Volume15 September2003 Number9
Chinese Critical Care Medicine, September 2003,Vol.15,No.9
PAGE: 516-518
Hypertensive urgencies and emergencies; new understanding and clinical practice
HU Da yi
Heart Center Beijing University People’s Hospital, Beijing Tongren Hospital, Capital University of Medical Science, Beijing 100044, China.
PAGE: 518
, 百拇医药
Relationship of homocysteine concentration in plasm with essential hypertension and cerebral hemorrhage
QIN Qing tong,ZHANG Dan hong
Central Hospital, Taizhou 318000, Zhejiang, China.
PAGE: 519-520
Present status in treatment of aspiration pneumonitis
YANG Guo dong, KANG Ding xin, YAO Xin min
, 百拇医药 The Study Center of Abstain Drug, Zhejiang Ninbo 315000, China.
PAGE: 521-522
Relationship between acid-base disturbance in blood gas analysis and prognosis of patients with severe acute respiratory syndrome
ZHUANG Jun hua, HUANG Xian zhang, WANG Jian bing, LIN Li, LIN lin
Clinical Laboratory, Ersha Island Branch, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510105, Gangdong, China.
, 百拇医药
Abstract: Objective: To study the influence of the acute blood gas analysis index change on the prognosis of patients with severe acute respiratory syndrome (SARS). Methods: Artery blood gas analysis indexes were determined in 38 of 103 cases of SARS patients during acute stage, the relationship between the change of blood gas analysis index and prognosis of patients with SARS was analyzed. Results: The lower partical pressure of carbon dioxide in artery (PaCO 2), partical pressure of oxygen in artery (PaO 2) in blood was, the higher death rate was. pH in blood had no significant influence on the prognosis of SARS patients. The prognosis of SARS patients were worse and the death rate was higher when patient had two or more acid-base disturbance. Conclusion: The artery blood gas analysis is useful for judging the conditions and prognosis of patients with SARS, and is beneficial for clinical treatment.
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PAGE: 523-525
Organism distribution and drug resistance in 7 cases of severe acute respiratory syndrome death patients with secondary bacteria infection
WANG Jian bing, XU Ning, SHI Han zheng, HUANG Xian zhang, LIN Lin
Clinical Laboratory Ersha Island Branch, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510105, Guangdong, China.
Abstract: Objective: To study the organism distribution and drug resistance of seven cases of severe acute respiratory syndrome (SARS) death patients with secondary bacterial infection. Methods: Thirty strains of bacteria from seven cases of SARS patients with secondary bacterial infection were classified and drug resistance was analyzed. Results: Seven cases of SARS death patients were all infected secondly and 5 cases were polyinfection. Twenty-four (31.5 percent) of 76 examed samples were positive. There were 30 strains of bacteria isolated from seven cases of SARS death patients with secondary bacterial infection. There were 9 strains of Gram negative bacteria (GNB), 8 strains of Gram positive cocci (GPC), and 13 strains of Fungi. The sensitive rate of vancomycin to GPC were 100.0 percent. The sensitive rate of imipenem, piperacillin/tazobactan were 100.0 percent, 44.5 percent, respectively. The sensitive rate of fluconazole to fungi was 92.4 percent. Conclusion: SARS patients are consitive to be infected secondary bacteria. Secondary bacteria infection is one of important reason of death.
, 百拇医药
PAGE: 525
Medical segregative observation of people closely contacted with SARS patients
ZHOU Rong bin, ZHANG Xiao he, LI Yi min, ZHU Xiong long, SUN Yu, ZHENG Li, CHEN Hui, LI Ai min
General Hospital of Beijing military area, Beijing 100700, China.
PAGE: 526-528
Analysis of mortal risk factors in 12 patients with severe acute respiratory syndrome
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LIU Hui yuan, SHI Yu ming
Institute of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou 510060, Guangdong, China.
Abstract: Objective: To investigate the risk factors in the dead patients with severe acute respiratory syndrome (SARS). Methods: The retrospective analyses were made on 12 dead cases and 32 recovered cases with SARS. Results: The mean age was 67 years old in 12 dead cases with SARS and was 42 in recovered control group. There were 1-5 other basic diseases in 5 cases of death group. The states of dead patients were severe and the deterioration of patients' condition was rapid. The CD + 4 and CD + 8 T lymphocytes in peripheral blood were (416.6±235.0) cells/μl and (296.1±181.5)cells/μl in survival patients and (143.8±78.1) cells/μl, (103.6±63.2) cells/μl in dead patients, they often decreased compared to the normal values, especially in dead cases. Five cases were infected with bacteria in 12 dead cases, among them 3 were infected with fungus and 2 were septicemia. In dead group, the occurrence rates of electrolyte maladjustment andkidney injury were 41.67 percent. Invasive ventilation was used in 10 cases and death rate was 80.0 percent, among them 5 patients were infected with bacteria. None was dead in the patients with non-invasive ventilation. Conclusion: The age and basic diseases are the main mortal risk factors in SARS. Other risk factorsinclude the decline of immune function, secondary infection, complications and use of invasive ventilation.
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PAGE: 529-531
Observation on tissue factor pathway during the onset of acute cerebral infarction
WEN Zhi bin, XIONG Shi long, HE Xiao fan, HE Me ixia, HE Shi lin, XIE Qin zhi, QIAN Zai fu, CHEN Fang ping, XIAO Bo, YANG Qi dong
Thrombosis and Hemostasis Lab, Department of Physiology, Xiangya Medical University, Central-South University, Changsha 410078, Hunan, China.
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Abstract: Objective: To establish the possible relationship between some coagulation factors and the onsetof acute cerebral infarction (ACI). Methods: The study population consisted of 71 patients with ACI confirmedby CT and 50 age-matched healthy volunteers. Blood samples were obtained during the onset periodof ACI. Tissue factor (TF) and tissue factor pathway inhibitor (TFPI) activity in plasma were assayed with the chromogenic assay. Plasma TF and TFPI antigen were measured with enzyme linked immunoadsorbent assay (ELISA). Plasma FⅦ coagulation activity (FⅦ∶C) and FⅧ coagulation activity (FⅧ∶C) were developed in the one-stage system. Plasma prothrombin (FⅡ) was determined with Ecarin assay. Plasma fibrinogen (Fbg) was measured with thrombin assay. Plasma antithrombin Ⅲ activity (ATⅢ) was determined using heparin cofactor activity assay. Results: Compared with the control, plasma TF activity and antigen in patients with ACI were significantly higher (both P<0.05). But plasma TFPI activity and antigen were remarkablylower in the ACI group (both P<0.05) Plasma FⅦ∶C was significantly higher (P<0.01), and FⅧ∶ C was markedly lower (P<0.05). Plasma FⅡ was remarkably higher (P<0.01). Similarly the Fbg was significantly higher in the ACI than that in the control group (P<0.01), whereas ATⅢ was significantly lower (P<0.01). Conclusion: The initiation of TF pathway is contributed to the onset of ACI and the blood is in hypercoagulable state during the early period of ACI.
