Arterial Blood Gas Analysis Index Research Articles

Application of high flow nasal canula in patients with pulmonary edema caused by seawater drowning

To investigate the therapeutic effect of high-flow nasal cannula oxygen therapy (HFNC) and non-invasive positive pressure ventilation (NPPV) on patients with pulmonary edema caused by seawater drowning. A retrospective analysis method was used. Based on the Utstein database of emergency drowning in the First Hospital of Qinhuangdao, the clinical data of patients with seawater drowning pulmonary edema admitted to the emergency medicine department of the First Hospital of Qinhuangdao from January 1, 2019 to December 31, 2022 were collected. The patients were divided into NPPV group and HFNC group according to different ventilation methods. The general data, endotracheal intubation rate in 7 days, arterial blood gas analysis indexes [arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), arterial oxygen saturation (SaO2)] and hemodynamic indexes (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, blood lactic acid) before and after treatment, length of stay in intensive care unit (ICU), oxygen therapy comfort of the two groups were compared. A total of 54 patients were enrolled, including 21 patients in the NPPV group and 33 patients in the HFNC group. There were no significant differences in gender, age, state of consciousness and other general information between the two groups. Compared with NPPV group, the rate of endotracheal intubation in HFNC group within 7 days was significantly lower [24.2% (8/33) vs. 33.3% (7/21), P < 0.05]. Before treatment, there were no significant differences in arterial blood gas analysis and hemodynamics between the two groups. After treatment, the above indexes in both groups were significantly improved compared with those before treatment, and PaO2, SaO2, systolic blood pressure, diastolic blood pressure and mean arterial pressure in HFNC group were significantly higher than those in NPPV group [PaO2 (mmHg, 1 mmHg≈0.133kPa): 93.56±6.37 vs. 82.14±6.25, SaO2: 1.02±0.09 vs. 0.95±0.11, systolic blood pressure (mmHg): 117.37±8.43 vs. 110.42±8.38, diastolic blood pressure (mmHg): 79.43±7.61 vs. 72.21±4.32, mean arterial pressure (mmHg): 92.34±6.32 vs. 85.12±5.38], PaCO2, heart rate and blood lactic acid were significantly lower than those in NPPV group [PaCO2 (mmHg) : 34.26±5.63 vs. 37.24±6.22, heart rate (times/min): 73.38±7.56 vs. 86.25±5.41, blood lactic acid (mmol/L): 1.38±0.36 vs. 2.25±1.14], and the differences were statistically significant (all P < 0.05). In addition, the length of ICU stay in HFNC group was significantly shorter than that in NPPV group (days: 13.30±2.38 vs. 16.27±4.26), and the comfort rate of oxygen therapy was significantly higher than that in NPPV group [66.7% (22/33) vs. 42.8% (9/21)], with statistical significance (all P < 0.05). HFNC can improve the oxygenation of patients with pulmonary edema caused by seawater drowning, improve hemodynamics, reduce the rate of tracheal intubation, shorten the length of ICU stay, and improve the comfort of oxygen therapy, which has certain clinical application value.

Effect of Ropivacaine Combined with Sufentanil on Hemodynamics and the Expression of Serum TNF-α and IL-6 in Parturients Undergoing Cesarean Section

