Objective To observe the expression of angiotensin-converting enzyme( ACE) and ACE2 in rat lung and kidney at different time point after smoke inhalation injury and to explore the possible mechanism. Methods Thirty healthy male SD rats were randomly divided into five groups( n = 6 in each group) , ie. a normal control group, and 4 injury groups of 1 h, 4 h, 10 h and 24 h respectively after 30 min of dense smoke inhalation. The rats were sacrificed at different time point. Lung and kidney tissue samples were collected for measurement of lung wet/dry weight ratio( W/D) , pathological study by HE staining, and ACE and ACE2 expression by immunochemistry staining. Results The inhaled rats all displayed acute lung injury symptoms. The lung W/D in the injury groups were significantly higher compared to the normal control group ( P lt; 0. 05, P lt; 0. 01) . ACE and ACE2 were expressed on cellular membrane of normal lung and kidney. The expression of ACE in lung was increased immediately after injury and the expression of ACE2 in lung was increased at 4 h after injury. No significant changes of the expression of ACE and ACE2 in kidney were observed in the five groups. Conclusion The imbalances of expression of ACE and ACE2 in lung might play an important role in the pathogenesis of smoke inhalation injury.
Objective To study the pathology and possible mechanism of experimental hydrochloric acid（HCl） inhalation-indued pulmonary fibrosis in rats.Methods 120 male SD rats were randomly divided into a nomal control group，a bleomycin group，a high dose HCl group，a middle dose HCl group and a low dose HCl group.The bleomycin group was intratracheally injected with bleomycin once to induce pulmonary fibrosis.The three HCl groups were intratracheally injected with HCl once per week.The control group was given saline by the same way.Six rats of each group were randomly sacrificed on day 7，14，28 and 42 respectively.The histological changes of lung tissue were studied by HE and Masson’s trichrome staining.Hydroxyproline level in lung tissue was measured by digestion method.Protein and mRNA expression of transforming growth factor-β1（TGF-β1） were assayed by immunohistochemistry and RT-PCR respectively.Results Alveolitis in three HCl groups was significantl compared to control group，most severe at the second week，then remained at a high level which was equivalent to or exceeded the level of the bleomysin group after 28 days.Pulmonary fibrosis in three HCl groups was also significantly more severe than that in the control group，but milder than that in the bleomysin group.The high-dose and middle-dose HCl groups were not significantly different from the bleomysin group on day 42.There was no difference between three HCl groups in the earlier period，but the high-dose HCl group has a significantly difference from low-dose group on day 42.The content of hydroxyproline in high-dose and middle-dose HCl groups was also significantly higher than that in the control group.On day 42 hydroxyproline content in high-dose HCl dose rather middle –or low dose group was similiar with the level of bleomysin group.Content of TGF-β1 mRNA in three HCl groups was comparable to the level of bleomysin group on day 28 and exceeded on day 42.The expression of TGF-β1 in three HCl groups was not significantly different from the bleomysin group on day 42.Conclusion Experimental acid aspiration might contribute to pulmonary fibrosis in rats.Acid induced alveolar epithelial cell damage，abnormal proliferation and repair and fibrosis could be involved..
Objective To evaluate the therapeutic effects of different airway management strategies early used for patients after abdominal surgery in general anesthesia. Methods According to gender, age,and operation location,200 patients after abdominal surgery in general anesthesia were randomly assigned to four groups, ie. a conventional treatment group ( Group A) , an incentive spirometry ( IS) therapy group ( Group B) , an aerosol inhalation group ( Group C) , a combination of inhalation and IS therapy group ( Group D) . Inhalation drugs included Budesonide, Terbutaline, and Ambroxol. The index of pulmonary function test ( FVC, FEV1 , PEF) and arterial blood gases analysis ( ABG) were measured, and the effect of secretions clearance and the improvement of respiratory symptoms were evaluated at 0.5 h,24 h, 48 h after extubation.Intratracheal intubation of the patients after leaving ICUwas followed up. Results FVC, FEV1 , PEF, ABG,sputumvolume, the effect of secretions clearance, clinical efficacy, and intratracheal intubation rate in group B, C and D were improved more significantly than those in group A. And the therapeutic effect was best in group D ( P lt;0. 05) . The secretions clearance was improved more better in group C and D, especially in those high-risk patients with advanced age, smoking history, and pulmonary cormobidities ( P lt; 0. 05) .Conclusions The combined use of IS training and inhalation therapy can improve airway secretions clearance and pulmonary function particularly for those patients after abdominal surgery in general anesthesia, especially for those high-risk patients.
