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find Author "徐远达" 7 results
  • 血浆置换辅助重症肌无力危象患者撤机的观察

    目的 回顾血浆置换辅助治疗重症肌无力危象伴撤机困难患者的疗效。方法 选择2000 ~2005 年因撤机困难入住广州呼吸疾病研究所ICU的重症肌无力患者11 例, 均需有创呼吸机辅助通气。其中接受了血浆置换( PE) 治疗7 例, 称PE 组; 仅接受常规治疗4 例, 称对照组。比较两组患者的住院天数、总通气天数、ICU 天数、用PE 前( 后) 的机械通气天数, 以及PE 前和撤机时的许氏临床相对评分。结果 血浆置换组用PE 前的通气天数( 19. 7 ±21. 3) d, 接受PE 后的通气天数为( 2. 57 ±5. 94) d, 总通气天数( 27 ±23) d; 对照组的总通气天数( 26 ±22) d, 两组的住院天数、总通气天数、ICU 天数均无显著差异。PE 组治疗前许氏绝对评分平均为44 分,4 次PE 治疗后许氏绝对评分平均为18 分, 相对计分为0. 59。结论 对这类撤机困难的重症肌无力危象患者应用PE 治疗4 次后, 在不增加治疗总费用的前提下, 能在较短时间内协助患者尽快撤机; 对急性呼吸衰竭机械通气的重症肌无力患者, 在综合治疗前提下, 机械通气7 d 以上仍难以撤机者, 可考虑应用血浆置换。

    Release date:2016-09-14 11:23 Export PDF Favorites Scan
  • 体外二氧化碳清除应用于慢性阻塞性肺疾病急性加重的研究进展

    Release date:2016-10-12 10:17 Export PDF Favorites Scan
  • Noninvasive Ventilation for Treatment of Acute Respiratory Failure Secondary to Severe Acute Respiratory Syndrome

    Objective To investigate the effects of noninvasive ventilation for the treatment of acute respiratory failure secondary to severe acute respiratory syndrome ( SARS) . Methods 127 patients with complete information were collected from the database of SARS in Guangdong province, who were all consistent with the ALI/ARDS diagnostic criteria. The patients were divided into three groups depending on ventilation status, ie. a no-ventilation group, a noninvasive ventilation group, and a mechanical ventilation group. The outcome of ventilation treatmentwas followed up.Multi-factor regression analysis was conducted to analyze the relations of ventilation treatment with ARDS and mortality, and factors associated with success of noninvasive ventilation. Results As soon as the patients met the diagnostic criteria of ALI/ARDS, the patients in the noninvasive ventilation group were in more serious condition and had a higher proportion of ARDS compared with the no-ventilation group ( P lt;0. 01) . The patients in the mechanical ventilation group had a higher mortality rate ( P lt;0.01) . 6 and 7 patients in the no-ventilation group had noninvasive ventilation and invasive ventilation thereafter, respectively. 15 patients in the noninvasive group switched to invasive ventilation. Compared with the patients without ventilation ( n =45) , the patients receiving noninvasive ventilation ( n = 61) were in more serious condition and at higher risk of developing ARDS ( P lt;0. 01) , but the mortality was not different between them ( P gt; 0. 05) . The patients who continued to receive noninvasive ventilation ( n = 40) were in more serious condition, and at higher risk of developing ARDS compared with the patients without ventilation ( n = 45) ( P lt; 0. 01) . 15 patients in the noninvasive group who switched to invasive ventilation were older than those patients continuing noninvasive ventilation.Conclusions For SARS patients fulfilling the ALI/ARDS criteria, the patients underwent noninvasive ventilation are more severe, run a higher probability of developing ARDS from ALI. But earlier initiation of noninvasive ventilation has no impact on mortality. The patients who tolerate noninvasive ventilation can avoid intubation, especially for young patients. However, the time and indication of shifting from noninvasive ventilation to invasive ventilation should be emphasized.

