持续小剂量肝素治疗严重脓毒症的疗效分析

Objective To investigate the therapeutic effects of continuous low-dose heparin on severe sepsis.Mehoda 67 severe septic patients were randomly divided into tow groups:routine treat-ment group(n=36)and heparin treatment group(n=31).The levels of platelet(PET)count,APTr,PT,FIB and AT-Ⅲ were determined before and after treatment in two groups.The days of mechanical ventilation and the incidence nltes of disseminated intravascular coagulopathy(DIC),acute renal failure(ARF),acute respiratory distress syndrome(ARDS),multiple organ dysfunction syndrome(MODS),The 7-day and 28-dav mortalitv were observed.Results There are significant differences for the incidence rate of ARDS,DIC.MODS and 28-day mortality between routine treatment group and heparin treatment group(P＜0.05).And there are no siguificant differences for the levels of PLT count,APTT,PT,FIB,AT-Ⅲ,the days of mechanical ventilation,the incidence rate of ARF,7-day mortality between routine treatment group and heparin treatment group (P>0.05).Conclusion Continuous low-dose heparin on severe sepsis was sale relatively,and it could improve the prognosis and decrease the mortality rate of severe septic patients.     

持续小剂量肝素治疗严重脓毒症的疗效分析

Objective To investigate the therapeutic effects of continuous low-dose heparin on severe sepsis.Mehoda 67 severe septic patients were randomly divided into tow groups:routine treat-ment group(n=36)and heparin treatment group(n=31).The levels of platelet(PET)count,APTr,PT,FIB and AT-Ⅲ were determined before and after treatment in two groups.The days of mechanical ventilation and the incidence nltes of disseminated intravascular coagulopathy(DIC),acute renal failure(ARF),acute respiratory distress syndrome(ARDS),multiple organ dysfunction syndrome(MODS),The 7-day and 28-dav mortalitv were observed.Results There are significant differences for the incidence rate of ARDS,DIC.MODS and 28-day mortality between routine treatment group and heparin treatment group(P＜0.05).And there are no siguificant differences for the levels of PLT count,APTT,PT,FIB,AT-Ⅲ,the days of mechanical ventilation,the incidence rate of ARF,7-day mortality between routine treatment group and heparin treatment group (P>0.05).Conclusion Continuous low-dose heparin on severe sepsis was sale relatively,and it could improve the prognosis and decrease the mortality rate of severe septic patients.     

小剂量普通肝素治疗脓毒症的临床研究

目的 探讨小剂量普通肝素对脓毒症的治疗作用.方法 将2007年10月至2009年12月入住我院ICU的85例脓毒症患者分为普通肝素治疗组45例和对照组40例.对照组给予早期应用广谱抗生素和容量复苏、控制血糖、抑酸保护胃黏膜、纠正水、电解质和酸碱平衡紊乱、脏器支持、基础病因治疗、营养支持及对症治疗.普通肝素治疗组在进行上述治疗的同时加用普通肝素5 U/(kg·h),24 h持续静脉泵入,疗程为1周(或用至患者出现低凝状态或出血倾向,或用至患者出院或死亡).比较2组患者治疗前后APACHEⅡ评分、CRP、凝血指标及血小板计数的变化;比较2组7 d及28 d转归及2组出血并发症发生率.结果 普通肝素治疗组28 d生存率为82.22%(37/45),对照组为62.50%(25/40),2组间差异有统计学意义(P＜0.05).治疗后1周APACHEⅡ评分2组差异无统计学意义(P＞0.05),但可以看出普通肝素治疗组的评分较对照组改善更大;普通肝素治疗组治疗前后比较,差异具有统计学意义(P＜0.05);治疗后1周2组CRP差异无统计学意义(P＞0.05),但2组治疗前后组内比较差异均有统计学意义(P＜0.01或P＜0.05).2组治疗前后凝血功能的指标及血小板计数均差异无统计学意义(P＞0.05);与对照组相比普通肝素治疗组未增加出血并发症的发生率.结论 小剂量普通肝素治疗能显著改善脓毒症患者的生存率,且无严重并发症,临床应用安全.

