Chinese Critical Care Medicine, November 2003,Vol.15,No.11
PAGE: 643-645
Thinking about the education of disaster medicine in China
LIU Zhen-li
Medical Affairs Department of the General Hospital of People’s Liberation Army, Beijing 100853, China.
PAGE: 646-650
Changes in Toll-like receptor 2 and 4 gene expression in vital organs in septic rats and their regulation mechanisms
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YAO Yong-ming, YAN Xiao-jian, YAO Feng-hua, CHENG Ming-hua, DONG Ning, YU Yan, SHENG Zhi-yong
Burns Institute, 304th Hospital of People's Liberation Army, Beijing 100037, China.
OBJECTIVE: To investigate the changes in Toll-like receptor (TLR) 2 and 4 gene expression in vital organs in septic rats and their potential regulation mechanism. METHODS: One hundred Wistar rats were randomly divided into normal controls (n=10), sham-operated group (n=10), septic group (n=60), and recombinant bactericidal/permeability increasing protein (BPI)-treated group (n=20). Severe sepsis was replicated by cecal ligation and puncture (CLP). Animals were sacrificed at different time points after CLP, tissue TLR2/4 mRNA expression in the liver, lungs, kidneys as well as intestine were measured by reverse transcription-polymerase chain reaction (RT-PCR). Plasma levels of tumor necrosis factor-α(TNF-α) and interleukin-10 (IL-10) were also determined by enzyme linked immunoadsorbent assay (ELISA). RESULTS: TLR2/4 mRNA could be detected in various tissues with low values both in normal controls and sham-operated group, but they were markedly up-regulated at 2 hours after CLP, peaking at 6-12 hours. Tissue TLR4 mRNA was gradually down-regulated 24 hours later, while TLR2 mRNA levels maintained high values up to 72 hours. In comparison with the CLP group, treatment with BPI significantly decreased TLR2 mRNA in various tissues at 12 and 24 hours (P<0.05 or P<0.01), also tissue TLR4 mRNA at 12 hours (P<0.05 or P<0.01), without marked influence on TLR4 mRNA expression at 24 hours in liver, lungs and small intestine (P>0.05). In addition, treatment with BPI could significantly lower plasma TNF-α levels at 12 hours post-CLP, on the other hand markedly elevate plasma IL -10 levels 24 hours later (P<0.01). CONCLUSION: These data suggest that severe peritoneal infection could result in up-regulation of TLR2/4 mRNA expression in vital organs, which might play important roles in mediating proinflammatory cytokine synthesis and release. Endotoxemia appears to be involved in the activation of tissue TLR2/4 expression associated with CLP-induced sepsis.
, 百拇医药
PAGE: 651-654
Study on gene expression difference of polymorphonuclear neutrophils in early and late periods of systemic inflammatory response syndrome
LIU Yi, DENG Xiao-ming, LI Jin-bao
Department of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
OBJECTIVE: To study the gene expression difference of polymorphonuclear neutrophils (PMN) in systemic inflammatory response syndrome (SIRS) in early and late periods termed as multiple organ dysfunction syndrome (MODS) and to evaluate the related changes in function of PMN. METHODS: Using cDNA microarray technology, RNA of peripheral blood PMN of 4 patients with SIRS was detected in early and late periods, the gene expression difference was obserred and analyzed. RESULTS: Among 8 464 genes there were 84 differently expressed with 19 expressed higher and 65 expressed lower. The differently expressed genes consisted of cell receptor genes (31 percent), immunity-related genes (27 percent), metabolism-related genes (20 percent), and genes of DNA binding or transcriptional factors (18 percent) etc. CONCLUSION: Differently expressed genes suggest that PMN in MODS be in a dysfunctional state characterized by decreasing innate immunity response and increased tissue auto-injury, which may portend a bad prognosis of the patients.
, 百拇医药
PAGE: 655-657
Expression of mRNA and protein of ubiquitin in diaphragmatic muscle in burned rats with sepsis in early stage
SHEN Chuan-an, CHAI Jia-ke, YAO Yong-ming, JIANG Jin-heng
304 th Hospital of People's Liberation Army, Beijing 100037, China.
OBJECTIVE: To study the expressions of mRNA and protein of ubiquitin in diaphragmatic muscle in burned rats with sepsis. METHODS: The model of burn sepsis was replicated by subjecting the rats to 30 percent total body surface area (TBSA) Ⅲ degree burn followed immediately by administration of endotoxin (6 mg/kg) into the peritoneal cavity. The rats were randomly divided into 2-and 6-hour groups and a normal control group, with 9 rats in each group. The expressions of ubiquitin mRNA in the diaphragmatic muscle was determined with Northern blot analysis. The expressions of ubiquitin protein in the diaphragmatic muscle were assayed with immunohistochemical method. RESULTS: The expressions of the ubiquitin mRNA (2.4 kb and 1.2 kb) in diaphragmatic muscle of burn rats with sepsis were significantly higher than that of normal control group, especially the 2.4 kb stripe (all P<0.01). A notable increase in the expressions of the ubiquitin mRNA was found in the 6-hour group compared with the 2-hour group (all P<0.01). The expressions of the ubiquitin protein in diaphragmatic muscle of burn rats with sepsis were significantly increased after injury compared with the normal control group. CONCLUSION: The expressions of mRNA and protein of ubiquitin in diaphragmatic muscle are continuously increased soon after injury, suggesting that the protein degradation rate is increased in burn with sepsis. The finding is helpful in the study of the change in metabolism of diaphragmatic muscle and respiratory function.
