Characteristics of sepsis in the emergency department of a tertiary hospital in Tianjin: A 4-year retrospective analysis / 中华急诊医学杂志

Objective:Taking emergency department (ED) as a starting point, to analyze the epidemiological characteristics and mortality risk factors of sepsis, and to provide evidences for ED to carry out the strategy of "three early and two lower" for sepsis.Methods:Based on the ED and inpatient medical record management information platform of Tianjin Medical University Gernal Hospital, adult ED patients with sepsis from January 1, 2017 to December 31, 2020 were included according to the third international consensus definitions for sepsis and septic shock in 2016 and the consensus of Chinese experts on early prevention and blocking of sepsis in 2020. The epidemiological characteristics of patients were retrospectively analyzed. Chi-square test was used to compare the difference of age, sex, hospitalization times, length of stay, hospitalization cost and infection location between dead patients and survival patients, and a stepwise logistic regression model was used to analyze the influencing factors of mortality in hospitalized patients with ED sepsis.Results:A total of 7 494 patients with sepsis in ED were included in this study, and the annual and monthly component ratios varied from 3.8‰ to 6.1‰ and 2.0‰ to 9.0‰, respectively. The main characteristics of patients with sepsis in ED were as follows: 40-69 years old (46.0%), male (59.0%), mostly diagnosed with sepsis (96.8%), mainly treated with urban health insurance (59.6%), and ED diagnosis and treatment fees of 2 000-8 000 Yuan (51.1%). The mortality of hospitalized patients with ED sepsis was 24.4% and that of hospitalized patients with septic shock was 28.8%. The main characteristics of hospitalized patients with ED sepsis were as follows: most of them were male (56.2%) patients over 70 years old (56.0%), most of them were diagnosed with sepsis (94.0%) and hospitalized for the first time (76.0%), the median hospitalization time was 15 d, most of them were hospitalized under urban health insurance (65.2%), and the median hospitalization fees was 47 000 Yuan. The risk factors of death were influenced by age and length of stay. Patients aged 70 years or older had a higher risk of death than those aged from 18 to 39 years, and patients with a length of stay of more than 7 d had a lower risk of death than those with a length of stay of shorter than 7 d. The primary infection focus were mainly respiratory and urinary systems, while the death rate of patients with hematological and abdominal infections was relatively high, and the difference was statistically significant ( P<0.01). Respiratory and abdominal infections were risk factors for death in patients with ED sepsis. Conclusions:The composition ratio of sepsis in ED patients is not regular in time, so vigilance of sepsis in elderly men and patients with respiratory system, blood system, urinary system and abdominal infections should be constantly raised. Patients with sepsis who are older, hospitalized more frequently, hospitalized for a shorter time, and infected in the respiratory system or abdomen have a higher risk of death.

Complement 5a regulates the function of dendritic cells to induce pathogenic polarization of regulatory T cell/helper T cell 17 in sepsis / 中华危重病急救医学

