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The influence of dexmedetomidine intrathecal injection on formation of chronic neuropathic pain in rats

Shidong ZHANG ; Shouyuan TIAN ; Jie WANG ; Juan XU

Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care.2013;(4):244-247. doi:10.3969/j.issn.1008-9691.2013.04.020

Objective To study the effect of dexmedetomidine(DEX)intrathecal administration on formation of chronic neuropathic pain induced by chronic constriction injury(CCI)in rats. Methods One hundred and twenty healthy adult male Sprague-Dawley(SD)rats were divided randomly into four groups(each n=30):sham group, model group,30μg/kg and 60μg/kg DEX intrathecal injection group(D30 group,D60 group). The CCI model was installed by left sciatic nerve ligaturing,sham surgery was done by exposing the sciatic nerve without ligation,and 30 μg/kg,60 μg/kg DEX(each,10 μl)and 10 μl normal saline were given intrathecally in D30,D60 and model groups respectively,all kinds of injection being once a day for 7 days. Hind paw mechanical contraction reflex threshold(MWT),heat-shrinkable reflex latency(TWL)and the score of motor dysfunction of hind extremity in rats were recorded on 1 day before ligation and 1,3,7 days after operation,and before ligation and 1,7,14 and 21 days after operation,the contents of tumor necrosis factor-α(TNF-α),interleukin(IL-1βand IL-6)in intumescentia lumbalis were measured by enzyme linked immunosorbent assay (ELISA). Results Compared with before operation,there were no significant differences in values of MWT,TWL,the motor function evaluation,TNF-α, IL-1β,and IL-6 at each time points(all P>0.05);however,with the prolongation of time,MWT and TWL were decreased,and the motor function evaluation,TNF-α,IL-1β,and IL-6 were increased in all the other groups. Compared with those of the sham group,MWT and TWL were declined,and the motor function evaluation,TNF-α, IL-1β,and IL-6 were elevated in model group. Compared with those of model group,30μg/kg and 60μg/kg DEX could significantly raise MWT(g)and TWL(s),obviously improve motor function and remarkably decrease the contents of TNF-α(pg/mg),IL-1β(pg/mg)and IL-6(pg/mg)in the spinal cord of CCI rats from 1 day after operation. And the changes in 60 μg/kg DEX group were more significant than those in 30 μg/kg DEX intrathecal injection group〔postoperative 1 day MWT:39.3±1.3 vs. 20.3±2.2,TWL:10.9±0.4 vs. 8.2±1.1,motor function score:2.00±0.00 vs. 2.00±0.75,TNF-α:33±7 vs. 125±18,IL-1β:108±12 vs. 203±34,IL-6:156±39 vs. 405±75,all P<0.05〕. Conclusions The DEX intrathecal administration has certain degree of dose-dependent therapeutic effect on hyperalgesia in CCI rat models. The mechanism is related to the amelioration of inflammatory reaction at the lumbar segment of spinal cord.

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Effects of marzulene(L-glutamine and sodium gualenate)on the cellular immunity of patients with severe acute pancreatitis

Guodong XIA ; Yi LIU ; Mingming DENG

Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care.2013;(4):237-239. doi:10.3969/j.issn.1008-9691.2013.04.018

