Comparing gastrointestinal dysfunction score and acute gastrointestinal injury grade for predicting short-term mortality in critically ill patients

BACKGROUND The prognosis of critically ill patients is closely linked to their gastrointestinal(GI)function.The acute GI injury(AGI)grading system,established in 2012,is extensively utilized to evaluate GI dysfunction and forecast outcomes in clinical settings.In 2021,the GI dysfunction score(GIDS)was developed,building on the AGI grading system,to enhance the accuracy of GI dysfunction severity assessment,improve prognostic predictions,reduce subjectivity,and increase reproducibility.AIM To compare the predictive capabilities of GIDS and the AGI grading system for 28-day mortality in critically ill patients.METHODS A retrospective study was conducted at the general intensive care unit(ICU)of a regional university hospital.All data were collected during the first week of ICU admission.The primary outcome was 28-day mortality.Multivariable logistic regression analyzed whether GIDS and AGI grade were independent risk factors for 28-day mortality.The predictive abilities of GIDS and AGI grade were compared using the receiver operating characteristic curve,with DeLong’s test assessing differences between the curves’areas.RESULTS The incidence of AGI in the first week of ICU admission was 92.13%.There were 85 deaths(47.75%)within 28 days of ICU admission.There was no initial 24-hour difference in GIDS between the non-survival and survival groups.Both GIDS(OR 2.01,95%CI:1.25-3.24;P=0.004)and AGI grade(OR 1.94,95%CI:1.12-3.38;P=0.019)were independent predictors of 28-day mortality.No significant difference was found between the predictive accuracy of GIDS and AGI grade for 28-day mortality during the first week of ICU admission(Z=-0.26,P=0.794).CONCLUSION GIDS within the first 24 hours was an unreliable predictor of 28-day mortality.The predictive accuracy for 28-day mortality from both systems during the first week was comparable.

Effect of dietary fibre on the gastrointestinal microbiota during critical illness:A scoping review

The systemic effects of gastrointestinal(GI)microbiota in health and during chronic diseases is increasingly recognised.Dietary strategies to modulate the GI microbiota during chronic diseases have demonstrated promise.While changes in dietary intake can rapidly change the GI microbiota,the impact of dietary changes during acute critical illness on the microbiota remain uncertain.Dietary fibre is metabolised by carbohydrate-active enzymes and,in health,can alter GI microbiota.The aim of this scoping review was to describe the effects of dietary fibre supplementation in health and disease states,specifically during critical illness.Randomised controlled trials and prospective cohort studies that include adults(>18 years age)and reported changes to GI microbiota as one of the study outcomes using non-culture methods,were identified.Studies show dietary fibres have an impact on faecal microbiota in health and disease.The fibre,inulin,has a marked and specific effect on increasing the abundance of faecal Bifidobacteria.Short chain fatty acids produced by Bifidobacteria have been shown to be beneficial in other patient populations.Very few trials have evaluated the effect of dietary fibre on the GI microbiota during critical illness.More research is necessary to establish optimal fibre type,doses,duration of intervention in critical illness.

Diagnostic value of digital continuous bowel sounds in critically ill patients with acute gastrointestinal injury: A prospective observational study

BACKGROUND Acute gastrointestinal injury(AGI)is common in intensive care unit(ICU)and worsens the prognosis of critically ill patients.The four-point grading system proposed by the European Society of Intensive Care Medicine is subjective and lacks specificity.Therefore,a more objective method is required to evaluate and determine the grade of gastrointestinal dysfunction in this patient population.Digital continuous monitoring of bowel sounds and some biomarkers can change in gastrointestinal injuries.We aimed to develop a model of AGI using continuous monitoring of bowel sounds and biomarkers.AIM To develop a model to discriminate AGI by monitoring bowel sounds and biomarker indicators.METHODS We conducted a prospective observational study with 75 patients in an ICU of a tertiary-care hospital to create a diagnostic model for AGI.We recorded their bowel sounds,assessed AGI grading,collected clinical data,and measured biomarkers.We evaluated the model using misjudgment probability and leave-one-out cross-validation.RESULTS Mean bowel sound rate and citrulline level are independent risk factors for AGI.Gastrin was identified as a risk factor for the severity of AGI.Other factors that correlated with AGI include mean bowel sound rate,amplitude,interval time,Sequential Organ Failure Assessment score,Acute Physiology and Chronic Health Evaluation II score,platelet count,total protein level,blood gas potential of hydrogen(pH),and bicarbonate(HCO3-)level.Two discriminant models were constructed with a misclassification probability of<0.1.Leave-one-out cross-validation correctly classified 69.8%of the cases.CONCLUSION Our AGI diagnostic model represents a potentially effective approach for clinical AGI grading and holds promise as an objective diagnostic standard for AGI.

