不同置换量的连续性血液滤过治疗多器官功能障碍综合征的疗效分析

目的观察不同置换量的连续性静脉-静脉血液滤过(continuous veno-venous hemo-filtration,CVVH)治疗多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)的疗效及预后。方法选择2010年8月至2013年6月在百色市人民医院 ICU 接受 CVVH 治疗的 MODS患者60例,按随机数字表法分为低剂量组(CVVH 组)和高剂量组(HVHF组)。CVVH 组30例,前稀释方式置换液流量2 L/h[平均(34.70±5.38)ml·kg-1·h-1];HVHF组30例,前稀释方式置换液流量4~5 L/h[平均(68.0±6.49)ml·kg-1·h-1],对比分析2组CVVH 治疗前和治疗24 h后的生命体征、APACHEⅡ评分、APACHEⅡ死亡风险系数、SOFA 评分、平均动脉压(MAP)、氧合指数(PaO2/FiO2)、血尿素氮(BUN)、血肌酐(SCr)、C 反应蛋白(CRP)、白介素-2(IL-2)、白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子(TNF-α)、γ型干扰素(IFN-γ)等指标,并统计2组患者28日病死率。结果(1)经过治疗后,CVVH组的APACHEⅡ评分、APACHEⅡ死亡风险系数、SOFA评分、PaO2/FiO2、CRP、IL-2、IL-6、IL-8、TNF-α、IFN-γ改善,但无统计学意义(P>0.05),MAP、pH、BUN、SCr改善有统计学意义(P<0.05);(2)经过治疗后,HVHF组的 APACHEⅡ评分、APACHEⅡ死亡风险系数、SOFA评分、PaO2/FiO2、MAP、BUN、SCr、CRP、IL-2、IL-6、IL-8、TNF-α、IFN-γ改善均有统计学意义(P<0.05);(3)CVVH 组的28日的病死率为46.67%,HVHF组为36.67%,HVHF低于 CVVH组,但2组差异无显著性(P<0.05)。结论2组均能改善 MODS 患者病情,降低病死率,但高剂量的CVVH 治疗更有利于缓解 MODS病情,其机制可能与清除炎症介质有关。     

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目的　观察持续高流量血液滤过 (HVHF)对重症急性胰腺炎 (SAP)伴多器官功能障碍综合征(MODS)的治疗作用。方法　 1997～ 2 0 0 2年 2 8例SAP伴MODS接受了HVHF治疗。APACHEⅡ评分为(14 36± 3 96 )分 ,BalthazarCT评分为 (8 5± 1 4 )分。从发病到开始HVHF时间 (6 0± 6 1)d ,HVHF治疗时间为 (4 0 4± 3 99)d。置换液以前稀释方式输入 ,流量为 4 0 0 0mL/h ,血流量 2 5 0～ 30 0mL/min ,连续 2 4h不间断。滤器为AN6 9膜 ,面积 1 2m2 ,每 2 4h更换 1次。采用低分子肝素抗凝。结果　 2 8例病人中 ,2 0例治愈出院 ,2例因经济原因放弃治疗 ,6例死亡 (2 1 4 % )。HVHF后体温、心率和呼吸频率显著降低 ;APACHEⅡ评分显著下降(14 4± 3 9vs 9 9± 4 3,P <0 0 1) ;动脉血氧分压显著提高 (6 8 5± 19 5vs 91 9± 2 5 0 ,P <0 0 1)。所有病人均良好耐受HVHF治疗 ,HVHF过程中血流动力学稳定 ,未发现明显的副作用。结论　对SAP伴MODS的病人 ,HVHF明显改善体温、心率、呼吸频率、APACHEⅡ评分和动脉血氧分压。HVHF过程中血流动力学稳定 ,可能成为重要的辅助治疗措施。     

