目的 对解毒理肺汤联合复方异丙托溴铵溶液(商品名:可必特)雾化吸入辅助治疗鲍曼不动杆菌肺炎的疗效及安全性进行探讨.方法 80例鲍曼不动杆菌肺炎患者,随机分为对照组与研究组,各40例.对照组接受可必特雾化吸入治疗,研究组接受解毒理肺汤联合可必特雾化吸入治疗.比较两组患者治疗效果、治疗前后各项炎性标志物水平、不良反应发生情况.结果 研究组治疗总有效率95.0％高于对照组的77.5％,差异具有统计学意义(P<0.05).治疗后,研究组患者C反应蛋白(CRP)(11.69±3.01)μg/ml、白细胞计数(WBC)(6.22±1.93)×109/L、中性粒细胞比例(NEUT％)(52.25±5.05)％、肿瘤坏死因子-α(TNF-α)(2.07±0.31)pg/ml均低于对照组的(19.55±3.61)μg/ml、(8.73±1.74)×109/L、(64.39±5.30)％、(2.97±0.36)pg/ml,差异均具有统计学意义(P<0.05).研究组不良反应发生率5.0％低于对照组的20.0％,差异具有统计学意义(P<0.05).结论 在鲍曼不动杆菌肺炎临床治疗中,更推荐以解毒理肺汤联合可必特雾化吸入方法进行辅助治疗,不仅能够缓解炎症水平,还可促进治疗效果的提高,使整体安全性得到保障.

目的 比较脓毒症组方联合替加环素和亚胺培南/西司他丁与替加环素联合亚胺培南/西司他丁对重症泛耐药鲍曼不动杆菌肺部感染的疗效. 方法 选取重症医学科重症泛耐药鲍曼不动杆菌肺部感染患者62例,随机分为对照组40例和治疗组22例.对照组给予替加环素联合亚胺培南/西司他丁治疗,治疗组给予脓毒症组方、替加环素、亚胺培南/西司他丁治疗.比较2组临床疗效、细菌学疗效及预后等.结果 治疗组总有效率和细菌假定清除率高于对照组,差异有统计学意义(P<0.05).治疗组治疗后体温低于对照组,ICU住院天数少于对照组,差异有统计学意义(P<0.05). 结论 脓毒症组方联合替加环素和亚胺培南/西司他丁用于治疗重症泛耐药鲍曼不动杆菌肺炎能取得满意的治疗效果.

Objective To observe and compare the clinical efficacy of tigecyclinc combined with imipenem/cilastation,imipenem/cilastation combined with cefoperazone sulbacta,prolonging intravenous infusion of imipenem/cilastatin combined with cefoperazone sulbactam on severe pan-resistance Acinetobacter baumannii.Methods 36 patients with severe pulmonary infection were randomly divided into trial group 1,2 and 3 with each group of 12 patients and ticyclinc combined with imipenem/cilastatin,imipenem/cilastatin combined with cefoperazone sulbactam,imipenem/cilastatin with prolonged intravenous infusion time combined with cephalosporins Paclitaxel were given each of these 3 groups respectively (P<0.05).The clinical efficacy,bacteriological efficacy and laboratory data,changes of scoring system were compared.Results The clinical effective rate of group 3 were 66.7%,higher than group 1 and group 2 with effective rate of 58.3% and 50.0% respectively.The total clearance rate of bacteria in group 3 was 58.3%,which was higher than that in experimental group 1 and group 2 with 41.7% and 16.7% respectively.The difference of effective rate between the two groups was significant (P<0.05).The levels of temperature, WBC, N%, PCT APACHEⅡ of the three groups were significantly decreased compared to those before treatment,and the difference is statistically significant(all P<0.05).Conclusion 3 hours of Imipenem/cilastatin infusion can improve the efficacy in treatment of severe pan-resistant patients with Acinetobacter baumannii infection,and it is suitable for applying to clinical treatment.