Objective:To explore the mechanism of complement 5a (C5a) in the pathogenesis of sepsis.Methods:SPF male C57BL/6J mice were selected and divided into sham operation group (Sham group), cecal ligation and puncture (CLP) group and CLP+anti-C5A monoclonal antibody intervention group (CLP+anti-C5a group) according to random number table with 20 mice in each group. A CLP model was reproduced to induce sepsis, and those in the Sham group only underwent laparotomy without ligation and perforation. In the CLP+anti-C5a group, 0.15 mg of anti-C5a monoclonal antibody was injected intraperitoneally immediately after CLP, and in the Sham group and CLP group were given equal amount of normal saline. The cumulative survival rate was analyzed by Kaplan-Meier method. Serum levels of tumor necrosis factor-α (TNF-α), interleukins (IL-12, IL-4), and interferon-γ (IFN-γ) were measured 24, 48 and 72 hours after operation by enzyme linked immunosorbent assay (ELISA). Immunohistochemical staining was used to observe the expression of C5a receptor (C5aR) in lung and kidney tissues 48 hours after operation. The proportions of dendritic cell (DC), regulatory T cell (Treg) and helper T cell 17 (Th17) in splenic mononuclear cells 48 hours after operation were analyzed by flow cytometry.Results:The 7-day cumulative survival rate of mice in the CLP group was significantly lower than that in the Sham group (30.00% vs. 100.00%; Log-Rank test: χ 2 = 47.470, P < 0.001), and the peripheral blood inflammatory mediators TNF-α, IL-12 and IL-4 were increased 24 hours after operation, followed by a significant decreasing at 48 hours, and then gradually increased at 72 hours. IFN-γ gradually increased 24 hours after operation and lasted for 72 hours. Immunohistochemistry showed that a large number of C5aR was expressed in pulmonary and renal endothelial cells 48 hours after operation in the CLP group. Compared with the Sham group, the proportion of DC [(1.80±0.30)% vs. (6.90±1.20)%, P < 0.05] and Treg [(0.38±0.02)% vs. (4.00±0.50)%, P < 0.05] in splenic mononuclear cells was down-regulated in the CLP group, the proportion of Th17 was up-regulated [(0.83±0.08)% vs. (0.32±0.03)%, P < 0.05], and disorder of immune function was found. After anti-C5A monoclonal antibody intervention, the 7-day cumulative survival rate increased significantly compared with the CLP group (54.54% vs. 30.00%; Log-Rank test: χ 2 = 28.090, P < 0.001); TNF-α, IL-12 and IFN-γ were further increased, while IL-4 was significantly decreased; the expression of C5aR in lung and kidney tissues were significantly decreased, and the expression of mature DC cells [(5.10±1.20)% vs. (1.80±0.30)%, P < 0.05] and Treg [(2.58±0.05)% vs. (0.38±0.02)%, P < 0.05] in spleen were significantly increased compared with the CLP group, and Th17 was significantly decreased [(0.54±0.05)% vs. (0.83±0.08)%, P < 0.05]. Conclusion:It is preliminarily concluded that anti-C5A monoclonal antibody may improve the prognosis of sepsis by improving the polarization of mature DC and T cells in the spleen, and C5a plays an important role in the immune regulation of sepsis cells.

The application of three accelerated diagnostic protocols in stratifying emergency department patients with chest pain / 中华急诊医学杂志

Objective:To compare the ability of Vancouver chest pain rule, Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol and Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol in rapid assessment of patients with chest pain.Methods:Patients with chest pain suggestive of acute coronary syndrome were recruited from January 2017 to February 2017 in Emergency Department of Tianjin Medical University General Hospital. Patients were stratified into various risk groups with Vancouver chest pain rule, Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol and Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol. The end point was acute myocardial infarction (AMI) within 30 days.Results:A total of 134 patients were enrolled. Fifty-seven patients were preliminary classified as a low risk for suitable discharge by Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol, and one of them had AMI within 30 days. The sensitivity of stratifying low-risk patient was 83.3%, the specificity was 43.8%, and the negative predictive value was 98.2%. Fifty-one patients were preliminary classified as a low risk for suitable discharge by Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol, and none of them had AMI within 30 days; the sensitivity of stratifying low risk patient was 100%, the specificity was 39.8%, and the negative predictive value was 100%. Twenty-four patients were preliminary classified as a low risk for suitable discharge by Vancouver chest pain rule, and none of them had AMI within 30 days; the sensitivity of stratifying low risk patient was 100%, the specificity was 18.8%, and the negative predictive value was 100%.Conclusions:Using accelerated diagnostic protocols to stratify emergency department patients with chest pain achieved early and safe emergency department discharge. The Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol stratified more than 30% of low-risk patient, with a sensitivity of no less than 98% and a specificity of no less than 99.5%.