, 百拇医药
PAGE: 532-534
Comparison of the intracranial pressure value in patients with hypertensive intracerebral hemorrhage treated with traditional craniotomy and puncture drainage
SONG Shao jun, FEI Zhou, ZHANG Xiang
Institute of Neurosurgery of Chinese People's Liberation Army, Xijing Hospital, Fourth Military Medical University, Xi'an 710033， Shanxi, China.
Abstract: Objective: To compare the difference of intracranial pressure (ICP) in patients with hypertensive intracerebral hemorrhage (HICH) treated with two surgical procedures, traditional craniotomy and puncture drainage. Methods: One hundred and twelve cases with HICH were randomly divided into two groups. In one group, 60 patients were operated by traditional craniotomy and in another group, 52 cases by puncture drainage and urokinase treatment. In the meantime, ICP was monitored by placing catheter in lateral ventricle on the contralateral side of the hemorrhage. ICP values were recorded after operation at once, at 24 hours, 72 hours and 1 week. Results: Although all the patients showed increased ICP, the increasing degree in patients treated with traditional craniotomy had lower ICP values(P<0.05 or P<0.01). Conclusion: Traditional craniotomy has advantages over puncture drainage for patients with HICH at least with respect to decreasing ICP.
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PAGE: 535-537
Influence of hypoxia-reoxygenation on nitric oxide synthesis Ⅲ gene expression in cultured cerebral arterial endothelial cell
SONG Zhen ju, YANG Guang tian, LU De qin, WANG Di xun
Department of Emergency Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
Abstract: Objective: To investigate the change of nitric oxide synthase (NOS) Ⅲ
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gene expression in culturedcerebral arterial endothelial cells during hypoxia and reoxygenation. Methods: ①The cells were divided into six groups: control, hypoxia for 1 hour, reoxygenation for 2, 6, 12, 24 hours after hypoxia for 1 hour. ②The expression of NOSⅢ mRNA was detected semiquantitatively by reverse transcription-polymerase chain reaction (RT-PCR). ③Immunocytochemistry was used to detect the expression of NOSⅢ protein. Results: ①The gene and protein expression of NOSⅢ was increased during hypoxia for 1 hour. ②The gene and protein expression of NOSⅢ was decreased during reoxygenation for 2, 6, 12 hours afterhypoxia for 1 hour, expecially at 6 hours after reoxygenation. After cells were reoxygenation for 24 hours, the expression was restored to the normal level. Conclusions: The experiment showed that hypoxia could increase the levels of NOSⅢ gene and protein expression and reoxygenation inhibited the increment of this gene expression.
, 百拇医药
PAGE: 538-541
Expression of aquaporin-4 protein in brain from rats with hemorrhagic edema
LI Yan hua, SUN Shan quan
Department of Neurobiology, Chongqing University of Medical Science, Chongqing 400016, China.
Abstract: Objective: To study the expression of aquaporin-4 (AQP4) protein in perihematomal tissue after intracerebral hemorrhage (ICH) in rats. Methods: The experimental ICH model was established in rats by injecting quantitative collagenase into the left caudate nuclei of the rats. The changes of brain water content (BWC) were measured by the wet and dry weight methods. Immunohistochemistry was used to determine the change of expression of AQP4 protein during different periods after ICH. Results: BWC and AQP4 protein expression in perihematomal tissue were increased at 6 hours after ICH and reached peak at 72 hours. In one week following ICH, it was still higher than normal level. In addition, the expression of AQP4 was positively correlated with BWC(r=0.9857, P<0.01). Conclusion: AQP4 has a relevant relationship with the formation of brain edema after ICH.
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PAGE: 541
Missiagnosis analysis of 16 cases of senile atypical subarachnoid hemorrhage
PEN You lin
Fuan Health of Hospital, Jiangsu Dongtai 224222, China.
PAGE: 542-545
Early intravenous thrombolysis with recombinant tissue plasminogen activator for acute cerebral infarction
WANG Shen yan, WANG Xu li hong, ZENG Hong, ZUO Ying, HU Nan, LI Xue ying, HUANG Fei, YU Hai ling, WANG Hong yuan
, 百拇医药
Emergency Department, Beijing Emergency Medical Center, Beijing 100031,China.
Abstract: Objective: To evaluate the efficacy and safety of recombinant tissue plasminogen activator (rt-PA) and to explore the most suitable dosage of rt-PA in the early treatment of the Chinese patients with acute cerebral infarction (ACI). Methods: The patients who suited for the standard were divided into three groups. Group A received rt-PA at 0.9 mg/kg, group B received rt-PA at 0.7 mg/kg, and group C did not receive any thrombolytic therapy. In thrombolytic groups, rt-PA at 8 mg was injected intravenously in a bolus at first and then the rest was given over 60 minutes. The maximal dosage was 90 mg. The Chinese stroke scale (CSS) and Barthel Index (BI) were used to evaluate the recovery of neurological functions after rt-PA treatment for 24 hours and 90 days. The hemorrhagic rate and 30 days mortality rate were also analysed. Results: In group A the CSS significant effectiverate was 41.18 percent at 24 hours and 76.47 percent at 90 days after thrombolysis. At 90 days BI significant effective rate was 58.82 percent. At 30 days hemorrhagicrate was 8.82 percent and mortality rate was 5.88 percent. In group B, the CSS significant effective rate was 39.39 percent at 24 hours and 69.70 percent at 90 days. At 90 days, BI significant effective rate was 54.55 percent, and at 30 days, hemorrhagic rate was 9.09 percent and mortality rate was 9.09 percent. In group C, the CSS ignificant effective rate was 21.21 percent, at 24 hours and 30.30 percent at 90 days (P>0.05). At 90 days, BI was 21.21 percent the mortality rate was 9.09 percent. At 30 days the mortality rate was no significant difference within three groups At 90 days, significant effective rate was 73.13 percentvs. 30.30 percent in thromblytic and control groups (P=0.001 7). The significant disability rate was 13.43 perent vs. 24.24 percent. Conclusions: For Chinese individuals, with ACI, rt-PA thrombolytsis was effective and safe. The dosage of 0.9 mg/kg for foreign people also fitted for Chinese individuals.
, 百拇医药
PAGE: 546-549
Study on early heart rate variability in patients with severe acute cerebral vascular disease
LI Shu juan, SU Ying ying, LIU Miao
NICU, Xuanwu Hospital, Capital University of Medical Science, Beijing 100053, China.
