上消化道出血非手术治疗的现状

上消化道出血（upper gesitiresit bleeding,UGB）是指屈氏韧带以上的消化道出血,是临床常见的急症,必须紧急处理,若治疗不及时或不当,病死率较高。上消化道出血的病因很多,有器官本身溃疡、炎症、机械、肿瘤、血管病变、全身性血液病等。     

ICU老年肺部感染患者的临床特点

目的 探讨ICU老年肺部感染患者的临床特点,为临床诊断治疗提供依据.方法 对我院ICU收治的63例60岁以上的老年重症肺部感染患者的临床资料进行分析.结果 ICU老年肺部感染患者的病情危重,免疫功能低下,基础疾病多,并发症多,死亡率高.结论 ICU老年肺部感染患者的症状不典型,应重视肺部感染的早期诊断,积极治疗肺部感染的同时,应加强基础疾病的治疗.     

ICU常见机会性真菌感染CSCD

重症监护室(ICU)收治的患者多数都有免疫功能受损,是真菌感染的易感人群,这类人群发生真菌感染后病情严重,预后较差。ICU常见的机会性真菌感染有念珠菌、曲霉菌、隐球菌、马尔尼菲蓝状菌和组织胞浆菌等,主要与艾滋病、器官移植、恶性肿瘤、使用皮质类固醇激素和免疫抑制剂等因素相关,这些真菌感染临床症状常无特异性,容易被忽视而延误诊治。因此,熟悉ICU常见真菌感染的诊治原则,确保早期诊断和及时治疗,是降低真菌感染发生率和死亡率的关键。     

ICU常见机会性真菌感染

重症监护室(ICU)收治的患者多数都有免疫功能受损,是真菌感染的易感人群,这类人群发生真菌感染后病情严重,预后较差。ICU常见的机会性真菌感染有念珠菌、曲霉菌、隐球菌、马尔尼菲蓝状菌和组织胞浆菌等,主要与艾滋病、器官移植、恶性肿瘤、使用皮质类固醇激素和免疫抑制剂等因素相关,这些真菌感染临床症状常无特异性,容易被忽视而延误诊治。因此,熟悉ICU常见真菌感染的诊治原则,确保早期诊断和及时治疗,是降低真菌感染发生率和死亡率的关键。     

脓毒性休克的诊疗进展

<正>脓毒症是由于感染引起的全身性炎症反应综合征,为大手术术后、严重创伤或感染后常见并发症。脓毒症的发病机制复杂,病理过程涉及炎症、组织损害、凝血功能、免疫等一系列问题~([1]),且与机体多系统、多器官病理生理性改变相关~([2]),常见致病菌为革兰阴性细菌~([3])。脓毒性休克是重症监护室常见危重症,是脓毒症引起的循环功能障碍表现,具有发病急、进展快,且常累及多个脏器,严重威胁患者生命健康,降低患者的生活质量~([4])。近年来,器官功能支持技术及     

VEGF, MVD 在胃癌预后及上消化道出血风险的研究进展

胃癌是危害人类健康的常见恶性肿瘤,也是上消化道出血常见的病因之一。其发生发展是多因素、多基因改变参与的长期、协同的病理过程。血管生成(angiogenesis)是这一发展过程中的关键步骤,血管内皮生长因子(vascular endothelial growth factor,VEGF)和微血管密度(micro vessel density,MVD)作为调控血管生成的主要因子和微血管的主要评价指标,在胃癌患者预后、临床病理因素中的作用被广泛研究。上消化道出血(upper gastrointestinal hemorrhage)是胃癌患者的常见临床症状威胁和影响患者的生存质量。新近有研究者提出,VEGF及MVD与胃癌患者的上消化道出血风险正相关,本文就相关研究进展进行介绍。     

