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编号:10488397
Chin Crit Care Med,June 2004,Vol.16,No.6
http://www.100md.com 2004年11月3日 急救快车
     321-324

    Current understanding in definitions and diagnosis of sepsis

    Yao Yong-ming, Sheng Zhi-yong, Lin Hong-yuan, Chai Jia-ke

    304 th Hospital of PLA, Beijing 100037, China

    325-327

    Sepsis: challerge and intervention strategy

    Lin Hong-yuan

    304 th Hospital of PLA, Beijing 100037, China
, http://www.100md.com
    328-332

    Multi-center clinical study on the diagnostic criteria for multiple organ dysfunction syndrome with illness severity score system

    The Research Group of Major Project Granted by Beijing Municipal Sciences and Technology Commission “The Diagnosis and Treatment of MODS: the Effect of Integrated Traditional and Western Medicine on Mortality” (writer: Zhang Shu-wen, Wang Chao, Yin Cheng-hong, Wang Hong, Wang Bao-en).
, 百拇医药
    Department of Infection and Emergency, Beijing Friendship Hospital Affiliated to the Capital University of Medical Sciences, Beijing 100050, China

    OBJECTIVE: To establish the diagnostic criteria for multiple organ dysfunction syndrome (MODS) with illness severity score according to the evaluation of clinical MODS data from hosptal in Beijing. METHODS: The clinical data from 413 MODS cases in eight hospitals with III-leve in Beijing was analyzed by multi-center retrospective cohort study. The significant difference of the each descriptor between non-survivor group and survivor group was analyzed, and then the significant descriptor was selected as the potential indicator. Based on the above analysis, the abnormal range of each descriptor was divided into 4 intervals, assigned corresponding points, diagnostic criteria for MODS was established. RESULTS: Severe infection, major operations, trauma and severe pancreatitis were the main etiological factor for MODS. The mortality of MODS in hospital was 53.5%, and the mortality rate for 28 days hospitalization was 37.3%. The correspondent mortality rate in MODS with 2-6 dysfunction organs was 28.6%-100.0%. The mortality rate of MODS complicated by the dysfunction of brain, cardiovascular system, kidney, and lung was 72.8%, 64.3%, 61.7%, and 54.7% respectively. The frequency of machinery ventilation support was 76.0% and the frequency of hemodialysis was 8.2%. The script of diagnostic criteria for MODS with the illness severity score system was established. The script mainly was involved in the evaluation of seven organs or systems, including respiratory system, cardiovascular system, kidney, hemologic system, liver and alimentary system. Only one parameter was used in each organ, they were FiO2/PaO2, systolic blood pressure (SBP), serum creatinine, platelet count, conscious state and the defecation status. 0-4 scores were endued with each index according to the severity of the illnesses respectively. Every descriptor was 5 points, showing 0 point with normal organ function, and 1-4 scores with organ dysfunction and aggravation. CONCLUSION: The mortality of MODS in hospitals is 53.5% in Beijing. The main etiological factors for MODS still are severe infection, major operations, trauma and severe pancreatitis. The diagnostic criteria for MODS with the illness severity score and the prognostic evaluation system established might have clinical significance and practicability, but further studies with large samples are still needed.
, 百拇医药
    333-337

    Changes of intestinal mucosal lymphocyte homing in rats with multiple organ dysfunction syndromes

    Yang Hui, Tang Cheng-wei.

    Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041,Sichuan, China

    OBJECTIVE: To observe the changes of intestinal mucosal lymphocyte homing in rats with multiple organ dysfunction syndromes (MODS) and study the role of intestinal mucosal lymphocyte play in MODS. METHODS: A rat model of MODS was reproduced by occluding the superior mesenteric artery for 45 minutes followed by reperfusion for 6 hours. From the fifth hour after reperfusion, intestinal lymph of rats (MODS group 1, n=10) was collected for 1 hour. Intestinal lymph was also collected from rats of control group 1 (n=6). The population of lymphocytes and the percentage of T and B cells were measured in both groups. From the third hour after reperfusion, intestinal lymph of rats (MODS group 2, n=6) was collected for 2 hours. Then, intestinal lymphocytes were labeled with51 Cr and were infused into blood circulation again at the sixth hour of reperfusion. Various organs were taken out 1 hour later for measurement of 51 Cr-lymphocytes distribution in organs by γ-counter. Intestinal lymph of control rats (group 2, n=6) was collected. Labeled lymphocytes were also infused into blood circulation of rats again. RESULTS: The number of lymphocytes from intestinal mucosa migrated into blood circulation was decreased, the counts were (0.28±0.15)X107/h and (2.69±0.61)X107/h respectively, while 51 Cr-intestinal lymphocytes homed to intestinal mucosa were increased in MODS induced by intestine ischemia/ reperfusion. At the same time, the levels of endotoxin and tumor necrosis factor-α (TNF-α) in intestinal lymph were also elevated. CONCLUSION: Increased homing of intestinal mucosal lymphocyte is involved in MODS of rats.
, 百拇医药
    338-344