Abstract: Objective: To investigate the dynamic changes of heart rate variability (HRV) in acute cerebral vascular disease, in order to make a criteria for evaluating cerebral function, and establish an assessment for risk stratification after acute stroke. Methods: All 35 patients who suffered from cerebral vascular disease in the distribution of the carotid artery system were studied from 1 to 7 days following the stroke. HRV analysis with 24-hour Holter tapes were performed every day or every other day continuously for 5 days. According to GCS, the patients were divided into two groups. Critical cerebral vascular disease (CCVD): a state of severe cerebral dysfunction with the Glasgow coma scale (GCS) value between 3 and 8. Non-critical cerebral vascular disease (nCCVD): a state of slightly cerebral dysfunction with the GCS value between 9 and 15. Results: Of the 35 patients, 17 were classified to CCVD, 18 to nCCVD. The CCVD patients had significantly decreased HRV, especially the standard deviation of all R-R intervals (SDNN) and total frequency (TF). The 24-hour heart rate variability graph lost its circadian variation showing a low and plain curve during the whole day. There was a significant correlation between the decrease of HRV and bad prognosis. The borderline of HRV for prognosis was： SDNN≤60 ms、 TF≤1 500 ms 2/Hz, high frequency (HF)≤600 ms 2/Hz, low frequency (LF)≤1000 ms 2/Hz. Dynamic observation proved that if the components of HRV reached this standard, it always indicated bad outcome. On the contrary, if those components increased continuously and were higher than those of the above, it was always indicative of good outcome. These changes always advanced GCS. Prognosis had a high correlate with TF, LF, HF and GCS. Logistic regression showed that only TF, HF and GCS were the main factors affecting the prognosis. The accurate rate of death predication was 88.89 percent, the accurate rate of survival was 82.14 percent. It was much better than the traditional GCS. Conclusions: HRV decreases significantly in CCVD and loses its circadian variation. Dynamic observation of HRV offers a good marker for monitoring cerebral function and the progress of disease. HRV could be considered as an objective, non-traumatic and sensitive indicator of the cerebral function and prognosis.
, 百拇医药
PAGE: 549
36 cases of chronic hematom under meninges treated with minimally invasive punctune and aspiration
LIU Jin feng, HE Zhuo
People’s Hospital, Henan Zhenping 474250, China.
PAGE: 550-552
Study on clinical significances of the application of nasotracheal intubation guided with fiberbronchoscope to the postoperative patients with hypertensive intracerebral hemorrhage
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ZHANG Jian jun, YAN Xiao feng, DONG Wei feng, ZHANG Jun, GU Shui jun, XUAN Hong fei, SI Yun
Department of Neurosurgery, The First People's Hospital of Xiaoshan, Hangzhou 311201, Zhejiang, China.
Abstract: Objective: To explore the clinical signification of the application of nasotracheal intubation guided with fiberbronchoscope to the postoperative patients with hypertensive intracerebral hemorrhage (HICH) who had respiration failure. Methods: Ninety-four postoprative patients with HICH were divided intotwo groups, A group treated with nasotracheal intubation and B group treated with tracheal incision. The oxygen metabolism, pulmonary complication incidence of two groups were analyzed and compared. Results: The basic oxygen metabolism and the need of mechanical ventilation in the cases with respiration failure were satisfying in two groups (both P>0.05). The mean reserved time of artificial airway in A group was(14.2±6.5)days, which in B group was(19.1±7.2)days (P<0.01). The occurent rates of combined infection in lung and double-infection were lower in A group than these in B group (56.3 percent vs. 91.3 percent, P<0.05; 10.4 percent vs. 39.1 percent, P<0.01; respectively), with their resident days shorter and prognosisbetter in A group than these in B group (P<0.05). Conclusion: The nasotracheal intubation guided with fiberbronchoscope has small trauma, lower incidence of complication, which may be considered as a better selection for the postoperative patients with HICH who had respiration failure.
, 百拇医药
PAGE: 553-556
Effects of naloxone on rat cortical neuron apoptosis induced by anoxia
SONG Yang, SHEN Hong, DING Ai shi, FAN Ming
Department of Emergency, General Hospital of People's Liberation Army, Beijing 100853, China.
Abstract: Objective: To investigate the damage of anoxia on the cultured rat's cortical neurons and the protective effects of naloxone. Methods: Cortical neurons cultured for 12 days were randomly divided into three groups: control, anoxic group and anoxic group plus naloxone treated. Cortical neurons were exposed to anoxic environment for 6 hours and then cultured for 24 hours under normoxic condition. The apoptosis of neurons was detected with the method of TdT-mediated dUTP nick end labeling (TUNEL) and the apoptotic rate of neurons was measured using flow cytometry. Results: Anoxia could lead to increasing apoptosis and death of rate cortical neurons. Naloxone could reduce neuron apoptosis. There was a significant difference between the anoxic group and anoxic group plus naloxone (P<0.01). Conclusion: Naloxone can ameliorate the toxicity damage of neurons caused by anoxia through reducing neuron apoptosis, which suggests that naloxone could protect rat's cortical neurons from damage under anoxia condition.
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PAGE: 556
Effect of losartan and Nitrendipine on fibrinolytic system in patient with essential hypertensim
YIN Ping, WANG Lei, RONG Yu dong
International Diagnosis and Treat Center, Tianjin First Central Hospital, Tianjin 300192, China.
PAGE: 557-559
Wilms' tumor-1 gene expression in myelodysplastic syndrome and its changes in the process of myelodysplastic syndrome transforming into acute leukemia
, 百拇医药
YANG Jie kun, LI Jin lan, LI Zeng gang, LI Zhi gang, LIU Peng jiang, LI Jing yi, LU Hai rong, DENG Qi, LIN Xue mei, CAO Jin ni
Tianjin First Central Hospital, Tianjin 300192, China.
Abstract: Objective: To observe expression of Wilms' tumor-1 (WT1) gene in the different subtypes of myelodysplastic syndrome (MDS), and to explore the regularity of expression of WT1 gene in the process of MDS transforming into acute leukemia (AL). Methods: The method of reverse transcriptase-polymerase chain reaction (RT-PCR) was used, the levels of WT1 gene's presentation in different types of montagers of MDS were analyzed, and the relationship between the level and the clinical characteristic was analyzed. At the same time, the expression of WT1 gene in AL patients, post-MDS-AL patients and normal controls were examined. Results: The positive rate of WT1 gene expression in 49 patients with MDS was 22.4 percent (11/49), refractory anemia (RA) was 0(0/13), RA with excess of blast(RAEB) was 25.0 percent (6/24), RAEB in transformation (RAEB-t) was 41.7 percent (5/12). The positive rates of WT1 expression were gradually increased in three types of MDS (P<0.05 and P<0.01). The positive rates of WT1 expression were higher in AL and post-MDS-AL patients (48.5 percent，32/66 and 50.0 percent, 4/8) than that in MDS patients (P<0.01). There was no expression of WT1 gene in normal control. Conclusion: There is a relatively high expression rate of WT1 gene in RAEB, RAEB-t of MDS, but relatively low expression rate in RA. The method of RT-PCR, is high sensitiveness and specificity, can trustful be used in the procession of monitoring MDS' progression and its transformation into AL.
