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Objective:To evaluate the value of lung ultrasonography score (LUS) on assessing extravascular lung water (EVLW) and prognosis in patients with acute respiratory distress syndrome (ARDS).Methods:The clinical data of 46 patients meeting ARDS Berlin definition admitted to intensive care unit (ICU) of Ningbo Yinzhou People's Hospital from July 2016 to December 2019 were retrospectively collected. The general data, vital signs, blood lactic acid (Lac), oxygenation index (OI), LUS, extravascular lung water index (EVLWI), sequential organ failure assessment (SOFA) score, clinical pulmonary infection score (CPIS) and the length of ICU stay were collected. According to the prognosis of patients during ICU treatment, the patients were divided into survival group and non-survival group, and the clinical characteristics between the two groups were compared. The correlation between LUS and OI, EVLWI, SOFA, and CPIS were analyzed by Pearson correlation analysis. Receiver operator characteristic (ROC) curve was plotted to determine the prognostic value of LUS for ARDS patients during ICU treatment.Results:Forty-six patients were enrolled in the analysis, of whom 32 patients survived (69.6%), and 14 patients died (30.4%) during ICU treatment. There was no significant difference in gender, age, left ventricular ejection fraction (LVEF) or heart rate (HR) between the two groups. Compared with the survival group, the mean arterial pressure (MAP) and OI in the non-survival group were significantly lowered [MAP (mmHg, 1 mmHg = 0.133 kPa): 57.48±33.34 vs. 85.45±19.56, OI (mmHg): 74.50±18.40 vs. 233.06±28.28, both P < 0.05], while Lac, LUS, EVLWI, SOFA and CPIS were significantly increased [Lac (mmol/L): 6.78±2.56 vs. 2.21±1.42, LUS score: 23.57±2.03 vs. 15.58±2.24, EVLWI (mL/kg): 22.93±2.56 vs. 12.96±2.18, SOFA score: 20.21±3.35 vs. 12.43±2.97, CPIS score: 8.07±1.38 vs. 4.59±1.04, all P < 0.01], and the length of ICU stay was significantly shortened (days: 9.33±3.28 vs. 16.89±4.12, P < 0.05]. Pearson correlation analysis showed that a significant negative linear correlation was found between LUS and OI ( r = -0.823, P < 0.01), and positive linear correlations were found between LUS and EVLWI, SOFA, CPIS ( r values were 0.745, 0.614, 0.757, respectively, all P < 0.01). ROC curve analysis showed that both LUS and EVLWI could predict the prognosis of ARDS patients during ICU treatment, and the areas under ROC curve (AUC) of LUS and EVLWI were 0.936 and 0.991, respectively. When the cut-off of LUS score was 20.5, the sensitivity and specificity were 85.7% and 81.2% respectively. Conclusions:LUS score has a good correlation with EVLWI monitored by pulse index continuous cardiac output (PiCCO), which can reflect lung water content. LUS score can be used as an early prognostic indicator for ARDS patients.
