ICU危重患者发生血小板减少的常见发生机制有血小板滞留增多、血小板生成减少、血小板消耗、血液稀释、假性血小板减少以及免疫介导的血小板破坏等等.有很多ICU危重患者发生血小板减少的原因可能并不止单单一个,例如脓毒症导致的血小板减少,一方面是因为患者血小板生成减少造成,另一方面则是因为溶血素消耗以及破坏增加的情况.

许多人觉得胆结石只要不发作就不要紧,殊不知小结石会惹出大麻烦:当胆道系统出现结石时,容易引起胰液倒流,导致急性胰腺炎发生;而胰腺炎的合并症多,致死率很高,被称作消化内科的"心肌梗死".邓先生的经历要引起我们的重视.

目的:探讨CT引导下臭氧消融术治疗睡椎间盘突出症的疗效.方法:治疗组116例在CT引导下精确定位采用椎间盘内注射臭氧行臭氧消融术治疗,对照组108例采用传统外科手术治疗腰椎间盘突出症.结果:治疗组:116例患者均随访3个月显效:85例(73.3％),有效18例(15.5％).无效:13例(11.2％),未发现严重并发症及复发;对照组:108例患者均随访3个月.显效:65例(60.2％),有效:30例(27.8％),无效:13例(120％),并发症21例(19.8％),复发1例.治疗组显效率高于对照组,对照组并发症发生率明显高于治疗组(P＜0.05).结论:臭氧消融术是治疗腰椎间盘突出症的一种创伤小、痛苦小、并发症少、安全有效的微创方法,具有较大的临床实用价值

Objective:To study the effect of atorvastatin on blood lipid and hsCRP effects in patients with coronary heart disease.Methods:120 cases of patients with coronary heart disease were randomly divided into two groups,the treatment group of 60 cases on the basis of routine treatment with atorvastatin calcium 20mg QN,and 60 cases in control group only to conventional treatment,not of Atorvastation,were observed in two groups before treatment and after 6 weeks treatment of lipids and hsCRP changes.Results:The treatment group after treatment of 6weeks lipids and hsCRP had obvious improvement than before treatment(P<0.05),and compared with the control group also had statistical differences(P<0.05).Conclusion:Atorvastatin in coronary heart disease patients with good lipid regulating effect,and can effectively reduce the level of hsCRP,good safety performance,and thus it is of being popularized and used for patients with septic shock

目的:集束化治疗感染性休克的临床效果观察.方法:选择120例感染性休克患者随机分为两组,62例患者实施集束化治疗(治疗组),58例患者实施常规治疗(对照组),观察两组患者治疗后CVP、MAP、SCVO2变化、血清乳酸含量、MODS发生率、28天病死率.结果:两组患者入选时的病情无统计学差异(P＞0.05).治疗组治疗后6h及24小时的CVP、MAP、SCVO2、乳酸值变化、MODS发生率、28天住院病死率与对照组比较均有统计学差异(P＜0.05).结论:集束化治疗能较显著的改善感染性体克患者的生存和预后情况

目的:探讨多巴胺联合去甲肾上腺素在感染性休克中的疗效.方法:将120 例感染性休克患者随机分为观察组和对照组各60 例,观察组在常规抗感染、扩容等的基础上给予多巴胺联合去甲肾上腺素抗休克;对照组在常规抗感染、扩容等的基础上给予多巴胺抗休克,观察两组的血液动力学、血乳酸.结果:观察组治疗后24h 的中心静脉压(CVP)、平均动脉压(MAP)、血乳酸及中心静脉氧饱和度(ScvO2)改善显著优于对照组(P<0.05).结论:在常规抗感染、扩容等的基础上应用多巴胺联合去甲肾上腺素治疗感染性休克疗效较好,值得临床推广使用

objective Explore type B natriuretic peptide(BNP)test joint CVP determination of heart failure patients in the diagnosis of the clinical significance.Methods In 248 cases with difficulty breathing for symptoms of heart failure patients suspected BNP and CVP determination,according to the history,clinical presentation,assistant examination and to respond to treatment,and other comprehensive judgment to make clinical diagnosis,more BNP joint CVP determination and pure BNP determination result and clinical diagnosis of the relationship between the two.The exhaust is heart failure diagnosis is a good index,and promote the use of clinical.Results BNP and CVP is more clinical significance for heart failure diagnosis,BNP quartile value 1800ng/L and CV>12 cmH2O diagnosis of heart failure positie predictie alue 99.5%,and simple quartile BNP 1800ng/L,with increased CVP,heart failure diagnosis of the positie predictie alue 89.7%(P<0.05);BNP<100ng/L and CVP is not high,heart failure negatie predictie alue 100%,eliminate heart failure;Pure BNP<100ng/L,heart failure negatie predictie alue 90.9%(P<0.05),BNP joint CVP determination and pure in heart failure diagnosis of BNP determination are significantly different.Conclusion BNP and CVP more help to determine the rapid diagnosis early or the exclusion of heart failure,heart failure diagnosis is the better index,and promote the use of clinical

