Showing papers in "Chinese Journal of Critical Care Medicine in 2004"

Immune regulation mechanism of thymosin - α1 on severe sepsis patients

Abstract: Objective To study the immune regulation mechanism of thymosin - α1 on severe sepsis patients. Methods Total patients of 44 were divided into two groups randomly, therapy group and control group. The control group was given routine therapy and console drugs while the therapy group was given routine therapy and thymosin - α1 for ten days. Results Compared with the control group, the HLA - DR level in therapy group increased greatly while C response protein value, APACHE Ⅱ score and the number of organ dysfunction in therapy group decreased significantly. Moreover, the mortality in therapy group also decreased on the 28th day. Conclusions Thymosin - α1 may improve the immunological function of severe sepsis patients and ameliorate their prognosis

Therapeutic effect analysis of acute traumatic brain injury

Abstract: Objective To find out the factors that determine the prognosis of traumatic brain injury (TBI) by analysing the previous clinical data.Methods 3 700 cases of acute TBI in recent 5 years were classified, the survival rate and mortality of these patients were analysed to evaluate the therapeutic effect and the effect of both acute surgery and intra-cranial pressure monitor (ICPM) on the mortality of severe TBI were further evaluated.Results The mortality of severe(GCS≤8), moderate(GCS 9～12) and slight(GCS 13～15) TBI were 46%, 12% and 0 respectively. Both the temporal distribution and clinical characters of death can be obviously divided into different phases:acute phase(1 week),80%of all dead patients occurred, the death was mainly due to intractable intracranial hypertension; Subacute phase or transition period (1～3 weeks), nearly 20% cases occurred, the death was mainly due to the failure of organs(lung,kidney,heart,etc.); Chronic phase or recovery stage(3 weeks), 2%of that occurred, the death was mainly due to chronic consumption of the body, which reminded us the different therapeutic focuses in different phases. Emergent surgery and ICPM had lowered the mortality to 32% and 36% respectively.Conclusions It is very important to recognize the different characters in each phase. The timely and accurate treatment (including emergent surgery and ICPM) is very important to lower the mortality.

Effects and mechanisms of lymph on endotoxic shock in rats

Abstract: Objective To observe the effects of exogenous normal lymph on endotoxic shock induced by LPS and discuss its mechanisms. Methods Forty male Wistar rats were randomly divided into four groups: endotoxin group, lymph group, plasma group and normal group. The rats in the preceding three groups were injected intravenously with lipopolysaccharide(LPS,5 mg/kg.bw,iv)to duplicate endotoxic shock model. LPS was replaced by equivalent normal saline in the normal group. 15 minutes later, lymph without cell components was infused in lymph group. The amount of lymph was one fifteenth of blood volume. In plasma group, lymph was replaced by plasma. In normal and endotoxin groups, lymph was replaced by normal saline. When 4 hours passed after the infusion of LPS, we prepared the plasma fraction and homogenate from tissues of heart, liver, kidney and lung. Subsequently, we detected the changes of tumor necrosis factor-alpha(TNF-α),nitric oxide(NO),nitric oxide synthases(NOS),inducible nitric oxide synthases(iNOS),superoxide dismutase(SOD) and malondialdehyde(MDA). Results After lymph infusion, all parameters including the plasma TNF-α level (18.81±3.70 fmol/mL), NO concentration(46.02±9.29 μmol/L),NOS activity(25.16±4.20 U/mL),SOD activity(102.15±17.88 NU/mL)and MDA level(8.19±164 nmol/mL) in lymph group showed significant statistically difference when compared with three other groups (P0.05～0.01).Conclusion Exogenous normal lymph may be of value in the process of interfering in endotoxic shock. Alleviating the production of cell factors and inhibiting lipid peroxidation may be the relevant mechanisms.

