重症急性胰腺炎合并肺损伤发病机制的研究

重症急性胰腺炎(sever acute pancreatitis,SAP)具有发病急、病程进展快、病死率高等特点。SAP除引起胰腺局部损伤外。尚可出现胰外多器官的损伤。急性肺损伤(acute lung injury。ALI)和急性呼吸窘迫综合征(acute respiratory distress syndrome。ARDS)是最常见的一种早期并发症。ALI是一种肺泡毛细血管膜弥漫性损伤导致肺水肿和肺不张。临床表现为呼吸窘迫和顽固性低氧血症的综合征。进一步发展即为ARDS。SAP中有大约30～50％合并有ALI和ARDS。     

骨折并发急性肺损伤/急性呼吸窘迫综合征的早期诊断与治疗体会

急性肺损伤(acute lung injury,ALI)和急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)是由多种炎性介质及效应细胞共同参与并逐渐加重的炎症继发性损伤与继发性弥漫性肺实质损伤.ALI/ARDS在1967年美国科罗拉多大学的呼吸和危重医学家 Ashbaugh首先提出时其病死率高达75%,2000年以来国际上ARDS病死率已降到25%～40%[1],但相对骨科临床医生来说,对ALI/ARDS的早期诊治认识程度还不够,甚至延误其诊断而降低干预性治疗的成功率,因为目前严重创伤和多发性骨折是诱发ALI/ARDS的主要原因之一.     

血管内皮细胞生长因子在急性肺损伤中的作用

急性肺损伤(acute lurg injury,ALI)和急性呼吸窘迫综合征(acute respiratory distressyndrome,ARDS)的特征性病理改变为肺毛细血管通透性增高所致的肺水肿,血管内皮细胞生长因子能抗血管内皮细胞凋亡并增加血管通透性,可能在ALI和ARDS的病理过程中起到重要作用.现对血管内皮细胞生长因子在ALI中的作用进行综述,旨在为ALI和ARDS的治疗提供新的思路.     

急性呼吸窘迫综合征机械通气治疗

急性肺损伤（acute lungin jury，ALI）是以低氧血症为特征的急性呼吸衰竭，急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）是ALI病情进展的结果。机械通气是纠正ARDS低氧血症的主要手段。ARDS的病理生理特点决定了患者机械通气中必须采用特殊的通气策略。     

中、西医对急性肺损伤/急性呼吸窘迫综合征的认识及展望

背景 急性肺损伤/急性呼吸窘迫综合征(acute lung injury/acute respiratory distress syndrome,ALI/ARDS)由肺内外多种病因引起,其发病机制复杂,病死率高. 目的 文章拟将中、西医两方面对ALI/ARDS的研究作一浅显的对比回顾c内容 综合相关文献,西医和中医无论在病理机制还是治疗方面都各有研究,其中既有相通之处又各成体系. 趋向 为中西医结合治疗ALI/ARDS提供新的线索.     

急性胰腺炎常见并发症及防治

急性胰腺炎仍然是目前临床常见病和多发病,起病急、发展快、并发症严重、病死率高,常并发肝、肾、肠道等胰外器官损伤,现将急性胰腺炎的常见并发症与防治介绍如下.1急性肺损伤(severe acute pancreatitis,ALI)与急性呼吸窘迫综合征(acute respirato distress syndrome,ARDS)     

严重胸外伤致急性肺损伤患者气管切开时机分析

<正>严重胸外伤易并发急性肺损伤(acute lung injury,ALI)/急性呼吸窘迫综合征(acute respiratory distress syn-drome,ARDS),如不及时正确处理则易继发肺部感染、肺不张、多脏器功能障碍(MODS)等,死亡率高。机械通气是治疗ALI/ARDS的有效手段。     

急性胰腺炎并发ALI及ARDS的机制

急性胰腺炎发病急骤,病情变化迅速,可并发急性肺损伤(ALI)及急性呼吸窘迫综合征(ARDS),甚至发生多器官功能障碍综合征,病死率一直居高不下.急性胰腺炎并发ALI及ARDS的机制错综复杂,涉及炎症反应失控、细胞的损伤与凋亡、胰酶的作用、凝血与纤溶失衡等多个层面,而这些层面彼此相互关联形成复杂的网络.深入探讨急性胰腺炎并发ALI及ARDS的机制,将为临床诊治提供更多新的作用靶点.     

急性肺损伤的干细胞治疗研究进展

背景 保护性肺通气治疗可降低急性肺损伤(acute lung injury,ALI)及急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的病死率,但因损伤的肺组织未得到及时修复,其病死率仍居高不下. 目的 审视干细胞疗法对ALI或ARDS的疗效. 内容 阐述间充质干细胞(mesenchymal stem cell,MSC)、胚胎干细胞(embryonic stem cell,ESC)、诱导多能干细胞、内皮祖细胞及内源性肺干细胞治疗ALI的研究进展. 趋向 MSC由于细胞来源广泛、易于分离和增殖、实验证据丰富而最具临床转化前景.     