目的:总结重症医学科多重耐药菌(MDRO)肺部感染患者的中医证候要素、证型与病原学相关资料,分析两者联系.方法:临床分析2013年5月至2015年12月广州市番禺区中心医院及广州市番禺区中医院重症医学科就诊的MDRO肺部感染患者,采用描述性统计学方法,计算证候、症状的频数、构成比;总结分析其临床特征、病原学资料和中医辨证分型的异同.结果:纳入研究患者141例,分析145株多重耐药菌,在重症医学科肺部感染多重耐药菌分布中革兰氏阴性菌明显占优势,约占总耐药菌的77.93％,排前4位的依然是铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌及肺炎克雷白菌,共占革兰氏阴性菌的70.80％.革兰氏阳性菌只占22.07％,以金黄色葡萄球菌、表皮葡萄球菌为主.中医证型分析中实证占80.00％,而痰热壅肺证比例尤为突出,占38.62％;虚证占20.00％,其中以气阴两虚证为主,占15.17％.革兰氏阴性菌主要表现为痰热壅肺、气阴两虚、风热犯肺、肺胃热盛证,而革兰氏阳性菌以肺胃热盛、痰热壅肺为主要证型;铜绿假单胞菌感染多见痰热壅肺证(51.72％);大肠埃希菌感染以痰热壅肺证为主(35.29％);鲍曼不动杆菌感染主要以气阴两虚证为主(33.33％);肺炎克雷白菌感染则以痰热壅肺证(37.50％)及肺胃热盛证(31.25％)为主;耐药金葡菌感染以痰热壅肺证(28.57％)及肺胃热盛证(28.57％)为主.结论:多重耐药菌肺部感染的中医证型仍以实证为主,痰热壅肺证是多重耐药菌的主要中医证候,虚证以气阴两虚为主,亦不可忽视.ICU肺部感染多重耐药菌与中医辨证之间存在一定程度的交叉相关性,在治疗中要重视清热化痰及益气养阴药物和方法的运用.

目的:观察“肺感2方”治疗多重耐药菌(multi-drug resistant organisms,MDRO)肺部感染的临床疗效.方法:67例MDRO肺部感染患者随机分为观察组34例和对照组33例.对照组根据多重耐药细菌药敏结果选择抗生素治疗及对症支持治疗,观察组在对照组基础上给予“肺感2方”,并观察疗效及不良反应,2周为1个疗程.结果:治疗后2周观察组及对照组在急性生理与慢性健康评分(acute physiology and chronic health evaluation,APACHEⅡ评分)、降钙素原(procalcitonin,PCT)、C反应蛋白(C reactive protein,CRP)及氧和指数均有改善,观察组APACHEⅡ评分、PCT及氧合指数分别为(11.82+7.19)分、(0.49±0.34) μg·L-1、(331.23±35.25),对照组APACHEⅡ评分、PCT及氧合指数分别为(15.31±6.76)分、(0.86±0.62) μg·L-1、(312.53±20.25),两组比较,差异均有统计学意义(P＜0.05).两组治疗后CRP均较治疗前明显改善(P＜0.05),但两组治疗后比较,差异无统计学意义(P＞0.05).观察组患者细菌清除率为77.78％,对照组为52.94％,两组比较,差异有统计学意义(P＜0.05).对照组有效率为69.70％,观察组为91.18％,两组比较,差异有统计学意义(P＜0.05).两组不良反应发生率比较,差异无统计学意义(P＞0.05).结论:“肺感2方”治疗多重耐药菌肺部感染临床疗效显著.

目的:评价乌司他丁对重症脓毒症患者的临床疗效及对炎性因子的影响.方法:选取2013年3月-2014年3月间诊治的重症脓毒症患者76例,将其分为对照组与观察组,各组38例;对照组患者接受常规治疗,观察组患者接受乌司他丁治疗;比较两组患者治疗前后的临床疗效以及炎症介质肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和白介素-1β(IL-1β)水平值.结果:对照组患者治疗后的总有效率为84.21％略低于观察组为89.47％(P＞0.05);治疗前后,两组患者TNF-α、IL-6、IL-1β,经比较其差异有统计学意义(P＜0.05);治疗后,上述各观察指标组间经比较其差异有统计学意义(P＜0.05).结论:乌司他丁用于重症脓毒症患者的临床疗效较显著,优于常规治疗.

Objective To study the efficacy of continuous renal replacement therapy(CRRT) in patients with refractory heart failure.Methods 32 patients with refractory heart failure were treated with drugs,but had no effect.Thus,treatment was combined with CRRT.Analyze the changes of clinical symptoms and indices including HR,RR,PaO2,SvO2 and LVEF.Results With CRRT in 12 h and 24 h,both clinical symptoms and the indices were significantly improved(P0.05) and there was no severe complication.Conclusion CRRT is a safe and effective way for patients with refractory heart failure.

