早期连续血液净化治疗腹部创伤术后腹腔高压的临床应用价值

目的探讨早期连续血液净化治疗（CBP）腹部创伤术后腹腔高压（IAH）的临床应用价值。方法回顾性分析福建医科大学附属二院重症医学科,2008年9月至2014年3月间收治的35例腹部创伤术后IAH患者临床资料,根据是否进行早期CBP,将患者分为早期CBP组（17例）和对照组（18例）。比较腹腔间隙综合征（ACS）发病例数、IAH持续时间和预后情况;比较两组的平均动脉压、氧合指数（PaO2／FiO2）水平、腹腔压力（IAP）平均值和乳酸水平。IAH持续时间、平均动脉压、PaO2／FiO2、IAP平均值和乳酸水平以-x±s表示,组间比较采用t检验;两组ACS发病例数和死亡例数比较采用χ2检验。结果早期CBP组出现ACS和死亡例数（分别为4例和2例）均较对照组（分别为13例和9例）明显降低,均差异有统计学意义（χ2=8．30,5．93;P〈0．05）;早期CBP组IAH持续时间[（3．22±1．47）d]较对照组[（6．53±2．38）d]缩短（t=4．91,P〈0．05）;早期CBP组的平均动脉压[（92．17±8．37）mmHg]（1mmHg=0．133kPa）和PaO2／FiO2水平（309．80±74．70）均高于对照组[分别为（68．92±8．35）mmHg和（256．60±85．50）],均差异有统计学意义（t=8．22,2．04;P〈0．05）;而早期CBP组的IAP平均值和乳酸水平[分别为（11．81±1．59）mmol／L和（2．05±1．31）mmol／L]则均低于对照组[分别为（18．38±3．87）mmol／L和（3．35±1．44）mmol／L],均差异有统计学意义（t=6．50,2．79;P〈0．05）。结论腹部创伤术后腹腔高压的早期CBP是一种能有效降低IAP和预防ACS的治疗措施。     

重症医学科重度子痫前期产妇围手术期临床路径的应用

目的 评价综合重症医学科(ICU)开展重度子痫前期产妇围手术期临床路径(CP)的效果,并分析其变异情况以促进质量改进.方法 比较福建医科大学附属第二医院ICU内实行CP前1年(2009年1月至12月,14例)和实施CP后1年(2010年1月至12月,22例)收治的重度子痫前期产妇ICU停留时间、住院费用、并发症发生率、病死率以及术后前3 d血压控制的总有效率.结果 与实施CP前1年组比较,实施CP后1年组ICU停留时间(h)明显缩短(65.5±24.9比86.3±28.2,t=2.321,P＜0.05),ICU住院费用(元)明显减少(6 463.6±1 838.2比8 136.5±2 142.8,t=2.496,P＜0.05),并发症发生率有所下降(36.4%比42.8%,x2=0.100,P＞0.05);血压控制的总有效率术后1 d、2 d明显提高(1 d:59.1%比14.3%,2 d:86.4%比50.0%,均P＜0.05),而术后3 d则无明显差异(95.4%比85.7%,P＞0.05).实施CP前1年组死亡1例,实施CP后1年组无死亡.结论 通过对重度子痫前期产妇围手术期实施CP管理,降低了患者的医疗负担,促进了医疗质量持续改进.

Abstract：

Objective To evaluate the effect of implementation of perioperative clinical pathway (CP)for severe preeclampsia patients in intensive care unit (ICU), and to discuss variation factors in order to improve clinical quality. Methods Thirty-six patients treated in ICU in the Second Clinical Hospital of Fujian Medical University were divided into two groups according to time of 1 year before implementation of CP (from January to December in 2009, n = 14) and 1 year after implementation of CP (from January to December in 2010, n = 22). The length of stay in ICU, cost of hospitalization, occurrence of major complications and mortality, as well as the total effective rate of control of blood pressure in the first 3 days after operation were compared. Results Compared with the group of patients of 1 year before implementation of CP, in the group of patients of 1 year after implementation of CP, the length of stay in ICU (hours) was significantly shorter (65. 5 ±24. 9 vs. 86. 3 ±28. 2, t = Z. 321, P＜0. 05), the cost of hospitalization (yuan) was significantly lower (6 463. 6±1 838.2 vs. 8 136. 5±2 142.8, r = 2. 496, P＜ 0. 05), the occurrence rate of major complications was lower (36. 4% vs. 42. 8%, x2 = 0. 100, P＞0. 05), the total effective control rate of blood pressure was significant improved on the 1st and the 2nd postoperative day (1 day: 59. 1 % vs. 14. 3%, 2 days: 86. 4% vs. 50. 0%, both P＜0. 05), but there was no significant change on the 3rd postoperative day (95. 4% vs. 85. 7%, P＞0. 05). One patient died before the application of CP,and none after its application. Conclusion These results suggested that it was beneficial to implement the program in preeclampsia patients to improve medical quality.     