不同模式血液净化治疗脓毒症的临床研究

目的 探讨高容量血液滤过(HVHF)和连续性静脉静脉滤过透析(CVVHDF)两种模式治疗脓毒症的效果.方法 18例脓毒症患者按随机数字表法分为两组,A组(HVHF模式,10例)置换液流速4L/h;B组(CVVHDF模式.8例)置换液流速2L/h,透析液流速2L/h.于治疗oh、12h和24 h测定血清和超滤液中自细胞介素6(IL-6)、白细胞介素10(IL-10)的浓度.同时观察两组患者治疗前、后体温、心率、平均动脉压、氧合指数、急性生理学和慢性健康状况评分(APACHEⅡ评分)、尿素氮和肌酐的变化.结果 A、B两组患者治疗后体温较治疗前明显下降(P＜O.01);A组患者治疗后氧合指数较治疗前明显升高(P＜0.05);A组患者氧合改善较B组更明显(P＜0.05);A组患者治疗后APACHEⅡ评分较治疗前明显降低(P＜0.01).B组患者APACHEⅡ评分治疗后较治疗前降低(P＜0.05);A组患者APACHEⅡ评分的降低较B组更明显(P＜0.01);两组患者心率、平均动脉压、尿素氮、肌酐指标治疗前、后比较差异无统计学意义(P＞0.05).A组患者血清IL-6浓度治疗后较治疗前明显降低(P＜0.01);B组患者血清IL-6浓度治疗前较治疗后明显降低(P＜0.05);A组患者血清IL-6浓度降低程度较B组更明显(P＜0.05);A、B组患者血清IL-10浓度治疗后较治疗前有降低趋势,但差异无统计学意义(P＞0.05);A、B组患者超滤液中均检测到IL-6、IL-10.结论 HVHF模式较LWVHDF模式更能降低机体基础代谢率及耗氧量.增加机体组织的氧供,改善脓毒症患者脏器功能的指标;HVHF、CVVHDF‘两种模式均能通过超滤清除炎性介质,HVHF模式清除效果优于CVVHDF模式.     

连续性血液净化抢救MODS临床疗效

目的观察连续性血液净化（CBP）[包括连续性静脉-静脉血液滤过（CVVH）和血浆置换（PE）]抢救妇产科相关多器官功能障碍综合征（MODS）的疗效。方法收集我科收治的5例MODS患者的临床资料,包括CBP治疗前MODS评分、APACHEⅡ评分和血肌酐值,住院天数和治疗模式,评价患者预后。结果患者治疗前MODS评分6～18分,APACHEⅡ评分8～28分,血肌酐101．04632．4μmol／L。住院时间8～84d。5例患者中,3例治愈,1例遗留慢性肾衰竭,1例死亡。结论CBP对MODS患者的救治是有效的和至关重要的。     

高容量血液滤过对多脏器功能障碍综合征犬CD14+单核细胞白细胞-DR抗原表达的影响

目的 观察高容量血液滤过(HVHF)对多脏器功能障碍综合征(MODS)犬CD14+单核细胞犬白细胞DR抗原(DLA-DR)表达的影响.方法 通过2次打击建立犬MODS模型,随机分HVHF组和MODS组,HVHF组建模后给予HVHF治疗24h,MODS组不给HVHF治疗.监测CD14+单核细胞DLA-DR表达及主要器官功能指标变化.结果 与实验前(6.52±1.47)比较,MODS组CD14+单核细胞DLA-DR明显降低(P＜0.01).在T5、T7、T8、T9时间点HVHF组CD14+单核细胞DLA-DR水平显著高于MODS组(P＜0.05).HVHF组主要器官功能明显改善.结论 HVHF能改善器官功能,提高CD14+单核细胞DLA-DR的表达,有助于重建机体内稳态.     

