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     

连续性肾脏替代治疗应用局部枸橼酸抗凝1例护理体会

局部枸橼酸抗凝法(regional citrate anticoagulation,RCA)在高危出血患者中行连续性血液净化(CBP)治疗其有效性已得到证实,现将1例慢性肾功能不全并上消化道出血患者采用局部枸橼酸抗凝方法顺利完成持续静静脉血液透析滤过(continuous veno-venous hemodiafiltration,CVVHDF)治疗患者的护理体会报道如下。1资料与方法1.1病例报告患者,男,86岁,既往"冠心病、心功能不全、高血压病、脑梗死、类风湿性关节炎"病史,曾行"肾动脉狭窄     

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.     

流感病毒致重症肺炎肺外脏器损伤9例分析

重症肺炎患者脏器损伤以多器官功能障碍综合征（MODS）为主,常见急性呼吸窘迫综合征（ARDS）,肺外脏器以中枢神经系统损害、急性肾功能不全、血凝障碍以至出现弥散性血管内凝血（DIC）、胃肠道损害等为多.笔者发现流感病毒所致重症肺炎肺外脏器损伤程度不一,现报道如下.     

重型颅脑损伤合并应激性溃疡56例救治体会

应激性溃疡是严重创伤、感染、脓毒症、休克、烧伤、大手术、中枢系统损伤、多器官功能衰竭等导致的胃十二指肠黏膜的糜烂。重型颅脑损伤（GCS评分〈8分）更容易合并应激性溃疡。2005～2009年,我科共收治重型颅脑损伤合并应激性溃疡患者56例,现将救治体会报道如下。     

更换经口气管插管困难2例

经口气管插管建立人工气道是抢救危重患者特别是呼吸衰竭患者的重要方法之一，临床上有时会遇到需要更换气管插管以维持人工气道畅通的情况，现将我院重症医学科（ICU）2例更换插管困难病例报告如下。     

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.     

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.