ABSTRACT
Objective To evaluate the effect of alprostadil on the microcirculation and mortality after the fluid resuscitation in patients with septic shock.Methods The patients who met the criteria of septic shock admitted to our hospital from March 2015 to September 2016 were selected as the subjects.After the shock resuscitation reached the standard,they were randomly divided into control group and alprostadil group.Control group was given a standard treatment.On the basis of standard treatment,alprostadil group was given alprostadil 10μg/d plus tube.The heart rate,mean arterial pressure (MAP),central venous pressure (CVP),lactic acid (Lac) and urine volume were recorded at 0,1,3 and 7 days.The microcirculation index under the tongue including small vessel density (TvDs),perfused small microvessel density (PvDs),small vessel perfusion ratio (PPVs),microvascular flow index (MFI) and heterogeneity index (HI) were recorded at 0,6,24 and 72h.The patients' hospitalization time in ICU,total hospitalization time and mortality rate of follow-up 28 days were recorded.Results Forty-eight patients were enrolled in this study,of which 23 were in control group and 25 in alprostadil group.The heart rate and MAP had no significant changes in alprostadil group,but the CVP decreased significantly compared with control group (P＜0.05) at 1,3,7 days after the treatment,and urine volume increased at 3 and 7 days in the alprostadil group (P＜0.05);but TvDs did not increase at 6 and 24h in the two groups,while PvDs,PPVs,MFI,HI increased at 6,24 and 72h in the two groups,with a higher value at 24 and 72h than the 6h.The 72-h indexes were significantly higher in alprostadil group than in control group (P＜0.05).The mechanical ventilation (MV) was significantly lower in alprostadil group than in control group (P＜0.05);ICU hospitalization time and total hospitalization time was significantly shorter in alprostadil group than in control group (P＜0.05).The hospital mortality and 28-day mortality were lower in alprostadil group than in control group (P＜0.05).Conclusions Alprostadil could significantly improve the microcirculation and urine volume in the patients after resuscitation for septic shock,with little effect on systemic circulation,effectively improve the prognosis of patients,and shortening the mechanical ventilation time,ICU stay time and total hospitalization time,thus reducing the mortality rate.
ABSTRACT
Objective To evaluate the effect of plan-do-check-act (PDCA) cycle management method on improving multidrug-resistant organisms (MDROs) prevention and control measures.Methods PDCA cycle management method was applied to improve the management system and management process of a hospital,prevention and control efficacy of MDROs in clinic departments between July-December 2014 (before PDCA implementation) and January-June 2015 (after PDCA implementation) was compared.Results After half a year implementation of PDCA cycle management,the total implementation rate of MDROs prevention and control measures increased from 57.14％ (360/630) to 79.69％ (510/640),difference was statistically significant(P＜0.05);implementation rate of recording by doctors during the disease course,recording by nurses during the nursing process,registration and reporting of MDROs,as well as posting isolation signs were all improved,difference was statistically significant (all P＜0.05).The total isolation rate of MDROs declined from 30.65％ (347/1 132)before PDCA implementation to 22.61％ (236/1 044) after PDCA implementation,difference was statistically significant (x2 =10.393,P＜0.05).Conclusion Application of PDCA cycle can improve the prevention and control measures of MDROs.
ABSTRACT
Objective To evaluate the clinical efficacy of alprostadil in patients with septic shock associated with acute respiratory distress syndrome (ARDS),and to explore its possible mechanism.Methods From January 2015 to June 2016,patients with septic shock associated with ARDS and meeting the inclusion criteria were involved in the study in department of critical care medicine in First Hospital of Lanzhou University and randomly divided into the control group and alprostadil group.The standard treatment was given in control group,alprostadil 10μg 2/d was given in alprostadil group on base of standard treatment.Monitoring indexes were recorded in 1,3 and 6 days after enrollment.General condition of patients,APACHE Ⅱ score,ventilator conditions (PO2,PCO2,RR,PEEP,FiO2,oxygenation index,airway resistance,lung compliance),mechanical ventilation time,ICU stay time,hospital follow-up,28-day follow-up,immune index (CD4+/CD8+),inflammatory markers (CRP,PCT,IL-6) were monitored.Results Sixty-five patients were included in this study,32 in control group and 33 in alprostadil group.At 3 and 6 days after the treatment,APACHE Ⅱ score,respiratory rate (RR),the inspired oxygen concentration (FiO2),airway resistance,and C reactive protein (CRP),procalcitonin (PCT)-6 and interleukin (IL-6) levels significantly decreased,compared with pretreatment and 1 day posttreatment,in the two groups and lower in alprostadil group than in the control group on the 6th day (P＜0.05);at the same time,these indexes such as arterial partial pressure of oxygen (PaO2),lung compliance,oxygenation index,CD4+/CD8+ significantly increased 3 and 6 days after the treatment compared with pretreatment and 1 day posttreatment in the two groups,and on the 6thday,significantly higher in the alprostadil group than in the control group (P＜0.05).Time of mechanical ventilation,ICU stay and hospital stay in the alprostadil group was respectively lower than that in the control group (P＜0.05);The hospital mortality and the 28-day mortality rate were significantly lower in the alprostadil group than in the control group (P＜0.05).Conclusion Alprostadil can improve the lung function in patient with septic shock associated with ARDS,shorten the time of mechanical ventilation,ICU stay and hospital stay,and reduce the mortality rate,which may be associated with that alprostadil reduces systemic inflammatory reaction and enhance immunity by improving microcirculation.