中药肠道去污对创伤后脓毒症患者动脉血乳酸水平、清除率及氧合指数的影响

目的:观察中药肠道去污疗法对创伤后脓毒症患者动脉血乳酸水平、清除率及氧合指数的影响。方法:60例患者随机平均分入治疗组和对照组。治疗组采用通腑净化汤和西医常规治疗,对照组仅采用西医常规治疗。观察治疗前以及治疗6 h、12 h、24 h、48 h后动脉血乳酸水平、清除率及氧合指数情况。结果:治疗6 h后治疗组乳酸浓度以及乳酸清除率与对照组比较,差异有显著性意义(P0.05),治疗12 h、24 h、48 h后比较,差异有非常显著性意义(P0.01)。治疗后,2组各时间段乳酸浓度与治疗前比较,差异均有显著性意义(P0.05)。治疗12 h、24 h、48 h后2组氧合指数比较,差异有非常显著性意义(P0.01)。治疗后,2组各时间段氧合指数与治疗前比较,差异均有显著性意义(P0.05)。2组患者治疗时间超过48 h的死亡率比较,治疗组为6.67%(2/30),对照组16.67%(5/30),2组比较,差异有显著性意义(P0.05)。结论:中药肠道去污结合西医常规治疗能提高脓毒症患者的氧利用率以及乳酸清除率,改善全身氧代谢状况,降低死亡率。     

脓毒症急性肾损伤相关因素分析

目的:探讨脓毒症并发急性肾损伤(AKI)患者的临床特点及其影响预后的因素。方法:回顾性分析2011年12月至2016年12月入住首都医科大学附属北京中医医院急诊重症监护室的脓毒症患者90例。用单因素及多因素Logistic回归分析研究其临床特点及影响预后的危险因素。结果:90例脓毒症并发AKI患者占42例,AKI组死亡率明显高于非AKI组(P0.05)。单因素分析显示:肾病史、肺部感染、MODS、CRRT、中药干预和呼吸机的使用是影响AKI恢复的主要因素。多因素分析显示:如果MODS增高和肺部感染存在会增加其死亡风险。结论:器官衰竭数目、及需机械通气支持可作为判断脓毒症并发AKI患者预后的重要依据。     

血必净注射液对脓毒症大鼠白细胞介素-6表达及血小板的影响

目的观察中药血必净注射液对盲肠结扎穿孔术（CLP）所致脓毒症大鼠血浆白细胞介素-6（IL-6）、外周血单个核细胞IL-6mRNA表达和血小板计数（PLT）的影响。方法将78只清洁级Wistar大鼠按随机数字表分为正常组、假手术组、CLP组和血必净组,后3组按活杀时间再分为手术后12h、24h、48h和72h4个亚组,每组6只。各组于相应时间点经腹主动脉取血,采用酶联免疫吸附法（ELISA）检测血浆IL-6水平,分离单个核细胞应用实时荧光定量聚合酶链反应检测IL-6mRNA的表达,并观察大鼠PLT的变化。结果CLP组大鼠血浆IL-6水平以及外周血单个核细胞IL-6mRNA的表达在术后各时间点均显著高于正常组（P〈0.05或P〈0.01）,而PLT明显低于正常组（P〈0.05或P〈0.01）。血必净注射液干预后,血浆IL-6水平以及外周血单个核细胞IL-6mRNA表达显著低于CLP组（P〈0.05或P〈0.01）,PLT在干预后24h、48h、72h也恢复至正常范围。结论血必净注射液能显著降低脓毒症大鼠血浆前炎症因子IL-6蛋白质以及mRNA表达水平,并能明显升高PLT,从而防止脓毒症的进一步发展。     

儿童脓毒症相关性脑病发生的危险因素分析

目的 分析脓毒症病儿发生脓毒症相关性脑病(SAE)的危险因素.方法 选取2018年1月至2020年2月入住徐州市儿童医院的脓毒症病儿158例,其中符合SAE诊断标准病儿57例,未发生SAE病儿101例,通过单因素分析和多因素回归等方法,研究脓毒症病儿发生SAE的危险因素.结果 SAE组病儿死亡率(29.8％)高于非SAE组(9.9％),差异有统计学意义(P<0.05).凝血功能障碍、高同型半胱氨酸血症、高尿酸血症是儿童SAE发生的独立危险因素,差异有统计学意义(P<0.05).结论 凝血功能障碍、高同型半胱氨酸血症、高尿酸血症对脓毒症病儿是否发生SAE有一定预测价值.     

