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To investigate the impact of goal directed analgesia on the outcome of patients with mechanical ventilation in intensive care unit. A total of 126 patients who needed mechanical ventilation were recruited. With a method of before and after paired comparison, they were divided into two group:( 1 ) analgesia with empirical administration or control group; ( 2 ) goal directed analgesia based on critical-care pain observation tool (CPOT). Compared with the control group, after goal directed analgesia was applied, the consumption of midazolam significantly dropped from ( 368. 47 ± 27. 41 ) mg to ( 151. 27 ± 29. 31 ) mg (P<0. 05), whereas the consumption of dexmedetomidine significantly increased from ( 623. 62 ± 20. 91) μg to (812. 34 ± 22. 57) μg(P<0. 05). The median score of Richmond agitation-sedation scale increased from -3 to -1. The incidence of delirium significantly reduced from 23. 81% to 17. 46%( P<0. 05). The mean ventilator duration was significantly shortened from (168. 49 ± 11. 41) h to (142. 38 ± 13. 24) h(P<0. 05). ICU length of stay was significantly shortened from (23. 64 ± 9. 26) d to (19. 63 ± 8. 46) d ( P < 0. 05 ) . Due to the mild sedation, patients receiving goal directed analgesia report less delirium, less ventilation time and shorter ICU length of stay, suggesting that the general outcome is improved.
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Objective To detect the effect of low-dose heparin on endothelial function by detecting the change of yon Willebrand factor (vWF) in blood plasma of patients with sepsis shock after treatment with low-dose heparin in order to observe organ function and prognosis of patients.Methods A total of 118 patients with sepsis shock were randomized into low-dose heparin group and control group.In addition to the routine treatment,the patients in low-dose heparin group were given low-dose heparin,while those in control group were not.The levels of APTT,PT,platelet (PLT) count,hepatic function and renal function were determined before and after treatment in two groups,and hemorrhagic events or other complications were recorded.The lengths of stay in ICU and in hospital,the days of mechanical ventilation and the rates of acute respiratory distress syndrome (ARDS),disseminated intravascular coagulation (DIC) and multiple organ dysfunction syndrome (MODS) and 28-day survival rate in the two groups were documented.The levels of vWF in patients of two groups were determined by using immunoturbidimetry before and after treatment.Results The rates of DIC and MODS in low-dose heparin group decreased significantly after therapy (rate of DIC,10.6％ vs.26.7％,P ＜ 0.05;rate of MODS,19.3％ vs.32.0％,P ＜ 0.05).Hepatic function and renal function in low-dose heparin group were significantly improved than that in the control group (P ＜ 0.05),28-day survival rate in the low-dose heparin group was higher than that in the control group (78.3％ vs.69.1％,P ＜0.05),the differences between low-dose heparin group and control group were not statistically significant in the lengths of stay in ICU and hospital,the days of mechanical ventilation and the rate of ARDS (P ＞ 0.05).The differences in APTT,PT and PLT were not significant from pre-treatment to after treatment and between the two groups (P ＞ 0.05).The levels of vWF in low-dose heparin group decreased significantly after therapy rather than those in control group (P ＜ 0.05).Conclusions The endothelial function is improved in patients with sepsis shock after employment of lowdose heparin.Low-dose heparin alleviates the interaction between coagulation and inflammation,improves hepatic,renal and other important organs function,decreases the rate of MODS and increases 28-day survival rate patients with sepsis.The low-dose heparin therapy is a safe and promising treatment in sepsis patients without severe side effects.
