目的 總結超聲引導下經皮經肝穿刺膽管引流術(PTCD)的優、缺點,為臨床治療重癥急性膽管炎（SAC）提供參考。方法 回顧性分析我院1994年8月至2008年7月期間對156例老年SAC患者行在超聲引導下的PTCD治療的臨床資料。結果 156例行PTCD均獲成功,1次穿刺成功140例，其成功率達89.7%（140/156）; 16例首次穿刺失敗后再次穿刺均成功。無一例發生腹腔出血、膽汁性腹膜炎等并發癥。本組引流效果較好,中毒危象緩解，黃疸減退，肝功能改善。結論 PTCD較外科手術創傷小、操作簡單、快速,具有微創的特點,對老年、有嚴重合并癥及復雜疾病不能耐受手術及麻醉的SAC患者，其作為緊急搶救措施切實可行,并為后期施行根治性手術爭取了時間。
In order to observe activity of tumor necrosis factor (TNF) in the serum, pancreatic histopathological damage, as well as their relationships in acute necrotizing pancreatitis (ANP), thirty five SD rats were randomly divided into 7 groups according to their sampling time with 5 in each group. ANP was induced by retrograde infusion of 5% sodium taurocholate through biliopancreatic duct in 6 experimental groups (Group B1～B6).Blood and pancreatic tissue samples were obtained at hour 0,0.5,2,4,6 or 8 respectively when the animals were sacrificed.Results showed that serum level of TNF activity rose significantly in Group B2,and reached the maximal value in Group B4.The pancreatic histopathological damage in ANP rats was getting worse along with time. Serum TNF activity had close relation to pancreatic histopathological score (r=0.63, Ｐ＜0.01),suggesting that serum TNF may play an important role in the process of deterioration of pancreatic tissue damage during ANP.
目的:探討顱腦損傷患者術中急性腦膨出的病因、診斷及治療。方法:對127例術中發生急性腦膨出的顱腦損傷患者的臨床資料進行回顧性分析。結果:急性腦膨出的原因為同側腦腫脹者74例,為對側遲發性血腫者51例,而為同側遲發性血腫者2例。共死亡48例(37.8%),其中31例因腦疝死亡。結論:通過鉆孔探查或積極的CT掃描,及時發現顱腦損傷患者術中急性腦膨出的原因,并盡早正確處理極其重要,是搶救此類患者成功的關鍵。
目的:探討合理的營養支持方式對重癥急性胰腺炎(SAP)患者營養狀況及預后的影響。方法:將60例SAP患者隨機分為全胃腸外營養支持(對照組)和腸內與腸外相結合營養支持(實驗組)兩組,對比營養支持前后兩組患者的血紅蛋白、總蛋白、血清白蛋白、氮平衡、血脂等生化指標,每天觀察相關并發癥情況。結果:實驗組血清白蛋白、總蛋白、血紅蛋白、氮平衡方面明顯優于對照組(Plt;0.05),且并發癥少。結論:腸內與腸外結合的營養支持方式可以改善SAP患者的營養狀況,對SAP患者治療有積極的作用。
Objective To explore the predictive value of simplified acute physiological score Ⅱ (SAPS-Ⅱ) combined with lactate clearance rates (LCR) at different moments for mortality in sepsis patients. Methods A total of 188 patients with sepsis admitted in the hospital from April 2020 to February 2023 were selected, who were evaluated using the SAPS-Ⅱ scale. Spectrophotometry was used to detect blood lactate at baseline, after 6h, 12h, 24h, and 48h, then the LCR after 6h, 12h, 24h, and 48h were calculated. The patients were divided into a survival group (n=139) and a death group (n=37) based on 28 day outcome. Logistic regression analysis was used to explore the risk factors of sepsis death, and the efficacy of SAPS-Ⅱ scores combined with LCR at different moments in predicting patient death was analyzed using receiver operating characteristic (ROC) curve. Results Twelve patients fell off, and 37 died in the remaining 176 patients, the mortality rate was 21.02%. The age, temperature, random blood glucose, blood urea nitrogen, serum creatinine, and SAPS- Ⅱ scores in the death group were significantly higher than those in the survival group (P<0.05), while platelet count and LCR at all moments were significantly lower than those in the survival group (P<0.05). The LCR of the death group continued to decrease with time. The trend of changes in the survival group were opposite, and the differences in the two groups between each two moments were statistically significant (P<0.05). The SAPS-Ⅱ scores and LCR at all moments were risk factors for patient death (P<0.05). The SAPS-Ⅱ score and LCR at all moments had predictive value for patient death, and the area under ROC curve of the combined prediction was 0.921 (95%CI 0.825 - 1.000), which was higher than the individual prediction and LCR at each moment combined with SAPS II score prediction (P<0.05). Conclusion The SAPS-Ⅱ scores and LCR at different moments are all related to death of sepsis patients, and the combined prediction of death by the above indicators is highly effective.
