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Objective:To investigate the clinical significance of neutrophil-to-lymphocyte ratio (NLR) in classification of patients with coronavirus disease 2019 (COVID-19).Methods:A retrospective analysis was performed on 72 patients with COVID-19 admitted to the critical ward of Cancer Center of Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in Wuhan from February to March in 2020. The patients were divided into two groups: moderate type (non-severe group) and severe/critical type (severe group). The results of white blood cell count (WBC), neutrophil count (NEU), lymphocyte count (LYM), interleukin-6 (IL-6) and D-dimer were collected at the 2nd day after admission from the two groups, and the NLR was calculated. The diagnostic value of WBC, NEU, LYM, IL-6, D-dimer and NLR on COVID-19 classification was evaluated by the receiver operating characteristic (ROC) curve.Results:A total of 72 COVID-19 patients were enrolled, among whom 52 were moderate, 17 were severe, and 3 were critical. The most common clinical manifestations of patients were fever (70.8%), cough (36.1%), chest tightness and breathlessness (37.5%), diarrhea (15.3%), fatigue (15.3%), vomiting and nausea (11.1%), occasionally accompanied by acute dyspnea (2.8%), and only one patient had no clinical symptom (1.4%). The levels of WBC, NEU, IL-6, D-dimer and NLR in the severe group were significantly higher than those in the non-severe group [WBC (×10 9/L): 7.81±3.65 vs. 5.34±1.69, NEU (×10 9/L): 5.83±3.13 vs. 3.24±1.53, IL-6 (ng/L): 133.63 (71.09, 249.61) vs. 28.05 (6.41, 101.24), D-dimer (mg/L): 0.86 (0.31, 2.56) vs. 0.33 (0.20, 0.71), NLR: 6.14±4.75 vs. 2.66±1.93, all P < 0.05], and the level of LYM was significantly lower than that in the non-severe group (×10 9/L: 1.09±0.56 vs. 1.49±0.74, P < 0.05). The results of ROC curve analysis showed that the areas under ROC curve (AUC) of WBC, NEU, LYM, IL-6, D-dimer and NLR for COVID-19 classification were 0.790 [95% confidence interval (95% CI) was 0.684-0.897), 0.869 (95% CI was 0.789-0.949), 0.719 (95% CI was 0.592-0.847), 0.790 (95% CI was 0.682-0.898), 0.676 (95% CI was 0.526-0.827), and 0.888 (95% CI was 0.814-0.963) respectively. The AUC of NLR was the highest, which was of high diagnostic value; when the optimum cut-off value of NLR was 3.00, the sensitivity was 100%, and the specificity was 73.1%. Conclusion:NLR can be used as a biomarker to predict classification of COVID-19 patients independently, which can provide a theoretical basis for the classification management of COVID-19 patients.
