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严重的对乙酰氨基酚肝毒性常常会引起急性肝衰竭(ALF),作者在美国的22所三级护理中心调查了由对乙酰氨基酚引起的肝衰竭的发生率、危险因素和预后,用超过6年的时间收集到662例完全符合ALF(包括肝源性凝血症和肝性脑病)标准的患者资料,详细分析后发现:其中有275例(45%)是由对乙酰氨基酚引起的。调查发现,对乙酰氨基酚相关性ALF的年度百分比由1998年的28%上升至2003年的51%。对乙酰氨基酚的中位摄入量为24g(相当于48个高含量的片剂)。在上述275例中,误服过量者有131例(48%),有意服用者(即有自杀倾向者)有122例(44%),还有22例(8%)为不明意图。在误服组中38%同时服用了两种或多种对乙酰氨基酚制剂,63%患者服用了含有镇静剂的复合制剂。据报道,81%患者因为急性或慢性疼痛误服了对乙酰氨基酚和(或)其他镇痛剂。总体上,有178例研究对象(65%)存活,74例(27%)未经肝移植而死亡,23例(8%)进行了肝移植,其中71%的患者仅存活了3周。未接受移植的存活率和肝移植存活率在误服组和有意服用组差别不明显。 相似文献
46.
为了控制夜间护理质量,了解夜间护理工作存在的主要问题,对我院2年来护理夜查房的资料进行回顾性分析,以利于制定相应的护理管理措施,达到全面提高护理质量的目的。1对象和方法1.1对象2003年9月—2005年9月内科、针推科、外科、骨伤科、急诊科护理夜查房资料530份。1.2方法回顾分析530份夜查房资料中护士仪表、劳动纪律、环境卫生、陪伴管理、重病人护理、医院感染管理6个方面及不同职称护理人员的检查结果。1.3统计学方法采用t检验及χ2检验。2结果2.1夜查房检查结果(见表1)表1530份夜查房分项检查结果项目存在问题例构成比%护士仪表21.05… 相似文献
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Gregory Guldner MD MS Jason Schultz BS Perry Sexton MD Corwyn Fortner BS Mark Richmond MD 《Academic emergency medicine》2003,10(2):134-139
OBJECTIVES: Physicians commonly use etomidate for adult rapid-sequence intubation (RSI), but the manufacturer does not recommend its use for children under 10 years of age due to a lack of data. The authors present their experience with etomidate for pediatric RSI in order to further develop its risk-benefit profile in this age group. METHODS: Trained abstractors reviewed the medical records for all children under 10 years old who received etomidate for RSI between July 1996 and April 2001. RESULTS: 105 children, with an average age of 3 (+/-2.9) years, received a median dose of 0.32 (+/-0.12) mg/kg of etomidate. The systolic blood pressure increased an average of 4 mm Hg (95% CI = -3.3 to 9.2); the diastolic blood pressure increased 7 mm Hg (95% CI = -3.1 to 11) within 10 minutes of receiving etomidate. The heart rate increased an average of 10 beats/min (95% CI = 4.0 to 17.4). Complications included three patients who vomited within 10 minutes of etomidate administration. There were no cases of documented myoclonus, status epilepticus, or new-onset seizures. Thirty-eight patients received corticosteroids during the hospital course, none for suspected adrenal insufficiency. Three patients died, all from severe brain injury. CONCLUSIONS: In children less than 10 years old, etomidate seems to produce minimal hemodynamic changes, and appears to have a low risk of clinically important adrenal insufficiency, myoclonus, and status epilepticus. The association between etomidate and emesis (observed in less than 3% of enrolled patients) remains unclear. For clinical situations in which minimal blood pressure changes during RSI are critical, etomidate appears to have a favorable risk-benefit profile for children under 10 years old. 相似文献
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Dr. Arni Raghavendrarao Raghuram M.Ch. Subbiah Kumar MD Kathamuthu Balamurugan DA Arulmurugan DA Ramiah Krishnan M.Ch. Perichiappan Sivakami BS Eluvathingal Varghese John M.Ch. 《Indian Journal of Thoracic and Cardiovascular Surgery》2006,22(3):178-181
Background Beating heart surgery has now become the commonest technique of doing Coronary Artery Bypass Graft Surgery (CABG) in our country.