Objective To observe the effects of marzulene(L-glutamine and sodium gualenate)on cellular immune function in patients with severe acute pancreatitis(SAP). Methods A prospective study method was conducted in which 80 patients with SAP were divided into trial group and control group(each 40 cases)according to the table of random number methods,and in the mean time 20 healthy volunteers were enrolled in the healthy control group. Both SAP groups received standard total parenteral nutrition(TPN)with same quantities of heat and nitrogen, and the trial group additionally accepted intravenous drip of marzulene 0.4 g?kg-1?d-1(once a day)for 7 days,while the control group received the same amount of normal saline intravenous drip for 7 days. One day before treatment and on the 7th day after treatment,the peripheral venous blood samples were collected. The T-lymphocyte proliferation activity was tested by methyl thiazolyl tetrazolium(MTT)assay,and the interleukin-2(IL-2)and interleukin-6(IL-6) secretion levels were detected by enzyme-linked immunosorbent assay(ELISA). Results Compared to the healthy control group,the levels of T lymphocyte proliferation activity〔absorbance(A)value〕and IL-2(ng/L)were markedly decreased and IL-6(ng/L)secretion level was obviously increased before treatment in the two SAP groups(P<0.05 or P<0.01). Compared to prior treatment,the levels of T lymphocyte proliferation activity and IL-2 were significantly increased after 7 days of treatment in the trial group(both P<0.05),and basically restored to normal levels,while in the control group they were progressively decreased(both P<0.05),the levels in trial group being significantly higher than those of the control group(T lymphocyte proliferation activity:1.08±0.27 vs. 0.43±0.25,IL-2:16.5±1.4 vs. 9.4±2.9,both P<0.05),but compared to prior treatment,the level of IL-6 was significantly decreased in the two SAP groups(both P<0.05),the level of IL-6 in control group was recovered to the level of healthy control group,and the level in trial group being significantly lower than that of the control group(18.8±4.5 vs. 22.3±3.1, P<0.05). Conclusions The patients with SAP have cellular immune dysfunction,the manifestations being the suppression of T lymphocyte proliferation and IL-2 and increase of IL-6 release. Early application of marzulene can help to improve the immune function of lymphocytes in patients with SAP.

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The effect and safety of thoracic drainage by central venous catheter in critical patients with pleural effusion

Yi CHEN ; Huasheng TONG ; Lei SU

Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care.2013;(4):234-236. doi:10.3969/j.issn.1008-9691.2013.04.017

Objective To investigate the effect and safety of thoracic drainage by central venous catheter in critical patients with pleural effusion. Methods A prospective study was carried out,in which 46 critical patients with pleural effusion admitted to department of critical care medicine were included,and according to the types of their primary diseases to make matched pairs,and they were divided into two groups:conventional drainage control group and central venous catheter drainage observation group(each 23 cases). The drainage effect and complications were compared between the two groups,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score, quantitative pleural effusion and the counts of white blood cells(WBC)and of platelets(PLT),the levels of prothrombin time(PT),procalcitonin(PCT)and C-reactive protein(CRP),etc. were measured on the baseline and 24 hours after the operation. Results There were no significant differences in the APACHEⅡ score,quantitative pleural effusion,amount and duration of drainage,as well as the levels of WBC,PLT,PT and PCT between group control and observation(all P>0.05). The post-drainage CRP(μg/L)level in group observation was much lower than that in group control(77.26±67.20 vs. 106.13±66.23,P<0.01). There was a trend that the incidence of complication in group control was higher than that in group observation(26.1%vs. 4.3%),but the difference was not statistically significant(P>0.05). Conclusions In the comparison between the conventional drainage and thoracic drainage with central venous catheter,the therapeutic effects for treatment of critical patients with pleural effusion were similar, but the stress was milder and the incidence of complications was lower in the latter group. Therefore,the thoracic drainage with central venous catheter is a safe,effective and alternative method to substitute the conventional drainage for critical patients with pleural effusion.

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The effect of early application of acupressure combined with hot belly on recovery of gastrointestinal function in abdominal post-operative patients

Qieying ZHU ; Na HU

Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care.2013;(4):227-229. doi:10.3969/j.issn.1008-9691.2013.04.014

