低分子肝素早期治疗脓毒症临床研究

18例脓毒症患者随机分为两组,对照组进行常规抗感染、液体复苏、控制血糖、基础病因治疗等,治疗组在常规治疗基础上加低分子肝素钙0.6 ml皮下注射,1次/12 h,疗程7 d.发现治疗组治疗后APACHEⅡ评分较治疗前及对照组治疗后明显下降;治疗组住ICU时间和28 d病死率低于对照组,但无统计学差异;两组治疗前后各凝血指标均无明显改变.认为低分子肝素用于脓毒症患者临床应用安全,是一种有前景的治疗手段.     

海水淹溺致急性肺损伤兔病理学特征的实验观察

目的 新西兰兔海水淹溺致急性肺损伤(seawater drowning induced acute lung injury,SWD-ALI)时的病理学特征.方法 制作SWD-ALI的动物模型,采用半定量分析的方法对其肺组织学分析,以评价其特征.结果 SWD-ALI有不同于临床常见ALI的病理学变化:①病变多见于低垂部位.②组织学变化以肺泡隔断裂、炎细胞浸润最为常见,分布范围最广;其次是肺内出血、肺泡萎陷实变;肺泡及间质水肿相对较轻.结论 SWD-ALI的主要病理学变化为肺泡隔断裂和大量炎细胞浸润.     

ARDS药物治疗的新进展

急性呼吸窘迫综合征(ARDS)是常见呼吸系统危重症,其发病率和治疗费用均处于高位,治疗困难,病死率在30％左右.目前,ARDS的治疗多是支持性的,目的在于提高肺部气体的交换并防止并发症的发生.一些有潜力的ARDS治疗的药物研究了很多,可能对ARDS患者的氧合、肺水等的吸收有益,然而尚没有充足的证据证明其在降低病死率等重要临床指标方面有效.     

老年病人术后躁动治疗失误四例临床分析

躁动是围术期病人常见并发症之一,虽然持续时间短,但危害较重.随着社会人口老龄化,老年人在住院患者中的比例越来越高.老年人因器官功能减退加上并存疾病较多,围术期躁动处理应非常谨慎.     

欧洲心脏病学会关于急性冠状动脉综合征和介入治疗术中出血的共识要点

近年来,抗血栓治疗在急性冠状动脉综合征(ACS)治疗中的应用日趋普遍和强化.包括抗血小板药物(阿司匹林、氯吡格雷)、静脉或皮下抗凝药(普通肝素、低分子肝素、磺达肝癸钠、比伐卢定),以及糖蛋白Ⅱb/Ⅲa受体阻断剂在内的多种抗血栓药物极大地改善了缺血,提高了患者的预后.目前的冠状动脉再血管化治疗已日益普及,使得疗效提高的空间已经有限,因此着力减少治疗的副作用就显得尤为重要.     

ω-3脂肪酸对脓毒症病人治疗的影响

目的:探讨ω-3脂肪酸对脓毒症病人的免疫调节和抗炎作用。方法:将18例病人随机分为鱼油治疗组和常规治疗组。鱼油治疗组病人为常规治疗加鱼油,并于治疗前和治疗后第5天用流式细胞仪检测单核细胞HLA-DR表达率,同时检测炎症反应指标,包括C反应蛋白(CRP)、IL-6和肿瘤坏死因子α(TNF-α),观察病情严重程度(APACHEⅡ评分)和氧合指数(PaO2/FiO2)的变化。结果:相对于常规治疗组,鱼油治疗组病人血清CRP、IL-6和TNF-α均明显下降;氧合指数改善;单核细胞HLA-DR表达率、APACHEⅡ评分较常规治疗组无显著性差异。结论:应用ω-3脂肪酸可使脓毒症病人血清炎症介质表达减少,但对单核细胞HLA-DR的表达未见调节作用。     