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Objective:To study the effect of early immune enteral nutrition combined with glutamine (Gln) parenteral nutrition on T-lymphocyte subsets in patients with severe pulmonary infection in the intensive care unit (ICU).Methods:A total of 70 ICU patients with severe pulmonary infection who were treated in Yinzhou People′s Hospital from January 2017 to October 2019 were selected, and the patients were divided into enteral nutrition group and combined group according to a completely random method with 35 cases in each group. Both groups of patients were given conventional treatment; patients in the enteral nutrition group was given immunoenhanced enteral nutrition on the basis of conventional treatment, and those in the combined group was given Gln on the basis of enteral nutrition group. The levels of arterial oxygen partial pressure (PaO 2), arterial oxygen saturation (SaO 2), arterial partial pressure of carbon dioxide (PaCO 2), CD 8+, CD 3+, CD 4+/CD 8+, procalcitonin (PCT), hypersensitive C-reactive protein (hs-CRP) and tumor necrosis factor alpha (TNF-α) before and after treatment were detected and compared between two groups. The treatment efficacy was compared between two groups too. Results:After treatment, the levels of SaO 2 and PaO 2 in combined group were higher than those in enteral nutrition group, the level of PaCO 2 in combined group was lower than that in enteral nutrition group, but there were no significant differences ( P>0.05). After treatment, the levels of CD 3+, CD 4+/CD 8+ in combined group were higher than those in enteral nutrition group [(62.37 ± 6.15)% vs. (59.35 ± 5.24)%, 1.50 ± 0.18 vs. 1.12 ± 0.11], the level of CD 8+ in combined group was lower than that in enteral nutrition group [(33.15 ± 6.11)% vs. (37.72 ± 8.57)%], and there were significant differences ( P<0.05). The levels of PCT, hs-CRP and TNF-αin combined group were lower than those in enteral nutrition group [(3.83 ± 0.82) μg/L vs. (6.47 ± 1.34) μg/L, (6.92 ± 1.25) mg/L vs. (12.72 ± 3.83) mg/L, (92.35 ± 13.05) ng/L vs. (125.26 ± 18.35) ng/L], and there were significant differences ( P<0.05). The total effective rate in combined group was higher than that in enteral nutrition group [88.57%(31/35) vs. 65.71%(23/35)], and there was significant difference ( χ2=5.185, P<0.05). Conclusions:Early immune enteral nutrition combined with Gln parenteral nutrition has significant effects on patients with severe pulmonary infection in ICU, and can improve the level of T-lymphocyte subsets, control infection, and reduce inflammatory factor levels.
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Objective:To evaluate the value of lung ultrasound (LUS) in the early assessment of patients with acute respiratory distress syndrome (ARDS).Methods:A prospective double-blind cohort study was conducted. Patients with ARDS conformed to the Berlin diagnosis criteria admitted to the Intensive Care Unit (ICU) of Ningbo Yinzhou People’s Hospital from July 2016 to January 2020. According to the oxygenation index (OI), the patients were divided into the mild to moderate group (100 mmHg<OI≤300 mmHg) and the severe group (OI≤100 mmHg); Patients underwent LUS and transpulmonary thermodilution technique (TPTD) monitoring and chest CT on the first day after diagnosis. Acute physiology and chronic health status (APACHEⅡ) score, lung injury score (LIS), and PaO 2/FiO 2 (OI) were recorded at admission. LUS score, EVLWI, OI, APACHEⅡ score and LIS were compared. The correlation between LUS and EVLWI, OI, APACHEⅡ score and LIS score was measured by Pearson linear correlation anaysis. Receiver operating characteristic (ROC) curve were used to evaluate LUS score in predicting ARDS. Results:A total of 52 patients with ARDS were enrolled, 34 patients in the mild to moderate group and 18 patients in the severe group. Compared with chest CT scans, the accuracy of LUS diagnosis was 93.12%, the sensitivity was 91.33%, the specificity was 95.31%, the positive predictive value was 95.95%, and the negative predictive value was 90.03%. Pearson linear correlation analysis showed that LUS was positively correlatied with EVLWI ( r=0.756, P<0.01), LIS score ( r=0.817, P<0.01), and APACHEⅡ score ( r=0.655, P<0.01), while was negatively correlated with OI ( r=-0.823, P<0.01). The areas under the receiver operating characteristic curves of LUS and EVLWI measured by TPTD were 0.922 ( P<0.01) and 0.972 ( P<0.01), LUS score threshold value of 19.5 had the sensitivity of 0.833 and specificity of 0.791 for prediction of severe ARDS. Conclusions:LUS is convenient and easy to perform, and LUS score has a high value, which is a better prognostic indicator for early assessment of ARDS patients.
