ABSTRACT
Objective To observe the clinical efficacy of noninvasive ventilation (NIV) on the treatment of acute respiratory distress syndrome (ARDS) caused by severe pneumonia after kidney transplantation. Methods The clinical data of 17 patients who were diagnosed as ARDS caused by severe pneumonia after kidney transplantation and treated with NIV in Sichuan Provincial People's Hospital from January 1st, 2014 to June 1st, 2016 were collected and retrospectively analyzed. According to the result of NIV treatment, the patients were divided into NIV success group (n = 9) and NIV failure group (n = 8). The differences in gender, age, underlying diseases, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, laboratory parameters on the day when ARDS was diagnosed, daily immunosuppressive dosage, NIV support condition and duration, arterial blood gas analysis and adverse reactions between the two groups were compared. Receiver operating characteristic curve (ROC) was plotted, and the predictive value of each parameters for NIV results was evaluated. Results The two groups were similar in gender, age, and underlying diseases. The APACHEⅡ score, serum levels of procalcitonin (PCT) and brain natriuretic peptide (BNP), serum creatinine (SCr), daily tacrolimus dose, and NIV support condition in NIV failure group were significantly higher than those in NIV success group [APACHEⅡscore: 16.7±5.7 vs. 10.3±2.1, PCT (μg/L): 32.8 (1.2, 187.7) vs. 0.3 (0.1, 2.9), BNP (ng/L): 832.4 (263.7, 1 180.2) vs. 157.0 (33.9, 218.5), SCr (μmol/L): 284.8 (90.5, 474.2) vs. 186.6 (76.7, 206.3), daily tacrolimus dose (mg): 3.6 (3.1, 4.0) vs. 2.6 (2.0, 3.5), inspiratory positive airway pressure (IPAP,cmH2O, 1 cmH2O = 0.098 kPa): 14.8±4.1 vs. 9.0±1.1, expiratory positive airway pressure (EPAP, cmH2O): 7.6±1.8 vs. 4.7±0.8, fraction of inspired oxygen (FiO2): 0.75±0.25 vs. 0.43±0.06, all P < 0.05], and the oxygenation index (PaO2/FiO2) after treatment was significantly lower than that of NIV success group [mmHg (1 mmHg = 0.133 kPa):107.4±65.2 vs. 268.7±98.8, P < 0.05]. There was no significant difference in albumin (Alb), white blood cell count (WBC), daily mycophenolate mofetil dose, use of glucocorticold, NIV duration, pH value, arterial partial pressure of carbon dioxide (PaCO2), or the incidence of sputum drainage disorder or pneumothorax between the two groups. ROC curve analysis showed that the predictive value of APACHEⅡ score, serum PCT and BNP levels, tacrolimus daily dosage and PaO2/FiO2changes after NIV treatment for the efficacy of NIV was high, the area under the ROC curve (AUC) was 0.813, 0.778, 0.903, 0.778, 0.764, respectively; when the cut-off value of APACHEⅡ score was 16.0, PCT was 4.1 μg/L, BNP was 180.5 ng/L, tacrolimus daily dosage was 2.5 mg, PaO2/FiO2increased 49.5 mmHg, the sensitivity was 87.5%, 75.2%, 87.5%, 87.5% and 75.0%, respectively, and the specificity was 77.8%, 66.7%, 88.9%, 74.4%, 88.9%, respectively. However, SCr was not sensitive to the NIV effect prediction. Conclusions NIV in the treatment of ARDS caused by severe pneumonia after kidney transplantation has a certain value. The fewer tacrolimus daily dosage, the lower APACHE Ⅱ score and levels of PCT and BNP, the more effective promotion of PaO2/FiO2after NIV treatment, and the better curative effect is suggested.
ABSTRACT
Objective To analyze the laboratory index characteristics of pulmonary hypertention (PH ) patients with different function states and pressure stages .Methods 2 752 patients diagnosed with PH in the outpatient department ,emergency depart-ment and inpatient department of this hospital from January 2006 to December 2011 were retrospectively analyzed .The clinical as-sessment of the disease condition was done according to the function state and pressure stage of PH recommended by WHO .The characteristics of hematological indexes ,inflammatory indicators and blood gas analysis were observed as well .Results The most common hematological abnormal indexes were the serum brain natriuretic peptide (BNP) elevation(89 .12% ) ,abnormal liver func-tion(58 .32% ) and abnormal hemoglobin(58 .32% ) .The proportion of the PH patients with the elevation of erythrocyte sedimenta-tion rate(ESR) and high-sensitivity C-reactive protein (hs-CRP) were 78 .52% and 73 .59% respectively .The constituent ratio of the BNP increase ,liver function abnormality ,abnormal hemoglobin ,elevation of UA and ESR had statistical differences among the PH patients with different function states and pressure stages (P<0 .05) .The most commonly blood gas analysis abnormality was hypoxemia(83 .08% ) .Respiratory alkalosis had the highest incidence rate in the acid-base imbalance(24 .58% ) .Conclusion The most common hematological abnormal indexes among PH patients are the elevation of serum BNP ,abnormal liver function and he-moglobin abnormality .The laboratory abnormal indexes of above 3 items and the increase of UA and ESR are always related with the severity of disease ,which should to be followed-up .