改良俯卧位对俯卧位通气临床疗效及并发症的影响

目的观察改良俯卧位对俯卧位通气(PPV)临床疗效及并发症的影响。方法将该院呼吸和危重症医学科行PPV的52例患者随机分为对照组和实验组各26例,对照组应用常规方法进行PPV,实验组采用改良俯卧位进行PPV。比较两组患者PPV的临床效果和并发症发生情况。结果两组间俯卧位前和俯卧位后12 h的氧合指数无明显差异(P>0.05);两组患者俯卧位后12 h的氧合指数均较各组俯卧位前明显改善(P<0.05);两组患者气管插管脱出、血流动力学显著波动、误吸和面部水肿的发生率无显著差异(P>0.05);实验组皮肤压疮的发生率明显低于对照组(P<0.05)。结论改良俯卧位对PPV的临床疗效无显著影响,但可以降低皮肤压疮的发生率。     

机械通气患者呼气流速受限危险因素分析及其对患者预后的影响

目的 评估重症医学科机械通气患者中呼气流速受限的发病率，并确定与呼气流速受限相关的主要临床特征、危险因素和对患者预后的影响。方法 选取需要机械通气的患者202例，通过呼气末正压通气(PEEP)试验分为呼气流速受限组和非呼气流速受限组，在患者行机械通气12小时内测定呼吸力学指标，每日测定呼吸力学指标，连测3日。所有患者均行简化急性生理状态评分系统(SAPS)评分和器官衰竭评分(SOFA)；改良的英国医学委员会呼吸困难评分量表（mMRC）评定呼吸困难严重程度。结果 22.77%的患者存在为呼气流速受限，其中脓毒性休克39例、ARDS 25例、失血性休克27例、慢性阻塞性肺疾病急性恶化32例、急性呼吸衰竭45例、心力衰竭12例和脑血管病合并肺炎22例。呼气流速受限患者的体重指数(BMI)较高，呼气流速受限与心脏病史、慢性肺病史有关(均P<0.05)。呼吸力学数据方面，呼气流速受限患者呼吸困难评分较差，最大气道阻力高，弹性阻力增加，具有较高的呼气末正压和内源性呼气末正压，峰值压较高，氧合指数较低(均P<0.05)。呼气流速受限组患者SOFA评分、SAPSⅡ评分均较高，机械通气时间更长，具有更高的病死率(均P<0.05)。结论 BMI高、肺病或心脏病史是重症医学科机械通气患者呼气流速受限的高危因素。呼气流速受限患者的呼吸力学参数更差。呼气流速受限患者机械通气时间较长，住院时间较长，病死率较高，预后差。     

黄芩苷通过调控巨噬细胞M2极化对脊髓损伤大鼠炎症反应的抑制作用

探讨黄芩苷对大鼠脊髓损伤（SCI）的保护作用,阐明其作用机制。     

左乙拉西坦在癫痫患者中的应用

目的 探讨左乙拉西坦对癫痫患者认知功能及脑电图改善的影响.方法 选取2018年4月至2019年4月本院收治的癫痫患者86例作为研究对象,按照抽签分组法分为对照组与观察组,每组43例.对照组接受卡马西林治疗,观察组接受左乙拉西坦治疗.比较两组临床疗效、认知功能及脑电图改善情况.结果 观察组治疗总有效率为95.35％,高于对照组的79.07％,差异有统计学意义(P<0.05).治疗后,两组FIQ、VIQ、PIQ评分均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05).观察组心电图总改善率为90.70％,高于对照组的72.09％,差异有统计学意义(P<0.05).结论 左乙拉西坦治疗癫痫效果显著,能明显提高患者的认知功能,且有助于改善脑电图,值得临床推广应用.     

