重症肺炎患者血清IL-2水平及与呼吸功能的相关性分析

目的:研究重症肺炎患者血清白细胞介素-2(IL-2)水平及与呼吸功能的相关性。方法:选择2013年5月~2016年5月在我院进行诊治的重症肺炎患者80例为观察组,同期在我院呼吸科入住的一般呼吸道感染患者80例为对照组,分别检测两组的血清IL-2水平,记录呼吸频率,取动脉血检测氧分压和氧合指数,采用单因素回归分析血清IL-2与呼吸功能的相关性。结果:观察组的血清IL-2水平明显高于对照组(P0.05);观察组的呼吸频率明显高于对照组(P0.05),氧分压和氧和指数均明显低于对照组(P0.05);血清IL-2水平与呼吸频率呈明显正相关(P0.05),与氧分压和氧和指数呈明显负相关(P0.05)。结论:重症肺炎患者血清IL-2水平明显升高,且与呼吸功能密切相关,能作为判断重症肺炎患者呼吸功能的客观检查指标。     

房水平单向活瓣式补片对老年先天性心脏病合并重度肺动脉高压 的临床效果分析

目的:探究房水平单向活瓣式补片对老年先天性心脏病伴重度肺动脉高压患者的作用疗效。方法:选取我院心血管科收治的先天性心脏病伴重度肺动脉高压患者80例,随机分为对照组和实验组。对照组40例,予以常规基础药物治疗(波生坦);实验组,在基础药物治疗两个疗程后,采用房水平单向活瓣式补片进行手术治疗。比较两组患者治疗前后的肺动脉压(PAP)、体动脉压(SAP)、肺动脉压/体动脉压(PAP/SAP)、动脉血氧分压(Pa O2)、二氧化碳分压(Pa CO2)及吸氧浓度、右室收缩末期内径变化情况。结果:治疗后,与对照组比较,实验组肺动脉压下降幅度较大(P0.05);与治疗前比较,实验组肺动脉压与体动脉压的比值显著下降,且优于对照组(P0.05);治疗后,实验组动脉血氧分压、二氧化碳分压以及吸氧浓度显著优于对照组(P0.05);治疗后,实验组患者右室收缩末期内径显著小于对照组(P0.05);随访结果:实验组死亡1例、术后活瓣坏死2例、其余37例病情均转好且无复发情况;对照组死亡4例、出现各项并发症16例、剩余20例病情转好。结论:房水平单向活瓣式补片法可有效改善患者的肺动脉压、体动脉压、动脉血氧分压、二氧化碳分压及吸氧浓度、右室收缩末期内径及6 min步行距离,对老年先天性心脏病伴重度肺动脉高压患者疗效显著。     

Monoamine oxidase, an intracellular probe of oxygen pressure in isolated cardiac myocytes

The activity of monamine oxidase, an enzyme located almost exclusively at the outer mitochondrial membrane, toward the substrate phenylethylamine is used to report the oxygen pressure at the outer mitochondrial membrane of intact cardiac myocytes isolated from hearts of adult rats. The rate of substrate oxidation, under the conditions used, follows the Michaelis-Menten relation, and accordingly can be used as a measure of the local chemical activity of dissolved oxygen. The oxygen pressure at the outer mitochondrial membrane of myocytes, at rest and after 2- to 3-fold stimulation of respiratory oxygen consumption, differs from the extracellular oxygen pressure by at most 2 torr. This implies that most of the large, about 20 torr, difference in oxygen pressure between capillary lumen and mitochondria of the working heart must be extracellular. At physiologically relevant concentrations of the substrates phenylethylamine and norepinephrine, monoamine oxidase activity is relatively insensitive to extracellular oxygen pressure in the range 155 to 8 torr, suggesting a limited role for regulation of biogenic amine oxidation by oxygen availability.     