Abstract：

Objective To explore the therapeutic effects of low-dose unfractionated heparin(UFH) therapy on sepsis. Methods Eighty-five sepsis patients were divided into two groups: heparin treatment group ( n = 45 )and routine treatment group (control group) (n =40). The patients of control group received a series of remedies,including broad-spectrum antibiotics in early stage, supplementing of circulation volume, protecting of mucosal membrane of stomach, correcting the water, electrolyte and acid-base disturbance, and nutrition and supportive therapy. The patients of UFH treatment group were treated with UFH 5 U/( kg · h) by continuous intravenous infusion for 7 days in addition to routine treatment. The difference of APACHE-Ⅱ score, CRP, coagulation markers and platelet count between two groups were analyzed before and after treatment. The hemorrhage complication and survival rate in 7 days and 28 days were compared between the two groups. Results The survival rate was 82.22％ and 62.50％ in UFH treatment group and control group respectively (P ＜ 0.05). There was no significant difference of coagulation markers and PLT count between the two groups before and after treatment (P ＞ 0. 05). The incidence of hemorrhage complication was not higher in UFH treatment group compared with that of control group (P ＞ 0.05 ).Conclusion UFH therapy can improve the survival rate of patients with sepsis.     

乳酸和急性生理学及慢性健康状况评分对老年脓毒症患者预后的评估

目的 研究乳酸和急性生理学及慢性健康状况评分(APACHEⅡ评分)对老年脓毒症患者预后的评估作用.方法 收集我院急诊科老年脓毒症患者90例,按照入院时血乳酸值分成乳酸升高组56例,乳酸正常组34例,比较2组的病死率、休克发生率、机械通气率和多器官功能障碍综合征(MODS)发生率和APACHEⅡ评分;根据APACHEⅡ评分(＜15、15～24、≥25)分为3组,比较3组患者的病情和预后.结果 乳酸升高组患者机械通气率、休克发生率、MODS发生率和病死率均明显高于乳酸正常组(33.9%比5.8%,35.7%比5.8%,42.8%比8.8%,30.3%比2.9%,均P＜0.01)、APACHEⅡ评分明显大于乳酸正常组[(24.3±7.5)分比(16.1±5.2)分,P＜0.05],随着APACHEⅡ评分增高,患者病情逐渐加重,休克发生率和住院病死率明显升高(P＜0.05),患者乳酸水平也明显增高,分别是[(1.7±0.5)、(3.9±0.6)、(6.2±1.3)mmol/L,P＜0.05].结论 血乳酸和APACHEⅡ评分都可以评估老年脓毒症患者病情严重程度和预后,两者升高提示预后较差.

Abstract：

Objective To study the prognosis function of lactic acid and acute and chronic physiology health scoreⅡ(APACHEⅡscore) in elderly patients with sepsis. Methods The Clinical data of 90 elderly patients with sepsis were collected at Department of Emergency, Xuanwu Hospital of Capital University of Medical Sciences. Patients with elevated blood lactic acid and 34 cases with normal lactic acid, the differences of fatality rate,shock, mechanical ventilation and MODS incidence and APACHE Ⅱ score were compared between 2 groups. According to APACHE Ⅱ score (＜15 scores, 15 -24 scores, ≥25 scores), the patients were divided into three groups,the difference of condition and prognosis were compared among each groups. Results The mechanical ventilation,shock, MODS and APACHE Ⅱ score in elderly septic patients with elevated lactate were significantly higher than those in normal lactic acid group( P ＜ 0.05) with mortality significantly increased(30.3% vs 2.9%, P =0.005).With the APACHE Ⅱ score increasing, the patient's illness was gradually worsened; shock incidence and hospital mortality were increased significantly, P ＜ 0.05. Conclusions The lactic acid levels and APACHE Ⅱ score can effectively assess the patients condition and prognosis, the elderly sepsis patients with elevated blood lactate had a serious condition and poor prognosis.     

无创正压通气在老年慢性阻塞性肺疾病急性加重期患者中的应用效果分析

Objective To study the clinical effect of non-invasive positive pressure ventilation (NPPV) in elderly patients with acute exacerbation of chronic obstructive pulmonary diseases (AECOPD). Methods One hundred and Fourteen elderly patients with AECOPD were divided into two groups. The observed group of 58 patients was given oxygen, anti-inflammatory and other conventional treatment, at the same time NPPV treatment was given, But the control group of 56 cases was only given the conventional treatment. The difference of blood oxygen pressure ( PaO2 ), carbon dioxide partial pressure ( PaCO2 ), pH value, respiratory rate (RR) and heart rate (HR)between two groups were compared after 12 h. To compare two groups endotracheal intubation rate and mortality differences. Results The pH and PaO2 of the observation group were significantly higher than that before treatment , HR, RR and PaCO2 decreased significantly compared with before treatment, and the various indicators were better than the same period in the control group. The observation group endotracheal intubation rate and mortality were less than the control group ( all P ＜ 0. 05). Conclusions NPPV can effectively alleviate breathing difficulties of the elderly patients with AECOPD and correct hypoxia. NPPV can reduce the rate of endotracheal intubation and mortality.     

