目的 探讨早期碱剩余对感染性休克患者病情严重程度的预测价值。 方法 对2009年2月－2011年2月资料完整入院的感染性休克患者60例进行回顾性分析，按死亡及存活进行分组，对最初24 h的碱剩余值差异及血乳酸清除率情况进行对照研究。 结果 死亡组碱剩余值变化及乳酸清除率低于存活组（P＜0.05）。治疗后碱剩余≤−6 mmol/L较碱剩余＞−6 mmol/L的患者病死率明显增加，尤其是治疗后24 h 碱剩余仍≤−6 mmol/L病死率高达92.23%。 结论 早期碱剩余有助于感染性休克预后评估和指导临床治疗。
【摘要】 目的 探讨甲型H1N1流感危重症患者的抢救疗效。 方法 2009年10月－2010年1月，对我院ICU收治5例甲型H1N1流感危重症患者采用集束化治疗方案进行救治，并就患者的器官功能变化进行评价。 结果 5例患者平均住院天数为（11.8±5.59）d，4 例存活，1例死亡。存活患者在治疗过程中急性生理和既往健康 （APACHE）Ⅱ、多器官功能障碍综合征评分（MODS）、全身性感染相关的器官衰竭评分 （SOFA）总体呈逐渐下降趋势。死亡者APACHEⅡ、SOFA评分均呈逐渐升高趋势。 结论 对甲型H1N1流感危重症患者采取集束化救治疗效良好。【Abstract】 Objective To explore the effect of bundle therapy on severe patients with influenza A (H1N1). Methods Bundle therapy were used in 5 severe patients with influenza A from October 2009 to January 2010. The patients’ organ dysfunction were observed for. Results The average in-hospital duration was (11.80±5.59) days. Four patients survived and one died with the survival ratio of 80%. Acute physiology and chronic health evaluation (APACHE) II score, Multiple organ dysfunction syndrome (MODS) score and sepsis-related organ failure assessment (SOFA) score gradually decreased in 4 survived patients, while gradually increased in the died patient. Conclusion Bundle therapy is effective on patients with severe influenza A.
【摘要】 目的 探讨脓毒性休克早期液体复苏的临床反应性。 方法 对2008年2月—2010年2月38例采用早期目标定向治疗方案治疗的脓毒性休克患者按是否存活进行分组，就中心静脉压、心率、平均动脉压、输液量、尿量、血乳酸等指标进行评价。 结果 38例采用早期目标定向治疗方案治疗6 h均达标，存活21例（55.26%），死亡17例（44.74%），两组患者输液总量及输液种类差异无统计学意义（Pgt;0.05），存活组6、24 h尿量及血乳酸清除率明显优于死亡组（Plt;0.05）。 结论 血乳酸清除率及尿量可作为脓毒性休克液体复苏有效的临床监测指标。【Abstract】 Objective To study the clinical response to early fluid resuscitation therapy in septic shock patients. Methods Thirty-eight septic shock patients received early goal-directed therapy (EGDT) in the ICU of our hospital from February 2008 to February 2010. The patients were divided into survival group (n=21) and dead group (n=17). Indexes like central venous pressure (CVP), heart rate (HR), mean arterial pressure (MAP), fluid input, urine output, and blood lactate were evaluated. Results Six hours after the EGDT, the results for the patients were all up to standard. There were 21 cases of survival (55.26%) and 17 cases of death (44.74%). The total fluid input and liquid types were similar in the two groups (Pgt;0.05). The urine output and lactate clearance at hour 6 and 24 for the survival group were better than that for the dead group (Plt;0.05). Conclusion The lactate clearance and urine output can be regarded as an surveillance indicator of fluid resuscitation for patients with septic shock.
Objective To observe the incidence rate of cardiovascular adverse events and evaluate the safety of dexmedetomidine or midazolan sedation in patients with long-term mechanical ventilation in intensive care unit (ICU). Methods From January 2014 to December 2015, patients admitted to ICU aged ≥18 years with mechanical ventilation time ≥48 hours were randomly divided into dexmetomidine group (group D) and midazolam group (group M). Adverse events such as cardiovascular events during sedation were observed. Results There were 144 cases in group D and 143 cases in group M. Slow heart rate was the prominent manifestation in group D. The incidence of heart rate <50 beats per minute in group D (4.86%) was less than that in group M (6.29%), but there was no statistical difference ( P=0.681). Group D had lower blood pressure (40.28% vs. 72.73%), tachycardia (18.75% vs. 41.96%), arrhythmia (16.67% vs. 34.97%) and 28- day mortality (22.22% vs. 42.66%) than those in group M (P<0.01). No cardiac arrest, sinus arrest, hypertension, hyperglycemia, or hypoglycemia were found in the two groups. Conclusion The long-term sedation of dexmetidine in patients with mechanical ventilation is safe; in cardiovascular adverse events, the 28-day mortality is lower than that of traditional midazolam sedation, and the duration of mechanical ventilation is no longer than that of traditional midazolam sedation, with slightly longer ICU length of stay.
目的 研究氯胺酮能否降低咪达唑仑诱导急诊危重患者气管插管对血压的影响。 方法 将2010年6月－2011年12月收治的56例急诊危重呼吸衰竭成年患者，随机分成咪达唑仑+芬太尼（MF）组和咪达唑仑+氯胺酮（MK）组，气管插管前咪达唑仑0.05 mg/kg静脉注入，然后MF组芬太尼2 μg/kg静脉注入，MK组氯胺酮0.5 mg/kg静脉注入，待患者达镇静状态后实施气管插管。记录用药前和插管后10 min的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）的变化，观察低血压的发生情况。 结果 实施药物诱导气管插管后血压下降以MF组更明显（P＜0.01）。低血压发生率MF组为51.7%，MK组为18.5%，两组比较差异有统计学意义（χ2=6.715，P=0.01）。 结论 急诊危重患者气管插管应用氯胺酮可减少咪达唑仑所致低血压的发生率。
Objective To evaluate the rescue intubation induced by ketamine and midazolam in patients with acute respiratory failure.Methods 81 patients with acute respiratory failure admitted between June 2010 and June 2012 were recruited in the study. They were randomly divided to a MF group to receive 0. 05 mg/kg of midazolam + 1 to 2 μg/kg of fentanyl ( n =41) , and aMK group to received 0. 05 mg/kg of midazolam + 0. 5 to 1 mg/kg of ketamine ( n =40) for rescue intubation. The APACHEⅡ score on initial24 hours after admission in ICU, length of ICU stay, and 28-day mortality were recorded. The differences in arterial blood pressure, heart rate, respiration rate, and blood oxygen saturation before intubation and 10 minutes after intubation were compared. Incidences of hypotension and other adverse events and difficult intubation were also recorded.Results The midazolamdose in the MK group was significantly less than that in the MF group ( P lt; 0. 01) . The blood pressure in both groups decreased. The systolic blood pressure dropped most significantly in the MF group ( P lt;0. 05) . The incidence of hypotension was 41. 5% in the MF group, significantly higher than that in the MK group ( 20. 0% , P lt;0. 05) . The incidence of hypotension had no correlation with midazolamdosage ( P gt;0. 05) . There was no significant difference in adverse events except for the arrhythmia between two groups. The length of ICU stay and 28-day mortality were similar in both groups ( P gt; 0. 05) . The incidence of difficult tracheal intubation was nearly 50% in both groups.Conclusions In patients with respiratory failure, rescue intubation induced by ketamine can reduce the dose of midazolam and reduce the incidence of hypotension without more complications. The optimal dose of ketamine in induced tracheal intubation requires further study.