摘要信息：【摘要】目的 探讨重度脑卒中患者急性期血浆中性粒细胞弹性蛋白酶(NE)的含量、变化及其临床意义。方法收集重度急性脑卒中患者 20 例(实验组),分别监测发病后 12h、24h、48h、72h及7d的血浆中NE含量,健康对照组 20 例。结果 实验组在7d观察中死亡2例,健康对照组 NE 含量(17.7±8.0)ng/ml。重度脑卒中患者发病72h时血浆中 NE含量与健康对照组、12h及7d时间点差异有统计学意义(均P< 0.05),其血浆中 NE 含量在发病 24h开始升高,72h时达到高峰,7d后复査恢复正常。结论、重度脑卒中患者血浆中 NE 含量升高,呈动态变化。在发病后 72h达高峰,此时更易发生炎症级联反应甚至导致 SIRS,为进一步研究相关问题提供了一定的理论依据。

摘要信息：百草枯是一种高效能剧毒性接触型除草剂，中毒者临床病死率高，中毒表现以急性肺损伤为主，同时伴有肝、肾等多器官损伤，经口服中毒者病死率高达50%～70%[1-2]，多数死于呼吸衰竭，目前无特效解毒药。百草枯致死摄入剂量约为20～40 mg/kg，相当于5～15 mL 20%百草枯水溶液[3]，口服量大于40 mL百草枯水溶液属于爆发型中毒患者[4]，多在1 d内出现肺水肿，数小时至数天内发生急性呼吸窘迫综合征或多器官功能衰竭，多数1～4 d内死亡，临床存活率极低。本例患者口服百草枯约100 mL，属于爆发型中毒患者，转入院时已出现严重急性呼吸窘迫综合征，应用西维来司他钠及一氧化氮（NO）吸入等联合疗法成功救治并康复出院，属极为罕见病例，现报道如下，仅供临床参考。

摘要信息：Inhalation of acid fumes and aspiration of liquid substances or gastric contents may not initiate dyspnea within several hours after exposure but may result in delayed onset of alveolar edema. The present report presents three cases of inhalation or aspiration of chemical substances that resulted in acute respiratory distress syndrome (ARDS). Due to different underlying reasons, three patients developed ARDS resulting from chemical pneumonitis and pulmonary infection. From patients with dyspnea, dry rales could be heard in both lungs, with <92% percutaneous oxygen saturation at room air. All patients were treated using a high-flow nasal cannula and sivelestat sodium. Oxygenation gradually improved and the patients were discharged without adverse events. These cases suggest that early treatment with sivelestat sodium may improve the clinical outcomes of patients with ARDS.

摘要信息：【摘 要】 目的 观察西维来司他钠联合气道压力释放通气(APRV)在创伤所致重度急性呼吸窘迫综合征(ARDS)治疗中的应用效果。方法选取2021年1月一2022年12月厦门市海沧医院收治的创伤所致重度 ARDS 患者 80 例,采用随机数字表法分为观察组和对照组,各 40 例。在常规对症处理基础上,对照组予 APRV 治疗,观察组在对照组基础上加用注射用西维来司他钠治疗,2组均持续治疗1周。比较2组患者预后情况(机械通气时间、ICU 住院时间和病死率),治疗前后炎性因子[白介素-6(1L-6)、降钙素原(PCT)、C 反应蛋白(CRP)]、血气指标[二氧化碳分压(PaC0,)、动脉血氧分压(Pa0,)、Pa0,/Fi0,]和肺功能[第1秒用力呼气容积(FEV,)、用力肺活量(FVC)、FEV,FVC]。结果 观察组病死率为2.50%,低于对照组的22.50%( =7.314,P=0.007);观察组机械通气时间与 ICU住院时间均短于对照组(P 均<0.01);治疗1周后,2 组 Ⅱ-6、PCT、CRP、PaC0,水平均较治疗前降低,Pa0,、Pa0,FiO,、FEV,、FVC、FEV,/FVC 均较治疗前升高,且观察组降低或升高的程度大于对照组(P均<0.01)。结论 西维来司他钠联合 APRV 在创伤所致重度 ARDS 治疗中应用效果较好,能改善患者血气指标,减轻炎性反应,提升肺功能,进而促进其快速康复,利于改善疾病预后。

摘要信息：Background:Acryloyl chloride is a highly toxic volatile liquid that can cause pulmonary edema. However, no sufficient treatment reports have been published to date. Here, we report a case of acute respiratory distress syndrome (ARDS) caused by acryloyl chloride inhalation. Case presentation:The patient was a 36-year-old man with accidental exposure to acryloyl chloride. The patient had dyspnea and wet cough, with approximately 88% percutaneous oxygen saturation at room air. He was diagnosed with ARDS and admitted to the intensive care unit. Initially, he was treated with a high-flow nasal cannula and sivelestat sodium. However, due to the possibility of delayed exacerbation, the patient was switched to methylprednisolone. Oxygenation gradually improved, and the patient was discharged on the day 8 of hospitalization. Conclusion:We report the case of a patient who developed ARDS with delayed exacerbation after the inhalation of acryloyl chloride, which was treated without endotracheal intubation.

