急性血液稀释技术在动物实验围手术期中的应用

目的观察急性血液稀释技术(ANH)在狗断肢冷冻再植实验中对改善术中、术后动物全身状态的作用。方法在狗后肢深低温冷冻再植实验中,对照组(A组)采用静脉补充等量乳酸钠林格氏液,实验组(B组)采用急性血液稀释技术,对比两组各时点循环动力学指标、血常规、术后动物苏醒时间、抬头时间、站立时间、术后进食、进水时间。结果 1术中两组Pa O2、PCO2值均在正常范围,呼吸频率正常,B组心率明显低于A组,术中血红蛋白、红细胞压积输血前A组与B组无统计学差异,术后B组明显高于A组,差异存在显著性。2术后动物苏醒时间、抬头时间、站立时间、术后进食量、进水量B组均明显优于A组,存在显著差异。结论在狗断肢深低温冷冻再植实验中,急性血液稀释技术(ANH)能明显改善动物术中的全身状态,加快术后恢复速度。     

急性脑梗死患者血浆D二聚体、纤溶酶原活性检测的临床价值

目的为探讨急性脑梗死(ACI)患者血浆D二聚体(D-D)及纤溶酶原活性(PLG:A)联合检测的临床价值。方法采用SysmexC S2000i全自动血凝仪对120例急性脑梗死患者及80例健康对照者血浆D-D及PLG:A进行联合检测并进行比较。结果 ACI患者血浆D-D水平明显高于健康对照组(P0.01)。急性脑梗死患者血浆PLG:A明显低于健康对照组(P0.05)。结论联合检测血浆D-D及PLG:A水平对了解ACI患者的病情发展和预后判断有重要临床价值。     

Bedside ultrasound as a predictive tool for acute chest syndrome in sickle cell patients

Background

Acute chest syndrome (ACS) is the leading cause of death for patients with sickle cell disease (SCD). Early recognition of ACS improves prognosis.

Topical tranexamic acid for the treatment of acute epistaxis in the emergency department

Objective

To evaluate the effectiveness and potential benefits of topical tranexamic acid (TXA) in the management of acute epistaxis.

姬爱芳刘宽荣老年急性心肌梗死86例疗效观察

目的：探讨老年人急性心肌梗死的临床治疗效果。方法对2011年1月—2013年12月我院住院治疗急性心肌梗死患者86例的临床治疗情况进行回顾性分析。结果显著好转11例,好转69例,有进步5例,死亡1例,治疗有效率为93.02%。住院时间11 d~21 d,平均15.5 d。结论根据老年急性心肌梗死患者的特点,准确诊断,正规治疗,可以提高临床治疗效果。     

New polymyxin derivatives that display improved efficacy in animal infection models as compared to polymyxin B and colistin

Polymyxin B and colistin (polymyxin E) are bactericidal pentacationic lipopeptides that act specifically on Gram‐negative bacteria, first by disrupting their outermost permeability barrier, the outer membrane (OM), and then damaging the cytoplasmic membrane. The discovery of both polymyxin B and colistin was published independently by three laboratories as early as in 1947. They were subsequently used in intravenous therapy. Unfortunately, they also exhibit significant and dose‐limiting nephrotoxicity. Therefore, polymyxins were reserved as agents of last‐line defense. The emergence of extremely multiresistant strains has now forced clinicians to reinstate polymyxins in the therapy of severe infections. However, the current dosage regimens lead to insufficient drug concentrations in serum and clinicians have been advised to use larger doses, which further increases the risk of nephrotoxicity. Very recently, the interest in developing better tolerated and more effective polymyxins has grown. This review focuses on describing four development programs that have yielded novel derivatives that are more effective than the old polymyxins in animal infection models. Compounds from three programs are superior to the old polymyxins in the rodent lung infection model with Acinetobacter baumannii and/or Pseudomonas aeruginosa. One of them is also more effective than polymyxin B in A. baumannii mouse thigh infection. The fourth program includes compounds that are approximately tenfold more effective in Escherichia coli murine pyelonephritis than polymyxin B.     

