Volume 96  ·  Issue 21  ·  2016

Idiopathic normal pressure hydrocephalus (iNPH), as a group of idiopathic clinical syndromes without obvious triggers, is characterized by the triad of gait disturbance, cognitive impairment and urinary incontinence. In 1965, Hakim and Adams first proposed the concept of normal intracranial pressure hydrocephalus (NPH) syndrome. Its clinical manifestations are not only triad, but also ventricular enlargement and normal cerebrospinal fluid pressure by lumbar puncture^[1]。 In recent years, more and more neuroscientists at home and abroad have paid attention to and studied this disease. Many hospitals in China are also carrying out surgical treatment of iNPH. But there are still many problems to be faced together.

Severe neurosurgical patients often have different degrees of consciousness disorders, and most of them are accompanied by respiratory dysfunction, spontaneous cough, poor sputum discharge function, poor discharge of secretions in the airway, easy to complicate lung infection, affecting ventilation and ventilation function, and in severe cases, leading to hypoxemia, which will aggravate the function damage of the brain and vital organs in the whole body, seriously affect the prognosis of patients, and even become a fatal factor. Therefore, the Neurosurgery Branch of Chinese Medical Association and the China Neurosurgery Critical Care Management Collaborative Group organized and wrote the Expert Consensus on Airway Management of Critical Neurosurgery Patients in China (2016).

Normal pressure hydrocephalus (NPH) refers to the triad of gait disturbance, cognitive impairment and urinary incontinence as clinical manifestations. The patient's condition shows progressive development to varying degrees, with ventricular enlargement on imaging examination and cerebrospinal fluid pressure measured at 70-200 mmH₂O (1 mmH₂O =0.009 8 kPa) A group of clinical syndromes of.

Airway management is an important part of basic treatment for all critically ill patients, and improper airway management will directly threaten patients' lives. Severe neurosurgical patients often have airway obstruction due to central and non-central reasons, resulting in hypoxia, aggravating the condition and even life-threatening. Based on the understanding of the importance of airway management in critically ill patients, in order to improve the level of airway management in critically ill patients and ensure patient safety, the following expert consensus has been reached on the basis of reviewing a large number of literatures.

Severe neurosurgical patients (such as severe craniocerebral trauma, brain tumor, severe cerebrovascular disease, intracranial inflammatory lesions, etc.) often have metabolic disorders such as consciousness and swallowing dysfunction, acute stress reaction, hormone secretion and visceral function imbalance, resulting in malnutrition and immune function decline, which in turn increases the risk of infection, organ dysfunction and death, and affects clinical outcome. Severe neurosurgical patients, in addition to the metabolic characteristics of other severe patients, also have the following particularities^[1,2]: (1) Most of them are accompanied by different degrees of consciousness disorder, dysphagia and motor dysfunction: (2) High metabolism and higher nutritional demand; (3) Spontaneous respiratory disorder will prolong the time of mechanical ventilation; (4) There are mostly endocrine dysfunction; (5) some stress gastrointestinal dysfunction; (6) there are special nutrient requirements associated with nerve damage repair; (7) Most of them are complicated with basic diseases such as diabetes and hyperlipidemia. All of the above can lead to a high risk of malnutrition and an adverse clinical outcome.

To investigate some important issues for diagnosis and treatment of idiopathic normal-pressure hydrocephalus (iNPH), such as standardized pre-operative assessment, initial pressure value of diverter pump, and pressure regulation during follow-up.

Twenty six iNPH patients (21 males) who treated in Department of Neurosurgery of 2nd Affiliated Hospital of Zhejiang University School of Medicine from 2011 to 2015 were analyzed retrospectively. The average age was 60.5 year. The analysis focused on the treatment process of iNPH, initial pressure value of diverter pump, choice of diverter pump, and pressure regulation during follow-up.

As a result, 24 cases (92.3%) had a good prognosis based on their imaging and clinical manifestations. Based on the literature and their clinical experiences, this department established a diagnosis and treatment procedure of iNPH and a pressure regulation procedure for the follow-up of iNPH. Moreover, it is proposed that choosing an anti-gravity diverter pump and making an initial pressure value 20 mmH₂O less than pre-surgical cerebrospinal pressure may be beneficial for the prognosis.

This standardized diagnosis and treatment procedure for iNPH is practical and effective.

To study the perioperative management and surgical treatment of patients with neurosurgical critical diseases and thrombocytopenia.

