氨茶碱联合肾上腺素抢救心跳骤停30例临床观察

目的 观察对心跳骤停患者早期联合应用氨茶碱与肾上腺素进行复苏的疗效。方法将心跳骤停患者61例．随机分为观察组（30例）和对照组（31例），所有病例均于心跳骤停后常规给予清除呼吸道异物、气管插管、机械通气（吸入氧浓度为80％），心脏按压、除颤、建立静脉通道和心电监护等复苏措施，观察组反复给予肾上腺索（肾上腺索lmg静注，3—5min后重复使用），同时给予氨茶碱快速静注（O．5∥次。3。5min后重复使用，最大剂量为1．0g）；对照组反复给予肾上腺索（肾上腺紊ling静注，3-5min后重复使用）。观察两组患者心电活动及自主循环恢复率，不同时间点存活情况及出院存活率。并进行统计学分析。结果 观察组心电活动及自主循环恢复率、不同时间点存活率及出院存活率均高于对照组，差异有统计学意义（P〈0．05）。结论 早期联合应用氨茶碱和肾上腺束对心跳骤停的复苏疗效优于单纯使用肾上腺素，有助于提高心肺复苏成功率。     

心肺复苏时联合使用血管加压素氨茶碱肾上腺素的研究

目了：了解心肺复苏时联合使用肾上腺素、血管加压素，氨茶碱的疗效。方法：29例心跳停搏的患者随机分为两组，肾上腺素标准剂量组（对照组）15例，联合使用肾上腺素，血管加压素，氨茶碱（治疗组）14例，各组分别观察自主循环恢复率及恢复时间。结果：对照组，治疗组自主循环恢复率分别为13．3％，64．3％，治疗组的自主循环恢复率明显高于对照组，同时治疗组的自主循环恢复时间明显小于对照组。结论：心肺复苏期间，联合应用肾上腺素，血管加压素，氨茶碱比单独使用标准剂量的肾上腺素能显著提高自主循环恢复率，缩短自主循环恢复时间。     

肾上腺素在心、肺、脑复苏时的应用

目的：探讨肾上腺素在心博骤停的治疗效果。方法：本组83例患用肾上腺素静注治疗按3mg-6mg-9mg-12mg-15mg-18mg-21mg递增剂量治疗。分析43例治疗后复苏疗效。结果：83例心博骤停患中43例经高剂量肾上腺素治疗后复苏。5分钟内用15mg肾上腺素治疗复苏占全部复苏病例的90．7％。结论：心肺脑复苏期间应用肾上腺素5分钟内15mg能显提高自主循环恢复率，缩短自主循环恢复时间，改善心博骤停患的预后。但病例少，今后应作更多更细的探索。     

氨茶碱救治呼吸心跳骤停43例疗效分析

心肺脑复苏 (CPCR)是目前抢救呼吸心跳骤停的有效手段 ,但成功率仍很低。为此 ,我们观察了腺苷受体拮抗剂氨茶碱在CPCR中的作用 ,报道如下。1资料与方法1 1临床资料 :86例均为院外呼吸心跳骤停患者 ,其呼吸心跳停止时间为3～11分钟 ,年龄14～81岁 ,平均55岁。随机分为氨茶碱组与常规复苏组 ,每组各43例。两组病例的年龄、呼吸心跳停止时间 ,具有可比性。1 2方法 :氨茶碱组在常规复苏的基础上给予氨茶碱0 5g静注或气管导管内给药 (有研究表明气管内给药比静脉给药省时4分钟 ) ,无效则每隔5分钟重复应用0 25g,最多4次。常规复苏组行正规CP…     

