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Objective: To investigate the effects of dobutamine combined with anisodamine hydrobromide on endothelial function and immune function in patients with septic shock. A total of 100 patients with septic shock admitted from January 2023 to January 2024 were randomly divided into control group and observation group, with 50 cases each. The control group was given dobutamine and normal saline, and the observation group was given dobutamine and anisodaminehydrobromide. After treatment, compared with the observation group, the levels of TNF-α, CRP, IL-6, PCT, VO2, O2ER, E-SLT, sTM, ET-1, Ang-2 and CD8+ in the control group were all increased, while the levels of ScvO2, DO2, CD4+, CD3+ and CD4+/CD8+ were decreased. There was statistical difference (P<0.05). In addition, the length of hospital stay, time of getting out of bed and duration of shock in control group were significantly higher than those in observation group, while the total clinical effective rate was lower than that in observation group (P<0.05). Statistical difference between the two groups (P>0.05). Dobutamine combined with anisodamine hydrobromide can improve the endothelial function, clear the inflammatory mediators, improve immune function, and reduce the incidence of complications on septic shock patients, which has clinical application value. [ABSTRACT FROM AUTHOR]

Objective: To study the clinical value of serum heparin binding protein (HBP), neopterin (neopterin) and ubiquitin specific protease 13 (USP13) in predicting the clinical outcome of patients with sepsis. Methods: 157 patients with sepsis who were admitted to our hospital from June 2021 to June 2023 were selected, and patients were divided into non-shock group (n = 93) and shock group (n = 64) according to whether septic shock occurred, the levels of serum HBP, neopterin and USP13 were compared between two groups. The 28 d mortality of 157 patients with sepsis were counted, the data of death group and survival group and the levels of serum HBP, neopterin and USP13 were compared, the influencing factors of 28 d death in patients with sepsis upon admission were analyzed by multivariate Logistic regression model, the predictive value of serum HBP, neopterin and USP13 of 28 d death in patients with sepsis upon admission were analyzed by receiver operating characteristic (ROC) curve. Results: Compared with non-shock group, the serum HBP and neopterin in shock group were significantly increased (P < 0.05) and the serum USP13 was significantly decreased (P < 0.05) . 157 patients with sepsis admitted for 28 d and 47 deaths, with an incidence of 29.94%. Compared with survival group, the acute physiology and chronic health status score II (APACHE-II), the proportion of complicated with diabetes mellitus, sequential organ failure assessment score (SOFA), HBP and neopterin in death group were significantly increased (P < 0.05) and serum USP13 was significantly decreased (P < 0.05) Multivariate Logistic regression analysis showed that, elevated APACHE II score, elevated SOFA score, complicated with diabetes mellitus, elevated HBP, elevated neopterin and decreased USP13 were risk factors for 28 d death in patients with sepsis upon admission (P < 0.05) ROC curve showed that, the area under the curve (AUC) (95%CI) of serum HBP, neopterin, USP13, HBP+neopterin, neopterin+USP13, HBP+USP13, HBP+neopterin+USP13 for predicting 28 d death in patients with sepsis upon admission were 0.722 (0.627~0.818), 0.768 (0.691~0.844), 0.647 (0.547~0.747), 0.849 (0.779~0.919), 0.845 (0.780~0.910), 0.832 (0.755~0.910), 0.923 (0.876~0.969), the combined prediction efficiency of HBP+neopterin+USP13 was significantly better than that of single or two tests (P<0.05). Conclusion: High levels of serum HBP, neopterin, and low levels of serum USP13 are associate with 28 d death and septic shock in patients with sepsis, Detection of serum HBP, neopterin combine with USP13 can effectively predict 28 d death in patients with sepsis upon admission. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical features and risk factors of sepsis-induced cardiomyopathy in children with sepsis, aiming to provide reference for enhancing the diagnosis and treatment levels of clinicians. Methods Clinical data of children with sepsis were retrospectively analyzed. All patients were divided into the sepsis-induced cardiomyopathy group and non-sepsisinduced cardiomyopathy group according to whether sepsis-induced cardiomyopathy occurred.Clinical characteristics and outcomes were compared between two groups. The risk factors of sepsis-induced cardiomyopathy were analyzed. Results Three hundred and ninty-eight children with sepsis were included in this study, and the incidence of sepsis-induced cardiomyopathy was 15.58% (62/398) . The age of children in the sepsis-induced cardiomyopathy group was 49 (18, 108) months, older than 19 (6, 52) months in the nonsepsis-induced cardiomyopathy group. The incidence of septic shock in the sepsis-induced cardiomyopathy group was 83.87% (52/62), which was higher than 42.56% (143/336) in the non-sepsis-induced cardiomyopathy group. The mortality rate in the sepsis-induced cardiomyopathy group was 29.03% (18/62), significantly higher than 14.58% (49/336) in the non-sepsis-induced cardiomyopathy group. All differences were statistically significant (all P < 0.05) .Multivariate Logistic regression analysis showed that the influence of age on sepsis-induced cardiomyopathy was statistically significant (OR=1.010, 95%CI 1.003-1.017, P = 0.006) . The higher the lactic acid level, the higher the risk of sepsis-induced cardiomyopathy, with statistical significance (OR=1.163, 95%CI 1.034-1.308, P = 0.012) . The higher the cTnI level, the higher the risk of sepsis-induced cardiomyopathy, with statistical significance (OR=9.929, 95%CI 4.651-21.197, P < 0.001) . Conclusions Compared with children with non-sepsis-induced cardiomyopathy, children with sepsis-induced cardiomyopathy are more prone to septic shock and have higher mortality. Age, lactic acid and cTnI levels are the independent influencing factors for sepsis-induced cardiomyopathy in children. [ABSTRACT FROM AUTHOR]

