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1.
Chinese Critical Care Medicine ; (12): 654-658, 2021.
Article in Chinese | WPRIM | ID: wpr-909378

ABSTRACT

Objective:To investigate the predictive value of heparin binding protein (HBP) for sepsis.Methods:From June 2019 to December 2020, 188 patients admitted to the department of emergency of Hunan Provincial People's Hospital were enrolled. The patients were divided into non-sepsis group (87 patients) and sepsis group (101 patients) according to Sepsis-3 criteria. Gender, age, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), HBP, sequential organ failure assessment (SOFA) score, quick SOFA (qSOFA) score, modified early warning score (MEWS) and patients' recent medication history were recorded, the differences in the above indicators between the two groups were compared. The risk factors of sepsis were analyzed by Logistic regression. Spearman correlation analysis was used to analyze the correlation between HBP, PCT, CRP and SOFA score to evaluate the predictive value of HBP, PCT and CRP for the severity of septic organ failure. Receiver operating characteristic curve (ROC curve) were drawn to evaluate the diagnostic value of HBP, PCT and CRP for sepsis.Results:Compared with the non-sepsis group, the sepsis group had significantly higher levels of HBP, PCT, CRP, WBC, SOFA score, qSOFA score, and MEWS [HBP (μg/L): 55.46 (24.57, 78.49) vs. 5.90 (5.90, 9.01), PCT (μg/L): 6.83 (1.75, 30.64) vs. 0.23 (0.12, 0.75), CRP (mg/L): 67.35 (26.23, 123.23) vs. 4.45 (2.62, 47.22), WBC (×10 9/L): 11.84 (7.18, 16.06) vs. 6.58 (5.47, 8.99), SOFA score: 6 (4, 8) vs. 0 (0, 0), qSOFA score: 2 (1, 3) vs. 0 (0, 1), MEWS: 4 (3, 6) vs. 1 (0, 2)], the length of hospital stay was significantly prolonged [days: 10 (4, 17) vs. 0 (0, 7)], and the mortality was significantly increased [29.7% (30/101)vs. 4.6% (4/87)], with statistical significance (all P < 0.05). Correlation analysis showed that HBP, PCT and CRP were significantly positively correlated with SOFA score ( r values were 0.60, 0.33, and 0.38, respectively, all P < 0.01), among which HBP had the strongest correlation, CRP was the second, and PCT was the weakest. Logistic regression analysis showed that HBP, PCT and CRP levels were independent risk factors for sepsis [odds ratio ( OR) were 1.015, 1.094, 1.067, 95% confidence intervals (95% CI) were 1.007-1.022, 1.041-1.150, 1.043-1.093, all P < 0.01]. ROC curve analysis showed that HBP, PCT and CRP all had some diagnostic value for sepsis [the area under ROC curve (AUC) were 0.92, 0.87, 0.80, 95% CI were 0.88-0.97, 0.82-0.92, 0.74-0.87, respectively, all P < 0.01]. Among them, the diagnostic efficacy of HBP was higher when the cut-off value was ≥15.11 μg/L, its sensitivity and specificity were 86.14% and 89.66%, respectively, which were higher than the sensitivity (81.19%) and specificity (80.46%) when the PCT cut-off value was≥ 1.17 μg/L. However, CRP had the best sensitivity of 94.06% for the diagnosis of sepsis but lacked of specificity (63.22%). Conclusion:HBP can be used as a biological indicator for predicting sepsis and can assess the severity of organ failure in septic patients.

2.
Article in Chinese | WPRIM | ID: wpr-908387

ABSTRACT

Objective:To discuss the role of continuous blood purification (CBP) therapy in children with severe adenovirus pneumonia.Methods:A total of 114 children with severe adenovirus pneumonia admitted to the Department of PICU at Children′s Hospital of Hunan Province from June 2018 to July 2019 were selected as the research objects.According to whether treated with CBP, they were divided into CBP group and control group.The following indicators during the process of treatment were compared between two groups, including respiratory mechanics indicators[respiratory index(PaO 2/FiO 2), dynamic lung compliance(Cdyn)]; hemodynamic indicators(heart rate and mean arterial pressure); changes in levels of inflammatory factors interleukin(IL)-6, IL-10, tumor necrosis factor(TNF)-α and the prognosis 28 days after admission. Results:The respiratory mechanics index, serum IL-6 and TNF-α levels of two groups after treatment were significantly lower than those before treatment, and the serum IL-10 level was significantly higher than that of this group before treatment.There were statistical differences in the CBP group before and after treatment, while there was no statistical difference in control group.In the CBP group, the serum IL-6 and TNF-α levels after treatment were significantly lower than those of the control group( P<0.05), and the serum IL-10 level was significantly higher than that of the control group( P<0.05). The 28-day mortality rate of patients in CBP group was 8.6%(3/35), which was significantly lower than 13.9%(11/79) of control group ( P<0.05). Conclusion:CBP could improve the main respiratory mechanical indexes of adenovirus pneumonia and decrease the level of inflammatory cytokines.

