Objective To compare the efficacy of combined electroacupuncture and metoclopramide treatment with that of metoclopramide only in improving gastric emptying in critically ill neurosurgical patients. Methods In this prospective case-control pilot study, a total of 16 adult critically ill mechanically ventilated patients who were treated in the surgical intensive care unit were enrolled. Electrical stimulation was applied to 4 pairs of points (maximum intensity < 9.8 mA at 2 Hz). Patients in the control group received standard treatment with intravenous metoclopramide only. Patients in the experimental group received intravenous metoclopramide plus electroacupuncture treatment once daily for 6 consecutive days. Results Gastric residual volume in the experimental group (n = 7) reduced gradually until the fourth day after treatment with electroacupuncture combined with routine metoclopramide administration. Beginning on the fourth day, residual volume was maintained at less than 200 ml per day for the following two days. In the control group (n = 9), there was a gradual reduction in residual volume during the first four days followed by a rebounding increase over the next two days. Conclusions Electroacupuncture combined with intravenous metoclopramide is a more effective treatment for gastric emptying than metoclopramide alone in adult critically ill patients with impaired brain function.
Hypoxaemia occurring in patients with chronic renal failure (CRF) during haemodialysis (HD) has long been known. Several mechanisms of pathogenesis have been proposed. Before and after regular HD, lung ventilation (LV) and alveolar permeability (AP) were measured in 24 male patients with CRF (age, 61-75 years). LV and AP were determined by 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) radioaerosol inhalation lung scan (99mTc-DTPA lung scan). The LV images were visually interpreted according to established criteria, including the presence or absence of an inhomogeneous distribution, inverted base to apex gradient and segmental hypoventilation. The degree of AP in the total right lung was presented as the clearance rate (K; %.min-1) of the time-activity curve from dynamic total right lung images. Ten male normal controls (age, 62-76 years) were enrolled in the study for comparison. Ten of 24 (42%) cases showed an inhomogeneous distribution and eight of 24 (33%) cases showed hypoventilation on equilibrium LV images. After regular HD for 5 h, no significant changes in the LV images were found. Before HD, the CRF patient group (K=1.14+/-0.36%.min-1) had a significantly faster clearance rate than that of normal controls (0.75+/-0.14%.min-1, P<0.05). Moreover, the clearance rate after HD was significantly slower (0.87+/-0.15%.min-1, P<0.05) than that before HD. CRF can predispose patients to LV change and AP damage. After HD, the damage to AP is significantly improved. However, after HD, the change in LV is not significant.
Prolonged cold ischemia time is associated with postoperative intra-abdominal coagulopathic hemorrhage in patients after LDLT. It is, therefore, necessary to shorten the cold ischemia time in order to reduce the risk of postoperative intra-abdominal hemorrhage due to coagulopathic causes.
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