ObjectiveTo investigate the role of recombinant human growth hormone (rhGH) in the treatment of patients with multiple organ dysfunction syndrome (MODS). MethodsThirty-eight patients with MODS routinely treated with antibiotics and nutrition support were divided into two groups: the rhGH group and control group. The rhGH group was treated by subcutaneous injection of 5 U rhGH for two weeks. ResultsOn the 7th day of treatment, the score of APACHE Ⅱ in the rhGH group was much higher than the control group, the levels of ALT, AST, BUN and Cre did not change much compared with the control group. The level of albumin in the rhGH group increased (P＜0.05). The stay in ICU, time of mechanical ventilation and hospital stay decreased compared with the control group (P＜0.05). ConclusionrhGH can effectively improve the pathophysiology of critically ill patients and has no side effects on the function of liver and kidney, meanwhile it can shorten hospital stay and decrease mortality.
ObjectiveTo study the change and significance of the serum nitric oxide (NO) level in patient with obstructive jaundice complicated with renal dysfunction. MethodsThe level of NO, BUN, Cr in serum and the activity of NOS in 25 patients with obstructive jaundice and renal dysfunction and 26 healthy adults was studied.ResultsThe patients’ serum NO level and the activity of NOS were significantly lower than those in the control group(P＜0.01)，whereas the serum BUN and Cr levels were significantly higher than those in control group(P＜0.01). The linear correlation analysis showed that the serum NO had a negative correlation between serum BUN and Cr level (P＜0.01). ConclusionThe patients with obstructive jaundice and renal dysfunction may lead to the decrease of serum NO level. NO may have some protective effects to the renal function during obstructive jaundice.
ObjectiveTo elucidate the mechanism of multiple organs dysfunction (MOD) during acute obstructive cholangitis (AOC). MethodsThe reports about MOD and AOC in recent 10 years were collected and reviewed.ResultsApplicable animal models of AOC were established. During AOC, the decrease of Kupffer cells (KCs) phagocytic function and clearance function, hepatocyte mitochondrion damage, the effect of KCs on protein synthesis of hepatocytes and activation of KCs by endotoxin played an important role in the pathogenesis of MOD. ConclusionThe mechanism of pathogenesis of MOD during AOC is complicated and the changes of KCs functions is one of major factors.
Objective To investigate the effect of nitric oxide (NO) on the renal function in acute biliary infection. Methods 35 Wistar rats were divided randomly into acute biliary infection group (AC), group of AC with Larginine(L), group of L-NAME(N), group of simple biliary obstruction(O) and a sham-operated group(SO), and serum NO、 BUN、 Cr and NOS were determined and pathologic changes of liver and kidney were observed. Results NO and NOS were significantly higher in L group than in any other groups (P＜0.05), BUN and Cr were significantly lower than in AC and N groups (P＜0.05), but showed no significance compared with O group (P＞0.05). The pathology of kidney in L group showed a less severe change than that in AC group; NO and NOS in N group were lower than those in other groups. BUN and Cr were higher than those in other groups (P＜0.05). Conclusion NO has a protection for renal function in acute biliary infected rats the mechanism being related to its dilative effect on renal vessels and increased renal blood perfusion.
Objective To make clear the effect of gastrointestinal tract ischemia on multiple organ dysfunction syndrome (MODS). Methods The literature in the recent years was reviewed.Results The low-flow states of gastrointestinal tract and decrease of gastrointestinal intramucosal pH, which occured following a variety of insults (sever trauma, hemorrhagic shock, et al), as well as overgrowth of enterobacteria, may result in a significant increase of permeability of bowel and lead to endotoxemia and bacterial translocation. Ischemia also resulted in release of TNF, IL-6 into the systemic circulation, dysfunction of gastrointestinal tract motility, and activation of neutrophile which was integral in local and distant organ damage. Conclusion These data suggest that the management of correct ischemia of gastrointestinal tract, which include fluid infusion to replacement of blood volume, early enteral nutrition, improvement of gastrointestinal movement, could contribute to improve the intestinal barrier function, and prevent the development of MODS.
To observe the change in plasma endotoxin and cytokine during the early period of intra-abdominal infection (IAI) complicated by multiple system organ dysfunction (MSOD) in animals. Twenty rabbits were randomly divided in to two groups. One group received the operation of cecal ligation plus puncture (CLP) inducing IAI complicated by MSOD, and another group received sham operation as a control. All animals were placed in metabolic cages and maintained with intravenous infusion for one week. Plasma levels of endotoxin and cytokine (TNF, IL-1, IL-6) were determined seperately at the beginning (0 hour) or 1, 2, 3, 4, 5, 6 and 24 hours after CLP. Blood bacteria cultures and pathological examination of several organs were made when the animal was dead or killed. Results: The levels of plasma endotoxin, TNF and IL-6 were found to be significantly increased at one or two hours after CLP, the incidence rate of bacteriemia was 80% and the pathological alterations in the abdomen and organs were remarkale, with an average survival time of 84.1±39.0 hours in CLP group. No change in plasma IL-1 level was found in the CLP group. Conclusion: The plasma levels of endotoxin and cytokine (TNF and IL-6) do increase in the early period of IAI complicated by MSOD, and the change in plasma IL-1 is not obvious.
