目的:观察乙酰半胱氨酸注射液(NAC)治疗慢性重型乙型肝炎的疗效。方法:收治的慢性重型肝炎早、中期分为对照组(57例),治疗组(58例),对照组给予一般支持治疗、门冬氨酸钾镁,血浆或白蛋白等基础治疗及促肝细胞生长素100mg/d。治疗组在对照组的基础上加用乙酰半胱氨酸注射液8g/d静脉滴注,疗程30d,并于用药前,用药后15d,30d分别抽血查肝功,凝血酶原活动度。结果:治疗组血清总胆红素(TBil),凝血酶原活动度(PTA)的改善程度明显优于对照组,差异有统计学意义。结论:乙酰半胱氨酸注射液能明显降低患者血清TBil,提高PTA,对重型肝炎的治疗有较好的帮助。
目的:通过对61例重型脑伤合并消化道应激性溃疡出血的内科综合治疗,评价其疗效在治疗中的地位。方法:对61例重型脑伤合并消化道应激性溃疡出血的患者进行内科综合治疗,分析其疗效。结果:消化道应激性溃疡出血一般发生在入院的2～6 d,占观察例数的86.9%(53例),出血后,在治疗的两周内痊愈42例(占68.9%)。结论:重型脑伤合并消化道应激性溃疡出血是临床危急重症,积极的了解和祛除病因,持续监控,积极的、有效的综合治疗,能取得满意的疗效,提高痊愈率和患者的生存质量。
ObjectiveTo investigate the effects of large trauma craniotomy on severe traumatic brain injury. MethodsA total of 132 cases of severe traumatic brain injury adopted large trauma craniotomy between July 2008 and August 2013, and the clinical data were retrospectively analyzed. ResultsAccording to the results of GOS assessment at discharge, 67 patients (50.75%) were satisfied, 26 (19.70%) were mildly disable, 10 (7.58%) were severely disable, 12 (9.09%) were in vegetative state, and 17 (12.88%) were dead. ConclusionCorrect use of large trauma craniotomy on severe brain injury cases will help to improve the treatment outcome, reduce complications and improve quality of survival.
Objectives To assess the efficacy and safety of standard trauma craniectomy (STC), compared with limited craniectomy (LC) for severe traumatic brain injury (sTBI) with refractory intracranial hypertension. Methods We searched the Cochrane Central Register of Controlled Trials-Central (The Cochrane Library Issue 3, 2008), MEDLINE (1966 to October 2008), EMbase (1984 to October 2008), CMB-disc (1979 to October 2006) and CNKI (1979 to October 2008) for completed studies, as well as clinical trial registries for ongoing studies and completed studies with unpublished data. The reference of included studies and relevant supplement or conference abstracts were handsearched. The search results were extracted, and then the quality of included studies was assessed using RevMan 5.0. Meta-analysis was conducted if the data was similar enough. Results Two randomized controlled trials (RCTs) involving 716 participants were identified. Compared with the LC group, the STC group had statistically significant, more favorable outcome on the basis of the Glasgow Outcome Scale, using measures such as mortality, efficiency, and survival, compared with those of LC group, which had statistic difference. The mean ICP fell more rapidly and to a lower level in the STC group than in the LC group. There was no statistically significant difference on the incidence of postoperative complications, including delayed hematoma, incision cerebrospinal fluid fistula, encephalomyelocele, traumatic epilepsy, and intracranial infection as well. Conclusion The efficacy of STC is superior to LC for severe TBI with refractory intracranial hypertension resulting from unilateral frontotemporoparietal contusion with or without intracerebral or subdural hematoma.
目的:了解评价血浆置换(PE)治疗慢性乙型重型肝炎的临床疗效及价值。方法:观察重型肝炎患者PE前后总胆红素、白蛋白5项指标及乏力、腹胀等临床症状变化,比较治疗组和对照组治疗后好转率的差异。统计分析PE治疗及次数与患者预后的关系。检测部分患者PE前后内毒素(LPS)浓度,探讨LPS与患者预后的关系。结果:治疗组和对照组早中期患者好转率分别为54.4％和27.8％(Plt;0.01);晚期患者的好转率分别为8.3％和1.4％(Pgt;0.05)。PE治疗2到4次,患者的好转率分别为39.4％、43.6％和42.9％,但PE次数在不同组别患者的好转率之间差异无统计学意义(Pgt;0.05)。PE治疗后好转患者血清内毒素浓度下降(Plt;0.01)。结论:PE能明显改善患者肝功能指标,提高早中期患者的好转率。PE次数为2到4次时,患者的好转率较高,但不同的PE次数未显示相应患者的临床转归之间有统计学意义的差异。血清LPS浓度与患者预后有相关性,治疗前血清LPS浓度低且治疗后下降者,预后较好;相反,治疗前血清LPS浓度高且治疗后下降不明显者,预后较差。