扶正祛邪方治疗多重耐药菌肺部感染临床研究

目的 探讨扶正祛邪方对多重耐药菌(multidrug resistant organism,MDRO)肺部感染患者炎症因子、临床肺部感染评分(clinical pulmonary infection score,CPIS)及致病菌清除率的影响。方法选取2018年6月—2020年6月本院收治的113例MDRO肺部感染患者作为研究对象,依照随机数字表法分为2组。对照组56例予以常规西医治疗,观察组57例在对照组治疗基础上联合扶正祛邪方治疗。比较2组患者治疗前后血清炎症因子水平、CPIS及急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分以及致病菌清除率。结果 治疗后,观察组患者白细胞计数(white blood cell,WBC)、超敏C反应蛋白(hypersensitive C reactive protein,hsCRP)及降钙素原(procalcitonin,PCT)水平显著低于对照组(P<0.05);CPIS及APACHEⅡ评分显著低于对照组(P<0.05);致病菌清除率显著高于对照组(P<0.05)。结论 扶正祛邪方联合西药治疗可显著提高MDRO肺部感染患者致病菌清除率,降低炎症因子水平,改善患者病情。     

头孢哌酮/舒巴坦联合多西环素对多重耐药鲍曼不动杆菌肺炎治疗效果观察

目的:研究头孢哌酮/舒巴坦联合多西环素在多重耐药鲍曼不动杆菌肺炎的治疗效果。方法:将30例多重耐药鲍曼不动杆菌致肺部感染患者随机分为对照组和观察组各15例,对照组患者进行头孢哌酮/舒巴坦注射液治疗,观察组患者进行头孢哌酮/舒巴坦联合多西环素治疗,比较两组患者治疗前、后的炎性反应指标、内毒素(革兰阴性菌脂多糖)定量、APACHEⅡ评分变化,观察治疗期间体温、临床疗效等。结果:治疗后观察组患者的WBC、CRP、PCT水平、内毒素定量及APACHEⅡ评分改善效果明显优于对照组,体温下降至正常体温的时间显著短于对照组,治疗总有效率高于对照组,差异均有统计学意义(P<0.05)。结论:头孢哌酮/舒巴坦联合多西环素治疗多重耐药鲍曼不动杆菌肺炎中能有效改善患者的炎性反应指标、毒素定量及APACHEⅡ评分,还能尽快促使患者的体温恢复正常,提升整体治疗效果,值得推广。     

血常规、PCT、CRP及细菌培养在皮肤疖病中的应用价值

目的 探讨血常规、PCT、CRP及细菌培养在皮肤疖病中的应用价值。方法 选择2018年1月至2020年1月本院治疗的120例疖病患者。按随机数字表法分为两组,观察组60例,根据药敏试验结果调整抗生素;对照组60例经验性使用抗生素。收集并比较两组患者的一般资料、入院第1天与治疗第7天的实验室检查结果(WBC计数、NE、PCT、CRP、脓液细菌培养、药敏试验结果 )以及住院情况。结果 两组患者的一般资料对比无统计学意义(P0.05)。治疗第7天,观察组NE绝对值[(9.35±3.05)×109/L]低于对照组[(10.81±3.28)×109/L],两组比较差异有统计学意义(P0.05);观察组PCT含量[(0.25±0.03)ng/mL]低于对照组[(0.28±0.03)ng/mL],两组比较差异有统计学意义(P0.05);观察组CRP水平[(31.26±5.12)mg/L]低于对照组[(46.35±5.15)mg/L],两组比较差异有统计学意义(P0.05)。细菌培养结果为金黄色葡萄球菌,多重耐药(MDR)菌株为15株(12.50%)。观察组住院时间[(12.63±3.29)d]低于对照组[(18.25±5.45)d],两组比较差异有统计学意义(P0.05);观察组住院费用[(3206.02±309.25)元]低于对照组[(5604.06±513.84)元],两组比较差异有统计学意义(P0.05)。结论 NE、PCT、CRP可用于疖病早期诊断,细菌培养及药敏试验对抗生素的选择、缩短住院时间、减少住院费用具有重要意义。     

温脾理气通腑法干预脓毒症胃肠功能障碍的效果

目的观察温脾理气通腑法治疗脓毒症胃肠功能障碍的临床疗效。方法将70例患者随机分为治疗组和对照组,每组35例,两组均给予西医常规治疗,治疗组在西医常规治疗的基础上,联合温脾理气通腑法治疗,疗程均为6 d,观察两组胃肠功能障碍评分、中医症候积分、急性生理与慢性健康Ⅱ(APACHEⅡ)评分、ICU停留时间、28天死亡率和多器官功能障碍综合征(MODS)的发生率、C反应蛋白(CPR)及降钙素原(PCT)的变化。结果治疗后治疗组总有效率为90%,肠胃功能障碍、中医临床症候、APACHEⅡ评分分别从(7.85±4.90)、(13.05±4.50)、(23.85±4.30)下降到(2.15±1.80)、(4.06±3.30)、(10.00±3.30);对照组总有效率为70%,肠胃功能障碍、中医临床候诊、APACHEⅡ评分分别从(7.28±4.10)、(12.96±3.60)、(22.96±4.50)下降到(4.86±2.30)、(9.46±4.20)、(15.44±4.20),治疗组改善程度优于对照组,差异有统计学意义(P0.05);治疗后两组PCT、CRP均较治疗前明显下降,差异有统计学意义(P0.05),且治疗组较对照组下降更为明显,差异有统计学意义(P0.05);治疗组MODS发生率、ICU停留时间亦明显低于对照组,差异有统计学意义(P0.05),但28天死亡率两组比较差异无统计学意义(P0.05)。结论温脾理气通腑法可有效改善脓毒症患者的胃肠功能,抑制机体炎症反应,降低MODS的发生。     

