ABSTRACT
Objective To investigate the effect of self-made traditional Chinese medicine(TCM) decoction on pregnancy outcome in patients with hypertensive disorder complicating pregnancy. Methods A total of 124 pregnant hypertensive patients admitted to the Department of Critical Care of Guizhou Provincial People's Hospital from October 2016 to October 2018 were enrolled. The 62 patients who were treated with western medicine conventional method;62 patients who were treated with self-made TCM decoction on the basis of western medicine conventional method. The western medicine conventional treatment group was given magnesium sulfate combined with nicardipine; the self-made TCM treatment group was supplemented with TCM decoction on the basis of conventional western medicine treatment (composition: uncaria, raw oyster 20 g, gastrodia elata, eucommia, salvia miltiorrhiza, medlar rehmannia glutinosa each 15 g, rhizoma, mulberry parasitic, astragalus, ophiopogonis each 10 g. Severe headache and dizziness plus tortoise shell, gentian grass 15 g, anemarrhenae 10 g; severe edema plus cassia twig, aristolochiae 15 g, astragali, ginger skin 10 g), be decocted in water for oral dose, morning and evening oral, one dose a day, 1 week for a course of treatment, the two groups were continued for 4 weeks after the evaluation of clinical efficacy. The changes of blood pressure and blood coagulation parameters, placental bed arterial hemodynamics, pregnancy outcome index were observed before and after treatment; antihypertensive effects and adverse reactions after treatment were recorded. Results After treatment, the systolic blood pressure (SBP), diastolic blood pressure (DBP), Fibrinogen (Fib), placental bed arterial pulsation index (PI), end-systolic blood flow velocity and end-diastolic blood flow velocity ratio (S/D) and resistance index (RI) in both groups were lower than those before treatment, the prothrombin time (PT) and activated partial thromboplastin time (APTT) were significantly longer than before treatment, and the time-averaged flow rate (TAV) increased than that before treatment; SBP, DBP, Fib, PI, S/D and RI were significantly lower in self-made TCM treatment group than those in western medicine conventional treatment group [SBP (mmHg, 1 mmHg = 0.133 kPa): 114.26±17.07 vs. 132.72±17.64, DBP (mmHg): 82.98±6.24 vs. 90.09±6.48, Fib (g/L): 3.21±0.45 vs. 3.64±0.31, PI: 0.59±0.14 vs. 0.75±0.15, S/D: 1.70±0.21 vs. 1.93±0.25, RI: 0.43±0.08 vs. 0.54±0.12, all P < 0.05], PT, APTT, TAV in self-made TCM treatment group were significantly higher than western medicine conventional treatment group [PT (s): 12.26±0.57 vs. 11.72±0.44, APTT (s): 27.11±1.34 vs. 25.69±1.48, TAV (cm/s): 15.64±2.88 vs. 12.49±2.76, all P < 0.05]. The rate of cesarean section, postpartum hemorrhage, fetal heart abnormality and neonatal asphyxia in self-made TCM treatment group were significantly lower than those in western medicine conventional treatment group [cesarean section rate: 9.84% (6/61) vs. 27.78% (15/54), postpartum hemorrhage rate: 1.64% (1/61) to 14.81% (8/54), fetal heart abnormal rate: 3.28% (2/61) vs. 16.67% (9/54), the incidence of neonatal asphyxia: 1.64% (1/61) vs. 12.96% (7/54), all P < 0.05]. The total effective rate of the self-made TCM treatment group was significantly higher than that of western medicine conventional treatment group [98.39% (61/62) vs. 87.10% (54/62), P < 0.05]. However, there was no significant difference in the incidence of adverse reactions between the self-made TCM treatment group and western medicine conventional treatment group [16.39% (10/61) vs. 16.67% (9/54), P > 0.05]. Conclusion Self-made TCM decoction can improve the maternal and infant outcomes by improving the hypercoagulable state and placental hemodynamics in hypertensive patients with hyperthyroidism, the antihypertensive effect is remarkable and the safety is good.
