SARS合并MODS病人的治疗方案

严重急性呼吸综合征(SARS)具有急性起病、传染性强、易感人群普遍、传播快、病死率高的临床特点。SARS发病人群以青壮年为主,但死亡者以老年人为主。对SARS死亡病例的分析发现,70%～100%伴有肺外器官功能改变,70.9%伴发其他基础疾病,30%为65岁以上的老年人。因此,患有多种基础疾病的老年SARS病人可能因肺部感染启动老年多器官功能不全(MODS)而引起死亡。     

传染性非典型肺炎死亡危险因素分析

目的 分析山西省24例SARS死亡病例临床特征及导致死亡危险因素。方法 对2003-03-07～2003-06-04山西省24例SARS死亡病例的临床资料进行回顾性分析。结果 24例患者男13例(54．2％)，女11例(45．8％)；主要临床表现为发热、咳嗽、畏寒、气促等。实验室检查早期的白细胞计数、淋巴细胞百分比均下降。胸部X线显示肺部斑片状阴影。短期内病灶增多。7d内死亡3例(12．5％)，7～14d死亡11例(45．8％)，14d以上死亡10例(41．7％)。14例(58．3％)病人有基础疾病(共18例基础疾病)，其中4例(22．2％)糖尿病，3例(16．7％)脑血管病，3例(16．7％)心血管病，6例(33．3％)高血压，1例(5．6％)表皮松懈症，1例(5．6％)精神分裂症；7例(38．9％)同时合并2种或2种以上疾病。24例SARS死亡患者中16例死于急性呼吸窘迫综合征(ARDS)(66．7％)，ARDS并发多器官功能障碍综合征(MODS)死亡5例(20．8％)，患者感染SARS后原有基础疾病加重导致死亡3例(12．5％)。多因素分析结果显示年龄大于50岁、缺乏心理治疗、早期淋巴细胞减少为死亡独立危险因素。结论 年龄大于50岁、早期淋巴细胞减少是SARS死亡独立危险因素；心理治疗是保护因素。     

36例SARS患者外周血象检查结果分析

目的　通过对 3 6例严重急性呼吸综合征 (SARS)患者外周血细胞数据的研究 ,动态监测SARS患者的血象变化 ,探讨血象在发生、发展转归中的临床意义。　方法　收集江门市医院 3 6例确诊SARS患者的外周血检查数据 ,进行动态分析。　结果　入院时 3 6例患者外周血白细胞计数 (WBC)均值为 ( 5 2± 3 0 )× 10 9/L随后WBC升高 ,至第4周有 91 6%病例WBC计数恢复正常 ,入院时淋巴细胞值低于 1 5× 10 9/L者占 88 9% ( 3 2 / 3 6) ,均值为 ( 1 0± 0 5 )×10 9/L ,入院 4周后有 86 1%患者淋巴细胞绝对数恢复正常。 1例血小板降低 ,占 2 8%。其他细胞分类及血红蛋白无明显异常。　结论　白细胞降低或正常及淋巴细胞降低可作为SARS的早期诊断指标 ,淋巴细胞降低可作为SARS早期诊断的标准之一 ;淋巴细胞的降低显示SARS病毒严重侵犯患者免疫功能 ,淋巴细胞是否回升可作为监测患者免疫功能是否重建的指标     

SARS患者外周血细胞以及APACHE Ⅱ和MODS评分的变化对预后的影响

目的:研究严重急性呼吸综合征(SARS)患者疾病进程中外周血细胞的变化以及疾病危重程度评分的变化对预后的影响.方法:选择50例SARS患者,分为SARS组(22例)及重症SARS组(28例),重症SARS组又分为存活组(14例)与死亡组(14例).对患者的外周血白细胞、淋巴细胞、血小板、APACHEⅡ(急性生理学和慢性健康评分Ⅱ)和MODS(多器官功能不全评分)的变化以及对预后的影响进行分析.结果:所有SARS患者的白细胞在疾病早期无明显变化,中期有升高趋势,晚期恢复正常;SARS组淋巴细胞未见明显下降,而死亡组则从第1周～6周,呈明显下降趋势;死亡组SARS患者在早期、晚期出现血小板下降;死亡组的APACHEⅡ评分明显高于存活组;死亡组中、晚期的MODS评分显著高于存活组.结论:SARS患者早期淋巴细胞和血小板的变化对判断预后有一定的意义,下降预示着病情危重,动态下降则预示着死亡危险的增加;动态评估APACHEⅡ和MODS对判断预后有着重要的意义.     