, 百拇医药
PAGE: 658-661
Comparison of effect of norepinephrine-dobutamine and that of dopamine alone on splanchnic perfusion in sheep with septic shock
YANG Yi, QIU Hai-bo, TAN Yan, ZHOU Shao-xia, LI Shu-qing
Department of Critical Care Medicine, Zhong-da Hospital and School of Clinical Medcine, Southeast University, Nanjing 210009, Jiangsu, China.
OBJECTIVE: To compare the effect of norepinephrine-dobutamine and that of dopamine alone on splanchnic perfusion in sheep with septic shock. METHODS: Twenty sheep with septic shock induced by lipopolysaccharides were divided into two groups. When systolic pressure was decreased to 39.75 mm Hg(1 mm Hg=0.133 kPa), basic values of hemodynamic parameters and intestinal intramucosal pH (pHi) were monitored. The animals were randomized to either receive an intravenous infusion of norepinephrine-dobutamine in combination or dopamine alone, and the dosage was titrated to obtain a mean arterial pressure (MAP)>90.00 mm Hg with an optimal cardiac preload. Hemodynamic parameters and mucosal pHi were repeatedly measured at 1-, 2-, 3-, 4-hour after basic measurement. RESULTS: After norepinephrine-dobutamine or dopamine infusion, MAP, cardiac output, and oxygen delivery were increased in all animals compared to basic values in both groups (P<0.05). Compared to baseline values (4.0±1.8)mmol/L, lactate concentrations were decreased at 3-hour (2.3±1.1) mmol/L and 4-hour (2.1±1.1) mmol/L in the norepinephrine-dobutamine group (P<0.05). There were no differences in arterial lactate concentrations in the dopamine group, but arterial pH was decreased from 7.40±0.05 to 7.26±0.06 at 2-hour (P<0.05 ). No Change in pHi was found in the dopamine group, but in the norepinephrine-dobutamine group, compared to baseline, pHi was increased from 7.19±0.04 to 7.36±0.07 at 3-hour (P<0.05). CONCLUSION: Both norepinephrine-dobutamine and dopamine could improve systemic hemodynamics in sheep with septic shock, but the effect of norepinephrine-dobutamine in combination was better than dopamine on splanchnic perfusion
, 百拇医药
PAGE: 662-665
Application of the acute physiology and chronic health evaluation Ⅱ score system to patients with infection of Pseudomonas aeruginosa in lower respiratory tract in intensive care unit
SHAO Chang-zhou, QU Jie-ming, HE Li-xian
Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
OBJECTIVE: To predict the infection and evaluate the severity of illness and prognosis for patients with infection of Pseudomonas aeruginosa (PA) in lower respiratory tract in intensive care unit (ICU) with the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ). METHODS: The clinical data of 122 cases with infection of PA in lower respiratory tract were compared and studied. These data were evaluated with APACHEⅡ score system according to Knaus method. RESULTS: APACHEⅡ scores of the 29 nonsurvivors were significantly higher than that of 93 survivors (18.78±7.13 vs. 11.70±5.79, t=5.43， P<0.01). The patients with coinfections other than PA had a higher APACHEⅡ score (14.76±6.89 vs. 10.08±6.14, P<0.01), a higher mortality (27.91 percent vs. 13.89 percent, P<0.01), and more days of stay in ICU 〔(28.47±23.59)days vs. (16.64±21.19) days〕 than those without. Patients with severe pneumonia had higher APACHEⅡ scores (15.57±6.97 vs. 11.81±6.03) and poorer prognosis (39.22 percent vs. 12.68 percent) than those without. For all patients, when the APACHEⅡ scores became higher and higher, the outcome became poorer and poorer, and the mortality higher and higher, and the percentage of severe pneumonia higher and higher. There was a significant correlation between APACHEⅡscore and actual mortality (r=0.75, P<0.01) and predicted mortality (r=0.81, P<0.01). Actual and predicted mortality increased along with the increase in APACHEⅡ scores by 5 scores. The sensitivity and positive rate of predicted mortality was 100.00 percent and 86.72 percent respectively. CONCLUSION: APACHEⅡ score system is highly valuable in predicting the infection and evaluating the severity of illness and prognosis in patients with infection of PA in lower respiratory tract in ICU.
, 百拇医药
PAGE: 666-668
Prospective study of systemic inflammatory response syndrome of patients with nosocomial G- bacteria infection
DONG Chen-ming, ZHAO Jian-xiong, LI Pei-jie, YANG Lan, NIU Tian-ping, CHEN Tian-duo Lanzhou Medical College Second Affiliated Hospital, Lanzhou Emergency Centre, Lanzhou 730030, Gansu, China.
