多潘立酮对慢性阻塞性肺疾病机械通气患者胃肠功能障碍的临床效果观察

目的:探讨多潘立酮对慢性阻塞性肺疾病(COPD)机械通气患者胃肠功能障碍的临床效果.方法:采用前瞻性随机对照研究方法,选择2010年11月～2012年11月我院重症医学科收治的需要机械通气且存在胃肠功能障碍的COPD患者48例,按抽签法随机分为两组,对照组(n=24)为常规治疗组,治疗组(n_24)在常规治疗基础上给予鼻饲多潘立酮片10 mg,3次/天.观察周期为1周,通过观察患者胃肠功能障碍症状的恢复情况、胃排空情况及实验室检查指标评价多潘立酮的疗效.结果:治疗组和对照组胃肠功能障碍临床症状改善的有效率分别为87.5％和62.5％,治疗组显著高于对照组(P＜0.05);治疗组和对照组胃排空功能的有效率分别为83.33％和58.33％,治疗组显著高于对照组(P＜0.05);对照组治疗前后血红蛋白、离子、白蛋白、肌酐、尿素氮水平比较无显著差异(P＞0.05),治疗组治疗前后各指标亦无统计学差异(P＞0.05).治疗后两组血红蛋白,白蛋白有所升高,但各指标比较无统计学差异(P＞0.05).结论:多潘立酮辅助治疗可以有效改善COPD机械通气患者的胃肠功能障碍,促进胃排空,提高肠内营养的耐受性.     

The Utility of the Swine Model to Assess Biological Rhythms and Their Characteristics during Different Stages of Residence in a Simulated Intensive Care Unit: A Pilot Study

The purpose of this pilot study was to explore the utility of the mammalian swine model under simulated intensive care unit (sICU) conditions and mechanical ventilation (MV) for assessment of the trajectory of circadian rhythms of sedation requirement, core body temperature (CBT), pulmonary mechanics (PM) and gas exchange (GE). Data were collected prospectively with an observational time-series design to describe and compare circadian rhythms of selected study variables in four swine mechanically ventilated for up to seven consecutive days. We derived the circadian (total variance explained by rhythms of τ between 20 and 28?h)/ultradian (total variance explained by rhythms of τ between 1 and <20?h) bandpower ratio to assess the robustness of circadian rhythms, and compare findings between the early (first 3 days) and late (subsequent days) sICU stay. All pigs exhibited statistically significant circadian rhythms (τ between 20 and 28?h) in CBT, respiratory rate and peripheral oxygen saturation, but circadian rhythms were detected less frequently for sedation requirement, spontaneous minute volume, arterial oxygen tension, arterial carbon dioxide tension and arterial pH. Sedation did not appear to mask the circadian rhythms of CBT, PM and GE. Individual subject observations were more informative than group data, and provided preliminary evidence that (a) circadian rhythms of multiple variables are lost or desynchronized in mechanically ventilated subjects, (b) robustness of circadian rhythm varies with subject morbidity and (c) healthier pigs develop more robust circadian rhythm profiles over time in the sICU. Comparison of biological rhythm profiles among sICU subjects with similar severity of illness is needed to determine if the results of this pilot study are reproducible. Identification of consistent patterns may provide insight into subject morbidity and timing of such therapeutic interventions as weaning from MV.     

A video and photographic study of aggregation,swimming and respiratory behaviour changes in the Grey Nurse Shark (Carcharias taurus) in response to the presence of SCUBA divers

The Grey Nurse Shark (Carcharias taurus) is a popular attraction for shark eco-tourism using SCUBA. The species is also ‘globally Vulnerable’ (IUCN 2008. List of Threatened Species. www.iucnredlist.org/). Magic Point (off Maroubra) in Sydney is favoured by recreational SCUBA divers wishing to observe these sharks. The objective of this study was to experimentally test the level of the activities of recreational SCUBA divers on shark behaviour. This study assessed the shark responses to diver group size (4, 8 and 12), time of day (am, noon and pm) and diver distance from the sharks (3?m and 6?m). The study found that diver activity does affect the aggregation, swimming and respiratory behaviour of sharks at this site, albeit at short-term levels. Diver group size had no significant effect on shark aggregation, but the proximity of divers to the sharks was crucial. Shark distribution in the cave changed significantly in the presence of divers at 3?m distance from the cave, but stayed unchanged at 6?m. This was particularly apparent in the presence of large groups of 12 divers at 3?m distance when sharks increased their swim speed and ventilation mechanism from ‘active’ to ‘RAM’ ventilation. Such change coincided with a sudden decrease in ventilation frequency. Our research suggests that these effects are short-term and that sharks resume their behaviour once the divers retreat. If divers abide by the current code of practice for diving at this site, it is unlikely that their activities will substantially impact Grey Nurse Sharks in the long term.     