连续性高容量血液滤过治疗烧伤后多器官功能障碍综合征的临床观察

目的：探讨连续高容量血液滤过（CHVHF）治疗烧伤后多器官功能障碍综合征（MODS）患者的治疗效果。方法：回顾性分析16例接受CHVHF治疗的烧伤后MODS患者的临床资料。CHVHF治疗使用PRIS- MA机器及M100高通量血滤器,血管通路采用双腔中心静脉导管,抗凝使用低分子肝素或无肝素。置换液为前置换,流量4～4.5 L/h。测定治疗前后心率、体温、平均动脉压、氧饱和度、pH、氧合指数、肺泡动脉氧分压差、碳酸氢根、血肌酐、尿素氮,血钾、钠,氯,血乳酸等。结果：16例患者中存活7例。经CHVHF治疗后,患者血氧改善,血尿素氮、肌酐水平较治疗前明显降低。CHVHF治疗后体温、心率降低,血压升高。10例合并高钠血症和7例合并高乳酸血症的患者,血钠和血乳酸治疗前后比较差异显著（P〈0.01）。结论：CHVHF用于救治烧伤后MODS患者疗效确切,在清除毒素的同时,可提高肺换气功能,稳定水、电解质及酸碱平衡。     

不同血液滤过方式联合血液灌流对蜂蛰伤合并多器官功能障碍综合征患者心肌酶谱、抗氧化能力及肾功能的影响

目的探究蜂蛰伤合并多器官功能障碍综合征(multiple organ dysfunction syndrome, MODS)患者行不同方式血液滤过联合血液灌流治疗的效果及其对肾功能、抗氧化能力及心肌酶谱的影响。方法采用数字表法将我院2017年8月至2020年8月间蜂蛰伤合并MODS患者103例随机分为两组, 观察组52例行连续性静脉-静脉血液滤过(CVVH)联合血液灌流, 对照组51例行间歇性血液透析联合血液灌流, 两组患者均连续治疗3次。对比治疗前、后疗效、患者肾功能、抗氧化能力及心肌酶谱变化。结果治疗后, 观察组乳酸脱氢酶、肌酸激酶同工酶、丙二醛、血清胱抑素C、血尿素氮、血肌酐和肌酸激酶水平均较对照组低, 谷胱甘肽过氧化物酶、超氧化物歧化酶较对照组高, 差异具有统计学意义(P<0.05)。两组患者并发症发生情况差异无统计学意义(P>0.05)。结论 CVVH联合血液灌流可显著改善蜂蛰伤合并MODS患者心肌酶水平和机体抗氧化能力, 改善肾功能, 且安全有效。     

多器官功能障碍综合征病人预后分析

目的研究多器官功能障碍综合征（MODS）病人发生血小板缺乏的危险因素及其对预后的影响。方法对5家教学医院加强医疗病房（ICU）中1年内收治的366例MODS病人进行回顾性分析。记录病人的人口统计学资料、临床信息、急性生理和慢性健康评分（APACHEⅡ）及序贯性器官衰竭评分（SOFA）。主要研究终点为住院病死率。结果住院期间共有151例病人死亡（41．3％）。血小板缺乏[P=0．022，OR（比数比）=2．143，可信限（95％CI）1．114～4．121]，神经系统衰竭（P〈0．01，OR=6．033，95％CI3．164～11．506）和最高SOFA评分（P〈0．01，OR=1．215，95％CI1．112～1．328），是预后的独立危险因素。共有220例MODS病人（60．1％）发生血小板缺乏。ICU住院时间（P=0．023，OR=1．017，95％CI1．002～1．032）和最高SOFA评分（P〈0．01，OR：1．271，95％CI1．187～1．361）是发生血小板缺乏的独立危险因素，而最高SOFA评分（P〈0．01，OR=1．405，95％CI1．276～1．548）和继发性血小板缺乏（P〈0．01，OR=3．517，95％CI1．780～6．951）是伴有血小板缺乏的MODS病人死亡的独立危险因素。结论血小板缺乏在MODS病人中非常普遍，并导致住院病死率升高.     