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Objective To investigate the risk factors of acute kidney injury (AKI) occurring in patients with critical neurological disease, and the related factors affecting their prognosis. Methods The clinical data of 207 patients with critical neurological disease admitted to the Department of Critical Care Medicine of Anhui Provincial Hospital Affiliated to Anhui Medical University (South District) from January 2016 to March 2017 were analyzed retrospectively, they were assigned into an AKI group (40 cases) and a non-AKI group (167 cases), and according to the prognosis, the patients with AKI were subdivided into a survival subgroup (14 cases) and a death subgroup (26 cases). Clinical data of Glasgow coma score (GCS), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), blood glucose, white blood cell count (WBC), central venous pressure (CVP), blood sodium, cystatin C, urea nitrogen (BUN) etc. index levels and the proportions of patients using glycerin fructose and furosemide before occurrence of AKI were collected. The indexes with statistical significant differences found in the univariate analysis were analyzed by multivariate logistic regression analysis to screen out the risk factors influencing the occurrence of AKI and the factors related to the prognosis of the AKI patients; the receiver operating characteristic curve (ROC) was drawn to assess the predictive value of risk factors in patients with severe neurological disease to develop AKI. Results The incidence of AKI was 19.3% (40/207) in the patients with critical neurological disease. The hospital mortality in AKI group was significantly higher than that in the non-AKI group [65.0% (26/40) vs. 22.2% (37/167), P < 0.01]. Compared with non-AKI group, GCS (4.44±1.65 vs. 5.39±1.62), CVP [cmH2O (1 cmH2O = 0.098 kPa): 7.69±2.66 vs. 8.98±2.56] were obviously lower in AKI group at admission, APACHEⅡ(24.50±3.67 vs. 20.05±4.42), blood glucose (mmol/L: 12.33±6.53 vs. 9.33±3.26), serum sodium (mmol/L: 144.75±10.85 vs. 140.58±5.23), WBC (×109/L: 16.15±6.25 vs. 12.79±4.22), Cystatin C (mg/L: 1.27±0.74 vs. 0.74±0.26) and BUN (mmol/L: 7.81±3.33 vs. 5.53±3.20) and proportion of male [77.5% (31/40) vs. 59.9% (100/167)], patients with the comorbidity of hypotension [37.5% (15/40) vs. 19.8% (33/167)], use of glycerin fructose [17.5% (17/40) vs. 3.6% (6/167)], or use of furosemide [70.0% (28/40) vs. 13.8%(6/167)] were significantly increased in AKI group, there was a statistically significant difference between the above two groups (all P < 0.05). Multivariate logistic regression analysis showed that the hyperglycemia [odds ratio (OR) = 1.201, 95% confidence interval (95%CI) = 1.01-1.42, P < 0.05] and use of furosemide for treatment (OR = 24.493, 95%CI =4.92-120.36, P < 0.01) were the independent risk factors for occurrence of AKI in critical neurological patients. ROC curve analysis showed that blood sugar had certain predictive value of developing AKI in patients with critical neurological disease, the area under the ROC curve (AUC) of blood glucose was 0.733, when the optimal cut-off value of blood glucose was 9.05 mmol/L, the sensitivity was 77.5% and the specificity was 62.6%. Compared with the survival subgroup in the patients with AKI, the GCS at admission in death subgroup was significantly lower (3.77±0.87 vs. 5.50±2.03), but their levels of blood glucose (mmol/L: 16.51±9.10 vs. 10.09±2.89) and BUN (mmol/L: 10.26±3.07 vs. 6.48±2.70) were obviously higher than those in the survival subgroup (all P < 0.05). Conclusion AKI is one of the common complications in patients with critical neurological disease, hyperglycemia and the use of furosemide are the independent risk factors of occurrence of AKI in such patients; the blood glucose has moderate predictive value; and lower GCS, higher glucose and BUN levels in AKI patients may enhance their risk of death.
