河北省生理科学会暨危重病医学专业委员会2004学术年会召开

河北省生理科学会暨危重病医学专业委员会于2004年6月4-6日在河北省石家庄市华北大厦召开了《河北生理科学会暨危重病医学专业委员会2004学术年会》,河北医科大学承办了此次会议。这是21世纪河北省生理科学会召开的第一次大型盛会。河北省生理科学会暨危重病医学专业相关从业人员140余人以极大的热情参加了大会。与会代表涵盖河北省各高校及研究单位的生理学和病理生理学教研工作,以及各医院Icu、麻醉、急诊与呼吸等危重病医学专业的临床工作人员。     

15例ICU危重病的护理体会

１５例ＩＣＵ危重病的护理体会莫金玲广西忻城县人民医院５４６２００随着我国医疗卫生事业发展，在较大医院都设立了重症监护室（ＩＣＵ）。现将笔者在自治区医院进修期间对１５例ＩＣＵ危重病人的护理介绍如下。１临床资料在１５例危重病人中，男性１０例，女性５例；年...     

双歧三联活菌胶囊联合早期肠内营养保护呼吸科危重病患者肠黏膜屏障功能作用

目的探讨双歧三联活菌胶囊联合早期肠内营养保护呼吸科危重病患者肠黏膜屏障功能作用。方法选取68例呼吸科危重病患者,随机分为联合组和对照组各34例。两组患者均予以留置胃管鼻饲行早期肠内营养。联合组患者在此基础上加用双歧三联活菌肠溶胶囊630mg研磨水化后自留置鼻饲管内注入,3次/d,连用14d。判断并比较两组患者治疗前和治疗14d后营养指标及肠黏膜屏障指标的变化。结果治疗14d后,两组患者白蛋白(ALB)、淋巴细胞总数(LYM)和三头肌皮褶厚度(TSF)指标均较前明显下降(t=2.17、2.24、2.39、2.91、3.03、3.42,P0.05或P0.01),且联合组的下降幅度明显低于对照组(t=2.15、2.24、2.22,P0.05);同时两组患者血清二胺氧化酶(DAO)和D-乳酸指标较前均明显下降(t=2.97、3.43、2.26、2.38,P0.05或P0.01),且联合组的下降值较对照组更明显(t=2.19、2.31,P0.05)。结论双歧三联活菌胶囊联合早期肠内营养可减轻或纠正呼吸科危重病患者的负氮平衡,减缓其营养状况恶化;并可下调血清DAO和D-乳酸指标,保护与改善其肠黏膜屏障功能,加快患者康复。     

小儿危重病护理评分法对于小儿护理的干预指导分析

目的:探讨小儿危重病护理评分法对于小儿护理干预指导的临床价值,寻求更有效的护理方法,提高护理质量。方法:从我院2013年2月至2015年4月收治的小儿危重患儿中随机选取120例,并分成观察组和对照组,观察组患儿采用小儿危重病护理评分法对小儿护理进行指导干预,对照组患儿则采用常规小儿危重病护理方法,分析对比两组患儿的临床护理效果。结果:根据评分法的不同分数段我们发现,评分数≤70的患儿并发症以及死亡率较高,而评分数≥90的患儿并发症以及死亡率较低(P0.05)。观察组的护理有效率为93.33%,对照组的护理有效率为73.33%,观察组的护理有效率明显高于对照组(P0.05)。结论:小儿危重病护理评论法可以对患儿的病情进行科学有效的评估,为临床护理提供科学依据。通过护理评分来指导干预小儿危重病护理,可以有效的提高护理有效率,增强临床护理水平和质量。     

整合医学在急诊科危重病救治中的应用

整合医学是医学发展的必然方向和必由之路,强调将医学各领域最先进的理论知识和临床各专科最有效的实践经验进行有机整合,是更加符合人体健康和疾病治疗的新医学体系。急诊科危重病员往往同时存在多脏器功能障碍,救治中应运用整体观、整合观和医学观的原则,切实解决临床实践中遇到的问题。当前,有必要在组织管理层面上借力整合医学推动急诊医学的建设与发展。     

