目的:探讨高压氧辅助治疗新型冠状病毒肺炎(COVID-19)的临床疗效及其不同介入时机对疗效的影响.方法:回顾性分析湖北医药学院附属东风医院2020年1～3月收治的符合《新型冠状病毒感染的肺炎诊疗方案(试行第五版)》诊断标准的患者88例,按是否进行高压氧治疗分为常规治疗组(50例)及高压氧辅助治疗组(38例),比较两组患者治疗后在核酸转阴时间、CT病灶吸收好转时间、淋巴细胞恢复正常时间及住院时间等方面的差异.同时将高压氧辅助治疗的COVID-19(普通型)患者33例按介入时机分为早期组(入院1～10 d)15例、晚期组(入院后10 d)18例,比较两组患者间在住院时间上的差异.结果:高压氧辅助治疗组的核酸转阴时间、CT病灶吸收好转时间、淋巴细胞恢复正常时间、住院时间均短于常规治疗组,介入高压氧治疗早期组住院时间明显优于晚期组,差异均有统计学意义(P<0.05).结论:在常规治疗的基础上辅以高压氧治疗可以加快COVID-19患者核酸转阴、CT病灶吸收及淋巴细胞恢复时间,缩短住院时间,并且高压氧介入时间越早住院时间越短.

Drug retention enema is a common therapy for various illnesses. However, it is impossible to keep the drug in the colon for a long time, due to the limitation of the current equipment, and it is unable to achieve the purpose of retention enema. A retention enema device was designed by the department of intensive care unit (ICU) of Dongfeng Hospital Affiliated to Hubei University of Medicine. The retention enema device adds a spindle shaped inflatable air bag on the basis of the traditional enema device, which not only fix on the anus, but also prevent the leakage of enema fluid. It can achieve retention enema, play the enema drug effect fully, and significantly reduce the nursing workload, in addition, the silica gel material of the retention enema device ensures the comfort of the patients, the decompression air bag also avoids the damage of the high pressure of the spindle fixed air bag for the patients, which is worthy of clinical use.

目的探讨连续性血液净化（CBP）治疗合并急性肾损伤（AKI）的多器官功能障碍综合征（MODS）患者的临床价值及预后影响因素。方法选择2014年1月—2017年12月就诊治疗的68例合并AKI的MODS,记录患者一般资料,检测CBP治疗前后炎性因子、肝肾功能、血流动力学、急性生理学及慢性健康状况评分（APACHEⅡ评分）等指标和预后情况,并分析影响预后的危险因素。结果治疗后68例合并AKI的MODS患者C反应蛋白、白介素-6、肿瘤坏死因子-α、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、直接胆红素、肌酐、尿素、心率、中心静脉压水平、APACHEⅡ评分及序贯性器官衰竭评分（SOFA）均较治疗前降低,而平均动脉压、心脏指数和氧和指数水平均升高（P ＜0. 01）。本组病死率为44. 12%。年龄≥60岁、AKIⅢ期、器官衰竭个数＞ 3个、采用机械通气及APACHEⅡ评分和SOFA评分过高均为影响合并AKI的MODS经CBP治疗后预后的独立危险因素（P ＜0. 05,P ＜0. 01）。结论 CBP治疗可显著降低合并AKI的MODS患者炎性因子水平,改善其肝肾功能和血流动力学,临床应及时评估预后情况,给予有效干预措施改善预后。

目的 观察参附注射液联合糖皮质激素对脓毒血症患者降钙素原(PCT)、N末端B型利钠肽原(NT-proBNP)及炎症因子的影响.方法 患者90例按随机数字表法分为两组,在常规治疗基础上,对照组接受糖皮质激素治疗,观察组联合应用参附注射液治疗.比较两组炎症因子、NT-proBNP及PCT水平变化,并进行疗效评价及不良反应发生情况分析.结果 治疗后两组肿瘤坏死因子-α(TNF-α)、白细胞介素-18(IL-18)、白细胞介素-10(IL-10)水平均明显降低(P＜0.05),且以观察组降低更为显著(P＜0.05).治疗后两组PCT和NT-proBNP均低于治疗前(P＜0.05);且观察组低于对照组(P＜0.05).治疗后,两组单核细胞表面人类白细胞抗原DR位点(HLA-DR)水平比治疗前提升(P＜0.05),且观察组高于对照组(P＜0.05).对照组总有效率为82.22％,明显低于观察组的95.56％(P＜ 0.05).对照组出现疑似药物不良反应3例(6.67％),观察组出现疑似药物不良反应2例(4.44％),两组差异无统计学意义(P＞0.05).结论 参附注射液联合糖皮质激素辅助治疗脓毒血症疗效显著,其作用机制可能与减轻炎症反应,提升免疫力,同时降低NT-proBNP及PCT水平,提升HLA-DR水平有关.

