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Background@#Although the use of extra-corporeal membrane oxygenation (ECMO) has been rapidly increasing, the benefit of ECMO in patients with acute respiratory distress syndrome (ARDS) remains unclear. Our objective was to investigate the effect of venovenous ECMO (VV-ECMO) on adult patients with severe ARDS.@*Methods@#We conducted a multi-center, retrospective, cohort study in the intensive care units (ICUs) of six teaching hospitals between January 2013 and December 2018. Patients with severe ARDS who received VV-ECMO support were included. The detailed demographic data and physiologic data were used to match ARDS patients without ECMO. The primary endpoint was the 28-day mortality.@*Results@#Ninety-nine patients with severe ARDS supported by VV-ECMO and 72 patients without ECMO were included in this study. The acute physiology and chronic health evaluation II score was 23.1 ± 6.3 in the ECMO group and 24.8 ± 8.5 in the control group (P = 0.1195). The sequential organ failure assessment score was 12.8 ± 3.4 in the ECMO group and 13.7 ± 3.5 in the control group (P = 0.0848). The 28-day mortality of patients with ECMO support was 39.4%, and that of the control group was 55.6%. The survival analysis curve showed that the 28-day mortality in the ECMO group was significantly lower than that in the control group (P = 0.0097). Multivariate Cox regression analysis showed that the independent predictors of the 28-day mortality were the requirement of vasopressors before ECMO (hazard ratio [HR]: 1.006; 95% confidence interval [CI]: 1.001–1.013; P = 0.030) and duration of mechanical ventilation before ECMO (HR: 3.299; 95% CI: 1.264–8.609; P = 0.034).@*Conclusions@#This study showed that ECMO improved the survival of patients with severe ARDS. The duration of mechanical ventilation and the requirement of vasopressors before ECMO might be associated with an increased risk of death.
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BACKGROUND@#Although the use of extra-corporeal membrane oxygenation (ECMO) has been rapidly increasing, the benefit of ECMO in patients with acute respiratory distress syndrome (ARDS) remains unclear. Our objective was to investigate the effect of venovenous ECMO (VV-ECMO) on adult patients with severe ARDS.@*METHODS@#We conducted a multi-center, retrospective, cohort study in the intensive care units (ICUs) of six teaching hospitals between January 2013 and December 2018. Patients with severe ARDS who received VV-ECMO support were included. The detailed demographic data and physiologic data were used to match ARDS patients without ECMO. The primary endpoint was the 28-day mortality.@*RESULTS@#Ninety-nine patients with severe ARDS supported by VV-ECMO and 72 patients without ECMO were included in this study. The acute physiology and chronic health evaluation II score was 23.1 ± 6.3 in the ECMO group and 24.8 ± 8.5 in the control group (P = 0.1195). The sequential organ failure assessment score was 12.8 ± 3.4 in the ECMO group and 13.7 ± 3.5 in the control group (P = 0.0848). The 28-day mortality of patients with ECMO support was 39.4%, and that of the control group was 55.6%. The survival analysis curve showed that the 28-day mortality in the ECMO group was significantly lower than that in the control group (P = 0.0097). Multivariate Cox regression analysis showed that the independent predictors of the 28-day mortality were the requirement of vasopressors before ECMO (hazard ratio [HR]: 1.006; 95% confidence interval [CI]: 1.001-1.013; P = 0.030) and duration of mechanical ventilation before ECMO (HR: 3.299; 95% CI: 1.264-8.609; P = 0.034).@*CONCLUSIONS@#This study showed that ECMO improved the survival of patients with severe ARDS. The duration of mechanical ventilation and the requirement of vasopressors before ECMO might be associated with an increased risk of death.
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Objective · To analyze the assessment value of pulmonary vascular permeability index (PVPI) and procalcitonin (PCT) levels to the severity and prognosis of acute respiratory distress syndrome (ARDS) associated with septic shock.Methods·Clinic data of 100 ARDS patients admitted to Affiliated Hospital of Nantong University was analyzed retrospectively.The clinical data was collected as follows:gender,age,infection site,acute physiology,chronic health evaluation Ⅱ (APACHE Ⅱ),sequential organ failure (SOFA) score,serum PCT level,and hemodynamic parameters which were monitored by pulse indicator continuous cardiac output (PiCCO).Patients with septic shock associated with ARDS patients were divided into mild,moderate and severe groups.The patients were divided into survival group and death group according to the 28-day prognosis,and the differences in the parameters between two groups were analyzed,to evaluate PVPI and PCT in predicting the severity and prognosis of septic shock associated ARDS.Results · There were significant differences in PVPI and PCT between ARDS group associated with septic shock and not (P=0.000).PVPI and PCT increased with the severity of ARDS,and there was a statistically significant difference between the ARDS groups in different degrees of PVPI (P=0.000).Pearson correlation analysis showed that PVPI was positively correlated with APACHE Ⅱ score and SOFA score (r=0.554,P=0.000;r=0.431,P=0.000),and PCT was positively correlated with APACHE Ⅱ score and SOFA score (r=0.313,P=0.004;r=0.320,P=0.004).Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve of the prognosis of ARDS patients with sepsis was significantly higher than those of the two groups.Conclusion · PVPI can assess the severity of ARDS in patients with septic shock,and PVPI and PCT are predictive factors of prognosis.The combination of PVPI and PCT contributes to early stage diagnosis of ARDS associated with septic shock.
