抗凝联合血必净治疗严重栓塞性疾病并多器官功能障碍综合征二例

患者1，男，61岁，因车祸伤后13d突发胸痛、呼吸困难1d于2007—08—16急诊转入我院。体格检查：患者急剧呼吸困难，口唇明显紫绀，吸入氧浓度（FiO2）在45％时，末梢血氧饱和度（SPO2）〈90％；腰背部可见25．0cm×2．0cm×1．5cm皮肤挫裂伤，已缝合，可见大量脓苔，部分伤口已裂开并见出血；两侧胸部可见20cm×30cm皮下淤斑，右下肺呼吸音偏低，双腋下及背底部可闻及少许湿性哆音，心界不大，     

Acute Cerebellar Infarction Complicated with Multiple Intracerebral Hemorrhage Treated by An Integrated Chinese and Western Medicine Approach: A Case Report

正Cerebellar infarction accounts for almost 3%of all ischemic strokes,with 27,400 new cases each year in the USA alone.~(1)Since the computerized tomography(CT)scan is often negative in the early hours after onset,it is difficult to diagnose,especially     

Successful Treatment with Integrated Chinese and Western Medicine for Severe Overdose of Amlodipine: A Case Report

<正>Introduction Amiodipine is a dihydropyridine calcium channel blocker(CCB)that inhibits calcium influx into cardiac,vascular smooth muscle cells,and pancreatic beta cells,leading to dilation of arteries and arterioles and reduction in insulin secretion.Oral administration of amiodipine is absorbed slowly but almost completely,with a high oral bioavailability up to 60%-80%.It has a large volume of distribution(21 L/kg)and a long elimination phase(t_(1/2)35-48 h).~(1-3))Severe amiodipine     

Integrated Chinese and Western Medicines Shorten Treatment Course of Subacute Invasive Pulmonary Aspergillosis: A Case Report

正Aspergillosis infection (AI) is the most common type of fungal infection,and the lungs are the most affected organs of deep Al.Due to the wide application of broad-spectrum antibiotics,glucocorticoids and immunosuppressants,as well as increased number of human immunodeficiency virus infection and organ transplant recipients,the incidence of Al has been     

tudy on Diagnosis and Treatment of Infectious Multiple Organ Dysfunction Syndrome by Integrated Traditional Chinese and Western Medicine

Objective: To explore the diagnostic and therapeutic approach of integrated traditional Chinese and western medicine (TCM-WM) on infectious multiple organs dysfunction syndrome/multiple system and organ failure (MODS/MSOF) for elevating the successful rate of rescuing the patients. Methods: Diagnosis with western medicine and Syndrome Differentiation of TCM in 225 in-patients of acute infectious disease complicated with MODS/MSOF were conducted, and TCM treatment, based on western medical comprehensive treatment, was given to observe the effect and explore the mechanism of the TCM-WM therapy. Results: Up to the end of 1998, 161 cases of the 225 cases were successfully cured and 64 died, the mortality being 28.4%. Among them, 58 out of 140 cases of MSOF died, the mortality was accounted for 41.4%. In 106 cases conformed to the diagnostic criteria of MSOF proposed by Professor Knaus WA, USA, 52 cases were cured successfully and 54 died, the mortality being 50.94%. Conclusion:TCM-WM treatment could elevate the therapeutic effect in treating MODS, the mechanism might be through improving the hemodynamic and hemorrheologic condition of patients to relieve nail-fold microcirculation disorder; influencing the levels of cytokine and inflammatory mediator, so as to alleviate the systemic inflammatory reaction, it might also abate the inhibited condition of gastro-intestinal motility, alleviate the intestinal flora imbalance, prevent intestinal bacteria and endotoxin malposition, and protect cells from peroxidation.     

地塞米松治疗重症胰腺炎并发多器官功能障碍综合征疗效观察

目的 探讨糖皮质激素(GC)治疗重症急性胰腺炎(SAP)并发多器官功能障碍综合征(MODS)的临床效果.方法 将37例SAP并发MODS患者随机分为常规治疗组(对照组,n=18)和地塞米松治疗组(治疗组,n=19).对照组给予常规治疗;治疗组在常规治疗的基础上,于MODS发生前后1～3 d,给予地塞米松10 mg,2～3次/d,3～5 d后停药.结果 治疗组患者的体温、血氧分压(PaO2)、心率、腹痛缓解时间、血淀粉酶、血胆红素及急性生理学及慢性健康状况Ⅱ(APACHEⅡ)评分均较对照组明显下降(P<0.05),住院时间显著缩短(P<0.01),PaO2较对照组明显升高(P<0.05).治疗组治疗后各项观察指标也较治疗前明显改善.结论 在治疗SAP并发MODS过程中,早期、足量使用地塞米松类药物,可明显减轻症状,缩短病程.     