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PAGE: 560-562
Evaluation oxygen free radicals related index before liver transplantation to forejudge prognosis
LIU Chun, ZHOU Xiao si, GENG Qiu ming
The Third Hospital of Peking University, Beijing 100083, China.
Abstract: Objective: To research the relationship of oxygen free radicals related index before liver transplantation with prognosis. Methods: Lipid peroxide (LPO), total antioxidant capacity (TAC), nitric oxide (NO) and total bilirubin (T-BIL) in blood from 18 patients were measured before liver transplantation, and the relationship with prognosis was analyzed. Results: The blood LPO of death group was (17.13±4.16) μmol/L, it was obviously higher than that of survival group (7.97±3.52) μmol/L (P<0.05). The blood TAC of survival group was (38.05±19.13) kU/L, it was higher than that of death group (32.54±3.07)kU/L, but there was no obvious difference(P>0.05). There was no obvious difference between the bloodNO of death group was (50.80±14.80)μmol/L, and survive group was (150.46±19.54) μmol/L (P>0.05). The blood T-BIL of death group was (425.98±214.18) μmol/L， it was obviously higher than that of survival group(172.10±144.32) μmol/L (P<0.05). So the blood LPO and TAC were choosen as the index to forejudge prognosis, and an equation was established to forecast if the patient would be death or survive : Y 1=0.3290 X 1+0.0998 X 2-3.9040, Y 2=1.3520 X 1-0.0500 X 2-11.4640， X 1 represented serum LPO, X 2 represented serum TAC. 100.0 percent accuracy was forecasted in the survival group by the equation, 83.3 percent accuracy was in the death group. The overall patients were forejudged 94.4 percent accurately. Conclusion: Measuring LPO and TAC in blood maybe forejudging prognosis properly and can be used as routine examination before liver transplantation. The equation is preferable to forejudging prognosis, it can be used to choose from high risk patients to improve survival rate of the patients after operation. Therefore, it is valuable in clinical practise.
, 百拇医药
PAGE:563-565
Analysis of factors related to mortality of critical patients with acute renal dysfunction
CHAI Wen zhao, DU Bin, MO Xiao li, ZHOU Xiang, ZHANG Ying, ZHANG Jun, LIU Da wei
ICU, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Abstract: Objective: To investigate the high risk factors related to mortality rate of critical patients with acute renal dysfunction in intensive care unit (ICU). Methods: The data of patients with acute renal dysfunction hospitalized in ICU of Peking union medical college hospital during August 1999 to May 2001 were retrospectively investigated and the high risk factors related to hospital mortality were analyzed. The statistical analysis methods were univariate and multivariate factors analysis. Results: Among 1 218 critical patients hospitalized during August 1999 to May 2001, there were 149 patients with acute renal dysfunction. One hundred and thirty-five patients were investigated completely. Fifty-five (41 percent) died during the hospital stay. By univariate analysis, risk factors related to hospital mortality included acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, the systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock, chronic respiratory dysfunction, sepsis-related organ failure assessment (SOFA) score, acute respiratory dysfunction, coagulation dysfunction, central nerves system dysfunction, cardiovascular dysfunction, management of noradrenaline and continuous venovenous hemofiltration (CVVH). By multivariate analysis, only APACHEⅡ score and management of noradrenaline and CVVH were determinedas risk factors of hospital mortality independently. If the three factors were excluded, sepsis, central nerves system dysfunction, oliguria became the risk factors of mortality (all P<0.05). Conclusion: The prognosis of critical patients with the acute renal dysfunction correlate with degree of basic diseases. There include oliguresis, coagulation dysfunction, central nerves system dysfunction and sepsis. In spite of management of CVVH, acute renal dysfunction per se can affect the prognosis of the critical patients.
, 百拇医药
PAGE: 566-567
anagement for hemobilia after hepatobiliary surgery
JIANG Kai, ZHOU Ning xin, HUANG Zhi qiang, HUANG Xiao qing, LIU Rong, ZHANG Wen zhi, WANG Mao qiang
Department of Hepatobiliary Surgery, the General Hospital of People's Liberation Army, Beijing 100853, China
Abstract: Objective: To investigated the diagnosis and treatment for hemobilia after hepatobiliary surgery. Methods: The data were collected from 21 patients with postoperative hemobilia treated in our hospital from October 1989. The data from patients including age, with or without hypertension history, operation procedure, bleeding time after operation, clinical manifestation, diagnosis method, hepatic artery embolization and operative management were analyzed to summarize the clinical treatment hemobilia. Results: There were 13 men and 8 women. Twelve patients had hypertension history. Sixteen patients were underwent with emergency hepatic artery angiography and were treated with hepatic artery embolization, the other five cases were managed directly by operation. In the operation group, 2 patients were under gone two times operative management respectively. The effectiveness of operation for all patients was good and without rebleeding. Conclusion: Emergency hepatic artery angiography and embolization as a first diagnosis procedure and minimally invasive treatment should be the first and safe selection for all hemobilia.
, 百拇医药
PAGE: 568-569
Study on drug delivery of the 3H-BCHU polylacties acid released agents on gliosarcoma
ZHANG You ping, XU Xin nu, WANG Jin huan, LU Ge, LIU Ping, SU Tong fang, LIU Hong sheng, QI Jian bin, GAO Bo
Tianjin First Central Hospital, Tianjin 300192, China.
PAGE: 569-570
Clinical study of alliance clecompression on middle and late period tentorial herniation
, 百拇医药
TANG Xiang, LAN Zu xiu, ZHENG Jun, XIE Bao jun, WANG You cun
Hechi The First People’s Hospital, Guangxi Yizhou 546300, China.
PAGE: 572-573
Effect of shengmai parenteral solution on immiediate hemodynamics in patients with congestive heart failture
LI Hui, JIN Zhang an, HUO Yan ming
East Hospital, Beijing Fengtai 100078,China.
, 百拇医药
PAGE: 574-575
Introduction of a simple and easy stereotactic technology-no framework and stereotaetic punction and drainage technology to treat cerebral hemorrhage
LIN Zhao fen, SUN Yong, ZHANG Yu ke, WANG Xiao dong, YANG Xing yi
Changzheng Hospital, The second surgeon university, Shanghai 200003, China., 百拇医药
PAGE: 516-518
Hypertensive urgencies and emergencies; new understanding and clinical practice
HU Da yi
Heart Center Beijing University People’s Hospital, Beijing Tongren Hospital, Capital University of Medical Science, Beijing 100044, China.
