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Objective:To investigate the effects of continuous renal replacement therapy (CRRT) on plasma concentration, clinical efficacy and safety of colistin sulfate.Methods:Clinical data of patients received with colistin sulfate were retrospectively analyzed from our group's previous clinical registration study, which was a prospective, multicenter observation study on the efficacy and pharmacokinetic characteristics of colistin sulfate in patients with severe infection in intensive care unit (ICU). According to whether patients received blood purification treatment, they were divided into CRRT group and non-CRRT group. Baseline data (gender, age, whether complicated with diabetes, chronic nervous system disease, etc), general data (infection of pathogens and sites, steady-state trough concentration, steady-state peak concentration, clinical efficacy, 28-day all-cause mortality, etc) and adverse event (renal injury, nervous system, skin pigmentation, etc) were collected from the two groups.Results:A total of 90 patients were enrolled, including 22 patients in the CRRT group and 68 patients in the non-CRRT group. ① There was no significant difference in gender, age, basic diseases, liver function, infection of pathogens and sites, colistin sulfate dose between the two groups. Compared with the non-CRRT group, the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) were higher in the CRRT group [APACHE Ⅱ: 21.77±8.26 vs. 18.01±6.34, P < 0.05; SOFA: 8.5 (7.8, 11.0) vs. 6.0 (4.0, 9.0), P < 0.01], serum creatinine level was higher [μmol/L: 162.0 (119.5, 210.5) vs. 72.0 (52.0, 117.0), P < 0.01]. ② Plasma concentration: there was no significant difference in steady-state trough concentration between CRRT group and non-CRRT group (mg/L: 0.58±0.30 vs. 0.64±0.25, P = 0.328), nor was there significant difference in steady-state peak concentration (mg/L: 1.02±0.37 vs. 1.18±0.45, P = 0.133). ③ Clinical efficacy: there was no significant difference in clinical response rate between CRRT group and non-CRRT group [68.2% (15/22) vs. 80.9% (55/68), P = 0.213]. ④ Safety: acute kidney injury occurred in 2 patients (2.9%) in the non-CRRT group. No obvious neurological symptoms and skin pigmentation were found in the two groups. Conclusions:CRRT had little effect on the elimination of colistin sulfate. Routine blood concentration monitoring (TDM) is warranted in patients received with CRRT.
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Objective:To accurately and effectively identify the most critical needs of extracorporeal membrane oxygenation (ECMO) treatment for patients with severe cardiopulmonary diseases, and to better carry out continuous improvement of medical service quality an patients' satisfaction.Methods:Patients who underwent ECMO and transferred from 56 medical institutions in the Henan Provincial People's Hospital Critical Care Medicine Specialist Alliance [the patients who were transported before applying quality function deployment (QFD) from June 2017 to May 2018 were enrolled as the control group, and patients who were transported after applying QFD from June 2018 to May 2019 were the observation group], medical staff in the alliance hospitals, ECMO transfer teams and transfer driver teams were enrolled as the subjects of the survey. QFD was applied to convert the collected requirements into quality improvement elements for targeted improvement measures.Results:A total of 125 questionnaires were distributed in this survey, and 116 valid questionnaires were collected, including 91 from patients (including 27 from the control group and 64 from the observation group), 10 from the medical staff of the alliance hospitals, 10 from the ECMO transport teams and 5 from the transport driver teams. The questionnaire recovery rate was 92.8%. The improvement elements of ECMO treatment for patients with critical cardiopulmonary diseases were ranked according to the importance, and the top five were as follows: the accuracy of the first diagnosis, the specialization of ECMO team, the guarantee of vehicle safety, the seamless responses, and the smooth coordinated rescue protocol.Conclusion:The top five improvement elements should be prioritized in ECMO treatment of patients with critical cardiopulmonary disease in all hospitals of the Alliance to ensure more accurate and timely treatment.
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Objective:The purpose of this study was to investigate the evaluating value of modified critical care ultrasonic examination(M-CCUE) scheme for the etiological diagnosis of shock in ICU patients.Methods:The prospective study collected relevant clinical data of various shock patients admitted to the Department of Intensive Care Medicine, Henan Provincial People's Hospital from May 2020 to July 2021, including hemodynamic、blood indicators、organ/tissue perfusion and prognostic evaluation indicators.All selected patients completed the initial M-CCUE assessment within 30 minutes, were scored according to the M-CCUE score system and related data results were analyzed.Results:Ninety-three patients were included in this study,Two of them were not completed the M-CCUE assessment due to emergency treatment immediately after entering our department, and five were excluded due to inconsistent ultrasound judgments by the two physicians. In the end, a total of 86 patients were enrolled in the group. In patients applied with M-CCUE scheme,time to preliminary diagnosis and final diagnosis were (13.02±3.15)min and (67.70±20.20)min respectively, the accuracy of diagnosis was 83.7%. Among them, distributed shock accounted for 60.4%, hypovolemic shock accounted for 25.6%, cardiogenic shock and obstructive shock accounted for 3.5%, and mixed shock accounted for 7%; MCS is (13.27±4.91), M-CCUE scheme had the high sensitivity and specificity for the diagnosis of distributed shock (sensitivity 91.2%, specificity 93.9%), hypovolemic shock (sensitivity 96.0%, specificity 96.7%), cardiogenic shock (sensitivity 85.7%, specificity 98.7%) and obstructive shock (sensitivity 60.0%, specificity 100%); MCS has a good positive correlation with APACHEⅡ score ( r=0.861, P<0.001), and has no correlation with ICU cost ( r=0.012, P=0.915). There is no significant difference in MCS between the 28d death group and the recovery group ( P=0.391). Conclusions:For shock patients admitted to ICU with unknown etiology, the initial diagnosis of the cause of the M-CCUE program takes less time, has a higher correct diagnosis rate, sensitivity and specificity, and its quantitative evaluation results can predict the patient's criticality.