无创辅助通气早产儿呼吸道感染病原菌分布 及影响因素分析

目的分析无创辅助通气早产儿呼吸道感染的病原菌及相关影响因素。方法选择2016年3月至2018年10月我院新生儿监护室收治的100例行无创辅助通气呼吸的早产儿为观察组。选择同期100例正常早产儿作为对照组。对两组患儿痰样本进行细菌鉴定,记录患儿基本情况并检测血中CD3~+、CD3~+/CD8~+、CD3~+/CD19~+和CD19~+/CD23~+水平。结果观察组患儿呼吸困难、发热、咳嗽、肺部喘鸣音及湿罗音发生率均高于对照组,差异有统计学意义(均P0.05)。观察组患儿血液中CD3~+、CD3~+/CD8~+水平明显低于对照组,CD3~+/CD19~+及CD19~+/CD23~+水平明显高于对照组,差异有统计学意义(均P0.05)。观察组患儿革兰阳性菌的感染率为17.00%,革兰阴性菌感染率为27.00%,其中金黄色葡萄球菌、大肠埃希菌和肺炎克雷伯菌的感染率占比相对较高。季节、通气时间、胎龄及出生体重是影响患儿呼吸道感染发生的独立性影响因素(P0.05)。结论无创辅助通气早产儿呼吸道感染病原菌以金黄色葡萄球菌、大肠埃希菌和肺炎克雷伯菌为主,季节、通气时间、胎龄及出生体重均是导致感染发生及发展的独立性影响因素。     

控制通气在全麻患儿支气管异物取出术中的应用研究

目的:探讨静脉全麻下小儿支气管异物取出术中控制通气的应用效果。方法:选择2014年1月～2018年7月本院收治的支气管异物患儿138例为研究对象,所有患儿均在静脉全麻下行支气管异物取出术,采用随机数字表法将其分为对照组(采用自主呼吸通气,69例)和观察组(采用控制通气,69例),比较两组手术时间、麻醉时间、苏醒时间、置镜首次成功率、置镜时间、置镜难易程度、心率、平均动脉压(MAP)、血氧饱和度(SpO_2)及不良反应发生率。结果:观察组手术时间、麻醉时间、苏醒时间均短于对照组(P0.05);观察组置镜首次成功率高于对照组,置镜难度低于对照组,置镜时间短于对照组(P0.05);观察组麻醉后心率、MAP水平低于对照组,SpO_2水平高于对照组(P0.05);观察组不良反应发生率均低于对照组(P0.05)。结论:静脉全麻患儿支气管异物取出术中,采用控制通气的方式效果较好,其具有较强的可控性,且安全性高,是一种较理想的手术麻醉方案。     

递增负荷运动对不同海拔高原人群通气量与心率变化的影响*

目的: 分析不同海拔高原人群在递增负荷运动情况下的通气量与心率的变化特征,探讨其作为高原体力劳动强度分级评价指标的可行性。方法: 选取高原习服男性青年军人88名,平均年龄21.7±1.6。其中3 000 m 30人,3 700 m 30人,4 300 m 28人,进行递增负荷踏车运动,运动负荷从30 W开始,每5 min增加30 W,直到不能坚持则停止运动。采用COSMED K5运动肺功能仪测量每一运动负荷的肺通气量,POLAR V800心率表测量每一运动负荷的运动心率。结果: 不同海拔递增负荷运动中完成最大负荷的人数具有显著差异(P＜0.05),海拔越高,完成人数越少。同一海拔,不同负荷之间,随着负荷的增加,通气量与心率明显增大(P＜0.05),且无上限值;同一负荷,随海拔增加,通气量与心率也明显增大(P＜0.05)。结论: 通气量与心率具有作为高原体力劳动强度分级评价指标的可行性。     