Background: This study aims to investigate the effect of ropivacaine combined with sufentanil on hemodynamics and expression levels of serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in parturients undergoing cesarean section. Methods: The clinical data of 135 parturients undergoing cesarean section were retrospectively collected. After anesthesia, 135 parturients were divided into observation group (68 cases) and control group (67 cases). The observation group was anesthetized with ropivacaine combined with sufentanil before operation, while the control group was anesthetized with ropivacaine. Anesthesia related indexes, hemodynamics at different times and arterial blood gas analysis indexes of the two groups were observed and recorded. The peripheral venous blood of the two groups was taken 1 day before delivery, 12 hours after delivery and 24 hours after delivery to detect expression levels of TNF-α and IL-6. The Apgar scores of the two groups of newborns were recorded at 1 and 5 minutes after delivery, respectively. Results: Compared with the control group, the observation group had a shorter time to reach the maximum block plane, a longer time to maintain analgesia, and a lower visual analog scale (VAS) score at 6 h postpartum (p &lt; 0.05). Moreover, the mean arterial pressure (MAP) and heart rate (HR) during skin resection (T1) in the observation group were higher (p &lt; 0.05), and the cardiac output (CO), stroke volume (SV) and systemic circulation resistance (SVR) during T1 and end of surgery (T2) in the observation group were higher (p &lt; 0.05). PaCO2 was increased and PaO2 in the control group at T1 and T2 was decreased after anesthesia (p &lt; 0.05). Compared with 1 day before delivery, the serum levels of TNF-α and IL-6 increased at 12 and 24 hours after delivery. Compared with the control group, the serum levels of TNF-α and IL-6 in the observation group were lower at 12 and 24 hours after delivery (p &lt; 0.05). Conclusions: The anesthetic effect of ropivacaine combined with sufentanil before cesarean section is better, which can effectively stabilize the mean arterial pressure, heart rate and other hemodynamic indicators of the puerpera, inhibit the inflammation in the puerpera, and have no adverse effects on the newborn.

Study on anisodamine hydrobromide improves Th17/Treg imbalance in resuscitated pigs

To investigate whether anisodamine can regulate the ratio of helper T helper cells/regulatory T cells (Th17/Treg) and its protective effect on animals after resuscitation. Twenty-four Beijing white minipigs were randomly divided into sham operation group (Sham group), resuscitation and normal saline group (SA group), and resuscitation and anisodamine hydrobromide group (AH group), with 8 pigs in each group. In SA group and AH group, ventricular fibrillation was induced by continuous stimulation with intraventricular electrodes for 8 minutes and then resuscitated to establish ischemia/reperfusion (I/R) model. In SA group, after cardiopulmonary resuscitation (CPR), only normal saline was intravenously infused, while in AH group, normal saline and anisodamine hydrobromide were given intravenously at the same time point. Hemodynamic indexes, arterial blood gas analysis indexes, interleukins (IL-17, IL-10) levels in venous blood and IL-17/IL-10 ratio were recorded at 6 different time points: baseline, immediately after return of spontaneous circulation (ROSC), 1 hour, 2 hours, 4 hours and 6 hours after ROSC. The animals were sacrificed at 6 hours after ROSC, and intestinal lymphatic tissues were taken to observe pathological changes under light microscope. At the same time, the levels of IL-17 and IL-10 in intestinal lymphatic tissue were measured (the ratio of IL-17/IL-10 represents the ratio of Th17/Treg cytokines) to evaluate the immune status of the resuscitated animals. The bacterial translocations of different groups were evaluated by culturing intestinal lymphoid tissue. With the extension of ROSC time, the levels of IL-17 in venous blood and the IL-17/IL-10 ratio in pig blood samples continued to decrease, while the levels of IL-10 continued to increase. From 2 hours after ROSC, the IL-17/IL-10 ratio in AH group was significantly higher than that in SA group continued until at 6 hours after ROSC (0.79±0.05 vs. 0.49±0.08, P < 0.05). Light microscopy showed that the number and size of lymph nodules in the cortex of intestinal lymphatic tissue were less in AH group, compared with SA group. Compared with Sham group, the levels of IL-17 and IL-17/IL-10 ratio also decreased in intestinal lymphatic tissue at 6 hours after ROSC [IL-17 (ng/L): 155.23±0.92, 178.76±7.25 vs. 209.21±19.82, IL-17/IL-10 ratio: 1.43±0.13, 1.92±0.18 vs. 3.30±0.31, all P < 0.05], and IL-10 increased significantly (ng/L: 109.85±11.60, 93.55±81.83 vs. 63.45±0.62, all P < 0.05); IL-17/IL-10 ratio in AH group was significantly higher than that in SA group (1.92±0.18 vs. 1.43±0.13, P < 0.05). Tissue culture indicated the intestinal bacterial translocation after resuscitation, suggesting that the animals had immunosuppression and the increased risk of intestinal secondary infection after resuscitation. Compared with SA group, the risk of bacterial translocation was lower than that in AH group [62.5% (5/8) vs. 87.5% (7/8), P < 0.05]. Anisodamine plays an immunomodulatory role by affecting the balance of Th17/Treg cytokines in resuscitated animals, so as to reduce the risk of intestinal secondary infection and has an organ protective effect.

