Interpretation:Hb and respiratory infection showed a nonlinear U-shaped association; such a relation is modified by the chronotype sleep behavior. Objective:To examine the association between Hb and the incidence of hospitalized respiratory infection, and to explore potential modification effects of sleep behaviors. Methods:Included were 292,568 individuals without respiratory disease, cancer, or anemia diagnosis in the United Kingdom Biobank . Hb (g/dL) was measured at baseline. The interaction between Hb and sleep behaviors, including sleep duration, insomnia, chronotype, and daytime sleepiness with respiratory infection, was tested. Results:The cohort was followed up at a median 12.6 years, and 16,669 incident respiratory infections (9,334 in men, 7,335 in women) were identified. There was a nonlinear U-shaped association between Hb and respiratory infection in both men and women, where the risk increased markedly with Hb above 15.0 g/dL for men and 13.5 g/dL for women. In men, compared with the third quintile group, the hazard ratio (HR; 95% confidence interval [CI]) of respiratory infection in the Q1, Q2, Q4, and Q5 quintile groups was 1.28 (1.21-1.37), 1.07 (1.00-1.14), 1.06 (0.99-1.13), and 1.09 (1.02-1.17), respectively. In women, the HR (95% CI) was 1.20 (1.12-1.29), 1.09 (1.01-1.17), 1.01 (0.94-1.09), and 1.05 (0.98-1.13) in the Q1, Q2, Q4, and Q5 quintile groups of Hb, respectively, compared with the third quintile group. There was a significant interaction between Hb concentration and chronotype on the risk of respiratory infection (P for interaction = 0.005). The elevated risk of respiratory infection associated with Hb was more pronounced among participants with late chronotype. Conclusion:The study suggests that Hb and respiratory infection have a nonlinear U-shaped association and that such a relation is modified by chronotype.

目的 探讨血清可溶性髓样细胞触发受体-1(sTREM-1)动态水平与脓毒症患者预后的相关性,为临床提供参考.方法 回顾性分析80例脓毒症患者的临床资料.根据患者随访28 d的预后情况分组,死亡患者为预后不良组(19例),未死亡患者为预后良好组(61例).对比两组患者序贯器官衰竭(SOFA)评分、急性生理与慢性健康量表(APACHEⅡ)评分及血清sTREM-1动态水平.Pearson相关分析血清sTREM-1动态水平与SOFA评分、APACHEⅡ评分的相关性.采用受试者操作特征(ROC)曲线对SOFA评分、APACHEⅡ评分及血清sTREM-1动态水平判断不良预后的价值进行分析.结果 预后不良组患者入院1 d、3 d、5 d的SOFA评分、APACHEⅡ评分及血清sTREM-1动态水平显著高于预后良好组(P<0.05);Pearson相关分析结果显示血清sTREM-1动态水平与SOFA评分、APACHEⅡ评分具有正相关性(P<0.05);ROC分析显示SOFA评分、APACHEⅡ评分及血清sTREM-1动态水平对判断脓毒症患者不良预后的准确性均较高.结论 ICU脓毒症病情进展影响SOFA评分、APACHEⅡ评分及血清sTREM-1动态水平,血清sTREM-1动态水平与SOFA评分、APACHEⅡ评分具有正相关性,可监测以上指标对脓毒症患者的预后进行评估.

Neuroinflammation plays an important part in secondary traumatic brain injury (TBI). Bromodomain-4 (BRD4) exerts specific proinflammatory effects in various neuropathological conditions. However, the underlying mechanism of action of BRD4 after TBI is not known. We measured BRD4 expression after TBI and investigated its possible mechanism of action. We established a model of craniocerebral injury in rats. After different inter-vention measures, we used western blotting, immunofluorescence, real-time reverse transcription-quantitative polymerase chain reaction, neuronal apoptosis, and behavioral tests to evaluate the effect of BRD4 on brain injury. At 72 h after brain injury, BRD4 overexpression aggravated the neuroinflammatory response, neuronal apoptosis, neurological dysfunction, and blood-brain-barrier damage, whereas upregulating expression of HMGB-1 and NF-& kappa;B had the opposite effect. Glycyrrhizic acid could reverse the proinflammatory effect of BRD4 overexpression upon TBI. Our results suggest that: (i) BRD4 may have a proinflammatory role in secondary brain injury through the HMGB-1/NF-& kappa;B signaling pathway; (ii) inhibition of BRD4 expression may play a part in secondary brain injury. BRD4 could be targeted therapy strategy for brain injury.

