Objective To study the employment of noninvasive ventilation with nasopharyngeai airway in coma patients with cerebral stroke.Methods One hundred and fifty-five stroke patients treated with noninvasive ventilation admitted from May 2011 to May 2013 were studied.There were 88 male and 67 female,aged 30-95 years with mean age 73 years,The patients suffered from stroke with APACHE Ⅱ score 5-13 and Glasgow coma score 7-13.There were 78 cases in the nasopharyngeal airway group,and 77 cases in oropharyngeal airway group as control.SBP,DBP,HR,SpO2 and PCO2 were observed in the two groups at the time of beginning of noninvasive ventilation with neither airway (T0),and after placement of either airway and noninvasive ventilation for 10 min (T10),20min (T20),and 30 min (T30),respectively.The differences in rate of endotracheal intubation and the incidence of pulmonary infection were compared between the two groups.Results PaO2,SBP,PCO2 were improved after 30 minutes of noninvasive ventilation in the oropharyngeal airway group,and SBP DBP,HR decreased which were associated with improved respiration,less stress response,and then good blood circulation system.The better improvement of respiration was observed in nasopharyngeal airway group after 30 minutes of noninvasive ventilation.More improvements in PaO2,PCO2,SBP,DBP,HR were observed 30 minutes after noninvasive ventilation with nasopharyngeal airway compared with control group (P ＜ 0.05).The endotracheal intubation was used in 31 cases (40.3％) in the oropharyngeal airway group,and among them,19 cases (24.7％) suffered pulmonary infection.But there were 15 cases (19.2％) with endotracheal intubation in the nasopharyngeal airway group and 11 cases (14.1％) with pulmonary infection.The length of ICU stay,incidence of endotracheal intubation,and rate of pulmonary infection were lower in nasopharyngeal airway group (P ＜ 0.05).Conclusions The nasopharyngeal airway used in noninvasive ventilation can effectively ameliorate ventilation dysfunction in stroke patients,correct hypoxia and lessen accumulation of carbon dioxide,also reduce the pulmonary infection and the rate of endotracheal intubation.Nasopharyngeal airway used in noninvasive ventilation is a effective modality to solve upper airway obstruction and offer effective ventilation in stroke patients.

Objective To explore the administration of Dexmedetomidine combined with remifentanil for sedation and analgesia of ICU patients with hypertensive cerebral hemorrhage after operation.Methods A total of 60 patients with hypertensive cerebral hemorrhage treated with hematoma removal under craniotomy were selected from May 2013 to June 2015.The patients were randomly (random number) divided into the Dexmedetomidine combined with remifentanil group (D + R, n =30), and Midazolam combined with remifentanil group (M + R, n =30).The blood pressure, respiration rate, oxygen saturation, heart rate, ICP (intracranial pressure), Ramsay sedation scores, and IL-1, and TNF-α levels were recorded after sedation and analgesia in ICU, and 6 h, 24 h, 48 h after operation (T0-T3).Results Compared with M +R group, the MAP, RR, HR, ICP, IL-1β, TNF-α, rate of reoperation for check bleeding, and mortality were significantly decreased in D + R group (P ＜ 0.05), and Ramsay sedation score was significantly increased at the same time (P ＜ 0.05) without excessive sedation and analgesia noticed.Conclusions Dexmedetomidine combined with remifentanil exhibits significant benefit in many respects including control of great fluctuations of blood pressure and intracranial pressure after craniotomy, reduce the production and release of inflammatory mediators, reduce the occurrence of rebleeding after operation.It shows good controllability and safety, it is an optimal method producing sedation and analgesia in ICU patients with hypertensive cerebral hemorrhage after operation.