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Objective:To explore the diagnostic accuracy of muscle ultrasound and plasma monocyte chemoattractant protein-1 (MCP-1) for ICU-acquired weakness (ICU-AW) in patients with sepsis.Methods:A prospective observational study was conducted. Patients with sepsis admitted to the intensive care unit (ICU) of Henan Provincial People's Hospital from April 2021 to October 2021 were enrolled. The demographic data were collected. The enrolled patients were evaluated with Medical Research Council (MRC) score every day until discharged from ICU. During this period, patients with total MRC score < 48 (for two consecutive times and a time interval of 24 hours) were divided into ICU-AW group, those with total MRC score ≥ 48 were served as non-ICU-AW group. On the 1st, 4th and 7th day following admission into ICU, ultrasound was used to measure the muscle linear thickness of the rectus femoris (RF-MLT), the cross sectional area of the rectus femoris (RF-CSA) and the muscle linear thickness of the vastus intermedius muscle (VI-MLT). And meanwhile, the plasmas samples of patients were collected to measure MCP-1 concentration by enzyme-linked immunosorbent assay (ELISA). The difference of each index was compared between the ICU-AW group and the non-ICU-AW group. The risk factors of ICU-AW in patients with sepsis were analyzed by binary Logistic regression. Besides, receiver operator characteristic curve (ROC curve) was plotted, the diagnostic value of ultrasound parameters and plasma MCP-1 level for ICU-AW in patients with sepsis was analyzed.Results:A total of 99 septic patients were enrolled, with 68 patients in the ICU-AW group and 31 patients in the non-ICU-AW group. Compared with the patients in the ICU-AW group, the patients in the non-ICU-AW group tended to be older, and had higher sequential organ failure assessment (SOFA) score, higher acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, higher rates of septic shock, higher blood lactic acid and lower Glasgow coma score (GCS). Binary Logistic regression analysis showed that APACHEⅡ score and septic shock were the risk factors of ICU-AW for septic patients [odds ratio ( OR) and 95% confidence interval (95% CI) were 1.310 (1.138-1.509) and 0.232 (0.072-0.746), respectively, both P < 0.05]. The RF-MLT, RF-CSA and VI-MLT on the 1st, 4th and 7th ICU day was falling over time. Compared with the patients in the ICU-AW group, the patients in the non-ICU-AW group had smaller RF-MLT on the 7th day [cm: 0.32 (0.22, 0.47) vs. 0.45 (0.34, 0.63), P < 0.05] and higher 7-day RF-CSA atrophy rate [25.85% (10.37%, 34.28%) vs. 11.65% (2.28%, 22.41%), P < 0.05]. According to ROC curve analysis, 7-day RF-MLT had diagnostic value for ICU-AW of septic patients. Area under ROC curve (AUC) was 0.688 (95% CI was 0.526-0.849); when the cut-off value was 0.41 cm, the sensitivity and the specificity were 66.7% and 68.4%. The levels of plasma MCP-1 in the ICU-AW group were significantly higher than those in the non-ICU-AW group on the 1st, 4th and 7th day. ROC curve analysis showed that the plasma MCP-1 levels on the 1st, 4th and 7th day played a significant role to diagnose ICU-AW for septic patients, the AUC and 95% CI were 0.732 (0.629-0.836), 0.865 (0.777-0.953), 0.891 (0.795-0.986), respectively. When the cut-off values were 206.3, 410.9, 239.5 ng/L, the sensitivity was 87.1%, 64.0%, 82.4%, and the specificity was 54.4%, 96.1%, 86.2%, respectively. Conclusion:The muscle mass parameters on the 7th day of bedside ultrasound and plasma MCP-1 levels had certain diagnostic values for ICU-AW in patients with sepsis.
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2019 novel coronavirus (2019-nCoV) Delta variant of concern (VOC) is one of the variants of 2019-nCoV, which has the characteristics of strong transmission, high pathogenicity, and rapid progression. 2019-nCoV Delta VOC has caused a global pandemic. Understanding the characteristics of 2019-nCoV Delta VOC and implementing targeted control measures are important aspects of controlling the pandemic. In this paper, the characteristics and control measures of 2019-nCoV Delta VOC were reviewed.
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Objective:To explore the risk factors of intensive care unit acquired weakness (ICUAW) in patients with sepsis, and to evaluate the predictive value of each risk factor for ICUAW.Methods:A case control study was conducted, 60 septic patients admitted to the intensive care unit (ICU) of Henan Provincial People's Hospital from October 20, 2020 to February 20, 2021 were enrolled. The patients were divided into two groups: sepsis ICUAW group and sepsis non-ICUAW group. The data of gender, age, body mass index (BMI), acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, complications, mechanical ventilation, duration of ICUAW, length of stay in ICU, fasting blood glucose, blood lactic acid (Lac), procalcitonin (PCT), C-reactive protein (CRP), sequential organ failure assessment (SOFA) score, outcome, antimicrobial agent, glucocorticoid, sedatives and analgesics drugs and vasoactive drugs were collected. Risk factors were screened by univariate Logistic regression analysis, and odds ratio ( OR) was adjusted by multivariate binary logistic regression, P < 0.05 was considered as independent risk factors. Finally, the receiver operating characteristic curve (ROC curve) was drawn to analyze the predictive value of independent risk factors. Results:The APACHEⅡ score of the sepsis ICUAW group was significantly higher than that of the sepsis non-ICUAW group (23.05±8.17 vs. 15.33±4.89, P < 0.05), the total length of stay in the ICU was significantly longer than that of the sepsis non-ICUAW group (days: 15.1±9.2 vs. 8.5±3.4, P < 0.05), the improvement rate of patients was significantly lower than that of the sepsis non-ICUAW group [45.0% (9/20) vs. 95.0% (38/40), P < 0.05]. After univariate Logistic regression and multicollinearity test analysis, 7 factors including APACHEⅡ score, average SOFA score, blood lactic acid, proportion of mechanical ventilation, sedatives and analgesics drugs, type of antibiotics and type of vasoactive drugs were included in the binary Logistic regression model [ OR: 1.21, 2.05, 2.26, 0.21, 1.54, 2.07, 1.38, 95% confidence interval (95% CI): 1.09-1.35, 1.42-2.94, 1.12-4.57, 0.05-0.66, 1.03-2.29, 1.27-3.37, 0.96-2.00, all P < 0.05]. Hosmer-Lemchaw test P = 0.901, and the correct percentage of prediction was 85%, indicating good model fit. Multivariate binary Logistic regression analysis showed that APACHEⅡ score and average SOFA score were independent risk factors for the occurrence of ICUAW in septic patients (APACHEⅡscore: OR = 1.17, 95% CI was 1.004-1.376, P = 0.044; average SOFA score: OR = 1.86, 95% CI was 1.157-2.981, P = 0.01). ROC curve analysis showed that the mean value of APACHEⅡ score, average SOFA score and their combined detection had a certain predictive value for the occurrence of ICUAW in sepsis patients, areas under ROC curve (AUC) were 0.787, 0.881, 0.905, 95% CI was 0.646-0.928, 0.791-0.972, 0.828-0.982, all P < 0.05. When the cut-off value was 19.500, 6.225, 0.375, the sensitivity was 75%, 90%, 90%, and the specificity were 80%, 80%, 85%, respectively. Conclusion:APACHEⅡ score and average SOFA score can be used as independent risk factors for the occurrence of ICUAW in sepsis, and their combined predictive value is better than that of individual index.
