心脏瓣膜置换术患者在麻醉手术期间血浆儿茶酚胺和血流动力学变化

采用高效液相色谱-电化学检测方法及Ｓｗａｎ－Ｇａｎｚ导管技术。对２４例心脏瓣膜置换术患者检测麻醉手术期间血浆儿茶酚胺（ＣＡ）和血流动力学的变化。结果提示，这类患者麻醉前血浆ＣＡ增高，可反映血流动力学的受累程度；由于心肺转流（ＣＰＢ）期间和 ＣＰＢ后的影响因素较多，血浆 ＣＡ水平不能完全反映血流动力学的变化；循环功能的维持有赖于多种因素的综合作用。     

心脏瓣膜置换术患者在麻醉手术期间血浆儿茶酚胺和血流动力学…

采用高效液相色谱－电化学检测方法及Ｓｗａｎ－Ｇａｎｚ导管技术，对２４例心脏瓣膜置换术患者检测麻醉手术期间血浆儿茶酚胺（ＣＡ）和血流动力学的变化。结果提示，这类患者麻醉前血浆ＣＡ增高，可反映血流动力学的受累程度；由于心肺转流（ＣＰＢ）期间和ＣＰＢ后的影响因素较多，血浆ＣＡ水平不能完全反映血流动力学变化；循环功能的维持有赖于多种因素的综合作用。     

脑动脉瘤病人血浆弹性蛋白酶水平分析

目的　探讨血浆中多形核嗜中性白细胞（ Ｐ Ｍ Ｎ） 弹性蛋白酶与脑动脉瘤发病的相关性。方法　应用 Ｅ Ｌ Ｉ Ｓ Ａ 方法检测１９ 例脑动脉瘤病人（ 破裂组１３ 例,未破裂组６ 例） 及１７ 例非血管性颅内病变病人血浆 Ｐ Ｍ Ｎ 弹性蛋白酶水平。结果　脑动脉瘤组血浆 Ｐ Ｍ Ｎ 弹性蛋白酶水平明显高于对照组（ Ｐ ＝ ０ ．０４７） 。破裂组与未破裂组血浆 Ｐ Ｍ Ｎ 弹性蛋白酶水平差异无显著性（ Ｐ ＞ ０ ．０５） 。结论　血浆 Ｐ Ｍ Ｎ 弹性蛋白酶水平增高与脑动脉瘤发生之间存在相关性。     

早期液体复苏对感染性休克患者血流动力学的影响

目的 分析早期液体复苏对感染性休克患者血流动力学的影响。方法 选取2011年1月至2012年4月我院ICU收治的26例感染性休克患者作为研究对象,随机分为对照组和试验组,各13例。两组患者均采用PICCO监测,并根据早期复苏目标导向疗法（early goal directed therapy,EGDT）进行早期液体复苏治疗。对照组和试验组复苏液分别为林格液和6%羟乙基淀粉130/0.4氯化钠溶液。分别于复苏开始时（0 h）、8 h和24 h收集患者的血流动力学参数。结果 试验组和对照组的CVP、CI、ITBVI及GEDVI水平均随着时间的增加上升（P＜0.05）,但EVLWI在对照组明显增加（P＜0.05）,而试验组无明显变化。除试验组EVLWI外,与开始复苏（0 h）相比较,试验组和对照组的CVP、CI、ITBVI、GEDVI及对照组的EVLWI与开始复苏（0 h）相比较均有明显差异（P＜0.05）。经重复测量资料的方差分析发现,试验组CVP和GEDVI较对照组上升水平明显,对照组EVLWI较试验组上升水平明显,差异均具有统计学意义（P＜0.05）。结论 感染性休克患者根据EGDT方案使用6%羟乙基淀粉130/0.4氯化钠溶液进行复苏,能更好地改善患者的血流动力学指标。     

