目的:提高临床医师对以腹痛为首发症状的肥胖型2型糖尿病酮症酸中毒（DKA）并高脂血症（HL）性急性胰腺炎（AP）的认识。方法:回顾性分析我院2005年1月至2008年3月收治的9例肥胖型2型糖尿病酮症酸中毒并高脂血症性急性胰腺炎患者的临床资料。结果:（1）9例均为青年男性，年龄30.78±5.56岁；（2）病前均无糖尿病史及相关症状，均无高脂血症史；（3）病前均无暴饮、暴食和胆石症史；（4）均以腹痛为首发症状，均有腹压痛；（5）均为肥胖体型，体质指数28.33±1.54 kg/m2；（6）均达到DKA诊断标准；（7）入院时有7例血淀粉酶升高，其中6例超过正常值3倍以上，2例正常（其中1例入院后升高达正常值3倍以上）；（8）入院时均有高脂血症，其中3例脂血，6例TG均gt;113 mmol/L，DKA纠正后（入院后第3天）TG降至1.1～1.8 mmol/L，TC降至3.6～4.6 mmol/L；（9）B超或CT均有胰腺炎改变；（10）治愈后症状解除，血TG、TC均正常或稍高，血尿淀粉酶均正常。结论:（1）以腹痛就诊的DKA患者，应常规查TG、TC、血尿淀粉酶、胰腺B超或CT，以排除高脂血症性胰腺炎；（2）青年肥胖型2型糖尿病可能以糖尿病酮症酸中毒并高脂血症性急性胰腺炎为首发表现入院。
目的：探讨毒蕈中毒所致中毒性肝炎的临床表现、治疗与预后关系。方法：对3例急性毒蕈中毒患者进行回顾性临床分析。结果：3例患者均出现中毒性肝炎，2例经治疗后好转，1例因多器官功能衰竭死亡。结论：中毒性肝炎如导致多脏器损害，预后差；及早洗胃，彻底清除毒物是救治关键；血浆置换治疗有一定疗效，肝移植是最有效的治疗手段。
目的：探讨醒脑静注射液联合纳络酮注射液在急性安定中毒治疗中的疗效。方法：本研究采用醒脑静注射液联合纳络酮注射液治疗急性安定中毒55例并与单纯纳络酮治疗的51例进行对照。106例患者均经静脉血毒物测定为安定中毒；来诊时均有意识障碍，平均年龄（30.35±7.95）合并酒精中毒及其他疾病20例，常规给予洗胃、补液、利尿促排泄、纠正电解质失衡、吸氧及抗感染等对症处理。结果：醒脑静注射液治疗组与对照组患者比较，神志恢复时间(h),治疗组(1.73±0.98)显著短于对照组(3.22±1.38)(P＜0.01)；同组患者就诊时与清醒后的神志、呼吸、血压、心率及瞳孔等临床指标比较差异有显著性(P＜0.05)。结论:醒脑静注射液与纳络酮联合应用，治疗急性安定中毒与对照组比较起效快、疗效确定，临床应用安全可靠。
目的：观察慢性酒精中毒所致震颤谵妄的临床特点及预后。方法：对32例慢性酒精中毒所致震颤谵妄患者的临床资料进行回顾性分析，探讨其临床特点及预后。结果：32例患者中，因应激方式不当饮酒者19例，平均饮酒年龄20.3±9.6年，平均每日摄入乙醇量276.4±21.9 g。因戒断而出现临床症状者15例。临床表现为多种精神症状和不同程度的意识障碍，伴有肢体震颤。头部CT扫描发现脑萎缩者30例。经治疗后症状痊愈者25人，好转者4人。结论：慢性酒精中毒所致震颤谵妄发作的病理生理机制尚不明了，但其发作与戒断关系密切，经积极干预可获得较满意的预后。
探讨血液灌流（HP）对急性药物中毒患者血中毒物的清除作用及临床疗效。方法：收集我院2002年7月～2006年12月住院的鼠药（主要为毒鼠强、四亚甲基二砜四胺）和部分药物中毒患者69例，其中34例按常规给予洗胃、解毒、排毒、保肝、利尿或呼吸支持等综合治疗（非HP组），35例在综合治疗基础上同时给予HP。通过观察灌流前后的临床疗效。结果：HP组35例中死亡3例，生存率91.4%，非HP组34例中死亡5例，生存率85.3%（P＞0.05）。HP组病程明显缩短（P＜0.05）。HP后患者意识清醒及抽摔停止时间较非HP组显著提前。通过对清除率的计算发现：不同药物的清除效果有差异，其中氮卓类清除效果好，清除率为（91.6±12.5）%。结论：HP能不同程度清除体内毒物，可明显缩短病程、减少并发症，对于急性重度中毒可望提高生存率。
Objective To investigate the influence of chronic alcohol ingestion on the severity of acute lung injury (ALI) induced by oleic acid and lipopolysaccharide (LPS).Methods Thirty-two SD rats were randomly administrated with alcohol or water for 6 weeks，then instilled with oleic acid and LPS to induce ALI or with normal saline as control.Thus the rats were randomly divided into two injury groups [ethanol group and water group] and two control groups [ethanol group and water group] (n=8 in each group). PaO2,Wet to dry lung weight ratio (W/D)，levels of γ-glutamylcysteinylglycine (GSH) and malonaldehyde (MDA) in the lung tissue were measured.Results Compared to corresponding control groups，the PaO2 and GSH significantly decreased，and the lung W/D and MDA level were significantly increased in the injury groups (all Plt;0.05).In the injury groups，the changes of above parameters were more significant in the alcohol group than thoe in the water group (all Plt;0.05)，except the lung W/D with no significant difference.Conclusion Chronic ethanol ingestion was relevalent to oxidation/ antioxidation imbalance and more severe lung injury in rats with severe septic after trauma,which suggests that chronic alcohol abuse could increase the severity of acute lung injury.
