Micropump Research Articles

Effect of dexmedetomidine on stress response and immune balance in mechanical ventilation patients with acute respiratory distress syndrome

Objective To investigate the effect of dexmedetomidine on stress response and immune balance in patients with acute respiratory distress syndrome(ARDS) undergoing mechanical ventilation. Methods From March 2016 to September 2018, 90 ARDS patients with mechanical ventilation in Chongqing Three Gorges Center Hospital were randomly divided into dexmedetomidine group(D group, 30 cases), propofol group(P group, 30 cases), midazolam group(M group, 30 cases) by random number table method.Another 30 healthy workers in our hospital were selected as normal control group(C group). In M, P and D groups, the sedative drugs were infused by micro-pump on the basis of analgesic treatment(fentanyl citrate). The heart rate(HR), mean arterial pressure(MAP), Murray score, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, plasma norepinephrine(NS), plasma cortisol(Cor), and blood T lymphocyte subsets(CD4+, CD8+, CD4+/CD8+) were observed in all patients at T0(the beginning of sedation), T1 (6h after sedation), T2 (24h after sedation), T3(48h after sedation). The levels of NS and Cor in plasma and blood T lymphocyte subsets(CD4+, CD8+, CD4+/CD8+) in C group were measured at 8∶00 a. m.the next day. Results The plasma NS and Cor at T0 in M, P and D group were higher than those in C group (all P 0.05). The levels of CD8+ at T2 and T3 in P and D groups were higher than that of M group (all P<0.05). The level of CD4+/CD8+ at T3 in D group were higher than that in M and P group[(1.46±0.30) vs.(1.26±0.33), (1.46±0.30) vs.(1.32±0.34)](t=0.21, 0.15, all P<0.05). Conclusion Sedation with dexmedetomidine or propofol can alleviate stress response and improve immune function in ARDS patients undergoing mechanical ventilation, and dexmedetomidine is better than propofol. Key words: Respiratory distress syndrome, Adult; Ventilators, mechanical; T-Lymphocytes; Dexmedetomidine; Propofol; Midazolam

Effect of thymosin α1 on sepsis in rats

Objective To evaluate the effect of thymosin α1 (Tα1) on sepsis in rats. Methods A total of 120 pathogen-free healthy male Sprague-Dawley rats, weighing 250-300 g, aged 7 weeks, were divided into 3 groups using a random number table method: sham operation group (group S, n=24), sepsis group (group CLP, n=48) and Tα1 group (group T, n=48). Sepsis was induced by modified cecal ligation and puncture in anesthetized rats, and vena cava cannula was placed through the right jugular vein to connect the micropump infusion device.In group S, the cecum was only turned without ligation and perforation, and total venous nutrient solution 60 ml was intravenously infused daily for 3 days.After successful establishment of the model, total venous nutrient solution 60 ml was intravenously infused daily for 3 days in group CLP.After successful establishment of the model in group T, Tα1 0.18 mg/kg was subcutaneously injected daily at a fixed time, and total venous nutrient solution 60 ml was intravenously infused daily for 3 days.Twenty-four rats in group CLP and group T were selected, and the survival rate were observed within 3 days after establishing the model.At 12, 24, 36 and 72 h after establishing the model, 6 rats were selected from each group, and blood samples were collected from the jugular vein for determination of the levels of regulatory T cells (Tregs) and T helper cell 17 (Th17) (using flow cytometry) and serum interleukin-10 (IL-10), IL-17 and tumor necrosis factor-alpha (TNF-α) concentrations (by enzyme-linked immunosorbent assay), and the IL-10/TNF-α ratio was calculated. Results Compared with group S, the level of Tregs in peripheral blood was significantly decreased at 24 h after establishing the model and was increased at 36 and 72 h after establishing the model, and the level of Th17 in peripheral blood and serum IL-10, IL-17 and TNF-α concentrations were increased at each time point after establishing the model, and the IL-10/TNF-α ratio was increased at 36 and 72 h after establishing the model in group CLP, and the levels of Tregs and Th17 in peripheral blood were significantly increased at 72 h after establishing the model, the concentrations of serum IL-10 and IL-17 were increased at each time point after establishing the model, serum TNF-α concentrations were increased at 12 and 24 h after establishing the model, and the IL-10/TNF-α ratio was increased at 36 and 72 h after establishing the model in group T (P<0.05). Compared with group CLP, the levels of Tregs and Th17 in peripheral blood were significantly decreased, the serum IL-10 and IL-17 concentrations and IL-10/TNF-α ratio were decreased at 36 and 72 h after establishing the model, serum TNF-α concentrations were decreased at 72 h after establishing the model, and the survival rate was increased within 3 days after establishing the model in group T (P<0.05). Conclusion Tα1 can reduce sepsis through improving the cellular immune function in rats. Key words: Sepsis; Thymosin; Immunity, cellular

