Efficacy and safety of carrimycin in ten patients with severe pneumonia following solid organ transplantation

BACKGROUND The number of patients undergoing solid organ transplantation has increased annually.However,infections in solid organ transplant recipients can have a severe effect on patient survival owing to the continued use of immunosuppressants.Carrimycin is a novel macrolide antibiotic produced by genetically engineered streptomyces spiramyceticus harboring a 4’’-O-isovaleryltransferase gene(ist)from streptomyces thermotoleran.Carrimycin has good antibacterial and antiviral effects.However,no relevant studies have been conducted on the efficacy and safety of carrimycin in patients with severe pneumonia(SP)after solid organ transplantation.AIM To explore the efficacy and safety of carrimycin in patients with SP after solid organ transplantation to provide a medication reference for clinical treatment.METHODS In March 2022,ten patients with SP following solid-organ transplantation were treated at our hospital between January 2021 and March 2022.When the condition was critical and difficult to control with other drugs,carrimycin was administered.These ten patients'clinical features and treatment protocols were retrospectively analyzed,and the efficacy and safety of carrimycin for treating SP following solid organ transplantation were evaluated.RESULTS All ten patients were included in the analysis.Regarding etiological agent detection,there were three cases of fungal pneumonia,two cases of bacterial pneumonia,two cases of Pneumocystis pneumonia,and three cases of mixed infections.After treatment with carrimycin,the disease in seven patients significantly improved,the course of the disease was significantly shortened,fever was quickly controlled,chest computed tomography was significantly improved,and oxygenation was significantly improved.Finally,the patients were discharged after curing.One patient died of acute respiratory distress syndrome,and two patients discontinued treatment.CONCLUSION Carrimycin is a safe and effective treatment modality for SP following solid organ transplantation.Carrimycin may have antibacterial and antiviral effects in patients with SP following solid organ transplantation.

Time to recovery from severe pneumonia and its predictors among pediatric patients admitted in Mizan-Tepi University Teaching Hospital,South West Ethiopia,2022

Objective:Despite trials and programs for the prevention of childhood mortality due to pneumonia,Ethiopia is among the top five countries with the highest number of deaths due to pneumonia.Although the prevalence of pneumonia has increased in the abovementioned trials,little is known about the recovery time from severe pneumonia and its predictors in the study area.Therefore,this study aimed to assess the time to recovery from severe pneumonia and its predictors among pediatric patients admitted to Mizan-Tepi University Teaching Hospital,Ethiopia,in 2022.Methods:A total of 591 children admitted for severe pneumonia were selected using simple random sampling.Data were entered into Epi-data version 4.4.2.1 and expor ted to STATA version 14 for analysis,and the assumptions of Cox propor tional hazard models and goodness of fit were assessed through Shoenfeld residual and Cox-Snell residual,respectively.Bivariate and multivariable Cox regression models were used to identify the predictors of mor tality.Results:This study revealed that 91.54%(95%confidence interval[CI]:89.00–93.53)of participants recovered with an incidence rate of 24.10(95%CI:22.15–26.21)per 100 person-day–observations.The hmedian recovery time of children was 4 days(95%CI:2–6).Children who were not exclusively breastfed(AHR=1.3;95%CI:1.03–1.66),who had a history of inability to suck/feed(AHR=0.81;95%CI:0.65–0.99)were independent predictors of the time to recovery.Conclusions:Children with severe pneumonia who had not exclusively breastfed and who had a history of inability to suck/feed were independent predictors of time to recovery.Therefore,all stakeholders and concerned health care providers should focus more on early diagnosis and management and hasten early recovery based on the identified factors.

