Sepsis-associated acute kidney injury (SA-AKI) is one of the most common complications of sepsis, characterized by high incidence and mortality. Currently, supportive treatment remains the main approach in clinical practice, lacking specific targeted drugs. Mitochondrial dysfunction and metabolic reprogramming play significant roles in the pathophysiological process of SA-AKI. The kidneys, with their high mitochondrial density and high energy demand, are particularly sensitive to mitochondrial dysfunction. Metabolic reprogramming is another important mechanism for the onset of SA-AKI. When sepsis occurs, the metabolic patterns of kidney cells undergo significant changes, initially shifting from oxidative phosphorylation (OXPHOS) to aerobic glycolysis metabolism, accompanied by inhibition of fatty acid oxidation (FAO). The initial intention is an adaptive protective response of the cells, but persistent metabolic imbalance leads to lipid accumulation and fibrosis, progressing to chronic kidney disease. The two mechanisms interact with each other, jointly causing the occurrence and progression of SA-AKI. This article focuses on these two core mechanisms, systematically reviews the research progress of targeted treatment strategies of SA-AKI, elaborates on the potential application value of mitochondrial protectants and metabolic regulators, deeply analyzes the mechanism of action, in vitro and in vivo experimental evidence, and clinical translation prospects of various drugs, summarizes the current research bottlenecks and looks forward to future development directions, aiming to provide theoretical basis and new research ideas for precise targeted treatment of SA-AKI.

This study aimed to investigate coagulation management strategies by experienced critical care physicians across China. The questionnaire was independently designed referencing current guidelines and literature, and refined through five rounds of multidisciplinary review, covering basic information, blood product supply, clinical practices, and laboratory support. The survey recruited 473 senior physicians from 473 Intensive Care Units (ICUs) at 431 tertiary hospitals across China. Many hospitals reported a shortage of blood products. Most physicians preferred a strategy of fixed ratio for transfusion in traumatic (350/473, 74.0 %) and non-traumatic (271/ 473, 57.29 %) massive hemorrhage. For patients with hemorrhage and coagulopathy, fresh frozen plasma (FFP) (421/473, 89.0 %), prothrombin complex concentrate (PCC) (274/473, 57.9 %), and cryoprecipitate (Cryo) (213/473, 45.0 %) were commonly used. In cases of massive hemorrhage, 39.7 % (188/473) of physicians would empirically administer PCC, and 77.6 % (367/473) would rely on the results of traditional laboratory tests. Human fibrinogen (FIB) concentrate (373/473, 78.9 %) and Cryo (380/473, 80.3 %) were commonly used to replenish fibrinogen. To raise plasma FIB levels, 1-2 g of FIB (352/473, 74.4 %) and 5-15 units (U) of Cryo (402/ 473, 84.99 %) were usually administered empirically; a FIB level above 2.0 g/L was the most commonly used standard for treatment termination (234/473, 49.5 %). Tranexamic acid (TXA) was commonly used to treat traumatic (338/473, 71.5 %) or non-traumatic (326/473, 68.9 %) intracranial hemorrhage. Significant variation was observed in the use of FFP (351/473, 74.2 %) and PCC (171/473, 36.2 %) to treat hemorrhage caused by vitamin K antagonists. Significant differences have been observed in blood product supply and treatment strategies used by ICU physicians for massive hemorrhage in critically ill patients, suggesting the need for treatment protocol standardization and further research. Keypoints: This nationwide expert survey provides a comprehensive understanding of current clinical practices in blood product transfusion and coagulation management for critically ill patients with hemorrhage. Most hospitals encounter a shortage of blood products while treating massive hemorrhage. Blood product transfusion ratios, plasma transfusion strategies, and PLT transfusion indications are notably different when treating critically ill patients with massive versus non-massive hemorrhage. Practical variations exist regarding the threshold indications and dosing of PCC, FIB, Cryo, and TXA in the setting of hemorrhage. Discrepancy and knowledge gaps still exist in antithrombotic reversal strategy for vitamin K antagonists, novel oral anticoagulant (NOAC), and antiplatelet drug-induced hemorrhage.