Severity of acute gastrointestinal injury grade is a good predictor of mortality in critically ill patients with acute pancreatitis

BACKGROUND Gastrointestinal(GI)dysfunction is a common and important complication of acute pancreatitis(AP),especially in patients with severe AP.Despite this,there is no consensus means of obtaining a precise assessment of GI function.AIM To determine the association between acute gastrointestinal injury(AGI)grade and clinical outcomes in critically ill patients with AP.METHODS Patients with AP admitted to our pancreatic intensive care unit from May 2017 to May 2019 were enrolled.GI function was assessed according to the AGI grade proposed by the European Society of Intensive Care Medicine in 2012,which is mainly based on GI symptoms,intra-abdominal pressure,and feeding intolerance in the first week of admission to the intensive care unit.Multivariate logistic regression analysis was performed to assess the association between AGI grade and clinical outcomes in critically ill patients with AP.RESULTS Among the 286 patients included,the distribution of patients with various AGI grades was 34.62%with grade I,22.03%with grade II,32.52%with grade III,and 10.84%with grade IV.The distribution of mortality was 0%among those with grade I,6.35%among those with grade II,30.11%among those with grade III,and 61.29%among those with grade IV,and AGI grade was positively correlated with mortality(χ2=31.511,P<0.0001).Multivariate logistic regression analysis showed that age,serum calcium level,AGI grade,persistent renal failure,and persistent circulatory failure were independently associated with mortality.Compared with the Acute Physiology and Chronic Health Evaluation II score(area under the curve:0.739 vs 0.854;P<0.05)and Ranson score(area under the curve:0.72 vs 0.854;P<0.01),the AGI grade was more useful for predicting mortality.CONCLUSION AGI grade is useful for identifying the severity of GI dysfunction and can be used as a predictor of mortality in critically ill patients with AP.

Acute gastrointestinal injury in critically ill patients with COVID-19 in Wuhan,China

BACKGROUND The coronavirus disease 2019(COVID-19)is spreading rapidly around the world.Most critically ill patients have organ injury,including acute respiratory distress syndrome,acute kidney injury,cardiac injury,or liver dysfunction.However,few studies on acute gastrointestinal injury(AGI)have been reported in critically ill patients with COVID-19.AIM To investigate the prevalence and outcomes of AGI in critically ill patients with COVID-19.METHODS In this retrospective study,demographic data,laboratory parameters,AGI grades,clinical severity and outcomes were collected.The primary endpoints were AGI incidence and 28-d mortality.RESULTS From February 10 to March 102020,83 critically ill patients out of 1314 patients with COVID-19 were enrolled.Seventy-two(86.7%)patients had AGI during hospital stay,of these patients,30 had AGI gradeⅠ,35 had AGI gradeⅡ,5 had AGI gradeⅢ,and 2 had AGI gradeⅣ.The incidence of AGI gradeⅡand above was 50.6%.Forty(48.2%)patients died within 28 days of admission.Multiple organ dysfunction syndrome developed in 58(69.9%)patients,and septic shock in 16(19.3%)patients.Patients with worse AGI grades had worse clinical variables,a higher incidence of septic shock and 28-d mortality.Sequential organ failure assessment(SOFA)scores(95%CI:1.374-2.860;P<0.001),white blood cell(WBC)counts(95%CI:1.037-1.379;P=0.014),and duration of mechanical ventilation(MV)(95%CI:1.020-1.340;P=0.025)were risk factors for the development of AGI gradeⅡand above.CONCLUSION The incidence of AGI was 86.7%,and hospital mortality was 48.2%in critically ill patients with COVID-19.SOFA scores,WBC counts,and duration of MV were risk factors for the development of AGI gradeⅡand above.Patients with worse AGI grades had a higher incidence of septic shock and 28-d mortality.