Advances in the research of the relationship between skin regulatory T cells and wound healing and immune diseases / 中华烧伤杂志

As the body′s largest organ, skin harbors a large amount of immune cells to regulate both innate and adaptive immune responses. Regulatory T cells (Tregs), as a subset of T lymphocytes with negative regulatory functions, play an important role in maintaining the immune homeostasis of different tissue. However, researches of skin Tregs are largely limited and uncompleted as compared with other tissue. In recent years, a comprehensive understanding is increasingly showing the specialized functions of Tregs in skin, including the orchestration of tissue wound healing, involvement in hair follicle recycling, and modulation of proper immune homeostasis. In this review, we outline the classification and characteristics of Tregs in skin, distribution, migration routes, immune effects, and relationship with wound healing, which aims to deepening our understanding towards the immunological effects of T lymphocytes subsets in skin and its regulatory pathways.

Safety evaluation of ultrasound location in axillary venipuncture / 中华急诊医学杂志

Objective To explore the success rate and safety of axillary venipuncture catheterization with ultrasound localization and homologous surface localization(Magney).Method A total of 80 patients were enrolled in the EICU from January 2017 to September 2018.They were randomly assigned to the Magney method(n=35)and the ultrasound-guided method(n=45).The number of successful punctures,success rate and complications were recorded.Results Compared with ultrasound-guided method,the one-time success rate(25.7％vs 68.9％,P＜0.01),puncture greater than 2 times(34.3％vs 11.1％,P=0.012),and total success rate(82.9％vs 100％,P=0.004)in Magney method were significantly different.Both of the two puncture methods were mis-invasive,and the difference was not statistically significant.In Magney method 2 patients occurred hematoma and 1 patient brachial plexus injury,but no infection occurred within 48 h.While no such occurrence was found in ultrasound-guided method.Conclusion Ultrasound-guided method axillary venipuncture is a safe and effective method of central venous catheterization,which has higher success rate and safety than Magney method.

Safety evaluation of ultrasound location in axillary venipuncture / 中华急诊医学杂志

Objective@#To explore the success rate and safety of axillary venipuncture catheterization with ultrasound localization and homologous surface localization (Magney).@*Method@#A total of 80 patients were enrolled in the EICU from January 2017 to September 2018. They were randomly assigned to the Magney method (n=35) and the ultrasound-guided method (n=45). The number of successful punctures, success rate and complications were recorded.@*Results@#Compared with ultrasound-guided method, the one-time success rate (25.7% vs 68.9%, P<0.01), puncture greater than 2 times (34.3% vs 11.1%, P=0.012), and total success rate (82.9% vs 100%, P=0.004) in Magney method were significantly different. Both of the two puncture methods were mis-invasive, and the difference was not statistically significant. In Magney method 2 patients occurred hematoma and 1 patient brachial plexus injury, but no infection occurred within 48 h. While no such occurrence was found in ultrasound-guided method.@*Conclusion@#Ultrasound-guided method axillary venipuncture is a safe and effective method of central venous catheterization, which has higher success rate and safety than Magney method.

The value of cardiopulmonary resuscitation quality index in evaluating the prognosis during cardiopulmonary resuscitation / 中华急诊医学杂志

Objective To explore the timeliness value of cardiopulmonary resuscitation quality index (CQI) in patients' prognostic evaluation during cardiopulmonary resuscitation (CPR).Methods A prospective descriptive study was conducted.According to whether they got return of spontaneously circulation (ROSC) or not,45 patients receiving CPR were divided into the ROSC group and non-ROSC group.The changes of CQI and partial pressure of end-tidal carbon dioxide (PETCO2) during CPR were collected,and were analyzed to valuate the prognosis of patients.Results The initial,end,and average PETCO2 were statistically different between the ROSC group and the non-ROSC group [7.0(3.6,14.6) vs 7.0(3.6,14.6) mmHg;29.5(19.8,35.9) vs 4.0(2.3,10.2)mmHg;and 22.2(11.8,36.3) vs 4.0(2.5,9.0) mmHg,respectively;P＜0.05],and the end CQI was statistically different between the two groups (59.6±8.9 vs 34.8±5.2,P＜0.05).The CQI differences between the two groups initiated at 11 min after CPR,and stopped at 29 min after CPR.The optimal cut-offpoint of terminal CQI and PETCO2 for prognostic was 33.2 and 16.1 mmHg respectively,and there was a statistically difference in the area under the curve between them (P＜0.05).Conclusions During CPR,both CQI and PETCO2 can be used to evaluate the prognosis,and CQI is more capable of predicting in the late stage of CPR.

