重度磷化氢中毒所致多脏器损害的临床治疗分析

目的：观察并分析重度磷化氢中毒所致多脏器损害的临床治疗。方法选取2010年3月-2014年3月于我院接受治疗的重度磷化氢中毒所致多脏器损害的患者11例,回顾病例,分析该疾病的临床治疗。结果患者普遍表现有头晕、头痛、胸闷、咳嗽等临床症状,其中吸入中毒者的肝脏和心脏、肾脏损害程度比口服中毒者程度较轻;吸入中毒者的死亡率33.33%,低于口服中毒者的死亡率的60.00%,组间差异具有统计学意义（P〈0.05）。结论重度磷化氢中毒能够严重损伤患者的肝脏、心脏、肾脏和肺脏等,可以引起多脏器功能衰竭,治疗时主要采用对症解毒治疗和综合治疗相结合,帮助患者恢复健康。     

血清补体及IL-25在SLE中的表达及临床意义

目的 探讨血清补体（C）及IL-25在SLE累及单个或多个器官系统时的表达差异,以及血清C3、C4、总补体（CH50）、IL-25、CRP、抗双链DNA（dsDNA）抗体之间的相关性。方法 选择151例SLE患者,按SLE累及器官情况分为单纯SLE组（58例）、单器官损伤组（67例,其中狼疮性肾炎51例、血液系统损伤13例、其他器官损伤3例）和多器官损伤组（26例,其中狼疮性肾炎合并其他器官损伤25例,血液系统损伤合并脑损伤1例）。观察3组患者血清C3、C4、CH50、IL-25、CRP水平和抗dsDNA抗体阳性率间的差异,并分析各指标间的相关性。结果 3组SLE患者血清C4、CH50、IL-25、CRP水平相近, 组间血清C3水平和抗dsDNA抗体阳性率比较差异均有统计学意义（P均< 0.05）;与其他2组比较,多器官损伤组血清C3较低,抗dsDNA抗体阳性率较高（P均< 0.017）。Spearman相关性分析显示,SLE患者的C3水平与C4（r_s = 0.73,P < 0.001）、CH50（r_s = 0.81,P < 0.01）水平呈正相关,而与IL-25呈负相关（r_s = -0.14,P < 0.001）。结论 SLE患者发生多器官损伤时血清C3水平下降、抗dsDNA抗体阳性率升高,检测血清补体水平对SLE患者发生多器官损伤的预测有重要意义。     

新生儿感染性疾病时血清电解质变化与器官功能障碍的关系

目的　探讨新生儿感染性疾病并发多器官功能障碍时血气及血电解质的变化。方法　对 4 4例以感染性疾病为第一诊断 ,最终发展为多器官功能障碍新生儿的血清电解质变化与器官功能障碍程度进行回顾分析。结果　随着器官障碍数的增加 ,低钠血症、高钾血症、低钙血症的发生率也显著增加。低钠血症组神经系统功能障碍发生率明显增高 ,ALT、CK MB及LDH水平亦明显增高。高钾血症组患儿血ALT、AST、BUN、TB、IB水平均高于正常血钾组。低钙血症组与正常血钙组比较血AST、CK、CK MB、LDH水平明显增高 ,同时CRP水平也明显增高。结论　器官障碍数越多 ,电解质异常的发生率越高。低钠血症时 ,神经系统功能障碍的发生率明显增高。当肾功能损害和严重溶血时血钾明显增高。感染越严重时 ,心肌损害、肝细胞损害越严重。血钙水平能反应病情的严重程度     

MARS治疗慢性重型肝炎并多脏器衰竭疗效观察

目的应用分子吸附循环系统(MARS)治疗慢性重型肝炎并多脏器衰竭(MOF)患者,观察其在肝脏支持及治疗由肝功能衰竭引起多脏器衰竭的临床效果.方法治疗组40例慢性重型肝炎并发MOF患者,经MARS治疗110次,平均2.75次,比较治疗前后临床表现、肝功能、血常规、凝血功能等指标,以及血NH3、BUN、血Cr、电解质及酸碱平衡等生化指标.对照组42例同类患者.结果 MARS治疗能明显改善患者的预后指标MELD,与对照组比较,提高了抢救成功率.通过清除毒性物质,改善内环境,对肝脏有较明显的支持作用.在治疗肝性脑病,缓解脑水肿,防治肾功能衰竭等方面优于对照组.在调整电解质、晶体渗透压、酸碱平衡,创造补液及能量补充空间,治疗浮肿等方面具有较好的临床效果.在缓解SIRS状态,改善心、肺功能,缓解中毒性鼓肠及顽固性腹水等方面也有一定的效果.安全性良好.结论 MARS治疗在肝脏支持,并发症处理,治疗多脏器衰竭等方面具有较大的应用价值.     

