乌司他丁联合血必净治疗烧伤脓毒症的疗效分析

目的 对乌司他丁联合血必净治疗烧伤脓毒症的临床疗效进行分析和探讨.方法 选择我院在2012年1月~2016年4月收治的80例烧伤脓毒症患者作为研究对象,随机地将这些患者划分为对照组和观察组,每组各有40例.采用单纯乌司他丁治疗对照组患者,采用乌司他丁联合血必净治疗观察组.两组患者均连续进行7天的治疗,对两组患者的治疗效果进行分析和比较.结果 在经过精心的治疗之后,观察组患者达到了87.5%(35/40)的28天生存率,对照组达到了67.5%(27/40)的28天生存率;在生存率方面相比,两组患者差异显著,具有统计学意义(P<0.05);同时,在各项炎症因子、慢性健康和急性生理状况评分、ICU入住时间、机械通气时间等方面,观察组均低于对照组,两组患者相比差异显著,具有统计学意义(P<0.05).结论 乌司他丁联合血必净治疗烧伤脓毒症能够有效地降低患者的炎症反应、ICU入住时间,并且极大地提升患者的生存率,值得在临床上推广和应用.     

右美托咪定对脓毒症患者谵妄的预防作用

目的观察右美托咪定是否可通过减少早期炎症因子释放而降低ICU脓毒症患者谵妄发生率,缩短谵妄持续时间。方法将我院重症医学科2015年12月至2017年2月收治的脓毒症患者68例随机分为2组:右美托咪定组(34例)、对照组(34例)。两组患者均给予脓毒症指南规定的标准束集化治疗,右美托咪定组给予生理盐水50 m L+200μg右美托咪定以0.5μg/(kg·h)泵入,对照组予以相同剂量生理盐水泵入。每组患者每日予以CAM-ICU评估,对比两组患者谵妄发生率、谵妄持续时间及ICU入住时间。同时检测所有患者入ICU时(0 h)、24 h、48 h血中IL-6、神经元特异性烯醇化酶(NSE)表达变化。结果右美托咪定组的谵妄发生率较对照组明显下降(17.6%vs.41.2%,P<0.05),ICU住院时间较对照组缩短[(10±3)d vs.(12±2)d,P<0.05],但两组谵妄持续时间比较差异无统计学意义(P>0.05)。与对照组比较,右美托咪定组患者在入ICU时(0 h)、24 h、48 h血浆IL-6、NSE水平降低(P<0.05)。结论右美托咪定可以降低ICU脓毒症患者谵妄发生率,缩短ICU住院天数,但不影响谵妄持续时间,其机制可能与右美托咪定减少ICU脓毒症患者早期炎症因子IL-6及NSE释放有关。     

乌司他丁对ICU脓毒症患者凝血功能障碍的影响

目的:探讨乌司他丁对重症监护病房(ICU)脓毒症患者凝血功能障碍的影响及其机制。方法:选择64例ICU脓毒症患者,按随机数字表法分成治疗组和对照组,各32例。对照组患者采用常规治疗,治疗组患者在对照组治疗的基础上加用乌司他丁注射液,每次取10万单位溶于500 ml 15%葡萄糖注射液或氯化钠注射液中静脉滴注,每日3次,连用7 d。统计两组患者的机械通气时间、ICU住院时间和30 d生存率;检测患者治疗前与治疗后第1、3、7天的血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)、白细胞计数(WBC)和白细胞介素-6(IL-6)水平。结果:治疗后,治疗组患者的机械通气时间、ICU住院时间显著短于对照组,生存率显著高于对照组,差异有统计学意义(P<0.05);治疗组外周血中的WBC和IL-6水平显著低于对照组,差异有统计学意义(P<0.05);治疗组治疗后第7天的各凝血指标水平与治疗前和治疗后对照组比较,差异均有统计学意义(P<0.05),各项凝血指标在治疗后7 d恢复至正常水平。结论:乌司他丁可改善ICU脓毒症患者的凝血功能,其作用机制可能与乌司他丁抑制炎性因子的释放及相应的凝血因子功能有关。     