老年重叠综合征患者血清脑钠素水平的变化及其意义

目的观察单纯慢性阻塞性肺疾病（COPD）与COPD合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者,即重叠综合征（OS）患者体内血清脑钠素（BNP）水平的变化。方法回顾性分析2009年7月至2013年5月海军总医院呼吸内科住院患者113例,所有患者均经过完整的肺功能、动脉血气、超声心动图、夜间多导睡眠监测及血清BNP的检测。结果 COPD组（68例）与OS组（45例）患者的年龄、性别比例及身高体重指数（BMI）差异均无统计学意义（P〉0.05）;COPD组与OS组平均肺动脉压（m PAP）分别为（21.5±5.7）mm Hg和（29.2±6.3）mm Hg,OS组显著高于COPD组（P〈0.05）,而COPD组与OS组BNP平均浓度分别为（65.27±16.52）pm/ml与（98.59±27.38）pg/ml,两组比较差异也具有统计学意义（P〈0.05）。结论相对于单纯COPD患者,OS患者的平均肺动脉压和血清脑钠素水平更高。     

海水和淡水肺内灌注对兔肺损伤作用的实验观察

Objective To investigate differences in lung injury induced by seawater and freshwater perfusion in rabbits. Methods 21 New Zealand rabbits were randomly divided into the normal group (the control group), the freshwater group and the seawater group. Same amounts of seawater and freshwater were perfused in the lungs of rabbits through tracheal incubation. Changes in the indices concerning symptomatology, blood-gas, hemodynamics, tumor necrosis factor (TNF-α), interleukin 6 (IL-6), histology and lung injury were monitored 3 hours later. Then, the obtained data were analyzed statistically to see the differences in lung lesions of different animal groups. Results Blood-gas analysis, inflammatory factor measurement, lung injury score indicated that seawater and freshwater perfusion could all induce lung injury to a certain extent, and the injury induced by seawater perfusion was obviously severer(P<0.05). Conclusions Lung injury induced by seawater perfusion is severer than that by freshwater perfusion.     

分次灌注海水致兔呼吸窘迫综合征模型的建立

目的通过向兔气管插管内灌入海水，建立海水淹溺致急性呼吸窘迫综合征模型。方法14只新西兰大白兔被随机平分为C组（对照组，无任何处理）和S组（海水组，用海水灌注）。观察分次适量海水灌入气管插管后症状学、血气分析、血液动力学、血清中肿瘤坏死因子（TNF—α）和白细胞介素-6（IL-6）的变化。2h后给每组试验兔拍摄肺CT片，并观察其组织病理学变化。结果与C组相比，S组的O2和CO2指数显著降低（P〈0．01），呼吸动力学和血液动力学的情况明显恶化。TNF—α和IL-6增高，这一结果提示肺损伤发生于兔被海水灌注之后。另外，还发现模型兔有明显的肺水肿、肺泡隔断裂和炎性渗出。结论成功复制了既符合海水淹溺的实际情况，又符合国内外急性呼吸窘迫综合征诊断标准的海水淹溺致急性肺损伤动物模型。     

海水和淡水肺内灌注对兔肺损伤作用的实验观察

Objective To investigate differences in lung injury induced by seawater and freshwater perfusion in rabbits. Methods 21 New Zealand rabbits were randomly divided into the normal group (the control group), the freshwater group and the seawater group. Same amounts of seawater and freshwater were perfused in the lungs of rabbits through tracheal incubation. Changes in the indices concerning symptomatology, blood-gas, hemodynamics, tumor necrosis factor (TNF-α), interleukin 6 (IL-6), histology and lung injury were monitored 3 hours later. Then, the obtained data were analyzed statistically to see the differences in lung lesions of different animal groups. Results Blood-gas analysis, inflammatory factor measurement, lung injury score indicated that seawater and freshwater perfusion could all induce lung injury to a certain extent, and the injury induced by seawater perfusion was obviously severer(P<0.05). Conclusions Lung injury induced by seawater perfusion is severer than that by freshwater perfusion.