ImportancePrevious research has suggested that Xuebijing injection (XBJ), an herbal-based intravenous preparation, may reduce mortality among patients with sepsis.ObjectiveTo determine the effect of XBJ vs placebo on 28-day mortality among patients with sepsis.Design, Setting, and ParticipantsThe Efficacy of Xuebijing Injection in Patients With Sepsis (EXIT-SEP) trial was a multicenter, randomized double-blind, placebo-controlled trial conducted in intensive care units at 45 sites and included 1817 randomized patients with sepsis (sepsis 3.0) present for less than 48 hours. Patients aged 18 to 75 years with a Sequential Organ Failure Assessment score of 2 to 13 were enrolled. The study was conducted from October 2017 to June 2019. The final date of follow-up was July 26, 2019. Data analysis was performed from January 2020 to August 2022.InterventionsThe patients were randomized to receive either intravenous infusion of XBJ (100 mL, n = 911) or volume-matched saline placebo (n = 906) every 12 hours for 5 days.Main Outcomes and MeasuresThe primary outcome was 28-day mortality.ResultsAmong the 1817 patients who were randomized (mean [SD] age, 56.5 [13.5] years; 1199 [66.0%] men), 1760 (96.9%) completed the trial. In these patients, the 28-day mortality rate was significantly different between the placebo group and the XBJ group (230 of 882 patients [26.1%] vs 165 of 878 patients [18.8%], respectively; P < .001). The absolute risk difference was 7.3 (95% CI, 3.4-11.2) percentage points. The incidence of adverse events was 222 of 878 patients (25.3%) in the placebo group and 200 of 872 patients (22.9%) in the XBJ group.Conclusions and RelevanceIn this randomized clinical trial among patients with sepsis, the administration of XBJ reduced 28-day mortality compared with placebo.Trial RegistrationClinicalTrials.gov Identifier: NCT03238742

OBJECTIVETo investigate the development present situation of the department of critical care medicine in Inner Mongolia Autonomous Region (hereinafter referred to as Inner Mongolia), in order to promote the standardized and homogeneous development of critical care medicine in Inner Mongolia, and also provide a reference for discipline construction and resource allocation.METHODSA survey study was conducted in comprehensive intensive care unit (ICU) of tertiary and secondary hospitals in Inner Mongolia by online questionnaire survey and telephone data verification. The questionnaire was based on the Guidelines for the Construction and Management of Intensive Care Units (Trial) (hereinafter referred to as the Guidelines) issued by the National Health Commission in 2009 and the development trend of the discipline. The questionnaire covered six aspects, including hospital basic information, ICU basic information, personnel allocation, medical quality management, technical skill and equipment configuration. The questionnaire was distributed in September 2022, and it was filled out by the discipline leaders or department heads of each hospital.RESULTSAs of October 24, 2022, a total of 101 questionnaires had been distributed, 85 questionnaires had been recovered, and the questionnaire recovery rate had reached 84.16%, of which 71 valid questionnaires had been collected in a total of 71 comprehensive ICU. (1) There were noticeable regional differences in the distribution of comprehensive ICU in Inner Mongolia, with a relatively weak distribution in the east and west, and the overall distribution was uneven. The development of critical care medicine in Inner Mongolia was still lacking. (2) Basic information of hospitals: the population and economy restricted the development of ICU. The average number of comprehensive ICU beds in the western region was only half of that in the central region (beds: 39.0 vs. 86.0), and the average number of ICU beds in the eastern region was in the middle (83.6 beds), which was relatively uneven. (3) Basic information of ICU: among the 71 comprehensive ICU surveyed, there were 44 tertiary hospitals and 27 secondary hospitals. The ratio of ICU beds to total beds in tertiary hospitals was significantly lower than that in secondary hospitals [(1.59±0.81)% vs. (2.11±1.07)%, P < 0.05], which were significantly lower than the requirements of the Guidelines of 2%-8%. The utilization rate of ICU in tertiary and secondary hospitals [(63.63±22.40)% and (44.65±20.66)%, P < 0.01] were both lower than the bed utilization rate required by the Guidelines (75% should be appropriate). (4) Staffing of ICU: there were 376 doctors and 1 117 nurses in tertiary hospitals, while secondary hospitals had 122 doctors and 331 nurses. There were significant differences in the composition ratio of the titles of doctors, the degree of doctors, and the titles of nurses between tertiary and secondary hospitals (all P < 0.05). Most of the doctors in tertiary hospitals had intermediate titles (attending physicians accounted for 41.49%), while most of the doctors in secondary hospitals had junior titles (resident physicians accounted for 43.44%). The education level of doctors in tertiary hospitals was generally higher than that in secondary hospitals (doctors: 2.13% vs. 0, masters: 37.24% vs. 8.20%). The proportion of nurses in tertiary hospitals was significantly lower than that in secondary hospitals (17.01% vs. 24.47%). The ratio of ICU doctors/ICU beds [(0.64±0.27)%, (0.59±0.34)%] and ICU nurses/ICU beds [(1.76±0.56)%, (1.51±0.48)%] in tertiary and secondary hospitals all failed to meet the requirements above 0.8 : 1 and 3 : 1 of the Guidelines. (5) Medical quality management of ICU: compared with secondary hospitals, the proportion of one-to-one drug-resistant bacteria care in tertiary hospitals (65.91% vs. 40.74%), multimodal analgesia and sedation (90.91% vs. 66.67%), and personal digital assistant (PDA) barcode scanning (43.18% vs. 14.81%) were significantly higher (all P < 0.05). (6) Technical skills of ICU: in terms of technical skills, the proportion of bronchoscopy, blood purification, jejunal nutrition tube placement and bedside ultrasound projects carried out in tertiary hospitals were higher than those in secondary hospitals (84.09% vs. 48.15%, 88.64% vs. 48.15%, 61.36% vs. 55.56%, 88.64% vs. 70.37%, all P < 0.05). Among them, the placement of jejunal nutrition tube, bedside ultrasound and extracorporeal membrane oxygenation were mainly completed independently in tertiary hospitals, while those in secondary hospitals tended to be completed in cooperation. (7) Equipment configuration of ICU: in terms of basic equipment, the ratio of the total number of ventilators/ICU beds in tertiary and secondary hospitals [0.77% (0.53%, 1.07%), 0.88% (0.63%, 1.38%)], and the ratio of injection pump/ICU beds [1.70% (1.00%, 2.56%), 1.25% (0.75%, 1.88%)] didn't meet the requirements of the Guidelines. The equipment ratio was insuffcient, which means that the basic needs of development had not been met yet.CONCLUSIONSThe development of comprehensive ICU in Inner Mongolia has tended to mature, but there is still a certain gap in the development scale, personnel ratio and instruments and equipment compared with the Guidelines. Moreover, the comprehensive ICU appears the characteristics of relatively weak eastern and western regions, and the overall distribution is uneven. Therefore, it is necessary to increase efforts to invest in the construction of the department of critical care medicine.