手助腹腔镜行伴肝脾切除联合手术36例报告

目的：探讨手助腹腔镜用于伴肝脾切除复杂联合手术的可行性和安全性。方法：根据病灶部位和手术要求选择恰当的手助切口,为36例伴肝或脾联合病灶患者施行手助腹腔镜手术,其中肝脾联合切除4例,左肝巨大血管瘤及子宫全切除1例,巨脾及胆总管切开取石3例,改良Sugiura手术28例。结果：36例联合手术均在手助腹腔镜下获得成功,平均手术时间146min,平均出血133ml,术后无严重并发症发生,术后平均住院11.2d。结论：严格掌握手术适应证,手助腹腔镜行伴肝脾切除复杂联合手术是安全可行的,有利于减少创伤,降低手术难度,缩短手术时间,有效控制出血。     

Clinical outcome and bridge to transplant rate of left ventricular assist device recipient patients: comparison between continuous-flow and pulsatile-flow devices

BACKGROUND: Long-term implantable continuous axial-flow pumps are increasingly used in bridging heart failure patients to heart transplant. Compared to pulsatile left ventricular assist devices (LVADs), they offer smaller dimensions, less surgical trauma and less thromboembolisms. However concerns still remain about the long-term effects of continuous-flow on patients' outcome. The aim of this study was to review our mechanical bridge to transplant experience to compare pre- and post-transplant outcomes between pulsatile and continuous-flow LVAD recipients. METHODS: Thirty-six patients with a continuous-flow device (Micromed DeBakey, Houston, TX or InCor Berlin Heart, Berlin, Germany--group A) were compared with 41 patients supported with a pulsatile device (Novacor, WorldHeart, Oakland, CA--group B). RESULTS: Mean age (48.6+/-12.4 vs 47.2+/-12.5) and LVAD duration (119.3+/-115.4 vs 128.3+/-198.3) were similar in the two groups. Group A recipients were smaller compared to group B (mean body surface area=1.77+/-0.18 vs 1.93+/-0.16; p<0.001). Idiopathic dilated cardiomyopathy was not significantly greater between the two groups (78% vs 58.3%; p=0.085). Successful bridging to transplantation was similar in group A compared to group B (52.8% vs 63.4%; p=non significant). On-VAD mortality was similar between the two groups (A vs B=33.3% vs 36.6%; p=non significant). Thirty-day mortality after HTx in group A was 10.5% compared to 7.7% in group B (p=non significant). First year post-transplant incidence of treated rejections (36.8% vs 46%; p=non significant) as the mean number of rejection/patient (0.38+/-0.5 vs 0.53+/-0.83; p=non significant) were similar in group A compared to group B. CONCLUSIONS: In our experience, when compared to pulsatile LVAD, continuous-flow pumps are similarly effective in transplant rate and post-transplant outcome.     

新生儿窒息并多脏器损害相关危险因素探讨

目的 :探讨新生儿窒息后多脏器损害的危险因素。方法 :对 110例新生儿窒息并发多脏器损害的发生率及其与各种因素的关系进行分析。结果 :① 110例新生儿窒息并发多脏器损害 74例 ,发生率为 6 7 2 7%。②重度窒息中多脏器损害的发生率为 78 84% ,明显高于轻度窒息组 5 6 9% ( χ2 =5 99　P <0 0 2 5 )。③多脏器损害的发生率与窒息程度、胎龄、Apgar评分、宫内窘迫、羊水情况、分娩状态、窒息持续时间、能否及时合理复苏有密切关系。结论 :预防新生儿窒息并发多脏器损害 ,应重视围产期保健 ,分娩前的严密监测 ,加强产儿科合作 ,及时合理复苏和重视复苏后的监护     

Pancreatitis: critical care update

Severe acute pancreatitis (SAP) is a common pathology requiring critical care input. Patients often present with evidence of physiological dysfunction that may require organ support for optimization. Various scoring systems are available which can help in identifying those most at risk of morbidity and mortality. Complications can be significant, and may require surgical intervention for management. As such these patients should be managed with full multidisciplinary input to ensure appropriate targeted treatment. Underlying causes for SAP should be aggressively investigated to reduce the potential for recurrent episodes and where appropriate allow for secondary preventative measures. These patients often require prolonged and recurrent intensive care stays. Of those who are discharged, ongoing issues with chronic pain and nutrition are not uncommon and can lead to significant psycho-social challenges in the community.