PAGE: 518
, 百拇医药
Relationship of homocysteine concentration in plasm with essential hypertension and cerebral hemorrhage
QIN Qing tong,ZHANG Dan hong
Central Hospital, Taizhou 318000, Zhejiang, China.
PAGE: 519-520
Present status in treatment of aspiration pneumonitis
YANG Guo dong, KANG Ding xin, YAO Xin min
, 百拇医药 The Study Center of Abstain Drug, Zhejiang Ninbo 315000, China.
PAGE: 521-522
Relationship between acid-base disturbance in blood gas analysis and prognosis of patients with severe acute respiratory syndrome
ZHUANG Jun hua, HUANG Xian zhang, WANG Jian bing, LIN Li, LIN lin
Clinical Laboratory, Ersha Island Branch, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510105, Gangdong, China.
, 百拇医药
Abstract: Objective: To study the influence of the acute blood gas analysis index change on the prognosis of patients with severe acute respiratory syndrome (SARS). Methods: Artery blood gas analysis indexes were determined in 38 of 103 cases of SARS patients during acute stage, the relationship between the change of blood gas analysis index and prognosis of patients with SARS was analyzed. Results: The lower partical pressure of carbon dioxide in artery (PaCO 2), partical pressure of oxygen in artery (PaO 2) in blood was, the higher death rate was. pH in blood had no significant influence on the prognosis of SARS patients. The prognosis of SARS patients were worse and the death rate was higher when patient had two or more acid-base disturbance. Conclusion: The artery blood gas analysis is useful for judging the conditions and prognosis of patients with SARS, and is beneficial for clinical treatment.
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PAGE: 523-525
Organism distribution and drug resistance in 7 cases of severe acute respiratory syndrome death patients with secondary bacteria infection
WANG Jian bing, XU Ning, SHI Han zheng, HUANG Xian zhang, LIN Lin
Clinical Laboratory Ersha Island Branch, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510105, Guangdong, China.
Abstract: Objective: To study the organism distribution and drug resistance of seven cases of severe acute respiratory syndrome (SARS) death patients with secondary bacterial infection. Methods: Thirty strains of bacteria from seven cases of SARS patients with secondary bacterial infection were classified and drug resistance was analyzed. Results: Seven cases of SARS death patients were all infected secondly and 5 cases were polyinfection. Twenty-four (31.5 percent) of 76 examed samples were positive. There were 30 strains of bacteria isolated from seven cases of SARS death patients with secondary bacterial infection. There were 9 strains of Gram negative bacteria (GNB), 8 strains of Gram positive cocci (GPC), and 13 strains of Fungi. The sensitive rate of vancomycin to GPC were 100.0 percent. The sensitive rate of imipenem, piperacillin/tazobactan were 100.0 percent, 44.5 percent, respectively. The sensitive rate of fluconazole to fungi was 92.4 percent. Conclusion: SARS patients are consitive to be infected secondary bacteria. Secondary bacteria infection is one of important reason of death.
, 百拇医药
PAGE: 525
Medical segregative observation of people closely contacted with SARS patients
ZHOU Rong bin, ZHANG Xiao he, LI Yi min, ZHU Xiong long, SUN Yu, ZHENG Li, CHEN Hui, LI Ai min
General Hospital of Beijing military area, Beijing 100700, China.
PAGE: 526-528
Analysis of mortal risk factors in 12 patients with severe acute respiratory syndrome
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LIU Hui yuan, SHI Yu ming
Institute of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou 510060, Guangdong, China.
Abstract: Objective: To investigate the risk factors in the dead patients with severe acute respiratory syndrome (SARS). Methods: The retrospective analyses were made on 12 dead cases and 32 recovered cases with SARS. Results: The mean age was 67 years old in 12 dead cases with SARS and was 42 in recovered control group. There were 1-5 other basic diseases in 5 cases of death group. The states of dead patients were severe and the deterioration of patients' condition was rapid. The CD + 4 and CD + 8 T lymphocytes in peripheral blood were (416.6±235.0) cells/μl and (296.1±181.5)cells/μl in survival patients and (143.8±78.1) cells/μl, (103.6±63.2) cells/μl in dead patients, they often decreased compared to the normal values, especially in dead cases. Five cases were infected with bacteria in 12 dead cases, among them 3 were infected with fungus and 2 were septicemia. In dead group, the occurrence rates of electrolyte maladjustment andkidney injury were 41.67 percent. Invasive ventilation was used in 10 cases and death rate was 80.0 percent, among them 5 patients were infected with bacteria. None was dead in the patients with non-invasive ventilation. Conclusion: The age and basic diseases are the main mortal risk factors in SARS. Other risk factorsinclude the decline of immune function, secondary infection, complications and use of invasive ventilation.
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PAGE: 529-531
Observation on tissue factor pathway during the onset of acute cerebral infarction
WEN Zhi bin, XIONG Shi long, HE Xiao fan, HE Me ixia, HE Shi lin, XIE Qin zhi, QIAN Zai fu, CHEN Fang ping, XIAO Bo, YANG Qi dong
Thrombosis and Hemostasis Lab, Department of Physiology, Xiangya Medical University, Central-South University, Changsha 410078, Hunan, China.
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Abstract: Objective: To establish the possible relationship between some coagulation factors and the onsetof acute cerebral infarction (ACI). Methods: The study population consisted of 71 patients with ACI confirmedby CT and 50 age-matched healthy volunteers. Blood samples were obtained during the onset periodof ACI. Tissue factor (TF) and tissue factor pathway inhibitor (TFPI) activity in plasma were assayed with the chromogenic assay. Plasma TF and TFPI antigen were measured with enzyme linked immunoadsorbent assay (ELISA). Plasma FⅦ coagulation activity (FⅦ∶C) and FⅧ coagulation activity (FⅧ∶C) were developed in the one-stage system. Plasma prothrombin (FⅡ) was determined with Ecarin assay. Plasma fibrinogen (Fbg) was measured with thrombin assay. Plasma antithrombin Ⅲ activity (ATⅢ) was determined using heparin cofactor activity assay. Results: Compared with the control, plasma TF activity and antigen in patients with ACI were significantly higher (both P<0.05). But plasma TFPI activity and antigen were remarkablylower in the ACI group (both P<0.05) Plasma FⅦ∶C was significantly higher (P<0.01), and FⅧ∶ C was markedly lower (P<0.05). Plasma FⅡ was remarkably higher (P<0.01). Similarly the Fbg was significantly higher in the ACI than that in the control group (P<0.01), whereas ATⅢ was significantly lower (P<0.01). Conclusion: The initiation of TF pathway is contributed to the onset of ACI and the blood is in hypercoagulable state during the early period of ACI.
