哮喘持续发作的病因及防治

哮喘持续发作按一般的概念为哮喘持续状态的同义词。其相应的定义是哮喘急性严重发作时,应用一般平喘药物包括静脉滴注氨茶碱而仍不能缓解在2 4h以上者。目前已不再使用这一名称和定义,哮喘持续发作定为急性重症哮喘,从字义上更为妥当和理想。其定义是哮喘急性发作,常规治疗无效,或呈暴发性发作,发作后短时间内就进入危重状态,按中华医学会呼吸病学会《支气管哮喘防治指南》判断标准应属重度-危重型。1　病　因哮喘的持续发作主要与下列因素有关:(1)哮喘患者及其家属对病情严重程度、进展速度估计不足,未及时就诊及治疗。(2 )即使就诊,但就…     

哮喘持续状态和哮喘猝死

哮喘持续状态和哮喘猝死上海第二医科大学瑞金医院（２０００２５）邓伟吾哮喘急性严重发作可威胁病员生命，以往习惯上诊断为哮喘持续状态，但作为反映病情的严重性，哮喘持续状态的诊断显然不够理想，似应采用哮喘急性严重发作为妥。并建议临床医师对每例哮喘急性发作的...     

冬春干寒话哮喘

哮喘是一种发作性的肺部过敏性疾病。年轻人常表现为急性暴发性哮喘发作,持续数小时后,迅速缓解。老年人则不然,其呼吸困难往往是进行性的,并有夜间加重的特点,持续数日、数月,常常被迫采取坐位,两手前撑,双肩耸起,额部冷汗,疲惫不堪。本病按其特点分为下列三种类型:1.外因性哮喘:发病与吸入某些外界过敏性抗     

利多卡因治疗支气管哮喘的临床应用

目的观察利多卡因(LC)治疗重度支气管哮喘(哮喘)74例的临床效果.方法从1994年10月～2003年12月,我院共收集哮喘患者147例,并随机分成8组,其中花草过敏哮喘(PHAA)16例分成4组,COPD诱发哮喘(COPDAA)131例分成4组.1.PHAA(1)哮喘急性发作2组治疗组和对照组各4例(2)哮喘持续状态2组治疗组和对照组各4例.2.COPDAA(1)哮喘急性发作61例分2组①治疗组32例,②对照组29例;(2)哮喘持续状态70例分2组①治疗组34例,②对照组36例.各治疗组以LC为主,各对照组以氨茶咸(Ami)为主.PHAA不配用消炎药物;COPDAA在综合治疗方案应用地塞米松(DE)、青霉素(BEN)和吸氧(Oi)等基础上,治疗组加用LC;对照组加用Ami.LC和AMi疗效判定有效时间限于用药后60min内哮喘终止.结果LC治疗PHAA 8例总有效率为100%;LC治疗COPDAA急性发作32例和哮喘持续状态34例,总有效率分别是71.87%和70.58%.总有效率治疗组显著高于对照组.结论LC是治疗重度哮喘的最理想的首先药物.     

67例重症哮喘临床分析及治疗体会

急性重症哮喘,过去称为哮喘持续状态,是指严重的哮喘发作持续24小时以上,病人表现为极度呼吸困难等特征,发绀明显,甚至出现呼吸循环衰竭,如果处理不当常常危及患者生命.现结合我院近二年治疗的67例重症哮喘病例,谈一下我们治疗重症哮喘的体会。     

重症哮喘的临床治疗体会

重症哮喘指的是哮喘急性发作,常规平喘药物不能控制,是呼吸内科的常见急症之一。哮喘患者虽经吸入糖皮质激素(≦1000μg/d)和应用长效β受体激动剂或茶碱类药物治疗后,哮喘症状仍持续存在或继续恶化,或哮喘呈暴发性发作,从哮喘发作后短时间内即进入重危状态,临床上常难以处理。     

氨茶碱静脉维持疗法的安全剂量

静脉连续滴注氨茶硷是治疗急性哮喘最常用、最有效的方法。但由于本药治疗指数低,有效剂量的个体差异甚大,而对于急性重症哮喘,茶硷剂量不足或过量同样危险。我们参照国内外文献和有关临床资料,对住院的25例哮喘急性发作病人进行了动态的血药浓度检测和验证,结果介绍如下: 一、病历选择:25例均为支气管哮喘急性发作病人。其中4例为哮喘持续状态。男11例,女     

支气管哮喘持续状态的急救护理

1 典型病例 王××,男,56岁,工人,患支气管哮喘32年,每年寒冬,初春受凉后发病,再次发作多持续1～5天,最长时间半月。我们按下述急救原则治疗后,其哮喘持续状态得到迅速控     

有创机械通气联合肌松剂维库溴铵治疗重症哮喘28例疗效观察

支气管哮喘急性发作是临床常见的急症,多数轻、中度哮喘发作的治疗并不困难,但有部分哮喘经内科常规治疗后病情仍然不能控制,可发展为重症和危重哮喘.这部分重症和危重哮喘过去曾被命名为致死性哮喘、难治性急性重症型哮喘和哮喘持续状态等,目前大多数学者主张用重症哮喘（severe asthma）表述.重症哮喘是ICU常见的危重症之一,为探讨重症哮喘抢救治疗的有效措施,我们选择2008年1月-2013年1月我院ICU收治的54例重症哮喘患者,对其中28例行有创机械通气联合肌松剂维库溴铵治疗,并进行疗效比较研究,现报告如下.     