The effect of Xuebijing injection on the procoagulation of tissue factor by inositol-requiring enzyme 1α signaling pathway / 中华急诊医学杂志

Objective To investigate the effect of Xuebijing injection on lipopolysaccharide (LPS)-mediated the procoagulant activity of tissue factor (TF) in abdominal aortic endothelial cells from rats.Methods Abdominal aortic endothelial cells from rats were randomLy(random number) divided into the control group,LPS group (500 ng/mL),Xuebijing group (1,5,25 μL/mL),and LPS+Xuebijing group (1,5,25 μL/mL),respectively.Cell proliferation was measured by CCK8 and lactate dehydrogenase (LDH) level in supematants was determined at 24,48,and 72 h;Expressions ofinositol-requiring enzyme-1α (IRE 1α),unspliced-box binding protein-1 (uXBP-1),spliced-box binding protein 1 sXBP-1),and protein disulfide isomerase (PDI) were determined by Western blotting at 72 h.Procoagulant activity of TF was measured as the ability of monolayer to support activation of factor with the addition of a and Ca2+ by chromogenic substrate method.Results Compared with the control group,the cell proliferation was decreased and LDH level was increased in the LPS group (P＜0.05),and there were markedly up-regulated in the expression of IRE1 α,uXBP1,sXBP1,and PDI (P＜0.05).Compared with the control group,treatment with Xuebijing injection could promote cell proliferation and reduce the release of LDH (P＜0.05 or P＜0.01),which were gradually enhanced along with the observational intervals.Compared with the LPS group,the LPS+Xuebijing group showed obviously higher cell proliferation and lower release of LDH (P＜0.05 or P＜0.01),expressions of IRE 1 α,uXBP 1,sXBP 1,and PDI were significantly reduced (P＜0.01);meanwhile,F Ⅹ a activity was decreased in the LPS+Xuebijing group,and 5 μ L/mL Xuebijing was the optimal dose in down-regulation of F Ⅹ a.Conclusions These results suggest that treatment with Xuebijing injection can markedly down-regulate the expression of PDI by inhibiting the IRE1α-XBP1 signaling pathway to suppress the procoagulant activity of TF in abdominal aortic endothelial cells from rats.

Analysis of cross-sectional survey for adult emergency patients in Tianjin / 中华急诊医学杂志

Objective To show epidemiological characteristics of adult emergency patients and to provide data support for grading clinics.Methods Adult emergency patients (older than 14 years) from 50 hospitals in Tianjin were included.Name,gender and age of patients,as well as visiting time/department,chief complaint,severity of the disease,prognosis were considered to cross-sectional survey from 8:00,30 Aug 2016 to8:00,31 Aug 2016.Chi-squared test,Fisher's exact test,or t test was used to statistical analysis as appropriate.Results Of 6 569 patients,most originated from medical (n =3 964,60.34％) and surgical (n =2 017,30.31％).Patients' average age was 46.90 ± 18.70 (14-99) years old and there were more patientsaged from 30 to 39 (n =1 285,19.56％).Hospital crowded periods were between 8:00-11:00 and 17:00-22:00.In these periods,average number of patients was more than 300.Concerning the severity of disease,83 patients (1.26％) were in grade 1 (the most severe cases),301 patients (4.58％) in grade 2,1 500 patients (22.83％) in grade 3,and 4 685 patients (71.33％) were in grade 4 (the less severe cases).Most ambulatory patient represented trauma (n =124,35.23％),neurological (n =68,19.32％) and cardiovascular (n =49,13.92％) diseases.However,50.57％ of them were not considered urgent.Conclusions Most patients visited emergency department were nonurgent and originated from medical and surgical department in Tianjin.Crowded periods gathered at 8:00-11:00 and 17:00-22:00.Most ambulatory patients were trauma,neurological and cardiovascular disease;however,half of them was stable and need no emergency intervention.

