Objective To observe the effects of positive end-expiratory pressure(PEEP) on oxygen utiliza-tion coefficient in patients with acute respiratory distress syndrome(ARDS). Methods 28 ARDS patients with me-chanical ventilation were studied. Catheter of central vein was laid. Increment levels of PEEP(0,5, 10, 15 and 20cmH2O) were applied sequentially. Hemodynamics and oxygen metabolism parameters were measured and calcula-tion of O2 UC [O2 UC = (SaO2 -SvO2.)/SaO2] were carried out respectively. O2 UC in 30 normal subject groups were carried out. Results Arterial oxygen tension(PaO2) increased significantly(P < 0.05) at PEEP 5cmH2O. Oxygen u-tilization coefficient (O2 UC), heart rate(HR) and mean blood pressure (MBP) were not significantly different (P >0.05) at PEEP 10cmH2O. At PEEP 15cmH2 O, O2UC and HR increased significantly (P < 0.05), but M BP reduced obviously(P < 0.05). Conclusions Too high PEEP can result in oxygen utilization coefficient of ARDS patient de-acend furthur, can not really correct oxygen difieiency condition in patients' organization cell. The optimal PEEP should be found, and blood capacity should be appropriately increased.

Objective To evaluate the effects of an optimized resuscitation bundle on prognosis of emergency patients with septic shock.Methods 65 patients with septic shock,admitted into emergency intensive care unit (ICU),were randomly divided into the treatment group(treated by an optimized resuscitation bundle)and the control group(treated by surviving sepsis campaign classics methods)by using random number table.The scores of sepsis-related organ failure assessment(SOFA) scores,the vasoactive agent application times,the mechanical ventilation times,the stay days of ICU,and 28-day mortality of the two groups were observed and compared.Results 3,7 day after erollment the SOFA score of the treatment group was (9.1 ± 2.5) points,(8.2 ± 2.8) points,respectively,which was lower than that of the control group[(10.1 ± 3.3) points,(9.5 ± 3.1) points] at the same time(t =4.52,3.99,all P ＜ 0.05) ; 8-day mortality rate of the treatment group was 28.1％,which was lower than that of the control group (48.5％) (x2 =12.84,P ＜ 0.05).Conclusion Application of an early optimized resuscitation bundle can significantly improve the prognosis of emergency patients with septic shock.

Objective To get the knowledge of the diagnosis and treatment of acute pulmonary embolism (APE)in primary hospital.Methods The clinical data of the patients diagnosed with APE were retrospectively reviewed.The patients were clarified into different risk-group by revised Geneva score and Wells score according to the clinical records.Results 17 patients were diagnosed with APE in this time slot,in which male 10 cases and female 7 cases,average age was (51.8 ±18.4)years old,and among them,4 cases with 4 scores of revised Geneva score,9 cases with 4 to 10 scores,4 cases with more than 11,6 cases with less than 4 Wells score,11 cases with more than 4,2 cases with low risk and 15 cases with intermediate risk.The length of hospital stay was (10.9 ±5.4)days in average.In this group,one patient was dead,seven cases improved,six cases remarkably improved and three cases were recued.Fourteen patients received anticoagulation agents and three cases without any.Eleven patients were given thrombolystic therapy,one case was operated and six cases were given interventional treatment.Conclusion Clinicians know APE and keep alert gradually.However,it should be improved in respects of treating and following the APE patients.