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Objective:To correlate N-terminal pro-B-type natriuretic peptide (NT-proBNP) and heart type fatty acid binding protein (H-FABP) levels with the prognosis of patients with heart failure.Methods:Forty-nine patients with severe heart failure who received treatment in Tongde Hospital from December 2017 to June 2019 were included in the observation group. Forty-nine healthy subjects who concurrently received health examination were included in the control group. The heart function of the 49 patients was graded by the New York Heat Association (NYHA) classification. The levels of NT-proBNP and H-FABP were measured in different NYHA grades of patients and the healthy controls. The value of NT-proBNP and H-FABP levels in the diagnosis of heart failure was investigated and NT-proBNP and H-FABP levels were correlated with prognosis of heart failure.Results:In the observation group, NT-proBNP and H-FABP levels were (341.52 ± 12.74) pg/mL and (69.01 ± 11.45) ng/mL, respectively, which were significantly higher than (189.60 ± 12.73) pg/mL and (37.25 ± 11.44) ng/mL, respectively, in the control group ( t = 59.047 and 13.735, both P < 0.001). In patients with NYHA III grade severe heart failure, NT-proBNP and H-FABP levels were (295.62 ± 42.38) pg/mL and (75.09 ± 19.15) ng/mL, respectively, which were significantly higher than (120.43 ± 21.69) pg/mL and (21.76 ± 5.22) ng/mL, respectively in patients with NYHA I grade severe heart failure, (203.51 ± 42.77) pg/mL and (44.92 ± 10.85) ng/mL in patients with NYHA Ⅱ grade severe heart failure ( F = 55.100, 46.040, both P < 0.001). NT-proBNP and H-FABP levels in patients with NYHA I grade severe heart failure were significantly lower than those in patients with NYHA Ⅱ grade severe heart failure ( t = 7.231, 8.130, both P < 0.001). The sensitivity and accuracy of detecting NT-proBNP and H-FABP levels alone in the diagnosis of heart failure (76.92%, 78.85%, 84.69%, 86.73%) were significantly lower than those of detecting NT-proBNP and H-FABP levels in combination (98.08%, 97.96%, χ2 = 75.760, 10.913, both P < 0.001). NT-proBNP and H-FABP levels were positively correlated with the prognosis of heart failure ( r = 0.362, 0.611, both P < 0.05). Conclusion:NT-proBNP and H-FABP levels are positively correlated with the prognosis of severe heart failure in older adult patients. Detecting NT-proBNP and H-FABP levels in combination can increase the sensitivity and accuracy in the diagnosis of severe heart failure.
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Objective In critically ill elderly patients with "heat fecaloma with watery discharge", deficiency syndrome occupies its eighty to ninety percent, while "heat accumulation" occupies its ten to twenty percent; in fact, it is "dry feces accumulation stagnation and manure water side stream". Factors of Qi deficiency, blood deficiency, Yin deficiency, Yang deficiency, etc. are the main causes of dry stool accumulating in the intestine and manure water flows to side stream. The therapeutic principles of this disease should be removing stasis by purgation, in the mean time supplementing Qi and moistening intestine, or moisturizing dryness by nourishing blood, or supplementing Yin and increasing fluids, or warming yang for relaxing bowels in order to solve the root causes of the disease. The mechanism of heat fecaloma with watery discharge in critically ill elderly patients is different from that of general patients; clinically it is necessary to interrogate the disease history in detail, synthesize the four diagnostic methods, and differentiate manifestations from root cause, deficiency from sthenia, mildness from severity and amelioration from urgency. Casually using attack should be avoided, and aiming to treat its root cause is the proper therapeutic method.
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Objective To evaluate the effects of early and late tracbeostomy on patients with acute severe cerebral trauma.Methods In the retrospective study,167 patients with severe brain trauma ( GCS ＜ 9 ) requiring prolonged mechanical ventilation ( MV ) were managed by percutaneous dilational tracheostomy (PDT) from May 2001 to December 2010.According to the transoral incubation MV duration,the patients were divided into the early tracheostomy (ET) group ( MV duration≤7 d,81 cases)and late tracheostomy (LT) group (MV duration ＞ 7 d,86 cases).The basic clinical characteristics,pre-and post-PDT MV period,total MV duration,length of post-PDT ICU stay,length of ICU stay,length of hospital stay and mortality were compared between the two groups.Results The two groups showed no statistical differences in aspects of age,sex,acute physiology and chronic health evaluation Ⅱ (A-PACHE Ⅱ ) score,GCS,trauma index and craniotomy rate (P＞0.05).Compared with LT group,ET group significantly shortened the pre-PDT MV period [ (5.16 ± 1.33 ) d∶ ( 1 1.64 ± 4.25 ) d,P ＜ 0.01 ],post-PDT MV period ( median:15.0 d∶ 17.0 d,P ＜ 0.05 ),total MV duration ( median:18.0 d∶26.0 d,P＜0.05),length of post-PDT ICU stay (median:16.0 d∶21.0 d,P＜0.01 ) and length of ICU stay (median:21.0 d∶32.0 d,P ＜0.01 ).But the two groups had no statistical differences concerning the length of hospital stay ( P ＞ 0.05 ),ICU mortality ( 17％ ∶ 14％,P ＞ 0.05 ) and in-hospital mortality (25％∶28.4％,P ＞0.05).Kaplan-Meier curves showed that the frequency of MV and ICU stay rate within 60 days in ET group were significantly lower than those in LT group.Conclusions For patients with severe brain trauma,early tracheostomy shortens the duration of MV and length of ICU stay without affecting their prognosis.Thereby,tracheostomy can be performed at early stage when managing acute severe brain injury.