ω-3脂肪酸对脓毒症病人治疗的影响

目的:探讨ω-3脂肪酸对脓毒症病人的免疫调节和抗炎作用。方法:将18例病人随机分为鱼油治疗组和常规治疗组。鱼油治疗组病人为常规治疗加鱼油,并于治疗前和治疗后第5天用流式细胞仪检测单核细胞HLA-DR表达率,同时检测炎症反应指标,包括C反应蛋白(CRP)、IL-6和肿瘤坏死因子α(TNF-α),观察病情严重程度(APACHEⅡ评分)和氧合指数(PaO2/FiO2)的变化。结果:相对于常规治疗组,鱼油治疗组病人血清CRP、IL-6和TNF-α均明显下降;氧合指数改善;单核细胞HLA-DR表达率、APACHEⅡ评分较常规治疗组无显著性差异。结论:应用ω-3脂肪酸可使脓毒症病人血清炎症介质表达减少,但对单核细胞HLA-DR的表达未见调节作用。     

低分子肝素早期治疗脓毒症临床研究

18例脓毒症患者随机分为两组,对照组进行常规抗感染、液体复苏、控制血糖、基础病因治疗等,治疗组在常规治疗基础上加低分子肝素钙0.6 ml皮下注射,1次/12 h,疗程7 d.发现治疗组治疗后APACHEⅡ评分较治疗前及对照组治疗后明显下降;治疗组住ICU时间和28 d病死率低于对照组,但无统计学差异;两组治疗前后各凝血指标均无明显改变.认为低分子肝素用于脓毒症患者临床应用安全,是一种有前景的治疗手段.     

海水淹溺致急性肺损伤兔病理学特征的实验观察

目的 新西兰兔海水淹溺致急性肺损伤(seawater drowning induced acute lung injury,SWD-ALI)时的病理学特征.方法 制作SWD-ALI的动物模型,采用半定量分析的方法对其肺组织学分析,以评价其特征.结果 SWD-ALI有不同于临床常见ALI的病理学变化:①病变多见于低垂部位.②组织学变化以肺泡隔断裂、炎细胞浸润最为常见,分布范围最广;其次是肺内出血、肺泡萎陷实变;肺泡及间质水肿相对较轻.结论 SWD-ALI的主要病理学变化为肺泡隔断裂和大量炎细胞浸润.     

老年病人术后躁动治疗失误四例临床分析

躁动是围术期病人常见并发症之一,虽然持续时间短,但危害较重.随着社会人口老龄化,老年人在住院患者中的比例越来越高.老年人因器官功能减退加上并存疾病较多,围术期躁动处理应非常谨慎.     

欧洲心脏病学会关于急性冠状动脉综合征和介入治疗术中出血的共识要点

近年来,抗血栓治疗在急性冠状动脉综合征(ACS)治疗中的应用日趋普遍和强化.包括抗血小板药物(阿司匹林、氯吡格雷)、静脉或皮下抗凝药(普通肝素、低分子肝素、磺达肝癸钠、比伐卢定),以及糖蛋白Ⅱb/Ⅲa受体阻断剂在内的多种抗血栓药物极大地改善了缺血,提高了患者的预后.目前的冠状动脉再血管化治疗已日益普及,使得疗效提高的空间已经有限,因此着力减少治疗的副作用就显得尤为重要.     

生长激素联合低热量营养对脓毒症患者的影响

目的 探讨生长激素联合低热量营养支持对脓毒症患者的影响.方法 17例患者随机分为治疗组与时照组.治疗组为低热量营养83.7kJ/(kg·d)+重组人生长激素(rhGH)(12 U/d,肌肉注射,共计7 d).对照组采用热量125.4 kJ/(kg·d)营养支持.蛋白质均为1.5g/(kg·d).于营养支持前、营养支持后第4天和第8天分别测血清白蛋白、血清转铁蛋白、血清前白蛋白浓度;血清免疫球蛋白IgA、IgG、IgM;外周血CD4+、CD8+T淋巴细胞亚群.结果 2组患者治疗前基线特征无统计学差异,治疗第8天,与对照组相比,血清前白蛋白[治疗组(0.25±0.02)g/L,对照组(0.21±0.02)g/L,P<0.05]、转铁蛋白[治疗组:(2.01±0.15)g/L,对照组(1.73±0.18)g/L,JP<0.05]均有显著改善,血清白蛋白水平[治疗组:(28.40±2.99)g/L,对照组:(26.04±3.12)g/L,P>0.05]无明显差异,免疫指标IgG[治疗组:(13.82±2.05)g/L,对照组:(10.48±1.49)g/L,JP<0.05]、IgM[治疗组:(1.80±0.44)g/L,对照组:(1.52±0.39)g/L,P<0.05]及CD4+[治疗组:(39.2±4.01)%,对照组:(34.27±4.59)%,P<0.05]均明显升高,差异有统计学意义.结论 生长激素联合低热量喂养可以增加患者的营养耐受性,同时增加蛋白质合成.改善氮平衡.     

