Clinical Evaluation of Enteral Nutrition+Probiotics in the Treatment of Gastrointestinal Dysfunction After Severe Traumatic Brain Injury

Objective:To evaluate the therapeutic effect of enteral nutrition+probiotics in patients with gastrointestinal dysfunction after severe craniocerebral injury.Methods:From September 2018 to February 2023,80 patients(20-82 years old)with gastrointestinal dysfunction who were admitted to the Intensive Care Unit at the Third People’s Hospital of Xining were included in the study.Their primary condition was severe craniocerebral injury,and all of them received conventional symptomatic treatment.Group A received enteral nutrition+probiotic therapy,whereas group B received enteral nutrition only.The differences in the following indicators were compared before and after treatment:nutritional and biochemical indicators,gastrointestinal function indicators,Glasgow Coma Scale(GCS),Sequential Organ Failure Assessment(SOFA),APACHE II score,serum procalcitonin(PCT),neutrophil(N)ratio,and C reactive protein(CRP).Result:The nutritional and biochemical indicators in group A were higher than those in group B,P<0.05;the time to first passage of flatus,time to first passage of stool,and bowel sound recovery time in group A were shorter than those in group B,P<0.05;the GCS of group A was higher than that of group B,P<0.05;the SOFA and APACHEⅡscores of group A were not different from those of group B,P>0.05;and the PCT,N ratio,and CRP levels of group A were lower than those of group B,P<0.05.Conclusion:In patients with gastrointestinal dysfunction after severe craniocerebral injury,enteral nutrition+probiotic therapy is highly effective and feasible,as it can optimize various nutritional indicators,shorten the gastrointestinal function recovery time,and reduce the body’s stress response.

A Multi-Center Randomized Controlled Study UsingΔP_(CO2)/Ca-v_(O2)as the Target to Guide Early Tissue Hypoperfusion in Sepsis in Plateau Areas

Objective:To explore the value of using the venous-arterial carbon dioxide partial pressure difference and the arterial-venous oxygen content difference ratio(ΔP_(CO2)/Ca-v_(O2))as targets to guide early tissue hypoperfusion in sepsis in plateau areas.Methods:90 sepsis patients admitted to the Third People’s Hospital of Xining and Golmud People’s Hospital from June 2017 to December 2022 were selected as the research subjects,and they were divided into the Scv_(O2)(central venous oxygen saturation)group and theΔP_(CO2)/Ca-v_(O2)group,with 45 cases in each group.The two groups were treated with early shock resuscitation according to different protocols.The hemodynamic characteristics of the two groups of patients before and after resuscitation were observed,and the volume responsiveness was evaluated.The ROC(receiver operating characteristic)curve was used to analyze the significance ofΔP_(CO2)/Ca-v_(O2),Scv_(O2),lactate,lactate clearance,and urine output in evaluating patient prognosis and the correlation betweenΔP_(CO2)/Ca-v_(O2)and the above indicators was explored.Results:Compared with before resuscitation,after fluid resuscitation,the heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP),cardiac index(CI),lactate,lactate clearance rate,and urine output of the two groups of patients were significantly improved(P<0.05);in terms of therapeutic effect,the 28-day mortality rate,6-hour fluid balance,and lactic acid clearance of theΔP_(CO2)/Ca-v_(O2)group were better than the Scv_(O2)group.The ROC characteristic curve showed that theΔP_(CO2)/Ca-v_(O2)value can effectively predict the prognosis of patients(AUC=0.907,sensitivity was 97%,specificity was 72.4%,and critical value was 1.84).ΔP_(CO2)/Ca-v_(O2)significantly correlated with Scv_(O2),lactic acid,and lactic acid clearance rate.Conclusion:TheΔP_(CO2)/Ca-v_(O2)value can be used to guide fluid resuscitation in early hypoperfusion in sepsis in plateau areas,improve patients’hemodynamics,reduce lactate indicators,and increase urine output.ΔP_(CO2)/Ca-v_(O2)level>1.84 can effectively improve patient prognosis.

Analysis of the Efficacy of Humidified High-Flow Nasal Oxygen Therapy Combined with Alveolar Lavage in the Treatment of Patients with Severe Pneumonia Complicated with Respiratory Failure

Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia complicated with respiratory failure admitted to the Third People’s Hospital of Xining from July 2021 to December 2022 were randomly divided into two groups:group A and group B.The patients in group A were given humidified high-flow nasal oxygen therapy combined with alveolar lavage,whereas those in group B were given humidified high-flow nasal oxygen therapy.The treatment efficacy,blood gas analysis results,and differences in inflammatory mediators were compared between the two groups.Results:The curative effect in group A(96.67%)was significantly higher than that in group B(81.67%),P<0.05;the partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygen saturation(SpO2),and Horowitz index(P/F)of group A were significantly better than group B,P<0.05;the interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),and C-reactive protein(CRP)levels,white blood cell(WBC)count,serum procalcitonin(PCT),and neutrophil(N)percentage of group A were significantly lower than those of group B,P<0.05.Conclusion:For patients with severe pneumonia complicated with respiratory failure,alveolar lavage,on the basis of humidified high-flow oxygen therapy,can inhibit local inflammation,improve blood gas analysis results,promote disease recovery,and improve the clinical treatment effect。

离子液体在电沉积铝及铝合金中的应用

离子液体具有不挥发、不燃烧、热稳定性高、电化学窗口宽等特点,被认为是一种满足可持续发展和绿色化学需求的溶剂介质,因其在室温下可以电沉积出多种活泼金属及合金而备受关注。本文系统地介绍了近年来离子液体在电沉积铝及铝合金中的应用进展,分类概括了用于电沉积铝及铝合金的离子液体类型;综述了电沉积机理;对不同形貌的金属铝以及二元、三元铝合金的电沉积技术进行了详细的阐述;最后探讨了当前离子液体在电沉积铝及铝合金理论与技术研究中存在的问题,并对其发展方向进行了展望。

纤维支气管镜治疗重症肺部感染合并肺不张患者的临床效果

目的探讨纤维支气管镜治疗重症肺部感染合并肺不张患者的效果。方法选取西宁市第三人民医院在2016年3月至2018年3月收治的重症肺部感染合并肺不张患者72例,进行回顾性研究。依照随机数字表法实施分为2组,每组36例。36例重症肺部感染合并肺不张患者采用常规治疗作为A组;在此基础之上采用纤维支气管镜治疗的36例重症肺部感染合并肺不张患者作为B组。A组男性27例,女性9例;年龄44~65岁,平均年龄(54.12±19.57)岁。B组男性26例,女性10例;年龄45~64岁,平均年龄(54.94±18.58)岁。观察比较两组的血气分析指标,PCT、CRP、血浆内脂素指标,疗效及临床康复时间。结果 B组患者在治疗后其各临床症状康复时间短于A组,B组治疗后PCT、CRP、血浆内脂素均低于A组,B组SaO_(2)、PaO_(2)、OI均高于A组,且Lac低于A组(P<0.05)。结论对于重症肺部感染合并肺不张患者而言,纤维支气管镜可以在直视下观察患者的气管黏膜水肿、渗出、充血及分泌物的情况,能尽可能地将气道分泌物吸出,从而疏通支气管、改善患者呼吸功能,并开展病原菌培植与药敏试验,针对性地应用抗生素,比常规的治疗其效果更为良好,可推广。