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Objective@#To investigate the implementation and application effect of 1-hour bundle in the treatment of patients with sepsis.@*Methods@#A convenient sampling method was conducted. 102 patients with sepsis admitted to central intensive care unit (ICU) of Henan Provincial People's Hospital from January 2018 to February 2019 were enrolled. Thirty-five patients with 3-hour and 6-hour bundle from January to September in 2018 were served as the control group, and 67 patients who received 1-hour bundle from October 2018 to February 2019 were served as the observation group. The patients in the control group was treated with 3-hour and 6-hour bundle according to 2012 international guidelines for the diagnosis and treatment of severe sepsis and septic shock; and those in the observation group were treated and nursed according to the 1-hour bundle published by Surviving Sepsis Campaign (SSC) update 2018, and the sepsis cluster treatment medical team was established. The team members were trained in relevant knowledge and discussed the possible obstacles within the team and propose feasible measures. The implementation of the 1-hour bundle in the observation group was recorded. The general data of the patients in both groups including gender, age, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), etc. were collected, and the outcome indicators [duration of mechanical ventilation, length of ICU stay, 28-day mortality] were observed.@*Results@#In the observation group, 37 of 67 patients receiving 1-hour bundle met the target, with the overall achievement rate of 55.2% (37/67). Of the 37 eligible patients, 5 patients receiving 1-hour bundle met the target before the training of 1-hour bundle, accounting for only 33.3% (5/15) of the 15 patients who received 1-hour bundle during the same period. With the extension of training time, the achievement rate of sepsis 1-hour bundle was gradually increased [the achievement rate at 1 week and 4 weeks of training was 40.0% (4/10) and 52.4% (11/21), respectively], and increased to 81.0% (17/21) at the end of 12 weeks training. Thirty-seven patients who received 1-hour bundle and met the criteria were enrolled and compared with the control group. There was no significant difference in gender, age, or APACHEⅡ score between the two groups. Compared with the control group, the duration of mechanical ventilation and length of ICU stay of the observation group were significantly shortened (days: 6.15±0.49 vs. 7.24±0.53, days: 8.21±1.49 vs. 9.51±1.92), and the 28-day mortality was decreased significantly [10.8% (4/37) vs. 31.4% (11/35)], with statistically significant differences (all P < 0.05).@*Conclusions@#Through teamwork, discussion and improvement, the achievement rate of sepsis 1-hour bundle can be significantly improved. The use of sepsis 1-hour bundle can effectively decrease the duration of mechanical ventilation and length of ICU stay, and reduce the 28-day mortality.
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OBJECTIVE@#To investigate the implementation and application effect of 1-hour bundle in the treatment of patients with sepsis.@*METHODS@#A convenient sampling method was conducted. 102 patients with sepsis admitted to central intensive care unit (ICU) of Henan Provincial People's Hospital from January 2018 to February 2019 were enrolled. Thirty-five patients with 3-hour and 6-hour bundle from January to September in 2018 were served as the control group, and 67 patients who received 1-hour bundle from October 2018 to February 2019 were served as the observation group. The patients in the control group was treated with 3-hour and 6-hour bundle according to 2012 international guidelines for the diagnosis and treatment of severe sepsis and septic shock; and those in the observation group were treated and nursed according to the 1-hour bundle published by Surviving Sepsis Campaign (SSC) update 2018, and the sepsis cluster treatment medical team was established. The team members were trained in relevant knowledge and discussed the possible obstacles within the team and propose feasible measures. The implementation of the 1-hour bundle in the observation group was recorded. The general data of the patients in both groups including gender, age, acute physiology and chronic health evaluation II (APACHE II), etc. were collected, and the outcome indicators (duration of mechanical ventilation, length of ICU stay, 28-day mortality) were observed.