1例接受ECMO治疗的暴发性心肌炎患者院间转运的管理

<正>随着科学的创新与发展,从1972年体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)技术首次在呼吸窘迫综合征患者身上成功运用后,ECMO技术已逐渐被运用于各种原因引起的呼吸或循环衰竭患者中[1-2]。ECMO是将体内的静脉血经体外膜肺氧合后再用血泵或体外循环机将血液灌回体内,维持患者生命体征,为残存心肺功能的恢复赢得宝贵时间[3]。有研究表明,对爆发性心肌炎患者应积极行ECMO治     

体外膜肺氧合临床应用与团队建设--附17例临床报告

目的总结17例体外膜肺氧合（ECMO）临床管理与团队建设经验。方法2003年1月至2005年8月选用不同器材共施行ECMO17例，包含心血管内外科疾病（7例）和呼吸病患者（10例）。结果心血管病患者存活4例，呼吸病患者存活8例。ECMO支持时间15—79h。医院ECMO团队逐渐建立，并建立ECMO规范。结论体外膜肺氧合（ECMO）与传统心脏外科体外循环在很多方面存在不同；ECMO团队建设直接关系ECMO成功率与技术发展；应结合我国国情，关注ECMO技术带来的经济问题和伦理问题。     

ECMO治疗重症低氧血症的护理体会

体外膜肺氧合（ECMO）技术是一种持续体外生命支持疗法,其核心部分是膜肺和血泵,分别起到人工肺和人工心的作用,可为危重患者提供一定的氧供及稳定的循环血量,有效地维持心、脑等重要脏器的血供和氧供,为患者后续治疗获得宝贵时间。我院2006年3月～2009年5月应用体外膜肺氧合（ECMO）治疗严重低氧血症患者12例,本文就应用ECMO患者护理进行探讨,现报告如下：     

体外膜肺氧合并发症防治进展

体外膜肺氧合(extracorporeal membrane oxygen-ation,ECMO)是指一种将部分静脉血从体内引流到体外,再经膜肺氧合后由驱动泵将动脉血液泵入体内的中短期心肺辅助技术。ECMO通过对循环呼吸功能较长时间的有效辅助使心肺得到充分地休息,支持期间保证全身氧供,维持机体内环境和血流动力学的相对稳定,为心肺功能的恢复赢得时间。1972年H ill首先报道了一例成人创伤后呼吸衰竭的患者ECMO支持成功的经验,Bartlett等于1975年第一次成功地将ECMO应用于新生儿呼吸衰竭的治疗。随着ECMO的不断发展,ECMO的支持时间由最初的几个小时到能支持…     

体外膜肺氧合在肺移植患者护理中的现状

肺移植是目前终末期肺病最有效的治疗方法,而体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)作为呼吸和循环支持的有效手段,常应用于肺移植的患者,ECMO的原理是将血液从体内引到体外,经膜式氧合器氧合,再用泵将血液灌入体内,可进行长时间心肺支持。ECMO的常用模式有VV-ECMO和VA-ECMO,ECMO是一项复杂的护理技术,除常规的密切观察患者意识和生命体征变化外,ECMO管路护理、出血与血栓的观察和护理、液体平衡的管理、镇痛镇静、转运护理等也极为重要。本文就体外膜肺氧合技术在肺移植患者护理中的现状进行综述。     

体外膜肺氧合的临床应用与护理进展

ECMO是体外膜肺氧合(Extracorporeal membrane oxygenation)的英文缩写。本文阐述了体外膜肺氧合的定义、基本原理、适应症和禁忌症以及相关的护理问题,现将ECMO技术应用的护理进展做一综述。     

体外膜肺氧合期间机体免疫系统变化的研究进展

<正>体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)是一项为严重心肺功能不全的患者提供短期生命支持的技术,能部分代替心脏的泵血功能及肺的氧合功能,等待器官功能恢复,或提供桥接治疗[1]。近年来,ECMO在危重患者中的应用越来越广泛,除传统的急性心功能衰竭及呼吸衰竭外,还拓展至体外心肺复苏、肺移植和心脏移植等领     

心脏术后心功能不全者应用体外膜肺氧合的护理

体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)是一种呼吸循环支持技术,将静脉血引流至体外,经人工肺(氧合器)氧合后再经动脉或静脉输回,使心肺得到充分休息,为心肺功能的恢复赢得时[1].2012年1月至2013年03月,我科对5例心脏术后心功能不全患者使用ECMO辅助技术,取得满意效果,现将护理体会报告如下.     

体外膜肺氧合治疗心内直视术后心肺功能衰竭患者的护理

体外膜肺氧合(extracorporeal memberane oxygenation,ECMO)是将血液从体内引到体外,经膜肺氧合后再用血泵或体外循环机将血液灌入体内,对一些呼吸或循环衰竭的患者进行有效支持的技术,它可使心肺得到充分的休息,为心功能和     

体外膜肺氧合与呼吸机治疗重症甲型H1N1流感病毒性肺炎体会

体外膜肺氧合（extracorporeal membrane oxygenation,ECMO）作为一种有效的心肺支持治疗手段,在各种严重的呼吸功能衰竭和心脏功能衰竭中具有重要作用.ECMO支持治疗时间较长,技术复杂,一些严重的并发症直接影响ECMO治疗效果,影响预后。     

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…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…