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Objective:To assess the application of extracorporeal membrane oxygenation (ECMO) regional treatment pattern in patients with severe cardiopulmonary diseases.Methods:A retrospective analysis was conducted. Patients with severe cardiopulmonary disease who were transferred to Henan Provincial People's Hospital after ECMO treatment in cooperative hospitals were selected. The patients who received regular ECMO treatment from June 2017 to May 2018 were enrolled as the control group, and the patients who received ECMO regional treatment from June 2018 to May 2019 were selected as the observation group. The ECMO regional treatment pattern referred to implement a referral program for critical patients in primary hospitals, which mainly included the establishment of ECMO regional cooperative treatment network and ECMO referral team, the formulation of ECMO referral management standards, and the promotion of the merging of high-quality medical resources. Time of establishment of ECMO, ECMO regional treatment satisfaction, and the incidence of adverse events were also compared.Results:There were 27 patients enrolled in the control group and 64 patients in the observation group. There were no significant differences in gender, age, body mass index (BMI), ECMO mode, hypertension or coronary heart disease history between the two groups. Compared with the control group, the time for establishment of ECMO in the observation group was significantly shorter (minutes: 38.10±17.19 vs. 54.67±41.30, t = 2.715, P = 0.008), the ECMO treatment satisfaction of the observation group was also significantly higher than that of the control group (98.4% vs. 88.9%, χ 2 = 4.120, P = 0.042), and the incidence of ECMO referral adverse events was significantly lower than that of the control group (6.25% vs. 25.93%, χ 2 = 6.918, P = 0.009). Conclusion:The ECMO regional collaborative pattern in patients with severe cardiopulmonary diseases can shorten the time for establishment of ECMO, improve the satisfaction of ECMO treatment, and reduce the incidence of adverse events in ECMO referral.
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Objective:To assess the value of point of care ultrasound on cardiac output (CO) and volume responsiveness in patients with septic shock.Methods:A prospective investigation study was conducted. Twenty-four mechanical ventilation patients with septic shock who needed pulse-indicated continuous cardiac output (PiCCO) monitoring in the department of critical care medicine of Zhengzhou University People's Hospital, Henan Provincial People's Hospital from November 25, 2020 to April 30, 2021 were selected as the subjects, the patient's basic information and laboratory test results were recorded. PiCCO was used as standard to monitor CO and stroke volume variability (SVV) at 0, 2, 6, 12, 24 and 48 hours. At the same time, point of care transthoracic echocardiography (TTE) was used to measure velocity time integral (VTI) and inferior vena cava diameter (dIVC), the CO, VTI variation rate (△VTI) and dIVC variation rate (△dIVC) were calculated. Then, using the value monitored by PiCCO as the standard, the consistency and correlation analysis were carried out between point of care ultrasound with PiCCO.Results:Twenty-two out of 24 patients obtained satisfactory ultrasound Doppler images, the heart rate (HR), mean arterial pressure (MAP) and body temperature of the enrolled patients were consistent with the pathophysiological characteristics of septic shock. With the extension of treatment time, HR and CO both gradually decreased, and MAP gradually increased, reaching a peak or trough at 48 hours after admission. The difference were statistically significant compared with the time of admission [HR (bpm): 90.36±15.35 vs. 116.82±19.82, MAP (mmHg, 1 mmHg = 0.133 kPa): 87.82±11.06 vs. 58.82±9.85, CO (L/min): 4.80±0.56 vs. 6.78±1.31, all P < 0.05]. The CO obtained by PiCCO and point of care ultrasound had good agreement [5.36 (4.78, 6.33) L/min and 5.21 (4.88, 6.35) L/min, respectively], the average difference value at each time point was (-0.02±0.69) L/min, the 95% agreement limit range was -1.35-1.34, and there was a high degree of correlation ( rs = 0.800, P < 0.001); The SVV by PiCCO and the △dIVC by point of care ultrasound were in good agreement [18.00% (14.00%, 24.00%) and 21.00% (14.00%, 25.75%), respectively], the average difference value at the time point was (-3.16±6.89)%, the 95% agreement limit range was -16.89-10.54, and there was a moderate correlation ( rs = 0.702, P < 0.001); The SVV by PiCCO and the △VTI by point of care ultrasound were in good agreement [18.00% (14.00%, 24.00%) and 16.00% (11.25%, 20.75%), respectively], the average difference value at each time point was (13.03±14.75)%, and the 95% agreement limit range was 1.72-27.78, and there was a high correlation ( rs = 0.918, P < 0.001). Conclusion:Point of care ultrasound can accurately assess CO and volume responsiveness of patients with septic shock, and the △VTI is better than the △dIVC in assessing volume responsiveness.
