Objective To investigate the application effect of nasojejunal feeding tube nutrition in patients with severe traumatic brain injury. Methods The clinical data of 54 patients with severe traumatic brain injury admitted to the Department of Surgical Critical Care Medicine,the Third Affiliated Hospital,Sun Yatsen University between June 2012 and December 2014 were analyzed retrospectively. They were divided into either a nasojejunal feeding tube nutrition support group (nasojejunal group,n = 26)or an asogastric feeding tube nutrition support group (asogastric group,n = 28)according to the different ways of enteral nutrition. All patients began to receive nasal feeding whole protein preparations (enteral nutritional emulsion,TPF-D)from the second day after admission to intensive care unit (ICU). The time to reach the enteral nutrition support target,the time of parenteral nutritional support,nutritional index (albumin and hemoglobin),the time admission to ICU,and the incidences of infection and gastrointestinal complications in both groups were observed. Results (1)According to the body weight to calculate calorie demand, the nasojejunal group reaching the time of enteral nutrition support target was faster than that of the asogastric group (3. 0 ± 0. 8 d vs. 7. 7 ± 2. 5 d). There was significant difference between the 2 groups (P < 0. 01). The time of the combined parenteral nutrition support in the nasojejunal group was reduced significantly compared with the asogastric group (2. 0 ±0. 8 d vs. 6. 7 ±2. 5 d). There was significant difference between the 2 groups (P <0. 01). (2)At day 30after treatment,the levels of total serum protein and hemoglobin in the nasojejunal group were higher than those of the asogastric group (64 ± 6 g/ L vs. 61 ± 6 g/ L and 120 ± 17 g/ L vs. 106 ± 16 g/ L,respectively. There were significant differences (P < 0. 05). (3)The mean length of stay in the ICU was obviously shorter in nasojejunal group compared with the asogastric group (11 ± 5 d vs. 14 ± 6 d). There was significant difference between the 2 groups (P < 0. 05). (4)There were no significant differences in complications of the patients,such as the incidences of pulmonary infection,hyperglycemia,and diarrhea between the 2 groups (P > 0. 05). Conclusion Nasojejunal feeding tube nutrition support may be faster to achieve the target of enteral nutrition supports and shorten the time in ICU.

Liver transplantation has become the most effective treatment of end-stage liver disease. Nursing care for enhanced recovery is safe and effective in the management after liver transplantation, which is conducive to the early recovery of body function of the recipients. In this article, relevant literature review was conducted to summarize the standard operation procedure (SOP) of nursing care for enhanced recovery after liver transplantation from the postoperative vital signs and fluid temperature management, gastrointestinal function and nutrition management, early grading activities, sedation, analgesia and sleep management, infection prevention and control, etc.

Objective To investigate the effect of human umbilical cord mesenchymal stem cells (HUC-MSCs) on CD4+T cells in liver after hepatic ischemia-reperfusion injury (HIRI) in mice. Methods Two hundred and twenty-five mice were randomly divided into sham group, control group and MSC group, with 75 mice in each group. HIRI model mice were used in MSC group and control group. HUC-MSCs were injected in MSC group through inferior vena cava. Normal saline was injected in control group through inferior vena cava. Only laparotomy and abdominal closure were performed in sham group without blood vessel clipping. At 6, 12 and 24 h after operation, 15 mice of each group were randomly selected to sample eyeball blood and liver tissues, and the 30 mice left in each group were used to extract intrahepatic mononuclear cells. The number of intrahepatic mononuclear cells, percentage, number and positive rate of CD4+T cells in the mice of various groups at different time points were compared. The content of interleukin (IL)-17 in serum and liver tissue as well as expression levels of costimulatory molecules B7-1 and B7-2 messenger RNA (mRNA) in liver tissues of the mice at different time points were compared. Results At 12 and 24 h after operation, the number of intrahepatic mononuclear cells of control group was significantly higher than that of sham group, while the number of intrahepatic mononuclear cells of MSC group was significantly lower than that of control group (P<0.01-0.05). At 6, 12 and 24 h after operation, the percentage, number and positive rate of CD4+T cells of control group were significantly higher than those of sham group (all P<0.01), while the percentage of CD4+T cells of MSC group was significantly lower than that of control group (P<0.01-0.05). At 12 and 24 h after operation, the number and positive rate of CD4+T cells of MSC group were significantly lower than those of control group (P<0.01-0.05). At 6, 12 and 24 h after operation, the IL-17 contents in serum and liver tissues of control group were higher than those of sham group (all P<0.01), while the IL-17 contents in serum and liver tissues of MSC group were lower than those of control group (all P<0.01). At 6 h after operation, the mRNA expression level of B7-2 of control group was higher than that of sham group (P<0.05). At 12 and 24 h after operation, the mRNA expression levels of B7-1 and B7-2 of control group were higher than those of sham group (all P<0.01), while the mRNA expression levels of B7-1 and B7-2 of MSC group were lower than those of control group (all P<0.01). Conclusions HUC-MSCs inhibits the number of CD4+T cells and the secretion of IL-17 in liver after HIRI, as well as decreases the number of intrahepatic mononuclear cells and the mRNA expression of B7-1 and B7-2, thereby alleviating HIRI.