常温体外循环期间血浆ET,ANP及血流动力学的变化

采用Ｓｗａｎ－Ｇａｎｚ导管技术和放射免疫检测方法对比研究了常温和低温体外循环（ＣＰＢ）对犬血流动力学及血浆内皮素（ＥＴ）和心钠素（ＡＮＰ）的影响。结果显示：低温ＣＰＢ期间外周循环总阻力（ＴＰＲ）明显高于常温ＣＰＢ间，并伴有血浆ＥＴ水平显著增高；ＣＰＢ期间血浆ＡＮＰ几无明显变化。血浆ＥＴ水平与ＴＰＲ是正相关；但ＡＮＰ与ＴＰＲ无相关性。结果提示，低温ＣＰＢ期间血浆ＥＴ增加是ＴＰＲ增高的原因之一；常温Ｃ     

肾病综合征出血热肾血流动力学及形态学改变的超声对照分析

目的观察。肾病综合征出血热（HFRS）病程中形态学改变与血流动力学改变的规律。方法用彩色多普勒超声仪对198例经血清学证实为HFRS患者病程中。肾内动脉的血流频谱及血流量与150例正常人对照。形态学通过二维声像图观察肾脏体积、肾实质厚度、椎体回声的改变。结果发热期、恢复期各级肾动脉血流频谱各项参数与正常对照组比较，均未见统计学差异（P〉0．05）。低血压休克期、少尿期、多尿期各级肾动脉阻力指数明显高于正常组（P〈0．01），收缩期峰值流速、舒张期末血流速度在低血压休克期、少尿期、多尿期低于对照组（P〈0．05）。低血压休克期、少尿期、多尿期肾脏形态学改变与正常组比较体积明显增大、肾实质明显增厚、椎体回声减低，部分可见肾包膜下出血。结论HFRS病程中各期形态学和各级肾血流动力学改变存在着规律性变化，形态学与肾血流动力学变化相结合动态观察为临床医师提供了解肾脏病情进展情况，可检测治疗效果，对评估预后发展提供了重要依据。     

不同升压药物对感染性休克患者血乳酸及预后影响的比较

目的：探讨不同升压药物对感染性休克患者血乳酸及预后的影响。方法收集本科室收治的感染性休克患者共80例,随机分为两组,其中一组患者使用多巴胺（DA）治疗（DA组,40例）;另一组使用去甲肾上腺素（NA）治疗（NA组,40例）,两组患者液体复苏及一般治疗方法无差异。用药8 h后,观察两组患者血流动力学、血乳酸、乳酸清除率及病死率。结果治疗8 h后,两组患者的心率增快及平均动脉压（MAP）升高的程度无统计学差异（P均＞0.05）。治疗8 h后NA组的乳酸清除率显著大于DA组（χ2=4.206,P＜0.05）。DA组病死率高于NA组,差异具有统计学意义（χ2=5.41,P＜0.05）。结论 NA和DA对维持感染性休克患者血流动力学稳定均有效,NA能更有效地清除血乳酸及降低患者的病死率。     

经皮肾镜碎石术后发生感染性休克28例分析

目的：分析经皮。肾镜碎石术（PCNL）后并发感染性休克的原因和防治措施。方法：回顾性分析2008年6月～2012年6月间行PCNI。后发生感染性休克28例患者的临床资料：男18例,女lO例。明确感染性休克诊断后立即行抗休克治疗,维持血容量和血流动力学稳定,同时行经验性抗感染治疗。结果：所有患者血压皆在24～96小时内逐渐恢复正常,术后3～6天内体温、血常规恢复正常。术后14天内均治愈出院。结论：感染性休克是PCNL后的一个严重并发症,术前采用抗生素有效抗感染、术中低压灌注并缩短手术时间、术后加强生命体征监测,可有效防治感染性休克的发生。     

小剂量血管加压素在感染性休克中的应用进展

血管加压素应用于感染性休克可以改善组织灌注,稳定血流动力学.它的主要作用机制是在感染性休克状态下,血浆血管加压素水平的相对性缺乏与血管对血管加压素的敏感性增强.目前研究主张小剂量血管加压素与其他血管活性药物联合使用治疗感染性休克,由于缺乏临床多中心随机对照研究,血管加压素仍是感染性休克的二线升压药.     

