Objective:To analyze the effects of citric acid anticoagulation on coagulation function and inflammatory factors in patients with sepsis and high-risk bleeding treated with continuous renal replacement therapy (CRRT).Methods:A total of 80 patients with sepsis with high-risk bleeding who received CRRT treatment in the Affiliated Hospital of Jining Medical University from February 2018 to August 2023 were retrospectively selected as the study objects, 40 cases were treated with low molecular weight heparin (control group) and 40 cases were treated with citric acid (observation group).Both groups were treated continuously, and the anticoagulant effect, coagulation function, electrolyte and inflammatory factor levels of the two groups were compared 7 d after medication.Results:The total effective rate of anticoagulation in the observation group after treatment was higher than that in the control group: 97.50% (39/40) vs. 75.00% (30/40), there was statistical difference ( χ2 = 8.54, P<0.05). After treatment, the levels of activated partial thrombin time (APTT), thrombin time (TT) and prothrombin time (PT) in the observation group were lower than those in the control group: (31.08 ± 8.31) s vs. (41.76 ± 8.36) s, (23.41 ± 5.02) s vs. (29.05 ± 5.13) s, (15.47 ± 3.50) s vs. (19.96 ± 4.75) s, there were statistical differences ( P<0.05). There were no statistical differences in the levels of potassium, chloride, sodium and calcium between the two groups after treatment ( P>0.05). After treatment, the levels of C-reactive protein (CRP) and procalcitonin (PCT) in the observation group were lower than those in the control group :(2.60 ± 0.86) mg/L vs. (4.35 ± 1.12) mg/L, (0.11 ± 0.03) μg/L vs. (0.19 ± 0.05) μg/L, there were statistical differences ( P<0.05). Conclusions:The application of citric acid anticoagulant in patients with sepsis and high-risk bleeding treated with CRRT can achieve significant curative effect, which can not only improve the anticoagulant effect, stabilize coagulation function and electrolyte level, but also down-regulate the level of inflammatory factors.

Objective:To analyze the effects of citric acid anticoagulation on coagulation function and inflammatory factors in patients with sepsis and high-risk bleeding treated with continuous renal replacement therapy (CRRT).Methods:A total of 80 patients with sepsis with high-risk bleeding who received CRRT treatment in the Affiliated Hospital of Jining Medical University from February 2018 to August 2023 were retrospectively selected as the study objects, 40 cases were treated with low molecular weight heparin (control group) and 40 cases were treated with citric acid (observation group).Both groups were treated continuously, and the anticoagulant effect, coagulation function, electrolyte and inflammatory factor levels of the two groups were compared 7 d after medication.Results:The total effective rate of anticoagulation in the observation group after treatment was higher than that in the control group: 97.50% (39/40) vs. 75.00% (30/40), there was statistical difference ( χ2 = 8.54, P<0.05). After treatment, the levels of activated partial thrombin time (APTT), thrombin time (TT) and prothrombin time (PT) in the observation group were lower than those in the control group: (31.08 ± 8.31) s vs. (41.76 ± 8.36) s, (23.41 ± 5.02) s vs. (29.05 ± 5.13) s, (15.47 ± 3.50) s vs. (19.96 ± 4.75) s, there were statistical differences ( P<0.05). There were no statistical differences in the levels of potassium, chloride, sodium and calcium between the two groups after treatment ( P>0.05). After treatment, the levels of C-reactive protein (CRP) and procalcitonin (PCT) in the observation group were lower than those in the control group :(2.60 ± 0.86) mg/L vs. (4.35 ± 1.12) mg/L, (0.11 ± 0.03) μg/L vs. (0.19 ± 0.05) μg/L, there were statistical differences ( P<0.05). Conclusions:The application of citric acid anticoagulant in patients with sepsis and high-risk bleeding treated with CRRT can achieve significant curative effect, which can not only improve the anticoagulant effect, stabilize coagulation function and electrolyte level, but also down-regulate the level of inflammatory factors.

