Effect of high-dose dexamethasone on perioperative lactate levels and glucose control: a randomized controlled trial

IntroductionBlood lactate levels are increasingly used to monitor patients. Steroids are frequently administered to critically ill patients. However, the effect of steroids on lactate levels has not been adequately investigated. We studied the effect of a single intraoperative high dose of dexamethasone on lactate and glucose levels in patients undergoing cardiac surgery.MethodsThe Dexamethasone for Cardiac Surgery (DECS) trial was a multicenter randomized trial on the effect of dexamethasone 1 mg/kg versus placebo on clinical outcomes after cardiac surgery in adults. Here we report a pre-planned secondary analysis of data from DECS trial participants included at the University Medical Center Groningen. The use of a computer-assisted glucose regulation protocol—Glucose Regulation for Intensive care Patients (GRIP)—was part of routine postoperative care. GRIP aimed at glucose levels of 4 to 8 mmol/L. Primary outcome parameters were area under the lactate and glucose curves over the first 15 hours of ICU stay (AUC₁₅). ICU length of stay and mortality were observed as well.ResultsThe primary outcome could be determined in 497 patients of the 500 included patients. During the first 15 hours of ICU stay, lactate and glucose levels were significantly higher in the dexamethasone group than in the placebo group: lactate AUC₁₅ 25.8 (13.1) versus 19.9 (11.2) mmol/L × hour, P <0.001 and glucose AUC₁₅ 126.5 (13.0) versus 114.4 (13.9) mmol/L × hour, P <0.001. In this period, patients in the dexamethasone group required twice as much insulin compared with patients who had received placebo. Multivariate and cross-correlation analyses suggest that the effect of dexamethasone on lactate levels is related to preceding increased glucose levels. Patients in the placebo group were more likely to stay in the ICU for more than 24 hours (39.2%) compared with patients in the dexamethasone group (25.0%, P = 0.001), and 30-day mortality rates were 1.6% and 2.4%, respectively (P = 0.759).ConclusionsIntraoperative high-dose dexamethasone increased postoperative lactate and glucose levels in the first 15 hours of ICU stay. Still, patients in the dexamethasone group had a shorter ICU length of stay and similar mortality compared with controls.

Trial registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00293592","term_id":"NCT00293592"}}NCT00293592. Registered 16 February 2006.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-015-0736-9) contains supplementary material, which is available to authorized users.     

异基因外周血干细胞移植患者人类白细胞抗原B27的表达

目的:分析白血病患者行异基因外周血干细胞移植后人类白细胞抗原B27的表达特点,及其与慢性移植物抗宿主病的关系。方法:选择2003-09/2006-06在广西医科大学第一附属医院行异基因外周血干细胞移植术的45例白血病患者,按《血液病诊断和疗效标准》进行疾病的诊断和分型。全部患者均知情同意并签署知情同意书。男27例,女18例,22～51岁。其中急性髓细胞白血病13例、急性淋巴细胞白血病17例、慢性粒细胞白血病15例。供者均为白细胞抗原配型6个位点全相合的同胞兄妹。急性髓细胞白血病和慢性粒细胞白血病患者采用BU/CY方案:马利兰4mg/(kg·d)×4d,环磷酰胺60mg/(kg·d)×2d;急性淋巴细胞白血病患者预处理采用TBI/CY方案:全身照射5.0Gy/d×2d,环磷酰胺60mg/(kg·d)×2d。供者采用粒细胞集落刺激因子皮下注射动员干细胞。采用美国Baxter CS-3000plus血细胞分离机采集外周血干细胞,每位供者采集0, 1, 2d3次。回输单个核细胞、粒-单核系集落形成单位、CD34 细胞。采用流式细胞术动态检测45例白血病患者异基因外周血干细胞移植前后人类白细胞抗原B27表达的变化。结果:45例患者全部进入结果分析。①45例患者均获得造血重建,经荧光标记PCR短串联重复序列DNA位点分析,全部患者移植后血细胞的DNA与供者血细胞DNA完全一致。发生急性移植物抗宿主病4例,慢性移植物抗宿主病14例,出血性膀胱炎3例,肝静脉闭塞病4例。②移植后发生慢性移植物抗宿主病患者人类白细胞抗原B27表达水平明显低于无移植物抗宿主病患者[移植后180d:(30.13±10.24)%,(39.61±10.89)%;移植后峰值:(33.53±10.36)%,(45.76±12.09)%,P<0.05]。③移植前未缓解白血病患者人类白细胞抗原B27表达水平则明显高于移植前达到完全缓解患者[(27.39±10.31)%,(16.62±8.58)%,P=0.005],移植后疾病复发患者复发时人类白细胞抗原B27表达水平明显高于其移植后完全缓解时[(27.76±10.09)%,(15.69±6.98)%,P=0.015]。移植前未缓解和移植后复发患者人类白细胞抗原B27表达水平与肿瘤细胞占骨髓非红系细胞的百分比呈正相关关系(r=0.756,P=0.000)。结论:移植前未缓解和移植后复发白血病患者人类白细胞抗原B27表达与肿瘤细胞占骨髓非红系细胞的百分比呈正相关,人类白细胞抗原B27表达水平随着肿瘤细胞百分比的增高而升高。     

