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Objective:To analyze the cardio-pulmonary ultrasound features of cardiogenic pulmonary edema (CPE) and pneumonia in adults with acute dyspnea, and to construct a differential diagnosis model.Methods:Seven hundred and forty-three patients with sudden acute dyspnea admitted to Hebei General Hospital from November 2018 to May 2022 were retropectively included. Ultrasonographer A performed lung ultrasound with 12 zone method, and interpreted and recorded the ultrasonic signs (including A-lines area, B-lines area, consolidation area and pleural effusion area) together with ultrasonographer B. According to the ultrasonic characteristics of the whole lung, it was divided into A-profile and B-profile. According to the continuity and symmetry of the distribution of B-lines in bilateral lung fields, it could be divided into bilateral lung continuous and discontinuous B-profile, bilateral lung symmetric and asymmetric B-profile. Left ventricular ejection fraction (LVEF), left ventricular filling pressure (E/e′), right ventricular dilatation, tricuspid annular systolic displacement (TAPSE) and inferior vena cava diameter (IVCD) were evaluated by echocardiography, and all the indexes were transformed into binary variables. According to the final clinical diagnosis and treatment results, the disease was divided into CPE group and pneumonia group. Binary Logistic regression model was used to screen independent influencing factors, and partial regression coefficient β value was used as a weight to assign a score, and a differential diagnosis model was established based on the total score. The predictive value of the model was evaluated by the receiver operating characteristic curve (ROC) and area under curve (AUC). After the model was built, 30 patients with CPE or pneumonia were independently collected by ultrasonographer C as external validation data, which were included in the model to draw ROC curve and evaluate the differential diagnosis efficiency of the model. The consistencies between ultrasonographer A and B, A and C in observing lung ultrasound were explored.Results:A total of 743 patients from 43 clinical departments were included, including 246 cases in CPE group and 497 cases in pneumonia group. Multivariate logistic regression analysis showed that bilateral lung continuous B-profile, bilateral lung symmetric B-profile, ≥1 pleural effusion area, LVEF<50%, E/e′>14 were the risk factors for CPE (all OR>1, P<0.05), and ≥1 consolidation area and ≥1 pleural sliding disappearance area were the protective factors for CPE (all OR>1, P<0.05). The sensitivity, specificity and AUC of combined cardio-pulmonary ultrasound index β value weight score in the differential diagnosis of CPE and pneumonia were 0.939, 0.956 and 0.986, respectively. The AUC of external validation data was 0.904. Ultrasonographer A and B, A and C had good consistency in the interpretation of lung ultrasound signs ( P<0.05). Conclusions:The differential diagnosis model based on combined cardio-pulmonary ultrasound indexes has high differential diagnosis efficiency for CPE and pneumonia, and can be used in bedside cardio-pulmonary ultrasound practice.
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Sepsis is a host reaction disorder caused by infection, in which oxidative stress is involved in the mechanism of organ damage. Vitamin C deficiency caused by trauma and infection is very common in critically ill patients. As a highly effective antioxidant, vitamin C can alleviate oxidative stress, reduce the inflammatory response, protect endothelial cell function, and reduce platelet activation. However, no definite clinical study confirms that patients with sepsis can benefit significantly from vitamin C supplementation. In order to further explore the clinical value of vitamin C in patients with sepsis, this paper discusses the pathophysiology of sepsis, the physiological function and deficiency of vitamin C, the basic research and clinical trials of vitamin C.
