PA-MSHA疫苗对严重创伤患者并发肺部感染的预防作用

目的研究绿脓杆菌菌毛株(PA-MSHA)疫苗对严重创伤患者免疫功能影响和对并发肺部感染的预防作用。方法选择ICU住院严重创伤患者共55例,随机分为两组:①对照组:27例,给予常规治疗;②疫苗组:28例,除常规救治外,从入院当天给予皮下注射PA-MSHA疫苗1．0 mL,1次/d,连续注射14 d。分别在入院当天和入院第14天取静脉血测定免疫功能指标,并统计入院第14天内并发肺部感染的发生率。结果疫苗组在入院第14天时血清IgG、补体C3和C4、NK(自然杀伤细胞)活性、CD3、CD4和CD4/CD8比值均比入院当天有明显升高(P＜0．01),而对照组仅有补体C3值在入院第14天出现明显升高(P＜0．05);对照组在入院第14天内并发肺部感染发生率为44．4%,疫苗组为21．4%,疫苗组肺部感染发生率明显低于对照组(P＜0．01)。结论PA-MSHA疫苗能够明显提高严重创伤患者机体免疫功能,并且能一定程度预防肺部感染的发生率。     

补充力肽的肠外营养在危重病人中的应用价值

目的：探讨补充力肽的肠外营养在危重病人中的应用价值。方法：将22例随机分为两组，对照组：单纯给予静脉营养；力肽组：除给予静脉营养外，按1.5Ml/kg补充力肽。分别在静脉营养治疗前1d及治疗后第4、7、14天测定氮平衡、营养指标、免疫功能指标和病人耐受性指标。结果：治疗第7天后两组病人均由负氮平衡转为正氮平衡，营养指标、免疫功能指标均明显增高，但力肽组增高更明显；病人耐受性指标中，力肽组无显著变化而对照组出现血葡萄糖和总胆红素升高。结论：补充力肽比单纯肠外营养更能明显改善危重病人的营养支持和免疫功能的效果，提高病人的耐受性。     

疼痛复合液骶管阻滞疑过敏性休克1例

1病例资料男性,53岁,因右侧腰、臀、腿疼痛1个月来院就诊。门诊检查：一般情况良好,右侧直腿抬高试验20°,平卧挺腹试验阳性;外院CT检查示L5～S1椎间盘突出,右侧神经根受压。病人否认有药物过敏史。     

硝酸甘油致窦性心动过缓1例

硝酸甘油应用于临床已 10 0余年 ,对心绞痛、心肌梗死治疗效果明显 ,且副作用少 ,国内外有关应用硝酸甘油时引起窦性心动过缓 (简称窦缓 )报道较少 ,作者将所遇 1例静脉滴注时发生病例报告如下。1　临床资料患者男性 ,44岁 ,因突发心前区疼痛半小时来我院急诊 ,2周前曾有相似发作史。检查心电图Ⅱ、Ⅲ、ａＶＦ导联ＳＴ段明显抬高 ,数小时后血磷酸肌酸酶和肌钙蛋白升高。诊断为急性下壁心肌梗死 ,入ＩＣＵ后予硝酸甘油 10 μｇ/ｍｉｎ加入葡萄糖液静滴 ,滴入前监测心率 72次 /分 ,血压 15 /11ｋＰａ ,滴后3ｍｉｎ患者感头胀 ,4ｍｉｎ时出现阵…     

绿幕安对多重耐药菌重症感染的治疗价值探讨

随着细菌耐药性问题日趋严重，特别是多重耐药性（multi-drug resistance，MDR）细菌感染，已成为危重症监护病房（ICU）内制约患者救治成功率的主要因素之一。作者近年通过应用绿幕安（绿脓杆菌菌毛株疫苗）来提高患者自体的细胞和体液免疫功能，从而达到治疗MDR菌感染的目的，现报告2例典型病例。     

