面罩吸氧辅助治疗急性肺损伤及急性呼吸窘迫综合征的效果观察

急性肺损伤（ALI）及急性呼吸窘迫综合征（ARDS）是在严重感染、休克、创伤及烧伤等非心源性疾病过程中，肺毛细血管内皮细胞和肺泡上皮细胞损伤造成弥漫性肺间质及肺泡水肿，导致急性低氧性呼吸功能不全或衰竭^[1]。早期主要表现为顽同性低氧血症和呼吸窘迫，是一种常见危重症，病死率高达60％以上，严重影响病人生存质量。氧疗是纠正ALI及ARDS病人低氧血症的基本手段，常规鼻导管吸氧难以奏效，面罩吸氧可提供较高浓度的氧气啪，易于实施。临床实践中对20例病人采用面罩吸氧，取得满意效果。现报告如下。     

应用储氧袋面罩救治1例急性呼吸窘迫综合征患者的护理

氧疗是纠正急性呼吸窘迫综合征(ARDS)患者低氧血症的基本手段[1],常规用鼻导管吸氧对ARDS患者常难以凑效.本科应用储氧袋面罩吸氧治疗ARDS患者,解决了鼻导管吸氧难以凑效的问题,报告如下.     

抗凝治疗——急性肺损伤/急性呼吸窘迫综合征治疗的新思路

急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)是指由心源性以外的各种肺内外致病因素导致的急性、进行性呼吸衰竭,以呼吸窘迫和低氧血症为特点,常需要机械通气治疗[1].     

急性肺损伤的中医药治疗进展

急性肺损伤(ALI)是急性呼吸窘迫综合征(ARDS)的早期阶段.常在严重感染、休克、创伤及烧伤等非心源性疾病过程中,由于肺毛细血管内皮细胞和肺泡上皮细胞受损,形成弥漫性肺间质及肺泡水肿,从而导致的急性低氧性呼吸功能不全或衰竭,是1种常见而严重的呼吸急症.     

急性肺损伤和成人呼吸窘迫综合征的预防性和针对性治疗进展

急性肺损伤(acute lung injury,ALI)是机体受到创伤、休克以及严重感染等因素打击后,引起的呼吸窘迫和顽固性低氧血症。成人呼吸窘迫综合征(adult respiratory distress syndrome,ARDS)是肺内严重的急性炎症反应,属于ALI的严重阶段,其特征是肺泡-毛细血管屏障的损伤和肺泡内富含     

急性肺损伤/急性呼吸窘迫综合征患者的治疗及护理进展

急性肺损伤(ALI)是指患者在肺内外致病因素(如严重感染、烧伤、严重创伤、急性重症胰腺炎等)作用下,引起肺内血管内皮和肺泡上皮损伤为主要病理变化的肺部炎症反应综合征,临床表现为难以纠正的进行性低氧血症和呼吸窘迫,肺部影像学上表现为弥漫性渗出病变,其进展的最严重的情况是急性呼吸窘迫综合征(ARDS)[1]     

稳定表达血管生成素1的骨髓间充质干细胞对内毒素诱导急性肺损伤干预作用的研究进展

急性肺损伤(ALI)是由感染、创伤、休克等多种原因引起的弥漫性肺微血管内皮细胞损伤导致的血管通透性增高,以肺间质、肺泡水肿和肺不张为病理生理特征,临床表现为进行性呼吸窘迫和顽固性低氧血症,严重者可发展成为急性呼吸窘迫综合征(ARDS)[1].     

乌司他丁对急性肺损伤/急性呼吸窘迫综合征患者血清一氧化氮、内皮素-1的影响

急性肺损伤(acute lung injury,ALI)是一种失控的炎症反应,以肺血管内皮细胞及肺上皮细胞的广泛损伤为病理特点,临床上表现为肺部弥漫性渗出和难以用单纯吸氧纠正的低氧血症.Au如果得不到及时控制,将发展为急性呼吸窘迫综合征(acute respiratory distress syndrome ARDS)[1].     