Copyright of Journal of China Medical University is the property of Journal of China Medical University Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To investigate the clinical value of systemic inflammatory markers in predicting the prognosis of septic shock. Methods: 46 patients with septic shock treated in the Department of severe Medicine, Shiqian people's Hospital, Tongren City, Guizhou Province from July 2019 to July 2022 were retrospectively analyzed. 46 patients were followed up for 60 days and divided into survival group (n=22) and death group (n=24). The counts of leukocytes, neutrophils, lymphocytes, monocytes and platelets were collected before admission, and the ratio of neutrophils to lymphocytes (neutrophil-to-lymphocyte ratio, NLR), the ratio of platelets to lymphocytes (platelet-to-lymphocyte ratio, PLR) and the ratio of lymphocytes to monocytes (lymphocyte-to-monocyte ratio, LMR) were calculated. At the same time, the biochemical indexes such as creatinine (Cr) and C-reactive protein (CRP) were recorded, the differences of these indexes between the survival group and the death group were compared, and the correlation between NLR, PLR, LMR and Cr levels was observed. Shapiro-Wilk test was used for normality test, Mann-Whitney U test was used to compare the count data of the two groups with non-normal distribution, Spearman correlation analysis was used for correlation analysis, binary logistic regression analysis was used to explore the independent risk factors affecting the prognosis of septic shock, and the working characteristic curve (ROC curve) and survival curve were drawn to evaluate the value of risk factors in predicting the death of septic shock. Results: There were significant differences in leukocyte, neutrophil, lymphocyte, monocyte, platelet count, NLR, PLR and LMR between the treatment group and the normal control group. There were significant differences in neutrophils, lymphocytes, NLR and CRP between the survival group and the death group on the day of admission, but there was no significant difference in other indexes. The level of creatinine was positively correlated with NLR in patients with septic shock. Multivariate logistic regression analysis showed that only NLR was an independent risk factor for 60-day prognosis of patients with septic shock (OR=1.038, P=0.031). ROC curve analysis found that the area under the curve was 0.705 (95% CI: 0.597~0.812); the cutoff value of NLR to predict the risk of death was 16.35 (sensitivity was 66.7%, specificity was 72.7%) according to the principle of Yoden index, that is, the mortality rate of septic shock was higher when NLR > 16.35. Kaplan-Meier method was used to analyze the survival prognosis at 60 days after treatment. The results showed that the median survival time of NLR≤ 16.35 group was significantly higher than that of NLR 16.35 group (P=0.018). Conclusion: The initial NLR of ICU is helpful to judge the condition of septic shock and has certain clinical value in evaluating the survival and prognosis of patients, and it is an independent predictor of death. [ABSTRACT FROM AUTHOR]

This paper summarized the nursing measures for a patient with septic shock combine with multiple organ dysfunction syndromes. Key issues of nursing were summarized in perspectives of mechanical ventilation, medication, catheter maintenance, skin care and emotional care. Comprehensive interventions were carried out to relieve symptoms of shock, improve the vital signs and reduce the incidence of complications. (本文总结1例脓毒性休克伴多脏器功能障碍综合征患者的护理干预措施, 主要从机械通气护理、用药护理、管路护理、皮肤护理及情志护理等方面进行护理干预, 改善患者休克症状和各项生命体征, 减少并发症的发生。)

