The commonest cause of death in patients after liver surgery is liver failure,especially in patients with cirrhosis.A proper preoperative assessment of liver function can significantly impact on the rate of postoperative liver failure. Similarly, a good postoperative assessment of liver function can help to predict recovery of liver function and to guide treatments,especially in the surgical ICU.There are more and more methods which can be used to assess liver function,such as liver biochemical indicators,comprehensive scoring systems,quantitative liver function tests and liver volumetric measurements.From the modern medical aspect,using the evalution method for liver function which has mentioned before often exist great bias. The combined use of several methods,which can give more accurate assessment of liver function,is recommended.

Objective To improve the treat effect of the orthotopic liver transplantation patients with severe sepsis. Methods Fif-ty-six post-surgery patients were enrolled in this study. Patients were divided into two groups. One was non-OLT group (A group) and the other was OLT group (B group). Besides general data, the surveillance of blood lactate, the number of failure organs, APACHE Ⅱand MODS were recorded. 28-days survival rate and follow-up were checked. Results The mortality of hospitalization in non-OLT group was 30% and 57.6% in OLT group. The level of blood lactate in OLT group at the 1 st day increased significantly, which was statistically differ-ent with that in non-OLT group (P <0.01). It decreased but kept higher than that in non-group in following seven days. The numbers of failure organs in OLT group were more than in non-OLT group (P <0.01). The continuous APACHE Ⅱ score had no significant difference between two groups. But the continuous MODS score in OLT group was higher than in non-OLT group (P <0.01). Conclusions The 28-days mortality of OLT with severe sepsis is almost two times as much as that of non-OLT. It should cause more attention. The OLT with se-vere sepsis is more likely suffered from failure organs and difficult to recovery. To assess the condition of failure organs in OLT patients with severe sepsis, MODS score is better than APACHE Ⅱ score in this study. It is suggested that the standard of score system could be improved or come up with new score for organ transplantation. It will be better if blood lactate score is included.

Lipids metabolism can change after traumas such as operation or injury.The process is com-prised of accelerated hydrolysis of triglyceride in adipose tissue,accelerated absorption of fatty acids by extra-he-patic tissue,improved lipid oxidation rate,and augmented re-esterification of fatty acids in liver and adipose tis-sue.Mechanisms of lipid mobilization include sympathetic stimulation,insulin resistance,and inflammation.How-ever,lipid absorption by liver and intestine is inhibited after trauma.Through post-trauma nutritional support,glu-cose administration improves re-esterification of fatty acids and inhibits lipid oxidation without affecting lipolysis.Fat emulsion infusion inhibits both absorption and secretion of triglyceride in liver.Therefore,clinicians should a-void over-alimentation of glucose and fat to prevent lipid overload,particularly in liver. Intervention of post-trau-matic lipid metabolism improves the outcomes:administration of long-chain triglycerides can prevent exhaustion of essential fatty acids,and administration of cholesterol can improve absorption and oxidation of fat emulsion.

Objective This study aims to evaluate the effect of joint training on professional core competencies of Intensive Care Unit (ICU) nurses.Methods Nurses enrolled in Joint Training Program (the experimental group) between 2007 to 2009 were interviewed with questionnaire and compared with those received general training (the control group).Data were collected before and after 10 months of training.Scores of ICU nurse core competencies from the two groups were analyzed and compared.Restults Comparing with the control group,scores of the experimental group showed statistical differences on total score,theory dimension,technical dimension and 54 items.Conclusions Joint training could improve the professional core competencies of ICU nurses,especially the competences of management and application of nursing to critically ill patients and ICU special skills.

Objective To develop a software for diabetic dieting guide.Method One set of food catering software for diabetic patients was developed based on the energy exchange among a variety of foods using VEB on conditions of a balance of total energy and three major energy material.Result The food catering software was feasible and reasonable so that it could control the indexes of blood glucose,blood lipid and body mass index(BMI).Conclusion The food catering software for diabetic patients is perfect in function and can enhance diabetic compliance and feasiblility.

Objective To explore the influence on the bad eating habits of diabetes by the management of diabetes education with families participation.Method Sixty-six patients with type 2 diabete mellitus were chosen as study object.They were divided into the experiment group and the control group at random.The diabetic knowledge and die behavior education were taken to the two groups and the families of the experiment group.The bad eating habits of the two groups were investigated before and after management. Results The snack,night snack and out eating times were significantly decreased in the experiment group than the control group and before management.There were statistical significant difference(all P<0.05).Conclusion The management of diabetes education with families participation can improve the bad eating habits so as to delay the progression of diabetes.

21 patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)and hypertension were treated by orthodontic applince for 3 months.All complains of snore were alleviated or disappeared during sleep,the short of breath and drowsy in the daytime were disap-peared,AHI decreased(P<0.01)and the lowest SaO2 increased(P<0.01).The blood pressure tend to normal.The orthodontic appliance can effectively control OSAHS and hypertension.

