支气管哮喘持续状态的病人急救及预防

支气管哮喘是因过敏因素引起的一种支气管反应性过度增高的疾病，通过神经体液，而导致气道可逆性的痉挛、狭窄。大部分支气管哮喘脱离激发因子后，对支气管解痉剂，肾上腺皮质激素治疗反应良好，短时间内发作终止，部分重症者经积极处理但哮喘不能终止，持续24小时以上者称为哮喘持续状态。此病是内科争症应及时抢救，往往因分泌物     

105例老年支气管哮喘持续状态的健康教育和护理

哮喘严重发作持续24小时以上不能缓解者称为哮喘持续状态，它对多种治疗均有耐受性而不易根治或好转，是呼吸系统四大抢救病种之一。临床表现极度的呼吸困难，严重紫绀，大汗淋漓，甚至出现呼吸循环衰竭，危及生命因此及早发现其先兆症状并做好健康教育和相应护理工作是预防哮喘发作的基础，也是抢救成功的关键。     

支气管哮喘持续状态

护士长:今天我们查房,先请责任护士报告病情。责任护士:患者,女性,25岁,住院号:60429,咳嗽、咳痰气喘反复发作两年,病情加重10天,于昨晚入院。体检:神清、急性病容,端坐呼吸,口唇肢端明显紫绀,呼吸34次/分,两肺大量哮     

重度支气管哮喘和哮喘持续状态患者的血气改变及分析

为了解哮喘急性发作期血气变化的规律,正确识别和处理,现将我院１０年间救治的８６例患者临床资料报道如下。１　材料与方法１－１　观察对象　８６例重症支气管哮喘和哮喘持续状态均为我院１０年间急诊观察及住院病人。男３６例,女５２例,年龄９～６２岁,平均年龄为２９－４±１６－３岁。病程＜５年者１２例（１４－０％）,５～１０年者３６例（４１－９％）,＞１０年＜２０年者３１例（３６－０％）,＞２０年者７例（８－１％）。诊断标准均符合１９９７年支气管哮喘防治指南（支气管哮喘的定义、诊断、治疗、疗效判断标准及教育…     

哮喘持续状态

病史摘要刘××,男,42岁,工人,住院号258607。主诉喘憋7天。现病史 7天前因受凉后感全身乏力、头痛、咳嗽、体温达38.2℃。服用复方扑尔敏、犀羚解毒丸及复方新诺明无效,感胸闷、喘息并逐渐加重,不能平卧,每日咳出白粘痰及少许黄脓痰20ml。当地就医,诊断为支气管哮喘,给予氨茶硷、舒喘灵、强的松各1片,1天3次,肌注青、链霉素,喘息未缓解。3     

哮喘持续状态患儿的护理

哮喘持续状态又称哮喘危重状态，是指哮喘发作在合理应用常规缓解药物治疗后，仍有严重或进行性呼吸困难者。由于此时支气管呈严重阻塞，威胁生命，因此采用及时、积极的治疗及护理十分重要。     

90例重症支气管哮喘持续状态患者的急救

目的：探讨重症支气管哮喘持状态患者的急救措施。方法：回顾性分析我院１２年间９０例重症支气管哮持续状态患者的临床资料。结果：９０例重症支气管哮喘持续状态患者中单纯低氧血症１６例（１７．７％），单纯酸碱紊乱１７例（１８．８％），二重酸碱失衡５７例（６３．３％），酸碱紊乱合并低氧血症２１例（２３．３％），并发呼吸衰竭１６例，心力衰竭６例。所有患者缓解出院。结论：通过对９０例重症支气管哮喘持续状态患者的回     

哮喘持续状态治疗体会

急性重症哮喘指哮喘急性发作引起支气管极度痉挛，导致严重呼吸困难，一般平喘药物包括静脉滴注氨茶碱而不能在24h内缓解者为哮喘持续状态，其病因和发病机制相当复杂，目前普遍认为哮喘是一种气道慢性非特异性炎症性疾病。近年来，国际上对哮喘的治疗原则基本已达到共识。现将我院ICU近几年来6例原发病病情危重的基础上合并哮喘持续状态的治疗以总结，报道如下：     

The Treatment of Status Asthmaticus

For general practitioners, in whose practice is included a major proportion of the medical management of infants and children, and for the specializing pediatrician as well, Postgraduate Medicine presents this special regular department devoted to brief discussions by recognized authorities on their preferred methods of the treatment and management of diseases and problems of infancy and childhood.     

