The first case of severe avian influenza A (H7N9) in Guangdong Province in 2018 successfully treated with extracorporeal membrane oxygenation / 中华危重病急救医学

Human infection with avian influenza A (H7N9) is easy to induce severe acute respiratory distress syndrome (ARDS), and traditional mechanical ventilation cannot correct hypoxemia, so patients may die from multiple organ failure (MOF) caused by persistent hypoxia. Extracorporeal membrane oxygenation (ECMO) can provide effective respiratory support and win time for the treatment of severe H7N9. The first case of severe H7N9 in Guangdong Province in 2018 was admitted to Zhongshan Hospital Affiliated to Sun Yat-sen University. The case was insult with severe ARDS caused by H7N9, the traditional mechanical ventilation could not correct hypoxemia, and the lung condition gradually improved with ECMO assistance. After 13 days of ECMO support, the patient was successfully weaned from ECMO and was transferred to a general ward after 55 days. After 102 days of rehabilitation, the patient was discharged from hospital and followed up for 2 months, who was in good health and had a good quality of life. This article states the diagnosis and treatment of severe H7N9 in details, providing experience for the treatment of severe H7N9 in the future.

Clinical application of extracorporeal membrane oxygenation for treatment of adult acute respiratory distress syndrome / 中国中西医结合急救杂志

Objective To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) treatment for adult acute respiratory distress syndrome (ARDS) caused by lung infections,so as to explore the clinical efficacy and application value of ECMO.Methods The patients with 7 ARDS who were responded poorly to mechanical ventilation in Zhongshan Affiliated Hospital of Sun Yat-sen University from January 2003 to January 2015 were collected.All patients were divided into a study group (7 cases) treated by ECMO and a control group (7 cases) treated by traditional methods.The percutaneous incision on femoral vein-internal jugular vein (V-V) was selected to carry out ECMO intubation,and the V-V ECMO model was used for auxiliary bypass of flow.The comparisons between the two groups for the results of hemodynamics,blood-gas analysis and oxygen metabolism were performed to evaluate synthetically the adjuvant effects of ECMO.Results Seven ARDS patients caused by lung infections were treated by ECMO,including 4 cases with bacterial pneumonia,2 cases with H7N9 and 1 case with H1N1.Thc duration of ECMO was (21.00 ± 10.06) days;2 cases were weaned from ECMO successfully,and 1 case recovered and discharged.Seven cases with ARDS caused by severe lung bacterial infections in control group were all not recovered on discharge.After treatment,the heart rate (HR),pulmonary arterial wedge pressure (PCWP),venous partial pressure of oxygen (PvO2),arterial blood lactic acid (Lac) in study group were significantly lower than those in the control group [HR (bpm)was 100± 12 vs.120± 19,PCWP (mmHg,1 mmHg =0.133 kPa) was 8.8 ± 2.6 vs.11.6± 3.8,PvCO2 (mmHg) was 40.8 ± 13.1 vs.48.9 ± 16.2,Lac (mmol/L) was 2.1 ± 0.8 vs.5.2 ± 0.6,all P ＜ 0.05],the mean arterial pressure (MAP),cardiac output index (CI),arterial and venous blood pH values,arterial partial pressure of oxygen (PaO2),arterial partial pressure carbon dioxide (PaCO2),arterial oxygen saturation (SaO2),oxygen delivery (DO2),oxygen consumption (VO2),oxygen extraction (ERO2) were obviously higher in study group than those control group [MAP (mmHg) was 83.6 ± 8.2 vs.72.2 ± 94,CI (mL· s-1 · m-2) was 93.35 ± 3.33 vs.81.68 ± 8.33,pH of arterial blood was 7.4 ± 0.1 vs.7.1 ± 0.3,PaO2 (mmHg):98.5 ± 20.4 vs.49.3 ± 12.6,PaCO2 (mmHg):38.9 ± 16.2 vs.26.1 ± 17.4,SaO2:0.95 ± 0.02 vs.0.58 ± 0.04,pit of venous blood was 7.1 ± 0.2 vs.6.4 ± 0.3,PvCO2 (mmHg) was 40.8 ± 13.1 vs.48.9 ± 16.2,SvO2 was 0.75 ± 0.07 vs.0.49 ± 0.08,DO2 (mL· min-1 · m-2) was 651 ± 36 vs.400 ± 81,VO2 (mL· min-1 · m-2) was 245.0 ± 11.2 vs.103.0 ± 14.8,ERO2 was (35.6± 3.9)％ vs.(21.3± 5.2)％,all P ＜ 0.05].Conclusions ECMO can improve hypoxemia.So it can improve the metabolism and maintain hemodynamic stability,in the mean time the patients may gain more time for diagnosis and treatment of their primary lung diseases.The key points of a successful ECMO are suitable selection of patients and forceful prevention of complications.

