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OBJECTIVE@#To investigate the incidence and risk factors of hypothermia in patients with acute renal injury (AKI) receiving continuous renal replacement therapy (CRRT), and to compare the effects of different heating methods on the incidence of hypothermia in patients with CRRT.@*METHODS@#A prospective study was conducted. AKI patients with CRRT who were admitted to the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital) from January 2020 to December 2022 were enrolled as the study subjects. Patients were divided into dialysate heating group and reverse-piped heating group according to randomized numerical table method. Both groups were provided with reasonable treatment mode and parameter setting by the bedside physician according to the patient's specific condition. The dialysis heating group used the AsahiKASEI dialysis machine heating panel to heat the dialysis solution at 37 centigrade. The reverse-piped heating group used the Barkey blood heater from the Prismaflex CRRT system to heat the dialysis solution, and the heating line temperature was set at 41 centigrade. The patient's temperature was then continuously monitored. Hypothermia was defined as a temperature lower than 36 centigrade or a drop of more than 1 centigrade from the basal body temperature. The incidence and duration of hypothermia were compared between the two groups. Binary multivariate Logistic regression analysis was used to explore the influencing factors of hypothermia during CRRT in AKI patients.@*RESULTS@#A total of 73 patients with AKI treated with CRRT were eventually enrolled, including 37 in the dialysate heating group and 36 in the reverse-piped heating group. The incidence of hypothermia in the dialysis heating group was significantly lower than that in the reverse-piped heating group [40.5% (15/37) vs. 69.4% (25/36), P < 0.05], and the hypothermia occurred later than that in the reverse-piped heating group (hours: 5.40±0.92 vs. 3.35±0.92, P < 0.01). Patients were divided into hypothermic and non-hypothermic groups based on the presence or absence of hypothermia, and a univariate analysis of all indicators showed a significant decrease in mean arterial pressure (MAP) in hypothermic patients (n = 40) compared with the non-hypothermic patients [n = 33; mmHg (1 mmHg ≈ 0.133 kPa): 77.45±12.47 vs. 94.42±14.51, P < 0.01], shock, administration of medium and high doses of vasoactive drug (medium dose: 0.2-0.5 μg×kg-1×min-1, high dose: > 0.5 μg×kg-1×min-1) and CRRT treatment were significantly increased [shock: 45.0% (18/40) vs. 6.1% (2/33), administration of medium and high doses of vasoactive drugs: 82.5% (33/40) vs. 18.2% (6/33), administration of CRRT (mL×kg-1×h-1): 51.50±9.38 vs. 38.42±10.97, all P < 0.05], there were also significant differences in CRRT heating types between the two groups [in the hypothermia group, the main heating method was the infusion line heating, which was 62.5% (25/40), while in the non-hypothermia group, the main heating method was the dialysate heating, which was 66.7% (22/33), P < 0.05]. Including the above indicators in a binary multivariate Logistic regression analysis, it was found that shock [odds ratio (OR) = 17.633, 95% confidence interval (95%CI) was 1.487-209.064], mid-to-high-dose vasoactive drug (OR = 24.320, 95%CI was 3.076-192.294), CRRT heating type (reverse-piped heating; OR = 13.316, 95%CI was 1.485-119.377), and CRRT treatment dose (OR = 1.130, 95%CI was 1.020-1.251) were risk factors for hypothermia during CRRT in AKI patients (all P < 0.05), while MAP was protective factor (OR = 0.922, 95%CI was 0.861-0.987, P < 0.05).@*CONCLUSIONS@#AKI patients have a high incidence of hypothermia during CRRT treatment, and the incidence of hypothermia can be effectively reduced by heating CRRT treatment fluids. Shock, use of medium and high doses of vasoactive drug, CRRT heating type, and CRRT treatment dose are risk factors for hypothermia during CRRT in AKI patients, with MAP is a protective factor.