3.
Article in Chinese | WPRIM | ID: wpr-908367

ABSTRACT

Objective:To summary the mixed infection as well as clinical characteristics and analyze the risk factors for mixed infection of severe adenovirus pneumonia(SAP) in children.Methods:The clinical data of 114 children with SAP were retrospectively analyzed.Multivariate Logistic regression analysis was performed to assess the risk factors for mixed infection.Results:The incidence age was from 6 months to 2 years(62.5%). High fever(94.7%), cough(98.2%), dyspnea(86.8%) and lethargy(95.6%) were the main symptoms.Laboratory examination showed that children with SAP were prone to increased white blood cell count, C-reactive protein, procalcitonin, aspartate aminotransferase, alanine aminotransferase and CK-MB, as well as decreased proportion of CD3 + , CD4 + , CD8 + , CD4 + /CD8 + and NK cells.The main complications intrapulmonary organ were respiratory failure(80.7%). The main complications extrapulmonary organ were circulatory complications (55.3%). SAP was easily combined with other pathogenic infections.Streptococcus pneumoniae(22.9%)was the most common bacterial pathogen.Respiratory syncytial virus(10.0%)were the most common virus, in addition, mycoplasma pneumoniae(17.1%) was also common.Multivariable Logistic regression analysis showed that the decreasing ratio of CD4 + /CD8 + and NK cells, congenital heart disease and congenital airway dysplasia were the independent risk factors for mixed infection of SAP in children( P<0.05). Conclusion:The SAP patients could easily suffer from mixed infection and high fatality rate.Immune dysregulation is the important risk factors for mixed infection of SAP in children.So immunoregulatory treatment is very important.

4.
Article in Chinese | WPRIM | ID: wpr-907758

ABSTRACT

Objective:To analyze the influence of factors before initiation of extracorporeal cardiopulmonary resuscitation (ECPR) on the prognosis of patients, so as to explore the intervention timing and improvement strategy of ECPR.Methods:A retrospective analysis was performed on 29 patients who underwent ECPR in the First Affiliated Hospital of Hunan Normal University (Hunan people's Hospital)from July 2018 to April 2021. Patients were divided into the survival group ( n = 13) and death group ( n = 16) according to whether they survived at discharge. The duration of conventional cardiopulmonary resuscitation (CCPR), initial heart rate before ECPR, the ratio of out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), and the ratio of transported cases outside the hospital were compared between the two groups. According to different CCPR time, the patients were divided into the ≤45 min group, 45-60 min group and >60 min group to compare the hospital survival and sustained return of spontaneous circulation (ROSC) rate . According to the location of cardiac arrest, the patients from emergency department and other department were divided to compare the survival of IHCA. Results:The total survival rate was 44.83%, the average duration of extracorporeal membrane oxygenation (ECMO) was 114 (33.5, 142.5) h, and the average duration of CCPR time was 60 (44.5, 80) min. The duration of ECMO was longer in the survival group than in the death group ( P = 0.001). The duration of CCPR (the time from CPR to ECMO) in the survival group was significantly shorter than that in the death group ( P = 0.010). Patients with defibrillatory rhythm had higher hospital survival rate ( P = 0.010). OHCA patients had higher mortality than IHCA patients ( P = 0.020). Mortality of patients transferred from other hospitals was higher ( P = 0.025). Hospital survival and ROSC decreased in turn by CCPR duration ≤ 45 min, 45-60 min, and > 60 min ( P = 0.001). The location of CA occurrence had no impact on the hospital survival rate of IHCA patients ( P=0.54). Conclusions:Hospital survival of ECPR is higher than that of CCPR. ECPR is effective for refractory cardiac arrest. The prognosis of ECPR is significantly related to the duration of CCPR, initial heart rate, and location of CA. Education and team training should be strengthened to improve the survival rate of ECPR.

