BackgroundSevere traumatic brain injury (TBI) induces a hypermetabolic state that heightens the risk of mortality and poor neurological outcomes. Early enteral nutrition (EEN), typically defined as initiation within 48 h of injury, is considered crucial, yet robust evidence of its specific benefits in TBI patients remains limited.MethodsFollowing PRISMA guidelines, we systematically searched the PubMed, Embase, Web of Science, and Cochrane Library databases through December 25, 2025, for studies comparing EEN with delayed enteral nutrition (DEN) in adults with TBI. Outcomes included clinical outcomes, nutrition status, and complications. Study quality was assessed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. The primary outcome was short-term mortality, defined as from hospital admission to 90 days post-discharge. Sensitivity analyses and subgroup analyses explored heterogeneity.ResultsTen studies (6 randomized controlled trials [RCTs]; 4 observational; 13,046 patients) were included. When all studies (RCTs and observational) were pooled, there was no significant difference in short-term mortality risk between EEN and DEN (risk ratio [RR] = 0.64; 95% CI, 0.32–1.31). However, a prespecified sensitivity analysis limited to RCTs showed a significant reduction in mortality with EEN (RR = 0.58; 95% CI, 0.35–0.96). EEN significantly shortened mechanical ventilation duration and reduced both ICU and hospital length of stay. Nutritional status, including serum albumin levels, glucose control, caloric intake, and positive nitrogen balance, was markedly improved with EEN, without increasing hospitalization costs. EEN also significantly lowered rates of sepsis, central nervous system infection, stress ulcer, ventilator-associated pneumonia, and total adverse events (all p values range from <0.00001 to 0.04), though it was associated with a mildly elevated risk of diarrhea (p = 0.02).ConclusionIn this meta-analysis, EEN initiated within 48 h of TBI showed a trend toward reduced short-term mortality and improvements in clinical and nutritional outcomes compared to DEN. However, these findings should be interpreted cautiously given the high risk of bias and substantial statistical heterogeneity in the included studies. Future high-quality, large-scale RCTs are needed to confirm these effects and refine optimal feeding strategies in this population.Systematic review registrationhttps://inplasy.com/wp-content/uploads/2026/01/INPLASY-Protocol-8729.pdf.

Background:Acute respiratory distress syndrome (ARDS) is one of the most common organ dysfunctions in sepsis. The potential benefits of sivelestat, a selective inhibitor of neutrophil elastase, for patients with septic ARDS remain unclear. The current systematic review and meta-analysis aimed to evaluate the effectiveness of sivelestat in reducing mortality and improving other important outcomes in this patient population. Methods:We searched PubMed, EMBASE, and Cochrane Library databases until May 30, 2025, for studies comparing sivelestat in septic patients with ARDS against controls. The primary outcome was mortality. We assessed study quality and conducted subgroup analyses, sensitivity analyses, regression analyses, and GRADE evaluations to explore potential heterogeneity. Results:A total of 17 studies involving 5,062 patients met the inclusion criteria. Overall, sivelestat significantly reduced the risk of mortality compared to controls (odds ratio [OR] = 0.63; 95% confidence interval [CI], 0.48-0.84; I 2 = 39%). Meta-regression showed that differences in baseline PaO2/FiO2 and risk of mortality significantly influence the effectiveness of sivelestat interventions, as shown in sequent subgroup analyses of patients with partial pressure of oxygen/fraction of inspiration oxygen (PaO2/FiO2) < 200 mmHg (OR = 0.61; 95% CI 0.51-0.73) and those with a mortality rate greater than 30% (OR = 0.48; 95% CI 0.37-0.60). A similar result was found when we pooled results from adjusted regression analyses (hazard ratio = 0.48; 95% CI 0.28-0.82). Additionally, sivelestat significantly improved PaO2/FiO2 on days 1, 3, 5, and 7 after treatment and was associated with a significant reduction in the duration of mechanical ventilation (standardized mean difference [SMD] = -0.58 days; 95% CI, -0.96 to -0.19), and length of ICU stay (SMD = -0.76 days; 95% CI, -1.09 to -0.43). Conclusion:Sivelestat significantly increased PaO2/FiO2 levels after treatment, leading to a improvement in mortality and other clinical outcomes. Further studies with well-designed protocols for administering sivelestat are needed to validate these findings. Systematic review registration:https://inplasy.com/wp-content/uploads/2025/06/INPLASY-Protocol-7969.pdf, identifier INPLASY202560111.

