营养支持是重症患者综合治疗的一个重要组成部分,影响重症患者病死率的危险因素之一就是营养不良,而且是独立因素可增加并发症发生率和病死率[1].由于重症患者不仅存在不同程度的意识障碍、进食困难、消化和吸收欠佳,导致营养素摄入和吸收减少;加上重症患者往往存在感染、血液循环不稳定、脏器功能不全等应激高分解状态,使得基础代谢率明显增加,而且患者常常丢失过多,体内营养素贮存很快耗尽,使得营养素的需求和消耗增加;另外,重症患者常存在体内酸碱失衡、体内微环境发生改变、激素分泌异于正常,代谢状况复杂程度远远高于单纯饥饿或肿瘤,使得营养素的利用也存在不同程度的异常.

目的:探讨血清髓样细胞触发受体-1(sTREM-1)、肺功能指数与肺癌患者术后肺部感染的关系及其预测价值.方法:回顾性分析2016年1月-2019年1月在我院进行手术治疗的115例肺癌患者的临床资料,根据患者术后72 h是否发生肺部感染将其分为感染组(n=28)及未感染组(n=87).对比两组患者临床资料、术后6h血清sTREM-1、降钙素原(PCT)水平及术前肺功能指数[第一秒用力呼气量(FEVl)、呼气流量峰值(PEF)]变化,记录感染组患者痰细菌培养结果,采用Logistic分析肺癌患者术后感染的影响因素,并采用受试者工作特征(ROC)曲线分析sTREM-1、FEV1、PEF在肺癌术后感染的预测价值.结果:感染组术后入住ICU比例大于未感染组,感染组TNM分期为Ⅳ期的比例大于未感染组(P＜0.05),感染组术后6h血清sTREM-1、PCT水平高于未感染组,术前FEV1、PEF水平低于未感染组(P＜0.05).感染组痰培养结果提示G-菌为17例,占60.71％;G+菌10例,占35.71％;真菌1例,占3.57％.二元多因素Logistic分析提示术后6h血清sTREM-1水平升高、术前FEV1下降及PEF下降、术后入住ICU为肺癌患者术后感染的独立影响因素.三者联合预测曲线下面积为0.850(95％CI:1.350～1.745,P=0.000),敏感度与特异性分别为91.3％与80.6％,优于sTREM-1、FEV1、PEF的单独预测效能.结论:sTREM-1水平升高,术前FEV1、PEF水平降低与肺癌患者术后肺部感染密切相关,对sTREM-1、FEV1、PEF三者联合分析对于预测肺癌患者术后肺部感染的发生具有较高的预测价值.

Objective:To investigate effects between6 -shogaol and NF-κB with docking. Methods:Docking was carried out against structure of NF-kappa B p 50 homodimer bound to a kappa B site for possible inhibitory effect of6-SH. A suitable active-site was identified in the target protein via define active site module within the Discovery Studio 2. 5. It works on cavity detection algorithm, where,a shape comparison filter was combined with Monte Carlo technique to produce various ligand conformations. This was carried out to calculate the non-bonded interactions between the ligand and catalytic residues of the target protein. Result:Docking analysis showed that,6-SH was located deep in the cleft lined with Tyr57,Val 58 and Cys59,Tyr143,Lys 145 and Lys 146 of the Chain B of p 50 NF-κB. It also showed the formation of the one pi-cation interaction with Lys145. In terms of scoring profile,6-SH was again revealed as efficient ligand to control the activity of NF-κB with DOCK SCORE of 41 . 27 and ligand internal energy of-3 . 52 . Conclusion:It is proved by docking the effect6-SH on the inhibition of NF-κB.

