Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue最新文献_第8页

[Respiratory tract hypohydration in mechanical ventilation patients: a clinical observation study in 67 patients]. 机械通气患者呼吸道水合不足67例临床观察研究

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

Pub Date : 2012-10-01

Chang-xin Hu, Xiao-bo Hu, Zhi-yong Shao, Li Zheng, Ya-ping Li

引用次数: 0

[Effects of glutathione ethyl ester on smoke inhalation lung injury]. [谷胱甘肽乙酯对烟雾吸入性肺损伤的影响]。

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

Pub Date : 2012-10-01 DOI: 10.3760/CMA.J.ISSN.1003-0603.2012.10.015

Shu Zhang, F. Qi, Zhen-hua Zuo, Wei Liu, Jian-xin Wang

OBJECTIVETo investigate the effects of glutathione (GSH) precursor glutathione ethyl ester (GSEt) on smoke inhalation induced lung injury rats.METHODSSixty healthy male Sprague-Dawley (SD) rats were divided into groups by random digits table method, which included normal group, model group, GSEt high dose group and GSEt low dose group. Smoke inhalation induced lung injury rats model was established. GSEt treatments were given through intraperitoneal injection for 50 mg/kg or 150 mg/kg 5 minutes after the injury. Arterial blood gas analysis was monitored at 2, 12 and 24 hours after injury in each group. Rats were sacrificed for lungs, and bronchoalveolar lavage fluid (BALF) was collected for analysis of GSH activity; and the activity of GSH, catalase (CAT) and glutathione reductase (GR) were detected in pulmonary tissue homogenate.The changes of pulmonary tissue pathology was observed through light microscope.RESULTSCompared to normal group, arterial partial pressure of oxygen (PaO(2)) in model group were decreased significantly in each time; the activity of GSH in BALF, and the activity of GSH, CAT, GR in lung tissue were also observed decreased significantly. Compared with model group, GSEt treatment (150 mg/kg) with the PaO(2) advanced at 12 hours (82.9±7.0 mm Hg vs. 63.9±6.5 mm Hg, P<0.05), the activity of GSH was increased at the 12 hours and 24 hours (12 hours: 2.19±0.41 mg/g vs. 0.79±0.21 mg/g, 24 hours: 1.75±0.47 mg/g vs. 0.67±0.10 mg/g, both P<0.05); the activity of CAT in GSEt low dose group (50 mg/kg) was increased at the 24 hours and the same increase was also observed in GSEt high dose group (150 mg/kg) at 12 hours and 24 hours (low dose group 24 hours: 70.1±5.5 U/g vs. 56.3±5.0 U/g; high dose group 12 hours: 90.9±8.1 U/g vs. 67.9±6.1 U/g, 24 hours: 94.7±7.7 U/g vs. 56.3±5.0 U/g, all P<0.05); the activity of GR in GSEt high dose group was increased at 24 hours (5.25±0.77 mmol/g vs. 4.37±0.64 mmol/g, P<0.05). The histological abnormality of lung tissue was alleviated after application of GSEt (150 mg/kg) 12 hours later, less inflammatory cells infiltration and no punctate hemorrhage in lung tissues.CONCLUSIONGSEt can enhance antioxidant capacity in lung tissues, it have a good protection for pulmonary injury.

目的探讨谷胱甘肽(GSH)前体谷胱甘肽乙酯(GSEt)对烟雾吸入性肺损伤大鼠的保护作用。方法采用随机数字表法将60只健康雄性SD大鼠分为正常组、模型组、GSEt高剂量组和GSEt低剂量组。建立烟雾吸入致大鼠肺损伤模型。伤后5分钟腹腔注射GSEt 50 mg/kg或150 mg/kg。分别于伤后2、12、24 h监测各组动脉血气分析。取大鼠肺，取支气管肺泡灌洗液(BALF)分析GSH活性;检测肺组织匀浆中谷胱甘肽、过氧化氢酶(CAT)和谷胱甘肽还原酶(GR)活性。光镜下观察肺组织病理变化。结果与正常组比较，模型组各时间点动脉氧分压(PaO(2))均显著降低;BALF中GSH活性及肺组织中GSH、CAT、GR活性均显著降低。与模型组比较，GSEt治疗(150 mg/kg)使PaO(2)提前12 h(82.9±7.0 mm Hg vs. 63.9±6.5 mm Hg, P<0.05)， GSH活性在12 h和24 h均升高(12 h: 2.19±0.41 mg/g vs. 0.79±0.21 mg/g, 24 h: 1.75±0.47 mg/g vs. 0.67±0.10 mg/g, P<0.05);GSEt低剂量组(50 mg/kg)在24 h时CAT活性升高，GSEt高剂量组(150 mg/kg)在12 h和24 h时CAT活性升高(低剂量组24 h: 70.1±5.5 U/g vs. 56.3±5.0 U/g);高剂量组12 h: 90.9±8.1 U/g vs. 67.9±6.1 U/g, 24 h: 94.7±7.7 U/g vs. 56.3±5.0 U/g, P均<0.05);GSEt高剂量组小鼠GR活性在24 h升高(5.25±0.77 mmol/g vs. 4.37±0.64 mmol/g, P<0.05)。GSEt (150 mg/kg)给药12 h后肺组织组织学异常减轻，炎症细胞浸润减少，肺组织无点状出血。结论人参皂苷能增强肺组织抗氧化能力，对肺损伤有较好的保护作用。

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引用次数: 0

[Effect of 45 degree angle semirecumbent position on ventilator-associated pneumonia in mechanical ventilated patients: a meta-analysis]. [45度角半卧位对机械通气患者呼吸机相关性肺炎的影响:meta分析]。

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

Pub Date : 2012-10-01 DOI: 10.3760/CMA.J.ISSN.1003-0603.2012.10.004

Yu-xin Leng, Ya-han Song, Z. Yao, Xi Zhu

OBJECTIVETo systemically analyze the effect of 45 degree angle semirecumbent position on the incidence of ventilator-associated pneumonia (VAP) and other outcomes in mechanical ventilated patients, and to evaluate whether 45 degree angle semirecumbent position is superior to 25 degree angle-30 degree angle head of bed (HOB).METHODSThe randomized controlled trials (RCTs) comparing the effect of different HOB on the outcomes of mechanical ventilated patients were searched (from 1st January 1990 to 20th July 2012) from five databases including the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, China Knowledge Resource Integrated Database (CNKI), and Wanfang Database. Meta analysis was conducted using RevMan 5.0 software.RESULTSData extracted from five RCTs with a total of 427 patients were analyzed. The risks of developing clinically diagnosed VAP were significantly lower among the patients in semirecumbent 45 degree angle position compared to the patients in lower position [15.96% (34/213) vs. 26.64% (57/214), relative risk (RR)=0.57, 95% confidence interval (95%CI) 0.39 to 0.83, P=0.003], while no significant differences were detected between the two groups regarding the mortality rate [27.04% (53/196) vs. 28.22% (57/202), RR=0.93, 95%CI 0.68 to 1.27, P=0.66], the length of intensive care unit (ICU) stay [weighted mean difference (WMD)=-0.45, 95%CI -1.08 to 0.18, P=0.16] and the percentage of antibiotics treatment [71.11% (32/45) vs. 60.87% (28/46), RR=1.14, 95%CI 0.85 to 1.53, P=0.37]. Two of the five trials (91 patients) were included in the sub-analysis between 45 degree angle group (45 patients) and 25 degree angle-30 degree angle group (46 patients). The results showed that comparing with 25 degree angle-30 degree angle, 45 degree angle semirecumbent position had no significance in improving patients' clinical outcomes.CONCLUSIONThis study proved that the clinically preferred semirecumbent 45 degree angle position did have effect in reducing the incidence of VAP, nevertheless, whether it's superior to 25 degree angle-30 degree angle needs to be confirmed by larger-scale, higher-quality RCTs.

