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Clinical Effects of Intensive Insulin Therapy Treating Traumatic Shock Combined with Multiple Organ Dysfunction Syndrome 被引量:8
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作者 杜俊东 刘宏鸣 +5 位作者 刘荣 姚咏明 焦华波 赵晓东 尹会男 黎沾良 《Journal of Huazhong University of Science and Technology(Medical Sciences)》 SCIE CAS 2011年第2期194-198,共5页
The therapeutic effects of intensive insulin therapy in treatment of traumatic shock combined with multiple organ dysfunction syndrome (MODS) were investigated. A total of 114 patients with traumatic shock combined ... The therapeutic effects of intensive insulin therapy in treatment of traumatic shock combined with multiple organ dysfunction syndrome (MODS) were investigated. A total of 114 patients with traumatic shock combined with MODS were randomly divided into two groups: control group (n=56) treated with conventional therapy, and intensive insulin therapy group (n=58) treated with conventional therapy plus continuous insulin pumping to control the blood glucose level at range of 4.4-6.1 mmol/L. White blood cells (WBC) counts, prothrombin time (PT), serum creatinine (SCr), alanine aminotransferase (ALT), serum albumin and PaO2 were measured before and at the day 1, 3, 5, 7 and 14 after treatment. The incidence of gastrointestinal dysfunction, the incidence of MODS, hospital stay and the mortality were also observed and compared. After intensive insulin therapy, the WBC counts, SCr, ALT and PT were significantly reduced (P0.05), but the level of serum albumin was significantly increased (P0.05) at the day 3, 5, 7 and 14. In the meantime, the PaO2 was significantly elevated at the day 3, 5 and 7 (P0.01) after intensive insulin therapy. The incidence of gastrointestinal dysfunction, the incidence of MODS, the length of hospital stay and the mortality were markedly decreased (P0.01). The results suggest early treatment with intensive insulin therapy is effective for traumatic shock combined with MODS and can decrease the length of hospital stay and the mortality. 展开更多
关键词 intensive insulin therapy traumatic shock multiple organ dysfunction syndrome
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Morphological changes in interstitial cells of Cajal in the deep muscular plexus and enteric motor neurons of the intestine in rats with multiple organ dysfunction syndrome 被引量:5
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作者 Zhengxu Cai Yi Li Qinghui Qi 《Neural Regeneration Research》 SCIE CAS CSCD 2010年第8期635-640,共6页
BACKGROUND:Gastrointestinal motility dysfunction in multiple organ dysfunction syndrome (MODS) has been reported to be related to damage to interstitial cells of Cajal (ICC). In the entedc nervous system, ICC and... BACKGROUND:Gastrointestinal motility dysfunction in multiple organ dysfunction syndrome (MODS) has been reported to be related to damage to interstitial cells of Cajal (ICC). In the entedc nervous system, ICC and smooth muscle cells are connected in a network to form a special functional unit. Many gastrointestinal motility dysfunction diseases are associated with damage to this network.OBJECTIVE:To investigate the morphological changes of intestinal ICC, and to explore the mechanisms underlying gastrointestinal motility dysfunction in rats with MODS.DESIGN, TIME AND SE'I-FING:The randomized, controlled, experiment was performed at the Central Laboratory of the First Affiliated Hospital of Dalian Medical University of China between June 2007 and March 2009.MATERIALS:Escherichia coli (E. colistrain O127 H6) and bovine serum albumin were purchased from Sigma, USA.METHODS:A total of 40 Wistar rats were equally and randomly divided into MODS group and control group. Suspension of E. coil strain O127 H6 containing BaSO4 and saline were sterilely injected into the abdominal cavity of rats in the MODS and control groups, respectively.MAIN OUTCOME MEASURES:Immunohistochemical double-staining and confocal laser scanning microscopy were used to observe the morphological changes in intestinal cholinergic nerves and ICC in the deep muscular plexus network. Electron microscopy was employed to evaluate the ultrastructural features of ICC in the deep muscular plexus of rats with MODS.RESULTS:Compared with the control group, the distributions and densities of cholinergic/nitrergic newes and ICC in the deep muscular plexus were significantly decreased in the MODS group (P 〈 0.01). The enteric nerve-ICC network were disrupted.CONCLUSION:There is ultrastructural injury in the ICC in the deep muscular plexus and enteric nerves of the intestine in rats with MODS, which may be associated with the dysmotility of the gastrointestinal tract in MODS. 展开更多
关键词 enteric nerves interstitial cells of Cajal multiple organ dysfunction syndrome vesicular acetylcholine transporter peripheral nervous system diseases neural regeneration
