Objectives: To investigate the effect of Shenfu Injection(参附注射液, SFI) on inflammatory factors in patients with acute myocardial infarction complicated by cardiogenic shock(CS) treated with and intra-aortic b...Objectives: To investigate the effect of Shenfu Injection(参附注射液, SFI) on inflammatory factors in patients with acute myocardial infarction complicated by cardiogenic shock(CS) treated with and intra-aortic balloon pump(IABP). Methods: This study enrolled 60 patients with ST-segment elevation myocardial infarction(STEMI) complicated by CS. Patients underwent IABP and emergency percutaneous coronary intervention(PCI) were randomly divided into two groups by random number table with 30 cases in each group, one given SFI treatment(100 m L/24 h), one not. The two groups were then compared in a clinical setting for left ventricular function, biochemical indicators and Inflammatory factors, including C-reactive proteins(CRP), interleukin-1(IL-1) and tumor necrosis factor alpha(TNF-α). Major adverse cardiac and cerebrovascular events(MACCE) events were compared between patients of the two groups both in-hospital and in follow-ups. Results: The IABP support treatment times of patients in the IABP+SFI group were significantly shorter than the IABP group(52.87±28.84 vs. 87.45±87.31, P=0.047). In the patients of the IABP+SFI group, the CRP peak appeared in 24 h after PCI operation. The CRP peak in the patients of the IABP+SFI group was significantly lower than that in the IABP group(31.27±3.93 vs. 34.62±3.47, P=0.001). The increases in range of TNF-α in the patients of the IABP+SFI group were significantly lower than those of the IABP group(182.29±22.79 vs. 195.54±12.02, P=0.007). The increases in range of IL-1 in the patients of the IABP+SFI group were significantly lower than those of the IABP group(214.98±29.22 vs. 228.60±7.03, P=0.019). The amplitude elevated TNF-α 72 h after admission was an independent risk factor of in-hospital MACCE events(OR 0.973, 95% CI 0.890–0.987, P=0.014) in patients with STEMI and CS. Conclusion: Patients with STEMI complicated by CS treated by IABP and SFI had a reduced inflammatory reaction, a reduced dependence of CS on IABP and shortened the course of disease.展开更多
BACKGROUND Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) complicates management of the condition, and often leads to poor prognosis. Prompt and accurate monitoring of cardiovascular and accompa...BACKGROUND Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) complicates management of the condition, and often leads to poor prognosis. Prompt and accurate monitoring of cardiovascular and accompanying hemodynamic changes is crucial in achieving adequate management of the condition. Advances in technology has availed procedures such as pulse index continuous cardiac output (PiCCO), which can offer precise monitoring of cardiovascular functions and hemodynamic parameters. In this study, PiCCO is evaluated for its potential utility in improving management and clinical outcomes among elderly patients with AMI complicated by CS. AIM To assess whether use of the PiCCO system can improve clinical outcomes in elderly patients with AMI complicated by CS.METHODS Patients from emergency intensive care units (EICU) or coronary care units (CCU) were randomized to receive PiCCO monitoring or not. The APACHE II score, SOFA score, hs-TnI, NT-proBNP, PaO2/FiO2 ratio and lactate levels on day 1, 3 and 7 after treatment were compared. The infusion and urine volume at 0-24 h, 24-48 h and 48-72 h were recorded, as were the cardiac index (CI), extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI) and global end diastolic volume index (GEDVI) at similar time intervals. RESULTS Sixty patients with AMI complicated by CS were included in the study. The PiCCO group had a significantly lower APACHE II score, SOFA score, hs-TnI and NT-proBNP levels on day 1, 3 and 7 after treatment. The infusion and urine volume during 0-24 h in the PiCCO group were significantly greater, and this group also showed significantly higher ADL scores. Furthermore, the PiCCO group spent lesser days on vasoactive agents, mechanical ventilation, and had a reduced length of stay in EICU/CCU. Additionally, the CI was significantly higher at 48 h and 72 h in the PiCCO group compared with that at 24 h, and the EVLWI, ITBVI and GEDVI were significantly decreased at 48 h and 72 h. CONCLUSION Applying the PiCCO system could improve the clinical outcomes of elderly patients with AMI complicated by CS.展开更多
