Evaluation value of serum AGEs level combined with LIS score on prognosis of elderly patients with sepsis-related ALI/ARDS / 国际检验医学杂志

Objective To study the evaluation value of lung injury score(LIS)and advanced glycation end products(AGEs)expression levels on the prognosis of elderly patients with sepsis-related acute lung injury/acute respiratory distress syndrome(ALI/ARDS).Methods A total of 98 elderly patients with sepsis-related ALI/ARDS admitted to First Branch of the First Affiliated Hospital of Chongqing Medical University from March 2019 to April 2021 were selected as the research group,and the patients were divided into two sub-groups according to their survival within 30 d after admission:the survival group(55 cases)and the death group(43 cases).Another 51 elderly patients with non-ALI/ARDS sepsis admitted to First Branch of the First Affiliated Hospital of Chongqing Medical University in the same period were selected as the control group.After admission,the clinical data of patients were recorded,and the levels of serum creatinine,troponin I,B-type brain natriuretic peptide(BNP),serum C-reactive protein(CRP)and procalcitonin(PCT)were de-tected.Enzyme-linked immunosorbent assay was used to determine the levels of AGEs in patients'serum.The LIS score was evaluated by LIS scale.With clinical factors as independent variables and prognosis as dependent variables,Logistic regression curve was used to analyze the death factors of elderly sepsis-related ALI/ARDS patients.Results AGEs levels,LIS scores,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores decreased sequentially in the death group,survival group,and control group(all P<0.05).The levels of lactic acid,blood glucose,troponin I,PCT,BNP and CRP in arterial blood of patients in the death group were significantly higher than those in the survival group and the control group(P<0.05).The results showed that arterial lactate,blood glucose,troponin I,PCT,BNP,CRP,AGEs,APACHE Ⅱ score,and LIS score were all independent risk factors for mortality in elderly sepsis-related ALI/ARDS patients(P<0.05).The area under the curve(AUC)of LIS score predicting prognosis in elderly sepsis-related ALI/ARDS pa-tients was 0.857(95%CI:0.821-0.911),and AUC of serum AGEs was 0.861(95%CI:0.809-0.908).LIS score and AGEs level had certain predictive value for the prognosis of elderly sepsis-related ALI/ARDS pa-tients.Conclusion The LIS score and AGEs level of the elderly patients with sepsis-related ALI/ARDS are independent risk factors of death,which have important predictive value for prognosis.

The effect of Yu's Qingre Huoxue prescription on colonic mucosa of ulcerative colitis model rats / 中国现代医生

@#Objective To investigate the effect of Yu's Qingre Huoxue prescription enema on colonic mucosa in rats with ulcerative colitis(UC).Methods A total of 30 Wistar rats were randomly divided into blank control group,model group,mesalazine group,Chinese medicine high-dose,medium-dose and low-dose groups(5 rats in each group).After successful modeling with trinitrobenzene sulfonic acid,the rats were given 14 days enema with distilled water,mesalazine suspension,and high,medium and low concentration Yu's Qingre Huoxue prescription.The general condition and weight changes of rats were recorded daily,and colon macroscopic damage index(CMDI)and mucosal injury score under microscope of rats in each group were compared.Results Compared with blank control group,the weight of rats in model group decreased significantly(P<0.05).The blank control group had normal water and food intake and activity,glossy fur and normal stool.The rats in model group and each administration group were found to have anal fouling,residual blood in stool,decreased appetite,messy fur,dim luster and other conditions,and the above conditions were gradually improved after enema treatment.Compared with blank control group,the CMDI and mucosal injury scores of model group were significantly increased(P<0.05).Compared with model group,CMDI and mucosal injury scores of mesalazine group and Chinese medicine high-dose,medium-dose and low-dose groups were significantly decreased(P<0.05).Conclusion Yu's Qingre Huoxue prescription can effectively improve the clinical symptoms of diarrhea,mucous,pus and blood stools in UC model rats,reduce the damage of colonic mucosa,promote mucosal repair,and have a good effect on the treatment of UC in rats.