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To explore the usability of regional saturation of cerebral oxygenation (rScO2) combined with percentage of α variability (PAV) in predicting brain function prognosis in patients with traumatic brain injury (TBI). Methods A retrospective analysis was conducted. The clinical data of patients with TBI who were monitored rScO2 and bedside quantitative electroencephalogram (qEEG) admitted to intensive care unit (ICU) of Henan Provincial People's Hospital from August 2018 to July 2019 were collected. The rScO2, PAV, and Glasgow coma scale (GCS) score were recorded within 72 hours after the TBI. The primary prognostic indicator was the 3-month Glasgow outcome score (GOS) score. The differences between the two groups of poor prognosis of brain function (GOS score 1-3) and good prognosis (GOS score 4-5) were compared. Binary multivariate Logistic regression analysis was used to analyze the correlation between rScO2, PAV, GCS score and the prognosis of brain function in patients with TBI. In addition, receiver operating characteristic (ROC) curve was plotted to analyze the predicting value of rScO2 and PAV only or combination for prognosis of brain function. Results A total of 42 patients with TBI were enrolled in the study, with rScO2≥0.60 (grade Ⅰ) in 14 patients, 0.50≤rScO2 < 0.60 (grade Ⅱ) in 16 patients,and rScO2 < 0.50 (grade Ⅲ) in 12 patients. PAV 3-4 scores (grade Ⅰ) were detected in 16 patients, 2 scores (grade Ⅱ) in 17 patients, and 1 score (grade Ⅲ) in 9 patients. GCS score 9-14 (grade Ⅰ) were observed in 13 patients,4-8 (grade Ⅱ) in 23 patients, and 3 (grade Ⅲ) in 6 patients; 18 patients had poor prognosis and 24 had good one. The rScO2, PAV and GCS scores of the poor-prognosis group were significantly higher than those in the good-prognosis group [rScO2 with grade Ⅲ: 55.6% (10/18) vs. 8.3% (2/24), PAV with grade Ⅲ: 38.9% (7/18) vs. 8.4% (2/24), GCS score with grade Ⅲ: 27.7% (5/18) vs. 4.1% (1/24)] with significant differences (all P < 0.05). There was no significant difference in other general data including gender, age, total length of hospital stay or acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score between the two groups. Binary multivariate Logistic regression analysis showed that rScO2 and PAV were independent risk factors for prognosis of brain in patients with TBI [rScO2: odds ratio (OR) = 4.656, 95% confidence interval (95%CI) was 1.071-20.233, P = 0.040; PAV: OR = 3.525, 95%CI was 1.044-11.906, P = 0.042]. ROC curve analysis showed that both of rScO2 and PAV had predictive value for the prognosis of brain function in patients with TBI (AUC was 0.796 and 0.780, respectively, both P < 0.01), and rScO2 combined with PAV had higher predictive value with the AUC of 0.851 (P < 0.01) than rScO2 or PAV alone, the sensitivity was 94.4% and the specificity was 62.5%. Conclusions rScO2 and PAV were associated with early brain function prognosis in patients with TBI. The combination of two monitoring indicators can reliably assess the prognosis of brain function in patients with TBI.
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Objective@#To explore the usability of regional saturation of cerebral oxygenation (rScO2) combined with percentage of α variability (PAV) in predicting brain function prognosis in patients with traumatic brain injury (TBI).@*Methods@#A retrospective analysis was conducted. The clinical data of patients with TBI who were monitored rScO2 and bedside quantitative electroencephalogram (qEEG) admitted to intensive care unit (ICU) of Henan Provincial People's Hospital from August 2018 to July 2019 were collected. The rScO2, PAV, and Glasgow coma scale (GCS) score were recorded within 72 hours after the TBI. The primary prognostic indicator was the 3-month Glasgow outcome score (GOS) score. The differences between the two groups of poor prognosis of brain function (GOS score 1-3) and good prognosis (GOS score 4-5) were compared. Binary multivariate Logistic regression analysis was used to analyze the correlation between rScO2, PAV, GCS score and the prognosis of brain function in patients with TBI. In addition, receiver operating characteristic (ROC) curve was plotted to analyze the predicting value of rScO2 and PAV only or combination for prognosis of brain function.@*Results@#A total of 42 patients with TBI were enrolled in the study, with rScO2≥0.60 (grade Ⅰ) in 14 patients, 0.50≤rScO2 < 0.60 (grade Ⅱ) in 16 patients, and rScO2 < 0.50 (grade Ⅲ) in 12 patients. PAV 3-4 scores (grade Ⅰ) were detected in 16 patients, 2 scores (grade Ⅱ) in 17 patients, and 1 score (grade Ⅲ) in 9 patients. GCS score 9-14 (grade Ⅰ) were observed in 13 patients, 4-8 (grade Ⅱ) in 23 patients, and 3 (grade Ⅲ) in 6 patients; 18 patients had poor prognosis and 24 had good one. The rScO2, PAV and GCS scores of the poor-prognosis group were significantly higher than those in the good-prognosis group [rScO2 with grade Ⅲ: 55.6% (10/18) vs. 8.3% (2/24), PAV with grade Ⅲ: 38.9% (7/18) vs. 8.4% (2/24), GCS score with grade Ⅲ: 27.7% (5/18) vs. 4.1% (1/24)] with significant differences (all P < 0.05). There was no significant difference in other general data including gender, age, total length of hospital stay or acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score between the two groups. Binary multivariate Logistic regression analysis showed that rScO2 and PAV were independent risk factors for prognosis of brain in patients with TBI [rScO2: odds ratio (OR) = 4.656, 95% confidence interval (95%CI) was 1.071-20.233, P = 0.040; PAV: OR = 3.525, 95%CI was 1.044-11.906, P = 0.042]. ROC curve analysis showed that both of rScO2 and PAV had predictive value for the prognosis of brain function in patients with TBI (AUC was 0.796 and 0.780, respectively, both P < 0.01), and rScO2 combined with PAV had higher predictive value with the AUC of 0.851 (P < 0.01) than rScO2 or PAV alone, the sensitivity was 94.4% and the specificity was 62.5%.@*Conclusions@#rScO2 and PAV were associated with early brain function prognosis in patients with TBI. The combination of two monitoring indicators can reliably assess the prognosis of brain function in patients with TBI.
