Pub Date : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.12.005
Wei Wang, Xianqun Rao, Chao Yuan, Yao Wang, Bin He, Qiang-Hui Liu, Xiao-Quan Xu, G. Ma, Kai Sun
Objective To evaluate the relationship between the status of collateral circulation provided by multiphase CT angiography and the benefit and risk of vascular recanalization in patients with middle cerebral artery (MCA) occlusion. Methods This retrospective study included 49 patients diagnosed with acute MCA occlusion and treated with rt-PA in the First Affiliated Hospital of Nanjing Medical University from October 2017 to September 2018. According to the ASPECTS collateral circulation score, the patients were divided into two groups: good collateral group (n=31) and poor collateral group (n=18). The benefits and risks after thrombolysis in the two groups were compared, including 24-h NIHSS score, 30-day mortality, 90-day modified rankin scale (mRS) score, and the incidence of symptomatic cerebral hemorrhage. Statistical analysis was performed using t test, corrected χ2 test, or Fisher's exact test. Results The 24-h NIHSS score and 90-day mRS score in the good collateral group were significantly lower than those in the poor collateral group (4.6±5.6 vs 12.5±8.4, P=0.00; 1.7±1.7 vs 3.1±1.5, P 0.05), but the 30-day mortality of the poor collateral group was still greater than that of the good collateral group (11.1% vs 0%). Conclusion For patients with acute MCA infarction and receiving vascular recanalization therapy, patients with good collateral circulation can achieve good clinical outcomes, restore better recent neurological function, and obtain lower incidence of symptomatic cerebral hemorrhage and lower disability and mortality rate. Key words: Retrospective studies; Acute ischemic stroke; Intravenous thrombolysis; Multiphase CT angiography; Collateral circulation
目的探讨大脑中动脉闭塞患者多期CT血管造影显示的侧支循环状况与血管再通的利弊关系。方法回顾性研究2017年10月至2018年9月南京医科大学第一附属医院诊断为急性MCA闭塞并接受rt-PA治疗的49例患者。根据ASPECTS侧支循环评分将患者分为两组:良好侧支组(n=31)和不良侧支组(n=18)。比较两组溶栓后的获益和风险，包括24小时NIHSS评分、30天死亡率、90天改良rank量表(mRS)评分、症状性脑出血发生率。统计学分析采用t检验、校正χ2检验或Fisher精确检验。结果良好侧支组24 h NIHSS评分和90 d mRS评分显著低于不良侧支组(4.6±5.6 vs 12.5±8.4,P=0.00;(1.7±1.7 vs 3.1±1.5,P 0.05)，但不良侧枝组的30天死亡率仍高于良好侧枝组(11.1% vs 0%)。结论急性MCA梗死患者接受血管再通治疗时，侧支循环良好的患者临床效果较好，近期神经功能恢复较好，症状性脑出血发生率较低，致残率和死亡率较低。关键词:回顾性研究;急性缺血性中风;静脉溶栓;多期CT血管造影;侧支循环
{"title":"Clinical prognosis analysis of collateral circulation and vascular recanalization in patients with acute ischemic stroke based on multiphase CTA","authors":"Wei Wang, Xianqun Rao, Chao Yuan, Yao Wang, Bin He, Qiang-Hui Liu, Xiao-Quan Xu, G. Ma, Kai Sun","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.12.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.12.005","url":null,"abstract":"Objective \u0000To evaluate the relationship between the status of collateral circulation provided by multiphase CT angiography and the benefit and risk of vascular recanalization in patients with middle cerebral artery (MCA) occlusion. \u0000 \u0000 \u0000Methods \u0000This retrospective study included 49 patients diagnosed with acute MCA occlusion and treated with rt-PA in the First Affiliated Hospital of Nanjing Medical University from October 2017 to September 2018. According to the ASPECTS collateral circulation score, the patients were divided into two groups: good collateral group (n=31) and poor collateral group (n=18). The benefits and risks after thrombolysis in the two groups were compared, including 24-h NIHSS score, 30-day mortality, 90-day modified rankin scale (mRS) score, and the incidence of symptomatic cerebral hemorrhage. Statistical analysis was performed using t test, corrected χ2 test, or Fisher's exact test. \u0000 \u0000 \u0000Results \u0000The 24-h NIHSS score and 90-day mRS score in the good collateral group were significantly lower than those in the poor collateral group (4.6±5.6 vs 12.5±8.4, P=0.00; 1.7±1.7 vs 3.1±1.5, P 0.05), but the 30-day mortality of the poor collateral group was still greater than that of the good collateral group (11.1% vs 0%). \u0000 \u0000 \u0000Conclusion \u0000For patients with acute MCA infarction and receiving vascular recanalization therapy, patients with good collateral circulation can achieve good clinical outcomes, restore better recent neurological function, and obtain lower incidence of symptomatic cerebral hemorrhage and lower disability and mortality rate. \u0000 \u0000 \u0000Key words: \u0000Retrospective studies; Acute ischemic stroke; Intravenous thrombolysis; Multiphase CT angiography; Collateral circulation","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"1485-1489"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46148745","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}
Pub Date : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.12.010
Dong Shuangyong, Han Han, Xu Yuansheng, Song Junfeng, Yu Zhen-xi, L. Jing, Zheng Xuyang
Objective Through the study of angiotensinⅡ- type 2 receptor agonist (AT2R) after pretreatment of mechanical ventilation lung injury (VILI) in rats model, to clarify the role of angiotensin Ⅱ - type 2 receptor agonist (C21) in alleviating VILI inflammation and the damage of immune function and its possible mechanism. Methods In this experiment, the acute lung injury model was established by mechanical spring-volume ventilation in SD rats, and C21 pretreatment was performed to observe the pathological condition of lung tissue in rats with different ventilation duration, and to detect the inflammatory changes of BALF lavage fluid. Flow cytometry was used to detect the CD68+/iNOS+ labeled M1 type AMφ and the CD68+/Arg-1+ labeled M2 type AMφ in alveolar lavage fluid. Results The mechanical VILI rat model was successfully established. The pathological injury score of the mechanical ventilation 4 h model, the wet/dry weight of lung tissue, the number of cells and protein in BALF lavage fluid were increased significantly, the levels of TNF-α and IL - 1 were increased significantly, the levels of IL-4 and IL-10 were decreased