预防性治疗重症急性胰腺炎合并肺损伤的体会

重症急性胰腺炎 ( severe acute pancreatitis,SAP)可以引起全身炎症性反应综合征 ( systemicinflammatory response syndrome,SIRS) ,并进一步出现包括肺、心、肝、肾及循环系统等损伤 ,甚至衰竭而至患者死亡 [1] 。这其中 ,急性呼吸窘迫综合征 ( a-cute respiratory distress syndrome,ARDS)是 SAP的主要并发症之一 ,其死亡率高达 5 0 % [2 ]。目前研究认为 ,ARDS患者肺部的损伤是持续炎症分子学机制[3 ] 。如何抑制过度炎症反应成为 ARDS预防性治疗关键。我们自 1 996年 2月～ 2 0 0 1年 1 2月采取乌司他丁 ( UTI)联合大剂量激…     

Severe acute respiratory syndrome mimicking acute abdomen

Severe acute respiratory syndrome (SARS) is a novel epidemic disease. The clinical presentation can sometimes be very non-specific. The present study reports a case of SARS, which presented as acute abdomen, warranting laparotomy. The atypical presentation in the present case reminded us of the importance of strict infection control measures in all surgery-related specialist workplaces.     

False surgical acute abdomen with intermittent acute porphyria

This article presents a case of acute intermittent porphyria admitted to the Surgery Department of C.F. Craiova Hospital between 18.08.2003-26.08.2003 then transferred to the Colentina Hospital in Bucharest for diagnosis confirmation and adequate treatment. The purpose of this paper is to bring attention on a rare metabolic inherited disease that, due to its non-specific and often noisy symptoms and limited possibilities of biochemical, enzymatic and genetic diagnosis, could generate potential serious confusions. The presentes case illustrates the fact that sometimes the acute attack may be mistaken for an acute surgical affection which requires an emergency operation with all the aggravating consequences and delay in the real diagnosis. About 1% of acute attacks of porphyria may be fatal. Only the drugs known as safe should be prescribed. Basic treatment consists in oral and intravenous glucose and hematin administration.     

Erroneous diagnosis of acute appendicitis in acute gynecological diseases

On the basis of an analysis of 84 observations the authors describe special features of the clinical course and diagnosis of gynecological diseases simulating acute appendicitis (rupture of the ovary, extrauterine pregnancy, torsion or rupture of the ovarian cyst, adnexitis).     

Reversible acute tubular necrosis following severe acute renal rejection

The clinical observation of 6 out of 250 renal transplant patients showed that acute renal rejection may lead to reversible acute tubular necrosis (ATN) necessitating intermittent haemodialysis treatment. Despite missing early response to high-dose (methyl-) prednisolone therapy (during a mean period of 4.7 days) all 6 patients developed spontaneous diuresis 14.5 days on average after onset of rejection while on maintenance immunosuppressive therapy. From the clinical course the conclusion was drawn that in severe cases of renal rejection with arteriographic and histological findings consistent with acute tubular necrosis, prolonged therapy with high doses of (methyl-) prednisolone is not desirable, since after reversal of immunological rejection the onset of spontaneous diuresis will be determined mainly by the duration of the healing and recovery phase of acute tubular necrosis.     

Risk factors of acute kidney injury after acute myocardial infarction

Objectives: To study the risk factors for acute kidney injury (AKI) in-patients with acute myocardial infarction (AMI).

Methods: A total of 1371 cases of adult in-patients with AMI in the First People's Hospital of Changzhou from January 2008 to December 2012 were retrospectively analyzed. Based on the occurrence of AKI diagnosed according to the 2012 KDIGO AKI criteria, they were divided into AKI group and non-AKI group and further into conservative treatment groups, coronary angiography (CAG) groups, and coronary artery bypass grafting (CABG) groups based on the timing of AKI occurrence, respectively. Related risk factors of AKI were analyzed by univariate and multivariate logistic regressions.

Results: 410 (29.9%) developed AKI. Patients with AKI had significantly increased in-hospital mortality than patients without AKI. Multivariate logistic regression analysis showed that decreased baseline eGFR, increased fasting plasma glucose (FPG), use of diuretics and Killip grade IV were independent risk factors of AKI, while increased DBP on admission was a protective factor for patients in conservative treatment group. Decreased baseline eGFR, increased FPG, use of diuretics, intraoperative hypotension and acute infection were independent risk factors of AKI for patients in the CAG group. Decreased baseline eGFR, increased FPG, use of diuretics and low cardiac output syndrome after operation were independent risk factors of AKI for patients in the CABG group.

Conclusions: AKI is a common complication and associated with increased mortality after AMI. Decreased baseline renal function, increased FPG and use of diuretics were common independent risk factors of AKI after AMI.