目的应用累积Meta分析的方法评价气道压力释放通气(APRV)对急性呼吸窘迫综合征(ARDS)患者住院病死率的影响。方法计算机检索PubMed、Web of Science、Cochrane Library、WanFang Data、CNKI和VIP数据库,搜集与研究目的相关的随机对照试...目的应用累积Meta分析的方法评价气道压力释放通气(APRV)对急性呼吸窘迫综合征(ARDS)患者住院病死率的影响。方法计算机检索PubMed、Web of Science、Cochrane Library、WanFang Data、CNKI和VIP数据库,搜集与研究目的相关的随机对照试验(RCT),检索时限均为建库至2022年6月30日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用StataSE 12.0软件进行累积Meta分析。结果共纳入9个RCT,包括533例患者。Meta分析结果显示,与传统机械通气相比,APRV能够降低ARDS患者的住院病死率[RR=0.70,95%CI(0.54,0.91),P<0.01]。结论当前证据表明,APRV可降低ARDS患者住院病死率。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。展开更多
The present approach is an advancement of the author’s former attempts to develop an atom model of Helium with well-defined electron trajectories. Thus it calls in question the traditional quantum mechanics which ass...The present approach is an advancement of the author’s former attempts to develop an atom model of Helium with well-defined electron trajectories. Thus it calls in question the traditional quantum mechanics which assume—in contrast and as a consequence of Heisenberg’s uncertainty principle—electronic probabilities of presence. Its basic idea consists of the assumption that the motions of the two electrons are influenced by their spins exhibiting the value h/2π, but in two different ways: on the one hand, one spin induces a rotation;and on the other hand, the other spin induces a harmonic oscillation. A second important relation is given by the fact that the retroactive force of the oscillation process is due to the centrifugal force when the process runs along the surface of a sphere, whereas in usual oscillation processes—such as the one of a spring pendulum—it is due to a permanent shift between potential and kinetic energy. Therefore, in the present case, the potential energy remains constant since the distance between the nucleus and the—diametrically positioned—electrons remains constant. Considering these two conditions and the usual physical relations such as Coulomb attraction, centrifugal force, and the conservation laws of the angular momentum and of the energy, it was possible to compute the respective key values. Thereby, the deflection of the oscillation angle ψ = 45˚is remarkable. Finally, the process is described using a Cartesian coordinate system with z as the rotation axis, a variable oscillation distance d and variable rotation velocities r<sub>rot</sub>. Thereby, the projections onto the x-axis and on the y-axis are not identically equal, leading to an elliptic projection shape. Thus this system is anisotropic, in contrast to the isotropic array of the conventional quantum mechanics according to Schrödinger, where the 1s-orbital is spherically symmetrical. This anisotropy explains the existence of interatomic Van der Waals forces, which enable the condensation of He展开更多