significantly, and the level of inflammatory reaction decreased with the increase of ventilation time. The M1/M2 ratio in the 4 h ventilation model group was the highest, which was significantly different from the control group (P<0.05). Compared to the model group, the C21 pretreatment significantly reduced the levels of proinflammatory factors TNF-αand IL-1, and increased the levels of anti-inflammatory factors IL-4 and IL-10 in BALF (P<0.01). After the intervention of AT2R agonist at 4 h, 6 h and 8 h, the M1/M2 ratio of the model was lower than that of the model without AT2R agonist at 4 h, 6 h and 8 h. Conclusion Mechanical ventilation for 4 h in SD rats can establish a mechanical ventilation lung injury model. AT2R agonist C21 can promote the polarization of macrophages to m2-type, and C21 pretreatment may alleviate VILI inflammation and immune damage by altering the polarization of macrophages. Key words: Ventilator-induced lung injury; AngiotensinⅡ- type 2 receptor agonist; Alveolar macrophages; Rats
{"title":"Regulation of angiotensin II type 2 receptor in mechanically ventilated lung injury","authors":"Dong Shuangyong, Han Han, Xu Yuansheng, Song Junfeng, Yu Zhen-xi, L. Jing, Zheng Xuyang","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.12.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.12.010","url":null,"abstract":"Objective \u0000Through the study of angiotensinⅡ- type 2 receptor agonist (AT2R) after pretreatment of mechanical ventilation lung injury (VILI) in rats model, to clarify the role of angiotensin Ⅱ - type 2 receptor agonist (C21) in alleviating VILI inflammation and the damage of immune function and its possible mechanism. \u0000 \u0000 \u0000Methods \u0000In this experiment, the acute lung injury model was established by mechanical spring-volume ventilation in SD rats, and C21 pretreatment was performed to observe the pathological condition of lung tissue in rats with different ventilation duration, and to detect the inflammatory changes of BALF lavage fluid. Flow cytometry was used to detect the CD68+/iNOS+ labeled M1 type AMφ and the CD68+/Arg-1+ labeled M2 type AMφ in alveolar lavage fluid. \u0000 \u0000 \u0000Results \u0000The mechanical VILI rat model was successfully established. The pathological injury score of the mechanical ventilation 4 h model, the wet/dry weight of lung tissue, the number of cells and protein in BALF lavage fluid were increased significantly, the levels of TNF-α and IL - 1 were increased significantly, the levels of IL-4 and IL-10 were decreased significantly, and the level of inflammatory reaction decreased with the increase of ventilation time. The M1/M2 ratio in the 4 h ventilation model group was the highest, which was significantly different from the control group (P<0.05). Compared to the model group, the C21 pretreatment significantly reduced the levels of proinflammatory factors TNF-αand IL-1, and increased the levels of anti-inflammatory factors IL-4 and IL-10 in BALF (P<0.01). After the intervention of AT2R agonist at 4 h, 6 h and 8 h, the M1/M2 ratio of the model was lower than that of the model without AT2R agonist at 4 h, 6 h and 8 h. \u0000 \u0000 \u0000Conclusion \u0000Mechanical ventilation for 4 h in SD rats can establish a mechanical ventilation lung injury model. AT2R agonist C21 can promote the polarization of macrophages to m2-type, and C21 pretreatment may alleviate VILI inflammation and immune damage by altering the polarization of macrophages. \u0000 \u0000 \u0000Key words: \u0000Ventilator-induced lung injury; AngiotensinⅡ- type 2 receptor agonist; Alveolar macrophages; Rats","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"1511-1516"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43718291","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}
Pub Date : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.12.013
薛彦, Xue Yan, 弓清梅, Gong Qing-mei
Objective To investigate plasma interleukin-35 (IL-35) expression in sepsis patients, and to assess the regulatory activity of IL-35 on CD4+ and CD8+ T cells in sepsis patients. Methods A prospective study was conducted. Forty-one sepsis patients and nineteen healthy controls were enrolled in this study. According to the survival outcome on 28 day after admission, sepsis patients were further divided into the survival group (n=30) and death group (n=11). Peripheral blood samples were collected within one hour of visit. Plasma IL-35 level was measured by enzyme linked immunosorbent assay (ELISA), while CD3+, CD4+, and CD8+ T cell counts were measured by flow cytometry. The correlation between IL-35 expression/T cell counts and sequential organ failure assessment (SOFA) score was also assessed. Peripheral CD4+ and CD8+ T cells from sepsis patients were purified and stimulated with recombinant human IL-35 for 48 h. mRNA relative levels of T-bet, GATA-3, FoxP3, and RORγt in CD4+ T cells and perforin, granzyme B, and FasL in CD8+ T cells were measured by real-time PCR. Interferon-γ (IFN-γ), IL-4, IL-10, IL-17, and tumor necrosis factor-α (TNF-α) levels in the cultured supernatants were measured by ELISA. Transcription factor level and cytokine expression was compared prior to and post IL-35 stimulation. Results Plasma IL-35 was significantly elevated in sepsis patients when compared with controls [(76.76±10.33) pg/mL vs (27.53±8.31) pg/mL, P 0.05). Moreover, T cell counts were negatively correlated with SOFA score (P<0.01). IL-35 stimulation resulted in the reduction of mRNA relative level of Th1 transcription factor T-bet and Th17 transcription factor RORγt in CD4+ T cells from sepsis patients (P<0.01), while elevation in regulatory T cell transcription factor FoxP3 mRNA (P<0.01). However, IL-35 stimulation did not affect Th2 transcription factor GATA-3 mRNA in CD4+ T cells (P=0.745). IFN-γ and IL-17 production by CD4+ T cells was significantly decreased in response to IL-35 stimulation (P<0.05), while IL-10 was increased (P<0.01) and IL-4 was comparable (P=0.536) between CD4+ T cells with and without IL-35 stimulation. IL-35 stimulation led to the down-regulation of mRNA relative level of perforin and granzyme B (P<0.01). However, FasL mRNA was comparable between CD8+ T cells with and without IL-35 stimulation (P=0.795). IFN-γ and TNF-α secretion was also reduced in response to IL-35 stimulation (P<0.05). Conclusion Elevated plasma IL-35 level is an important indicator for poor prognosis of sepsis patients. IL-35 inhibits the activity of CD4+ and CD8+ T cells in sepsis patients, and might take part in the pathogenesis of sepsis. Key words: Sepsis; Interleukin-35; Cytokine; T lymphocytes; Immune