Studies on the relationship of vitamin D receptor gene distribution and bone mineral density in patients with maintenance peritoneal dialysis / 中国医师杂志

Objective To explore frequency distribution of vitamin D receptor (VDR) genotype and the correlations between polymorphism of VDR gene Bsm Ⅰ sites and bone mineral density in the patients undergoing maintenance peritoneal dialysis.Methods A case-control study was conducted based on 82 patients with maintenance peritoneal dialysis and 80 healthy people.The frequency distribution of VDR genotype in two groups was detected and analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).Serum biochemistry and bone mineral density of the patients undergoing maintenance peritoneal dialysis were detected by dual energy X-ray absorption (DEXA) and automatic biochemical analyzer,respectively.All data was analyzed with SPSS 19.0 software.Results The frequency distribution of VDR genotype between case group and control group had no significant difference (P ＞ 0.05).The serum biochemical index such as Ca,P,alkaline phosphatase (ALP) and parathyroid hormone (PTH)] of patients with maintenance peritoneal dialysis had no significant difference among three VDR genotypes(P ＞0.05).Compared to VDR bb genotype,the serum Ca was significantly higher in VDR BB genotype (P ＜0.05).The bone mineral density (BMD) and T-Score of patients with VDR BB genotype were the lowest,the BB genotype was the highest,and the difference was statistically significant among three genotypes (P ＜0.05).Conclusions The frequency distribution of VDR genotype between case group and control group had no significant difference.However,there is a correlation between VDR gene BsmⅠ sites and bone mineral density of maintenance peritoneal dialysis patients.

Clinical Observation of Shensong Yangxin Capsules in the Treatment of Brainstem Hemorrhage Complicat-ed with Cerebrocardiac Syndrome Accompanied by Arrhythmia / 中国药房

OBJECTIVE:To observe therapeutic efficacy and safety of Shensong yangxin capsules in the treatment of brainsten hemorrhage complicated with cerebrocardiac syndrome(CCS)accompanied by arrhythmia. METHODS:Medical information of 98 patients with brainstem hemorrhage complicated with CCS arrhythmia were analyzed retrospectively and divided into control group (49 cases)and observation group(49 cases)according to drug use. Control group was given routine treatment as mannitol and pi-racetam. Observation group was additionally given Shensong yangxin capsules 1.2 g orally or via nasal feeding,3 times a day,on the basis of control group. Treatment course of 2 groups lasted for 4 weeks. Clinical efficacies of 2 groups were observed as well as the levels of catecholamine [norepinephrine(NE),epinephrine(E),dopamine(DA)],ET-1 and NO,the occurrence of ADR be-fore and after treatment. RESULTS:Total response rate of observation group was significantly higher than that of control group (75.5% vs. 46.93%),with statistical significance(P0.05). 3 and 7 d after treatment,the levels of NE,E,DA,ET-1 and NO in 2 groups were significantly lower than before,and the observation group was significantly lower than the control group,with statisti-cal significance(P0.05). CONCLU-SIONS:Based on routine treatment,Shensong yangxin capsules shows significant therapeutic efficacy for CCS,can reduce levels of catecholamine and doesn't increase the occurrence of ADR.

Analysis of pathogenic fungus distribution and prognosis in patients with bloodstream infection critically ill sepsis in intensive care unit / 实用医学杂志

Objective To analyze the pathogenic fungus distribution and the risk factors affecting the prognosis in patients with bloodstream infection critically ill sepsis in intensive care unitso as to provide evidence for clinical treatment. Methods From January 2008 to January 2015 , the clinic data of patients with severe sepsis and septic shock were retrospectively studied. The factors affecting the prognosiswere found out using a multivariate logistic regression analysis. Results From January 2008 to January 2015 , there were 870 bloodstream infection critically ill sepsis. Risk factors affecting the prognosis of critically ill sepsis patients were as follows: serum albumin, age, APACHEⅡ and procalcitonin. Conclusion Bloodstream infection critically ill sepsis in intensive care unit contributes a high motality. APACHEⅡ, age, blood lactate, procalcitonin , blood lactate and serum albumin are the risk factors affecting the prognosis of critically ill sepsis patients.