Zhenwu Decoction:connotation interpretation based on severe cases and modern pathophysiological mechanisms and application in treatment of heart failure in critical care unit / 中国中药杂志

Zhenwu Decoction is recorded in Treatise on Febrile Diseases by an outstanding physician ZHANG Zhong-jing in the Han dynasty. With effect of warming yang, transforming Qi, and promoting urination, Zhenwu Decoction is mainly used to treat edema due to yang deficiency. The studies of the severe and critical cases and the pathophysiological mechanisms have demonstrated that the record of Zhenwu Decoction in Treatise on Febrile Diseases describes the clinical symptoms and therapeutic regimen of acute heart failure. The syndrome treated by this formula may be related to the misdiagnosis and wrong treatment. Due to the difficult distinguishing between cardiogenic dyspnea and pulmonary dyspnea, high doses of Ephedrae Herba may be misused for inducing sweating, which may finally lead to the acute aggravation of heart failure, electrolyte disorder, and pulmonary infection. The syndrome treated by Zhenwu Decoction can illustrate the lack of experience of ancient physicians in treating acute heart failure. The description of "trembling and shivering" may be the clinical manifestation of heart failure, which is an upgraded version of "trembling and shaking" treated by Linggui Zhugan Decoction.(1)In terms of diseases, Zhenwu Decoction is suitable for the treatment of acute or chronic heart failure, cardiorenal syndrome, and diuretic resistance. The decoction is especially suitable for treating whole heart failure, acute heart failure, heart failure with reduced ejection fraction, and heart failure with the syndrome of sold and dampness. In addition, it can be used to treat both type Ⅱ and type Ⅳ cardiorenal syndrome.(2)In terms of symptoms, Zhenwu Decoction can be used for treating chest tightness, palpitations, lower limb edema, difficult urination or increased urine output, fear of cold, pale fat tongue with teeth marks, white and slippery tongue fur, and deep or slow pulse.(3)In terms of the pharmacological mechanism, Zhenwu Decoction treats heart failure following the principle of promoting urination, expanding blood vessels, and invigorating heart in modern medicine. Aconiti Lateralis Radix Praparata is the sovereign herb in the formula, with the recommended dosage of 30-60 g. However, arrhythmia may be caused by high doses of Aconiti Lateralis Radix Praparata, which should be used with concern. In addition to Zhenwu Decoction, Shenqi Pills, Renshen Decoction, Wuling Powder, and Fangji Huangqi Decoction with the effect of invigorating spleen, replenishing Qi, warming Yang, and promoting urination can be used in the recovery stage. The therapy of reinforcing Yang was the last choice for critical cases due to the lack of medical conditions, unclear clinical diagnosis in history, which should be treated objectively now.

Experience of treating severe cases of 2019 novel coronavirus pneumonia in Changde area / 中华危重病急救医学

Since the cluster of the 2019 novel coronavirus (2019-nCoV) pneumonia, a large number of patients gathered, the mortality of critical patients has remained high and the treatment was unclear. In this outbreak, Hunan Changde region immediately set up a hospital and intensive care unit. The patients relieved through respiratory support, hemodynamics management, nutritional support, the application of antiviral drugs, analgesic and sedation. The treatment experience in severe cases of 2019-nCov pneumonia patients were summarized as follows: in terms of respiratory support, we needed to pay attention to the advantages of high-flow nasal cannula oxygen therapy (HFNC) and the intervention of mechanical ventilation, pay attention to the ventilator parameters, and adopt prone position timely. In the aspects of fluid resuscitation and volume management, we should pay attention to the characteristics of severe patients' volume status, perform early evaluation, and clinicians should focused on hemodynamic management beside the bed. In the aspect of nutritional support and evaluation and maintenance of intestinal function, early enteral nutrition should be adopted in time. However, the trade-off between the risk of intestinal function and nutritional support in patients with mechanical ventilation and the antiviral benefits of Kaletra needed to be reevaluated, the optimized way of analgesia and sedation was adopted, at the same time, the usage and side effects of antiviral drugs should be paid attention to. We should grasp the opportunity of transportation for severe patients. It is suggested that some warning scores should be used to facilitate early recognition of patients with severe infection and then they should be earlier transferred to the designated hospital for intensive care.

Evaluation of Blood Gas and Dynamic Monitor of Respiratory Mechanics in Respiratory Failure Children with Mechanical Ventilation / 实用儿科临床杂志

Objective To explore the clinical significances of blood gas and dynamic monitor of respiratory mechanics in respiratory failure children with mechanical ventilation.Methods Sixty-four children who need mechanical ventilation over 24 hours were divided into pulmonary disease group(44 cases) and non-pulmonary disease group(20 cases) in pediatric intensive care unit(PICU),from Jan.2005 to May 2008.By Evita 4 ventilator,dynamic monitor of respiratory mechanics,such as respiratory system compliance(Crs),airway resistance(Raw),mean airway pressue(MAP),minute ventilation(MV),oxgen index(OI),Qs/Qt,respiratory index(RI) and blood gas in these children were determined.Their characteristics and clinical significance were analyzed.Results Many parameters such as Crs,Raw,MAP,MV,Qs/Qt,OI,RI were significantly different between 2 groups(Pa

Construction of cooperation net works of techniques for nursing critical cases / 中华医院管理杂志

Cooperation networks of nursing techniques were constructde by way of perspective practice so as to enhance the quality of nursing critical cases, the success rate of emergency treatments and patients' life quality. The measures included training in techniques for nmsing critical cases, making the rounds of wards and consultations, and enlarging the scope ofthe cooperation networks. Quantification methods were introduced into management, networks of critical case assessment were used in managing patients, and the system for assessing training in techniques for nursing critical cases was used in managing nursing personnel, thus improving the quality of the nursing pensonnel, ensuring the rational allocation of human resources and promoting the enhancement of the hospital's medical quality and its social and economic benefits. It is therefore not difficu1t to see that the cooperation networks are of application and dissemination value.

Constructon of cooperation networks of techniques for nursing critical cases / 中华医院管理杂志

Cooperation networks of nursing techniques were constructed by way of perspective practice so as toenhance the quality of nursing critical cases, the success rate of emergency treatments and patients' life quality. Themeasures included taming in techniques for nursing critical cases, making the runds of wards and consultations, andenlarging the scope of the cooperation networks. Quantification methods were introduced into management, networks ofcritical case assessment were ed in managing patients, and the system for assessing taming in techniques for nursingcritical cases was used in managing nineing personnel, thus improving the quality of the nursing personnel, ensuringthe rational allocation of human resources and promoting the enhancement of the hospital's medical quality and its social and econondc benefits. It is therefore not difficult to see that the cooperation networks are of application and dissemination value.