大黄对重度急性有机磷农药中毒的疗效

目的：观察大黄对重度急性有机磷农药中毒（SAOPP）的疗效。方法：将68例SAOPP患者随机分为大黄治疗组和对照组，对照组采用常规内科综合治疗，大黄治疗组在对照组治疗的基础上加用大黄粉鼻饲，监测两组患者首次排便时间、机械通气时间、胆碱酯酶（CHE）活性、C反应蛋白、自细胞计数、急性生理与慢性健康评分Ⅱ（APACHEⅡ评分）、阿托品用量、氯磷定用量、呼吸机相关性肺炎（VAP）发生率、多器官功能不全综合征（MODS）发生率及死亡率等相关指标，比较两组疗效。结果：与对照组比较，大黄治疗组患者首次排便时间缩短（P〈0．05）、机械通气时间缩短（P〈0．01）、CHE活性升高（P〈0．05或P〈0.01）、C反应蛋白含量降低（P〈0．05）、白细胞计数降低（P〈0．05或P〈0．01）、APACHE珏评分降低（P〈0．05或P〈0．01）、阿托品用量减少（P〈0．05）、氯磷定用量减少（P〈0．01）、VAP发生率降低（P〈0．05）、MODS的发生率降低（P〈0．05），其死亡率亦有所下降。结论：大黄可改善SAOPP患者的胃肠功能、促进肠道毒物排泄、减少解毒药物的用量，并且能减轻炎症反应、促进患者及早撤离呼吸机、降低病情的严重程度、防治MODS。     

乌司他丁治疗慢性阻塞性肺疾病急性加重期的临床疗效

Objective To discuss the effect of ulinastatin on chronic obstructive pulmonary disease with acute exacerbation and part of the mechanism. Methods Seventy-two cases consistent with the diagnostic criteria were randomly divided into ulinastatin statin therapy group and control group (36 cases each group),two groups both received conventional treatment,the treatment group on this basis was added ulinastatin with 200 000 U,intravenous injection, three times a day. Results In the treatment group the total effective rate was 86.11%, significantly better than in the control group 69.44% (P<0.05), its improvement in APACHE Ⅱ score,blood gas analysis and reduction in CRP,TNF-α,IL-8 was superior to the control group. The treatment group was significantly shorter than the control group in mechanical ventilation and ICU stay time (P<0.05). Conclusions Conventional therapy as basis plus ulinastatin has better clinical efficacy,for whose chronic obstructive pulmonary disease with acute exacerbation mechanism may lie in the inhibition of inflammatory mediators and cytokines release, reducing inflammation, relaxing smooth muscle,improving the patient's ventilatory function and blood rheotogy.     

危重甲型H1N1流感的甲基泼尼松龙治疗体会

目的探索甲型H1N1流感危重型患者的激素治疗。方法回顾性对我院收治的5例甲型H1N1流感危重患者使用激素后进行疗效观察。结果4例治愈,1例遗留有后遗症。结论甲型H1N1流感危重患者可试用的甲基泼尼松龙治疗,其疗效尚需进一步观察,同时注意大剂量糖皮质激素的副作用。     

乌司他丁治疗慢性阻塞性肺疾病急性加重期的临床疗效

Objective To discuss the effect of ulinastatin on chronic obstructive pulmonary disease with acute exacerbation and part of the mechanism. Methods Seventy-two cases consistent with the diagnostic criteria were randomly divided into ulinastatin statin therapy group and control group (36 cases each group),two groups both received conventional treatment,the treatment group on this basis was added ulinastatin with 200 000 U,intravenous injection, three times a day. Results In the treatment group the total effective rate was 86.11%, significantly better than in the control group 69.44% (P<0.05), its improvement in APACHE Ⅱ score,blood gas analysis and reduction in CRP,TNF-α,IL-8 was superior to the control group. The treatment group was significantly shorter than the control group in mechanical ventilation and ICU stay time (P<0.05). Conclusions Conventional therapy as basis plus ulinastatin has better clinical efficacy,for whose chronic obstructive pulmonary disease with acute exacerbation mechanism may lie in the inhibition of inflammatory mediators and cytokines release, reducing inflammation, relaxing smooth muscle,improving the patient's ventilatory function and blood rheotogy.     

锁骨下静脉置管并发纵隔旁血肿1例

患者,男,69岁,既往身体健康,因“化脓性脑膜炎”入院,因低血压而行右侧锁骨下静脉穿刺置管术,术后第1天复查双肺CT发现右肺上叶纵隔旁类圆形团块影。间隔4d后行双肺增强CT示右肺上叶纵隔旁见类圆形团块影,大小为4．9cm×5．4cm×5．0cm,其上缘与胸膜顶关系密切,平均病灶CT值为79HU,动态增强扫描病灶未见强化征象。结合临床分析考虑为纵隔旁血肿。     

