Characteristics and Treatment of Fever in Patients with Severe Craniocerebral Injury / 医药导报

Fever in patients with severe craniocerebral injury was a frequent occurrence.The rate of fever patients lead to plant man or death high up to 28％-72％.The univariate analysis found that there was significant association between fever and motality.One of the common cause of fever was non-infectious fever,which related with craniocerebral injury,including central fever,dehydration fever,clonus and rebleading fever.The major complication was central high fever after servere craniocerebral injury.The temperature high up to 39 ℃,which aggravated the original basic diseases,lead to respiratory and circulatory failure.Another cause of fever was infection fever which associated with nosocomial infection.Serious disease,long hospiltal stay,high proportion of invasive operation,coma were the high risk factors of patients with craniocerebral injury.The major type of nosocomial infection were pudmonary infection and surgical site infection.By reviewing domestic and foreign literatures and expert consensus,this article was intended to explore the characteristics and mechanism of fever in patients with craniocerebral injury.In order to reduce the secondary brain injury,decrease the disability rate,increase the sutrvival rate,diagnosis and treatment should be taken early.

Significance of the MELD scoring system in surgical treatment of obstructive jaundice / 中华肝胆外科杂志

Objective To prospectively study the clinical significance of the MELD scoring system in surgical treatment of obstructive jaundice.Methods 112 patients with obstructive jaundice who were admitted into our hospital from January 2009 to December 2013 were divided into two groups:group A (Stage Ⅰ PTCD and stage Ⅱ open operation,n =53) and group B (1 stage open surgery,n =59).The amount of intraoperative bleeding blood loss,operation time,postoperative complications,duration of hospitalization,mortality rate,and the changes in liver function after surgery were compared between the two groups.Results The differences in the liver function index of the two groups on the same postoperative date were significantly different (P ＜ 0.05).The liver function of group A recovered faster than group B.Patients in group A with a MELD ＜ 10 points stayed in hospital significantly longer when compared with patients in group B.For patients in group A with MELD ＞ 10 points,the operation time,bleeding volume,postoperative complications and hospitalization were significantly less than the patients in group B (P ＜ 0.05).There were 3 patients (group B) who died with MELD ≥ 20 points after operation.Conclusions In patients with obstructive jaundice with a MELD score greater than 10 points,especially those with a score equal to or greater than 20,PTCD should be performed first to relieve biliary tract obstruction,followed by a stage Ⅱ open surgical operation after the liver function had improved.MELD had important clinical significance in the evaluation of operation risk in patients with obstructive jaundice.