Accidental placement of venous return catheter in the superior vena cava during venovenous extracorporeal membrane oxygenation for severe pneumonia: A case report

BACKGROUND Venovenous extracorporeal membrane oxygenation(V-V ECMO)has become an important treatment for severe pneumonia,but there are various complications during the treatment.This article describes a case with severe pneumonia success-fully treated by V-V ECMO,but during treatment,the retrovenous catheter,which was supposed to be in the right internal vein,entered the superior vena cava directly in the mediastinum.The ECMO was safely withdrawn after multidiscip-linary consultation.Our experience with this case is expected to provide a reference for colleagues who will encounter similar situations.CASE SUMMARY A 64-year-old man had severe pulmonary infection and respiratory failure.He was admitted to our hospital and was given ventilation support(fraction of inspired oxygen 100%).The respiratory failure was not improved and he was treated by V-V ECMO,during which the venous return catheter,which was supposed to be in the right internal vein,entered the superior vena cava directly in the mediastinum.There was a risk of massive mediastinal bleeding if the catheter was removed directly when the ECMO was withdrawn.Finally,the patient underwent vena cava angiography+balloon attachment+ECMO with-drawal in the operating room(prepared for conversion to thoracotomy for vascular exploration and repair at any time during surgery)after multidiscip-linary consultation.ECMO was safely withdrawn,and the patient recovered and was discharged.CONCLUSION Patients may have different vascular conditions.Multidisciplinary cooperation can ensure patient safety.Our experience will provide a reference for similar cases.

Effects of nursing team communication and collaboration on treatment outcomes in intensive care unit patients with severe pneumonia

BACKGROUND Severe pneumonia is a common severe respiratory infection worldwide,and its treatment is challenging,especially for patients in the intensive care unit(ICU).AIM To explore the effect of communication and collaboration between nursing teams on the treatment outcomes of patients with severe pneumonia in ICU.METHODS We retrospectively analyzed 60 patients with severe pneumonia who were treated at the ICU of the hospital between January 1,2021 and December 31,2023.We compared and analyzed the respiratory mechanical indexes[airway resistance(Raw),mean airway pressure(mPaw),peak pressure(PIP)],blood gas analysis indexes(arterial oxygen saturation,arterial oxygen partial pressure,and oxygenation index),and serum inflammatory factor levels[C-reactive protein(CRP),procalcitonin(PCT),cortisol(COR),and high mobility group protein B1(HMGB1)]of all patients before and after treatment.RESULTS Before treatment,there was no significant difference in respiratory mechanics index and blood gas analysis index between 2 groups(P>0.05).However,after treatment,the respiratory mechanical indexes of patients in both groups were significantly improved,and the improvement of Raw,mPaw,plateau pressure,PIP and other indexes in the combined group after communication and collaboration with the nursing team was significantly better than that in the single care group(P<0.05).The serum CRP and PCT levels of patients were significantly decreased,and the difference was statistically significant compared with that of nursing group alone(P<0.05).The levels of serum COR and HMGB1 before and after treatment were also significantly decreased between the two groups.CONCLUSION The communication and collaboration of the nursing team have a significant positive impact on respiratory mechanics indicators,blood gas analysis indicators and serum inflammatory factor levels in the treatment of severe pneumonia patients in ICU.

Analysis of the Efficacy of Xuebijing Combined with Antimicrobials in the Treatment of Intensive Care Unit Patients with Severe Pneumonia

Objective:To analyze the therapeutic effect of Xuebijing+antimicrobials in intensive care unit(ICU)patients with severe pneumonia.Methods:60 ICU patients with severe pneumonia from June 2021 to June 2023 were selected and divided by the random number table method,with 30 cases in each group.The observation group received Xuebijing+antimicrobial treatment,while the control group received only antimicrobial treatment.The differences in rehabilitation indexes,test indexes,and inflammation indexes were compared between the two groups.Results:Mechanical ventilation time,fever reduction time,cough relief time,and hospitalization time of the observation group were significantly shorter than those of the control group(P<0.05);C-reactive protein,procalcitonin,and white blood cell count of the observation group were significantly lower than those of the control group(P<0.05);interleukin-6 and tumor necrosis factor-aαof the observation group were significantly lower than those of the control group(P<0.05).Conclusion:The treatment of severe pneumonia patients in ICU with Xuebijing+antibacterial drugs can reduce inflammation,enhance immune function,shorten the pneumonia recovery time,and reduce the adverse reactions of severe pneumonia.

