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Objective:To explore the difference of coagulation function and its correlation with prognosis in patients with acute respiratory distress syndrome (ARDS) caused by extrapulmonary sepsis and pulmonary infection.Methods:ARDS patients caused by extrapulmonary sepsis and pulmonary infection admitted to the ICU were retrospectively analyzed at the First Affiliated Hospital of China Medical University from July 2017 to June 2019. The clinical characteristics were collected including sequential organ failure assessment (SOFA), coagulation parameters [prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (Fib), D-Dimer (D-D), fibrinogen degradation product (FDP), antithrombin Ⅲ(AT-Ⅲ), platelet (PLT)], duration of mechanical ventilation, length of stay (LOS) in ICU and 28-day mortality. According to the risk factors, the patients were divided into extrapulmonary sepsis group and pulmonary infection group. The correlation analysis between coagulation parameters and the prognosis of ARDS patients were analyzed by multivariate logistic regression analysis.Results:A total of 268 ARDS patients were screened and 28 cases were excluded. Finally, 240 ARDS patients were enrolled, including 145 caused by extrapulmonary sepsis and 95 by pulmonary infection. PT, INR and APTT in the extrapulmonary sepsis group were significantly higher than those in pulmonary infection group ( P<0.05). AT-Ⅲ level was lower than that in pulmonary infection group ( P<0.05). Ninty-three patients survived at 28 days in the non-pulmonary sepsis group, the mortality rate was 35.9% (52/145). PT, INR, APTT in patients who died at 28 days were significantly higher than those of the patients who survived ( P<0.05), while AT-Ⅲ level was lower than those of the patients who survived ( P<0.05). 49 patients survived at 28 days in the pulmonary infection group, the mortality rate was 48.4% (46/95). There was no significant difference in the coagulation parameters between two groups. Multivariate logistic regression analysis showed that SOFA score without PLT( OR=1.210,95% CI 1.067-1.372, P=0.003) and INR ( OR=2.408,95% CI 1.007-5.760, P=0.048) were independent risk factors for 28-day mortality in extrapulmonary sepsis group. Coagulation parameters are not independent risk factors for 28-day mortality in ARDS patients related to pulmonary infection. Conclusion:There are significant differences in coagulation function between ARDS patients caused by extrapulmonary sepsis or pulmonary infection. INR is an independent risk factor for 28-day mortality in extrapulmonary sepsis group.
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Objective:To investigate the implementation of the currently recognized and effective treatment strategies for acute respiratory distress syndrome (ARDS) in Liaoning Province in order to improve the clinical implementation of ARDS treatment strategies.Methods:From January 1st to January 31st, 2019, doctors from the department of critical care medicine of the First Affiliated Hospital of China Medical University applied the self-designed Questionnaire about critical care physicians' clinical behaviors on ARDS patients to investigate the critical care physicians in all levels of hospitals in Liaoning Province. The questionnaire was sent and retrieved in the form of Email and WeChat applet. The investigation included physicians' basic information and treatment behavior. The treatment strategies included 25 multiple-choice questions, such as ventilator mode, sedation, analgesia and other related questions about ARDS patients with different severities. Results:Totally 160 questionnaires were retrieved in this study, 14 questionnaires with a completion rate of less than 75% were excluded, and there were totally 146 questionnaires finally accepted. The surveyed 146 critical care physicians came from 28 hospitals in Liaoning Province, and the majority were 25-44 years old (80.2%) and attending physicians (34.2%). Years of medical service and intensive care units (ICU) service were mainly less than 5 years (31.5% and 43.9%, respectively). 88.4% of the hospitals were Grade Ⅲ Level A hospitals, 89.0% were teaching hospitals, and 48.6% had more than 2 000 beds. The number of ICU beds was mainly 10-19 (39.0%), and only 4.1% had over 60 beds. 77.2% of the hospitals did not have respiratory therapists, however there were 19.1% of the hospitals owning 1-4 respiratory therapists. Most physicians had positive implementation of currently recognized effective treatment strategies in ARDS, yet some of them still depended on the severity of the patients. More than 80% of the physicians monitored the peak pressure, plateau pressure and respiratory compliance of all ARDS patients (no significant differences between severity of illness). The control range of above monitoring indicators would be changed with patients' condition. Half of the physicians controlled the peak pressure of mild ARDS patients at 20-29 cmH 2O (1 cmH 2O = 0.098 kPa) and plateau pressure at 15-34 cmH 2O. However, for severe patients, more physicians chose peak pressure and plateau pressure of 30-39 cmH 2O (67.8%) and 25-34 cmH 2O (70.3%) respectively. For the moderate to severe ARDS patients, majority of the physicians had positive implementation in improving oxygenation, choosing positive end expiratory pressure (PEEP) and applying low tidal volume (LVT) strategy, while conservative method was put toward on mild patients. For severe patients, 97.3% of the physicians preferred immediate invasive mechanical ventilation, 92.4% ensured tidal volume below 8 mL/kg, 61.7% chose PEEP of 15-20 cmH 2O, 97.8% applied deep sedation, 82.5% chose neuromuscular blocking agents, 82.3% preferred to prone positioning ventilation, and 84.3% of the physicians chose to use hormone therapy. For mild ARDS patients, 77.2% of the physicians chose LVT strategy and mostly control PEEP at 5-9 cmH 2O. There were three main reasons that affect the physicians' implementation. The first reason was physicians' subjective attitude, the second was lacking in execution conditions, and the third was physicians' considering of the complications. Conclusions:Most critical care physicians in Liaoning Province had positive implementation toward the currently recognized effective ARDS treatment strategies, but a few performed poorly. According to the reasons that affected the physicians' treatment behaviors, it is necessary to strengthen physicians' awareness of treatment, apply strict training, standardize the clinical implementation of effective treatment strategies, and then improve the prognosis of ARDS patients.
