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肺损伤与急救高峰论坛

肺损伤与急救高峰论坛

  • 召开年:2011
  • 召开地:上海
  • 出版时间: 2011-05

主办单位:上海市医学会

会议文集:肺损伤与急救高峰论坛论文集

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  • 摘要:目的:探讨各种急性中毒并发急性呼吸窘迫综合征病例的发病原因及预后转归情况。rn 方法:回顾性分析8年来我院收治的各种急性中毒后合并发生 ARDS的发生率,以及合并ARDs病例经过积极救治后治愈率及死亡率情况。rn 结果:576例急性中毒患者中,并发ARDs患者26例,占4,51%,其中以百草枯中毒最多见(50%),其次为毒鼠强中毒28.57%、磷化锌中毒25%、硫化氢中毒1 5%等,在26例并发ARDs病例中死亡比例高达65.38%。rn 结论:各种急性中毒后患者一旦合并ARDS发生,死亡比例将大大增加,而且各种毒素所致中毒后出现ARDs并发比例有所差异,对于各种毒素所致中毒,从治疗早期就应有所警戒,早期采用综合防治可减少发生率和病死率,尤其对开展百草枯中毒的防治研究具有重要意义。
  • 摘要:Background:Abnormal proliferation, apoptosis, migration and contraction of airway smooth muscle (ASM) cells inairway remodeling in asthma are basical叹excessive repair responses to a network of inflammatory mediators suchas PDGF, but the mechanisms of such responses remain unclear. Nogo-B, a member of the reticulum family4(RTNa), is known to play a key role in arteriogenesis and tissue repair. Further studies are needed to elucidate therole of Nogo-B in airway smooth muscle abnormalities.Methods:A mouse model of chronic asthma was established by repented OVA inhalation and subjected to Nogo-Bexpression analysis using immunohistochemistry and Western Blotting. Then, primary human bronchial smoothmuscle cells (HBSMCs) were cultured in vitro and a siRNA interference was performed to knockdown the expressionof Nogo-B in the cells-The effects of Nogo-B inhibition on PDGF-induced IiBSMCs proliferation, migration andcontraction were evaluated-Finally, a protPOmic analysis was conducted to unveil the underlying mechanismsresponsible for the function of Nogo-B.Results:Total Nogo B expression was approximately 3.68 fold lower in chronic asthmatic mice compared to naivemice, which was obvious in the smooth musde layer of the airways. Interference of Nogo B expression饰siRNArexdted nearly%%reduction in mRNA in cultured HBSMCs. In addition, knockdown of Nogo-R using specificsiRNA significantly decreased PDGF-induced migrztion of HBSMCs by 2-3fold, and increased the cellularcontraction by 16'Yo compared to negative controls, but had limited effects on PDGF induced proliferation.furthermore, using proteomic analysis, we demonstrate that the expression of actin related protein 7J3 complexsubunit 5 (ARPC 213) decreased and, myosin regulatory light chain 9 isoform a (MYL-9) increased after Nogo-Bknockdown.
  • 摘要:Ever since the introduction of invasive hemodynamic monitoring to major burn care,its utility remains controversial.Besides complications,invasive monitoring as a guidcline for burn shock resuscitation is often associated with significant excessive fluid burden.Ire early systemic Pathnphysinlngy of majvx blurs is char.ICtC1171x1.tlucnuuiun of Ir.rtu}dvrvnics. IlypuvolaniasulteJ from massive plasma-IJcc tluid c;Iravasationto cxtcrsivc inacasing ut miaova-ccular pcrmeubai:yquires rapiJ and adequate fluid resuscitation for the mainte-n
