Epidemiology and risk factors for mortality in critically ill patients with pancreatic infection

Background:The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the(1)setting of infection onset(community-acquired,early onset,or late-onset hospital-acquired),(2)presence or absence of either localized or diffuse peritonitis,and(3)severity of disease expression(infection,sepsis,or septic shock).This classification system demonstrated reliable risk stratification in intensive care unit(ICU)patients with intra-abdominal infection.This study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and mortality.Methods:This was a secondary analysis of an international observational study(“AbSeS”)investigating ICU patients with intra-abdominal infection.Only patients with pancreatic infection were included in this analysis(n=165).Mortality was defined as ICU mortality within 28 days of observation for patients discharged earlier from the ICU.Relationships with mortality were assessed using logistic regression analysis and reported as odds ratio(OR)and 95%confidence interval(CI).Results:The overall mortality was 35.2%(n=58).The independent risk factors for mortality included older age(OR=1.03,95%CI:1.0 to 1.1 P=0.023),localized peritonitis(OR=4.4,95%CI:1.4 to 13.9 P=0.011),and persistent signs of inflammation at day 7(OR=9.5,95%CI:3.8 to 23.9,P<0.001)or after the implementation of additional source control interventions within the first week(OR=4.0,95%CI:1.3 to 12.2,P=0.013).Gramnegative bacteria were most frequently isolated(n=58,49.2%)without clinically relevant differences in microbial etiology between survivors and non-survivors.Conclusions:In pancreatic infection,a challenging source/damage control and ongoing pancreatic inflammation appear to be the strongest contributors to an unfavorable short-term outcome.In this limited series,essentials of the AbSeS-classification,such as the setting of infection onset,diffuse peritonitis,and severity of disease expression,were not associated with an increased mortality risk.

手术后应用氯胺酮降低腹部外科手术患者的吗啡用量：一项前瞻性、随机、双盲、对照研究

背景氯胺酮能够降低手术后吗啡的用量，但给药的适合剂量及持续时间仍然不是很清楚。在这项研究中，我们比较了仅在手术中给予氯胺酮和持续到手术后48小时对吗啡用量影响的差异。方法81例拟行腹部外科手术的患者在双盲的条件下被随机分为3组：（1）PERI组的患者在手术中及手术后48小时给予氯胺酮（单次给予0．5mg／kg后持续给予2μg·kg^-1·h^-1）。（2）INTRA组的患者只在手术中给予氯胺酮（单次给予0．5mg／kg后持续给予2μg·kg^-1·h^-1）。（3）CTRL组的患者给予安慰剂。记录手术后48小时的吗啡用量，视觉模拟评分（VAS）及副作用（镇静评分、恶心及呕吐评分、梦魇、精神障碍或幻想）。结果手术后24小时的吗啡累积用量在PERI组（中位数27mg，四分位距为[19]）显著低于INTRA组（48mg[41．5]）和CTRL组（50mg[21]）（P〈0．005）。手术后VAS评分PERI组和INTRA组显著低于CTRL组（P〈0．001）。恶心的发生率CTRL组显著高于PERI组（27％与4％，P=0．005）。镇静评分和精神障碍在各组间没有观察到差异。结论手术后48小时持续给予低剂量氯胺酮能够改善手术后的疼痛，显著降低吗啡的用量，且呕吐的发生率较低，也没有氯胺酮副作用的发生。