    Release date:2016-08-30 11:54 Export PDF Favorites Scan
  • Cardiac Function Index and Global Ejection Fraction for Assessment of Left Ventricular Systolic Function

    ObjectiveTo investigate the clinical significance of cardiac function index (CFI) and global ejection fraction (GEF), derived from single-indicator transpulmonary thermodilution technique, in assessment of cardiac function in critically ill patients. MethodsA prospective clinical observational study was conducted in the Intensive Care Unit of the First Affiliated Hospital of Guangzhou Medical University. Between January 2012 and December 2012, 39 patients who underwent PiCCO monitoring were recruited, including 18 cases with left ventricular systolic dysfunction and 21 cases without left ventricular systolic dysfunction. Both groups underwent transpulmonary thermodilution measurements and transthoracic cardiac ultrasonography. Pearson correlation analysis was conduced to assess the correlation between left ventricular ejection fraction (LVEF) and CFI and GEF. ROC curve was established to calculate the predicted threshold of CFI and GEF for diagnosing cardiac insufficiency. ResultsLVEF was significantly correlated with CFI and GEF (r=0.553, P < 0.005; r=0.468, P < 0.005). The area under ROC curve of CFI, GEF and LVEF for diagnosing cardiac insufficiency was 0.885, 0.862 and 0.903, respectively (P > 0.05 for comparison). The cut-off value of CFI for predicting cardiac insufficiency was 4.25/min, with a sensitivity of 77.8% and a specificity of 88.9%. The cut-off value of GEF for predicting cardiac dysfunction was 19.5/min, with a sensitivity of 88.9% and a specificity of 66.7%. ConclusionCFI and GEF measured by transpulmonary thermodilution correlate well with LVEF assessed by transthoracic echocardiography, both can be used for assessment of left ventricular systolic function.

    Release date:2016-10-02 04:55 Export PDF Favorites Scan
  • Stroke Volume Variation and Intrathoracic Blood Volume Index as Indicator of Fluid Responsiveness in Mechanically Ventilated Septic Shock Patients with Spontaneous Breathing

    ObjectiveTo evaluate the value of stroke volume variation (SVV) and intrathoracic blood volume index (ITBVI) to predict fluid responsiveness in mechanically ventilated septic shock patients with spontaneous breathing. MethodsA prospective observational study was conducted in the Department of Critical Care Medicine of the First Affiliated Hospital of Guangzhou Medical University. Fluid resuscitation data was collected in septic shock patients who received PiCCO monitoring from June 2013 to June 2014. Transpulmonary thermodilution data were collected before and after fluid resuscitation, including cardiac index (CI), SVV, ITBVI, and central venous pressure (CVP). Seventeen patients were defined as responders by an observed increase of≥15% in the cardiac index (CI) after fluid resuscitation, 12 patients were defined as non-responders. Pearson correlation between changes of CI (ΔCI) and SVV, ITBVI, CVP was established. Area under the receiver operating characteristic (ROC) curve of SVV, ITBVI and CVP was calculated for predicting fluid responsiveness. ResultsBaseline CI and ITBVI were significantly lower in the responders (P < 0.05).There was no significant difference in baseline SVV between the responders and the non-responders (P > 0.05). A significant correlation was found between baseline ITBVI andΔCI (r=-0.593, P < 0.001), but no significant correlation between SVV andΔCI (r=0.037, P=0.847) or CVP andΔCI (r=0.198, P=0.302). The area under ROC curve of SVV, ITBVI and SVV for predicting fluid responsiveness was 0.640 (P=0.207), 0.865 (P=0.001), and 0.463 (P=0.565), respectively. The cut-off value of ITBVI for predicting fluid responsiveness was 784 mL/m2 with a sensitivity of 100.0% and a specificity of 70.6%. ConclusionIn mechanically ventilated septic shock patients with spontaneous breathing, ITBVI may be a valuable indicator in predicting fluid responsiveness compared with SVV.

