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Objective:To establish a nomogram model for individualized prediction of poor prognosis in patients with cirrhosis of esophagogastric variceal bleeding (EGVB), and verify its efficacy, so as to provide a scientific basis for the prevention and treatment of EGVB.Methods:The clinical data of 389 patients with cirrhosis of EGVB from January 2010 to December 2018 in Hangzhou Hospital of Zhejiang Medical and Health Group were retrospectively analyzed. All patients were followed up for 3 years, including 232 cases with poor prognosis (poor prognosis group) and 157 cases with good prognosis (good prognosis group). The general clinical data and laboratory results were compared between 2 groups. Receiver operating characteristic (ROC) curve was used to analyze the optimal cut-off value of poor prognosis factors in patients with cirrhosis of EGVB; multivariate Logistic regression analysis was used to analyze independent risk factors of poor prognosis in patients with cirrhosis of EGVB. A nomogram model to predict poor prognosis in patients with cirrhosis of EGVB was established with R language software 4.0 "rms" package. Internal validation of the nomogram model was performed using correction curves, and the prediction efficiency of the nomogram model was evaluated using decision curves.Results:The age, ascites rate, liver surface roughness rate, end-stage liver disease model score (MELD score), Child-Turcotte-Pugh score (CTP score), alanine aminotransferase (ALT), aspartate transaminase (AST), international standard ratio (INR) and total bilirubin (TBIL) in poor prognosis group were significant higher than those in good prognosis group: (62.48 ± 6.21) years old vs. (58.71 ± 5.93) years old, 51.29% (119/232) vs. 35.03% (55/157), 60.78% (141/232) vs. 42.03% (66/157), (13.89±1.93) scores vs. (11.32 ± 1.69) scores, (8.93 ± 0.77) scores vs. (7.46 ± 0.63) scores, (37.73 ± 5.21) U/L vs. (32.13 ± 5.03) U/L, (64.19 ± 11.31) U/L vs. (57.36 ± 10.29) U/L, 1.73 ± 0.41 vs. 1.61 ± 0.39 and (24.31 ± 2.63) μmol/L vs. (19.86 ± 2.17) μmol/L, the albumin, hemoglobin and serum sodium were significantly lower than those in good prognosis group: (36.21 ± 4.51) g/L vs. (39.12 ± 4.96) g/L, (86.31 ± 8.27) g/L vs. (92.28 ± 9.67) g/L and (136.58 ± 18.24) mmol/L vs. (141.21 ± 19.26) mmol/L, and there were statistical differences ( P<0.01 or<0.05). ROC curve analysis results show that the optimal cut-off values of age, MELD score, CTP score, albumin, ALT, AST, hemoglobin, INR, TBIL and serum sodium for predicting poor prognosis in patients with cirrhosis of EGVB were 55 years old, 14.20 scores, 9.30 scores, 35 g/L, 38 U/L, 67 U/L, 88 g/L, 1.90 scores, 25 μmol/L and 135 mmol/L, respectively. Multivariate Logistic regression analysis results showed that age≥55 years old, ascites, MELD score ≥14.20 scores, CTP score ≥9.30 scores, albumin<35 g/L and INR≥1.90 were independent risk factors for poor prognosis in patients with cirrhosis of EGVB ( HR = 1.528, 1.439, 1.637, 1.795, 1.521 and 1.596; 95% CI 1.165 to 1.891, 1.088 to 1.790, 1.308 to 1.966, 1.385 to 2.205, 1.262 to 1.780 and 1.259 to 1.933; P<0.05 or<0.01). To construct a nomogram model that integrates independent risk factors for poor prognosis in patients with cirrhosis of EGVB, the predictive power of the model was good (C-index 0.839, 95% CI 0.781 to 0.948). The corrected curve of nomogram model to predict poor prognosis in patients with cirrhosis of EGVB was close to the ideal curve; when the high risk threshold>0.02, nomogram model provided a significant additional clinical net benefit to predict poor outcome in patients with cirrhosis of EGVB, which was higher than the individual risk factors. Conclusions:The nomogram model based on age, ascites, MELD score, CTP score, albumin, INR and other independent risk factors that affect the high risk of poor prognosis in patients with cirrhosis of EDVB has great clinical value in screening and identifying high risk of poor prognosis in patients with cirrhosis of EDVB.