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Objective:To explore a better indicator that can predict septic shock induced acute kidney injury (AKI) by combining renal resistive index (RRI) and central venous pressure (CVP).Methods:A prospective observational study was conducted. Patients with septic shock admitted to department of critical care medicine of Hebei General Hospital from November 2017 to October 2018 were enrolled. Baseline characteristics such as age, gender, underlying diseases, infection sites, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) in the first 24-hour, sequential organ failure assessment (SOFA) were recorded; Doppler-based RRI was obtained on the first day when hemodynamics was relatively stable, meanwhile the dose of norepinephrine and hemodynamic parameters were assessed. Urine output per hour, the total duration of mechanical ventilation, the length of intensive care unit (ICU) stay and 28-day mortality were also collected. Observational end point was death at discharge or the 28th day after ICU admission, whenever which came first. The patients were divided into AKI and non-AKI groups according to the 2012 Kidney Disease: Improving Global Organization (KDIGO) clinical practice guideline. The baseline and prognostic indicators, variables potentially associated with AKI were compared between the two groups. The variables independently associated with septic shock induced AKI were identified using multivariable Logistic regression. The predictive value of RRI and RRI combining CVP for AKI were analyzed by the receiver operating characteristic (ROC) curve.Results:A total of 107 patients were enrolled, with 59 patients in AKI group and 48 patients in non-AKI group. There was significant difference in RRI, CVP, percentage of norepinephrine dosage ≥0.5 μg·kg -1·min -1, procalcitonin (PCT), lactate (Lac), and serum creatinine (SCr) between the two groups. Logistic regression analysis showed that high CVP, RRI, Lac and PCT were independent risk factors for septic shock induced AKI [CVP: odds ratio ( OR) = 1.20, 95% confidence interval (95% CI) was 1.03-1.40, P = 0.022; RRI: OR = 3.02, 95% CI was 2.64-3.48, P = 0.006; Lac: OR = 2.43, 95% CI was 1.32-4.50, P = 0.005; PCT: OR = 1.20, 95% CI was 1.05-1.38, P = 0.009]. ROC curve analysis showed that the area under ROC curve (AUC) values of CVP≥9.5 mmHg (1 mmHg = 0.133 kPa) and RRI≥0.695 for predicting septic shock induced AKI were 0.656 and 0.662 respectively. The AUC value of the combination of RRI and CVP was greater compared with either RRI or CVP alone in predicting septic shock induced AKI, which AUC value was 0.712, 95% CI was 0.615-0.809, the sensitivity was 59% and the specificity was 75%. Conclusions:High CVP and RRI were independent risk factors for septic shock induced AKI. The combination of RRI and CVP performs poorly in predicting septic shock induced AKI. Further studies are needed to describe factors influencing Doppler-based assessment of RRI, which may help clinicians to prevent AKI early.
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Objective To evaluate the relationship between the mechanism of simvastatin-induced improvement of permeability of pulmonary microcirculation and vascular endothelial growth factor α (VEGF-oα) in septic rats.Methods Eighty clean-grade healthy female Wistar rats,aged 49-63 days,weighing 200-250 g,were divided into 4 groups using a random number table method:control group (group C,n =8),sham operation group (group Sham,n =24),sepsis group (group Sep,n =24) and simvastatin group (group S,n =24).Sepsis was induced by cecal ligation and puncture (CLP) in anesthetized rats.Simvastatin 20 mg/kg was injected to the stomach once a day for two weeks before CLP in group S,and the equal volume of normal saline was given instead in the other groups.Rats were sacrificed after anesthesia in group C,and 8 rats selected at 6,24 and 48 h after CLP were sacrificed after anesthesia in the other three groups,and blood samples and lung specimens were collected.The concentrations of VEGF-α and intercellular adhesion molecule-1 (ICAM-1) in serum were measured by enzyme-linked immunosorbent assay.The wet/dry lung weight ratio (W/D ratio) was determined,and the expression of VEGF-α in lung tissues was detected by immunohistochemistry.Results Compared with group C,W/D ratio was significantly increased,the expression of VEGF-α was up-regulated,and the concentrations of serum ICAM-1 were increased in Sep and S groups,the concentration of serum VEGF-α was increased in group Sep (P＜0.05),no significant change was found in serum VEGF-α concentrations in group S,and no significant change was found in the parameters mentioned above in group Sham (P＞0.05).Compared with group Sep,W/D ratio was significantly decreased,the expression of VEGF-α was down-regulated,and the concentrations of serum VEGF-α and ICAM-1 were decreased in group S (P＜0.05).Conclusion The mechanism by which simvastatin improves permeability of pulmonary microcirculationis associated with the decreased level of VEGF-α in local lung tissues and peripheral blood of septic rats.