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Objective To evaluate clinical significance of the grade of ischemia by QRS complex on the admission electrocardiogram(ECG)to predict severe arrithmia in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods Patients with acute ST-segment elevation myocardial infarction(STEMI)admitted to emergency department from July 2003 to April 2008 were enrolled.A total of 223 patients met the criteria(ischemic chest pain ≥ 30 min,2 or more adjacent leads of ST segment elevation and onset time within 12 h).Exclusion criteria were bundle branch block and left ventricular hypertrophy.All enrolled patients were divided into two groups based on the enrollment electrocardiogram:grade 2 ischemia(ST elevation without terminal QRS distortion; n =134)and grade 3 ischemia(ST elevation with terminal QRS distortion; n =89).Patients of the two groups had comparable genderproportion,average age and coronary heart disease risk factors etc.All patients received thrombolytic therapy.The incidence rate of ST segment resolution(STR)and severe arrithmia in hospital stay were observed.Numerical variables were expressed mean ± standard deviation and compared by unpaired Student't test,Categorical variables were expressed percentage and compared by chi square test.Multiple logistic regression analysis was used to determine independent predictors of severe arrithmia.Results Patients with grade 3 ischemia had greater Σ ST on admission and 2 h after thrombolysis ECGs(P ＜ 0.01),the incidence rate of STR in patients with grade 3 ischemia was lower than that in patients with grade 2 ischemia(P ＜0.01).The peak creatine kinase MB fraction was higher in patients with grade 3 ischemia than that in patients with grade 2 ischemia(P ＜ 0.01).There was no significant difference of the incidence of severe arrithmia,such as ventricular premature beat,ventricular tachycardia or fibrillation,second-degree or third-degree atrioventricular block,and sinus arrest between the two groups(P ＞ 0.05),but there was a trend of higher incidence of severe arrithmia in patients with grade 3 ischemia compared with that in patients with grade 2 ischemia.Multiple logistic regression analysis demonstrated that the independent predictors of severe arrithmia were duration from symptom to thrombolysis and initial.Σ ST,whereas grade 3 ischemia remained a strong predictor of severe arrithmia.Conclusions Grade 3 ischemia on admission is associated with lower incidence of STR in patients with ST-segment elevation myocardial infarction(STEMI)after thrombolysis and a strong predictor of severe arrithmia.
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Objective To investigate the effects of N - acetylcysteine (NAC) on apoptosis and the expressions of Fas/FasL mRNA in lung tissue of rats with paraquat - induced acute lung injury.Methods Forty five male SD rats were randomly (random number) divided into normal control group,paraquat (PQ) group,and NAC treatment group.The rat model of acute lung injury was made with 2％ PQ induction in dose of 25 mg/kg injected,and NAC was injected into the PQ poisoning rats (200 mg/kg) 30 minutes after PQ administration in NAC treatment group.In the control group,equal amount of saline instead was injected into the rats.Apoptosis was detected by using TUNEL method and the expressions of Fas/FasL mRNA were evaluated by using reverse transcription polymerase chain reaction (RT- PCR),and the levels of Fas/FasL protein were detected by using western blot analysis.Results Compared with control group,cell apoptosis and expressions Fas/FasL mRNA in PQ group were significantly different ( P ＜ 0.05 ).Compared with PQ group,cell apoptosis and expressions Fas/FasL mRNA in NAC group were significantly decreased,were significant lower (P ＜ 0.05).Conclusions NAC inhibited apoptosis in lung tissue of rats with paraquat induction by regulating the activation of Fas/FasL systems.