Advances in pharmacological treatment for acute respiratory distress syndrome / 中国基层医药

Acute respiratory distress syndrome(ARDS) is a common critical syndrome with high morbidity and mortality.The treatments include respiratory support and drug therapy.In this paper, the latest clinical advances in the treatment of ARDS with glucocorticoids, statins, antioxidants, recombinant human activated protein C, sedatives and muscle relaxants, exogenous alveolar surfactants, mesenchymal stem cells, and vasodilators are reviewed.

Effect of dexmedetomidine on stress response and immune balance in mechanical ventilation patients with acute respiratory distress syndrome / 中国基层医药

Objective@#To investigate the effect of dexmedetomidine on stress response and immune balance in patients with acute respiratory distress syndrome(ARDS) undergoing mechanical ventilation.@*Methods@#From March 2016 to September 2018, 90 ARDS patients with mechanical ventilation in Chongqing Three Gorges Center Hospital were randomly divided into dexmedetomidine group(D group, 30 cases), propofol group(P group, 30 cases), midazolam group(M group, 30 cases) by random number table method.Another 30 healthy workers in our hospital were selected as normal control group(C group). In M, P and D groups, the sedative drugs were infused by micro-pump on the basis of analgesic treatment(fentanyl citrate). The heart rate(HR), mean arterial pressure(MAP), Murray score, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, plasma norepinephrine(NS), plasma cortisol(Cor), and blood T lymphocyte subsets(CD4+, CD8+, CD4+/CD8+) were observed in all patients at T0(the beginning of sedation), T1 (6h after sedation), T2 (24h after sedation), T3(48h after sedation). The levels of NS and Cor in plasma and blood T lymphocyte subsets(CD4+, CD8+, CD4+/CD8+) in C group were measured at 8∶00 a. m.the next day.@*Results@#The plasma NS and Cor at T0 in M, P and D group were higher than those in C group (all P<0.05), while the levels of CD4+ were lower than those in C group(all P<0.05). Compared with T0, the plasma NS and Cor decreased at T3 in M, P and D group (all P<0.05). The plasma Cor at T3 in P group was lower than that in M group[(475.77±49.69)μg/L vs.(502.33±60.92)μg/L](t=-26.57, P<0.05). The plasma NS and Cor at T3 in D group were lower than those in M group[(20.64±4.70)ng/L vs.(25.29±4.03)ng/L, (442.83±66.59)μg/L vs.(502.33±60.92)μg/L](t=-4.51, -59.50, all P<0.05), and were lower than those of P group[(20.64±4.70)ng/L vs.(23.60±4.49)ng/L, (442.83±66.59)μg/L vs.(475.77±49.69)μg/L](t=-2.96, -32.93, all P<0.05). Compared with T0, the level of CD4+ decreased at T1, T2 and T3(except T3 in D group) in M, P and D group (all P<0.05), and the level of CD8+ decreased at T1, T2 and T3 in M and P group (all P<0.05), but those in D group at T1, T2 and T3 were not significantly decreased(all P>0.05). The levels of CD8+ at T2 and T3 in P and D groups were higher than that of M group (all P<0.05). The level of CD4+/CD8+ at T3 in D group were higher than that in M and P group[(1.46±0.30) vs.(1.26±0.33), (1.46±0.30) vs.(1.32±0.34)](t=0.21, 0.15, all P<0.05).@*Conclusion@#Sedation with dexmedetomidine or propofol can alleviate stress response and improve immune function in ARDS patients undergoing mechanical ventilation, and dexmedetomidine is better than propofol.

