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Objective:To investigate the clinical efficacy and prognostic influencing factors of open abdomen technique for acute pancreatitis with abdominal compartment syndrome (ACS).Methods:The retrospective cohort study was conducted. The clinical data of 186 patients of acute pancreatitis with ACS who were admitted to 6 hospitals, including 65 cases in the 910th Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army, 46 cases in the First Affiliated Hospital of Wenzhou Medical University, 33 cases in the Fujian Provincial Hospital, 31 cases in the Second Affiliated Hospital of Fujian Medical University, 7 cases in the People′s Hospital Affiliated to Quanzhou Medical College, 4 cases in the Shishi General Hospital, from January 2013 to December 2020 were collected. There were 142 males and 44 females, aged (43±8)years. Observation indica-tors: (1) patients conditions after being treatment with open abdomen technique; (2) analysis of clinical characteristics in patients with different treatment outcomes; (3) changing trend of the volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in patients with different treatment outcomes; (4) influencing factors for prognosis of patients. Measurement data with normal distribution were represented as Mean± SD, and compari-son between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or the continuity correction chi-square test. Repeated measurement data were analyzed using the repeated ANOVA. Spearman correlation analysis was used for correlation analyses. The COX regression model was used for univariate analysis and COX regression model with forward regression was used for multivariate analysis. Results:(1) Patients conditions after being treatment with open abdomen technique. Intra-abdominal pressure, oxygena-tion index, levels of lactic acid and sequential organ failure score of the 186 patients were (23.3±1.9)mmHg (1 mmHg=0.133 kPa), (121±24)mmHg, (5.0±3.4)mmol/L and 10.4±3.6 before the treatment with open abdomen technique and (11.2±2.9)mmHg, (222±38)mmHg, (3.2±2.1)mmol/L and 4.4±2.3 at postoperative 168 hours, showing significant differences in time effects before and after the treatment ( Ftime=855.26,208.50, 174.91,208.47, P<0.05). (2) Analysis of clinical characteristics in patients with different treatment outcomes. Of the 186 patients, 166 cases survived and were discharged, and 20 cases died during hospitalization. Age, sequential organ failure score, duration of ACS and levels of lactic acid during hospitalization before the treatment with open abdomen technique were (41±7)years, 9.4±3.4, 13(10,21)hours and (4.2±0.6)mmol/L in surviving patients, versus (45±6)years, 11.5±2.4, 65(39,84)hours and (5.2±0.5)mmol/L in dead patients, respectively, showing significant differences between them ( t=-2.10, -2.71, Z=-5.36, t=-7.16, P<0.05). Duration of postoperative acute gastro-intestinal injury, duration of continuous renal replacement therapy, time to liberation from mech-anical ventilation, duration of vasoactive drugs therapy, cases undergoing early abdominal closure, cases without intestinal fistula or with postoperative high-order intestinal fistula and low-order intestinal fistula during hospitalization after the treatment with open abdomen technique were 4(2,6)days, 4(3,7)days, 34(21,41)days, 3(2,6)days, 126, 131, 23, 12 in surviving patients, versus 13(10,17)days, 10(8,18)days, 0(0,3)days, 8(6,12)days, 1, 2, 15, 3 in dead patients, respectively, showing significant differences between them ( Z=-5.60, -3.75, -3.64, -3.06, χ2=41.43, 45.86, P<0.05). (3) Changing trend of the volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in patients with different treatment outcomes. The volume of urine output, levels of lactic acid, levels of enteral nutrient intake and the sequential organ failure score in surviving patients during hospitalization were (0.29±0.10)mL/(kg·h), (4.2±0.6)mmol/L, 0.0 kcal/(kg·d) and 9.4±3.4 before the treatment with open abdomen technique and (2.22±0.15)mL/(kg·h), (1.9±0.7)mmol/L, (20.7±2.9)kcal/(kg·d) and 3.7±2.2 at postoperative 168 hours. The above indicators in dead patients during hospitalization were (0.28±0.08)mL/(kg·h), (5.2±0.5)mmol/L, 0.0kcal/(kg·d) and 11.5±2.4 before the treatment with open abdomen technique and (0.28±0.09)mL/(kg·h), (7.7±0.8)mmol/L, (4.6±1.8)kcal/(kg·d) and 12.4±2.1 at postoperative 168 hours. There were significant differences in time effects in the above indicators in surviving patients and dead patients before and after the treatment with open abdomen technique ( Ftime=425.57, 188.59, 394.84, 37.52, P<0.05). There were interactive effects between the above indicators and the treatment outcome at different time points ( Finteraction=383.14, 233.04, 169.83, 36.61, P<0.05). There were signifi-cant differences in the change trends of the above indicators between the surviving patients and the dead patients during hospitalization ( Fgouprs=2 739.56, 877.98, 542.05, 240.85, P<0.05). (4) Influen-cing factors for prognosis of patients. Results of univariate analysis showed that age, sequential organ failure score, duration of ACS before surgery, procalcitonin, lactic acid, postoperative high-order intestinal fistula, abdominal hemorrhage, duration of postoperative acute gastrointestinal injury, duration of continuous renal replacement therapy, duration of vasoactive drugs therapy, early abdominal closure were related factors influencing prognosis of patients under-going treatment with open abdomen technique ( hazard ratio=1.07, 1.18, 1.39, 1.16, 8.25, 12.26, 2.83, 1.29, 1.56, 1.41, 0.02, 95% confidence interval as 1.00-1.15, 1.45-2.27, 1.22-1.57, 1.02-1.32, 1.75-38.90, 7.37-41.23, 1.16-6.93, 1.22-1.37, 1.23-1.99, 1.08-1.84, 0.00-0.16, P<0.05). Results of multivariate analysis showed that extended duration of ACS before surgery, postoperative high-order intestinal fistula and extended duration of postoperative acute gastrointestinal injury were independent risk factors influencing prognosis of patients undergoing treatment with open abdomen technique ( hazard ratio=1.05, 7.95, 1.17, 95% confidence interval as 1.01-1.32, 2.05-30.87, 1.13-1.95, P<0.05) and early abdominal closure was an independent protective factor ( hazard ratio=0.10, 95% confidence interval as 0.01-0.89, P<0.05). Results of Spearman correlation analysis showed that duration of ACS was positively correlated with sequential organ failure score before surgery ( r=0.71, P<0.05). Conclusions:Open abdomen technique is effective for acute pancreatitis with ACS. Extended duration of ACS before surgery, postoperative high-order intestinal fistula and extended duration of postoperative acute gastrointestinal injury are independent risk factors for prognosis of patients during hospitalization and early abdominal closure is an independent protective factor.
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Background:In the clinical setting, the effect of intra-abdominal hypertension on the human body is dependent on time, but its role is not yet clear.Objective:To investigate the effect of the duration of intra-abdominal hypertension (IAH) on the prognosis of critically ill patients.Methods:This prospective cohort study enrolled 256 IAH patients who were admitted to the Surgical ICU of 10 Grade A hospitals in Fujian Province from January 2018 to December 2020. The duration of IAH (DIAH) was obtained after monitoring IAP, and ICU length of stay, duration of mechanical ventilation, duration of continuous renal replacement therapy (CRRT) and average daily energy intake from enteral nutrition during ICU stay were observed and recorded. The correlation was analyzed by Spearman rank correlation. The patients were divided into the survival group and the death group according to their survival state at 60 days after enrollment. Thereafter, clinical characteristics between the two groups were compared. Multivariable logistic regression was used to study and validate the relationship between DIAH and 60-day mortality. The receiver operating characteristics (ROC) curve was established to evaluate the predictive abilities of DIAH on the mortality risk.Results:In critically ill patients, DIAH was positively correlated with duration of mechanical ventilation ( r=0.679, P<0.001), duration of CRRT ( r=0.541, P<0.001) and ICU length of stay ( r=0.794, P<0.001), respectively. In addition, there was a negative correlation between DIAH and average daily energy intake from enteral nutrition ( r=-0.669, P<0.001). After multivariable adjustment, DIAH was an independent risk factor for 60-day mortality in critically patients with IAH ( OR=1.05, 95% CI: 1.01-1.12; P = 0.012), and exhibited a linearity change trend relationship with mortality risk. The ROC curve analysis of DIAH showed that the area under ROC curve (AUC) was 0.825 (95% CI: 0.763~0.886, P<0.01). When the cut-off value was 16.5 days, the sensitivity was 78.4% and the specificity was 75.4%. Conclusions:DIAH is an important risk factor for prognosis in critically ill patients. Early identification and rapid intervention for the etiology of IAH should be performed to shorten DIAH.
