BACKGROUND:The timing and selection of patients for liver transplantation in acute liver failure are great challenges.This study aimed to investigate the effect of Glasgow coma scale(GCS)and APACHE-II scores on liver ...BACKGROUND:The timing and selection of patients for liver transplantation in acute liver failure are great challenges.This study aimed to investigate the effect of Glasgow coma scale(GCS)and APACHE-II scores on liver transplantation outcomes in patients with acute liver failure.METHOD:A total of 25 patients with acute liver failure were retrospectively analyzed according to age,etiology,time to transplantation,coma scores,complications and mortality.RESULTS:Eighteen patients received transplants from live donors and 7 had cadaveric whole liver transplants.The mean duration of follow-up after liver transplantation was 39.86±40.23 months.Seven patients died within the perioperative period and the 1-,3-,5-year survival rates of the patients were72%,72%and 60%,respectively.The parameters evaluated for the perioperative deaths versus alive were as follows:the mean age of the patients was 33.71 vs 28 years,MELD score was 40 vs32.66,GCS was 5.57 vs 10.16,APACHE-II score was 23 vs 18.11,serum sodium level was 138.57 vs 138.44 mmol/L,mean waiting time before the operation was 12 vs 5.16 days.Low GCS,high APACHE-II score and longer waiting time before the operation(P【0.01)were found as statistically significant factors for perioperative mortality.CONCLUSION:Lower GCS and higher APACHE-II scores are related to poor outcomes in patients with acute liver failure after liver transplantation.展开更多
Perpose: In order to establish the pathophysiological features and strategy for stercoral perforation of the colon, we herein analyze a series of stercoral perforation of the colon. Method: Ten patients were diagnosed...Perpose: In order to establish the pathophysiological features and strategy for stercoral perforation of the colon, we herein analyze a series of stercoral perforation of the colon. Method: Ten patients were diagnosed with stercoral perforation. Clinical features, primary diseases, triggers, causative bacteria in ascites, postoperative complications, pathological features, severity of the disease, and effect of direct hemoperfusion with polymyxin B immobilized fiber (PMX-DHP) were investigated. Results: Nine patients had a long history of serious and chronic constipation and 7 patients had hypertension. Causative bacteria in ascites during the operation were most commonly Escherichia coli. There were a lot of severe postoperative complications such as sepsis, disseminated intravascular coagulation, and acute lung injury. With regard to the microscopic findings of the perforation site, the intestinal wall showed severe nonspecific inflammatory changes, including an increase of mono-nuclear cells in the lamina propria. There were 4 hospital deaths, so the mortality rate was 40%. APACHE- II and SOFA score were high postoperation and 24 hours after the operation. PMX-DHP was performed in 8 cases of severe conditions of stercoral perforation of the colon. Because the catecholamine index improved within 24 hours, four of 8 cases were rescued. Conclusion: Most of the patients with stercoral perforation of the colon had severe postoperative complications. The severity of the disease was extremely high, therefore, early diagnosis based on pathophy-siological features and comprehensive therapies including PMX-DHP were necessary for strategy of treating stercoral perforation of the colon.展开更多
Objective: To explore the clinical effect of glutamine combined with ulinastatin in the diagnosis and treatment of sepsis. Methods: Sixty-four patients with sepsis were admitted to the emergency department of our hosp...Objective: To explore the clinical effect of glutamine combined with ulinastatin in the diagnosis and treatment of sepsis. Methods: Sixty-four patients with sepsis were admitted to the emergency department of our hospital from January 2020 to January 2021. They were divided into two groups according to the random number table method. They were divided into the control group (n=32) and the treatment group (n=32). Those who received single drug therapy (ulinastatin) were included in the control group, and those who received cooperative drug therapy (ulinastatin+glutamine) were included in the treatment. ① Effective rate: the effective rate in the treatment group was higher than that in the control group (P < 0.05);②APACHE-II score (acute and chronic health score system). Compared with before treatment (P > 0.05), the APACHE-II scores of the treatment group and the control group all increased after treatment, and the increase of the treatment group was more obvious (P < 0.05). ③ Levels of inflammatory factors: before the start of the treatment plan, there was no significant difference between the two groups through the measurement of interleukin -1β, interleukin -6 and other indicators (P > 0.05). After the implementation