目的 探究早期应用β受体阻滞剂对脓毒症患者血浆相关炎症因子的影响,以及患者发生心肌损伤的相关性和在华北石油管理局总医院治疗的院内早期结果.方法 回顾性分析92例脓毒症患者病例,根据药物使用情况将患者分为β受体阻滞剂治疗组(治疗组)和对照组.两组患者入院后均采取脓毒症早期目标导向治疗,对照组患者治疗相比组患者多应用β受体阻滞剂.取所有患者入院治疗后3 d、7 d静脉血液,采用ELISA法测定患者不同治疗时间点肿瘤坏死因子α(TNF-α),白细胞介素-6(IL-6),白细胞介素-1β(IL-1β)的浓度,根据患者病情,收集病程中心脏功能指标,判定两组患者脓毒症心肌损伤情况,并评价患者院内死亡率和两组患者生存曲线.结果 治疗组患者在入院3、7 d时血浆中TNF-α、IL-6、IL-1β均显著低于对照组(P<0.05).治疗组患者与对照组患者在院内死亡率上无显著差异,但是治疗组患者心肌损伤发生率显著低于对照组患者(P<0.05).结论 早期应用β受体阻滞剂可以降低脓毒症患者相关血浆炎症因子的水平,降低心肌损伤程度,减少脓毒症心肌病发生率.

目的 探讨脓毒症心肌病患者血清中血红素氧化酶1(hemo oxygenese-1,HO-1)水平变化及其与患者疾病早期诊断及预后的相关性.方法 选取2019年7月至2020年7月河北省任丘市华北石油管理局总医院重症医学科收治的76例脓毒症患者进行前瞻性研究.根据入组排除标准,共入组69例.依据检测,记录相应心功能信息,将静息时左心室射血分数(left ventricular ejection fraction,LVEF)≥50％为心功能正常组(37例),<50％为心功能异常组(32例).选取同期本院志愿者13例为对照组.检测记录入院6h内的血清高敏肌钙蛋白T(high-sensitivity cardiac troponin T,hs-cTnT)及N末端B型利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)水平,留取血样,提取外周血白细胞总核糖核酸,反转录后利用实时荧光定量聚合酶链式扩增进行HO-1表达水平检测.采用受试者工作特征曲线(receiver operating characteristic,ROC)曲线下面积分析hs-cTnT,NT-proBNP以及HO-1表达水平对脓毒症心肌病患者损伤水平的预测价值,并进一步分析HO-1与脓毒症心肌损伤后心功能的相关性.结果 心功能异常组hs-cTnT与NT-proBNP较心功能正常组明显升高;与对照组相比,脓毒症患者外周血白细胞中HO-1表达均显著升高,其中心功能异常组的表达水平高于心功能正常组,差异有显著性(P<0.05).ROC分析显示,NT-proBNP曲线下面积为0.882,hs-cTnT曲线下面积为0.832,HO-1曲线下面积为0.837.而NT-proBNP+HO-1曲线下面积为0.966,hs-cTnT+HO-1曲线下面积为0.931.Pearson相关性分析表明,NT-proBNP、hs-cTnT、HO-1水平均与心功能存在负相关(R分别为-0.82,-0.65,-0.81,P<0.05).结论 脓毒症患者外周血中NT-proBNP、hs-cTnT与HO-1水平均升高,且其水平与损伤后心功能呈负相关,即表达水平越高,则表明心脏损伤越严重,心功能越差.此外,NT-proBNP联合HO-1具有更好地预测脓毒症后心肌损伤的价值.

Objective To evaluate the value of P(cv-a)CO2 combined with fluid load status in assessing prognosis of patients with septic shock.Methods The data of 95 patients with septic shock were collected from October 2015 to March 2017, and the included patients were divided into 4 groups according to the presence of fluid overload and P(cv-a)CO2 threshold of 6 mmHg (1 mmHg=0.133 kPa) 72 hours after treatment. Group A: fluid overload + P(cv-a)CO2≥6 mmHg; Group B: non-fluid overload + P(cv-a) CO2≥6 mmHg; Group C: fluid overload + P(cv-a)CO2<6 mmHg; Group D: non-fluid overload + P(cv-a)CO2<6 mmHg. The differences in the mortality rate on 28 and 90 days, mechanical ventilation time, ICU time, and hospital stay time were compared among the four groups.Results There were statistically significant differences in mechanical ventilation time, ICU time, hospital stay, 28-day mortality and 90-day mortality among the 4 groups (P<0.05).Conclusions The combination of P(cv-a)CO2 and fluid overload condition can evaluate the prognosis of patients with septic shock.

