人工肝血浆置换治疗重症肝炎并发症的预防与护理

【目的】研究重症肝炎进行人工肝血浆置换治疗时并发症的发生及其防治方法。【方法】分析45例重症肝炎患者采用血浆置换128次治疗过程中出现并发症35次的临床资料。【结果】并发症总发生率28%(36/128),其中过敏反应22%(28/128)低血压4%(5/128)。低血钙1.6%(2/128)出血0.8%(1/128),无继发感染发生,经及时处理后大都缓解。【结论】严密监测、严格操作、细心护理是保障人工肝治疗成功的关键,积极防治并发症对成功完成治疗是重要的,血浆置换对重症肝炎的治疗是安全可行的。

Comparative study on the efficacy of transoral robotic surgery and non-robotic surgery for tongue base tumors

Objective:To compare the efficacy of transoral robotic surgery(TORS)and non-robotic surgery(NRS)in the treatment of tongue base tumors.Methods:A total of 45 patients with tongue base tumors treated in our hospital were selected,and they were divided into the TORS group and NRS group according to different surgical methods.The surgical indicators and postoperative complications of patients in the two groups were compared and analyzed.Results:Compared with the NRS group,the operative time,bleeding volume and length of hospital stay were less in the TORS group,and the postoperative recurrence rate was less in the TORS group than that in the NRS group.The incidence rate of dysphagia and restricted mouth opening in the TORS group was lower than that in the NRS group within 30 d after surgery,and the difference was statistically significant(P<0.05).Conclusion:TORS has better minimally invasive advantages in the treatment of tongue base tumors,including less intraoperative bleeding,smaller trauma,shorter length of hospital stay and faster recovery.

重型肝炎继发细菌感染的临床特点及疗效分析

目的探讨重型肝炎继发细菌感染的临床特点及预后。方法回顾性分析该院2012年6月至2015年10月收治的36例重型肝炎患者的临床资料,通过检测其炎症指标白细胞及中性粒细胞、C反应蛋白(CRP)、红细胞沉降率(ESR)、降钙素原(PCT)、糖类抗原199(CA199)、铁蛋白的改变及早期继发感染的相关性,并及早进行抗感染治疗,对其相关资料及疗效进行统计分析。结果 36例患者均表现出1种或1种以上炎症指标水平升高,其中白细胞及中性粒细胞水平升高25例,占69.44%(25/36);CRP水平升高27例,占75%(27/36);ESR水平升高16例,占44.44%(16/36);PCT水平升高11例,占30.56%(11/36);CA199水平升高7例,占19.44%(7/36);铁蛋白水平升高23例,占63.89%(23/36)。所有患者均使用1种或1种以上抗生素进行抗感染,36例患者经抗感染及综合护肝治疗后,其中27例病情随着炎症指标的恢复正常或下降逐渐康复,但仍有9例死亡,死亡率为25.0%。9例死亡中因出现消化道大出血4例,2例出现肝性脑病,2例出现顽固性腹水及肝肾综合征3例。结论重型肝炎继发细菌感染发生率较高,以腹腔、呼吸道及胃肠道感染为主,病原菌主要为革兰阴性杆菌多见,通过炎症标志物的检测早期识别感染,并及早进行抗感染治疗,可有效防止因感染导致的病情恶化及相关并发症的出现,降低死亡率。

Comparison of reflux esophagitis and its complications between African Americans and non-Hispanic whites

