【摘要】 目的 探讨严重腹腔感染合并呼吸循环功能障碍的有效治疗方法。方法 选择2004 年10 月至2006 年5 月期间我院ICU 收治的严重腹腔感染合并呼吸循环功能障碍患者42 例,其中治疗组( n = 22) 应用乌司他丁和生长激素联合治疗方案,对照组( n = 20) 应用常规治疗。比较2 组病例的临床病死率,并对2 组病例的ICU 住院时间及呼吸支持时间、循环支持时间的差异进行分析。结果 治疗组与对照组的临床病死率(22. 7 % vs35. 0 %) 差异无统计学意义( Pgt; 0. 05) ,而治疗组较对照组ICU 住院时间〔(12. 1 ±4. 2) d vs (18. 8 ±3. 6) d〕、呼吸支持时间〔(10. 1 ±3. 1) d vs (15. 4 ±4. 4) d〕及循环支持时间〔(5. 6 ±1. 8) d vs (11. 3 ±2. 1) d〕明显减少( P lt;0. 05) 。结论 乌司他丁和生长激素联合使用可以改善严重腹腔感染合并呼吸循环功能障碍的治疗效果。
Objective To study the effects of different levels of intra-abdominal pressure （IAP） on hemodynamics and oxygen metabolism in pig and to find the parameters early reflecting hemodynamics and oxygen metabolism of intra-abdominal hypertension （IAH）. Methods Fifteen pigs were anaesthetized, and trachea intubation and transfemoral cannula were performed then. Swan-Ganz catheters were inserted to pulmonary artery via internal jugular vein, and aeroperitoneum was set up by airing CO2. These pigs were randomly divided into three groups (5 pigs in each group) according to different levels of IAP （IAP10, IAP20, IAP30）. Hemodynamics and oxygen metabolism values were observed and recorded before airing, 6, 12, 18 and 24 hours after airing, respectively. Results There was no remarkable changes of hemodynamics and oxygen metabolism values in IAP10 group （Pgt;0.05）； When the IAP level reached 20 cm H2O, there was significant elevation （P＜0.01) in artery blood lacticacid （ABL）, and mixed venous oxygen saturation （SvO2） decreased significantly （P＜0.05) at 24 hours. When the IAP level reached 30 cm H2O, HR began to increase significantly at 18 hours after airing （P＜0.05). After 24 hours, all the indices of hemodynamics and oxygen metabolism were either significantly increased or decreased in IAP30 group. Two pigs in the group of IAP30 died during 24 hours after airing, while other pigs survived. Conclusion This study demonstrates that the hemodynamics and oxygen metabolism values begin to change in pigs when the IAP level reaches 20 cm H2O, and high level of IAP that lasted for 24 hours shows deterioration of hemodynamic and oxygenation levels. The indices of SvO2 and ABL can early reflect tissue oxygenation in IAH.
ObjectiveCell sheet technology(CST) demonstrates the innovation and advantage by overcoming some immanent shortcomings of traditional tissue engineering. To review the research progress of CST in oral tissue engineering. MethodsThe related home and abroad literature about CST and its application in stomatology was extensively reviewed and analyzed. ResultsCompared to the traditional tissue engineering technology, CST has the features of high seeding density, abundant matrix, good biological compatibility, and perfect operability, which can improve the survival rate of cell transplantation and promote functional reconstruction. It is reported that CST has been successfully used in the following fields, repair and reconstruction of periodontium, soft tissues of oral mucosa, and bones in maxillofacial region. ConclusionWith the development of CST and combined with the traditional tissue engineering technologies, it will promote the tissue engineering further progress in stomatology.
目的 探讨连续肾脏替代疗法（CRRT）对ICU急性肾功能衰竭（ARF）患者的血浆细胞因子、肾功能指标及其预后的影响。方法 选取我科2002年6月至2003年11月符合ARF的ICU患者38例，其中治疗组20例采用CRRT治疗，对照组18例采用肾脏非替代治疗（保守治疗）。两组患者于治疗前、后分别抽取静脉血标本作血浆细胞因子和肾功能指标的检测，并统计两组患者的临床死亡病例数。 结果 与对照组比较，治疗组的血浆肿瘤坏死因子、白细胞介素-6、白细胞介素-8及血肌酐和血尿素氮水平有显著改善（P＜0.05），而临床死亡率改变不明显（Pgt;0.05）。结论 CRRT能有效清除ICU的ARF患者的炎性细胞因子，改善肾功能指标，但其最终预后仍然很差。对于ICU的ARF患者，应该强调预防的重要性。
Abdominal compartment syndromeIntra;abdominal pressureIntra;gastric pressureIntra;cystic pressure
Objective To investigate the effect of intra-abdominal hypertension(IAH) on respiratory function in pigs.Methods Twelve pigs were randomly divided into two groups (n=6 in each group),ie.IAH20 group(intra-abdominal pressure=20 mm Hg) and IAH30 group(intra-abdominal pressure=30 mm Hg).Pig model of IAH was established by intraperitoneally injection of carbon dioxide.The changes in respiratory function parameters including pulmonary dynamic compliance（Cdyn），peak inspiratory pressure(PIP) ,SpO2 and PaCO2 were recorded at different time points.Results Cdyn was significantly decreased at different time points compared with baseline in group IAH30 and group IAH20.PIP significantly increased at different time points compared with baseline in both IAH groups，but group IAH30 was more severe than group IAH20. No significant changes of SpO2 and PaCO2 were found in two IAH groups.Conclusion IAH can impair respiratory function by decreasing lung compliance and increasing inspiratory pressure.