重症肺炎合并ARDS的护理1例

急性呼吸窘迫综合征(ARDS),是多种原因引起的急性呼吸衰竭,临床上以呼吸窘迫、顽固性低氧血症和非心源性肺水肿为特征.以肺泡毛细血管损伤为主要表现,其表现为肺水肿的产生、肺内微血栓形成、低氧血症生成,临床特征包括呼吸频速、窘迫和进行性低氧血症.ARDS不是一个独立的疾病,作为连续的病理过程,其早期阶段为急性肺损伤(ALI),重度的AIJ即ARDS.     

内毒素所致急性肺损伤的免疫治疗策略

急性肺损伤 (ALI)是各种严重的休克、感染、创伤、中毒等导致的急性弥漫性肺泡和肺血管内皮细胞的损伤。严重者在临床上表现为显著的呼吸窘迫、顽固性进行性低氧血症、肺顺应性下降 ,即急性呼吸窘迫综合征 (AROS)。大多数研究认为 ,ALI或ARDS的最危险因素依次为 :脓毒血症、误吸胃液、肺挫伤、大量输血等 ,也见于严重外伤[1] 。因此 ,ALI的最常见形式往往见于脓毒败血症时的内毒素损害。目前的动物实验、临床研究也多以内毒素来制作模型。其主要病理多认为是内毒素直接或间接损伤肺泡上皮和肺血管内皮细胞 ,导致毛细血管通透性升高、…     

Pathogenesis of acute encephalitis and acute encephalopathy

Many aspects of the pathogenesis of acute encephalitis and acute encephalopathy have been clarified in this decade, although many unknown mechanisms remain to be elucidated. According to progress of MRI and neuroimmunological analysis and the observation of clinical findings, many new syndromes were found, which enhanced our understanding of acute encephalitis and acute encephalopathy. The pathogenesis of encephalitis is divided into infection and immune mediated mechanisms. The antibodies to neuronal surface antigens(NSA) such as NMDA receptors, leucin-rich glioma inactivated 1 (LGI1) and aquaporin 4 were demonstrated in specific encephalitis, limbic encephalitis and neuromyelitis optica. Anti-NSA antibody encephalitis should be treated by immunotherapy such as corticosteroid and plasmapheresis. Acute encephalitis with refractory repetitive partial seizures (AERRPS) is a devastating postinfectious disease in children and adults, although the pathogenesis of AERRPS is poorly understood. Influenza associated encephalopathy(IAE) is characterized by it's high incidence in Japanese children between 1 year and 5 years of age, its onset in the first or the second day of illness and its high mortality (15-30%) and morbidity (25-40%). We proposed the classification of IAE with poor prognosis from the neuroradiological findings. Four types of encephalopathy seem to be differentiated from each other, acute necrotizing encephalopathy (ANE) type, hemorrhagic shock and encephalopathy syndrome (HSES) type, acute brain swelling (ABS) type, febrile convulsive status epilepticus (FCSE) type. The notable radiological features are thalamic lesions in ANE, diffuse cerebral cortical cytotoxic edema in HSES, reversible cerebral swelling in ABS which sometimes reaches lethal brain herniation, and in FCSE type, dendritic high signal in subcortical white matter by DWI ("bright tree appearance") appears simultaneously with the later onset of repetitive focal seizure. These four types are not specific to IAE but are noticed in another encephalopathies caused by HHV6, rotavirus, etc.     

Concomitant acute sinusitis and acute lung rejection

Two lung transplant recipients had concomitant acute sinusitis and acute lung rejection. Antibiotics and decongestants alleviated the sinusitis, but the symptoms of cough and dyspnea as well as spirometric defects necessitated treatment of acute lung rejection. In patients with clinical evidence of acute sinusitis after lung transplantation, concomitant acute lung rejection should be suspected if dyspnea or pulmonary dysfunction is also present. This appears to be the first report of concomitant acute sinusitis and acute lung rejection.     

