Showing papers in "Chinese Journal of Critical Care Medicine in 2003"

Changes of the serum levels of hs-CRP between transient ischemic attack and cerebral infarction

Abstract: Objectives To survey the serum level of high sensitivity C-reactive protein (hs-CRP)in transient ischemic attack patients,and to assess the correlation between hs-CRP,other dangerous factors and cerebral infarction.Methods 83 TIA patients were divided in to three groups, TIA could be relieved in 60 minutes(A group), TIA could be relieved completely more than 60 minutes(B group) and TIA deteriorated into cerebral infarction(C group).Many factors were measured within 24 hours,such as hs-CRP,BP,BS,PTL,MPV,FIB,TC,TG,HDL-C,LDL-C,ApoA-I,and ApoB 100.Head CT and MRI were carried out within 72 hours,then we did the relative analysis research.Results ①The serum hs-CRP level of B and C group was higher than A group (P0.01),and the level was different obviously between B and C group.②The correlative analysis of A and B group demonstrated that serum hs-CRP had obvious positive relationship with SBP,BS,TC,LDL-C and Lp(a).③After correcting age,the correlation still existed between hs-CRP and SBP,BS,TC,Lp(a).But the correlation between hs-CRP and other factors vanished.Conclusion ①The rise of hs-CRP had something with the damage of brain.②SBP、BS、TC、Lp(a) were the major relative factors about the rise of hs-CRP.③The rise of hs-CRP was instructive significance in treating and estimating prognosis.

Apolipoprotein E gene polymorphism with hypertensive renal injury and renal substantial hypertension

Abstract: ObjectiveTo explore the relationship of the polymorphism of apolipoprotein E gene(ApoE) to hypertensive renal injury and renal substantial hypertension.MethodsBased on PRC technology,we tested the polymorphism of apolipoprotein E gene in 48 patients with hypertension and normal renal function(EH-NRF), 46 with hypertension hypertension and renal failure (EH-CRF), 52 with renal substantial hypertension and normal renal function (RH-NRF), 56 with renal substantial and renal failure (RH-CRF) and 50 normal controls(NC)in Heilongjiang.ResultsThree gene types (the DD,the II and the ID) were detected.D allele and DD which were in EH-NRF and NC had no obvious difference (P0.05). The frequency of D allele and DD was higher in EH-CRF, RH-NRF, RH-CRF than that in EH-NRF, NC, and the difference was significant (P0.05,P0.001).ConclusionsThe I/D polymorphism of ApoE gene has no relationship with EH,but was obviously concerned with the complications of EH,which may play a role in renal injury.D allele may be the genetic risk of renal injury in Han in Heilongjiang.The polymorphism of ACE gene can not account for hypertension,which suggests there exist different genetic elements between hypertension with uremia and uremia with hypertension.

Comparison of direct PCI and thrombolytic therapy (Urokinase) for acute myocardial infarction:healing effect and cost/effect result

Abstract: Objective To compare the healing effect and cost/effect result of direct percutaneous coronary intervention (PCI) and thrombolytic therapy (Urokinase,UK) in acute myocardial infarction (AMI). Methods This was an observing cohort study. 93 cases of AMI were treated with thrombolytic therapy (UK), but 59 cases of AMI were treated with direct PCI. We compared the results of ultrasonic cardiograph (UCG), clinical effects and cost/effect result both in hospital and the follow-up period. Results In hospital period, the UCG examination showed that the percentage of patients with normal wall motion was higher in PCI group (38.98%) than that in UK group (24.73%)(P=0.021). The rates of dyskinesia was 11.83% in UK group which was higher than that in PCI (0). The left ventricular ejection fraction (LVEF%) in PCI group(56.77±9.85) was higher than that in UK group (52.23±10.69)(P=0.029). During hospital, the rates of heart failure in PCI group (16.90%) was less than that in UK group (30.10%)(P=0.068).The accumulative heart failure rate during follow-up period in PCI group (13.60%) was also less than that in UK group (38.70%)(P=0.001).The mortality during hospital in PCI group was less than that in UK group, but which showed no significant difference. The accumulative mortality was 3.40% in PCI group which was less than that in UK group (15.10%)(P=0.014). The accumulative mortality of patients over 60 years of age in PCI group (3.39%) was also less than that in UK group (13.98%) (P=0.022). During follow-up period, the scores of life quality in patients of PCI group were higher than those in the UK group. The cost and total cost/effect result of PCI were higher than that of UK. Conclusions Direct PCI therapy limited left ventricular re-modeling, improves the rate of heart failure and mortality. But the cost and cost/effectiveness were higher.