Mechanisms underlying feed intolerance in the critically ill: Implications for treatment

Malnutrition is associated with poor outcomes in critically ill patients. Although nutritional support is yet to be proven to improve mortality in non-malnourished critically ill patients, early enteral feeding is considered best practice. However, enteral feeding is often limited by delayed gastric emptying. The best method to clinically identify delayed gastric emptying and feed intolerance is unclear. Gastric residual volume （GRV） measured at the bedside is widely used as a surrogate marker for gastric emptying, but the value of GRV measurement has recently been disputed. While the mechanisms underlying delayed gastric emptying require further investigation, recent research has given a better appreciation of the pathophysiology. A number of pharmacological strategies are available to improve the success of feeding. Recent data suggest a combination of intravenous metoclopramide and en/thromycin to be the most successful treatment, but novel drug therapies should be explored. Simpler methods to access the duodenum and more distal small bowel for feed delivery are also under investigation. This review summarises current understanding of the factors responsible for, and mechanisms underlying feed intolerance in critical illness, together with the evidence for current practices. Areas requiring further research are also highlighted.

Fluid and electrolyte overload in critically ill patients: An overview

Fluids are considered the cornerstone of therapy for many shock states, particularly states that are associated with relative or absolute hypovolemia. Fluids are also commonly used for many other purposes, such as renalprotection from endogenous and exogenous substances, for the safe dilution of medications and as "maintenance" fluids. However, a large amount of evidence from the last decade has shown that fluids can have deleterious effects on several organ functions, both from excessive amounts of fluids and from their non-physiological electrolyte composition. Additionally, fluid prescription is more common in patients with systemic inflammatory response syndrome whose kidneys may have impaired mechanisms of electrolyte and free water excretion. These processes have been studied as separate entities(hypernatremia, hyperchloremic acidosis and progressive fluid accumulation) leading to worse outcomes in many clinical scenarios, including but not limited to acute kidney injury, worsening respiratory function, higher mortality and higher hospital and intensive care unit lengthof-stays. In this review, we synthesize this evidence and describe this phenomenon as fluid and electrolyte overload with potentially deleterious effects. Finally, we propose a strategy to safely use fluids and thereafter wean patients from fluids, along with other caveats to be considered when dealing with fluids in the intensive care unit.

Association of interleukin-6 with acute lung injury risk and disease severity in sepsis

Sepsis is a life-threatening condition caused by a dysregulated response of the body in response to an infection that harms its tissues and organs.Interleukin-6(IL-6)is a significant component of the inflammatory response as part of the pa-thogenesis of sepsis.It aids in the development of Acute lung injury and,subse-quently,multiple organ dysfunction syndrome.This letter probes into the corre-lation between plasma IL-6 levels and the risk of developing acute lung injury and multiple organ dysfunction syndrome in critically ill patients with sepsis.While it shows promising results,limitations like its observational study design,a limited sample size,a single center involvement,single-time-point measurement,and a lack of a control group restrain its cogency.The study is a big step in identifying IL-6 as a biomarker to improve patient care.

Antioxidant enriched enteral nutrition and oxidative stress after major gastrointestinal tract surgery

AIM: To investigate the effects of an enteral supple-ment containing antioxidants on circulating levels of antioxidants and indicators of oxidative stress after major gastrointestinal surgery.METHODS: Twenty-one patients undergoing major upper gastrointestinal tract surgery were randomised in a single centre, open label study on the effect of postoperative enteral nutrition supplementedwith antioxidants. The effect on circulating levels of antioxidants and indicators of oxidative stress, such as F2-isoprostane, was studied. RESULTS: The antioxidant enteral supplement showed no adverse effects and was well tolerated. After surgery a decrease in the circulating levels of antioxidant parameters was observed. Only selenium and glutamine levels were restored to pre-operative values one week after surgery. F2-isoprostane increased in the first three postoperative days only in the antioxidant supplemented group. Lipopolysaccharide binding protein (LBP) levels decreased faster in the antioxidant group after surgery.CONCLUSION: Despite lower antioxidant levels there was no increase in the circulating markers of oxidative stress on the first day after major abdominal surgery. The rise in F2-isoprostane in patients receiving the antioxidant supplement may be related to the conversion of antioxidants to oxidants which raises questions on antioxidant supplementation. Module AOX restored the postoperative decrease in selenium levels. The rapid decrease in LBP levels in the antioxidant group suggests a possible protective effect on gut wall integrity. Further studies are needed on the role of oxidative stress on outcome and the use of antioxidants in patients undergoing major abdominal surgery.

