急性肺损伤与急性呼吸窘迫综合征的诊断与治疗策略

急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）是多个危险因素直接或间接引起肺部损伤的连续病理过程,以表现低氧血症为特征,ARDS是ALI严重末期的表现。低流量、呼气末正压（PEEP）保护性通气的措施可明显改善氧和,减轻机械通气肺损伤,降低病死率,明显优于传统通气方式。     

急性肺损伤与急性呼吸窘迫综合征的诊断与治疗策略

急性肺损伤(ALI)和急性呼吸窘迫综合征(ARDS)是多个危险因素直接或间接引起肺部损伤的连续病理过程,以表现低氧血症为特征,ARDS是ALI严重末期的表现.低流量、呼气末正压(PEEP)保护性通气的措施可明显改善氧和,减轻机械通气肺损伤,降低病死率,明显优于传统通气方式.     

ALI/ARDS患者糖皮质激素的治疗效果和时机

急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)是临床各科经常遇到的急症,其发病机制主要是中性粒细胞向炎症部位的移动,释放出大量的炎性介质和细胞因子,引起肺泡毛细血管膜通透性增高,弥漫性肺损伤和蛋白性肺泡水肿液聚集等病理生理改变.临床表现为呼吸困难、呼吸窘迫、顽固的低氧血症,虽然使用机械通气和呼气末正压通气(PEEP)后,其病死率有所下降,但仍然维持在50%左右.就糖皮质激素的作用机制,对不同原因引起的ALI/ARDS治疗效果,使用时机作一综述,期望对ALI/ARDS治疗过程中糖皮质激素的使用予以规范.     

ALI/ARDS患者糖皮质激素的治疗效果和时机

急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)是临床各科经常遇到的急症,其发病机制主要是中性粒细胞向炎症部位的移动,释放出大量的炎性介质和细胞因子,引起肺泡毛细血管膜通透性增高,弥漫性肺损伤和蛋白性肺泡水肿液聚集等病理生理改变。临床表现为呼吸困难、呼吸窘迫、顽固的低氧血症,虽然使用机械通气和呼气末正压通气(PEEP)后,其病死率有所下降,但仍然维持在50%左右。就糖皮质激素的作用机制,对不同原因引起的ALI/ARDS治疗效果,使用时机作一综述,期望对ALI/ARDS治疗过程中糖皮质激素的使用予以规范。     

急性有机磷农药中毒救治中的几个问题

解决急性有机磷农药中毒病死率居高不下的问题,必须提高救治中的辩证思维.正确理解标本兼治的含义,外周性、中枢性抗胆碱药物和复能剂联合应用,合理维持阿托品化,积极应用机械通气进行必要的呼吸支持治疗和适时行血液灌流治疗是救治有机磷农药中毒的有效保证.     

急性有机磷农药中毒救治中的几个问题

解决急性有机磷农药中毒病死率居高不下的问题,必须提高救治中的辩证思维。正确理解标本兼治的含义,外周性、中枢性抗胆碱药物和复能剂联合应用,合理维持阿托品化,积极应用机械通气进行必要的呼吸支持治疗和适时行血液灌流治疗是救治有机磷农药中毒的有效保证。     

肺保护策略机械通气的再评价

通常认为急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者应用肺保护策略机械通气可降低病死率,主要由于潮气量的降低。对已发表的随机对照研究再次分析,发现平台压与患者病死率明显相关。平台压低于30cmH2O时,潮气量可以在一定范围内增加,不影响患者预后。但选择小潮气量可能对病人有害。随机对照研究在试验设计、统计学分析、病人同质性等方面依然存在很多问题。从现有资料看,潮气量和平台压都很重要。     

肺保护策略机械通气的再评价

通常认为急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)患者应用肺保护策略机械通气可降低病死率,主要由于潮气量的降低.对已发表的随机对照研究再次分析,发现平台压与患者病死率明显相关.平台压低于30cmH2O时,潮气量可以在一定范围内增加,不影响患者预后.但选择小潮气量可能对病人有害.随机对照研究在试验设计、统计学分析、病人同质性等方面依然存在很多问题.从现有资料看,潮气量和平台压都很重要.     