Application of intravenous catheters combined with micropump extension tube in central venous catheterization of children

目的 探讨静脉留置针联合微量泵输液延长管在儿童中心静脉置管中的应用效果。 方法 将97例拟行中心静脉置管患儿分为A组(49例)和B组(48例)，A组采用传统方法进行置管，B组利用静脉留置针联合微量泵输液延长管辅助进行置管操作。比较两种方法的1次穿刺成功率、置管成功率、置管时间及并发症发生率。 结果 B组1次穿刺成功率为85.4%(41/48)，高于A组65.3%(32/49)，两组间差异有统计学意义(P 0.05)。 结论 应用静脉留置针联合微量泵延长管的辅助作用，可以提高儿童中心静脉置管1次穿刺成功率，缩短置管时间，减少置管并发症。

Micro pumps driven by BZ gel

Micro pumps driven by BZ gel

Technique improvement and experience sharing of cannulation of the mouse submandibular salivary gland via the Wharton’s duct

Objective This paper described my technique improvement and experience sharing of Cannulation of the mouse submandibular salivary gland via the Wharton’s duct in order to accelerate the submandibular gland gene therapy research in China. Methods The operation process of the technology was introduced in detail, and the improvement of the original technology was made. The micro pump and microsurgical instruments were introduced to make the operation more precise and precise, which made the success rate higher. Results On the basis of a certain surgical operation experience, we trained three times per week, every time three to five mouse. Due to inappropriate operation technique and unclear understanding of the anatomy, initially intubation success rate was very low. The location of intubation always was incorrect, intubation site bleeding aometimes happened, poor control of anesthesia led to the death of mice. With the accumulation of operating experience, intubation success rate rapidly improveed about four weeks later, even achieve 100% success rate. Different drugs need different injection speed. If we injection of saline only, there were no significant damage between injection speed 10 μl/min and 25 μl/min, the volume of 25 μl and 50 μl. If we injected nanoparticle+ small interfering RNA (siRNA, specific target gene siRNA), the injection speed of 25 μl/min can cause more damage than that of 10 μl/min.25 μl/min resulted in heavier tissue damage in female mice. Conclusion Retrograde intubation through the mouse Wharton’s Duct required some training to master. Familiar with the anatomy was the key. If the anatomical location was accurate, we could gradually training intubation techniques, force and the angle of the cannulation to continuously improve the success rate of this operation. Key words: Salivary glands; Submandibular gland; Gene therapy; Cannulation; Technology

Improvements and materials for production of a magnetic drive micropump: an overview and recommendations

Improvements and materials for production of a magnetic drive micropump: an overview and recommendations

Analysis of the effect of cluster management strategy in the hospital transhipment safety management of ICU patients

Objective To test the effect of the cluster management strategy in the hospital of ICU patients, in order to ensure the safety of the transhipment of the ICU patients. Methods From February 2016 to November 2017, 351 cases of ICU patients in a three class first class cancer hospital were selected as the subjects, including 182 cases in the control group from February 2016 to December 2016 and 169 cases in the experimental group from January 2017 to November 2017. The patients in the control group carried out conventional traditional transport management measures, and the patients in the experimental group were transported by cluster management strategy. The incidence of adverse events in the hospital transhipment was observed and compared. Results The test group received the cluster management strategy intervention ICU hospital transport of patients with adverse events (associated with disease, correlation, and transfer of personnel information, poor communication pipeline displacement, arteriovenous catheter prolapse, monitor lead loose, monitor micro pump power supply, and related equipment) rates were 15.38% (26/169), 9.47% (16/169), 3.55% (6/169), 2.96% (5/169), 2.37% (4/169), 2.37% (4/169), 2.96% (5/169), 5.92% (10/169), significantly lower than the control group were 29.12% (53/182), 26.92% (49/182), 10.44% (19/182), 7.69% (14/182), 7.14% (13/182), 7.69% (14/182), 11.54% (21/182), 20.33% (37/182), the difference was statistically significant (χ2=3.835-17.695, P<0.01 or 0.05). Conclusion Cluster management strategy can improve the safety of ICU patients in hospital transport, and suggest extensive clinical promotion. Key words: Intensive care units; Cluster management; Hospital transport; Safety care

