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Objective To compare the effects of two different types of enteral nutrition on postpyloric feeding critical ill patients.Methods A prospective study was conducted to continuously collect 60 critical ill patients with indications ofpost-pyloric feeding in ICU and NICU wards of our hospital from January 2016 to December 2018.They were randomly (random number) divided into the peptide-based enteral nutrition (PBEN) group and intact protein enteral nutrition (IPEN) group with 30 patients in each group.Enteral nutrition was started immediately within 24 h after the nasointestinal tube was placed,and the PBEN group was treated with peptide-based enteral nutrition,while the IPEN group was treated with intact protein enteral nutrition.The nutritional metabolism index,intestinal barrier index on the 7th and 14th days after enteral nutrition treatment were observed and compared.The enteral feeding complications,incidence of feeding intolerance,gastrointestinal adaptability and 7-day enteral nutrition compliance rate of the two groups during the enteral nutrition were also observed and compared.Chi-square test was used for counting data and t test was used for measuring data.Results On the 7th and 14th days after enteral nutrition therapy,there was no statistical difference in nutritional metabolism indexes between the two groups (P＞0.05).In comparison of intestinal barrier indexes,diamine oxidase (DAO) level in the PBEN group was lower than that in the IPEN group at the same time,and the difference was statistically significant [7th day:(6.1±2.9) U/mL vs (7.8±2.7) U/mL,t=-2.354,P=0.019;14th day:(4.7±1.6) U/mL vs (6.9±2.0) U/mL,t=-3.285,P=0.004].During enteral nutrition,the diarrhea rate of patients in the PBEN group was slightly higher than that in the IPEN group (6.6％ vs 3.3％),while the abdominal distension rate in the IPEN group was slightly higher (3.3％ vs 10.0％),but there was no statistical difference between the two groups (P＞0.05).The gastrointestinal adaptation time of patients in the PBEN group was significantly shorter than that in the IPEN group [(7.8±1.3) h vs (9.1±2.0) h,t=-2.334,P=0.027].The 7-day enteral nutrition compliance rate showed no significant difference between the two groups(P＞0.05).Conclusions Diarrhea was the main complication in the PBEN group and abdominal distension was the main complication in the IPEN group for post-pyloric feeding critical ill patients.Peptide-based enteral nutrition could repair the intestinal barrier function of post-pyloric feeding critical ill patients and increase the adaptability of gastrointestinal tract in the initial stage of enteral nutrition.
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Objective To explore the clinical diagnostic value of bedside lung ultrasound in emergency (BLUE) for patients with postoperative hypoxemia in intensive care unit (ICU). Methods Fifty patients with hypoxemia after ICU surgery postoperation were enrolled in Beijing China-Japan Friendship Hospital from April 2017 to October 2018, the chest X-ray, BLUE and chest CT examinations were performed at the same time, and the diagnostic result of chest CT was the gold standard. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate of the 3 methods in the diagnosis of hypoxemia were statistically analyzed, and the results of diagnostic consistency of 3 methods were compared. Results The chest CT findings showed there were 40 cases with different degrees of pneumothorax, pleural effusion, pulmonary consolidation and atelectasis in 50 patients. When the chest X ray was used to diagnose hypoxemia as the pathogenesis, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rate were 32.5%, 60.0%, 76.47%, 18.18% and 38.0% respectively; the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rate of BLUE were 80.0%, 70.0%, 91.43%, 46.67% and 78.0% respectively. The consistency test showed that the chest X-ray diagnosis rate of postoperation hypoxemia as the cause was significantly lower than that of chest CT (Kappa = 0.091, P = 0.047) and BLUE (Kappa =0.107, P = 0.031). The consistancy was relatively good when the diagnosis rate of postoperation hypoxemia obtained from BLUE regimen was compared with that obtained from chest CT (Kappa = 0.634, P = 0.000). Conclusion The use of BLUE for diagnosis of hypoxemia being the pathogenesis of the postoperative patients in ICU is superior to the use of routine chest X ray, and compared with applying chest CT, BLUE is faster, more convenient and worthy to be clinically applied widely.
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The heart and kidney damage is a clinical disease commonly seen, the 2 organs can interact with each other as cause and effect, leading to a series of clinical symptoms which is the cardiorenal syndrome (CRS). In 2008, according to the connection between the heart and kidney, the nephrologists Ronco, etc, completed the definition and classification of CRS, including type Ⅰ and type Ⅲ of CRS being acute cardiorenal syndrome (ACRS). ACRS refers to the fact that when the damage of heart or kidney dysfunction influences each other leading to a clinical syndrome caused by a sharp deterioration of cardiorenal function. At present, no definite diagnostic criteria for ACRS have yet been made. The pathogenesis of ACRS may be related to the renin-angiotensin-aldosterone system (RAAS), nitric oxide-reactive oxygen species (NO-ROS) system, inflammatory reaction, the excessive activation of sympathetic nervous system and so on. Clinically, about 50% of ACRS patients are accompanied by acute decompensated cardiorenal dysfunction or failure, that seriously impact on the patients' clinical prognosis and survival rate, so it is necessary to find an effective therapeutic regimen. At present, the treatments of ACRS have mainly the diuretic, angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor inhibitor (ARB), β-receptor blocker, positive inotropic drugs, recombinant human erythropoietin, recombinant human brain natriuretic peptide, continuous blood purification (CBP) etc, and traditional Chinese medicine (TCM) also has a certain effect for improving the clinical symptoms of ACRS patients. Now the pathogenesis, diagnosis, and combined treatment of TCM and western medicine for treatment of ACRS are summarized.