OBJECTIVE: To study the characteristics of systemic inflammatory response syndrome(SIRS) of inpatients with nosocomial G- bacteria infection in order to find on effective treatment. METHODS: Eighty-two inpatients of SIRS with lower respiratory tract infection with G-bacteria were studied prospectively until discharge or death. They were divided into two groups: observation group (42 cases) and control group (40 cases). Bacteria culture of sputum and drug sensitivity was performed. Routine treatment was carried out in the control group, and rhubarb and antibiotics with lower endotoxin releasing property were given to the observation group. The course of SIRS, the incidence of MODS, and the mortality were compared. RESULTS: The duration with SIRS in observation group and control group was respectively (6.2±1.3) days and (7.4±1.2)days, u=3.91, P<0.05; the incidence of MODS was 11.4 percent and 32.3 percent, respectively, χ2=4.27, P<0.05. The mortality rates of the patients with SIRS in two groups were 8.6 percent and 29.0 percent, respectively. CONCLUSION: The results indicated that the treatment with rhubarb could obviously reduce the duration of SIRS compared with routine method. The same is true in the incidence of MODS and mortality rate.
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PAGE: 669-674
Evaluation of glucocorticoid in treatment for patients with acute respiratory distress syndrome as a result of serious community-acquired pneumonia
SONG Zhi-fang， GUO Xiao-hong， WANG Shu-yun, XIE Wei, YIN Na, ZHANG Yue, SHAN Hui-min, LI Wen-hua
Medical Intensive Care Unit， Xinhua Hospital， The Second Medical University of Shanghai，Shanghai 200092, China.
, 百拇医药
OBJECTIVE: To evaluate the usage of glucocorticoid(GC) in treatment for patients with acute respiratory distress syndrome (ARDS) resulting from serious community-acquired pneumonia (SCAP). METHODS: The clinical data from all patients with ARDS resulting from SCAP in medical ICU (MICU) from May 2000 to Feb. 2003 were collected. Their age, sex, acute physiology and chronic health evaluation (APACHEⅡ) score, PaO2/FiO2 and Qs/Qt, the severity of SCAP, mechanical ventilation (MV) and the level of positive end-expiratory pressure(PEEP), time of stay in ICU, improvement of SCAP and oxygenation, as well as mortality and reasons of death were analyzed, respectively. So was did the influence of administration of GC on hypoxemia， septic shock, and their prognosis. RESULTS: There were 24 cases totally, among them 7 patients had not taken GC, and 5 patients were cured (71.4 percent), and the other 2 cases died (28.6 percent) Their direct cause of death were multiple organ dysfunction syndrome(MODS) and ARDS， respectively In 17 cases GC was given because hypoxemia and septic shock could not be alleviated with ordinary therapy, including MV Among them only 5 patients (29.4 percent) were cured, and all others (12 cases, 70.6 percent) died, and the major direct cause of death was MODS(6 cases，75.0 percent). A few of them died of ARDS and septic shock(1 case，12.5 percent, respectively). The severity of SCAP, as well as other clinical data of the survivors, showed no significant difference compared with the nonsurvivors (P>0.05). But except for their PaO2/FiO2, Qs/Qt and shock, their pulmonary infection was better controlled than deaths (P<0.001). CONCLUSION: Refractory hypoxemia and septic shock of patients with pulmonary ARDS might be alleviated by GC when they are treated with routine methods, including MV, thus it enabled to win the time for other effective treatments.
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PAGE: 675-679
Influence of catecholamines on myocardium in experimental septic shock
SONG Da-lin, MEI Shao-ping, DONG Yan-hu, Herbert Spapen
Department of Molecular Biology, Hiser Medical Center of Qingdao, Qingdao 266033, Shandong, China.
OBJECTIVE: To study the influence of catecholamine on myocardium in rats with septic shock and its mechanism by biochemical and pathophysiological methods to evaluate the underlying pathophysiologic mechanism of myocardial damage and the influence of catecholamine on the myocardial injury. METHODS: Septic shock was replicated in rats by cecal ligation and puncture (CLP). Dobutamine (DB), norepinephrine (NE) and combination of DB and NE were usedin the lowest dose. The rats were randomly divided into sham operations, CLP control group, CLP+DB group, CLP+NE group and CLP+DB+NE group, 8 rats in each group. Troponin I (cTnI) and total creatine kinase (CK) were measured, and myocardial tissue was examined under light microscopy and electron microscopy. RESULTS: An significantly increased cTnI level was found in CLP septic shock rats, compared with sham rats(P<0.05). In the present study, the use of DB or NE alone, or the combination of the two drugs, was not found to influence the cTnI levels. But, the total CK levels in catecholamine-treated group were significantly increased(P<0.05). There was no statistically significant correlation between cTnI and CK levels. Morphological study confirmed the results of cTnI. Findings that were common in the myocardium of CLP septic shock rats included extracellular and intracellular edema as well as mitrochondrial injury. However, no conclusive evidence was found for the influence of catecholamine on myocardial damage. CONCLUSION: No evidence of the influence of catecholamine on myocardial damage is found. Pathological study suggests that myocardial injury is the result of ischemia.