Objective To investigate the effectiveness and safety of rosuvastatin and simvastatin in the treatment of hyperlipidemia. Methods The database including CNKI, VIP, Wanfang data base and CBM were retrieved to search the clinical randomized controlled trials (RCT) of rosuvastatin and simvastatin in the treatment of hyperlipidemia, and the data were analyzed with Review Manager 5.2. Results Eighteen RCTs were included with a total sample size of 1819 cases with hyperlipidemia, in which there were 917 patients in rosuvastatin group and 902 in simvastatin group. The Meta-analysis results showed that there were significantly lower serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG) and significantly higher level of high-density lipoprotein cholesterol (HDL-C) in rosuvastatin group compared with those of simvastatin group [(MD=-0.15, 95%CI:-0.22--0.09, P<0.01), (MD=-0.18, 95%CI:-0.25--0.11, P<0.01), (MD=-0.23, 95%CI:-0.28--0.19, P<0.01) and (MD=-0.11, 95%CI:-0.06--0.15, P<0.01)]. There was no significant difference in the incidence of gastrointestinal adverse reaction between the two groups. Conclusion The current clinical evidences show that rosuvastatin has a better effect on the treatment of hyperlipidemia, and has no adverse reactions.

Objective To assess the relation between the central venous-to-arterial carbon dioxide difference [P(cv-a)CO2] and cardiac index (CI) measured with ultrasonic cardiac output monitor (USCOM) in patients with septic shock.Method A retrospective observational study conducted in intensive care unit (ICU). After early resuscitation, 66 consecutive septic shock patients with central venous oxygen saturation(ScvO2)≥70% were included. Measurements were performed at a 6 h interval (T0, T6, T12, T18, T24) during the first 24 h after their admission into ICU. Heart rate(HR), mean arterial pressure (MAP), central venous pressure (CVP), P(cv-a)CO2, cardiac index(CI) and ScvO2 were obtained. Patients were separated into Low P(cv-a)CO2 group (n=35) and High P(cv-a)CO2 group (n=31) according to a threshold of 6 mmHg at T0.Result At T0, T6, T12, T18 and T24, there were significant differences between low and high P(cv-a)CO2 groups for CI[(4.1±1.4) vs (2.4±0.6)L/(min·m2)],P< 0.001; [(4.4±0.9) vs (2.8±0.7)L/(min·m2)],P< 0.001; [ (4.1±1.3) vs (2.9±0.6) L/min·m2], P< 0.001; [(4.0±1.3) vs (2.7±0.8)L/(min·m2)],P< 0.001; [(4.2±1.4) vs (2.9±0.8) L/(min·m2)],P< 0.001. At each time point, there were significant differences between low and high P(cv-a)CO2 groups for P(cv-a)CO2(P<0.05), but not for HR、MAP、CVP、ScvO2 (P>0.05). The correlation between CI and P(cv-a)CO2 value was inversely correlated (r=-0.804,P<0.001), but not for ScvO2(r=0.088, P>0.05). Receiver operating characteristic curve analysis confirmed the association of P(cv-a)CO2with CI (AUC: 0.782;P< 0.001; 95% confidence interval 0.710 to 0.853). The cut-off for the best predictive value of CI≥2.2L/(min·m2) was an P(cv-a)CO2 of 5.55 mmHg or lower with a sensitivity of 85.7% and specificity of 66.8%.Conclusion CI measured with USCOM and P(cv-a)CO2 values were inversely correlated in patients with septic shock. In patients with septic shock recovery process, P(cv-a)CO2 may be an indicator of the adequacy of very useful for evaluation of cardiac output, it should be early identification and treatment need patients who require resuscitation or still remain inadequately resuscitated by using a variety of effective index.

