Risk factors and their interactive effects on severe acute pancreatitis complicated with acute gastrointestinal injury

BACKGROUND There are many risk factors for severe acute pancreatitis(SAP)complicated with acute gastrointestinal injury(AGI),but few reports on the interaction between these risk factors.AIM To analyze the risk factors for SAP complicated with AGI and their interactive effects.METHODS We selected 168 SAP patients admitted to our hospital between December 2019 and June 2022.They were divided into AGI group and non-AGI group according to whether AGI was present.Demographic data and laboratory test data were compared between the two groups.The risk factors for SAP with concomitant AGI were analyzed using multifactorial logistic regression,and an analysis of the interaction of the risk factors was performed.RESULTS The percentage of patients with multiple organ dysfunction syndrome,acute physiological and chronic health scoring system II(APACHE II)score,white blood cell count and creatinine(CRE)level was higher in the AGI group than in the non-AGI group.There was a statistically significant difference between the two groups(P<0.05).Logistic regression analysis indicated that an APACHE II score>15 and CRE>100μmol/L were risk factors for SAP complicating AGI.The interaction index of APACHE II score and CRE level was 3.123.CONCLUSION An APACHE II score>15 and CRE level>100μmol/L are independent risk factors for SAP complicated with AGI,and there is a positive interaction between them.

Severity of acute gastrointestinal injury grade is a good predictor of mortality in critically ill patients with acute pancreatitis

BACKGROUND Gastrointestinal(GI)dysfunction is a common and important complication of acute pancreatitis(AP),especially in patients with severe AP.Despite this,there is no consensus means of obtaining a precise assessment of GI function.AIM To determine the association between acute gastrointestinal injury(AGI)grade and clinical outcomes in critically ill patients with AP.METHODS Patients with AP admitted to our pancreatic intensive care unit from May 2017 to May 2019 were enrolled.GI function was assessed according to the AGI grade proposed by the European Society of Intensive Care Medicine in 2012,which is mainly based on GI symptoms,intra-abdominal pressure,and feeding intolerance in the first week of admission to the intensive care unit.Multivariate logistic regression analysis was performed to assess the association between AGI grade and clinical outcomes in critically ill patients with AP.RESULTS Among the 286 patients included,the distribution of patients with various AGI grades was 34.62%with grade I,22.03%with grade II,32.52%with grade III,and 10.84%with grade IV.The distribution of mortality was 0%among those with grade I,6.35%among those with grade II,30.11%among those with grade III,and 61.29%among those with grade IV,and AGI grade was positively correlated with mortality(χ2=31.511,P<0.0001).Multivariate logistic regression analysis showed that age,serum calcium level,AGI grade,persistent renal failure,and persistent circulatory failure were independently associated with mortality.Compared with the Acute Physiology and Chronic Health Evaluation II score(area under the curve:0.739 vs 0.854;P<0.05)and Ranson score(area under the curve:0.72 vs 0.854;P<0.01),the AGI grade was more useful for predicting mortality.CONCLUSION AGI grade is useful for identifying the severity of GI dysfunction and can be used as a predictor of mortality in critically ill patients with AP.

Heparanase inhibition leads to improvement in patients with acute gastrointestinal injuries induced by sepsis