重症急性胰腺炎并发多器官功能障碍综合征诊治分析

目的 讨论重症急性胰腺炎并发多器官功能障碍综合征的临床特点和诊治分析.方法 选择2010-01～2013-10间的重症急性胰腺炎的患者54例,随机分为观察组和对照组,各27例.两组同时应用重症监护,胃肠减压,纠正水电解质紊乱和酸碱失衡,纠正低血压,抗休克,透析,使用血管活性药物或强心剂,行气管插管或切开,给予护肝药物,抗生素,行全胃肠外营养.观察组在此基础上加用地塞米松,10 mg,2 ～3次/d静滴;静脉滴注乌司他丁,2×106 U,2次/d;根据病情发展酌情处理半量或延长使用时间.结果 经过治疗后,观察组的总有效率为70.4％,比对照组高（P＜0.05）,差异有统计学意义.观察组体温、血淀粉酶、血氧分压、疼痛缓解时间、白细胞计数、血胆红素及慢性健康状况评分等各项指标数据都比对照组改善明显,（P＜0.05）,差异有统计学意义.结论 通过胃肠减压,纠正水电解质紊乱和酸碱失衡,纠正低血压,抗休克,透析,应用抗生素,胃肠营养支持等综合治疗,配合应用地塞米松和乌司他丁,对重症急性胰腺炎合并多器官功能障碍综合征的治疗是可靠安全的,能有效降低死亡率.     

重症胃肠功能障碍中西医结合集束化防治管理优化方案研究

目的 观察3个不同的集束化防治管理方案对重症胃肠功能障碍（急性胃肠损伤）患者关键预后指标的影响,筛选优化的集束化防治管理方案。方法 将180例ICU患者随机分为3组,实施3种不同的治疗方案（方案1是尽早限制性给予肠内营养,以及早期给予肠外营养和中药;方案2是尽早给予合理性肠内营养和中药,3 d后肠内营养不足目标热量60%时加肠外营养;方案3是方案2减去中药）,疗程为7 d,比较3种方案对患者腹腔内压（intra abdominal pressure,IAP）、腹腔灌注压（abdominal perfusion pressure, APP）、胃肠功能、病情严重程度、ICU住院时间、28 d存活率、ICU病死率等的影响。结果 治疗后方案2组患者IAP显著降低,APP显著升高,病情严重程度减轻,28 d存活率显著增高（P<0.05）。结论 方案2能改善重症胃肠功能障碍患者的IAP、APP和病情,提高患者28 d存活率,显著优于方案1和方案3。     

血液灌流在急性有机磷中毒合并多器官功能障碍患者中的应用研究

目的研究血液灌流(hemoperfusion,HP)技术在急性有机磷中毒(AOPP)合并多器官功能障碍(MODS)患者中的应用。方法选取105例AOPP合并MODS患者,依据是否行血液灌流治疗分组。治疗组73例,采用HP+内科治疗;对照组32例,采用常规内科治疗。比较两组患者入院后第1、3、5天胆碱酯酶(CHE)活力恢复情况和C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、血清淀粉酶(AMS)的变化情况,以及各器官障碍恢复时间、并发症发生率、病死率情况。结果两组患者性别、年龄及农药种类无明显差异。治疗组住院天数较对照组短,CHE恢复速度较对照组明显增快(P<0.01)。治疗组第3、5天CRP、AMS、TNF-a降低速度均较对照组快(P<0.05)。治疗组各器官障碍恢复时间均较对照组快(P<0.05)。治疗组病死率、并发症发生率低于于对照组(P<0.05)。结论尽早行HP治疗,可明显改善有AOPP合并MODS患者抢救效果和预后。     

罕见啶虫脒经口中毒致多器官功能不全一例

啶虫脒中毒罕见且机制不详,缺乏足够的病例。本文分享成功抢救重症啶虫脒中毒1例,探讨啶虫脒的早期诊断和治疗。     

急性脑出血的中西医结合抢救治疗

出血性中风属急性脑血管病变中非外伤性的脑实质内出血，为致残率和死亡率 较高的一种常见病。本文针对急性脑出血的部位和出血量的不同，采用中西医结合抢救用药原则做了概括论述，对临床诊治具有一定的意义。     

急性脑血管病并发MODS的临床特征与对策

目的　探讨急性脑血管疾病 (ACVD)并发多器官功能障碍综合症 (MODS)的临床特征及防治对策。方法　对 42例ACVD并发MODS的病例资料进行临床分析。结果　 42例中 ,受累衰竭器官总计 1 31个 ,平均 3 .1个 ,死亡人数 2 7例 ,病死率 64 .3 %。结论　ACVD并发MODS时病死率与脏器数目有关 ,积极治疗原发病 ,有效控制感染 ,加强脏器功能保护与支持是降低MODS病死率的关键。     

Integrated Chinese and Western Medicine in Treatment of Critical Coronavirus Disease (COVID-19) Patient with Endotracheal Intubation: A Case Report

Coronavirus disease 2019(COVID-19)is an infectious disease caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).The disease has spread globally,resulting in the coronavirus pandemic.Common symptoms include fevler,cough,and shortness of breath.Muscle pain,sputum production and sore throat are less common.While the majority of cases result in mild symptoms,some progress to severe or critical pneumonia and multi-organ failure.Worldwide,there is a high mortality rate in severe or critical patients of COVID-19.Here we report a critical case of COVID-19 patient with endotracheal intubation successfully treated with integrated Chinese and Western medicine(ICWM).     

