的脱机拔管程序基础上进行脱机拔管,比较使用高流量氧疗(HNFC)组和常规氧疗组(COT组)对患者拔管后72 h再插管率、ICU住院时间及拔管后6、24、72 h患者呼吸频率、心率、平均动脉压(MAP)氧饱和度(SaO2)、氧合指数(PaO2/FiO2)及二氧化碳分压(PaCO2)。结果共纳入符合入组标准的患者38例,其中HFNC组16例,COT组22例;脱机拔管后6 h HFNC组患者呼吸频率、氧饱和度(SaO2)、氧合指数(PaO2/FiO2)均优于COT组(P<0.05),患者心率、平均动脉压(MAP)、血气分析中二氧化碳分压(PaCO2)两组差异无统计学意义(P=0.39);脱机拔管后24 h、72 h HFNC组PaO2/FiO2优于COT组(P<0.05),HFNC组患者PaCO2值显著小于COT组(P<0.05),脱机拔管后24h血氧饱和度(SaO2)HFNC组优于COT组(P<0.05),但72 h血氧饱和度(SaO2)两组差异无统计学意义(P=0.21)、呼吸频率、心率及平均动脉压(MAP)两组两个时间点差异无统计学意义。HNFC组中拔管后72 h内有3例患者重新插管(18.8%),COT组有6例患者重新插管(27.3%),两组再插管率比较差异有统计学意义(P<0.05);两组患者ICU住院时间比较:(15.5±3.4) d vs (16.6±5.2) d,差异无统计学意义。结论针对基于颈椎损伤伴高位截瘫患者术后脱机拔管患者中,使用经鼻高流量氧疗较常规氧疗可以改善拔管后患者的呼吸及氧合情况,降低拔管患者24、72 h的PaCO2,明显降低患者重新插管率,但并不减少ICU的住院时间。
文摘<strong>Objective:</strong> Explore the rule of autonomic nervous dysfunction in the patients with urination disorder after high level spinal cord injury, and seek a safe, objective and accurate method to evaluate autonomic nervous function. <strong>Patients and Method:</strong> 48 patients with dysuria after cervicothoracic SCI were selected. Before, during and after imaging urodynamic examination with slow filling in supine position, blood pressure and ECG were monitored simultaneously. The symptoms of sweating, shivering, headache, flushing and chills were observed and recorded. The study of the relationship among the changes of blood pressure, heart rate and urodynamic indexes and the above symptoms was analyzed. <strong>Results:</strong> They were divided into three groups: group A (no obvious abnormality), group B (hyperactivity) and group C (hypoactivity) according to their BP, HR and existing the symptoms or not. <strong>Conclusion:</strong> The incidence of autonomic dysfunction in the high level SCI patients with dysuria was very high (79.17%), most of them were hyperactivity, and a few were low function. The changes of SBP and DBP in the hypoactivity group all appeared an increasing and then declining trend, while the change of HR in the low function one was lower than normal and decreased continuously. The main inducements of AD are neurogenic detrusor overactivity, detrusor sphincter dyssynergia, elevated abdominal pressure and abnormal bladder sensitivity. The asymptomatic patients had a higher occurrence rate (43.75%). Only by imaging urodynamic examination with slow filling and synchronous blood pressure monitoring, can autonomic nervous function of the patients be evaluated safely, objectively, early and accurately.
