【摘要】目的觀察負壓球在食管癌、賁門癌術后的臨床應用價值。方法1999年2009年對觀察組食管癌、賁門癌術后使用負壓球細管引流,對照組術后使用傳統粗膠管水封瓶閉式引流,兩組均286例。結果觀察組在胸腔積液、第二天鎮痛劑應用、引流口感染及術后住院時間等方面與對照組相比差異有統計學意義，而術后膿胸、第一天鎮痛劑應用及管腔堵塞等方面與對照組相比無差異。結論負壓球細管引流用于食管癌、賁門癌術后胸腔引流,創傷小,效果確切滿意。
ObjectiveTo investigate the relationship between platelets changes and outcomes of acute respiratory distress syndrome (ARDS) patients.MethodsA total of 275 ARDS patients treated in Zhongshan Hospital of Fudan University were retrospectively enrolled from 2008 to 2015. Their clinical characteristics, experimental test results and disease outcomes were obtained from the archived medical records. The correlation between the decreasing of platelet within three days and the prognosis of ARDS and in each subgroup were analyzed by statistical methods, including COX analysis and Kaplan-Meier curve.ResultsThere were 233 patients validly selected through eliminating those with exclusion criteria. They were divided into a decreasing group and a non-decreasing group according to their platelet counts in three days. There was significant difference in the ontcome between the two groups with the univariate analysis, the COX analysis and Kaplan-Meier curve (all P<0.05). According to the initial platelet count and change of platelet in 3 days all the patients were categorized into 9 subgroups. The mortality among them was compared and two risk groups were defined, including a persistently low platelet group (the initial platelet count <139×109/L with an increase less than 16×109/L during the first three days after the diagnosis), and a decreased platelet group (the initial platelet count ≥139×109/L and platelet count decreased more than 30×109/L during the first three days after the diagnosis). The other subgroups made up a non-risk group. Merging two risk groups as one risk group and comparing with the non-risk group, there were significant differences in the outcome between two groups with the univariate analysis, the multiplicity COX analysis and Kaplan-Meier curve (all P<0.05), the differences of coagulation function indexes were not significant (allP>0.05). The platelet count of the risk group was also an independent risk factor for ARDS mortality in the surgery subgroup (P=0.003), the non-hypertension subgroup (P=0.018) and the pneumonia subgroup (P<0.001).ConclusionLow platelets and declining platelets are closely associated with poor prognosis in most ARDS patients, which might be applied in clinical prognosis evaluation.