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Objective To investigate the risk factors of death and to establish an early multi-index predictive model for mortality moderately of severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) in elderly patients.Methods Clinical data of 58 digible elderly patients of MSAP and SAP between January 2014 and May 2017 in First Affiliated Hospital of Harbin Medical University were analyzed retrospectively,including 18 cases (31.0％) in the death group and 40 cases in the control group (69.0％).Univariate analysis and logistic regression analysis were used to screen out the independent risk factors related to death,combined with these independent risk factors,the unweighted predictive model (unwScore) and weighted predictive model (wScore) for mortality were established.The receiver-operating characteristic (ROC) curves of independent risk factors and predictive models were drawn to determine the cut-off value,to calculate the area under the curve (AUC),sensitivity,specificity,positive predictive value and negative predictive value and to observe the clinical predictive effectiveness.Student's t-test was used to analyze continuous variables that complied with a normal distribution expressed as ((x) ± s).Mann-Whitney U test was used to analyze abnormally distributed variables expressed as median (quartile range) [M(P25,P75)].chi-square test or Fisher's exact test was used to analyze categorical data expressed by rate (％).Univariate analysis was used to screen out data with statistically significant difference,and then Logistic regression analysis was performed to determine independent predictors.Results Univariate analysis showed that there were statistically significant differences in pro-calcitonin,serum albumin (ALB),serum calcium,D-dimers,mean arterial pressure,pleural effusion and peritoneal effusion between the two groups (P ＜0.05);multivariate analysis showed that ALB,pleural effusion and peritoneal effusion were independent risk factors for mortality of MSAP,SAP in early patients,which AUC were 0.815,0.678,0.696,sensitivity were 0.611,0.556,0.667,specificity were 0.825,0.800,0.725,the positive predictive values were 61.1％,55.6％,52.2％,and the negative predictive values were 82.5％,80.0％,89.9％,respectively.The AUC of unwScore and wScore were 0.852 and 0.863,the sensitivity were 0.667 and 0.778,the specificity were O.875 and 0.800,the positive predictive values were 70.6％ and 63.6％,and the negative predictive values were 85.4％ and 88.9％,respectively.Conclusion ALB,pleural effusion and peritoneal effusion were independent risk factors for mortality of MSAP,SAP in elderly patients.The multi-index predictive model had good clinical predictive effectiveness,which could provide clinical references for the treatment of MSAP and SAP in elderly patients.
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Objective To evaluate the early predictive and diagnostic value of procalcitonin (PCT) in abdominal infection after pancreatoduodenectomy(PD).Methods The clinical data of 62 patients with PD in the First Affiliated Hospital of Harbin Medical University from April 2016 to April 2017 were retrospectively analyzed.The general data and postoperative conditions of the patients were recorded.Serum PCT,C-reactive protein (CRP) levels and WBC counts were measured before and 1,3,and 5 days after surgery.According to the postoperative abdominal infection,the patients were divided into abdominal infection group (n =10) and control group(n =52).The area under the ROC curve (AUC) was calculated by plotting the receiver operating characteristic (ROC) curve,and the cut-off value was determined to compare the sensitivity and specificity of the two groups of patients.Results There were no significant difference between two groups on age,gender,BMI,diabetes mellitus,preoperative laboratory indicators,anesthetic time,operation time,intraoperative bleeding and blood transfusion,surgical procedures and Braun anastomosis,which were comparable.The incidence of postoperative hyperglycemia,surgical incision infection,pancreatic fistula,biliary fistula,mortality,postoperative hospital stay and total medical costs of abdominal infection group were significantly higher than those of control group (P ＜ 0.05).There were no significant differences on PCT,CRP,and WBC between the two groups before surgery.The PCT level of the abdominal infection group was significantly higher than that of the control group at the 1st postoperative day and the difference was statistically significant (P ＜0.05).The sensitivity of predicting abdominal infection was 90％ and the specificity was 75％,which was significantly higher than those of CRP and WBC.There were no significant differences on the sensitivity and specificity of PCT,CRP and WBC for postoperative abdominal infection at 3 and 5 days after surgery,but the sensitivity of the combined diagnosis was as high as 100％ and 90％,significantly higher than 3 indicators alone,respectively.Conclusions Serum PCT level may predict in advance or diagnose early abdominal infection after PD.The combination of PCT,CRP and WBC might be more valuable for the diagnosis of abdominal infection after PD.
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Objective To investigate the effects of hyperbaric oxygen (HBO) therapy on interleukin-1 β( IL-1 β) and interleukin-6 ( IL-6 ) levels in patients with moderate or severe traumatic brain injury ( TBI ) and to analyze its therapeutic efficacy.MethodsOne hundred and fifty-six patients with moderate or severe TBI were randomly divided into a control group and an HBO adjunctive therapy group with 78 cases in each.The control group received essential neurosurgical treatment and conventional drug treatment,and the HBO group was given one HBO therapy session in addition.IL-1 β and IL-6 were quantitatively determined using sandwich ELISA,and the patients'scores on the Glasgow coma scale (GCS) were measured before and after treatment.The Glasgow outcome scale (GOS) was used to evaluate in a follow-up 6 months after injury.ResultsThe average IL-1 β and IL-6 levels of the two groups and their average GCS scores were not significantly different before treatment.After treatment,IL-1 βand IL-6 levels decreased significantly and GCS scores increased significantly in both groups,but there were significant inter-group differences in all three measures.Six months after injury the GOS evaluation indicated that significantly more patients had better outcomes in the HBO group than in the control group. Conclusion Conventional treatment combined with HBO therapy can promote neurofunction recovery in TBI patients.The mechanism may be related to down-regulation of serum IL-1 β and IL-6.
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Objective To investigate effects of hyperbaric oxygen (HBO) therapy on C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) levels in patients with moderate or severe traumatic brain injury (TBI)and to analyze its therapeutic efficacy. Methods One hundred and eight patients with moderate or severe TBI were randomly divided into a control group (54 cases) and an HBO adjunctive therapy group (HBO group, 54 cases).Both groups received essential neurosurgical treatment and conventional drug treatment, and the HBO group was given one session of HBO therapy in addition. Serum CRP and TNF-α were detected, and the scores on the Glasgow coma scale (GCS) were measured before and after treatment. CRP was detected by turbidimetric immunoassay and TNF-α using ELISA. Glasgow outcome scale (GOS) scores were evaluated in a follow-up 6 months after injury. Results Average CRP, TNF-α and GCS measurements showed no statistically significant difference between the groups before treatment. After treatment, CRP and TNF-α were significantly lower and GCS scores significantly better in both groups, but patients in the HBO group were, on average, significantly better than the controls on all three measures.Six months later, GOS evaluation gave a significantly larger number of patients with a better prognosis in the HBO group compared with the controls. Conclusion HBO therapy can significantly decrease serum CRP and TNF-α after severe TBI, thus enhancing therapeutic efficacy.
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Objective To investigate the efficacy of hyperbaric oxygen combined with donepezil in the treat-ment of patients with vascular dementia(VD). Methods Sixty-four patients with VD were randomly divided into a control group(donepezil group,n=32)and a treatment group(hyperbaric oxygen combined with donepezil,n=32).The course of treatment was 12 weeks.All patients were tested using the Mini-Mental State Examination(MMSE)and Hasegawa's dementia scale(HDS)before and after treatment. Results After 12 weeks of treatment,the MMSE scores and HDS scores of patients increased significantly in both the control and treatment groups.There were signifi-cant differences between the control and treatment groups in terms of MMSE and HDS scores.Conclusion Hyperbar-ic oxygen combined with donepezil could significantly improve cognition in VD patients.