Objective To observe blood gas analysis of internal carotid artery and internal jugular vein to calculate the cerebral extraction of oxygen, and to investigate the relationship between oxyhemoglobin in internal jugular vein, cerebral extraction of oxygen, and the prognosis of patients with head injury. Method Seventy patients with acute severe head injury in ICU of Taizhou People Hospital were studied, and another 80 patients with mild head injury were enrolled as controls. Twenty-four hours after first aid such as keeping airway open and circulatory and ventilation support, and emergency craniotomy, the blood samples from internal carotid artery and internal jugular vein were collected for blood gas analysis including SaO2, PaO2, SjvO2, PJVO2 > PaCO2, PJVCO2, SaO2-SjvO2, Pa-jvCCO2, CaO2-CjvO2 and Ca-jvO2/CaCO2 (CEO2, cerebral oxygen extraction). Results There were significant differences in SjvO2, PjvO2, Sa-jvO2, Pa-jvO2 Ca-jvO2 and CEO2 between two groups. Conclusions The SjvO2 and CEO2 represent the cerebral oxygen uptake and oxygen consumption precisely, and they can be used to predict the outcome of patients with severe craniocerebral trauma commendabiy.

Objective To investigate the prognostic effects of continuous renal replacement therapy on multiple organ dysfunction complicated with acute kidney injury.Methods Fifty nine patients who were diagnosed with multiple organ dysfunction syndrome (MODS) complicated with acute kidney injury (AKI) and underwent continuous renal replacement therapy (CRRT) were selected and grouped according to the Kidney Disease Improving Global Outcomes (KDIGO) staging.Their clinical data before CRRT were collected.The patients were grouped according to the Intensive Care Unit (ICU) prognosis,namely death and survival.The differences between two groups were analyzed.The multinomial logistic regression analysis was performed to explore the prognostic factors.Results With the increase of KDIGO stage,the Acute Physiology And Chronic Health Evaluation Ⅱ (APACHEII) score,Sequential Organ Failure Assessment (SOFA) score,the need for vasoactive drugs,and the number of cases with oliguria and ICU mortality rates showed an increasing trend,and those differences were statistically significant (P ＜ 0.05).After multivariate analysis,KDIGO Ⅲ stage,the number of failed organs,oliguria,and the mean daily fluid balance were independent risk factors of death in patients who were diagnosed with MODS complicated with AKI and underwent CRRT.Conclusions The KDIGO classification plays an important role in predicting the prognosis of patients with MODS complicated with AKI in need of CRRT.The number of failed organs,oliguria,and the mean daily fluid balance are also the risk factors for prognosis.

Objective To study the relationship between efflux pump MexAB‐OprM and carbapenem resistance of Pseudomonas aerginosa strains .Methods The minimum inhibitory concentrations of imipenem and meropenem were determined by agar dilution method for 75 strains of P .aerginosa in the absence or presence of MC207110 to screen the phenotypes of active efflux pump .Reverse transcriptase‐polymerase chain reaction (RT‐PCR) method was used to determine the mRNA expression level of mexA which encodes the membrane fusion protein in active efflux pump MexAB‐OprM and the reference (housekeeping) gene rpoD .PCR method was used to amplify the regulatory genes mexR ,nalC ,and nalD of active efflux pump MexAB‐OprM in the strains overexpressing the efflux pump . The PCR products were subject to DNA sequencing and BLAST analysis . Results Of the 75 P .aeruginosa strains ,13 (17 .3% ) were positive for efflux pump MexAB‐OprM .Overexpression of the efflux pump was identified in 10 of the 13 strains and associated with positive regulatory genes mexR ,nalC and nalD .A Gly71→Glu mutation in nalC was found in 9 strains ,and a Ser209→Arg mutation in nalC was identified in 8 strains .Only one strain had a Thr158→Ile mutation in nalD .Eight strains had mutation in mexR .Conclusions Overexpression of multidrug efflux pump MexAB‐OprM plays an important role in carbapenem resistance of P .aeruginosa .High level expression of MexAB‐OprM is related to the mutations of its regulatory genes .

