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Objective To explore the related factors of diarrhea onset in critically ill patients during early enteral nutrition (EEN). Methods Thirty Zhejiang Provincial Emergency Intensive Care Units (EICU) and ICU to implement EEN support for critically ill patients from July 2016 to August were enrolled, and the incidence of diarrhea within 1 week after EEN administration was observed. The patients were divided into a diarrhea group and a non-diarrhea group according to whether diarrhea occurred or not during EEN. The basic status data [sex, age, body mass index (BMI), albumin, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), nutritional risk screening (NRS2002), major disease diagnosis], and EN status (feeding route, infusion method, EN type, amount of EN on days 4 and 7), and clinical treatment (applying following treatments or not: mechanical ventilation and its duration, vasoactive drugs, gastrointestinal motility drugs, probiotics) and clinical outcomes (survival after discharge or not) were collected in two groups. Multivariate Logistic regression analysis was performed on the indexes with statistically significant differences obtained from the univariate analysis to screen out the relevant risk factors of occurrence of diarrhea in critically ill patients during EEN administration. The receiver operating characteristic curve (ROC) was drawn to analyze the predictive value of each risk factor for occurrence of diarrhea in critically ill patients with EN therapy. Results Of the 510 critically ill patients who underwent EEN, 156 had diarrhea, 70.5% (110/156) had diarrhea within 4 days of EEN, most diarrhea lasts for 3 days and most frequency of diarrhea was 3-4 times a day. The univariate analysis showed that the age of patients in the diarrhea group was significantly higher than that in the non-diarrhea group (years:69.42±17.94 vs. 65.76±17.69), the mechanical ventilation time and ICU hospitalization time were significantly longer than those of non-diarrhea group [mechanical ventilation time (days): 8 (5, 14) vs. 8 (4, 9), ICU hospitalization time (days): 11.5 (8.0, 19.0) vs. 9.0 (6.0, 14.0)], the proportion of probiotics used and the proportion of feeding by nasal tube were significantly higher than those of non-diarrhea group [proportion of probiotics: 26.9% (42/156) vs. 14.4% (51/354), proportion of nasal tube feeding: [26.9% (42/156) vs. 14.4% (51/354)]. Multivariate Logistic regression analysis showed that the use of probiotics was a protective factor for diarrhea during EEN in critically ill patients [odds ratio (OR) = 0.447, 95% confidence interval (95%CI) = 0.273-0.730, P = 0.001]. ROC analysis showed that the area under the curve (AUC) of probiotics predicting diarrhea was 0.598 (95%CI = 0.554-0.640), P < 0.001, sensitivity was 35.9%, and because AUC was less than 0.7, the accuracy and sensitivity of predicting diarrhea with probiotics was considered to be relatively poor. Conclusion The incidence of diarrhea is high in EEN in critical illness patients and its occurrence is related to various factors. The addition of probiotics can reduce the incidence of diarrhea.
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OBJECTIVE:To study the effects of etanercept combined with cyclophosphamide on related indexes of patients with rheumatoid arthritis complicated with interstitial pneumonia (RA-IP).METHODS:A total of 84 RA-IP patients were randomly divided into control group (42 cases) and observation group (42 cases).Control group was given Etanercept for injection 25 mg subcutaneously twice a day.Observation group was additionally given Cyclophosphamide tablets 50 mg orally,once a day,increasing by 50 mg every 7 d later,with maximum dose lower than 100 mg,for consecutive 2 weeks,2 weeks later repeated,on the basis of control group.Both groups were treated for 3 months.The number of joint tenderness and joint swelling,morning stiffness time,VAS score,DAS28 score,CRP,ESR,serum rheumatoid factor (RF),TNF-α,p (O2),VC,clinical score,imaging score,physiological score and the occurrence of ADR were observed in 2 groups before and after treatment.RESULTS:After treatment,the number of joint tenderness and joint swelling,morning stitffness time,VAS score,DAS28 score,the levels of CRP,ESR,RF and TNF-α,clinical score,imaging score,physiological score in 2 groups were significantly lower than before treatment;the observation group was significantly lower than control group.p(O2) and VC of 2 groups were significantly higher than before treatment,and the observation group was significantly higher than the control group,with statistical significance (P＜0.05).There was no statistical significance in the incidence of ADR between 2 groups (P＞0.05).CONCLUSIONS:Etanercept combined with cyclophophamide in the treatment of RA-IP can improve clinical symptom,signs,life quality and lung function without increasing the occurrence of ADR.
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Objective:To explore the efficacy of etanercept combined leflunomide to treat ankylosing spondylitis (AS) and its safety.Methods:90 cases with AS patients admitted in our hospital from June 2016 to January 2015 were selected.The patients were divided into observation group and control group by random number table method,45 cases in each group.Observation group was treated with etanercept combined with leflunomide,the control group were treated by leflunomide only.Morning stiffness time,AS activity index (BASDAI),AS measurement index (BASMI) were recorded before and after treatment in two groups,the total effective rate and adverse reaction were compared between the two groups.Results:After treatment,the BASDAI and morning stiffness time,BASMI of two groups of patients compared with before treatment were decreased,and the indexes above of the observation group were significantly lower than the control group,the difference was statistically significant (P＜0.05);The effective rate of the observation group was significantly higher than that of the control group,the difference was statistically significant (P＜0.05);During the course of treatment,the main adverse reactions occurred in patients with liver function damage,diarrhea and allergic skin rash,but there was no significant difference in the incidence of adverse reactions between the two groups (P＞0.05).Conclusion:Etanercept combined with leflunomide can obtain ideal effect,and low incidence rate of adverse reaction,it is worth popularizing in clinical use.