ABSTRACT
Objective To investigate the effect of stanozolol on nitrogen balance ,grip strength and clinical outcomes of criti‐cal patients with high nutrition risk .Methods We enrolled patients who were admitted to the ICU of Guizhou provincial Hospital during the time period from January 2014 to June 2014 and ,as patients with high nutrition risk .Patients ,who received same base nutritional support program ,were divided into two groups .Treatment group who were treated with stanozolol administrated with gastric or jejunal tube for 7 days by 4 mg Tid .The control group whose members underwent placebo simultaneously with the treat‐ment group .The nitrogen balance ,grip strength of both groups was measured when at admitted and 4th as well as 7th day .Prealbu‐min ,total bilirubin ,alanine aminotransferase ,and aspartate aminotransferase were measured when at the same time and before leave hospital .The duration of the mechanical ventilation ,ICU stays ,hospital stays and mortality within 28 days were recorded .Results There was no statistical significance in the differences between all the indicators of the two groups at admission(P>0 .05) .The du‐ration of mechanical ventilation ,ICU stays ,hospital stays were decreased significantly in the treatment group (P0 .05) .Nitrogen bal‐ance ,prealbumin ,grip strength and liver function parameters in the treatment group were significantly higher than they were been at admitted and control group at 4th and 7th day (all P<0 .05) .Liver function parameters of treatment group gradually decreased to the normal range before discharge .Conclusion In critically ill patients treated with anabolic steroid stanozolol ,can promote protein synthesis ,reduce muscle and other lean tissue decomposition ,improve clinical symptoms ,short the length of hospital stay and ICU stay .But we should pay more attention on liver function in critically ill patients who treated with stanozolol .
ABSTRACT
Objective To investigate the clinical effect of nicorandil for treatment of patients with acute respiratory distress syndrome (ARDS).Methods A prospective randomized controlled trial was conducted. A total of 40 cases of patients with ARDS admitted to Department of Critical Care Medicine of Guizhou Provincial People's Hospital from October 2012 to October 2014 were enrolled, and they were randomly divided into two groups, 20 cases in each group. The two groups were treated with routine western medicine after admission. On this basis, the observation group was given nicorandil 10 mg, while the control group was given warm boiled water 10 mL, through gastric tubes 3 times a day, the therapeutic course being consecutive 5 days in both groups. The length of stay in intensive care unit (ICU), duration of mechanical ventilation after treatment, oxygenation index (OI), alveolo-arterial oxygen partial pressure difference (PA-aO2), positive end-expiratory pressure (PEEP), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, Glasgow coma score (GCS) before and after treatment, the predicted death rate (PDR) and 28-day mortality were compared between the two groups. The predicitive factors for 28-day mortality were screened by binary logistic analysis.Results The length of stay in ICU and duration of mechanical ventilation of control group were longer than those of observation group, but the difference was not statistically significant [ICU length of stay (day): 14.55±12.71 vs. 9.15±6.00, duration of mechanical ventilation (day): 13.25±12.27 vs. 7.75±5.32, bothP > 0.05]. After treatment, the GCS was higher than that before treatment in control group and observation group (11.95±3.98 vs. 10.75±4.89, 12.95±3.67 vs. 12.20±4.56), while APACHE Ⅱ score, PDR and PEEP were all lower than those before treatment [APACHE Ⅱ: 21.05±8.58 vs. 24.90±5.63, 18.70±11.21 vs. 26.65±7.67; PDR: (47.71±29.49)% vs. (61.00±23.29)%, (36.79±18.49)% vs. (56.12±18.16)%; PEEP (cmH2O, 1 cmH2O = 0.098 kPa): 4.40±3.14 vs. 5.75±2.59, 3.80±2.55 vs. 7.55±3.32], but there were no statistically significant differences between the two groups before and after treatment (allP > 0.05). After treatment, the OI was significantly higher and the PA-aO2 was significantly lower than those before treatment in the two groups, and the degrees of improvement of the observation group were more remarkable than those of the control group [OI (mmHg, 1 mmHg = 0.133 kPa): 224.72±85.12 vs. 141.37±45.82, PA-aO2 (mmHg): 132.60±46.64 vs. 204.30±121.2, bothP 0.05). Binary logistic regression analyses showed that the PA-aO2 [odds ratio (OR) = 0.958,P = 0.013, 95% confidence interval (95%CI) = 0.927 - 0.991], APACHE Ⅱ score (OR = 0.882,P = 0.010, 95CI = 0.803 - 0.970), GCS (OR = 1.399, P = 0.004, 95%CI = 1.111 - 1.761) and PDR (OR = 0.907,P = 0.002, 95%CI = 0.853 - 0.965) after treatment were the independent predictors of 28-day mortality.Conclusion Nicorandil can significantly improve oxygenation, but cannot reduce 28-day mortality in patients with ARDS.