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Application of bedside continuous blood purification in patients with multiple organ dysfunction syndromes 被引量:21
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作者 Hai-bo Liu Min Zhang +1 位作者 Jing-xiao Zhang Yong-jie Yin 《World Journal of Emergency Medicine》 CAS 2012年第1期40-43,共4页
BACKGROUND:The complications of systemic inflammatory response syndrome(SIRS)include acute lung injury,acute kidney injury,shock,and multiple organ dysfunction syndrome(MODS).In recent years,how to clear inflammatory ... BACKGROUND:The complications of systemic inflammatory response syndrome(SIRS)include acute lung injury,acute kidney injury,shock,and multiple organ dysfunction syndrome(MODS).In recent years,how to clear inflammatory mediators has become a hot topic in critical care medicine.Researchers hypothesize that continuous blood purification(CBP) can effectively eliminate a variety of inflammatory mediators which participate in the occurrence of MODS and adjust the immune imbalance.This study aimed to observe the effects of CBP in MODS patients.METHODS:In this retrospective clinical study,a total of 38 MODS patients,18 males and 20 females,were enrolled.After conventional therapy,all the patients received CBP.Biochemistry,blood gas analysis,oxygenation index,mean arterial blood pressure(MAP),acute physiology and chronic health evaluation(APACHE) II scores were monitored.RESULTS:After CBP,the vital signs of patients were rapidly stable,and electrolyte disorders and acid-base imbalance were corrected.Renal function,blood gas,oxygenation index were all improved.MAP was increased,and APACHE II score was significantly decreased.All patients had good tolerance,stable hemodynamics,and no obvious adverse reaction on CBP compared with pre-CBP.CONCLUSION:CBP can effectively clean toxins,correct electrolyte acid-base balance,and improve systemic inflammatory response syndrome and the organ function of MODS patients. 展开更多
关键词 Systemic inflammatory response syndrome Continuous blood purification multiple organ dysfunction syndromes
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Animal model of non-bacterial multiple organ dysfunction syndrome in the elderly 被引量:2
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作者 Qinglei ZHU Shiwen WANG Jie YANG Tong YIN Xiaoshun QIAN Qiao XUE Bin XU 《Journal of Geriatric Cardiology》 SCIE CAS CSCD 2004年第1期58-64,共7页
Objective To establish a model of multiple organ dysfunction syndrome in the elderly (MODSE) by intraperitoneal injection of different doses of zymosan, and to compare the multiple organ dysfunction syndrome (MODS) in... Objective To establish a model of multiple organ dysfunction syndrome in the elderly (MODSE) by intraperitoneal injection of different doses of zymosan, and to compare the multiple organ dysfunction syndrome (MODS) in adult and in the elderly rats. Methods Adult and senile rats, injected with different doses of zymosan intraperitoneally were examined for the changes in the function and morphology of the vital organs, including heart, liver, brain, lungs, and kidneys using blood gas and biochemistry analysis and histopathological examination methods. Results Compared with the normal controls of the adult and the elderly rats, the blood gas and blood biochemistry changed in different degrees in the different dosed zymosan groups. Pathological changes were also found in the vital organs including lungs, heart, liver, brain, kidneys, erc in the experimental groups. Under the same concentrations of zymosan, the reductions in respiratory, cardiac and renal functions in the senile groups were much more severe than those in the corresponding adult group. In the similar degree of model duplication, the senile rats had the tendency to die later than the adult rats. Conclusions Zymosan can be used in both elderly and adult rats to induce MODS model, and the best dosage for MODSE was 0.Sg/kg injected peritoneally. The model would hopefully be used in the study of mechanisms and the therapeutics on MODSE. 展开更多
关键词 multiple organ dysfunction syndrome in the ELDERLY ANIMAL model rat ZYMOSAN
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Blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration for patients with multiple organ dysfunction syndrome 被引量:8
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作者 Lu-yi Liu Yong-jian Zhu +3 位作者 Xiao-li Li Ya-feng Liang Zuo-peng Liang Yong-hong Xia 《World Journal of Emergency Medicine》 CAS 2012年第1期44-48,共5页