The Effect of Personalized Comprehensive Care on the Nursing Care of Severe Pneumonia Patients

Objective:To explore the value of receiving personalized comprehensive care for patients with severe pneumonia.Methods:73 patients with severe pneumonia who visited the clinic from February 2020 to February 2023 were included in this study.The patients were randomly grouped into Group A and Group B.Group A received personalized comprehensive care whereas Group B received conventional care.The value of care was compared.Results:The duration of mechanical ventilation time,the time taken for fever and dyspnea relief,and the hospitalization time of Group A were shorter than those in Group B(P<0.05).The blood gas indexes such as PaO_(2),PaCO_(2),and blood pH of Group A were better than those of Group B(P<0.05).The pulmonary function indexes such as peak expiratory flow(PEF),forced vital capacity(FVC),and forced expiratory volume in 1 second(FEV_(1))of Group A were better than those of Group B,P<0.05.Moreover,the patients in Group A were generally more satisfied with the care given compared to the patients in Group B(P<0.05).Conclusion:Personalized comprehensive care improves blood gas indexes,enhances lung function,accelerates the relief of symptoms,and also enhances patient satisfaction in severe pneumonia patients.

Sequential treatment of severe pneumonia with respiratory failure and its influence on respiratory mechanical parameters and hemodynamics

BACKGROUND The pathophysiological characteristics of severe pneumonia complicated by respiratory failure comprise pulmonary parenchymal changes leading to ventilation imbalance,alveolar capillary injury,pulmonary edema,refractory hypoxemia,and reduced lung compliance.Prolonged hypoxia can cause acid-base balance disorder,peripheral circulatory failure,blood-pressure reduction,arrhythmia,and other adverse consequences.AIM To investigate sequential mechanical ventilation’s effect on severe pneumonia complicated by respiratory failure.METHODS We selected 108 patients with severe pneumonia complicated by respiratory failure who underwent mechanical ventilation between January 2018 and September 2020 at the Luhe Hospital’s Intensive Care Unit and divided them into sequential and regular groups according to a randomized trial,with each group comprising 54 patients.The sequential group received invasive and non-invasive sequential mechanical ventilation,whereas the regular group received invasive mechanical ventilation.Blood-gas parameters,hemodynamic parameters,respiratory mechanical parameters,inflammatory factors,and treatment outcomes were compared between the two groups before and after mechanical-ventilation treatment.RESULTS The arterial oxygen partial pressure and stroke volume variation values of the sequential group at 24,48,and 72 h of treatment were higher than those of the conventional group(P<0.05).The carbon dioxide partial pressure value of the sequential group at 72 h of treatment and the Raw value of the treatment group at 24 and 48 h were lower than those of the conventional group(P<0.05).The pH value of the sequential group at 24 and 72 h of treatment,the central venous pressure value of the treatment at 24 h,and the Cst value of the treatment at 24 and 48 h were higher than those of the conventional group(P<0.05).The tidal volume in the sequential group at 24 h of treatment was higher than that in the conventional group(P<0.05),the measured values of interleukin-6 and tumor necrosis factor-αin the sequential group at 72 h of treatment were lower than those in the conventional group(P<0.05),and the total time of mechanical ventilation in the sequential group was shorter than that in the conventional group,with a statistically significant difference(P<0.05).CONCLUSION Treating severe pneumonia complicated by respiratory failure with sequential mechanical ventilation is more effective in improving respiratory system compliance,reducing inflammatory response,maintaining hemodynamic stability,and improving patient blood-gas levels;however,from this study’s perspective,it cannot reduce patient mortality.