Application of Visual Artificial Airway in Patients with ARDS Assisted by Pulmonary Ultrasound.

Objective To explore the application of pulmonary ultrasound in visual nursing of artificial airway in patients with acute respiratory distress syndrome (ARDS). Methods Seventy-eight ARDS patients with mechanical ventilation admitted from February 2021 to January 2022 were included and divided into the intervention group and the control group. The control group was given routine airway nursing, and the intervention group was given visual airway nursing management through lung ultrasound. The arterial blood gas analysis indexes, mechanical ventilation time, ICU treatment time, total hospitalization time, aspiration, and the incidence of ventilator-associated pneumonia (VAP) were compared between the two groups. Results After treatment, PaO2, PaCO2, SPO2, and oxygenation indexes were significantly improved compared with those before treatment, and the indexes in the intervention group were better than those in the control group after treatment, and the differences were statistically significant (P < 0.05). The mechanical ventilation time (5.39 ± 0.68 vs. 7.92 ± 0.59 days), ICU treatment time (8.05 ± 1.14 vs. 10.71 ± 1.16 days), and total hospitalization time (12.05 ± 2.20 vs. 15.68 ± 2.18 days) in the intervention group were significantly shorter than those in the control group (P < 0.05). The incidences of aspiration (2.56% vs. 15.38%) and VAP (5.13% vs. 20.51%) in the intervention group was significantly lower than that in the control group (P < 0.05). Conclusion The application of visual artificial airway management assisted by lung ultrasound in ARDS patients can shorten the treatment time and hospitalization time of mechanical ventilation, reduce the incidence of aspiration and VAP, and improve the prognosis of patients.

Comparison of positive and negative pressure extubation after mechanical ventilation in intensive care unit patients

