目的 探討早期堿剩余對感染性休克患者病情嚴重程度的預測價值。 方法 對2009年2月－2011年2月資料完整入院的感染性休克患者60例進行回顧性分析，按死亡及存活進行分組，對最初24 h的堿剩余值差異及血乳酸清除率情況進行對照研究。 結果 死亡組堿剩余值變化及乳酸清除率低于存活組（P＜0.05）。治療后堿剩余≤?6 mmol/L較堿剩余＞?6 mmol/L的患者病死率明顯增加，尤其是治療后24 h 堿剩余仍≤?6 mmol/L病死率高達92.23%。 結論 早期堿剩余有助于感染性休克預后評估和指導臨床治療。
【摘要】 目的 探討甲型H1N1流感危重癥患者的搶救療效。 方法 2009年10月－2010年1月，對我院ICU收治5例甲型H1N1流感危重癥患者采用集束化治療方案進行救治，并就患者的器官功能變化進行評價。 結果 5例患者平均住院天數為（11.8±5.59）d，4 例存活，1例死亡。存活患者在治療過程中急性生理和既往健康 （APACHE）Ⅱ、多器官功能障礙綜合征評分（MODS）、全身性感染相關的器官衰竭評分 （SOFA）總體呈逐漸下降趨勢。死亡者APACHEⅡ、SOFA評分均呈逐漸升高趨勢。 結論 對甲型H1N1流感危重癥患者采取集束化救治療效良好。【Abstract】 Objective To explore the effect of bundle therapy on severe patients with influenza A (H1N1). Methods Bundle therapy were used in 5 severe patients with influenza A from October 2009 to January 2010. The patients’ organ dysfunction were observed for. Results The average in-hospital duration was (11.80±5.59) days. Four patients survived and one died with the survival ratio of 80%. Acute physiology and chronic health evaluation (APACHE) II score, Multiple organ dysfunction syndrome (MODS) score and sepsis-related organ failure assessment (SOFA) score gradually decreased in 4 survived patients, while gradually increased in the died patient. Conclusion Bundle therapy is effective on patients with severe influenza A.
【摘要】 目的 探討膿毒性休克早期液體復蘇的臨床反應性。 方法 對2008年2月—2010年2月38例采用早期目標定向治療方案治療的膿毒性休克患者按是否存活進行分組，就中心靜脈壓、心率、平均動脈壓、輸液量、尿量、血乳酸等指標進行評價。 結果 38例采用早期目標定向治療方案治療6 h均達標，存活21例（55.26%），死亡17例（44.74%），兩組患者輸液總量及輸液種類差異無統計學意義（Pgt;0.05），存活組6、24 h尿量及血乳酸清除率明顯優于死亡組（Plt;0.05）。 結論 血乳酸清除率及尿量可作為膿毒性休克液體復蘇有效的臨床監測指標。【Abstract】 Objective To study the clinical response to early fluid resuscitation therapy in septic shock patients. Methods Thirty-eight septic shock patients received early goal-directed therapy (EGDT) in the ICU of our hospital from February 2008 to February 2010. The patients were divided into survival group (n=21) and dead group (n=17). Indexes like central venous pressure (CVP), heart rate (HR), mean arterial pressure (MAP), fluid input, urine output, and blood lactate were evaluated. Results Six hours after the EGDT, the results for the patients were all up to standard. There were 21 cases of survival (55.26%) and 17 cases of death (44.74%). The total fluid input and liquid types were similar in the two groups (Pgt;0.05). The urine output and lactate clearance at hour 6 and 24 for the survival group were better than that for the dead group (Plt;0.05). Conclusion The lactate clearance and urine output can be regarded as an surveillance indicator of fluid resuscitation for patients with septic shock.
