Effect of midazolam on delirium in critically ill patients: a propensity score analysis

ObjectiveTo observe the association between exposure to midazolam within 24 hours prior to delirium assessment and the risk of delirium.MethodsWe performed a systematic cohort study with two sets of cohorts to estimate the relative risks of outcomes among patients administered midazolam within 24 hours prior to delirium assessment. Propensity score matching was performed to generate a balanced 1:1 matched cohort and identify potential prognostic factors. The outcomes included the odds of delirium, mortality, length of intensive care unit stay, length of hospitalization, and odds of being discharged home.ResultsA total of 78,364 patients were included in this study, of whom 22,159 (28.28%) had positive records. Propensity matching successfully balanced covariates for 9348 patients (4674 per group). Compared with no administration of midazolam, midazolam administration was associated with a significantly higher risk of delirium, higher mortality, and a longer intensive care unit stay. Patients treated with midazolam were relatively less likely to be discharged home. There was no significant difference in hospitalization duration.ConclusionsMidazolam may be an independent risk factor for delirium in critically ill patients.     

碱性成纤维细胞生长因子对谷氨酸毒性损伤豚鼠视网膜内突触小泡蛋白表达的影响

目的:探讨过量谷氨酸毒性损伤豚鼠视网膜内突触小泡蛋白(SYP)的表达及碱性成纤维细胞生长因子(bFGF)对其表达的影响。方法:豚鼠随机分成谷氨酸钠损伤组、对照组和bFGF治疗组。采用免疫组织化学方法和图像分析技术,对各组豚鼠视网膜内SYP免疫反应产物的表达进行检测。结果:对照组豚鼠视网膜内SYP的表达为强阳性,主要定位于外网状层和内网状层,损伤组视网膜相应区域内阳性反应产物的光密度值明显低于对照组,bFGF治疗后SYP的阳性表达明显高于损伤组,且与对照组相比,无显著性差异。结论:bFGF可抑制过量谷氨酸钠诱发的视网膜内SYP的表达减少,上调SYP的表达,对视神经损伤有显著地促功能修复作用。     

Optimization of photo-biomodulation therapy for wound healing of diabetic foot ulcers in vitro and in vivo

Unclear optical parameters make photo-biomodulation (PBM) difficult to implement in diabetic foot ulcer (DFU) clinically. Here, 12 wavelengths (400–900 nm) were used to conduct PBM to heal DFU wounds in vitro and in vivo. PBM at 10 mW/cm² and 0.5–4 J/cm² with all 12 wavelengths promoted proliferation of diabetic wound cells. In a mimic DFU (mDFU) rat model, PBM (425, 630, 730, and 850 nm, and a combination light strategy) promoted mDFU healing. The positive cell proliferation, re-epithelialization, angiogenesis, collagen synthesis, and inflammation were possible mechanisms. The combination strategy had the best effect, which can be applied clinically.     

应变率成像评价原发性高血压患者左心室心肌的舒缩功能障碍

目的:探讨应变率成像技术(SRI)为临床无创评估原发性高血压患者心脏舒缩功能障碍的价值。方法:将90例原发性高血压患者依据左心室心肌质量指数(LVMI)分为两组:左室肥厚(LVH)组46例和无左室肥厚(NLVH)组44例。行常规超声心动图检查并测量左房、左室大小,室间隔和左室后壁厚度,同时测定LVEF和LVFS、E/A比值等参数。应用应变率成像技术,对左心室纵向各室壁心肌在整个心动周期中SR参数进行分析测定,并与45例正常人(对照组)对照比较。结果:⑴与对照组及NLVH组相比,LVH组左房较大,室壁增厚,心肌收缩期SR参数绝对值均明显降低(P<0.05),而LVEF、LVFS无差异(P>0.05);并且室壁收缩期SR的绝对值与室壁的肥厚程度呈负相关(P<0.05)。⑵LVH组心肌快速充盈期SR参数同E/A比值都显著降低(P<0.05)。而室壁的厚度与室壁的快速充盈期SR无相关性(P>0.05)。3组心室肌的心房收缩期SR参数无明显差别(P>0.05)。⑶LVH组收缩后收缩(PSC)的出现率(59.8%)显著高于Normal组(21.0%)和NLVH组(36.6%)(P<0.05)。LVH组收缩后收缩的SR绝对值、收缩后收缩与收缩期SR的比值均大于其他两组(P<0.05)。结论:SR能反映不同程度原发性高血压患者左心室心肌舒缩功能障碍。     