Efficacy and safety of sivelestat in patients with acute lung injury in the intensive care unit / 中华急诊医学杂志

Objective:To explore the efficacy and safety of sivelestat, a neutrophil elastase (NE) inhibitor, in the treatment of acute lung injury (ALI) in the intensive care unit (ICU).Methods:A retrospective analysis was performed on 171 patients with ALI in the ICU of the First Affiliated Hospital of Zhengzhou University from June 2020 to June 2021, including 77 patients in the sivelestat group and 94 patients in the conventional treatment group. Acute physiology and chronic health evaluation (APACHE) Ⅱ score, Murray lung injury score, oxygenation index (PaO 2/FiO 2 ratio), inflammatory cytokines (IL-6, IL-10, TNF-α), ventilator-free days (VFD), the length of ICU stay, and the 28-day mortality were collected to assess the efficacy of sivelestat. At the same time, adverse reactions and laboratory test results within 30 days after the use of sivelestat were recorded to assess the safety. Results:Compared with conventional treatment, oxygenation index, Murray lung injury scores, IL-6, IL-10, and TNF-α were significantly improved after 7 days of sivelestat treatment. Compared with the conventional treatment group, the VFD was significantly longer ( P = 0.0119) and the length of ICU stay was significantly shorter ( P = 0.0269) in the sivelestat group. The mortality was 14.29% in the sivelestat group and 22.34% in the conventional treatment group and, with no statistically significant. In the meantime, sivelestat did not increase adverse reactions within 30 days after treatment. Conclusions:Sivelestat treatment is safe and more effective than conventional treatment for ALI patients in the ICU.

Scoring methods in injury assessment of rats with trauma combined with seawater immersion / 中华创伤杂志

Objective:To explore and establish the scoring method of injury assessment in rats with trauma combined with seawater immersion, so as to provide a reference for injury assessment in the special environment of trauma combined with seawater immersion.Methods:Sixty-four SD rats were divided into two groups according to the random number table, including hemorrhagic shock group and compound injury group, with 32 rats per group. Each group was divided into trauma combined with seawater immersion group and simple trauma group, with 16 rats per group. In trauma combined with seawater immersion group, the hemorrhagic shock model was placed in 15℃ seawater for 1 hour to start bleeding, and the blood loss was 30% of the total blood volume. The composite injury model caused 10% Ⅱ degree burns and was incised along the vental midline with a length of about 2 cm, and then placed in 15℃ seawater for 1 hour. The death and survival time were recorded.The survival time significantly longer than 4 hours out of water was recorded as survival, and significantly shorter than 4 hours out of water was recorded as death. Data were observed within 9 hours after injury, including the changes of physiological indexes (respiration, blood pressure, anal temperature) and arterial blood gas (blood glucose, pH value, blood lactic acid, arterial oxygen partial pressure, arterial carbon dioxide partial pressure, bicarbate, sodium ion, chloride ion, calcium ion, potassium ion). Each index were compared between trauma combined with seawater immersion group and simple trauma group. According to the survival situation of all the trauma combined with seawater immersion group at 4 hours out of water, the rats were divided into survival group and death group. The indicators affecting survival were screened, and then the scatter plot of each index corresponding to the mortality rate was established. According to the trend of each index in different interval in the scatter chart, the score table of injury condition was established.Results:The total mortality was 28% (9/32) in trauma combined with seawater immersion group, and was 6% (2/32) in simple trauma group ( P<0.05). The survival time in trauma combined with seawater immersion group [(8.1±3.7)hours] was shorter than that in simple trauma group [(11.3±4.8)hours] ( P<0.05). In trauma combined with seawater immersion group, the respiratory rate[(58.8±2.9)times/min] was slower than that in simple trauma group [(100.4±7.2)times/min], blood pressure [(80.0±25.1)mmHg] was lower than that in simple trauma group [(89.8±18.1)mmHg], and anal temperature [22.4(20.1, 25.0)℃] was significantly lower than that in sample trauma group [31.7(30.5, 33.2)℃], pH value (7.1±0.1) was lower than that in simple trauma group (7.3±0.1), and arterial oxygen partial pressure [(196.3±34.1)mmHg], arterial carbon dioxide partial pressure [45.5(35.1, 51.1)mmHg], serum sodium [145(142, 148)mmol/L], serum chlorine [120(115, 125)mmol/L], serum calcium [(1.3±0.1)mmol/L]as well as serum potassium [(3.6±0.8)mmol/L] were higher than those in simple trauma group [(149.4±22.6)mmHg, 29.7(25.6, 34.5)mmHg, 142(139, 144)mmol/L, 118(114, 121)mmol/L, (1.2±0.1)mmol/L, (3.3±0.6)mmol/L] (all P<0.05). There were no significances in other indexes between the two groups ( P>0.05). In death group, the breathing[36(30, 36)times/min], blood pressure [(43.1±21.8)mmHg], anal temperature [(20.0±1.9)℃], pH value (7.1±0.1), and bicarbonate [(12.3±2.2)mmol/L] were significantly inhibited or suppressed compared with survival group [60(48, 78)times/min, (86.6±19.3)mmHg, (23.0±3.1)℃, 7.2±0.1, (14.6±2.3)mmol/L (all P<0.05). While the two groups showed no significant differences in other indices ( P>0.05). Therefore, the respiration, blood pressure, rectal temperature, pH value and bicarbonate that significantly affect the survival of rats were screened. According to the death rate corresponding to different intervals, a score value was assigned to the interval as the weight of its impact on survival, namely on the severity of the injury, and an injury score table for trauma combined with seawater immersion in rats was established. The injury scoring scale <6 points indicated no death, 6-9 points indicated the mortality of 50%, ≥9 points indicated the mortality of 71%. The 6 points and 9 points were cutoff value of the scale. It can be considered that the scale of <6 points was classified as minor injury, 6-9 points as moderate injury, and ≥9 points as severe injury. Conclusions:The seawater immersion can result in reduced survival time and increased early mortality, manifested as respiratory depression, more serious blood loss, severe hypothermia, severe metabolic acidosis, water and electrolyte disorders (high sodium, high chlorine, high calcium, and high potassium), etc. According to the respiration, blood pressure, anal temperature, pH value and bicarbate, which affect the survival of rats, the injury rating scale of rats with trauma combined with seawater immersion can be established by using the scatter chart. The predicted mortality rate by using the rating scale was roughly consistent with the actual mortality rate, so the injury rating scale basically had a good prediction and hint for the trauma rats combined with seawater immersion.

