Correlation between Pulmonary Endothelin Receptors and Alveolar-arterial Oxygen Gradient in Rats with Hepatopulmonary Syndrome

The correlation between pulmonary endothelin receptors and alveolar-arterial oxygen gradient （A aDO2） in rats with hepatopulmonary syndrome was investigated. Animals were divided into 2 groups： Sham operated （Sham） group and common bile duct ligation （CBDL） group. Arterial blood gas was evaluated by a blood gas analyzer. The concentrations of ET-1 in blood and lung tissue sample were evaluated by radioimmunoassay. The distribution and expression of two kinds of subtype receptor of ET-1, ETRA and ETRB were examined by in situ hybridization. The results showed that the level of A aDO2, was higher in CBDI. group than that in Sham group （P〈0.05）. The levels of plasma and pulmonary ET-1 in CBDL group were both higher than in Sham group （P〈0.05 ）. There was no significant difference in average A of ETRA between two groups by imaging analysis （0.21±0.06 vs 0.22±0.08, P〉0.05）, while that of ETRB was higher in CBDI. group than in Sham group （0.58±0.16 vs 0.28±0.07, P〈0.05）. The expression of ETRBinlung was positively correlated with A aDO2（P〈0.05）. It was concluded that the widened A-aDO2 may be related with enhancement of the expression of ETRB in lung.

Combined APACH Ⅱ score and arterial blood lactate clearance rate to predict the prognosis of ARDS patients

Objective:To explore the easily applicable indicators of practical value to evaluate the prognosis of acute respiratory distress syndrome（ARDS）.Methods:Blood and biochemical tests and bloodgas analyses were performed upon entry into the ICUs,12 h,24 h,48 h and 72 h after that in 72 ARDS patients（who were admitted to the ICUs of our hospital from January 2000 to December 2009）.Then APACHEⅡscores were achieved by combining relevant physiological parameters and laboratory results.Results:There was a statistical difference between the death group and survival group at different time points upon entering the ICUs in terms of APACHEⅡscore, alveolar-arterial oxygen difference and arterial blood lactate clearance rate.PaO2/FiO2 values were recorded to be statistically different between the death group and survival group 24 h,48 h and 72 h,respectively after entry into the ICUs.In addition,registered linear regression existed between APACHEⅡscore,alveolar-arterial oxygen difference or PaO2/FiO2 value and time. APACHEⅡscore 24 h and 72 h after entering ICUs predicted mortality with an area under the ROC curve（AUC） standing respectively at 0.919 and 0.9SS.Arterial blood lactate clearance rate 12 h, 24 h,48 h and 72 h after entering ICUs predicted mortality with an area under the ROC curve （AUC） at 0.918,0.918,0.909 and 0.991,respectively.Conclusions:APACHEⅡscore applied in combination with arterial blood lactate clearance rate is of clinical significance in assessing the prognosis of ARDS patients.

Pentoxifylline in hepatopulmonary syndrome

AIM： To determine the effects of pentoxifylline （PTX） on clinical manifestations and evaluate arterial blood gas data in hepatopulmonary syndrome （HPS） in chil- dren. METHODS： In a pilot study of 10 children with chronic liver disease, who had HPS, 20 mg/kg/d PTX was ad- ministered for 3 mo. Clinical data and arterial blood gas parameters were evaluated at baseline, the end of the treatment period, and 3 mo after drug discontinuation. RESULTS： Six patients could tolerate PTX, while four patients experienced complications, Among patients who could tolerate PTX, there was a significant increase in arterial oxygen pressure （PaO2） （P = 0,02） and oxy- gen saturation （Sa02） （P = 0.04） and alveolar-arterial oxygen gradient （P = 0.02） after 3 mo of treatment. Significant decreases in Pa02 （P = 0.02） and alveolararterial oxygen gradient （P = 0.02） were also seen after drug discontinuation. CONCLUSION： PTX may improve PaO2, Sa02 and alve- olar-arterial oxygen gradient in the early stage of HPS.

Effects of high-volume hemofiltration on alveolar- arterial oxygen exchange in patients with refractory septic shock

BACKGROUND：High-volume hemofiltration （HVHF） is technically possible in severe acute pancreatitis （SAP） patients complicated with multiple organ dysfunction syndrome （MODS）. Continuous HVHF is expected to become a beneficial adjunct therapy for SAP complicated with MODS. In this study, we aimed to explore the effects of fluid resuscitation and HVHF on alveolar- arterial oxygen exchange, the Acute Physiology and Chronic Health Evaluation II （APACHE II） score in patients with refractory septic shock. METHODS：A total of 89 refractory septic shock patients, who were admitted to ICU, the Provincial Hospital affiliated to Shandong University from August 2006 to December 2009, were enrolled in this retrospective study. The patients were randomly divided into two groups： fluid resuscitation （group A, n=41）, and fluid resuscitation plus high-volume hemofiltration （group B, n=48）, The levels of O2 content of central venous blood （CcvO2）, arterial oxygen content （CaO2）, alveolar-arterial oxygen pressure difference P（A-a）DO2, ratio of arterial oxygen pressure/alveolar oxygen pressure （PaO2/ PAO2）, respiratory index （RI） and oxygenation index （OI） were determined. The oxygen exchange levels of the two groups were examined based on the arterial blood gas analysis at different times （0, 24, 72 hours and 7 days of treatment） in the two groups. The APACHE II score was calculated before and after 7-day treatment in the two groups. The levels of CcvO2, CaO2 on day 7 in group A were significantly lower than those in group B （CcvO2：0.60±0.24 vs, 0.72±0.28, P〈0.05; CaO2：0.84±0.43 vs. 0.94±0.46, P〈0.05）. The level of oxygen extraction rate （O2ER） in group A on the 7th day was significantly higher than that in group B （ 28.7±2.4 vs. 21.7±3.4, P〈0.01）. The levels of P（A-a）DO2 and RI in group B on the 7th day were significantly lower than those in group A. The levels of PaO2/PAO2 and OI in group B on 7th day were significantly higher than those in group A （P〈0.05 or P〈0.01）. The APACHE II score in the two groups reduced gradually after 7-day treatment, and the APACHE II score on the 7th day in group B was significantly lower than that in group A （8.2±3.8 vs. 17.2±6.8, P〈0.01）. HVHF combined with fluid resuscitation can improve alveolar- arterial-oxygen exchange, decrease the APACHE II score in patients with refractory septic shock, and thus it increases the survival rate of patients.