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早期乳酸清除率對重癥感染患者預后的評估研究

目的 分析早期乳酸清除率對重癥感染患者預后的臨床評估價值。方法 選取2009 年1 月至2011 年12 月收治的248 例重癥感染患者為研究對象進行回顧性分析。根據患者轉歸分為生存組和死亡組, 比較兩組一般資料、APACHEⅡ 評分、膿毒癥休克發生率、初始血乳酸濃度和治療 6 h的乳酸清除率差異。根據乳酸清除率水平分為高乳酸清除率組和低乳酸清除率組, 比較兩組一般資料、APACHEⅡ評分、膿毒癥休克發生率、初始血乳酸濃度和病死率的差異。結果 生存組和死亡組患者的一般資料、APACHEⅡ評分、初始血乳酸濃度間的差異均無統計學意義( P gt;0. 05) 。生存組乳酸清除率明顯高于死亡組[ ( 32. 6 ±11. 3) % 比( 15. 2 ±10. 1) % , P = 0. 024] , 而膿毒癥休克發生率明顯低于死亡組( 30. 9% 比87. 5% , P = 0. 019) 。高乳酸清除率組的膿毒癥休克發生率( 34. 6% 比 53. 7%) 及死亡率( 25. 5% 比61. 1% ) 明顯低于低乳酸清除率組( P 均lt;0. 05) 。結論 早期乳酸清除率可用于早期評估重度感染患者的預后轉歸。

Clinical Study on Cerebral Shock after Intracerebral Emorrhage

ObjectiveTo analyze the clinical characteristics of cerebral shock after intracerebral emorrhage (ICH) to enhance the understanding of cerebral shock after ICH. MethodsA total of 136 patients with ICH admitted to hospital from February 2010 to December 2011 were enrolled in this study.Barthel index (BI) and NIH Stroke Scale (NIHSS) were finished within 48 hours.All the patients were divided into cerebral shock group and no cerebral shock group.All of the 136 patients were matched to shock group (39 cases) and no shock group (39 cases) by the baseline NIHSS score.After 6 months,we judged the prognosis of stroke patient by mRS and compared the prognosis between the two groups. ResultsIn 136 patients,95 had cerebral shock (69.85%),and 41 didn't.The NIHSS score in the shock group was higher than that in the no shock group,but the BI score was lower in the shock group.Six months later,2 patients died in shock group,in which lost follow up was in 1,good prognosis in 11,and poor prognosis in 25.In no shock group,1 patient died,2 were lost of follow up,and the prognosis was good in 29 and poor in 7.The prognosis in the shock group was poorer than that in the no shock group. ConclusionThere are neurological deficit symptoms and poor self-care ability in ICH patients associated with brain shock.The period of brain shock impact the prognosis of the patients with cerebral hemorrhage;early functional rehabilitation for stroke patients with brain shock is expected to improve the prognosis of patients with cerebral stroke.

Diagnosis and Treatment of Septic Shock after Percutaneous Nephrolithotomy

【摘要】　目的　探討微創經皮腎鏡碎石術后并發感染性休克的原因和防治措施。　方法　回顧性分析2005年1月-2010年12月5例經皮腎鏡術300例，其中術后并發感染性休克5例的臨床資料。男1例，女4例，均表現為術后2~8 h內出現寒戰、高熱、煩燥不安，血壓降至80/50 mm Hg（1 mm Hg=0.133 kPa）以下，心率超過120次/min。所有患者均行抗感染和抗休克治療。　結果　所有患者均在72 h內停用升壓藥，1周內體溫及血常規恢復正常，術后15 d治愈出院。　結論　感染性休克是微創經皮腎鏡碎石術嚴重的并發癥之一，術前有效抗感染、術中低壓灌注、術后加強生命體征的監測、早期發現并合理處理，可有效防治感染性休克的發生。【Abstract】　Objective　To explore the etiology and treatment of septic shock after percutaneous nephrolithotomy. 　Methods　From Janurary 2005 to December 2010, the clinical data of five patients with septic shock after percutaneous nephrolithotomy in our hospital were retrospectively analyzed. The patients, including one male and four females, had chillness and high temperature after the nephrolithotomy. The blood pressure decreased to under 80/50 mm Hg （1 mm Hg=0.133 kPa）, and the heart rate was more than 120 per minute. All patients underwent anti-shock and anti-infection therapies rapidly.　Results　Five patients were cured in the end, their temperature and blood routine tests returned to normal within one week.　Conclusions　Septic shock is one of the serious complications after percutaneous nephrolithotomy. Effective preoperative preparation, low pressure irrigation during operation, early diagnosis and treatment postoperatively are the effective ways to prevent the septic shock.