目的 探讨液体复苏对创伤致严重脓毒症和脓毒性休克患者心肌损伤的影响.方法 选取严重脓毒症和脓毒性休克患者26例,均给予液体复苏治疗.根据预后分为2组,治疗3d后存活患者21例为存活组,治疗3d后死亡患者5例为死亡组；根据患者指标达标情况将存活组分为2组,达标患者13例(中心静脉压为8～ 12 mmHg(1 mmHg =0.133kPa),平均动脉压为65 ～ 90 mmHg,混合静脉血氧饱和度为70％以上)为达标组.未达标患者8例为未达标组,分析各组患者间血流动力学指标、组织灌注指标、心肌损伤指标.结果 液体复苏治疗后,患者肺动脉楔压、心指数、体循环血管阻力指数、左心室每搏工作指数、右心室每搏工作指数均显著升高,患者肺循环血管阻力指数、血乳酸浓度、血二氧化碳分压均显著下降(P均＜0.05).存活组与死亡组患者心肌肌钙蛋白Ⅰ、N末端-心室利钠肽前体均显著下降(P均＜0.05).死亡组患者心肌肌钙蛋白Ⅰ、N末端-心室利钠肽前体均明显高于存活组(P均＜0.05).未达标组患者心肌肌钙蛋白Ⅰ、N末端-心室利钠肽前体均明显高于达标组(P均＜0.05).结论 液体复苏可显著改善严重脓毒症和脓毒性休克患者的心肌功能,心肌肌钙蛋白Ⅰ和N末端-心室利钠肽前体等心肌损伤指标与患者的预后有着密切联系.

The early diagnosis and evaluation of sepsis can improve the survival rate of patients,but usually it takes a long time by a professional physician with complex technologies to complete.In the early stage of sepsis,there is cardiac function obstacle.It is an important factor which leads to systemic circulation disorder.BNP is mainly synthesized by the ventricular myocyte under the circumstances of the volume expansion or excessive pressure load,and it will generate the ventricular wall stress which can stimulate the production of BNP.Recently,researches have showed that the elevation of serum BNP in sepsis is multifactorial,especially in myocardial injury,myocardial depression and cardiac insufficiency.BNP might be useful for early diagnosis,condition monitoring and prognosis of sepsis-induced myocardial dysfunction.

Sepsis is still a severe problem for the critical care medicine.And multiple-organ failure generated by sepsis is still the most major cause of death in the ICU patients.Blood purification is a kind of organic functional supporting method.With the help of extracorporeal circulation,it can obliterate the plasma inflammatory cytokine,toxin and excessive moisture through the man-made semipermeable membrane,in order to maintain homeostasis.In recent years,there are 3 kinds of theories concerning high volume hemofiltration to explain the clinical transformation after blood purification therapy in the sepsis patients.

Objective: To continuous blood purification(CBP) on sepsis and multiple organ dysfunction syndrome((MODS)).Methods: A total of 42 patients with MODS and sepsis [average dysfunctional organs number(3.87±1.06)] were given CBP therapy,with continuous veno-venous hemofiltration(CVVH) as main therapy.During the CBP therapy,vital signs,as well as temperature,ABG,blood routine examination,and internal environment etc were monitored on time.Results: During the CBP therapy,blood Pressures of the 42 patients were stable.After the therapy,several clinical indicators were improved,such as BUN,Cr,APACHE Ⅱ scores,MODS scores,SOFA scores,and Vasoactive drugs dose.And there were significant differences in changes of lactic acid and intercellular adhesion molecule 1(ICAM-1) levels between two groups(P0.05).Conclusions: CBP is a satisfactory therapy in the treatment of sepsis combined with MODS.

急性脑血管病变是一种常见且发病迅猛的危重症,该疾病引起的并发症如颅内压升高,急性肾功能衰竭未得到有效的控制,极易引发脑疝,严重者可导致患者死亡[1].因甘露醇可在急性发作期迅速降低颅内压,缓解脑水肿,故将其作为首选治疗方法.但研究发现应用剂量的不当会损伤肾脏,引起体内电解质紊乱,严重者可出现急性肾功能衰竭(ARF)甚至死亡[ 2].