无创正压通气在老年慢性阻塞性肺疾病急性加重期患者中的应用效果分析

Objective To study the clinical effect of non-invasive positive pressure ventilation (NPPV) in elderly patients with acute exacerbation of chronic obstructive pulmonary diseases (AECOPD). Methods One hundred and Fourteen elderly patients with AECOPD were divided into two groups. The observed group of 58 patients was given oxygen, anti-inflammatory and other conventional treatment, at the same time NPPV treatment was given, But the control group of 56 cases was only given the conventional treatment. The difference of blood oxygen pressure ( PaO2 ), carbon dioxide partial pressure ( PaCO2 ), pH value, respiratory rate (RR) and heart rate (HR)between two groups were compared after 12 h. To compare two groups endotracheal intubation rate and mortality differences. Results The pH and PaO2 of the observation group were significantly higher than that before treatment , HR, RR and PaCO2 decreased significantly compared with before treatment, and the various indicators were better than the same period in the control group. The observation group endotracheal intubation rate and mortality were less than the control group ( all P ＜ 0. 05). Conclusions NPPV can effectively alleviate breathing difficulties of the elderly patients with AECOPD and correct hypoxia. NPPV can reduce the rate of endotracheal intubation and mortality.     

前列腺素E1联合血浆置换治疗慢性重型肝炎的临床研究

Objective To investigate the curative effect, timing and feasibility of prostaglandin E1 combined plasma exchange in treatment of chronic severe hepatitis. Methods Eighty-eight patients with chronic severe hepatitis were randomly divided into treatment group and control group. The treatment group was given prostaglandin E1 combined plasma exchange treatment based on the comprehensive treatment of internal medicine. Control group only had given the internal medicine comprehensive treatment. Results The symptoms and signs of the treatment group were improved after treatments, especially with total bilirubin, cholinesterase, prothrombin activity, NH3 ( P ＜ 0.01,P ＜ 0.05 ). After treatment, except for albumin, the others indicators of the two groups had significant difference ( P ＜ 0.05). Follow-up for three months, the total effective rate of the treatment group was 69.6% ( 32cases ), early effective rate was 79.3% (23 cases), mid-term effective rate was 64.3% (9 cases) were all significantly higher than those of control group [47.6% (20 cases), 55.6% ( 15 cases), 38.5% (5 cases)] (P ＜ 0. 01 ).Conclusion Prostaglandin E1 combined with plasma exchange in treatment of chronic severe hepatitis can improve the liver function and survival rate significantly.     

前列腺素E1联合血浆置换治疗慢性重型肝炎的临床研究

Objective To investigate the curative effect, timing and feasibility of prostaglandin E1 combined plasma exchange in treatment of chronic severe hepatitis. Methods Eighty-eight patients with chronic severe hepatitis were randomly divided into treatment group and control group. The treatment group was given prostaglandin E1 combined plasma exchange treatment based on the comprehensive treatment of internal medicine. Control group only had given the internal medicine comprehensive treatment. Results The symptoms and signs of the treatment group were improved after treatments, especially with total bilirubin, cholinesterase, prothrombin activity, NH3 ( P ＜ 0.01,P ＜ 0.05 ). After treatment, except for albumin, the others indicators of the two groups had significant difference ( P ＜ 0.05). Follow-up for three months, the total effective rate of the treatment group was 69.6% ( 32cases ), early effective rate was 79.3% (23 cases), mid-term effective rate was 64.3% (9 cases) were all significantly higher than those of control group [47.6% (20 cases), 55.6% ( 15 cases), 38.5% (5 cases)] (P ＜ 0. 01 ).Conclusion Prostaglandin E1 combined with plasma exchange in treatment of chronic severe hepatitis can improve the liver function and survival rate significantly.     

Therapeutic efficacy of charcoal hemoperfusion in patients with acute severe dichlorvos poisoning

AIM: To assess the efficacy of hemoperfusion (HP) in the treatment of the patients with acute severe dichlorvos (DDVP) poisoning. METHODS: One hundred and eight patients with acute severe DDVP poisoning in the two teaching hospitals were enrolled. Sixty-seven patients were treated with HP (HP group) and forty-one patients accepted traditional treatment only as the control. Serum concentration of DDVP was determined by gas chromatography. RESULTS: The duration of coma, impaired consciousness, ICU stay, and mechanical ventilation     