Objective To evaluate the curative effect and security of amiodarone combined with lidocaine in the treatment of ventricular electrical storm.Methods Sixteen patients with ventricular electrical storm were subjected to the treatment of amiodarone from June 2009 to June 2012,but the treatment were found to be inefficacious.The16 patients were then treated with lidocaine on basis of amiodarone.the clinical effect and security of the treatment were analyzed.Results Among the 16 patients,9(56.3%) were converted into sinus rhythm and there was no ventricular tachycardia or ventricular fibrillation occurred anymore.Three patients(18.8%) had paroxysmal ventricular tachycardia and had no influence on hemodynamic.Two patients(12.5%) had ventricular fibrillation,but they were converted into sinus rhythm by electric cardioversion.Two patients(12.5%) died because of ventricular fibrillation frequently.The total effective rate reached 87.5%.Among the 16 patients,one(6.3%) occurred sinus bradycardia,and another one(6.3%) occurred hypotension.Conclusion When amiodarone is found to be not efficacious for the patients with ventricular electrical storm,treatment of amiodarone combined with lidocaine can be safe and effective.

Objective:To discover the regulation of blood glucose changes by observing the hyperglycemia in patients at the early stage of non-ST-elevation myocardial infarction (NSTEMI). Methods: 86 NSTEMI patients without previous history of DM admitted in Panyu Central Hospital between March 2010 and June 2011 were analyzed. Blood glucose was measured at baseline and the fasting glucose was examined on the 2nd to 7th day after admission. On the 7th day, OGTT was conducted. Results: Among the 86 patients, 28 patients were newly diagnosed DM, 39 were impaired glucose regulation, and 19 were normal glucose metabolism. The average blood glucose was down to normal level on the 2nd day for the normal glucose metabolism group. The accordance between fasting hyperglycemia and positive OGTT was as Kappa = 0. 260,P= 0. 014.With the adjusted variations,the fasting glucose ≥ 7. 0mmol/L on the 2nd day of admission were the predictors for DM,and OR= 3. 55,95% CI 2. 114 ~ 11. 126,P= 0. 012. Conclusion: Most NSTEMI patients, as high as 77.9%, without previous history of DM may combine with impaired glucose regulation or DM. Therefore, for guiding of clinic treatment, OGTT should be performed to clarify it should be impaired glucose regulation, DM or not.In conclusion, persistent fasting hyperglycemia could be regarded as a predictive risk factor in patients with&nbsp;impaired glucose regulation or DM.

目的:评价颜氏"益心方"治疗糖尿病合并冠心病心绞痛的临床疗效。方法:将60例糖尿病合并冠心病心绞痛患者随机分为治疗组和对照组,治疗组在西药治疗基础上,予颜氏"益心方"胶囊口服;对照组予纯西药治疗,疗程均12周。观察治疗前后两组的心绞痛症状、心电图的改善情况、硝酸甘油停减率、中医证候疗效以及血脂、血糖、CRP变化。结果:在心绞痛症状、心电图的改善方面,治疗组明显优于对照组(P<0.05)。两组药物均能降低血脂、血糖及CRP,治疗组在降低TG、LDL-C,降低CRP方面作用更明显(P<0.05)。结论:益心方对治疗糖尿病合并冠心病心绞痛疗效确切,在调节脂质代谢紊乱,抑制血管炎性因子等方面起了重要作用。

Objectives To investigate the effect of community combination intervention treatment on hypertension.Methods Parallel randomized comparison clinical trial was used.500 patients with hypertension who also had one or more of the following intervene risk factors were included in this study:(1) dyslipidemia(total cholesterol≥5.7 mmol/L);(2) diabetes [fasting plasma glucose≥7.0 mmol/L and(or) 2-hour postprandial blood glucose≥11.1 mmol/L];(3) obesity(body mass index≥28 kg/m2).The patients were divided into combination intervention treatment group(n=220) and optional treatment group(n=280).Blood pressure,targeted organ damage and incidence of complications between the two groups were measured and compared.Results Blood pressure control of combination intervention treatment group significantly surpassed optional treatment group [systolic blood pressure(140.09±15.18)mm Hg vs.(145.90±16.81)mm Hg,diastolic blood pressure(79.12±13.38)mm Hg vs.(81.90±13.63)mm Hg,P<0.05].Patients in combination intervention treatment group were with significantly lighter targeted organ damage,including left ventricular ejection fraction,carotid intimal-medial thickness,serum creatinine,urinary albumin when compared with optional treatment group(P<0.05).Incidences of cardiovascular and cerebrovascular events,including acute myocardial infarction,unstable angina,cerebral hemorrhage,cerebral infarction,transient ischemic attack in combination intervention treatment group were significantly lower than those in optional treatment group(P<0.05).Conclusions It is important for community combination intervention treatment to control hypertension,which can prevent complications of hypertension,targeted organ damage,cardiovascular and cerebrovascular events.