淋巴细胞凋亡在高容量血液滤过防治多器官功能障碍中的变化及意义

目的观察高容量血液滤过（HVHF）防治家猪多器官功能障碍（MODS）对淋巴细胞凋亡的影响。方法19头猪采用失血性休克＋复苏灌注＋内毒素血症复制MODS模型，随机分为HVHF组（n=10）和MODS组（n=9）。采用酶联免疫吸附试验（ELISA）检测血清白细胞介素（IL）-1β、IL-10浓度；采用流式细胞仪技术检测淋巴细胞凋亡；采用免疫印迹杂交法检测淋巴细胞膜表面Fas表达。结果HVHF组治疗后IL1β浓度明显下降；IL-10由治疗开始后即明显下降，至6h达到最低点，此后维持在稳定状态；淋巴细胞膜表面Fas表达明显下降，淋巴细胞凋亡率逐渐减少。HVHF组各主要器官功能均明显改善，动物死亡率和MODS发生率显著低于MODS组。结论HVHF通过对促炎／抗炎细胞因子平衡的调节，下调了淋巴细胞膜表面Fas表达，减少淋巴细胞凋亡，恢复其功能，从而对MODS起到一定的防治作用。     

连续性肾脏替代治疗与间歇性血液透析治疗多器官功能障碍综合征的疗效比较

目的比较连续性肾脏替代治疗(CRRT)与间歇性血液透析(IHD)治疗伴急性肾功能衰竭(ARF)的多器官功能障碍综合征(MODS)患者的疗效.方法49例伴ARF的MODS患者,23例接受CRRT,26例接受每周3次或隔日1次的IHD.所有患者血液净化治疗前及治疗后记录液体摄人量,每日晨检查血肌酐、尿素氮、血钾、血碳酸氢根浓度,动脉血pH值.结果CRRT组和IHD组每日液体摄入量分别为(5128±103)ml、(2207±97)ml(P＜0.05).IHD组21例次出现透析相关低血压、17例次透析间期发生容量依赖性心功能衰竭,高于CRRT组的3例次及2例次(P＜0.05).IHD组每日晨血尿素氮、血肌酐、碳酸氢根、pH值组内比较差异有显著性意义(P＜0.05),而CRRT组组内比较差异没有显著性意义(P＞0.05);IHD组每日晨平均血肌酐、尿素氮高于CRRT组(P＜0.05);IHD组和CRRT组存活率分别为65.4%(17/26)、34.8%(8/23),但在APACHEⅡ评分27以上、衰竭器官数在3个以上的患者中,CRRT组和IHD组存活率分别为26.7%、14.3%(P＞005).结论CRRT控制伴ARF的MODS患者酸碱平衡、液体平衡及氮质血症优于IHD.     

Effects of Coupled Plasma Filtration Adsorption on Septic Patients with Multiple Organ Dysfunction Syndrome

Aim: The aim of this study was to observe the effects of coupled plasma filtration adsorption (CPFA) on septic patients with multiple organ dysfunction syndrome (MODS). Methods: A total of 14 patients were randomly divided into two groups, and, respectively, received 10 h of CPFA or high-volume hemofiltration (HVHF). The mean arterial pressure (MAP), electrolytes and acid–base balance, the sequential organ failure assessment (SOFA) score, and the acute physiology and chronic health evaluation II (APACHE II) score were analyzed. Serum levels of high-mobility group box-1 (HMGB-1) protein, tumor necrosis factor-α (TNF-α), and intercellular adhesion molecule-1 (ICAM-1) were also measured by enzyme-linked immunosorbent assay. Results: After CPFA and HVHF, temporary reduction in blood urea nitrogen and serum creatinine, electrolytes and acid–base metabolism balance were well maintained. Both the SOFA and the APACHE II scores were markedly reduced after CPFA (p < 0.01), while only the SOFA score was significantly decreased after HVHF (p < 0.05). After 10-h treatment with CPFA, the MAP and oxygen index (PaO₂/FiO₂) were significantly higher than those at 0 h. Furthermore, the serum levels of HMGB-1, ICAM-1, and TNF-α decreased after 10 h of CPFA (p < 0.05), while the serum levels of HMGB-1 declined at 5 h of HVHF, but rebounded at 10 h, and the serum levels of TNF-α and ICAM-1 were no significant change after treatment with HVHF. Conclusions: The study indicated that CPFA could be superior to HVHF in improving the clinical manifestations and eliminating inflammatory mediators, which had implications in the optimal treatment of septic patients with MODS.     

