三种麻醉机通气系统对患者肺部病原微生态的影响研究

目的分析不同麻醉机通气系统对患者肺部病原微生态的影响情况。方法选择90例全麻插管手术患者作为研究对象,将其随机分为A组(未干预组)、B组(呼吸过滤器组)和C组(麻醉消毒机组),每组30例,比较患者术后肺部感染发生情况。结果三组在麻醉前进行病原菌检测,检出定植菌株,均为条件致病菌:革兰阳性菌、革兰阴性菌和真菌,主要为微球菌、凝固酶阴性葡萄球菌、芽胞杆菌、棒状杆菌、黄杆菌属、酵母样真菌。三组麻醉机各部位病原菌阳性率比较:麻醉前,三组麻醉机不同部位的病原菌阳性率差异无统计学意义(P0.05);结束麻醉后,检查麻醉机各端口病原菌阳性检出率,其中C组显著低于A组(P0.05),A、B两组差异无统计学意义(P0.05)。B、C两组患者术后肺部感染发生率显著低于A组患者(P0.05)。结论经过干预的麻醉机通气系统对患者肺部微生态环境的影响较小,患者术后呼吸道感染的发生率显著降低。     

国产DNM-86型多功能麻醉机

当前,随着医疗卫生事业的蓬勃发展,我国的麻醉机正处于更新换代时期。广大基层医院迫切需要一种价廉物美的轻便型麻醉机来替代旧式的麻醉机。虽然,国外原装机及组装机也有所供应,但其价格昂贵,且都是按半紧闭流量设计,作吸入式麻醉时不能尽如人意,实非一般医院使用的理想麻醉机。而对部队野战医院来说,则更需要一种平时、战时都能适用的麻醉机。     

国外麻醉机的发展趋势

麻醉是外科手术的基础。麻醉机的质量好坏直接关系到病人的生命。为此,很多麻醉机生产厂家都不遗余力地更新改进其产品,以尽可能满足临床麻醉的需要,保证病人的安全。由于我国麻醉机的很多产品仍处于国外数十年前的产品水平,远远不能满足国内市场的需要。为促进国内厂家改进产品,提高质量,本文简要介绍国外麻醉机的一些情况及发展趋势。 1、主要国际名牌麻醉机简介     

全能麻醉机用于插管前辅助呼吸50例

目前,插管全麻的比例增多。麻醉医师的业务技能也要求进一步地提高。气静复合全麻的难度在于诱导及肌松药物使用后至插管前这一段时间内。随着病人自主呼吸变浅、变慢、到消失,既需要良好的通气又要防止通气不良导致ＳＰＯ２下降。为此,我们使用全能麻醉机进行插管前辅...     

Drger麻醉呼吸设备的维修与探讨

介绍了Dr／tger麻醉机与呼吸机结构与工作原理。Fabius麻醉机潮气量不准与压力报警故障分析及排除方法;呼吸机FiO2低报警与开机后反复起动自检的故障分析及排除方法。     

MHJ-1型综合麻醉机的结构原理和操作规程

MHJ-1型综合麻醉机(图1)的主要结构由三大部分组成:1)麻醉机:部件有1.氧气贮气瓶及其相应减压器;2.氧化亚氮贮气瓶及其相应减压器;3.氧与氧化亚氮混合装置及流量表;4.乙醚蒸发器;5.氟烷蒸发器,     

呼吸模式对心血管变异性非线性特性的影响

目的研究不同呼吸模式对心血管调节系统的影响。方法对16名健康的大学生采集心电、血压和呼吸信号,采用频谱分析方法和基于Volterra—Wiener级数的非线性方法分析自主呼吸、控制呼吸和屏气对心血管调节的影响。结果与自主呼吸模式相比,10次／分钟的控制呼吸使心率变异性的非线性特性定性和定量上均显著降低,而自主呼吸节律的控制呼吸的非线性特性定性上无显著差异,但定量上仍然显著降低。这些结果提示自主呼吸是保持心肺耦合的最优呼吸模式。     

