RESUMO
Objective:To evaluate the value of mechanical ventilation combined with ultrasound in evaluating the volume reactivity of patients with septic shock.Methods:A prospective study was performed, and 59 patients with septic shock who were admitted to the Emergency Intensive Care Unit of the First Affiliated Hospital of Xinjiang Medical University from October 2016 to February 2018 were included according to the established inclusion and exclusion criteria. First, end-expiratory block test (EEO) and end-inhalation block test (EIO) were performed, followed by volume expansion test (VE) (intravenous infusion of 250 mL saline for 10 min), with cardiac index (CI) change value after VE (ΔCI)≥15% for volume-responsive group (37 cases), ΔCI<15% for volume-free group (22 cases), Vigileo-FloTrac system was used to continuously monitor EEO, EIO, and VE before and after changes in hemodynamic parameters, such as central venous pressure (CVP), mean arterial pressure (MAP), stroke volume variation (SVV), CI, and improved inferior vena cava diameter (IVCD) and respiratory variability index (RVI). The values of predicted capacity reactivity such as changes in CVP, MAP, SVV, CI, and RVI before and after EIO were evaluated, and the relationship between EEO, EIO, and capacity reactivity was analyzed by ROC curve.Results:There was no significant difference between MAP and CI in the response group and non-response group after EEO, EIO and VE intervention ( P>0.05). EEO-ΔSVV, EEO-ΔRVI, EEO-ΔCVP, EIO-ΔSVV and EIO-ΔRVI were compared between the reaction group and the non-reaction group, and the difference was statistically significant ( P<0.05); In the correlation analysis, EEO-ΔRVI and EIO-ΔRVI were correlated with VE-ΔRVI ( r=0.695, P<0.01; r=-0.489, P<0.01); EEO-ΔCVP and VE-ΔCVP were correlated ( r=0.566, P<0.01); EEO-ΔSVV, EIO-ΔSVV are related to VE-ΔSVV ( r=0.842, P<0.01; r= -0.727, P<0.01), and the ROC curve showed ( AUCEEO-ΔSVV=0.890, 95% CI: 0.792-0.988), showed AUCEEO-ΔSVV> AUCEEO-ΔRVI> AUCEIO-ΔSVV> AUCEIO-ΔRVI> AUCEEO-ΔCVP. Conclusions:EEO and EIO combined with ultrasound have certain clinical value in the evaluation of volume responsiveness in patients with septic shock, and the evaluation value of SVV and RVI is superior to CVP, MAP, and CI.
RESUMO
AIM:To investigate the effects of Auricularia auricular-judae polysaccharide ( AAP) on pulmonary tissues of rats with LPS-induced acute lung injury (ALI) and its mechanisms.METHODS: Adult Sprague-Dawley rats were randomly divided into control group , LPS group, low-dose AAP group, middle-dose AAP group, high-dose APP group, and dexamethasone group.The rats were injected with LPS (8 mg/kg, ip) to induce ALI.The rats in the AAP groups were treated with AAP for 7 d before the induction of ALI .The protein concentration in the bronchoalveolar lavage fluid (BALF) was measured.The lung edema degree was measured by detecting the wet /dry weight ratio.The myeloper-oxidase ( MPO) , total antioxidant capacity ( T-AOC) , total superoxide dismutase ( T-SOD) , nitric oxide synthase ( NOS) and malondialdehyde ( MDA) levels were determined .The pathological changes of the lung tissues were evaluated by HE staining.RESULTS:Treatment with AAP significantly improved LPS-induced lung pathological changes , attenuated the protein concentration in the BALF and wet/dry weight ratio , inhibited the activities of MPO and NOS , reduced MDA level and increased the activities of T-AOC and T-SOD.CONCLUSION: AAP protects against LPS-induced acute lung injury in rats.