中华急诊医学杂志最新文献

{"title":"Diagnostic value of plasma procalcitonin for bacterial infection in patients receiving extracorporeal membrane oxygenation","authors":"Xiao Ran, Yongsheng Li","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.08.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.08.016","url":null,"abstract":"Objective \u0000To evaluate the diagnostic value of plasma procalcitonin (PCT) for bacterial infection in patients receiving extracorporeal membrane oxygenation (ECMO). \u0000 \u0000 \u0000Methods \u0000Clinical data of patients receiving ECMO therapy admitted between August 2016 and January 2018 in Department of Critical Care Medicine, Tongji Hospital of Tongji Medical College were analyzed retrospectively. All patients receiving ECMO with bacterial culture were eligible for inclusion. Plasma PCT, IL-6, CRP and WBC levels detected within 24 h of bacterial cultures were analyzed immediately. Bacterial infection in ECMO was determined through bacterial culture and clinical characteristics. Finally, receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of inflammatory markers for bacterial infection in ECMO patients. \u0000 \u0000 \u0000Results \u0000Seventeen patients met the inclusion criteria, including 15 patients with acute respiratory failure and 2 patients with acute circulatory failure. There were 37 positive bacterial cultures, and 91 plasma PCT levels were detected in the process of ECMO. Compared with IL-6, CRP and WBC, plasma PCT had significant clinical significance in the diagnosis of bacterial infection (AUC=0.818,P<0.001). The cut-off value of PCT was 1.0 ng/mL, with a sensitivity of 92% and a specificity of 43%. \u0000 \u0000 \u0000Conclusions \u0000Compared with other conventional inflammatory markers, plasma PCT has more diagnostic value for bacterial infection in ECMO patients. \u0000 \u0000 \u0000Key words: \u0000Procalcitonin; Extracorporeal membrane oxygenation; Bacteria; Infection; Diagnosis; Inflammatory markers; Respiratory failure; Circulatory failure","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"1000-1004"},"PeriodicalIF":0.0,"publicationDate":"2019-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48205387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of different ventilation modes on the ventilation rate and prognosis in patients with cardiac arrest after advanced airway placement","authors":"Fu Yangyang, Danyu Liu, Kui Jin, Lili Zhang, Shanshan Yu, Y. Wang, Lu Yin, Jun Xu, Huadong Zhu","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.08.015","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.08.015","url":null,"abstract":"Objective \u0000To investigate the effect of different ventilation modes on the ventilation rate and prognosis in patients with cardiac arrest after advanced airway placement. \u0000 \u0000 \u0000Methods \u0000Based on the national database of emergency cardiac arrest treatment, patients treated with advanced airway placement during cardiopulmonary resuscitation (CPR) were enrolled in PUMCH Emergency Department from December 2013 to June 2018. The physiological parameters, such as electrocardiograph waveform, pulse oximetry plethysmographic waveform and capnography, were recorded at least 18 minutes. The demographic data and resuscitation parameters were collected. Waveform capnography was used for calculating ventilation rate (VR) and the VR between 8 to 12 breaths/min was defined as the qualified ventilation rate (QVR). According to the ventilation modes, patients were divided into the bag-mask group (BMG) and mechanical ventilation group (MVG). According to the VR, patients in the mechanical ventilation group were divided into two subgroups, the high-frequency ventilation subgroup (HFV subgroup) with the VR more than 20 breaths/min and the low-frequency VR subgroup (LFV subgroup) with the VR less than 20 breaths/min. VR, the qualified ventilation rate ratio (QVRR), the return of spontaneous circulation (ROSC), and 24-h and 7-day survival were compared between the two groups and subgroups. \u0000 \u0000 \u0000Result \u0000A total of 90 patients were enrolled in the analysis with 22 patients in the bag-mask group and 68 patients in the mechanical ventilation group. The total rate of ROSC was 35.6%, 24-h survival was 1.1% and 7-day survival was 0. The first 18 minutes ventilation data were collected and added up to 1 620 min. The median VR was 16.5 (12.0, 26.0) breaths/min and the QVRR was 30%. Compared with the mechanical ventilation group, the VR in the