Gastrointestinal dysfunction (GD) is a common complication after endotoxemia, which can further aggravate the progress of infection. Acupuncture uses metal needles of different shapes and techniques to stimulate specific points on the human body, which are effective in treating various diseases, including gastrointestinal diseases. We aimed at exploring the clinical effect of acupuncture on the recovery of visceral sensation, proximal gastric compliance, and autonomic nervous function in patients with septic GD. A total of 73 sepsis with GD patients were selected using modified single section ultrasonography combined with clinical symptoms in the First People’s Hospital of Lanzhou City during 2019. The participants were randomly allocated to routine-treatment (control group) and study group receiving acupuncture. The indexes before and after treatment included gastric residue, gastric dilatation, pressure and volume, gastric compliance, autonomic nerve function, APACHE II score, and infection index were measured and compared. Before treatment, there was no significant difference in the basic information of the two groups, including gastric volume and pressure, gastric residue, gastric compliance, autonomic nerve function, and APACHE II score. After treatment, the maximum gastric volume and pressure, gastric residue, and APACHE II score of the two groups were significantly improved ( P < 0.05 ). In addition, the maximum gastric volume and pressure of the study group were significantly higher, while gastric residual, autonomic nerve function, and APACHE II were significantly lower than those of the control group ( P < 0.05 ). However, our results showed that acupuncture did not further reduce inflammatory markers, including white blood cells, C-reactive protein, and procalcitonin. To sum up, on the basis of basic treatment, the application of acupuncture can further improve the clinical symptoms of GD in patients with sepsis, enhance gastrointestinal motility, and improve autonomic nervous function, which is worthy of clinical application and promotion.

Objective:To investigate the clinical value of continuous increase of blood lactic acid (Lac) in prognosis evaluation of patients with sepsis.Methods:From January 2016 to December 2018, 84 patients with sepsis in the Department of Critical Medicine of Lanzhou First People's Hospital were retrospectively analyzed. According to the final outcome, the patients were divided into death group and survival group. The general condition, initial Lac, Lac at 6, 12, 18, 24 h, and the duration of Lac>2 mmol/L (T Lac>2) were compared between the two groups. Receiver operating characteristic curve (ROC) was used to analyze the sensitivity and specificity of gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), initial lac, 6, 12, 18, 24 h lac, T Lac>2 in evaluating the prognosis of patients with sepsis. At the same time, the relationship between these parameters and the prognosis of patients was analyzed by Cox regression analysis to evaluate the clinical value of the time of continuous increase of blood lactate in the prognosis of patients with sepsis. Results:There was no significant difference in age, gender, APACHE Ⅱ score and initial lac between the two groups ( P>0.05). The Lac of death group was higher than that of survival group at 6, 12, 18 and 24 h after treatment ( P<0.05), and T Lac>2 in death group was significantly longer than that in survival group ( P<0.05). Cox regression analysis showed that age, gender, APACHE Ⅱ score, initial Lac, 6, 12, 18, 24 h lac had no significant effect on the prognosis of sepsis patients, while T Lac>2 was significantly correlated with survival rate and death risk. The longer T Lac>2 was, the lower the survival rate and the higher the risk of death. At the same time, ROC curve analysis showed that gender, age, APACHE Ⅱ score and area under the curve (AUC) of initial lac showed that these indicators could not effectively evaluate the prognosis of patients ( P>0.05). The area under the curve of T Lac>2 was the largest, and the evaluation of prognosis was the best, followed by 24 h Lac and 18 h, 12 h and 6 h Lac. In addition, the sensitivity of T Lac>2, 24, 18, 12, 6 h for sepsis mortality risk assessment were 90.9%, 81.8%, 81.8%, 81.8%, 88.6%, and the specificity were 71.4%, 52.5%, 52.5%, 47.7% and 25.2%, respectively. Conclusions:Transient increase of lactic acid can not evaluate the prognosis of patients with sepsis, but the duration of lactic acid increase has a significant impact on the prognosis of patients with sepsis. The longer the increase of Lactic acid (T Lac>2) is, the lower the survival rate and the higher the risk of death. The sensitivity and specificity of lactic acid duration in evaluating the risk of death were higher than those of other parameters, and the prognostic efficacy was the best.