Reference value range of pulse oximetry plethysmographic waveform parameters in the normal adults / 中华急诊医学杂志

Objective To Pulse oximetry saturation has been wildly used clinically.It has been reported that pulse oximetry plethysmographic waveform (POP) reflected the peripheral tissue perfusion.In this study,we parameterized POP,observed the value of POP parameters in normal adults,and established the normal reference value range.Methods A multi-center prospective descriptive study.Total of 1 019 adult volunteers with normovolemia from 7 cities were enrolled in this study.Sex,age,height,weight and pulse oximetry data in awake and spontaneous breathing under in quiet conditions in the room temperature were collected.POP parameters and perfusion index were analyzed using MATLAB 2012a software.The normal reference value ranges of POP parameters,including the amplitude of POP (Amp) and the area under the curve of POP (AUC),were formulated.Results Statistical differences of POP parameters were detected between men and women in the normal adult.The 95％ confidence reference value of POP parameters in normal population was as follows:Amp (104.8-2298.7) PVA and AUC (3265.8-6028.5) PVPGin total,Amp (129.4-2433.6) PVA and AUC (3319.0-5862.2) PVPG in male;Amp (89.5-2138.2) PVA and AUC (3163.9-5929.9) PVPG in female.Conclusions POP,including the amplitude of POP (Amp) and the area under the curve of POP (AUC),had normal reference value ranges in normal adults.

Research progress of prognosis and recognition methods for return of spontaneous circulation during cardiopulmonary resuscitation / 中华急诊医学杂志

Cardiopulmonary resuscitation is the most comonly used method facing cardiac arrest.The 2010 CPR guidelines emphasized high quality chest compressions and recommended continuous compression for 2 minutes after defibrillation to minimize interruptions in compressions.However,starting chest compressions immediately after a defibrillation shock may be harmful,if the heart is providing spontaneous beats and being subjected to external compressions at the same time.So it is very important to recognize ROSC during CPR,the methods of which include touching the pulse,amplitude spectral area,partial pressure end-tidal carbon dioxide,coronary perfusion pressure,central venous oxygen saturation,chest compression fraction,regional cerebral oxygen saturation,photoplethysmography,conjunctival oxygen tension,transthoracic-impedance plethysmography and echocardiography.This paper gives a review of the ROSC prognosis and recognition methods during CPR.

Clinical study of the changes in homeostasis during the course of acute poisoning in patients treated with hemoperfusion / 中华急诊医学杂志