To study the effects of early enteral nutrition and selective decontamination of digestive tract on the lipopolysacchride (LPS) translocation and cytokines and the developing of multiple organ dysfunction syndrome (MODS). Thirty six rabbits were divided into 3 groups: ①control group (CON group, n＝12), the rabbits were bled to shock state (MAP was 5.33 kPa) for 1 hour and then were resuscitated by with replacement of the lost blood and 2 volume of the equilibrium liquid, ②selective decontamination of digestive tract (SDD group, n＝12), the procedure was the same as the CON group but the rabbit was fed with the antibiotics 3 days before the experiment and all through the experiment, ③early enteral nutrition group (EN group, n＝12), treatment was the same as CON group. After resuscitation the feeding tube was placed into the stomach for enteral nutrition. On the 1st, 3rd, 5th and 7th day the blood samples were taken for testing the LPS, TNFα and the organs’ function. Results: The MODS incidence, the levels of LPS and TNFα of the EN group were obviously lower than those in SDD and CON groups; the levels of the LPS and TNFα of the SDD group remained high in the 5th day. SDD group had a higher incidence of the MODS and mortality than that of the EN group. Conclusion: Ischemiareperfusion damage can produce the LPS translocation, which causes the development of MODS. SDD can’t decrease the LPS translocation so that the incidence of MODS and mortality remain high. Early EN can inhibit LPS translocation and reduce the development of MODS.
To evaluate the process from systemic inflammatory response syndrome (SIRS) to multiple organ dysfunction syndrome (MODS) and probe the therapeutic strategies for elderly patients, we retrospectively studied the clinical data of SIRS and MODS in 292 elderly patients with surgical abdominal emergency. Results: On admission, the morbidity rate of SIRS was 41.1%. Afterwards the morbidity rate of MODS was 14.2%, and the mortality rate of the elderly patients with SIRS was 11.7%. After 48 hours of therapy, MODS was developed in 40.5% of the cases also with SIRS. Of all the 292 elderly patients, 19 cases (6.5%) developed MODS and 16 patients (84.2%) died. Conclusion: The outcome of the patients with surgical abdominal emergency may be improved if SIRS is early diagnosed, the cause of SIRS after 48 hours therapy is well defined and the body inflammatory response is properly regulated.
Objective To compare the clinical efficacy and safety of thrombolysis with anticoagulation therapy for patients with acute sub-massive pulmonary thromboembolism. Methods The clinical data of 84 patients with acute sub-massive pulmonary thromboembolism were analyzed retrospectively, mainly focusing on the in-hospital efficacy and safety of thrombolysis and/ or anticoagulation. The efficacy was evaluated based on 6 grades: cured, markedly improved, improved, not changed, deteriorated and died. Results Among the 84 patients,49 patients received thrombolysis and sequential anticoagulation therapy( thrombolysis group) , 35 patients received anticoagulation therapy alone( anticoagulation group) . As compared with the anticoagulation group, the thrombolysis group had higher effective rate( defined as patients who were cured, markedly improved or improved, 81. 6% versus 54. 3%, P = 0. 007) , lower critical event occurrence ( defined as clinical condition deteriorated or died, 2. 0% versus 14. 3% , P = 0. 032) . There was no significant difference in bleeding rates between the two groups ( thrombolysis group 20. 4% versus anticoagulation group 14. 3% , P gt; 0. 05) . No major bleeding or intracranial hemorrhage occurred in any of the patients. Conclusions Thrombolysis therapy may be more effective than anticoagulation therapy alone in patients with acute sub-massive pulmonary thromboembolism, and thus warrants further prospective randomized control study in large population.
Objective To explore the role of renin-angiotensin system( RAS) in acute lung injury( ALI) /acute respiratory dysfunction syndrome( ARDS) by using amouse cecal ligation and puncture ( CLP)model.Methods The ALI/ARDS animal models were assessed bymeasuring blood gas, wet/dry lung weight ratio( W/D) , and lung tissue histology 18 hours after CLP operation. After the ALI/ARDS models was successfully established, immunohistochemistry, western blotting and radioimmunity were used to investigate the changes of several key enzymes of RAS, such as ACE, ACE2 and Ang Ⅱ. In addition, two groups of animals received a separate intraperitoneal injection of angiotensin-converting enzyme ( ACE) inhibitor captopril or recombinant mouse ACE2 ( rmACE2) after CLP, then the changes of RAS in ALI/ARDS modelswere observed. Results The extensive lung injuries can be observed in the lung tissues from CLP-treated animals 18 hours after operation. The CLP-induced ALI/ARDS led to an increase in the wet/dry weight ratio of the lung tissues, and a decrease in the PaO2 /FiO2 [ ( 194. 3 ±23. 9) mm Hg vs ( 346. 7 ±20. 5) mm Hg,P lt;0. 01] . Immunohistochemistry and western blotting tests of the lung tissues from CLP-treated animals showed a decrease in the ACE2 protein level. However, in both the CLP and sham mice there were no significant differences between the two groups. CLP markedly increased Ang Ⅱ level in lungs and plasma of mice, and RAS drugs significantly impacted the Ang Ⅱ levels of mice. Compared with the CLP group,captopril or rmACE2 led to a decrease of the Ang Ⅱ level in mice [ Lung: ( 1. 58 ±0. 16) fmol /mg,( 1. 65 ±0. 21) fmol /mg vs ( 2. 38 ±0. 41) fmol /mg; Plasma: ( 178. 04 ±17. 87) fmol /mL, ( 153. 74 ±10. 24) fmol /mL vs ( 213. 38 ± 25. 44) fmol /mL] . Conclusions RAS activation is one of the characteristics of CLP-induced ALI/ARDS in mice models. ACE and ACE2 in RAS have a different role in the regulation of AngⅡ synthesis, while ACE has a positive effect in generating AngⅡ, and ACE2 shows a negative effect.