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Objective:To investigate the clinical efficacy and effects on hemorheology of acupuncture therapy combined with gaba-pentin in the treatment of patients with tension headache. Methods:Totally 92 cases of patients with tension headache were randomly divided into the observation group (n=46) and the control group (n=46) according to the random number table. The control group was given gabapentin, while the observation group was treated with acupuncture therapy on the basis of treatment in the control group. The treatment course was 4 weeks. The clinical efficacy, changes of the headache indices, VAS score and hemorheology levels before and after the treatments in the two groups were compared, and the incidence of adverse reactions was observed as well. Results:The to-tal effective rate of the observation group (93. 48%) was significantly higher than that of the control group (73. 91%, P<0. 05). Af-ter the treatment, the headache indices in both groups significantly decreased (P<0. 05), and the decrease in the observation group was more significant than that in the control group (P<0. 05). The VAS scores in both groups significantly decreased after the treat-ment (P<0. 05), and the decrease in the observation group was more significant than that in the control group (P<0. 05). The plas-ma viscosity, hematocrit and platelet aggregation rate in both groups significantly decreased after the treatment (P<0. 05), and the decrease in the observation group was more notable than that in the control group (P<0. 05). No severe adverse reactions were shown in both groups during the treatment course. Conclusion: Acupuncture therapy combined with gabapentin in the treatment of patients with tension headache shows striking effects, which can improve hemorheology with promising safety and deserves further studies.
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Objective To evaluate the value of transpulmonary pressure (Ptp) guided optimal positive end-expiratory pressure (PEEP) selection in patients with early acute respiratory distress syndrome (ARDS).Methods A prospective randomized self-control study was conducted.ARDS patients in the early stage (onset ≤3 days) undergoing intubation and mechanical ventilation admitted to intensive care unit (ICU) of Jiangsu Provincial Subei People's Hospital from December 2013 to December 2015 were enrolled.The PEEP level was regulated to 30 cmH2O (1 cmH2O =0.098 kPa) after recruitment maneuver,and then it was gradually decreased to 0 with lowering by 3 cmH2O every 5 minutes.The optimal PEEP was titrated by Ptp,lowest dead space fraction (VD/VT),highest static lung compliance (Cst),and optimal oxygenation,respectively.Parameters of respiratory mechanics and gas exchange were observed.Results Totally 28 patients with ARDS (including 17 male and 11 female) were included with the average age of (45 ± 12) years old,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 21 ± 9,oxygenation index (PaO2/FiO2) was (165 ± 76) mmHg (1 mmHg =0.133 kPa).① During decremental PEEP titration,Ptp was gradually decreased,and expiratory Ptp (Ptp-e) was more than zero [(1.3±0.3) cmH2O] when PEEP was (9.6 ± 2.3) cmH2O.Cst was initially improved until reaching a peak,and then deteriorated.Cst was highest [(50 ± 8) mL/cmH2O] when PEEP was (11.5 ± 2.4) cmH2O.PaO2/FiO2 reached the maximum [(312 ± 99) mmHg] at PEEP level of (18.0 ± 2.5) cmH2O.Compared with Ptp-e 3.00-5.99 cmH2O,PaO2/FiO2 was significantly decreased when Ptp-e became negative (all P ＜ 0.05).VD/VT was lowest (0.52 ±0.05) when PEEP was (10.1 ± 2.2) cmH2O.When compared with ventilation [inspiratory Ptp (Ptp-i) 0-2.99 cmH2O],it was significantly higher during high (Ptp-i ≥ 15 cmH2O,all P ＜ 0.05).② There were no statistically significant differences in the levels of optimal PEEP,Ptp-i and Ptp-e among Ptp,lowest VD/VT and highest Cst methods (all P ＞ 0.05),but they were significantly less than optimal oxygenation method (all P ＜ 0.05).Compared with baseline and the method of optimal oxygenation,Cst in other three PEEP titration methods including Ptp,lowest VD/VT and highest Cst was improved obviously (mL/cmH2O:46± 7,47±9,50± 8 vs.30± 8,35 ± 10,all P ＜ 0.05).PaO2/FiO2 (mmHg) in the method of Ptp and lowest VD/VT were higher than the baseline (252 ± 86,258 ± 72 vs.165 ± 76,both P ＜ 0.05),but significantly lower than that of optimal oxygenation method (312 ± 99,both P ＜ 0.05),and did not significantly differ from that of highest Cst (268± 85,both P ＞ 0.05).Compared with baseline and the method of optimal oxygenation,VD/Vr improved significantly in ventilated patients on PEEP targeting with Ptp and lowest VD/VT (0.53±0.05,0.52±0.05 vs.0.59±0.05,0.58±0.04,all P ＜ 0.05).Conclusion Titration the optimal PEEP level with the method of Ptp could promote collapse alveolar recruitment,improve oxygenation and lung compliance,decrease dead space ventilation,and will not cause alveolar excessive inflation in patients who undergoing mechanical ventilation with early ARDS.