5.
Chinese Journal of School Health ; (12): 1613-1615, 2021.
Article in Chinese | WPRIM | ID: wpr-905797

ABSTRACT

Objective@#To systematically evaluate the relationship between the community food environment with overweight and obesity risk in children,and to provide evidence based evidence for the development of guidelines and policies.@*Methods@#Relevant Chinese and English literatures published from 1998 to 2020 were searched in the database of CBM, CNKI, Wanfang Data, Cochrane Library, PubMed, EMbase.@*Results@#A total of 8 English literatures were included in this systematic evaluation, including 3 cohort studies and 5 cross sectional studies. The results showed that the number and type, as well as distance to food stores/restaurants in the neighborhood of family or school were associated with the weight status, waist circumference and obesity risk of children. The number of fast food restaurants, convenience stores, and grocery stores was positively correlated with the risk of childhood obesity,and the number of supermarkets and free markets was associated with a lower risk of overweight and obesity in children.@*Conclusion@#The community food environment might be associated with childhood obesity, which is warrented more high quality scientific evidence.

6.
Chinese Critical Care Medicine ; (12): 885-889, 2020.
Article in Chinese | WPRIM | ID: wpr-866923

ABSTRACT

Acute myocardial infarction with cardiogenic shock (AMI-CS) refers to the rapid decrease in cardiac output in a short period of time, and it leads to severe insufficient perfusion of various organs and causes systemic microcirculatory dysfunction, which is the most common cause of the death of patients with acute myocardial infarction (AMI). At present, the main strategy for clinical treatment of AMI-CS is revascularization, which reduces the mortality of AMI-CS. However, myocardial ischemia and reperfusion can cause ischemia/reperfusion (I/R) injury, induce myocardial mitochondrial dysfunction, and a large amount of reactive oxygen species (ROS) accumulation. Mitochondrial-mediated apoptosis of cardiomyocytes is the main reason of cardiomyocyte death during reperfusion injury. This article summarizes the role of mitochondrial in AMI-CS, which focus on three aspects of mitochondrial permeability transition pore (mPTP) opening, mitochondrial autophagy and mitochondrial fusion/division. It is expected to provide new ideas for clinical AMI-CS and identify potential complications targets.

7.
Chinese Critical Care Medicine ; (12): 850-853, 2020.
Article in Chinese | WPRIM | ID: wpr-866908

ABSTRACT

Objective:To investigate the people's cardiopulmonary resuscitation (CPR) ability in Hunan Province and whether there are differences in the skill level of CPR among respondents of different ages and education levels.Methods:A self-made questionnaire was conducted to survey people in Hunan Province by means of WeChat from May 2018 to April 2019. The questionnaire referred to 2016 National consensus on cardiopulmonary resuscitation in China issued by Cardiopulmonary Resuscitation Specialized Committee of Chinese Research Hospital Association and 2017 version of American Heart Association (AHA) CPR operational guide, and combined with the CPR assessment scale of Hunan Provincial People's Hospital. The contents of the survey included the basic information of the subjects, the common knowledge and skills of first aid, the willingness to learn CPR skills and implement CPR, and the operational requirements of high quality CPR, etc. Results:A total of 6 563 people received the on-site first aid knowledge questionnaire, and 4 355 people completed and submitted the questionnaire. The recovery rate was 66.36%, of which 3 602 valid questionnaires were from IP in Hunan Province, and the qualified rate was 82.71%. Among the subjects, 1 532 were men (42.53%) and 2 070 were women (57.47%). The majority aged group from 19 to 30 (59.41%) and from 31 to 50 (36.70%). 307 were rural (8.52%) and 3 295 were urban (91.48%); and the majority levels of education were senior or technical secondary school (38.26%) and undergraduate or junior college (44.50%). Of the 3 602 respondents, 39.09% indicated that they had been exposed to CPR knowledge and only 0.36% indicated that they did not wish to participate in CPR training. 69.93% of the respondents said they would actively to help if they wet cardic arrest, and 97.92% of those were willing to do so if the patients were relatives or friends. The survey results showed that only 8.91% of respondents chose relatively high-quality CPR options (chest compressions were performed first, the pressing point was located in the sternum of the midpoint of bilateral nipple line, the pressing frequency was 100-120 times/min, pressing depth was 5-6 cm, the ratio of chest compression to artificial ventilation was 30∶2). Among these people, the correct rate was higher in the ages of 31-50 years old and ≤ 18, 19-30 than those ≥51 years old (12.71% vs. 0%, 6.87%, 8.70%, χ2 = 41.420, P < 0.01). The correct rate of education at graduate level and above was higher than those in junior middle school and below, high school or technical secondary school, undergraduate or junior college (19.57% vs. 2.07%, 3.41%, 13.72%, χ2 = 152.262, P < 0.01). Conclusions:The public in Hunan Province have a strong sense of first aid, and some of the theoretical knowledge of CPR. People between 31 years old and 50 years old of age and with graduate education and above know more about CPR, but the overall mastery of CPR skills is poor. It is necessary to further improve the ability of the public as the first witness by teaching various skills of CPR in various forms.

