目的:探讨早期目标导向镇静(EGDS)联合有创无创序贯治疗AECOPD伴严重呼吸衰竭患者的疗效.方法:收治AECOPD伴发呼吸衰竭患者46例,随机分为治疗组和对照组.治疗组采用早期目标导向镇静联合有创无创序贯机械通气方案,对照组采用常规镇静及机械通气方案,比较两组治疗效果.结果:治疗组入住ICU时间、总机械通气时间、谵妄发生率、VAP发生率和院内死亡率均显著优于对照组(P<0.05).结论:目标导向镇静联合有创无创序贯机械通气治疗AECOPD伴呼吸衰竭的患者能减少入住ICU时间、机械通气时间,降低病死率,从而改善预后.

目的 探讨艾司洛尔联合乌司他丁在空腔脏器穿孔致脓毒性休克患者术后的心肌保护.方法 选择2016年2月至2018年2月因空腔脏器穿孔致脓毒性休克术后入住ICU的52例患者,根据治疗方案随机分为研究组26例与对照组26例,对照组给予常规治疗方案,研究组在常规方案上加用艾司洛尔及乌司他丁治疗.观察两组患者的炎性介质(TNF-α、IL-1β)、CK同功酶质量定量(CK-MB)、超敏肌钙蛋白T(hs-cTNT)、钠尿肽(PROBNP)、心律失常发生率、血管活性药物用量、入住ICU时间.结果 治疗后不同时间段,研究组患者的炎性介质指标、心肌损害指标、心律失常发生率及入住ICU时间均低于常规治疗组,差异有统计学意义(P<0.05),血管活性药物用量差异无统计学意义(P>0.05).结论 艾司洛尔联合乌司他丁能有效降低脓毒性休克患者的心肌损,能降低心律失常的发生率,对循环无明显影响.

Objective To observe the analgesic and sedative effect of butorphanol tartrate on hyperlipidemic severe acute pancreatitis (HL-SAP) patients undergoing invasive mechanical ventilation.Methods A total of 47 HL-SAP patients undergoing invasive mechanical ventilation were randomized into treatment group (23 cases) or control group (24 cases).Butorphanol tartrate and sufentanil were used for analgesia and sedation in the treatment group,while midazolam and sufentanil were used for analgesia and sedation in the control group.Richmond Agitation-Sedation Scale(RASS) sedation scores and Critical-Care Pain Observation Tool(CPOT) analgesia scores after 4,12,24 and 48 hours of sedation and analgesia were compared between the two groups,and duration of mechanical ventilation,ICU stay and incidence rate of delirium were compared as well.Results On the 4th,12th,24th and 48th hour after sedation and analgesia,RASS scores and CPOT scores showed significant differences between the two groups (P ＜ 0.05) and changed over time,there was an interaction between group and time,the scores in the treatment group were superior to those in the control group(P ＜ 0.05),and the incidence rate of delirium in the treatment group was significantly lower than that in the control group(17.4％ vs.45.8％,P ＜ 0.05).The treatment group had less ICU stay and less duration of mechanical ventilation compared with the control group (P ＜ 0.05).Conclusion For HL-SAP patients undergoing invasive mechanical ventilation,butorphanol tartrate in combination with sufentanil is safe and reliable when used for sedation and analgesia.It can significantly improve sedative and analgesic effect,reduce the incidence of delirium and the duration of mechanical ventilation,and thus its application should be actively promoted.

目的 观察乌司他丁联合大剂量氨溴索对急性呼吸窘迫综合征(ARDS)患者细胞因子的影响.方法 将173例人住重症监护室(ICU)的ARDS患者随机分成4组:A组43例,采用常规综合治疗和机械通气治疗;B组43例,在A组基础上加用大剂量氨溴索治疗;C组42例,在A组基础上加用乌司他丁治疗;D组45例,在A组基础上加用乌司他丁和大剂量氨溴索治疗,共7d.观察4组患者治疗前后肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)水平的变化,记录28 d病死率.结果 C、D2组治疗后48 h以及治疗后7d的TNF-α、IL-6、IL-8水平显著低于A组(P＜0.01),而IL-10水平只在治疗后48 h显著低于A组(P＜0.01);B、C、D组28 d病死率低于A组,但差异无统计学意义(P＞0.05).结论 乌司他丁联合大剂量氨溴索治疗能降低ARDS患者的TNF-α、IL-6、IL-8水平,对ARDS患者有较好的治疗作用.

