ObjectiveTo investigate different levels of positive end-expiratory pressure (PEEP) on respiratory function and hemodynamics in patients with acute respiratory distress syndrome (ARDS) complicated with intra-abdominal hypertension(IAH). MethodsThirty patients with moderate ARDS admitted in ICU between January 2012 and December 2014 were recruited in the study. They were divided into three groups according to intra-abdominal pressure (IAP),including 10 patients with normal abdominal pressure as a normal IAP group,10 patients with IAP of 12-15 mm Hg as an IAPⅠ group,and 10 patients with IAP of 16-20 mm Hg as an IAPⅡ group. The optimal level of PEEP was titrated according to the best oxygenation methods. The changes of oxygenation index (OI),respiratory mechanics and hemodynamics before and after the optimal level of PEEP were monitored and compared in all groups. The 28-day mortality and ICU stay were also compared. ResultsThe OI after titration was significantly improved compared to baseline in all groups (all P<0.01). The OI after titration in the IAPⅡ group was significantly higher than that in other two groups (all P<0.05). The static lung compliance (Cst) after titration significantly improved than baseline in all groups(all P<0.05),but no significant difference was revealed among three groups (all P>0.05). In the IAPⅡ group,the levels of PEEP,IAP,blood lactate,heart rate and airway plateau pressure after titration were significantly increased than baseline but higher than those in other two groups(all P<0.05),while the level of mean arterial pressure was significantly decreased and significantly lower than those in other two groups(all P<0.01). Meanwhile,the ICU stay was longest in the IAPⅡ group (P<0.01). There was no significant difference in 28-day mortality among three groups(all P>0.05). ConclusionsPEEP can significantly improve oxygenation in patients with ARDS complicated with IAH. The higher the IAP is,the higher the PEEP level is required. However the higher PEEP will significantly increase IAP which will cause adverse impacts on hemodynamics and can not improve the prognosis.
Objective To investigate the predictive value of extracorporeal membrane oxygenation (ECMO) pre-computer multiple scoring systems in the mortality of patients with cardiogenic shock. Methods A retrospective analysis was performed on 100 patients with cardiogenic shock due to various reasons who were treated with veno-arterial ECMO (VA-ECMO) from July 2020 to July 2022. The patients were followed up for 30 days and divided into a survival group (35 cases) and a death group (65 cases) according to whether they survived 30 days after withdrawal. General clinical data, blood biochemistry data within 24 hours before ECMO, ventilator parameters, past medical history and other data were collected, and sequential organ failure score (SOFA) before VA-ECMO, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), survival after veno-arterial ECMO (SAVE) score and modified SAVE score were calculated. Blood biochemical indicators and clinical scores related to patient prognosis were screened using two-independent sample t test or Man-Whitney U test. The predictive efficacy of each score on short-term prognosis (30-day post-discharge mortality) was evaluated by receiver operating characteristic curve and area under curve (AUC). Results There were significant differences in APACHEⅡ score, SAVE score and modified SAVE score between two groups (P<0.05). The AUC and its 95%CI of APACHEⅡ score was 0.696 (95%CI 0.592 - 0.801), of SAVE score was 0.617 (95%CI 0.498 - 0.736), and of post SAVE score was 0.664 (95%CI 0.545 - 0.782), respectively. All AUCs were relatively low (<0.75). Conclusion SOFA, APACHEⅡ, SAVE score and modified SAVE score have limited clinical value in the prognosis assessment of ECMO patients, and do not show obvious advantages.
目的 总结肝移植治疗慢性重症肝炎急性肝衰竭的经验，以期改善预后。 方法 回顾性分析我院施行的3例慢性重症肝炎急性肝衰竭肝移植临床资料。结果 2例男性，1例女性，术前均诊断为慢性重症肝炎急性肝衰竭，肝功能Child分级均为C级，MELD评分分别为56.72、31.90及52.83，肝性脑病Ⅱ°～Ⅳ°，均合并肺部、腹腔感染，术前人工肝治疗1～3次，均行背驮式肝移植，术后病例3停用免疫抑制剂11 d，病例2和病例3痊愈出院，病例1因严重感染继发多器官功能衰竭死亡。结论 术前、术后人工肝支持改善内环境、术中及时补充凝血物质和术后有效控制感染是保证肝移植治疗慢性重症肝炎急性肝衰竭良好预后的关键措施。