Objective
To summarize the effect of mild hypothermia on post-cardiac surgery patients with multiple organ dysfunction system(MODS).
Methods
We retrospectively analyzed the clinical data of 90 patients with MODS after cardiac surgery under cardiopulmonary bypass(CPB) from May 2010 through June 2014 in our hospital. There were 57 males and 33 females at 61±6 years. The patients were divided into two groups including a NT group (without pre-hypothermia treatment,n=32) and a HT group(with pre-hypothermia treatment,n=58).
Results
Of the 90 patients, totally 18 patients died, 8 patients (13.8%) in the HT group, 10 patients (31.2%) in the NT group with a statistical difference (P<0.05). In the NT group, 12 patients (37.5%) were treated by intra-aortic balloon pump (IABP), and 9 patients (15.5%) in the HT group with a statistical difference between the two groups (P<0.05). The patients' heart rate (HR) decreased significantly after the application of hypothermia. The HR of difference between the two groups at 36 h was significant (P<0.05). The mean aortic pressure (MAP) in the HT group was lower than that of the NT group significantly at 0 h, because we used sedation and muscular relaxation agent. But the MAP in the HT group was significantly higher than that of the NT group after hypothermia 36 h (P<0.05). In the HT group, pressure of oxygen (PO2), mixed venous oxygen saturation (SvO2), and lactic acid (Lac) were improved significantly compared with those of the NT group significantly (P<0.05). There was no statistical difference in prothrombin time (PT) or activated partial thromboplastin time (APTT) between the two groups (P>0.05). But there was a statistical difference in platelet (PLT) between the two groups at 36 h (P<0.05). The aspartate aminotransferase (AST), alannine aminotransferase (ALT), creatinine (Cr) were improved significantly in the HT group (P<0.05).
Conclusion
Mild hypothermia can improve the organ function effectively. It can slow the MODS development speed and win the time of protection and further treatment for cells and organs. It is an effective and safety therapeutic technique for MODS after cardiac surgery.
ObjectiveTo investigate changes of lipopolysaccharidebinding protein (LBP) and its clinical significance in activation of Kupffer cells (KCs) during endotoxemia.MethodsWistar rat endotoxemia model was established by injection of a dose of LPS (5 mg/kg, Escherichia coli O111∶B4) via the tail vein of rats, then sacrificed 1, 3, 6 and 12 hour respectively. Hepatic tissue was collected to measure LBP mRNA expression by reverse transcritasepolymerase chain reaction (RTPCR). The levels of plasma endotoxins, LBP, TNFα and IL6 were determined. The pathological changes of hepatic tissue were observed under electron microscope.ResultsWhen the levels of plasma LPS elevated, expression of LBP mRNA in hepatic tissue were ber than that in control rats. The levels of plasma LBP, TNFα and IL6 were increased markedly also in rat with endotoxemia when compared with that in control groups (P＜0.01). KCs were seen to be enlarged in size, their surface projections were increased in number, and their cytoplasm was full of phagocytic vacuoles or electron dense phagosomes which indicated active phagocytosis.ConclusionLPS can markedly upregulate LBP mRNA expression in hepatic tissue, the levels of plasma LBP also increased. LBP may be a critical factor of LPS which stimulates KCs to produce and release different proinflammary mediators.
摘要:目的:總結汶川地震26例多器官功能衰竭患者的臨床資料,就其發病特點,治療經過及預后進行探討,為防治提供依據。方法:對汶川地震26例多器官功能衰竭患者的臨床資料進行回顧性分析。結果:19例患者死亡,死亡率為73.1%。死亡率隨著功能衰竭的器官數量增多而增高,4個及以上器官功能衰竭者死亡率為100%。結論:多器官功能衰竭預后差,死亡率高。強調對 MOF的早期識別、早期診斷、早期治療以及治療上的統籌兼顧,防治結合。Abstract: Objective: To investigate the clinical characteristic and treatable methods of the multiple organ failure (MOF) in Wenchuan earthquake. Methods: The clinical records of the 26 patients with MOF were studied retrospectively. Results: Nineteen patients died and the mortality was 73.1%.The mortality increased along with the quantity of the organ failure, and the death rate of the patients with equal or more than 4 organs failure was 100%. Conclusion:The prognosis of the patients with MOF was bad and the death rate was high in Wenchuan earthquake. We emphasize the early recognition, early diagnose and early treatment and the treatment of overall planning and allround consideration and prevention in combination with treatment.
