Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue最新文献

Objective: To observe serum cardiac specific microRNA-208a (miR-208a) levels in ST segment elevation acute myocardial infarction (STEAMI) patients, and to explore the role of serum miR-208a levels in the diagnosis of STEAMI.

Methods: The serum miR-208a concentrations were assessed within 12 hours after STEAMI, while 30 healthy individuals as control. Serum miR-208a concentrations were measured with real-time quantity reverse transcription-polymerase chain reaction (qRT-PCR), and serum cardiac troponin I (cTnI) or MB isoenzyme of creatine kinase (CK-MB) concentrations were measured with enzyme linked immunosorbent assay (ELISA).

Results: The contents of serum cTnI or CK-MB in STEAMI patients were significantly higher than those in healthy individuals (cTnI: 17.72±8.43 μg/L vs. 0.05±0.01 μg/L, CK-MB: 250.83±177.26 μg/L vs. 71.20±20.50 μg/L, both P<0.01). Serum miR-208a concentrations were detected in all individuals with STEAMI within 60 PCR cycle (0-6 hours: 44.95±4.77, 6-12 hours: 43.98±4.68), but were beyond detection for all individuals in the healthy control group. The serum miR-208a relative levels in STEAMI patients were at least more than 215 fold than that in healthy persons, compared with qRT-PCR (Ct=60) of miR-208a in healthy control persons (P<0.01).

Conclusion: Serum miR-208a may be a new biomarker the early diagnosis of STEAMI patients.

Objective: To explore the relationship between reduced left ventricular ejection fraction (LVEF) and characteristics of coronary artery disease (CAD) and investigate the association between reduced LVEF and cardiovascular prognosis.

Methods: A total of 677 hospitalized patients with angiographic CAD were enrolled. All patients' clinical data were recorded. LVEF were measured, high sensitive C-reactive protein (hs-CRP), white blood cell (WBC) and classic cardiovascular risk factors were recorded after admission. All patients were followed up from admission. The primary end point was combination occurrence of major adverse cardiovascular and cerebral events (MACCE), including death, targeted vascular revascularization, non-fatal myocardial infarction and rehospitalization due to unstable angina or heart failure, transient ischemic attack or stroke.

Results: All patients were tracked for (15±12) months, and patients were divided into normal LVEF group (LVEF≥0.50, n=585) and reduced LVEF group (LVEF<0.50, n=92) according to LVEF level. Compared with normal LVEF group, reduced LVEF group had more severe coronary stenosis (Gensini score: 62.85±41.45 vs. 47.68±33.26, P<0.05), a higher level of WBC and hs-CRP (WBC: 7.60±2.71 ×10(9)/L vs. 7.09±2.13 ×10(9)/L, hs-CRP: 5.68±3.97 mg/L vs. 3.97±3.75 mg/L, both P<0.05). A total of 146 MACCE occurred during follow-up periods. Compared with no-MACCE group, LVEF levels were significantly lower in MACCE group (0.576±0.113 vs. 0.603±0.101) and there were a higher level of hs-CRP and Gensini score in MACCE group (hs-CRP: 5.26±3.99 mg/L vs. 3.91±3.72 mg/L, Gensini score: 53.72±35.50 vs. 48.63±34.59, all P<0.05). Moreover, both of univariate and multivariate Cox regression analysis indicated LVEF be an independent predictor of MACCE in patients with CAD [univariate: relative risk (RR)=0.974, 95% confidence interval (95%CI) 0.960 to 0.988, P=0.000; multivariate: RR=0.979, 95%CI 0.961 to 0.998, P=0.033]. Kaplan-Meier analysis suggested that patients with reduced LVEF had an increased MACCE occurrence (χ(2)=14.56, P<0.05).

Conclusion: LVEF level may be associated with coronary artery severity, and could be independently predict the prognosis of CAD.

Objective: To assess the clinical applicability of focused transthoracic echocardiography (TTE) in intensive care unit (ICU) performed by intensivists and its impacts on clinical managements.

Methods: After 12-hour tutorials and initial cardiac clinical assessments, intensivists performed a focused TTE (2-4 views of 2D, without Doppler or M mode) examination in 88 patients to assess left ventricular function and left ventricular volume status, and rule out local ventricular wall motion abnormalities and significant pericardial effusions. Each investigation was immediately reviewed by an echocardiograph to determine the technical quality of the TTE and the accuracy of the intensivist's interpretation.

