经输尿管镜碎石术后感染性休克并急性肺损伤的救治分析

目的探讨输尿管镜碎石术后感染性休克继发急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的治疗方法。方法总结分析15例输尿管镜碎石术后感染性休克继发ALI/ARDS患者的临床表现和治疗方法。患者在输尿管镜碎石术后2~78 h出现ALI/ARDS表现,予以抗感染、机械通气、糖皮质激素、连续性肾脏替代治疗(CRRT)、营养支持等综合治疗。结果 15例患者中,即使是合适的术前泌尿系统抗感染的治疗,术后安置输尿管内双J管的扩张引流,也并不能完全防止输尿管镜碎石术后出现全身炎症反应,引发ALI/ARDS。菌血症和全身炎症反应综合征(SIRS)持续时间影响着住院时间和预后。本组15例患者诊断感染性休克至出现ALI/ARDS时间25.13 h;CRRT替代治疗8例(53.3%);平均在科时间10.8 d;机械通气时间平均72 h;治愈13例,自动出院2例。结论对输尿管镜碎石术后感染性休克继发急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的患者,早期发现诊断、积极合理的抗生素应用、有效的机械通气支持、精确的容量管理、糖皮质激素的补充及营养支持,同时在上述综合治疗的基础上增加CRRT协助治疗可提高治疗成功率。     

呼吸支持阶梯化管理在老年急危重症患者院前转运救治中的应用价值

目的 探讨呼吸支持阶梯化管理在老年急危重症患者院前转运救治中的应用价值,为治疗该类型病症提供方法。方法 选取2020年8月—2022年8月实施院前转运救治的老年急危重症患者86例,采取数字表法随机分为观察组和对照组,每组43例。对照组接受常规呼吸支持治疗,观察组给予呼吸支持阶梯化管理治疗。观察并比较2组呼吸支持方式、复苏情况、慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、治疗前后生命体征指标[心率(HR)、舒张压(DBP)、收缩压(SBP)]值和气道并发症情况。结果 2组选择呼吸支持方式最常见是气管插管,其次是复苏体位,其中观察组复苏体位方式选择率显著高于对照组(P<0.05),气管切开选择率显著低于对照组(P<0.05);观察组复苏成功率显著高于对照组(P<0.05),平均复苏时间及呼吸平稳时间显著少于对照组(P<0.05), APACHEⅡ评分显著低于对照组(P<0.05)。治疗后,2组HR、 MAP、 PaCO₂较治疗前显著性降低(P<0.05),观察组显著低于对照组(P<0.05), 2组PaO₂     

气道压力释放通气治疗急性肺损伤和急性呼吸窘迫综合征的临床研究进展

气道压力释放通气作为一种新的通气模式不同于常规通气模式。它通过从高气道压向低气道压释放完成机械通气,而常规通气是通过吸气相升高气道压力来完成机械通气的,同时由于它具有低气道压、低分钟通气量、对心血管的损害小等诸多的优点越来越受到临床医生和研究者的关注。     

吸入性中毒致急性肺损伤和急性呼吸窘迫综合征的救治体会

吸入性中毒发病快,救治难度大,死亡率高。我院2006年3月～2007年2月共收治吸入性中毒致急性肺损伤(ALI)和急性呼吸窘迫综合征(ARDS)患者27例,经即时抢救,对症处理,全部治愈,现报道如下。临床资料27例吸入性中毒致ALI患者(男24,女3),年龄18～54岁,平均(38.2±8.4)岁。所有患者均有明确的吸入性中毒病史并符合中华医学会呼吸病学分会ALI和ARDS的诊断标准[1]。其中固体光气中毒13例,盐酸气体中毒2例,硝酸气体中毒2例,氯气中毒4例,一氧化碳中毒2例,硫化氢气中毒2例,硝酸和硫酸混合气体中毒1例,硼酸气体中毒1例。23例为务工人员,2例为个体…     

气道压力释放通气治疗急性肺损伤和急性呼吸窘迫综合征的研究进展

气道压力释放通气是以持续气道正压为工作基础的压力控制机械通气模式,其从高气道压向低气道压释放压力产生通气量进行气体交换.它能在肺保护通气策略基础上维持肺复张、开放及减少呼吸机相关肺损伤.它对急性肺损伤/急性呼吸窘迫综合征患者在降低气道峰压及平均压、提高氧合、改善血流动力学和胃肠灌注、减少镇静和麻醉药物使用等方面产生广泛有利影响;而且,自主呼吸对重力依赖区塌陷肺组织的重新开放在其中发挥重要作用,其应用受到研究者和临床医师越来越多的关注.     

