目的 探討胰性腦病的可能的發病機制、發病情況及防治措施.方法 計算機檢索中文科技期刊全文數據庫(1989～2004),收集有關胰性腦病的臨床研究,并進行統計分析.結果 共納入43篇文獻,435例患者.胰性腦病在重癥急性胰腺炎中的發病率遠高于輕癥急性胰腺炎;發病年齡趨向中、老年;病死率為43.67%;病因仍以膽系疾病為主;伴發低氧的幾率不高于未并發胰性腦病患者.結論 胰性腦病的發生可能是多因素共同作用的結果,仍需進一步探討其發病機制.血清髓鞘堿性蛋白有望成為有價值的診斷指標.防治以治療原發病急性胰腺炎為主,重在預防.胰酶抑制劑和早期營養支持有一定預防作用.
Objective To have more insight into roles of growth differentiation factor-15 (GDF15) in digestive tumor. Method The basic and clinical studies on the GDF15 in the digestive tumors published were searched in the databases for summarizing the latest advances on this issue. Results The GDF15, a novel member of transforming growth factor-β superfamily, played the diverse roles in the progress of the various diseases. The increasing number of evidence indicated that the GDF15 was associated with the diagnosis and prognostication of the digestive tumors, eg: colorectal cancer, hepatocellular carcinoma, pancreatic adenocarcinoma, and might serve as a potential biomarker and therapeutic target for the multiple digestive tumors. Conclusions Current basic and clinical studies provide some evidences that GDF15 plays a role in digestive tumors. Further studies are needed to elucidate its roles and molecular mechanisms in different stages of diseases.
【摘要】 目的 觀察帕瑞昔布鈉超前鎮痛在小兒上肢骨折手術的鎮痛效果及不良反應發生情況。 方法 選擇2009年6月－2010年12月氣管插管全身麻醉下擇期行單側上肢骨折切開復位內固定手術患兒90例，隨機分為帕瑞昔布鈉組（P組）、曲馬多組（T組）及對照組（C組），每組各30例患兒；于麻醉前分別靜脈注射帕瑞昔布鈉1 mg/kg、曲馬多2 mg/kg、等容量生理鹽水。3組患兒年齡、性別、體重、手術時間等一般情況差異無統計學意義（Pgt;0.05）。各組均于術后2、4、6、8 h各時間點觀察患兒疼痛評分、鎮靜評分；觀察拔除患兒氣管導管后5 min躁動評分；記錄患兒術中芬太尼總用量及術后鎮痛藥物用量；隨訪術后24 h內不良反應的發生情況。 結果 術后各個時間點P組疼痛評分明顯低于T、C組（Plt;0.01）；T組鎮靜評分于術后2、4、6 h明顯高于P、C組（Plt;0.01），鎮靜評分在P、C組之間比較差異無統計學意義（Pgt;0.05）；P組術后躁動評分明顯低于T、C組（Plt;0.01）；P組患兒圍手術期芬太尼用量明顯少于T、C組（Plt;0.01）；T組術后惡心嘔吐發生率明顯高于P、C組（Plt;0.05）。P組無呼吸抑制、傷口異常出血等嚴重不良反應。 結論 帕瑞昔布鈉超前鎮痛用于小兒上肢骨折手術可產生明顯鎮痛作用，并可有效預防蘇醒期躁動發生，明顯減少圍手術期芬太尼用量，惡心嘔吐等不良反應發生率明顯低于曲馬多。【Abstract】 Objective To study the efficacy and safety of preemptive analgesia with parecoxib sodium in children undergoing upper limb orthopedic surgery. Methods Ninety children from June 2009 to December 2010 scheduled for elective upper limb orthopedic surgery under general anesthesia were selected and randomly divided into three groups with 30 children in each. For the children in group P (parecoxib sodium), group T (tramadol) and group C (control), preemptive analgesia was induced by an intravenous injection of parecoxib sodium at 1 mg/kg, tramadol at 2 mg/kg, and normal saline respectively before anesthesia. Pain intensity score and sedation score were recorded 2, 4, 6, and 8 hours respectively after operation. The agitation score was measured 5 minutes after extubation. The perioperative fentanyl consumption and postoperative analgesic medicine consumption were recorded. The adverse effects were observed within 24 hours after operation. Results The demographic data such as age, gender, weight, and operation time did not differ statistically among the three groups of children (Pgt;0.05). Compared with groups T and C, the pain score in group P was significantly lower at all time points after operation (Plt;0.01). The sedation score in group T was significantly higher than those in group P and C 2, 4, and 6 hours after operation (Plt;0.01), but the sedation score did not differ significantly between groups P and C (Pgt;0.05). The agitation score after trachea extubation in group P was significantly lower than