目的 探讨早期体外膈肌起搏治疗对机械通气患者的膈肌功能及预后的影响.方法 选取2019年10月至2021年7月湖南省人民医院(湖南师范大学附属第一医院)急诊重症监护室中进行有创机械通气的患者共47例,随机(随机数字法)分为治疗组(n=23)和对照组(n=24),对照组患者行临床常规治疗,治疗组在此基础上每天行体外膈肌起搏治疗,从机械通气第3天开始直至撤机,追踪随访至出院后30 d.比较两组患者撤机时膈肌厚度、膈肌移动度及膈肌增厚分数以及机械通气时间、撤机失败人数、住院时间、死亡人数.结果 与对照组比较,治疗组患者膈肌厚度(cm)[(0.21±0.05)vs.(0.16±0.05)]、膈肌移动度(cm)[(1.38±0.37)vs.(1.11±0.48)]、膈肌增厚分数(％)[26(19,32)vs.18.5(10.25,20)]均增加,差异有统计学意义(均P＜0.05);治疗组机械通气时间更短(d)[:10(7,15)vs.13(10.25,19)],差异有统计学意义(P＜0.05),但撤机失败人数(例)[(7 vs.9)]、住院时间(d)[22(15,30)vs.24(17.25,34.25)]、死亡人数(例)(8vs.8),差异无统计学意义(P＞0.05).结论 早期应用体外膈肌起搏,能改善机械通气患者患者膈肌功能,延缓膈肌功能下降,增加膈肌移动度及膈肌增厚分数,缩短机械通气时间.

目的 探讨在股静脉-动脉体外膜肺氧合(venous-arterial extracorporeal membrane oxygenation,V-A ECMO)装机过程中同时置入6 F血管鞘进行下肢远端灌注的有效性及安全性.方法 收集2018年8月至2021年4月在湖南省人民医院实行股动-静脉穿刺置管的V-A ECMO治疗患者共53例,将在装机的同时使用6 F血管鞘远端灌注和未进行远端灌注或在发现动脉插管侧肢体缺血表现后再进行远端灌注的患者分为血管鞘组(n=19)和对照组(n=34).分析两组患者临床特点、成功装机所耗时间、肢体并发症发生率、总体病死率、需要连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)支持比率及CRRT支持患者存活率等差异.结果 血管鞘组及对照组成功撤机率分别为63.2％(12/19)、61.8％(21/34)(χ2=0.01,P=0.92),存活出院率分别为57.9％(11/19)、47.1％(16/34)(χ2=0.57,P=0.45).两组成功装机耗时分别为(28.08±9.44)min、(26.40±12.13)min(MannWhitney Z=0.38,P=0.70).两组中需要进行CRRT治疗的分别为21.1％(4/19)、35.3％(12/34)(χ2=1.17,P=0.28).两组CRRT支持的存活出院率分别为10.5％(2/19)、2.9％(1/34)(P=0.25).穿刺部位出血血管鞘组4例,对照组7例(χ2=0.01,P=0.96).出现因动脉插管原因导致的单侧下肢缺血血管鞘组及对照组分别为1例(5.26％)和10例(29.41％)(χ2=4.32,P=0.03).存活出院后置管侧肢体出现异常的情况:血管鞘组未发现可能与动脉插管相关的后遗症,对照组出现4例股动脉插管侧远端肢体乏力,检查发现有腓总神经脱髓鞘样病变,1例患者因ECMO治疗期间下肢缺血坏死进行了截肢手术,存活出院患者总体下肢缺血后遗症比率分别为0、14.7％(P=0.07).1例患者灌注管与连接管相接处有血栓形成.两组均没有出现明显过度灌注及远端动脉血栓栓塞表现.结论 在装机过程中同时使用6F血管鞘用于股V-A ECMO中的远端灌注是安全、有效的,可以降低出院患者肢体导管相关性缺血并发症发生率.但它对于提高生存率及降低CRRT的使用率未表现出显著性优势.

