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Objective:To evaluate the effect and safety of different heating methods in continuous renal replacement therapy (CRRT) treatment.Methods:One-hundred and twenty critical patients, who hospitalized in the department of ICU of Nanjing University of TCM affiliated Hospital from Nov. 2018 to Aug. 2020, were enrolled in this study and divided randomly and equally into four groups: control group (heated by Prismaflex′s blood warming equipment), group A (heated by spiral-wound case blood warming equipment), group B (heated by 3M Bair Hugger warming carpet) and group C (heated by 3M displacement liquid warming equipment). All the patients were monitored levels of rectal temperature, forehead temperature, and temperatures of CRRT′s arterial and venous ends in 12 hours after CRRT treatment. The rates of low or high temperature and max fluctuation range of temperature were recorded.Results:The highest temperatures of rectal, arterial and venous ends of CRRT in three groups were (37.20±0.23)℃, (37.15±0.35)℃, (37.16±0.24)℃, (37.21±0.35)℃, (37.15±0.31)℃, (37.19±0.23)℃ and (36.49±0.52)℃, (36.36±0.46)℃, (36.68±0.22)℃, respectively. After CRRT treatment, the highest temperatures of rectal in each group were (36.85±0.31)℃, (36.75±0.35)℃ and (36.96±0.21)℃, respectively. The highest temperatures of arterial and venous ends of CRRT in each group were (36.81±0.32)℃, (36.65±0.31)℃, (36.99±0.20)℃, (36.34±0.41)℃, (36.20±0.42)℃ and (36.30±0.28)℃, respectively. The highest temperatures of rectal, arterial and venous ends of CRRT in Group A and C were higher than those in control group. The highest temperatures of rectal and arterial ends of CRRT in Group A and B were lower than those in Group C ( t values were 2.037-4.559, P<0.05). After CRRT treatment, the lowest rectal temperatures in three groups were (36.85±0.31)℃, (36.75±0.35)℃ and (36.96±0.21)℃, respectively. The lowest temperatures of arterial and venous ends of CRRT in three groups were (36.81±0.32)℃, (36.65±0.31)℃, (36.99±0.20)℃, (36.34±0.41)℃, (36.20±0.42)℃ and (36.30±0.28)℃, respectively. The lowest temperatures of rectal, arterial and venous ends of CRRT in Group A and C were higher than those in control group. The lowest temperatures of rectal and arterial ends of CRRT in Group A and B were lower than those in Group C ( t values were 2.032-6.194, P<0.05). After CRRT treatment, the fluctuation of rectal temperatures in three groups were (0.34±0.11)℃, (0.38±0.15)℃ and (0.26±0.11)℃, respectively. The fluctuation of arterial and venous ends of CRRT temperatures in three groups were (0.30±0.14)℃, (0.35±0.23)℃, (0.22±0.14)℃, (0.33±0.16)℃, (0.39±0.23)℃ and (0.26±0.09)℃, respectively. The fluctuation levels of rectal, arterial and venous ends of CRRT in Group A and C were higher than those in control group. The fluctuation levels of rectal and arterial ends of CRRT in Group A and B were lower than those in Group C ( t values were 2.032-6.194, P<0.05). After CRRT treatment, the fluctuation of △RBC in three groups were 0.11±0.07, 0.11±0.06 and 0.09±0.06, respectively. The fluctuation of △Fib in three groups were 0.83±0.32, 0.84±0.28 and 0.60±0.31, respectively. Correlation analysis showed C methods was most related with the fluctuation temperatures of venous ends of CRRT. Conclusion:Heating replacement fluid by 3M blood warming device is proved to be the best way to prevent heat loss in CRRT treatment.
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Objective:To systematically review the effect of Tongfu Xiefei method on prognosis and respiratory mechanics parameters in patients with acute respiratory distress syndrome (ARDS).Methods:The randomized controlled trials (RCT) of Tongfu Xiefei method for ARDS published on PubMed, Web of Science, Embase, CNKI and Wanfang database from January 1st 2001 to June 30th 2019 were searched. Conventional treatment for ARDS that included mechanical ventilation, prone ventilation, anti-infection, organ function maintenance and nutritional therapy were used in the control group. While the Tongfu Xiefei method was applied in the experimental group based on the conventional treatment. The main outcome was in-hospital mortality, and the secondary outcomes included mechanic ventilation time, length of intensive care unit (ICU) stay and respiratory mechanics parameters. Two researchers independently searched the literature, collected data and assessed the risk of bias. The bias risk assessment was completed by RevMan 5.3 software. The Meta-analysis was completed by R software. The potential publication bias of main outcome was evaluation.Results:A total of 27 RCTs were included. There were 1 763 patients, including 899 in the experimental group and 864 in the control group. Meta-analysis showed that, compared with the control group, the in-hospital mortality of the experimental group significantly decreased [relative risk ( RR) = 0.46, 95% confidence interval (95% CI) was 0.36 to 0.59, P < 0.000 1], the mechanic ventilation time and the length of ICU stay were significantly shortened [mechanical ventilation time: standard mean difference ( SMD) = -1.92, 95% CI was -2.56 to -1.29, P < 0.000 1; length of ICU stay: SMD = -1.84, 95% CI was -2.49 to -1.18, P < 0.000 1], oxygenation index was significantly improved ( SMD = 2.26, 95% CI was 1.56 to 2.96, P < 0.000 1), airway peak pressure, airway platform pressure, mean airway pressure and airway resistance significantly decreased (airway peak pressure: SMD = -1.26, 95% CI was -2.35 to -0.18, P = 0.021 8; airway platform pressure: SMD = -0.61, 95% CI was -1.08 to -0.14, P = 0.010 7; mean airway pressure: SMD = - 1.67, 95% CI was - 2.93 to -0.42, P = 0.009 1; airway resistance: SMD = -0.88, 95% CI was -1.09 to -0.67, P < 0.000 1), while lung compliance increased ( SMD = 1.57, 95% CI was 0.78 to 2.36, P < 0.000 1). The results of publication bias assessment showed that there was no potential publication bias ( P = 0.499). Conclusion:Tongfu Xiefei method is capable of reducing the in-hospital mortality, shortening the mechanical ventilation time and the length of ICU stay, and improving respiratory mechanics parameters for patients with ARDS.