, 百拇医药
PAGE: 680-682
Rational therapeutic regime of glucocorticoid in patients with acute respiratory distress syndrome and its receptor mechanism
MA Jun
Transplantation Center, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
OBJECTIVE: To study the change in glucocorticoid receptor (GR) and cortisol, for the purpose of proposing a rational use of glucocorticoid (GC) in patients with acute respiratory distress syndrome(ARDS), and to evaluate its receptor mechanism.
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METHODS: ARDS patients in general ICU were enrolled for the study. GR of peripheral leukocytes in the patients were determined by radioligand binding assay using (3H) dexamethasone as ligand. ARDS patients were stratified into three groups, i.e. mild, moderate and severe by clinical indices. The dosage of GC in the treatment of ARDS varied according to the level of GR and clinical indices. RESULTS: The proposed usage of GC according to the levels of GR, cotisol and clinical indices in the treatment of ARDS was shown to be rational. CONCLUSION: The therapeutic effect of individualized dosage of GC may be much better in the treatment of ARDS.
, 百拇医药
PAGE: 683-685
Analysis on diagnosis, treatment and influential factors in fever patients during epidemic of severe acute respiratory syndrome
LIU Gui-hua, ZHENG Ya-an, WANG Zheng, GE Bao-lan.
Emergency Department, the Third Affiliated Hospital, Peking University, Beijing 100083, China.
OBJECTIVE: To analyze the etiology, therapy and influential factors in fever patients during the epidemic of severe acute respiratory syndrome (SARS), so as to define early and differential diagnosis for SARS from other disease with fever. METHODS: The epidemiological and the clinical data of 4 060 patients with fever admitted to the emergency department of the Third Hospitical affiliated to Peking University from March 5th to May 10th in 2003 were analyzed, and their influential factors were evaluated. RESULTS: Of 4060 patients with fever 275 cases were admitted to the isolated ward, 145 cases were diagnosed as SARS (3.75 percent), 29 belonged to suspected cases, and in 101 cases SARS was ruled out. Ninety-three cases were non-SARS-pneumonia, 2 were epidemic encephalitis, 8 were epidemic cerebrospinal meningitis, and 3 cases were epidemic hemonorrhagic fever. CONCLUSION: During epidemic of SARS, the etiology of fever is influenza or other virus infection in 90 percent of patients. Non-SARS-pneumonia and infectious diseases with fever accounted for certain proportion of patients with fever. Our diagnostic level should be improved. SARS could not be ruled out only by a high white blood cells count. Chest X-ray examination have to be repeated, because abnormal chest X-ray do not always appear at the same time with fever.
, 百拇医药
PAGE: 686-687
Reasons of operative acute abdomen with systemic inflammatory response syndrome
ZHANG Chun, YAO Cong, QIAO Wan-hai, et al
Emergency Department, the Second Hospital, Xian traffic University, Xian 100083, Shanxi, China.
PAGE: 687-688
Assessment and clinical analysis of children with multiple organ failure
, 百拇医药
ZENG Xiao-hui, ZHAO Xiang-wen, ZHU Yi-min, et al
Intens ive care unit of Hunan Children Hospital, Changsha, Hunan 410007, China.
PAGE: 689
Protection in close manipulation for patients with severe acute respiratory syndrome in ICU
YU Song, TANG Jian
The Center ICU of the People’s Hospital, Haikou, Hainan 570208, China.
, 百拇医药
PAGE: 690-693
Advances in basic research on Janus kinase/signal transducer and activators of transcription pathway and sepsis
WANG Song-bai, YAO Yong-ming (690)
Burn Institute, 304th Hospital of People’s Liberation Army, Beijing 100037, China.
PAGE: 694-697
Recent advances in research on Toll-like receptors
, 百拇医药
LI Zhi-jie, LIU Jing-hua, JIANG Yong
Department of Pathophysiology, Laboratory of shock and Microcirculation of People’s Liberation Army, First Military Medical University, Guangzhou 510515, Guangdong, China.
PAGE: 697
Treatment experiences in 63 patients with severe acute respiratory syndrome:a retrospective analysis
YANG Zao-cheng, PENG Bi-bo, ZHANG Yong,et al
, 百拇医药
General Hospital of Armed Police, Beijing 100039, China.
PAGE: 698-701
Nutritional support for patients with multiple organ dysfunction syndromes
LIU Jun
Department of Nephrology, Nanfang Hospital, First Military Medical University, Guangzhou 510515, Guangdong, China.
PAGE: 701-704
Extracellular effect of high mobility group box-1 protein and its role in sepsis: an overview
WANG Song-bai, YAO Yong-ming (701)
Research Department of Burn Institute, 304th Hospital of People’s Liberation Army, Beijing 100037, China., 百拇医药
Thinking about the education of disaster medicine in China
LIU Zhen-li
Medical Affairs Department of the General Hospital of People’s Liberation Army, Beijing 100853, China.