Objective:To explore the risk factors of septic acute kidney injury (sAKI) in patients with sepsis, construct a predictive model for sAKI, verify the predictive value of the model, and develop a dynamic nomogram to help clinical doctors identify patients with high-risk sAKI earlier and more easily.Methods:A cross-sectional study was conducted. A total of 245 patients with sepsis admitted to intensive care unit (ICU) of the Affiliated Hospital of Jining Medical University from May 2013 to November 2023 were enrolled as the research subjects. The patients were divided into sAKI group and non-sAKI group based on whether they suffered from sAKI during ICU hospitalization. The differences of the demographic, clinical and laboratory indicators of patients between the two groups were compared. Logistic ordinal regression analysis was performed to analyze the imbalanced variables between the two groups, and to construct a sAKI predictive model. The predictive value of the sAKI predictive model was evaluated through 5-fold cross validation, calibration curve, and decision curve analysis (DCA), and to develop an online dynamic nomogram for the predictive model.Results:A total of 245 patients were enrolled in the final analysis. 110 (44.9%) patients developed sAKI during ICU hospitalization and 135 (55.1%) patients did not develop sAKI. Compared with the non-sAKI group, the patients in the sAKI group had higher ratios of female, hypertension, invasive mechanical ventilation (IMV), renal replacement therapy (RRT), vasopressin usage, and neutrophil count (NEU), aspartate aminotransferase (AST), blood urea nitrogen (BUN), serum creatinine (SCr), uric acid (UA), Na +, K +, procalcitonin (PCT), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, and sequential organ failure assessment (SOFA) score. Multivariate Logistic ordinal regression analysis showed that female [odd ratio ( OR) = 2.208, 95% confidence interval (95% CI) was 1.073-4.323, P = 0.020], hypertension ( OR = 2.422, 95% CI was 1.255-5.073, P = 0.012), vasopressin usage ( OR = 2.888, 95% CI was 1.380-6.679, P = 0.002), and SCr ( OR = 1.015, 95% CI was 1.009-1.024, P < 0.001) were independent risk factors for sAKI in septic patients, and a sAKI predictive model was constructed: ln[ P/(1+ P)] = -4.665+0.792×female+0.885×hypertension+1.060×vasopressin usage+0.015×SCr. The 5-fold cross validation showed that the average area under the receiver operator characteristic curve (AUC) was 0.860, indicating the sAKI predictive model had a good performance. The calibration curve analysis showed that the calibration degree of the sAKI predictive model was good. DCA showed that the net profit of the sAKI predictive model was relatively high. A static nomogram and an online dynamic nomogram were constructed for the sAKI predictive model. Compared with the static nomogram, the dynamic nomogram allowed for manual selection of corresponding patient characteristics and viewing the corresponding sAKI risk directly. Conclusions:Female, hypertension, vasopressin usage, and SCr are the main risk factors for sAKI in patients with sepsis. The sAKI predictive model constructed based on these factors can help clinical doctors identifying high-risk patients as early as possible, and intervene in a timely manner to provide preventive effects. Compared with the common static nomogram, online dynamic nomogram can make predictive models clearer, more intuitive, and easier.

Objective:To investigate the effects of early hyperbaric oxygen combined with piracetam on hepatic and renal function and myocardial enzyme spectrum in patients with acute carbon monoxide poisoning (ACOP).Methods:A total of 103 patients with ACOP treated in the Emergency Department of Affiliated Hospital of Jining Medical University from January 2015 to January 2019 were selected and divided into control group (53 cases, hyperbaric oxygen treatment) and observation group (50 cases, hyperbaric oxygen combined with piracetam treatment). The changes in the renal function, myocardial enzyme spectrum, superoxide dismutase (SOD), and the hepatic function, as well as the clinical efficacy, and the incidences of adverse reactions were compared between the two groups.Results:The total effective rate of the observation group (98.00%) was significantly higher than that of the control group (79.25%), and there was a statistically significant difference ( P<0.05). After treatment, the levels of blood urea nitrogen (BUN), creatinine (Cr), uric acid, β2 microglobulin (β2-MG), creatine kinase (CK), creatine kinase isoenzyme (CK-MB), α-hydroxybutyrate dehydrogenase (α-HBDH), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) in the observation group were lower than those in the control group, while the level of SOD in the observation group was higher than that in the control group, and there were statistically significant differences ( P<0.05). In terms of the incidences of delayed encephalopathy, acute cerebral infarction, rhabdomyolysis, and pressure ulcer, there was no statistically significant difference between the two groups ( P>0.05). Conclusion:The early hyperbaric oxygen combined with piracetam has a significant clinical efficacy in treating patients with ACOP. It can alleviate the myocardial damage caused by hypoxia, and plays a positive role in protecting hepatic and renal function.

Objective:To investigate the effects of early hyperbaric oxygen combined with piracetam on hepatic and renal function and myocardial enzyme spectrum in patients with acute carbon monoxide poisoning (ACOP).Methods:A total of 103 patients with ACOP treated in the Emergency Department of Affiliated Hospital of Jining Medical University from January 2015 to January 2019 were selected and divided into control group (53 cases, hyperbaric oxygen treatment) and observation group (50 cases, hyperbaric oxygen combined with piracetam treatment). The changes in the renal function, myocardial enzyme spectrum, superoxide dismutase (SOD), and the hepatic function, as well as the clinical efficacy, and the incidences of adverse reactions were compared between the two groups.Results:The total effective rate of the observation group (98.00%) was significantly higher than that of the control group (79.25%), and there was a statistically significant difference ( P<0.05). After treatment, the levels of blood urea nitrogen (BUN), creatinine (Cr), uric acid, β2 microglobulin (β2-MG), creatine kinase (CK), creatine kinase isoenzyme (CK-MB), α-hydroxybutyrate dehydrogenase (α-HBDH), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) in the observation group were lower than those in the control group, while the level of SOD in the observation group was higher than that in the control group, and there were statistically significant differences ( P<0.05). In terms of the incidences of delayed encephalopathy, acute cerebral infarction, rhabdomyolysis, and pressure ulcer, there was no statistically significant difference between the two groups ( P>0.05). Conclusion:The early hyperbaric oxygen combined with piracetam has a significant clinical efficacy in treating patients with ACOP. It can alleviate the myocardial damage caused by hypoxia, and plays a positive role in protecting hepatic and renal function.