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Relationship between early changes of central venous-to-arterial carbon dioxide difference and the prognosis in patients with septic shock

Shuanghua WU ; Shunwu LI ; Ting WANG

Chinese Journal of Postgraduates of Medicine.2014;37(31):12-14,21. doi:10.3760/cma.j.issn.1673-4904.2014.31.005

Objective To explore the relationship between early changes of central venous-toarterial carbon dioxide difference (Pcv-aCO2) and the prognostic in patients with septic shock.Methods One hundred and three patients with septic shock were retrospectively analyzed.The patients were divided into death group (37 cases) and survival group (66 cases) according to prognosis.The patients were divided into four groups according to the changes of 0 and 6 h Pcv-aCO2:Pcv-aCO2 persistently high group (16 cases),Pcv-aCO2 increased group (19 cases),Pcv-aCO2 decreased group (22 cases),Pcv-aCO2 persistently normal group (46 cases).All the patients were treated with early goal-directed therapy (EGDT),and central venous oxygen saturation (ScvO2) ≥0.70 was the target.The acute physiology and chronic health evaluation (APACHE) Ⅲ score,sepsis related organ failure assessment (SOFA) and mortality were compared.Results There was no statistical difference in 0 h Pcv-aCO2 (P ＞ 0.05).The Pcv-aCO2 in 6,12 and 24 h in survival group was significantly lower than that in death group [(5.0 ± 1.8) mmHg (1 mmHg =0.133 kPa) vs.(6.8 ± 2.3) mmHg,(4.7 ± 2.3) mmHg vs.(7.2 ± 3.0) mmHg,(3.2 ± 1.5) mmHg vs.(7.5 ± 3.3) mmHg],and there was statistical difference (P ＜ 0.05 or ＜ 0.01).The APACHE Ⅲ score in survival group was significantly lower than that in death group [(51.6 ± 23.8) scores vs.(87.7 ± 35.9) scores],and there was statistical difference (P ＜ 0.05).The time of mechanical ventilation,APACHE Ⅲ score,SOFA,length of stay in hospital and mortality in Pcv-aCO2 persistently high group and Pcv-aCO2 increased group were significantly higher than those in Pcv-aCO2 decreased group and Pcv-aCO2 persistently normal group,and there were statistical differences (P ＜ 0.05 or ＜ 0.01).Conclusion The Pcv-aCO2 persistently high during the early resuscitation of septic shock is associated with multi-organ dysfunction and worse prognosis,and provides guidance for clinical treatment.

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Comparison of preoperative diagnostic value between ultrasonography and magnetic resonance imaging for the extrathyroidal extension of papillary thyroid carcinoma

Xian WANG ; Yerong CHEN ; Guoliang ZHANG ; Jin ZHANG ; Heng ZHANG ; Hao HUANG ; Xiaoqin QIAN ; Shudong HU

Chinese Journal of Postgraduates of Medicine.2018;41(1):48-53. doi:10.3760/cma.j.issn.1673-4904.2018.01.013

Objective To evaluate the diagnostic value of preoperative ultrasonography(US)and magnetic resonance imaging (MRI) for the extrathyroidal extension (ETE) in patients with papillary thyroid carcinoma(PTC).Methods The clinical data of 90 patients with PTC from January 2013 to June 2016 were analyzed retrospectively,and all patients were examined by US and MRI before operation.The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of minimal ETE, extensive ETE and ETE (minimal ETE + extensive ETS) were compared between UC and MRI.Results The diagnostic minimal ETE sensitivity of UC was significantly higher than that of MRI (81.9% vs.60.0%), and there was statistical difference (P<0.05).The diagnostic extensive ETE specificity of MRI was significantly higher than that of UC(80.9% vs.63.5%),and there was statistical difference (P<0.01).The diagnostic ETE sensitivity and NPV of UC were significantly higher than those of MRI(97.4% vs.88.3% and 80.0% vs.50.0%),and there were statistical differences (P<0.05 or <0.01).Conclusions US has a higher sensitivity, compared with MRI for diagnostic minimal ETE.MRI has a higher specificity for diagnostic extensive ETE,compared with US.And US has a higher sensitivity and NPV for diagnostic ETE,compared with MRI.