目的系统分析45度角半卧位对机械通气患者呼吸机相关性肺炎(VAP)发生率及其他结局的影响，并评价45度角半卧位是否优于25度角-30度角床头位(HOB)。方法从Cochrane中央对照试验注册库、MEDLINE、Embase、中国知识资源综合数据库(CNKI)和万方数据库(Wanfang Database) 5个数据库中检索1990年1月1日至2012年7月20日期间比较不同HOB对机械通气患者预后影响的随机对照试验(RCTs)。采用RevMan 5.0软件进行Meta分析。结果从5个随机对照试验中提取数据，共427例患者进行分析。半卧45度角位患者发生临床诊断为VAP的风险明显低于低卧位患者[15.96% (34/213)vs. 26.64%(57/214)，相对危险度(RR)=0.57, 95%可信区间(95% ci) 0.39 ~ 0.83, P=0.003]，两组患者的死亡率差异无统计学意义[27.04% (53/196)vs. 28.22% (57/202)， RR=0.93, 95% ci 0.68 ~ 1.27, P=0.66]。重症监护病房(ICU)住院时间[加权平均差(WMD)=-0.45, 95%CI = -1.08 ~ 0.18, P=0.16]和抗生素治疗百分比[71.11%(32/45)比60.87% (28/46)，RR=1.14, 95%CI 0.85 ~ 1.53, P=0.37]。5个试验中的2个(91例)被纳入45度角组(45例)和25度角-30度角组(46例)的亚分析。结果显示，与25度角-30度角相比，45度角半卧位对改善患者临床疗效无显著意义。结论本研究证实临床首选的半卧45度角体位确实有降低VAP发生率的作用，但是否优于25度角-30度角体位，还需通过更大规模、更高质量的随机对照试验来证实。

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引用次数: 5

[Effects of simvastatin on lipopolysaccharide induced α-subunit epithelial sodium channel mRNA in rat lung alveolar type II epithelial cells]. 辛伐他汀对脂多糖诱导的大鼠肺泡II型上皮细胞α-亚基上皮钠通道mRNA的影响。

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

Pub Date : 2012-10-01 DOI: 10.3760/CMA.J.ISSN.1003-0603.2012.10.009

Pei Liu, Dao-miao Xu

OBJECTIVETo study the impact of simvastatin on α-subunit epithelial sodium channel (α-ENaC) mRNA expression in primary culture alveolar typeII (ATII) epithelial cell of rats induced by lipopolysaccharide (LPS) in vitro.METHODSATII of primary generation were isolated from adult Sprague-Dawley (SD) rats. The cells were randomly divided into five groups: blank control group, LPS injured group (final concentration of LPS 1 mg/L), simvastatin low and high concentration groups (final concentration of simvastatin 20 μmol/L, 30 μmol/L, respectively), solution control group. Then, after being intervened for 1, 12 and 24 hours, the level of human tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were monitored by enzyme-linked immunosorbent assay (ELISA), and α-ENaC mRNA expression was tested by reverse transcription-polymerase chain reaction (RT-PCR).RESULTSAfter being intervened for 1, 12 and 24 hours, expressions of TNF-α and IL-1β in LPS injured group were obviously higher than those in blank control group. Expressions of TNF-α and IL-1β at 1, 12 and 24 hours in simvastatin low concentration group were significantly decreased compared with those in LPS injured group (TNF-α 1 hour: 1178.80±127.43 ng/L vs. 2336.00±170.04 ng/L, 12 hours: 1003.60±59.61 ng/L vs. 2479.80±210.41 ng/L, 24 hours: 695.80±25.24 ng/L vs. 1167.60±132.72 ng/L; IL-β 1 hour: 285.00±42.60 ng/L vs. 429.60±27.39 ng/L, 12 hours: 238.60±24.12 ng/L vs. 822.20±12.74 ng/L, 24 hours: 213.40±17.87 ng/L vs. 637.60±22.96 ng/L, all P<0.05). Expressions of TNF-α and IL-1β in high concentration group were decreased more obviously than those in low concentration group (TNF-α 1 hour: 965.60±24.45 ng/L vs. 1178.80±127.43 ng/L, 12 hours: 522.80±16.89 ng/L vs. 1003.60±59.61 ng/L, 24 hours: 252.40±17.64 ng/L vs. 695.80±25.24 ng/L; IL-1β 1 hour: 225.60±34.44 ng/L vs. 285.00±42.60 ng/L, 12 hours: 190.60±17.64 ng/L vs. 238.60±24.12 ng/L, 24 hours: 152.80±14.70 ng/L vs. 213.40±17.87 ng/L, all P<0.05), but increased compared with those in blank control group. After being intervened for 1 hour, no evident changes were observed in expression of α-ENaC mRNA in all groups. After being intervened for 12 hours and 24 hours, evident decrease in expression of α-ENaC mRNA (A value) was observed in LPS injured group compared with blank control group (12 hours: 0.211±0.021 vs. 0.496±0.027, 24 hours: 0.253±0.030 vs. 0.482±0.030, both P<0.05). Expressions of α-ENaC mRNA in simvastatin low concentration group evidently increased compared with those in LPS injured group (12 hours: 0.363±0.030 vs. 0.211±0.021, 24 hours: 0.309±0.024 vs. 0.253±0.030, both P<0.05). Expressions of α-ENaC mRNA in simvastatin high concentration group increased more obviously compared with those in low concentration group (12 hours: 0.413±0.034 vs. 0.363±0.030, 24 hours: 0.346±0.024 vs. 0.309±0.024, both P<0.05), but decreased compared with blank control group. No evident difference in expressions of all indexes in solution control