Liver dysfunction-related COVID-19:A narrative review

The coronavirus 2019 disease(COVID-19)is caused by a novel coronavirus,severe acute respiratory syndrome coronavirus 2.This disease was designated by the World Health Organization as a pandemic on March 11,2020,which is not seen before.There are no classical features among the cases of the disease owing to the involvement of nearly all body tissues by the virus.Hepatic involvement is one of the characteristics of the COVID-19 course.There are six possible mechanisms of such involvement:Direct virus injury,drug-induced effect,inflammatory cytokine storm,hypoxia-ischemic destruction,abnormalities in liver function tests,and pre-existing chronic liver diseases.Liver abnormalities are seen commonly in the severe or critical stage of COVID-19.Therefore,these abnormalities determine the COVID-19 severity and carry a high rate of morbidity and mortality.The elderly and patients with comorbidities like diabetes mellitus and hypertension are more vulnerable to liver involvement.Another issue that needs to be disclosed is the liver manifestations following the COVID-19 vaccination,such as autoimmune hepatitis.Of note,complete vaccination with third and fourth booster doses is necessary for patients with previous chronic liver diseases or those who have been subjected to liver transplantation.This review aims to explore the various aspects of liver dysfunction during the COVID-19 course regarding the epidemiological features,predisposing factors,pathophysiological mechanisms,hepatic manifestations due to COVID-19 or following vaccination,role of liver function tests in the assessment of COVID-19 severity,adverse effects of the therapeutic agents for the disease,and prognosis.

Effect of Rhubarb on Gastrointestinal Dysfunction in Critically III Patients： A Retrospective Study Based on Propensity Score Matching

Background： Gastrointestinal dysfunction plays a critical role in the prognosis of critically ill patients. Previous studies showed rhubarb, a traditional Chinese herb, can protect the intestinal barrier function, prevent intestinal bacterial translocation, and promote gastrointestinal peristalsis, but the clinical studies are less. The aim of this study was to evaluate the effects of rhubarb on gastrointestinal dysfunction in critically ill patients. Methods： From June 2015 to May 2017, a total of 368 critically ill patients with Grade I III acute gastrointestinal injury （AGI） were enrolled in this study. Patients were divided into two groups according to the exposure factors （whether the patients received rhubarb treatment）： the rhubarb group and the usual treatment group. Clinical data were collected within the first 24 h of the Intensive Care Unit （ICU） admission and 7 days after treatment. Survival data on day 28 after ICU admission and the durations oflCU and total hospitalization were also collected. Propensity score matching （PSM） was conducted to reduce confounding bias between the groups. The logistic regression was conducted to screen the influence factors. Results： The eligible patients were divided into rhubarb group （n = 219, 59.5%） and usual treatment group （n = 149, 40.5%）. Betbre PSM, the remission rate of feeding intolerance in rhubarb group and usual treatment group were 59.8% and 39.6%, respectively. After PSM, the remission rate of feeding intolerance in rhubarb group and usual treatment group was 77.9% and 30.9%, respectively. The remission rates of feeding intolerance in rhubarb group were significantly higher than those in the usual treatment group （all P 〈 0.05）. Compared with the usual treatment group, the rhubarb group had a higher rate of AGI improvement, lower level of C-reactive protein, shorter stay in ICU before and after PSM （P 〈 0.05）. There was no significant difference in 28-day mortality between rhubarb and usual treatment groups before and after PSM （48 vs. 33, P 0.959; and 16 vs. 21, P = 0.335）. The logistic regression analysis showed that the single factor, whether receiving rhubarb therapy, affected the proportion of patients whose enteral nutrition needs ≥83.7 kJ·kg^-1d^-1 after 7 days of treatment （odds ratio： 7.908, 95% confidence interval： 3.661-17.083, P 〈 0.001）. No serious adverse effects were found in two groups. Conclusions： The rhubarb might significantly improve feeding tolerance and relieve gastrointestinal dysfunction in critically ill patients, without serious adverse reactions. It provided proof for the treatment of gastrointestinal dysfunction with rhubarb during clinical practice.

