急性百草枯中毒患者血清降钙素原水平的动态变化及意义

目的：观察急性百草枯中毒患者血清降钙素原（PCT）水平的变化,探讨其与预后的关系。方法：选取2013-09-2013-12我院急诊医学部收治的64例急性百草枯中毒患者,以入院期间为观察终点分为生存组和死亡组;根据PCT浓度分为正常组、低水平组、高水平组。测定患者入院后第1、3、7天的血清PCT,比较不同分组患者PCT浓度差异并分析PCT浓度变化与预后关系。结果：164例患者存活35例,死亡29例,存活率为54.7%。根据早期PCT浓度分为正常组、低水平组和高水平组,3组患者死亡率比较差异有统计学意义（P〈0.05）;2不同PCT浓度与MODS的发生率比较,高水平组MODS的发生率显著高于低水平组、正常组,差异有统计学意义（P〈0.05）;3PCT动态变化显示：死亡组第1、3、7天PCT水平显著高于生存组,[第1天：（1.61±0.76）∶（0.06±0.02）,第3天：（2.13±1.32）∶（0.19±0.09）,第7天：（2.51±1.26）∶（0.12±0.08）,P〈0.05];生存组患者PCT于第3天左右达高峰后呈下降趋势,死亡组则呈逐步上升趋势。结论：PCT浓度升高可作为判断急性百草枯中毒患者中毒严重程度的指标;及时动态检测PCT,对了解中毒程度,预后评估及指导临床治疗有重要意义。     

生态免疫肠内营养保护肠屏障功能的研究

目的探讨生态免疫肠内营养对全身炎症反应综合征(SIRS)大鼠肠屏障功能的保护作用。方法通过尾静脉注射脂多糖(LPS)建立SIRS大鼠模型,60只雄性SD大鼠随机分为4组(标准营养组、免疫增强组、生态营养组、生态免疫组),分别给予不同构成的肠内营养剂7d,观察各组大鼠血浆D-乳酸、二胺氧化酶(DAO)以及尿乳果糖/甘露醇(L/M)比值的动态变化。结果治疗7d后,生态营养组大鼠血浆D-乳酸水平明显低于标准营养组和免疫增强组(P<0.05),但这3组均高于生态免疫组3倍或以上(P<0.01)。血浆DAO水平标准营养组显著高于其他3组(P<0.01)。注射LPS后第1天起,各组大鼠尿液L/M比值均有大幅升高,至第6天回落到注射前水平。第1天时生态免疫组尿L/M比值低于其他3组(P<0.05),第3天时标准营养组尿L/M比值显著高于另外3组(P<0.01),至第6天各组已无明显差异。结论联合应用免疫增强营养素和生态制剂的生态免疫肠内营养能更有效地保护肠屏障功能。     

COPD急性发作期SIRS评分与患者预后的关系

目的探讨慢性阻塞性肺疾病(COPD)急性发作期患者全身炎性反应综合征(SIRS)与血清C-反应蛋白(CRP)、铁蛋白(SF)、空腹血糖(BS)的关系及其对患者预后的影响。方法检查对照组及COPD急性发作期病人体温、心率、呼吸频率、血白细胞计数、CRP、SF、BS等指标,记录SIRS评分,并做预后追踪。结果SIRS评分越高,死亡率越高,但2分、3分之间的差异无显著性,4分与3分之间存在显著性差异(P<0.05);SIRS评分与CRP成正比,且2分与3分之间均存在显著性差异(P<0.05);SIRS评分为4分时血清SF水平显著升高,与其他几组之间存在显著性差异,1分、2分、3分均与对照组无显著性差异。SIRS评分中存在白细胞或体温异常者,死亡率最高,达9.9%和8.1%,CRP、SF亦显著升高,与其他两项比较均存在显著性差异(P<0.05)。SIRS评分与空腹静脉血糖之间无明显统计学关系。结论SIRS评分对COPD急性加重期病人的预后判定具有一定的临床意义,但亦有一定的局限性,应结合CRP、SF等指标综合分析。体温异常、白细胞异常两指标与预后关系更为密切。     

