目的:探讨入院后24～48 h内肠内营养(EN)支持治疗对重症急性胰腺炎(SAP)患者肾损伤(AKI)的保护作用.方法:回顾性分析联勤保障部队第九○九医院2020年6月—2022年6月收治的163例SAP患者的临床资料,根据EN开始时间不同,入院后24～48 h内EN支持治疗为观察组(n=78)、入院后48～72 h内EN支持治疗为对照组(n=85).比较2组患者EN前后AKI分期、血肌酐(Cr)、尿素、尿酸、胱抑素-C、IL-1、IL-6、IL-8、CRP、TNF-α、APACHE Ⅱ评分变化.结果:观察组EN治疗后无一例AKI分期升期,对照组EN治疗后AKI分期升期5例(13.89％),差异有统计学意义(P＜0.05);观察组EN治疗后AKI分期降期17例(54.84％),对照组EN治疗后AKI分期降期8例(22.22％),差异有统计学意义(P＜0.05).观察组EN治疗后Cr、尿素、尿酸、胱抑素-C小于对照组,差异有统计学意义(P＜0.05);观察组EN治疗IL-1、IL-6、IL-8、CRP、TNF-α、APACHEⅡ评分小于对照组,差异有统计学意义(P＜0.05).结论:对于SAP患者入院后24～48 h予EN支持治疗,可以降低炎症反应,保护肾功能,防止肾功能损伤进一步加重.

Objective:To investigate the influencing factors of conversion to open surgery in patients with traumatic splenic rupture undergoing laparoscopic splenectomy and to construct a risk prediction model.Methods:Clinical data of 62 patients with traumatic splenic rupture admitted to The 909th Hospital from June 2019 to June 2022 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 47 patients were male and 15 female,aged from 29 to 51 years, with a median age of 41 years. 17 patients were diagnosed with grade Ⅱ splenic trauma, 35 cases of grade Ⅲ splenic trauma and 10 cases of grade Ⅳ splenic trauma. Intraoperative conversion to open surgery was performed in 14 patients. The influencing factors of intraoperative conversion to open surgery were analyzed by Chi-square test and multivariate Logistic regression analysis. The prediction model for risk of conversion to open surgery was constructed. The ROC curve was drawn to analyze the prediction efficiency of this model for the risk of conversion to open surgery.Results:Univariate analysis showed that the conversion rate in patients with BMI≥27 kg/m2, grade Ⅳ trauma, experienced attending physician as chief surgeon, intraoperative splenic injury and poor exposure was significantly increased (χ2=7.468, 15.336, 5.124, 15.849, 12.111; P<0.05). Multivariate analysis demonstrated that experienced chief surgeon, intraoperative splenic injury and poor exposure were the independent influencing factors for intraoperative conversion to open surgery (HR=17.717, 20.764, 10.343; P<0.05). Taking intraoperative conversion to open surgery as the dependent variable, and experienced chief surgeon, intraoperative splenic injury and poor exposure as the independent variables, the prediction model for risk of intraoperative conversion to open surgery was constructed as Logit(P)=-18.980+2.875×X1+3.033×X2+2.336×X3 (X1 was experienced chief surgeon, X2 was intraoperative splenic injury, X3 was poor exposure). The area under the ROC curve (AUC) of this prediction model was 0.925, the sensitivity was 0.857 and the specificity was 0.854.Conclusions:Insufficient experience of chief surgeon, intraoperative splenic injury and poor exposure are the independent influencing factors for the failure of laparoscopic surgery in patients with splenic rupture. Eligible patients for laparoscopic surgery can be screened by constructing risk prediction models.

