The effect of a hemofilter during extracorporeal circulation on hemodynamics in patients with SIRS

Objective: To evaluate the hypothesis that extracorporeal hemopurification with a hemofilter contributes to the stabilization of hemodynamics in patients with systemic inflammatory response syndrome (SIRS) due to a mechanism other than the removal of cytokines.¶Design: Prospective study.¶Setting: Intensive care unit (ICU) in a university hospital.¶Patients: Seven critically ill patients who met criteria for SIRS with unstable hemodynamics requiring vasopressors after emergency surgery.¶Interventions: Before initiation of continuous hemofiltration (CHF) extracorporeal circulation through the hemofilter (ECC) with a hollow-fiber polyacrylonitrile hemofilter was performed for 6 h.¶Measurements and results: Vital signs were monitored continuously and hemodynamics were evaluated intermittently. The blood level of endotoxin and the plasma levels of cytokines were measured at 0 and 6 h. Changes in plasma levels of cytokines passing through the hemofilter were evaluated at 3 h. A significant decrease of body temperature (P < 0.05 at 3 and 6 h vs 0 h), a significant elevation of mean arterial pressure (P < 0.05 at 0.5 h, P < 0.01 at 3 and 6 h vs 0 h), and a significant increase of urinary flow rate (P < 0.05 at 0 to 3 h vs –3 to 0 h) were observed with ECC. Neither the blood level of endotoxin nor the plasma levels of cytokines decreased. A significant increase of plasma IL-6 as it passed through the hemofilter was noted.¶Conclusions: The beneficial effects of hemopurification with a hemofilter on SIRS patients are possibly due to mechanisms other than the elimination of cytokines with ultrafiltration, diffusion, or adsorption.     

体外循环下心房粘液瘤切除13例围术期护理体会

目的:探讨体外循环下心房粘液瘤的护理配合方法。方法:总结13例体外循环下心房粘液瘤患者切除术的术前、术中、术后全程配合护理经验。结果:术后并发心律失常3例,脑栓塞1例,经积极治疗,均康复出院。结论:体外循环下心房粘液瘤手术过程中给予积极护理配合,可促进手术顺利进行,降低术后并发症的发生,利于患者早期康复。     

苯扎氯铵药物贴一次性护脐带的研制与临床应用

目的 寻找一种适用于新生儿脐部护理的有效方法，预防新生儿脐部感染的发生。方法 选择2004年9月-2005年8月来我院待产的560例产妇，随机分为研究组和对照组各280例。研究组采用苯扎氯铵药物贴与一次性护脐带对新生儿脐部进行包扎，对照组采用传统的方法对新生儿脐部进行包扎，比较2组新生儿脐部愈合情况。结果 2组患儿脐部干湿情况，差异有显著性，P〈0．01；研究组和对照组脐部感染情况，差异有显著性，P〈0．05。研究组脐部弹性好，对照组无弹性；研究组与对照组滑脱情况，分别为14．64％和67．50％。结论 苯扎氯铵药物贴一次性护脐带具有收敛、止血、抗感染的作用，为新生儿的脐部的护理提供了新的方法。     

小儿先天性心脏病体外循环中血液稀释水平对乳酸和术后转归的影响

目的探讨小儿体外循环(ECC)中不同Hb浓度对血乳酸及术后转归的影响。方法将择期行先天性心脏病体外循环下心内直视手术患儿60名随机分为3组,每组各20名。组Ⅰ接受轻度血液稀释,Hb达(80—90)g/L;组Ⅱ接受中度血液稀释,Hb达(70—79)g/L;组Ⅲ接受重度血液稀释,Hb达(60—69)g/L。记录比较各组ECC前、ECC中、ECC后和术后24h乳酸含量、动脉氧分压(PaO2),各组体外循环库血使用率、术后呋塞米用量、术后并发症和恢复时间。结果3组乳酸浓度和PaO2在ECC前、ECC中、ECC后和术后24h均在正常范围,3组间均无统计学差异(P>0.05);体外循环库血使用率组Ⅱ(30%)和组Ⅲ(15%)均明显少于组Ⅰ(50%);但术后呋塞米用量组Ⅱ和组Ⅲ均明显高于组Ⅰ(P<0.05);3组患儿均痊愈出院且并发症少。结论小儿体外循环应用中度血液稀释[Hb(70—79)g/L]和重度血液稀释[Hb(60—69)g/L]对乳酸和术后转归无影响,可明显减少库血用量。     