宣白承气汤加减治疗热毒内盛型肺炎相关性脓毒症疗效观察

目的观察宣白承气汤治疗热毒内盛型肺炎相关性脓毒症临床疗效。方法将60例肺炎相关性脓毒症患者随机分为对照组和宣白承气汤观察组(观察组)各30例,两组均予西医常规治疗,观察组在此基础上加用宣白承气汤加减。观察两组治疗第3、7天血气分析中氧分压(PaO_2)、氧合指数(OI)、乳酸(Lac)及C-反应蛋白(CRP)、降钙素原(PCT)等炎症指标变化,同时比较两组治疗后急性生理与慢性健康评分(APACHEⅡ评分)、全身性感染相关性器官功能衰竭评分(SOFA评分)、临床肺部感染评分(CPIS评分)及重症医学科(ICU)住院时间、28天病死率。结果两组于治疗第3、7天的PaO_2、OI、Lac均有所好转,CRP、PCT及APACHEⅡ、SOFA、CPIS评分均有所下降,且第7天上述指标观察组较对照组明显改善,PaO2[(118.4±13.6)比(82.4±11.1)mmHg];OI[(298.1±21.7)比(236.4±20.5)];Lac[(1.0±0.2)比(2.1±0.5)mmol/L];CRP[(35.2±11.0)比(76.9±17.4)mg/L];PCT[(0.9±0.2)比(3.2±1.6)ug/L];APACHEII [(10.2±1.9)比(15.7±3.2)分];SOFA [(1.9±0.7)比(4.0±1.9)分];CPIS[(2.1±0.9)比(4.5±1.0)分],差异均有统计学意义(P0.05),观察组的ICU住院时间、28天病死率均较对照组低,差异均有统计学意义(P0.05)。结论对热毒内盛型肺炎相关性脓毒症患者应用宣白承气汤有助于减轻炎症反应,提高肺的氧合功能,保护全身各组织器官功能,从而改善预后。     

经纤维支气管镜肺泡灌洗阿米卡星在呼吸机相关肺炎合并肾功能不全患者中的应用

目的评价经纤维支气管镜肺泡灌洗阿米卡星在呼吸机相关肺炎合并肾功能不全患者中的应用。方法选择我院2011年6月~2015年6月呼吸机相关肺炎合并肾功能不全的患者48例随机分为观察组和对照组,两组均使用头孢哌酮舒巴坦钠针抗感染治疗,对照组在气管镜肺泡灌洗后不保留药物,观察组在肺泡灌洗后下气道内保留硫酸阿米卡星针,治疗结束后比较观察组、对照组治疗前后及两组之间常用评价指标的变化。结果观察组治疗7 d后APACHEⅡ评分、CPIS评分、PCT、CRP与治疗前及对照组治疗7 d后比较,差异有统计学意义(P0.05);观察组治疗14 d后与对照组治疗14 d后比较CPIS、PCT差异有统计学意义(P0.05),但两组APACHEⅡ、CRP差异无统计学意义(P0.05);观察组治疗前后GFR无恶化(P0.05);观察组与对照组住院天数比较差异有统计学意义(P0.05)。结论通过支气管镜肺泡灌洗给予阿米卡星局部保留,联合使用头孢哌酮舒巴坦治疗MDA-PA致VAP合并肾功能不全患者,与单用头孢哌酮舒巴坦比较,治疗后APACHEⅡ、CPIS、CRP、PCT均有明显好转,而血清肌酐没有明显升高,并且住院天数明显缩短,可减轻患者经济负担。     