{"title":"The regulatory activity of interleukin-35 to CD4+ and CD8+ T cells in sepsis patients","authors":"薛彦, Xue Yan, 弓清梅, Gong Qing-mei","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.12.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.12.013","url":null,"abstract":"Objective \u0000To investigate plasma interleukin-35 (IL-35) expression in sepsis patients, and to assess the regulatory activity of IL-35 on CD4+ and CD8+ T cells in sepsis patients. \u0000 \u0000 \u0000Methods \u0000A prospective study was conducted. Forty-one sepsis patients and nineteen healthy controls were enrolled in this study. According to the survival outcome on 28 day after admission, sepsis patients were further divided into the survival group (n=30) and death group (n=11). Peripheral blood samples were collected within one hour of visit. Plasma IL-35 level was measured by enzyme linked immunosorbent assay (ELISA), while CD3+, CD4+, and CD8+ T cell counts were measured by flow cytometry. The correlation between IL-35 expression/T cell counts and sequential organ failure assessment (SOFA) score was also assessed. Peripheral CD4+ and CD8+ T cells from sepsis patients were purified and stimulated with recombinant human IL-35 for 48 h. mRNA relative levels of T-bet, GATA-3, FoxP3, and RORγt in CD4+ T cells and perforin, granzyme B, and FasL in CD8+ T cells were measured by real-time PCR. Interferon-γ (IFN-γ), IL-4, IL-10, IL-17, and tumor necrosis factor-α (TNF-α) levels in the cultured supernatants were measured by ELISA. Transcription factor level and cytokine expression was compared prior to and post IL-35 stimulation. \u0000 \u0000 \u0000Results \u0000Plasma IL-35 was significantly elevated in sepsis patients when compared with controls [(76.76±10.33) pg/mL vs (27.53±8.31) pg/mL, P 0.05). Moreover, T cell counts were negatively correlated with SOFA score (P<0.01). IL-35 stimulation resulted in the reduction of mRNA relative level of Th1 transcription factor T-bet and Th17 transcription factor RORγt in CD4+ T cells from sepsis patients (P<0.01), while elevation in regulatory T cell transcription factor FoxP3 mRNA (P<0.01). However, IL-35 stimulation did not affect Th2 transcription factor GATA-3 mRNA in CD4+ T cells (P=0.745). IFN-γ and IL-17 production by CD4+ T cells was significantly decreased in response to IL-35 stimulation (P<0.05), while IL-10 was increased (P<0.01) and IL-4 was comparable (P=0.536) between CD4+ T cells with and without IL-35 stimulation. IL-35 stimulation led to the down-regulation of mRNA relative level of perforin and granzyme B (P<0.01). However, FasL mRNA was comparable between CD8+ T cells with and without IL-35 stimulation (P=0.795). IFN-γ and TNF-α secretion was also reduced in response to IL-35 stimulation (P<0.05). \u0000 \u0000 \u0000Conclusion \u0000Elevated plasma IL-35 level is an important indicator for poor prognosis of sepsis patients. IL-35 inhibits the activity of CD4+ and CD8+ T cells in sepsis patients, and might take part in the pathogenesis of sepsis. \u0000 \u0000 \u0000Key words: \u0000Sepsis; Interleukin-35; Cytokine; T lymphocytes; Immune","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"1524-1528"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48590664","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}
Pub Date : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.12.014
Feifei Shao, Qiqiang Liang, W. Xiao, Man Huang
Objective To investigate the difference between bronchoalveolar lavage fluid (BALF) and tracheal aspirate (TA) on the use of antibiotics in patients with severe pneumonia. Methods Patients with severe pneumonias admitted to the Department of General Intensive Care Unit of Second Affiliated Hospital of Zhejiang University School of Medicine, between December 2014 and March 2019 were retrospectively analyzed. The difference of effects of BLAF and TA on the use of antibiotics in patients with severe pneumonia were compared and analyzed, as well as the effects of antibiotic de-escalation on patient’s mortality were evaluated. The quantitative data were analyzed by independent sample t test, and the enumeration data were determined by Chi-square test or Fisher exact probability method. Results Among the 120 patients, more bacteria were detected in BALF than in TA (82 vs 60, P<0.05). More fungi were detected in BALF than in TA (20 vs 3, P<0.05). Compared with TA, BALF results were more likely to guide the adjustment of antibiotic regimens (41 vs 16, P<0.05), including guidance for antibiotics de-escalation (27 vs 9, P<0.05). There was no significant difference in the 14-day mortality, 28-day mortality, hospital stay and duration of mechanical ventilation between the two groups (all P<0.05). Conclusions Compared with TA, BALF, as a pathogens detection method for severe pneumania, has more advantages in guiding antibiotics administration, including antibiotic de-escalation, which will not increase the mortality of patients. Key words: Severe pneumonia; Bronchoalveolar lavage fluid; Tracheal aspirate; Antibiotics administration; Antibiotics de-escalation
目的探讨支气管肺泡灌洗液（BALF）和气管吸出物（TA）在重症肺炎患者抗生素使用方面的差异。方法对2014年12月至2019年3月浙江大学医学院附属第二医院普通重症监护室收治的重症肺炎患者进行回顾性分析。比较分析了BLAF和TA对重症肺炎患者抗生素使用效果的差异，并评估了抗生素降级对患者死亡率的影响。定量数据采用独立样本t检验进行分析，计数数据采用卡方检验或Fisher精确概率法确定。结果120例患者中，BALF中细菌检出率高于TA（82 vs 60，P＜0.05），真菌检出率高于TA20 vs 3，P＜0.01），包括抗生素降级指导（27vs9，P<0.05）。两组在14天死亡率、28天死亡率、住院时间和机械通气持续时间方面无显著差异（均P<0.05），包括抗生素降级，这不会增加患者的死亡率。关键词：重症肺炎；支气管肺泡灌洗液；气管吸出物；抗生素管理；抗生素降级