Objectives To explore ventilation induced cytokine production and the role of oxidant stress in lung stretch. Methods Both in vitro and in vivo models of ventilator-induced lung injury (VILI) were used. Alveolar epithelial cells were stretched in vitro to mimic the lung injury in VILI. Rats were ventilated at large tidal volume to produce ventilator-induced lung injury in vivo. A total of 23 inflammatory cytokines were screened with micro gene array in stretched alveolar epithelial cells. Cytokines found to have up-regulated in cells were measured in serum and lung tissue of rats exposed to large tidal volume ventilation. For investigating the intracellular pathway of cytokine up-regulation in VILI, exogenous TNF-α or H2O2 was added to culture media of alveolar epithelial cells. Cytokines were then measured. To explore the role of oxidant stress in VILI, N-acetylcysteine (NAC), as an anti-oxidant, was used in vitro and in vivo. Results We found that transforming growth factor-β1 (TGF-β1 and transforming growth factor-β2 (TGF β2) were up-regulated in stretched alveolar epithelial cells and also in serum of rats with large tidal volume ventilation. Tumor necrosis factor-α (TNF-α) had no effects on TGF-β production in alveolar epithelial cells. Exogenous H2O2, as an oxidant, increased TGF-β production in alveolar epithelial cells. NAC, an anti-oxidant, decreased stretch induced TGF-β production, along with a down-regulation of oxidant injury. NAC also blocked the up-regulation of TGF-β in in vivo model of VILI. Conclusion TGF-β1 and TGF-β2 were up-regulated in VILI. Oxidant injury mediated up-regulation of TGF-β in VILI. NAC, which attenuated oxidant injury and blocked TGF-β up-regulation in VILI, could be a future therapeutic strategy in VILI.

AIM: To investigate the effect of ulinastatin plus thymosin - a, therapy on improving immune function in septic patients. METHODS: 70 patients were divided into two groups. One group was classical treatment group ( CT) with regular therapy and another group was classical treatment plus immunotherapy group ( CIT) with ulinastatin plus thymosin -a, for a week. The immune index before and after treatment on day 0,1,3 and 7 was observed, including the clinical and survival data. RESULTS: The most common pathogen of sepsis was bacteria, and infection by fungi was in rare. The common locations of bacteria observed were sputum and abdominal drainage. The level of TNF - α was significant lower in CIT group than that in CT group (P <0.05). IL - 10 level was significantly higher in CIT group than that in CT group (P < 0.05 ). IgG level was significant lower in CIT group than that in CT group (P < 0.05 ). No significant difference in the levels of IgA, IgM, C_3 and C_4 between two groups was observed (P > 0.05 ). CD4~+ T lymphocytes were significant higher in CIT group than those in CT group (P < 0.05 ). From day 7 to day 28, the lymphocytes and level of HLA -DR in CD14~+ monocytes were significant higher in CIT group than those in CT group (P < 0.05). The time of mechanical ventilation and vasopressors used in CIT group was shorter than those in CT group ( P < 0.05 ). But the length of stay and the cost in ICU showed no significant increase between these two groups (P >0.05). During hospitalization, 20 patients died in the CT group and 13 patients died in CIT group ( P < 0.05 ). The long - term survival time in CIT group was longer than that in CT group ( P < 0.05 ). CONCLUSION: Immunotherapy in septic patients can decrease TNF - α level and increase IL - 10 level. Immunotherapy in septic patients can increase IgC level slightly, CD4~+ T lymphocyte, and HLA - DR in CD14~+ monocytes, which improve the immune paralysis in septic patients. Immunotherapy can shorten the time of mechanical ventilation and vasopressors used, but it doesn't increase the length of stay and the cost.

Objective To evaluate the prevalence of NI in the SICU at our hospital. Methods 181 NI patients in the SICU were retrospectively analysed during Jan 1996～Dec 2000.Results The average NI rate was 9.81%. The major sites of NI were respiratory tract(36.96 %),thoracic/abdominal cavity(25.47 %)and bloodstream infections(9.32 %).The difference in major pathogens of infections in different sites reached statistical significance. For respiratory tract, thoracic/abdominal cavity and bloodstream infections,bacteria were the most common pathogens. Fungi were the moat frequent isolate from urine and stool. Mixed infection proportion was 52.25 %. The most common pathogens were Enterococci, Methicillin resistant Staphylococci、 Pseudomonas Aecruginosa、Escherichia Coli、Candida Albicans and Candida Tropicalis. Conclusions The most common pathogens of NI in SICU are different in different infection sites. The pathogens were complicated and most strains are antibiotics resistant. So it is important to establish NI control and to understand the changes of pathogens so as to prevent the infection.