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Humans , Continuous Renal Replacement Therapy , Incidence , Prospective Studies , Acute Kidney Injury , Dialysis SolutionsABSTRACT
Objective:To observe the application effect of high-flow nasal canula oxygen therapy (HFNC) after extubation in patients with mechanical ventilation (MV) in the intensive care unit (ICU).Methods:A prospective study was conducted. From January 2018 to June 2020, 163 MV patients admitted to Yijishan Hospital of Wannan Medical College were enrolled, and they were divided into HFNC group (82 cases) and traditional oxygen therapy group (81 cases) according to the oxygen therapy model. The patients included in the study were given conventional treatment according to their condition. In the HFNC group, oxygen was inhaled by a nasal high-flow humidification therapy instrument. The gas flow was gradually increased from 35 L/min to 60 L/min according to the patient's tolerance, and the temperature was set at 34-37 ℃. The fraction of inspiration oxygen (FiO 2) was set according to the patient's pulse oxygen saturation (SpO 2) and SpO 2 was maintained at 0.95-0.98. A disposable oxygen mask or nasal cannula was used to inhale oxygen in the traditional oxygen therapy group, and the oxygen flow was 5-8 L/min, maintaining the patient's SpO 2 at 0.95-0.98. The differences in MV duration before extubation, total MV duration, intubation time, reintubation time, extubation failure rate, ICU mortality, ICU stay, and in-hospital stay were compared between the two groups, and weaning failure were analyzed. Results:There was no significant differences in MV duration before extubation (days: 4.33±3.83 vs. 4.15±3.03), tracheal intubation duration (days: 4.34±1.87 vs. 4.20±3.35), ICU mortality [4.9% (4/82) vs. 3.7% (3/81)] and in-hospital stay [days: 28.93 (15.00, 32.00) vs. 27.69 (15.00, 38.00)] between HFNC group and traditional oxygen therapy group (all P > 0.05). The total MV duration in the HFNC group (days: 4.48±2.43 vs. 5.67±3.84) and ICU stay [days: 6.57 (4.00, 7.00) vs. 7.74 (5.00, 9.00)] were significantly shorter than those in the traditional oxygen therapy group, the reintubation duration of the HFNC group was significantly longer than that of the traditional oxygen therapy group (hours: 35.75±10.15 vs. 19.92±13.12), and the weaning failure rate was significantly lower than that of the traditional oxygen therapy group [4.9% (4/82) vs. 16.0% (13/81), all P < 0.05]. Among the reasons for weaning failure traditional oxygen therapy group had lower ability of airway secretion clearance than that of the HFNC group [8.64% (7/81) vs. 0% (0/82), P < 0.05], there was no statistically differences in the morbidity of heart failure, respiratory muscle weakness, hypoxemia, and change of consciousness between the two groups. Conclusion:For MV patients in the ICU, the sequential application of HFNC after extubation can reduce the rate of weaning failure and the incidence of adverse events, shorten the length of ICU stay.
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Objective To evaluate the clinical value of hs-CRP,Tbil and BUA in the diagnosis of coronary atherosclerosis on 320 slice dynamic volume computed tomography(320-DVCT).Methods 160 patients with stable angina pectoris were included.All patients underwent 320-DVCT coronary artery imaging and laboratory testing including plasma hs-CRP,Tbil and BUA.The plaques of coronary artery were classified as soft plaque,fibrous plaque and calcified plaque on CT values.The three indicators were used to confirm the ability of diagnosis on number of lesions,plaque character and the degree of stenosis.100 healthy persons served as the control group.Results With the concentration of hs-CRP,BUA increased and Tbil concentration decreased,the number and the stenosis degree of coronary lesions became increased,and easier to form a soft plaque.Conclusion The hs CRP,Tbil and BUA can offer the accurate diagnosis of lesions number,plaque character and stenosis degree of the coronary artery,which is showed on 320-DVCT.The hs-CRP,Tbil and BUA are conducive to the risk assessment of coronary atherosclerosis.