目的 探讨急性一氧化碳中毒后迟发性脑病(DEACMP)患者血清B细胞淋巴瘤-2(Bcl-2)、半胱氨酸天冬氨酸蛋白酶-3(Caspase-3)、半胱氨酸天冬氨酸蛋白酶-9(Caspase-9)水平与病情、预后的关系.方法 选取2019年1月—2022年9月收治的DEACMP 92例作为DEACMP组,急性一氧化碳中毒(ACMP)后未发生DEACMP 50例作为ACMP组,健康体检者50例作为健康体检组.比较DEACMP组、ACMP组和健康体检组3组,DEACMP患者急性期和恢复期,以及预后不良和预后良好DEACMP患者血清Bcl-2和Caspase-3、Caspase-9水平,采用Pearson相关性分析探讨DEACMP患者血清Bcl-2和Caspase-3、Caspase-9与长谷川痴呆量表(HDS)、格拉斯哥预后量表(GOS)的相关性,绘制受试者工作特征(ROC)曲线评估血清Bcl-2、Caspase-3、Caspase-9单独及联合检测对DEACMP患者预后预测价值.结果 DEACMP组、ACMP组和健康体检组血清Bcl-2和Caspase-3、Caspase-9依次降低(P<0.05).DEACMP患者血清Bcl-2和Caspase-3、Caspase-9急性期均高于恢复期,预后不良均高于预后良好(P<0.01).Pearson相关性分析显示,DEACMP患者血清Bcl-2、Caspase-3、Caspase-9与HDS、GOS均呈负相关(P<0.01).ROC曲线分析结果显示,血清Bcl-2、Caspase-3、Caspase-9单独及联合检测对DEACMP患者预后不良预测的曲线下面积分别为0.859、0.780、0.798和0.921.结论 DEACMP患者血清Bcl-2、Caspase-3、Caspase-9水平与病情和预后相关,三者联合检测对DEACMP患者预后预测价值较高.

目的 探讨经对侧上颌间隙(CTM)入路神经内镜手术治疗颅底岩尖肿瘤的疗效.方法 回顾性分析2015年1月至2020年2月经CTM入路神经内镜手术治疗的35例颅底岩尖肿瘤的临床资料.结果 术后病理检查显示软骨肉瘤12例,脊索瘤11例,脑膜瘤6例,神经鞘瘤4例,蛛网膜囊肿2例.12例软骨肉瘤和11例脊索瘤中,术后24h内CT+术后1周MRI显示,肿瘤全切除17例(73.91％),大部分切除6例;4例神经鞘瘤和2例蛛网膜囊肿均全切除;6例脑膜瘤中,5例全切除,1例次全切除.未见颈内动脉损伤.25例术中观察到脑脊液漏;5例术后发生脑脊液鼻漏;1例因鼓膜穿刺管出现脑脊液耳漏.5例术后出现新发神经缺陷或原有缺陷加重,6例术后出现暂时性上颌神经感觉迟钝或神经痛,1例发生特发性感音神经性听力损失.结论 CTM入路神经内镜手术治疗岩尖肿瘤,增加了手术的自由度和可视性,提高了肿瘤全切除率,降低了颈内动脉损伤的风险.

目的 探讨引发严重创伤患者短期内死亡的病理生理学因素，筛选相关病理生理耗竭指标，并依此建立高效精简的生理学预警评分。方法 前瞻性研究2020年7月1日—2021年6月30日厦门大学附属东南医院（第909医院）急诊科收治的严重创伤患者139例，男性101例，女性38例；年龄6～81岁，平均53.0岁。根据48h治疗结局分为存活组（100例）和死亡组（39例），收集患者一般临床资料和各项生理学指标，应用SPSS 25.0统计软件对各指标进行Logistic回归分析，筛选出影响严重创伤患者预后的病理生理学指标，并根据生理学评分标准对各指标进行赋值，建立生理学预警评分，最后绘制受试者工作特征（ROC）曲线并计算ROC曲线下面积（AUC）。结果 本组病死率28.1%（95%CI:0.20～0.36）。两组患者性别、新损伤严重度评分（NISS）、升压药使用比例、凝血酶原时间（PT）、乳酸（Lac）、压力校正性心率（PAR）评分值、血小板计数（PLT）、纤维蛋白原（FIB）、氧合指数（OI）、体温（T）、格拉斯哥昏迷评分（GCS）、序贯性脏器衰竭评分（SOFA）和多脏器功能障碍综合征（MODS）评分、血清肌酐（sCr）、红细胞压积（HCT）、白细胞计数（WBC）组间比较差异均有统计学意义（P＜0.05）；而年龄、PAR和总胆红素（TBil）组间比较差异均无统计学意义（P＞ 0.05）。Logistic回归分析显示，GCS、T、Lac和FIB是严重创伤患者发生48h内死亡的独立影响因素。ROC曲线显示生理学预警评分AUC值分别0.953，其预测性能显著优于NISS（P＜0.001）和MODS评分（P＜0.05）。结论 生理学预警评分与严重创伤患者48h病死率具有良好的相关性，在一定程度上能够反映严重创伤患者的病情严重程度，可作为评估严重创伤患者预后的有效指标。

Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.