Objective : Nicotinamide mononucleotide adenylyl transferase 2 (NMNAT2) is a crucial factor for the survival of neuron. The role of NMNAT2 in damage following traumatic brain injury (TBI) remains unknown. This study was designed to investigate the role of NMNAT2 in TBI-induced neuronal degeneration and neurological deficits in rats.Methods : The TBI model was established in Sprague-Dawley rats by a weight-dropping method. Real-time polymerase chain reaction, western blot, immunofluorescence, Fluoro-Jade C staining, and neurological score analyses were carried out.Results : NMNAT2 mRNA and protein levels were increased in the injured-side cortex at 6 hours and peaked 12 hours after TBI. Knocking down NMNAT2 with an injection of small interfering RNA in lateral ventricle significantly exacerbated neuronal degeneration and neurological deficits after TBI, which were accompanied by increased expression of BCL-2-associated X protein (Bax).Conclusion : NMNAT2 expression is increased and NMNAT2 exhibits neuroprotective activity in the early stages after TBI, and Bax signaling pathway may be involved in the process. Thus, NMNAT2 is likely to be an important target to prevent secondary damage following TBI.

The outer mitochondrial membrane protein mitochondrial Rho-GTPase 1 (Miro1) is known to be involved in the regulation of mitochondrial transport required for neuronal protection. Previous reports established that disruption of Miro1-dependent mitochondrial movement could result in nervous system diseases such as Parkinson’s disease and Alzheimer’s disease. This study was designed to explore the expression and mechanisms of Miro1 in secondary brain injury after traumatic brain injury (TBI). A total of 115 male Sprague Dawley rats were used in the weight-drop TBI rat model, and Miro1 in vivo knockdown was performed 24 h before TBI modeling by treatment with Miro1 short-interfering RNA. Real-time polymerase chain reaction, western blot, immunofluorescence, adenosine triphosphate (ATP) level assay, neuronal apoptosis, brain water content measurement, and neurological score analyses were carried out. Our results showed that the mRNA and protein levels of Miro1 were increased after TBI and co-localized with neurons and astrocytes in the peri-injury cortex. Moreover, Miro1 knockdown further exacerbated neuronal apoptosis, brain edema, and neurological deficits at 48 h after TBI, accompanied by impaired mitochondrial transport, reduction of mitochondria number and energy deficiency. Additionally, the apoptosis-related factors Bax upregulation and Bcl-2 downregulation as Miro1 knockdown after TBI implied that antiapoptotic effects on neuroprotection of Miro1, which were verified by the Fluoro-Jade C (FJC) staining and TUNEL staining. In conclusion, these findings suggest that Miro1 probably plays a neuroprotective role against secondary brain injury through the mitochondria trafficking pathway, suggesting that enhancing Miro1 might be a new strategy for the treatment of TBI.

目的:观察并分析不同治疗方法对ICU重症感染并发多器官功能障碍综合征患者的临床疗效.方法:以我院ICU收治的68例重症感染并发多器官功能障碍综合征患者作为研究对象,随机均分为两组,对照组进行常规治疗,观察组在对照组基础上加行肾脏替代疗法,对比两组患者的救治成功率.结果:观察组和对照组救治成功率分别为97.06％(33/34)和82.35％(28/34),观察组救治成功率显著高于对照组(P﹤0.05).结论:对于ICU内重症感染并发多器官功能障碍综合征的患者进行肾脏替代疗法效果显著,可有效提高患者的救治成功率,值得应用于临床.