川西北高寒草甸不同放牧模式对土壤呼吸的影响

采用土壤二氧化碳(CO_2)通量自动测量系统,对不同放牧模式(全年禁牧、夏季放牧、冬季放牧和自由放牧)下川西北高寒草甸的土壤呼吸进行监测,比较了不同放牧模式下土壤呼吸的季节动态和温度敏感性。研究发现:1)放牧模式可以改变高寒草甸土壤呼吸的季节动态变化。禁牧、夏季放牧以及自由放牧样地的土壤呼吸在季节上的变化趋势基本相似,而冬季放牧样地的土壤呼吸最大值与前者相比明显向后推迟;2)放牧模式并不改变高寒草甸年平均土壤呼吸速率,但对不同季节土壤呼吸速率的影响不同;3)不同放牧模式可以改变土壤呼吸对温度的敏感性(Q_(10))。不同放牧模式下土壤呼吸Q_(10)值大小依次为:禁牧1a(8.13)冬季放牧(7.49)禁牧3a(5.46)夏季放牧(5.20)自由放牧(4.53)。该地区土壤呼吸的Q_(10)值均明显高于热带和其它温带草地土壤呼吸的Q_(10)值。结果表明,放牧模式是影响高寒草甸土壤碳排放的一个重要因素。此外,在未来全球气候变暖背景下,在生长季节无放牧干扰的高寒草甸可能比放牧干扰的高寒草甸释放出更多的CO_2到大气中。     

颅内动脉瘤手术的麻醉处理

目的:对40例颅内动脉瘤手术的麻醉处理进行回顾.方法:诱导插管后施行丙泊酚和异氟醚静吸复合全麻,术中应用压宁定、尼莫地平或异氟醚施行控制性降压,用Ohmedar麻醉机施行控制呼吸.结果:诱导后HR和MAP有显著性降低,但在正常范围内;维持期MAP略有下降,但MAP平均值仍维持在(13.8±1.50)kPa,其他指标SpO2、PETCO2、ECG等均无大变化.结论:颅内动脉瘤夹闭术的麻醉诱导及维持要求平顺稳定,术中需施行控制性降压以避免脑动脉瘤破裂并减少出血.     

黄土高原四种人工植物群落土壤呼吸季节变化及其影响因子

以黄土高原侧柏、柠条、沙棘和油松人工植物群落为对象,土壤呼吸日动态和季节变化及其与环境因子之间的关系,结果表明:4种植物群落土壤呼吸速率具有典型的日变化和季节变化模式, 4种群落中,以侧柏6月土壤呼吸日变幅最大,沙棘6月土壤呼吸日变幅最小,大部分群落不同月份最大土壤呼吸与最小土壤呼吸倍数在1.1～1.6之间.4种群落中,以柠条土壤呼吸季节变幅最大,侧柏最小,最大土壤呼吸与最小土壤呼吸的倍数为1.5～2.2倍之间.同一植物类型土壤呼吸具有明显的季节变化特征,其具体变化趋势因植物类型而异.4种植物群落土壤呼吸速率与土壤和大气温度以及土壤含水量的关系在不同季节表现为不同的关系,其中侧柏和柠条土壤呼吸与土壤温度均呈乘幂关系,与大气温度为指数关系.沙棘土壤呼吸与土壤温度和大气温度均为乘幂关系,油松土壤呼吸与土壤温度和大气温度均为线性关系.这表明土壤呼吸与土壤和大气温度之间的关系及其紧密程度因植被类型而异.综合分析表明,同一气候区相同环境因子对不同植物群落土壤呼吸的影响作用不同,且因其自身具有明显的季节变化,从而导致对土壤呼吸的调控作用也具有明显的季节变异模式.     

Positive outcome of average volume-assured pressure support mode of a Respironics V60 Ventilator in acute exacerbation of chronic obstructive pulmonary disease: a case report