Importance Previous research has suggested that Xuebijing injection (XBJ), an herbal-based intravenous preparation, may reduce mortality among patients with sepsis.Objective To determine the effect of XBJ vs placebo on 28-day mortality among patients with sepsis.Design, Setting, and Participants The Efficacy of Xuebijing Injection in Patients With Sepsis (EXIT-SEP) trial was a multicenter, randomized double-blind, placebo-controlled trial conducted in intensive care units at 45 sites and included 1817 randomized patients with sepsis (sepsis 3.0) present for less than 48 hours. Patients aged 18 to 75 years with a Sequential Organ Failure Assessment score of 2 to 13 were enrolled. The study was conducted from October 2017 to June 2019. The final date of follow-up was July 26, 2019. Data analysis was performed from January 2020 to August 2022.Interventions The patients were randomized to receive either intravenous infusion of XBJ (100 mL, n = 911) or volume-matched saline placebo (n = 906) every 12 hours for 5 days.Main Outcomes and Measures The primary outcome was 28-day mortality.Results Among the 1817 patients who were randomized (mean [SD] age, 56.5 [13.5] years; 1199 [66.0%] men), 1760 (96.9%) completed the trial. In these patients, the 28-day mortality rate was significantly different between the placebo group and the XBJ group (230 of 882 patients [26.1%] vs 165 of 878 patients [18.8%], respectively; P < .001). The absolute risk difference was 7.3 (95% CI, 3.4-11.2) percentage points. The incidence of adverse events was 222 of 878 patients (25.3%) in the placebo group and 200 of 872 patients (22.9%) in the XBJ group.Conclusions and Relevance In this randomized clinical trial among patients with sepsis, the administration of XBJ reduced 28-day mortality compared with placebo.