Effect of L-arginine on nitric oxide and endothelin in the reperfusion injury after myocardial ischemia in rabbits

Abstract: Objective To study the role of nitric oxide and endothelin during myocardial ischemia-reperfusion injury(MIRI) and effect of L-arginine(L-Arg) Methods The rabbits were randomly divided into three groups (n=10,in each),sham operated group(A), myocardial ischemia-reperfusion group(B), myocardial ischemia-reperfusion+L-arg(C) Nitric oxide products (NOP), endothelin (ET) levels,and lactate dehydrogenase (LDH) activities were measured before ischemia,40 minutes after ischemia and 20 minutes after reperfusionMeanwhile NOP,ET concentration and LDH activity in myocardium were measured,and the ultrastructure changes of myocardium was observed under electron microscope at 20 minutes after reperfusionResults Compared with group A,NOP decreased, ET and LDH increased at 40 minutes ( P 0 05 and P 0 01) and more significantly at 20 minutes after reperfusion( P 0 01)in plasma,and NOP and LDH decreased but ET increased ( P 0 05 and P 0 01) at 20 minutes after reperfusion in myocardium and there were abnormal changes of the myocardial ultrastructure at 20 minutes after reperfusion;L-Arg reversed the results of indices mentioned as above markedlyConclusions The ischemia-reperfusion results in dysfunction of the endothelium (NO level decreasing and ET level increasing)which is an important factor during MIRI,L-Arg reduces MIRI by protecting coronary endothelium(raising NO level and dropping ET level)

Clinical analysis of 197 patients with critical severe acute respiratory syndrome in Beijing areas

Abstract: Objective To investigate the clinical characteristics of critical severe acute respiratory syndrome Methods The clinical date of 197 patients with critical SARS in Beijing were studied retrospectively Results The 197 patients included 95 males and 102 females,aged 18～86 The past history,the age,difficult breath,second fever,lymphocyte count dropping,abnormality of artery blood gas,subsets of T lymphocyte,myocardium enzyme step-up and some physiological predicators,X-ray chest radiography,abnormality of EKG and incidence rate of complication had significantly difference in critical SARS,compared with those mild cases Conclusion The above-mentioned signs correlated with the patient's severity of the SARS Correct judgement of the severity is important

Significance of QT dispersion for prognosis in the critical illness

Abstract: Objective To determine significance of QT dispersion for prognosis in the critical illness Methods There were 47 cases in the death group, 40 cases in the disease group and 43 cases in the normal group 12-lead ECG was recorded in all cases R-R interval and QT interval were measured by hands R-R, QTc, QTc and QTcd were obtained by calculation respectively Results In the death groups, R-R, QTc, QTc and QTcd were 0 62±0220 ms, 03 6±0069 ms, 00 6±0033 ms and 0079±0046 ms respectively; In the disease groups, R-R, QTc, QTc and QTcd were 080±0134ms , 0416±003 ms, 0034±0014 ms and 0039±0016 ms respectively; In the normal group, R-R, QTc, QTc and QTcd are 082 ±0088 ms, 0402±003 ms, 0027±001 ms and 0031±001 ms respectively R-R, QTc, QTc and QTcd showed obvious difference between the death group and the disease group (P0001, 0002 , 0001 and 0001 respectively) R-R, QTc, QTc and QTcd showed obvious difference between the death group and the normal group ( P0001, 0002 , 0001 and 0001 respectively) Conclusion QT dispersion has predictable value in prognosis of the serious illness, but the values of clinical use is limited [

Study of relationship between serum procalcitonin levels and severity of injury, sepsis, organ failure, and mortality in injured patients

Abstract: Objective To compare procalcitonin (PCT) plasma levels of injured patients with the incidence and severity of systemic inflammatory response syndrome (SIRS), infection, and multiple organ dysfunction syndrome (MODS) and to assess the predictive value of PCT for these posttraumatic complications. Methods We retrospective studied patients with mechanical trauma in terms of severity of injury, development of infectious complications, and organ dysfunctions. Two hundred and sixty injured patients with injury severity score ≥9 points were enrolled in this study from January 2002 to January 2004. Blood samples were collected on the day of admission and on days 1,3, 5, 7, 10, 14, and 21 thereafter. We determined PCT serum levels using a specific immunoluminometric assay. We retrospectively evaluated the occurrence of SIRS, sepsis, and MODS using patients' charts. Results Mechanical trauma led to the increase of PCT plasma levels which was dependent on the severity of injury, with peak values on days 1 and 3 ( P 0 05) and a continuous decrease within 21 days after trauma. Patients with SIRS demonstrated a significant increase of peak PCT plasma levels ( P 0 05) compared with patients without SIRS. The highest PCT plasma concentrations early after injury were observed in patients with sepsis (7.0±3.2 μg/L, day 1) or severe MODS (5.5±2.6 μg/L, day 1) with a sustained increase ( P 0 05) for 14 days compared with patients with an unevenful posttraumatic course(1.0±0.3 μg/L). Moreover, the increase of PCT plasma levels during the first 3 days after trauma predicted ( P 0.0001; logistic regression analysis) severe SIRS, sepsis, and MODS. Conclusions These data indicate that PCT was a sensitive and predictive indicator of sepsis and severe MODS in injured patients. Routine analysis of PCT levels seems to be helpful in early recognition of these posttraumatic complications. Thus, PCT may be a useful marker to monitor the inflammatory status of injured patients at risk.