小儿危重病护理评分法在小儿护理干预中的应用

目的:探讨小儿危重病护理评分法对于小儿护理干预的临床应用价值,提高我院的护理质量和护理水平。方法:随机选取2014年1月至2015年6月在我院住院治疗的小儿危重患儿68例,将他们随机分为观察组和对照组,每组患儿34例。观察组患儿采用小儿危重病护理评分法对小儿护理进行护理干预,对照组患儿则采用我院常规小儿危重病护理方法,分析对比两组患儿的临床护理效果。结果:观察组患儿的护理总有效率为91.17%,而对照组患儿的护理总有效率为73.52%,观察组的护理总有效率明显高于对照组(P0.05)。结论:小儿危重病护理评论法可以对患儿的病情进行科学有效的评估,为临床护理提供科学依据。通过护理评分来指导临床葫芦干预,可以有效的提高护理有效率,增强医疗服务水平和服务质量。     

胶质细胞谷氨酸转运体-1反义寡核苷酸对脑缺血预处理神经保护效应的抑制作用

本研究应用胶质细胞谷氨酸转运体-1(glial glutamate transporter-1,GLT-1)的反义寡核苷酸(antisense oligo-deoxynucleotides,AS-ODNs)抑制Wistar大鼠GLT-1蛋白的表达,观察其对脑缺血预处理(cerebral ischemic preconditioning.CIP)增强脑缺血耐受作用的影响,探讨GLT-1在CIP诱导的脑缺血耐受中的作用.将凝闭双侧椎动脉的Wistar大鼠随机分为7组:(1)Sham组:只暴露双侧颈总动脉,不阻断血流;(2)CIP组:夹闭双侧颈总动脉3 min;(3)脑缺血打击组:夹闭双侧颈总动脉8 min;(4)CIP 脑缺血打击组:夹闭双侧颈总动脉3 min作为CIP,再灌注2 d后,夹闭双侧颈总动脉8min;(5)双蒸水组:于分离暴露双侧颈总动脉(但不夹闭)前12 h、后12 h及后36 h右侧脑室注射双蒸水,每次5 μL,其它同sham组;(6)AS-ODNs组:于分离暴露双侧颈总动脉(但不夹闭)前12 h、后12 h及后36 h右侧脑室注射GLT-1 AS-ODNs溶液,每次5 μL,其它同sham组,再根据AS-ODNs的剂量进一步分为9 nmol和18 nmol 2个亚组;(7)AS-ODNs CIP 脑缺血打击组:于CIP前12 h、后12 h及后36 h右侧脑室注射GLT-1 AS-ODNs溶液,每次5 μL,其它同CIP 脑缺血打击组,根据AS-ODNs的剂量进一步分为9 nmol和18 nmol 2个亚组.Western blot分析法观察GLT-1蛋白的表达,硫堇染色观察海马CA1区锥体神经元迟发性死亡(delayed neuronal death,DND)情况.Western blot分析显示,侧脑室注射GLT-1 AS-ODNs可剂量依赖性地抑制大鼠海马CA1区GLT-1蛋白表达.硫堇染色显示,sham组和CIP组海马CA1区未见明显的DND;脑缺血打击组海马CA1区有明显的DND:预先给予CIP可显著对抗脑缺血打击引起的DND,表明CIP可以诱导海马CA1区神经元产生缺血性耐受,对抗脑缺血打击引起的DND;而在GLT-1 AS-ODNs CIP 脑缺血打击组,侧脑室注射GLT-1 AS-ODNs后,大鼠海马CA1区出现了明显的DND,表明GLT-1 AS-ODNs通过抑制大鼠GLT-1蛋白表达从而减弱CIP对抗脑缺血打击的神经保护作用.以上结果进一步证实了GLT-1参与CIP诱导的脑缺血耐受.     