血液透析患者代谢性酸中毒对机体营养状况的影响

目的 了解维持性血液透析(MHD)患者代谢性酸中毒(MA)的发生情况,探讨MA对机体营养状况的影响。方法 89例MHD患者,透析前抽血查HCO3-和尿素氮、肌酐、血白蛋白、前白蛋白、钙、磷和PTH等指标,并计算Kt/V、总淋巴细胞计数(TLC)和nPCR等营养相关的指标。将89例患者分为MA组(HCO3-≤21mmol/L,61例)和非MA组(HCO3->21 mmol/L,28例),进行分析比较。结果89例患者透析前HCO3-为(19.26±3.51)mmol/L,MA发生率68.5％,透析前血HCO3-与血钙正相关(P<0.05),与血磷、血尿素氮、肌酐、尿酸、白蛋白、前白蛋白和nPCR呈负相关(P<0.05),而与体重指数(BMI)、TLC、Kt/V和PTH无明显相关(P>0.05)。MA组和非MA组比较,血尿素氮、肌酐、白蛋白、前白蛋白和nPCR差异显著(P<0.05);而二组BMI、TLC、Kt/V、钙、磷和PTH水平均无显著差异(P>0.05)。结论 轻度的MA,即使在透析充分的MHD患者也是很常见的,这种轻度的MA可能主要是由于机体蛋白质摄入增加引起,短期内对机体的营养指标似无明显影响。有关长期MA对机体营养状况的影响,尚待临床进一步观察。     

The effects of pre-arrest heparin administration dose for cardiac arrest model using extracorporeal lung and a heart assist (ECLHA) in dogs

BACKGROUND AND PURPOSE: Clinical and experimental studies have shown that marked activation of blood coagulation occurs in cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). Extracorporeal lung and heart assist (ECLHA) is applied in CA patients who cannot be rescued using conventional therapies. We hypothesized that the dose of heparin administered during the pre-arrest period would influence the outcome in a canine model of CA induced by 15 min of normothermia followed by ECLHA, which consists of heparin coating membrane lung and tubing. We therefore investigated the effects of two dose regimes of the pre-arrest heparin for this model. METHODS: Twelve mongrel female dogs were divided into two groups: a group given 200 U/kg heparin (H200, n=6) and a group given 700 U/kg heparin (H700, n=6), group during pre-arrest period. Normothermic ventricular fibrillation (VF) was induced in all dogs for 15 min, followed by 24h of ECLHA with rapidly induced mild hypothermia (33 degrees C) and 120 h of intensive care. Outcome evaluations included: (1) activated coagulation time (ACT); (2) catecholamine dose; (3) hematocrit (Hct) and platelet count; (4) survival rate; (5) neurological deficit scores (NDS); (6) postmortal macroscopic examination with the exception of the brain. RESULTS: In the H200 group, four dogs died of cardiogenic shock within 28 h. The autopsy revealed extensive patchy hemorrhages in the heart and intestine. In the H700 group, the amount of dopamine was significantly lower (6+/-10mg versus 75+/-41 mg, p<0.05) and the survival rate was significantly higher (100% versus 17%, p<0.05) than in the H200 group. The NDS at 120 h in the H700 group was 18+/-8% and the autopsy revealed an almost normal external appearance of the vital organs. There were no significant differences between groups in either the Hct and platelet count during the 24h of resuscitation, and no bleeding complications were observed. CONCLUSION: The use of ECLHA to resuscitate animals in prolonged CA may require a large dose of systemic heparin during the pre-arrest period even if ECLHA circuit was coated with heparin.     