{"title":"Effect of bronchoalveolar lavage on the use of antibiotics in patients with severe pneumonia","authors":"Feifei Shao, Qiqiang Liang, W. Xiao, Man Huang","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.12.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.12.014","url":null,"abstract":"Objective \u0000To investigate the difference between bronchoalveolar lavage fluid (BALF) and tracheal aspirate (TA) on the use of antibiotics in patients with severe pneumonia. \u0000 \u0000 \u0000Methods \u0000Patients with severe pneumonias admitted to the Department of General Intensive Care Unit of Second Affiliated Hospital of Zhejiang University School of Medicine, between December 2014 and March 2019 were retrospectively analyzed. The difference of effects of BLAF and TA on the use of antibiotics in patients with severe pneumonia were compared and analyzed, as well as the effects of antibiotic de-escalation on patient’s mortality were evaluated. The quantitative data were analyzed by independent sample t test, and the enumeration data were determined by Chi-square test or Fisher exact probability method. \u0000 \u0000 \u0000Results \u0000Among the 120 patients, more bacteria were detected in BALF than in TA (82 vs 60, P<0.05). More fungi were detected in BALF than in TA (20 vs 3, P<0.05). Compared with TA, BALF results were more likely to guide the adjustment of antibiotic regimens (41 vs 16, P<0.05), including guidance for antibiotics de-escalation (27 vs 9, P<0.05). There was no significant difference in the 14-day mortality, 28-day mortality, hospital stay and duration of mechanical ventilation between the two groups (all P<0.05). \u0000 \u0000 \u0000Conclusions \u0000Compared with TA, BALF, as a pathogens detection method for severe pneumania, has more advantages in guiding antibiotics administration, including antibiotic de-escalation, which will not increase the mortality of patients. \u0000 \u0000 \u0000Key words: \u0000Severe pneumonia; Bronchoalveolar lavage fluid; Tracheal aspirate; Antibiotics administration; Antibiotics de-escalation","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"1529-1532"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42913107","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}
Objective To investigate the value of mechanical power (MP) to predict the potential of the lung recruitment maneuver and assess prognoses in patients with acute respiratory distress syndrome (ARDS). Methods Patients with moderate-to-severe ARDS who required mechanical ventilation therapy longer than 24 hours were randomly selected April 2017 to April 2019. The lung recruitment maneuver (RM) protocol was performed according to the patient's condition, their MP, lung ultrasound score (LUS), oxygenation index (P/F), and dead volume ratio (Vd/Vt), which were monitored before the RM and one hour after the RM. The patients were divided into the lung recruitment maneuver potential positive group (RMP-P group) and lung recruitment maneuver potential negative group (RMP-N group) according to whether the variation in the patient's RM aeration score (ΔLUS) was≥5. Differences in MP between the two groups were compared and correlations between MP variation (ΔMP), aeration score variation (ΔLUS), oxygenation index variation (ΔP/F), and dead volume ratio variation (ΔVd/Vt) were analyzed. The receiver operating characteristic curve (ROC) was used to calculate the predictive value of MP for the potential of RM and the prognosis (28-day mortality) of patients with moderate or severe ARDS. Results Eighty-three patients were enrolled in the study, 45 in the RMP-P group and 38 in the RMP-N group. There was no statistical difference in the baseline levels between the two groups (P>0.05). After RM treatment, MP, LUS scores, and Vd/Vt for each patient in the two groups decreased significantly compared to the pre-RM values, whereas, the P/F increased significantly (P 0.05). The ΔMP, ΔLUS, and ΔVd/Vt in the RMP-P group were significantly higher than those in the RMP-N group (P 0.05). There was a significant positive correlation between ΔMP and ΔLUS and ΔVd/Vt in all patients (r=0.4746, 0.3995, P 0.05). The area under the ROC curves of ΔMP for predicting the potential of RM was 0.856, with a sensitivity of 91.1% and a specificity of 63.2%. The AUC of the 28-day survival status was 0.788, with a sensitivity of 84.3% and a specificity of 62.5% (P<0.05). Conclusions Mechanical power monitoring before and after RM can be used to predict the potential of the lung recruitment maneuver and assess the prognosis in patients with moderate-to-severe ARDS. Key words: Acute respiratory distress syndrome; Mechanical power; Recruitment maneuver potential; Lung ultrasound score; Prognosis
{"title":"The value of mechanical power to predict the potential of lung recruitment maneuvers and assess prognosis in patients with acute respiratory distress syndrome","authors":"Yongpeng Xie, Kexi Liu, Yanli Wang, Suxia Liu, Hui Zheng, Lijuan Cao, Xiaomin Li","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.12.015","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.12.015","url":null,"abstract":"Objective \u0000To investigate the value of mechanical power (MP) to predict the potential of the lung recruitment maneuver and assess prognoses in patients with acute respiratory distress syndrome (ARDS). \u0000 \u0000 \u0000Methods \u0000Patients with moderate-to-severe ARDS who required mechanical ventilation therapy longer than 24 hours were randomly selected April 2017 to April 2019. The lung recruitment maneuver (RM) protocol was performed according to the patient's condition, their MP, lung ultrasound score (LUS), oxygenation index (P/F), and dead volume ratio (Vd/Vt), which were monitored before the RM and one hour after the RM. The patients were divided into the lung recruitment maneuver potential positive group (RMP-P group) and lung recruitment maneuver potential