Rhabdomyolysis-induced acute kidney injury (RIAKI) is a serious clinical disease in intensive care unit, characterized by high mortality and low cure rate. Continuous renal replacement therapy (CRRT) is a common form of treatment for RIAKI. There are currently no guidelines to guide the application of CRRT in RIAKI. To solve this problem, this article reviews the advantages and limitations of CRRT in the treatment of RIAKI, as well as new viewpoints and research progress in the selection of treatment timing, treatment mode, treatment dose and filtration membrane, with the aim of providing theoretical guidance for the treatment of CRRT in RIAKI patients.
ObjectiveTo retrospectively evaluate the risk factors of mortality in postoperative acute kidney injury (AKI) patients undergoing continuous renal replacement therapy (CRRT) after cardiopulmonary bypass (CPB). MethodsWe retrospectively analyzed the clinical data of 66 patients (38 males and 28 females with mean age of 59.11±12.62 years) underwent CRRT after cardiovascular surgery in our hospital between May 2009 and June 2014. The patients were divided into a survival group (18 patients) and a death group (48 patients) according to treatment outcome at discharge. Univariate analysis for risk factors of death was carried out for preoperative characteristics and lab results among study population. Significant univariate factors were then further analyzed by multivariable logistic regression models. ResultsSignificant predictors of death included blood transfusion volume during operation, peak level of blood sugar and lactate during operation, the total bilirubin level and platelet count on the first day after operation, hypotension on the first day after operation, pulmonary infection, multiple organ dysfunction syndrome (MODS) and the interval time of oliguria and CRRT (P<0.05). Logistic regression showed that there were statistical differencs in hypotension on the first day after operation, postoperative platelet count, and interval time of oliguria and CRRT respectively (P<0.05). ConclusionImproving intraoperative management, reducing bleeding and blood transfusion, controlling blood sugar level, dealing with complications such as hypotension, pulmonary infection and MODS more aggressively, starting CRRT when needed may be helpful to reduce mortality. Monitoring of the blood pressure and platelet count on the first day after operation is useful for prognosis estimation.
Clinically, non-contrastive computed tomography (NCCT) is used to quickly diagnose the type and area of ??stroke, and the Alberta stroke program early computer tomography score (ASPECTS) is used to guide the next treatment. However, in the early stage of acute ischemic stroke (AIS), it’s difficult to distinguish the mild cerebral infarction on NCCT with the naked eye, and there is no obvious boundary between brain regions, which makes clinical ASPECTS difficult to conduct. The method based on machine learning and deep learning can help physicians quickly and accurately identify cerebral infarction areas, segment brain areas, and operate ASPECTS quantitative scoring, which is of great significance for improving the inconsistency in clinical ASPECTS. This article describes current challenges in the field of AIS ASPECTS, and then summarizes the application of computer-aided technology in ASPECTS from two aspects including machine learning and deep learning. Finally, this article summarizes and prospects the research direction of AIS-assisted assessment, and proposes that the computer-aided system based on multi-modal images is of great value to improve the comprehensiveness and accuracy of AIS assessment, which has the potential to open up a new research field for AIS-assisted assessment.