8.
Article in Chinese | WPRIM | ID: wpr-865005

ABSTRACT

Community acquired pneumonia (CAP) is an important cause of death in children under five years old.Viruses and bacteria are common causes.At present, accurate diagnosis of the pathogen of cap in children is still a clinical challenge.Clinical diagnosis of pathogens mainly through the collection of various samples (such as nasopharyngeal swab, sputum, blood, body fluids, etc.) for pathogen detection (such as antigen, antibody, culture, polymerase chain reaction (PCR) detection). Different samples and different detection methods have their own advantages and disadvantages, especially in the diagnosis of viral pneumonia and bacterial pneumonia, which lead to great differences in treatment measures.In order to identify different pathogens early and reduce the irrational use of antibiotics, clinicians and researchers are still exploring methods regarding early accurate pathogen diagnosis.Metabonomics is a rapidly developing field, which aims to identify and quantify the concentration changes of all metabolites or metabonomics in model systems.Most disease states are related with metabolic homeostasis.Metabonomics can provide clues for the discovery of new biomarkers, and also be used for the study of infections caused by different pathogens.Non targeted metabonomics analysis provides a new diagnostic approach for the etiology of cap in children.

9.
Article in Chinese | WPRIM | ID: wpr-864229

ABSTRACT

Severely ill children usually present unstable vital signs and function impairment of one or more organs or systems.They also have or potentially have life-threatening clinical features.It's necessary for pediatric intensive care doctors to carry out bedside examinations, diagnoses and timely treatment according to the continuously changing condition of the children.In order to meet the requirements on the rescue time for critically ill patients, the point-of-care testing inspection mode characterized by gathering materials on the spot, simple operation and instant result reporting becomes increasingly popular among medical staff.

10.
Article in Chinese | WPRIM | ID: wpr-863850

ABSTRACT

Objective:To determine plasma metabonomic profiles of rats with early sepsis, to find the differential metabolites and related metabolic pathways of sepsis at different time points, and to reveal the pathophysiological changes of sepsis rats in the early stage.Methods:Fifteen 8-week-old male SD rats were randomly (random number) divided into the sham operation group (S group, n=6) and sepsis group (C group, n=9). Sepsis rat model was established by cecal ligation and puncture, and rats in the sham operation group only freed the cecum but without ligation and perforation. Plasma was collected from orbital blood at 2, 6 and 12 h after modeling, and metabonomics was determined by gas chromatography-mass spectrometry (GC-MS). The endogenous metabolites were identified by comparing the standard ion fragment spectrum library of NIST database and Feihn metabonomics database. Multivariate regression analysis was carried out through MetaboAnalyst4.0, including principal component analysis (PCA) and partial least squares discriminant analysis (PLS-DA) to identify the changes of metabolites, screen the related differential metabolites ( P<0.05, fold change>1.5, VIP >1.5), and then further analyze the related metabolic pathways through KEGG. Results:The PCA and PLS-DA pattern recognition showed that there was a cluster type distribution between the sepsis group and sham operation group at each time point, as well as between sepsis group at different time points. Fourteen, 25 and 21 differential metabolites were respectively detected between S2 h/C2 h group, S6 h/C6 h group and S12 h/C12 h group. The related signal pathways of differential metabolites were starch and sucrose metabolism and galactose metabolism at 2 h; starch and sucrose metabolism, galactose metabolism, cysteine and methionine metabolism, arginine and proline metabolism, glycine, serine and threonine metabolism, arachidonic acid metabolism and aminoacyl tRNA biosynthesis at 6 h; and galactose metabolism, arginine and proline metabolism, arginine biosynthesis, alanine, aspartic acid and glutamate metabolism, D-glutamine and D-glutamate metabolism, and vitamin B6 metabolism at 12 h.Conclusions:The plasma metabolites of sepsis rats in the early stage show significant dynamic differences, and the changes of plasma metabolites may be involved in the pathophysiological process of sepsis.