AIM: To determine the effect of ethnicity on the severity of reflux esophagitis (RE) and its complications. METHODS: A retrospective search of the endoscopy database at the University of Florida Health Science Center/Jacksonville for all cases of reflux esophagitis and its complications from January 1 to March 31, 2001 was performed. Inclusion criteria were endoscopic evidence of esophagitis using the LA classif ication, reflux related complications and self-reported ethnicity. The data obtained included esophagitis grade, presence of a hiatal hernia, esophageal ulcer, stricture and Barrett's esophagus, and endoscopy indication. RESULTS: The search identified 259 patients with RE or its complications, of which 171 were non-Hispanic whites and 88 were African Americans. The mean ages and male/female ratios were similar in the two groups. RE grade, esophageal ulcer, stricture and hiatal hernia frequency were likewise similar in the groups. Barrett's esophagus was present more often in non-Hispanic whites than in African Americans (15.8% vs 4.5%; P < 0.01). Heartburn was a more frequent indication for endoscopy in non-Hispanic whites with erosive esophagitis than in African Americans (28.1% vs 7.9%; P < 0.001). CONCLUSION: Distribution of RE grade and frequency of reflux-related esophageal ulcer, stricture andhiatal hernia are similar in non-Hispanic whites and African Americans. Heartburn was more frequently and nausea/vomiting less frequently reported as the primary endoscopic indication in non-Hispanic whites compared with African Americans with erosive esophagitis or its complications. African Americans have a decreased prevalence of Barrett's esophagus compared with non-Hispanic whites.

Advanced age and the clinical outcomes of transcatheter aortic valve implan-tation

Aortic valve stenosis （AS） is common in the elderly. Although surgical replacement of the valve has been the gold standard of management, many patients have been excluded from surgery because they were very old, frail, or had co-morbidities that increased operative risks. In the last decade, transcatheter aortic valve implantation （TAVI） has emerged as a new treatment option suitable for these patients. This article reviews the available literature on the role of TAVI in elderly patients with severe aortic stenosis. Published studies showed that elderly individuals who underwent TAVI experienced better in-hospital recovery, and similar short and mid-term mortality compared to those underwent surgical treatment of AS. However, long-term outcomes of TAVI in elderly patients are still unknown. The available data in the literature on the ef-fect of advanced age on clinical outcomes of TAVI are limited, but the data that are available suggest that TAVI is a beneficial and tolerable procedure in very old patients. Some of the expected complications after TAVI are reported more in the oldest patients such as vascular in-jures. Other complications were comparable in TAVI patients regardless of their age group. However, very old patients may need closer monitoring to avoid further morbidities and mortality.

Prevalence of atrial fibrillation in Thai elderly

Atrial fibrillation （AF） is an important health problem due to its association with serious complications.Ill Stroke is one of the most serious complications and is the leading cause of death and disabilities in this population. AF in- creases the risk of embolic stroke five times compared to general population. The prevalence of AF varies from 0.5%-15% depending on studied populations such as age,

Reaching proficiency in laparoscopic splenectomy

AIM:To investigate the proficiency level reached in laparoscopic splenectomy using the learning curve method.METHODS:All patients in need of splenectomy for benign causes in whom laparoscopic splenectomy was attempted by a single surgeon during a time period of 6 years were included in the study (n=33). Besides demographics, operation-related variables and the response to surgery were recorded. The patients were allocated to groups of five, ranked according to the date of the operation. Operation duration, complications, postoperative length of stay, conversion to laparotomy and splenic weight were then compared between these groups.RESULTS: There was a significant difference regarding operation times between the groups (P = 0.001). An improvement was observed after the first 5 cases. The learning curve was flat up to the 25th case. Following the 25th case the operation times decreased still further. There was no difference between the groups regarding the other parameters.CONCLUSION: Unlike the widely accepted "L" shape, the learning curve for laparoscopic splenectomy is a horizontal lazy "S" with two distinct slopes. Privileges may be granted after the first 5 cases. However proficiency seems to require 25 cases.