目的研究辛伐他汀对脂多糖(LPS)诱导的大鼠肺泡ii型(ATII)上皮细胞α-亚单位上皮钠通道(α-ENaC) mRNA表达的影响。方法从成年Sprague-Dawley (SD)大鼠中分离第一代satii。将细胞随机分为5组:空白对照组、LPS损伤组(LPS终浓度为1 mg/L)、辛伐他汀低、高浓度组(辛伐他汀终浓度分别为20、30 μmol/L)、溶液对照组。干预1、12、24 h后，采用酶联免疫吸附法(ELISA)检测人肿瘤坏死因子-α (TNF-α)、白细胞介素-1β (IL-1β)水平，采用逆转录聚合酶链反应(RT-PCR)检测α-ENaC mRNA表达。结果干预1、12、24 h后，LPS损伤组TNF-α、IL-1β表达明显高于空白对照组。辛伐他汀低浓度组1、12、24小时TNF-α、IL-1β的表达均较LPS损伤组显著降低(TNF-α 1小时:1178.80±127.43 ng/L比2336.00±170.04 ng/L, 12小时:1003.60±59.61 ng/L比2479.80±210.41 ng/L, 24小时:695.80±25.24 ng/L比1167.60±132.72 ng/L;IL-β 1小时:285.00±42.60 ng/L vs. 429.60±27.39 ng/L, 12小时:238.60±24.12 ng/L vs. 822.20±12.74 ng/L, 24小时:213.40±17.87 ng/L vs. 637.60±22.96 ng/L，均P<0.05)。高浓度组TNF-α、IL-1β的表达较低浓度组下降更明显(TNF-α 1 h: 965.60±24.45 ng/L vs. 1178.80±127.43 ng/L, 12 h: 522.80±16.89 ng/L vs. 1003.60±59.61 ng/L, 24 h: 252.40±17.64 ng/L vs. 695.80±25.24 ng/L;IL-1β 1小时:225.60±34.44 ng/L vs. 285.00±42.60 ng/L, 12小时:190.60±17.64 ng/L vs. 238.60±24.12 ng/L, 24小时:152.80±14.70 ng/L vs. 213.40±17.87 ng/L，均P<0.05)，但与空白对照组比较均升高。干预1h后，各组α-ENaC mRNA表达均无明显变化。干预12 h和24 h后，LPS损伤组α-ENaC mRNA (A值)表达明显低于空白对照组(12 h: 0.211±0.021比0.496±0.027,24 h: 0.253±0.030比0.482±0.030,P均<0.05)。辛伐他汀低浓度组α-ENaC mRNA表达量明显高于LPS损伤组(12 h: 0.363±0.030比0.211±0.021,24 h: 0.309±0.024比0.253±0.030,P均<0.05)。辛伐他汀高浓度组α-ENaC mRNA表达量较低浓度组明显升高(12 h: 0.413±0.034比0.363±0.030,24 h: 0.346±0.024比0.309±0.024,P均<0.05)，但较空白对照组降低。与空白对照组相比，溶液对照组各指标的表达均无明显差异。结论大剂量辛伐他汀可提高大鼠原代培养ATII上皮细胞α-ENaC mRNA的表达。这可能通过调节TNF-α和IL-1β的水平起作用。

{"title":"[Effects of simvastatin on lipopolysaccharide induced α-subunit epithelial sodium channel mRNA in rat lung alveolar type II epithelial cells].","authors":"Pei Liu, Dao-miao Xu","doi":"10.3760/CMA.J.ISSN.1003-0603.2012.10.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1003-0603.2012.10.009","url":null,"abstract":"OBJECTIVE\u0000To study the impact of simvastatin on α-subunit epithelial sodium channel (α-ENaC) mRNA expression in primary culture alveolar typeII (ATII) epithelial cell of rats induced by lipopolysaccharide (LPS) in vitro.\u0000\u0000\u0000METHODS\u0000ATII of primary generation were isolated from adult Sprague-Dawley (SD) rats. The cells were randomly divided into five groups: blank control group, LPS injured group (final concentration of LPS 1 mg/L), simvastatin low and high concentration groups (final concentration of simvastatin 20 μmol/L, 30 μmol/L, respectively), solution control group. Then, after being intervened for 1, 12 and 24 hours, the level of human tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were monitored by enzyme-linked immunosorbent assay (ELISA), and α-ENaC mRNA expression was tested by reverse transcription-polymerase chain reaction (RT-PCR).\u0000\u0000\u0000RESULTS\u0000After being intervened for 1, 12 and 24 hours, expressions of TNF-α and IL-1β in LPS injured group were obviously higher than those in blank control group. Expressions of TNF-α and IL-1β at 1, 12 and 24 hours in simvastatin low concentration group were significantly decreased compared with those in LPS injured group (TNF-α 1 hour: 1178.80±127.43 ng/L vs. 2336.00±170.04 ng/L, 12 hours: 1003.60±59.61 ng/L vs. 2479.80±210.41 ng/L, 24 hours: 695.80±25.24 ng/L vs. 1167.60±132.72 ng/L; IL-β 1 hour: 285.00±42.60 ng/L vs. 429.60±27.39 ng/L, 12 hours: 238.60±24.12 ng/L vs. 822.20±12.74 ng/L, 24 hours: 213.40±17.87 ng/L vs. 637.60±22.96 ng/L, all P<0.05). Expressions of TNF-α and IL-1β in high concentration group were decreased more obviously than those in low concentration group (TNF-α 1 hour: 965.60±24.45 ng/L vs. 1178.80±127.43 ng/L, 12 hours: 522.80±16.89 ng/L vs. 1003.60±59.61 ng/L, 24 hours: 252.40±17.64 ng/L vs. 695.80±25.24 ng/L; IL-1β 1 hour: 225.60±34.44 ng/L vs. 285.00±42.60 ng/L, 12 hours: 190.60±17.64 ng/L vs. 238.60±24.12 ng/L, 24 hours: 152.80±14.70 ng/L vs. 213.40±17.87 ng/L, all P<0.05), but increased compared with those in blank control group. After being intervened for 1 hour, no evident changes were observed in expression of α-ENaC mRNA in all groups. After being intervened for 12 hours and 24 hours, evident decrease in expression of α-ENaC mRNA (A value) was observed in LPS injured group compared with blank control group (12 hours: 0.211±0.021 vs. 0.496±0.027, 24 hours: 0.253±0.030 vs. 0.482±0.030, both P<0.05). Expressions of α-ENaC mRNA in simvastatin low concentration group evidently increased compared with those in LPS injured group (12 hours: 0.363±0.030 vs. 0.211±0.021, 24 hours: 0.309±0.024 vs. 0.253±0.030, both P<0.05). Expressions of α-ENaC mRNA in simvastatin high concentration group increased more obviously compared with those in low concentration group (12 hours: 0.413±0.034 vs. 0.363±0.030, 24 hours: 0.346±0.024 vs. 0.309±0.024, both P<0.05), but decreased compared with blank control group. No evident difference in expressions of all indexes in solution control","PeriodicalId":23992,"journal":{"name":"Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue","volume":"26 1","pages":"604-7"},"PeriodicalIF":0.0,"publicationDate":"2012-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82035942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[The effects of three dosages of nebulized unfractionated heparin on alveolar coagulation and tissue inflammation injury in endotoxin-induced acute lung injury rat model]. [三种剂量未分离肝素雾化对内毒素致急性肺损伤模型大鼠肺泡凝固及组织炎症损伤的影响]。

