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Objective:To investigate the efficacy of intravenous combined with aerosol inhalation of polymyxin B for the treatment of pneumonia caused by multidrug-resistant Gram-negative (G -) bacteria. Methods:A observational study was conducted. The clinical data of 45 patients with pneumonia due to multidrug-resistant G - bacteria admitted to intensive care unit of Fujian Medical University Union Hospital from January to October in 2020 were analyzed. According to the different use methods of polymyxin B, 25 patients who received single intravenous drip (the first dose was 2.0 mg/kg, then 1.25 mg/kg, once every 12 hours) from January to April in 2020 were enrolled in the routine group, and 20 patients who received intravenous drip combined with aerosol inhalation (25 mg once every 12 hours, sputum in the airway was sucked and then sprayed aerosol) from May to October in 2020 were enrolled in the combination group. After the treatment course of polymyxin B, the total bacterial clearance rate, total clinical efficiency rate, recovery time of body temperature, time of bacterial clearance and the change of serum procalcitonin (PCT) level before and after treatment were compared between the two groups. Moreover, the incidence of adverse reactions during treatment in the two groups was observed. Results:The results of sputum culture in the routine group were Acinetobacter baumannii in 13 patients, Klebsiella pneumoniae in 5 patients, Pseudomonas aeruginosa in 6 patients, Enterobacter cloacae in 1 patient; the sputum culture results of the combination group showed that there were 5 patients of Acinetobacter baumannii, 9 Klebsiella pneumoniae and 6 Pseudomonas aeruginosa. There was no significant difference in the results of sputum culture between the two groups ( P > 0.05). The total bacterial clearance rate and the total clinical efficiency rate of the combination group were significantly higher than those in the routine group (total bacterial clearance rate: 70.0% vs. 40.0%, total clinical efficiency rate: 75.0% vs. 40.0%, both P < 0.05). The recovery time of body temperature and the time of bacterial clearance of the combination group were significantly shorter than those in the routine group [recovery time of body temperature (days): 6.0±3.9 vs. 10.2±7.3, time of bacterial clearance (days): 6.1±5.2 vs. 11.5±6.8, both P < 0.05]. No significant difference was found in serum PCT level before treatment between the two group. There was no significant difference in serum PCT level before and after treatment in the routine group [μg/L: 0.85 (0.44, 2.87) vs. 1.43 (0.76, 5.30), P > 0.05]. The serum PCT level after treatment in the combination group was significantly lower than that before treatment [μg/L: 0.27 (0.10, 0.70) vs. 0.91 (0.32, 3.53), P < 0.05], and it was significantly lower than that in the routine group [μg/L: 0.27 (0.10, 0.70) vs. 0.85 (0.44, 2.87), P < 0.01]. The incidence of renal toxicity of polymyxin B between the combination group and the routine group was not significantly different (5.0% vs. 4.0%, P > 0.05). Conclusions:The efficacy of intravenous combined with aerosol inhalation of polymyxin B for the treatment of pneumonia due to multidrug-resistant G - bacteria is better than that of intravenous drip of polymyxin B only. The aerosolized polymyxin B will not increase the risk of renal injury.
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Objective:To study the clinical efficacy of adjuvant therapy with thymosin alpha -1 in patients with severe peritoneal cavity infection(sIAI),and to explore its effect to celluar immune function and T-like receptor.Methods: A total of 60 patients with sIAI,who received treatment in the intensive care unit of our hospital in January 2012-December 2014,were divided into observation group and control group.Cases in control croup received routine treatment ,and cases in observation group received routine treatment besides thymosin alpha-1.T-lymphocyte subsets were determined by flow cytometry and expression of Toll-like receptor (TLR)2 and TLR4 in the peripheral blood mononuclear cells were determined by real time PCR before treatment and in the 2nd week after treatment.The scores of acute physiology and chronic health evaluation ( APACHE)Ⅱscore and gastrointestinal function were recorded before treatment and in the 2nd week after treatment.The rate of systemic inflammatory response syndrome (MODS),the rate of death in hospital stays,intestinal function recovery and hospital stays in both groups were compared .Results: (1) CD3+,CD4+and CD4+/CD8+of cases in observation group significantly increased ( P0.05).Conclusion:Adjuvant therapy with thymosin alpha-1 in patients with sIAI has good clinical efficacy ,and can improve the cellular immune function ,decrease the expression of Toll-like receptor.
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Objective To evaluate the effects of mechanical ventilation with heliox-oxygen on acute lung injury (ALI) in rabbits.Methods Thirty healthy New Zealand male rabbits, weighing 2.2-2.4 kg, were randomly divided into 3 groups (n =10 each) using a random number table: control group (C group), ALI group and mechanical ventilation with helium-oxygen group (HO group).The right common carotid artery was cannulated for fluid administration and blood sampling in the rabbits anesthetized with urethane.In ALI and HO groups, 1.2 ml/kg hydrochloric acid (HC1) of pH value 1.0 was injected into the right bronchus, followed by 2 ml air injection, and 5 min later 0.8 ml/kg HCI of pH value 1.0 was injected into the left bronchus, followed by 2 ml air injection.In C group, the equal volume of normal saline was given as previously described.After ALI, the rabbits were mechanically ventilated with airoxygen (air 50％-oxygen 50％) in C and ALI groups, or with helium-oxygen (helium 50％-oxygen 50％)in HO group.Mechanical ventilation (tidal volume 8 ml/kg, respiratory rate 30 breaths/min, inspiratory/ expiratory ratio 1 : 1) lasted for 4 h in the three groups.At 30 min before and after HC1 injection (T0,1) and 1, 2, 3 and 4 h of ventilation (T2-T5) , arterial blood samples were collected to detect the levels of surfactant-protein (SP-A) in serum by enzyme-linked immunosorbent assay.The animals were sacrificed at T5, and lungs were removed for examination of the pathologic changes with light microscope.The wet to dry lung weight ratio (W/D ratio) was calculated.Results Compared with group C, the levels of SP-A in serum were significantly increased at T1-T5, and W/D ratio was increased in ALI and HO groups.Compared with group ALI, the levels of SP-A in serum were significantly decreased at T5, and W/D ratio was decreased in HO group.Conclusion Mechanical ventilation with heliox-oxygen can reduce ALI in rabbits.
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AIM: The aim of this study was to investigate the hemodynamic characteristics of the denervated orthotopic transplanted hearts. METHODS: Eighteen patients with end - stage cardiopathy underwent orthotopic cardiac transplantation received immunosuppressive induction therapy. The changes of hemodynamics were closely monitored during the perioperative period and the periodic check-up of echocardiogram and electrocardiograph were followed up in the postoperative long-term period. RESULTS: All recipients were received vasoactive drug and active diuretic therapy during the perioperative period. An increase in central venous pressure in concomitance with decrease in cardiac output, cardiac index and mixed venous oxygen saturation within 24 to 48 hours and tend to stable 48 hours postoperation were detected. In the follow - up period, the cardiac functions of allografts were all recovered well. No recipient complained angina pectoris. CONCLUSIONS: The hemodynamic characteristics and clinical pharmacological therapeutic implications of cardiac denervation are very unique. Rational application of inotropic support and diuretic therapy and vasodilatation combined with prudent administration of some agents, which affect the physiology of denervated heart, are the most effective measures for the prevention of postoperative complications of cardiac allograft.