内皮素和一氧化氮对脓毒性休克实验模型中器官损伤，肠系膜缺血和存活的影响

The development of potent drugs to treat cardiopulmonary failure in sepsis, such as antibiotics and new immunomodulatory therapeutic approaches have not prevented sepsis from being a major health problem. Dysfunction of the vascular endothelium is an early event in septic shock. The recognition of endothelium-derived substances, such as nitric oxide and endothelin, important mediators of systemic inflammatory response syndrome,led to the proposal that pharmacological inhibition of nitric oxide and endothelin production could represent a useful strategy in the treatment of septic shock. Splanchnic ischemia and translocation of endotoxin from the gut to the circulation contributes significantly to the high mortality rate in sepsis-related syndromes. This vasoconstriction in the splanchnic circulation can be partially blocked by inducible nitric oxide synthase inhibitor aminoguanidine or endothelin receptor antagonist bosentan in experimental models of septic shock. It can be suggested that endothelin and nitric oxide may affect survival. Although septic shock is a highly complex pathophysiological state, the course of septic shock has different phases with different characteristics which need different (special) treatment strategy. The inhibition of nitric oxide production during hyperdynamic,earlier phase of sepsis combined with the blockade of endothelin receptors at a later stage during the hypodynamic,late phase appears to be a novel promising strategy for the therapy of septic shock. The aim of this review is to discuss the role of nitric oxide and endothelin in sepsis and the potential therapeutic implications of blockade of nitric oxide and endothelin as a target in treatment of human septic shock. Briefly the importance of timing of intervention is also emphasized.     

子宫中隔切除术后预防粘连方法探讨

目的 探讨子宫中隔并不孕患者宫腔镜术后不同处理方法预防宫腔粘连的效果.方法 55例子宫中隔并不孕患者行腹腔镜监护下宫腔镜子宫中隔切除术(TCRS),术后针对不同患者采用不同术后处理措施,包括宫腔放置与不放IUD,是否进行人工周期治疗,部分患者术后使用GnRH-a类药物治疗术后第1、3个月行宫腔镜检查随访,宫内放置IUD的患者;于术后第3个月取环.结果 54例患者术后进行宫腔镜检查随访,其中40例分别于术后第1、3个月完成了术后2次宫腔镜检查,另14例只完成一次检查.宫腔术后放环与否对术后宫腔形态影响无差异(P>0.05),术后使用人工周期治疗患者较未使用者子宫内膜厚,此两者术后第3个月宫腔镜检查发现宫底创面均已有内膜覆盖.使用GnRH-a类药物患者术后官腔形态满意.结论 TCRS术后宫腔放置IUD无助于预防术后粘连的发生;术后人工周期治疗应更个体化并有针对性的使用GnRH-a类药物治疗.术后及时进行宫腔镜检查随访可防止术后宫底新粘连的形成.     

10例狂犬病误诊原因分析

狂犬病近年来发病率有逐年增加的趋势,近十二年来,我们共遇见狂大病２３例,其中１０例被误诊为其它疾病,现就其误诊原因进行分析如下。１临床资料１．１ 一般资料：男８例,女２例;年龄最大７８岁,最小４岁。发病季节为３月～１１月。首诊科室,儿科３例、内科３例、转院３例、急诊科１例。１．２ 临床表现：发热７例,恐风５例,恐水６例,怕光３例,流涎１０例,胸闷、气促、呼吸困难４例,烦躁不安１０例,多汗７例,恐惧６例,肢体麻木４例,抽搐４例,恶心、呕吐２例,昏厥１例。所有病例发病至死亡时间为２天～６天,死亡原因为…     

住院患者精神用药情况调查分析

目的：了解目前住院精神患者的药物使用情况。方法：采用一日法调查西安市精神卫生中心403例住院精神患者诊断和治疗情况，并与上海市精神卫生中心2004年调查结果相比较。结果：①传统精神药物使用显著减少，新型精神药物使用占据首位；②抗精神病药物使用趋向小剂量化；③本组联用丙戊酸盐类药物显著增多；④我院精神药物使用情况与上海精神卫生中心比较有显著差异。结论：近年来精神药物使用情况已发生了显著变化，与新型精神药物疗效好，副作用少，患者依从性高有关。     

欧洲药典适用性认证介绍

目的介绍欧洲药典适用性认证程序,为国内药品监管机构和原料药生产企业提供信息,促进我国原料药生产企业的国际化。方法通过查阅调研欧盟相关药品法规和与EDQM同行面对面的交流,详细了解欧洲药典适用性认证的组织机构和具体程序。结果与结论欧洲药典适用性认证程序在对原料药的质量控制有重要作用,加强了药典的监管力度,进一步保证了原料药的质量、安全性和有效性。     