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Objective To explore the effect of warming yang for diuresis method combined with blood purification on the clinical therapeutic effect of patients with acute renocardiac syndrome (ARCS).Methods Sixty ARCS patients admitted to the Department of Intensive Care Unit (ICU) of Affiliated Hospital of Tianjin Institute of Chinese Medicine from May 2013 to October 2016 were enrolled, they were divided into an observation group and a control group by random number table, 30 cases in each group, one case died of multiple organ failure due to aggravation of infection, thus the actual observation number was 29 patients in the control group. The continuous vein-vein hemofiltration (CVVH) was applied in the two groups, 6-13 hours each time, and according to the disease situation, the continuous ultrafiltration time was determined, generally about 3-7 days; the observation group was additionally treated with warming yang for diuresis oral herbal decoction, 1 dose daily, 2 times a day, once 100 mL orally taken. The changes of cardiac and renal function indexes, traditional Chinese medicine (TCM) syndrome score and clinical efficacy were observed before and after treatment in the two groups.Results After treatment, the heart and renal function indexes were significantly improved, serum creatinine (SCr), urea nitrogen (BUN), N-terminal pro-brain nitric peptide (NT-proBNP) were all significantly lower than those before treatment in both groups, glomerular filtration rate (GFR), urine output, left ventricular ejection fraction (LVEF), cardiac output index (CI) were all significantly higher than those before treatment in both group; 7 days after treatment, BUN was significantly lower in observation group than that in control group (mmol/L:10.38±1.02 vs. 13.68±2.67), GFR, urine output, CI were significantly higher in observation group than those in control group [GFR (mL/min): 62.02±4.47 vs. 52.95±1. 92, urine output (mL/24 h): 875.41±44.26 vs. 537.82±79.65, CI (L·min-1·m-2): 3.12±0.51 vs. 3.07±0.17, allP < 0.05]; the effective rate of TCM syndrome score and clinical efficacy were significantly higher in observation group than those in control group [total effective rate of TCM syndrome score: 80.0% (24/30) vs. 55.17% (16/29), total effective rate: 93.33% (28/30) vs. 72.41% (21/29), both P < 0.05].Conclusions The warming yang for diuresis TCM decoction intake combined with CVVH can improve the cardiac and renal functions and clinical symptoms, and increase urine output for patients with ARCS.
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ObjectiveTo investigate the therapeutic effect of Xiaoqinglong decoction for supplementary treatment of patients with ventilator-associated pneumonia (VAP).Methods Thirty-three VAP patients with syndrome of traditional Chinese medicine (TCM) as interior retention of phlegm and exopathic cold admitted to Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine (TCM) from July 2011 to December 2014 were enrolled, and their historical data were retrospectively analyzed. According to the difference in treatment methods, the patients were divided into TCM treatment Xiaoqinglong decoction group (observation group, 18 cases) and general treatment group (control group, 15 cases). The patients in both groups were given conventional western medicine treatment, including anti-infection, phlegm elimination and cough relieve, protection of gastric mucosa and organ function, nutritional support, prevention of bedsore and thrombosis, etc. Additionally, the patients in TCM treatment group were given Xiaoqinglong decoction (drug composition: herba ephedrae 15 g, ramulus cinnamomi 15 g, herba asari 15 g, rhizoma zingiberis 15 g, chinese peony 15 g, rhizoma pinelliae 15 g, fructus schisandrae 15 g, radix glycyrrhizae preparata 10 g) for nasal feeding, once 150 mL, twice a day, once every 7 days. The changes in body temperature were observed before and 3 days and 7 days after treatment, and peripheral blood was collected for determination of white blood cell count (WBC) and C-reactive protein (CRP) level in the two groups. Comprehensive therapeutic effects of the patients in both groups were recorded.Results There were no significant differences in body temperature, WBC and CRP before treatment between the two groups. After treatment, the above parameters in both groups were significantly lower than those before treatment, and they showed a decrease tendency with time prolongation. The decrease in body temperature and WBC in observation group was more obvious than those of control group, and the comparisons showed statistical significant differences on 7 days after treatment [body temperature (℃): 36.5±0.6 vs. 37.0±0.8, WBC (×109/L):6.7±3.0 vs. 8.9±2.5, bothP 0.05). The total effective rate on the 7th day after treatment in observation group was higher than that of control group [83.3% (15/18) vs. 80.0% (12/15)], but no statistical significant difference was seen (P > 0.05).Conclusions The Xiaoqinglong decoction can reduce the inflammatory reaction of patients with VAP, and improve their symptoms.