BACKGROUND Patients with sepsis are at high risk for acute gastrointestinal injury(AGI),but the diagnosis and treatment of AGI due to sepsis are unsatisfactory.Heparanase(HPA)plays an important role in septic AGI(S-AGI),but its specific mechanism is not completely understood,and few clinical reports are available.AIM To explore the effect and mechanism of HPA inhibition in S-AGI patients.METHODS In our prospective clinical trial,48 patients with S-AGI were randomly assigned to a control group to receive conventional treatment,whereas 47 patients were randomly assigned to an intervention group to receive conventional treatment combined with low molecular weight heparin.AGI grade,sequential organ failure assessment score,acute physiology and chronic health evaluation II score,D-dimer,activated partial thromboplastin time(APTT),anti-Xa factor,interleukin-6,tumour necrosis factor-α,HPA,syndecan-1(SDC-1),LC3B(autophagy marker),intestinal fatty acid binding protein,D-lactate,motilin,gastrin,CD4/CD8,length of intensive care unit(ICU)stay,length of hospital stay and 28-d survival on the 1^(st),3^(rd) and 7^(th) d after treatment were compared.Correlations between HPA and AGI grading as well as LC3B were compared.Receiver operator characteristic(ROC)curves were generated to evaluate the diagnostic value of HPA,intestinal fatty acid binding protein and D-lactate in S-AGI.RESULTS Serum HPA and SCD-1 levels were significantly reduced in the intervention group compared with the control group(P<0.05).In addition,intestinal fatty acid-binding protein,D-lactate,AGI grade,motilin,and gastrin levels and sequential organ failure assessment score were significantly decreased(P<0.05)in the intervention group.However,LC3B,APTT,anti-Xa factor,and CD4/CD8 were significantly increased(P<0.05)in the intervention group.No significant differences in interleukin-6,tumour necrosis factor-α,d-dimer,acute physiology and chronic health evaluation II score,length of ICU stay,length of hospital stay,or 28-d survival were noted between the two groups(P>0.05).Correlation analysis revealed a significant negative correlation between HPA and LC3B and a significant positive correlation between HPA and AGI grade.ROC curve analysis showed that HPA had higher specificity and sensitivity in diagnosis of S-AGI.CONCLUSION HPA has great potential as a diagnostic marker for S-AGI.Inhibition of HPA activity reduces SDC-1 shedding and alleviates S-AGI symptoms.The inhibitory effect of HPA in gastrointestinal protection may be achieved by enhanced autophagy.

血清NLR联合AGI分级对急性缺血性卒中患者血管内治疗临床结局的预测价值

目的探讨中性粒细胞与淋巴细胞比值(NLR)联合急性胃肠损伤分级(AGI)对急性缺血性卒中患者(AIS)血管内治疗(EVT)临床结局的预测价值。方法回顾性纳入卒中中心就诊并接受EVT治疗的AIS患者。根据手术后90 d改良Rankin量表(mRS)分数将患者分为预后良好(mRS≤2分)组和预后不良组(mRS>2分)。收集两组患者临床资料及中医证型。计算术前NLR并记录入院后1周内AGI最高值进行统计分析。研究AIS患者接受EVT后预后不良的风险因素,并利用logistic回归进行分析。同时绘制受试者工作特征(ROC)曲线,评估NLR联合AGI分级对AIS患者接受EVT的预后价值。结果共纳入164例患者,其中预后良好组89例(54.3%),预后不良组75例(45.7%)。预后不良组年龄、入院美国国立卫生研究院卒中量表(NIHSS)评分、住院总费用、高血压病比例、三酰甘油、尿素、NLR水平、发生肺炎比例、AGI分级高于预后良好组,淋巴细胞计数水平低于预后良好组(均P<0.05)。预后不良组患者中风痰阻络证比例高于存活组(P<0.05)。多因素logistic回归分析显示,NLR(OR=1.121,95%CI:1.025~1.227,P=0.012)、AGI严重程度(OR=1.936,95%CI:1.233~3.040,P=0.004)、尿素水平(OR=1.343,95%CI:1.036~1.741,P=0.026)、风痰阻络证(OR=3.335,95%CI:1.136~9.568,P=0.025)、发生肺炎(OR=4.529,95%CI:1.444~14.210,P=0.010)为AIS患者行EVT后结局不良的独立危险因素。ROC曲线分析显示,NLR联合AGI分级评估急性缺血性卒中患者血管内治疗预后不良的曲线下面积大于NLR、AGI分级单独评估。结论NLR、AGI对AIS患者EVT治疗的预后评估有一定的预测作用,二者联合可以提高其预测价值。

Neutrophil-to-lymphocyte ratio predicts acute kidney injury occurrence after gastrointestinal and hepatobiliary surgery

