BackgroundSepsis-induced cardiomyopathy (SIC), a major complication of sepsis characterized by myocardial injury and cardiac dysfunction, significantly increases mortality. Inflammation plays a central role in SIC, yet specific biomarkers for early diagnosis remain limited. This study aimed to identify inflammatory cytokines associated with SIC and evaluate their diagnostic potential.MethodsSerum levels of 40 immune-related cytokines were measured in 25 SIC patients, 25 sepsis patients, and 10 healthy controls using antibody microarrays. Correlation analysis examined associations between cytokines and clinical parameters, while Receiver operating characteristic (ROC) curves and logistic regression assessed their predictive accuracy for myocardial dysfunction.ResultsUrokinase-type plasminogen activator receptor (uPAR) was found to be significantly elevated in SIC patients compared to sepsis patients and healthy controls. Furthermore, uPAR levels were found to significantly and positively correlated with Acute Physiology and Chronic Health Evaluation II (APACHE II) score, sequential organ failure assessment score (SOFA), B-type natriuretic peptide (BNP), as well as the use and duration of vasopressor therapy, and negatively correlated with fraction of shortening (FS). ROC curve analysis showed that the predictive value of uPAR was inferior to that of BNP, cardiac troponin I (cTnI), and FS; while superior to that of left ventricular end-diastolic dimension (LVEDD). Logistic regression analysis showed that uPAR significantly affected the occurrence of myocardial dysfunction.ConclusionOur study suggests that uPAR may serve as a candidate biomarker associated with SIC. Combining uPAR with other markers could enhance diagnostic accuracy. Additionally, uPAR levels may be associated with vasopressor use in SIC patients.

BACKGROUND:Sepsis patients have a high mortality rate and are frequently anemic. The importance of early detection and blood transfusion treatment cannot be overstated. OBJECTIVE:A systematic review and meta-analysis of published literature was conducted to evaluate the association between hemoglobin and the prognosis of patients with sepsis. METHODS:The PubMed, Embase, Cochrane Library and Chinese Biomedical Literature (CBM) databases were searched from inception to May 21, 2023. Pediatric patients were excluded, and there were no language restrictions. A random effects model was used to calculate pooled odds ratios to assess the relationship between hemoglobin and prognosis in sepsis. RESULTS:There were 110,004 patients included in 9 studies, of which 51,568 had a poor prognosis. The results of univariate and multivariate analyzes showed that hemoglobin was associated with the prognosis of patients with sepsis (univariate OR: 1.35, 95 % confidence interval (CI): 1.16-1.58; multivariate OR: 1.26, 95 % CI: 1.13-1.40). Dose-response meta-analysis showed that there was a nonlinear relationship between hemoglobin level and prognosis in patients with sepsis. CONCLUSION:The level of hemoglobin at admission is related to the prognosis of patients with sepsis, and decreases in hemoglobin level are associated with an increase in the mortality rate of patients with sepsis. Therefore, early transfusion of red blood cells should be performed in patients with sepsis, and early attention should be given to anemia in patients with sepsis. However, more robust studies are needed to further determine the level of early hemoglobin maintenance in patients with sepsis.

脓毒症病死率在全球高居不下,常诱发非感染器官发生功能障碍,心肌损伤是脓毒症最严重的并发症之一,其病理机制复杂,尚无特异性疗法.中医药属"厥脱""热毒""喘证"等病证范畴.中医药在脓毒症治疗中发挥重要作用,脓毒症心肌病目前尚缺乏系统的中医辨证论治及理法方药整理小结.文章基于热毒证及清热解毒法、血瘀证及活血化瘀法、腑气不通证及通里攻下法及急性虚证及扶正固脱法的"四证四法"辨治思路,整理经典文献、现代中医专家认识、基础及临床实验证据,对中医药治疗脓毒症心肌病的辨证、中药汤剂及中药注射剂的研究进展进行阐述.