Objective To investigate the prognostic risk factors of patients with septic shock based on circulatory and cellular immune effects, to accurately regulate the noradrenaline dose, alleviate immune function suppression, and improve the success rate of septic shock treatment. Methods This is an observational, retrospective, cohort study. According to the inclusion and exculusion criteria, 160 patients with septic shock treated in ICU of the first affiliated hospital of Kunming medical university from May 2021 to December 2022 were collected, and all of them were given standard cluster treatment. At the same time, according to 28d survival outcome in patients with septic shock was divided into death group （n = 89) and survival group （n = 71), statistics of two groups of patients admitted to the hospital within 24h baseline data, test indicators, the weighted average dose of noradrenaline, blood gas index, microcirculation index, cellular immunity and early treatment of clinical data in 72h. Meaningful indicators were identified by single-factor analysis, and a multivariate COX proportional risk regression model was applied to screen out independent risk factors affecting the prognosis of patients with septic shock. Results Multivariate COX regression model analysis results showed that: age （HR = 1.05, 95%CI: 1.09～1.12, P = 0.036), nutritional mode （HR = 0.74, 95%CI: 0.56～0.90, P = 0.037), the weighted average dose of norepinephrine （HR = 6.21, 95%CI: 4.09～9.43, P < 0.001), IL-6 （HR = 1.16, 95%CI: 1.09～1.31, P = 0.012), absolute value of T lymphocytes （HR = 0.47, 95%CI: 0.24～0.91, P = 0.025), mHLA-DR （HR = 0.46, 95%CI: 0.28～0.75, P = 0.002) .Six factors were independent risk factors affecting the outcome of patients with septic shock to visualize the forest plots presented. Conclusions The age, the weighted average dose of norepinephrine and IL-6 are the dangerous factors affecting the prognosis of patients with septic shock. The hazard ratio is greater than 1. Nutrition, T-lymphocyte absolute value and mHLA-DR are the protection factors affecting the prognosis of patients with septic shock. The hazard ratio is less than 1. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Hainan Medical University is the property of Journal of Hainan Medical College Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To explore the distribution of blood culture pathogens and clinical characteristics in children with acute leukemia complicated with septic shock. Methods Clinical data of 70 acute leukemia children complicated with septic shock who were positive for blood culture were retrospectively analyzed. The pathogenic findings and clinical characteristics of these cases were collected. Results Among 70 children， 44 （62.9%） cases were positive for blood culture. 33 Gram-negative bacteria （GNB）， 12 Gram-positive bacteria（ GPB） and 2 fungi were cultured. The most common GNB was Pseudomonas aeruginosa（ 8/33， 24.2%）， followed by Escherichia coli（ 6/33， 18.2%）， Stenotrophomonas maltophilia（ 5/33， 15.2%） and Klebsiella pneumoniae（ 4/33， 12.1%）. GPB mainly consisted of Staphylococcus epidermidis， Staphylococcus aureus， Staphylococcus haemolyticus and Streptococcus retardans（ 2/12， 16.7% for each）. Multi-drug resistant organisms（ MDRO） accounted for 48.9%（ 22/45）. Compared with GPB infections， the duration of antibiotic exposure before septic shock was significantly longer in patients with GNB infections （Z = -1.988， P = 0.047）. However， there were no significant differences in the length of hospital stay， duration of neutropenia and fever and site of primary infection before septic shock， vital signs， severity of illness and level of infection indicators at the onset of septic shock， primary treatment， and clinical outcome between two groups（ all P > 0.05）. Compared with non-MDRO infected children， the length of hospital stay and the duration of antibiotic exposure before septic shock were significantly longer in MDRO infected children （t = -2.203， P = 0.035； Z = -2.099， P = 0.036）. Multivariate logistic regression analysis indicated that the length of hospital stay before septic shock was independently associated with MDRO infections （P = 0.045， OR = 1.059， 95%CI： 1.001-1.121）. Conclusions GNB are the leading pathogens of blood culture in pediatric acute leukemia complicated with septic shock. No significant difference was observed in the clinical characteristics between children infected with GNB and GPB. The longer the hospital stay， the higher the risk of MDRO infections. [ABSTRACT FROM AUTHOR]

Copyright of Imaging Science & Photochemistry is the property of Imaging Science & Photochemistry Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

目的观察并发谵妄的脓毒性休克患者血清血小板内皮细胞黏附分子1（PECAM-1）水平变化情况，分析 其对患者并发谵妄的预测效能。方法选择入住ICU的137例脓毒性休克患者，根据是否发生谵妄，将患者分为谵 妄组48例和非谵妄组89例。采集患者静脉血，采用ELISA法测定血清PECAM-1水平；采用Spearson相关分析脓毒 性休克患者血清PECAM-1水平与序贯器官衰竭估计（SOFA）评分及血清CRP、TNF-α、IL-6的相关性；应用多因素 Logistic回归分析血清PECAM-1对脓毒性休克患者并发谵妄的影响；绘制受试者工作特征曲线（ROC），评估血清 PECAM-1对脓毒性休克并发谵妄的预测效能。结果谵妄组血清PECAM-1水平高于非谵妄组（P<0. 01）。脓毒性 休克患者血清PECAM-1 水平与SOFA 评分以及血清CRP、TNF-α、IL-6 水平均呈正相关（rs 分别为0. 374、0. 241、 0. 245、0. 329，P 均<0. 05）。血清PECAM-1 水平是脓毒性休克患者并发谵妄的影响因素（OR=1. 435，95% CI 为 1. 178～1. 749）。PECAM-1预测脓毒性休克并发谵妄的曲线下面积为0. 821（95% CI 为0. 747～0. 881），当PECAM-1 截断值为14. 06 μg/L 时，约登指数最大，其预测脓毒性休克并发谵妄的敏感度为82. 50%、特异度为72. 13%。 结论脓毒性休克并发谵妄患者血清PECAM-1水平显著升高，监测血清PECAM-1水平可能有助于脓毒性休克并 发谵妄的早期诊断及干预。 [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives To analyze the correlation of blood lactate concentration in artery，central vein and peripheral vein of patients with septic shock，and to explore the value of blood lactate and lactate clearance rate in different periods of time in evaluating the prognosis of patients with septic shock. Methods A total of 60 patients with septic shock in ICU of building 3 of the First Affiliated Hospital of Kunming Medical University from June 2020 to February 2021 were selected as the research objects. The general data of the patients were collected，and the blood gas parameters of artery，peripheral vein and central vein at admission and 6 h，12 h and 24 h after treatment， as well as arterial blood gas parameters at 48 h and 72 h after the treatment were monitored. First，according to the source of blood samples，they were divided into the artery group，the central vein group and the peripheral vein group. The correlation of blood lactic acid concentration in artery，central vein and peripheral vein was analyzed. Then，according to the 28 day survival of patients，they were divided into the death group and the survival group. The evaluation value of blood lactic acid and lactic acid clearance rate in different periods of early stage on the prognosis of patients was discussed. Results （1） According to Pearson correlation analysis，there was a correlation between arterial lactic acid and central venous lactic acid at ICU admission and 6 h，12 h，24 h after the treatment，with r value between 0.89-0.90 at each time period，P < 0.05；there was a correlation between arterial lactic acid and peripheral venous lactic acid at ICU admission and 6 h，12 h，24 h after treatment，with r value between 0.83-0.87 at each time period，P < 0.05. （2） By drawing ROC curve，the AUC of arterial lactic acid at the initial and 6 h，12 h，24 h，48 h and 72 h after the treatment were 0.64，0.62，0.64，0.72，0.66，0.63， respectively， P < 0.05. The AUC of arterial lactate was the highest at 24 h，with the best cutoff value of 2.42 mmol/L，sensitivity of 0.64 and specificity of 0.66. （3） By drawing the ROC curve，the AUC of arterial lactic acid clearance at 6 h，12 h，24 h，48 h and 72 h were 0.66，0.61，0.74，0.72 and 0.70，respectively， P < 0.05. The AUC of 24 h lactate clearance was the highest，with the best cutoff value of 19.57%，sensitivity of 0.64 and specificity of 0.68. Conclusions （1） There is a correlation between arterial and central venous blood lactic acid levels and between arterial and peripheral venous blood lactic acid levels in patients with septic shock. （2） The arterial lactate and lactate clearance rate 24 hours after the treatment have a good evaluation value for the prognosis of patients with septic shock. [ABSTRACT FROM AUTHOR]