Immunological Treatment for Sepsis and Septic Shock

Expression of hot shock protein 47 in pre-retinal membrane of proliferative vitreoretinopathy and the influence of transforming growth factor-β2 on expression of hot shock protein 47 in retinal pigment epithelial cell

ObjectiveTo observe the expression of hot shock protein 47 (HSP47) in pre-retinal membrane of proliferative vitreoretinopathy (PVR) and the influence of transforming growth factor-β2 (TGF-β2) on the expression of HSP47 in retinal pigment epithelial (RPE) cell. MethodsPre-retinal membranes were collected and observed by hematoxylin-eosin, Masson and immunohistochemical staining. Cultured ARPE-19 cells were treated with TGF-β2 at serial concentration (0, 1, 5, 10 ng/ml) and time (0, 12, 24, 48 hours), respectively. And then the mRNA and protein expressions of HSP47 and Col-Ⅰ were measured by fluorescence quantitative reverse transcription polymerase chain reaction and Western blot at the same time. ResultsA lot of epithelial cells with pigmental particles were observed in pre-retinal membranes of PVR, much accumulated collagen protein was observed in the specimens, and HSP47 positive expression was bserved in cytoplasm and stroma of most of the epithelioid cells. Compared with 0 ng/ml group, the expressions of HSP47 mRNA in ARPE-19 were up-regulated by 1.32, 2.35, 1.85 fold, significant differences were observed in all groups (F=27.21, P<0.05); the expressions of protein were up-regulated by 2.33, 2.89, 2.60 fold, significant differences were observed in all groups (F=39.78, P<0.05). The expressions of Col-Ⅰ mRNA were up-regulated by 1.29, 1.52, 2.11 fold, significant differences were observed in all groups (F=23.45, P<0.05); the expressions of protein were up-regulated by 1.18, 1.49, 2.11 fold and significant differences were observed in all groups (F=29.10, P<0.05). Compared with 0 hour group, the expressions of HSP47 mRNA were up-regulated by 1.56, 1.84, 2.86 fold in ARPE-19 cells stimulated by 5 ng/ml TGF-β2 for 12, 24 and 48 hours, and the differences were all significant (F=31.56, P<0.05); the expressions of protein were up-regulated by 2.08, 2.37, 2.80 fold, and the differences were all significant (F=49.18, P<0.05). The expressions of Col-Ⅰ mRNA were up-regulated by 1.57, 1.86, 2.78 fold and the differences were all significant (F=54.43, P<0.05), the expressions of protein were up-regulated by 1.38, 1.59, 2.16 fold and the differences were all significant (F=42.52, P<0.05). ConclusionTGF-β2 may play a role in the pathologic process of PVR by promoting the expression of HSP47 and then increasing the synthesis and accumulation of Col-Ⅰ.

Effect of electroconvulsive therapy on brain functional network in major depressive disorder

Electroconvulsive therapy (ECT) is an interventional technique capable of highly effective neuromodulation in major depressive disorder (MDD), but its antidepressant mechanism remains unclear. By recording the resting-state electroencephalogram (RS-EEG) of 19 MDD patients before and after ECT, we analyzed the modulation effect of ECT on the resting-state brain functional network of MDD patients from multiple perspectives: estimating spontaneous EEG activity power spectral density (PSD) using Welch algorithm; constructing brain functional network based on imaginary part coherence (iCoh) and calculate functional connectivity; using minimum spanning tree theory to explore the topological characteristics of brain functional network. The results show that PSD, functional connectivity, and topology in multiple frequency bands were significantly changed after ECT in MDD patients. The results of this study reveal that ECT changes the brain activity of MDD patients, which provides an important reference in the clinical treatment and mechanism analysis of MDD.

