Objective:To investigate the effects of rhubarb enema on the expression of inflammatory factors and interleukin-33(IL-33)and its prognosis in patients with SAP complicated with sepsis.Methods:A total of 47 patients wi...Objective:To investigate the effects of rhubarb enema on the expression of inflammatory factors and interleukin-33(IL-33)and its prognosis in patients with SAP complicated with sepsis.Methods:A total of 47 patients with SAP complicated with ARDS admitted to the Department of Critical Care Medicine,the First Affiliated Hospital of Chongqing Medical University from June 2016 to December 2018 were randomly divided into SAP with ARDS sepsis group(sepsis group)and SAP.In the ARDS non-sepsis group(non-sepsis group),20 patients were treated according to the guidelines for the diagnosis and treatment of acute pancreatitis in China in 2013.They were given regular fasting,gastrointestinal decompression,fluid resuscitation,acid suppression,and growth.On the basis of the inhibition of water,electrolytes,acid-base balance,add rhubarb 3 g/kg,water 200 mL,filter the slag juice to 37~38℃for retention enema for more than 15min,2 times a day For a total of 7 days.The inflammatory markers WBC,PCT,heart rate,respiratory rate,oxygenation index(PaO2/FiO2),pancreatic severity score(BISAP),and IL-33 and various cytokine changes were recorded in the two groups.Results:On the first day of admission,the patients in the sepsis group had more severe inflammation index(WBC:14.23±2.95,PCT:3.62±2.04,heart rate:104.02±8.89,respiration:26.81±2.44),and the oxygenation index was more.Poor(PaO2/FiO2:164.08±21.05),IL-33(46.32±7.82)and higher cytokine expression(TNF-α:266.78±72.89,IL-1:53.47±10.52,IL-6:1824.68±598.53,IL-8:160.42±50.34),the difference was statistically significant compared with the non-sepsis group,P<0.01.After the treatment of rhubarb enema,the above indicators were significantly decreased in both groups,and admission.The difference was statistically significant on the first day,P<0.01.However,on the seventh day after treatment,the sepsis patients hadΔIL-33(41.63±7.86)and cytokines(ΔTNF-α:258.90±72.18,ΔIL-1:47.87±11.85,ΔIL-6:1775.57±598.31,ΔIL-8:143.12±51.98),oxygenation index(162.01±43.23)improved better than non-sepsis group,P<0.01,and the rate of invasive ventilation was not statistically significant.P>0.05.Conclusion:SAP combined with sepsis leads to the use of rhubarb enema in patients with ARDS to significantly improve the concentration of IL-33 as a"target"factor and reduce the proinflammatory factors TNF-α,IL-1,IL-6 and IL-8.Level,improve the patient's oxygenation,has clinical application value.展开更多
Severe acute pancreatitis(SAP)is a life-threatening acute abdominal disease with two peaks of death:the first in the early stage,characterized by systemic inflammatory response-associated organ failure;and the second ...Severe acute pancreatitis(SAP)is a life-threatening acute abdominal disease with two peaks of death:the first in the early stage,characterized by systemic inflammatory response-associated organ failure;and the second in the late stage,characterized by infectious complications.Neutrophils are the main immune cells participating in the whole process of SAP.In addition to the traditional recognition of neutrophils as the origination of chemokine and cytokine cascades or phagocytosis and degranulation of pathogens,neutrophil extracellular traps(NETs)also play an important roles in inflammatory reactions.We reviewed the role of NETs in the occurrence and development of SAP and its fatal complications,including multiple organs injury,infected pancreatic necrosis,and thrombosis.This review provides novel insights into the involvement of NETs throughout the entire process of SAP,showing that targeting NETs might be a promising strategy in SAP treatment.However,precision therapeutic options targeting NETs in different situations require further investigation.展开更多
目的研究导致重症急性胰腺炎(sever acute pancreatitis,SAP)并发感染的危险因素,为减少SAP并发感染提供参考。方法将本院重症监护室(intensive care unit,ICU)2013年5月至2015年5月收治的118例SAP患者根据治疗期间是否发生感染分为感染...目的研究导致重症急性胰腺炎(sever acute pancreatitis,SAP)并发感染的危险因素,为减少SAP并发感染提供参考。方法将本院重症监护室(intensive care unit,ICU)2013年5月至2015年5月收治的118例SAP患者根据治疗期间是否发生感染分为感染组(41例)与未感染组(77例)。回顾性分析及对比两组患者的性别、年龄、病因、有无2型糖尿病、是否手术治疗、是否留置引流管、有无低氧血症、急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、器官衰竭数、机械通气时间、禁食时间、血清淀粉酶水平及血钙水平共13项指标。对上述指标进行单因素分析,将存在显著性差异的指标纳入Logistic回归模型,分析SAP并发感染的危险因素。结果两组患者在性别、年龄、病因、2型糖尿病、留置引流管的分布方面无显著差异(P>0.05)。两组患者在手术治疗、低氧血症、APACHEⅡ评分、器官衰竭数、机械通气时间、禁食时间、血清淀粉酶水平及血钙水平方面存在显著差异(P<0.05)。Logistic回归分析显示,手术治疗、低氧血症、高APACHEⅡ评分、多器官衰竭、长时间机械通气及长时间禁食为SAP并发感染的危险因素。结论入院时高APACHEⅡ评分、多器官功能衰竭及低氧血症提示SAP患者很可能出现继发感染,而SAP早期采用手术治疗、过长的机械通气时间和禁食时间均会增加感染的发生风险。展开更多