Effects of mucosolvan combined with fiberoptic bronchoscopy on respiratory function, inflammatory response and stress state in patients with severe pneumonia

Objective: To investigate the effect of mucosolvan combined with fiberoptic bronchoscopy on respiratory function, inflammatory response and stress state in patients with severe pneumonia. Methods: From January 2017 to June 2018, 82 patients with severe pneumonia were randomly divided into observation group and control group (all 41 cases). Patients in the control group received conventional anti-infective treatment, and the observation group was treated with fiberoptic bronchoscopy combined with mucosolvan on the basis of the control group. Respiratory function, inflammatory response and stress status were compared between the two groups. Results: Before treatment, there was no significant difference in Cdyn, WOB and PaO2/FiO2 between the two groups. After treatment, Cdyn and PaO2/FiO2 in the observation group were (36.28±4.28) mL/cmH2O and (376.23±24.21) mmHg respectively, while those in the control group were (26.89±3.76) mL/cmH2O and (322.12±23.16) mmHg, respectively. The levels of Cdyn and PaO2/FiO2 in the observation group were higher than those in the control group. After treatment, the WOB in the observation group was (7.81±0.72) J/L, and the WOB in the control group was (8.33±1.23) J/L. WOB of both groups was lower than that before treatment, and in observation group WOB was lower than that of control group, the difference was statistically significant. In CRP, PCT and sTREM-1 levels, there was no significant difference between the two groups before treatment. After treatment, CRP, PCT and sTREM-1 in the observation group were (39.10±6.03) mg/L, (14.57±2.05) ng/L, (15.02±3.02) ng/L respectively, while those in the control group were (59.72±8.81) mg/L, (20.03±3.09) ng/L, (34.21±5.28) ng/L, respectively. CRP, PCT, sTREM-1 in both groups were lower than those before treatment, and CRP, PCT, sTREM-1 in observation group were lower than those in control group. Before treatment, there was no significant difference with Cor, Ang-I and Ang-II in two groups. After treatment, the levels of Cor, Ang-I and Ang-II in the observation group were (114.76±15.85) ng/mL, (6.72±0.64) ng/mL, (27.28±3.43) ng/mL respectively, while those in the control group were (193.15±22.64) ng/mL, (12.10±1.68) ng/mL, (43.02±5.57) ng/mL, respectively. In the observation group, the levels of Cor, Ang-I and Ang-II were lower than those in the control group. Conclusion: Mucosolvan combined with fiberoptic bronchoscopy can effectively improve the respiratory function of patients with severe pneumonia, and reduce inflammation and stress state of the body.

Effect of fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol on the SIRS and target organ damage in patients with severe pneumonia complicated by respiratory failure

Objective:To study the effect of fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol on the systemic inflammatory response syndrome (SIRS) and target organ damage in patients with severe pneumonia complicated by respiratory failure.Methods: A total of 68 patients with severe pneumonia complicated by respiratory failure who received inpatient treatment in our hospital between July 2013 and December 2016 were collected and then divided into the control group (n=35) who received conventional therapy and the observation group (n=33) who received fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol + conventional therapy after the therapies were reviewed. The systemic inflammatory response as well as cardiac and liver function before and after treatment were compared between two groups of patients.Results: Before treatment, differences in serum levels of inflammatory factors, myocardial enzyme spectrum and liver function indexes were not statistically significant between the two groups of patients. After treatment, serum inflammatory factors IL-6, IL-8, TNF-α and CRP levels in observation group were lower than those in control group;serum myocardial enzyme spectrum LDH,α-HBDH, CKMB and cTnI levels were lower than those in control group;serum liver function index Alb content was higher than that in control group while ALP, TBA, ALT and AST contents were lower than those in control group.Conclusion:Fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol can effectively reduce the degree of SIRS, and also reduce the cardiac and liver function injury in patients with severe pneumonia complicated by respiratory failure.