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The clinical analysis of acute cerebral ischemic stroke after cranial cerebral operation

Jingyu CUI

Chinese Journal of Postgraduates of Medicine.2017;40(12):1126-1128. doi:10.3760/cma.j.issn.1673-4904.2017.12.018

Objective To explore the etiology, treatment, prevention and prognosis of acute cerebral ischemic stroke after cranial cerebral operation. Methods Five cases with acute cerebral ischemic stroke after cranial cerebral operation between May 2016 and January 2017 were retrospectively analyzed. Pre-operation condition, image materials, operational process, chemotherapy, situation of ischemic stroke and prognosis was analyzed. Two cases received operation because of traumatic brain injury (TBI). Three cases received operation because of hypertensive intra-cerebral hemorrhage (ICH), among whom 1 case was diagnosed as acute occipital infarction by CT examination 6 d after operation of basilar massive hemorrhage complicalted with brain hernia, and 1 case was diagnosed as acute occipital infarction by CT examination 8 d after sudden unconsciousness and operation of thalamus hemorrhage complicated with jammed both lateral ventricles. All of the cases were misdiagnosed and mistreated. Results One case showed persisted vegetable state, and 4 cases were dead. Conclusions Acute cerebral ischemic stroke after cranial cerebral operation can be easily misdiagnosed and mistreated.Once it starts, and the prognosis is bad,meanwhile the timely prevention of it is vital.

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Research progress on the effect of thyroid stimulating hormone on health

Minmin SHI ; Qiang MENG

Chinese Journal of Postgraduates of Medicine.2017;40(12):1136-1138. doi:10.3760/cma.j.issn.1673-4904.2017.12.022

Elevated thyroid stimulating hormone (TSH) level is an early manifestation of subclinical hypothyroidism (SCH). In the early stages of SCH, patients did not have significant clinical symptoms and were therefore often not taken seriously.However, more and more studies have shown that changes in TSH levels are closely related to human health in recent years. This paper summarizes and analyzes the literature about the effect of TSH on the health, summarizes the research progress of TSH and health relationship in recent 10 years, and provides a new way for the diagnosis and treatment of human diseases.

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Comparative study of minimally invasive transurethral bipolar plasma prostatectomy on the treatment of the benign prostatic hyperplasia of the elderly

Jing WANG ; Xiaoning LIU ; Jinguang GUO ; Chao LIN ; Haitao LI ; Gongsheng LYU

Chinese Journal of Postgraduates of Medicine.2017;40(12):1118-1121. doi:10.3760/cma.j.issn.1673-4904.2017.12.016

Objective To observe the recent effect and safety of minimally invasive transurethral double pole plasma-prostatectomy (PKEP) for the treatment of the benign prostatic hyperplasia (BPH). Methods One hundred and twenty-six patients with BPH were selected by parallel group design, and divided into two groups by piecewise equilibrium stochastic method. Sixty-three patients in the control group were treated with transurethral prostate electrotomy (TURP). The study group of 63 patients was treated with PKEP. Weight, operation time, intraoperative bleeding and complications of the patients were recorded. Three months after surgery, the maximum urine flow rate (Qmax), residual urine volume (PVP), international prostate symptom score(IPSS)and quality of life score(QOL)was used to evaluate the improvement of symptoms. Results The average operation time, postoperative hospital stay, time placing a urinary catheter in study group was shorter than that in the control group(50.2 ± 8.5)min vs (62.4 ± 10.3)min,(5.0 ± 0.7)d vs.(6.4 ± 1.2)d,(38.4 ± 2.7)h vs.(80.5 ± 6.9)h,intraoperative blood loss was less than that in the control group, (62.4 ± 13.7)ml vs.(91.6 ± 23.5)ml,and removing tissue volume was better than that in the control group (53.4 ± 5.9) g vs. (39.6 ± 7.2) g. Differences were statistically significant (P < 0.05). After surgery, the PVP significantly reduced, Qmaxincreased significantly, the IPSS and QOL scores significantly reduced, and the differences were statistically significant(P<0.05). However, there was no significant difference between PVP, Qmax, IPSS and QOL in the two groups(P>0.05).The incidence of postoperative complications in the study was 30.16%(19/63), significantly lower than that of the control group(46.03%,29/63), and the difference was statistically significant(P<0.05). Conclusions PKEP is better than TURP in the treatment of large volume BPH of old age, and PKEP is safer than TURP.