Background:Vitamin D is commonly used in clinical practice, while its clinical significance in critically ill patients remains controversial. Therefore, we aimed to perform a systemic review and meta-analysis to investigate the effect of vitamin D on this patient population. Methods:We searched for randomized controlled trials (RCTs) in PubMed, Embase, and the Cochrane Library databases from inception until August 15, 2024. Studies evaluating critically ill adult patients who received vitamin D compared to controls were included. The primary outcome was short-term mortality. We used the Cochrane risk of bias tool and GRADE system to evaluate the study quality and evidence. Secondary outcomes were changes in serum 25-hydroxyvitamin D levels, mechanical ventilation (MV) duration, and length of stay (LOS) in the ICU or hospital. We also conducted meta-regression, subgroup analyses, and trial sequential analysis (TSA) to explore the potential heterogeneity among the included trials. Results:Nineteen RCTs with 2,754 patients were eligible. Overall, vitamin D significantly increased serum 25-hydroxyvitamin D levels and significantly reduced the short-term mortality (risk ratio [RR] = 0.83; 95%CI, 0.70-0.98; p = 0.03, I 2 = 13%), duration of MV (MD = -2.96 days; 95% CI, -5.39 to -0.52; I 2 = 77%; p = 0.02) and ICU LOS (MD = -2.66 days; 95% CI, -4.04 to -1.29, I 2 = 70%; p = 0.0001) but not hospital LOS (MD = -0.48 days; 95% CI, -2.37 to 1.40; I 2 = 31%; p = 0.61). The meta-regression analysis revealed that the proportion of MV (MV%) accounted for the source of heterogeneity, and the subgroup analyses based on MV% suggested that the MV group was more likely to benefit from vitamin D applications than the partly MV group in all the predefined outcomes (all p values<0.05). TSA for short-term mortality suggested that more data is required to confirm our main conclusion. Conclusion:Vitamin D supplementation increased serum 25-hydroxyvitamin D levels and significantly benefited critically ill patients, especially those with MV. Systematic review registration:https://inplasy.com/inplasy-2022-10-0074/, INPLASY2022100074.

Background:The creatinine-to-cystatin C ratio (CCR) has been developed as a novel biomarker of sarcopenia and prognostic evaluation in various hospitalized populations. However, evidence supporting the use of CCR in patients with chronic kidney disease (CKD) remains limited. Thus, we aimed to evaluate whether CCR could be a marker of muscle mass for predicting prognosis in patients with CKD. Methods:We searched PubMed, Embase, Wanfang, China National Knowledge Infrastructure, Web of Science, and Cochrane Library databases up to March 15, 2025. Studies were included if they reported a relationship between CCR and muscle measurements or prognosis in adults with CKD. The risk of bias in non-randomized studies-of exposures tool was used to assess the quality of the study. The primary outcome was all-cause mortality. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Results:Nine studies (seven cohort and two cross-sectional studies) involving 31,673 adults were included. The quality of the included studies ranged from moderate to high. Pooling the results from multifactorial analyses showed that CCR can reliably predict mortality, either using CCR as a category variable [n = 24,778; hazard ratio (HR) = 2.16; 95% CI, 1.40-2.88; I 2 = 48%] or a continuous variable (n = 3,313; HR = 0.73; 95% CI, 0.57-0.93; I 2 = 68%). CCR was positively correlated with handgrip strength (n = 874; r = 0.38, P < 0.001) and skeletal muscle index (n = 357; r = 0.42, P < 0.001). Similarly, the area under curves (AUC) suggested that CCR had poor-to-fair diagnostic efficacy for handgrip strength (AUC = 0.640; 95% CI: 0.605-0.0.675), skeletal muscle index (AUC = 0.684; 95% CI: 0.596-0.772), and sarcopenia (AUC = 0.720; 95% CI: 0.619-0.822). For nutrition status, lower CCR was associated with significantly lower albumin but not body mass index. Conclusions:This meta-analysis suggests that CCR could serve as a valuable tool for evaluating muscle mass, as well as an indicator of nutritional status and an independent predictor of prognosis in patients with CKD. These findings encourage the use of CCR in this patient population. However, more high-quality studies are needed to confirm these findings. Systematic review registration:https://inplasy.com/inplasy-2022-9-0097/, identifier: NPLASY202290097.