目的 探索中医药治疗脓毒症相关急性呼吸窘迫综合征的用药规律.方法 检索中国知网、万方数据库、维普中文期刊数据库、Web of Science、PubMed从建库以来至2022年4月30日关于中医药治疗脓毒症相关急性呼吸窘迫综合征的相关文献,并建立Excel数据库,利用SPSS Modeler 18.0和SPSS Statistics28软件对其进行用药频次统计、四气五味归经分析、药物关联规则分析以及聚类分析.结果 共纳入36篇文献,83味中药,其中用药频次前10位为大黄、厚朴、芒硝、枳实、苦杏仁、黄芩、瓜蒌、桃仁、甘草、石膏;功效使用频次前3位为清热药、泻下药、补虚药;四气多寒、温,五味多苦、甘、辛,归经多属肺、心、肝经;药物关联规则分析前5项组合分别为枳实-厚朴,大黄-厚朴,枳实-厚朴、大黄,大黄-苦杏仁,大黄-芒硝;高频药物进行聚类分析得到3组药物组合.结论 中医药治疗脓毒症相关急性呼吸窘迫综合征,治宜通腑泄热、活血解毒、止咳平喘,同时兼以扶正祛邪,标本兼治,关键药物为大黄.

ABSTRACT Sepsis-induced myocardial dysfunction (SIMD) contributes significantly to cardiovascular dysfunction during septic shock. We aimed to evaluate the potential role of Xinmailong injection (XMLI), a polypeptide medicine extracted from Periplaneta americana, in reversing the progression of myocardial damage to SIMD in sepsis patients. This was a multicenter, randomized, double-blind, parallel-group trial. We recruited all patients consecutively admitted to intensive care units (ICUs) who were aged 18 to 85 years old and met the sepsis 3.0 criteria. The primary outcome measure was the incidence of sepsis-induced myocardial dysfunction while in the ICU. Of the 192 patients, 96 were assigned to the treatment group, and 96 to the control group. Subsequently, 41 patients [41/96 (42.7%)] in the XMLI group and 61 patients in the placebo group [61/96 (63.5%)] were confirmed to have diastolic dysfunction on the fifth day (D5). The incidence of diastolic SIMD was significantly different between the two groups (P = 0.004). There were 36 deaths in the two groups during the 28-day follow-up, with a general mortality rate of 18.8% (36/192). The 28-day mortality rates were not significantly different between the groups (P = 0.45). However, the brain natriuretic peptide (BNP) plasma concentration trends on D0, D2, and D5 significantly differed between the two groups (P = 0.049). In septic patients, XMLI decreased the occurrence rate of diastolic SIMD more effectively than the placebo. The improvement in serum BNP concentration was also greater in the XMLI group. XMLI may, therefore, effectively and safely improve cardiac function in patients with sepsis.

中医药防治传染病具有数千年的历史,构建了较为完整的理论体系,积累了丰富的临床经验.认为新型冠状病毒肺炎(简称新冠肺炎)属于中医学“疫病”之“湿温”范畴.在总结前人疫病治疗经验的基础上,结合新冠肺炎中医临床特征及临床实践,提出基于“急性虚证”的新冠肺炎病机理论,并倡导“全程补虚”的新冠肺炎中医药治疗策略,针对轻症(无肺炎)、普通型(有肺炎)、危重症、恢复期四个阶段,分别采用补气化秽、培元截断、扶元救逆及益气养阴、降气平喘、活血化瘀之法,可为临床防治新冠肺炎提供思路.

中西医结合医学是中国特有的医学模式,现已成为我国主要的医疗保健力量.回顾中西医结合六十年,在临床、科研以及人才培养方面取得突出成就,为国家医疗事业发展做出重要贡献.本文总结既往中西医结合发展经验与不足,认为要防止中医西化,坚持中西医结合,加速发展创新.

PURPOSE:The purpose of this study was to examine the effects of Baduanjin sequential therapy (BST) on the quality of life and cardiac function in patients with AMI after PCI.SUBJECTS:96 patients with AMI after PCI were randomly assigned as subjects to two groups: BST group who received 24 weeks of BST training and control group who received no training.METHODS:The methods used in this study included the changes in SF-36 subscales, the measures of left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), the body mass index (BMI), and the abdominal circumference.RESULTS:Of the 96 participants, 82 total patients completed the entire study. At 12 weeks, role physical and health transition of SF-36 were significantly different between the two groups, with a difference of 26.12 (95% CI, 11.59 to 40.64) in role physical and a difference of 15.94 (95% CI, 5.60 to 26.28) in health transition (p < 0.05). However, there were statistically significant differences in all aspects of SF-36 between the two groups at 24 weeks (p < 0.05). The BST also lowered abdominal circumference and BMI as compared with the control group. In the 24-week follow-up, a significant difference was found in the decline of the LVEF in the control group (p=0.020), while there was a nonsignificant difference in the BST group (p=0.552). Compared with the control group, the BST group reduced 50 pg/ml on the NT-pro-BNP at 24 weeks (p=0.013). The effects of BST exercise were maintained at 24 weeks after the intervention. No serious adverse events were observed.CONCLUSIONS:The BST appears to improve the quality of life in patients with AMI after PCI, with additional benefits of lowered abdominal circumference and BMI and improved level of cardiac function. This trial is registered with NCT02693795.

