目的 探讨胰性脑病的可能的发病机制、发病情况及防治措施.方法 计算机检索中文科技期刊全文数据库(1989～2004),收集有关胰性脑病的临床研究,并进行统计分析.结果 共纳入43篇文献,435例患者.胰性脑病在重症急性胰腺炎中的发病率远高于轻症急性胰腺炎;发病年龄趋向中、老年;病死率为43.67%;病因仍以胆系疾病为主;伴发低氧的几率不高于未并发胰性脑病患者.结论 胰性脑病的发生可能是多因素共同作用的结果,仍需进一步探讨其发病机制.血清髓鞘碱性蛋白有望成为有价值的诊断指标.防治以治疗原发病急性胰腺炎为主,重在预防.胰酶抑制剂和早期营养支持有一定预防作用.
【摘要】 目的 比较喉罩全麻与气管插管全麻两种麻醉方法在小儿侧卧位短小手术中的优缺点。 方法 2009年6月-2010年2月，将40例择期行侧卧位短小手术儿患，随机分为喉罩全麻（L）组与气管插管全麻（T）组，每组各20例。观察患儿术中心率（HR）、平均动脉压（MAP）、脉搏血氧饱和度（SpO2）、气道峰压（Pmax），恶心呕吐、术后躁动等围术期不良反应。 结果 T组插管后及拔管后即刻HR、MAP均高于L组患儿（Plt;0.05）；SpO2、Pmax在两组之间比较差异无统计学意义（Pgt;0.05），T组患儿术后躁动发生率明显高于L组（Plt;0.05）。 结论 喉罩可以安全、有效地用于小儿侧卧位短小手术麻醉，且操作简便，插管期和拔管期心血管应激反应轻，术后躁动发生率低。【Abstract】 Objective To compare the safety and efficacy of laryngeal mask airway (LMA) and tracheal tube in lateral general anesthetic operation on children. Methods From June 2009 to February 2010, 40 children scheduled to undergo general anesthesia for minor surgical procedures in lateral position were randomly divided into the laryngeal mask airway group (group L) and the tracheal tube group (group T) with 20 in each. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2), top airway pressure (Pmax) of the patients were observed. In addition, side effects such as nausea, vomiting, and emergence agitation were also recorded. Results HR and MAP of patients in group T were significantly higher than those of patients in group L after intubation and after extubation (Plt;0.05). There was no difference in Pmax and SpO2 between the two groups (Pgt;0.05). The incidence of emergence agitation in group T was significantly higher than that in group L. Conclusions LMA intubation can provide the same safe and effective ventilation as tracheal intubation for children undergoing lateral general anesthetic operation. LMA is superior to tracheal intubation in insertion response, and the incidence of emergence agitation is lower.
【摘要】 目的 观察帕瑞昔布钠超前镇痛在小儿上肢骨折手术的镇痛效果及不良反应发生情况。 方法 选择2009年6月－2010年12月气管插管全身麻醉下择期行单侧上肢骨折切开复位内固定手术患儿90例，随机分为帕瑞昔布钠组（P组）、曲马多组（T组）及对照组（C组），每组各30例患儿；于麻醉前分别静脉注射帕瑞昔布钠1 mg/kg、曲马多2 mg/kg、等容量生理盐水。3组患儿年龄、性别、体重、手术时间等一般情况差异无统计学意义（Pgt;0.05）。各组均于术后2、4、6、8 h各时间点观察患儿疼痛评分、镇静评分；观察拔除患儿气管导管后5 min躁动评分；记录患儿术中芬太尼总用量及术后镇痛药物用量；随访术后24 h内不良反应的发生情况。 结果 术后各个时间点P组疼痛评分明显低于T、C组（Plt;0.01）；T组镇静评分于术后2、4、6 h明显高于P、C组（Plt;0.01），镇静评分在P、C组之间比较差异无统计学意义（Pgt;0.05）；P组术后躁动评分明显低于T、C组（Plt;0.01）；P组患儿围手术期芬太尼用量明显少于T、C组（Plt;0.01）；T组术后恶心呕吐发生率明显高于P、C组（Plt;0.05）。P组无呼吸抑制、伤口异常出血等严重不良反应。 结论 帕瑞昔布钠超前镇痛用于小儿上肢骨折手术可产生明显镇痛作用，并可有效预防苏醒期躁动发生，明显减少围手术期芬太尼用量，恶心呕吐等不良反应发生率明显低于曲马多。