摘要:目的:总结汶川地震26例多器官功能衰竭患者的临床资料,就其发病特点,治疗经过及预后进行探讨,为防治提供依据。方法:对汶川地震26例多器官功能衰竭患者的临床资料进行回顾性分析。结果:19例患者死亡,死亡率为73.1%。死亡率随着功能衰竭的器官数量增多而增高,4个及以上器官功能衰竭者死亡率为100%。结论:多器官功能衰竭预后差,死亡率高。强调对 MOF的早期识别、早期诊断、早期治疗以及治疗上的统筹兼顾,防治结合。Abstract: Objective: To investigate the clinical characteristic and treatable methods of the multiple organ failure (MOF) in Wenchuan earthquake. Methods: The clinical records of the 26 patients with MOF were studied retrospectively. Results: Nineteen patients died and the mortality was 73.1%.The mortality increased along with the quantity of the organ failure, and the death rate of the patients with equal or more than 4 organs failure was 100%. Conclusion:The prognosis of the patients with MOF was bad and the death rate was high in Wenchuan earthquake. We emphasize the early recognition, early diagnose and early treatment and the treatment of overall planning and allround consideration and prevention in combination with treatment.
【摘要】目的 探讨暴发性急性胰腺炎（FAP）的诊治方法。方法 回顾性分析1999年3月至2004年5月我院收治的79例重症急性胰腺炎（SAP）患者的临床资料。结果 79例SAP患者中, FAP患者17例，其中3 d内手术的4例均治愈 ，延期手术4例与非手术治疗的9例均死亡。 结论 主要根据SAP患者的临床表现、动态B超检查或APACHE Ⅱ评分短期大幅增高即可诊断FAP。 一旦确诊，应当机立断，力争手术治疗。 血液滤过或使用大剂量激素可能为呼吸、循环不稳定的患者创造手术时机 。手术方式宜尽量简单有效，开腹手术和经腹腔镜辅助下的腹腔灌洗术引流效果较好，局麻下下腹切口减压引流效果差。手术前后应加强器官功能的监护和支持。
ObjectiveTo investigate changes of lipopolysaccharidebinding protein (LBP) and its clinical significance in activation of Kupffer cells (KCs) during endotoxemia.MethodsWistar rat endotoxemia model was established by injection of a dose of LPS (5 mg/kg, Escherichia coli O111∶B4) via the tail vein of rats, then sacrificed 1, 3, 6 and 12 hour respectively. Hepatic tissue was collected to measure LBP mRNA expression by reverse transcritasepolymerase chain reaction (RTPCR). The levels of plasma endotoxins, LBP, TNFα and IL6 were determined. The pathological changes of hepatic tissue were observed under electron microscope.ResultsWhen the levels of plasma LPS elevated, expression of LBP mRNA in hepatic tissue were ber than that in control rats. The levels of plasma LBP, TNFα and IL6 were increased markedly also in rat with endotoxemia when compared with that in control groups (P＜0.01). KCs were seen to be enlarged in size, their surface projections were increased in number, and their cytoplasm was full of phagocytic vacuoles or electron dense phagosomes which indicated active phagocytosis.ConclusionLPS can markedly upregulate LBP mRNA expression in hepatic tissue, the levels of plasma LBP also increased. LBP may be a critical factor of LPS which stimulates KCs to produce and release different proinflammary mediators.
ObjectiveTo investigate the prognostic value of high mobility group protein 1 (HMGB1) in patients with ventilator-associated pneumonia (VAP). MethodsA total 118 VAP patients admitted between March 2013 and March 2015 were recruited in the study. The patients were divided into a death group and a survival group according to 28-day death. Baseline data, HMGB1, C-reactive protein (CRP), clinical pulmonary infection score (CPIS), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sepsis-related organ failure assessment (SOFA) scores were collected on 1st day (d1), 4th day (d4), and 7th day (d7) after VAP diagnosis. The possible prognostic factors were analyzed by univariate and logistic multivariate analysis. ResultsThere were 87 cases in the survival group and 31 cases in the death group. Age, female proportion, body mass index, HMGB1 (d1, d4, d7), APACHEⅡ (d1, d4, d7) and SOFA (d1, d4, d7) scores were all higher in the death group than those in the survival group (all P < 0.05). HMGB1 (d4, P=0.031), APACHEⅡ (d4, P=0.018), SOFA (d4, P=0.048), HMGB1(d7, P=0.087), APACHEⅡ(d7, P=0.073) and SOFA (d7, P=0.049) were closely correlated with 28-day mortality caused by VAP. Multivariate analysis revealed that HMGB1 (d4, HR=1.43, 95%CI 1.07 to 1.78, P=0.021), SOFA (d4, HR=1.15, 95%CI 1.06 to 1.21, P=0.019) and HMGB1 (d7, HR=1.27, 95%CI 1.18 to 1.40, P=0.003) were independent predictors of death in the VAP patients. ROC curve revealed HMGB1 (d4, d7) and SOFA (d4) with area under ROC curve of 0.951, 0.867 and 0.699. ConclusionIndividual HMGB1 level can be used as a good predictor of the short-outcomes of VAP.