Objectives To study the role of the kidney in the maintenance of metabolic alkalosis of critically ill patients during perioperative period.Methods The patients who had metabolic alkalosis in the surgical intensive care unite（SICU） from Nov 2004 to Feb 2005 were enrolled in the alkalosis group；and the control group were the perioperative patients in the department of hepatic surgery at the same time，those who had acid-base imbalance were excluded.The enrolled patients underwent routine tests and some parameters such as creatinine clearance rate（Ccr，to evaluate glomerular filtration rate），titratible acid，ammonium ion，urinary bicarbonate，net acid excretion were calculated.Results The Ccr of the alkalosis group and control group was（76.2±37.1）mL/min vs（98.5±31.9）mL/min，respectively（P=0.042） with a decrement of 22% in the alkalosis group.The titratible acid was（25.2±19.4）mmol/24 h vs（49.9±26.4）mmol/24 h，respectively（P=0.002）；the net acid excretion was（156.5±84.3） mmol/24 h vs（117.5±32.1）mmol/24 h，respectively（P=0.047）；the ammonium ion was（140.6±81.6） mmol/24 h vs（78.7±16.3）mmol/24 h，respectively（P=0.002）.The postoperative electrolytes of the alkalosis group and control group：[K+] was（3.51±0.67）mmol/L vs（4.14±0.59）mmol/L，respectively（P=0.002）；[Cl－] was（98.4±8.3）mmol/L vs（102.8±3.0）mmol/L，respectively（P=0.035）；[Ca2+] was（2.14±0.21）mmol/L vs（2.25±0.14）mmol/L，respectively（P=0.049）；[P] was（0.83±0.34）mmol/L vs（1.11±0.23）mmol/L，respectively（P=0.004）；[Na+] was（139.6±7.7）mmol/L vs（140.8±4.6）mmol/L，respectively（P=0.535）；[Mg2+] was（0.94±0.15）mmol/L vs（0.90±0.16）mmol/L，respectively（P=0.338）.Conclusions Decreased glomerular filtration rate and enhanced renal acidification function are the important factors that maintain the metabolic alkalosis during perioperative period.Potassium，chloride，calcium and phosphorus are decreased during metabolic alkalosis，while sodium and magnesium has no significant change.
Objective To investigate the clinical characteristics and risk factors associated with death in critically ill patients with severe community-acquired pneumonia( CAP) .Methods A retrospective analysis was carried out in 125 hospitalized patients with severe CAP admitted from July 2008 to February 2012. Earlier clinical features were compared between 109 survival patients and 16 dead patients, and logistic regression analysis was conducted. Results The death group had more underlying diseases than the survival group( P lt;0. 05) . The heart rate at admission in the death group was significantly higher than that in the survival group( P lt;0.05) . The ratio and number of complication, the highest temperature before admission, the platelet count, the arterial blood pH, PaO2 and PaO2 /FiO2 in the death group were significantly lower than those in the survival group( P lt; 0. 05) . Logistic regression analysis showed that the number of underlying diseases, heart rate and PaO2 were predictors of death in the patients with severe pneumonia. Conclusion The number of underlying diseases, heart rate and PaO2 has highly predictive value of death for severe CAP.