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1.
目的:探讨连续性静脉-静脉血液滤过(CVVH)治疗急性呼吸窘迫综合征(ARDS)的疗效。方法:回顾性分析52例ARDS患者,分为对照组22例,采用常规治疗+机械通气;CVVH组30例,采用常规治疗+机械通气+CVVH,分别观察2组患者在治疗前后血气指标、机械通气时间及APACHEⅡ评分的变化。结果:30例ARDS患者加用CVVH治疗后,各项血气指标、治愈率及死亡率与对照组比较,差异有统计学意义。结论:CVVH治疗ARDS时能有效清除患者血管外肺水和致炎介质,明显改善了患者的氧合功能,提高了抢救成功率。 相似文献
2.
目的:观察乌司他丁对西宁地区急性肺损伤(ALI)的疗效。方法:将50例急性肺损伤患者,随机分为两组,实验组25例,对照组25例,所有患者均行ICU综合治疗,实验组加用乌司他丁,观察两组患者呼吸频率(RR)、血气指标、急性生理和慢性健康状况评分Ⅱ(APACHEⅡ评分)、急性呼吸窘迫综合征(ARDS)发生率及死亡率变化。结果:治疗第7天实验组患者RR、APACHEⅡ评分、动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)较对照组明显改善(P〈0.05),两组间ARDS发生率及死亡率比较差异均有统计学意义(P〈0.05)。结论:乌司他丁能显著改善西宁地区急性肺损伤患者的氧合,降低ARDS发生率,对改善预后有积极的作用。 相似文献
3.
目的探讨床旁连续性静脉-静脉血液滤过(CVVH)治疗高龄呼吸窘迫综合征(ARDS)伴高钠血症的疗效。方法对18例高龄ARDS伴高钠血症患者进行床旁CVVH治疗,动态观察患者的血钠浓度及调整置换液成分,记录肾功能、血气指标、血浆渗透压变化及APACHEⅡ评分并进行分析。结果治疗后血浆渗透压较治疗前下降[(318.5±20.2)mmol/L vs.(294.4±15.1)mmol/L,P<0.01];治疗后氧合指数治疗前上升[(157.4±34.2)vs.(178.4±40.4),P<0.05],APACHEⅡ评分较治疗前下降[(20.8±9.4)分vs.(14.5±8.8)分,P<0.05],前后比较差异有统计学意义。结论 CVVH治疗高龄ARDS伴高钠血症患者,能有效纠正高钠血症,改善氧合指数及APACHEⅡ评分。 相似文献
4.
目的 观察乌司他丁联用大黄治疗严重胸外伤后急性肺损伤(ALI)的作用机制和疗效.方法 根据APACHEⅡ的评分标准随机分为实验组(乌司他丁+大黄),UIT组,对照组,每组各30例.观察各组患者机械通气时间、住院时间、X线胸片评分、急性呼吸窘迫综合征(ARDS)发生率及病死率,并测定治疗前后患者体温、WBC、C反应蛋白、血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及血气分析指标等变化.结果 各治疗组中相关指标的改善程度均好于对照组,以实验组为佳.结论 乌司他丁联用大黄对肺功能有很好的保护作用,能改善ALI的预后. 相似文献
5.
急性呼吸窘迫综合征机械通气患者院内死亡的危险因素分析 总被引:3,自引:2,他引:3
目的了解急性呼吸窘迫综合征(ARDS)机械通气患者院内死亡的危险因素,提高临床救治水平。方法回顾性调查2001年4月~2005年4月93例机械通气>48 h的ARDS患者入院时的年龄、血气分析以及急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分等38项指标,根据是否院内死亡对各项指标进行单因素检验和多因素Logistic回归分析。结果院内死亡率为30.1%。单因素分析中,两组的总住院时间、重症监护治疗时间、部分凝血活酶时间、红细胞计数、血糖水平、消化道出血以及APACHEⅡ评分等指标具有显著性差异(P均<0.05)。生存组气管切开比例显著高于死亡组(P<0.05),Logistic回归分析显示血糖水平(P=0.043,OR4.114,95%CI:1.048~16.143)和APACHEⅡ评分(P=0.003,OR2.054,95%CI:1.271~3.317)与ARDS患者机械通气后死亡有关。结论血糖水平和APACHEⅡ评分是ARDS机械通气患者院内死亡的独立危险因素。 相似文献
6.
