第一部分诊疗指南肝脏是结直肠癌血行转移最主要的靶器官,结直肠癌肝转移(colorectal cancer liver metastases)是结直肠癌治疗的重点和难点之一。有15%~25%的结直肠癌病人在确诊时即合并肝转移,而另有15%~25%的病人将在结直肠癌原发灶...第一部分诊疗指南肝脏是结直肠癌血行转移最主要的靶器官,结直肠癌肝转移(colorectal cancer liver metastases)是结直肠癌治疗的重点和难点之一。有15%~25%的结直肠癌病人在确诊时即合并肝转移,而另有15%~25%的病人将在结直肠癌原发灶根治术后发生肝转移,其中绝大多数(80%~90%)的肝转移灶初始无法获得根治性切除。肝转移也是结直肠癌病人最主要的死亡原因,未经治疗的肝转移病人中位生存期仅6.9个月。展开更多
Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the c...Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the clinician, and this effort may serve to increase nationwide awareness and to improve the treatment result of ALI/ARDS. Methods The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations was derived from a 2001 publication sponsored by the International Sepsis Forum. A systematic review of the literature was undertook, and the reported results were graded into five levels to create recommendation grading from A to E, with a being the highest grade. Results It is essential to control the primary disease in ALI/ARDS. Role of noninvasive positive-pressure ventilation in ALI/ARDS is undefined. Noninvasive positive-pressure ventilation can not be considered in patients with coma, shock and damage of airway clearance. Limitation of end-inspiratory plateau pressure is important in the management of ARDS and may be facilitated by permissive hypercapnia. Recruitment maneuver should be considered to open collapsed lung and improve oxygenation. A minimum amount of positive end-expiratory pressure (PEEP) should be set to prevent atelectasis at end expiration in ARDS. If it is possible, setting the level of PEEP may be guided by measurement of static pulmonary pressure-volume curve . Unless contraindicated, patients with ARDS should be maintained semi-recumbent. Prone positioning should be considered in the patients with severest ARDS. Sedation protocols should be used. Paralysis is not recommended . The limited fluid management strategy is beneficial for ARDS. Corticosteroid is not recommended for ARDS. The role of other drugs is uncertain in ARDS. Conclusion Evidence-based recommendations can be made regarding many aspects of the acute management of ALI/ARDS that will hopefully translate into improved outcomes for the critically ill patient. The guidelines will be updated when some important new knowledge becomes available.展开更多
文摘第一部分诊疗指南肝脏是结直肠癌血行转移最主要的靶器官,结直肠癌肝转移(colorectal cancer liver metastases)是结直肠癌治疗的重点和难点之一。有15%~25%的结直肠癌病人在确诊时即合并肝转移,而另有15%~25%的病人将在结直肠癌原发灶根治术后发生肝转移,其中绝大多数(80%~90%)的肝转移灶初始无法获得根治性切除。肝转移也是结直肠癌病人最主要的死亡原因,未经治疗的肝转移病人中位生存期仅6.9个月。
文摘Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the clinician, and this effort may serve to increase nationwide awareness and to improve the treatment result of ALI/ARDS. Methods The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations was derived from a 2001 publication sponsored by the International Sepsis Forum. A systematic review of the literature was undertook, and the reported results were graded into five levels to create recommendation grading from A to E, with a being the highest grade. Results It is essential to control the primary disease in ALI/ARDS. Role of noninvasive positive-pressure ventilation in ALI/ARDS is undefined. Noninvasive positive-pressure ventilation can not be considered in patients with coma, shock and damage of airway clearance. Limitation of end-inspiratory plateau pressure is important in the management of ARDS and may be facilitated by permissive hypercapnia. Recruitment maneuver should be considered to open collapsed lung and improve oxygenation. A minimum amount of positive end-expiratory pressure (PEEP) should be set to prevent atelectasis at end expiration in ARDS. If it is possible, setting the level of PEEP may be guided by measurement of static pulmonary pressure-volume curve . Unless contraindicated, patients with ARDS should be maintained semi-recumbent. Prone positioning should be considered in the patients with severest ARDS. Sedation protocols should be used. Paralysis is not recommended . The limited fluid management strategy is beneficial for ARDS. Corticosteroid is not recommended for ARDS. The role of other drugs is uncertain in ARDS. Conclusion Evidence-based recommendations can be made regarding many aspects of the acute management of ALI/ARDS that will hopefully translate into improved outcomes for the critically ill patient. The guidelines will be updated when some important new knowledge becomes available.