探讨“扶正祛邪、截断扭转”论治新型冠状病毒肺炎(COVID-19)及并发脓毒症的科学依据.新型冠状病毒感染所引发的炎性反应是COVID-19患者主要的病理改变,特别是后期危重患者多并发脓毒症.中医药治疗脓毒症具有潜在优势,其中扶正祛邪是COVID-19治疗的主要治则,截断扭转疗法由著名中医学家姜春华提出,并由“岐黄学者”方邦江教授等用于治疗脓毒症,取得较好临床疗效.故建议COVID-19并发脓毒症患者早期运用“扶正祛邪、截断扭转”治法,并可进一步开展大型临床研究验证其效果.

Acute myocardial infarction (AMI) is a serious type of coronary artery disease (CAD) with the potential for substantial morbidity and mortalit. Percutaneous coronary intervention (PCI) is an effective treatment. However, most patients still suffer from angina pectoris, anxiety, depression and reduced cardiac function after PCI. The purpose of this study was to examine the effects of Baduanjin sequential therapy (BST) on the quality of life and cardiac function in patients with AMI after PCI. The study was a randomized controlled trial. Patients with AMI after PCI randomly assigned to a BST group (N = 48) or a control group (N = 48). The BST exercise consists of the sitting and standing forms. The sitting Baduanjin was conducted twice a day in the hospital, for 30 min/session. After the patient was discharged from the hospital, the standing Baduanjin was performed fifth weekly, lasting up to 24-weeks, for 30 min/session. The control group received usual care without Baduanjin. The primary outcomes were the changes of SF-36 subscales. Secondary outcomes included measures of left ventricular ejection fraction(LVEF), N-terminal pro B-type natriuretic peptide (NT-pro-BNP), the Body Mass Index (BMI) and the abdominal circumference. Of the 96 participants, 82 total patients completed the entire study. At 12 weeks, Role Physical and Health Transition of SF-36 were significantly different between the two groups, with a difference of 26.12 [95% CI, 11.59 to 40.64] in Role physical and a difference of 15.94 [95% CI, 5.60 to 26.28] in Health Transition (p<0.05). However, there were statistically significant differences in all aspects of SF-36 between the two groups at 24 weeks (p<0.05). The BST also lowered the abdominal circumference and BMI as compared with control group. In the 24-week follow-up, a significant difference was found in the decline of the LVEF in control group (p=0.020),while there was non-significant difference in the BST group (p=0.552). Compared with control group, the BST group reduced 50pg/ml on the NT-Pro-BNP at 24 weeks(p=0.013). The effects of BST exercise were maintained at 24weeks after the intervention. No serious adverse events were observed. The BST appears to improve the quality of life in patients with AMI, with additional benefits of lowered the abdominal circumference and BMI and improved the level of cardiac function. Clinical Trials.gov:NCT02693795. https://clinicaltrials.gov/ct2/ show/NCT02693795?term=NCT02693795&rank=1.

目的:观察化瘀解毒法对脓毒症休克患者血流动力学障碍的影响.方法:前瞻性研究纳入脓毒症休克患者共66例,随机分为化瘀解毒组35例与对照组31例.对照组按照2012年指南进行进行常规治疗;化瘀解毒组在指南治疗的基础上加用血必净注射液治疗.观察记录2组患者C-反应蛋白(CPR)、降钙素原(PCT)、血乳酸(LAC);对PiCCO监测的患者,记录血流动力学指标、去甲肾上腺素的用量;记录2组患者凝血功能,患者28天生存率.结果:治疗第5天,化瘀解毒组SOFA评分明显小于对照组,化瘀解毒组CRP水平呈下降趋势,对照组呈上升趋势,2组间比较,差异有统计学意义(P＜0.05).治疗5天后,化瘀解毒组活化部分凝血活酶时间(APTT)下降,对照组APTT升高,2组间比较,差异有统计学意义(P＜0.05).化瘀解毒组28天生存率85.7％,高于对照组57.7％,差异有统计学意义(P＜0.05).2组在4h、12h、24 h、48 h、72 h和5天时去甲肾上腺素用量方面比较,差异无统计学意义(P＞0.05).治疗第5天,2组PCT、LAC水平、凝血指标血小板计数(BPC)、凝血酶原时间(PT)、纤维蛋白原(FIB)比较,差异均无统计学意义(P＞0.05).因病情需要,15例脓毒症休克患者采用PiCCO监测,其中化瘀解毒组10例,对照组5例.化瘀解毒组与对照组相比较,2组在治疗前、24 h、48 h外周循环阻力(SVR)、外周循环阻力指数(SVRI)方面比较,差异均无统计学意义(P＞0.05).结论:化瘀解毒法能够提高患者的28天生存率,在改善血流动力学、减少血管活性药物使用方面有一定意义,且不增加出血风险.

