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Objective:To investigate the clinical characteristics and prognosis of secondary hemophagocytic syndrome (HPS) in adults.Methods:The clinical data of 43 adult patients with primary secondary HPS in Mianyang Central Hospital of Sichuan Province from January 2014 to June 2020 were retrospectively analyzed. The patient's clinical manifestations and biochemical indicators were summarized. The clinical characteristics of patients between high-level ferritin (≥5 000 μg/L) group and low-level ferritin (<5 000 μg/L) group, lymphoma-related HPS group and infection-related HPS group were compared. Logistic regression model was used for multivariate survival analysis.Results:All patients had fever as the main complaint, and infections were manifested at the onset or during treatment. In all patients, 88.4% (38/43) had hemophagocytosis in the bone marrow; 88.4% (38/43) had varying degrees of cytopenia; 36.6% (15/41) had reduced fibrinogen [median value 0.93 g/L (0.50-1.35 g/L)]; 76.7% (33/43) had elevated aminotransferase. Compared with the low-level ferritin group (19 cases), the high-level group (21 cases) had a lower proportion of monocytes (0.081±0.040 vs. 0.163±0.076, P = 0.016), the incidence of fibrinogen reduction and the incidence of aminotransferase elevation were high [60.0% (12/20) vs. 11.1% (2/18), P = 0.002; 95.2% (20/21) vs. 52.6% (10/19), P = 0.006]. Compared with infection-related HPS patients, lymphoma-related HPS patients had a higher incidence of lymphadenopathy [72.7% (16/22) vs. 27.8% (5/18), χ2 = 8.021, P = 0.005] and a lower incidence of aminotransferase elevation [59.1% (13/22) vs. 94.4% (17/18), χ2 = 4.848, P = 0.028]. Multivariate analysis showed that the high proportion of neutrophils ( OR = 0.886, 95% CI 0.786-0.998, P = 0.046) and high-level albumin ( OR = 0.376, 95% CI 0.156-0.907, P = 0.030) after treatment were protective factors for survival of patients. Conclusions:Among adult patients with primary secondary HPS, the proportion of monocytes in patients with ferritin ≥5 000 μg/L is low, and liver damage and fibrinogen reduction are more likely to occur. Lymphoma-related HPS patients are more likely to have lymphadenopathy, and infection-related HPS patients are more likely to have liver damage. After treatment, a low proportion of neutrophils and hypoproteinemia indicate a poor prognosis in adult patients with secondary HPS.
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Objective To evaluate the effects of dexmedetomidine combined with subanesthetic dose of ketamine on the emergence agitation in the patients undergoing thoracotomy.Methods Eighty ASA physical status Ⅱ or Ⅲ patients,aged 55-75 yr,weighing 50-75 kg,scheduled for elective esophageal cancer resection,were randomly divided into 4 groups (n =20 each) using a random number table:normal saline group (NS group),dexmedetomidine group (group D),subanesthetic dose of ketamine group (group K),and dexmedetomidine combined with ketamine group (group DK).In DK and K groups,ketamine 0.5 mg/kg was injected intravenously (within 1 min) at 10 min before the end of the operation.In DK and D groups,dexmedetomidine 0.5 μg/kg was infused intravenously over 10 min starting from 10 min before the end of operation.In group NS,the equal volume of normal saline was infused intravenously over 10 min starting from l0 min before the end of operation.The emergence time,extubation time,duration of ICU stay,occurrence and degree of agitation,and development of cardiovascular events and hypoxemia within 24 h after operation were recorded.Ramsay sedation scores were recorded before induction of anesthesia (T1),immediately after completion of administration at the end of surgery (T2),and at 0,5,10 and 30 min after extubation (T3-6).Results There was no significant difference in the emergence time,extubation time,and duration of ICU stay between the four groups.Compared with group NS,Ramsay sedation scores were significantly increased at T3-6,the incidence and degree of agitation were decreased,and the incidence of cardiovascular events and hyoxemia was decreased in D,K and DK groups.Compared with D or K group,Ramsay sedation scores were significantly increased at T3-6,the incidence and degree of agitation were decreased,and the incidence of cardiovascular events and hyoxemia was decreased in group DK.Conclusion Dexmedetomidine combined with subanesthetic dose of ketamine can prevent the emergence agitation in the patients undergoing thoracotomy,which provides better efficacy than either alone.
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Objective To evaluate the effects of sub anesthetic dose of ketamine combined with sufentanil on postoperative patient-controlled intravenous analgesia (PCIA)in patients undergoing radical resection of esophageal cancer.Methods Ninety patients,ASAⅠorⅡ,aged 55-75 years old,se-lected for radical resection of esophageal cancer were randomly divided into three groups:group S1,group S2,group SK,30 patients in each group were treated with PCIA.Group S1,2 μg/kg sufentanyl;group S2,2.5 μg/kg sufentanyl;group SK 2 μg/kg sufentanyl+90 μg·kg-1·h-1 ketamine.6 mg of granisetron was added to each group,and then diluted into 100 ml of normal saline.All patients were administered load-ing doses of 5 ml analgesics 30 min before the end of the operation.The VAS score,Ramsay sedation score, SBP,DBP,HR,SpO2 and adverse effects were recorded respectively at 4,8,24 and 48 hours after opera-tion.The total times of pressing PCIA were also recorded in 48 h after operation.Results There was no statistically significant difference in Ramsay sedation score,SBP,DBP,HR and SpO2 at 4,8,24,48 hours after operation in the three groups.Compared with group S1,the VAS score and total number of pressing PCIA times in groups SK and S2 were significantly lower in 48 h after operation (P <0.05).Compared with group S2,VAS score and the total number of pressing PCIA times in group SK were significantly de-creased in 48 h after operation (P <0.05).Two patients from group SK occurred respiratory depression 48 h after operation.There was no statistically significant difference in incidence of adverse effects in the three groups.Conclusion Sub anesthetic dose of ketamine combined with sufentanil on PCIA can reduce postoper-ative sufentanil consumption and significantly relieve the postoperative pain in patients undergoing radical re-section of esophageal cancer.The analgesic effect is better than using sufentanil alone.
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Objective To observe the renal expression of cyclooxygenase-2(COX-2) in diabetic nephropathy rats and the effects of Losartan as angiotensin II type 1(AT1) receptor antagonist.Methods Twenty-eight diabetic Sprague-Dawley(SD) rats induced with intraperitoneal injection of streptozotocin were randomly divided into two groups: diabetic rats without therapy(group D,n=14) and diabetic rats treated with Losartan(group L,n=14).Twenty SD rats were used as the control(group N).The urine and blood samples in 24h were collected after the treatment with Losartan for 10 weeks.The rats were killed and the renal expression of COX-2 was determined with immunohistochemistry.Results Expression of COX-2 in the nephridial tissue and the concentration of urinary thromboxane B_2(TXB_2) in group D were significantly higher than those in group N(P