ABSTRACT
Objective:To explore the effective ability and strategy of improving in-hospital emergency in large general hospitals through investigating and analyzing the epidemiological characteristics and outcomes of patients treated by rapid response team (RRT) in the Fourth People's Hospital of Shenyang.Methods:The clinical data of 145 patients treated by RRT in the Fourth People's Hospital of Shenyang from April 1st to June 30th in 2019 were retrospectively analyzed. The clinical data including gender, age, RRT response time, disease type, direct cause of RRT initiation, the incidence of cardiac arrest, intensive care unit (ICU) admission rate and outcome were statistically analyzed. The correlation between indicators was analyzed by Pearson correlation. Pareto diagram was used to analyze the direct cause of RRT initiation.Results:A total of 145 patients were treated by RRT within 3 months. The ratio of male ( n = 85) to female ( n = 60) was 1.42∶1. The age of patients treated by RRT was (72.83±14.84) years old, and the response time was (3.27±1.42) minutes. The incidence of cardiac arrest was 23.4% (34/145), and the ICU admission rate was 29.7% (43/145). The hospital mortality was 40.0% (58/145), and the rescue success rate was 60.0% (87/145). Correlation analysis showed that there was a significant positive correlation between the incidence of cardiac arrest and hospital mortality ( r = 0.545, P < 0.01). According to the disease type of patients treated by RRT analysis, respiratory system diseases ( n = 44, 30.3%) accounted for the most, followed by circulatory system diseases ( n = 43, 29.7%), nervous system diseases ( n = 25, 17.2%), digestive system diseases ( n = 19, 13.1%), trauma ( n = 5, 3.4%), endocrine system diseases ( n = 3, 2.1%), urinary system diseases ( n = 2, 1.4%) and others ( n = 4, 2.8%). Further analysis showed that patients aged between 85 years old and 94 years old were prone to the respiratory system diseases, accounting for 48.5% (16/33) of the population in this age group, while the cardiovascular system diseases were the most common in patients older than 55 years old, accounting for 31.0% (40/129) of the population in this age group. Pareto diagram showed that the percentages of direct causes of RRT initiation ranked from high to low, the cumulative percentage of pneumonia ( n = 30, 20.7%), acute myocardial infarction ( n = 26, 17.9%), stroke ( n = 20, 13.8%), septic shock ( n = 14, 9.7%), heart failure ( n = 10, 6.9%), respiratory and cardiac arrest ( n = 9, 6.2%), and gastrointestinal bleeding ( n = 7, 4.8%), which were the main direct causes of RRT initiation with a total of 80%. Conclusions:Respiratory system and circulatory system diseases are the main causes for RRT treatment in first-aid patients in the Fourth People's Hospital of Shenyang. The hospital mortality significantly increases once patients suffered cardiac arrest. The RRT can provide effective intervention earlier and faster, and establish a complete RRT emergency strategy, which is helpful to improve the in-hospital emergency ability in large general hospitals.
ABSTRACT
Objective To explore the diagnostic value of sputum smear coupled with simplified clinical pulmonary infection score (CPIS) of ventilator associated pneumonia (VAP) in the early stage.Methods A cohort of 59 consecutive patients with VAP admitted in Intensive Care Unit from June,2014 to June,2016 were enrolled for a prospective and observational study.Concurrently,another 59 patients without pulmonary infection undergone mechanical ventilation over 48 hrs,were assigned into the control group.The criteria of exclusion were patients with pulmonary malignancies,autoimmune diseases and immunodeficiency.APACHE Ⅱ scores of all patients were recorded.All patients' inferior airway sputum which met the criteria was taken to make a validated sputum smear (i.e.polymorphonuclear leukocyte ＞ 25and squamous epithelial cell ＜ 10 per low-power field) for Gram stain and culture on the admission day.Meanwhile,simplified CPIS were calculated.Data were statistically processed by SPSS 15.0,enumeration data were statistically analyzed by Chi-Square test,and measurement data were represented as Mean ± SD.The significant differences in characteristics between two groups were analyzed by independent t test,and P ＜ 0.05 was considered statistically significant.As positive sputum smear and simplified CPIS ≥ 5 were set respectively as a positive screening criterion,sensitivity,specificity,positive predictive value and negative predictive value of each marker and combined markers were calculated.Results There were no significant differences in demographics and clinical features (including age,sex,APACHE Ⅱ scores) of patients in VAP and non-VAP patients (P ＞ 0.05).The rates of bacteria detected were Gram-negative [44.1％ (26/59)],Gram-positive [40.6％ (24/59)],none [10.2％ (6/59)] and both [5.1％ (3/59)] bacteria in VAP group,while [39.0％ (23/59)],[30.5％ (18/59)],[27.1％ (16/59)] and [3.4％ (2/59)]were found in non-VAP group correspondingly.There were no significant differences in the percentages of different bacteria in sputum smear between two groups (P ＞ 0.05).The values of diagnostic sensitivity of sputum smear and sputum smear coupled with simplified CPIS were 89.8％ and 84.7％;the specificity were 27.1％ and 79.7％;the positive predictive values were 55.2％ and 80.6％;and the negative predictive values were 72.7％ and 83.9％,respectively.Conclusions No matter the ventilated patients suffered VAP or not,bacteria might be detected from their lower respiratory tracts.Sputum smear could not be taken as an exclusively diagnostic evidence.While sputum smear coupled with simplified CPIS might improve the diagnostic efficacy of VAP,and provide the guildlines of appropriate choice of antibiotics employed in the early stage.