1例急性胰腺炎合并胆囊坏疽和穿孔

2020年4月青岛大学附属威海市中心医院重症医学科收治1例脓毒性休克患者。此患者因腹痛入院,经急诊诊治鉴别,以“急性胰腺炎”收入消化内科。其病情进展迅速,因休克转入重症医学科进行抢救。对休克原因进行评估和筛查,经剖腹探查术术中明确诊断为急性胆囊坏疽并穿孔、急性胰腺炎。术后经抗感染、容量复苏、脏器功能支持,最终抢救成功。     

中心静脉压监测在救治急性右室心肌梗死中的应用价值

目的探讨急性右室心肌梗死扩容治疗时中心静脉压（CVP）应维持的最佳范围。方法将68例急性右室心肌梗死并低血压休克患者采用随机对照的原则分为3组（A组、B组、C组）,3组均予相同的基础治疗,如休息、吸氧、镇静、止痛、抗凝、抗血小板及再灌注治疗,在此治疗的基础上给予扩容治疗,使A组患者CVP维持在6~12 cm H2O,B组患者CVP维持在13-19 cm H2O,C组患者CVP维持在20-26 cm H2O,监测患者的心率、平均动脉压、心输出量、尿量及肺水肿发生率,比较各组疗效。另分别计算出单纯右室心肌梗死与非单纯右室心肌梗死患者的CVP值并进行比较。结果B组和C组在心率、平均动脉压、心输出量、尿量方面均优于A组（P〈0.05）,而B组和C组比较,差异无统计学意义;A组和B组的肺水肿发生率明显低于C组（P〈0.05）,而A组和B组比较,差异无统计学意义;单纯右室心肌梗死组的CVP明显高于非单纯右室心肌梗死组的CVP（P〈0.05）。结论急性右室心肌梗死扩容治疗时中心静脉压（CVP）应维持的最佳范围为13-19 cm H2O。     

乌司他丁治疗慢性阻塞性肺疾病急性加重期的临床疗效

Objective To discuss the effect of ulinastatin on chronic obstructive pulmonary disease with acute exacerbation and part of the mechanism. Methods Seventy-two cases consistent with the diagnostic criteria were randomly divided into ulinastatin statin therapy group and control group (36 cases each group),two groups both received conventional treatment,the treatment group on this basis was added ulinastatin with 200 000 U,intravenous injection, three times a day. Results In the treatment group the total effective rate was 86.11%, significantly better than in the control group 69.44% (P<0.05), its improvement in APACHE Ⅱ score,blood gas analysis and reduction in CRP,TNF-α,IL-8 was superior to the control group. The treatment group was significantly shorter than the control group in mechanical ventilation and ICU stay time (P<0.05). Conclusions Conventional therapy as basis plus ulinastatin has better clinical efficacy,for whose chronic obstructive pulmonary disease with acute exacerbation mechanism may lie in the inhibition of inflammatory mediators and cytokines release, reducing inflammation, relaxing smooth muscle,improving the patient's ventilatory function and blood rheotogy.     

乌司他丁治疗慢性阻塞性肺疾病急性加重期的临床疗效

Objective To discuss the effect of ulinastatin on chronic obstructive pulmonary disease with acute exacerbation and part of the mechanism. Methods Seventy-two cases consistent with the diagnostic criteria were randomly divided into ulinastatin statin therapy group and control group (36 cases each group),two groups both received conventional treatment,the treatment group on this basis was added ulinastatin with 200 000 U,intravenous injection, three times a day. Results In the treatment group the total effective rate was 86.11%, significantly better than in the control group 69.44% (P<0.05), its improvement in APACHE Ⅱ score,blood gas analysis and reduction in CRP,TNF-α,IL-8 was superior to the control group. The treatment group was significantly shorter than the control group in mechanical ventilation and ICU stay time (P<0.05). Conclusions Conventional therapy as basis plus ulinastatin has better clinical efficacy,for whose chronic obstructive pulmonary disease with acute exacerbation mechanism may lie in the inhibition of inflammatory mediators and cytokines release, reducing inflammation, relaxing smooth muscle,improving the patient's ventilatory function and blood rheotogy.     

乌司他丁治疗慢性阻塞性肺疾病急性加重期的临床疗效

Objective To discuss the effect of ulinastatin on chronic obstructive pulmonary disease with acute exacerbation and part of the mechanism. Methods Seventy-two cases consistent with the diagnostic criteria were randomly divided into ulinastatin statin therapy group and control group (36 cases each group),two groups both received conventional treatment,the treatment group on this basis was added ulinastatin with 200 000 U,intravenous injection, three times a day. Results In the treatment group the total effective rate was 86.11%, significantly better than in the control group 69.44% (P<0.05), its improvement in APACHE Ⅱ score,blood gas analysis and reduction in CRP,TNF-α,IL-8 was superior to the control group. The treatment group was significantly shorter than the control group in mechanical ventilation and ICU stay time (P<0.05). Conclusions Conventional therapy as basis plus ulinastatin has better clinical efficacy,for whose chronic obstructive pulmonary disease with acute exacerbation mechanism may lie in the inhibition of inflammatory mediators and cytokines release, reducing inflammation, relaxing smooth muscle,improving the patient's ventilatory function and blood rheotogy.