肝门阻断开放后血流动力学和动脉血气变化

观察了２０例肝手术患者肝门阻断（ＰＴＯ）及开放（ＰＴＲ）的血流动力学及动脉血气变化。结果：血流动力学及动脉血气指标ＰＴＯ期间均有较明显改变，但ＰＴＲ后分别于３０ｍｉｎ，６０ｍｉｎ内恢复至阻断前水平。表明肝门阻断术在临床中应用是安全可靠的。     

Elevated methemoglobin in patients with sepsis

Background: It has been reported that large amounts of nitric oxide (NO) are released in patients with sepsis. NO is converted to methemoglobin and nitrate. This study was designed to determine whether blood methemoglobin levels were increased in patients with sepsis or septic shock.
Methods: Forty-five critically ill patients including 8 with sepsis but without shock, 6 with septic shock and 31 non-septic patients were enrolled in the study. For septic and septic shock patients, blood methemoglobin concentrations were measured during sepsis or septic shock and at the time of recovery or just before the onset of sepsis. For the remaining non-septic patients, methemoglobin concentrations were measured at ICU admission and discharge.
Results: Blood methemoglobin levels in the presence of sepsis or septic shock were significantly ( P <0.05) higher than those in non-septic patients and those at recovery or just before the onset of sepsis in both septic and septic shock patients.
Conclusions: Blood methemoglobin concentration may be useful as a marker of the onset of sepsis or septic shock.     

丙酮酸乙酯对脓毒症休克犬肠黏膜屏障功能的保护作用

目的探讨丙酮酸乙酯（EP）对脓毒症休克犬肠黏膜屏障功能的影响。方法健康雄性杂种犬20只，内毒素（LPS）静脉注射复制犬脓毒症休克模型，随机分为对照组（8只）和EP组（12只）。对照组只接受林格液复苏。EP组另外给予丙酮酸乙酯首剂0．05g／kg．然后按0．05g·kg^-1·h^-1持续泵入。脓毒症休克模型建立前及建立后0、8、12和24h取血测定血浆二胺氧化酶（DAO）活性和血浆D-乳酸含量，试验24h处死动物后取小肠标本，进行肠黏膜炎性损伤病理学评分。结果EP组犬的肠黏膜炎性损伤程度病理学评分为2．33±0．25，明显轻于模型组的3．39±0．38，两组比较，差异有统计学意义（P〈0．05）。两组实验犬在休克后血浆D-乳酸含量和DAO活性逐渐升高，对照组较EP组升高更为明显（P〈0．05）。结论EP能显著改善肠组织灌流及功能指标，减轻肠黏膜的病理损害，对脓毒症休克时小肠有保护作用。     

Comparison of the postoperative changes in the humoral and cellular immune activity in septic and non-septic colorectal cancer patients

The effect of sepsis on the host resistance of 34 colorectal cancer patients with normal preoperative immune reactivity was studied. A significant change (p less than 0.01) was found in the IgG level of the septic patients (n = 13) when comparing their values with those of the non-septic patients (n = 21), on the third and 7th days postoperatively. There was no appreciable change in the IgA and IgM levels. The E rosette formation and the blast transformation values of the patients showed a marked decrease on the 7th day postoperatively. In the non-septic patients the normal initial values reappeared on the 10th postoperative day, while in the septic cases they significantly decreased as compared to both their own values and to those of the non-septic patients assessed during the same period (p less than 0.05). The possible factors serving for the prevention of decrease in the resistance of the host organism, are discussed.     

Predictors of septic shock in obstructive acute pyelonephritis

Purpose

Acute pyelonephritis (APN) with obstructive uropathy is not uncommon and often causes serious conditions including sepsis and septic shock. We assessed the risk factors for septic shock in patients with obstructive APN associated with upper urinary tract calculi.

Methods

We retrospectively studied 69 patients with obstructive APN associated with upper urinary tract calculi who were admitted to our hospital. Emergency drainage for decompression of the renal collecting system was performed for empirical treatment in cases of failure of initial treatment and for severe cases. We assessed the risk factors for septic shock by multivariate logistic regression analysis.

