As the core facility of offshore wind power systems,the structural safety of offshore booster stations directly impacts the stable operation of entire wind farms.With the global energy transition toward green and lowc...As the core facility of offshore wind power systems,the structural safety of offshore booster stations directly impacts the stable operation of entire wind farms.With the global energy transition toward green and lowcarbon goals,offshore wind power has emerged as a key renewable energy source,yet its booster stations face harsh marine environments,including persistent wave impacts,salt spray corrosion,and equipment-induced vibrations.Traditional monitoring methods relying on manual inspections and single-dimensional sensors suffer from critical limitations:low efficiency,poor real-time performance,and inability to capture millinewton-level stress fluctuations that signal early structural fatigue.To address these challenges,this study proposes a biomechanics-driven structural safety monitoring system integrated with deep learning.Inspired by biological stress-sensing mechanisms,the system deploys a distributedmulti-dimensional force sensor network to capture real-time stress distributions in key structural components.A hybrid convolutional neural network-radial basis function(CNN-RBF)model is developed:the CNN branch extracts spatiotemporal features from multi-source sensing data,while the RBF branch reconstructs the nonlinear stress field for accurate anomaly diagnosis.The three-tier architectural design—data layer(distributed sensor array),function layer(CNN-RBF modeling),and application layer(edge computing terminal)—enables a closedloop process from high-resolution data collection to real-time early warning,with data processing delay controlled within 200 ms.Experimental validation against traditional SOM-based systems demonstrates significant performance improvements:monitoring accuracy increased by 19.8%,efficiency by 23.4%,recall rate by 20.5%,and F1 score by 21.6%.Under extreme weather(e.g.,typhoons and winter storms),the system’s stability is 40% higher,with user satisfaction improving by 17.2%.The biomechanics-inspired sensor design enhances survival rates in salt fog(85.7%improvement)and dynamic loads,highlighting its robust engineering applicability for intelligent offshore wind farm maintenance.展开更多
This paper focuses on the research of the main transformer selection and layout scheme for new energy step-up substations.From the perspective of engineering design,it analyzes the principles of main transformer selec...This paper focuses on the research of the main transformer selection and layout scheme for new energy step-up substations.From the perspective of engineering design,it analyzes the principles of main transformer selection,key parameters,and their matching with the characteristics of new energy.It also explores the layout methods and optimization strategies.Combined with typical case studies,optimization suggestions are proposed for the design of main transformers in new energy step-up substations.The research shows that rational main transformer selection and scientific layout schemes can better adapt to the characteristics of new energy projects while effectively improving land use efficiency and economic viability.This study can provide technical experience support for the design of new energy projects.展开更多
BACKGROUND:The surgical step-up approach often requires multiple debridements and might not be suitable for infected pancreatic necrosis(IPN)patients with various abscesses or no safe route for percutaneous catheter d...BACKGROUND:The surgical step-up approach often requires multiple debridements and might not be suitable for infected pancreatic necrosis(IPN)patients with various abscesses or no safe route for percutaneous catheter drainage(PCD).This case-control study aimed to investigate the safety and effectiveness of one-step laparoscopic pancreatic necrosectomy(LPN)in treating IPN.METHODS:This case-control study included IPN patients undergoing one-step LPN or surgical step-up in our center from January 2015 to December 2020.The short-term and long-term complications after surgery,length of hospital stay,and postoperative ICU stays in both groups were analyzed.Univariate and multivariate logistic regression analyses were performed to explore the risk factors of major complications or death.RESULTS:A total of 53 IPN patients underwent