Objective To observe the systemic inhalation anesthetic effects of preterm children with different gestational ages under ocular fundus examination, and to assess its safety. Methods Fifty-one preterm children with retinopathy of prematurity (ROP) were included in the study. These kids were divided into 2 groups, group Ⅰ included 24 kids with a corrected gestational age of 33 to ＜44 weeks, and group Ⅱ included 27 kids with a corrected gestational age of 44 to 64 weeks. The preterm months were same (t=-1.3.P＞0.05), but the body weights were different (t=-10.5.P＜0.05) between these two groups. Anesthesia was induced by inhalation of 6% sevoflurane, and the period from the beginning of inhalation to disappearance of body movement was the induction time. 6% sevoflurane was inhaled continuously for another period of the induction time, and then the concentration of sevoflurane was adjusted to a maintenance concentration. The initial maintenance concentration was 3%, and was adjusted by 0.5% each time. Sequential method was used to determine the subsequent maintenance concentration. If the preceding patient had not moved during the maintenance period, the sevoflurane concentration was decreased by 0.5% for the next patient. If the preceding patient had moved during the maintenance period, the sevoflurane concentration was increased by 0.5% for the next patient. Respiratory depression and cough during the induction and maintenance period, duration of anesthesia and recovery time were recorded. Choking and vomiting during drinking or milk-feeding in one hour after the ocular fundus examination were also recorded. Results The effective inhale concentration in 50% patient of sevoflurane was 2.5% in group Ⅰ, 2.9% in group Ⅱ. The average maintenance concentration was (2.5plusmn;0.5)% in group Ⅰ, (3.0plusmn;0.5)% in group Ⅱ. The difference was statistically significant (t=-3.3.P＜0.05). The average duration of anesthesia and the average awake time were the same (t=0.04 and -1.0 respectively.P＞0.05) between these two groups. The average induction time was significantly shorter in group Ⅰ than in group Ⅱ, the difference was statistically significant (t=-4.9.P＜0.05). All patients were successfully completed the ocular examination. No respiratory depression or cough occurred during and after the examination. No choking and vomiting during drinking or milkfeeding in one hour after the ocular fundus examination. Conclusion Anesthesia with inhaled sevoflurane by a face mask is safe for preterm outpatients undergoing fundus examination.
【摘要】目的探讨喉癌手术后患者对两种不同雾化方式的耐受性,为选择最佳雾化方式提供参考。方法将49例喉癌手术后患者随机分为观察组(25例)和对照组(24例),观察组采用氧气雾化吸入,对照组采用空气压缩泵雾化吸入。分别记录两组患者雾化吸入前及吸入15 min时脉搏血氧饱和度(SpO2)及心率;雾化过程中患者有无心慌、气紧等不适以及雾化后痰液的性质及量。采用SPSS 13.0软件进行统计分析。结果两组患者雾化吸入15 min时的SpO2差异有统计学意义(Plt;001),观察组高于对照组;而两组患者雾化吸入前SpO2、心率、不适主诉及雾化后痰液的性质差异均无统计学意义(Pgt;005)。结论氧气雾化吸入可以提高喉癌手术后患者雾化过程中的SpO2,使患者感觉更加舒适。【Abstract】Objective To investigate postoperative patients with laryngeal carcinoma atomization of two different forms of tolerance, in order to choose the best means of atomization. Methods Fifty postoperative patients with laryngeal carcinoma were divided into observation group using oxygen inhalation and control group using the air compression pump inhalation. Two groups of patients were recorded the value of SpO2 and heart rate before 15 minutes after the inhalation,as well as the discomforts such as flustered,gas tight during the atomization process and the nature and olume of sputum. Results The results of two groups of patients at the time of 15 minutes inhalation SpO2 statistically significant difference (Plt;001), the observation group than in the control group average SpO2 high; and two groups of patients with preinhalation SpO2 average, average heart rate, Discomfort chief complaint and the nature of sputum after aerosol compared no significant difference (Pgt;005). Conclusion Oxygen inhalation in patients with laryngeal cancer can improve the atomization process SpO2 value, so that patients feel more comfortable.