PEEP治疗急性呼吸衰竭的临床观察与护理

目的:观察不同压力水平的PEEP对全身氧动力学的影响,探讨改善急性呼吸衰竭患者缺氧状况的最佳护理方法。方法　20例患者均经右侧颈内静脉放置Swan-Ganz导管和961型床边监护仪监测血流动力学,患者依次按PEEP为0,3.68,7.35,11.03mmHg 4种水平进行调节,用热稀释法测定4次平均后得心脏指数。同时进行血气分析研究,以观察不同压力水平的PEEP对气体交换功能和氧动力学的影响。结果 当PEEP为3.68mmHg时,PaO2开始显著增加（P<0.05）,随着 PEEP增加,PaO2逐渐升高。PaCO2在PEEP增加过程中无明显变化、血流动力学和氧动力学变化:心脏指数在PEEP为3.68 mmHg时开始下降（P<0.05）.且PEEP压力水平越高,CI下降越明显,DO2在PEEP为7.35mmHg以下变化不明显,在11.03mmHg时出现显著降低（P <0.05）。结论 PEEP治疗急性呼吸衰竭时,虽然有一定程度改善肺部氧气交换功能,但高压力水平的PEEP使用反而会使DO2下降,所以临床上在使用PEEP治疗时,应适当补充血容量,应用正性心肌药物,使心脏指数增加。以改善患者缺氧情况,同时应根据患者生命体征、中心静脉压、末梢血氧饱和度的变化选择最佳PEEP。     

85例ICU深部真菌感染分析

随着先进创伤性诊疗技术的开展和广谱抗生素和激素的使用,以及患者高龄化和病情危重复杂等因素,使临床深部真菌感染日益增多且趋向复杂化,并常导致致死性终末感染[1]。而且随着临床抗真菌药物的运用,真菌耐药性也越来越严重[2]。真菌感染的临床表现往往不典型,早期与细菌感染鉴别非常困难,为了进一步认识深部真菌感染,将2004年10月至2005年10月间长征医院ICU内85例深部真真菌感染患者临床资料总结如下。1资料与方法1.1一般资料收住ICU的危重症患者并发深部真菌感染85例,男性52例(61.8%),女性33例(38.82%);年龄15～90岁,(52.35±5.45)岁。…     

胸腺肽α1对脓毒症小鼠CD4+CD25+Foxp3+T细胞的干预效应

严重脓毒症和脓毒症休克,是危重患者最主要的死因[1],同时抗菌素滥用导致的负面影响日益严重[2-3].近年来发现免疫紊乱是脓毒症发病的重要机制,但对免疫调节治疗却充满争议[4].胸腺肽α1(thymosin-α1,Tα1)具有强大的免疫调节活性[5],已越来越多地应用于危重患者[6];调节性T细胞(以下简称Treg)与脓毒症免疫紊乱密切相关,其中最具代表性的是CD4+CD25+Foxp3+T细胞[7-8].     

重症监护病房铜绿假单胞菌医院感染病例对照研究

目的 探讨重症监护病房(ICU)铜绿假单胞菌医院感染的危险因素,为制定医院感染的防治策略、措施提供依据.方法 采用回顾性病例对照研究和非条件Logistic多元回归分析方法,分析2002年1月至2006年12月1 950例ICU患者铜绿假单胞菌医院感染危险因素.结果 64例患者发生铜绿假单胞菌医院感染(作为感染组),发生率为3.3%.同期与感染组同一科室的37例发生大肠埃希菌医院感染患者作为对照组.单因素分析结果:使用激素、昏迷或颅脑损伤、腹部手术、有胸腹引流管、机械通气、开放气道是铜绿假单胞菌医院感染的危险因素[使用激素:相对比值比(OR)=3.364,95%可信区间(95%CI)1.445～7.830;昏迷或颅脑损伤:OR=4.026,95%CI 1.545～10.490;腹部手术,OR=0.166,95%CI 0.068～0.403;有胸腹引流管:OR=0.350,95%CI 0.150～0.818;开放气道:OR=4.095,95%CI 1.638～10.740].多因素Logistic分析结果:铜绿假单胞菌医院感染的独立危险因素有使用激素、机械通气(使用激素:OR=3.143,95%CI 1.115～8.856;机械通气:OR=3.195,95%CI 1.607～6.353,P＜0.05和P＜0.01).结论 使用激素和机械通气是铜绿假单胞菌医院感染的独立危险因素,应针对危险因素采取措施以控制医院感染.

