全身炎症反应患者血液净化时抵抗素含量变化的研究

目的研究连续性血液净化（CBP）治疗对全身炎症反应综合征（SIRS）患者血清抵抗素含量的影响。方法将120例SIRS患者在常规对症治疗的基础上,分为常规治疗组60例;以及在常规治疗的基础上进行CBP治疗组（CBP组）,CBP组患者均在常规治疗的同时行CBP治疗72h,在治疗0,24,48,72,96h时检测患者血清抵抗素含量,并进行APACHEⅡ评分。结果两组SIRS患者治疗前血清抵抗素含量均明显高于正常对照组（P〈0．01）,且常规治疗组和CBP组抵抗素含量比较无统计学意义（P〉0．05）,经过96h治疗,各组患者抵抗素水平均明显降低常规治疗组经过96h治疗,血清抵抗素水平降低缓慢（P〈0．05）;CBP治疗组经CBP治疗后SIRS患者血清抵抗素含量逐渐降低,治疗48h后已显著低于治疗前（P〈0．05）,治疗72h后降低更为明显（P〈0．01）。SIRS患者抵抗素与APACHEⅡ评分呈正相关（r=0．58,P〈0．01）。结论CBP治疗可清除血液中炎症因子抵抗素的作用,改善患者内皮细胞功能,并为临床观察CBP的治疗效果提供了新的监测指标。     

Molecular dynamics of ultradian glucocorticoid receptor action

In recent years it has become evident that glucocorticoid receptor (GR) action in the nucleus is highly dynamic, characterized by a rapid exchange at the chromatin template. This stochastic mode of GR action couples perfectly with a deterministic pulsatile availability of endogenous ligand in vivo. The endogenous glucocorticoid hormone (cortisol in man and corticosterone in rodent) is secreted from the adrenal gland with an ultradian rhythm made up of pulses at approximately hourly intervals. These two components - the rapidly fluctuating ligand and the rapidly exchanging receptor - appear to have evolved to establish and maintain a system that is exquisitely responsive to the physiological demands of the organism. In this review, we discuss recent and innovative work that questions the idea of steady state, static hormone receptor responses, and replaces them with new concepts of stochastic mechanisms and oscillatory activity essential for optimal function in molecular and cellular systems.     

外科ICU腹腔感染患者行连续性血液净化的护理

目的探讨外科ICU严重腹腔感染患者行连续性血液净化(continuous blood purification,CBP)的护理对策。方法回顾性总结2007年1月至2009年6月107例重症急性胰腺炎或肠瘘合并腹腔感染患者床边行CBP治疗的临床资料及护理体会。结果 107例患者中死亡11例,放弃治疗6例,余90例患者行CBP治疗24 h后症状、体征改善。所有患者在CBP治疗期间发生的并发症:导管感染32例(29.90%),意外拔管3例(2.80%),凝血8例(44.85%),血流动力学改变5例(14.01%)。结论腹腔感染患者行CBP治疗对清除炎症介质和细胞毒素、替代肾脏功能有较好的临床效果,但也带来了额外的风险;加强基础护理和心理护理、重视血流动力学监测和预见性护理对提高治疗效果、降低并发症的发生率有重要意义。     

全身炎症反应综合征患者行连续性血液净化的护理

目的探讨连续性血液净化（CBP）治疗应用于全身炎症反应综合征患者的护理措施。方法对12例全身炎症反应综合征危重患者应用CBP治疗,重点对患者进行严格无菌操作,严密观察病情变化,做好针对性护理,及时发现并协助ICU医师处理各种并发症。结果经CBP治疗后,生化检查示多种炎症介质较治疗前滴度明显下降,全身炎症反应减轻,11例患者转普通病房继续治疗,1例患者因费用原因放弃治疗。结论CBP治疗对全身炎症反应综合征危重患者有显著疗效,治疗期间严密监控和精确护理是保证疗效的关键。