Liver transplantation(LT)is the only effective treatment for hepatopulmonary syndrome(HPS).Moreover,perioperative refractory hypoxemia(pRH)is a prevalent life-threatening condition and has extremely limited treatment options.Here,we report three patients with HPS who experienced pRH after LT and were consecutively treated with different salvage therapies,ephedrine inhalation,intravenous use of methylene blue with nitric oxide(NO)inhalation,and NO inhalation alone.The results showed that unresolved severe hypoxia may induce fatal morbidity such as early biliary leakage and acute kidney injury.Early initiation of NO inhalation,rather than ephedrine,can significantly improve oxygenation in patients with pRH and may help prevent hypoxia-related complications.Therefore,based on the response to these exploratory salvage treatments,we further demonstrate the unique ventilation-perfusion mismatch pathophysiology in specific lung regions during pRH in HPS.We propose that early inhalation of NO is an important treatment option to rescue severe hypoxia in patients with HPS during the perioperative period of LT.

ObjectiveTo investigate the application value of perioperative intensive airway management in prevention of lung infection after liver transplantation (LT).MethodsClinical data of 914 patients undergoing LT in the Third Afifliated Hospital of Sun Yat-sen University between January 2004 and September 2014 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. All patients were transferred into ICU after LT. According to whether the intensive airway management was performed during the perioperative period, the patients were divided into the group with airway management (the study group) and the group without airway management (the control group). Among the 170 patients of study group, 152 were males and 18 were females with the average age of (48±11) years old. Among the 744 patients of control group, 655 were males and 89 were females with the average age of (49±12) years old. The measures of intensive airway management included the basic nursing of strengthening back-slapping for excreting phlegm and respiratory function exercise,maintaining gastrointestinal decompression and clear drainage, preventing aspiration, moistening airway, aseptic suction, also included reducing the use of ventilator, giving aerosol inhalation of budesonide and ambroxol within 12-24 h after anesthetic awareness, performing sputum suction by ifberoptic bronchoscopy when necessary to ensure sputum excretion from airway. The incidence of lung infection and mortality within 1 month after LT of the two groups were compared. The infection incidence and mortality between two groups were compared using Chi-square test.ResultsThe incidence of lung infection of study group was 17.1% (29/170), which was significantly lower than 28.9% (215/744) of control group (χ2=9.91,P<0.05). The mortality 1 month after LT of study group was 4.1% (7/170), which was signiifcantly lower than 10.1%(75/744) of control group (χ2=6.03,P<0.05).ConclusionPerioperative intensive airway management can signiifcantly reduces the incidence of perioperative lung infection and mortality after LT.

Objective To investigate the rationality and efficacy of enhanced recovery after surgery (ERAS) in liver transplant recipients. Methods Clinical data of 465 liver transplant recipients were retrospectively analyzed. All recipients were divided into the ERAS group (n=163) and control group (n=302) according to whether they received ERAS. The severity of disease in the ERAS group was worse than that in the control group. Operation situations including the operation time, anhepatic phase and intraoperative blood transfusion volume of the liver transplant recipients were observed and recorded. Postoperative recovery conditions including the length of intensive care unit (ICU) stay, total length of hospital stay, total ventilator removal time at postoperative 28 d and postoperative re-intubation rate were recorded. The survival rates at 90 d, 180 d and 1 year after liver transplantation were calculated. The influencing factors of survival rate of liver transplant recipients were analyzed. Results The anhepatic phase in the ERAS group was 45 (39, 53) min, significantly longer than 40 (32, 48) min in the control group (P < 0.05). The volume of erythrocyte infusion in the ERAS group was 10 (7, 13) U, significantly less than 18 (10, 28) U in the control group (P < 0.05). The length of postoperative ICU stay and total length of hospital stay in the ERAS group were 135 (84, 212) h and 24 (18, 33) d, significantly shorter than 154 (103, 253) h and 34 (20, 50) d in the control group (both P < 0.05). Total ventilator removal time at postoperative 28 d was 26 (25, 27) d, significantly longer than 26 (23, 27) d in the control group (P < 0.05). The postoperative re-intubation rate in the ERAS group was 11.0%, significantly lower than 20.8% in the control group (P < 0.05). The 90 d, 180 d and 1-year survival rates in the ERAS group were 92.8%, which were significantly higher than 81.1%, 78.1% and 75.7% in the control group (all P < 0.05). ERAS and operation time were the independent influencing factors of survival rate of liver transplant recipients (both P < 0.05). Conclusions ERAS after liver transplantation can improve the survival rate of recipient, shorten the length of hospital stay, reduce the re-intubation rate and accelerate the rehabilitation after liver transplantation.