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??Value of early goal-directed therapy for treatment of surgical patients with severe sepsis DAI Hai-wen, ZHANG Zhao-cai, YAN Jing, et al. Department of Intensive Care Unit, Zhejiang Hospital, Hangzhou 310013, China Corresponding author: YAN Jing, E-mail: zjicu@vip.163.com Abstract Objective To investigate the effect of early goal-directed therapy (EGDT) on surgical patient with severe sepsis. Methods One hundred and seventy-seven surgical patients with severe sepsis admitted between August 2004 and June 2007 at 7 hospitals of Grade III Level A in Zhejiang Province were randomized to conventional treatment group (n=90) and EGDT group (n=87), the former was underwent fluid resuscitation goaled by central venous pressure (CVP), mean artery blood pressure (MBP) or systolic blood pressure (SBP) and urinary output, and the latter was guiding by CVP, MBP or SBP and UO plus central venous oxygen saturation (ScvO2)??The patients were achieved the goals by treating with fluid, transfusions and cardiac stimulants in a period of 6 hours after enrollment. The difference of 28-day survival (primary endpoint), the length of stay in ICU, mechanical ventilation time, antibiotics utilization time, complication of newly infection and clinical scores (secondary endpoints) between the 2 groups was compared. Results In comparison with conventional group, the 28-day survival of EGDT group was increased by 18% (79.3% vs 61.1%, P=0.023), the APACHE II score and MODS score were significantly improved after 6h of EGDT fluid resuscitation (APACHE II: 21.7±5.9 vs 15.4±4.3, P=0.008; MODS: 8.4±3.3 vs 5.1±2.9, P=0.017), there is no difference in other parameters for secondary endpoint (all P>0.05). Conclusion EGDT improved 28-day survival and clinical scores and had beneficial effects on outcomes in surgical patients with severe sepsis.     

Prognostic predictors in patients with sepsis after gastrointestinal tumor surgery: A retrospective study

BACKGROUNDThere have been different reports on mortality of sepsis; however, few focus on the prognosis of patients with sepsis after surgery.AIMTo study the clinical features and prognostic predictors in patients with sepsis after gastrointestinal tumor surgery in intensive care unit (ICU).METHODSWe retrospectively screened patients who underwent gastrointestinal tumor surgery at Peking University Cancer Hospital from January 2015 to December 2019. Among them, 181 patients who were diagnosed with sepsis in ICU were included in our study. Survival was analysed by the Kaplan-Meier method. Univariate and multivariate adjusted analyses were performed to identify predictors of prognosis.RESULTSThe 90-d all-cause mortality rate was 11.1% in our study. Univariate analysis showed that body mass index (BMI), shock within 48 h after ICU admission, leukocyte count, lymphocyte to neutrophil ratio, international normalized ratio, creatinine, procalcitonin, lactic acid, oxygenation index, and sequential organ failure assessment (SOFA) score within 24 h after ICU admission might be all significantly associated with the prognosis of sepsis after gastrointestinal tumor surgery. In multiple analysis, we found that BMI ≤ 20 kg/m², lactic acid after ICU admission, and SOFA score within 24 h after ICU admission might be independent risk predictors of the prognosis of sepsis after gastrointestinal tumor surgery. Compared with SOFA score, SOFA score combined with BMI and lactic acid might have higher predictive ability (area under the receiver operating characteristic curve, 0.859; 95% confidence interval, 0.789-0.929).CONCLUSIONLactic acid and SOFA score within 24 h after ICU admission are independent risk predictors of the prognosis of sepsis after gastrointestinal tumor surgery. SOFA score combined with BMI and lactic acid might have good predictive value.     

