Showing papers in "Chinese Journal of Critical Care Medicine in 2005"

Ventilator-associated pneumonia in intensive-care unit

Abstract: Objective To explore pathogens and drug resistance in ventilator-associated pneumonia (VAP), and to provide the corresponding clinical prevention strategies. Method We analyzed 154 VAP patients' clinical data, pathogens distribution and resistance rate of bacilli. Results The incidence of VAP was 36.5%, the aged accounted for 61%. Among all the pathogens caused VAP, 77.93% of sputum culture results were gram-negative bacilli, most of which were Pseudomonas aeruginosa, Acinetobacter baumanii, Chryseobacterium, Pseudomonas maltophilia and Staphylococcus aureus. Most of gram-negative bacilli showed high resistance rate to common used antibiotics. Conclusions Extensive and dynamic monitoring of VAP pathogens and rational use of antibiotics were advocated for controlling VAP effectively.

Analysis of mortality in the MODS cases

Abstract: Objective To investigate the outcome and predictive factors of multiple organ dysfunction syndrome(MODS).Methods We retrospectively studied the relationship of the mortality with original causes of MODS,the numbers of dysfunctional organ,the single dysfunctional organ, and compared the parameters between survival patients and dead patients.Results The mortality were different in original causes of MODS,the numbers of dysfunctional organ,the single dysfunctional organ.There were significant differences in the APACHEⅢ scores from the first day, the APACHEⅡ scores from the second day.The MAP,urine output showed significant differences from the third day,the WBC from the fifth day,and the CVP,pH,TBIL,ALB,Cr from the seventh day.The Logistic analysis indicated the numbers of dysfunctional organ and the APACHE?Ⅲ scores could influence the mortality.Conclusion We can predict the prognosis of MODS patients according to the original causes of MODS,the numbers of dysfunctional organ,the single dysfunctional organ and the tendency of common parameters.

Effect of L-arginine on myocardial cell energy metabolism during the ischemia/reperfusion injury in rabbits

Abstract: Objective To study the effect of L-arginine (L-Arg) on myocardial cell energy metabolism during myocardial ischemia/reperfusion injury (MIRI) and its mechanism. Methods MIRI models of the rabbits were randomly divided into three groups (n=10, in each), cotrol group (A), MIRI group (B) and MIRI+L-Arg group (C). The contents of adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP), total adenylic acid number (TAN), energy charge (EC), nitric oxide (NO), endothelin (ET), malonyldialdehyde (MDA) and the activity of superoxide dismutase (SOD) in the myocardial tissue were measured, respectively. Meanwhile, the ultrastructure changes in myocardium were observed during MIRI. Results The ATP, ADP, TAN, EC, NO and SOD levels of myocardial tissue in C group were higher than those in B group (P0.05 and P0.01); the contents of ET, MDA myocardial tissue in C group were lower than those in B group (P0.05); and there were not significant differences in ADP, AMP, TAN, NO and MDA between C and A group (P0.05); abnormal changes of the myocardial ultrastructure in C group were ameliorated remarkably too during MIRI. Conclusions L-Arg can improve myocardial cell energy metabolism in the reperfusion injury after myocardial ischemia by decreasing oxygen free radical and ET levels, raising NO level and SOD activity.

Study of QT interval dispersion and P wave dispersion in children with vasovagal syncope

Abstract: Objective To probe the changes of QT interval dispersion (QTd) and P wave dispersion (Pd) in children with vasovagal syncope(VVS). Methods 12-lead simultaneous body surface electrocardiogram (12ECG) were taken from 55 cases with VVS (research group) aged 4 to 18 years old (mean 11.56±2.29 years) and 55 healthy children as control (control group) with SR-1000A automated electrocardiography made by Guangdong Zhongshan. The HR,QT d and P d were tested by hand during three clear waves cycles in 12ECG. Results HR decreased (P0.01),QT max and QT min and QT d prolonged (P0.01) ,QT cmin and QT cdincreased (P0.01 or 0.05),P cmax and P cmindecreased(P0.01),P d and P cdslightly prolonged(P0.05)in research group, compared with the control. There were no differences in QT d and QT cdand P d and P cdboth sex and the result of HUTT with VVS (P0.05). Conclusions There are no significances in QT d and P d both sex and the result of HUTT with VVS. QT d and QT cdof VVS children markedly increase. P d and P cddon't obviously prolong. The children of VVS will give precautions of occurring ventricular arrhythmia in clinical application.

Study of patterns of trauma care

Abstract: Objective To study the effects of patterns of trauma care on the outcome of the trauma patients.Methods There were 8 271 cases for injuries to our emergency department from January 1,1996 to January 1,2004.Trauma patients(n=2 033)entering emergency department from January 1,1996 to December 31,1997 were assigned to the different surgical departments and were used as control group.Trauma patients(n=6 238) were directly admitted to the trauma department from January 1,1998 to January 1,2004 and were used as clinical group.The outcomes between these two groups were compared.Results The time spent in trauma diagnoses,the time between reaching emergency room and definitive operation,length of hospital staty,mortality and the incidence of complications in clinical group all reduced significantly regardless of mild or severe trauma,single or multiple trauma, compared with control group.Conclusion The patterns of trauma care have a significant influence on the outcome of trauma patients.Specialized trauma care is superior to other types of trauma care.

