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.

目的 评价乌司他丁联合血必净治疗脓毒症的临床疗效.方法 检索中国万方数据库、中国生物医学文献数据库(CBM)、中国期刊文献数据库(CNKI)、维普(VIP)、Cochrane图书馆临床对照试验库、PubMed数据库,查找建库至2013年9月乌司他丁联合血必净治疗脓毒症的随机对照临床试验(RCT),提取资料,采用Cochrane提供的RevMan5.0进行分析评价.结果 纳入15个RCT共l 469例脓毒症患者,meta分析显示,血必净联合乌司他丁治疗脓毒症与单一使用乌司他丁(血必净、常规治疗)相比能降低机械通气时间、减少住院时间、降低治疗后的APACHEII评分;联合用药与单一用血必净相比,可以降低病死率(SMD=0.47,95％ CI 0.25～-0.85,P=0.01);联合用药与单一用乌司他丁(SMD=-1.70,95％CI-2.63～-0.77,P=0.0003)、常规治疗(SMD=-1.84,95％ CI-2.60 ～-1.08,P＜0.001)相比,可以降低IL-6的水平;联合用药与常规治疗(SMD=-4.32,95％ CI-7.73 ～-0.91,P=0.01)相比,可以降低PCT的水平.结论 采用乌司他丁联合血必净治疗脓毒症患者在机械通气时间、住院时间、APACHEII评分等方面有一定的优势.

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]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 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.

[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.

患者男,60岁.因间歇胸闷6个月入院.有高血压病史5年,最高血压160/90mmHg,口服降压药控制在130/80mmHg左右,无糖尿病史和烟酒嗜好.

Objective:To evaluate the epidemiology and drug resistance of pathogenic microorganism which caused nosocomial in- fection in patients in ICU,and helped doctors to decide rational diagnosis and retreatment.Methods Retrospective analysis of the pathogens including bacteria,fungus isolated from the samples from the ICU of Tongji hospital between January 2002 to September 2003,and at the same time their drug susceptibility tests were done.Results The pathogens of nosocomial infection were mainly Gram-negative bacilli (60.3%),followed with fungus(25.4%)and Gram-positive bacilli(14.3%).Pseudomonas aerouginasa predominated in Gram-negative bacilli with 42.5% ,candida albicans predominated in fungus with 68.2%.In S.aureus the proportion of MRSA was 87.4%,and the propor- tion of MASE in S.epidermidis was 62.6%.Drug susceptibilily tests suggested that most Gram-negative bacilli were poorly sensitive to supus- en,ceftazidime andimipenem but MRSA was highly sensitive to Vancomycin.Conclusions Gram-negative bacilli predominated in the patho- gens of the nosocomial infection in ICU,but we must pay more attention that fungal infections are becoming more common.Changes in patho- gens and the rate of drug resistance make it difficult to choose antibiotics to retreat nosocomial infetoin by experience.Dynamic understanding the distribution of isolation and drug susceptibility test results of different pathogenic bacteria has significant importance in helping doctors to decide rational therapy.

目的:探讨大黄防治多器官功能不全综合征(MODS)的临床疗效.方法:对收治ICU的615例危重病人,治疗组260例,在常规治疗的基础上给予大黄鼻饲(20g/d),分3～4次;对照组355例,只给予常规(不用大黄)治疗.两组病人的病情及其他治疗方法无差异.统计观察两组病人MODS的发生率及病死率.结果:615例危重病人发生MODS 98例.MODS的发生率治疗组11.15%,对照组19.44%.发生MODS的患者死亡64例.MODS病死率治疗组为48.28%,对照组为72.46%.两组病人MODS的发生率和病死比较具有统计学意义.结论:大黄治疗危重病患者可降低MODS的发生率,提高MODS的抢救成功率.

急性有机磷农药中毒(AOPP)是内科常见急重症之一,其临床过程与患者接触农药种类、中毒方式、服毒量、服药至就诊时间、毒物吸收的速度、个体差异、救治过程中阿托品、复能剂及血液灌流的应用情况都有密切关系.及时、合理的救治是提高治愈率,抢救患者生命的关键.现将我院2001年5月-2004年5月急诊科对67例口服有机磷农药中毒患者用血液灌流抢救,与对照组2000年1月-2003年1月对45例使用阿托品,复能剂等常规治疗者相比,疗效显著.报告如下.

危重哮喘是临床哮喘急性发作期依据病情严重程度评价分度中最严重的一型,通常在内科去除过敏原及发病诱因,同时使用解痉、抗感染药等常规治疗效果不好,患者缺氧严重,甚至可危及病人生命.