Objective To summarize the effect of mild hypothermia on post-cardiac surgery patients with multiple organ dysfunction system(MODS). Methods We retrospectively analyzed the clinical data of 90 patients with MODS after cardiac surgery under cardiopulmonary bypass(CPB) from May 2010 through June 2014 in our hospital. There were 57 males and 33 females at 61±6 years. The patients were divided into two groups including a NT group (without pre-hypothermia treatment,n=32) and a HT group(with pre-hypothermia treatment,n=58). Results Of the 90 patients, totally 18 patients died, 8 patients (13.8%) in the HT group, 10 patients (31.2%) in the NT group with a statistical difference (P<0.05). In the NT group, 12 patients (37.5%) were treated by intra-aortic balloon pump (IABP), and 9 patients (15.5%) in the HT group with a statistical difference between the two groups (P<0.05). The patients' heart rate (HR) decreased significantly after the application of hypothermia. The HR of difference between the two groups at 36 h was significant (P<0.05). The mean aortic pressure (MAP) in the HT group was lower than that of the NT group significantly at 0 h, because we used sedation and muscular relaxation agent. But the MAP in the HT group was significantly higher than that of the NT group after hypothermia 36 h (P<0.05). In the HT group, pressure of oxygen (PO2), mixed venous oxygen saturation (SvO2), and lactic acid (Lac) were improved significantly compared with those of the NT group significantly (P<0.05). There was no statistical difference in prothrombin time (PT) or activated partial thromboplastin time (APTT) between the two groups (P>0.05). But there was a statistical difference in platelet (PLT) between the two groups at 36 h (P<0.05). The aspartate aminotransferase (AST), alannine aminotransferase (ALT), creatinine (Cr) were improved significantly in the HT group (P<0.05). Conclusion Mild hypothermia can improve the organ function effectively. It can slow the MODS development speed and win the time of protection and further treatment for cells and organs. It is an effective and safety therapeutic technique for MODS after cardiac surgery.
ObjectiveTo explore the relationship between blood glucose variability index and persistent organ failure (POF) in acute pancreatitis (AP). MethodsWe prospectively included those patients who were diagnosed with AP with hyperglycemia and were hospitalized in the West China Center of Excellence for Pancreatitis of West China Hospital of Sichuan University from July 2019 to November 2021. The patients were given blood glucose monitoring at least 4 times a day for at least 3 consecutive days. The predictive value of blood glucose variability index for POF in patients with AP was analyzed. ResultsA total of 559 patients with AP were included, including 95 cases of POF. Comparing with those without POF, patients with AP complicated by POF had higher levels of admission glucose (11.0 mmol/L vs. 9.6 mmol/L), minimum blood glucose (6.8 mmol/L vs. 5.8 mmol/L), mean blood glucose (9.6 mmol/L vs. 8.7 mmol/L), and lower level of coefficient of variation of blood glucose (16.6 % vs. 19.0 %), P<0.05. Logistic regression analyses after adjustment for confounding factors showed that the risk of POF increased with the increase of admission glucose [OR=1.11, 95%CI (1.04, 1.19), P=0.002], minimum blood glucose [OR=1.28, 95%CI (1.10, 1.48), P=0.001] and mean blood glucose [OR=1.18, 95%CI (1.04, 1.33), P=0.010]; with the higher level of coefficient of variation of blood glucose [OR=0.95, 95%CI (0.92, 0.99), P=0.021], the risk of POF decreased. The results of area under the curve (AUC) of the receiver operator curves showed that AG [AUC=0.787, 95%CI (0.735, 0.840)] had the highest accuracy in predicting POF, with sensitivities of 60.0% and specificities of 84.7%. ConclusionHigh admission glucose, minimum blood glucose, mean blood glucose, and low coefficient of variation of blood glucose were risk factors for the development of POF in patients with hyperglycemic AP on admission.