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Objective To systematically assess whether cilostazol can delay the progression or decrease the carotid intima-media thickness (clMT).Methods Papers on the effect of cilostazol on cIMT in randomized controlled trials and cohort studies were retrieved from a number of foreign and domestic databases.The data were analyzed by Review Manager 5.3.Results Six randomized controlled trials and two cohort studies were included in this study.A total of 1107 patients were divided into cilostazol therapy group (n=533) and control group (n=574).Meta-analysis showed that cilostazol therapy for 6 months,12 months,≥24 months could reduce the maximum cIMT with a mean difference of-0.04 mm (95％CI:-0.05--0.03,P=0.000),a mean difference of -0.04 mm (95％CI:-0.05--0.03,P=0.000) and a mean difference of-0.08 mm (95％CI:-0.11-0.05,P =0.000) respectively.Conclusion Cilostazol therapy for 6 months,12 months,24 months or more than 24 months can reduce the maximum cIMT,which is needed to be confirmed by studies with a large sample of clinical data.
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Objective To observe the effect of different explosion impulse on rabbit lung injury and decide the death curve,so as to provide a reference for the prediction of lung injury.Methods Six healthy male New Zealand white rabbits with weight of 2.0-2.5 kg and age of (6 ± 1)months were selected.The rabbits were put 0.5 m,0.6 m,0.7 m,0.9 m,1.0 m,and 1.2 m away from 90 g TNT to carry out the blast injury experiment.The characteristic parameters of blast shock wave and general lung injury were recorded.Based on the experimental results combined with theoretical analysis,the changes of rabbit lung injury depending on the explosion distance as well as the rabbit death curve were determined.Results After the 90 g TNT explosion,the peak overpressure of shock wave and the corresponding specific impulse decreased quickly with the increase of explosion distance.The peak overpressure was 0.79 MPa and the specific impulse was 82 Pa · s at the explosion distance of 0.5 m.The peak overpressure was 0.1 MPa and the specific impulse was 34 Pa · s at the explosion distance of 1.2 m.The rabbits at 0.5 m and 0.6 m died,the rabbit at 0.7 m was severely injured,and the rabbits at 0.9 m,1.0 m,and 1.2 m were slightly injured.The dependence of lung injury degree on the explosion distance under 90 g TNT explosion was established based on dimensional analysis theory.The lung injury degree was exponentially attenuated with the explosion distance:φ =(R/0.6)-5.64(φ represented lung injury degree,and R represented the explosion distance).Considering the combined injury effects of peak overpressure of shock wave and its specific impulse on rabbit lung,the death curve of rabbit was determined:(p-0.1) (I-59) =2.6 (p represented peak overpressure,and I represented specific impulse).The criterion of "overpressure-specific impulse" was used to estimate the death of rabbit,and the death curve of rabbit was determined as (p-0.1)(I-59) =2.6(p represented peak overpressure and I represented specific impulse).The critical overpressure was 0.1 MPa and the critical specific impulse was 59 Pa · s.Conclusions Under the explosion condition of 90 g TNT,the relationship between degree of lung injury in rabbits and explosion distance is established.Death curve of rabbits is determined based on the damage effect of shock wave peak overpressure and specific impulse on the lungs of rabbits,which is significant for predicting the blast injury.