Objective To explore the clinical effect and application value of early acupressure combined with hot belly(hot compress on abdomen)to promote the recovery of gastrointestinal function after abdominal surgery. Methods A prospective random controlled study was conducted from January 2012 to October 2012,200 hospitalized patients having undergone abdominal surgery were randomly divided into a control group(100 cases)and an observation group(100 cases). Traditional nursing method was applied to take care of the abdominal postoperative patients in the control group,that was at post-operative 6 hours the patient may begin to turn over in bed,once 2 hours,and on the post-operative 1 day,according to the patient's disease situation,he or she may be allowed to ambulate in the room without any other additional measures,waiting for the recovery of gastrointestinal function. In the observation group, beside the traditional nursing method used in the control group,additionally,acupressure and abdominal fomentation was applied twice a day for 4 days. The postoperative bowel sound recovery time,the anus spontaneous exhaust time, the incidences of abdominal distension and intestinal obstruction were observed. Results In the observation group, the gurgling sound recovery time and anus spontaneous exhaust time were significantly shorter than those in the control group〔gurgling sound recovery time(hour):17.77±2.67 vs. 18.87±3.18,anus spontaneous exhaust time(hour):28.27±6.30 vs. 30.85±6.74,both P<0.01〕;the incidences of postoperative abdominal distention and intestinal obstruction were obviously lower than those in the control group(bloating:9.0%vs. 23.0%,intestinal obstruction:1.0% vs. 9.0%,both P<0.01). Conclusion Early application of acupressure combined with hot belly for abdominal postoperative patients can significantly promote the recovery of gastrointestinal function,that is beneficial to the reduction of the incidences of complications.

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Effect of diammonium glycyrrhizinate and astragalus membranaceus injection on the comprehensive score of acute lung injury

Zheng LI ; Hua HUANG ; Fengkun CHEN ; Kegang HUANG ; Yaoyuan LIANG ; Wenyan QIU ; Shuai CHEN ; Yuji LIANG

Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care.2013;(4):213-215. doi:10.3969/j.issn.1008-9691.2013.04.009

Objective To explore the effect of diammonium glycyrrhizinate(DG) and astragalus membranaceus (AM) injection on the clinical comprehensive score in patients with acute lung injury (ALI). Methods According to the random number table method,a prospective random controlled study was conducted in which 60 cases of patients with ALI were divided into a study group and a control group(each,30 cases). Both groups received a comprehensive treatment based on the new guidelines,and the study group was additionally given DG and AM injection(DG 150 mg+AM 20 ml)one time per day for 7 days. The scores of lung injury,acute physiology and chronic health evaluationⅡ(APACHEⅡ)and systemic inflammatory response syndrome(SIRS)were measured at baseline,3rd and 7th day after treatment,and ventilation support time and final disease mortality rate were also calculated in all the patients. Results There were no statistically significant differences between the two groups in the scores of lung injury,APACHEⅡand SIRS before treatment and after treatment for 3 days(all P>0.05),with prolonged treatment,the above indexes were significantly reduced compared with those before treatment in the two groups,and the decreases in scores of indexes in study group was more significant than those in control group after treatment(lung injury score:1.31±0.99 vs. 2.29±1.08,APACHEⅡscore:18.43±8.17 vs. 24.23±6.98,SIRS score:1.69±0.89 vs. 2.60±1.04,all P<0.01). The time(hour)for ventilator support in study group was shorter than that in the control group(176.10±57.81 vs. 286.07 ± 156.27,P<0.01),but there was no statistically significant difference in mortality rate between the two groups(13.33%vs.16.67%,P>0.05). Conclusion The results suggest that DG and AM injection improve the scores of lung injury,APACHEⅡand SIRS,and alleviate the lung injury,so that the injection is beneficial to the early weaning from the ventilator to support treatment in patients with acute lung injury,and has certain therapeutic effect on ALI.