重症监护病房长期机械通气患者撤机困难的原因及死亡影响因素分析

目的:探讨重症监护病房(ICU)长期机械通气患者撤机困难的原因及撤机死亡的影响因素。方法:对2015年6月至2018年10月我院收治的80例长期机械通气患者的临床资料进行回顾性分析,按照患者撤机结果分为撤机成功组52例和撤机困难组28例,根据患者存活情况分为存活组59例和死亡组21例。比较各组临床资料,分析撤机困难的原因及撤机死亡的影响因素。结果:撤机困难组年龄、心功能不全比例、多器官功能障碍(MODS)比例、呼吸机相关肺炎(VAP)比例、肝功能不全比例、肾功能不全比例、血尿素氮显著高于撤机成功组,机械通气时间、气管切开时间显著长于撤机成功组,血清白蛋白显著低于撤机成功组(P0.05)。死亡组年龄、合并糖尿病比例、心功能不全比例、MODS比例、VAP比例、肝功能不全比例、肾功能不全比例、血尿素氮显著高于存活组,机械通气时间、气管切开时间显著长于存活组,血清白蛋白显著低于存活组(P0.05)。多因素Logistic回归分析显示:年龄、合并糖尿病、MODS、VAP、机械通气时间、气管切开时间、血清白蛋白是ICU长期机械通气患者撤机死亡的影响因素(P0.05)。结论:患者治疗期间发生脏器功能不全或器官功能衰竭、机械通气时间较长、气管切开时间较长、营养状态较差是长期机械通气患者撤机困难的主要原因,年龄、合并糖尿病、MODS、VAP、机械通气时间、气管切开时间、血清白蛋白是ICU长期机械通气患者撤机死亡的影响因素。     

190例上消化道出血的观察及护理

上消化道出血是指屈氏韧带以上的消化道（食管、胃、十二指肠、胰和胆等脏器）疾病引起的出血,是消化系统的常见病、多发病。临床表现为不同程度的呕血、黑便,常伴周围循环衰竭,是临床常见的急症之一。我院１９９７年１月至１９９８年７月共收治上消化道出血患者１９０...     

36例急性上消化道大出血抢救成功的护理与体会

急性上消化道大出血是临床上常见的急症,主要临床表现为呕血和解柏油样黑便,往往因失血量过多,引起急性循环衰竭,若抢救不及时,可导致死亡.我科自1990年以来收治急性上消化道大出血患者共36例,抢救效果良好,现将抢救护理经验总结介绍如下:1 临床资料本组36例中,男性28例,女性8例,18岁～39岁26例,40岁～60岁10例.经X线钡餐或纤维胃镜检查诊断为胃、十二指肠溃疡出血的19例,胃炎并发出血的11例,肝硬化食道下段静脉曲张破裂出血的6例.36例均以呕血和黑便为主.     

蝰蛇咬伤致多脏器功能衰竭抢救1例

<正>蝰蛇咬伤是临床常见急症。蝰蛇是以血循毒为主的毒蛇,被其咬伤后其毒素对全身组织器官均产生不同程度的中毒效应,部分病人很快出现多脏器功能不全(MODS),若不及时救治或救治失误可发生多脏器功能衰竭(MOF),而且其     

Multiple organ dysfunction syndrome.

The multiple organ dysfunction syndrome (MODS), though newly described, has manifested itself in intensive care unit (ICU) patients for several decades. As the name implies, it is a syndrome in which more than one organ system fails. Failure of these multiple organ systems may or may not be related to the initial injury or disease process for which the patient was admitted to the ICU. MODS is the leading cause of morbidity and mortality in current ICU practice. While the pathophysiology of MODS is not completely known, much evidence indicates that, during the initial injury which precipitates ICU admission, a chain of events is initiated which results in activation of several endogenous metabolic pathways. These pathways release compounds which, in and of themselves, are usually cytoprotective. However, an over exuberant activation of these endogenous systems results in an inflammatory response which can lead to development of failure in distant organs. As these organs fail, they activate and propagate the systemic inflammatory response. No therapy has proven entirely efficacious at modulating this inflammatory response and the incidence and severity of MODS. In current ICU practice, treatment is focused on prevention and treating individual organ dysfunction as it develops. With increased understanding of the pathophysiology of MODS therapy will come newer modalities which inhibit or interfere with the propagation of the endogenous systemic inflammatory response. These newer therapies hold great promise and already some are undergoing clinical investigation.     