Objective To summarize the treatment experience of sepsis after liver transplantation.Methods The clinical features and treatment methods of 1 patient developing sepsis after liver transplantation, who was admitted and treated in the Surgical Intensive Care Unit of the Third Affiliated Hospital of Sun Yat-sen University in September 201 4,were retrospectively studied.The interpretation of International Guidelines for Management of Severe Sepsis and Septic Shock (SSC Guidelines)and relevant literature were reviewed.Results One male patient at the age of 50 years old developed high fever and decrease of blood pressure at 1 d after liver transplantation,and was diagnosed as septic shock.The symptoms were relieved after the appropriate treatment like goal-directed fluid resuscitation,anti-infection and blood purification,etc.And the patient was discharged in stable conditions.Conclusions It is easy to develop infection after liver transplantation and the fatality rate of sepsis caused by infection is high.Once the sepsis occurs,clinicians must perform early goal-directed therapy and bundle therapy according to the SSC Guidelines positively,and select the appropriate drugs according to the pathogen culture results in order to reduce the fatality rate.

Objective:To evaluate the immunogenicity and immune persistence of purified Vero cells rabies vaccine (PVRV) with Zagreb and Essen regimen.Methods:Prospective study: Patients with first Class II exposure to rabies were recruited from the Dog Injury Cinic of Guangxi Center for Disease Control and Prevention (Guangxi CDC) and randomly divided into the Zagreb (2-1-1) and Essen (1-1-1-1-1) regimen group. All patients were inoculated with the vaccines from the same manufacturer and batch, and 3 ml serum was collected at the 45th day and in 1-year, 2-year and 3-year after immunization. Rapid fluorescent inhibition test (RFFIT) was used to detect rabies virus neutralizing antibody (RVNA). The attenuation of RVNA positive rate and geometric mean titer (GMT) with time was analyzed. Retrospective study: The informed consents for rabies vaccine in the Dog Injury Clinic of Guangxi CDC were checked out. The patients who were injected with PVRV (same manufacturer but unlimited batch) but without passive immune agents for the first time within 3 years were selected and divided into 1-year, 2-year and 3-year group. Each group was further divided into Zagreb and Essen regimen group. The serum (3 ml) was collected at 1 year, 2 years and 3 years after immunization and detected the RVNA by RFFIT.Results:Prospective study: The RVNA positive rates on the 45th day and in 1-year, 2-year and 3-year after immunizationin in the Zagreb and Essen regimen group were 100%, 95%, 85%, 80% and 98.25%, 89.47%, 89.47%, 85.96%, respectively. There was no statistically significant difference in the RVNA positive rates at the same time point between the two regimen groups ( P>0.05). The RVNA GMT on the 45th day and in 1-year, 2-year, and 3-year in the Zagreb and Essen regimen group were 11.32 IU/ml, 1.69 IU/ml, 1.30 IU/ml, 1.30 IU/m and 13.18 IU/ml, 2.13 IU/ml, 1.87 IU/ml, 1.84 IU/m, respectively. There was no significant difference in the RVNA GMT levels at the same time point between the two regimen groups ( F=1.971, P=0.164). The RVNA GMT levels in the two regimen groups had the same trend of attenuation over time (time*group F=0.702, P=0.435). Retrospective study: The RVNA positive rates in 1-year, 2-year and 3-year after immunization in the Zagreb and Essen regimen group were 100%, 95%, 91.43%和94.73%, 86.21%, 87.5%, respectively. There was no statistically significant difference in the RVNA positive rates at the same time point between the two regimen groups ( P>0.05). The RVNA GMT in 1-year, 2-year, and 3-year groups after immunization in the Zagreb and Essen regimen group were 2.65 IU/ml, 2.03 IU/ml, 1.57 IU/ml和3.2 IU/ml, 2.58 IU/ml, 2.45 IU/ml, respectively. There was no significant difference in the RVNA GMT levels at the same time point between the two regimen groups ( P>0.05). Conclusions:The PVRV showed the same excellent immunogenicity and immune persistence after the vaccination with the Zagreb and Essen regimens.