氨茶碱和肾上腺素合用在心脏停搏患者中的疗效

目的探讨氨茶碱和肾上腺素联合应用在心脏停搏患者中的疗效是否优于单纯使用肾上腺素.方法24例心跳骤停患者给予氨茶碱和肾上腺素合并用药,30例心跳骤停患者单用肾上腺素作为对照组.比较两组病人的心脏电活动和自主循环恢复情况以及存活率.结果合用组79.2%(19/24)患者恢复心电活动,高于肾上腺素组53.3%(16/30),差异接近显著(P=0.082).合用组1h、3h、6h的生存率分别为87.5%(21/24)、54.2%(13/24)和37.5%(9/24),亦分别高于肾上腺素组(1h56.7%;3h20%;6h13.3%),差异具有显著意义(P＜0.05).合用组有12例(50.0%)患者恢复自主循环,也高于肾上腺素组(40.0%,12/30),但差异不显著(P=0.462).合用组有2例(8.3%)患者出院,高于肾上腺素组(3.3%,1/30),差异不显著(P=0.579).结论氨茶碱与肾上腺素联合用药在心脏停搏患者中的疗效可能优于单纯使用肾上腺素.     

1例PCI术后并发急性冠脉血栓的救治及护理

冠脉支架植入术（PCI）是恢复心肌血流再灌注的重要方法,尽管术后24h内支架内急性血栓形成发生率极小（1%）,但其病死率高达37.5%,若不及时发现或处理不当后果严重。我科2013年7月成功救治了1例PCI术后并发急性冠脉血栓的患者,现报道如下。1病例介绍患者,男71岁,因ACS在DSA手术室局麻下行冠状动脉造影＋支架植入术,术毕10分钟患者诉胸痛,给予硝酸甘油5mg舌下含化，疼痛小能缓解，继之吗啡3mg静脉注射、吸氧，胸痛仍未缓解，心电监护示呼吸13次／分、心率43次／分、血压76／42mmHg、SPO2 78％，立即予以肾上腺素、阿托品、多巴胺静脉注射。手术者考虑PCI术后并发急性冠脉血栓，立即经股动脉行冠状动脉造影术，术中患者突发心跳骤停，立即心肺复苏、电除颤，肾上腺素、阿托品静脉注射。     

大剂量肾上腺素复苏的临床观察

作者对二例外伤后呼吸心跳骤停病人用大剂量肾上腺素复苏获得成功,现报告如下。 例1:患者男性,36岁,主因汽车翻车坠入道旁泥坑内引起窒息,呼吸心跳骤停30分钟后送急诊室。立即清除呼吸道异物,快速气管插管,胸外心脏按压,建立静脉通路,肾上腺素采用递增法静脉注射,2mg、4mg、6mg,每隔3分钟一次,于开始复     

纳洛酮治疗急性海洛因中毒后心跳呼吸骤停3例

目的：观察纳洛酮对急性海洛因中毒心跳、呼吸骤停的抢救效果.方法：对中毒后引起呼吸、心跳骤停3例患者,分别给予纳洛酮0.8～2.0 mg加入10%葡萄糖注射液中静脉注射或静脉滴注,配合常规心肺复苏治疗.结果：3例均心跳、呼吸恢复,抢救成功.结论：纳洛酮对抢救急性海洛因中毒后心跳呼吸骤停有积极意义.     

血凝酶过敏致心跳骤停

1例41岁女性因粘连性肠梗阻入院行回肠末段切除术。术后给予血凝酶1KU＋0．9％氯化钠注射液20ml静脉注射，1次／2h，连用3次。前2次用药时患者无不良反应，第3次用药过程中，患者突然神志不清，叹息样呼吸，口唇青紫，面色苍白，双侧瞳孔散大，心跳骤停。立即停药，给予胸外心脏按压，面罩给氧，同时静脉注射利多卡因、肾上腺素和阿托品。抢救30min，患者心跳、呼吸恢复。     

电击致呼吸,心跳骤停抢救成功1例

本科于1997年6月25日成功抢救1例电击后呼吸、心跳骤停患者，现报道如下。一、临床资料（一）一般资料：患者，男性，18岁。以电击后意识丧失、口层青紫15分钟入院。送院途中由同伴行胸外心脏按压。查体：面色、口唇紫钳，四肢冰冷，呼吸、心跳停止。瞳孔等圆等大，直径0．5cm，对光反射消失。心电图成一直线。（二）心、肺、脑复苏过程；按1986美国CPR标准持续胸外心脏按压，建立静脉通道，静注肾上腺素2mg，用200J进行直流电击复律。持续心电监护，2分钟后恢复自主心律及自主呼吸，心率102次／分。随即给予地塞米松20mg加人20％甘露醇25…     