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Critical care medicine has developed rapidly and has become an indispensable comprehensive subject in clinical medicine at home and abroad.In recent years,the government has vigorously implemented the "Healthy China" strategy and strived to achieve a higher level of national health.The Henan Provincial People's Hospital has set up a network of interconnected "Wisdom · Critical Care Medicine Specialist League" to meet the major strategic needs of the country,and to play a role in attracting large hospitals to promote the sinking of quality medical resources and the improvement of grassroots service capabilities.Complementary advantages and resource sharing are conducive to achieve win-win cooperation and coordinated development between the third-grade class-A hospital and grassroots hospitals.
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Objective To explore the predictive value of heparin-binding protein (HBP) combined with sequential organ failure assessment (SOFA) score in patients with septic shock. Methods Seventy-eight patients with sepsis admitted to intensive care unit (ICU) of Henan Provincial People's Hospital from December 2016 to May 2017 were enrolled. Thirty healthy persons were enrolled as controls. The patient's gender, age, length of ICU stay, and blood culture results, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), blood lactate (Lac), HBP, SOFA score, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, organ failure and vasoactive agents usage within 24 hours of admission were recorded. The differences in the above indicators between the groups were compared, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of HBP, SOFA score and their combination in patients with septic shock. Results All patients were enrolled in the final analysis, including 64 with sepsis and 14 with septic shock. Compared with the sepsis group, the proportion of patients with septic shock who were positive for blood culture, organ failure, and vasoactive agents was higher [57.1% (8/14) vs. 7.8% (5/64), 100.0% (14/14) vs. 65.6% (42/64), 100.0% (14/14) vs. 18.8% (12/64), all P < 0.01], SOFA and APACHEⅡscores were also higher (SOFA: 8.93±4.16 vs. 5.89±2.68, APACHEⅡ: 22.29±4.89 vs. 15.28±5.14, both P < 0.01);however, there was no significant difference in gender, age or length of ICU stay between the two groups. Compared with the healthy control group, HBP, PCT, CRP and Lac levels were significantly increased in the sepsis group and the septic shock group. HBP in the septic shock group was significantly higher than that in the sepsis group (μg/L: 120.33±43.49 vs. 68.95±54.15, P < 0.05), but there was no significant difference in PCT, CRP or Lac between septic shock group and sepsis group [PCT (μg/L): 1.42 (0.47, 46.00) vs. 0.71 (0.19, 4.50), CRP (mg/L): 102.90±78.12 vs. 102.07±72.15, Lac (mmol/L): 1.81 (1.14, 3.65) vs. 1.59 (1.17, 2.24), all P > 0.05]. It was shown by ROC curve analysis that the area under the ROC curve (AUC) of SOFA score for predicting septic shock was 0.715 [95% confidence interval (95%CI) = 0.540-0.890, P = 0.012], and when the optimal cut-off value was 7.5, the sensitivity was 64.3%, the specificity was 76.6%. The AUC of HBP was 0.814 (95%CI = 0.714-0.913, P < 0.001), and when the optimal cut-off value was 89.43 μg/L, the sensitivity was 78.6%, the specificity was 76.6%; when the two were combined, the AUC was 0.829 (95%CI = 0.724-0.935, P < 0.001), the sensitivity was 92.9%, and the specificity was 61.9%. Conclusion HBP can be used as a biological indicator for predicting septic shock, and the accuracy of predicting septic shock can be improved with the combination of SOFA score.
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Objective@#To verify the accuracy of oxygen concentration (FiO2) of modified oxygen treatment with Venturi and humidity system.@*Methods@#Patients just after ventilator weaning and before the removal of tracheal intubation/tracheotomy tube, who admitted to the intensive care unit (ICU) of Henan Provincial People's Hospital from May 1st to December 15th in 2017, were enrolled. All patients were given a modified oxygen treatment with Venturi and humidity system, and the oxygen flow rate (Flow) of the Venturi device and the oretical value of FiO2 were adjusted according to the patient's condition. Patients were divided into five groups based on doctor's orders: Flow 3 L/min FiO2 0.24, Flow 3 L/min FiO2 0.26, Flow 6 L/min FiO2 0.28, Flow 6 L/min FiO2 0.30, Flow 9 L/min FiO2 0.35. The value of FiO2 at the inhalation end of patients of each group was measured by TSI airflow analyzer, and the consistency between the measured value of FiO2 at the inhalation end and the FiO2 marked value of Venturi was compared and analyzed.@*Results@#When the FiO2 theoretical value of Venturi were adjusted to 0.24, 0.26, 0.28, 0.30, and 0.35, the measured values of FiO2 at the inhalation end of patients were 0.38±0.05, 0.38±0.05, 0.40±0.04, 0.41±0.04, and 0.77±0.11, respectively, which were all significantly higher than the theoretical value of FiO2 (all P < 0.01). The difference between the measured value of FiO2 at the inhalation side and the FiO2 value of the Venturi annotated and the difference rate were both "V"-shaped, both of which decreased with the increase in theoretical value of FiO2 to a Flow of 9 L/min and a theoretical value of FiO2 0.35, the accuracy was the worst, with the FiO2 difference of 0.42±0.11, and the FiO2 difference rate of (121.6±36.5)%.@*Conclusion@#There is a difference between the measured value and the theoretical value of FiO2 at the inhalation end of the modified Venturi oxygen therapy humidification system, which needs to be paid attention to during clinical oxygen therapy.
