Objective To analyze P wave dispersion (Pd) and QT dispersion (QTd) of the patients with cononary heart disease (CHD) before and after percutaneous coronary intervention (PCI) and to evaluate the influence of Tongguan capsule on improving myocardial ischemia in vivo cardiac electrophysiology. Methods 60 CHD patients treated by PCI were divided into the trial group (Tongguan Capsule 4 weeks+ conventional western medicine) and control group (conventional western medicine) randomly. Pd and QTd/QTcd of two groups before and after treamtment were measured. Results Pd and QTd/QTcd of the trial group were obviously declined. The difference between two groups was marked. Conclusion The treatment of Tongguan Capsule can improve Pd and QTd/QTcd of the patients with CHD, which suggest Tongguan Capsule can improve myocardial ischemia.

Objective To evaluate the teaching method of three-stage learning(STL) in ICU's ventilation education.Methods 18 ICU interns and transferred doctors were taught with STL method in ventilation education.The teaching effect was evaluated.Results Doctors with STL method got better effect.Conclusion STL method is practical and suitable for ventilation teaching in ICU.

Acute myocardial infarction (AMI) is one of the most common cardiovascular diseases. The clinical pathway is the therapeutic program for disease-specific treatment and its implementation may reduce both the duration and cost of the hospital stay. This study aims to construct and evaluate the efficacy of clinical pathways (CPs) based on integrated traditional Chinese and Western medicine for patients with AMI.

Objective To observe the effect of Tongmai Capsules(TC) on high-sensitivity C-reactive protein(hs-CRP) in acute coronary syndrome(ACS) patients.Methods Fifty-four ACS patients were randomized into the treatment group(N=26) and the control group(N=28).The two groups were given routine treatment for coronary heart disease and the complications.Additionally,the control group was given the placebo,and the treatment group was given TC,the treatment lasting one month.The change of the symptom scores was observed before and after treatment,and the hs-CRP level at the admission day,on the 7th day of treatment and after treatment for one month was also detected.Results(1) The score of symptoms of ACS was improved to various degrees in both groups(P0.05) while was decreased in the treatment group(P

ObjectiveTo evaluate the clinical efficacy and safety of astragalus injection on the immune function in patients with senile sepsis.Methods Sixty patients with old age sepsis in Critical Care Medicine Department of Guangdong Provincial Traditional Chinese Medicine Hospital were enrolled and randomly assigned into control and treatment groups according to the table of random numbers, 30 cases in each group. According to 2012 sepsis guidelines for treatment, including antibacterial drug, mechanical ventilation, visceral function support, etc., the therapy was given to the control group; besides the treatment in the control group, intravenous drip of 60 mL astragalus injection(10 mL per ampoule) in 250 mL 0.9% normal saline was additionally given in the treatment group, once a day for 7 days. Before and after treatment, the immunological indexes, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment(SOFA) score, duration of mechanical ventilation and time of stay in intensive care unit(ICU), 28-day mortality and adverse drug reactions were compared between the two groups.Results Before treatment, there were no statistically significant differences in CD3+, CD3+CD4+, CD3+CD8+ and T helper cells /T suppressor cells(Th/Ts)levels between the two groups(allP>0.05), while CD3-NK+ of the control group was significantly higher than that in the treatment group〔(10.47±6.22)% vs. (6.26±4.13)%,P<0.05〕. After treatment in treatment group, CD3+, CD3+CD4+ and CD3-NK+ were increased, CD3+CD8+,Th/Ts were decreased compared with those before treatment; in the control group after treatment, CD3+,CD3+CD8+ and CD3-NK+ were decreased and CD3+CD4+ and Th/Ts increased compared with those before treatment. In the comparisons between the treatment group and control group after treatment, the differences in CD3+, CD3+CD4+ and CD3+CD8+ had statistical significance〔CD3+:(30.30±17.17)% vs.(41.91±22.29)%, CD3+CD4+:(31.54±13.24)% vs.(40.08±15.28)%, CD3+CD8+:(14.25±8.10)% vs.(9.52±9.33)%,allP<0.05〕; while the differences in Th/Ts and CD3-NK+ had no statistical significance(bothP>0.05). After treatment in the treatment group, IgG was increased compared with that in the control group〔IgG(g/L): 13.07±5.43 vs. 10.10±3.96,P<
0.05〕. The differences in IgA, IgM, complement(C3,C4) and total serum complement activity(CH50) in the comparisons between the two groups had no statistical significance after treatment(allP>0.05). The differences in APACHEⅡ score(13.83±6.18 vs. 15.90±7.48), SOFA score(7.38±4.66 vs. 6.89±4.19), time of stay in ICU(day: 11.63±5.13 vs. 13.62±8.08), invasive ventilation time(hour: 155.44±119.68 vs. 224.08±174.15) and noninvasive ventilation time(hour: 55.55±42.24 vs. 98.57±43.17) had no statistical significance in comparisons between the treatment group and control group after treatment(allP>0.05). The difference in 28-day mortality had no statistical significance in comparison between the treatment group and control group〔16.7%(5/30) vs. 20.0%(6/30),P>0.05〕. In 60 cases, there were 2 patients with adverse drug reaction, one diarrhea and another little rashes, the rest of the patients did not appear any drug side effect.ConclusionAstragalus injection combined with conventional western medicine therapy possibly has certain effect on adjustment of disturbance of immunologic functions in old patients with sepsis, and its therapeutic safety is well.