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The clinical research on Ditan Xingnao Chengqi soup for treatment of patients with sepsis brain dysfunction

Chunlin MA ; Ronghui WANG ; Daoye LIANG ; Fukui ZHENG

Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care.2013;(4):210-212. doi:10.3969/j.issn.1008-9691.2013.04.008

Objective To study the clinical effects of Ditan Xingnao Chengqi soup for treatment of patients with sepsis brain dysfunction. Methods Sixty-two cases of sepsis brain dysfunction were divided into treatment group(32 cases)and control group(30 cases)according to random digits table. Both groups received general clinical treatment,while the treatment group additionally accepted Ditan Xingnao Chengqi soup through nasal feeding. The changes of C-reactive protein(CRP)of two groups before treatment and after treatment for 12,24,48,72 hours and 1 week were observed. Besides,the Glasgow Outcome Scale(GOS)was used to assess the curative effect of two groups, and its clinical significance was judged. Meanwhile,the hospitalization costs,the times staying in hospital and total effective rates of the two groups after treatment were observed. In addition,cost-effectiveness analysis was carried out. Results With the extension of therapeutic time,the levels of CRP(mg/L)in the two groups were reduced effectively in comparison with those before treatment,and the change was more obvious in the treatment group;after treatment for 24 hours,the difference in the level of CRP between the two groups began to be statistically significant(106.5±22.3 vs. 201.6±25.4,P<0.05). The GOS of two groups after treatment had been increased markedly in comparison to that before treatment,and the change was more obvious in treatment group(72 hours:10.34±0.76 vs. 7.34±0.48,1 week:13.16±0.86 vs. 9.56±0.64,both P<0.05). Hospitalization costs(yuan)of treatment group in intensive care unit (ICU)was lower than that in control group(43276.16±1844.23 vs. 51347.75±2011.06,P<0.05),and the duration of staying(day)in ICU of treatment group was shorter than that in control group(15.11±2.25 vs. 20.30±2.97,P<0.05). The total effective rate of treatment group was higher than that of control group,but the difference had no statistical significance(87.5%vs. 60.0%,P>0.05).The ratio of cose effectiveness analysis in treatment group was smaller than that of control group(497.42 vs. 855.80,P<0.05). Conclusions Ditan Xingnao Chengqi soup has a relatively good effect on antagonizing inflammatory factors,controlling excessive inflammatory response and improving disturbance of consciousness. The early intervention with this agent for a patient with sepsis cognitive impairment can control the disease situation,improve the patient's prognosis and reduce his or her hospitalization costs.

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An experimental study on inhibitory effects and mechanisms of N-butanol extract of Potentilla anserine L. against hypoxia-induced nitric oxide on hippocampus neurons of rats

Jing BU ; Yongliang ZHANG ; Lingzhi LI ; Haiying GONG ; Jianyu LI

Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care.2013;(4):201-204. doi:10.3969/j.issn.1008-9691.2013.04.005

Objective To study in vitro the inhibitory effects and mechanisms of N-butanol extract of Potentilla anserine L.(NP)against hypoxia-induced nitric oxide(NO)in hippocampus neuron of rats. Methods The models of hippocampus neurons hypoxia injury of Sprague-Dawley(SD)neonatal rats were cultured in vitro. The cultured hippocampus neurons were divided randomly into blank control group, hypoxia injury model group, nimodipine group(2 μmol/L)and NP high(250.0 mg/L),middle(62.5 mg/L),low(15.6 mg/L)dose groups. The activities of hippocampus neurons were examined by methyl thiazolyl tetrazolium(MTT)assay,and meanwhile their contents of nitrogen monoxidum(NO)were detected. Half quantity reverse transcription-polymerase chain reaction(RT-PCR)and Western blotting were used to detect neuronal nitric oxide synthetase(nNOS)mRNA and protein expression levels respectively in each group,immunocytochemistry stain was used to detect protein positive rate. Results Compared with blank control group,the activity of neuron〔absorbance(A)value〕was significantly decreased(0.0826±0.0095 vs. 0.3315±0.0105),content of NO(μmol/g:0.0509±0.0027 vs. 0.0291±0.0032), the expression levels of nNOS mRNA (0.1463±0.0081 vs. 0.0801±0.0058), the positive rate of nNOS〔(74.4238±3.9423)%vs.(28.3714±4.1361)%〕,the expression levels of nNOS protein(A value:1.9130±0.0471 vs. 0.5068±0.0368)were all significantly increased in the hypoxia injury model group(all P<0.01). Compared with hypoxia injury model,the activity of neuron was increased,contents of NO,the expression levels of nNOS mRNA,the positive rate of nNOS,the express levels of nNOS protein were decreased in each medicine group,especially prominent in the NP high concentration group〔the activity of neuron:0.1681±0.0118,contents of NO:0.0319±0.0044,nNOS mRNA:0.0648±0.0032,nNOS positive rate:(40.1240±6.4900)%,nNOS protein:1.3924±0.0621,all P<0.01〕. There were no statistical significant differences between the NP low concentration group and model group(all P>0.05). Conclusions NP can ameliorate the injury of rat hippocampus neurons induced by hypoxia in vitro. The possible mechanisms might be related to the effective inhibition of the synthesis of nNOS and NO excessive generation.

