葛根素注射液对高粘血症血液流变学指标的影响

目的观察葛根素注射液对高粘血症血液流变学指标的影响。方法观察组采用葛根素静脉滴注,对照组采用复方丹参注射液静脉滴注。结果观察两组对高粘血症血液流变学指标的影响,两组治疗前后血液流变学指标变化比较差异有统计学意义（P〈0．05）。其中全血低切粘度、全血还原粘度、红细胞压积下降幅度,葛根素注射液组明显优于复方丹参液组（P〈0．05）。结论应用葛根素注射液对高粘血症血液流变学指标的影响优于复方丹参注射液,且安全性好,无明显不良反应。     

高粘滞综合征患者的血液流变学观察

血液流变学检测为医学科学提供了重要手段，心脑血管病的研究已从血压、血脂、动脉粥样硬化形成的机理等角度、转入血液流变学内源因素的探讨．血液流动性和有形成份的粘弹性及变形性的改变是导致心脏血管疾病尤其是高粘血症发生的原因和基础．为此，哈尔滨市第一医院和黑龙江省医院门诊１９９５年至１９９６年对４８例高粘血症患者进行了血液流变学测定，并对其中八项指标与正常对照组进行了比较，现报告如下：资料与方法一、资料来源：选自１９９５年至１９９６年门诊及住院高粘血症患者４８例，男女各２４例，年龄４２－７０岁，正常对照…     

激光量子辐照血液疗法对高粘滞血症患者血液流变学的影响

目的：研究激光量子辐照血液疗法(Laser Quantum Irraduarion on Blood Therapy,LQIBT)的治疗作用。方法：47名高粘滞血症患被分入LQIBT组及对照治疗组．观察治疗前后的疗效及血液流变学变化。结果：高粘滞血症患血液流变学各项指标均明显高于健康对照组(P<0．01);LQIBT组的疗效优于对照治疗组（P<0.05);两组治疗前后血液流变学各项指标均有不同程度的下降,但LQIBT组的各项指标经统计学处理有显性差异(P<0.05),而对照治疗组的各项指标经统计学处理无显性差异（P>0．05)。结论：LQIBT能明显改善高粘滞血症患的血液流变学特性,从而发挥临床治疗作用。     

富氧对海拔3 700m高原人体血液流变学的影响

目的探讨在高原建立富氧室对机体血液流变学的影响.方法在海拔3 700m高原室内充氧,使氧浓度提高为24%～25%.12名受试者在富氧条件下睡眠10h,出富氧室4h后,检测红细胞压积(HCT)、血液粘度(ηb)、血浆粘度(ηp)、还原粘度(ηr)、红细胞刚性指数(IR)、红细胞变形系数(TK)和血细胞聚集系数(VAl).结果富氧后较富氧前ηb、ηp、IR、TK和VAI均降低,有显著性差异(P<0.05),HCT、ηr无统计学意义(P>0.05).结论富氧10h可改善高原机体缺氧,并且增强机体的氧储备可持续4h以上.     

川芎嗪对高脂蛋白血症血液流变学影响的研究

为了探讨川芎嗪对高脂蛋白血症(以下简称高脂血症)的血液流变学的影响,我们于1993年1月～1995年12月间对收治的65例高脂血症的患者,采取随机分为治疗组40例和对照组25例,治疗前后进行血流变学指标检测,并进行对比观察。现报告如下。     

黄芪和丹参液联用对急性有机磷中毒患者血液流变学变化的影响

目的:探索黄芪和丹参液联用对急性有机磷农药中毒患者血液流变学变化的影响。方法:将24名重度急性有机磷中毒患者随机分为常规治疗组12例、黄芪和丹参液联合治疗组12例及健康对照组8例。两组患者分别在第1、3、5、7 d采取静脉血作血液流变学指标的检测,健康对照组门诊检测1次。结果:与正常对照组相比,中毒组患者初期红细胞数、血小板、全血高切黏度、血浆黏度、红细胞聚集指数明显升高,红细胞变性能力明显降低(P<0.01);治疗后,黄芪和丹参液联合治疗组血液流变学各项指标恢复明显较常规治疗组快,差异有统计学意义(P<0.05)。结论:黄芪和丹参液联用可有效改善急性有机磷中毒患者的血液流变学。     