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Objective To evaluate the value of bedside lung ultrasound for diagnosis of acute re-spiratory distress syndrome ( ARDS) and for assessment of the severity. Methods Fifty patients of both se-xes suspected of having ARDS ( oxygenation index＜300 mmHg) and required lung CT tests and Pulse Indi-cator Continuous Cardiac Output because of their condition, aged 18-80 yr, were selected. At 24 h after entering ICU, chest CT, lung ultrasound and arterial blood gas analysis were performed to record Extravas-cular Lung Water Index ( EVLWI) and the number of B lines, and lung injury ultrasound score and oxygen-ation index were calculated. The patients diagnosed with ARDS by chest CT and lung ultrasound were divid-ed into 3 groups: mild group ( 200 mmHg＜oxygenation index≤300 mmHg) , moderate group ( 100 mmHg＜oxygenation index≤200 mmHg) and severe group ( oxygenation index≤100 mmHg) . Kappa consistency a-nalysis was used to assess the consistency between lung ultrasound and chest CT in diagnosis of ARDS. The receiver operating characteristic curves of th number of B lines, EVLWI and lung injury ultrasound score in assessing the severity of ARDS were drawn, and the area under the curve and 95％ confidence interval ( CI) , critical value, sensitivity and specificity were calculated. Results Forty-six patients were diag-nosed as having ARDS by both chest CT and lung ultrasound. There was good consistency ( Kappa value 0. 648, P＜0. 01) between chest CT and lung ultrasound in diagnosis of ARDS. There was good consistency ( Kappa value 0. 788, P＜0. 01) between lung ultrasound and chest CT in diagnosis of pulmonary consolida-tion. Lung ultrasound and chest CT were in good agreement ( Kappa value 0. 825, P＜0. 01) with each oth-er in diagnosis of pulmonary consolidation in the posterior region. Compared with mild group, the lung inju-ry ultrasound score was significantly increased, and the number of B lines was increased in moderate group, and the lung injury ultrasound score and EVLWI were significantly increased, and the number of B lines was increased in severe group ( P＜0. 05) . Compared with moderate group, the lung injury ultrasound score and EVLWI were significantly increased, and the number of B lines was increased in severe group ( P＜0. 05) . The area under the curve ( 95％ CI ) of the number of B lines in diagnosing severe ARDS was 0. 915 ( 0. 905-0. 935 ) , and the critical value, sensitivity and specificity were 15. 5, 78. 9％ and 85. 2％, respectively. The area under the curve ( 95％ CI) of lung injury ultrasound score in diagnosing severe ARDS was 0. 856 (0. 833-0. 878), and the critical value, sensitivity and specificity were 25. 5, 73. 7％ and 82. 5％, respectively. The area under the curve (95％ CI) of EVLWI in diagnosing severe ARDS was 0. 907 ( 0. 888-0. 933) , and the critical value, sensitivity and specificity were 15. 5, 73. 7％and 92. 6％, respectively. Conclusion Lung ultrasound can be used for diagnosis of ARDS and for evalu-ation of the severity of ARDS.
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Objective To evaluate the effect of cardiopulmonary ultrasound in guiding volume ther-apy in the patients with sepsis-induced myocardial injury. Methods Thirty-eight patients of both sexes with septic myocardial injury, aged 28-64 yr, weighing 60-90 kg, received anti-infection, respiratory and circulatory comprehensive treatment. The patients were divided into group Ⅰ ( n=19) and group Ⅱ(n=19) by using a random number table method. Central venous pressure (CVP) was used to guide vol-ume therapy, and fluid replacement was carried out using the CVP 2-5 principle in groupⅠ. Cardiopulmo-nary ultrasound was used to guide volume therapy in group Ⅱ. Blood samples were taken before volume therapy and on 1, 3 and 5 days after volume therapy to determine the concentrations of N-terminal pro-B-type natriuretic peptide, cardiac troponin I and creatine kinase isoenzyme MB in serum. The CVP, positive fluid balance, lactic acid, central venous oxygen saturation and urine volume were recorded at 6, 24, 48 and 72 h after volume therapy. Left ventricular ejection fraction was recorded at 1, 3 and 5 days after vol-ume therapy. The length of intensive care unit stay and 28-day fatality were recorded. Results Compared with groupⅠ, the CVP and fluid positive balance were significantly decreased at each time point after vol-ume therapy, the concentration of serum N-terminal pro-B-type natriuretic peptide was decreased at 5 days after volume therapy ( P<0. 05) , and no significant difference was found in concentrations of cardiac tropo-nin I and creatine kinase isoenzyme MB in serum, lactic acid, central venous oxygen saturation and urine volume, left ventricular ejection fraction, length of intensive care unit stay or 28-day fatality rate at each time point in groupⅡ( P>0. 05) . Conclusion Cardiopulmonary ultrasound can reduce the volume of liq-uid infused, avoid fluid overload and avoid accentuating myocardial injury when used to guide volume thera-py in the patients with sepsis-induced myocardial injury.