Effect of ligustrazini on myocardial cell energy metabolism in the reperfusion injury after myocardial ischemia in rabbits

Abstract: Objective To study the effect of ligustrazini (LGT) on myocardial cell energy metabolism during myocardial ischemia-reperfusion injury (MIRI).Methods Using rabbit MIRI models,animals were randomly divided into three groups (n=10 in each),control group(A),MIRI group(B) and MIRI+LGT group(C),the contents of ATP,ADP and AMP (TAN,EC) in the myocardial tissue were measured,respectively.Meanwhile,the ultrastructure changes in myocardium were observed during MIRI.Results In C group ATP,ADP,TAN and EC levels of myocardial tissue were higher than those in B group(ATP:C(5 05±1 34) μmol/g(wet·weight),B(2 86±1 22) μmol/g(wet·weight),P0 01;ADP:C 1 67±0 40,B 1 12±0 25,P0 01;TAN:C 8 42±1 90,B 5 83±1 55,P0 01;EC:C 0 70±0 03,B 0 58±0 07,P0 01);and there were not significant differences between C and A group about ADP?AMP and TNA (ADP:A(2 04±0 53) μmol/g(wet·weight),P0 05;AMP:A(1 45±0 29) μmol/g(wet·weight),P0 05;TAN:A(10 26±2 05) μmol/g(wet·wt),P0 05);abnormal changes of myocardial ultrastructure in B group were ameliorated remarkably during MIRI.Conclusions LGT could improve myocardial cell energy metabolism in the reperfusion injury after myocardial ischemia.

Comparison of healing effect of noninvasive positive pressure ventilation and invasive positive pressure ventilation in patients of acute respiratory failure

Abstract: Objective To compare the clinical efficacy of noninvasive positive pressure ventilation (NPPV) and invasive positive pressure ventilation (IPPV) in patients with acute respiratory failure (ARF), and evaluate the effect of NPPV on the treatment of ARF.Methods 52 patients with ARF caused by various disorders were divided randomly into NPPV group (26 cases) and IPPV group (26 cases). Patients in two groups were treated by NPPV through a face mask or IPPV with endotracheal intubation respectively when disorders causing ARF were managed by medical therapy. Arterial blood gases were analyzed, and the rate of complication and outcome were observed.Result In NPPV group, seven patients were transformed into IPPV for worsening condition and arterial blood gases. Mortality rate in NPPV group (15.4%) was similar to IPPV group (19.2%) (P0.05). After 6 hours of ventilatory support therapy, artery blood gas of cured patients of two groups improved significantly and similarly. Duration of mechanical ventilation and hospital stay in patients receiving NPPV were significantly shorter than those in patients receiving IPPV (P0.05). Rate of complication in NPPV group was markedly lower than that in IPPV group (P0.05). Conclusion Clinical efficacy of NPPV were similar to IPPV in selected patients with ARF. Use of NPPV in patients with ARF might reduce duration of mechanical ventilation and hospital stay, and decrease rate of complication. NPPV might be the ventilatory support therapy of the first choice for the selected patients with ARF.

Peritoneal dialysis and continuous renal replacement therapy in critical ill patients

Abstract: Objective To compare the effect of peritoneal dialysis and continuous vena-vena hemodialysis/hemofiltration (CRRT) on critical ill patients Methods We retrospectively reviewed 20 cases with severe acute renal failure,among whom 12 patients were treated with PD and 8 patients with CRRT The basic information,including age,sex,primary disease,type of dialysis,severity of the disease,biochemistry index,dialysis related complications and dialysis expense per day were all recorded Results There were no differences in age,sex,severity of the disease and changes in serum biochemistry between two groups(P0 05) No difference was found in the incidence of renal recovery and patient mortality between two groups(P0 05) However,seventy-five percent of CRRT patients had dialysis related complications,which was higher than that of PD patients(P0 05) Dialysis expense per day were (3220 94±95 32) yuan in CRRT patients,which were higher than(619 27±108 9) yuan in PD patients Conclusion Compared with CRRT,PD had the same effect on critical ill patients Our data suggested that PD should be used as the first therapy for critical ill patients in China

Clinical effect of aminophylline associating with epinephrine on the treatment of cardiac arrest

