Volume15 July2003 Number7
Chinese Critical Care Medicine, July 2003, Vol.15, No.7
PAGE：387-388
Thinking about severe acute respiratory syndrome
LIU You-ning
Department of Hepatobiliary Surgery, the General Hospital of People’s Liberation Army, Beijing 100853, China.
PAGE：388
Therapeutic problems of lung exubation during middle and late stages in severe acute respiratory syndrome patients
, 百拇医药
ZHANG Bo-li
Tianjin Herbalist doctor College, Tianjin, China.
PAGE：389-390
Medical strategies for emergency response on chemical terrorism
YUE Mao-xing
306th Hospital of People’s Liberation Army, Beijing 100101, China.
PAGE：391-394
Pathology and pathophysiology of severe acute respiratory syndrome
, 百拇医药
ZHAO Jing-min, ZHOU Guang-de, SUN Yan-ling
302th Hospital of People’s Liberation Army, Beijing 100039, China.
PAGE：395-397
Current issues on the diagnosis and treatment of severe acute respiratory syndrome
ZHANG Jian-peng, LIU You-ning, CHEN Liang-an
Respiratory Disease Department, General Hospital of Chinese Armed Police Force, Beijing 100039, China.
, http://www.100md.com
PAGE：397
Consideration of discharge criteria for severe acute respiratory syndrome patients
WANG Shao-jun, WANG Feng-mei, LI Yu-ming
The Third Central Hospital of Tianjin, Tianjin 300170, China.
PAGE：398-400
Respiratory monitoring in mechanical ventilated patients
QIN Ying-zhi
, 百拇医药
The Third Centra Hospital of Tianjin, Tianjin Ventilator Therapy and Research Center, Tianjin 300170, China.
PAGE：400
Cardiac functional evaluation in severe SARS patients during hypoxemia
WANG Shao-jun, LI Yu-ming, WANG Feng-mei, LIU Ying-wu
The Third Central Hospital of Tianjin, Tianjin 300170, China.
PAGE：401-403
, 百拇医药
Analysis of acute physiology and chronic health evaluation III in the 54 patients with severe acute respiratory syndrome
SHI Hai-yan, ZHANG Fu-chun, YIN Zhi-biao, DENG Xi-long
The Eighth People's Hospital of Guangzhou, Guangzhou 510060, Guangdong, China.
Objective: To evaluate the acute physiology and chronic health evaluation III (APACHE Ⅲ) in the severe acute respiratory syndrome (SARS) patients and its significance in prognosis. Methods: The clinical data of 54 SARS patients, including survivors (43 cases) and nonsurvivors (11 cases) were collected and evaluated with APACHE Ⅲ scoring system. The correlation of scores and prognosis was evaluated. Results: The scores of the nonsurvivors were higher remarkably than those of the surviving group (P<0.01). The scores of the acute physiology score (APS) and year score (YS) in the death group were higher obviously than those of the surviving group (both P<0.01). Elderly patients with severe disease had a high mortality. The scores of APACHE Ⅲ had positive correlation with the over all fatality rate. When the scores of APACHE Ⅲ was higher than 60, the fatality rate increased obviously. Conclusion: The scores of APACHE Ⅲ in the SARS are correlated with the patient's condition and prognosis.
, http://www.100md.com
PAGE：403
Science face upto to fact of undiscovered, frustration and challenge from severe acute respiratory syndrome
SHEN Hong
Department of Hepatobiliary Surgery, the General Hospital of People’s Liberation Army, Beijing 100853, China.
PAGE：404-407
Clinical features of 77 patients with severe acute respiratory syndrome
, http://www.100md.com
LI Guo-qiang, ZHANG Yu-hua
The Affiliated Hospital of Chinese Armed Force Police Medical College, Tianjin 300162, China.
Objective: To analyze the clinical features of the severe acute respiratory syndrome (SARS) and the value for caring of patients suspected of having this disease. Methods: The data of the clinical presentations and course of disease in 77 epide miologically linked patients (27 men and 50 women, 15 to 74 years old) in whom SARS was diagnosed after April 16, 2003 in Tianjin, China were summarized. Results: Exposure to ailing patients and occurrence of the disease ranged from minimal to close contact, such as between patient and health care personnel. The incubation period ranged from 1 to 11 days. All patients presented fever, and some of them complained of rigor, dry cough, dyspnea, malaise, headache, and hypoxemia. Physical examination of the chest revealed bubbling rales and dullness on percussion. Lymph openia was observed in 80% of all patients, and some patients had mildly elevated am inotransferase levels but normal serum creatinine levels. Serial chest radiographs showed progressive inflammatory changes. One patient died of progressive respiratory failure; pathological examination of the lung showed diffuse alveolar damage. One patient died of suicide. There was no evidence of infection by Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella pneumophila. All patients received corticosteroid and ribavirin therapy for a mean of (18.6±5.4) days after the onset of symptoms, and were treated with a combination of beta-lactams and macrolide early for (4.0±1.9)days, but with no clinical or radiologic evidences of improvement. Conclusion: The combination treatment, especially including corticosteroid and ribavirm, is efficient.
, http://www.100md.com
PAGE：408-410
Effect of severe thoracic trauma combined with endotoxin challenge on phagocytosis function of alveolar macrophages and pulmonary interstitial macrophages
ZHANG Wei, JIANG Yao-guang, XIE Zhi-jian, HU Cheng-xiang, LI Lei
Center of Thoracic Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China.