, 百拇医药
PAGE: 532-534
Comparison of the intracranial pressure value in patients with hypertensive intracerebral hemorrhage treated with traditional craniotomy and puncture drainage
SONG Shao jun, FEI Zhou, ZHANG Xiang
Institute of Neurosurgery of Chinese People's Liberation Army, Xijing Hospital, Fourth Military Medical University, Xi'an 710033， Shanxi, China.
Abstract: Objective: To compare the difference of intracranial pressure (ICP) in patients with hypertensive intracerebral hemorrhage (HICH) treated with two surgical procedures, traditional craniotomy and puncture drainage. Methods: One hundred and twelve cases with HICH were randomly divided into two groups. In one group, 60 patients were operated by traditional craniotomy and in another group, 52 cases by puncture drainage and urokinase treatment. In the meantime, ICP was monitored by placing catheter in lateral ventricle on the contralateral side of the hemorrhage. ICP values were recorded after operation at once, at 24 hours, 72 hours and 1 week. Results: Although all the patients showed increased ICP, the increasing degree in patients treated with traditional craniotomy had lower ICP values(P<0.05 or P<0.01). Conclusion: Traditional craniotomy has advantages over puncture drainage for patients with HICH at least with respect to decreasing ICP.
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PAGE: 535-537
Influence of hypoxia-reoxygenation on nitric oxide synthesis Ⅲ gene expression in cultured cerebral arterial endothelial cell
SONG Zhen ju, YANG Guang tian, LU De qin, WANG Di xun
Department of Emergency Medicine, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
Abstract: Objective: To investigate the change of nitric oxide synthase (NOS) Ⅲ
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gene expression in culturedcerebral arterial endothelial cells during hypoxia and reoxygenation. Methods: ①The cells were divided into six groups: control, hypoxia for 1 hour, reoxygenation for 2, 6, 12, 24 hours after hypoxia for 1 hour. ②The expression of NOSⅢ mRNA was detected semiquantitatively by reverse transcription-polymerase chain reaction (RT-PCR). ③Immunocytochemistry was used to detect the expression of NOSⅢ protein. Results: ①The gene and protein expression of NOSⅢ was increased during hypoxia for 1 hour. ②The gene and protein expression of NOSⅢ was decreased during reoxygenation for 2, 6, 12 hours afterhypoxia for 1 hour, expecially at 6 hours after reoxygenation. After cells were reoxygenation for 24 hours, the expression was restored to the normal level. Conclusions: The experiment showed that hypoxia could increase the levels of NOSⅢ gene and protein expression and reoxygenation inhibited the increment of this gene expression.
, 百拇医药
PAGE: 538-541
Expression of aquaporin-4 protein in brain from rats with hemorrhagic edema
LI Yan hua, SUN Shan quan
Department of Neurobiology, Chongqing University of Medical Science, Chongqing 400016, China.
Abstract: Objective: To study the expression of aquaporin-4 (AQP4) protein in perihematomal tissue after intracerebral hemorrhage (ICH) in rats. Methods: The experimental ICH model was established in rats by injecting quantitative collagenase into the left caudate nuclei of the rats. The changes of brain water content (BWC) were measured by the wet and dry weight methods. Immunohistochemistry was used to determine the change of expression of AQP4 protein during different periods after ICH. Results: BWC and AQP4 protein expression in perihematomal tissue were increased at 6 hours after ICH and reached peak at 72 hours. In one week following ICH, it was still higher than normal level. In addition, the expression of AQP4 was positively correlated with BWC(r=0.9857, P<0.01). Conclusion: AQP4 has a relevant relationship with the formation of brain edema after ICH.
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PAGE: 541
Missiagnosis analysis of 16 cases of senile atypical subarachnoid hemorrhage
PEN You lin
Fuan Health of Hospital, Jiangsu Dongtai 224222, China.
PAGE: 542-545
Early intravenous thrombolysis with recombinant tissue plasminogen activator for acute cerebral infarction
WANG Shen yan, WANG Xu li hong, ZENG Hong, ZUO Ying, HU Nan, LI Xue ying, HUANG Fei, YU Hai ling, WANG Hong yuan
, 百拇医药
Emergency Department, Beijing Emergency Medical Center, Beijing 100031,China.
Abstract: Objective: To evaluate the efficacy and safety of recombinant tissue plasminogen activator (rt-PA) and to explore the most suitable dosage of rt-PA in the early treatment of the Chinese patients with acute cerebral infarction (ACI). Methods: The patients who suited for the standard were divided into three groups. Group A received rt-PA at 0.9 mg/kg, group B received rt-PA at 0.7 mg/kg, and group C did not receive any thrombolytic therapy. In thrombolytic groups, rt-PA at 8 mg was injected intravenously in a bolus at first and then the rest was given over 60 minutes. The maximal dosage was 90 mg. The Chinese stroke scale (CSS) and Barthel Index (BI) were used to evaluate the recovery of neurological functions after rt-PA treatment for 24 hours and 90 days. The hemorrhagic rate and 30 days mortality rate were also analysed. Results: In group A the CSS significant effectiverate was 41.18 percent at 24 hours and 76.47 percent at 90 days after thrombolysis. At 90 days BI significant effective rate was 58.82 percent. At 30 days hemorrhagicrate was 8.82 percent and mortality rate was 5.88 percent. In group B, the CSS significant effective rate was 39.39 percent at 24 hours and 69.70 percent at 90 days. At 90 days, BI significant effective rate was 54.55 percent, and at 30 days, hemorrhagic rate was 9.09 percent and mortality rate was 9.09 percent. In group C, the CSS ignificant effective rate was 21.21 percent, at 24 hours and 30.30 percent at 90 days (P>0.05). At 90 days, BI was 21.21 percent the mortality rate was 9.09 percent. At 30 days the mortality rate was no significant difference within three groups At 90 days, significant effective rate was 73.13 percentvs. 30.30 percent in thromblytic and control groups (P=0.001 7). The significant disability rate was 13.43 perent vs. 24.24 percent. Conclusions: For Chinese individuals, with ACI, rt-PA thrombolytsis was effective and safe. The dosage of 0.9 mg/kg for foreign people also fitted for Chinese individuals.
, 百拇医药
PAGE: 546-549
Study on early heart rate variability in patients with severe acute cerebral vascular disease
LI Shu juan, SU Ying ying, LIU Miao
NICU, Xuanwu Hospital, Capital University of Medical Science, Beijing 100053, China.