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

Pub Date : 2012-10-01 DOI: 10.3760/CMA.J.ISSN.1003-0603.2012.10.011

Zongyu Wang, Sheng-nan Wu, Xi Zhu

OBJECTIVETo observe the effects of three dosages of nebulized unfractionated heparin (UFH) on alveolar coagulation, inflammation and lung histology in endotoxin-induced acute lung injury rat model, and investigate the appropriated dose of local UFH in managing intrapulmonary coagulopathy.METHODSTwenty-nine male Wistar rats were divided into control (n=5) and UFH group (n=24) in table of random number, which were duplicated to be endotoxin-induced ALI rat model with lipopolysaccharide (LPS) injecting by intravenous route. The UFH group was divided into three subgroups, which were administered once with 6, 12 and 18 U/g aerosolized UFH in 10 ml at 2 hours after challenge, respectively, while the control group was simply nebulized with normal saline. All rats were sacrificed at 6 hours after intravenous administration of LPS, bronchoalveolar lavage was performed, and the fluid was collected. Enzyme-linked immune sorbent assay (ELISA) was used to measure the level of thrombin-antithrombin complex (TATc), tumor necrosis factor-α (TNF-α) in bronchoalveolar lavage fluid (BALF), and lung wet/dry (W/D) weight ratio, histology score were recorded.RESULTSAt 6 hours after LPS-induced lung injury, the levels of TATc and TNF-α, lung W/D weight ratio and histology score in 6 U/g and 12 U/g group were all lower than those of control group significantly (TATc: 0.959±0.681 μg/L, 1.165±0.854 μg/L vs. 2.141±0.791 μg/L, TNF-α: 4.449±5.054 ng/L, 9.096±4.099 ng/L vs. 18.184±3.869 ng/L, W/D weight ratio: 7.018±1.137, 7.367±0.349 vs. 8.472±0.614, histology score: 16.0±1.0, 16.5±1.5 vs. 19.6±0.4, P<0.05 or P<0.01). There was no significant difference in the comparisons between the subgroups of UFH in TATc level in BALF and lung histology score. For the TNF-αlevel in BALF, 18 U/g group evidently exceeded that of 6 U/g group (15.503±8.753 ng/L vs. 4.449±5.054 ng/L, P<0.01), and lung W/D weight ratio in 18 U/g group was also significantly higher comparing to 6 U/g (8.850±1.157 vs. 7.018±1.137, P<0.05) and 12 U/g group (8.850±1.157 vs. 7.367±0.349, P<0.05).CONCLUSIONIt was appropriate for the dose of nebulized UFH to be administered no more than 12 U/g in ALI treatment, which was enough to inhibit alveolar coagulant cascade, decrease early inflammatory response and alleviate lung tissue injury.

目的观察三种剂量未分离肝素雾化对内毒素致急性肺损伤大鼠肺泡凝血、炎症及肺组织学的影响，探讨局部未分离肝素治疗肺内凝血病的适宜剂量。方法29只雄性Wistar大鼠随机分为对照组(n=5)和UFH组(n=24)，经静脉注射脂多糖(LPS)复制内毒素诱导的ALI大鼠模型。将UFH组分为3个亚组，攻毒后2小时，分别以6、12、18 U/g的UFH雾化10 ml给药一次，对照组简单用生理盐水雾化。所有大鼠于静脉注射LPS后6小时处死，行支气管肺泡灌洗，收集积液。采用酶联免疫吸附试验(ELISA)测定大鼠支气管肺泡灌洗液(BALF)中凝血酶-抗凝血酶复合物(TATc)、肿瘤坏死因子-α (TNF-α)水平，肺湿/干(W/D)重量比，记录组织学评分。结果lps诱导肺损伤后6 h, 6 U/g组和12 U/g组大鼠TATc、TNF-α水平、肺W/D重量比和组织学评分均显著低于对照组(TATc: 0.959±0.681 μg/L、1.165±0.854 μg/L vs. 2.141±0.791 μg/L, TNF-α: 4.449±5.054 ng/L、9.096±4.099 ng/L vs. 18.184±3.869 ng/L, W/D重量比:7.018±1.137、7.367±0.349 vs. 8.472±0.614，组织学评分:16.0±1.0、16.5±1.5 vs. 19.6±0.4,P<0.05或P<0.01)。UFH各亚组间BALF中TATc水平及肺组织学评分比较差异无统计学意义。BALF中TNF-α水平，18 U/g组明显高于6 U/g组(15.503±8.753 ng/L vs. 4.449±5.054 ng/L, P<0.01)，肺W/D重量比也显著高于6 U/g组(8.850±1.157 vs. 7.018±1.137,P<0.05)和12 U/g组(8.850±1.157 vs. 7.367±0.349,P<0.05)。结论雾化UFH治疗ALI的剂量以不超过12 U/g为宜，足以抑制肺泡凝血级联反应，降低早期炎症反应，减轻肺组织损伤。

{"title":"[The effects of three dosages of nebulized unfractionated heparin on alveolar coagulation and tissue inflammation injury in endotoxin-induced acute lung injury rat model].","authors":"Zongyu Wang, Sheng-nan Wu, Xi Zhu","doi":"10.3760/CMA.J.ISSN.1003-0603.2012.10.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1003-0603.2012.10.011","url":null,"abstract":"OBJECTIVE\u0000To observe the effects of three dosages of nebulized unfractionated heparin (UFH) on alveolar coagulation, inflammation and lung histology in endotoxin-induced acute lung injury rat model, and investigate the appropriated dose of local UFH in managing intrapulmonary coagulopathy.\u0000\u0000\u0000METHODS\u0000Twenty-nine male Wistar rats were divided into control (n=5) and UFH group (n=24) in table of random number, which were duplicated to be endotoxin-induced ALI rat model with lipopolysaccharide (LPS) injecting by intravenous route. The UFH group was divided into three subgroups, which were administered once with 6, 12 and 18 U/g aerosolized UFH in 10 ml at 2 hours after challenge, respectively, while the control group was simply nebulized with normal saline. All rats were sacrificed at 6 hours after intravenous administration of LPS, bronchoalveolar lavage was performed, and the fluid was collected. Enzyme-linked immune sorbent assay (ELISA) was used to measure the level of thrombin-antithrombin complex (TATc), tumor necrosis factor-α (TNF-α) in bronchoalveolar lavage fluid (BALF), and lung wet/dry (W/D) weight ratio, histology score were recorded.\u0000\u0000\u0000RESULTS\u0000At 6 hours after LPS-induced lung injury, the levels of TATc and TNF-α, lung W/D weight ratio and histology score in 6 U/g and 12 U/g group were all lower than those of control group significantly (TATc: 0.959±0.681 μg/L, 1.165±0.854 μg/L vs. 2.141±0.791 μg/L, TNF-α: 4.449±5.054 ng/L, 9.096±4.099 ng/L vs. 18.184±3.869 ng/L, W/D weight ratio: 7.018±1.137, 7.367±0.349 vs. 8.472±0.614, histology score: 16.0±1.0, 16.5±1.5 vs. 19.6±0.4, P<0.05 or P<0.01). There was no significant difference in the comparisons between the subgroups of UFH in TATc level in BALF and lung histology score. For the TNF-αlevel in BALF, 18 U/g group evidently exceeded that of 6 U/g group (15.503±8.753 ng/L vs. 4.449±5.054 ng/L, P<0.01), and lung W/D weight ratio in 18 U/g group was also significantly higher comparing to 6 U/g (8.850±1.157 vs. 7.018±1.137, P<0.05) and 12 U/g group (8.850±1.157 vs. 7.367±0.349, P<0.05).\u0000\u0000\u0000CONCLUSION\u0000It was appropriate for the dose of nebulized UFH to be administered no more than 12 U/g in ALI treatment, which was enough to inhibit alveolar coagulant cascade, decrease early inflammatory response and alleviate lung tissue injury.","PeriodicalId":23992,"journal":{"name":"Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue","volume":"12 1","pages":"612-5"},"PeriodicalIF":0.0,"publicationDate":"2012-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87185255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

[Effects of simvastatin on lipopolysaccharide induced α-subunit epithelial sodium channel mRNA in rat lung alveolar type II epithelial cells]. 辛伐他汀对脂多糖诱导的大鼠肺泡II型上皮细胞α-亚基上皮钠通道mRNA的影响。

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

Pub Date : 2012-10-01

Pei-ying Liu, Dao-miao Xu

Objective: To study the impact of simvastatin on α-subunit epithelial sodium channel (α-ENaC) mRNA expression in primary culture alveolar typeII (ATII) epithelial cell of rats induced by lipopolysaccharide (LPS) in vitro.