Objective: To observe the difference of phagocytosis between alveolar macrophages and pulmonary interstitial macrophages, and to investigate their responses to severe thoracic trauma with or without lipopolysaccharide (LPS) challenge. Methods: A rat model of severe thoracic trauma was reproduced by thoracic impact machine. The alveolar macrophages and interstitial macrophages were isolated before injury and at 2, 4, 8, 16, 24 hours after injury respectively. The dynamic changes of this macrophage phagocytosis were tested by malachite green colorimetry. Results: Macrophage phagocytosis function was increased during the early stage after trauma (2 and 4 hours) and then decreased. The phagocytosis function of alveolar macrophages was stronger than that of interstitial macrophages in all time points before and after trauma. After challenge with LPS, no further significant effect on the alveolar macrophages was found, while LPS challenge could stimulate the phagocytosis of interstitial macrophages. Conclusion: Alveolar macrophages and pulmonary interstitial macrophages are function alheterogenous, and their response to trauma and combined with endotoxin challenge are different. The results indicate that the two subgroups of macrophages play different roles in immune function disorder after trauma.
, 百拇医药
PAGE：411-414
Pulmonary alveolar proteinosis: a report of 2 cases, with literature review
GAO Zhan-cheng, XUE Qing, XUE Yu, LI Yin-ping, SHEN Dan-hua, HE Quan-ying
Department of Respiratory Medicine, People's Hospital, Peking University, Beijing 100044, China.
Objective: To summarize and analyze the clinical manifestations of pulmonary alveolar proteinosis (PAP) and its treatment. Methods: Retrospective analysis of 2 cases with literature was reviewed. Results: PAP presented a protracted chronic clinical course with overt symptoms but few physical signs, distinct chest radiography, and was a benign process. It was manifested as primary or secondary pathological changes. Typical chest CT scan showed “map” or “cobble stone” changes. Clinically, PAP was characterized by its incompatibility between symptoms and signs, and also radiographic picture and physical signs. The examination of brochoalveolar lavage fluid could be used to confirm the diagnosis of PAP with periodic acid-schiff staining and electro microscopic examination. Whole lung lavage was an efficient therapy for PAP. Conclusion: It is very important for physicians to pay much more attention on the early diagnosis and treatment of pulmonary alveolar proteinosis.
, 百拇医药
PAGE：415-417
Clinical application of a software for the analysis of arterial blood gases graph in 231 patients with chronic obstructive pulmonary disease
CHEN Jian-rong, CAI Ying-yun, XIE Xiao-qian, CAO Yan, CHEN Jia-yi, TAO Yi-jiang
Department of Emergency, Second Affiliated Hospital of Nantong Medical College, Nantong 226001 Jiangsu, China.
Objective：To evaluate the clinical significance of a computer software for the analysis of arterial blood gases graph (ABGG) in chronic obstructive pulmonary disease (COPD). Methods：The software was developed with Win98 as the operating platform and the visual software Delphi 5.0 from Borland Company, and it was used for evaluation of the changes in arterial blood gases (ABG) of 231 COPD cases. Results： (1) With the software it took only (4.7±0.5)s to draw and analyze an ABGG of COPD patients during oxygen inhalation; the time was much shorter than manual analysis (90.2±4.9)s, P< 0.001. (2) During acute attack, the distributions of the arterial blood gases parameters on ABGG were as follows：55.4% of cases in the area of insufficient ventilation and deranged gas exchange (area 5), 22.9% of cases in the area of compensated ventilation and deranged gas exchange (area 4), 21.6% of cases in the area of excessive ventilation and deranged gas exchange (area 6). (3) When the COPD patient's condition improved, the location of ABG in ABGG shifted from area 5 to area 4 or area 6. The distributions of the arterial blood gases parameters on ABGG of 106 cases on admission were significantly different from those at the time of discharge. (4) With deterioration of patient's condition, it shifted to area 5. Before death, the arterial blood gases parameters were exclusively in the area 5. Conclusion：The computer software for ABGG shortened the time to draw and evaluate ABG during oxygen inhalation, and it could reflect the changes in patient's condition promplly.
, 百拇医药
PAGE：418-421
Role of phospholipase A2 in injury of lung complicated by acute pancreatitis and the therapeutic effect and mechanism of verapamil on it
ZHANG Hong, LI Yong-yu
Department of Pathophysiology, Medical College of Tongji University, Shanghai 200331, China. (E-mail: ZhangHongxue2@263.net)
Objective: To investigate the role of phosph olipase A2 (PLA2) in injury of lung complicated by acute pancreatitis (AP) and the therapeutic effect of verapamil, furthermore to explore its possible mechanism. Methods: Eighty-two Sprague-Dawley rats both male and female were divided into three groups. AP was induced by injecting 3% sodium deoxycholate (1 ml/ kg) into the biliopancreatic duct except the rats of sham operation group. Ten minutes after operation, rats were injected intraperitoneally with saline or verapamil, respectively. At 4 hours and 8 hours after treatment, the volume of as cites and pulmonary coefficient were measured. The amylase activity and calcium concentration in plasma and PLA2 in ascites and homogenate of lung were determined. The survival time and mortality of rats in different groups were recorded, and the pathomorphism of pancreas and lung was observed under microscope. Results: Verapamil reduced the mortality (P<0.05), and prolonged the survival time of rats with AP significantly (P<0.05), attenuated ascites volume, amylase activity and hypocalcemia in plasma, PLA2 activity in ascites and lung homogenate, and ameliorated the inflammatory injury of pancreas and lung. Conclusion: The results suggest that PLA2 plays a role in the injury of lung complicated by AP and verapamil possesses a therapeutic effect on the AP induced by sodium deoxycholate in rats, in which the mechanism might be due to inhibit PLA2 activity by blocking calcium channel to ameliorate the damage of pancreas and lung which is induced by the overload of Ca2+.
, 百拇医药
PAGE: 421
Clinical severe acute respiratory syndrome courses and immunomodulator therapy
LI Yu-ming, ZHANG Jian-peng, WANG Shao-jun
PAGE: 422-425
Role of neurokinin-1 receptor in lung injury in rats with acute necrotizing pancreatitis
SHI Xin, GAO Nai-rong, YIN Yong, YANG Yong-jiu, HU Hao-lin, TANG Wen-hao
, 百拇医药
Department of General Surgery, Zhong-Da Hospital, Southeast University, Nanjing 210009, Jiangsu, China.