Theoretical and experimental evaluation of the effects of an argon gas mixture on the pressure drop through adult tracheobronchial airway replicas

Argon has the potential to be a novel inhaled therapeutic agent, owing to the neuroprotective and organoprotective properties demonstrated in preclinical studies. Before human trials are performed, an understanding of varying gas properties on airway resistance during inhalation is essential. This study predicts the effect of an 80% argon/20% oxygen gas mixture on the pressure drop through conducting airways, and by extension the airway resistance, and then verifies these predictions experimentally using 3-D printed adult tracheobronchial airway replicas.The predicted pressure drop was calculated using established analytical models of airway resistance, incorporating the change in viscosity and density of the 80% argon/20% oxygen mixture versus that of air. Predicted pressure drop for the argon mixture increased by approximately 29% compared to that for air. The experimental results were consistent with this prediction for inspiratory flows ranging from 15 to 90 slpm. These results indicate that established analytical models may be used to predict increases in conducting airway resistance for argon/oxygen mixtures, compared with air. Such predictions are valuable in predicting average patient response to breathing argon/oxygen mixtures, and in selecting or designing delivery systems for use in administration of argon/oxygen mixtures to critically ill or injured patients.     

A mathematical model of electron transfer within the mitochondrial respiratory cytochromes

A simple mathematical model of electron flow along the mitochondrial respiratory cytochrome assembly and the transfer of electrons to molecular oxygen is presented. First, an expression for the current-voltage relationship for a biological oxygen electrode is derived, and from this the relationship between oxygen consumption rate and oxygen partial pressure is determined. An independent relationship between mitochondrial oxygen partial pressure and oxygen supply rate is then derived. By eliminating oxygen partial pressure from these two expressions, we may obtain a relationship between oxygen supply rate and oxygen consumption rate. This model is then used to investigate the effects of tissue dysoxia, uncoupling of oxidative phosphorylation, increased cellular diffusional resistance and inhomogeneities in oxygen supply on oxygen consumption. It is concluded that each of the above contribute in varying degrees to the phenomenon of "pathological oxygen supply dependency".     

Oxygen as a driving gas for nebulisers: safe or dangerous?

Changes in blood gas tensions occurring when 100% oxygen or air was used as the driving gas for nebulised salbutamol were studied in 23 patients with severe airways obstruction. The patients fell into three groups: nine had chronic bronchitis and emphysema with carbon dioxide retention, seven had emphysema and chronic bronchitis without carbon dioxide retention, and seven had severe asthma (no carbon dioxide retention). When oxygen was used as the driving gas patients who retained carbon dioxide showed a mean rise of 1.03 kPa (7.7 mm Hg) in their pressure of carbon dioxide (Pco2) after 15 minutes (p less than 0.001) but the Pco2 returned to baseline values within 20 minutes of stopping the nebuliser. The other two groups showed no rise in Pco2 with oxygen. When air was used as the driving gas none of the groups became significantly more hypoxic. Although it is safe to use oxygen as the driving gas for nebulisers in patients with obstructive airways disease with normal Pco2, caution should be exercised in those who already have carbon dioxide retention.     

Oxygen pressure gradients in isolated cardiac myocytes

Intracellular oxygen pressure within intact isolated cardiac myocytes is studied as a function of steady state extracellular oxygen pressure. The fractional saturation of myoglobin with oxygen is used to report sarcoplasmic oxygen pressure. The fractional oxidation of cytochrome oxidase, the fractional oxidation of cytochrome c, the rate of respiratory oxygen uptake, and lactate accumulation are used to reflect the availability of oxygen at the inner mitochondrial membrane. These probes of mitochondrial function show no large change with decreasing extracellular oxygen pressure until that pressure is less than 2 torr and intracellular myoglobin is largely deoxygenated. Sarcoplasmic oxygen pressure in resting cells is nearly the same as extracellular oxygen pressure and is about 2 torr less in cells whose respiration has been increased 3.5-fold by mitochondrial uncoupling. Oxygen pressure at the mitochondrial inner membrane differs from sarcoplasmic oxygen pressure by no more than 0.2 torr and from extracellular oxygen pressure by no more than 2 torr. We conclude that differences of oxygen pressure within the cardiac myocyte are very small. This implies that most of the large, about 20 torr, difference in oxygen pressure between capillary lumen and mitochondria of the working heart must be extracellular. We conclude also that mitochondria of the cardiac myocyte become oxygen limited only when sarcoplasmic myoglobin is almost entirely deoxygenated.     