直接数字化摄影在尘肺病检查及诊断中的应用研究

目的：探讨直接数字化摄影（DR）技术在尘肺病检查和诊断方面的应用价值。方法选择来我院欲提交诊断的20世纪60～80年代参加国防施工的复退军人及部分经职业健康查体筛选的企业工人共计811例,同时拍摄高千伏（HkV）胸片及DR胸片,部分加照CT扫描胸片,并对二组胸片进行质量及尘肺病诊断一致性等方面的比较。结果二组胸片的质量对比发现：DR胸片总体质量优于高千伏胸片,尤其DR胸片的一级片率明显高于 HkV胸片,DR胸片的三级片率明显低于HkV胸片,且差异有统计学意义（ P ＜0．05）;DR胸片在图像清晰度及肺部微细结构显示方面较好,两组胸片的诊断结果基本一致,尘肺患者胸片在小阴影形态、总体密集度、分布范围方面无明显差别。结论 DR胸片质量好于HkV胸片,三级片率明显低于HkV胸片;DR摄影可用于尘肺病检查与分期诊断。     

皮肤再生医疗技术治疗糖尿病足溃疡疗效分析

目的:分析、总结、探讨皮肤再生医疗技术在临床上治疗糖尿病足溃疡的可行性与有效性。方法:对32例糖尿病足溃疡住院病人采用皮肤再生医疗技术为主、必要时配合植皮的治疗方法进行局部创面修复。结果:32例糖尿病足溃疡应用皮肤再生医疗技术获得修复9例(占28.1％),皮肤再生医疗技术 皮片移植12例(占37．5％),皮肤再生医疗技术 皮瓣修复5例(占15．6％),进行截肢6例(占18．8％)。结论:及时就诊、及时采用皮肤再生医疗技术为主的治疗方法能有效修复溃疡创面、降低糖尿病足截肢率。     

重组人表皮细胞生长因子促进慢性创面的愈合

目的观察重组人表皮生长因子（ｒｈＥＧＦ）对慢性创面愈合的影响。方法应用国产ｒｈＥＧＦ，采用自身对照法（对照药物：１％磺胺嘧啶银霜），对６１例慢性创面（烧伤残留肉芽创面３７例，溃疡创面２４例）进行局部治疗。以创面愈合为指标，与对照组平行比较，判读创面愈合时间。结果ｒｈＥＧＦ用于慢性创面的治疗，明显缩短创面愈合时间。肉芽创面愈合时间较对照组缩短约１５天，具有显著性差异（Ｐ＜０．００１）；溃疡创面愈合时间亦有缩短。结论ｒｈＥＧＦ有促进慢性创面愈合的作用     

颈部血管损伤的诊断与救治(附23例报告)

目的分析颈部血管损伤的诊断和治疗特点,提高治疗成功率,降低死亡率。方法通过回顾性总结我院8年来颈部血管损伤23例的诊治经过,总结出颈部血管损伤的现场急救要点和临床诊治的特征。结果本组23例中18例痊愈,2例死亡,3例有程度不等的后遗症。结论现场急救要及时,诊断要正确。不同类型的颈部血管损伤要采取不同的治疗方法。     

普瑞博思在胃肠钡餐造影检查中的应用

目的总结和评价普瑞博思在胃肠钡餐造影检查中的应用价值。材料与方法203例在胃肠钡餐造影中服用普瑞博思,其中195例是全胃肠道钡餐造影检查,采取常规服药法;8例在上消化道中采取机动服药法。结果在195例服普瑞博思后有192例在3小时内完成了全胃肠道检查。服药后30～60分钟检查小肠最佳,90～150分钟检查结肠最理想。8例幽门不开放在服药后7例十二指肠充盈。206例仅有1例出现可忍受的阵发性腹痛,不良反应率小于0．5％。结论普瑞博思是一种服用方便、安全、高效的胃肠道促动力药,在胃肠钡餐造影检查中应用它,可以缩短检查时间,提高工作效率和检查质量。