急性重度有机磷农药中毒合并严重阿托品中毒一例救治体会

1 病例简介 患者,女,23岁,于2000-02-23入院,T 36.5 ℃,BP 120/70 mm Hg(1 mm Hg=0.133 kPa) ,R 30次/min,P 138次/min .急性重症面容,昏迷状,瞳孔等大等圆(直径1.5 mm),双肺呼吸音粗,双肺底可闻及湿啰音,心音有力,律齐,心率138次/min,腹软,肝脾肋下未触及,双下肢无水肿.确诊为急性重度有机磷农药中毒后,立即建立静脉通道,肌肉注射氯磷定、静脉推注阿托品10～20 mg,再给予大剂量的复能剂3 d,10 g/d,之后给予小剂量复能剂3 d,4 g/d.     

中西医结合治疗扁平疣疗效观察

目的 :观察自制中药消疣液与 0 1%维A酸霜外用治疗扁平疣的疗效。方法 :扁平疣患者 12 9例 ,随机分为治疗组 65例 ,对照组 64例 ,治疗组采用自制消疣液与 0 1%维A酸霜外用治疗 ;对照组单纯用 0 1%维A酸霜治疗。结果 :治疗组有效率 81 4% ,对照组有效率 5 3 1% ,两组比较 ,有效率差异有高度显著性 (χ2 =11 97,P <0 0 0 5 )。结论 :自制中药消疣液配合 0 1%维A酸霜外用治疗扁平疣有良好疗效。     

成功抢救防冻液重度中毒一例

1 病例简介 患者,男,53岁,于2008-05-16T13:00驾车时,因口渴误饮半瓶可乐瓶装的防冻液(约250 ml),于18:00出现恶心、头晕、视物模糊、手麻等不适反应,立即到内蒙古当地医院就诊,当地医院给以静脉滴注盐酸纳洛酮、能量合剂等治疗(患者家属诉未曾洗胃).患者于次日1:00出现烦躁、意识障碍等醉酒样体征,当地医院值班医生给予地西泮注射液1支,于4:00患者病情加重,家属要求转入我院治疗.     

连续性肾脏替代治疗联合血液灌流治疗毒蕈所致多器官功能衰竭

目的:探讨连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)联合血液灌流治疗(he-moperfusion,HP)毒蕈中毒所致的多器官功能衰竭(multiple organ dysfunction syndrome,MODS)的疗效。方法:选择30例毒蕈中毒所致多器官功能衰竭患者,随机分为联合组及HP组(n=15),均行常规及HP治疗,HP治疗2 h后,联合组再行CRRT治疗24 h。治疗14 d后,测定患者炎性因子、心肌酶及肝肾功能指标。结果:治疗14 d后,两组患者AST、ALT、LDH、心肌酶(creatine kinase-MB,CK-MB)、血清肌酐(serum creatinine,SC)、IL-6及C反应蛋白(C-reactive protein,CRP)较治疗前均降低,差异有统计学意义(P<0.05)。与HP组比较,联合组患者肝肾功能及心肌酶指标均好转,病死率下降,差异有统计学意义(P均<0.05)。结论:CRRT联合HP治疗可通过调节炎性因子C反应蛋白、IL-6等表达水平来改善MODS症状,降低病死率。     

中西医结合治疗多器官衰竭60例分析

目的 研究中医中药在多器官衰竭(MOF)中的治疗及预防作用，探索中西医结合治疗MOF的有效途径。方法对该院重症监护病房收治的60例MOF患在常规治疗的同时，根据辨证论治的原则加用中药治疗。结果60例MOF患死亡率为62．5％。结论与献报道比较，两个及三个器官衰竭死亡率有所降低，表明中西医结合治疗MOF是一条有效的途径。     

Severe Mycoplasma Pneumonia in Child with Bilateral Parapneumonic Effusion Successfully Treated with Integrated Chinese and Western Medicine: A Case Report

正Mycoplasma pneumonia is a common communityacquired pneumonia(CAP)in Asia.Children suffering from M.pneumoniae tend to progress quickly and develop severe pneumonia with a poor prognosis.(1)Effective management of M.pneumoniae infections include macrolides,tetracyclines or fluoroquinolones,     

连续性肾脏替代治疗在产科急性肾功能衰竭及多器官功能障碍综合征中的应用

目的：评估连续性肾脏替代治疗(CRRT)在产科急性肾功能衰竭和多器官功能障碍综合征作用和疗效。方法：回顾性分析16例产科急性肾功能衰竭患者36例次CRRT治疗的临床资料,观察患者治疗前后血肌酐、尿素氮、尿酸、电解质和血气的变化及血压、心率的改变。结果：治愈13例,死亡3例。结论：连续性肾脏替代治疗能有效纠正产科急性肾功能衰竭患者液体平衡、纠正酸中毒和电解质紊乱,治疗中血流动力学稳定,适用于产科急性肾衰及多器官功能障碍综合征患者。