PAGE: 646-650
Changes in Toll-like receptor 2 and 4 gene expression in vital organs in septic rats and their regulation mechanisms
, http://www.100md.com
YAO Yong-ming, YAN Xiao-jian, YAO Feng-hua, CHENG Ming-hua, DONG Ning, YU Yan, SHENG Zhi-yong
Burns Institute, 304th Hospital of People's Liberation Army, Beijing 100037, China.
OBJECTIVE: To investigate the changes in Toll-like receptor (TLR) 2 and 4 gene expression in vital organs in septic rats and their potential regulation mechanism. METHODS: One hundred Wistar rats were randomly divided into normal controls (n=10), sham-operated group (n=10), septic group (n=60), and recombinant bactericidal/permeability increasing protein (BPI)-treated group (n=20). Severe sepsis was replicated by cecal ligation and puncture (CLP). Animals were sacrificed at different time points after CLP, tissue TLR2/4 mRNA expression in the liver, lungs, kidneys as well as intestine were measured by reverse transcription-polymerase chain reaction (RT-PCR). Plasma levels of tumor necrosis factor-α(TNF-α) and interleukin-10 (IL-10) were also determined by enzyme linked immunoadsorbent assay (ELISA). RESULTS: TLR2/4 mRNA could be detected in various tissues with low values both in normal controls and sham-operated group, but they were markedly up-regulated at 2 hours after CLP, peaking at 6-12 hours. Tissue TLR4 mRNA was gradually down-regulated 24 hours later, while TLR2 mRNA levels maintained high values up to 72 hours. In comparison with the CLP group, treatment with BPI significantly decreased TLR2 mRNA in various tissues at 12 and 24 hours (P<0.05 or P<0.01), also tissue TLR4 mRNA at 12 hours (P<0.05 or P<0.01), without marked influence on TLR4 mRNA expression at 24 hours in liver, lungs and small intestine (P>0.05). In addition, treatment with BPI could significantly lower plasma TNF-α levels at 12 hours post-CLP, on the other hand markedly elevate plasma IL -10 levels 24 hours later (P<0.01). CONCLUSION: These data suggest that severe peritoneal infection could result in up-regulation of TLR2/4 mRNA expression in vital organs, which might play important roles in mediating proinflammatory cytokine synthesis and release. Endotoxemia appears to be involved in the activation of tissue TLR2/4 expression associated with CLP-induced sepsis.
, 百拇医药
PAGE: 651-654
Study on gene expression difference of polymorphonuclear neutrophils in early and late periods of systemic inflammatory response syndrome
LIU Yi, DENG Xiao-ming, LI Jin-bao
Department of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
OBJECTIVE: To study the gene expression difference of polymorphonuclear neutrophils (PMN) in systemic inflammatory response syndrome (SIRS) in early and late periods termed as multiple organ dysfunction syndrome (MODS) and to evaluate the related changes in function of PMN. METHODS: Using cDNA microarray technology, RNA of peripheral blood PMN of 4 patients with SIRS was detected in early and late periods, the gene expression difference was obserred and analyzed. RESULTS: Among 8 464 genes there were 84 differently expressed with 19 expressed higher and 65 expressed lower. The differently expressed genes consisted of cell receptor genes (31 percent), immunity-related genes (27 percent), metabolism-related genes (20 percent), and genes of DNA binding or transcriptional factors (18 percent) etc. CONCLUSION: Differently expressed genes suggest that PMN in MODS be in a dysfunctional state characterized by decreasing innate immunity response and increased tissue auto-injury, which may portend a bad prognosis of the patients.
, 百拇医药
PAGE: 655-657
Expression of mRNA and protein of ubiquitin in diaphragmatic muscle in burned rats with sepsis in early stage
SHEN Chuan-an, CHAI Jia-ke, YAO Yong-ming, JIANG Jin-heng
304 th Hospital of People's Liberation Army, Beijing 100037, China.
OBJECTIVE: To study the expressions of mRNA and protein of ubiquitin in diaphragmatic muscle in burned rats with sepsis. METHODS: The model of burn sepsis was replicated by subjecting the rats to 30 percent total body surface area (TBSA) Ⅲ degree burn followed immediately by administration of endotoxin (6 mg/kg) into the peritoneal cavity. The rats were randomly divided into 2-and 6-hour groups and a normal control group, with 9 rats in each group. The expressions of ubiquitin mRNA in the diaphragmatic muscle was determined with Northern blot analysis. The expressions of ubiquitin protein in the diaphragmatic muscle were assayed with immunohistochemical method. RESULTS: The expressions of the ubiquitin mRNA (2.4 kb and 1.2 kb) in diaphragmatic muscle of burn rats with sepsis were significantly higher than that of normal control group, especially the 2.4 kb stripe (all P<0.01). A notable increase in the expressions of the ubiquitin mRNA was found in the 6-hour group compared with the 2-hour group (all P<0.01). The expressions of the ubiquitin protein in diaphragmatic muscle of burn rats with sepsis were significantly increased after injury compared with the normal control group. CONCLUSION: The expressions of mRNA and protein of ubiquitin in diaphragmatic muscle are continuously increased soon after injury, suggesting that the protein degradation rate is increased in burn with sepsis. The finding is helpful in the study of the change in metabolism of diaphragmatic muscle and respiratory function.
