急性烟雾吸入性肺损伤药物治疗的研究进展

烟雾吸入是火灾中受害者死亡的最主要原因。烟雾中的颗粒物、有毒气体、刺激剂以及窒息剂的共同作用,使肺部发生急剧的病理生理反应,造成急性肺损伤,进而导致人员大量伤亡。近20年来,对烟雾吸入性急性肺损伤的病理生理学机制有了比较清楚的认识,药物治疗方面也取得了较大的进展,本文对此作一综述。     

急性烟雾吸入性肺损伤药物治疗的研究进展

烟雾吸入是火灾中受害者死亡的最主要原因.烟雾中的颗粒物、有毒气体、刺激剂以及窒息剂的共同作用,使肺部发生急剧的病理生理反应,造成急性肺损伤,进而导致人员大量伤亡.近20年来,对烟雾吸入性急性肺损伤的病理生理学机制有了比较清楚的认识,药物治疗方面也取得了较大的进展,本文对此作一综述.     

52例烟雾吸入性肺损伤救治分析

烟雾吸入性肺损伤（smoke inhalation acute lung injury）是火灾,矿井爆炸等的常见并发症,具有发病急,进展快,病死率高等临床特点,目前临床无特效治疗方法 .如何提高烟雾吸入性肺损伤的救治成功率已引起国内外学者的关注.现就我科曾经救治的52例烟雾吸入性肺损伤患者的救治方法 进行总结,旨在探讨烟雾吸入性肺损伤的有效救治方法 ,提高临床救治水平.     

烟雾吸入性急性肺损伤/急性呼吸窘迫综合征的研究进展

目前烟雾吸入性急性肺损伤（ALI）／急性呼吸窘迫综合征（ARDS）的发病机制尚未完全明确，可能与烟雾所致的氧化性损伤、肺表面活性物质变化、细胞因子改变、细胞凋亡的发生有关。与机制相应的治疗方法仍未找到，常见的临床治疗方法（如：机械通气，肺泡灌洗，药物治疗）虽然已被证明有一定疗效，但仍然无法治愈烟雾吸入性ALI／ARDS。体外二氧化碳排除及一氧化氮治疗等新方法的尝试为我们进一步研究烟雾吸入性ALI／ARDS提供了新的思路。     

烟雾刺激通过损伤A549细胞DNA诱导细胞凋亡发生

<正>呼吸道烟雾吸入性损伤是一种极其常见的损伤,常发生于火灾、毒气泄漏或是吸烟等情况下~([1])。烟雾吸入性损伤常常由于吸入燃烧产生的高温、有毒气体而导致,轻者可以出现呼吸道的不适反应,重者则会影响呼吸道的通畅,导致患者窒息死亡。呼吸道烟雾吸入性损伤主要分为两个方面:首先,高温气体的吸入可以引起呼吸道的灼伤,导致呼吸道黏     

大鼠棉花烟雾吸入性肺损伤中的氧化应激

目的 探讨大鼠棉花烟雾吸入性肺损伤中的氧化应激反应机制.方法 18只雄性SD大鼠随机分成对照组、6h组、24 h组,每组6只.复制大鼠棉花烟雾吸入性肺损伤模型,6h组、24 h组大鼠分别在烟雾吸入后6h或24 h行安乐死,ELISA法检测大鼠肺组织丙二醛(MDA)、谷胱甘肽(GSH)、一氧化氮(NO)、诱导型一氧化氮合酶(iNOS)、γ-谷氨酰半胱氨酸合成酶(γ-GCS)浓度,荧光定量PCR法行肺组织iNOS mRNA、γ-GCS mRNA定量.结果 6h组、24 h组大鼠肺组织匀浆中的MDA、NO、iNOS、γ-GCS浓度、iNOS mRNA和γ-GCS mRNA的相对表达量均高于对照组,且NO浓度、iNOSmRNA和γ-GCS mRNA的相对表达量24 h组高于6h组(P值均＜0.05);而6h组和24 h组GSH浓度均低于对照组,且24 h组低于6h组(P值均＜0.05).结论 在大鼠棉花烟雾吸入性肺损伤中,氧化应激反应加剧,同时抗氧化体系的激活不足以对抗氧化应激损伤,氧化/抗氧化体系失衡,导致肺损伤逐渐加重.     