Methods: ATII of primary generation were isolated from adult Sprague-Dawley (SD) rats. The cells were randomly divided into five groups: blank control group, LPS injured group (final concentration of LPS 1 mg/L), simvastatin low and high concentration groups (final concentration of simvastatin 20 μmol/L, 30 μmol/L, respectively), solution control group. Then, after being intervened for 1, 12 and 24 hours, the level of human tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were monitored by enzyme-linked immunosorbent assay (ELISA), and α-ENaC mRNA expression was tested by reverse transcription-polymerase chain reaction (RT-PCR).

Results: After being intervened for 1, 12 and 24 hours, expressions of TNF-α and IL-1β in LPS injured group were obviously higher than those in blank control group. Expressions of TNF-α and IL-1β at 1, 12 and 24 hours in simvastatin low concentration group were significantly decreased compared with those in LPS injured group (TNF-α 1 hour: 1178.80±127.43 ng/L vs. 2336.00±170.04 ng/L, 12 hours: 1003.60±59.61 ng/L vs. 2479.80±210.41 ng/L, 24 hours: 695.80±25.24 ng/L vs. 1167.60±132.72 ng/L; IL-β 1 hour: 285.00±42.60 ng/L vs. 429.60±27.39 ng/L, 12 hours: 238.60±24.12 ng/L vs. 822.20±12.74 ng/L, 24 hours: 213.40±17.87 ng/L vs. 637.60±22.96 ng/L, all P<0.05). Expressions of TNF-α and IL-1β in high concentration group were decreased more obviously than those in low concentration group (TNF-α 1 hour: 965.60±24.45 ng/L vs. 1178.80±127.43 ng/L, 12 hours: 522.80±16.89 ng/L vs. 1003.60±59.61 ng/L, 24 hours: 252.40±17.64 ng/L vs. 695.80±25.24 ng/L; IL-1β 1 hour: 225.60±34.44 ng/L vs. 285.00±42.60 ng/L, 12 hours: 190.60±17.64 ng/L vs. 238.60±24.12 ng/L, 24 hours: 152.80±14.70 ng/L vs. 213.40±17.87 ng/L, all P<0.05), but increased compared with those in blank control group. After being intervened for 1 hour, no evident changes were observed in expression of α-ENaC mRNA in all groups. After being intervened for 12 hours and 24 hours, evident decrease in expression of α-ENaC mRNA (A value) was observed in LPS injured group compared with blank control group (12 hours: 0.211±0.021 vs. 0.496±0.027, 24 hours: 0.253±0.030 vs. 0.482±0.030, both P<0.05). Expressions of α-ENaC mRNA in simvastatin low concentration group evidently increased compared with those in LPS injured group (12 hours: 0.363±0.030 vs. 0.211±0.021, 24 hours: 0.309±0.024 vs. 0.253±0.030, both P<0.05). Expressions of α-ENaC mRNA in simvastatin high concentration group increased more obviously compared with those in low concentration group (12 hours: 0.413±0.034 vs. 0.363±0.030, 24 hours: 0.346±0.024 vs. 0.309±0.024, both P<0.05), but decreased compared with blank contr

目的:研究辛伐他汀对脂多糖(LPS)诱导大鼠肺泡ii型(ATII)上皮原代培养细胞α-亚单位上皮钠通道(α-ENaC) mRNA表达的影响。方法:从成年SD大鼠中分离第一代ATII。将细胞随机分为5组:空白对照组、LPS损伤组(LPS终浓度为1 mg/L)、辛伐他汀低、高浓度组(辛伐他汀终浓度分别为20、30 μmol/L)、溶液对照组。干预1、12、24 h后，采用酶联免疫吸附法(ELISA)检测人肿瘤坏死因子-α (TNF-α)、白细胞介素-1β (IL-1β)水平，采用逆转录聚合酶链反应(RT-PCR)检测α-ENaC mRNA表达。结果:干预1、12、24小时后，LPS损伤组TNF-α、IL-1β表达明显高于空白对照组。辛伐他汀低浓度组1、12、24小时TNF-α、IL-1β的表达均较LPS损伤组显著降低(TNF-α 1小时:1178.80±127.43 ng/L比2336.00±170.04 ng/L, 12小时:1003.60±59.61 ng/L比2479.80±210.41 ng/L, 24小时:695.80±25.24 ng/L比1167.60±132.72 ng/L;IL-β 1小时:285.00±42.60 ng/L vs. 429.60±27.39 ng/L, 12小时:238.60±24.12 ng/L vs. 822.20±12.74 ng/L, 24小时:213.40±17.87 ng/L vs. 637.60±22.96 ng/L。结论:大剂量辛伐他汀可提高原代培养大鼠ATII上皮细胞α-ENaC mRNA的表达。这可能通过调节TNF-α和IL-1β的水平起作用。