ARDS的常规非机械通气治疗现状

ARDS是重症患者常见的临床问题,病死率较高.ARDS时除机械通气治疗外,非机械通气治疗手段包括液体管理、药物治疗、体外生命支持治疗等也显示出不同的临床疗效,需要临床医生加以关注.     

重组人生长激素对机械通气患者氧合的影响

为了探讨重组人生长激素（rhGH）对机械通气治疗危重患者的治疗效果,将31例机械通气治疗的危重患者随机分为rhGH组和对照组,rhCM组每晚皮下注射rhGH8IU,连续记录7d内的各项指标。结果显示,rhGH组机械通气时间明显短于对照组,差异有统计学意义;rhGH组患者APACHEⅡ评分于用药后第5天开始明显低于对照组;对用药不同阶段氧合指标的比较,两组患者氧分压指标的变化差异统计学意义,而应用rhGH组患者呼吸指数和氧合指数于用药后第5天和第7天明显高于对照组,有统计学意义。因此,应用rhGH可以促进机械通气的危重患者自主呼吸功能的恢复。     

不同机械通气模式下吸痰对ARDS患者肺通气及顺应性的影响

为探讨不同机械通气模式下吸痰对ARDS患者肺通气及顺应性的影响。选择20例ARDS机械通气患者,随机分为A/C组与SIMV组;分别给予开放式吸痰,记录吸痰前后肺通气指标及呼吸系统顺应性指标的变化。结果吸痰后各时间点呼吸频率均显著增加(P0.01);潮气量、分钟通气量在0s显著降低,吸痰后15s、1min显著增加(P0.01);两通气模式比较SIMV组呼吸频率、分钟通气量增加显著(P0.01)。吸痰前后动静态顺应性、动态P-V曲线斜率差异不显著(P0.05),通气模式之间亦无统计学差异。提示开放式吸痰引起呼吸频率显著增加,潮气量及分钟通气量先是下降然后显著增加;SIMV模式呼吸频率、通气量增加较为显著。不同通气模式下吸痰对呼吸系统顺应性影响不显著。     

急性呼吸窘迫综合征肺泡塌陷与肺复张的意义

大量肺泡塌陷是急性呼吸窘迫综合征(ARDS)病理生理改变的基础,可导致顽固性低氧血症、肺泡表面活性物质丢失、呼气气流受限、去复张性肺损伤、肺部感染和生物性肺损伤。积极的实施肺开放策略,实现塌陷肺泡的复张具有重要的临床意义。肺复张导致肺泡过度膨胀、循环干扰,以及肺泡难以复张因素的存在,使肺泡完全复张可能并不必要。在避免肺泡塌陷危害与肺复张的局限性之间寻求平衡,才能使肺复张确立其在ARDS治疗中的恰当地位。     

Visual and somesthetic influences on postural orientation in the median plane

We investigated optic and somesthetic contributions to perceived body orientation in the pitch dimension. In a within-subject factorial design, each of 12 subjects attempted to set his/her body erect or 45° back from erect while restrained in a movable bed surrounded by an adjustable box The box provided a visual environment consisting of either a grid pattern, two luminous lines, or complete darkness. Both the grid pattern and the luminous lines were effective at-biasing settings of body position when the box was pitched; the pitched grid was more effective than the pitched lines. Although the pitch of the box influenced orientation to both goals, the effect was greater for the diagonal goal than for the erect goal. We present a model of postural orientation in the median plane that involves vestibular, somatosensory, and visual inputs.     