Objective To investigate the effects of enalapril and bisoprolol on the heart rate variability(HRV) and blood pressure in patients with primary hypertension.Methods 120 cases of patients with primary hypertension were randomly divided into a observation group and a control group,60 cases for each group.Combination therapy of enalapril and bisoprolol were conducted on the observation group for 6 months,and levamlodipine besylate tablet therapy was conducted on the control group for 6 months.Changes of the blood pressure and heart rate variability of the two groups before and after the therapy were compared.Results The observation group had a better blood pressure control than the control group,and its heart rate variability parameters was remarkably improved compared to that of the control group(P0.05).Also,there was remarkable improvement(P0.05) compared to that before the therapy.Conclusion There is high blood pressure and HRV reduction occurrence generally among patients with primary hypertension.The combination therapy of enalapril and bisoprolol for patients with primary hypertension can effectively control blood pressure and remarkably improve the heart rate variability of patients,and thus it is of being popularized and used for patients with primary hypertension clinically.

"复苏"主要是指"心肺复苏"(CPR),但是,心肺复苏成功的关键不仅是自主呼吸和心跳的恢复,更重要的是中枢神经系统功能的恢复,故将"心肺复苏"扩展为"心肺脑复苏"(CPCR),心肺复苏(CPR)是临床医学最困难、最代表水平、最具有挑战意义的问题之一.如何提高CPR的成功率,一直为临床医务人员所关注.复苏后出现的多器官功能不全综合征(MODS)即复苏后综合征(P RM)在临床工作中越来越常见.本研究回顾分析48例患者的临床特点,并探讨有效的抢救治疗措施.

Objective:To investigate clinical efficacy of heparin treatment in unstable angina pectoris patients.Methods:58 patients were randomly divided into treatment group and control group,each were 29 cases.Nitrates,β-blockers,calcium antagonists,aspirin enteric coated tablet,angiotensin-converting enzyme inhibitors were given in control group.And on this basis,heparin was added in treatment group.Results:The frequency of angina pectoris in the treatment group was reduced significantly(P<0.01).And the clinical symptoms and ischemic ST segment depressed of electrocardiographic improved in the treatment group was also better(P<0.05).Conclusion:The effect of heparin treatment in unstable angina pectoris is reliable and under APTT monitoring this treatment is safe enough for clinical use.

目的 评价冠心宁注射液治疗慢性肺源性心脏病的临床疗效.方法 将232例慢性肺源性心脏病患者随机分为治疗组和对照组,治疗组116例,在常规治疗基础上给予冠心宁注射液20ml静脉滴注,每日1次;对照组116例,在常规治疗基础上给予丹参注射液30ml静脉滴注,每日1次.结果 治疗组有效率为95.7%,肝功、心电图及血流变学较对照组明显改善,对照组有效率为76.7%,两组有效率比较,差异有显著性(P＜0.05).结论 冠心宁注射液治疗慢性肺源性心脏病疗效显著,值得临床使用.

6 Astellas公司的凝血因子Xa抑制剂Ⅱ期临床结果良好 Astellas公司报道了其研发的抗血栓新药YM150(一种口服凝血因子Xa抑制剂)的ONYX-2Ⅱ期临床研究首批数据,结果显示其预防髋关节置换术患者的静脉血栓栓塞作用比依诺肝素好.

自主神经受损是糖尿病患者较常见、较早出现的慢性并发症,心率变异性(HRV)是否为判断糖尿病患者伴有自主神经受损的准确、敏感的指标.我们观察了102例糖尿病患者的HRV变化,现报告如下.

目的探讨阻塞性睡眠呼吸暂停综合征的患者HRV参数的变化及临床意义.方法将48名阻塞性睡眠呼吸暂停综合征患者与健康对照组进行比较分析.结果阻塞性睡眠呼吸暂停综合征患者的HRV的各项参数与正常对照组存在显著差异(P＜0.05).结论阻塞性睡眠呼吸暂停综合征患者表现的夜间交感神经功能亢进、迷走神经功能受抑制,可作为阻塞性睡眠呼吸暂停综合征的筛选工具.