Sepsis is currently defined as a life-threatening multiple organ dysfunction caused by host dysregulated response to infection, with high morbidity and mortality in intensive care units. Patients with sepsis are often complicated with cardiac dysfunction known as septic cardiomyopathy (SCM). The occurrence of SCM is related to the high mortality of patients, which has been closely concerned for a long time, and is also one of the challenges to be solved in the systematic treatment of sepsis. A large number of studies have shown that oxidative stress contributes to the pathogenesis of SCM. The role of oxidative stress in SCM and the potential treatment measures for redox imbalance are discussed in this paper.

Background: Previous cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes. Methods: We conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was allcause mortality within 28 days of enrollment. Results: Forty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference -0.40 [95% CI -0.71 to - 0.09]; P= 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P= 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference - 1.6% [95% CI - 4.3% to 1.2%]; P=0.42) between groups. Conclusions: In this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness.

BACKGROUND:Sepsis is commonly acute and critical illness with high morbidity and high mortality, and requires timely diagnosis and treatment. Septic patients had elevated serum H-FABP levels, which may correlate with disease severity and mortality. However, previous studies showed that the association between H-FABP and mortality during the sepsis remains unclear. Thus, we performed a study to analyze this relationship.METHODS:The electronic databases such as Cochrane Library, PubMed, Embase, Web of Science, Cochrane Clinical Trials Database, Wanfang Database, and China National knowledge Infrastructure (CNKI) were systematically searched to determine the qualified clinical trials. The study language is limited to English or Chinese. The 2 authors used Cochrane Risk of Bias Tool v.2.0 to independently check the quality of papers and extract relevant data. Comprehensive analysis of data extracted in the research using appropriate statistical methods.RESULTS:Evaluation of the relationship between the prognosis of patients with sepsis and serum H-FABP is the result of this study.CONCLUSION:The analysis results of this study can infer that H-FABP may be an independent risk factor for the prognosis of patients with sepsis. It is also helpful for clinical workers to make early evaluation and early treatment of patients with sepsis.ETHICS AND DISSEMINATION:The conclusions of this meta-analysis study are based on the published evidence. Therefore, moral recognition is unnecessary.OSF REGISTRATION NUMBER:DOI: 10.17605/ OSF.IO / 2V4HN.(https://osf.io/2v4hn/).

心力衰竭(HF)是各种心脏结构或功能性疾病导致心室充盈和(或)射血功能受损,心排血量不能满足机体组织代谢需要,以肺循环和(或)体循环淤血,器官、组织血流灌注不足为临床表现的一组综合征,主要表现为呼吸困难、体力活动受限和体液潴留.目前HF的患病率和住院率呈逐年上升趋势,已成为主要的公共卫生问题之一.HF的常规治疗方法包括消除诱因、限制液体入量,强心、利尿、扩血管等药物治疗.减少体内水钠潴留,减轻心脏前负荷及调节心脏神经内分泌功能是治疗HF的重要组成部分.连续性肾脏替代治疗(CRRT)通过超滤作用清除患者体内多余的水分及调节神经内分泌功能,可有效改善患者的HF症状,目前已广泛应用于临床.本文将对CRRT在HF患者中的应用进行综述,以期更好地指导CRRT在HF患者中的应用.