Eleven patients with the diagnosis of neurosurgical critical diseases and thrombocytopenia who received surgical treatment in Department of Neurosurgery, Peking Union Medical College Hospital from 2010 to 2015 were reviewed retrospectively. All eleven patients received platelet transfusions preoperatively. The safety and efficacy of surgical treatment were analyzed by GOS score at 6 months after operations.

Platelet counts of six patients who received minimally invasive surgery reached 80×10⁹ /L by platelet transfusions preoperatively. Platelet counts of five patients who received Craniotomy and ventriculoperitoneal shunt reached 100×10⁹ /L by platelet transfusions preoperatively. Eight patients received platelet transfusions postoperatively according to a low platelet count 24 hours after operations. Two patients died after surgery and one died after discharge. All other eight survival patients got well recovery with an average GOS score of 4.5 at six months after operations.

Patients with neurosurgical critical diseases and thrombocytopenia could receive surgical treatment in collaboration with relative departments.

To analyze the association of blood glucose variability and short-term outcome in critically ill.

The retrospective study including 552 patients admitted to the Affiliated Hospital of Inner Mongolia Medical University from January 2013 to March 2015. The initial blood glucose (GluAdm), the first 24 hours average blood glucose(GluMV1d) and glycemic lability index(GLI1d), 72-hour average blood glucose (GluMV3d) and glycemic lability index(GLI3d) were recorded. The receiver operating characteristic curve (ROC curve) was applied to evaluate the association between GluAdm, GLI1d, GLI3d and APACHE Ⅱ score and prognosis.

The levels of APACHE Ⅱ, GluAdm, GLI 1d, GLI 3d of nonsurvivors were higher than those of survivors[(23.2±5.2) vs (16.7±4.4), (12.3±5.2)mmol/L vs(9.2±2.2)mmol/L, (23.3±12.2)vs(12.3±11.1), (21.6±19.3)vs(13.2±9.9), P<0.05]; there was no statistically significant difference between GluMV1d and GluMV3d; when ROC was applied, and the area under the curve (AUC) of APACHEⅡ, GLI1d and GLI3d were 0.826±0.035, 0.726±0.052 and 0.786±0.046, which were significantly higher than the GluMV1d and GluMV3d (0.412±0.031, 0.425±0.026,P<0.05) .It is correlated between GluAdm, GLI1d, GLI3d and the 28-day mortality, ICU days and total time of hospitalization.

Blood glucose variability is closely related with the mortality in critical ill patients, GLI1d, GLI3d and APACHEⅡ score of critically ill patients have a similar predictive value in the short-term prognosis.

To investigate the presence of upper motor neuron dysfunction in patients with Charcot-Marie-Tooth disease (CMT) by triple stimulation technique (TST) to provide evidence for gene diagnosis.

A total of 65 CMT patients confirmed by genetic testing from Peking University Third Hospital between August 2013 and August 2015, underwent physical examination and routine electrophysiological tests and triple stimulation technique. The TST combined transcranial magnetic stimulation (TMS) of the motor cortex with peripheral collision studies. The results were expressed by the TST amplitude ratio (TST test/ TST control). Based on the result of physical examination and the ratio of TST, the function of upper motor neuron was assessed.

All of the CMT patients had typical presentations and were confirmed genetically. Hyperreflexia, Babinski sign and muscular hypertonia were discovered in lower limbs in 7 CMT patients, while 2 patients complicated with hyperreflexia and Hoffmann sign in upper limbs. TST amplitude ratio was significantly altered in 10 patients, including 5 patients with pyramid sign: hyperreflexia, Babinski sign and muscular hypertonia was discovered in lower limbs while 2 patients complicated with hyperreflexia and Hoffmann sign in upper limbs. The disease-causing mutations were: MFN2 mutations in 5 patients, 1 patient with BSCL2 mutation, 3 patients with GJB1 mutations and 1 patient with GDAP mutation. In summary, 18.5% (12 patients) of the 65 CMT patients had upper motor neuron dysfunction based on the result of physical examination and the ratio of TST.

Upper motor neuron dysfunction may be found in CMT patients, which may provide clues for the testing of disease-causing mutations.

To compare the characteristics of naming impairment in Parkinson's disease (PD) without dementia, Parkinson's disease dementia (PDD) and Alzheimer's disease (AD).