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Objective To investigate the effect of serum calcium level on the prognosis of patients with sepsis. Methods Clinical data of 119 patients with sepsis admitted to intensive care medicine (ICU) of the First Affiliated Hospital of the University of Science and Technology of China from January 2017 to October 2018 were retrospectively analyzed. Gender, age, and C-reactive protein (CRP), procalcitonin (PCT), serum calcium levels, acute physiology and chronic health evaluationⅡ(APACHEⅡ), sequential organ failure score (SOFA) within 24 hours of diagnosis, and 28-day mortality were collected. The patients were divided into the normal serum calcium group (serum calcium 2.00-2.67 mmol/L) and the hypocalcemia group (serum calcium < 2.00 mmol/L) according to their serum calcium level. The patients were divided into survival group and death group according to 28-day prognosis. Pearson correlation test was used to analyze the correlation between serum calcium level and clinical indicators. Receiver operator characteristic (ROC) curve was used to analyze the predictive value of serum calcium level on prognosis. Results A total of 119 patients with sepsis were included, including 50 patients with normal serum calcium, with serum calcium level of (2.14±0.10) mmol/L; and 69 patients of hypocalcemia, and the incidence of hypocalcemia was 57.98%, with serum calcium level of (1.81±0.14) mmol/L. In the hypocalcemia group, except that the APACHEⅡ score was significantly higher than that of the normal serum calcium group (25.59±5.52 vs. 22.28±4.89, P < 0.01), there was no significant difference in gender, age, CRP, PCT and SOFA score between the two groups. The 28-day mortality rate of the hypocalcemia group was significantly higher than that of the normal serum calcium group [78.26% (54/69) vs. 48.00% (24/50), χ2 = 10.45, P < 0.01]. The level of serum calcium in the death group was significantly lower than that in the survival group (mmol/L: 1.90±0.20 vs. 2.04±0.19), while the APACHEⅡ score was significantly higher than the survival group (25.78±5.25 vs. 21.20±4.68), with statistically significant differences (both P < 0.01). There was a negative correlation between serum calcium level and PCT, APACHEⅡ scores in patients with sepsis (r1 = -2.10, P1 = 0.04;r2 = -3.91, P2 < 0.01), but no correlation with CRP and SOFA score (r1 = 0.75, P1 = 0.46; r2 = -1.21, P2 = 0.23). The ROC curve analysis showed that the area under the ROC curve (AUC) for predicting the prognosis of sepsis patients with serum calcium level was 0.70 [95% confidence interval (95%CI) = 0.602-0.798], and the best cut-off value was 1.92 mmol/L, with the sensitivity was 52.56%, and the specificity was 82.93%. Conclusions The prognosis of sepsis patients with hypocalcemia is poor. Serum calcium level can be used as a predictor of prognosis in patients with sepsis.
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Objective@#To study the risk factors of prognosis in patients with septic shock, and to provide a reliable evidence to evaluate severity.@*Methods@#A retrospective analysis was conducted. The data of 185 patients with septic shock admitted to the intensive care unit (ICU) of Anhui Provincial Hospital Affiliated to Anhui Medical University from March 2016 to December 2018 were enrolled. Routine blood test, blood biochemistry, blood gas analysis, myoglobin (Myo), cardiac troponin I (cTnI), blood lactic acid (Lac), procalcitonin (PCT) and ratio of C-reactive protein and albumin (CRP/ALB) of patients on the day of septic shock diagnosis were collected. Glasgow coma scale (GCS), quick sequential organ failure assessment (qSOFA), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and multiple organ dysfunction score (MODS) as well as the time from hospitalization to septic shock and duration of mechanical ventilation were recorded. The patients were divided into death group and survival group according to whether they survived or not on 28 days. According to Myo level, the patients were divided into two groups: Myo elevation group (Myo > 98 μg/L) and Myo normal group (Myo≤98 μg/L). Patients with Myo elevation were divided into survival subgroup and death subgroup according to the prognosis of 28 days. The clinical data were compared among the groups, and the influencing factors of prognosis in septic shock patients were screened by multivariate Logistic regression analysis.