重症超声在危重患者右心功能动态监测中的应用探究

目的 探讨重症超声在危重患者右心功能动态监测中的应用价值。方法 选取2022年1月至2023年1月我院ICU收治的103例伴右心功能障碍的危重症患者,比较患者治疗前与治疗48 h后超声指标[右心室前壁厚度(RVAW)、右心室舒张末期面积/左心室舒张末期面积(RVEDA/LVEDA)、三尖瓣环收缩期移位(TAPSE)、收缩期三尖瓣反流峰值速度(TRmax)]、血流动力学指标[中心静脉压(CVP)]、血液检查指标[血乳酸(Lac)、N末端B型利钠肽前体(NT-proBNP)、肌钙蛋白I(c TnI)、肾小球滤过率(eGFR)]、预后指标[急性生理与慢性健康(APACH Ⅱ)评分、序贯器官衰竭评估(SOFA)评分];比较治疗前超声指标、血流动力学指标、血液检查指标与48 h预后指标的相关性。结果 患者治疗48 h后RVAW、RVEDA/LVEDA、TRmax、CVP、Lac、NT-proBNP、cTnI、APACH Ⅱ评分、SOFA评分较治疗前降低(P<0.05),患者治疗48 h后TAPSE、eGFR较治疗前上升(P<0.05)。RVAW、RVEDA/LVEDA、CVP、NT-proBNP、c TnI与APACH Ⅱ评分、SOFA评分均呈正相关(P<0.05),TAPSE、eGFR与APACH Ⅱ评分、SOFA评分呈负相关(P<0.05),TRmax、Lac与APACH Ⅱ评分、SOFA评分均无相关性(P>0.05)。结论 重症超声在重症患者中应用价值高,能动态监测患者右心功能,并与患者预后显著相关,为临床伴右心功能障碍的重症患者诊疗提供有效信息。

允许性低热量营养支持在老年重症患者治疗中的临床价值

目的探讨允许性低热量营养支持在老年重症患者治疗中的应用价值。方法选取西京医院2018年1—6月收治的符合条件的126例老年重症患者作为研究对象。根据随机数字表法分成标准热量组、试验A组和试验B组,各42例。患者在入院24~48 h内开始实施早期营养支持,7 d后,标准热量组增加至30 kcal/(kg·d),试验A组增加至15 kcal/(kg·d),试验B组增加至9 kcal/(kg·d)。比较各组的营养相关指标(白蛋白、前白蛋白及氮平衡)、急性胃肠道损伤(AGI)分级、序贯性器官功能衰竭(SOFA)评分、并发症和临床结局。结果治疗后,试验A组和试验B组各项营养指标高于标准热量组(P<0.05),且试验A组各项营养指标高于试验B组(P<0.05);试验A组和试验B组的AGI分级评分与SOFA评分均低于标准热量组(P<0.05),且试验A组AGI分级评分与SOFA评分均低于试验B组(P<0.05)。试验A组各并发症的发生率均小于标准热量组和试验B组(P<0.05)。试验A组治疗2周、4周后的死亡率及试验B组治疗4周后的死亡率均低于标准热量组(P<0.05),试验A组治疗2周、4周后的死亡率均低于试验B组(P<0.05)。结论允许性低热量营养支持对老年重症患者具有重要的临床意义,采用15 kcal/(kg·d)的热量水平能够改善老年重症患者的营养状况、保护胃肠道功能,有效控制并发症和病死率。

床旁胃肠超声指导ICU急性胃肠损伤危重病人肠内营养治疗的应用价值

目的应用胃肠超声评价急性胃肠道损伤(AGI)病人的胃肠功能,并确定开始肠内营养(EN)治疗的时机。方法前瞻性选择2022年3月~2023年5月我院重症医学科(ICU)AGI水平为2级(AGIⅡ)的危重病人103例,记录了以下数据,包括超声胃窦横截面积(CSA)、降结肠或升结肠直径(CD)、蠕动频率(CPF)、EN开始时间、前白蛋白(PA)、EN剂量和EN并发症。经EN治疗后胃肠功能恢复判定为成功,如有EN治疗并发症,则判定失败。分析EN治疗后胃肠功能的变化,以确定EN时机。结果成功组68例,失败组35例。两组年龄、腹内压(IAP)、急性生理与慢性健康状况评分Ⅱ(APACHE-Ⅱ)、PA及疾病构成比较差异无统计学意义(P>0.05)。EN成功组的EN启动时间为(14.71±8.89)小时、CSA为(9.24±1.30)cm^(2),CD为(2.86±0.41)cm,EN失败组分别为(19.52±13.53)小时、(10.82±1.96)cm^(2)和(3.38±0.46)cm,两组比较差异有统计学意义(P<0.05),而前者的CPF[(2.84±0.96)次/分钟]较后者[(2.32±0.98)次/分钟]更快,差异有统计学意义(P<0.05)。ROC分析显示,CSA、CD和CPF预测EN成功具有较大的价值,阈值分别为CSA≤9 cm^(2)(AUC=0.892),CD≤2.8 cm(AUC=0.858)和CPF>3次/分钟(AUC=0.744);当CSA、CD和CPF联合预测生成PRE_1时,AUC最大(0.968),预测价值最高,可确定启动EN的最佳时机。结论超声监测CSA、CD、CPF可预测AGIⅡ级危重症病人EN治疗的疗效,并指导EN治疗的最佳启动时机。

