84例急性重症胰腺炎并发ARDS的观察及护理

重症胰腺炎(severe acute pancreatitis,SAP)常合并多脏器损害,其中急性呼吸窘迫综合征(ARDS)是最严重、最常见的并发症之一,死亡率很高,有文献报道高达50％。我科1997年8月-2002年8月共收治重症胰腺炎84例,并发ARDS 21例,治愈13例,死亡8例,死亡率为38％,显著低于文献报道。现将其护理体会报告如下。     

急性呼吸窘迫综合征预后的影响因素探讨

目的探讨影响急性呼吸窘迫综合征(ARDS)预后的因素。方法对我院呼吸内科重症监护室(R ICU)30例ARDS患者性别、年龄、基础疾病、诱发因素(肺源性、肺外源性)、合并下呼吸道感染、行机械通气、并发多器官功能障碍综合征(MODS)、发病至确诊时间、APACHEⅡ评分、氧合指数(PaO2/F iO2)、C-反应蛋白(CRP)、血清白蛋白(ALB)、血尿素氮(BUN)等因素与其预后的关系行单因素分析。将单因素分析有显著性意义的变量分级并赋值,采用多因素Logistic回归筛选预后因素。结果 30例ARDS患者死亡20例,存活10例。患者的病死率与性别、年龄、诱发因素、合并下呼吸道感染、行机械通气无关。死亡组与存活组患者的APACHEⅡ评分、PaO2/F iO2、CRP、ALB基础值(治疗前)比较差异均无显著性(P>0.05)。既往患基础病、并发MODS、发病至确诊时间长、CRP升高及确诊时BUN指标异常是ARDS患者死亡的独立危险因素。结论既往患基础疾病、并发MODS、发病至确诊时间长、CRP升高与ARDS患者死亡密切相关。     

严重胸部创伤并发急性呼吸窘迫综合征的机械通气治疗策略

目的　总结和探讨严重胸部创伤并发急性呼吸窘迫综合征 (ARDS)的机械通气治疗方法。方法　分两个阶段回顾分析 94例严重胸部创伤并发ARDS的呼吸机应用及综合治疗过程。结果　本组患者死亡 8例 ,死亡率 8 5 %。 1995年 1月后低容量机械通气的呼吸机使用时间为 6 8± 2 2天(P <0 0 5 ) ,死亡 3例 ,死亡率 5 7% ,较 1995年前低。结论　早期诊断、及时治疗是治疗ARDS的关键 ,合理的机械通气是治疗的有效方法 ,小潮气量、低呼气末正压通气及随时调整通气模式和呼吸参数可显著提高机械通气的治疗效果     

重型颅脑损伤合并急性呼吸窘迫综合征的治疗经验

目的总结重型颅脑损伤(GCS<8分)合并急性呼吸窘迫综合征(ARDS)的治疗经验。方法对36例重型颅脑损伤合并ARDS的资料进行回顾分析。结果全部病人均采用早期机械通气+呼吸末正压通气(PEEP),22例存活,14例死亡,抢救成功率61.11%。结论决定重型颅脑损伤合并ARDS患者预后的主要因素是早期诊断、早期治疗和机械通气。PEEP是治疗ARDS有效的通气方式。     

重症胰腺炎合并急性呼吸窘迫综合征患者的护理分析

目的探讨重症胰腺炎合并急性呼吸窘迫综合征患者的护理措施。方法对我院30例重症胰腺炎合并急性呼吸窘迫综合征患者采取精心治疗及护理。结果所有患者呼吸窘迫症状得到改善。21例行气管插管或气管切开。予呼吸机辅助通气,21例治疗7～40d痊愈出院,9例经抢救无效死亡,死亡原因为全身严重感染和多脏器功能不全,死亡率为30．0％。结论重症胰腺炎合并急性呼吸窘迫综合征病情凶险变化快,早期诊断、早期治疗及早期精心护理是降低其病死率的关键。     

重症急性胰腺炎合并上消化道出血的诊治

目的：探讨重症急性胰腺炎合并上消化道大出血的诊断和治疗。方法：回顾分析1998—05—2005—06我院收治的18例重症急性胰腺炎并发上消化道出血患者的临床资料。结果：急性胃黏膜病变出血13例，保守治疗10例，死亡4例；手术治疗3例，死亡1例。消化性溃疡手术治疗2例，死亡1例；胃镜下止血1例，止血成功。胃底静脉曲张出血2例病人经手术切除脾脏后治愈。结论：对于重症急性胰腺炎合并上消化道大出血的患者的治疗应在保守治疗的基础上积极手术治疗，但手术治疗应简单有效，对于区域性门脉高压引起的出血应选择脾切除手术。     