卡马西平联用尼美舒利相关粒细胞缺乏症

1例78岁男性患者因带状疱疹神经痛、慢性阻塞性肺疾病合并感染,给予头孢唑肟钠（2.25 g静脉滴注,1次/d）、卡马西平（0.2 g口服,2次/d）、尼美舒利（100 mg口服,2次/d）、二羟丙茶碱（0.5 g静脉滴注,1次/d）、甲钴胺（0.5 mg口服,3次/d）、地塞米松（5 mg,静脉滴注1次）、盐酸哌替啶（25 mg,肌内注射1次）和盐酸布桂嗪（100 mg,肌内注射3次）等药物治疗。第7天,停用头孢唑肟钠,改为磷霉素钠（8 g静脉滴注,1次/d）。第11天,血常规检查示白细胞计数1.6×10^9/L,中性粒细胞0.03,中性粒细胞绝对值0.1×10^9/L,淋巴细胞绝对值0.9×10^9/L。立即停用所有药物,给予对症支持治疗。第15天,外周血白细胞计数0.9×10^9/L,中性粒细胞0.02,中性粒细胞绝对值0.1×10^9/L,淋巴细胞绝对值0.7×10^9/L。行骨髓穿刺检查,诊断为粒细胞缺乏症。第17天患者出现右肺气胸、肺不张。第20天出现急性呼吸衰竭、多脏器衰竭合并重症感染,经抢救无效死亡。     

甘草酸单铵结合氦-氖激光治疗银屑病62例

目的用甘草酸单铵结合低能量氦-氖激光,观察治疗银屑病患者。方法62例寻常型银屑病患者,分为两组,A组用低能量氦-氖激光血管内照射,同时用甘草酸单铵静脉滴注,共36例;B组仅用甘草酸单铵,共26例。通过30d治疗。结果总有效率82.2%,其中A组有效率88.9%,B组73.1%(经Ridit检验,U＝2.76,P＜0.01),两组差异有极显著性意义。结论甘草酸单铵结合氦-氖激光治疗银屑病,比单用甘草酸单铵效果好。     

颅脑损伤患者并发肺部感染的护理体会

目的：为了使并发肺部感染的病人更多、更好、更早的痊愈。方法：通过对32例颅脑外伤并发肺部感染病人的严密观察,采取更换体位、超声雾化、有效排痰训练等有效的护理措施干预,从而控制了肺部感染。结果：痊愈17例,占53.1%;显效12例,占37.5%,无效2例,占6.2%;死亡1例,占3.1%;实践证明,有效的护理干预对提高患者治疗成功率有着重要意义。     

Treatment with Ziprasidone for schizophrenia patients with OCD

Comorbidity of obsessive–compulsive disorder (OCD) has been observed in about 15% of schizophrenic patients and has been associated with poor prognosis. Therefore, there is a need for specific treatment options for these patients (schizo-obsessive, ScOCD).This is an open, prospective study, aiming to test the efficacy of Ziprasidone (80–200 mg/d) in ScOCD patients and comparing the response to the treatment between stable schizophrenic (N=16) and stable ScOCD (N=29) patients.Treatment effect with Ziprasidone was different in schizophrenic patients when stratified based on OCD comorbidity. Overall, the effect on OCD symptoms (as measured by the Yale Brown Obsessive Compulsive Scale, YBOCS) was found to be bimodal—either no response or exacerbation (for 45% of the patients, n=13) or significant improvement of symptoms (55%, n=16). Those who improved in OCD symptoms, improved also in negative and general schizophrenia symptoms, while ScOCD-unimproved group worsened in all symptoms. Whereas schizophrenic patients without OCD responded in a modest Gaussian distribution, they improved in schizophrenia negative symptoms and in general anxiety.This data suggests that schizo-obsessive disorder is a distinct and complex condition with more than one underlying pathogenesis. Definition of these ScOCD subgroups defined by their response to Ziprasidone might contribute to personalized medicine within the OCD–schizophrenia spectrum. Moreover, this finding suggests that ScOCD may be considered as a special schizophrenic subtype and its inclusion in schizophrenia treatment studies need to be further explored due to its divergent response.     

