床旁超声联合血乳酸对感染性休克患者容量反应性的预测价值分析

目的:研究床旁超声与血乳酸(LAC)联合应用于感染性休克患者容量反应性预测中的效能。方法:选取2015年10月~2017年10月于我院接受治疗的120例感染性休克患者进行研究。对所有患者均开展补液试验,并按照试验结果的差异将其分作反应组63例和无反应组57例。对两组人员均实施床旁超声检查以及LAC水平检测,并对比相关指标水平。通过Pearson相关性分析明确感染性休克患者床旁超声指标与LAC水平的关系。采用受试者工作特征(ROC)曲线分析床旁超声与LAC联合预测上述患者容量反应性的效能。结果:两组补液后平均动脉压(MAP)、中心静脉压(CVP)均高于补液前(P<0.05),反应组补液前下腔静脉呼吸变异率(△IVC)、主动脉峰值流速呼吸变异率(△VpeakAO)、肱动脉最大速度变异率(△VpeakBA)高于补液后及无反应组(P<0.05)。两组补液后LAC水平均低于补液前,且反应组低于无反应组(P<0.05)。经Pearson相关性分析可得:感染性休克患者LAC水平与△IVC、△VpeakAO、△VpeakBA均呈正相关(P<0.05)。经ROC曲线分析可知:床旁超声联合LAC预测感染性休克患者容量反应性的曲线下面积、灵敏度、特异度以及约登指数均高于床旁超声和LAC单独预测。结论:感染性休克患者补液后LAC水平降低,床旁超声联合LAC预测感染性休克患者容量反应性的效能较高,具有一定的临床应用价值。     

心脉通胶囊联合非诺贝特对饮食控制疗法效果不佳的高脂血症患者血脂、血液流变学和血管内皮功能的影响

摘要 目的：观察心脉通胶囊联合非诺贝特对饮食控制疗法效果不佳的高脂血症患者血脂、血液流变学和血管内皮功能的影响。方法：所选病例为我院2019年5月~2021年9月期间接诊的68例饮食控制疗法效果不佳的高脂血症患者。采用随机数字表法进行分组,68例患者共分为对照组和联合组,例数各为34例。对照组患者接受非诺贝特治疗,联合组患者接受心脉通胶囊联合非诺贝特治疗,对比两组临床总有效率、血脂、血液流变学和血管内皮功能,记录两组治疗期间不良反应发生情况。结果：联合组的临床总有效率高于对照组（P<0.05）。治疗2个月后,联合组的血清全血还原黏度、低密度脂蛋白胆固醇（LDL-C）、血管内皮素-1（ET-1）、血浆比黏度、甘油三酯（TG）、全血比黏度、总胆固醇（TC）、纤维蛋白原水平、血细胞比容水平低于对照组,降钙素基因相关肽（CGRP）、高密度脂蛋白胆固醇（HDL-C）、一氧化氮（NO）水平高于对照组（P<0.05）。两组不良反应发生率对比无统计学差异（P>0.05）。结论：心脉通胶囊联合非诺贝特治疗饮食控制疗法效果不佳的高脂血症患者,可有效控制血脂,调节血液流变学和血管内皮功能,应用价值较好。     

彩色多普勒超声测量椎动脉血流量对后循环缺血的诊断价值

目的：探讨彩色多普勒超声技术测量椎动脉血流量对后循环缺血（PCI）的诊断价值。方法：选取2012年1月至2013年1月在本院神经内科住院并接受治疗的PCI患者58例作为观察组,另选取同期住院并确诊为非后循环缺血症的患者50例作为对照组。所有患者均接受颈部血管超声检查,测量椎动脉内径及血流量,观察组患者需行头颅CTA检查,比较两组患者的椎动脉内径、血流量及颈动脉硬化斑块发生率等。结果：观察组患者的椎动脉内径及血流量明显低于对照组,两组比较差异有统计学意义（P〈0．01）;观察组颈动脉硬化斑块的发生率为77．5％（44例）,对照组颈动脉硬化斑块的发生率为42％（21例）,两组比较差异有统计学意义（P〈0．05）。无狭窄、轻度狭窄、重度狭窄及闭塞的椎动脉血流量的变化（此处所指的血流量是指小于200mL/min那部分患者）有明显差异（P〈0．05）。结论：与头颅CTA对比检查,彩色多普勒具有直接、准确、方便及可重复性等优点,可有效的诊断后循环缺血症状。     

Relevance of blood groups in transfusion of sickle cell disease patients

Blood groups are clinically significant in sickle cell disease (SCD) as transfusion remains a key treatment in this pathology. The occurrence of a delayed haemolytic transfusion reaction (DHTR) is not rare and is a life-threatening event. The main cause of DHTR is the production of alloantibodies against red blood cell antigens. The high rate of alloimmunization in SCD patients is mainly due to the differences of red blood groups between patients of African descent, and the frequently Caucasian donors. From an immuno-haematological point of view, DHTR in SCD patients has specific features: classical antibodies known to be haemolytic can be encountered, but otherwise non significant antibodies, autoantibodies and antibodies related to partial and rare blood groups are also frequently found in individuals of African descent. In some cases, there are no detectable antibodies. As alloimmunization remains the main cause of DHTR, it is extremely important to promote blood donation by individuals of African ancestry to make appropriate blood available.     