Protective effects of esmolol on lung function in septic rat

Objective To explore the protective effects of short-acting β1 receptor blocker esmolol on lung injury in septic rats and explore its mechanism. Methods Fifty-four male Sprague-Dawley rats were randomly(random number) divided into three groups (n=18 in each), namely sham operation group(Sham), sepsis group(Spesis),esmolol group(ES).Each group were further divided into three subgroups of 6 h,12 h and 24 h(n=6 in each subgroup).The sepsis models were established with cecal ligation and puncture (CLP) in rats of Sepsis group and ES group, while rats of SH group were treated with laparotomy without CLP. Dwelled cannulation in the left internal jugular vein was performed after the model establishment. Saline in the rate of 1 mL/h was continuously pumped intravenously into the rats of SH group and Sepsis group by micro pump for 6 h, and esmolol solution in the rate of 1 mL/h [15 mg/(kg·h)] was continuously pumped into the rats of ES group for 6h.Rats in each subgroup were sacrificed at 6h,12h and 24 h after modeling, separately. The levels of catecholamine (CA) in plasma and levels of NF-κB in lung tissue were measured by ELISA. The protein levels of TLR4 and NF-κB in lung tissue were detected by Western Blot. The protein content of alveolar lavage fluid, wet/dry weight ratio(W/D) of lung tissue, lung coefficient and lung water content were measured. The pathological changes of lung tissues were observed under an optical microscope. Results ①The levels of CA in plasma in Sepsis and ES groups at 6 h after modeling was significantly increased compared with Sham group (P<0.05), and the level of CA in plasma increased significantly in ES group compared with Sham and Sepsis groups (P<0.05). At 12 h after modeling, level of CA in plasma was still significantly increased in ES group compared with SH group (P<0.05); At 24 h after modeling, level of CA in plasma was increased significantly in ES group compared with Sepsis group (P<0.05).②At 6 h,12 h and 24 h after modeling, levels of NF-κB in lung tissue were significantly increased in Sepsis group and ES group compared with SH group (P<0.05),and levels of NF-κB in lung tissue in ES group were also significantly lower than those in Sepsis group at given intervals (P<0.05).③ At 6 h,12 h and 24 h after modeling, protein content of alveolar lavage fluid, wet/dry weight ratio (W/D) in lung tissue, lung coefficient and lung water content in Sepsis group and ES group were significantly increased compared with SH group (P<0.05), and protein content of alveolar lavage fluid, wet/dry weight ratio (W/D) in lung tissue, lung coefficient and lung water content in ES group also significantly lower than those in Sepsis group at given intervals (P<0.05).④Western Blot revealed at 6 h,12 h and 24 h after modeling, the protein levels of TLR4 and NF-κB in lung tissue in Sepsis group and ES group were significantly increased compared with SH group (P<0.05),and the protein levels of TLR4 and NF-κB in lung tissue of ES group were also significantly lower than those in Sepsis group at all given intervals (P<0.05).⑤The lightest degree of pathological change was observed in SH group, the most serious degree of pathological change was found in Sepsis group, and the pathological change was significantly alleviated in ES group compared with Sepsis group whereas the pathological change was significantly increased compared with SH group at all given intervals. Conclusions Esmolol can promote the secretion of catecholamine,inhibit the release of inflammatory cytokines,reduce lung permeability,reduce pulmonary edema,and thus play an important role in protecting the lungs.The mechanism may be that esmolol improves the responsiveness of β-adrenergic receptor to catecholamine,and regulates the level of inflammatory cytokines by inhibiting TLR4—NF-κB—TNF-α signaling pathways,thus exerting protective effect on the lungs. Key words: Sepsis; Esmolol; Catecholamine; TNF-α; NF-κB; Toll-like receptors 4