Objective To detect the levels of high mobility group box 1 protein HMGB1),tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),C-reactive protein (CRP) in order to explore the clinical significance of HMGB1 in patients with severely traumatic brain injury.Methods A total of 75 patients composed of 40 male and 35 female with severely traumatic brain injury were hospitalized from March 2011 through March 2012.The scores of Glasgow Coma Scale (GCS) were 5-8 within 12 hours after brain injury.Casualties with history of hypertension,diabetes,severe diseases of heart,liver and kidney,and with concurrent trauma of other parts of body were excluded.Another 50 healthy subjects were enrolled as controls.Serum samples were taken from both patients and controls at admission.The levels of HMGB1,TNF-α and IL-6 were measured by using enzyme-linked immunosorbent assay (ELISA).The level of CRP was measured by using automatic biochemistry analyzer.Comparisons of the levels of HMGB1,TNF-α,IL-6and CRP between casuahies and healthy controls were carried out.The correlations of HMGB1 with TNF-α,IL-6,CRP in patients with severe traumatic brain injury were analyzed.Thereafter,75 patients were divided into two groups post hoc:the death group and the survival group.On the 1st day,the 3rd day and the 7th day after trauma,serum HMGB1 was detected.The comparison of HMGB1 was made between death group and survival group by using t-test.Results Serum HMGB1 level in the traumatic patients was higher than that of healthy controls (P ＜ 0.01).Correlative analysis showed that there was a positive correlation between HMGB1 and TNF-α (r =0.365,P＜0.05),IL-6 (r=0.530,P＜0.05),CRP (r=0.661,P＜0.05) in patients with severe traumatic brain injury.Serum HMGB1 level in the death group was higher than the survival group (P ＜ 0.01).Conclusions Increased serum HMGB1 level was found after severe traumatic brain injury.There were positive correlations between HMGB1 and three inflammatory factors,TNF-α,IL-6and CRP.Serum HMGB1 should be used as reliable hiomarker to judge the prognosis of patients with severe traumatic brain injury.

ObjectiveTo explore the influence of early enteral nutrition (EEN) on the immune function and outcome in patients with severe traumatic brain injury.MethodsTotally 131 patients with severe traumatic brain injury who were admitted to the Intensive Care Unit of our hospital between March 2010 and March 2011 were enrolled in this study.Among them,69 were in EEN group and 62 were in control group.On day 7,humoral immune function was measured using automatic biochemistry analyzer,and the peripheral blood lymphocyte subset proportions were measured using flow cytometry.The complications were recorded in the initial 7 days after trauma.ResultsCompared with the control group,the EEN group had significantly lower incidences of complications including glucose metabolism disorder,diarrhea/stomach intestine distend,infection,multiple organ dysfunction syndrome,and stress ulcer on day 7 ( P =0.000,0.002,0.001,0.004,and 0.002).Hospital mortality in the EEN group was also significantly lower than that in control group ( P =0.028).The serum levels of IgM and IgG in EEN group were significantly higher than in control group ( both P =0.000),whereas the serum levels of C3 and C4 in the EEN group were significantly lower ( both P =0.000).IgA showed no significant difference between these two groups (P =0.144).The serum levels of CD3 + CD4 + T lymphocytes,CD4 +/CD8 + T lymphocytes,and CD19 + lymphocytes in the EEN group were significantly higher than in control group (all P =0.000),while CD3 + CD8 + T lymphocytes showed no significant difference ( P =0.070 ),The serum level of CD16+ CD56+ T lymphocytes in the EEN group was significantly lower than that in control group (P =0.026).ConclusionPatients with severe traumatic brain injury have good tolerance of EEN,which may enhance the immune function and improve the outcome of the patients.