【Abstract】 Objective To study the efficacy and safety of preemptive analgesia with parecoxib sodium in children undergoing upper limb orthopedic surgery. Methods Ninety children from June 2009 to December 2010 scheduled for elective upper limb orthopedic surgery under general anesthesia were selected and randomly divided into three groups with 30 children in each. For the children in group P (parecoxib sodium), group T (tramadol) and group C (control), preemptive analgesia was induced by an intravenous injection of parecoxib sodium at 1 mg/kg, tramadol at 2 mg/kg, and normal saline respectively before anesthesia. Pain intensity score and sedation score were recorded 2, 4, 6, and 8 hours respectively after operation. The agitation score was measured 5 minutes after extubation. The perioperative fentanyl consumption and postoperative analgesic medicine consumption were recorded. The adverse effects were observed within 24 hours after operation. Results The demographic data such as age, gender, weight, and operation time did not differ statistically among the three groups of children (Pgt;0.05). Compared with groups T and C, the pain score in group P was significantly lower at all time points after operation (Plt;0.01). The sedation score in group T was significantly higher than those in group P and C 2, 4, and 6 hours after operation (Plt;0.01), but the sedation score did not differ significantly between groups P and C (Pgt;0.05). The agitation score after trachea extubation in group P was significantly lower than the other two groups (Plt;0.01). The quantity of fentanyl used in group P was significantly lower than in groups T and C (Plt;0.01). The incidence of postoperative nausea or vomiting in group T was higher than those in groups P and C (Plt;0.05). There was no depression of breath or abnormal hemorrhage in group P. Conclusion Parecoxib sodium has a better analgesic effect in children undergoing upper limb orthopedic surgery. The agitation score and the incidence of postoperative nausea or vomiting are significantly lower, and the use of parecoxib sodium can also significantly reduce the perioperative fentanyl consumption.
Objective To have more insight into roles of growth differentiation factor-15 (GDF15) in digestive tumor. Method The basic and clinical studies on the GDF15 in the digestive tumors published were searched in the databases for summarizing the latest advances on this issue. Results The GDF15, a novel member of transforming growth factor-β superfamily, played the diverse roles in the progress of the various diseases. The increasing number of evidence indicated that the GDF15 was associated with the diagnosis and prognostication of the digestive tumors, eg: colorectal cancer, hepatocellular carcinoma, pancreatic adenocarcinoma, and might serve as a potential biomarker and therapeutic target for the multiple digestive tumors. Conclusions Current basic and clinical studies provide some evidences that GDF15 plays a role in digestive tumors. Further studies are needed to elucidate its roles and molecular mechanisms in different stages of diseases.