BACKGROUND Postoperative acute kidney injury(AKI) is a complex pathological process involved intrarenal and systemic inflammation caused by renal hypoperfusion, nephrotoxic drugs and urinary obstruction. Neutrophil-to-lymphocyte ratio(NLR) is a marker of inflammation reflecting the progress of many diseases. However, whether NLR at admission can predict the occurrence of AKI after surgery in the intensive care unit(ICU) remains unknown.AIM To clarify the relationship between NLR and the occurrence of AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU.METHODS A retrospective analysis of 282 patients receiving surgical ICU care after gastrointestinal and hepatobiliary surgery in our hospital from December 2014 to December 2018 was performed.RESULTS Postoperative AKI occurred in 84 patients(29.79%) in this cohort. NLR by the multivariate analysis was an independent risk factor for occurrence of postoperative AKI in patients with gastrointestinal and hepatobiliary surgery in the ICU. In this cohort, receiver operating characteristic curves of AKI occurrence showed that the optimal cut-off value of NLR was 8.380. NLR was found to be significantly correlated with the white blood cell count, neutrophil count, lymphocyte count, arterial lactate and dialysis(P < 0.05). Additionally, NLR value at admission was higher in AKI patients compared with the non-AKI patients and increased with the severity of AKI. Patients with NLR ≥ 8.380 exhibited significantly higher incidences of postoperative AKI and severe AKI than patients with NLR < 8.380(AKI: 38.12% vs 14.85%, P < 0.001;severe AKI: 14.36% vs 1.98%, P = 0.001).CONCLUSION NLR at admission is a predictor of AKI occurrence in patients with gastrointestinal and hepatobiliary surgery in ICU. NLR should be included in the routine assessment of AKI occurrence.

Management of acute kidney injury in gastrointestinal tumor:An overview

Gastrointestinal tumors remain a global health problem.Acute kidney injury(AKI)is a common complication during the treatment of gastrointestinal tumors.AKI can cause a decrease in the remission rate and an increase in mortality.In this review,we analyzed the causes and risk factors for AKI in gastrointestinal tumor patients.The possible mechanisms of AKI were divided into three groups:pretreatment,intrafraction and post-treatment causes.Treatment and prevention measures were proposed according to various factors to provide guidance to clinicians and oncologists that can reduce the incidence of AKI and improve the quality of life and survival rate of gastrointestinal tumor patients.

Risk Factors for Gastrointestinal Injuries in Acute Coronary Syndrome Patients with Double Antiplatelet Therapy in One-Year Follow-Up

Background: The goal is to determine the incidence of symptomatic gastrointestinal (GI) injuries in acute coronary syndrome (ACS) patients receiving double antiplatelet therapy (DAPT). The risk factors for serious GI complications are also evaluated. Methods: 603 eligible patients from the Department of Cardiology at Zhongda Hospital between January 2014 and August 2015 were enrolled and the occurrence of GI injuries within one year assessed. The risk factors for serious GI complications were identified using cox regression analysis. Results: After one-year follow-up, 108 (17.9%) out of 603 patients developed symptomatic GI injuries: 22 (3.65%) with serious GI complications and 86 (14.2%) with GI symptoms. Drinking habit (95% CI: 1.512 - 8.796;P = 0.004) and previous peptic injury (95% CI: 2.307 - 18.080;P = 0.001) are independent predictors of serious GI complications, while proton pump inhibitor (PPI) was protective (95% CI: 0.120 - 0.699;P = 0.006) per cox regression analysis. Additionally, GI injuries of both serious GI complications and GI symptoms peaked in the first three months. Conclusions: Symptomatic GI injuries were relatively common in ACS patients with DAPT, especially in the first three months. Previous peptic injury and drinking habit were significant independent risk factors for serious GI complications, while PPI played a protective role in ACS with DAPT.

AGI评分、甘油三酯联合hs-CRP/Alb比值评估高甘油三酯血症性急性胰腺炎患者疾病严重程度及复发情况的临床应用研究

目的探讨采用急性胃肠损伤(AGI)评分、甘油三酯(TG)联合高敏C反应蛋白/白蛋白(hs-CRP/Alb)比值评估高甘油三酯血症性急性胰腺炎(HTG-AP)患者疾病严重程度及复发情况的应用效能。方法招募2019年6月至2022年6月电子科技大学医学院附属绵阳医院收治的HTG-AP患者89例,其中轻度急性胰腺炎(MAP)32例(MAP组),中重度急性胰腺炎(MSAP)38例(MSAP组)和严重急性胰腺炎(SAP)19例(SAP组)。随访观察患者出院3个月内病情复发情况,采用多因素Cox回归分析探讨影响疾病复发的因素,采用受试者工作特征(ROC)曲线评估AGI、TG联合hs-CRP/Alb比值预测疾病复发的效能。结果SAP组AGI评分、hs-CRP、hs-CRP/Alb比值水平显著高于MSAP组和MAP组(P<0.05),Alb水平显著低于MSAP组和MAP组(P<0.05)。MSAP组AGI评分、hs-CRP、hs-CRP/Alb比值水平显著高于MAP组(P<0.05),Alb水平显著低于MAP组(P<0.05)。89例患者失访5例,在随访期间复发29例,未复发55例。多因素Cox回归分析结果显示,较高水平的AGI评分、TG、hs-CRP/Alb比值是HTG-AP患者病情复发的独立危险因素(P<0.05)。ROC曲线分析结果显示,TG、AGI评分、hs-CRP/Alb比值均具有预测HTG-AP患者病情复发的应用价值(P<0.05),且三者联合可进一步提高预测效能[AUC(95%CI)=0.965(0.916~1.000),P<0.05]。结论AGI评分、hs-CRP/Alb比值增高与HTG-AP严重程度具有关联性,TG、AGI评分联合hs-CRP/Alb比值可用于评估HTG-AP病情复发的风险。