BACKGROUND:Blood hemoperfusion with resin adsorption can clean larger molecules that exceed the molecular weight cutoff of combined continuous veno-venous hemofiltration(CWH).Hence blood hemoperfusion with resin adsor... BACKGROUND:Blood hemoperfusion with resin adsorption can clean larger molecules that exceed the molecular weight cutoff of combined continuous veno-venous hemofiltration(CWH).Hence blood hemoperfusion with resin adsorption combined CWH(HP+CWH) has higher ability of mediator clearance,and can improve clinical outcomes in theory.This study aimed to investigate the effect of blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration(HP+CWH) on plasm cytokines like TNF-α,IL-1β,IL-6,cellular immunity and prognosis in patients with multiple organ dysfunction syndrome(MODS).METHODS:This was a prospective,randomized clinical trial.A total of 30 patients who had been diagnosed with MODS were enrolled in this study.Patients were randomly allocated to routine treatment+HP+CWH group(treatment group) and routine treatment+only CWH group(control group).In the treatment group,patients received blood hemoperfusion with resin adsorption for 2hours,and then received CWH for 10 hours every day.In the control group,patients received CWH for 12 hours only every day.The patients in the two groups received blood purification therapy for three days.The plasma of patients in the treatment group was obtained at 0,2,12,24,26,36,48,50,60 hours,5th day,7th day and 10 th day,respectively.The plasma of patients in the control group was obtained at 0,12,24,36,48,60 hours,5th day,7th day and 10 th day,respectively.APACHE Ⅱscore,T-lymphocytes subpopulations,blood lactate acid concentration,heart rate,breathing rate,and oxygenation index were observed.RESULTS:Plasma cytokines like TNF-α,IL-1β,IL-6 decreased markedly after HP(P<0.01);T-lymphocytes subpopulations CD3+,CD4+,CD8+,CD4+/CD8+ increased after HP+CWH or only CWH.The plasma concentrations of TNF-α,IL-1β and IL-6 in the two groups were not markedly different at 12,36,and 50 hours.But on the 5th day,the plasma concentrations of TNF-α,IL-1β and IL-6 in the treatment group were lower than those in the control group(P<0.05).On the 28 th day,5patients died in the treatment group,and 6 patients in the control group.CONCLUSIONS:Both HP+CWH and CWH can clean plasma cytokines like TNF-α,IL-1β,and IL-6,and improve cellular immunity and clinical symptoms and signs of patients.Compared with only CWH,the plasma concentrations of TNF-α,IL-1β and IL-6 were lower on the 5th day,and patients have an increased survival rate on the 28 day in the HP+CWH group. 展开更多
关键词 Hemoperfusion with resin adsorption Continuous veno-venous hemofiltration multiple organ dysfunction syndrome CYTOKINES
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Magnetic resonance imaging correlates of bee sting induced multiple organ dysfunction syndrome: A case report 被引量:5
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作者 Sushant K Das Li-Chuan Zeng +4 位作者 Bing Li Xiang-Ke Niu Jing-Liang Wang Anup Bhetuwal Han-Feng Yang 《World Journal of Radiology》 CAS 2014年第9期737-740,共4页
Occasionally systemic complications with high risk of death,such as multiple organ dysfunction syndrome(MODS),can occur following multiple bee stings.This case study reports a patient who presented with MODS,i.e.,acut... Occasionally systemic complications with high risk of death,such as multiple organ dysfunction syndrome(MODS),can occur following multiple bee stings.This case study reports a patient who presented with MODS,i.e.,acute kidney injury,hepatic and cardiac dysfunc-tion,after multiple bee stings.The standard clinical findings were then correlated with magnetic resonance imaging(MRI)findings,which demonstrates that MRI may be utilized as a simpler tool to use than other mul-tiple diagnostics. 展开更多
关键词 BEE STING multiple organ dysfunction syn-drome Magnetic resonance imaging RHABDOMYOLYSIS Acute kidney injury MYOCARDITIS
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Effect of intestinal function-recovering decoction on treatment of multiple organ dysfunction syndrome in rats
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作者 Shu-Jie Zhao Dong Zhang +3 位作者 Shi-Ji Wang Ying Chen Jin-Feng Han Yu-Shan Wang 《Asian Pacific Journal of Tropical Medicine》 SCIE CAS 2013年第11期889-892,共4页
Objective:To analyze the effect of intestinal function-recovering decoction on multiple organ dysfunction syndrome in rats,and to investigate a novel solution to multiple organ dysfunction syndrome.Methods:Multiple or... Objective:To analyze the effect of intestinal function-recovering decoction on multiple organ dysfunction syndrome in rats,and to investigate a novel solution to multiple organ dysfunction syndrome.Methods:Multiple organ dysfunction syndrome was induced in 60 Sprague-Dawley rats by intestinal ischemia-reperfusion combined with cecal ligation and puncture.Then these rats were intragastrically administered physiological saline(group Ⅰ,n=20),ampicillin(group Ⅱ,n=20) or intestinal function-recovering decoction(group Ⅲ,n=20).After treatment, serum malondialdehyde and superoxide dismutase levels were compared among three groups. Simultaneously,bacterial culture of various organ tissues was performed and bacterial and endotoxin translocation were observed.Results:Compared with group 1,serum malondialdehyde, alanine aminotransferase and aspartate aminotransferase levels were significantly decreased(all P<0.05) and serum superoxide dismutase level was significantly increased(P<0.05) in the group Ⅲ. However,there were no significant differences in these indices between groups Ⅱ and Ⅲ(P>0.05). The rate of bacterial translocation in the groups Ⅱ and Ⅲ was significantly lower than in the group Ⅰ(P<0.05),and no significant difference was observed between groups Ⅱ and Ⅲ(P>0.05). Conclusions:Intestinal function-recovering decoction can significantly reduce endotoxin and bacterial translocation and stabilize enteral oxidative-antioxidative balance. 展开更多
