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晚期泡型肝包虫病行肝移植术后肺、脑复发一例

Clinical features and treatment of patients with late-onset injuries in the 2008 Wenchuan earthquake

objective To analyze clinical features and treatment of patients with late-onset injuries in the 2008 Wenchuan earthquake．Methods Clinical data of three patients with late-onset injuries were analyzed retrospectively．Results The first patient was compromised with late-onset traumatic diaphragmatic hernia complicated with shock．The second and third patients were suffered from late—onset traumatic hepatic rupture．After prompt surgery operation，the first and second subjects survived．Unfortunately，the third patient died of severe abdominal infection despite successful operation .Conclusion Late-onset organ injuries must be recognized and treated promptl

静脉胰岛素泵联合持续血糖监测系统对肝移植术后患者血糖控制的有效性及安全性：附 1 例报道

目的 总结 1 例肝移植患者术后使用胰岛素泵联合持续血糖监测系统（CGMS）进行血糖控制的有效性及安全性。 方法 回顾性分析笔者所在医院科室于 2015 年 11 月收治的 1 例肝移植患者的临床资料，该患者术后使用胰岛素泵联合 CGMS 进行血糖控制。 结果 本例患者的血糖控制时间为 4 127 min。血糖控制参数：最大值 9.8 mmol/L，最小值 4.7 mmol/L（自觉无头晕、乏力等低血糖症状），平均 6.9 mmol/L，目标血糖达标时间为4 030 min，占 98%。血糖变异参数：标准差（SD ）为 1.1 mmol/L，血糖不稳定指数为 7.32（mmol/L）2/（h·d），平均血糖波动幅度为 0，平均日内血糖改变为 3.4 mmol/L。控制期间营养情况：肠内营养的碳水化合物用量为 115 g，全胃肠外营养的碳水化合物用量为 516 g，胰岛素用量为 139 U（用量均值为 2 U/h），平均采样时间为 109 min。肝移植术后 3 周患者痊愈出院，术后 1 个月随访无不适，复查糖化血红蛋白为 4.9%。 结论 胰岛素泵联合 CGMS 的血糖控制效果较好，但该结论仍需要大样本、多中心及前瞻性的随机对照试验给予证实。

机械敏感性 Piezo1 离子通道在急性呼吸窘迫综合征中的作用和机制研究

Retrospective analysis of death causes and relevant factors in victims of the 2008 W enchuan earthquake

Objective To analyze death causes and relevant factors in victims of Wenchuan earthquake．Methods Medical records of 27 dead patients admitted to W est China Hospital during the first 30 days after Wenchuan earthquake were analyzed retrospectively．Patient census data，diagnoses，dispositions，and prognoses were collected． Results A total of 2702 patients with earthquake related injuries were admitted to West China Hospital．The overall mortality rate was 1％(27／2702 patients)．The death were associated with age≥70．severe cerebral injuries and severe underlying illness．Mortality rate was highest in aged patients with comorbidities．Conclusions Insufficient pre-hospital treatment and inappropriate transfer procedure may contribute to the early death．Complicated with comorbidities is the leading cause of late death．Earlier involvement of intensivist in medical intervention in such a disaster is demanded．

Analysis of Tracheal Intubation in Intensive Care Unit

Objective To evaluate the clinical features and complications of bedside tracheal intubation in intensive care unit ( ICU) , and explore the suitable strategy of intubation. Methods In this retrospective study,42 patients who underwent bedside tracheal intubation in ICU during September 2008 and March 2009 were divided into a schedule group ( n =24) and an emergency group ( n =18) . The time to successful intubation, number of intubation attempts, and complications were recorded. The schedule group was defined as those with indications for intubation and fully prepared, while the emergency group was defined as those undergoing emergency intubations without full preparation due to rapid progression of disease and accidental extubation. Results The success rate for all patients was only 57. 1% on the first attempt ofintubation. The main complications during and after induction were hypotension ( 45. 2% ) and hypoxemia ( 50. 0% ) . Compared with the emergency group, the schedule group had fewer attempts to successful intubation ( 1. 71 ±1. 12 vs. 2. 67 ±1. 75) , higher success rate on the second attempt ( 87. 5% vs.61. 1%) , and lower ypoxemia incidence ( 29. 1% vs. 77. 8%, P lt; 0. 05) . Conclusions The tracheal intubation in ICU is a difficult and high risk procedure with obvious complications. Early recognition ofpatients with indications and well preparation are critical to successful bedside intubation.