Optimisation of positive and expiratory pressure for maximal delivery of oxygen to tissues using oesophageal Doppler ultrasonography.

OBJECTIVE--To assess oesophageal Doppler ultrasonography as a convenient means of optimising positive end expiratory pressure for maximal delivery of oxygen to tissues. DESIGN--Measurements of blood flow, arterial oxygen saturation, and cardiac output by thermodilution (when available) at baseline and at 20-30 minutes after each incremental increase (2.5-5.0 cm H2O) in positive and expiratory pressure to a maximum of 20.0 cm H2O. If the cardiac output fell by more than 15% measurements were repeated after stepwise decreases in positive end expiratory pressure. No other manoeuvre such as endotracheal suction or changing ventilator settings, drug or fluid dosage, or the patient''s position was performed for at least one hour before the start of the study or during it. SETTING--Intensive care unit. PARTICIPANTS--10 Patients being mechanically ventilated for acute respiratory failure who had stable haemodynamic and blood gas values and required a fractional inspired oxygen concentration of greater than or equal to 0.45. They were assessed on a total of 11 occasions. INTERVENTIONS--Incremental increases in positive end expiratory pressure followed when indicated by stepwise decreases. END POINT--The positive end expiratory pressure providing maximal delivery of oxygen to tissues. MEASUREMENTS and MAIN RESULTS--Arterial oxygen saturation increased with positive end expiratory pressure in all patients by an average of 6.1%. In nine of the 11 studies, however, cardiac output fell by 15% to 30% after the second increment. On the two other occasions cardiac output and oxygen delivery rose by up to 54%. Positive end expiratory pressure was decreased on seven occasions; there was considerable individual variation in the time taken for cardiac output to rise and arterial oxygen saturation to fall. In six patients good agreement was seen between the results from Doppler ultrasonography and thermodilution, the mean of the differences being -0.3% with narrow limits of agreement (-14.4% to 13.9%). CONCLUSIONS--Oesophageal Doppler ultrasonography is a rapid, safe, and reliable technique for optimising positive end expiratory pressure to obtain maximal delivery of oxygen to tissues. The results show the need to consider haemodynamic consequences when altering positive end expiratory pressure.     

重型颅脑损伤后颅内高压的治疗研究进展

重型颅脑损伤后颅内压增高预示着不良的神经功能预后和极高的死亡率,一直是临床治疗中的研究热点,可采取高渗性脱水,亚低温疗法,巴比妥昏迷治疗及外科手术干预等治疗措施控制颅内压。由于亚低温治疗会增加患者发生肺炎的风险,巴比妥类药物副作用较大,现均已少用。近来研究发现,监测颅内压、脑灌注压、脑组织氧分压并指导临床治疗,可降低死亡率与改善预后。也有研究发现去骨瓣减压术治疗顽固性颅内高压与神经功能预后较差有关。目前关于颅内高压治疗的最佳方案仍存在争议,未来还需根据患者病情,为其制定规范化与个体化的治疗方案,预防继发性颅脑损伤,降低颅内压。本文就近年来重型颅脑损伤后颅内高压的治疗进展进行阐述。     

Lack of additional action of oxygen on pulmonary artery pressure at the peak of verapamil or captopril action in pulmonary hypertension secondary to mitral stenosis]

