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Objective:To investigate the effects of respiratory mechanics-guided sedation strategy on diaphragm function in chronic obstructive pulmonary disease (COPD) patients treated with mechanical ventilation (MV).Methods:A prospective study was conducted. Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) received invasive MV who were admitted to the Affiliated Huxi Hospital of Jining Medical University from May 2020 to May 2021 were enrolled. The patients were divided into observational group and control group by random number table method. All patients were intubated for MV, and received bronchodilators, glucocorticoid, anti-infectives, expectorant, nutritional support, analgesia and sedation. The sedatives were dexmedetomidine combined with propofol, and the analgesics were sufentanil in both groups. Respiratory mechanics monitoring was performed every 6 hours in the observational group, and the depth of sedation was adjusted according to the parameters of respiratory mechanics: when airway resistance (Raw) > 20 cmH 2O·L -1·s -1, deep sedation was given to maintain Richmond agitation-sedation scale (RASS) ≤ -3; when the Raw was 10-20 cmH 2O·L -1·s -1, the initial depth of sedation maintained to reach the RASS score of -2-0; when Raw < 10 cmH 2O·L -1·s -1, withdrawn the sedation, or given light sedation, and maintained the RASS score of -2-0. While the control group received light sedation. The patients' diaphragmatic excursions (DE) was measured by bedside ultrasound, tidal volume (VT) and respiratory rate (RR) were recorded, and the diaphragmatic rapid shallow breathing index (D-RSBI, D-RSBI = RR/DE) and diaphragmatic excursion efficiency (DEE, DEE = VT/DE) were calculated. The differences in DE, D-RSBI, and DEE before and 3 days and 5 days of treatment between the two groups were compared. The difference in the RASS score within 3 days of sedation between the two groups was compared. The differences in the duration of MV and 28-day mortality between the two groups were compared. Results:A total of 96 patients were selected. Six patients were excluded due to delirium or the duration of MV shorter than 3 days. Finally, 90 patients were enrolled, with 46 in the observational group, and 44 in the control group. There were no statistically significant differences in DE, D-RSBI or DEE before treatment between the two groups. After treatment, D-RSBI in both groups was gradually decreased, and DEE was gradually increased with time. The D-RSBI at 3 days and 5 days of treatment in the observational group were significantly lower than those in the control group (times·min -1·mm -1: 1.73±0.48 vs. 1.96±0.35 at 3 days, 1.45±0.64 vs. 1.72±0.40 at 5 days, both P < 0.05), and DEE were significantly higher than those in the control group (mL/mm: 19.7±4.3 vs. 17.1±3.9 at 3 days, 25.8±5.6 vs. 22.9±5.4 at 5 days, both P < 0.05). There was no significant difference in DE at all time points between the two groups. The RASS scores within 2 hours of sedation in the observational group were significantly lower than those in the control group (1 day: -3.78±0.92 vs. -2.34±0.68, 2 days: -2.87±1.04 vs. -2.43±0.79, both P < 0.05), while no statistical difference at 3 days was found between the two groups. The duration of MV in the observational group was significantly shorter than that in the control group (days: 5.78±2.01 vs. 6.84±2.27, P < 0.05). One patient died in each of the control group and the observational group, and there was no significant difference in the 28-day mortality between the two groups (2.3% vs. 2.2%, P > 0.05). Conclusion:For AECOPD patients undergoing MV, respiratory mechanics-guided sedation strategy can reduce D-RSBI, increase DEE, shorten the duration of MV, and have a certain protective effect on the diaphragm.