Objective To investigate the profile and antibiotic resistance of bacteria in patients with ascites infection in intensive care unit (ICU) patients in order to provide a reference for rational clinical use of antibiotics. Methods A retrospective analysis was conducted. The bacteria isolated from ascetic fluid patients admitted from January 1st, 2004 to October 31st, 2015 to ICU of the First Affiliated Hospital of Anhui Medical University were identified, and their susceptibility to antibiotics was analyzed. Patients, who were admitted from January 1st, 2004 to December 31st, 2009 were assigned to group A, and patients admitted afterwards were assigned to group B. Results A total of 637 specimens of ascetic fluid were examined, with 185 positive culture (29.0%) during the 12 years, and 203 strains of bacteria were found. Among them 126 strains (62.1%) of gram-negative bacteria (G-), 54 (26.6%) of gram-positive bacteria (G+) and 23 (11.3%) strains of fungi were found. Compared the result of group B with that of group A, the proportion of G- bacteria was increased [71.2% (99/139) vs. 44.2% (27/64)], and that of G+ decreased [17.3% (24/139) vs. 46.9% (30/64)] in group B. The difference was statistically significant (χ2 = 20.34, P = 0.001). The main pathogenic bacteria were G-, and Enterobacteriaceae was the most common pathogenic bacteria in intra-abdominal infection of ICU patients. The isolation rate of Escherichia coli and Klebsiella pneumoniae(35.7%, 10.3%) ranked in the first and third in G- bacteria, respectively. The resistant rate of Escherichia coli against penicillin and third generation cephalosporin were > 95.0% and > 73.3%, and it showed a sensitive rate of 70% to β-lactam/inhibitor, amikacin and minocycline, and a higher sensitivity to carbapenems and tigecycline (11.1%, 0). Forty-eight strains of non-fermentation bacteria were found with a rate of 23.7%. The positive rates of Acinetobacter baumannii in groups A and B were 7.8% (5/64) and 23.7% (33/139), respectively, and they ranked first among non-fermentation bacteria. Twenty strains (62.5%) multidrug-resistant Acinetobacter baumannii were found. Acinetobacter baumannii showed a resistance rate of 84.6% to cefoperazone/sulbactam, 35.3% to minocycline, and 53.3% to tigecycline. Candida albicans was the most commonly isolated fungus in intra-abdominal infections (87.5%). No strains resistant to common antifungal drugs were isolated. Conclusions G- bacteria was the main pathogen in intra-abdominal infection in patients with ascites. Non-fermenters showed an increasing trend of producing infection, and the proportion of multidrug-resistant Acinetobacter baumannii infection increased year by year, and more attention should be taken by attending doctors.

Objective To investigate the clinical features and prognostic factors of nosocomially acquired candidemia.Methods A retrospective analysis was conducted for hospitalized patients with nosocomial candidemia between January 2012 and December 2014 at the First Affiliated Hospital of Anhui Medical University.The univariate and multivariate Logistic regression analyses were used to determine the prognostic factors of candidemia.Results A total of 92 patients were diagnosed with nosocomially acquired candidemia.The most common pathogen was Candida glabrata (C.glabrata,39/92,42.4％),followed by Candida albicans (C.albicans,30/92,32.6％),then Candida krusei (C.krusei,7/92,7.6％),Candida tropicalis (C.tropicalis,5/92,5.4％),Candida parapsilosis (C.parapsilosis,4/92,4.4％) and other Candida spp.(7/92,7.6％).The sensitivity rates of Candida spp.strains against flucytosine,amphotericin B,voriconazole,fluconazole and itraconazol were 100.0％,98.9％,92.4％,82.6％oo and 77.2％,respectively.The 30-day attributable case fatality rate was 13.0％(12/92).Multivariate Logistic regression analyses indicated that presence of central venous catheter (OR=4.833,95％CI:1.010-23.125,P=0.049),invasive mechanical ventilation (OR=6.075,95％CI:1.144-32.257,P=0.034),and receiving hemodialysis (OR =8.367,95 ％ CI:1.390-50.364,P =0.020)were factors independently correlated with increased mortality.Conclusions The pathogens causing nosocomially acquired candidemia are mainly C.glabrata,C.albicans and C.krusei.The drug susceptibility of Candida spp.varies among fluconazole,itraconazol voriconazole.The resistant rates of Candida spp.against voriconazole,fluconazole and itraconazol are different.The presence of central venous catheter,invasive mechanical ventilation and receiving hemodialysis are factors independently correlated with increased mortality.