one-step LPN and 37 IPN patients underwent surgical step-up approach in this study.There was no significant difference in the incidence of death,major complications,new-onset diabetes,or new-onset pancreatic exocrine insufficiency between the two groups.However,the length of hospital stay in the one-step LPN group was significantly shorter than that in the surgical step-up group.Univariate regression analysis showed that the surgical approach(one-step/step-up)was not the risk factor for major complications or death.Multivariate logistic regression analysis indicated that computed tomography(CT)severity index,American Society of Anesthesiologists(ASA)class IV,and white blood cell(WBC)were the significant risk factors for major complications or death.CONCLUSION:One-step LPN is as safe and effective as the surgical step-up approach for treating IPN patients,and reduces total hospital stay.展开更多
AIM To determine percentage of patients of necrotizing pancreatitis(NP) requiring intervention and the types of interventions performed. Outcomes of patients of step up necrosectomy to those of direct necrosectomy wer...AIM To determine percentage of patients of necrotizing pancreatitis(NP) requiring intervention and the types of interventions performed. Outcomes of patients of step up necrosectomy to those of direct necrosectomy were compared. Operative mortality, overall mortality, morbidity and overall length of stay were determined. METHODS After institutional ethics committee clearance and waiver of consent, records of patients of pancreatitis were reviewed. After excluding patients as per criteria, epidemiologic and clinical data of patients of NP was noted. Treatment protocol was reviewed. Data of patients in whom stepup approach was used was compared to those in whom it was not used. RESULTS A total of 41 interventions were required in 39% patients. About 60% interventions targeted the pancreatic necrosis while the rest were required to deal with the complications of the necrosis. Image guided percutaneous catheter drainage was done in 9 patients for infected necrosis all of whom required further necrosectomy and in 3 patients with sterile necrosis. Direct retroperitoneal or anterior necrosectomy was performed in 15 patients. The average time to first intervention was 19.6 d in the non step-up group(range 11-36) vs 18.22 d in the Step-up group(range 13-25). The average hospital stay in non step-up group was 33.3 d vs 38 d in step up group. The mortality in the step-up group was 0%(0/9) vs 13%(2/15) in the non step up group. Overall mortality was 10.3% while post-operative mortality was 8.3%. Average hospital stay was 22.25 d.CONCLUSION Early conservative management plays an important role in management of NP. In patients who require intervention, the approach used and the timing of intervention should be based upon the clinical condition and local expertise available. Delaying intervention and use of minimal invasive means when intervention is necessary is desirable. The step-up approach should be used whenever possible. Even when the classical retroperitoneal catheter drainage is not feasible, there should be an attempt to follow principles of step-up technique to buy time. The outcome of patients in the step-up group compared to the non stepup group is comparable in our series. Interventions for bowel diversion, bypass and hemorrhage control should be done at the appropriate times.展开更多
The ideal treatment strategy for Crohn’s disease (CD) remains uncertain, as does the optimal endpoint of therapy. Top-down versus step-up describes two different approaches: early use of immunomodulators and biologic...The ideal treatment strategy for Crohn’s disease (CD) remains uncertain, as does the optimal endpoint of therapy. Top-down versus step-up describes two different approaches: early use of immunomodulators and biological agents in the former versus initial treatment with steroids in the latter, with escalation to immunomodulators or biological drugs in patients proven to be steroid refractory or steroid dependent. Top-down therapy has been associated with higher rates of mucosal healing. If mucosal healing proves to be associated with better long-term outcomes, such as a decreased need for hospitalization and surgery, top-down therapy may be the better approach for many patients. The main concern with the top-down approach is the toxicity of the immunomodulators and biological agents, which