ObjectiveOur study aim is to explore the mechanisms of short peptide passages on intestinal dysfunction in septic mice utilizing a metabolomics approach, which provides a new scientific basis for the clinical study of sepsis.MethodsMices were allocated at random into four groups: control (Con), cecal ligation and puncture followed by one, three or 7 day short-peptide-based enteral nutrition group (CLP + SPEN1), (CLP + SPEN3), and (CLP + SPEN7) groups. A liquid chromatography-mass spectrometry-based metabolomics method was used to analyze changes in serum metabolites in septic mice.ResultsShort peptides showed effectiveness in reducing symptoms, mucosal inflammation, and intestinal function damage scores in septic mice. The 16sRNA analysis showcased significant variances in the distribution of bacterial communities between the CLP + SPEN1, CLP + SPEN3, and CLP + SPEN7 groups. At the phylum level, statistically significant variances in the relative abundance of Proteobacteria, Firmicutes, and Bacteroidetes were recognized. The metabolomics analysis results showed significant separation of metabolites between the CLP + SPEN1 and CLP + SPEN3 groups, as well as significant differences in metabolite profiles between the CLP + SPEN3 and CLP + SPEN7 groups. Utilizing a differential Venn diagram, four metabolites were commonly different; 10-heptadecanoic and dodecanoic acids had statistical significance. The abundance of both dodecanoic and lactic acid bacteria was negatively associated at the genus level.ConclusionShort peptides were found to promote the growth of beneficial bacteria, Lactobacillus and uncultured_bacterium_f_Muribaculaceae, while reducing intestinal metabolites such as Dodecanoic acid and 10-Heptadecenoic acid. Moreover the Lactobacillus may play a significant therapeutic role in the treatment of sepsis. However, due to the limited number of experimental samples, the exact mechanism of action of short peptides awaits further confirmation.

目的 研究β-羟基-β-甲基丁酸(HMB)对肝硬化患者的肌肉质量、营养状况的影响.方法 选择 2021 年 8 月至2022 年 8 月于重庆市大足区人民医院收治的符合入选标准的肝硬化患者.采用便利抽签法随机将其分为对照组(n=30)与试验组(n=30),两组患者均给予保肝、降酶、营养治疗等常规治疗.试验组在对照组治疗的基础上加用口服营养补充剂(富含HMB)进行治疗.对比两组患者在 3 个时间点(0 周、3 周、6 周)的体重、白蛋白、握力、骨骼肌质量参数(SMI)、肱三头肌皮褶厚度(TSF)、上臂肌围(AMC)、肝功能Child-Pugh分级、Barthel指数评分情况.结果 试验组患者的体重和SMI、白蛋白都明显增高,且两组之间的差异具有统计学意义(P＜0.05).两组TSF、AMC都有所下降,但两组差异无统计学意义(P＞0.05).两组的肝功能Child-Pugh分级、Barthel指数差异无统计学意义(P＞0.05).结论 肝硬化患者因代谢合成受损,肌肉减少症较常见,本研究通过对肝硬化患者给予HMB营养制剂干预,发现在一定程度上能改善骨骼肌的功能及机体的营养状态;抑制肌肉和蛋白质分解,增加患者的肌肉质量,但没有改善肝功能的损伤程度及个人自理能力.