, 百拇医药
PAGE: 658-661
Comparison of effect of norepinephrine-dobutamine and that of dopamine alone on splanchnic perfusion in sheep with septic shock
YANG Yi, QIU Hai-bo, TAN Yan, ZHOU Shao-xia, LI Shu-qing
Department of Critical Care Medicine, Zhong-da Hospital and School of Clinical Medcine, Southeast University, Nanjing 210009, Jiangsu, China.
OBJECTIVE: To compare the effect of norepinephrine-dobutamine and that of dopamine alone on splanchnic perfusion in sheep with septic shock. METHODS: Twenty sheep with septic shock induced by lipopolysaccharides were divided into two groups. When systolic pressure was decreased to 39.75 mm Hg(1 mm Hg=0.133 kPa), basic values of hemodynamic parameters and intestinal intramucosal pH (pHi) were monitored. The animals were randomized to either receive an intravenous infusion of norepinephrine-dobutamine in combination or dopamine alone, and the dosage was titrated to obtain a mean arterial pressure (MAP)>90.00 mm Hg with an optimal cardiac preload. Hemodynamic parameters and mucosal pHi were repeatedly measured at 1-, 2-, 3-, 4-hour after basic measurement. RESULTS: After norepinephrine-dobutamine or dopamine infusion, MAP, cardiac output, and oxygen delivery were increased in all animals compared to basic values in both groups (P<0.05). Compared to baseline values (4.0±1.8)mmol/L, lactate concentrations were decreased at 3-hour (2.3±1.1) mmol/L and 4-hour (2.1±1.1) mmol/L in the norepinephrine-dobutamine group (P<0.05). There were no differences in arterial lactate concentrations in the dopamine group, but arterial pH was decreased from 7.40±0.05 to 7.26±0.06 at 2-hour (P<0.05 ). No Change in pHi was found in the dopamine group, but in the norepinephrine-dobutamine group, compared to baseline, pHi was increased from 7.19±0.04 to 7.36±0.07 at 3-hour (P<0.05). CONCLUSION: Both norepinephrine-dobutamine and dopamine could improve systemic hemodynamics in sheep with septic shock, but the effect of norepinephrine-dobutamine in combination was better than dopamine on splanchnic perfusion
, 百拇医药
PAGE: 662-665
Application of the acute physiology and chronic health evaluation Ⅱ score system to patients with infection of Pseudomonas aeruginosa in lower respiratory tract in intensive care unit
SHAO Chang-zhou, QU Jie-ming, HE Li-xian
Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
OBJECTIVE: To predict the infection and evaluate the severity of illness and prognosis for patients with infection of Pseudomonas aeruginosa (PA) in lower respiratory tract in intensive care unit (ICU) with the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ). METHODS: The clinical data of 122 cases with infection of PA in lower respiratory tract were compared and studied. These data were evaluated with APACHEⅡ score system according to Knaus method. RESULTS: APACHEⅡ scores of the 29 nonsurvivors were significantly higher than that of 93 survivors (18.78±7.13 vs. 11.70±5.79, t=5.43， P<0.01). The patients with coinfections other than PA had a higher APACHEⅡ score (14.76±6.89 vs. 10.08±6.14, P<0.01), a higher mortality (27.91 percent vs. 13.89 percent, P<0.01), and more days of stay in ICU 〔(28.47±23.59)days vs. (16.64±21.19) days〕 than those without. Patients with severe pneumonia had higher APACHEⅡ scores (15.57±6.97 vs. 11.81±6.03) and poorer prognosis (39.22 percent vs. 12.68 percent) than those without. For all patients, when the APACHEⅡ scores became higher and higher, the outcome became poorer and poorer, and the mortality higher and higher, and the percentage of severe pneumonia higher and higher. There was a significant correlation between APACHEⅡscore and actual mortality (r=0.75, P<0.01) and predicted mortality (r=0.81, P<0.01). Actual and predicted mortality increased along with the increase in APACHEⅡ scores by 5 scores. The sensitivity and positive rate of predicted mortality was 100.00 percent and 86.72 percent respectively. CONCLUSION: APACHEⅡ score system is highly valuable in predicting the infection and evaluating the severity of illness and prognosis in patients with infection of PA in lower respiratory tract in ICU.
, 百拇医药
PAGE: 666-668
Prospective study of systemic inflammatory response syndrome of patients with nosocomial G- bacteria infection
DONG Chen-ming, ZHAO Jian-xiong, LI Pei-jie, YANG Lan, NIU Tian-ping, CHEN Tian-duo Lanzhou Medical College Second Affiliated Hospital, Lanzhou Emergency Centre, Lanzhou 730030, Gansu, China.