have been linked with infectious complications as well as an increased risk of lymphoma. It is unlikely that one strategy will be best for all patients given the underlying heterogeneity of CD presentation and severity. Ultimately, we must weigh the safety and efficacy of the therapies with the risks of the disease itself. Unfortunately our ability to risk stratify patients at diagnosis remains rudimentary. The purpose of this paper is to review the data that supports or refutes the differing treatment paradigms in CD, and to provide a rationale for an approach, termed the "accelerated step-up" approach, which attempts to balance the risks and benefits of our currently available therapies with the risk of disease related complications as we understand them in 2008.展开更多
BACKGROUND Emphysematous hepatitis(EH)is a rare,rapidly progressive fulminant gasforming infection of the liver parenchyma.It is often fatal and mostly affects diabetes patients.CASE SUMMARY We report a case of EH suc...BACKGROUND Emphysematous hepatitis(EH)is a rare,rapidly progressive fulminant gasforming infection of the liver parenchyma.It is often fatal and mostly affects diabetes patients.CASE SUMMARY We report a case of EH successfully managed by a step-up approach consisting of aggressive hemodynamic support,intravenous antibiotics,and percutaneous drainage,ultimately followed by laparoscopic deroofing.Of 11 documented cases worldwide,only 1 of the patients survived,treated by urgent laparotomy and surgical debridement.CONCLUSION EH is a life-threatening infection.Its high mortality rate makes timely diagnosis essential,in order to navigate treatment accordingly.展开更多
Double-crossed-step-stress(DCSS) accelerated life test(ALT) method is widely used for estimating the lifetime of products with high reliability and long lifetime. In order to further reduce the test time and test cost...Double-crossed-step-stress(DCSS) accelerated life test(ALT) method is widely used for estimating the lifetime of products with high reliability and long lifetime. In order to further reduce the test time and test cost, a double-synchronous-step-stress(DSSS) ALT method which combines a double-synchronous-step-downstress(DSSDS) ALT method and a double-synchronous-step-up-stress(DSSUS) ALT method is proposed. The accelerated stresses decrease and increase in a synchronous way with one step in the DSSDS-ALT and DSSUSALT methods, respectively. Monte Carlo method is adopted to simulate the two methods, and the validity and efficiency of them are demonstrated by the simulation results. In addition, a comparison analysis of efficiency between DSSDS-ALT method and DSSUS-ALT method is carried out. The result shows that the DSSDS-ALT method compared with the DSSUS-ALT method can significantly improve the test efficiency under the same test condition.展开更多
This work focuses on the fuzzy controller for the proposed three-phase interleaved Step-up converter(ISC).The fuzzy controller for the proposed ISC converters for electric vehicles has been discussed in detail.The pro...This work focuses on the fuzzy controller for the proposed three-phase interleaved Step-up converter(ISC).The fuzzy controller for the proposed ISC converters for electric vehicles has been discussed in detail.The proposed ISC direct current(DC-DC)converter could also be used in automobiles,satellites,industries,and propulsion.To enhance voltage gain,the proposed ISC Converter combines boost converter and interleaved converter(IC).This design also reduces the number of switches.As a result,ISC converter switching losses are reduced.The proposed ISC Converter topology can produce a 143 V output voltage and 1 kW of power.Due to the high voltage gain of this converter design,it is suitable for medium and high-power systems.The proposed ISC Converter topology is simulated in MATLAB/Simulink.The simulated output displays a high output voltage.But the output voltage contains maximum ripples.Fuzzy proposes an ISC Converter which makes closed loop responsiveness and reduces the output voltage ripple.The proposed ISC converter has the lowest ripple output voltage,which is less than 2%,because the duty cycle is regulated using the fuzzy logic controller.It offers high voltage gain,minimal ripple,and low switching loss.The performance of the proposed converter is compared to that of the fuzzy and Pro-portional Integral(PI)controllers implemented in MATLAB.展开更多
