Objective To investigate the efficiency of combining traditional Chinese medicine with western medicine in the treatment of severe acute pancreatitis (SAP). Methods The clinical results of sixty three cases of SAP of non-operative treatment with injection of Salia miltorrhizae composita, and oral or gastric tube feeding of decoction Qing-Yi-Tang were retrospectively studied. Results Thirty four cases were categorised as SAP Ⅰ grade, and 29 cases as SAP Ⅱ grade. A variety of complications occurred in 19 cases (30.16%), 3 patients died (4.76%), and 4 patients developing abscess of pancreas (6.35%) which had to be operated on.Conclusion The individualization principle on the basis of cause and clinical stage of the disease should be stressed in treating SAP. The patients who had complication needing to be operated on should be timely performed. There is a good efficiency in the treatment of SAP with the traditional Chinese medicine combining with western medicine.
Objective To evaluate the relationship between endothelin (ET) in bile and peripheral blood with systemic and hepatobiliary injury in patients with acute cholangitis of severe type (ACST). Methods ET, ALT and total bilirubin in bile and peripheral veinous blood of 25 patients with acute cholangitis of severe type (ACST) were detected during operation, one week and two weeks after operation. Results The contents of ET, ALT and total bilirubin were significantly lower on 7-day and 14-day after operations as compared with that during operations (Ｐ＜0.05 and Ｐ＜0.01). The concentration of ET in peripheral veinous blood paralleled with that in bile. Conclusion This suggests that ET is tightly related with the pathologic process of ACST. So, in patients with ACST, the dynamic measurement of ET in peripheral veinous blood can be an index for judging the degree of pathological damage either to the hepatobiliary or systemic systems.
ObjectiveTo summarize the changes and interaction of the cytokine in severe acute pancreatitis associated lung injury. MethodsThe published literatures at domestic and aboard in recent years about severe acute pancreatitis associated lung injury were collected and reviewed. ResultsThe cytokines had a chain effect, and influenced each other when severe acute pancreatitis with lung injury attacked. ConclusionsRelated cytokines play important roles in severe acute pancreatitis associated lung injury. Researching the related cytokines will contribute to the diagnosis and treatment for severe acute pancreatitis with lung injury.
摘要:目的:探讨重症急性胰腺炎(SAP)继发感染的临床特点。方法:将我院20039~20053收治的SAP140例,按是否感染,分成感染组和对照组,对比分析其临床资料。结果:感染组病死率高于对照组(P=0023);感染组入院初期,Ranson评分、CT评分、APACHE Ⅱ评分、血糖、ARDS和肠麻痹发生率、感染前手术率及呼吸机辅助呼吸率高于对照组(Plt;005);以G感染胰腺、胰周围及肺部为主;肺部感染时间为107±25d,胰腺或胰周为176±29d。结论:急性期全身反应轻重及胰腺坏死程度是SAP继发感染的基础;临床有创治疗措施是促进因素。
Objective To explore the thromboembolic events and mortality in patients with different types of severe pneumonia, and to analyze the related high-risk factors. Methods A total of 161 severe pneumonia patients who admitted in intensive care unit from January 2018 to February 2023 were included in the study. The patients were divided into a COVID-19 group (n=88) and a community-acquired pneumonia (CAP) group (n=73) according to the type of pneumonia, and divided into a thrombosis group and a non-thrombosis group according to the occurrence of thrombosis. The patients were followed-up until discharge or in-hospital death, registering the occurrence of thrombotic events. Results During the in-hospital stay, 32.9% of CAP and 36.4% of COVID-19 patients experienced thrombotic events (P>0.05). In CAP group all the events (including 24 paitents) were venous thromboses, while in COVID-19 group 31 patients were venous and 3 were arterial thromboses (2 were cerebral infarction, and 1 with myocardial infarction). There were statistically significant difference in gender, age, venous thromboembolism score (VTE score), activated partial thromboplastin time (APTT), and procalcitonin (PCT) between the TE group and the Non-TE group. Logistic regression analysis showed that thrombotic events was associated with sex, age and APTT; gender (female: OR=2.47, 95%CI 1.13 - 5.39, P<0.05) and age (OR=1.04, 95%CI 1.01 - 1.07, P<0.05) were