基金Chongqing Municipal Health and Family Planning Commission Chinese Medicine Science and Technology Project(No.ZY201702071)Chongqing Municipal Health and Family Planning Commission Medical Research Project(No.2018MSXM097)。
文摘Objective:To investigate the effects of rhubarb enema on the expression of inflammatory factors and interleukin-33(IL-33)and its prognosis in patients with SAP complicated with sepsis.Methods:A total of 47 patients with SAP complicated with ARDS admitted to the Department of Critical Care Medicine,the First Affiliated Hospital of Chongqing Medical University from June 2016 to December 2018 were randomly divided into SAP with ARDS sepsis group(sepsis group)and SAP.In the ARDS non-sepsis group(non-sepsis group),20 patients were treated according to the guidelines for the diagnosis and treatment of acute pancreatitis in China in 2013.They were given regular fasting,gastrointestinal decompression,fluid resuscitation,acid suppression,and growth.On the basis of the inhibition of water,electrolytes,acid-base balance,add rhubarb 3 g/kg,water 200 mL,filter the slag juice to 37~38℃for retention enema for more than 15min,2 times a day For a total of 7 days.The inflammatory markers WBC,PCT,heart rate,respiratory rate,oxygenation index(PaO2/FiO2),pancreatic severity score(BISAP),and IL-33 and various cytokine changes were recorded in the two groups.Results:On the first day of admission,the patients in the sepsis group had more severe inflammation index(WBC:14.23±2.95,PCT:3.62±2.04,heart rate:104.02±8.89,respiration:26.81±2.44),and the oxygenation index was more.Poor(PaO2/FiO2:164.08±21.05),IL-33(46.32±7.82)and higher cytokine expression(TNF-α:266.78±72.89,IL-1:53.47±10.52,IL-6:1824.68±598.53,IL-8:160.42±50.34),the difference was statistically significant compared with the non-sepsis group,P<0.01.After the treatment of rhubarb enema,the above indicators were significantly decreased in both groups,and admission.The difference was statistically significant on the first day,P<0.01.However,on the seventh day after treatment,the sepsis patients hadΔIL-33(41.63±7.86)and cytokines(ΔTNF-α:258.90±72.18,ΔIL-1:47.87±11.85,ΔIL-6:1775.57±598.31,ΔIL-8:143.12±51.98),oxygenation index(162.01±43.23)improved better than non-sepsis group,P<0.01,and the rate of invasive ventilation was not statistically significant.P>0.05.Conclusion:SAP combined with sepsis leads to the use of rhubarb enema in patients with ARDS to significantly improve the concentration of IL-33 as a"target"factor and reduce the proinflammatory factors TNF-α,IL-1,IL-6 and IL-8.Level,improve the patient's oxygenation,has clinical application value.
基金Natural Science Foundation ofChina(Nos.81974552,81774160)the Scientific Research Foundation of the Science and Technology Department of Sichuan Province(No.2022YFS0417).
文摘Severe acute pancreatitis(SAP)is a life-threatening acute abdominal disease with two peaks of death:the first in the early stage,characterized by systemic inflammatory response-associated organ failure;and the second in the late stage,characterized by infectious complications.Neutrophils are the main immune cells participating in the whole process of SAP.In addition to the traditional recognition of neutrophils as the origination of chemokine and cytokine cascades or phagocytosis and degranulation of pathogens,neutrophil extracellular traps(NETs)also play an important roles in inflammatory reactions.We reviewed the role of NETs in the occurrence and development of SAP and its fatal complications,including multiple organs injury,infected pancreatic necrosis,and thrombosis.This review provides novel insights into the involvement of NETs throughout the entire process of SAP,showing that targeting NETs might be a promising strategy in SAP treatment.However,precision therapeutic options targeting NETs in different situations require further investigation.
文摘目的研究导致重症急性胰腺炎(sever acute pancreatitis,SAP)并发感染的危险因素,为减少SAP并发感染提供参考。方法将本院重症监护室(intensive care unit,ICU)2013年5月至2015年5月收治的118例SAP患者根据治疗期间是否发生感染分为感染组(41例)与未感染组(77例)。回顾性分析及对比两组患者的性别、年龄、病因、有无2型糖尿病、是否手术治疗、是否留置引流管、有无低氧血症、急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、器官衰竭数、机械通气时间、禁食时间、血清淀粉酶水平及血钙水平共13项指标。对上述指标进行单因素分析,将存在显著性差异的指标纳入Logistic回归模型,分析SAP并发感染的危险因素。结果两组患者在性别、年龄、病因、2型糖尿病、留置引流管的分布方面无显著差异(P>0.05)。两组患者在手术治疗、低氧血症、APACHEⅡ评分、器官衰竭数、机械通气时间、禁食时间、血清淀粉酶水平及血钙水平方面存在显著差异(P<0.05)。Logistic回归分析显示,手术治疗、低氧血症、高APACHEⅡ评分、多器官衰竭、长时间机械通气及长时间禁食为SAP并发感染的危险因素。结论入院时高APACHEⅡ评分、多器官功能衰竭及低氧血症提示SAP患者很可能出现继发感染,而SAP早期采用手术治疗、过长的机械通气时间和禁食时间均会增加感染的发生风险。