bag-mask group were lower (10 breaths/min vs 21 breaths/min) and the QVRR was higher (88.9% vs 11.5%). The ROSC, 24-h survival and 7-day survival had no statistical differences between the two groups. In the mechanical ventilation group, the ratio of VR more than 20 breaths/min was 52.6%. Between the two subgroups, there was no statistical difference in ROSC, 24-h survival and 7-day survival. \u0000 \u0000 \u0000Conclusions \u0000Compared with the mechanical ventilation during CPR, the VR is lower with bag-mask ventilation, and the QVRR is higher. But there was no statistical difference on the outcomes. There was no difference on the outcomes between the two mechanical ventilation subgroups. \u0000 \u0000 \u0000Key words: \u0000Cardiac arrest; Cardiopulmonary resuscitation; Mechanical ventilation; Ventilation rate; Bag-mask ventilation","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"995-999"},"PeriodicalIF":0.0,"publicationDate":"2019-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41353129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of high-flow nasal cannula oxygen therapy in patients with high cervical spinal cord injury","authors":"Feng-lu Yang, Chunshuang Wu, X. Cao, Ding-qian Wu, Xiao Lu","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.08.017","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.08.017","url":null,"abstract":"Objective \u0000To study the effect of high-flow nasal cannula oxygen therapy (HFNC) in reduction in re-intubation rate, length of ICU stay and improvement of respiratory function in patients with high cervical spinal cord injury. \u0000 \u0000 \u0000Methods \u0000Single center retrospective study was carried out in our intensive care unit from September 2016 to March 2018. Post-operative patients ready for planned extubation with high cervical spinal cord injury were included. The length of ICU stay, re-intubation rate in case of respiratory failure, respiratory rate, pulse rate, MAP, SaO2, PaO2/FiO2, and PaCO2 of patients at 6, 24 and 72 h after extubation were compared between the HFNC and conventional oxygen therapy (COT) groups. \u0000 \u0000 \u0000Results \u0000During the study period, 38 patients were enrolled in the study. Of them, 16 patients were assigned in the HFNC group and 22 patients in the COT group. Re-intubation rate was significantly different between the two groups (18.8% vs 27.3%, P<0.05), but the length of ICU stay had no significant difference [(15.5±3.4) days vs (16.6±5.2) days]. The respiratory rate, pulse rate, SaO2 and PaO2/FiO2 at 6 h after extubation in the HFNC group were improved markedly than those in the COT group (P<0.05); and the PaCO2 and PaO2/FiO2 at 24 and 72 h after extubation in the HFNC group had much more improvement than those in the COT group (P<0.05). \u0000 \u0000 \u0000Conclusions \u0000Among individuals with post-operative high cervical spinal cord injury, high-flow oxygen therapy could reduce re-intubation rate, and PaCO2 level, and improve the respiratory function, but cannot reduce the length of ICU stay. High-flow oxygen therapy may offer advantages for patients with high cervical spinal cord injury. \u0000 \u0000 \u0000Key words: \u0000High-flow nasal cannula; High cervical spinal cord injury; Post-operation; Extubation; retrospective study","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"1005-1009"},"PeriodicalIF":0.0,"publicationDate":"2019-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48696216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of activated cannabinoid receptor 2 in lipopolysaccharide-induced secretion of RAW264.7 macrophage inflammatory cytokines and its possible mechanism","authors":"Q. Yuan, Anpeng Liu, Qiangsheng Liu, Fei Zheng, Yanlin Wang, Zongze Zhang","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.08.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.08.012","url":null,"abstract":"Objective \u0000To investigate the role of activated cannabinoid receptor 2 (CB2R) in lipopolysaccharide (LPS)-induced secretion of RAW264.7 macrophage inflammatory cytokines and its possible mechanism. \u0000 \u0000 \u0000Methods \u0000Macrophages were seeded in 6-well plates (2 mL/well) at the density of 1×105 cells/mL and randomly divided into four groups (n=6 each group): control group (group C), LPS group (group LPS), LPS plus CB2R agonist HU308 group (group LPS+HU308), and LPS plus HU308 plus 3-Methyladenine group (group LPS+HU308+3-MA). LPS with the final concentration of 1 μg/mL were added in group LPS, group