  • 摘要:7 days). Nine patien;s died cf MODS or sepsis,giving a mortality rate of 8.57%. Conclusion:Caution and preventive measures are needed farpersons in ships for fire-related bums.">The 105 patients admitted to our Bum Institute from 1st January 1996 to 31st 1>ecember2007,whit ship fire"related burns were studied retospectively. The mean age was 30.2士12.6years with a range of 1-58. One hundred and three patients (98.1%) we:e men and 2 (1.9%)women. T'he mean total bum surface uea帅SA) was 46.5%, mos即deep burns. The mostcommon areas of burn were the head, neck and upper limb. Summer months July, August,)uue and September were times of highest incidence. Fifty-seven份」咐patients hadinhalation injury, 42 received tracheotomy, and }8 received mechanical ventilation. Thetreatment was complex, difficult, long, and cps你The internal between bum and start ofresuscitation ranged from Z.1 to 67 h with a mean of (S,士4.4) h. Forty-two patients (40%)started intravenous fluid resuscitation 6 h after bum. Twenty-four patients (23%) receivedinsufficent fluid resuscitation developed hypotension and severe shock at admission.Ninety-two (87.6%) patients required operations including tracheotomy, debridementand grafting, per patient was 5.2. The mean length of hospital stay was 44.2 days. 2ulmonaryedema w as the most common complication during the early post-burn period (within 7days), and sepss during the later period (>7 days). Nine patien;s died cf MODS or sepsis,giving a mortality rate of 8.57%. Conclusion:Caution and preventive measures are needed farpersons in ships for fire-related bums.
  • 摘要:目的:为了能及时解决吸入性烧伤患者的痛苦,避免支气管和肺叶水肿造成呼吸困难甚至窒息死亡,或减少做插管手术所带来的损伤.rn 方法:采用药物对呼吸道口的喷雾疗法扣点滴吸入疗法。rn 结果:患者吸入药物后随着不断吸入药物深入至肺腔,呼吸道炽热感逐步消失,肺腔出现清凉感,在药物作用下患者出现咳嗽,随着咳嗽的作用使进入肺腔的药物伴随着吸入烟尘及黏液一起形成黑色痰排出体外,一般急诊患者在用药二小时内缓解该症状,用药二十四小时完全恢复正常呼吸功能,有利于进一步治疗烧伤的结果。rn 结论:通过数十年来使用“张氏烧伤灵”对广大吸入性烧伤患者临床施治,疗效显著,独树一帜,减轻了患者的痛苦和医疗费用,提高了患者的生存基率和烧伤急救医务工作者.的专业技术水平。
  • 摘要:目的:了解骨髓间充质干细胞(BMscs)在急性肺损伤(ALI)中的作用及其机制.rn 方法:查阅近年有关BMsCs在ALI中的相关文献,并结合笔者单位开展的BMSCs 移植对烟雾吸入性损伤肺组织的保护作用及其体内向功能细胞分化的研究,进行分析和阐述。rn 结果:BMSCs能主动归巢至ALI或吸入性损伤部位并通过分化参与纽织修复,同时能调节和平衡肺损伤时局部和全身炎性反应和免疫紊乱。rn 结论:具有主动归巢、分化以及抗炎一免疫调节效应的BMsCs对ALI或吸入性损伤具有全面的生物学效应,有潜在的临床治疗价值,并为今后的基因一干细胞治疗奠定了基础。
  • 摘要:尽管吸入性损伤的研究在不断深入,但因其复杂的病理生理特征,临床救治依然困难,死亡率仍很高。本文回顾近年来国内外吸入性损伤、急性肺损伤以及ARDS的研究和治疗进展,重点阐述了无创通气、肺保护性通气、液体通气以及高频通气等机械通气模式对吸入性损伤早期呼吸支持作用,总结了药物治疗并展望干细胞治疗吸入性损伤的应用前景。
  • 摘要:目的:观察高频振荡联合部分液体通气对蒸气吸入性损伤兔肺泡灌洗液的影响。rn 方法:新西兰大白兔40只制成重度蒸气吸入性损伤并急性呼吸衰竭模型,随机分为五组,其中一组作为对照组,致伤后给予吸氧治疗,4h后经颈动脉抽血处死,另四组分别采用四种方法进行通气治疗(CMV,CMv+PLV,HFOV 及HFOV+PLV)。通气治疗4h后经颈动脉抽血处死大白兔。各组大白兔处死后立即经气管插管用生理盐水8ml×3次灌洗,并收集灌洗液。计量后离心,收集沉淀的细胞进行涂片、固定、染色,然后进行细胞计数及分类,分离细胞后使用流式细胞仪检测中性粒细胞凋亡及坏死。上清液则进行各种炎性因子(E一选择素、P-选择素、ICAM-1和ET-1)总蛋白、丙二醛检测。rn 结果:1.细胞计数及分类:各组BALF回收率无明显差别,cMV组BALF中中性粒细胞均分别明显高于其他三个治疗组(P<0.01),HFOV+PLV组中性粒细胞均最低,11FOV+PLy组中性粒细胞比例和cMv+PLV组比较差别有显著性(P<0.01);各治疗组肺泡巨噬细胞(AM)的百分比均高于对照组,2.细胞凋亡:HFOV+PLV组中性粒细胞凋亡率和早期凋亡率较其它三组高,同时坏死细胞数量也最少。HFOV组和HF0v+PLV组中性粒细胞早期凋亡率较CMV组和CMV+PLV组明显升高(Po.05).3.总蛋白、丙二醛浓度各治疗组间的差异无统计学意义(P>0.05)。 E-选择素、P-选择素,ICAM-1和ET-1浓度各治疗组间的差异无统计学意义 (P>0.05).rn 结论:与其它三种通气模式相比,高频振荡通气联合部分液体通气能提高吸入性损伤兔肺泡中性粒细胞凋亡,减少肺组织内炎性细胞浸润。