Results

Overall, 45 patients (65.2 %) underwent emergency drainage and 23 (33.3 %) patients showed septic shock. Poor performance status and the presence of diabetes mellitus (DM) in the septic shock group were more common than in the non-septic shock group (p = 0.012 and p = 0.011, respectively). The platelet count and serum albumin level in the septic shock group were significantly lower than in the non-septic shock group (p = 0.002 and p = 0.003, respectively). Positive rates of midstream urine culture and blood culture in the septic shock group were significantly higher than in the non-septic shock group (p = 0.022 and p = 0.001, respectively). Multivariate analysis showed that decreases in the platelet count (OR 5.43, p = 0.014) and serum albumin level (OR 5.88, p = 0.023) were independent risk factors for septic shock.

Conclusion

Patients with obstructive APN associated with upper urinary tract calculi who have decreases in platelet count and serum albumin level should be treated with caution against the development of septic shock.     

Clinical and experimental studies on the role of platelet-activating factor (PAF) in the pathogenesis of septic DIC

Various toxic factors induced by endotoxin (Et) are thought to be deeply involved in the pathogenesis of severe infections. In this study, particular attention was paid to the role of the platelet-activating factor (PAF) in these conditions, and clinical and experimental studies were conducted on the relationship between PAF and the changes observed in the general parameters after surgical infections. In the clinical study, changes in the PAF concentration in the blood of seven patients with disseminated intravascular coagulation (DIC), five of whom were septic and two non-septic, were monitored by gas/mass spectrometry. The mean PAF level in the septic DIC group tended to be higher than that in the non-septic DIC group. Moreover, in the septic DIC group, the relationship between the increase in the PAF level and platelet count was analyzed with the lapse of time and we surmised a negative correlation between these parameters.Experimentally, we also investigated the role of PAF in Et shock and the effect of an anti-PAF agent and protease inhibitor. The Et-induced fall in blood pressure was similarly prevented by both the anti-PAF agent and protease inhibitor. However, the decrease in the platelet count was more significantly inhibited by the anti-PAF agent than by the protease inhibitor, whereas the parameters of the blood coagulation/fibrinolysis system were more affected by the protease inhibitor than by the anti-PAF agent.     

Hyaluronan in sepsis

Abstract: Sepsis and septic shock are important causes of morbidity and mortality in the intensive care unit (ICU). Mortality rates in septic shock are estimated to be 40-5O%, in spite of modrn intensivc care. Death is commonly caused by cardiovascular collapse and multiple organ dysfunction syndrome (MODS). Hepatic dysfunction is a common component of MODS. and can have a major impact on prognosis and survival. Sepsis is, among other derangements, also accompanied by disturbed tissue water homeostasis with increased extravasation of water resulting in tissue oedema. Hyaluronan is an interstitial macromolecule that participates in the regulation of tissue hydration. It is normally present in small concentrations in the blood, and is rapidly cleared from the blood by the liver endothelial cells. The synthesis of hyaluronan can be stimulated by inflammatory mediators. Thus sepsis and hyaluronan turnover could interact in many ways. The aim of the present investigations was to study possible changes in circulating hyaluronan concentrations in relation to sepsis and septic shock. Plasma levels of hyaluronan were studied in 44 patients with infections and septic shock. Increased plasma concentrations were found, and the increase correlated to disease severity and outcome. In experimentally induced sepsis in pigs, an increase in circulating concentrations was found, and a relation to haemodynamic instability and outcome was seen. A moderate increase in blood hyaluronan concentrations was seen after surgical trauma in both humans and pigs. Crystalloid infusion therapy also caused a small increase in plasma hyaluronan concentrations in healthy volunteers, probably through an increased washout of interstitital hyaluronan. The hepatic turnover of hyaluronan was studied in septic shock patients. Low extraction ratios at high circulating concentrations were found, suggesting a reduced capacity of hepatic uptake and an increased inflow to the circulation. The kinetics of plasma turnover of hyalurorian were studied in septic and non-septic ICU patients. A prolonged half-life was seen among the septic patients, suggesting a reduced clearance capacity. In conclusion, sepsis is accompanied by increased circulating hyaluronan concentrations. The magnitude of thc increase seems to correlate to disease severity and outcome. The cause of this increase is suggested to be both reduced hepatic uptake function, and increased input to the circulation. The relative contribution of these mechanisms, and the possible clinical utility of plasma hyaluronan measurements, remain to be determined.     