Objective To observe the effects of hemoperfusion on homeostasis in patients with acute poisoning.Methods The data of 26 acute poisoning patients treated with hemoperfusion were retrospective analyzed.The clinical data included blood pH,PvCO2,PvO2,blood lactate,potassium,free-calcium,bicarbonate and blood glucose assayed and recorded at 0 min,30 min and 120 min after hemoperfusion.The statistical software SPSS 18.0 was utilized to analyze the statistical differences in the above biomarkers among three different intervals after hemoperfusion.Results At the beginning of hemoperfusion therapy,levels of homeostasis indicators were pH (7.36 ± 0.05),PvCO2 (41.0 ± 8.8) mmHg,PvO2 (37.0 ± 11.8)mmHg,lactate (1.35 ± 1.00) mmol/L,potassium (3.1 ± 0.5) mmol/L,sodium (136.3 ± 4.8)mmol/L,free-calcium (0.95 ± 0.11) mmol/L,blood glucose (7.90 ± 3.47) mmol/L,bicarbonate (22.8±3.3) mmol/L.At30min,the levels of those were (7.36±0.04),(40.0±5.7) mmHg,(41.0±7.5) mmHg,(1.11 ±0.57) mmol/L,(3.1±0.4) mmol/L,(137.3 ±5.4) mmol/L,(0.94 ±0.12) mmol/L,(6.20 ± 1.55) mmol/L,(22.2 ±2.3) mmol/L,respectively.At 120 min,the levels of those were (7.35 ± 0.06),(38.0 ± 6.7) mmHg,(46.0 ± 7.9) mmHg,(0.69 ± 0.52)mmol/L,(3.0±0.4) mmol/L,(137.3±5.0) mmol/L,(0.97±0.10) mmol/L,(5.88±1.43)mmol/L,(22.0± 2.2) mmol/L,respectively.Apparently,there were significant statistical difference in PvO2,lactate and blood glucose (P ＜ 0.05) among three different intervals,and no significant statistical differences in other indicators (P ＞ 0.05).Conclusions There were no significant effects of hemoperfusion on relevant indicators in acute poisoning patients.

Neuropilin-1 is a co-expression receptor for membrane associated transforming growth factor-βcontributing to the immunosuppressive property of rgulatory T cells / 中国中西医结合急救杂志

Objective To investigate the effect of co-expression of neuropilin-1(Nrp-1)and transforming growth factor-β(TGF-β)on regulatory T cell(Treg)-mediated immunosuppression. Methods CD4+CD25+Tregs were isolated from the spleens of male Balb/c mice. CD4+CD25+Tregs were blocked with various doses of Nrp-1 antibody(Ab-Nrp-1,0.5,5,10 μg/ml)for 24 hours with anti-CD3/CD28 and lipopolysaccharide(LPS)stimulation, and expression of Nrp-1 and TGF-βwas determined by flow cytometry. Meanwhile,CD4+CD25+Tregs were cultured with different doses of Ab-Nrp-1 for 1 hour,and co-cultured with CD4+CD25-T cell for 12,24 and 48 hours respectively,the proliferative activity of CD4+CD25-T cells was analyzed by microplate reader. Results Compared to control group,the expressions of Nrp-1 and TGF-β were significantly increased under anti-CD3/CD28 and LPS stimulation(both P<0.05),and treatment with Ab-Nrp-1 markedly inhibited the expression of TGF-β in a dose-dependent manner(P<0.05). The normal Treg had the potential to inhibit the proliferation of CD4+CD25-T cells(P<0.05),while various doses of Ab-Nrp-1 had the ability to reverse the immunosuppressive function of CD4+CD25+Treg in a dose-and time-dependent response manner,5μg/ml has the strongest ability,expecially after 24 hours. Conclusion Treg cell plays an important role in mediating immunosuppressive response via membrane associated TGF-β,and co-expression of Nrp-1 can markedly promote the immunosuppressive function.

Effect of the blood lipid level in the prognosis of patients with sepsis / 中国医师进修杂志

