Objective To study the changes of arterial blood lactate(ABL) and serum enzymes activities and thier correlation.Method Lactate dehydrogenase(LDH),alkaline phosphatase(AKP) and creatine kinase(CK) in serum were determined in sixty-four critical patients in the intensive care unit(ICU) at admission immediately,following 24h,48h and 72h,respectively.The patients was divided into three groups:favorable,survival and death groups.Results Before treatment,ABL level was(3.9?2.5,2.9?1.3 and 3.8?2.3)mmol/L in favorable,survival and death groups respectively.Although ABL in favorable and survival groups were decreased gradually to normal level during 24～72h,the death group showed that the decline was very slowly it still persistent elevated in 72h.There was significanct difference between the death group and the favorable and survival groups(P

Objective To explore the anticoagulation effect of low molecular weight heparin (LMWH) combination with warfarin at the early stage at the treatment of intracranial venous sinus thrombosis.Methods 80 cases of intracranial venous sinus thrombosis patients in people's hospital of Xinjiang Uygur autononous region from January 2010 to December 2014 were chosen to be analyzed retrospectively.37 cases in observation group were treated with low molecular heparin (LMWH) in combination with warfarin, and 43 cases in control group were treated with warfarin.The clinical curative effect between two groups was compared post-treatment.Results The effective rate in observation group was 91.89%, which was significantly higher than 67.44% in control group (P<0.05) .The recanalization rate of involved intracerebral venous in observation group was 89.19%, which was significantly higher than 67.29% in control group(P<0.05).After treatment, the prothrombin time (PT), thrombin time (TT) and activated partial thromboplastin time (APTT) were higher and fibrinogen (FBG) in both groups was lower than those pre-treatment(P<0.05).The PT and APTT was higher and FBG was lower in observation group than those in control group(P<0.05).Conclusion Low molecular weight heparin in combination with warfarin worked well than single warfarin in the treatment of intracranial venous sinus thrombosis.

Objective To investigate the influence of pure intercostal nerve block combined with hydromorphone hydrochlo-ride intravenous analgesia on the occurrence of postoperative cognitive function and analgesia in elder patients with thoracic surger-y.Methods Ninety-six ASA I?Ⅱ elder patients with elective thoracic operation were divided into intercostal nerve block group (A),intercostal nerve block combined with hydromorphone hydrochloride intravenous analgesia group (B)and hydromorphone hydrochloride intravenous analgesia group(C)according to the random number table method,32 cases in each group.The patient-controlled intravenous analgesia(PCIA)with sufentanyl was postoperatively performed in all cases.When analgesia effect was poor, dezocine 0.1mg/kg was intravenously injected.The mean artery pressure(MAP),heart rate(HR),respiratory rate(RR),visual ana-logue scale (VAS)score and mini mental state examination (MMSE)score were recorded at postoperative 2,6,24,48 h in 3 groups.Results The MMSE score in the group B was higher than that in the group A and C,the VAS score was lower than that in the group A and C,the difference was statistically significant(P <0.05).Postoperative MAP and HR in the group B were more sta-ble than those in the group A and C,the difference was statistically significant(P <0.05).RR in the group C was more fast and had smaller range than those in the group A and B,the difference was statistically significant(P <0.05).Conclusion Intercostal nerve block combined with hydromorphone hydrochloride intravenous analgesia can achieve better postoperative analgesic effect with sta-ble postoperative blood dynamics and low occurrence rate of early postoperative cognitive dysfunction.

Objective To investigate the influence of preemptive analgesia with Hydr- omorphone Hy-drochloride on postoperative cognitive function and inflammation cytokines in the elderly patients. Methods Ninety ASA I orⅡ elder patients were randomly divided in control group (C)and Hydromorphone Hydrochloride group(H) with 45 cases each. Hydromorphone Hydrochloride 2 mg was injected iv before induction of anesthesia in group H. Observed plasma concentrations of the CRP、 TNF-α and IL-6 at different time. Cognitive function was assessed by minimental state examination. Results Plasma the CRP、 TNF-a and IL-6 concentrations were lower and MMSE scales were higher in group H than in group C. Conclusion Preemptive analgesia with Hy-dromorphone Hydrochloride 2 mg can reduce the incidence of postoperative cognitive dysfunction in the elderly patients.