目的 探讨APACHEⅡ是否适用于评估急性呼吸窘迫综合征(ARDS)患者病情及预后.方法 采集232例ARDS患者与病情、预后及疗效有关的数据,采用ROC曲线下面积,灵敏度、特异度、准确度、阳性预测值、阴性预测值、阳性似然比和阴性似然比等指标验证APACHE Ⅱ评分系统真实性;采用Lemeshow-Hosmer拟合优度检验验证APACHE Ⅱ评分系统的可靠性.结果 死亡组与生存组两组之间患者的APACHEⅡ评分差异有统计学意义(P<0.05),APACHEⅡ评分与ARDS患者的预后呈明显正相关(P<0.05),APACHEⅡROC曲线下面积=0.842(P=0.000),并确定最佳临界点为16.50分.以此最佳临界点评估得到预测的灵敏度为85.62%、特异度为68.60%、阳性预测值为0.82、阴性预测值为0.74;以APACHE Ⅱ进行预后评估得到的预测结果与实际结果比较差异无统计学意义(2=12.087 P=0.147).结论 APACHE Ⅱ可用于对ARDS病情预测. 相似文献
7.
目的:探讨乌司他丁联合肺复张法治疗急性呼吸窘迫综合征(ARDS)的有效性及预后分析。方法:将62例ARDS患者按照随机数字表法分为对照组(常规治疗)和实验组(常规治疗+乌司他丁),各31例。比较两组患者的动脉血气和呼吸力学指标,同时比较两组患者病死率。结果:实验组患者动脉血气和呼吸动力学指标明显优于对照组,差异显著(P<0.05);实验组治疗后病死率仅为3.23%,低于对照组的19.35%,差异显著。结论:乌司他丁联合肺复张法治疗急性呼吸窘迫综合征治疗效果好,值得在临床进一步推广应用。 相似文献
8.
目的:探讨对ARDS(急性呼吸窘迫综合征)患者应用CBP(连续性血液净化)进行治疗的临床效果。方法:回顾我院2008年10月~2010年12月,我科收治的60例ARDS患者临床资料,随机分为治疗组与对照组,每组患者30例。两组患者在入院后均建立了人工气道,并以呼吸机进行控制/辅助呼吸,对对照组30例患者进行常规治疗,对治疗组30例患者在对照组基础上应用CBP进行治疗,对两组APACHEⅡ评分与血气分析以及TNF-α和IL-1β其变化进行对比。结果:治疗组的APACHEⅡ评分与血气分析较对照组明显改善(P<0.05),同时TNF-α与IL-1β的表达也较对照组明显降低(P<0.05)。结论:对ARDS(急性呼吸窘迫综合征)患者应用CBP(连续性血液净化)进行治疗,不但能将其体内的TNF-α与IL-1β有效的清除,而且有利于改善其呼吸功能,效果确切,应予合理推广。 相似文献
9.