Long-term study of pathological changes of living renal grafts from elderly relatives in young recipients / 器官移植

Objective To investigate the safety of young recipients undergoing living donor renal transplantation from elderly relative donors through long-term follow-up of the pathological changes. Methods According to the age of donors, 28 young recipients were divided into the observation group (n=14, elderly donors) and control group (n=14, young and middle-aged donors). The 7-year survival after renal transplantation, the serum creatinine (Scr) levels at various postoperative time points were compared between two groups. The chronic pathological injury scores of renal allograft biopsy at time-zero, postoperative 6-month and 7-year were compared between two groups. The expression levels of renal interstitial fibrosis indicators connective tissue growth factor (CTGF), transforming growth factor (TGF)-β, laminin (LN), fibronectin (FN), cell senescence indicators intercellular connexin (Cx)-43 and mammalian target of rapamycin (mTOR) at postoperative 6-month and 7-year were compared between two groups. Results The 7-year survival rates in the observation and control groups were 78.5% and 92.8% with no statistical significance (P > 0.05). In the observation and control groups, the levels of Scr were 190 and 160 μmol/L at the postoperative 7 d, and 170 and 125 μmol/L at postoperative 1 month. At each postoperative time point, the levels of Scr in the observation group were significantly higher than those in the control group (all P > 0.05). The total chronic pathological injury scores of renal transplant biopsy at time-zero in the observation group was significantly higher than that in the control group (P > 0.05), whereas the total chronic pathological injury scores at postoperative 7-year did not significantly differ between two groups (P > 0.05). Within either group, the total chronic pathological injury scores at postoperative 7-year was remarkably higher than those at time-zero and postoperative 6-month (both P < 0.05). The expression levels of CTGF, TGF-β, LN, FN, mTOR, Cx43 of renal transplant tissue at postoperative 7-year did not significantly differ between two groups (all P > 0.05). Conclusions The long-term follow-up outcomes demonstrate that the pathological changes of young recipients undergoing renal transplantation from elderly donors are similar to those from young and middle-aged donors. It is safe and feasible for young recipients to undergo renal transplantation from elderly donors in the pathological perspective.