Influence of half-mannitol on early enlargement of hematoma in hypertensive cerebral hemorrhage

Abstract: Objective To study the influence of mannitol on early enlargement of hematoma in hypertensive cerebral hemorrhage, and to discuss how to use mannitol correctly. Methods 84 patients with hypertensive supratentorial non-thalamic cerebral hemorrhage and light intracranial hypertension, and with less than 50 mL of hematoma volume determined by cranial CT within 6 h after the onset were randomly divided into a group in which mannitol was used(n=28), a group in which half-mannitol was used(n=28) and a group in which non-mannitol was used(n=28) within 24 h. Cranial CT was redone at 48h. If the volume of hematoma increased by 33%, it should be considered as early enlargement of hematoma. The influence of using mannitol within 24 h after the onset on early enlargement of hematoma was analyzed. Results 11 patients in the group in which mannitol was used within 24 h after the onset had early enlargement of hematoma, 3 patients in the group using half-mannitol and 2 patients in the group using non-mannitol had hematoma enlargement. There was significant difference between them. The integral comparison of nerve function defect in them was similar. Conclusion Improper use of mannitol within 24h after the onset may increase the incidence of early enlargement of hematoma in the patients with hypertensive cerebral hemorrhage, and exacerbate the patient's conditions. For patients with hypertensive cerebral hemorrhage with light intracranial hypertension, especial those within 24h after the onset, mannitol should not be used blindly.

Protective effects of polydatin on focal cerebral ischemia in rats

Abstract: Objective To study the protective mechanism of polydatin (PD) on focal cerebral ischemia in rats. Methods The middle cerebral artery (MCA) was occluded with thread according to modified Zealonga's method. The rats were randomly divided into three groups: sham-operated group,ischemia model group, PD pretreatment group. The contents of MDA, water, the activities of SOD, GSH-Px, CAT and NOS in the brain tissue were determined and the pathological section of brain tissue was observed. Results PD could significantly improve the activities of SOD, GSH-Px and CAT in brain tissue, lower the content of MDA, reduce the brain edema. PD also had the trendency to lower the activity of NOS. The observation on the pathological section of brain tissue indicated that PD could alleviate the injury of cerebral ischemia. Conclusion PD has an obvious protective effect on focal cerebral ischemia in rats, and its treatment mechanism may come from effectively scavenging free radicals and improving the anti-oxidative ability of the brain tissue.

Comparison of four intensive care score modes in the patients with severe sepsis

Abstract: Objective To study four severity scoring systems,APACHE?Ⅱ,APACHE?Ⅲ,SAPS?Ⅱ and MODS in the patients with severe sepsisMethods Fifty-six patients satisfied the severe sepsis standard and were divided into two groupsOne was survival group(A group) and the other was dead group(B group)Besides recording general data,the continuous surveillance of APACHE?Ⅱ,APACHE?Ⅲ,SAPS?Ⅱ and MODS were followed on the 1st,3rd and 7th dayResults By the level of P001,four scoring systems were applied in seven days,MODS was significantly different only on the 1st day,but the others were significantly different on the 1st,3rd and 7th dayThe P value of APACHE Ⅲ was always minimum and that of MODS was maximumConclusions The newest scoring systems do not mean the best,and the choice of the scoring system should change with different diseasesFour scoring systems were applied for evaluating the symptoms and prognosis of the patients with severe sepsis in SICU with seven days,the APACHE Ⅲ is the best,APACHE?Ⅱ and SAPS?Ⅱ are secondary and MODS is worst

Diagnostic difference of head-up tilt table test in the patients of unexplained dizziness and syncope

Abstract: Objective To probe diagnostic difference of head-up tilt table test in the patients of unexplained dizziness and syncope.Methods There were 338(male 127 and female 211) patients of unexplained dizziness and syncope aged from 4 to 70 years old(mean 24.93±16.15 years) who accepted head-up tilt table test(BHUT) at 70 degrees with power tilt table.Negative cases of them were given sublingual glyceryl trinitrate 0.2 mg and accepted sublingual nitroglycerin head-up tilt table test(SNHUT).These data were statisticsed by computer with SPSS 11.0 software.Results ①Systolic pressure,diastolic pressure,heart rate and reaction type of positive result were not different in dizziness group and syncope group(P0.05).②The positive rate of dizziness group and syncope group was 31.43%(11/35)vs 42.90%(130/303)in HUTT and 28.57%(8/28)vs 33.82%(70/207)in BHUT and 42.86%(3/7)vs 62.50%(60/96)in SNHUT(all P0.05).The positive rate was obviously higher in SNHUT than in BHUT(P0.05).③The syncope episodes occurred when standing time was slightly longer in dizziness group than in syncope group :(29.13±11.01 min) vs(23.52±12.80 min) in BHUT and(6.00±3.61 min) vs(4.98±3.51 min) after given sublingual glyceryl trinitrate in SNHUT(all P0.05).Conclusion The partial patients of unexplained dizziness resulted from vasovagal syncope but they don't show syncope attack in clinic.These patients should think highly of tilt table test.