关键词 multiple organ dysfunction syndrome INTESTINAL function-recovering DECOCTION MALONDIALDEHYDE Superoxide DISMUTASE
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A Case Report of Scrub Typhus: Secondary Acute Arrest of Hemopoiesis with Multiple Organ Dysfunction Syndromes
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作者 Guancheng Song Ying Song +2 位作者 Yanfang Zhang Xi Huang Jianchuan Deng 《Open Journal of Blood Diseases》 CAS 2022年第3期53-59,共7页
Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi (O. tsutsugamushi) in which humans are accidental hosts. Acute arrest of hemopoiesis (AAH) always manifests in pancytopenia and with supportive treat... Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi (O. tsutsugamushi) in which humans are accidental hosts. Acute arrest of hemopoiesis (AAH) always manifests in pancytopenia and with supportive treatment or inducement removal, the AAH patients would show significant improvement in blood routine for about a week. As a rapidly progressive and potentially life-threatening organ function disorder syndrome, multiple organ dysfunction syndrome (MODS) is often induced by many factors including infection, illness and injury. We received a rare case of scrub typhus rapidly presenting with AAH and MODS 2 weeks ago. The clinical data of a 32-year-old female with O. tsutsugamushi-induced AAH and MODS was summarized retrospectively and analyzed with a literature review. In this case, we selected tigecycline and moxifloxacin as treatment regimens for scrub typhus. When the potential infection was controlled, her pancytopenia and hepatic function rapidly improved in a few days. 展开更多
关键词 Scrub Typhus Orientia tsutsugamushi Acute Arrest of Hemopoiesis multiple organ dysfunction syndrome
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Successful treatment of severe burn patients with multiple organ dysfunction syndrome:A case report
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作者 Lingfeng Wang Ling-feng Wang +5 位作者 Yongdong Li Xiyuan Xu Ji Chen Weiqing Wang Zaiqing Huang Lihua Zhang 《Discussion of Clinical Cases》 2014年第1期1-11,共11页
Multiple organ dysfunction syndrome is the presence of altered organ function of two or more organ systems in acute ill patients with severe trauma,burn,shock and infection.In this case,the patient with burn area amou... Multiple organ dysfunction syndrome is the presence of altered organ function of two or more organ systems in acute ill patients with severe trauma,burn,shock and infection.In this case,the patient with burn area amounted to 95%and the third-degree burn was up to 90%.He underwent gastrointestinal tract,blood clotting,lung,brain,heart,liver dysfunction,and cardiac arrest for 30 minutes during the courses of treatment,and was discharged from the hospital after 108 days on the basis of comprehensive treatment and repeated skin grafting. 展开更多
关键词 multiple organ dysfunction syndrome BURNS CLINICAL
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Prolonged intestinal mucosal acidosis is associated with multiple organ failure in human acute pancreatitis: Gastric tonometry revisited 被引量:4
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作者 Gabor C Kovacs Geza Telek +2 位作者 Janos Hamar Jozsef Furesz Janos Regoly-Merei 《World Journal of Gastroenterology》 SCIE CAS CSCD 2006年第30期4892-4896,共5页
AIM: To evaluate whether multiple determinations of intramucosal pH (pHi) in acute pancreatitis (AP) patients could provide additional information of the disease severity during early hospitalization. METHODS: T... AIM: To evaluate whether multiple determinations of intramucosal pH (pHi) in acute pancreatitis (AP) patients could provide additional information of the disease severity during early hospitalization. METHODS: Twenty-one patients suffering from acute pancreatitis were monitored by gastric tonometry in the first 72 h after hospital admission. RESULTS: In the survivor group (n = 15) the initially low phi values returned to normal level (pHi ≥ 7.32) within 48 h (median pHi: d 1: 7.21; d 2: 7.32; d 3: 7.33). In contrast, pHi values in the non-survivor group n = 6) were persistently either below or in the low normal range (median pHi 7.12; 7.12; 7.07 respectively), but pHi differences between the two groups reached significance only after 24 h (P 〈 0.01). Mucosal acidosis detected at any time during the monitored period was associated with the emergence of single or multiple organ dysfunction (P 〈 0.01). CONCLUSION: Prolonged gastric mucosal acidosis was associated with remote organ dysfunction and failure in Acute Pancreatitis, however, correlation with the fatal outcome became significant only 24 h after admission. Due to its non-invasive nature gastric tonometry may supplement the pro-inflammatory markers to achieve a multi-faceted monitoring of the disease. 展开更多