Objective To analyze the risk factors for septic shock complicated with acute renal injury(AKI). Methods Totally 154 patients with septic shock were divided into AKI group(114 cases)and non-AKI group(40 cases)according to whether they were accompanied by AKI. Univariate analysis and multivariate Logistic regression analysis were used to analyze the influencing factors and risk factors for septic shock complicated with AKI. Results Significant differences were found in age, BMI, sepsis-related organ failure assessment score(SOFA score), chronic health evaluation Ⅱ score, serum lactate level, mean arterial pressure at 6 h after resuscitation, heart rate at 6 h after resuscitation, urine output per hour at 6 h after resuscitation, the dose of norepinephrine at 6 hour after resuscitation, peripheral perfusion index(PPI)at the beginning resuscitation, PPI at 6 hour after resuscitation, the changes of peripheral perfusion index (ΔPPI), 24-hour fluid balance, the positive rate of blood culture, and 28-day mortality between the two groups(all P< 0. 05). Multivariate analysis showed that SOFA score was independent risk factor for septic shock complicated with AKI, and the elevated ΔPPI level was independent protective factor for septic shock complicated with AKI(both P<0. 05). Conclusion SOFA score is independent risk factor for septic shock complicated with AKI, while the elevated ΔPPI level is independent protective factor. [ABSTRACT FROM AUTHOR]

目的 动态监测脓毒性休克患者的临床相关指标，并分析患者并发室上性心动过速（SVT）的危险因素及 其对 SVT 的预测价值。方法 选择脓毒性休克患者 74 例，根据是否发生 SVT 分为 SVT 组 33 例和无 SVT 组 41 例。 两组入院后第 1、3、5 天动态监测白细胞（WBC）、C 反应蛋白（CRP）、降钙素原（PCT）、脂多糖（LPS）、脑钠尿肽 （BNP）、钾离子（K+ ）、肌酐（Cr）、血乳酸（Lac）、平均动脉压（MAP）、动脉血氧分压（PaO2 ）、去甲肾上腺素（NE），对两组 比较有意义的因素进行多因素Logistic回归分析；绘制各危险因素预测脓毒症并发SVT的受试者工作特征（ROC）曲 线，计算曲线下面积（AUC），评价其预测效能。结果 入院第1天，两组WBC、CRP、PCT、LPS、BNP、K+ 、Cr、Lac、MAP、 PaO2、NE比较差异均无统计学意义（P均>0. 05）；入院第3天，SVT组CRP、PCT、LPS、BNP均高于无SVT组，K+ 、MAP均 低于无SVT组（P均<0. 05），两组WBC、Cr、Lac、PaO2、NE比较差异均无统计学意义（P均>0. 05）；入院第5天，SVT组 WBC、LPS、BNP、Cr均高于无SVT组，Lac、MAP均低于无SVT组（P均<0. 05），两组CRP、PCT、K+ 、PaO2、NE比较差异均 无统计学意义（P均>0. 05）。多因素Logistic回归分析结果显示，第3天PCT、LPS、BNP和第5天BNP升高均是脓毒性 休克并发SVT的独立危险因素（P均<0. 05）。第3天PCT的AUC为0. 852（95% CI：0. 751～0. 924），最佳截断值14. 5， 此时敏感度72. 73%、特异度92. 68%；第3天LPS的AUC为0. 917（95% CI：0. 830～0. 969），最佳截断值22. 72，此时敏 感度78. 79%、特异度95. 12%，第3天BNP的AUC为0. 836（95% CI：0. 732～0. 912），最佳截断值236. 05，此时敏感度 84. 85%、特异度 70. 73%；第 5 天 BNP 的 AUC 为 0. 948（95% CI：0. 869～0. 986），最佳截断值 128. 95，此时敏感度 87. 88%、特异度87. 80%。结论 入院第3天PCT、LPS、BNP及第5天BNP升高是脓毒性休克患者发生SVT的独立危 险因素，其中第3天PCT、LPS和第5天BNP对预测SVT发生具有一定的临床价值。 [ABSTRACT FROM AUTHOR]

