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In the process of continuous renal replacement therapy (CRRT), various factors such as the temperature of replacement fluid, the flow of fluid and the circulation of blood in cardiopulmonary bypass, lead to the temperature of the blood injected back into the body is often lower than normal. It leads to the decrease of body temperature and the occurrence of hypothermia, which can be life-threatening in severe cases. In clinical practice, medical staff mostly reduces the occurrence of hypothermia in patients with CRRT by means of the heating device of the machine, the heating of the liquid temperature box for cardiopulmonary bypass, and the application of heating blankets, but the effect is not ideal. Therefore, medical staff of the department of critical care medicine of the Second Affiliated Hospital of Anhui Medical University designed a heating device and temperature control system for CRRT dialysis fluid bag, and obtained the National Invention Patent of China (ZL 2021 1 0334906.7). The device includes a heating and thermal insulation device and a temperature control system, wherein the heating and thermal insulation device is composed of the body of the heating dialysis fluid bag and the temperature control structure, which solves the problems of safe and efficient liquid heating and thermal insulation during the CRRT process. The temperature control system can display the dynamic state of the patient's body temperature, adjust the temperature of the dialysis fluid bag in time, and monitor the temperature of the blood transfusion in real time through the cooperation of the five modules of data collection, data handle, data analysis, regulation and display. This design is applied to CRRT, which can achieve precise control of body temperature of critically ill patients, and has certain clinical significance.
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Objective@#To summarize the experience of naso pyloric posterior blind feeding tube and the application value and nursing strategy of gastric fluid reinfusion technique in critically ill patients.@*Methods@#A total of 100 patients with gastroduodenal retention were selected from February 2016 to April 2018 in our hospital. The gastrointestinal dysfunction was classified as class II to grade II, and the daily gastrointestinal decompression amount was more than 500 ml as the research object. All the 100 patients were treated with nasal blinded pylorus tube and were randomly divided into two groups. Based on prevention/control infection and organ function support protection and so on, the self-made modified closed autologous gastric juice retransfusion system was used for enteroenteroenteral retransmission and enteral nutrition treatment, while the patients in the control group only carried out enteral nutrition and did not carry out gastric juice transfusion. The indexes of the patients during the treatment of gastric juice were monitored, including water electrolyte disturbance and acid-base balance disorder, the time required for the total enteral nutrition, the imbalance of intestinal flora, the average number of gastric fluid return and the feeding intolerance, etc., and the complications and the complications during the process of the gastric juice transfusion were recorded. The success rate of nutrient tube after blind pylorus pylorus was analyzed and its causes were analyzed.@*Results@#After naso pylorus pylorus, the success rate of the nutrient tube was 91%. The main reasons for failure included the patients is intolerant of nutrient tube and limited body position. There were no statistical difference in the incidence of dysbacteriosis, aspiration and primary metabolic acid-base disturbance between the experimental group and the control group (P>0.05). In the experimental group, the number of patients with serious electrolyte disturbance, feeding intolerance and the number of days required to achieve total enteral nutrition, and the average number of days required for gastric juice transfusion were 1, 6, 5, (5.74±1.42)d, respectively, were significantly less than those in the control group of 8, 15, 19, (13.94±3.53) d, with statistically significant differences (χ2=-15.239-7.294, P <0.05 or 0.01).@*Conclusions@#In the patients with ICU, it is easy to operate, easy to master, and to reduce the incidence of internal environment disorder and feeding intolerance, which is suitable for clinical popularization.