目的 了解分析全国中医医院重症医学科发展现状及趋势,为提高全国中医/中西医结合重症医学学科水平提供方向.方法 采用表格问卷调查形式,收集分析全国三级甲等(三甲)中医医院重症医学科的资料,进行排位分析.结果 共调查了全国90家大型三甲中医医院,重症加强治疗病房(ICU)平均床位数为(22.0±15.4)张,占医院总床位数的1.75％.所统计的医院中ICU平均数量为(2.2±1.6)个,95.6％设有综合ICU,54.4％设有专科ICU.床旁多功能持续心电监护仪、有创呼吸机、无创呼吸机、血液净化仪平均数与ICU平均床位数比值分别为1.15、0.69、0.16与0.10.ICU医师和护士配置平均人数与ICU床位数比值分别为0.65和1.70.大多数中医医院ICU能够独立开展常见器官功能监测及功能支持.结论 我国三甲中医医院重症医学科发展日趋完善,尤其在性质、管理、技术及设备配置上符合相关指南要求,但ICU床占比、人员配备仍需进一步加强.

Objective To observe the protective effects of Xuebijing injection (XBJ) on the myocardium and serum nuclear factor-κB (NF-κB) expressions, endothelin-1 (ET-1), von Willebrand factor (vWF) and endothelial nitric oxide synthase (eNOS) in rats with sepsis,and to investigate the protection of cardiac dysfunction.Methods Forty-two male Sprage-Dawely (SD) rats were divided randomLy into sham group (n=6),CLP group (n=18) and XBJ group (n=18).The animal models of sepsis were induced by cecal ligation and puncture (CLP) and XBJ was given by intraperitoneal injection.Heart rate, cardiac function such as left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), intact ventricular septum (IVS) activity were observed.The histopathological changes were observed by Hematoxylin-Eosin (HE) staining.The levels of serum ET-1, vWF, eNOS and NF-κB were measured by enzyme-linked immunosorbent assay (ELISA).The expression of NF-κB in cardiac tissue was detected by immunohistochemical staining.Results After 24 hours of modeling, compared with sham group, the heart rate,LVESD and LVEDD increased while IVS activities degree decreased in CLP group (P<0.05).The heart rate increased while LVEF decreased in XBJ group (P<0.05).Compared with 24 hours,the heart rate decreased in 48 hours in CLP group (P<0.05).Compared with CLP group, the heart rate,LVESD decreased while LVEF and IVS activity increased in XBJ group in 24 hours and 48 hours (P<0.05).After 24 hours of modeling, compared with sham group,the levels of serum ET-1 and vWF increased while eNOS level decreased in CLP group(P<0.05).The levels of serum ET-1 and vWF in XBJ group were lower than that in CLP group(P<0.05) while eNOS level in XBJ group was higher than that in CLP group(P<0.05).After 48 hours of modeling, ET-1 level in XBJ group was lower than that in CLP group(P<0.05).After 24 hours of modeling, compared with sham group, serum NF-κB level increased in CLP and XBJ group (P<0.05) ,which was lower in XBJ group than that in CLP group(P<0.05).The rate of NF-κB positive cells in CLP group was higher than that in sham group(P<0.05),whilewas lower in XBJ group than that in CLP group (P<0.05).Conclusion XBJ could improve cardiac and endothelial function in CLP rats,which might be through the intervention of NF-κB pathway,decreasing the expression of NF-κB,thereby increasing the expression of eNOS,reducing the endothelial damage.