ABSTRACT
Objective To investigate the influence of propofol on endotoxin-induced expression of vascular endothelial growth factor (VEGF) receptor 2 in renal glomerular endothelial cells of rats.Methods The primarily cultured renal glomerular endothelial cells of Sprague-Dawley rats were seeded in 24-well plates at a density of 1×106 cells/ml (200 μl/well) and divided into 6 groups (n =35 each) using a random number table:control group (group C);introlipid group (group I);propofol group (group P);lipopolysaccharide (LPS) group (group L);LPS + introlipid group (group L+I);LPS + propofol group (group L+P).In group I,10％ introlipid was added with the final concentration of 4 μg/ml.In group P,propofol was added with the final concentration of 4 μg/ml.In group L,LPS was added with the final concentration of 10 μ g/ml.In group L+I,10％ introlipid was added with the final concentration of 4 μg/ml at 30 min before LPS with the final concentration of 10 μg/ml was added.In group L+P,propofol was added with the final concentration of 4 μg/ml at 30 min before LPS with the final concentration of 10 μg/ml was added.After 6 h of incutation,the cells were collected for measurement of cell permeability and VEGF receptor 2 mRNA expression (using RT-PCR),VEGF receptor 2 protein expression (by Western blot),and for examination of the morphology of cytoskeletal protein filamentous-actin (F-actin) with confocal microscope (by immunofluorescence).Results Compared with group C,the expression of VEGF receptor 2 mRNA and protein was significantly up-regulated,and the cell permeability was increased in L,L+I and L+P groups,and no significant changes were found in the parameters mentioned above in I and P groups.Compared with group L,the expression of VEGF receptor 2 mRNA and protein was significantly down-regulated,and the cell permeability was decreased in L+P group,and no significant changes were found in L+I group.F-actin connected closely between adjacent cells and a dense peripheral F-actin band was formed in C,I and P groups,while F-actin depolymerized,the peripheral F-actin band was disrupted,and cells shrank in L and L+I groups.In group L+P,a tighter intercellular connection of F-actin was observed and cytoskeleton was found to be intact.Conclusion Propofol can inhibit endotoxin-induced increase in the permeability of renal glomerular endothelial cells through down-regulating the expression of VEGF receptor 2 in rats.
ABSTRACT
Objective To explore the diagnostic value of gram-stained sputum smears in elderly patients with ventilator-associated lower respiratory infection (VALRI).Methods 368 elderly patients undergoing mechanical ventilation over 48 hours in ICU were retrospectiely analyzed from Jun 2009 to Jun 2011.42 patients fulfilled the inclusion criteria (with good-quality sputa and presence of the same microorganism in sputum and blood cultures).58 gram-stained smears and sputum cultures were obtained and analyzed.Results The diagnostic sensitivity and specificity of Gram-positive bacteria and Gram-negative bacteria by gram-stained smears were 82.35％ and 78.05％,80.49％ and 82.35％,respectively.The positive and negative predictive value of Gram-positive bacteria and Gramnegative bacteria were 63.64％ and 91.43％,91.67％ and 60.87％,respectively.The coincidence rates in diagnosing Gram-positive bacteria and Gram-negative bacteria were 81.03％ and 79.31％,respectively.Conclusions Gram-stained sputum smear is reliable in diagnosing ventilator-associated lower respiratory infection in elderly patients,and has a certain clinical significance in guiding to the selection of antibiotics.
ABSTRACT
Objective To investigate the influence of propofol pretreatment on the increased glomerular endothelial cell permeability induced by lipopolysaccharide (LPS) in rats.Methods Glomerular endothelial cells isolated from SD rats were cultured in 24-well plates(200 μl/well) and transwell filters (100 μl/filter) at 1×106/ml and assigned into 6 groups (n=10 each):control group (group C) , introlipid group (group I), propofol group (group P) , LPS group (group L), LPS+introlipid group (group L+I) and LPS+propofol group (group L +P). In group I, 10% introlipid 4 μg/ml was added. In group P, 4 μg/ml propofol was added. In group L, 10 μg/ml LPS was added. In group L+I, 10% introlipid 4 fig/ml combined with 10 μg/ml LPS was added. In group L+ P, 4 μg/ml propofol combined with LPS 10 μg/ml was added. Introlipid or propofol was added 30 min before the administration of LPS and the corresponding concentrations mentioned above were all final concentrations.After 6 h incubation with LPS, the cells were collected for measurement of vascular endothelial growth factor (VEGF) mRNA expression using RT-PCR. The supernatant was collected for determination of the VEGF concentration by ELJSA. The endothelial cell permeability was determined. Results Compared with group C, the expression of VEGF mRNA was up-regulated and the VEGF concentration and endothelial cell permeability were significantly increased in L, L+I and L + P groups (P＜0.05 ) ,but no significant change was found in the parameters mentioned above in I and P groups (P＞0.05). Compared with group L, the expression of VEGF mRNA was downregulated and the VEGF concentration and endothelial cell permeability were significantly decreased in L+P group (P＜0.05), but no significant change was found in the parameters mentioned above in group L+I(P＞0.05). A positive correlation existed between the concentration of VEGF and the permeability of endothelial cells(r= 0.833,P＜0.05).Conclusion Propofol pretreatment can decrease the increased glomerular endothelial cell permeability induced by LPS probably through down-regulation of VEGF expression.