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Sepsis is the systemic inflammatory response to infection, and premonition of multiple organ dysfunction syndrome. It was a common complication of critical patient, and its mortality was high. Lung always was attacked in sepsis, and acute lung injury / acute respiratory distress syndrome (ALI/ARDS) usually emerged first. The incidence was also high. Endotoxin-induced lung injury was the main reason, and the fatality was high. Thus, it is important to study its change of mechanism and pathophysiology, and to discover new way of treating ALI, in order to decreasing the mortality of critical ill patients.Tetramethylpyrazine (TMP) was chose in clinical treatment as a Chinese traditional medicine usually. TMP had many functions, such as adjusting inflammatory reaction, decreasing oxygen-derived free radicals level, improving microcirculation, and resisting blood coagulation. This study investigated the effects of TMP on endotoxin-induced ALI in rats, and observed the changes of lung permeability index (LPI), extravascular lung water (EVLW), tumor necrosis factor-α(TNF-α), malondialdehyde (MDA) and pathology of lung. The mechanism of endotoxin-induced lung injury and the protective effect of TMP were discussed.ObjectiveTo study the effects of TMP on endotoxin-induced ALI in rats, the changes of LPI, EVLW, TNF-α, MDA and microstructure of lung were observed. And the mechanism of endotoxin induced lung injury was discussed.Methods48 SD rats were randomly divided into control group, ALI group, pretreatment group (TMP 60mg/kg, intravenous injection, once a day for one week, before the LPS was injected), treatment group (TMP 60mg/kg, intravenous injection, at 30 min after the LPS was injected). The LPI, EVLW, serum TNF-αand MDA were determined. And pathological change of lung was observed.Results1.LPS(5mg/kg) was injected through caudal vein of rats. After 0.5h, the rats’heart rate and breath rate were increased gradually, and PaO2 was decreased rapidly, and the oxygenation index was lower than 300, the model of endotoxin-induced ALI was established.2.After the endotoxin-induced ALI model was established, we found that LPI and EVLW were increased obviously, and the level of serum TNF-αand MDA was increased.3.TMP decreased the concentration of serum TNF-αand MDA significantly, depressed produce of LPI, EVLW, and improved the change of pathology in endotoxin-induced ALI rats.Conclusions1.The animal model of endotoxin-induced ALI was made successfully after 0.5h, when LPS (5mg/kg) was injected into SD rats through caudal vein.2.Endotoxin-induced lung injury was induced by complicated mechanism, such as oxygen-derived free radicals injury, excessive and uncontrolled inflammatory response, and so on. It could induce the disruption of the alveolar–capillary membrane barrier, lead to pulmonary edema, a proteinaceous exudate flooded into the alveolar spaces. They impaired gas exchange, and precipitated respiratory failure.3.TMP could reduce level of serum TNF-αand MDA, depress LPI and EVLW, improve the pathological changes of lung. TMP protected the lung from endotoxin-induced ALI. In fact, lots of the evidences certified that the effectiveness of nutritional support considerably in the last 30 years, and it was a part of therapy in each clinic department in our country. But there were still many complicated theories and clinical problems need to be tackled, such as the nutritional support in hypercatabolism coursed by sepsis, severity trauma, MODS and so on. As we know, undernutrition was an independent risk factor for hypermetabolism, increased patients’hospitalization time, delayed recovery, lower quality of life as well as higher hospital costs and higher mortality. Nutritional support had been proved to be beneficial, with significant positive effects on complications, and to enhance immune function, improve the outcome. Most of patients in ICU are elderly patients. They had lower basal metabolic rate, organ function decreased and metabolic disorder. So, how to give appropriate nutrition support to elderly critical patients is a difficult problem. This study analyzed the nutrition status with nutritional risk screening and investigated the relationship between the nutrition support and prognosis of 85 elderly critical patients in general ICU retrospectively. ObjectiveTo evaluate the current nutritional status and nutrition support of elderly critical patients in ICU, and analyze the changes of nutritional correlated index and outcome after nutrition support.MethodDate of 85 cases in ICU (from Aug.2005 to Aug.2006) were collected. They were more than 60 years old. 85 cases were divided into survival group and death group according to the prognosis. To analyze the nutritional status when they admitted in ICU and investigate the relationship between the nutrition support and prognosis retrospectively.Result1.The Nutritional risk screening 2002 score was 3 to 6 (4.6±0.9), there was no difference between survival group and death group. The body mass index (BMI) of patients in survival group was higher than that in death group(P<0.05),2.The APACHEⅡscore of death group was higher than that of survival group, and time of stay in ICU was longer.3.Hemoglobin and serum albumin in survival group were higher than that in death group in first day admited to ICU (P<0.05). In the tenth day, the support of parenteral nutrition and nonprotein-calorie/nitrogen in survival group was less than those in death group (P<0.05), but serum albumin in survival group was higher (P<0.01).Conclusion1.Many elderly critical patients were in malnutrition by nutritional risk screening, all of them needed nutrition support.2.The more patient’s condition was serious, the poorer nutrition was, the longer time they stayed in ICU, the higher mortality rate was.3.The effective nutrition support should be given to elderly critical patients and the essential energy should be supplied, that may be help to improve the prognosis of elderly critical patients.
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