Objective:To discuss the effect of sequential invasive and non-invasive mechanical ventilation on severe organophosphate poisoning with respiratory failure(RF).Methods:A clinical retrospective analysis was carried out to investigate 32 cases of severe organophosphate poisoning with RF treated by sequential invasive and non-invasive mechanical ventilation in EICU.Results:Twenty-eight patients of thirty-two were cured(87.5%).Four patients developed intermediate syndrome(IMS),2 patients died(6.3%).Conclusion:Sequential invasive and non-invasive mechanical ventilation is an effective therapy on severe organophosphate poisoning with RF.Attention must be paid to acute respiratory failure(ARF) caused by IMS.

Objective To investigate whether the early use of tetramethylpyrazine(TMP) could improve the oxygenation ,reduce the rate of pulmonary lesion ,increase the survival rate and shorten the hospital days in the patients with severe acute pancreatitis (SAP) .Methods A total of 42 patients with SAP were randomly divided into the control (C) group(21 cases ,receiving the conven-tional treatment combined with the respiratory support treatment ) .The TMP group(21 cases ,receing the conventional treatment , respiratory support and TMP treatment ) .Results In the C group ,6 cases were intubated(28 .57% ) ,9 cases were acute respiratory distress syndrome(ARDS)(42 .86% ) ,the survival rate was 80 .95% ,the average hospitalization was (21 .6 ± 7 .3)d;in the TMP group ,3 cases were intubated(14 .28% ) ,6 cases were ARDS(28 .57% ) ,the survival rate was 85 .71% ,the average hospitalization was(17 .9 ± 6 .4)d .The survival rate had no statistical difference between the two groups (P>0 .05) .In addition ,the TMP group was superior to the C group in the average hospital days .Conclusion Eerly TMP interrention significantly reduced the rate of endo-tracheal intubation and the occurrence rate of ARDS ,shorten the hospital days ,but without increasing the survival rate .

Objective To study the protective effect of TMP(Tetramethylpyrazine) on LPS(Lipopolysaccharides)-induced inflammatory response of human type Ⅱ alveolar epithelial cells (HAECⅡ) and its corresponding mechanism.Methods HAECⅡ (A549 cells derived from human lung adenocarcinoma cells) were cultured in vitro.Inflammation model was established using A549 cells after LPS stimulation.TMP and FK866 (a specific inhibitor for pre-B cell colony-enhancing factor), were added to intervene respectively.Expression level of mRNA, inflammatory factors including tumor necrosis factor-α (TNF-α), interleukin-1β(IL-1β), interleukin-8 (IL-8) and PBEF(pre-B cell colony-enhancing factor) were detected by q-PCR and Western blot, respectively.The activation of NF-κB(Nuclear factor κB) was examined by Western blot to find the changes in phosphorylated P65 protein level in both nucleus and cytoplasm.Results Both the mRNA and protein level of TNF-α, IL-1β, IL-8 and PBEF in A549 cells were significantly higher after LPS stimulation than those in the control group(P<0.001).Meanwhile, the phosphorylation of P65 protein in the nucleus and cytoplas was higher(P<0.001).The expression of the aforementioned inflammatory factors and the phosphorylation of P65 protein were significantly lower after TMP inter-vention than those of LPS group(P<0.05).In comparison, after FK866 was added, the expression of TNF-α, IL-1β and IL-8 and the phosphorylation of P65 protein were also decreased(P<0.01).Conclusions TMP may be involved in the reduction of PBEF expression, which therefore inhibits NF-κB activation, antagonizes alveolar epithelial cell inflammatory response.

OBJECTIVE:To investigate the effects of Shenfu injection on hemodynamecs in patients after the success of cardiopulmonary resuscitation(CPR),and explore the protective effects of which on myocardial injury. METHODS: A total of 178 patients with return of spontaneous circulation in central intensive care unit were randomly assigned to receive 50 mL Shenfu injection iv gtt(group SF) or Mg-contained polarized solution(control group). Hemodynamic indexes were monitored,and serum myocardium enzymes(CK) and cardiac troponin I(CTn I) were determined simultaneously before and after treatment. RESULTS: Patients in both group presented with low blood pressure BP,low cardiac output and myocardial injury after CPR. In the treatment group compared with control group,the hemodynamic indexes were markedly improved,the cardiac pumping function,cardiac output,cardiac index,stroke volume and mean arterial pressure were all significantly increased,while serum CK,CK-MB,LDH,AST and CTn I levels were all decreased obviously after treatment.CONCLUSION: Shenfu injection can markedly improve hemodynamic indexes,enhance the myocardial contractile force,effectively decrease serum myocardium enzymes and repair the damage of myocardial cells caused by the myocardial ischemia and anoxemia after cardiac arrest in patients with return of spontaneous circulation after cardiac arrest.