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Objective To investigate the effect of high-flow nasal cannula oxygen therapy (HFNC) on the clinical efficacy and diaphragm function of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The patients with mild to moderate AECOPD (clinical classification Ⅰ-Ⅱ) admitted to Huxi Hospital Affiliated to Jining Medical College from January to October in 2018 were enrolled. The patients were divided into HFNC treatment group and routine oxygen therapy control group (each n = 37) by randomly number table method. The two groups were given bronchiectasis drugs, corticosteroids, expectorant, anti-infection treatment, at the same time, the HFNC treatment group was given HFNC with the initial flow rate of 40 L/min. The routine oxygen therapy control group was given low flow oxygen, and the initial flow rate was 3 L/min. General data such as gender, age, clinical grade, acute physiology and chronic health evaluationⅡ (APACHEⅡ) score were recorded. Bedside ultrasound was used to measure the diaphragmatic excursions during quiet breathing (DEq), diaphragmatic excursions during deep breathing (DEd), and diaphragmatic shallow fast breathing index (D-RSBI) before and 2, 24 and 48 hours after treatment in both groups and compared, meanwhile, arterial blood gas analysis was performed, and arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) were recorded. Results Two patients in the HFNC treatment group withdrew from the study because they could not tolerate HFNC, while other patients were enrolled in the analysis. There was no statistically significant difference in gender, age, proportion of AECOPDⅡ grade or APACHEⅡscore between the two groups, indicating that the general data of the two groups were comparable and balanced. There was no statistically significant difference in DEq, DEd, D-RSBI, PaO2 or PaCO2 before treatment between the two groups. After treatment, DEp in both groups was decreased gradually with time, it was decreased earlier in the HFNC treatment group, and it showed significant difference as compared with that before treatment at 2 hours after treatment (mm: 18.3±3.1 vs. 20.1±4.2, P < 0.01), and it was significantly lower than that in the routine oxygen therapy control group (mm: 18.3±3.1 vs. 20.3±3.7, P < 0.05); DEd was gradually increased in both groups, it was significantly increased in the HFNC treatment group, and it was significantly higher than that in the routine oxygen therapy control group at 24 hours and 48 hours after treatment (mm: 55.2±7.6 vs. 50.8±9.2 at 24 hours, 59.4±7.7 vs. 53.6±9.1 at 48 hours, both P < 0.05); D-RSBI was decreased gradually in both groups, it was decreased earlier and more significant in the HFNC treatment group, and it was significantly lower than that in routine oxygen therapy control group at 24 hours and 48 hours after treatment (times·min-1·mm-1: 0.41±0.13 vs. 0.51±0.20 at 24 hours, 0.31±0.12 vs. 0.43±0.17 at 48 hours, both P < 0.05). After treatment, there was no statistically significant difference in PaO2 or PaCO2 between the two groups. Conclusion HFNC can effectively relieve diaphragm fatigue in patients with mild to moderate AECOPD, but it had no effect on carbon dioxide retention.
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Objective To investigate the effect of early mobilization on diaphragmatic function in patients with mechanical ventilation (MV). Methods Sixty chronic obstructive pulmonary disease with acute exacerbation (AECOPD) patients with respiratory failure (RF) and underwent MV admitted to intensive care unit (ICU) of Huxi Affiliated Hospital of Jining Medical College from January 2016 to January 2017 were enrolled. The patients were divided into treatment group (n = 30) and control group (n = 30) by randomly number table method. The two groups were given analgesia, sedation, MV, antibiotics, nutritional support and other treatments. An implementation plan was developed based on the clinical practice of pain, irritability and delirium in adult patients (PAD) with ICU, while the treatment group was given early mobilization (such as joint activity, stand to the bed, 3 times a day). The diaphragmatic thickness at the end of expiration (DTee), diaphragmatic thickness at the end of inspiration (DTei) and diaphragmatic thickening fraction (DTF) were measured by bedside ultrasonography before and 24 hours, 48 hours, 3 days and 5 days after treatment respectively. Results There were no significant differences in the parameters of the diaphragm before treatment between the two groups. In the control group, DTee was gradually decreased at 5 days after treatment and was significantly lower than that before treatment (cm: 0.26±0.06 vs. 0.28±0.08, t = 3.045, 1 = 0.005). While there was no significant change in DTee in the treatment group. There was no significant difference in DTee between the two groups at different time points after treatment. DTei and DTF were significantly increased in the two groups after treatment, and reached the peak value at 48 hours; with the prolonged of MV time, DTei and DTF in the control group at 3 days and 5 days were significantly lower than those at 48 hours [DTei (cm): 0.35±0.07, 0.34±0.07 vs. 0.36±0.08; DTF: (29.29±11.01)%, (28.62±11.97)% vs. (32.48±15.63)%, all 1 < 0.01]; there were no significant changes in the treatment group. DTF in the treatment group at 3 days and 5 days was significantly higher than that in the control groups [(38.53±11.39)% vs. (29.29±11.01)%, (37.27±11.26)% vs. (28.62±11.97)%, both 1 < 0.01]. Conclusion MV can lead to diaphragmatic dysfunction, while early mobilization can delay diaphragmatic atrophy and systolic dysfunction in MV patients.
