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Objective:To understand the status of sedation and analgesia treatment and management in pediatric intensive care unit(PICU) in Shandong Province, and to provide the basis for the improvement of sedation and analgesia treatment plan.Methods:This study was a multi-center retrospective study.The PICUs of 6 tertiary hospitals in Shandong Province participated in this study.The data of 1 340 children admitted to these 6 PICUs from January 2016 to December 2018 were collected.The age, gender, the pediatric risk of mortality score Ⅲ at 24 hours after admission, whether they received mechanical ventilation, whether they received sedation and(or) analgesia, whether they were monitored sedation and(or) analgesia, and in-hospital mortality were analyzed.The children were divided into the simple sedation group( n=798), the sedation + analgesia group( n=120) and the non-sedation analgesia group( n=422) according to whether they received sedation and(or) analgesia.The diseases, proportion of mechanical ventilation, incidence of hypotension, average length of stay in PICU and in-hospital mortality were compared among the three groups. Results:The median age of the 1 340 children was (13.3±6.4) months, including 786 males(58.7%). Sedation therapy had been carried out in 6 PICUs, of which 5 PICUs had routine sedation assessment; 4 PICUs had carried out analgesic therapy, of which only 2 had routine pain assessment.A total of 918 children(68.5%)received sedation and(or) analgesia, midazolam was the most commonly used sedative drug, followed by dexmedetomidine, and 526 children(57.3%)were monitored for sedation assessment, the most commonly used assessment method was the Richmond agitation sedation score.One hundred and twenty(9.0%)cases received sedation combined with analgesia, fentanyl was the most commonly used analgesic, and 38 children(31.7%) underwent routine pain assessment.There was no significant difference in age and sex among the three groups.The proportion of surgical diseases and patients received mechanical ventilation(100.0%, 120/120) were the highest in the sedation + analgesia group.The proportion of mechanically ventilated patients was the lowest in the non-sedation analgesia group(11.4%, 48/422). The mean duration of mechanical ventilation in the sedation + analgesia group was slightly shorter than that in the simple sedation group( P>0.05). The incidence of hypotension was highest in the sedation + analgesia group, and lowest in the non-sedation analgesia group[21.7%(26/120) vs.2.1%(9/422), P<0.01]. There was no significant difference in in-hospital mortality and mean PICU stay among three groups. Conclusion:Benzodiazepines are still the main sedative drugs used in PICUs in Shandong Province.In recent years, the usage of dexmedetomidine has gradually increased, but the proportion of analgesic use is very low.At present, analgesic and sedative therapy is mainly used for children after surgery and receiving mechanical ventilation.Although analgesic and sedative therapy does not increase the in-hospital mortality and average length of stay in PICU, it increases the incidence of hypotension.The sedative and analgesic treatment and assessment in the PICU of Shandong Province are still not standardized, mainly reflected in infrequently analgesic treatment and the assessment of sedation and pain, which need to be further improved.
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Objective:To analyze the epidemiological characteristics of acute paraquat(PQ)poisoning in children in southwest Shandong, and the risk factors for pulmonary interstitial fibrosis.Methods:This retrospective study was performed on the clinical data of children with acute PQ poisoning admitted from January 2013 to December 2017 in 12 hospitals in southwest Shandong.All participants were divided into pulmonary interstitial fibrosis group and no pulmonary interstitial fibrosis group on the basis of the chest CT 14 days after poisoning.The epidemiological characteristics and risk factors of pulmonary interstitial fibrosis were analyzed.Results:During the study period, a total of 307 children with acute PQ poisoning were admitted to 12 hospitals, of which 61 (19.87%) were suffering from acute PQ poisoning.Forty-nine cases with complete clinical data were analyzed, including 26 male and 23 female patients poisoned by oral.The age distribution ranged from 8 months to 14 years.Poisoning mainly occured from July to September of each year.The mortality of acute PQ poisoning was 8.2%(4/49), and the incidence of pulmonary interstitial fibrosis in survival patients was 44.4%(20/45). Statistical differences ( P<0.05) were found between the pulmonary interstitial fibrosis and no pulmonary interstitial fibrosis, with regard to the times of blood purification, the time from poison exposure to blood purification, the application rate of glucocorticoids, the concentration of PQ in urine, the pediatric critical illness score, the time from poison exposure to gastric lavage, the white blood count at admission, serum creatinine, arterial blood lactate, PaO 2, PaCO 2, and PaO 2/FiO 2; however, there was no significant difference in the proportion of blood purification treatment, the mode of blood purification treatment, alanine aminotransferase, aspartate aminotransferase, urea nitrogen, creatine kinase and troponin.Stepwise logistic regression analysis showed that the time from exposure to poison to gastric lavage( OR=0.683, 95% CI 0.210-2.222)and to blood purification( OR=0.0133, 95% CI 0.004-0.042), the times of blood purification( OR=2.862, 95% CI 1.450-5.648), concentration of PQ in urine( OR=1.435, 95% CI 1.085-1.898), and the use of glucocorticoids( OR=0.190, 95% CI 0.048-0.757) were the risk factors for pulmonary interstitial fibrosis( P<0.05). Conclusion:Early gastric lavage and blood purification, increasing the frequence of adminitrating purification appropriately, using low-dose glucocorticoids can reduce the incidence of pulmonary interstitial fibrosis of children with acute PQ poisoning.
