Objective To expand the influence and promotion effect of the grassroots health demonstration base of appropriate technology at county level,explore the practice model for full coverage.Methods Four consortium and eight units in the county were engaged into the whole process,the whole cycle,synchronous implementation;the promotion practices were divided into different stages with different focuses based on priority setting;Stratified training,classified promotion strategies were involved to carry out the appropriate technology for all 11 items covered.Results The technical promotion training,technical promotion applications were completed with full coverage in the county,gained high satisfaction from both medical staff and public.Enhanced the technology radiation ability,also the base's annual development was increasing year by year.Conclusions The base construction full coverage promotion experiences can be shared and learned by other areas which aims for the promotion of fit health techniques.

目的 评价大黄、芒硝用于治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)无创机械通气之后出现腹胀的临床疗效.方法 将64例COPD合并Ⅱ型呼吸衰竭患者随机分为治疗组和对照组,对照组使用无创机械通气、抗感染、胃肠减压等综合治疗;治疗组在对照组基础上加用大黄、芒硝腹部外敷.观察2组患者5天后腹内压、动脉血二氧化碳分压(PCO2)等.结果 治疗后,2组患者的腹内压及PCO2均低于治疗前,且治疗组显著低于对照组(P＜0.05);治疗组患者平均带呼吸机时间显著低于对照组(P＜0.05).结论 大黄、芒硝外敷腹部对治疗COPD无创机械通气患者腹部胀气具有良好的疗效,并可间接改善患者的呼吸功能.

目的 分析重症监护病房(ICU)住院患者肺炎克雷伯菌近6年的分布及耐药变迁.方法 收集浙江海盐县人民医院ICU 2009-2015年期间肺炎克雷伯菌感染患者的病例资料,分析其临床特点、微生物学特征及药敏和耐药情况.结果 7年共分离1127株肺炎克雷伯菌,检出率16.1％,居各种致病菌首位;检出部位以痰液、中段尿及血液标本为主,分别占50.7％、20.40％、14.2％.肺炎克雷伯菌虽对多种抗生素的耐药性有上升趋势,但总体仍保持较好的敏感性.另外,超广谱β-内酰胺酶(ESBLs)产生率变化不大,2009-2015年分别为27.3％、26.2％、26.7％、27.2％、25.4％、26.3％、26.6％.结论 肺炎克雷伯菌是呼吸道感染的常见致病菌,且近年来有感染增多趋势,及早预防及合理用药,能够有效地降低感染的发生率.

Objective To systematically review the efficacy of statins for contrast induced nephropathy(CIN)prevention in cardiac intervention surgery patients. Methods We electronically searched databases including PubMed,Web of Knowledge, The Cochrane Library(Issue 5, 2015), VIP, WanFang Data and CNKI to collect randomized controlled trials(RCTs) about statins for CIN prevention in cardiac intervention surgery patients from inception to May2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies.Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 25 RCTs involving 37 353 patients were included, among them, 3 794 were CIN patients. The results of meta-analysis indicated that: compared with the placebo/blank group, the incidence rate of CIN was decreased in the statins group with a significant difference(OR=0.68,95%CI 0.63 to 0.73, P0.000 01). Conclusion Current evidence shows statins can reduce incidence of CIN in cardiac intervention surgery patients. Due to limited quality and quantity of the included studies, the above conclusions need more high quality studies to verify.

目的 分析不同病因所致的急性呼吸窘迫综合征(ARDS)的救助措施,为临床的预后判断提供依据.方法 根据病因的不同将72例ARDS患者分为A组(肺内源性ARDS组)36例和B组(肺外源性ARDS组)36例,所有患者均给予适当的营养支持、吸痰、常规药物及机械通气等.观察并详细记录两组患者重症医学科住院时间、机械通气救治时间和死亡情况.结果 A组的重症医学科住院时间和机械通气救治时间长于B组(均P＜0.05);A组患者1周内病死率(38.9％)也显著高于B组(16.7％,P＜0.05),但总病死率与B组相当,差异无统计学意义(P＞0.05).结论 肺内源性所致的ARDS患者病情相对较重,需要及时抢救,针对病因实施有效的抢救以降低病死率.