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A study on correlation between global end-diastolic volume index and central venous pressure in fluid resuscitation in patients with severe sepsis

Zhuheng WANG ; Jing ZHANG ; Yuwei LI ; Jin WANG ; Hongxia CHANG

Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care.2013;(4):248-249. doi:10.3969/j.issn.1008-9691.2013.04.022

Objective To explore the correlation between global end diastolic volume index(GEDI)and central venous pressure(CVP)of severe sepsis patients during fluid resuscitation by pulse induced continuous cardiac output(PiCCO )test. Methods Sixty-four severe sepsis patients had been treated by fluid resuscitation strictly in accordance with the guidelines for treatment of sepsis in 2008. During the treatment,GEDI and corresponding CVP data were measured and recorded to observe the correctness of volume reaction under different CVP ranges,and the relativity between GEDI and CVP was analyzed. Results In the whole process of monitoring circulatory blood volume,no significant correlation between CVP and GEDI(r=-0.012,P>0.05)was found in severe patients with severe sepsis. When the CVP was in 0-8 mm Hg(1 mm Hg=0.133 kPa)or greater than 12 mm Hg,there was no correlation with the GEDI(r=-0.009,-0.020,respectively,both P>0.05). When the CVP was in 8-12 mm Hg at the 6 hours resuscitation target required by the guidelines,there was an obvious positive correlation between CVP and GEDI(r=0.653,P<0.01). Conclusion CVP is not suitable to be an exclusive target indicator for fluid resuscitation volume.

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Analysis of risk factors for prognoses of 176 patients with acute paraquat intoxication

Jinzhu WANG ; Chao LAN ; Li LI ; Changhua SUN

Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care.2013;(4):240-243. doi:10.3969/j.issn.1008-9691.2013.04.019