老年急性肺损伤和急性呼吸窘迫综合征的药物治疗

急性呼吸窘迫综合征（ARDS）是由多种原因导致的以呼吸窘迫和低氧血症为特征的一种急性进行性呼吸困难,是临床上常见的危重症之一,死亡率很高。其中老人因为心肺功能差,免疫功能低下,应激能力差,其病死率高于青壮年,有报道老年人病死率高达85％,大约为年轻人的2～3倍,故更应引起重视。然而,尽管自1967年首次报道本病以来,国内外进行了深入研究,针对其诱发因素、致病机制、诊断和治疗取得了较大进展,但是遗憾的是,     

山羊高原重度原发性肺冲击伤模型的建立

目的 建立山羊在海拔4 600 m高原环境下的重度原发性肺冲击伤模型,分析高原重度原发性肺冲击伤的特点,为院前救治提供实验基础。方法 选取健康山羊28只,随机分为3 m组22只,3.5 m组6只,采用8 kg TNT当量新型爆炸物,在相同的环境条件下致伤,观察致伤后山羊肺冲击伤伤情,分别于伤前、伤后1 h、24 h监测山羊生命体征、肌钙蛋白Ⅰ,观察肺大体解剖,测肺组织重量、湿/干比重(W/D)等,对重伤山羊进行院前ABC救治。结果 伤后t≤15 min死亡12只,伤后15 min相似文献   

Sickle acute lung injury: role of prevention and early aggressive intervention strategies on outcome

Acute chest syndrome in sickle cell disease is a form of acute lung injury that may progress to acute respiratory distress syndrome and death. Despite recent advances in diagnosis and treatment that have resulted in improved survival in sickle cell disease, acute chest syndrome remains the most common cause of death in this population. The current standards of treatment for acute chest syndrome have been reviewed. Biomedical re-search forms the basis for sound clinical decision making and implementation of interventions that target prevention, diagnosis, and effective treatment options. Although current clinical trials are ongoing to address several new potential therapeutic options,more research using preventative and interventional strategies in sickle acute lung injury is warranted.     

缺血预处理对高原大鼠肝脏缺血/再灌注损伤早期的影响

目的:了解在高原缺血预处理(IPC)对肝脏缺血/再灌注损伤(I/R)早期保护作用及其机制.方法:SD大鼠45只随机分为3组:假手术组、缺血再灌注组、缺血预处理组.各组恢复血流后分别于1,3,6 h取血液标本,检测血清ALT(nkat/L)、丙二醛(MDA,mmol/L)、NO(μmol/L)的含量.结果:缺血预处理组NO的水平明显高于缺血再灌注组(1 h:95.8±10.1 vs 64.2±6.8,P＜0.01;3 h:91.2±9.7 vs 69.5±7.2,P＜0.01;6 h:77.4±8.6 vs 63.7±6.1,P＜0.01),低于假手术组;而ALT(1 h:2257.1±201.7 vs 2912.2±398.4,P＜0.01;3 h:2465.5±243.4 vs 3637.4±441.8,P＜0.01;2545.5±223.4 vs 4027.5±496.8,P＜0.01)、MDA(1 h:25.1±4.3 vs 38.7±7.6,P＜0.01;3 h:27.5±5.4 vs 45.3±8.8,P＜0.01;34.2±6.7 vs 53.2±10.5,P＜0.01)明显低于缺血再灌注组,高于假手术组.结论:在高原缺氧环境下,缺血预处理对大鼠肝脏缺血再灌注损伤有明显保护作用,其机制可能与缺血与预处理抑制肝脏脂质过氧化物的产生,提高内源性NO的产生,改善肝脏的微循环有关.     

Travel to high altitude with pre-existing lung disease.

The pathophysiology of high-altitude illnesses has been well studied in normal individuals, but little is known about the risks of high-altitude travel in patients with pre-existing lung disease. Although it would seem self-evident that any patient with lung disease might not do well at high altitude, the type and severity of disease will determine the likelihood of difficulty in a high-altitude environment. The present review examines whether these individuals are at risk of developing one of the main forms of acute or chronic high-altitude illness and whether the underlying lung disease itself will get worse at high elevations. Several groups of pulmonary disorders are considered, including obstructive, restrictive, vascular, control of ventilation, pleural and neuromuscular diseases. Attempts will be made to classify the risks faced by each of these groups at high altitude and to provide recommendations regarding evaluation prior to high-altitude travel, advice for or against taking such excursions, and effective prophylactic measures.     

Water balance and lung fluids in rats at high altitude.