Abstract: Objective To determine whether aminophylline associating with epinephrine has more beneficial effect than epinephrine on the victims of cardiac arrest. Methods Cardiac electrical activity, spontaneous circulation and survival rate of 24 patients received intravenous epinephrine and aminophylline compared with those of 30 cases received only epinephrine. Results ①There were 19(79.2%) cases who recovered cardiac electrical activity in the group with aminophylline, and 6(53.3%) in only epinephrine group. The difference was marginally significant (P=0.082).②The survival rate of 1 h(87.5%), 3 h(54.2%) and 6 h(37.5%) in the group with aminophylline were significantly higher than that of 1 h 56.7%, 3 h 20.0% and 6 h 13.3% in only epinephrine group respectively ( P 0.05). ③There were 12 cases (50.0%) who recovered spontaneous circulation in the group with aminophylline, which were higher than in only epinephrine group (40%). The difference was not statistically significant (P=0.462).④There were 2 cases (8.3%, 2/24) who discharged in the group with aminophylline, which was higher than in only epinephrine group (3.3%, 1/30). The difference was also not statistically significant (P=0.579). Conclusion These results suggested that aminophylline associating with epinephrine on the treatment of cardiac arrest might be better than only epinephrine.

Analysis of triple acid-base disturbances in critical ill patients

Abstract: Objective To improve the diagnosis and treatment of triple acid-base disturbance (TABD) in critical ill patients Methods Clinical features , arterial blood gas and plasma electrolytes of 168 critical ill patients were analyzed Results Of the total 168 patients , 121(720%) had TABD of respiratory alkalosis, 47(280%) had TABD of respiratory acidosis pH745 was found in 92 patients (548%), and pH735 in 39 patients (232%) PaO 280 mmHg was found in 75 patients (446%) ,and PaO 260 mmHg in 41 patients (546%) The potential 〔HCO 3 -〕 increased in 113 patients (672%) and anion gap(AG)18 mmol was found in 168 patients The mortality was 411% (69 patients) Conclusion TABD of respiratory alkalosis could be diagnosed when there appeared respiratory alkalosis, increased AG and potential〔HCO 3 -〕24+05×△PaCO 2+25 TABD of respiratory acidosis could be diagnosed when there were respiratory acidosis, increased AG and potential 〔HCO 3 -〕24+035×△PaCO 2+558

Complications at the anaphase of the critical severe acute respiratory syndrome and its treating strategies

Abstract: ObjectiveTo analyse the causes and to evaluate treating strategies of the patients occurring at the anaphase of the critical severe acute respiratory syndrome (SARS) by summarizing their complications.MethodsTo analyse retrospectively the underlying condition,complications,treating process and prognosis of 10 critical SARS patients.Results5 had the underlying condition, 10 cases had used high doses of glucocorticoid and broad-spectrum antibiotics for a long time,all of them had acute respiratory function failure.After anti-infection ,ventilation support and other colligating therapies for about a month,4 cases had still acute respiratory function failure, CD4 and CD8 serum level of 8 cases was lower than the normal, 7 had secondary hyperglycemia ,2 had secondary hypertension,1 had severe malnutrition and electrolyte disturbance,1 had psyche and behaviour disorder,3 had pneumothorax; 8 had hospital acquired pneumonia, 3 of 8 developed to be mutiple organ dysfunction syndrome;total mortality was 30%(3/10). ConclusionThere were many complications at the anaphase of the critical SARS patients; The major causes that induced complication included chronic underlying condition ,defected immunity,long use of high doses of glucocorticoid and broad-spectrum antibiotics;the key to treat patients at the anaphase of the critical SARS were to treat actively the underlying diseases and complications,to improve immunity, and to use reasonable antibiotics and glucocorticoid.

Effect of burn injury on the expression of cytokine genes in skin

Abstract: Objective To study the effects of burn injury on the expression of cytokine genes.Methods Male ICR mice, 20～25 g, were anesthetized with intraperitoneal pentobarbital, which resulted in 20% Ⅲ degree burn injury. The unburned skin and serum were collected at 24 hours after the burn injury. Total RNAs were isolated from the skin. The expression of TNF-α, IL-1α and IL-6 genes were estimated by reversal transcription -polymerase chain reaction (RT-PCR). The level of TNF-α and IL-6 were also measured by ELISA.Results 20% Ⅲdegree burn injury could induce the expression of TNF-α and IL-6 genes in the unburned skin whereas the burn injury had no effects on the expression of IL-1α. The expression of TNF-α and IL-6 genes could not be detected in the skin of control animals. The burn injury increased the level of TNF-α in skin, but not in serum.The level of TNF-α in skin and serum was much lower in the control. Furthermore, the concentration of IL-6 was elevated both in the skin and in the serum after the burn. On the contrary, the level of IL-6 both in the skin and in the serum was low in the control group. There were significant differences between two groups (P0.01).Conclusion Burn injury might activate the skin immune system, and make the skin function as a cytokine-generating organ.