预见性护理在ICU脑卒中患者中的应用价值

目的探讨预见性护理用于ICU脑卒中患者的临床价值及对本病急性期并发症的影响。方法选取2018年1月~2019年6月某院ICU183例脑卒中患者,随机分为试验组(预见性护理+脑卒中ICU常规护理,92例)和对照组(脑卒中ICU常规护理,91例)。比较观察两组ICU入住时间,统计并发症。结果试验组ICU平均入住时间为(5.7±2.3)d,短于对照组(8.8±3.1)d;试验组住院期间并发症发生率为7.61%,低于对照组的24.18%,差异有统计学意义(P<0.05)。结论 ICU脑卒中患者采用预见性护理可有效预防急性期并发症,缩短ICU入住时间,对促进早期康复、改善预后具有积极作用。     

ICU亚谵妄高危患者综合干预方案的制订及实践

目的探讨综合干预方案对重症医学科(ICU)亚谵妄的高危患者的预防作用。方法采用随机对照研究方法,将2019年7月至2020年6月入住ICU的清醒患者120例随机分为试验组和对照组,每组各60例。对照组接受ICU常规护理,包括基础护理、心理护理、每日唤醒、进行呼吸同步训练、合理选择镇静剂和早期活动。试验组在对照组常规护理基础上,实行综合干预。干预措施总结为五干预,包括人文干预、物理干预、感知干预、认知和定向力干预、药物干预。记录比较两组患者在ICU住院期间亚谵妄发生率、谵妄发生率、亚谵妄持续时间、非计划性拔管率、约束率、机械通气时间、镇静剂日均费用、ICU住院时间和患者满意度。结果试验组患者在ICU住院期间亚谵妄发生率、谵妄发生率、亚谵妄持续时间、约束率、机械通气时间、镇静剂日均费用、ICU住院时间均低于对照组,差异有统计学意义(P 0.05),患者满意度高于对照组,两组差异有统计学意义(P 0.05)。试验组和对照组非计划性拔管率差异无统计学意义(P 0.05)。结论综合干预方案可以对ICU亚谵妄的高危患者起到预防作用。     

比较平衡盐溶液与生理盐水对脓毒症患者急性肾损伤的影响

目的比较平衡盐溶液与生理盐水对脓毒症患者急性肾损伤的影响。方法前瞻性选取2019年2-8月山西医科大学第一医院重症医学科(ICU)收治的90例脓毒症患者,随机分为试验组和对照组,每组45例。试验组给予平衡盐溶液(钠钾镁钙葡萄糖注射液)用于液体复苏治疗,对照组给予生理盐水,连续用药5 d,余常规治疗不予干预。比较两组患者用药期间肾功能情况、急性生理学和慢性健康状况评分(APACHEⅡ评分)、序贯器官衰竭估计评分(SOFA评分)、急性肾损伤(AKI)发生率、高氯血症发生率、连续肾脏替代疗法(CRRT)使用时间、有创呼吸机使用时间、住ICU时间及住院时间、研究液使用量、用药结束后28 d生存率等。结果试验组高氯血症发生率、AKI发生率明显低于对照组,差异有统计学意义(P<0.05);试验组CRRT使用时间、有创呼吸机使用时间、住ICU时间及住院时间等短于对照组,差异有统计学意义(P<0.05);试验组血清肌酐下降程度整体优于对照组,入组第2天(D2)和第3天(D3)两组比较差异有统计学意义(P<0.05);试验组SOFA评分改善、APACHEⅡ评分改善明显优于对照组,差异有统计学意义(P<0.05);两组研究液使用量比较,差异无统计学意义(P>0.05);试验组28 d生存率明显高于对照组,差异有统计学意义(P<0.05)。结论使用平衡盐溶液用于脓毒症患者的液体复苏,可有效降低入住ICU脓毒症患者的AKI发生率,且能够有效减轻入住ICU时已经合并AKI患者的肾损伤程度,延缓患者病情进展,缩短住院日,改善预后。     