Application of automatic and intelligent micro pump in changing vasoactive agents

Objective To explore the effects of automatic and intelligent micro pump in changing vasoactive agents. Methods This research selected 60 patients with a great number of vasoactive agents (dopamine or adrenalin hydrochloride) after cardiac surgery of Cardiovascular Surgery in Chinese PLA General Hospital from April to November 2016. Those patients were divided into experimental group (n=30, changing agents with the automatic and intelligent micro pump) and control group (n=30, changing agents with the traditional method of dual pump) . The fluctuation of blood pressure (BP) of patients between two groups was compared before and after changing agents. Results There was no significant difference in BP of both group patients before changing vasoactive agents (P>0.05) . The mean BP of patients in the control group was significantly higher than that in the experimental group 30 seconds after changing vasoactive agents (P=0.011) . The degree of fluctuation of BP of patients in the control group was greater than that in the experimental group 30 seconds and one minute after changing agents with a significant difference (P<0.05) . Conclusions The automatic and intelligent micro pump has a big advantage in maintaining a stable BP during changing agents by pump. It is worth to be used widely in clinical application. Key words: Intelligent micro pump; Automatic; Vasoactive agents; Application

Effect of capsaicin on cardiac dysfunction in diabetic rats: an in vitro experiment

Objective To evaluate the effect of capsaicin on cardiac dysfunction in diabetic rats using an in vitro experiment. Methods Healthy male Sprague-Dawley rats, weighing 240-260 g, in which type 1 diabetes mellitus was induced by intraperitoneal streptozotocin 50 mg/kg, were studied.Eighteen diabetic rats were selected at 8 weeks after successful establishment of the model and divided into 3 groups (n=6 each) using a random number table: diabetes mellitus group (DM group), capsaicin group (CAP group) and capsaicin plus capsazepine group (CPZ group). Another 8 rats with normal blood glucose served as control group (C group). Rat hearts were quickly removed under deep anesthesia and retrogradely perfused with an oxygen-saturated K-H solution (at 37 ℃) using a Langendorff apparatus.Cardiac function was maintained stable for 10 min.The hearts were continuously perfused with K-H solution for 30 min in C and DM groups.The hearts were perfused with K-H solution for 20 min, and capsaicin (1.4×10-9 g/L) was then infused for 10 min via the branch of aortic cannula using micro pump in CAP group.The hearts were perfused with K-H solution for 10 min, and capsaicin receptor-transient receptor potential vanilloid type 1 antagonist capsazepine (1.4×10-7 g/L) was then infused for 10 min followed by infusion of capsaicin (1.4×10-9 g/L) at 0.5 ml/min for 10 min via the branch of aortic cannula using a micro-pump in CPZ group.Left ventricular systolic pressure (LVSP), left ventricular developed pressure (LVDP), left ventricular end-diastolic pressure (LVEDP), heart rate, the maximum rate of increase or decrease in left ventricular pressure (±dp/dtmax) were recorded at 10, 20 and 30 min of continuous infusion (T1-3). Results There was no significant difference in LVEDP and ±dp/dtmax at each time point among the four groups (P>0.05). Compared with C group, LVSP and LVDP were significantly decreased at T1-3 in DM and CPZ groups and at T1-2 in CAP group, and heart rate was significantly decreased at T1-3 in DM, CPZ and CAP groups (P 0.05). LVSP and LVDP were significantly lower at T3 in CPZ group than in CAP group (P<0.05). Conclusion Capsaicin can mitigate cardiac dysfunction in diabetic rats, and the mechanism is related to activating transient receptor potential vanilloid type 1. Key words: Capsaicin; Diabetes mellitus; Heart function tests

Investigation on the related factors of central venous catheter congestion of ICU patients

