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1.
目的:探讨连续性血液净化(CBP)对多器官功能障碍综合征(MODS)患者凝血功能的影响。方法:选取2010年4月~2016年2月我院收治的48例MODS患者为研究对象,均行CBP治疗。观察CBP治疗前后患者凝血功能及急性生理与慢性健康评分(APACHEⅡ)、MODS评分。结果:治疗后PT、APTT高于治疗前,D-D、FIB及APACHEⅡ、MODS评分均低于治疗前(P0.05)。结论:连续性血液净化治疗可有效改善多器官功能障碍综合征患者凝血功能,促进凝血-纤溶系统平衡的恢复,控制患者病情恶化。  相似文献   

2.
连续性血液净化治疗对脓毒症患者凝血功能的影响   总被引:7,自引:3,他引:4  
目的观察连续性血液净化(CBP)治疗对脓毒症患者凝血功能的影响。方法对19例脓毒症患者行30例次CBP治疗,在治疗前、停止治疗时及治疗后第2天观察患者APACHEⅡ评分及凝血功能的相关参数的变化。结果治疗后APTT、TT较治疗前延长,差异有显著意义;治疗后第2天,APTT、TT仍延长,但无统计学意义,PT、Fg无明显变化,APACHEⅡ评分、D—D较治疗前下降,差异有显著意义。结论CBP是治疗严重脓毒症的有效措施之一,能改善其凝血功能,而改善凝血功能的机制可能与多种因素有关。  相似文献   

3.
目的观察清热化瘀汤对严重脓毒症患者凝血功能及预后的影响,为其临床运用提供依据。方法选择72例2010年至2012年于清远市中医院ICU住院的严重脓毒症患者,随机分为治疗组(38例)和对照组(34例),两组均按照指南要求给予常规治疗,治疗组于常规治疗基础上加用清热化瘀汤治疗。治疗前及治疗7d后两组均检测PLT、PT、APTT、FIB、D—D等凝血相关指标,并记录APACHE-Ⅱ评分,随访统计住院天数及28d病死率。结果(1)与治疗前比较,治疗后治疗组PLT、PT、APTF、FIB、D—D等凝血指标均有改善(P均〈0.01),对照组仅PLT、FIB、D-D有改善(P均〈0.01);且治疗后,治疗组PLT、FIB高于对照组(P均〈0.05),PT、APTT、D-D低于对照组(P均〈0.05)。(2)治疗后两组APACCHE-Ⅱ评分均下降(P均〈0.01),且治疗组低于对照组(P〈0.05)。(3)两组住院天数相近。(4)两组28d病死率差异无统计学意义(P〉0.05)。结论清热化瘀汤可通过改善严重脓毒症患者的凝血功能而改善预后。  相似文献   

4.
连续性血液净化对重症脓毒症患者内皮损伤的保护作用   总被引:3,自引:2,他引:1  
目的研究连续性血液净化(CBP)治疗重症脓毒症患者,对血管内皮损伤的保护作用,及血管内皮损伤与病情演变之间的关系。方法17例重症脓毒症患者接受连续性血液净化(CBP)治疗共25次,观察患者接受CBP治疗前、治疗结束后次日血管性假性血友病因子(vWF)、凝血象、血常规及生化指标等变化;根据患者接受CBP治疗前和治疗后采集血标本时间不同,分为治疗前组和治疗后组;根据患者的预后分为存活组和死亡组。结果CBP治疗后组vWF较治疗前组显著降低(P〈0.05),治疗后组APACHEⅡ和MODS评分也较治疗前组明显降低(P〈0.05);CBP治疗前组,vWF与血白细胞计数(WBC)及血小板计数(PLT)呈正相关(P〈0.01),与氧合指数呈负相关(P〈0.05);CBP治疗后组,vWF与WBC和D-二聚体均呈正相关(P〈0.01,0.05)。CBP治疗后存活组患者,vWF仅仅与血WBC呈正相关(P〈0.01);而CBP治疗后死亡组患者,vWF与总脱水量及红细胞比积呈正相关(P〈0.01),而与PT-INR和APTT呈负相关(P〈0.01,P〈0.05)。结论CBP治疗对重症脓毒症患者血管内皮损伤起到保护作用;在CBP治疗过程中,脱水过多,又可能加重血管内皮损伤。  相似文献   