OBJECTIVE: To study the characteristics of systemic inflammatory response syndrome(SIRS) of inpatients with nosocomial G- bacteria infection in order to find on effective treatment. METHODS: Eighty-two inpatients of SIRS with lower respiratory tract infection with G-bacteria were studied prospectively until discharge or death. They were divided into two groups: observation group (42 cases) and control group (40 cases). Bacteria culture of sputum and drug sensitivity was performed. Routine treatment was carried out in the control group, and rhubarb and antibiotics with lower endotoxin releasing property were given to the observation group. The course of SIRS, the incidence of MODS, and the mortality were compared. RESULTS: The duration with SIRS in observation group and control group was respectively (6.2±1.3) days and (7.4±1.2)days, u=3.91, P<0.05; the incidence of MODS was 11.4 percent and 32.3 percent, respectively, χ2=4.27, P<0.05. The mortality rates of the patients with SIRS in two groups were 8.6 percent and 29.0 percent, respectively. CONCLUSION: The results indicated that the treatment with rhubarb could obviously reduce the duration of SIRS compared with routine method. The same is true in the incidence of MODS and mortality rate.
, http://www.100md.com
PAGE: 669-674
Evaluation of glucocorticoid in treatment for patients with acute respiratory distress syndrome as a result of serious community-acquired pneumonia
SONG Zhi-fang， GUO Xiao-hong， WANG Shu-yun, XIE Wei, YIN Na, ZHANG Yue, SHAN Hui-min, LI Wen-hua
Medical Intensive Care Unit， Xinhua Hospital， The Second Medical University of Shanghai，Shanghai 200092, China.
, 百拇医药
OBJECTIVE: To evaluate the usage of glucocorticoid(GC) in treatment for patients with acute respiratory distress syndrome (ARDS) resulting from serious community-acquired pneumonia (SCAP). METHODS: The clinical data from all patients with ARDS resulting from SCAP in medical ICU (MICU) from May 2000 to Feb. 2003 were collected. Their age, sex, acute physiology and chronic health evaluation (APACHEⅡ) score, PaO2/FiO2 and Qs/Qt, the severity of SCAP, mechanical ventilation (MV) and the level of positive end-expiratory pressure(PEEP), time of stay in ICU, improvement of SCAP and oxygenation, as well as mortality and reasons of death were analyzed, respectively. So was did the influence of administration of GC on hypoxemia， septic shock, and their prognosis. RESULTS: There were 24 cases totally, among them 7 patients had not taken GC, and 5 patients were cured (71.4 percent), and the other 2 cases died (28.6 percent) Their direct cause of death were multiple organ dysfunction syndrome(MODS) and ARDS， respectively In 17 cases GC was given because hypoxemia and septic shock could not be alleviated with ordinary therapy, including MV Among them only 5 patients (29.4 percent) were cured, and all others (12 cases, 70.6 percent) died, and the major direct cause of death was MODS(6 cases，75.0 percent). A few of them died of ARDS and septic shock(1 case，12.5 percent, respectively). The severity of SCAP, as well as other clinical data of the survivors, showed no significant difference compared with the nonsurvivors (P>0.05). But except for their PaO2/FiO2, Qs/Qt and shock, their pulmonary infection was better controlled than deaths (P<0.001). CONCLUSION: Refractory hypoxemia and septic shock of patients with pulmonary ARDS might be alleviated by GC when they are treated with routine methods, including MV, thus it enabled to win the time for other effective treatments.
, http://www.100md.com
PAGE: 675-679
Influence of catecholamines on myocardium in experimental septic shock
SONG Da-lin, MEI Shao-ping, DONG Yan-hu, Herbert Spapen
Department of Molecular Biology, Hiser Medical Center of Qingdao, Qingdao 266033, Shandong, China.
OBJECTIVE: To study the influence of catecholamine on myocardium in rats with septic shock and its mechanism by biochemical and pathophysiological methods to evaluate the underlying pathophysiologic mechanism of myocardial damage and the influence of catecholamine on the myocardial injury. METHODS: Septic shock was replicated in rats by cecal ligation and puncture (CLP). Dobutamine (DB), norepinephrine (NE) and combination of DB and NE were usedin the lowest dose. The rats were randomly divided into sham operations, CLP control group, CLP+DB group, CLP+NE group and CLP+DB+NE group, 8 rats in each group. Troponin I (cTnI) and total creatine kinase (CK) were measured, and myocardial tissue was examined under light microscopy and electron microscopy. RESULTS: An significantly increased cTnI level was found in CLP septic shock rats, compared with sham rats(P<0.05). In the present study, the use of DB or NE alone, or the combination of the two drugs, was not found to influence the cTnI levels. But, the total CK levels in catecholamine-treated group were significantly increased(P<0.05). There was no statistically significant correlation between cTnI and CK levels. Morphological study confirmed the results of cTnI. Findings that were common in the myocardium of CLP septic shock rats included extracellular and intracellular edema as well as mitrochondrial injury. However, no conclusive evidence was found for the influence of catecholamine on myocardial damage. CONCLUSION: No evidence of the influence of catecholamine on myocardial damage is found. Pathological study suggests that myocardial injury is the result of ischemia.