Application value of extravascular lung water index and pulmonary vascular permeability index in patients with acute respiratory distress syndrome / 中国综合临床

Objective To investigate the value of extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) in the diagnosis and treatment of acute respiratory distress syndrome(ARDS).Methods From February 2015 to October 2016,selected 80 patients with ARDS in Danzhou Municipal People's Hospital,including 19 cases mild patients,28 cases moderate cases and 33 cases severe cases.The patients' EVLWI,PVPI,acute physiology and chronic health score system Ⅱ (APACHE Ⅱ)score,lung injury score (LIS) were detected.Results The score of APACHE Ⅱ in severe group was 22.81(21.91,25.40) points,significantly higher than that in mild group (19.81 (18.12,21.10) points) and moderate group(20.07 (19.01,22.02),P =0.002).The LIS,EVLWI and PVPI in Severe group were 2.01(1.83,2.11) points,17.01 (14.82,23.02) ml/kg and 3.82 (3.01,5.01),significantly higher than that in mild group (1.01 (0.98) points,1.7412.71 (10.89,13.67) ml/kg,2.71 (2.36,2.94)) and moderate group (1.52 (1.36,1.91) points,14.21 (13.10,16.60) ml/kg,3.01 (2.52,3.03),P ＜ 0.05),LIS,EVLWI and PVPI in moderate group were significantly higher than the mild group (P＜0.05).The mortality rate of 28 d in moderate and severe group was 32.14％ (9/28) and 51.52％ (17/33),which was significantly higher than that in mild group 0.00％(0/19) (P＜0.05).EVLWI and PVPI were 19.12(17.22,22.96) ml/kg and 3.71(3.08,5.22) in patients with death,which were significantly higher than those in survival 14.19 (11.20,16.59) ml/kg and 2.97(2.31,3.10) (P=0,021 and 0.016);EVLWI was positively correlated with PVPI,LIS and APACHE Ⅱ score(rs =0.411,0.323 and 0.304,P＜ 0.001).PVPI was positively correlated with LIS and APACHE Ⅱ score (rs =0.346,0.297,P＜0.001).No correlation between LIS and APACHE Ⅱ score (P＞0.05).Conclusion EVLWI and PVPI have certain apphcation value in the diagnosis and treatment of ARDS,and it is related to the patient's condition and prognosis.

Association study on classification,injury score, kyphosis deformity and nerve function injury of thoracolumbar fracture / 重庆医学

Objective To investigate the association between the lumbar vertebral fracture damage degree with the fracture classification,injury score,kyphosis deformity and nerve function injury.Methods According to the damage degree of posterior lig ament complex(PLC),the patients were divided into the PLC intact group and PLC injury group.Its relationship with PLC injury was researched by evaluating the fracture classification,injury score and nerve function injury situation in the two groups.Results The LCS score and TLICS score in the PLC injury group were (7.1±0.8) points and (8.2±0.6) points,which were higher than (5.7±0.5) points and (4.6±0.7) points in the PLC intact group.The Denis score in the PLC injury group was more serious.The Cobb angle in the PLC injury group was 29°,and which in the PLC intact group was 19°.The proportion of nerve function insufficiency in the PLC injury group was 89％,while which in the PLC intact group was only 60 ％.Conclusion The thoracolumbar vertebral fracture is closely related with PLC.PLC damage degree is positively correlated with the fracture classification,injury score,kyphosis deformity and nerve function injury degree.