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Objective@#To explore the clinical application value of enhanced recovery after surgery (ERAS) in the laparoscopic surgery for cholecystolithiasis comorbid with choledocholithiasis.@*Methods@#The prospective study was conducted. The clinicopathological data of 52 patients with cholecystolithiasis comorbid with choledocholithiasis who were admitted to the Third Affiliated Hospital of Zunyi Medical University from September 2016 to September 2018 were collected. Patients were divided into 2 groups by random number table: patients in observation group received laparoscopic cholecystectomy + choledocholithotomy + choledochoscopic exploration + T-tube drainage (or primary suture of common bile duct) and perioperative management guided by the concept of enhanced recovery after surgery (ERAS), and patients in control group received traditional perioperative management. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) postoperative complications; (4) postoperative pain scores; (5) changes in hepatic function and blood routine during perioperative period. Follow-up using outpatient examination and telephone interview was performed to detect complications during the postoperative 6 months up to March 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the paired t test or repeated ANOVA. Count data were described as absolute numbers and percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability.@*Results@#Fifty-two patients were screened for eligibility, including 20 males and 32 females, aged 25-68 years, with an average age of 53 years. There were 30 patients in the observation group and 22 in the control group. (1) Surgical situations: the operation time and volume of intraoperative blood loss were (133±19)minutes and (47±21)mL in the observation group, and (136±22)minutes and (49±23)mL in the control group, respectively, showing no significant difference between the two groups (t=-0.386, -0.211, P>0.05). (2) Postoperative situations: time to out-of-bed activity, time to initial food intake, time to first anal flatus, duration of postoperative hospital stay, and hospital expenses were (18±4)hours, (19±5)hours, (28±2)hours, (4.0±1.0)days, and (1.82±0.22)×104 yuan in the observation group, and (29±7)hours, (46±9)hours, (37±4)hours, (6.6±1.6)days, and (2.25±0.29)×104 yuan in the control group, respectively, showing significant differences between the two groups (t=-7.054, -14.169, -9.426, -6.582, -5.809, P<0.05). (3) Postoperative complications: 1 of 30 patients in the observation group had postoperative biliary leakage, with a postoperative complication rate of 3.3%, and was cured after symptomatic support treatment. Six of 22 patients in the control group had postoperative complication, with a postoperative complication rate of 27.3%, including 2 of biliary leakage, 1 of hemorrhage, 1 of abdominal infection, 1 of pulmonary infection, 1 of urinary infection, and they were cured after symptomatic support treatment. There was a significant difference between the two groups (χ2=4.358, P<0.05). (4) Postoperative pain scores: from postoperative 6 hours to 48 hours, the postoperative pain score changed from 2.4±0.7 to 1.9±0.9 in the observation group, and from 4.1±0.7 to 2.9±0.9 in the control group, respectively, showing a significant difference in the changing trend between the two groups (F=78.053, P<0.05). (5) Changes in hepatic function and blood routine during perioperative period: from preoperation to postoperative 3 days, levels of alamine aminotransferase (ALT), aspartate transaminase (AST), gamma-glutamyltransferase (GGT), total bilirubin (TBil), and count of white blood cells in the observation group changed from (77±20)U/L to (53±12)U/L, from (85±22)U/L to (61±17)U/L, from (166±39)U/L to (55±24)U/L, from (40±13)μmol/L to (29±12)μmol/L, from (7.0±2.0)×109/L to (6.8±1.9)×109/L, and changed from (79±23)U/L to (62±14)U/L, from (88±24)U/L to (64±17)U/L, from (179±34)U/L to (74±29)U/L, from (45±13)μmol/L to (35±12)μmol/L, from (7.9±2.4)×109/L to (7.5±1.9)×109/L in the control group, respectively. The levels of ALT, AST, GGT, TBiL, and count of WBC showed increasing at postoperative 1 day, and decreasing at postoperative 3 days. There was no significant difference in the changing trend between the two groups (F=0.058, 0.471, 3.021, 1.593, 2.172, P>0.05).@*Conclusion@#ERAS is safe and effective in the laparoscopic surgery for choledocholithiasis comorbid with cholecystolithiasis.
