群蜂蜇伤20例临床诊治分析

目的总结群蜂蜇伤的救治方法,为临床提供经验。方法回顾性分析20例群蜂蜇伤患者的临床资料。结果治愈14例,好转5例,1例因多脏器功能损害,血管内溶血而死亡。结论群蜂蜇伤是临床上常见的急症,应根据其轻、中、重程度及时采用有效的治疗措施,防止并发症发生是救治成功的关键。     

间断温血灌注对供心代谢及酶的影响

在１２次猪的心脏移植实验中，供心的保护分两组，Ⅰ组供心用冷晶体停搏液灌注，Ⅱ组用温血灌注，在供心取出前及主动脉开放１５ｍｉｎ后对心肌代谢及酶学的有关指标进行监测。Ⅰ组心肌氧耗率明显低于正常，而Ⅱ组与正常无明显差异。心肌氧耗率下降程度Ⅰ组明显高于Ⅱ组。心肌糖耗率及冠状动静脉ｐＨ、磷酸肌酸激酶同功酶差值两组均与正常无明显差异。本实验结果提示间断温血停搏对心肌的保护作用与冷晶体停搏相似，但对于心肌代谢功能的恢复则优于后者。     

疫情防控常态化时期福建省人体器官捐献协调员工作满意度研究

目的  分析新型冠状病毒肺炎（新冠肺炎）疫情防控常态化时期福建省人体器官捐献协调员工作满意度现状并提出相应建议。 方法  以网络问卷调查的方式,对福建省在职人体器官捐献协调员工作满意度相关情况进行调查。对人体器官捐献协调员工作总满意度各维度进行相关性分析,进而分析工作总满意度的影响因素。 结果  人体器官捐献协调员工作总满意度为（2.9±0.8）分,总体偏低,其中工作本身提升满意度为（4.7±1.3）分,工作薪酬福利满意度为（2.0±1.4）分,工作沟通满意度为（2.0±1.3）分。工作薪酬福利满意度与工作沟通满意度呈正相关（r=0.653,P < 0.05）。多重因素在工作满意度上存在差异,人体器官捐献协调员工作总满意度与性别、工作性质、工作年限、月平均收入、年龄、学历、岗位性质有关。 结论  新冠肺炎疫情防控常态化时期,福建省人体器官捐献协调员工作满意度偏低,建议从政府和医院等不同层面出发,采用灵活多样的方式,进一步完善人体器官捐献协调员相关保障政策。     

Unusual radiological presentation of sirolimus-associated pneumonitis

Sirolimus-associated pneumonitis, a rare but serious drug-induced lung injury, has become a great concern clinically, because of the increasing use of sirolimus (rapamycin) in patients who have been subjected to solid organ transplantation. We report sirolimus-associated pneumonitis in two women who underwent renal transplantation. At variance with previous reports, the radiological findings shown on chest radiographs and computed tomography scans of the chest in these two cases were consolidation lesions mainly with minimal interstitial abnormalities. Our reported cases highlight that awareness of various radiological findings of sirolimus-associated pneumonitis is pivotal for physicians to make early diagnosis of the disorder in patients who have undergone solid organ transplantation.     

Celioscopic intra-abdominal retraction: Comparison of two mechanical devices

The proper utilization and safety of rapidly developing celioscopic instrumentation remains uncertain. A porcine model was developed for testing two different types of mechanical, intra-abdominal retraction devices. One instrument was inflatable, forming a broad compliant interface for tissue retraction. The second device consisted of three rubber-shod metal arms which formed a rigid, non-contiguous sweep. Each intra-abdominal device was placed with identical manual traction upon the spleen, ileum and liver in sequential fashion with pressure maintained for 10min. Photographic documentation of the gross effects of retraction was obtained along with histological sectioning of each portion of the involved viscera with controls. The retraction devices produced small contusions with punctate, petechial haemorrhages within the tissue, with the tips of each capable of tissue laceration. On each organ, the balloon retraction device produced the least amount of gross and histological damage, demonstrating iatrogenic injury directly attributable to device design.     

Coping in relation to perceived threat of the risk of graft rejection and Health‐Related Quality of Life of organ transplant recipients

The most serious risk connected with transplantations besides infection is graft rejection. Organ transplant recipients (OTRs) perceive graft rejection as a stress factor and a threat. The primary aim of the present study was to examine types of coping used to handle the threat of the risk of graft rejection among OTRs and to investigate relations between coping and perceived threat as well as Health‐Related Quality of Life (HRQoL). A second aim was to test the General Coping Questionnaire (GCQ) for reliability in relation to the threat of the risk of graft rejection. Three different questionnaires, the Perceived Threat of the Risk of Graft Rejection (PTGR), GCQ and the SF‐36, were mailed to 229 OTRs between 19 and 65 years old. Patients were transplanted with a kidney, a liver or a heart and/or a lung. All patients with follow‐up time of 1 year ± 3 months and 3 years ± 3 months were included. With an 81% response rate, the study comprised of 185 OTRs. The differences between the transplanted organ groups in their use of coping were small. Likewise, coping related weakly with sex, age, time since transplantation and whether they had experienced graft rejections or not. The respondents tended in general to use more of the ‘positive’ coping (strategies related to positive well‐being). The measured coping in relation to the perceived threat of the risk of graft rejection seem to be relatively stable over time and quite independent of demographic and clinical variables.     

