目的评估不同时机气管切开对重症脑血管病患者的影响。方法对青岛大学附属青岛市中心医院2018年1月至2020年12月进行气管切开的56例重症脑血管病患者进行回顾性分析。根据经口插管时间将患者分成早期气管切开ET组(≤10 d)共28例,晚期气...目的评估不同时机气管切开对重症脑血管病患者的影响。方法对青岛大学附属青岛市中心医院2018年1月至2020年12月进行气管切开的56例重症脑血管病患者进行回顾性分析。根据经口插管时间将患者分成早期气管切开ET组(≤10 d)共28例,晚期气管切开LT组(>10 d)共28例,其中男38例,女18例,年龄44~86岁。观察2组患者的基础特征、气管切开后重症医学科(intensive care unit,ICU)住院时间、重症医学科总住院时间、呼吸机相关性肺炎(ventilator associated pneumonia,VAP)发生率,肺部感染患者抗生素使用时间,痰培养多重耐药(multidrug resistant,MDR)发生率及细菌培养的菌群分布等。结果2组患者在基础特征如年龄、性别、急性生理和慢性健康状况(acute physiology and chronic health evaluationⅡ,APACHEII)评分以及格拉斯哥昏迷(glasgow coma scale,GCS)评分比较,差异无统计学意义(P>0.05),2组间气管切开后的ICU住院时间(中位数分别为7.5 d和7 d,P=0.729)及VAP发生率(分别为39%和61%,P=0.109)差异无统计学意义。但早期气管切开组的ICU总住院时间(中位数分别为15.5 d和22 d,P<0.001),抗生素使用时间分别为[(11.8±3.2)d和(17.1±4.1)d,P<0.001]及多重耐药发生率较晚期气管切开组均明显减少(分别为39%和79%,P=0.003)。而且早期气管切开组肺炎克雷伯菌引起的肺部感染发生率更低(P=0.029)。结论早期气管切开明显缩短重症脑血管病患者的ICU住院时间及肺部感染患者抗生素使用时间,减少多重耐药的发生率,但并没有减少VAP的发生率。而对于气管切开指征及时机仍需有效的手段进一步评估。展开更多
In order to explore the changes and the roles of TXA2 and PGI2 during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage, 31 cases subject to craniotomy were divided into three gr...In order to explore the changes and the roles of TXA2 and PGI2 during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage, 31 cases subject to craniotomy were divided into three groups： group A, 9 patients with postoperative hypertensive crisis; group B, 13 patients without postoperative hypertensive crisis; and group C, 9 patients without history of hypertension and hypertensive intracerebral hemorrhage. TXA2, TXB2, 6-keto-PGF1α and PGI2 were measured after operation in the three groups respectively. The postoperative blood pressure in group A, including SBP and DBP, was elevated more obviously than that in the other two groups. TXA2 and PGI2 in group A were significantly higher than those in other two groups （P〈0.01）. Moreover, the ratio of TXB2 to 6-keto-PGF1α in group A was significantly higher than that in other two groups （P〈0.05）. The increase of TXA2 and the relative inadequacy of prostacyclin, especially 6-keto-PGF1α, may play roles in the postoperative hypertensive crisis. And the increased value of TXB2 to 6-keto-PGF1α could provide the basis for diagnosis of postoperative hypertensive crisis.展开更多
文摘目的评估不同时机气管切开对重症脑血管病患者的影响。方法对青岛大学附属青岛市中心医院2018年1月至2020年12月进行气管切开的56例重症脑血管病患者进行回顾性分析。根据经口插管时间将患者分成早期气管切开ET组(≤10 d)共28例,晚期气管切开LT组(>10 d)共28例,其中男38例,女18例,年龄44~86岁。观察2组患者的基础特征、气管切开后重症医学科(intensive care unit,ICU)住院时间、重症医学科总住院时间、呼吸机相关性肺炎(ventilator associated pneumonia,VAP)发生率,肺部感染患者抗生素使用时间,痰培养多重耐药(multidrug resistant,MDR)发生率及细菌培养的菌群分布等。结果2组患者在基础特征如年龄、性别、急性生理和慢性健康状况(acute physiology and chronic health evaluationⅡ,APACHEII)评分以及格拉斯哥昏迷(glasgow coma scale,GCS)评分比较,差异无统计学意义(P>0.05),2组间气管切开后的ICU住院时间(中位数分别为7.5 d和7 d,P=0.729)及VAP发生率(分别为39%和61%,P=0.109)差异无统计学意义。但早期气管切开组的ICU总住院时间(中位数分别为15.5 d和22 d,P<0.001),抗生素使用时间分别为[(11.8±3.2)d和(17.1±4.1)d,P<0.001]及多重耐药发生率较晚期气管切开组均明显减少(分别为39%和79%,P=0.003)。而且早期气管切开组肺炎克雷伯菌引起的肺部感染发生率更低(P=0.029)。结论早期气管切开明显缩短重症脑血管病患者的ICU住院时间及肺部感染患者抗生素使用时间,减少多重耐药的发生率,但并没有减少VAP的发生率。而对于气管切开指征及时机仍需有效的手段进一步评估。
文摘In order to explore the changes and the roles of TXA2 and PGI2 during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage, 31 cases subject to craniotomy were divided into three groups： group A, 9 patients with postoperative hypertensive crisis; group B, 13 patients without postoperative hypertensive crisis; and group C, 9 patients without history of hypertension and hypertensive intracerebral hemorrhage. TXA2, TXB2, 6-keto-PGF1α and PGI2 were measured after operation in the three groups respectively. The postoperative blood pressure in group A, including SBP and DBP, was elevated more obviously than that in the other two groups. TXA2 and PGI2 in group A were significantly higher than those in other two groups （P〈0.01）. Moreover, the ratio of TXB2 to 6-keto-PGF1α in group A was significantly higher than that in other two groups （P〈0.05）. The increase of TXA2 and the relative inadequacy of prostacyclin, especially 6-keto-PGF1α, may play roles in the postoperative hypertensive crisis. And the increased value of TXB2 to 6-keto-PGF1α could provide the basis for diagnosis of postoperative hypertensive crisis.
