ABSTRACT
OBJECTIVE To investigate nosocomial pulmonary infection in elderly patients receiving long-term(at least 30 day) mechanical ventilation. METHODS Retrospective survey was carried out in the aged patients with long-term mechanical ventilation,who admitted from Jan 2002 to Jun 2005.The risk factors of common pneumonia were studied by means of Logistic regression analysis. RESULTS In 69 cases with long-term mechanical ventilation,53 patients were caught common pneumonia(76.81%).Pulmonary tuberculosis and plural tuberculosis were(7(10.14%)) and(1(1.14%)),respectively.Nontuberculous mycobacterial infection was identified in 3 cases(4.35%).There were 8 cases suffered from Pneumocystis carinii pneumonia(11.59%).The length of mechanical ventilation and aspiration seemed to be the important risk factors for the development of common bacterial pneumonia. CONCLUSIONS The most significant preventive measures of common pneumonia include short mechanical ventilation and prevention of aspiration of gastric contents.Mycobacterium tuberculosis,nontuberculous mycobacteria and P.carinii induced pneumonia also should be considered in the elderly with(long-term) mechanical ventilation.
ABSTRACT
Objective To investigate the cause of pleural effusion in elderly patients on mechanical ventilation, and to analyze the effect of mechanical ventilation on hemodynamics. Methods 100 elderly patients admitted to our hospital from Jan 2002 to Oct 2004 who had received mechanical ventilation were studied retrospectively and logistic regression analysis of risk factors of pleural effusion before and after mechanical ventilation were performed. 8 patients of them were examined by ultrasonic cardiography before and during mechanical ventilation. Results Before mechanical ventilation there were 27 patients complicated with pleural effusion. After mechanical ventilation another 33 patients were showed to develop pleural effusion. Totally 60 mechanical ventilated patients had pleural effusion. The analysis of logistic regression showed that cardiac insufficiency was significantly correlated with pleural fluid in the patients receiving mechanical ventilation. The transmembrane pressure of tricuspid valve was increased during mechanical ventilation. Conclusion Incidence of pleural effusion increased, hemodynamics changed and the transmembrane pressure of tricuspid valve increased with mechanical ventilation in the elderly patients. Cardiac insufficiency was an important risk factor of pleural effusion.
ABSTRACT
Objective To evaluate the effects of interleukin-10 and dexamethasone on expression of TNF-? mRNA, IL-1? mRNA, and IL-1ra mRNA in acute lung injury (ALI). Methods A rat model of ALI was reproduced by intratracheal instillation of endotoxin (LPS) with a dose of 10mg/kg. 72 male S-D rats were randomly divided into control group, LPS group, LPS+IL-10 group, and LPS+Dex group, 18 rats in each group (6 rats at 2h, 6h, and 24h respectively). RT-PCR method was used to determine the expression of TNF-? mRNA, IL-1? mRNA, and IL-1ra mRNA in lung tissue. Results In LPS group TNF-? mRNA expression peaked at 2h, then decreased sharply; IL-1? mRNA expression increased markedly at 2h, peaked at 6h, then decreased; IL-1ra mRNA expression increased and peaked at 6h, and remained higher than control group at 24h. Both IL-10 and Dex inhibited TNF-? mRNA and IL-1? mRNA expression, but with no effect on IL-1ra mRNA expression. Pathological examination revealed that IL-10 or Dex attenuated injury to lung parenchyma. Conclusions The up-regulation of expression of both TNF-? mRNA and IL-1? mRNA was much earlier than that of the expression of IL-1ra mRNA, suggesting that there was an imbalance of inflammatory and anti-inflammatory mediators in the early phase of ALI. Both IL-10 and Dex could inhibit the expression of inflammatory mediators and exert no effect on the expression of anti-inflammatory mediators, thus contributing a balance effect between them and relieving ALI in rats.