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Objective To explore the effect of early enteral nutritional (EEN) support rate of reaching the standard on the prognosis of mechanical ventilation (MV) patients with fulminant myocarditis. Methods The clinical data of 17 MV patients with fulminant myocarditis admitted to Intensive Care Unit (ICU) of Yinzhou Hospital Affiliated to Ningbo University Medical College from February 11, 2015 to May 15, 2018 were analyzed retrospectively, and according to whether the 60% calculated nutritional target value of early enteral nutrition (EEN) was achieved within 7 days of treatment or not, they were divided into an EEN support standard group (10 cases) and a non-standard group (7 cases). The clinical data of MV time, length of stay in ICU, total hospitalization time, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and albumin (Alb) and prealbumin (PA) on the date of entering into ICU and on the date getting out of ICU were collected in the two groups, the difference of above indexes were compared between the two groups. Results The MV time, length of stay in ICU and the total hospitalization time in EEN support standard group were obviously shorter than those in EEN support non-standard group [MV time (hours): 93.59±32.11 vs. 131.07±45.34, length of stay in ICU (days): 14.78±5.24 vs. 19.21±6.78, total hospitalization stay (days): 21.28±5.62 vs. 27.19±4.82, all P < 0.05]. In comparisons between the two groups, the APACHE Ⅱ scores on discharge from ICU and the difference values in Alb, PA respectively between levels on date entering into ICU and getting out of ICU were of no statistical significant differences [APACHE Ⅱ score out of ICU: 6.72±2.14 vs. 7.21±2.15, Alb difference value between levels entering into ICU and getting out of ICU (g/L): 3.59±2.23 vs. 4.18±1.93, PA difference value as above mentioned (mg/L): 20.81±12.13 vs. 16.07±17.34, all P > 0.05]. Conclusion The standard EEN support for patients with acute fulminant myocarditis undergoing MV can shorten MV duration, length of stay in ICU and total hospitalization time.
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Objective To observe the effect of early enteral nutrition (EN) on immune function in patients with severe acute pancreatitis (SAP). Methods Nineteen patients with SAP admitted to Yinzhou People's Hospital of Ningbo City from March 11, 2015 to December 16, 2016 were enrolled, they were divided into two groups according to the different times of EN given, 11 patients who were early supported with EN were assigned in the research group and another 8 patients whose EN support was delayed were included in the control group. The patients in two groups were treated with routine non-operative western medicine after admission, and the jejunal nutritional tube was placed in the nasal cavity for EN administration. The research group was given early EN beginning at 72 hours after admission, on the first day, 250 mL sugar saline was administered at a rate of 60 mL/h, and on the second day and afterward, it was changed to 200 mL Ruineng (a commercial kind of EN); in the control group, the EN began on 7 to 10 days after admission, using the same principle and method as the research group; EN was given for 3 weeks in both groups. Venous blood was collected from each patient before and after the EN support, and immunoglobulin (IgG, IgM and IgA) levels were determined by immunoturbidimetry, the time of improved Marshall score ＜ 1 was observed. Results The levels of immunoglobulin IgG (g/L: 11.13±2.56 vs. 8.17±1.12), IgM (g/L: 1.71±0.96 vs. 0.76±0.71) and IgA (g/L: 3.74±1.85 vs. 2.13±0.13) in the research group after treatment were significantly higher than those before treatment (all P ＜ 0.05);the changes in the above indicators before and after treatment in the control group were not obvious [IgG (g/L): 8.32±0.93 vs. 8.21±1.04, IgM (g/L): 0.87±0.73 vs. 0.81±0.66, IgA (g/L): 2.15±0.37 vs. 2.11±0.17]. The levels of IgG, IgM and IgA in the research group after treatment were significantly higher than those in the control group (all P ＜ 0.05), the time of Marshall score ＜ 1 was siginificantly shorter than the research group than that in control group (days: 12.31±1.27 vs. 16.18±1.13, P ＜ 0.05). Conclusion Administration of EN as early as possible can effectively enhance the immune function of patients with SAP and improve their prognosis.
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Objective To develop a simple and sensitive HPLC‐UV method to determined actarit in plasma .Methods The chromatographic separation was carried out on a Dikma C18 column with a mobile phase composed of water containing 1.2% acetic acid‐methanol (50∶50 ,V/V ) at a flow rate of 1 .0 ml/min and the temperature of column was 30℃ .UV wave‐length mode was monitored at 245 nm .Results A linear response function was established for the range of concentrations 75‐4 000 ng/ml for actarit .The inter‐and intra‐day precision value were less than 10% for actarit and the accuracy was more than 90% .The extraction recovery was more than 88% .Conclusion This simple ,sensitive ,and exclusive method could be used in routine clinical practice to monitor actarit concentrations in human plasma .
