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1.
目的 分析急性呼吸窘迫综合征患者肺内和肺外源性因素。方法 回顾性分析60例ARDS(急性呼吸窘迫综合征)患者临床资料。结果ARDSp(由肺部原因引起的急性呼吸窘迫综合征)患者19例,ARDSexp(由肺外原因引起的急性呼吸窘迫综合征)患者41例;ARDSexp组氧合指数要比ARDSp组高,差异具有统计学意义(P〈0.05);ARDSp组患者主要为肺炎14例,ARDSexp组患者肺外原因主要为急性重症胰腺炎12例;ARDSp组的肺损伤评分、APACHE II评分要比ARDSexp组高,差异具有统计学意义(P〈0.05);ARDSp组死亡10例,ARDSexp组死亡19例,差异不具有统计学意义。结论 对急性呼吸窘迫综合征患者肺内和肺外源性因素分析发现,虽然ARDSexp的患病率较高,但是病情程度较轻,死亡率要比ARDSp组低。 相似文献
2.
目的比较老年患者中肺部原因诱发的急性呼吸窘迫综合征(acute respiratory distress syndrome of pulmonary origin,ARDSp)和肺外原因诱发的ARDS(ARDS of extra-pulmonary origin,ARDSexp)临床特征差异性。方法回顾性研究本院2000年1月-2012年6月收治的符合2012年ARDS柏林定义且年龄〉60岁的老年患者临床资料。结果 ARDSp患者以肺炎最多见,占肺部原因的77.6%;ARDSexp最多见的是脓毒症,占43.8%。ARDSp与ARDSexp组入选时APACHEⅡ评分分别为20.4分和20.7分(P=0.898),肺损伤评分分别为2.7分和2.5分(P=0.385),序贯性器官功能衰竭(sequential organ failureassessment,SOFA)评分分别为6.1分和8.4分(P=0.013),住院病死率分别为58.6%及43.8%(P=0.289)。两组主要死亡原因均为多器官功能障碍综合征和严重呼吸衰竭。结论老年ARDS患者中,尽管ARDSexp组器官功能衰竭重于ARDSp组,但两组在APACHEⅡ评分、肺损伤评分、住院病死率以及主要死亡原因等方面无显著差异。 相似文献
3.
目的观察肺源性和非肺源性急性呼吸窘迫综合征(ARDS)早期病人应用不同水平呼气末正压(PEEP)时静态呼吸系统总顺应性以及呼吸功的差异。方法将22例ARDS患者分为肺源性ARDS组(ARDSp,10例)和非肺源性ARDS组(ARDSexp,12例)。通过肺监测仪和呼吸机记录食道压变化值(△Peso)、平台压、呼气末压力、呼吸功,通过公式计算静态呼吸系统总顺应性的数值。结果随着PEEP水平的提高,两种原因ARDS的呼吸功均增大;ARDSp的呼吸功大于ARDSexp,除了在15cmH2O水平:在不同PEEP水平时,ARDSp和ARDSexp的静态呼吸系统总顺应性差异无统计学意义。结论ARDSp的呼吸功大于ARDSexp,两者的呼吸系统总顺应性差异无显著性。 相似文献
4.
目的:探讨治疗后 C-反应蛋白(CRP)下降率对评估严重脓毒症患者预后的作用。方法选择确诊为严重脓毒症的103例患者,根据治疗3 d 后 CRP 下降率分为 A 组(治疗3 d 后 CRP 较治疗前下降<30%)、B 组(治疗3 d 后 CRP 较治疗前下降30%~50%)、C 组(治疗3 d 后 CRP 较治疗前下降≥50%),比较3组患者机械通气带机时间、ICU 平均住院天数、平均 ICU 住院费用、平均总住院天数及28 d 病死率。结果A 组患者与 B、C 组患者机械通气平均带机时间、ICU 平均住院天数、平均 ICU 住院费用、平均总住院天数及28 d 病死率比较差异均有统计学意义(P <0.05)。B 组患者机械通气平均带机时间、ICU 平均住院天数、平均 ICU 住院费用、平均总住院天数及28 d 病死率均高于 C 组,但差异无统计学意义(P >0.05)。判断脓毒症患者存活的治疗后3 d CRP 下降率的最佳界点值为31.48%,敏感性为86.54%,特异度为100%。结论严重脓毒症抗感染治疗3 d 后 CRP 下降率是一个敏感性好、特异性强的用于判断患者预后良好的指标。 相似文献
5.