Background: This study aims to investigate the attitude and knowledge of Chinese physicians towards obstructive sleep apnea syndrome (OSAS). Methods: Seven hospitals in China including 580 doctors were organized to participate in this study. In this present investigation, a self-reported questionnaire that aims to assess the attitude and knowledge of physicians towards OSAS was used. Results: A total of 563 questionnaires were returned. Among the 560 respondents who completed the questionnaires, 532 (95%) respondents thought snoring might be a disease and 507 (80.5%) respondents knew what OSAS is. Respondents in the relevant professional group (RP group) were more familiar with OSAS than those in the non-related professional group (NRP group) (P=0.027), and both groups strongly agreed on these two statements: "OSAS needs to be treated aggressively or given attention" and "knowledge of OSAS needs to be enhanced" (P > 0.05). Mean OSAS knowledge score of physicians was 44.87 +/- 20.64. The RP group had a higher score than the NRP group, P=0.009. Based on location, Southern hospitals had a higher score than Northern hospitals (P=0.026), while Western hospitals had a higher score than Eastern hospitals (P=0.006). Tertiary level hospitals had a higher score compared with lower-level hospitals (P=0.000). Respondents had higher scores when a sleep center was present in the hospital (P=0.012). Respondents with higher professional titles had higher scores (P=0.000). Treatments from highest to lowest scores were as follows: weight loss, quit smoking and alcohol, continuous positive airway pressure (CPAP), avoid fatigue, surgery and drugs. Conclusions: Doctors recognized that snoring might be a disease and they recommended aggressive treatment or give attention for OSAS. However, their knowledge of OSAS was poor. They were willing to further their knowledge of OSAS.

目的：探讨左西孟旦治疗重症监护病房（ICU）心力衰竭患者临床效果，以及对心功能和B型脑钠肽（BNP）、超敏C反应蛋白（hs‐CRP）等的影响。方法选择2013年2月至2016年2月于该院治疗的144例ICU心力衰竭患者作为研究对象，按照随机数字表法分为观察组（72例）和对照组（72例），两组患者均给予适当休息、吸氧、低盐饮食，并给予常规药物治疗。对照组在常规治疗基础上联合应用多巴酚丁胺静脉滴注，初始剂量2μg／（kg · min），1 h后增至4μg／（kg · min），持续用药24 h。观察组在常规治疗基础上联合应用左西孟旦，初始负荷量12．0μg／kg静脉注射10 min ，然后以0．1μg／（kg · min）持续静脉泵入50 min ，如耐受性好剂量增至0．2μg／（kg · min），持续静脉泵入24 h。两组患者分别于治疗前、后检测左心室射血分数（LVEF）、左室舒张末期内径、BNP、hs‐CRP 水平，观察临床疗效、用药3个月和6个月后病死率与再次入院率及不良反应发生情况。结果治疗后观察组总有效率（81．9％）显著高于对照组（66．7％），差异有统计学意义（P＜0．05）；观察组LVEF明显增高，BNP、hs‐CRP水平明显降低，差异均有统计学意义（P＜0．05）；观察组在用药3、6个月后病死率与再次入院率优于对照组，但差异无统计学意义（P＞0．05）；两组患者均发生恶心、呕吐、胸痛、心悸、低血压、头痛、低血钾等不良反应，两组各种不良反应发生情况比较差异无统计学意义（P＞0．05）。结论左西孟旦能有效提高ICU心力衰竭患者临床效果，改善心功能及BNP和hs‐CRP水平，安全性好，值得临床推广应用。

Objective To investigate the in vitro multi-direction differentiation ability of TERT gene modified sheep adi-pose derived mesenchymal stem cells and to verify the role of TERT gene in immortalization of sheep adipose derived mesenchymal stem cells. Methods The TERT-ADSCs were subcultured. P3 and P30 cells were selected to proceed induced osteogenic and neu-ral differentiation. Histological staining and RT-PCR of specifically expressed genes were used to identify the multi-direction differ-entiation ability of TERT-ADSCs. Results TERT-ADSCs can be stably subcultured to P30. After induction of osteogenic differenti-ation of P3 and P30,process of bone nodules was obviously visible,cells were stained reddish brown after alizarin red staining and specific gene CBFA and Osteocalcin were expressed. After induction of neural differentiation,cells presented triangle or dendritic morphology,Nissl bodies can be observed by toluidine blue staining and specific gene NSE and GFAP were expressed. Conclusion The TERT-ADSCs of sheep still has the potential of multi-direction differentiation after having been subcultured several times, which provides a theoretical basis for the immortalization study of ADSCs.