positively associated with thrombotic events. During the in-hospital follow-up, 44.3% of CAP patients and 42.5% of COVID-19 patients died (P>0.05). Receiver operator characteristic (ROC) curve analysis showed that APACHEⅡ score was more accurate in predicting mortality of severe pneumonia, and the area under the ROC curve (AUC) was 0.77 (95%CI 0.70 - 0.84, sensitivity 74.3%, specificity 68.1%), the AUC of the VTE score was 0.61 (95%CI 0.53 - 0.70, Sensitivity 31.4%, specificity 81.7%); the AUC of the creatinine was 0.64 (95%CI 0.56 - 0.73, sensitivity 72.9%, specificity 51.2%). While the Kappa value for kidney disease was 0.409 (P<0.05) presenting moderate consistency. Conclusions The incidence of thromboembolic events and mortality are high in patients with different types of severe pneumonia. Thrombophilia was associated with sex, age, and APTT. APACHEⅡ score, VTE score, and creatinine value were independent risk factors for predicting death from severe pneumonia.
Objective To explore the effects of Metabolic Syndrome (MS) and its components on the condition and prognosis of patients with Severe Pneumonia. Methods 306 patients with severe pneumonia admitted to the intensive care unit of Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2020 to July 2023 were included as study subjects.The patients were divided into MS and non-MS groups according to whether they were combined with MS,and into survival and death groups according to 28-day prognosis,and the general data, laboratory indexes, condition and prognostic indexes of the two groups were compared; multifactorial logistic regression was used to analyze the independent risk factors for the prognosis of patients with severe pneumonia. ResultsThe levels of test indicators such as body mass index (BMI), fasting blood glucose (FBG), triglyceride (TG), blood lactate,white blood cell count(WBC),urea phosphate (Urea), creatinine (SCr),as well as the incidence of acute respiratory distress syndrome (ARDS), shock,multiple organ dysfunction syndrome (MODS), rate of endotracheal intubation and mortality, ICU treatment cost,and total treatment cost of the MS group were significantly higher than those of the non-MS group; the levels of high-density lipoprotein cholesterol (HDL-C) and oxygenation index (OI) of the MS group were significantly lower than those of the non-MS group (P<0.05).Multifactorial logistic regression analysis showed that the risk of death from severe pneumonia was 1.276 times higher in combined MS than in no combined MS (95%CI: 1.013, 5.114, P=0.047). Subgroup analyses also showed that the risk of death from non-viral severe pneumonia was 2.147 times higher in those with MS than those without (95%CI: 1.175, 8.428, P=0.023). ConclusionSevere pneumonia with MS may be more severe and may have a worse prognosis.
Objective To determine the incidence of vitamin B1 deficiency in critically ill patients, to compare vitamin B1 levels between septic and non-septic patients, and to explore the relationship between vitamin B1 levels and lactate levels. Methods Using a retrospective study method, critically ill patients admitted to the Department of Intensive Care of Nanjing Drum Tower Hospital from February 2022 to November 2022 were included in the study, and the patients were divided into sepsis and non-sepsis groups according to the admission diagnosis, and the differences in the vitamin B1 levels of the patients between the two groups were analyzed, as well as the correlation between the vitamin B1 levels and the lactic acid levels. Results There was a significant difference in serum vitamin B1 levels between the sepsis patients and the non-sepsis patients [(1.6±0.3)ng/mL vs. (2.1±0.2)ng/mL, P=0. 009]. For all patients, there was no correlation between vitamin B1 levels and lactate levels. But when the patient was in a hyperlactate state (lactate level ≥2 mmol/L), vitamin B1 levels were significantly negatively correlated with lactate levels (r=–0. 229, P=0. 004). Conclusions Vitamin B1 deficiency is prevalent in critically ill patients and is strongly correlated with whether or not the patient is septic. Vitamin B1 levels are significantly and negatively correlated with lactate levels when the patient's lactate level is ≥2 mmol/L.