Objective: To investigate the expression of neurokinin-1 receptor (NK-1R) in the lung tissue, and the relationship between expression of NK-1R and lung injury in rats with acute necrotizing pancreatitis (ANP). Methods: One hundred and twenty adult Sprague-Dawley rats were randomly divided into ANP and control groups. Animals in group ANP were induced by the retrograde intraductal infusion of 5% sodium taurocholate (0.1 ml/kg), and animals in normal control group received laparotomy only. The accumulation of polymorphonuclear leukocytes in lung tissues was measured with myeloperoxidase (MPO) assay. Lung endothelial barrier destruction was measured by lung capillary permeability (LCP). Reverse transcription polymerase chain reaction (RT-PCR) was used to determine the mRNA expression of NK-1R, western blot analysis was used to determine NK-1R protein expression levels, and immunohisto chemistry was used to localize expression site of NK-1R. Results: NK-1R mRNA level was enhanced in the lung of ANP compared with normal control group. Western blot analysis showed overexpression of NK-1R protein level exited in ANP group. Statistical analysis revealed correlation between NK-1R mRNA and MPO (r=0.83, P<0.01) and LCP (r=0.79, P<0.01) respectively. With immunohistochemistry staining, moderate to strong NK-1R immunoreactivity was localized to alveolar membrane, I epithelium, II epithelium and polymorphonuclear leukocytes in the lung of ANP. Conclusion: In ANP, overexpression of NK-1R contributes to disturbance of neuropeptides loop, resulting in aggregation of neutrophilic granulocyte and promoting deterioration of lung injury.
, http://www.100md.com
PAGE: 426-428
Clinic analysis of multiple interventional ways treating 37 cases with acute necrotic pancreatitis
LIANG Chi
The Third Affiliated Hospital, Guangxi Medical University, Nanning 530031, Guangxi, China.
Objective: To investigate the effects of multiple interventional ways to treat acute necrotic pancreatitis (ANP). Methods: To study retrospectively different treatments for ANP, 37 patients were injected through pancreatic artery with octreotide, antibiotic dexamethasone, procaine, while 30 controls with traditional way. Results: For patients subjected with intervention, abdomen pain was released, amylopsin was normal, treating time was shorter than that of controls (P<0.05 or P<0.01); the incidence of complications of intervention and control were 19.44% and 41.93% respectively, and the mortality were 2.70% and 16.67% (all P<0.05). Conclusion: Interventional treatment for ANP is more effective than the traditional treatment.
, 百拇医药
PAGE: 428
The comparative effects of aminophylline and salbutamol on the treatment of infant allergic cough
LI Shu-li
Ruyang Country People’s Hospital, Ruyang 471200, Henan, China.
PAGE: 429-431
Effects of polymixin B on I-κB kinase mRNA expression in lipopolysaccharide- induced pulmonary alveolar macrophages
, 百拇医药
YIN Wen, YANG Jian-hong, HU Xiao-min, YUAN Jing, LUO Yan-jun, LI Yue-cai
Department of Emergency, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, Shanxi, China
Objective: To investigate effects of polymixin B (PMB) on I-κB kinase(IKK-β), inhibitor protein(IκB-α) and nuclear factor-kappa B(NF-κB) in lipopolysaccharide (LPS)-induced pulmonary alveolar macrophages (PAM), and explore the anti- inflammatory mechanism of PMB. Methods: PAM from rats collected by bronchoalveolar lavage was cultured and divided into three groups. In the control group, PAM was not stimulated with LPS and not treated with PMB. In the LPS stimulated group, PAM was stimulated with LPS. In the PMB treated group, PAM was pretreated with PMB half an hour prior to LPS stimulation. The expression of IKK-β mRNA, level of IκB-α and the activity of NF-κB in PAM were measured by in situ hybridization(ISH), enzyme linked immunoadsorbent assay (ELISA) and electrophoretic mobility shift assay(EMSA), respectively. Results: In the LPS stimulated group, the expression of IKK-βmRNA (0.147±0.015) and activity of NF-κB (0.828±0.019) in PAM significantly increased, whereas levels of IκB-α (0.228±0.021) decreased (all P<0.01) in PMB treated groups. The expression of IKK-βmRNA (0.112±0.022) and activity of NF-κB (0.358±0.011) were down-regulated while level of IκB-α (0.477±0.016) was up-regulated(P<0.01). Conclusion: LPS might induce expression of IKK-βmRNA, degradation of IκB-α and activation of NF-κB PMB could inhibit the expression of IKK-β, degradation of IκB-α and activation of NF-κB, showing marked anti-inflammatory property.
, 百拇医药
PAGE: 432-434
Protective effect of a protease inhibitor on acute lung injury after hepatic is chemia/reperfusion in the rat
WANG Xiao-lin, ZHANG Hong, LIU Rong, WANG He-mei
The General Hospital of People’s Liberation Army, Beijing 100853, China.
