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Objective:To analyze the clinical characteristics of septic shock caused by upper and lower gastrointestinal perforation.Methods:Clinical data of patients with septic shock due to gastrointestinal perforation admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from January 2018 to December 2019 were analyzed retrospectively. The general information; procalcitonin (PCT), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sequential organ failure assessment (SOFA) scores during the first 24 hours in intensive care unit (ICU); results of ascites culture during the first 72 hours in ICU; the maximum dosage and total time of norepinephrine (NE) in ICU; mechanical ventilation time, the length of ICU stay, occurrence of acute kidney injury (AKI), continuous renal replacement therapy (CRRT) and 28-day mortality were collected. The patients were divided into upper gastrointestinal tract group (stomach and duodenum) and lower gastrointestinal tract group (jejunum, ileum, appendix, colon and rectum), with a boundary of Treitz. The clinical features between the two groups were compared.Results:There were 33 patients in the upper gastrointestinal tract group and 30 patients in the lower gastrointestinal tract group. There was no significant difference in gender and age between the two groups. The main pathogens in the ascites cultures in the upper gastrointestinal tract group were Candida albicans (45.5%), Enterococcus faecalis (18.2%) and Escherichia coli (18.2%). Escherichia coli (46.2%) and Enterococcus faecalis (30.8%) were the main pathogens in the lower gastrointestinal tract group. There were significant differences in PCT, the length of ICU stay, mechanical ventilation time, the maximum dosage and total time of NE between the upper gastrointestinal tract group and lower gastrointestinal tract group [PCT (μg/L): 17.69 (3.83, 26.62) vs. 32.82 (4.21, 100.00), the length of ICU stay (hours): 149.0 (102.5, 302.0) vs. 115.5 (30.8, 214.5), mechanical ventilation time (hours): 106.0 (41.5, 183.0) vs. 57.5 (25.0, 122.3), the maximum dosage of NE (μg·kg -1·min -1): 1.2 (0.5, 2.0) vs. 0.7 (0.5, 1.2), the total time of NE (hours): 72.0 (21.0, 145.0) vs. 26.5 (18.0, 80.5), all P < 0.05], while there was no statistically differences in APACHEⅡ or SOFA scores [APACHEⅡ: 30.0 (24.5, 35.0) vs. 28.0 (25.0, 33.5), SOFA: 10.67±4.14 vs. 9.50±3.33, both P > 0.05]. Compared with the lower gastrointestinal tract group, patients in the upper gastrointestinal tract group were more likely to have AKI (78.8% vs. 53.3%, P < 0.05) and require CRRT (39.4% vs. 16.7%, P < 0.05), but there was no significant difference in the 28-day mortality (39.4% vs. 43.3%, P > 0.05). Conclusions:The clinical characteristics of septic shock caused by upper and lower gastrointestinal perforation are not the same. Patients with septic shock caused by upper gastrointestinal perforation are more likely to suffer from fungal infection, with more severe shock, more likely to have AKI and require CRRT, and significantly longer mechanical ventilation and the length of ICU stay. While patients with septic shock caused by lower gastrointestinal perforation showed higher PCT.
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Carbon dioxide (CO 2) ejection syndrome is common after artificial pneumoperitoneum, and it often attracts the attention of anesthesiologists because of its rapid changes in vital signs. CO 2 ejection syndrome is not uncommon in critically ill patients, and may occur after mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). There are few relevant reports about CO 2 ejection syndrome, and a considerable number of clinicians have little understanding of the pathological changes. A case of AECOPD patient with CO 2 ejection syndrome after endotracheal intubation was admitted to the intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University. After treatment, such as fluid expansion, vasoactive drugs and ventilator assistance, the patient's condition improved and was transferred out of the ICU. It is expected to provide some references by summarizing the diagnosis and treatment of this case and reviewing relevant literature reports.
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Objective:To discuss the feasibility of offering specialized courses of critical care medicine in undergraduate clinical medicine education, so as to alleviate the shortage of critical care medicine staffs and lay a foundation for improving the success rate for the treatment of critical cases.Methods:The undergraduates majoring in clinical medicine from 2008 to 2011 in Guizhou Medical University (the former Guiyang Medical College) were enrolled. After they had been enrolled in the undergraduate education for 3 years and were ready for Grade four, which meant basic medicine teaching had been completed and clinical medicine teaching was about to start, they were introduced and preached to each discipline, including critical care medicine. The undergraduates were free to choose professional direction of clinical training in Grade four. Students majoring in clinical medicine from 2012 to 2014 were free to choose their major direction when they entered the school.Results:From September 2011 to July 2019, the university had cultivated 246 undergraduates majoring in clinical critical care medicine from 2008 to 2014, and the critical care medicine professional team of affiliated hospital had undertaken 540 teaching hours. By July 2019, all students had graduated on time, with an employment rate of 100%. Forty students took postgraduate programs in our school and other schools, accounting for 16.3%.Conclusions:Professional education of critical care medicine in the undergraduate course of clinical medicine can mobilize students' interest in learning and subjective initiative, which is conducive to career selection. During the clinical training, the students can identify and timely cure critical care cases in the early stage, and partly alleviate the current shortage of critical care medical staffs.
