急性呼吸衰竭(acute respiratory failure,ARF)是由于各种突发因素引起肺通气和(或)换气功能迅速出现严重障碍,以致静息状态下不能维持有效气体交换,从而产生严重缺氧和(或)高碳酸血症,并引起一系列生理、病理及相应临床症状的综合征.临床病因多见于感染、外伤、中毒、神经源性及肺血管性疾病等.

To explore the PBL-Multimedia-Human analogue three-in-one teaching role in the five-year undergraduate education in emergency medicine.Compared study of two groups of five-year undergraduate students was used to investigate the results and feedback of various teaching models.The results showed that the traditional student-teaching classes in the theory and the first aid skills operation test were 74.34 ±7.21 and 73.38 ±6.04 points respectively,and the reform of teaching students in the the-ory course and the first aid skills operation test were 78.60 ±7.04 and 84.46 ±4.92 respectively.There was a significant differ-ence between two groups (P<0.05).The feedback survey also affirmed on teaching reform.Therefore,we think the PBL-Mul-timedia-Human analogue three-in-one teaching on five-year undergraduate has a significant effect,and it is worth popularizing in emergency medicine teaching.

Objective:To assess the relationship of determine the APACHE Ⅱ score and B-type natriuretic peptide factors with prognosis in patients with severe pneumonia. Method:199 cases with severe pneumonia admitted from Nov 2009 to Mar 2011 were prospectively analyzed,which divided into general treatment and mechanical ventilation group. The vital sign,APACHE Ⅱ score,B-type natriuretic peptide and other biochemical findings were evaluated. And then the relationship between these parameters and clinical outcome was analyzed. Result:63 patients(32%) accepted mechanical ventilation treatment. Compared to the general treatment group,mechnical ventination group demonstrated significant change of respiratory and heart rate.Moreover,APACHE Ⅱ score,B-type natriuretic peptide,blood lactate and Serum creatinine of mechanical ventilation group were significantly increased. APACHE Ⅱ score 8,BNP667 ng/L,Cr 142 μmol/L and Lac 2 mmol/L related to need for mechanical ventilation and 30d mortality in ICU. Conclusion:APACHE Ⅱ score,BNP,Cr and Lac have prognostic value and were reliable markers for predicting both high risk for mechanical ventilation and mortality.

目的 分析急诊重症监护室ARDS患者新发血小板减少的原因,探讨新发血小板减少对ARDS预后的影响.方法 对2009-11～2011-03期间入住急诊重症监护室(EICU)的629例患者进行前瞻性研究,根据患者入EICU 5 d内血小板水平分为三组,组1:新发血小板减少不伴ARDS;组2:ARDS伴新发血小板减少;组3:ARDS不伴血小板减少.分析三组患者血生化指标,使用CRRT、机械通气治疗情况,EICU住院时间及死亡率.结果 ARDS合并新发血小板减少患者(组2)较非ARDS患者(组1)显著增多(46%和4.5%,P<0.001);组2、组3 EICU死亡率比较差异无统计学意义(P=0.14);但组2存活患者EICU住院时间较组3明显延长(30 d和17 d,P=0.017);新发血小板减少者30 d内未恢复正常者较恢复正常者EICU死亡率显著增高(71.4%和21.4%,P=0.015).结论 ARDS患者易并发血小板减少,新发血小板减少可致ARDS患者EICU住院时间延长;30 d内血小板减少未能恢复正常者EICU死亡率显著升高;新发血小板减少可能与炎症反应及行CRRT、机械通气治疗有关.

<正>患者,女,47岁,农民。因发作性胸闷、气促、咯粉红色泡沫样痰1年余,再发2 h入院。2007年4月3日患者曾因突发胸闷、咳嗽、咯粉红色泡沫样痰1 d至当地医院就诊,口唇紫绀,双肺湿性啰音,心率106次/min,血压137/87 mm Hg(1 mm Hg=0.133 kPa),SaO_2 66%,X线胸片示两肺散在斑片状影,拟诊重

本文对51例患者急诊胃镜的结果进行分析,报告如下. 临床资料 一、一般资料 1996年至1998年收住的51例因呕血和/或黑便的患者进行急诊胃镜检查,其中男性42例,女性9例,男女之比为14:3,年龄15～60岁,平均年龄41.9岁(见附表).