急性肺损伤发病机制研究进展

急性肺损伤/急性呼吸窘迫综合征(acute lung injury,ALI/acute respiratory distress syndrome,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.ALI的严重阶段即是ARDS.为了更有效地防治ALI/ARDS,首先要阐明ALI/ARDS的发病机制,本文就近年来ALI/ARDS发病机制的研究作一综述.     

急性肺损伤/急性呼吸窘迫综合症的异常凝血纤溶状态

急性肺损伤(ALI)-急性呼吸窘迫综合症(ARDS)是以肺泡上皮细胞和血管内皮屏障损伤、急性炎症反应、富含蛋白的肺水肿为特征的急性肺损伤.     

肾移植术后急性呼吸窘迫综合征的护理研究

急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)是肾移植受者死亡的主要原因之一.对本院收治的23例肾移植术后重症肺部感染致ARDS患者进行分析,报告如下.     

急性肺损伤的分子遗传学研究进展

急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)是危重病患者死亡的主要原因.流行病学研究发现ALI/ARDS的发病率和病死率存在明显的种族差异,非洲裔和西班牙裔美国人ALI/ARDS病死率远远高于白种人群,我国大陆和台湾地区病死率也高达52.0％～70.4％.临床研究也发现尽管脓毒症、肺部感染、误吸、外科术后及多发伤是ALI/ARDS发病的高危因素,但仅部分患者进展至ALI/ARDS,且预后也存在个体差异.目前研究证实ALI/ARDS的发病和预后的种族和个体差异与人群遗传结构有关.     

氯氮平中毒继发急性肺损伤/急性呼吸窘迫综合征的抢救体会

目的:探讨氯氮平中毒继发急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)有效的治疗方法。方法:总结分析16例氯氮平中毒继发ALI/ARDS患者的临床表现和治疗方法。患者在中毒后6～144h出现ALI/ARDS表现,予气管插管、机械通气,抗胆碱药物治疗及血液灌流等综合治疗。结果:本组患者均治愈,平均住院时间(14±1.6)d;机械通气时间平均(134±12)h,中毒后(48～96)h意识转清。结论:氯氮平中毒继发的急性肺损伤/急性呼吸窘迫综合征主要与肺水肿、吸入性肺炎及氯氮平对肺组织的直接损伤作用有关。早期进行机械通气联合血液灌流和合理抗胆碱药物的,是治疗重度氯氮平重度并发急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的有效方法。     

Ang-2与ALI/ARDS血管外肺水的关系及临床意义

急性肺损伤(ALI)和急性呼吸窘迫综合征(ARDS)是由肺部和全身疾病引起的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的急性低氧性呼吸功能不全或衰竭.血管生成素2(Ang-2)是一个前炎症细胞因子,血循环中高水平的Ang-2导致血管通透性增高,引起血管渗漏.Ang-2能够导致ALI/ARDS患者毛细血管通透性增加,与血管外肺水具有正相关性,循环中Ang-2越高氧合指数越差,是预测ALI/ARDS发展和预后的一个指标.Ang-2阻滞剂能够降低血管通透性和改善肺功能障碍程度,有针对性的以Ang-2 为靶向的干预治疗则可能为ALI/ARDS的治疗提供了一种新的思路与手段.     

两种小儿急性肺损伤和急性呼吸窘迫综合征的分析

当前病理生理研究认为,引起急性肺损伤（ALI）及其危重阶段--急性呼吸窘迫综合征（ARDS）有两类病因：肺本身因素引起的直接肺损伤（ALI/ARDSp）;肺外因素引起的间接肺损伤（ALI/ARDSexp）.笔者就本院PICU自1996年以来收治的88例ALI/ARDSp和ALI/ARDS exp两组患儿作临床比较分析,现分析如下.     

氢气对肺损伤的保护效应及其机制研究进展

目前,急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的病死率居高不下,大约为35％～40％,是重症监护病房( ICU)患者死亡的主要原因之一[1].ALI/ARDS的发病机制非常复杂,仍不十分清楚,目前认为其发生发展是多种病因共同作用的结果.越来越多的研究表明,氧化损伤和过度失调的炎症反应在ALI/ARDS发生发展中起着非常重要的作用.现就其研究进展综述如下.     

急性肺损伤/急性呼吸窘迫综合征诊治进展

急性肺损伤(acute lung injury,ALI)和急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)是指由心源性以外的各种肺内外致病因素导致的急性、进行性缺氧性呼吸衰竭。Ashbough于1967年报道ARDS时,他所指的ARDS的"A"字意指Adult,即成人[1],其实ALI/ARDS是一种常见危     

气体信号分子与急性肺损伤

急性肺损伤(acute lung injury,ALI)由多种炎性介质及效应细胞共同参与,并呈级联放大的瀑布样炎症继发性损伤与弥漫性肺实质损伤,且可进一步发展为急性呼吸窘迫综合征(ARDS).ALI/ARDS发病机制复杂[1],病死率高,已成为临床危重病学研究的热点和难点,故探寻新的治疗方法显得尤为重要.内源性气体信号分子一氧化氮(NO)、一氧化碳(CO)和硫化氢(H2S)的发现为肺损伤等疾病的研究提供了一个全新的思路.研究发现它们均参与了ALI的发病且对ALI具有调节作用.二氧化硫(SO2)是最近提出的一种新型气体信号分子,在心血管系统中发挥广泛的生物学活性[2].     

