目的 探讨三种新型肾上腺髓质素前体(ProADM)、可溶性糖基化终末产物受体(sRAGE)、高迁移率族蛋白B?1(HMGB?1)炎症标志物水平对重症监护室(ICU)感染患者病情严重程度及预后的评估价值.方法 选取2018年1月至2019年12月本院ICU收治的86例感染患者为研究对象,根据脓毒症定义的标准将其分为脓毒症组55例、脓毒性休克组31例;另选取40例同期本院健康体检者作为对照组.收集三组临床一般资料,于入院24 h内采用酶联免疫吸附法检测ProADM、sRAGE、HMGB?1水平.评估研究组患者急性生理学及慢性健康状况评分系统(APACHE II)评分、序贯器官功能障碍评分(SOFA),并随访1个月,记录随访结果(死亡或存活).采用Pearson相关性分析ProADM、sRAGE、HMGB?1与APACHE II、SOFA评分及预后的相关性.结果 三组的ProADM、sRAGE、HMGB?1指标比较差异具有统计学意义(P<0.05);经两两比较发现,脓毒症组及脓毒性休克组的ProADM、sRAGE、HMGB?1指标显著高于对照组,差异具有统计学意义(P<0.05);且脓毒性休克组的各指标显著高于脓毒症组,差异具有统计学意义(P<0.05).脓毒性休克组的APACHE II、SOFA评分均显著高于脓毒症组,差异具有统计学意义(P<0.05).随访结果显示,有36例患者死亡,50例患者存活,死亡率为41.86％,死亡组患者的ProADM、sRAGE、HMGB?1指标显著高于存活组,差异具有统计学意义(P<0.05).Pearson相关性分析结果显示,ProADM、sRAGE、HMGB?1指标与APACHE II、SOFA评分及预后均呈正相关关系(P<0.05).结论 ICU脓毒症患者ProADM、sRAGE、HMGB?1水平高于健康人,且与患者感染严重程度及预后情况密切相关.

目的 研究创新型护理流程模式在综合ICU中的应用效果.方法 选取2018年3月～2019年3月我院综合ICU病房患者为本次研究对象,将其随机分为实验组和对照组,各39例,其中对照组采取常规护理方式,实验组在其基础上采取创新型护理流程模式,对护理效果分别进行观察.结果 实验组护理效果明显优于对照组,差异有统计学意义(P<0.05).结论 创新型护理流程模式是有效的综合ICU护理方式,此方式有明显效果,值得推广.

To reduce the energy consumption and improve economic performance of freeze-drying, a cascade system and a two-stage compression heat pump system for freeze-dryers, in which R600a/R290 and R290 served as work fluids respectively, have been investigated. The analyses on the performance of the two systems were conducted through variation of the temperature in the intermediate heat exchanger, heating platen and vapor condenser. The results show that the two systems are both feasible to freeze-dryer. Under the operational conditions in convention, the cascade heat pump system is slightly superior to the two-stage compression system.

To reduce energy consumption and improve economics of freeze-dryer, a two-stage compression cycle and cascade heat pump cycle for freeze-dryer, in which NH3 is used as working medium, had been constructed. The influences of operational conditions during freeze-drying on the characteristics of the two systems were investigated through calculation of performances on the heat pump cycles. The intermediate temperatures of the two systems are optimized. The results shows that both of the cycles can be used in freeze-dryer, the cascade heat pump cycle is better than two-stage compression cycle under the conventional operational conditions. Higher performances can be obtained by lowering the temperature ofheating platen and increasing the temperature of vapor condenser. The reasonable intermediate temperatures arepresent by the equal pressure ratio method due to the little variation of COP with the intermediate temperature of the systems.