吸入性损伤103例死亡原因分析及治疗体会

吸入性损伤指热力和烟雾引起的呼吸道乃至肺实质的损伤 ,是烧伤患者的主要死亡原因之一。 1990～ 2 0 0 1年 ,我们收治吸入性损伤患者 10 3例 ,死亡 3 7例 ,现对死亡原因进行分析并探讨治疗体会。临床资料 :本组男 71例 ,女 3 2例 ,年龄 2～ 67岁 ,烧伤总面积为 11%～ 97% , 度烧伤面积占 6%～ 71%。根据受伤原因、症状、体征将其分为轻、中、重度组。各组死亡原因见表 1。表 1　 3 7例患者的死亡原因 ( n)死亡原因　轻度组中度组重度组窒息 412急性中毒 13肺内感染 35呼吸窘迫 16菌血症 2 2 4多器官衰竭 1肾衰 11合计 7 82 2　　治疗原则 :…     

富氢生理盐水对烟雾吸入所致大鼠急性肺损伤的保护作用

目的 观察富氢生理盐水对烟雾吸入所致大鼠急性肺损伤的保护作用.方法 雄性Sprague-Dawlay大鼠72只,随机分为空白对照组18只,损伤对照组18只,生理盐水组（NS组）18只和富氢生理盐水组（HS组）18只.损伤对照组、NS组、HS组制作烟雾吸入性急性肺损伤模型,空白对照组不做特殊处理.造模成功后,损伤对照组不注射任何药物,NS组、HS组分别于造模后2、6、12 h各取6只大鼠腹腔注射5 mL/kg生理盐水和富氢生理盐水.造模24h后检测各组大鼠血清TNF-α,采用免疫组化法检测大鼠肺组织中的NF-κB p65,原位末端标记法（TUNEL）检测肺组织细胞凋亡情况,计算凋亡指数（AI）.光镜下观察大鼠肺组织病理改变,透射电子显微镜观察肺组织亚细胞结构改变.结果 大鼠血清TNF-α水平、肺组织中NF-κB p65阳性表达率、肺细胞AI在损伤对照组、NS组及HS组均高于空白对照组,HS组低于相应时点的NS组（P均＜0.05）;HS组造模后2h肺细胞AI＜造模后6h＜造模后12h（P均＜0.05）,光镜及电镜观察结果与之一致.结论 富氢生理盐水对大鼠烟雾吸入性急性肺损伤的肺组织有保护作用,应用越早,效果越好.     

烧伤病人吸入性损伤的气道管理

吸入性损伤通常为吸入高热气流或烟雾所致，是热力或热和化学的复合性损伤，烟雾中含有燃烧不完全产物，病人往往伴有cO及其它有毒气体（如NO2，SO2）中毒，损伤发生后易发生窒息，危及生命，导致死亡。因此，加强烧伤病人吸入性损伤的气道管理，尽可能的减少并发症，对降低死亡率有重要作用。     

烟雾吸入性肺损伤对肺泡吞噬细胞功能的损害

烟雾吸入性肺损伤(SII)者易发生细菌性肺炎和ARDS,可能与烟雾导致肺泡吞噬细胞(AM)功能损害有关。作者给绵羊吸入烟雾,观察SII前后AM抗菌能力变化以及AM对中性粒细胞(PMN)凋亡的影响。 方法 绵羊(n=9)麻醉后,气管插管接呼吸机辅助呼吸。纤维支气管镜末端嵌顿于二级支气管,冲洗远端气道获取支气管肺泡灌洗液(BALF)。在发烟器中燃烧40g棉花球以产生烟雾,绵羊在128次呼吸中吸入     