The rod-and-frame illusion in erect and supine observers

Previous studies have found that the effect of a tilted frame on egocentric rod adjustments is greater when an overhead display in a horizontal plane is viewed from a supine body position than when a vertical display is viewed from an erect body position. The present studies were designed to see whether this phenomenon could be attributed to an intravisual orientation contrast effect or to the effects of visually induced eye torsion. No significant erect-supine differences were found on measures of either effect. Errors in the direction of frame tilt were significantly greater in the supine position when observers were asked to align a visible rod or an unseen hand-held disk with the head, but no effect of body position was found in matching the orientation of the disk with the rod. The data suggest that erect-supine differences in frame effects are not attributable simply to intravisual factors. The results are discussed in terms used by Harris (1974) to describe “straight-ahead shifts” in judging spatial directions with respect to the median plane.     

Posture,muscular tone and visual attention in 5 month‐old infants

The present paper aims at studying the relationships between posture, muscle tone and visual attention in 5 month‐old infants. To this end, a specially designed seating arrangement made it possible to vary posture while keeping constant the spatial relationship between eyes and stimuli. Five month‐olds were placed in the reclining position (30°) or in a more erect position (60°). The more erect the posture, the more difficult it should be for the infant to maintain a straight body axis. Muscle tone was evaluated, and infants distinguished in terms of whether they were hypertonic or hypotonic. It was hypothesised that in a more erect position hypotonic children, who experience more difficulties in maintaining posture, should organise their visual exploration in ways different from those considered to be hypertonic. To test it, pairs of three‐dimensional stimuli were presented in the distal visual field for one group (N=48) and in the proximal visual field in another group (N=32) for 2 min in each posture. The dynamical organisation of attention was evaluated through the number and duration of fixations on each target, the number of shifts from one target to the other (alternations) and the number of repetitions (back to the previous target). Results showed that visual behaviour was significantly affected by the distance at which stimuli were presented. Infants spent more time in visual exploration when the object was within reach than when it was out of reach. Although posture was shown to play a role in the organisation of visual exploration, no link with muscle tone was found, a surprising result which is discussed. Copyright © 2002 John Wiley & Sons, Ltd.     

Visually induced reorientation illusions.

It is known that rotation of a furnished room around the roll axis of erect subjects produces an illusion of 360 degrees self-rotation in many subjects. Exposure of erect subjects to stationary tilted visual frames or rooms produces only up to 20 degrees of illusory tilt. But, in studies using static tilted rooms, subjects remained erect and the body axis was not aligned with the room. We have revealed a new class of disorientation illusions that occur in many subjects when placed in a 90 degrees or 180 degrees tilted room containing polarised objects (familiar objects with tops and bottoms). For example, supine subjects looking up at a wall of the room feel upright in an upright room and their arms feel weightless when held out from the body. We call this the levitation illusion. We measured the incidence of 90 degrees or 180 degrees reorientation illusions in erect, supine, recumbent, and inverted subjects in a room tilted 90 degrees or 180 degrees. We report that reorientation illusions depend on the displacement of the visual scene rather than of the body. However, illusions are most likely to occur when the visual and body axes are congruent. When the axes are congruent, illusions are least likely to occur when subjects are prone rather than supine, recumbent, or inverted.     

Comparison of deaf and hearing children on body-object localization.

20 profoundly deaf and 20 normal hearing children from ages 10 to 13 were compared as to their ability to locate visually the position of apparent vertical and the apparent location of the longitudinal axis of the body under erect and 30 degrees left and right body-tilt. Both deaf and normal hearing children were able accurately to locate a rod to the apparent visual vertical, but deaf children were significantly more accurate in aligning a rod to their apparent body-position than hearing children. This finding is discussed from both a learning view and from a hypothesis of developmental lag.     

急性肺损伤生物标志物研究进展

急性肺损伤是临床常见的呼吸系统急危重症,是多个危险因素直接或间接引起肺部损伤的连续病理过程,低氧血症为其特征,其发病机制复杂,病亡率高,目前临床上仍缺乏有效的早期诊断方法,严重影响了疾病的预后,因此需寻找一个简单有效的诊断方法,如血清生物标志物的测定等来帮助本病的诊断以取得更好的疗效。