Influence of Radix Salviac Miltiorrhizae (RSM) on cardiac myocyte levels of transforming growth factor-β_1 and preventive effects of RSM on left ventricular hypertrophy in spontaneously hypertensive rats

Abstract: Objective To observe the effects of Radix Salviac Miltiorrhizae (RSM) on left ventricular hypertrophy (LVH) in spontaneously hypertensive rats (SHR) and to investigate its mechanisms. Methods 18 SHRs aged 8 weeks old were divided into three groups randomly. One group the rats were killed at 8 weeks. RSM or distilled water (1 g·kg -1 ·d -1 ) was injected abdominal cavity into two groups for 10 weeks. Systolic blood pressure (SBP) and left ventricular mass index (LVMI) were measured. HE?VG and immunohistochemistry staining combined with computed morphometry were used to evaluate the diameter (TDM) and cardiomyocyte area(CA), the collagen volume fraction (CVF),perivascular circumferential area (PVCA) and the transforming growth factor-β 1(TGF-β 1) expression in the left ventricular tissue. Results Compared with 8-week-old rats, the SBP,LVMI,TDM,CA,CVF,PCVA and TGF-β 1 expression increased markedly in 18-week-old SHRs. RSM could inhibit the LVH significant and TGF-β 1 expression decreased, however SBP reduced obviously(P0.01). Conclusion RSM could inhibit the development of LVH in SHR, which was probably related to the decreased expression of cardiac TGF-β 1.

Change of serum TNF-α and NO level and its clinical significance in the patients with acute organic phosphorus pesticide poisoning

Abstract: Objective To explore the change of serum TNF-α and NO level and its clinical significance in the patients with acute organic phosphorus pesticide(AOPP) poisoning.Methods Serum TNF-α and NO were measured on the 1st, 3rd, 5th day and on 12～14 days in 42 patients with AOPP poisoning and 20 healthy individuals.Results Serum TNF-α and NO level were the highest on the 1st day, and maintained the higher level on the 3rd, 5th day(P0.05～0.01),but there were not statistical differences on 12～14 days(P0.05) compared with control group.Within the first 5 days of the treatment,serum TNF-α and NO level were dramatically different between slight group,moderate group and severe group(P0.05～0.01).Serum TNF-α and NO level were positive correlation with the severity of the patients.Conclusions TNF-α and NO level were involved in the pathogenesis of AOPP poisoning,and one of NO production causes might be due to TNF-α damage to the vascular endoepithelial cells.

Effect of growth hormone on myocardial injury in rats after cardiopulmonary resuscitation

Abstract: ObjectiveTo observe the protective effects of growth hormone on myocardial injury in rats after cardiopulmonary resuscitation.MethodsCardiac arrest was induced by asphyxiation and ice-cold 0.5 M kcl and resuscitation efforts begun in five minutes after arrest.Eighteen Sprague Dawley rats were randomly divided into 3 groups:sham control group;routine treatment group;growth hormone treatment group(n=6,per group).ResultsCompared with routine treatment group,growth hormone treatment group showed a significant reduction of plasma CK-MB and TNF-α level.The TUNEL-positive cells markedly decreased,but there was an increase in myocardial Bcl-2 expression.ConclusionGrowth hormone can inhibit myocardial apoptosis via promoting the expression of Bcl-2,thus protect the myocardium of rats after resuscitation.

Dynamic changes and significance of serum neuron specific enolase during acute period in the patients with intracerebral hemorrhage

Abstract: ObjectiveTo investigate the dynamic changes and clinical significance of serum neuron specific enolase(NSE)during acute period in the patients with intracerebral hemorrhage(ICH).MethodsThe serum levels of NSE in the patients with ICH were measured by radio-immunoassay method,the correlated analysis between NSE and the volume of hemorrhage and neurological function deficit was performed.ResultsThe serum levels of NSE was higher in the ICH group than in control group(P0.05 or P0.01),the serum levels of NSE increased in the first 24 hours after ICH,reached peak on (2.7±0.9) days after ICH,then began to decrease.The peak serum levels of NSE positively correlated with the volume of hemorrhage (r=0.36,P0.05)and the neurological function deficit(r=0.34,P0.05).ConclusionThe serum levels of NSE during acute period can serve as an indicator of seriousness and prognosis in patients with ICH.