The aim of the study was to investigate whether oxygen causes a further decrease in pulmonary artery pressure after administration of calcium channel blocker-verapamil-or angiotensin converting enzyme inhibitor-captopril-in the secondary pulmonary hypertension. We studied 37 patients with the secondary pulmonary hypertension (mean pulmonary artery systolic pressure = 56.1 mm Hg) due to mitral stenosis. After having completed hemodynamic diagnostic procedures, basal oxygen test was performed and pulmonary artery pressure was recorded at 10 min of oxygen breathing. Then, 10 mg of verapamil was injected into the pulmonary artery of 16 patients and 21 patients received 75 mg of oral captopril. At the peak of vasodilation, 30 min after verapamil and 90 min after captopril administration, pulmonary artery pressure was recorded and oxygen test was repeated. Baseline oxygen test produced a statistically significant decrease in pulmonary artery pressure. Verapamil and captopril also lowered pulmonary artery systolic and diastolic pressures. The second oxygen test did not cause a further decrease in the pulmonary artery pressure; mean pulmonary artery systolic pressure was 52.3 +/- 23.7 mm Hg, pulmonary artery diastolic pressure 22.7 +/- 10.6 mm Hg before and 49.1 +/- 23.8 mm Hg and 23.0 +/- 13.5 mm Hg, respectively after the test in verapamil group, and 47.0 +/- 15.5 mm Hg and 21.7 +/- 8.4 mm Hg before and 46.6 +/- 15.4 mm Hg, respectively in captopril subset. The results may support the thesis that vasodilating effect depends rather on the degree of pulmonary vascular changes than on the vasodilatory mechanism of particular drugs.     

Haemodynamic Effects of Salbutamol in Patients Needing Circulatory Support after Open-heart Surgery

The effects of substituting an infusion of salbutamol for isoprenaline were studied in 12 patients needing circulatory support after valve replacement surgery. The cardiac output rose while the heart rate remained unaltered. There was a reduction in systemic vascular resistance, and though the oxygen uptake tended to rise the increase in cardiac output was proportionately greater so that the arteriovenous oxygen difference fell.It is suggested that the drug is of value for two reasons. It causes a selective reduction in peripheral arteriolar resistance, which avoids peripheral pooling, but permits limited myocardial work to be used to generate flow rather than pressure, and the increase in cardiac output is not accompanied by a corresponding rise in oxygen uptake.     

The Hyperbaric Chamber at the Royal Victoria Hospital,Montreal

The single apparent and potential benefit of hyperbaric oxygen is the great increase in the blood content of dissolved oxygen achieved when pure oxygen is breathed at increased pressure. The design of an economical chamber for this purpose is presented. A large number of physiological measurements (cardiac output, electroencephalogram, electrocardiogram, etc.) can be performed on patients or experimental animals within the chamber by use of unique electronic connections in the chamber wall which permits all recording equipment to remain outside. Expected arterial blood oxygen tensions have been achieved in patients studied at 2, 3, and 4 atmospheres. Safety features are emphasized. No complication has resulted in 113 dives over the period January to June 1964, one-half of which were for treatment of patients. The chamber has been used clinically as an adjunct to treatment of shock, certain forms of malignancy, anaerobic infections, coronary occlusion, and problems of ischemia, and for preservation of organs for transplantation.     

Oxygen distribution in murine tumors: characterization using oxygen-dependent quenching of phosphorescence.

In the present work, a novel method for detecting hypoxia in tumors, phosphorescence quenching, was used to evaluate tissue and tumor oxygenation. This technique is based on the concept that phosphorescence lifetime and intensity are inversely proportional to the oxygen concentration in the tissue sample. We used the phosphor Oxyphor G2 to evaluate the oxygen profiles in three murine tumor models: K1735 malignant melanoma, RENCA renal cell carcinoma, and Lewis lung carcinoma. Oxygen measurements were obtained both as histograms of oxygen distribution within the sample and as an average oxygen pressure within the tissue sampled; the latter allowing real-time oxygen monitoring. Each of the tumor types examined had a characteristic and consistent oxygen profile. K1735 tumors were all well oxygenated, with a peak oxygen pressure of 37.8 +/- 5.1 Torr; RENCA tumors had intermediate oxygen pressures, with a peak oxygen pressure of 24.8 +/- 17.9 Torr; and LLC tumors were all severely hypoxic, with a peak oxygen pressure of 1.8 +/- 1.1 Torr. These results correlated well with measurements of tumor cell oxygenation measured by nitroimidazole (EF5) binding and were consistent with assessments of tumor blood flow by contrast enhanced ultrasound and tumor histology. The results show that phosphorescence quenching is a reliable, reproducible, and noninvasive method capable of providing real-time determination of oxygen concentrations within tumors.     

