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Objective:To investigate the effects of fluid resuscitation under pulse-indicated continuous cardiac output monitoring on endothelial function, inflammatory indexes and hemodynamics in patients with traumatic shock.Methods:The clinical data of 62 patients with traumatic shock who received treatment in the First Affiliated Hospital of Zhejiang Chinese Medical University, China between July 2019 and July 2020 were retrospectively analyzed. These patients were divided into observation and control groups ( n = 31/group) according to different fluid resuscitation methods. The control group was given conventional fluid resuscitation and the observation group was subjected to guided fluid resuscitation under pulse-indicated continuous cardiac output monitoring. General treatment and nitric oxide, endothelin-1, C-reactive protein, interleukin-6, interleukin-1β, tumor necrosis factor-α, central venous pressure, mean arterial pressure, and central venous oxygen saturation before and 24 hours after treatment as well as complications were compared between the two groups. Results:Time to early resuscitation, duration of mechanical ventilation, intensive care unit length of stay and the length of hospital stay in the observation group were (5.33 ± 0.51) hours, (37.45 ± 4.84) hours, (8.75 ± 1.20) days, (16.85 ± 2.03) days, respectively, which were significantly shorter than those in the control group [(8.14 ± 1.20) hours, (46.06 ± 4.71) hours, (11.46 ± 1.63) days, (20.01 ± 2.41) days, t = 11.999, 7.098, 7.455, 5.584, all P < 0.01). At 24 hours after treatment, serum level of nitric oxide in the observation group was significantly higher than that in the control group [(52.04 ± 3.91) μmol/L vs. (40.25 ± 4.25) μmol/L, t = 11.367, P < 0.01]. Serum level of endothelin-1 in the observation group was significantly lower than that in the control group [(66.95 ± 4.75) ng/L vs. (78.04 ± 7.92) ng/L, t = 6.686, P < 0.01)]. Serum levels of C-reactive protein, interleukin-6, interleukin-1β, tumor necrosis factor-α in the observation group were (8.32 ± 1.56) mg/L, (113.03 ± 15.74) ng/L, (69.82 ± 6.50) ng/L, (42.80 ± 4.32) ng/L, respectively, which were significantly lower than those in the control group [(11.61 ± 1.74) mg/L, (130.42 ± 20.68) ng/L, (81.33 ± 7.30) ng/L, (56.11 ± 6.36) ng/L, t = 7.838, 3.726, 6.556, 9.639, all P < 0.01)]. Mean arterial pressure, central venous pressure and central venous oxygen saturation in the observation group were (76.64 ± 5.05) mmHg, (10.79 ± 0.53) mmHg, (79.93 ± 5.04) %, respectively, which were significantly higher than those in the control group [(70.32 ± 4.31) mmHg, (9.50 ± 0.62) mmHg, (73.40 ± 4.76) %, t = 5.300, 8.806, 5.245, all P < 0.01]. The incidence of complications in the observation group was significantly lower than that in the control group [9.68% (10/31) vs. 32.26% (8/31), χ2 = 4.769, P < 0.05]. Conclusion:Fluid resuscitation under pulse-indicated continuous cardiac output monitoring has an obvious effect traumatic shock, which can improve vascular endothelial function, inflammatory index and hemodynamic index, and is worthy of popularization and application.
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ObjectiveTo observe the curative effect of Xiangshaliujunzi decoction on critically ill patients with gastrointestinal dysfunction accompanied by spleen deficiency syndrome of traditional Chinese medicine (TCM) and its influence on tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6).Methods Forty-eight critically ill patients admitted to Department of Emergency Intensive Care Unit (EICU) in Zhejiang Provincal Hospital of Traditional Chinese Medicine Xiasha Campus from February to December 2015 were enrolled, and they were randomly divided into observation group (26 cases) and control group (22 cases) by random number table method. The patients in both groups were given routine emergency western therapy, and in the observation group, additionally, Xiangshaliujunzi decoction (ingredients: codonopsis pilosula 20 g, atractylodes macrocephala koidz 12 g, poria cocos 12 g, radix glycyrrhizae preparata 4 g, rhizoma pinelliae preparatum 6 g, pericarpium citri reticulatae 5 g, fructus amomi villosi 5 g, radix aucklandiae 4 g, rhizoma zingiberis recens 3 pieces) 80 mL was prepared and divided into two parts for nasal feeding, once 40 mL, twice a day, while the patients in the control group received the nasal feeding with the same amount of warm boiled water. Before treatment and 3 days and 5 days after treatment, the gastrointestinal function scores were assessed, and the changes of the levels of plasma TNF-α, IL-6 were recorded.Results There were no statistical significant differences in gastrointestinal function scores, the levels of TNF-α and IL-6 between the two groups before treatment and 3 days after treatment (allP ﹥ 0.05). But 5 days after the treatment, the gastrointestinal function scores, the levels of TNF-α and IL-6 were obviously decreased in two groups, and the degree of decrease in observation group was more significant [gastrointestinal function score: 0.92±0.85 vs. 2.27±0.77, TNF-α (ng/L): 17.7±2.4 vs. 25.0±4.2, IL-6 (ng/L): 16.9±2.4 vs. 25.0±3.4, allP < 0.01].Conclusion Xiangshaliujunzi decoction has therapeutic effect on critically ill patients with gastrointestinal dysfunction and accompanied by spleen deficiency in TCM, the mechanism may be related to decreasing the levels of TNF-α and IL-6, thereby depressing the inflammation.
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Objective] To investigate the protective effect and potential mechanism of Astragalus injection on mucosa epithelial cells in rats with sepsis . [Methods] Thirty Sprague-Dawley rats were randomly divided into sham,model and Astragalus injection treatment groups with 10 rats in each group.Rat sepsis model was constructed by cecal ligation and puncture.Rats in the Astragalus injection treatment group received 800 mg·kg-1 of Astragalus injection at 15 minutes before and 6 hours after operation. Intestinal mucosa were harvested and frozen at -80℃ on post-operation 24 hours. Intestinal mucosa epithelial cell apoptosis was detected by TUNEL,while Bcl-2 and Bax levels were determined by real-time quantitative PCR(qPCR) and Western blot technique.[Results] The apoptosis indexes were 5.2±0.3,22.3±1.2 and 11.2±0.9 of sham,model and Astragalus injection treatment group,respectively. Apoptosis index in model group was significantly higher than that in sham group( P<0.05),while the apoptosis of mucosa epithelial cells was significantly attenuated after Astragalus injection treatment(P<0.05).In model group,the expression of Bcl-2 was lower than that of sham group,whereas the expression of Bax was higher than that in sham group(P<0.05).Astragalus injection treatment significantly lowered Bax level while elevated Bcl-2 expression, compared with model group(P<0.05). [Conclusion] Astragalus injection could suppress sepsis-induced apoptosis of mucosa epithelial cells via up-regulating Bcl-2 and down-regulating Bax.