ObjectiveSarcopenia is a syndrome of decreased muscle mass and deficits in muscle strength and physical function. We aimed to investigate the relationship between creatinine/cystatin C ratio (CCR) and sarcopenia and the prognostic value of CCR in hospitalized patients.Materials and methodsWe searched for relevant studies in PubMed, EMBASE, and the Cochrane Database up to August 25, 2022. Meta-analyses were performed to evaluate the relationship between CCR and skeletal muscle [computed tomography-assessed skeletal muscle (CTASM), muscle strength, and physical performance], prognosis and important clinical outcomes in hospitalized adults. The pooled correlation coefficient, the area under the receiver operating characteristic (ROC) curves, and hazard ratio (HR) together with their 95% confidence intervals (CIs) were calculated. We also conducted subgroup analyses to explore the sources of heterogeneity.ResultsA total of 38 studies with 20,362 patients were eligible. These studies were of moderate to high quality. Our results showed that CCR was significant correlations with all CTASM types (Fisher’s Z ranged from 0.35 to 0.5; P values ranged from < 0.01 to 0.01), handgrip strength (Fisher’s Z = 0.39; 95% CI, 0.32–0.45; P < 0.001) and gait speed (Fisher’s Z = 0.25; 95% CI, 0.21–0.30; P < 0.001). The ROC curves suggested that CCR had good diagnostic efficacy (0.689; 95% CI, 0.632–0.746; P < 0.01) for sarcopenia. CCR can reliably predict mortality in hospitalized patients, which was confirmed by regression analysis of CCR as both continuous (HR 0.78; 95% CI, 0.72–0.84; P < 0.01) and categorical variables (HR 2.05; 95% CI, 1.58–2.66; P < 0.0001). In addition, less evidence showed that higher CCR was independently associated with a shorter duration of mechanical ventilation, reduced length of stay in the intensive care unit and hospital, less nutritional risk, and decreased complications in hospitalized patients.ConclusionCCR could be a simple, economical, and effective screening tool for sarcopenia in hospitalized patients, and it is a helpful prognostic factor for mortality and other important clinical outcomes.Systematic review registrationhttps://inplasy.com/inplasy-2022-9-0097/, identifier INPLASY202290097.

ObjectiveBioelectrical impedance-derived phase angle (PA) has exhibited good prognostic values in several non-critical illnesses. However, its predictive value for critically ill patients remains unclear. Thus, we aimed to perform a systematic review and meta-analysis to investigate the relationship between PA and survival in such a patient population.Materials and methodsWe searched for relevant studies in PubMed, Embase, and the Cochrane database up to Jan 20, 2022. Meta-analyses were performed to determine the association between the baseline PA after admission with survival. We further conducted subgroup analyses and sensitivity analyses to explore the sources of heterogeneity.ResultsWe included 20 studies with 3,770 patients. Patients with low PA were associated with a significantly higher mortality risk than those with normal PA (OR 2.45, 95% CI 1.97–3.05, P < 0.00001). Compared to survivors, non-survivors had lower PA values (MD 0.82°, 95% CI 0.66–0.98; P < 0.00001). Similar results were also found when pooling studies reported regression analyses of PA as continuous (OR = 0.64; 95% CI 0.52–0.79, P < 0.00001) or categorical variable (OR = 2.42; 95% CI 1.76–3.34; P < 0.00001). These results were further confirmed in subgroup analyses and sensitivity analyses.ConclusionOur results indicated that PA may be an important prognostic factor of survival in critically ill patients and can nicely complement the deficiencies of other severity scoring systems in the ICU setting.