兔肺内、外源性急性呼吸窘迫综合征血清和支气管肺泡灌洗液中炎性介质的表达 总被引:4,自引:0,他引:4
目的:比较肺内、外源性急性呼吸窘迫综合征(ARDS)兔血清和支气管肺泡灌洗液(BALF)中炎性介质的表达。方法:健康新西兰家兔24只,随机分为肺内源性ARDS(ARDSp)组和肺外源性ARDS(ARDSexp)组,每组12只。稀盐酸气管内滴入法制作ARDSp动物模型,静脉注射油酸法制作ARDSexp模型。测定基础状态和注药后静脉血及肺泡灌洗液肿瘤坏死因子α(TNF-α),白细胞介素1β(IL-1β),IL-6水平。结果:两组动物均在注药后3h内达到ARDS诊断指标;损伤后两组动物血清及BALF炎性介质水平均有增高,ARDSp组动物以BALF中炎性介质表达为主,ARDSexp组动物以血清炎性介质表达为主。结论:由不同原因引起的ARDS由于其发病机制和损伤部位不同,其炎性介质表达和病理改变是不同的,ARDSp的炎性介质表达以BALF为主,病理改变以肺泡水肿、炎细胞浸润为主;ARDSexp的炎性介质表达以血清为主,病理改变以肺间质水肿为主。 相似文献
6.
目的:观察比较小潮气量加肺复张(recruitment maneuver,RM)持续时间的选择对肺内/外源性急性呼吸窘迫综合征(ARDSp/ARDSexp)的影响.方法:选择甲流重症肺炎呼吸衰竭患者10例(ARDSp),外源性急性呼吸窘迫综合征16例(ARDSexp),两组均给予容量-压力控制模式辅助呼吸,甲流呼衰组(ARDSp)在容量-压力控制模式下给予间歇高呼气末正压(PEEP)加小潮气量的RM,评价RM的不同持续时间对ARDSp(ARDSp组,10例)、ARDSexp(ARDSexp组,16例)的影响,比较二者间的差别.结果:RM持续时间≥60s时平均动脉压(MAP)降低、HR加快,较RM前差别有统计学意义,RM停止后恢复正常.与RM前比较,气道平台压(Pplat)、呼吸系统顺应性(Crs)在RM实施时即明显增加(P<0.05);氧合指数(OI)在RM持续时间≥40s的三个时间段明显增加,SpO2在RM持续时间≥30s的四个时间段明显增加(P<0.05);在RM持续时间≥60s时,Pplat增加显著,而Crs、OI、SpO2较(40~59)s未见明显增加;对RM反应ARDSexp组优于ARDSp组,两组比较差别有统计学意义(P<0.05).ARDSp组出现气胸1例,皮下气肿3例;ARDSexp组出现皮下气肿2例,均发生在RM持续时间≥60s.结论:间歇高PEEP加小潮气量的肺复张对甲流重症肺炎呼吸衰竭有效,持续时间宜在(40~59)s,对肺外源性肺损伤比肺内源性肺损伤效果好. 相似文献
7.
目的 探讨静脉输注丙种球蛋白(IVIG)治疗急性特发性血小板减少性紫癜(AITP)的疗效。方法 将48例符合AITP患儿分为IVIG治疗组和糖皮质激素(激素)治疗对照组。结果 IVIG治疗组和激素对照组有效率均为95%,但IVIG治疗组血小板回升时间中位数为3.2d,血小板达峰值8.1d,出血症状控制时间为3.5d,对照组的此三项指标为9.2d,12.1d,7.4d,两者比较有显著性意义(P<0.01)。同时住院天数IVIG组平均为12d,对照组为19d,亦有明显差异。结论 IVIG为治疗AITP理想的药物。 相似文献
8.
糖皮质激素与感染造成外周血白细胞计数升高的鉴别 总被引:1,自引:0,他引:1
目的:探讨患者应用糖皮质激素后出现白细胞升高是糖皮质激素的作用还是感染加重,注意分析可避免抗菌药物的滥用,节约医疗成本。方法收集2011年1月至2012年12月于该科住院和门诊治疗的74例患者,根据其病种及治疗方案分为非感染激素组(n=15)、感染非激素组(n=29)和感染激素组(n=30),分别在糖皮质激素和(或)抗菌药物治疗0、3、7 d时采集静脉血,对其外周血白细胞计数(WBC)、C反应蛋白(CRP)及外周白血细胞形态进行检测。结果与治疗同期感染非激素组比较,感染激素组在应用糖皮质激素3 d和7 d后WBC显著升高(P<0.01);两激素组在应用糖皮质激素3 d和7 d后WBC无显著差异(P>0.05),两激素组外周血涂片可见较多分叶核中性粒细胞(P<0.05)。而感染激素组与感染非激素组比较,CRP变化无显著差异(P>0.05)。结论糖皮质激素升高外周血白细胞,以升高中性粒细胞为主,可以以CRP及外周血涂片结果为参考指标了解患者感染控制情况。 相似文献
9.