創傷性降主動脈肺動脈瘺并脊髓休克的圍術期護理

摘要:通過對1例創傷性降主動脈肺動脈瘺并脊髓休克的圍術期護理,使患者順利出院。術前嚴密的病情觀察、活動與飲食指導、積極的術前準備以及術后的嚴密監護、肢體血供的觀察與護理、體位管理與壓瘡護理、穿刺部位的觀察及護理、尿路感染及心理護理等是護理的關鍵。

頸部槍擊傷并頸動脈斷裂一例報告

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膈肌電刺激治療在膿毒性休克液體復蘇后困難撤機患者中的應用研究

目的 探討膈肌電刺激治療在膿毒性休克液體復蘇后困難撤機（撤呼吸機）患者中的應用研究。方法 將2022年1月—2024年10月在我院重癥監護病房（intensive care unit，ICU）治療的72例膿毒性休克液體復蘇后困難撤機患者隨機分為兩組。對照組使用常規呼吸訓練，在此基礎上，觀察組使用膈肌電刺激治療。對比兩組的膈肌指標、肺功能指標、撤機指標及并發癥情況、Borg呼吸困難評分及病情指標。結果 觀察組干預后平靜呼吸膈肌移動度、深呼吸膈肌移動度、深呼吸膈肌厚度均大于對照組（P<0.05）；觀察組干預后第1秒用力呼氣容積（forced expiratory volume in the first second，FEV1）、用力肺活量（forced vital capacity，FVC）、峰值呼氣流量、FEV1/FVC均高于對照組（P<0.05）。觀察組撤機成功率高于對照組，撤機時間、ICU住院時間短于對照組，呼吸機相關性肺炎、肺部氣壓傷、再插管等并發癥發生率低于對照組（P<0.05）。觀察組干預后Borg呼吸困難評分、急性生理學和慢性健康狀況評價Ⅱ評分、序貫器官衰竭評分低于對照組（P<0.05）。結論 膈肌電刺激治療在膿毒性休克液體復蘇后困難撤機（撤呼吸機）患者中的應用效果顯著，能提高膈肌活動度及厚度，改善肺功能，提高撤機成功率，降低相關并發癥風險，減少呼吸困難和疲勞，提高生活質量。

Dopamine versus Norepinephrine for Septic Shock: A Systemic Review

Objective To systemically review the efficacy and safety of dopamine versus norepinephrine in patients with septic shock. Methods Database searches of MEDLINE, EMbase, Cochrane Controlled Trials Register, VIP, CNKI, and CBM (from the date of database establishment to June 2011) were conducted. Additional studies for collecting relevant data were retrieved via both references of articles and direct contact with authors. Prospectively, randomized controlled trials (RCTs) of dopamine compared with norepinephrine therapy in septic shock patients were selected. The quality of included trials was assessed and relevant data were extracted. Then statistical analysis was performed using RevMan 5.1. Results Nine trials with 3 179 participants were included. The results of meta-analysis showed: compared with norepinephrine, dopamine was associated with a significant 12% elevation in the risk ratio of in-hospital death events of septic shock patients (RR=1.12, 95%CI 1.04 to 1.21, P=0.002). The risk of arrhythmias in dopamine group was 2.63-fold than that in norepinephrine group (RR=2.63, 95%CI 1.51 to 4.55, P=0.000 6). The cardiac index of septic patients in dopamine group was higher than that in norepinephrine group (MD=0.42, 95%CI 0.21 to 0.63, Plt;0.000 1). No significant difference could be found in the heart rate (MD=17.05, 95%CI –0.71 to 34.81, P=0.06) and mean arterial pressure (MD= –0.87, 95%CI –24.97 to 7.62, P=0.30). Conclusion Findings from this meta-analysis suggest that compared with dopamine, norepinephrine significantly reduces both 28-day mortality of septic shock patients and incidence rate of arrhythmias. Norepinephrine is better than dopamine in aspects of efficacy and safety.