Correlation between copeptin and the disease severity, outcome and stress hyperglycemia in severe pneumonia patients / 中华急诊医学杂志

Objective To study the changes of plasma copeptin level in pneumonia patients and to explore the correlation between copeptin and disease severity,outcome as well as stress hyperglycemia.Methods A total of 45 patients with severe pneumonia were included in a prospective observation.The plasma levels of copeptin,CRP and blood glucose were measured after admission,and the APACHE Ⅱ scores were recorded within 24 hours.The patients were given insulin therapy by intravenous micro-dosage pump,and the total doses of insulin were recorded.All the patients with 28-day survival were followed up.Results The plasma levels of copeptin of severe pneumonia patients after admission were positively correlated with APACHE Ⅱ (r =0.481,P =0.001) and blood glucose (r =0.417,P =0.004),and were also correlated with the total insulin doses in patients under insulin therapy (blood glucose ≥ 10.0 mmol/L).The plasma levels of copeptin of the survival group were significanatly higher than the non-survival group,COX regression multivariate analysis showed that copeptin was an independent risk factor of death in severe pneumonia patients (P =0.005,OR =1.022,95％ CI:1.00-1.044),and the area under the ROC curve was 0.740 9 (P =0.006).Conclusion The plasma levels in all patients with copeptin of severe pneumonia after admission is positively correlated with APACHE Ⅱ and stress hyperglycemia,suggesting a useful approach to the judgment of disease severity,outcome and glucose control.

Correlation of procalcitonin to the severity of injury, complications and outcome of simple brain trauma patients / 中华急诊医学杂志

Objective To study the changes of serum procalcitonin (PCT) in the patients with simple brain trauma and its relationships with injury of severity, complications and outcome of injury.Methods A total of 120 patients with simple brain trauma were evaluated in a prospective observational study.The serum levels of procalcitonin and C-reactive protein were measured 1,2,3,5,7 and 10 days after the admission.During the following ten days after admission,the clinical data of patients with simple brain trauma were recorded,and also the patients with 28-day survival were followed up.Another 30 healthy subjects were enrolled in normal group for comparison. Results In different periods after trauma,the PCT levels in brain injury patients with different degree of injury severity were significantly different ( P ＜ 0.05 ).During the first two days after admission,there were no significant differences in serum PCT levels between non-infection group and infection group,but significant differences were found between two groups on the 3rd,5th,7th and 10th days ( P ＜ 0.05 ).Kaplan-Meier survival analysis showed the 28 days survival between the group with high PCT level and the group with lower PCT level was statistically significant ( P ＜0.05 ). Conclusions Poor outcomes and complications such as infection were often occurred in simple brain trauma patients with initially high PCT.The frequent determination of serum PCT levels is a useful approach to the judgment of injury severity and proguosis in patients with simple brain trauma.

Clinical efficacy of fluid resuscitation with 75 g/L NaCi solution in traumatic hypovolemic shock:a Meta-analysis of randomized controlled trials / 中华创伤杂志

Objective To investigate the efficacy and safety of fluid resuscitation with 75 g/L NaCl solution in traumatic hypovolemic shock using Meta-analysis. Methods Based on the inclusion criteria,the randomized controlled trials (RCTs) were identified by retrieving the databases including PUBMED,EMBASE,OVID,Cochrane library and EBSCO.The quality of studies was also evaluated.Indices including systolic blood pressure,hemoglobin,serum Na level and mortality were extracted from the enrolled RTCs and were comparatively analyzed between the 75 g/L NaCl group and the isotonic saline group for evaluating the safety and efficacy of 75 g/L NaCI solution.The extracted data were analyzed by using the Review Manager 5.0.25. Results Six RCTs were eligible for Meta-analysis.The 75 g/L NaCl group displayed remarkable increase in systolic blood pressure and decrease in hemoglobin level,compared with the isotonic saline group ( MD =6.23,95％ CI 2.78-9.69,P ＜ 0.01 ; MD =-6.11,95％CI -8.25-3.96,P ＜ 0.01,respectively).Short-term hyperosmolar state in 75 g/L NaCl group was increased significantly but was considered acceptable ( MD =7.97,95％ CI 7.55-8.38,P ＜ 0.01 ).No significant difference in mortality was found between 75 g/L NaCl group and isotonic saline group ( RR =0.96,95％ CI 0.84-1.10,P ＞ 0.05). Conclusion Fluid resuscitation with 75 g/L NaCl solution is safe and effective for traumatic hypovolemic shock.

The use of nasointestinal tube feeding in patients receiving mechanical ventilation / 中国实用内科杂志

Objective To evaluate the effect of nasointestinal tube in patients receiving mechanical ventilation.Methods Patients receiving mechanical ventilation were randomLy divided into two groups.The two groups were isocaloric and isonitrogen.The study group used nasointestinal tube feeding.The control group used nasogastric tube feeding.Nutrition status,ventilator days,aspiration incidence and pneumonia incidence were measured.Results 178 patients receiving me- chanical ventilation were divided into two groups.The study group showed reduction in aspiration incidence and pneumoni- a incidence.Other measurements showed no significant difference.Conclusion Nasointestinal tube feeding could reduce aspiration and pneumonia incidence in patients receiving mechanical ventilation.

Enteral nutrition in critically ill patients with hyperglycemia / 肠外与肠内营养

Objectives:To observe the effect of different formulas of enteral nutrition on the variety of blood glucose and blood lipid in critically ill patients with hyperglycemia. Methods:Ensure, Nutrison and Glucerna were randomly used with equal daily calorie in 45 patients receiving enteral nutrition. Fasting blood glucose, blood routine, serum potassium, serum sodium, serum chlorine, liver and kidney function, prealbumin, tranferrin, urea and creatinine in 24hr urine were monitored in all cases. Results:The fasting blood glucose was significantly increased in patients having received. Ensure and Nutrison and did need insulin treatment. The fluctuation of fasting blood glucose was less in patients who had used Glucerna and didn’t need insulin(P