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  • 心肺复苏并发冠状动脉破裂及迟发性肝破裂一例并文献复习

    目的总结分析心肺复苏(CPR)患者的近期与远期并发症。方法对 1 例肺癌术后 CPR 并发冠状动脉及迟发性肝破裂患者的临床资料,结合文献复习进行分析。总结其临床特点,诊治方案与预后。结果患者女,66 岁,左肺腺癌(T1bN0M0,Ia 期),行左上肺肺癌根治术,术后 13 h 突发心跳骤停,给予 CPR 2 h,期间出现失血性休克,床边开胸探查,发现冠状动脉左前降支有一破损口;CPR 后第 12 天,再次失血性休克,腹部超声:肝脏破裂出血,予内科保守治疗后,出血吸收。术后 3 个月,神志恢复,格拉斯哥昏迷量表评分 9 分,转下级医院继续康复。文献检索后经筛选剔除,共检索到相关文献 14 篇。35 例冠状动脉破裂(尸体解剖回顾性研究)、34 例肝破裂(个案报道)。肝破裂病死率高达 70.6%。左肝比右肝破裂多,大部分通过 CT/超声诊断。治疗上包括手术、保守、肝动脉栓塞。结论CPR 合并冠状动脉、肝破裂患者,起病急,病死率高。临床上需警惕、避免、甄别 CPR 并发症,做到早诊断、早治疗。

    Release date:2021-04-25 10:17 Export PDF Favorites Scan
  • Effect of Prone Position Ventilation on Hemodynamics in Patients with Interstitial Lung Disease Concurrent with Acute Respiratory Distress Syndrome

    Objective To investigate the effect of prone position ventilation (PPV) on hemodynamics in patients with interstitial lung disease (ILD) concurrent with acute respiratory distress syndrome (ARDS) or not. Methods Severe ARDS patients received PPV treatment in intensive care unit from 2013 to 2015 were retrospectively analyzed. Pulse index continuous cardiac output (PiCCO) monitoring indices were compared 2h before PPV (PPV-2), in-PPV (PPVmean) and 2h after turn back to supine position (PPV+2), including mean arterial pressure (MAP), cardiac index (CI), intrathoracic blood volume index (ITBVI), etc. Heart function, liver function, renal function, coagulative function were compared before and after all the PPV treatment. Results Thirty-six severe pulmonary ARDS patients were recruited. Norepinephrine (NE) dose was (0.14±0.10) μg·kg-1·min-1 and lactate concentration was (1.70±0.57) mmol/L before PPV. CI in all the patients was increased [(4.06±0.95) L·min-1·m-2 vs. (3.98±1.05) L·min-1·m-2, P > 0.05) and central venous oxygen saturation, ITBVI [(76.94±8.94)% vs. (70.67±8.23)%, (982.17±245.87) mL/m2 vs. (912.97±177.65) mL/m2, P < 0.05)] were significantly increased compared with PPV-2, while heart rate (HR), MAP, urine volume were decreased (P > 0.05). The patients were divided into an ILD group (n=17) andanon-ILD group (n=19),and no significant differences were found in baseline data between two groups. Compared with PPV-2, MAP was significant decreased at PPV+2 [(85.44±10.84) mm Hg vs. (89.21±10.92) mm Hg, P < 0.05) in the ILD group. Compared with PPVmean, CI was obviously declined at PPV+2 in the ILD group. Activated partial thromboplastin time was increased [(67.04±97.52)s vs. (41.24±8.72) s, P < 0.05] and BUN was higher [(10.64±4.95) μmol/L vs. (8.18±3.88) μmol/L, P < 0.05] in the ILD group, while no significant difference was found in the non-ILD group. Conclusion PPV will not affect cardiac output in severe ARDS patients with ILD. It can increase venous return and improve tissue perfusion, but the perfusion of the abdomen organ need to be monitored cautiously.

    Release date:2016-10-02 04:56 Export PDF Favorites Scan
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