{"title":"[Effects of simvastatin on lipopolysaccharide induced α-subunit epithelial sodium channel mRNA in rat lung alveolar type II epithelial cells].","authors":"Pei-ying Liu, Dao-miao Xu","doi":"","DOIUrl":"","url":null,"abstract":"Objective: To study the impact of simvastatin on α-subunit epithelial sodium channel (α-ENaC) mRNA expression in primary culture alveolar typeII (ATII) epithelial cell of rats induced by lipopolysaccharide (LPS) in vitro.Methods: ATII of primary generation were isolated from adult Sprague-Dawley (SD) rats. The cells were randomly divided into five groups: blank control group, LPS injured group (final concentration of LPS 1 mg/L), simvastatin low and high concentration groups (final concentration of simvastatin 20 μmol/L, 30 μmol/L, respectively), solution control group. Then, after being intervened for 1, 12 and 24 hours, the level of human tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were monitored by enzyme-linked immunosorbent assay (ELISA), and α-ENaC mRNA expression was tested by reverse transcription-polymerase chain reaction (RT-PCR).Results: After being intervened for 1, 12 and 24 hours, expressions of TNF-α and IL-1β in LPS injured group were obviously higher than those in blank control group. Expressions of TNF-α and IL-1β at 1, 12 and 24 hours in simvastatin low concentration group were significantly decreased compared with those in LPS injured group (TNF-α 1 hour: 1178.80±127.43 ng/L vs. 2336.00±170.04 ng/L, 12 hours: 1003.60±59.61 ng/L vs. 2479.80±210.41 ng/L, 24 hours: 695.80±25.24 ng/L vs. 1167.60±132.72 ng/L; IL-β 1 hour: 285.00±42.60 ng/L vs. 429.60±27.39 ng/L, 12 hours: 238.60±24.12 ng/L vs. 822.20±12.74 ng/L, 24 hours: 213.40±17.87 ng/L vs. 637.60±22.96 ng/L, all P<0.05). Expressions of TNF-α and IL-1β in high concentration group were decreased more obviously than those in low concentration group (TNF-α 1 hour: 965.60±24.45 ng/L vs. 1178.80±127.43 ng/L, 12 hours: 522.80±16.89 ng/L vs. 1003.60±59.61 ng/L, 24 hours: 252.40±17.64 ng/L vs. 695.80±25.24 ng/L; IL-1β 1 hour: 225.60±34.44 ng/L vs. 285.00±42.60 ng/L, 12 hours: 190.60±17.64 ng/L vs. 238.60±24.12 ng/L, 24 hours: 152.80±14.70 ng/L vs. 213.40±17.87 ng/L, all P<0.05), but increased compared with those in blank control group. After being intervened for 1 hour, no evident changes were observed in expression of α-ENaC mRNA in all groups. After being intervened for 12 hours and 24 hours, evident decrease in expression of α-ENaC mRNA (A value) was observed in LPS injured group compared with blank control group (12 hours: 0.211±0.021 vs. 0.496±0.027, 24 hours: 0.253±0.030 vs. 0.482±0.030, both P<0.05). Expressions of α-ENaC mRNA in simvastatin low concentration group evidently increased compared with those in LPS injured group (12 hours: 0.363±0.030 vs. 0.211±0.021, 24 hours: 0.309±0.024 vs. 0.253±0.030, both P<0.05). Expressions of α-ENaC mRNA in simvastatin high concentration group increased more obviously compared with those in low concentration group (12 hours: 0.413±0.034 vs. 0.363±0.030, 24 hours: 0.346±0.024 vs. 0.309±0.024, both P<0.05), but decreased compared with blank contr","PeriodicalId":23992,"journal":{"name":"Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue","volume":"24 10","pages":"604-7"},"PeriodicalIF":0.0,"publicationDate":"2012-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30957304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Domestic imipenem cilastatin sodium for the treatment of severe aspiration pneumonia, a curative effect observation]. 【国产亚胺培南西司他汀钠治疗重症吸入性肺炎1例疗效观察】。

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

Pub Date : 2012-10-01 DOI: 10.3760/CMA.J.ISSN.1003-0603.2012.10.016

Haiyan Yin, Xiaoling Ye, Rui Zhang, Youfeng Zhu

OBJECTIVETo evaluate the efficacy and safety of domestic imipenem cilastatin sodium for the treatments of severe aspiration pneumonia.METHODSA randomize, open, parallel-controlled trial was conducted. Sixty-eight patients with severe aspiration pneumonia were divided into trial group (n=36) and control group (n=32) by random distribution method. The application of trial group domestic imipenem cilastatin sodium was 1.0 g intravenous drip, every 6-8 hours for 7-14 days. The control group application with imported injection imipenem cilastatin sodium was 1.0 g intravenous drip, every 6-8 hours for 7-14 days. The highest daily temperature (T), heart rate (HR), breathing rate (RR), pulse blood oxygen saturation (SpO(2)), blood oxygen partial pressure (PaO(2)), inhaled oxygen concentration (FiO(2)), oxygenation index (PaO(2)/FiO(2)), airway peak pressure (Paw), minute ventilation (MV) and white blood count (WBC), pro calcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP) index before and 1, 3, 7 days after treatment, and liver and kidney function, chest X-rays, and sputum cultures of drug sensitive test were conducted. And the effectiveness and safety were determined according to the standards.RESULTSAfter treatment indexes of the two groups were obviously improved, i. e. T, HR, RR, Paw, MV, the WBC, PCT, CRP were gradually declined, PaO(2)/FiO(2) was gradually raised. There were statistical significance before and 3 days after treatment in the trial and the control group [T: 37.35±0.91 centigrade vs. 38.43±1.06 centigrade, 37.28±0.88 centigrade vs. 38.35±1.11 centigrade; HR: 90.25±10.60 bpm vs. 118.94±15.46 bpm, 89.31±11.17 bpm vs. 124.34±17.87 bpm; RR: 25.14±3.17 bpm vs. 32.28±4.49 bpm, 24.81±2.43 bpm vs. 33.13±4.17 bpm; Paw: 23.03±3.04 cm H(2)O vs. 33.22±4.59 cm H(2)O, 22.75±3.22 cm H(2)O vs. 33.63±4.79 cm H(2)O; MV: 8.67±1.26 L/min vs. 11.80±2.01 L/min, 8.88±1.45 L/min vs. 13.21±2.90 L/min; WBC: 11.26±1.96 ×10(9)/L vs. 14.57±3.10 ×10(9)/L, 12.28±3.38 ×10(9)/L vs. 15.25±4.93 ×10(9)/L; PCT: 6.90±5.46 μg/L vs. 16.97±7.93 μg/L, 6.17±6.13 μg/L vs. 21.26±11.54 μg/L; CRP: 85.50±37.91 mg/L vs. 120.17±45.47 mg/L, 94.31±38.51 mg/L vs. 142.34±53.57 mg/L; PaO(2)/ FiO(2): 182.06±40.88 mm Hg vs. 98.67±20.62 mm Hg, 184.09±43.78 mm Hg vs. 96.22±22.59 mm Hg, all P<0.05]. There was no significant change in SpO(2) before and after treatment in two groups. And the total clinical effective rate in trial and control group were 83.4% and 81.2%, adverse reaction rate were 13.9% and 9.4%, bacterial removal rate were 90.3% and 87.0% respectively, and there was no significant difference between the two groups (all P>0.05).CONCLUSIONDomestic imipenem cilastatin sodium can effectively control severe aspiration pneumonia, and it is safe and effective antibiotics.