Objective: To study the role of a protease inhibitor (ulinastatin) in protection of lung damage following hepatic ischemia/reperfusion in rat. Methods: Thirty-two healthy male SD rats were randomly divided into four groups (n=8 in each group). Group A was served as sham-injury control group, group B rats were subjected to 90 minutes hepatic ischemia, and group C rats underwent 120 minutes reperfusion after 90 minutes ischemia of the liver. Ulinastatin (UTI) was administered to animals in group D which were reperfused 120 minutes after 90 minutes of ischemia of the liver. In addition to plasma malondialdehyde (MDA), broncho-alveolar lavage fluid protein (BALFP) content, and lung dry-to-wet weight ratios(D/W) were respectively examined in each group. The concentration of myeloperoxidase (MPO) in lung tissue was also measured. Results: Compared to group A, plasma MDA, content of MPO in lung tissues and BALFP were significantly increased in both group B and group C, but they were much lower than those in group D. In addition, D/W was markedly decreased during hepatic ischemia and after 120 minutes reperfusion, while it was significantly increased in animals pretreated with UTI. Conclusion: Acute lung injury after hepatic ischemia and reperfusion is mainly induced by the oxidant stress, and neutrophil infiltration in the lung tissues is responsible for the damage under these conditions. Proteases inhibitors such as UTI might have antioxidation effects which attenuate lung injury induced by trauma to remote organs.
, http://www.100md.com
PAGE: 435-437
Effects of esmolol and fentanyl on the hemodynamic and catecholamine response to tracheal intubation in hypertensive patients
CHENG Ming-hua, YAO Yong-ming
Department of Anesthesiology, First Affiliated Hospital of Medical College, Shantou University, Shantou 515041, Guangdong, China.
Objective: To compare effects of esmolol and fentanyl on the hemodynamic and catecholamine response to tracheal intubation in hypertensive patients. Methods: Sixty hypertensive patients were randomly allocated into one of four groups: the patients received 0.9% saline in group A, 2 mg/kg esmolol in group B, 2 μg/kg fentanyl in group C and 2 mg/kg esmolol combined with 2 μg/kg fentanyl in group D before intubation. Tracheal intubation was performed with 0.1 mg/kg midazolam, 0.6 mg/kg atracurium and 2 mg/kg propofol. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR), rate-pressure product (RPP), plasma noradrenaline (NA) and adrenaline (A) concentrations were measured before and after intubation. Results: SAP, DAP, HR, RPP, NA and A levels in group A at 1 and 3 minutes after intubation were significantly higher than the baseline values (all P<0.01). NA levels in group B and SAP in group C increased significantly after intubation (both P<0.05). The hemodynamics and catecholamine in group D after intubation were not significantly different from the baselines (all P>0.05). Conclusion: 2 mg/kg esmolol or 2 μg/kg fentanyl can partly reduce hemodynamic response to intubation and 2 mg/kg esmolol combined with 2μg/kg fentanyl can completely attenuate the hemodynamic and catecholamine response in hypertensive patients.
, http://www.100md.com
PAGE: 438-440
A study of mechanical ventilation pattern in different recovery stages of muscle relaxant after general anesthesia
GAO Lu-bo, SONG Zhen-guo, LI Jin-cheng
Department of Anesthesiology, Cancer Hospital of Tianjin Medical University, Tianjin 300060, China.
Objective: To observe the effects of intermittent positive pressure ventilation (IPPV), synchronized intermittent mandatory ventilation (SIMV), and biphasic intermittent positive airway pressure (BiPAP) on the recovery time of automatic breathing in patients in different stages of recovery of general anesthesia with muscle relaxant. Methods: Thirty patients were randomly divided into three groups. The initial ventilation pattern was IPPV for all patients. After the last dose of muscle relaxant, the pattern of ventilation of group II and group III was adjusted to SIMV and BiPAP, respectively. The airway peak pressure(Ppeak), minute ventilation(MV), expiration carbon dioxide(PEtCO2), blood gases, and the interval between the last dose of muscle relaxant and automatic breathing(LR-S) was observed. Results: (1) When T1 appeared, Ppeak of the BiPAP group was lower than that of the IPP V group and SIMV (all P<0.01). When TR=0.75, Ppeak of IPPV group was lower compared with the SIMV and BiPAP groups (all P<0.01). (2) When T1 re-appeared, the MV of BiPAP was higher than that of the IPPV group (P<0.05), but was not different from that of the SIMV group (P>0.05). When T4 appeared, TR=0.25, TR=0.75, MV of SIMV group and BiPAP group was higher than that of IPPV group (all P<0.01). (3) When TR=0.25, TR=0.75, the PEtCO2 of the SIMV group and BiPAP group was lower than that of IPPV group (all P<0.05). (4) Partial pressure of carbon dioxide in artery (PaCO2) of the SIMV and BiPAP group was lower than that of the IPPV group (all P<0.05). (5) The LR-S before extubation was shorter in SIMV and BiPAP group than that in IPPV group (P<0.05). Conclusion: SIMV and BiPAP have the advantages as follows: no confrontation between mechanical ventilation and autonomous breathing, quick recovery of autonomous breathing, little change in airway pressure, high MV and low PEtCO2. So SIMV and BiPAP are more suitable for recovery from anesthesia. In addition, BiPAP can lower the airway's peak pressure and decrease the probability of barotraumas; therefore it is more suitable for those patients with high airway pressure.
, 百拇医药
PAGE: 441-444
The present and prospects of clinical diagnosis and treatment of severe acute respiratory syndrome
CAO Yi-zhan, NIE Qing-he
Emergency Department, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, Shanxi, China.
nieqinghe@hotmail.com,nieqinghe@163.com
PAGE: 444
, 百拇医药 Relationship between endotracheal intubation pattern and nosocomial infection of medical staff during treatment of severe acute respiratory syndrome
ZHAO Dong-wei
Department of Anesthesiology, 252nd Hospital of People’s Liberation Army, Baoding 071000, Hebei, China.
PAGE: 445-446
Development of morphological and functional research on alveolar epithelial type II cell
, http://www.100md.com
LIU Qi-lin, HU Sen, SHENG Zhi-rong
Burns Institute, 304th Hospital of People’s Liberation Army, Beijing 100037, China
PAGE: 447-448
The epidemiological study of severe acute respiratory syndrome
FENG Li-jie, SONG Kang-xing, SHEN Hong
Emergency Department, General Hospital of People’s Liberation Army, Beijing 100853, China., 百拇医药
PAGE：387-388
Thinking about severe acute respiratory syndrome
LIU You-ning
Department of Hepatobiliary Surgery, the General Hospital of People’s Liberation Army, Beijing 100853, China.