Background: Equipoise exists regarding the implementation of evidence-based guidelines for nutritional therapy in critical illness because some previous cluster-randomised controlled trials (cRCTs) demonstrate patient benefits whilst others do not. We aimed to resolve this issue by initiating an appropriately powered cRCT to assess whether active implementation of an evidence-based guideline for nutrition therapy in critical illness could reduce mortality.Methods: We did a multicentre, cluster-randomised, parallel-controlled trial in 97 intensive care units (ICUs) throughout China. We developed an up-to-date, evidence-based nutrition guideline. ICUs randomly allocated to implement the guideline formed a local "intervention team", which actively implemented the guideline using standardized educational materials. ICUs assigned to the control group remained unaware of the guideline. All ICUs enroled critically ill patients who were expected to stay longer than seven days. The primary outcome was all-cause mortality within 28 days of enrolment .Findings Between March, 2018 and July, 2019, we enrolled 1,373 patients at 48 guideline ICUs and 1,399 patients at 49 control ICUs. Implementation of the nutrition guideline resulted in significantly earlier enteral nutrition (EN) initiation (1.20 vs. 1.55 mean days to initiation of EN; difference -0.40 [95% CI, -0.71 to -0.09]; P=0.01) and delayed parenteral nutrition (PN) initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI, 0.44 to 1.67]; P=0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference -1.6% [95% CI -4.3% to 1.2%]; p=0.42) between study groups.Interpretation: Active implementation of an evidence-based guideline can change practice. Our active implementation strategy improved the provision of nutrition therapy to critically ill patients. However, in our cRCT, this improvement in care did not translate to a reduction in mortality. We did not identify any safety concerns associated with the active implementation of our evidence-based guideline for nutrition therapy. Trial Registration: The study was registered in the ISRCTN registry before enrolment commenced (No. ISRCTN12233792). Funding Statement: The study was funded by the Key Research and Development Program Foundation of Jiangsu Province of China (no. BE2015685) and Nutricia, Wuxi, China.Declaration of Interests: Dr. GSD reported receiving academic research grants related to nutrition in critical illness from the Australian National Health and Medical Research Council, Fresenius Kabi Deutschland GmbH and Baxter Healthcare Pty Ltd and speakers honoraria from Fresenius Kabi Deutschland GmbH, Baxter Healthcare Australia, Pty Ltd, Nestle Healthcare, Vevy, Switzerland and Nutricia Pharmaceutical (Wuxi) Co., Ltd. China. Dr. AvZ reports personal fees from Baxter, personal fees from Nestle, personal fees from Fresenius Kabi, grants and personal fees from Nutricia, grants from Cardinal Health grants from Mermaid grants from Lyric, outside the submitted work. Dr. WqL reported receiving speakers honoraria from Nutricia Pharmaceutical (Wuxi) Co., Ltd. China. No other disclosures were reported.Ethics Approval Statement: The study was approved by the local hospital ethics committees of all the participating ICUs. At each site, informed consent was obtained from the patients or their next of kin before enrolment.

OBJECTIVE:To investigate the different outcomes of two types of acute kidney injury (AKI) according to standard of Kidney Disease: Improving Global Outcomes-AKI (KDIGO-AKI), and to analyze the risk factors that affect the prognosis of intensive care unit (ICU) patients in China.METHODS:A secondary analysis was performed on the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a multicenter prospective study involving 3 063 patients in 22 tertiary ICUs in 19 provinces and autonomous regions of China. The demographic data, scores reflecting severity of illness, laboratory findings, intervention during ICU stay were extracted. All patients were divided into pure AKI (PAKI) and acute on chronic kidney disease (AoCKD). PAKI was defined as meeting the serum creatinine (SCr) standard of KDIGO-AKI (KDIGO-AKISCr) and the estimated glomerular filtration rate (eGFR) at baseline was ≥ 60 mL×min-1×1.73 m-2, and AoCKD was defined as meeting the KDIGO-AKISCr standard and baseline eGFR was 15-59 mL×min-1×1.73 m-2. All-cause mortality in ICU within 28 days was the primary outcome, while the length of ICU stay and renal replacement therapy (RRT) were the secondary outcome. The differences in baseline data and outcomes between the two groups were compared. The cumulative survival rate of ICU within 28 days was analyzed by Kaplan-Meier survival curve, and the risk factors of ICU death within 28 days were screened by Cox multivariate analysis.RESULTS:Of the 3 063 patients, 1 042 were enrolled, 345 with AKI, 697 without AKI. The AKI incidence was 33.11%, while ICU mortality within 28 days of AKI patients was 13.91% (48/345). Compared with PAKI patients (n = 322), AoCKD patients (n = 23) were older [years old: 74 (59, 77) vs. 58 (41, 72)] and more critical when entering ICU [acute physiology and chronic health evaluation II (APACHE II) score: 23 (19, 27) vs. 15 (11, 22)], had worse basic renal function [eGFR (mL×min-1×1.73 m-2): 49 (38, 54) vs. 115 (94, 136)], more basic complications [Charlson comorbidity index (CCI): 3 (2, 4) vs. 0 (0, 1)] and higher SCr during ICU stay [peak SCr for diagnosis of AKI (μmol/L): 412 (280, 515) vs. 176 (124, 340), all P < 0.01]. The mortality and RRT incidence within 28 days in ICU of AoCKD patients were significantly higher than those of PAKI patients [39.13% (9/23) vs. 12.11% (39/322), 26.09% (6/23) vs. 4.04% (13/322), both P < 0.01], while no significant difference was found in the length of ICU stay. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate in ICU in AoCKD patients was significantly lower than PAKI patients (Log-Rank: χ 2 = 5.939, P = 0.015). Multivariate Cox regression analysis showed that admission to ICU due to respiratory failure [hazard ratio (HR) = 4.458, 95% confidence interval (95%CI) was 1.141-17.413, P = 0.032], vasoactive agents treatment in ICU (HR = 5.181, 95%CI was 2.033-13.199, P = 0.001), and AoCKD (HR = 5.377, 95%CI was 1.303-22.186, P = 0.020) were independent risk factors for ICU death within 28 days.CONCLUSIONS:Further detailed classification (PAKI, AoCKD) based on KDIGO-AKISCr standard combined with eGFR is related to ICU mortality in critical patients within 28 days.