of the treatment operation, the levels of the above indicators in the treatment group were lower (P < 0.05). ④ Immune function: before the treatment plan was launched, there was no significant difference in IgG, IgA and other indicators between the two groups (P > 0.05). After the treatment operation was implemented, the above indicators in the treatment group were higher (P < 0.05). ⑤ Adverse reactions: In terms of the incidence of nausea and vomiting, the treatment group and the control group were compared (P > 0.05). Conclusion: The combination of glutamine and ulinastatin in the diagnosis and treatment of sepsis is effective, which is beneficial to relieve symptoms, weaken the expression activity of inflammatory factors, and improve immune function, and has high application value.展开更多
Background Evaluation of the severity of the pregnant women with suitable admission to the Intensive Care Unit （ICU） is very important for obstetricians. By now there are no criteria for critically ill obstetric pat...Background Evaluation of the severity of the pregnant women with suitable admission to the Intensive Care Unit （ICU） is very important for obstetricians. By now there are no criteria for critically ill obstetric patients admitted to the ICU. In this article, we investigated the admission criteria of critically ill patients admitted to the ICU in order to provide a referral basis of reasonable use of the ICU. Methods A retrospective analysis of critically ill pregnant women admitted to the ICU in Perking University Third Hospital in China in the last 6 years （from January 2006 to December 2011） was performed, using acute physiology and chronic health evaluation II （APACHE-II）, Marshall and WHO near miss criteria to assess the severity of illness of patients. Results There were 101 critically ill pregnant patients admitted to the ICU. Among them, 25.7% women were complicated with internal or surgical diseases, and 23.8% women were patients of postpartum hemorrhage and 23.8% women were patients of pregnancy-induced hypertension. Sixty-nine cases （68.3%） were administrated with adjunct respiration with a respirator. Sixteen cases （15.8%） required 1-2 types of vasoactive drugs. Fifty-five cases （54.5%） required a hemodynamic monitoring. Seventy-three cases （72.3%） had multiple organ dysfunctions （MODS）. The average duration in ICU was （7.5＋3.0） days. A total of 12.9%, 23.8% and 74.3% of women were diagnosed as critically ill according to the APACHE-II, Marshall and WHO near miss criteria, respectively. The rate was significantly different according to the three criteria （P〈0.01）. Conclusions The WHO near miss criteria can correctly reflect the severity of illness of pregnant women, and the WHO near miss criteria are appropriate for admission of critically ill pregnant women to ICU in China.展开更多
Background Although small-bowel perforation is a life-threatening emergency even after immediate surgical intervention,studies have rarely investigated surgical outcomes due to its relatively low incidence.This study ...Background Although small-bowel perforation is a life-threatening emergency even after immediate surgical intervention,studies have rarely investigated surgical outcomes due to its relatively low incidence.This study aimed to investigate the outcomes of emergency surgery for patients with small-bowel perforation transferred to the intensive care unit(ICU)and the risk factors for mortality.Methods Consecutive patients with small-bowel perforation who were confirmed via emergency surgery and transferred to the ICU in Zhongshan Hospital,Fudan University(Shanghai,China)between February 2011 and May 2020 were retrospectively analysed.Medical records were reviewed to determine clinical features,laboratory indicators,surgical findings,and pathology.Results A total of 104 patients were included in this study,among whom 18(17.3%),59(56.7%),and 27(26.0%)underwent perforation repair,segmental resection with primary anastomosis,and small-bowel ostomy,respectively.Malignant tumours were the leading cause of perforation in these patients(40.4%,42/104).The overall post-operative complication rate and mortality rates were 74.0%(77/104)and 19.2%(20/104),respectively.Malignant tumour-related perforation(odds ratio[OR],4.659;95%confidence interval[CI],1.269–17.105;P=0.020)and high post-operative arterial blood-lactate level(OR,1.479;95%CI,1.027–2.131;P=0.036)were identified as independent risk factors for post-operative mortality in patients with small-bowel perforation transferred to the ICU.Conclusions Patients with small-bowel perforation who are transferred to the ICU after emergency surgery face a high risk of post-operative complications and mortality.Moreover,those patients with malignant tumour-related perforation and higher post-operative blood-lactate levels have poor prognosis.展开更多