Management of survivors of out-of-hospital cardiac arrest

Sudden cardiac death is a major cause of death in the western world. Since a 1-year recurrence rate of 30% is expected in survivors of sudden death, treatment is mandatory. If an apparent cause (e.g. proarrhythmia or acute ischemia) exists, treatment is generally directed at its alleviation. However, in most patients no obvious cause is found. Both noninvasive and invasive diagnostic procedures are employed to uncover treatable etiologies. If a treatable cause is not found, an electrophysiological study may be employed to tailor antiarrhythmic therapy. At this point, many patients still cannot be offered an adequate antiarrhythmic treatment. For these patients, amiodarone, antiarrhythmic surgery or an implantable defibrillator may be appropriate options. Algorithms for diagnostic and therapeutic interventions in survivors of sudden cardiac death are delineated.     

Accuracy of Death Certificates in COPD: Analysis from the TORCH Trial

ABSTRACT

The Towards a Revolution in COPD Health (TORCH) trial was an international clinical trial of chronic obstructive pulmonary disease (COPD) patients where cause of death was assigned by an independent committee. Comparison of death certificate data and adjudicated cause of death allows a unique opportunity to determine death certificate accuracy and frequency of COPD listing on death certificates of COPD patients. In this analysis, the authors determine the concordance between adjudicated cause of death and primary and secondary cause of death from death certificates. In 317 (80%) of informative deaths, the primary or secondary cause of death from certificates agreed with adjudicated cause of death. Only 229 (58%) of death certificates in these COPD patients listed COPD on the certificate. COPD was not listed on the death certificate in 21% of deaths adjudicated to be caused by COPD exacerbation. Compared with pulmonary causes, the listing of COPD on certificates occurred with less frequency than cardiovascular, cancer and other categories of death. The combined primary and secondary listing on death certificates has good concordance with actual cause of death. COPD is under-reported on death certificates, and this under-reporting is more frequent when the primary cause of death is not pulmonary.     

骨科老年住院患者死亡情况分析

目的分析骨科老年住院患者的死亡情况。方法对北京军区总医院骨科2011年1月至2015年12月期间老年住院患者死亡病例进行回顾性分析,包括患者一般情况、入院诊断、合并内科疾病及死亡原因等。结果共收集54例死亡患者,男性26例,女性28例,平均年龄82.3岁。57.4%的死亡患者因髋部骨折入院。合并内科疾病最常见的为高血压,占44.4%。同时患有≥3种疾病的患者占48.1%。肺部感染是死亡最常见的原因,占70.3%。结论骨科老年住院死亡患者中以髋部骨折最常见,多数患者通常合并多种内科疾病,肺部感染是死亡的主要原因。     

The Cause of Death in Inflammatory Bowel Disease: A Comparison of Death Certificates and Hospital Charts in Rochester, New York

Objective: This study examines the causes of death from Crohn's disease and ulcerative colitis by comparing death certificates with hospital charts as part of an ongoing, community-based analysis in Rochester, NY. Methods: A registry of 1358 inflammatory bowel disease patients followed from January 1973 to December 1989 was analyzed for the cause of death by a study of death certificates as well as by a study of hospital records, including surgical pathology and autopsy records. A panel of physicians defined specific criteria for diagnosis, cause of death, and relation of death to inflammatory bowel disease. Results: One hundred and thirty patients (59 with ulcerative colitis and 71 with Crohn's disease) from the registry were found to have death certificates recorded by Monroe County during this period. There was an 80% concordance of the death certificate to the hospital record for the cause of death and its relationship to inflammatory bowel disease. Discordance was noted in cases of colon cancer and surgical complications. Conclusions: Sixty-eight percent of Crohn's disease and 78% of ulcerative colitis patients died from causes unrelated to their inflammatory bowel disease. Deaths caused by Crohn's disease decreased from 44% in the 1973–1980 period to 6% in the 1981–1989 period. Crohn's disease was it direct cause of death in 25% of the female patients, whereas only 6% of male patients died directly of Crohn's disease. Colorectal cancer caused 14% of the deaths in ulcerative colitis patients, three times more often than in Crohn's disease patients. Excluding cancer, there were only two deaths directly due to ulcerative colitis, both in the first 2 yr after diagnosis.     