目的 评价地佐辛配伍丙泊酚联合喉罩用于无痛纤维支气管镜检查的效果。 方法 将2012年10月－12月拟行纤维支气管镜检查，且按美国麻醉医师协会分级Ⅰ或Ⅱ级的60例患者，随机分为芬太尼组（F组）、地佐辛组（D组）、生理盐水组（N组）,每组20例。采用双盲法给药，静脉注射芬太尼（10 μg/mL）或地佐辛（1 mg/mL）或生理盐水0.1 mL/kg，5 min后3组缓慢静脉注射丙泊酚2 mg/kg诱导后置入喉罩，术中保留自主呼吸，持续泵入丙泊酚4～6 mg/（kg·h）维持麻醉，观察3组患者诱导前（T0）、诱导后时（T1）、纤维支气管镜操作时（T2）、术毕时（T3）及拔除喉罩时（T4）的生命体征，记录丙泊酚总用量、苏醒时间、苏醒时的呼吸道疼痛视觉模拟评分（VAS），记录术中及术后有关并发症的发生情况。 结果 与N组相比，D、F两组丙泊酚总用量减少、苏醒时间缩短，头昏及术中体动发生率、VAS评分明显降低（P＜0.05）；呼吸暂停的发生率D组最低（P＜0.05）；恶心、呕吐的发生率F组最高（P＜0.05）。 结论 地佐辛配伍丙泊酚联合喉罩用于无痛纤维支气管镜检查，麻醉效果满意，术后镇痛效果好，值得临床推广。
Objective To evaluate the effectiveness and safety of early veno-venous hemofiltration in patients with severe acute pancreatitis (SAP). Methods We searched Cochrane Central Register of Controlled Trials (Issue 4, 2005), MEDLINE (1990 to 2006) and CBMdisc (1990 to 2006). We also handsearched the references of relevant articles. We included randomized controlled trials (RCTs) and non-randomized clinical controlled trials (CCTs) comparing early veno-venous hemofiltration versus conventional therapy only, which reported either mortality rate, cure rate, or both. Two reviewers assessed the quality of each trial and extracted data independently. Trials were graded methodologically. The Cochrane Collaboration’s RevMan 4.2.8 software was used for statistical analysis. Results Ten RCTs and 6 CCTs involving 891 patients were included, all of which were China-based. The Jadad scores of all included RCTs were less than 3. Five trials were incorrectly described as having used random allocation. The baseline data of each trial were comparable. Meta-analyses showed that hemofiltration significantly increased the overall cure rate (OR 3.01, 95%CI 1.28 to 7.09) and decreased the overall mortality rate (OR 0.43, 95%CI 0.27 to 0.70). Moreover, APACHE-II score, conversion to operation rate and incidence of complications of SAP were reduced significantly., The duration of abdominal pain or distension and hospitalization stay were shortened compared with non-hemofiltration. However, continuous veno-venous hemofiltration (CVVH) did not improve overall prognosis, with greater possibility of adverse events. Repeated or intermittent short veno-venous hemfiltration (RSVVH/ISVVH) either with or without peritoneal dialysis, could improve the overall prognosis without any adverse events reported. Conclusions Based on these findings, early RSVVH/ISVVH was effective and safe for SAP, but the efficacy of CVVH could not be proven. Current studies were only available from China and were poor in methodological quality. Further, high-quality, large-scale, randomized controlled trials are required to identify reliably the effectiveness and safety of early veno-venous hemofiltration for SAP.
Integrated traditional Chinese and Western medicine has been used to treat acute pancreatitis (AP) for more than 50 years. It has become a dominant and specialized disease treated by integrated traditional Chinese and Western medicine. After many years of clinical practice, a relatively mature and complete treatment system has been formed. Therefore, it was proposed by the Chinese Society of Integrated Traditional Chinese and Western Medicine, the Chinese Medical Association, and the Chinese Association of Traditional Chinese Medicine to update and formulate the “Guidelines for the Diagnosis and Treatment of Acute Pancreatitis with Integrated Traditional Chinese and Western Medicine” (2021) group standards in 2022, and “Integrated Traditional Chinese and Western Medicine Practice Guidelines for Diagnosis and Treatment of Acute Pancreatitis” finally published. The guideline condenses 25 kinds of important clinical issues, which guide to explain the diagnosis and treatment of AP in detail, focusing on the integration of traditional Chinese medicine and Western medicine in the management of AP, such as staging and syndrome differentiation, early fluid therapy, pain management, and organ function support in early stage. The advantages and the timing of early intervention of traditional Chinese medicine in AP are emphasized. This guideline also proposes suggestions on nutritional support, management of causes, treatment of late local complications and infections, as well as prevention of recurrence and follow-up strategies for long-term complications. This paper provides an interpretation of this guideline.