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Objective:To evaluate the effect of continuing health management on type 2 diabetes mellitus based on WeChat platform by Meta-analysis.Methods:Clinical randomized controlled trials connected with WeChat continuing health management for type 2 diabetes was searched by database including China Knowledge Network, Wanfang, Weipu, PubMed, Elsevier Science Direct, CINAHL, Web of Science, Cochrane Library. Cochrane bias risk assessment tool was used for evaluating the methodological quality of the included literatures. Meta-analysis of the data extracted from the included literature was performed by RevMan5.2 statistical software to assess heterogeneity of the outcome indicators and extract value of mean difference ( MD) and odds ratio ( OR). Results:A total of 1 133 patients with type 2 diabetes from 9 researches were enrolled in the study. The results showed that the WeChat continuing health management group had statistically significant differences in levels of fasting blood glucose ( MD value was -0.98, 95% CI -1.14 - -0.83, P<0.01), postprandial blood glucose ( MD value was -1.27, 95% CI -1.56 - -0.97, P<0.01), glycated hemoglobin ( MD value was -0.69, 95% CI -0.82 - -0.56, P<0.01), total cholesterol ( MD value was -0.54, 95% CI -0.65 - -0.44, P<0.01), triglyceride ( MD value was -0.50,95% CI -0.67 - -0.32, P<0.01) and low-density lipoprotein ( MD value was -0.52, 95% CI -0.74 - -0.30, P<0.01) compared with the control group. Conclusions:WeChat continuing health management intervention can effectively control the blood sugar and blood lipid levels of patients with type 2 diabetes mellitus and improve their self-management ability. For the deficiencies of little included references, the result still required a large-sample and high-quality randomized controlled trials to enhance accuracy.
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Objective To observe the clinical features of atrial fibrillation (AF) patients, and to explore the correlation between the routine detection index and the new-onset AF and to find out risk factors for new AF in critically ill patients. Methods A prospective observational study was conducted. The patients with AF admitted to intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University from March 2016 to June 2017 were enrolled. The patients were divided into new-onset AF group and past-existed AF group according to their past history of AF (including persistent AF, paroxysmal AF or permanent AF). In addition, patients in ICU without history of AF and new-onset AF were selected as the control group (no AF group). The general epidemiological characteristics of patients in three groups, and the blood biochemical, coagulation and other related indicators at the time of AF occurred (new-onset AF group) or 48 hours after ICU admission (AF group and no AF group) were analyzed; the difference of laboratory indexes between patients in new-onset AF group with AF within 48 hours before occurred and patients in no AF group within 48 hours after admission to ICU was compared. The relationship between each index and new-onset AF were analyzed. Pearson or Spearman rank correlation was used for analysis. Risk factors of new-onset AF were analyzed by Logistic regression analysis. Results 1 673 patients were admitted to ICU, including 179 cases of AF (10.70%), and 106 males and 73 females, with an average age of (71.73±23.22) years. There was 75 new-onset AF (morbidity 4.48%), and had a 28-day mortality of 45.33% (34/75). There were differences in age, previous heart disease and heart failure (HF) among new-onset AF group (n = 75), past-existed AF group (n = 104) and no AF group (n = 75). Compared with other two groups, renal insufficiency rates, troponin, serum sodium, calcium and procalcitonin levels were higher, mechanical ventilation time and the length of ICU stay were significantly prolonged, ICU and hospitalization costs were higher in new-onset AF group. Compared with no AF group, new-onset AF patients with the higher percentage of septic shock, the accumulation of vascular contraction drugs within 24 hours after AF usage were higher, and used more anti-arrhythmic drugs, has higher brain natriuretic peptide (pro-BNP), serum creatinine, blood lactic acid levels, and lower albumin, oxygenation index, and serum potassium levels, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score and 28-day mortality were higher. Correlation analysis showed that age, APACHE Ⅱ score, septic shock, HF, cardiovascular disease, renal insufficiency were positively correlated with new-onset AF (r values were 0.393, 0.270, 0.386, 0.251, 0.194, 0.170;P values were 0.000, 0.001, 0.000, 0.002, 0.017, 0.037, respectively). The age [odds ratio (OR) = 0.962, P = 0.046], basic oxygenation index (OR = 1.005, P = 0.028) and serum potassium levels (OR = 1.638, P = 0.022) were the risk factors for new-onset AF. Conclusions Critical patients with a high incidence of AF, new-onset AF significantly prolong the length of ICU stay; age, APACHE Ⅱ score, septic shock, cardiovascular disease, and renal insufficiency are related to new-onset AF; age, basic oxygenation index and serum potassium levels are risk factors for new-onset AF.