目的 探讨免疫增强型复合肠内营养制剂对脓毒血症肿瘤患者的临床疗效.方法 选择2018年6月至2020年7月重庆市大足区人民医院重症监护室收治的符合入选标准的合并脓毒血症肿瘤患者,随机分为试验组和对照组,各30例.对照组给予常规营养治疗,试验组在对照组的基础上加用富含免疫增强型复合肠内营养制剂治疗.并监测比较两组患者在3个时间点(0周、1周、2周)白蛋白(ALB)、降钙素(PCT)、C反应蛋白(CRP)、序贯器官衰竭估计(SOFA)评分、D-乳酸(D-Lac)、二胺氧化酶(DAO)和细菌内毒素的情况,监测两组发生肠功能障碍(腹泻、腹胀、胃潴留)的例数、肺部感染、重症监护室入住时间及死亡例数情况.结果 两组患者的ALB、PCT、CRP、SOFA评分、肺部感染发生的例数、患者重症监护室入住时间及死亡例数、两组生存曲线之间差异均无统计学意义(P>0.05).肠功能监测指标(DAO、D-Lac、内毒素)试验组较对照组下降幅度更大,差异有统计学意义(P<0.05).对照组肠功能障碍(腹泻、腹胀、胃潴留)发生的例数多于试验组,差异有统计学意义(P<0.05);结论 早期肠内营养治疗均能改善引起脓毒血症的肿瘤患者的营养及炎症反应状态,提高肿瘤患者的治疗疗效,其中免疫增强型复合肠内营养制剂治疗在改善肿瘤患者的肠功能检测指标方面较显著,并一定程度减少了肠功能障碍并发症的发生.

目的:探讨重症超声与脉搏指示持续心排血量(pulse-indicated continuous cardiac output,PiCCO)对急性心力衰竭(acute heart failure,AHF)患者的容量管理,对比2种方式早期治疗效果,在治疗及时性方面为患者提供一定的科学依据.方法:选择2017年1月至2018年9月重庆市大足区人民医院重症监护室(intensive care unit,ICU)收治的符合入选标准的AHF患者,随机分为试验组(n=30)和对照组(n=28).试验组采用重症超声监测指导,对照组采用PiCCO监测指导,对比2组患者72 h内的N末端B型利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、中心静脉压(central venous pressure,CVP)、平均动脉压(mean arterial pressure,MAP)、乳酸清除率、中心静脉血氧饱和度(central venous oxygen saturation,ScvO2)的情况;统计肺部感染发生率、机械通气时间、ICU入住时间、28 d死亡率、生存曲线、6h复苏达标情况及3h内能进行容量监测的例数;2种监测方法在治疗前后的心功能,血容量指标比较情况.结果:72 h 2组NT-proBNP、CVP、MAP、乳酸清除率、ScvO2差异均无统计学意义(P＞0.025).2组患者肺部感染发生率对照组大于试验组,差异有统计学意义(P＜0.025).3h内能进行容量监测的例数,试验组明显多于对照组,差异有统计学意义(P＜0.05).2组6h容量达标人数差异无统计学意义(P＞0.05).2组患者在机械通气时间、ICU入住时间、28 d死亡率、生存时间方面差异均无统计学意义(P＞0.05).治疗前后心功能指标对比:试验组治疗前心输出量(cardiac output,CO)、左心射血分数(left ventricular ejection fraction,LVEF)指标小于治疗后,差异均有统计学意义(P＜0.05);对照组治疗前心脏指数(cardiac index,CI)、全心射血分数(global ejection fraction,GEF)指标小于治疗后,差异有统计学意义(P＜0.05).治疗前后血容量指标对比:试验组治疗后下腔静脉呼吸异变率、左心室舒张末期容积(left ventricular end diastolicvolume,LVEDV)、每搏量(stroke volume,SV)高于治疗前,下腔静脉(inferior vena cava,IVC)低于治疗前,差异有统计学意义(P＜0.05);对照组治疗后每搏量指数(stroke volume index,SVI)高于治疗前,全心舒张末期容积指数(global end diastolic volume,GEDI)低于治疗前,差异有统计学意义(P＜0.05).结论:通过重症超声与PiCCO对AHF患者的容量管理临床研究,两者均能准确地评估容量和预测容量反应性.但比较PiCCO,重症超声明显缩短了治疗过程的延迟时间,在血流动力学变化的情况下也能及时操作监测,且其属于无创操作,在治疗中可反复进行检查,实时进行容量的管理,可以减少一定的操作和治疗风险,比如导管相关性感染、肺部感染等问题,提高AHF患者的早期救治能力.但是,PiCCO和重症超声对患者不能降低其死亡率,故需进一步研究其他综合性治疗方案减少患者的死亡风险,提高AHF患者的存活率.

