营养支持疗法在 ICU 重症患者中的应用

目的：分析营养支持疗法在ICU重症患者中的应用效果。方法将100例ICU重症患者随机分为试验组与对照组各50例。对照组患者采用常规抗感染、纠正水电解质紊乱、吸氧等治疗,试验组在对照组的基础上加用营养支持疗治疗。比较2组机械通气持续时间、淋巴细胞计数、血清白蛋白水平和并发症发生情况。结果试验组机械通气持续时间短于对照组,淋巴细胞计数、血清白蛋白水平明显高于对照组,差异均有统计学意义（P＜0．05）。试验组并发症发生率低于对照组,差异有统计学意义（ P＜0．05）。结论营养支持疗法在ICU重症患者中具有良好的应用效果,能有效改善淋巴细胞、血清白蛋白水平,缩短机械通气持续时间,减少并发症发生,值得临床推广应用。     

比较肠内营养和肠外营养支持治疗对重症患者的影响

目的对重症患者进行肠内营养(EN)或肠外营养(PN)支持治疗,比较营养代谢状况、留住ICU的时间、并发症发生率,探讨营养支持治疗对重症患者的影响。方法将2010年8月至2011年8月期间入住我院重症医学科(ICU)符合纳入标准的70例重症患者按照1∶1的设计随机分为肠内营养疗法组(EN组)与肠外营养疗法组(PN组),两组皆于入住后第1天开始给予EN或PN支持治疗。于入住当天及第8天分别检测记录各项营养状态指标。同时对患者留住ICU的时间及临床并发症进行比较。结果两组入住第8天的血清白蛋白、血红蛋白及体质量指数皆较入住当天下降(P<0.05),EN组入住第8天的前白蛋白较入住当天有明显升高(P<0.05),PN组入住第8天的前白蛋白与入住当天比较差异无统计学意义。EN组血清白蛋白、前白蛋白、血红蛋白及体质量指数的下降幅度明显低于PN组(P<0.05);EN组留住ICU时间明显低于PN组(P<0.05);EN组留住ICU期间的并发症发生率低于PN组(P<0.01)。结论肠内营养能更加有效地改善重症患者的营养状况,减少ICU留住时间,降低其留住ICU期间的并发症发生率。     

ICU重症患者应用营养支持疗法的临床观察

目的 探讨ICU重症患者应用营养支持疗法的临床效果.方法 收集整理2010年5月至2011年5月期间我院收治的80例ICU重症患者,将其分为治疗组和对照组各40例,治疗组患者使用常规治疗联合营养支持疗法,给予患者补充能量、维生素及矿物质;对照组患者仅使用常规治疗.结果 治疗组患者的治疗情况明显优于对照组患者,两组患者的指尖的机械通气持续时间、血清白蛋白、淋巴细胞计数和体重指数均优于对照组,P<0.05,差异有统计学意义,各种并发症的情况少于对照组患者,治疗效果当中,营养支持的治疗组患者效果更佳.结论 在治疗ICU重症患者的时候,配合营养支持疗法可以在很大程度上提高患者的生存、康复几率,与常规治疗相比,加入营养支持疗法可以在有效的提高患者的康复效果,值得在临床过程中进行推广使用.     

循证护理对降低ICU重型颅脑外伤患者并发症的作用分析

目的探究对ICU重型颅脑外伤患者实施循证护理的效果及降低并发症发生率的影响,为临床提供指导。方法随机将2014年1月～2017年12月我院94例ICU重型颅脑外伤患者分为观察组(47例,应用循证护理)、对照组(47例,应用常规护理)。对比两组患者的机械通气时间、ICU入住时间、平均住院时间、急性生理及慢性健康评分、格拉斯哥评分、满意度及并发症发生率。结果观察组机械通气时间、ICU入住时间、平均住院时间均短于对照组,P 0.05;观察组满意度(97.87%)高于对照组(80.65%),P 0.05;观察组患者并发症发生率(8.51%)低于对照组(25.53%),P 0.05;观察组干预后急性生理及慢性健康评分低于对照组,且格拉斯哥评分高于对照组,P 0.05。结论对ICU重型颅脑外伤患者实施循证护理具有较佳的效果,可有效减少并发症发生,缩短ICU入住时间、机械通气时间及住院时间,并可在一定程度上改善患者昏迷程度,值得实践。     

术后ICU机械通气患者应用机械振动排痰护理改善肺部并发症的效果观察

目的:探究术后重症监护病房(ICU)机械通气患者应用机械振动排痰护理改善肺部并发症的效果。方法:选取86例术后入住ICU行机械通气患者为受试对象,随机数表法分为观察组与对照组各43例。对照组患者实施人工扣背排痰护理干预,观察组患者则采取机械振动排痰护理进行干预,比较两组患者脱机时间、抗生素使用时间、住ICU时间及肺部并发症改善效果差异。结果:观察组患者脱机时间、抗生素使用时间、住ICU时间均明显少于对照组(P0.05);观察组患者肺部并发症改善有效率明显高于对照组(P0.05)。结论:术后ICU机械通气患者应用机械振动排痰护理可有效缓解其肺部并发症,对预后恢复有利。     