目的 探讨引发严重创伤患者短期内死亡的病理生理学因素,筛选相关病理生理耗竭指标,并依此建立高效精简的生理学预警评分.方法 前瞻性研究2020年7月1日—2021年6月30日厦门大学附属东南医院(第909医院)急诊科收治的严重创伤患者139例,男性101例,女性38例;年龄6～81岁,平均53.0岁.根据48h治疗结局分为存活组(100例)和死亡组(39例),收集患者一般临床资料和各项生理学指标,应用SPSS 25.0统计软件对各指标进行Logistic回归分析,筛选出影响严重创伤患者预后的病理生理学指标,并根据生理学评分标准对各指标进行赋值,建立生理学预警评分,最后绘制受试者工作特征(ROC)曲线并计算ROC曲线下面积(AUC).结果 本组病死率28.1％(95％CI:0.20～0.36).两组患者性别、新损伤严重度评分(NISS)、升压药使用比例、凝血酶原时间(PT)、乳酸(Lac)、血小板计数(PLT)、纤维蛋白原(FIB)、氧合指数(OI)、体温(T)、格拉斯哥昏迷评分(GCS)、序贯性脏器衰竭评分(SOFA)和多脏器功能障碍综合征(MODS)评分、血清肌酐(sCr)、红细胞压积(Hct)、白细胞计数(WBC)组间比较差异均有统计学意义(P<0.05);而年龄、压力校正性心率(PAR)和总胆红素(TBil)组间比较差异均无统计学意义(P>0.05).Logistic回归分析显示,GCS、T、Lac和FIB是严重创伤患者发生48h内死亡的独立影响因素.ROC曲线显示生理学预警评分AUC值分别0.953,其预测性能显著优于NISS(P<0.001)和MODS评分(P<0.05).结论 生理学预警评分与严重创伤患者48h病死率具有良好的相关性,在一定程度上能够反映严重创伤患者的病情严重程度,可作为评估严重创伤患者预后的有效指标.

军民融合是军队医院新形势下的发展方向,军地卫生机构融合过程中还存在一些短板,也是日常训练中暴露的弱项.文章针对联勤保障部队第九○九医院前期参加的两批次批量伤员急救演练,演训中在通信保障、伤员分类、信息录入、术前准备、应激伤员处置、伤员扮演、担架员储备等方面方面发现了一系列实际问题,针对存在的问题,分析总结原因,对流程和方法提出改进措施,采取了诸如强化了入院宣教,合理利用门诊信息化设备,改进分类牌和信息录入方法,手术室前移,加强心理骨干和标准化伤员培训,制定伤员军地分流预案等措施,为进一步提高军民融合型医院救治能力和救治效率积累了经验.

创伤严重程度的评估通常采用创伤评分描述,创伤评分是根据创伤对人体造成的损伤程度、特征、结局等进行定量分类和评分,通常用数值代表其损伤严重程度.根据创伤评分所适用的时间阶段、场所、指标类别以及专科情况的不同可将创伤评分进行不同的分类,每一类创伤评分系统均有其适应证.危重症创伤患者的评估通常需要根据其解剖学损伤程度、病理生理学指标变化以及机体耗竭程度等指标综合进行评价,以判断其严重程度及预后.