白藜芦醇体外对肝癌HepG2细胞分化及P21WAF1/CIP1表达的影响

目的:探讨白藜芦醇(Resvratrol,Res)在体外对肝癌细胞分化及相关周期蛋白依赖激酶抑制因子P21WAF1/CIP1的影响.方法:体外培养肝癌HepG2细胞.用MTT法检白藜芦醇对HepG2细胞的生长抑制作用,用倒置显微镜观察肝癌细胞的形态改变,用放射免疫法检测其AFP分泌.以RT-PCR方法检测HepG2细胞中P21WAF1、CIP1mRNA的表达,用免疫细胞化学检测其P21WAF1、CIP1蛋白的表迭.结果:白藜芦醇呈时间剂量性抑制HepG2细胞株的增殖,使其亚细胞结构趋于正常,AFP分泌量下降,并显著上调HepG2细胞中P21WAF1/CIP1 mRNA和蛋白的表达.结论:白藜芦醇能诱导HepG2细胞在体外向正常肝细胞分化,并上调其P21WAF1/CIP1的表达.     

大鼠侧脑室注射腺苷A1受体反义寡聚脱氧核苷酸抑制脑缺血耐受的诱导

目的:观察侧脑室注射腺苷A1受体(ARA1)反义寡聚脱氧核苷酸(As-ODN)对脑缺血预处理(CIP)脑保护作用的影响,进一步探讨腺苷A1受体在CIP脑保护作用中的作用。方法:将54只凝闭双侧椎动脉的Wistar大鼠分为Sham组、CIP组、损伤性脑缺血组、CIP 损伤性脑缺血组、双蒸水 CIP 损伤性脑缺血组、ARA1As-ODN组、ARA1As-ODN CIP组、和ARA1As-ODN CIP 损伤性脑缺血组。ARA1As-ODN的剂量分为10nmol/5μl和20nmol/5μl,溶于双蒸水中,侧脑室注射。所有动物均在Sham手术后或末次全脑缺血/再灌注后7d断头取脑,硫堇染色观察海马CA1区锥体神经元迟发性死亡(DND)情况。结果:Sham组和CIP组均未见DND。与Sham、CIP组相比,损伤性脑缺血组出现了明显的DND,表现为组织学分级(HG)升高和锥体神经元密度(ND)下降(P<0.05)。CIP可显著抑制损伤性脑缺血引起的DND。与CIP 损伤性缺血组相比,ARA1As-ODN CIP 损伤性脑缺血组出现了显著的DND,表现为HG升高、ND降低(P<0.05),这种变化与ARA1As-ODN的剂量呈明显正相关。结论:腺苷A1受体As-ODN可阻断CIP诱导的脑缺血耐受,进一步证实了腺苷A1受体表达上调参与CIP诱导的脑缺血耐受。     

二氧化锰对氟喹诺酮类抗生素在多孔介质中吸附和迁移的影响

土壤中的金属氧化物如二氧化锰等能够影响污染物(如氟喹诺酮类抗生素)的吸附、迁移和降解等环境行为。本实验以环丙沙星(CIP,一种广泛使用的氟喹诺酮抗生素)为目标污染物,用二氧化锰覆盖石英砂(MOCS)模拟土壤中金属氧化物,采用等温吸附实验和土柱迁移实验探究金属氧化物对CIP在多孔介质中吸附和迁移的影响规律及机制。其中,等温吸附实验的主要目的是使用Freundlich模型定量分析二氧化锰对CIP的吸附作用,土柱迁移实验的主要目的是探究不同含量的二氧化锰(0、55和109μg Mn·g~(-1)sand)在多孔介质中对CIP迁移的影响。结果表明,较大比表面积的MOCS对CIP吸附的KF值是石英砂的1.63倍,导致随着锰含量从0增加至109μg Mn·g~(-1)sand,最大出流比C/C0从0.96降低至0.72,说明随着二氧化锰含量的增加,其对CIP迁移产生的抑制作用逐渐增强。该结果与一维对流扩散模型拟合结果一致,109μg Mn·g~(-1)sand土柱的katt1、katt2和Smax1值是55μg Mn·g~(-1)sand土柱相应值的2.04～2.33倍,是0μg Mn·g~(-1)sand土柱相应值的4.21～12.69倍。使用低表面张力溶液(20%乙醇背景溶液)淋洗土柱后,CIP总的质量回收率达到95%以上,表明本实验中二氧化锰对CIP的吸附是可逆的。由CIP迁移实验结果可知,二氧化锰对有机阳离子有较强的吸附作用,使机阳离子在土柱中的迁移受到抑制。     