negative group (RMP-N group) according to whether the variation in the patient's RM aeration score (ΔLUS) was≥5. Differences in MP between the two groups were compared and correlations between MP variation (ΔMP), aeration score variation (ΔLUS), oxygenation index variation (ΔP/F), and dead volume ratio variation (ΔVd/Vt) were analyzed. The receiver operating characteristic curve (ROC) was used to calculate the predictive value of MP for the potential of RM and the prognosis (28-day mortality) of patients with moderate or severe ARDS. \u0000 \u0000 \u0000Results \u0000Eighty-three patients were enrolled in the study, 45 in the RMP-P group and 38 in the RMP-N group. There was no statistical difference in the baseline levels between the two groups (P>0.05). After RM treatment, MP, LUS scores, and Vd/Vt for each patient in the two groups decreased significantly compared to the pre-RM values, whereas, the P/F increased significantly (P 0.05). The ΔMP, ΔLUS, and ΔVd/Vt in the RMP-P group were significantly higher than those in the RMP-N group (P 0.05). There was a significant positive correlation between ΔMP and ΔLUS and ΔVd/Vt in all patients (r=0.4746, 0.3995, P 0.05). The area under the ROC curves of ΔMP for predicting the potential of RM was 0.856, with a sensitivity of 91.1% and a specificity of 63.2%. The AUC of the 28-day survival status was 0.788, with a sensitivity of 84.3% and a specificity of 62.5% (P<0.05). \u0000 \u0000 \u0000Conclusions \u0000Mechanical power monitoring before and after RM can be used to predict the potential of the lung recruitment maneuver and assess the prognosis in patients with moderate-to-severe ARDS. \u0000 \u0000 \u0000Key words: \u0000Acute respiratory distress syndrome; Mechanical power; Recruitment maneuver potential; Lung ultrasound score; Prognosis","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"1533-1538"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46336752","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}
Pub Date : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.12.012
Li Zizhuo, Chai Yan-fen, Shou Songtao, Huang Liquan
Objective To explore the success rate and safety of axillary venipuncture catheterization with ultrasound localization and homologous surface localization (Magney). Method A total of 80 patients were enrolled in the EICU from January 2017 to September 2018. They were randomly assigned to the Magney method (n=35) and the ultrasound-guided method (n=45). The number of successful punctures, success rate and complications were recorded. Results Compared with ultrasound-guided method, the one-time success rate (25.7% vs 68.9%, P<0.01), puncture greater than 2 times (34.3% vs 11.1%, P=0.012), and total success rate (82.9% vs 100%, P=0.004) in Magney method were significantly different. Both of the two puncture methods were mis-invasive, and the difference was not statistically significant. In Magney method 2 patients occurred hematoma and 1 patient brachial plexus injury, but no infection occurred within 48 h. While no such occurrence was found in ultrasound-guided method. Conclusion Ultrasound-guided method axillary venipuncture is a safe and effective method of central venous catheterization, which has higher success rate and safety than Magney method. Key words: Axillary vein; Central vein catheterization; Ultrasound; Complications; Magney method
{"title":"Safety evaluation of ultrasound location in axillary venipuncture","authors":"Li Zizhuo, Chai Yan-fen, Shou Songtao, Huang Liquan","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.12.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.12.012","url":null,"abstract":"Objective \u0000To explore the success rate and safety of axillary venipuncture catheterization with ultrasound localization and homologous surface localization (Magney). \u0000 \u0000 \u0000Method \u0000A total of 80 patients were enrolled in the EICU from January 2017 to September 2018. They were randomly assigned to the Magney method (n=35) and the ultrasound-guided method (n=45). The number of successful punctures, success rate and complications were recorded. \u0000 \u0000 \u0000Results \u0000Compared with ultrasound-guided method, the one-time success rate (25.7% vs 68.9%, P<0.01), puncture greater than 2 times (34.3% vs 11.1%, P=0.012), and total success rate (82.9% vs 100%, P=0.004) in Magney method were significantly different. Both of the two puncture methods were mis-invasive, and the difference was not statistically significant. In Magney method 2 patients occurred hematoma and 1 patient brachial plexus injury, but no infection occurred within 48 h. While no such occurrence was found in ultrasound-guided method. \u0000 \u0000 \u0000Conclusion \u0000Ultrasound-guided method axillary venipuncture is a safe and effective method of central venous catheterization, which has higher success rate and safety than Magney method. \u0000 \u0000 \u0000Key words: \u0000Axillary vein; Central vein catheterization; Ultrasound; Complications; Magney method","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"1520-1523"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42782083","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}
Pub Date : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.12.009
杨帆, Yang Fan, 李旭声, Li Xusheng, 李娅, Li Ya, 刘小瑜, L. Xiaoyu, 刘梦婷, Liu Mengting, 丁洪光, Ding Hong-guang, 曾红科, Zeng Hong-ke
Objective This study aimed to explore whether high pressure would increase expression of TNF-a and IL-1β. Methods BV2 microglia cells were treated with a self-made device. BV2 microglia cells were randomly divided into five groups according to different pressures: control group, 20 mmHg group, 25 mmHg group, 30 mmHg group, and 35 mmHg group. BV2 microglia cells were randomly divided into five groups according to different intervention time: control group, 6 h group, 12 h group, 24 h group. TNF-α and IL-1β expression were assessed by Western Blotting or double immunofluorescence. Results The 30 mmHg group had the highest expression levels of TNF-α and IL-1β as compared with control group (both P 0.05). Conclusions High pressure may increase the expression levels of TNF-α and IL-1β of microglia. Key words: Pressure; Microglia; TNF-α; IL-1β