Peripherally inserted central catheters in critically ill patients-complications and its prevention:A review

Peripherally inserted central catheter(PICC)is extensively used in critical care settings,because it plays a vital role in providing safe central venous entry.However,PICC is associated with several complications,which should be detected to shorten the duration of patients'improvement,reduce health care cost,and lessen the incidence of various PICC-related complications.Therefore,this study aimed to outline current literature on PICC procedures,potential complications,and measures for prevention.Understanding evidence-based guidelines regarding insertion technique,early detection of complications,and care bundle of PICC is significant in complication prevention.Implementation of education,training,and appropriate multidisciplinary approaches on PICC care among nurses and caregivers is the key to preventing complications.Thus,the strict care of indwelling PICC lines,the targeted and reasonable PICCassociated complication prevention,and nursing care have a major clinical significance in reducing the occurrence of potential PICC complications.

Comparison of early pre-cutting vs standard technique for biliary cannulation in endoscopic retrograde cholangiopancreatography: A personal experience

AIM： To compare the results and complications of early pre-cutting technique with standard technique. METHODS： From January 2003 to December 2004, a total of 426 consecutive therapeutic biliary ERCP procedures were performed by one endoscopist （T.A.）. Data were retrospectively collected according to procedure indication and results. Of these, 293 procedures （70.4%） were done with standard technique （group A） and 223 procedures （29.6%） with early pre-cutting technique in case of difficult cannulation （group B）. The results and complications of ERCP were compared. RESULTS： Success rate of first attempt cannulation was 98.0% in group A and 87.8% in group 13. The overall incidence of post-ERCP pancreatitis, hemorrhage, perforation and cholangitis was 0%, 0.2%, 0.5% and 0.5%, respectively. Morbidity rate was not significantly different. No procedure-related mortality was occurred. CONCLUSION： For an experienced hand, the early pre-cutting technique for biliary cannulation is safe and effective as standard technique.

Comparison of in-hospital outcomes between octogenarians and nonagenarians undergoing transcatheter aortic valve replacement： a propensity matched analysis

Background Aortic valve stenosis （AS） is very common in the elderly patients above 80 years. Transcatheter aortic valve replacement （TAVR） in such patients is being increasingly performed. This study sought to assess in-hospital outcome differences between octogenarians and nonagenarians and predictors of mortality in nonagenarians undergoing TAVR with severe AS. Method The study population was derived from the National Inpatient Sample （MS） for the years 2012-2014 using ICD-9 CM procedure codes 35.05 and 35.06 for TAVR. Hospitalizations below 80 years of age were excluded. After performing propensity score matching （1： 2）, in-hospital outcomes were compared in matched cohorts. Then, multivariate model was developed to analyze predictors of in-hospital mortality in nonagenarians. Results There were 11,630 hospitalizations in the octogenarian and 5815 hospitalizations in the nonagenarian group. Primary outcome of in-hospital mortality （6% vs. 4.1%, P ≤ 0.001） was higher in nonagenarians compared to octogenarians. Secondary outcomes including stroke （3.4% vs. 2.8%, P ≤ 0.001）, renal failure （18.9% vs. 17.3%, P ≤0.001）, blood transfusion （35% vs. 32.6%, P ≤ 0.001）, vascular complications （4.5% vs. 3.5%, P ≤ 0.001）, and pacemaker implantation （27.8% vs. 24.8%, P ≤ 0.001） were higher in nonagenarians. There was no difference in their length of stay. Median cost （70,3745 vs. 65,3815, P ≤ 0.001） was slightly higher with nonagenarian. Conclusions Although in-hospital mortality is slightly higher in nonagenarians, it is acceptable. This difference in mortality is at least partly explained by higher complications in nonagenarians. Efforts should be made to decrease the complications which can further narrow the difference in in-hospital mortality between the groups.