血清乳酸评估对危重患者预后的临床研究

目的:研究血清乳酸评估对危重患者预后的意义,为后期临床诊断提供参考。方法:选取2012年3月—2014年4月我院收治的危重患者78例,对其血清乳酸进行评估,根据评估结果分为观察组与对比组,40例患者血清乳酸在监测过程中升高为观察组,38例患者血清乳酸监测持续正常为对比组。分析两组患者不良预后与临床变化,同时将观察组存活与死亡患者的血清乳酸监测情况进行评估。结果:观察组多器官功能不全者32例,休克31例,死亡22例;对比组多器官功能不全者15例,休克3例,死亡8例。观察组进入重症监护病房后,死亡组乳酸值为(6.21±2.51)mmol/L,乳酸峰值为(8.87±2.59)mmol/L,0.5天乳酸清除率为(23.21±18.54)mmol/L;存活组乳酸值为(2.21±1.89)mmol/L,乳酸峰值为(4.12±2.15)mmol/L,0.5天乳酸清除率为(44.78±26.58)mmol/L。结论:血清乳酸评估对危重患者预后具有十分重要的意义。     

重大疾病患者住院医疗费用影响因素实证研究

虽然我国医药卫生体制改革已经取得显著成效,但重大疾病患者住院医疗费用负担仍然沉重,因病致贫、因病返贫问题依然严峻。研究基于实地调研,对江苏省无锡市9家三级医院2015—2016年恶性肿瘤患者的住院医疗费用进行了描述性分析、单因素方差分析及多元逐步回归分析,结果显示：住院日、医院类型、转归情况是影响重大疾病患者住院医疗费用的主要因素。基于此,研究提出完善大病保障制度、控制医疗费用不合理上涨及提高重大疾病患者控费意识等对策建议,旨在控制医疗费用的不合理上涨,减轻大病患者的疾病经济负担和增强医改获得感。     

Biomarkers of Endothelial Activation Are Associated with Poor Outcome in Critical Illness

Background

Endothelial activation plays a role in organ dysfunction in the systemic inflammatory response syndrome (SIRS). Angiopoietin-1 (Ang-1) promotes vascular quiescence while angiopoietin-2 (Ang-2) mediates microvascular leak. Circulating levels of Ang-1 and Ang-2 in patients with SIRS could provide insight on risks for organ dysfunction and death distinct from inflammatory proteins. In this study, we determined if biomarkers of endothelial activation and inflammation exhibit independent associations with poor outcomes in SIRS.

Methods

We studied 943 critically ill patients with SIRS admitted to an Intensive Care Unit (ICU) of an academic medical center. We measured plasma levels of endothelial markers (Ang-1, Ang-2, soluble vascular cell adhesion molecule-1 (sVCAM-1)) and inflammatory markers (interleukin-6 (IL-6), interleukin-8 (IL-8), granulocyte-colony stimulating factor (G-CSF), soluble tumor necrosis factor receptor-1 (sTNFR-1)) within 24 hours of enrollment. We tested for associations between each marker and 28 day mortality, shock, and day 3 sequential organ failure assessment (SOFA) score. For 28 day mortality, we performed sensitivity analysis for those subjects with sepsis and those with sterile inflammation. We used multivariate models to adjust for clinical covariates and determine if associations identified with endothelial activation markers were independent of those observed with inflammatory markers.

