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1.
J Invest Surg ; 32(8): 689-696, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29693474

RESUMO

Objective: The objectives of this study were to examine the clinical profile of critically ill patients with septic acute kidney injury (AKI) and to investigate clinical characteristics associated with the outcome of patients. Methods: Data from 582 critically ill patients were collected and retrospectively reviewed. Patients were divided into two groups: without AKI development and with AKI development. Baseline characteristics, laboratory, and other clinical data were compared between these two groups, and correlations between the characteristics and AKI development were examined. Patients with AKI development were further divided into two groups according to the survival outcome, and variables associated with the outcome were determined. Results: AKI was developed in 54.12% (n = 315) of patients, and these patients had blood pressure, SOFA score, APACHE II score, GCS, and various blood chemistry and hematology characteristics significantly different from the patients without AKI. Demographic characteristics (e.g. age and weight) were comparable between the two groups of patients. Among the 315 patients with AKI, 136 of them died during the study period. Multivariate logistic regression analysis revealed that the outcome of patients was associated with lung infection, coagulation system dysfunction, staphylococcus aureus infection, and use of various treatments (epinephrine, norepinephrine, and the use of mechanical ventilation) after AKI development. Conclusion: AKI occurred in approximately half of the critically ill patients admitted to ICU. The site and type of infections, as well as the use of vasopressor agents, were associated with the outcome.

2.
Zhongguo Zhong Yao Za Zhi ; 39(18): 3527-34, 2014 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-25532389

RESUMO

OBJECTIVE: To study the characteristics and regular pattern of the medicine in common use and combined medication in patients of acute pancreatitis in real world. METHOD: Collect the information of 5 433 acute pancreatitis patients in 19 grade IIIA general hospitals in China, analysis by descriptive statistics and association rule. RESULT: In the 5 433 patients of acute pancreatitis, the glycyrrhizic acid injection and somatostatin are the frequency top used Chinese traditional and western medication. Glycyrrhizic acid injection, somatostatin and insulin are the frequency top used drug combination pattern. CONCLUSION: The Chinese and western integrative medicine drug use pattern are accord with the clinical guideline of acute panceatitis. The hepatic and renal function, blood routine and coagulation function should be monitored when the medicines are used.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Medicina Tradicional Chinesa/métodos , Pancreatite/tratamento farmacológico , Adolescente , Adulto , Idoso , Anti-Inflamatórios/uso terapêutico , Quimioterapia Combinada , Feminino , Ácido Glicirrízico/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Somatostatina/uso terapêutico , Adulto Jovem
3.
Chin J Integr Med ; 19(10): 730-5, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23975164

RESUMO

OBJECTIVE: To investigate the correlation between different Chinese medicine (CM) syndromes and variations in microcirculation in septic shock patients. METHODS: seventy Septic shock patients were divided into four groups: heat damaging qi-yin group (HDQY, 23 cases); yin exhaustion and yang collapse group (YEYC, 26 cases); excessive heat in Fu organ group (EHFO, 10 cases); and heat damaging nutrient-blood group (HDNB, 11 cases). Sublingual microcirculation parameters were observed by sidestream dark-field (SDF) imaging and scored by Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA), and parameters of microcirculation perfusion variations and prognoses were analyzed. RESULTS: Compared with those with qi-yin heat damage, perfused vessel density (PVD) in other groups decreased dramatically (P<0.05), and APACHE II scores increased significantly (P<0.05). In addition, the recovery time was prolonged substantially (P<0.05), and the mixed venous oxygen saturation (SVO2) decreased (P<0.05). Blood lactic acid increased significantly (P<0.05), and the mixed SVO decreased (P<0.05), in the YEYC group. Compared with the thermal injury camp blood group, sublingual microcirculation parameter variations showed no obvious difference in the YEYC and EHFO groups (P>0.05). There were significant positive correlations between CM syndromes and APACHE II scoring in different groups (r=0.512, P<0.05). There were negative correlations between PVD and APACHE II scoring (r=-0.378, P=0.043), the proportion of perfused vessels (PPV) and APACHE II scoring (r=-0.472, P=0.008), as well as between the microvascular flow index (MFI) and APACHE II scoring (r=-0.424, P=0.023) in different patients. CONCLUSION: Sublingual microcirculation may serve as a clinical diagnostic parameter of the patient condition, as well as being a prognostic indicator.


Assuntos
Medicina Tradicional Chinesa , Microcirculação/fisiologia , Soalho Bucal/irrigação sanguínea , Soalho Bucal/fisiopatologia , Choque Séptico/sangue , Choque Séptico/fisiopatologia , Idoso , Dopamina/uso terapêutico , Relação Dose-Resposta a Droga , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Perfusão , Choque Séptico/tratamento farmacológico , Choque Séptico/mortalidade , Síndrome
4.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue ; 24(3): 158-61, 2012 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-22401160