OBJECTIVE:To investigate the predictive value of heparin binding protein (HBP) for sepsis.METHODS:From June 2019 to December 2020, 188 patients admitted to the department of emergency of Hunan Provincial People's Hospital were enrolled. The patients were divided into non-sepsis group (87 patients) and sepsis group (101 patients) according to Sepsis-3 criteria. Gender, age, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), HBP, sequential organ failure assessment (SOFA) score, quick SOFA (qSOFA) score, modified early warning score (MEWS) and patients' recent medication history were recorded, the differences in the above indicators between the two groups were compared. The risk factors of sepsis were analyzed by Logistic regression. Spearman correlation analysis was used to analyze the correlation between HBP, PCT, CRP and SOFA score to evaluate the predictive value of HBP, PCT and CRP for the severity of septic organ failure. Receiver operating characteristic curve (ROC curve) were drawn to evaluate the diagnostic value of HBP, PCT and CRP for sepsis.RESULTS:Compared with the non-sepsis group, the sepsis group had significantly higher levels of HBP, PCT, CRP, WBC, SOFA score, qSOFA score, and MEWS [HBP (μg/L): 55.46 (24.57, 78.49) vs. 5.90 (5.90, 9.01), PCT (μg/L): 6.83 (1.75, 30.64) vs. 0.23 (0.12, 0.75), CRP (mg/L): 67.35 (26.23, 123.23) vs. 4.45 (2.62, 47.22), WBC (×109/L): 11.84 (7.18, 16.06) vs. 6.58 (5.47, 8.99), SOFA score: 6 (4, 8) vs. 0 (0, 0), qSOFA score: 2 (1, 3) vs. 0 (0, 1), MEWS: 4 (3, 6) vs. 1 (0, 2)], the length of hospital stay was significantly prolonged [days: 10 (4, 17) vs. 0 (0, 7)], and the mortality was significantly increased [29.7% (30/101) vs. 4.6% (4/87)], with statistical significance (all P < 0.05). Correlation analysis showed that HBP, PCT and CRP were significantly positively correlated with SOFA score (r values were 0.60, 0.33, and 0.38, respectively, all P < 0.01), among which HBP had the strongest correlation, CRP was the second, and PCT was the weakest. Logistic regression analysis showed that HBP, PCT and CRP levels were independent risk factors for sepsis [odds ratio (OR) were 1.015, 1.094, 1.067, 95% confidence intervals (95%CI) were 1.007-1.022, 1.041-1.150, 1.043-1.093, all P < 0.01]. ROC curve analysis showed that HBP, PCT and CRP all had some diagnostic value for sepsis [the area under ROC curve (AUC) were 0.92, 0.87, 0.80, 95%CI were 0.88-0.97, 0.82-0.92, 0.74-0.87, respectively, all P < 0.01]. Among them, the diagnostic efficacy of HBP was higher when the cut-off value was ≥ 15.11 μg/L, its sensitivity and specificity were 86.14% and 89.66%, respectively, which were higher than the sensitivity (81.19%) and specificity (80.46%) when the PCT cut-off value was ≥ 1.17 μg/L. However, CRP had the best sensitivity of 94.06% for the diagnosis of sepsis but lacked of specificity (63.22%).CONCLUSIONS:HBP can be used as a biological indicator for predicting sepsis and can assess the severity of organ failure in septic patients.

鹦鹉热是鹦鹉热衣原体源于鹦形目动物、禽类等经过接触传播所致自然疫源性人畜共患传染病.因临床病例较少,容易误诊或漏诊.本文介绍了3例确诊鹦鹉热的患者,分析患者的临床表现、发病不同时期的影像学特点、治疗以及转归,以期为此类疾病诊治提供参考.

恶性心律失常是常见棘手的急诊难题.本文报告一例急性心肌梗死患者,突发逸搏与室速交替,运用急诊临时心脏起搏联合艾司洛尔实现对心率的绝对控制,并使得患者得到成功救治.