{"title":"High pressure increases the express of TNF-α and IL-1β in BV2 microglia","authors":"杨帆, Yang Fan, 李旭声, Li Xusheng, 李娅, Li Ya, 刘小瑜, L. Xiaoyu, 刘梦婷, Liu Mengting, 丁洪光, Ding Hong-guang, 曾红科, Zeng Hong-ke","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.12.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.12.009","url":null,"abstract":"Objective \u0000This study aimed to explore whether high pressure would increase expression of TNF-a and IL-1β. \u0000 \u0000 \u0000Methods \u0000BV2 microglia cells were treated with a self-made device. BV2 microglia cells were randomly divided into five groups according to different pressures: control group, 20 mmHg group, 25 mmHg group, 30 mmHg group, and 35 mmHg group. BV2 microglia cells were randomly divided into five groups according to different intervention time: control group, 6 h group, 12 h group, 24 h group. TNF-α and IL-1β expression were assessed by Western Blotting or double immunofluorescence. \u0000 \u0000 \u0000Results \u0000The 30 mmHg group had the highest expression levels of TNF-α and IL-1β as compared with control group (both P 0.05). \u0000 \u0000 \u0000Conclusions \u0000High pressure may increase the expression levels of TNF-α and IL-1β of microglia. \u0000 \u0000 \u0000Key words: \u0000Pressure; Microglia; TNF-α; IL-1β","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"1507-1510"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49640809","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}
Pub Date : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.12.008
Xiaojiao Yang, Kailiang Zhao, Man Li, Chen-yang Wang, Qianying He, Weixing Wang
Objective To investigate the aggravation of pancreatic tissue injury in rats with acute hypertriglyceridemic pancreatitis and the possible role of NADPH oxidase (NOX). Methods Thirty SPF rats were randomly (random number)divided into five groups: N group, H group, NLAP group, HLAP group and HAPO group. AMY, TG, TC and FFA levels were detected. The pathological changes of pancreas were observed under light microscope and the ultrastructural changes of pancreatic acinar cells were observed by TEM. Serum levels of MDA, SOD, IL-1β, TNF-α and LDH were detected. The expression of NOX4, p-Akt and p-GSK3β in pancreas was detected by immunofluorescence, and the expression of NF-κB and TNF-α in pancreas was detected by immunohistochemistry. Results Intraperitoneal injection of P-407 could significantly increase the levels of serum TG, TC and FFA in rats. After acute pancreatitis induced by L-Arg, the levels of serum AMY in the NLAP and HLAP groups were significantly increased, while Apocynin could significantly decrease the level of serum AMY. Compared with the NLAP group, the pathological injury of pancreatic tissue in the HLAP group was more serious, the level of inflammatory mediators was significantly increased, and the cell necrosis was more serious. After inhibiting NOX, the activation of Akt/GSK3β pathway was regulated and the pancreatic injury was improved. Conclusion In HTGP, NOX aggravates pancreatic injury by regulating the activation of Akt/GSK3 β pathway. Inhibition of NOX expression can play a protective role in pancreas injury of HTGP.. Key words: Hypertriglyceridemia; Acute pancreatitis; Pancreatic injury; NADPH oxidase; Oxidative stress
{"title":"NADPH oxidase participates in pancreatic injury in rats with acute hypertriglyceridemic pancreatitis by regulating Akt/GSK3 β pathway","authors":"Xiaojiao Yang, Kailiang Zhao, Man Li, Chen-yang Wang, Qianying He, Weixing Wang","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.12.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.12.008","url":null,"abstract":"Objective \u0000To investigate the aggravation of pancreatic tissue injury in rats with acute hypertriglyceridemic pancreatitis and the possible role of NADPH oxidase (NOX). \u0000 \u0000 \u0000Methods \u0000Thirty SPF rats were randomly (random number)divided into five groups: N group, H group, NLAP group, HLAP group and HAPO group. AMY, TG, TC and FFA levels were detected. The pathological changes of pancreas were observed under light microscope and the ultrastructural changes of pancreatic acinar cells were observed by TEM. Serum levels of MDA, SOD, IL-1β, TNF-α and LDH were detected. The expression of NOX4, p-Akt and p-GSK3β in pancreas was detected by immunofluorescence, and the expression of NF-κB and TNF-α in pancreas was detected by immunohistochemistry. \u0000 \u0000 \u0000Results \u0000Intraperitoneal injection of P-407 could significantly increase the levels of serum TG, TC and FFA in rats. After acute pancreatitis induced by L-Arg, the levels of serum AMY in the NLAP and HLAP groups were significantly increased, while Apocynin could significantly decrease the level of serum AMY. Compared with the NLAP group, the pathological injury of pancreatic tissue in the HLAP group was more serious, the level of inflammatory mediators was significantly increased, and the cell necrosis was more serious. After inhibiting NOX, the activation of Akt/GSK3β pathway was regulated and the pancreatic injury was improved. \u0000 \u0000 \u0000Conclusion \u0000In HTGP, NOX aggravates pancreatic injury by regulating the activation of Akt/GSK3 β pathway. Inhibition of NOX expression can play a protective role in pancreas injury of HTGP.. \u0000 \u0000 \u0000Key words: \u0000Hypertriglyceridemia; Acute pancreatitis; Pancreatic injury; NADPH oxidase; Oxidative stress","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"1501-1506"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41724036","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}
Pub Date : 2019-11-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.11.010
Wenqi Qi, Chun-Mei Huang, F. Bian, Q. Ge