目的：探讨中心静脉-动脉二氧化碳分压差（ΔPCO2）作为检测指标指导感染性休克液体复苏治疗的可行性。方法选取感染性休克患者57例，随机分为试验组（ n ＝30）和对照组（ n ＝27）治疗。监测2组中心静脉压（ CVP）、氧合指数（ PaO2／FiO2）、ΔPCO2、急性生理功能和慢性健康状况评分系统Ⅱ（ APACHEⅡ评分）、序贯器官衰竭估计（SOFA）评分、住ICU时间、机械通气时间、28 d病死率、6 h液体平衡。结果2组治疗6 h后CVP，PaO2／FiO2均有明显升高，APACHEⅡ评分和SOFA评分均明显下降，差异有统计学意义（ P ＜0)．05）。治疗后试验组CVP和PaO2／FiO2均显著高于对照组，APACHEⅡ评分、SOFA评分以及住ICU时间、机械通气时间、6 h液体平衡均低于对照组，差异有统计学意义（ P ＜0．05）。2组28 d病死率差异无统计学意义（ P ＞0．05）。结论监测ΔPCO2辅助液体复苏可有效降低液体平衡量，缩短机械通气时间和住ICU时间，改善治疗效果。

目的 探讨集束化干预措施对重症医学科中心静脉导管使用率和中心静脉导管感染率的影响.方法 2011年1-12月基线阶段进行中心静脉导管目标监测,2012年1月-2014年12月干预阶段实施中心静脉导管的集束化干预措施并行目标监测,比较干预前后中心静脉导管使用率和中心静脉导管感染率.结果 实施集束化干预措施后中心静脉导管使用率从73.0％下降至58.8％ (P＜0.01),中心静脉导管感染率从4.86％下降至1.84％(P＜0.05).结论 集束化干预措施能降低重症医学科中心静脉导管使用率和感染率.

目的 观察RNF43在宫颈癌组织中的表达水平及其与宫颈癌发生发展的相关性.方法 纳入2013年1月-2015年1月华北石油管理局总医院妇产科诊治的76对配对的宫颈癌及癌旁组织标本为研究对象,提取组织总RNA,应用半定量RT-PCR方法检测RNF43的表达水平,结合宫颈癌患者临床资料分析RNF43表达与宫颈癌患者临床资料之间的相关性.在5株宫颈癌细胞株中检测RNF43的表达,并通过MTT增殖实验和克隆形成实验检测RNF43对宫颈癌细胞株增殖的影响.结果 半定量RT-PCR发现60.5％ (46/76)的宫颈癌中RNF43低表达,且RNF43在宫颈癌中的低表达与肿瘤的TNM分期以及淋巴结转移相关(x2=15.134、13.740,P＜0.01).RNF43在HeLa细胞中无表达,在SiHa细胞和CaSki细胞中低表达,在C-33A和C4-1细胞中高表达.在HeLa细胞中恢复RNF43表达后可以抑制细胞的增殖和克隆形成能力.结论 RNF43在宫颈癌中频发表达降低,且与肿瘤的TNM分期及淋巴结转移相关,RNF43具有作为宫颈癌诊断及预后评估标志物的潜能,可抑制宫颈癌细胞的增殖能力.

Objective To investigate the fluctuations in serum concentration of human epididymal secretory protein human epididymis -specific protein 4( HE4)during the phases of the menstrual cycle and the correlation between HE4 values and age in healthy young women. Methods Forty - five women with regular menstrual cycles were included in the study. All selected candidates are divided into two groups based on age. Blood samples were collected at follicular(FP),ovulatory(OP),and luteal(LP)phases of the hormonal cycle. Results The values of HE4 observed were 38. 9 ± 1. 2 pmol/ L(FP),45. 7 ± 1. 1 pmol/ L(OP),and 41. 9 ± 1. 2 pmol/ L(LP). The difference between FP and OP was statistically significant( P = 0. 0002). By contrast,serum CA125 levels were 13. 9 ± 0. 7 IU / ml( FP),13. 2 ± 0. 4 IU / ml( OP),and 13. 6 ± 0. 4 IU / ml(LP),respectively. The differences between the three phases of the hormonal cycle were not statistically significant( P >0. 05). The levels of HE4 observed in serum samples of women less than or equal to 35 years were 37. 6 ± 1. 3 pmol/ L in the FP,46. 7 ± 1. 3 pmol / L in the OP,and 42. 7 ± 1. 5 pmol/ L in the LP. In this group,a statistically significant difference was observed in the FP compared with the OP( P < 0. 0001). The levels of HE4 observed in serum samples of women over 35 years were 44. 2 ± 0. 8 pmol/ L in the FP,42. 3 ± 1. 7 pmol/L in the OP,and 39. 1 ± 2. 0 pmol/ L in the LP,no statistically significant difference was observed during the different hormonal phases in the group of women over 35. The levels of CA125 observed in serum samples of women less than or equal to 35 years old were 12. 8 ± 0. 7 IU/ ml in the FP,12. 5 ± 0. 7 IU/ ml in the OP,and 13. 2 ± 0. 7 IU/ ml in the LP. There wasnˊt a statistically significant difference in the group. The levels of CA125 observed in serum samples of women over 35 years were 13. 3 ± 0. 7 IU/ ml in the FP,13. 6 ± 0. 8 IU/ ml in the OP,and 13. 7 ± 0. 6 IU/ml in the LP,no statistically significant difference was observed during the different menstrual phases in the group of women over 35 years old. Conclusion In the young women ,it is essential to define a threshold of normality of the HE4 marker which is affected by menstrual cycle;but the CA125 has little change during different phases of menstrual cycle.