ObjectiveTo observe the changes of the blood lipid levels in patients with sepsis,and reveal the clinical significance of the blood lipid level in the prognosis of patients with sepsis.MethodsThe blood lipid levels and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) of 40 patients with sepsis(sepsis group) were recorded.The blood lipid levels were compared with those of 25 healthy people (control group).The correlation of the blood lipid level with APACHE Ⅱ score and prognosis of sepsis was analyzed.ResultsIn sepsis group,plasma total cholesterol(TC),high density lipoprotein (HDL),low density lipoprotein (LDL),apolipoprotein B (ApoB) was (3.92 ±0.96) mmol/L,(1.10 ±0.39) mmol/L,(2.44 ± 0.81 ) mmol/L and ( 1.03 ± 0.27) g/L respectively,which were significantly decreased compared with those in control group [ ( 4.40 ± 0.55 ) mmol/L,( 1.61 ± 0.42) mmol/L,(2.79 ± 0.47 ) mmol/L,( 1.13 ± 0.12 ) g/L] (P ＜0.05).In sepsis group,26 cases survived and 14 cases died.TC,triacylglycerol (TG),HDL,LDL,apolipoprotein A Ⅰ (ApoA Ⅰ ),ApoB,platelet count and albumin level of death patients was (3.33 ±0.92) mmol/L,(0.81 ±0.39) mmol/L,(1.03 ±0.27) mmol/L,(1.83 ±0.68) g/L,(1.03 ±0.27) g/L,(0.86 ±0.27) g/L,(140.0 ±82.3) × 109/L,and (32.00 ±5.52) g/L,respectively,which were significantly decreased compared with those of survival patients [ (4.24 ± 0.84) mmol/L,( 1.21 ± 0.44) mmol/L,( 1.25 ±0.30) mmol/L,(2.77 ±0.68) mmol/L,(1.25 ±0.13) g/L,(1.13 ±0.23) g/L,(215.9 ± 101.0) × 109/L,(36.12 ±6.30) g/L](P＜0.05).APACHEM Ⅱ score of death patients was (20.5 ±4.2) scores,which was increased compared with that of survival patients [ ( 13.8 ± 4.8) scores ] ( P ＜ 0.05 ).Multivarisble Logistic regression analysis showed plasma HDL and APACHE Ⅱ score was independent risk factor (standard regression coefficient,HDL =-6.222,APACHE Ⅱ score =0.337).Conclusions Disorders of lipid metabolism exist in patients with sepsis.Plasma HDL level is a good indicator in assessment of prognosis in patients with sepsis and it shows better results combined with APACHE Ⅱ score.

The influence of Xuebijing injection and low molecular weight heparin on coagulation function and prognosis in patients with severe sepsis / 中华急诊医学杂志

Objective To compare between the impact of Xuebijing injectio (a Chinese herbal medicine preparation) and that of low molecular weight heparin (LMWH) on coagulation function and prognosis in patients with severe sepsis, so as to guide the treatment of sepsis. Method A total of 89 patients with severe sepsis were randomly(random number) divided into 3 groups, namely Xuebijing group (group A),LMWH group (group B) and routine group (group C). The patients of group C received a series of remedies according to the guideline for severe sepsis. The patients of group A were treated with Xuebijing injectio in addition to routine treatment. The patients of group B were treated with LMWH along with routine treatment.Data of blood coagulation function tests and APACHE Ⅱ score of patients in three groups before and after treatment were analyzed respectively. The 28-day mortality and length of hospital stay were compared among three groups. All data were analyzed by using t-test, Analysis of Variance, q-test, x2-test and rank sum treatment, all markers of the blood coagulation function tests in group A improved significantly after treatment (P＜0.01), while only some markers of the blood coagulation function tests improved in the other two groups ( P ＜ 0. 05 or P ＜ 0. 01 ); After treatment, the blood coagulation function in group A improved significantly more than that in other two groups ( P ＜ 0.05 ), while there were some markers of the blood coagulawith the data before treatment, the APACHE Ⅱ score in group A and group B decreased after treatment (P＜0.05). After treatment, the APACHE Ⅱ score of group A and group B decreased significantly more than that of group C ( P ＜ 0.05). But there was no significant difference between group A and group B ( P ＞Xuebijing obviously improves the blood coagulation function in patients with severe sepsis, while LMWH only improves some markers of the coagulation function tests. Both Xuebijing and LMWH reduce mortality and improve prognosis of patients with sepsis.