目的 探讨急性自发性脑出血患者(ICH)血清基质金属蛋白酶9(MMP-9)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肌糖蛋白-C(TNC)、肿瘤坏死因子α(TNF-α)水平,分析血清指标与脑水肿体积及预后的关系.方法 选取自2017年1月至2018年12月收治的112例ICH患者为观察组,选取同期体检的112例健康者为健康组.采用酶联免疫吸附实验(ELISA)检测血清MMP-9、NGAL、TNC、TNF-α及血生化指标水平.治疗后第7、14天行头颅CT测量脑水肿体积变化.根据治疗后3个月的改良Rankin量表评分(mRS)对观察组患者进行神经功能预后评定,并将患者分为预后良好组(mRS≤2分)与预后不良组(mRS≥3分).采用单因素及多因素Logistic回归分析MMP-9、NGAL、TNC、TNF-α水平与脑水肿发生及预后的关系.结果 观察组患者血清MMP-9、NGAL、TNC、TNF-α水平均高于健康组,差异有统计学意义(P<0.05).血清MMP-9、NGAL、TNC、TNF-α截断值分别为155.9 ng/ml[受试者工作特征曲线下面积(AUC)=0.912,95％可信区间0.874～0.949)]、307 ng/ml(AUC=0.875,95％可信区间0.826～0.925)、43.7 pg/ml(AUC=0.854,95％可信区间0.799～0.910)、105.4 pg/ml(AUC=0.848,95％可信区间0.798～0.897).治疗前、治疗后7 d及治疗后14 d,TMMP-9、NGAL、TNC、TNF-α高水平组患者脑水肿体积均大于低水平组,差异均有统计学意义(P<0.05).患者血清MMP-9、NGAL、TNC、TNF-α水平增高,NIHSS评分以及CPR水平是ICH患者预后不良的独立危险因素(P<0.05).结论 ICH患者MMP-9、NGAL、TNC、TNF-α表达明显升高,与脑水肿扩大及预后不良相关.

目的:研究心型脂肪酸结合蛋白在内毒素致大鼠心肌损伤中的动态变化及其规律,为临床脓毒症心肌损伤的诊断及心功能评估提供动物实验的依据.方法:将雄性Wistar大鼠随机分组:正常对照组、内毒素组.内毒素组:腹腔注射LPS(10mg/kg,用2mLnS溶解)后,正常对照组:腹腔注射同等剂量生理盐水.于3h、6h、12h、24h、48h眼球后静脉丛取血,测量血清中心型脂肪酸结合蛋白(H-FABP)、肌钙蛋白T(cTnT)、心型肌酸激酶(CK-MB)、脑钠肽(BnP)含量.结果:(1)H-FABP:与正常对照组相比,内毒素各组的H-FABP含量明显升高,其中H-FABP含量在3h升高,6h达到高峰,12h出现快速下降,48h下降幅度减少(P<0.01);(2)cTnT:与正常对照组相比,cTnT在6h明显升高,12h达到高峰,24h有所下降,48h仍保持较高浓度(P<0.01);(3)CK-MB:与正常对照组相比,CK-MB在6h明显升高,12h达到高峰,48h保持在较高浓度(P<0.01);(4)BnP:与正常对照组相比,内毒素各组BnP明显升高,并随时间推移,呈上升趋势(P<0.01).结论:血清H-FABP可作为诊断内毒素心肌损伤的早期生物标记物之一,并与cTnT和CK-MB相结合,能更好的发现内毒素的心肌损伤及严重程度.