目的 评价无创正压通气救治急性左心衰竭肺水肿的临床疗效.方法 38例急性左心衰竭患者随机分为治疗组与对照组.治疗组19例,在常规抗心衰治疗基础上联合应用无创正压通气治疗.对照组19例,为常规抗心衰治疗.观察治疗前、治疗后6小时的动脉血氧分压(PaO2)、氧饱和度(SaO2)、二氧化碳分压(PaCO2)、心率(HR)、呼吸频率(RR)、血压(BP)、心功能改善情况.结果 两组患者治疗前各指项比较.差异无统计学意义.治疗组治疗后6小时的PaO2、SaO2,、PaCO2、HR、RR、BP均较对照组明显改善(P<0.05);6小时心功能改善,有效率治疗组较对照组明显增高(P<0.05).结论 在充分使用药物治疗心源性肺水肿的基础上,合用无创正压通气治疗,可使肺水肿和心功能迅速改善.并对心衰继发的息性肺损伤有明确的疗效.

目的观察综合干预治疗对高血压患者疗效的影响。方法采用随机平行对照临床试验,选200例高血压患者且具有至少下列1项可干预的危险因素:①血脂异常:总胆固醇(TC)≥5.7mmol/L;②糖尿病:空腹血糖(FPG)≥7.0mmol/L或(和)餐后2h血糖(2hPG)≥11.1mmol/L;③肥胖:体质指数(BMI)≥28kg/m2。随机分成严格治疗组及随意治疗组。监测血压、血脂、血糖变化及并发症发生率。结果严格干预治疗组的血压、血糖及血脂水平的控制效果均优于随意治疗组(P<0.05);严格干预治疗组脑出血、脑梗死、急性心肌梗死、脑卒中发病率及死亡率明显低于随意治疗组(P<0.05)。结论综合干预对控制高血压、血糖及血脂有重要作用,综合干预治疗高血压是预防脑出血、脑梗死、急性心肌梗死、脑卒中等心脑血管事件的有效手段。

目的探讨无创正压通气治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的临床价值。方法本组44例患者均给予常规基础治疗,同时采用双水平无创正压通气治疗,治疗期间严密检测患者生命体征及动脉血气分析变化。结果无创正压通气治疗1h后血气分析中pH、动脉血二氧化碳分压(PaCO2)、动脉氧分压(PaO2)开始改善,6h后改善更为明显,72h后血气分析指标恢复正常,上机后各时间段与治疗前比较pH、PaO2和PaCO2变化差异均有统计学意义(P<0.05)。结论无创机械通气治疗COPD合并Ⅱ型呼吸衰竭疗效确切,掌握好适应证,选择合适的通气模式和参数,是治疗成功的关键。

目的:探讨多巴胺联合食管心房调搏负荷试验(TEAP)在诊断冠心病的准确性。方法:选取30例有胸痛或胸闷症状临床怀疑心绞痛但常规心电图无明显心肌缺血表现者,先行TEAP,30min后静脉使用多巴胺10μg/(kg.min),当血压达到稳定后,再次行TEAP。记录先后两次负荷试验结果,以冠状动脉造影结果作为诊断冠心病标准(冠脉狭窄≥50%为阳性,诊断冠心病;<50%为阴性,诊断非冠心病)。比较两种负荷试验方法的敏感性及特异性。结果:TEAP敏感性为57.1%,特异性为77.8%;多巴胺联合TEAP敏感性为81.0%,特异性为88.9%。联合负荷试验敏感性高于TEAP(P<0.05),两组特异性无统计学差异(P>0.05)。结论:与常规的TEAP比较,多巴胺联合TEAP能提高诊断冠心病的敏感性,不降低特异性,可作为诊断冠心病的有效方法。