目的 探讨血乳酸持续增高时间(TLac>2 mmol/L)对重症患者预后的影响.方法 回顾性分析2015年1月～2018年12月在兰州市第一人民医院住院急性生理与慢性健康(APACHEⅡ)评分>15分合并血乳酸(Lac)>2 mmol/L的重症患者114例.从入院开始,每6小时测血气并记录Lac水平,截止于Lac水平降至正常范围或患者死亡.记录并分析所有研究对象的一般情况、APACHEⅡ评分、TLac>2 mmol/L及转归,依据患者最终转归情况分为存活组(62例)与死亡组(52例).对比两组患者入院一般状况、入院时Lac,APACHEⅡ评分及TLac>2 mmol/L,并将所有研究对象的TLac>2 mmol/L和转归进行Cox回归分析,以评价TLac>2 mmol/L对重症患者预后的影响.结果 两组患者性别、年龄、入院时首次Lac及APACHEⅡ评分比较,差异无统计学意义(P>0.05);死亡组TLac>2 mmol/L长于存活组,差异有统计学意义(P<0.05);Cox回归分析,提示TLac>2 mmol/L越长,患者生存率越低,死亡风险越高.结论 一过性的乳酸增高,对重症患者的预后不一定有影响,但TLac>2 mmol/L对重症患者预后有显著影响,TLac>2 mmol/L越长,患者生存率越低,死亡风险越高.

目的 观察应用GE呼吸机能量代谢模块指导AECOPD有创机械通气患者肠内营养实施过程,评价此方法在AE-COPD有创机械通气中的临床价值.方法 收集2015年1月—2018年12月在我科住院的AECOPD实施有创机械通气的患者42例,其中对照组21例,采用常规机械通气管理,应用整蛋白型肠内营养混悬液(TP)实施肠内营养;观察组21例,根据呼吸机能量代谢监测数据指导肠内营养,应用整蛋白纤维型肠内营养混悬液(TPF-T)实施肠内营养.结果 治疗7 d后,实验组血清白蛋白、血清总蛋白、PaO2、OI、SBT通过率显著高于对照组(P<0.05),容量过负荷的人数少于对照组(P<0.05).结论 应用GE呼吸机能量代谢监测数据指导AECOPD有创机械通气患者的营养治疗,可促进患者的营养状态恢复,提高患者SBT通过率,辅助增强有创机械通气效果;同时提高营养支持的能量密度可明显降低营养治疗中容量过负荷,有利于患者的呼吸功能改善,促进病情转归.

目的 探讨动态监测血乳酸(LAC)在多脏器功能障碍综合征(MODS)患者治疗中的指导意义.方法 选择2015年1月～2016年10月在兰州市第一人民医院重症医学科收治的63例MODS患者,根据监测LAC与否分成实验组和对照组.实验组32例,根据LAC水平、中心静脉压(CVP)、中心静脉血氧饱和度(ScvO2)、平均动脉压(MAP)及尿量这5个变量调整补液、血管活性药物及升级治疗;对照组31例,根据监测CVP、ScvO2、MAP及尿量这4个变量调整补液、血管活性药物及升级治疗.记录两组患者入院时、入院24h、48 h、72 h的Glasgow昏迷评分(GCS)、氧合指数(PaO2/FiO2)、压力调整心率(PAHR)、胆红素、Cr、PLT,并在各个时间段将这些指标进行MODS严重程度评分,比较两组患者入院时及治疗72 h后WBC、PCT及APACHEⅡ,比较两组患者不同时间点的MODS严重程度评分、使用机械通气时间、住重症医学科的时间及死亡率.结果 治疗72 h,实验组WBC、PCT明显低于对照组,差异有统计学意义(P＜0.01);实验组APACHEⅡ、MODS评分明显低于对照组,差异有统计学意义(P＜0.01);实验组使用机械通气时间、住ICU时间明显短于对照组(P＜0.01).结论 动态监测LAC和乳酸清除率(LCR)对MODS患者的治疗具有重要的指导意义,该指标稳定、可靠、可缩短使用机械通气的时间及住重症医学科的时间.

呼吸衰竭是呼吸临床危重症，各种疾病最终均并发呼吸衰竭，从而引起严重呼吸功能障碍，此时机体存在不同程度的组织低氧及二氧化碳潴留，易引起其他器官相继出现功能障碍；而组织低氧时，无法通过有氧呼吸获得足够的能量，因此组织细胞增强糖酵解，导致血乳酸（LAC）浓度增高，可能诱发高碳酸血症。在此过程中，血乳酸和动脉血气各项指标均有相应变化，且两者之间具有一定的相关性。

Blood lactate concentration reacted to body tissue perfusion is a sensitive marker for cells under hypoxia.It increased significantly when the body is in a poor perfusion and low oxygen.When hypoperfusion has been controled ef-fectively,and hypoxia quickly has been corrected,the level of lactic acid in vivo decreased rapidly.The lack of oxygen is a major aspect of respiratory failure pathophysiological changes,which causing the blood lactic acid increased,further-more blood lactic acidosis.The purpose of this review is to detect blood lactic acid and to analyse of the test results.In the end,we summarized clinical significance of blood lactic acid in the common disease of respiratory failure and pro-vided rational clinical therapy for such diseases.