The studies on the changes of nitric oxide synthase in the lung tissue of traumatic hemorrhagic shock rats under dry heat environment of desert and their relations to the secondary lung injuris / 中华急诊医学杂志

Objective To study the pathological changes and expressions of NO and iNOS mRNA in the lung tissue of traumatic hemorrhagic shock rats under dry heat environment of desert and their relations to the lung injury.Methods A total of 140 male SD rats were randomly (random number) ivided into the room temperature (25 ℃) environment traumatic hemorrhagic shock group (room temperature group) and the dry heat traumatic hemorrhagic shock groups (dry heat group,temperature 40℃,humidity 10％),respectively,and each groups was further randomly divided into 7 subgroups:the control subgroup,post shock subgroups at 0,0.5,1,1.5,2and 3 h (n =10 in each subgroup).The rats of control subgroup were not treated,and rats of dry heat group were placed in dry heat environment for 60 min,then anesthetized,fixed,and insertion of intravenous indwelling needles and catherization of right carotid artery,jugular vein and the right femoral artery were performed.After stabilization for 10 min,2500 g iron wheel was used to be dropped from 30 m height and vertically hit the upper left femoral of SD rats in order to make comminuted fracture,wounds were quickly dressed after injury.Exsanguination from right femoral artery was kept until MAP maintained at (35 ± 5) mmHg,and resuscitation was carried out after continue monitoring for 60 min.After the establishment of traumatic hemorrhagic shock model in each environment,the rats were sacrificed at given intervals,and thoracotomy was performed to take broncho-alveolar lavage fluid (BALF) and lung tissue.Pathological changes of lung tissues were observed by using HE staining and NO concentration of lung tissue was detected by one-step method,and changes of the iNOS mRNA expressions were detected by using fluorescence quantitative PCR.Then t test,ANOVA and Pearson correlation analysis were used for the data analysis.Results The pathological change in dry heat group at each interval was more severe,and pulmonary histopathological injury score was higher,and the protein exudation was more profuse compared with the room temperature group.NO concentration in lung tissue homogenate of dry heat group was higher than that of room temperature group (t =2.472,P ＜ 0.05),and the difference in NO level between different intervals within the dry heat group was statistically significant (F =6.77,P ＜ 0.01).The NO concentration in dry heat group reached its maximum at 2 h (3.35 ± 0.23) μmol / g and the peak value emerged sooner than that in room temperature group.The difference was statistically significant in overall expression of iNOS mRNA between two groups analyzed with t test (t =3.619,P ＜ 0.01),and there was statistically significant difference between intervals within the dry heat group (F =12.34,P ＜0.01).The values of iNOS mRNA in the dry heat group were higher than those in the room temperature group at the same given intervals,and the peak value appears at 1.5 h in dry heat group,and the room temperature group it began to increase at 2 h.The concentration of NO and the expression of iNOS mRNA were positively correlated with each other in two groups (r =0.680,r =0.376).The expression of iNOS mRNA and lung histopathological injury score was positively correlated in two groups (r =0.846,r =0.899).Conclusions When traumatic hemorrhagic shock occurred in the dry heat desert environment,the lung injury was more severe and appeared sooner than that in the room temperature environment.NO and iNOS played important roles in the secondary lung injury in the wake of traumatic hemorrhagic shock in rats under the dry heat environmengt of desert.

A gravidade e a região da lesão corporal correlacionam com resultados a longo prazo em paciente com traumatismo grave? / Do the severity and the body region of injury correlate with long-term outcome in the severe traumatic patient? / ¿La gravedad y la región de la lesión corporal se correlacionan conlos resultados a largo plazo en un paciente con traumatismo grave?

Justificativa e objetivos: investigar se o índice de gravidade da lesão (ISS) e a escala abreviada de lesões (AIS) estão correlacionados com a qualidade de vida em longo prazo em pacientes com traumatismo grave. Métodos: pacientes que sofreram lesões de 2005 a 2007, com IGL≥15, foram pesquisados 16-24 meses após as lesões. O questionário de avaliação da saúde (HAQ-DI) foi usado para medir o estado funcional e o modelo abreviado do questionário com 12 itens (Short Form-12 [SF-12]) foi usado para medir o estado de saúde dividido em seus dois componentes: o resumo do componente saúde física (PCS) e o resumo do componente saúde mental (MCS). Os resultados dos questionários foram comparados com os componentes do ISS e da AIS. Os resultados do SF-12 foram comparados com os valores esperados da população geral. Resultados: preencheram os questionários 74 pacientes (taxa de resposta de 28%). A média dos escores foi: PCS 42,6 ± 13,3; MCS 49,4 ± 1,4; HAQ-DI 0,5 ±0,7. Houve correlação com HAQ-DI e PCS (Rho de Spearman: -0,83; p < 0,05) e nenhuma correlação entre HAQ-DI e MCS ou entre MCS e PCS (Rho de Spearman = -0,21 e 0,01, respectivamente). Os escores cutâneo-externo e extremidades-pélvico da AIS correlacionaram com o PCS (Rho de Spearman: -0,39 e -0,34, p < 0,05) e com o HAQ-DI (Rho de Spearman: 0,31 e 0,23; p < 0,05). A condição física em comparação com a população normal foi pior, exceto para os grupos com idades entre 65-74 e 55-64 anos. Conclusões: os pacientes com fraturas pélvicas e de extremidades são mais propensos a apresentar incapacidade em longo prazo. A gravidade das lesões externas influenciou a deficiência em longo prazo. .

