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Objective:To investigate the clinical effect of Jiedu Limai decoction in septic patients with syndrome of heat-toxin exuberance.Methods:A prospective randomized controlled trial was conducted. From March 2019 to April 2020, septic patients with syndrome of heat-toxin exuberance admitted to intensive care unit (ICU) of Shanghai General Hospital and Songjiang Branch of Shanghai General Hospital were enrolled as the research objects, and they were divided into routine treatment group and Jiedu Limai decoction group by the random number table method. Patients in both groups were given standard treatment in accordance with the guidelines, and patients in the Jiedu Limai decoction group were given Jiedu Limai decoction in addition to the standard treatment, once a day for 14 days. The 28-day survival of patients of the two groups were recorded, the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, sequential organ failure assessment (SOFA) score, coagulation indexes, infection indexes, inflammatory cytokines and organ function indicators before treatment and 7 days after treatment in both groups were recorded, and the prognosis of the two groups were recorded.Results:A total of 259 patients with infection or clinical diagnosis of infection admitted during the experimental observation period were included, and those who did not meet the Sepsis-3 diagnostic criteria, more than 80 years old or less than 18 years old, with multiple tumor metastases, autoimmune system diseases, with length of ICU stay less than 24 hours, with acute active gastrointestinal bleeding and with incomplete data were excluded. One hundred patients were finally enrolled, with 50 patients in the routine treatment group and 50 patients in the Jiedu Limai decoction group. There were no statistically significant differences in coagulation indexes, infection indicators, inflammatory cytokines and organ function indicators before treatment between the two groups. After 7 days of treatment, the coagulation indexes, infection biomarkers and inflammatory cytokines in the Jiedu Limai decoction group were significantly lower than those in the routine treatment group [D-dimer (mg/L): 2.2 (1.8, 8.5) vs. 4.0 (1.5, 8.7), fibrinogen (Fib, g/L): 3.7 (3.4, 4.3) vs. 4.2 (3.7, 4.3), fibrinogen degradation product (FDP, mg/L): 7.2 (5.4, 10.2) vs. 13.2 (9.2, 15.2), procalcitonin (PCT, μg/L): 0.4 (0.2, 2.9) vs. 0.5 (0.2, 0.9), C-reactive protein (CRP, mg/L): 50.1 (9.5, 116.0) vs. 75.1 (23.5, 115.2), interleukin-6 (IL-6, ng/L): 31.6 (21.6, 81.0) vs. 44.1 (14.0, 71.3), all P < 0.05], and the levels of B-type brain natriuretic peptide (BNP) and kidney injury molecule-1 (KIM-1) were significantly lowered [BNP (ng/L): 261.1 (87.5, 360.3) vs. 347.3 (128.8, 439.4), KIM-1 (μg/L): 0.86 (0.01, 1.40) vs. 1.24 (1.05, 1.57), both P < 0.05]. Compared with the routine treatment group, the number of new organ failure in the Jiedu Limai decoction group was decreased (30.0% vs. 50.0%, P < 0.05). Although there was no significant difference in 28-day mortality between the two groups ( P > 0.05), the 28-day mortality in the Jiedu Limai decoction group was lower than that in the routine treatment group (18.0% vs. 24.0%). Conclusion:Combining Jiedu Limai decoction to the sepsis guideline in treating syndrome of heat-toxin exuberance can effectively improve patients' coagulation function, the situation of heart and renal injury, reduce the level of inflammatory cytokines, and fewer people develop new organ failure after treatment.
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Objective To observe the effect of intermittent inhalation of budesonide on lung function and recurrence in asthmatic infants .Methods 120 children with recurrent wheezing and asthma predictive index were selected.They were randomly divided into control group and observation group according to the digital table ,60 cases in each group .The two groups were given conventional treatment .The observation group was treated with high dose of inhaled budesonide in the acute phase for 7 days,and stopped after the symptoms were controlled .However,cold air or acute infection caused wheezing recurrence ,used the above dose for 7 days to control the wheezing symptoms ,if not properly controlled to extend the treatment time so that wheezing control .In the control group ,children were treated with foggy cans inhalation of fluticasone propionate aerosol .After the symptoms were controlled ,the dose was reduced for 3 months.If the cold air or the occurrence of acute wheezing ,should be treated in time.The time of disappearance of wheeze in the lungs of the two groups was observed .The changes of lung function were observed before and after treatment for 6 months.The number of recurrent respiratory tract infections was observed in the two groups during this period.Results The disappearance time of wheeze ,cough,wheezing rale between the two groups had no statistically significant differences(t =0.67,P =0.25;t =0.96,P =0.17;t =1.60,P =0.06).Before treatment,the lung function indicators between the two groups had no statistically significant differences (all P>0.05).After treatment, TV,VPFE/VE,TPTEF/TE of the two groups were improved (all P<0.05),and there were no statistically significant differences between the two groups (all P>0.05).The number of respiratory infections ,the number of wheezing and the duration of wheezing in the observation group were less than those in the control group (t=14.72,P=0.00;t=9.15,P=0.00;t=6.97,P=0.00).There were 5 cases of hoarseness and 4 cases of rash in the control group .There were no serious adverse reactions in the observation group ,the difference was statistically significant (χ2 =9.73,P=0.002).Conclusion Intermittent inhalation of budesonide suspension can improve the clinical symptoms and improve lung function in children .It is better than long -term inhaled glucocorticoid in prevention of wheezing and with safety.It is suitable for clinical use .