Objective To observe the changes of serum kallikrein binding protein（Kal）and vascular endothelial cadherin（VE-Cad）levels and to evaluate their predictive value for the prognosis of septic shock（SS). Methods Totally 201 patients with SS（observation group）were divided into the death group and survival group according to the 28-day prog⁃ nosis；another 200 healthy people who took physical examination in the same period were selected as the control group. The levels of serum VE-Cad and Kal, sepsis-related organ failure assessment（SOFA）score，and acute physiology and chronic health evaluation（APACHE）Ⅱ score in each group were compared between the observation group and the control group. On the 1st, 3rd and 5th days, the serum Kal and VE-Cad levels were compared between the death group and survival group. The correlation between the above indexes was analyzed by Pearson correlation. The risk factors for death of SS patients were analyzed by Logistic Regression analysis. The predictive value of serum VE-Cad and Kal levels for prognosis of patients with SS were analyzed by ROC. Results The levels of serum VE-Cad，SOFA，and APACHE Ⅱ scores in the observation group were higher than those in the control group, while the level of Kal in the observation group was lower than in the control group（all P<0. 05). On the 1st, 3rd and 5th days, the serum VE-Cad levels of the death group were higher than those of the survival group，and the serum Kal level was lower than that of the survival group（all P<0. 05)， and SOFA and APACHE Ⅱ scores of the death group were higher than those of the survival group（both P<0. 05）. Serum VE-Cad level was positively correlated with SOFA and APACHE Ⅱ scores in the death group on the 1st day after admission（both P<0. 05)，while serum Kal level was negatively correlated with SOFA and Apache Ⅱ scores（both P<0. 05）. Multivariate stepwise logistic regression analysis showed that VE-Cad（OR=1. 382，95%CI=1. 045-1. 786）was a risk fac⁃ tor for death of SS patients，and Kal（OR=0. 429，95%CI=0. 187-0. 968）was a protective factor for SS patients（P< 0. 05）. On the 1st day after admission，the AUC of serum VE-Cad combined with Kal in judging the prognosis of SS patients was significantly higher than that of VE-Cad or Kal alone（all P<0. 05), as well as the accuracy，sensitivity，and specificity（all P<0. 05). Conclusions The decrease of serum Kal level and the increase of VE-Cad level are the independent influencing factors for death of SS patients. The combined detection of serum Kal and VE-Cad can predict the prognosis of SS patients better than the single detection of each index. [ABSTRACT FROM AUTHOR]

To explore the difference of shock sensitivity in mitochondrial quantity and function from different types of tissues. The hemorrhagic shock and septic shock models were simulated at animal and cellular levels. mtDNA detection, mitochondrial morphology observation and ROS detection were undertaken to observe mitochondrial quantity and function in intestinal, vascular as well as myocardial tissues at different times of hemorrhagic/septic shock. Under hemorrhagic shock or hypoxia stimulation, the sensitivity of mitochondrial quantity in intestinal tissue was significantly higher than that in vascular and myocardial tissues (P<0.05). The number of mitochondria in intestine, vascular and heart increased significantly from 0.5 h, 1 h and 2 h after hemorrhagic shock, respectively. Under septic shock or LPS stimulation, the sensitivity of mitochondrial quantity in intestinal tissue was much lower than that in vascular and myocardial tissues (P<0.05). The number of mitochondria in intestine, vascular and heart increased significantly from 9 h, 6 h and 3 h after septic shock, respectively. Only high concentration of LPS stimulation for a long time may increase the number of mitochondria in intestinal epithelial cells obviously. There were differences in sensitivity and response degree of mitochondrial function from different types of tissue to various types of shock stimulation, but they were all later than the increase in mitochondrial quantity. The different tissue sensitivity to various types of shock may be related to the different shock sensitivity of mitochondria in different types of tissue. The abnormal increase of mitochondrial number is the initial link of mitochondrial damage and cell dysfunctions after shock. The different shock sensitivity of mitochondria in different tissues is also one of the important causes of different injury degrees of various tissues after shock. [ABSTRACT FROM AUTHOR]

目的总结儿童急性白血病（AL）合并脓毒性休克的临床特点，分析AL合并脓毒性休克患儿死亡的危险 因素。方法对47例AL合并脓毒性休克患儿的临床资料作回顾性分析，总结其临床特点，分析患儿死亡的危险因 素。结果47例患者感染部位为肺部21例、肠道14例、腹腔6例、皮肤3例、其他3例。47例患儿中临床表现为发热 47例、呼吸增快40例，尿少38例、肢端发凉35例、畏寒及寒战32例、抽搐5例、意识障碍3例。47例患者血标本共培 养出细菌35株，其中革兰氏阴性杆菌21株，对亚胺培南和美罗培南均敏感；革兰氏阳性球菌12株，对万古霉素和利 奈唑胺均敏感；真菌2株，对两性霉素B和伏立康唑均敏感。47例患者治疗后存活25例、死亡22例，与存活患者比 较，死亡患者原发病复发率、有创呼吸机通气率、治疗第6个小时乳酸水平、胃肠功能衰竭率均较高，左室射血分数 低（P 均<0. 05）。治疗第6个小时血清乳酸水平、胃肠功能衰竭是AL合并脓毒性休克患儿死亡的独立危险因素（P 均<0. 05）。结论AL合并脓毒性休克患儿的主要感染部位为肺部、肠道，病原菌以革兰氏阴性杆菌较多。抗休克 治疗第6个小时血清乳酸水平增高、合并胃肠功能衰竭是导致AL合并脓毒性休克患儿死亡的主要因素。 [ABSTRACT FROM AUTHOR]

