Zhonghua nei ke za zhi
-
Zhonghua nei ke za zhi · Jan 2019
[Effect of neurally adjusted ventilatory assist on trigger of mechanical ventilation in acute exacerbation of chronic obstructive pulmonary disease patients with intrinsic positive end-expiratory pressure].
Objective: To compare the trigger delay and work of trigger between neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with intrinsic positive end-expiratory pressure (PEEP) during mechanical ventilation. Methods: AECOPD patients with intrinsic PEEP (PEEPi) greater than or equal to 3 cmH(2)O (1 cmH(2)O=0.098 kPa) were enrolled during invasive mechanical ventilation. Subjects were ventilated with low, medium and high pressure under either NAVA or PSV mode. ⋯ Trigger delay time increased according to the increase of pressure level in PSV mode. Conclusion: The presence of PEEPi in AECOPD patients leads to obvious trigger delay under PSV mode, which is positively correlated with PEEPi level. NAVA significantly reduces trigger delay time and work of trigger compared with PSV mode.
-
Zhonghua nei ke za zhi · Jan 2019
[Plasma relative abundance of epidermal growth factor receptor mutations predicts clinical response to epidermal growth factor receptor-tyrosine kinase inhibitors in patients with advanced lung adenocarcinoma].
Objective: To determine whether relative abundance of epidermal growth factor receptor (EGFR) mutations in plasma predicts clinical response to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in patients with advanced lung adenocarcinoma. Methods: In this prospective study, adult patients with advanced lung adenocarcinoma were enrolled in our hospital from 1 April 2016 to 1 January 2017. EGFR mutations in tumor tissues were detected by ADx-amplification refractory mutation system (ADx-ARMS). ⋯ As to subjects with L858R mutation, the ORRs were 10/15, 2/4 and 3/6, respectively, with median PFS 9.6, 5.5 and 9.5 monthes. Conclusions: The relative abundance of EGFR mutations in plasma predicts clinical response to EGFR-TKIs in patients with advanced lung adenocarcinoma. The higher the mutation abundance is, the better the efficacy of EGFR-TKIs is.
-
Zhonghua nei ke za zhi · Dec 2018
[Using peripheral perfusion index and venous-to-arterial CO(2) difference/arterial-central venous O(2) difference ratio to assess lactate clearance in septic patients after resuscitation].
Objective: The relationship of venous-to-arterial CO(2) difference(Pv-aCO(2))/arterial-central venous O(2) difference (Ca-vO(2)) ratio, peripheral perfusion index(PI) and lactate clearance(LC) were investigated during resuscitation in septic patients. And, the meaning of the combination PI and Pv-aCO(2)/Ca-vO(2) ratio to interpret incoherence of lactate clear was explored. Methods: The patients with sepsis were prospectively observed, who admitted to critically care medicine department of Peking Union Medical College Hospital. ⋯ Multivariate analysis showed both Pv-aCO(2)/Ca-vO(2) ratio [Exp(B) 2.235, 95% CI 1.232-4.055, P=0.008] and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) [Exp (B) 1.087, 95%CI 1.022-1.156, P=0.008] were independent risk factor of non-lactate clearance. 8h-PI was significantly negative correlated with the 8 h Pv-aCO(2) gap (r=-0.311, P=0.004), but not significantly with Pv-aCO(2)/Ca-vO(2) ratio (r=-0.094, P=0.385). Conclusions: Both high Pv-aCO(2)/Ca-vO(2) ratio and low PI were related to non-lactate clearance after resuscitation in sepsis. Combined PI and Pv-aCO(2)/Ca-vO(2) ratio could interpret incoherence of latacte clearance after resuscitation.
-
Zhonghua nei ke za zhi · Nov 2018
[Correlation of transcutaneous oxygen pressure and blood lactate in patients with septic shock].
To analyze the correlation between transcutaneous oxygen pressure (P(tc)O(2)) and blood lactate in patients with septic shock. Fifty-sixpatients with septic shock were prospectively investigated. P(tc)O(2) was monitored continuously for 6 hours, and arterial blood gas was measured at baseline (T0) and 6 hours(T6). ⋯ The low predictive value of P(tc)O(2) was 29 mmHg of lactate clearance under 20% with a sensitivity 85.2% and a specificity 65.5%. The low predictive value of P(tc)O(2) in high lactate clearance group was significantly higher than that in low lactate clearance group, while the duration of P(tc)O(2)<40 mmHg was shorter than the latter. During 6 h continuous monitoring, patients with a significant low P(tc)O(2) or prolonged duration of low P(tc)O(2) have relatively high lactate or low lactate clearance after resuscitation.
-
Zhonghua nei ke za zhi · Oct 2018
[The clinical significance of circulating follicular helper T cells in patients with anti-neutrophil cytoplasmic myeloperoxidase antibody-associated vasculitis].
Objective: To investigate the change of circulating follicular helper T cells (cTfh) in patients with anti-neutrophil cytoplasmic myeloperoxidase antibody-associated vasculitis (MPO-AAV), and to analyze the relationship between cTfh and disease activity. Methods: Thirty-eight untreated MPO-AAV patients (patient group) and thirty-eight healthy volunteers (control group) were enrolled in this study. cTfh and membrane expression of inducible co-stimulator (ICOS) and programmed cell death protein 1 (PD-1) were detected by flow cytometry (FCM). Serum anti-neutrophil cytoplasmic myeloperoxidase antibody (MPO-ANCA) was measured by ELISA. ⋯ Nevertheless, the expression of PD-1 on cTfh was only positively correlated with the ratio of PD-1(+) Tfh (r=0.473, P=0.003). Conclusions: Enhanced cTfh in patients with MPO-AAV might produce MPO-ANCA, which is related to the aggravation of MPO-AAV. Thus, cTfh and its ICOS could be potentially targeted for the treatment of MPO-AAV.