Background and objectives: To investigate if the Injury Severity Score (ISS) and the Abbreviated Injury Score (AIS) are correlated with the long-term quality of life in severe trauma patients. Methods: Patients injured from 2005 to 2007 with an ISS ≥ 15 were surveyed 16-24 months after injury. The Health Assessment Questionnaire (HAQ-DI) was used for measuring the functional status and the Short Form-12 (SF-12) was used for measuring the health status divided into its two components, the PCS (Physical Component Summary) and the MCS (Mental Component Summary). The results of the questionnaires were compared with the ISS and AIS components. Results of the SF-12 were compared with the values expected from the general population. Results: Seventy-four patients filled the questionnaires (response rate 28%). The mean scores were: PCS 42.6 ± 13.3; MCS 49.4 ± 1.4; HAQ-DI 0.5 ± 0.7. Correlation was observed with the HAQ-DI and the PCS (Spearman's Rho: -0.83; p < 0.05) and no correlation between the HAQ-DI and the MCS neither between the MCS and PCS (Spearman's Rho = -0.21; and 0.01 respectively). The cutaneous-external and extremities-pelvic AIS punctuation were correlated with The PCS (Spearman's Rho: -0.39 and -0.34, p < 0.05) and with the HAQ-DI (Spearman's Rho: 0.31 and 0.23; p < 0.05). The physical condition compared with the regular population was worse except for the groups aged between 65 -74 and 55 -64. Conclusions: Patients with extremities and pelvic fractures are more likely to suffer long-term disability. The severity of the external injuries influenced the long-term disability. .

Justificación y objetivos: investigar si el Índice de Gravedad de la Lesión (Injury Severity Score [ISS]) y la Escala Abreviada de Lesiones (Abbreviated Injury Score [AIS]) están correlacionados con la calidad de vida a largo plazo en pacientes con traumatismo grave. Métodos: pacientes que sufrieron lesiones entre 2005 y 2007, con un ISS ≥ 15, fueron encuestados 16-24 meses después de las lesiones. Se usó el Cuestionario de Evaluación de la Salud-Índice de Incapacidad (Health Assessment Questionnaire-Disability Index [HAQ-DI]) para medir el estado funcional, y el modelo abreviado del cuestionario con 12 ítems (Short Form-12 [SF-12]) para medir el estado de salud dividido en 2 componentes: el índice de salud física (Physical Component Summary [PCS]) y el índice de salud mental (Mental Component Summary [MCS]). Los resultados de los cuestionarios fueron comparados con los componentes del ISS y del AIS. Los resultados del SF-12 fueron comparados con los valores esperados en la población general. Resultados: setenta y cuatro pacientes rellenaron los cuestionarios (tasa de respuesta de un 28%). Las puntuaciones medias fueron: PCS 42,6 ± 13,3; MCS 49,4 ± 1,4; HAQ-DI 0,5 ± 0,7. Se registró una correlación con HAQ-DI y PCS (rho de Spearman: −0,83; p < 0,05) y ninguna correla-ción entre HAQ-DI y MCS o entre MCS y PCS (rho de Spearman = −0,21; y 0,01, respectivamente). Las puntuaciones cutáneo-externas y extremidades-pélvicas de la AIS se correlacionaron con el PCS (rho de Spearman: −0,39 y −0,34; p < 0,05) y con el HAQ-DI (rho de Spearman: 0,31 y 0,23; p < 0,05). La condición física en comparación con la población normal fue peor, excepto para los grupos con edades entre 65-74 y 55-64 años. Conclusiones: los pacientes con fracturas pélvicas y de extremidades ...

