呼吸机在急性呼吸窘迫综合征中的应用研究

目的分析呼吸机机械通气在急性呼吸窘迫综合征（ARDS）中的应用价值。方法回顾性分析我院2004年12月～2006年6月收治的22例ARDS患者采用呼吸机通气治疗为核心的综合治疗的经验。结果22例ARDS患者,带机时间为1～20d,平均带机时间6d;机械通气治疗后,心率、呼吸、血压、PH、PaO2、PaCO2较治疗前明显好转,对比差异有显著性意义;18例存活,4例死亡,病死率18.18%。结论早期及时有效的使用呼吸机通气治疗为核心的综合治疗是防治创伤造成的急性呼吸窘迫综合征的重要方法。     

重症胸外伤致急性呼吸窘迫综合征30例

目的　探讨胸外伤致急性呼吸窘迫综合征 (ARDS)的诊断和治疗。　方法　对 30例严重胸外伤并急性呼吸窘迫综合征 (ARDS)患者进行回顾性研究 ,分析其血气、PaO2 FiO2 、Qs Qt等与诊断及治疗的关系。　结果　本组患者ARDS占同期胸外伤 (30 6例 )的 9.8% ,占严重胸外伤(730例 )的 41.1%。早期血气分析显示PaO2 为 (6 .5 1± 0 .97)kPa,PaCO2 为 (4.6 4± 1.0 9)kPa ,Qs Qt为 (2 4.72± 8.93) % ,PaO2 FiO2 为 (12 .11± 2 .99)kPa。 30例均给予机械通气 ,平均 6 .8d ,并发肺炎13例。全组死亡 4例 ,死亡率为 13.3%。治愈者平均住院 34 .2d。　结论　早期诊断和治疗ARDS ,正确地使用呼吸机治疗并及时处理多发伤和休克是降低本病死亡率的有效措施。同时 ,早期处理并发症和合理应用抗生素也相当重要。     

重症急性胰腺炎合并急性呼吸窘迫综合征36例临床分析

目的:探讨急性重症胰腺炎并发ARDS综合治疗效果及其意义。方法:对2000-10~2006-10我院收治的重症胰腺炎合并ARDS 36例患者的临床资料进行回顾性分析。结果:I组给予常规治疗基础上行人工呼吸机辅助通气,死亡8例,死亡率47.06%(8/17)。Ⅱ组在常规治疗基础上,尽快应用呼吸机纠正缺氧,强调"最佳"呼气末正压(PEEP),低平台压,适当潮气量,所谓"保护性肺通气"。在Ⅱ组中我们对胆总管下端有梗阻征象的病人(10例)行ERCP及EST术;治愈14例,死亡5例,死亡率26.32%(5/19)。结论:对重症急性胰腺炎合并ARDS综合治疗技术的应用,提高了急性重症胰腺炎并发ARDS的抢救成功率。     

机械通气治疗肺挫伤24例

肺挫伤是创伤后常见病之一 ,有报道死亡的创伤病人中 1/4有胸部外伤[1] 。我院ＩＣＵ 1994年 1月～ 1999年11月间共收治需机械通气治疗的肺挫伤病人 2 4例 ,现对他们的临床资料进行回顾分析 ,探讨肺挫伤机械通气的呼吸模式及影响预后的因素。资料与方法1.临床资料 :经胸部Ｘ线和ＣＴ检查明确诊断肺挫伤 87例中在ＩＣＵ进行机械通气治疗≥ 48ｈ的 2 4例患者。男19例 ,女 5例 ;年龄 5～ 86岁 ,平均 (39±5 )岁。致伤原因 :交通伤 2 0例 (83% ) ,坠落伤 3例 (12 % ) ,爆炸伤 1例 (4 % )。2 4例中单纯胸部外伤 6例 (5 % ) ,多发伤18例 (75 % )。…     

肋骨接骨板内固定结合早期呼吸机支持治疗创伤性急性呼吸窘迫综合征

对18例严重胸外伤致急性呼吸窘迫综合征(ARDS)患者采取纯钛爪形接骨板内固定结合早期呼吸机支持治疗.患者呼吸机支持呼气末正压通气(PEEP)值低,支持时间短,呼吸功能恢复快,无呼吸机相关严重损伤发生,胸部畸形纠正.此方法是治疗严重胸外伤致ARDS的有效方法,有利于严重多发伤康复,降低了致死率和致残率.     