急性阑尾炎62例临床分析

目的：探讨急性阑尾炎手术治疗的临床疗效。方法对2010年1月—2012年12月住院治疗急性阑尾炎62例患者的临床资料进行回顾性分析。结果57例手术切除阑尾患者中,55例切口Ⅰ期愈合,2例因阑尾穿孔引起腹膜炎,切口延期愈合;5例保守治疗患者均痊愈。住院8 d ~18 d,平均10.5 d,无严重并发症发生。结论急性阑尾炎手术治疗应依据个体化原则,选择适合患者情况的治疗方法,是提高临床疗效的重要因素。     

危重患者急性胃肠损伤早期肠康复的效果评价

目的 评价对急性胃肠损伤(AGI)患者进行早期肠康复的效果,提出进一步完善的意见.方法 调查住院危重患者AGI的发病和肠内营养的使用情况及其效果,患者涉及ICU、神经外科、胸外科等,患者未行胃肠道手术.早期将各种必需的药物与营养制剂,通过肠内途径应用于需要营养治疗的患者,促进肠道多种功能的代偿,改善肠黏膜屏障作用、减少肠内毒素和细菌的易位,满足机体对营养物质的需要.结果 56名危重患者在急性疾病阶段及时进行了肠康复治疗,促进患者顺利渡过危急病情.经严格统计分析后认为效果满意.早期肠康复对术后并发症起到了预防作用.除提供机体能量外,在维护肠功能、改善肠黏膜屏障、减少肠内毒素、阻止细菌易位、调节肠道微生态和降低肠源性感染等方面也起到了较好的作用.患者的胃内容物一次抽吸量平均为(280.00±10.17) ml/d.所有患者未发生喂食物误吸.结论 AGI患者应及早进行肠康复治疗和护理,胃内容物一次抽吸的定量管理对临床选择肠内营养的时机有较好的指导意义.急性胃肠损伤新概念的提出和分级管理有利于危重患者的康复,对肠内营养的剂量和逐步增加的时限应进一步研究.     

急性缺血性脑卒中患者幽门螺杆菌感染与CRP、PCT关系探讨

目的 探讨急性缺血性脑卒中患者的幽门螺杆菌(HP)感染状况及其与C-反应蛋白(CRP)、降钙素原(PCT)在急性缺血性脑卒中临床上的意义.方法 分析2012年7月-2014年1月在宁波市第二医院神经内科接受治疗的急性缺血性脑卒中患者的临床资料.将入组的急性缺血性脑卒中患者作为观察组,都在发病7d内入院,对照组选择同期门诊的健康体检者.入院治疗次日上午、对照组在体检当天抽取9 ml的肘正中静脉血,分别检测患者的CRP、PCT及HP抗体.比较2组患者的一般资料、Hp感染状况以及Hp感染状况与CRP、PCT的相关性.结果 本研究共纳入研究对象150例,其中观察组患者77例,对照组73例,2组受试者的基线资料差异无统计学意义(P＞0.05);观察组患者的Hp-IgG阳性率(x2=11.72,P＜0.01)、Hp-CIM阳性率(x2=9.770,P＜0.01)均显著高于对照组;Hp现症感染患者[Hp-CIM阳性组,(7.8±1.8) mg/L]、Hp既往感染者[Hp-IgG阳性组,(5.4±1.3) mg/L]及正常对照组[(2.2±0.6)mg/L]所对应的CRP水平比较结果差异具有统计学意义(F=305.3,P＜0.01),且Hp-CIM阳性组患者最高,正常对照组最低;Hp现症感染患者[(1.9±0.7)ng/ml]、Hp既往感染者[(1.4±0.3) ng/ml]及正常对照组[(0.3±0.1)ng/ml]所对应的PCT水平比较结果提示差异具有统计学意义(F=305.3,P＜0.01),且Hp-CIM阳性组患者最高,正常对照组最低.结论 缺血性脑卒中与Hp感染关系密切,而Hp感染状况与CRP和PCT有着一定的相关性.