Right Ventricular Perforation after Pacemaker Implantation in an Elderly Woman： A Case Report

Background： Cardiac pacing is a proven and effective treatment used worldwide with a low incidence of complications depending on the patient group. Late lead perforation is a rare complication without a standard treatment. Case summary： We report a case of a 98-year old woman submitted to pacemaker implantation due to symptomatic second-degree atrio-ventricular block. After two days she returned to the hospital with thoracic pain and was diagnosed with RV （right ventricular） lead perforation. She was submitted to cardiac surgery with lead extraction and RV repair. Discussion： There are two major types of complications after pacemaker implantation, mechanical and infection. Reported perforation rates after pacemaker implantation range from 0.1%-0.8%. While acute lead perforation is very well described, late lead perforation is only described in case reports with a low rate of tamponade or death. Management of subacute or delayed RV lead perforation is not well defined due to very limited data. Question remains on whether to extract the lead or not.

Advances in the diagnosis and treatment of patients with cancer cachexia

Cachexia is a common complication with an incidence rate of 50%–80% in cancer patients. It is also responsible for 20% of mortality among these patients. Cachexia can significantly reduce the efficacy of antitumor therapies and increase treatment-related toxicity and adverse effects in cancer patients. This increases the symptom burden in patients, affects their quality of life, and ultimately shortens their survival time. The mechanism underlying the development of cachexia is complex and diverse and involves various factors and pathways, each playing an important role. Treatment approaches for cachexia are multimodal, including nutrition support therapy, appetite stimulants, and therapeutic drugs that specifically target the mechanism behind the disease. In recent years, we have gradually gained a better understanding of cachexia, and significant progress has been made in delineating molecular mechanisms, staging and diagnosis, and therapeutic drug treatment of cancer cachexia. This article reviews the research progress of cancer cachexia based on these contexts.

Geriatric cardiology and the Great Wall International Congress of Cardiology 2015

The burgeoning geriatric population worldwide has resulted in an unprecedented challenge to the cardiology community. Cardiovascular disease is the major cause of morbidity and mortality in the elderly population, but its recognition and management are characteristically confounded by substantial comorbidities, polypharmacy, and other complexities of care, not encountered in younger cardiac patients.

What is New in Supportive Care in Cancer？

The Annual Symposium of the Multinational Association of Supportive Care in Cancer （MASCC）/International Society of Oral Oncology （ISOO） was held in Vancouver, Canada,June 24-26, 2010. The symposium brought together health care professionals from many countries and many fields of expertise for an excellent forum of ideas, lectures and collegial interactions,and discussed methods to minimize cancer-induced side effects, the symptoms and complications of its treatment, and psychosocial issues facing cancer patients and their families. Some ideas and studies selected from the presentations of different fields of supportive care in cancer presented in this symposium are introduced in this paper.

无创正压通气治疗危重症甲型H1N1流感的临床评价

目的 探讨无创正压通气（NIPPV）应用于危重症甲型H1N1流感所致的急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）的可行性.方法 20例危重甲型H1N1流感患者应用NIPPV治疗,观察不同时间PaO2、PaCO2、pH、呼吸频率（RR）的变化.结果 应用NIPPV治疗H1N1流感所致ALI/ARDS,在通气2 h后可提高PaO2,降低呼吸频率;通气24 h后,PaO2、RR显著改善;病情恶化气管插管2例,无死亡病例.结论 对危重症甲型H1N1流感患者早期积极应用NIPPV治疗可改善缺氧,降低呼吸频率,改善呼吸肌疲劳,降低气管插管率.

危重症甲型H1Nl流感合并多器官功能障碍42例临床分析

目的探讨危重症甲型HlNl流感患者合并多器官功能障碍的临床特点。方法回顾性研究分析北京佑安医院收治的42例危重症甲型HlNl流感患者临床资料。结果42例患者有25例（59．5％）存在多器官功能障碍，死亡15例，17例无MODS患者死亡3例，两者比较差异有统计学意义（P〈0．05）。MODS患者肺部以外的受损器官损害程度均较轻，并非死亡的直接原因，存在MODS的死亡患者主要因呼吸衰竭死亡。结论危重症甲型H1N1流感并存多器官功能障碍导致预后不佳，但是肺部病变是死亡的主要原因。