重症胸外伤并发急性呼吸窘迫综合征临床分析

本文对 4 6例重症胸部创伤并发急性呼吸窘迫综合征 (ARDS)进行临床分析 ,探讨呼吸机治疗及其它治疗方法 ,以提高抢救成功率     

严重胸腹伤并发急性呼吸窘迫综合征的机械通气治疗

目的 总结和探讨严重胸腹伤并发急性呼吸窘迫综合征(ARDS)的机械通气治疗方法.方法 回顾分析90例严重胸腹伤并发ARDS的诊治经过.根据机械通气策略和方法的不同将本组病例分成两组:传统机械通气组38例,肺保护性通气组52例.比较两组通气时间、氧合状况、呼吸机相关肺损伤(VALI)发生率及病死率.结果 传统机械通气组通气时间平均(7.56±2.49)天,氧合指数为276.58±24.20,VALI发生率44.74%,病死率34.21%;肺保护性通气组通气时间平均(5.47±2.81)天,氧合指数为362.38±27.66,VALI发生率19.23%,病死率13.46%.与传统机械通气相比,肺保护性通气治疗能缩短通气时间,改善氧合状况,降低VALI发生率及病死率.结论 对严重胸腹伤并发ARDS患者,肺保护性通气的治疗效果明显优于传统机械通气,值得在临床上推广应用.     

低潮气量加呼气末正压通气治疗创伤后急性呼吸窘迫综合征的临床研究

目的　探讨低潮气量 (LTV) 呼气末正压 (PEEP)机械通气 (MV)治疗创伤性急性呼吸窘迫综合征 (ARDS)的疗效。　方法　 1997年 10月～ 2 0 0 3年 10月 ,我科 2 6例创伤性ARDS患者 ,分为传统潮气量 (12～ 15ml/kg)机械通气组 (A组 ) 11例 (1997年 10月～ 2 0 0 0年 8月 ) ;低潮气量 (5～ 8ml/kg) PEEP机械通气组 (B组 ) 15例 (2 0 0 0年 9月～ 2 0 0 3年 10月 )。比较两组的血气、血流动力学指标 ,呼吸机所致肺损伤 (VILI)发生率 ,发生多器官功能不全综合征(MODS)的时间、发生率和ARDS的病死率。　结果　两组中血流动力学和血气指标中氧分压(PaO2 )比较 ,差异无显著性意义。B组二氧化碳分压 (PaCO2 )高于A组 (P <0 .0 5 ) ,B组中发生MODS的时间延长 (P <0 .0 5 ) ,MODS的发生率和ARDS的病死率降低且无VILI发生。　结论　低潮气量 PEEP机械通气在创伤性ARDS的治疗中 ,改善氧合与传统方法比较 ,差异无显著性意义 ,PEEP(5～ 18cmH2 O)和轻度高碳酸血症 (PHC)对血流动力学无明显影响 ,且能有效地减少VILI,延长MODS发生的时间 ,适合在ARDS中应用。     

重度烧伤并发急性呼吸窘迫综合征的诊断和治疗

目的探讨重度烧伤后并发急性呼吸窘迫综合征(ARDS)的病因及治疗方法。方法对26例重度烧伤并发ARDS患者的发病原因及治疗方法进行回顾性分析。结果26例患者诊断及时,治疗正确,16例抢救成功,10例死亡。结论重度烧伤并发ARDS死亡率较高,早期诊断、尽早使用呼吸机治疗对降低死亡率有重要意义。     

胸部严重创伤并发急性呼吸窘迫综合征8例救治体会

报告胸部严重创伤并ARDS 8例应用机械通气的治疗方法,取得了良好的临床治疗效果。认为无论选择何种通气模式,只有条件使用适当以及相应的治疗措施有效,均可取得良好的临床治疗效果,同时应用深入氧图像分析结果所测得的血气指标,调整呼吸机使用最佳状态,对纠正低氧血症起到至关重要的作用。     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Die rechtsmedizinische Identifizierung — Bedeutung und Beweiswert —

Zusammenfassung Bei der rechtsmedizinischen Identifizierung kann die Identität im strengen Sinn allenfalls bei lebenden Personen festgestellt werden; sonst läßt sich nur von Teilen auf das Ganze (vom Untersuchungsobjekt auf die Person) schließen, wobei die verschiedenen Merkmale des Untersuchungsobjektes entsprechend der Hdufigkeit ihres Vorkommens eine unterschiedliche Beweiskraft haben. Bei der Schädelidentifizierung mit Hilfe moderner photographischer oder elektronischer Superprojektionsverfahren ergeben sich unter Berücksichtigung der Weichteildicken so viele (fiktive) Vergleichspunkte, daß bei geeignetem Vergleichsmaterial (Photographien) Identität wegen der Vielzahl übereinstimmender Bezugspunkte in den meisten Fällen evident ist.     

Imaging of abdominal nodal spread in malignant disease

This is a review of the role of imaging procedures for the assessment of abdominal and pelvic lymph nodes. The diagnosis of malignant lymphatic spread is rarely the sole purpose of imaging, because it is usually part of a general abdominal examination, most frequently with CT or US, or increasingly with MRI. These studies are often requested in order to obtain information about the situation to be encountered during surgery, or to alert the surgeon to irresectability or to unexpected metastases outside the initially planned area of exploration. In most surgically treated tumours the role of imaging for preoperative staging is limited, due either to its insufficient sensitivity or because the initial treatment is independent of the lymph node stage. Imaging is commonly used to verify treatment response to chemo- or radiotherapy and for follow-up.Correspondence to: S. Delorme