急诊部

1、消化道动力不足，常见功能性消化不良，会使胃肠不能正常蠕动，食物不能正常向下推进而感觉腹胀。 2、胃酸及消化酶分泌过少：食物难以消化，会堆积在胃肠道，也同样会引起腹胀。 3、胃肠道被堵塞：如胃肠道肿瘤或肠梗阻时，使食物在胃肠道内堆积，不能正常通过，或异物梗阻造成腹胀。

1.困难气道气管插管术2.经皮气管切开术3.中心静脉置管术4.USCOM血流动力学监测技术5.脉搏指示剂心排量监测技术PICCO6.连续性血液净化技术：血液灌流7.连续性血液净化技术：血液滤过8.连续性血液净化技术：CPFA

最新疗法之疗效背景支气管壁的结构性改变（气道重塑）可发生于哮喘患者中。本综述描述了哮喘患者气道重塑的进展，及不同哮喘治疗方法对其产生的影响。气道重塑过程中发生的支气管壁结构性改变可能与上皮损伤、上皮下增厚/纤维化、气道平滑肌增生、杯形细胞肥大和增生或血管生成有关。皮质类固醇类药物常用于哮喘患者炎症的治疗，但通常认为其对气道重塑的疗效有限。通常认为气道重塑是不可逆转的，但长期使用高剂量吸入性皮质类固醇 (ICS) 能引起积极的气道改变。研究显示，在需要尽可能地降低 ICS 剂量的情况下，长效 β2 激动剂联合 ICS 可能会对气道重塑产生积极疗效。奥马珠单抗能减轻气道炎症，但尚无证据表明其可影响气道重塑。最新研究表明，美泊利单抗（抗白介素 5）可改善特定人群的气道重塑病情，但尚无足够证据证明其在气道重塑组织病理学组成方面的影响。尚无充分的证据显示，靶向肿瘤坏死因子 α 的药物可影响哮喘患者的气道重塑。结论气道重塑是一个复杂的过程，不同治疗对其的疗效尚未完全明确。需进行深入研究以明确在气道重塑过程中哪些组成可能会成为治疗靶点，以预防一些哮喘患者进行性肺功能丧失。J Allergy Clin Immunol. 2011 Sep;128(3):439-48; quiz 449-50. Epub 2011 Jul 12.What effect does asthma treatment have on airway remodeling? Current perspectives.Durrani SR, Viswanathan RK, Busse WW.AbstractAirway remodeling, or structural changes of the airway wall arising from injury and repair, plays an important role in the pathophysiology of asthma. Remodeling is characterized as structural changes involving the composition, content, and organization of many of the cellular and molecular constituents of the bronchial wall. These structural changes can include epithelial injury, subepithelial thickening/fibrosis, airway smooth muscle hyperplasia, goblet cell hypertrophy and hyperplasia, and angiogenesis. Historically, these changes are considered a consequence of long-standing airway inflammation. Recent infant and child studies, however, suggest that remodeling occurs in parallel with inflammation in asthmatic subjects. Despite advancements in the recognition of key cellular and molecular mechanisms involved in remodeling, there remains a paucity of information about which treatments or interactions are most likely to regulate these processes. Furthermore, it is unclear as to when is the best time to initiate treatments to modify remodeling, which components to target, and how best to monitor interventions on remodeling. Indeed, inhaled corticosteroids, which are generally considered to have limited influence on remodeling, have been shown to be beneficial in studies in which the dose and duration of treatment were increased and prolonged, respectively. Moreover, several studies have identified the need to identify novel asthma indices and phenotypes that correlate with remodeling and, as a consequence, might specifically respond to new therapies, such as anti-IgE, anti-IL-5, and anti-TNF-α mAbs. Our review will evaluate the development of remodeling in asthmatic subjects and the effects of treatment on these processes.Copyright 2011 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.PMID: 21752441