Circulatory and Metabolic Effects of Oxygen in Myocardial Infarction

The circulatory and metabolic effects of inhalation of oxygen in high concentration were investigated in 50 patients with acute myocardial infarction. The heart rate, arterial blood pressure, cardiac out-put, blood gas tensions, pH, and lactate and pyruvate levels were measured. In general, oxygen inhalation produced a fall in cardiac output and stroke volume and a rise in blood pressure and systemic vascular resistance. In a small number of patients with very low cardiac out-puts there was a rise in output. A substantial rise in arterial oxygen tension was obtained even in patients with low initial values. The raised arterial blood lactate levels which were frequently present were reduced after oxygen. The therapeutic implications of these effects are discussed.     

Visualization and Analysis of Blood Flow and Oxygen Consumption in Hepatic Microcirculation: Application to an Acute Hepatitis Model

There is a considerable discrepancy between oxygen supply and demand in the liver because hepatic oxygen consumption is relatively high but about 70% of the hepatic blood supply is poorly oxygenated portal vein blood derived from the gastrointestinal tract and spleen. Oxygen is delivered to hepatocytes by blood flowing from a terminal branch of the portal vein to a central venule via sinusoids, and this makes an oxygen gradient in hepatic lobules. The oxygen gradient is an important physical parameter that involves the expression of enzymes upstream and downstream in hepatic microcirculation, but the lack of techniques for measuring oxygen consumption in the hepatic microcirculation has delayed the elucidation of mechanisms relating to oxygen metabolism in liver. We therefore used FITC-labeled erythrocytes to visualize the hepatic microcirculation and used laser-assisted phosphorimetry to measure the partial pressure of oxygen in the microvessels there. Noncontact and continuous optical measurement can quantify blood flow velocities, vessel diameters, and oxygen gradients related to oxygen consumption in the liver. In an acute hepatitis model we made by administering acetaminophen to mice we observed increased oxygen pressure in both portal and central venules but a decreased oxygen gradient in the sinusoids, indicating that hepatocyte necrosis in the pericentral zone could shift the oxygen pressure up and affect enzyme expression in the periportal zone. In conclusion, our optical methods for measuring hepatic hemodynamics and oxygen consumption can reveal mechanisms related to hepatic disease.     

综述与专论: 高压氧疗法治疗脑缺血的相关机制

脑缺血是指大脑各部分血液供应不足导致脑组织缺血缺氧，进而导致密集缺血区脑组织出现不可逆的损伤坏死，其高致残率、高死亡率会对患者及其家庭造成严重的伤害。在脑缺血发生后，及时采取一定的治疗措施控制梗死灶的大小，并挽救半暗带中的细胞是脑缺血预后的关键。高压氧疗法是针对脑缺血的一种潜在治疗方法，在近年来得到了越来越广泛的关注和研究，本文旨在综述近年来国内外关于高压氧疗法治疗脑缺血的相关机制及研究进展，为脑缺血患者的治疗和预后提供新思路。     

Effect of intermittent normobaric hypoxia on dynamics of disease state in patients with hypertension]

Curative effect of intermittent normobaric hypoxia created when breathing in gaseous hypoxic mixture containing 10% of oxygen and 90% of nitrogen has been examined in 41 patients with hypertonic disease. Adaptation to hypoxia has been studied for its effect on the central hemodynamics psychoemotional state and kinetics of oxygen supply of the skin. The pronounced positive effect of treatment was achieved in 70.7% of patients, the arterial pressure decreasing at the expense of different mechanisms depending on the type of blood circulation. Besides, a decrease in the emotional tension of patients and normalization of oxygen consumption and transport were observed.     

