ABSTRACT
Objective:To compare the safety of dexmedetomidine and midazolam in weaning mechanical ventilation patients after cardiopulmonary bypass (CPB) in ICU.Methods:From August 2016 to December 2018, 51 patients admitted to the People's Hospital of Jinhua for mechanical ventilation after ICU CPB cardiac surgery were randomly divided into dexmedetomidine group and midazolam group according to the numerical table method.During mechanical ventilation, dexmedetomidine was used to sedate the study group(26 cases), and midazolam was used in the control group (25 cases). The total time of mechanical ventilation, CPOT score, ICDSC score, incidence of sinus bradycardia during mechanical ventilation were counted, and the anterograde amnesia was observed after extubation.The safety and related factors of drug withdrawal in patients undergoing mechanical ventilation after CPB surgery of two different sedations were compared and evaluated.Results:Statistical analysis showed that the CPOT score of the dexmedetomidine group was (1.04±0.45)points, which was significantly lower than that of the midazolam group[(2.24±0.83)points], the difference was statistically significant between the two groups( t=-6.40, P<0.01). The ICDSC score of the dexmedetomidine group was (0.96±0.20)points, which of the midazolam group was (1.04±0.35)points, the difference was no statistically signiyicant between the two groups( t=-0.99, P>0.05). The total time of mechanical ventilation was (29.71±17.96)h in the dexmedetomidine group and (26.13±20.02)h in the midazolam group, there was no statistically significant difference between the two groups( t=0.67, P>0.05). During mechanical ventilation sedation, the dexmedetomidine group had more bradycardia, the difference was statistically significant(χ 2=11.96, P<0.01). There was no anterograde amnesia in the dexmedetomidine group, but all of the patients in the midazolam group had anterograde amnesia. Conclusion:Compared with the midazolam group, the CPOT score was lower in the dexmedetomidine sedation group with the same SAS score of 4(superficial sedation), which in line with the principles of " deep analgesia, shallow sedation". Although bradycardia occurs during the use of drugs, it can recover spontaneously after withdrawal and is safe to use.
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Objective To observe the effects of nasal feeding with different enteral nutrition (EN) agents, TPF-D emulsion and Briprin (SP) suspension on blood glucose level in patients with hyperglycemia under mechanical ventilation after cardiac surgery of extracorporeal circulation (CPB). Methods Forty patients with mechanical ventilation and hyperglycemia after CPB cardiac surgery admitted to the Department of Intensive Care Unit (ICU) of Jinhua People's Hospital from August 2016 to October 2018 were selected. According to the different EN preparations given after the surgery, the patients were divided into two groups: a TPF-D group (21 cases) and a Briprin group (19 cases). Both groups were given reasonable analgesia, sedation and other conventional treatment to maintain the hemodynamic stability and balances between water electrolytes and acid-base. EN therapy was applied within 24 ~48 hours after ICU admission and caloric requirements were calculated according to ideal body weight. The EN treatment in TPF-D group was given by TPF-D nasal feeding, the drip rate started from 20-30 mL/h and gradually increased to 50-100 mL/h according to patients' tolerance; in the Briprin group, EN was given by nasal feeding of SP, and the feeding mode was the same as that of TPF-D group. The mechanical ventilation time, postprandial 2 hours blood glucose level and blood glucose increase rate of the two groups were observed; the glycosylated albumin (GA) and serum triglyceride (TG) levels were measured 3 days after EN administration, and the first postoperative defecation time was also observed in the two groups. Results After EN therapy, there were no statistically significant differences in mechanical ventilation time and TG level after 3 days of EN treatment between the TPF-D group and the SP group [mechanical ventilation time (hours): 31.52±19.56 vs. 27.26±14.35, TG (mmol/L) after 3 days of EN therapy: 1.32±0.37 vs. 1.62±0.57, both P > 0.05]. The glucose level and glucose increase rate at postprandial 2 hours, and GA level after 3 days of EN therapy in TPF-D group were obviously lower than those in the SP group [glucose level 2 hours postprandial (mmol/L): 7.68±1.20 vs. 11.60±1.69, the glucose increase rate at 2 hours postprandial: (-0.01±0.15)% vs. (0.39±0.24)%, and GA after 3 days of EN therapy: (12.81±1.64)% vs. (16.32±2.35)%, all P < 0.01]. The time of the first bowel movement in the TPF-D group was earlier than that in the SP group (days: 2.48±0.51 vs. 3.84±0.69, P < 0.01). Conclusion The effect of applying TPF-D EN emulsion was less than that of SP suspension on glucose level in post-operative CPB patients with hyperglycemia and after mechanical ventilation, showing when using TPF-D, the stability of blood glucose is better and defecation earlier.
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Objective To investigate the outcomes of unselected peripheral T cell lymphoma (PTCL) patients treated with in-tensive first-line chemotherapy with high-dose therapy followed by autologous stem cell transplantation (ASCT).Methods Here a nonrandom study was reported for 23 PTCL patients treated with first-line intensive chemotherapy followed by autologous stem cell trans-plantation and 23 PTCL patients treated with conventional chemotherapy during January in 2000 to 2011 .All patients had received E-CHOP for 6~8 cycles, and autologous stem cell transplantation group was administrated with intensive chemotherapy followed by ASCT after complete remission or partial remission .Results There was no statistically significant difference in short-term therapeutic effect between two groups( P >0.05), but the 5-year overall survival(OS) of autologous stem cell transplantation group( 58%) was higher than conventional chemotherapy group , as well as 5-year disease-free survival time (DFS) (45%in autologous stem cell transplanta-tion group, and 21%in conventional chemotherapy group ) with both statistical significance ( P <0.05).Only the incidence of Ⅳ° myelosuppression in autologous stem cell transplantation group ( 100%) was higher than that in conventional chemotherapy group ( 13%) ( P <0.01 ) .Conclusions First-line intensive chemotherapy followed by autologous stem cell transplantation for peripheral T cell lymphoma was quietly safe utility , it was better than conventional chemotherapy which would be considered as first -line method.