生长激素联合低热量营养对脓毒症患者的影响

目的 探讨生长激素联合低热量营养支持对脓毒症患者的影响.方法 17例患者随机分为治疗组与时照组.治疗组为低热量营养83.7kJ/(kg·d)+重组人生长激素(rhGH)(12 U/d,肌肉注射,共计7 d).对照组采用热量125.4 kJ/(kg·d)营养支持.蛋白质均为1.5g/(kg·d).于营养支持前、营养支持后第4天和第8天分别测血清白蛋白、血清转铁蛋白、血清前白蛋白浓度;血清免疫球蛋白IgA、IgG、IgM;外周血CD4+、CD8+T淋巴细胞亚群.结果 2组患者治疗前基线特征无统计学差异,治疗第8天,与对照组相比,血清前白蛋白[治疗组(0.25±0.02)g/L,对照组(0.21±0.02)g/L,P<0.05]、转铁蛋白[治疗组:(2.01±0.15)g/L,对照组(1.73±0.18)g/L,JP<0.05]均有显著改善,血清白蛋白水平[治疗组:(28.40±2.99)g/L,对照组:(26.04±3.12)g/L,P>0.05]无明显差异,免疫指标IgG[治疗组:(13.82±2.05)g/L,对照组:(10.48±1.49)g/L,JP<0.05]、IgM[治疗组:(1.80±0.44)g/L,对照组:(1.52±0.39)g/L,P<0.05]及CD4+[治疗组:(39.2±4.01)%,对照组:(34.27±4.59)%,P<0.05]均明显升高,差异有统计学意义.结论 生长激素联合低热量喂养可以增加患者的营养耐受性,同时增加蛋白质合成.改善氮平衡.     

海水和淡水肺内灌注对兔肺损伤作用的实验观察

Objective To investigate differences in lung injury induced by seawater and freshwater perfusion in rabbits. Methods 21 New Zealand rabbits were randomly divided into the normal group (the control group), the freshwater group and the seawater group. Same amounts of seawater and freshwater were perfused in the lungs of rabbits through tracheal incubation. Changes in the indices concerning symptomatology, blood-gas, hemodynamics, tumor necrosis factor (TNF-α), interleukin 6 (IL-6), histology and lung injury were monitored 3 hours later. Then, the obtained data were analyzed statistically to see the differences in lung lesions of different animal groups. Results Blood-gas analysis, inflammatory factor measurement, lung injury score indicated that seawater and freshwater perfusion could all induce lung injury to a certain extent, and the injury induced by seawater perfusion was obviously severer(P<0.05). Conclusions Lung injury induced by seawater perfusion is severer than that by freshwater perfusion.     

分次灌注海水致兔呼吸窘迫综合征模型的建立

目的通过向兔气管插管内灌入海水，建立海水淹溺致急性呼吸窘迫综合征模型。方法14只新西兰大白兔被随机平分为C组（对照组，无任何处理）和S组（海水组，用海水灌注）。观察分次适量海水灌入气管插管后症状学、血气分析、血液动力学、血清中肿瘤坏死因子（TNF—α）和白细胞介素-6（IL-6）的变化。2h后给每组试验兔拍摄肺CT片，并观察其组织病理学变化。结果与C组相比，S组的O2和CO2指数显著降低（P〈0．01），呼吸动力学和血液动力学的情况明显恶化。TNF—α和IL-6增高，这一结果提示肺损伤发生于兔被海水灌注之后。另外，还发现模型兔有明显的肺水肿、肺泡隔断裂和炎性渗出。结论成功复制了既符合海水淹溺的实际情况，又符合国内外急性呼吸窘迫综合征诊断标准的海水淹溺致急性肺损伤动物模型。     

海水和淡水肺内灌注对兔肺损伤作用的实验观察

Objective To investigate differences in lung injury induced by seawater and freshwater perfusion in rabbits. Methods 21 New Zealand rabbits were randomly divided into the normal group (the control group), the freshwater group and the seawater group. Same amounts of seawater and freshwater were perfused in the lungs of rabbits through tracheal incubation. Changes in the indices concerning symptomatology, blood-gas, hemodynamics, tumor necrosis factor (TNF-α), interleukin 6 (IL-6), histology and lung injury were monitored 3 hours later. Then, the obtained data were analyzed statistically to see the differences in lung lesions of different animal groups. Results Blood-gas analysis, inflammatory factor measurement, lung injury score indicated that seawater and freshwater perfusion could all induce lung injury to a certain extent, and the injury induced by seawater perfusion was obviously severer(P<0.05). Conclusions Lung injury induced by seawater perfusion is severer than that by freshwater perfusion.