Objective To explore the risk factors influencing the prognoses by analyzing clinical data of patients with acute paraquat intoxication,and provide a basis for clinical prevention and treatment of the disease. Methods The clinical data of 176 patients with acute paraquat intoxication admitted into our Hospital were retrospectively collected during the period from January 2012 to February 2013. After admission,the conventional medical treatment was given to all the patients,and according to the prognoses of 28 days after poisoning,the patients were divided into death group and survival group. The gender,age,toxic dose,time elapsed from poisoning to admission,time elapsed from poisoning to gastric lavage,number of cases treated with drug lavage,white blood cell count(WBC),alanine amino-transferase(ALT),aspartate amino-transferase(AST),blood urea nitrogen(BUN), serum creatinine(SCr),acute physiology and chronic health evaluation system Ⅱ(APACHE Ⅱ)score,carbon dioxide combining power(CO2CP),number and time of cases revealing arterial blood oxygen saturation(SaO2)<0.90, and the survival rate within 28 days after admission were recorded. Multivariate logistic regression was used to analyze the factors related to the prognosis. Results ①Of the 176 cases,96 survived and 80 died in 28 days,the survival rate being 54.55%.②Univariate analysis showed the poisoning dose(ml),time elapsed from poisoning to admission (minute), WBC(×109/L), ALT(U/L),AST(U/L),BUN(mmol/L),SCr(μmol/L),APACHEⅡ scores, CO2CP (mmol/L),number of cases with SaO2<0.90 in the survival group were significantly lower than those in the death group〔38.14±39.44 vs. 88.50±58.79,41.11±30.29 vs. 90.00±59.31,11.78±3.61 vs. 16.13±5.02,84.46±42.53 vs. 156.35±76.62,76.21±38.69 vs. 184.00±86.48,5.34±2.89 vs. 10.51±6.80,84.17±77.38 vs. 199.74±162.13, 0.96±1.60 vs. 3.60±2.61,22.02±4.47 vs. 18.35±4.19,4(4.17%)vs. 80(100.00%),respectively,all P<0.01〕;there were no statistically significant differences in time elapsed from poisoning to admission(hour),number of cases treated with drug lavage and time of revealing SaO2<0.90(day)between survival group and death group〔7.96±3.39 vs. 8.05±4.26, 20(20.83%)vs. 24(30.00%), 62.25±18.45 vs. 65.70±45.10,respectively,all P>0.05〕.③Multivariate logistic regression revealed poisoning doses>30 ml〔odds ratio(OR)=6.455,95% confidence interval(95%CI)3.177-13.113,P<0.001〕,time elapsed from poisoning to admission>30 minutes(OR=8.639, 95%CI 4.043-18.461, P<0.001), WBC>12×109/L (OR=2.745,95%CI 1.388-5.426, P=0.004),BUN>8 mmol/L(OR=6.713,95%CI 2.650-17.006,P<0.001)and CO2CP≤22 mmol/L(OR=4.737,95%CI 2.389-9.394, P<0.001) were the risk factors correlated with the prognosis of patients with acute paraquat intoxicationl. Conclusion Poisoning doses,time elapsed from poisoning to admission,BUN,CO2CP and WBC are the independent risk factors for predicting prognosis of acute paraquat intoxication.

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Increase of correctness in revascularization of coronary artery disease by first assessment of coronary computed tomography angiography

Xue ZHAI ; Luyue GAI ; Kaiyi ZHANG ; Jingjing GAI

Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care.2013;(4):230-233. doi:10.3969/j.issn.1008-9691.2013.04.016

Objective To discuss the influence of coronary computed tomography angiography(CCTA)on correctness of assessing revascularization in patients with coronary artery disease. Methods A retrospective study method was conducted,605 cases underwent CCTA before coronary angiography(CAG)from 2008 to 2009 in Chinese PLA General Hospital were selected as CCTA before CAG group,and meanwhile 616 cases examined by CAG directly were selected as direct CAG group. Patients with multiple procedures of CAG were excluded. The proportions of various treatment strategies were compared,including per-cutaneous coronary intervention(PCI),coronary artery bypass grafting(CABG),medical therapy(MT),normal rate of CAG and the correctness of assessing revascularization between the two groups. Results The comparison between the baseline of the two groups showed that in the CCTA before CAG group,there were more severe lesions than those in the direct CAG group,such as Syntax score(11.31±8.90 vs. 10.23±9.73,P<0.05). Compared with direct CAG group,the triage of PCI and CABG in the CCTA before CAG group was significantly increased〔PCI:65.3%(395/605)vs. 57.1%(352/616),CABG:16.5%(100/605)vs. 3.4%(21/616)〕,while the percentages of medical treatment and normal CAG were obviously reduced〔medical treatment:11.7%(71/605)vs. 19.3%(119/616),normal rate of CAG:6.4%(39/605)vs. 20.1%(124/616),all P<0.01〕. With the guidance of CCTA,the correctness of assessing revascularization was increased〔81.8%(495/605)vs. 60.6%(373/616),P<0.01〕. Conclusion Compared with the direct induction by CAG,the CCTA examination carried out before CAG is capable of increasing the rate of correctness in the determination of revascularization in coronary heart diseases.

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