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Objective To observe the effect of different fluid resuscitation strategies on respiratory mechanics and oxygena-tion in the patients with septic shock .Methods The treatment data in 125 patients with septic shock in ICU of this hospital were retrospectively investigated and analyzed .The patients were divided into the restriction fluid resuscitation group (n=58) and open fluid resuscitation (n=67) according to fluid resuscitation results .The changes of respiratory mechanics (static lung compliance ,in-spiratory resistance) and oxygenation before and after resuscitation were compared between the two groups .Meanwhile the hemo-dynamics and vasoactive drugs application were recorded in the two groups .Results The hemodynamic indicators had no statistical difference between the two groups .The use amounts and use time of vasoactive drugs in the open fluid resuscitation group were less than those in the restriction fluid resuscitation group (P<0 .01);the airway resistance in the two groups had no obvious change be-tween before and after resuscitation ,the lung compliance and oxygenation in the restriction fluid resuscitation group were superior to those in the open fluid resuscitation group (P<0 .01) .With the fluid resuscitation amount increase ,the lung compliance in the re-striction fluid resuscitation group and open fluid resuscitation group were progressively poorer ,which was especially obvious in the open fluid resuscitation group(P<0 .01);the amount of fluid resuscitation was negatively correlated with the lung compliance and oxygenation (R= -0 .783、-0 .860 ,P<0 .01) .Conclusion In treating septic shock ,although the open resuscitation strategy has smaller dose and use time of vasoactive drugs ,but the lung compliance and oxygenation are affected ,while the restriction fluid re-suscitation strategy is in contrast .
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Objective To explore the effect of high positive end-expiratory pressure (PEEP) for the treatment of neurological pulmonary edema (NPE) in patients undergoing mechanical ventilation,and to look for the best mechanical ventilation strategy to improve the prognosis.Methods A prospective study was conducted,and 120 patients with NEP admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Guangxi Traditional Chinese Medical University from January 2010 to August 2013 were enrolled and divided into two groups according to random number table (n=60 in each group).The patients in two groups were given empiric treatment for the disease,and they underwent mechanical ventilation.In the normal PEEP group PEEP was 3-10 cmH2O (1 cmH2O =0.098 kPa),and in the high PEEP group PEEP was 11-30 cmH2O,and all the rest parameters were the same.Clinical indices before and 7 days after treatment,and 28-day morality rate were compared between two groups.Results The 28-day morality rate in high PEEP group was obviously lower than that in the normal PEEP group [25.0％ (15/60) vs.65.0％ (39/60),x2=6.465,P=0.011].The clinical signs in both groups were improved after treatment.Compared with the normal PEEP group,the clinical indices in high PEEP group were more significantly improved.There were significant differences in body temperature (℃ 37.4 ± 0.5 vs.38.5 ± 0.6),respiratory rate (times/min 18.3 ± 3.1 vs.23.3 ±3.5),heart rate (beats/min 94.7 ±8.5 vs.113.5 ±8.0),white blood cell count [WBC (× 109/L) 12.5 ±2.1 vs.17.1 ± 1.7],acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (15.6 ± 3.2 vs.19.8 ± 3.7),Glasgow coma score (GCS 12.5 ± 2.1 vs.8.5 ± 2.9),gastrointestinal dysfunction score (3.9 ± 3.0 vs.3.6 ± 2.4),oxygenation index [PaO2/FiO2 (mmHg,1 mmHg=0.133 kPa) 196.5 ± 45.1 vs.134.1 ± 22.3],serum creatinine [SCr (μmol/L) 86.5 ± 35.6 vs.98.5 ± 37.7],total bilirubin [TBil (μmol/L) 39.7 ± 23.5 vs.41.5 ± 16.2],C-reacting protein [CRP (mmol/L) 53.7 ± 21.4 vs.108.4 ± 26.3],prothrombin time [PT (s) 15.0 ± 2.1 vs.20.4 ± 2.2],activated partial thromboplastin time [APTT (s):37.3 ±4.9 vs.56.7 ± 13.6],international normalized ratio (INR 2.52 ±0.64 vs.4.01 ±0.77),extra vascular lung water index [EVLWI (mL/kg) 7.53 ± 1.21 vs.15.85 ±3.41],pulmonary vascular permeability index (PVPI 6.07 ± 0.89 vs.9.47 ± 1.26),mean arterial pressure [MAP (mmHg) 87.3 ± 10.9 vs.98.7 ± 13.6],cardiac output [CO (L/min) 7.15 ± 1.42 vs.5.65 ± 1.82],systemic vascular resistance index [SVRI (KP) 112.4 ± 9.5 vs.136.5 ± 11.9],and blood lactate (mmol/L:2.53 ± 1.23 vs.5.81 ± 2.17) between high PEEP group and normal PEEP group (P＜0.05 or P＜0.01).Conclusion Prognosis can be improved in NPE patients with the use of high PEEP in mechanical ventilation.