Objective To explore the influencing factors of central venous catheter blockage for patients in ICU to provide evidence for reducing the risk of catheter clogging and improving nursing quality. Methods A self-designed central venous catheter questionnaire and central venous catheter assessment table were used to investigate the catheterization of 209 patients in ICU. Results There were 39 clogging cases among the 209 cases of patients, the plugging rate was 18.66%.The results of multi-factor analysis showed that the risk factors for central venous catheter blockage were the femoral vein catheterization and central venous pressure >13 mmHg.The attachment of the attached device was the protective factor. Conclusions Central venous catheter jam of ICU patients closely related to the catheter site, the indwelling time, the type of liquid seal tube, additional device categories, micropump pumping speed, patient age, central venous pressure, prothrombin time, platelet number, type of infusion and puncture times.Among them, the femoral vein catheter and central venous pressure >13 mmHg are the risk factors for central venous catheter blockage, and the positive pressure infusion connector is the protective factor. In order to reduce the risk of central venous catheter blockage, the related factors should be taken into account for the clinical work. Key words: Central venous catheter; Blocking; Related factors; Nursing

Antiplatelet regimen following stent-assisted embolization for intracranial aneurysms

Objective To investigate the efficacy and safety of one antiplatelet regimen following stent-assisted embolization for intracranial aneurysms. Methods Clinical data were analyzed retrospectively in 684 patients with intracranial aneurysms who underwent stent-assisted embolization from July 2014 to July 2016 at Wuhan General Hospital of the Chinese Liberation Army. Tirofiban hydrochloride was injected immediately after stent deploying and infused continuously by micro-pump for 24 hours. Dual antiplatelet therapy (aspirin 100 mg/d + clopidogrel 75 mg/d) started on the second day. Postoperatively, the platelet activation function was dynamically monitored by flow cytometry. The dose adjustment criteria of antiplatelet drugs were based on the platelet inhibition status (the positive rate of CD62P after adenosine diphosphate activation was below 20%) and specific postoperative conditions such as hemorrhage or ischemia for 486 cases (passive adjustment group) before June 2015, and those for 198 cases (active adjustment group) after June 2015 were only according to the platelet inhibition status regardless of hemorrhage or ischemia. Results Complications were reported in 67 out of 684 (9.8%) cases and included aneurysm rerupture (n=23, 3.4%), hydrocephalus requiring ventriculoperitoneal shunting (n=13, 1.9%), stent thrombosis (n=9, 1.3%), cerebral infarction (n=6, 0.9%), intracranial hemorrhage in remote areas (n=4, 0.6%), plaque shedding (n=2, 0.3%) cases, aneurysm recurrence (n=3, 0.4%) and death (n=26, 3.8%). The medication regimen was adjusted in a total of 221 (32.3%) patients including 147 (30.2%, 147/486) cases in the passive adjustment group and 74 (37.4%, 74/198) cases in the active adjustment group. There was significant difference in the complication rate of hemorrhage between passive and active adjustment groups (9.1% [44/486] vs. 3.5% [7/198], P<0.05). No significant difference was identified in the complication rate of ischemia between the two groups (0.2% [1/462] vs. 1.0% [2/196], P=0.19). Transient ischemic attack occurred in 3 (0.4%) cases during the process of dose reduction of clopidogrel which remitted following the dose increase. No case of resistance to antiplatelet therapy was found. Conclusion Antiplatelet therapy regimen guided by platelet activation assay could be useful for preventing thrombosis and hemorrhagic events following stent-assisted embolization for intracranial aneurysms. Key words: Intracranial aneurysm; Aneurysm, ruptured; Embolization, therapeutic; Stents; Platelet aggregation inhibitors; Coil

Effect of continuous pulse injection of urokinase on thrombosis of arteriovenous fistulas