RESUMO

OBJECTIVE: To investigate the clinical significance of dynamic monitoring of changes in the sublingual microcirculation in patients with severe sepsis to determine the degree of severity of the clinical condition and prognosis. METHODS: A prospective study was conducted. Sixty--five patients in the intensive care unit (ICU) in Beijing Friendship Hospital were enrolled from June 2010 to December 2010, among whom there were 30 cases of sepsis, 35 cases of severe sepsis. The severe sepsis patients received the early goal--directed resuscitation; and at 0 (before treatment), 6, 12, 24, 48, 72 hours after resuscitation, the technology of sidestream dark--field was used to measure the sublingual total vessel density (TVD), perfusing vessel density (PVD), proportion of perfused vessels (PPV), microvascular flow index (MFI) of sublingual microcirculation in patients and acute physiology and chronic health evaluation II (APACHEII) score, ICU days and 28--day mortality were recorded. Thirty healthy individuals were enrolled as the control group. RESULTS: The sublingual PPV and MFI were significantly lower in sepsis patients than those of the control group [PPV: (73.60 ± 16.77)% vs. (85.17 ± 7.60)%; MFI: 3.23 ± 0.77 vs. 3.78 ± 0.35, both P < 0.05]; PVD, PPV, MFI in severe sepsis patients were not only significantly lower than those of the sepsis group {PVD[mm/mm²]: 7.53 ± 4.38 vs.12.15 ± 2.88; PPV: (49.13 ± 33.74)% vs. (73.60 ± 16.77)%; MFI: 2.21 ± 1.41 vs. 3.23 ± 0.77, all P < 0.05}. After the early goal--directed fluid resuscitation, the sublingual microcirculation was improved significantly compared with that before treatment (0 hour), and they were remarkably apparent at 12 hours {TVD[mm/mm²]: 5.76 ± 2.25 vs. 6.72 ± 4.37; PVD [mm/mm²]: 7.57 ± 1.77 vs. 5.48 ± 4.39; PPV:(69.47 ± 19.24)% vs. (34.55 ± 30.82)%; MFI: 3.17 ± 0.49 vs. 1.55 ± 1.14, all P < 0.05}. Compared with the sepsis group, APACHEII score of the severe sepsis group was elevated (24.77 ± 7.45 vs. 19.30 ± 10.36, but P>0.05), the length of stay in ICU (days) was longer (20.60 ± 19.87 vs. 10.33 ± 9.53, P < 0.05), and the 28--day mortality was higher (45.71% vs. 36.36%, but P>0.05). In the severe sepsis group, compared with the survival group (19 cases), the sublingual microcirculation in the non-survival group (16 cases) PVD, PPV, MFI were significantly decreased{PVD[mm/mm²]:6.70 ± 5.15 vs. 8.53 ± 3.13; PPV: (44.23 ± 37.71)% vs. (54.96 ± 28.41)%; MFI: 1.89 ± 1.65 vs. 2.58 ± 0.98, P < 0.05 or P < 0.01}, but APACHEII score and length of stay in ICU (days) were not significantly different (23.19 ± 6.46 vs. 20.31 ± 6.03; 16.13 ± 10.90 vs. 19.19 ± 9.90, both P > 0.05). Correlation analysis showed that: PPV showed a significant negative correlation with the prognosis of the patients (r = -0.374, P < 0.05). CONCLUSION: Sequential monitoring of the sublingual microcirculation in patients with severe sepsis can be used to determine the disease severity, and to forecast the outcome of the patient.


Assuntos
Microcirculação , Soalho Bucal/irrigação sanguínea , Sepse/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Sepse/patologia , Adulto Jovem
5.
Zhongguo Zhong Xi Yi Jie He Za Zhi ; 30(8): 819-22, 2010 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-21038649

RESUMO

OBJECTIVE: To explore the efficacy of Qishen Huoxue Granules (QHG) for auxiliary treatment of critical patients with acute kidney injury (AKI). METHODS: Fifty-two AKI patients came from critical care medical department of Beijing Friendship Hospital were randomly assigned to two groups: Group A (25 patients) was treated with QHG (consisted of Radix Astragali, Radix Salviae miltiorrhizae, Radix Paeoniae rubra, Flos Carthami, and Radix Angelicae sinensis, etc., 10 g/bag, administered via gastric perfusion, 3 times per day, 10 g in each time) and continuous renal replacement therapy (CRRT); Group B (27 cases) was treated only by CRRT, all for 14 days. Besides, mechanical ventilation and vasoactive drugs were applied in case of necessary. The time of renal function recovery, days in ICU, 28-day mortality, changes of serum Cystatin C concentration as well as the time of mechanical ventilation (T-V) and vasoactive drugs application (T-D) in patients, who received corresponding treatment were observed. RESULTS: The renal function recovery time in Group A was markedly earlier than that in Group B (P < 0.05), with concentration of serum Cystatin C began to decrease from day 10. T-V and T-D in Group A were markedly shorter than those in Group B, respectively (P < 0.05). No significantly statistical difference between the two groups for days in ICU and 28-day mortality was found (P > 0.05). CONCLUSION: QHG shows favorable prospect in treating critical AKI patients, it can significantly accelerate the renal function recovery time, shorten the duration of mechanical ventilation and vasoactive drugs application.


Assuntos
Lesão Renal Aguda/terapia , Cuidados Críticos , Medicamentos de Ervas Chinesas/uso terapêutico , Fitoterapia , Terapia de Substituição Renal , Lesão Renal Aguda/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Cistatina C/sangue , Feminino , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Terapia de Substituição Renal/métodos
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