11.
Article in Chinese | WPRIM | ID: wpr-751885

ABSTRACT

Objective To observe the effect of curcumin on myocardial mitochondrial related gene (mtATP6), high mobility group box 1(HMGB1) mRNA expression and plasma HMGB1 level in rats with sepsis, and to explore a new strategy for protection of myocardial injury in sepsis.Methods A rat sepsis model was established by cecal ligation and puncture (CLP). Thirty male Sprague-Dawley rats were randomly (random number) divided into the sham operation group (sham group), sepsis group (CLP group), and curcumin intervention group (Cur group), with 10 rats in each group. Rats in the Cur group were treated with curcumin by intraperitoneal injection at 100 mg/kg, and normal saline was injected into rats in the sham and CLP groups. Five rats were randomly (random number) sacrificed at 6 h and 24 h after modeling. The pathological changes of myocardial tissue were observed under light microscope. The levels of CK and CK-MB in serum were detected. The HMGB1 level in plasma was detected by ELISA. Real-time PCR was used to detect the expression of HMGB1 mRNA and mtATP6 in myocardial tissue. One-way ANOVA were performed in multigroup mean comparison, LSD-t test was used to compare the mean values of two samples, andP<0.05 was considered statistically significant.Results The pathological score of myocardial tissue in the Cur group was lower than those in the CLP group at 6 h and 24 h (P<0.05). The CK and CK-MB in the Cur group were lower than those in the CLP group at 6 h and 24 h (P<0.05). The levels of HMGB1 in the Cur group were lower than those in the CLP group at 6 h and 24 h (P<0.05). The expression levels of HMGB1 mRNA and mtATP6 in myocardial tissue of the CLP group were lower than those in the sham group at 6 h (P<0.05), while the expression levels of HMGB1 mRNA and mtATP6 in myocardial tissue of the Cur group were higher than those in the CLP group at 6 h, but the difference was not statistically significant (P>0.05).Conclusion Curcumin protects acute myocardial injury by affecting HMGB1 release and translocation down-regulation of extracellular levels and regulation of mtATP6 expression in CLP model rats.

12.
Article in Chinese | WPRIM | ID: wpr-743932

ABSTRACT

Pediatric trauma includes traumatic injuries such as car accidents,falling injuries,falls, cuts,sprains,burns,and ill-treatment. It is a major public health problem worldwide. At present,the level of comprehensive trauma treatment in China still needs to be improved,and the fatality rate and disability rate of trauma are very high. Optimized and simplified pediatric trauma treatment process is the basis for improving the rescue rate. Fast and effective trauma assessment tools can fight for "golden time" for traumatic children. Pediatric trauma life support should be widely promoted as basic skills for trauma treatment. Pediatric bedside ultrasound has become an important means of individualized and precise treatment for critically ill patients.