OBJECTIVE:To evaluate the effect of Tanreqing injection on acute lung injury in patients undergoing noninvasive positive pressure ventilation(NIPPV).METHODS: 162 patients with acute lung injury were randomly assigned to receive Tanreqing injection plus NIPPV(treatment group) or NIPPV alone(control group).At 8,24,48 h of undergoing NIPPV,parameters such as patients' subjective symptoms,vital sign,blood gas analysis PaO2/FiO2 and NIPPV duration etc were recorded.RESULTS: In the treatment group compared with the control group,the mean duration of NIPPV was shorter(P

Objective To evaluate the safety of nasogastric tube feeding and nasojejunal tube feeding in early enteral nutrition treatment of acute pancreatitis.Methods Using key words,subject headings,and citation tracing,we searched literatures reporting randomised controlled trials on early enteral nutrition treatment of acute pancreatitis through nasojejunal tube and nasogastric tube in the following databases:PubMed,Embase,Cochrane library,Wanfang,China National Knowledge Infrastructure (CNKI),and VIP published since the founding of the databases up to 2016.Meta-analysis was performed with the selected literature.Results Seven randomised controlled trials with 367 patients were included.Meta-analysis showed that the nasogastric tube group was not inferior to the nasojejunal tube group in the incidence of recurrent abdominal pain,gastrointestinal adverse reaction,the total length of hospital stay,and mortality.Conclusion Enteral nutrition via nasogastric tube is safe and well tolerated,may be a safe approach of nutrition treatment for acute pancreatitis.

Physiology is the main course in the education of preclinical medicine.And the functional experiment education is one of the important ingredients in it.The teaching style should be open,the students capability of independent thoughts should be raised and at the same time their precise scientism and cooperation spirit should be cultivated following the basic outline of teaching.

Objective To investigate the clinical effect of digital multifunction trauma rinser(DMTR) on wound cleaning .Meth-ods 278 trauma patients from 6 hospitals were divided into groups by hand washing and DMTR .The cleaning time ,the amount of cleaning fluid and the effects of wound cleaning and bacterial clearance and healing were compared between the two groups .Results DMTR save time ,reduced the amount of cleaning fluid ,reduced residual bacteria ,and had better wound healing in patients with large wound area .Conclusion DMTR ,which is worthy of clinical application ,has better effect on cleaning large wounds than the traditional manual debridement w ay .

Teaching of Critical Care Medicine faces several challenging issues includingcomprehensive intensive or specialist intensive, approach of curriculum, tralning of team working ability, building of teaching platform and teaching staff. Critical care medical education requires the concept of viewing the discipline as a whole. Under its guidance and with the opportunity of critical care medical subspecialties building, critical care medical education should focus on bothcompre-hensive critical care and specialist critical care, and have rational planning of Critical Care Medicine course. Through the construction and integration of ICU, we should create a comprehen-sive clinical practice platform of critical care medicine to carry out clinical practice and team work tralning. Meanwhile, construction of quality critical care medicine faculty should be based on its pro-fessional features.

Objective To investigate the application value of double-tube gastrostomy in the duodenal rupture repair.Methods The retrospective cohort study was adopted.The clinical data of 41 patients who underwent duodenal rupture repair at the Chongqing Emergency Medical Center from January 2005 to January 2015 were collected.Twenty-five patients using Hassan triple-tube gastrostomy technique between January 2005 and December 2009 were divided into the triple-tube (TT) group and 16 patients using double-tube gastrostomy technique between January 2010 and January 2015 were divided into the double-tube (DT) group.Duodenal rupture repair included suture repair,pedicled ileal flap to repair duodenal defect and end to end anastomosis.Patients underwent the regular treatments of anti-infection,antishock,somatostatin inhibition,nutritional support and complications prevention.Patients were injected with 500 mL/d nutrient solution using enteral nutritional tube from 48 hours after operation,and then dosage was gradually increased to total enteral nutrition and digestive juices collected from drainage fluid were transfused to enteral nutritional tube.The postoperative complications (duodenal fistula,intraperitoneal infection,incision infection,pulmonary infection and intestinal obstruction),operation method,operation time,volume of blood loss,euteral nutritional tube removal time and duration of hospital stay were observed.Measurement data with normal distribution were presented as x ± s and comparison between groups was analyzed using an independent sample t test.Comparison of count data was analyzed using chi-square test or Fisher exact probability.Results All the 41 patients underwent duodenal rupture repair,including 28 using suture repair of duodenal rupture,8 using pedicled ileal flap to repair duodenal defect and 5 using end to end anastomosis,with the intraoperative duodenal decompression and placement of intestinal feeding tube.The operation time was (184 ± 38)minutes in the TT group and (153 ± 37)minutes in the DT group,with a significant difference between the 2 groups (t =2.566,P ＜0.05).The volume of intraoperative blood loss was (1 112 ± 707)mL in the TT group and (1 011 ± 595)mL in the DT group,with no significant difference between the 2 groups (t =0.476,P ＞ 0.05).The proportions of duodenal fistula,intraperitoneal infection,incision infection and pulmonary infection in the TT and DT groups were 3/25 and 1/16,8/25 and 5/16,9/25 and 4/16,10/25 and 6/16,respectively,showing no significant difference between the 2 groups (x2=0.003,0.545,0.026,P ＞ 0.05).Eleven patients were complicated with postoperative early intestinal obstruction,including 10 (3 with partial duodenal stenosis and 7 with incomplete small intestinal obstruction) in the TT group and 1 (partial duodenal stenosis) in the DT group,showing a significant difference in the incidence of postoperative early intestinal obstruction between the 2 groups (P ＜ 0.05).Patients with early intestinal obstruction had remission after conservative treatment of gastrointestinal decompression and fasting.The time of intestinal feeding tube indwelling and duration of hospital stay were (25 ±9)days and (29 ± 9)days in the TT group,(19 ± 9)days and (23 ± 8) days in the DT group,with significant differences between the 2 groups (t =2.188,2.120,P ＜ 0.05).Conclusion Double-tube gastrostomy technique for duodenal rupture repair can simplify the operation procedures and reduce operation time,recovery time and risk of postoperative intestinal obstruction,with a reliable efficacy.