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Objective:To investigate the effect of terlipressin on prognosis of adult septic shock patients.Methods:All randomized controlled clinical trials (RCT) of terlipressin in the treatment of adult septic shock patients from January 1980 to December 2019 were retrieved from CNKI, Wanfang, SinoMed, PubMed, Embase, Springer Link, Cochrane Library, Google Scholar, and etc. Patients in the treatment group received terlipressin while patients in the control group received norepinephrine or other vasopressors. Main outcome indicator was mortality. Secondary outcome indicators included the incidence of severe adverse events, limb peripheral ischemic events and renal complications. Literature screening, data extraction and quality evaluation were conducted by two researchers respectively. Meta-analysis was performed with RevMan 5.3 software. Funnel plot was used to analyze the publication bias.Results:A total of 507 related literatures were retrieved. According to the inclusion and exclusion criteria, 8 RCT studies were finally included, with a total of 811 patients. One study was considered to have a lower risk of bias, 6 studies had uncertain risk of bias, and 1 study had a higher risk of bias. The Meta-analysis showed that terlipressin did not significantly improve the mortality of septic shock patients compared with the control group [odds ratio ( OR) = 0.89, 95% confidence interval (95% CI) was 0.67-1.19, P = 0.45]; increased the incidence of severe adverse events ( OR = 2.98, 95% CI was 1.99-4.45, P < 0.000 01); there was a tendency to increase the incidence of limb peripheral ischemic events, but without statistical difference ( OR = 10.81, 95% CI was 0.88-133.19, P = 0.06); and reduced the incidence of renal complications ( OR = 0.30, 95% CI was 0.09-0.96, P = 0.04). Funnel plot analysis indicated that there might be publication bias in a study on case fatality and incidence of serious adverse events in the included literature. No significant publication bias was found in studies on the incidence of limb peripheral ischemic events and the incidence of kidney-related complications. Conclusions:The available evidence suggests that terlipressin could not significantly improve mortality in adult's septic shock patients, but it may reduce the incidence of renal complications. A tendency to increase the incidence of limb peripheral ischemic events in the terlipressin-treated group needs to be emphasized.
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Critical patients in the intensive care unit (ICU) are often accompanied with acute pain,which may lead to a series of physiological responses that affect the prognosis of patients.With the continuous advancement of modem medicine,the pain management strategies and analgesics have also greatly developed,and the concept has been continuously updated.In the individualized diagnosis and treatment mode,the pain management is an indispensable component of ICU comprehensive treatment.Multimodal analgesia (MMA) strategies have also shown to be effective in optimizing analgesia in critical patients.However,there are still many shortcomings and differences in pain evaluation and its management.The characteristics and methodologies of related analgesics need to be further summarized and discussed.The current literature about the evaluation of pain,pharmacology and non-pharmacological techniques were reviewed to provide references for the scientific and reasonable implementation of analgesia treatment in ICU.
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Objective@#To investigate the effect of dexmedetomidine on stress response and immune balance in patients with acute respiratory distress syndrome(ARDS) undergoing mechanical ventilation.@*Methods@#From March 2016 to September 2018, 90 ARDS patients with mechanical ventilation in Chongqing Three Gorges Center Hospital were randomly divided into dexmedetomidine group(D group, 30 cases), propofol group(P group, 30 cases), midazolam group(M group, 30 cases) by random number table method.Another 30 healthy workers in our hospital were selected as normal control group(C group). In M, P and D groups, the sedative drugs were infused by micro-pump on the basis of analgesic treatment(fentanyl citrate). The heart rate(HR), mean arterial pressure(MAP), Murray score, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, plasma norepinephrine(NS), plasma cortisol(Cor), and blood T lymphocyte subsets(CD4+, CD8+, CD4+/CD8+) were observed in all patients at T0(the beginning of sedation), T1 (6h after sedation), T2 (24h after sedation), T3(48h after sedation). The levels of NS and Cor in plasma and blood T lymphocyte subsets(CD4+, CD8+, CD4+/CD8+) in C group were measured at 8∶00 a. m.the next day.@*Results@#The plasma NS and Cor at T0 in M, P and D group were higher than those in C group (all P<0.05), while the levels of CD4+ were lower than those in C group(all P<0.05). Compared with T0, the plasma NS and Cor decreased at T3 in M, P and D group (all P<0.05). The plasma Cor at T3 in P group was lower than that in M group[(475.77±49.69)μg/L vs.(502.33±60.92)μg/L](t=-26.57, P<0.05). The plasma NS and Cor at T3 in D group were lower than those in M group[(20.64±4.70)ng/L vs.(25.29±4.03)ng/L, (442.83±66.59)μg/L vs.(502.33±60.92)μg/L](t=-4.51, -59.50, all P<0.05), and were lower than those of P group[(20.64±4.70)ng/L vs.(23.60±4.49)ng/L, (442.83±66.59)μg/L vs.(475.77±49.69)μg/L](t=-2.96, -32.93, all P<0.05). Compared with T0, the level of CD4+ decreased at T1, T2 and T3(except T3 in D group) in M, P and D group (all P<0.05), and the level of CD8+ decreased at T1, T2 and T3 in M and P group (all P<0.05), but those in D group at T1, T2 and T3 were not significantly decreased(all P>0.05). The levels of CD8+ at T2 and T3 in P and D groups were higher than that of M group (all P<0.05). The level of CD4+/CD8+ at T3 in D group were higher than that in M and P group[(1.46±0.30) vs.(1.26±0.33), (1.46±0.30) vs.(1.32±0.34)](t=0.21, 0.15, all P<0.05).@*Conclusion@#Sedation with dexmedetomidine or propofol can alleviate stress response and improve immune function in ARDS patients undergoing mechanical ventilation, and dexmedetomidine is better than propofol.