目的：探究多巴胺联合去甲肾上腺素对感染性休克患者血压、心率（HR）及内环境的影响。方法选取该院2012年1月至2014年1月收治的120例感染性休克患者，根据治疗方法不同分为对照组和观察组各60例。对照组仅行多巴胺治疗，观察组采用多巴胺与去甲肾上腺素联合治疗，对比患者平均动脉压（MAP）、HR、乳酸、中心静脉血氧饱和度（ScVO2）、每小时平均尿量、滤过钠排泄分数（FENa）、滤过水排泄分数（FEH2O）及内生肌酐清除率（Ccr）指标的情况。结果观察组患者治疗后MAP、ScVO2、Ccr、每小时平均尿量、FEH2O 的值显著高于对照组，HR、乳酸、FENa显著低于对照组，差异有统计学意义。两组不良反应发生率比较差异无统计学意义。结论多巴胺与去甲肾上腺素联用治疗感染性休克，能够促进各脏器内部的血液流动，升高血压，减缓患者HR 变动，同时增加肾血流量和肾小球的滤过率，使得ScVO2、Ccr、每小时平均尿量、FEH2O 升高，乳酸、FENa降低，恢复内环境的稳定。

<正>重症感染合并脓毒性血症诱发多器官功能障碍(muhipeorgan dysfunction syndromes,MODS)已成为ICU患者主要死亡原因之一。重症感染时全身炎症性反应之一是血小板减少。笔者检测35例重症感染并发血小板减少患者血小板水平,报道如下。

中暑主要发生在热环境下生活和工作中的人群中.在特殊职业(高温、高湿环境工种)的人群中尤为多见.除起决定作用的环境因素外,人群的健康水平、年龄及对高温、高湿环境的耐受程度以及预防措施不当对中暑的发病也起着至关重要的作用.重症中暑的病死率很高.

OBJECTIVETo discuss the measures of gastric lavage for severe acute organophosphorus pesticides poison (AOPP) patients complicated with respiratory failure and treated with mechanical ventilation.METHODS92 cases of respiratory failure due to severe AOPP treated with mechanical ventilation were treated for gastric lavage with nasal gastric tube or gastrotomy. Patients of each gastric lavage method were divided into fasting toxicosis group (fasting group) and post-meal toxicosis group (post-meal group).RESULTSWhen treated for lavage with nasal gastric tube, the duration of coma, the time for reaching atropinization and the dosage of atropine needed, the total dosage of atropine used, the mechanical ventilation time, the time for restoring 50% of the normal value of choline esterase, the hospitalization time and charges, the relapse rate, the rate of atropine toxicosis and mortality were respectively: 13 (3 - 24) h, 180 (60 - 290) min, 150 (80 - 310) mg, 300 (90 - 870) mg, 17 (4 - 52) h, (5.0 +/- 2.3) d, 9 (7 - 18) d, (8080 +/- 2570) yuans, 0, 0, and 4.76% in the fasting groups; all the figures were superior to those of the post-meal group with the same treatment: 26 (4 - 55) h, 380 (110 - 690) min, 360 (90 - 730) mg, 3610 (1100 - 9070) mg, 36 (6 - 110) h, (7.8 +/- 3.6) d, 12 (9 - 35) d, (10 720 +/- 3350) yuans, 45%, 30%, and 30.00% (P < 0.01 or P < 0.05). There was no obvious difference between the fasting group and the post-meal group in curative effect, complication occurrence rate and mortality except for the charges when treated with gastrotomy. For the post-meal toxicosis patients gastrotomy showed a better effect than the nasal gastric tube and there was no difference in charges.CONCLUSIONSIt is suggested that severe AOPP patients complicated with respiratory failure and treated with mechanical ventilation should hare lavage with nasal gastric tube, if they were poisoned in fasting state, but they should be washed through gastrotomy if poisoned after meal.