Drotrecogin alfa: a new approach in the treatment of severe sepsis

Severe sepsis is a common and frequently fatal condition. Evidence showing a link between the coagulation system and the inflammatory response to sepsis led to the development of drotrecogin alfa (activated) as an agent in the treatment of sepsis. This recombinant form of the natural protein, activated protein C (Xigris^TM, Eli Lilly & Co.), has been shown to significantly reduce mortality in a large randomised, controlled Phase III study involving 1690 patients. The exact mode of action of drotrecogin alfa (activated) remains uncertain, although it clearly combines anticoagulant and anti-inflammatory properties. Although associated with an increased risk of bleeding, this is usually procedure-related rather than spontaneous. Although costly, this is a drug that effectively reduces mortality rates in patients with severe sepsis.     

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目的　观察持续高流量血液滤过 (HVHF)对重症急性胰腺炎 (SAP)伴多器官功能障碍综合征(MODS)的治疗作用。方法　 1997～ 2 0 0 2年 2 8例SAP伴MODS接受了HVHF治疗。APACHEⅡ评分为(14 36± 3 96 )分 ,BalthazarCT评分为 (8 5± 1 4 )分。从发病到开始HVHF时间 (6 0± 6 1)d ,HVHF治疗时间为 (4 0 4± 3 99)d。置换液以前稀释方式输入 ,流量为 4 0 0 0mL/h ,血流量 2 5 0～ 30 0mL/min ,连续 2 4h不间断。滤器为AN6 9膜 ,面积 1 2m2 ,每 2 4h更换 1次。采用低分子肝素抗凝。结果　 2 8例病人中 ,2 0例治愈出院 ,2例因经济原因放弃治疗 ,6例死亡 (2 1 4 % )。HVHF后体温、心率和呼吸频率显著降低 ;APACHEⅡ评分显著下降(14 4± 3 9vs 9 9± 4 3,P <0 0 1) ;动脉血氧分压显著提高 (6 8 5± 19 5vs 91 9± 2 5 0 ,P <0 0 1)。所有病人均良好耐受HVHF治疗 ,HVHF过程中血流动力学稳定 ,未发现明显的副作用。结论　对SAP伴MODS的病人 ,HVHF明显改善体温、心率、呼吸频率、APACHEⅡ评分和动脉血氧分压。HVHF过程中血流动力学稳定 ,可能成为重要的辅助治疗措施。     

原发性高血压并糖尿病老年患者血压与靶器官损害的关联性研究

目的:探讨原发性高血压合并糖尿病老年患者血压与靶器官损害的关联性。方法:将本院收治的70例高血压合并糖尿病患者纳入A组,68例单纯高血压患者纳入B组,52例单纯糖尿病患者纳入C组,并将同时期的46例健康体检志愿者纳入D组。对四组患者的临床指标进行统计学分析。结果:A组患者的TC、LDL-C以及IMT水平均显著高于B、C两组;与B组比较,A组患者的24 h SBP、n SBP水平显著增高,同时24 h DBP、d DBP显著降低;A组患者的靶器官损害比例也显著高于其他组,比较差异均有统计学意义(P0.05)。结论:原发性高血压合并糖尿病能够显著加重患者的血压变异性以及靶器官的损害程度。     

心率变异性分析在青年高血压靶器官损伤患者的诊疗意义

目的:研究心率变异性(HRV)分析对青年高血压靶器官损伤患者的诊疗意义.方法:选取我院收治的青年高血压患者100例,依据患者是否伴发其他病症、器官损伤等因素,将入选患者划分为观察A组及观察B组各50例,观察A组患者为原发性高血压伴靶器官损伤组,观察B组为单纯原发性高血压组,选取同期于我院体检健康体的青年50例设为对照组进行对照研究;入选3组均进行24h动态生命体征以及心电图监测,对其相关指标变化情况进行对比分析.结果:观察A、B组SDNN、TRIA、SDNN5、PNN50明显低于对照组(P<0.05);观察A组SDNN、SDNN5、TRA、SDANN明显低于观察B组(P<0.05);观察B组各项心率变异性指标明显低于对照组(P<0.05);观察A、B组间PNN50比较统计学差异(P>0.05).结论:应用HRV分析可对青年高血压靶器官损害患者病情进行及早诊断,有助于提升临床疗效.