| Trauma and severe trauma is still the main cause of death and permanent disability to young man,which is a worldwide health problem. Improve the measures before the emergency and hospitalization treatment can reduce the morbidity and mortality, severe trauma is characteristic with surgical intervention and ICU treatment. ICU is a place to optimize and improve the prognosis of patients with severe trauma, provided the advanced technology and professional staff in continuous support therapy. However, no matter how advanced technology in ICU and intervention measures, most of trauma patients still died in ICU. Sepsis is the leading cause of death in the ICU patients, Although the study of sepsis has been underway for decades, but the mortality rate is still as high as 18-50%[1]. In the United States each year more than 250000 patients died of sepsis. As the aggravate age, immune defect causes aging, the incidence of sepsis is rising year by year. To explore the high risk factors of the ICU patients death is imminent, in an article on the study of intensive care patients the cause of death, the independent risk factors of death in patients are circulatory failure, respiratory failure, central nervous system failure[2]. In the analysis of the risk factors for the prognosis of patients with sepsis, according to another article, age, APACHE ?score high, urea nitrogen, serum creatinine high and elevated c-reactive protein in patients with sepsis was an independent predictor of poor prognosis[3]. Different ICU calculated the risk factors of death is not the same, we urgently want to analyze the cause of death and risk factors of surgical ICU, for later will provide a scientific basis for improve the quality of medical and rescue success rate, and can reduce the case fatality rate[2].Through the literature, We know sepsis is the leading cause of death in the ICU patients, even if the treatment of sepsis in most clinical trials is failed,As the treasure of traditional Chinese medicine, administration of electroacupuncture(EA) in diseases such as pain relief, sepsis, neuroprotection gradually be taken seriously. The high mobility protein B1(HMGB – 1), is a kind of inflammatory cytokines which is able to start and maintain cascade amplification effects. In rats stroke model, alpha 7 nachr expression decreased, and electric acupuncture preconditioning can reduce the decline of alpha 7 nachr, electric acupuncture preconditioning can reduce inflammation to improve the ischemia-reperfusion injury in rats by the activation of alpha 7 acetylcholine receptors of cholinergic pathway, give play to the role of brain protection, electric acupuncture can reduce cerebral infarction volume, improve neurologic outcome, inhibition of neural cell apoptosis[4].Therefore, the main purpose of this paper is to analyze the surgical ICU death cause of patients during hospitalization and death risk factors, and through the relevant basic research to explore the curative whether can through the cholinergic anti-inflammatory pathway cytokine secretion in the rat model of sepsis, reduce mortality ICU patients for clinical provide a theoretical basis.Part 1 Death causes of patients in the surgical intensive care unit(ICU)Objective To summarize the death causes in the surgical intensive care unit(ICU).Methods The relevant information for death cases in the surgical ICU of Xijing Hospital of Fourth Military Medical University in past 15 years, from December 1999 to February 2015, were retrospectively analyzed. The gender, age, reason and date hospitalization, date of ICU transport, past medical history, whether admitted to hospital in emergency or not, department transferred from, whether operated or not, date of death, the main cause of death, acute physiology and chronic health evaluation ?(APACHE?) score, whether received mechanical ventilation, whether received continuous renal replacement therapy( CRRT) or antifungal therapy, as well as the proportion of the patients with body temperature above 39 ?, white blood cell( WBC) above 10×109/L, platelet( PLT) below 100×109/L, albumin( Alb) below 35 g/L between two periods, from December 1999 to July 2007( the first period), and from August 2007 to February 2015( the second period).Results From December 1999 to February 2015, 4317 patients were treated in the ICU. Among them, the number of death cases was 186 and the mortality was 4.3%. In the first time period, from December 1999 to July 2007, the number of total patients was 1356 and death cases were 109(the mortality rate was 8.0%). In the second period, from August 2007 to February 2015, the number of ICU patients was 2961 and 77 were dead(the mortality rate was 2.6%). The difference of mortality was significant statistically between the two time intervals(?2 = 66.707, P = 0.001). Compared with death rate of patients transferred from emergency department in the first period(9.8%, 87/1356), the rate was lower in the second period(51.9%, 40/2961, ?2 = 16.181, P = 0.001). The death rate of the patients with Alb below 35 g/L in the