目的:探究急救护理路径对严重创伤患者的急救价值.方法:选取笔者所在医院2016年1月-2019年1月救治的300例严重创伤患者为研究对象.将2016年1月-2017年12月收治的150例患者设为常规组,将2018年1月-2019年1月收治的150例患者设为路径组.常规组采取常规急救护理措施,路径组采取急救护理路径措施.比较两组并发症发生率、早期病死率、绿色通道停留时间与相关辅助检查时间,并比较两组护理人员管理风险护理质量.结果:路径组并发症发生率为10.67％,早期病死率为8.67％,均低于常规组的19.33％、16.67％,差异有统计学意义(P<0.05).路径组绿色通道停留时间、相关科室人员到达时间、抽血及其他检查时间、急诊室停留时间均短于常规组,差异有统计学意义(P<0.05).路径组护理人员管理风险护理质量评分高于常规组,差异有统计学意义(P<0.05).结论:急救护理路径可降低患者早期病死率,减少并发症的发生;不仅能提高护理人员管理风险护理质量,还能缩短绿色通道停留时间及相关辅助检查时间,从而有效挽救患者的生命.

目的 探讨疫情期间基于现场实时监测(on-site real-time monitoring,ORM)系统的问题教学法(problem based learning,PBL)在基层卫生士官培训中的应用效果.方法 将48名基层卫生士官随机分成两组,观察组24名应用基于现场实时监测系统的PBL教学模式进行培训,对照组24名进行网络平台授课(钉钉软件)模式进行培训,课程结束时比较学习成绩和问卷调查结果,评估两组培训效果的差异.结果 观察组在问卷调查结果及考试总成绩两方面均优于对照组(P＜ 0.05).结论 基于现场实时监测系统的PBL教学法优于普通网课模式,疫情期间的远程教学效果良好,优势明显,提升卫生士官分析、解决问题能力的同时提高了自主学习能力和积极性,在基层卫生士官的远程培训上有一定的应用前景.

This study was to explore the effect and mechanism of Let-7b nanocomposite on the expression of inflammatory factors in the cerebrospinal fluid (CSF) of purulent meningitis. 45 patients with purulent meningitis (PM) were selected as observation group (group A), and 38 patients with normal CSF without central nervous system diseases were selected as the control group (group B). The CSF of the two groups were collected to detect the inflammatory factors interleukin-8 (IL-8), macrophage inflammatory protein-1 α (MIP-1 α ), matrix metalloproteinase 9 (MMP9), interleukin 1 β (IL-1 β ), tumor necrosis factor- α (TNF- α ), and Let-7b level with the double antibody sandwich enzyme-linked immunosorbent assay (ELISA). The Let-7b nanocomposite was prepared, and its morphology, particle size, and Zeta potential were analyzed. In addition, the degradation kinetics, cytotoxicity, and phagocytic efficiency (PE) of Let-7b nanocapsules were detected. 36 healthy adult New Zealand (NZL) rabbits were randomly grouped into a control group (group C) (0.9% normal saline (NS)), a model group (Escherichia coli (E. coli) modeling, group D), and a test group (E. coli modeling + Let-7b nanocapsules, group E), with 12 rabbits in each group. The changes of inflammatory factors in CSF of the three groups were detected and compared. It was found that the expression levels of IL-8 and IL-1 β in the group A were much higher than those in the group B (P < 0.01), and the MMP9 and TNF- α levels in the group B were much lower in contrast to the group A ( P < 0.001). The expression of Let-7b in the group A was lower obviously in contrast to the group B ( P < 0.001). Let-7b nanocapsules were irregularly spherical, with an average particle size (APS) of 23.1 nm, a polydispersity index (PDI) of 0.232, and the Zeta potential of around +15 mV. Let-7b nanocapsules showed obvious polymer shell absorption peaks at 1,015 cm -1 , 1,228 cm -1 , and 1,547 cm -1 . The IL-8 and IL-1 β levels of the group D were greatly different from those in the other two groups ( P < 0.01). The levels of TNF- α and MMP9 in the group D were greatly different in contrast to the group C ( P < 0.001) and the group E ( P < 0.01). It indicated that Let-7b nanocomposite could lower the expression levels of IL-8, IL-1 β , MMP9, and TNF- α in the CSF of patients with purulent meningitis dramatically, which provides a reliable basis for immunotherapy of purulent meningitis with Let-7b.