Objective To investigate the effects of preemptive analgesia with nalbuphine on inflammatory factors in elderly patients undergoing thoracotomy. Methods Eighty elderly patients with ASA I or Ⅱ undergoing thoracotomy were randomly allocated into control group (group C:n=40) and Nalbuphine group (group N:n=40). Each patient received 20 mg of Nalbuphine intravenously before induction of anesthesia in group N and same volume of normal saline in group C. Plasma levels of IL-10, TNF-α and IL-6 were measured at different time points. The VAS was recorded and the MAP, HR, SpO2 and PaCO2 were monitored. Results Compared with group C, the levels of TNF-α and IL-6 were lower, while IL-10 was higher at T2, T3, T4 in group N(P < 0.05). The VAS, MAP, HR and PaCO2 in group N were lower than those in group C at T2, T3 and T4 (P < 0.05). Conclusion Preemptive analgesia with Nalbuphine can improve the efficacy of postoperative analgesia and effectively reduce inflammatory reaction in the old patients undergoing thoracotomy.

Objective The purpose of this study was to investigate the protective effect of dexmedetomidine(DEX)on pathological car-diomyocyte hypertrophy.Methods An in vitro cell population was established in neonatal rats.The rats were divided into six groups:control group(C)without serum for 24 h,model group(A)with angiotensin Ⅱ(Ang Ⅱ)for 24 h,dexmedetomidine group(AD)with Ang Ⅱ+DEX(5μmol/L)for 24 h,C'group with serum-free culture for 48 h,A'group with Ang Ⅱfor 24 h,and AD'group with DEX+Ang Ⅱfor 24 h.The morphological changes of cells were observed by immunofluorescence.The protein expressions of atrial natriuretic peptide(ANP),brain natriuretic peptide(BNP),and myosin heavy chain(β-MHC)were detected by western blot,and the cell activity was detected by CCK-8.Results Compared with group C,the size of cells in group A was larger,and that in group AD was even more significant.Simi-lar observations were found for hypertrophy related proteins.Compared with group C,the expression of ANP,BNP,and βMHC increased in group A,although the increase in AD group was more obvious.CCK-8 detection showed that compared with group C,the activity of group A decreased and that of group AD increased significantly.Compared with the C'group,the expression of hypertrophy-related pro-tein in the A'group was significantly increased,but the expression of ANP and BNP protein in the AD'group was significantly lower than that in the A'group.The differences were statistically significant(P<0.05).Conclusion Dexmedetomidine can alleviate the occur-rence of pathological hypertrophy through compensatory mechanisms similar to physiological myocardial hypertrophy,and may play a role in myocardial protection.