目的 探讨限制性液体复苏治疗策略对创伤失血性休克患者预后的影响.方法 选取2014年1月～2015年12月在华北石油管理局总医院治疗的创伤失血性休克患者共67例,根据创伤失血性休克患者液体复苏方法不同将其分为观察组(36例)和对照组(31例),观察两组患者凝血指标(TT、APTT、PLT)、血气分析指标(氧合指数、血乳酸)和复苏效果(病死率和MODS、ARDS并发症发生率).结果 观察组复苏6h血乳酸低于对照组,氧合指数高于对照组,差异有显著统计学意义(P＜0.05).凝血指标复苏6h观察组APTT、PT低于对照组,PLT高于对照组,差异有统计学意义(P＜0.05).观察组患者病死率以及MODS、ARDS并发症发生率均显著低于对照组(P＜0.05).结论 限制性液体复苏治疗创伤失血性休克具有良好的临床疗效,可以降低病死率和并发症发生率.

目的：探讨影响宫腔粘连患者TCRA术后妊娠结局的因素。方法2010年12月至2012年12月华北石油管理局总医院收治的宫腔粘连（ IUA）患者中符合纳入排除标准76例。登记患者临床资料及随访资料，差异有统计学意义（ P <0(．05）。结果符合标准入组患者76例，有明确宫腔操作史68例，占89．47%。患者年龄、手术前后月经情况对术后妊娠率均无影响（ P >0．05）。宫腔操作次数、病因、粘连程度、手术效果、术后妊娠时间对术后妊娠率均有影响（ P <0．05）。轻度和中重度粘连手术效果差异有统计学意义（ P <0．05）；术前月经情况对手术效果无明显影响（ P >0．05）。结论宫腔粘连的病因以宫腔操作为主。发病原因、宫腔操作次数、粘连程度、手术效果及术后妊娠时间是影响妊娠率的主要因素。

Objective To investigate the clinical characteristics,treatment methods and prognosis of primary malignant melanoma of the esophagus(PMME). Methods 17 PMME patients who received surgical treatment in the Fourth Hospital of Hebei Medical University from March 1993 to January 2014 were analysed. Clinical symptoms, laboratory examination results and treatment methods were recorded,and prognosis was observed. Survival rate was calculated using Kaplan- Meier method,and analysis of prognosis was conducted using Cox regression model. Results After pathological staging,4 patients were found at stageⅠ,7 patients were at stage Ⅱ,and 6 patients were at stage Ⅲ;lymphatic metastasis occurred in 11 patients,and 6 patients had no lymphatic metastasis. The tumor was found in the middle and lower part of the esophagus in all the patients. The observation through esophagoscope showed gray black mass(8 / 17) or overlying filthy gray black moss like mass(5 / 17)in esophagus lumen. All the patients underwent esophageal carcinoma resection,esophagogastrostomy and lymph node dissection,with a resection rate of 100% . Postoperative adjuvant therapy was undertaken on 11 patients,and 6 patients didn't receive adjuvant therapy. The average survival time was 23. 5 months,with a median survival time of 16. 0 months,and 1- year,3 - year and 5 - year survival rates were 58. 8% ,17. 7% and 11. 8% respectively. The patients at different pathological stages were significantly different in survival curve( χ2 = 12. 150,P = 0. 002). The patients without lymphatic&nbsp;metastasis and with lymphatic metastasis were significantly different in surivial curve(χ2 = 8. 855,P = 0. 003). The patients who received adjuvant therapy and patients who didn't receive adjuvant therapy were not significantly different in survival curve (χ2 = 0. 049,P = 0. 824). Multivariate Cox regression analysis showed that pathological staging was an independent influencing factor for survival and prognosis of PMME patients〔b = 1. 444,SE = 0. 462,Wald χ2 = 9. 797,95% CI(1. 716,10. 475), HR = 4. 240,P = 0. 002〕. Conclusion PMME has high malignancy degree and poor prognosis;common manifestation under esophagoscope is gray black mass or overlying filthy gray black moss like mass in esophagus lumen;pathological staging is an independent influencing factor for the prognosis of patients;radical resection should be the primary therapy,and postoperative adjuvant chemoradiotherapy has no obvious influence on survival time.