目的 观察清金化痰汤离子导入联合西药治疗痰热蕴肺型重症肺炎的疗效.方法 采用随机数字表法将80例痰热蕴肺型重症肺炎患者分成对照组和治疗组各40例.对照组给予重症肺炎西医常规治疗,治疗组在对照组治疗的基础上,加用清金化痰汤经穴位(双侧肺俞、定喘、脾俞)离子导入,每日1次,共7 d.比较2组患者治疗前后血清白细胞(WBC)、C反应蛋白(CRP)、降钙素原(PCT)等血清学炎症指标,中医证候积分,急性生理与慢性健康(APACHE-Ⅱ)评分及血清学红细胞(RBC)、血小板(PLT)、天门冬氨酸氨基转移酶(AST),丙氨酸氨基转移酶(ALT),肌酐(CREA)等安全性指标.结果 与治疗前比较,2组治疗后的血清学炎症指标含量均显著下降(P＜0.05);与对照组治疗后比较,治疗组治疗后血清学炎症指标水平、中医证候积分、APACHE-Ⅱ评分均显著降低(P＜0.05),中医证候疗效及APACHE-Ⅱ评分改善率显著提高(P＜0.05);2组患者治疗前后安全性指标水平差异无统计学意义(P＞0.05).结论 清金化痰汤中药离子导入能缓解痰热蕴肺型的重症肺炎临床症状,临床疗效较单纯西药治疗更优.

Background: Using continuous glucose monitoring (CGM) in critically ill adult patients requiring insulin ther-apy has increased with inconsistent results. Thus, we conducted a meta-analysis to assess the effect of CGM and frequent point-of-care (POC) measurements in such a patient population. Methods: We searched PubMed, Embase, Cochrane Library, China national knowledge infrastructure, and Wanfang for relevant articles from inception to Jan 15, 2022. Randomized controlled trials (RCTs) were considered if they focused on critically ill patients who required insulin and were treated with CGM or any POC measurements. We used the Cochrane risk evaluating tool to assess study quality. Subgroup analysis and publication bias were also conducted. Results: We finally included 19 RCTs with 1,852 participants. The quality of the included studies were at a low to moderate levels. Overall, CGM devices significantly reduced hypoglycemia incidence (Risk ratio (RR) 0.35; 95% CI, 0.25-0.49; P<0.00001) than the POC measurement. Further subgroup and sensitivity analyses confirmed this result. The CGM group also had lower over-all mortality (RR 0.54; 95% CI, 0.34-0.86; P=0.01), lower glucose variability, and nosocomial infection. The time in, below, or above target blood glucose range, insulin use, and length of stay in the ICU were comparable between the two groups. In addition, few studies provided data in favor of decreased nursing workload and medical costs in the CGM group. Conclusions: The CGM technique could significantly reduce hypoglycemia incidence, overall mortality, and glucose variability compared to POC measurement in critically ill patients. However, further large, well-designed RCTs are required to confirm our results.

Condition being studied: Vitamin D supplementation in critically ill patients.The research team comes from the Department of Critical Care Medicine of a tertiary hospital in China, and all the team members have perfect clinical experience in treatments of nebulized antibiotics.Moreover, our team members have published more than 20 meta-analyses, which can guarantee the successful completion of the current research.METHODS Participant or population: Adult (≥18 years old) ICU patients.