护理干预在ICU重症患者呼吸机相关性肺炎预防中的应用效果

目的:总结分析护理干预在ICU重症患者呼吸机相关性肺炎预防中的应用效果。方法:选择2017年11月~2018年11月期间某院ICU收治的70例应用呼吸机辅助通气治疗的重症患者为研究对象,随机分为观察组和对照组各35例,对照组接受常规护理措施,观察组应用护理干预措施,观察比较两组患者的临床效果。结果:观察组机械通气时间(105.2±5.2)h及VAP发生率20.00%明显低于对照组机械通气时间及VAP发生率42.86%,组间差异具有统计学意义(P<0.05)。结论:护理干预措施不仅能明显缩短ICU重症患者机械辅助通气时间,还能有效预防相关性肺炎发生,值得推广使用。     

集束化护理干预对糖尿病ICU机械通气患者呼吸机相关性肺炎的预防作用

目的 探讨集束化护理干预对糖尿病重症监护室(ICU)机械通气患者呼吸机相关性肺炎(VAP)的预防作用。方法 选择蚌埠医学院第一附属医院重症医学科2016年6月至2019年10月收治的糖尿病ICU机械通气患者60例为研究对象,按照随机数字表法分为对照组与观察组,每组各30例,对照组接受常规护理,观察组在对照组基础上加集束化护理干预,对两组患者VAP发生率、机械通气时间、ICU住院时间、临床肺部感染积分(CPIS)、血氧饱和度(SpO2)、空腹血糖进行比较。结果 观察组患者VAP发生率为6.67%,明显低于对照组的26.67%,差异有统计学意义(P 0.05);观察组患者机械通气时间、ICU住院时间均较对照组短,差异有统计学意义(P 0.05);观察组干预后SpO2明显高于对照组,CPIS评分、空腹血糖低于对照组,差异有统计学意义(P 0.05)。结论 集束化护理干预可有效预防糖尿病ICU机械通气患者VAP,还可缩短患者ICU住院时间,改善血氧饱和度及空腹血糖,值得推广。     

eCASH理念下早期康复护理对ICU重症肺炎机械通气患者预后的影响

目的 探讨对ICU重症肺炎机械通气患者实施以患者为中心的舒适化浅镇静策略（e CASH）理念下早期康复护理对预后的影响。方法 纳入我院2022年1～12月收治的64例ICU重症肺炎机械通气患者,随机进行分组,各32例,对照组予以ICU常规护理,观察组基于对照组予以e CASH理念下早期康复护理,详细统计两组机械通气时间、入住ICU时间,应用舒适状况量表（GCQ）评估两组脱机时舒适度,应用ICU急性生理及慢性健康状况评分Ⅱ（APACHEⅡ）评估两组预后效果,监测两组干预前后动脉血气分析指标,观察两组干预前后T淋巴细胞亚群变化,对比并发症发生率。结果 比较对照组,观察组机械通气时间、入住ICU时间更短,GCQ评分更高,APACHEⅡ评分更低（P <0.05）;比较对照组,干预后,观察组Pa O2水平更高,Pa CO2、NT-pro BNP水平更低（P <0.05）;比较对照组,干预后,观察组CD4+、CD4+/CD8+水平更高,CD8+水平更低（P <0.05）;比较对照组,观察组并发症发生率更低（P <0.05）。结论 对ICU重症肺炎机械通气患者实施以患者为中心...     

早期肺康复方案对ICU重症肺炎机械通气患者脱机及并发症的影响

目的 探究早期肺康复分级方案对ICU重症肺炎机械通气患者脱机及并发症的影响。方法 选取我院ICU于2021年10月1日～2022年9月30日入住的100例重症肺炎机械通气患者,按照电脑随机法划为两个组别,观察组、对照组,各50例。对照组采用常规康复干预方案,观察组则采用早期肺康复分级方案。比较两组干预前后序贯器官衰竭检测(SOFA)评分、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)评分;机械通气时间与ICU住院时间;并发症(呼吸机相关肺炎、谵妄、深静脉血栓、压力性损伤、ICU获得性衰弱)发生率。结果 APACHEⅡ评分、SOFA评分两组干预后均较干预前下降,且观察组评分均较对照组的低(P <0.05);机械通气时间与ICU住院时间,观察组均较对照组的短(P <0.05);观察组并发症发生率为10.00%低于对照组的38.00%(P <0.05)。结论 ICU重症肺炎机械通气患者应用早期肺康复分级方案可减轻病情严重程度,显著缩减机械通气时间、ICU住院时间,明显降低并发症发生风险,值得在临床上推广。     

ICU人工气道患者的集束化护理干预效果观察

目的探讨分析集束化护理干预在临床实践中对于ICU人工气道患者的治疗效果。方法随机选取2010年至2013年在本院ICU病房建立人工气道患者120例,本实验研究采取的是随机、对照的研究方法,将这些患者随机分为两组,其中实验组60例患者,对照组60例患者;在进行手术之后,对实验组患者进行集束化护理干预,对于对照组患者进行常规护理;对于两组患者手术之后ICU住院时间、机械通气时间及相关并发症发生率等情况进行比较。结果两组患者术后比较发现,对照组的患者ICU入住时间长,机械通气时间长,相关并发症发生率高,两组的实验数据差异明显,P〈0.05,差异具有统计学意义。结论 ICU人工气道患者在术后进行集束化护理干预可以很大程度上减少并发症的发生率,对于患者的恢复有很大的帮助,值得临床上大力的推广。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Trichinellosis in immigrants in Switzerland

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.