急性胃肠道损伤分级联合序贯器官衰竭评分对脓毒症患者28天预后有评估价值

目的:探讨急性胃肠损伤(AGI)分级联合序贯器官衰竭评分(SOFA)对脓毒症患者28 d预后的预测价值。方法:以192例脓毒症患者为研究对象,根据患者28 d是否存活分为存活组和死亡组,比较2组的临床特征。入院1周内每日记录AGI分级,并分析不同AGI分级患者的临床特征。分别绘制AGI分级、SOFA评分、急性生理学及慢性健康状况(APACHEⅡ)评分以及AGI分级联合SOFA评分对患者28 d预后的受试者工作特征(ROC)曲线,计算相应的曲线下面积(AUC),并进行比较。结果:192例脓毒症患者28 d死亡率为38.0%(73/192),AGI的发生率为89.1%(171/192),其中1级患者69例,2级72例,3级26例,4级4例。AGI分级越高,患者危重症评分、28 d死亡率越高(P均<0.01)。多元回归分析显示,年龄、乳酸、机械通气(MV)、AGI分级以及APACHEⅡ评分是脓毒症患者28 d死亡的独立危险因素(P均<0.05)。ROC曲线分析提示,AGI分级、SOFA评分对患者28 d死亡的预测能力均低于APACHEⅡ评分,但两者相结合的预测能力与APACHEⅡ评分相当(P>0.01)。结论:脓毒症患者AGI发生率高,AGI分级联合SOFA评分对脓毒症患者28 d预后有预测价值。

基于随机森林算法的重型颅脑损伤患者并发急性胃肠损伤的现状及风险模型构建

目的探讨重型颅脑损伤患者并发急性胃肠损伤的危险因素,为预防急性胃肠损伤提供借鉴。方法2021年1月至2023年1月,便利抽样法选取某院收治的重型颅脑损伤患者150例为研究对象,建立基于重型颅脑损伤并发急性胃肠损伤的危险因素的随机森林算法的预测模型。结果150例重症颅脑损伤患者中,并发急性胃肠损伤患者94例,占62.67%。是否并发急性胃肠道损伤的患者在糖尿病、白蛋白、APACHE-Ⅱ评分、休克指数、液体负平衡、酸中毒、深度镇静、呼吸衰竭方面的差异均有统计学意义(均P<0.05)。构建重型颅脑损伤并发急性胃肠损伤的随机森林模型,树的数量为103时出现的错误率最低;影响重型颅脑损伤并发急性胃肠损伤的因素重要性排序为糖尿病、液体负平衡、急性生理与慢性健康评分、白蛋白、深度镇静及酸中毒;随机森林模型预测重型颅脑损伤并发急性胃肠损伤的受试者工作特征曲线(receiver operating characteristic,ROC)下面积(area under curve,AUC)为0.798,Logistic回归模型的AUC为0.773。结论构建的重型颅脑损伤并发急性胃肠损伤的风险预测模型预测效能较高,临床值得推广应用。