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。     

机械通气下支气管肺灌洗治疗重症呼吸衰竭

机械通气是救治呼吸衰竭的重要方法,但在临床使用中患者的呼吸道分泌物难以消除,影响呼衰和抗感染的治疗效果.支气管肺灌洗可有效地清除支气管分泌物,减轻气道炎症.我们对11例重症呼衰患者在机械通气下行支气管肺灌洗局部治疗,取得满意的疗效,报告如下. 1 资料与方法 1.1 临床资料:男8例,女3例;年龄34～81岁,平均(55.5±13.6)岁.基础疾病为慢性阻塞性肺疾病(COPD),重症哮喘,肺部感染,胰腺炎,呼吸道烧伤等.Ⅰ型呼衰5例(急性呼吸窘迫综合征:ARDS),Ⅱ型呼衰6例.均行气管切开机械通气治疗,ARDS者给予PEEP.     

生长抑素治疗重症急性胰腺炎的临床研究

目的:评价生长抑素在重症急性胰腺炎治疗中的疗效。方法:将57例重症急性胰腺炎患者分为生长抑素治疗组(30例)和对照组(27例),分析两组治疗后症状、体征变化情况及并发症、住院日数和死亡率等。结果:生长抑素治疗可缩短住院时间,减少并发症,降低病死率。结论:生长抑素治疗重症急性胰腺炎有良好的疗效。     

内科综合治疗急性重症胰腺炎临床体会

目的:探讨重症急性胰腺炎的治疗方法和效果.方法:回顾并分析2005-01～2009-01我科收治的29例重症急性胰腺炎患者的治疗方法和效果.结果:全部患者经使用生长抑素和全肠外营养(TPN)治疗,28例好转出院,其中合并胆道梗阻3例,1例给手术治疗,1例合并糖尿病、心肺疾病死亡.结论:生长抑素治疗重症急性胰腺炎具有较好的效果.     

Adolescent acute patellardislocation

Acute patellar dislocation is a traumatic and memorable event. The normal patellofemoral joint is controlled by a delicate balance of static and dynamic forces and structural congruity for effective function. Imbalance of the forces or congruity results in dislocation. Current work on osteochondral and chondral lesions that are radiographically silent and found at arthroscopy add new information about the frequency of articular damage. The major role of the patellofemoral ligament to normal patellar stability and the consequence of its avulsion relative to recurrent patellar instability has also been recently documented.     

Radiation-induced acute dysphagia

Purpose

Acute toxicity in head and neck (H&N) cancer patients treated with definitive radiotherapy (RT) has a crucial role in compliance to treatments. The aim of this study was to correlate doses to swallowing-associated structures and acute dysphagia.

Methods

We prospectively analyzed 42?H&N cancer patients treated with RT. Dysphagia (grade ≥ 3) and indication for percutaneous endoscopic gastrostomy (PEG) insertion were classified as acute toxicity. Ten swallowing-related structures were considered for the dosimetric analysis. The correlation between clinical information and the dose absorbed by the contoured structures was analyzed. Multivariate logistic regression method using resampling methods (bootstrapping) was applied to select model order and parameters for normal tissue complication probability (NTCP) modelling.

Results

A strong multiple correlation between dosimetric parameters was found. A two-variable model was suggested as the optimal order by bootstrap method. The optimal model (Rs = 0.452, p < 0.001) includes V₄₅ of the cervical esophagus (odds ratio [OR] = 1.016) and D_mean of the cricopharyngeal muscle (OR = 1.057). The model area under the curve was 0.82 (95% confidence interval 0.69–0.95).

Conclusion

Our results suggested that the absorbed dose to the cricopharyngeal muscle and cervical esophagus might play a relevant role in the development of acute RT-related dysphagia.

     

Lisinopril-induced acute pancreatitis

Drugs are an uncommon but well-recognised cause of acute pancreatitis and new agents of drug-induced pancreatitis continue to be reported. We describe only the 10th reported case of lisinopril-induced pancreatitis in a young female patient.     