@*Results@#185 patients were all enrolled in the final analysis, there were 106 deaths and 79 survivors on 28 days, 154 patients with elevated Myo and 31 patients with normal Myo. ① Compared with the patients with septic shock in the survival group, the death group had older patients, increased qSOFA, APACHEⅡ, MODS scores and blood Myo, Lac, PCT levels, faster heart rate, decreased GCS score, and shorter time from hospitalization to septic shock and duration of mechanical ventilation. However, there was no significant difference in cTnI or CRP/Alb between the two groups. Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 1.037, 95% confidence interval (95%CI) was 1.010-1.065, P = 0.007], heart rate (OR = 1.020, 95%CI was 1.003-1.037, P = 0.023), qSOFA score (OR = 2.839, 95%CI was 1.321-6.102, P = 0.008), Myo (OR = 1.492, 95%CI was 1.088-2.045, P = 0.013), time from hospitalization to septic shock (OR = 0.938, 95%CI was 0.898-0.980, P = 0.004) and duration of mechanical ventilation (OR = 0.936, 95%CI was 0.899-0.975, P = 0.001) were independent risk factors for prognosis in patients with septic shock. ② Compared with Myo normal group, the Myo elevation group had higher 28-day mortality [61.0% (94/154) vs. 38.7% (12/31), χ2 = 5.259, P = 0.022]. Compared with the survival patients with elevated Myo, the death patients were older, and had higher PCT and qSOFA score, faster heart rate, lower GCS score, and shorter time from hospitalization to septic shock and duration of mechanical ventilation. But there was no significant difference in CRP/Alb between the two groups. Multivariate Logistic regression analysis showed that qSOFA score (OR = 2.796, 95%CI was 1.270-6.153, P = 0.011), time from hospitalization to septic shock (OR = 0.925, 95%CI was 0.884-0.967, P = 0.001) and duration of mechanical ventilation (OR = 0.931, 95%CI was 0.884-0.980, P = 0.006) were independent risk factors for the prognosis in the septic shock patients with elevated blood Myo.@*Conclusions@#Age, heart rate, qSOFA score, Myo, time from hospitalization to septic shock, duration of mechanical ventilation were independent risk factors for the prognosis of patients with septic shock. The 28-day mortality in patients with elevated blood Myo was significantly higher than that in those with normal blood Myo. The qSOFA score, time from hospitalization to septic shock and duration of mechanical ventilation were independent risk factors for the prognosis of septic shock patients with elevated blood Myo.
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Objective To study the risk factors of prognosis in patients with septic shock, and to provide a reliable evidence to evaluate severity. Methods A retrospective analysis was conducted. The data of 185 patients with septic shock admitted to the intensive care unit (ICU) of Anhui Provincial Hospital Affiliated to Anhui Medical University from March 2016 to December 2018 were enrolled. Routine blood test, blood biochemistry, blood gas analysis, myoglobin (Myo), cardiac troponin I (cTnI), blood lactic acid (Lac), procalcitonin (PCT) and ratio of C-reactive protein and albumin (CRP/ALB) of patients on the day of septic shock diagnosis were collected. Glasgow coma scale (GCS), quick sequential organ failure assessment (qSOFA), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and multiple organ dysfunction score (MODS) as well as the time from hospitalization to septic shock and duration of mechanical ventilation were recorded. The patients were divided into death group and survival group according to whether they survived or not on 28 days. According to Myo level, the patients were divided into two groups: Myo elevation group (Myo > 98 μg/L) and Myo normal group (Myo≤98 μg/L). Patients with Myo elevation were divided into survival subgroup and death subgroup according to the prognosis of 28 days. The clinical data were compared among the groups, and the influencing factors of prognosis in septic shock patients were screened by multivariate Logistic regression analysis. Results 185 patients were all enrolled in the final analysis, there were 106 deaths and 79 survivors on 28 days, 154 patients with elevated Myo and 31 patients with normal Myo. ① Compared with the patients with septic shock in the survival group, the death group had older patients, increased qSOFA, APACHEⅡ, MODS scores and blood Myo, Lac, PCT levels, faster heart rate, decreased GCS score, and shorter time from hospitalization to septic shock and duration of mechanical ventilation. However, there was no significant difference in cTnI or CRP/Alb between the two groups. Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 1.037, 95% confidence interval (95%CI) was 1.010-1.065, P = 0.007], heart rate (OR = 1.020, 95%CI was 1.003-1.037, P = 0.023), qSOFA score (OR = 2.839, 95%CI was 1.321-6.102, P = 0.008), Myo (OR = 1.492, 95%CI was 1.088-2.045, P = 0.013), time from hospitalization to septic shock (OR = 0.938, 95%CI was 0.898-0.980, P = 0.004) and duration of mechanical ventilation (OR = 0.936, 95%CI was 0.899-0.975, P = 0.001) were independent risk factors for prognosis in patients with septic shock. ② Compared with Myo normal group, the Myo elevation group had higher 28-day mortality [61.0% (94/154) vs. 38.7% (12/31), χ2 = 5.259, P = 0.022]. Compared with the survival patients with elevated Myo, the death patients were older, and had higher PCT and qSOFA score, faster heart rate, lower GCS score, and shorter time from hospitalization to septic shock and duration of mechanical ventilation. But there was no significant difference in CRP/Alb between the two groups. Multivariate Logistic regression analysis showed that qSOFA score (OR = 2.796, 95%CI was 1.270-6.153, P = 0.011), time from hospitalization to septic shock (OR = 0.925, 95%CI was 0.884-0.967, P = 0.001) and duration of mechanical ventilation (OR = 0.931, 95%CI was 0.884-0.980, P = 0.006) were independent risk factors for the prognosis in the septic shock patients with elevated blood Myo. Conclusions Age, heart rate, qSOFA score, Myo, time from hospitalization to septic shock, duration of mechanical ventilation were independent risk factors for the prognosis of patients with septic shock. The 28-day mortality in patients with elevated blood Myo was significantly higher than that in those with normal blood Myo. The qSOFA score, time from hospitalization to septic shock and duration of mechanical ventilation were independent risk factors for the prognosis of septic shock patients with elevated blood Myo.
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Objective To investigate the protective effect of ligustrazine on the transporting function of hepatocellular mitochondria membrane in the rats with sepsis-induced acute liver injury (SALI). Methods The Sprague-Dawley (SD) rats were randomly divided into sham operation group, SALI group [established by cecal ligation and puncture (CLP)], ligustrazine treatment group (injection of ligustrazine 60 mg/kg through tail vein after CLP) and ligustrazine preventive group (7 days before CLP, ligustrazine was injected daily through tail vein for 60 mg/kg), and there were 12 rats in each group. Abdominal aorta blood and liver were harvested at 10 hours after operation. The content of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and mitochondrial aspartate aminotransferase (m-AST) were determined by enzyme coupling rate method. The content of ATP was detected by colorimetric and chemical fluorescein method. The activity of mitochondrial ATPase was detected by phosphorus quantification. The expressions of mitochondrial membrane aquaporin 8 (AQP8) and carnitine palmitoyl transferase (CPT) were detected by Western Blot. Results Compared with sham operation group, the levels of serum ALT, AST and m-AST were significantly increased in SALI group, ligustrazine treatment group and ligustrazine preventive group, and the content of ATP was reduced, the activity of mitochondrial membrane ATPase, the expressions of AQP8 and CPT-1A were significantly decreased. Compared with SALI group, the levels of serum ALT, AST and m-AST were significantly decreased in ligustrazine treatment and ligustrazine preventive groups [ALT (U/L): 123.8±32.8, 105.0±44.5 vs. 233.0±110.1; AST (U/L):427.0±117.9, 303.9±110.3 vs. 742.6±441.4; m-AST (U/L): 239.6±64.9, 168.2±60.0 vs. 412.8±252.6; all P <0.01], the content of ATP were significantly increased (nmol/mg: 29.5±10.3, 34.6±11.2 vs. 19.3±8.8, both P < 0.01), the activity of ATPase in hepatocellular mitochondrial membrane were significantly increased [Na+-K+-ATPase (U/mg):3.91±0.30, 3.97±0.35 vs. 2.87±0.82; Mg2+-ATPase (U/mg): 3.75±0.38, 3.88±0.35 vs. 2.64±1.06; Ca2+-ATPase (U/mg): 3.15±0.58, 2.98±0.31 vs. 1.75±1.25; Ca2+-Mg2+-ATPase (U/mg): 3.82±0.31, 3.91±0.42 vs. 2.57±1.01, all P < 0.01], the expressions of AQP8 and CPT-1A were significantly increased [percentage increase from sham operation group (100%), AQP8/COX-Ⅳ: (79.12±7.79)%, (88.40±9.22)% vs. (62.08±11.91)%; CPT-1A/COX-Ⅳ:(87.92±10.06)%, (84.91±17.48)% vs. (72.11±7.82)%, all P < 0.01]. The levels of serum AST and m-AST in ligustrazine preventive group were significant lower than those in ligustrazine treatment group [AST (U/L): 303.9± 110.3 vs. 427.0±117.9; m-AST (U/L): 168.2±60.0 vs. 239.6±64.9, both P < 0.05]. There was no significant difference in the expression of CPT-2 in mitochondrial membrane between the four groups. Conclusions Ligustrazine could play a protective role on the mitochondrial membrane function of transporting water, ion and fat in the rats with SALI. The preventive function of ligustrazine is better than the treatment effect of the rats with sepsis.