Background: Severe sepsis in elderly is a serious problem. Elderlies are more vulnerable to sepsis than adults due to their hypoimmunity, coagulation abnormalities and organ dysfunction. Acute pyelonephritis (APN) with obstructive uropathy is not uncommon and often causes severe sepsis and septic shock. Acute obstructive pyelonephritis sometimes requires emergency drainage via a ureteral stent or percutaneous nephrostomy. Acupuncture has been proved as an alternative method for renal colic pain control and maybe a potential organ protection function in sepsis. Case report: We report a case of a 104-year-old female centenarian with severe sepsis induced by acute obstructive pyelonephritis. The initial clinical manifestation in the case was atypical, which was misdiagnosed as acute heart failure and pneumonia. The centenarian underwent percutaneous nephrostomy, electro-acupuncture treatment, anti-infective therapy and mechanical ventilation. The patient was achieved successful treatment and discharged from hospital with no sequel. Conclusions: To date, no clinical case report of this nature has been described implicating centenarian with severe sepsis induced by APN. Patient hiding illness state made diagnosis more difficult. The effect of combination traditional Chinese and western medicine was satisfactory, experience was worth reference to improve the diagnosis and treatment of severe sepsis in elderly patients.

To observe the effects of Xinmailong injection on the cardiac function and extravascular lung water in patients with acute heart failure. 43 AHF patients were randomly divided into the Xinmailong treatment group(n=20) and the control group(n=23). The two groups were both given routine treatment of

OBJECTIVE:To observe hemodynamic characteristics and the correlation with syndrome types of traditional Chinese medicine (TCM) in patients with septic shock, so as to direct the treatment based on syndrome differentiation. METHODS:A prospective observation was conducted. Sixty-eight patients with septic shock admitted to the Department of Critical Care Medicine of Dade Road General Hospital of Guangdong Hospital of TCM from January 2013 to July 2015 were enrolled. Pulse indicating continuous cardiac output (PiCCO) was used to monitor the hemodynamic changes, including heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), cardiac index (CI), global end diastolic volume index (GEDVI), extravascular lung water index (EVLWI), maximum rate of the increase in pressure (dPmax) and systemic vascular resistance index (SVRI), for assessment of hemodynamics. According to the CI, the patients were divided into two groups , i.e. high CI group (CI ≥ 50.0 mL×s(-1)×m(-2), n = 34) and low CI group (CI < 50.0 mL×s(-1)×m(-2), n = 34), and the clinical and hemodynamic characteristics of two groups were investigated. The TCM differentiation was conducted with "four syndromes and four methods", and the hemodynamic characteristics of different syndrome types were investigated, the correlation between the TCM syndrome factors and hemodynamic parameters was analyzed. The patients were divided into survival group and death group, and clinical parameters and hemodynamic characteristics were compared between two groups. RESULTS:The acute physiology and chronic health evaluation II (APACHEII) score and blood glucose of low CI group were higher than those of high CI group [APACHEII score: 24.4±7.2 vs. 19.8±7.4, t = -2.279, P = 0.023; blood glucose (mmol/L): 9.7 (7.7, 14.6) vs. 6.7 (5.6, 10.0), Z = -2.257, P = 0.024], CI and GEDVI were lowered [CI (mL×s(-1)×m(-2)): 36.7±8.3 vs. 68.4±16.7, t = 10.285, P = 0.000; GEDVI (mL/m(2)): 689.0 (566.0, 883.8) vs. 838.5 (692.8, 1?247.3), Z = -2.711, P = 0.007], while SVRI was increased [kPa×s×L(-1)×m(-2): 248.7 (202.1, 324.5) vs. 143.4 (102.7, 171.4), Z = -5.336, P = 0.000]. Accompanied symptoms were found to occur more commonly in septic shock patients, and the most common syndrome elements were Qi deficiency syndrome (n = 45), blood stasis syndrome (n = 40), heat-toxin syndrome (n = 37), Fushi syndrome (n = 24) and Yin deficiency syndrome (n = 10), respectively. There was no significant difference in hemodynamic parameters among patients with five types of syndrome (all P > 0.05). However, only the CI of those with Qi deficiency syndrome was significantly lower than that of heat-toxin syndrome (mL×s(-1)×m(-2): 48.3±18.3 vs. 53.3±21.7, P < 0.05). While the results after removing the effect of accompanied symptoms showed that CI of Qi deficiency syndrome was significantly lower than that of non-Qi deficiency syndrome (mL×s(-1)×m(-2): 48.3±18.3 vs. 61.7±21.7, t = -2.783, P = 0.007), CI of heat-toxin syndrome was significantly higher than that of non-heat-toxin syndrome (mL×s(-1)×m(-2): 58.3±21.7 vs. 48.3±16.7, t = 2.133, P = 0.037), EVLWI of blood stasis syndrome was significantly lower than that of non-blood stasis syndrome [mL/kg: 10.0 (7.0, 15.1) vs. 14.9 (8.5, 26.8), Z = -2.075, P = 0.038]. Compared with survival group (n = 38), APACHEII score in death group (n = 30) was increased (25.8±8.4 vs. 19.1±5.4, t = -3.940, P = 0.000), the proportion of continuous renal replacement therapy (CRRT) was increased [60.0% (18/30) vs. 31.6% (12/38), χ (2) = 5.493, P = 0.019], HR was increased (bpm: 118.5±20.5 vs. 98.1±19.9, t = -4.157, P = 0.000), and the proportion of Qi deficiency syndrome was increased [86.7% (26/30) vs. 50.0% (19/38), χ (2) = 10.070, P = 0.002]. CONCLUSIONS:Patients with sepsis shock may be divided into high-output and low-resistance and low-output and high-resistance groups according to hemodynamics, with respective hemodynamic characteristics. Hemodynamic performance differed among different syndrome types, and there was a certain relationship. Hemodynamic monitoring with PiCCO was a useful supplement of TCM, which was good for the evidence-based medicine.