PAGE：388
Therapeutic problems of lung exubation during middle and late stages in severe acute respiratory syndrome patients
, 百拇医药
ZHANG Bo-li
Tianjin Herbalist doctor College, Tianjin, China.
PAGE：389-390
Medical strategies for emergency response on chemical terrorism
YUE Mao-xing
306th Hospital of People’s Liberation Army, Beijing 100101, China.
PAGE：391-394
Pathology and pathophysiology of severe acute respiratory syndrome
, 百拇医药
ZHAO Jing-min, ZHOU Guang-de, SUN Yan-ling
302th Hospital of People’s Liberation Army, Beijing 100039, China.
PAGE：395-397
Current issues on the diagnosis and treatment of severe acute respiratory syndrome
ZHANG Jian-peng, LIU You-ning, CHEN Liang-an
Respiratory Disease Department, General Hospital of Chinese Armed Police Force, Beijing 100039, China.
, http://www.100md.com
PAGE：397
Consideration of discharge criteria for severe acute respiratory syndrome patients
WANG Shao-jun, WANG Feng-mei, LI Yu-ming
The Third Central Hospital of Tianjin, Tianjin 300170, China.
PAGE：398-400
Respiratory monitoring in mechanical ventilated patients
QIN Ying-zhi
, 百拇医药
The Third Centra Hospital of Tianjin, Tianjin Ventilator Therapy and Research Center, Tianjin 300170, China.
PAGE：400
Cardiac functional evaluation in severe SARS patients during hypoxemia
WANG Shao-jun, LI Yu-ming, WANG Feng-mei, LIU Ying-wu
The Third Central Hospital of Tianjin, Tianjin 300170, China.
PAGE：401-403
, 百拇医药
Analysis of acute physiology and chronic health evaluation III in the 54 patients with severe acute respiratory syndrome
SHI Hai-yan, ZHANG Fu-chun, YIN Zhi-biao, DENG Xi-long
The Eighth People's Hospital of Guangzhou, Guangzhou 510060, Guangdong, China.
Objective: To evaluate the acute physiology and chronic health evaluation III (APACHE Ⅲ) in the severe acute respiratory syndrome (SARS) patients and its significance in prognosis. Methods: The clinical data of 54 SARS patients, including survivors (43 cases) and nonsurvivors (11 cases) were collected and evaluated with APACHE Ⅲ scoring system. The correlation of scores and prognosis was evaluated. Results: The scores of the nonsurvivors were higher remarkably than those of the surviving group (P<0.01). The scores of the acute physiology score (APS) and year score (YS) in the death group were higher obviously than those of the surviving group (both P<0.01). Elderly patients with severe disease had a high mortality. The scores of APACHE Ⅲ had positive correlation with the over all fatality rate. When the scores of APACHE Ⅲ was higher than 60, the fatality rate increased obviously. Conclusion: The scores of APACHE Ⅲ in the SARS are correlated with the patient's condition and prognosis.
, http://www.100md.com
PAGE：403
Science face upto to fact of undiscovered, frustration and challenge from severe acute respiratory syndrome
SHEN Hong
Department of Hepatobiliary Surgery, the General Hospital of People’s Liberation Army, Beijing 100853, China.
PAGE：404-407
Clinical features of 77 patients with severe acute respiratory syndrome
, http://www.100md.com
LI Guo-qiang, ZHANG Yu-hua
The Affiliated Hospital of Chinese Armed Force Police Medical College, Tianjin 300162, China.
Objective: To analyze the clinical features of the severe acute respiratory syndrome (SARS) and the value for caring of patients suspected of having this disease. Methods: The data of the clinical presentations and course of disease in 77 epide miologically linked patients (27 men and 50 women, 15 to 74 years old) in whom SARS was diagnosed after April 16, 2003 in Tianjin, China were summarized. Results: Exposure to ailing patients and occurrence of the disease ranged from minimal to close contact, such as between patient and health care personnel. The incubation period ranged from 1 to 11 days. All patients presented fever, and some of them complained of rigor, dry cough, dyspnea, malaise, headache, and hypoxemia. Physical examination of the chest revealed bubbling rales and dullness on percussion. Lymph openia was observed in 80% of all patients, and some patients had mildly elevated am inotransferase levels but normal serum creatinine levels. Serial chest radiographs showed progressive inflammatory changes. One patient died of progressive respiratory failure; pathological examination of the lung showed diffuse alveolar damage. One patient died of suicide. There was no evidence of infection by Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella pneumophila. All patients received corticosteroid and ribavirin therapy for a mean of (18.6±5.4) days after the onset of symptoms, and were treated with a combination of beta-lactams and macrolide early for (4.0±1.9)days, but with no clinical or radiologic evidences of improvement. Conclusion: The combination treatment, especially including corticosteroid and ribavirm, is efficient.
, http://www.100md.com
PAGE：408-410
Effect of severe thoracic trauma combined with endotoxin challenge on phagocytosis function of alveolar macrophages and pulmonary interstitial macrophages
ZHANG Wei, JIANG Yao-guang, XIE Zhi-jian, HU Cheng-xiang, LI Lei
Center of Thoracic Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China.