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Objective To summarize the experience of naso pyloric posterior blind feeding tube and the application value and nursing strategy of gastric fluid reinfusion technique in critically ill patients. Methods A total of 100 patients with gastroduodenal retention were selected from February 2016 to April 2018 in our hospital. The gastrointestinal dysfunction was classified as class II to grade II, and the daily gastrointestinal decompression amount was more than 500 ml as the research object. All the 100 patients were treated with nasal blinded pylorus tube and were randomly divided into two groups. Based on prevention/ control infection and organ function support protection and so on, the self-made modified closed autologous gastric juice retransfusion system was used for enteroenteroenteral retransmission and enteral nutrition treatment, while the patients in the control group only carried out enteral nutrition and did not carry out gastric juice transfusion. The indexes of the patients during the treatment of gastric juice were monitored, including water electrolyte disturbance and acid-base balance disorder, the time required for the total enteral nutrition, the imbalance of intestinal flora, the average number of gastric fluid return and the feeding intolerance, etc., and the complications and the complications during the process of the gastric juice transfusion were recorded. The success rate of nutrient tube after blind pylorus pylorus was analyzed and its causes were analyzed. Results After naso pylorus pylorus, the success rate of the nutrient tube was 91%. The main reasons for failure included the patients is intolerant of nutrient tube and limited body position. There were no statistical difference in the incidence of dysbacteriosis, aspiration and primary metabolic acid-base disturbance between the experimental group and the control group (P>0.05). In the experimental group, the number of patients with serious electrolyte disturbance, feeding intolerance and the number of days required to achieve total enteral nutrition, and the average number of days required for gastric juice transfusion were 1, 6, 5, (5.74±1.42)d, respectively, were significantly less than those in the control group of 8, 15, 19,(13.94±3.53)d, with statistically significant differences (χ2=-15.239-7.294, P <0.05 or 0.01). Conclusions In the patients with ICU, it is easy to operate, easy to master, and to reduce the incidence of internal environment disorder and feeding intolerance, which is suitable for clinical popularization.
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Objective To compare the accuracy of ultrasound,pulse indicator continuous cardiac output monitoring (PiCCO) and traditional methods in predicting fluid responsiveness in septic patients.Methods Forty-six septic patients of both sexes,aged 18-72 yr,requiring mechanical ventilation treatment in the intensive care unit,were enrolled in the study.Venous blood samples were collected for determination of plasma B-type natriuretic peptide (BNP) concentrations by chemiluminescence assay,and central venous pressure (CVP) was recorded.Stroke volume variation (SVVTTE),distensibility index of inferior vena cava (dIVC) and velocity time integral changes of aortic blood flow (△VTI) were measured by ultrasound method.SVVPiCCO and global end-diastolic volume index (GEDVI) were measured by PiCCO method.The patients were divided into negative fluid responsiveness group and positive fluid responsiveness group according to the fluid responsiveness after volume expansion.The receiver operating characteristic curves of the parameters mentioned above in predicting fluid responsiveness were drawn.A consistency check for dIVC,△VTI and SVVPiCCO thresholds was conducted by using Kappa statistics.The agreement between SVVTTEand SVVPiCCO was analyzed by the Bland-Altman analysis.Results There were 24 patients in positive fluid responsiveness group and 22 patients in negative fluid responsiveness group.Compared with negative fluid responsiveness group,the plasma BNP concentration,CVP and GEDVI were significantly decreased,and SVVPiCCO,SVVTTE,dIVC and △VTI were increased before volume expansion in positive fluid responsiveness group (P＜0.05).The area under the curve (95％ confidence interval),sensitivity and specificity of the plasma BNP concentration were 0.894 (0.807-0.981),81.8％ and 79.2％,respectively,of CVP 0.859 (0.752-0.965),81.8％ and 79.2％,respectively,of GEDVI 0.772 (0.628-0.915),72.7％ and 75.0％,respectively,of SVVPiCCO 0.965 (0.922-1.008),95.8％ and 81.8％,respectively,of SVVTTE 0.940 (0.874--1.006),91.7％ and 86.4％,respectively,of dIVC 0.964 (0.920-1.008),83.3％ and 95.5％,respectively,and of △VTI 0.958 (0.909-1.008),87.5％ and 90.9％,respectively.The Kappa value for dIVC threshold and SVVPiCCO threshold was 0.826,and for △VTI threshold and SVVPiCCO threshold was 0.743 (P＜0.01).The mean deviation of SVVTTE and SVVPiCCO was 0.209,95％ confidence interval (-2.967-3.385)％,and the limit of agreement (-2.46-2.62)％ (P＜ 0.05).Conclusion Ultrasound and PiCCO methods can accurately predict fluid responsiveness,have a good agreement and are superior to the traditional method in septic patients.
