大剂量云南白药治疗应激性胃溃疡的疗效观察及护理

目的观察大剂量云南白药治疗应激性胃溃疡的疗效及总结护理对策。方法将2000年9月～2001年12月收治的104例各种原因引起的应激性消化道出血病人作为对照组,选择2002年1月～2003年2月的92例各种原因引起的应激性消化道出血病人作为实验组。两组在常规止血药治疗基础下,实验组加用冰盐水、云南白药局部治疗,对照组加用冰盐水、去甲肾上腺素及凝血酶,观察两组治疗效果。结果实验组:显效62例,有效24例,无效6例,总有效率93.5%;对照组:显效24例,有效31例,无效49例,总有效率52.9%。两组疗效比较,字2=10.61,P<0.01,差异有统计学意义。结论云南白药直接作用于出血部位,能使血小板黏附、聚集,加速凝血酶生成等,从而缩短了凝血过程,保护胃黏膜促进溃疡愈合。     

磷酸二酯酶-5抑制剂治疗良性前列腺增生所致下尿路症状的研究进展

BPH所至下尿路症状(LUTS/BPH)的药物治疗在解除患者症状、预防和阻断BPH的发展,有效降低严重并发症和手术疗法风险的效果令人瞩目,已经成为LUTS/BPH的一线治疗选择。近年来磷酸二酯酶-5抑制剂(PDE5-Is)用于治疗LUTS/BPH的研究成果显著,PDE5-Is不论是单独应用,还是与α1肾上腺能受体拮抗剂(α1-ARAs)联合应用,对于缓解LUTS/BPH的效果确切,联合治疗效果更优。本文就PDE5-Is治疗LUTS/BPH的国内外研究进展作一综述。     

Development of breakpoints of carbapenems for intraabdominal infections based on pharmacokinetics and pharmacodynamics in peritoneal fluid

This study aimed to develop breakpoints of carbapenems for intraabdominal infections, based on pharmacokinetics (PK) and pharmacodynamics (PD) at the target site. Imipenem, meropenem, and doripenem were each administered to 8-11 patients before abdominal surgery, and venous blood and peritoneal fluid samples were obtained. The drug concentrations in plasma and peritoneal fluid were determined and analyzed using population pharmacokinetic modeling. Using the pharmacokinetic model parameters, a Monte Carlo simulation was performed to estimate the probabilities of attaining the bacteriostatic and bactericidal targets (20% and 40% of the time above the minimum inhibitory concentration [MIC], respectively) in peritoneal fluid. The bacteriostatic and bactericidal breakpoints were defined as the highest MIC values at which the bacteriostatic and bactericidal probabilities in peritoneal fluid were 80% or more. The breakpoints for the minimum and maximum approved dosages of each drug were identical for imipenem, meropenem, and doripenem, and some of these values varied with dosing interval and infusion time. Site-specific PK-PD-based breakpoints are proposed here for the first time, and should help us to select appropriate carbapenem regimens for intraabdominal infections.     

Practical aspects of differential ventilation with selective peep in acute respiratory failure

Hypoxaemia in association with acute respiratory failure continues to be a severe problem in some intensive care patients. Among strategies proposed, we want to focus attention on differential ventilation with selective PEEP, administered in the lateral position. This ventilation technique has proved successful in the treatment of refractory hypoxaemia due to severe bilateral lung disease.The rationale of this concept is briefly presented in this paper, where the main emphasis is laid on the practical aspects of its clinical application. Two case reports are included as examples of our experiences.     

Increased Tidal Volume Variability in Children is a Better Marker of Opioid-Induced Respiratory Depression than Decreased Respiratory Rate

OBJECTIVE: During opioid administration, decreasing respiratory rate is typically used as a predictor of respiratory depression. Prior to opioid-induced apnea, progressively irregular breathing patterns have been noticed. We hypothesize that opioid administration to children will increase tidal volume variability (TV(var)) and that this will be a better predictor of respiratory depression than a decrease in respiratory rate. METHODS: We recruited 32 children aged 2-8 years scheduled to undergo surgery. During spontaneous ventilation, flow rates and respiratory rates were continuously recorded, while remifentanil was infused at stepwise increasing doses each lasting 10 min. The infusion was continued until the patient showed signs of respiratory depression. Flow data from each dose was used to calculate tidal volumes, from which TV(var) was calculated. The respiratory rate and TV(var) during the last (D(last)), second to last (D-2), and third to last (D-3), administered doses were compared to those during baseline (fourth to last dose). We chose a threshold of TV(var) increase and compared it to a decrease in respiratory rate below 10 breaths per min as predictors of respiratory depression. RESULTS: Compared to baseline, the TV(var) increased by 336% and 668% during D(-2) and D(last), respectively, whereas respiratory rate decreased by 14.3%, 31.7%, and 55.5% during D(-3), D(-2), and D(last), respectively. A threshold increase in TV(var) of 150% over baseline correctly predicted respiratory depression in 41% of patients, compared to a drop in respiratory rate correctly predicting 22% of patients. CONCLUSIONS: TV(var) increases as children approach opioid-induced respiratory depression. This is a more useful predictor of respiratory depression than a fall in respiratory rate because the TV(var) increase is 10 times the drop in respiratory rate. A TV(var) increase also correctly predicts respiratory depression twice as often as decreased respiratory rate and is independent of age-related alterations in physiologic respiratory rates.     

Representation and classification of breath sounds recorded in an intensive care setting using neural networks

Objective.Develop and test methods for representing and classifying breath sounds in an intensive care setting. Methods.Breath sounds were recorded over the bronchial regions of the chest. The breath sounds were represented by their averaged power spectral density, summed into feature vectors across the frequency spectrum from 0 to 800 Hertz. The sounds were segmented by individual breath and each breath was divided into inspiratory and expiratory segments. Sounds were classified as normal or abnormal. Different back-propagation neural network configurations were evaluated. The number of input features, hidden units, and hidden layers were varied.Results.2127 individual breath sounds from the ICU patients and 321breaths from training tapes were obtained. Best overall classification rate for the ICU breath sounds was 73% with 62% sensitivity and 85% specificity. Best overall classification rate for the training tapes was 91% with 87%sensitivity and 95% specificity. Conclusions.Long term monitoring of lung sounds is not feasible unless several barriers can be overcome. Several choices in signal representation and neural network design greatly improved the classification rates of breath sounds. The analysis of transmitted sounds from the trachea to the lung is suggested as an area for future study. This revised version was published online in July 2006 with corrections to the Cover Date.