【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.
ObjectiveTo observe the effects of cluster therapy combined with anisodamine, dexamethasone and ambroxol on arterial blood gas, inflammatory cytokines and pulmonary pathological changes by making an early (<48 h) primary blast lung injury model in rats. MethodsEighty Wistar rats were randomly divided into six groups, ie. a control group (n=5), an injury group (n=15), an ambroxol treatment group (n=15), a dexamethasone treatment group, a scopolamine treatment group (n=15), a combination of ambroxol, dexamethasone and anisodamine group (n=15). The treatment groups were injected intraperitoneally with ambroxol 46.7 mg/kg (three times a day) or (and) dexamethasone at 5 mg·kg–1·d–1 or (and) anisodamine at a dose of 3.33 mg/kg (three times a day). The rats in the injury group were injected intraperitoneally with an equal volume of normal saline. Respiratory rate and weight change were observed before and after injury. Five rats were sacrificed at 6 hours, 24 hours and 48 hours after injury in each experimental group. Arterial blood gas analysis, Yelverton pathological score, lung tissue wet/dry weight ratio, serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were measured. The lung histopathology was observed. ResultsAfter lung blast injury, the rats in the injury group showed progressive respiratory acidosis, and hypoxemia increased with the increase of IL-6 and TNF-α in a time-dependent manner. The PaO2 decreased in the groups with ambroxol, dexamethasone and anisodamine alone or in combination with anisodamine, and the contents of serum IL-6 and TNF-α decreased. Pathological edema and inflammatory infiltration of lung tissue were alleviated significantly. ConclusionsAfter treatment with dexamethasone, anisodamine and ambroxol after lung blast injury, blood gas analysis is improved, inflammatory factor level is decreased and lung injury is alleviated, indicating that the three drugs can treat lung detonation injury in rats. The cluster therapy is superior to the single drug therapy.