This study explored the mechanism of NEAT1 in sepsis-induced AKI rats. Cecal ligation punctures (CLP)-induced AKI rats were injected with siRNA-NEAT1 lentivirus. Kidney histopathology and apoptosis were evaluated via hematoxylin-eosin and TUNEL staining, respectively. ELISA determined the levels of Blood urea nitrogen (BUN), serum creatinine (SCr), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), TNF-α, Interleukin (IL)-1β, and IL-6. Colorimetry measured malondialdehyde (MDA), superoxide dismutase (SOD) activities. qPCR analyzed NEAT1, miR-27a-3p, TAB3, Bcl-2, and Bax expressions. siNEAT1 reversed the promotive effect of CLP on kidney histopathological injury, and BUN, SCr, NGAL, KIM-1, TNF-α, IL-1β, IL-6, MDA, and Bax levels and apoptosis, but raised CLP-downregulated SOD and Bcl-2 levels. NEAT1 sponged miR-27a-3p which targeted TAB3. siNEAT1 upregulated miR-27a-3p and downregulated TAB3 expression. TAB3 overexpression reversed the inhibitory effect of siNEAT1 on the LPS-induced apoptosis of HK-2 cells. siNEAT1 alleviated sepsis-induced AKI in rats and LPS-induced sepsis of cells via miR-27a-3p/TAB3 axis.

目的:分析24小时乳酸清除率(24 h LCR)、序贯器官衰竭评分(SOFA评分)及简化急性生理评分(SAPSⅡ评分)在腹腔感染致脓毒症患者预后评估中的作用.方法:选择2014年3月～2015年9月我院收治的脓毒症患者37例,根据预后将患者分为两组,存活组(28例)和死亡组(9例).运用受试者工作特征曲线(ROC)比较24 h LCR、降钙素原(PCT)、SOFA评分、SAPSⅡ评分在腹腔感染致脓毒症患者预后评估中的效能并探讨它们之间的关系.结果:①死亡组患者PCT、SOFA评分及SAPSⅡ评分明显高于存活组患者,差异具有统计学意义;死亡组患者24 h LCR低于存活组患者,差异具有统计学意义.②24 h LCR、PCT、SOFA评分及SAPSⅡ评分在预测腹腔感染致脓毒症患者预后方面均有很大的价值,各指标ROC曲线下面积比较,差异均不具统计学意义.③24 h LCR与PCT呈负相关;SOFA评分与PCT呈正相关;SOFA评分与SAPSⅡ评分呈正相关.结论:24 h LCR、PCT、SOFA评分及SAPSⅡ评分在腹腔感染致脓毒症患者预后评估中具有重要意义.

目的:探讨硫普罗宁辅助治疗急性有机磷中毒的疗效及其对肝功能和外周血对氧磷酶1(PON1)表达的影响.方法:90例急性有机磷中毒患者随机分为观察组(n=45)和对照组(n=45),对照组给予常规治疗,观察组在对照组基础上联合硫普罗宁治疗.治疗10 d后比较两组临床疗效、实验室指标、肝功能及血清PON1水平变化.结果:观察组临床总有效率为91.11％,明显高于对照组的71.11％(P<0.05).治疗后,两组血清乳酸(Lac)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、谷氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBil)等指标水平较前明显下降,乙酰胆碱酯酶(CHE)、血清PON1水平则较前明显升高(P<0.05);且治疗后观察组各项指标均显著优于对照组(P<0.05).结论:在急性有机磷中毒患者中使用硫普罗宁辅助治疗,可有效改善肝功能、增加PON1的表达,提高临床疗效,值得应用推广.