自主循环恢复后轻度低温对心室纤颤兔心功能和心肌结构的影响

目的 观察轻度低温干预对心室纤颤(室颤)兔自主循环恢复(ROSC)后心脏功能、心肌结构和48 h存活率的影响.方法 将新西兰兔按随机数字表法分为4组,采用心外膜电刺激致颤4 min行心肺复苏(CPR)复制动物CPR模型,ROSC后即分别给予常温[(39.0±0.5)℃,n=10]和低温[(33.5±0.5)℃,n=10]处理;同时设常温(n=8)和低温(n=8)对照.各组均监测4h血流动力学指标,观察48 h存活情况;取心肌组织进行病理学观察,检测细胞凋亡[原位末端缺刻标记法(TUNEL)];测定左室心尖组织ATP、ADP、AMP含量[高效液相色谱(HPLC)法],并计算心肌能荷(EC).结果 ①血流动力学:低温对照组和常温对照组比较,心率(HR)、左室压力下降最大速率(-dp/dt max)在基线后各时间段均有下降;左室压力上升最大速率(+dp/dt max)和平均动脉压(MAP)在0.5h有显著差异,而在其他时段均无差异;左室舒张期末压(LVEDP)、左室收缩期末压(LVESP)和股动脉收缩压(SBP)、舒张压(DBP)在各时间段均无显著差异.②复苏后低温组与复苏后常温组比较,HR(次/min)和-dp/dt max(mm Hg/s)在ROSC后0.5、1、2、3、4h均有下降(HR:216.5±33.3比292.9±38.4,218.2±28.0比294.3±37.0,227.5±25.4比291.4±25.3,232.4±27.4比278.1±30.8,230.6±22.0比285.1±38.2;-dp/dt max:1 847.1±241.2比2 383.3±470.9,1 860.7±167.8比2 154.6±319.5,1 822.3±389.7比2 239.7±379.0,1 950.6±412.9比2 229.6±392.4,1 875.7±555.6比2 396.7±420.1,均P＜0.05); LVEDP、+dp/dt max、LVESP、股动脉血压(SBP、DBP、MAP)在ROSC后各时间点均无显著差异.③复苏后低温组48h心肌组织形态损害较复苏后常温组轻.④复苏后低温组心肌细胞凋亡指数(AI)低于复苏后常温组(26.39％比42.02％,P＜0.05).⑤能量检测:复苏后低温组ATP含量(μmol/g)高于复苏后常温组(0.97±0.26比0.65±0.16,P＜0.05).复苏后常温组EC明显低于常温对照组和低温对照组[(0.33±0.13)％比(0.52±0.12)％、(0.55±0.06)％,均P＜0.05],而复苏后低温组EC[(0.41±0.12)％]与两对照组无显著差异.⑥复苏后低温组48 h存活率高于复苏后常温组(100％比60％,P=0.043).结论 室颤兔ROSC后存在心肌结构损害和心功能下降;轻度低温干预可降低48 h死亡率,其保护机制可能与抑制复苏后心肌细胞进一步的损害和凋亡有关;轻度低温对心功能无明显直接抑制,也不引起血流动力学恶化.     

Comparing the survival between extracorporeal rescue and conventional resuscitation in adult in-hospital cardiac arrests: Propensity analysis of three-year data

Aim

Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to have survival benefit over conventional CPR (CCPR) in patients with in-hospital cardiac arrest of cardiac origin. We compared the survival of patients who had return of spontaneous beating (ROSB) after ECPR with the survival of those who had return of spontaneous circulation (ROSC) after conventional CPR.

Methods

Propensity score-matched cohort of adults with in-hospital prolonged CPR (>10 min) of cardiac origin in a university-affiliated tertiary extracorporeal resuscitation center were included in this study. Fifty-nine patients with ROSB after ECPR and 63 patients with sustained ROSC by CCPR were analyzed. Main outcome measures were survival at hospital discharge, 30 days, 6 months, and one year, and neurological outcome.

Results

There was no statistical difference in survival to discharge (29.1% of ECPR responders vs. 22.2% of CCPR responders, p = 0.394) and neurological outcome at discharge and one year later. In the propensity score-matched groups, 9 out of 27 ECPR patients survived to one month (33.3%) and 7 out of 27 CCPR patients survived (25.9%). Survival analysis showed no survival difference (HR: 0.856, p = 0.634, 95% CI: 0.453-1.620) between the groups, either at 30 days or at the end of one year (HR: 0.602, p = 0.093, 95% CI: 0.333-1.088).