微波直接接触辐射器临床应用的生物学效能

目的:评定微波直接接触辐射器临床应用的生物学效能。方法:动物实验于2004-09/2005-01在武汉市武昌铁路医院动物实验室完成。选择健康大耳白兔30只,按随机数字表法分为3组:对照组、直接接触辐射组、近场辐射组,每组10只。对照组:不做任何处理。直接接触辐射组:采用自制圆盘形直接辐射器(直径10.3m,频率915MHz,功率0～10W,天线为微带型,单元结构,驻波系数<3,专利号zl00324703.1)紧贴皮毛照射左侧桡骨骨折处,设定时间10min,功率5W,温度5～10℃,1次/d,10次为1个疗程,休息3d,再进行下一疗程,共3个疗程。近场辐射组:采用WR-Ⅱ型微波治癌机配备的圆柱形近场辐射器,距皮毛5cm,功率50W,时间为30min,温度5～10℃,1次/d,10次为1个疗程,休息3d,再进行下一疗程,共3个疗程。每周拍摄左前肢桡骨X射线片。每天进行临床一般检查,定期测定血清总蛋白、球蛋白、补体C3,观察全身状态。临床观察于2005-02/07选择武汉市武昌铁路医院门诊及住院患者402例,接受体表圆盘形直接辐射器理疗患者300例,为实验组,接受体表圆柱形近场辐射理疗患者102例,为对照组。实验组颈椎病患者:5min/次,功率2～6W,隔日1次,5次为1个疗程;急性创伤患者:骨折需固定术后24h方可进行理疗,8～10min/次,功率10W,10次为1个疗程;慢性腰腿痛患者:10～15min/次,功率10～15W,10次为1个疗程。对照组患者:治疗时间30min/次,治疗功率50～100W,治疗方法:距患部3～5cm。结果:动物实验结果:①直接接触辐射组、近场辐射组兔骨折愈合过程明显缩短。②X射线片显示直接接触辐射组、近场辐射组骨痂生成较对照组提前14d。③组织学观察直接接触辐射组、近场辐射组镜下见大片软骨组织及成骨细胞明显增生活跃,大片状骨小梁排列成网架状;对照组镜下见软骨组织成成骨细胞增生不活跃。④直接接触辐射组、近场辐射组疗效比较无差异,与对照组比较差异显著。⑤直接接触辐射组出现的副作用少于近场辐射组。⑥直接接触辐射组血清总蛋白、γ-球蛋白、补体C3含量高于近场辐射组和对照组。临床观察结果:①临床观察:急性期一期愈合患者占90%,慢性期患者症状减轻、缓解好转占80%。②疗效比较:实验组、对照组患者功能部分恢复,主要体征消失,症状缓解分别为284,96例,功能症状、体征与治疗前无好转变化分别为16,6例,治疗有效率分别为94.74%,93.75%。③副作用:实验组、对照组患者出现头昏症状分别为5,0例,出现胸闷症状分别为0,8例,出现失眠症状分别为0,2例,出现月经不调症状为0,2例,反应率分别为1.6%,21.5%。结论:微波直接接触辐射器临床使用的生物学效能优于近场辐射器,减少副作用、提高效率、节能、省时。     