急性胃肠功能损伤分级指导下脓毒症患者早期肠内营养的效果及对近期预后的影响

目的探讨急性胃肠功能损伤(AGI)分级指导下脓毒症患者早期肠内营养(EN)的效果及对近期预后的影响。方法回顾性选择2014年3至8月浙江省14个成人综合ICU收治的脓毒症患者102例,按照入院后1周内最差的AGI分级分为4组:无AGI组、AGIⅠ级组、AGIⅡ级组、AGIⅢ+Ⅳ级组。比较各组入院时急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、平均动脉压(MAP)等基本资料及住院28 d生存率、无机械通气时间、抗生素使用时间、入院7 d内EN达标比例等指标。采用Kaplan-Meier生存曲线和log-rank检验评估不同AGI分级脓毒症患者生存率的差异,采用Cox回归分析脓毒症患者生存预后的独立影响因素。结果4组患者APACHEⅡ评分、SOFA评分、MAP、乳酸、无机械通气时间及抗生素使用时间比较,差异均有统计学意义(均P<0.05)。存在AGI的患者住院28 d生存率低于无AGI患者,且AGI分级越高,生存率呈下降趋势,差异均有统计学意义(均P<0.05)。入院第3天EN 80%达标、第7天EN达标的患者住院28 d生存率高于未达标组,差异均有统计学意义(均P<0.05)。Cox回归分析发现乳酸(HR=1.180,95%CI:1.045~1.340,P=0.008)、AGI分级(HR=1.304,95%CI:1.041~1.567,P=0.012)、APACHEⅡ评分(HR=1.069,95%CI:1.013~1.129,P=0.015)和SOFA评分(HR=1.183,95%CI:1.040~1.330,P=0.005)是导致脓毒症患者死亡的独立危险因素,而MAP(HR=0.969,95%CI:0.949~0.989,P=0.003)和入院第7天EN达标(HR=0.458,95%CI:0.225~0.930,P=0.031)则是保护性因素。结论基于AGI分级标准来指导脓毒症患者的早期EN具有一定的临床适用性。同时,AGI分级越高预示死亡率越高,而EN早期达标则可降低脓毒症患者的死亡率。

急性上消化道出血继发急性肾损伤和病情进展危险因素分析

目的:探讨急性上消化道出血(AUGIB)患者继发急性肾损伤(AKI)和病情进展的危险因素。方法:回顾性分析厦门大学附属东南医院2021年1月至2023年6月收治的233例上消化道出血患者临床资料,根据入院后是否发生AKI分为AKI组(n=67)和非AKI组(n=166),AKI患者根据病情是否进展分为进展组(n=21)和无进展组(n=46)。采用单因素和多因素分析上消化道出血继发急性肾损伤和病情进展的危险因素。结果:233例AUGIB患者中消化道溃疡患者157例、食管胃底静脉曲张42例、急性胃黏膜损伤18例、食管贲门撕裂综合征10例、异物6例。AKI患者67例,发生率为28.76%,其中,21例发生AKI进展,进展率为31.34%。单因素分析发现,冠心病、肝硬化、血小板计数<50×10^(9)/L、血红蛋白计数<60 g/L、血清白蛋白<35 g/L、上消化道出血分级高危及以上AUGIB患者AKI发生率较高(P<0.05)。多因素分析发现,冠心病(OR=2.706,95%CI 1.127~6.494)、血小板计数<50×10^(9)/L(OR=3.570,95%CI 1.249~10.203)、上消化道出血分级高危及以上(OR=3.078,95%CI 1.145~8.227)是AKI发生的独立危险因素。单因素分析发现,67例AUGIB继发AKI患者中,男性、糖尿病、乙型肝炎、肝硬化、既往上消化道出血病史、血小板计数<50×10^(9)/L、血红蛋白计数<60 g/L、血清白蛋白<35 g/L、上消化道出血分级高危及以上患者AKI进展发生率较高(P<0.05)。多因素分析发现,肝硬化(OR=7.975,95%CI 1.400~45.441)、血小板计数<50×10^(9)/L(OR=19.612,95%CI 2.640~145.703)、上消化道出血分级高危及以上(OR=6.814,95%CI 1.183~27.985)是AKI进展的独立危险因素。结论:AUGIB患者要警惕AKI的发生,冠心病、血小板计数<50×10^(9)/L、上消化道出血分级高危及以上是AKI发生的独立危险因素,而肝硬化、血小板计数<50×10^(9)/L、上消化道出血分级高危及以上是AKI进展的独立危险因素。

