新型甲型H1N1流感危重症存活和死亡病例的临床特点分析

Objective To understand the clinical features of critically ill patients with pandemic 2009 influenza A(H1N1)and investigate the risk factors associated with death cases. Methods The clinical features of 55 critically ill patients with pandemic 2009 influenza A(H1N1)viral infection hospitalized at Beijing Ditan Hospital from October 3 to December 15,2009 were retrospectively analyzed,and a comparative analysis was performed on the manifestations of the survival and the death groups of patients. Results There were 31 males and 24 females.The age ranged from 10 months to 84 year old,and the mean(SD)was 38(20)year old.The critically ill cases were more in patients under age 65(48/55),with obesity(33/49),with underlying diseases(26/49),and pregnancy(6/24).Both the survivors and non-survivors of patients had high fever,cough,sputum(some sputum with blood),dyspnea,r(a)les of both lungs fields.and all further developed severe pneumonia.The patients also showed respiratory failure(54/55)and ARDS(26/55).All of them received oseltamivir therapy,and 38 patients received mechanical ventilation and 30 were giyen steroid therapy.Secondary infection occurred in 27 cases.and ventilatorassociated pneumonia happened in 10 patients.In the early stage of onset,C-reactive protein(CRP) increased [ (131 ± 130)mg/L] and low counts of T lymphecytes were present [ CD4+ , CD8+T was (217 ±139)/μl and (162 ± 82)/μl]. With the progress of disease, the non-survival cases had persistently increased CRP and the counts of T lymphocytes did not recover, while the secondary fungal infection was significantly higher than in the survivor cases (P <0. 05). By using BMI, underlying diseases, ARDS, the day of Oseltamivir initiated, steroid therapy, following bacterial and fungal infection as variables through logistic regression analysis, it was shown that higher BMI and following fungal infection were associated with higher fatal risks ( OR was 6. 512, 19. 631 respective0ly, both of P value was low than 0. 05 ). There was no death case who received oseltamivir treatment within 48 hours of onset of disease. Conclusions Critical illness in pandemic 2009 influenza A (H1N1)was associated with patients under age 65, with obesity,underlying diseases, and pregnancy. Persistently increased CRP and lower counts of T lymphocytes were associated with unfavorable prognosis. The patients with higher BMI and secondary fungal infection had higher fatal risks. Oseltamivir treatments at early stage would probably reduce mortality.     

重型颅脑损伤患者ICU早期监护对预后的影响

目的探讨重型颅脑损伤患者ICU早期监护对预后的影响。方法 2009-05～2011-05,我院诊治的60例重型颅脑损伤患者,随机分为2组,对照组(常规监护组)和观察组(ICU早期监护组),回顾性分析其临床资料,总结ICU早期监护对预后的影响。结果与对照组相比,观察组治愈率(76.7%)明显提高,伤残率(16.7%)和病死率(6.6%)明显降低,P<0.05,差异具有统计学意义。对照组有19例患者出现并发症,而观察组有5例患者出现并发症。结论对于重型颅脑损伤患者,ICU早期监护明显提高临床治疗效果,有利于患者预后,值得临床广泛推广。     

注射用哌拉西林/舒巴坦治疗泌尿系统感染的疗效评价

摘 要 目的：比较哌拉西林/舒巴坦与美洛西林/舒巴坦治疗急性细菌性中重度泌尿系统感染的临床疗效,评价其有效性和安全性。方法：76例急性细菌性中重度泌尿系统感染患者随机分为试验组和对照组各38例, 分别给予哌拉西林/舒巴坦2.5 g或美洛西林/舒巴坦.5 g,溶于0.9%氯化钠注射液250 ml,ivd,q8h或q12h,1个疗程为7 d。连续治疗2个疗程后对两组临床疗效、细菌学疗效、药品不良反应等进行综合评价。结果：试验组和对照组痊愈率分别为57.9%和47.4%,总有效率分别为84.2%和78.9%。两组细菌清除率分别为89.2%和82.5%,治疗后细菌转阴率分别为89.5%和86.9%;不良反应发生率均为2.63%。两组各项评价指标比较,差异均无统计学意义（P>0.05）。结论：哌拉西林/舒巴坦对于治疗急性细菌性中重度泌尿系统感染安全有效。     

药源性尿潴留

药源性尿潴留系指临床上应用某些药物后使尿液滞留于膀胱而不能排出。表现为下腹胀痛、膨隆,膀胱极度充盈。现就引起尿潴留的药物简介如下。 抗菌药物 林可霉素、氨苄西林、培氟沙星、复方磺胺甲(口恶)唑、呋喃妥因、氯霉素、甲硝唑、泻痢停(主含磺胺甲(口恶)唑)等。林可霉素致尿潴留的发生率0.9％,一般在用药后2—4天就发生尿潴留,停药或对症治疗后可恢复正常。     