Objective:To understand the current situation of the control and treatment status of asthma in outpatients with asthma. Methods:The life and control of disease in patients with asthma was studied with questionnaire.Results:Among the common factors that caused or aggravated asthma,the effect of smoke accounted for 12%,improper application of air conditioning accounted for 7%,inappropriate exercise accounted for 26%,drug factors accounted for 12%,emotional changes accounted for 15%,exposure to allergens accounted for 28%.Conclusion:Healthy life,scientific use of drugs,avoiding to contact with irritating substances would help to control asthma.

目的：探讨脓毒症病死率评分系统（MEDS）在急诊脓毒症患者救治中的应用价值。方法：对我院急诊科2011年3月至2014年4月间65例急诊脓毒症病例进行MEDS评级，以随访28 d为终点分组为生存组40例和死亡组25例，比较两组评级情况。结果：生存阴患者极低、低、中度危险级患者比例显著高于死亡组，高危险级、极高危险级患者比例显著低于死亡组，数据间比较差异具有统计学意义（P<0.05），且生存组患者随着MEDS的加重，患者比例数逐渐下降，死亡组患者随着MEDS评级的加重，患者比例数逐渐上升。结论：在急诊应用MEDS进行脓毒症病情严重程度的评估对于预判脓毒症患者死亡情况具有重要的指导意义，可较好的预测患者28 d的生存和死亡率。

Our aim is to investigate the significance of electrogastrography in the treatment of esophageal variceal hemorrhage with octreotide. Electrogastrography was performed in patients with esophageal variceal hemorrhage before and during the treatment consisting of various doses of octreotide (25 ug h(-1) group and 50 ug h(-1) group). The dominant power of electrogastrography and its relationship with the hemostatic efficacy of octreotide treatment were evaluated. Dominant power of electrogastrography decreased significantly during treatment with octreotide (P < 0.05). The reduction in the amplitude of dominant power in the 50 ug h(-1) group was significantly larger than in the 25 ug h(-1) group (P < 0.05), and it was correlated with hemostatic efficacy of octreotide treatment. We conclude that octreotide treatment in patients with esophageal variceal hemorrhage can result in a significant decrease of dominant power, which correlates with the hemostatic efficacy of octreotide, so the change of dominant power could be used as a predictor of evaluating the treatment efficacy of octreotide in esophageal variceal hemorrhage patients.

Objective To study the effects of limited fluid resuscitation and aggressive fluid resuscitation on intestinal epithelium mechanical barrier dysfunction in rats with uncontrolled hemorrhagic shock. Method models of 36 sd rats with uncontrolled hemorrhagic shock were installed and divided randomly into 3 groups:(a)control group,(B) limited fluid resuscitation group,(c) aggressive fluid resuscitation group.fluid resuscitation was not used in a group, while different measures of fluid resuscitation in B and c group, To evaluate histopathology scoring and observe ultrastructure of intestinal mucosal by electron microscope all of rats after 5h.Result The histopathology scoring of a group is higher significantly than B and c group. The damages of intestinal epithelium cells, microvilli, mitochondria, nuclear in B group were lighter than those in group c under observing electron microscope. Conclusion uHs lead to serious damages in intestinal epithelium mechanical barrier, there were few damages by applying the limited fluid resuscitation than that by aggressive fluid resuscitation, and it was benefical for intestinal Epithelium mechanical Barrier in rats with uHs.

目的选择病史(History)、心电图(electrocardiogram ECG)、年龄(Age)、危险因素(Risk factors)、肌钙蛋白(Troponin I)5项指标组成的HEART评分系统作为病情评估、疾病诊断、预后评估的方法,研究其在急诊胸痛患者中的应用价值。方法收集本院急诊科自2011年3月1日至2011年12月31日收治的以胸痛为主诉的93例急诊患者作为研究对象,分为心源性胸痛组和非心脏源性胸痛组,心源性胸痛组中再按照患者的病情转归分为急性心肌梗死组和心绞痛组,对各组患者分别进行病情评估并对照分析。结果 HEART评分在病情及预后评估方面,心源性胸痛组与非心脏源性胸痛组有显著差异(P<0.01);心源性胸痛组中两组患者中比较均有显著差异(P<0.01);在疾病诊断方面,诊断更为准确、规范,漏诊率降低。结论对于急诊胸痛患者,HEART评分能简单、快速、准确进行病情及预后评估,可作为急诊胸痛患者生存预测和治疗决策选择的可行性量化指标,在急诊快速病情评估和疾病诊断中有重要的应用价值。