Matrix metalloproteinase-9 concentrations in critically ill patients

Matrix metalloproteinase-9 is involved in the processing of cytokines during sepsis. We studied 10 critically ill patients within 12 h of fulfilling the American Consensus Conference criteria for severe sepsis and compared the results with 12 critically ill non-septic control patients and eight healthy subjects. Total matrix metalloproteinase-9 concentrations were measured on days 1, 2 and 3. The median admission Acute Physiological and Chronic Health Evaluation II score was 19.5 (range 13-27) in the septic patients and 20.5 (range 7-28) in the non-septic patients. Four patients from each group died within 28 days. Matrix metalloproteinase-9 concentrations were elevated significantly in both groups of patients compared with healthy subjects (p = 0.0004) but there was no difference between patients with and without sepsis. Matrix metalloproteinase-9 levels did not change with time, and there was no difference between survivors and those who died. We conclude that matrix metalloproteinase-9 represents a non-specific marker of systemic inflammation.     

sRAGE is elevated in septic patients and associated with patients outcome

BACKGROUND: (1) To evaluate in septic patients the plasma levels of soluble receptor for advanced glycation end products (sRAGE), a soluble splice variant of the full length receptor RAGE, which is involved in acute inflammation (2) to determine whether sRAGE could be used as a potential diagnostic and prognostic marker in sepsis in the surgical intensive care unit. MATERIALS AND METHODS: An observational clinical noninterventional pilot study in a surgical intensive care unit with patients admitted to the intensive care unit over a 6-mo period with clinical evidence of severe sepsis or septic shock. RESULTS: Twenty-nine intensive care patients were enrolled in the study within the first 24 h after onset of severe sepsis or septic shock. Eight healthy volunteers served as controls. Plasma sRAGE concentrations were elevated in septic patients compared with healthy volunteers (1764 +/- 138 versus 1026 +/- 177 pg/mL, P < 0.05). Additionally, nonsurvivors after 28 days have had higher plasma sRAGE concentrations than survivors (2302 +/- 189 versus 1326 +/- 112 pg/mL, P < 0.001). Receiver operating characteristic curve analysis of plasma sRAGE concentrations of septic patients showed a specificity of 75% and a sensitivity of 84.6% with 1596 pg/mL as cutoff. CONCLUSIONS: This is the first study showing elevated plasma sRAGE concentrations in septic patients. It is noteworthy that nonsurvivors had higher plasma sRAGE concentrations than survivors, suggesting that sRAGE is related to severity and outcome of septic patients. Further clinical studies are required to investigate the usefulness of sRAGE as a new sepsis marker.     

Changes in platelet aggregation, TXB2 and 6-keto-PGF1 alpha in surgical shock

Platelet aggregation rate (PAR), plasma concentration of TXB2 and 6-Keto-PGF1 alpha were measured in 26 patients with shock (hypovolumic shock 10 and septic shock 16) and 10 controls. PAR, plasma TXB2 and 6-Keto-PGF1 alpha were increased during shock, with TXB2 increased more significantly than 6-Keto-PGF1 alpha, accordingly the TXB2/6-Keto-PGF1 alpha ratio were raised during shock, especially in the septic cases. PAR, plasma TXB2 and 6-Keto-PGF1 alpha will decrease while shock become subsiding, and elevate while shock become irreversible. As a rule, the change of PAR is parallel with the concentration of plasma TXB2. The speed of platelet aggregation and plasma TXB2 concentration were higher in eleven mortal cases.     

Effect of an endotoxin-removing column containing immobilized polymyxin B fiber in a patient with septic shock from gram-positive infection

A 67-yr-old patient with septic shock caused by gram-positive infection fell into circulatory collapse. Direct hemoperfusion with an endotoxin-removing column was then carried out for 120 min. As a result, blood pressure and systemic vascular resistance increased significantly during this therapy. Cardiac output changed from hyperdynamic to normodynamic, and plasma endotoxin level decreased. After this treatment, the patient recovered. From this experience, we consider that the endotoxin-removing column may be effective for septic shock patients.