Objective To discuss the value of glucocorticoid steroids (GCs) in the treatment of patients with severe community-acquired pneumonia (SCAP) complicated with septic shock.Methods A prospectively controlled randomized trial was conducted.Fifty-eight SCAP patients complicated with septic shock admitted to emergency intensive care unit (ICU) of China-Japan Friendship Hospital from May 2014 to February 2016 were enrolled.The patients were randomly divided into conventional treatment group (n =29) and GCs group (n =29).Fluid resuscitation,vasopressors,mechanical ventilation if needed,antibiotics and other general treatment including symptomatic treatment and eliminating phlegm were given to patients in both groups.Beside the treatment mentioned above,80 mg methylprednisolone once a day for 7 days was added to patients in GCs group.The changes in oxygenation index (PaO2/FiO2) and C-reactive protein (CRP) at 1,4,8 days after treatment as well as the imaging improvement in both groups were observed.Discharge or death was set as a cut-off point,the average time of temperature controlling,duration of mechanical ventilation,time of vasopressors usage and 28-day mortality were observed.The incidence of hyperglycemia,infection and hemorrhage of digestive tract were observed.Results There were no statistically differences in gender,age and body mass between the two groups,indicating that baseline data for the two groups were balanced.PaO2/FiO2 after treatment in the two groups was gradually increased,and it was significantly higher at 8 days after treatment in GCs group than that of conventional treatment group [mmHg (1 mmHg =0.133 kPa):426.46 ± 86.97 vs.363.00 ± 83.96,P ＜ 0.05].CRP after treatment in the two groups was gradually decreased,and it was significantly lower at 4 days and 8 days after treatment in GCs group than that of conventional treatment group (mg/L:95.78 ± 47.38 vs.124.72 ± 51.01,57.60 ± 47.44 vs.88.85 ± 48.18,both P ＜ 0.05).Radiographic imaging improved rate at 4 days and 8 days after treatment in GCs group was significantly higher than that of conventional treatment group (55.2％ vs.27.6％,75.9％ vs.51.7％,both P ＜ 0.05),and average time of temperature controlling (days:3.94 ± 2.39 vs.7.22 ± 3.11),time of vasopressors usage (hours:13.64 ± 6.47 vs.28.34 ± 12.56),and the average hospitalization days (days:28.50 ± 8.61 vs.36.21 ± 15.26)in GCs group were significantly shorter than those of conventional treatment group (all P ＜ 0.01).There was no significant difference in duration of mechanical ventilation between GCs group and conventional treatment group (days:13.39 ± 2.62 vs.16.16 ± 5.85,P ＞ 0.05).28-day mortality of the two groups was 10.3％ equally (P ＞ 0.05).No significant differences in the incidences of hyperglycemia (10.3％ vs.6.9％),infection (51.7％ vs.55.2％) and gastrointestinal bleeding (3.4％ vs.0) were found between GCs group and conventional treatment group (all P ＞ 0.05),indicating that glucocorticoid steroids could not increase the common side effects.Conclusion GCs is an important adjuvant treatment of patients with SCAP complicated with septic shock.

Objective To explore the prognostic value of B-type natriuretic peptide (BNP) for 28-day mortality of elderly patients with non-cardiac critical ill in emergency intensive care unit (EICU). Methods A total of 70 elderly non-cardiac critically ill patients (age≥60 years) in EICU were enrolled, and the blood samples were collected to detect BNP level after the patients' admission to EICU. After 28 days, the mortality was assessed. Results Twenty-two patients (31.4 %) died during 28 days observation, whose BNP levels were significantly higher than that of the survivors [ln BNP: (6.4 ± 1.2) ng/L vs. ( 5. 1 ± 1.5 ) ng/L, P＜ 0. 05] ; BNP level had an area under the receiver operating characteristic curve of 0. 759 (95% CI: 0. 636-0. 882, P＜0.05) for predicting mortality,and the optimal cut point of BNP was 342 ng/L (sensitivity 77.3%, specificity 68.7%).Conclusions BNP level could be a predictor for 28-days mortality for elderly non-cardiac critically ill patients.

Objective To explore the clinical value of alprostadil in the treatment of hyperlipidemic severe acute pancreatitis (HSAP).Methods A prospective randomized controlled study method was used.56 HSAP cases admitted in emergency intensive care unit (ICU)from May 2015 to November 2016 were enrolled and divided randomly into routine group and alprostadil group using random number method.All the patients in routine group received the routine conservative treatments.Alprostadil group was given both routine treatments and the intravenous injection of 20 μg alprostadil once a day for 7 days.Serum amylase,triglyceride,thromboxane A2 (TXA2) and IL-6 level were detected before,3 d and 8 d after the treatment.MCTSI score and modified Marshall score were calculated.The duration of SIRS,abdominal pain relief time,the start time of enteral nutrition,the average hospitalization days and mortality were recorded.Results There was no significant difference between the two groups on gender,age and body mass.There were no significant statistical differences between the two groups on serum amylase,triglyceride,TXA2,IL-6,MCTSI score and modified Marshall score before treatment,which were all obviously decreased after treatment,and the differences were statistically significant.Serum amylase and triglyceride levels were not statistically different between two groups on 8 days after the treatment,but TXA2 [(85.3 ± 26.8) ng/L vs (138.3 ± 34.3) ng/L],IL-6 [(6.99 ± 1.85)ng/L vs (10.58 ± 2.46) ng/L)],MCTSI score[(2.36 ± 1.10) vs (3.21 ± 1.37)],and modified Marshall score [(1.99 ± 0.57) vs (2.64 ± 0.73)] were all obviously lower than those in routine group,and the differences were statistically significant (P value ＜ 0.05).The duration of SIRS [(5.02 ± 1.81) d vs (6.79 ± 1.17) d],abdominal pain relief time [(4.89 ± 1.47) d vs (6.14 ± 1.58) d],the starting time of enteral nutrition [(4.68 ± 0.86) d vs (6.39 ± 1.11) d],and the average hospitalization ay [(29.30 ±8.61)d vs (34.31 ± 9.33)d] in alprostadil group were obviously shorter than those in routine group,and the differences were statistically significant (P value ＜0.05).But there was no significant difference on hospital mortality.Conclusions Alprostadil can relieve pancreatic injury,reduce organ injury and alleviate abdominal pain early,and promote the recovery of gastrointestinal function by improving pancreatic microcirculation in HSAP.