Application of 16S rDNA Sequencing Technology in the Analysis of Pathogenic Bacteria in Sputum of Severe Pneumonia

The diagnosis of pathogenic bacteria in severe pneumonia is difficult and the prognosis is poor. Its outcome is closely related to bacterial pathogenicity and the timeliness and pertinence of antibiotic treatment. Therefore, early diagnosis is of great significance to the prognosis of patients. Sputum examination and culture is the gold standard for the diagnosis of pathogens of severe pneumonia. However, due to the long time of bacterial culture, the early use of antibiotics, the change of bacteria species, mixed infection and other problems, the results of bacterial culture in sputum are often false negative. With the continuous application of new molecular biology techniques in clinical detection, the classification of bacteria and microorganisms has deepened from the identification of phenotypic characteristics to the classification of gene characteristics. Sequencing analysis with 16S rDNA sequencing technology has the characteristics of high sequencing flux, large amount of data obtained, short cycle, and can more comprehensively reflect the species composition of microbial community, real species distribution and abundance information. In this paper, 16S rDNA sequencing technology was used to analyze the bacterial population composition in the sputum of severe pneumonia, and to explore a new method of etiological diagnosis.

Application of 16s rDNA Sequencing in the Analysis of Pathogenic Bacteria in Sputum of Severe Bacterial Pneumonia

Objective: 120 patients with severe pneumonia who were kept in the comprehensive ICU of our hospital in 2018 were selected, and 16s rDNA sequencing was performed to analyze the composition of pathogenic bacteria in the sputum of severe pneumonia. Methods: The sputum samples of patients with severe bacterial pneumonia were collected, and the diversity of pathogens in the samples was analyzed by polymerase chain reaction (PCR) amplification and high-throughput sequencing (16s rDNA PCR-DGGE). Results: Sequence showed that sputum samples contained a relatively large number of species, and there were many species that were not detected by sequencing. The dominant bacteria were Streptococcus, Sphingomonas, Corynebacterium, Denatobacteria, Aquobacteria, Acinetobacteria, Prevotella, Klebsiella, Pseudomonas, etc. Conclusion: Bacteria caused by sputum of severe bacterial pneumonia are complex and diverse, which provides new methods and ideas for individualized treatment of patients with severe pneumonia.

Effects of short-term intensive insulin therapy on systemic inflammatory response and stress response in patients with severe pneumonia

Objective:To study the effects of short-term intensive insulin therapy on systemic inflammatory response and stress response in patients with severe pneumonia.Methods:Patients with severe pneumonia who were treated in our hospital between March 2015 and October 2017 were chosen as the research subjects and randomly divided into the INS group who received short-term intensive insulin combined with routine therapy and the control group who received short-acting insulin combined with routine therapy. The levels of inflammatory factors and stress mediators in serum as well as the expression intensity of inflammatory molecules in peripheral blood were determined before treatment as well as 3 d and 7 d after treatment.Results:Compared with same group before treatment, serum IL-1β, IL-13, suPAR, sTREM1, sP-selectin, SF, 8-iso-PGF2α, AQP1 and AQP5 levels as well as peripheral blood NF-κB, COX2, RANTES, CD28 and CD80 expression intensity of both groups significantly decreased 3 days and 7 days after treatment, and serum IL-1β, IL-13, suPAR, sTREM1, sP-selectin, SF, 8-iso-PGF2α, AQP1 and AQP5 levels as well as peripheral blood NF-κB, COX2, RANTES, CD28 and CD80 expression intensity of INS group 3 d and 7 d after treatment were significantly lower than those of control group.Conclusion: Short-term intensive insulin therapy has inhibitory effect on the systemic inflammatory response and stress response in patients with severe pneumonia.