氢溴酸山莨菪碱改善脓毒症休克患者微循环障碍的初步观察

目的:初步观察氢溴酸山莨菪碱(654-1)改善脓毒症休克患者微循环的临床疗效。方法:脓毒症休克患者62例,随机分为对照组和观察组,每组31例。对照组采用抗生素、液体复苏、升压等常规治疗,观察组在对照组基础上加用654-1(10mg, iv, q6h),疗程均为72h。收集两组患者治疗前、治疗后3h、6h、24h、48h、72h的毛细血管再充盈时间(CRT)、血乳酸(LAC)水平,以及治疗前、治疗后1天、3天、5天下肢坏死情况。手指按压法观察指/趾甲CRT;动脉血气分析仪检测LAC;彩色多普勒检测肢端坏死发生率。统计分析各指标组间差异。结果:观察组CRT治疗后24h、48h、72h明显短于对照组,观察组LAC治疗后48h、72h明显低于对照组,差异均有统计学意义(P<0.01),其它时间点两指标检测结果差异均无统计学意义(P>0.05)。治疗前及治疗后1天、3天两组未发现肢端坏死病例,及至治疗后5天对照组发生2例肢端坏死,观察组0例,组间发生率无统计学差异(P>0.05)。结论:常规治疗加654-1能明显改善脓毒症休克患者微循环障碍。     

小剂量阿加曲班在连续性血液净化治疗中的应用观察

目的 探讨分析小剂量阿加曲班在连续性血液净化治疗中的应用效果.方法 选取本院2015年1月～ 2015年12月收治的16例连续性肾脏替代治疗患者,给予其小剂量阿加曲班治疗,总结分析患者血滤器凝血和穿刺处出血及血肿情况.结果 统计观察发现,血凝器凝血情况治疗前后无明显差异,患者穿刺部位无明显出血和血肿情况,凝血Ⅰ级、Ⅱ级、Ⅲ级分别占13例(80.82％)、2例(16.44％)、1例(2.74％),凝血Ⅳ级为0.Ⅰ级、Ⅱ级、Ⅲ级凝血情况差异比较大,有统计学意义.结论 小剂量阿加曲班在连续性血液净化治疗中应用效果显著,能有效抗凝,无严重并发症,具有临床推广价值.     

重度子痫前期产妇产后早期血压调控的临床观察

目的 探讨并总结重度子痫前期产妇产后早期血压调控的经验.方法 回顾性分析34例重度子痫前期产妇产后早期血压调控的情况.按给药不同分为硝普钠组、硝酸甘油组、盐酸乌拉地尔组等3组,各组给药途径均为经静脉微泵.同时各组予静脉滴注人血白蛋白10 g后静脉推注速尿10 mg,每日3～4次.比较3组病人用药前、后1 h的血压变化,...     

重症医学科重度子痫前期产妇围手术期临床路径的应用

Objective To evaluate the effect of implementation of perioperative clinical pathway (CP)for severe preeclampsia patients in intensive care unit (ICU), and to discuss variation factors in order to improve clinical quality. Methods Thirty-six patients treated in ICU in the Second Clinical Hospital of Fujian Medical University were divided into two groups according to time of 1 year before implementation of CP (from January to December in 2009, n = 14) and 1 year after implementation of CP (from January to December in 2010, n = 22). The length of stay in ICU, cost of hospitalization, occurrence of major complications and mortality, as well as the total effective rate of control of blood pressure in the first 3 days after operation were compared. Results Compared with the group of patients of 1 year before implementation of CP, in the group of patients of 1 year after implementation of CP, the length of stay in ICU (hours) was significantly shorter (65. 5 ±24. 9 vs. 86. 3 ±28. 2, t = Z. 321, P＜0. 05), the cost of hospitalization (yuan) was significantly lower (6 463. 6±1 838.2 vs. 8 136. 5±2 142.8, r = 2. 496, P＜ 0. 05), the occurrence rate of major complications was lower (36. 4% vs. 42. 8%, x2 = 0. 100, P＞0. 05), the total effective control rate of blood pressure was significant improved on the 1st and the 2nd postoperative day (1 day: 59. 1 % vs. 14. 3%, 2 days: 86. 4% vs. 50. 0%, both P＜0. 05), but there was no significant change on the 3rd postoperative day (95. 4% vs. 85. 7%, P＞0. 05). One patient died before the application of CP,and none after its application. Conclusion These results suggested that it was beneficial to implement the program in preeclampsia patients to improve medical quality.     

富含ω-3多不饱和脂肪酸肠内营养制剂对重型颅脑损伤患者免疫平衡的影响

目的 观察富含ω-3多不饱和脂肪酸肠内营养制剂对重型颅脑损伤患者免疫平衡的影响。方法 选择2019年6月～2021年6月因重型颅脑损伤术后进入某院重症医学科加强监护治疗的患者42名，随机分为对照组[肠内营养混悬液(SP,百普力组),n=20]和实验组[肠内营养乳剂组(TPF-T,瑞能),n=22)]两组，患者在进入重症医学科后立即抽血行降钙素原(PCT)、外周血淋巴细胞总数、IL-2、IL-6、IL-10等检查。两组患者均经空肠营养管进行早期肠内营养支持，然后在入科后第48 h、72 h、96 h、7 d复测相关指标。通过对比上述数据的变化来评估富含ω-3多不饱和脂肪酸肠内营养制剂对重型颅脑损伤患者免疫平衡的影响。结果 在PCT的变化上，实验组与对照组无统计学差异(P>0.05)。在外周血淋巴细胞总数的变化上，实验组在进行肠内营养72h后明显高于对照组，差异具有统计学意义(P<0.05)。在IL-2、IL-6、IL-10的变化上，实验组在进行肠内营养96 h后明显低于对照组，差异具有统计学意义(P<0.05)。结论 富含ω-3多不饱和脂肪酸肠内营养制剂可能有助于降低重...