代谢性酸中毒病人应用碳酸氢盐指针

在重症治疗、内科、麻醉科领域内对代酸病人应用碳酸氢盐指针上存在明显争议,本文作者总结了过去4年来应用NaHCO_3的大量文献并提出个人看法。代酸分类广义代酸是指动脉血pH值<7.35,HCO_3~-浓度<21mmol/L。代酸有多种,有一种分类法是根据阴离子间隙(AG—anion gap),AG值是血浆内钠的容     

乙酰唑胺的临床应用进展

乙酰唑胺(Diamox,DMX)是1950年由Willer等合成的一种异环式磺胺药物,曾一度用于心原性水肿和青光眼的辅助治疗。随着临床治疗学的不断进步,目前DMX对上述疾病已失去其实用价值。Friedbtry及Becker等近来的研究发现,DMX对人体红细胞、胃粘膜、肾实质、胰腺、中枢神经等众多组织细胞的碳酸酐酶有广谱抑制作用,使细胞内生化反应之CO_2+H_2O(?)H~++HCO_3~-顺向途径受阻,从而纠正诸多病理状态的生化代谢紊乱,由此崛起了一系列临床新用途。目前已拓展到下列疾病的治疗。 1 腰穿后头痛 在各种疾病做腰部穿刺留取脑脊液和外科手术腰麻过程中,由于低颅压反应或药物刺激,患者常遗留持续头痛等不适,其发生率达20％之多,一般对症治疗常     

乙酰唑胺对高原移居者记忆与肢体功能作用延续的对比试验

目的：探讨口服乙酰唑胺对改善高原移居者记忆功能与肢体运动能力的作用及保留延续时间。方法：选择驻海拔3700m 个月的健康汉族男性青年40名，随机分甲、乙两组，甲组口服乙酰唑胺、乙组口服炒面胶囊，于服药前运动前，服药前运动后，服药10d运动前，服药10d运动后，停药10d运动前，停药10d运动后，采用心理生理能力测试仪进行左右手交叉动作频率和数字记忆广度倒背数两项测验，应用自行车功量仪进行负荷运动。甲乙两组进行同阶段结果组间对比。结果：甲组服药10d运动前后，停药10d运动前后左右手交叉敲击动作频率测验总次数、正确次数均较乙组增多(P＜0．01或P＜0．05)，错误次数显著减少(P＜0．01)。甲组停药10d运动前后与自身服药前运动前后比较总次数、正确次数显著增多(P＜0．01或P＜0．05)，错误次数显著减少(P＜0．01)。数字记忆广度倒背数测验，甲组服药10d运动前[(6．1&;#177;1．3)分]、后[(5．7&;#177;1．4)分]，停药10d运动前[(5．2&;#177;1．3)分]、后[(4．9&;#177;1．0）分]，得分均较乙组[(3．3&;#177;0．9)，(3．1&;#177;1．2)，(3．2&;#177;1．4)，(3．1&;#177;1．1)分]显著增多(t=4．76～8．23，P＜0.01]，甲组停药10d运动前后与自身服药前运动前后比较得分显著增多(P＜0．01或P＜0．05)。结论：口服乙酰唑胺能有效，显著的提高和改善高原移居者的记忆功能与肢体运动能力，其药物生理效应能保留延续至停药10d。     

颅脑外伤后头痛相关因素分析及护理

痛觉是感觉神经系统的功能,是机体自我保护的一种反射机制,影响着机体局部或整体的功能,给患者带来痛苦,甚至危及生命[1,2].目前,疼痛已成为继体温、脉搏、呼吸、血压四大生命体征之后的第五生命体征[3].颅脑外伤后24~48 h,患者通常都会出现头痛,不仅仅引起患者不适,还可能导致严重的并发症,甚至死亡.2009年10月以来,我们对102例颅脑外伤患者的头痛进行了因素分析,并给予规范化护理,取得满意效果.现报告如下.     

