ABSTRACT
Objective:To clarify the incidence and the related risk factors of postoperative delirium in liver transplantation (LT) recipients to provide rationales for early identification of delirium and constructing the related models.Methods:The authors used the "肝移植""移植术""肝移植手术""肝脏移植""移植肝""谵妄""谵语""危险因素""相关因素""影响因素"and "liver transplantation""liver transplant""delirium""delirious""delirium confusion""risk factors""relevant factors""root cause analysis"as the Chinese and English keywords, searching Wanfang data, China Biomedical Literature Database, CNKI, PubMed, Embase, Web of Science, Cochrane Library, BMJ and the literature for the incidence or risk factors of postoperative delirium in LT recipients. The researchers independently performed literature screening, methodological evaluation and data extraction. And RevMan 5.4 and State16.0 software were employed for data processing.Results:A total of 19 articles involving 5003 samples were retrieved and 22 risk factors identifies. Meta-analysis showed that the incidence of POD was 23%(1151/5003). The statistically significant risk factors included preoperative blood ammonia concentration >46 mmol/L ( OR=3.51, 95% CI: 1.53-8.09, P<0.001), model for end-stage liver disease (MELD) score >15 points ( OR=4.24, 95% CI: 2.51-7.16, P<0.001), preoperative hepatic encephalopathy ( OR=3.00, 95% CI: 2.09-4.31, P<0.001), preoperative dosing of diuretics ( OR=2.36, 95% CI: 1.38-4.04, P<0.001), history of alcoholism ( OR=3.16, 95% CI: 1.06-9.40, P=0.040), longer anhepatic period ( OR=1.04, 95% CI: 1.03-1.06, P<0.001) and elevated aspartate transaminase concentration at Day 1 post-operation ( OR=1.33, 95% CI: 1.15-1.53, P<0.001). Conclusions:Preoperative blood ammonia concentration >46 mmol/L, MELD score >15, hepatic encephalopathy, dosing of diuretic, a history of alcoholism, longer anhepatic period and elevated aspartate transaminase at Day 1 post-operation are risk factors for postoperative delirium after LT. Postoperative reintubation is not a risk factor for postoperative delirium.
ABSTRACT
Objective Up to the present time, no reports are seen at home or abroad on the clinical characteristics of severe acute pancreatitis (SAP) with persistent inflammation-immunosuppression-catabolism syndrome (PICS), and few studies have been conducted on the risk factors for PICS.This article summarizes the clinical characteristics of PICS in SAP patients and presents a multivariate regression analysis of its risk factors.Methods This is a retrospective study on the clinical data about 214 cases of SAP treated for over 14 days in the Surgical Intensive Care Unit (SICU) from January 1, 2014 to December 31, 2015.According to the diagnostic criteria of PICS, we divided the SAP patients into a PICS group (n=149) and a non-PICS group (n=65).We compared the systemic and pancreatitis-specific complications and mortality rates in the SICU and at 12 months after discharge.We also performed a multivariate regression analysis on the risk factors of PICS.Results The incidence rates of biliary SAP and multiple-organ dysfunction syndrome (MODS) were significantly higher in the PICS (44.3% and 93.3%) than in the non-PICS group (29.2% and 55.4%) (P=0.038).The results of multivariate regression analysis showed that the risk factors for PICS included obesity (OR=2.3;95% CI: 1.0-5.2), biliary causes (OR=4.2;95% CI: 1.4-13.0), and MODS (OR=4.4;95% CI: 1.3-14.4).The survival rate at 12 months after discharge was remarkably lower in the PICS than in the non-PICS group (88.5% vs 98.2%, P=0.036).Conclusion The incidence rate of PICS is high in SAP patients.Obesity, biliary causes and MODS are independent risk factors for PICS.The complication of PICS may be an important indicator of the poor prognosis of SAP.
ABSTRACT
Objective Acute pancreatitis exhibits different clinical and ultrasonic features in patients complicated with acute acalculous cholecystitis ( AAC) at different stages .The aim of this study was to analyze the ultrasonic characteristics of acute pancreati-tis complicated with AAC at different stages . Methods We retrospectively analyzed the clinical data about 41 cases of acute pancrea-titis with moderate to severe AAC .According to whether AAC developed within or after 2 weeks of the onset of acute pancreatitis , we divided the patients into an early-stage group (n=18) and a late-stage group (n=23).We recorded the gallbladder size, gallbladder wall thickness , fluid around the gallbladder , biliary sludge deposition and the Murphy′s sign by ultrasonography , obtained AAC-related clinical and laboratory data concerning body temperature , Murphy′s sign, WBC count and C-reactive protein level , and analyzed the ultrasonic features of AAC at different stages in the acute pancreatitis patients. Results All the patients experienced a fever of >38.5℃, 38.89%with chills in the early onset group and 47.83%in the late onset group .Increases were observed in patients of the early-and late-stage groups in the WBC count ( 94.44%vs 82.61%) , the C-reactive protein level ( 100%vs 91.30%) , and the fluid volume around the gallbladder (94.44%vs 60.86%, P<0.05), but incidence rate of gallbladder wall thickening was significantly lower in the former than in the latter group (11.11%vs 78.26%, P<0.01). Conclusion AAC developing at different stages of acute pancreatitis has different ultrasonic features , with higher incidence rates of fluid around the gallbladder in the early stage and gallbladder wall thickening in the late stage.
ABSTRACT
Acute coagulopathy of trauma-shock (ACoTS) occurs in 25% of patients with severe trauma in the early phase, and the mortality of those patients is four-fold higher than patients without coagulopathy. The pathophysiology of this complicated phenomenon has been focused on in recent years. Tissue injury and hypoperfusion, activated protein C and Complements play important roles in the early phase after trauma. While the use of blood products, hypothermia, acidosis and inflammation are the main mechanism in late phase. Supplementing coagulation factors and platelets to improve ACoTS are inefficient. Only positive resuscitation from shock and improving tissue hypoperfusion have expected benefits.