second period(59.7%, 46/2961) was higher than that in the first period(41.3%, 45/1356, ?2 = 6.151, P = 0.017). The top three causes of death from December 1999 to July 2007 were sepsis(35.8%), trauma(22.0%) and cancer operation(13.8%). From August 2007 to February 2015, the top three causes of death were sepsis(41.6%), damage of the central nervous system(16.9%) and cancer operation(14.3%). Top three reasons for ICU admission were trauma(29.03%), abdominal pain(20.97%) and others(18.82%). Top three departments the patients transferred from were the emergency department(19.35%), orthopedics department(17.20%) and hepatobiliary department(16.13%).Conclusion Sepsis and severe trauma are the leading causes of death in severe ICU patients.Part 2 Risk factors in the surgical intensive care unitObjective To analyze the risk factors for patients in the surgical intensive care unit(ICU).Method The relevant information for death cases in the surgical ICU of Xijing Hospital of Fourth Military Medical University in past 15 years, from December 1999 to February 2015, was retrospectively analyzed. The gender, age, acute physiology and chronic health evaluation ?(APACHE?) score, whether received mechanical ventilation, whether received continuous renal replacement therapy( CRRT), as well as the proportion of the patients with body temperature above 39 ?, white blood cell( WBC) above 10×109/L, platelet( PLT) below 100×109/L, albumin( Alb) below 35 g/L,Statistics the related clinical data of 201 alive patients in order to analysis risk factor.. The difference between the death and survival groups was compared.Result Logistic regression analysis showed that age(OR=2.025,95%CI 1.500~2.734,P=0.000), mechanical ventilation(OR=3.514,95%CI 1.701~7.259,P=0.001), CRRT(OR=5.604,95%CI 3.003~10.459,P=0.000), body temperature above 39 ?(OR=1.992,95%CI 1.052~3.771,P=0.034) were risk factors for ICU mortality.Conclusion Age and mechanical ventilation and body temperature above 39 and CRRT ?are risk factors, patients with risk factors for high mortality should be paid enough attention.Part 3 Electroacupuncture pretreatment to improve sepsis in the rat inflammatory responseObjective Sepsis, as one of the leading causes of death in hospitalized patients in the ICU, we explored the best electroacupuncture pretreatment will point can activate the cholinergic anti-inflammatory pathway reduce the inflammatory cytokines secretion of sepsis in rats.Method Experiment 1: 20 normal SD rats were randomized, divided into the CLP group and the blank group, the experimental repeat 3 times. Detect rats 7 days survival rate.Experiment 2: rats were randomly divided into 7 groups: take blood to TNF alpha ELISA test.Experiment 3: the SD rats were divided into two groups: EA+CLP group and CLP group.Result Experiment 1: CLP group two died of sepsis the first postoperative day, two died on the second day, the seventh day of postoperative death 1, only 7 days survival rate is 50%; Control group no cecum ligation and puncture 10 SD rats, after 7 days, did not die, 7 days survival rate was 100%.Experiment 2: 12 hours after CLP cytokine secretion of TNF alpha reach peak, postoperative 24 hours until 72 hours the cytokine TNF alpha has maintained at a high level.Experiment 3: Control group and the EA group of western results can be seen that the EA group HMGB-1 was obviously lower than the control group. Immunofluorescence results the EA group of immunofluorescence labeling alpha 7-n Ach R expression is significantly higher than the control group.ConclusionElectroacupuncture pretreatment can activate the cholinergic anti-inflammatory pathway to inhibit inflammatory cytokines secretion.SummarySepsis, severe trauma is the leading cause of death in surgical ICU patients. death risk factors including age, mechanical ventilation treatment after respiratory failure, CRRT treatment after acute kidney injury,as well as the temperature >39 ?.patients merger risk factors should be given enough attention. As sepsis as the main death reason of the ICU patients, improve an inflammatory response in patients with sepsis is the basis our research target, through the literature including we know as the treasure of Chinese traditional medicine, is of great help to the treatment of diseases, We produced by CLP sepsis model, and through the three groups of experimental verification 7 days survival, confirmed the CLP model success; By the ELISA method for different time group rats blood testing, explore the secretion of cytokines TNF alpha phase; Electric acupuncture preconditioning normal SD rats will hole for five days, including western results confirm pretreatment can reduce HMGB-1 expression in pulmonary macrophages, immunofluorescence results show that the electric acupuncture pretreatment by alpha 7-n Ach R pathway to improve sepsis inflammation. Confirm electric acupuncture preconditioning in rats can activate the cholinergic anti-inflammatory pathway to improve inflammatory factor and treatment of sepsis. |
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