Pneumocystis carinii pneumonia. An uncommon cause of death in African patients with acquired immunodeficiency syndrome.

Admissions and deaths in a pulmonary medicine ward in Abidjan, Cote d'Ivoire, West Africa, were evaluated over a 6-month period in 1989 with systematic autopsies on all patients who died. Of 473 patients admitted, 38% were HIV-1 seropositive, 4% were HIV-2 seropositive, and 14% reacted to both viruses. A total of 100 patients (21%) died, and deaths were twice as frequent in HIV-seropositive compared with HIV-negative patients. The pathology of 78 autopsies showed that the predominant cause of death in HIV-seropositive patients was disseminated tuberculosis (40%). Cancer was the cause of death in 64% of HIV-negative patients. Pneumocystosis was found in only 9% of HIV-seropositive autopsies. Since Pneumocystis carinii is an uncommon cause of death in this population, prophylaxis for P. carinii pneumonia is not warranted for HIV-infected patients in Africa. In contrast, research on chemoprophylaxis for tuberculosis is urgently required.     

体质指数与收缩性心力衰竭预后的相关性

目的 在没有心血管疾病的正常人群中,超重和肥胖会增加死亡风险.然而,某些慢性疾病患者,低体质指数(BMI)与病死率增加相关.研究旨在探讨BMI对收缩性心力衰竭(心衰)患者预后的影响.方法 对540例经超声心动图证实左室射血分数≤45%的陈旧性心肌梗死和扩张型心肌病患者进行随访,平均年龄58.53岁,其中男性84.2%.结果 在随访期间(中位随访时间24个月),共有92例死亡,其中87例患者心原性死亡,92例因心衰再次入院.与BMI≥28.0 kg/m~2肥胖的收缩性心衰患者比较,低体重(BMI<18.5 kg/m~2)和正常体重(BMI≥18.5 kg/m~2、<24.0 ks/mm~2)收缩性心衰患者全因病死率、心原性病死率、心衰病死率和总心脏事件率均显著升高(均为P<0.05),OR(95%CI)分别是5.44(1.78～16.66)、4.30(1.71～10.82),5.42(1.77～16.59)、4.00(1.59～10.10),8.94(2.37～33.74)、4.97(1.52～16.20),2.10(1.09～4.07)、1.79(1.14～2.82).多元Cox回归校正年龄、性别、NYHA分级、左室射血分数值以后,BMI分组对收缩性心衰患者全因病死率(OR=0.77,P<0.05)、心原性病死率(OR=0.78,P<0.05)和心衰病死率(OR=0.79,P<0.05)仍有显著影响.结论 收缩性心衰患者BMI低是预后差的一个独立预测因素.在南陈旧性心肌梗死和扩张型心肌病所致的收缩性心衰患者中,与肥胖患者相比,极低体重和正常体重患者全因病死率、心原性病死率和心衰病死率较高.     

Clinical study on mortality of rheumatoid arthritis compared with malignant rheumatoid arthritis]

OBJECTIVE: To determine how the mortality of patients with rheumatoid arthritis (RA) behave in comparison with that of patients with malignant rheumatoid arthritis (MRA). METHODS: The mortality of RA patients selected at randam identified in 1991-2000 (n = 104) was compared with that of 18 MRA patients. Hazard ratios of death were calculated with a multivariate survival analysis. A clinical study of patients with both RA and MRA was performed in mortality. RESULTS: Excess mortality was seen in MRA patients in Kaplan-Meier survival curves (p = 0.02 by log-rank test). MRA patients were treated more often with cytostatic and immunosuppressive drugs. Infection was the main cause of death in both RA and MRA patients. Vasculitis was not reported as the cause of death in MRA patients. Secondary amyloidosis played an important role in RA death rather than MRA. CONCLUSION: There remained an excess mortality in MRA patients compared with RA, and infection was attributable to the key cause of death in both RA and MRA suggesting therapeutic side effects.     