Imaging acute pancreatitis

Acute pancreatitis is a common condition (thought to be increasing in incidence worldwide), which has a highly variable clinical course. The radiologist plays a key role in the management of such patients, from diagnosis and staging to identification and treatment of complications, as well as in determining the underlying aetiology. The aim of this article is (i) to familiarise the reader with the pathophysiology of acute pancreatitis, the appearances of the various stages of pancreatitis, the evidence for the use of staging classifications and the associated complications and (ii) to review current thoughts on optimising therapy.The International Symposium on Acute Pancreatitis (AP) in Atlanta defined AP as inflammation of the pancreas with variable secondary involvement of remote organs [1]. The incidence ranges from 5 to 80 per 100 000, with the highest incidence occurring in the USA and Finland [2]. In the UK, the incidence of AP requiring hospital admission has doubled in the past three decades, from 4.9 per 100 000 (1963–1974) to 9.8 per 100 000 (1987–1998) [3]. The severity of AP is highly variable; it can range from mild and self-limiting to fulminant. The latter occurs in 20–30% of all cases of AP and is associated with a protracted clinical course, often complicated by sepsis, multiorgan failure and a mortality rate of up to 50% [1]. It is widely accepted that these two subgroups are separate entities; mild pancreatitis (also known as oedematous AP) rarely progresses to the fulminant necrotising subtype. Clearly, the prognosis and management for these two subgroups of AP are very different. In mild oedematous AP, management is primarily supportive, whereas necrotising AP usually requires care in an intensive unit setting with a combination of surgical and radiological interventions.The commonest aetiological factors for AP are cholelithiasis and alcohol; the former is more prevalent in southern Europe, whereas alcohol-induced pancreatitis is more common in northern Europe. Alcohol is also known to be associated with a higher incidence of acute fulminant pancreatitis [4]. Other less common causes for AP include iatrogenic causes such as endoscopic retrograde cholangiopancreatography (ERCP), abdominal surgery, trauma, congenital pancreatic divisum, hyperlipidaemia, hypercalcaemia and various infections.The initial diagnosis for AP is made clinically from signs and symptoms of an acute abdomen and an elevation of pancreatic enzymes, such as amylase and lipase, in the blood or urine. Once the diagnosis is confirmed, it is usually evident clinically within the first 48–72 h as to whether the condition will be mild or fulminant [5]. Mild pancreatitis is characterised by minimal or absent systemic organ dysfunction and tends to abate by the third day. In contrast, fulminant pancreatitis demonstrates progressive clinical symptoms and signs with associated metabolic and multiorgan dysfunction. Since the 1980s, many clinical scoring systems, such as Ranson''s criteria [6] and the APACHE II (Acute Physiology and Chronic Health Evaluation) score [7], have been used to provide an objective assessment of the severity of pancreatitis.     

Association of manifestations of acute stress disorder and acute cerebrovascular disease

The study comprised 32 patients who were with clinically, laboratory and neuroradiologically confirmed associated occurrence of acute stress disorder and stroke. All the examinees were civilians exposed to war stress, so it could be directly designated as the cause of acute stress disorder and indirectly denoted as a trigger of cardiovascular, endocrine and cerebrovascular disorder that brought to stroke.     

Potential role of imaging for assessing acute pancreatitis-induced acute kidney injury

Acute kidney injury (AKI) is a common complication of acute pancreatitis (AP) that is associated with increased mortality. Conventional assessment of AKI is based on changes in serum creatinine concentration and urinary output. However, these examinations have limited accuracy and sensitivity for the diagnosis of early-stage AKI. This review summarizes current evidence on the use of advanced imaging approaches and artificial intelligence (AI) for the early prediction and diagnosis of AKI in patients with AP. CT scores, CT post-processing technology, Doppler ultrasound, and AI technology provide increasingly valuable information for the diagnosis of AP-induced AKI. Magnetic resonance imaging (MRI) also has potential for the evaluation of AP-induced AKI. For the accurate diagnosis of early-stage AP-induced AKI, more studies are needed that use these new techniques and that use AI in combination with advanced imaging technologies.     

MRI in acute poliomyelitis

MRI can be used in the diagnosis of anterior horn infection and for assessing the extent of disease. There are no specific MRI signs to differentiate between the various possible pathogens. This is demonstrated in the present case of poliomyelitis, in which MRI of the spine played an important role in establishing the diagnosis.