Objective: To explore the impact of limited fluid resuscitation combined with norepinephrine on hemodynamics and oxygen metabolism in septic shock. Methods: 62 patients of septic shock were divided randomly two groups according to resuscitation methods. Treatment group (n=31) was given limited fluid resuscitation, control group (n=31) was given conventional fluid resuscitation. Changes of indicators of hemodynamics and oxygen metabolism were observed, and incidence of DIC, MODS, ARDS and mortality within 2 weeks were recorded. Result: At 1 h, 3 h and 6 h after treatment, levels of CVP and MAP were increased significantly, and HR was decreased significantly in the two groups (P<0.05). At 3 h, 6 h after treatment, MAP level of the treatment group was significantly lower than that of the control group (P<0.05), while there was no statistically significant difference in HR and CVP between the two groups (P>0.05). At 1 h, 3 h and 6 h after treatment, the PaCO2, PaO2, SaO2 and PaO2/FiO2 were all improved in different degrees in the two groups, and at 3 h, 6 h after treatment, PaO2 and PaO2/FiO2 were significantly higher in the treatment group than those in the control group (P<0.05). After 3 d treatment, the incidence of MODS in the treatment group was significantly lower than that in the control group (P<0.05), while there was no significant difference between the two groups in hypotension, ARDS, DIC and mortality within 2 weeks (P>0.05).Conclusion: Limited fluid resuscitation combined with small dose of norepinephrine for septic shock can contribute to maintain hemodynamic stability, improve oxygen metabolism, reduce the occurrence of complications and improve the prognosis. [ABSTRACT FROM AUTHOR]

Objective To study the sublingual microcirculation in patients suffering from septic shock with different tongue colors, and explore the relationship between tongue colors and prognoses. Methods A prospective observational study was carried out. Patients with septic shock admitted in Intensive Care Unit (ICU) in Hospital of Integrated Traditional Chinese and Western Medicine affiliated to Nanjing University of Chinese Medicine from May 2017 to May 2018 with completed medical records were selected. The patients were divided into two groups (red tongue group and purple tongue group) based on tongue colors at 6h after initial resuscitation. Total vessel density (TVD), perfused vessel density (PVD), proportion of perfused vessel (PPV), and microvascular flow index (MFI) were detected with sublingual sidestream dark field (SDF) technology. Sublingual microcirculatory and prognoses in two group groups were compared according to above parameters. Results There were 59 patients in two groups, red tongue color group (RTC, n = 34), and purple tongue color group (PTC, n = 25). Compared with RTC group, APACHE II score, SOFA score and arterial lactate in PTC group were significantly higher,PTC group had a significantly higher 28 day mortality rate. Compared with RTC group, TVD, PVD, PPV, and MFI were significantly lower in PTC group. Purple tongue color and arterial lactate level had close relationship with mortality according to multivariate logistic analysis. Kaplan Meier survival analysis demonstrated surv iv al rate of 28 day in the PTC was significantly lower than that in RTC (P 0.001). Conclusion Tongue color may correlate with sublingual microcirculation and prognoses. It can be used to estimate survival rate in 28 days of patients with septic shock. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Modern Laboratory Medicine is the property of Journal of Modern Laboratory Medicine Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

目的比较高、低目标血压治疗对老年脓毒性休克患者胃肠功能及预后的影响。方法选取老年脓毒性休克患者62例,随机分为高目标组33例和低目标组29例。两组均给予脓毒性休克集束治疗,高目标组和低目标组目标平均动脉压分别控制在80～85、65～70 mm Hg。记录两组治疗3 d后急性胃肠损伤(AGI)发生情况、急性生理与慢性健康评分Ⅱ(APACHEⅡ)、全身性感染相关性器官功能衰竭评分(SOFA评分)及28 d病死率。两组治疗前及治疗3 d测量腹腔内压(IAP),行腹部超声检查并测算胃动力指数(MI)及肠系膜上动脉收缩期峰值流速(Vps)、舒张末期流速(Vpd)、搏动指数(PI)、阻力指数(RI)。结果高目标组发生AGI 12例(36. 36%),低目标组为28例(96. 55%),两组比较P <0. 01。高目标组治疗后MI、Vpd、Vps均高于治疗前,低目标组治疗后IAP高于治疗前(P均<0. 05)。治疗后高目标组IAP低于低目标组,MI、Vpd、Vps均高于低目标组(P均<0. 05)。高目标组治疗后APACHEⅡ、SOFA评分分别为(13. 03±3. 6)、(3. 60±0. 93)分,低目标组分别为(14. 93±2. 67)、(4. 75±1. 05)分,两组比较P均<0. 05。高目标组28 d病死率为15. 15%(5/33),低于低目标组的34. 48%(10/29),两组比较P>0. 05。结论老年脓毒性休克患者采取高目标血压治疗较低目标血压治疗更有助于减轻其胃肠功能损伤,并可降低其AGI发生率、改善其预后。 [ABSTRACT FROM AUTHOR]

目的探讨早期外周灌注指数(PI)、乳酸及降钙素原(PCT)对脓毒性休克患者预后的预测价值。方法选择ICU住院的脓毒性休克患者80例,根据患者住院第28天的生存情况分为生存组48例和死亡组32例。回顾性收集患者入住ICU当天(D0)和经过标准治疗1 d(D1)的PI、乳酸及PCT等资料,绘制D1时PI、乳酸及PCT单独及联合预测患者预后的受试者工作特征(ROC)曲线,计算曲线下面积(AUC)、敏感度、特异度及单独预测时的Cut-off值。结果 D0时两组PI、乳酸及PCT水平比较差异均无统计学意义(P均> 0. 05)。D1时死亡组PI低于生存组,乳酸及PCT水平均高于生存组(P均<0. 05)。D1时PI、乳酸及PCT单独预测患者预后的AUC分别为0. 906(95%CI:0. 842 4～0. 968 8)、0. 795(95%CI:0. 695 3～0. 894 6)、0. 809(95%CI:0. 697 4～0. 920 5),敏感度分别为87. 5%、72. 9%、89. 6%,特异度分别为81. 2%、78. 1%、71. 9%,Cut-off值分别为0. 27、4. 30、3. 73。PI、乳酸及PCT联合预测患者预后的AUC为0. 932(95%CI:0. 879～0. 985),均高于三项指标单独预测的AUC。结论脓毒性休克患者经过标准治疗1 d后PI低于0. 27、乳酸高于4. 30 mmol/L、PCT高于3. 73 ng/mL均提示预后不良,PI与乳酸、PCT三项指标联合检测可更好地预测患者预后。 [ABSTRACT FROM AUTHOR]