外周血淋巴细胞在判断传染性非典型肺炎病情中的临床意义

目的　探讨外周血淋巴细胞在判断传染性非典型肺炎 (严重急性呼吸综合征 ,SARS)病情中的临床意义。方法　回顾性分析 83例SARS患者的临床资料 ,比较入院时外周血淋巴细胞在不同病情SARS患者中的表现 ,以及与患者住院时间和X线病灶吸收时间之间的关系。结果　淋巴细胞计数 <0 8× 10 9/L者重症占 89% ,普通型占 11% ,两者差异有显著性 (P <0 0 1) ,<0 8× 10 9/L者在出现呼吸功能障碍以外并发症患者中占 6 4 % ,而在无呼吸功能障碍以外并发症患者中占 2 8% ,差异有显著性 (P =0 0 0 1) ;淋巴细胞计数 <0 8× 10 9/L者在住院时间≥ 30d患者中占 5 7% ,而在住院时间 <30d患者中占 38% ,差异无显著性 (P >0 0 5 ) ;X线病灶吸收时间 :淋巴细胞计数 <0 8× 10 9/L者平均为 (17 73± 6 30 )d ,淋巴细胞计数≥ 0 8× 10 9/L者平均 (15 77± 5 83)d ,差异无显著性(P >0 0 5 )。结论　SARS患者近半数外周血淋巴细胞下降 ,重症患者更为明显 ,可能与其出现细胞免疫功能损伤及损伤程度有关 ;SARS患者外周血淋巴细胞计数下降者更容易出现呼吸功能障碍以外并发症 ;SARS患者外周血淋巴细胞计数与其住院时间、X线病灶吸收时间之间没有明显关系。     

严重急性呼吸综合征682例临床分析

目的探讨严重急性呼吸综合征(severe acute respiratory syndrome,SARS)的临床特点.方法回顾性统计分析北京小汤山医院收治的682例SARS临床病例资料.结果682例SARS患者的年龄分布于13～76岁.356例(52.2%)有明确的接触史,有171例(25.1%)发病前曾到过医院.677例(99.3%)患者出现发热,5例患者体温正常.其它主要症状包括咳嗽(44.3%)、气促(12.2%)、腹泻(8.9%);外周血白细胞计数正常或降低占87.4%;ALT和CPK升高的比例分别为16.4%、2.5%;全部患者都有肺部病变,累及双肺占69.8%;死亡6例.结论该病有较强的传染性,医院是重要的传播场所;发热、咳嗽、胸片异常及外周血白细胞正常或降低是该综合征的主要临床特点.     

SARS合并多器官功能不全患者的治疗建议方案

严重急性呼吸综合征 (severeacuterespiratorysyndrome ,SARS)具有急性起病、传染性强、易感人群普遍、传播快、病死率高的临床特点。SARS发病人群以青壮年为主 ,但死亡者以老年人为主。通过对SARS死亡病例的分析发现 ,70 %～ 10 0 %伴有肺外器官功能改变 ,70 .9%伴发其它基础疾病 ,30 %为≥ 6 5岁的老年人。因此 ,患有多种基础疾病的老年SARS患者可能因肺部感染启动老年多器官功能不全(multipleorgansdysfunctionsyndromeintheelderly ,MODSE)或老年多器官衰竭 (multipleorgansfailureintheelderly ,MOFE)而引起死亡。但是 ,目前…     

肺表面活性物质治疗急性呼吸窘迫综合征

急性呼吸窘迫综合征(ARDS)是严重的呼吸危重症,也是SARS导致死亡的重要原因,目前尚无有效治疗方法,国外报告病死率高达45%～92%.肺表面活性物质(PS)的异常在ARDS呼吸衰竭的发生上起着关键性作用.由于PS在新生儿呼吸窘迫综合征(RDS)治疗上的成功,人们想到用PS来治疗ARDS,本文介绍这方面近年的进展.     

ARDS流行病学现状

急性呼吸窘迫综合征(Acte respiratory distress syndrome，ARDS)以进行呼吸困难和顽固性氧血症为特征的急性呼吸衰竭，1967年由Ashbaugh等首次提出。目前认为，ARDS是全身炎症反应综合征(SIRS)在肺部失控的结果，也是多器官功能障碍综合征(MODS)在肺部的表现，病理上主要表现为肺内急性炎症，广泛的肺泡-毛细血管膜损伤，     

急性呼吸窘迫综合征误诊一例

急性呼吸窘迫综合征是指非心源性的各种肺内外致病因素导致的肺实质急性弥漫性损伤、严重的急性缺氧性呼吸衰竭,临床表现为急性进行性呼吸困难,顽固性低氧血症及肺部弥漫性浸润.病情进展快,患者多死于低氧血症或MODS.现将本院最近误诊ARDS 1例抢救经验报告如下.     

Value of D-Dimers in patients with acute aortic dissection

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.     

Research of combined liver-kidney transplantation model in rats

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.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

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.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

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.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

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.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

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.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

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.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

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.