激光量子辐照血液疗法对高粘滞血症患者血液流变学的影响

目的：研究激光量子辐照血液疗法（ Ｌａｓｅｒ Ｑｕａｎｔｕｍ Ｉｒｒａｄｕａｔｉｏｎ ｏｎ Ｂｌｏｏｄ Ｔｈｅｒａｐｙ, Ｌ Ｑ Ｉ Ｂ Ｔ） 的治疗作用。方法：４７ 名高粘滞血症患者被分入 Ｌ Ｑ Ｉ Ｂ Ｔ组及对照治疗组,观察治疗前后的疗效及血液流变学变化。结果：高粘滞血症患者血液流变学各项指标均明显高于健康对照组（ Ｐ＜ ０．０１）; Ｌ Ｑ Ｉ Ｂ Ｔ组的疗效优于对照治疗组（ Ｐ＜ ０．０５） ;两组治疗前后血液流变学各项指标均有不同程度的下降,但 Ｌ Ｑ Ｉ Ｂ Ｔ组的各项指标经统计学处理有显著性差异（ Ｐ＜ ０．０５） ,而对照治疗组的各项指标经统计学处理无显著性差异（ Ｐ＞ ０ ．０５） 。结论： Ｌ Ｑ Ｉ Ｂ Ｔ能明显改善高粘滞血症患者的血液流变学特性,从而发挥临床治疗作用。     

洗胃对口服中毒患者血液流变学指标的影响

目的 探讨洗胃对口服中毒血液流变学指标的影响。方法 测定11例口服患洗胃前后血液流变学指标的变化,并以18例健康体检做为正常对照。结果 洗胃后多项血液粘滞度指标显下降,红细胞刚性指数明显升高。结论 中毒患常规洗胃后血液处于低粘状态,是易于并发症的原因之一。     

高脂血症患者血液流变学指标变化及探讨

为探讨高脂血症患者与血液高黏滞的关系,对2003年3月至2004年10月来院就诊及住院的65例高脂血症患者的血液流变学指标及血脂两项指标进行了检测。现将结果报道如下。1材料与方法1.1检测对象对照组30例为2003年来院体检者;其中男性17例,女性13例,年龄35~62岁,经血脂检测及临床检     

高浓度氧摄入对自由基离子代谢和血液流变学的影响

高压氧或高浓度氧的摄入，不仅能够提高运动的耐受性，改善心肌缺血现象，而且能够迅速促进运动性疲劳的恢复。高压氧或高浓度氧的摄入，与提高运动能力的可能机制与诱导抗氧化酶系统的活性、抑制自由基上升幅度、改善红细胞弹性、提高变形能力、加快微循环血量、增强机体的防御能力等机制有关。但是氧摄入过多易破坏机体自身代谢平衡，造成氧中毒。     

危重患者腹腔内高压的发生率及其危险因素评估

目的探讨危重患者腹腔内高压(IAH)的发病率及相关危险因素。 方法采用前瞻性研究方法,对2013年7～11月期间入住广州市第一人民医院重症加强护理病房(ICU)的54例危重患者,经膀胱尿管间接测定腹腔内压力,记录人口学特征、入住ICU时的主要诊断、是否辅助通气及呼气末正压值、腹部手术情况、临床检验结果、腹围、中心静脉压、液体平衡、危重评分等指标,并采用logistic回归分析探讨IAH的危险因素。 结果危重患者的IAH发生率为37.0%(20/54),其中Ⅰ级10例,Ⅱ级8例,Ⅲ级2例,Ⅳ级0例。IAH患者较非IAH患者拥有较高急性生理与慢性健康评分[(20.1±6.2)分,(14.9±5.6)分,t＝8.04,P＝0.000]、贯续器官衰竭估计评分[(10.4±6.4)分,(5.5±4.3)分,t＝7.31,P<0.05]及中心静脉压[(10.4±2.8)mmHg,(8.9±2.0)mmHg,t＝6.21,P<0.05](1mmHg＝0.133kpa),相关危险因素有机械通气、腹腔积液、感染性休克、胆道疾病(均P<0.05)。 结论ICU危重患者的IAH发生率较高,且以轻中度为主,与机械通气、腹腔积液、感染性休克及胆道系统疾病密切相关。     

早期肠内营养对危重患者的影响

目的通过对危重患者入院24～48h内早期肠内营养支持的研究，了解其对危重患者的影响。方法选择我院综合性ICU中的危重患者，随机分为实验组和对照组。实验组在入院24～48h内开始肠内营养；对照组在入院48h后开始肠内营养。检测两组患者的营养指标、感染发生率、机械通气时间。结果共有206例危重患者进入实验。实验组的热量摄入、氮平衡优于对照组，感染发生率降低。结论早期肠内营养能更好地改善危重患者的营养摄入，降低感染发生率。     

术后重症患者β细胞功能改变初探

目的 探讨术后重症患者β细胞功能改变及其与预后的关系.方法 32.例术后入ICU患者年龄16岁且无糖尿病病史,根据APACHE Ⅱ评分是否10分,分为对照组和重症组.测定术前当日及术后第1天清晨空腹胰岛素(FINS)、空腹C肽(FCP)并计算HOMA-β细胞功能指数.结果 重症组术后第1天FINS、FCP、HOMA-β细胞功能指数与术前当日比较差异均有统计学意义(均P<0.05),与对照组比较差异均有统计学意义(均P<0.05);术后第1天FINS、空腹C肽、HOMA-β细胞功能指数与APACHE Ⅱ评分、APACHEⅢ评分和住ICU天数高度负相关.结论 术后重症患者可能存在胰岛β细胞功能不全.     