LPS+HU308 and group LPS+HU308+3-MA. After incubation for 15 min, 3-MA with a final concentration of 10 mmol/L was added into group LPS+HU308+3-MA . HU308 with the final concentration of 10 μmol/L was added in group LPS+HU308 and group LPS+HU308+3-MA at 15 min after 3-MA intervention, and the cells were then incubated for 24 h. The concentrations of TNF-α, IL-18 and IL-1β in supernatant serum of each group were determined by ELISA. The expressions of ICAM-1 and NLRP3 mRNA were detected by RT-PCR. The expressions of LC3 and Beclin1 were detected by Western blot, and the ratio of LC3-II/LC3-I was calculated. LSD-t test was used for sample pairwise comparison, and one way ANOVA for inter-group comparison. A P<0.05 was considered statistically significant. \u0000 \u0000 \u0000Results \u0000Compared with group C, the concentrations of TNF-α [(228.86±10.20) pg/mL vs (140.05±5.54) pg/mL], IL-1β [(363.62±8.14) pg/mL vs (244.82±9.11) pg/mL], and IL-18 [(293.28±13.57) pg/mL vs (202.84±9.54) pg/mL] in supernatant serum were increased (all P<0.05), the expressions of ICAM-1 [(5.88±0.32) vs (1.00±0.03)] and NLRP3 [(8.07±0.93) vs (1.01±0.05)] mRNA were increased (all P<0.05), the expressions of LC3-II/LC3-I ratio [(0.50±0.03) vs (0.40±0.06)] and Beclin1 [(0.51±0.04) vs (0.16±0.03)] were up-regulated in group LPS (all P<0.05). Compared with group LPS, the concentrations of TNF-α [(165.44±7.07) pg/mL], IL-1β [(272.09±3.35) pg/mL] and IL-18 [(220.41±6.01) pg/mL] in supernatant serum were significantly decreased (all P<0.05), the expressions of ICAM-1 [(3.21±0.35)] and NLRP3 [(1.54±0.30)] mRNA were decreased (all P<0.05), the expressions of LC3-II/LC3-I ratio [(0.71±0.03)] and Beclin1 [(0.71±0.02)] were up-regulated in group LPS+HU308 (all P<0.05). Compared with group LPS+HU308, the concentrations of TNF-α [(197.06±5.59) pg/mL], IL-1β [(318.98±11.54) pg/mL] and IL-18 [(243.33±8.71) pg/mL] in supernatant serum were significantly increased (all P<0.05), the expressions of ICAM-1 [(4.04±0.21)] and NLRP3 [(5.87±0.77)] mRNA were increased (all P<0.05), the expressions of LC3-II/LC3-I ratio [(0.44±0.08)] and Beclin1 [(0.32±0.03)] were down-regulated in group LPS+HU308+3-MA (all P<0.05). \u0000 \u0000 \u0000Conclusions \u0000Activation of cannabinoid receptor 2 can alleviate LPS-induced the secretion of RAW264.7 macrophage inflammatory cytokines, and its mechanism may be related to enhanced autophagy. \u0000 \u0000 \u0000Key words: \u0000Cann","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"978-982"},"PeriodicalIF":0.0,"publicationDate":"2019-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43959803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of butylphthalide injection to mitochondrial function of porcine cerebral neuron after cardiopulmonary resuscitation","authors":"Xichao Fan, Ziren Tang, Peng Xiao, Xiao-ping Wang, Cai-jing Lin, Shen Zhao","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.08.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.08.011","url":null,"abstract":"Objective \u0000To investigate the mechanism of cerebral protection by treatment of butylphthalide (NBP) and its effect to mitochondria in a porcine model of cardiac arrest (CA) after cardiopulmonary resuscitation (CPR). \u0000 \u0000 \u0000Methods \u0000Healthy Wuzhishan pigs weighting (30±2) kg were divide into three groups randomly(random number): The sham group (n=6), the control group (n=12) and the NBP group (n=12). Operation was performed in the sham group. Cardiac arrest of ventricular fibrillation was induced by programed electrical stimulation in the control and NBP group. After CPR, asynchronous defibrillation of 150J was performed to achieve the restoration of spontaneous circulation. NBP was injected at the rate of 2.5 mg•kg-1 in the NBP group. Hemodynamics were recorded at baseline, 1 hr, 2 hr, 3 hr and 4 hr after CPR. The number of injured neurons, apoptosis index and evaluation of mitochondrial injury were calculated under light and electrical microscope respectively. Mitochondria were separated by differential centrifugation. Mitochondrial respiratory function was measured with oxygen consumption of R3 and R4, respiratory control rate (RCR), ADP/oxygen. Mitochondrial permeability transition pore (MPTP) open was tested by colorimetric. \u0000 \u0000 \u0000Results \u0000After CPR, the mean artery pressure, coronary perfusion pressure and cardiac output decreased significantly, whereas no significant differences were found between the control and NBP group (P>0.05). Significant cerebral injury was found after CPR. The number of injured neurons, apoptosis index and evaluation of mitochondrial injury were improved significantly by the NBP treatment (P<0.05). Compared with the sham group, oxygen consumption of R3 and R4, R3/R4 and ADP/O decreased significantly in the cerebral frontal cortex mitochondria of the control group (P<0.01), whereas they were increased in the NBP group (P<0.01). MPTP increased in the control group, which could be improved by the NBP treatment. \u0000 \u0000 \u0000Conclusions \u0000NBP can improve the neurologic outcome after CPR and decrease the apoptosis of neurons by improving the respiratory function of mitochondria and inhibiting the MPTP opening. \u0000 \u0000 \u0000Key words: \u0000Cardiac arrest; Cardiopulmonary resuscitation; Butylphthalide injection; Neurologic outcome; Mitochondrial function","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"971-977"},"PeriodicalIF":0.0,"publicationDate":"2019-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49585273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protective effect of Baicalin on lipopolysaccharide induced H9C2 cell inflammation and its mechanism","authors":"Meng-fang Li, Long-wang Chen, Xiyi Hu, Lai Zhen, J. Lian, Guangju Zhao, Q. Qiu, G. Hong","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.08.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.08.013","url":null,"abstract":"Objective \u0000To investigate the protective effect of Baicalin on inflammation induced by lipopolysaccharide in H9C2 cardiomyocytes and its possible mechanism. \u0000 \u0000 \u0000Methods \u0000H9C2 myocardial cells were cultured and pretreated with baicalin at the final concentration of 10, 20, 30 μmol/L for 12 hours, then stimulated with LPS at the final concentration of 1 μg/mL for 6 hours. The control group was treated with the same amount of saline to collect cell samples. CCK-8 (The Cell Counting Kit-8) was used to detect cell activity, enzyme-linked immunosorbent assay (ELISA) was used to detect the expression levels of interleukin-6 (IL-6), interleukin-1beta (IL-1β), tumor necrosis factor-alpha (TNF-α), Western blot was used to detect the protein expression levels of NF-κB p65, p-NF-κB p65, p38 MAPK, p-p38 MAPK, IκBα and p-IκBα. SPSS 23.0 statistical software was used. Independent sample t test was used for comparison between two groups, and one-way ANOVA test was used for comparison among multiple groups. \u0000 \u0000 \u0000Results \u0000The survival rate of myocardial cells in the control group was (93.67 +1.453)%. Compared with the control group, the survival rate of H9C2 myocardial cells induced by LPS decreased (P 0.05). Compared with LPS group, the survival rate of H9C2 myocardial cells in baicalin intervention group increased (P 0.05). \u0000 \u0000 \u0000Conclusions \u0000Baicalin may alleviate LPS-induced cardiomyocyte inflammation by inhibiting the activation of NF-kappa B and p38 MAPK, and improve cell survival. \u0000 \u0000 \u0000Key words: \u0000Baicalin; Lipopolysaccharide; Cardiomyocyte; NF-κB; P38 MAPK; Sepsis; Inflammation","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"983-988"},"PeriodicalIF":0.0,"publicationDate":"2019-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48923205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applicability of CT examination decision rules in head injured children","authors":"R. Zhen, Gui-long Feng, Kai Fan, Wei-jing Wen, Rui Zhang, Yuanwei Fu, Weizong Liu","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.08.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.08.008","url":null,"abstract":"Objective \u0000To explore the applicability of the three commonly used CT examination decision rules in Chinese head injured children. \u0000 \u0000 \u0000Methods \u0000This prospective observational study included 1 538 children and adolescents (aged <18 years), who were treated at the Emergency Department of First Hospital of Shanxi Medical University after head injuries. The three clinical decision rules include the Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE; UK); the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury, that was developed by the Pediatric Emergency Care Applied Research Network (PECARN; USA), and the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) rule. Diagnostic accuracy had been evaluated by using the rule-specific predictor variables to predict each rule-specific outcome measure in populations who met inclusion and exclusion criteria for each rule. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and ROC curve were referred to the diagnostic accuracy. Indicators were characterized by 95% CI. \u0000 \u0000 \u0000Results \u0000Of the 1 538 patients, CTs were obtained for 339 patients (22.04%). Forty-nine patients (3.19%) had positive CT results, 8 patients (0.52%) underwent neurosurgery, 2 patients (0.13%) died, and 1 patient (0.07%) may be missed. In this study, CHALICE was applied for 1 394 children (90.70%; 95% CI: 89.24%-92.15%), PECARN for 801 children (52.11%; 95% CI: 49.62%-54.61%), and CATCH for 325 patients (21.15%; 95% CI: 19.10%-23.19%). The validation sensitivities of CHALICE, PECARN, and CATCH rules were 92.6% (74.2%-98.7%), 100% (56.1%-100%), and 85.7% (42.0%-99.2%), respectively; the specificities were 78.1% (75.7%-80.2%), 48.0% (44.5%-51.5%) and 70.8% (65.4%-75.6%); positive predictive value were 7.7% (5.1%-11.3%), 0.9% (0.4%-1.9%) and 6.1% (2.5%-13.2%); and negative predictive value were 99.8% (99.2%-100%), 99.1% (98.1%-99.6%), and 99.6% (97.2%-100%), respectively. \u0000 \u0000 \u0000Conclusions \u0000The clinical decision rules of CHALICE, PECARN and CATCH have high sensitivities. The specificity of PECARN rule is lower than those of CHALICE and CATCH rules. The above three clinical decision rules can be used for the decision of CT examination in Chinese children with head injury in practice. \u0000 \u0000 \u0000Key words: \u0000Children; Head trauma; CT examination; Clinical decision rules; Applicability; CATCH; PECARN; CHALICE","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"956-961"},"PeriodicalIF":0.0,"publicationDate":"2019-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47920258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of noninvasive ventilation with the helmet compared with facial mask in patients with acute respiratory failure: a randomized controlled study","authors":"Mengtian Shan, C. Lan, Rongchang Chen, Xing Meng, Xinya Jia, Xiaoqian Pang, Zhongshi Li, Ji Min Xie, Qi Liu","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.08.018","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.08.018","url":null,"abstract":"Objective \u0000To explore the effect of noninvasive ventilation (NIV) with helmet or facial mask on clinical efficacy, tolerability, and prognosis in patients with acute respiratory failure. \u0000 \u0000 \u0000Methods \u0000Fifty patients with acute respiratory failure according to the inclusion criteria were recruited from January 2018 to July 2018 in Emergency Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University. Included patients were randomly allocated into the helmet group or facial mask group. Based on conventional drug therapy, pressure support mode was performed with the interface of the helmet or facial mask. Oxygenation index, arterial carbon dioxide partial pressure, and respiratory rates were measured before and after the treatment, and the data were compared and analyzed by the repeated measures ANOVA. Tolerance score, complication rate, tracheal intubation rate, and mortality rate were recorded at each observation time point of the two groups. \u0000 \u0000 \u0000Results \u0000The oxygenation index before NIV, at 4 h and at the end of NIV treatment of the helmet group were significantly increased from (160.29±50.32) mmHg to (249.29±83.47) mmHg and (259.24±87.09) mmHg; the oxygenation index of the facial mask group were increased from (168.63±38.63) mmHg to (225.00±74.96) mmHg and (217.69±77.80) mmHg, and there was no significant difference within the two groups (P 0.05). Patients in the helmet was better tolerated than those in the facial mask group [ratio of good tolerance 96% (24/25) vs 56% (14/25) (P = 0.001) and fully tolerance 80% (20/25) vs 36% (9/25) (P =0.002)] and had less complications (1/25 vs 10/25, P = 0.002). 84% patients in the helmet group and 76% patients in the facial mask group were successfully weaned and discharged after NIV treatment (P =0.480). \u0000 \u0000 \u0000Conclusions \u0000Similar clinical efficacy in improving blood gas exchange and relieving dyspnea were observed in the helmet group and the facial mask group in patients with acute respiratory failure. However, the helmet is better tolerant, and had lower complication rate, which is especially suitable for patients with chest trauma combined with facial injuries. \u0000 \u0000 \u0000Key words: \u0000Helmet; Facial mask; Noninvasive ventilation; Acute respiratory failure; Chest trauma; Randomized controlled trial","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"1010-1016"},"PeriodicalIF":0.0,"publicationDate":"2019-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42533860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical application of severe multiple trauma treatment model based on damage control strategy","authors":"Lunxian Tang, Zhongmin Liu, Gui-Ping Sun, Zengchun Li, Hong Sun, Xiaowei Bao, Chunmei Wang, Ji Shengchao, Shao Qin","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.08.