Objective To investigate the early prediction,diagnosis and treatment of thoracic injury complicated by adult respiratory distress syndrome (ARDS).Methods The blood gas,occurrence index of traumatic ARDS,pathogenic bacteria and drug sensitivity in ventilator associated pneumonia (VAP) were analyzed retrospectively in 18 cases of thoracic injury.Results The initial PaCO 2 was (32.1?5.2) mm Hg,PaO 2 (57.7?10.1) mm Hg,the occurrence index of traumatic ARDS (-29.00?11.50) and the mechanical ventilation time 6.4 days on average.Of the infective bacterium of VAP,gram negative bacterium took up 70.6%, gram positive bacterium 17.10%,fungus 12.30% and the mixed infection 31.60% with the total mortality of 16.6%.Conclusion The occurrence index of traumatic ARDS can be used as a parameter of the early prediction and outcome.Meanwhile multiple injuries and shock should be treated correctly,ventilator applied earlier and the mechanical ventilation time shortened.It suggests that more attention should be paid to the prevention of VAP and the reasonable use of antibiotic drugs.

Objective To investigate the effect of reformative ventilation method (head-high leg-low 30°-declivate prone position ) in the ventilation of acute respiratory distress syndrome ( ARDS ) patients, and compared with normal prone position ventilation. Methods Forty-four patients of ARDS underwent ventilation were divided into prone position group (22 cases) and reformative prone position group (22cases) by random digits talle. Continuous 30° semireclining position was kept in normal time. The patients of the two groups underwent different prone position ventilation 4 hours every day,and indexes of hemodynamics and respiration before,during and after prone position ventilation were recorded and analyzed. Results After prone position ventilation, oxygenation index of two groups improved similarly (P ＞ 0.05 ). In prone position group, lung compliance decreased [2 h, ( 25.6 ± 5.8 ) ml/cm H2O ( 1 cm H2O = 0.098 kPa) vs. ( 37.2 ± 20.5 )ml/cm H2O] ,average airway pressure increased [2 h, ( 18.5 ± 3.9) cm H2O vs. ( 15.6 ± 5.3 )cm H2O] ,heart rate increased [2 h, ( 112.0 ± 16.2 ) beats/min vs. ( 102.0 ± 11.3 ) beats/min], mean arterial blood pressure decreased [2 h, (86.0 ± 6.7) mm Hg ( 1 mm Hg = 0.133 kPa) vs. (93.5 ± 7.5 ) mm Hg] ,central venous pressure increased[2 h, ( 15.5 ± 3.3 ) cm H2O vs. ( 12.6 ± 4.3 ) cm H2O]. These changes persistently existed during prone position ventilation (P ＜ 0.05 ),and they disappeared in 1 hour when recovered to 30 °semireclining position. Conclusion Reformative prone position ventilation not only has same effect on improving oxygenation index, but also obviates adverse effect on lung compliance and hemodynamics.

Objective To compare the clinical efficacy of three kinds of replacement fluid for continuous hemofiltration in severe sepsis,and to develop a more rational composition.Methods Fifty severe sepsis patients with continuous hemofiltration were divided into four groups randomly.The configuration of the replacement fluid in accordance with the random number table,randomly selected from four different formulations:group A (13 cases):Ports composition provided by Nanjing general hospital;group B (12 cases):Zhongshan hospital composition; group C (11 cases):an improved composition; group D (14 cases):an improved composition by Donghua hospital affiliated to SUN Yat-sen university.Blood electrolytes,blood gas analysis,renal function,blood glucose(highest and lowest serum glucose in treatment period),high sensitive C-reactive protein(hs-CRP) concentration,calcium concentration in filter were tested before and after every treatment period.Results The concentration of blood electrolytes during treatment had no significant change (P ＞ 0.05).Renal function were improved significantly after treatment among four groups (P ＜ 0.05).The level of hs-CRP decreased significantly after treatment (P ＜ 0.05) and there was no significant difference among four groups (P ＞ 0.05).The change of serum glucose during treatment was the smallest in group D than that in group A,B,C [(3.0 + 0.9) mmol/L vs.(11.2 + 2.0),(3.8 + 1.1),(5.5 +1.3) mmol/L](P ＜ 0.05).Calcium concentration in filter was the lowest in group D than that in group A,B,C [(1.5 + 0.5) mmol/L vs.(2.0 + 0.7),(2.3 + 0.5),(2.1 + 0.4) mmol/L] (P ＜ 0.05).The dosage of heparin was the least during treatment in group D than that in group A,B,C[(6.5 ± 2.8) U/(kg·h) vs.(8.9 ± 3.4),(7.9 ± 3.0),(8.7 ± 3.1) U/ (kg· h)] (P ＜ 0.05).Conclusions Improved composition by Donghua hospital affiliated to SUN Yat-sen university hospital compared to other compositions can better maintain a stable blood glucose levels,have a better anticoagulant effect,reducing the application of heparin,maintain a stable homeostasis.It is worthy of using in clinic.

Objective To evaluate the degree of hypothermia cerebral resuscitation patients by acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and judge the prognosis,so as to prove the effectiveness of its application.Methods Data of 34 cases of patients with mild hypothermia cerebral resuscitation in ECIU or ICU were continuously observed,calculated the scores of APACHE Ⅱ and verify for establishing the regression model.Results The APACHE Ⅱ score was 20-47 (33.86 ± 5.12) scores.The APACHE Ⅱ score in 9 patients who were survived within 72 h was (27.83 ± 4.89) scores,and in 25 patients who were dead within 72 h was (35.56 ± 7.12) scores,there was significant difference (P ＜ 0.01).Logistic regression analysis showed that APACHE Ⅱ score was the risk factor (P ＜ 0.01).Conclusion APACHE Ⅱ score can be applied to evaluate the degree of mild hypothermia cerebral resuscitation and prognosis,it can guide the clinical decision making.