Results

Higher levels of all biomarkers were associated with increased 28 day mortality except levels of Ang-1 which were associated with lower mortality. After adjustment for comorbidities and sTNFR-1 concentration, a doubling of Ang-1 concentration was associated with lower 28 day mortality (Odds ratio (OR) = 0.81; p<0.01), shock (OR = 0.82; p<0.001), and SOFA score (β = -0.50; p<0.001), while Ang-2 concentration was associated with increased mortality (OR = 1.55; p<0.001), shock (OR = 1.51; p<0.001), and SOFA score (β = +0.63; p<0.001). sVCAM-1 was not independently associated with SIRS outcomes.

Conclusions

In critically ill patients with SIRS, early measurements of Ang-1 and Ang-2 are associated with death and organ dysfunction independently of simultaneously-measured markers of inflammation.     

Association of Glycemic Control Parameters with Clinical Outcomes in Chronic Critical Illness

ObjectiveChronic critical illness (CCI) is a term used to designate patients requiring prolonged mechanical ventilation and tracheostomy with associated poor outcomes. The present study assessed the impact of glycemic parameters on outcomes in a CCI population.MethodsA retrospective case series was performed including 148 patients in The Mount Sinai Hospital Respiratory Care Unit (2009-2010). Utilizing a semi-parametric mixture model, trajectories for the daily mean blood glucose (BG), BG range, and hypoglycemia rate over time identified low- (n = 87) and high-risk (n = 61) hyperglycemia groups and low- (n = 90) and high-risk (n = 58) hypoglycemia groups. The cohort was also classified into diabetes (DM, n = 48), stress hyperglycemia (SH, n = 85), and normal glucose (n = 15) groups.ResultsHospital- (28% vs. 13%, P = .0199) and 1-year mortality (66% vs. 46%, P = .0185) rates were significantly greater in the high- versus low-risk hyperglycemia groups, respectively. The hypoglycemia rate (< 70 mg/dL) was lower among ventilator-liberated patients compared to those who failed to liberate (0.092 vs. 0.130, P < .0001). In the SH group, both hospital mortality (high-risk hyperglycemia 48% and low-risk hyperglycemia 15%, P = .0013) and 1-year mortality (high-risk 74% and low-risk 50%, P = .0482) remained significantly different, while no significant difference in the diabetes group was observed. There were lower hypoglycemia rates with SH compared to diabetes (< 70 mg/dL: 0.086 vs. 0.182, P < .0001; < 40 mg/dL: 0.012 vs. 0.022, P = .0118, respectively).ConclusionTighter glycemic control was associated with improved outcomes in CCI patients with SH but not in CCI patients with diabetes. Confirmation of these findings may lead to stratified glycemic control protocols in CCI patients based on the presence or absence of diabetes. (Endocr Pract. 2014;20:884-893)     

Detailed Characterization of Brain Dysfunction in a Long-Term Rodent Model of Critical Illness

Neurochemical Research - Critical illness encompasses a wide spectrum of life-threatening clinical conditions requiring intensive care. Our objective was to evaluate cognitive, inflammatory and...     

Intravenous Pamidronate is Associated with Reduced Mortality in Patients with Chronic Critical Illness