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To investigate the effect of dexmedetomidine on stress response and immune balance in patients with acute respiratory distress syndrome ( ARDS) undergoing mechanical ventilation.Methods From March 2016 to September 2018,90 ARDS patients with mechanical ventilation in Chongqing Three Gorges Center Hospital were randomly divided into dexmedetomidine group (D group,30 cases),propofol group(P group,30 cases), midazolam group(M group,30 cases) by random number table method.Another 30 healthy workers in our hospital were selected as normal control group (C group).In M,P and D groups,the sedative drugs were infused by micro -pump on the basis of analgesic treatment ( fentanyl citrate ).The heart rate ( HR),mean arterial pressure ( MAP), Murray score,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score,plasma norepinephrine ( NS), plasma cortisol(Cor),and blood T lymphocyte subsets (CD+4 ,CD+8 ,CD+4 ／CD+8 ) were observed in all patients at T0 (the beginning of sedation),T1 (6h after sedation),T2 (24h after sedation),T3(48h after sedation).The levels of NS and Cor in plasma and blood T lymphocyte subsets (CD+4 ,CD+8 ,CD+4 ／CD+8 ) in C group were measured at 8:00 a.m.the next day.Results The plasma NS and Cor at T0 in M,P and D group were higher than those in C group (all P＜0.05),while the levels of CD +4 were lower than those in C group ( all P＜0.05).Compared with T0,the plasma NS and Cor decreased at T3 in M,P and D group (all P＜0.05).The plasma Cor at T3 in P group was lower than that in M group[(475.77 ±49.69)μg／L vs.(502.33 ±60.92) μg／L] (t＝-26.57,P＜0.05).The plasma NS and Cor at T3 in D group were lower than those in M group [(20.64 ±4.70) ng／L vs.(25.29 ±4.03) ng／L, (442.83 ±66.59) μg／L vs.(502.33 ±60.92) μg／L] ( t＝-4.51,-59.50,all P＜0.05),and were lower than those of P group [( 20.64 ±4.70) ng／L vs.( 23.60 ±4.49) ng／L, (442.83 ±66.59) μg／L vs.( 475.77 ± 49.69)μg／L](t＝-2.96,-32.93,all P＜0.05).Compared with T0,the level of CD +4 decreased at T1,T2 and T3 (except T3 in D group) in M,P and D group (all P＜0.05),and the level of CD +8 decreased at T1,T2 and T3 in M and P group (all P＜0.05),but those in D group at T1,T2 and T3 were not significantly decreased (all P＞0.05). The levels of CD +8 at T2 and T3 in P and D groups were higher than that of M group ( all P＜0.05).The level of CD+4 ／CD+8 at T3 in D group were higher than that in M and P group [(1.46 ±0.30) vs.(1.26 ±0.33),(1.46 ± 0.30) vs.(1.32 ±0.34)]( t＝0.21,0.15,all P＜0.05).Conclusion Sedation with dexmedetomidine or propofol can alleviate stress response and improve immune function in ARDS patients undergoing mechanical ventilation ,and dexmedetomidine is better than propofol.