Satisfaction with information and its relationship with adherence in patients with chronic pain

□ Due to the nature of chronic pain it would be expected that patients are highly adherent to their pain medication. However, results from this study have shown that 23 per cent of patients often or always avoid using their pain medication, 13.4 per cent often or always alter dosages, and 10.3 per cent often or always stop taking their medication for a while. This suggests intentional non‐adherence to pain medication □ Less than 50 per cent of respondents were satisfied with information provided on side effects, what to do if side effects occur, and possible interactions with other medication □ Patients' satisfaction with information about their medication was related to self‐reported adherence; greater satisfaction was associated with higher self‐reported adherence     

喜炎平注射液联合更昔洛韦治疗儿童巨细胞病毒肺炎疗效观察

目的:探讨喜炎平注射液联合更昔洛韦(GCV) 治疗小儿巨细胞病毒(CMV)肺炎的方法及效果。方法:选取我院2010年3月至2016年5月住院确诊的CMV肺炎患儿47例,随机分为观察组24例和对照组23例。对照组在常规治疗基础上加用GCV抗病毒治疗:诱导期每次5 mg/kg,每12 h一次静脉滴注,每次滴注时间>1 h,连用2周;维持期每次10 mg/kg,隔日一次,总疗程4周。观察组在常规治疗基础上加用喜炎平联合GCV治疗,GCV用法用量疗程同对照组,喜炎平注射液5 mg/(kg·d)静脉滴注,每天1次,疗程2周。观察两组患儿临床疗效及预后。结果:(1) 观察组在退热时间、住院时间短于对照组(P均<0.01)。治疗2周后,观察组肺部啰音及影像学改变阳性率低于对照组,血氧分压、二氧化碳分压的改善程度均优于对照组(P均<0.05);(2)治疗2周后两组总有效率比较差异无统计学意义(P>0.05),但观察组显效率高于对照组(62.5% vs 30.4%,P<0.05);(3)两组不良反应比较差异无统计学意义(P>0.05)。结论:小儿CMV肺炎在常规综合治疗、GCV抗病毒治疗同时,联合喜炎平注射液,可提高显效率、缩短疗程、改善预后,且具有较高安全性。     

Genomic profiling associated with recurrence in patients with rectal cancer treated with chemoradiation

PURPOSE: Stage II and III adenocarcinoma of the rectum has an overall 5-year survival rate of approximately 50%, and tumor recurrence remains a major problem despite an improvement in local control through chemotherapy and radiation. The efficacy of chemoradiation therapy may be significantly compromised as a result of interindividual variations in clinical response and host toxicity. Therefore, it is imperative to identify those patients who will benefit from chemoradiation therapy and those who will develop recurrent disease. In this study, we tested whether a specific pattern of 21 polymorphisms in 18 genes involved in the critical pathways of cancer progression (i.e., drug metabolism, tumor microenvironment, cell cycle regulation, and DNA repair) will predict the risk of tumor recurrence in rectal cancer patients treated with chemoradiation. PATIENTS AND METHODS: A total of 90 patients with Stage II or III rectal cancer treated with chemoradiation were genotyped using polymerase chain reaction (PCR)-based techniques for 21 polymorphisms. RESULTS: A polymorphism in interleukin (IL)-8 was individually associated with risk of recurrence. Classification and regression tree analysis of all polymorphisms and clinical variables developed a risk tree including the following variables: node status, IL-8, intracellular adhesion molecule-1, transforming growth factor-beta, and fibroblast growth factor receptor 4. CONCLUSION: Genomic profiling may help to identify patients who are at high risk for developing tumor recurrence, and those who are more likely to benefit from chemoradiation therapy. A larger prospective study is needed to validate these preliminary data using germline polymorphisms on tumor recurrences in rectal cancer patients treated with chemoradiation.