Objective To investigate the therapeutic effect and safety of plasma exchange in the treatment of patients with severe liver disease in pregnancy. Methods Clinical data of 28 patients with severe liver disease in pregnancy in Surgical Intensive Care Unit (SICU), the Third Afifliated Hospital of Sun Yat-sen University from March 2009 to October 2013 were analyzed retrospectively. According to the therapeutic schedule, the patients were divided into treatment group (n=12, age range:21 to 28 years old, median age:25 years old) and control group (n=16, age range:18 to 29 years old, median age:24 years old). The informed consents of all patients were obtained and the ethical committee approval was received. All patients were transferred to SICU after childbirth and received treatments of anti-infection, anti-virus, liver protection, reducing jaundice, supplying human albumin and gamma globulin, infusing blood coagulation and so on. And patients in treatment group received the treatment of exchange of homotype fresh plasma on the basic of the above treatments. The differences between 2 groups in clinical examination indicators and therapeutic effect were compared. The adverse reactions after plasma exchange in treatment group were observed. The examination indicators of 2 groups were compared using t test and the ratios were compared using Chi-square test. Results The blood total bilirubin (TB), albumin (ALB) , serum creatinine (Scr), fasting blood glucose (FPG) , prothrombin time activity (PTA) and arterial lactic acid (Lac) were (197±69)μmol/L, (30±7)g/L, (111±42)μmol/L, (5.7±2.4)mmol/L, (55±24)%, (2.3±0.6)mmol/L respectively in treatment group and were (299±113)μmol/L, (24±6)g/L, (165±82)μmol/L, (3.7±1.7)mmol/L, (33±11)%, (4.4±1.5)mmol/L respectively in control group. The indicators in treatment group were signiifcantly improved compared with those in control group (t=-3.453, 2.389,-4.892, 2.798, 6.079, -3.339; P<0.05). The effective rate in treatment group (92%,11/12) was signiifcantly higher than that in control group (56%,9/16) ( χ2=4.215, P<0.05). One case in treatment group suffered transitional hypotension after plasma infusion and the blood pressure returned to normal 1 h later after giving a small dose of vasoactive drugs. Conclusions Plasma exchange can improve the clinical examination indicators and therapeutic effect of patients with severe liver disease in pregnancy. It is a safe and effective treatment.

ObjectiveTo investigate the effects of early enteral nutrition on the recovery of patients with severe hepatitis after liver transplantation (LT).MethodsThirty-two patients with severe hepatitis undergoing allogeneic orthotopic LT in the Third Affiliated Hospital of Sun Yat-sen University between June 2012 and April 2014 were included in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients were randomized into the enteral nutrition group and the parenteral nutrition group according to the random number table method. Among the 14 patients in the enteral nutrition group, all patients were males with the average age of (42±9) years old. Among the 16 patients in the parenteral nutrition group, 14 were males and 2 were females with the average age of (44±10) years old. Patients in the enteral nutrition group were given warm water and lactulose through gastro-jejunal tube 1 d after LT. Enteral nutritional suspension was offered 2 d after LT and gradually increased to 1 000 ml/d, meanwhile, parenteral nutrition was reduced gradually. Patients in the parenteral nutrition group were given parenteral nutrition. Patients in both groups started normal diet after full recovery of the intestinal function. Venous blood was collected before LT and 1, 10 d after LT to examine hepatic and renal function. The recovery of gastroenteric function, hepatic and renal function and incidence of infection were observed 2 weeks after LT. The comparison of the observed indexes of two groups was conducted usingt test or rank-sum test and the rate comparison was conducted using Fisher's exact test.Results The postoperative recovery time of gastroenteric function of the enteral nutrition group was (6.1±1.4) d, which was significantly shorter than (10.6±3.8) of the parenteral nutrition group (t=-4.21,P<0.05). The median ALT, AST, TB, prealbumin and blood urea-nitrogen (BUN) in the enteral nutrition group 10 d after LT were respectively 106 (50-163) U/L, 62 (27-135) U/L, 67 (35-116) μmol/L, 201 (105-389) mg/L and 12.5 (6.4-18.8) mmol/L, and those in the parenteral nutrition group were respectively 276 (46-716) U/L, 119 (33-447) U/L, 131 (89-391) μmol/L, 162 (103-238) mg/L and 26.1(12.9-37.6) mmol/L. Signiifcant difference was observed (Z=-3.76,-3.15,-4.01, 2.93,-3.79;P<0.05). The incidence of infection of the enteral nutrition group 2 weeks after LT was 43% (6/14), which was signiifcantly lower than 69% (11/16) of the parenteral nutrition group (P<0.05). ConclusionCompared with parenteral nutrition, early enteral nutrition after LT may promote the recovery of gastroenteric function, improve the hepatic and renal function and nutritional situation and reduce the incidence of postoperative infection, which is beneficial to postoperative recovery.