ObjectiveTo determine the optimal dose of Dachengqi Decoction （大承气汤， DCQD） for the treatment of acute intestinal obstruction （AIO） through a randomized， double-blind， dosage parallel controlled， multi-center clinical trial， and to providee evidence support for the reasonable dosage of DCQD in clinical practice. MethodsBased on the commonly used clinical dose of DCQD， three different groups were set up， including low-dose group which used Dahuang （Radix et Rhizoma Rhei） 12 g， Houpo （Cortex Magnoliae Officinalis） 9 g， Zhishi （Fructus Aurantii Immaturus） 9 g， and Mangxiao （Natrii Sulfas） 4.5 g， medium-dose group using Dahuang 36 g， Houpo 27 g， Zhishi 27 g， Mangxiao 13.5 g， and high-dose group using Dahuang 60 g， Houp0 45 g， Zhishi 45 g and Mangxiao 22.5 g. Initially， 149 AIO patients with Yangming （阳明） bowel excess syndrome were randomly assigned to three groups using a stratified randomization method， and both the patients and the doctors were blinded. In addition to conventional western medicine treatment， each group was given 12 bags of granules made from the raw herbs of DCQD at different doses， taken orally or injected through a gastric catheter once every 6 hours， 3 bags each time， for 3 consecutive days. After treatment， the indicators of the three groups of patients with primary AIO and non-primary AIO were evaluated respectively， and the full analysis set （FAS） and per-protocol set （PPS） were used for analysis. The primary outcomes were the time to recover voluntary bowel movements and voluntary flatulence. The secondary outcomes were the ideal rate of spontaneous defecation and the ideal rate of spontaneous flatus. The occurrence of adverse events during the study was recorded and analyzed using the safety analysis set （SS）. ResultsA total of 91 patients with primary AIO and 58 patients with non-primary AIO were included in the FAS and SS analysis， while 80 primary AIO patients and 56 non-primary AIO patients were included in the PPS analysis. Both FAS and PPS analysis showed significant differences in the time to recover voluntary bowel movements and voluntary flatulence among primary AIO patients in different dose groups of DCQD （P＜0.01）， and the high- and medium-dose groups assumed less time than the low-dose group （P＜0.05）. There was no statistically significant difference in the ideal rate of spontaneous defecation and spontaneous flatus among the three groups （P＞0.05）. And consistent results were seen in the non-primary AIO patients among the three groups. Five adverse events occurred in primary AIO patients （3 in the low-dose group， 1 in the medium-dose group， and 1 in the high-dose group）， mainly manifested as abdominal distension and abdominal pain， and there was no statistically significant difference in the incidence of adverse events （P＞0.05）. No adverse events occurred in patients with non-primary AIO. ConclusionDCQD， as an effective treatment for patients with AIO， is commonly used at a medium dose for patients with primary AIO and at a high dose for patients with non-primary AIO. The therapeutic advantage is mainly reflected in the shorter time to recover spontaneous defecation and spontaneous flatulence and the improvement of intestinal function.

Objective To investigate the distribution and antimicrobial resistance profiles of the common pathogens isolated from urine from 2015 to 2021 in the CHINET Antimicrobial Resistance Surveillance Program.Methods The bacterial strains were isolated from urine and identified routinely in 51 hospitals across China in the CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021.Antimicrobial susceptibility was determined by Kirby-Bauer method,automatic microbiological analysis system and E-test according to the unified protocol.Results A total of 261 893 nonduplicate strains were isolated from urine specimen from 2015 to 2021,of which gram-positive bacteria accounted for 23.8％(62 219/261 893),and gram-negative bacteria 76.2％(199 674/261 893).The most common species were E.coli(46.7％),E.faecium(10.4％),K.pneumoniae(9.8％),E.faecalis(8.7％),P.mirabilis(3.5％),P.aeruginosa(3.4％),SS.agalactiae(2.6％),and E.cloacae(2.1％).The strains were more frequently isolated from inpatients versus outpatients and emergency patients,from females versus males,and from adults versus children.The prevalence of ESBLs-producing strains in E.coli,K.pneumoniae and P.mirabilis was 53.2％,52.8％and 37.0％,respectively.The prevalence of carbapenem-resistant strains in E.coli,K.pneumoniae,P.aeruginosa and A.baumannii was 1.7％,18.5％,16.4％,and 40.3％,respectively.Lower than 10％of the E.faecalis isolates were resistant to ampicillin,nitrofurantoin,linezolid,vancomycin,teicoplanin and fosfomycin.More than 90％of the E.faecium isolates were ressitant to ampicillin,levofloxacin and erythromycin.The percentage of strains resistant to vancomycin,linezolid or teicoplanin was＜2％.The E.coli,K.pneumoniae,P.aeruginosa and A.baumannii strains isolated from ICU inpatients showed significantly higher resistance rates than the corresponding strains isolated from outpatients and non-ICU inpatients.Conclusions E.coli,Enterococcus and K.pneumoniae are the most common pathogens in urinary tract infection.The bacterial species and antimicrobial resistance of urinary isolates vary with different populations.More attention should be paid to antimicrobial resistance surveillance and reduce the irrational use of antimicrobial agents.

