Zhonghua nei ke za zhi
-
Zhonghua nei ke za zhi · Jul 2017
[The value of the excursion of diaphragm tested by ultrosonography to predict weaning from mechanical ventilation in ICU patients].
Objective: To evaluate the excursion of the diaphragm and analyze the value in predicting weaning from mechanical ventilation in intensive care unit patients. Methods: The patients with mechanical ventilation (>48 hours) in ICU at Hebei Forth Medical University Hospital from June 2014 to December were classified into a success group or a failure group according to the weaning outcome. T-piece spontaneous breathing (SBT), airway occlusion pressure at 0.1 sec (P(0.1)) and maximal inspiratory pressure (MIP), rapid shallow breathing index (RSBI) and P(0.1)/MIP were measured or calculated. ⋯ The cutoff value of diaphragmatic excursion for predicting successful extubation was determined to be 1.14 cm by ROC curve analysis. The sensitivity of diaphragmatic excursion to predict successful weaning was 89.2% and the specificity was 75.0%, the AUC(ROC) was 0.849. Conclusion: As an early predictor of diaphragmatic dysfunction, diaphragmatic excursion is probably superior to the traditional parameters in predicting weaning from ventilator in ICU patients.
-
Zhonghua nei ke za zhi · Jun 2017
[The significances of peripheral neutrophils CD(55) and myeloperoxidase expression in patients with myeloperoxidase-specific anti-neutrophil cytoplasmic antibody associated vasculitis].
Objective: To investigate the expression of CD(55) and myeloperoxidase (MPO) on neutrophils in patients with MPO-specific anti-neutrophil cytoplasmic antibody associated vasculitis(MPO-AAV), and analyze the relationship between the expression and clinical manifestation. Methods: Forty untreated patients with active MPO-AAV (patient group) and 30 healthy volunteers (control group) were enrolled in this study. The CD(55) on neutrophils and both membrane and cytoplasmic MPO were detected by flow cytometry. ⋯ It might protect neutrophils from attacking by complement alternative pathway. Activated neutrophils release more MPO and lysosome to intensify the inflammation reaction and aggravate the disease. Thus CD(55) might become a new potential target for the treatment of this disease in the future.
-
Zhonghua nei ke za zhi · Jun 2017
[The effects of different tidal volume ventilation on right ventricular function in critical respiratory failure patients].
Objective: To observe and explore the effects of different tidal volume (VT) ventilation on right ventricular (RV) function in patients with critical respiratory failure. Methods: Consecutive respiratory failure patients who were treated with invasive ventilator over 24 h in the Department of Critical Care Medicine at the Fourth Hospital of Hebei Medical University from June to December in 2015 were enrolled in this study. Clinical data including patients' vital signs, ventilator parameters and RV echocardiography were collected within 6 h (D0), day1(D1), day2 (D2) and day3 (D3) after ventilation started. ⋯ Conclusions: Positive pressure mechanical ventilation resulted in RV systolic dysfunction. Lower VT may have the protective effect on RV function. Trial registration: Chinese Clinical Trial Registry, ChiCTR-POC-15007563.
-
Zhonghua nei ke za zhi · May 2017
Meta Analysis[Levofloxacin-based triple therapy versus bismuth-based quadruple therapy in the treatment of Helicobacter pylori as the rescue therapy: a meta analysis].
Objective: To evaluate the efficacy of levofloxacin-based triple therapy and bismuth-based quadruple therapy in the treatment of Helicobacter pylori (Hp) infection as rescue regimens. Methods: Related randomized controlled trials assessing the efficacy and safety of levofloxacin-based triple therapy eradicating Hp as salvage treatment were retrieved from Pubmed, Cochrane Library, SPRINGER, VIP database, WanFang database and CKNI database. The literature quality was evaluated by the improved Jadad criterion. ⋯ The adverse effects were significantly lesser(19.1% vs 29.5%, OR=0.47, 95%CI 0.26-0.82, P<0.05), whereas the compliance rate was significantly higher in levofloxacin group (96.0% vs 89.9%, OR=2.27, 95%CI 1.33-3.87, P<0.05). Conclusions: Comparing with bismuth-based quadruple therapy, levofloxacin-based triple therapy has higher eradication rate, compliance rate and lesser side effects, so we recommend it as a second-line rescue therapy after front-line Hp eradication failure. The optimal second-line alternative scheme might differ among countries depending on quinolone resistance.
-
Zhonghua nei ke za zhi · May 2017
Observational Study[The predictive value of dynamic arterial elastance in arterial pressure response after norepinephrine dosage reduction in patients with septic shock].
Objective: To assess whether dynamic arterial elastance(Ea(dyn))can be used to predict the reduction of arterial pressure after decreasing norepinephrine (NE) dosage in patients with septic shock. Methods: A prospective observational cohort study was conducted. Thirty-two patients with septic shock and mechanical ventilationwere enrolledfrom January 2014 to December 2015 in ICU of Wuxi People's Hospital of Nanjing Medical University. ⋯ Ea(dyn)≤0.97 predicted a decrease of MAP when decreasing NE dose, with an area under the receiver-operating characteristic curve of 0.85. The sensitivity was 100.0% and specificity was 73.7%. Conclusions: In septic shock patients treated with NE, Ea(dyn) is an index to predict the decrease of arterial pressure in response to NE dose reduction.