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Objective To systematically evaluate the effect of high-flow nasal cannula oxygen (HFNC) on improving the atelectasis and respiratory function in adults after cardiac surgeries.Methods All randomized controlled trials (RCTs) about HFNC therapy for adults after cardiac surgeries published from January 2000 to March 2018 were searched through CNKI, CBM, VIP, Wanfang, PubMed, Springer Link, Embase, Web of Science, Cochrane Library. The references from relevant articles were searched. The experimental group was treated with HFNC while the control group treated with conventional oxygen therapy (COT). The outcome measurements included radiological atelectasis score (RAS), endotracheal reintubation rate and the length of intensive care unit (ICU) stay. Two researchers were responsible for literature screening, data extraction and quality evaluation respectively. Meta-analysis was performed with RevMan 5.2 software. Funnel plot was used to analyze the publication bias.Results A total of 4 RCTs were enrolled and 643 patients were included (325 in experimental group and 318 in control group). Meta-analysis showed that the tracheal reintubation rate in experimental group was lower than that in control group [odds ratio (OR) = 0.26, 95％ confidence interval (95％CI) = 0.09-0.74,P = 0.01], but there was no significant difference in RAS [mean difference (MD) = -0.15, 95％CI = -0.50-0.21,P = 0.41] and the length of ICU stay (MD= 0.09, 95％CI =-0.09-0.26,P = 0.33) between experimental group and control group. Sensitivity analysis was performed in two trials with low risk of bias, which demonstrated that there was no significant difference in RAS between the two groups (MD =0.06, 95％CI = -0.26-0.37,P = 0.73). It was shown by the funnel analysis that there was bias in the study of the length of ICU stay in the literature, while the bias of RAS and tracheal reintubation rate was low.Conclusion Compared with COT, HFNC could reduce the rate of tracheal reintubation in adults after cardiac surgeries, but no difference was found in improving atelectasis or reducing the length of ICU stay.
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Objective To investigate the clinical efficacy of methylene blue in the treatment of refractory hypotension caused by vascular paralysis during the course of vasodilatory shock. Methods The related articles were searched by retrieving the terms using methylene blue, vascular paralysis, hemodynamics, hypotension, vasodilatory shock in CNKI, China Biomedical Literature database, Wanfang database, PubMed, Springer Link, and BIOSIS Previews database. The retrieval time was from January 1994 to June 2017. The randomized clinical trials (RCTs) which using methylene blue as the experimental group, normal saline or catecholamine as the control in the treatment of refractory hypotension caused by vascular paralysis during the course of vasodilatory shock were collected. The primary end points were mean arterial pressure (MAP) immediately or 1 hour after the methylene blue administration, and the mortality at the longest follow-up available; the secondary end point was serum lactic acid (Lac) 1 hour after the methylene blue administration. Literature screening, data extraction and quality evaluation were carried out by two researchers. Meta analysis was performed using RevMan 5.3 software. The sensitivity analysis was performed in two trials with low risk of bias. The funnel plot for MAP was performed in five relative trials to analyze the research and publication bias. Results Totally 269 relative articles were collected, according to the inclusion and exclusion criteria, finally 6 RCTs with 214 patients were enrolled, 108 in methylene blue group, and 106 in control group. Four of the studies were considered to have mild to moderate risk of bias, two studies of high risk of bias. The Meta-analysis demonstrated that compared with the control group, methylene blue could significantly improve MAP [mean difference (MD) = 4.87, 95% confidence interval (95%CI) = 2.61 to 7.13, P < 0.000 1], reduce the serum Lac levels (MD = -1.06, 95%CI = -1.98 to -0.14, P = 0.02), and the mortality was decreased without statistical difference [odds ratio (OR) = 0.58, 95%CI = 0.25 to 1.31, P = 0.19]. Sensitivity analysis was performed in two trials with low risk of bias, which demonstrated methylene blue could exactly increase MAP (MD = 8.93, 95%CI = 1.55 to 16.32, P = 0.02). Funnel plot for MAP was performed in five relative trials which found no obvious publication bias. Conclusions Methylene blue could significantly increase MAP in the patients with refractory hypotension caused by vascular paralysis during the course of vasodilatory shock, decrease the Lac levels, and does not increase the risk of death. Therefore, methylene blue should be a potential and safe vasoconstrictor.
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Objective To investigate and analyze the risk factors,morbidity and mortality rates of multiple organ dysfunction syndrome (MODS) after multiple trauma.Methods The clinical data of all 155 patients with multiple trauma admitted to our ICU from Sep 2008 to Jun 2011 were retrospectively analyzed,including treatment,injury severity score (ISS) and its relationship with MODS.Results The morbidity of MODS among all 155 patients was 18.7％ (29/155).There were 3,7 and 19 patients died due to multiple trauma in 39 ISS ＜ 16,58 ISS 16-25,and 58 ISS ≥25 cases respectively.The morbidity of MODS was significantly higher in patients with ISS ≥25 ( x2 =12.321,P =0.002) than in others.There were 15 cases with MODS and 28 cases without MODS died respectively in multiple trauma patients ( x2 =10.236,P =0.001 ).Conclusion MODS is the important reason for death in multiple trauma patients.It is pivotal to actively deal with primary trauma to avoid the second insult to the patients and support vital organs early in order to improve the prognosis of multiple trauma.
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Hyperglycemia is common in critically ill patients,even in patients without a history of diabetes mellitus.Stress plays an important role in the genesis of hyperglycemia.Many studies have demonstrated the association between hyperglycemia and adverse outcomes.Tight glycaemic control using intensive insulin therapy can reduce morbidity and mortality associated with critical illness.Application of the therapy shows a good prospect and is also facing some problems.