OBJECTIVE:To evaluate clinical application of improved percutaneous tracheostomy with dilatational technique. METHODS:In 55 patients an improved percutaneous tracheostomy was used, and in another 52 patients an old technique of percutaneous tracheostomy was used. RESULTS:The cost of the improved percutaneous tracheostomy was only (216.0+/-4.4) yuan, operation time was (5.0+/-3.5) minutes, while the cost of the old method was (3 011.0+/-5.3) yuan, and operation time was (10.0+/-6.9) minutes. The difference between them was significant (t=23.60, 4.76, both P<0.001), but there were no differences in the time of bleeding and healing (both P>0.05). CONCLUSION:The improved percutaneous tracheostomy was more expeditious, costless, better healing, scar smaller. Therefore, it is useful in emergency care, and it can take the place of classical tracheostomy.

Objective: To investigate the therapeutic effects of mechanical ventilation in patients with severe acute left heart failure. Methods: 21 patients with 25 episodes of severe acute heart failure received mechanical ventilation on the basis of routine treatment. Results: Effective rate of severe acute left heart failure in mechanical ventilation group was 96%, 5 patients died ( 23.8% ). 1 patient died from left heart failure, 4 patients died from other reasons. While in 17 cases of routine treatment group, 12 patients died ( 70.6% ) ( P 0.01 ). Conclusion: Mechanical ventilation showed notably effective in treating patients with severe acute left heart failure.

资料与方法 1、一般资料：本组患者 23例，男 16例，女 7例。年龄 31～ 73岁，平均年龄 40.3岁。脑血管意外 10 例，脑外伤 13例。于昏迷后 1～ 3天行气管切开。 2、方法： （ 1）器械准备：气管切开套件内有手术刀、 14G静脉穿刺套管、 10ml注射器、导丝及引导管、扩张管、有孔扩张钳、有气囊气管套管。检查管道是否通畅，导丝是否平滑，气囊是否漏气。 （ 2）病人准备：去枕仰卧、肩下垫薄枕，使颈过伸，标出 1、 2气管环及气管切开位置。

目的：探讨人工机械通气下危重症病人进行支气管肺灌洗术(BAL)治疗的新途径。方法：保持人工机械通气的同时应用纤维支气管镜经气管导管外侧旁路插入气管内行BAL治疗。术中比较治疗前、中和后6h的血气结果以及疗效。结果：8例病人共9次行BAL，均获成功。BAL前与中比较PaO２、SaO２下降无显著差异(P＞0.05)，而BAL后6h与BAL前比较PaO２、SaO２均显著升高(P＜0.01和P＜0.05)，PaCO2显著下降(P＜0.01)。结论：改良法行BAL是一种安全、有效的方法。

机械通气在治疗急性呼吸窘迫综合征(ARDS)时,如何避免通气/血流比的进一步失调,尽量减少肺损伤或致命性并发症,已成为成功抢救ARDS的关键.压力控制通气(PCV)模式是目前逐渐被接受的一种机械通气模式.我们在1998年8月～1999年12月应用PCV模式治疗ARDS患者8例,并与常规容量控制通气(VCV)模式治疗ARDS患者10例作比较,探索其临床应用价值,现报道如下.

口服有机磷农药重度中毒伴呼吸衰竭时,胃管洗胃及解毒药物治疗成功率低,反跳多,病死率高.1996年1月～1999年12月,我们对重度有机磷农药中毒伴呼吸衰竭24例采用呼吸机支持下切开洗胃救治,效果良好,报告如下.

1 病历简介 1.1 例1.男,30岁,从50 m高处跌伤1小时入ICU.X线胸片示右胸腔积液、双侧股骨干骨折和开放性右胫腓骨中下段粉碎性骨折.CT示肺挫伤,肝包膜下血肿,肾挫伤,颅脑未见异常.