目的 探讨全程健康教育模式在小儿糖尿病中的应用价值.方法 以该科2017年5月—2018年12月收治的74例糖尿病患儿进行研究,按照护理干预方案分为基础护理+全程健康教育模式干预的观察组,与单纯基础护理的对照组,各37例.结果 两组的空腹血糖值、糖化血红蛋白值、总胆固醇、甘油三酯、低密度酯蛋白等实验室指标值差异有统计学意义(P<0.05);观察组护理干预后的血糖值与糖化血红蛋白恢复正常的持续时间均优于对照组(P<0.05);观察组的糖尿病相关并发症(心血管、视网膜、肾脏、神经病变)的发生率明显低于对照组(P<0.05).结论 全程健康教育模式对小儿糖尿病的血糖控制具有积极影响价值,值得推广应用.

Objective To investigate nutritional treatment in the intensive care unit (ICU) of the mainland China. Methods A cross-sectional study was conducted in 116 ICUs of 118 mainland hospitals on April 26th, 2017. All patients of these ICUs were investigated at 0 o'clock on April 26th. Demographic and clinical parameters of those patients on April 25th (the investigation day) were recorded, including the dates of hospitalization, ICU admission and nutrition initiation and clinical outcome on 28 days after the investigation day. Results A total of 1953 patients were collected, including 631 females and 1306 males. The mean age was (64.1±19.3) years old (1950 cases). The means of Glasgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) scores were (10.76±4.35)(1749 cases), (5.65±3.52)(1783 cases), (17.14±7.31)(1792 cases), respectively. The outcomes of 28 days after the investigation day were 1483 survivors (75.9%), 312 non-survivors (16.0%) and 158 cases (8.1%) being lost to follow-up. There were no significant differences between the males and the females in age, severity of disease and clinical outcomes of 28 days but in height and weight. There were 73.7%(1440 cases) of patients with normal or mildly injured gastrointestinal function, 10.8%(210 cases) with moderately or severely injured function, 1.7%(33 cases) with gastrointestinal failure and 13.2%(258 cases) without evaluation. To the investigation day, enteral nutrition (EN) had been initiated in 69.4%(1356 cases) of patients and parenteral nutrition (PN) in 36.4%(711 cases) of patients. There were 1720(88.1%) patients with EN administration on the investigation day. The proportion of patients with nausea, vomit/regurgitation, aspiration, abdominal pain, abdominal distention and diarrhea was 4.8%(93 cases), 5.4%(105 cases), 0.9%(17 cases), 8.7%(170 cases), 27.5%(538 cases) and 4.3%(84 cases) respectively, while that of patients using EN was 3.1%(40 cases), 4.25%(54 cases), 0.79%(10 cases), 4.41%(56 cases), 26.85%(341 cases) and 5.43%(69 cases) correspondingly. The proportion of cases starting EN within 24, 48 and 72 hours after ICU entry was 22.4%(437/1953), 38.6%(754/1953) and 46.6%(911/1953), respectively. The proportion of cases receiving ≥80% estimated energy target (=past body weight ×25 kcal/kg.d) within 3, 7 and 14 days after ICU entry was 12.9%(78/607), 18.7%(189/1010) and 23%(305/1325) respectively, while that of cases with EN was 9.9%(60/607), 15.0%(151/1010) and 18.6%(246/1325) correspondingly. Conclusions Nowadays, most of patients in the mainland ICUs receive nutrition therapy and the EN usage rate is much higher than the PN rate. However, the time of EN initiation and the target-reaching rate of energy are suboptimal and an individualized plan of nutrition therapy is still missing. Details of energy delivery still need to be improved. DOI: 10.11855/j.issn.0577-7402.2019.05.05

目的:探讨临床护理路径在小儿腹泻护理中应用的效果.方法:按随机数字表法将2017年9月-2018年3月符合条件的90例急性腹泻患儿分为对照组和试验组,对照组进行传统常规护理,试验组采用临床护理路径.比较两组在腹泻缓解率、住院时间、患儿配合程度、焦虑状态、进食情况、家长对护理服务满意度的差异.结果:试验组患儿腹泻缓解总有效率、腹泻病程、住院时间、护理过程患儿的配合程度、焦虑状态、进食情况、家长的护理服务满意度均优于对照组(P<0.05).结论:临床护理路径可提高小儿腹泻的临床疗效,提升患儿的护理配合度,缓解其焦虑情绪,改善其进食情况,缩短住院时间,患儿家长满意度高.

