【目的】探讨检测急性肺栓塞患者的血浆脑钠肽（BNP）、肌钙蛋白I（cTnI）及D‐二聚体（D‐dimer）水平变化的临床意义。【方法】选择本院2009年1月至2013年12月收治的急性肺栓塞患者64例，根据患者病情分为大面积肺栓塞组（ n ＝27）...【目的】探讨检测急性肺栓塞患者的血浆脑钠肽（BNP）、肌钙蛋白I（cTnI）及D‐二聚体（D‐dimer）水平变化的临床意义。【方法】选择本院2009年1月至2013年12月收治的急性肺栓塞患者64例，根据患者病情分为大面积肺栓塞组（ n ＝27）和非大面积肺栓塞组（ n ＝37），对两组患者血浆cTnI、BNP及D‐dimer水平进行测定，观察比较两组患者各指标水平的变化及右心功能和病死率。【结果】大面积肺栓塞组BN P、血浆cTnI水平明显高于非大面积肺栓塞组，两组比较差异有显著性（ P ＜0．05）；两组D‐dimer浓度比较差异无统计学意义（ P ＞0．05）；大面积肺栓塞组的右心功能不全者和病死率均高于非大面积肺栓塞组，两组比较差异有统计学意义（ P ＜0．05）。【结论】检测BNP、cTnI及D‐dimer水平对APE患者临床诊断、临床决策及预后判断具有重要的临床意义。展开更多
The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline （henceforth： saline） and to discuss the impact of saline infusion, specifically on systemic aci...The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline （henceforth： saline） and to discuss the impact of saline infusion, specifically on systemic acid-base bal- ance and renal hemodynamics. Studies have shown that electrolyte balance, including effects of saline infusion on serum electrolytes, is often poorly understood among practicing physicians and inappropriate saline prescribing can cause increased morbidity and mortality. Large-volume （〉2 L） saline infusion in healthy adults induces hyperohloremia which is associated with metabolic acidosis, hyperkalemia, and negative protein balance. Saline overload （80 ml/kg） in rodents can cause intestinal edema and contractile dysfunction associated with activation of sodium-proton exchanger （NHE） and decrease in myosin light chain phosphorylation. Saline infusion can also adversely affect renal hemody- namics. Microperfusion experiments and real-time imaging studies have demonstrated a reduction in renal perfusion and an expansion in kidney volume, compromising 02 delivery to the renal perenchyma following saline infusion. Clinically, saline infusion for patients post abdominal and cardiovascular surgery is associated with a greater number of adverse effects including more frequent blood product transfusion and bicarbonate therapy, reduced gastric blood flow, delayed recovery of gut function, impaired cardiac contractility in response to inotropes, prolonged hospital stay, and possibly increased mortality. In critically ill patients, saline infusion, compared to balanced fluid infusions, in- creases the occurrence of acute kidney injury. In summary, saline is a highly acidic fluid. With the exception of saline infusion for patients with hypochloremic metabolic alkalosis and volume depletion due to vomiting or upper gastroin- testinal suction, indiscriminate use, especially for acutely ill patients, may cause unnecessary complications and should be avoided. More education regarding saline-related effects and adequate electrolyte management is needed.展开更多
文摘【目的】探讨检测急性肺栓塞患者的血浆脑钠肽（BNP）、肌钙蛋白I（cTnI）及D‐二聚体（D‐dimer）水平变化的临床意义。【方法】选择本院2009年1月至2013年12月收治的急性肺栓塞患者64例，根据患者病情分为大面积肺栓塞组（ n ＝27）和非大面积肺栓塞组（ n ＝37），对两组患者血浆cTnI、BNP及D‐dimer水平进行测定，观察比较两组患者各指标水平的变化及右心功能和病死率。【结果】大面积肺栓塞组BN P、血浆cTnI水平明显高于非大面积肺栓塞组，两组比较差异有显著性（ P ＜0．05）；两组D‐dimer浓度比较差异无统计学意义（ P ＞0．05）；大面积肺栓塞组的右心功能不全者和病死率均高于非大面积肺栓塞组，两组比较差异有统计学意义（ P ＜0．05）。【结论】检测BNP、cTnI及D‐dimer水平对APE患者临床诊断、临床决策及预后判断具有重要的临床意义。
文摘The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline （henceforth： saline） and to discuss the impact of saline infusion, specifically on systemic acid-base bal- ance and renal hemodynamics. Studies have shown that electrolyte balance, including effects of saline infusion on serum electrolytes, is often poorly understood among practicing physicians and inappropriate saline prescribing can cause increased morbidity and mortality. Large-volume （〉2 L） saline infusion in healthy adults induces hyperohloremia which is associated with metabolic acidosis, hyperkalemia, and negative protein balance. Saline overload （80 ml/kg） in rodents can cause intestinal edema and contractile dysfunction associated with activation of sodium-proton exchanger （NHE） and decrease in myosin light chain phosphorylation. Saline infusion can also adversely affect renal hemody- namics. Microperfusion experiments and real-time imaging studies have demonstrated a reduction in renal perfusion and an expansion in kidney volume, compromising 02 delivery to the renal perenchyma following saline infusion. Clinically, saline infusion for patients post abdominal and cardiovascular surgery is associated with a greater number of adverse effects including more frequent blood product transfusion and bicarbonate therapy, reduced gastric blood flow, delayed recovery of gut function, impaired cardiac contractility in response to inotropes, prolonged hospital stay, and possibly increased mortality. In critically ill patients, saline infusion, compared to balanced fluid infusions, in- creases the occurrence of acute kidney injury. In summary, saline is a highly acidic fluid. With the exception of saline infusion for patients with hypochloremic metabolic alkalosis and volume depletion due to vomiting or upper gastroin- testinal suction, indiscriminate use, especially for acutely ill patients, may cause unnecessary complications and should be avoided. More education regarding saline-related effects and adequate electrolyte management is needed.