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.08.009","url":null,"abstract":"Objective \u0000To study the superiority of severe multiple trauma treatment model based on damage control strategy. \u0000 \u0000 \u0000Methods \u0000In the intergrated injury first-aid mode, the intensive care unit-guided damage control strategy was used to treat severe multiple trauma. \u0000 \u0000 \u0000Results \u0000A total of 789 severe multiple damage patients were treated with damage control strategies in our hospital from December 2018 to December 2018. Sixty-nine patients died and the survival rate was 91.25%. \u0000 \u0000 \u0000Conclusions \u0000The intensive care unit-guided trauma control strategy has a satisfactory clinical effect in the treatment of patients with severe multiple trauma. \u0000 \u0000 \u0000Key words: \u0000Damage control; Severe multiple trauma; Emergency model; Intensive care medicine","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"962-965"},"PeriodicalIF":0.0,"publicationDate":"2019-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48027925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors and clinical features of septic patients with human herpes viruses’ nucleic acid detected positive in blood","authors":"Yingjun Zhao, Zhongshu Kuang, C. Tong, C. Yao","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.08.019","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.08.019","url":null,"abstract":"Objective \u0000To measure the reads numbers of Human Herpes Virus in blood sample from patients with sepsis by using Next Generation sequencing (NGS) and explore the relationship between read number of virus and the severity, prognosis, immune status of septic patients. \u0000 \u0000 \u0000Methods \u0000Blood sample and clinical information from 150 patients with sepsis were enrolled in this study. All patients’ blood samples were sent to perform NGS pathogenic test. According to the results of NGS, septic patients were divided into HHV-detected group and HHV-undetected group. Besides, patients were scored with Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) on the day of blood collection. The counts of total leukocytes, lymphocytes and the levels of cytokines were also measured. \u0000 \u0000 \u0000Results \u000051.3 percent of septic patients were detected with HHV nucleic acid. The APACHE II and SOFA scores were significantly higher in HHV-detected patients compared with patients in HHV-undetected group. Besides, patients who had a higher SOFA score might lead to a higher detection rate of HHV. Moreover, the 28-day and 90-day mortality rates were higher in detected group (P < 0.01). The detection of HHV nucleic acid was positively correlated with a high 90-day mortality rate (P = 0.0056). One-way analysis of variance revealed that the counts of total lymphocyte and different types of lymphocyte (CD19+B、CD4+T、CD8+T、CD56+ lymphocyte) were significantly less in detected group than that in undetected group. Furthermore, both the levels of pro-inflammatory cytokines (TNF-α、IL-2R、IL-6、IL-8) and anti-inflammatory cytokines (IL-10) in detected group were significantly higher than those in undetected group. Gender, age, APACHEⅡ, SOFA, IL-2R, IL-10, CD19+B lymphocyte and T cells, were still significant even after multivariate logistic analyses. \u0000 \u0000 \u0000Conclusions \u0000The detection rate of HHV nucleic acid in patients with sepsis was high. The detection of HHV was a high-risk factor of death in patients with sepsis. The cut-off value which is more than 100 had a significant clinical value. The infection of HHV could be conducted by dysfunction of immunity. \u0000 \u0000 \u0000Key words: \u0000Sepsis; Next-generation sequencing; Human herpes virus; Immune statusCLC:R459.7","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"1017-1022"},"PeriodicalIF":0.0,"publicationDate":"2019-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41846501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}