@*RESULTS@#In the observation group, 37 of 67 patients receiving 1-hour bundle met the target, with the overall achievement rate of 55.2% (37/67). Of the 37 eligible patients, 5 patients receiving 1-hour bundle met the target before the training of 1-hour bundle, accounting for only 33.3% (5/15) of the 15 patients who received 1-hour bundle during the same period. With the extension of training time, the achievement rate of sepsis 1-hour bundle was gradually increased [the achievement rate at 1 week and 4 weeks of training was 40.0% (4/10) and 52.4% (11/21), respectively], and increased to 81.0% (17/21) at the end of 12 weeks training. Thirty-seven patients who received 1-hour bundle and met the criteria were enrolled and compared with the control group. There was no significant difference in gender, age, or APACHE II score between the two groups. Compared with the control group, the duration of mechanical ventilation and length of ICU stay of the observation group were significantly shortened (days: 6.15±0.49 vs. 7.24±0.53, days: 8.21±1.49 vs. 9.51±1.92), and the 28-day mortality was decreased significantly [10.8% (4/37) vs. 31.4% (11/35)], with statistically significant differences (all P < 0.05).@*CONCLUSIONS@#Through teamwork, discussion and improvement, the achievement rate of sepsis 1-hour bundle can be significantly improved. The use of sepsis 1-hour bundle can effectively decrease the duration of mechanical ventilation and length of ICU stay, and reduce the 28-day mortality.
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Humanos , APACHE , Unidades de Cuidados Intensivos , Pronóstico , Sepsis/terapia , Choque SépticoRESUMEN
Objective:To examine the expression of TRAF6 in esophageal organization from protein level and analyze the correlations between TRAF6 expression and clinical features.Methods: Seventy-eight patients with esophageal adenocarcinoma who were admitted to the Department of Oncology , Henan Province Hospital of TCM from January 2005 and January 2010 were finally eligible for present study and the corresponding esophageal normal tissues and clinical data were collected .All the specimens were confirmed by pathology for esophageal squamous cell carcinoma or esophageal normal tissues .The expression of TRAF6 in the tissue samples was detected by immunohistochemistry .The correlation between the TRAF6 expression and clinical characteristics of patients was analyzed.Results:The positive expression rate of TRAF 6 in esophageal cancer organizations and normal esophageal mucosal tissues were 71.79%and 10.26%,respectively.The positive expression rate of TRAF6 in esophageal cancer were significantly higher than those in normal esophageal mucosal tissue ( P0.05),but with lymph node metastasis and clinical stage (P<0.05).Patients with positive TRAF6 expression had significantly lower five-year survival rate than those with tumors having positive TAK1 expression.Conclusion:TRAF6 may play an important role in the pathology and development of squamous cell carcinoma ,and could be an important therapeutic target in the treatment of esophageal cancer .
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Background and purpose: Ursolic acid is widely present in spica prunellae, hedyotis diffusa and other heat antidotes. The growth of a variety of tumor cells can be inhibited and induced apoptosis by ursolic acid.This study was aimed to investigate the effect and possible mechanisms of UA on inducing apoptosis of human gastric carcinoma BGC823 cells. Methods: The MTT assay was used to detect the antiproliferative effect of UA on BGC823 cells. Flow cytometry was used to detect cell cycle and apoptosis of BGC823 cells. The expression level of bcl-2 and bax gene was investigated by real time-polymerase chain reaction (real time-PCR). Results: UA inhibited the proliferation of BGC823 cells in a dose and time-dependent way. After treatment by UA for 24. 48 and 72 h, the IC_(50) of BGC823 was 36.88, 34.72, and 32.18 μmol/L, respectively. UA could signifcantly induce apoptosis of BGC823 cells and block cells at G_2/M phase. UA could increase the expression of bax gene and decrease the expression of bcl-2 gene in a dose and time-dependent way. Conclusion: UA could induce apoptosis and inhibit the proliferation of BGC823 cells in a dose and time-dependent way. It could arrest cell cycle of BGC823 cells at G_2/M phase. Its mechanisms might be associated with the up-regulation of bax gene and down-regulation of bcl-2 gene.