ABSTRACT: INTRODUCTION: We were able to treat a patient with acute exacerbation of chronic obstructive pulmonary disease who also suffered from sleep-disordered breathing by using the average volume-assured pressure support mode of a Respironics V60 Ventilator (Philips Respironics: United States). This allows a target tidal volume to be set based on automatic changes in inspiratory positive airway pressure. This removed the need to change the noninvasive positive pressure ventilation settings during the day and during sleep. The Respironics V60 Ventilator, in the average volume-assured pressure support mode, was attached to our patient and improved and stabilized his sleep-related hypoventilation by automatically adjusting force to within an acceptable range. CASE PRESENTATION: Our patient was a 74-year-old Japanese man who was hospitalized for treatment due to worsening of dyspnea and hypoxemia. He was diagnosed with acute exacerbation of chronic obstructive pulmonary disease and full-time biphasic positive airway pressure support ventilation was initiated. Our patient was temporarily provided with portable noninvasive positive pressure ventilation at night-time following an improvement in his condition, but his chronic obstructive pulmonary disease again worsened due to the recurrence of a respiratory infection. During the initial exacerbation, his tidal volume was significantly lower during sleep (378.9 +/- 72.9mL) than while awake (446.5 +/- 63.3mL). A ventilator that allows ventilation to be maintained by automatically adjusting the inspiratory force to within an acceptable range was attached in average volume-assured pressure support mode, improving his sleep-related hypoventilation, which is often associated with the use of the Respironics V60 Ventilator. Polysomnography performed while our patient was on noninvasive positive pressure ventilation revealed obstructive sleep apnea syndrome (apnea-hypopnea index = 14), suggesting that his chronic obstructive pulmonary disease was complicated by obstructive sleep apnea syndrome. CONCLUSION: In cases such as this, in which patients with severe acute respiratory failure requiring full-time noninvasive positive pressure ventilation therapy also show sleep-disordered breathing, different ventilator settings must be used for waking and sleeping. On such occasions, the Respironics V60 Ventilator, which is equipped with an average volume-assured pressure support mode, may be useful in improving gas exchange and may achieve good patient compliance, because that mode allows ventilation to be maintained by automatically adjusting the inspiratory force to within an acceptable range whenever ventilation falls below target levels.     

Respiration rhythms and heartbeats of diapausing Colorado potato beetles, Leptinotarsa decemlineata, at low temperatures

Discontinuous gas exchange cycles (DGCs), active muscular ventilation, microcycles of repetitive openings, and heartbeats of diapausing adult Colorado potato beetle, Leptinotarsa decemlineata Say (Coleoptera: Chrysomelidae), were studied at low temperatures (0, 5, and 10 °C) using an electrolytic respirometer combined with an infrared actograph. The DGC of the adult constriction-flutter-open type was the main respiration mode in fully quiescent beetles at temperatures from 5 to 10 °C. The CO₂ bursts were actively ventilated at temperatures above 5 °C. During the flutter period, a series of microcycles appeared, but no muscular contractions associated with the microcycles were detected. We identified this respiration mode as discontinuous suction ventilation.
The hydration condition of the beetles did not influence the frequency of the gas exchange cycles, but dehydrated beetles showed significantly longer flutter periods and shorter ventilation periods than hydrated beetles. The heartbeat frequencies were influenced by both temperature and hydration status.
We conclude from the results that DGCs are used at rest in adult L. decemlineata under various environmental conditions and also at low temperatures. Our results showed that DGCs are the main respiration mode of resting adult Colorado potato beetle irrespective of its hydration state and temperature. Our method resolves O₂ uptake and subsequent CO₂ release in flutter and ventilation periods and shows that diffusion is replaced by convection to reduce water loss in adult beetles.     

Respiratory responses to hypoxia in relation to mode of life of two erythrinid species (Hoplias malabaricus and Hoplias lacerdae)

Predominantly, Hoplias malabaricus inhabits stagnant O₂ poor environments, whereas Hoplias lacerdae occurs in well-aerated streams. The present study evaluates the influence of mode of life on O₂ uptake and gill ventilation in equally-sized (300 g) specimens of this genus at 25° C. Comparing the species, H. lacerdae was characterized by the highest O₂ uptake and gill ventilation combined with a relatively higher cost of breathing and a lower O₂ extraction. Both species substantially increased ventilation in response to hypoxia with the difference that H. malabaricus exclusively augmented tidal volume, whereas H. lacerdae also increased breathing frequency.     

Four‐dimensional imaging of murine subpleural alveoli using high‐speed optical coherence tomography

The investigation of lung dynamics on alveolar scale is crucial for the understanding and treatment of lung diseases, such as acute lung injury and ventilator induced lung injury, and to promote the development of protective ventilation strategies. One approach to this is the establishment of numerical simulations of lung tissue mechanics where detailed knowledge about three‐dimensional alveolar structure changes during the ventilation cycle is required. We suggest four‐dimensional optical coherence tomography (OCT) imaging as a promising modality for visualizing the structural dynamics of single alveoli in subpleural lung tissue with high temporal resolution using a mouse model. A high‐speed OCT setup based on Fourier domain mode locked laser technology facilitated the acquisition of alveolar structures without noticeable motion artifacts at a rate of 17 three‐dimensional stacks per ventilation cycle. The four‐dimensional information, acquired in one single ventilation cycle, allowed calculating the volume‐pressure curve and the alveolar compliance for single alveoli. (© 2013 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