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Objective:To evaluate the diagnostic value of ultrasonic measurement of artery peak velocity variation (ΔVpeak) on predicting fluid responsiveness in critically ill patients.Methods:Databases of PubMed, Embase, Cochrane Library, SinoMed, Wanfang, CNKI and VIP were retrieved from the establishment of the database to November 2019. The retrieval literatures were about the research of ΔVpeak used to judge fluid responsiveness. According to the inclusion and exclusion criteria, the relevant literatures were screened by two researchers, and the data of the included literatures were extracted. The quality of literatures was evaluated by quality assessment of diagnostic accuracy studies (QUADAS). Meta Dics 1.4 software was used to analyze the literatures that met the quality standard by Meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio ( DOR) were calculated. The summary receiver operating characteristic (SROC) curve was drawn and the area under SROC curve (AUC) was calculated. The χ 2 test and Spearman correlation coefficient were used to analyze heterogeneity, and Deek test was used to analyze publication bias. Results:A total of 1 854 patients were enrolled in 31 studies, including 11 domestic studies and 20 foreign studies. Using 14 items of QUADAS to evaluate the quality of literatures, it was found that the enrolled literatures were all in Grade A, indicating that the overall quality of literatures was high. The scattered distribution of SROC curve was not "shoulder arm shape", and Spearman correlation coefficient was 0.062 ( P = 0.710), so there was no threshold effect. The heterogeneity test showed that I2 = 57.2% ( P = 0.001), indicating that there was a certain degree of heterogeneity among the studies, and the source of heterogeneity was non threshold effect. Meta regression analysis showed that the reason for heterogeneity was the method of volume load test [ DOR = 3.87, 95% confidence interval (95% CI) was 1.56-9.57, P = 0.004 8]. According to the results of heterogeneity analysis, there was no significant heterogeneity ( I2 = 10.6, P = 0.288 5) among the studies after removing the samples of the passive leg raising (PLR) instead of the volume expansion. A meta-analysis was done with random effects model. The results showed that the pooled DOR was 23.85 (95% CI was 17.57 to 32.37), pooled sensitivity was 0.82 (95% CI was 0.80 to 0.85), pooled specificity was 0.83 (95% CI was 0.80 to 0.85), pooled PLR was 4.17 (95% CI was 3.58 to 4.86), and pooled NLR was 0.22 (95% CI was 0.18 to 0.28). The AUC was 0.901 2 (95% CI was 0.88 to 0.93), and Q index was 0.832 5. The results of Deek funnel plot showed that there was no published bias in all the studies ( P = 0.19). Conclusions:Ultrasonic measurement of ΔVpeak has a high value in predicting fluid responsiveness. It is a reliable parameter for the evaluation of shock, critical illness and surgical operation population who need to monitor the fluid responsiveness.
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Objective To evaluate the effect of high load application of atorvastatin on the clinical outcome of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).Methods Eighty patients diagnosed with AMI were continuously enrolled in this study and randomly divided into two groups:high dose group(n=40) and control group(n=40).Application of high load atorvastatin before operation in loading group.The levels of serum lipid and cardiac function were measured and analyzed.Results The levels of BNP((204±60.3) pg/mL vs.(328.3±67.5) pg/mL;t=1.938,P=0.0315) on 7 days after PCI and levels of LVEF((50.3±6.0)％ vs.(56.9±7.3)％;t=2.169,P=0.019) on 1 month after PCI in high dose group were significantly better than those in control group.Correlation analysis showed that the administration of statin was negatively associated with levels of BNP(r=-0.157,P=0.021) on 7 days after PCI and positively associated with LVEF(r=-0.328,P=0.026) on 1 month after PCI.Conclusion The treatment of high dose statin before PCI may reduce the ischemia-reperfusion injury and prevent the no-reflow development,which therefore improve the cardiac function of AMI patients.