Correlation of intestinal flora disorder with systemic inflammatory response and stress response in children with severe pneumonia

Objective:To study the correlation of intestinal flora disorder with systemic inflammatory response and stress response in children with severe pneumonia.Methods: The children who were diagnosed with severe pneumonia in Xiangyang No. 1 People's Hospital between April 2014 and December 2017 were selected as the pneumonia group of the study, and the healthy children who received physical examination in Xiangyang No. 1 People's Hospital during the same period were selected as the control group. The feces was collected to determine the number of intestinal flora bifidobacteria and Escherichia coli (E. coli). Besides, the serum was collected to determine the contents of inflammatory cytokines and oxidative stress indexes, and the peripheral blood was collected to determine the expression intensity of inflammatory molecules and oxidative stress molecules.Results:The number of bifidobacteria and the level of Bifidobacterium and E. coli ratio B/E in feces as well as SOD content in serum of pneumonia group were significantly lower than those of control group whereas the number of E. coli in feces, TLR2, TLR4, NOX2, iNOS and FOXP3 expression intensity in peripheral blood as well as G-CSF, sTREM1, TNF-α, LPO and NO contents in serum were significantly higher than those of control group;Pearson correlation analysis showed that B/E level in feces of pneumonia group was negatively correlated with TLR2, TLR4, NOX2, iNOS and FOXP3 expression intensity in peripheral blood as well as G-CSF, sTREM1, TNF-α, LPO and NO contents in serum, and positively correlated with SOD content in serum.Conclusion:The intestinal flora disorder in children with severe pneumonia can aggravate the degree of systemic inflammatory response and stress response in the course of disease.

The research idea of Xuebijing injection in influencing severe pneumonia-pulmonary fibrosis with blood stasis syndrome evolution by inhibiting inflammation, endotoxin and dispersing blood stasis

Severe pneumonia is one of the most serious infectious diseases.Delayed intervention may lead to pulmonary fibrosis,which greatly threatens people’s life and health.Blood stasis syndrome is an important underlying syndrome throughout the evolution of severe pneumonia-pulmonary fibrosis.Xuebijing injection(XBJ)was developed under the theoretical system of“Three syndromes and three methods”,demonstrating a good efficacy in treating severe pneumonia and pulmonary fibrosis due to its effect of removing blood stasis and dispersing toxins.Previous studies have shown that XBJ can protect vascular endothelial function,improve coagulation function and regulate immunity by inhibiting inflammatory.Hence,the research hypothesis is put forward that XBJ treats blood stasis syndrome by removing blood stasis and dredging blood vessels,to inhibit the disease progress of severe pneumonia to pulmonary fibrosis.Further researches are need to confirm the function and explore the mechanism of XBJ.

Effect of ulinastatin combined with antibiotics on systemic inflammatory response and stress hormone secretion in patients with acute severe pneumonia

Objective:To study the effect of ulinastatin combined with antibiotics on systemic inflammatory response and stress hormone secretion in patients with acute severe pneumonia. Methods: A total of 78 patients with acute severe pneumonia in our hospital between December 2014 and January 2017 were randomly divided into routine group and ulinastatin group, each with 39 cases. Routine group were treated with conventional antibiotics, ulinastatin group were treated with ulinastatin and antibiotics, and the treatments lasted for 2 weeks. The differences of serum acute phase proteins, inflammatory factors and stress hormones were compared between the two groups before and after treatment.Results: Before treatment, there were no significant differences in serum contents of acute phase proteins, inflammatory factors or stress hormones between the two groups. After 2 weeks of treatment, serum acute phase protein prealbumin (PA) content in ulinastatin group was higher than that in routine group whereas C-reactive protein (CRP) content was lower than that in routine group;serum inflammatory cytokines interleukin-1β (IL-1β), interleukin-2 (IL-2) and interleukin-6 (IL-6) contents in ulinastatin group were lower than those in routine group;serum stress hormones NE, Cor and AngII contents in ulinastatin group were lower than those in routine group. Conclusion:Ulinastatin combined with antibiotics for acute severe pneumonia can inhibit the systemic inflammatory response and stress response.