宣肺通腑方干预急性肺损伤患者胃肠功能紊乱的临床观察

目的观察基于“肺与大肠相表里”理论的宣肺通腑方干预急性肺损伤患者胃肠功能紊乱的疗效。方法将50例接受宣肺通腑汤联合乳果糖口服液治疗的急性肺损伤患者设为联合组,再收集同期同科室50例仅接受乳果糖口服液治疗的同类型患者设为对照组。比较两组临床症状积分,并根据病例信息整理患者胃肠激素、炎症指标变化,分析其安全性。结果治疗7 d后,两组临床症状积分均下降,且联合组低于对照组(P<0.05);两组血清胃动素、胃泌素、血管活性肠肽水平均上升(P<0.05),肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)水平均下降(P<0.05),且联合组变化幅度大于对照组(P<0.05);两组不良反应发生情况差异无统计学意义(P>0.05)。结论基于“肺与大肠相表里”理论宣肺通腑方干预急性肺损伤患者胃肠功能紊乱可能有较好的疗效,能够改善患者胃肠功能,减轻炎性反应,且安全性良好。

miR-155调节脓毒症诱导的炎症反应及肠道功能障碍的机制

目的探讨miR-155在脓毒症中的临床价值,以及其在脓毒症引起的炎症反应和肠道功能障碍中的作用。方法采用前瞻性观察性研究方法,收集2021年11月至2023年4月新疆医科大学第一附属医院129例脓毒症患者及129例同期健康体检者外周血样本,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),评价miR-155在脓毒症中的诊断价值。所有脓毒症患者进一步根据病情严重程度分为脓毒症组(n=83)和脓毒性休克组(n=46)。根据欧洲危重症医学会(ESICM)提出的诊断标准,进一步将脓毒症患者分为急性胃肠损伤(AGI)组(n=75)和非AGI组(n=54),比较两组循环miR-155及外周血清二胺氧化酶(DAO)的表达水平。采用盲肠结扎穿孔法(CLP)建立脓毒症大鼠模型,并按照随机数字法将32只大鼠分为假手术(Sham)组、CLP组、miR-155阴性对照组(CLP大鼠术前1个月腹腔注射250μL miR-155腺相关病毒空载体)和miR-155腺相关病毒抑制组(CLP大鼠术前1个月腹腔注射250μL miR-155腺相关敲低病毒),每组8只。于造模后24 h经腹主动脉采血并取大鼠小肠组织,采用苏木素-伊红(HE)染色观察小肠病理学改变并进行肠黏膜损伤评分(Chiu′s评分);采用实时荧光定量PCR(qRT-PCR)检测miR-155表达水平;采用酶联免疫吸附法检测大鼠血清DAO、肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)水平;采用免疫组化法及蛋白质免疫印迹法检测肠道紧密连接蛋白[紧密连接蛋白-封闭蛋白1(Claudin-1)及闭合蛋白(Occludin)]的表达。结果脓毒症患者外周血miR-155表达量较健康体检者明显升高,且脓毒性休克患者外周血miR-155表达量亦高于脓毒症患者(P<0.05)。经ROC曲线分析,外周血miR-155表达量可区分脓毒症患者与健康体检者(AUC为0.932,敏感度为91.9%,特异度为90.5%),也可区分脓毒症与脓毒性休克患者(AUC为0.883,敏感度为79.2%,特异度为80.6%),也可区分脓毒症AGI和非AGI患者(AUC为0.933,敏感度为80.4%,特异度为93.4%)。此外,脓毒症组外周血miR-155表达量与C-反应蛋白(CRP)、降钙素原(PCT)、乳酸、急性生理学与慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)、DAO、IL-6及TNF-α呈正相关(均P<0.05)。动物实验结果提示,与Sham组相比,CLP组大鼠小肠黏膜水肿、炎症细胞浸润,绒毛破坏塌陷、排列紊乱、部分腺体结构不完整,Chiu′s评分明显升高,血清TNF-α、IL-6、DAO水平明显升高,小肠黏膜组织紧密连接蛋白表达减少。与CLP组相比,miR-155抑制组大鼠肠道损伤得到明显缓解,表现为Chiu′s评分、IL-6、TNF-α、DAO水平下降,紧密连接蛋白表达增加。结论miR-155可能是诊断脓毒症的潜在生物标志物,降低其表达水平可减轻脓毒症诱导的炎症反应和肠道功能障碍。

