急诊应用呼吸机治疗重症急性左心心力衰竭的效果观察

目的观察探讨急诊应用呼吸机治疗重症急性左心心力衰竭的临床疗效,总结其临床经验及应用价值。方法选取我院2007年6月至2012年6月78例重症急性左心心力衰竭的患者,随机分为观察组和对照组,各39例,对照组送急诊后给予常规治疗,观察组送急诊后给予在常规治疗的基础上给予呼吸机治疗,观察对比两组患者的入院途中病死率、入院后病死率、急诊病死率、继发多器官功能衰竭(MOF)后放弃治疗率及总病死率。结果观察组的入院途中病死率、入院后病死率、急诊病死率、继发多器官功能衰竭(MOF)后放弃治疗率及总病死率均比对照组明显降低(P<0.05),具有统计学意义。结论急诊应用呼吸机治疗重症急性左心心力衰竭的临床疗效明显,可以有助于早期改善呼吸功能,纠正缺血缺氧现象,以缓解心功能衰竭的病情和阻碍病情进一步发展。     

急诊应用呼吸机治疗重症急性左心心力衰竭的临床疗效评价

目的:探讨急诊应用呼吸机治疗重症急性左心心力衰竭的临床效果。方法:选取2015年3月~2016年9月期间某院收治的经确诊为重症急性左心衰竭的患者总计100例作为研究对象,随机分为观察组和对照组各50例,其中仅对对照组50例患者进行常规治疗,包括镇静、强心、扩血管和利尿治疗等;对研究组患者在对照组基础上辅以呼吸机进行治疗,观察分析两组患者的治疗效果。结果:研究组的总有效率96%明显高于对照组的总有效率70%,该差异具有统计学意义(P0.05);治疗后观察组的pH值、PaO2、PaCO2、SaO2值均高于治疗前,HR、MAP值则低于治疗前,该差异具有统计学意义(P0.05)。结论:重症急性左心衰竭患者可在常规治疗的基础上辅以呼吸机治疗,它不仅在使用过程中安全有效,而且可以快速改善患者的临床症状,纠正缺氧缺血现象,改善心功能,降低死亡率,在治疗中取得了良好的临床疗效。目前,使用无创呼吸机进行正压通气的症状性急性左心衰患者在临床实践中已得到广泛认可,值得临床推广应用。     

无创呼吸机用于急诊ICU中急性心力衰竭合并呼吸衰竭的疗效观察

目的 观察急诊ICU急性心力衰竭并呼吸衰竭患者应用无创呼吸机治疗的效果.方法 资料选取本院2015年2月至2016年2月急诊ICU中诊治急性心力衰竭并呼吸衰竭96例患者进行回顾性分析,根据治疗时所用不同治疗方案分成两组,将应用常规治疗42例患者设为对照组,将应用无创呼吸机治疗54例患者设为观察组,对两组血气与血氧指标、呼吸状况及并发症进行对比.结果 观察组在两组治疗后PaCO2、PaO2与SaO2值均改善基础上,其改善幅度比对照组显著(P＜0.05);观察组SGPQ总分为(64.20±13.45)分,比对照组(76.35±13.56)分优,且总并发症率(5.56％)比对照组(23.81％)低(P＜0.05).结论 急诊ICU急性心力衰竭并呼吸衰竭患者应用无创呼吸机治疗能够改善血气、血氧指标和呼吸状况,且减少并发症发生,具有临床推广价值.     

应用呼吸机治疗重症急性左心衰竭的疗效分析

目的探讨应用呼吸机治疗重症急性左心衰竭的临床疗效。方法我院急诊收治的重症急性左心衰竭患者82例,随机分为观察组和对照组各41例。对照组患者在急诊入院后,立即给予心力衰竭的常规治疗,包括镇静治疗、强心治疗、扩血管治疗、利尿治疗等;观察组患者在对照组患者治疗的基础上,同时给予患者PEEP呼吸机辅助呼吸治疗。结果观察组患者的入院中途病死率、入院后病死率、急诊病死率以及总病死率均明显低于对照组患者(χ2=19.66,P<0.05),两组患者的继发MOF后放弃治疗率比较,差异无统计学意义(χ2=2.90,P>0.05)。观察组患者治疗后的血液p H值、HR、Sa O2、Pa O2和Pa CO2与治疗前相比,均有明显的改善(P<0.05)。结论应用呼吸机治疗重症急性左心衰竭具有显著的疗效,可以有效的改善患者的呼吸功能,纠正患者的缺血缺氧表现,从而缓解患者的病情发展,值得临床推广使用。     

无创正压通气治疗急性左心衰竭20例治疗体会

目的 对急性左心衰竭患者在给予常规药物治疗的基础上采取无创正压通气的辅助治疗,观察治疗的疗效.方法 所有患者给予急性左心衰竭的常规治疗.治疗组同时使用美国伟康公司BiPAP S/T-D30呼吸机,模式S/T,吸氧流量4～6L/min.吸气压力(IPAP)8～16cmH20,吸气压力(EPAP)2～6cmH20.结果 治疗组患者呼吸困难明显改善,总有效率95%,而对照组呼吸困难改善者70%,治疗组优于对照组,差异有统计学意义,P＜0.05.结论 在抢救急性左心衰竭患者时,应在常规抗心力衰竭药物基础上尽早应用无创通气,可防止病情恶化,降低死亡率,提高治疗率.     