伊曲康唑序贯疗法治疗老年MODS患者侵袭性肺部真菌感染14例

目的 观察伊曲康唑序贯疗法治疗老年多脏器功能障碍综合征（MODS）患者侵袭性肺部真菌感染的疗效。方法 回顾分析重症监护病房（ICU）中,老年MODS患者侵袭性真菌感染14例,最初应用伊曲康唑注射液7～14d,第1～2d,200mg,1次／12h,第3～14d,200mg,1次／d;然后,采用伊曲康唑胶囊或口服液序贯治疗,400mg／d剂量水平,疗程2—4周。结果 临床有效率85．7％,真菌清除率为92．9％,真菌清除平均天数为6．1d;患者28d生存率85．7％,不良反应发生率为42．9％。结论 对老年MODS合并侵袭性真菌感染患者在综合治疗的基础上,应用广谱抗真菌药物——伊曲康唑序贯疗法,是巩固疗效,防止复发值得推广的给药方式。临床应用伊曲康唑时,应注意适应证、药物不良反应及药物的相互作用。     

多发性骨髓瘤并发上消化道侵袭性念珠菌病2例报道及文献复习

目的 探讨多发性骨髓瘤(Multiple myeloma,MM)并发上消化道侵袭性念珠菌病的临床特点,提高诊治该病的水平.方法 回顾分析我科2例多发性骨髓瘤并发上消化道侵袭性念珠菌病的诊治过程,分析、总结治疗经验,并结合文献复习骨髓瘤并发上消化道侵袭性念珠菌感染的易感因素、临床表现、诊断和鉴别诊断及治疗.结果 MM患者1,女性,异基因造血干细胞移植术后4个月发生腹泻伴腹部隐痛,抗移植物抗宿主病(graftversus host disease,GVHD)治疗无效,经胃镜诊断上消化道念珠菌病,予卡泊芬净治愈出院.MM患者2,男性,化疗过程中疾病进展,并出现腹胀、腹痛,对症处理改善,再次化疗时上述症状加重并发肺部念珠菌病,发生急性心、肾功能不全,经胃镜诊断上消化道念珠菌病,予伊曲康唑、米卡芬净治疗,最终因肺部真菌感染加重,治疗无效死亡.结论 多发性骨髓瘤并发上消化道侵袭性念珠菌病易发生误诊、漏诊.临床医生需提高对该病的认识,首选电子胃镜明确诊断、判断疗效.     

重症监护病房洋葱伯克霍尔德菌医院感染的特征及耐药性分析

目的了解重症监护病房（ICU）洋葱伯克霍尔德菌引起医院感染的特征及耐药情况,为临床治疗及控制该菌的暴发流行提供实验依据。方法常规方法对我院2003年1月至2007年10月ICU的病人的各种临床标本进行分离培养,细菌鉴定及药敏试验采用全自动微生物鉴定仪VITEK-2进行。结果引起ICU医院感染的洋葱伯克霍尔德菌共有99例,感染以肺部感染为主,对临床常用的多种抗菌药物表现交叉耐药,对头孢匹肟、亚胺培南、哌拉西林、阿米卡星、庆大霉素的敏感率较差在50．0％以下;对环丙沙星、左氧氟沙星、头孢他啶、氨曲南、哌拉西林／他唑巴坦、美诺培南和复方新诺明的敏感率较高,分别为82．8％、87．9％、91．9％、72．7％、55．6％、62．6％和100．0％。结论引起ICU医院感染的洋葱伯克霍尔德菌具有多重耐药性,临床治疗时应根据药敏结果选用抗菌药物。     

Hemobilia--evolution of current diagnosis and treatment.

"Hemobilia," upper gastrointestinal tract bleeding that originates from within the biliary tract, has become widely recognized due to an increased clinical awareness of the disorder and to improvements in diagnostic techniques. In addition, the growing use of percutaneous liver puncture for the diagnosis of and therapy for hepatobiliary diseases and the increased incidence of both blunt and penetrating hepatic trauma have contributed to a rising incidence of hemobilia. We review the history, pathophysiology, and current approaches to the diagnosis and treatment of this disease.     