不同带教模式对本科实习护生职业获益感的影响

目的探讨不同带教模式对临床本科实习护生职业获益感的影响。方法选取某医学院校本科实习护生78名,按班级的不同分为观察组(42名)和对照组(36名),观察组采用一对一导师制带教模式培养,对照组以传统功能制带教模式培养,比较2组在职业获益感及出科成绩方面的差异。结果观察组的职业获益感总分、正向职业感知维度、团队归属感维度、自身的成长维度及出科成绩均高于对照组,差异有统计学意义(P<0.05)。结论一对一导师制带教模式较传统功能制带教优势明显,有利于提高实习护生职业获益感,培养更为优秀的护理人才。     

脂氧素及其在牙周炎症消退中的作用

脂氧素（LX）是调节炎症消退的重要内源性脂质抗炎递质,被称作炎症的“刹车”信号。局部应用LX类似物后,牙槽骨破坏明显减轻,且炎症细胞和免疫细胞对牙周结缔组织的浸润也明显减少,即LX在促进牙周炎症的消退中起着不可忽视的作用。     

老年慢性肾衰竭病人行血液透析的护理

随着老年人口的迅速增长,老年人慢性肾衰竭的发病率有明显增高的趋势[1]。血液透析是慢性肾衰竭病人的主要治疗方法之一,护理是否恰当,严重影响着血液透析病人以后的生活质量和并发症的发生率。因此,对老年性慢性肾衰竭病人行血液透析治疗,对并发症及相关危险因素进行了探讨和研究,并采取了相应的护理措施,大大地降低了各种并发症的发生,取得了良好的效果,80例病人在透析过程中无1例死亡。现将护理总结如下。1一般资料选取我院血液净化室2000年1月—2005年12月行血液透析的老年病人80例,年龄最小60岁,最大83岁。血管通路:使用16G内瘘针进行…     

Combined Haploidentical and Umbilical Cord Blood Allogeneic Stem Cell Transplantation for High-Risk Lymphoma and Chronic Lymphoblastic Leukemia

Limited studies have reported on outcomes for lymphoid malignancy patients receiving alternative donor allogeneic stem cell transplants. We have previously described combining CD34-selected haploidentical grafts with umbilical cord blood (haplo-cord) to accelerate neutrophil and platelet engraftment. Here, we examine the outcome of patients with lymphoid malignancies undergoing haplo-cord transplantation at the University of Chicago and Weill Cornell Medical College. We analyzed 42 lymphoma and chronic lymphoblastic leukemia (CLL) patients who underwent haplo-cord allogeneic stem cell transplantation. Patients underwent transplant for Hodgkin lymphoma (n?=?9, 21%), CLL (n?=?5, 12%) and non-Hodgkin lymphomas (n?=?28, 67%), including 13 T cell lymphomas. Twenty-four patients (52%) had 3 or more lines of therapies. Six (14%) and 1 (2%) patients had prior autologous and allogeneic stem cell transplant, respectively. At the time of transplant 12 patients (29%) were in complete remission, 18 had chemotherapy-sensitive disease, and 12 patients had chemotherapy-resistant disease. Seven (17%), 11 (26%), and 24 (57%) patients had low, intermediate, and high disease risk index before transplant. Comorbidity index was evenly distributed among 3 groups, with 13 (31%), 14 (33%), and 15 (36%) patients scoring 0, 1 to 2, and ≥3. Median age for the cohort was 49 years (range, 23 to 71). All patients received fludarabine/melphalan/antithymocyte globulin conditioning regimen and post-transplant graft-versus-host disease (GVHD) prophylaxis with tacrolimus and mycophenolate mofetil. The median time to neutrophil engraftment was 11 days (range, 9 to 60) and to platelet engraftment 19.5 days (range, 11 to 88). Cumulative incidence of nonrelapse mortality was 11.6% at 100 days and 19 % at one year. Cumulative incidence of relapse was 9.3% at 100 days and 19% at one year. With a median follow-up of survivors of 42 months, the 3-year rates of GVHD relapse free survival, progression-free survival, and overall survival were 53%, 62%, and 65%, respectively, for these patients. Only 8% of the survivors had chronic GVHD. In conclusion, haplo-cord transplantation offers a transplant alternative for patients with recurrent or refractory lymphoid malignancies who lack matching donors. Both neutrophil and platelet count recovery is rapid, nonrelapse mortality is limited, excellent disease control can be achieved, and the incidence of chronic GVHD is limited. Thus, haplo-cord achieves high rates of engraftment and encouraging results.