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Objective:To explore the value of bedside lung ultrasound in the early diagnosis and severity assessment of ventilator-associated pneumonia (VAP).Methods:A prospective observational study was conducted in 60 patients with VAP (VAP group) and 62 patients without VAP (control group) who were admitted to department of intensive care unit of General Hospital of Ningxia Medical University from September 2018 to July 2020. The gender, age and underlying diseases of non-VAP group were matched with VAP group. The general clinical data such as gender, age, underlying diseases, department source of the patient, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment (SOFA) score were recorded. The body temperature, white blood cell count (WBC), procalcitonin (PCT), oxygenation index (PaO 2/FiO 2), alveolar artery oxygen differential pressure (P A-aDO 2) were recorded. During mechanical ventilation, the patient's body temperature, WBC, sputum characteristics, and the change of the lung ultrasound were dynamically observed. With or without dynamic air bronchogram, lung ultrasound was considered to be positive as long as there were small subpleural consolidation or tissue-like sign. Ventilator-associated pneumonia lung ultrasound score (VPLUS) and lung ultrasound score (LUSS) were performed, and chest CT scan was completed on the same day. Use positive chest CT scan as the standard to evaluate the diagnostic efficacy of lung ultrasound, VPLUS score, and the combination of the two with PCT for VAP. LUSS was used to assess the severity of disease in patients with VAP. The correlation between LUSS and PaO 2/FiO 2, P A-aDO 2, APACHEⅡscore and SOFA score were analyzed. Results:① General information: compared with non-VAP group, VAP group had more emergency surgery patients [51.7% (31/60) vs. 33.9% (21/62), P = 0.047], APACHEⅡ score and SOFA score were significantly higher (APACHEⅡscore: 15.4±5.7 vs. 13.4±3.4, P = 0.021; SOFA score: 8.8±4.2 vs. 6.3±3.3, P < 0.001), body temperature tended to rise (℃: 38.3±0.8 vs. 38.0±0.9, P = 0.054), more patients had airway purulent secretions [65.0% (39/60) vs. 41.9% (26/62), P = 0.011], and mechanical ventilation time and length of ICU stay were longer [mechanical ventilation time (days): 10.5 (6.6, 15.0) vs. 4.3 (3.0, 6.0), P < 0.001; length of ICU stay (days): 14.8 (9.0, 18.0) vs. 6.0 (4.0, 9.1), P < 0.001], 28-day mortality rate was higher [31.7% (19/60) vs. 9.7% (6/62), P = 0.003].② Diagnostic efficacy evaluation: when lung ultrasound was positive, VPLUS≥3 and PCT > 0.5 μg/L were used separately for the diagnosis of VAP, the sensitivity was 73.3%, 75.0%, 61.7%, respectively; the specificity was 80.6%, 58.1% and 59.7%, respectively; the 95% confidence interval (95% CI) was 0.685-0.842, 0.574-0.748, 0.514-0.694, respectively, all P < 0.05, positive lung ultrasound had good sensitivity and specificity. When positive lung ultrasound or VPLUS≥3 were combined with PCT > 0.5 μg/L for tandem test, the specificity of VAP diagnosis was increased to 95.2% and 83.9%, respectively; but the specificity of VAP diagnosis of positive lung ultrasound combined with PCT > 0.5 μg/L was higher than VPLUS ≥3 combined with PCT > 0.5 μg/L (95.2% vs. 83.9%, P < 0.05).③ Correlation analysis: LUSS showed a significant positive correlation with APACHEⅡ and SOFA score ( r values were 0.407, 0.399, P values were 0.001, 0.002, respectively), LUSS had no relation with PaO 2/FiO 2 and P A-aDO 2 ( r values were 0.189, -0.064, P values were 0.629, 0.149, respectively). Conclusions:Lung ultrasound can early detect VAP , and its diagnostic specificity is significantly improved when combined with PCT > 0.5 μg/L. LUSS is closely related to the severity of disease in VAP patients, therefore, lung ultrasound may be an effective method for early diagnosis and efficacy evaluation of VAP patients.
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Objective:To evaluate the predictive effect of the 24 h energy expenditure value obtained by indirect calorimetry (IC) on the prognosis of patients with multiple traumatic mechanical ventilation.Methods:A total of 140 patients with multiple traumatic mechanical ventilation who were hospitalized in the ICU of General Hospital of Ningxia Medical University from December 1st, 2016 to August 31st, 2018 were selected as research objects. The general information such as sex, age, Height, weight, and clinical diagnosis were recorded. The IC method was used to measure the patient's 24 h energy expenditure, and the ratio of 24 h energy expenditure to the actual body weight of the patients was calculated the energy expenditure of 24 h energy expenditure per kilogram of body weight. The patient’s mechanical ventilation time and length of stay in ICU were statistically analyzed. The outcome indexes were 28-day mortality and the incidence of hospital-acquired infection. The receiver operating characteristic curve (ROC) was used to analyze the predictive value of 24 h energy expenditure and 24 h energy expenditure per kilogram of body weight.Results:The mechanical ventilation time was positively correlated with 24 h energy expenditure and 24 h energy expenditure per kilogram of body weight ( r=0.470, r=0.247, both P<0.01). The length of sty in ICU was positively correlated with the 24 h energy expenditure of patients with multiple trauma( r=0.276, P<0.05). The area under the ROC curve (AUC) of the 24 h energy expenditure and 24 h energy expenditure per kilogram of body weight for the 28 d mortality and the incidence of hospital-acquired infection were 0.647, 0.663, 0.832, 0.646, with the 24 h energy expenditure per kilogram of body weight greater than 30.4 kcal/(kg·d) as the best critical value for judging 28 d mortality. The sensitivity was 66.5%, specificity was 77.0%, and the 24 h energy expenditure consumption greater than 2 083 kcal/d was used as the optimal critical value for judging the susceptibility to acquire hospital infection, with a sensitivity of 80.0% and specificity of 80.7%. Conclusions:The mechanical ventilation time and length of stay in ICU are closely related to energy expenditure in patients with multiple trauma. The 24 h EE per kilogram of body weight and 24 h energy expenditure have a certain predictive effect on the prognosis of patients with multiple trauma.