基于局地气候优化的城市蓝绿空间规划途径研究进展

在高密度、高强度的城市建设模式下,我国大中城市内部均面临着热岛效应加剧、通风能力下降、灰霾天气频发等局地气候环境问题。城市蓝绿空间作为调控城市风热环境、改善大气环境质量的关键要素,已成为城市空间规划设计领域应对局地气候问题的重要研究对象。本文通过对国内外城市蓝绿空间局地气候效应研究文献资料的回顾,从城市蓝绿空间规划布局、网络构建两个层面,梳理了冷岛景观特征优化、冷岛空间镶嵌布局、通风廊道网络连通、通风廊道界面管控的规划学途径研究进展,并总结了相关研究的主要成果及存在的主要问题,提出从智能仿真平台、评估指标体系、规划设计指南、实施保障机制4方面建立城市蓝绿空间规划应对局地气候问题的研究框架,以期为城市气候适应性规划理论创新提供有益启示。     

Effect of lung-protective ventilation on severe Pseudomonas aeruginosa pneumonia and sepsis in rats

Pneumonia caused by Pseudomonas aeruginosa carries a high rate of morbidity and mortality. A lung-protective strategy using low tidal volume (V(T)) ventilation for acute lung injury improves patient outcomes. The goal of this study was to determine whether low V(T) ventilation has similar utility in severe P. aeruginosa infection. A cytotoxic P. aeruginosa strain, PA103, was instilled into the left lung of rats anesthetized with pentobarbital. The lung-protective effect of low V(T) (6 ml/kg) with or without high positive end-expiratory pressure (PEEP, 10 or 3 cmH(2)O) was then compared with high V(T) with low PEEP ventilation (V(T) 12 ml/kg, PEEP 3 cmH(2)O). Severe lung injury and septic shock was induced. Although ventilatory mode had little effect on the involved lung or septic physiology, injury to noninvolved regions was attenuated by low V(T) ventilation as indicated by the wet-to-dry weight ratio (W/D; 6.13 +/- 0.78 vs. 3.78 +/- 0.26, respectively) and confirmed by histopathological examinations. High PEEP did not yield a significant protective effect (W/D, 4.03 +/- 0.32) but, rather, caused overdistension of noninvolved lungs. Bronchoalveolar lavage revealed higher concentrations of TNF-alpha in the fluid of noninvolved lung undergoing high V(T) ventilation compared with those animals receiving low V(T). We conclude that low V(T) ventilation is protective in noninvolved regions and that the application of high PEEP attenuated the beneficial effects of low V(T) ventilation, at least short term. Furthermore, low V(T) ventilation cannot protect the involved lung, and high PEEP did not significantly alter lung injury over a short time course.     

同步间歇指令通气和适应性支持通气对COPD合并呼吸衰竭患者周围循环和血气的影响

目的:研究同步间歇指令通气(SIMV)与适应性支持通气(ASV)对慢性阻塞性肺部疾病(COPD)合并呼衰患者机体外周血循环、血气指标的影响。方法:选取2006年3月至2013年12月在我院接受治疗的COPD合并呼吸衰竭患者86例,对其分别先后采用ASV、SIMV呼吸模式,记录呼吸机参数、外周血循环参数及血气指标。结果:ASV组呼吸频率(RR)、潮气量(TV)、吸气峰值压(PIP)均显著低于SIMV组(均P0.01);ASV组外周血心率(HR)、收缩压(SBP)、舒张压(DBP)、中心静脉压(CVP)均显著低于SIMV组(均P0.01);ASV组动脉血氧分压(PaO_2)、pH、血氧饱和度(Sa O2)均较SIMV组显著升高(均P0.05)。结论:ASV模式下治疗COPD合并呼吸衰竭患者的呼吸参数、外周血循环参数、血气改善效果优于SIMV模式。     

The Cerebral Cost of Breathing: An fMRI Case-Study in Congenital Central Hypoventilation Syndrome

