Risk factors analysis of acute renal failure in patients with ECMO / 临床麻醉学杂志

Objective To explore the risk factors of acute renal failure (ARF)in patients with ECMO.Methods Retrospective analysis the patients with ECMO.There were 91 males and 79 fe-males.The age was 18-73 years old.Data of patients'preoperative basic situation(gender,age, history of related diseases,including hypertension,diabetes,heart history),related clinical situations during ECMO period,complications were collected.Patients were divided into two groups according to the ARF occurring.We selected the risk factors which may affect the ARF through the single factor analysis,and then determined the independent risk factors that affected the ECMO ARF by lo-gistic regression analysi.Results This study included 170 cases,91 cases occurred ARF (53.5%). Single factor analysis:the patient with CPR before ECMO,high lactic acid levels pre-ECMO,high inotropic equivalents,large amounts of red blood cells,plasma and platelet transfusion,high C-reac-tive protein levels and high BNP levels during ECMO,long time of ECMO support were associated with patients with ARF.Multiple factors analysis showed that high lactic acid levels pre-ECMO (OR 2.96,95% CI 1.38-6.34),P=0.005),high inotropic equivalents (OR 3.17,95% CI 1.52-6.61, P=0.002)were independent risk factors of ARF in patients with ECMO.Conclusion The patients with ECMO have a high incidence of acute renal failure,large doses of positive inotropic drug and high lactic acid levels are independent risk factors of acute renal failure in patients with ECMO.

Effect of ulinastatin for hepatoprotection following extracorporeal membrane oxygenation / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the effect of ulinastatin in hepatoprotection following extracorporeal membrane oxygenation (ECMO).</p><p><b>METHODS</b>Forty patients with ECMO were randomized into two groups to receive ulinastatin treatment or not. Venous blood samples were collected to test ALT and AST levels following ECMO treatment for 12, 24 and 48 h.</p><p><b>RESULTS</b>The two groups showed no significant difference in liver function indices before ECMO treatment. In both groups, the liver function worsened significantly after a 12-h ECMO treatment, but improved gradually after 24 h. The liver function damages were obviously lessened in ulinastatin group compared to those in patients without ulinastatin treatment (P<0.05). ECMO treatment significantly improved the liver function of the patients.</p><p><b>CONCLUSION</b>ECMO can significantly improve the liver function. The liver function damage reaches the peak level after a 12-h ECMO treatment, and ulinastatin can protect the liver function in patients undergoing ECMO.</p>

Clinical analysis of the effects and the side effects of different patterns of postoperative analgesia / 中国医师进修杂志

ObjectiveTo explore the effects and the side effects of different pattems of postoperative analgesia. MethodsThe data of postoperative analgesia in 725 patients underwent obstetrics and gynecology operation was analysed retrospectively, patient-controlled intravenous analgesia(PCIA) with 352 cases (PCIA group) or patient-controlled epidural analgesia(PCEA ) with 373 cases(PCEA group ). The analgesic effect, sedation scale and side effects were compared. ResultsThe analgesic effect and sedation scale at 12,24 h after operation in PCEA group was lower than that in PCIA group(P ＜0.05). The incidence of vomiting in PCEA group was lower than that in PCIA group [6.4％(24/373) vs. 9.9％(35/352)], the incidence of itchy skin and infection in PCEA group were higher than those in PCIA group [4.8％(18/373)vs. 2.6％ (9/352), 3.2％( 12/373 ) vs. 0], there was significant difference between two groups (P ＜ 0.05 ). Old people fell less pain than wrinkly and young people (P＜0.05). ConclusionsThe effect of PCEA is better than PCIA. Paresthesia is main in PCEA. Vomiting is more in PCIA. Old people feel less pain than wrinkly and young people. So postoperative analgesia is selected by concrete conditions.