the other two groups (Plt;0.01). The quantity of fentanyl used in group P was significantly lower than in groups T and C (Plt;0.01). The incidence of postoperative nausea or vomiting in group T was higher than those in groups P and C (Plt;0.05). There was no depression of breath or abnormal hemorrhage in group P. Conclusion Parecoxib sodium has a better analgesic effect in children undergoing upper limb orthopedic surgery. The agitation score and the incidence of postoperative nausea or vomiting are significantly lower, and the use of parecoxib sodium can also significantly reduce the perioperative fentanyl consumption.
【摘要】 目的 比較喉罩全麻與氣管插管全麻兩種麻醉方法在小兒側臥位短小手術中的優缺點。 方法 2009年6月-2010年2月，將40例擇期行側臥位短小手術兒患，隨機分為喉罩全麻（L）組與氣管插管全麻（T）組，每組各20例。觀察患兒術中心率（HR）、平均動脈壓（MAP）、脈搏血氧飽和度（SpO2）、氣道峰壓（Pmax），惡心嘔吐、術后躁動等圍術期不良反應。 結果 T組插管后及拔管后即刻HR、MAP均高于L組患兒（Plt;0.05）；SpO2、Pmax在兩組之間比較差異無統計學意義（Pgt;0.05），T組患兒術后躁動發生率明顯高于L組（Plt;0.05）。 結論 喉罩可以安全、有效地用于小兒側臥位短小手術麻醉，且操作簡便，插管期和拔管期心血管應激反應輕，術后躁動發生率低。【Abstract】 Objective To compare the safety and efficacy of laryngeal mask airway (LMA) and tracheal tube in lateral general anesthetic operation on children. Methods From June 2009 to February 2010, 40 children scheduled to undergo general anesthesia for minor surgical procedures in lateral position were randomly divided into the laryngeal mask airway group (group L) and the tracheal tube group (group T) with 20 in each. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), top airway pressure (Pmax) of the patients were observed. In addition, side effects such as nausea, vomiting, and emergence agitation were also recorded. Results HR and MAP of patients in group T were significantly higher than those of patients in group L after intubation and after extubation (Plt;0.05). There was no difference in Pmax and SpO2 between the two groups (Pgt;0.05). The incidence of emergence agitation in group T was significantly higher than that in group L. Conclusions LMA intubation can provide the same safe and effective ventilation as tracheal intubation for children undergoing lateral general anesthetic operation. LMA is superior to tracheal intubation in insertion response, and the incidence of emergence agitation is lower.
Objective To propose an innovative self-supervised learning method for vascular segmentation in computed tomography angiography (CTA) images by integrating feature reconstruction with masked autoencoding. Methods A 3D masked autoencoder-based framework was developed, where in 3D histogram of oriented gradients (HOG) was utilized for multi-scale vascular feature extraction. During pre-training, random masking was applied to local patches of CTA images, and the model was trained to jointly reconstruct original voxels and HOG features of masked regions. The pre-trained model was further fine-tuned on two annotated datasets for clinical-level vessel segmentation. Results Evaluated on two independent datasets (30 labeled CTA images each), our method achieved superior segmentation accuracy to the supervised neural network U-Net (nnU-Net) baseline, with Dice similarity coefficients of 91.2% vs. 89.7% (aorta) and 84.8% vs. 83.2% (coronary arteries). Conclusion The proposed self-supervised model significantly reduces manual annotation costs without compromising segmentation precision, showing substantial potential for enhancing clinical workflows in vascular disease management.