目的 总结急性重度敌敌畏中毒的临床特征和救治体会.方法 回顾性分析2014年7月至2019年12月厦门大学附属东南医院暨联勤保障部队第九〇九医院收治的57例急性重度敌敌畏中毒患者的临床资料,其中男性23例、女性34例,年龄38(18～80)岁,均为口服中毒.在重症监护下,给予基础救治措施,包括清除毒物、特效解毒剂、血液净化、呼吸支持、循环支持等;针对顽固性低血压和严重心律失常在积极给予容量复苏、纠正酸中毒、稳定内环境的同时,增加保护心肌药、血管活性药和抗心律失常药的使用,必要时安装临时起搏器.观察患者心脏损害发生情况、转归和预后,分析影响患者预后的相关因素.采用多因素Logistic回归分析影响患者预后的独立危险因素.结果 本组73.7％(42/57)的患者合并不同程度心脏损害,表现为心肌酶谱不同程度升高42例(100.0％)、心电图改变39例(92.9％)、心律失常25例(59.5％)、低血压14例(33.3％)、高血压2例(4.8％).本组患者重症监护病房(ICU)住院时间2～10?d,平均(5.6±1.7)d;总住院时间2～14?d,平均(9.5±2.4)d.本组患者治愈45例,好转5例,死亡7例(12.3％),其中4例死于心搏骤停或严重?室性心律失常,2例死于多器官功能衰竭,1例死于中枢性呼吸循环功能衰竭.单因素分析显示,死亡患者入院时格拉斯哥昏迷评分(GCS)较存活者低(分:3.4±0.6比4.3±1.1,P=0.039),严重心律失常发生率较存活者高〔57.1％(4/7)比20.0％(10/50),P=0.033〕.安装临时起搏器的严重心律失常患者存活率显著高于未安装临?时起搏器者〔20.0％(10/50)比0(0/7),P<0.01〕.存活和死亡患者年龄比较差异无统计学意义(岁:36.8±10.4比?39.5±11.2,P=0.526).Logistic回归多因素分析显示,入院时GCS评分≤6分〔优势比(OR)=2.417,95％可信区间(95％CI)为1.853～4.692,P=0.028〕、伴严重心律失常(OR=1.438,95％CI为1.072～3.739,P=0.031)是急性重度敌敌畏中毒患者死亡的独立危险因素,安装临时起搏器是患者死亡的独立保护因素(OR=0.896,95％CI为0.657～0.964,P=0.015).结论 心脏损害在急性重度敌敌畏中毒中常见,继发严重心律失常与患者死亡相关.在使用保护心肌药和血管活性药的同时,合理选择抗心律失常药,必要时安装临时起搏器能稳定血压、保证循环灌注,提高救治成功率.

介绍了机动医疗平台的常见种类,结合其在国内外新型冠状病毒肺炎疫情防控中的实践情况,总结了野战帐篷医院、野战方舱医院、车载式移动医院、医院船、医疗救护直升机等机动医疗平台在突发重大传染病防控中应用的优势和局限性,展望了机动医疗平台未来的发展方向,为今后重大突发公共卫生事件和生物战防控提供了借鉴.

目的 系统评价颈部创伤急性期(院前及急诊科)致死性伤因.方法 系统检索中国知网、万方、PubMed、EMbase等数据库,从建库至2020年9月所有提供急性期内颈部创伤患者死亡数据的文献,应用Stata 15进行数据分析,通过漏斗图评价发表偏倚.结果 共纳入文献29篇,颈部创伤患者1276例.meta分析结果显示急性期颈部创伤患者致死性伤因包括颈部脊髓损伤、颈部大血管损伤、颈部呼吸道损伤,死亡率分别为0.06(95％CI:0.04～0.08,P＜0.05)、0.06(95％CI:0.03～0.09,P＜0.05)、0.03 (95％CI:0.01～0.06,P＜0.05).结论 急性期内颈部创伤的致死性伤因主要包括颈部脊髓损伤、颈部大血管损伤及颈部呼吸道损伤,积极适当的院前损伤控制性手术干预是进一步改善颈部创伤患者预后的有效方案.