Objective To observe the incidence rate of cardiovascular adverse events and evaluate the safety of dexmedetomidine or midazolan sedation in patients with long-term mechanical ventilation in intensive care unit (ICU). Methods From January 2014 to December 2015, patients admitted to ICU aged ≥18 years with mechanical ventilation time ≥48 hours were randomly divided into dexmetomidine group (group D) and midazolam group (group M). Adverse events such as cardiovascular events during sedation were observed. Results There were 144 cases in group D and 143 cases in group M. Slow heart rate was the prominent manifestation in group D. The incidence of heart rate <50 beats per minute in group D (4.86%) was less than that in group M (6.29%), but there was no statistical difference ( P=0.681). Group D had lower blood pressure (40.28% vs. 72.73%), tachycardia (18.75% vs. 41.96%), arrhythmia (16.67% vs. 34.97%) and 28- day mortality (22.22% vs. 42.66%) than those in group M (P<0.01). No cardiac arrest, sinus arrest, hypertension, hyperglycemia, or hypoglycemia were found in the two groups. Conclusion The long-term sedation of dexmetidine in patients with mechanical ventilation is safe; in cardiovascular adverse events, the 28-day mortality is lower than that of traditional midazolam sedation, and the duration of mechanical ventilation is no longer than that of traditional midazolam sedation, with slightly longer ICU length of stay.
Objective To evaluate the rescue intubation induced by ketamine and midazolam in patients with acute respiratory failure.Methods 81 patients with acute respiratory failure admitted between June 2010 and June 2012 were recruited in the study. They were randomly divided to a MF group to receive 0. 05 mg/kg of midazolam + 1 to 2 μg/kg of fentanyl ( n =41) , and aMK group to received 0. 05 mg/kg of midazolam + 0. 5 to 1 mg/kg of ketamine ( n =40) for rescue intubation. The APACHEⅡ score on initial24 hours after admission in ICU, length of ICU stay, and 28-day mortality were recorded. The differences in arterial blood pressure, heart rate, respiration rate, and blood oxygen saturation before intubation and 10 minutes after intubation were compared. Incidences of hypotension and other adverse events and difficult intubation were also recorded.Results The midazolamdose in the MK group was significantly less than that in the MF group ( P lt; 0. 01) . The blood pressure in both groups decreased. The systolic blood pressure dropped most significantly in the MF group ( P lt;0. 05) . The incidence of hypotension was 41. 5% in the MF group, significantly higher than that in the MK group ( 20. 0% , P lt;0. 05) . The incidence of hypotension had no correlation with midazolamdosage ( P gt;0. 05) . There was no significant difference in adverse events except for the arrhythmia between two groups. The length of ICU stay and 28-day mortality were similar in both groups ( P gt; 0. 05) . The incidence of difficult tracheal intubation was nearly 50% in both groups.Conclusions In patients with respiratory failure, rescue intubation induced by ketamine can reduce the dose of midazolam and reduce the incidence of hypotension without more complications. The optimal dose of ketamine in induced tracheal intubation requires further study.
目的 研究氯胺酮能否降低咪達唑侖誘導急診危重患者氣管插管對血壓的影響。 方法 將2010年6月－2011年12月收治的56例急診危重呼吸衰竭成年患者，隨機分成咪達唑侖+芬太尼（MF）組和咪達唑侖+氯胺酮（MK）組，氣管插管前咪達唑侖0.05 mg/kg靜脈注入，然后MF組芬太尼2 μg/kg靜脈注入，MK組氯胺酮0.5 mg/kg靜脈注入，待患者達鎮靜狀態后實施氣管插管。記錄用藥前和插管后10 min的收縮壓（SBP）、舒張壓（DBP）、平均動脈壓（MAP）、心率（HR）的變化，觀察低血壓的發生情況。 結果 實施藥物誘導氣管插管后血壓下降以MF組更明顯（P＜0.01）。低血壓發生率MF組為51.7%，MK組為18.5%，兩組比較差異有統計學意義（χ2=6.715，P=0.01）。 結論 急診危重患者氣管插管應用氯胺酮可減少咪達唑侖所致低血壓的發生率。