新疆维吾尔自治区基层医院平均住院日调查分析

目的 通过对新疆维吾尔自治区14个县乡级医疗机构住院患者平均住院日及影响因素进行分析,为县乡级医疗机构进一步提高医疗管理质量提供依据.方法 将2009-2010年1504例县乡级医院住院患者平均住院天数,按性别、年龄、院别、付费方式、疾病分类进行描述性统计和秩和检验分析.结果 不同性别间及院别间平均住院日差异均有统计学意义(均P＜0.05),男性平均住院日为10.39 d,女性为8.69d,乡级医院为9.27d,县级医院为9.50 d.不同年龄间平均住院日差异有统计学意义(P＜0.05),小于15岁组、15 ～24岁组、25～44岁组、45 ～65岁组、大干65岁组平均住院日分别为8.10 d、7.66d、8.83 d、10.26 d和11.33 d.自费患者平均住院日为8.39 d,新农合组为9.10 d,商业保险组10.17 d,社会基本医疗保险患者则为11.08 d.不同疾病分类间平均住院日差异明显,妊娠类平均住院日最短,为6.73 d,而肿瘤患者则为14.26 d.结论 不同性别、不同年龄段、不同疾病分类及不同付费方式间平均住院日存在差异,县级医疗机构和乡级医疗机构住院患者平均住院日也存在差异.     

不同方法治疗慢性宫颈炎的疗效分析

目的慢性宫颈炎是妇科最常见的疾病之一,可引起盆腔脏器炎症,并且与宫颈癌的发生关系密切。本文诣在探讨不同方法在慢性宫颈炎中的疗效。方法回顾性分析新乡市中心医院收治的210例宫颈炎患者,采用药物保妇康栓、聚焦超声治疗及宫腔镜下宫颈电切术的临床效果进行统计分析。结果宫颈电切术治疗有效率为97.9%,明显高于另外两组,差异有统计学意义。结论宫腔镜下宫颈电切术治愈慢性宫颈炎,并且切除宫颈移行带,减少宫颈癌发生。     

The effect of temperature and of cetrimide on the rate of loss of refractility of spores of Bacillus megaterium

The rate of germination of spores of Bacillus megaterium at 30° is not significantly different from the rate at 37° but the onset of germination is delayed; outgrowth is normal. At 45° germination of some spores occurs but the rate is much slower than at 37°, and there is no lag; emergence occurs from only a proportion of the germinated spores and after 3 or 4 vegetative cells have been produced, replication ceases. A single regression equation can represent the germination rate of the spores at 37° in the presence of from 0.0005 to 0.02% w/v of cetrimide and in its absence. In 0.0005% w/v of cetrimide, germ cells emerge from some of the germinated spores but many of them become swollen and disintegrate. Concentrations of 0.00125% w/v or more progressively inhibit swelling and completely inhibit emergence.     

经尿道前列腺汽化电切术与经尿道前列腺电切术治疗前列腺增生症的效果对比

目的 对比分析经尿道前列腺汽化电切术与经尿道前列腺电切术治疗前列腺增生症的效果.方法 将本院2011年3月～2013年2月收治的90例前列腺增生症患者随机分为观察组（n=45）和对照组（n=45）,观察组患者采用经尿道前列腺汽化电切术治疗,对照组患者采用尿道前列腺电切术治疗,比较两组患者的疗效.结果 观察组的手术时间、术中出血量、术后冲洗时间、术后留置导尿管时间、住院时间少于对照组（P＜0.05）,残余尿量、国际前列腺症状评分和生活质量评分优于对照组（P＜0.05）,但是两组患者的并发症发生率差异无统计学意义（P＞0.05）.结论 经尿道前列腺汽化电切术治疗前列腺增生症具有疗效更确切、出血少、恢复快等优势,可以作为治疗前列腺增生症的首选方法.     

甲巯咪唑治疗甲状腺功能亢进症致白细胞减少12例临床分析

目的探讨甲巯咪唑治疗甲状腺功能亢进症引起白细胞减少的规律及治疗对策。方法回顾分析本院2007年2月至2012年2月使用甲巯咪唑治疗甲状腺功能亢进症致白细胞减少12例的临床资料。结果 75%（9/12）的病例白细胞减少发生在治疗开始的第2～3个月;全部病例白细胞减少均发生在甲巯咪唑15～45mg/d治疗阶段;口服抗白细胞减少药物及皮下注射重组人粒细胞集落刺激因子治疗的有效率为83.3%（10/12）。结论甲巯咪唑药物可导致白细胞减少、粒细胞减少;用药前后应密切监测血常规,掌握白细胞减少的情况,如明显减少应及时停药,予以升白细胞药物对症治疗,必要时给予重组人粒细胞集落刺激因子皮下注射治疗。