Conclusions

This study failed to demonstrate a survival difference between patients who had ROSB after institution of ECMO and those who had ROSC after conventional CPR. Further studies evaluating the role of ECMO in conventional CPR rescued patients are warranted.     

Acute exacerbation of interstitial lung disease in the intensive care unit: Principles of diagnostic evaluation and management

Interstitial lung disease (ILD) is typically managed on an outpatient basis. Critical care physicians manage patients with ILD in the setting of an acute exacerbation (ILD flare) causing severe hypoxia. The principles of management of acute exacerbation of ILD are different from those used to manage patients with acute respiratory distress syndrome from sepsis, etc. Selected patients may be candidates for aggressive measures like extracorporeal membrane oxygenation and lung transplantation, while almost all patients will benefit from early palliative care. This review focused on the types of ILD, diagnosis, and management pathways for this challenging condition.     

A moderate dose of propofol and rapidly induced mild hypothermia with extracorporeal lung and heart assist (ECLHA) improve the neurological outcome after prolonged cardiac arrest in dogs

BACKGROUND AND PURPOSE: Propofol has been shown to protect against neuronal damage induced by brain ischaemia in small animal models. We reported previously that mild hypothermia (33 degrees C) in combination with extracorporeal lung and heart assist (ECLHA) improved the neurological outcome in dogs with cardiac arrest (CA) of 15 min induced during normothermia. In the present study, we investigated the neuroprotective effect of propofol infusion under mild hypothermia with ECLHA in this model. METHODS: Twenty-one female dogs (15 mongrel dogs and 6 beagles) were divided into three groups: Midazolam 0.1 mg/(kg h) infusion group (M, n=7), Propofol 2 mg/(kg h) infusion group (P2, n=7), Propofol 4 mg/(kg h) infusion group (P4, n=7). Normothermic ventricular fibrillation (VF) was induced in all dogs for 15 min, followed by brief ECLHA and 168 h of intensive care. The drug infusion was initiated at a constant rate after the restoration of spontaneous circulation (ROSC) to 24 h. Mild hypothermia (33 degrees C) was maintained for 20 h. Neurological deficit scores (NDS: 0%=normal, 100%=brain death) were evaluated for neurological function from 33 to 168 h. RESULTS: One dog in the M group died, and the remaining dogs survived for 168 h. The P4 group showed better neurological recovery compared with the M group (48 h, 21+/-16% versus 32+/-15%; 72 h, 7+/-6% versus 25+/-11%; 96 h, 6+/-6% versus 21+/-6%; 120 h, 5+/-5% versus 20+/-6%; 144 h, 4+/-4% versus 20+/-6%; 168 h, 4+/-4% versus 20+/-6%, p<0.05). One dog in the P2 and three dogs in the P4 group achieved full neurological recovery (NDS: 0%). The number of intact pyramidal cells in the hippocampal CA1 was greater in the propofol groups than midazolam group (p<0.05). CONCLUSION: The combination of propofol infusion at a rate of 4 mg/(kg h), 24h and rapidly induced mild hypothermia (33 degrees C) with ECLHA might provide a successful means of cerebral resuscitation from CA.     

PDCA循环护理管理模式在胃癌根治手术护理中的应用效果及其对并发症发生的影响

目的探讨PDCA循环护理管理模式在胃癌根治手术护理中的应用效果及其对并发症发生的影响。方法选取2017年8月至2019年2月本院收治的86例行胃癌根治术的患者为研究对象,按照随机原则将其分成对照组与观察组,各43例。对照组给予常规胃癌根治术围手术期护理,观察组在对照组基础上采用PDCA循环护理管理模式,比较两组的胃肠功能指标、护理前、后3周生活质量及并发症发生情况。结果观察组的术后肠鸣音恢复时间、肛门排气恢复时间、饮食恢复时间及排便恢复时间均明显短于对照组,差异具有统计学意义(P<0.05)。护理前,两组的WHOQOL-BREF评分比较,差异无统计学意义(P>0.05);护理后3周,两组的WHOQOL-BREF评分均显著增高,且观察组高于对照组,差异具有统计学意义(P<0.05)。观察组的胃肠功能障碍、肺部感染、切口感染、吻合口瘘、压疮发生率均明显低于对照组,差异具有统计学意义(P<0.05)。结论PDCA循环护理管理模式可有效促进胃癌患者根治患者胃肠功能恢复,降低并发症发生率,提高患者术后生活质量,值得临床推广。     