运中汤治疗危重症患者脾虚浊毒型急性胃肠功能障碍临床研究

目的 探讨运中汤治疗危重症患者胃肠功能障碍(脾虚浊毒型)的临床疗效。方法 选取危重症合并胃肠功能障碍(脾虚浊毒型)患者80例,按照随机数字表法分为2组。对照组(40例)予西医基础治疗,观察组(40例)在对照组治疗基础上加用运中汤加减治疗。比较2组患者疾病治疗效果及胃肠功能恢复情况,评价其临床疗效。结果 观察组治疗后的临床疗效较对照组明显提高;腹内压、ICU治疗时间、APACHE-II评分、机械通气时间、血乳酸、胃泌素较对照组明显下降,胃蛋白酶较对照组升高,差异有统计学意义(P<0.05)。结论 运用运中汤可改善危重症合并胃肠功能障碍患者的胃肠功能,改善患者预后,为危重症患者胃肠功能障碍的治疗提供了新的思路及可行性。

CXCL14在慢性危重症模型小鼠心功能损伤中的作用

目的 探索CXC趋化因子配体14(CXCL14)在慢性危重症(CCI)模型小鼠心功能损伤中的作用。方法 采用盲肠结扎穿刺术(CLP)诱导脓毒血症建立CCI小鼠模型。24只C57BL/6小鼠按照随机数字表法分成假手术组、CCI组、CCI+CXCL14组和CCI+Anti-CXCL14组,每组6只。CLP后12 d,采用M型超声心动图记录各组小鼠左心室射血分数(LVEF),酶联免疫吸附测定(ELISA)检测脑钠素(BNP)水平评估小鼠心功能。采用苏木精-伊红(HE)染色法观察心肌组织,比较各组小鼠心肌细胞排列和纤维化情况。采用ELISA法检测心肌组织CXCL14表达水平。采用蛋白质印迹法检测小鼠心肌组织纤维化相关蛋白α-平滑肌肌动蛋白(α-SMA)和Ⅲ型胶原蛋白(CollagenⅢ)的表达情况。结果 与假手术组比较,CCI组小鼠LVEF明显降低[(59.17±3.35)%比(74.31±2.16)%,P<0.01],BNP明显升高[(11.27±0.50)比(6.07±0.45),P<0.01],心肌组织病理损伤明显,心肌细胞体积增大,心肌纤维排列紊乱,CXCL14含量明显升高[(0.55±0.02)ng/mg protein比(0.40±0.03)ng/mg protein,P <0.01],心肌纤维化相关蛋白α-SMA [(0.66±0.02)比(0.31±0.05),P <0.01]和CollagenⅢ[(0.64±0.04)比(0.40±0.04),P<0.01]表达增加。与CCI组比较,CXCL14重组蛋白处理可进一步降低小鼠LVEF[(50.97±3.52)%比(59.17±3.35)%,P<0.05],升高BNP水平[(14.73±0.74)比(11.27±0.50),P<0.01],加重心肌组织病理损伤,进一步升高CXCL14含量[(0.75±0.05)ng/mg protein比(0.55±0.02)ng/mg protein,P<0.01]和心肌纤维化相关蛋白α-SMA表达水平[(0.79±0.05)比(0.66±0.02),P<0.05],对CollagenⅢ表达无显著影响[(0.75±0.06)比(0.64±0.04),P>0.05];而CXCL14抗体处理可抑制CCI模型小鼠LVEF下降[(69.29±2.08)%比(59.17±3.35)%,P<0.01],降低BNP水平[(8.77±0.40)比(11.27±0.50),P<0.01],改善心肌组织纤维化,对CXCL14含量无显著影响[(0.54±0.05)ng/mg protein比(0.55±0.02)ng/mg protein,P>0.05],可抑制CCI模型小鼠心肌组织α-SMA[(0.61±0.03)比(0.77±0.04),P<0.01]和CollagenⅢ表达[(0.57±0.04)比(0.80±0.05),P<0.01]。结论 CCI模型小鼠心肌CXCL14表达升高,可能通过促进心肌纤维化导致心功能损伤。