Mechanisms of adenosine 5'-monophosphate catabolism in human erythrocytes

Uncertainties regarding the role of pyrimidine nucleotidase (PyrNase) in AMP catabolism were resolved by studies of erythrocytes from normal controls, controls with young mean cell ages, and patients with hereditary hemolytic anemia due to severe deficiency of PyrNase. Hemolysates from the latter exhibited undiminished capacity to dephosphorylate AMP over a broad range of pH, indicating that PyrNase was not directly involved. In each subject group, the rates of AMP dephosphorylation between pH 5.1 and 8.3 were indistinguishable from those of IMP, suggesting a potential role for AMP-deaminase, an erythrocyte enzyme that was stimulated by coformycin at pH 7.2. Quantitative analysis of catabolites in incubated hemolysates confirmed that AMP degradation preferentially occurred via deamination to IMP with subsequent dephosphorylation by another erythrocyte nucleotidase isozyme, deoxyribonucleotidase. Both AMP-deaminase and deoxyribonucleotidase have acidic pH optima with minimal activities at physiologic pH, suggesting that this pathway of AMP catabolism could accelerate depletion of the adenine nucleotide pool and thereby mediate the demise of senescent erythrocytes sequestered in the spleen.     

颈动脉海绵窦瘘12例的眼部表现

0　引言　颈动脉海绵窦瘘 (CCF)是眼科和神经外科较为常见的一种颅内动、静脉直接交通 ,眼部症状和体征在本症中尤其突出 .临床上只要及时发现 ,正确诊断 ,治疗恰当 ,均能获得理想效果 .我院自 1998- 0 1/ 1999- 0 2共收治 CCF患者 12例 ,经介入治疗后效果十分满意 .1　对象和方法　 CCF患者 12 (男 8,女 4)例 ;年龄 9～ 6 8岁 ,单侧 11例 ,双侧 1例 ;有外伤史者 11例 ,伤后有昏迷史者 10例 ,伴有骨盆骨折 3例 ,腰椎骨折等 8例 ,病史 1～ 5 2 d.全部患者均主诉颅内“飕飕样”杂音 ,夜间尤甚 . 8例伤后头痛 ,严重鼻衄 1例 ,视物模糊 11例…     

Venous renal tumor extension: a prospective US evaluation

To evaluate the ability of ultrasonography (US) to determine venous tumor extension, we studied 120 consecutive patients with renal neoplasms. The incidence of renal vein involvement in this group was 18%; caval tumor extension occurred in 11% of the patients. Real-time US clearly visualized the entire retrohepatic inferior vena cava (IVC) in 96% of the examinations, and the ipsilateral renal vein was well seen on 88% of the scans. Of the caval sonograms that could be evaluated (115/120), intravascular tumor thrombi were detected in all 13 cases (sensitivity and specificity = 100%). Of the assessable sonograms of the renal vein (105/120), tumor invasion was identified by US in 21 of 22 cases (sensitivity = 95.5%, specificity = 100%). Venous tumor involvement was seen with intravascular lesions of different echogenicity, which caused a neoplastic-induced renal or caval vein enlargement in most cases. Our findings show that US is of great value in the preoperative assessment of intravascular tumor extension and provides a useful alternative to inferior venacavography.