    Analysis of the early and late gene expression of lipopolysaccharide activated macrophages by cDNA microarray

    Li Chong-hui, Zhang Ai-qun, Liu Ju-chao, Zang Chuan-bo, Chen Ming-yi, Xu Ying-xin, Huang Zhi-qiang.

    Institute of Hepatobiliary Surgery, Institute of General Surgery, General Hospital of PLA, Beijing 100853, China

    OBJECTIVE: To study the early and late changes in mRNA expression in macrophages in response to lipopolysaccharide (LPS) with a cDNA microarray approach using the Clontech Atlas microarray. METHODS: mRNA was isolated from unstimulated control and LPS stimulated murine peritoneal macrophages at 2 hours and 24 hours poststimulation,converted to 33 P radiolabeled cDNA, and hybridized to mouse array membranes. RESULTS: In macrophages being stimulated for 2 hours, 69 out of 1 176 genes were found to differ by over 3-fold compared with the control. Among them 44 genes were up-regulated and 25 genes were down-regulated. In macrophages stimulated for 24 hours, 11 genes were up-regulated and 26 genes were down-regulated compared with the control. Only 8 genes were identified both at 2 hours and at 24 hours poststimulation. The expressions of many genes encoding transcription factor, cytokines, cell signaling modulators and apoptosis associated proteins were found to have changed. Some genes that were not previously linked to this model, such as bric-a-brac (BTB) and cap-n-collar(CNC) homology 1(BACH1), early growth response protein 2 (EGR2), E47 interaction protein 1 (EIP1), Ngfi-A binding protein 2 (NAB2), myeloblastosis oncogene-like protein (MYBL2), neurofibromatosis 1 (NF1), ciliarry neurotropic factor (CNTF) and semaphorin 4A (Sema4A). CONCLUSION: This study has allowed us to identify genes that may potentially be regulated by LPS at early and late phase in macrophages. These may contribute to better understanding of the mechanism underlying LPS or bacteria induced inflammatory and immune response following infection and trauma.
, http://www.100md.com
    344

    Investigetion on relationship of weaning from mechanical ventilation and mortality

    Ge Ying, Wang Yong, Wang Da-qing, Su Xiao-lin, Li Jun-ying, Chen Jing

    The Affiliated Hospital of Chuanbei Medical College, Nanchong 637000, Sichuan, China

    345-347

    Defensin-5 and Matrilysin mRNA expression in the intestine of scalded rats and its relation to bacterial translocation
, 百拇医药
    Yang Hong-ming, Chai Jia-ke, Wu Yan-qiu, Lu Yi, Yin Hui-nan, Liu Qiang, Jin Hua, Sheng Zhi-yong.

