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

Objective: To investigate the effects of PNU282987, a α7 nicotinic acetylcholine receptor agonist (α7nAChR), on organ function and survival rate in dogs with lethal burn shock.

Methods: Twelve adult male Beagle dogs were subjected to 50% total body surface area (TBSA) full-thickness flame injury, and then they were randomly divided into a burn group and a PNU282987 group (PNU group), each n=6. The dogs in PNU group received PNU282987 (0.38 mg/kg, venous pumping) and the dogs in burn group received equal amount of normal saline solution as the control group. The mean arterial pressure (MAP) and the plasma levels of tumor necrosis factor-α (TNF-α), alanine aminotransferase (ALT), MB isoenzyme of creatine kinase (CK-MB), creatinine (Cr), blood urea nitrogen (BUN) were continuously determined before and 0.5, 2, 4, 8, 12, 24 hours after burn. All the above measurements were performed with animals in conscious and cooperative state. At the end of 24-hours-period experiment, the survival rate was recorded.

Results: The MAP significantly decreased after burn compared with the baseline data before-injury. The level of MAP in PNU group were significantly higher than those of the burn group from 4 hours after burn, and it returned to 83.6% of baseline level at 24 hours. In contrast, those in the burn group progressively decreased with time till death. The plasma levels of TNF-α in PNU group were significantly lower than those of burn group at each time points post injury. The ALT, Cr, BUN and CK-MB of the burn group increased persistently, while those of the PNU group increased at first and decreased subsequently except for ALT increased persistently, and they were all significantly lower than those of the burn group till to the time point of 12 hours (ALT:51.2±7.0 U/L vs. 104.8±7.4 U/L, Cr:42.7±5.4 μmol/L vs. 88.5±4.8 μmol/L, BUN:4.9±1.2 mmol/L vs. 14.7±1.4 mmol/L, CK-MB:564.0±39.1 U/L vs. 734.0±35.9 U/L, all P<0.05). At the end of 24-hours-period experiment, the survival rate of the PNU group was 50% (3/6) and significantly higher than that of the burn group 0(0/6).

Conclusions: The results indicated that PNU282987 decrease the levels of inflammatory cytokine, improve the organ functions and increase 24-hour survival rate in dogs with lethal burn injury. And PNU282987 may have potential clinical application.

Objective: To observe the clinical effects of Chenxia Sijunzi decoction on promoting gastrointestinal function recovery in severe patients.

Methods: A prospective randomized controlled study was conducted. Eighty severe patients feeding with enteral nutrition from September 2011 to March 2012 were divided into three groups according to the method of random number table. The traditional Chinese medicine group and western medicine group were consisted of 35 cases respectively, and 10 cases were control group. Control group was routine symptomatically treated without any medicines for promoting gastrointestinal power function, helping the lower extremities to move and enhancing the turn over, letting the gastrointestinal function recover by its self. Chinese medicine group was tube fed with Chenxia Sijunzi decoction on the basis of control group, western medicine group was tube fed with the multienzyme tablets and mosapride dispersible tablets on the basis of control group. Then the differences in bowel sound recovery time and the time for passage of gas by anus and the bowel movement time and length of stay in hospitals within three groups were observed.

Results: The time of bowel sound recovery (41.02±7.52 hours, 44.02±6.23 hours), gas passage time by anus (49.90±6.95 hours, 51.32±5.12 hours) and the bowel movement time (58.22±6.71 hours, 60.91±3.72 hours) in both traditional Chinese medicine and the western medicine group were significantly reduced compared with the control group (54.62±5.51 hours, 64.68±9.47 hours, 78.20±7.11 hours, all P<0.01), and the days in hospital (5.1±1.7 days, 5.0±1.5 days) were shortened significantly compared with the control group (8.9±1.4 days, both P<0.01). However, results did not demonstrate any significant differences in each testing index between traditional Chinese medicine and western medicine group (all P>0.05).