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To investigate the value of early dynamic monitoring of blood lactic acid concentration in evaluating the severity and prognosis of septic shock in children. Methods: 90 children with septic shock were enrolled in this study, starting with diagnostic shock, blood lactate at 0 h and 6 h were dynamically monitored, and 6 h lactate clearances were calculated. According to PCIS scores, they were divided into ≥ 70 points group(n=41), 60~70 points group(n=40) and ＜60 points group(n=9); according to the prognosis, they were divdided into survival group (n=62) and death group (n=28); according to the lactate clearance rate, they were divdided into high lactate clearance rate group (n=57) and low lactate clearance rate group (n=33). The PCIS score, 0 h lactic acid and lactate clearance rate of each group were compared. Results: There were significant in 0 h lactic acid and lactate clearance rate among ≥ 70 points group, 60~70 points group and ＜60 points group (P＜0.05). The 0 h lactic acid and lactate clearance rate in ≥ 70 points group were lower than those in the 60~70 points group, which were lower in ＜60~70 points group than than that in ＜60 points group (P＜ 0.05). There were significant differences in the PCIS scores, 0 h lactic acid and lactate clearance rate between survival group and death group(P＜0.05). There were significant differences in the PCIS scores between high lactate clearance rate group and low lactate clearance rate group(P＜0.05). PCIS score was negative correlated with 0h lactate concentration (r=-0.619), and was positively correlated with the lactate clearance (r=-0.702). Conclusions: In the evaluation of the severity and prognosis of septic shock in children, early lactate clearance rate was more useful than that of single blood lactate acid. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Contemporary Pediatrics is the property of Xiangya Medical Periodical Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Nursing of Integrated Traditional Chinese & Western Medicine is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To investigate the clinical effect of conventional close Ulinastatin and early goal-directed therapy (EGDT) on patients with septic shock. Methods: 47 patients diagnosed with septic shock were randomly divided into 2 groups, the control group and the test group. The 24 patients in control group were given EGDT. and the 23 patients in experiment group were given conventional dose Ulinastatin combined with EGDT. Hemodynamic status, lactic acid, and vasoactive chug use were observed during treatments: at the same time, ventilator weaning time, ICU stay time, and 28-day hospital mortality were also recorded. Results: hi both groups, mean arterial pressure post-treatment levels were increased and lactic acid was decreased at 6. 12. 24. 48. and 72 h (P<0.05): and the heart rate was decreased at 24, 48. and 72 h (P<0.05).The dosage of vasoactive chugs was reduced in treatment group, but difference between two groups was not significant (P>0.05). Compared with control group, SOFA score in treatment group was reduced and difference between two groups was significant in the third, fifth and seventh clay after treatment (P<0.05). However. APACHE-II score was not significantly different between two groups (P>0.05). Ventilator weaning time and ICU stay were significantly shorter in treatment group as compared with controls, but 28-clay hospital mortality did not appear statical differences (P>0.05). Conclusions: Conventional close Ulinastatin and early goal-clirected therapy (EGDT) can improve hemodynamics, shorten ventilation and ICU stay time in treatment of patients with septic shock. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the role of clinical pharmacists in the clinical drug treatment for patients with septic shock. METHODS: The clinical pharmacists participated in the anti-infective treatment for a patient with septic shock from the aspects of antibiotics categories selection, dosage, route of administration and monitoring of adverse drug reactions, etc. And then the clinical pharmacists formulated individualized drug administration program and made recommendations and provided pharmaceutical care for the patient. RESULTS: The clinicians adopted the advice provided by clinical pharmacists to stop vancomycin and add cefoperazone sulbactam, the patient’s temperature dropped and the infection was controlled. CONCLUSIONS: The clinical pharmacists participate in clinical treatment, assist clinicians to make decisions in drug treatment, provide pharmaceutical care for the patient, ensure the safety and effectiveness of medication and promote the rational drug application. [ABSTRACT FROM AUTHOR]

Objective To explore the feasibility and value of Cv-aCO2/Ca-vO2,LCR and IVCrvi as the end point ofearly recovery in patients with septic shock. Methods Sixty patients with septic shock admitted to the hospital from June 2016 to February 2018 were enrolled. All patients underwent early fluid resuscitation and were evaluated with Cv-aCO2/Ca-vO2, LCR, IVCrvi. The urine volume was greater than 0.5 m L/(kg·h)and the mean arterial pressure was greater than 65 mm Hg(1 mm Hg=0.133 k Pa). Patients were divided into the compliance group and the non-standard group according to the compliance criteria. Results After resuscitation treatment, Cv-aCO2/Ca-vO2, LCR and IVCrvi were significantly improved in all patients. The improvement of index in patients in the standard group was better than that in the non-standard group, the difference was statistically significant(P0.05). Conclusion Early resuscitation in patients with septic shock can be assessed with Cv-aCO2/Ca-vO2,LCR,IVCrvi, which has important guiding value for resuscitation therapy. [ABSTRACT FROM AUTHOR]