关键词 Acute pancreatitis Human studies Intramucosal pH Mucosal barrier dysfunction Septic complications Bacterial translocation multiple organ dysfunction
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Treatment of a patient with severe lactic acidosis and multiple organ failure due to mitochondrial myopathy:A case report
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作者 Ling Chen Tian-Kui Shuai +4 位作者 Yu-Wei Gao Min Li Peng-Zhong Fang Waydhas Christian Li-Ping Liu 《World Journal of Clinical Cases》 SCIE 2023年第22期5398-5406,共9页
BACKGROUND Mitochondrial myopathy is a rare genetic disease with maternal inheritance that may involve multiple organ systems.Due to the lack of typical characteristics,its clinical diagnosis is difficult,and it is of... BACKGROUND Mitochondrial myopathy is a rare genetic disease with maternal inheritance that may involve multiple organ systems.Due to the lack of typical characteristics,its clinical diagnosis is difficult,and it is often misdiagnosed or even missed.CASE SUMMARY The patient was a young college student.When he presented at the hospital,he had severe lactic acidosis,respiratory failure,and shock with multiple organ dysfunction syndrome(MODS).He was treated by mechanical ventilation,venoarterial extracorporeal membrane oxygenation,and other organ support.However,his condition continued to worsen.After a thorough and detailed medical and family history was taken,a mitochondrial crisis was suspected.A muscle biopsy was taken.Further genetic testing confirmed a mitochondrial gene mutation(TRNL13243A>G).The final diagnosis of mitochondrial myopathy was made.Although there is no known specific treatment,intravenous methylprednisone and intravenous immunoglobulin were started.The patient’s shock eventually improved.The further course was complicated by severe infection in multiple sites,severe muscle weakness,and recurrent MODS.After 2 mo of multidisciplinary management and intensive rehabilitation,the patient could walk with assistance 4 mo after admission and walk independently 6 mo after admission.CONCLUSION More attention should be paid to mitochondrial myopathy to avoid missed diagnosis and misdiagnosis. 展开更多
关键词 Mitochondrial myopathy Mitochondrial crisis Hyperlactatemia Extracorporeal membrane oxygenation multiple organ dysfunction syndrome Case report
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Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage 被引量:52
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作者 Hong Chen Fei Li Jia-Bang Sun Jian-Guo Jia 《World Journal of Gastroenterology》 SCIE CAS CSCD 2008年第22期3541-3548,共8页
AIM: To study retrospectively the influence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients with early acute pancreatitis (AP) (during the first week after admission) on phys... AIM: To study retrospectively the influence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients with early acute pancreatitis (AP) (during the first week after admission) on physiological functions, and the association of the presence of IAH/ACS and outcome. METHODS: Patients (n = 74) with AP recruited in this study were divided into two groups according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter during the first week after admission. Patients (n = 44) with IAP ≥ 12 mmHg were assigned in IAH group, and the remaining patients (n = 30) with IAP < 12 mmHg in normal IAP group. For analysis of the influence of IAH/ACS on organ function and outcome, the physiological parameters and the occurrence of organ dysfunction during intensive care unit (ICU) stay were recorded, as were the incidences of pancreatic infection and in-hospital mortality. RESULTS: IAH within the first week after admission was found in 44 patients (59.46%). Although the APACHE Ⅱ scores on admission and the Ranson scores within 48 h after hospitalization were elevated in IAH patients in early stage, they did not show the statistically significant differences from patients with normal IAP within a week after admission (16.18 ± 3.90 vs 15.70 ± 4.25, P = 0.616; 3.70 ± 0.93 vs 3.47 ± 0.94, P = 0.285, respectively). ACS in early AP was recorded in 20 patients (27.03%). During any 24-h period ofthe first week after admission, the recorded mean IAP correlated significantly with the