胃肠道功能障碍在肝硬化脓毒症患者预后中的价值

目的 评估急性胃肠道损伤(AGI)和肠脂肪酸结合蛋白(I-FABP)在肝硬化脓毒症患者预后中的价值。方法 回顾性分析2020年9月—2023年3月某院重症监护病房(ICU)收治的84例肝硬化脓毒症患者临床资料,并选择同期41例失代偿期肝硬化患者作为对照组。采用酶联免疫吸附测定(ELISA)法测定患者血清I-FABP水平。计算入院终末期肝病模型(MELD)和序贯器官衰竭评估(SOFA)评分,根据住院病历评估AGI程度,观察30天和90天生存状况。采用Spearman相关分析判断变量间相关性,多因素Cox回归分析确定肝硬化脓毒症死亡的危险因素。采用受试者工作特征(ROC)曲线确定最佳临界值,ROC曲线下面积(AUC)比较诊断效能。结果 肝硬化脓毒症组患者AGI分级和I-FABP水平均高于对照组(均P<0.05)。肝硬化脓毒症患者I-FABP与降钙素原(PCT)、MELD和SOFA评分均相关(均P<0.05),AGI分级与SOFA评分呈正相关(P=0.038)。肝硬化脓毒症组患者30天病死率为25.0%(21例),90天病死率为35.7%(30例)。多因素Cox回归分析显示,基线I-FABP、SOFA评分与30天和90天生存结局独立相关,且I-FABP四分位数显示出良好的预后区分能力。ROC曲线显示,I-FABP能明显提高SOFA评分对患者预后的预测效能。结论 肝硬化脓毒症患者AGI分级和I-FABP水平明显升高。血清I-FABP与患者预后相关,并可提高SOFA评分对生存结局的预测效能。

基于气机升降理论运用电针干预脓毒症患者急性胃肠损伤的临床研究

目的观察基于气机升降理论运用电针干预脓毒症急性胃肠损伤的临床安全性与有效性。方法53例患者按随机数字表法分为试验组27例对照组26例。两组均采用常规治疗,试验组在常规治疗基础上依据气机升降理论选用相关穴位加用电针治疗,疗程14 d。比较两组患者在治疗前和治疗第3、7、14天的胃肠功能指标、炎症指标、相关评分及28 d生存率之间的差异。结果试验组第7、14天急性胃肠损伤分级(AGI)低于同期对照组(P<0.05),治疗有效率优于对照组;试验组第3、7天腹腔内压力(IAP)低于同期对照组(P<0.05);试验组第3、7、14天肠鸣音高于同期对照组(P<0.05);试验组第3天肠内营养泵速高于同期对照组(P<0.05);试验组治疗后炎症指标均较前降低(P<0.05),对照组第7、14天C反应蛋白(CRP)、降钙素原(PCT)较前降低(P<0.05);试验组第3天胃肠功能障碍(GIF)评分低于同期对照组(P<0.05);治疗后两组患者急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分均较前降低(P<0.05);两组患者28 d生存率无明显差异(P>0.05)。结论基于气机升降理论运用电针干预脓毒症急性胃肠损伤,可有效改善患者胃肠功能,减轻炎症反应及脓毒症严重程度。

AGI分级标准对胃肠功能障碍评估价值及其在早期EN中的应用效果

目的:探讨急性胃肠损伤(acute gastrointestinal injury,AGI)分级标准对危重症患者胃肠功能障碍评估价值及其在早期肠内营养(enteral nutrition,EN)支持中的应用效果.方法:选取2013-01/2014-01河南省中医院重症监护病房(intensive care unit,ICU)收治的78例胃肠功能障碍患者为研究对象,患者入住ICU后12-24 h内行EN治疗.根据AGI分级标准将患者分为Ⅰ级35例,Ⅱ级22例,Ⅲ级12例,Ⅳ级9例,并按AGI指南对患者实施对应治疗,观察EN实施前后营养状态、病情程度及EN摄入量达标率、胃肠黏膜功能的变化,并分析AGI分级与EN喂养率及热量达标率的关系.结果:4组患者入ICU时急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluation systemⅡ,APACHEⅡ)、血清白蛋白(serum albumin,ALB)、氮平衡(nitrogen balance,NB)、总蛋白(total protein,TP)、胃黏膜pH值、乳酸值、胃黏膜二氧化碳分压(PgCO2)水平无统计学差异(P>0.05),治疗7 d后,Ⅰ-Ⅲ级患者APACHEⅡ评分、乳酸值、PgCO2均显著下降(P<0.05),ALB、NB、TP、pH值水平显著升高(P<0.05).Ⅳ级患者入住ICU 7 d时,APACHEⅡ评分、乳酸值、PgCO2显著高于Ⅰ-Ⅲ级患者(P<0.05),而NB、TP、pH值水平均低于Ⅰ-Ⅲ级患者(P<0.05),各组间ALB水平差异无统计学意义(P>0.05).Ⅰ-Ⅳ级患者24 h喂养率分别为91.43%、68.18%、50.00%、0.00%,48 h喂养率分别为100.00%、81.82%、58.33%、0.00%,7 d热量达标率分别为100.00%、81.82%、66.67%、22.22%.相关分析显示,AGI分级与24 h喂养率、48 h喂养率及72 h营养达标率呈负相关(均P<0.05).结论:AGI分级与EN治疗效果具有良好的相关性,可作为危重症患者胃肠道功能的评价指标.