All participants came from outpatient clinic or inpatients of our hospital during 2011-2013. Object and action naming tests were evaluated among patients with PD without dementia (n=60), PDD (n=60), AD (n=60) and healthy control group (n=60).

The object naming score of PD without dementia group was 40.2±2.8, PDD group was 36.0±3.1, AD group was 31.6±4.0 and healthy control group was 44.1±2.2, while the action naming score of PD without dementia group was 27.3±2.6, PDD group was 20.5±4.0, AD group was 22.5±2.7 and healthy control group was 31.6±1.4. The object and action naming were both impaired in PD without dementia, PDD and AD patients compared with healthy control group (P<0.01).

PD patients without dementia have slight object and action naming impairments with more impairments in action naming. Action naming is more impaired in PDD patients, while object naming is more impaired in AD patients.

To evaluate the efficacy of pulsatile gonadotropin-releasing hormone (GnRH) therapy in male patients with pituitary stalk interruption syndrome (PSIS).

Fourteen male PSIS patients, who had received subcutaneous pulsatile GnRH therapy for at least four weeks at Peking Union Medical College Hospital from April 2014 to September 2015, were included in the study. Serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone level, testicular volume and sperm in ejaculation were measured. After treatment for four weeks, subjects with serum LH≥1.24 U/L were classified as"good response group", and others were classified as"poor response group".

All patients were born by breech delivery and presented with absent pubertal development. Laboratory findings showed combined pituitary hormone deficiency in all patients. Pituitary stalk interruption syndrome was diagnosed based on MRI findings. Totally 11 out of 14 patients showed good response to pulsatile GnRH therapy. Their LH level increased from 0.32 (0.15, 0.61) U/L to 4.34(2.52, 7.39)U/L(P<0.001), FSH from 0.84 (0.30, 1.50) U/L to 7.12 (4.53, 10.09) U/L(P<0.001); serum testosterone level from 0 (0, 0.45) nmol/L to 2.46 (0.56, 11.45) nmol/L (P=0.004) and testicular volume from 2.0 (2.0, 4.0) ml to 4.0 (3.0, 6.0) ml (P=0.005). Sperm was detected in seminal samples after treatment for 8 weeks in two patients and for 12 weeks in one patients. Three out of 14 patients showed poor response to pulsatile GnRH therapy.

Pulsatile GnRH therapy can effectively establish the pituitary-testicular axis function for most patients with pituitary stalk interruption syndrome, indicating enough reserve of gonadotrophs in the pituitary.

To compare the efficacy between unilateral laminectomy approach bilateral decompression and traditional total laminectomy decompression in the treatment of graft bone fusion and internal fixation for degenerative lumbar spinal stenosis with the unilateral symptoms.

From January 2013 to December 2014, a total of 40 patients with unilateral symptoms of lumbar spinal stenosis were treated in Department of Spinal Surgery Bozhou People's Hospital of Anhui Province. Twenty patients(group A ) were treated by severe symptoms unilateral facetectomy and resection of superior articular and laminectomy and lateral recess decompression, interbody fusion, pedicle screw fixation.Twenty patients(group B ) were treated by total laminectomy interbody fusion and pedicle screw fixation.The time of operation, blood loss of the two groups were recorded.At the same time the visual analog scale (VAS), Oswestry disability index(ODI), Japanese Orthopaedic Association Scores(JOA) before and after operation (3, 6 , 12months) were recorded retrospectively. The effect of surgery were evaluated and compared.

The VAS, JOA, and ODI of group A preoperation is respectively have no significant differences with the group B (P>0.05). The operation time, blood loss in operation of group A was respectively(133.2±25.3) min, (415.0±42.1) ml, significant differences with the group B[(491.0±46.3)ml; (156.2±28.5) min,P<0.05)]. The VAS, JOA, ODI of group A had no significant differences with the group B (P>0.05) at 3, 6 months after operation.The VAS, JOA, ODI of group A was respectively (3.0±0.6), (25.3±5.1), (16.5±1.5)scores, had significant differences with the group B and preoperation (P<0.05) at 12 months after operation. The radiographic data showed that the interbody fusion rate of group A was 100%, and group B was 95%, had significant differences by statistical analysis (P<0.05) at 12 months afer operation.