Objective To investigate the curative effect and safety of continuous pulse injection of urokinase for the treatment of arteriovenous internal fistula thrombosis. Methods During the period from Jan. 2011 to Dec. 2014, 40 patients with arteriovenous internal fistula thrombosis were collected. They were randomly assigned to the improved group (continuous pulse urokinase injection) and control group (traditional urokinase application) according to the table of random digit. Thrombin time, prothrombin time, D-dimer, fibrinogen, hemoglobin, platelet, lipid and colored doppler ultrasonography of arteriovenous internal fistula before thrombolysis were recorded. All the patients used the 18 G venous indwelling needles. In the improved group, continuous pulse injection of urokinase (200 000 units) was performed. The same dose of urokinase were injected by micro-pump at the speed of 20 000 U/min in the control group. After that all the patients still received micro-pump injection of 300 000 units urokinase at the speed of 20 000 U/min, subcutaneous injection of low molecular heparin (4 000 U), intravenous injection of papaverine (30 mg), oral administration of aspirin (150 mg) for 3 days, respectively. We recorded the internal fistula recanalization, vital signs, bleeding, and the dose of urokinase every hour. The end points of our study were internal fistula recanalization, severe bleeding and pulmonary thromboembolism. The treatment could be repeated during the three days after admission. We compared the time and incidence of recanalization, dose of urokinase, incidence of bleeding and pulmonary thromboembolism between two groups. Results A total of 28 cases (93.33%) showed successful results in (30.33±27.23)hours an average, with (20 000±12 000)units urokinase in the improved group. Whereas, 22 cases (75.86%) showed successful results in an average of (50.15±22.18)hours, with (25 000±18 000)units urokinase in the control group. There was significant difference in the time and incidence of recanalization, dose of urokinase between two groups (P 0.05). Conclusions Compared to traditional urokinase application, continuous pulse urokinase injection achieves higher recanalization rate, shorter recanalization time, and less dose of urokinase. It does not increase the risk of bleeding as well. For the treatment of arteriovenous internal fistula thrombosis, continuous pulse urokinase injection is an effective and safe way, with great clinical value. Key words: Urinary plasminogen activator/TU; Injections, jet; Arteriovenous fistula/CO/DT; Thrombosis/CO/DT; Thrombolytic therapy

The efficacy of milrinone micropump in treatment of chronic heart failure and the influence to the level of amino-terminal B-type natriuretic peptide precursor in serum

Objective To investigate the efficacy of milrinone micropump in treatment of chronic heart failure(CHF), and the influence to the level of amino-terminal B-type natriuretic peptide precursor(NT-proBNP) in serum. Methods 120 cases with CHF were selected, they were randomly divided into the observation group and the control group according to a random number table.The patients of the control group were treated with standardized anti-conventional treatment of heart failure according to their heart function, the patients of the observation group were given milrinone micropump on the basis of the standardized anti-conventional treatment of heart failure.The efficacy of clinical conditions 1 week after treatment and NT-proBNP levels in serum before and after treatment were compared between two groups. Results The clinical efficacy of the observation group was 95.00%, which was higher than 76.67% of the control group, the difference was statistically significant(χ2=8.67, P<0.05). The serum level of NT-proBNP of the observation group was (38.9±9.2)ng/L, which was significantly lower than (86.3±32.4)ng/L of the control group, the difference was statistically significant(t=9.86, P<0.05). Conclusion Milrinone micro pump used in the treatment of CHF can significantly improve the clinical efficacy, and lower the serum level of NT-proBNP, improve heart function, it is safe and reliable and worth to application in the clinical. Key words: Heart failure; Milrinone; Natriuretic peptide, type B

Protection against myocardial ischemia -reperfusion injury in rats by a novel selective lymphotoxin binding p55TNFR

Objective To investigate the effect of a novel lymphotoxin with selectively binding to p55 tumor necrosis factor receptor (p55TNFR) on myocardial ischemia -reperfusion injury in rats in order to explore the mechanism. Methods A total of 40 SD rats were randomly (random number) assigned into four groups (n =10 in each) , namely sham operation group (group A), I/R group (group B), wild type rhLTα treatment group (group C), and p55TNFR selective rhLTα (rhLTα-Q107E) treatment group (group D). After I/R model rats were established, various therapeutic agents or saline were given by continuous intravenous infusion for 24 h via a micropump. After 24 hours of treatment, serum myocardial zymogram, such as aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatine kinase (CK), as well as superoxide dismutase (SOD), malondialdehyde (MDA) and glutathione peroxidase (GSH-Px) activities were determined. Myocardial infarction size (MIS) was measured by nitro blue tetrazolium chloride (NBT) staining. Results Compared to sham operation group, MIS, AST, LDH, CK, MDA were increased, while the activities of SOD and GSH-Px were decreased. However, all the effects were significantly reversed by treatment with rhLTα-Q107E (P 0.05). Conclusions The rhLTα-Q107E plays a role in the protection against myocardial ischemia -reperfusion injury in rats by the mechanism of scavenging oxygen free radicals and increasing the activity of endogenous antioxidant system. Key words: p55TNFR; Ischemia-reperfusion; Myocardial injury; Oxidative stress