IntroductionSerum phosphate level is often deranged during critical illness. Hyperphosphatemia, as a marker of disease severity, attracts more and more attention. This study aimed to evaluate the impact of hyperphosphatemia on clinical outcomes in critically ill patients.MethodsWe searched for relevant studies in PubMed, EMBASE, and the Cochrane database up to Jan 10, 2022. Two authors independently screened studies, extracted data, and assessed the study quality. Meta-analyses were performed to determine hyperphosphatemia prevalence and evaluate its relationship with prognosis and important clinical outcomes. We also conducted subgroup analysis and sensitivity analyses to explore the sources of heterogeneity.ResultsTen studies with 60,358 patients met the inclusion criteria. These studies were moderate to high quality. The median prevalence of hyperphosphatemia was 30% (range from 5.6 to 45%). Patients with hyperphosphatemia had a significantly higher risk of all-cause mortality than those without (OR 2.85; 95% CI, 2.35 to 3.38, P < 0.0001). Subgroup analyses, sensitivity analyses, and regression analyses further confirmed these results. In addition, patients with hyperphosphatemia required more CRRT (OR 4.96; 95% CI, 2.43 to 10.2, P < 0.0001) but not significantly increased duration of mechanical ventilation (mean difference, MD 0.13, 95% CI −0.04 to 0.30; P = 0.138), length of stay in intensive care unit (ICU) (SMD 0.164 day, 95% CI −0.007 to 0.335; P = 0.06), and length of stay in hospital (SMD 0.005 day, 95% CI −0.74 to 0.75; P = 0.99).ConclusionsOur results indicated that hyperphosphatemia was associated with all-cause mortality in critically ill patients. However, due to the retrospective design of the included studies, more prospective, well-designed research is required in the future.Systematic Review Registration[https://doi.org/10.37766/inplasy2021.12.0130], identifier [INPLASY2021120130].

目的 探讨地锦草总黄酮对肠源性脓毒症大鼠的肠道保护作用.方法 将80只SD大鼠随机分为空白对照组、脓毒症组、地锦草对照组和地锦草组,每组各20只.地锦草对照组和地锦草组在手术前用地锦草总黄酮溶液作为唯一饮用水,持续2周,使每只大鼠的总摄药量均衡;其余2组用注射用水自由喂养.脓毒症组和地锦草组采用盲肠结扎穿孔术建立脓毒症模型,空白对照组和地锦草对照组仅开腹取出阑尾后还纳,不进行结扎和穿孔.评估4组大鼠24 h生存状态,采用终点显色法测定各组血清内毒素水平,酶联免疫吸附试验(ELISA)法检测血清TNF-α和IL-1β含量,透射电镜扫描观察回肠黏膜屏障结构变化,TUNEL染色法检测回肠组织细胞凋亡情况,Western Blot法检测回肠黏膜组织Occludin蛋白表达.结果 电镜下可见脓毒症组肠黏膜表面的微绒毛稀疏,有脱落现象,细胞间紧密连接打开,上皮细胞损伤严重,细胞器结构消失;地锦草组肠黏膜表面微绒毛排列尚整齐,紧密连接仅出现局部的结构模糊,上皮细胞线粒体肿胀,细胞器结构尚存在.TUNEL染色法显示,脓毒症组回肠黏膜细胞呈现明显的凋亡现象;而地锦草组细胞凋亡明显减少.与对照组比较,脓毒症组24 h死亡率、血清内毒素、TNF-a和IL-1β水平明显升高(P<0.05),Occludin蛋白表达明显降低(P<0.05).与脓毒症组比较,地锦草组24 h死亡率、血清内毒素、TNF-a和IL-1β水平明显降低(P<0.05),Occludin蛋白表达明显提高(P<0.05).结论 地锦草总黄酮可保护脓毒症大鼠的肠道屏障功能,抑制全身炎症反应,改善肠源性脓毒症预后.

Subgroup analysis: We grouped the included studies by route of administration of GLN for subgroup analysis in enteral (EN) and intravenous (IV).Sensitivity analysis: None.