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??Effect of early continuous high??volume hemofiltration on severe acute pancreatitis with acute lung injuryTONG Zhi??hui??LI Wei??qin,YU Wen??kui??et al??Research Institute of General Surgery,Nanjing General Hospital of Nanjing Command of PLA,Nanjing 210002??China Corresponding author??LI Wei??qin??E??mail??liweiqin@jlonline.com AbstractObjectiveTo investigate the effect of early continuous high??volume hemofiltration (HVHF) on lung function in patients with severe acute pancreatitis.MethodsBased on the method of prospective,randomized and controlled clinical trial,55 patients suffered SAP with acute lung injury between January 2006 and December 2007 at Nanjing General Hospital of Nanjing Command of PLA were divided into control group and HVHF group.The oxygenation index,the morbility of ALI/ARDS and the case and time of mechanical ventilation (MV) between two groups were compared.Results??1??In HVHF group,the oxygenation indexes on the 3rd,10th day after admission were improved greater than those on the admission??P<0??05??.Meanwhile,in control group,the oxygenation index only on the 10d after admission was improved greater than that on the admission??P<0??05??.And the oxygenation indexes of 3d,10d after admission in HVHF group were improved greater than those in control group??P<0??05??.??2?? In HVHF group,the morbility of ALI/ARDS on the 10th day after admission was lower than that on the admission??P<0??05??,but the same result was not seen in control group??P??0??05??.And the morbility of ALI/ARDS on the 10d after admission in HVHF group was lower than that in control group??P<0??05??.??3??There were no significant difference between the two groups of the patients treated with MV??P??0??05??.But the duration time of MV in HVHF group was shorter than that in control group??P<0.05??.ConclusionEarly continuous high??volume hemofiltration can improve the function of lung in SAP,and is an important adjunctive therapy.     

以血浆作透析液行血液透析联合高容量血液滤过治疗对肝衰竭患者血浆细胞因子的影响

目的 以人体新鲜冰冻血浆作透析液行血液透析(HD-PBD)后继续进行高容量血液滤过(HVHF)，观察其对肝功能衰竭患者血浆细胞因子的影响。 方法 12例肝功能衰竭患者行HD-PBD治疗6 h后，应用同一滤器(AV600)继续行HVHF治疗24 h。分别在治疗前(0 h)及治疗后6、30 h取血，应用酶联免疫吸附法(ELISA)检测TNF-α、IL-1β、IL-6和IL-8的水平，同时观察治疗前后血清胆红素、总胆汁酸(TBA)、血氨、BUN、Scr水平，并监测动脉血气分析和电解质浓度的变化。 结果 (1)HD-PBD对胆红素和TBA的清除较HVHF明显(P < 0.05)；(2)HVHF在清除血氨、BUN、Scr、纠正电解质和酸碱失衡方面比HD-PBD更有效(P < 0.05)；(3)停止HD-PBD后继续行HVHF治疗24 h，胆红素仍有所下降(P < 0.05)；(4)治疗后TNF-α、IL-6和IL-8较治疗前明显下降。 结论 对肝功能衰竭患者，HD-PBD联合HVHF治疗能显著降低血清胆红素、总胆汁酸、BUN、Scr、血氨及部分细胞因子，调节水电解质和酸碱平衡，并且安全、简便、易行和成本低廉。     

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目的研究脓毒症相关肝损伤的发生率、表现形式、发病及持续时间,分析肝功能异常对预后的影响。方法回顾性分析2010年1～12月中国医科大学附属第一医院重症医学科诊治150例脓毒症病人的资料,其中49例(32.7%)于诊断脓毒症后的1～23d发生肝功能异常。结果肝功能异常病人中胆红素升高17例(34.7%),转氨酶升高22例(44.9%),胆红素与转氨酶均升高10例(20.4%)。肝功能异常持续时间1～25d,肝功能异常者的多器官功能障碍综合征(MODS)发生率57.1%(28/49),病死率34.7%(17/49),住ICU时间1～107d,机械通气时间9～1140h,与无肝功能异常的脓毒症病人比较MODS发生率、病死率、住ICU时间、机械通气时间的差异均有统计学意义。肝功能异常的病人中,高胆红素升高者的肝功能恢复率最低,高胆红素、高转氨酶病人MODS发生率最高。结论脓毒症病人相关肝损伤发生率较高,合并肝功能异常的脓毒症病人预后差,MODS发生率高,以胆红素升高为表现的脓毒症病人肝功能恢复率低。     

