RESUMO
Objective To investigate the effect of dapagliflozin on myocardial work and energy metabolism in patients with heart failure with reduced ejection fraction(HFrEF)without type 2 diabetes mellitus(T2DM).Methods Patients with HFrEF without T2DM who visited Wuzhou People's Hospital from January 2021 to January 2022 were randomly divided into conventional group and dapagliflozin group(conventional treatment+dapagliflozin).After treatment(12 months),myocardial work[global work index(GWI),global constructed work(GCW),global wasted work(GW),and global work efficiency(GWE)],energy metabolism[(free fatty acids(FFA)and β-hydroxybutyric acid(β-HB)],traditional cardiac function[left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),and left ventricular ejection fraction(LVEF)],clinical efficacy,prognosis[mortality,rehospitalization,and incidence of major adverse cardiovascular events(MACE)]and adverse reactions were compared between the two groups.Results A total of 128 patients with HFrEF without T2DM were enrolled,including 63 patients in the dapagliflozin group and 65 patients in the conventional group.After treatment,the LVEDD,LVESD,GWW,NT-pro BNP in the dapagliflozin group was significantly lower than that in the conventional group(P＜0.05),while the LVEF,GWI,GCW,GWE,β-HB acid and FFA were significantly higher than those in the conventional group(P＜0.05).The total effective rate and hypoglycemia rates in the dapagliflozin group were significantly higher than those in the conventional group(P＜0.05),and the rehospitalization rate and MACE rate were significantly lower than those in the conventional group(P＜0.05).There were no significant differences in mortality,renal adverse events,urinary tract infections and gastrointestinal symptoms between the two groups(P＞0.05).Conclusion Dapagliflozin has significant clinical efficacy in patients with HFrEF without T2DM,which can increase the serum levels of FFA and ketones,improve effective work,and reduce ineffective work,but it is necessary to be vigilant against hypoglycemia.
RESUMO
Objective To investigate the occurrence of healthcare-associated infection(HAI)and catheter-related infection in a general intensive care unit(GICU),so as to strengthen the management.Methods Targeted monitor method was adopted,monitor scheme was established ,personal monitor contents and forms were designed,hospi-talized GICU patients were investigated prospectively between May 2012 and May 2013,and surveyed data were an-alyzed.Results A total of 868 patients were investigated,65 times (7.49%)of HAI occurred;infection rate per day was 21.49‰,adjust infection rate per day was 7.26‰.Infection rate of ventilator-associated pneumonia ,catheter-associated urinary tract infection ,and central venous catheter-related bloodstream infection per day was 23.91‰,3.46‰,and 6.12‰,respectively;the main infection site was respiratory tract (67.69%).Sixty-five isolates of pathogens were detec-ted,81.54%(n=53)of pathogens were gram-negative bacilli,and with multidrug resistance.Conclusion HAI rate is high in GICU ,the use of various types of catheters is an important factor for HAI in GICU patients.Targeted mo-nitoring on ICU is a scientific and effective method ,it can timely reflect the weak links of infection control practice and promote HAI control .