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Objective To investigate the distribution of virulence-related genes in multidrug resistant Escherichia coli.Methods Seven virulence genes papA,cnf1,cnf2,cfaB,ipaB,hofQ and ompT were detected by PCR in 20 strains of multidrug resistant Escherichia coli clinically isolated,and the positive genes were further searched in 31 strains of Escherichia coli in BioCyc database whose genomies had been fully sequenced.Results Virulence genes hofQ and ompT were detected in 20 strains of Escherichia coli with a positive rate of 95.0％ (19/20) and 55.0％ ( 11/20),respectively.Among 31 strains of Escherichia coli in BioCyc,21 (67.7％) were positive for hofQ gene and 15 (48.4％) were positive for ompT gene.Conclusion hofQ and ompT genes are prevalent in multidrug resistant Escherichia coli.
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OBJECTIVE To evaluate the clinical efficacy of piperacillin/tazobactam for severe community acquired pneumonia(CAP) among elderly.METHODS Seventy-six elderly cases of severe CAP were randomized into piperacillin/tazobactam group and ceftriazone group,and the sputum culture was underwent for each case before and after treatment.RESULTS The total efficacy rates and bacterial clearance rates in piperacillin/tazobactam group and ceftriazone group were 92.11% and 88.89%,and 73.68% and 58.82%,respectively,and the differences between the two groups were statistically significant.CONCLUSIONS It suggestes that piperacillin/tazobactam be a more effective drug for severe CAP among elderly in old age.
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OBJECTIVE To study the mechanisms of chromosome and plasmid-mediated quinolones resistance in Escherichia coli(ECO).METHODS Clinical isolates of ECO were collected from clinical specimens at ICU of Yinzhou People′s Hospital from Dec 2007 to Jun 2008.To detect the susceptibility to 30 types of antibiotics K-B disk diffusion method was used.The susceptibicity to ciprofloxacin and levofloxacin were detected by agar dilution testing.Then six type genes gyrA,qnrA,qnrB,qnrS,aac(6′)-Ⅰb-Cr,and qepA were investigated by PCR.In the meantime,the PCR products were sequenced.RESULTS The alterations in gyrA were found in all 20 tested strains.Two new subtypes were found in ECO 13 and ECO 15.Three strains were found acc(6′)-Ⅰb-Cr and ECO 2 was detected qurA gene.CONCLUSIONS The mutations in gyrA play a dominant role in the resistance to quinolones in ECO.Both aac(6′)-Ⅰb-Cr and qepA may responsible for quinolones resistance in ECO too.
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OBJECTIVE To investigate the antibiotics resistance of Escherichia coli(ECO) and distrubtion of aminoglycoside-modifying enzymes and 16S RNA methylase genes in ICU.METHODS The samples of 20 ECO isolates were collected from Dec 2007 to Jun 2008 of patients in ICU.To determine the sensitivity to the 30 antibacterials K-B method was used and aminoglycoside-modifying enzymes and 16S RNA methylase genes were analyzed by polymerase chain reaction(PCR).RESULTS In among the 20 ECO isolates,8 strains carried aac(3)-Ⅱ(40%),3 carried aac(6′)-Ⅰb(15%) and ant(3″)-Ⅰ(15%),1 be found aph(3′)-Ⅰ(10%)and 13 be found aadA4/5 aminoglycoside-modifying enzymes genes,no strain carried 16S RNA methylase genes.CONCLUSIONS aac(3)-Ⅱ、aac(6′)-Ⅰb,ant(3″)-Ⅰ,aph(3′)-Ⅰ and aadA4/5 aminoglycoside-modifying enzymes genes exist in ECO widely,they should be the main cause inducing the high rate of drug-resistance to aminoglycosides.