5.
连续性血液净化治疗全身性炎症反应综合征的研究   总被引:13,自引:0,他引:13  
目的 研究连续性血液净化(CBP)治疗全身性炎症反应综合征(SIRS)的疗效,并探讨其使用时机。方法 选择27例处于SIRS状态的患者给予CBP治疗,观察治疗前、中、后患者血液生化指标、血常规、血气分析和肿瘤坏死因子α(TNFα),并进行APACHEⅡ、SAPSⅡ和MODS评分。结果 与治疗前相比较,CBP治疗第2天晨和CBP治疗结束后次日晨患者APACHEⅡ、SAPSⅡ和MODS评分较治疗前降低,治疗过程中氧合指数(PO2/FiO2)有所改善,治疗过程中及治疗后压力调整心率(PAHR)较治疗前降低。CBP治疗后,TNFα降低不明显。结论 CBP治疗SIRS疗效确切,但患者的预后与患者病情的严重程度和原发病能否有效得以控制有关;CBP治疗过程中患者心、肺功能有所改善;CBP治疗SIRS并非通过清除TNFα而起作用。  相似文献   

6.
连续性血液净化治疗重症急性胰腺炎机制的临床研究   总被引:11,自引:2,他引:9  
目的 研究连续性血液净化 (CBP)治疗重症急性胰腺炎 (SAP)的机制。方法 选择 10例SAP患者给予CBP治疗 ,观察治疗前、中、后患者血液生化指标、血常规、血气分析和肿瘤坏死因子α(TNF -α) ,并进行APACHEⅡ、SAPSⅡ和MODS评分。结果 与治疗前相比较 ,CBP治疗第 2日晨和CBP治疗结束后次日晨患者APACHEⅡ、SAPSⅡ和MODS评分较治疗前降低 ,治疗后氧合指数 (PO2 /FiO2 )有明显改善 ,压力调整心率 (PAHR)治疗过程中较治疗前降低。CBP治疗次日晨PO2 /FiO2 及PAHR与治疗前的差值 ,和CBP脱水量呈正相关 ;CBP治疗第 2日晨 ,脱水量与MODS评分呈负相关。CBP治疗过程中血BUN、Cr和尿酸均降低 ,治疗时间越长 ,降低越明显。CBP治疗后TNF -α降低不明显。结论 CBP治疗后心、肺功能的改善与脱水后组织器官间质水肿减轻有关 ,但并非脱水越多越好。从清除BUN、Cr来看 ,CBP治疗时似乎越长越好 ;但对BUN、Cr正常的患者 ,治疗时间可以缩短。治疗前、中、后的TNF -α变化不支持CBP治疗SAP是通过清除TNF -α而起作用的观点。  相似文献   

7.
山莨菪碱对多器官功能障碍综合征患者凝血功能的影响   总被引:1,自引:0,他引:1  
目的探讨MODS患者凝血系统的变化及山莨菪碱对其凝血异常的影响.方法46例MODS患者随机分为A、B两组,A组为常规治疗组,B组在常规治疗的基础上加用山莨菪碱,观察治疗前及治疗第4、7天的APACHEⅡ评分及Marshall评分和凝血指标包括凝血酶原时间(PT)、部分激活的凝血酶原时间(APTT)、凝血酶时间(TT)、抗凝血酶Ⅲ(AT-Ⅲ)、血小板计数(PLT)及血浆D-二聚体(D-D)情况,对其变化趋势进行分析,20名健康成人作对照组.结果治疗前所有入选MODS患者均存在凝血异常,表现为APTT、PT、TT延长(P<0.01),AT-Ⅲ活性下降(P<0.01),血浆D-D明显升高(P<0.01),血小板计数下降(P<0.01);经治疗后两评分水平均改善,同时APTT、PT、TT逐渐趋于正常,AT-Ⅲ活性恢复,血小板计数回升,D-D明显下降,所有改变均以B组明显,且第4天时即已表现出明显变化.结论MODS患者存在凝血异常,该异常主要表现为凝血、纤溶激活而抗凝抑制,山莨菪碱能使MODS患者的凝血异常改善.  相似文献   