The levels of angiopoietin-2 in patients with acute respiratory distress syndrome and its value on prognosis / 中华危重病急救医学

Objective To approach the correlation between angiopoietin-2 (Ang-2) levels and degree of lung injury and prognosis and its clinical significance in patients with acute respiratory distress syndrome (ARDS). Methods A prospective observation was conducted. Fifty-three ARDS patients admitted to Department of Critical Care Medicine of Third Affiliated Hospital of Anhui Medical University from January 2012 to March 2014 were enrolled. According to the criteria of the Berlin Definition of ARDS,the patients were divided into mild group (n=15),moderate group(n=22)and severe group(n=16). Meanwhile,ARDS patients were further divided into survival group(n=29)and non-survival group(n=24)according to 28-day outcomes. Twenty cases of non-ARDS patients were served as control. The acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,oxygenation index(PaO2/FiO2),lung injury score(LIS)were recorded within 24 hours after admission. And the plasma levels of Ang-2,interleukin-6(IL-6)and C-reaction protein (CRP)were measured. The independent risk factors of ARDS were analyzed by univariate and multivariable logistic regression. Receiver operating characteristic curve(ROC)was plotted to evaluate the value of Ang-2 in predicting ARDS. Results Compared with non-ARDS group,APACHEⅡ score,SOFA score,LIS score,mortality were significantly increased,PaO2/FiO2 was significantly decreased,and plasma Ang-2,IL-6,CRP were significantly elevated〔APACHEⅡscore:20.7±5.0 vs. 14.1±5.3,SOFA score:7.7±3.5 vs. 3.5±2.1,LIS score:1.69±0.71 vs. 0.28±0.27,PaO2/FiO2(mmHg,1 mmHg=0.133 kPa):159.5±61.3 vs. 394.0±63.2,mortality:45.3%(24/53) vs. 20.0%(4/20),Ang-2(μg/L):4.73(2.59,6.99)vs. 1.22(0.61,1.52),IL-6(ng/L):56.50(27.15,139.90)vs. 13.05(4.38,15.55),CRP(mg/L):95.75(41.74,189.72)vs. 10.56(3.92,21.36),P<0.05 or P<0.01〕. Each index increased or decreased more significantly with the aggravation of the disease. It was shown by correlation analysis that the plasma levels of Ang-2 was significantly positive correlated with IL-6(r=0.468,P=0.000),CRP(r=0.492,P=0.000),APACHEⅡscore(r=0.560,P=0.000),SOFA score(r=0.508,P=0.000)and LIS score (r=0.588,P=0.000),significantly negatively correlated with PaO2/FiO2(r=-0.685,P=0.000). Factors, APACHEⅡ score,LIS score,PaO2/FiO2,Ang-2 and IL-6 founded statistical significance in univariate analysis were analyzed using multivariable logistic regression. High APACHEⅡscore at admission〔odds ratio(OR)=1.316, 95% confidence interval(95%CI)=1.040-1.633,P=0.022〕and increased plasma Ang-2 levels(OR=1.287, 95%CI=1.041-1.760,P=0.038)were the independent prognostic factors for the 28-day mortality in ARDS. The area under the ROC curve of Ang-2 was 0.964,the optimal critical value of Ang-2 was 1.79μg/L,the specificity was 90.0%,and sensitivity was 92.5%. Plasma levels of Ang-2 was better in predicting ARDS than APACHEⅡscore, SOFA score and IL-6. Conclusions The plasma level of Ang-2 was significantly increased in patients with ARDS. The plasma level of Ang-2 was correlated with the severity of acute lung injury and had important prognosis evaluation.