13.
Article in Chinese | WPRIM | ID: wpr-797647

ABSTRACT

Objective@#To observe the effect of curcumin on myocardial mitochondrial related gene (mtATP6), high mobility group box 1(HMGB1) mRNA expression and plasma HMGB1 level in rats with sepsis, and to explore a new strategy for protection of myocardial injury in sepsis.@*Methods@#A rat sepsis model was established by cecal ligation and puncture (CLP). Thirty male Sprague-Dawley rats were randomly (random number) divided into the sham operation group (sham group), sepsis group (CLP group), and curcumin intervention group (Cur group), with 10 rats in each group. Rats in the Cur group were treated with curcumin by intraperitoneal injection at 100 mg/kg, and normal saline was injected into rats in the sham and CLP groups. Five rats were randomly (random number) sacrificed at 6 h and 24 h after modeling. The pathological changes of myocardial tissue were observed under light microscope. The levels of CK and CK-MB in serum were detected. The HMGB1 level in plasma was detected by ELISA. Real-time PCR was used to detect the expression of HMGB1 mRNA and mtATP6 in myocardial tissue. One-way ANOVA were performed in multigroup mean comparison, LSD-t test was used to compare the mean values of two samples, and P<0.05 was considered statistically significant.@*Results@#The pathological score of myocardial tissue in the Cur group was lower than those in the CLP group at 6 h and 24 h (P<0.05). The CK and CK-MB in the Cur group were lower than those in the CLP group at 6 h and 24 h (P<0.05). The levels of HMGB1 in the Cur group were lower than those in the CLP group at 6 h and 24 h (P<0.05). The expression levels of HMGB1 mRNA and mtATP6 in myocardial tissue of the CLP group were lower than those in the sham group at 6 h (P<0.05), while the expression levels of HMGB1 mRNA and mtATP6 in myocardial tissue of the Cur group were higher than those in the CLP group at 6 h, but the difference was not statistically significant (P>0.05).@*Conclusion@#Curcumin protects acute myocardial injury by affecting HMGB1 release and translocation down-regulation of extracellular levels and regulation of mtATP6 expression in CLP model rats.

14.
Article in Chinese | WPRIM | ID: wpr-797160

ABSTRACT

Objective@#To analyze the clinical characteristics of fatal cases with confirmed severe adenovirus pneumonia in children in order to improve the diagnosis and treatment.@*Methods@#The fatal cases of severe adenovirus pneumonia admitted to Pediatric Intensive Care Unit of Hunan Provincial People′s Hospital from January 2019 to July 2019 were collected, whose clinical features, diagnosis, treatment, and the causes of death were analyzed retrospectively.@*Results@#A total of eight children were enrolled, and the age ranged from 3 months to 3 years old, and five cases were between 6 months to 2 years old.Three cases had underlying diseases.Adenovirus genotype identification was performed on six patients, and the results showed that all patients were infected with adenovirus type 7.All patients presented persistent high fever, with a peak temperature between 39.8℃ to 41.0℃, which persisted 10 to 37 days.Blood routine test before admission PICU showed that four cases had the decrease in white blood count and hemoglobin concentration, accompanied byincreased serum ferritin levels.Seven cases complicated with infection.Four cases had parainfluenza virus type 3 infection.Six cases had bacterial infection, and Gram-negative bacilli were predominant.One had fungal septicemia.Conventional mechanical ventilation were performed in all patients in this group.Four cases in this group died of severe acute respiratory distress syndrome.The other four cases died of disseminated intravascular coagulation associated with massive gastrointestinal bleeding, pulmonary hemorrhage, heart failure and septic shock combined with multiple organ failure.@*Conclusion@#Fatal adenoviruspneumonia mostly apppears in children between 6 months to 2 years old or with underlying diseases.Adenovirus type 7 was the main serotype.The occurrence of reactive hemophagocytic phenomenon should be worsen progression of the disease.Co-infection may be an important cause of death.

15.
Article in Chinese | WPRIM | ID: wpr-790066

ABSTRACT

Objective To analyze the clinical characteristics of fatal cases with confirmed severe ad﹣enovirus pneumonia in children in order to improve the diagnosis and treatment. Methods The fatal cases of severe adenovirus pneumonia admitted to Pediatric Intensive Care Unit of Hunan Provincial People′s Hospital from January 2019 to July 2019 were collected,whose clinical features,diagnosis,treatment,and the causes of death were analyzed retrospectively. Results A total of eight children were enrolled, and the age ranged from 3 months to 3 years old,and five cases were between 6 months to 2 years old. Three cases had underly﹣ing diseases. Adenovirus genotype identification was performed on six patients,and the results showed that all patients were infected with adenovirus type 7. All patients presented persistent high fever,with a peak temper﹣ature between 39. 8℃ to 41. 0℃,which persisted 10 to 37 days. Blood routine test before admission PICU showed that four cases had the decrease in white blood count and hemoglobin concentration,accompanied by﹣increased serum ferritin levels. Seven cases complicated with infection. Four cases had parainfluenza virus type 3 infection. Six cases had bacterial infection,and Gram﹣negative bacilli were predominant. One had fun﹣gal septicemia. Conventional mechanical ventilation were performed in all patients in this group. Four cases in this group died of severe acute respiratory distress syndrome. The other four cases died of disseminated intra﹣vascular coagulation associated with massive gastrointestinal bleeding, pulmonary hemorrhage, heart failure and septic shock combined with multiple organ failure. Conclusion Fatal adenoviruspneumonia mostly app﹣pears in children between 6 months to 2 years old or with underlying diseases. Adenovirus type 7 was the main serotype. The occurrence of reactive hemophagocytic phenomenon should be worsen progression of the disease. Co﹣infection may be an important cause of death.