The effects of graded administration of positive end expiratory pressure on the fluid filtration rate in isolated rabbit lungs,using normal lungs,hydrostatic oedema lungs and oleic acid induced oedema

The influence of positive end expiratory pressure (PEEP) on the fluid filtration rate (FFR) in the pulmonary circulation has been the subject of considerable investigation but data are conflicting. We studied twentynine isolated rabbit lung preparations, FFR was sensed by a force transducer. Autologous blood was used to prime the perfusion circuit. Hydrostatic oedema was achieved by increasing the left atrial pressure to 16 mmHg. In order to bring about increased membrane permeability oleic acid was injected through the pulmonary artery. Increasing and decreasing levels of PEEP at 0, 5, 10 and 15 cm H₂O were each used for ten minutes in each of three experimental models. The FFR, pH, mean pulmonary arterial pressure (MPAP), mean left atrial pressure (MLAP), PaO₂, PaCO₂ and oncotic pressure were measured in each experiment. There was a significant correlation between PEEP and FFR (+0.94) in non-oedema lungs. With no PEEP the FFR was 0 g/min and with 15 cm of PEEP it increased to 0.07 g/min, on removing the PEEP the FFR returned to 0 g/min. In the hydrostatic lung oedema model the correlation was also significant but negative (r=−0.94). With no PEEP the FFR was 0.33 g/min, with PEEP of 15 cm H₂O it decreased to 0.08 g/min. No correlation between PEEP and FFR was found in the oleic acid preparation. In the normal lung PEEP increases capillary hydrostatic pressure and total lung vascular area and decreases interstitial pressure. It is by these mechanisms that PEEP causes an increase in FFR. In the hydrostatic oedema model PEEP decreases FFR by increasing the interstitial pressure and by decreasing the total lung vascular area. In the oleic acid preparation the coefficient of filtration is so large that small changes in pressure or vascular area do not modify the FFR. We suggest that PEEP may be beneficial by decreasing FFR in hydrostatic lung oedema, but it may increase the FFR in the normal lung, while having no effect in oleic acid lung injury. This research has been partially supported by Conicit, Venezuela Grant N.S1-1378     

An experimental model for studying the effects of uridine and inosine on renal circulation and function in the rat

Summary The effects of uridine and inosine on blood pressure, renal plasma flow (RPF), intrarenal blood distribution, glomerular filtration rate (GFR) and serum and urine electrolytes were investigated in the rat. Uridine constantly produced an elevation in blood pressure, an increase in RPF and an even greater rise in GFR, resulting in a significant increase in FF which was due to a prevalent constriction of the efferent arterioles. Inosine produced a short-lived pressor effect followed by a more prolonged fall of blood pressure. RPF and GFR increased significantly and to a similar extent so that there was no change in FF. It is suggested that these two substances may be involved in the vasomotor control of the kidneys.     

肺表面活性物质对B型嗜血流感杆菌生长的影响

目的　评估肺表面活性物质固尔苏 (Curosurf)在体外实验中对B型嗜血流感杆菌 (Hib)生长的影响。方法　将Hib分别与生理盐水 (对照组 )及不同浓度的Curosurf (1 ,1 0 ,2 0mg/ml实验组 )在37℃条件下孵育 5h时 ,分别于 0、 1、 5h取出 0 1ml,系列稀释后接种到脑心浸液琼脂培养基上 ,置于37℃孵箱中孵育 2 4h后进行菌落计数。结果　随孵育时间延长 ,各组菌落计数均有下降 ,1mg/mlCurosurf组菌落数量下降较少 ,与对照组相比差异无显著性意义。 1 0 ,2 0mg/ml实验组菌落下降程度明显高于对照组 (P <0 0 1 )。结论　Curosurf在体外对B型嗜血流感杆菌生长有抑制作用 ;Curosurf的抑菌作用为剂量依赖类型。     

Immunologic and viral markers in the circulation of anti-HIV negative heroin addicts