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/m2): 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), χ2 = 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), χ2 = 10.070, P = 0.002]. Conclusions Patients with sepsis shock may be divided into high-output and low-resistance & 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.

ObjectiveTo 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 evaluationⅡ (APACHEⅡ) score (r= 0.749,P= 0.000;r= 0.645,P= 0.000).Conclusions In patients with severe sepsis, there are hemodynamics disorders and effect in microcirculation perfusion. Xuebijing injection can improve hemodynamics and cardiac function in the patients with severe sepsis, and the mechanism may be related to the improvement of endothelial function.

Objective To analyze patients with acute chest pain as their chief complaint in order to improve our capability of early identifying and diagnosing high-risk patients,give them proper treatment in time and avoid misdiagnosis and improper treatment. Methods The clinical data of 813 patients with chest pain as their chief complaint admitted in the emergency department and critical care medicine department in Guangdong Provincial Traditional Chinese Medicine Hospital from January to December in 2011 were retrospectively analyzed. According to the process of diagnosis and treatment formulated by the chest pain center,all the patients must immediately finish the first electrocardiograph(EEC)examination in 10 minutes and the relevant blood biochemical examinations within 30 minutes after admission. Results In accordance with the relevant examinations,the confirmed diagnoses were as follows:there were 276 cases of unstable angina,accounting for 33.95%;145 cases of stable angina,17.84%;121 cases of acute myocardial infarction,14.88%;103 cases of respiratory system disease,12.67%;78 cases of skeletal muscle disease,9.59%;46 cases of the digestive system disease,5.66% and the high-risk non cardiac chest pain(such as aortic dissection/rupture of tumor or acute pulmonary embolism)12 cases,1.48%.Seven hundred and eighty-five patients finished the first EEC examination in 10 minutes,and 147 patients completed the chest computed tomography(CT)scan within an hour. Conclusions Acute chest pain is a common symptom in emergency department. It is necessary to identify the high-risk patients according to a process as soon as possible in order to get an accurate diagnosis and an effective treatment in time.

Objective To explore the effect and application of the clinical teaching method of stage-separated to targeted management in the comprehensive ICU. Methods ICU rotation learning plans were developed for 113 probationers and rotating physicians,who were given the training of stage-separated to targeted teaching. The program was divided into three stages based on corresponding teaching objective and comprehensive examination and assessment with combination the dynamic and static evaluation were carried out to three parts. Results The probationers and rotating physicians had significant improvement in the familiarity and mastery of ICU specialist knowledge and skills through the systematic training. Conclusion Such training program can effectively improve the ICU specialized quality and comprehensive ability of the probationers and rotating physicians and bring about better clinical teaching effect.

[Objective] To re-evaluate the diagnostic value of electrocardiogram (ECG) for coronary heart disease (CHD) by coronary arteriogram (CAG). [Methods] ECG and CAG in 375 cases preliminarily diagnosed as having CHD were analyzed. [Results] ECG was abnormal in 252 cases and normal in 123 cases; 278 cases were diagnosed as having CHD and 97 non-CHD by CAG. CHD was confirmed in 205 cases from 252 with abnormal ECG and in 73 cases from 123 with normal ECG. The sensitivity of ECG for CHD was 73.7% and the specificity was 51.5% , indicating that the changes of ECG having different diagnostic value for CHD (P