优化复苏集束化策略对脓毒性休克预后的影响

目的 探讨优化复苏集束化策略对急诊脓毒性休克患者预后的影响.方法 将经急诊重症监护室(ICU)收住的脓毒性休克患者65例用数字表法随机分为治疗组(采用优化复苏集束化策略)32例和对照组(采用拯救脓毒症运动经典方法)33例.观察和比较两组患者器官衰竭评分系统(SOFA)评分的变化及血管活性药物使用时间、机械通气时间、ICU住院时间和28 d病死率.结果 治疗组人选后3d、7 d SOFA评分分别为(9.1±2.5)分、(8.2±2.8)分,均低于对照组同期的(10.1 ±3.3)分、(9.5±3.1)分(=4.52、3.99,均P＜0.05);治疗组28 d病死率为28.1％,低于对照组的48.5％(x2=12.84,P＜0.05).结论 早期应用优化复苏集束化策略可以明显改善急诊脓毒性休克患者的预后.     

糖尿病患者的心理护理

<正>目前,我国2型糖尿病患者已近4千万人。而且糖尿病发病率也在逐年激增,从1980年的0.8%,到1995年的2.9%,再到2000年超过3.5%,糖尿病已经成为一种日益严重的公共健康问题。糖尿病是慢性内分泌代谢性疾病,从它的发病机制来看,情、志创伤是其中重要一环,所以调和情志是糖尿病康复的重要内容。对糖     

护理干预对首次血液透析直接穿刺患者舒适度的影响

2005年4月～2007年5月，我们对78例首次直接穿刺透析的患者除行常规护理外，给予针对性的护理干预，取得满意效果。现报告如下。     

Anthogyr自动取冠桥器的临床评价

目的:评价Anthogyr(安多健)自动取冠桥器拆除烤瓷冠桥的临床效果.方法:随机选择2组共80例不良烤瓷修复体病例对比研究;实验组42例烤瓷修复体使用安多健自动取冠桥器拆除:对照组38例烤瓷修复体采用常规车针破冠法拆除.结果:实验组优秀47.62%,良好35.71%,失败16.67%,优良率85.71%;对照组优秀15.79%,良好57.79%,失败26.32%,优良率73.68%;两组优良率无显著性差异,但在耗费时间和对基牙、对冠桥损坏方面比较两组间有极显著性差异(p＜0.005).结论:安多健自动取冠桥器操作简便,拆冠迅速,安全省时,冠桥可作临时替代冠再利用.但是其震动噪音易引起恐惧疼痛,建议局麻下进行拆冠.     

口腔癌手术患者医院感染现状及危险因素分析

目的 调查口腔癌手术患者医院感染现状,探讨医院感染危险因素,为医院感染防控提供科学依据.方法 前瞻性目标监测调查2019年1月-2020年12月山东省某三甲医院口腔颌面外科的口腔癌患者,分析口腔癌手术患者医院感染的发生率及危险因素.结果 本研究纳入394例口腔癌手术患者,发生医院感染58例,医院感染率为14.72％;总...     

外科重症监护病房内栓塞症的诊断与治疗--附4例报告及文献复习

目的 分析外科重症监护病房（surgical intensive care unit,SICU）内常见栓塞症（脂肪栓塞和羊水栓塞）的临床表现,探讨其诊断和治疗方法。方法 对我院2002年SICU确诊的4例栓塞症患者的临床资料进行回顾性分析。结果 4例患者中,男1例,女3例,年龄23～36岁,1例为左上肢、双下肢长骨骨折致脂肪栓塞,1例为左股骨骨析致脂肪栓塞,1例为剖宫产术中发生羊水栓塞、1例为催产素引产失败后发生羊水栓基。4例患者均不同程度出现意识改乏、呼吸衰竭、贫血、血小板减少,除1例病情较重死亡,其余均痊愈出院。结论 SICU内患者病情复杂,对长骨骨折及高危产妇,要警惕栓塞症的发生,如果早期诊断,及时治疗,预后良好。     