VALUE OF MRI IN DIAGNOSIS OF OBSTETRICAL BRACHIAL PLEXUS PALSY PRE-GANGLIONIC INJURY

Objective To evaluate the value of MRI in diagnosis of obstetrical brachial plexus palsy pre-gangl ionic injury. Methods From November 2006 to February 2008, 10 patients with obstetrical brachial plexus palsy were treated, 8 males and 2 females, aged from 2 months to 3 years (11.4 months on average). There were 7 cases of left side and 3 of right side.According to Tassin classification, 2 cases were type II, 6 type III and 2 type IV. All patients were performed MRI examinations before the operation, whose results were compared with those of exploration during the operation. Results MRI examinations showed 1 patient was normal and 9 patients had post-traumatic spinalmeningolcele. The 6 patients had displacement of spinal cord (4 towards the healthy side and 2 towards the sick side), 6 had deformity of spinal cord, and 2 had avulsed nerve root thickening. MRI detected 19 nerve roots were positive, 16 were true positive and 3 false positive in surgical exploration. MRI detected 6 nerve roots were negative, 4 were true negative and 2 false negative in surgical exploration. The sensitivity, specificity and accuracy of MRI in diagnosis of obstetrical brachial plexus palsy pre-gangl ionic injury were 84.2%, 80.0% and 83.3%, respectively. There were significant differences in the results by preoperative MRI examinations and by exploration during the operation (P lt; 0.05). Conclusion MRI can show pre-gangl ionic injury of brachial plexus of the patients with obstetrical brachial plexus palsy and can supply references for early diagnosis and operation time. MRI can be routinely conducted as a preoperative examination.

Application progress and prospect of critical care ultrasound in weaning process

Weaning difficulty is common in critically ill patients. Prolonged mechanical ventilation and weaning failure adversely affect the clinical outcome. How to better promote and achieve the early extubation is a very important subject. As a multi-dimensional monitoring method of important structure, function and morphology, critical care ultrasound which is helpful to improve our understanding and grasp of the core links in the respiratory circuit can comprehensively evaluate the state and reserve capacity of some important organs, such as the heart, lungs and diaphragm. It has great value in assessment of weaning and guided treatment. This paper will review the application of severe ultrasound in weaning.

Effect of colloid priming on blood pressure in the first hour in critically ill patients receiving continuous renal replacement therapy

Objective To investigate and compare the effects of succinylated gelatin injection and saline priming on the first hour blood pressure in critically ill patients receiving continuous renal replacement therapy (CRRT). Methods Inpatients who received continuous venous-venous dialysis filtration therapy in the intensive care unit of West China Hospital of Sichuan University between January and May 2024 were selected. The patients were randomly divided into an experimental group (colloidal solution group) and a control group (crystalloid solution group) in a 1∶1 ratio. The colloidal solution group used succinylated gelatin injection as the priming solution, and used the dual connection method to draw blood to the machine. The patient’s systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate at 10 minutes before and 0, 1, 3, 5, 10, 30 and 60 minute after CRRT initiation, the name and dosage of vascular compression drugs pumped intravenously at 0, 30 and 60 minutes, and the liquid inlet and outlet in the first hour were monitored and recorded. The crystalloid solution group used normal saline as the priming solution, and the rest of the methods were the same as those of the colloidal solution group. Two groups of patients were compared for changes in blood pressure and heart rate during the first hour of CRRT, as well as the incidence of hypotension. Results A total of 208 patients were included, with 104 cases in each group. There was no significant difference in baseline data between the two groups (P>0.05). At 3 minutes after CRRT, the systolic blood pressure of the crystalloid solution group was lower than that of the colloidal solution group [(122.56±23.82) vs. (129.43±25.46) mm Hg (1 mm Hg=0.133 kPa); t=−2.005, P=0.046]. There was no statistically significant difference in diastolic blood pressure, mean arterial pressure, or heart rate between the two groups at different time points (P>0.05). The intra group comparison results showed that the systolic blood pressure of the crystalloid solution group decreased compared to before at 1, 3, 5, and 10 minutes after CRRT (P<0.05), while the diastolic blood pressure and mean arterial pressure decreased compared to before at 3, 5, and 10 minutes after the start of CRRT (P<0.05); there was no statistically significant difference in blood pressure of the colloidal solution group among different time points after the start of CRRT (P>0.05). The heart rate of the crystalloid solution group was higher at 10 minutes after the start of CRRT than at 3 minutes after CRRT (P=0.045); 60 minutes after the start of CRRT, the heart rate in the colloidal solution group was lower than that 0 minutes after CRRT (P=0.032); there was no statistically significant difference between the two groups at other time points within each group (P>0.05). On the first hour of CRRT, there was a statistically significant difference in the incidence of hypotension between the two groups [33 cases (31.7%) vs. 18 cases (17.3%); χ2=5.845, P=0.016]. Conclusions The use of colloidal solution pre-flushing is more advantageous to improving the decrease in blood pressure in the first hour of CRRT in severe patients than crystalloid solution group pre-flushing. And it can reduce the incidence of hypotension in the first hour of CRRT in severe patients.

新型冠状病毒性肺炎疫情时期器官移植调整策略及体会

目的探讨新型冠状病毒性肺炎（简称新冠肺炎）疫情时期器官捐献移植工作的调整策略，总结经验。方法解读新冠肺炎疫情期间器官移植工作指南和第一版专家共识后，四川大学华西医院器官移植中心制定了器官移植调整方法。结果于 2020 年 1 月 24 日至 2020 年 2 月 6 日进行公民逝世后器官捐献 4 例，均为男性，平均年龄 39.5 岁。捐献后共行器官移植手术 8 例，其中肝脏移植 4 例，肾脏移植 4 例。移植受体平均年龄 48 岁，男 6 例，女2 例。8 例移植手术顺利，7 例患者无输血。手术后患者恢复顺利，无外科并发症发生，无感染相关并发症发生。结论新冠肺炎疫情期间，通过调整方法和流程，可以安全开展器官移植工作和实现疫情防控。