【摘要】 目的 探讨脓毒血症患者胆碱酯酶水平与患者病情及预后的关系。 方法 2007年6月-2009年6月，将89例脓毒血症患者设定为脓毒血症组，进行血清胆碱酯酶测定及APACHEⅡ评分；另择82例健康人为正常组，测定血清胆碱酯酶值，比较两者之间差异；89例脓毒症患者按病况再分为存活组及死亡组，比较两者之间血清胆碱酯酶及APACHEⅡ评分差异。 结果 治疗前脓毒血症组胆碱酯酶水平明显低于正常组，有统计学意义（Plt;0.01）；脓毒血症组APACHEⅡ评分与血清胆碱酯酶呈负相关；死亡组APACHEⅡ评分明显高于存活组，而血清胆碱酶低于存活组（Plt;0.01）。 结论 胆碱酯酶同APACHEⅡ评分呈负相关，能明显反映脓毒症患者病情严重程度及预后。【Abstract】 Objective To explore the relationship between the level of cholinesterase and the patients condition and the prognosis in the patients with sepsis. Methods From June 2007 to June 2009, 89 patients with sepsis were selected as the sepsis group, whose cholinesterase level was assayed and evaluated by APACHE Ⅱ score. Another 82 healthy people were as the control whose cholinesterase level was assayed and compared with that in the sepsis group. The patients in the sepsis group were subdivided into survival and death group; the level of cholinesterase and the result of APACHE Ⅱ score were compared between the two groups. Results The level of cholinesterase in sepsis group was significantly lower than that in the control group before treatment, and the difference was significant (Plt;0.01); the APACHE Ⅱ score negatively correlated with the serum cholinesterase in sepsis group. The APACHE Ⅱ score in the death group was significantly higher than that in the survival group, but the level of cholinesterase was obviously lower in the death group than that in the survival group (Plt;0.01). Conclusion The serumal cholinesterase negatively correlates with the APACHE Ⅱ score, which could obviously reflect the patients condition and the prognosis of sepsis.
【Abstract】Objective To explore the effect and indication of splenectomy in liver transplantation. Methods From January 2001 to April 2006, 260 patients underwent piggyback orthotopic liver transplantation (PBOLT), and 28 patients had undergone combined PBOLT and splenectomy (splenectomy group). These patients were compared to 56 randomly selected non-splenectomy patients from the same transplant period, meaningly two controls were selected for every non-splenectomy case. Two groups were analyzed with respect to rate of infection and survival rate, as well as biopsy-proven acute allograft rejection within 30 days after transplantation. Results Rate of infection in the splenectomy group was higher than that in the non-splenectomy patients (85.7% vs 55.4%, P＜0.05). Acute rejection and survival rates in the splenectomy group were lower than those in the non-splenectomy patients (3.6% vs 14.3%, P＜0.05; 46.4% vs 82.1%, P＜0.05). Conclusion Concomitant splenectomy with PBOLT has a significantly higher patient mortality rate; it is mainly due to its septic complications. At present, unless there is a certain indication for splenectomy, this procedure is not recommended.
Objective To explore the effect of IL-10 on the inhibition of early proinflammatory cytokine release in intraabdominal infection and early sepsis. Methods Forty eight SD rats were randomized into 4 groups, 12 in each group, ①sham operation group, ②control group, ③prophylactic group, ④therapeutic group. Group 1 underwent laparotomy only, group 2 received laparotomy and cecal ligation plus punctures (CLP) with saline injected once every 3 hrs, group 3 underwent CLP and IL-10 injection intraperitoneally 1 hr before surgery and once every 3 hrs following operation, group 4 received CLP and IL-10 injection once every 3 hrs after operation. At 3 and 9 hr points, rats were sacrificed and blood samples were taken for measurement of inflammatory cytokines. Results Almost no inflammatory cytokines were detected in sham group, CLP produced a significant rise in serum TNF-α (tumor necrosis α), IL-1, IL-6 (interleukin 1,6) in control group, IL-10 reduced the rise of inflammatory cytokines significantly. Conclusion IL-10 could inhibit the early inflammatory cytokine release in rat model of sepsis. Suggesting it may attenuate the severity of inflammation.
ObjectiveTo detecte the expressions of phosphatase and tensin homolog deleted on chromosome ten (PTEN) gene and protein in peripheral blood mononuclear cells (PBMC) of patients with sepsis and to explore its role in the pathogenesis of acute obstructive suppurative cholangitis (AOSC). MethodsThe PBMC and serum were separated from AOSC patients (n=25) before treatment and in 1 week after recure, and healthy volunteers (normal control group, n=15). The serum levels of lipopolysaccharide (LPS), tumor necrosis factor-α (TNF-α) and interleukin 10 (IL-10) were detected by enzyme linked immunosorbent assay (ELISA) methods. The mRNA and protein expression levels of PTEN, nuclear fator κB P65 (NF-κB), and inhibitor of NF-κB (IκB) were detected by real-time quantitative polymerase chain reaction (qRT-PCR) and Western blot, respectively. ResultsThe levels of LPS, TNF-α, and IL-10 before treatment were significantly higher than those of normal control group (P < 0.05), the indicators were significantly decreased and close to normal levels in 1 week after recure. The mRNA and protein expression levels of PTEN and IκB before treatment were lower than those of normal control group (P < 0.05), NF-κB P65 was higher than those of normal control group (P < 0.05), while the phosphorylation levels of PTEN and IκB were higher than those normal control group (P < 0.05), and in 1 week after recure, the above indicators returned to normal levels. ConclusionsSepsis shift may be associated with the occurrence of intestinal LPS, and caused the imbalance between proinflammatory and anti-inflammatory cytokines in the body. PTEN for phosphorylation activation of IκB or directly activation of NF-κB participate the originating process of sepsis, hinting a therapeutic potentialities in the early stage of sepsis.