Evaluation and outcome of patients with syncope

We studied 433 patients with syncope to derive insights into the diagnostic evaluation and outcome of patients with this common problem. This study shows that the etiology of syncope was not found in approximately 41% of patients. When a cause of syncope was determined, it was most frequently established on the basis of initial history, physical examination and an electrocardiogram (EKG). Furthermore, many of the other entities (e.g., aortic stenosis, subclavian steal) were suggested by findings on the history and physical examinations that required directed diagnostic testing. Initial EKG was abnormal in 50% of patients but led to a cause of syncope infrequently (less than 7%). Prolonged electrocardiographic monitoring, which has assumed a central role in the evaluation of syncope, led to a specific cause in only 22% of patients. Other tests were less often helpful in assigning a cause of syncope. At 5 years, the mortality of 50.5% in patients with a cardiac cause of syncope was significantly higher than the 30% mortality in patients with a noncardiac cause or 24.1% in patients with an unknown cause. At 5 years, a mortality of 50.5% in patients with a cardiac cause of syncope was noted. There were 54 actual deaths in this group as compared to 10.7 expected deaths based on 1980-86 mortality data from Allegheny County, PA (standardized mortality ratio = 5.02). At 5 years, a 33.1% incidence of sudden death was noted in patients with cardiac cause of syncope, as compared with 4.9% in patients with a noncardiac cause and 8.5% in patients with an unknown cause. Mortality and sudden death remained significant for the first 3 years after which the survival curves were parallel. A cardiac cause of syncope was an independent predictor of sudden death and mortality. Recurrences were common but were not associated with an increased risk of mortality or sudden death. Major vascular events were also more frequent in patients with cardiac causes of syncope. The results of this study will be helpful in designing future studies to evaluate the usefulness of newer diagnostic techniques. Furthermore, short- and long-term outcome data will be useful in planning intervention strategies in these patients.     

Causes of death among patients with HIV in Singapore from 1985 to 2001: results from the Singapore HIV Observational Cohort Study (SHOCS)

OBJECTIVES: To investigate the major primary and contributory causes of death among HIV patients in Singapore. DESIGN: A retrospective observational cohort study of all adult patients seen at the national referral centre for HIV in Singapore between 1985 and 2001. METHODS: Data were extracted from the patients' records by 10 trained health care workers. AIDS-defining conditions were established using predefined criteria. For each case, a single principal cause of death and up to three contributory causes were identified. RESULTS: A total of 1504 patients aged 17 years or over were seen before the end of 2001, of whom 504 have died. The most frequent principal causes of death were Mycobacterium avium (17.5%), Mycobacterium tuberculosis (9.7%), pneumonia (cause unknown) (6.5%) and Cryptococcus neoformans (6.7%). Three hundred and eighteen patients (63.1%) died from an AIDS-defining condition. CONCLUSIONS: The causes of death were similar to those found in Western cohorts, except that disseminated M. avium was a more frequent cause of death.     

The causes of death in Korean patients with systemic lupus erythematosus over 11 years

We investigated the causes of death and analyzed the prognostic factors in Korean systemic lupus erythematosus (SLE) patients. We evaluated 1010 patients with SLE who visited Seoul Saint Mary's Hospital from 1997-2007. Changing patterns in the causes of death were analyzed. Survival rate was calculated by the Kaplan-Meier method and the log-rank test. The risk factors for death were analyzed by multivariate logistic regression analysis. The 5-year survival rate was 97.8%. Over the period of the study, 59 deaths were observed. Among 44 patients who died in our hospital, the most common cause of death was infection (37.3%), with SLE-related death as the next most frequent cause (22.0%). In comparison with earlier data, the proportion of SLE-related deaths has fallen and the proportion of infections has risen. SLE-related death was the most frequent cause of early death, while infection was the most common cause of death in the overall population. In univariate analysis, damage related to SLE, cumulative glucocorticoid dose, mean glucocorticoid dose for 1?month before death, intravenous methylprednisolone therapy and cyclophosphamide treatment were associated with death (p?相似文献