OBJECTIVE To study the alteration of microbial population distribution in intensive care unit (ICU) for the reference to clinical drug administration. METHODS The distributed features of 413 strains of infection germs detected among the patients of ICU were statistically analyzed during the years of 2002 to 2005. RESULTS The main germs of 413 strains were Pseudomonas aeruginosa(87 strains), Acinetobacter baumannii(48 strains), Stenotrophomonas maltophilia(34 strains), Staphylococcus epidermidis(30 strains), S. aureus (20 strains) and Escherichia coli (19 strains). The first 3 species were P. aeruginosa (21.07%), A. baumannii(11.62%) and Sten. maltophilia (8.23%). CONCLUSIONS Most pathogens in ICU are Gram-negative bacteria and the proportion of Sten. maltophilia increases gradually. It is a very important clinical value to inspect the bacterial distribution and antibiotics should be used rationally.

Objective A stable rat model of heat stroke was established to investigate heat stroke-induced changes of the intestinal epithelial tight junction (TJ) barrier permeability, and to investigate the mechanism by observing the changes of TJ protein (occludin) expression and TJ morphology. Methods SD rats were randomly divided into two groups(n = 10): heat stroke group and normal control group. Stable model of heat stroke was established. Anesthetized rats were exposed to 42 ℃ in a ventilated chamber for 50min, after heat exposure, the rats were placed in room temperature(26 ℃ ) for 2 h. Then the rats were sacrificed and samples were taken. The effect of heat stroke on intestinal epithelial barrier permeability was observed through changes of plasma FD4 and endotoxin concentration, cytokines concentration was detected as inflammatory indicators. The general and micro pathology was observed by light microscope (hematoxylin and eosin-staining, HE staining) and transmission electron microscope (TEM). Occludin expression was investigated by Western bloting and immunochemistry. Results At 2 h after heat exposure, intestinal epithelial barrier permeability( FD4 and endotoxin concentration), and cytokines levels of heat stroke group were significantly higher than normal control group(P ＜ 0. 05 ). In morphology, by observing the light micrographs of HE jejunal tissue, the sloughing of epithelium off the basement membrane at the villus tips of the heat stroke group compared with the normal controlgroup. In many visual fields (VF)( ≥6VF/slice), this phenomenon was not universal. Under TEM, TJ of normal enterocytes was integrated with the compact zonal structure. At 2 h after heat exposure, TJ of heat stroke group was broken with widen intercellular space, and the density of TJ was decreased. In immunochemistry assay, the positive signal was distributed along the cell membrane in normal small intestinal tissue, while the signal was obviously decreased in heat stroke group.The results of Western bloting showed that occludin expresion of heat stroke group was significantly lower than normal control group(P ＜0.05). Conclusion Heat stroke decreased occludin expression, opened the intestinal epithelial TJ, which destroyed intestinal epithelial tight junction barrier, induced high intestinal epithelial barrier permeability, produced endotoxemia and systemic inflammatory response syndrome (SIRS).

Fluid overload is frequently found in patients with intravenous fluid resuscitation,and recent studies showed the potential risks of fluid overload for organ failure and mortality.To avoid volume overload and its associated complications,strategies to identify fluid responsiveness are necessary.Apart from the amount of fluid utilized for resuscitation,the type of fluid used also impacts patient outcome.In recent years,there has also been an increasing focus on comparing various resuscitation fluids with respect to both benefits and risks.In this article,through analyzing the impact of fluid overload on patient outcome,we describe the differences in static and dynamic estimates of fluid responsiveness,and review the current literature regarding choice of intravenous fluids for resuscitation in critically ill patients to help clinicians to make appropriative decision on intravenous fluids prescription and to optimize patient outcome.

Objective To investigate the pathogenic bacteria types and distribution characteristics of critical patients with lower respiratory tract infection in neurosurgery department,and to analyze the high risk fac?tors of lower respiratory tract infections. Methods A retrospective analysis of 80 cases of critical patients with lower respiratory tract infection in neurosurgery department of General Hospital of People Liberation Army from April 2013 to April 2014 was carried out. The pathogenic bacteria types and distribution characteristics of lower respiratory tract infection were analyzed by means of bacterial identification,and single factor and multi factor Lo?gistic regression analysis was carried out to analyze the related factors of lower respiratory tract infection.Results One hundred and thirty?four strains of pathogenic bacteria were cultured from sputum of 80 cases of patients. Among which the gram negative bacteria were 109 strains,accounting for 81.34%(109/134),while the Gram positive bacteria were 17 strains,accounting for 12.69%(17/134) and the fungi were 2 strains,accounting for 1.49%(2/134).The proportion of three kinds of pathogenic bacteria had statistical significance(P=0.004, 0.001). The single factor Logistic regression analysis showed that,younger age,use of ventilator,use of antimi?crobial drugs and pulmonary infection rate were protective factors of lung infection(OR(95%CI)=0.586(0.475-0.722),0.708(0.574-0.873),0.827(0.697-0.981);P=0.043,0.007,0.000);disturbance of consciousness, tracheotomy,insert gastric tube, surgery and pulmonary infection incidence were risk factors for lung infection (OR(95%CI)=4.769(1.069-21.276),11.612(5.438-24.792),22.989(19.385-27.263),10.426(8.789-12.361);P=0.001,0.008,0.005,0.002).The multi factor Logistic regression analysis showed that there was a significant correlation between the trachea incision, the consciousness and the lower respiratory tract infection (OR(95%CI)=4.627(2.143-20.645),10.412(2.334-46.455);P=0.009,0.002).Conclusion Patients with conscious disturbance and tracheotomy were more likely to have lower respiratory tract infections. The pathogens of lower respiratory tract infections are Gram?negative bacteria,and the majority of pathogens are high resistance, and it is multi drug resistance.