Abstract: Objective: To investigate the dynamic changes of heart rate variability (HRV) in acute cerebral vascular disease, in order to make a criteria for evaluating cerebral function, and establish an assessment for risk stratification after acute stroke. Methods: All 35 patients who suffered from cerebral vascular disease in the distribution of the carotid artery system were studied from 1 to 7 days following the stroke. HRV analysis with 24-hour Holter tapes were performed every day or every other day continuously for 5 days. According to GCS, the patients were divided into two groups. Critical cerebral vascular disease (CCVD): a state of severe cerebral dysfunction with the Glasgow coma scale (GCS) value between 3 and 8. Non-critical cerebral vascular disease (nCCVD): a state of slightly cerebral dysfunction with the GCS value between 9 and 15. Results: Of the 35 patients, 17 were classified to CCVD, 18 to nCCVD. The CCVD patients had significantly decreased HRV, especially the standard deviation of all R-R intervals (SDNN) and total frequency (TF). The 24-hour heart rate variability graph lost its circadian variation showing a low and plain curve during the whole day. There was a significant correlation between the decrease of HRV and bad prognosis. The borderline of HRV for prognosis was： SDNN≤60 ms、 TF≤1 500 ms 2/Hz, high frequency (HF)≤600 ms 2/Hz, low frequency (LF)≤1000 ms 2/Hz. Dynamic observation proved that if the components of HRV reached this standard, it always indicated bad outcome. On the contrary, if those components increased continuously and were higher than those of the above, it was always indicative of good outcome. These changes always advanced GCS. Prognosis had a high correlate with TF, LF, HF and GCS. Logistic regression showed that only TF, HF and GCS were the main factors affecting the prognosis. The accurate rate of death predication was 88.89 percent, the accurate rate of survival was 82.14 percent. It was much better than the traditional GCS. Conclusions: HRV decreases significantly in CCVD and loses its circadian variation. Dynamic observation of HRV offers a good marker for monitoring cerebral function and the progress of disease. HRV could be considered as an objective, non-traumatic and sensitive indicator of the cerebral function and prognosis.
, 百拇医药
PAGE: 549
36 cases of chronic hematom under meninges treated with minimally invasive punctune and aspiration
LIU Jin feng, HE Zhuo
People’s Hospital, Henan Zhenping 474250, China.
PAGE: 550-552
Study on clinical significances of the application of nasotracheal intubation guided with fiberbronchoscope to the postoperative patients with hypertensive intracerebral hemorrhage
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ZHANG Jian jun, YAN Xiao feng, DONG Wei feng, ZHANG Jun, GU Shui jun, XUAN Hong fei, SI Yun
Department of Neurosurgery, The First People's Hospital of Xiaoshan, Hangzhou 311201, Zhejiang, China.
Abstract: Objective: To explore the clinical signification of the application of nasotracheal intubation guided with fiberbronchoscope to the postoperative patients with hypertensive intracerebral hemorrhage (HICH) who had respiration failure. Methods: Ninety-four postoprative patients with HICH were divided intotwo groups, A group treated with nasotracheal intubation and B group treated with tracheal incision. The oxygen metabolism, pulmonary complication incidence of two groups were analyzed and compared. Results: The basic oxygen metabolism and the need of mechanical ventilation in the cases with respiration failure were satisfying in two groups (both P>0.05). The mean reserved time of artificial airway in A group was(14.2±6.5)days, which in B group was(19.1±7.2)days (P<0.01). The occurent rates of combined infection in lung and double-infection were lower in A group than these in B group (56.3 percent vs. 91.3 percent, P<0.05; 10.4 percent vs. 39.1 percent, P<0.01; respectively), with their resident days shorter and prognosisbetter in A group than these in B group (P<0.05). Conclusion: The nasotracheal intubation guided with fiberbronchoscope has small trauma, lower incidence of complication, which may be considered as a better selection for the postoperative patients with HICH who had respiration failure.
, 百拇医药
PAGE: 553-556
Effects of naloxone on rat cortical neuron apoptosis induced by anoxia
SONG Yang, SHEN Hong, DING Ai shi, FAN Ming
Department of Emergency, General Hospital of People's Liberation Army, Beijing 100853, China.
Abstract: Objective: To investigate the damage of anoxia on the cultured rat's cortical neurons and the protective effects of naloxone. Methods: Cortical neurons cultured for 12 days were randomly divided into three groups: control, anoxic group and anoxic group plus naloxone treated. Cortical neurons were exposed to anoxic environment for 6 hours and then cultured for 24 hours under normoxic condition. The apoptosis of neurons was detected with the method of TdT-mediated dUTP nick end labeling (TUNEL) and the apoptotic rate of neurons was measured using flow cytometry. Results: Anoxia could lead to increasing apoptosis and death of rate cortical neurons. Naloxone could reduce neuron apoptosis. There was a significant difference between the anoxic group and anoxic group plus naloxone (P<0.01). Conclusion: Naloxone can ameliorate the toxicity damage of neurons caused by anoxia through reducing neuron apoptosis, which suggests that naloxone could protect rat's cortical neurons from damage under anoxia condition.
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PAGE: 556
Effect of losartan and Nitrendipine on fibrinolytic system in patient with essential hypertensim
YIN Ping, WANG Lei, RONG Yu dong
International Diagnosis and Treat Center, Tianjin First Central Hospital, Tianjin 300192, China.
PAGE: 557-559
Wilms' tumor-1 gene expression in myelodysplastic syndrome and its changes in the process of myelodysplastic syndrome transforming into acute leukemia
, 百拇医药
YANG Jie kun, LI Jin lan, LI Zeng gang, LI Zhi gang, LIU Peng jiang, LI Jing yi, LU Hai rong, DENG Qi, LIN Xue mei, CAO Jin ni
Tianjin First Central Hospital, Tianjin 300192, China.
Abstract: Objective: To observe expression of Wilms' tumor-1 (WT1) gene in the different subtypes of myelodysplastic syndrome (MDS), and to explore the regularity of expression of WT1 gene in the process of MDS transforming into acute leukemia (AL). Methods: The method of reverse transcriptase-polymerase chain reaction (RT-PCR) was used, the levels of WT1 gene's presentation in different types of montagers of MDS were analyzed, and the relationship between the level and the clinical characteristic was analyzed. At the same time, the expression of WT1 gene in AL patients, post-MDS-AL patients and normal controls were examined. Results: The positive rate of WT1 gene expression in 49 patients with MDS was 22.4 percent (11/49), refractory anemia (RA) was 0(0/13), RA with excess of blast(RAEB) was 25.0 percent (6/24), RAEB in transformation (RAEB-t) was 41.7 percent (5/12). The positive rates of WT1 expression were gradually increased in three types of MDS (P<0.05 and P<0.01). The positive rates of WT1 expression were higher in AL and post-MDS-AL patients (48.5 percent，32/66 and 50.0 percent, 4/8) than that in MDS patients (P<0.01). There was no expression of WT1 gene in normal control. Conclusion: There is a relatively high expression rate of WT1 gene in RAEB, RAEB-t of MDS, but relatively low expression rate in RA. The method of RT-PCR, is high sensitiveness and specificity, can trustful be used in the procession of monitoring MDS' progression and its transformation into AL.
