血小板及骨髓象变化在危重病临床监测中的意义

目的　研究血小板及骨髓象变化在危重病临床监测中的意义。方法　ICU危重病患者 2 13例 ,入选标准为各种原因所致的SIRS和MODS。回顾性将病例分为死亡组 (n=6 2 ) 和存活组 (n=15 1)。入院后当天及 3、 7、 10d进行APACHEⅡ评分和血小板检查 ,入院后次日对各种体液进行细菌和真菌培养。35例患者在入ICU后 2 4小时内进行骨髓象检查。结果　入ICU时存活组和死亡组APACHEⅡ评分明显增高 ,但差异无显著意义 ;治疗 7d和 10d后 ,存活组下降至 10分以下 ,而死亡组上升至 2 0分以上 (P <0 0 1)。血小板在入院时两组均降低 ,但在治疗 7d和 10d死亡组患者血小板再度进行性下降 ,而存活组上升至正常范围 (P <0 0 0 1)。严重的阴沟杆菌感染、金黄色葡萄球菌感染 (MRA)和真菌性脓毒症 ,血小板低下的发生率分别为 72 3%、 89 6 %和 93 5 %。危重病患者骨髓象显示存活组带状核和分叶核粒细胞、浆细胞、巨核细胞明显高于死亡组 (P <0 0 5 ) ,而淋巴细胞死亡组显著高于存活组 (P <0 0 1)。结论　血小板进行性下降和骨髓抑制能较正确、敏感地反映危重病患者的病情和预后 ,而血小板检查快速、简单易行在临床上更有实用价值。     

血小板及骨髓象变化对危重病患者预后的影响

目的 探讨血小板及骨髓象变化对危重病患者预后的影响.方法 将危重病患者按血小板是否减少分为血小板减少组和非血小板减少组,按随访结果 再分为存活组和病死组,所有患者分别记录入ICU 24 h内APACHEⅡ评分、多器官功能障碍综合征(MODS)发生率和入ICU 1、3、5、7、10 d血小板计数.血小板减少组中20例患者行骨髓穿刺涂片检查.结果 血小板减少组APACHEⅡ评分、MODS发生率及住院病死率均明显高于非血小板减少组,但住ICU时间两组比较差异无统计学意义;危重病患者骨髓象显示,存活组巨核细胞数高于病死组(P＜0.05),同时发现,存活组杆状核、分叶核粒细胞和浆细胞数高于病死组,而淋巴细胞数显著低于病死组.结论 血小板进行性下降和骨髓象变化能较正确、敏感地反映危重病患者的病情和预后,而血小板检查快速、简单易行,在临床上更有实用价值.     

血小板及骨髓象变化与危重病患者预后关系的研究

目的 探讨血小板及骨髓象变化与危重病患者预后的关系。方法将危重病患者按血小板是否减少分为血小板减少组和非血小板减少组，根据患者预后再分为死亡组和生存组，所有患者分别记录入ICU24h内APACHEⅢ评分、多器官功能障碍综合症（MODS）发生率和入ICU1、3、7、14D的血小板计数。血小板减少组中51例行骨髓穿刺涂片检查。结果血小板减少组APACHEⅢ评分、MODS发生率及住院病死率均明显高于非血细胞减少组，但住ICU时间两组比较差异无统计学意义；危重病患者骨髓象显示，生存组巨核细胞数高于死亡组（P〈0．05），同时，生存组杆状核、分叶核细胞和浆细胞数高于死亡组，但淋巴细胞数显著低于死亡组。结论血小板进行性下降和骨髓象抑制能较准确、敏感地反映危重病患者的病情和预后，而血小板检查快速、简单易行，在临床上有实用价值。     

血小板水平在危重病临床监测中的意义

目的：了解血小板水平在危重病临床监测中的意义。方法：重症监护病房(ICU)患者51例，于入院第1天测定血小板水平和急性生理学慢性健康状况评分Ⅱ(APACHEⅡ评分)，并按患者的APACHEⅡ评分分值将患者分为3组，分析3组患者的血小板水平和预后；根据出院情况将患者分为生存组和死亡组，比较2组患者的血小板水平和APACHEⅡ评分。结果：入ICU时3组患者的血小板水平和死亡率比较有显著性差异(P＜0．05)；死亡组APACHEⅡ评分较生存组高，血小板水平较生存组低．2组患者的APACHEⅡ评分和血小板水平比较均有显著性差异(P＜0．001)。结论：患者APACHEⅡ评分分值越高，病情越重，血小板水平越低，死亡率越高。血小板水平能准确、敏感地反映危重病患者的病情和预后。     

危重病患者血小板水平与APACHEⅡ评分的关系

目的:研究危重病患者血小板水平变化与APACHEⅡ评分的关系。方法:危重病患者71例于入院第1d测定血小板水平和APACHEⅡ评分,并按APACHEⅡ评分分为3组,分析各组患者的血小板水平和预后;根据预后分为存活组和死亡组。比较两组的血小板水平和APACHEⅡ评分。结果:不同APACHEⅡ评分分值组患者的血小板水平和死亡率比较有显著性差异(P<0.05);存活组血小板水平较死亡组高,APACHEⅡ评分较死亡组低,两组患者的血小板水平和APACHEⅡ评分比较均有显著性差异(P<0.01)。结论:患者病情越重,血小板水平越低,APACHEⅡ评分越高,死亡率越高。     