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The lung is a major target organ in acute paraquat (PQ) poisoning, but early PQ-induced severe liver failure is also an important life-threatening situation that can't be neglected. At present, toxin elimination through blood purification is a routine effective therapy recommended at the initial stage of PQ poisoning. However, the mode, therapeutic course and efficacy of blood purification for treatment of liver failure induced by PQ intoxication are still further to be explored. Theoretically, PQ is a substance with small molecule soluble in water, so hemofiltration (HF) is more suitable to be applied for treatment of PQ poisoning, but since PQ itself elimination rate (170 mL/min) from the kidney is far greater than the extracorporeal elimination rate of HF, it is suggested that HF be used only in cases with kidney functional injury caused by PQ poisoning. After PQ intoxication, a great amount of inflammatory mediators are produced; under this circumstance, if continuous veno-venous hemo-filtration (CVVH) is applied, its convection and dispersion features can remove the inflammatory mediators and toxin. Using hemoperfusion (HP) combined with CVVH not only can reduce the concentration of PQ but also can decrease plasma cytokine levels and ameliorate the organ damages. Thus, in cases with hepatic and renal functional damage, the application of combination of HP and CVVH is more effective for the treatment. Bilirubin adsorption can not only reduce bilirubin, but also can decrease PQ concentration, and it is also a means to treat PQ poisoning. In this article, the experience of using CVVH combined with HP, plasma separation and bilirubin adsorption for treatment of 1 case with liver failure induced by PQ poisoning was reported.
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Objective To explore the prognostic role of nutritional benefit assessment (NUTRIC score), nutritional risk screening 2002 (NRS 2002), traditional nutritional laboratory indicators albumin (ALB) and prealbumin (PA) in critically ill patients. Methods A historical-prospective cohort study was conducted. The data of 427 patients admitted to Department of Critical Care Medicine of the Affiliated Hospital of Guizhou Medical University from February 2014 to October 2014 were retrospectively analyzed, and thereafter a follow-up of 275 critically ill patients from November 2014 to April 2015 prospectively enrolled was performed. 261 patients were enrolled finally. Patients were divided into death group and survival group according to 28-day and 90-day outcome, the baseline data, acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, NRS 2002, NUTRIC score, ALB and PA were compared between the two groups. Logistic regression analysis was used to find risk factors for 28-day and 90-day prognosis. Results ① NRS 2002 score of all the 261 patients were greater than or equal to 3 with 100% nutritional risk. The patients in NUTRIC score 5-9 group had lower ALB and PA, higher NRS 2002 score, longer mechanical ventilation time and length of intensive care unit (ICU) stay, which indicated they were more serious. ② Twenty eight-day mortality was 20.7% (54 died from 261). Compared with survival group, the patients in death group had higher APACHE Ⅱ, SOFA, and NUTRIC scores [29.00 (22.75, 34.25) vs. 24.00 (20.00, 28.00), 10.0 (8.0, 13.0) vs. 9.0 (7.0, 11.0), 6.37±1.84 vs. 5.59±1.64, all P < 0.01], and longer days from hospital to ICU admission and mechanical ventilation time in ICU [1.5 (0, 9.2) days vs. 0 (0, 4.0) days, 6.0 (4.0, 11.0) days vs. 4.2 (2.5, 7.8) days, both P < 0.05]. It was revealed by logistic regression analysis that APACHE Ⅱ score [odds ratio (OR) = 1.089, 95% confidence interval (95%CI) = 1.039-1.141, P = 0.000] and days from hospital to ICU admission (OR = 1.042, 95%CI = 1.014-1.071, P = 0.003) were the independent risk factors for 28-day death in critically ill patients. ③ Ninety-day mortality was 42.5% (111 died from 261). Compared with the survival group, the death group patients were older with higher APACHE Ⅱ, SOFA, NRS 2002, and NUTRIC scores [age (years): 64.44±18.11 vs. 54.25±19.66, APACHE Ⅱ: 27.00 (23.00, 31.00) vs. 23.00 (20.00, 27.00), SOFA: 10.0 (8.0, 12.0) vs. 9.0 (7.0, 11.0), NRS 2002: 5.08±1.47 vs. 4.67±1.41, NUTRIC: 6.32±1.58 vs. 5.33±1.68], ALB was significantly reduced [g/L: 27.70 (23.05, 32.00) vs. 30.73 (26.90, 34.20)], and mechanical ventilation time in ICU was extended obviously [days: 5.7 (3.6, 11.0) vs. 3.9 (2.4, 7.0), all P < 0.05]. It was revealed by logistic regression analysis that old age (OR = 1.019, 95%CI = 1.002-1.037, P = 0.029) and NUTRIC score (OR = 1.211, 95%CI = 0.983-1.491, P = 0.072) were the independent risk factors for 90-day death probability, and ALB probability was the protect factor for 90-day death (OR = 0.954, 95%CI = 0.916-0.994, P = 0.024). Conclusion It was NUTRIC score but not NRS 2002, ALB and PA predicted 90-day mortality in critically ill patients.