无创BiPAP呼吸机治疗重症急性左心衰竭的临床效果分析

目的使用BiPAP呼吸机对重症急性左心衰竭进行治疗病分析临床效果。方法从2010年7月至2012年6月,我院共治疗急性左心衰竭患者56例,分为观察组和对照组。两组患者均按常规方式进行高流量吸氧以及静脉给药治疗,观察组患者采用BiPAP呼吸机治疗重症急性左心衰竭。结果两组患者经过治疗后,临床效果均较为良好,但观察组患者在利用BiPAP呼吸机进行治疗后,患者的临床症状改善结果明显优于对照组,差异具有统计学意义(P<0.05)。经过比较,观察组患者的病死率明显低于对照组。结论 BiPAP呼吸机在治疗重症急性左心衰竭具有良好的临床效果,是一种切实可行的治疗手段。     

急性左心衰竭患者应用双水平正压通气呼吸机辅助通气后的临床疗效分析

目的分析急性左心衰竭患者应用双水平正压通气呼吸机辅助通气后的临床疗效。方法从本院2017年1至2018年11月接受的急性左心衰竭患者中,抽取58例,随机将其分为对照组与观察组,均29例,对照组采用常规综合处理方案进行治疗,观察组在此基础上应用双水平正压通气呼吸机辅助治疗,观察两组患者血气指标。结果观察组标氧分压(PaO_2)、二氧化碳分压(PaCO_2)、心率(HR)、呼吸频率(RR)等各项指标均显著由于对照组(P <0.05)。结论对急性左心衰竭患者应用双水平正压通气呼吸机辅助通气治疗能够有效改善患者血气指标,促进其康复。     

急诊重症急性左心衰竭患者应用无创呼吸机模式治疗的疗效评价

目的探究急诊重症急性左心衰竭患者应用呼吸机辅助通气无创模式治疗的疗效。方法选取我院急诊科2013年9月至2015年9月收治的68例重症急性左心衰竭患者,随机分为观察组和对照组,每组34例患者。对照组经常规急诊进行治疗,观察组在对照组之上应用呼吸机辅助通气无创模式治疗,对比两组抢救效果、并发症情况。结果观察组和对照组抢救的总有效率分别为94.12%、61.76%,差异具有统计学意义,P<0.05。两组急诊病死率、并发症发生率比较,观察组均明显少于对照组,组间比较,差异显著,P<0.05。结论急诊重症急性左心衰竭经急诊治疗后应用呼吸机辅助通气无创模式治疗,可获得较好的临床疗效,且可降低急诊患者的死亡和并发症情况,具有重要的临床价值。     

有创呼吸机辅助通气联合吗啡治疗重症急性左心衰竭的疗效

目的:对有创呼吸机辅助通气联合吗啡治疗重症急性左心衰竭的疗效进行研究比较.方法:选取我院2015年1月~2016年4月收治的100例重症急性左心衰竭患者,并依照治疗方式分组,两组均接受吗啡静脉注射的常规治疗;观察组50例,在对照组基础上增加有创呼吸机辅助通气治疗.对比两组治疗前后的pH值、PaO2、心率(HR)、血气分析(SaO2)以及呼吸频率(RR),并对病症疗效、缓解时间等进行记录分析.结果:观察组在pH值、HR、SaO2以及RR等情况指标上显著优于对照组,差异显著(P<0.05);观察组治疗总有效率96.00%,症状缓解时间(13.6±2.26)d,明显优于对照组治疗总有效率72.00%,症状缓解时间(20.9±1.59)d,差异有统计学意义(P<0.05).结论:对重症急性左心衰竭实施有创呼吸机辅助通气联合吗啡治疗能够大大增加治疗有效率与抢救成功率,并在一定程度上改善生命指标,值得推广.     

急诊内科治疗老年重症心力衰竭患者的临床效果探讨

目的:探讨老年重症心力衰竭急诊内科治疗方法及效果。方法:将本院2016年6月-2018年2月接收的81例老年重症心力衰竭病患随机分成研究组(41例)与对照组(40例),对照组采取急诊内科常规治疗,主要给予患者使用利尿剂及强心类药物,研究组则在常规治疗的基础上,为患者加用美托洛尔与厄贝沙坦氢氯噻嗪,观察两组治疗前后左心射血分数(LVEF)、B型脑钠肽(BNP)指标变化情况及随访半年疾病复发率。结果:治疗后观察组LVEF升高幅度及BNP下降幅度大于对照组(P0.05);半年内观察组疾病复发率为2.44%,明显低于对照组15.00%的复发率(P0.05)。结论:针对老年重症心力衰竭患者,在常规治疗基础上加用美托洛尔与厄贝沙坦氢氯噻嗪治疗可显著改善患者心功能,降低疾病复发率。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

基层医院护士在临床合理用药中的作用

目的充分利用护士在医师和患者间的特殊地位和作用,促进基层临床合理用药。方法从护士的工作性质出发,论述护士参与促进合理用药的方便和优势。结果通过实践,护士在促进合理用药中的作用得到有效发挥,基层合理用药环境得到极大改善。结论充分利用护士与医师和患者间的特殊桥梁作用,在基层医院促进合理用药,规范医师用药行为,防止药物滥用,引导患者安全用药,降低药源性疾病。