Objective: To observe the difference of phagocytosis between alveolar macrophages and pulmonary interstitial macrophages, and to investigate their responses to severe thoracic trauma with or without lipopolysaccharide (LPS) challenge. Methods: A rat model of severe thoracic trauma was reproduced by thoracic impact machine. The alveolar macrophages and interstitial macrophages were isolated before injury and at 2, 4, 8, 16, 24 hours after injury respectively. The dynamic changes of this macrophage phagocytosis were tested by malachite green colorimetry. Results: Macrophage phagocytosis function was increased during the early stage after trauma (2 and 4 hours) and then decreased. The phagocytosis function of alveolar macrophages was stronger than that of interstitial macrophages in all time points before and after trauma. After challenge with LPS, no further significant effect on the alveolar macrophages was found, while LPS challenge could stimulate the phagocytosis of interstitial macrophages. Conclusion: Alveolar macrophages and pulmonary interstitial macrophages are function alheterogenous, and their response to trauma and combined with endotoxin challenge are different. The results indicate that the two subgroups of macrophages play different roles in immune function disorder after trauma.
, 百拇医药
PAGE：411-414
Pulmonary alveolar proteinosis: a report of 2 cases, with literature review
GAO Zhan-cheng, XUE Qing, XUE Yu, LI Yin-ping, SHEN Dan-hua, HE Quan-ying
Department of Respiratory Medicine, People's Hospital, Peking University, Beijing 100044, China.
Objective: To summarize and analyze the clinical manifestations of pulmonary alveolar proteinosis (PAP) and its treatment. Methods: Retrospective analysis of 2 cases with literature was reviewed. Results: PAP presented a protracted chronic clinical course with overt symptoms but few physical signs, distinct chest radiography, and was a benign process. It was manifested as primary or secondary pathological changes. Typical chest CT scan showed “map” or “cobble stone” changes. Clinically, PAP was characterized by its incompatibility between symptoms and signs, and also radiographic picture and physical signs. The examination of brochoalveolar lavage fluid could be used to confirm the diagnosis of PAP with periodic acid-schiff staining and electro microscopic examination. Whole lung lavage was an efficient therapy for PAP. Conclusion: It is very important for physicians to pay much more attention on the early diagnosis and treatment of pulmonary alveolar proteinosis.
, 百拇医药
PAGE：415-417
Clinical application of a software for the analysis of arterial blood gases graph in 231 patients with chronic obstructive pulmonary disease
CHEN Jian-rong, CAI Ying-yun, XIE Xiao-qian, CAO Yan, CHEN Jia-yi, TAO Yi-jiang
Department of Emergency, Second Affiliated Hospital of Nantong Medical College, Nantong 226001 Jiangsu, China.
Objective：To evaluate the clinical significance of a computer software for the analysis of arterial blood gases graph (ABGG) in chronic obstructive pulmonary disease (COPD). Methods：The software was developed with Win98 as the operating platform and the visual software Delphi 5.0 from Borland Company, and it was used for evaluation of the changes in arterial blood gases (ABG) of 231 COPD cases. Results： (1) With the software it took only (4.7±0.5)s to draw and analyze an ABGG of COPD patients during oxygen inhalation; the time was much shorter than manual analysis (90.2±4.9)s, P< 0.001. (2) During acute attack, the distributions of the arterial blood gases parameters on ABGG were as follows：55.4% of cases in the area of insufficient ventilation and deranged gas exchange (area 5), 22.9% of cases in the area of compensated ventilation and deranged gas exchange (area 4), 21.6% of cases in the area of excessive ventilation and deranged gas exchange (area 6). (3) When the COPD patient's condition improved, the location of ABG in ABGG shifted from area 5 to area 4 or area 6. The distributions of the arterial blood gases parameters on ABGG of 106 cases on admission were significantly different from those at the time of discharge. (4) With deterioration of patient's condition, it shifted to area 5. Before death, the arterial blood gases parameters were exclusively in the area 5. Conclusion：The computer software for ABGG shortened the time to draw and evaluate ABG during oxygen inhalation, and it could reflect the changes in patient's condition promplly.
, 百拇医药
PAGE：418-421
Role of phospholipase A2 in injury of lung complicated by acute pancreatitis and the therapeutic effect and mechanism of verapamil on it
ZHANG Hong, LI Yong-yu
Department of Pathophysiology, Medical College of Tongji University, Shanghai 200331, China. (E-mail: ZhangHongxue2@263.net)
Objective: To investigate the role of phosph olipase A2 (PLA2) in injury of lung complicated by acute pancreatitis (AP) and the therapeutic effect of verapamil, furthermore to explore its possible mechanism. Methods: Eighty-two Sprague-Dawley rats both male and female were divided into three groups. AP was induced by injecting 3% sodium deoxycholate (1 ml/ kg) into the biliopancreatic duct except the rats of sham operation group. Ten minutes after operation, rats were injected intraperitoneally with saline or verapamil, respectively. At 4 hours and 8 hours after treatment, the volume of as cites and pulmonary coefficient were measured. The amylase activity and calcium concentration in plasma and PLA2 in ascites and homogenate of lung were determined. The survival time and mortality of rats in different groups were recorded, and the pathomorphism of pancreas and lung was observed under microscope. Results: Verapamil reduced the mortality (P<0.05), and prolonged the survival time of rats with AP significantly (P<0.05), attenuated ascites volume, amylase activity and hypocalcemia in plasma, PLA2 activity in ascites and lung homogenate, and ameliorated the inflammatory injury of pancreas and lung. Conclusion: The results suggest that PLA2 plays a role in the injury of lung complicated by AP and verapamil possesses a therapeutic effect on the AP induced by sodium deoxycholate in rats, in which the mechanism might be due to inhibit PLA2 activity by blocking calcium channel to ameliorate the damage of pancreas and lung which is induced by the overload of Ca2+.
, 百拇医药
PAGE: 421
Clinical severe acute respiratory syndrome courses and immunomodulator therapy
LI Yu-ming, ZHANG Jian-peng, WANG Shao-jun
PAGE: 422-425
Role of neurokinin-1 receptor in lung injury in rats with acute necrotizing pancreatitis
SHI Xin, GAO Nai-rong, YIN Yong, YANG Yong-jiu, HU Hao-lin, TANG Wen-hao
, 百拇医药
Department of General Surgery, Zhong-Da Hospital, Southeast University, Nanjing 210009, Jiangsu, China.