Objective To understand the distribution and changing resistance profiles of clinical isolates of Enterococcus in hospitals across China from 2015 to 2021.Methods Antimicrobial susceptibility testing was conducted for the clinical isolates of Enterococcus according to the unified protocol of CHINET program by automated systems,Kirby-Bauer method,or E-test strip.The results were interpreted according to the Clinical & Laboratory Standards Institute(CLSI)breakpoints in 2021.WHONET 5.6 software was used for statistical analysis.Results A total of 124 565 strains of Enterococcus were isolated during the 7-year period,mainly including Enterococcus faecalis(50.7％)and Enterococcus faecalis(41.5％).The strains were mainly isolated from urinary tract specimens(46.9％±2.6％),and primarily from the patients in the department of internal medicine,surgery and ICU.E.faecium and E.faecalis strains showed low level resistance rate to vancomycin,teicoplanin and linezolid(≤3.6％).The prevalence of vancomycin-resistant E.faecalis and E.faecium was 0.1％and 1.3％,respectively.The prevalence of linezolid-resistant E.faecalis increased from 0.7％in 2015 to 3.4％in 2021,while the prevalence of linezolid-resistant E.faecium was 0.3％.Conclusions The clinical isolates of Enterococcus were still highly susceptible to vancomycin,teicoplanin,and linezolid,evidenced by a low resistance rate.However,the prevalence of linezolid-resistant E.faecalis was increasing during the 7-year period.It is necessary to strengthen antimicrobial resistance surveillance to effectively identify the emergence of antibiotic-resistant bacteria and curb the spread of resistant pathogens.

Objective To examine the changing antimicrobial resistance profile of Enterobacter spp.isolates in 53 hospitals across China from 2015 t0 2021.Methods The clinical isolates of Enterobacter spp.were collected from 53 hospitals across China during 2015-2021 and tested for antimicrobial susceptibility using Kirby-Bauer method or automated testing systems according to the CHINET unified protocol.The results were interpreted according to the breakpoints issued by the Clinical & Laboratory Standards Institute(CLSI)in 2021(M100 31st edition)and analyzed with WHONET 5.6 software.Results A total of 37 966 Enterobacter strains were isolated from 2015 to 2021.The proportion of Enterobacter isolates among all clinical isolates showed a fluctuating trend over the 7-year period,overall 2.5％in all clinical isolates amd 5.7％in Enterobacterale strains.The most frequently isolated Enterobacter species was Enterobacter cloacae,accounting for 93.7％(35 571/37 966).The strains were mainly isolated from respiratory specimens(44.4±4.6)％,followed by secretions/pus(16.4±2.3)％and urine(16.0±0.9)％.The strains from respiratory samples decreased slightly,while those from sterile body fluids increased over the 7-year period.The Enterobacter strains were mainly isolated from inpatients(92.9％),and only(7.1±0.8)％of the strains were isolated from outpatients and emergency patients.The patients in surgical wards contributed the highest number of isolates(24.4±2.9)％compared to the inpatients in any other departement.Overall,≤ 7.9％of the E.cloacae strains were resistant to amikacin,tigecycline,polymyxin B,imipenem or meropenem,while ≤5.6％of the Enterobacter asburiae strains were resistant to these antimicrobial agents.E.asburiae showed higher resistance rate to polymyxin B than E.cloacae(19.7％vs 3.9％).Overall,≤8.1％of the Enterobacter gergoviae strains were resistant to tigecycline,amikacin,meropenem,or imipenem,while 10.5％of these strains were resistant to polycolistin B.The overall prevalence of carbapenem-resistant Enterobacter was 10.0％over the 7-year period,but showing an upward trend.The resistance profiles of Enterobacter isolates varied with the department from which they were isolated and whether the patient is an adult or a child.The prevalence of carbapenem-resistant E.cloacae was the highest in the E.cloacae isolates from ICU patients.Conclusions The results of the CHINET Antimicrobial Resistance Surveillance Program indicate that the proportion of Enterobacter strains in all clinical isolates fluctuates slightly over the 7-year period from 2015 to 2021.The Enterobacter strains showed increasing resistance to multiple antimicrobial drugs,especially carbapenems over the 7-year period.