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Objective To evaluate the effect of simvastatin preconditioning on acute renal injury in septic rats.Methods A total of 128 pathogen-free healthy female Wistar rats,aged 49-63 days,weighing 200-250 g,were divided into 4 groups using a random number table:control group (group C,n=8),sham operation group (group Sham,n=40),sepsis group (group Sep,n =40) and simvastatin preconditioning group (group SP,n=40).Sepsis was induced by cecal ligation and puncture (CLP).Simvastatin was injected through a gastric tube into the stomach once a day for 2 consecutive weeks before CLP in group SP,while the equal volume of normal saline was given instead in the other groups.Eight rats were randomly selected from Sham,Sep and SP groups,and the survival rates within 48 h after CLP were recorded.Eight rats were randomly selected at 3,6,24 and 48 h after CLP for blood sampling in Sham,Sep and SP groups,and blood samples were collected after anesthesia in group C.White blood cells were counted,and the serum cystatin C (Cys-C) concentrations were determined by enzyme-linked immunosorbent assay.Kidney specimens were obtained for determination of the percentage of C-reactive protein (CRP) positive cells in renal tissues by immunohistochemistry.The rectal temperature was recorded.Results Compared with group C,the survival rates,white blood cell count and rectal temperature were significantly decreased,and the serum Cys-C concentration and percentage of CRP positive cells in renal tissues were increased in Sep and SP groups (P＜0.05),and no significant change was found in the parameters mentioned above in group Sham (P＞0.05).Compared with group Sep,the survival rates,white blood cell count and rectal temperature were significantly increased,and the serum Cys-C concentration and percentage of CRP positive cells in renal tissues were decreased in group SP (P＜0.05).Conclusion Simvastatin preconditioning can inhibit inflammatory responses of renal tissues and reduce acute renal injury in septic rats.
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In patients with a functional gut,enteral nutrition is the preferred route of nutrition support.The favorable effects of enteral nutrition include prevention of mucosal atrophy,maintaining of the integrity of gut flora,and improvement of immunocompetence.The guidlines recommend EN be withheld in patients requiring significant hemodynamic support,because of highdose catecholamine agents which could reduce EN tolerance.Splanchnic perfusion is reduced in sepsis shock,yet vasoactive agents have demonstrated both improved and diminished perfusion.Inadequate perfusion increases the risk of experiencing rare but serious adverse events.This study summarizes the tolerability and safety of enteral nutritionin in critically iH patients with hemodynamic instability and provides theoretical basis for the early administration of EN.
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ObjectiveTo investigate the effects of simvastatin preconditioning on the expression of inducible and endothelial nitric oxide synthase ( iNOS,eNOS) in thoracic aorta in a rat model of sepsis.Methods Eighty pathogen-free female Wistar rats aged 4 months weighing 200-250 g were randomly divided into 4 groups:group normal control (group Ⅰ,n =8) ; group sham operation (group Ⅱ,n =8) ; group sepsis (group Ⅲ,n =32) and group simvastatin preconditioning (group Ⅳ,n =32).Sepsis was induced by cecal ligation and puncture (CLP) in groups Ⅲ and Ⅳ.In group Ⅳ simvastatin 20 mg/kg was given via a gastric tube once a day for 2 weeksbefore CLP.The thoracic aorta specimens were taken at 3,6,24 and 48 h after CLP (n =8 at each time point)for detection of iNOS and eNOS protein expression by Western blot analysis.ResultsCLP significantly up-regulated iNOS expression and down-regulated eNOS expression in group Ⅲ as compared with groups Ⅰ and Ⅱ.Simvastatin pretreatment significantly attenuated CLP-induced increase in iNOS expression and decrease in eNOS expression in group Ⅳ as compared with group Ⅲ.ConclusionSimvastatin preconditioning can protect vascular endothelial cells from septic injury by down-regulating iNOS expression and up-regulating eNOS expression in vascular endothelial cells.