OBJECTIVE:To investigate the effects of Xuebijing injection on hemodynamics, cardiac function, and endothelial function in patients with severe sepsis in order to study the therapeutic effect of Xuebijing in the treatment of severe sepsis. METHODS:A prospective randomized controlled trial was conducted. Sixty-six severe sepsis patients admitted to the Department of Critical Care Medicine of Guangdong Hospital of Traditional Chinese Medicine from March 2013 to February 2014 were enrolled. The patients were divided into control group (n = 31) and Xuebijing group (n = 35). The patients in both groups were treated according to "2012 international guidelines for management of severe sepsis and septic shock", and the patients in Xuebijing group received Xuebijing injection of 50 mL(added with 100 mL of 0.9% sodium chloride injection) twice a day for 5 days, and those in control group received instead 150 mL of 0.9% sodium chloride injection for 5 days. The heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), and dosage of vasoactive drugs before and 1 day and 5 days after treatment were determined for hemodynamics assessment. Blood lactic acid (Lac), central venous oxygen saturation (ScvO2), and difference in arterial-venous blood carbon dioxide pressure (Pv-aCO2) were determined for microcirculation assessment. The left ventricular ejection fraction (LVEF), cardiac output (CO), left ventricular end diastolic diameter (LVEDD), the ratio of blood flow of mitral orifice between rapid filling period and atrial systole period (E/A), and B-type natriuretic peptide (BNP) were determined for cardiac function assessment. Vascular endothelial growth factor (VEGF) and soluble receptor (sFLT-1) were assessed for endothelial function assessment. The relationship among the indexes of the hemodynamics, microcirculation, cardiac function, and endothelial function was analyzed with Pearson related-analysis. RESULTS:After treatment, HR, MAP, CVP, Lac, ScvO2, and Pv-aCO2 were improved in both groups compared with those before treatment, and the dosage of norepinephrine (NE) was decreased in Xuebijing group. Compared with control group, MAP at 5 days after treatment in Xuebijing group was significantly increased [mmHg (1 mmHg = 0.133 kPa): 74.9±10.7 vs. 70.2±6.6, P < 0.05], the dosage of NE was decreased [μg×kg-1×min-1: 0.01 (0.00, 0.22) vs. 0.10 (0.05, 0.80), P < 0.05], LVEF was significantly increased (0.617±0.125 vs. 0.533±0.129, P < 0.05), BNP was significantly decreased [ng/L: 117.3 (52.0, 443.0) vs. 277.2 (67.9, 2 370.2), P < 0.05], while VEGF showed no significant change (ng/L: 101.1±23.2 vs. 89.6±20.5, P > 0.05), and sFLT-1 was significantly decreased (ng/L: 245.7±86.2 vs. 295.1±95.1, P < 0.05). It was shown by Pearson coefficient bivariate correlation analysis that sFLT-1 was negatively correlated with MAP and ScvO2 (r = -0.569, P = 0.000; r = -0.341, P = 0.008) 5 days after treatment, while it was positively associated with Lac and acute physiology and chronic health evaluation II (APACHE II) score (r = 0.749, P = 0.000; r = 0.645, P = 0.000). CONCLUSIONS:After treatment, HR, MAP, CVP, Lac, ScvO2, and Pv-aCO2 were improved in both groups compared with those before treatment, and the dosage of norepinephrine (NE) was decreased in Xuebijing group. Compared with control group, MAP at 5 days after treatment in Xuebijing group was significantly increased [mmHg (1 mmHg = 0.133 kPa): 74.9±10.7 vs. 70.2±6.6, P < 0.05], the dosage of NE was decreased [μg×kg-1×min-1: 0.01 (0.00, 0.22) vs. 0.10 (0.05, 0.80), P < 0.05], LVEF was significantly increased (0.617±0.125 vs. 0.533±0.129, P < 0.05), BNP was significantly decreased [ng/L: 117.3 (52.0, 443.0) vs. 277.2 (67.9, 2 370.2), P < 0.05], while VEGF showed no significant change (ng/L: 101.1±23.2 vs. 89.6±20.5, P > 0.05), and sFLT-1 was significantly decreased (ng/L: 245.7±86.2 vs. 295.1±95.1, P < 0.05). It was shown by Pearson coefficient bivariate correlation analysis that sFLT-1 was negatively correlated with MAP and ScvO2 (r = -0.569, P = 0.000; r = -0.341, P = 0.008) 5 days after treatment, while it was positively associated with Lac and acute physiology and chronic health evaluation II (APACHE II) score (r = 0.749, P = 0.000; r = 0.645, P = 0.000).