目的:探讨“早期血流动力学干预”对不明原因低血容量性休克的容量管理,为早期治疗提供科学依据.方法:选择2013年9月至2017年1月我科收治的符合入选标准的56例低血容量休克患者,按随机数字表法分为实验组和对照组,每组28例.其中实验组中有2例病人治疗过程中要求转上级医院治疗,1人放弃治疗;对照组中有2例病人放弃治疗,3人转上级医院治疗.故最终纳入分析的实验组为25人,对照组为23人.实验组患者采用早期目标导向性液体治疗(early goal-directed therapy,EGDT),利用中心静脉压(central venous pressure,CVP)指导容量复苏及治疗,对照组患者根据经验采用传统容量复苏方法治疗,2组均在达到目标治疗后适当脱水降低心脏前负荷以便保护心肺功能.观察2组患者治疗前后急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluation Ⅱ,APACHEⅡ)、平均动脉压(mean arterial pressure,MAP)、CVP、血乳酸清除率、复苏液体量、使用血管活动药物的例数、肾功能损害例数、肺水肿例数及心衰发生例数;同时观察72 h内反复出现容量不足需再次扩容的例数;3、6h的休克纠正达标率例数;2组患者重症监护室(intensive care unit,ICU)入住天数及死亡例数.结果:2组APACHEⅡ评分都逐步下降,24 h后实验组评分明显低于对照组(P＜0.05);72 h后血管活动药物使用例数、肾功能损害例数及再次出现休克需扩容纠正例数明显少于对照组(P＜0.05);72 h肺水肿、心衰发生例数治疗组多于对照组(P＜0.05).6、24 h实验组液体总入量明显多于对照组,而72 h液体总量明显少于对照组(均P＜0.05);治疗6、24 h后实验组乳酸清除率明显优于对照组(P＜0.05).2组CVP、MAP均较治疗前有明显改善,CVP在6、24、72 h实验组优于对照组,MAP在6、24 h实验组优于对照组(P＜0.05).治疗后3、6h的休克纠正达标率例数,实验组明显优于对照组(P＜0.05).2组患者ICU入住时间及死亡例数的差异无统计学意义(P＞0.05).结论:不明原因低血容量性休克在“早期血流动力学干预下”采取EGDT液体治疗有显著疗效,但仍有不足.在复苏过程中因液体负荷过高发生心衰、肺水肿的医源性再损伤概率较大.故容量治疗阶段提出了寻找最佳心脏前负荷的设想.

目的 探究脉搏指示连续心排血量监测(PICCO)指导下连续性血液净化技术(CBP)在急性肾损伤并发心力衰竭中的应用效果.方法 将96例急性肾损伤(AKI)并发心力衰竭患者随机分为观察组和对照组各48例,对照组给予CBP治疗,观察组给予PICCO指导下CBP治疗.观察2组治疗前后血尿素氮(BUN)、血肌酐(SCr)、左室舒张末期内径(LVEDD)、左室收缩末内径(LVESD)、左室射血分数(LVEF)、平均动脉压(MAP)、心率(HR)、血氧饱和度[Sp(O2)]以及钾、钙水平变化情况.结果 治疗后,2组BUN、SCr、LVEDD、LVESD、HR及钾、钙水平显著低于治疗前(P均<0.05),且观察组显著低于对照组(P<0.05);治疗后,2组MAP、Sp(O2)、LVEF水平均显著高于治疗前(P均<0.05),且观察组显著高于对照组(P<0.05).结论 PICCO指导下CBP能够改善AKI并发心力衰竭患者肾功能和心功能,调节血流动力学和电解质水平.

目的 探讨莫西沙星联合用药治疗老年重症肺炎的临床疗效及对细菌清除率的影响.方法 选取医院2015年10月至2017年3月收治的老年重症肺炎患者92例,采用随机数字表法分为对照组和观察组,各46例.对照组患者静脉滴注头孢哌酮钠舒巴坦钠治疗,观察组患者加用静脉滴注莫西沙星治疗,两组患者均治疗7～14 d.结果 观察组患者治疗总有效率为93.48％,明显高于对照组的71.74％(χ2=7.57,P=0.00);观察组患者的肺部炎症、症状体征、发热、痰液颜色及白细胞计数恢复至正常时间明显短于对照组(P<0.01);观察组细菌清除率为78.43％,明显高于对照组的59.18％(χ2=4.33,P=0.03);两组患者不良反应发生率相当(6.52％比10.87％,P>0.05).结论 莫西沙星联合用药治疗老年重症肺炎的疗效显著,可促进患者症状和体征改善,提高细菌清除率,不良反应较少,值得推广.