Esmolol improves clinical outcome and tissue oxygen metabolism in patients with septic shock through controlling heart rate

To investigate whether esmolol could improve clinical outcome and tissue oxygen metabolism by controlling heart rate (HR) in patients with septic shock. A single-center double-blinded randomized controlled trial was conducted. The patients suffering from septic shock received 6-hour early goal directed herapy (EGDT) with pulmonary artery wedge pressure ≥ 12 mmHg (1 mmHg = 0.133 kPa) or central venous pressure CVP) ≥ 12 mmHg requiring norepinephrine to maintain mean arterial pressure (MAP) ≥ 65 mmHg and HR ≥ 95 bpm admitted to intensive care unit (ICU) of Guangdong General Hospital from September 2013 to September 2014 were enrolled. They were randomly divided into esmolol group and control group by computer-based random number generator. All patients received conventional basic treatment, while those in the esmolol group received in addition persistent esmolol infusion by micro pump with dosage of 0.05 mg · kg(-1) · min(-1) with the dosage adjusted to maintain HR lower than 100 bpm within 24 hours. The patients in control group did not receive drug intervention for HR. The primary end-points consisted of length of stay in ICU and 28-day mortality. The secondary end-points included hemodynamic parameters [HR, MAP, CVP, cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI)] and tissue oxygen metabolism parameters [central venous oxygen saturation (ScvO2), lactate level (Lac)] before and 24, 48, 72 hours after the treatment. A total of 48 patients with septic shock were enrolled with 24 patients in esmolol group and 24 in control group. (1) The primary end-points: compared with control group, the length of stay in the ICU in the esmolol group was significantly shortened (days: 13.75 ± 8.68 vs. 21.70 ± 6.06, t = 3.680, P = 0.001), and 28-day mortality was significantly lowered [25.0% (6/24) vs. 62.5% (15/24 ), χ2 = 6.857, P = 0.009]. (2) The secondary end-points: there were no significant difference in the hemodynamic and tissue metabolism parameters before treatment between two groups. No significant difference was found between before and after treatment of all above parameters in control group. HR and Lac in the esmolol group were obviously declined, SVI, SVRI, SCvO2 were gradually increased, but no significant difference in MAP, CVP, and CI was found. Compared with the control group, HR in the esomolol group was significantly lowered (bpm: 84.4 ± 3.5 vs. 111.2 ± 7.2, P < 0.01), SVRI and ScvO2 were significantly increased from 24 hours [SVRI (kPa · s · L(-1) ·m(-2)): 137.9 ± 1.6 vs. 126.9 ± 1.3, ScvO2: 0.652 ± 0.017 vs. 0.620 ± 0.017, both P < 0.01]; SVI was significantly increased (mL/m2: 39.9 ± 2.2 vs. 36.8 ± 1.7, P < 0.01) and Lac level significantly declined from 48 hours (mmol/L: 2.8 ± 0.3 vs. 3.4 ± 0.3, P < 0.01). The results demonstrate that HR controlled by a titrated esmolol infusion given to septic shock patients was associated with an improvement in tissue metabolism, reduction in the length of ICU stay and lowering of 28-day mortality.

Effect of dexmedetomidine combined with seven isoflurane for elderly patients with rectal cancer radical operation on recovery quality