The improved unilateral laminectomy approach and bilateral decompression have less operation time and blood loss, more satisfactory for the lumbar spinal stenosis patients with the unilateral severe symptoms, the other side moderate stenosis and mild symptoms.The efficacy of lumbar stability and bilateral decompression is better by operation of improved unilateral approach.

To explore the MRI characteristics of injuries of triangular fibrocartilage complex (TFCC), and provide imaging basis for the early diagnosis and treatment of the injuries.

A total of 10 healthy volunteers without wrist injuries and 200 patients from Beijing Jishuitan Hospital who complained ulnar-sided wrist pain and were highly suspected as the injury of TFCC underwent the wrist magnetic resonance examination. All subjects were in a prone position and underwent examination on coronal T₁WI scan and PD-FS on 3 planes respectively. Then the MRI characteristics of 3 healthy volunteers and 67 patients with TFCC injuries that confirmed by operation were analyzed. According to the comparative analysis of normal anatomy and Palmer classification, the injuries were classified and MRI features of different types of injuries were analyzed. At last, imaging findings were compared with surgical results.

Three healthy volunteers without injuries showed mainly in low signal intensity on T₁WI and PD-FS images. According to Palmer classification, there were 52 traumatic injuries (ⅠA 9, ⅠB 25, ⅠC 3, ⅠD 13, In addition, 1 has central perforation and ulnar avulsion and 1 has ulnar and radial injuries simultaneously) and 15 degenerative injuries (ⅡA 5, ⅡB 1, ⅡC 2 , ⅡD 1 , ⅡE 6) among 67 patients. The central perforation mainly demonstrated as linear high signal perpendicular to the disk, and run in a sagittal line. The ulnar, distal, and radial avulsion mainly showed the injuries were irregular, the structures were ambiguous, and there was high signal intensity in the injured structures on PD-FS. Degenerative injuries demonstrated the irregularity of TFC and heterogeneous signals on PD-FS. There were mixed intermediate-high signals and changes in the articular cartilage of lunate and ulna, high signal in the lunotriquetral ligament and ulnocarpal or radioulnar arthritis.

MRI can demonstrate the anatomy of TFCC accurately, evaluate and make the general classification of injuries. It is of significance for the early diagnosis and treatment protocols of the TFCC injuries.

To explore the correlation between susceptibility weighted imaging (SWI) manifestation and serum cystatin C level for delayed graft function (DGF).

The conventional MRI, SWI and serum cystatin C of 27 cases with DGF in nephrotransplantation center in Third Affiliated Hospital of Suzhou University from September 2014 and August 2015 were retrospectively analyzed.By contrasting conventional MRI images of transplanted kidney in DGF, the imaging manifestations of benign tumors such as cysts and angiomyolipomas were excluded on SWI images, and then making the renal cortex as the reference, if the abnormal signal lesions were found in the transplanted kidney, the location and signal intensity would be analyzed. The differences in serum cystatin C level between DGF groups without and with abnormal signal lesions were compared by using independent-sample t-test.The correlation between SWI manifestation and serum cystatin C level for DGF was assessed with Spearman rank correlation analysis.

A total of 15 cases were found without abnormal signal lesions and the average value of their serum cystatin C level was (2.92±0.44) mg/L.A total of 12 cases were found with abnormal low signal lesions located at junctional zone between cortex and medulla, and the average value of their serum cystatin C level was (6.91±0.96) mg/L. The differences in serum cystatin C level between the two DGF groups were statistically significant (t=-4.040, P=0.000). There was a positive correlation between the abnormal low signal lesions on SWI and serum cystatin C level (r=0.660, P=0.000).

The status of renal function impairment could be reflected by being with or without abnormal signal lesions on SWI. A relatively big renal function impairment may be predicted by the appearance of abnormal low signal lesions at junctional zone between cortex and medulla on SWI.

To study the clinical characteristics and prognosis of unprotected left main (ULM) coronary artery disease patients with chronic kidney disease after drug-eluting stents (DES) implantation.

267 ULM coronary artery disease patients who has implanted DES were included in the study from January 2005 to March 2010. Patients were divided into two groups according to their estimated glomerular filtration rate (eGFR): eGFR <60 ml·min ^-1·1.73 m^-2 (77 patients), and eGFR≥ 60 ml·min^-1·1.73 m^-2 (190 patients) . The clinical parameters and prognosis of ULM patients treated with DES in different eGFR groups were retrospectively compared.