    Burn Institute, 304 th Hospital of PLA, Beijing 100037, China

    OBJECTIVE: To investigate the effect of burn injury on the expression of rat defensin-5 (RD-5) and Matrilysin mRNA in the intestine of scalded rats and to determine its relation to bacterial translocation. METHODS: Thirty-two Wistar rats were divided randomly into sham injury group (n=8) and burn group (n=24). Rats of the burn group were subjected to 30% total body surface area (TBSA) full-thickness scald injury. At 8, 24 and 72 hours after the injury, the animals (n=8 at each time point) were sacrificed and ileum was sampled for the determination of the expression of RD-5 mRNA and Matrilysin mRNA with reverse transcription-polymerase chain reaction (RT-PCR) technique. Cultures of mesenteric lymph nodes (MLN), liver, spleen and lung were carried out at 24 hours after the injury to assess the rate of bacterial translocation to visceral organs,and the morphological changes in ileal Paneth cells were observed. RESULTS: The expression of RD-5 mRNA was significantly up-regulated at 8 hours when compared with control group. It was down-regulated sharply at 24 hours but was still higher than control group, and at 72 hours it was down-regulated to a level lower than control. On the contrary, the expression of Matrilysin mRNA was up-regulated continuously to 72 hours, and it was significantly higher than control. Bacterial translocation rate was significantly higher in rats of the burn group at 24 hours (58.3%) than in control group (8.3%, P<0.01), but there were no obvious morphological changes in ileal Paneth cells at the same time point. CONCLUSION: The expressions of both RD-5 mRNA and Matrilysin Mrna are up-regulated in the early stage after the injury, but their time phases are different. The phenomenon might imply that there is a host protective response against bacterial translocation.
, http://www.100md.com
    348-351

    Protective effect of ketamine against septic shock in rats

    Song Xue-min, Li Jian-guo, Wang Yan-lin, Zhou Qing, Du Zhao-hui, Jia Bao-hui, Hu Zheng-fang, LI Pei.

    Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan 430071, Hubei, China

    OBJECTIVE: To investigate the effects and the mechanism of ketamine on hemodynamics and pro-inflammatory cytokine levels of plasma in septic shock rats. METHODS: Cecal ligation and puncture (CLP) was used to reproduce septic shock model. Twenty healthy and male Sprague-Dawlay (SD) rats weighing (225±25) g were randomly divided into four equal groups: Sham CLP group, CLP group, ketamine I (KT I) and ketamine II (KT II) group. Thirty minutes before CLP, normal saline (0.9 %) was infused continously at a rate of 5 ml·kg-1·h-1 through the left femoral vein cannula in sham CLP and CLP group, and ketamine (5 mg·kg-1·h-1 and 10 mg·kg-1·h-1, respectively) was infused continously in KT I or KT II group. The right femoral artery was cannulated to monitor mean arterial pressure. The plasma levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were measured using enzyme-linked immunosorbent assays (ELISA). RESULTS: CLP produced progressive hypotension, and a large increase in the plasma TNF-α and IL-6 concentrations. The hemodynamic responses were reversed and the cytokine responses were suppressed in ketamine treated animals. CONCLUSION: Ketamine administration has protective effect against septic shock in CLP rats.
, 百拇医药
    351

    Use of anisodamine in emergency treatment of three shock patients

    Yu Hai-yun, Li Yan-qing, Hu Jian-guo

    Ningcheng the second People Hospital, Chifeng 024200, Neimenggu, China

    352-354

    Change in intestinal function in sepsis in rat

    Li Jun-you, Sun Dan, Lu Yi, Jin Hua, Jiang Xiao-guo, Hu Sen, Sheng Zhi-yong.
, http://www.100md.com
    Research Department of Burn Institute, 304 th Hospital of PLA, Beijing 100037, China

    OBJECTIVE: To study the barrier function, absorption, permeability and peristalsis of intestine in sepsis in rats. METHODS: A Wistar rat model of sepsis was reproduced by ischemia/reperfusion (I/R) of the intestine combined with endotoxin challenge. Animal were randomly divided into normal, I/R 1 hours (I/R 1), I/R 2 hours (I/R 2), I/R 4 hours (I/R 4) and I/RL groups. The following parameters were measured in the experiments: (1) diamin oxidase activity (DAO), D-lactate and D-xylose levels in blood using spectrophotometry; (2) transit function of small intestine; (3) pathological examination of small intestine by light microscope. RESULTS: The results showed that plasma DAO activity was increased in I/R 1, I/R 4 and I/RL (all P<0.05), and small intestinal tissue DAO was decreased in I/R 2 and I/RL (both P<0.05). Negative correlations were found between plasma and intestinal DAO (r=-0.909, P<0.001). Plasma D-lactate was elevated significantly in I/R 1, I/R 2, and I/RL (all P<0.05). D-xylose content was increased at I/R1 and I/RL groups (both P<0.05), and it was significantly higher than controls at 3 hours. Similarly, a positive correlation was found between plasma DAO activity and plasma D-lactate level(r=0.559, P<0.05). CONCLUSION: The intestinal barrier function, absorption function, permeability, and transit are impaired after gut ischemia/reperfusion combined with endotoxin challenge.
, 百拇医药
    355-357

    Alterations in myocardial function in early stage of sepsis in rabbits

    Pan Xiao-jin, Sun Hua.