, 百拇医药
PAGE: 680-682
Rational therapeutic regime of glucocorticoid in patients with acute respiratory distress syndrome and its receptor mechanism
MA Jun
Transplantation Center, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
OBJECTIVE: To study the change in glucocorticoid receptor (GR) and cortisol, for the purpose of proposing a rational use of glucocorticoid (GC) in patients with acute respiratory distress syndrome(ARDS), and to evaluate its receptor mechanism.
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METHODS: ARDS patients in general ICU were enrolled for the study. GR of peripheral leukocytes in the patients were determined by radioligand binding assay using (3H) dexamethasone as ligand. ARDS patients were stratified into three groups, i.e. mild, moderate and severe by clinical indices. The dosage of GC in the treatment of ARDS varied according to the level of GR and clinical indices. RESULTS: The proposed usage of GC according to the levels of GR, cotisol and clinical indices in the treatment of ARDS was shown to be rational. CONCLUSION: The therapeutic effect of individualized dosage of GC may be much better in the treatment of ARDS.
, 百拇医药
PAGE: 683-685
Analysis on diagnosis, treatment and influential factors in fever patients during epidemic of severe acute respiratory syndrome
LIU Gui-hua, ZHENG Ya-an, WANG Zheng, GE Bao-lan.
Emergency Department, the Third Affiliated Hospital, Peking University, Beijing 100083, China.
OBJECTIVE: To analyze the etiology, therapy and influential factors in fever patients during the epidemic of severe acute respiratory syndrome (SARS), so as to define early and differential diagnosis for SARS from other disease with fever. METHODS: The epidemiological and the clinical data of 4 060 patients with fever admitted to the emergency department of the Third Hospitical affiliated to Peking University from March 5th to May 10th in 2003 were analyzed, and their influential factors were evaluated. RESULTS: Of 4060 patients with fever 275 cases were admitted to the isolated ward, 145 cases were diagnosed as SARS (3.75 percent), 29 belonged to suspected cases, and in 101 cases SARS was ruled out. Ninety-three cases were non-SARS-pneumonia, 2 were epidemic encephalitis, 8 were epidemic cerebrospinal meningitis, and 3 cases were epidemic hemonorrhagic fever. CONCLUSION: During epidemic of SARS, the etiology of fever is influenza or other virus infection in 90 percent of patients. Non-SARS-pneumonia and infectious diseases with fever accounted for certain proportion of patients with fever. Our diagnostic level should be improved. SARS could not be ruled out only by a high white blood cells count. Chest X-ray examination have to be repeated, because abnormal chest X-ray do not always appear at the same time with fever.
, 百拇医药
PAGE: 686-687
Reasons of operative acute abdomen with systemic inflammatory response syndrome
ZHANG Chun, YAO Cong, QIAO Wan-hai, et al
Emergency Department, the Second Hospital, Xian traffic University, Xian 100083, Shanxi, China.
PAGE: 687-688
Assessment and clinical analysis of children with multiple organ failure
, 百拇医药
ZENG Xiao-hui, ZHAO Xiang-wen, ZHU Yi-min, et al
Intens ive care unit of Hunan Children Hospital, Changsha, Hunan 410007, China.
PAGE: 689
Protection in close manipulation for patients with severe acute respiratory syndrome in ICU
YU Song, TANG Jian
The Center ICU of the People’s Hospital, Haikou, Hainan 570208, China.
, 百拇医药
PAGE: 690-693
Advances in basic research on Janus kinase/signal transducer and activators of transcription pathway and sepsis
WANG Song-bai, YAO Yong-ming (690)
Burn Institute, 304th Hospital of People’s Liberation Army, Beijing 100037, China.
PAGE: 694-697
Recent advances in research on Toll-like receptors
, 百拇医药
LI Zhi-jie, LIU Jing-hua, JIANG Yong
Department of Pathophysiology, Laboratory of shock and Microcirculation of People’s Liberation Army, First Military Medical University, Guangzhou 510515, Guangdong, China.
PAGE: 697
Treatment experiences in 63 patients with severe acute respiratory syndrome:a retrospective analysis
YANG Zao-cheng, PENG Bi-bo, ZHANG Yong,et al
, 百拇医药
General Hospital of Armed Police, Beijing 100039, China.
PAGE: 698-701
Nutritional support for patients with multiple organ dysfunction syndromes
LIU Jun
Department of Nephrology, Nanfang Hospital, First Military Medical University, Guangzhou 510515, Guangdong, China.
PAGE: 701-704
Extracellular effect of high mobility group box-1 protein and its role in sepsis: an overview
WANG Song-bai, YAO Yong-ming (701)
Research Department of Burn Institute, 304th Hospital of People’s Liberation Army, Beijing 100037, China., 百拇医药