It is being used even in such high risk situations like diffuse coronary disease and Critical Left Main stem Stenosis (LMCS)
with good results. The aim of this study is to retrospectively review our results in Off-Pump Coronary Artery Bypass Surgery
(OPCAB) in patients with critical left main stem stenosis.
Methods This study is a retrospective analysis of the data of patients who underwent primary coronary artery bypass surgery. During
the period from April 2003 to September 2005 a total of 64 patients underwent OPCAB procedure for critical LMCS. During the
same period 10 patients underwent CABG on Cardio Pulmonary Bypass (CPB). The age range was 36–77yrs. The sex distribution
was M: F 53∶10. Ten patients were done as emergency. 2 of them were on Intra Aortic Balloon Pump (IABP) support preoperatively.
10 patients were high risk with a Euro score of ≥5.
Results Left Internal Mammary Artery (LIMA) was used in 78% of cases. Average grafts per patient was 2.96. The median ventilation
time was 5.91 hrs. New IABP insertion in postoperative period was required in 1 patient. One patient was reexplored for bleeding.
There was one perioperative myocardial infarction. 57% of patients did not need any blood transfusion. There was no conversion
to CPB. There was no operative mortality. Inotropes were used in ten cases.
Conclusions OPCAB is a safe method of revascularization in patients with critical LMCS. Preoperative IABP is useful in patients with cardiogenic
shock. However, there is a place for CPB in patients needing additional procedures like Mitral Valve repair (MV repair) or
Dor's procedure or when the vessels are very diffusely diseased. Those patients who are unstable despite IABP support may
be managed by Beating heart On Pump (BHOP) technique. 相似文献
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Plasmid DNA encoding transforming growth factor-beta1 suppresses chronic disease in a streptococcal cell wall-induced arthritis model. 总被引:6,自引:0,他引:6
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X Y Song M Gu W W Jin D M Klinman S M Wahl 《The Journal of clinical investigation》1998,101(12):2615-2621
Transforming growth factor beta is a potent immunomodulator with both pro- and antiinflammatory activities. Based on its immunosuppressive actions, exogenous TGF-beta has been shown to inhibit autoimmune and chronic inflammatory diseases. To further explore the potential therapeutic role of TGF-beta, we administered a plasmid DNA encoding human TGF-beta1 intramuscularly to rats with streptococcal cell wall-induced arthritis. A single dose of 300 microg plasmid DNA encoding TGF-beta1, but not vector DNA, administered at the peak of the acute phase profoundly suppressed the subsequent evolution of chronic erosive disease typified by disabling joint swelling and deformity (articular index = 8.17+/-0. 17 vs. 1.25+/-0.76, n = 6, day 26, P < 0.01). Moreover, delivery of the TGF-beta1 DNA even as the chronic phase commenced virtually eliminated subsequent inflammation and arthritis. Both radiologic and histopathologic as well as molecular evidence supported the marked inhibitory effect of TGF-beta1 DNA on synovial pathology, with decreases in the inflammatory cell infiltration, pannus formation, cartilage and bone destruction, and the expression of proinflammatory cytokines that characterize this model. Increases in TGF-beta1 protein were detected in the circulation of TGF-beta1 DNA-treated animals, consistent with the observed therapeutic effects being TGF-beta1 dependent. These observations provide the first evidence that gene transfer of plasmid DNA encoding TGF-beta1 provides a mechanism to deliver this potent cytokine that effectively suppresses ongoing inflammatory pathology in arthritis. 相似文献