持续血液净化在热射病合并多器官功能障碍综合征治疗中应用

目的：探讨持续血液净化（cBP）对热射病（Hs）合并多器官功能障碍综合征（MODS）治疗效果 方法。2005年5月-2009年8月．“将持续血液净化应用于热射病合并MODs患者11例（男10例,女1例,年龄17-25岁）．每次治疗24-48h,置换液以前稀释方式输入．流量为2-4L／h．血流量150-250ml／min．采用普通肝素抗凝．而对于部分严重出血倾向患者．在给予补充血小板．凝血酶原复合物、纤维蛋白原等凝血底物的同时给予小剂量肝素抗凝。结果：11例患者中9侧痊愈。出院,2例焉亡;cBP治疗中患者血流动力学保持相对稳定．平均动脉压．心率和氧台指数均有所改善,,多巴胺剂照逐渐减少（p〈0．05）．APACHE11评分降低（P〈0．05）;血中肌酐,尿素氮．肌红蛋白0肌酸激酶下降明显（P〈0.05）．但胆红素无明显变化（P〉0.05）,治疗中未发现明显副作用。结论：持续血液净化对热射病台并MODS患者有改善预后的作用．患者耐受性好,是抢救热射病合并MODS患者有效手段之一。     

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??Evaluation of the severity and prognosis of ICU patients with AGI grading system and its clinical significance??A report of 296 patients ZHU Cheng-rui??LUAN Zheng-gang??YIN Xiao-han??et al. Intensive Care Unit??the First Affiliated Hospital of China Medical University??Shenyang 110001??China
Corresponding author??MA Xiao-chun??E-mail??xcma2972@sina.com
Abstract Objective To discuss the relationships of the acute gastrointestinal injury (AGI) grades??the severity and the prognosis of the patients. Methods The AGI grades and other clinical data of 296 critical patients admitted from January 2013 to September 2013 in ICU of the First Affiliated Hospital of China Medical University were studied retrospectively. The cause of disease, APACHE ?? score??SOFA score, complications and prognosis among different AGI grades were analyzed statistically. Results Among 296 patients, 289 patients ??97.6%?? had AGI. AGI grade??(136 cases)and AGI grade ??118 cases??were the main. Among all the AGI patients, primary AGI accounted for 67.8%??secondary AGI accounted for 32.2%??primary AGI was more serious than secondary AGI ??P=0.000??. There were statistically significant differences of APACHE ??SOFA score among different AGI grades??P=0.015??0.003??. APACHE ?? scores of AGI grade ?? and ?? were higher than AGI grade ??and ??, the AGI grade ?? SOFA scores were higher than other AGI grades??P<0.05??. There was no difference in the 28 days mortality rate and the incidence of MODS of AGI grade ?? and ??but there were differences of all other AGI grades (all P<0.05). The occasion of severe acute gastrointestinal damages was almost in early time of patients adopted to ICU??and the common cause of AGI grade ?? and ?? was severe abdominal infection. Conclusion The AGI is extremely common in critical patient??but most of AGI in ICU is mild. There are statistically differences in severity and prognosis between mild AGI??grade ?? and ?? and severe AGI??grade ?? and ????.     

