血小板计数和持续全身炎症反应综合征预测急性胰腺炎并发多脏器功能不全的研究

目的　评估血小板计数和持续全身炎症反应综合征(SIRS)预测急性胰腺炎(AP)并发多脏器功能不全综合征(MODS)的价值。方法　回顾性分析152例AP病人的临床资料,按持续SIRS时间分为A组(无SIRS发生)、B组(持续SIRS≤3天)和C组(持续SIRS＞3天),比较各组血小板计数、MODS发生率和病死率,并描绘血小板计数预测AP并发MODS的ROC曲线。结果　入院24小时内3组病人的血小板计数有显著差异。SIRS＞3天组病人的MODS发生率及病死率明显高于其他2组。SIRS＞3天和血小板计数＜80×109/L预测AP并发MODS的似然比分别是12.65和5.29。血小板计数(80×10     

Neopterin as a prognostic biomarker in intensive care unit patients

Purpose

The present study was undertaken to evaluate urinary neopterin in intensive care unit patients.

Materials and Methods

Urinary neopterin levels were determined in systemic inflammatory response syndrome (n = 10), sepsis (n = 18), septic shock (n = 9), and multiple organ dysfunction syndrome (n = 5). It was tested whether neopterin is a differential parameter among the patient groups. Furthermore, the results were also evaluated by comparing with a healthy control group (n = 30), and the relationship between neopterin and mortality or Acute Physiology and Chronic Health Evaluation II scores were investigated.

Results

Neopterin levels of the control group and patients were detected as 111 ± 11 and 3850 ± 1081 μmol/mol creatinine, respectively (P < .05). It was significantly increased in the sepsis and septic shock groups compared to the systemic inflammatory response syndrome group (P < .05). Neopterin levels were significantly higher in the patients with mortality and lower Acute Physiology and Chronic Health Evaluation II scores.

Conclusion

This study showed that monitoring of urinary neopterin profile can be used in intensive care units to show the degree and prognosis of the disease.     

Multiple organ dysfunction syndrome following single wasp sting

Wasp stings have been associated with wide variety of reactions from mild local reaction like wheal formation to fatal systemic reactions. Life threatening complications following a single wasp sting are relatively rare and unexpected. We report here the clinical course of a 12 year old child who developed Multiple Organ Dysfunction Syndrome (MODS) and died after a single wasp sting.     

25例多器官功能衰竭综合征患者临床分析

目的：探讨创伤后 ＭＯＤＳ的危险因素和防治。方法：回顾性研究了 １９９７年 ９月～１９９９年 ７月 ＳＩＣＵ收治的创伤患者 １５８例的临床资料。结果：２５例（１５． ８２％）患者发生 ＭＯＤＳ,其中 １２ 例死亡,病死率为 ４８％, 低血压、感染和 ＩＳＳ值为高危因素。 ＭＯＤＳ患者中发生低血压者 １６例（６４％）,发生感染者 １９ Ｎ（７６％）。 ＭＯＤＳ死亡患者均发生过低血压（１００％）,ＩＳＳ 值均≥１６。结论：对具有高危因素的患者应警惕 ＭＯＤＳ的发生,早期诊断, 正确处理是获得良好预后的关键。     

MODS患者血清铜蓝蛋白测定的意义

目的探讨血清中铜蓝蛋白动态变化对多器官功能障碍综合症（MODS）患者早期诊断和病因判断的价值。方法于入院当天分别检测60例MODS患者（MODS组）、30例非MODS患者（对照组）血清铜蓝蛋白（CP）、超敏C反应蛋白（CRCP）、α-酸性糖蛋白（AAG）的含量,并对入选的住院患者进行APACHEⅡ和MODS评分。结果MODS组与对照组相比其APACHEⅡ、MODS评分、血清铜蓝蛋白（CP）、超敏C反应蛋白（CRCP）、α-酸性糖蛋白（AAG）的比较,差异有统计学意义（P〈0.05）。非感染组与感染组相比较,铜蓝蛋白与超敏C反应蛋白均明显升高,差异有统计学意义（P〈0.05）。结论 MODS患者铜蓝蛋白、超敏C反应蛋白、α-酸性糖蛋白的检测有助于MODS早期诊断;铜蓝蛋白及超敏C反应蛋白的监测有助于MODS病因的初步判断。     

Is ivabradine suitable to control undesirable tachycardia induced by dobutamine in cardiogenic shock treatment?

Inotropic treatment remains the cornerstone for cardiogenic shock, an emergency that requires immediate resuscitative therapy before shock irreversibly damages vital organs. Although the sympathomimetic drug dobutamine is the most widely-used inotropic drug worldwide, it has several side effects including sinus tachycardia. Dobutamine partly restores systolic heart failure (HF); however, it increases the heart rate (HR) which counterbalances the beneficial effects. Ivabradine, a new selective I_f inhibitor, provides specific HR reduction and is indicated in stable coronary artery disease and in stable chronic HF with left ventricular dysfunction. Despite scarce data indicating beneficial effects of ivabradine in sinus tachycardia in various clinical settings, this drug remains contraindicated in acute HF. We propose that ivabradine could help to prevent the dobutamine-induced side effects, and that their combination in clinical practice could lead to pure inotropic effects, useful for the management of cardiogenic shock.     

防治SARS中药的筛选

SARS在世界范围内流行 ,在紧急阶段 ,由于临床处治方案颇有争议 ,迅速的筛选出有效的中成药供临床急用尤为重要和迫切。利用 9个药理筛选模型交叉验证的方法 ,综合评价了 30个中成药的有效性。 19个药物作为有效的药物筛选出来 ,其中 8个最有效作为控制SARS不同阶段症状的药物由全国防治非典指挥部科技攻关组在 2003年5月22日对全国进行发布。本文就筛选的策略 ,顶层设计和主要研究思路做一介绍 ,具体试验结果将陆续发表。     

无肝素法体外膜肺氧合联合连续肾脏替代疗法抢救脏器功能衰竭患者的护理

目的 总结使用无肝素法体外膜肺氧合(ECMO)联合连续肾脏替代疗法(CRRT)抢救脏器功能衰竭患者的护理体会.方法 回顾性分析2012年6月-2014年6月实施体ECMO联合CRRT的6例多脏器功能衰竭患者的护理资料 ,归纳出其并发症的发生原因以及给予的护理干预.结果 血栓形成和感染是多脏器功能衰竭患者实施ECMO联合CRRT最严重的并发症 ,精心细致护理能及时发现潜在的风险并加以干预 ,对减少无肝素抗凝对ECMO联合CRRT治疗滤器管路凝血.结论 正确的护理干预以及有效的预防措施是联合CRRT 抢救MODS患者成功的重要环节.     

腹部火器伤诊治现状

腹部火器伤在历次战争中约占病员总数的6％左右，在平时较少见，一旦发生，即可造成伤员多个脏器破裂、大出血、功能损伤等一系列严重的病理改变，可在极短的时间内夺走伤员的生命。对此，临床医生较为陌生，容易误诊误治，本文就腹部火器伤的诊治现状做一综述。