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Effect of tamsulosin hydrochloride combined with clear stasis and kidney decoction on chronic prostatitis and its influence on immune function and urine flow rate

Jianguo HAO ; Huajun ZHANG ; Jialong XING

Chinese Journal of Postgraduates of Medicine.2017;40(12):1114-1118. doi:10.3760/cma.j.issn.1673-4904.2017.12.015

Objective To investigate the efficacy of tamsulosin hydrochloride combined with clear stasis and kidney decoction on chronic prostatitis and its influence on immune function and urine flow rate. Methods In this study, 115 patients with chronic prostatitis were selected and divided into treatment group (58 patients) and control group (57 patients) according to the random number table method.The control group used tamsulosin hydrochloride treatment, and the treatment group was treated with clear stasis and kidney decoction on the basis of the control group.The patients in two groups were treated continuously for 4 weeks. The clinical efficacy was evaluated and compared, the changes of immune function, free flow rate and maximum urinary flow rate were measured and compared between two groups.Results The total effective rate of the treatment group was significantly higher than that of the control group:94.83%(55/58)vs.78.95%(45/57)P<0.05.The levels of IgA and IgG before treatment in two groups had no significant differences(P>0.05).After treatment, the levels of IgA and IgG in two groups significantly decreased compared with those before treatment(P<0.05), and the levels of IgA and IgG in treatment group were significantly lower than those in control group(P<0.05).The levels of NIH-CPSI scores and WBC before treatment in two groups had no significant differences (P > 0.05). After treatment, The levels of NIH-CPSI scores and WBC significantly decreased compared with those before treatment(P<0.01), and the levels of NIH-CPSI scores and WBC in treatment group were significantly lower than those in control group (P < 0.01). After treatment lecithin (+- ++) and (+++- +++++) in treatment group was 3,55 cases, in control group was 12,45 cases, and there was significant difference (χ2= 6.392, P = 0.011). Before treatment, the levels of free urine flow rate, maximum urine flow rate, maximum urine flow rate time and residual urine volume in two groups had no significant differences(P>0.05). After treatment, the levels of free urine flow rate and maximum urine flow rate in two groups significantly increased, the levels of maximum urine flow rate time and residual urine volume in two groups significantly decreased, and there were significantly differences compared those before treatment (P < 0.05).The levels of free urine flow rate, maximum urine flow rate, maximum urine flow rate time and residual urine volume between two groups had significant differences after treatment(P<0.01).The adverse reaction rate in control group and treatment group was 3.51%(2/57),6.90%(4/58), and there was no significant difference(χ2=0.414,P=0.667).Conclusions Tamsulosin hydrochloride combined with clear stasis and kidney decoction in patients with chronic prostatitis can significantly relieve the clinical symptoms and improve the immune function of the local prostate, and the effect is exact.

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Comparative study on pre- diagnosed computed tomography features and post- surgery pathological risk grades of the gastrointestinal stromal tumors

Haixia SU ; Bingcang HUANG ; Lei ZHANG

Chinese Journal of Postgraduates of Medicine.2017;40(12):1109-1113. doi:10.3760/cma.j.issn.1673-4904.2017.12.014

Objective To study the value of pre-surgery computed tomography(CT)scan on post-surgery pathological risk grades of gastrointestinal stromal tumor(GIST).Methods Forty-one patients of GIST were retrospectively evaluated and confirmed by histological diagnosis. Tumor size, density, margin, contour, location, growth pattern, degree and pattern of lesion enhancement was analyzed. Results Based on pathological results, the total diagnosis accuracy of location and character on CT is 95.1%(39/41)and 92.6%(38/41), respectively.Tumors size of low risk group was smaller than that in the other two groups(P>0.05).There was no significant difference in tumor size between moderate and high risk groups. Using Chi-test analysis, tumor density, margin, contour, growth pattern was statistically different among different pathological risk grades (P < 0.05). CT features of enhancement were not significantly different among the pathological risk groups (P > 0.05). Conclusions CT plays an important role not only in the detection and localizing GIST but also in the evaluation of the extension and characteristics of these tumors. CT imaging can predict the invasive behaviors through tumor density, size, shape, contour, growth pattern and enhanced pattern.