目的研究影响急性呼吸窘迫综合征(ARDS)患者预后的危险因素。方法回顾分析2008年1月至2011年1月145例ARDS患者资料,分为存活组(n=80)和死亡组(n=65)。分别从年龄、APACHEⅡ评分、SOFA评分、器官功能不全数目、脓毒症严重程度、肺源性与非肺源性ARDS等方面分析与患者预后的关系。结果单因素分析显示存活组和死亡组之间,年龄(P<0.001)、APACHEⅡ评分(P<0.001)、SOFA评分(P=0.003)、器官功能不全数目(P<0.001)、脓毒症严重程度(P<0.001)、肺源性与非肺源性ARDS(P=0.043)、是否应用抗凝剂(P=0.006)差异有统计学意义。多因素分析显示,APACHEⅡ评分(P=0.016,OR:1.095,95%CI:1.017~1.179)、脓毒症严重程度(P<0.001,OR:2.559,95%CI:1.609~4.072)、肺源性与非肺源性ARDS(P=0.033,OR:0.348,95%CI:0.131~0.920)影响预后。结论 APACHEⅡ评分、脓毒症严重程度、ARDS诱发因素是影响ARDS患者预后的独立危险因素。 相似文献
10.
目的探讨乌司他丁对急性呼吸窘迫综合征(ARDS)患者凝血功能的影响。方法将80例ARDS患者按随机数字表法分为治疗组和对照组,各40例。对照组给予机械通气、抗感染、营养支持治,治疗组在此基础上加用乌司他丁针10万U+0.9%氯化钠溶液100ml静脉滴注3次/d,连续7d。比较两组患者住ICU时间、机械通气时间、28d病死率以及治疗前后急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、氧合指数、血浆凝血酶原时间(PT)、纤维蛋白原(FIB)和D-二聚体(D- D)水平及血小板计数(Plt)变化。结果治疗组住 ICU时间、28d病死率、APACHE Ⅱ评分均低于对照组(均P<0.05),氧合指数、FIB、Plt水平均高于对照组(均P<0.05),PT、D- D水平治疗后低于对照组(均P<0.05)。结论在常规治疗的基础上,应用乌司他丁治疗能改善ARDS患者的凝血功能及炎症指标,缩短机械通气时间、入住ICU时间,降低病死率。 相似文献
11.
Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P < 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (>0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P <0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P < 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD. 相似文献
12.
Jiageng Zhu Jun Li Ruipeng Ji Jianghao Su Mingshun Shen Zhigang Cao 《南京医科大学学报(自然科学版)》2007,21(2):125-128
Objective: To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods: SD rats served as both donors and recipients. 4℃ sodium lactate Ringer's was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava (IVC) inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results: Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion: This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment. 相似文献
13.
Tao Ye * Zhi-quan Liu Jian-jun Mu Xi-han Fu Jun Yang Bao-lin Gao and Xiao-hong Zhang Department of Cardiology First Hospital of Xi'an Jiaotong University Xi'an Hanzhong Cardiovascular Institute Hanzhong 《中国医学科学杂志(英文版)》2004,19(4):248-251
Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P< 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P< 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure. 相似文献
14.
目的:评价使用安心颗粒对急诊经皮冠状动脉介入术(PPCI)术后生活质量的影响.方法:将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组(术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次)和对照组(仅接受基础药物治疗).所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表(MIDAS)、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果:入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异(P>0.05);出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低(P<0.05);组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低(P<0.05).两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血(P>0.05).两组发生轻度血小板减少症的患者数比较无差异(P>0.05).结论:PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险. 相似文献
15.
Jingming Zhu Ningning Hui Xiuhong Jiang Huaxing Zhang Chengzhang Fu 《南京医科大学学报(自然科学版)》2007,21(6):386-389
Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P<0.01);the MAP decreased(P<0.01)and the HR increased drastically(P<0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients. 相似文献
16.
Objective:To investigate the gene expression of osteoprotegerin(OPG) and osteoclast differentiation factor(ODF) in the bone tissue of patients with hip fracture due to osteoporosis. Methods:OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers(over 50 years old) with hip fracture(Observer Group) and 30 cases of hip facture sufferers with no osteoporosis(Control group) were analyzed with the Semi-Quantitative RT-PCR method. Results:The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion:Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption. 相似文献
17.
Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P. 相似文献
18.
Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine. 相似文献
19.
Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center. 相似文献
20.
Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine
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A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care(~'4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes. 相似文献