目的 探讨血流动力不稳型骨盆骨折(unstable pelvic fractures,HUPF)合适的损伤控制急救方案.方法 横截面回顾性分析第九〇九医院(厦门大学附属东南医院)77例HUPF患者采用不同损伤控制措施的效果.A组为损伤现场未进行骨盆外固定、入院急诊CT确定骨盆不稳定骨折后立即行支架外固定,12例;B组为损伤现场骨盆下肢联合木板外固定,急诊CT后更换为骨盆支架外固定,18例;C组为现场骨盆下肢联合木板外固定,急诊CT后进行介入栓塞术,术中卸除木板,术后更换为骨盆支架外固定,17例;D组为现场骨盆带外固定,急诊CT后行介入栓塞术,术中维持骨盆带,术后更换为支架外固定,15例;E组为现场骨盆带外固定,急诊CT后行介入栓塞术,术中维持骨盆带,术后保留骨盆带并支架外固定,15例.各组经急诊损伤控制性术后进一步分流专科救治.选择患者平均输血量、休克指数恢复时间和存活率为观察指标,评价各指标的组间差异.结果 A-E组输血量依次减少,A组(4720.00±1996.00)mL,E组(1287.00±112.50)mL(F=38.74,P<0.001);A-E组休克指数恢复时间依次缩短,A组(21.70±18.38)h,E组(4.73±1.10)h(F=10.23,P<0.001);A-E组存活率依次为42％,55％,59％,73％,87％.结论 HUPF患者合适的损伤控制急救措施是现场骨盆外固定优于未固定、急诊介入栓塞优于不栓塞、术中维持固定优于卸除固定、术后保留原固定基础上的骨盆外支架固定优于去除原固定的骨盆外支架固定.

为充分发挥军地医疗资源优势,满足灾害事故批量伤病员及战创伤伤病员救治需求,解放军909医院以建设打仗型医院为目标,探讨军民融合一体化救治体系,提高平时为民、战时为军的医疗救治实效. 1 体系构建背景与现状 1.1 灾害事故救援我国是世界上地质灾害最严重的国家之一,特别是近年全球气候恶化,地震、洪涝等灾害性事件频发[1].漳州地区处地震高发带,台风等灾害季节性发生,易造成人员伤亡;漳州境内多山、水,高速公路和国道纵横,县道、乡道密布,交通伤发生率居高不下[2].因此,构建军民融合战创伤一体化救治体系,有效应用军地医疗资源进行灾害事故医疗救援具有现实意义.

OBJECTIVE:To investigate the clinical effect of low molecular weight heparin sodium combined with antivenin in the treatment of severe and critical bite by Trimeresurus stejnegeri. METHODS:The clinical data of 48 patients with severe or critical bite by Trimeresurus stejnegeri admitted to emergency department of Southeast Hospital Affiliated to Xiamen University from March 2017 to May 2019 were retrospectively analyzed. On the basis of early treatment of antivenom serum, internal administration and external application of Jidesheng snake tablet, and wound incision and detoxification, the patients were divided into heparin treatment group and non-heparin treatment group according to whether the low molecular heparin sodium was used or not. The patients in the two groups were compared in terms of gender, age, clinical classification, swelling degree of injured limbs, change of coagulation function index, bleeding of skin, mucous membrane or digestive tract, blood transfusion, local symptoms of bite, length of hospital stay and prognosis. RESULTS:There was no significant difference in terms of gender, age, clinical classification or swelling degree of injured limbs between the two groups. On the 3rd day of treatment, the platelet count (PLT) in the heparin treatment group was significantly higher than that in the non-heparin treatment group [×109/L: 210.0 (160.0, 252.0) vs. 136.0 (104.0, 198.5), P < 0.05]. However, there was no significant difference in the four coagulation test results between the two groups. On the 6th day of treatment, the plasma thrombin time (TT) in the heparin treatment group was significantly shorter than that on the 3rd day of treatment [s: 30.3 (20.4, 37.0) vs. 34.7 (24.0, 73.4), P < 0.05], and the fibrinogen (FIB) in the heparin treatment group was significantly higher than that in the non-heparin treatment group [g/L: 0.60 (0.31, 1.07) vs. 0.20 (0.14, 0.60), P < 0.01]. The incidence of bleeding in the heparin treatment group was significantly lower than that in the non-heparin treatment group [21.7% (5/23) vs. 64.0% (16/25), P < 0.01]; 11 patients in the heparin treatment group and 18 patients in the non-heparin treatment group received blood transfusion and prothrombin complex supplement respectively. There was no significant difference in the length of hospital stay between the heparin group and non-heparin treatment group (days: 6.91±1.92 vs. 7.48±2.27, P > 0.05). The patients in both groups were followed up for 1 week to 1 month after treatment, and no death or local necrosis of skin and soft tissue was found. CONCLUSIONS:For the patients with severe and critical bite by Trimeresurus stejnegeri, on the basis of injection of antivenom serum, internal administration and external application of Jidesheng snake tablet, and wound incision and detoxification, early application of low molecular weight heparin sodium anticoagulation and other comprehensive treatment is helpful to improve limb swelling and inflammation, reduce blood transfusion, promote the recovery of coagulation function, and shorten the length of hospitalization.