Abstract. To assess the degree of immune system activation associated with addiction or hepatotropic viruses infection, we examined 60 HIV-negative heroin addicts for the presence of hepatitis B virus (HBV) infection markers, hepatitis C virus antibodies (anti-HCV), various auto-antibodies, and serum levels of soluble interleukin-2 receptors (sIL-2R). In addition, 28 anti-HCV positive patients comprising the disease control group, were also examined. Our results demonstrated a high prevalence of anti-HCV antibodies (61.7% and 90% with 1st and 2nd generation ELISA, respectively). Eighty-seven percent (87Yi) of the addicts positive for anti-HCV by the latter and 92.8% of the disease control patients, were also positive with 2nd generation recombinant immuno-blot assay (RIBA-II). In 88.9% of anti-HCV positive addicts, antibody to C22–3 was the predominant (anti-C33c in 81.5%). Antibodies to C33c and C22–3 polypeptides were also more frequent in disease control group (92.8% and 85.7%, respectively). Anti-HCV antibodies were associated with increased transaminases (ALT or AST, P<0.05), as well as with longer duration of addiction (P<0.005). HBV infection markers (HBsAg, anti-HBc only and anti-HBs) were also present in the addicts (5%, 28.3% and 26.7%, respectively). Rheumatoid factors (RF) were detected in 36.7%, antinuclear antibodies (ANA) in 11.7%, antibodies (IgG and/or IgM) against cardiolipin (anti-CL) and double stranded DNA (anti-ds DNA) in 20% and 50%, respectively. RF, ANA, anti-CL and anti-dsDNA antibodies were also detected in the disease control group (32.10/, 89.3%, 28.5% and 28.5% respectively). Auto-antibodies of at least one specificity, were found in 83.3% of addicts independently of anti-HCV antibodies, HBV infection markers, increased ALT or AST levels, and the duration of addiction. They were, on the other hand, associated in addicts with antibodies to the C22–3 polypeptide of HCV (P = 0.0001) and with both of the predominant antibodies (anti-C33c and anti-C22–3) of the HCV (P<0.01 and P<0.05 respectively) in the disease control group. Thirty-nine addicts (65%) and 50% of the disease control patients were found to have increased levels of sIL-2R. In contrast to the disease control group, serum sIL-2R levels of addicts were associated with RF (P<0.05), anti-dsDNA (P< 0.0005) and total auto-antibodies (P=0.0005), while there was a slight negative correlation with the duration of addiction (r= -0.26, P<0.05). However, sIL-2R levels, were not associated with HBV and HCV infection markers in both groups. We conclude that intravenous heroin addiction appears to be associated with an increased prevalence of HCV and non-organ specific auto-antibodies. The latter may be driven by C22–3 and C33c polypeptides of HCV. Increased sIL-2R levels attest to a cellular immune activation in addicts, which is slightly correlated with shorter duration of addiction, independently of HCV or HBV, but in association with auto-antibodies production.     

高容量血液滤过对早期感染性休克猪复苏液体量和血管活性药物用量的影响

目的了解高容量血液滤过（ HVHF）对感染性休克早期液体复苏所需液体量和维持血压所需血管活性药物用量的影响。方法给予18只健康猪静脉输注内毒素50μg/kg诱导感染性休克模型,制模成功后随机分为三组（每组6头）：对照组、常规流量血液滤过组（ NVHF组）和HVHF组,均给予机械通气。感染性休克模型建立后每组均应用乳酸林格液液体复苏,以每搏输出量变异率（ SVV）＜10％作为液体复苏终止指标,之后静脉输注乳酸林格液保持SVV＜10％,如平均动脉压（ MAP ）仍未达到基础值的90％以上,予持续静脉泵入去甲肾上腺素维持MAP在基础值90％以上,记录实验开始后基础、成模及治疗1、2、3、4、5、6 h血流动力学指标和治疗期间维持SVV＜10％,以及MAP达到基础值90％以上各组乳酸林格液用量和去甲肾上腺素用量。结果与对照组比较,HVHF组在开始治疗1 h后维持SVV＜10％所需乳酸林格液用量明显减少（ P＜0.05）, NVHF组在1、3、4 h维持SVV＜10％所需乳酸林格液用量较对照组明显减少（ P＜0.05）;与NVHF组比较,血液滤过治疗2 h后,HVHF组维持SVV＜10％所需乳酸林格液用量明显减少（P＜0．05）;与对照组和NVHF组比较,血液滤过治疗4 h后,HVHF组维持MAP所需去甲肾上腺素用量明显减少（P＜0．05）,而NVHF组与对照组比较差异无统计学意义。结论早期应用HVHF治疗感染性休克能够明显减少猪复苏液体量和去甲肾上腺素用量。     