To investigate the effect of positive and negative pressure extubation on mechanical ventilation patients in the intensive care unit (ICU). A prospective randomized controlled study was performed, 105 ICU patients who successfully passed the spontaneous breathing test (SBT) after mechanical ventilation of Nanjing Jiangbei Hospital Affiliated to Nantong University from January 2019 to March 2021 were enrolled. According to random number table method, they were randomly divided into positive pressure extubation group (53 cases) and negative pressure extubation group (52 cases). During extubation, all patients were placed in semi-decubitus position (raising the head of bed at an angle range from 30 degree angle- 45 degree angle), the secretions from mouth, nose, throat and trachea were removed. In the negative pressure extubation group, the sputum suction tube was inserted into the tracheal tube and passed over the distal opening to carry out continuous negative pressure suction in the tracheal tube after disconnecting the ventilator. Meanwhile, after the tracheal tube balloon was evacuated, the sputum suction tube was pulled out together with the tracheal tube. In the positive pressure extubation group, the patients were guided to inspiratory forcibly under the original SBT mode. When the patients reached the inspiratory peak, the ballon was evacuated and the tracheal tube was removed. After extubation, all patients were given nasal catheter oxygen inhalation (oxygen flow 5 L/min). Arterial blood gas analysis indexes [pH value, arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2)] were recorded 5 minutes and 1 hour after extubation in both groups. Vital signs (including tachypnea, tachycardia, elevated blood pressure and decreased oxygen saturation) and complications (including severe cough, airway hyperresponsiveness and pneumonia) were observed 30 minutes after extubation in both groups. Five minutes after extubation, blood gas analysis showed that the PaO2 of positive pressure extubation group was significantly higher than that of negative pressure extubation group [mmHg (1 mmHg ≈ 0.133 kPa): 123.4±30.2 vs. 111.0±21.1, P < 0.05], the pH value and PaCO2 in positive pressure extubation group were slightly lower than that of negative pressure extubation group [pH value: 7.411±0.042 vs. 7.419±0.040, PaCO2 (mmHg): 39.7±4.7 vs. 40.5±5.6], but the differences were not statistically significant (both P > 0.05). One hour after extubation, the pH value, PaO2 and PaCO2 in positive pressure extubation group were slightly lower than those in negative pressure extubation group, but the differences were not statistically significant. Within 30 minutes after extubation, the incedences of tachypnea, tachycardia, elevated blood pressure and oxygen desaturationin in positive pressure extubation group were significantly lower than those in negative pressure extubation group [tachypnea: 9.4% (5/53) vs. 28.8% (15/52), tachycardia: 15.1% (8/53) vs. 32.7% (17/52), elevated blood pressure: 11.3% (6/53) vs. 30.8% (16/52), oxygen desaturation: 7.5% (4/53) vs. 34.6% (18/52), all P < 0.05], the incidence of severe cough in positive pressure extubation group was significantly lower than that in negative pressure extubation group [9.4% (5/53) vs. 30.8% (16/52), P < 0.05], but there was no significant difference in the incidence of complications of airway hyperresponsiveness between the two groups [1.9% (1/53) vs. 5.8% (3/52), P > 0.05]. No pneumonia occurred in both groups within 48 hours after extubation. The positive pressure extubation method can ensure full oxygenation of patients undergoing mechanical ventilation in ICU, avoid hypoxia, and reduce the occurrence of hypoxia and severe cough, which is more conducive to the stability of vital signs.

Effect of positive end expiratory pressure level selection in prone position ventilation on lung recruitment and inflammatory factors in patients with severe acute respiratory distress syndrome

To investigate the effect of positive end expiratory pressure (PEEP) level selection on prone position ventilation and inflammatory factors in patients with severe acute respiratory distress syndrome (ARDS). A prospective randomized controlled study was conducted. The 100 patients with severe ARDS admitted to Union Jiangbei Hospital, Huazhong University of Science and Technology from March 2016 to March 2019 were enrolled. Patients were divided into two groups according to the random number table method, with 50 cases in each group. All patients were given lung protective ventilation strategy and prone position ventilation treatment on the basis of treatment of primary disease. The lower level of PEEP [8-12 cmH2O (1 cmH2O = 0.098 kPa)] was the control group, and the higher level of PEEP (13-17 cmH2O) was the observation group. Patients' vital signs were continuously monitored during mechanical ventilation. The indexes of pulmonary recruitment were recorded, including the dynamic lung compliance (Cdyn), pulmonary drive pressure (DP), heart rate and lactate (Lac) levels before and 48 hours after the treatment. The levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), high sensitivity C-reaction protein (hs-CRP) in serum were detected by enzyme linked immunosorbent assay (ELISA). Arterial blood gas was detected, including arterial partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), and arterial partial pressure of carbon dioxide (PaCO2). The occurrence of pleural effusion and heart, liver and kidney dysfunction were recorded. In the control group, the PEEP level was (10.9±1.2) cmH2O, and the observation group PEEP level was (15.6±1.5) cmH2O. There was no significant difference in the index of lung recruitment, the levels of inflammatory factors and the arterial blood gas analysis index between the two groups before treatment. After prone ventilation, the index of lung recruitment and the arterial blood gas analysis index were much better in both groups. The effect of lung recruitment and oxygenation in the observation group with higher PEEP level were significantly superior to the control group with lower PEEP level [Cdyn (mL/cmH2O): 37.61±5.09 vs. 32.51±4.97, DP (cmH2O): 10.36±1.51 vs. 12.55±1.35, heart rate (bpm): 93.13±10.56 vs. 108.56±12.49, Lac (mmol/L): 2.34±0.41 vs. 3.41±0.57, PaO2 (mmHg, 1 mmHg = 0.133 kPa): 95.13±3.33 vs. 91.81±2.75, PaO2/FiO2 (mmHg): 180.12±7.25 vs. 150.29±8.52, PaCO2 (mmHg): 38.31±2.13 vs. 45.22±2.61, all P < 0.05]. The levels of inflammatory factors after treatment were higher than before treatment in both groups. Higher PEEP level will cause increased inflammatory factor level than the control group [IL-6 (ng/L): 526.24±125.18 vs. 465.18±130.52, TNF-α (ng/L): 42.47±2.20 vs. 34.12±1.89, hs-CRP (mg/L): 101.24±23.26 vs. 83.56±25.51, all P < 0.05]. Furthermore, the occurrence of pleural effusion and heart, liver, kidney dysfunction in the observation group were lower than that of the control group (4.0% vs. 8.0%, 10.0% vs. 16.0%, 2.0% vs. 10.0%, 2.0% vs. 6.0%, respectively, all P < 0.05). The higher PEEP level combined with prone position ventilation is beneficial to the severe ARDS patients with better lung recruitment effect and arterial blood gas improvement, thus promote the patients' recovery. But the higher initial PEEP will induce the release of inflammatory factors to a certain extent.