危重症病人胃肠功能障碍与预后关系的临床研究

目的:探讨危重症病人胃肠功能障碍与预后的关系。方法:回顾性分析300危重症病人临床资料,将其分为胃肠功能障碍组(181例)和非胃肠功能障碍组(119例)。评价胃肠功能障碍与急性生理和慢性健康(A-PACHEⅡ)评分、多器官功能障碍综合征(MODS)及预后的关系。结果:综合性重症监护病房(G ICU)内胃肠功能障碍的患病率为60.3%。胃肠功能障碍组病人APACHEⅡ评分、MODS发生率和病死率,均较非胃肠功能障碍组明显升高(P<0.05)。结论:危重症病人胃肠功能障碍提示病情严重和预后不良。

危重病人胃肠功能障碍与衰竭定量诊断评分方案

胃肠功能障碍与衰竭(gastrointestinal dysfunction and failure,GIDF)是多器官功能障碍综合征(MODS)和多器官功能衰竭(MOn发生发展的一个重要因素,是多种严重疾病和器官损伤的共同病理生理过程.

芒硝贴敷脐治疗对改善危重病患者胃肠功能的疗效研究

目的:芒硝贴敷脐治疗危重病患者不同AGI分级胃肠功能障碍的效果分析。方法:分别选取2016年1月—2016年12月期间医院ICU病房AGI分级为I、II、III、IV级的患者各30例作为研究对象,并分别将其随机分配为治疗组和对照组,对照组采用常规西药治疗,治疗组在对照组基础上给予芒硝贴敷脐治疗,比较AGI分级为I、II、III、IV级患者两组治疗后的胃肠功能恢复指标以及总体疗效。结果:AGI分级为I、II、III、IV级的患者治疗组的腹胀缓解时间、肠内营养开始时间均明显的短于对照组,比较差异具有显著性(P<0.05);在治疗第7天时,AGI分级为I、II、III的患者治疗组APACHEⅡ评分明显的低于对照组,比较差异具有显著性(P<0.05);AGI分级为II、III级患者治疗组的总有效率明显的高于对照组,比较差异具有显著性(P<0.05)。结论:芒硝贴敷脐治疗有效的促进了危重病患者胃肠功能的恢复,提高了AGI分级为II、III级患者的治疗效果。

香砂六君子汤对危重症胃肠功能障碍患者疗效及炎性因子的影响

目的：观察香砂六君子汤对危重症胃肠功能障碍脾虚证患者的临床疗效及对肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）的影响。方法选择2015年2月至12月浙江省中医院下沙院区急诊重症加强治疗病房（EICU）收治的危重症患者48例，按随机数字表法分为观察组（26例）和对照组（22例）。两组均给予危重症常规西医治疗，观察组在常规治疗基础上加用香砂六君子汤（党参20 g，炒白术12 g，茯苓12 g，炙甘草4 g，法半夏6 g，陈皮5 g，砂仁5 g，木香4 g，生姜3片）浓煎成80 mL，每日分2次鼻饲。对照组以等量温开水鼻饲。记录治疗前、治疗后3 d、5 d患者胃肠功能评分并检测血浆TNF-α、IL-6水平的变化。结果治疗前及治疗3 d两组患者胃肠功能评分和TNF-α及IL-6水平比较差异无统计学意义（均P＞0.05）；治疗后5 d，两组胃肠功能评分、TNF-α及IL-6均明显降低，且观察组的降低程度较对照组更显著〔胃肠功能障碍评分（分）：0.92±0.85比2.27±0.77，TNF-α（ng/L）：17.7±2.4比25.0±4.2，IL-6（ng/L）：16.9±2.4比25.0±3.4，均P＜0.01〕。结论香砂六君子汤对危重症胃肠功能障碍脾虚证患者有治疗作用，其机制可能与降低危重症患者TNF-α及IL-6水平，从而减轻炎症反应有关。