Réanimation Urgences最新文献_第7页

La foudre: un phénomène redouté, des aspects cliniques souvent méconnus 闪电:一种可怕的现象，临床方面往往不为人知

Réanimation Urgences Pub Date : 2000-08-01 DOI: 10.1016/S1164-6756(00)90076-8

L. Mermet , S. Villedieu-Poignant , J.F. Vincent , P. Dupont

引用次数: 0

Phospholipase A2 sécrétée de type IIA et syndrome inflammatoire 磷脂酶A2与IIA型炎症综合征有关

Réanimation Urgences Pub Date : 2000-08-01 DOI: 10.1016/S1164-6756(00)90075-6

O Fourcade , M.F Simon , F Le Balle , J Fauvel , M Génestal , B Cathala , H Chap

{"title":"Phospholipase A2 sécrétée de type IIA et syndrome inflammatoire","authors":"O Fourcade , M.F Simon , F Le Balle , J Fauvel , M Génestal , B Cathala , H Chap","doi":"10.1016/S1164-6756(00)90075-6","DOIUrl":"10.1016/S1164-6756(00)90075-6","url":null,"abstract":"<div>Phospholipase A2 are enzymes that hydrolyse the sn-2 position of glycerophospholipids, and play a pivotal role in the generation of lipid inflammatory mediators. The type IIA secretory phospholipase A2 (sPLA2) is a distal effector of inflammation, produced by a number of cells challenged with inflammatory stimuli such as tumor necrosis factor or interleukin-1. Hydrolysis of the glycerophospholipids generates arachidonic acid, which is implicated in eicosanoid synthesis, and some important lipid mediators such as lyso-platelet activating factor, lysophosphatidic acid (LPA), or lysophosphatidylcholine (LPC). High levels of sPLA2 are found in the plasma of patients suffering from sepsis, septic shock, adult respiratory distress syndrome and multiple organ failure. The levels are correlated to the intensity of the systemic inflammatory response and possibly to the outcome. This review presents important results concerning the pathophysiological implications of sPLA2 in inflammatory disorders. We also present the role of LPA and LPC. The utility of the determination of sPLA2 activity in clinical practice is discussed.</div>","PeriodicalId":101063,"journal":{"name":"Réanimation Urgences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1164-6756(00)90075-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76886943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

L'évaluation de la satisfaction des patients des services d'urgences est-elle possible? 是否有可能评估急诊病人的满意度?

Réanimation Urgences Pub Date : 2000-08-01 DOI: 10.1016/S1164-6756(00)90072-0

J Reboul-Marty , P Thoreux , M Debien , J.L Roynard , M Durand , G Languillat

{"title":"L'évaluation de la satisfaction des patients des services d'urgences est-elle possible?","authors":"J Reboul-Marty , P Thoreux , M Debien , J.L Roynard , M Durand , G Languillat","doi":"10.1016/S1164-6756(00)90072-0","DOIUrl":"10.1016/S1164-6756(00)90072-0","url":null,"abstract":"<div>The aim of this study was to assess patients' satisfaction in an emergency unit.Methods: French-speaking patients and volunteers that came to the emergency unit between 10:00 am and 12:00 pm were included in the study for a two-week period. In order to obtain reliable responses, the investigators interviewed the patients face to face with the assistance of a specific questionnaire.Results: Fifty-two percent of the 514 interviewed patients agreed to answer the investigators' questions; the major reason for failure to reply was the lack of time. Using the Principal Components Analysis, the data were gathered into six dimensions: reception, waiting room 1, waiting room 2, staff appreciation, communication, and waiting time. Six scores of dissatisfaction were established, ranging from 0 (most satisfied) to 100 (most dissatisfied). The results showed that the most worrying point was the waiting (45 ± 22 min). The perception of the length of waiting time was statistically related (P < 0.0001) to the time spent in the emergency unit, contrary to its tolerance. The second point of dissatisfaction was the location (waiting room 1:30 ± 22; waiting room 2.31 ± 22). Finally, the most motivating point for the staff was the recognition of their work by the patients (28 ± 15).Conclusion: This study found the reasons for the published dissatisfaction. Its intent was to quantify the degree of dissatisfaction and to treat the problems on a hierarchical basis, thus making it possible to better meet the patients' needs. The assessment of patients' satisfaction in an emergency unit is possible but implies a significant deployment of means to obtain a satisfying response rate.</div>","PeriodicalId":101063,"journal":{"name":"Réanimation Urgences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1164-6756(00)90072-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84607384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 5

Agenda 议程

Réanimation Urgences Pub Date : 2000-08-01 DOI: 10.1016/S1164-6756(00)90080-X

引用次数: 0

Agenda 议程

Réanimation Urgences Pub Date : 2000-08-01 DOI: 10.1016/S1164-6756(00)90077-X

引用次数: 0

L'héliox en réanimation et en médecine d'urgence heliox在复苏和急诊医学中的应用

Réanimation Urgences Pub Date : 2000-08-01 DOI: 10.1016/S1164-6756(00)90074-4

D Tassaux , P Jolliet , J.C Chevrolet

引用次数: 3

Transfusion de concentré globulaire en réanimation pédiatrique 小儿复苏中红细胞浓缩物的输血

Réanimation Urgences Pub Date : 2000-08-01 DOI: 10.1016/S1164-6756(00)90073-2

F Gauvin , M Chaïbou , S Leteurtre , B Toledano , H Hume , F Proulx , P.C Hébert , A Martinot , F Leclerc , J Lacroix