文摘BACKGROUND:The timing and selection of patients for liver transplantation in acute liver failure are great challenges.This study aimed to investigate the effect of Glasgow coma scale(GCS)and APACHE-II scores on liver transplantation outcomes in patients with acute liver failure.METHOD:A total of 25 patients with acute liver failure were retrospectively analyzed according to age,etiology,time to transplantation,coma scores,complications and mortality.RESULTS:Eighteen patients received transplants from live donors and 7 had cadaveric whole liver transplants.The mean duration of follow-up after liver transplantation was 39.86±40.23 months.Seven patients died within the perioperative period and the 1-,3-,5-year survival rates of the patients were72%,72%and 60%,respectively.The parameters evaluated for the perioperative deaths versus alive were as follows:the mean age of the patients was 33.71 vs 28 years,MELD score was 40 vs32.66,GCS was 5.57 vs 10.16,APACHE-II score was 23 vs 18.11,serum sodium level was 138.57 vs 138.44 mmol/L,mean waiting time before the operation was 12 vs 5.16 days.Low GCS,high APACHE-II score and longer waiting time before the operation(P【0.01)were found as statistically significant factors for perioperative mortality.CONCLUSION:Lower GCS and higher APACHE-II scores are related to poor outcomes in patients with acute liver failure after liver transplantation.
文摘Perpose: In order to establish the pathophysiological features and strategy for stercoral perforation of the colon, we herein analyze a series of stercoral perforation of the colon. Method: Ten patients were diagnosed with stercoral perforation. Clinical features, primary diseases, triggers, causative bacteria in ascites, postoperative complications, pathological features, severity of the disease, and effect of direct hemoperfusion with polymyxin B immobilized fiber (PMX-DHP) were investigated. Results: Nine patients had a long history of serious and chronic constipation and 7 patients had hypertension. Causative bacteria in ascites during the operation were most commonly Escherichia coli. There were a lot of severe postoperative complications such as sepsis, disseminated intravascular coagulation, and acute lung injury. With regard to the microscopic findings of the perforation site, the intestinal wall showed severe nonspecific inflammatory changes, including an increase of mono-nuclear cells in the lamina propria. There were 4 hospital deaths, so the mortality rate was 40%. APACHE- II and SOFA score were high postoperation and 24 hours after the operation. PMX-DHP was performed in 8 cases of severe conditions of stercoral perforation of the colon. Because the catecholamine index improved within 24 hours, four of 8 cases were rescued. Conclusion: Most of the patients with stercoral perforation of the colon had severe postoperative complications. The severity of the disease was extremely high, therefore, early diagnosis based on pathophy-siological features and comprehensive therapies including PMX-DHP were necessary for strategy of treating stercoral perforation of the colon.
文摘Objective: To explore the clinical effect of glutamine combined with ulinastatin in the diagnosis and treatment of sepsis. Methods: Sixty-four patients with sepsis were admitted to the emergency department of our hospital from January 2020 to January 2021. They were divided into two groups according to the random number table method. They were divided into the control group (n=32) and the treatment group (n=32). Those who received single drug therapy (ulinastatin) were included in the control group, and those who received cooperative drug therapy (ulinastatin+glutamine) were included in the treatment. ① Effective rate: the effective rate in the treatment group was higher than that in the control group (P < 0.05);②APACHE-II score (acute and chronic health score system). Compared with before treatment (P > 0.05), the APACHE-II scores of the treatment group and the control group all increased after treatment, and the increase of the treatment group was more obvious (P < 0.05). ③ Levels of inflammatory factors: before the start of the treatment plan, there was no significant difference between the two groups through the measurement of interleukin -1β, interleukin -6 and other indicators (P > 0.05). After the implementation of the treatment operation, the levels of the above indicators in the treatment group were lower (P < 0.05). ④ Immune function: before the treatment plan was launched, there was no significant difference in IgG, IgA and other indicators between the two groups (P > 0.05). After the treatment operation was implemented, the above indicators in the treatment group were higher (P < 0.05). ⑤ Adverse reactions: In terms of the incidence of nausea and vomiting, the treatment group and the control group were compared (P > 0.05). Conclusion: The combination of glutamine and ulinastatin in the diagnosis and treatment of sepsis is effective, which is beneficial to relieve symptoms, weaken the expression activity of inflammatory factors, and improve immune function, and has high application value.