Effect of diammonium glycyrrhizinate and astragalus membranaceus injection on the comprehensive score of acute lung injury / 中国中西医结合急救杂志

Objective To explore the effect of diammonium glycyrrhizinate(DG) and astragalus membranaceus (AM) injection on the clinical comprehensive score in patients with acute lung injury (ALI). Methods According to the random number table method,a prospective random controlled study was conducted in which 60 cases of patients with ALI were divided into a study group and a control group(each,30 cases). Both groups received a comprehensive treatment based on the new guidelines,and the study group was additionally given DG and AM injection(DG 150 mg+AM 20 ml)one time per day for 7 days. The scores of lung injury,acute physiology and chronic health evaluationⅡ(APACHEⅡ)and systemic inflammatory response syndrome(SIRS)were measured at baseline,3rd and 7th day after treatment,and ventilation support time and final disease mortality rate were also calculated in all the patients. Results There were no statistically significant differences between the two groups in the scores of lung injury,APACHEⅡand SIRS before treatment and after treatment for 3 days(all P>0.05),with prolonged treatment,the above indexes were significantly reduced compared with those before treatment in the two groups,and the decreases in scores of indexes in study group was more significant than those in control group after treatment(lung injury score:1.31±0.99 vs. 2.29±1.08,APACHEⅡscore:18.43±8.17 vs. 24.23±6.98,SIRS score:1.69±0.89 vs. 2.60±1.04,all P0.05). Conclusion The results suggest that DG and AM injection improve the scores of lung injury,APACHEⅡand SIRS,and alleviate the lung injury,so that the injection is beneficial to the early weaning from the ventilator to support treatment in patients with acute lung injury,and has certain therapeutic effect on ALI.

Evaluation of Lung Injury Score as a Prognostic Factor of Critical Care Management in Multiple Trauma Patients with Chest Injury

PURPOSE: Chest injuries in multiple trauma patients are major predisposing factor for increased length of stay in intensive care unit, prolonged mechanical ventilator, and respiratory complications such as pneumonia. The aim of this study is the evaluation of lung injury score as a risk factor for prolonged management in intensive care unit (ICU). METHODS: Between June to August in 2011, 46 patients admitted to shock and trauma center in our hospital and 24 patients had associated chest damage without traumatic brain injury. Retrospectively, we calculated injury severity score (ISS), lung injury score, and the number of fractured ribs and performed nonparametric correlation analysis with length of stay in ICU and mechanical ventilator support. RESULTS: Calculated lung injury score(<48 hours) was median 1(0-3) and ISS was median 30(8-38) in study population. They had median 2(0-14) fractured ribs. There were 2 bilateral fractures and 2 flail chest. Ventilator support was needed in 11(45.8%) of them for median 39 hours(6-166). The ISS of ventilator support group was median 34(24-34) and lung injury score was median 1.7(1.3-2.5). Tracheostomy was performed in one patient and it was only complicated case and ICU stay days was median 9(4-16). In correlation analysis, Lung injury score and ISS were significant with the length of stay in ICU but the number of fractured ribs and lung injury score were predicting factors for prolonged mechanical ventilator support. CONCLUSION: Lung injury score could be a possible prognostic factor for the prediction of increased length of stay in ICU and need for mechanical ventilator support.

Lung Injury Score in Predicting the Outcome of the Patients in the Intensive Care Unit / 대한구급학회지

Introduction: Lung Injury Score (LIS) provides a quantitative method for scoring acute lung injury that usually occurs after sepsis. The aim of this study is to evaluate the LIS in prediction the patients outcome and determine the relationship between the LIS and mortality rate, acute physiology and chronic health evaluation II (APACHE II) score and multiple organ failure (MOF) score. METHODS: Patients admitted to Intensive Care Unit (ICU), Severance Hospital Yonsei University College of Medicine from November 1995 to March 1996 were included. LIS at admission and discharge, APACHE II score with MOF score and duration of ICU stay between survivors and nonsurvivors were compared. Relationship of LIS between mortality rate and APACHE II score and MOF score were evaluated. RESULTS: LIS is higher in nonsurvivors than survivors at admission and discharge with statistical significance. LIS of survivors and nonsurvivors at discharge was lower and higher than those at admission (p<0.05) respectively. Correlation coeffcient of LIS with mortality rate, MOF score and APACHE II score were 0.60 (p<0.05), 0.23 and 0.17. CONCLUSIONS: LIS score was highly correlated with mortality rate. Therefore LIS is a good predictor of outcome in the intensive care unit.