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Objective To investigate the effects of sequential blood purification on cardiac function in patients with acute organophosphorus pesticide poisoning (AOPP),and to analyze its application value.Methods Forty-five patients with severe AOPP and toxic myocarditis were researched and randomly divided into two groups.Sequential blood purification included hemoperfusion(HP) and continuous veno-venous hemofiltration (CVVH).In treatment group,23 patients were treated with HP + CVVH on the basis of the conventional therapy.Twenty-two patients of control group received the conventional therapy with HP.The differences of two groups on left ventricular ejection fraction (LVEF) and B-type natriuretic peptide (BNP) were compared before treatment and at 24,48 and 72 h after treatment.Results Before treatment,the levels of LVEF and BNP in treatment group were (47.7 ± 9.8)％ and (511.3 ± 285.3) ng/L,in control group were (47.3 ± 10.2)％ and (535.4 ± 303.9) ng/L,and there were no significant differences (P ＞ 0.05).The levels of LVEF at each time point after treatment in treatment group were significantly higher than those of control group:(52.7 ± 7.3) ％ vs.(47.8 ± 8.4)％,(55.2 ± 5.2)％ vs.(50.6 ± 7.1)％,(60.7 ± 6.3)％ vs.(53.3 ± 5.2)％,and the levels of BNP in treatment group were significantly lower than those of control group:(320.7 ± 181.8) ng/L vs.(496.7 ±268.9) ng/L,(252.7 ±113.8) ng/L vs.(384.3 ±167.5) ng/L,(122.4 ±66.7) ng/L vs.(294.8 ± 121.8) ng/L,there were significant differences between two groups (P＜ 0.05 or ＜ 0.01).In treatment group,the levels of LVEF at 24,48 and 72 h after treatment were significantly increased:(52.7 ± 7.3)％,(55.2 ± 5.2)％,(60.7 ± 6.3)％ vs.(47.7 ± 9.8)％,and the levels of BNP were significantly decreased:(320.7 ± 181.8),(252.7 ± 113.8),(122.4 ±66.7) ng/L vs.(511.3 ±285.3) ng/L,there were significant differences (P ＜ 0.01).In control group,the levels of LVEF and BNP at 24 h after treatment were (47.8 ± 8.4)％ and (496.7 ± 268.9) ng/L,before treatment were (47.3 ± 10.2)％ and (535.4 ± 303.9) ng/L,and there were no significant differences (P ＞ 0.05);the levels of LVEF at 48 and 72 h after treatment were significantly increased:(50.6 ± 7.1)％,(53.3 ± 5.2)％ vs.(47.3 ± 10.2)％,the levels of BNP were significantly decreased:(384.3 ± 167.5),(294.8 ± 121.8) ng/L vs.(535.4 ± 303.9) ng/L,and there were significantl differences (P ＜ 0.05 or ＜ 0.01).Conclusion Sequential blood purification treatment of AOPP can reduce myocardial injury and improve the cardiac function.
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Objective To explore the relationship between superior vena cava-jugular vein oxygen saturation-differential value (ScVO2-SjVO2) and injury severity and prognosis in patients suffered from severe traumatic brain injury,finding out the chnical value.Methods Forty-three patients with severe tranmatic brain injury were selected and divided into two groups according to Glasgow Coma Scale (GCS) score,19 cases were enrolled in GCS 3-5 scores group;24 cases in GCS 6-8 scores group;20 contemporaneous cases in control group had conscious and without traumatic brain injury.The changes of ScVO2-SjVO2 at 0,12,24,48 h after admission of ICU among the groups were observed.In addition according to the degree of change in ScVO2-SjVO2,12 cases were enrolled in ScVO2-SjVO2 ＜ 0.05 group;14 cases in ScVO2-SjVO2 0.05-0.15 group; 17 cases in ScVO2-SjVO2 ＞ 0.15 group.The GCS score and mortality rate in patients after brain injury 28 d among groups were observed.Results GCS 3-5 scores group compared with control group,ScVO2-SjVO2 reduced significantly at 0,12,24,48 h after admission of ICU (-0.071 ±0.032 vs.0.093 ±0.049,-0.097 ±0.052 vs.0.081 ±0.052,-0.035 ±0.031 vs.0.089 ± 0.059,0.036 ± 0.033 vs.0.081 ± 0.064),there were significant differences (P ＜ 0.01).GCS 6-8 scores group compared with control group,ScVO2-SjVO2 dramatically increased at 0,12,24 h after admission of ICU(0.173 ± 0.043,0.158 ± 0.067,0.123 ± 0.073),there were significant differences (P ＜ 0.01 or ＜ 0.05).ScVO2-SjVO2 ＜0.05 group and ScVO2-SjVO2 ＞0.15 group compared with ScVO2-SjVO2 0.05-0.15group,the mortality rate significantly increased,the mortality rate were 8/12,4/17,1/14,respectively,there were significant differences (P ＜0.01).ScVO2-SjVO2 ＜0.05 group and ScVO2-SjVO2 ＞0.15 group compared with ScVO2-SjVO2 0.05-0.15 group,GCS score decreased significantly[(4.17 ± 1.34),(5.88 ±1.35) scores vs.(6.86 ± 1.35) scores],and there was significant difference (P ＜0.01 or ＜0.05).Conclusions When ScVO2-SjVO2 ＜ 0.05,the difference is negatively related to the deg~e of brain injury.When ScVO2-SjVO2 ＞0.15,the difference is positively related to the degree of brain injury;ScVO2-SjVO2 can assess injury severity objectively in patients who suffered from severe traumatic brain injury,and it also expresses the rate of cerebral oxygen metabolism.It can provide a basis for treatment accurately and timely,and judgment prognosis.