目的:探讨血清亲环素B(CypB)在早期胃癌病人中的改变及辅助诊断价值,以期为早期胃癌的临床诊疗提供参考.方法:纳入49例早期胃癌病人为观察组.另纳入同期健康体检者45名作为对照组.采用酶联免疫吸附法检测2组外周血血清CypB、癌胚抗原(CEA)及糖类抗原-199(CA-199)水平,并分析各指标在早期胃癌病人中的诊断价值,以及早期胃癌病人外周血CypB水平与CEA及CA-199的相关性.结果:观察组病人外周血血清CypB、CEA及CA-199水平均明显高于对照组(P<0.01);观察组病人外周血血清CypB水平与CEA及CA-199均呈明显正相关关系(P<0.05);ROC曲线分析显示,以4.030 ng/mL为截点值,CypB诊断早期胃癌的敏感性为76.36％,特异性为75.51％,曲线下面积为0.766,诊断效能优于CEA及CA-199.结论:早期胃癌病人外周血血清CypB水平升高,对辅助诊断具有一定价值.

There is a lack of large-scale epidemiological data on the clinical practice of enteral nutrition (EN) feeding in China. This study aimed to provide such data on Chinese hospitals and to investigate factors associated with EN delivery.

Objective To discuss the influence of ulinastatin on cell apoptosis mediated by mitochondrial pathways in endotoxic myocardial injury rats.Methods A total of 24 male Wistar rats were randomly divided into three groups:the control group,the endotoxin group and the ulinastatin group,8 rats in each group.Rats in the endotoxin group and ulinastatin group both received 10 mg/kg lipopolysaccharide by intraperitoneal injection,and rats in the ulinastatin group were given 20 000 U/kg ulinastatin 1 h after injection.Rats in the control group only injected equal dose saline at the same time.The pathological changes of myocardial tissues were observed.The serum troponin T (cTnT),and brain natriuretic peptide (BNP) levels were detected by enzyme-linked immunosorbent assay,and the myocardial cell apoptosis index was calculated.The expressions of Bcl-2,Bax,CytC,Caspases-3 proteins in myocardial cell were also determined by immunohistochemistry.Results Rats in the endotoxin group had severe myocardial tissue damage,while rats in the ulinastatin group had a slightly myocardial tissue damage.The levels of cTnT,BNP all showed significantly differences among these three groups (F=69.217,18.250;all P＜ 0.05);the cTnT expressions [(20.3 ± 1.0),(18.7 ± 1.3),(12.2 ± 1.0) μg / L]and BNP expressions [(26.6 ± 1.4),(23.0 ± 2.4),(17.0 ± 1.6)pg/L] in the endotoxin and ulinastatin groups were much higher than those in the control group,and were highest in the endotoxin group (all P ＜ 0.05).The myocardial cell apoptosis index in the ulinastatin group was much lower than that in the endotoxin group [(19.8 ± 1.7)％ vs.(22.6 ± 1.2)％,t =3.675,P =0.020].Meanwhile,the expression of Bcl-2 in the endotoxin and ulinastatin groups was much higher than that in the control group [(80.3 ± 3.8),(76.6 ± 2.90),(49.6 ± 3.9)],and was highest in the endotoxin group (all P ＜ 0.05);the expressions of Bax [(70.8 ± 1.7),(80.0 ± 4.8),(99.7 ± 5.6)],CytC [(120 ± 5),(132 ± 3),(151 ± 7)] and Caspases-3 [(108.8 ± 4.0),(113.9 ± 5.2),(157.2 ± 2.5)] in the endotoxin and ulinastatin groups were lower than those in the control group,and were lowest in the endotoxin group (all P ＜ 0.05).Conclusion Ulinastatin may reduce the occurrence of myocardial cell apoptosis by inhibiting the activation of mitochondrial pathways,and plays a certain protective role on endotoxic myocardial injury.