乌司他丁治疗慢性阻塞性肺疾病急性加重期的临床疗效

Objective To discuss the effect of ulinastatin on chronic obstructive pulmonary disease with acute exacerbation and part of the mechanism. Methods Seventy-two cases consistent with the diagnostic criteria were randomly divided into ulinastatin statin therapy group and control group (36 cases each group),two groups both received conventional treatment,the treatment group on this basis was added ulinastatin with 200 000 U,intravenous injection, three times a day. Results In the treatment group the total effective rate was 86.11%, significantly better than in the control group 69.44% (P<0.05), its improvement in APACHE Ⅱ score,blood gas analysis and reduction in CRP,TNF-α,IL-8 was superior to the control group. The treatment group was significantly shorter than the control group in mechanical ventilation and ICU stay time (P<0.05). Conclusions Conventional therapy as basis plus ulinastatin has better clinical efficacy,for whose chronic obstructive pulmonary disease with acute exacerbation mechanism may lie in the inhibition of inflammatory mediators and cytokines release, reducing inflammation, relaxing smooth muscle,improving the patient's ventilatory function and blood rheotogy.     

乌司他丁治疗慢性阻塞性肺疾病急性加重期的临床疗效

Objective To discuss the effect of ulinastatin on chronic obstructive pulmonary disease with acute exacerbation and part of the mechanism. Methods Seventy-two cases consistent with the diagnostic criteria were randomly divided into ulinastatin statin therapy group and control group (36 cases each group),two groups both received conventional treatment,the treatment group on this basis was added ulinastatin with 200 000 U,intravenous injection, three times a day. Results In the treatment group the total effective rate was 86.11%, significantly better than in the control group 69.44% (P<0.05), its improvement in APACHE Ⅱ score,blood gas analysis and reduction in CRP,TNF-α,IL-8 was superior to the control group. The treatment group was significantly shorter than the control group in mechanical ventilation and ICU stay time (P<0.05). Conclusions Conventional therapy as basis plus ulinastatin has better clinical efficacy,for whose chronic obstructive pulmonary disease with acute exacerbation mechanism may lie in the inhibition of inflammatory mediators and cytokines release, reducing inflammation, relaxing smooth muscle,improving the patient's ventilatory function and blood rheotogy.     

奥布卡因凝胶用于气管切开止痛导致吞咽困难1例

患者,男,86岁,因"呼吸困难2d"入院,诊断为呼吸肌无力、呼吸衰竭、胆囊炎,考虑患者需要终身使用呼吸机,遂行经皮扩张气管切开。住院14个月后出现气管切开处疼痛不适,查体见气管切开处局部皮肤潮湿、发红,可见少许白色分泌物,考虑皮肤感染[1～2]导致疼痛,给予外用百多邦(莫匹罗星)软膏及制霉菌素,口服双氯芬酸钾,同时保持切开处局部干燥等,疼痛缓解不明显,给予临时外用盐酸奥布卡因凝胶止痛,患者疼痛明显改善,但随后进食时出现吞咽困难,食物反流至鼻腔     

颅底骨折插胃管新方法

目的探讨颅底骨折患者插胃管新方法。方法 48例颅底骨折昏迷患者采用经口盲插胃管或在喉镜指引下经口插胃管。结果 48例患者经口盲插成功率60%,喉镜指引下经口插胃管成功率100%。结论经口插胃管对颅底骨折患者可以避免早期经鼻插胃管引起的颅内感染,同时为早期建立肠内营养创造条件。     

不典型腹主动脉夹层1例报告

1病例简介 患者,男,52岁,既往“高血压病”史20余年,间断应用降压药,血压控制不理想,因“下腹痛1d”入院,患者于入院前1d无明显原因出现右下腹疼痛,无转移痛,呈阵发性钝痛,每次持续10余分钟可略缓解,与活动关系不明显,轻微右侧腰痛,无其他不适。就诊于当地医院,查体体温正常,右下腹压痛及反跳痛,肾区无叩痛,行腹部彩超检查未见异常,查血常规白细胞、中性粒细胞分数增高。综合情况考虑为急腹症以急性阑尾炎可能性最大,遂行剖腹探查。     

不典型腹主动脉夹层1例报告

1 病例简介 患者,男,52岁,既往"高血压病"史20余年,间断应用降压药,血压控制不理想,因"下腹痛1 d"入院,患者于入院前1 d无明显原因出现右下腹疼痛,无转移痛,呈阵发性钝痛,每次持续10余分钟可略缓解,与活动关系不明显,轻微右侧腰痛,无其他不适.就诊于当地医院,查体体温正常,右下腹压痛及反跳痛,肾区无叩痛,行腹部彩超检查未见异常,查血常规白细胞、中性粒细胞分数增高.综合情况考虑为急腹症以急性阑尾炎可能性最大,遂行剖腹探查.     

骨髓增生异常综合征合并气管食管瘘1例并文献复习

本文报道1例骨髓增生异常综合征合并气管食管瘘。该患者以发热为主诉入院,入院后完善胸部CT、胃镜及纤维支气管镜检查,明确诊断为纵隔感染、气管食管瘘。因患者有骨髓增生异常综合征基础疾病,治疗难度大,请多学科进行会诊,并进行文献复习,治疗难度大,最终放弃治疗。通过本例少见危重病的分析总结,积累临床经验,希望对此类似疾病的诊治...     

颈内静脉穿刺置管并发血肿导致窒息1例

患者,男,60岁,主因"发热、乏力、纳差"7d,意识障碍1d入院。既往体健。7d前无明显诱因出现发热,伴乏力、纳差,自测体温37.7℃,3d前始于当地诊所静脉滴注药物治疗,病情无好转,1d前出现意识障碍,于当地中医院查血常规、肝功能、心肌酶等明显异常来我院。入院查体:体温38.2℃,呼吸29     

静脉注射有机磷农药中毒并软组织渗漏1例

患者,男,36岁,个体经营者,离异,疑似静脉药瘾史.于2012年7月24日17时被家人发现躺在路边,口吐白沫,呼之不应,于次日1∶ 00送至我院急诊科就诊.急诊科查体:血压130/90mm Hg(1mm Hg=0.133kPa),浅昏迷状态,大汗淋漓,皮肤湿冷,双侧瞳孔直径1mm,光反射消失,口唇稍发绀,双肺可闻及广泛湿啰音,心率80次/min.