<strong>Background</strong><strong>:</strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:;" "=&qu...<strong>Background</strong><strong>:</strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">Septic shock is a rapidly changing and fatal syndrome that can </span><span style="font-family:Verdana;">cause comprehensive deterioration of cardiopulmonary and renal function and multiple organ failure. At the same time, septic shock has the complex clinical manifestations and hemodynamics. PiCCO can accurately </span><span style="font-family:Verdana;">monitor blood flow, physical and volume indicators, and active and effective fluid resuscitation are important measures to reduce the fatality rate of septic shock and improve the prognosis of patients. </span><b><span style="font-family:Verdana;">Objectives: </span></b><span style="font-family:Verdana;">To explore the application an</span><span style="font-family:Verdana;">d nursing of PiCCO in early fluid resuscitation in patie</span><span style="font-family:Verdana;">nts with septic shock. </span><b><span style="font-family:Verdana;">Me</span><span style="font-family:Verdana;">thods:</span></b><span style="font-family:Verdana;"> This was a retrospective observ</span><span style="font-family:Verdana;">ational study. The observation group and the control group each had 30 cases. The observation group used PiCCO to guide fluid resuscitation;the control group used conventional methods to guide fluid resuscitation.</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">The changes in CVP, HR, MAP, and urine volume per hour were observed in the two groups. The changes of various indicators before and after fluid resuscitation, the length of stay in ICU and the mortality rate were compared between the two groups. All the outcomes were collected from the electronic medical case system after patients’ discharge from the hospital. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">APACHE </span></span><span style="font-family:Verdana;">II</span><span style="font-family:;" "=""><span style="font-family:Verdana;">, CVP, HR, MAP were compared between th</span><span style="font-family:Verdana;">e obse</span><span style="font-family:Verdana;">rvation group and th</span></span><span style="font-family:;" "=""><span style="font-family:Verdana;">e control group, and the differences w</span><span><span style="font-family:Verdana;">ere statistically significant (</span><i><span style="font-family:Verdana;">P</span></i></span></span><i><span style="font-family:;" "=""> </span></i><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.05). The blood volume of patients in the observatio</span><span style="font-family:;" "=""><span style="font-family:Verdana;">n group was significantly improved after fluid supplementation</span><span><span style="font-family:Verdana;"> (</span><i><span style="font-family:Verdana;">P</span></i></span></span><i><span style="font-family:;" "=""> </span></i><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.05). Compared with the control group, the length of stay in ICU in the observation group was significantly shorter, and the mortality rate was also significantly reduced</span><span style="font-family:Verdana;"> (</span><i><span style="font-family:Verdana;">P</span></i></span><span> </span><span style="font-family:Verdana;"><</span><span> </span><span style="font-family:Verdana;">0.05</span><span><span style="font-family:Verdana;">). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> PiCCO can be better used in early fluid resuscitation of patients with septic shock.</span></span>展开更多
To investigate the effect of hypertonic saline / dextran 70 (HSD) on cardiac function in delayed resuscitation of burn shock. Methods: HSD was used for resuscitation 6 h postburn in dogs and its effect on cardiac func...To investigate the effect of hypertonic saline / dextran 70 (HSD) on cardiac function in delayed resuscitation of burn shock. Methods: HSD was used for resuscitation 6 h postburn in dogs and its effect on cardiac function was evaluated byvolume load,MAP, LVSP,LVEDP, + dp/dtmax, -dp/dtmax, CO and SVR. Results: The volume of HSD was 30.50% less duringfirst 24 h postburn and 59.50% less during 4 h after resuscitation than that of lactated Ringer’s solution (LR’s). MAP, LVSP,LVEDP, + dp/dtmax, -dp/dtmax and CO increased and SVR reduced in HSD resuscitation. Conclnsion: Smaller volume of HSD canexpand plasma volume significantly and improve cardiac function in delayed resuscitation of burn shock.展开更多
BACKGROUND Fulminant myocarditis is the critical form of myocarditis that is often associated with heart failure, malignant arrhythmia, and circulatory failure. Patients with fulminant myocarditis who end up with seve...BACKGROUND Fulminant myocarditis is the critical form of myocarditis that is often associated with heart failure, malignant arrhythmia, and circulatory failure. Patients with fulminant myocarditis who end up with severe multiple organic failure and death are not rare.AIM To analyze the predictors of in-hospital major adverse cardiovascular events(MACE) in patients diagnosed with fulminant myocarditis.METHODS We included a cohort of adult patients diagnosed with fulminant myocarditis who were admitted to Beijing Anzhen Hospital from January 2007 to December2017. The primary endpoint was defined as in-hospital MACE, including death,cardiac arrest, cardiac shock, and ventricular fibrillation. Baseline demographics,clinical history, characteristics