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Objective To investigate the effects of traditional Chinese medicine colquhounia root tablet on the expression of tight junction protein claudin-2 and ZO-1 in bronchial epithelium tissues of rats with acute lung injury (ALI), and to study the mechanism of protective effect of colquhounia root tablet on ALI. Methods Twenty-four healthy male Sprague-Dawley (SD) rats were randomly divided into control group, ALI group and colquhounia root tablet pretreatment group, with 8 rats in each group. The model of ALI was reproduced by intravenous injection of oleic acid 0.04 mL/kg, and the rats in cont rol group were given the same amount of normal saline (NS) instead. The rats in colquhounia root tablet pretreatment group were intragastric administrated with colquhounia root tablet of 600 mg·kg-1·d-1 (2 mL) for 10 days before model reproduction, and the rats in control group and ALI group were given the same amount of NS. At 4 hours after model reproduction, the blood was drawn from abdominal aorta, and bronchoalveolar lavage fluid (BALF) was collected for determination of protein content in plasma and BALF, and the lung permeability index (LPI) was calculated. The rats were sacrificed to collect lung tissues for determination of lung wet/dry weight ratio (W/D), the changes in pathology of lung tissue were observed after hematoxylin and eosin (HE) staining with light microscope, and lung injury score (LIS) was evaluated. The immunohistochemic al staining was used to detect the expression and localization of claudin-2 and ZO-1 in bronchial epithelium tissues. The protein expressions of claudin-2 and ZO-1 in bronchial epithelium tissues were determined by Western Blot. Results Compared with control group, the lung injury in ALI group was more obvious including cellular edema and structural disorder of intercellular connection by optical microscope, and LIS, W/D ratio, and LPI were significantly increased (LIS: 3.81±0.42 vs. 0.40±0.08, W/D: 7.68±0.64 vs. 4.44±0.39, LPI: 0.89±0.15 vs. 0.38±0.05, all P < 0.01). Claudin-2 and ZO-1 were mainly expressed in the bronchial epithelium cell, and the expression degrees were significantly weakened in ALI group as compared with control group. It was shown by Western Blot results that compared with control group, the protein expressions of claudin-2 and ZO-1 were significantly down-regulated in ALI group [claudin-2 protein (gray value): 0.43±0.31 vs. 2.16±1.33, ZO-1 protein (gray value): 1.25±0.41 vs. 2.82±0.76, both P < 0.01]. Compared with ALI group, colquhounia root pretreatment could effectively diminish the degree of ALI (LIS: 1.22±0.39 vs. 3.81±0.42, W/D: 4.62±0.84 vs. 7.68±0.64, LPI: 0.46±0.07 vs. 0.89±0.15, all P < 0.01), and the protein expressions of claudin-2 and ZO-1 were significantly up-regulated [claudin-2 protein (gray value): 2.98±0.91 vs. 0.43±0.31, ZO-1 protein (gray value): 2.35±0.51 vs. 1.25±0.41, both P < 0.01]. Conclusion Administration of colquhounia root table could attenuate lung injury induced by oleic acid with improving epithelial barrier function via up-regulate the expression claudin-2 and ZO-1, which play a protective effect on the lung of rats with ALI.
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Objective To study the effect of laparoscopic cholecystectomy(LC) in the treatment of patients with schistosomiasis hepatic cirrhosis(SHC) complicated with symptomatic gallstone. Methods The clinical data of 256 cases of SHC with symptomatic gallstone underwent cholecystectomy in recent 4 years in our hospital were reviewed retrospectively. Of them, 74 underwent LC , which was compared with the cases who underwent open cholecystectomy(OC) in operation time, operative heamorrage,operative complications, and hospital stay.Results The operation time in LC group and OC group was 63 min and 54 min respectively; the operative bleeding of LC group was 15.6ml, OC group 85 ml;and hospital stay was 1.2days in LC group,8.9 days in OC group。Six cases of LC group was converted to OC.None had postoperative complications in LC group; but 1 case in OC group had bile leakage. Conclusions With strict the operative indications and proper operative method,LC in the treatment of SHC patients with gallstone is safe and feasible.