15例Dieulafoy病的内镜下诊断及治疗

目的:探讨消化道内窥镜对于胃Dieulafoy病的诊断和治疗作用。方法:对山东省立医院近3年收治的15例Dieulafoy病的临床资料进行回顾性分析。结果:13例内镜下止血治疗成功,无再出血(随访时间为12个月到36个月);1例内镜下治疗后再次出血,给予第二次内镜治疗后,随访18个月未再出血;1例因患者家属商议后坚持行外科手术治疗(近端胃切除术)。结论:内镜下治疗可作为处理胃Dieulafoy病的首选方案,仔细而谨慎的内镜下操作有助于提高胃Dieulafoy病的诊断。     

腹腔镜切除与内镜联合治疗胃肠道肿瘤的效果观察

目的：分析腹腔镜联合内镜治疗胃肠道肿瘤的可行性和临床效果。方法：对我院收治的行腹腔镜切除与内镜联合治疗的75例胃肠道肿瘤患者的临床资料进行回顾性分析,其中腹腔镜与胃镜联合治疗34例,腹腔镜与肠镜联合治疗41例。总结分析治疗效果。结果：75例患者中有72例手术成功,3例患者因肿瘤位置不佳中转开腹,腹腔镜与胃镜联合平均手术时间（72.8±12.7）min,出血量5~30mL,术后无吻合口瘘、吻合口出血、腹腔感染等并发症,住院时间（7.5±0.5）d。结论：腹腔镜联合内镜治疗胃肠道肿瘤具有创伤小、手术安全的特点,是一种有效、安全的治疗手段,值得临床推广应用。     

枯草杆菌二联活菌预防肝硬化上消化道出血后并发症的临床疗效研究

目的:探讨枯草杆菌二联活菌预防肝硬化上消化道出血后自发性细菌性腹膜炎(SBP)和肝性脑病(HE)等并发症的疗效。方法:将60例确诊为肝硬化合并上消化道出血患者随机分为对照组和治疗组(各30例),对照组采用常规综合治疗,治疗组在常规综合治疗基础上加用枯草杆菌二联活菌制剂,连续治疗2周后观察两组疗效及肝功能指标治疗前后的变化情况。结果:治疗组和对照组预防SBP的有效率分别为83.3%和56.7%,差异有统计学意义(P0.05);预防肝性脑病的有效率分别为83.3%和80%,差异无统计学意义(P0.05)。两组治疗后ALT、AST和ALB水平均明显改善,且治疗组改善较对照组更为显著,差异有统计学意义(P0.05)。结论:在基础治疗前提下,枯草杆菌二联活菌可预防肝硬化上消化道出血后SBP的发生,且有利于肝功能的改善。     

Gastric Cooling for Massive Upper Gastrointestinal Bleeding

The treatment of massive upper gastrointestinal hemorrhage by gastric hypothermia was studied clinically in 23 patients: five with peptic ulcer, six with multiple gastric erosions, nine with portal hypertension and varices, and three with coagulation defects. Hemorrhage was controlled in 13 of the patients. The high mortality (14 out of 23 patients) was attributed to the severity of the bleeding and to the underlying disease, particularly in patients with liver failure. This form of treatment is a useful method of treating selected patients with upper gastrointestinal hemorrhage.     

The patient with candidemia: Treatment choices and algorithms

Candidemia and other forms of invasive candidiasis have become increasingly important health care-associated infections. Risk factors are easily identified in patients with this disease, and about one half are residents of an ICU. In recent years, the treatment of candidemia and invasive candidiasis has significantly evolved from amphotericin B-based regimens to the echinocandins and fluconazole. A strategy of “step-down” therapy from an echinocandin to fluconazole in selected non-neutropenic patients with candidemia has been commonly practiced but not well studied. The approach to candidemia in the neutropenic patient is similar, but a lipid formulation of amphotericin B or voriconazole is often preferred because of the risk of concomitant mold infection. The biggest therapeutic challenge remaining to clinicians is the intensive care unit patient with multiple risk factors and a clinical suspicion of invasive candidiasis. Because optimal therapy in these patients is unknown, well-designed clinical trials and the continued development of non-culture-based diagnostic assays are crucial.