危重症患儿应激性高血糖的研究进展

危重症患儿在应激状态下可出现应激性高血糖,而持续的高血糖可以引起一系列的有害后果.目前认为应激性高血糖的机制与危重症患儿在应激时神经内分泌的改变有关.危重疾病时发生胰岛素抵抗可能与胰岛素受体功能异常、受体后信号转导、葡萄糖转运及细胞内代谢障碍等因素有关.应激性高血糖治疗原则为积极治疗原发病,同时应通过严格控制补液以控制高糖性高渗状态.     

Vitamin D status of chronically ill or disabled children in Victoria

OBJECTIVE: To establish the percentage prevalence of hypovitaminosis D in chronically ill or disabled children in Melbourne, Australia. METHODOLOGY: A group of inpatients at the Royal Children's Hospital, Melbourne, Victoria, as identified by the primary unit, were sampled to measure serum vitamin D and parameters of bone turnover. A second group of disabled children (outpatients) were also measured to establish vitamin D status. RESULTS: Of the total population, 54.9% were found to have low serum 25 hydroxy (25OH) vitamin D levels. Of the inpatient group, 25.4% were vitamin D deficient (<30 nM/L), and 27.1% were vitamin D insufficient (30-50 nM/L). The mean 25OH vitamin D was 52.1 nM/L. Of the outpatient group, 15.4% were vitamin D deficient, whilst 42.3% were found to be insufficient. The mean vitamin D level was 41.2 nM/L. No difference attributable to intellectual versus physical disability was found. Anticonvulsant use and ambulatory status was not predictive of vitamin D status in the children examined. Of the total population, 0.05% were found to have secondary hyperparathyroidism. The mean 25OH vitamin D level of this subgroup was 30.6 nM/L. Dark skin tone was found to be significantly associated with hypovitaminosis D (P = 0.001), where all five children with dark skin tone were found to have serum 25OH vitamin D levels <50 nM/L. Of the seven disabled children (outpatients) found to be iron deficient, four had coexistent hypovitaminosis D. CONCLUSION: The percentage prevalence of hypovitaminosis D is high in both chronically ill, and physically/intellectually disabled children in Melbourne, Australia. Increased vigilance and recognition of this deficiency state is needed as an important health prevention strategy.     

Evaluating biapenem dosage regimens in intensive care unit patients with Pseudomonas aeruginosa infections: a pharmacokinetic/pharmacodynamic analysis using Monte Carlo simulation

This study was conducted to identify optimal dosage regimens and estimate pharmacokinetic/pharmacodynamic (PK/PD) characteristics of short-infusion (SI) versus extended-infusion (EI) biapenem against Pseudomonas aeruginosa infections in Chinese intensive care unit (ICU) patients. A total of 85 strains of P. aeruginosa were collected, and the minimum inhibitory concentration (MIC) of biapenem was measured by the serial two-fold agar dilution method. We designed four frequently used clinical regimens: biapenem 300?mg I.V. q12h, q8h, and q6h, and 600?mg q12h. The Monte Carlo Simulation (MCS) was performed using previously published pharmacokinetic data to calculate the probability of target attainment (PTA) and the cumulative fraction of response (CFR) of these regimens as an SI (0.5?h) and an EI (1?h, 2?h, 3?h, and 4?h).For a target of 40%fT_>MIC (serum drug concentration remains above the MIC for a dosing period), none of the regimens achieved any CFRs>90% for P. aeruginosa, multidrug–resistant P. aeruginosa (MDR-PA) and even non–MDR-PA. The traditional biapenem SI regimens most commonly seen in clinical practice were insufficient in treating both MDR and non-MDR P. aeruginosa in ICU patients. However, biapenem 600?mg q12h over 2–4?h EI regimens could achieve CFR>90% with 20%fT_>MIC. Clinical trials should aim to validate the potentially greater PK/PD index with higher, more frequent doses and longer extended infusions.     

连续性血液净化(CBP)治疗危重症患者对机体氧化抗氧化指标的影响研究

目的:分析危重症采用连续性血液净化对治疗机体氧化抗氧化指标的影响。方法:选我院22例重症监护室行CBP治疗的患者,不同时间段取血,并检测血清过氧脂质(LPO)与谷胱甘肽氧化物酶(GSH-Px)的水平,行APACHEIII的评分。结果:相较于健康对照组,LPO升高,GSH-Px降低;在CBP的不同时间段治疗后,APACHEIII评分有着明显改善;LPO、GSH-Px与APACHEIII的评分分别呈正、负相关。结论:CBP可改善患者氧化抗氧化紊乱,从而减轻氧化损伤,促进危重症患者病情得到较好的改善,而LPO及GSH-Px是检测危重症患者病情轻重的关键指标,可作为判断预后与CBP停止的时机起到了重要的依据。     

