Clinical DataCase selection: 100 cases who met thediagnostic criteria of senile dementiaformulated by American Association ofPsychiatry in Handbook of Diagnosis andStatistics (DSM-Ⅲ-R, 3rd revised edition)
BACKGROUND Hydrofluoric acid(HF)is one of the most common causes of chemical burns.HF burns can cause wounds that deepen and progress aggressively.As a result,HF burns are often severe even if they involve a small are...BACKGROUND Hydrofluoric acid(HF)is one of the most common causes of chemical burns.HF burns can cause wounds that deepen and progress aggressively.As a result,HF burns are often severe even if they involve a small area of the skin.Published cases of HF burns have mostly reported small HF burn areas.Few cases of HF inhalation injury have been reported to date.CASE SUMMARY A 24-year-old man suffered from extensive hydrofluoric acid burns covering 60%of the total body surface area(TBSA),including deep second degree burns on 47%and third degree burns on 13%of the TBSA,after he fell into a pickling pool containing 15%HF.Comprehensive treatments were carried out after the patient was admitted.Ventricular fibrillation occurred 9 times within the first 2 h,and the lowest serum Ca2+concentration was 0.192 mmol/L.A dose of calcium gluconate(37 g)was intravenously supplied during the first 24 h,and the total amount of calcium gluconate supplementation was 343 g.Extracorporeal membrane oxygenation(ECMO)was applied for 8 d to handle the acute respiratory distress syndrome(ARDS)induced by the HF inhalation injury.The patient was discharged after 99 d of comprehensive treatment,including skin grafting.CONCLUSION Extensive HF burns combined with an inhalation injury led to a potentially fatal electrolyte imbalance and ARDS.Adequate and timely calcium supplementation and ECMO application were the keys to successful treatment of the patient.展开更多
Coronavirus disease 2019(COVID-19)related acute respiratory distress syndrome(ARDS)is a severe complication of infection with severe acute respiratory syndrome coronavirus 2,and the primary cause of death in the curre...Coronavirus disease 2019(COVID-19)related acute respiratory distress syndrome(ARDS)is a severe complication of infection with severe acute respiratory syndrome coronavirus 2,and the primary cause of death in the current pandemic.Critically ill patients often undergo extracorporeal membrane oxygenation(ECMO)therapy as the last resort over an extended period.ECMO therapy requires sedation of the patient,which is usually achieved by intravenous administration of sedatives.The shortage of intravenous sedative drugs due to the ongoing pandemic,and attempts to improve treatment outcome for COVID-19 patients,drove the application of inhaled sedation as a promising alternative for sedation during ECMO therapy.Administration of volatile anesthetics requires an appropriate delivery.Commercially available ones are the anesthetic gas reflection systems AnaConDa®and MIRUSTM,and each should be combined with a gas scavenging system.In this review,we describe respiratory management in COVID-19 patients and the procedures for inhaled sedation during ECMO therapy of COVID-19 related ARDS.We focus particularly on the technical details of administration of volatile anesthetics.Furthermore,we describe the advantages of inhaled sedation and volatile anesthetics,and we discuss the limitations as well as the requirements for safe application in the clinical setting.展开更多
【目的】探讨气管插管序贯经鼻高流量吸氧在重症医学病房(intensive care unit,ICU)机械通气脱机拔管后患者中的应用效果。【方法】选取2023年1月至2025年1月在本院接受治疗的100例ICU机械通气患者作为研究对象,按照随机数字表法将患者...【目的】探讨气管插管序贯经鼻高流量吸氧在重症医学病房(intensive care unit,ICU)机械通气脱机拔管后患者中的应用效果。【方法】选取2023年1月至2025年1月在本院接受治疗的100例ICU机械通气患者作为研究对象,按照随机数字表法将患者分为对照组和观察组,每组50例。两组患者均根据统一标准实施脱机拔管操作,观察组在拔管后采用气管插管序贯经鼻高流量吸氧,对照组采用面罩6 L/min吸氧。比较两组患者ICU机械通气患者脱机拔管后的血氧指标[血氧饱和度(oxygen saturation,SaO_(2))、动脉血氧分压(partial pressure of oxygen,PaO_(2))、氧合指数(oxygenation index,OI)]、拔管后48 h内再插管率、ICU住院时间。【结果】干预48 h后,两组患者SaO_(2)、PaO_(2)、OI值均高于干预前,且观察组患者高于对照组(P<0.05)。两组拔管后48 h内的再插管率、ICU住院时间比较,差异无统计学意义(P>0.05)。【结论】气管插管序贯经鼻高流量吸氧在ICU机械通气脱机拔管后患者中的应用效果显著,患者血氧指标显著改善,且安全性较高。展开更多