脑出血并发高钠血症18例临床特点分析 总被引:4,自引:0,他引:4
152例脑出血患者按血钠水平分为高钠血症组(18例)和对照组(134例),对两组进行对照分析,结果高钠血症组死亡11例,病死率61.11%;对照组死亡26例,病死率19.40%,两者差异有显著意义(P<0.01)。丘脑出血发生率,高钠血症组明显高于对照组(P<0.05);空腹血糖浓度≥6.1mmol/L、血白细胞计数≥10.0g/L、血压≥23.9/14.6kPa、体温≥39℃及血肿破入脑室者百分比,高钠血症组均明显高于对照组(P<0.01)。结果表明,脑出血并发高钠血症主要与其自身病理生理机理有关;其病死率高,多预后不良。 相似文献
10.
目的:比较NP方案与MVP方案对晚期非小细胞肺癌(NSCLC)的治疗效果。方法:86例患分别用NP(NVB 25mg/m^2,iv,d1.8;DDP50mg/日,iv,d1-3)或MVP(MMC6-8mg/m^2,iv,d1;vds3mg/m^2,iv,d1.8;DDP50mg/日,iv,d1-3)方案治疗1。结果:NP组总有效率47.5%(19/40),CR3例,PR16例;MVP组总有效率43.5%(20/46),无CR,PR20例。两组总有效率无显性差异(P>0.05),分析影响疗效的因素发现,病期早较病期晚好(P<0.05)初治较复治好,但统计学无显性差异(P>0.05)。骨髓抑制为限制性反应,白细胞下降分别为100%和91.3%,Ⅲ度以上下降分别为55%和24%。注射局部毒性反应在NP组72.2%,Ⅲ度8.3%。MVP组无此反应。结论:对晚期非小细胞肺癌,选用NP方案和MVP方案疗效均较好且相似,值得临床采用。 相似文献
11.
Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P < 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (>0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P <0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P < 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD. 相似文献
12.
Jiageng Zhu Jun Li Ruipeng Ji Jianghao Su Mingshun Shen Zhigang Cao 《南京医科大学学报(自然科学版)》2007,21(2):125-128
Objective: To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods: SD rats served as both donors and recipients. 4℃ sodium lactate Ringer's was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava (IVC) inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results: Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion: This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment. 相似文献
13.
Tao Ye * Zhi-quan Liu Jian-jun Mu Xi-han Fu Jun Yang Bao-lin Gao and Xiao-hong Zhang Department of Cardiology First Hospital of Xi'an Jiaotong University Xi'an Hanzhong Cardiovascular Institute Hanzhong 《中国医学科学杂志(英文版)》2004,19(4):248-251
Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P< 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P< 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure. 相似文献
14.
目的:评价使用安心颗粒对急诊经皮冠状动脉介入术(PPCI)术后生活质量的影响.方法:将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组(术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次)和对照组(仅接受基础药物治疗).所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表(MIDAS)、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果:入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异(P>0.05);出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低(P<0.05);组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低(P<0.05).两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血(P>0.05).两组发生轻度血小板减少症的患者数比较无差异(P>0.05).结论:PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险. 相似文献
15.
Jingming Zhu Ningning Hui Xiuhong Jiang Huaxing Zhang Chengzhang Fu 《南京医科大学学报(自然科学版)》2007,21(6):386-389
Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P<0.01);the MAP decreased(P<0.01)and the HR increased drastically(P<0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients. 相似文献
16.
Objective:To investigate the gene expression of osteoprotegerin(OPG) and osteoclast differentiation factor(ODF) in the bone tissue of patients with hip fracture due to osteoporosis. Methods:OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers(over 50 years old) with hip fracture(Observer Group) and 30 cases of hip facture sufferers with no osteoporosis(Control group) were analyzed with the Semi-Quantitative RT-PCR method. Results:The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion:Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption. 相似文献
17.
The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas: report of 9 cases 总被引:1,自引:0,他引:1
Shaoqin Chen Shengquan Zou Qibao Dai Peisheng Huang Weihua Cai Hong Li 《南京医科大学学报(自然科学版)》2007,21(6):398-401
Objective:To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas(SPTP). Methods:Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin(HE) staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results:Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin(9/9 cases), AAT(9/9 cases), NSE(9/9 cases), ACT(7/9 cases), CK20(2/9 cases), CgA(1/9 cases), S-100(3/gcases), PR(4/gcases), Syn(3/9 cases) and CD56(5/9cases), negative in CEA and ER. Conclusion:SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype. 相似文献
18.
Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine
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A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care(~'4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes. 相似文献
19.
Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P. 相似文献
20.
Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine. 相似文献