精神病噎食患者的临床分析与护理对策

目的分析精神科患者噎食的原因并提出护理对策。方法选取我院2010年至2012年成功抢救的15例精神科噎食患者作为研究对象,分析患者的临床资料,总结护理对策。结果导致精神病噎食的原因主要抗精神病药物所致的锥体外系反应,精神病患者由于智力衰退、病症发作等原因没有自控能力。通过对患者采取有效的护理措施后,大大减少患者噎食的发生。结论分析精神病噎食的原因并采取相应的护理措施可减少噎食的发生。     

危重新生儿压疮高危因素分析及护理对策

目的探讨危重新生儿压疮发生的高危因素,并总结相应有效的预防护理对策。方法对人住NICU的危重新生儿压疮高危因素进行分析评估,采取相应的预防对策。结果发生压疮12例,压疮发生率0．76％。结论针对引发新生儿压疮的各类危险因素进行相应的预防护理,对于降低压疮的发生具有重要意义。     

含不同剂量谷氨酰胺肠内营养在老年危重患者营养支持中的应用

目的通过不同剂量谷氨酰胺肠内营养对老年危重患者的营养支持,观察老年危重患者营养状态、胃肠道功能改善情况。方法将90例老年危重患者完全随机化法分成3组：不含谷氨酰胺的营养支持对照组（A组）,低剂量谷氨酰胺[0．3g/（kg·d）]肠内营养组（B组）,高剂量谷氨酰胺[0．6g／（kg·d）]肠内营养组（C组）。于营养支持的第1、7、14天清晨采集空腹静脉血,测定血浆二胺氧化酶、谷氨酰胺,观察血清谷氨酰胺含量变化对肠黏膜屏障功能的影响,并测定血红蛋白、血清白蛋白、转铁蛋白、前白蛋白等营养指标及氮平衡情况,同时观察患者的腹胀、腹泻、胃潴留等胃肠道功能情况。结果营养支持后第7、14天B组和C组血浆谷氨酰胺水平分别为（1886．8±420．5）、（2228．6±440．2）g/L和（1889．6±436．1）、（2174．3±440．8）g/L,较A组（1612．0±493．5）和（1869．7±559．8）μg/L显著升高（P=0．027,P=0．008）;二胺氧化酶在B组和C组分别为（2310±1271）、（1602．5±1137．9）U／L和（2076．3±567）、（1586．3±530．9）U／L,较A组的（3250±923）和（2476±862）U／L显著降低（P=0．000,P=0．000）。营养支持后第7天转铁蛋白、前白蛋白明显改善（P=0．023,P=0．047）,第14天血红蛋白明显改善（P=0．003）。B、C组成功实施EN人数和达到EN目标人数分别是4和25例、3和27例,较A组12和13例多（P=0．008,P=0．000）,胃肠道的并发症发生率较A组少。结论含谷氨酰胺的肠内营养能早期改善危重患者的肠黏膜屏障功能和营养状态,减少胃肠功能并发症。通过肠道给予谷氨酰胺,有利于成功实施肠内营养,并实现全肠内营养。     

质量管理工具在危重患者基础护理质控中的应用

目的：探讨应用先进的质量管理工具优化护理质控,提高护理质量。方法：应用统计表、柏拉图等质量管理工具对危重患者基础护理质控结果进行分析总结并持续改进。结果：通过应用质量管理工具进行质控分析统计,提高了护理人员全员质控意识,增强了护理人员工作责任心,基础护理质量和患者满意度明显提高。结论：质量管理工具的运用较文字记录能更直观地反映基础护理质控中存在的问题,运用数据及图表形式更具说服力,每位护理人员能一目了然地知道科室基础护理中存在的问题,从而提高护理人员对本科室基础护理质量的重视程度,激发了护士参与质量管理的积极性,达到主动、有效整改。     

超声定位外周静脉穿刺导入中心静脉置管在颅脑外伤危重患者中的临床应用

目的 探讨超声定位外周静脉穿刺导入中心静脉置管在颅脑外伤危重患者中的临床价值.方法 选取本院收治的114例颅脑外伤危重患者作为研究对象,随机分为观察组和对照组,每组57例,观察组行外周静脉穿刺导入中心静脉置管,对照组行超声定位锁骨下静脉穿刺置管术治疗,比较两组一次置管成功率、导管留置时间及并发症发生率.结果 观察组一次置管成功率明显高于对照组,组间比较差异有统计学意义（P＜0.05）;观察组并发症发生率明显低于对照组,组间比较差异有统计学意义（P＜0.05）;观察组导管留置时间明显长于对照组,组间比较差异有统计学意义（P＜0.05）.结论 超声定位外周静脉穿刺导入中心静脉置管应用于颅脑外伤危重患者可取得较好的效果,其穿刺成功率较高,并发症少,且可长期留置导管,有较高的应用价值.