Objective To study the effects of high volume hemofiltration (HVHF) according to pulse-indicated continuous cardiac output (PiCCO) on patients with acute respiratory distress syndrome (ARDS).Methods A prospective randomly controlled trial was conducted.163 patients with ARDS admitted to Taizhou People's Hospital,Medical College,Nantong University,between February 2011 and January 2014,were enrolled.The patients were randomly divided into conventional therapy group (n＝ 50),HVHF group (n =55),and PiCCO + HVHF group (n＝58) by random number table.The patients in conventional therapy group received routine treatment including mechanical ventilation and drug treatment according to ARDS treatment guideline.The patients in the HVHF group received HVHF treatment of 18 hours per day on 1,3,5,7 days on the basis of conventional therapy.Patients in the PiCCO + HVHF group received HVHF treatment according to PiCCO.The indexes of lung function and PiCCO monitoring were recorded at intensive care unit (ICU) admission (before) and 4 days and 7 days after treatment.The serum levels of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were determined by enzyme linked immunosorbent assay (ELISA),and the prognosis of patients was recorded.Results In three groups,oxygenation index (PaO2/FiO2),static lung compliance (Cs) were gradually increased,and respiratory rate (RR),lactic acid (Lac) were gradually decreased.The indicators in HVHF and PiCCO + HVHF groups were significantly improved compared with conventional therapy group.The indexes in PiCCO + HVHF group were significantly increased or decreased compared with those in HVHF group,and the statistical differences were found on the 7th day after treatment [PaO2/FiO2 (mmHg,1 mmHg=0.133 kPa):189.3 ± 36.8 vs.166.3 ± 36.1,Cs (mL/cmH2O):76.7 ± 18.9 vs.67.0 ± 18.2,RR (times/min):16.4 ±5.2 vs.19.2 ± 5.4,Lac (mmol/L):1.20 ±0.41 vs.1.41 ±0.43,all P＜0.01].In PiCCO +HVHF group,cardiac index (CI) was gradually increased,and extra vascular lung water index (EVLWI) and intra thoracic blood volume index (ITBVI) were gradually decreased.There were significant differences in the indexes 4 days and 7 days after treatment compared with those before treatment [CI (L·min-1·m-2):4.62 ± 1.13,4.83 ± 1.10 vs.4.01 ± 1.02,EVLWI (mL/kg):7.6 ± 2.7,6.5 ± 2.6 vs.12.4 ± 2.9,ITBVI (mL/m2):801.3 ± 120.9,785.4 ± 118.7 vs.980.1 ± 168.6,all P＜0.01].After treatment,the serum levels of TNF-α and IL-1β in three groups were gradually decreased.Compared with the conventional therapy group,the serum levels of TNF-α and IL-1β on 4 days and 7 days in the HVHF and PiCCO + HVHF groups were significantly decreased,and the statistical differences were found on 7 days [TNF-α (ng/L):68.35 ± 12.63,67.54 ± 12.90 vs.85.35 ± 13.70; IL-1β (ng/L):424.6 ± 142.9,412.2 ± 140.2 vs.895.2 ± 187.7,all P＜0.01].Compared with the HVHF group,the serum levels of TNF-α and IL-1β in the PiCCO + HVHF group were slightly decreased without statistical differences.Compared with the conventional therapy group,the number of organ failure,duration of mechanical ventilation,the length of stay in ICU and hospital mortality in HVHF group and PiCCO + HVHF group were lowered,and the statistical differences were found in PiCCO + HVHF group compared with HVHF group [number of organ failure:2.41 ± 0.79 vs.2.72 ± 0.80,duration of mechanical ventilation (days):4.8 ± 2.0 vs.5.7 ± 2.1,the length of stay in ICU (days):11.5 ± 3.4 vs.13.1 ± 3.6,hospital mortality:31.0％ (18/58) vs.41.8％ (23/55),all P＜0.05].Conclusions Levels of inflammatory factors in patients with ARDS could be reduced by HVHF.The oxygenation and compliance of lung can be improved,the number of organ failure can be lowered,the duration of mechanical ventilation and the length of stay in ICU can be shortened,and the hospital mortality could be declined by PiCCO guided HVHF.