Effect of lymph on acute microcirculatory disturbance of rats induced by dextran 500

Abstract: Objective To study the interference effect of lymph on acute disturbance of microcirculation in rats induced by dextran 500.Methods Twenty male Wistar rats were anesthetized by intramuscular injection of pentobarbital sodium(50 mg/kg·bw),and administrated intravenously dextran 500 (1 g/kg·bw)within 1 min,then we duplicate the acute disturbance of microcirculation animal models.Lymph was infused through cervical vein with one fifteenth of body blood volume in a constant speed after 6 min of making model in lymph treatment group,and the lymph was replaced by the equivalent volume of normal saline (NS)in model group.The mesentery near the lower ileum was spread on the observed window to investigate the internal diameter of mesenteric micro-vessels(A 1,A 2,V 1,V 2)and micro-blood flow condition by using a vital microscope with TV recorder before and after making model and after lymph or NS treatment.The analysis of blood flow condition by Tian’s multiple score method was used.The rats were connected the right common carotid artery with pressure transducer. Blood pressure was monitored continuously, and the survival time was recorded.Results ①Dextran 500 could lead to acute disturbance of microcirculation in rats.The diameter of mesenteric micro-vessels contracted(P005～001),the micro-blood flow speed slowed(P005)and the red cell aggregated(P0.05～0.01)after making model in the two groups,but the two groups had no statistical difference before and after making model(P005).②Lymph can markedly improved disturbance of microcirculation.The abnormality of the diameter of mesenteric micro-vessels, the micro-blood flow speed and the condition of the red cell aggregation in lymph treatment group was significantly slighter than those of control group(P005～001).③Lymph can improve blood pressure.The blood pressure droped continuously in control group after making model,but it can be kept in a higher level in lymph treatment group(P005).④The survival time of the rats in lymph treatment group was significantly longer than the control group(P005).Conclusion Lymph could markedly improve the acute disturbance of microcirculation induced by dextran 500 ,maintain the blood pressure and lengthen the survival time in rats.

Blood rheology alternation of local tissue after emergency multiple repairing non-thermic high voltage electrical injury

Abstract: Objective To investigate the alteration of blood rheology of non-thermic high voltage electrical wounded tissue after performing emergency multiple repair(EMR)Methods Emergency multiple repair were performed to treat the hind limbs tissue injuries which were caused by non-thermic high voltage electrical factor The femoral vein blood was phlebotomized after 6 hours After collecting the parameter, the blood flow parameter was compared Results MAIE, MTIE, IR and τC changed obviously in two groups, MTIE,MAIE and IR in the control group declined while they all rose to the normal level in experimental group The changes had statistical difference Conclusion EMR treatment can improve the high agglutination state of blood flow distinctly

Therapeutic effect of Smecta on organophosphorus pesticide poisoning

Abstract: Objective To investigate the therapeutic effect of Smecta on organophosphorus pesticide poisoning.Methods 56 patients were divided into two groups:①control group (26 patients) received conventional gastric lavage and catharsis;②The treatment group (30 patients) were given Smecta by gastric duct after conventional salvage;We observed serum acetylcholinesterase (AChE) activities,course of diseases and gastrointestinal function in two groups Results The recovery time of AChE and the course of diseases in the treatment group were significantly shorter than those of control group; the incidence of gastrointestinal function was also lower in the treatment group.Conclusion Smecta could protect gastriontestinal function of organophosphorus pesticide poisoning cases, prevent poison absorption and accelerate gastrointestinal function recovery. [