In higher eGFR group, left ventricular ejection fraction (LVEF) and morbidity of coronary ostial lesions were higher than the other group. Cerebrovascular diseases (13.0% vs 5.3%), chronic total occlusion (CTO, 28.6% vs 12.1%), hypertension (70.1% vs 53.2%) were more common in lower eGFR patients(all P<0.05). Total mortality and cardiac mortality were higher in eGFR<60 ml·min^-1·1.73 m^-2 group (P=0.016, 0.006, respectively). Low eGFR level was an independent risk factor after adjusting multiple factors.

For the ULM disease patients with reduction in kidney function (eGFR<60 ml·min^-1·1.73 m^-2), DES should be selected with a careful study considering its increasing risk of death. Chronic renal insufficiency is a risk factor and may predict poor prognosis for patients with ULM after DES implantation.

Use epidemiological approaches to investigate the correlation between the siesta and blood pressure.

From March 1^st, 2011 to June 30^th 2013, a total of 950 people were collected from East Jiaozhou Qingdao region using variable sampling methods including stratified method, the entire group method, random and proportional methods. Medical professionals conducted a person-to-person survey, collecting the data and inputting it into computers, after which a database was established using STATA 12.0. We analyzed the correlation between the siesta time and blood pressure/hypertension by using rank correlation method (Spearman). Logistic regression method was used to analyze the relationship between high blood pressure and different time and habit of the siesta after adjusting age, sex and BMI.

There was a negative correlation between the time of siesta and the systolic pressure with r=-0.18, P<0.001; there was no relationship between the time of siesta and the diastolic pressure withr=-0.07, P=0.02; also, there is a negative correlation between the time of siesta and the hypertension morbidity, with r=-0.22, P<0.001. In the Logistic regression analysis about the period of time to take a nap and the risk of hypertension, it was found that the relative risk factors for hypertension were more than 60-year-old, BMI >25 kg/m² and no siesta habits.

The time of siesta is negatively correlated to the systolic pressure, rather than the diastolic pressure, and it can generally reduce the incidence of hypertension. The relative risk factors of hypertension are more than 60-year-old, BMI >25 kg/m ² and no siesta habits in all four seasons. We recommend that take a nap a day, or it might be even better for systolic blood pressure to take longer siesta.

A 29-year-old female was admitted to the First Affiliated Hospital of the People's Liberation Army General Hospital on August 8, 2015 due to intermittent rash for 1 month and fever with neck mass for 2 weeks. The patient developed wheal-like rash on both upper limbs without trigger 1 month ago, mild pruritus, which resolved after self-administration of anti-allergic drugs. A similar rash reappeared on both upper limbs and face 2 weeks ago. Then fever and fatigue occurred after working outdoors in the hot sun. The fever was mainly low fever, with the highest body temperature of 38.0℃. The peak body temperature was obvious in the afternoon and night, and it could be reduced to normal the next day after symptomatic treatment. Fever is accompanied by obvious sore throat and oral ulcer, pulsatile headache, intermittent attacks, obvious in the temporal and occipital regions, aggravated when changing body position, no nausea, vomiting, and normal vision. At the beginning of the fever, a mass was found in the left neck, which was progressively enlarged and tender. There was no nasal congestion, runny nose, cough or expectoration during the course of the disease; No abdominal pain, diarrhea, frequent urination, urgency and painful urination, no joint and muscle pain, no weight loss, night sweats, etc. Visited a local hospital and had a peripheral blood white blood cell count of 3.2×10⁹/L, considered as an "infectious disease", given acyclovir tablets, moxifloxacin hydrochloride tablets and acetaminophen tablets and other drugs successively, the headache was relieved, and the body temperature could temporarily drop to 37℃, but it rose again the next day. Three days ago, when the patient's body temperature increased, he again experienced bilateral severe pulsatile pain in the temporal and occipital regions, aggravated symptoms of postural change, accompanied by nausea, and vomited the stomach contents once, which was non-jetting. Physical examination at admission: temperature 36.6 ℃, pulse 72 beats/min, breathing 18 beats/min, blood pressure 92/62 mmHg (1 mmHg =0.133 kPa). Several swollen lymph nodes can be palpable in the left neck, with obvious tenderness, the larger one is about 2.5 cm ×1.0 cm, with medium texture, smooth surface, good mobility, no adhesion to the subcutaneous area, and no swollen lymph nodes are palpable in the remaining area. A 0.4 cm ×0.3 cm ulcer was seen in the right buccal mucosa of the oral cavity, with tenderness. The pharynx is slightly red and the tonsils are not large. No abnormal signs of heart, lung, abdomen and nervous system were observed.