危重患者易发生应激性溃疡,部分患者会并发大出血,出现大出血后一般会有明显的临床表现,如胃管有血、柏油样便、呕血、贫血等.非典型(无明显临床表现)的溃疡大出血罕见,我院于2012年8月收治1例,现报道如下: 1 病例简介 患者,男,55岁,因"外伤致上胸部以下感觉运动障碍3+h"2012年8月14日人院.入院时患者神清语弱,精神差,颈部压痛,颈活动障碍,双上肢感觉减退,肌张力低下,肌力2～3级,能自主活动,双侧胸部乳头平面以下感觉运动障碍,双下肢感觉、运动、反射消失.CT示颅内未见确切异常,C6双侧下关节突、C7双侧上关节突骨折,T6骨折,肺气肿,纵膈挫伤待排,肺挫伤.完善术前准备后于2012年8月22日在全麻下行经颈后路单侧椎板切开椎管扩容减压椎管成形、颈6、7自体植骨融合术,术毕回骨科进行相应治疗,一般情况较好,术后当日开始进食.

目的 了解重症监护病房(ICU)各类机械通气相关事件(VAE)的发生情况,为研究干预措施提供参考依据.方法 采用前瞻性调查方法对2013年4月-7月所有新入院在ICU使用机械通气时间＞2d、年龄≥18岁的49例患者进行留置机械通气所发生的有关事件监测,并对49例患者VAE发生率进行分析比较.结果 49例患者中共发生VAE 16例,发生率为32.6％,其中包括呼吸机相关并发症3例、与感染有关的呼吸机相关并发症8例、疑诊呼吸机相关肺炎4例和拟诊呼吸机相关肺炎1例.与未发生VAE的患者相比,发生VAE的患者年龄和急性生理学及慢性健康状况Ⅱ评分更高,机械通气时间和住院时间更长,预后更差,抗菌药物使用率更高,差异均有统计学意义(P＜ 0.05).结论 VAE监测客观、简便,可以为患者制定VAE预防干预措施提供依据.

Objective To observe the clinical effect of septic shock treated with early goal-directed therapy.Methods 160 patients with septic shock were randomly divided into two groups,in which 80 patients were treated with early goal-directed therapy(treatment group),and 58 patients with conventional treatment(control group).After treatment,the change of CVP,MAP,SCVO2,serum lactic acid,MODS incidence,28 days case-fatality rate were compared in the two groups of patients. Results In the two groups of patients,the disease before treatment was not statistically different(P>0.05).And there was statistically difference in the change of CVP,MAP,SCVO2,serum lactic acid,MODS incidence,28 days case-fatality rate after 6 and 24 hours treatment with early goal-directed therapy in the treatment group(P<0.05).Conclusion The treatment with early goal-directed therapy can significantly improve the survival and prognosis of patients with septic shock.

目的:探讨多巴胺联合去甲肾上腺素在感染性休克中的疗效.方法:将120 例感染性休克患者随机分为观察组和对照组各60 例,观察组在常规抗感染、扩容等的基础上给予多巴胺联合去甲肾上腺素抗休克;对照组在常规抗感染、扩容等的基础上给予多巴胺抗休克,观察两组的血液动力学、血乳酸.结果:观察组治疗后24h 的中心静脉压(CVP)、平均动脉压(MAP)、血乳酸及中心静脉氧饱和度(ScvO2)改善显著优于对照组(P<0.05).结论:在常规抗感染、扩容等的基础上应用多巴胺联合去甲肾上腺素治疗感染性休克疗效较好,值得临床推广使用

Objective To explore the correlation between the prognosis and the blood lactate and lactate clearance rate in critical ill patients.Methods The data of 129 critical ill patients were collected,including blood lactate after admission to ICU,the blood lactate and lactate clearance rate after 6 hours and 12 hours in ICU.A total of 129 cases were divided into survival group and dead group,low lactate clearance rate group and high lactate clearance rate group,and the differences between them were compared for statistical significance.Results There were no differences in age and the initial blood concentration of lactate(P0.05);The lactate clearance rate after 6 hours and 12 hours in survival group was significantly higher than it in dead group[(45.25±12.52)% VS(8.53±11.21)% and(78.27±21.53)% VS(-10.63±8.22)%,P0.01];The mortality in high lactate clearance rate group was significantly lower than it in the low lactate clearance rate group(20.0% VS 51.0 %,P0.01).Conclusion Blood lactate and lactate clearance rate can be regarded as good indicators to evaluate the severe degree and to predict the prognosis of critical ill patients.