A pilot study examining the role of regional cerebral oxygen saturation monitoring as a marker of return of spontaneous circulation in shockable (VF/VT) and non-shockable (PEA/Asystole) causes of cardiac arrest

Background

Non-invasive monitoring of cerebral perfusion and oxygen delivery during cardiac arrest is not routinely utilized during cardiac arrest resuscitation. The objective of this study was to investigate the feasibility of using cerebral oximetry during cardiac arrest and to determine the relationship between regional cerebral oxygen saturation (rSO2) with return of spontaneous circulation (ROSC) in shockable (VF/VT) and non-shockable (PEA/asystole) types of cardiac arrest.

Methods

Cerebral oximetry was applied to 50 in-hospital and out-of-hospital cardiac arrest patients.

Results

Overall, 52% (n = 26) achieved ROSC and 48% (n = 24) did not achieve ROSC. There was a significant difference in mean ± SD rSO2% in patients who achieved ROSC compared to those who did not (47.2 ± 10.7% vs. 31.7 ± 12.8%, p < 0.0001). This difference was observed during asystole (median rSO2 (IQR) ROSC versus no ROSC: 45.0% (35.1–48.8) vs. 24.9% (20.5–32.9), p < 0.002) and PEA (50.6% (46.7–57.5) vs. 31.6% (18.8–43.3), p = 0.02), but not in the VF/VT subgroup (43.7% (41.1–54.7) vs. 42.8% (34.9–45.0), p = 0.63). Furthermore, it was noted that no subjects with a mean rSO2 < 30% achieved ROSC.

Conclusions

Cerebral oximetry may have a role as a real-time, non-invasive predictor of ROSC during cardiac arrest. The main utility of rSO2 in determining ROSC appears to apply to asystole and PEA subgroups of cardiac arrest, rather than VF/VT. This observation may reflect the different physiological factors involved in recovery from PEA/asytole compared to VF/VT. Whereas in VF/VT, successful defibrillation is of prime importance, however in PEA and asytole achieving ROSC is more likely to be related to the quality of oxygen delivery. Furthermore, a persistently low rSO2 <30% in spite of optimal resuscitation methods may indicate futility of resuscitation efforts.     

严重多发伤患者血浆肠脂肪酸结合蛋白水平变化及其与胃肠功能障碍的关系

目的探讨严重多发伤患者血浆肠脂肪酸结合蛋白(iFABP)水平变化及其与创伤后胃肠功能障碍的关系。方法36例多发伤患者分为轻伤组(ISS评分<16分,15例)和重伤组(ISS评分>16分,21例),再根据是否并发胃肠功能障碍分为胃肠功能障碍组(32例)和非胃肠功能障碍组(4例),另10例择期手术者为正常对照组。正常对照组采外周静脉血1次,多发伤患者分别于伤后第1、3、5天采外周静脉血3次,采用酶联免疫吸附测试法检测iFABP。结果与正常对照组相比,轻伤组和重伤组血浆iFABP水平于伤后第1天即显著升高(P<0.01),且重伤组显著高于轻伤组(P<0.01),随后iFABP水平逐渐下降,轻伤组于第5天恢复至正常水平,而重伤组仍显著高于正常对照组(P<0.01);胃肠功能障碍组伤后第1天血浆iFABP水平显著高于非胃肠功能障碍组(P<0.01),其差异一直持续到创伤后第5天。多发伤后第1、3、5天血浆iFABP水平与胃肠功能障碍评分均有相关性。结论严重多发伤后早期血浆iFABP水平显著升高,其水平变化与创伤严重程度和胃肠功能障碍程度呈正相关,这种变化可能对创伤后胃肠功能障碍的早期预测有较重要意义。