Acute shoulder infection following acupuncture—A report of three cases

Worldwide, acupuncture is a popular alternative medicine for releasing pain, treating diseases, or promoting health. Although it is generally considered safe, a few complications have been reported. These complications ranged from minor side effects, such as pain, local hematoma formation, or the aggravation of symptoms, to serious complications including mechanical injuries, such as pneumothorax and severe infection requiring surgical treatment. In orthopedic clinics, reports of complications caused by acupuncture are rare. We present three cases who developed severe infection following acupuncture, leading to irreversible osteoarthritic changes in their glenohumeral joints. All of them mentioned a history of acupuncture therapy before their shoulder became swollen and hot and no other infection source could be detected. Possible explanations included: (1) breakdown of the sterile technique; (2) no consensus of acupoint or how deep the needle should be inserted; (3) patient’s comorbidities, such as diabetes mellitus or previous shoulder pathology, were not considered. Although these three patients underwent debridement and proper management with antibiotics according to the culture data, eventually, they still progressed to severe glenohumeral joint destruction. Strict infection control guidelines should be established to lower this type of life-threatening complication.     

生脉注射液联合乌司他丁治疗感染性休克的临床研究

目的探讨生脉注射液联合乌司他丁治疗感染性休克的临床疗效。方法对2013年3月—2016年3月在屯昌县人民医院接受治疗的感染性休克患者80例,随机分为对照组(40例)和治疗组(40例)。对照组患者静脉滴注注射用乌司他丁,20万U加入生理盐水200 m L,2次/d。治疗组在对照组的基础上静脉滴注生脉注射液,60 m L加入生理盐水250 m L,1次/d。两组患者均连续治疗7 d。比较两组患者治疗前后临床效果、血清细胞因子水平和免疫功能变化。结果治疗后,对照组和治疗组总有效率分别为80.00%和95.00%,两组总有效率比较差异有统计学意义(P0.05)。治疗后,两组患者血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、血小板(PCT)、内皮素-1(ET-1)及NO水平都显著降低,IL-10则升高,同组治疗前后比较差异具有统计学意义(P0.05);且治疗组上述指标水平优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者CD~(3+)和CD~(4+)水平及CD~(4+)/CD~(8+)都显著升高,同组治疗前后比较差异具有统计学意义(P0.05);且治疗组患者免疫功能显著优于对照组,两组比较差异具有统计学意义(P0.05)。结论生脉注射液联合乌司他丁治疗感染性休克疗效显著,可增强机体免疫功能及减轻炎症反应,具有一定的临床推广应用价值。     

经皮肝穿刺胆道引流治疗急性梗阻性化脓性胆管炎合并感染性休克的疗效分析

目的 评价经皮肝穿刺胆道引流(PTCD)治疗急性梗阻性化脓性胆管炎(AOSC)合并感染性休克的临床效果.方法 回顾性分析2010年12月-2015年12月收治的79例AOSC合并感染性休克患者的临床资料,并总结其治疗经验.结果 79例患者均行PTCD,穿刺成功率100％,无明显手术相关并发症发生.75例患者于经皮肝穿刺胆道引流管置入术后3～7 d感染性休克症状消失,4例患者于住院期间死上.75例患者中62例患者于病情稳定后根据梗阻原因行二期手术或双介入手术治疗,2例患者于病情稳定后拒绝二次手术治疗,11例患者不能二期手术或双介入手术带管生存,平均4.7个月.结论 对合并感染性休克的AOSC患者行急症PTCD治疗不仅可以快速退黄减压,降低病死率,而且可以改善休克症状,为二期手术或双介入手术治疗创造机会和条件,是一种安全有效的治疗方式.     

Procalcitonin kinetics – prognostic and diagnostic significance in septic patients

Introduction

Severe sepsis and septic shock are advanced clinical conditions representing the patient''s response to infection and having a variable but high mortality rate. Early evaluation of sepsis stage and choice of adequate treatment are key factors for survival. Some study results suggest the necessity of daily procalcitonin (PCT) monitoring because of its prognostic and discriminative value.

Material and methods

An observational and prospective study was conducted to evaluate the prognostic and discriminative value of PCT kinetics in comparison to PCT absolute value measurements. In a group of 50 intensive care unit patients with diagnosis of severe sepsis or septic shock, serum PCT measurements were performed on admission, and on the 2^nd, 3^rd and 5^th day of therapy. The level of PCT was determined with a commercially available test according to the manufacturer''s protocol.

Results

The kinetics of PCT assessed by ΔPCT was statistically significant in the survivors vs. the non-survivors subgroup (ΔPCT_3/1, p = 0.022; ΔPCT_5/1, p = 0.021). ΔPCT has no statistical significance in the severe sepsis and septic shock subgroups for all analyzed days. Only the 5^th day PCT level was significantly higher in the non-survivors vs. survivors group (p = 0.008). The 1^st day PCT level in the severe sepsis vs. septic shock group has a discriminative impact (p = 0.009).

