Meta analysis on intravenous antioxidants therapy in the treatment of moderately severe and severe acute pancreatitis / 中华胰腺病杂志

Objective To investigate the efficacy of intravenous antioxidants therapy in treating moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP).Methods Pubmed,Embase,Cochrane library and CNKI databases for all randomized control trials published before March 18st,2016 manually was searched by computer.Data on AP associated mortality and length of stay (LOS) were collected.The quality of the trials included was assessed by the Cochrane systematic review method.Results Fifteen trials with data of 620 patients were eligible for final inclusion.Among the 15 trials,detailed randomization for grouping was clearly described in 5 studies and obvious bias was observed in 1 study.Three studies had obvious biases considering whether outcome assessment was blinded,outcome data was incomplete and outcome report was selective.No other apparent bias was found.Statistical analysis showed that compared with control group,intravenous antioxidants administration did not significantly reduce mortality (12.1 vs 9.7,RD=-0.02,95％ CI-0.08～-0.03,P=0.44;RR=0.83.95％ CI0.51～ 1.34,P=0.44),but could shorten LOS (MD=-2.02;95％ CI-4.00～-0.05;P=0.04).Conclusions Intravenous antioxidants could greatly shorten LOS of patients with MSAP and SAP.

Significance of heparin in the treatment of patients with sepsis / 中华危重病急救医学

The latest definition of sepsis (Sepsis-3) is the life-threatening organ dysfunction due to overreaction of immune system caused by infection. The situation can develop into multiple organ dysfunction syndromes (MODS). In the pathological process of pathogen invasion, a large number of inflammatory factors directly damage organ function, while dysfunction of coagulation system is also involved in this process. With the overreaction of inflammation, disseminated intravascular coagulation (DIC) occurred, which further exacerbated organ damage. As excessive inflammation and coagulation disorders are mutually reinforced, the clearance of pathogenic microorganisms and the control of inflammatory reactions cannot effectively improve the sepsis caused by MODS. As a clinically readily available anticoagulant, heparin is widely used in a variety of severe situations caused by DIC, thromboembolic disease and some invasive procedure for anticoagulant treatment. In recent years, domestic and foreign studies have found that heparin has a certain anti-inflammatory effect, which can reduce the incidence of DIC, improve sepsis patients with microcirculation and MODS, reduce 28-day mortality. However, there is controversy in its effectiveness and safety. Therefore, the application of heparin in the treatment of sepsis need to be further defined and discussed.