  • 摘要:目的:探讨纤维支气管镜在重症烧伤病人抢救中的应用及治疗价值。rn 方法:对5例吸入性损伤病人在机械通气辅助支持下,通过床旁纤维支气管镜引导分别行吸痰及支气管肺泡灌洗,对比纤维支气管镜治疗前后的临床症状、白细胞计数、血气、痰培养及胸片结果。rn 结果:5例病人经纤支镜吸痰及冲洗治疗后呼吸困难及白细胞计数均在短时间内明显改善,血气提示氧分压的升高和二氧化碳的降低,痰培养细菌减少或转阴,胸片提示病灶吸收好转。rn 结论:纤维支气管镜在吸入性损伤病人抢救中有很大应用价值,值得推广。
  • 摘要:目的:探讨烧伤伴吸入性损伤患者气管切开的时机与指征。rn 方法:回顾性总结分析30例在烧伤24小时内行气管切开术和20例在烧伤24小时后行气管切开术。rn 结果:在烧伤24小时内行气管切开术者死亡l例,24小时后行气管切开术者死亡5例。rn 结论:大面积烧伤伴呼吸道损伤,在烧伤后及早行气管切开术可降低死亡率。
  • 摘要:The presem study was designed to find ota whether SB432542, an inhibitor of transfomung growth factor B1activin receptor-like kinase, could protect the lung from LPS-induced injury. Inflanxatory lung injury model was inducedby inUatracheal administration of LPS. C57BL/6 mice were randomly divided imo the sham control group (S group), theLPS stimulation group (L group), the LPS+early S8431542 treatment group (1e group), and the LPS+delayed SB432542treabnent group (Id group). S8431542 was admitted intraperitoneally on study days 1, 2, and 3 to the mice in 1e group,whereas those in Id group received the same dose of SB432542 on days 4, 5, and 6. Pulmonary TNF-u and IL-1p mRNA expressions were tested. Pathological evaluaLOns of pulmonary alveolnis and collagen deposition and fibrosiswere performed on study days 7 and 28, along with the determination of pulmonary hydroxyproline, matrixmetalbproteinase 9, and tissue inhibitor of matrix metalloproleinase 1 on study day 2E. As a result, LPS stimulationresulted in significant increases of the pulmonay TNF-a and IL-16 mRNA expressions as web as pathological scores foralveolitis on day 7 and increased collagen deposition, hydroxyproline content, and pathological scores for fibrosis on day即。with a decrease of malnx metalloproteinase S activity. Those parameters were further aggravated in the 1e groupvahereas relieved significantly in the Id group. These data suggest that SB43t542 therapy for inflammatory lung ir,lurycould be harmful if performed Miring early-phase inflatntnatory response. However, the ttterapy would prevent lung frominflanmatory injury and fibrosis i1 it was initiated late.
  • 摘要:Alternation of surface markers on menocytes is associated with the development ofinflammation. The goals of the present study were to detect CD47 expression on monocytesby flow cytometry and explore its relationship with disease severity and MODS in burnedpatients. The results show CD47 expression on monocytes from all burned patients was lower than that from the healthy population for 24 days after burn. There was asigilificant difference in CD4%expression on monocytes between the patients with differingbum severity in the 5rst 7 days after injury (<0.05). Considering the relationship betweenCIYf7 expression and M.ODS, we found the CD47 ^xpression on:nonocytes from patientswi MODS was lowerin the first 3 days after injury than that from patientswithout MODS. In conclusion, diminished CD47 expression on monocytes is associated withbum severity attd the occurrence of MODS in burn patients.
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