Evidence-based application of self-made anti-carbon dioxide retention atomizer in patients with chronic obstructive pulmonary disease and respiratory failure

To apply the concept of evidence-based nursing in the practice of inhalation therapy for patients with chronic obstructive pulmonary disease (COPD) complicated respiratory failure, introduce the application method of self-made anti-carbon dioxide retention atomizer, and to observe the application effect. Patients with COPD combine respiratory failure admitted to the respiratory department of Harrison International Peace Hospital Affiliated to Hebei Medical University from May 2018 to April 2019 were enrolled. All patients received atomization inhalation therapy in addition to anti-infection and spasmolysis. By using self-made carbon dioxide retention atomizer time node, 40 patients in the prospective study using home-made carbon dioxide retention atomizer inhalation therapy from November 2018 to April 2019 were enrolled as observation group. Through evidence-based nursing strategy, the related literature at home and abroad was retrieved, to find the clinical evidence, formulation and implementation of care plan. Forty patients who received inhalation therapy with normal mask atomizer from May to October in 2018 were enrolled as the control group in the retrospective analysis. The peripheral arterial blood gas analysis indexes [pH value, arterial oxygen partial pressure (PaO2), arterial carbon dioxide partial pressure (PaCO2)], the disappearance of pulmonary asthma at 5 minutes before atomization inhalation and 20 minutes after atomization inhalation, and the patient's cooperation in treatment were compared between the two groups. All patients were included in the final analysis. There was no significant difference in blood gas analysis indexes between the two groups. After 20 minutes of atomization inhalation, the pH value, PaO2 and PaCO2 of the two groups were improved, and the improvement was more obvious in the observation group [pH value: 7.32±0.35 vs. 7.25±1.25, PaO2 (mmHg, 1 mmHg = 0.133 kPa) : 61.50±1.55 vs. 59.50±1.05, PaCO2 (mmHg) : 43.25±1.65 vs. 49.05±1.75, all P < 0.05]. The lung asthma in the two groups was significantly improved with 20 minutes of atomization inhalation as compared with that before atomization, and the improvement of lung asthma in the observation group was significantly better than that in the control group (asthma score: 0.91±0.29 vs. 1.65±0.35, P < 0.05). The good coordination rate of the observation group was significantly higher than that of the control group [90% (36/40) vs. 70% (28/40), χ2 = 3.828, P = 0.048]. Compared with the inhalation treatment with ordinary mask nebulizer, inhalation treatment with self-made anti-carbon dioxide retention atomizer for COPD patients with respiratory failure can reduce carbon dioxide retention, significantly improve respiratory failure symptoms and improve compliance.