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Objective To investigate the effects of β-blockers on cardiac protection and hemodynamic in patients with septic shock. Methods A prospective randomized controlled trial was conducted. Forty-one patients with septic shock in accordance with early goal directed treatment and met the target within 6 hours,and admitted to intensive care unit (ICU)of Affiliated Huxi Hospital of Jining Medical College from January 2012 to January 2014 were enrolled. The patients were divided into treatment group (n=21)and control group (n=20)by random number table. The patients in both groups were given the standard treatment,esmolol was giving to patients in treatment group in order to control the heart rate (HR)below 100 bpm within 2 hours,and the patients in control group only received standard treatment. The changes in hemodynamic parameters〔mean arterial pressure(MAP),central venous pressure(CVP), HR,cardiac index(CI),stroke volume index(SVI),systemic vascular resistance(SVRI),global end diastolic volume index(GEDVI)〕,biochemistry metabolic of tissue〔central venous oxygen saturation(ScvO2),lactic acid(Lac)〕,and cardiac markers 〔troponin I (cTnI)〕before and 12,24,48,72 hours after the treatment were recorded. Results①Before treatment,the hemodynamic parameters,tissue metabolism index and cTnI had no significant differences in both groups (all P>0.05).②The hemodynamic parameters after treatment in the control group showed no significant difference compared with that before treatment. HR and CI in the treatment group were gradually declined after treatment,SVRI and GEDVI were gradually increased. There were significant differences in HR,CI,SVRI,and GEDVI between treatment group and control group from 12 hours on〔HR(bpm):93±4 vs. 118±13,CI (L·min-1·m-2):3.3 ±0.8 vs. 4.5 ±0.6,SVRI (kPa·s·L-1·m-2):159.2 ±27.4 vs. 130.5 ±24.2,GEDVI(mL/m2):668 ±148 vs. 588 ±103,P0.05). The ScvO2 was not decreased in both groups.④Compared with before treatment,cTnI in the control group was gradually increased,peaked at 72 hours,and that in the treatment group was gradually increased,peaked at 24 hours and then gradually declined. Compared with control group,the cTnI (μg/L)in the treatment group was decreased significantly at 24,48,72 hours (1.15 ±0.57 vs. 1.74 ±0.77,0.93 ±0.52 vs. 2.15 ±1.23,0.52 ±0.36 vs. 2.39 ±1.17,all P<0.01). Conclusionsβ-blockers (esmolol) can improve cardiac function and myocardial compliance,reduce the myocardial injury in patients with sepsis shock. Although β-blockers can decrease cardiac output,it has no influence on the circulation function and tissue perfusion.