Certain motor activities - like walking or breathing - present the interesting property of proceeding either automatically or under voluntary control. In the case of breathing, brainstem structures located in the medulla are in charge of the automatic mode, whereas cortico-subcortical brain networks - including various frontal lobe areas - subtend the voluntary mode. We speculated that the involvement of cortical activity during voluntary breathing could impact both on the “resting state” pattern of cortical-subcortical connectivity, and on the recruitment of executive functions mediated by the frontal lobe. In order to test this prediction we explored a patient suffering from central congenital hypoventilation syndrome (CCHS), a very rare developmental condition secondary to brainstem dysfunction. Typically, CCHS patients demonstrate efficient cortically-controlled breathing while awake, but require mechanically-assisted ventilation during sleep to overcome the inability of brainstem structures to mediate automatic breathing. We used simultaneous EEG-fMRI recordings to compare patterns of brain activity between these two types of ventilation during wakefulness. As compared with spontaneous breathing (SB), mechanical ventilation (MV) restored the default mode network (DMN) associated with self-consciousness, mind-wandering, creativity and introspection in healthy subjects. SB on the other hand resulted in a specific increase of functional connectivity between brainstem and frontal lobe. Behaviorally, the patient was more efficient in cognitive tasks requiring executive control during MV than during SB, in agreement with her subjective reports in everyday life. Taken together our results provide insight into the cognitive and neural costs of spontaneous breathing in one CCHS patient, and suggest that MV during waking periods may free up frontal lobe resources, and make them available for cognitive recruitment. More generally, this study reveals how the active maintenance of cortical control over a continuous motor activity impacts on brain functioning and cognition.     

A comparison of biologically variable ventilation to recruitment manoeuvres in a porcine model of acute lung injury

BackgroundBiologically variable ventilation (return of physiological variability in rate and tidal volume using a computer-controller) was compared to control mode ventilation with and without a recruitment manoeuvre – 40 cm H₂O for 40 sec performed hourly; in a porcine oleic acid acute lung injury model.MethodsWe compared gas exchange, respiratory mechanics, and measured bronchoalveolar fluid for inflammatory cytokines, cell counts and surfactant function. Lung injury was scored by light microscopy. Pigs received mechanical ventilation (F_IO₂ = 0.3; PEEP 5 cm H₂O) in control mode until PaO₂ decreased to 60 mm Hg with oleic acid infusion (PaO₂/F_IO₂ <200 mm Hg). Additional PEEP to 10 cm H₂O was added after injury. Animals were randomized to one of the 3 modes of ventilation and followed for 5 hr after injury.ResultsPaO₂ and respiratory system compliance was significantly greater with biologically variable ventilation compared to the other 2 groups. Mean and mean peak airway pressures were also lower. There were no differences in cell counts in bronchoalveolar fluid by flow cytometry, or interleukin-8 and -10 levels between groups. Lung injury scoring revealed no difference between groups in the regions examined. No differences in surfactant function were seen between groups by capillary surfactometry.ConclusionsIn this porcine model of acute lung injury, various indices to measure injury or inflammation did not differ between the 3 approaches to ventilation. However, when using a low tidal volume strategy with moderate levels of PEEP, sustained improvements in arterial oxygen tension and respiratory system compliance were only seen with BVV when compared to CMV or CMV with a recruitment manoeuvre.     

Lung regional stress and strain as a function of posture and ventilatory mode

During positive-pressure ventilation parenchymal deformation can be assessed as strain (volume increase above functional residual capacity) in response to stress (transpulmonary pressure). The aim of this study was to explore the relationship between stress and strain on the regional level using computed tomography in anesthetized healthy pigs in two postures and two patterns of breathing. Airway opening and esophageal pressures were used to calculate stress; change of gas content as assessed from computed tomography was used to calculate strain. Static stress-strain curves and dynamic strain-time curves were constructed, the latter during the inspiratory phase of volume and pressure-controlled ventilation, both in supine and prone position. The lung was divided into nondependent, intermediate, dependent, and central regions: their curves were modeled by exponential regression and examined for statistically significant differences. In all the examined regions, there were strong but different exponential relations between stress and strain. During mechanical ventilation, the end-inspiratory strain was higher in the dependent than in the nondependent regions. No differences between volume- and pressure-controlled ventilation were found. However, during volume control ventilation, prone positioning decreased the end-inspiratory strain of dependent regions and increased it in nondependent regions, resulting in reduced strain gradient. Strain is inhomogeneously distributed within the healthy lung. Prone positioning attenuates differences between dependent and nondependent regions. The regional effects of ventilatory mode and body positioning should be further explored in patients with acute lung injury.