经鼻高流量氧疗对阻塞性睡眠呼吸暂停综合征患者的临床疗效研究

目的:探讨经鼻高流量氧疗对阻塞性睡眠呼吸暂停综合征患者的临床疗效。方法:选择2013年7月至2017年7月我院接诊的80例急阻塞性睡眠呼吸暂停综合征患者进行研究,通过随机数表法分为观察组(n=45)和对照组(n=35)。观察组采用经鼻高流量氧疗进行治疗,对照组采用无创正压通气进行治疗,比较两组临床疗效、夜间呼吸暂停时间、呼吸暂停低通气指数(AHI)、总睡眠时间、醒觉时间、血氧饱和度、治疗前后血压、高敏C反应蛋白(hs-CRP)、低密度脂蛋白(LDL)、总胆固醇(TC)水平及生活质量评分的变化。结果:观察组患者治疗后有效率为88.89%,显著高于对照组(71.43%,P0.05)。治疗后,观察组夜间最低血氧饱和度、总睡眠时间、醒觉时间、生活质量评分均明显高于对照组,AHI、收缩压、舒张压、平均动脉压、血清hs-CRP、LDL以及TC水平均显著低于对照组(P0.05)。结论:经鼻高流量氧疗用于阻塞性睡眠呼吸暂停综合征患者的临床疗效明显优于无创正压通气进行治疗,其可显著改善患者的临床症状,提高患者的生活质量。     

Non-invasive mechanical ventilation for acute respiratory failure.

The value of mechanical ventilation using intermittent positive pressure ventilation delivered non-invasively by nasal mask was assessed in six patients with life threatening exacerbations of chronic respiratory disease. Median (range) arterial oxygen and carbon dioxide tensions were 4.4 (3.5-7.2) kPa and 8.7 (5.5-10.9) kPa respectively, with four patients breathing air and two controlled concentrations of oxygen. The arterial oxygen tension increased with mechanical ventilation to a median (range) of 8.7 (8.0-12.6) kPa and the carbon dioxide tension fell to 8.2 (6.5-9.2) kPa. Four patients discharged after a median of 10 (8-17) days in hospital were well five to 22 months later. One died at four days of worsening sputum retention and another after five weeks using the ventilator for 12-16 hours each day while awaiting heart-lung transplantation. This technique of mechanical ventilation avoids endotracheal intubation and can be used intermittently. Hypercapnic respiratory failure can be relieved in patients with either restrictive or obstructive lung disease in whom controlled oxygen treatment results in unacceptable hypercapnia. Respiratory assistance can be tailored to individual need and undertaken without conventional intensive care facilities.     

Dynamic pressure method for kla measurement in large-scale bioreactors

A dynamic method is proposed for k(l)a measurement in aerated and agitated reactors, in which a change in the total pressure in the reactor by approximately 20% leads to a simultaneous change in the oxygen concentration in all the bubbles in the dispersion. This procedure suppresses the influence of nonideal mixing of the gas phase on the k(l)a value. Other dynamic methods so far used do not possess this advantage. They are based on a step change in oxygen concentration in the entering gas, where the interfacial nitrogen transport and the finite rate of the concentration change propagation into the individual bubbles in the dispersion can cause an error in the reported k(l)a values of more than hundreds of percent. The reliability of the pressure method is tested by comparison both with the standard dynamic method, in which pure oxygen is absorbed in a liquid from which all other gas components were previously removed, and with the steady-state sulphite method. The signal of the oxygen probe used in the experiments must be independent of the pressure. A test for this in dependence is described. The pressure method is also suitable for large-scale reactors since the necessary pressure changes are sufficiently small and, morever, air can be used.