Objective To compare clinical outcomes of percutaneous nephrolithotomy (PCNL) in patients who initially presented with and without urosepsis. Methods The study included patients who underwent PCNL for renal and ureter urolithiasis removal from January 2010 to December 2014 in our hospital. A 1∶1 matched-pair analysis was performed to compare outcomes and complications of patients who had obstructive urolithiasis with urosepsis initially (OUU) with patients who had obstructive urolithiasis with no urosepsis initially (NOUU) before PCNL. Results A total of 172 patients were included involving 122 (71%) males and 50 (29%) females with a mean age of 46.2 years (range 32 to 65 years). There were no significant differences between two groups in age, gender, BMI, complications, the size of the stones, stone's number and stone location (P>0.05). OUU groups had the similar stone-free rates (86.0%vs. 84.8%, P=0.829) as the NOUU group. OUU group had higher overall complications rate, longer duration of nephrostomy tube (NT), longer hospital length of stay (LOS), longer courses of postoperative antibiotics and higher grade of antibiotics after PCNL (all P<0.05). Higher fever developed postoperatively (11.6%vs. 3.5%, P=0.043), higher asymptomatic bacteriuria (11.6% vs. 3.5%, P=0.043) and symptomatic urinary tract infections (10.5% vs. 2.3%, P=0.029) were also found in OUU groups. There was no significant difference between two groups in sepsis (2.3% vs. 1.2%, P=0.560). Conclusion PCNL after decompression for urolithiasis-related urosepsis has similar success but higher complication rates than obstructive urolithiasis with no urosepsis initially.
ObjectiveTo investigate the changes of platelet-leukocyte aggregates (PLA) level in patients with sepsis and its diagnostic value in sepsis complicated with acute respiratory distress syndrome (ARDS).MethodsA prospective study was carried in adult sepsis patients admitted to our hospital from January 2015 to November 2016. According to the 2012 " Berlin definition” diagnostic criteria, 58 cases of sepsis with ARDS were allocated to an experimental group and 139 cases of sepsis non-ARDS patients were allocated to a control group. Immediately after the diagnosis of sepsis, elbow vein blood samples were collected for flow cytometry assay of PLA. The acute physiology and chronic health assessment II (APACHE II score) of each group was performed and the receiver operating characteristic (ROC) curve was drawn.ResultsPlatelet-neutrophil aggregates (PNA) and platelet-lymphocyte aggregates (PLyA) in the experimental group were higher than those in the control group, but there were no significant differences (both P>0.05). The platelet-monocyte aggregates (PMA) of the experimental group was significantly higher than that of the control group (P<0.05). Peripheral blood PMA was positively correlated with APACHE II score (r=0.671, P<0.001). When PMA was used as the test variable, the area under the curve (AUC) was 0.945 with significant diagnostic value (P<0.001), and optimal cutoff value of PMA was 8.25%, with diagnostic sensitivity of 0.806 and diagnostic specificity of 0.951. When APACHE II was used as the test variable, AUC was 0.930, with significant diagnostic value (P<0.001), and optimal threshold of APACHE II was 16.500 with diagnostic sensitivity of 0.871 and diagnostic specificity of 0.852.ConclusionPMA is of great value in the diagnosis of sepsis with ARDS.
Objective To investigate the diagnosis and treatment strategy of urosepsis caused by ureteral calculi in solitary kidney. Methods The clinical data of patients with urosepsis caused by ureteral calculi in solitary kidney in the Department of Urology of Chengdu 363 Hospital Affiliated to Southwest Medical University from March 2015 to March 2020 were analyzed retrospectively. Results A total of 23 patients were included. One patient received ureteroscopic holmium laser lithotripsy, after which urosepsis and renal function deteriorated, then got better after anti-infection and hemodialysis treatment in intensive care unit; 17 patients received implantation of ureteral stent by cystoscopy, and 5 patients received percutaneous nephrostomy by ultrasound guiding, the 22 patients received ureteroscopic lithotripsy or flexible ureteroscopic lithotripsy electively. One patients had subcapsular renal hematoma postoperatively and worse renal insufficiency, the rest 22 patients had improved renal function. All patients were cured clinically. Conclusions For solitary kidney patients who have urosepsis caused by ureteral calculi, emergency treatment is necessary. The relief of urinary obstruction must be based on effective anti-infection. Choosing cystoscopic ureteral stent implantation or percutaneous nephrostomy depends on patients’ individualization. Ureterscopic lithotripsy simultaneously is not recommended. Ureteral intubation before cystoscopic ureteral stent implantation is important, which can increase the success rate of ureteral stent implantation.