ABSTRACT
Objective To evaluate the effects of fluid resuscitation and large-volume hemofiltration (HVHF) on the Alveolar-arterial oxygen exchange in patients with refractory septic shock. Method A total of 89 intensive care patients with refractory septic shock treated with fluid resuscitation and/or HVHF were enrolled between August 2006 and December 2009. All the patients were randomly divided into two groups. In group A, patients were treated with fluid resuscitation, n = 41 cases) and in group B, patients were treated with large-volume hemofiltration and fluid resuscitation, n =48). The O2 content of central venous blood(CcvO2), arterial oxygen content (CaO2), Alveolar-arterial oxygen pressure difference (P(A-a)DO2), the ratio of arterial oxygen pressure/alveolar oxygen pressure (PaO2/PAO2), respiratory index (RI) and oxygenation index (OI) were checked. The levels of oxygen exchange in two groups were detected by arterial blood gas analysis before treatnent, 24 hour, 72 hour and 7 days after treatment. The APACHE Ⅱ scores in patients with refractory septic shock were measured before and the 7th day after treatment with HVHF and/or fluid resuscitation respectively. Data were analyzed by using t -test and chi-square test to compare the differences and ratio between two groups and were expressed in mean ± standard deviation, and the analysis of variance was done with SPSS version 12.0 software. Results ① The differences in CcvO2 and CaO2 between two groups were[(0.60±0.24) vs. (0.72±-0.28), P ＜0.05 and (0.84±0.43) vs. (0.94±0.46), P ＜0.05]; and the oxygen extraction rates (O2ER) were significantly different between two groups [(28.7±2.4) vs. (21.7±3.4), P<0.01];② The levels of P(A-a)DO2、ratio of PaO2/PAO2、RI and OI in group B were reduced more significantly than in group A (P<0.05 or P<0.01);③The APACHE Ⅱ scores in both groups were gradually reduced after treatment for 7 days, and the APACHE Ⅱscore in group B on the 7th day of treatment were lower than that in group A[(17.2 ± 6.8) vs. (8.2 ± 3.8), P ＜ 0.01]. Conclusions Fluid resuscitation and HVHF could improve alveolar-arterial-oxygen exchange in patients with refractory septic shock, and at the same time decreased the APACHE Ⅱ scores, improving the survival rate of patients.
ABSTRACT
Objective To study the therapeutic effects of omeprazoie in high-dose given by continuous intravenous infusion in the treatment of stress-related mucosal injury of G-I tract in intensive care patients.Method Totally 98 intensive care patients with stress-related mucosal injury(SRMI)were enrolled from August 2006 to October 2008 Department in Intensive Care Unit(ICU)of the Provincial Hospital Affiliated to Shandong University.All the patients were randomly divided into high-dose omeprazoie group(group A)and control group(group B).In group A,omeprazoie was administrated in loading dose of 80 mg Ⅰ.Ⅴ.in 5 minutes followed by maintenance dose of 8.0 mg/h intravenous infusion for 72 hours,while in group B,omeprazoie was given in dose of 40mg/8h intravenous infusion for 72 hours.The pH value of gastric juice was determined by German Roche pH test paper every 2 to 8 hours in the patients of both groups.The coffee like or red juice in the gastrointestine decompressor was observed.At the same time,hemoglobin(HB)was detected by Automatic blood cell analyzer Sysmex XE-2100,blood urea nitrogen(BUN)was determined by Automatic Analyzer Au5400,and buffer excess(BE)was checked by GEM Premie arterial blood gas analyzer in all patients.Data were expressed as mean ± standard deviation(x-± s)and the analysis of variance was done with SPSS 12.0 software.Comparison of mean value between two groups was conducted with t-test and the ratio was calculated by using chi-square test(X2 test).The change was considered as statistically significant if P value was less than 0.05.Results Four,eight,and 24 hours after treatment with omeprazole,the pH values in patients of group A were higher than those in patients of group B(four hous:6.63 ±0.62 vs.3.14 ±0.26,P＜0.01;eight hours and 24 hours:P＜0.05 or P＜0.01).At 8 hours and 24 hours after treatment,the HB was higher,BUN and BE were lower in group A than those in group B(P＜0.03 or P＜0.01).The total rate of hemostasis of upper G-I tract bleeding in group A was higher than that in group B(95.35%vs.78.19%,P＜0.05).Conclusions For treating the intensive care patients with SRMI,the continues intravenous infusion of omeprazole inhigh dose is superior to conventional dosage.