穴位埋线是指将羊肠线、蛋白线用特殊的方法埋入相应的穴位内,利用异种蛋白对穴位内产生的刺激来达到治疗的方法,目前主要用于疼痛科、骨科及一些慢性病症等,应用的范围越来越广.应用穴位埋线疗法将蛋白线注入穴位内在体内缓慢吸收起到长期刺激作用,以达到疏通经络,调节阴阳及脏腑气血功能的作用,提高机体应急能力,促进病灶部位血管床增加,血流量增大,血管的通透性和血液循环改善,从而使患者的症状减轻或消失,达到良好的治疗效果.

对收治的1例急性二氯乙烷(DCE)重度中毒病例的治疗与转归进行临床分析.该患者于中毒性脑病病情明显好转后出现周围神经原性损伤,经近1年的康复治疗基本治愈.1,2-DCE中毒主要引起以混合性脑水肿为主的中毒性脑病,但在抢救治疗后期出现周围神经损害极为罕见,是否属于中毒性脑病后遗症,尚有待进一步观察.

目的:总结硫酸二甲酯吸入性中毒的临床特点、救治方法、转归.方法:回顾性分析4例硫酸二甲酯吸入中毒患者的临床表现、抢救措施及转归.结果:4例硫酸二甲酯吸入中毒均为重度中毒.4例患者在及时转入ICU后予有创机械通气、糖皮质激素、PEEP等综合治疗,4~5 d即氧合改善,肺部渗出明显吸收,在5~6 d均成功脱机.1例因气道损伤较轻,予第6天顺利拔除经口气管插管,其余3例均属重度气道吸入性损伤,在持续ICU治疗19、28、20 d均成功拔除人工气道,其中1例在住院19 d出现因气道异物导致窒息经抢救后好转.所有患者眼部损伤经及时冲洗和含抗生素、激素眼药水治疗后约5~7 d后好转,未有视力下降和角膜损伤等严重并发症.2例患者出现轻度肝功能损害,经治疗1周后复查正常.4例患者均顺利康复出院.结论:硫酸二甲酯具有高毒性,吸入性中毒主要损伤眼、呼吸系统,而且进展迅速,重度中毒,均出现中毒性肺水肿甚至急性呼吸窘迫综合征(ARDS),以及严重的气道损伤,主要抢救治疗要点为尽早机械通气,早期、足量短程使用糖皮质激素纠正低氧血症和中毒性肺水肿,并定期以气管镜检查评估气道损伤程度,并指导气道管理,防止严重气道相关性并发症,预后均良好.

Objective To investigate the clinical features of severe trauma in the elderly and analyze the risk factors for death. Methods Clinical data of 130 elderly traumatic patients and 120 young and middle-aged traumatic patients admitted in Intensive Care Unit (ICU) of our hospital from January 2010 to October 2014 were collected and retrospectively analyzed. The cause, traumatic condition, treatment and prognosis were analyzed and compared between the 2 groups. Results In the elderly trauma group, the scores of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) was 19.71±12.48, 39.2% of them had comobidities, their mean length of ICU stay was (6.17±5.97)d, the rate of mechanical ventilation was 56.2%, the incidence of multiple organ dysfunction syndrome (MODS) and pneumonia were 36.9% and 22.3%, respectively, and the mortality was 34.6%. All these values were significantly higher than those in the young and middle-aged group (P<0.05). Conclusion The mortality is higher in elderly than in young and middle-aged traumatic patients. The APACHE Ⅱ score, more comobidities and occurrence of MODS are the independent risk factors for death.