Sepsis is a serious problem among the elderly population as its incidence and mortality rates dramatically increase with advanced age. More importantly, the elderly has increased vulnerability to developing sepsis due to diminished physiologic reserve, presence of comorbidities, immunosenescence and frequent instrumentation. Those who survive severe sepsis are more likely to have irreversible organ damage, cognitive impairments, and diminished overall function. Additionally, elderly patients with sepsis often present with atypical symptoms which further complicates and potentially delays diagnosis. Although sepsis is a serious life-threatening disease, recognition of this problem is very low compared to other age-associated diseases. Therefore, the purpose of this review is to analyze the challenges facing this cohort and how to optimize their management.

Objective To study the therapeutic action of SHENFU (ginseng-aconite) injection on post-operation of liver transplantation. Methods From Jan. 2004 to Mar. 2005, 30 cases underwent orthotopic liver allotransplantation were divided into two groups randomly. The patients in control group received routine transfusion, while the patients in SHENFU injection group, besides the routine transfusion, received SHENFU injection as well. Results 120 minutes after the SHENFU treatment, the mean arterial pressure (MAP) of the patients was raised from 53.21?8.52mmHg to 75.62?7.58mmHg, meanwhile the heart rate (HR) declined from 115.3?13.2/min to 90.1?7.2/min. At the same time, the contents of lactic acid, IL-6, IL-8 and TNF-? in the patients also declined from 9.82?3.96mmol/L, 89.02?43.75pg/ml, 58.24?33.61 pg/ml and 42.33?28.15pg/ml to 4.31?2.11mmol/L, 30.08?25.12pg/ml, 29.83?20.05pg/ml and 24.52?15.61pg/ml, respectively. Compared with the control group, there existed significant differences (P

Objective To study the curative effect of continuous renal replacement therapy (CRRT) to the patients with acute renal failure after liver transplantation. Methods From Mar. 2004 to Jan. 2005, the continuous renal replacement therapy was applied to 7 patients with acute renal failure after liver transplantation. The average time of CRRT was 36.1h. The volume of fluid displacer during CRRT was 2-4L/h and the volume of blood flow was 150～250ml/min. Normal heparin was used as anticoagulant. Results For the 7 patients, 4 improved, 2 died. The contents of blood urea nitrogen (BUN) and blood Cr of all the 7 patients have obviously declined(P0.05). The haemodynamic variables were stabilized during CRRT and no obvious side-effect related to CRRT was found. Conclusions CRRT improved the prognosis to the patients with acute renal failure after liver transplantation, showed a favorable tolerance, and may be applied as a emergency measure to the patients with acute renal failure.

Objective To investigate the etiopathogenesis of exertional heat stroke(EHS)induced by military training of those patients admitted in military hospitals,and analyze the influence of EHS as a predisposing factor on prognosis.Methods Eighteen patients with EHS were admitted in 6 military hospitals from Sep.1995 to Aug.2007,their clinical data were retrospectively analyzed.All cases were evaluated according to Minard's EHS predisposing factors including the individual's physiologic limitations,environmental conditions and the organizational predisposing factors.According to the final treatment outcome,18 cases of EHS were divided into fatal group(Group F)and survival group(Group S).The significance of deviation on the predisposing factors,and of the differences on the accumulated predisposing factors between the two groups,was analyzed.Results All the 18 cases of EHS occurred after military training,and complicated with multiple organ dysfunction syndrome(MODS).Hyposthenia,excessive physical efficiency training,incorrect disease classification to the patients,and inappropriate diagnosis and treatment were found to be the strong predictors to a grave prognosis.The effect of accumulated predisposing factors of EHS in group F was significantly higher than that in group S(10.0?1.41 vs 5.64?1.96,P

Objective To analyze the possible effective intervention for heat stroke(HS)associated with multiple organ dysfunction syndrome(MODS)as a result of cross-country training.Methods All the data of causes of HS,clinical manifestations,laboratory findings,clinical interventions and outcome were collected and analyzed in five cases of HS associated with MODS.Results Four patients survived and one died of severe DIC and MODS.The levels of creatin kinase and myoglobulin in survived patients lowered gradually 4-5 days after effective treatments.No sequela was found in survived patients.Conclusions The therapeutic principle for the patients of HS associated with MODS is early commencement of hypothermia,fluid expansion,anticoagulation,blood purification and deep-sedation.

ObjectiveTo investigate the effect of continuous renal replacement therapy (CRRT) on the elderly patients with acute renal function failure.Methods11 elderly patients with acute renal function failure were treated with continuous renal replacement therapy. The average time of CRRT was 24.8 h. The ultrafiltration rate during CRRT was 2～4 L/h and blood flow rate was 150～250 ml/min. Normal heparin was used as anticoagulant.ResultsAmong 11 patients, 7 were mend, 3 died. The blood urea nitrogen (BUN) and creatinine (Cr) levels of all patients obviously declined (P<0.01). The haemodynamic variables of all patients were stabilized during CRRT and no obvious side-effect related to CRRT was found.ConclusionThe treatment of CRRT can improve the sufferer prognosis to the elderly patients with acute renal function failure, not restricted by age, and is the effective means to the elderly patients with acute renal function failure.