    Intensive Care Unit, the Second Affiliated Hospital of Nantong Medical College, Nantong 226001, Jiangsu, China

    OBJECTIVE: To study the alterations in myocardial function in early stage of sepsis. METHODS: Twenty rabbits were randomly divided into two groups. In the control group (n=10) only laparotomy was done, and in the sepsis group the animals received cecal ligation and puncture (CLP). In both groups left ventricular catheter was placed via right internal carotid artery. Left ventricular systolic peak pressure (LVSP), maximal positive change in filling pressure versus time (+dp/dt max), maximal negative change in filling pressure versus time (-dp/dt max) were monitored, and serum troponin I (TnI) was measured per hour for five times (0, 1, 2, 3, 4 hours after operation). RESULTS: Compared to the basic levels, LVSP, +dp/dt max and -dp/dt max decreased significantly an hour after CLP in sepsis group (all P<0.05), with the tendency of decrease with elapse of time. Serum TnI increased significantly an hour after CLP in sepsis group, and continued to increase with the passage of time. In contrast, no significant change was observed in control group. CONCLUSION: Cardiac muscle is injured, and myocardial systolic and diastolic functions are depressed in early stage of sepsis in rabbit model.
, http://www.100md.com
    358-360

    Anti-endotoxin core glycolipid antibody: the preparation of immune serum of E. Coli J5

    Xu Xin-nu, Li Zhi-jun, Li Yin-ping

    Key Lab for Critical Care Medicine of the Ministry of Health, First Central Hospital, Tianjin 300192, China

    OBJECTIVE: To prepare high titer anti-endotoxin core glycolipid (J5) antibody (CGL) for the treatment of Gram-negative bacteremia and septic shock. METHODS: Nontoxic bacterial vaccine (50×1012U/L) against E. Coli O111: B4 mutant strain J5 was prepared. J5 bacterial vaccine was injected into rabbits through ear marginal vein (saline as control preparation), one time pre three days, totally five times. Injected doses were as following: 0.1 ml, 0.2 ml, 0.4 ml, 0.6 ml, and 0.8 ml. One week after fifth injection, blood samples from heart were collected and immune serum was isolated. Indirect clotting test was used to determine the titer of antibody and cross reaction. RESULTS: Among 12 immunized rabbits, titers of antibody against E. Coli J5 were exceeding 1∶1 024 in 6 rabbits, and they had cross reaction with various kinds of Gram-negative bacterial endotoxins. CONCLUSION: The titer of anti-endotoxin core glycolipid (E.Coli J5) antibody prepared by us appears to be high, and it can combine with various kinds of Gram-negative bacterial endotoxins.
, 百拇医药
    360

    Diagnostic value of procalcitonin in sepsis in the elderly

    Zhang Li, Wang Yan-ou, Wang Dong-hao

    The First Central Hospital, Tianjin 300192, China

    361-363

    Influence of lipopolysaccharide pretreatment on acute lung injury induced by lipopolysaccharide in rats

    Xue Yun, Wu Xin-min, Zhang Sheng-suo, Zhang Xi-zhe, Fu Zhan-li, Zhang Chun-li.Department of Anesthesia, First Hospital, Peking University, Beijing 100034, China
, 百拇医药
    OBJECTIVE: To evaluate the effect of lipopolysaccharide pretreatment on blocking the development of lipopolysaccharide (E. Coli O55: B5) induced acute lung injury. The activity of nuclear factor-κB (NF-κB) in alveolar macrophages was assessed to elucidate its mechanism. METHODS: Thirty-six Wistar rats were divided into three groups: normal saline (A), lipopolysaccharide (B), lipopolysaccharide preconditioning (C). Rat model of acute lung injury was reproduced by administering intraperitoneally lipopolysaccharide in a dose of 6 mg/kg. Group A and B served as control. In the test group (group C) lipopolysaccharide was given intraperitoneally 0.5 mg/kg, 0.5 mg/kg and 1.0 mg/kg consecutively for 3 days before lipopolysaccharide challenge. Four hours after lipopolysaccharide/normal saline administration, the animals were killed. Blood gas was measured. And total protein of bronchoalveolar lavage fluid (BALF) was calculated by measuring the radioactivity of 99 Tc labeled serum albumin. Wet/dry ratios of the lungs of each group were determined. The nuclear protein of the alveolar macrophages was extracted from BALF, and the activity of NF-κB was assayed with electrophoretic mobility shift assay (EMSA). Microscopic examination of the lung was done. RESULTS: In group C, partial pressure of oxygen in artery (PaO2) was significantly higher than that in group B, and total protein content of BALF was significantly lower in group A and C than that in group B. Activity of NF-κB in group C was higher than group A and B. CONCLUSION: Lipopolysaccharide pretreatment can reduce the severity of acute lung injury induced by lipopolysaccharide challenge. This phenomenon may be related with change in the activity of NF-κB of the alveolar macrophages.
, 百拇医药
    364-365