Early versus late intravenous insulin administration in critically ill patients

Objective To investigate whether timing of intensive insulin therapy (IIT) after intensive care unit (ICU) admission influences outcome. Design and setting Single-center prospective cohort study in the 14-bed medical ICU of a 1,171-bed tertiary teaching hospital. Patients The study included 127 patients started on ITT within 48 h of ICU admission (early group) and 51 started on ITT thereafter (late group); the groups did not differ in age, gender, race, BMI, APACHE III, ICU steroid use, admission diagnosis, or underlying comorbidities. Measurements and results The early group had more ventilator-free days in the first 28 days after ICU admission (median 12 days, IQR 0–24, vs. 1 day, 0–11), shorter ICU stay (6 days, IQR 3–11, vs. 11 days, vs. 7–17), shorter hospital stay (15 days, IQR 9–30, vs. 25 days, 13–43), lower ICU mortality (OR 0.48), and lower hospital mortality (OR 0.27). On multivariate analysis, early therapy was still associated with decreased hospital mortality (OR_adj 0.29). The strength and direction of association favoring early IIT was consistent after propensity score modeling regardless of method used for analysis. Conclusions Early IIT was associated with better outcomes. Our results raise questions about the assumption that delayed administration of IIT has the same benefit as early therapy. A randomized study is needed to determine the optimal timing of therapy. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. M.N.G. was supported by K23 HL60710, RO1 HL084060, and RO1 HL60710.     

Pharmacokinetics of single-dose intravenous amikacin in critically ill patients undergoing slow hemodialysis

Objective The pharmacokinetics of amikacin were studied in patients undergoing slow hemodialysis (HD).Design Slow HD was performed at the dialysate flow rate of 30 ml/min. After a single intravenous dose of amikacin 5 mg/kg, pharmacokinetic variables were calculated by fitting indivdual concentration-time curves to a two-compartment open model.Patients 6 critically ill patients with renal failure were entered into the study.Results The volume of distribution was 0.35±0.03 l/kg. Total body clearance was 35.1±2.3 ml/min with an elimination half-life of 10.5 h. During a 10.5 h session of slow HD, the serum amikacin concentration decreased from the peak level of 21.3±1.2 mg/l to 7.2±0.9 mg/l.Conclusion Slow HD eliminate amikacin more efficiently than other types of slowly performed renal replacement therapy and had profound effects on the pharmacokinetics. Amikacin elimination by this approach should be taken into consideration for designing a dosage schedule during the treatment.     

Effect of ranitidine on gastric intramucosal pH in critically ill patients

Objective: To determine whether ranitidine a) increases the values of gastric intramucosal pH (pHi) in critically ill patients, as determined by tonometry; b) reduces the variability of these measurements. Design: Prospective, double blind, randomized, placebo-controlled study. Setting: General Intensive Care Unit of a teaching hospital. Patients: Twenty-five critically ill, mechanically ventilated patients requiring arterial catheter and nasogastric tube. Interventions: Tonometer placement; blind, random administration of intravenous ranitidine (50 mg) or placebo. Measurements and main results: Tonometer saline PCO₂ (PCO₂i), arterial blood gases, gastric juice pH and pHi were determined immediately before, and 2, 4, 6 and 8 h after, ranitidine (12 patients) or placebo (13 patients). Ranitidine significantly increased gastric juice pH, but did not affect PCO₂i or pHi; pHi was 7.34 ± 0.14 before ranitidine, and 7.30 ± 0.12, 7.31 ± 0.11, 7.31 ± 0.14 and 7.31 ± 0.12 – 2, 4, 6 and 8 h, respectively, after ranitidine administration (p = 0.55). Ranitidine did not modify the coefficients of variation of PCO₂i or pHi, either. No significant changes in gastric juice pH, PCO₂i or pHi were observed in the placebo group. Conclusions: In critically ill patients, ranitidine has no effect on pHi values, and does not increase the reproducibility of pHi measurements. Received: 24 October 1996 Accepted: 22 October 1997     