Analysis of the characteristics of cellular immune function and its prognostic risk factors in patients with community-acquired pneumonia

To analyze the characteristics of cellular immune function and its prognostic risk factors in patients with community-acquired pneumonia (CAP). The clinical data of patients diagnosed as CAP admitted to department of respiratory and critical care medicine of the Second Affiliated Hospital of Anhui Medical University from June 2018 to February 2019 were retrospectively analyzed. The patients were divided into survival group and death group according to the mortality at discharge and 28-day survival after hospital discharge; in addition, they were divided into bacterial group, fungi group and mixed infection group according to pathogen results at discharge. The differences of general clinical characteristics, arterial blood gas analysis indexes, plasma albumin, cellular immune function, inflammatory cytokines, the length of hospital stay among groups were analyzed. The correlation between the prognosis-related indicators in patients were analyzed by Pearson test or Spearman test, and Logistic regression model was used to analyze the risk factors of patients in non-survival group. 106 patients were finally enrolled, 69 of whom were survived, and 37 dead. Among 56 patients with pathogen results, 27 were diagnosed as bacterial infection, 11 as fungal infection, and 18 with mixed infection. Compared with the survival group, plasma albumin level, total T cell count, CD4+T cell count, CD8+T cell count were decreased in the death group, temperature, pH, acute physiology and chronic health evaluation II (APACHE II), procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein (CRP) were increased, and the length of hospital stay was significantly shortened. While there was no significant difference in gender, age, mean arterial pressure, arterial oxygen pressure, CD4+/CD8+, regulation T cell/effect T cell (TREG/TEF) between the two groups. Correlation analysis showed that plasma albumin, the length of hospital stay, APACHE II score, CD4+T cell count, CD8+T cell count, CD4+/CD8+, PCT, IL-6, CRP were correlated with death (r value was -0.480, -0.209, 0.203, -0.279, -0.270, 0.271, 0.247, 0.410, 0.329, all P < 0.05). Logistic regression analysis showed that plasma albumin, CD4+T cell count, CD8+T cell count, CD4+/CD8+decreased; APACHE II score, PCT, IL-6, and CRP increased; the length of hospital stay were correlated with death, and all were independent risk factors for death in CAP patients (all P < 0.05). Correlation analysis showed that the APACHE II score was negatively related to plasma albumin (r = -0.375, P < 0.05), positively related to CRP and IL-6 (r value was 0.363 and 0.333 respectively, both P < 0.05); negative correlation between plasma albumin and IL-6 (r = -0.372, P < 0.05), PCT and CD4+T cell count (r = -0.354, P < 0.05), CRP and the length of hospital stay (r = -0.356, P < 0.05). There were no significant correlations between the others. There was no significant difference in cellular immune function or inflammatory factor expression between different pathogenic infections. Cellular immune dysfunction, hypoproteinemia, APACHE II score and elevated inflammatory index are all influential factors for the death of CAP patients. Apart from conventional anti-infective treatment, the symptoms of hypoproteinemia and cellular immune function can predict the severity and prognosis of CAP patients.