摘要信息：硝酸和氢氟酸等强酸性物质具有很强的氧化性,被广泛应用于工业生产中,强酸吸入引起化学性肺炎偶见报道。严重的化学性肺炎会引起急性肺水肿，出现危及生命的急性呼吸窘迫综合征(acuterespiratory distress syndrome,ARDS)。目前针对化学性肺炎的治疗不仅缺乏统一标准，而且强烈依赖于激素、抗感染等传统治疗方案。西维来司他钠为新型 ARDS 治疗药物,其面世弥补了 ARDS 临床治疗手段的匮乏。本文报道了1例早期应用西维来司他钠成功治疗硝酸氢氟酸混合物吸入致ARDS 的病例，以分享救治体会。

摘要信息：【摘 要】 目的 观察西维来司他钠联合气道压力释放通气(APRV)治疗创伤所致重度急性呼吸窘迫综合征(ARDS)的疗效及对血气指标、炎性因子和预后的影响。方法选取2020年4月一2021年4月徐州仁慈医院重症医学科收治创伤所致重度 ARDS 患者 80 例,随机数字表法分为观察组(40 例)和对照组(40 例)。2 组均予基础治疗,对照组加用 APRV 治疗,观察组加用 APRV 治疗和西维来司他钠治疗。比较2组治疗期间血清炎性因子、血气和血流动力学指标、急性生理和慢性健康状况(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分变化,以及机械通气时间.ICU 住院时间、病死率差异。结果 2组治疗7d后血清 PCT、IL6、CRP水平、APACHEⅡ评分、SOFA 评分较治疗前降低(P<0.05),且观察组血清 PCT、IL6、CRP水平低于对照组(t/P =9.309/0.000、12.221/0.000、5.471/0.000)。2 组患者治疗期间 Pa0,、Pa0,/ Fi0,增高,PaC0,降低(P<0.05),HR、CVP、MAP 下降后又回升(P<0.05),观察组患者治疗24 h、72h时 PaO,、PaO, /FO,、HR、CVP、MAP 高于对照组,PaC0,低于对照组(治疗24 h:t/P=2.092/0.0405.931/0.000、2.854/0.006、3.683/0.002、3.978/0.000、2.063/0.042;治疗72 h: t/P = 2.202/0.031、3. 177/0.0025.380/0.000、10.125/0.000、5.993/0.000、4.314/0.000)。2 组患者机械通气时间、ICU 住院时间、病死率比较差异均无统计学意义(P均>0.05)。结论 西维来司他钠联合 APRV 可降低血清炎性因子水平,提高氧合指数,但不能缩短机械通气时间和住院时间、降低病死率。

摘要信息：Thoracic trauma in China was scarcely reported. This study aimed to summarize the clinical profiles and to analyze the management approaches of patients with traumatic thoracic injury.Data for consecutive patients with thoracic trauma from January 2003 to January 2018 were retrospectively collected and analyzed. Patients' profiles and clinical outcomes were compared between those patients treated with a dedicated thoracic trauma team and those without.The study included 4168 patients with mean age of 49.0 years, of whom 82.1% were male. Traffic accident accounted for 42.7% of the injuries. Most of the patients (66.8%) had rib fractures. Associated injuries were present in 48.3% of the patients; of them 86.0% were extremity fractures. Majority of the patients were managed without surgical procedures other than tube thoracostomy (33.2%). ICU service was needed in 12.0% of the patients. Patients treated with thoracic trauma team were older (53.59 ± 16.8 year vs 45.1 ± 18.0 year, P < .001), less male (78.3% vs 85.2%, P < .001), with higher injury severity scores (17.5 ± 10.1 vs 13.7 ± 8.2, P < .001), required more ventilator support (48.3% vs 25.3%, P < .001) and underwent more tube thoracostomy and other surgeries (43.8% vs 24.2%, and 34.4% vs 14.1%, respectively, all P < .001), yet with a shorter hospital stay (11.7 ± 9.0 days vs 12.7 ± 8.8 days, P < .001), and numerically lower ICU usage and mortality when compared to those without.Thoracic trauma in China usually affects mid-age males. Traffic accident is the top one etiology. The most common type of thoracic injuries is rib fracture. Associated injuries occur frequently. Nonoperative treatment and tube thoracostomy are effective for majority of the patients. A multidisciplinary approach with a dedicated thoracic trauma team could improve the treatment for these patients.