A Single Switch Hybrid Step-up Converter with high voltage gain, which is suitable for renewable energy system, is proposed in this paper. The proposed converter consists of one switched diode-inductor cell and a capa...A Single Switch Hybrid Step-up Converter with high voltage gain, which is suitable for renewable energy system, is proposed in this paper. The proposed converter consists of one switched diode-inductor cell and a capacitor. While switching, both are charged in parallel from the input source and discharged in series to the output. In order to obtain extra voltage gain at lower duty cycle, the voltage multiplier cell is integrated with the proposed converter. The main advantages of the converter are high voltage gain, reduced voltage stress, simple structure and low output voltage ripples. The operating principle and steady state theoretical analysis are presented. A 250 W prototype converter is implemented with 12 V input and 120 V output to verify the design and analysis of this converter and it has an efficiency of over 90% in all operations.展开更多
目的探讨多学科团队(MDT)模式下升阶梯(Step-up)与跨阶梯(Step-jump)策略治疗重症急性胰腺炎(SAP)合并感染性胰腺坏死(IPN)的效果对比。方法回顾性分析2021年1月至2024年6月期间曲靖市第一人民医院收治的57例SAP合并IPN患者的临床资料,...目的探讨多学科团队(MDT)模式下升阶梯(Step-up)与跨阶梯(Step-jump)策略治疗重症急性胰腺炎(SAP)合并感染性胰腺坏死(IPN)的效果对比。方法回顾性分析2021年1月至2024年6月期间曲靖市第一人民医院收治的57例SAP合并IPN患者的临床资料,经MDT评估后分为两组,Step-up组(n=35)采用升阶梯策略治疗,Step-jump组(n=22)采用跨阶梯策略治疗。采用独立样本t检验、Mann-Whitney U和χ^(2)检验比较两组患者手术时间,术中出血量及输血情况,术后抗生素使用时间和引流管拔除时间,住院时间,术后生命体征、实验室检查、影像学检查等指标和并发症发生情况;采用Kaplan-Meier法绘制两组患者的生存曲线。结果57例患者中,3例拒绝手术,54例接受手术治疗,术后48~72 h生命体征均恢复稳定。Step-jump组与Step-up组患者相比,手术时间延长[145.0(104.0,186.0)min vs 97.0(65.0,130.0)min,P=0.041],术中出血量增加[130.0(80.0,180.0)m L vs 60.0(40.0,80.0)m L,P<0.001],差异有统计学意义。两组患者在术后第3天C反应蛋白(CRP)[(127.8±44.9)mg/L vs(118.3±52.9)mg/L]、术后第3天白细胞计数(WBC)[(13.1±3.1)×10^(9)/L vs(12.8±2.6)×10^(9)/L]、抗生素使用时间[(12.5±2.0)d vs(13.2±4.1)d]、总体并发症发生率[12.1%(4/33)vs 14.3%(3/21)]方面比较,差异无统计学意义(均P>0.05)。两组患者在总住院时间、ICU住院时间、引流管拔除时间、术后生命体征转归时间等方面比较,差异无统计学意义(P>0.05)。术后影像学随访提示两组患者胰周病变均明显改善。Step-jump组和Step-up组患者术后30 d累积生存率分别为95.5%、94.3%。结论根据MDT评估结果对SAP合并IPN患者选取升阶梯或跨阶梯策略进行治疗,均有较好的临床效果和安全性。展开更多
基金supported by the Science and Technology Project of China Huaneng Group Co.,Ltd.Research on Key Technologies for Monitoring and Protection of Offshore Wind Power Underwater Equipment(HNKJ21-H40).
文摘As the core facility of offshore wind power systems,the structural safety of offshore booster stations directly impacts the stable operation of entire wind farms.With the global energy transition toward green and lowcarbon goals,offshore wind power has emerged as a key renewable energy source,yet its booster stations face harsh marine environments,including persistent wave impacts,salt spray corrosion,and equipment-induced vibrations.Traditional monitoring methods relying on manual inspections and single-dimensional sensors suffer from critical limitations:low efficiency,poor real-time performance,and inability to capture millinewton-level stress fluctuations that signal early structural fatigue.To address these challenges,this study proposes a biomechanics-driven structural safety monitoring system integrated with deep learning.Inspired by biological stress-sensing mechanisms,the system deploys a distributedmulti-dimensional force sensor network to capture real-time stress distributions in key structural components.A hybrid convolutional neural network-radial basis function(CNN-RBF)model is developed:the CNN branch extracts spatiotemporal features from multi-source sensing data,while the RBF branch reconstructs the nonlinear stress field for accurate anomaly diagnosis.The three-tier architectural design—data layer(distributed sensor array),function layer(CNN-RBF modeling),and application layer(edge computing terminal)—enables a closedloop process from high-resolution data collection to real-time early warning,with data processing delay controlled within 200 ms.Experimental validation against traditional SOM-based systems demonstrates significant performance improvements:monitoring accuracy increased by 19.8%,efficiency by 23.4%,recall rate by 20.5%,and F1 score by 21.6%.Under extreme weather(e.g.,typhoons and winter storms),the system’s stability is 40% higher,with user satisfaction improving by 17.2%.The biomechanics-inspired sensor design enhances survival rates in salt fog(85.7%improvement)and dynamic loads,highlighting its robust engineering applicability for intelligent offshore wind farm maintenance.