目的探讨小剂量肝素辅助治疗对脓毒性休克患者肝肾功能、血管内皮细胞功能以及近期预后的影响 方法脓毒性休立患片122例:按照不同治疗方式将忠Vf分成肝素绀与对照纟U(每绀61例)，对照绀采用常规药 物治疗，肝素绀在常规治疗的基础上加用小剂量肝素(1〜2万U/24 h)输助治疗。治疗2周后比较两绀肝忖功能、 血管内皮细胞功能、并发症发生率，并计算治疗结束后28 d生存率。结果两组治疗后肌酐、尿素氮、谷丙转氨 酶、谷草转氨酶、血管性假性血友病因子均降低，以肝素组为著(P均<0. 05);两组治疗前后及两组间凝血功能指 标比较，P均>0.05与对照组比较，肝素组弥散性血管内凝血、多器官功能不全综合征发生率少(P均<0. 05) ;28 d生存率高(χ2 =3. 909, <0.05)。结论对脓毒性休克患者注射小剂量肝素能改善患者肝肾以及血坑•内皮细胞 功能，降低相关并发症的发生率，改善近期预后。 [ABSTRACT FROM AUTHOR]

目的观察脓毒性休克患者早期容量复苏后血浆氨基末端B型脑钠肽前体（NT-proBNP)水平变化，并 分析其与血流动力学指标和疾病严重程度的相关性。方法 73例脓毒性休克患者在脉搏指示连续心排血量 (PiCCO)监测下给予早期目标指导性治疗(EGDT)。分别于复苏前和复苏后3、6、24、48 h采用电化学发光法测定 静脉血浆NT-F0BNP和动脉血乳酸(Lac)并计算乳酸清除率（LCR)，记录各时点的平均动脉压（MAP)、心脏指数 (CI)、全心舒张末期容积指数（GEDI)、胸腔内血容量指数（ITBI)、血管外肺水指数（ELWI);分别于复苏后24、48、 72 h进行急性生理与慢性健康评分(APACHE II评分）评估疾病严重程度。分析血浆NT-proBNP水平与血流动力 学指标及APACHE II评分的相关性。结果与复苏前相比，复苏后3、6、24、48 h血浆NT-proBNP水平升高，动脉 血Lac水平下降，MAP、CI、GEDI、ITBI、EVLW均升高（P均<0.01)。其中，复苏后48 h的MAP、CI高于复苏后24 h，复苏后48 h的血浆NT-proBNP水平高于复苏后3 h(P均<0.01)。复苏后3、6、24、48 h的血浆NT-proBNP水平 与MAP、CI、GEDI、LCR呈正相关(P均< 0.05)，与Lac呈负相关(P < 0.01);复苏后24 h的血浆NT-proBNP水平与 ITBI呈正相关(P <0. 01);复苏后48、72 h的血浆NT-proBNP水平与APACHE II评分呈正相关(P <0.01)(结论 脓毒性休克患者早期容量复苏后血浆NT-proBNP水平升高，且与血流动力学指标（MAP、CI、GEDI)、LCR及疾病严 重程度有关，血浆NT-proBNP水平可能在早期容量复苏评估中有一定价值。 [ABSTRACT FROM AUTHOR]

Human sepsis is thought to be systemic inflammatory response syndrome (SIRS) that is activated by invasive infection. It can rapidly develop into sever sepsis, septic shock and multiple organ dysfunction(MODS). Severe sepsis places a large burden on health care systems,with an incidence ranging from 50 to 300 cases per000 population and a short-term mortality of 20% to 25%, reaching up to 50%when shock is present. Destructing pathogenic microorganisms,blocking inflammatory mediators and processing multiple organ dysfunction syndrome(MODS) did not significantly reduce the mortality of sepsis. Glucocorticoids have powerful anti-inflammatory effects,but the evaluations about the effect of glucocorticosteroid are varing. Whether it is good for the treatment of sepsis has been controversial. This review only discusses the progress of glucocorticoids in the treatment of severe sepsis and septic shock. We hope to continue to investigate the reason of the complexity of Glucocorticosteroids response when the patient developed into severe sepsis and septic shock. And the diagnose of the relative adrenal insufficiency and the chance of using and stoping of Glucocorticosteroids will be more clear in the future. [ABSTRACT FROM AUTHOR]

目的：观察脓毒症休克早期复苏患者应用微创方法监测血流动力学的效果。方法选取21例脓毒性休克患者，入院后立即经传感器连接微创血流动力学监测仪监测心输出量（CO）、心脏指数（CI）、心率（HR）、平均动脉压（MAP）、体循环阻力指数（SVRI），同时放置肺动脉漂浮导管（PAC）接监护仪监测上述指标。均给予充分液体复苏。比较治疗0、1、2、3、4、5、6 h 两种监测方法测得上述指标的值，并计算其相关性。结果19例患者顺利完成6 h 的早期复苏治疗，2例因需外科手术干预退出研究。19例患者相同时间点 PAC 和微创血流动力学监测获得的 CO、CI、HR、MAP、SVRI 差异无统计学意义；PAC 和微创血流动力学监测获得的 CO 相关系数为0．84，P ＜0．05；CI 相关系数为0．84，P ＜0．05；HR 相关系数为1，P ＜0．05；MAP 相关系数为0．98，P ＜0．05；SVRI 相关系数为0．72， P ＜0．05。结论微创血流动力学监测技术是脓毒性休克早期复苏患者较好的血流动力学监测工具。 [ABSTRACT FROM AUTHOR]