溶栓疗法与抗凝剂在缺血性脑血管病中的应用现状

溶栓疗法是国际上公认的急性脑梗死唯一有效的治疗方法。早期缺血脑组织再灌注的益处远远超过再灌注损伤 ,至于溶栓药物剂量的应用要因体重、发病距实施溶栓时间及用药途径而异。溶栓并抗凝剂治疗有协同作用 ,可以有效地预防再通后的再梗死 ,但要严格掌握适应证 ,并动态观察出血、凝血指标 ,最大限度地预防继发性出血     

Anticoagulant Therapy in Thrombosis and Embolism

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Why has treatment of adrenal insufficiency, or Addison's disease, changed so little in the past 30 years? How can modern adrenal function studies facilitate diagnosis and management? Dr Stoffer explains his practical approach to diagnosis and treatment of chronic adrenal insufficiency. As clinicians become more comfortable with the use of adrenal function studies to monitor this disease, their patients' quality of life can be expected to improve markedly.     

Pharmacokinetics of Ketamine at Dissociative Doses in an Adult Patient With Refractory Status Asthmaticus Receiving Extracorporeal Membrane Oxygenation Therapy

PurposeFirst-line management of severe asthma exacerbations include the use of inhaled short-acting β-agonists, anticholinergics, and systemic corticosteroids. Continuous intravenous ketamine given at dissociative doses may be a pharmacologic option in patients who are intubated with life-threatening severe bronchospasm unresponsive to standard therapy. We describe the case of a 44-year-old man admitted to the intensive care unit for status asthmaticus requiring intubation and mechanical ventilation.MethodsThe patient developed severe refractory hypercapnic respiratory failure necessitating additional respiratory support with veno-venous extracorporeal membrane oxygenation (ECMO) therapy. Ketamine treatment was initiated at 0.5 mg/kg/h continuous infusion on the day of admission for pain control and required up-titration to 2 mg/kg/h by intensive care unit day 4 for bronchodilation. Whole blood samples were obtained for pharmacokinetic analysis of ketamine during ECMO.FindingsThe plasma concentration at steady state was 1018.7 ng/mL, with an estimated clearance of 1.96 L/kg/h after up-titration. The V_d was 14.18 L/kg, the k_e was 0.14 hr⁻¹, and the t_½ was 5 hours.ImplicationsCompared with healthy adults, there was a 6.5-fold increase in the V_d. However, the V_d was similar compared with critically ill patients not receiving ECMO. Further studies should focus on the effect of ECMO on ketamine pharmacokinetic properties.     

Anticoagulant Therapy in Coronary Artery Disease

The “when, why and how” to use anticoagulants in coronary disease is still controversial. In these statements two internationally known authorities express their views. It is challenging to read their opinions.     

急性脑梗死抗凝和抗血小板疗效比较

目的通过比较急性脑梗死抗凝和抗血小板治疗疗效,指导临床实践。方法收集360例急性脑梗死患者资料,分为抗凝组,抗血小板组和联合治疗组,比较三组疗效。结果联合治疗组疗效优于单独治疗组,两单独治疗组之间疗效差异无统计学意义。结论抗凝联合抗血小板治疗急性脑梗死优于单独应用抗凝或抗血小板药物治疗。     

脑静脉窦血栓形成的抗凝治疗及预后分析

目的：观察不同方案的抗凝治疗对于脑静脉窦血栓形成（CVST）的疗效。方法：回顾分析33例应用抗凝治疗的CVST患者,其中静脉控速肝素治疗21例（A组）,低分子肝素治疗9例（B组）,联合介入溶栓抗凝治疗3例（C组）,评价疗效及预后。结果：A、B组的显效时间之间差异有统计学意义（P〈0．05）。结论：规范的抗凝治疗能明显提高CVST的治愈率,严格静脉控速肝素与低分子肝素具有相似的抗凝效果,并且出血不良反应无增加。     

A Simple Rule for Control of Anticoagulant Therapy

Since anticoagulants of the coumarin type have been reported to decrease at least four coagulation factors, there is doubt as to which test to use in the control of anticoagulant therapy. Early extensive experience showed the Quick prothrombin time alone to suffice for laboratory control of therapy with coumarin-type anticoagulants. Subsequent failures with this test are explained by the use of unsatisfactory thromboplastin.