Objective: To investigate the expression of neurokinin-1 receptor (NK-1R) in the lung tissue, and the relationship between expression of NK-1R and lung injury in rats with acute necrotizing pancreatitis (ANP). Methods: One hundred and twenty adult Sprague-Dawley rats were randomly divided into ANP and control groups. Animals in group ANP were induced by the retrograde intraductal infusion of 5% sodium taurocholate (0.1 ml/kg), and animals in normal control group received laparotomy only. The accumulation of polymorphonuclear leukocytes in lung tissues was measured with myeloperoxidase (MPO) assay. Lung endothelial barrier destruction was measured by lung capillary permeability (LCP). Reverse transcription polymerase chain reaction (RT-PCR) was used to determine the mRNA expression of NK-1R, western blot analysis was used to determine NK-1R protein expression levels, and immunohisto chemistry was used to localize expression site of NK-1R. Results: NK-1R mRNA level was enhanced in the lung of ANP compared with normal control group. Western blot analysis showed overexpression of NK-1R protein level exited in ANP group. Statistical analysis revealed correlation between NK-1R mRNA and MPO (r=0.83, P<0.01) and LCP (r=0.79, P<0.01) respectively. With immunohistochemistry staining, moderate to strong NK-1R immunoreactivity was localized to alveolar membrane, I epithelium, II epithelium and polymorphonuclear leukocytes in the lung of ANP. Conclusion: In ANP, overexpression of NK-1R contributes to disturbance of neuropeptides loop, resulting in aggregation of neutrophilic granulocyte and promoting deterioration of lung injury.
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PAGE: 426-428
Clinic analysis of multiple interventional ways treating 37 cases with acute necrotic pancreatitis
LIANG Chi
The Third Affiliated Hospital, Guangxi Medical University, Nanning 530031, Guangxi, China.
Objective: To investigate the effects of multiple interventional ways to treat acute necrotic pancreatitis (ANP). Methods: To study retrospectively different treatments for ANP, 37 patients were injected through pancreatic artery with octreotide, antibiotic dexamethasone, procaine, while 30 controls with traditional way. Results: For patients subjected with intervention, abdomen pain was released, amylopsin was normal, treating time was shorter than that of controls (P<0.05 or P<0.01); the incidence of complications of intervention and control were 19.44% and 41.93% respectively, and the mortality were 2.70% and 16.67% (all P<0.05). Conclusion: Interventional treatment for ANP is more effective than the traditional treatment.
, 百拇医药
PAGE: 428
The comparative effects of aminophylline and salbutamol on the treatment of infant allergic cough
LI Shu-li
Ruyang Country People’s Hospital, Ruyang 471200, Henan, China.
PAGE: 429-431
Effects of polymixin B on I-κB kinase mRNA expression in lipopolysaccharide- induced pulmonary alveolar macrophages
, 百拇医药
YIN Wen, YANG Jian-hong, HU Xiao-min, YUAN Jing, LUO Yan-jun, LI Yue-cai
Department of Emergency, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, Shanxi, China
Objective: To investigate effects of polymixin B (PMB) on I-κB kinase(IKK-β), inhibitor protein(IκB-α) and nuclear factor-kappa B(NF-κB) in lipopolysaccharide (LPS)-induced pulmonary alveolar macrophages (PAM), and explore the anti- inflammatory mechanism of PMB. Methods: PAM from rats collected by bronchoalveolar lavage was cultured and divided into three groups. In the control group, PAM was not stimulated with LPS and not treated with PMB. In the LPS stimulated group, PAM was stimulated with LPS. In the PMB treated group, PAM was pretreated with PMB half an hour prior to LPS stimulation. The expression of IKK-β mRNA, level of IκB-α and the activity of NF-κB in PAM were measured by in situ hybridization(ISH), enzyme linked immunoadsorbent assay (ELISA) and electrophoretic mobility shift assay(EMSA), respectively. Results: In the LPS stimulated group, the expression of IKK-βmRNA (0.147±0.015) and activity of NF-κB (0.828±0.019) in PAM significantly increased, whereas levels of IκB-α (0.228±0.021) decreased (all P<0.01) in PMB treated groups. The expression of IKK-βmRNA (0.112±0.022) and activity of NF-κB (0.358±0.011) were down-regulated while level of IκB-α (0.477±0.016) was up-regulated(P<0.01). Conclusion: LPS might induce expression of IKK-βmRNA, degradation of IκB-α and activation of NF-κB PMB could inhibit the expression of IKK-β, degradation of IκB-α and activation of NF-κB, showing marked anti-inflammatory property.
, 百拇医药
PAGE: 432-434
Protective effect of a protease inhibitor on acute lung injury after hepatic is chemia/reperfusion in the rat
WANG Xiao-lin, ZHANG Hong, LIU Rong, WANG He-mei
The General Hospital of People’s Liberation Army, Beijing 100853, China.
