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

Objective: To explore the mechanism that continuous blood purification (CBP) improve the lung mechanical ventilation parameters, cytokine levels and blood gas analysis results in severe asthma patients, and compare the differences in those parameters between bicarbonate and lactate displacement liquid.

Methods: According to the random number table, 26 severe asthma patients were allocated into control group (n=10), bicarbonate group (n=8) and lactate group (n=8). Twenty-four hours treatment with mechanical ventilation (control group), mechanical ventilation + CBP (bicarbonate group) or mechanical ventilation + CBP (lactate group) were conducted respectively. Lung mechanical ventilation parameters, serum cytokine level and blood gas analysis results, arterial blood lactate, and electrolytes level were compared among groups.

Results: After 24-hour CBP, the lung mechanical ventilation parameters were improved, cytokine levels were decreased, and pH value and partial pressure of oxygen were improved in bicarbonate group and lactate group. The two kinds of displacement liquid had no influence in arterial partial pressure of oxygen (PaO(2)), arterial blood lactate, and serum electrolytes level. The pH value in lactate group was higher than that in bicarbonate group (7.39±0.05 vs. 7.30±0.01, P<0.01). The arterial partial pressure of carbon dioxide (PaCO(2)) was lower in lactate group than that in bicarbonate group (57.14±5.04 mm Hg vs. 89.00±3.66 mm Hg, P<0.01).

Conclusions: Combine CBP might improve the lung mechanical ventilation parameter, cytokine level and blood gas analysis more quickly in severe asthma treatment. The lactate displacement liquid improves the retention of carbon dioxide more.

Objective: To investigate the characteristics of the confined space accident and its medical rescue strategy.

Methods: Thirty-six patients with emergency rescue in the five confined space accident during June 2009 to July 2012 were retrospectively analyzed.

Results: Twenty-nine people were caught in four confined space accidents caused by building collapse and 7 people were caught in one confined space accident caused by a tower of babel blast furnace damage which caused severe gas and hydrogen sulfide poisoning. For the 36 wounded, the shortest rescue time was 1.5 hours and the longest was 10.5 hours. Fourteen people were killed (mortality rate 38.89%). Characteristics of the confined space accident: the wounded activity environment was very harsh, the wounded were restricted particularly, the wounded injuries were diverse, the psychological depression was very common. The confined space environment and the complexity of wounded disease determined its medical rescue specificity and were very different from the usual trauma emergency.

Conclusions: Confined space accident caused very painful casualties. The key reason is that the relevant personnel failed to clearly recognize the potential risks in the confined space or nearby, making the confined space into another "quiet killer". This problem needs to be paid highly attention.

Objective: To study the role of plasma D-dimer in human severe acute pancreatitis (SAP) and its relationship with disease severity.

Methods: A prospective study was performed. From February 2010 to June 2011, plasma concentration of D-dimer and the results of other routine laboratory tests were measured in 32 SAP inpatients at admission immediately and 24, 48, 72 hours after admission. Ranson scores were also recorded. The relationship between plasma concentration of D-dimer and the results of other routine laboratory tests, Ranson scores were analyzed, and so did the relationship between plasma concentration of D-dimer and severity of patient's condition.

Results: (1) There were no obvious changes for plasma concentration of D-dimer and the results of other routine laboratory index in 32 SAP inpatients at each time points after admission. (2) Plasma concentration of D-dimer of SAP was positively related to white blood count (WBC), creatinine (Cr), prothrombin time (PT) and activated partial thromboplastin time (APTT) and negatively related to hematocrit (Hct), albumin and calcium (P<0.05 or P<0.01). Plasma concentration of D-dimer of SAP at 48 hours after admission had positive relationship with Ranson scores (r=0.729, P=0.001). (3) Plasma concentration of D-dimer of SAP inpatients in CT grade D, E stage were significantly higher than that in CT grade B, C stage (1.18±0.02 mg/L, 1.23±0.01 mg/L vs. 0.90±0.02 mg/L, 0.93±0.01 mg/L, all P<0.05). (4) Plasma concentration of D-dimer of SAP in inpatients with multiple organ failure (MOF) at 24 hours and 48 hours were significantly higher than that in inpatients without MOF (24 hours: 1.26±0.02 mg/L vs. 0.93±0.02 mg/L, 48 hours:1.25±0.02 mg/L vs. 0.93±0.02 mg/L, both P<0.05).

Conclusion: Plasma concentration of the D-dimer is significantly increased in SAP patients, and is related to the severity. The first plasma concentration of D-dimer of SAP after admission can well reflect severity of patient's condition.

Objective: To investigate the effect of ulinastatin (UTI) in traumatic brain injury (TBI) with multiple injuries.

Methods: A prospective analysis of TBI patients with multiple injuries was performed. Sixty cases of cranial trauma with multiple injuries patients were randomly divided into two groups. There were 28 cases in control group while 32 cases in treatment group. Control group underwent conventional treatment while intravenous infusion of UTI was performed in treatment group. The dose of UTI was 200 kU every 8 hours. Patients' intracranial cerebral pressure (ICP) were monitored at admission and 10 days after treatment. At the same time levels of white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT), alanine aminotransferase (ALT), aspartate amino transfer enzymes (AST), creatinine (Cr), blood urea nitrogen (BUN), tumor necrosis factor-α (TNF-α), interleukin (IL-2, IL-6) were detected.

Results: ICP was down trend after treatment in UTI group, but there was no statistical difference compared with the control group. Hepatic and renal function and inflammation factor levels were significantly decreased in both groups. WBC, CRP, PCT, ALT, AST, Cr, BUN, TNF-α, IL-2, IL-6 were significantly lower in UTI group than those in control group (WBC:12.3±4.5×10(9)/L vs. 15.9±6.3×10(9)/L, CRP:46.12±11.47 mg/L vs. 64.24±18.31 mg/L, PCT:4.51±1.27 μg/L vs. 10.51±4.27 μg/L, ALT:47.26±8.23 U/L vs. 60.94±8.39 U/L, AST:42.67±7.63 U/L vs. 68.51±10.17 U/L, Cr:79.62±15.36 μmol/L vs. 102.36±16.82 μmol/L, BUN:6.35±2.36 mmol/L vs. 8.39±1.67 mmol/L, TNF-α:93.6±31.5 μg/L vs. 195.8±23.9 μg/L, IL-2:12.3±4.5 μg/L vs. 15.9±6.3 μg/L, IL-6:52.36±12.46 μg/L vs. 69.34±26.13 μg/L, all P<0.05). The incidence of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) in UTI group were significantly lower than those in control group (21.88% vs. 46.43%, 9.38% vs. 28.57%, both P<0.05).

Conclusion: Application of UTI treatment in TBI with multiple trauma patients can potentially protect the brain, liver and other organ function, thus significantly reduce incidence rate of SIRS and MODS by reducing the release of inflammatory mediators and systemic reaction to the trauma invasion.