Objective To investigate the effects of dexmedetomidine combined with sevoflurane on elderly patients with postoperative recovery quality. Methods Selected 60 cases of abdominal rectal cancer resection for elderly patients,which were ASA I or II,were randomly divided into two groups by a random number table method,while each groupincluded 30 cases:the control group(group N)and the dexmedetomidine group(group D).Before the induction of anesthesia,group D vein was injected with micro pump(more than 10 min) of dexmedetomidine 1μg/kg (which was formulated with physiological saline as 4μg/mL),and then was given to maintain the dexmedetomidine 0.5μg/h and N group was injected with micro pump of the same volume of normal saline.The two groups of anesthesia were same,by which the static inhalation of composite general anesthesia.Observation were recorded before induction of anesthesia(T0),given dexmedetomidine(TI),after intubation 1 min(T1),5 min(T2),drawing tube immediately(T3),extubation after 5min(T4),30min(T5)the time of HR,BP,Sp O2,BIS;propofol and remifentanil dosage,operative time,operation time,a nesthesia time,recovery time,drawing tube time,extubation after Ramsay Sedation score,pain score,patient satisfaction and adverse reactions were recorded. Results In T3 period,the changes of HR (82±14)times/min,SBP(130±8)mm Hg,DBP(85±13)mm Hg in group N were more obvious than(70±12) timse/min,SBP(121±7)mm Hg,DBP(79±9)mm Hg in group D,the difference between the two groups had statistical significance(t= 6.28,4.63,2.08,all P 0.05).In group N,postoperative restlessness in 8 cases,nausea and vomiting in 10 cases,chills in 9 cases,which were significantly higher than 2 cases,2 cases,2 cases in group D(χ2= 4.32,6.67,5.45,all P< 0.05).At the same time,the satisfaction score of patient in group D(3.0±0.3) point,which was significant higher than(2.7±0.5)points in group N(t= 1.88,P<0.05). Conclusion Dexmedetomidine detomidine composite sevoflurane anesthesia can improve the postoperative recovery quality of elderly patients with rectal cancer radical surgery. Key words: Rectal Carcinoma; Dexmedetomidine; Seven halothane; Aged

Analysis of object surface cleanness and relative factors in cardiac surgical ICU

Objective To assess the effect of existing cleaning methods applied in cardiac surgical intensive care unit, analyze potential danger and provide evidence to support clean processes in the future. Methods Each patient′s bed unit was defined as a sample and the frequency of hand-to-bed contact and the extent of patient-to-bed contact were assessed.Totals of 15 monitoring surface on each sheet were taken after sterilization within 24 hours and the Relative Light Units(RLU) of the monitoring surface values were compared with Adenosine Triphosphate (ATP) bioluminescence techniques. Results RLU values were more than 500 on bedside table surface, bed block, ECG buttons, micro pump surface, pressurized infusion ball surface and crank bed. RLU values were between 250 and 500 on nurses′ small table surface, breathing machine buttons, rulers and stethoscope surface. RLU values were less than 250 on treatment plate, footboard, pump lines and vacuum tube surface. Conclusions Hand hygiene plays a significant role in daily life. It is important to strengthen routine hand hygiene publicity and education, and monitoring and supervision can be used as an effective measure to improve the surface cleanliness of objects. Key words: ICU; Adenosine triphosphate bioluminescence techniques; Cleanliness

Analysis of the effects of high-dose amiodarone on cardioversion of paroxysmal atrial fibrillation in 109 patients

Objective To observe the efficacy and safety of high-dose amiodarone administered by continuously intravenous infusion for cardioversion of paroxysmal atrial fibrillation.Methods From 2008 to 2010,109 patients suffered from paroxysmal atrial fibrillation were treated with high-dose arniodarone (125 mg/h) administered by continuously intravenous infusion.Before cardioversion,patients were treated with low molecular weight heparin anticoagulant therapy,Laboratory tests on FT3,FT4,TSH,serum ions,etc,and coloured Doppler ultrasound imaging of heart,and ECG and blood pressure monitoring were carried out.Amiodarone hydrochloride injectio of 150 mg was mixed with sodium chloride 50 mL homogeneously,and then infused continuously by micro-pump in a rate of 41 mL/h until resume of sinus rhythm or infusion was kept up to 24 h.After successful cardioversion,as appropriate,the intravenous amiodarone was maintained in a rate of 0.5-1.0 mg/min for 6-12 h joined with oral amiodarone dosing,and the total dose was limited up to 3000 mg.Results A cohort of 104 (95.4％) patients had the restoration of sinus rhythm after cardioversion.The mean dose of amiodarone for cardioversion was (774.52 t 700.53) mg,and time required for cardioversion was (6.3 ± 5.55) hours.Conclusions The patients with paroxysmal atrial fibrillation are given high-dose amiodarone (125 mg/h) continuously intravenous infusion therapy and have high cardioversion success rate,less complications and side effects,as well as other advantages at the basic hospital.The method above has broad application prospects. Key words: Amiodarone; High-dose; Continuously intravenous infusion; Paroxysmal atrial fibrillation ; Cardioversion

Micro-pump with no moving parts

Micro-pump with no moving parts