Toll样受体4信号转导研究进展

Toll样受体4(TLR4)作为LPS信号转导受体,在与LPS反应时可形成一个由TLR4和MD 2构成的复合体,其在细胞内的信号转导依赖于不同的接头蛋白。在早期反应时,TLR4依赖MyD88和Mal可导致NF кB激活;而在后期反应中,通过TRIF和TRAM可引起NF кB和IRF3的迟发激活。由此诱导细胞因子、化学趋化因子和其他转录因子的表达。     

IKK/NF-κB信号转导通路与危重病

NF κB可调节众多的基因转录 ,尤其是涉及炎症和急性应激反应的基因转录 ,从而启动一系列的细胞级联和全身性反应 ,并最终导致器官功能不全 ,提示IKK NF κB信号转导通路在危重病中有重要的作用。     

血管外肺水指数在脓毒症相关性ALI/ARDS患者液体管理中的意义

Objective The management of fluid infusion is crucial in severe sepsis/septic shock patients.The correlation of extravascular lung water index(EVLWI) versus oxygenation index ( PaO2/FiO2 ) and EVLWI versus intrathoracic blood volume index(ITBVI) were analysed in this present study. Method Totally 24 patients,admitted to the Intensive Care Unit of Second Affiliated Hospital of Zhejiang University, College of Medicine and diagnosed as severe sepsis/septic shock with acute lung injury and/or acute respiratory distress syndrome,were enrolled. ITBVI and EVLWI were detected with PiCCO technique. Correlation of EVLWI and PaO2/FiO2, ITBVI and EVLWI were analysed,respectively. Simple correlation and simple linear regression were used for statistical analysis. Results Significant negative correlation was found of EVLWI and PaO2/FiO2 ( r = - 0. 45, P ＜ 0.01).EVLWT = 14 mL/kg was defined as the cutoff value for the subgroup analysis. No correlation was found between EVLWI and PaO2/FiO2 in the subgroup with EVLWI≤ 14 mL/kg ( r = 0. 12, P = 0.243), but in the subgroup with EVLWI ＞ 14 mL/kg, significant negative correlation was found ( r = - 0. 47, P ＜ 0. 01 ). When EVLWI was higher than 14 mL/kg,EVLW should be decreased to improve oxygenation and other aspects should be taken into account. No significant correlation was found between ITBVI and EVLWI. A ITBVI value 1000 mL/m2 was also defined as the cutoff value for the subgroup analysis. No significant correlation was found in the subgroup with ITBVI≤ 1000 mL/m2( r = 0.13, P = 0.17), while significant positive correlation was found in the subgroup with ITBVI ＞ 1000 mL/m2. This result suggested that in patients of severe sepsis/septic shock with ALI/ARDS, when the blood volume is high, ITBV should be decreased to improve the oxygenation,however,it is not useful in the situation of high pulmonary vascular permeability. Conclusions Extravascular lung water has a important role in the fluid management in patients of severe sepsis/septic shock with ALI/ARDS.     

颈动脉内膜剥脱术后发生并发症的危险因素

目的 探讨颈动脉内膜剥脱术(CEA)后并发症发生率及其相关危险因素.方法 选取2018年6月至2020年10月在诸暨市人民医院行CEA手术的颈动脉狭窄患者进行随访调查,根据术后30 d的随访结果,将其分为并发症组(n=51)和无并发症组(n=107);分析患者CEA术后的并发症发生率及其分布,采用χ2检验、逐步logi...     

双肺移植患者肺康复方案的构建及应用

目的 构建双肺移植患者肺康复方案并评价其应用效果.方法 采用便利抽样法,选取2020年1月—2021年3月杭州市某三级甲等医院行双肺移植术的46例患者为研究对象,采用随机数字表法分为试验组和对照组,每组各23例.试验组在对照组方案的基础上接受肺康复方案的干预,由呼吸治疗专科护士主导的肺康复小组全程指导,包括术前预康复训...     

氧化应激参与脓毒症过程的研究进展及其对治疗的启发

尽管生物技术和医疗干预手段日益先进,但脓毒症仍是住院病人死亡的重要原因.一方面,脓毒症过程信号调控机制复杂,应用一两种细胞因子或其抗体无法实现对多条信号通路的调控,一度被寄以重望的信号转导通路单靶点干预在多数临床试验中结果令人失望.另一方面,失控性炎症反应解释不了脓毒症的全部,现在认识到脓毒症存在免疫抑制和激活并存[1].近20年来,免疫学和细胞分子生物学方面的研究揭示了氧化应激对脓毒症过程的积极参与.于是能否针对氧化应激找到多靶点作用的药物,是这些研究带给我们的启示.     

护士主导的诊断性失血管理方案在特重度烧伤患者中的应用

目的 构建护士主导的诊断性失血管理方案并应用于特重度烧伤患者,以降低其诊断性失血量。 方法 成立多学科协作团队,构建护士主导的诊断性失血管理方案,对2020年6月14日收治的15例成批特重度烧伤患者进行干预,并评价其效果。 结果 干预前,每例预计诊断性失血量为（37.45±8.17） ml/d,干预后,每例实际诊断性失血量为（18.16±6.35） ml/d,两组比较,差异具有统计学意义（t=102.215,P<0.001）。结论 护士主导的诊断性失血管理方案能够有效降低特重度烧伤患者的诊断性失血量。     

1例冠心病患者行肝胰十二指肠切除术后并发假性动脉瘤的护理

总结1例冠心病患者行肝胰十二指肠切除术后并发肝动脉假性动脉瘤的护理经验。护理要点：加强病情观察和护理,警惕急性冠状动脉综合征的发生;重视前哨出血;落实肝动脉假性动脉瘤保守治疗期间护理;介入治疗后并发症的预防与护理。经过精心的治疗和护理,患者于术后78 d康复出院。     

连续性肾脏替代治疗中非计划性滤器更换原因分析

连续性肾脏替代治疗(contintlous renal replace-ment therapy,CRRT),又称为连续性血液净化(contin-uous blood purification,CBP),是近二三十年来发展起来的一种新的血液净化技术,一般定义为采用每天连续24 h或接近24 h的一种连续性血液净化疗法以替代肾脏功能的技术~([1]).