多指标协同应用在危重症合并血小板减少患者诊断DIC中的作用

Objective To observe critical patients with thrombocytopenia,and exam their coagulation function,so as to diagnose disseminated intravascular coagulation(DIC)in the early stage.Methods Totally 56 critical patients complicated with thrombocytopenia were enrolled in the investigation;complete set of DIC tests were performed.A total of 26 cases were diagnosed as DIC according to the criteria from the International Society of Thrombosis Haemostasis(ISTH).The sensitivity,specificity,accuracy,likelihood ratio,predictive value of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(Fg),antithrombin Ⅲ and bleeding signs(including petechia and ecchymosia)were calculated by applying fourfold table.Results The specificity of PT prolongation and Fg reduction was 87.0%;the sensitivity of ATⅢ decrease,and each of PT prolongation,Fg reduction,and bleeding(including petechia and ecchymosis)were as high as 96.0%.Conclusion Multi-markers based on thrombocytopenia are likely to improve sensitivity and specificity of DIC diagnosis.     

多指标协同应用在危重症合并血小板减少患者诊断DIC中的作用

Objective To observe critical patients with thrombocytopenia,and exam their coagulation function,so as to diagnose disseminated intravascular coagulation(DIC)in the early stage.Methods Totally 56 critical patients complicated with thrombocytopenia were enrolled in the investigation;complete set of DIC tests were performed.A total of 26 cases were diagnosed as DIC according to the criteria from the International Society of Thrombosis Haemostasis(ISTH).The sensitivity,specificity,accuracy,likelihood ratio,predictive value of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(Fg),antithrombin Ⅲ and bleeding signs(including petechia and ecchymosia)were calculated by applying fourfold table.Results The specificity of PT prolongation and Fg reduction was 87.0%;the sensitivity of ATⅢ decrease,and each of PT prolongation,Fg reduction,and bleeding(including petechia and ecchymosis)were as high as 96.0%.Conclusion Multi-markers based on thrombocytopenia are likely to improve sensitivity and specificity of DIC diagnosis.     

多黏菌素治疗人禽流感继发铜绿假单胞菌感染一例

目的探讨人感染高致病性禽流感继发多耐药铜绿假单胞菌(MDRP)肺部感染的治疗方法。方法2006年6月,对1例高致病性H5N1亚型禽流感并急性呼吸窘迫综合征(ARDS)青年男性患者进行机械通气治疗,随后出现MDRP的肺部感染;病原学药敏结果显示,该株MDRP仅对多黏菌素B和E等少量抗菌药物敏感;遂予以多黏菌素B每日40～100mg分2次肌肉或静脉注射,并多黏菌素E每日30～50万u分3～4次雾化吸入,使用剂量根据痰菌半定量检测结果进行调整。结果多黏菌素B全身用药累积疗程33d,累积剂量1760mg;多黏菌素E雾化吸入累积疗程36d,累积剂量1485万u;患者肺部感染得到有效控制;多黏菌素治疗MDRP有效且不良反应较轻,其治疗终点的判断需根据临床和实验室资料进行全面评估。结论多黏菌素能有效治疗禽流感患者继发MDRP的感染。     

慢性乙型肝炎重叠急性戊型肝炎的临床特点

目的:观察慢性乙型肝炎重叠急性戊型肝炎(慢乙肝加戊肝)的临床特点.方法:比较慢乙肝加戊肝(20例)与单纯急性戊肝(20例)的临床表现与肝功能.结果:慢乙肝加戊肝后黄疸的发生率、白蛋白/球蛋白倒置、凝血酶原时间延长、前白蛋白显著下降等均较单纯急性戊肝组显著(P＜0.05～P＜0.005).结论:慢性乙肝重叠感染急性戊肝后肝功能损害严重、病死率高、预后差.