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Objective To investigate the effects of different tidal volumes and positive end expiratory pressures on cell apoptosis in lung tissue of rats with acute lung injury.Methods Forty healthy male Sprague-Dawley rats were randomly(random number)divided into five groups,namely low tidal volume group(LV,VT 8 mL/kg),high tidal volume group(HV,VT 30 mL/kg),low tidal volume group with PEEP 2cmH2O(LV2P,VT 8 mL/kg,PEEP 2 cmH2O),low tidal volume group and PEEP 5cmH2O (LV5P,VT 8 mL/kg,PEEP 5 cmH2O)and low tidal volume group and PEEP 8 cmH2O(LV8P,VT 8 mL/kg,PEEP 8 cmH2O).After intravenous administration of oleic acid(OA,0.1 mL/kg),the rat model of acute lung injury was made.Mechanical ventilation was employed in rats of the experiment groups.Rats were sacrificed and their whole lungs were taken after mechanical ventilation for 2 hours.The transferase d-UTP end labeling assay(TUNEL)was used to define the extent and distribution of apoptotic cells in bronchus and lung tissues.The level of caspase-3 protein was determined by immunohistochemistry.Results The apoptotic cells on both alveolar septum and bronchial epithelium obviously increased with high level of caaspase-3 protein in HV group.The number of apoptotic cells obviously decreased with decrease in caspase-3 protein after PEEP ventilation.These changes were more significant in LV5P than those in other groups(P ＜ 0.01).Conclusions The mechanical ventilation with low tidal volume and PEEP produces protective effects on lung from injury.The cell apoptosis plays an important role in the course of VILI.
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Objective To investigate the effect of simvastatin on endothelial cell function in a rat model of sepsis. Methods Ninety-six pathogen-free female Wistar rats aged 4 months weighing 200-250 g were randomly divided into 3 groups (n = 32 each): group sham operation (group Ⅰ ); group sepsis (group Ⅱ )and group simvastatin + sepsis(group Ⅲ ) . Sepsis was induced by cecal ligation and puncture (CLP). In group Ⅲ simvastatin 20 mg/kg was given via a gastric tube once a day for 2 weeks. Blood samples were taken from carotid artery at 3,6, 24 and 48 h ( n = 8 at each time point) for WBC count and measurement of serum E-selectin concentration (by ELISA) . Results CLP significantly increased WBC count and serum E-selectin concentration in group Ⅱ as compared with group Ⅰ . The peak values were reached at 6 h after operation. Simvastatin pretreatment attenuated the sepsis-induced increase in WBC count and serum E-selectin concentration in group Ⅲ. Conclusion Protection of endothelial cell function is involved in the mechanism of treatment of sepsis with simvastatin.
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Objective To investigate the thyroid hormone changes and their relationship with the state of severity in critically ill patients. Methods Ninety-two patients with no thyroidal illness syndrome admitted to the ICU from January ,2009 to December,2009 were enrolled in this study. The common situations and the score of acute physiology and chronic health evaluation Ⅱ were assessed on addmission. We measured the thyroid hormone levels on the day after admission and analysed whether thyroid hormone levels were related to disease severity. Results The thyroid hormone levels in septic shock group [TT3 (1.16 ± 0.24) nmol/L, TT4 (68.93 ± 24.11) nmol/L, FT3 (3.76 ± 0.21) prnol/L, FT4 (16.40 ± 2.74) pmol/L, TSH (1.58 ± 1.01) mU/L] were significantly lower than those in non-septic shock [TT3 (1.50 ± 0.25) nmol/L, TT4 (91.70 ± 21.90) nmol/L, FT3 (4.24 ± 0.45) pmol/L, FT4(17.98 ± 3.28) pmol/L, TSH (2.43 ± 2.76) mU/L] (P ＜ 0.05). The serum thyroid hormone levels of free triiodothyronine (FT3) ,free thyroxine (FT4) were related to the score of APACHE Ⅱ in septic shock(P ＜ 0.05).Conclusions The levels of thyroid hormone were significantly lower in critically ill patients than the control group and had positive correlation with the disease severity.
