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To determine the existence of a close link between inflammation and coagulation in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) and to examine their prognostic value in the development of ARDS and clinical outcome, we made a prospective cohort study. The study subjects consisted of 57 patients: 19 patients with ARDS and 38 patients with ALI as defined by a Lung Injury Score of > or =2.5 and 1.0 to less than 2.5, respectively. According to the outcome, the patients were subdivided into the survivors and the nonsurvivors. Ten normal healthy volunteers served as control subjects. Plasma levels of soluble L-, P-, and E-selectins, intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), thrombomodulin (sTM), and neutrophil elastase were measured within 24 h after the diagnosis of ALI or ARDS. The number of systemic inflammatory response syndrome (SIRS) criteria being met by the patients and the disseminated intravascular coagulation (DIC) scores were determined simultaneously. The number of SIRS criteria and the DIC scores of the patients with ALI or ARDS showed high values, and more than half of the patients were complicated by DIC. The levels of sL-selectin in both groups of the patients were significantly lower than those of the control subjects. All other soluble adhesion molecules, neutrophil elastase, and sTM in the patients with ALI and ARDS were markedly elevated than those in the control subjects. The levels sICAM-1, sVCAM-1, and sTM in the ARDS patients significantly increased compared with the ALI patients. The number of SIRS criteria and the DIC scores in the nonsurvivors showed higher values than those in the survivors. In addition, we found significant differences in the levels of soluble adhesion molecules, neutrophil elastase, and sTM between the survivors and the nonsurvivors. In conclusion, we found a concurrent activation of both inflammation and coagulation in the patients with ALI or ARDS. The results also suggest that systemic activation of inflammation and coagulation associated with endothelial injury has prognostic value for the development of ARDS and poor outcome.  相似文献
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目的 探讨感染性休克患者血清C反应蛋白(C reactive protein,CRP)、白蛋白(albumin,ALB)比值(CRP/ALB)对预测急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的临床价值.方法 回顾性分析2013年1月至2015年5月我院ICU感染性休克患者65例.患者于入ICU后采外周静脉血,检测CRP、ALB,前7d每天进行急性生理功能和慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluation-Ⅱ,APACHE-Ⅱ),根据7d内是否合并ARDS分成感染性休克组和ARDS组.比较两组CRP、ALB和CRP/ALB,APACHE Ⅱ评分,Spearman相关分析入选时CRP/ALB、APACHE-Ⅱ评分的关系,受试者工作特征(ROC)曲线下面积法检验CRP/ALB的预测效力.结果 感染性休克组与ARDS组患者CRP、ALB含量差异无统计学意义(P>0.05),而CRP/ALB比值差异具有统计学意义(=5.93,P<0.05).CRP/ALB和APACHE-Ⅱ预测脓毒症的ROC曲线下面积分别为0.904(95%,CI:0.821 ~0.998),0.748(95%,CI:0.625 ~0.903).CRP/ALB与APACHEⅡ评分呈正相关(r=0.74,P<0.05).结论 CRP/ALB可预测感染性休克即将发生的ARDS,可能是一个有价值的临床指标,值得进一步研究.  相似文献
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目的 应用计算流体动力学(computational fluid dynamics, CFD)技术对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者不同程度呼吸窘迫状态时下呼吸道内气流运动特性进行模拟研究。方法 基于CT影像数据建立真实健康人体下呼吸道三维模型。采用标准k-ε湍流模型对下呼吸道内的气体流动进行数值模拟,分析下呼吸道内气流的速度、流量、压力以及壁面剪切应力等参数分布特点。结果 拟合下呼吸道空气流动阻力与呼吸强度的函数关系;得到下呼吸道内空气流速、压力、壁面剪切应力的分布特点以及空气流量在各肺及各叶支气管的分配情况。结论 通过CFD模拟分析可以获得更为详细的下呼吸道流场相关数据,为ARDS患者的临床治疗提供理论依据。  相似文献
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