Curative effect of remifentanil on labor analgesia in newborns

Objective: To investigate the curative effect of remifentanil on analgesia in newborns.Patients and methods: One hundred and twenty full-term puerperae from January 2013 to December 2013 were selected and randomly divided into three groups: remifentanil patient-controlled intravenous labor analgesia group (Group A, n = 40), patient-controlled epidural analgesia (PCEA) group (Group B, n = 40), and spontaneous labor group (Group C, n = 40). General conditions, visual analogue scale (VAS) score, labor stage, bleeding, delivery mode, neonatal asphyxia rate, oxyhemoglobin saturation in puerpera, and umbilical arterial blood gas analysis indexes of the fetus were measured. In addition, complications and adverse reactions were recorded.Results: VAS scores in Group A and B were significantly lower than that in Group C at each time point after analgesic intervention (p < .05), without differences at 30 min and 1 h after analgesia between Group A and B (p > .05). However, VAS scores in Group A were significantly higher than those in Group B at the full opening of the uterine orifice and fetal delivery (p < .05). The active phases in the first stage of labor in Group A and B were significantly shorter than that in Group C (p <.05). There were no significant differences in general conditions, VAS score before analgesia, the second and third stages of labor, delivery mode, bleeding, neonatal asphyxia rate, oxyhemoglobin saturation, pH value, partial pressure of oxygen (PO2), and partial pressure of carbon dioxide (PCO2) among three groups (p > .05).Conclusions: Remifentanil intravenous labor analgesia is not superior to PCEA, but does not increase adverse effects, suggesting it might be a supplementary method of PCEA.

Effect of inhalation of budesonide combined with ambroxol hydrochloride in the treatment of acute exacerbation of chronic obstructive pulmonary disease

Objective To investigate the effect of inhalation of budesonide combined with ambroxol hydrochloride in the treatment of chronic obstructive pulmonary disease(COPD) in acute exacerbation stage. Methods 60 patients with acute exacerbation of COPD treated in the Department of respiratory medicine of Zhenhai People's Hospital from January 2013 to December 2015 were selected as the research subjects in Ningbo, and they were randomly divided into control group and observation group according to the digital table, with 30 cases in each group.The control group received routine treatment, the observation group was given budesonide and ambroxol hydrochloride inhalation on the basis of conventional therapy.After 1 week of treatment, the clinical efficacy indicators of pulmonary function, arterial blood gas analysis index, time of symptoms were compared between the two groups. Results The total effective rate of the observation group was 100.0%, which was higher than 83.3% of the control group (χ2=5.455, P<0.05). After treatment, the forced expiratory volume in one second (FEV1), the ratio of FEV1 and forced vital capacity (FVC) (FEV1/FVC), arterial partial pressure of carbon dioxide (PaCO2), arterial oxygen pressure (PaO2) in the observation group were (2.09±0.69)L, (58.94±15.67)%, (35.08±3.79)mmHg, (85.92±4.97)mmHg, respectively, which in the control group were (1.43±0.57)L, (43.12±11.03)%, (48.47±4.24)mmHg, (79.54±4.56)mmHg, respectively, the differences between the two groups were statistically significant (t=4.039, 4.522, 12.896, 5.181, all P<0.05). The remission time of shortness of breath, cough, expectoration in the observation group were (2.04±0.86)d, (4.49±1.25)d, (4.56±1.34)d, respectively, which were shorter than those in the control group [(3.36±1.08)d, (6.53±1.82)d, (6.78±1.91)d], the differences between the two groups were statistically significant (t=5.237, 5.061, 5.212, all P<0.05). Conclusion Inhalation of budesonide combined with ambroxol hydrochloride in the treatment of acute exacerbation of COPD can effectively improve the treatment effect, and the pulmonary ventilation function and arterial blood gas status, and shorten the time of remission, and is benefit to disease control. Key words: Pulmonary disease, chronic obstructive; Budesonide; Ambroxol; Blood gas analysis; Respiratory function tests; Comparative effectiveness research

Prognostic value of oxygen challenge test for patients with cardiogenic shock receiving extracorporeal membrane oxygenation