线粒体在脓毒症肝损伤发病机制及治疗中的作用

线粒体功能障碍所致的细胞能量衰竭与脓毒症期间器官功能损害密切相关。肝脏细胞中存在丰富的线粒体,肝脏是脓毒症相关器官损伤的重要靶点。本文概述了线粒体在脓毒症肝损伤发病机制中的作用,以及线粒体修复过程的动态平衡对于维持线粒体稳态和减轻肝脏损伤的重要意义,以期为脓毒症治疗提供参考。     

Die extrakorporale Therapie septischer Patienten

Zusammenfassung Trotz zahlreicher Fortschritte in der Intensivmedizin stellt die Behandlung von Patienten mit schwerer Sepsis und septischem Schock eine medizinische Herausforderung dar. In der Pathogenese der systemischen Inflammation (SIRS) kommt es zur exzessiven Freisetzung von multiplen endogenen und exogenen inflammatorischen Mediatoren [z. B. Lipopolysaccharid (LPS), Tumor-Nekrose-Faktor (TNF)-α, Interleukin (IL)-1, IL-6] und zur Entwicklung eines Multi- Organ-Versagen (MOV). Dies führt bekannterma?en zu schlechten überlebenszahlen septischer Patienten. Ein komplexes dynamisches Kontrollsystem führt in der Abfolge meist zur zeitnahen gegen-regulatorischen antiinflammatorischen Antwort mittels Induktion anti-inflammatorischer Mediatoren (IL-10, transforming growth factor-beta [TGF-β]). In einer gro?en Anzahl septischer Patienten kommt es durch eine Persistenz des inflammatorischen Reizes zu einer Deaktivierung von antigenpr?sentierenden Zellen bzw. zu einem Versagen des zellvermittelten Immunsystems („Immunparalyse“). Unselektive und selektive intermittierende und kontinuierliche extrakorporale Therapieverfahren wurden evaluiert, ob diese in der Lage sind, in inflammatorische durch den klinischen Verlauf günstig zu beeinflussen. Technologische Fortschritte im Hinblick auf die Entwicklung von extrakorporalen Plasmapherese- bzw. Adsorptionsverfahren bieten heute neue, effektive M?glichkeiten, Mediatoren aus der Blutbahn septischer Patienten zu entfernen. In der vorliegenden übersichtsarbeit werden aktuell verfügbare und zukünftige adjunktive extrakorporale Therapiestrategien vorgestellt und vor dem Hintergrund aktueller Studien diskutiert.      

Streptococcus pneumoniae Peritonitis Postpartum

Summary A peritonitis cause by an ascending infection is a rare complication postpartum. A 37-year-old women presented with a secondary peritonitis due to Streptococcus pneumoniae. The patient had given birth to a healthy boy 4 weeks before and showed no symptoms of a bronchitis on admission. A operation was performed after the patient developed an acute abdomen, showing a diffuse peritonitis. High vaginal swabs and blood cultures taken on admission were positive for S. pneumoniae as well as the specimen taken during the operation. Thus we concluded that this was a case of an ascending infection. After antibiotic therapy with penicillin the patient could be discharged 8 days after the operation. Received: July 6, 1999 · Accepted: January 5, 2000     

Safety and Efficacy of Intravenous Colistin in Neonates With Culture Proven Sepsis

Background:

Although it is well described among adults, intravenous colistin use and its associated toxicities in newborns are poorly understood.

Objectives:

We present our experience of efficacy and safety of intravenous colistin in the treatment of sepsis in term and preterm neonates.

Patients and Methods:

The records of neonates who received colistin between January 2013 and February 2014 were retrospectively reviewed. All neonates with culture proven nosocomial infections due to multidrug resistant organisms and treated continuously with colistin for more than 72 hours were included in the study.

Results:

Patients were evaluated for clinical and microbiological response to the drug and its and side effects. Twelve newborn infants with mean 31.8 ± 3.5 weeks gestational age and median 1482 (810 - 3200) gram birth weight were included. 11/12 (91.7%) patients showed microbiological clearance with intravenous colistin. One patient who had recurrent cerebrospinal fluid positive culture was treated with intraventricular colistin. The major side effects observed was hyponatremia and hypokalemia in 2 (16.6%) patients, all infants required magnesium supplementation.

Conclusions:

Intravenous colistin administration appears to be safe and efficacious for multidrug-resistant gram-negative infections in neonates, including preterm infants. However, we believe that large prospective controlled studies are needed to confirm its efficacy and safety in neonates.     

The exploration of population pharmacokinetic model for meropenem in augmented renal clearance and investigation of optimum setting of dose

In recent years, augmented renal clearance (ARC), in which renal function is excessively enhanced, has been reported, and its influence on β-lactam antibiotics has been investigated. In this study, we aimed to determine the optimum population pharmacokinetic model of meropenem in patients with sepsis with ARC, and evaluated dosing regimens based on renal function. Seventeen subjects (6 with ARC and 11 without) were enrolled in this study. Predicted meropenem concentrations were evaluated for bias and precision using the Bland–Altman method. To examine the dosing regimen, Monte Carlo simulation was performed to calculate the cumulative fraction of response (CFR). In patients with ARC, the bias (average of the predicted value and measured value residuals) of models constructed by Crandon et al. (2011), Roberts et al. (2009), and Jaruratanasirikul et al. (2015) were 5.96 μg/mL, 10.91 μg/mL, and 4.41 μg/mL, respectively. Following 2 g meropenem every 8 h (180 min infusion), CFR ≥ 90%, a criterion of success for empirical therapy, was achieved, even with creatinine clearance of 130–250 mL/min. For patients with sepsis and ARC, the model of Jaruratanasirikul et al. showed the highest degree of accuracy and precision and confirmed the efficacy of the meropenem dosing regimen in this patient population.