ABSTRACT
Objective :To explore influence of ticagrelor combined percutaneous coronary intervention (PCI) on myo‐cardial perfusion ,serum levels of platelet activating factor (PAF) and activated platelet membrane glycoprotein Ⅱb／Ⅲa complex (PAC‐1) in patients with acute myocardial infarction (AMI ).Methods :A total of 120 AMI patients undergoing emergency PCI were selected , randomly and equally divided into clopidogrel combined aspirin group (control group) and ticagrelor combined aspirin group (T+ A group).Perfusion indexes ,cardiac function indexes and serum levels of PAF and PAC‐1 were measured and compared between two groups on 24h and six months after PCI ,and incidence of adverse events within six‐month was recorded .Results :After PCI ,there was no significant difference in TIMI grade 3 blood flow rate between two groups , P＝0.488. Compared with control group on six months after PCI ,there were significant rise in cardiac index [ (2.61 ± 1.31) L·min－1 ·m－2 vs.(3. 12 ± 1.37) L ·min－1 ·m－2 ] ,stroke volume [ (60.99 ± 5.13) ml vs.(71. 24 ± 5. 94) ml] and left ventricular ejection fraction [ (45.31 ± 6. 73 )% vs.(72.64 ± 7.29 )%] , and significant reductions in left ventricular end‐systolic dimension [ (59.41 ± 4. 12) mm vs.(53.12 ± 3.45) mm] ,serum levels of PAF [ (10. 31 ± 1. 69) μg／L vs .(8.26 ± 1.38) μg／L] and PAC‐1 [ (37.57 ± 5.74)% vs.(32.14 ± 4.93)%] in T+A group , P＜0. 05 or ＜0.01. During six‐month follow‐up ,no patient died in either group ,and incidence rate of adverse events in T+A group was significantly low‐er than that of control group (1. 67% vs.11.67%, P＝0. 028 ).Conclusion :Ticagrelor combined PCI can signifi‐cantly improve cardiac function and reduce peripheral blood levels of PAF and PAC‐1 with good safety in AMI pa‐tients .It′s worth clinical extension and application .
ABSTRACT
Objective To investigate the impacts of prehospital endotracheal intubation on postoperative pulmonary infection in the patients with severe traumatic brain injury.Methods Retrospectively, the clinical data of 284 patients with severe traumatic brain injury admitted in the 97th Hospital of PLA from July 2007 to December 2012 were analyzed.The patients were classified into two groups according to the timing of endotracheal intubation, namely, prehospital intubation group and admission intubation group.The postoperative pulmonary infection incidence, occurrence time, and the duration of treatment of the two groups were studied.Results The incidences of postoperative pulmonary infection in patients intubated before and after admission were 38.0％ and 25.2％ respectively.Pulmonary infection occurred in the prehospital intubation group was at the (9.9 ± 0.6) d after admission, and in the admission intubation group was at the (11.6 ± 0.3) d after admission.The duration of treatment for postoperative pulmonary infection was (21.2 ± 7.2) days and (14.5 ± 9.0) days respectively.Compared with the patients intubated after admission, patients intubated before admission suffered higher incidence (P ＜ 0.05), earlier onset (P ＜ 0.05), and longer treatment duration of pulmonary infection (P ＜ 0.01).Conclusions Severe traumatic brain injury patients with prehospital endotracheal intubation are more susceptible to pulmonary infection.Avoiding the tracheal injury and bacterial contamination in the procedure could reduce the incidence of pulmonary infection.
ABSTRACT
Objective To investigate the early changes of CD4 + T cells and the relevant cytokines in blood of patients with severe trauma.Methods Sixty-one consecutive patients with trauma admitted into the 97th Hospital of PLA from September 2009 to November 2011 were enrolled in this study.The exclusion criteria included:① Patients were younger than 18 or older than 75 years.②Patients received blood transfusion.③Those suffered from immune system disorders,tumors or diabetes,or recent history of virus,bacteria or parasites infections.④ Those had current or recent treatment with corticosteroids or immunosuppressive drugs.According to ISS score ≥ 16,there were 61 traumatic patients divided into mild trauma group and severe trauma group.Seventeen healthy volunteers were taken as control subjects.At admission,the peripheral venous blood samples of patients were taken to count the number of CD3+,CD4 +,CD8 + T cells by flow cytometry and to detect TNF-α,INF-γ,IL-1,IL4,IL-6 and IL-12 levels in plasma by enzyme linked immunosorbent assay,meanwhile the ratio of Th1 / Th2 type cytokine were calculated.Data were analyzed with t test and ANOVA or Kruskal-Wallis test by using SPSS version 16.0package.P value ＜ 0.05 was considered to be statistical significance.Results Compared with control group,mild trauma and severe trauma groups showed a similar decrease in number of CD3 + T cells,and severe trauma group showed a most significant decrease in number of CD4 + T cells.Severe trauma group had a lower INF-γ level compared with control group; IL-1 level in both mild trauma and severe trauma groups were lower than that in the control group; INF-γ/ IL-6 in severe group was significantly lower than that in the mild group.However,INF-γ IL-6 in mild group was higher than that in the control group.Conclusions The early stage of severe trauma exhibits a significant decrease in number of both CD3 + and CD4 +T cells,accompanied by a significant reduction in most of cytokines,and has a tendency of shift to Th2 type cytokine.Therefore,the changes of immune cells should be promptly and successively monitored after severe trauma.