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OBJECTIVE To investigate the effect of ventilation on the changes in TNF-? concentration of BALF on acute lung injury model.METHODS Forty healthy male Sprague-Dawley rats were randomly divided into five groups LV,HV,LV2P,LV5P,LV8P and the rat model of acute lung injury was built.Mechanical ventilation was employed in the test groups.Rats were sacrificed after 2 hours ventilation when the serum acquired.The supernatant of BALF was detected for TNF-? concentration.RESULTS The changes in TNF-? content of serum:the TNF-? contentration of serum was higher in HV group than that in LV group(P
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AIM: To investigate the effect of Salidroside on the proliferation, DNA synthesis, intracellular Ca 2+ content of rabbit PASMC (pulmonary artery smooth muscle cells) under hypoxia. METHODS: Techniques of cell culture, MTT test, -TdR incorporation, fluo-3 and confocal laser scanning microscopy were used. RESULTS: The A value of MTT and -TdR incorporation of PASMC increased significantly by 62% (P
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Objective To examine the effects of blood salvage and blood preservation on erythrocyte immunity in adults. Methods Fifty patients of both sexes (22 males, 28 females) aged 25-69 yr undergoing cardiovascular or orthopedic surgery or surgery for spleen rupture or ruptured ectopic pregnancy during which ZITI-2000 autotransfusion system was used to salvage shed blood were enrolled in this study. Blood samples were taken from autotransfusion system after being heparinized, filtered, centrifuged and washed (n = 50) (group Ⅰ) , and also directly from operative field (n = 50) (group Ⅱ). In group Ⅲ blood samples were taken from bank blood after being preserved in citrate-phosphate-dextrose-adenine (CPDA) anticoagulant solution for 2 weeks ( n = 50) . The rosette rate of RBC-C3b receptor (RBC-C3b RR), The rosette rate of RBC-immune complex (RBC-ICR), the percentage of CD35-positive erythrocyte and the content of SOD in erythrocyte were measured. Results The RBC-C3b RR, the percentage of CD35-positive erythrocyte and the SOD content in erythrocyte were significantly lower in group Ⅰ and Ⅲ than in group Ⅱ(P
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Objective To investigate the effects of anesthesia and operation on glomerular and renal tubular function Methods Forty patients without renal disease were assigned to 4 groups: general anesthesia + minor operation; general anesthesia +major operation; epidural block + minor operation and epidural block + major operation The concentration of ?_2-microglobulin(?_2-MG)、albumin(Alb)and immunoglobulin G(IgG)in urine were measured before operation ,1h following operation and 24h after operationResults In the groups of major operation, the concentrations of ?_2-MG, Alb and IgG in urine increased significantly during and after operation(P005)Conclusions The influences on renal glomerular and tubular function during perioperation are related to the degree of operative stimulation, but do not to the anesthesia
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Objective To evaluate the effects of propofol on glomerular and renal tubular functionsMethods Twenty-five patients without renal disease were randomly assigned to two groups: propofol group(n=13) and enflurane group(n=12), The creatinine, urea nitrogen, uric acid(UA) , ? 2 -microglobulin( ? 2-MG) concentrations in serum and urine were measured before induction of anesthesia, and 1, 2, 3, and 24h after induction Albumin(ALb), immunoglobulin G(IgG), pH, and protein in urine were also examinedResults In both groups , the urine concentrations of ? 2-MG , ALb and IgG were significantly increased following the administrations compared with those before induction of anesthesia (P