Objective:To analyze the effects of different nutrition modes on the glycemic control and gastrointestinal dysfunction in sepsis patients without gastrointestinal dysfunction. Methods:One hundred and thirty-eight sepsis patients were randomly divided into the enteral nutrition group and meal served nutrition group(69 cases each group). The enteral nutrition group and meal served nutrition group were treated with enteral nutrition liquid infusion and nutrition liquid meal served, respectively. The blood glucose control and incidence of gastrointestinal dysfunction between two groups were compared. Results:The incidence rates of hyperglycemia in enteral nutrient solution group and meal served nutrition group after 15 d of nutrition support were 4. 3% and 13. 0%, respectively, the difference of which was not statistically significant(P >0. 05). The difference of fasting blood glucose between two groups before nutritional support was not statistically significant(P>0. 05). Compared with before the nutritional support,the blood glucose levels in two groups after 1 to 15 d of nutritional support increased significantly(P<0. 01),the fasting blood glucose level in the enteral nutrient solution group after 1 to 15 d of nutritional support were lower than that in the meal served nutrition group(P<0. 01). The incidences of gastrointestinal dysfunction in the enteral nutrient solution group and meal served nutrition group after 15 d of nutrition support were 5. 8% and 15. 9%,respectively,the difference of which was not statistically significant(P>0. 05). Compared before nutrition support, the GIDF and SOFA scores in two groups after 15 d of nutrition support increased significantly(P<0. 01). The GIDF and SOFA scores in the enteral nutrient solution group after 15 d of nutrition support were significantly lower than those in the meal served nutrition group (P<0. 01). Pearson correlation analysis indicated that the GIDF score was positive correlation with SOFA score(P <0. 01). Conclusions:The incidences of the hyperglycaemia and gastrointestinal dysfunction between two groups are similar. The continuing enteral nutrient solution has better effects on the energy supply and improving the prognosis of patients,which is the preferred way in nutritional support for patients with sepsis.

Objective To explore and analyze the clinical efficacy of bronchoalveolar lavage combined with invasive noninvasive mechanical ventilation sequential therapy in the treatment of chronic obstructive pulmonary disease ( COPD) patients with respiratory failure. Method 100 cases of COPD complicated with respiratory failure patients from January 2011 to Decwmber 2013 in our hospital were selected according to the random number table, which were divided into observation group and control group, each group with 50 cases. The patients in control group were treated with invasive mechanical ventilation, while the observation group patients with the bronchoalveolar lavage therapy combined with sequential invasive-noninvasive mechanical ventilation therapy. Curative effect was observed and compared between the two groups after treatment. Result The infection correcting time, the total duration of me-chanical ventilation, duration of hospitalization of patients with respiratory failure were significantly shorter than those of the control group;each index with blood gas analysis in the two groups after switching windows significantly changed,pH, and PaO2 of the observation group patients after switching time window were significantly higher than those of the control group, and the PaCO2 was significantly lower than that of the control group, and the two groups had significant difference(P<0. 05); the overall complication rate of the patients in observation group after treat-ment was 10%, significantly lower than that of the control group (40%),with statistical significance(P<0. 05). Conclusion Bronchoalveolar lavage combined with sequential mechanical ventilation has significant curative effect in the treatment of COPD with respiratory failure, not only can effectively improve the symptoms of the COPD patients, control the infection, shorten the time of hospitalization, but also reduce the incidence of ventilator-associated pneu-monia and other complications rate; therefore it is an effective means of treatment, which is worthy of putting into clinical application.

目的 分析ICU院内肺部感染的病原菌的种类、分布及对常用抗生素的耐药情况.方法 回顾性分析ICU病区387例院内肺部感染患者的病原学资料.结果 共检出病原菌1073株:革兰阴性菌878株(81.8％),革兰阳性菌118株(11.0％),真菌77株(7.2％).革兰阳性菌以金黄色葡萄球菌比例最高(71株,6.6％),对万古霉素和利奈唑胺敏感率分别为98.6％和97.2％,耐甲氧西林金黄色葡萄球菌(MRSA) 48株(4.5％);革兰阴性菌前3位分别是鲍曼不动杆菌(361株,33.6％)、铜绿假单胞菌(184株,17.1％)和肺炎克雷伯菌(120株,11.2％),药敏试验呈多重耐药,泛耐药及全耐药鲍曼不动杆菌呈逐年递增趋势;真菌以白色念珠菌为主(57株,5.3％).结论 受检医院ICU病区院内肺部感染病原菌以革兰阴性菌为主,细菌耐药性明显增强.