Despite of the progress in the treatment of severe acute pancreatitis (SAP), there are still factors that hinder the improvement of the efficacy of treatment: there is a lack of an accurate and easy-to-use system for early severity prediction; the multidisciplinary collaboration mechanism needs to be further optimized; there is no clinical efficacy evaluation system for traditional Chinese medicine (TCM); the therapeutic targets of TCM are unclear; the effector substances are unknown; and the research and development of new medicines is still difficult. In order to further reduce the mortality of SAP and realize the goal of improving the efficacy, we should strengthen the integration of Chinese and Western medicine, multidisciplinary collaboration, and improve the treatment levels; as well as carry out basic and clinical research oriented to clinical value. We will also promote the innovative development of combined Chinese and Western medicine in the treatment of SAP by elucidating the mechanism, validating the efficacy and commercializing the achievements. In view of SAP, a major and difficult disease, we should insist on the principle of integrity and innovation, the synergy of Chinese and Western medicines and the complementarity of advantages, and promote the innovation and development of combined Chinese and Western medicines in the treatment of SAP, so as to further reduce the morbidity and mortality and to alleviate the burden of the disease.
目的 评价喉罩联合T型密封接头通气在新生儿无痛纤维支气管镜（纤支镜）诊治中的临床效果。 方法 对2010年3月－2012年10月收治的33例拟行纤支镜诊治的新生患儿，分为喉罩组（Ⅰ组）和常规组（Ⅱ组），两组患儿在术前半小时均静脉注射咪唑安定0.2～0.3 mg/kg基础上，Ⅰ组静脉注射枸橼酸芬太尼3～5 μg/kg，置入喉罩联合T型密封接头通气下行纤支镜诊治；Ⅱ组常规表面麻醉下行纤支镜诊治。分析术前（T1）、通过声门（T2）、诊治中（T3）、检查后（T4），脉搏血氧饱和度（SpO2）、心率（HR）的变化情况、纤支镜从T型密封接头入口或鼻孔到通过声门的时间、镜检时间、支气管肺泡灌洗次数、镜检期间不良反应（呛咳、憋气、肢体运动、呼吸道损伤）及麻醉满意度（由内镜医师评价）。 结果 Ⅰ组与Ⅱ组比较，T1、T4时间点SpO2、HR差异无统计学意义，T2、T3时间点SpO2＜85%、HR＜100次/min的发生率Ⅰ组与Ⅱ组比较差异有统计学意义（P＜0.01）；纤支镜从T型密封接头入口或鼻孔到通过声门时间差异无统计学意义（P＞0.05）；Ⅱ组镜检时间短于Ⅰ组，支气管肺泡灌洗次数少于Ⅰ组；Ⅰ组不良反应低于Ⅱ组，麻醉满意度高于Ⅱ组（P＜0.05）。 结论 喉罩联合T型密封接头通气在新生儿无痛纤支镜诊治气道管理安全有效可行，医师能从容操作。
【摘要】 目的 探讨血浆胰蛋白酶原激活肽(trypsinogen activation peptide,TAP)水平与重症急性胰腺炎(severe acute pancreatitis,SAP)胰腺坏死的关系。方法 2008年6月1日—2008年12月31日,采用ELISA法测定本院的35例SAP患者血浆TAP水平,并与胰腺增强CT扫描结果作对比,分析血浆TAP水平与胰腺坏死的关系,以及SAP无胰腺坏死组与SAP胰腺坏死组血浆TAP水平的差异。结果 入院时血浆TAP水平预测胰腺坏死的最佳截值点是10.43 nmol/mL,其敏感性、特异性、阳性预测值、阴性预测值分别为75%、73.9%、60%、15%,阳性比为2.87,阴性比为0.338。入院第1天血浆TAP水平预测胰腺坏死的最佳截值点是6.91 μmol/L,其敏感性、特异性、阳性预测值、阴性预测值分别为90.9%、65.2%、55.6%、6.3%,阳性似然比为2.61,阴性似然比为0.001。SAP胰腺坏死组入院时、入院第一天血浆TAP水平高于SAP无胰腺坏死组(Plt;0.05)。结论 血浆TAP水平变化与SAP病情变化密切相关,病程早期检测血浆TAP水平有助于SAP患者胰腺坏死的预测