Effects of ulinastatin combined with thymopentin on cellular immunity, humoral immunity and stress response in severe pneumonia

Objective:To explore the effects of ulinastatin combined with thymopentin on cellular immunity, humoral immunity and stress response in severe pneumonia.Methods: A total of 102 cases of severe pneumonia treated in our hospital from February 2016 to November 2017 were collected as subjects and randomly divided into the control group (n=51) and the observation group (n=51), the two groups were treated with routine symptomatic treatment. The control group was treated with the ulinastatin on the basis of routine treatment, the observation group was treated with thymopentin on the basis of the control group. The changes of cellular immunity, humoral immunity, stress response and liver function in the two groups were compared.Results: Before treatment, there was no significant difference in the levels of CD4+, CD8+, CD4+/CD8+, IgA, IgM, IgG, SOD, MDA, T-AOC, AKP, TB and ALT between the two groups (P>0.05). After treatment, the two groups of CD4+ and CD4+ /CD8+ were significantly increased (P<0.05), CD8+ was significantly lower than before treatment (P<0.05), and CD4+ and CD4+ /CD8+ in the observation group were significantly increased compared with the control group (P<0.05), CD8+was significantly lower than the control group (P<0.05);the two groups of IgA, IgM and IgG were significantly increased compared with those before treatment (P<0.05), and the IgA, IgM and IgG in the observation group were significantly higher than those in the control group (P<0.05);two groups of SOD and T-AOC were significantly higher than before treatment (P<0.05), while MDA was significantly lower than before treatment (P<0.05), and SOD and T-AOC in the observation group were significantly increased (P<0.05), and MDA was significantly lower than that of the control group (P<0.05);two groups of AKP, TB and ALT were significantly lower than those before treatment (P<0.05), and the AKP, TB and ALT in the observation group were significantly lower than those in the control group (P<0.05).Conclusions: ulinastatin combined with thymopentin in patients with severe pneumonia can effectively enhance the cellular immunity and humoral immune function, reduce oxidative stress damage and protect the liver function, which has clinical significance.

Effects of intensive insulin therapy on immune function, inflammatory markers, matrix metalloproteinase and stress response in patients with severe pneumonia

Objective:To explore the effects of intensive insulin therapy on immune function, inflammatory markers, matrix metalloproteinase and stress response in patients with severe pneumonia.Methods: From January 2016 to December 2017, 80 cases of severe pneumonia in ICU of our hospital were selected as the subjects of this study, according to the principle of randomization, they were divided into control group (40 cases) and observation group (40 cases). The control group was given routine insulin + routine treatment, and the observation group was given insulin intensification + routine treatment. The changes of immune function, inflammation index, matrix metalloproteinase and stress level were compared between the two groups before and after treatment.Results: After treatment, the levels of IgA, IgG and IgM in the two groups were significantly higher than those before treatment, and the levels of IgA, IgG and IgM in the observation group were significantly higher than those in the control group;the levels of TNF-α, sTREM1 and CRP in the two groups were significantly lower than those before treatment, and the levels of TNF-α, sTREM1 and CRP in the observation group were significantly lower than those in the control group;the levels of TIMP-1, MMP-9 and MMP-9/TIMP-1 in the two groups were significantly lower than those before treatment, and the levels of TIMP-1, MMP-9 and MMP-9/TIMP-1 in the observation group were significantly lower than those in the control group;the levels of SF and LPO in the two groups were significantly lower than those before treatment, while the levels of SOD in the observation group were significantly higher than those before treatment, and the levels of SF and LPO in the observation group were significantly lower than those in the control group, while the levels of SOD in the observation group were significantly higher than those in the control group. Conclusions:Intensive insulin therapy can effectively improve the immune function of severe pneumonia patients, reduce their inflammatory reaction, matrix metalloproteinase levels and oxidative stress injury.