小学阶段,阅读是学生学习的知识难点,同时也是教师教学的教学难点.在教学过程中采取恰当的教学策略是提高学生阅读能力的关键,朗读便是加深学生理解语文阅读的手段之一.

随着素质教育的贯彻实施,我国中小学在教育教学方面越来越重视对学生的基础教育,尤其是德育教育这一方面.而小学阶段正是学生形成正确的人生观、价值观的关键敏感时期.因此,教师要抓住这一关键时期对学生进行思想品德教育.

Objective To explore the clinical application value of the pulse indicated continuous cardiac output (PiCCO) monitoring in early fluid resuscitation and treatment of septic shock patients .Methods 50 patients with septic shock conforming to the inclusion criteria in our hospital from June 2013 to May 2015 were selected and ran‐domly divided into the study group and the control group according to the random number table method ,25 cases in each group .The study group was performed the fluid resuscitation and treatment under the guidance of PiCCO ,while the fluid resuscitation and treatment in the control group was guided by the central venous pressure (CVP) .The scores of acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ ) before and after treatment ,blood lactate clearance rate ,liquid quantity of resuscitation ,CVP ,urine volume ,MAP ,number of cases needing the mechani‐cal ventilation and cases of pulmonary edema and heart failure were observed in the two groups .Results The A‐PACHE Ⅱ scores after fluid resuscitation and treatment in the two groups were significantly decreased ,which at 72 h in the study group were significantly lower than that in the control group with statistical difference (P< 0 .05) .The fluid use amounts at 6 ,24 h in the study group were significantly more than those in the control group ,but the fluid total amounts at 72 h were significantly less than those in the control group ,the difference was statistically significant (P< 0 .05) ;the lactate clearance rate ,CVP ,urine volume and MAP at 6 ,24 h of treatment in the study group were superior to those in the control group ,the differences were statistically significant (P< 0 .05) .The number of cases of lung edema and heart failure occurrence at 72 h in the study group was significantly less than that in the control group with statistical difference (P< 0 .05) .No statistically significant difference in the cases number of using me‐chanical ventilation was found between the two groups (P> 0 .05) .Conclusion The PiCCO monitoring can more ac‐curately evaluate the volume status in the patients with septic shock ,precisely guides the fluid resuscitation and treat‐ment ,reduces the complications ,and has better guidance significance for the early fluid resuscitation and treatment in the patients with septic shock .

Objective To investigate the effect of pulse contour temperature dilution continuous cardiac output measurement (PICCO) monitor on the fluid resuscitation in patients with severe acute pancreatitis (SAP). Methods A total of 47 consecutive patients with severe acute pancreatitis were enrolled in this study from January 2012 to Janu-ary 2014. According to under the PICCO monitor or not, all the subjects of study were divided into the observation group with 25 cases and the control group with 22 cases. In the observation group, PICCO monitor was used to guide fluid resuscitation, while heart rate (HR), blood pressure (BP), central venous pressure (CVP) and urine were used to guide fluid resuscitation in the control group. The CVP, mean arterial pressure (MAP), HR, central venous oxyhemo-globin saturation (ScvO2) of the patients 6, 12, 24 hours after treatment in two groups were compared. The ICU stay time, total time of mechanical ventilation, cases of multiple organ dysfunction syndrome (MODS) and 28 days mortal-ity in two groups were compared. Results 6 hours after treatment, the CVP, MAP, ScvO2 of the observation group [(8.24 ± 2.18) mmHg, (79.40 ± 6.63) mmHg, (70.57 ± 6.49)%, respectively] were significantly higher than those in the control group [(6.41±2.30) mmHg, (71.05±4.60) mmHg, (63.03±5.61)%, respectively] (P<0.05), while HR of the observa-tion group [(109.07 ± 12.35) times/min] was significantly lower than that of the control group [(121.25 ± 14.31) times/min] (P<0.05). 12 hours after treatment, the HR of the observation group [(103.51±9.07) times/min] was significantly lower than that of the control group [(112.37±11.23) times/min] (P<0.05), while ScvO2 of the observation group [(72.25±7.63)%] was significantly higher than that of the control group [(66.29 ± 6.67)] (P<0.05). 24 hours after treatment, the CVP, MAP in the observation group [(9.16 ± 1.28) mmHg, (85.46 ± 10.36) mmHg, respectively] were significantly higher than those in the control group [(7.59±1.68) mmHg, (77.56±12.11) mmHg, respectively] (P<0.05). The incidence rate of MODS, ICU stay time, mechanical ventilation time in the observation group [16.00%, (9.27±1.39) days, (4.62±0.98) days, respective-ly] were significantly less than those in the control group [45.45%, (13.38 ± 2.27) days, (6.36 ± 1.20) days, respectively] (P<0.05). There was no significant difference between two groups in 28 days' mortality (P>0.05). Conclusion For pa-tients with severe acute pancreatitis, the fluid resuscitation under PICCO monitor is more effective. It can stabilize hemo-dynamics timely and effectively, shorten the time of mechanical ventilation, and reduce the incidence rate of MODS and the ICU stay time, which is worthy of clinical application and promotion.