Objective: To study the role of a protease inhibitor (ulinastatin) in protection of lung damage following hepatic ischemia/reperfusion in rat. Methods: Thirty-two healthy male SD rats were randomly divided into four groups (n=8 in each group). Group A was served as sham-injury control group, group B rats were subjected to 90 minutes hepatic ischemia, and group C rats underwent 120 minutes reperfusion after 90 minutes ischemia of the liver. Ulinastatin (UTI) was administered to animals in group D which were reperfused 120 minutes after 90 minutes of ischemia of the liver. In addition to plasma malondialdehyde (MDA), broncho-alveolar lavage fluid protein (BALFP) content, and lung dry-to-wet weight ratios(D/W) were respectively examined in each group. The concentration of myeloperoxidase (MPO) in lung tissue was also measured. Results: Compared to group A, plasma MDA, content of MPO in lung tissues and BALFP were significantly increased in both group B and group C, but they were much lower than those in group D. In addition, D/W was markedly decreased during hepatic ischemia and after 120 minutes reperfusion, while it was significantly increased in animals pretreated with UTI. Conclusion: Acute lung injury after hepatic ischemia and reperfusion is mainly induced by the oxidant stress, and neutrophil infiltration in the lung tissues is responsible for the damage under these conditions. Proteases inhibitors such as UTI might have antioxidation effects which attenuate lung injury induced by trauma to remote organs.
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PAGE: 435-437
Effects of esmolol and fentanyl on the hemodynamic and catecholamine response to tracheal intubation in hypertensive patients
CHENG Ming-hua, YAO Yong-ming
Department of Anesthesiology, First Affiliated Hospital of Medical College, Shantou University, Shantou 515041, Guangdong, China.
Objective: To compare effects of esmolol and fentanyl on the hemodynamic and catecholamine response to tracheal intubation in hypertensive patients. Methods: Sixty hypertensive patients were randomly allocated into one of four groups: the patients received 0.9% saline in group A, 2 mg/kg esmolol in group B, 2 μg/kg fentanyl in group C and 2 mg/kg esmolol combined with 2 μg/kg fentanyl in group D before intubation. Tracheal intubation was performed with 0.1 mg/kg midazolam, 0.6 mg/kg atracurium and 2 mg/kg propofol. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), heart rate (HR), rate-pressure product (RPP), plasma noradrenaline (NA) and adrenaline (A) concentrations were measured before and after intubation. Results: SAP, DAP, HR, RPP, NA and A levels in group A at 1 and 3 minutes after intubation were significantly higher than the baseline values (all P<0.01). NA levels in group B and SAP in group C increased significantly after intubation (both P<0.05). The hemodynamics and catecholamine in group D after intubation were not significantly different from the baselines (all P>0.05). Conclusion: 2 mg/kg esmolol or 2 μg/kg fentanyl can partly reduce hemodynamic response to intubation and 2 mg/kg esmolol combined with 2μg/kg fentanyl can completely attenuate the hemodynamic and catecholamine response in hypertensive patients.
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PAGE: 438-440
A study of mechanical ventilation pattern in different recovery stages of muscle relaxant after general anesthesia
GAO Lu-bo, SONG Zhen-guo, LI Jin-cheng
Department of Anesthesiology, Cancer Hospital of Tianjin Medical University, Tianjin 300060, China.
Objective: To observe the effects of intermittent positive pressure ventilation (IPPV), synchronized intermittent mandatory ventilation (SIMV), and biphasic intermittent positive airway pressure (BiPAP) on the recovery time of automatic breathing in patients in different stages of recovery of general anesthesia with muscle relaxant. Methods: Thirty patients were randomly divided into three groups. The initial ventilation pattern was IPPV for all patients. After the last dose of muscle relaxant, the pattern of ventilation of group II and group III was adjusted to SIMV and BiPAP, respectively. The airway peak pressure(Ppeak), minute ventilation(MV), expiration carbon dioxide(PEtCO2), blood gases, and the interval between the last dose of muscle relaxant and automatic breathing(LR-S) was observed. Results: (1) When T1 appeared, Ppeak of the BiPAP group was lower than that of the IPP V group and SIMV (all P<0.01). When TR=0.75, Ppeak of IPPV group was lower compared with the SIMV and BiPAP groups (all P<0.01). (2) When T1 re-appeared, the MV of BiPAP was higher than that of the IPPV group (P<0.05), but was not different from that of the SIMV group (P>0.05). When T4 appeared, TR=0.25, TR=0.75, MV of SIMV group and BiPAP group was higher than that of IPPV group (all P<0.01). (3) When TR=0.25, TR=0.75, the PEtCO2 of the SIMV group and BiPAP group was lower than that of IPPV group (all P<0.05). (4) Partial pressure of carbon dioxide in artery (PaCO2) of the SIMV and BiPAP group was lower than that of the IPPV group (all P<0.05). (5) The LR-S before extubation was shorter in SIMV and BiPAP group than that in IPPV group (P<0.05). Conclusion: SIMV and BiPAP have the advantages as follows: no confrontation between mechanical ventilation and autonomous breathing, quick recovery of autonomous breathing, little change in airway pressure, high MV and low PEtCO2. So SIMV and BiPAP are more suitable for recovery from anesthesia. In addition, BiPAP can lower the airway's peak pressure and decrease the probability of barotraumas; therefore it is more suitable for those patients with high airway pressure.
, 百拇医药
PAGE: 441-444
The present and prospects of clinical diagnosis and treatment of severe acute respiratory syndrome
CAO Yi-zhan, NIE Qing-he
Emergency Department, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, Shanxi, China.
nieqinghe@hotmail.com,nieqinghe@163.com
PAGE: 444
, 百拇医药 Relationship between endotracheal intubation pattern and nosocomial infection of medical staff during treatment of severe acute respiratory syndrome
ZHAO Dong-wei
Department of Anesthesiology, 252nd Hospital of People’s Liberation Army, Baoding 071000, Hebei, China.
PAGE: 445-446
Development of morphological and functional research on alveolar epithelial type II cell
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LIU Qi-lin, HU Sen, SHENG Zhi-rong
Burns Institute, 304th Hospital of People’s Liberation Army, Beijing 100037, China
PAGE: 447-448
The epidemiological study of severe acute respiratory syndrome
FENG Li-jie, SONG Kang-xing, SHEN Hong
Emergency Department, General Hospital of People’s Liberation Army, Beijing 100853, China., 百拇医药