目的 探讨重症慢性阻塞性肺疾病(COPD)患者IL?33/ST2比值与血气指标、氧化应激反应程度的相关性.方法 2017年5月至2019年5月期间在本院ICU接受治疗的重症COPD患者90例作为重症COPD组,同期在本院进行体检的健康志愿者100例作为正常对照组,对比两组血清IL?33/ST2比值,并根据重症COPD组中位数将其分为高IL?33/ST2比值组、低IL?33/ST2比值组各45例.对比两组研究对象动脉血气指标[氧分压(PaO2)、二氧化碳分压(PaCO2)、PH]、血清氧化应激指标[超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、活性氧(ROS)、丙二醛(MDA)]水平的差异.评估重症COPD患者血清IL?33/ST2比值与血气指标、氧化应激反应程度的相关性.结果 重症COPD组患者血清IL?33、ST2的水平均高于正常对照组,而IL?33/ST2比值低于正常对照组,差异有统计学意义(P<0.05).重症COPD患者的PaO2、PH水平、血清中SOD、CAT的水平均低于正常对照组,且随着IL?33/ST2比值的降低,PaO2、PH水平不断的降低;重症COPD患者的PaCO2水平,ROS及MDA的水平高于均正常对照组(P<0.05),且随着IL?33/ST2比值的降低,PaCO2水平,ROS及MDA的水平在不断的升高,差异具有统计学意义(P<0.05).结论 IL?33、ST2在重症COPD患者中表达较高,参与了COPD的发病过程,可在一定程度上反应病情,但比值异常降低,且具体比值与病情相关指标水平直接相关,可能是反映疾病严重程度及转归的有效指标之一.

1 病例资料 患者女 ,72 岁 ,因"突发左上腹疼痛 12 h"收治入联勤保障部队第九 ○ 九医院 . 患者有"高血压 、脑梗死"病史 4 年 ,无神经功能缺失后遗症 ,院外不规律服药 ,具体不详 ,无药物及食物过敏史 . 入院后行常规体检 ,完善相关辅助检查 ,诊断为"急性胰腺炎 、电解质紊乱 、高血压 Ⅰ 级" . 嘱禁食 ,持续胃肠减压 . 予生长抑素抑制胰腺分泌 ,皮下注射低分子量肝素钠抗微小血栓形成 ,地塞米松抗炎以减轻炎性介质对各脏器的损害 ,乳果糖 、四磨汤润肠 、通便治疗 ,补液及维持水电解质平衡等治疗 ,并予注射用雷贝拉唑钠(批号 F1709042 ,江苏奥赛康药业股份有限公司)20 mg ,bid ,ivgtt(早晚 9 :00左右用药 ,抑酸治疗 . 治疗第 2 天(d 2)凌晨(即首次静滴雷贝拉唑钠后约 4 h) ,患者出现躁动不安 ,胡言乱语 ,呼吸频率增快(34 次/min) ,心率 110 次/min ,予面罩吸氧 ,地西泮注射液 5 mg 静推 ,15 min 后患者上述症状消失 . 询问家属 ,其否认患者既往有性情 、精神方面不正常病史 ,结合入院及复查检查结果 ,排除低钠 、肝性脑病 、脑血管意外 、低血糖等 ,需考虑腹痛 、恐惧心理引起精神异常 ,暂予镇静 、止痛治疗 ,其他治疗继续当前方案 ,并观察患者病情变化 . 治疗 d 2 第 2次用药和 d 3 用药后 3 ～ 4 h 患者仍出现躁动(较前轻微) ,约10 ～ 20 min 后自行好转 ,未及时告知医师 .