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OBJECTIVE To investigate the antibiotics resistance of multi-resistant Acinetobactor baumannii(ABA) and genotypes of beta-lactamases in ICU.METHODS The samples of 20 A.baumannii isolates were collected from Oct 2007 to Jul 2008 from patients in ICU.To determine the sensitivity to the 32 kinds of antibacterials,K-B method was used and the detection of ESBLs and AmpC beta-lactamases was performed by three dimensional test and 21 types of beta-lactamases genes were analyzed by polymerase chain reaction(PCR).RESULTS Among the 20 ABA isolates,all carried TEM beta-lactamases gens(100%),10 carried OXA-23 beta-lactamases gens(50%) and 15 strains carried ADC beta-lactamases gene(75%),50% strains produced TEM,OXA-23 and ADC beta-lactamases simultaneously.Through determining sequence of one PCR product from TEM,OX23 and ADC respectively,we found TEM-116,OXA-73 and ADC-25 type beta-lactamases genes.CONCLUSIONS The antibiotics resistance of ABA is very serious.TEM,OXA-23 and ADC exist in multi-resistant A.baumannii widely.It should be the main causes as high rate of drug-resistantce to beta-lactamantibiotics.
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OBJECTIVE To investigate the antibiotic resistance of multi-resistant Acinetobacter baumannii(ABA) and distribution of aminoglycoside-modifying enzymes and 16S rRNA methylase genes in ICU in Yinzhou People′s Hospital in Ningbo. METHODS The samples of 20 ABA isolates were collected from Oct 2007 to Jul 2008 in ICU.K-B method was used to determine the sensitivity to 32 antibacterials and the aminoglycoside-modifying enzymes and 16S rRNA methylase genes were analyzed by polymerase chain reaction(PCR). RESULTS From 20 ABA isolates,8 strains carried aminoglycoside-modifying enzymes genes aac(3)-Ⅰ,aac(3)-Ⅱ,aac(6′)-Ⅰb,and ant(3″)-Ⅰ,their positive rate was 10%,15%,30% and 25%,respectively;no strain carried 16S rRNA methylase genes. CONCLUSIONS The antibiotics resistance of A.baumannii is very serious in Yinzhou People′s Hospital in Ningbo.Aminoglycoside-modifying enzymes genes aac(3)-Ⅰ,aac(3)-Ⅱ,aac(6′)-Ⅰb and ant(3″)-Ⅰ exist in multi-resistant A.baumannii widely.They would be the main causes of high drug-resistantce to aminoglycosides.
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OBJECTIVE To study the existence status of class Ⅰ integron and transposable element of multi-resistant Acinetobactor baumannii isolated form ICU of Yinzhou People′s Hospital in Ningbo. METHODS The samples of 20 A.baumannii isolates were collected from Oct 2007 to Jul 2008.The susceptibility to 32 antibiotics of the isolates was measured.The genetic markers of integron qacE△1-sul1 and transposable element tnpU were analyzed by polymerase chain reaction(PCR).The PCR products of tnpU or qacE△1-sul1 were sequenced for determination. RESULTS In the 20 ABA isolates,the positive rate of class Ⅰ integron qacE△1-sull was 75%,and the positive rate of transposable element tnpU was 55.0%. CONCLUSIONS The positive rate of the integron qacE△1-sul1 and transposable element tnpU for multi-resistant A.baumannii is high in Yinzhou People′s Hospital in Ningbo.It should be reevaluated the preventative role of chlorhexidine for operation.
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OBJECTIVE To investigate mycoplasma infection in ICU patients.METHODS Sixty-five samples from blood,respiratory tract and genitourinary tract of patients were collected respectively from Oct 2007 to July 2008 in ICU.Mycoplasma pneumoniae(Mp),Urealasma urealytium(Uu) M.fermentans(Mf) and M.penetrans(Mpe) were cultivated by modified mycoplasma fluid and solid medium.Mf and Mpe positive isolates were verified by nested polymerase chain reaction(rPCR),Mp and Uu were confirmed by fluorescent quantitative PCR.RESULTS It was found that the positive detection rate for Mp was 12.3%(8/65)in blood and 35.4%(23/65) in respiratory tract excreta and for Mu 1.5%(1/65) and 26.2%(17/65) in blood or Genitourinary tract,respectively.Mpe and Mf did not detected.CONCLUSIONS The state of mycoplasma infection is very severe,and often accompanies bacterial infection.It is necessary to consider mycoplasma when chose antibiotics.