目的评价气道压力释放通气(APRV)对急性呼吸窘迫综合征(ARDS)患者的有效性。方法应用计算机检索美国国立医学图书馆PubMed数据库、科学网(Web of Science)、Cochrane图书馆数据库、中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普...目的评价气道压力释放通气(APRV)对急性呼吸窘迫综合征(ARDS)患者的有效性。方法应用计算机检索美国国立医学图书馆PubMed数据库、科学网(Web of Science)、Cochrane图书馆数据库、中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP)、万方数据库2019年12月31日以前公开发表的关于APRV对ARDS患者疗效的临床随机对照试验,并通过纳入文献的参考文献进行引证检索。试验组采用APRV,对照组采用传统机械通气(CV);结局指标包括住院病死率、ICU住院时间、肺顺应性、氧合指数及平均气道压。纳入文献的质量由2名经过专业培训的循证医学研究人员完成,对符合质量标准的文献进行Meta分析,同时采用试验序贯分析(TSA)方法评价APRV对ARDS患者住院病死率样本量的情况。结果纳入8篇文献,共纳入患者461例患者,其中APRV组232例、CV组229例。结果显示APRV能够降低ARDS患者住院病死率(OR=0.63,95%CI=0.40~0.97,P=0.04),TSA结果显示Meta分析的样本量还未达到期望信息量,为避免假阳性结果的出现,还需进一步扩大临床样本量来验证结果的可靠性;APRV能够缩短ARDS患者ICU住院时间(OR=-4.14,95%CI=-6.81~-1.47,P=0.002);同时APRV能够改善ARDS患者肺部顺应性(MD=5.12,95%CI=0.33~9.91,P=0.04);但2组在改善氧合及平均气道压方面并无差异。结论APRV较CV能够降低ARDS患者住院病死率、缩短ARDS患者ICU住院时间、改善肺部顺应性;2组在改善患者氧合及平均气道压方面无差异。展开更多
文摘The present approach is an advancement of the author’s former attempts to develop an atom model of Helium with well-defined electron trajectories. Thus it calls in question the traditional quantum mechanics which assume—in contrast and as a consequence of Heisenberg’s uncertainty principle—electronic probabilities of presence. Its basic idea consists of the assumption that the motions of the two electrons are influenced by their spins exhibiting the value h/2π, but in two different ways: on the one hand, one spin induces a rotation;and on the other hand, the other spin induces a harmonic oscillation. A second important relation is given by the fact that the retroactive force of the oscillation process is due to the centrifugal force when the process runs along the surface of a sphere, whereas in usual oscillation processes—such as the one of a spring pendulum—it is due to a permanent shift between potential and kinetic energy. Therefore, in the present case, the potential energy remains constant since the distance between the nucleus and the—diametrically positioned—electrons remains constant. Considering these two conditions and the usual physical relations such as Coulomb attraction, centrifugal force, and the conservation laws of the angular momentum and of the energy, it was possible to compute the respective key values. Thereby, the deflection of the oscillation angle ψ = 45˚is remarkable. Finally, the process is described using a Cartesian coordinate system with z as the rotation axis, a variable oscillation distance d and variable rotation velocities r<sub>rot</sub>. Thereby, the projections onto the x-axis and on the y-axis are not identically equal, leading to an elliptic projection shape. Thus this system is anisotropic, in contrast to the isotropic array of the conventional quantum mechanics according to Schrödinger, where the 1s-orbital is spherically symmetrical. This anisotropy explains the existence of interatomic Van der Waals forces, which enable the condensation of He
文摘目的评价气道压力释放通气(APRV)对急性呼吸窘迫综合征(ARDS)患者的有效性。方法应用计算机检索美国国立医学图书馆PubMed数据库、科学网(Web of Science)、Cochrane图书馆数据库、中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP)、万方数据库2019年12月31日以前公开发表的关于APRV对ARDS患者疗效的临床随机对照试验,并通过纳入文献的参考文献进行引证检索。试验组采用APRV,对照组采用传统机械通气(CV);结局指标包括住院病死率、ICU住院时间、肺顺应性、氧合指数及平均气道压。纳入文献的质量由2名经过专业培训的循证医学研究人员完成,对符合质量标准的文献进行Meta分析,同时采用试验序贯分析(TSA)方法评价APRV对ARDS患者住院病死率样本量的情况。结果纳入8篇文献,共纳入患者461例患者,其中APRV组232例、CV组229例。结果显示APRV能够降低ARDS患者住院病死率(OR=0.63,95%CI=0.40~0.97,P=0.04),TSA结果显示Meta分析的样本量还未达到期望信息量,为避免假阳性结果的出现,还需进一步扩大临床样本量来验证结果的可靠性;APRV能够缩短ARDS患者ICU住院时间(OR=-4.14,95%CI=-6.81~-1.47,P=0.002);同时APRV能够改善ARDS患者肺部顺应性(MD=5.12,95%CI=0.33~9.91,P=0.04);但2组在改善氧合及平均气道压方面并无差异。结论APRV较CV能够降低ARDS患者住院病死率、缩短ARDS患者ICU住院时间、改善肺部顺应性;2组在改善患者氧合及平均气道压方面无差异。