Effect of dexmedetomidine on stress response and immune balance in mechanical ventilation patients with acute respiratory distress syndrome / 中国基层医药

To investigate the effect of dexmedetomidine on stress response and immune balance in patients with acute respiratory distress syndrome ( ARDS) undergoing mechanical ventilation.Methods From March 2016 to September 2018,90 ARDS patients with mechanical ventilation in Chongqing Three Gorges Center Hospital were randomly divided into dexmedetomidine group (D group,30 cases),propofol group(P group,30 cases), midazolam group(M group,30 cases) by random number table method.Another 30 healthy workers in our hospital were selected as normal control group (C group).In M,P and D groups,the sedative drugs were infused by micro -pump on the basis of analgesic treatment ( fentanyl citrate ).The heart rate ( HR),mean arterial pressure ( MAP), Murray score,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score,plasma norepinephrine ( NS), plasma cortisol(Cor),and blood T lymphocyte subsets (CD+4 ,CD+8 ,CD+4 ／CD+8 ) were observed in all patients at T0 (the beginning of sedation),T1 (6h after sedation),T2 (24h after sedation),T3(48h after sedation).The levels of NS and Cor in plasma and blood T lymphocyte subsets (CD+4 ,CD+8 ,CD+4 ／CD+8 ) in C group were measured at 8:00 a.m.the next day.Results The plasma NS and Cor at T0 in M,P and D group were higher than those in C group (all P＜0.05),while the levels of CD +4 were lower than those in C group ( all P＜0.05).Compared with T0,the plasma NS and Cor decreased at T3 in M,P and D group (all P＜0.05).The plasma Cor at T3 in P group was lower than that in M group[(475.77 ±49.69)μg／L vs.(502.33 ±60.92) μg／L] (t＝-26.57,P＜0.05).The plasma NS and Cor at T3 in D group were lower than those in M group [(20.64 ±4.70) ng／L vs.(25.29 ±4.03) ng／L, (442.83 ±66.59) μg／L vs.(502.33 ±60.92) μg／L] ( t＝-4.51,-59.50,all P＜0.05),and were lower than those of P group [( 20.64 ±4.70) ng／L vs.( 23.60 ±4.49) ng／L, (442.83 ±66.59) μg／L vs.( 475.77 ± 49.69)μg／L](t＝-2.96,-32.93,all P＜0.05).Compared with T0,the level of CD +4 decreased at T1,T2 and T3 (except T3 in D group) in M,P and D group (all P＜0.05),and the level of CD +8 decreased at T1,T2 and T3 in M and P group (all P＜0.05),but those in D group at T1,T2 and T3 were not significantly decreased (all P＞0.05). The levels of CD +8 at T2 and T3 in P and D groups were higher than that of M group ( all P＜0.05).The level of CD+4 ／CD+8 at T3 in D group were higher than that in M and P group [(1.46 ±0.30) vs.(1.26 ±0.33),(1.46 ± 0.30) vs.(1.32 ±0.34)]( t＝0.21,0.15,all P＜0.05).Conclusion Sedation with dexmedetomidine or propofol can alleviate stress response and improve immune function in ARDS patients undergoing mechanical ventilation ,and dexmedetomidine is better than propofol.

Clinical analysis of multiple organ dysfunction syndrome in multiple trauma patients / 中国综合临床

Objective To investigate and analyze the risk factors,morbidity and mortality rates of multiple organ dysfunction syndrome (MODS) after multiple trauma.Methods The clinical data of all 155 patients with multiple trauma admitted to our ICU from Sep 2008 to Jun 2011 were retrospectively analyzed,including treatment,injury severity score (ISS) and its relationship with MODS.Results The morbidity of MODS among all 155 patients was 18.7％ (29/155).There were 3,7 and 19 patients died due to multiple trauma in 39 ISS ＜ 16,58 ISS 16-25,and 58 ISS ≥25 cases respectively.The morbidity of MODS was significantly higher in patients with ISS ≥25 ( x2 =12.321,P =0.002) than in others.There were 15 cases with MODS and 28 cases without MODS died respectively in multiple trauma patients ( x2 =10.236,P =0.001 ).Conclusion MODS is the important reason for death in multiple trauma patients.It is pivotal to actively deal with primary trauma to avoid the second insult to the patients and support vital organs early in order to improve the prognosis of multiple trauma.