{"title":"Transfusion de concentré globulaire en réanimation pédiatrique","authors":"F Gauvin , M Chaïbou , S Leteurtre , B Toledano , H Hume , F Proulx , P.C Hébert , A Martinot , F Leclerc , J Lacroix","doi":"10.1016/S1164-6756(00)90073-2","DOIUrl":"10.1016/S1164-6756(00)90073-2","url":null,"abstract":"<div>Objective: To determine the incidence rate and the indications of red blood cell (RBC) transfusion in a pediatric intensive care unit (PICU).Patients and methods: A prospective observational cohort study of 303 consecutive patients was carried out in a multidisciplinary PICU in a tertiary care university hospital. All the patients were monitored daily over a three-month period. No interventions were done.Primary outcome measure: Reasons for and number of RBC transfusions.Secondary outcome measure: Comparison of the data between the group of transfused patients versus non-transfused patients.Results: Forty-five patients (5%) received one to 33 RBC transfusions, for a total of 103 transfusions. RBC transfusion was given according to the medical team and also clinical and paraclinical parameters, for the following reasons: respiratory failure (<math><mtext>84</mtext><mtext>103</mtext></math>), active bleeding (<math><mtext>67</mtext><mtext>103</mtext></math>), hemodynamic instability (<math><mtext>50</mtext><mtext>103</mtext></math>), blood lactate level > 2 mmol/L (<math><mtext>10</mtext><mtext>103</mtext></math>), or to increase oxygen delivery (<math><mtext>6</mtext><mtext>103</mtext></math>). In many cases, more than one reason was specified, but in seven cases, no specific reason was provided. The mean hemoglobin concentration before transfusion was 8.1 ± 1.9 g/dL (median: 7.9; range: 3.8 to 17.1 g/dL). The mean PRISM III score at entry was 9 ± 5. The following data were significantly higher in the transfused group: antecedent of neoplasm or cardiovascular disease, hematologic or cardiovascular disease as primary affection, multiple organ dysfunction syndrome, PRISM III score at entry, death and length of stay in PICU.Conclusion: In this PICU, 15% of the patients received at least one RBC transfusion. In most instances, the indication for a RBC transfusion was to support a respiratory failure. In 7% of the cases, there was no reported indication to explain the transfusion. Morbidity and mortality rates were higher among transfused patients.</div>","PeriodicalId":101063,"journal":{"name":"Réanimation Urgences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1164-6756(00)90073-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88004921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 13

Facteurs influençant le délai d'initiation de l'antibiothérapie des méningites aiguës bactériennes de l'adulte admises aux urgences 影响急诊入院成人急性细菌性脑膜炎抗生素治疗开始时间的因素

Réanimation Urgences Pub Date : 2000-08-01 DOI: 10.1016/S1164-6756(00)90071-9

F Joye , F Marion , M Ferrandière , R Lanotte , P.F Dequin , D Perrotin

{"title":"Facteurs influençant le délai d'initiation de l'antibiothérapie des méningites aiguës bactériennes de l'adulte admises aux urgences","authors":"F Joye , F Marion , M Ferrandière , R Lanotte , P.F Dequin , D Perrotin","doi":"10.1016/S1164-6756(00)90071-9","DOIUrl":"10.1016/S1164-6756(00)90071-9","url":null,"abstract":"<div>Objective: To evaluate the delay to antibiotic therapy (DA) in acute bacterial meningitis (ABM) in adults admitted to the emergency department (ED) and to identify the clinical factors.Patients and methods: A four-year retrospective study concerning patients admitted to the ED with a further proven diagnosis of ABM. Inclusion criteria: age > 15 years, non-tuberculous bacteria in cerebrospinal fluid (CSF) or in blood, proteinorrhachia > 0.40 g·L−1, glycorrhachia/glycemia < 0.5, leukocytes > 5 mm−3 in CSF (≥ 80% polynuclear neutrophils) or cloudy CSF. Exclusion criteria: tuberculous or non-bacterial or nosocomial meningitis, uncertain diagnosis or established diagnosis of ABM before admission.Results: Fifty-one patients, 27 males and 24 females, with a mean age of 45 years (range: 16–89 years) were included in the study. The mean DA was 216 min (range: 30–975 min). No patient was treated in less than 30 min. Factors associated with significantly longer DA included: a reason for administration other than “syndrome of meningeal irritation with fever” (P=0.041); unusual clinical features (P=0.032), in particular the absence of meningeal irritation or fever; the presence of a neurological deficiency; an advanced age (elderly); the realization of a cerebral CT scan before antibiotic therapy (P=0.0.27); management by a student instead of a senior in difficult cases (P=0.017); the recourse to the opinion of a specialist (P=0.013); and antibiotic therapy first administered in a department other than the ED (P=0.016).Conclusion: Initiation of antibiotic therapy in ABM is too long. Interindividual variability of clinical features and fluctuations in time are the principal reasons. A cerebral scan and the opinion of a specialist before antibiotic therapy prolongs DA. The first administration of ATB must be done in the ED. The quality of the city-hospital network and emergency physicians' clinical experience are criteria for a more rapid DA. Therefore, a “too fundamentalist medical knowledge,” to the detriment of a “more pragmatic clinical education,” could explain the DA that we noted.</div>","PeriodicalId":101063,"journal":{"name":"Réanimation Urgences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2000-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1164-6756(00)90071-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83022656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Syndrome de détresse respiratoire aiguë et maladie de Churg et Strauss 急性呼吸窘迫综合征和丘格和施特劳斯病

Réanimation Urgences Pub Date : 2000-08-01 DOI: 10.1016/S1164-6756(00)90079-3

C Bellanger-Depagne , D Peillon , O Levavasseur , P.J Souquet , J.P Bernard , D Boutry , C Combe

引用次数: 1

Réponse à la lettre de F. Thys 回复F. Thys的信

Réanimation Urgences Pub Date : 2000-08-01 DOI: 10.1016/S1164-6756(00)90083-5

P. Le Conte

引用次数: 0