Subject(s)
Humans , Blood Coagulation Disorders , Complement System Proteins , Physiology , Disseminated Intravascular Coagulation , Hypothermia , Inflammation , Protein C , Physiology , Shock, TraumaticABSTRACT
<p><b>PURPOSE</b>To compare the effects and side-effects of fondaparinux sodium and low molecular weight heparin in patients with hypercoagulability accompanied with traumatic infection.</p><p><b>METHODS</b>Thirty-six patients with post-traumatic infections in our hospital intensive care center were diagnosed with hypercoagulability from February 2012 to February 2013. These patients were randomly divided into 2 groups. In group F (18 patients), the patients were treated with fondaparinux sodium, 2.5 mg, 1/d for 11 d. In group L (18 patients), the patients were treated with low molecular weight heparin, 4100 U, 1/12 h for 11 d. The incidence of deep vein thrombosis, bleeding events and multiple organ dysfunction syndrome (MODS) and mortality of two groups after anticoagulation therapy were analyzed. Fibrinogen, D-dimer level and activity of antithrombin III were measured by the coagulation analyzer.</p><p><b>RESULTS</b>The incidence of deep vein thrombosis, MODS incidence and mortality were not significantly different between the two groups. The rate of bleeding evens in group F was lower than group L (p < 0.05). Antithrombin III got an upward trend after anticoagulant therapy, in which it was higher in group F than in group L on the 5th d and 11th d (p<0.05). Fibrinogen levels were gradually increased, and there was no significant difference between two groups (p>0.05). D-dimer was significantly decreased after anticoagulant therapy for 5 d (p<0.01), and there were significant differences between two groups on the 5th d and 7th d (p<0.05). It showed no significant difference on the 11th d (p>0.05).</p><p><b>CONCLUSION</b>Fondaparinux sodium and low molecular weight heparin can effectively improve coagulopathy in patients with traumatic infection. Compared with low molecular weight heparin, fondaparinux sodium may reduce the risk of bleeding events in patients with hypercoagulability accompanied by traumatic infection.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Fibrin Fibrinogen Degradation Products , Heparin, Low-Molecular-Weight , Therapeutic Uses , Infections , Multiple Organ Failure , Epidemiology , Polysaccharides , Therapeutic Uses , Thrombophilia , Drug Therapy , Venous Thrombosis , Epidemiology , Wounds and InjuriesABSTRACT
Objective To observe the effects of penehydidine hydrochloride (PHC) on t acute lung injury ( ALI) . To investigate into the expression of TLR4 on peripheral monocytes, kinetics of inflammatory and anti- inflammatory mediators. To explore the mechanism of TLR4 in ALI. Method A total of 45 patients with ALI were randomly divided into PHC treatment group(experimental group, n =21) and routine treatment group (control group, n = 24) . Patients of both groups were given with the routine treatment,and patients in experimental group were given with PHC in addition (1 mg,im,ql2h) . Therapeutic effects, average length of hospital stay, ICU stay,PaO_2 and PaO_2/FiO_2 > as well as the expression of TLR4 and some cytokines were observed for 48 hours. Results Patients of both groups got better gradually after treatment. The PaO_2 and PaO_2/FiO_2 of patients of both groups progressively increased. At 6 hours, 12 hours, 24 hours and 48 hours after treatment, the PaO_2 and PaO_2/FiO_2significantly increased than 0 hour ( P < 0.05). The improvement in experimental group was obviously better than that in control group at 6 hours, 24 hours and 48 hours after treatment (P < 0.05). There were no differences in average length of hospital stay between the two groups. The ICU stay was significantly shorter in the experimental group ( P < 0.01) . The expressions of TLR4 were higher in patients of both groups than in healthy ones (P <0.01) . TLR4 decreased significantly at 24 hours and 48 hours, while it was lower in experimental group than that in the control group (P < 0.05). The higher level of TLR4in the early stage implied worse prognosis. Most of them deteriorated to ARDS stage. At 24 hours, the incidence of ARDS in experimental group was 23.8 % , and 29.17% in control group. Two patients in control group didn' t become ARDS till 48 hours. Serum IL-1, IL-8 and TNF-α level reduced atr 24 hours in both groups. The reduction of IL-8 and TNF-α in experimental group was more obvious than in control group ( P < 0.05). IL-13 increased gradually from 0 hour to 24 hours, then descended a little at 48 hours. There was no difference in IL-13 some difference between the two groups ( P > 0.05) . Conclusions PHC can improve the arterial oxygen pressure, down-regulate TLR4, restrain inflammatory factors in its signal transduction downstream. This inhibitory action is not accomplished by increase in anti-inflammatory factors,but by down-regulating TLR4. PHC can prevent the development of ALI, and can be considered to act as an effective medicine for the treatment of ALI. TLR4 plays an important role in ALT process, and it is suggested that TLR4 can be used as a prognostic factor.
ABSTRACT
Objective To investigate the protective effect of Ganyu capsule on the experimental hepatic injury in mice and rats.Methods Acute hepatic injury was induced by intraperitoneal injection of 0.1 %CCl4 10mL/kg and D-galactosamine 500 mg/kg in mice;Cirrhosis was induced by 40 %CCl4 adding with variousagents in rats.The biochemical parameters such as serum ALT were examined and the histopathological changes of hepatic tissue was measured.Results Ganyu capsule could obviously inhibit the increase of serum ALT and AST activity and reduce the content of collagen in liver and the deseverity of hepatic fibrosis.Conclusion Ganyu capsule has protective effects on the acute and chronic hepatic injury in mice and rats.