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Objective To investigate the effects of positive end-expiratory pressure (PEEP) on hemodynamics and intra-abdominal pressure in patients with acute respiratory distress syndrome (ARDS) with normal intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) during mechanical ventilation under a incremental PEEP.Methods Eighteen ARDS patients with normal IAP or IAH treated in intensive care unit of Anhui Provincial Hospital were enrolled for study.At different PEEP levels (5,10,15,20 cmH2O),hemodynamic parameters including extravascular lung water index (EVLWI),intrathoracic blood volume index (ITBVI),stroke volume variation (SVV) and IAP were measured with PICCO technology.Results Compared with ARDS patients with normal IAP,the ARDS patients with IAH were characterized by:(1) EVLWI was decreasing under the increment of PEEP,but there was no significant difference between 15 cmH2O and 20 cmH2O (t =0.593,P =0.572).As PEEP was gradually escalated,EWLVI had no significant changes in patients with normal IAP.(2) SVV increased as PEEP was being titrated to higher level in both groups but in normal IAP group such effect was observed till PEEP above 10cmH2O (PEEP5 vs.PEEP10,t=0.326,P=0.752; PEEP,10 vs.PEEP 15,t=-20.032,P＜ 0.01).(3) There was no statistical difference in ITBVI between two groups at varied levels of PEEP.(4) PEEP could increase IAP levels and had much more profound effects on patients with IAH.Conclusions PEEP is a contributing factor changing IAP.It is necessary to take the level of PEEP into account as IAP variation is interpreted in patients under mechanical ventilation.Different PEEP levels can significantly affect the EVLWI in patients with IAH but not do not in ones with nomal IAP.
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Objective To discuss influence factors on prognosis of the patients with capillary leak syndrome (CLS) in ICU.Methods The clinical data of 191 patients with CLS in ICU were reviewed,and the patients were divided into three groups according to prognosis:death group ( n =37),cured group ( n =132) and non-healed group (n =22).The clinical data of death group were compared with those of cured group at admission,during the course of CLS and before discharging from hospital.Results Compared with the cured group,the central venous pressure and serum albumin decreased ( P ＜ 0.01 ) ; anion gap,triglycerides,pressure adjusted heart rate (PAHR) and oxygenation index were lower ( P ＜ 0.01 or P ＜ 0.05) ; serum glucose and SIRS score increased ( P ＜ 0.01 ) in death group.There was higher rate of poor renal function at admission in death group than that in other groups ( P ＜ 0.01 ).There were more many patients treated with intravenous administration of hydroxyethyl starch,ulinastatin and continuous blood filtration therapy in cured group than those in other groups ( P ＜ 0.05).Conclusions The factors influencing the outcomes of the patients with CLS were hypovolemia,severe hypoproteinemia,interior milieu disorder,malnutrition,hypoxemia,renal injury and severe systemic inflammatory response.The outcomes of patients with CLS in ICU could be improved by using hydroxyethyl starch,ulinastatin and continuous blood filtration therapy.