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Objective To explore the clinical efficacy of Montelukast in the treatment of severe asthma. Methods A retrospective analysis was conducted in the Department of Respiratory Medicine from January 2016 to August 2017.A total of 168 patients with moderately severe asthma were randomly divided into control group and observation group. The control group was treated with leukotriene receptor antagonist Montelukast and the observation group was treated with both Montelukast and budesonide inhalation suspension. Then we compared the clinical effect, lung function and blood gas index before and after treatment between the two groups. Results Significant improvement was observed in the clinical symptoms and lung function in the two groups of patients after the treatment. Compared to the control group, a better improvement was seen in the observation group (P＜0.05) . The results of blood gas analysis were significantly different between the two groups before and after the treatment (P＜0.05) . Conclusion In the treatment of moderately severe asthma, Montelukast combined with budesonide inhalation suspension has good clinical effect and can significantly alleviate symptoms, which can be widely used clinically.
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<p><b>OBJECTIVE</b>To explore the method of reduction of anterior dislocation of shoulder joint, evaluate the clinical effects of proneposition modified Hippocrates methods.</p><p><b>METHODS</b>From February 1998 to April 2011, 1 028 patients, 689 males and 339 females, with anterior dislocation of shoulder joint were treated with manipulation of proneposition modified Hippocrates methods. The average age was 38.3 years (ranged from 11 to 86 years). Thirty-two cases by Hippocrates method failure to reset success, 86 cases combined with geater tuberosity tore of humerus.</p><p><b>RESULTS</b>One thousand and twenty-seven example applications, it took average 50 s, 1 case was cured due to a combination of humerus surgical neck fracture. Eighty-six cases combined with greater tuberosity tore of humerus, 84 cases reached anatomical reattachment or nearly anatomical reattachment, 2 cases of large bone pieces instability were reduced by percutaneous needle. According to Neer score, there are 1 012 excellent cases, 15 good cases.</p><p><b>CONCLUSION</b>Proneposition modified Hippocrates method is better than Hippocrates. It has the advantage of anesthesia, lower expense, short replacement, less pain, easier to master, and worth applying widely.</p>
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Young Adult , Musculoskeletal Manipulations , Methods , Shoulder Dislocation , Therapeutics , Shoulder Joint , Wounds and InjuriesABSTRACT
This study was purposed to investigate the effects of 25 Gy gamma-ray irradiation on the CD62p expression, platelet count and the mean platelet volume (MPV) of manually enriched platelet suspension in different time of shelf life at 22 degrees C. Each of 16 bags with plasma-rich platelet was divided into two bags, one of which was exposed to 25 Gy gamma-ray of 137Cs and the other ones was not exposed. 16 bags then were preserved for 72 hours according to AABB standards. The irradiated platelets were regarded as the observation group, and the other ones were regarded as the control group, the expression of p-selectin (CD62p) in the above 2 groups was detected by flow cytometry before irradiation and at 24, 72 hours after irradiation respectively; at the same time, the platelet count and MPV were assayed by using blood cell counter. The results showed that the expression level of CD62p on platelet in irradiated and control groups increased along with the prolonging of preservation time, the expression rate of CD62p on the platelets preserved for 24 hours was higher than that on fresh platelets with significant difference (p<0.05); the expression rate of CD62p on the platelets preserved for 72 hours obviously was enhanced as compared with platelets preserved for 24 hours (p<0.01). There were no significant differences in CD62p expression rate, platelet count and MPV between irradiated and control groups preserved for 24 and 72 hours (p>0.05), however the MPV of irradiated and control groups preserved for 72 hours was higher than that of fresh platelets (p<0.05). It is concluded that the gamma-ray irradiation does not affect the quantity and quality of platelets, but the preservation time for manually enriched platelet suspension should be shortened as far as possible.