从急性肾衰竭到急性肾损伤

早在古希腊时代,医学研究者就已经对肾脏疾病有所认识.作为临床肾病学的奠基人,希波克拉底曾经这样描述:"尿液表面出现泡沫可以表明肾脏疾病的发生和迁延."这可能是关于肾脏疾病最早的临床记录.在20世纪的两次世界大战中,大量伤员死于休克后的肾衰竭,而当时将这种疾病描述为"战争性肾炎".直到1951年,急性肾衰竭(ARF)这一名称才首次出现在Smith所编写的教科书中,他从生理学、病理学和临床方面对其进行了全面描述并提出了治疗原则[1].直至2002年,一个由肾脏科与危重症医师组成的团体--"急性透析质量指导组"(ADQI)建议使用急性肾损伤(AKI)代替ARF,这样就把轻度的急性肾功能减低也包含其中,更加有利于早期诊断和干预[2].无论称谓如何变迁,ARF的主要临床特点仍然是肾小球滤过率(GFR)下降,以及由此导致的代谢产物潴留、水和电解质及酸碱平衡紊乱等一系列病理生理改变,并伴随着血液中某些反映肾功能的标志物如血肌酐(SCr)、尿素氮(BUN)等明显升高.     

A focus on acute cholecystitis and acute cholangitis

Biliary infections are very common intra-abdominal infections. Laparoscopic cholecystectomy for acute cholecystitis and endoscopic retrograde management of acute cholangitis play important roles in the treatment of biliary infections. Also antimicrobial therapy is nevertheless important in the overall management of biliary infections. A multidisciplinary team of physicians, including surgeons trained in laparoscopic techniques, interventional gastroenterologists, and interventional radiologists may improve outcomes of patients with biliary infections. This review focuses the clinical presentation, diagnosis, and state of the art management of acute cholecystitis and acute cholangitis.     

Assessment of acute phase proteins in acute ischemic stroke

Acute phase proteins (APPs) have been implicated to play important roles during both acute and chronic inflammatory processes in different diseases including ischemic stroke. Though there are several studies showing the importance of APPs as inflammation markers in acute ischemic stroke (AIS), the time course of these proteins during acute phase of AIS is not well known. Thus, the aim of this study was to show the changes in plasma levels of six APPs (i.e., haptoglobin [Hp], ceruloplasmin [Cp], high-sensitive C-reactive protein [h-CRP], fibrinogen, complement 3 [C3] and complement 4 [C4]) during the first 10 days after acute stroke. The study group consisted of 34 female and 19 male patients (n = 53; mean age 65 +/- 12 years), who had first acute ischemic stroke (AIS). An age-matched control group (n = 53; 32 female and 21 male subjects, mean age 62 +/- 6 years) was also included. To evaluate the plasma levels of six APPs, the blood samples of patients with AIS were withdrawn on admission (day 1), and after 3, 5 and 10 days, whereas only one measurement was performed in the control group. In addition, several cerebrovascular risk factors were determined. The peak levels of APPs were higher in the AIS group than the control group (p < 0.0001). In serial measurements, the levels of h-CRP, Hp, C3 and C4 showed alterations during 10 days after AIS (p < 0.0001, p < 0.05, p < 0.0001, p < 0.0001, respectively). The alterations in levels of fibrinogen and Cp were not statistically significant (p > 0.05). After stroke, h-CRP, C3 and fibrinogen reached their highest values on the third day, Cp and C4 on the fifth day, and Hp on the tenth day. The plasma levels of h-CRP correlated positively with other five APPs studied (p < 0.05). These findings support the importance of inflammation processes after stroke. We suggest that the differences in levels of APPs could be used in predicting the outcome of stroke patients.     

高血脂症性急性胰腺炎误诊急性阑尾炎患者的护理

目的 探讨高血脂症性急性胰腺炎患者病情观察及护理的要点.方法 回顾分析3例高血脂症性急性胰腺炎误诊为急性阑尾炎病例的临床资料,并对护理方法进行总结.结果 3例误诊病例入院时均有明显的三酰甘油水平升高（14.1～61.0 mmol/L）,血标本呈乳糜状脂浊血清,1例存有明显诱发因素,临床特点除右下腹症状、体征外,上腹部症状、体征持续存在,早期B超提示有腹腔积液,血、尿淀粉酶升高不明显.确诊后经严密观察病情、心理护理、营养支持护理、降血脂护理及健康宣教等护理后均痊愈出院.结论 临床护理工作中应提高对高血脂症性胰腺炎的认识,入院后全面的护理评估、仔细病情观察有助临床医生分析、判断病情,综合的护理干预促进疾病康复,重视健康宣教,有效控制血脂,去除诱发因素是疾病防治重点.