Objective To investigate the effect of noninvasive‐invasive‐noninvasive sequential‐mechanical‐ven‐tilation in patients with acute respiratory distress syndrome (ARDS) caused by severe acute pancreatitis (SAP) . Methods 67 cases of patients with ARDS caused by SAP were enrolled in the research and divided into treatment group (treated by noninvasive‐invasive‐noninvasive sequential‐mechanical‐ventilation) and control group (treated by invasive‐noninvasive sequential‐mechanical‐ventilation) according to the way of mechanical ventilation .The time of invasive ventilation ,the total time of mechanical ventilation ,the incidence rate of ventilator associated pneumonia (VAP) ,and the length of ICU stay were compared between two groups .Results The time of invasive ventilation ,the incidence rate of VAP and the length of ICU stay of treatment group were significantly lower than those of control group ( P < 0 .05 ) .Conclusion Noninvasive‐invasive‐noninvasive sequential‐mechanical‐ventilation shows better effect than invasive‐noninvasive sequential‐mechanical‐ventilation in patients with ARDS caused by SAP .

目的探讨慢性肺源性心脏病营养疗法的疗效。方法回顾性分析57例慢性肺源性心脏病患者的临床资料,将其随机分成两组,A组:营养疗法29例,予以血浆、脂肪乳、氨基酸等加强静脉营养;B组:非营养疗法28例。两组其余治疗(包括持续低流量吸氧、抗感染、解痉平喘、止咳化痰、强心利尿等对症处理)基本相同。结果治疗后,A组患者较B组临床症状明显改善,病死率明显降低,血气分析明显改善,血清清蛋白明显增高,差异有统计学意义(P<0.05)。结论营养疗法在慢性肺源性心脏病治疗中取得较满意疗效,值得临床推广应用。

<正>急性胰腺炎(acute pancreatitis,AP)是常见的急腹症,发病率为(4.9～80)/10万,其中重症急性胰腺炎(severe acutepancreatitis,SAP)的发生率为20%～30%,发病后常伴全身炎症反应,炎症介质和细胞因子进入血液循环后进一步激活其他

<正>1病史资料患者,女,64岁,因自服氧化乐果100ml后10分钟左右入院。入院时出现恶心呕吐、头昏、大汗淋漓,面色苍白,无抽搐、意识障碍、呼吸困难、大小便失禁。查体:T36.5℃,P60次/分,R21次/分,BP120/80mmHg。急性中毒貌,意识清楚,面色苍白,流涎,大汗淋漓,皮肤黏膜湿润,双侧瞳孔等大等圆,直径约0.1cm,对光反射灵敏,口腔充满大蒜味,双肺闻及少量细湿啰音,心浊音界不大,心率60次/分,心律齐,未闻及早搏,各瓣膜听诊