16.
Journal of Chinese Physician ; (12): 1752-1755, 2018.
Article in Chinese | WPRIM | ID: wpr-734027

ABSTRACT

Acute poisoning is usually an emergency,the acute poisoning of children is more prominent,Its death threat is greater than that of adults.Although the conventional treatment of acute poisoning is crucial,such as vomiting,gastric lavage,catharsis and diuresis,but for children with severe acute poisoning,simply using conventional treatment methods are often difficult to support the children through the dangerous period.In recent years,the application of blood purification therapy has saved more and more children with critically acute poisoning.Because of the variety of poisons,the complexity of toxicological mechanisms and the different clinical manifestations,emergency pediatricians mainly depend on the types of poisons and clinical experience to determine whether blood purification should be carried out in children with acute poisoning and what kind of blood purification mode should be chosen.There are almost no relevant guidelines for reference.Timing of blood purification therapy and reasonable mode selection are particularly important.

17.
Chinese Journal of Pediatrics ; (12): 128-133, 2018.
Article in Chinese | WPRIM | ID: wpr-809810

ABSTRACT

Objective@#To investigate the current application status of continuous blood purification (CBP) technology and equipment in pediatric intensive care unit (PICU) in China.@*Methods@#A cross-sectional survey was conducted to understand the current popularization of CBP technology and equipment, the management of CBP equipment and consumables, and the application of CBP in different diseases. A questionnaire named Application Status of Continuous Blood Purification Technology was applied. Children's hospitals and polyclinic hospitals with the pediatric qualification (pediatric emergency or critical care unit members of Chinese Medical Association and Chinese Medical Doctor Association) were selected.@*Results@#From December 2016 to February 2017, 53 hospitals completed the questionnaire, including 7 in northeast, 6 in north China, 16 in east China, 9 in south China, 5 in central China, 4 in the northwest, and 6 in the southwest region. Continuous renal replacement therapy (CRRT), the most widely used technology, was carried out in 51 hospitals. Other technologies were peritoneal dialysis (IPD) (n=37), artificial liver support (ALSS) (n=26) and blood adsorption (PA) (n=13). There were 107 CBP machines in the 51 hospitals used CBP technology, with an average of 2.10/hospital. In 36 hospitals CBP machines were managed independently by PICU (70%). Hospitals made their own displacement liquid (n=40, 78%), or purchased displacement liquid (n=11, 22%). Hospitals prepared dialysate on their own (n=38, 75%), or purchased dialysate (n=13 hospitals, 25%). In 46 (90%) hospitals, hemodialysis catheter was placed independently by PICU doctors. The routine operation and maintenance of CBP were mainly completed by the PICU nurses in 36 hospitals (71%). There were 39 hospitals (76%) where professional nurses manage and maintain CBP. Puncture sites were femoral vein (n=26, 51%), internal jugular vein (n=21, 41%) and venae subclavia (n=4, 8%). Forty-two hospitals (82%) selected B-mode ultrasound positioning and guidance when performing internal jugular vein puncture. A total of 40 (78%) hospitals have developed post dilution and combined dilution techniques during the implementation of CBP. The most common indications of CBP technology were different in different regions. They were sepsis in northeast (24.0%, 243/1 011) and east China region (32.0%, 982/3 069), multiple organ dysfunction syndrome in south China (29.2%, 444/1 520), north China (15.8%, 126/796), and southwest region (30.1%, 460/1 526), drug poisoning in central China region (21.6%, 325/1 506), and renal failure in northwest region (53.0%, 44/83).@*Conclusions@#CBP technology is widely used in the field of pediatric severe diseases in China. The eastern regions possess more CBP equipment than the western regions. CBP is widely used in the treatment of sepsis.

