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Objective To evaluate the efficacy of pulse indicator continuous cardiac output (PiC-CO) monitoring in guiding volume therapy in patients with sepsis complicated with acute kidney injury. Methods Eighty-five patients with sepsis complicated with acute kidney injury were divided into PiCCO group (n= 37) and routine group (n = 48) according to whether PiCCO monitoring was used to guide vol-ume therapy. The hemodynamic parameters at 6 and 24 h after volume therapy, fluid volume, consumption of vasoactive drugs, renal function, fatality in intensive care unit and 28-day fatality were recorded. Re-sults Compared with routine group, the volume of fluid for resuscitation at 24 h after volume therapy, and central venous pressure were significantly decreased (P<0. 05), the time of continuous renal replace-ment therapy was shortened, the urine volume was increased, the blood creatinine level was decreased, and the fatality rate in intensive care unit and 28-day fatality rate were decreased in group PiCCO (P<0. 05). Conclusion For the patients with sepsis complicated with acute kidney injury, PiCCO monitoring can reasonably guide volume therapy and is helpful in improving the prognosis.
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Objective To investigate the significance of hypoxia inducible factor lα and lactate and lactate clearance in patients with septic shock.Methods A prospective observational study was conducted.Thirty healthy volunteers (control group) and 40 cases of septic shock patients in EICU were recruited.According to the survival time,40 patients with septic shock were divided into survival group (21 cases,survival time ＞ 28 days) and death group (19 cases,survival time ≤ 28 d).The HIF-lα level was tested by ELISA assay.Lactate level of 0,6,12,24 h in arterial blood were also tested.Lactate clearance rate of the 6 h,12 h and 24 h were calculated.The association of HIF-1α and lactate level and lactate clearance rate,APACHE Ⅱ score and prognosis were evaluated.Results 40 patients with septic shock,20 male and 20 femnales,the mean age was (61.3 ± 12.8) years.The 28 day mortality rate was 47.5％.The average APACHE Ⅱ score was (23.7 ± 4.83) and arterial blood lactate levels was (5.88 ± 2.73) mmol/L.In death group and survival group,the levels of HIF-1α levels and blood lactate were significantly higher than that in the control group (P ＜ 0.05).The death group increased more significantly (P ＜ 0.05).In death group,the 6 h,12 h and 24 h lactate clearance rate were lower than the survival group (all P ＜ 0.01).APACHE Ⅱ score were higher than that in survival group (P ＜ 0.05) and the difference is statistically significant.The lactate and HIF-1α were positively correlated (r =0.868,P ＜ 0.01).Blood lactate and HIF-1α levels were all positively correlated with APACHEⅡ score (r =0.804,P ＜ 0.01) and (r =0.811,P ＜ 0.01).Conclusion The level of HIF-1α,blood lactate,lactate clearance rate are closely related with the severity and prognosis of septic shock and may become an important indicator of the prognosis.
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Objective To investigate the reliability of extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) in assessing the severity of acute respiratory distress syndrome (ARDS) in critically ill patients.Methods Forty-six patients with ARDS,who were admitted in our emergency intensive care unit,aged 18-72 yr,weighing 46-72 kg,of Acute Physiology and Chronic Health Evaluation Ⅱ score 11-25,were divided into 3 groups:PaO2/FiO2 ≤ 100 mmHg severe group (n =16);100 mmHg ＜PaO2/FiO2 ≤ 200 mmHg moderate group (n =14);200 mmHg ＜PaO2/FiO2 ≤ 300 mmHg mild group (n=16).Before treatment,and at 24 and 72 h after diagnosis of ARDS,PVPI,EVLWI,cardiac index (CI),and intrathoracic blood volume index (ITBVI) were measured,and blood gas analysis was performed.PaO2/FiO2 was calculated.The 28 day fatality after admission to hospital was recorded.Person correlation of PVPI and EVLWI with PaO2/FiO2,ITBVI and CI was analyzed.Results The PVPI,EVLWI and fatality rate were significantly higher at each time point in moderate group and severe group than in mild group,and in severe group than in moderate group (P＜0.05).The correlation coefficient between PVPI and PaO2/FiO2 was 0.778,and between EVLWI and PaO2/FiO2 was-0.437 (P＜0.05).There was no correlation between CI and ITBVI (P＞0.05).The correlation coefficient between EVLWI and PaO2/FiO2 was-0.448,and between EVLWI and ITBVI was 0.347 (P＜0.05).There was no significant difference between the correlation coefficient between PVPI and PaO2/FiO2 and the correlation coefficient between EVLWI and PaO2/FiO2 (P＜0.05).Conclusion PVPI and EVLWI both can assess the severity of ARDS in critically ill patients,showing a consistent reliability.
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Objective To study the effects and significance of thrombexane -B_2(TXB_2)and six-ketone-prostaglandin(6-k-PG)F1 α levels in the primary type of hyper-acute cerebral infarction with different sensitivities to aspirin.Methods Sixty-three patients with primary type of hyper-acute cerebral infarction were divided into three groups based on their sensitivities to aspirin:aspirin resistance(AR)group,aspirin semiresistance(ASR)group,aspirin sensitivity(AS)group.TXB_2 and 6-k-PGF1α levels were measured,compared and analyzed in the three groups before and two weeks after taking aspirin(100 mg/d).Results The total effective rate in AS group[87.0%(20/23)]was significantly higher than that in ASR group[55.0%(11/20)]and AR group[30.0%(6/20)](P<0.05).There was no significant difference of TXB_2 and 6-k-PGF1 α among the three groups before taking aspirin.After taking aspirin for two weeks,TXB_2 leveh in all the three groups were lower than those before making aspirin(P<0.01),6-k-PGF1α levels in all the three groups were higher than those before taking aspirin(P<0.01).Conclusions Aspirin can decrease the TXB_2 concentration and increase the 6-k-PGF1α concentration of the primary hyper-acute cerebral infarction. It may be reduce the risks of re-infarction after the primary acute infarction. Monitoring the concentration of TXB_2 and 6-k-PGF1α can be helpful to evaluate rehabilitation prognosis.