文摘Background Evaluation of the severity of the pregnant women with suitable admission to the Intensive Care Unit （ICU） is very important for obstetricians. By now there are no criteria for critically ill obstetric patients admitted to the ICU. In this article, we investigated the admission criteria of critically ill patients admitted to the ICU in order to provide a referral basis of reasonable use of the ICU. Methods A retrospective analysis of critically ill pregnant women admitted to the ICU in Perking University Third Hospital in China in the last 6 years （from January 2006 to December 2011） was performed, using acute physiology and chronic health evaluation II （APACHE-II）, Marshall and WHO near miss criteria to assess the severity of illness of patients. Results There were 101 critically ill pregnant patients admitted to the ICU. Among them, 25.7% women were complicated with internal or surgical diseases, and 23.8% women were patients of postpartum hemorrhage and 23.8% women were patients of pregnancy-induced hypertension. Sixty-nine cases （68.3%） were administrated with adjunct respiration with a respirator. Sixteen cases （15.8%） required 1-2 types of vasoactive drugs. Fifty-five cases （54.5%） required a hemodynamic monitoring. Seventy-three cases （72.3%） had multiple organ dysfunctions （MODS）. The average duration in ICU was （7.5＋3.0） days. A total of 12.9%, 23.8% and 74.3% of women were diagnosed as critically ill according to the APACHE-II, Marshall and WHO near miss criteria, respectively. The rate was significantly different according to the three criteria （P〈0.01）. Conclusions The WHO near miss criteria can correctly reflect the severity of illness of pregnant women, and the WHO near miss criteria are appropriate for admission of critically ill pregnant women to ICU in China.
基金supported by National Nature Science Foundation of China(No.82172803).
文摘Background Although small-bowel perforation is a life-threatening emergency even after immediate surgical intervention,studies have rarely investigated surgical outcomes due to its relatively low incidence.This study aimed to investigate the outcomes of emergency surgery for patients with small-bowel perforation transferred to the intensive care unit(ICU)and the risk factors for mortality.Methods Consecutive patients with small-bowel perforation who were confirmed via emergency surgery and transferred to the ICU in Zhongshan Hospital,Fudan University(Shanghai,China)between February 2011 and May 2020 were retrospectively analysed.Medical records were reviewed to determine clinical features,laboratory indicators,surgical findings,and pathology.Results A total of 104 patients were included in this study,among whom 18(17.3%),59(56.7%),and 27(26.0%)underwent perforation repair,segmental resection with primary anastomosis,and small-bowel ostomy,respectively.Malignant tumours were the leading cause of perforation in these patients(40.4%,42/104).The overall post-operative complication rate and mortality rates were 74.0%(77/104)and 19.2%(20/104),respectively.Malignant tumour-related perforation(odds ratio[OR],4.659;95%confidence interval[CI],1.269–17.105;P=0.020)and high post-operative arterial blood-lactate level(OR,1.479;95%CI,1.027–2.131;P=0.036)were identified as independent risk factors for post-operative mortality in patients with small-bowel perforation transferred to the ICU.Conclusions Patients with small-bowel perforation who are transferred to the ICU after emergency surgery face a high risk of post-operative complications and mortality.Moreover,those patients with malignant tumour-related perforation and higher post-operative blood-lactate levels have poor prognosis.