目的评价国产亚胺培南西司他汀钠治疗重症吸入性肺炎的疗效和安全性。方法采用随机、开放、平行对照试验。68例重症吸入性肺炎患者采用随机分布法分为试验组(n=36)和对照组(n=32)。试验组应用国产亚胺培南西司他汀钠1.0 g静脉滴注，每6-8 h，连用7-14天。对照组患者应用进口注射剂亚胺培南西司他汀钠1.0 g静脉滴注，每6-8 h，连用7-14 d。治疗前及治疗后1、3、7 d的最高日体温(T)、心率(HR)、呼吸频率(RR)、脉搏血氧饱和度(SpO(2))、血氧分压(PaO(2))、吸入氧浓度(FiO(2))、氧合指数(PaO(2)/FiO(2))、气道峰值压(Paw)、分气量(MV)、白细胞计数(WBC)、降钙素原(PCT)、高敏c -反应蛋白(hs-CRP)指数、肝肾功能、胸部x线片、并进行痰培养药敏试验。并根据标准对其有效性和安全性进行了测定。结果治疗后两组患者T、HR、RR、Paw、MV等指标均有明显改善，WBC、PCT、CRP逐渐下降，PaO(2)/FiO(2)逐渐升高。试验组与对照组治疗前、治疗后3 d差异有统计学意义[T: 37.35±0.91℃vs 38.43±1.06℃，37.28±0.88℃vs 38.35±1.11℃;心率:90.25±10.60 bpm vs. 118.94±15.46 bpm, 89.31±11.17 bpm vs. 124.34±17.87 bpm;RR: 25.14±3.17 bpm vs. 32.28±4.49 bpm, 24.81±2.43 bpm vs. 33.13±4.17 bpm;爪:23.03±3.04 cm H(2)O vs. 33.22±4.59 cm H(2)O, 22.75±3.22 cm H(2)O vs. 33.63±4.79 cm H(2)O;MV: 8.67±1.26 L/min vs 11.80±2.01 L/min, 8.88±1.45 L/min vs 13.21±2.90 L/min;白细胞:11.26±1.96×10 (9)/ L和14.57±3.10×10 (9)/ L, 12.28±3.38×10 (9)/ L和15.25±4.93×10 (9)/ L;PCT: 6.90±5.46μg / L和16.97±7.93μg / L, 6.17±6.13μg / L和21.26±11.54μg / L;CRP: 85.50±37.91 mg/L vs. 120.17±45.47 mg/L, 94.31±38.51 mg/L vs. 142.34±53.57 mg/L;PaO(2)/ FiO(2): 182.06±40.88 mm Hg vs. 98.67±20.62 mm Hg, 184.09±43.78 mm Hg vs. 96.22±22.59 mm Hg，均p < 0.05)。结论国产亚胺培南西司他汀钠能有效控制重症吸入性肺炎，是一种安全有效的抗菌药物。

{"title":"[Domestic imipenem cilastatin sodium for the treatment of severe aspiration pneumonia, a curative effect observation].","authors":"Haiyan Yin, Xiaoling Ye, Rui Zhang, Youfeng Zhu","doi":"10.3760/CMA.J.ISSN.1003-0603.2012.10.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1003-0603.2012.10.016","url":null,"abstract":"OBJECTIVE\u0000To evaluate the efficacy and safety of domestic imipenem cilastatin sodium for the treatments of severe aspiration pneumonia.\u0000\u0000\u0000METHODS\u0000A randomize, open, parallel-controlled trial was conducted. Sixty-eight patients with severe aspiration pneumonia were divided into trial group (n=36) and control group (n=32) by random distribution method. The application of trial group domestic imipenem cilastatin sodium was 1.0 g intravenous drip, every 6-8 hours for 7-14 days. The control group application with imported injection imipenem cilastatin sodium was 1.0 g intravenous drip, every 6-8 hours for 7-14 days. The highest daily temperature (T), heart rate (HR), breathing rate (RR), pulse blood oxygen saturation (SpO(2)), blood oxygen partial pressure (PaO(2)), inhaled oxygen concentration (FiO(2)), oxygenation index (PaO(2)/FiO(2)), airway peak pressure (Paw), minute ventilation (MV) and white blood count (WBC), pro calcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP) index before and 1, 3, 7 days after treatment, and liver and kidney function, chest X-rays, and sputum cultures of drug sensitive test were conducted. And the effectiveness and safety were determined according to the standards.\u0000\u0000\u0000RESULTS\u0000After treatment indexes of the two groups were obviously improved, i. e. T, HR, RR, Paw, MV, the WBC, PCT, CRP were gradually declined, PaO(2)/FiO(2) was gradually raised. There were statistical significance before and 3 days after treatment in the trial and the control group [T: 37.35±0.91 centigrade vs. 38.43±1.06 centigrade, 37.28±0.88 centigrade vs. 38.35±1.11 centigrade; HR: 90.25±10.60 bpm vs. 118.94±15.46 bpm, 89.31±11.17 bpm vs. 124.34±17.87 bpm; RR: 25.14±3.17 bpm vs. 32.28±4.49 bpm, 24.81±2.43 bpm vs. 33.13±4.17 bpm; Paw: 23.03±3.04 cm H(2)O vs. 33.22±4.59 cm H(2)O, 22.75±3.22 cm H(2)O vs. 33.63±4.79 cm H(2)O; MV: 8.67±1.26 L/min vs. 11.80±2.01 L/min, 8.88±1.45 L/min vs. 13.21±2.90 L/min; WBC: 11.26±1.96 ×10(9)/L vs. 14.57±3.10 ×10(9)/L, 12.28±3.38 ×10(9)/L vs. 15.25±4.93 ×10(9)/L; PCT: 6.90±5.46 μg/L vs. 16.97±7.93 μg/L, 6.17±6.13 μg/L vs. 21.26±11.54 μg/L; CRP: 85.50±37.91 mg/L vs. 120.17±45.47 mg/L, 94.31±38.51 mg/L vs. 142.34±53.57 mg/L; PaO(2)/ FiO(2): 182.06±40.88 mm Hg vs. 98.67±20.62 mm Hg, 184.09±43.78 mm Hg vs. 96.22±22.59 mm Hg, all P<0.05]. There was no significant change in SpO(2) before and after treatment in two groups. And the total clinical effective rate in trial and control group were 83.4% and 81.2%, adverse reaction rate were 13.9% and 9.4%, bacterial removal rate were 90.3% and 87.0% respectively, and there was no significant difference between the two groups (all P>0.05).\u0000\u0000\u0000CONCLUSION\u0000Domestic imipenem cilastatin sodium can effectively control severe aspiration pneumonia, and it is safe and effective antibiotics.","PeriodicalId":23992,"journal":{"name":"Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue","volume":"32 1","pages":"628-31"},"PeriodicalIF":0.0,"publicationDate":"2012-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80906619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

[Prospective observational study exploring the relationship between the levels and variability of blood glucose and the prognosis of critical patients]. [前瞻性观察研究探讨血糖水平和变异性与危重患者预后的关系]。

