ABSTRACT
Objective To observe the clinical curative effect of enteral nutrition (EN) liquid rich in omega-3 polyunsaturated fatty acids (ω-3PUFA) for patients suffering from acute respiratory distress syndrome (ARDS) and treated with mechanical ventilation.Methods A prospective study was conducted, 40 patients with ARDS admitted and treated in the intensive care unit (ICU) and respiratory department in the Traditional Chinese Medicine Hospital of Huzhou from May 2007 to October 2016 were enrolled, and they were randomly divided into a study group and a control group, each group 20 cases. The same heat EN support of different prescriptions was given respectively in the two groups, nasal feeding with EN emulsion rich in ω-3PUFA (TPF-T) was applied in the study group, while in the control group, nasal feeding with EN suspension liquid of protein fiber type (TPF) was given, and the target energy established for the two groups was 104.0 - 125.5 kJ·kg-1·d-1. In the two groups, before and after treatment for 7 days, the changes of nutrition indexes [total protein (TP), albumin (ALB)], inflammatory index [C-reactive protein (CRP)], immune indexes (T cell subgroup CD4, CD8 and CD4/CD8), blood gas analysis indexes [arterial blood oxygen partial pressure (PaO2), oxygenation index (PaO2/FiO2)] and mechanical ventilation time, the length of stay in ICU and fatality rate were observed; the occurrences of false aspiration, feeding tube obstruction, high blood sugar, excessive water, diarrhea, constipation, etc. complications related to the process of the treatment were observed in the two groups. Results After treatment, the levels of TP, ALB, CD4, CD4/CD8, PaO2, PaO2/FiO2 in two groups were higher than those before treatment, the levels of CRP and CD8 were lower than those before treatment, and the improvement degrees of indexes in study group were superior to those in the control group [TP (g/L): 59.9±4.8 vs. 58.6±4.1, ALB (g/L): 31.9±3.4 vs. 31.1±4.4, CRP (mg/L): 25.8±18.5 vs. 38.1±24.9, CD4: 0.30±0.05 vs. 0.28±0.04, CD8: 0.21±0.03 vs. 0.19±0.04, CD4/CD8: 1.57±0.39 vs. 1.55±0.42, PaO2 (mmHg, 1 mmHg = 0.133 kPa): 152.7±15.8 vs. 140.6±22.2, PaO2/FiO2 (mmHg): 304.5±32.1 vs. 280.2±44.1]; the survival patient mechanical ventilation time (days: 7.1±2.2 vs. 9.2±3.5) and length of stay in ICU (days: 10.4±2.8 vs. 12.6±3.6) were significantly shorter in study group than those in control group (allP < 0.05), and fatality rate was 15.0%in both groups.Conclusion The EN liquid rich in ω-3PUFA is more beneficial to the recovery of respiratory function than EN of protein fiber type in patients with ARDS, and the former EN also can shorten the mechanical ventilation time and the length of stay in ICU.
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Objective To explore the clinical manifestations of hypermastigote detected from bronchoalveolar lavage fluid in children with mycoplasma pneumoniae pneumonia (MPP).Methods The clinical data from 18 cases (7 male cases,11 female cases;the age raged from 5 months to 13 years;13 case lived in rural cottage,5 cases lived in town building;the course ranged from 2 to 60 days) of MPP coinfected with hypermastigote were retrospectively analyzed,including the symptomatic and physical examination data, laboratory test, chest imaging features, bronchoscopic manifestation imaging,treatment and prognosis.The clinical characteristics and treatment of MPP coinfected with hypermastigote were analyzed.Results Clinical symptoms showed that 18 cases had cough, 14 cases had fever and 4 cases had asthma;laboratory blood routine test detected that 13 cases had increased leukocytes,5 cases with increased eosinophils;11 cases with increased C reactive protein and 8 cases with increased erythrocyte sedimentation rate.Eleven of 18 cases received immunological examination,which showed that 3 cases had increased IgG,2 cases with increased IgM,5 cases with increased IgA,and 11 cases with decreased ratio of CD4 and CD8;bronchoalveolar lavage fluid test showed that 1 case had increased eosinophils and hypermastigote were detected in 18 cases.High density spotty shadow were seen in chest imaging.Mucosal congestion, attached with white sputamentum, longitudinal folds, floc floating and sputum bolt obstructing within the lumen were seen under the bronchoscopy.The macrolides antibiotics combined with metronidazole (5 cases received metronidazole lung lavage) were effective.Conclusions Hypermastigote is a new type pathogen isolated from the lower respiratory tract in Liaocheng.For patients with MPP who have unsatisfactory response, hypermastigote should be taken into account and combined with metronidazole in therapy for better effect.
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With the development of modern science,the updates of endoscopic technology,respiratory endoscopy has become essential means in the clinical diagnosis and treatment of respiratory disease in children.Due to the particularity of its complex structure and material,to strengthen the cleaning,disinfection and sterilization of respiratory endoscopy and attachment can ensure medical safety,prolong the service life of the endoscopic.It also was the primary guarantee to ensure that the treatment of respiratory endoscopy proceed smoothly and securely.
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Objective To observe the effect of local pain alleviation by wet compress with room temperature and low temperature lidocaine and cold wet compress in fructose infusion in children. Meth-ods 120 children patients with pain during fructose infusion were randomly divided into the wet compress group, the room temperature lidocaine group and the low temperature lidocaine group with 40 cases in each group. The analgesic effect was observed in the three groups. Results Analgesic effect of the low temper-ature lidocaine group was significantly better than the other two groups. Conclusions The wet compress with low temperature lidocaine can relieve the local pain in fructose infusion in children.