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Objective To explore the value of predicting fluid responsiveness using velocity time index variation (△VTI) and stroke volume variation (△SV) before and after passive leg raising (PLR)monitored by bedside temporary test equipment (TTE).Methods A cohort of 42 patients supported with mechanical ventilation in our hospital admitted from October 2014 to October 2015 were prospectively selected.The hemodynamic variables including heart rate (HR),mean arterial pressure (MAP),central venous pressure (CVP),VTI,SV and other parameters were monitored before and after after undergoing PLR.Fluid resuscitation volume expansion test was carried out after stroke volume index (SVI) monitored by pulse indicator continuous cardiac output monitoring (PICCO).Patients were divided into fluid responsiveness positive group and fluid responsiveness negative group according to presence or absence of SVI ≥ 15％ after fluid resuscitation volume expansion.Results Of 42 patients,22 belonged to fluid responsiveness positive group,20 got into fluid responsiveness negative group.There were no significant differences in basic clinical data between two groups.Before and after PLR,there were no distinct changes in HR and CVP (P ＞ 0.05),while MAP,VTI and SV increased significantly (P ＜ 0.05) after PLR in fluid responsiveness positive group.Contrarily,there were no noticeable changes in MAP and SV after PLR (P ＞ 0.05),but HR,CVP and VTI increased significantly (P ＜ 0.05) in fluid responsiveness negative group.The degrees of △VTI and △SV in fluid responsiveness positive group were much higher than those in fluid responsiveness negative group (P ＜0.05).According to SVI ≥ 15％ monitored by PICCO after fluid resuscitation volume expansion test as a standard,the area under the ROC (AUC) of △VTI between prePLR and post-PLR was 0.75 (95％ CI:O.593-0.907,P ＜ 0.01),the sensitivity and specificity were 63.6％ and 95％ respectively using △VTI 15.6％ as threshold value.The AUC of △SV was 0.844 (95％CI:O.716-0.972,P ＜0.01),the sensitivity and specificity were 81.8％ and 85.0％ respectively using △SV 10.5％ as threshold value.Conclusion △VTI and △SV monitored by TTE before and after PLR could be employed for predicting fluid responsiveness of critical patients under the status of spontaneous respiration.Their value for prediction of critical patients could be further improved by combined employment of these two indexes of variation.
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Objective To study the killing effect of cytokine-induced killer cells (CIK cells) on human lung adenocarcinoma cell line (A549) and the lung adenocarcinoma' s radiation resistant cell line (A549RR).Methods Peripheral blood mononuclear cells (PBMC) of healthy volunteers were stimulated by different cytokines,and were induced into killer activity CIK cells.The phenotype of CIK cells were analyzed by flow cytometer.A549 and A549RR cell lines were cultured separately with the CIK cells.The absorbance value (A) of the cells was measured by CCK8,and the killing rates of all cells which were cultured for 24 and 48 hours with the CIK were calculated.Results The rate of CD3+ CD56+ cell was 45.8 ％ after culture for 14 d.The killing rates of CIK cells to lung adenocarcinoma A549 cells and its radiation resistant cells A549RR were increased with the rise of the ratio of effective cells to target (5∶1-40∶1) and the increasing of culturing time (all P ＜ 0.001).The killing effect of CIK to A549 and A549RR cells had no obvious difference in the same culturing time and the same ratio of effective cells to target(all P ＞ 0.05).Conclusion CIK cells have strong anti-tumor effect against lung adenocarcinoma and its radiation resistant cells with high clinical application value.