Marshall score calculated at the same time interval in IAH group (r = 0.635, P < 0.001). Although ACS patients had obvious amelioration in physiological variables within 24 h after decompression, the incidences of pancreatitic infection, septic shock, multiple organ dysfunction syndrome (MODS) and death in the patients with ACS were significantly higher than that in other patients without ACS (pancreatitic infection: 60.0% vs 7.4%, P < 0.001; septic shock: 70.0% vs 11.1%, P < 0.001; MODS: 90.0% vs 31.5%, P < 0.001; mortality: 75.0% vs 3.7%, P < 0.001). CONCLUSION: IAH/ACS is a frequent finding in patients admitted to the ICU because of AP. Patients with IAP at approximately 10-12 mmHg and early signs of changes in physiologic variables should be seriously considered for urgent decompression to improve survival. 展开更多
关键词 Acute pancreatitis Abdominal compartment syndrome Intra-abdominal pressure Intra-abdominal hypertension organ dysfunction
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Early recognition of abdominal compartment syndrome in patients with acute pancreatitis 被引量:32
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作者 Zilvinas Dambrauskas Audrius Parseliunas +2 位作者 Antanas Gulbinas Juozas Pundzius Giedrius Barauskas 《World Journal of Gastroenterology》 SCIE CAS CSCD 2009年第6期717-721,共5页
AIM: To assess the value of widely used clinical scores in the early identification of acute pancreatitis (AP) patients who are likely to suffer from intra-abdominal hypertension (IAH) and abdominal compartment s... AIM: To assess the value of widely used clinical scores in the early identification of acute pancreatitis (AP) patients who are likely to suffer from intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS).METHODS: Patients (η = 44) with AP recruited in this study were divided into two groups (ACS and non-ACS) according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter. On admission and at regular intervals, the severity of the AP and presence of organ dysfunction were assessed utilizing different multifactorial prognostic systems: Glasgow-Imrie score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE-Ⅱ) score, and Multiorgan Dysfunction Score (MODS). The diagnostic performance of scores predicting ACS development, cut-off values and specificity and sensitivity were established using receiver operating characteristic (ROC) curve analysis.RESULTS: The incidence of ACS in our study population was 19.35%. IAP at admission in the ACS group was 22.0 (18.5-25.0) mmHg and 9.25 (3.0-12.4) mmHg in the non-ACS group (P 〈 0.01). Univariate statistical analysis revealed that patients in the ACS group had significantly higher multifactorial clinical scores (APACHE Ⅱ, Glasgow-Imrie and MODS) on admission and higher maximal scores during hospitalization (P 〈 0.01). ROC curve analysis revealed that APACHE Ⅱ, Glasgow-Imrie, and MODS are valuable tools for early prediction of ACS with high sensitivity and specificity, and that cut-off values are similar to those used for stratification of patients with severe acute pancreatitis (SAP).CONCLUSION: IAH and ACS are rare findings in patients with mild AR Based on the results of our study we recommend measuring the IAP in cases when patients present with SAP (APACHE Ⅱ 〉 7; MODS 〉 2 or Glasgow-Imrie score 〉 3). 展开更多
关键词 Acute pancreatitis Abdominal compartment syndrome Intra-abdominal pressure Intra-abdominal hypertension organ dysfunction
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Multiple-Organ Extracorporeal Support Therapies in Critically Ill Patients 被引量:1
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作者 José Lucas Daza María C. Correcha Ferro +7 位作者 Andrés David Cardenas Luis Daza Emilio Rey Jonathan de Jong John Galindo Gerardo Gutiérrez Luis Puello Yaroslad de la Cruz 《Open Journal of Nephrology》 2021年第2期281-293,共13页
The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious (sepsis, septic shock) as well as non-infectious (pancreatitis, la... The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious (sepsis, septic shock) as well as non-infectious (pancreatitis, large surgeries, traumatic injuries, burn patients and brain injuries), this syndrome is characterized by global hemodynamic and organ perfusion alterations accompanied by an uncontrolled and marked inflammatory response unresponsive to pharmacological treatment due to which extracorporeal organ support can be a viable option. Acute renal lesion can occur in up to 60% of patients receiving intensive care, and close to 10% - 20% require renal replacement therapy (RRT) globally this can be provided as peritoneal dialysis (PD) or intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), hybrid therapies known as sustained slow efficiency dialysis (SLED), which combines the benefits IHD and CRRT, slow continuous ultrafiltration (SCUF). Extracorporeal membrane oxygenation (ECMO) and extracorporeal