Objective To analyze and discuss the application value extravascular lung water index for the prognosis of patients with acute respiratory distress syndrome were evaluated.Methods Randomly selected 90 cases of acute respiratory distress syndrome as the object of study, the patients were divided according to the oxygenation index moderate, mild and severe groups of patients (30 cases). All patients entering the intensive care unit after the corresponding treatment, the mortality rate in patients with average contrast extravascular lung water index three days and one month period.Results Compared to the group with mild, moderate and severe patients extravascular lung water index average of 3 days significantly higher (P> 0.05); compared with mild group, the average moderate extravascular lung water index was significantly higher (P <0.05), the difference was statistically significant.Conclusion Extravascular lung water index to acute respiratory distress syndrome to evaluate the patient’s condition has important clinical value in evaluating the prognosis of patients.

目的:对食管癌手术后急性呼吸窘迫综合征的螺旋CT表现进行探讨.方法:选择我院食管癌术后急性呼吸窘迫综合征的80例患者作为研究对象,收治时间为2013年4月至2015年4月期间,按照数字抽签法将这80例患者分成两组,一组为实验组,共40例,一组为对照组,共40例,对照组患者给予X线诊断,实验组患者给予螺旋CT诊断,在诊断结束后,对比分析两组患者的诊断符合率.结果:实验组患者的诊断符合率92.50％,对照组患者的诊断符合率为72.50％ (P＜0.05),两组的差异具有统计学意义;40例行螺旋CT诊断的患者中,有36例患者表现为以下叶为主的双肺多发病变,病变部位均为双肺下叶,病变以在肺的后下部两侧对称或者非对称为主.结论:食管癌术后急性呼吸窘迫综合征的CT表现较为复杂,且伴双肺多发病变,应该引起充分的临床重视.

Objective:To find the best ventilation strategy for patients with acute respiratory distress syndrome(ARDS)to improve oxygenation,To monitor the safety of lung recruitment maneuver.Methods:In clinical experiments,selected ARDS patients underwent endotracheal intubation,on the breathing machine(PB840).20cases of ARDS Patients were randomly divided into a small tidal volume group(control group) and small tidal volume ventilation + lung recruitment maneuver group(experimental group).The control group take the small tidal volume(6mL/Kg) of the ventilation+ personally PEEP.the recruitment maneuver operation is as follows:before recruitment maneuver,take FiO2 to 100%,continuous 5 min,in a state of non-muscle relaxation breathing machine model will be adjusted to continuous positive airway pressure(CPAP),to give 30cmH2O of pressure,continuous 30 s,then recover to the original ventilation mode and conditions.Comparison of two kinds of ventilation strategies on clinical efficacy and prognosis of patients with such implications.Results:1,compared with the control group,the PO2,oxygenation index and cst of treatment group is significant improvement at 30min from start(P<0.01),also maintained at a higher value at 24h,48h.2,PIP and Plate is significantly lower(P<0.01)than in the control group.3,the implementation of lung recruitment maneuver does not increase the ventilator-associated lung injury.Conclusion:based on the personally PEEP,using of lung recruitment strategies of ventilation for treatment of ARDS is more suitable to improve compliance,improve oxygenation,reduce non-pulmonary organ damage than the small tidal volume ventilation strategy.It is an important supplement of the Lung protective ventilation strategy.It is a safe and effective ventilation method in patients with ARDS,and to be a good clinical value.

Acute lung injury,ALI/acute respi-ratory distress syndrome,ARDS is the most serious respiratory failure.Recently,some new points about ventilation has been advanced.In this article,the treatment for ARDS with recruitment maneuvers be introduced.

Objective The study is to observe the effect of thrombolysis therapy with urokinase to acute myocardial infarction ( AMI) and the occurrence of heart attacks. Methods 64 patients with acute Myocardial infarction were divided randomly in 2 groups and treated differently with Urokinase and un-urokinase medicine. The group with intravenous thrombolysis was treated with 1. 5 million units urokinase and another group with general medicine the 64 patients all underwent coronary artery angiographies later to evaluate the restoration of blood flow of infarct-related artery and record the heart events. Results The reperfusion rate of intravenous thrombolysis is 67. 7% while 27% in another group and the proportion of heart failure is lower in the group with intravenous thrombolysis. Conclusion The intravenous thrombolysis therapy should be an important method to AMI in primary hospital,the delaying result from changing hospital will affect the reperfusion.