分子吸附再循环系统治疗重症肝病的护理

分子吸附再循环系统(MARS)是一种用于危重肝衰竭患治疗的新型人工肝技术，本目的旨在探讨MARS人工肝治疗不同于血浆置换等常规人工肝治疗的特殊护理方法。通过对15例危重肝衰竭患42次MARS人工肝治疗的护理，总结出MARS人工肝治疗的健康教育、体外循环通路的建立及维护、管路预充、体外循环及血流动力学监护、感染并发症的预防和处理、防治出血并发症等系列护理要点。     

高效液相色谱法测定尼莫地平含量

 目的：建立高效液相色谱法测定尼莫地平片的含量及均匀度。方法：色谱柱ODS-C₁₈柱，流动相为甲醇∶水（4∶1），检测波长为238 nm。结果：在2.5～32 μg·ml^-1浓度范围内呈良好的线性关系，平均回收率为99.82%,RSD为0.67%。结论：该法专属性强，操作简便，结果准确。     

碳糊电极阳极吸附伏安法测定雷贝拉唑

目的:考察乳癖消巴布膏皮肤用药的安全性.方法:用健康家兔分别进行完整与破损皮肤的皮肤刺激性试验;用健康豚鼠进行皮肤过敏试验;用健康大鼠进行慢性经皮毒性试验.结果与结论:乳癖消巴布膏对家兔无皮肤刺激性.对豚鼠无致敏性,对大鼠无经皮毒性.     

复方蜥蜴散对慢性萎缩性胃炎大鼠模型胃黏膜细胞凋亡的影响

目的:观察以终末脱氧核糖核酸转移酶介导的原位缺口末端标记(terminal deoxynucleotidyl transferase-me-diated dUTP nick end labeling,TUNEL)技术检测复方蜥蜴散治疗后对CAG大鼠模型胃黏膜细胞凋亡的影响。方法:将90只SD雄性大鼠随机分为正常组,模型组,复方蜥蜴散大、中、小剂量组及维酶素组。除正常组以外,均采取55℃热盐水、2%水杨酸、20mmol/L脱氧胆酸钠3个致萎缩因素配合饥饱失常造成大鼠CAG模型,分别运用复方蜥蜴散大、中、小剂量及维酶素治疗,记录各组大鼠体重变化,以TUNEL法测定各组大鼠胃黏膜细胞凋亡率。结果:造模后大鼠体重增加缓慢,与正常组大鼠相比体重明显减轻(P<0.01)。治疗4周后,复方蜥蜴散大剂量组较模型组体重略有增加(P<0.05)。与正常组相比,模型组凋亡细胞指数显著升高(P<0.01);与模型组相比,各治疗组胃黏膜细胞凋亡率显著升高(P<0.01);与维酶素组相比,复方蜥蜴散治疗各组胃黏膜细胞凋亡率显著升高(P<0.05);与复方蜥蜴散小剂量组比较,复方蜥蜴散大剂量组胃黏膜细胞凋亡率显著升高(P<0.01)。结论:复方蜥蜴散治疗后可使CAG模型大鼠体重增加,并且可促进胃黏膜病变细胞凋亡,阻断CAG病变细胞的增殖,从而逆转胃黏膜组织萎缩,防止CAG的发生。     

产ESBLs肺炎克雷伯菌和大肠埃希菌耐药性分析

目的分析产超广谱β-内酰胺酶（ESBLs）肺炎克雷伯菌、大肠埃希菌的耐药性，指导临床合理用药。方法采用API鉴定系统进行菌株鉴定及药敏试验。结果2种细菌ESBLs总阳性检出率为60．2％（153／254）；肺炎克雷伯菌ESBLs为60．2％（53／88）；大肠埃希菌为60．2％（100／166）；产ESBLS菌株对青霉素类和头孢类抗菌药物大多耐药，仅对美罗培南非常敏感，产ESBLS菌株对抗菌药物的耐药率高于非产ESBLs菌株。结论医院及时监测产ESBLs菌的发生率及其耐药趋势以指导临床用药至关重要。     

人工肝

人工肝 (ａｒｔｉｆｉｃｉａｌｌｉｖｅｒ)是指能够替代肝脏功能、用以治疗肝功能衰竭的体外人工器官装置。肝脏具有解毒、转化、合成和分泌等复杂的生理功能 ,其功能衰竭必然导致体内毒性产物堆积和严重的代谢紊乱 ,这一病理过程反过来又影响肝细胞再生和功能恢复 ,形成恶性循环。与肾透析 (人工肾 )曾给肾功能衰竭治疗带来的革命性变化不同 ,人工肝仅具有正常肝脏部分解毒、代谢功能 ,对肝衰竭病人只能起辅助治疗作用 ,故只能称为人工肝支持系统 (ａｒｔｉｆｉ ｃｉａｌｌｉｖｅｒｓｕｐｐｏｒｔｓｙｓｔｅｍ ,ＡＬＳＳ)。1　人工肝支持系…