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Objective To investigate the effects of different early enteral nutrient (EN) emulsions of TPF-T and TP on nutritional status and intestinal mucosal barrier in patients with septic shock. Methods From May 2017 to May 2018, 112 patients with septic shock were continuously enrolled in the Department of Intensive Care Unit of the First People's Hospital of Taizhou, and they were randomly divided into a TPF-T group and TP group, each group with 56 cases. After admission, the patients in both groups were all treated according to the 2016 Saving Sepsis Campaign (SSC) Guidelines for septic shock. Both groups were supported with EN, TPT-T group was given TPF-T EN emulsion rich in fish oil, while TP group was supported with standard TP EN emulsion, and the therapeutic course was consecutive 7 days in both groups. The differences in nutritional status, inflammatory response, immune function, intestinal mucosal barrier, gastrointestinal symptoms and prognosis were compared between the two groups. Results After EN, the nutrition indicators such as albumin (Alb), prealbumin (PA), transferrin (TRF) and immune indexes (IgA, IgG), human leukocyte DR antigens (HLA-DR) and D-lactic acid were increased in both groups, reaching the peaks on the 7th day after EN application, Alb, PA, TRF, IgA, IgG, HLA-DR in the TPF-T group were significantly higher than those in the TP group [Alb (g/L): 34.43±5.81 vs. 33.59±5.34, PA (mg/L): 269.83±47.56 vs. 252.67±41.92, TRF (g/L): 3.43±0.64 vs. 3.32±0.81, IgA (mg/L): 159.45±34.56 vs. 143.31±33.81, IgG (mg/L): 4 947.68±871.66 vs. 4 583.75±841.54, HLA-DR: (68.22±9.11)% vs. (62.21±9.69)%], and after EN, the D-lactic acid in the TPF-T group was significantly lower than that in the TP group (mg/L: 30.42±6.79 vs. 33.34±7.31). The inflammatory indicators of tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), procalcitonin (PCT), endotoxin and diamine oxidase (DAO) were all gradually reduced in two groups, reached the lowest levels on the 7th day after EN application, and all the above-mentioned indicators in the TPF-T group were significantly lower than those in the TP group [TNF-α (ng/L):95.43±20.69 vs. 109.59±23.45, CRP (mg/L): 21.33±16.35 vs. 32.36±17.83, PCT (μg/L): 1.24±1.21 vs. 4.18±1.32, endotoxin (U/L): 10.32±2.31 vs. 11.54±2.69, DAO (g/L): 19.45±8.49 vs. 25.47±9.41]. The incidences of gastric retention, diarrhea and paralysis of lower digestive tract in TPF-T group were significantly lower than those in TP group [gastric retention: 14.29% (8/56) vs. 32.14% (18/56), diarrhea: 12.50% (7/56) vs. 35.71% (20/56), paralysis of lower digestive tract: 7.14% (4/56) vs. 23.21% (13/56)], the length of hospital stay was significantly shorter in the TPF-T group than that in the TP group (days: 18.77±5.08 vs. 21.71±6.67, P < 0.05); however, there was no significant difference in mortality between the two groups [14.29% (8/56) vs. 21.43% (12/56), P > 0.05]. Conclusion TPF-T could more effectively maintain nutritional status, reduce inflammatory reaction, improve immunity, protect intestinal mucosal barrier function, and has fewer adverse reactions, which was helpful to improve the prognosis of septic shock patients.