摘要:目的:定量测定50 %小儿在喉罩表面涂抹丁卡因胶浆的情况下平稳拔除喉罩时呼气末七氟烷浓度。方法:25例择期行四肢及体表手术的患儿,高流量吸入七氟烷诱导并以七氟烷和氧化亚氮维持麻醉,不使用肌肉松弛剂及静脉麻醉药物,手术结束后停止吸入氧化亚氮,并维持设定的七氟烷浓度10min后拔除喉罩。根据Dixon序贯法确定喉罩拔除时的七氟烷浓度,每0.1 Vol%七氟烷为1个增减单位。患儿未出现咳嗽、牙关紧闭、体动、屏气及喉痉挛则认为拔除喉罩平稳。结果:50 %小儿平稳拔除喉罩时呼气末七氟烷浓度(EC50)为1.22 Vol%(95 %的置信区间分别为0.99 Vol%～1.49 Vol%)。结论:在喉罩表面涂抹丁卡因胶浆的情况下,3～8岁患儿喉罩满意拔除时呼气末七氟烷EC50值为1.22 Vol%。Abstract: Objective: To determine the concentration of sevoflurane where 50%( EC50 ) of the attempts to remove the laryngeal mask airway (LMA ) with the Teracainum Gel would be successful in children. Methods: Twentyfive nonpremedicated children, aged 38 years old, ASA physical status I, scheduled for extremities or peripherical surgery were enrolled in this study. General anesthesia was induced with sevoflurane and maintained with sevoflurane and nitrous oxide in oxygen. After the surgery, the target concentration was maintained for at least 10 min, and then the LMA was removed. Each target concentration was predetermined by the Dixon’s upanddown method (with 0.1 Vol% as a step size), starting at 1.20 Vol% concentration of sevoflurane. A removal accomplished without coughing, teeth clenching, gross purposeful movement, breath holding or laryngospasm, during or within 1 min after removal was considered to be successful. Results:The concentration of sevoflurane to achieve successful LMA removal in 50% of children was 1.22 Vol% (95%CL, 0.99 Vol%1.49 Vol%). Conclusion: The EC50 value of sevoflurane for LMA smooth extubation in children aged 38 years old with teracainum gel was 1.22 Vol%.
Objective To compare three approaches of lipopolysaccharides ( LPS) administration for inducing acute lung injury ( ALI) in mice. Methods LPS ( 5 mg/kg) was intratracheally aerosol administered ( ITA group) , intratracheally instilled ( ITI group) , or intraperitoneally injected ( IPI group) to induce ALI in BLAB/ c mice. Evans Blue instead of LPS was intratracheally administered to observe the liquid distribution in the lungs. Two hours after LPS administration, the mice were sacrificed and the lungs were removed to determine wet-to-dry lung weight ratio ( W/D) , and the histological changes were evaluated by HE staining. Phosphorylation level of IκB-αand NF-κB p65 in lung tissue were investigated by Western blot. Transcription intensity of TNF-α and IL-1β mRNA in lung tissue were detected by real-time quantitative PCR. Results Evans Blue distributed more uniformly in the ITA group than the ITI group. The lung W/D ratio and histological changes score in three LPS administration groups were all significantly higher than the normal control group ( P lt;0. 01) , with the ITA group being the highest. The phosphorylation levels of IκB-αand NF-κB p65 were significantly higher in the ITA group than the ITI group ( P lt;0. 05) , and were significantly higher in the ITI group than the IPI group ( P lt; 0. 05) . Transcription intensity of TNF-αand IL-1βmRNA was significantly higher in the ITA group than the ITI group ( P lt;0. 05) , and were significantly higher in the ITI group than the IPI group ( P lt;0. 05) . Conclusion Being non-invasive and convenient,intratracheal LPS aerosol inhalation is an optimal method to induce ALI in mice because it induces more extensive and uniformly distributed injuries in lung.