Pathogens and drug-resistance of ventilator-associated pneumonia patients in emergency intensive care unit / 中国医师进修杂志

Objective To observe the pathogens and drug-resistance of ventilator-associated pneumonia (VAP) patients in emergency intensive care unit (EICU) for rational antibiotic therapy and the prevention of VAP. Method The sputum culture results and drug-resistance of pathogens of VAP patients in EICU from 2007 to 2009 were collected. Results One hundred and two mechanical ventilation patients were selected. VAP was occurred in 70 patients (68.6%). One hundred and fifty-seven pathogens had been examined,including 92 Gram-negative bacilli (58.6%),35 Gram-positive cocci (22.3%) and 30 fungus (19.1%). Pseudomonas aeruginosa and meticillin-resistant-staphylococcus aureus was 22 strains (14.0%)respectively, stenotrop homonas maltophilia was 21 strains (13.4%) and acinetobacter baumanii was 17 strains (10.8%). Fifty-nine patients (84.3%) had suffered from multiple pathogen infection, with 31 cases having 2 pathogens and 28 cases having 3 pathogens. Conclusions Pseudomonas aeruginosaa,methicillinresistant staphylococcus, stenotrophomonas maltophilia and acinetobacter baumanii are main pathogens of VAP in EICU patients,and candida albicans is still the main pathogens in fungal infection. The rate of multiple pathogen infection is very high, and the problem of drug-resistance is very severe.

The early diagnostic value and prognostic significance of serum procalcitonin in patients with sepsis / 中国医师进修杂志

Objective To investigate the early diagnostic value and prognostic significance of serum procalcitonin (PCT) in patients with sepsis. Methods Ninety cases between December 2008 and April 2009 were collected. According to the 1991 ACCP/SCCM and 2001 SCCM/ESICM/ACCP/ATS/SIS sepsis diagnosis criteria,they were divided into sepsis group (50 cases), nonbacterial systemic inflammation syndrome group (SIRS group, 17 cases) and control group (23 cases). Sepsis group was divided into two subgroups (survival group and death group) according to 28-day prognosis Dynamic changes of serum PCT, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC), and neutrophil count percentage (N) on the 1st, 4th day after admission was monitored,meanwhile, the maximal body temperature was recorded. Results The serum PCT level of sepsis group on the 1st day was higher than that in SIRS group and control group,and the difference was statistically significant [6.68 μg/L(1.16-12.46 μg/L) vs 0.22 μg/L(0.05-0.54 μg/L) vs 0.05 μg/L(0.05-0.27 μg/L), P < 0.05]. The serum PCT level of death group was higher than that in survival group,and the difference was statistically significant[11.89μg/L (10.00-28.67 μg/L) vs 2.44 μg/L(1.11-10.00 μg/L),P<0.05]. In sepsis group,serum PCT was positively correlated with APACHE Ⅱ score(r = 0.511, P = 0.000). The area under the ROC curve of PCT was bigger than that of CRP,WBC,N and ESR. The serum PCT level of survival group gradually decreased to normal level after the therapy,but the serum PCT level of death group didn't decrease significantly. Conclusions Serum PCT is a better biomarker in the early diagnosis of sepsis,and its sensitivity and specificity is superior to other inflammation parameters. It positively correlates with the severity of sepsis and can predict the prognosis.

Serum Cholinesterase and Its Clinical Significance in Patients with Sepsis / 天津医药

Objective:To explore the changes of serum cholinesterase(ChE)and its clinical significance in patients with sepsis.Methods:Serum cholinesterase concentration,acute physiology and chronic health evaluation(APACHE)Ⅱ scores were estimated in patients.The patients in this study were divided into the sepsis group and the non-sepsis group.The patients with sepsis were further divided into the death group and the survival group.The influence of altered serum ChE levels on prognosis was compared between the groups.Results:(1)Serum ChE was significantly lower in patients of sepsis group than that of control group(P ＜ 0.01).(2)In patients with sepsis,the serum ChE level was significantly lower in the death group compared with that of survival group(P ＜ 0.05).(3)In patients with sepsis the serum ChE levels were significantly negatively correlated with APACHE Ⅱ scores(r=-0.280,P ＜ 0.05),positively correlated with serum albumin and body mass index(r=0.458 and 0.287,P ＜ 0.05).Conclusion:Serum ChE levels can be used to determine the prognosis and severity of illness in patients with sepsis.