Aerial exposure tolerance of a newly discovered galaxiid

Laboratory experiments were conducted to investigate tolerance and physiological responses of Galaxias'nebula', a newly discovered and widespread African galaxiid, to aerial exposure. This species can tolerate emersion for at least 36 h. Changes in water level and dewatering did not induce the fish to burrow into the substratum or find refugia, nor was there detectable mucus production following aerial exposure. Opercular movement, a proxy for gill ventilation rate, however, did vary with changes in water level. The initial steady ventilation rate increased significantly when the fish were partially emersed and ventilation ceased immediately upon total air exposure. When fish were re-immersed, there was first a period of hyperactivity with a corresponding inflated gill ventilation rate which was restored to pretreatment levels within 2 h. This is the first documented case of amphibious capabilities in an African galaxiid, which has implications for the interpretation of its widespread distribution pattern.     

Cyclic release of carbon dioxide accompanied by abdominal telescoping movements in forager ants of Formica polyctena (Hymenoptera, Formicidae)

Abstract.  Discontinuous gas exchange and abdominal telescoping movements were investigated in intact forager ants of Formica polyctena Förster. For simultaneous recording of discontinuous gas exchange and abdominal movements, an electrolytic differential microrespirometer was combined with an infrared-optical device using an infrared-sensor diode commonly applied as a cardiograph in insect studies. The air in the insect chamber was saturated with water vapour, and an ant was contacted with a sliver of wet filter paper. Accordingly, the ants used in the experiments were regarded as being hydrated. The enforced immobility of the ant in the respirometry chamber (0.15 mL volume) induced continuous struggling during the first hours of measurement but, after 3–4 h, the activity periods alternated with quiescent periods when regular cycles of discontinuous gas exchange (8.97 mHz) were displayed. After remaining in the chamber for a day, the ants showed such cycles (8.15 mHz) without any interruption by periods of activity. The cyclic release of carbon dioxide (burst) was accompanied by a bout of telescoping movements of the abdominal segments (rapid contractions and slow relaxations), which were interpreted as active ventilation. The irregular and rare abdominal contractions, recorded during the interburst periods on the first day of measurements, were regarded as a symptom of stress because these disappeared on the second day. In approximately 20% of foragers, the telescoping movements during the interburst periods were characterized by very rapid (0.09 s) protractions and slow retractions of the abdominal segments, obviously acting as inspiration movements. The results do not support the hypothesis that discontinuous gas exchange is an adaptation for conserving water in ants.     

Egg cases of the genus Apristurus (Chondrichthyes: Scyliorhinidae): phylogenetic and ecological implications

The genus Apristurus has been divided formerly into three species subgroups based on morphological and molecular phylogenies. Previous studies have agreed on the separation into distinct species groups, the largest two of which have been described as the brunneus and spongiceps groups. An examination of the egg cases produced by these oviparous catsharks corroborates the distinction in species groups: egg cases of the brunneus group have long fibrous and curly tendrils at either end, whereas egg cases of the spongiceps group lack tendrils. The egg cases of A. kampae, A. manis, A. spongiceps and Apristurus sp. D are described for the first time, and the egg cases of A. brunneus and A. riveri are re-described to include comparable morphological characteristics. The ecological implications of egg case morphology on oviposition and ventilation are also discussed.     

早期经皮气管切开治疗原发性脑干出血的临床效果

目的:探讨早期经皮气管切开治疗原发性脑干出血中的临床效果。方法:选择2012年8月至2015年6月我院ICU收治的原发性脑干出血患者125例,按患者行气管切开的时间分组,以早期行气管切开(发病5 d内)定为观察组,发病5 d后行气管切开的患者定为对照组,对比两组患者的治疗效果。结果:两组患者的性别、年龄、APACHEII评分、GCS评分、疾病构成方面对比无明显差异(P0.05);观察组患者气管切开时机为(2.6±0.8)d,低氧血症发生的次数(20.6±5.5)次,镇静药物用量(132.8±23.4)mg,抗生素使用时间(11.2±0.9)d,机械通气时间(153.5±82.4)h,HAP发生率44.6%,病死率23.1%,均明显优于对照组患者,差异具有统计学意义(P0.05)。结论:早期气管切开有助于降低原发性脑干出血的死亡率,临床效果更好。