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??The effect of restrictive and non-restrictive fluid therapy on the postoperative hemodynamics and tissue oxygenation in major abdominal surgery SI Xiang, WU Jian-feng, CHEN Juan, et al. Department of Surgical Intensive Care Unit ,First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080,China.
Corresponding author:GUAN Xiang-dong,E-mail:carlg@163.net
Abstract Objective To discuss the effect of restrictive and non-restrictive fluid therapy on the postoperative hemodynamics and tissue oxygenation in major abdominal surgery. Methods The postoperative patient who received major abdominal surgery and admitted to surgical intensive care unit of the First Affiliated Hospital of Sun Yat-Sen University from April 2011 to February 2014 were analyzed retrospectively. The patient was divided into restrictive infusion group??<-10%??95 cases??and non-restrictive infusion group (≥-10%??42 cases) comparing with standard fluid therapy according to that textbook opinion. The effect of restrictive and non-restrictive fluid therapy on the postoperative hemodynamics and tissue oxygenation was investigated. Results There were 71 patients (74.7%) with SVV>10% in the restrictive group and 18 patients(42.8%) in the non-restrictive group??the hypovolemic incidence in the restrictive group was significantly higher than the non-restrictive group (P<0.05). The mean arterial pressure ??(96.9±14.0)mmHg vs. (82.3±14.8)mmHg??P=0.003??, systolic blood pressure ??(139.0±16.3) mmHg vs. (118.8±24.2) mmHg??P=0.007??, diastolic blood pressure ??(74.1±12.4) mmHg vs. (63.7±12.6) mmHg??P=0.014??, cardiac index ??3.8±1.3 vs. 3.1±0.9??P=0.035?? and stroke volume index ??51.8±19.3 vs. 41.3±14.3??P=0.047?? ??base excess??BEecf??(-1.8±4.2)mmol/L vs. (1.3±4.1)mmol/L??P=0.024??BEb??(-1.4±3.9) mmol/L vs (1.4±3.6) mmol/L??P=0.028?? was significantly higher in the non-restrictive group than in the restrictive group??the difference was statistically significant (P<0.05). The other indicators were not statistically significant. Conclusion For the major abdominal surgery patients??it was more prone to postoperative hypovolemia??tissue hypoperfusion and tissue hypoxia with restrictive infusion during the operation, while the hymodynamics was more stable for the patients in the non-restrictive group.     

Systemic and organ dysfunction response during infusion of recombinant human activated protein C (rhAPC) in severe sepsis and septic shock

AIM: The aim of this study was the assessment of the efficacy of recombinant human activated protein C (rhAPC) in septic patients. METHODS: A continuous observational prospective study on ICU patients with severe sepsis and septic shock was carried out. Applying the inclusion criteria of a national trial on the use of rhAPC, 15 patients (12 males and 3 females) were enrolled, mean age was 65.9 (SD 9.6), APACHE II score was > or =25. The following variables were assessed on 7 time-points (T1-T7): overall SOFA score; organ-specific SOFA score; APACHE II score; PCR, APTT, INR, fibrinogen, platelet count. Wilcoxon's statistical test and Spearman's correlation test (rho coefficient) between the SOFA and APACHE II scores were used. Test results with a P value below 0.05 were deemed significant. RESULTS: A significant correlation was identified between the APACHE II and SOFA scores. No significant change was found in Friedman's test and the respiratory, haematological and hepatic SOFA score, whereas cardiovascular, renal and neurological SOFA scores showed a significant trend between the ranks at the 7 time-points (chi2=14; df=6; P=0.029). During rhAPC treatment Friedman's test showed significant changes of PCR values over the 7 time-points (chi2=19.2; df=6; P=0.02). Wilcoxon's test indicated a significant decrease in the values recorded during the T2-T6 period. On day 28, 12 of the 15 patients originally enrolled were still alive. Mortality rate was therefore 20% (CI 95%). CONCLUSIONS: RhAPC is the first biological agent approved for the treatment of severe sepsis and septic shock. Our experience is confined to patients with severe sepsis and septic shock, and some severity indexes showed a modulation of the inflammatory processes and haemostatic balance, 2 factors which play a key role in the evolution of sepsis and organ dysfunction.