目的：观察卡介菌多糖核酸联合润燥止痒胶囊治疗慢性荨麻疹的疗效。方法： 将2008年4月~2009年4月门诊就诊的86例慢性荨麻疹患者随机分成两组，治疗组44例采用卡介菌多糖核酸2 mL肌注，隔日1次，18次为1疗程；同时予口服润燥止痒胶囊4粒，3次/d，连续治疗36天；对照组42例单独口服润燥止痒胶囊，方法疗程同治疗组。结果： 治疗组有效率为90.91%,对照组为7143%。两组比较差异有显著性（Plt;005）。结论： 卡介菌多糖核酸联合润燥止痒胶囊治疗慢性荨麻疹疗效确切。
“拯救脓毒症运动（Surviving Sepsis Campaign，SSC）”是国际危重病医学界为提高脓毒症诊治水平、降低病死率而于2002年发起的全球性运动。随后，由多个国际学术组织暨国际专家组发起与组编的《严重脓毒症与脓毒症休克治疗指南》[1]及其修订版[2]（以下统称为“SSC指南”）分别于2004年和2008年颁布。指南以循证医学为依据，总结了早期目标指导治疗（EGDT）、强化血糖控制（TGC）、小剂量激素替代治疗、活性蛋白C（APC）治疗等治疗方案，其核心就是将各自独立的疗法整合为整体化的“集束化治疗策略（Bundle Strategy）”，以期最大限度地发挥综合治疗效应[3]。按照SSC的建议，集束化治疗策略包括脓毒症复苏集束化策略（Sepsis Resuscitation Bundle）和脓毒症治疗集束化策略（Sepsis Management Bundle）。前者要求在诊断严重脓毒症后的6 h内完成血乳酸测定、血培养、早期广谱抗菌药物应用和EGDT等6项治疗策略；后者则要求在24 h内完成由小剂量激素、APC、TGC和限制气道平台压构成的4项治疗策略[4]。显然，上述策略借鉴了创伤救治的“黄金6小时”和“白银24小时”的理念。 目前已有越来越多的研究证据支持集束化治疗策略在急诊和ICU的早期实施，并显示出病死率降低的趋势。但实际的情况是临床上对该策略的实施与执行严重不足，集束化治疗策略所代表的强化、优先、积极的治疗理念并未获得普遍的贯彻，进而影响到获得病死率显著降低的收益。另一方面，集束化治疗策略的各治疗要素也非完美，其所依据的相关临床试验存在着诸多不足甚至可疑之处，而单纯的疗法叠加是否真能发挥事半功倍的效果也值得考量。为此，本文就当前国际上的相关研究进展进行反思，以供同道参考。
为预防应激性溃疡和消化道出血, 质子泵抑制剂( PPI) 、组胺H2 受体拮抗剂( H2 RA) 以及硫糖铝在ICU中的应用非常普遍。既往的研究认为以PPI 或H2RA 为代表的抑酸剂( ASD) 可致胃液pH 值增高, 为细菌在胃腔内定植创造了条件, 并进而增加医院获得性肺炎( HAP) , 尤其是呼吸机相关性肺炎( VAP) 发生的风险。我们通过文献复习发现,ASD 与VAP 的关联性迄今仍无明确的证据, 已有的临床研究结论互为矛盾; 另一方面, 既往研究多集中于硫糖铝与H2RA 的比较, 有关PPI 和H2RA 导致VAP 的风险比较研究仍然缺乏, PPI 是否比H2 RA 更易发生VAP 也缺乏研究可资证明。为此我们将有关内容综述如下, 以供同道参考。
Objective To investigate change of bispectral index(BIS) and hemodynamic index during induction and orotracheal intubation of sevoflurane anesthesia. Methods This study was a prospective before-after study in the same patients. A total of 30 ASA physical status I and II adult patients without airway abnormalities were enrolled to receive inhalation induction of anesthesia with 8% sevoflurane. Mean arterial pressure(MAP),heart rate(HR) and BIS were recorded before anesthesia(T1),when patients loss of consciousness(T2), before intubation (T3),at 1 min(T4) and 3 min(T5) after intubation. Results BIS at T1-T5 were 96.8±1.7,70.4±8.8,39.2±8.4,43.6±12.9 and 41.6±9.3 respectively, the measurements at T2-T5 were all markedly lower than at T1(Plt;0.05). HR at T3-T5 were all markedly higher than at T1(Plt;0.05). MAP at T2 and T3 were markedly lower than at T1, but at T4 was higher than at T1(Plt;0.05), and recovered to the level at T1 at T5(Pgt;0.05).BIS,HR and MAP at T4 were all significantly higher than T3(Plt;0.05). Conclusion Anesthesia induction with sevoflurane and small dose of succinylchoiline we used can provide adequate depth of general anesthesia,but can not prevent cardiovascular adverse reactions to intubation.