Objective To analyze the clinical features and microbial characteristics of patients with pyogenic liver abscess (PLA), and to determine the risk factors and biomarkers for early diagnosis of sepsis caused by PLA. Methods The demographic and clinical data of 198 patients with liver abscess admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2013 to June 2017 were analyzed retrospectively. Patients with non-bacterial liver abscess, death on admission and tumor metastasis were excluded. The 198 patients with liver abscess were divided into the sepsis group and non-sepsis group according to the disease progression. The general data of the two groups were analyzed to explore the risk factors of sepsis caused by liver abscess, biomarkers for early diagnosis, and the prognosis. Patients with positive culture were further divided into the Klebsiella pneumoniae group and non-Klebsiella pneumoniae group, and the general clinical data of the two groups were analyzed. Among the PLA patients with positive culture, 80.0% were Klebsiella pneumoniae, followed by E. coli. SPSS 19.0 software was used for statistical analysis, and univariate and logistic multivariate regression analysis was used to determined the risk factors of sepsis induced by PLA. The diagnostic value of white blood cell, neutrophil percentage and procalcitonin (PCT) at admission on the progression of liver abscess to sepsis was evaluated by the receiver operating characteristic (ROC) curve, area under the curve (AUC), sensitivity and specificity. Results The mortality of patients with sepsis caused by liver abscess was 20.8%. The white blood cell count, neutrophil percentage, and PCT at admission predicted the progression of sepsis in PLA patients, and the AUC were 0.76 (95%CI: 0.623-0.898), 0.818 (95%CI: 0.691-0.945), and 0.869 (95%CI: 0.765-0.974), respectively. Patients with diabetes were prone to develop sepsis after the occurrence of liver abscess. There was no significant difference in microbial characteristics between the sepsis group and non-sepsis group. Length of stay (LOS) in patients with sepsis was significantly prolonged [(19.6±12.5) d vs (16.0±9.3) d, P=0.033]. Conclusions Diabetes is an independent risk factor for the progression of liver abscess to sepsis. Klebsiella pneumoniae is the first pathogen of liver abscess. Patients with elevated glycated hemoglobin (≥9.9%) are prone to develop sepsis. White blood cell count (≥12.55×109/L), percentage of neutrophils (≥84.8%), and PCT (≥6.96 ng/mL) in patients with liver abscess indicated the progresses to sepsis, and thus the LOS of patients with sepsis is significantly prolonged and the mortality is significantly increased. Key words: Liver abscess; Sepsis; Risk factors; Early diagnosis; Retrospective studies
{"title":"Risk factors and early diagnosis of sepsis caused by liver abscess","authors":"Wenqi Qi, Chun-Mei Huang, F. Bian, Q. Ge","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.11.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.11.010","url":null,"abstract":"Objective \u0000To analyze the clinical features and microbial characteristics of patients with pyogenic liver abscess (PLA), and to determine the risk factors and biomarkers for early diagnosis of sepsis caused by PLA. \u0000 \u0000 \u0000Methods \u0000The demographic and clinical data of 198 patients with liver abscess admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2013 to June 2017 were analyzed retrospectively. Patients with non-bacterial liver abscess, death on admission and tumor metastasis were excluded. The 198 patients with liver abscess were divided into the sepsis group and non-sepsis group according to the disease progression. The general data of the two groups were analyzed to explore the risk factors of sepsis caused by liver abscess, biomarkers for early diagnosis, and the prognosis. Patients with positive culture were further divided into the Klebsiella pneumoniae group and non-Klebsiella pneumoniae group, and the general clinical data of the two groups were analyzed. Among the PLA patients with positive culture, 80.0% were Klebsiella pneumoniae, followed by E. coli. SPSS 19.0 software was used for statistical analysis, and univariate and logistic multivariate regression analysis was used to determined the risk factors of sepsis induced by PLA. The diagnostic value of white blood cell, neutrophil percentage and procalcitonin (PCT) at admission on the progression of liver abscess to sepsis was evaluated by the receiver operating characteristic (ROC) curve, area under the curve (AUC), sensitivity and specificity. \u0000 \u0000 \u0000Results \u0000The mortality of patients with sepsis caused by liver abscess was 20.8%. The white blood cell count, neutrophil percentage, and PCT at admission predicted the progression of sepsis in PLA patients, and the AUC were 0.76 (95%CI: 0.623-0.898), 0.818 (95%CI: 0.691-0.945), and 0.869 (95%CI: 0.765-0.974), respectively. Patients with diabetes were prone to develop sepsis after the occurrence of liver abscess. There was no significant difference in microbial characteristics between the sepsis group and non-sepsis group. Length of stay (LOS) in patients with sepsis was significantly prolonged [(19.6±12.5) d vs (16.0±9.3) d, P=0.033]. \u0000 \u0000 \u0000Conclusions \u0000Diabetes is an independent risk factor for the progression of liver abscess to sepsis. Klebsiella pneumoniae is the first pathogen of liver abscess. Patients with elevated glycated hemoglobin (≥9.9%) are prone to develop sepsis. White blood cell count (≥12.55×109/L), percentage of neutrophils (≥84.8%), and PCT (≥6.96 ng/mL) in patients with liver abscess indicated the progresses to sepsis, and thus the LOS of patients with sepsis is significantly prolonged and the mortality is significantly increased. \u0000 \u0000 \u0000Key words: \u0000Liver abscess; Sepsis; Risk factors; Early diagnosis; Retrospective studies","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"1383-1389"},"PeriodicalIF":0.0,"publicationDate":"2019-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42895478","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}