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

Pub Date : 2012-09-01 DOI: 10.3760/CMA.J.ISSN.1003-0603.2012.09.012

Xu Liu, Di-fen Wang, Jie Xiong

OBJECTIVETo explore the relationship between the levels and variability of blood glucose and the prognosis of critical patients.METHODSA prospective study was conducted. Blood glucose monitoring and prognosis observation were performed for the adult nondiabetic patients admitted in intensive care unit (ICU) from June 2011 to January 2012. Blood glucose monitoring terminal was 72 hours after admitting in ICU, prognosis was observed for 28 days after the end of turning into ICU. Acute physiology and chronic health evaluation II(APACHE II) scores when transferred into ICU and blood glucose variability [standard deviation (SD) of blood glucose, mean absolute blood glucose fluctuation amplitude (MAGE) and glycemic instability index (GLI)] were calculated. Patients were divided into death group and survival group according to the outcome, and the APACHE II score, mean blood glucose and blood glucose variability were compared between the two groups. Patients were divided into different groups based on the blood glucose, and the APACHE II score, blood glucose variability and 28-day mortality were compared among groups.RESULTSTotal 85 cases were enrolled. Compared with survivor group (n=58), in death group (n=27), APACHE II score (28.9±6.6 vs. 23.8±5.9), mean blood glucose (11.9±2.9 mmol/L vs. 9.4±1.8 mmol/L), SD of blood glucose (3.7±1.6 mmol/L vs. 2.4±1.0 mmol/L), MAGE (0.86±0.46 mmol/L vs. 0.54±0.25 mmol/L) and GLI (255.9±232.7 vs. 111.7±110.9) were increased (all P<0.05). SD of blood glucose (4.3±1.4 mmol/L), MAGE (1.1±0.4 mmol/L), GLI (345.3±210.3) and 28-day mortality (63.6%) in blood glucose >11.1 mmol/L group (n=22) were higher than those in ≤11.1 mmol/L group (n=63, 2.3±0.9 mmol/L, 0.5±0.2 mmol/L, 91.9±91.2, 20.6%, respectively, all P<0.05) and 7.8-11.1 mmol/L group (n=52, 2.3±0.9 mmol/L, 0.5±0.2 mmol/L, 85.2±66.4, 25.0%, respectively, all P<0.05). There were no significant differences between 7.8-11.1 mmol/L group and <7.8 mmol/L group (n=11) in SD of blood glucose (2.0±0.9 mmol/L), MAGE (0.5±0.3 mmol/L), GLI (123.8±166.7) and 28-day mortality (0, all P>0.05).CONCLUSIONBlood glucose variability is associated with critical patient's 28-day mortality, and may predict mortality as good as APACHE II score.

目的探讨危重患者血糖水平及变异性与预后的关系。方法采用前瞻性研究。对2011年6月至2012年1月入住重症监护病房(ICU)的成人非糖尿病患者进行血糖监测及预后观察。血糖监测终端为入ICU后72 h，转ICU结束后28 d观察预后。计算转入ICU时的急性生理和慢性健康评估II(APACHE II)评分和血糖变异性[血糖标准差(SD)、平均绝对血糖波动幅度(MAGE)和血糖不稳定指数(GLI)]。根据预后将患者分为死亡组和生存组，比较两组患者APACHE II评分、平均血糖和血糖变异性。根据血糖水平将患者分为不同的组，比较各组间APACHE II评分、血糖变异性和28天死亡率。结果共入组85例。与生存组(n=58)、死亡组(n=27)比较，APACHEⅱ评分(28.9±6.6 vs. 23.8±5.9)、平均血糖(11.9±2.9 mmol/L vs. 9.4±1.8 mmol/L)、血糖SD(3.7±1.6 mmol/L vs. 2.4±1.0 mmol/L)、MAGE(0.86±0.46 mmol/L vs. 0.54±0.25 mmol/L)、GLI(255.9±232.7 vs. 111.7±110.9)均升高(P11.1 mmol/L组(n=22)均高于≤11.1 mmol/L组(n=63、2.3±0.9 mmol/L、0.5±0.2 mmol/L、91.9±91.2、20.6%，均P0.05)。结论血糖变异性与危重患者28天死亡率相关，并可与APACHE II评分一样预测死亡率。

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引用次数: 3

[Management of blood glucose during enteral nutrition in critical patients]. [危重患者肠内营养期间血糖的处理]。

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

Pub Date : 2012-09-01

Yang Liu, Wei He, Hua Zhou, Tong Li, Yuan Xu

Objective: To investigate an effective and safe protocol for enteral nutrition (EN) patients permitting successfully transmit insulin administration from venous pump-in to subcutaneous injection.

Methods: A prospective randomized control study was conducted. Critical patients admitted to intensive care unit (ICU) of Beijing Tongren Hospital from September 2008 to February 2009 were randomly divided into two groups when the energy provided by EN up to half of the total energy requirement. Experiment group (n=44): the protocol was applied for insulin glargine and regular insulin injection; control group (n=43): protocol was applied for subcutaneous regular insulin injection. Target glucose range was 4.4-7.8 mmol/L (80-140 mg/dl). If blood glucose ≥11.1 mmol/L was maintained twicely, the approach of insulin administration would convert from subcutaneous injection to venous pump-in using the computerized glucose control protocol. If the infusion rate of insulin was less than 3 U/h and lasted more than 6 hours, blood glucose ≤7.8 mmol/L, insulin administration was switched to subcutaneous injection again. The general information and all glucose regulation data were recorded for analysis.

Results: The two groups did not differ at baseline for the general information, mean blood glucose and the glucose variation. A total of 1689 blood glucose records were analyzed. The mean blood glucose in experiment group, and was significantly lower than that in control group(7.58±1.17 mmol/L vs. 9.40±1.74 mmol/L, P<0.05). The rate of glucose values within target range in experiment group was significantly higher than that in control group [49.72% (534/1074) vs. 35.61% (219/615), P<0.01]. The glucose standard deviation (SD) in experiment group was significantly lower than that in control group (1.89±0.52 mmol/L vs. 2.17±0.94 mmol/L, P<0.05). The number of measurements needed per patient per day was significantly reduced in experiment group compared with control group (7.51±1.31 vs. 8.15±0.97, P<0.05). The ratio of patients converted to venous pump-in was significantly decreased in experiment group compared with control group (9.09% vs. 44.19%, P<0.01). Hypoglycemia (≤3.3 mmol/L) did not different between experiment group and control group [0.74% (8/1074) vs. 0.49% (3/615), P=0.75].

Conclusions: Compared with the conventional subcutaneous insulin injection protocol, this protocol with insulin glargine combined regular insulin subcutaneous injection can control the glucose level effectively during EN in critical patients. The glucose variation and the numbers of measurements were significantly reduced by this protocol. It is helpful for the insulin transmission from venous pump-in to subcutaneous injection.

目的:探讨一种有效、安全的肠内营养(EN)患者胰岛素给药从静脉泵入过渡到皮下注射的方案。方法:采用前瞻性随机对照研究。将2008年9月至2009年2月在北京同仁医院重症监护病房(ICU)住院的危重患者随机分为两组，实验组的能量供给达到总能量需求的一半。试验组(n=44):该方案应用于甘精胰岛素和常规胰岛素注射;对照组(n=43):采用常规胰岛素皮下注射方案。目标血糖范围为4.4 ~ 7.8 mmol/L (80 ~ 140 mg/dl)。如果两次血糖≥11.1 mmol/L，胰岛素给药方式由皮下注射改为静脉泵入，采用电脑化血糖控制方案。如胰岛素输注速度小于3u /h且持续时间大于6小时，血糖≤7.8 mmol/L，则再次改为皮下注射。记录一般信息和所有血糖调节数据进行分析。结果:两组一般资料、平均血糖及血糖变化在基线时无差异。共分析了1689份血糖记录。实验组的平均血糖明显低于对照组(7.58±1.17 mmol/L vs. 9.40±1.74 mmol/L)。结论:与常规胰岛素皮下注射方案相比，该方案甘精胰岛素联合常规胰岛素皮下注射可有效控制危重患者EN期间的血糖水平。该方案显著减少了葡萄糖变化和测量次数。这有助于胰岛素从静脉泵入到皮下注射的传递。

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引用次数: 0

[Interpretation of the 2010 management of bleeding following major trauma]. [2010年重大创伤后出血处理的解读]。

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

Pub Date : 2012-09-01

Mu Zhang, Fa-chun Zhou

引用次数: 0