elimination of CO<sub>2</sub>, have been used more frequently lately, these are temporal artificial support used for respiratory and/or cardiac insufficiency that is refractory to conventional treatment. Acute liver failure in adults has a mortality rate close to 50% furthermore one-third of patients hospitalized for cirrhosis are likely to progress to acute liver failure which will drastically increase its mortality. Based on concepts of albumin dialysis, one of its most known is the following: Molecular Adsorbent Recirculating System (MARS), Fractionated Plasma Separation and Absorption—FPSA (Prometheus<sup>®</sup>) and also, hemoperfusion with different cartridges used in different extracorporeal therapies, used in liver failure, rhabdomyolysis, cytokine release syndrome and more in the context of the pandemic covid19. The objective of this review is to know the different extracorporeal therapies and the therapeutic utility in critical patients. 展开更多
关键词 MODS (multiple organ dysfunction syndrome) RRT (Renal Replacement Therapy CRRT (Continuous Renal Replacement Therapy) SLED (Slow Efficiency Dialysis ECMO (Extracorporeal Membrane Oxygenation) ECCO2 (Extracorporeal Elimination of Carbon Dioxide) ARDS (Acute Respiratory Distress syndrome) AKI (Acute Kidney Injury)
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Influence of continuous blood purification on inflammation and target organ damage in patients with severe acute pancreatitis complicated by MODS
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作者 Tao Wang Fan Zhang +4 位作者 Meng Wei Yue Cheng Li-Wen Mo Jun Zhu Jie Long 《Journal of Hainan Medical University》 2017年第9期56-59,共4页
Objective:To study the influence of continuous blood purification on inflammation and target organ damage in patients with severe acute pancreatitis accompanied by MODS.Methods: A total of 78 patients with severe acut... Objective:To study the influence of continuous blood purification on inflammation and target organ damage in patients with severe acute pancreatitis accompanied by MODS.Methods: A total of 78 patients with severe acute pancreatitis complicated by MODS who were treated in our hospital between June 2012 and March 2016 were selected and divided into control group (n=39) and observation group (n=39) according to random number table. Control group were treated with routine treatment, observation group were treated with conventional treatment plus continuous blood purification, and serum inflammatory factors, liver function indexes and renal function indexes were compared between two groups of patients before and after treatment.Results: Before treatment, differences in serum levels of inflammatory factors, liver function indexes and renal function indexes were not statistically significant between two groups of patients. After treatment, serum inflammatory factors IL-6, IL-8, MCP-1 and HMGB1 levels of observation group were lower than those of control group, liver function indexes ALT, AST, TBIL and ALP levels of observation group were lower than those of control group, and renal function indexes Scr and BUN levels of observation group were lower than those of control group.Conclusion: Continuous blood purification can reduce the systemic inflammatory response as well as liver and kidney injury in patients with severe acute pancreatitis complicated by MODS. 展开更多
关键词 Severe acute pancreatitis multiple organ dysfunction syndrome Continuous blood purification INFLAMMATION Target organ damage
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Mutating Escherichia coli caused multiple organ dysfunction syndrome
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作者 Lihua Qi Wencheng Xue +2 位作者 Xuelin Liu Shaofu Qiu Jie Liu 《iLABMED》 2023年第3期190-195,共6页
Pathogenic Escherichia coli is of great concern in the clinical setting.But few reports have demonstrated the variation in disease course.We present a severe case of multiple organ dysfunction syndrome caused by E.col... Pathogenic Escherichia coli is of great concern in the clinical setting.But few reports have demonstrated the variation in disease course.We present a severe case of multiple organ dysfunction syndrome caused by E.coli infection.Pathogens isolated from blood and urine samples harboured many virulence factors.Whole‐genome sequencing and conventional analyses showed that the isolates experienced beneficial variations,both genetically and phenotypically,during the disease course.These findings showed that E.coli can cause sys-temic symptoms and informed us of the importance of assessing the reasons for such variations in pathogens occurring in vivo. 展开更多
关键词 Escherichia coli multiple organ dysfunction syndrome RESISTANCE VARIATION VIRULENCE
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外周血受体相互作用蛋白激酶3、混合系列蛋白激酶样结构域水平与新生儿坏死性小肠结肠炎病情严重程度的关系 被引量:1
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作者 黄艳 梁玉美 +1 位作者 冯燕妮 杨松媚 《实用临床医药杂志》 CAS 2024年第1期62-67,共6页