肺炎伴全身炎症反应综合征C反应蛋白及血糖变化关系研究

目的研究肺炎伴全身炎症反应综合征(SIRS)时C反应蛋白及血糖水平的变化及其意义。方法随机选取131例非SIRS肺炎、63例肺炎伴SIRS S1期、44例肺炎伴SIRS S2期,以及37例肺炎伴多器官功能不全综合征(MODS)的住院患者,对比研究血糖及CRP的改变以及治疗前后的变化。另设40例健康者为对照组。结果⑴非SIRS肺炎组血糖处于正常范围,与对照组比较差异无统计学意义;⑵SIRS S1组、SIRS S2组及MODS组血糖明显高于对照组,且各组间差异有统计学意义;⑶各肺炎组CRP均明显高于对照组,MODS组高于SIRS组,SIRS组高于非SIRS组,SIRS组中的S2组高于S1组,各组间差异有统计学意义;⑷经治疗1周后,CRP及血糖在MODS组分别下降了3.7%和11.2%,SIRS S2组下降14.6%和17.3%,SIRS S1组下降33.5%和21.1%,各组间的下降程度存在显著性差异。结论重症肺炎时,CRP及血糖随着病情加重平行升高。CRP及血糖两项指标的联合应用对于预测肺炎是否并发SIRS具有一定的临床意义。     

L-selectin shows time and gender dependency in association with MODS

BACKGROUND: Recent investigations have demonstrated gender related immunologic alterations after trauma. These complications arise due to polymorphonuclear granulocytes (PMN) interacting with endothelium via L-selectin. Therefore, the purpose of this study was to investigate gender related differences in the expression of L-selectin in relation to posttraumatic multiple organ dysfunction syndrome (MODS). METHODS: Multiply injured patients were prospectively entered in the study. MODS was determined using the Denver score. The concentration of L-selectin on the surface of PMN was determined using flow cytometry during a 14 days' period. RESULTS: 48 patients were included in the study. The kinetics of L-selectin were different comparing male and female patients. Male patients with MODS initially showed a rapid decrease of surface L-selectin from 80 to 20 ng/ml. A return to admission levels was related to MODS. Male patients without MODS displayed elevated L-selectin levels up to 140 ng/ml. Female patients, however, all showed an initial rapid decrease of L-selectin to 20 ng/ml. Women who developed posttraumatic MODS had significantly increased levels up to 110 ng/ml before development of MODS developed. CONCLUSIONS: We feel that a gender related dimorphism in the initial L-selectin expression following trauma exists and is associated with MODS. These findings indicate new therapeutic means for the treatment of MODS. Therapies should be timely and gender dependently coordinated.     

Pentoxifyllin Attenuates the Systemic Inflammatory Response Induced During Isolated Limb Perfusion With Recombinant Human Tumor Necrosis Factor-α and Melphalan

Background: Isolated limb perfusion (ILP) with recombinant human tumor necrosis factor- (rhTNF-) and melphalan harbors the risk of septic shock–like syndrome. Pentoxifyllin (PTX) produced a beneficial effect on cytokine response and survival in animal experiments of septic shock, and we were interested to explore its effect during TNF-ILP in humans.Methods: Eighteen consecutive patients underwent TNF-ILP and received PTX (30 mg/kg/day), whereas another 13 consecutive patients did not. PTX was given systemically after the limb extracorporeal circulation was started. Cardiac index, systemic vascular resistance (SVR), and pulmonary vascular resistance were recorded via a Swan-Ganz catheter. Blood levels of TNF-, interleukin-6, procalcitonin, and lipopolysaccharide-binding protein were determined before, during, and after ILP.Results: After reperfusion, systemic levels of TNF- were significantly less increased in the PTX group (peak, 2.8 vs. 1.3 ng/mL; P < .05), as were interleukin-6 values (peak, 68 vs. 22 pg/mL; P < .02) and lipopolysaccharide-binding protein plasma levels (peak, 215 vs. 105 g/mL; P < .03). Differences in cardiac index, SVR, and mean arterial blood pressure were not significantly different. Norepinephrine or dobutamine to maintain SVR was less required in the PTX group.Conclusions: PTX attenuates systemic cytokine production and influences components of the systemic inflammatory response after TNF-ILP. PTX may play a beneficial role in the management of septic shock–like syndrome, particularly in patients with leakage from the ILP circuit.Presented at the 55th Annual Meeting of the Society of Surgical Oncology, Denver, Colorado, March 14–17, 2002.     

SIRS评分对ICU鲍氏不动杆菌感染患者预后评估的研究

目的 评价SIRS评分对ICU危重症患者感染鲍氏不动杆菌预后的意义.方法 回顾性分析ICU 70例鲍氏不动杆菌感染的患者临床资料,研究其预后与SIRS评分的关系.结果 70例患者中,存活51例,占72.9％,死亡19例,死亡率为27.1％；在死亡的患者当中SIRS评分高的死亡率也高,差异有统计学意义(P＜0.05).结论对于鲍氏不动杆菌感染的ICU患者,SIRS评分分值高可能预示预后不良.