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Objective To study the effects of pulse high volume hemofiltration (PHVHF) on the changes of Th17 cells (T helper 17 cells) and CD4 + CD25 + reguratory T cells (Treg cells) in peripheral blood of patients with sepsis and to evaluate the clinical value of this intervention. Methods The patients were included in this prospective study as per the criteria of sepsis set by America Chest Physicians College/America Society for Critic Care Medicine in 1992. The patients were excluded: ① immune system disorder, ② acute stroke, ③ myocardial infarction, ④ virus hepatitis,⑤ human immunodeficiency virus infection, ⑥ under immunosuppressive therapy. Forty patients (24 males, 16 females, aged from 25 to 75years) with sepsis in ICU were enrolled from January. 2008 to November. 2010. According to the severity of disease, the patients were divided into three groups; moderate sepsis group (n = 14, 8 males, 6 females) , severe sepsis group (n = 15, 9 males, 6 females) , and septic shock group (n = 11, 7 males, 4 females). The initially clinical data of three groups were comparable. Twenty healthy individuals served as controls. According to the mode of treatment, forty patients were also divided into two groups: conventional treatment group (group A, n= 15) in which patients were treated without PHVHF within 5 days after admission and trial group (group B, n=25) in which patients were treated with pulsed high volume hemofiltration (PHVHF) within 5 days after admission. In group B, high volume hemofiltration (70 mL · kg-1 · h-1) was given to patients for 6 ～ 8 hours, and then conventional continuous vein - vein hemofiltration (35 mL · kg-1 · h-1) for 16 ~ 18 hours. The total length of period for continuum blood scavenging was 24 hours as one cycle. The interval between two cycles of blood scavenging was 24 hours. The changes of Th17 cells and CD4+ CD25 + Treg cells of 40 patients were detected with flow cytometry on the 1st day and the 5th day after admission. The data were analyzed by using SPSS version 13. 0 software. Measurement data were analyzed with Paired-samples t-test, independent-samples t-test or one way ANOVA . Ratio of small samples was compared with fisher's exact test, and the correlation was analyzed by using Pearson correlation analysis. Results The rates of Th17 cells were( 0.91 ±0.38)%, (2.09 ±0. 53)% , (3.90 ±0. 80)% , and ( 1. 85 ±0.35)% in control, moderate sepsis, severe sepsis, and septic shock groups, respectively, while the rates of CD4+ CD25+ Treg cells were (0.39 ±0.23)%, (1. 72 ±0. 59)% , (2.72 ±0. 22)% , and (3. 55 ±0. 51)% , respectively. The rate of Thl7 cells on the 1st day was higher in severe sepsis group than that in other two groups ( P 0. 05). Moreover , the rate of CD4+ CD25 + Treg cells was up - regulated on the 1st day in the following order from high to low: septic shock group > severe sepsis group > sepsis group (P < 0.05). The rates of Th17 cells and CD4 + CD25 + Treg cells in patients of group B decreased in greater degree than that did in patients of group A (P < 0.05 ). Conclusions The changes of Th17 cells and CD4 + CD25 + Treg cells may play an important role in pathogenesis of sepsis, and the pulsed high volume hemofiltration may be one of the effective treatments for the patients with sepsis by regulating the rates of Thl7 cells and CD4 + CD25 + Treg cells.
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Aim To evaluate the clinical application of propofol in critical patients with mechanical ventilation. Methods22 patients with mechanical ventilation after major operation were randomly divided into control group and propofol group patient in the propofol group were continually transfused with propofol by micro pump. Clinical manifestations, blood pressure, heart rate and the concentration of epinephrine (E)and norepinephrine (NE) in patients of both groups were observed. Results The patients in propofol group were all in sleeping state, while those in the control group had evidently higher blood pressure,heart rate and the concentration of epinephrine and norepinephrine after wearing of ventilator. There was a significant difference between the two groups ( P＜0.05) . Conclusion Propofol can make the critical patients quiet and inasleepingstate,inhilitthereleaseof epinephrine and norepinephrine, which rescdt in hemodynamic stability.