术中应用乌司他丁治疗对食管癌患者的影响

目的探讨术中应用乌司他丁治疗对食管癌患者的影响。方法 70例接受食管癌根治术治疗的食管癌患者,根据收治顺序单双号分为观察组和对照组,每组35例。观察组患者在麻醉诱导完成即刻静脉注射20万U乌司他丁,对照组则注入等量生理盐水,观察两组术后并发症发生情况和住院时间、ICU停留时间。结果观察组术后并发症发生率为8.57%,显著低于对照组的31.43%,差异有统计学意义(P<0.05);观察组ICU停留时间显著短于对照组,差异有统计学意义(P<0.05);两组住院时间比较差异无统计学意义(P>0.05)。结论食管癌患者术中应用乌司他丁治疗可以显著降低术后并发症发生,缩短ICU停留时间,具有重要的临床意义。     

乌司他丁联合连续性肾脏替代治疗对老年脓毒症患者肠黏膜屏障功能的影响评价

目的 观察连续性血液净化及其与乌司他丁联合对老年脓毒症患者肠粘膜屏障功能的影响,并与乌司他丁疗效相对比,进一步为临床治疗提供依据.方法 将入选的老年脓毒症患者96例随机分为乌司他丁治疗组(UTI组)(n=32)、肾脏替代治疗组(CRRT组)(n=32)和UTI+CRRT组(n=32).所有患者均按照指南给予基础治疗,同时UTI组及UTI+CRRT组加用同等剂量乌司他丁,CRRT组及UTI+CRRT组尽早行CRRT治疗.分别于入住ICU当时与入住ICU后第2、3、7天(D0、D2、D3、D7)测定血清肠脂肪酸结合蛋白(IFABP)、二胺氧化酶(DAO)、D-乳酸(D-Lac)水平变化,并记录患者APACHEⅡ评分、ICU住院时间及28 d生存情况.结果 入科时,3组APACHEⅡ评分、血浆IFABP、DAO、D-Lac水平差异均无统计学意义(P＞0.05).经治疗后,3组血浆IFABP、DAO、D-Lac水平均有所下降,但UTI+CRRT组下降趋势表现得更加明显;从D3观察点开始,UTI+CRRT组血浆IFABP、DAO、D-Lac水平均明显低于UTI组及CRRT组(P＜0.05).经治疗后,UTI+CRRT组APACHEⅡ评分及ICU住院时间小于另两组(P＜0.05).两组28 d病死率差异无统计学意义(P＞0.05).结论 UTI与CRRT治疗老年脓毒症患者对肠屏障功能都具有一定的保护作用,且疗效相似,但乌司他丁联合CRRT治疗对于肠粘膜屏障功能的保护作用更显著,可以更好地改善老年脓毒症患者的预后,明显减少ICU住院时间,但对降低28 d病死率影响不明显.     

乌司他丁改善早期脓毒症患者预后的临床疗效研究

目的:探讨乌司他丁对早期脓毒症患者的临床疗效.方法:选择2020年1～12月于我院确诊并治疗的早期脓毒症患者158例,采取随机数字法分为试验组和对照组,各79例,对照组利用传统治疗,试验组在传统治疗基础上加用乌司他丁治疗,观察两组ICU住院时间、病死率、症状改善等指标差异.结果:试验组28d病死率8.86％,并发症发病...     

乌司他丁治疗脓毒血症临床疗效观察

目的探讨乌司他丁治疗脓毒血症的临床疗效。方法选取2011年1月至2012年1月收治的42例脓毒血症患者作为研究对象,随机分为试验组和对照组,其中对照组20例采用常规治疗,试验组22例在常规治疗的基础上加用乌司他丁辅助治疗,观察两组治疗效果并比较两组接受治疗后的急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)测定情况。结果试验组治疗后好转率和平均住院时间与对照组比较,差异有统计学意义(P<0.05);试验组患者在治疗1、3、5 d后APACHEⅡ评分与对照组比较,差异有统计学意义(P<0.05)。结论采用乌司他丁辅助治疗脓毒血症临床疗效安全、可靠,值得推广应用。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.