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In recent years, more and more attention has been paid to the occurrence and harm of delirium, and intensive care unit (ICU) delirium has become a hot issue. The incidence of delirium in ICU patients is much higher than that of general wards, all kinds of complications caused by delirium and increased mortality should win enough attention of the clinicians. There is no uniform standard for the diagnosis and evaluation of ICU delirium, which is a major problem that affects clinicians in the early diagnosis and assessment of prognosis. By reviewing the domestic and international researches of ICU delirium, the latest progress of diagnostic and assessment instruments for delirium in ICU is stated, which provides an important basis for the early identification and diagnosis of delirium in ICU.
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Objective To investigate the protective effect of hesperidin on severe acute pancreatitis (SAP) in rats and its related mechanism.Methods Sixty male Sprague-Dawley (SD) rats were randomly divided into five groups (n = 12 in each group): sham group, SAP model group, dexamethasone group (5 mg/kg), low and high dose of hesperidin groups (10 mg/kg and 20 mg/kg). SAP rats were administered a retrograde infusion of 3.5％ sodium taurocholate solution into the biliopancreatic duct after laparotomy. Sham rats were administered with equivalent saline. The treatment was intravenously injected 5 minutes after operation through femoral vein. After 24 hours, the survival of animals was observed, the level of serum amylase, the volume of ascites and the relative specific gravity of the pancreas were measured; the pathological changes of pancreatic tissue were observed by Hematoxylin-eosin (HE) staining; the levels of serum and pancreatic tissue interleukin (IL-1β, IL-6) and tumor necrosis factor-α (TNF-α) were detected by enzyme linked immunosorbent assay (ELISA); the expression of Toll-like receptor 4 (TLR4), the phosphorylation of IL-1 receptor associated kinase (IRAK1) and nuclear factor-κB (NF-κB) were detected by Western Blot.Results Compared with SAP model group, the 24-hour survival rate were increased in low and high dose of hesperidin groups (83.3％, 100％ vs. 58.3％), the volume of ascites were reduced (mL: 7.36±0.91, 6.10±1.02 vs. 13.82±2.06), the levels of serum amylase were reduced (U/L: 1081.48±78.23, 1048.58±49.97 vs. 1990.37±127.27), the relative specific gravity of the pancreas were reduced [(7.52±1.02)％, (5.59±0.96)％ vs. (11.22±0.96)％], and the pathological damage of pancreatic tissue were reduced; the levels of serum and pancreatic tissue inflammatory factors were reduced in high dose hesperidin group [serum IL-1β (ng/L): 68.08±10.49 vs. 130.30±23.35, IL-6 (ng/L): 63.88±10.47 vs. 158.41±21.38, TNF-α(ng/L): 10.42±1.49 vs. 18.16±2.01; pancreas IL-1β (pg/μg): 13.87±1.84 vs. 20.08±1.66, IL-6 (pg/μg): 21.90±3.12vs. 38.13±3.57, TNF-α (pg/μg): 1.88±0.20 vs. 4.26±0.58]; the expression of TLR4, and the phosphorylation levels of IRAK1 and NF-κB were decreased in low and high dose of hesperidin groups (the sham operation group was 100, TLR4/β-actin: 91.9±15.6, 83.7±11.2 vs. 168.5±9.0, p-IRAK1/IRAK1: 117.4±7.6, 104.7±11.5 vs. 173.5±15.8, p-NF-κB p65/NF-κB p65: 119.9±9.3, 105.8±12.6 vs. 174.1±13.0), with statistically significant differences (allP < 0.05). The effects of dexamethasone were similar to that of high dose of hesperidin.Conclusions Hesperidin could significantly protect SAP rats, and this protection was related to the inhibition of TLR4/IRAK1/NF-κB signaling pathway, and to the reduction of pro-inflammatory cytokine expressions. The effect of high dose hesperidin (20 mg/kg) was more significant.
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Objective To explore the characteristic of early evaluation of patients with amplitude-integrated electroencephalogram (aEEG) on brain function prognosis after cardiopulmonary cerebral resuscitation (CPCR). Methods A retrospective analysis of the clinical data of patients with adult CPCR in intensive care unit (ICU) of Henan Provincial People's Hospital from March 2016 to March 2017 was performed. The length of stay, recovery time, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, aEEG and Glasgow coma scale (GCS) within 72 hours were recorded. The main clinical outcome was the prognosis of brain function (Glasgow-Pittsburgh cerebral performance category, CPC) in patients with CPCR after 3 months. Relationship between aEEG and GCS and their correlation with brain function prognosis was analyzed by Spearman rank correlation analysis. The effects of aEEG and GCS on prognosis of brain function were evaluated by Logistic regression analysis. The predictive ability of aEEG and GCS for brain function prognosis was evaluated by receiver operating characteristic (ROC) curve.Results A total of 31 patients with CPCR were enrolled, with 18 males and 13 females; mean age was (41.84±16.96) years old; recovery time average was (19.42±10.79) minutes; the length of stay was (14.84±10.86) days; APACHE Ⅱ score 19.29±6.42; aEEG grade Ⅰ(normal amplitude) in 7 cases, grade Ⅱ (mild to moderate abnormal amplitude) in 13 cases, grade Ⅲ (severe abnormal amplitude) in 11 cases; GCS grade Ⅰ (9-14 scores) in 7 cases, grade Ⅱ (4-8 scores) in 14 cases, grade Ⅲ (3 scores) in 10 cases; 19 survivals, 12 deaths; the prognosis of brain function was good (CPC 1-2) in 8 cases, and the prognosis of brain function was poor (CPC 3-5) in 23 cases. There was no significant difference in age, gender, recovery time, length of stay and APACHE Ⅱ score between two groups with different brain function prognosis, while aEEG grade and GCS grade were significantly different. Cochran-Armitage trend test showed that the higher the grade of aEEG and GCS, the worse the prognosis of CPCR patients (bothP-trend < 0.01). With the increase in GCS classification, the classification of aEEG was also increasing (r = 0.6206,P = 0.0003). Both aEEG and GCS were positively correlated with the prognosis of brain function (r1 = 0.7796,P1 < 0.0001;r2 = 0.7021,P2 < 0.0001). Univariate Logistic regression analysis showed that aEEG and GCS had significant effect on early brain function prognosis [aEEG: odds ratio (OR) = 37.234, 95％confidence interval (95％CI) = 3.168-437.652,P = 0.004, GCS:OR = 12.333, 95％CI = 1.992-76.352,P = 0.007]; after adjusting for aEEG and GCS, only aEEG had significant effect on the early prognosis of brain function (OR = 26.932, 95％CI = 1.729-419.471,P = 0.019). The ROC curve analysis showed that in the evaluation of the prognosis of CPCR patients with brain function, the area under ROC curve (AUC) of aEEG was 0.913, when the cut-off value of aEEG was 1.5, the sensitivity was 95.7％ and the specificity was 75.0％. The AUC of GCS was 0.851, the best cut-off value was 1.5, the sensitivity was 91.3％ and the specificity was 62.5％.Conclusion aEEG and GCS scores have a good correlation in the evaluation of brain function prognosis in patients with CPCR, the accuracy of aEEG in the early evaluation of the prognosis of patients with CPCR is higher than the GCS score.