摘要:目的: 探讨益活清下法治疗重症急性胰腺炎(severe acute pancreatitis, SAP)对血清单核趋化蛋白1及对器官功能不全的影响。 方法 : 依据纳入和排除标准,选取SAP患者24例,按1︰1随机分为治疗组和对照组,在接受相同西医治疗的基础上,治疗组使用中药“益活清下”法治疗,对照组同时接受中药安慰剂治疗。测定患者第0、1、3、5、7天血清MCP1的浓度水平,比较各器官功能不全的发生率与持续时间。 结果 :两组入院时Rason评分、CT评分、急性生理和慢性健康评价指标Ⅱ评分无统计学差异(〖WTBX〗P gt;005)。对照组第3天MCP1浓度水平明显高于治疗组,差异有统计学意义(〖WTBX〗P lt;005),对照组肠、肝功能不全的发生率高于治疗组,持续时间长于治疗组,但无统计学差异(〖WTBX〗P gt;005)。 结论 :益活清下法治疗重症急性胰腺炎,可降低患者血清MCP1的水平。Abstract: Objective: To investigated the impact of Yihuo Qingxia method on the serum monocyte chemoattractant protein1 of severe acute pancreatitis (SAP)and on the organs disfunction. Methods : Twentyfour SAP patients who admitted to hospital within 72h after onset were randomized into treatment group (n=12) and control group (n=12). The patients in the treatment group were treated by Yihuo Qingxia method, and the control group were administrated with placebo.The level of the serum mcp1 of the patients on the first,3rd,5th,7thday were measured, as well as the incidence and the duration of disfunction of the organs were compared.〖WTHZ〗Results :There were no statistical significance in admission Rason scores, CT scores, Acute physiology and chronic health evaltionⅡscores(APACHEⅡscores)(Pgt;005). The level of the serum Monocyte chemoattractant protein1 of the treatment group was lower than that of the placebo group generally(Plt;005).At the 3rd day after onset,the serum mcp1 level of the control group was significantly higher than that of the treament group(Plt;005).The incidence of the control group of the intestin disfunction and hepatic inadequacy was obviously higher than those of the treatment group,and the duration of the former was longer than that of the latter,but with no satistical significance. Conclusion :Yihuo Qingxia method can effectively cut down the level of the serum mcp1 of severe pancreatitis patients.
Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence of health-enhancing behaviors. It has been proven beneficial in reducing dyspnea and improving functional capacity and quality of life for patients with stable chronic respiratory disease. However, recent randomized clinical trials reported conflicting results on the timing of intervention, protocol and effectiveness of acute exacerbation or intensive care unit pulmonary rehabilitation to improve patient outcomes. We should find a balance between " dynamic” and " static” to maximize the benefit of patients from early pulmonary rehabilitation.
【摘要】目的 探讨急性重症胆管炎(ASC)患者的手术时机、治疗方式的选择以及患者围手术期的治疗。方法 回顾性分析156例ASC患者的临床资料。结果 治愈131例，死亡25例，总死亡率为16.0%。入院后行急诊手术者32例，术后死亡9例，死亡率28.1%； 入院后经支持治疗、纠正休克和酸碱失衡及抗感染治疗后再行手术者53例，死亡9例，死亡率为17.0%。行ERCP+乳头括约肌切开术治疗17例,行PTCD 治疗12例,行保守治疗42例。结论 对ASC患者掌握好手术时机，根据病情选择治疗方式，重视围手术期支持治疗以及适时手术治疗，是降低死亡率，提高疗效的重要措施。