of electrocardiograph and ultrasonic cardiogram,laboratory examination, and treatment were recorded. Multivariable logistic regression was used to examine risk factors for in-hospital MACE, and the variables were subsequently assessed by the area under the receiver operating characteristic curve(AUC).RESULTS The rate of in-hospital MACE was 40%. Multivariable logistic regression analysis revealed that baseline QRS duration > 120 ms was the independent risk factor for in-hospital MACE(odds ratio = 4.57, 95%CI: 1.23-16.94, P = 0.023). The AUC of QRS duration > 120 ms for predicting in-hospital MACE was 0.683(95%CI: 0.532-0.833, P = 0.03).CONCLUSION Patients with fulminant myocarditis has a poor outcome. Baseline QRS duration is the independent risk factor for poor outcome in those patients.展开更多
基金Supported by Beijing Chinese Medicine Technology Development Surfaces Subject of Special Funds(No.JJ2013-19)
文摘Objectives: To investigate the effect of Shenfu Injection(参附注射液, SFI) on inflammatory factors in patients with acute myocardial infarction complicated by cardiogenic shock(CS) treated with and intra-aortic balloon pump(IABP). Methods: This study enrolled 60 patients with ST-segment elevation myocardial infarction(STEMI) complicated by CS. Patients underwent IABP and emergency percutaneous coronary intervention(PCI) were randomly divided into two groups by random number table with 30 cases in each group, one given SFI treatment(100 m L/24 h), one not. The two groups were then compared in a clinical setting for left ventricular function, biochemical indicators and Inflammatory factors, including C-reactive proteins(CRP), interleukin-1(IL-1) and tumor necrosis factor alpha(TNF-α). Major adverse cardiac and cerebrovascular events(MACCE) events were compared between patients of the two groups both in-hospital and in follow-ups. Results: The IABP support treatment times of patients in the IABP+SFI group were significantly shorter than the IABP group(52.87±28.84 vs. 87.45±87.31, P=0.047). In the patients of the IABP+SFI group, the CRP peak appeared in 24 h after PCI operation. The CRP peak in the patients of the IABP+SFI group was significantly lower than that in the IABP group(31.27±3.93 vs. 34.62±3.47, P=0.001). The increases in range of TNF-α in the patients of the IABP+SFI group were significantly lower than those of the IABP group(182.29±22.79 vs. 195.54±12.02, P=0.007). The increases in range of IL-1 in the patients of the IABP+SFI group were significantly lower than those of the IABP group(214.98±29.22 vs. 228.60±7.03, P=0.019). The amplitude elevated TNF-α 72 h after admission was an independent risk factor of in-hospital MACCE events(OR 0.973, 95% CI 0.890–0.987, P=0.014) in patients with STEMI and CS. Conclusion: Patients with STEMI complicated by CS treated by IABP and SFI had a reduced inflammatory reaction, a reduced dependence of CS on IABP and shortened the course of disease.
文摘BACKGROUND Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) complicates management of the condition, and often leads to poor prognosis. Prompt and accurate monitoring of cardiovascular and accompanying hemodynamic changes is crucial in achieving adequate management of the condition. Advances in technology has availed procedures such as pulse index continuous cardiac output (PiCCO), which can offer precise monitoring of cardiovascular functions and hemodynamic parameters. In this study, PiCCO is evaluated for its potential utility in improving management and clinical outcomes among elderly patients with AMI complicated by CS. AIM To assess whether use of the PiCCO system can improve clinical outcomes in elderly patients with AMI complicated by CS.METHODS Patients from emergency intensive care units (EICU) or coronary care units (CCU) were randomized to receive PiCCO monitoring or not. The APACHE II score, SOFA score, hs-TnI, NT-proBNP, PaO2/FiO2 ratio and lactate levels on day 1, 3 and 7 after treatment were compared. The infusion and urine volume at 0-24 h, 24-48 h and 48-72 h were recorded, as were the cardiac index (CI), extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI) and global end diastolic volume index (GEDVI) at similar time intervals. RESULTS Sixty patients with AMI complicated by CS were included in the study. The PiCCO group had a significantly lower APACHE II score, SOFA score, hs-TnI and NT-proBNP levels on day 1, 3 and 7 after treatment. The infusion and urine volume during 0-24 h in the PiCCO group were significantly greater, and this group also showed significantly higher ADL scores. Furthermore, the PiCCO group spent lesser days on vasoactive agents, mechanical ventilation, and had a reduced length of stay in EICU/CCU. Additionally, the CI was significantly higher at 48 h and 72 h in the PiCCO group compared with that at 24 h, and the EVLWI, ITBVI and GEDVI were significantly decreased at 48 h and 72 h. CONCLUSION Applying the PiCCO system could improve the clinical outcomes of elderly patients with AMI complicated by CS.