文摘This paper focuses on the research of the main transformer selection and layout scheme for new energy step-up substations.From the perspective of engineering design,it analyzes the principles of main transformer selection,key parameters,and their matching with the characteristics of new energy.It also explores the layout methods and optimization strategies.Combined with typical case studies,optimization suggestions are proposed for the design of main transformers in new energy step-up substations.The research shows that rational main transformer selection and scientific layout schemes can better adapt to the characteristics of new energy projects while effectively improving land use efficiency and economic viability.This study can provide technical experience support for the design of new energy projects.
基金This work was supported by the Clinical Research Physician Program of Tongji Medical College,Huazhong University of Science and Technology。
文摘BACKGROUND:The surgical step-up approach often requires multiple debridements and might not be suitable for infected pancreatic necrosis(IPN)patients with various abscesses or no safe route for percutaneous catheter drainage(PCD).This case-control study aimed to investigate the safety and effectiveness of one-step laparoscopic pancreatic necrosectomy(LPN)in treating IPN.METHODS:This case-control study included IPN patients undergoing one-step LPN or surgical step-up in our center from January 2015 to December 2020.The short-term and long-term complications after surgery,length of hospital stay,and postoperative ICU stays in both groups were analyzed.Univariate and multivariate logistic regression analyses were performed to explore the risk factors of major complications or death.RESULTS:A total of 53 IPN patients underwent one-step LPN and 37 IPN patients underwent surgical step-up approach in this study.There was no significant difference in the incidence of death,major complications,new-onset diabetes,or new-onset pancreatic exocrine insufficiency between the two groups.However,the length of hospital stay in the one-step LPN group was significantly shorter than that in the surgical step-up group.Univariate regression analysis showed that the surgical approach(one-step/step-up)was not the risk factor for major complications or death.Multivariate logistic regression analysis indicated that computed tomography(CT)severity index,American Society of Anesthesiologists(ASA)class IV,and white blood cell(WBC)were the significant risk factors for major complications or death.CONCLUSION:One-step LPN is as safe and effective as the surgical step-up approach for treating IPN patients,and reduces total hospital stay.