Objective: Chronic critical illness (CCI), characterized by prolonged mechanical ventilation and tracheostomy, commonly manifests with elevated bone resorption, which has previously been shown to abate after treatment with intravenous (IV) bisphosphonates. Our study assessed the impact of pamidronate administration on clinical outcomes in a CCI cohort.Methods: A retrospective case series was performed on 148 patients admitted to The Mount Sinai Hospital Respiratory Care Unit (RCU) from 2009–2010. We identified patients with CCI who did (n = 30) or did not (n = 118) receive IV pamidronate (30 to 90 mg). Both groups included patients with normal and abnormal renal function. Pamidronate was administered for elevated urine or serum N-telopeptide, hypercalciuria, or hypercalcemia.Results: RCU and 1-year mortality were significantly lower in the pamidronate group (0 and 20%, respectively) compared to nonreceivers (19 and 56%, respectively) (P = .0077 and P = .0004, respectively). After adjusting for differences in baseline creatinine, estimated glomerular filtration rate, and serum calcium, the association with reduced mortality remained significant at 1 year (P = .0132) and with borderline significance for RCU mortality (P = .0911). Creatinine was significantly lower 7 days following pamidronate administration (P = .0025), with no significant difference at 14 days compared to baseline. Pamidronate receivers showed a greater increase in albumin during the RCU stay (2.49 to 3.23 g/dL), compared to nonreceivers (2.43 to 2.64 g/dL) (P = .0007). Pamidronate administration was associated with a significantly reduced rate of hypoglycemia compared to RCU patients not receiving pamidronate (0.09 versus 0.12; P = .0071).Conclusion: Pamidronate use in a CCI population is associated with reduced mortality, lower hypoglycemia rates, improved albumin, and stable renal function.Abbreviations:BMI = body mass indexCCI = chronic critical illnessCI = confidence intervalCKD = chronic kidney diseaseCTx = C-telopeptideeGFR = estimated glomerular filtration rateICU = intensive care unitIV = intravenousNTx = N-telopeptidePMV = prolonged mechanical ventilationRCU = respiratory care unit     

心血管危重症继发交感风暴37例临床分析

目的:探讨心血管危重症继发交感风暴的病因分布特点和治疗方法。方法:回顾性分析我院2001年-2011年37例心血管危重症继发交感风暴临床资料。结果:37例心血管危重症继发交感风暴患者,其中男性22例,女性15例,年龄55-82岁,平均68.25岁。病因分布为:心肌梗死29例,心衰3例,扩张性心肌病2例,电解质紊乱2例,Brugada综合征1例。治疗方法包括β受体阻滞剂、胺碘酮、利多卡因、电除颤等。其中,17例因反复发作室颤,经抗心律失常药物和电除颤治疗无效死亡,余20例病情得到控制。结论:心血管危重症继发交感风暴临床病因多样,病情凶险,应用β受体阻滞剂及抗心律失常药物,同时积极针对病因及诱因治疗,可以改善临床症状和预后。     

Circulating MicroRNA-150 Serum Levels Predict Survival in Patients with Critical Illness and Sepsis

Background and Aims

Down-regulation of miR-150 was recently linked to inflammation and bacterial infection. Furthermore, reduced serum levels of miR-150 were reported from a small cohort of patients with sepsis. We thus aimed at evaluating the diagnostic and prognostic value of miR-150 serum levels in patients with critically illness and sepsis.

Methods

miR-150 serum levels were analyzed in a cohort of 223 critically ill patients of which 138 fulfilled sepsis criteria and compared to 76 healthy controls. Results were correlated with clinical data and extensive sets of routine and experimental biomarkers.

Results

Measurements of miR-150 serum concentrations revealed only slightly reduced miR-150 serum levels in critically ill patients compared to healthy controls. Furthermore miR-150 levels did not significantly differ in critically ill patients with our without sepsis, indicating that miR-150 serum levels are not suitable for diagnostic establishment of sepsis. However, serum levels of miR-150 correlated with hepatic or renal dysfunction. Low miR-150 serum levels were associated with an unfavorable prognosis of patients, since low miR-150 serum levels predicted mortality with high diagnostic accuracy compared with established clinical scores and biomarkers.

Conclusion

Reduced miR-150 serum concentrations are associated with an unfavorable outcome in patients with critical illness, independent of the presence of sepsis. Besides a possible pathogenic role of miR-150 in critical illness, our study indicates a potential use of circulating miRNAs as a prognostic rather than diagnostic marker in critically ill patients.