文摘<strong>Background</strong><strong>:</strong><b><span style="font-family:;" "=""> </span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">Septic shock is a rapidly changing and fatal syndrome that can </span><span style="font-family:Verdana;">cause comprehensive deterioration of cardiopulmonary and renal function and multiple organ failure. At the same time, septic shock has the complex clinical manifestations and hemodynamics. PiCCO can accurately </span><span style="font-family:Verdana;">monitor blood flow, physical and volume indicators, and active and effective fluid resuscitation are important measures to reduce the fatality rate of septic shock and improve the prognosis of patients. </span><b><span style="font-family:Verdana;">Objectives: </span></b><span style="font-family:Verdana;">To explore the application an</span><span style="font-family:Verdana;">d nursing of PiCCO in early fluid resuscitation in patie</span><span style="font-family:Verdana;">nts with septic shock. </span><b><span style="font-family:Verdana;">Me</span><span style="font-family:Verdana;">thods:</span></b><span style="font-family:Verdana;"> This was a retrospective observ</span><span style="font-family:Verdana;">ational study. The observation group and the control group each had 30 cases. The observation group used PiCCO to guide fluid resuscitation;the control group used conventional methods to guide fluid resuscitation.</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">The changes in CVP, HR, MAP, and urine volume per hour were observed in the two groups. The changes of various indicators before and after fluid resuscitation, the length of stay in ICU and the mortality rate were compared between the two groups. All the outcomes were collected from the electronic medical case system after patients’ discharge from the hospital. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">APACHE </span></span><span style="font-family:Verdana;">II</span><span style="font-family:;" "=""><span style="font-family:Verdana;">, CVP, HR, MAP were compared between th</span><span style="font-family:Verdana;">e obse</span><span style="font-family:Verdana;">rvation group and th</span></span><span style="font-family:;" "=""><span style="font-family:Verdana;">e control group, and the differences w</span><span><span style="font-family:Verdana;">ere statistically significant (</span><i><span style="font-family:Verdana;">P</span></i></span></span><i><span style="font-family:;" "=""> </span></i><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">0.05). The blood volume of patients in the observatio</span><span style="font-family:;" "=""><span style="font-family:Verdana;">n group was significantly improved after fluid supplementation</span><span><span style="font-family:Verdana;"> (</span><i><span style="font-family:Verdana;">P</span></i></span></span><i><span style="font-family:;" "=""> </span></i><span style="font-family:Verdana;"><</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.05). Compared with the control group, the length of stay in ICU in the observation group was significantly shorter, and the mortality rate was also significantly reduced</span><span style="font-family:Verdana;"> (</span><i><span style="font-family:Verdana;">P</span></i></span><span> </span><span style="font-family:Verdana;"><</span><span> </span><span style="font-family:Verdana;">0.05</span><span><span style="font-family:Verdana;">). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> PiCCO can be better used in early fluid resuscitation of patients with septic shock.</span></span>
文摘To investigate the effect of hypertonic saline / dextran 70 (HSD) on cardiac function in delayed resuscitation of burn shock. Methods: HSD was used for resuscitation 6 h postburn in dogs and its effect on cardiac function was evaluated byvolume load,MAP, LVSP,LVEDP, + dp/dtmax, -dp/dtmax, CO and SVR. Results: The volume of HSD was 30.50% less duringfirst 24 h postburn and 59.50% less during 4 h after resuscitation than that of lactated Ringer’s solution (LR’s). MAP, LVSP,LVEDP, + dp/dtmax, -dp/dtmax and CO increased and SVR reduced in HSD resuscitation. Conclnsion: Smaller volume of HSD canexpand plasma volume significantly and improve cardiac function in delayed resuscitation of burn shock.
基金Supported by Beijing Natural Science Foundation,No.7184205Beijing Talents Fund,No.2017000021469G224Foundation of Beijing Anzhen Hospital,Capital Medical University,No.2016Z07
文摘BACKGROUND Fulminant myocarditis is the critical form of myocarditis that is often associated with heart failure, malignant arrhythmia, and circulatory failure. Patients with fulminant myocarditis who end up with severe multiple organic failure and death are not rare.AIM To analyze the predictors of in-hospital major adverse cardiovascular events(MACE) in patients diagnosed with fulminant myocarditis.METHODS We included a cohort of adult patients diagnosed with fulminant myocarditis who were admitted to Beijing Anzhen Hospital from January 2007 to December2017. The primary endpoint was defined as in-hospital MACE, including death,cardiac arrest, cardiac shock, and ventricular fibrillation. Baseline demographics,clinical history, characteristics of electrocardiograph and ultrasonic cardiogram,laboratory examination, and treatment were recorded. Multivariable logistic regression was used to examine risk factors for in-hospital MACE, and the variables were subsequently assessed by the area under the receiver operating characteristic curve(AUC).RESULTS The rate of in-hospital MACE was 40%. Multivariable logistic regression analysis revealed that baseline QRS duration > 120 ms was the independent risk factor for in-hospital MACE(odds ratio = 4.57, 95%CI: 1.23-16.94, P = 0.023). The AUC of QRS duration > 120 ms for predicting in-hospital MACE was 0.683(95%CI: 0.532-0.833, P = 0.03).CONCLUSION Patients with fulminant myocarditis has a poor outcome. Baseline QRS duration is the independent risk factor for poor outcome in those patients.