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PAGE: 560-562
Evaluation oxygen free radicals related index before liver transplantation to forejudge prognosis
LIU Chun, ZHOU Xiao si, GENG Qiu ming
The Third Hospital of Peking University, Beijing 100083, China.
Abstract: Objective: To research the relationship of oxygen free radicals related index before liver transplantation with prognosis. Methods: Lipid peroxide (LPO), total antioxidant capacity (TAC), nitric oxide (NO) and total bilirubin (T-BIL) in blood from 18 patients were measured before liver transplantation, and the relationship with prognosis was analyzed. Results: The blood LPO of death group was (17.13±4.16) μmol/L, it was obviously higher than that of survival group (7.97±3.52) μmol/L (P<0.05). The blood TAC of survival group was (38.05±19.13) kU/L, it was higher than that of death group (32.54±3.07)kU/L, but there was no obvious difference(P>0.05). There was no obvious difference between the bloodNO of death group was (50.80±14.80)μmol/L, and survive group was (150.46±19.54) μmol/L (P>0.05). The blood T-BIL of death group was (425.98±214.18) μmol/L， it was obviously higher than that of survival group(172.10±144.32) μmol/L (P<0.05). So the blood LPO and TAC were choosen as the index to forejudge prognosis, and an equation was established to forecast if the patient would be death or survive : Y 1=0.3290 X 1+0.0998 X 2-3.9040, Y 2=1.3520 X 1-0.0500 X 2-11.4640， X 1 represented serum LPO, X 2 represented serum TAC. 100.0 percent accuracy was forecasted in the survival group by the equation, 83.3 percent accuracy was in the death group. The overall patients were forejudged 94.4 percent accurately. Conclusion: Measuring LPO and TAC in blood maybe forejudging prognosis properly and can be used as routine examination before liver transplantation. The equation is preferable to forejudging prognosis, it can be used to choose from high risk patients to improve survival rate of the patients after operation. Therefore, it is valuable in clinical practise.
, 百拇医药
PAGE:563-565
Analysis of factors related to mortality of critical patients with acute renal dysfunction
CHAI Wen zhao, DU Bin, MO Xiao li, ZHOU Xiang, ZHANG Ying, ZHANG Jun, LIU Da wei
ICU, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Abstract: Objective: To investigate the high risk factors related to mortality rate of critical patients with acute renal dysfunction in intensive care unit (ICU). Methods: The data of patients with acute renal dysfunction hospitalized in ICU of Peking union medical college hospital during August 1999 to May 2001 were retrospectively investigated and the high risk factors related to hospital mortality were analyzed. The statistical analysis methods were univariate and multivariate factors analysis. Results: Among 1 218 critical patients hospitalized during August 1999 to May 2001, there were 149 patients with acute renal dysfunction. One hundred and thirty-five patients were investigated completely. Fifty-five (41 percent) died during the hospital stay. By univariate analysis, risk factors related to hospital mortality included acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, the systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock, chronic respiratory dysfunction, sepsis-related organ failure assessment (SOFA) score, acute respiratory dysfunction, coagulation dysfunction, central nerves system dysfunction, cardiovascular dysfunction, management of noradrenaline and continuous venovenous hemofiltration (CVVH). By multivariate analysis, only APACHEⅡ score and management of noradrenaline and CVVH were determinedas risk factors of hospital mortality independently. If the three factors were excluded, sepsis, central nerves system dysfunction, oliguria became the risk factors of mortality (all P<0.05). Conclusion: The prognosis of critical patients with the acute renal dysfunction correlate with degree of basic diseases. There include oliguresis, coagulation dysfunction, central nerves system dysfunction and sepsis. In spite of management of CVVH, acute renal dysfunction per se can affect the prognosis of the critical patients.
, 百拇医药
PAGE: 566-567
anagement for hemobilia after hepatobiliary surgery
JIANG Kai, ZHOU Ning xin, HUANG Zhi qiang, HUANG Xiao qing, LIU Rong, ZHANG Wen zhi, WANG Mao qiang
Department of Hepatobiliary Surgery, the General Hospital of People's Liberation Army, Beijing 100853, China
Abstract: Objective: To investigated the diagnosis and treatment for hemobilia after hepatobiliary surgery. Methods: The data were collected from 21 patients with postoperative hemobilia treated in our hospital from October 1989. The data from patients including age, with or without hypertension history, operation procedure, bleeding time after operation, clinical manifestation, diagnosis method, hepatic artery embolization and operative management were analyzed to summarize the clinical treatment hemobilia. Results: There were 13 men and 8 women. Twelve patients had hypertension history. Sixteen patients were underwent with emergency hepatic artery angiography and were treated with hepatic artery embolization, the other five cases were managed directly by operation. In the operation group, 2 patients were under gone two times operative management respectively. The effectiveness of operation for all patients was good and without rebleeding. Conclusion: Emergency hepatic artery angiography and embolization as a first diagnosis procedure and minimally invasive treatment should be the first and safe selection for all hemobilia.
, 百拇医药
PAGE: 568-569
Study on drug delivery of the 3H-BCHU polylacties acid released agents on gliosarcoma
ZHANG You ping, XU Xin nu, WANG Jin huan, LU Ge, LIU Ping, SU Tong fang, LIU Hong sheng, QI Jian bin, GAO Bo
Tianjin First Central Hospital, Tianjin 300192, China.
PAGE: 569-570
Clinical study of alliance clecompression on middle and late period tentorial herniation
, 百拇医药
TANG Xiang, LAN Zu xiu, ZHENG Jun, XIE Bao jun, WANG You cun
Hechi The First People’s Hospital, Guangxi Yizhou 546300, China.
PAGE: 572-573
Effect of shengmai parenteral solution on immiediate hemodynamics in patients with congestive heart failture
LI Hui, JIN Zhang an, HUO Yan ming
East Hospital, Beijing Fengtai 100078,China.
, 百拇医药
PAGE: 574-575
Introduction of a simple and easy stereotactic technology-no framework and stereotaetic punction and drainage technology to treat cerebral hemorrhage
LIN Zhao fen, SUN Yong, ZHANG Yu ke, WANG Xiao dong, YANG Xing yi
Changzheng Hospital, The second surgeon university, Shanghai 200003, China., 百拇医药