Conclusions

According to the results, single serum PCT measurement, regardless of absolute value, has a discriminative impact but no prognostic significance, during the first 2 days of therapy. The PCT kinetics is of prognostic value from the 3^rd day and is of earlier prognostic significance in comparison to changes in the patient''s clinical condition evaluated by SOFA score kinetics.     

经皮肾镜碎石术后感染性休克患者开放肾造瘘管必要性的研究

目的探讨经皮肾镜碎石术(PCNL)术后留置双J管患者发生感染性休克开放肾造瘘管的必要性,为PCNL术后感染性休克的治疗提供参考依据。方法选取某院2015年1月1日—2016年12月30日因PCNL术后并发感染性休克患者60例,将患者随机分为肾造瘘管夹闭组(30例)与肾造瘘管开放组(30例),收集两组相关临床资料进行分析。结果两组患者治疗24 h后心率(HR)、平均动脉压(MAP)、氧饱和度(SpO_2)、血清乳酸(Lac)、每小时尿量均较治疗前明显改善(均P0.05);开放组患者治疗24 h后HR、MAP、SpO_2、Lac、每小时尿量与夹闭组比较,差异均有统计学意义(均P0.05)。两组患者治疗3 d后血清降钙素原(PCT)、C反应蛋白(CRP)均较治疗前明显下降(均P0.05);开放组患者治疗3 d后血清PCT、CRP均低于夹闭组(均P0.05);两组患者治愈好转率均为100.00%,开放组患者术后住院时间和拔管时间均短于夹闭组,总住院费用少于夹闭组,差异均有统计学意义(均P0.05)。结论PCNL术后感染性休克的患者在常规留置双J管的基础上开放肾造瘘管是有必要的。     

以 SvO2为导向的早期目标导向液体治疗对感染性 休克猪血流动力学和氧动力学的影响

目的 评价以混合静脉血氧饱和度（SvO2）为导向的早期目标导向液体治疗（EGDT）对感染性休克猪血流 动力学和氧动力学的影响。方法 雄性巴马小型猪 12 只,采用随机数字表法均分为传统方法（C）组和目标导向（G） 组。采用静脉输注内毒素方法制造感染性休克模型后,C 组休克后维持平均动脉压（MAP）≥65 mmHg,中心静脉压 （CVP）8~12 mmHg,尿量≥0.5 mL/ （kg·h）,G 组除以上指标外,维持 SvO2≥0.65。治疗持续 6 h。分别在内毒素开始输 注 0、60、120、180、240、300、360、420 及 480 min（T0~T8）记录中心体温、血流和氧动力学指标及使用的液体和血管活 性药物使用情况。结果 与 C 组相比,在血流动力学方面 2 组各时点 MAP、心率（HR）、全身血管阻力指数（SVRI）差 异无统计学意义（P＞0.05）,G 组在 T4~T8 时点心输出量指数（CI）和 CVP 升高（P＜0.05）,在 T8 时点平均肺动脉压 （MPAP）和肺血管阻力指数（PVRI）降低（P＜0.05）;在氧动力学方面,G 组在 T3~T8 时点 SvO2升高,氧摄取率（O2ER） 降低（P＜0.05）,在 T4~T8 时点氧供（DO2）升高（P＜0.05）,T5~T8 时点血乳酸（Lac）降低,在 T8 时点动静脉 CO2分压 差［Δp（CO2）］降低（P＜0.05）,2 组动物各时点氧耗（VO2）差异无统计学意义（P＞0.05）。G 组补液量和尿量多,去甲肾上 腺素量较少（P＜0.05）,G 组多巴酚丁胺用量较多,而 C 组均未用。结论 以 SvO2为导向的 EGDT 在感染性休克救治 中可更加有效地稳定血流动力学和氧动力学,表现为心输出量增加、氧供增加、氧摄取率正常、组织灌注较好。     

液体负平衡应用于感染性休克患者对APACHEII评分的影响

摘要:目的 探讨液体负平衡对感染性休克患者急性生理学与慢性健康状态（APACHEII）评分的影响分析。方法 选取2018年1月～2020年1月本院收治的92例感染性休克患者,按不同液体管理模式分为常规组（采用液体平衡）和研究组（采用液体负平衡管理模式）各46例。对比分析2组患者心肺功能及APACHEII评分以及不良反应。结果 管理前2组患者全心舒张末期容量指数（GED-CVI）和血管外肺水指数（EVLWI）比较无统计学差异（P>0.05）,管理后2组GED-CVI、EVLWI水平均增加（P＜0.05）,研究组上述水平高于常规组（P＜0.05）;研究组和常规组均完成了管理计划,2组管理前APACHEII评分比较,差异均无统计学意义（P＞0.05）,管理后均低于管理前（P＜0.05）,管理后研究组低于常规组（P＜0.05）;2组患者均未见明显不良反应发生。结论 液体负平衡应用于感染性休克患者,可改善心肺功能指标,降低患者APACHEII评分,可作为临床管理及防控的参考指标。