新加黄龙汤治疗ICU脓毒症胃肠功能障碍的疗效观察

目的探讨新加黄龙汤治疗ICU脓毒症胃肠功能障碍的疗效。方法选择2018年7月～2019年6月在我院ICU治疗的脓毒症患者60例为研究对象,随机分为观察组与对照组,各30例。对照组给予常规治疗,观察组在此基础上给予新加黄龙汤治疗。比较两组治疗后急性生理与慢性健康评分Ⅱ(Acute physiology and chronic health evaluationⅡ,APACHEⅡ)、器官衰竭序贯评分量表(Sequential organ failure asesment,SOFA)评分、白细胞计数、降钙素原(procalcitonin,PCT)、C-反应蛋白(C-reactive protein,CRP)、胃肠功能障碍评分、腹围、肠鸣音、大便潜血等。结果治疗后,两组APACHEⅡ评分显著低于治疗前,差异有统计学意义(P0.05);治疗后,观察组APACHEⅡ评分显著低于对照组,差异有统计学意义(P0.05)。治疗后,两组SOFA评分显著低于治疗前,差异有统计学意义(P0.05);治疗后观察组SOFA评分显著低于对照组,差异有统计学意义(P0.05)。治疗后,两组白细胞计数、CRP水平、降钙素原水平显著低于治疗前,差异有统计学意义(P0.05);治疗后,观察组白细胞计数、CRP水平、降钙素原水平显著低于对照组,差异有统计学意义(P0.05)。治疗后两组肠功能障碍评分显著下降,腹围缩小,肠鸣音增加,大便潜血阳性率下降,与治疗前比较,差异有统计学意义(P0.05);治疗后,观察组肠功能障碍评分、腹围、大便潜血阳性率显著低于对照组,肠鸣音显著高于对照组,差异有统计学意义(P0.05)。结论新加黄龙汤能改善ICU脓毒症胃肠功能够障碍,改善预后。     

血必净在重症肺炎治疗中的应用研究

目的探究血必净在重症肺炎治疗中的应用价值。方法选取2018年7月至2019年7月本院收治的48例重症肺炎患者为研究对象,使用Excel表格将所有患者的基本信息纳入后进行随机分组,单数为对照组,双数为观察组,各24例。对照组实施常规治疗,观察组在常规治疗基础上展开血必净治疗方式,比较两组相关指标及评分。结果两组降钙素原(PCT)、超敏C反应蛋白(hs-CRP)的炎性反应以及D-二聚体、氧合分数(FiO2)差异有统计学意义(P<0.05);治疗后,两组急性生理与慢性健康评分(APACHEⅡ)、肺炎严重程度评分(PSI)评分差异有统计学意义(P<0.05);两组重症监护室住院时间与肺部感染评分(CPIS)比较差异有统计学意义(P<0.05)。结论对该疾病患者实施血必净治疗有良好应用价值。     

替加环素在多重或泛耐药鲍曼不动杆菌引起的重症医院获得性肺炎治疗中的运用价值

目的 探讨替加环素在多重或泛耐药鲍曼不动杆菌引起的重症医院获得性肺炎治疗中的运用价值。 方法 将2014年7月-2015年12月绍兴市上虞人民医院收治的64例多重或泛耐药鲍曼不动杆菌引起的重症医院获得性肺炎患者分为2组,每组32例。对照组采用头孢哌酮/舒巴坦治疗。观察组在对照组基础上给予替加环素治疗。对比2组临床治疗效果、细菌清除情况、不良反应、病情及炎性指标变化。 结果 观察组疗效显著高于对照组,差异有统计学意义(Z=2.099,P<0.05);观察组细菌清除率(71.87%)、脱机成功率(62.50%)显著高于对照组(43.75%和34.37%),ICU住院时间显著低于对照组,差异有统计学意义(χ2=5.189、5.067,t=4.467,P<0.05);2组不良反应发生率对比差异无统计学意义(P>0.05);2组治疗后生理与慢性健康Ⅱ评分表(APACHE Ⅱ评分)、降钙素原(PCT)、C反应蛋白(CRP)显著降低(P<0.05);观察组治疗后APACHE Ⅱ评分、CRP、PCT显著低于对照组治疗后,差异有统计学意义(t=5.079、8.156、8.633,P<0.05)。 结论 替加环素治疗多重或泛耐药鲍曼不动杆菌引起的重症医院获得性肺炎疗效显著,具有较高的细菌清除率。      

清肺通络汤治疗卒中后多重耐药菌感染肺炎的临床疗效

目的:观察清肺通络汤治疗卒中后多重耐药菌感染肺炎的临床疗效。方法:纳入79例脑卒中后多重耐药菌感染肺炎患者,随机分为治疗组40例和对照组39例。对照组给予常规脑卒中治疗,同时依据痰培养给予相应抗感染治疗;治疗组在对照组基础上给予清肺通络汤加减口服治疗。两组治疗周期均为14 d。评价两组患者的临床疗效及细菌学疗效,检测并比较两组患者的白细胞计数(WBC)、C反应蛋白(CRP)及降钙素原(PCT)水平。结果:治疗后,治疗组的总有效率为90.0%,对照组为59.0%,两组临床疗效比较差异有统计学意义(P0.05)。治疗后,两组患者的致病菌清除情况比较,差异无统计学意义(P0.05);两组患者的WBC、CRP水平较治疗前均明显降低(P0.05),且治疗组患者的WBC、CRP水平低于对照组(P0.05);治疗组患者的PCT水平较治疗前明显降低(P0.05),且治疗组患者的PCT水平低于对照组(P0.05)。结论:清肺通络汤结合西医常规疗法治疗卒中后多重耐药菌感染肺炎,具有良好的临床效果,值得在临床中推广。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.