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Objective To observe the expression of CD166 in advanced non-small cell lung cancer (NSCLC),and to explore the relationship between expression of CD166 and clinical characteristics,platinum-based chemotherapy effect of NSCLC patients.Methods A total of 64 cases of NSCLC patients at stage of Ⅲ,Ⅳ were enrolled.Tumor tissue samples were obtained before chemotherapy by bronchoscopy or lung biopsy,and immunohistochemical was used to detect the expression of CD166.All patients received platinum-based chemotherapy(NP/TC/ GP) for 2-4 cycles as the first line treatment.RECIST criterion was used for therapeutic evaluation.Results 46.9% (3 0 cases) of the patients with CD 1 6 6 was positive.The CD 1 6 6 expression was related with smoking (smoking 62.1%,no-smoking 34.3%,x2 =4.916,P =0.027) and degree of differentiation (moderately,low grade 68.2%,high grade 35.7%,x2 =6.112,P =0.013).The effectiveness rate of chemotherapy in CD166 positive patients was 23.3% (7 cases),was significantly lower than 61.8% in CD166 negative patients(21 cases,x2 =9.565,P =0.002).Conclusion NSCLC had CD166 expression,and the expression positive rate was increased in patients with smoking,and low differentiation cancer.The effectiveness rate of platinum-based was decreased in patients with CD166 positive expression,and detection of CD166 can predict the late NSCLC platinum-based chemotherapy effect.
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Objective To investigate the effect of hyperthermia on human hepatocellular carcinoma cell line SMMC-7721 after down-regulating the expression of mTOR,and its possible mechanisms.Methods An antisense mTOR (mammalian target of rapamycin) gene eukaryotic expression vector was transfected into SMMC-7721 cells.The expression of mTOR mRNA and protein were detected using RT-PCR and Western blotting,respectively.Hyperthermia was applied after the transfection,and the vitality of cell proliferation was evaluated using CCK-8 assays and the clone formation rate was determined by colony-forming assays.The migration of SMMC-7721 cells was measured using scratch assays.Apoptosis and the cell cycle were analyzed by flow cytometry.Results The expression of mTOR mRNA and protein were significantly decreased after transfection,indicating that the antisense vector could down-regulate the mTOR gene effectively.The proliferation,clone formation and migration of SMMC-7721 cells all were decreased markedly by hyperthermia after transfection.Flow cytometry showed that the rate of apoptosis was significantly increased.The number of cells in the S phase was increased and the cell cycle was induced to arrest at the S phase.Conclusions Down-regulating the expression of mTOR can increase the thermosensitivity of SMMC-7721 cells.The mechanism involves increased apoptosis and S phase arrest.
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Objective To evaluate the efficacy of whole body hyperthermia(WBH) in the treatment of advanced hepatic carcinoma and its effect on liver function.Methods From 2001 to 2004,39 cases of advanced hepatic carcinoma were treated with WBH.The effect of WBH on liver function was assessed by liver function test before and after treatment.Results ①The effective rate of WBH was 61.5%(24/39) in the treatment of advanced hepatic carcinoma with declined AFP in 60.0%(9/15) of patient and 100% of patients had pain relieve.The survival rates of 6 months,1 year and 2 years were 76.9%(30/39),59.0%(23/39) and 12.8%(5/39),respectively.②Alanine aminotransferase(ALT) elevated obviously in 1-3 d after treatment(P
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Objective: To investigate jugular bulb venous oxyg en partial pressure(PjO2)， hemoglobin saturation (SjO2) and the arterial t o jugular bulb venous oxygen content difference(AjDO2) during anesthesia with desflurane and isoflurane in patients with brain tumor. Methods: Fifty-six patients with brain tumor were randomized into desflur ane or isoflurane for maintaining anesthesia. PjO2, SjO2 and AjDO2 in pati ents were measured during normoventilation, hyperventilation and hypoventilation . Results: During normoventilation， SjO2 and PjO2 in desflu rane group was significantly higer than those in isoflurane group（P<0.05 or P<0.01）, and AjDO2 in desflurane group was significantly lower than that in isoflurane group（P<0.05）.Except that PjO2 in desflurane group was si gnificantly higer than that in isoflurane group during hyperventilation （P< 0.01）, there were no differences in SjO2, PjO2 or AjDO2 between the 2 g roups during hyperventilation or hypoventilation. While anesthesia with desflura ne and isoflurane, there was a positive correlation between PaCO2 and SjO2. Conclusion: At the same anesthetic effect concentration, desflur ane can significantly increase SjO2 and PjO2 in comparison to isoflurane un der normoventilation, suggesting that desflurane may have stronger effect of rel axing cerebral vessel than isoflurane.
