[Relationship between blood lactic level, lactic clearance, duration of lacticemia and prognosis of critically ill patients in intensive care unit].

OBJECTIVE: To study and quantify the relationship between dynamic lactic acid monitoring indexes and prognosis of critically ill patients in intensive care unit (ICU). METHODS: One hundred and one critically ill patients with elevated blood lactic acid level were included in this study and divided into death group (n=50) and survival group (n=51). Differences in their lactic acid indexes (including: lactic acid level, duration of lacticemia, lactic clearance), acute physiology and chronic health evaluation II (APACHEII) score, and other clinical indicators which reflected organ/system status were compared, and prognostic significant lacticemia indexes were formulated by multi-variable logistic analysis. Subsequently, patients were grouped by significant lactic indexes separately and compared with incidence of shock/multiple organ dysfunction syndrome (MODS), APACHE II score and mortality. RESULTS: Differences in lactic acid level, peak lactic acid level, 12-hour and 24-hour lactic acid clearance between death group and survival group showed statistically significant difference (P<0.05 or P<0.01). Peak lactic acid level, 12-hour lactic clearance, APACHE II score and blood pH had significant correlation with prognosis, odds ratios (OR) were 1.466, 0.922, 1.208, 0.032, respectively. Patients with peak lactic acid value> or =10 mmol/L or 12-hour lactic clearance< or =10% had significantly higher mortality: 77.8% and 70.6%, respectively (P<0.05 and P<0.01). Although patients with lacticemia>24 hours had higher mortality, there was no statistically significant difference. CONCLUSION: Peak lactic acid level, 12-hour lactic clearance, APACHE II score and blood pH are good indicators to evaluate patients' prognosis. Peak lactic acid value> or =10 mmol/L or 12-hour lactic clearance< or =10% is an alert of extremely bad prognosis. Prognosis value of duration of lacticemia is limited.

[Effect of total parenteral nutrition with supplementation of glutamine on the plasma diamine oxidase activity and D-lactate content in patients with multiple organ dysfunction syndrome].

OBJECTIVE: To explore the effect of total parenteral nutrition (TPN) supplemented with glutamine on the activity of plasma diamine oxidase (DAO) and D-lactate content in blood of patients with multiple organ dysfunction syndrome (MODS). METHODS: Forty patients with MODS in the intensive care unit (ICU) from September 2003 to June 2005 were involved in a randomized controlled study, and divided into routine group (group A, n=20), the glutamine +TPN treatment group (group B, n=20). All patients received equivalent nitrogen and caloric values in parenteral nutrition. Group A was given routine TPN, and group B was given extra glutamine 0.27 g.kg(-1).d(-1) (i. e. dipeptiven 0.4 g.kg(-1).d(-1)) for 7 days. The activity of plasma DAO and D-lactate content, the treatment time and the mortality rate of the two groups were determined before TPN, on the 1st, the 3rd and the 7th day after TPN. At the same time, 20 healthy blood donors formed the healthy control group (group C). All the data were analyzed with the SPSS 10.0 software. RESULTS: Before treatment, the activity of plasma DAO and D-lactate content of the two patient groups were significantly higher than those of group C (both P<0.01), and there was no difference between group A and group B (P>0.05). After the treatment of glutamine supplemented TPN, the activity of plasma DAO and D-lactate content of group B were lower than those of group A (both P<0.01). The duration of TPN was (15.8+/-2.3) days for group A and (12.5+/-2.4) days for group B. The former was significantly longer than that of group B (P<0.05). The mortality rate of group A was 25%, the mortality rate of group B was 10%, but there was no significant difference between the two groups (P>0.05). CONCLUSION: The glutamine (dipeptiven) supplementation through vein can help increase the supply of energy substrate to intestinal mucosa epithelium, and decrease the activity of plasma DAO and D-lactate content. It has an important effect on protecting the intestinal mucosa epithelial function. It also helps shorten the TPN treatment course.

[The research of related factors affecting the longevity of double chamber cardiac pacemaker].

OBJECTIVE: To research the related factors affecting the dual chamber cardiac pacemaker (PM) longevity, and provide the clinical basis for the PM reasonable application and design. METHODS: From 1991, 71 patients with AVB or SSS who used 9 kinds of dual-chamber PM were followed up. Every installed PM's related parameters, such as sensing electric current, resistance and pacing electric voltage, which may affect the PM longevity voltage had been recorded regularly. At the end point of survey, according to the related parameters of patients and PMs, the 71 patients were grouped into several groups. Then the related parameters were analyzed by statistical methods. RESULTS: The average of PM service life is 111 months +/- 19 months. Patient's basal heart rate, battery capacity, pacing electric voltage, pacing frequency, resistance, threshold value, pulse width and sensing electric current had all affected the PM's longevity (all P < 0.05) counted by Wilcoxon (Gehan) test. Sensing electric current (P = 0.000, RR = 3.072, 95% CI = 2.130 - 4.429), pacing electric voltage (P = 0.040, RR = 2.121, 95% CI = 1.126 - 3.998) and resistance (P = 0.049, RR = 1.786, 95% CI = 1.007 - 3.169) were the important predicting indictors of the PM longevity by Cox'proportional hazard risk regression analysis. CONCLUSION: Sensing electric current, pacing electric voltage and resistance are the important affecting factors of the PM longevity. Patient's basal heart rate, battery capacity, pacing frequency, threshold value and pulse width have influence of different degree on dual-chamber PM longevity.