Despite of the progress in the treatment of severe acute pancreatitis (SAP), there are still factors that hinder the improvement of the efficacy of treatment: there is a lack of an accurate and easy-to-use system for early severity prediction; the multidisciplinary collaboration mechanism needs to be further optimized; there is no clinical efficacy evaluation system for traditional Chinese medicine (TCM); the therapeutic targets of TCM are unclear; the effector substances are unknown; and the research and development of new medicines is still difficult. In order to further reduce the mortality of SAP and realize the goal of improving the efficacy, we should strengthen the integration of Chinese and Western medicine, multidisciplinary collaboration, and improve the treatment levels; as well as carry out basic and clinical research oriented to clinical value. We will also promote the innovative development of combined Chinese and Western medicine in the treatment of SAP by elucidating the mechanism, validating the efficacy and commercializing the achievements. In view of SAP, a major and difficult disease, we should insist on the principle of integrity and innovation, the synergy of Chinese and Western medicines and the complementarity of advantages, and promote the innovation and development of combined Chinese and Western medicines in the treatment of SAP, so as to further reduce the morbidity and mortality and to alleviate the burden of the disease.
Objective To evaluate the effectiveness and safety of early veno-venous hemofiltration in patients with severe acute pancreatitis (SAP). Methods We searched Cochrane Central Register of Controlled Trials (Issue 4, 2005), MEDLINE (1990 to 2006) and CBMdisc (1990 to 2006). We also handsearched the references of relevant articles. We included randomized controlled trials (RCTs) and non-randomized clinical controlled trials (CCTs) comparing early veno-venous hemofiltration versus conventional therapy only, which reported either mortality rate, cure rate, or both. Two reviewers assessed the quality of each trial and extracted data independently. Trials were graded methodologically. The Cochrane Collaboration’s RevMan 4.2.8 software was used for statistical analysis. Results Ten RCTs and 6 CCTs involving 891 patients were included, all of which were China-based. The Jadad scores of all included RCTs were less than 3. Five trials were incorrectly described as having used random allocation. The baseline data of each trial were comparable. Meta-analyses showed that hemofiltration significantly increased the overall cure rate (OR 3.01, 95%CI 1.28 to 7.09) and decreased the overall mortality rate (OR 0.43, 95%CI 0.27 to 0.70). Moreover, APACHE-II score, conversion to operation rate and incidence of complications of SAP were reduced significantly., The duration of abdominal pain or distension and hospitalization stay were shortened compared with non-hemofiltration. However, continuous veno-venous hemofiltration (CVVH) did not improve overall prognosis, with greater possibility of adverse events. Repeated or intermittent short veno-venous hemfiltration (RSVVH/ISVVH) either with or without peritoneal dialysis, could improve the overall prognosis without any adverse events reported. Conclusions Based on these findings, early RSVVH/ISVVH was effective and safe for SAP, but the efficacy of CVVH could not be proven. Current studies were only available from China and were poor in methodological quality. Further, high-quality, large-scale, randomized controlled trials are required to identify reliably the effectiveness and safety of early veno-venous hemofiltration for SAP.