重症哮喘的治疗

所谓重症哮喘系指对各种支气管扩张剂有耐药性,疗效不显,持续地处于顽固的喘息状态,进而陷入急性呼吸衰竭等重笃状态;或同时对激素有依赖性的喘息而言。临床特征 1.重症喘息时,由于有高度的支气管痉挛和气管内异常分泌,支气管内易形成粘液栓而窒息。此时支气管扩张剂常无效。 2.动脉血气分压的变化。普通喘息发作时一般的是PaO_2低下,而PaCO_2仍在正常范围。重症喘息发作时,由于合并粘液栓阻塞气     

医疗服务操作分类与编码的设计与应用简

医疗服务操作分类与编码是医学信息标准化的重要组成部分,是临床数据提取、分析和应用的基础。世界卫生组织及世界多国一直致力于开发、更新和维护此分类与编码。我国此前一直沿袭美国准备在2014年停止使用的ICD-9-CM-3（卷3）,中国需要结合国际主流设计思路,根据国情开发出适宜的多轴、一体化的医疗服务操作分类与编码体系。     

Adenocarcinoma of the stomach and esophagus and drinking water and dietary sources of nitrate and nitrite

We conducted a population-based case-control study of adenocarcinoma of the stomach and esophagus in Nebraska, U.S.A. Nitrate concentrations in public drinking water supplies were linked to residential water source histories. Among those using private wells at the time of the interview, we measured nitrate levels in water samples from wells. Dietary nitrate and nitrite were estimated from a food-frequency questionnaire. Among those who primarily used public water supplies (79 distal stomach, 84 esophagus, 321 controls), average nitrate levels were not associated with risk (highest versus lowest quartile: stomach OR=1.2, 95% CI [0.5-2.7]; esophagus OR=1.3, 95% CI [0.6-3.1]). We observed the highest ORs for distal stomach cancer among those with higher water nitrate ingestion and higher intake of processed meat compared with low intakes of both; however, the test for positive interaction was not significant (p=0.213). We did not observe this pattern for esophagus cancer. Increasing intake of nitrate and nitrite from animal sources was associated with elevated ORs for stomach cancer and with a significant positive trend in risk of esophagus cancer (P-trend=0.325 and 0.015, respectively). Larger studies with higher exposures to drinking water sources of nitrate are warranted to further evaluate N-nitroso compound precursors as risk factors for these cancers.     

Drinking water and dietary sources of nitrate and nitrite and risk of glioma

OBJECTIVE: Dietary nitrite has been associated with increased glioma risk; however, drinking water nitrate has not been extensively evaluated. METHODS: We conducted a population-based case-control study of adult glioma in Nebraska. Water utility nitrate measurements were linked to residential water source histories. We computed average nitrate exposure over a 20-year period. A food frequency questionnaire was used to assess dietary nitrate and nitrite. RESULTS: Increasing quartiles of the average nitrate level in drinking water were not significantly associated with risk (adjusted odd ratios: 1.4, 1.2, 1.3). Risk was similar among those with both higher and lower intakes of vitamin C, an inhibitor of N-nitroso compound formation. Dietary nitrite intake was not associated with risk. CONCLUSIONS: Our study does not support a role for drinking water and dietary sources of nitrate and nitrite in risk of adult glioma.     

黄体功能不健的调控机理

主要就引起卵巢黄体功能不健的因素 ,分别从激素调节、细胞因子 (VEGF、TNF α、BFGF、IFN γ、IGF)、C myc、Fas、SGP 2基因调控以及细胞连接、细胞粘附分子、NO等对卵巢功能的调节及对黄体细胞的凋亡影响进行阐述 ,认为卵泡发育不良、颗粒细胞、黄体细胞的凋亡与黄体功能不足有密切的关系。且多种细胞因子、基因表达产物参与此过程的调控。深入的研究这一调控机制 ,对于进一步了解卵巢卵泡生长发育、卵泡闭锁及黄体细胞凋亡的内在机制有重要意义     

人事聘用与工资制度改革的实践与体会

宜都市第一人民医院试行了以因事设岗、职位分级；竞争上岗、按岗聘用；岗位工资、绩效考核为内容的岗位聘用合同制和工资制度的改革实践，采取宣传发动、报批方案、分步实施、有序指导的改革措施，促进了该院员工观念的转变．加快了医院发展步伐，推进了“两个文明”建设，获得了诸多体会。     

浸润性和转移性膀胱癌的诊断和评价

一、膀胱癌的分级与分期 1.膀胱癌的组织学类型:尿路被覆的上皮统称为尿路上皮(urothelium).传统上将尿路上皮称为移行上皮(transitional epithelium).目前在文献和习惯上这两个名词常常被交替使用.膀胱癌的组织学类型包括尿路上皮癌、鳞状细胞癌和腺癌,其次还有较少见的转移性癌、小细胞癌和癌肉瘤等.     

Absorption and excretion of cholecalciferol and of 25-hydroxycholecalciferol and metabolites in birds

The absorption and excretion in vivo of cholecalciferol or 25-hydroxycholecalciferol (25-HCC) were determined in chicks (Gallus domesticus) and turkeys (Meleagris gallopavo). The overall net cholecalciferol or 25-HCC absorption in chicks and cholecalciferol in turkey poults was 66.5 +/- 3.3, 74.9 +/- 3.7 and 83.6 +/- 7.1% of the intake, respectively. The absorption of cholecalciferol or 25-HCC in chicks and turkeys occurred at the upper part of the intestine. 25-HCC, esters and non-polar metabolites of cholecalciferol or 25-HCC, and their polar metabolites, were secreted in the duodenum of chicks and turkeys but were partially reabsorbed at the upper part of the jejunum.