无创呼吸机在慢性阻塞性肺疾病急性加重期应用的疗效评价

摘要目的：观察无创呼吸机对不伴有呼吸衰竭的慢性阻塞性肺疾病急性加重期（AECOPD）患者症状、体征、血气分析和肺功能的影响。方法：80例AECOPD患者随机分为对照组和试验组,对照组给予常规治疗,如常规抗感染、化痰、平喘等治疗。试验组在常规治疗的基础上给予无创呼吸机正压通气（NIPPV）治疗。评价两组患者治疗前和治疗一周后临床症状体征、血气分析和肺功能的变化。结果：两组患者治疗后临床症状及体征评分较治疗前均呈下降趋势（P〈0．05）,但试验组下降更为明显（P〈0．05）,并且试验组症状改善时间明显缩短（P〈0．05）;治疗后两组的pH,PO2和SaO2均较治疗前升高,PC02较治疗前下降（P〈0．05）,和对照组相比,治疗后试验组的PO：和PC02改善更明显（P〈0．05）,而pH和Sa02无显著差异（P〉0．05）;治疗后两组的FEV1,FVC,FEV1实测值／预计值和FEVI％均较治疗前升高（P〈0．05）,试验组升高更明显（P〈0．05）。结论：对不伴有呼吸衰竭的AECOPD患者早期应用NIPPV治疗能有效改善临床症状和体征,缩短症状改善时间,改善通气,缓解呼吸肌疲劳,预防呼吸衰竭的发生。     

Blood Perfusion in a Murine Fibrosarcoma Tumor Model After Direct Current Electrotherapy a Study with 86Rb Extraction Technique

Electrotherapy with low-level direct current (DC) can induce antitu-mor effects in various tumor models. Applied in combination with certain anticancer drugs, it can significantly increase their effectiveness. It has been suggested that the demonstrated effects of electrotherapy arise from its modification of tumor blood flow. The effect of such treatment on blood perfusion of solid subcutaneous Sa-1 fibrosarcoma tumors in A/J mice was investigated with a ⁸⁶rubidium extraction technique. Following electrotherapy, the relative tissue perfusion of tumors was decreased by more than 50%. Three days after treatment, partial reperfusion of tumors occurred. The dynamics of the perfusion changes induced by electrotherapy are in agreement with tumor growth dynamics following this procedure. The effect of electrotherapy on the blood supply of tumors may be the major mechanism of antitumor action in our model. Electrotherapy could be useful as an adjuvant local procedure to other treatment modalities that require a hypoxic environment for their effectiveness.     

血液或无菌体液培养阳性标本中病原菌检测结果分析

目的：了解血培养（包括血液、无菌体液培养,下同）阳性标本中病原菌的分布及阳性报警时间,为临床及时明确病原菌和正确用药提供参考依据。方法：无菌条件下采集血培养标本注人相应的培养瓶,经仪器扫描后放入血培养仪进行检测,报警后及时进行菌种鉴定和药敏试验。结果：364例阳性报警标本中真阳性标本为176例,其中革兰阳性菌占61．7％,革兰阴性菌占35．0％,真菌占3．3％;188例为假阳性标本,其中革兰阳性菌占54％,革兰阴性菌占41．9％,真菌占4．0％;新生儿科的感染阳性率最高;不同种类病原菌的阳性报警时间多重叠;临床医生经验用药正确或根据药敏结果更换用药的百分比为78．2％。结论：本院引起血液、无菌体液感染的病原菌以革兰阳性细菌为主,病原菌种类较多,存在一定的污染;当新生儿有局部感染时要警惕脓毒血症;单独靠血培养仪报警时间来鉴定区分病原菌与污染菌不一定可靠,及时了解血培养结果及标准药敏结果可以辅助找出感染性疾病的病因,尽早正确合理的使用抗菌药物,从而优化抗菌治疗。     

Trypanosoma brucei: attenuation by cortcosteroids of the anemia of infected mice

BALBc/J mice infected with pleomorphic stabilate of Trypanosoma brucei develop a severe anemia. The anemia is initially normoblastic and normocytic but becomes macrocytic due to brisk and sustained reticulocytosis. Red blood cells from uninfected animals are destroyed when transfused into infected animals. Neither extensive intravascular hemolysis nor red cell agglutinins were detected in infected animals, but spherocytes were common in the peripheral circulation. Treatment of mice with either dexamethasone or hydrocortisone greatly retarded the development of the anemia. Comparison of the course of infection in these treated mice to that in normal mice suggests that these corticosteroids attenuate the anemia through their immunosuppressive action.