Effect of glutamine enteral nutrition + low molecular weight heparin on systemic inflammatory response in patients with severe pneumonia

Objective: To investigate the effect of glutamine enteral nutrition + low molecular weight heparin on systemic inflammatory response in patients with severe pneumonia. Methods:A total of 52 patients with severe pneumonia who were hospitalized in this hospital between January 2017 and October 2017 were divided into glutamine group (n=26) and control group (n=26) by random number table method. Control group received conventional enteral nutrition+ low molecular weight heparin treatment, glutamine group were treated with glutamine nutrient solution on the basis of the therapy for control group, and both therapies lasted for 7 d. The differences in serum levels of inflammatory factors, oxidative stress indexes and myocardial injury indexes were compared between the two groups before and after treatment. Results: Before treatment, serum levels of inflammatory factors, oxidative stress indexes and myocardial injury indexes were not significantly different between the two groups. After 7 d of treatment, serum inflammatory factors IL-10 and IL-18 levels of glutamine group were higher than those of control group whereas IL-17, sTREM-1 and PCT levels were lower than those of control group;serum oxidative stress indexes MDA and LHP levels were lower than those of control group whereas GSH-Px and CAT levels were higher than those of control group;serum myocardial injury indexes α-HBDH, cTnⅠ, NT-ProBNP and LDH levels were lower than those of control group. Conclusion: glutamine enteral nutrition + low molecular weight heparin can effectively relieve systemic inflammatory response and oxidative stress response, and reduce the myocardial injury in patients with severe pneumonia.

Effect of Xuebijing, thymopentin combined with symptomatic treatment on inflammatory response process in elderly patients with severe pneumonia

Objective:To study the effect of Xuebijing, thymopentin combined with symptomatic treatment on inflammatory response process in elderly patients with severe pneumonia. Methods: A total of 60 elderly patients with severe pneumonia who were treated in the hospital between August 2014 and July 2016 were collected and divided into control group and observation group according to the random number table, 30 cases in each group. Control group received clinical symptomatic treatment, and observation group received Xuebijing, thymopentin combined with symptomatic treatment. The differences in serum pro-inflammatory factors, anti-inflammatory factors as well as liver and kidney function indexes were compared between the two groups before and after treatment.Results: Before treatment, differences in serum levels of pro-inflammatory factors, anti-inflammatory factors as well as liver and kidney function indexes were not statistically significant between the two groups. After treatment, serum IL-1β, IL-6, IL-8, IL-4, IL-13, TB, ALT, AKP, Scr and CysC levels of both groups of patients were lower than those before treatment, and serum IL-1β, IL-6, IL-8, IL-4, IL-13, TB, ALT, AKP, Scr and CysC levels of observation group were lower than those of control group.Conclusion: Xuebijing, thymopentin combined with symptomatic treatment can effectively inhibit the degree of systemic inflammatory response and reduce the liver and kidney function injury in elderly patients with severe pneumonia.

Effect of ulinastatin + thymosin adjuvant therapy on inflammatory and stress response in patients with severe pneumonia

Objective: To investigate the effect of ulinastatin + thymosin adjuvant therapy on inflammatory and stress response in patients with severe pneumonia. Methods: A total of 66 patients with severe pneumonia who were diagnosed and treated in Huanggang Central Hospital between July 2016 and July 2017 were divided into control group (n=33) and study group (n=33) by random number table. Control group received routine therapy for severe pneumonia, and study group received routine therapy combined with ulinastatin + thymosin adjuvant therapy, which lasted for 1 week. The differences in serum levels of inflammatory factors and stress hormones were compared between the two groups before and after treatment. Results: Before treatment, the differences in serum levels of inflammatory factors and stress hormones were not statistically significant between the two groups. After 1 week of treatment, serum levels of inflammatory factors and stress hormones of both groups of patients were lower than those before treatment, serum levels of pro-inflammatory factors IL-1β, IL-2, IL-6, IL-8 and TNF-α as well as anti-inflammatory factors IL-4, IL-10 and IL-13 of study group were lower than those of control group, and serum stress hormones AngⅠ, AngⅡ, NE and Cor levels were lower than those of control group. Conclusion: Routine therapy combined with ulinastatin + thymosin adjuvant therapy can further inhibit the systemic inflammatory response and stress response and optimize the overall condition in patients with severe pneumonia.