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Objective To study the value of prealbumin(PAB) ,C reactive protein(CRP) and apolipoprotein A1(Apo A1) in e-valuating the prognosis of patients with severe pneumonia .Methods 63 cases of patients with severe pneumonia were selected ,and the fasting serum level of prealbumin ,C-reactive protein and apolipoprotein A1 were detected in 24 hours at the admission day ,and APACHE Ⅱ score was calcumulated .The patients were divided into group A (APACHEⅡscore <20) and group B(APACHEⅡscore≥20) ,with the incidence of MODS and mortality rate compared .The patients were divided into non-MODS group and MODS group .In addition ,the patients were divided into survival group and death group according to the prognosis .PAB ,CRP and Apo A1 in each group were compared .Results The incidence of MODS and mortality rate in group B (57 .9% ,47 .4% ) were higher than that in group A(24 .0% ,16 .0% )(P<0 .01 ,P<0 .05) .PAB and Apo A1 of patients in MODS group[(134 .13 ± 36 .20)mg/L , (0 .62 ± 0 .21)g/L] and death group[(129 .05 ± 52 .24)mg/L ,(0 .76 ± 0 .29)g/L] were respectively lower than that in non-MODS group[(215 .03 ± 72 .08)mg/L ,(1 .06 ± 0 .39)g/L] and survival group[(185 .52 ± 57 .63)mg/L ,(1 .15 ± 0 .36)g/L](P<0 .05) , while the CRP in MODS group(102 .37 ± 35 .65)mg/L and death group(96 .37 ± 34 .72)mg/L were higher than that in non-MODS group(69 .68 ± 32 .92)mg/L and survival group(62 .94 ± 38 .36)mg/L (P<0 .05) .Conclusion The measurement of PAB ,CRP and Apo A1 are valuable to evaluate the prognosis of the patients with severe pneumonia .
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Objective To study the clinical effects of Ditan Xingnao Chengqi soup for treatment of patients with sepsis brain dysfunction. Methods Sixty-two cases of sepsis brain dysfunction were divided into treatment group(32 cases)and control group(30 cases)according to random digits table. Both groups received general clinical treatment,while the treatment group additionally accepted Ditan Xingnao Chengqi soup through nasal feeding. The changes of C-reactive protein(CRP)of two groups before treatment and after treatment for 12,24,48,72 hours and 1 week were observed. Besides,the Glasgow Outcome Scale(GOS)was used to assess the curative effect of two groups, and its clinical significance was judged. Meanwhile,the hospitalization costs,the times staying in hospital and total effective rates of the two groups after treatment were observed. In addition,cost-effectiveness analysis was carried out. Results With the extension of therapeutic time,the levels of CRP(mg/L)in the two groups were reduced effectively in comparison with those before treatment,and the change was more obvious in the treatment group;after treatment for 24 hours,the difference in the level of CRP between the two groups began to be statistically significant(106.5±22.3 vs. 201.6±25.4,P0.05).The ratio of cose effectiveness analysis in treatment group was smaller than that of control group(497.42 vs. 855.80,P<0.05). Conclusions Ditan Xingnao Chengqi soup has a relatively good effect on antagonizing inflammatory factors,controlling excessive inflammatory response and improving disturbance of consciousness. The early intervention with this agent for a patient with sepsis cognitive impairment can control the disease situation,improve the patient's prognosis and reduce his or her hospitalization costs.
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AIM: To investigate the effects of irbesartan on acute myocardial ischemia-reperfusion injury and on expression of ICAM-1 and VCAM-1 in myocardial ischemia-reperfusion areas in rabbits. METHODS: Anterior descending branch of left coronary artery (LAD) was ligated in ischemia-reperfusion (IR) group but not in the sham group. Rabbits of IR group were subjected to 60 min of LAD occlusion, and 360 min of reperfusion. In the treated group, the rabbits were given irbesartan until the trial ended. Then, all rabbits were killed and tissue samples were removed from IR areas. After disposed with routine histological methods and stained with hematoxylin and eosin (HE), these samples were examined by light microscopy. The expression of ICAM-1 and VCAM-1 were also investigated by employing immunohistochemical SP method in the tissue samples. RESULTS: Degree of damage in cardiocytes and of neutrophil infiltration were more serious in IR group than those in sham group (P