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Objective To study the clinical efficacy of ulinastatin combined with ambroxol hydrochloride in the treatment of acute respiratory distress syndrome (ARDS) complicated with ventilator-associated pneumonia (VAP).Methods One hundred and ten cases of ARDS complicated with VAP were randomly divided into the study group (55 cases) and the control group (55 cases) according to the different treatment method.The two groups accepted symptomatic anti-infective treatment,and the control group was treated with 300mg of ambroxol twice daily,the study group were intravenously infused 200 000U ulinastatin on the basis of the control group,two groups of patients were treated for 1 week.The ventilation indicators,pathogen clearance rate,off-time rate,mechanical ventilation time,respiratory rate,APACHE score,lung injury score and adverse reactions during the treatment were compared between the two groups.Results After treatment,PaO2,PaO2/FiO2,CL,RAW and PIP in the study group were (97.83 ± 12.01)mmHg,(364.25 ±35.77)mmHg,(88.93 ±9.44)mL/cmH2O,(31.45 ±4.87)cmHH2O · L-1 · s-1,(21.43 ± 5.75)cmH2O,respectively,which in the control groupwere (83.25 ± 10.13)mmHg,(238.55 ± 34.29) mmHg,(62.77 ± 8.54) mL/cmH2 O,(37.97 ± 6.54) cmH2 O · L-1 · s-1,(29.12 ± 5.43) cnH2 O,respectively.The P.aO2,PaO2/FiO2,CL in the study group were significantly higher than those in the control group,the RAW,PIP in the study group were significantly lower than those in the control group,the differences were statistically significant (t =6.88,18.81,5.93,7.21,15.42,all P ＜ 0.05).The clearance rate of both Gram-positive lacteria (90.00％)and Gram-negative bacteria (92.00％) in the study group were significantly higher than those in the control group (66.67％ and 70.21％) (x2 =4.81,8.84;P =0.03,0.00).The mean mechanical ventilation time in the study group [(7.15 ± 2.43) days] was significantly shorter than that in the control group [(12.85 ± 3.12) days] (t =10.69,P ＜ 0.05).The respiratory rate,APACHE score and lung injury scores of the two groups were significantly lower than those before treatment (P ＜ 0.05).The respiratory rate,APACHE scores and lung injury scores of the study group [(18.94 ± 6.99) times/min,(12.53 ± 3.14) points,(1.31 ± 0.15) points] were significantly lower than those of the control group [(25.87 ± 6.12) times/min,(16.53 ± 4.42) points,(1.65 ± 0.32) points],the differences were statistically significant (t =5.53,5.47,7.14;P =0.00,0.00,0.00).The off-line success rate and mortality between the two groups had no statistically significant differences (all P ＞ 0.05).Conclusion Ulinastatin combined with ambroxol hydrochloride can significantly improve the respiratory function of ARDS patients complicated with VAP,significantly shorten the duration of mechanical ventilation,improve respiratory function,reduce lung injury and improve pathogens clearance rate,but with no significant impact on mortality.
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Objective To investigate the effect of Amikacin and prulifloxacin alternate application in the treatment of Lung infections in ICU resistant Acinetobacter Bauman.Methods 82 cases of Lung infections in ICU resistant Acinetobacter Bauman from August 2014 to August 2016 in our hospital were selected and randomLy divided into two groups, 41 cases in control group were given routine treatment, 41 cases in the experimental group were treated with Amikacin and prulifloxacin alternate application, and patients were treated continuous for two weeks.Levels of serum CRP, PCT, WBC, N%, SCR, BUN, AST, ALT, scores of APACHE II and CPIS and clinical efficacy were observed pre-and post-treatment.Results After two weeks, levels of serum CRP, PCT, WBC and N% in experimental group were significantly lower than control group, scores of APACHE II and CPIS were significantly lower than the control group, the total clinical efficiency was higher than the control group(P<0.05), and the levels of serum SCR, BUN, ALT, AST were lower, but had no statistically difference.Conclusion Amikacin and prulifloxacin alternate application in the treatment of Lung infections in ICU resistant Acinetobacter Bauman can reduce the patient's inflammatory reaction and the degree of infection.
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ObjectiveTo explore the effect of the calcium phosphate cement (CPC) /calcium polyphosphate fiber (CPPF) composites mixed with different proportion of minimal morselized bone on repair of bone defect in vivo. MethodsA total of 36 New Zealand white rabbits were completely randomly designed into A, B, C, D groups and their bilateral radial bone defect model was prepared. The minimal morselized bone (300-500 μm in diameter) was made from the iliac of those rats. The CPPF and CPC were evenly mixed into CPC/CPPF composites which were divided into four groups in accordance with the CPPF weight O, 10％, 30％ and 50％ in CPC/CPPF composite. The CPC/CPPF composites of the four groups was mixed with the minimal morselized bone with ratio of 6:4 and then the mixture was implanted the bone defect of the rabbits in four groups. The gross, X-ray and histological observations were done at four and eight weeks. The biomechanical test was performed at eight weeks. Results When CPPF occupies 30％ of the CPC/CPPF composite, the maximum compressive load and bending loads were better than those in the other groups ( P ＜ 0.05 ), when the histological observation showed the most tight link between the artificial composite and the bone interface and the closest similarity between material degradation rate and the ossification rate, with the best osteogenesis and the optimal ratio.ConclusionThe repair of bone defect can attain the optimal outcome through adding a certain ratio of minimal morselized bone into the CPC/CPPF to adjust the degradation rate of composites.