Background: Cardiopulmonary support, as extracorporeal membrane oxygenation (ECMO) or mechanical ventilation (MV), is crucial for ICU patients. However, some of these patients are difficult to wean. Therefore, we aimed to assess the efficacy and safety of levosimendan in facilitating weaning from cardiorespiratory support in this patient population. Methods: We searched for potentially relevant articles in PubMed, Embase, China National Knowledge Infrastructure, Wanfang, and the Cochrane database from inception up to Feb 30, 2021. Studies focusing on weaning data in MV/ECMO adult patients who received levosimendan compared to controls were included. We used the Cochrane risk of bias tool or the Newcastle-Ottawa Quality Assessment Scale to evaluate the study quality. The primary outcome was the weaning rate from MV/ECMO. Secondary outcomes were mortality, duration of MV, and ICU stay. Subgroup analysis, sensitivity analysis, and publication bias were also conducted. Results: Eighteen studies with 2,274 patients were included. The quality of the included studies was low to moderate. Overall, levosimendan effectively improved weaning rates from MV/ECMO [odds ratio (OR) = 2.32; 95%CI, 1.60-3.36; P < 0.00001, I-2 = 68%]. Subgroup analyses confirmed the higher successful weaning rates in ventilated patients with low left ventricular ejection fractions (OR = 4.06; 95%CI, 2.16-7.62), patients with ECMO after cardiac surgery (OR = 2.04; 95%CI, 1.25-3.34), and patients with ECMO and cardiogenic shock (OR = 1.98; 95%CI, 1.34-2.91). However, levosimendan showed no beneficial effect on patients with MV weaning difficulty (OR = 2.28; 95%CI, 0.72-7.25). Additionally, no differences were found concerning the secondary outcomes between the groups. Conclusions: Levosimendan therapy significantly increased successful weaning rates in patients with cardiopulmonary support, especially patients with combined cardiac insufficiency. Large-scale, well-designed RCTs will be needed to define the subgroup of patients most likely to benefit from this strategy.

Review question / Objective: Skeletal muscle reserves are crucial to critically ill patients' recovery and survival.We aimed to investigate the prevalence of skeletal muscle loss and prognostic value of Computed tomography (CT) -assessed skeletal muscle in such patient population.Condition being studied: The authors of the current study come from a tertiary hospital INPLASY 1

Background: The use of indirect calorimetry (IC) is increasing due to its precision in resting energy expenditure (REE) measurement in critically ill patients. Thus, we aimed to evaluate the clinical outcomes of an IC-guided nutrition therapy compared to predictive equations strategy in such a patient population. Methods: We searched PubMed, EMBASE, and Cochrane library databases up to Oct 25, 2020. Randomized controlled trials (RCTs) were included if they focused on energy delivery guided by either IC or predictive equations in critically ill adults. We used the Cochrane risk-of-bias tool to assess the quality of the included studies. Short-term mortality was the primary outcome. The meta-analysis was performed with the fixed-effect model or random-effect model according to the heterogeneity. Results: Eight RCTs with 991 adults met the inclusion criteria. The overall quality of the included studies was moderate. Significantly higher mean energy delivered per day was observed in the IC group, as well as percent delivered energy over REE targets, than the control group. IC-guided energy delivery significantly reduced short-term mortality compared with the control group (risk ratio=0.77; 95% CI, 0.60 to 0.98; I 2 =3%, P =0.03). IC-guided strategy did not significantly prolong the duration of mechanical ventilation (mean difference [MD]=0.61 days; 95% CI, -1.08 to 2.29; P =0.48), length of stay in ICU (MD=0.32 days; 95% CI, -2.51 to 3.16; P =0.82) and hospital (MD=0.30 days; 95% CI, -3.23 to 3.83; P =0.87). Additionally, adverse events were similar between the two groups. Conclusions: This meta-analysis indicates that IC-guided energy delivery significantly reduces short-term mortality in critically ill patients. This finding encourages the use of IC-guided energy delivery during critical nutrition support. But more high-quality studies are still needed to confirm these findings.