【Objective】 To explore the effects of limited fluid resuscitation on rat with uncontrolled hemorrhagic shock(UHS).【Methods】 36 SD rat were made the model of UHS and they were divided randomly into 3 groups which used different therapies: control group of rats with UHS were not given fluid resuscitation(A),the group of rats with UHS received limited fluid resuscitation(B),the group of rats with UHS received aggressive fluid resuscitation(C).After 2 h,all of rats were measured the concentration of ET and NO in portal vein blood,amount of bleeding,and given histopathology scoring of intestinal mucosal.【Results】 There was a difference among 3 groups in the concentration of ET and NO,amount of bleeding,histopathology scoring,group A was higher significantly than group B and C,and group B was lighter than group C.【Conclusion】 Compared with aggressive fluid resuscitation,the limited fluid resuscitation can reduce significantly the concentration of ET,NO in portal vein blood and NO/ET levels for rats with UHS,and decrease the damage of intestinal mucosa and benefit for improvement of microcirculation disturbance.

目的:研究褪黑素时ApoE基因敲除小鼠动脉粥样硬化的影响.方法:选用ApoE基因敲除小鼠作为动脉粥样硬化的动物模型,给予褪黑素干预治疗6周后,检测褪黑素对ApoE基因敲除小鼠氧自由基代谢状态及动脉粥样硬化的影响.结果:与正常对照组小鼠相比,ApoE基因敲除小鼠血清及肝组织丙二醛(MDA)含量明显增加,而血清及肝组织中超氧化物歧化酶(SOD)的含量显著降低;褪黑素治疗后可明显增加SOD的活性,降低MDA的含量,并可以减少ApoE基因敲除小鼠主动脉粥样硬化斑块的面积.结论:褪黑素能有效的抑制ApoE基因敲除小鼠体内氧化应激反应,增强其抗氧化能力,从而抑制动脉粥样硬化的形成及发展.

OBJECTIVE To explore the effect of chronic iron overload on the lesion of atherosclerosis (AS) in apolipoprotein (apo) E knockout mice. METHODS Twenty-four ApoE knockout mice were randomly divided into ApoE knockout group (0.1 mL saline for 4 weeks) and iron overload group (10 mg iron dextran for 4 weeks). The levels of serum iron (SI), total iron binding capacity, contents of malondialdehyde (MDA), and activity of superoxide dismutase (SOD) in the liver were measured. Iron deposition in the liver and heart was determined, and atherosclerotic plaque areas of the sinus aortae were analyzed. RESULTS In the iron overload group, the levels of SI increased by 377.86%, the saturation of transferrin increased by 121.98% and the levels of iron in the liver increased by 2,548.15% (P<0.01). The contents of MDA in the liver increased by 32.51% (P<0.01), and the activity of SOD in the liver decreased by 17.2% in the ApoE knockout group (P<0.05). The level of MDA in the liver increased by 411.15%, and the activity of SOD in the liver decreased by 46.84% in the iron overload group (P<0.01). There was a significant deposition of iron in the liver and heart of mice, and the areas of atherosclerotic plaque of sinus aortae increased markedly in the iron overload group. CONCLUSION Chronic iron overload may promote the development of AS lesion in the ApoE knockout mice, in which the increased oxidative stress and lipid oxidation may involve.

Melatonin是一种主要由人松果体腺分泌的吲哚类激素。除了具有调节睡眠、生殖、免疫和昼夜节律等生理作用外,还具有直接和/或间接的抗氧化作用,是一种高效的自由基清除剂,褪黑素可以清除包括OH、O_2~-和NO等多种自由基。褪黑素可以通过抗氧化等多种机制参与调节动脉粥样硬化的发生与发展。本文综述了近年来褪黑素与动脉粥样硬化关系的研究进展。