通常临床上危重患者肺脏是否发生病理变化，需将患者搬运至放射科行CT等影像学检查，即使进行床旁X线检查也过程繁琐，这对早期判断患者病情、减少转运风险提出了挑战。近年来超声技术在急诊室及重症加强治疗病房（ICU）中的应用越来越广泛，床旁超声因其直观、快捷、准确等特点，被医生形象地比喻为“看得见的听诊器”，已被国外发达国家和地区的ICU、麻醉科和急诊科等科室作为重症患者监测和评估的常规工具［1-6］。

OBJECTIVE:To observe the effect of purgation and detoxification therapy on gastrointestinal dysfunction of critically ill patients undergoing abdominal surgery. METHODS:Totally 56 inpatients with severe gastrointestinal dysfunction after abdominal surgery at ICU of Guangdong Provincial Hospital of Traditional Chinese Medicine were assigned to the treatment group and the control group, 28 in each group. All patients received routine Western medical treatment. Patients in the treatment group additionally took Modified Huanglian Jiedu Decoction (MHJD) and received electroacupuncture (EA) for 7 days. The first exhaust time, defecation time, scores for gastrointestinal dysfunction, mechanical ventilation time, ICU hospitalization time, and 28-day fatality rate were observed. Furthermore, serum levels of diamine oxidase (DAO) and D-lactic acid were detected at day 1, 3, and 7 after treatment. RESULTS:The first exhaust time and the first defecation time in the treatment group were ahead of schedule, when compared with those of the control group (P <0. 05). Scores for gastrointestinal dysfunction, mechanical ventilation time, serum levels of DAO obviously decreased in the treatment group (P <0. 05). There was no statistical difference in serum levels of D-lactic acid, ICU stay time, the incidence of pulmonary infection, and 28-day mortality between the two groups (P >0. 05). Results of Logistic analysis showed that scores for gastrointestinal dysfunction were related with the incidence of pulmonary infection (P <0. 05). CONCLUSION:MHJD combined EA could promote the recovery of gastrointestinal function in critically ill patients after abdominal surgery via improving intestinal barrier function, which was benefit for shortening mechanical ventilation time.

从五脏相关学说探讨多器官功能障碍综合征(MODS)的辨证论治,认为其发病及发展特点以器官功能障碍为中心,器官交互作用是其关键环节;而五脏相关学说的功能系统观及联系观强调人体作为一个整体,各器官系统功能及其相互关系,运用其对MODS进行辨证论治,有利于改善器官功能,从而提高中医临床疗效.