Abstract：

Objective To investigate the risk factors of nosocomial infection caused by Pseudomonas aeruginosa in intensive care unit (ICU), in order to provide reference for an effective measure of infection control. Methods A retrospective study of cases of Pseudomonas aeruginosa infection occurring in ICU was made with multivariable Logistic regression analysis. The clinical data of 1 950 cases admitted from January 2002 to December 2006 were found to have nosocomial infection caused by Pseudomonas aeruginosa were analyzed in order to identify its independent risk factors. Results Sixty-four out of 1 950 patients were found to suffer from nosocomial infection caused by Pseudomonas aeruginosa, the morbidity rate was 3.3%. At the same time, and in the same department, 37 patients suffering from infection caused by Escherichia coli, served as control group. Univariate analysis showed that the risk factors for nosocomial infection caused by Pseudomonas aeruginosa were the use of corticosteroid, unconsciousness or craniocerebral trauma, abdominal surgery, thorax/abdomen drainage tube, mechanical ventilation, and tracheostomy [the use of corticosteroid: odds ratio (OR)=3.364, 95% confidence interval (95%CI) 1.4457.830; unconsciousness or craniocerebral trauma: OR=4.026, 95%CI 1.54510.490; abdominal surgery: OR=0.166, 95%CI 0.0680.403; thorax/abdomen drainage tube: OR=0.350, 95%CI 0.1500.818;tracheostomy: OR=4.095, 95%CI 1.63810.740]. Multivariate analysis showed that the independent risk factors of nosocomial infection caused by Pseudomonas aeruginosa in ICU were: the use of corticosteroid and mechanical ventilation [the use of corticosteroid: OR=3.143, 95%CI 1.1158.856; mechanical ventilation: OR=3.195, 95%CI 1.6076.353, P<0.05 and P<0.01]. Conclusion The independent risk factors of nosocomial infection caused by Pseudomonas aeruginosa in ICU are the use of corticosteroid and mechanical ventilation. Measures should be taken to take care of the risk factors in order to prevent nosocomial infection caused by Pseudomonas aeruginosa in ICU.     

预存式自体输血在腰椎间盘突出手术中的应用疗效研究

目的 探讨预存式自体输血在腰椎间盘突出手术中应用的疗效.方法 采用分层抽样的方法将术中输血的50例腰椎间盘突出症患者随机分为两组,研究组(30例)采用预存式自体输血,对照组(20例)未进行预存式自体输血,将两组患者围手术期出血量、自体输血量及异体输血量、手术前后的血常规变化和输血后不良反应发生情况进行比较.结果 研究组围手术期出血量为(720±665)ml,低于对照组的(1060±558)ml,但差异无统计学意义(P＞0.05).研究组均未输注异体血而且安全渡过围手术期.两组术前、术后3 d、术后7 d血红蛋白水平、红细胞计数和白细胞计数比较差异均无统计学意义(P＞0.05),血小板计数在术后7 d两组比较差异有统计学意义(P＜0.05).研究组未见输血反应发生,对照组出现1例输血反应.结论 腰椎间盘突出手术中采用预存式自体输血可避免输注异体血,避免了异体输血的诸多不良反应,且临床疗效与输注异体血差异无统计学意义.

Abstract：

Objective To investigate the effect of predeposit autotransfusion in operation of the patients with lumbar disc protrusion.Methods Fifty patients of transfusion with lumbar disc protrusion were assigned into two groups by stratified sampling randomly,30 patients whose blood were predeposited before operation in experimental group,and the other 20 patients whose blood were not predeposited before operation in control group.The blood loss,the blood requirements during operations,the hemotological routine indexes and the complications related to blood transfusion were compared respectively.Results The blood loss of experimental group [ (720 ± 665 ) ml ] perioperative period was lower than that of control group [ ( 1060 ± 558 ) ml ],but there was no significant difference between two groups (P ＞ 0.05 ).All the patients in experimental group went through perioperative period safely without allogenic blood transfusion.Hemoglobin,red blood cell and white blood cell were not significantly different between two groups before and after operation for 3,7 days (P＞ 0.05 ),the platelet count after operation for 7 days was significantly different between two groups (P ＜ 0.05).No complication was observed in experimental group but 1 case with complication was observed in control group.Conclusions Predeposit autotransfusion is an effective to avoid homologous blood transfusion and its complications for the patients with lumbar disc protrusion.Furthermore,the clinical effect is not significantly different between the predeposit autotransfusion patients and the allogenic blood transfusion patients.