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Objective: To observe the controlled hypotension effects of nicardipine in 2 different ways for spinal tumor operalion. Methods: Twenty-four adult patients, scheduled for selective spinal tumor operation, were randomly divided into 2 groups. In groupⅠ(n=12), the nicardipine was infused at a rate of 10 μg*kg-1*min-1 and the infusion continued until MAP was at the level of 7.33-8.66 kPa, and then the rate was decreased to 1 μg*kg-1*min-1. In Group Ⅱ(n=12), nicardipine was given 0.01-0.02 mg/kg as the load dose, then infused at 1-2 μg*kg-1*min-1. Results: During the period of controlled hypotension, cardiac index(CI) increased significantly, other hemodynamic variables were stable and no hypertension rebound occurred in both groups. Reaching time of target blood pressure in groupⅡ was shorter than that in groupⅠ（P＜0.05）. The dose required to obtain target blood pressure in group Ⅱwas less than that in group Ⅰ（P＜0.05）. BP recovery time from discontinuing nicardipine infusion to pre-hypotension level,bleeding volume and transfusion volume were similar between 2 groups（P＞0.05）.During mass bleeding, serious arrhythmia and oliguria did not occur in any case. Conclusion: Controlled hypotension with nicardipine is rapid, stable and easily controlled without hypertension rebound. Nicardipine has considerable protective effects on heart and kidney during mass bleeding. The method of bolus injection followed with intravenous infusion is more suitable to clinical application.
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Objective To induce highly active hepatocellular carcinoma (HCC) specific cytotoxic T-lymphocyte (H-S-CTL) lines by co-culture of lymphocytes and hepatocellular carcinoma cells. Methods H-S-CTL were established by co-culture of autologous HCC cells and lymphocytes, under stimulation of IL-1,IL-2,IL-4 and IL-6.The cytotoxic activity of H-S-CTL for target cells were detected by 51Cr release assay and indirect immunofluorescence assay. Results Compared with auto-LAK, H-S-CTL showed much higher antitumor activity of significantly increased CD3+, CD4+ and CD8+ cells. Conclusions H-S-CTL lines with massive proliferations and high antitumor activity can be successfully obtained by ex vivo co-culture under the stimulation of interlukins.
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Objective:To discuss the early diagnosis of malignant hyperthermia(MH) and its treatment regimen without dantrolene.Methods: A patient of American Society of Anesthesiologist class Ⅰhad sudden muscle spasms and masseter muscle spasm during induction of anesthesia for idiopathic scoliosis surgery,and was diagnosed as having MH.Without using dantrolene,the patient was treated promptly with removal of inducement,control of temperature,adequate oxygen supply,maintaining of pH,water and electrolyte balance,and protection of renal function.The dynamic changes of the myoglobin in the blood and urine,serum creatine kinase,the blood gas indicators,and EtCO2,together with the pathological changes of the quadriceps were observed.Our experience on diagnosis and treatment was summarized.Results: The patient fully recovered and was discharged without any complications.The myoglobin in the blood and urine,serum creatine kinase and its isoenzyme increased rapidly and reached the peak one hour after MH,and maintained for about ten hours,then returned gradually to normal level about five days later.The temperature and EtCO2 increased immediately after development of MH,arterial blood gas quickly showed hypercapnic acidosis,but pH maintained normal or partial alkali during the treatment due to sodium bicarbonate administration;the alkali maintained obviously higher.Some quadriceps muscle cell had vacuolar degeneration and lysis.Conclusion: Non-ventilation induced increase of EtCO2 is a reliable indicator for early diagnosis of MH.Anesthetics,such as succinylcholine,should be avoided in patients at high risk of MH,and EtCO2 should be monitored.Once MH is diagnosed,dantrolene is the first choice.When without dantrolene,satisfactory outcome can be achieved through early diagnosis,timely removal of incentives,control of temperature,adequate oxygen supply,maintaining of stable internal environment,control of arrhythmia and protection of renal function.