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Objective To investigate the protective effect of hesperidin on severe acute pancreatitis (SAP) in rats and its related mechanism.Methods Sixty male Sprague-Dawley (SD) rats were randomly divided into five groups (n = 12 in each group): sham group, SAP model group, dexamethasone group (5 mg/kg), low and high dose of hesperidin groups (10 mg/kg and 20 mg/kg). SAP rats were administered a retrograde infusion of 3.5％ sodium taurocholate solution into the biliopancreatic duct after laparotomy. Sham rats were administered with equivalent saline. The treatment was intravenously injected 5 minutes after operation through femoral vein. After 24 hours, the survival of animals was observed, the level of serum amylase, the volume of ascites and the relative specific gravity of the pancreas were measured; the pathological changes of pancreatic tissue were observed by Hematoxylin-eosin (HE) staining; the levels of serum and pancreatic tissue interleukin (IL-1β, IL-6) and tumor necrosis factor-α (TNF-α) were detected by enzyme linked immunosorbent assay (ELISA); the expression of Toll-like receptor 4 (TLR4), the phosphorylation of IL-1 receptor associated kinase (IRAK1) and nuclear factor-κB (NF-κB) were detected by Western Blot.Results Compared with SAP model group, the 24-hour survival rate were increased in low and high dose of hesperidin groups (83.3％, 100％ vs. 58.3％), the volume of ascites were reduced (mL: 7.36±0.91, 6.10±1.02 vs. 13.82±2.06), the levels of serum amylase were reduced (U/L: 1081.48±78.23, 1048.58±49.97 vs. 1990.37±127.27), the relative specific gravity of the pancreas were reduced [(7.52±1.02)％, (5.59±0.96)％ vs. (11.22±0.96)％], and the pathological damage of pancreatic tissue were reduced; the levels of serum and pancreatic tissue inflammatory factors were reduced in high dose hesperidin group [serum IL-1β (ng/L): 68.08±10.49 vs. 130.30±23.35, IL-6 (ng/L): 63.88±10.47 vs. 158.41±21.38, TNF-α(ng/L): 10.42±1.49 vs. 18.16±2.01; pancreas IL-1β (pg/μg): 13.87±1.84 vs. 20.08±1.66, IL-6 (pg/μg): 21.90±3.12vs. 38.13±3.57, TNF-α (pg/μg): 1.88±0.20 vs. 4.26±0.58]; the expression of TLR4, and the phosphorylation levels of IRAK1 and NF-κB were decreased in low and high dose of hesperidin groups (the sham operation group was 100, TLR4/β-actin: 91.9±15.6, 83.7±11.2 vs. 168.5±9.0, p-IRAK1/IRAK1: 117.4±7.6, 104.7±11.5 vs. 173.5±15.8, p-NF-κB p65/NF-κB p65: 119.9±9.3, 105.8±12.6 vs. 174.1±13.0), with statistically significant differences (allP < 0.05). The effects of dexamethasone were similar to that of high dose of hesperidin.Conclusions Hesperidin could significantly protect SAP rats, and this protection was related to the inhibition of TLR4/IRAK1/NF-κB signaling pathway, and to the reduction of pro-inflammatory cytokine expressions. The effect of high dose hesperidin (20 mg/kg) was more significant.