A 38-year-old male came to the Department of Endocrinology of Peking Union Medical College Hospital in February 2014 due to "loss of appetite, weight loss and darkening of skin for more than half a year". The patient was diagnosed with AIDS in August 2013 and received antiviral therapy against human immunodeficiency virus (HIV), oral zidovudine 100 mg/time, twice/day; Critica (each tablet containing lopinavir 200 mg and ritonavir 50 mg) 2 tablets/time, 2 times/day; Lamivudine 100 mg/dose, 1 dose/d. Due to the suspected diagnosis of pulmonary tuberculosis, oral anti-tuberculosis drugs were also taken for 2 to 3 months (details unknown). After that, appetite loss, nausea, fatigue, weight loss and skin pigmentation gradually appeared, which lasted for half a year without relief, and came to our hospital for treatment in February 2014. Physical examination: blood pressure 100/70 mmHg (1 mmHg =0.133 kPa), dark skin all over the body, obvious pigmentation of the lips, no enlargement of the thyroid gland, clear breathing sounds in both lungs, heart rate 70 beats/min, and uniform rhythm. Plasma corticotropic hormone (ACTH)>275 pmol/L (reference value: 0-10 pmol/L) at 8:00 a.m. and serum cortisol 20.97 nmol/L (reference value: 110-607 nmol/L) at 8:00 a.m.; Serum potassium was 4.1 mmol/L, sodium 127 mmol/L, chlorine 94 mmol/L, and creatinine 113 μ mol/L (reference value: 59-104 μ mol/L). Thyroid function was normal, and CT of both adrenals showed that "the medial branch of the left adrenal gland was slender, and the right adrenal gland was almost invisible" (Figure 1)。 Diagnosis: AIDS; Primary adrenocortical insufficiency (AI).

A 23-year-old female was admitted to our hospital on May 12, 2007 due to "recurrence of acinar cell carcinoma of the right parotid gland 1 month after surgery". In April 2007, he underwent parotid mass resection in an external hospital due to right parotid mass. Postoperative pathology showed acinar cell carcinoma, and a mass under the right ear was found again 1 month after operation. Admission physical examination: body temperature 36.5 ℃, heart rate 90 beats/min, breathing 22 beats/min, a mass of 1.2 cm ×1.0 cm ×0.6 cm in size was seen at the lower pole of the parotid gland, with obvious tenderness, adhesion to surrounding tissues, and poor mobility; Re-examination of parotid CT scan showed high-density nodules in the right parotid gland, with uniform density and clear boundaries (Figure 1)。 Laboratory test: white blood cells 7.9×10⁹/L, hemoglobin 116 g/L; There were no abnormalities in liver and kidney function, electrolyte, coagulation function and blood glucose; There were no obvious abnormalities in chest CT and abdominal color Doppler ultrasound. Extended parotidectomy and total parotidectomy were performed under general anesthesia on May 19, 2007. The facial nerve was preserved. Postoperative pathology showed that acinar cell carcinoma (Figure 2)。 The patient refused further treatment after surgery. At the reexamination in February 2008, he developed mild limitation of mouth opening, and complained of occasional symptoms of headache and nausea. CT scans of parotid gland and brain showed intracranial metastases, involving the medial pterygopalatine muscle and pterygopalatine fossa (Figure 3，Figure 4)。

Severe infection is one of the main diseases in the Department of Critical Care Medicine (ICU). 51% of ICU patients have infection, and the incidence increases with the length of admission^[1]。 At least 750,000 patients in the United States develop severe infections and septic shock each year, with a trend of increasing year by year^[2]。 In recent years, immune dysfunction in severely infected patients has received extensive attention. Among them, the "cytokine storm" of severe infection and its secondary immunosuppression are considered to be the main pathophysiological processes. Immunosuppression can reduce the body's reactivity and clearance ability to antigen, and it is easy to occur secondary infection. Many studies have intervened for this process, but there have been few positive results. This is not only related to individual differences, but also to the timing of the intervention. Therefore, dynamic monitoring of the patient's immune function and individualized adjustment of the treatment plan according to the monitoring results may further reduce the mortality rate of patients with severe infection and septic shock.