Purpose:To evaluate the effectiveness of oxygen nebulization at preventing radiotherapyinduced mucositis in patients with nasopharyngeal cancer.Methods:Sixty patients with nasopharyngeal cancer treated with simultaneo...Purpose:To evaluate the effectiveness of oxygen nebulization at preventing radiotherapyinduced mucositis in patients with nasopharyngeal cancer.Methods:Sixty patients with nasopharyngeal cancer treated with simultaneous integrated boost intensity-modulated radiotherapy were randomly assigned to oxygen nebulization or ultrasonic nebulization groups;treatment was once daily for 20 minutes.All patients received routine oral care.We compared saliva pH and volume,food intake,and change in oral mucosa during radiotherapy,and dry mouth and sore throat after radiotherapy between the two groups.Results:There were significant differences in the incidence of grade III or IV mucositis,saliva volume and pH,and dry mouth and sore throat between the two groups when the total dose was 33 Gy(p<0.05 or p<0.01).Conclusion:Oxygen nebulization reduces radiotherapy-induced mucositis and relieves symptoms such as dry mouth and sore throat in patients with nasopharyngeal cancer.展开更多
目的:评估吸入一氧化氮(inhaled nitric oxide,INO)联合高频振荡通气(high frequency oscillatory ventilation,HFOV)治疗中重度新生儿持续肺动脉高压(persistent pulmonary hypertension of the newborn,PPHN)的疗效及安全性。方法:将...目的:评估吸入一氧化氮(inhaled nitric oxide,INO)联合高频振荡通气(high frequency oscillatory ventilation,HFOV)治疗中重度新生儿持续肺动脉高压(persistent pulmonary hypertension of the newborn,PPHN)的疗效及安全性。方法:将商丘市第一人民医院新生儿重症监护室收治的104例中重度PPHN患儿随机分为研究组(INO+HFOV,n=52)与对照组(INO+常规机械通气,n=52),比较两组干预后24 h及48 h的氧合指数(oxygenation index,OI)、右心室收缩压/体循环收缩压比值(right ventricular systolic pressure/systemic systolic blood pressure,RVSP/SBP)、左心室输出量(left ventricular output,LVO)、药物代谢指标(高铁血红蛋白、血小板)及通气并发症(气胸、脑室内出血)。结果:研究组干预后24 h及48 h OI(18.25±4.30 vs 23.75±5.20;12.45±3.15 vs 17.85±4.25)与RVSP/SBP比值(0.45±0.09 vs 0.52±0.10;0.38±0.07 vs0.44±0.08)均显著低于对照组(P<0.001),LVO(162.75±25.15 mL/kg vs 145.30±22.60 mL/kg;178.45±28.50 mL/kg vs 155.80±24.75 mL/kg)显著高于对照组(P<0.001)。研究组气胸发生率更低(1.92%vs 15.38%,P=0.036),两组高铁血红蛋白水平无差异,但研究组血小板计数显著低于对照组(P=0.031)。结论:INO联合HFOV可快速改善中重度PPHN患儿的氧合与血流动力学,降低肺动脉压力及气胸风险,安全性可控,为传统INO联合常规通气疗效不足的患儿提供了优化方案。展开更多
Background： Oxygen inhalation therapy is essential for the treatment of patients with chronic mountain sickness （CMS）, but the efficacy of oxygen inhalation for populations at high risk of CMS remains unknown. This...Background： Oxygen inhalation therapy is essential for the treatment of patients with chronic mountain sickness （CMS）, but the efficacy of oxygen inhalation for populations at high risk of CMS remains unknown. This research investigated whether oxygen inhalation therapy benefits populations at high risk of CMS. Methods： A total of 296 local residents living at an altitude of 3658 m were included; of which these were 25 diagnosed cases of CMS, 8 cases dropped out of the study, and 263 cases were included in the analysis. The subjects were divided into high-risk （180 ≤ hemoglobin （Hb） 〈210 g/L, n = 161） and low-risk （Hb 〈180 g/L, n = 102） groups, and the cases in each group were divided into severe symptom （CMS score ≥6） and mild symptom （CMS score 0-5） subgroups. Severe symptomatic population of either high- or low-risk CMS was randomly assigned to no oxygen intake group （A group） or oxygen intake 7 times/week group （D group）; mild symptomatic population of either high- or low-risk CMS was randomly assigned to no oxygen intake group （A group）, oxygen intake 2 times/week group （B group）, and 4 times/week group （C group）. The courses for oxygen intake were all 30 days. The CMS symptoms, sleep quality, physiological biomarkers, biochemical markers, etc., were recorded on the day before oxygen intake, on the 15th and 30th days of oxygen intake, and on the 15th day after terminating oxygen intake therapy. Results： A total of 263 residents were finally included in the analysis. Among these high-altitude residents, CMS symptom scores decreased for oxygen inhalation methods B, C, and D at 15 and 30 days after oxygen intake and 15 days after termination, including dyspnea, palpitation, and headache index, compared to those before oxygen intake （B group： Z = 5.604, 5.092, 5.741; C group： Z = 4.155, 4.068, 4.809; D group： Z = 6.021, 6.196, 5.331, at the 3 time points respectively; all P 〈 0.05/3 vs. before intake）. However, dyspnea/palpitation （A group： Z = 5.003, 5.428, 5.493, both P 〈 0.05/3 vs. before intake） and headache （A group： Z = 4.263, 3.890, 4.040, both P 〈 0.05/3 vs. before intake） index decreased significantly also for oxygen inhalation method A at all the 3 time points. Cyanosis index decreased significantly 30 days after oxygen intake only in the group of participants administered the D method （Z= 2.701, P = 0.007）. Tinnitus index decreased significantly in group A and D at 15 days （A group： Z = 3.377, P = 0.001, D group： Z = 3.150, P - 0.002）, 30 days after oxygen intake （A group： Z = 2.836, P = 0.005, D group： Z = 5.963, P 〈 0.0001） and 15 days after termination （A group： Z- 2.734, P = 0.006, D group： Z - 4.049, P = 0.0001）, and decreased significantly in the group B and C at 15 days after termination （B group： Z = 2.611, P = 0.009; C group： Z = 3.302, P = 0.001）. In the population at high risk of CMS with severe symptoms, oxygen intake 7 times/weeksignificantly improved total symptom scores of severe symptoms at 15 days （4 [2, 5] vs. 5.5 [4, 7], Z = 2.890, P = 0.005） and 30 days （3 [1, 5] vs. 5.5 [2, 7], Z= 3.270, P = 0.001） after oxygen intake compared to no oxygen intake. In the population at high risk of CMS with mild symptoms, compared to no oxygen intake, oxygen intake 2 or 4 times/week did not improve the total symptom scores at 15 days （2 [1, 3], 3 [1, 4] vs. 3 [1.5, 5]; 2＂2 = 2.490, P= 0.288）, and at 30 days （2 [0, 4], 2 [1, 4.5] vs. 3 [2, 5];2＂2- 3.730, P = 0.155） after oxygen intake. In the population at low risk ofCMS, oxygen intake did not significantly change the white cell count and red cell count compared to no oxygen intake, neither in the severe symptomatic population nor in the mild symptomatic population. Conclusions： Intermittent oxygen inhalation with proper frequency might alleviate symptoms in residents at high altitude by improving their overall health conditions. Administration of oxygen inhalation therapy 2-4 times/week might not benefit populations at high risk of CMS with mild CMS symptoms while administration of therapy 7 times/week might benefit those with severe symptoms. Oxygen inhalation therapy is not recommended for low-risk CMS populations.展开更多
文摘Clinical DataCase selection: 100 cases who met thediagnostic criteria of senile dementiaformulated by American Association ofPsychiatry in Handbook of Diagnosis andStatistics (DSM-Ⅲ-R, 3rd revised edition)
基金Supported by the National Nature Science Foundation of China,No.81701899 and No.81671911Youth Incubation Plan of the Military Medical Science and Technology,No.16QNP091+3 种基金Naval Medical University Youth Start-up Fund,No.2016QN10the Logistics Scientific Research Program,No.AWS14C001-4Jiangsu Provincial Health Commission Project,No.H2017071Suzhou Clinical Medical Center Construction Program,No.SZZXJ201506
文摘BACKGROUND Hydrofluoric acid(HF)is one of the most common causes of chemical burns.HF burns can cause wounds that deepen and progress aggressively.As a result,HF burns are often severe even if they involve a small area of the skin.Published cases of HF burns have mostly reported small HF burn areas.Few cases of HF inhalation injury have been reported to date.CASE SUMMARY A 24-year-old man suffered from extensive hydrofluoric acid burns covering 60%of the total body surface area(TBSA),including deep second degree burns on 47%and third degree burns on 13%of the TBSA,after he fell into a pickling pool containing 15%HF.Comprehensive treatments were carried out after the patient was admitted.Ventricular fibrillation occurred 9 times within the first 2 h,and the lowest serum Ca2+concentration was 0.192 mmol/L.A dose of calcium gluconate(37 g)was intravenously supplied during the first 24 h,and the total amount of calcium gluconate supplementation was 343 g.Extracorporeal membrane oxygenation(ECMO)was applied for 8 d to handle the acute respiratory distress syndrome(ARDS)induced by the HF inhalation injury.The patient was discharged after 99 d of comprehensive treatment,including skin grafting.CONCLUSION Extensive HF burns combined with an inhalation injury led to a potentially fatal electrolyte imbalance and ARDS.Adequate and timely calcium supplementation and ECMO application were the keys to successful treatment of the patient.