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Comparative study of intraoperative ultrasound in percutaneous hepatocholangiostomy

Jie LUO

Chinese Journal of Postgraduates of Medicine.2017;40(12):1080-1082. doi:10.3760/cma.j.issn.1673-4904.2017.12.007

Objective To analyze the method and effect of ultrasonic diagnosis in percutaneous hepatocholangiostomy, and to explore its clinical application value. Methods Twenty-one cases of patients who used intraoperative ultrasound in percutaneous hepatocholangiostomy from December 2014 to October 2016 were selected as experimental group. Twenty-three cases of patients who didn′t used intraoperative ultrasound in percutaneous hepatocholangiostomy within the same period were selected as control group. At the end, the treatment effect of the two groups were compared. Results In experimental group, the success rate of fistula was 100.0%(21/21), the mean operation time was (95.6 ± 20.7)min, the average bleeding was(7.4 ± 5.9)ml, the rate of stone clearance was 100.0%, and the rate of complication was 0. In control group, fistula success rate was 73.9%(17/23), average operation time was (117.8 ± 32.1) min, average bleeding during operation was (16.1 ± 13.3) ml, stone clearance rate was 78.3%, and complication rate was 8.7%.There were significant differences between two groups (P < 0.05). Conclusions Ultrasonic diagnosis used in percutaneous hepatocholangiostomy can significantly enhance the rate of calculus, and improve the success rate of fistula.This operation is simple and convenient, and clinical effect is better.

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Effects of dexmedetomidine on oxygenation during one-lung ventilation for esophagectomy

Xiaocui MA ; Hongbo WANG ; Tao TANG ; Zeqing HUANG

Chinese Journal of Postgraduates of Medicine.2017;40(12):1076-1080. doi:10.3760/cma.j.issn.1673-4904.2017.12.006

Objective To evaluate the effects of dexmedetomidine on hypoxic pulmonary vasoconstriction and oxygenation during one- lung ventilation (OLV) undergoing esophagectomy. Methods Fifty-six adult patients undergoing esophagectomy and requiring OLV were selected.During inhalational anesthesia with sevoflurane, patients were randomized to receive either dexmedetomidine (dexmedetomidine group,28 patients)or saline placebo(control group,28 patients). The bolus dose of 0.3 μg/kg over 10 min followed by a maintenance dose of 0.6 μg/(kg·h)was used in dexmedetomidine group. The arterial blood gas samples were obtained to evaluate the effects of dexmedetomidine on oxygenation in three times:T1:double-lung ventilation 10 min after anesthetic intubation;T2:OLV 10 min;T3:60 min after continuous infusion of dexmedetomidine. Outcomes included differences in hemodynamic parameters(heart rate and mean arterial pressure), end-tidal sevoflurane concentration, ephedrine dose and atropine dose.Results The levels of pH, arterial partial pressure of carbon dioxide(PaCO2)in two groups had no significant differences(P>0.05).The level of oxygenation index in two groups at T3had significant difference: (153.29 ± 19.00) mmHg(1 mmHg=0.133 kPa)vs. (117.79 ± 12.00) mmHg, 1 mmHg = 0.133 kPa, P < 0.01. At T3, the level of heart rate in dexmedetomidine group was significantly lower than that in control group:(68 ± 11)times/min vs.(89±13)tims/min;meanwhile, the level of end-tidal sevoflurane concentration in dexmedetomidine group was significantly lower than that in control group: (2.9 ± 0.8)% vs. (4.2 ± 0.1)%; there were significant differences (P < 0.01). The ephedrine dose in two groups had no significant difference(P>0.05).Conclusions Dexmedetomidine may provide clinically relevant benefits by improving oxygenation and decreasing the requirement of inhalational anaesthetic agents, thereby limiting its effect on hypoxic pulmonary vasoconstriction during OLV in adults undergoing esophagectomy surgical procedures.

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Analysis of influencing factor of bradycardia after acute cervical spinal cord injury

Simeng NIU ; Ning ZHOU ; Ying BAI

Chinese Journal of Postgraduates of Medicine.2017;40(12):1061-1064. doi:10.3760/cma.j.issn.1673-4904.2017.12.002

Objective To investigate the influence of bradycardia in patients of acute cervical cord injury. Methods A total of 184 patients with acute cervical cord injury were included. The influences of position and severity of cervical cord injury, combination with cerebral injury or not, with/without hyponatremia and with/without respiratory failureⅡon bradycardia incidence were analyzed by using single factor analysis and logistic regression analysis. Results In 184 patients, 102 patients with bradycardia were enrolled in bradycardia group and 82 patients without bradycardia were enrolled in control group. The position of cervical cord injury and rate of hyponatremia in two groups had no significant differences (P > 0.05). The severity of cervical cord injury, rate of brain trauma and rate of respiratory failureⅡ between two groups had significant differences (P < 0.05). Conclusions The severity of cervical cord injury is important influencing factor of bradycardia after cervical cord injury.With/without respiratory failureⅡand with/without cerebral injury are influencing factors of bradycardia after acute spinal cord injury,which may relate with the severity of cervical cord injury.

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