血小板在危重病患者全身炎症反应监测中的意义

目的 :研究血小板在危重病全身炎症反应监测中的意义 ,为全身炎症反应综合征 (SIRS)提供敏感而简易的临床监测指标。方法 :ICU内各种原因所致的 SIRS、脓毒症和多器官功能障碍综合征 (MODS)患者 2 13例 ,按临床结局将患者分为死亡组 (n=6 2 )和存活组 (n=15 1)。入院后当天和第 3d、7d、10 d进行急性生理学和慢性健康状况评分 (APACHE )、血常规和外周血中肿瘤坏死因子α(TNFα)检测。结果 :入 ICU时存活组和死亡组 APACHE 评分明显增高 ,但无显著差异 ;治疗 7d和 10 d后 ,存活组下降至 10分以下 ,而死亡组上升至 2 0分以上 (P<0 .0 1)。血小板计数在入院时两组均降低 ,治疗 3d后有明显回升 ,但在治疗后 7d和 10 d时死亡组患者血小板再度进行性下降 ,而存活组上升至正常范围 (P<0 .0 0 1) ;白细胞总数和分类两组间无显著差异。入院时两组患者外周血中 TNFα的浓度无显著差异 ,3d后两组 TNFα均升高 ;治疗 7d和 10 d后存活组 TNFα水平显著下降 ,而死亡组患者仍维持在相对高的水平 ,两组间有显著性差异 (P均 <0 .0 0 1)。结论 :血小板进行性下降能较正确、敏感地反映全身炎症反应的强弱 ,且其检查快速、简单、易行 ,在临床上有较大的实用价值。     

危重患者血小板减少症发病危险因素及预后分析

目的 研究ICU危重患者血小板减少症(TCP)的发病危险因素及预后分析.方法 前瞻性观察267例ICU危重患者血小板计数等指标的变化,并比较TCP的发病与危重病评分、病种、出血、ICU住院时间和死亡率等的关系.结果 TCP发病率26.6%,比非TCP患者MODS、APACHEⅡ、SAPS Ⅱ评分更高,ICU住院时间延长,ICU死亡率上升.Logistic回归分析中,脓毒症是TCP高风险的独立致病因素,血小板计数最低值与高出血风险保持显著相关,而缩短TCP持续时间能显著降低出血发生;入院时三种评分系统高分值与高死亡率相关,住院期间大于30%幅度的血小板计数下降是ICU患者有统计学意义的死亡危险因素,而血小板计数最低值的恢复与降低死亡率相关.结论 脓毒症是ICU危重患者TCP的主要原因;血小板计数可以作为评估出血、死亡等预后的指标,其动态变化可以独立于并作为危重病评分系统的补充.     

早期血磷水平对危重病患者预后的影响

目的 观察危重病患者早期血磷水平,探讨其对预后的影响.方法 入住我院重症监护病房(ICU)的危重病患者52例,入科后行急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ),检测血磷含量,记录患者机械通气时间及1个月的存活情况.结果 危重病患者早期血磷含量与APACHE Ⅱ评分、机械通气时间均存在显著负相关(P＜0.01);死亡组血磷较生存组显著降低(P＜0.05),APACHEⅡ评分明显增加(P＜0.05),机械通气时间明显延长(P＜0.05).结论 危重病患者早期检测血清磷含量对于判断其病情及预后具有重要价值.     

动态监测血小板水平与评估危重病患者的病情和预后

目的通过动态监测血小板水平以评估危重病患者的病情和预后。方法对住院危重病患者每隔1天进行1次血液细胞分析，观察血小板水平的发展趋势，分析存活组和死亡组的血小板水平变化与危重病患者的病情和预后的关系。结果危重病患者存活组与死亡组血小板水平均有不同程度的下降。存活组血小板水平下降到一定程度后就逐渐回升到正常范围，而死亡组血小板水平的总趋势呈进行性下降。在诊断为危重病前3d，两组血小板水平差异无统计学意义（P〉0．05），第7天后两组血小板水平差异有统计学意义（P〈0．01）。结论血小板水平的变化可以反映危重病患者当前的治疗效果，动态监测血小板水平的发展趋势可以评估危重病患者的病情和预后。     

血小板计数变化在急性重度中毒患者中的意义

目的:探讨急性重度中毒患者血小板计数变化规律及其临床意义。方法:对99例急性中毒患者第1、3、5、8、11天外周血小板计数的变化规律及其与预后的关系进行回顾性分析。结果:死亡组各时相血小板计数均低于存活组,且于第1、3、5天两组血小板计数比较差异均有显著性,P值分别是0.002、0.002、0.000,另外,死亡组各时相血小板计数减少检出率均高于存活组,入院时血小板计数<100×109/L检出共18例(占18%),死亡10例,病死率高达56%(10/18)。结论:急性中毒患者病情严重程度及病死率与血小板计数下降有一定的关系,血小板计数持续减少,患者预后差,并发症多且严重,病死率高,而血小板计数短暂下降后持续升高则提示预后良好,血小板的动态变化对预测急性中毒患者病情、判断预后是可靠的监测指标。     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.