To investigate the prognostic value of oxygen challenge test (OCT) for patients with cardiogenic shock receiving extracorporeal membrane oxygenation (ECMO). A retrospective analysis was conducted. Seventy-eight patients diagnosed with cardiogenic shock receiving veno-arterial (V-A) ECMO admitted to Department of intensive care unit (ICU) of Wuxi People's Hospital Affiliated to Nanjing Medical University from June 2012 to May 2017 were enrolled. Ten-minute OCT was implemented by transcutaneous oximetry at 6 hours after ECMO initiation. The basic data of patients (gender, age, primary disease); the acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, left ventricular ejection fraction (LVEF), mean arterial pressure (MAP) at the start of ECMO treatment; arterial blood gas analysis index, dose of vasoactive agents, transcutaneous oxygen pressure (PtO2), 10-minute OCT value (OCT10), oxygen challenge index (OCI) at 6 hours after ECMO initiation; and the ECMO support time, duration of mechanical ventilation and its parameters, and application of intra-aortic balloon pump (IABP) within 60 days were recorded. Patients were divided into the survival group and the death group according to their 60-day mortality status, and the differences between the two groups were compared. Receiver operating characteristic curve (ROC) analysis was used to analyze the prognostic value of OCT10 and OCI. According to the best boundary value of OCT10 and OCI, Kaplan-Meier survival curve was drawn and the 60-day cumulative survival rate was compared. The risk factors affecting prognosis were analyzed by multivariate Logistic regression. Sixty-seven patients were finally enrolled in the study, with 31 in the survival group and 36 in the death group. Compared with the survival group, APACHE II score, SOFA score, use of IABP in death group were higher, PtO2, OCT10 and OCI were lower, and duration of ECMO and ventilation were longer, but there was no significant difference in gender, age, primary disease, LVEF, MAP, ventilator settings, dose of vasoactive agents, or results of arterial blood gas between the two groups. OCT10, OCI, APACHE II score and SOFA score were predictive values for 60-day deaths, and the area under ROC curve (AUC) of OCT10 was 0.866±0.042 [95% confidence interval (95%CI) = 0.760-0.937], the AUC of OCI was 0.829±0.051 (95%CI = 0.717-0.910), the AUC of APACHE II score was 0.860±0.043 (95%CI = 0.754-0.933), and the AUC of SOFA score was 0.821±0.049 (95%CI = 0.708-0.904) (all P < 0.01). The cut-off point for OCT10 was ≥70.0 mmHg (1 mmHg = 0.133 kPa) with the sensitivity of 91.67% and the specificity of 67.74%. The cut-off point for OCI was ≥0.68 with the sensitivity of 88.68% and the specificity of 71.58%. According to the cut-off point for OCT10 or OCI, the 60-day cumulative survival rate of patients with high OCT10 was significantly higher than that of low OCT10 [58.06% (18/31) vs. 36.11% (13/36), χ2 = 5.425, P = 0.020]; the survival rate in high OCI group was significantly higher than that in low OCI group [55.17% (16/29) vs. 39.47% (15/38), χ2 = 5.119, P = 0.024]. It was shown by multivariate Logistic regression that OCT10 [odds ratio (OR) = 0.883, 95%CI = 0.791-0.965, P = 0.006] and OCI (OR = 0.011, 95%CI = 0.001-0.087, P = 0.005) were independent risk factors for 60-day mortality. OCT could predict the prognosis of patients with cardiogenic shock receiving ECMO.

Analysis the effect of G5 vibration expectoration machine on bronchial purification treatment in senile patients with chronic obstructive pulmonary disease

Objective To discuss the effect of G5 vibration expectoration machine on bronchial purification treatment in senile patients with chronic obstructive pulmonary disease(COPD). Methods 84 senile patients with COPD were randomly divided into two groups:artificial beating group (40 patients) and mechanical group(44 patients). The expectoration effect and arterial blood gas analysis of two groups were compared. Results After 4 days with expectoration nursing, the mechanical group was superior to the artificial beating group in the expectoration effect and arterial blood gas analysis indexes( all P＜0.05). Conclusion By comparison,G5 vibration expectoration machine is superior to the artificial beating means for promoting expectoration effect on senile patients with COPD,worthy to be popularized. Key words: G5 vibration expectoration machine; Expectoration; Chronic obstructive pulmonary disease; Senile person; Nursing