文摘Coronavirus disease 2019(COVID-19)related acute respiratory distress syndrome(ARDS)is a severe complication of infection with severe acute respiratory syndrome coronavirus 2,and the primary cause of death in the current pandemic.Critically ill patients often undergo extracorporeal membrane oxygenation(ECMO)therapy as the last resort over an extended period.ECMO therapy requires sedation of the patient,which is usually achieved by intravenous administration of sedatives.The shortage of intravenous sedative drugs due to the ongoing pandemic,and attempts to improve treatment outcome for COVID-19 patients,drove the application of inhaled sedation as a promising alternative for sedation during ECMO therapy.Administration of volatile anesthetics requires an appropriate delivery.Commercially available ones are the anesthetic gas reflection systems AnaConDa®and MIRUSTM,and each should be combined with a gas scavenging system.In this review,we describe respiratory management in COVID-19 patients and the procedures for inhaled sedation during ECMO therapy of COVID-19 related ARDS.We focus particularly on the technical details of administration of volatile anesthetics.Furthermore,we describe the advantages of inhaled sedation and volatile anesthetics,and we discuss the limitations as well as the requirements for safe application in the clinical setting.
文摘Purpose:To evaluate the effectiveness of oxygen nebulization at preventing radiotherapyinduced mucositis in patients with nasopharyngeal cancer.Methods:Sixty patients with nasopharyngeal cancer treated with simultaneous integrated boost intensity-modulated radiotherapy were randomly assigned to oxygen nebulization or ultrasonic nebulization groups;treatment was once daily for 20 minutes.All patients received routine oral care.We compared saliva pH and volume,food intake,and change in oral mucosa during radiotherapy,and dry mouth and sore throat after radiotherapy between the two groups.Results:There were significant differences in the incidence of grade III or IV mucositis,saliva volume and pH,and dry mouth and sore throat between the two groups when the total dose was 33 Gy(p<0.05 or p<0.01).Conclusion:Oxygen nebulization reduces radiotherapy-induced mucositis and relieves symptoms such as dry mouth and sore throat in patients with nasopharyngeal cancer.
文摘目的:评估吸入一氧化氮(inhaled nitric oxide,INO)联合高频振荡通气(high frequency oscillatory ventilation,HFOV)治疗中重度新生儿持续肺动脉高压(persistent pulmonary hypertension of the newborn,PPHN)的疗效及安全性。方法:将商丘市第一人民医院新生儿重症监护室收治的104例中重度PPHN患儿随机分为研究组(INO+HFOV,n=52)与对照组(INO+常规机械通气,n=52),比较两组干预后24 h及48 h的氧合指数(oxygenation index,OI)、右心室收缩压/体循环收缩压比值(right ventricular systolic pressure/systemic systolic blood pressure,RVSP/SBP)、左心室输出量(left ventricular output,LVO)、药物代谢指标(高铁血红蛋白、血小板)及通气并发症(气胸、脑室内出血)。结果:研究组干预后24 h及48 h OI(18.25±4.30 vs 23.75±5.20;12.45±3.15 vs 17.85±4.25)与RVSP/SBP比值(0.45±0.09 vs 0.52±0.10;0.38±0.07 vs0.44±0.08)均显著低于对照组(P<0.001),LVO(162.75±25.15 mL/kg vs 145.30±22.60 mL/kg;178.45±28.50 mL/kg vs 155.80±24.75 mL/kg)显著高于对照组(P<0.001)。研究组气胸发生率更低(1.92%vs 15.38%,P=0.036),两组高铁血红蛋白水平无差异,但研究组血小板计数显著低于对照组(P=0.031)。结论:INO联合HFOV可快速改善中重度PPHN患儿的氧合与血流动力学,降低肺动脉压力及气胸风险,安全性可控,为传统INO联合常规通气疗效不足的患儿提供了优化方案。