    Effect of treatment with somatostatin on sepsis in rats

    Zhang Yi-sheng, Zhao Guo-hai, Ding Le, Liang Ling, Wang Ming-hai

    Gejishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China

    365

    The illness severity evaluation for severe pediatric brain injury complicated multiple organ failure
, 百拇医药
    Dong Wei, Zhu Xin-wei, Liu Xue-yong, Cai Ke-sheng, Ni Ming-shan

    The People Hospital, Peixian 221600, Jiangsu, China

    366-367

    Correlation of serum interleukin-1 and coronary heart disease

    Gao Bo, Li Zhong-cheng

    Tianhe Hospital, Tianjin 300050, China

    367

    Type therapy for respiratory failure caused by organophosphorus peticide poisoning
, 百拇医药
    Yang Guo-liang, Zhang Hui-ying

    Zhutian Central Health Hospital, Feixian 273418, Shandong, China

    368-370

    Retrospective analysis and evaluation of published articles concerning glucocorticoid therapy for ARDS

    Lin Min-fang, He Quan-ying

    The People Hospital, Beijing University, Beijing 100044, China
, 百拇医药
    370

    Study on new methods of gastric tube insertion in patients with mechnical ventilation support

    Wang Hong-yan, Peng He-xin

    The People Hospital, Shenzhen 518020, China

    371-372

    Comparison of APACHE II and APACHE III for evaluating prognosis in patient with MODS after liver trandplantastion

, 百拇医药     Gao Hong-mei, Chang Wen-xiu, Cao Shu-hua

    The First Central Hospital, Tianjin 300192, China

    372

    Multiple organ support therapy in rescue patients of multiple organ dysfunction syndromes in ICU

    Li Yi-nan, Zhou Li-xin, Wu Min, Yu Tie-oum, Fang Bin, Wen Wei-biao, Zou Yi-cheng

    ICU, the First People Hospital, Foshan 528000, Guangdong, China
, 百拇医药
    373-374

    Antibiotics combined treatment with ulinastatin on sepsis caused by pathogenic vibrio infection

    Li Jing-rong, Lu Zhong-qiu, Zhao Chu-huan, Cheng Jun-yan, Li Hai-yan, Wu Bin

    The First Hospital Affiliated to the Wenshou University of Medical Sciences, Wenzhou 325000, China

    375-377

    Immunologic paralysis and sepsis
, 百拇医药
    Ji Jian-chao, Hu Sen

    304th Hospital of PLA, Beijing 100037, China

    377

    Laryngeal mask: a new method for airway management

    Lin Ru-yun, Song Jiang-ping, Zhang Jing

    ICU, Kunming 650021, Yunnan, China

    378--380

    cPLA2α: A crucial member in the cellular signaling pathway during inflammatory response
, http://www.100md.com
    Wang Xiao-hui, Yan Guang-tao

    General Hospital of PLA, Beijing 100853, China

    381-384

    Update in the pathagenesis and regulation of apoptosis in T lymphocytes during sepsis

    Dong Yue-qing, Huang Jun-hua, Yao Yong-ming

    304th Hospital of PLA, Beijing 100037, China

    384

    Experiences in the treatment of 46 cases with acute raticide poisoning

    Jing Zhong-ming, Liu Hou-peng

    The People Hospital, Qianxinanzhou 562400, Guizhou, China, 百拇医药