摘要信息：【摘要】 目的 系统评价创伤性脊髓损伤(spinal cord injury,SCI)在中国的流行病学特征和疾病经济负担。方法 计算机检索 PubMed、EMbase、WanFang Data、VIP 和 CNKI数据库,搜集有关中国 SCI流行病学和疾病经济负担的研究,检索时限均从1978年1月1日至2017年8月30日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用 Stata12.0软件进行合并分析。结果 共纳人 32篇文献。Meta 分析结果显示:我国 SCI年患病率为 37人次/100万[95%CI(21,53)],平均年龄范围 34.7~54.4岁,男性高于女性。汽车碰撞和高空坠落是 SCI的主要原因。SCI严重程度从 A~E级(ASIA 分级)不等,以A级为主,E级比例最低。结论，当前证据显示，我国 SCI发病率较高,具有较高的社会和医疗负担,SCI主要由汽车碰撞和高空坠落弓起。受纳入研究数量和质量的限制，上述结论尚待更多高质量研究予以验证。

摘要信息：Background:This study reports a 10-year retrospective analysis of multiple trauma complicated by pulmonary contusion. The purpose of this study is to ascertain the risk factors for mortality due to trauma in patients with pulmonary contusion, the impact of various treatment options for prognosis, and the risk factors for concurrent Acute Respiratory Distress Syndrome (ARDS). Methods:We retrospectively analyzed 252 trauma patients with lung contusion admitted to the General Hospital of Guangzhou Command from January 2000 to June 2011 by using the statistical processing system SPSS 17.0 for Windows. Results:We included 252 patients in our study, including 214 males and 38 females. The average age was 37.1 ± 14.9 years. There were 110 cases admitted to the ICU, of which 26 cases with ARDS. Nine of the 252 patients died. We compared those who survived with those who died by gender and age, the difference was not statistically significant (P = 0.199, P = 0.200). Separate univariate analysis of those who died and those who survived found that shock on admission (P = 0.000), coagulation disorders (P = 0.000), gastrointestinal bleeding (P = 0.02), the need for emergency surgery on admission (P = 0.000), pre-hospital intubation (P = 0.000), blood transfusion within 24 hours (P = 0.006), the use of mechanical ventilation (P = 0.000), and concurrent ARDS (P = 0.000) are poor prognosis risk factors. Further logistic analysis, including the admission GCS score (OR = 0.708, 95% CI 0.516-0.971, P = 0.032), ISS score (OR 1.135, 95% CI 1.006-1.280, P = 0.039), and concurrent ARDS (OR = 15.814, 95% CI 1.819-137.480, P = 0.012), identified the GCS score, ISS score and concurrent ARDS as independent risk factors of poor prognosis. Shock (OR = 9.121, 95% CI 0.857-97.060, P = 0.067) was also related to poor prognosis. Patients with injury factors such as road accident, falling injury, blunt injury and crush injury, et al.(P = 0.039), infection (P = 0.005), shock (P = 0.004), coagulation disorders (P = 0.006), emergency surgery (P = 0.01), pre-hospital intubation (P = 0.000), chest tube insertion (P = 0.004), blood transfusion (P = 0.000), usage of hormones (P = 0.002), phlegm (P = 0.000), ventilation (P = 0.000) were at a significantly increased risk for ARDS complications. Conclusions:Those patients with multiple trauma and pulmonary contusion admitted to the hospital with shock, coagulopathy, a need for emergency surgery, pre-hospital intubation, and a need for mechanical ventilation could have a significantly increased risk of mortality and ARDS incidence. A risk for poor prognosis was associated with gastrointestinal bleeding. A high ISS score, high APACHE2, and low GCS score were independent risk factors for poor prognosis. If patients developed an infection or were given drainage, hormones, and phlegm treatment, they were at higher risk of ARDS. Pre-hospital intubation and drainage were independent risk factors for ARDS. In patients with ARDS, the ICU stay, total length of stay, and hospital costs might increase significantly. A GCS score < 5.5, APACHE 2 score > 16.5, and ISS score > 20.5 could be considered indicators of poor prognosis for patients with multiple trauma and lung contusion.