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Objective To investigate the value of extravascular lung water index(EVLWI) in assessment of prognosis of elderly patients with combined septic shock and pulmonary capillary leakage.Methods Totally 34 elderly patients with septic shock and pulmonary capillary leakage in our hospital from Jan.2011 to Dec.2012 were selected.Cardiac index (CI),global end diastolic volume index (GEDI),systemic vascular resistance index (SVRI),pulmonary vascular permeability index (PVPI) and EVLWI were detected by pulse-indicator continuous cardiac output (PiCCO) technology for 3 days.Based on the actual body weight (ABW) and predicted body weight (PBW),the actual extravascular lung water index and predicted extravascular lung water index were calculated.Peak airway pressure (Ppeak),plateau pressure (Pplat),mean airway pressure (Pm),tidal volume (VT),positive end expiratory pressure (PEEP),oxygen concentration (FiO2) and static lung compliance (Cst) were monitored,the arterial partial pressure of oxygen (PaO2) was detected by blood gas analysis,and the PaO2/FiO2 (P/F) and oxygenation index (OI) were calculated.Chest X-ray,lung injury score (LIS) were conducted.The correlations of EVLWI to actual body weight (EVLWIa) and predicted body weight(EVLWIp) with P/F,Cst and LIS were analyzed.The predictive value of EVLWIa and EVLWIp in the prognosis in elderly patients with septic shock and pulmonary capillary leakage was assessed.Results At day 1,non-survivors had higher levels of SOFA score and lactate level than survivors (both P＜0.05).However,these variables including SOFA score,LIS,PVPI,lactate level,fluid balance,norepinephrine level,EVLWIa and EVLWIp were higher and PaO2/FiO2 was lower in non-survivors than in the survivors at day 3 (all P＜0.05).EVLWIa and EVLWIp were positively correlated with LIS (r=0.461 and 0.588,both P＜0.05) and negatively correlated with PaO2/FiO2 (P/F) (r=-0.307 and-0.436,both P＜0.05).EVLWIa and EVLWIp had negatively correlations with Cst,but r=-0.141 and-0.154,both P＞0.05.Multiple logistic regression analysis showed that SOFA,EVLWa and EVLWp were independent predictive risk factors for mortality in elderly patients with septic shock and pulmonary capillary leakage.The areas under the receiver operating characteristic curve (ROC) of SOFA,EVLWIa and EVLWIp for predicting the prognosis were 0.769,0.832 and 0.855 respectively.With 11.96ml/kg as the cutoff point of EVLWIp,the sensitivity and specificity of EVLWIp predicting the survival of patients was 94.4％ and 61.5％ respectively.Conclusions Extravascular lung water can predict the prognosis and reflect the severity of lung injury in elderly patients with septic shock and puhnonary capillary leakage.Compared with EVLWIa,the EVLWIp has a better correlation with lung injury and a higher predictive value for survival.
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Objective To evaluate the relationship between the extravascular lung water (EVLW) and other markers of lung injury and determine whether or not EVLW predicts survival in patients with acute respiratory distress syndrome (ARDS) and examine if indexing EVLW with predicted body weight (EVLWp) strengthens its discriminative power.Methods EVLW and other markers of lung injury [including:PaO2/FiO2(P/F),oxygenation index (OI) =mean pressure (Pm) × FiO2 × 100/PaO2,static compliance (Cst) and lung injury score (LIS)] were measured prospectively for 3 days in 27 patients with early ARDS between January 2011 and December 2011 at intensive care units (ICU) of Subei People's Hospital.The relationship between indexing EVLW with actual body weight (EVLWa),EVLWp and other markers of lung injury,the 28-day mortality were evaluated.Results Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),fluid balance in first 3 days,days of mechanical ventilation and ICU stay were significantly higher on admission in nonsurvivors compared with survivors (P ＜ 0.05).Nonsurvivors had higher OI,LIS,EVLWa and EVLWp than survivors at Days 1 and 3 (P ＜ 0.05).EVLWa and EVLWp were correlated positively with LIS (r =0.471,0.528 P ＜ 0.05) and OI (r =0.527,0.627,P ＜ 0.05) and negatively with P/F (r =-0.467,-0.646,P ＜ 0.05).EVLWp had a stronger correlation to LIS,OI and P/F than did EVLWa.No obvious correlation existed between EVLWa,EVLWp and Cst (r =-0.260,0.226,P ＞ 0.05).ROC curve analysis indicated that EVLWp (0.759,P ＜ 0.05) but not EVLWa (0.661,P＞0.05) discriminated between survivors and nonsurvivors.Three-dav average EVLWp ≥12.5ml/kg predicted the 28-day mortality with 62.5％ specificity and 80％ sensitivity.Conclusion Increased extravascular lung water is a feature of early ARDS and predicts survival.EVLWp,instead of EVLWa,improves the predictive value of extravascular lung water for survival and it is correlated with markers of disease severity.