肾小管酸中毒软骨病3例治疗体会

肾小管酸中毒软骨病,是一种少见病。在基层,人们对它认识不足。临床上极易引起长期误诊,常以风湿病误行治疗,又不易与其它肾性骨病相鉴别。我们近5年诊断治疗了3例典型患者,均取得了良好的结果,总结了一定的经验。同时复习其与范可尼氏综合征,家族性低血磷引起的肾小球骨病的鉴别诊断。     

呼吸性酸中毒的产生原因和机制是什么？

答：其原因和机制有6个方面。 （1）呼吸中枢抑制：能抑制呼吸中枢的药物（如麻醉药、止痛剂、安眠药）使用过量，严重缺氧导致的肺泡通气量减少，中枢神经系统的缺血、创伤、颅内压增高等．均可抑制呼吸、抑制通气，导致呼吸性酸中毒。     

乙酰唑胺对高原移居者记忆与肢体功能作用延续的对比试验

目的:探讨口服乙酰唑胺对改善高原移居者记忆功能与肢体运动能力的作用及保留延续时间。方法:选择驻海拔3700m6个月的健康汉族男性青年40名,随机分甲、乙两组,甲组口服乙酰唑胺、乙组口服炒面胶囊,于服药前运动前,服药前运动后,服药10d运动前,服药10d运动后,停药10d运动前,停药10d运动后,采用心理生理能力测试仪进行左右手交叉动作频率和数字记忆广度倒背数两项测验,应用自行车功量仪进行负荷运动。甲乙两组进行同阶段结果组间对比。结果:甲组服药10d运动前后,停药10d运动前后左右手交叉敲击动作频率测验总次数、正确次数均较乙组增多(P<0.01或P<0.05),错误次数显著减少(P<0.01)。甲组停药10d运动前后与自身服药前运动前后比较总次数、正确次数显著增多(P<0.01或P<0.05),错误次数显著减少(P<0.01)。数字记忆广度倒背数测验,甲组服药10d运动前犤(6.1±1.3)分犦、后犤(5.7±1.4)分犦,停药10d运动前犤(5.2±1.3)分犦、后犤(4.9±1.0)分犦,得分均较乙组犤(3.3±0.9),(3.1±1.2),(3.2±1.4),(3.1±1.1)分犦显著增多(t=4.76～8.23,P<0.01),甲组停药10d运动前后与自身服药前运动前后比较得分显著增多(P<0.01或P<0.05)。结论:口服乙酰唑胺能有效,显著的提高和改善高原移居者的记忆功能与肢体运动能力,其药物生理     

糖尿病酮症酸中毒患者不同补液途径的临床疗效对比

我院自2003年以来采用胃肠道补液为主纠正糖尿病酮症酸中毒（DKA），与传统静脉补液相比取得满意效果，现报告如下。 1 对象和方法 1．1 对象 DKA的诊断标准：原有糖尿病症状加重或新出现糖尿病症状伴有脱水，呼吸深大等酸中毒表现，血糖≥16．7mmol／L，血pH值〈7．3或HCO3≤12mmol／L，尿糖、尿酮体强阳性，伴脱水、不能正常饮食。     

Metabolic acidosis and coma following a severe acetaminophen overdose

OBJECTIVE: To report a case of metabolic acidosis and coma in a severe acetaminophen overdose. CASE SUMMARY: A 29-year-old white woman was admitted to the emergency department with a diminished level of consciousness and metabolic acidosis. The toxicology screen revealed a serum acetaminophen concentration of 1072 microg/mL, and she was consequently treated with intravenous acetylcysteine. Despite the elevated concentration, the patient did not manifest signs of hepatotoxicity. DISCUSSION: Metabolic acidosis and coma are rare manifestations in acetaminophen overdoses. In published case reports, severe acetaminophen ingestion independently causes metabolic acidosis and coma in the absence of hepatotoxicity. The mechanism by which metabolic acidosis occurs is not clearly defined. Studies conducted on animals demonstrated that in severe overdoses, acetaminophen may cause lactic acidosis by inhibiting mitochondrial respiration. The mechanism by which acetaminophen can cause coma is still unknown. CONCLUSIONS: Severe acetaminophen overdoses can independently cause metabolic acidosis and coma in the absence of hepatotoxicity.     