18.
Chinese Pediatric Emergency Medicine ; (12): 521-525,529, 2018.
Article in Chinese | WPRIM | ID: wpr-807012

ABSTRACT

Objective@#To understand the present situation of the emergency ability of the pediatrics in township hospital of Hunan province, and to provide the basis for improving the treatment of critical diseases and strengthening the medical quality in basic hospital.@*Methods@#Status survey, expert consultation, on-spot examination, and questionnaire were conducted.One representative of the 1 217 township hospitals participating in the appropriate health technologies for pediatric emergency was sent to a face-to-face survey by investigators.@*Results@#In 1 217 township hospitals, only 965 pediatricians had been certified.Among them, 58 township hospitals did not purchase the first aid equipment in the scope of the survey, and 211 township hospitals were not equipped with first aid drug.Less than 30% of township hospitals had tracheotomy kits, cardiac defibrillator and first aid equipment such as neonatal incubator, newborn radiation table and infusion pump.Among the trained 1 095 general practitioners, only 305(27.85%) understood the basic first-aid knowledge of this training in pediatrics; 258(258/1 217, 21.20%) township hospitals could not carry out 7 pediatric emergency projects of this survey.The proportion of the capable of carrying out rescue treatment including acute respiratory failure (191/1 217, 15.69%), heart failure (201/1 217, 16.52%) and shock(227/1 217, 18.65%) in township hospitals were less than 30%.@*Conclusion@#The primary hospital is the basis for the treatment of critical diseases in pediatrics, but the level of diagnosis and treatment and basic equipment need to be further strengthened.The urgent task is to strengthen the training of medical and nursing staff in the treatment of critical diseases in pediatrics.

19.
Article in Chinese | WPRIM | ID: wpr-699048

ABSTRACT

Objective To study the clinical data of patients treated with nasal continuous positive airway pressure (NCPAP) in PICU,and to explore the application time and range of NCPAP in critically ill children. Methods A prospective study was conducted to collect clinical data of 192 severe patients admitted to PICU from January 2016 to June 2017 who had shortness of breath after giving oxygen through nasal cath-eter for 1 hour and then switched to NCPAP. According to using NCPAP oxygen partial pressure,children were divided into three groups:group A[ shortness of breath ( PaO2≥70 mmHg,1 mmHg=0. 133 kPa) ], group B[shortness of breath combined,reduced oxygen partial pressure(50mmHg<PaO2<70 mmHg)],and group C[shortness of breath combined respiratory failure(PaO2≤50 mmHg)]. The indicators of three groups of children at different time points of NCPAP were compared. Results Among 192 children,161 (83. 85%) had respiratory diseases,14 (7. 29%) had severe hand-foot-mouth disease,10 (5. 21%) had severe sepsis, and 7 (3. 65%) had other multiple organ disorders. PaO2/FiO2gradually increased after using NCPAP for 1 hour and 4 hours,and the improvement of oxygenation in group A was most obvious,there was significant difference among the three groups (P<0. 05). There were significant differences in heart rate,shortness of breath after using NCPAP for 1 hour and 4 hours among the three groups (P<0. 05). There were 2 cases of ventilation failure in group A (failure rate 3. 57%),9 cases (11. 11%) of ventilation failure in group C,30 cases (54. 55%) of ventilation failure in group C,and there was significant difference in the failure rate of noninvasive ventilation among the three groups (χ2=51. 684,P<0. 001). There were significant differences in the discharge rate among the three groups (P<0. 05). Conclusion NCPAP has obvious effect on the critical-ly ill children with conventional oxygen remaining respiratory abnormalities;Children with respiratory failure under nasal catheter are prone to suffer from the failure of noninvasive assisted ventilation when using NCPAP assisted ventilation,closely monitor of the disease condition is needed.

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Article in Chinese | WPRIM | ID: wpr-699019

ABSTRACT

High mobility group box 1 ( HMGB1 ) is a highly conserved DNA-binding protein. The function of HMGB1 varied according to its molecular localization. Meanwhile,HMGB1 is located in the nu-cleus under physiological conditions. It contains stable nucleosome structure and can promote gene recombina-tion,repair,transcription etc,known as the"DNA chaperone". Intracellular HMGB1 has a protective effect on heart hypertrophy, heart failure, pancreatitis, hepatic ischemia/reperfusion injury, spinocerebellar ataxia and other protective effects.

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