Results: Intensivists successfully performed a diagnostic focused TTE in 86 patients (97.7%) and interpreted correctly in 75 patients (85.2%). Management including fluid treatment, inotropic agent and vasoactive agent in 22.7% of patients were changed directly based on the focused TTE, 45.5% of patients were provided with valuable information, while 31.8% of them with non-valuable information. The mean focused TTE acquisition time of the intensivist was (11.2±5.2) minutes.

Conclusions: After a brief standard training in using echocardiographic system, intensivists can successfully performed and correctly interpreted a focused TTE for critically ill patients. Our study demonstrates that new information can be provided by focused TTE, which can alter management in a significant number of patients. The present study supports incorporating bedside goal-directed, focused TTE into intensivists' training programs in China.

Objective: To investigate the effect of glucose level, variability on the prognosis of traumatic patients.

Methods: A retrospective study involving 300 traumatic patients admitted to intensive care unit (ICU) was performed. The average glucose (GluAve), glucose standard deviation (GluSD) and glucose coefficient of variation (GluCV) during the first 72 hours were calculated. Patients were divided into survivor group (n=249) and non-survivor group (n=51) based on outcomes. The GluAve, GluSD and GluCV were compared between the two groups. Patients were allocated into five subgroups based on GluAve (3.9-5.5, 5.6-6.6, 6.7-7.7, 7.8-9.9, ≥10.0 mmol/L) as well as four subgroups on GluCV (<15%, 15%-30%, 30%-50%, >50%). The mortality in hospital was compared among the different subgroups and the different GluCV in the same level of GluAve subgroups, respectively. Multifactor logistic regression was used to determine the risk factor of hospital death.

Results: The levels of GluAve, GIuSD, GluCV of non-survivor group were higher than those of survivor group [11.31±4.38 mmol/L vs. 8.50±3.40 mmol/L, 2.85±1.94 mmol/L vs. 1.87±1.67 mmol/L, (28.30±23.08)% vs. (20.90±13.70)%, all P<0.05]. With the gradual increment of GluAve and GluCV level, the mortality was raised accordingly (χ (2)(1)=26.332, P=0.000; χ (2)(2)=65.522, P=0.000). In the subgroup of GluAve 7.8-9.9 mmol/L, the mortality was 9.09% (3/33) with GluCV <15% versus 46.15% (6/13) with GluCV >50% (P<0.01) respectively, and in the subgroup of GluAve ≥10.0 mmol/L, the mortality corresponding rates were 21.05% (4/19) with GluCV < 15% and 61.54% (8/13) with GluCV > 50% (P<0.05). The multivariable logistic regression analysis demonstrated that GluAve and GluCV were risk factors of mortality[GluAve odds ratio (OR)=1.150, 95% confidence interval (95%CI) was 1.042 to 1.270, P=0.006; GluCV OR=1.022, 95%CI was 0.999 to 1.040, P=0.040], GluSD had no effect on mortality.

Conclusions: The increase in GluAve and GluCV in traumatic patients are significantly correlated with mortality. Control the level and the variability of blood glucose might be an important aspect of the multiple trauma death reduction.

Objective: To assess the clinical value of transcranial Doppler(TCD) ultrasonography in diagnosing brain death in patients with severe craniocerebral injury.

Methods: Forty patients of severe craniocerebral injury defined by a scene Glasgow coma scale(GCS)≤8, admitted to Department of Neurosurgery of First Central Clinical Hospital of Tianjin Medical University, were divided into two groups based upon the prognosis: the death group(n=15) and the survival group (n=25). All patients were examined dynamically by TCD, and the occurrence of retrograde diastolic flow (RDF) and mean velocity (Vm) of middle cerebral arteries (MCA) were measured as well as the pulse index (PI).

Results: In the survival group, 3 showed partial RDF which was found within 24 hours after injury, and the duration was short lasting for no more than 12 hours, and the RDF wave disappeared very quickly after treatment of drug or operation. These patients were in persistent vegetative state with Glasgow outcome score (GOS) 2, having been followed up for 6 months. In the death group, 12 showed fully RDF, 2 showed very small systolic spike. The characteristic change of 14 patients' cerebral hemodynamics took place 6-40 hours before clinical brain death. Compared with survival group, Vm of MCA was significantly decreased (20.07±13.97 cm/s vs. 56.72±16.87 cm/s), the value of PI was significantly increased (3.95±3.51 vs. 1.25±1.06), and the occurrence of RDF was also elevated (93.3% vs. 12.0%) in the death group, the differences were statistically significant (P<0.05 or P<0.01).

Conclusion: TCD with the advantages of easy and bedside operation, noninvasiveness, no disturbance from sedatives and repeatability in cerebral hemodynamic examination is of great clinic practical value in early diagnosing brain death in patients with severe cranial injury.