A disturbed water and electrolyte homeostasis is not generally held to be a primary mechanism in the pathogenesis of acute mountain sickness (AMS) and high altitude pulmonary edema (HAPE), but the association of oliguria and weight gain with AMS and HAPE has led to the hypothesis that water retention may be a facilitative mechanism, possibly caused by an effect of hypoxia to release antidiuretic hormone (ADH). To examine the problem, normal Long-Evans rats (N) and the strain with congenital diabetes insipidus (DI) were exposed to hypobaric hypoxia (0.5 atm) for 4 days, and fluid balance in the whole animals and in their lungs was studied. Both strains reduced water intake and were oliguric on acute exposure, but the N rats gained body weight and increased lung water, while the DI rats increased neither body weight nor lung water. Neither strain increased lung blood at high altitude. The oliguria in the DI rats could not have been due to a release of antidiuretic hormone, and was attributed to the diminished water intake in both strains. The protection against HAPE in the DI rats was probably due to their more severe dehydration that exists already in normoxia, and its further increase in hypoxia, compared with N rats.     

Influence of hemoglobin concentration on lung diffusing capacity for CO at high altitude

Lung diffusing capacity (D _LCO) was measured using a steady state method in high altitude (3600 m) natives. Regression coefficients ofD _LCO with height, age and hemoglobin concentration were determined and compared with results obtained with the same method at sea level. Influence of hemoglobin concentration was greater at 3600 m than at sea level. This difference could be due to capillary oxygen pressure and/or to the ratio DM/Vc but not to racial or genetic factors.     

抗胆碱药治疗高原肺水肿患者的临床研究

目的评估抗胆碱药对高原肺水肿（ＨＡＰＥ）的临床疗效及探讨其作用机制。方法将海拔４７００～５２６０米地区５８２例高原肺水肿患者分为３９３例抗胆碱药治疗组和１８９例一般疗法治疗的对照组,在治疗前及治疗后２４小时（ｈ）作无创血液动力学检测。结果抗胆碱药组患者的症状、体征、Ｘ线平片肺部阴影消失时间分别为（３３±１７）ｈ、（４６±２２）ｈ、（７５±２９）ｈ,平均住院日为（５３±１９）ｄ,与对照组比较差异有显著性（Ｐ均＜０．００１）,治愈率显著提高（Ｐ＜０．０５）,１４项血液动力学参数的异常改变得到纠正（Ｐ＜０．０５或Ｐ＜０．０１）。结论抗胆碱药具有疗效确切,疗程短,副作用小,治愈率高等突出优点。对血液动力学的作用为其重要的治疗机制之一,可作为高原肺水肿现场治疗的重要药物。     

Risk of early surgery for Crohn's disease: implications for early treatment strategies

OBJECTIVES: In this study we aimed to define the rate of early surgery for Crohn's disease and to identify risk factors associated with early surgery as a basis for subsequent studies of early intervention in Crohn's disease. METHODS: We assembled a retrospective cohort of patients with Crohn's disease diagnosed between 1991 and 1997 and followed for at least 3 yr, who were identified in 16 community and referral-based practices in New England. Chart review was performed for each patient. Details of baseline demographic and disease features were recorded. Surgical history including date of surgery, indication, and procedure were also noted. Risk factors for early surgery (defined as major surgery for Crohn's disease within 3 yr of diagnosis, exclusive of major surgery at time of diagnosis) were identified by univariate analysis. Multiple logistic regression was used to identify independent risk factors. RESULTS: Of 345 eligible patients, 69 (20.1%) required surgery within 3 yr of diagnosis, excluding the 14 patients (4.1%) who had major surgery at the time of diagnosis. Overall, the interval between diagnosis and surgery was short; one half of all patients who required surgery underwent operation within 6 months of diagnosis. Risk factors identified by univariate analysis as significantly associated with early surgery included the following: smoking; disease of small bowel without colonic involvement; nausea and vomiting or abdominal pain on presentation; neutrophil count; and steroid use in the first 6 months. Disease localized to the colon only, blood in the stool, use of 5-aminosalicylate, and lymphocyte count were inversely associated with risk of early surgery. Logistic regression confirmed independent associations with smoking as a positive risk factor and involvement of colon without small bowel as a negative risk factor for early surgery. CONCLUSIONS: The rate of surgery is high in the first 3 yr after diagnosis of Crohn's disease, particularly in the first 6 months. These results suggest that improved risk stratification and potent therapies with rapid onset of action are needed to modify the natural history of Crohn's disease.     

阿司匹林和氯吡格雷所致胃肠道损伤的防治策略

随着心脑血管疾病及其并发症发生率的增加以及对其预防和治疗的重视,阿司匹林和氯吡格雷的临床应用越来越广泛,随之而来的胃肠道损伤尤其是消化道出血的发生率明显增加。如何认识阿司匹林和氯吡格雷所致胃肠道损伤,并对其进行预防和治疗,是目前的热点问题。