Objective:To observe the effect of Danhong injection on blood coagulation function and blood lactic acid in patients with severe sepsis.Methods:A hundred patients with severe sepsis from the Intesive Care Unite were randomly classified into treat-ment group(n =52)and control group(n =48).Patients in both groups were treated with fluid resuscitation,anti infection drugs at admission and given the vasoactive drug,hydrocortisone and mechanical ventilation support when necessary.The treatment group was treated with Danhong injection intravenous infusion of 40 mL once a day.APACHE Ⅱscore,blood coagulation indexes and blood lactic acid were measured at admission and the seventh day of hospitalization.The mortality was monitored at the 28th day of hospitalization.Results:The blood coagulation indexes,blood lactic acid and APACHE Ⅱscore of the treatment group and the control group were of significant difference at the seventh day(P <0.05).The 28d mortality of the treatment group was lower than the control group,but the difference were not of statistically significance(P >0.05).Conclusion:Danhong injection can improve the blood coagulation state and decrease perfusion hypoxia in severe sepsis patients.

Objective:To explore clinical curative effect of the totally laparoscopic cholecystolithotomy in treatment of cholecystolithiasis.Method:From January 2008 to January 2011,the gall preserving lithotomy of 100 patients were divided into treatment group (50 cases) and control group (50 cases) .Treatment group were treated with laparoscopic cholecystolithotomy, the control group using laparotomy after cholecystolithotomy. The average operation time, peri operation period, postoperative exhaust time, hospitalization time, follow-up treatment and relapse of two groups were recorded.Result: The average operation time in the treatment group was (58.2±12.5) minutes and was (84.9±16.4)minutes in the control group, the differences was statistically significant(P<0.05). The postoperative exhaust time in treatment group was (23.7±1.8)hours and (36.9±1.2)in the control group,the differences was statistically significant(P<0.05).Hospitalization time in the treatment group was (5.1±0.9)days and (8.3±1.6)days in the control group, the differences was statistically significant(P<0.05). Complications occurred in 1 cases in the treatment group and 7 patients in the control group,the differences was statistically significant(P<0.05). Recurrence occurred in 1 cases in the treatment group and 3 patients in the control group, the differences was no statistically significant (P>0.05).Conclusion:Laparoscopic cholecystolithotomy for gallbladder stones (polyP) is safe,reliable,small injury, quick recovery,less complications,and is suitable for popularization and popularization.

目的：研究血浆半胱氨酸蛋白酶抑制剂C （ cystatin C，CysC）和N末端脑钠肽前体（ N-terminal probrain natriuretic peptides，NT-proBNP）对急性心力衰竭患者病情和预后的评估作用。方法选取2013年1月至2014年6月急诊心力衰竭患者115例，选取同期健康体检者58例为对照组，分别给予血浆NT-proBNP和CysC水平检查，比较观察组和对照组NT-proBNP和CysC的区别，根据临床心功能情况患者分成Ⅱ级36例，Ⅲ级39例和Ⅳ40例，分别比较NT-proBNP和CysC与心力衰竭严重程度的相关性。心力衰竭组根据预后分为事件组51例及非事件组64例，分别比较2组 NT-proBNP 和 CysC 的区别。结果心力衰竭组 NT-proBNP、CysC 水平均高于对照组（ P ＝0倐．001）。NT-proBNP和CysC与心力衰竭严重程度呈正相关性（ r ＝0．359，0．426， P ＝0．002，0．003），事件组NT-proBNP、CysC均高于非事件组（ P ＝0．001，0．015）。结论 NT-proBNP 和CysC水平能够评估急性心力衰竭患者病情和预后， NT-proBNP和CysC水平越高，病情越重，预后越差。

Objective: To explore the clinical efficacy of integrative medicine on treating VAP. Methods: 56 cases of VAP patients were randomly divided into two groups: western medicine group of 26 patients were given antibiotic treatment and integrative medicine treatment group with 30 patients were given antibiotic combined with Chinese medicine prescription which is on behalf of the guidance of TCM theory. Results: The total effective rate of integrative medicine treatment group (83%) was significantly better than that of the western medicine group (61%). Conclusion: The effect of integrative medicine on treating VAP is good, is worth promoting.