采用乙醇浸提法来提取地锦草中的有效成分,并对其生物活性进行研究.探讨了地锦草总黄酮的最佳提取工艺;通过体外抗氧化实验,对地锦草提取物的抗氧化活性进行研究;同时考察了提取物对大肠杆菌、枯草芽孢杆菌、青霉、曲霉的抗菌性能,并对地锦草提取物对α-淀粉酶的抑制活性进行研究.实验结果表明:地锦草总黄酮最佳提取工艺为乙醇体积分数为85％,料液比为1:15,提取次数为3次;体外抗氧化实验表明,地锦草具有抗氧化活性,且在浓度为8 mg/mL最为明显;抗菌性能实验表明,地锦草具有抗菌性能,且对青霉、曲霉的抗菌效果比较显著;α-淀粉酶的抑制活性的实验表明,地锦草提取物对α-淀粉酶的活性有抑制能力,在pH 6.8、浓度为4.8 mg/mL、温度为70℃时,其对α-淀粉酶的抑制效果达到最大.

Objective To explore the effection of TCM in treating patients with MDR-AB pneumonia. Methods Convenient selection a prospective study involved 60 patients in ICU of People’s Hospital affiliated to FuJian University of TCM,during April 2014 to April 2015, with MDR-AB pneumonia and randomly divided into sequential group and contrast group,30 cas-es each.All patients treated antibiotics with susceptibility tests at first.The sequential group combined and sequential with TCM for two weeks.The temperature, WBC in peripheral blood, Procalcitonin(PCT),sputum culture,the chest X-ray,mechani-cal ventilation time, the intensity of antibiotics apply were measured. Results There were 26 cases worked and 4 cases failed in the sequential group . The sequented time at the(5.23±1.76)d.The sequential group got significant improvements in various inflammatory indexes , shorter duration of mechanical ventilation and lower intensity of antibiotics apply, compared with the contrast group.Conclusion There were significant effection of MDR-AB pneumonia treated with antibiotics com-bined and sequential TCM.The accureacy of syndrome differentiation and the time to sequential therapy were the key.

目的：观察改良持续腰大池引流术在治疗神经重症患者中应用的临床效果。方法采用临床对照研究方法，选择我院重症医学科病房（ICU）收治神经重症患者60例为研究对象。按随机数字表法分为两组，各30例。观察组采用改良术中心静脉导管连接引流方法，对照组采用传统的硬膜外导管引流方法。记录并比较两组临床疗效和并发症发生情况。结果观察组患者置管成功率为93．33％（28／30）、对照组患者为86．67％（26／30），差异无统计学意义；观察组从堵管、导管活滑脱等发生率方面明显低于对照组；两组间在神经根刺激反应、颅内感染发生率方面无明显差异。从疗效上看，观察组需要导管留置时间，血性及感染性脑脊液清除时间均短于对照组，差异具有显著性；两组患者日均脑脊液引流量虽然无明显统计学差异，但观察组的每日引流量波动小，颅内压更稳定。结论改良的中心静脉导管连接持续腰大池引流术是一种安全、有效的方法，利于推广应用。

目的：探讨血浆降钙素原联合内毒素检测在重症患者革兰阴性菌感染早期诊疗中的临床意义。方法：以体检中心健康人为对照组，比较感染组患者血浆降钙素原及内毒素定量水平的治疗前后差异情况。结果：治疗前感染组患者血浆中的降钙素原定量水平（61.80±23.25）ng/ml明显高于对照组（21.12±11.32）ng/ml，同时血浆中的内毒素定量水平（87.54±25.75）pg/ml明显高于对照组（17.23±4.25）pg/ml，具有统计学差异（P＜0.05）。而治疗后，感染组血浆降钙素原及内毒素定量水平与对照组无明显差异。结论：血浆降钙素原及内毒素定量测定具有快速、敏感的特点，对重症患者革兰阴性菌感染的早期诊断具有重要的临床应用价值。