OBJECTIVE To analyze the results of the targeted monitoring of nosocomial infections in the ICU before and after the cleaning so as to reduce the incidence of nosocomial infections in the ICU and prevent the nosocomial infections.METHODS The patients who were enrolled the ICU from May 2011 to Oct 2011 group were selected as the control group,and the patients who were treated from Nov 2011 to Apr 2012 were set as the observation group.During the treatment period,the ICU was cleaned with the routine method in the control group,while the ICU of the observation group was cleaned with the intensified cleaning mode.The environmental health in the ICU and the incidence of nosocomial infections were monitored during the treatment period.RESULTS After taking the intensified cleaning mode,the environment of ICU was significantly better in the observation group than in the control group.During the treatment period,there were 41(9.6%) cases with infections in the control group and 28(7.7%) cases with infections in the observation group,the difference was statistically significant.CONCLUSION ICU is the risk department for nosocomial infections and is also the key target for hospital infection prevention and control.The intensified cleaning mode can improve the environmental health of the ICU and significantly reduce the incidence of nosocomial infections.

硫丹是高剧毒类有机氯杀虫剂,能引起多器官功能损害,及严重中枢神经损害,救治不及时可出现严重后遗症甚至死亡.通过对2例重度硫丹中毒案例的分析,指出硫丹中毒需要早期救治,关键在早期积极控制抽搐,保持气道通畅,防止因严重抽搐后导致呼吸衰竭,尽早彻底清除毒物,保护脏器功能.

目的:探讨重症中暑(热射病)患者综合救治方法.方法:总结我院重症医学科2007年8月~2012年9月收治的32例重症中暑(热射病)患者的救治经验,结合相关文献,对重症中暑患者合并多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS) 以及早期快速降温,早期积极液体复苏,早期抗凝干预和脑保护等关键救治措施进行分析.结果:32例重症中暑(热射病)患者,合并MODS 32例,治愈28例,其中留有后遗症3例,自动出院4例(均死亡).结论:重症中暑患者合并MODS的发生率极高,早期干预和规范救治,采用ICU综合救治手段"早期快速有效降温至核心体温38.8℃以下,早期积极液体复苏,加强凝血监测和早期抗凝干预和脑保护等"关键治疗措施,可极大提高重症中暑(热射病)患者生存率和改善预后.

>严重感染性休克(severe septic shock)和多器官功能障碍综合征(multiple organ dysfunctionsyndrome,MODS)是过度全身炎症反应(systemicinflammatory reaction syndrome,SIRS)后的严重状态,随着病情的恶化,甚至发展为多器官脏器功能衰竭(multiple organ failure,MOF),其病死率高,临床治疗困难。本研究报道一例严重感染性休克合并MODS的救治。

目的比较患者耐受喉罩和耐受气管导管的最低七氟醚浓度。方法40例择期行四肢短小手术的患者,ASAⅠ~Ⅱ级,随机分为喉罩(LMA)组(n=20)和气管导管(ETT)组(n=20)。静脉丙泊酚麻醉诱导后插入喉罩或气管导管,两组患者均采用吸入七氟醚和氧化亚氮维持麻醉,术中保留自主呼吸。手术结束时停吸氧化亚氮,使氧化亚氮的浓度在5min内降至<3%。随后逐渐降低挥发罐的七氟醚浓度,并密切观察患者对喉罩和气管导管的反应。记录患者出现吞咽、咳嗽、呃逆、头动或四肢运动时的七氟醚吸入浓度和呼气末浓度。结果对喉罩和气管导管出现反应的平均呼气末七氟醚浓度分别是0.42%和0.78%(P<0.05)。结论与耐受气管导管相比,耐受喉罩的七氟醚浓度明显较低。

甲状腺手术的麻醉临床上一直有争论.我们总结了我院2004年10月-2005年5月采用气管内全麻复合颈丛阻滞麻醉行甲状腺手术30例,并与单纯颈丛阻滞麻醉的甲状腺手术30例作对照,比较二种不同麻醉方法下围术期循环的变化.总结如下.

我院传统小儿静脉麻醉常用氯胺酮复合安定和/或羟基丁酸钠,常出现麻醉深度不稳定,术后苏醒期明显延长,其并发症和不良反应较多.自2003年起,我们陆续试用咪唑安定、氯胺酮诱导,丙泊酚复合氯胺酮持续输注用于小儿静脉麻醉,取得了较好的效果.现总结报道如下.