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Objective@#To analyze the epidemiological characteristics of acute paraquat(PQ)poisoning in children in southwest Shandong, and the risk factors for pulmonary interstitial fibrosis.@*Methods@#This retrospective study was performed on the clinical data of children with acute PQ poisoning admitted from January 2013 to December 2017 in 12 hospitals in southwest Shandong.All participants were divided into pulmonary interstitial fibrosis group and no pulmonary interstitial fibrosis group on the basis of the chest CT 14 days after poisoning.The epidemiological characteristics and risk factors of pulmonary interstitial fibrosis were analyzed.@*Results@#During the study period, a total of 307 children with acute PQ poisoning were admitted to 12 hospitals, of which 61 (19.87%) were suffering from acute PQ poisoning.Forty-nine cases with complete clinical data were analyzed, including 26 male and 23 female patients poisoned by oral.The age distribution ranged from 8 months to 14 years.Poisoning mainly occured from July to September of each year.The mortality of acute PQ poisoning was 8.2%(4/49), and the incidence of pulmonary interstitial fibrosis in survival patients was 44.4%(20/45). Statistical differences (P<0.05) were found between the pulmonary interstitial fibrosis and no pulmonary interstitial fibrosis, with regard to the times of blood purification, the time from poison exposure to blood purification, the application rate of glucocorticoids, the concentration of PQ in urine, the pediatric critical illness score, the time from poison exposure to gastric lavage, the white blood count at admission, serum creatinine, arterial blood lactate, PaO2, PaCO2, and PaO2/FiO2; however, there was no significant difference in the proportion of blood purification treatment, the mode of blood purification treatment, alanine aminotransferase, aspartate aminotransferase, urea nitrogen, creatine kinase and troponin.Stepwise logistic regression analysis showed that the time from exposure to poison to gastric lavage(OR=0.683, 95%CI 0.210-2.222)and to blood purification(OR=0.0133, 95%CI 0.004-0.042), the times of blood purification(OR=2.862, 95%CI 1.450-5.648), concentration of PQ in urine(OR=1.435, 95%CI 1.085-1.898), and the use of glucocorticoids(OR=0.190, 95%CI 0.048-0.757) were the risk factors for pulmonary interstitial fibrosis(P<0.05).@*Conclusion@#Early gastric lavage and blood purification, increasing the frequence of adminitrating purification appropriately, using low-dose glucocorticoids can reduce the incidence of pulmonary interstitial fibrosis of children with acute PQ poisoning.
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Objective To investigate the diagnostic value of the partial least square discriminant analysis (PLS-DA) model based on seven serum cytokines for children patients with mycoplasma pneumonia,the 7 cytokines includ interleukin-2 (IL-2),IL-4,IL-6,IL-8,IL-10,tumor necrosis factor alpha (TNF-α) and interferonγ(IFN-γ).Methods Serum levels of cytokines were measured by the double antibody sandwich method of ELI-SA in 140 patients with pneumoniae infection and 135 normal healthy controls,and data was analyzed with the receiver operation characteristic (ROC) curve and the PLS-DA.Results The area under the ROC curve (AUC) of serum IL-10 and IFN-γfor the diagnosis of MPP was 0.84 (95％ CL:0.79 ～ 0.89).The sensitivity of IL-10 and IFN-γ for the diagnosis of MPP was 91.4％ and 82.1％,with the specificity was 77.0％ and 82.2％,respectively.The diagnostic accuracy of the PLS-DA model based on seven serum cytokines for children MPP and the controls was 90.0％ and 88.15％,and the prediction accuracy was 86.4％ and 87.4％,respectively.Conclusion Seven serum cytokines based on PLS-DA model was helpful for the diagnosis of children patients with MPP.
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Objective To find the inpact(s) of Losartan on myocardial apoptosis in rats with heart failure. Methods Eight-week-old male SD rats were divided into control group (group C) , heart failure (group HF) and treatment group (group LS). Use of doxorubicin injection model, group LS at the same time in a row to the oral losartan, myocardial ultrastructure was examined by TEM. DNA-situ terminal labeling (TUNEL method) was used to detect myocardial apoptosis and myocardial BAX, BCL-2 protein expression was detected by immunohistochemistry. Results Group HF showed significant myocardial cell injury, and apoptotic bodies were found, serum CPK, CK-MB and LDH were increased. In LS group, myocardial apoptosis index was lower (P <0. 01) , myocardial cells BCL-2 expression, BAX expression reduced as compared with those in HF group. Conclusion Losartan can effectively inhibit the process of heart failure occurred in cardiomyocyte apoptosis, reverse myocardial damage and improve the prognosis of heart failure.
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Objective To find the inpact(s) of Losartan on myocardial apoptosis in rats with heart failure. Methods Eight-week-old male SD rats were divided into control group(group C),heart failure(group HF) and treatment group(group LS). Use of doxorubicin injection model,group LS at the same time in a row to the oral losartan,myocardial ultrastructure was examined by TEM. DNA-situ terminal labeling (TUNEL method) was used to detect myocardial apoptosis and myocardial BAX,BCL-2 protein expression was detected by immunohistochemistry.ResultsGroup HF showed significant myocardial cell injury,and apoptotic bodies were found,serum CPK,CK-MB and LDH were increased. In LS group,myocardial apoptosis index was lower (P
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0.05 ) between two groups. The side effects were 7.7 % and 13.3 % in treatment group and control group, respectively. CONCLUSION: The combination of CLA+CBS+Met for 1 wk is an effective and safe treatment for eradication of HP infection with recurrent abdominal in children.