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ObjectiveTo investigate the changes of serum creatine kinase isoenzyme (CK-MB) and creatine kinase (CK) ratio(CK-MB/CK) and cardiac troponin I(cTnI) simultaneously in patients with acute organophosphorus pesticide poisoning (AOPP) and the clinical value in disease condition judgment.Methods Eight hundred and sixty-eight AOPP patients without disease history of heart,lung,brain,kidney,muscle and other connective tissue were extracted 4 ml of fasting venous blood to determine CK,CK-MB and cTnI simultaneously at 2,12,24,48,96 and 120 hours after poisoning,and the CK-MB/CK was calculated.There were 279 mild poisoning cases (mild poisoning group),289 moderate poisoning cases (moderate poisoning group) and 300 severe poisoning group (severe poisoning group) ; and 208 cases with intermediate myasthenia syndrome (IMS)(IMS group) and 660 cases without IMS (non-IMS group).The result was compared with 288 healthy people (control group) in the same period.Results ( 1 ) The CK,CK-MB and cTnI of mild,moderate and severe poisoning groups between 2 to 12 h,13 to 24 h,25 to 120 h after poisoning were significandy higher than those in control group,CK-MB/CK was obviously lower (P ＜ 0.01 ).The CK,CK-MB,cTnI and CK-MB/CK had significant differences between each two of mild,moderate and severe poisoning groups (P＜ 0.01 or ＜ 0.05).The CK,CK-MB and cTnI of IMS group in 2 to120 h after poisoning were significantly higher than those in non-IMS group,and CK-MB/CK was lower (P ＜ 0.05 or ＜ 0.01 ).In IMS group,the rates of sudden cardiac death (SCD) and multiple organ dysfunction syndrome (MODS) were 23.08％(48/208),37.50％(78/208) respectively,while 4.24％(28/660),9.85％(65/660) in non-IMS group.The incidence of SCD and MODS of two groups had statistical significance (P ＜ 0.01 ).(2) According to IMS and non-IMS group,discriminant equation with independent variables of cTnI (X1), CK (X2) and CK-MB/CK (X3) was established:Y =-0.0014X1 + 0.0225X2 + 65.2376X3,F=21.4911,P ＜ 0.01.The discriminant critical value(Y0) was 2.8124.If Y ＜ 2.8124 belonged to IMS group and Y ≥2.8124 was in non-IMS group,the contribution rates of X1,X2 and X3 were 34.5％,25.4％ and 40.1％ respectively.The coincident rate of return was 91.26％.ConclusionsCK-MB/CK change has negative correlation with poisoning degree of AOPP;cTnI level is positively correlated with AOPP poisoning degree.they may be used to assist the clinical classification,disease judgement and to guide the emergency,treatment and prognosis assessment of AOPP.The function equation with cTnI,CK and CK-MB/CK can be used as effective prediction indexes of IMS,MODS and SCD in early period.
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Objective To investigate the effects of application and clinical value of the epinephrine with graduate increased dosage by the modality equation G=(K+2n-1)mg/3 min(K=1,2,n=1,2,3……,G≤0.2 mg/kg)and aminophylline and sheng-mai injection with uniform method at the same time rapidly combination on cardiopulmonary resuscitation (CPR).MethodsThree hundred and twenty-eight cases with sudden cardiac-arrest (CA) were randomly divided into 3 groups：112 cases with the standard-dose epinephrine group (SDE control group);106 cases with the first-dosage epinephrine for K=1 mg in the equation G=(K+2n-1)mg/3min (K=1,2,n=1,2,3……,G≤0.2 mg/kg,group (equation 1 group) and 110 cases with the first-dosage epinephrine for K=2mg(epuation 2 group).Patients'electrocardiogram and mean arterial pressure(MAP)and the heart rate(HR)and the time of recovery of spontaneous circulation (ROSC)were monitored,and the resuscitation effect were evaluated.ResultsTo compare the equation 2 group and equation 1 group with the SDE control group,the ROSC rate,the survival rate,the 24-hour survival rate and the scoring by Glasgow coma scale were all significantly elevated(P＜0.01)：but the average time from initial stage applied with the epinephrine in the CPR to ROSC in the equation 2 group and equation 1 group was much shorten significantly than that in the SDE control group(P＜0.01).To compare the equation 2 group and equation 1 group with the SDE control group：the average dose of the epinephrine was much reduced from initial stage applied with the epinephrine on CPR to ROSC(P＜0.05),but the cycle summation of apphcation epinephrine by mainline from the CPR initial stage to ROSC in the equation 2 group and equation 1 group was much significantly decreased than that in the SDE control group(P＜0.01).ConclusionsThe method of the epinephrine with graduate increased dosage by the equation G=(K+2n-1) mg/3min(K=1,2,n=1,2,3……,C≤0.2mg/kg)and aminophylline and sheng-mai injection with uniform method at the same time rapidly combination on CPR has better effects on increasing significandy the success rate of CPR,the survival rate,the time activity of success and shortening significantly time of the ROSC,improving brain and nervous system function.It can be new and effective method to increasing the success rate of resuscitation on the CPR.