Effect of sucralfate on gastric intramucosal pH in critically ill patients

Objective: To determine whether sucralfate administration affects the tonometric measurement of gastric intramucosal pH (pHi). Design: Non-randomized observational study. Setting: General intensive care unit of a teaching hospital. Patients: Twenty critically ill, mechanically ventilated, consecutively admitted patients requiring an arterial catheter and nasogastric tube. Interventions: Tonometer placement and sucralfate administration. Measurements and main results: We simultaneously determined tonometer saline PCO₂ (PCO₂i), arterial blood gases, pH of gastric juice and pHi. These parameters were evaluated immediately before sucralfate administration, and 2 h and 4 h after. We did not detect any change in either PCO₂i or pHi after sucralfate administration (PCO₂i: basal 6.4 ± 1.7, 2 h 6.3 ± 1.7, 4 h 6.3 ± 1.7; pHi: basal 7.35 ± 0.13, 2 h 7.36 ± 0.12, 4 h 7.36 ± 0.12). Conclusions: Sucralfate does not affect the tonometric measurement of PCO₂i and pHi. Received: 21 August 1996 Accepted: 18 April 1997     

Pharmacokinetics and pharmacodynamics of sequential intravenous and subcutaneous teicoplanin in critically ill patients without vasopressors

Objective To compare the pharmacokinetic parameters of sequential intravenous and subcutaneous teicoplanin in the plasma of surgical intensive care unit patients.Design and setting Prospective, randomized, crossover study in the surgical ICU of a university hospital.Patients Twelve patients with a suspected nosocomial infection, a serum albumin level higher than 10 g/l, body mass index less than 28 kg/m², and estimated creatinine clearance higher than 70 ml/min.Interventions Teicoplanin was first administered intravenously as a loading dose of 6 mg/kg per 12 h for 48 h and then continued at a daily dose of 6 mg/kg. On the fourth day patients were randomized in two groups according to the order of the pharmacokinetic studies.Measurements and results Serial plasma samples were obtained to measure teicoplanin levels. Compared with a 30-min intravenous infusion the peak concentration of teicoplanin after a 30-min subcutaneous administration occurred later (median 7 h, range 5–18) and was lower (16 µg/ml, 9–31; vs. 73, 53–106). Despite large and unpredictable interindividual differences no significant differences between subcutaneous and intravenous administration were observed in: trough antibiotic concentrations (10 µg/ml, 6–24; vs. 9, 5–30), the area under the teicoplanin plasma concentration vs. time curves from 0 to 24 h (AUC_0–24h; 309 µg/ml per minute, 180–640; vs. 369, 171–955), the proportion of the dosing interval during which the plasma teicoplanin concentration exceeded 10 µg/ml (96%, 0–100%; vs. 79%, 13–100%), and the ratio of AUC_0–24h to 10 (77, 45–160; vs. 92, 43–239).Conclusions In critically ill patients without vasopressors a switch to the subcutaneous teicoplanin after an initial intravenous therapy seems to give comparable pharmacodynamic indexes of therapeutic success.     

危重病人血浆甲状腺激素含量变化及其临床意义

目的　探讨危重病人血浆甲状腺激素（ Ｔ Ｈ） 的变化及其临床意义。方法　应用放射免疫分析法测定７３ 例危重病人和６０ 例健康人（ 对照组） 的血浆 Ｔ Ｈ 含量。结果　危重病人血浆 Ｔ３／ Ｆ Ｔ３ 含量〔（１０５ ±０４６）ｎ ｍｏｌ／ Ｌ〕／〔（２８５ ±１４１）ｐｍｏｌ／ Ｌ〕明显低于对照组〔（１９８ ±０５１）ｎｍｏｌ／ Ｌ, Ｐ＜ ００１〕／〔（６３７ ±１３１）ｐｍｏｌ／ Ｌ, Ｐ＜０００１〕;死亡组 Ｔ３／ Ｆ Ｔ３ 水平与非死亡组 Ｔ３／ Ｆ Ｔ３ 水平相比较有显著差异（ Ｐ＜ ００５／ Ｐ＜ ００１） 。结论　 Ｔ Ｈ 参与了危重病人的病理生理过程,监测危重病人血浆 Ｔ Ｈ 水平可作为反映病情程度和评估预后的一项参考指标。     

Polymicrobial bacteremia in critically ill patients

Objective To characterize the epidemiology of polymicrobial bacteremia (PMB) among critically ill patients.Design Prospective clinical study.Setting University medical center.Patients All patients with positive blood cultures in a medical-surgical ICU.Measurements PMB represents 8.4% of all true bacteremia in our ICU. Most of these patients were post-operative but none had malignancies or significant immunodepression. Over three-quarters of the episodes were nosocomial. No significant differences in factors associated with PMB were found when they were compared with a cohort of 154 monomicrobial episodes. Enterobacteriaceae were the most common organisms. Intravascular devices (42.8%) were the most common source of PMB, followed by intra-abdominal origin (21.4%). The overall mortality was 7.1%, a lower rate than has previously been described.Conclusions We suggest catheter replacement in patients who develop PMB and improving techniques of catheter maintenance in order to reduce its incidence.