文摘AIM To determine percentage of patients of necrotizing pancreatitis(NP) requiring intervention and the types of interventions performed. Outcomes of patients of step up necrosectomy to those of direct necrosectomy were compared. Operative mortality, overall mortality, morbidity and overall length of stay were determined. METHODS After institutional ethics committee clearance and waiver of consent, records of patients of pancreatitis were reviewed. After excluding patients as per criteria, epidemiologic and clinical data of patients of NP was noted. Treatment protocol was reviewed. Data of patients in whom stepup approach was used was compared to those in whom it was not used. RESULTS A total of 41 interventions were required in 39% patients. About 60% interventions targeted the pancreatic necrosis while the rest were required to deal with the complications of the necrosis. Image guided percutaneous catheter drainage was done in 9 patients for infected necrosis all of whom required further necrosectomy and in 3 patients with sterile necrosis. Direct retroperitoneal or anterior necrosectomy was performed in 15 patients. The average time to first intervention was 19.6 d in the non step-up group(range 11-36) vs 18.22 d in the Step-up group(range 13-25). The average hospital stay in non step-up group was 33.3 d vs 38 d in step up group. The mortality in the step-up group was 0%(0/9) vs 13%(2/15) in the non step up group. Overall mortality was 10.3% while post-operative mortality was 8.3%. Average hospital stay was 22.25 d.CONCLUSION Early conservative management plays an important role in management of NP. In patients who require intervention, the approach used and the timing of intervention should be based upon the clinical condition and local expertise available. Delaying intervention and use of minimal invasive means when intervention is necessary is desirable. The step-up approach should be used whenever possible. Even when the classical retroperitoneal catheter drainage is not feasible, there should be an attempt to follow principles of step-up technique to buy time. The outcome of patients in the step-up group compared to the non stepup group is comparable in our series. Interventions for bowel diversion, bypass and hemorrhage control should be done at the appropriate times.
文摘The ideal treatment strategy for Crohn’s disease (CD) remains uncertain, as does the optimal endpoint of therapy. Top-down versus step-up describes two different approaches: early use of immunomodulators and biological agents in the former versus initial treatment with steroids in the latter, with escalation to immunomodulators or biological drugs in patients proven to be steroid refractory or steroid dependent. Top-down therapy has been associated with higher rates of mucosal healing. If mucosal healing proves to be associated with better long-term outcomes, such as a decreased need for hospitalization and surgery, top-down therapy may be the better approach for many patients. The main concern with the top-down approach is the toxicity of the immunomodulators and biological agents, which have been linked with infectious complications as well as an increased risk of lymphoma. It is unlikely that one strategy will be best for all patients given the underlying heterogeneity of CD presentation and severity. Ultimately, we must weigh the safety and efficacy of the therapies with the risks of the disease itself. Unfortunately our ability to risk stratify patients at diagnosis remains rudimentary. The purpose of this paper is to review the data that supports or refutes the differing treatment paradigms in CD, and to provide a rationale for an approach, termed the "accelerated step-up" approach, which attempts to balance the risks and benefits of our currently available therapies with the risk of disease related complications as we understand them in 2008.
文摘BACKGROUND Emphysematous hepatitis(EH)is a rare,rapidly progressive fulminant gasforming infection of the liver parenchyma.It is often fatal and mostly affects diabetes patients.CASE SUMMARY We report a case of EH successfully managed by a step-up approach consisting of aggressive hemodynamic support,intravenous antibiotics,and percutaneous drainage,ultimately followed by laparoscopic deroofing.Of 11 documented cases worldwide,only 1 of the patients survived,treated by urgent laparotomy and surgical debridement.CONCLUSION EH is a life-threatening infection.Its high mortality rate makes timely diagnosis essential,in order to navigate treatment accordingly.
基金the National Natural Science Foundation of China(Nos.51265025 and 51665029)
文摘Double-crossed-step-stress(DCSS) accelerated life test(ALT) method is widely used for estimating the lifetime of products with high reliability and long lifetime. In order to further reduce the test time and test cost, a double-synchronous-step-stress(DSSS) ALT method which combines a double-synchronous-step-downstress(DSSDS) ALT method and a double-synchronous-step-up-stress(DSSUS) ALT method is proposed. The accelerated stresses decrease and increase in a synchronous way with one step in the DSSDS-ALT and DSSUSALT methods, respectively. Monte Carlo method is adopted to simulate the two methods, and the validity and efficiency of them are demonstrated by the simulation results. In addition, a comparison analysis of efficiency between DSSDS-ALT method and DSSUS-ALT method is carried out. The result shows that the DSSDS-ALT method compared with the DSSUS-ALT method can significantly improve the test efficiency under the same test condition.