目的探讨大负荷量氯吡格雷在急性心肌梗死(acute myocardial infarction,AMI)患者行直接经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗时的应用效果。方法把60例AMI患者随机分为常规负荷量(300mg)组和大负荷量(600mg)组,每组30例,入院后立即服用氯吡格雷,分别于服药前、服药后2h、4h取血以比浊法测定血小板最大聚集率;观察患者4周内有无严重出血、粒细胞减少、血小板减少等严重不良反应;观察血管开通时冠状动脉心肌梗死溶栓(thrombolysis in myocardial infarction,TIMI)血流分级及4周内心脏缺血事件。结果与服药前比较,服药后4h2组血小板最大聚集率都明显降低,但在服药后2h仅有大负荷量组明显降低;随访4周,大负荷量组发生慢血流或无血流2例,无死亡及支架内血栓形成病例;常规负荷量组发生慢血流或无血流7例,亚急性支架内血栓形成1例,死亡1例。2组均无严重出血,粒细胞减少、血小板减少等严重不良反应。结论与常规负荷量相比,大负荷量氯吡格雷能改善AMI患者行直接PCI治疗后早期的血小板拮抗不足,且不增加严重副作用。

Objective To evaluate the efficiency and the safety of amiodarone for the treatment of atrial fibrillation with rapid ventricular response,atrial flutter with rapid ventricular response,or ventricular arrhythmia in patients with acute coronary syndrome(ACS).Methods112 patients with the diseases mentioned above treated in our hospital were selected as the study objects.The first bolus of 150 mg amiodarone was given intravenously,repeated with the same dose if no efficacy shown.Later intravenous drip was given by 1.0 mg/min in 6 h,and then by 0.5/min.The total dosage was 1050-1500 mg.Then oral amiodarone was given 600 mg/d the first week,400 mg/d the second,200 mg/d the third and the forth.Results100 cases were effective in 0.5~24 h.ConclusionIntravenous and oral amiodarone is secure and effective in the treatment of atrial fibrillation with rapid ventricular response,atrial flutter with rapid ventricular response,or ventricular arrhythmia in patients with acute coronary syndrome.

Objectives To analyze the complications between angioseal blood vessel closure and manual compression in patients undergoing coronary angiography or percutaneous coronary interventions.Methods Nine hundred forty seven patients were allocated to hemostatic treatment with Angioseal blood vessel closure(mechanical group,n=179) or by manual compression(manual group,n=768) after coronary angiography or percutaneous coronary interventions.Time to achievement of hemostasis,braking time and vascular complications were compared between the two groups.Results Both time to achievement of hemostasis and braking time were significantly reduced in the mechanical group(P 0.01),but the incidence of various vascular complications was similar between mechanical group and manual group(P 0.05).Conclusions Angioseal blood vessel closure can achieve hemostasis and ambulation faster than manual compression,but it can not decrease vascular complications at the access site,arteriotomy closure device used as routine may not be reasonable after coronary angiography or percutaneous coronary interventions.

Objective To evaluate the predictors of recurrence of persistent atrial fibrillation(AF) after electroversion in the near future. Methods Electroversion was performed in 62 consecutive patients with persistent AF. The relationship between the recurrence of AF after electroversion and variables including age, sex, AF history, left atrial diameter, P-wave terminal force of V1 (PtfV1), presence of mitral stenosis, left ventricular ejection fraction, left atrial ejection force, VE/VA, presence of hypertension were analyzed. Results AF was recurrent in 22 (35.5%) of the 62 patients with persistent AF after electroversion in two months. Univariate analysis showed that left atrial enlargement (P0.001), mitral stenosis (P=0.012) and PtfV1 abnormality were related to the recurrence of persistent AF. Logistic regression analysis revealed that left atrial enlargement was the only independent risk factor for recurrence of AF. Conclusion Left atrial enlargement is the only independent risk factor for recurrent persistent AF after electroversion; mitral stenosis and PtfV1 abnormality increase the recurrence rate of persistent AF after electroversion in short-term.

Objectives To observe the clinical effect of platelet GPⅡb/Ⅲa receptor antagonist,tirofiban in patients with no reflow during percutaneous coronary intervention(PCI)procedure. Methods Forty-seven cases of no reflow patients during PCI procedure were infused with nitroglycerin, verapamil and tirofiban by turns, and the target vessel TIMI flow was graded accordingly. Results Tirofiban improved target vessel TIMI flow significantly than nitroglycerin and verapamil. Their effective proportions were 33/40,5/47,2/42,respectively. The differences were statistically significant(X2 = 72.216,P = 0.000). Conclusions Tirofiban has definite effect in patients with no reflow during PCI procure, and further investigation is necessary.