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ObjectiveHyperlipidemic severe acute pancreatitis, which has a poor prognosis, is a common acute and critical disease. To discuss the reactive factors and prognosis analysis of serum lipid level to plasma exchange in patients with hyperlipidemic severe acute pancreatitis (HL-SAP).MethodsA retrospective study was conducted on the clinical data of 70 HL-SAP patients admitted to the department of critical care medicine in Nanjing drum tower hospital from January 2010 to May 2018. All patients received plasma exchange therapy, and were divided into the high-response group (>60%) and the low-response group (< 60%) according to the decrease of serum triglyceride (TG) level. Single factor analysis was conducted with χ2 or Mann-Whitney U test in the patients' gender, age, body mass index (BMI), Ranson score, clinical acute physiology assessment and chronic health evaluation (APA-CHE), sequential organ failure assessment(SOFA), start time from incidence to plasmapheresis, plasma exchange dosage, blood flow velocity, serum amylase, albumin, red blood cells hematocrit (Hct), blood TG before plasma exchange, total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL). The factors, which include gender, start time from incidence to plasmapheresis, TG, and Hct, have statistical differences in single factor analysis and were incorporated into the Logstic regression analysis for a multifactor analysis.ResultsTG levels ranged from 10.10 to 53.60 mmol/L in 70 patients with an average of (21.45±13.56) mmol/L before plasma exchange while it ranged from 1.97 to 20.00 mmol/L with an average of (6.10±3.58) mmol/L after plasma exchange, and the difference was statistically significant (P<0.05). In this group, the TG decreased by 12.75%~89.43%, which included 46 patients in the high-response group and 24 patients in the low-response group. Compared with the low-response group, the high-response group has statistically significant (P<0.05) in the differences of gender, start time from incidence to plasmapheresis, serum amylase, plasma exchange dosage, red blood cells hematocrit (Hct), blood lipid before exchange, TC, and HDL. Multivariate Logistic regression analysis showed that changes in blood lipid level after plasmapheresis in HL-SAP patients were significantly correlated with gender, start time from incidence to plasmapheresis, red blood cells hematocrit (Hct), blood lipid before plasmapheresis (P<0.05). Compared with the low-response group, it has statistically significant in difference between acute kidney injury and mortality in the high-response group (P<0.05).ConclusionThe reactive factors for the efficacy of plasma exchange in patients with HL-SAP are gender, tart time from incidence to plasmapheresis, red blood cells hematocrit (Hct), and blood lipid before plasmapheresis. The low response group had a higher incidence of acute kidney injury and a poor prognosis.
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Objective To understand serum trough concentrations (Cmin) of teicoplanin and target concentration achieved in severely infected patients after three days treatment with different loading doses of teicoplanin,and find out optimal loading dose.Methods Severely infected patients who admitted to the intensive care unit(ICU) of a hospital from February 1,2016 to February 28,2017 were enrolled in the study.According to different drug loading doses (teicoplanin standard dose:6mg/kg;high dose:10mg/kg) and different creatinine clearance rates (Ccr:50mL/min as standard value),patients were divided into four subgroups:group of standard dose and normal Ccr (GsD1),group of standard dose and low Ccr (GSD2),group of high dose and normal Ccr (GHD1),group of high dose and low Ccr(GHD2).Serum Cmin,percentage of achieving target concentration,and adverse reactions of teicoplanin in different groups were compared.Results A total of 49 patients were enrolled in the study,17 patients were in GSD group,Cmin on 4th day before administration was (5.98 ± 2.67)mg/L;32 patients were in GHD group,Cmin on 4th day before administration was (9.05 ± 4.25)mg/L;Cmin in GHD group was higher than that in GsD group,and there was statistical difference between two groups(t=3.10,P=0.003).Values of Cmin in GSD1,GSD2,GHD1,and GHD2 groups were (5.78±2.72),(6.34±2.78),(8.21 ±3.77),and (12.07±4.81) mg/L respectively,differences among four groups were statistically significant(F =4.766,P =0.006).The Cmin in GHD2 group was higher than those in GHD1,GSD2,and GsD1 groups,percentage of achieving the target concentration were 9.09％ (1/11),16.67％ (1/6),28.00％(7/25),and 71.43％ (5/7) respectively,differences were statistically significant(x2=8.766,P=0.033).Complications associated with teicoplanin such as rash,damage to hepatic and renal function were not observed in all patients during the treatment course.Conclusion Whether the Ccr is normal or not,target Cmin can not be achieved early in patients given teicoplanin with standard loading dose;in patients with low Ccr,given high loading dose,target Cmin can be achieved early;while in patients with normal Ccr,higher loading dose may be needed.