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The therapeutic effects of intensive insulin therapy in treatment of traumatic shock combined with multiple organ dysfunction syndrome (MODS) were investigated. A total of 114 patients with traumatic shock combined with MODS were randomly divided into two groups: control group (n=56) treated with conventional therapy, and intensive insulin therapy group (n=58) treated with conventional therapy plus continuous insulin pumping to control the blood glucose level at range of 4.4-6.1 mmol/L. White blood cells (WBC) counts, prothrombin time (PT), serum creatinine (SCr), alanine aminotransferase (ALT), serum albumin and PaO(2) were measured before and at the day 1, 3, 5, 7 and 14 after treatment. The incidence of gastrointestinal dysfunction, the incidence of MODS, hospital stay and the mortality were also observed and compared. After intensive insulin therapy, the WBC counts, SCr, ALT and PT were significantly reduced (P<0.05), but the level of serum albumin was significantly increased (P<0.05) at the day 3, 5, 7 and 14. In the meantime, the PaO2 was significantly elevated at the day 3, 5 and 7 (P<0.01) after intensive insulin therapy. The incidence of gastrointestinal dysfunction, the incidence of MODS, the length of hospital stay and the mortality were markedly decreased (P<0.01). The results suggest early treatment with intensive insulin therapy is effective for traumatic shock combined with MODS and can decrease the length of hospital stay and the mortality.
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The purpose of this study was to investigate bacterial translocation and change in intestinal permeability in patients after abdominal surgery. Sixty-three patients undergoing elective abdominal surgery were enrolled in the study. Blood samples were collected prior to operation and 2, 24, 48 h after surgery for bacterial culture, microbial DNA extraction, plasma D-lactate and endotoxin measurement. PCR analysis was performed after DNA extraction, with beta-lactosidase gene of E. coli and 16S rRNA gene as target genes. All patients were observed for a period of 30 days for infectious complications. Our results showed that no bacterial DNA was detected before surgery, but after operation it was found in 12 patients (19.0%). Bacterial DNA was detected in 41.7% (10/24) of SIRS patients and 5.1% (2/39) of non-SIRS patients (P<0.01). About 83.3% of PCR-positive patients developed systemic inflammatory response syndrome (SIRS), but only 27.5% of PCR-negative patients did so (P<0.01). Two thirds of PCR-positive patients developed infectious complications, while none of PCR-negative patients did (P<0.01). The blood culture was positive only in 3 patients (4.8%), who were all PCR-positive. E. coli DNA was found in 66.7% of the PCR-positive patients. The plasma levels of D-lactate and endotoxin were elevated significantly 2, 24 and 48 h after operation in PCR-positive patients, with a significant positive correlation found between them (r=0.91, P<0.01). It is concluded that increased intestinal permeability was closely related with bacterial translocation. Intestinal bacterial translocation (most commonly E. coli) might occur at early stage (2 h) after abdominal surgery. Postoperative SIRS and infection might bear a close relationship with bacterial translocation.
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Objective To investigate the effects of tension free herniorrhaphy on endocrine functions of patients with inguinal hernia. Methods One hundred and twenty seven patients were randomly divided into tension free group( n =65) and conventional group ( n =62). The mean ages of tension free group and conventional group were(51.8?14) year and(48.4?12) year respectively. There were 52 indirect hernias and 13 direct hernias in tension free group. There were 51 indirect hernias and 11 direct hernias in conventional group. Bassini repair was used in conventional group. Peripheral blood samples were obtained preoperatively and 3 h, 24 h after operation for measuring the levels of cortisol, T3, TSH, insuline, C peptide and and glucose. The data were analysed through t test. Results The levels of cortisol, C peptide and glucose in conventional group were remarkably higher ( P
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ObjectiveTo evaluate the value of tensionfree herniorrhaphy for inguinal hernia. Methods(1)Comparison was made in operating time, early postoperative response, hospitalization time, postoperative complications and recurrence rate between the two herniorrhaphy groups.In tensionfree herniorrhaphy group( n=137),hernias were repaired with polypropylene mesh plug or mesh patch.(2)In conventional herniorrhaphy group (n=98 ) ,hernias were repaired with Bassini operation. Mean Follow up time was 22 month in the 2 groups. Results The operating time, analgesic use, early response and hospitaliz ation time in tensionfree herniorrhaphy group were significantly lower than those in conventional herniorrhaphy group(P