Objective To explore the distribution characteristics and prognostic risk factors of critically ill patients who has long-term hospitalization in intensive care unit ( ICU) . Methods A retrospective study was carried out to evaluate 119 critically ill patients from January 2003 to July 2009 by extracting data from computerized hospital information system. The patients were divided into a survival group and a non-survival group based on discharging outcomes. A binary logistic regression analysis wasintroduced to investigate potential risk factors of prognosis. Results Age, type of payment, entity of disease,and length of ICU stay were significantly different between the two groups ( P lt; 0. 05) in independent-Samples T test. Logistic regressions indicated that age, length of ICU stay and plasma infusion were independent predictors for worse outcome. Conclusions Age, length of ICU stay and plasma infusion may directly influence the prognosis of patients with prolonged stay in ICU. Intensive therapies should be emphasized for those patients at high risk.
【Abstract】 Objective When knee medial collateral ligament (MCL) rupture, the upper surface of medial meniscus is exposed totally, like the gulf panoramic, which is called “panoramic views of the bay sign” or the “bay sign”. To investigate the reliability and significance of the “bay sign” in diagnosis of knee MCL rupture under arthroscope. Methods Between March 2007 and March 2011, 127 patients with knees injuries were divided into the observation group (n=59) and control group (n=68) based on the MRI results. In the observation group, 59 patients had MCL rupture by MRI, including 12 cases of MCL injury alone, 16 cases of MCL injury with lateral meniscus torn, 27 cases of MCL injury with anterior cruciate ligament (ACL) injury, 3 cases of MCL injury with ACL and posterior cruciate ligament (PCL) injury, and 1 case of MCL injury with patellar dislocation; there were 38 males and 21 females with an average age of 23.2 years (range, 16-39 years). In the control group, 68 patients had no MCL rupture by MRI, including 38 cases of ACL injury, 4 cases of ACL and PCL injury, and 26 cases of ACL and lateral meniscus injury; there were 45 males and 23 females with an average age of 31.8 years (range, 25-49 years). The “bay sign” was observed under arthroscope in 2 groups before and after operation. Results The positive “bay sign” was seen under arthroscope in the patients of the observation group before MCL repair; the “bay sign” disappeared after repair. No “bay sign” was seen in patients of the control group before and after ACL reconstruction. Conclusion The “bay sign” is a reliable diagnostic evidence of MCL injury. It can be used as a basis to judge the success of MCL reconstruction during operation.
Objective To investigate the effectiveness of meniscal allograft in treatment of discoid meniscus tear. Methods Between May 2005 and September 2009, 7 cases of discoid meniscus tear were treated with meniscal allograft. There were 2 males and 5 females with an average age of 22.6 years (range, 18-33 years). The locations were the left knee in 5cases and the right knee in 2 cases. The causes were sport trauma in 4 cases, impact injury in 2 cases, and no apparent reason in 1 case. Of them, 7 cases had joint tenderness gap, 2 cases had positive results in floating patella test, 7 cases had positive results in McMurray test, and 6 cases had positive results in squatting test. The range of knee motion was 0-60°. The disease duration ranged from 3 months to 17 years (median, 26 months). Results The number of the pins was 9-13 (mean, 11). The operative time ranged from 1.5 to 2.7 hours (mean, 1.7 hours). The postoperative fever time ranged from 31 to 57 hours (mean, 46.4 hours). Incisions healed by first intention in 6 cases; infection occurred in 1 case after operation and was cured after 18 days of local irrigation with antibiotic sal ine. Seven patients were followed up 21.6 months on average (range, 12-53 months). The range of knee motion was 0-125°. All patients had the negative results of floating patella test, McMurray test, and squatting test. MRI showed that there was a good heal ing between the transplanted meniscus and the surrounding synovium. The Japanese Orthopaedic Association (JOA) score was 80.71 ± 4.82 at 6 months after operation, showing significant difference (t=10.11, P=0.00) when compared with the score (41.71 ± 8.07) before operation. Conclusion Meniscal allograft in treatment of discoid meniscus tear is a rel iable and effective method, which can ease knee pain.