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Objective To explore the clinical application value of enhanced recovery after surgery (ERAS) in the laparoscopic surgery for cholecystolithiasis comorbid with choledocholithiasis.Methods The prospective study was conducted.The clinicopathological data of 52 patients with cholecystolithiasis comorbid with choledocholithiasis who were admitted to the Third Affiliated Hospital of Zunyi Medical University from September 2016 to September 2018 were collected.Patients were divided into 2 groups by random number table:patients in observation group received laparoscopic cholecystectomy + choledocholithotomy + choledochoscopic exploration +T-tube drainage (or primary suture of common bile duct) and perioperative management guided by the concept of enhanced recovery after surgery (ERAS),and patients in control group received traditional perioperative management.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) postoperative complications;(4) postoperative pain scores;(5) changes in hepatic function and blood routine during perioperative period.Follow-up using outpatient examination and telephone interview was performed to detect complications during the postoperative 6 months up to March 2019.Measurement data with normal distribution were represented as Mean ± SD,and comparison between groups was analyzed using the paired t test or repeated ANOVA.Count data were described as absolute numbers and percentages,and comparison between groups was analyzed using the chi-square test or Fisher exact probability.Results Fifty-two patients were screened for eligibility,including 20 males and 32 females,aged 25-68 years,with an average age of 53 years.There were 30 patients in the observation group and 22 in the control group.(1) Surgical situations:the operation time and volume of intraoperative blood loss were (133± 19) minutes and (47 ± 21) mL in the observation group,and (136±22) minutes and (49±23)mL in the control group,respectively,showing no significant difference between the two groups (t=-0.386,-0.211,P＞0.05).(2) Postoperative situations:time to out-of-bed activity,time to initial food intake,time to first anal flatus,duration of postoperative hospital stay,and hospital expenses were (18±4) hours,(19±5) hours,(28±2)hours,(4.0± 1.0)days,and (1.82±0.22) × 104 yuan in the observation group,and (29±7)hours,(46±9)hours,(37±4)hours,(6.6±1.6)days,and (2.25±0.29) ×104 yuan in the control group,respectively,showing significant differences between the two groups (t =-7.054,-14.169,-9.426,-6.582,-5.809,P＜0.05).(3) Postoperative complications:1 of 30 patients in the observation group had postoperative biliary leakage,with a postoperative complication rate of 3.3％,and was cured after symptomatic support treatment.Six of 22 patients in the control group had postoperative complication,with a postoperative complication rate of 27.3％,including 2 of biliary leakage,1 of hemorrhage,1 of abdominal infection,1 of pulmonary infection,1 of urinary infection,and they were cured after symptomatic support treatment.There was a significant difference between the two groups (x2 =4.358,P ＜ 0.05).(4) Postoperative pain scores:from postoperative 6 hours to 48 hours,the postoperative pain score changed from 2.4 ± 0.7 to 1.9± 0.9 in the observation group,and from 4.1 ± 0.7 to 2.9 ± 0.9 in the control group,respectively,showing a significant difference in the changing trend between the two groups (F=78.053,P＜0.05).(5) Changes in hepatic function and blood routine during perioperative period:from preoperation to postoperative 3 days,levels of alamine aminotransferase (ALT),aspartate transaminase (AST),gamma-glutamyltransferase (GGT),total bilirubin (TBil),and count of white blood cells in the observation group changed from (77±20)U/L to (53± 12)U/L,from (85±22)U/L to (61± 17) U/L,from (166±39) U/L to (55±24) U/L,from (40± 13) μmol/L to (29±12) μmol/L,from (7.0±2.0) × 109/L to (6.8± 1.9) × 109/L,and changed from (79±23) U/L to (62± 14) U/L,from (88±24)U/L to (64± 17) U/L,from (179±34) U/L to (74±29) U/L,from (45± 13) μmol/L to (35±12) μmol/L,from (7.9±2.4)× 109/L to (7.5± 1.9)× 109/L in the control group,respectively.The levels of ALT,AST,GGT,TBiL,and count of WBC showed increasing at postoperative 1 day,and decreasing at postoperative 3 days.There was no significant difference in the changing trend between the two groups (F=0.058,0.471,3.021,1.593,2.172,P＞0.05).Conclusion ERAS is safe and effective in the laparoscopic surgery for choledocholithiasis comorbid with cholecystolithiasis.
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OBJECTIVE:To observe the clinical efficacy of Xuebijing injection in the treatment of severe acute pancreatitis(SAP).METHODS:65 patients with severe acute pancreatitis were enrolled:30 patients in the control group were randomly as-signed to receive standard combined therapy of west medicines,and 35 in the treatment group to receive Xuebijing injection 100 mL qd by iv gtt plus the combined therapy as in the control group.The course of treatment in both groups was 7 days.RESUL-TS:The total efficiency in the treatment group was 94.3% and that in the control group was 83.4%,showing significant differences between the two groups(P