文摘This work focuses on the fuzzy controller for the proposed three-phase interleaved Step-up converter(ISC).The fuzzy controller for the proposed ISC converters for electric vehicles has been discussed in detail.The proposed ISC direct current(DC-DC)converter could also be used in automobiles,satellites,industries,and propulsion.To enhance voltage gain,the proposed ISC Converter combines boost converter and interleaved converter(IC).This design also reduces the number of switches.As a result,ISC converter switching losses are reduced.The proposed ISC Converter topology can produce a 143 V output voltage and 1 kW of power.Due to the high voltage gain of this converter design,it is suitable for medium and high-power systems.The proposed ISC Converter topology is simulated in MATLAB/Simulink.The simulated output displays a high output voltage.But the output voltage contains maximum ripples.Fuzzy proposes an ISC Converter which makes closed loop responsiveness and reduces the output voltage ripple.The proposed ISC converter has the lowest ripple output voltage,which is less than 2%,because the duty cycle is regulated using the fuzzy logic controller.It offers high voltage gain,minimal ripple,and low switching loss.The performance of the proposed converter is compared to that of the fuzzy and Pro-portional Integral(PI)controllers implemented in MATLAB.
文摘A Single Switch Hybrid Step-up Converter with high voltage gain, which is suitable for renewable energy system, is proposed in this paper. The proposed converter consists of one switched diode-inductor cell and a capacitor. While switching, both are charged in parallel from the input source and discharged in series to the output. In order to obtain extra voltage gain at lower duty cycle, the voltage multiplier cell is integrated with the proposed converter. The main advantages of the converter are high voltage gain, reduced voltage stress, simple structure and low output voltage ripples. The operating principle and steady state theoretical analysis are presented. A 250 W prototype converter is implemented with 12 V input and 120 V output to verify the design and analysis of this converter and it has an efficiency of over 90% in all operations.
文摘目的探讨多学科团队(MDT)模式下升阶梯(Step-up)与跨阶梯(Step-jump)策略治疗重症急性胰腺炎(SAP)合并感染性胰腺坏死(IPN)的效果对比。方法回顾性分析2021年1月至2024年6月期间曲靖市第一人民医院收治的57例SAP合并IPN患者的临床资料,经MDT评估后分为两组,Step-up组(n=35)采用升阶梯策略治疗,Step-jump组(n=22)采用跨阶梯策略治疗。采用独立样本t检验、Mann-Whitney U和χ^(2)检验比较两组患者手术时间,术中出血量及输血情况,术后抗生素使用时间和引流管拔除时间,住院时间,术后生命体征、实验室检查、影像学检查等指标和并发症发生情况;采用Kaplan-Meier法绘制两组患者的生存曲线。结果57例患者中,3例拒绝手术,54例接受手术治疗,术后48~72 h生命体征均恢复稳定。Step-jump组与Step-up组患者相比,手术时间延长[145.0(104.0,186.0)min vs 97.0(65.0,130.0)min,P=0.041],术中出血量增加[130.0(80.0,180.0)m L vs 60.0(40.0,80.0)m L,P<0.001],差异有统计学意义。两组患者在术后第3天C反应蛋白(CRP)[(127.8±44.9)mg/L vs(118.3±52.9)mg/L]、术后第3天白细胞计数(WBC)[(13.1±3.1)×10^(9)/L vs(12.8±2.6)×10^(9)/L]、抗生素使用时间[(12.5±2.0)d vs(13.2±4.1)d]、总体并发症发生率[12.1%(4/33)vs 14.3%(3/21)]方面比较,差异无统计学意义(均P>0.05)。两组患者在总住院时间、ICU住院时间、引流管拔除时间、术后生命体征转归时间等方面比较,差异无统计学意义(P>0.05)。术后影像学随访提示两组患者胰周病变均明显改善。Step-jump组和Step-up组患者术后30 d累积生存率分别为95.5%、94.3%。结论根据MDT评估结果对SAP合并IPN患者选取升阶梯或跨阶梯策略进行治疗,均有较好的临床效果和安全性。
