胰岛素强化治疗对严重创伤患者炎性反应及预后的影响

Objective To investigate the effects of intensive insulin therapy on inflammatory re-sponse and prognosis of patients with severe trauma. Methods Eighty severely injured patients were di-vided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2 -4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6 -8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-α, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed. Results High fever appeared in 9 patients in IT group, and WBC exceeded 10.0×109 for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 pa-tients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5% ). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-α and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3 - 7 ( P<0.05 or P<0.01 ), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group ( P<0.05 or P<0.01 ). Plasma levels of TNF-α ( 1.3±0.6 μg/L) and CRP (55±16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0±0.8μg/L, 89±20 mg/L, respectively, P <0.01 ). Conclusions Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.     

循证护理在预防人工气道肺部感染中的应用价值?

目的：探索循证护理在预防人工气道肺部感染中的应用。方法选取建立人工气道患者32例循证护理患者为循证护理组,急诊建立人工气道39例常规护理患者作为常规护理组,比较分析两组患者肺部感染发生率,临床肺部感染评分(CPIS)、前降钙素原(PCT)、C-反应蛋白(CRP)的差异。结果循证护理组肺部感染发生率、CPIS 评分、PCT、CRP 分别为6.25%、(41.01±8.22)mg/L、(0.06±0.12)mg/L、(1.16±0.36)分,显著低于常规护理组,差异有统计学意义(P <0.05)。结论循证护理能有效地预防人工气道患者肺部感染的发生。     

阿托伐他汀对脑梗死患者P-选择素、可溶性细胞间粘附因子-1、基质金属蛋白酶-9的影响

目的探讨阿托伐他汀对脑梗死患者P-选择素、可溶性细胞间粘附因子-1(SICAM-1)、基质金属蛋白酶-9(MMP-9)的影响。方法选择105例脑梗死患者随机分为两组,分别给予阿托伐他汀和常规治疗,采用双抗体夹心法测定P-选择素、酶联免疫法测定SICAM-1、夹心酶联免疫吸附法测定MMP-9。结果阿托伐他汀治疗组三项指标浓度明显降低(P<0.05),常规治疗组无明显变化(P>0.05)。结论阿托伐他汀有抗炎及稳定粥样斑块作用。     

脑梗死患者血清同型半胱氨酸与白介素-8水平的初步分析

目的:探讨同型半胱氨酸在脑梗死发病机制中的作用;方法:检测不同类型脑梗死患者血清同型半胱氨酸及白介素-8水平;结果:随着病情加重,血清HCY与IL-8浓度逐渐增加;结论:HCY可能参与脑梗死的发病机制.     

慢性乙型肝炎患者外周血Tc和Ts细胞分析

目的:探讨慢性乙型肝炎病毒感染后外周血Tc细胞和Ts细胞状态。方法:用双重染色免疫细胞学技术检测40例慢性乙型肝炎患者外周血Tc和Ts细胞,并与HbsAb(+)、HbcAb(+)健康人对比。结果:慢性乙型肝炎外周血Tc细胞水平低于对照组,Ts水平高于对照组,差异均有显著性。结论:慢性乙型肝炎患者外周血Tc和Ts细胞水平与HbsAb(+)、HbcAb(+)健康人不同,这两种细胞水平可能与乙型肝炎病毒感染后慢性化机制有关。     

丹参酮ⅡA对脑梗死患者血清细胞因子水平的影响

本研究检测急性脑梗死(ACI)患者治疗前后血清肿瘤坏死因子(TNF)-α、白介素(IL)-1β、IL-6含量变化,探讨丹参酮ⅡA治疗缺血性脑损伤的机制. 1 对象与方法 1.1 对象系2005年9～11月本院收治的病程<48 h的ACI患者45例.符合全同第四届脑血管病学术会议修订的诊断标准,并经头颅CT/MRI证实.随机分为2组,(1)丹参酮组:23例,男12例,女11例;年龄57～76岁,平均(66.3±12.1)岁;按改良的爱丁堡-斯堪地那维亚神经功能缺损量表评分(SSS)为(17.23±5.12)分.(2)维脑路通组:22例,男13例,女9例;年龄55～76岁,平均(67.4±10.7)岁;SSS为(16.95±4.91)分.(3)正常对照组:22人,本院同期健康体检者,男13人,女9人;年龄51～74岁,平均(62.2±11.4)岁.各组年龄、性别差异无统计学意义;入组者排除近2周有感染、创伤、伴发恶性肿瘤、免疫性或血液系统疾病、严重心肝肾功能不全及糖尿病.     

接种冻干麻疹疫苗引起全身过敏性紫癜1例

患者 ,女 ,7岁 ,1997年 5月 6日 10 :0 0在武城县卫生防疫站接种门诊接受麻疹疫苗加强免疫 ,于左上臂三角肌附着处外侧缘皮下注射冻干麻疹疫苗 0 2ｍｌ(上海生物制品研究所生产 ,批号 96 0 4 5 4 ,效期 1997年10月 )。 5月 7日 8:0 0左右 ,患者恶心、呕吐数次 ,四肢、躯干、颈、面部均出现红色小皮疹 ,其家长带到附近个体诊所就诊 ,按“过敏”给予肌注地塞米松 2ｍｇ ,口服息斯敏 5ｍｇ。 5月 8日到县人民医院就诊 ,其皮疹较前明显增多 ,且大小不等融合成片 ,高起皮肤成紫斑 ,压之不褪色 ,紫斑间皮肤正常 ,口腔黏膜亦出现紫斑并破溃 ,患者…     

胰岛素强化治疗对严重创伤患者炎性反应及预后的影响

Objective To investigate the effects of intensive insulin therapy on inflammatory re-sponse and prognosis of patients with severe trauma. Methods Eighty severely injured patients were di-vided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2 -4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6 -8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-α, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed. Results High fever appeared in 9 patients in IT group, and WBC exceeded 10.0×109 for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 pa-tients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5% ). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-α and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3 - 7 ( P<0.05 or P<0.01 ), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group ( P<0.05 or P<0.01 ). Plasma levels of TNF-α ( 1.3±0.6 μg/L) and CRP (55±16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0±0.8μg/L, 89±20 mg/L, respectively, P <0.01 ). Conclusions Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.     

COPD稳定期患者家庭氧疗的现状分析

目的了解慢性阻塞性肺疾病(COPD)稳定期患者家庭氧疗现状。方法对2016年6月至2017年8月在重庆市人民医院门、急诊及住院治疗的COPD患者共263例采用调查问卷的形式进行调查。结果263例调查者中对于氧疗的认识仅约10%的患者达到完全了解的程度,其中162例(61.60%)患者未实施氧疗,101例(38.40%)患者实施氧疗,但仅有11例患者每天吸氧时间大于15h达到指南的氧疗要求,且患者氧疗行为随意性大。结论 COPD患者对于COPD持续氧疗的优点及重要性的认识严重不足,急需广大医务工作者加大健康教育力度,寻求切实有效的方法改变COPD患者氧疗现状。     

中药成方影响因素之浅析

目的分析影响中药成方制剂疗效的因素。方法通过收集有关资料及生产经验,寻找影响中药成方制剂疗效的相关因素。结果影响中药成方制剂疗效的因素是多方面的,从原药材-生产-使用都息息相关。结论为了保证药品的安全、有效,必须严格控制质量,合理用药。