Optic neuropathy resulting from indirect trauma

Minor blunt injury to the head and face may result in optic nerve contusion with secondary optic atrophy. The resulting visual loss is devastating for the individual. We report an uncommon but important complication that may result from an apparently trivial injury. Early identification and initiation of appropriate management may restore the individual's vision. Emergency physicians are often the first to see patients at risk of this complication yet there is little discussion of this injury in the emergency medicine literature.     

颅脑外伤听性脑干反应分析

目的探讨颅脑外伤对听力的影响,以供今后的临床工作参考。方法选择2010年8月至2013年7月收治的颅脑外伤患者70例作为观察组,以同期健康体检的正常成年人70例作为对照组,均进行听性脑干反应检查。对比两组患者阈值、各波潜伏期和波间期的差异。结果与对照组对比发现,观察组阈值明显较大,各波潜伏期明显较长,差异具有统计学意义(P0.05)。观察组Ⅲ~Ⅳ波间期、Ⅰ~Ⅴ波间期明显较对照组长,差异具有统计学意义(P0.05)。Ⅰ~Ⅲ波间期组间比较,差异无统计学意义(P0.05)。结论颅脑外伤患者多伴有不同程度的听力损害,采用听性脑干反应检查有助于识别听力损害情况,值得临床推广应用。     

Medication errors resulting from drug preparation and administration

BACKGROUND: The risks associated with drug use are not confined to adverse reactions. Failures can occur in the process of drug prescribing, dispensing and administration. Such preventable events are termed 'medication errors'. Errors in preparation and administration, the last step in the medication process, constitute a good indicator of the quality of the medication process, and are irredeemable. METHODS: A protocol for measuring errors in the preparation and administration of medication has been developed and used in an internal medicine department at the University Hospital of Dijon. RESULTS: This protocol has enabled several different rates of medication errors to be determined depending on the calculation approach used: 15.1% with respect to interventions by nurses, 41% relating to the total number of opportunities for error, and 8.8% with respect to a methodological problem analysed in the study. The potential clinical significance, incidence and causes of errors during the medication process were also analysed. DISCUSSION AND CONCLUSION: Medical errors are not detected in our health system and are thus not preventable. Their consequences are incompatible with a well organised treatment process. The rate of medication errors is therefore a good indicator of the quality of the medication system in a hospital that is following the current steps for risk reduction and accreditation.     

Flail chest in a neonate resulting from nonaccidental trauma

The authors present a 21-day-old infant who sustained a flail chest as a result of nonaccidental trauma. Initial treatment included endotracheal intubation and mechanical ventilation for hypoxemic respiratory failure followed by the administration of continuous positive airway pressure by nasal cannula. Further evaluation resulted in the identification of nonaccidental as the mechanism of injury. The pathophysiology of flail chest, its etiology, and treatment options are reviewed. In the absence of a documented history of significant thoracic injury or the presence of metabolic bone disease, nonaccidental trauma is the most likely diagnosis in infants and children with a flail chest.     

综合康复治疗颅脑外伤的疗效评价

目的 探讨综合康复治疗对颅脑外伤的疗效.方法 85例颅脑外伤患者,经过手术或对症处理后,采用高压氧、超声波、针刺及康复训练治疗,在治疗前后对患者进行格拉斯哥昏迷量表（GCS）、Fugl-Meyer评定（FMA）、Barthel指数（BI）评定.结果 治疗后,患者的GCS、FMA、BI评分都较治疗前有明显改善（P〈0.01）.结论 颅脑外伤后采用综合康复治疗是有效的.