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Objective To explore the characteristic of early evaluation of patients with amplitude-integrated electroencephalogram (aEEG) on brain function prognosis after cardiopulmonary cerebral resuscitation (CPCR). Methods A retrospective analysis of the clinical data of patients with adult CPCR in intensive care unit (ICU) of Henan Provincial People's Hospital from March 2016 to March 2017 was performed. The length of stay, recovery time, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, aEEG and Glasgow coma scale (GCS) within 72 hours were recorded. The main clinical outcome was the prognosis of brain function (Glasgow-Pittsburgh cerebral performance category, CPC) in patients with CPCR after 3 months. Relationship between aEEG and GCS and their correlation with brain function prognosis was analyzed by Spearman rank correlation analysis. The effects of aEEG and GCS on prognosis of brain function were evaluated by Logistic regression analysis. The predictive ability of aEEG and GCS for brain function prognosis was evaluated by receiver operating characteristic (ROC) curve.Results A total of 31 patients with CPCR were enrolled, with 18 males and 13 females; mean age was (41.84±16.96) years old; recovery time average was (19.42±10.79) minutes; the length of stay was (14.84±10.86) days; APACHE Ⅱ score 19.29±6.42; aEEG grade Ⅰ(normal amplitude) in 7 cases, grade Ⅱ (mild to moderate abnormal amplitude) in 13 cases, grade Ⅲ (severe abnormal amplitude) in 11 cases; GCS grade Ⅰ (9-14 scores) in 7 cases, grade Ⅱ (4-8 scores) in 14 cases, grade Ⅲ (3 scores) in 10 cases; 19 survivals, 12 deaths; the prognosis of brain function was good (CPC 1-2) in 8 cases, and the prognosis of brain function was poor (CPC 3-5) in 23 cases. There was no significant difference in age, gender, recovery time, length of stay and APACHE Ⅱ score between two groups with different brain function prognosis, while aEEG grade and GCS grade were significantly different. Cochran-Armitage trend test showed that the higher the grade of aEEG and GCS, the worse the prognosis of CPCR patients (bothP-trend < 0.01). With the increase in GCS classification, the classification of aEEG was also increasing (r = 0.6206,P = 0.0003). Both aEEG and GCS were positively correlated with the prognosis of brain function (r1 = 0.7796,P1 < 0.0001;r2 = 0.7021,P2 < 0.0001). Univariate Logistic regression analysis showed that aEEG and GCS had significant effect on early brain function prognosis [aEEG: odds ratio (OR) = 37.234, 95％confidence interval (95％CI) = 3.168-437.652,P = 0.004, GCS:OR = 12.333, 95％CI = 1.992-76.352,P = 0.007]; after adjusting for aEEG and GCS, only aEEG had significant effect on the early prognosis of brain function (OR = 26.932, 95％CI = 1.729-419.471,P = 0.019). The ROC curve analysis showed that in the evaluation of the prognosis of CPCR patients with brain function, the area under ROC curve (AUC) of aEEG was 0.913, when the cut-off value of aEEG was 1.5, the sensitivity was 95.7％ and the specificity was 75.0％. The AUC of GCS was 0.851, the best cut-off value was 1.5, the sensitivity was 91.3％ and the specificity was 62.5％.Conclusion aEEG and GCS scores have a good correlation in the evaluation of brain function prognosis in patients with CPCR, the accuracy of aEEG in the early evaluation of the prognosis of patients with CPCR is higher than the GCS score.
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Objective To investigate the influence of simvastatin treatment on Toll-like receptor 4 (TLR4) in monocytes of peripheral blood in patients with sepsis and severe sepsis and its significance. Methods A prospective randomized controlled trial was conducted. 106 patients with sepsis and 92 patients with severe sepsis admitted to Department of Critical Care Medicine of Henan Provincial People's Hospital from August 2013 to June 2015 were enrolled. These two groups of patients were randomized into conventional treatment group and simvastatin group. All patients received treatment according to the 2012 International Sepsis Treatment Guidelines, including anti-infection drugs, nutritional support, and palliative treatment, and the patients with severe sepsis were given early goal-directed therapy (EGDT). The patients in simvastatin group received simvastatin 40 mg daily orally for at least 15 days. The peripheral blood was collected and the monocytes were isolated at 1, 5, 10, 15 days after intensive care unit (ICU) admission. TLR4 expression on the surface of TLR4/CD14+ double positive monocytes was determined by flow cytometry, and adverse reaction was observed during treatment. Results TLR4 expression on the surface of monocytes showed a tendency of decreasing with prolongation of simvastatin treatment in the simvastatin group in patients with sepsis (n = 59) or severe sepsis (n = 54). However, in patients with sepsis, TLR4 level was significantly decreased from 10 days in simvastatin group as compared with that of conventional therapy group (n = 47), and it was decreased up to 15 days [mean fluorescence intensity (MFI): 21 (19, 28) vs. 27 (25, 33) at 10 days, Z = 2.198, P = 0.021; 16 (15, 21) vs. 26 (23, 34) at 15 days, Z = 4.611, P = 0.002]. In patients with severe sepsis, there was no significant difference in TLR4 level at different time points between simvastatin group and conventional treatment group (n = 38) [MFI: 55 (52, 63) vs. 56 (48, 65) at 1 day, Z = 0.313, P = 0.692; 47 (42, 56) vs. 49 (41, 58) at 5 days, Z = 0.827, P = 0.533; 40 (35, 42) vs. 42 (37, 45) at 10 days, Z = 1.012, P = 0.301; 33 (30, 38) vs. 38 (35, 41) at 15 days, Z = 0.539, P = 0.571]. No adverse reaction related with simvastatin was found during treatment in patients with sepsis or severe sepsis. Conclusions Statins could significantly down-regulate the TLR4 expression on peripheral blood monocytes in septic patients, while it showed no significant influence on TLR4 expression in patients with severe sepsis. A different effect of statins on TLR4 expression and the downstream inflammation process in sepsis and severe sepsis patients might partially explain the discrepancy in previous reports about the therapeutic effect of statins therapy in sepsis and severe sepsis patients.
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Objective To investigate the abnormal expression of proto-oncogene YES-associated protein (YAP) in gastric cancer tissues in the elderly and its correlation with poor prognosis.Methods Clinical data of 80 elderly patients with gastric cancer treated in our hospital from March 2011 to October 2014 were statistically analyzed.Results The positive expression rate of YAP was significantly higher in gastric carcinoma than in adjacent tissues [71.3％ (57/80) vs.13.8％ (11/80),P＜0.05].The positive expression of YAP were significantly associated gastric tumor size,tumor stage,invasion depth and lymph node metastasis (all P＜0.05),but had no correlation with tumor differentiation (P＞0.05).The 5-year survival rate was significantly lower in patients with YAP-positive expression than in patients with YAP-negative expression (P ＜ 0.05),but the differences in 1-year,3-year survival rates were not significant between the two groups (all P＞0.05)The YAP expression,tumor stage,lymph node metastasis were significantly associated with the prognosis of gastric cancer in patients (all P＜0.05).Conclusions YAP-positive expression rate is significantly higher in gastric cancer tissues than in adjacent tissues in the elderly,which indicates poor prognosis of patients with gastric cancer.