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Objective To explore the correlation of pulse pressure(PP) and outcome in refractory septic shock patients.Methods A total of 68 patients with refractory septic shock consecutively admitted in our ICU from January 2012 to December 2012 were retrospectively studied.Hemodynamic data and arterial lactate concentration were collected at the time of admission and 24 hours after admission.The outcome of Day 28 post-diagnosis was also recorded.Results (1) Compared with the survivors,heart rate(HR) at 24hours after admission was higher in non-survivors,while 24 h lactate clearance rate (rLac) was lower in them (P ＜ 0.05).Other hemodynamic parameters showed no difference between the non-survivors and the survivors at 24 hours after admission,including central venous pressure (CVP),mean arterial pressure (MAP),systolic blood pressure(SBP),diastolic blood pressure(DBP),PP,pulse pressure/heart rate (PP/HR),pulse pressure/mean arterial pressure(PP/MAP),pulse pressure/systolic pressure(PP/SBP),pulse pressure/diastolic pressure (PP/DBP),the value of SBP above MAP (SMP) and the value of DBP below MAP(MDP).(2)The mortality rate was higher in the patients with HR≥100 b/min than those with HR ＜ 100 b/min,but without statistical significance (56.25％ vs 36.11％,P =0.096).Compared with the survivors,no matter with HR≥100 b/min or HR ＜ 100 b/min,lactate(Lac) at the 24 hours after admission was higher in all the non-survivors (P ＜ 0.05),while with lower rLac (P ＜ 0.05).In those with HR ≥100 b/min,the following hemodynamic parameters were higher in the non-survivors than in the survivors,including PP,PP/HR,PP/MAP,PP/SBP,PP/DBP,SMP and MDP (all P values ＜ 0.05),while no statistical difference was observed in those with HR ＜ 100 b/min.(3)The mortality rate showed no statistical difference in those with MAP≥85 mmHg(1 mmHg =0.133 kPa) and with MAP ＜ 85 mmHg(42.42％ vs 48.57％,P =0.611).No matter MAP≥85 mmHg or MAP ＜ 85 mmHg,compared with the survivors,all the non-survivors had higher Lac at the 24 hours after admission (P ＜ 0.05),while with lower rLac (P ＜ 0.05).In those with MAP≥85 mmHg,HR was higher in the non-survivors than the survivors (P ＜ 0.05).In those with MAP ＜ 85 mmHg,compared with the survivors,the non-survivors had higher PP,PP/MAP,PP/SBP,PP/DBP,SMP and MDP (P ＜0.05),while with lower DBP (P ＜0.05).Conclusion PP is correlated with the outcome in refractory septic shock patients.When the HR and MAP differ,PP has different effect on the outcome and contributes more to the tissue perfusion and outcome in those with higher HR and lower MAP.
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OBJECTIVE@#To explore the effect of stimulus intensity on auditory event-related potentials (AERP) evoked by tone stimuli and speech stimuli respectively.@*METHOD@#Normal young participants were tested by both tone and speech stimulus with different intensity levels. Range of the intensity for the typical AERP to tone stimuli and speech stimuli were compared. Whether the effect of intensity on,speech stimuli AERP test is the same as that of the tone stimuli were analyzed.@*RESULT@#When intensity level ranged from 40 dBSL to 70 dBSL, typical AERP were recorded more easily with speech stimuli than with tone stimuli (P < 0.01). When stimulated by speech stimuli or by tone stimuli, the latency of P300 decreased with higher intensity, the influences of intensity to P300 latency have significant difference (P < 0.01), but not to P300 peak amplitude.@*CONCLUSION@#The effect of stimulus intensity on AERP evoked by speech stimuli is the same to the tone stimuli, but intensity range for typical AERP of speech stimuli was wider than tone stimuli. It may be resulted from that information contained in speech stimulus is more abundant than that contained in tone stimulus, or subjects were more familiar with speech stimulus than tone stimulus.
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Adult , Female , Humans , Male , Young Adult , Acoustic Stimulation , Methods , Evoked Potentials, Auditory , Physiology , Reaction Time , SpeechABSTRACT
Objective To compare the differences between C-peptide and insulin in evaluation of insulin resistance.Methods From 2003 to 2004,according to oral 75 g glucose tolerance test(OGTT),44 subjects were divided into normal glucose tolerance(NGT)group,isolated impaired fasting glucose(I-IFG)group,isolated impaired glucose tolerance(I-IGT)group and combined impaired glucose tolerance(C-IGT)group.We discussed the relationship between glucose infusion rate(GIR)by hyperinsulin euglycemic clamp and IAI,HOMA-IR,QUICKI(these indexes from fasting insulin level),fasting C-peptide level,respectively.Results (1)GIR of I-IFG,I-IGT,C-IGT groups declined significantly compared with that of NGT group(P0.05).IAI,HOMA-IR and QUICKI of each group were of good relation to GIR respectively(P0.05),whose relative rates were among 0.394~0.042.Conclusion The level of fasting C-peptide has no relationship wiht the degree of insulin resistance.
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Results of experimental studies with guinea pig showed that a strong blast may produce concussion of the vestibular apparatus. The parts injured include saccule and utricle and their maculas, semicircular canals and their cristas,and the nerves related to these organs.The most common pathological changes were hemorrhage, detachment of sensorial epithelium, collapse of membranous labyrinth, loss of oto-liths and degeneration of sensorial epithelial cells.The authors believe that these vestibular damages are produced by the combined action of strong noise and shock wave, being transmitted through the oral and round windows into the inner ear, producing a violent fluctuation of endolymph.