ABSTRACT
Objective:To evaluate the efficacy of roxatidine and omeprazolein on preventing gastrointestinal bleeding in critically ill patients.Methods:A prospective cohort study was conducted in adult patients admitted to an intensive care unit (ICU), who had risk factors for stress related mucosal disease (SRMD), and had an estimated stay of no less than 5 days and mechanical ventilation for more than 48 h. Patients were randomized into the experiment group (Roxatidine 75 mg IV Q12 h) and control group (Omeprazole 40 mg IV Q12 h). Demographic data, acute physiology and chronic health score (APACHEⅡ) and SOFA score on day 1 were collected, intragastric pH values were tested every 2 hours for the first 5 days, the daily average of pH and proportion of patients with average pH≥4 were calculated. Stool occult blood were detected at day 1 and bacterial culture of gastric juice were performed before medication administration and on day 5 after medication administration. The implementation of enteral nutrition support, situation of gastrointestinal hemorrhage and adverse effects were analyzed. Furthermore, length of hospital stay and mortality in ICU and on the 28th day were acquired. SPSS 22.0 software was used for data analysis. Consecutive data were expressed as mean and standard deviation, categorical data were expressed as frequencies (percentage). Comparison of measurement data between groups was performed by analysis of variance or rank sum test. Comparison of count data between groups was performed by the Chi-square test. P<0.05 was regarded as statistically significant. Results:A total of 91 patients were recruited and randomly separated into experimental group ( n=46) and control group ( n=45) from October 2017 to March 2018. There were no statistical differences in gender, age, body mass index (BMI), enteral nutrition status, APACHEⅡ and SOFA score on day 1 between the two groups (all P>0.05). Roxatidine in the experiment group rapidly increased the intragastric pH to ≥4.0 and continued to stabilize at pH ≥4.0 during the monitoring period. Omeprazole increased and maintained intragastric pH≥5.0. The proportion of patients with average pH≥4.0 was 82.5% in the second 24 hours in the experiment group, and stably increased to 90% on day 5. There were no significant differences between groups in gastrointestinal bleeding, length of hospital stay, and mortality in ICU and on 28th day(all P> 0.05). No drug related adverse effects occurred during the study period. Logistic-regression analysis did not screen for risk factors of SRMD. Conclusions:Roxatidine acetate hydrochloride can rapidly elevate and maintain the gastric pH above 4.0, and has similar efficacy and safety as omeprazole in inhibiting gastric acid secretion and preventing SRMD with gastrointestinal bleeding.
ABSTRACT
This paper reviewed recent advances in clinical and basic researches of scalp acupuncture based on evoked potentials (EPs).The role and significance of various EPs in scalp acupuncture were analyzed and compared.Eventrelated potentials (ERPs) which occupied leading position in EPs application nowadays and the latest advances in the related components of its action were combined to make a prospect of the scientific research methods of scalp acupuncture in the treatment of cerebral apoplexy and other diseases.
ABSTRACT
This study was aimed to explore the immediate effect mechanism of the middle 2/5 of the vertex-temporal anterior oblique line in the treatment of stroke by scalp acupuncture using event-related brain potential (ERP).A total of 30 stroke cases who met the inclusion criteria and 25 healthy subjects were selected.Patients in both groups were treated by scalp acupuncture,with stimulation on the middle 2/5 of the vertex-temporal anterior oblique line on the right side.ERP was detected before acupuncture and 10 min after acupuncture in both groups.The muscle strength and neurological deficit score of the stroke group were also detected.At the end of the experiment,the movement-related cortical potentials (MRCPs) of both the left and right hand were extracted from the ERP.The results showed that after 10 min scalp acupuncture stimulation,the neurological deficit score of the stroke group was lower than that of the pretreatment (P ＜ 0.05);the muscle strength rating was higher than before (P ＜ 0.05).Before and after acupuncture,the amplitude of MRCPs on the diseased side of the stroke group was significantly decreased compared to before (P ＜ 0.05).It was concluded that the immediate effect of scalp acupuncture treatment of hemiplegia patients with stroke was definite.Its mechanism may be that acupuncture stimulates the motor cortex through the vertex-temporal anterior oblique line,reduces the energy loss of brain motion planning,activates the damaged brain movement related area cortex neurons,improves the processing efficiency of movement in the brain,so as to promote the improvement of hemiplegic limb motor function immediately.And we also observed that the healthy side brain has a compensatory effect,which suggested that in our clinical scalp acupuncture,bilateral stimulation may be more effective.