文摘Background： Oxygen inhalation therapy is essential for the treatment of patients with chronic mountain sickness （CMS）, but the efficacy of oxygen inhalation for populations at high risk of CMS remains unknown. This research investigated whether oxygen inhalation therapy benefits populations at high risk of CMS. Methods： A total of 296 local residents living at an altitude of 3658 m were included; of which these were 25 diagnosed cases of CMS, 8 cases dropped out of the study, and 263 cases were included in the analysis. The subjects were divided into high-risk （180 ≤ hemoglobin （Hb） 〈210 g/L, n = 161） and low-risk （Hb 〈180 g/L, n = 102） groups, and the cases in each group were divided into severe symptom （CMS score ≥6） and mild symptom （CMS score 0-5） subgroups. Severe symptomatic population of either high- or low-risk CMS was randomly assigned to no oxygen intake group （A group） or oxygen intake 7 times/week group （D group）; mild symptomatic population of either high- or low-risk CMS was randomly assigned to no oxygen intake group （A group）, oxygen intake 2 times/week group （B group）, and 4 times/week group （C group）. The courses for oxygen intake were all 30 days. The CMS symptoms, sleep quality, physiological biomarkers, biochemical markers, etc., were recorded on the day before oxygen intake, on the 15th and 30th days of oxygen intake, and on the 15th day after terminating oxygen intake therapy. Results： A total of 263 residents were finally included in the analysis. Among these high-altitude residents, CMS symptom scores decreased for oxygen inhalation methods B, C, and D at 15 and 30 days after oxygen intake and 15 days after termination, including dyspnea, palpitation, and headache index, compared to those before oxygen intake （B group： Z = 5.604, 5.092, 5.741; C group： Z = 4.155, 4.068, 4.809; D group： Z = 6.021, 6.196, 5.331, at the 3 time points respectively; all P 〈 0.05/3 vs. before intake）. However, dyspnea/palpitation （A group： Z = 5.003, 5.428, 5.493, both P 〈 0.05/3 vs. before intake） and headache （A group： Z = 4.263, 3.890, 4.040, both P 〈 0.05/3 vs. before intake） index decreased significantly also for oxygen inhalation method A at all the 3 time points. Cyanosis index decreased significantly 30 days after oxygen intake only in the group of participants administered the D method （Z= 2.701, P = 0.007）. Tinnitus index decreased significantly in group A and D at 15 days （A group： Z = 3.377, P = 0.001, D group： Z = 3.150, P - 0.002）, 30 days after oxygen intake （A group： Z = 2.836, P = 0.005, D group： Z = 5.963, P 〈 0.0001） and 15 days after termination （A group： Z- 2.734, P = 0.006, D group： Z - 4.049, P = 0.0001）, and decreased significantly in the group B and C at 15 days after termination （B group： Z = 2.611, P = 0.009; C group： Z = 3.302, P = 0.001）. In the population at high risk of CMS with severe symptoms, oxygen intake 7 times/weeksignificantly improved total symptom scores of severe symptoms at 15 days （4 [2, 5] vs. 5.5 [4, 7], Z = 2.890, P = 0.005） and 30 days （3 [1, 5] vs. 5.5 [2, 7], Z= 3.270, P = 0.001） after oxygen intake compared to no oxygen intake. In the population at high risk of CMS with mild symptoms, compared to no oxygen intake, oxygen intake 2 or 4 times/week did not improve the total symptom scores at 15 days （2 [1, 3], 3 [1, 4] vs. 3 [1.5, 5]; 2＂2 = 2.490, P= 0.288）, and at 30 days （2 [0, 4], 2 [1, 4.5] vs. 3 [2, 5];2＂2- 3.730, P = 0.155） after oxygen intake. In the population at low risk ofCMS, oxygen intake did not significantly change the white cell count and red cell count compared to no oxygen intake, neither in the severe symptomatic population nor in the mild symptomatic population. Conclusions： Intermittent oxygen inhalation with proper frequency might alleviate symptoms in residents at high altitude by improving their overall health conditions. Administration of oxygen inhalation therapy 2-4 times/week might not benefit populations at high risk of CMS with mild CMS symptoms while administration of therapy 7 times/week might benefit those with severe symptoms. Oxygen inhalation therapy is not recommended for low-risk CMS populations.
