RÉSUMÉ
Objective:To juxtapose laparoscopic cholecystectomy combined with common bile duct exploration and stone extraction (LC+ LCBDE) against endoscopic retrograde cholangiopancreatography/sphincterotomy with laparoscopic cholecystectomy (LC+ ERCP/EST) in the therapeutic context of acute biliary pancreatitis.Methods:The clinical data of patients with acute biliary pancreatitis in Department of Hepatobiliary Surgery, Datong Third People's Hospital from January 2017 to January 2021 were retrospectively analyzed. A total of 44 patients were inrolled, including 23 males and 21 females, with the age of (60.6±11.7) years. Based on different treatment approaches, the patients were divided into the LC+ LCBDE group ( n=33) and the LC+ ERCP group ( n=11, LC+ ERCP/EST). Total bilirubin, direct bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood amylase, operation time, postoperative hospitalization stays, total hospitalization cost, postoperative anal exhaust time, and postoperative complications (bile leakage, fever, bleeding) were compared between the two groups. Results:There were no significant differences in preoperative total bilirubin, direct bilirubin, ALT, AST, and blood amylase between LC+ ERCP group and LC+ LCBDE groups (all P>0.05). In LC+ LCBDE group, operation time was 110.0 (96.3, 147.5) min, postoperative hospitalization time was 9.0 (7.5, 11.0) d, postoperative exhaust time was 2.0 (1.0, 2.0) d, and in LC+ LCBDE group, operation time was 60.0 (32.0, 65.0) min, postoperative hospitalization time was 7.0 (4.0, 8.0) d, postoperative exhaust time was 1.0 (1.0, 1.0) d. Comparisons with LC+ LCBDE group, LC+ ERCP group had shorter postoperative hospitalization stay and earlier postoperative exhaust time, the total hospitalization cost of LC+ LCBDE group was 23 829.3 (21 779.6, 27 221.9) yuan, which was higher than 36 894.8 (31 963.5, 41 172.2) yuan in LC+ ERCP group, and the differences were statistically significant (all P<0.05). Comparison of postoperative total bilirubin, direct bilirubin, ALT and AST between LC+ ERCP group and LC+ LCBDE group, with no significant difference(all P>0.05). No postoperative complications such as bile leakage, residual stones, fever and bleeding occurred in both groups. Conclusion:Compared with LC+ ERCP/EST, LC+ LCBDE in the treatment of acute biliary pancreatitis, although the operation time and hospital stay are longer, but the total hospitalization cost is less, there is no need for multiple operations, and it can be used as the first choice for acute biliary pancreatitis.
RÉSUMÉ
Objective To compare the efficacy of sedation with dexmedetomidine versus midazolam in mechanically ventilated patients.Methods Sixty patients aged 20-64 yr,with body mass index 21-25 kg/m2,APECHE Ⅱ score 10-25,requiring 24 h of nechanical ventilation in intensive care unit (ICU),were randomly divided into 2 groups (n=30 each): midazolam group (group M) and dexmedetomidine group (group D).A loading dose of midazolam 0.05 mg/kg was injected intravenously,followed by infusion at 0.03-0.20 mg· kg-1 · h-1 in group M.A loading dose of dexmedetomidine 1 μg/kg was injected intravenously,followed by infusion at 0.2-0.7 μg· kg-1 · h-1 in group D.Ramsay sedation score was maintained at 2-4.The satisfaction of the doctors in ICU with the sedative efficacy,hypotension and bradycardia were recorded.Delirium was recorded starting from the begging of sedation to 2 h after the end of sedation.The emergence time and occurrence of falling asleep again within 2 h after waking were also recorded.Results Compared with M group,the satisfactory level of the doctors in ICU with the sedative efficacy was significantly increased,the emergence time was significantly shortened and the incidences of falling asleep again within 2 h after waking and delirium were significantly decreased (P ＜ 0.05 or 0.01),and no significant change was found in the incidence of hypotension and bradycardia in group D (P ＞ 0.05).Conclusion The efficacy of sedation with dexmedetomidine is better than that of midazolam in mechanically ventilated patients.