Objective To investigate the application of emergency medical service (EMS) of Hebei Province and preliminarily analyze its value in the treatment of acute stroke patients. Methods We collected data of 4 147 acute stroke patients admitted to the Emergency Department between January 2016 and December 2016 in 49 hospitals of Hebei Province. Patients were divided into the EMS group and non-EMS group according to the pattern of arriving hospital. The general data, the onset-to-door time, door-to-treatment time, thrombolytic rate, length of hospital stay and prognosis were compared between the two groups. LSD-t test, Mann-Whitney U or Chi-squared test or Fisher exact test was used for statistical analysis as appropriate. Results A total of 4 147 acute stroke patients were enrolled, including 589 patients (14.2%) with hemorrhagic stroke and 3 558 patients (85.8%) with ischemic stroke. A total of 750 patients (18.1%) were admitted to the hospital by EMS. The proportion of patients with hemorrhagic stroke who used EMS was higher than that of ischemic stroke (33.4% vs 15.5%, P<0.01). The median onset-to-foor time in the EMS group was less than that in the non-EMS group (1.75 h vs 4.57 h, P<0.01). The median time of onset-to-door time within 1 h in the EMS group was longer than that of the non-EMS group (0.67 h vs 0.53 h, P<0.01). There was no significant difference between the two groups in 1-<2 h period and 2-<3 h period. The median time of onset-to-door time of ≥3 h in the EMS group was shorter than that of the non-EMS group (5.0 h vs 9.47 h, P<0.01). In the EMS group, the proportion of patients with onset-to-door time <3 h was higher than that of the non-EMS group (66.13% vs 57.44%, P<0.01). Compared with the non-EMS group, the time of door-to-treatment time was much shorter in the EMS group (87 min vs 101 min, P<0.01). The length of hospital stay in the EMS group was shorter than that of the non-EMS group [11 (7,14) days vs 12 (6,16) days, P<0.01]. In the EMS group, 15.9% patients received thrombolytic therapy, whereas only 11.0% patients in the non-EMS group received this therapy (P=0.001). In the EMS group, 88.8% patients achieved more favorable outcomes at discharge, which was higher than that in the non-EMS group (85.5%, P=0.02). Conclusions EMS is considered as effective in shortening onset-to-door time, reducing door-to-treatment time, improving thrombolytic rate, reducing hospitalization days, and enhancing the prognosis of acute stroke patients. Key words: Emergency medical services; Stroke; Therapy; Prognosis; Hebei Province
{"title":"Analysis on the application of emergency medical service in acute stroke treatment in Hebei Province","authors":"Yanling Dong, Xiao Han, Y. Huang, Haiying Wu, Heng-bo Gao, D. Yao, Tuokang Zheng, Hao Xiao, Q. Meng, Xiaolei Cui, Ying-ping Tian","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.11.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.11.005","url":null,"abstract":"Objective \u0000To investigate the application of emergency medical service (EMS) of Hebei Province and preliminarily analyze its value in the treatment of acute stroke patients. \u0000 \u0000 \u0000Methods \u0000We collected data of 4 147 acute stroke patients admitted to the Emergency Department between January 2016 and December 2016 in 49 hospitals of Hebei Province. Patients were divided into the EMS group and non-EMS group according to the pattern of arriving hospital. The general data, the onset-to-door time, door-to-treatment time, thrombolytic rate, length of hospital stay and prognosis were compared between the two groups. LSD-t test, Mann-Whitney U or Chi-squared test or Fisher exact test was used for statistical analysis as appropriate. \u0000 \u0000 \u0000Results \u0000A total of 4 147 acute stroke patients were enrolled, including 589 patients (14.2%) with hemorrhagic stroke and 3 558 patients (85.8%) with ischemic stroke. A total of 750 patients (18.1%) were admitted to the hospital by EMS. The proportion of patients with hemorrhagic stroke who used EMS was higher than that of ischemic stroke (33.4% vs 15.5%, P<0.01). The median onset-to-foor time in the EMS group was less than that in the non-EMS group (1.75 h vs 4.57 h, P<0.01). The median time of onset-to-door time within 1 h in the EMS group was longer than that of the non-EMS group (0.67 h vs 0.53 h, P<0.01). There was no significant difference between the two groups in 1-<2 h period and 2-<3 h period. The median time of onset-to-door time of ≥3 h in the EMS group was shorter than that of the non-EMS group (5.0 h vs 9.47 h, P<0.01). In the EMS group, the proportion of patients with onset-to-door time <3 h was higher than that of the non-EMS group (66.13% vs 57.44%, P<0.01). Compared with the non-EMS group, the time of door-to-treatment time was much shorter in the EMS group (87 min vs 101 min, P<0.01). The length of hospital stay in the EMS group was shorter than that of the non-EMS group [11 (7,14) days vs 12 (6,16) days, P<0.01]. In the EMS group, 15.9% patients received thrombolytic therapy, whereas only 11.0% patients in the non-EMS group received this therapy (P=0.001). In the EMS group, 88.8% patients achieved more favorable outcomes at discharge, which was higher than that in the non-EMS group (85.5%, P=0.02). \u0000 \u0000 \u0000Conclusions \u0000EMS is considered as effective in shortening onset-to-door time, reducing door-to-treatment time, improving thrombolytic rate, reducing hospitalization days, and enhancing the prognosis of acute stroke patients. \u0000 \u0000 \u0000Key words: \u0000Emergency medical services; Stroke; Therapy; Prognosis; Hebei Province","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"1357-1363"},"PeriodicalIF":0.0,"publicationDate":"2019-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47266338","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}
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