8.
目的研究连续性血液净化(CBP)治疗对全身炎症反应综合征(SIRS)患者血清抵抗素含量的影响。方法将120例SIRS患者在常规对症治疗的基础上,分为常规治疗组60例;以及在常规治疗的基础上进行CBP治疗组(CBP组),CBP组患者均在常规治疗的同时行CBP治疗72h,在治疗0,24,48,72,96h时检测患者血清抵抗素含量,并进行APACHEⅡ评分。结果两组SIRS患者治疗前血清抵抗素含量均明显高于正常对照组(P〈0.01),且常规治疗组和CBP组抵抗素含量比较无统计学意义(P〉0.05),经过96h治疗,各组患者抵抗素水平均明显降低常规治疗组经过96h治疗,血清抵抗素水平降低缓慢(P〈0.05);CBP治疗组经CBP治疗后SIRS患者血清抵抗素含量逐渐降低,治疗48h后已显著低于治疗前(P〈0.05),治疗72h后降低更为明显(P〈0.01)。SIRS患者抵抗素与APACHEⅡ评分呈正相关(r=0.58,P〈0.01)。结论CBP治疗可清除血液中炎症因子抵抗素的作用,改善患者内皮细胞功能,并为临床观察CBP的治疗效果提供了新的监测指标。  相似文献   

9.
高容量血液滤过治疗脓毒症合并MODS临床应用   总被引:4,自引:0,他引:4  
目的:探讨高容量血液滤过(HVHF)在脓毒症合并多器官功能障碍综合征(MODS)治疗中的临床疗效。方法:HVHF治疗6例脓毒症合并MODS患者,观察治疗前后患者血流动力学、呼吸参数等全身情况的变化及TISS评分、APACHE-II评分、MODS评分的变化。结果:6例经HVHF治疗后,血流动力学参数,TISS评分均有明显改善,APACHE-Ⅱ和MODS评分也有下降趋势。结论:HVHF可以改善全身感染合并MODS病人呼吸和循环功能,并有缓解病情,提高危重症病人生存率。  相似文献   

10.
血栓前体蛋白测定在严重脓毒症中的临床意义   总被引:4,自引:0,他引:4  
目的 评价血浆血栓前体蛋白( TPP)浓度变化在严重脓毒症中的意义。方法 应用酶联免疫技术测定2 2例严重脓毒症患者TPP浓度及凝血酶原时间( PT)、活化部分凝血激酶时间( APTT)、纤维蛋白原( Fib)、D- 二聚体含量,并与1 0例一般感染组、8例正常对照组进行比较。同时动态观察严重脓毒症患者收入重症监护治疗病房( ICU)后第1、3和5d各项凝血指标,及与感染相关器官衰竭评分系统( SOFA)、简化急性生理评分系统 ( SAPS )、Marshall多器官功能障碍综合征评分进行相关性分析。结果 1严重脓毒症组TPP浓度与D 二聚体含量阳性率显著高于一般感染组和正常对照组( P均<0 .0 5) ,而PT、APTT、Fib在3组间差异均无显著性( P均>0 .0 5)。2严重脓毒症死亡患者的TPP浓度持续升高,与SOFA、SAPS 、Marshall评分呈正相关。结论 TPP可作为严重脓毒症预后及早期高凝状态的诊断指标;与PT、APTT、Fib、D -二聚体相比具有更高的敏感性和特异性。  相似文献   

11.
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.  相似文献   

12.
Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.  相似文献   

13.
This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.  相似文献   

14.
目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4%(55/72)]明显高于成功组[31.7%(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3%(42/72)]高于成功组[38.1% (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9% (28/72)]高于成功组[23.8%(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大<6 cm、胎头位于坐骨棘上及宫口开大8~10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1%(44/72)]高于成功组[38.9%(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2%(52/72)]明显高于成功组[34.1 %(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.  相似文献   

15.
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.  相似文献   

16.
The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.  相似文献   

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目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高<20%视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P<0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P<0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P<0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.  相似文献   

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Ranganath C  Heller AS  Wilding EL 《NeuroImage》2007,35(4):1663-1673
Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.  相似文献   

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