Conclusion: Chenxia Sijunzi decoction can promote severe patient's gastrointestinal function recovery and reduce hospitalization days.

Objective: To investigate the characteristics of multidrug resistance (MDR) organisms from the lower respiratory tract in ventilated patients, and the constitution, detection time and mortality of the intensive care unit (ICU) patients with different clinical pulmonary infection scores (CPIS).

Methods: A retrospective study was conducted. The clinical data of 72 cases with lower respiratory tract MDR on ventilation more than 48 hours were collected from April 2010 to December 2011. CPIS were calculated at the same time. Thirty-three patients with CPIS>6 were diagnosed as ventilation associated pneumonia (VAP), while 39 having CPIS ≤6 (non-VAP). The characteristics of MDR, the detection time and mortality of the patients were compared between the two groups.

Results: The first five MDR were Baumannii [49.5%(34/74)], Klebsiella pneumoniae [24.3%(18/74)], Escherichia coli [20.3%(15/74)], Pseudomonas aeruginosa [5.4%(4/74)] and Methicillin-resistant Staphylococcus aureus [MRSA, 4.1%(3/74)] in VAP group, while the first five were Escherichia coli [40.2%(37/92)], Pseudomonas aeruginosa [33.7%(31/92)], Klebsiella pneumoniae [13.1%(12/92)], Baumannii [8.7%(8/92)] and MRSA [4.3%(4/92)] in non-VAP group. There was no significant difference in average detection time between VAP group and non-VAP group (10.7±1.5 days vs. 9.4±1.8 days, P>0.05). The mortality rate in VAP group was significantly higher than that in non-VAP group (39.4% vs. 23.1%, P<0.05).

Conclusions: Different MDR may be detected in lower respiratory tracts no matter the ventilated patients having VAP or not, which influence the patients prognosis and should be monitored intensively. Antibiotics should be empirically prescribed and adjusted dynamically.

Objective: To detect the relationship between the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and prognosis in patients with sepsis.

Methods: A prospective controlled study was conducted. Sixty cases, including 39 sepsis and 21 severe sepsis, were enrolled from May 2010 to October 2011 in intensive care unit (ICU) of Second Hospital of Tianjin Medical University. The serum level of NT-proBNP was determined and acute physiology and chronic health evaluation II (APACHEII) score was calculated on the 1st and 3rd day. The receiver operator characteristic curve (ROC curve) was draw. According to the 28-day prognosis, all patients were divided into the survival group (n=42) or the death group (n=18). At the same time 30 healthy people were enrolled as control group.

Results: The level of NT-proBNP in the sepsis patients on the 1st and 3rd day were significantly higher than those of healthy controls (65.77±34.78 ng/L, 74.23±42.12 ng/L vs. 48.36±35.53 ng/L, P<0.05 and P<0.01). The level on 1st day of the severe sepsis group was higher than sepsis group (71.69±32.86 ng/L vs. 50.11±36. 98 ng/L, P<0.05), but there was no statistically significance on the 3rd day. The level of NT-proBNP in death group was increased gradually and significantly higher than that of survival group on the 3rd days (99.20±44.34 ng/L vs. 66.79±39.28 ng/L, P<0.05), but no difference was found on the 1st day. The APACHEII score of severe sepsis group were much higher than those of sepsis group on the 1st and 3rd day (1st day:23.92±7.57 vs. 14.87±6.50, 3rd day:19.28±8.80 vs. 10.43±7.27, both P<0.01). The APACHEII score of death group were also much higher than those of survival group on the 1st and 3rd day (1st day:26.71±6.72 vs. 18.83±7.84, 3rd day:31.11±5.06 vs. 13.80±7.27, both P<0.01). The cut point for the evaluation of sepsis prognosis were NT-proBNP≥63.5 ng/L and APACHEII score≥20, which sensitivity were 65.4% and 88.5%, and specificity were 62.5% and 69.4% respectively.

Conclusion: Serum NT-proBNP levels elevation imply the poor prognosis in patients with sepsis.