<正>床边紧急心脏起搏是抢救心脏骤停及严重心动过缓的有效措施[1,2]。本文观察了60例心脑血管病急症患者床边紧急心脏起搏,报道如下。临床资料收集2006年1月～2010年3月到我院进行心脏急症治疗的病例120例(男67,女53),年龄39～

Objective To evaluate and analyze the application value of continuous Acute Physiology and Chronic Health EvaluationⅢ(APACHEⅢ)apply on critically ill patients in the intense care unit.MethodsBy collecting and sorting out the data of 320 cases of serious patients,the prognosis of patients were evaluated by APACHEⅢfor 3 days in continuation and tracking the results in the end.ResultsThere was a significant correlation between the score of APACHEⅢ and the actual mortality.The mortality increased remarkably when the score was>90.It is helpful that judging the result of serious patients by using continuous APACHEⅢ.ConclusionsAPACHEⅢ score system can be used to evaluate state of an illness and prognosis.It is the basis of medical quality and reasonable application of ICU source.

[Objective]Using Acute Physiology and Chronic Health Evaluation(APACHE) Ⅲ,disease condition and prognosis of 90 patients in Intensive Care Unit(ICU) were evaluated,so as to confirm its clinical value.[Methods]The data of 90 patients in ICU of Dongfeng General Hospital Affiliated to Hubei Medical and Pharmaceutical University from December 2008 to December 2009 were collected,and APACHE Ⅲ severe diseases evaluation system was adopted to evaluate.APACHE Ⅲ scores of every patient in the survival group and the death group were respectively calculated to forecasts the mortality rate and calculate the fatality rate of two groups.[Results]Among 90 patients,there were 54 cases in the survival group with the average scores of(49.54 ±18.76),and there were 46 cases in the death group with the average scores of(92.54±30.12).The APACHE Ⅲ scores of the death group was significantly higher than that of the survival group(P<0.01).The actual fatality rate and estimated mortality rate increased with the increase of APACHE Ⅲ scores.[Conclusion]APACHE Ⅲ severe diseases evaluation system can evaluate the disease condition and prognosis of severe diseases accurately and objectively,which is worth popularizing in clinic.

[Objective] To apply Acute Physiology Chronic Health Evaluation Ⅲ(APACHEⅢ)in evaluation of the ICU patient's condition and prognosis,and simultaneously compare the prognosis predicted by dynamic APACHEⅢ scoring and MODS scoring with the actual prognosis.[Methods]The clinical data of 286 critically ill patients were collected and divided into survival group (252 cases) and death group (34 cases).APACHEⅢ was adopted to evaluate patients of the 2 groups for the 1st,3rd,5th,7th day,the results were compared.MODS scoring and prognosis prediction were simultaneously carried out.[Results]The APACHEⅢ scores of the 1st,3rd,5th,7th day and fatality rate of death group were all higher than those of the survival group(P<0.05 or P<0.01).Dynamic scoring could help to determine prognosis.There was consistency between APACHE Ⅲ scoring and MODS scoring.MODS scoring was correlated with mortality.[Conclusion]Dynamic APACHEⅢ and MODS scoring systems can be used for evaluation of the ICU patient's condition and prognosis,and it is the evidence of medical quality and rational use of ICU resource.

"江边一碗水"为小檗科植物--南方山荷叶的干燥根茎,同科植物八角莲及六角莲药酒,其成分复杂,毒性较大,泡制成药酒可有一定保健或散瘀活血功效.我们于2009年6月收治1例重度"江边一碗水"中毒患者,该患者因过量服用该药酒致中毒,现将其救治过程和体会报告如下.

妊娠糖尿病系高危妊娠,严重危害母儿的健康,部分孕妇出现糖尿病并发症如妊娠高血压综合征、酮症酸中毒、巨大胎儿、死胎及死产、产科感染率增高等,但在分娩后糖尿病的临床表现均逐渐消失,在以后的妊娠中又出现,分娩后又恢复,部分患者在数年后可发展为临床糖尿病.我们近来收治2例妊娠糖尿病并发严重脓毒血症患者.现将诊治情况报道如下.