Integrated traditional Chinese and Western medicine has been used to treat acute pancreatitis (AP) for more than 50 years. It has become a dominant and specialized disease treated by integrated traditional Chinese and Western medicine. After many years of clinical practice, a relatively mature and complete treatment system has been formed. Therefore, it was proposed by the Chinese Society of Integrated Traditional Chinese and Western Medicine, the Chinese Medical Association, and the Chinese Association of Traditional Chinese Medicine to update and formulate the “Guidelines for the Diagnosis and Treatment of Acute Pancreatitis with Integrated Traditional Chinese and Western Medicine” (2021) group standards in 2022, and “Integrated Traditional Chinese and Western Medicine Practice Guidelines for Diagnosis and Treatment of Acute Pancreatitis” finally published. The guideline condenses 25 kinds of important clinical issues, which guide to explain the diagnosis and treatment of AP in detail, focusing on the integration of traditional Chinese medicine and Western medicine in the management of AP, such as staging and syndrome differentiation, early fluid therapy, pain management, and organ function support in early stage. The advantages and the timing of early intervention of traditional Chinese medicine in AP are emphasized. This guideline also proposes suggestions on nutritional support, management of causes, treatment of late local complications and infections, as well as prevention of recurrence and follow-up strategies for long-term complications. This paper provides an interpretation of this guideline.
目的 評價地佐辛配伍丙泊酚聯合喉罩用于無痛纖維支氣管鏡檢查的效果。 方法 將2012年10月－12月擬行纖維支氣管鏡檢查，且按美國麻醉醫師協會分級Ⅰ或Ⅱ級的60例患者，隨機分為芬太尼組（F組）、地佐辛組（D組）、生理鹽水組（N組）,每組20例。采用雙盲法給藥，靜脈注射芬太尼（10 μg/mL）或地佐辛（1 mg/mL）或生理鹽水0.1 mL/kg，5 min后3組緩慢靜脈注射丙泊酚2 mg/kg誘導后置入喉罩，術中保留自主呼吸，持續泵入丙泊酚4～6 mg/（kg·h）維持麻醉，觀察3組患者誘導前（T0）、誘導后時（T1）、纖維支氣管鏡操作時（T2）、術畢時（T3）及拔除喉罩時（T4）的生命體征，記錄丙泊酚總用量、蘇醒時間、蘇醒時的呼吸道疼痛視覺模擬評分（VAS），記錄術中及術后有關并發癥的發生情況。 結果 與N組相比，D、F兩組丙泊酚總用量減少、蘇醒時間縮短，頭昏及術中體動發生率、VAS評分明顯降低（P＜0.05）；呼吸暫停的發生率D組最低（P＜0.05）；惡心、嘔吐的發生率F組最高（P＜0.05）。 結論 地佐辛配伍丙泊酚聯合喉罩用于無痛纖維支氣管鏡檢查，麻醉效果滿意，術后鎮痛效果好，值得臨床推廣。
【摘要】 目的 探討血漿胰蛋白酶原激活肽(trypsinogen activation peptide,TAP)水平與重癥急性胰腺炎(severe acute pancreatitis,SAP)胰腺壞死的關系。方法 2008年6月1日—2008年12月31日,采用ELISA法測定本院的35例SAP患者血漿TAP水平,并與胰腺增強CT掃描結果作對比,分析血漿TAP水平與胰腺壞死的關系,以及SAP無胰腺壞死組與SAP胰腺壞死組血漿TAP水平的差異。結果 入院時血漿TAP水平預測胰腺壞死的最佳截值點是10.43 nmol/mL,其敏感性、特異性、陽性預測值、陰性預測值分別為75%、73.9%、60%、15%,陽性比為2.87,陰性比為0.338。入院第1天血漿TAP水平預測胰腺壞死的最佳截值點是6.91 μmol/L,其敏感性、特異性、陽性預測值、陰性預測值分別為90.9%、65.2%、55.6%、6.3%,陽性似然比為2.61,陰性似然比為0.001。SAP胰腺壞死組入院時、入院第一天血漿TAP水平高于SAP無胰腺壞死組(Plt;0.05)。結論 血漿TAP水平變化與SAP病情變化密切相關,病程早期檢測血漿TAP水平有助于SAP患者胰腺壞死的預測