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Objective To explore the clinical significance of platelet count, C-reaction protein and D-dimer in Kawasaki disease children with coronary artery lesion. Methods 54 cases of children with KD treated in our hospital from January 2013 to December 2015 were divided into coronary artery injury (CAL) group (n=15) and without coronary artery injury (NCAL) group (n=39), according to the cardiac ultrasound examination. The relationship between the changes of platelet count, C reactive protein and D- two and coronary artery lesion in the 2 groups of acute and convalescent stages were detected. Platelet count, C-reaction protein and D-dimer of 54 healthy children were measured as a control. Results The levels of the platelet count, C-reaction protein and D-dimer of the KD children during acute stage are significantly higher than the control group (P<0.05), while the levels of C-reaction protein and D-dimer of the KD children during recovery stage was significantly decreased after treatment (P<0.05), the platelet count is remarkably increased (P<0.01). The platelet count, C-reaction protein and D-dimer for the KD children with coronary artery malformation, either at acute stage or recovery stage, compared with the control group were significantly different (P<0.05), with statistical significance. Conclusion The changes of the platelet count, C-reaction protein and D-dimer levels have close relations with the cardiovascular damage to the KD children.
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Objective To investigate the clinical effect of milrinone in the treatment of children with congenital heart disease complicated by severe pneumonia and heart failure. Methods 94 patients with congenital heart disease complicated with severe pneumonia and heart failure in our hospital from March 2014 to February 2016 were selected,and randomly divided into experimental group and routine group,47 cases in each groups. The routine group were treated with conventional treatment, the experimental group in the conventional group received routine treatment based on the same given milrinone treatment. The clinical efficacy, symptom disappearance time and adverse reactions were compared between the two groups. Results The treatment in the experimental group the total efficiency (93.62%) was significantly higher than that of the conventional treatment group with the total effective rate (78.72%), significant difference, statistically significant (P<0.05); the experimental group in children with fever, cough, rales and other symptoms disappeared time is lower than the conventional group, the data had significant difference, has statistical significance (P<0.05); two groups of patients during treatment were not any serious adverse reactions, the adverse reaction condition no difference does not have statistical significance.Conclusion The clinical effect of milrinone in the treatment of children with congenital heart disease complicated by severe pneumonia and heart failure significantly, clinical efficacy, low incidence of adverse reactions, worthy of promotion.
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Objective To investigate the factors associated with hyporesponsiveness to erythropoietin (EPO) in patients on maintenance peritoneal dialysis (PD) . Methods Data of 114 PD patients in our PD center were collected . Patients were divided into three groups according to weekly EPO dose: hyperresponsive, hyporesponsive and normal responsive . Various factors were compared among three groups by linear correlation and ordinal regression analysis to predict EPO resistance . Results As compared to hyperresponsive and normal responsive groups,significantly lower serum hemoglobin [(78 .11±13 .42) vs (106 .28±23 .83), (96 .31±12 .33) g/L],albumin [(33 .98±4 .78) vs (39 .72±4 .26), (35 .76±4 .88) g/L], and significantly higher serum CRP [(26 .08±21 .66) vs (5 .46±1 .75), (11 .82±5 .63) mg/L], ferritin [(371 .08±89 .38) vs (289 .39±76 .84),(323 .07±62 .46) μg/L] were found in hyporesponsive group(all P ＜ 0 .01) . Erythropoietin resistance index (ERI) was correlated with CRP and albumin . Regression analysis showed that serum albumin,CRP and ferritin were strong predictors of EPO hyporespnsiveness . Conclusions Serum albumin,CRP and ferritin are closely related to hyporesponsiveness . Malnutrition and inflammatory state contribute to EPO hyporesponsiveness .