齐齐哈尔地区达斡尔族ABO、MN、P、Rh血型分布

达斡尔族是我国55个少数民族之一.达斡尔族是辽国契丹人的后裔,其先民就已定居黑龙江中、上游北岸,现主要居住在内蒙古自治区和黑龙江省,少数居住在新疆.人口12万余.齐齐哈尔地区是达斡尔族的主要聚居地.笔者调查了齐齐哈尔地区达斡尔族ABO、MN、P、Rh血型分布及血型分布的群体遗传特征,现报告如下. 1 材料与方法 1.1 调查对象齐齐哈尔地区达斡尔族人,随机采样,被检3代均系达斡尔族. 1.2 试剂抗-A、-B、-M、-N、-P1、-C、-c-D、-E、-e. 1.3 试验方法按文献[1]进行;计算方法(基因频率,基因组合体频率,吻合度测验)均参照文献[2]进行.     

Meaning, values, needs, and multiculturalism in bereavement

Meaning, Values, Needs, and Multiculturalism in Bereavement A review of Personal Care in an Impersonal World: A Multdimesional Look at Bereavemenl, edited by John D. Morgan. Amityville, NY: Baywood, 1993. 261 pp. ISBN 0-89503-109-4. $31.95. Keviewed by Kevin Ann Oltjenhruns.     

Nutrition, exercise, work, and sex in pregnancy

This article focuses on the effect of daily living on pregnancy outcome. Although most patients can continue their everyday activities without any concern about effect on pregnancy outcome, all pregnant patients want and need their physician's advice about all of these areas.     

Pathophysiology of prenatal drug-exposure: in utero, in the newborn, in childhood, and in agencies

Medical communities are documenting an increase in the numbers of infants being born with prenatal drug exposure. Medical, educational, and social agencies are serving large numbers of these infants, toddlers, and their families. These infants and toddlers constitute a population whose short-term and long-term needs have not been adequately identified or addressed in the health, social, emotional, or developmental domains. This article discusses the pathophysiology in prenatal drug exposure and the role of the nurse when providing services to these infants, toddlers, and their families.     

Association between serum ferritin, hemoglobin, iron intake, and diabetes in adults in Jiangsu, China

OBJECTIVE: To investigate the association between iron status, iron intake, and diabetes among Chinese adults. RESEARCH DESIGN AND METHODS: This cross-sectional household survey was carried out in 2002 in Jiangsu Province, China. The sample contained 2,849 men and women aged > or =20 years with a response rate of 89.0%. Iron intake was assessed by food weighing plus consecutive individual 3-day food records. Fasting plasma glucose (FPG), serum ferritin, and hemoglobin were measured. RESULTS: The prevalence of anemia was 18.3% in men and 31.5% in women. Mean hemoglobin and serum ferritin increased across groups with increasing FPG. The prevalence of anemia among women was 15.0% in individuals with FPG >7.0 mmol/l compared with 32.6% in individuals with FPG <5.6 mmol/l. There was a similar, however not significant, trend among men. In women, after adjusting for known risk factors, the odds ratio (OR) of diabetes was 2.15 (95% CI 1.03-4.51) for subjects in the upper quartile of hemoglobin compared with the rest, and the corresponding OR for the upper quartile of serum ferritin was 3.79 (1.72-8.36). Iron intake was positively associated with diabetes in women; fourth quartile intake of iron yielded an OR of 5.53 (1.47-20.44) compared with the first quartile in the multivariate analyses. In men, similar trends were suggested, although they were not statistically significant. CONCLUSIONS: Iron status and iron intake was independently associated with risk of diabetes in Chinese women but not in men.     

Brotizolam, a triazolothienodiazepine, in insomnia

Sixty-three outpatients with chronic insomnia were treated for 3 weeks under double-blind conditions with either brotizolam (n = 29) at a dose of 0.25 mg or 0.5 mg or placebo (n = 34). A 3-day placebo period preceded and followed the double-blind treatment phase. Brotizolam consistently produced significantly more sleep improvement than placebo but also more adverse effects. In those patients switched abruptly from brotizolam to placebo, rebound insomnia was observed, being most marked at the first post-brotizolam placebo night.     

Peak expiratory flow in healthy,young, non-active subjects in seated,supine, and prone postures

Objective: To compare the PEFs in healthy, young, non-active subjects in seated, supine, and prone postures. Methods: A total of 30 healthy volunteers (15 male, mean age 22.7 years, non-smokers, sedentary) underwent a physical examination, spirometry to confirm normal pulmonary function, and PEF using the Mini-Wright Peak Flow Meter while wearing a nose clip. PEF measurements were repeated three times in each of three positions (seated, prone, and supine) in random order and differed by less than 20 L/min for a given position. Paired Student’s t-tests were used to analyze the results, and the significance level was set at 5%. Results: The PEF values obtained when the study participants were in a seated position (481.0 ± 115.1 L/min) were higher than those obtained when participants were in prone (453.7 ± 112.1 L/min) or supine (453.2 ± 114.3 L/min) positions (p < 0.05). No significant difference in PEF values was observed between the prone and supine positions. Conclusion: Body posture affects PEF in healthy, young, non-active subjects. PEFs are higher when subjects are in a seated position compared to prone or supine positions, but no difference in PEF is observed between the prone and supine positions.