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Objective To discuss endoscopic surgical treatment and its effect of intranasal contact point headaches.Methods Twe(n)ty-five patients with intranasal contact point headaches were treated by endoscopic rhinoplasty of nasal cavity,including middle turbinoplasty,functional resection of ostiomeatal complex,endoscopic submucous septoplasty.Achieved organic combination of the above surgery methods according to the different results of the CT scan and endoscope,the surgical procedure waft designed individually.Results All patients were followed up for 9 to 12 months.Recovery was 21 cases(84.00%),efficacy was 3 cases(12.00%),inefficacy was 1 case(4.00%),the rate of fully recovered without serious complication was 96.00%(24/25).Conclusions Intranagal contact point headaches is a sort of the nasal headaches as a result of multi abnormality of nasal cavity structure.Endoscopic rhinoplagty is an effective treatment by means of reconstructing the balance of bilateral nasal cavity and improving its function.
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Objective To establish a method for recognizing nasal bleeding sites and hemorrhagic foci of hidden epistaxis.Methods The bleeding sites and hemorrhagic foci,as well as the used surgical techniques and the curative effects were studied retrospectively in 122 patients with spistaxis from Jan.2005 to Oct.2007,in whom the bleeding sites and hemorrhagic foci were not found by routine nasoscope examination.Under nasal endoscopic monitoring,electric heat cauterization(EHC),microwave coagulation(MC) and micro-traumatic nasal packing(MTNP) were applied respectively to treat the hidden epistaxis.Results The hemorrhagic foci were found in the following sites:Olfactory cleft 48 cases(39.3%),superior wall of inferior nasal meatus 20 cases(16.4%),posteroinferior wall of middle nasal meatus 6 cases(4.9%) and so on.Epistaxis was well controlled in 113 of 122 cases(92.6%),in whom the hemorrhagic foci were found by endoscope,by laser soldering,MC and EHC.Packing with mini gel foam was used in 9 cases,for whom the hemorrhagic foci were not found.No complications occurred during a 1-2 months of follow up after treatment.Of the 122 cases,106 cases(86.9%) stopped bleeding by treatment once and 16 cases(13.1%) stopped by treatment twice.Conclusion The lateral or posterior area of middle and inferior nasal meatus,and olfactory cleft area are the frequent sites of hidden epistaxis.Examination with endoscopy,combined with the findings on the middle and inferior turbinate and the features of blood flow in different sites,will be important on recognizing the hidden epistaxis and locating the hemorrhagic foci.
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Objective To investigate the pathogenesis,diagnosis and therapy of intranasal contact point headache.Method The clinical data of 73 patients with contact point headache between the septum and the lateral nasal wall were retrospectively reviewed and the anatomical abnormality of nasal carity was determined by CT scanning of the sinuses and endoscopy.All the patients underwent surgical intervention for correcting the abnormal anatomical conditions of nasal cavity.Results The headache disappeared in 67 of the 73 patients after topical anesthesia,and in the 6 remainders after maxillary sinus puncture.Among the anatomic variations in all the cases,endoscopy revealed that 31 sides there was hypertrophy of ethmoidal bulla,hypertrophy and medial deriation of processus uncinatus in 59 cases,abnormality of middle turbinate in 91 sides,and upper nasal septal deviation in 51 cases.Among the 73 cases,there was confact of two or mose sites of mucosa of the abnormalities in 57 cases.The headache disappeared in 64 patients(87.7%) one week after operation,and it was reduced in 9 cases(12.3%).12-month follow-up showed recovery in 59 cases(80.8%),in 12 cases(16.4%) it was partially relieved,and in 2 cases(2.7%) there was no effect.Conclusions Abnormal nasal septa,enlarged turbinates and other anatomic abnormalities are the most common findings in contact point headache.Pressure due to mucosal contact between the septum and lateral nasal wall mucosa,and maxillary sinus orifice occlusion are the major causes of contact point headaches.Endoscopy,CT scanning,and topical anesthesia are ideal in diagnosis of intranasal contact point headache.