[Objective]To evaluate the safety and effectiveness of the tirofiban,which was used in the percutaneous coronary intervention therapy for the patients with acute myocardial infarction with st-segment elevation(STEMI).[Methods] The patients with confirmed STEMI were randomly divided into test group and control group,and the test group received intravenous tirofiban before PCI.The TIMI blood flow before and after PCI,the left ventricular ejection fraction after PCI for 1 week,bleeding complications and the cardiovascular events which occurred in 30 days were observed in both 2 groups.[Results] Compared with the PCI group,the tirofiban group had the higher harvest rate of TIMI Class Ⅲ blood flow,and the difference was significant(P0.05);the left ventricular ejection fraction after PCI for 1 week was higher than the PCI group,and the difference was significant(P0.05);bleeding complications had the tendency of being higher than the PCI group,but the difference was not significant(P0.05),with no sever hemorrhage;the incidence of the main cardiovascular events was lower than the PCI group,and the differences was significant(P0.05).[Conclusion] The tirofiban can improve the TIMI blood flow in the infarct related artery of patients with STEMI,so it can be safely used in the emergency interventional treatment of STEMI,and significantly lower the incidence of the cardiovascular events which occur in 30 days.

急性心肌梗死(acute myocardial infarction,AMI)是心血管疾病中的一种急症,因其病情凶险、死亡率高,长期以来一直是急诊工作中首要重视的疾病.患者抢救成功与否,往往取决于能否得到及时早期正确的诊断及治疗.

[Objective] To investigate the clinical effect of Tanreqing injection in Ventilator Associated Pneumonia(VAP).[Methods]50 patients with VAP in Affiliated Dongfeng Hospital of Yunyang Medical College were divided randomly into the treatment group and the control group.The tracheal intubation/incision,mechanical ventilation and active support care were performed in all patients.Besides basal treatment,the treatment group accepted Tanreqing Injection 20ml by intravenous injection for 10 days.[Results] There was no significant difference in age and Acute Physiology and Chronic Health Evaluation Ⅱ(APCHE II)between two groups respectively(P0.05).The effectual rate on sputum drainage,antiinflammatory and bacteriostasis of the treatment group and the control group was 92.0% and 68% respectively,and which had statistical significance between them.The effect on blood gas and weaning successful rate of the treatment group were higher than those of the control group respectively(P0.05).And the treatment group had no significant adverse reactions.[Conclusion]Tanreqing injection is a safe and effective assistant medicine in VAP.

Objective To investigate the integratived therapy effect of rhubarb which used in patients with ARDS.Methods 60 patients with ARES were divided randomly into two groups,one is control group which were treated by general treatment and the other is treatment group which were treated by general treatment as well as rhbubarb given through stomach tube.The plasm concentrations of IL-6,IL-8 and blood gas analysis were observed.Results After treatment with rhubarb 7 day,concentrations of IL-6,IL-8,blood gas analysis were improved significantly (P<0.05 or P<0.01) compared to control group;Although blood gas analysis improved significantly(P<0.05 or P<0.01),concentrations of IL-6,IL-8 hadn’t significantly change changed in control group(P>0.05);Treatment with rhubarb hospitalization time and the mortality were significant different(P<0.05 or P<0.01) compared to control group.Conclusion Rhubarb could restrain release of inflammatory media,decrease the mortality,shorten hospitalization time, and improve pulmonary function of patient with ARDS.

目的探讨血管性假血友病因子(vWF)及高敏C反应蛋白(hs-CRP)检测在原发性高血压患者中的临床意义。方法选120例原发性高血压患者及30例正常者空腹取肘静脉血采用酶联免疫吸附双抗体夹心法(ELISA),测定血浆vWF含量;采用免疫比浊法测定其hs-CRP血浆浓度,按原发性高血压分期分组。结果高血压Ⅰ,Ⅱ,Ⅲ期患者vWF含量及高敏C反应蛋白(hs-CRP)水平显著高于正常对照组(P<0.01),且原发性高血压合并有冠心病、糖尿病者vWF,hs-CRP水平显著增高,经系统治疗后,患者vWF含量及hs-CRP水平较发病时显著下降。结论vWF是血管内皮受损的标志物,C反应蛋白(CRP)是组织损伤、炎症反应的标志,高血压患者存在内皮细胞受损及炎症反应,内皮细胞受损及炎症反应程度与病情正相关。系统治疗对稳定原发性高血压病情有利。