急性胃肠损伤分级护理对急性胰腺炎患者症状改善时间的影响

目的评价急性胃肠损伤(AGI)分级护理在急性胰腺炎(AP)患者中的实施效果和意义。方法选取200例AP患者作为研究对象,均为厦门大学附属中山医院消化内科于2021年3月至2022年2月收治,按简单随机抽样法将其分为2组。对照组(100例)实施常规护理,观察组(100例)运用AGI分级护理。比较2组的胃肠道功能改善情况、并发症发生率、实验室指标以及护理满意率。结果观察组的胃肠道功能恢复(腹胀腹痛缓解、排气、排便和肠鸣音恢复)时间均短于对照组(P均<0.05)。观察组的各种并发症(全身感染、胰腺假性囊肿、胰周脓肿、急性液积聚)总发生率较对照组更低(P<0.05)。出院时及出院1个月后,观察组的血清淀粉酶、尿淀粉酶水平和白细胞计数均较同期对照组更低(P均<0.05),且2组均低于同组入院时(P均<0.05)。观察组的护理总满意率高于对照组(P<0.05)。结论AGI分级护理对AP患者胃肠道功能的恢复、并发症发生率的降低、实验室指标的改善以及护理满意率的提升均可起到积极作用。

“老十针”为主治疗脓毒症合并急性胃肠损伤的临床研究

目的 观察“老十针”配合常规药物治疗脓毒症合并急性胃肠损伤(acute gastrointestinal injury,AGI)的临床疗效。方法 将66例脓毒症合并AGI患者随机分为观察组和对照组,每组33例。对照组按照SEPSIS3.0治疗方案治疗,观察组在对照组基础上加用“老十针”针刺治疗。观察两组治疗前后肠鸣音分级、AGI分级、急性生理与慢性健康(acute physiology and chronic health evaluationⅡ, APACHEⅡ)评分及各项炎症指标[降钙素原(procalcitonin, PCT)、C-反应蛋白(C-reactive protein, CRP)]的变化情况。结果 两组治疗后肠鸣音分级及AGI分级与同组治疗前比较,差异均具有统计学意义(P<0.05)。观察组治疗后肠鸣音分级及AGI分级与对照组比较,差异具有统计学意义(P<0.05)。观察组治疗后APACHEⅡ评分及PCT水平较同组治疗前均显著下降,对照组治疗后APACHEⅡ评分及CRP、PCT水平较同组治疗前均显著下降,差异均具有统计学意义(P<0.05)。两组治疗后APACHEⅡ评分及CRP、PCT水平比较,差异均无统计学意义(P>0.05)。结论 “老十针”配合常规药物治疗可以改善脓毒症合并AGI患者的胃肠症状,促进胃肠道功能恢复。

胃肠道超声在重症患者中的临床应用

胃肠道超声是一种无创、实时性强的检查技术,能够提供动态的影像信息,对胃肠道结构、功能和血流灌注等进行评估,有助于早期诊断和个体化治疗方案的制定。本文主要综述了胃肠道超声应用于监测重症患者的胃肠道功能障碍、指导重症患者营养方案的实施,指导重症患者肠内营养管、引流管的放置,评估血管,确定急腹症的病因(如肠梗阻、胃肠道穿孔)等方面,具有重要的临床意义。胃肠道超声有望成为重症医学领域中不可或缺的工具。