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Objective To investigate gut barrier dysfunction and bacterial translocation (BT) from gastrointestinal tract in postoperative patients using polymerase chain reaction (PCR) and plasma D-lactate measurement, and to study the relationship between BT and infections complications. Methods 34 patients undergoing selective gastrointestinal operations were observed. Blood samples were collected prior to and 2, 24, 48 h after surgery for bacterial culture, plasma D-lactate, and LPS measurement. PCR was used to detect microbial DNA. PCR was performed after DNA extraction, with target ?-lactosidase gene of E. coli and 16S rRNA gene of most pathogenic bacteria. All the patients were observed for 30 days for monitoring infectious complications. Results No bacterial DNA was detected before surgery, but it was positive in 7 patients (20.6%) after operation. Bacterial DNA was discovered in 38.9% (7/18) of SIRS (systemic inflammatory response syndrome) patients, no bacterial DNA was detected in the 16 non-SIRS patients (P
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ObjectiveTo investigate the hemodynamic changes after multiple firearm injuries in a swine model. Methods Twelve pigs were divided into 2 groups randomly, with control group ( n =6) subjected to catheterization only. Multiple trauma group ( n =6) was subjected to tangential fracture of parietal bone and comminuted fractures of bilateral femora (ISS≥16) using 5 8 mm bullets. The hemodynamic changes, including MAP, PAP, PAWP, CO, SVRI and portal vein blood flow, were observed at different time intervals up to 72 h after trauma or catheterization. At the same time, gastric pHi was measured as well. Results Compared with control group pigs in multiple trauma group suffered a hyperdynamic circulation developed at 48～72 hours. The cardiac output rose and vascular resistance declined obviously. The pulmonary artery pressure and pulmonary capillary wedge pressure elevated significantly. Mean artery pressure, portal vein blood flow and gastric pHi declined significantly. Conclusion Without severe blood loss and hemorrhagic shock, the decrease of portal vein blood flow and viscera underperfusion still took place after multiple firearm injuries.
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Objective To observe the changes in gut mucosal barrier and gut-origin bacteria-endotoxin translocation in acute necrotizing pancreatitis (ANP) rats. Methods Wistar rats were divided randomly into normal group (n=6), sham operation group (n=30) and ANP group (n=39). ANP was introduced by infusion of artificial bile into biliopancreatic duct. Morphology of pancreas and intestine were observed and tight junction on ileum epithelia were assessed by cryofracture replicas electroscopy. Plasma levels of D-lactic acid and endotoxin were examined at various time points. The rates of bacterial translocation to abdominal organs were also calculated. Results Mucosal and tight junction damages of the gut were found during early stage of ANP. Simultaneously, plasma D-lactate levels increased and endotoxemia occurred. The rate of bacterial translocation to organs was 59.5% 72h after ANP occurred. Conclusions Gut barrier function can be injured in the early stage of ANP, and resulting in gut origin bacteria-endotoxin translocation, which may be the originator of systemic inflammatory reaction and secondary infection of the pancreas.
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OBJECTIVE To evaluate the safety and clinical efficacy of cefoperazone/sulbactam in the treatment of biliary tract infections.METHODS In this prospective multicenter study,159 hospitalized patients with biliary tract infections received cefoperazone/sulbactam,and the clinical and bacteriological efficacy as well as the side effects were evaluated.RESULTS The clinical effective rate of cefoperazone/sulbactam in the treatment of biliary tract infections was 86.78%.After treatment,the body temperature reduced to normal rapidly,the average time of defervescence was 3.09?1.81 days.Pathogen eradication rate was 85.71%.No adverse reactions were reported during the study period.CONCLUSIONS Cefoperazone/sulbactam can be used as one of antibiotics of choice in the initial empirical therapy for biliary tract infections.
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Objective To study the effect and mechanism of intensive insulin therapy on stress hyperglycemia in rabbits with sepsis. Methods Rabbits were subjected to cecal ligation plus puncture (CLP) to reproduce sepsis. Sixty rabbits were randomly divided into three groups, control group (n=12), CLP group, and intensive insulin therapy group (n=24). The following parameters were measured with the method indicated in parentheses: blood glucose (blood sugar meter), glucose transporter 4 (GluT4) mRNA expression (RT-PCR), GluT4 protein level (Western blot). Results Compare with the control group, the level of blood glucose was significantly increased at 2h after CLP and reached its peak 12h after CLP (P
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Objective To determine the kinetic changes of plasma D-lactate and endotoxin levels in patients after intraperitoneal operations. Methods Blood samples of 63 patients undergoing selective laparotomy were collected 0, 2, 24 and 48h after surgery. According to various criteria, the patients were divided into two groups respectively, i.e. extensive operation or medium sized operation,involvement of gastrointestinal (GI) tract or non-involvement GI tract, and development of symptoms of SIRS or no SIRS after operation. Plasma levels of D-lactate and endotoxin in systemic circulation were determined. Results The analytical data showed that the plasma levels of D-lactate and endotoxin were elevated significantly at 2, 24 and 48h post laparotomy in SIRS patients and major surgery group, and there was also a significant correlation between the plasma levels of D-lactate and endotoxin(?=0.91,P