目的:觀察七氟醚靶控用于低流量吸入麻醉維持的臨床規律及血流動力學變化,尋求靶控下的藥物量化指標。方法:選擇60例20～60歲手術患者,隨機分2組每組30例:P組(丙泊酚)常規實施全憑靜脈TCI靶控麻醉;S組(七氟醚),實施低流量七氟醚靶控吸入麻醉(BIS值40)。分別記錄誘導前(T1),插管后5(T2)、15(T3)、30(T4)45(T5)、60(T6)、90(T7)、120(T8)min時的、MBP、HR、;Sev組患者加記各個時點的七氟醚IT、ET的MAC值。結果:T2點兩組均比T1 降低(Plt;0.05),S 組高于P組(Plt;0.05),兩組比較T3至T7無顯著性差異(Pgt;0.05);S 組T3 至T7 各點ET值無統計學差異,ET%:2.46,約1.4 MAC。結論:(1)七氟醚誘導較靜脈麻醉誘導患者血流動力學穩定,(2)低流量七氟醚靶控吸入麻醉維持平穩,調控簡便,效果良好。
Objective To compare the changes between deep hypothermic circulatory arrest (DHCA) with deep hypothermic low flow (DHLF) cardiopulmonary bypass (CPB) on pulmonary surfactant (PS) activity in infants with congenital heart disease. Methods Twenty infants with ventricular septum defect and pulmonary hypertension were assigned to either DHCA group or DHLF group according to the CPB methods respectively. Measurements of saturated phosphatidylcholine /total phospholipids (SatPC /TPL), saturated phosphatidylcholine/ total protein (SatPC/TP) and static pulmonary compliance were performed before institution of CPB, 5 minutes after cessation of CPB and 2 hours. Results The length of ICU stay in DHLA group was significantly longer ( P lt;0 05) than that in DHCA group. SatPC/TPL, SatPC/TP and static pulmonary compliance in DHLF group were significantly lower compared with DHCA group ( P lt;0.01). Conclusion DHLF could lower the PS activity level significantly as compared with DHCA in infants with congenital heart disease.
ObjectiveTo systematically review the clinical effects of non-humidified versus humidified low-to-moderate flow oxygen inhalation therapy via nasal cannula. MethodsRandomized controlled trials (RCTs), clinical controlled trials (CCTs) and cross-over studies about the clinical effects of non-humidified versus humidified low-to-moderate flow nasal cannula oxygen inhalation therapy in hospitalized adult patients were searched in The Cochrane Library (Issue 3, 2016), The Joanna Briggs Institute Evidence Based Practice (EBP) Database, EMbase, PubMed, Web of Science, CBM, CNKI, VIP and WanFang Data from inception to March 2016. Three reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of nine RCTs and three CCTs involving 3 756 patients were finally included. The results of meta-analysis indicated that: non-humidified was superior to humidified oxygen therapy in reducing bacterial contamination of oxygen apparatus (P < 0.05) and the time of daily replacement of sterile water oxygen humidifier bottles (P < 0.05), while the two groups were alike in relieving nasal dryness (RR=1.08, 95%CI 0.91 to 1.29, P=0.37), nasal bleeding (RR=1.17, 95%CI 0.66 to 2.08, P=0.59) and discomfort (RR=0.80, 95%CI 0.56 to 1.14, P=0.22). ConclusionCurrent evidence indicates that there is no significant difference between non-humidified and humidified low-to-moderate flow nasal cannula oxygen inhalation therapy in relieving patients' nasal dryness, nasal bleeding and discomfort. But non-humidified oxygen therapy can reduce bacterial contamination of oxygen apparatus, simplify the operation procedures and lessen nurses' operation time.
Standardizing the emergency assessment and management process for patients with implantable continuous-flow left ventricular assist device (LVAD) in emergency and intensive care settings is of great significance for reducing delays in diagnosis and treatment, lowering the mortality associated with LVAD-related emergencies, and improving overall prognosis and long-term survival. To this end, a multidisciplinary expert committee was convened to develop this consensus, integrating international evidence-based findings with clinical practice experience in China, with an emphasis on highlighting the characteristics of domestically manufactured devices. The aim is to establish an actionable standardized emergency management protocol to enhance clinical identification and response efficiency, reduce the risk of LVAD-related emergencies, and improve patient outcomes. Using a modified Delphi method, this consensus proposes a structured decision-making pathway that integrates an "ABC" rapid assessment with parallel device troubleshooting, prioritizing the use of point-of-care echocardiography for hemodynamic evaluation and complication assessment. Key emergency scenarios covered include low-flow alarms, pump thrombosis, right heart dysfunction, bleeding and anticoagulation imbalance, arrhythmias, and cardiac arrest. This consensus applies to implantable continuous-flow LVADs commonly used in China, including domestically manufactured devices such as Corheart 6, CH-VAD, EVAHEART, and HeartCon, as well as the imported device HeartMate 3.