ObjectiveTo explore the influence of general anesthesia with laryngeal mask and preoperative inhalation of budesonide aerosol on the incidence of respiratory adverse events during pediatric anesthesia recovery. MethodsA total of 100 child patients scheduled to undergoing inguinal hernia repair between December 2012 and February 2014 were randomly divided into two groups (group A and B) with 50 in each. All the patients underwent general anesthesia with laryngeal mask, while patients in group B inhaled budesonide aerosol before anesthesia. Then, we observed the incidence of adverse events in both groups, including laryngospasm, respiratory tract infection, and pulmonary complications. ResultsCompared with group A, patients in group B had a lower incidence of adverse events (P<0.05). ConclusionPreoperative application of budesonide aerosol inhalation can significantly reduce adverse events in the process of anesthesia recovery in children.
ObjectiveTo observe the clinical efficacy of triple aerosol inhalation of pulmicort respules,ipratropine and ventolin in treatment of severe acute asthma exacerbations in adults. Methods46 cases of severe asthmatic patients with acute exacerbations admitted between May 2011 and May 2013 were recruited in the study.They were randomly divided into a treatment group and a control group,23 cases in each group.The control group received aminophylline and methylprednisolone intravenously,while the treatment group received triple aerosol inhalation of pulmicort respules,ipratropine and ventolin on the basic treatment of the control group.The clinical efficacy,the score of asthma symptom of the day and night,the time of disappearance of symptoms and wheezing sound,the glucocorticoid dosage and the incidence of adverse reactions of each group were compared. ResultsComparison of clinical efficacy of two groups drew significant differences (P<0.05) after 7 days.The score of asthma symptom of the day and night in the treatment group was lower than that of the control group (P<0.05).Except cough,the duration of wheezing,breathlessness,chest distress and extinction time of wheezing sound in the treatment group were shorter than those in the control group (P<0.05).The triple inhalation therapy can reduce the dosage and shorten the period of intravenous glucocorticoid treatment with slight adverse reactions (P<0.05). ConclusionIn the treatment of severe asthmatic patients with acute exacerbations,the clinical efficacy of triple aerosol inhalation of pulmicort respules,ipratropine and ventolin on the base of intravenous treatment is satisfactory with rapid onset,which can also reduce the glucocorticoid dosage and the incidence of adverse reactions.So the combination therapy is worthy of clinical use.
ObjectiveTo retrospectively compare the clinical effects of high frequency oscillatory ventilation (HFOV) and conventional ventilation (CV) on patients with acute respiratory distress syndrome (ARDS) induced by smoke inhalation injury. MethodsForty-three patients with smoke inhalation induced ARDS were admitted in the Center Hospital of Hu Ludao between October 2004 and June 2015.Among the patients, 19 cases were treated with CV (CV group) and 24 cases were treated with HFOV (HFOV group).The clinical data were collected and compared between two groups including blood gas at certain time points (6 h, 24 h, 48 h, 96 h, and 7 d) as well as complications and prognosis. ResultsThere was no significant difference in arterial blood gas between two groups before treatment (P > 0.05).After ventilation treatment, there were significant differences in arterial blood gas parameters between two groups except arterial carbon dioxide partial pressure at 48 and 96 h.And the patients in the HFOV group improved more obviously.The hospitalization time and ventilation time in the HFOV group were significantly shorter than those in the CV group (P < 0.05).No significant difference was found between two groups in the incidences of mortality, complications or 30-day survival rate (P > 0.05). ConclusionsBoth high frequency oscillatory ventilation and conventional ventilation can improve the clinical status in patients with smoke inhalation induced ARDS.These two ventilation modes do not present any difference with respect to prognosis by present evidence.