目的分析新生儿坏死性小肠结肠炎(NEC)患儿外周血受体相互作用蛋白激酶3(RIPK3)、混合系列蛋白激酶样结构域(MLKL)的表达情况及其与病情严重程度的关系。方法选取92例NEC患儿纳入NEC组,并根据病情严重程度进一步分为轻度NEC组(Ⅰ级)60... 目的分析新生儿坏死性小肠结肠炎(NEC)患儿外周血受体相互作用蛋白激酶3(RIPK3)、混合系列蛋白激酶样结构域(MLKL)的表达情况及其与病情严重程度的关系。方法选取92例NEC患儿纳入NEC组,并根据病情严重程度进一步分为轻度NEC组(Ⅰ级)60例和重度NEC组(Ⅱ~Ⅲ级)32例,另选取同期诊治的60例腹股沟斜疝患儿纳入对照组。采用实时荧光定量聚合酶链反应检测外周血RIPK3 mRNA、MLKL mRNA表达;采用Pearson相关分析法明确NEC组外周血RIPK3 mRNA与MLKL mRNA表达的相关性;采用免疫印迹法检测NEC回肠组织和正常回肠组织中RIPK3、MLKL蛋白表达;采用多因素Logistic回归分析明确重度NEC发生的独立危险因素。绘制受试者工作特征曲线,分析外周血RIPK3 mRNA、MLKL mRNA单独及联合预测重度NEC的价值。结果NEC组外周血RIPK3 mRNA、MLKL mRNA相对表达量分别为(2.41±0.52)、(3.03±0.64),高于对照组的(1.02±0.21)、(0.93±0.20),差异有统计学意义(P<0.001)。NEC回肠组织中RIPK3、MLKL蛋白相对灰度值分别为(1.20±0.21)、(1.13±0.24),高于正常回肠组织的(0.34±0.12)、(0.32±0.11),差异有统计学意义(P<0.05)。NEC组患儿外周血RIPK3 mRNA与MLKL mRNA相对表达量呈正相关(r=0.623,P<0.001)。重度NEC组合并气腹征、多器官功能障碍综合征、败血症者占比和RIPK3 mRNA、MLKL mRNA相对表达量均高于轻度NEC组,差异有统计学意义(P<0.05);RIPK3 mRNA、MLKL mRNA相对表达量升高是重度NEC发生的独立危险因素(P<0.05)。外周血RIPK3 mRNA、MLKL mRNA联合预测重度NEC的曲线下面积大于RIPK3 mRNA、MLKL mRNA单独预测(Z=4.127、4.261,P<0.05)。结论RIPK3 mRNA、MLKL mRNA在NEC患儿外周血中表达升高,两者均与NEC病情严重程度有关,且两者联合检测对重度NEC具有较高的预测价值。 展开更多
关键词 新生儿坏死性小肠结肠炎 受体相互作用蛋白激酶3 混合系列蛋白激酶样结构域 多器官功能障碍综合征
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感染性休克患者血管加压素水平变化与病情程度及预后的关系
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作者 王春玲 张卓 +2 位作者 赵景 周庆明 王莉莎 《国际检验医学杂志》 CAS 2024年第16期1952-1956,1961,共6页
目的探讨感染性休克(SS)患者血管加压素(VP)水平变化与病情程度及预后的关系。方法选取2021年12月至2022年12月该院SS患者96例作为研究组,另选取同期该院的健康志愿者95例作为对照组。比较两组血浆VP水平,分析其与多器官功能障碍综合征(... 目的探讨感染性休克(SS)患者血管加压素(VP)水平变化与病情程度及预后的关系。方法选取2021年12月至2022年12月该院SS患者96例作为研究组,另选取同期该院的健康志愿者95例作为对照组。比较两组血浆VP水平,分析其与多器官功能障碍综合征(MODS)评分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、血清C反应蛋白(CRP)、降钙素原(PCT)水平相关性。研究组接受纠正休克治疗,依据住院治疗28 d后的预后情况分为预后良好组、预后不良组,并比较两组临床资料。多因素Logistic回归分析预后不良的影响因素。分别构建新预测方案与常规预测方案,采用曲线下面积(AUC)、净重新分类指数、综合判别改善指数评价不同预测方案的预测效能。结果与对照组比较,研究组血浆VP水平明显降低,MODS评分、APACHEⅡ评分、血清CRP、PCT水平明显升高,差异有统计学意义(P<0.05)。Pearson相关性分析显示,研究组血浆VP水平与MODS评分、APACHEⅡ评分、血清CRP、PCT水平呈负相关(r=-0.426、-0.519、-0.483、-0.395,P<0.05)。预后不良组糖尿病占比、并发急性呼吸窘迫综合征(ARDS)占比、并发急性肾损伤(AKI)占比及MODS评分、APACHEⅡ评分、血清CRP、PCT水平高于预后良好组,而血浆VP水平低于预后良好组,差异有统计学意义(P<0.05)。Logistic回归分析显示,并发ARDS、并发AKI、血浆VP、MODS评分、APACHEⅡ评分、血清CRP、PCT均为SS患者预后不良的影响因素(P<0.05)。血浆VP预测SS患者预后不良的AUC为0.752,新预测方案预测SS患者预后不良的AUC大于常规预测方案预测SS患者预后不良的AUC(P<0.05)。结论SS患者血浆VP水平降低,且与病情程度密切相关,基于Logistic回归分析结果建立新预测方案,该方案对预后不良具有一定预测价值。 展开更多
关键词 感染性休克 血管加压素 预后 多器官功能障碍综合征
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序贯性血液净化机治疗中毒所致的多器官功能障碍的临床效果及安全性评估
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作者 徐静 赵敏 +2 位作者 姜薇薇 于蕾 肖克来提·霍加合买提 《中国医学装备》 2024年第6期101-105,共5页
目的:研究序贯性血液净化机治疗中毒所致的多器官功能障碍的临床效果及安全性。方法:选取2020年5月至2022年2月新疆医科大学第一附属医院收治的110例中毒所致多器官功能障碍综合征(MODS)患者,采用随机数表法将其分为序贯性血液净化组和... 目的:研究序贯性血液净化机治疗中毒所致的多器官功能障碍的临床效果及安全性。方法:选取2020年5月至2022年2月新疆医科大学第一附属医院收治的110例中毒所致多器官功能障碍综合征(MODS)患者,采用随机数表法将其分为序贯性血液净化组和单种血液净化组,每组55例。对比两组患者在不同血液净化治疗下营养代谢指标、肠道屏障功能指标、急性生理与慢性健康量表(APACHEⅡ)评分、MODS早期预测评分系统及重症监护室(ICU)住院时间,同时记录不同血液净化治疗期间的并发症发生率。结果:两组治疗7d后,序贯性血液净化组患者的血红蛋白(Hb)、白蛋白(ALB)、胱抑素A(PAB)以及总胆固醇(TC)高于单种血液净化组,谷丙转氨酶(ALT)和甘油三酯(TG)均低于单种血液净化组,差异有统计学意义(t=4.454、4.474、13.22、2.035、51.358、2.195,P<0.05)。两组治疗7d后,钾离子(K+)及钠离子(Na+)差异无统计学意义(P>0.05)。序贯性血液净化组治疗7d后谷氨酸水平及谷氨酰胺水平高于单种血液净化组,尿乳果糖/甘露醇(L/M)比值低于单种血液净化组,差异有统计学意义(t=32.83、3.435、4.132,P<0.05)。序贯性血液净化组治疗7d后APACHEⅡ评分、MODS评分低于单种血液净化组,ICU住院时间短于单种血液净化组,差异有统计学意义(t=4.438、4.481、7.421,P<0.05),血液净化治疗并发症发生率低于单种血液净化组,差异有统计学意义(χ^(2)=5.238,P<0.05)。结论:序贯性血液净化治疗相比于单种血液净化治疗,在中毒所致的多器官功能障碍综合征治疗中可更好的促进调节机体营养代谢指标,改善肠道屏障功能,康复效果更好,并发症发生率较低,同时缩短了ICU住院时间。 展开更多
关键词 中毒 多器官功能障碍综合征(MODS) 单种血液净化 序贯性血液净化 营养代谢 肠道屏障功能 并发症
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体外循环后胆碱酯酶水平与全身炎症反应综合征 和并发症的关系研究
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作者 魏廷举 赵俊杰 +3 位作者 徐大千 冯琛灿 刘安康 徐敬 《中国循证心血管医学杂志》 2024年第8期972-976,1003,共6页
目的探讨体外循环(CPB)后胆碱酯酶水平变化以及与全身炎症反应综合征(SIRS)的关系,进一步研究其对多器官功能障碍综合征(MODS)的预测价值。方法本研究对2021年2月至2022年12月期间于郑州大学第一附属医院计划接受CPB下心脏手术的患者进... 目的探讨体外循环(CPB)后胆碱酯酶水平变化以及与全身炎症反应综合征(SIRS)的关系,进一步研究其对多器官功能障碍综合征(MODS)的预测价值。方法本研究对2021年2月至2022年12月期间于郑州大学第一附属医院计划接受CPB下心脏手术的患者进行前瞻性分析。其中48例患者发生SIRS作为SIRS组,另外50例未发生SIRS作为对照组。数据收集时间:术前(H0),ICU入院后4 h(H4)、8 h(H8)、12 h(H12)、24 h(H24)和48 h(H48)。通过现场及时检测技术测量血清丁酰胆碱酯酶(BChE)活性,并用血红蛋白(Hb)校正。评估H24和H48时血清BChE活性与急性生理学和慢性健康评估Ⅱ(APACHEⅡ)评分之间的相关性。利用受试者操作特征(ROC)曲线分析BChE活性对CPB后SIRS患者MODS的预测效能。结果SIRS组患者预后更差,包括H24和H48时APACHE II和序贯器官衰竭(SOFA)评分均高于对照组(P<0.05),且ICU住院时间更长(P=0.030)。SIRS组和对照组在术后H12时血清BChE活性降至最低值,分别为1.16(0.73,1.47)×10^(3) U/g Hb和0.82(0.71,1.0)×10^(3) U/g Hb。且SIRS组血清BChE水平在H8-H48期间一直低于对照组(P<0.05)。经Spearman相关分析,SIRS患者H24时血清BChE含量与APACHEII评分之间存在负相关关系(r=-0.381,P=0.009)。SIRS组中19例患者进展至MODS,其中15例发生在ICU H24~H48期间。MODS组患者H8-H48期间血清BChE水平一直低于非MODS组(P<0.05)。最后,利用H8和H12血清BChE预测MODS风险,ROC曲线结果显示,当H8 BChE≤0.98×10^(3) U/g Hb或H12≤0.76×10^(3) U/g Hb时,MODS进展风险大大增加,曲线下面积分别为0.748和0.838。结论CPB后SIRS患者血清BChE活性显著降低,CPB术后早期BChE耗竭与SIRS严重程度和MODS进展风险具有密切关系。 展开更多
关键词 体外循环 胆碱酯酶 全身炎症反应综合征 多器官功能障碍综合征
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