目的 探讨重症急性胰腺炎并发多器官功能障碍及预后关系的临床研究。 方法 回顾分析2008年1月－2010年12月收治的51例重症急性胰腺炎患者的临床资料。 结果 其中出现全身炎症反应综合征者46例（90.20%），多器官功能障碍36例（70.59%），重症急性胰腺炎并发多器官功能障碍者治愈好转20例，未合并者治愈好转13例。死亡18例。 结论 引起重症急性胰腺炎患者死亡的最主要因素是多器官功能障碍，早预防、早发现、综合治疗多器官功能障碍有助于降低重症急性胰腺炎患者死亡率。
ObjectiveTo explore protective strategies for organ function of fulminant acute pancreatitis (FAP) in early stage. MethodsThe clinical data of 37 patients with FAP admitted to this hospital within 72 h after onset of symptoms between January 2000 and September 2010 were analyzed retrospectively. FAP was defined as presence of multiple organ dysfunction syndrome (MODS) within 72 h after onset of symptoms. A total of 37 patients with a confirmed diagnosis of FAP were divided into two groups based on whether adopting the protective strategies for organ function in early stage or not. Patients treated between January 2000 and May 2004 did not adopt the protective strategies for organ function (Named nonprotection group, n=21); The other patients treated between June 2004 and September 2010 adopted protective strategies for organ function (Named protection group, n=16). With the exception of the protecting strategies for organ function, the patients with severe acute pancreatitisin received standard treatment in two groups. The acute physiology and chronic health evaluation (APACHE) Ⅱ score and multiple organ dysfunction score (Marshall), rate of pancreas infection, and case fatality were compared between two groups. ResultsCompared with the nonprotection group on day 3 after admission, APACHEⅡ score and Marshall score decreased in the protection group (APACHEⅡ score : 15.71±2.95 versus 17.72±3.77, P=0.137; Marshall score: 6.93±2.73 versus 8.06±2.36, P=0.206, respectively). In addition, the case fatality on day 7 and in hospital case fatality in the protection group decreased as compared with the nonprotection group (case fatality on day 7: 18.75% versus 33.33%, P=0.461; in hospital case fatality: 43.75% versus 57.14%, P=0.515, respectively). There was no significant difference of the rate of pancreas infection between two groups (P=1.000). ConclusionsIt from a case of a particular disease perspective, though the difference is not significant, but the observed improvement in prognosis is attributed by protective strategies for organ function of FAP in early stage to a certain degree, however it is verified by needing to more cases.
Objective To investigate the dynamic expression and clinical significance of myoglobin, creatine kinase and inflammatory mediators in the serum of patients with multiple trauma. Methods From May 2013 to March 2015, 56 patients with multiple trauma admitted in EICU were recruited in the study. According to the injury severity, 56 patients were divided into a mild trauma group, a medium trauma group and a severe trauma group. The subjects were further divided into a MODS group and a non-MODS group based on multiple organ dysfunction syndrome (MODS) criteria. Twenty healthy adults undergoing physical examination were recruited as control. Serum myoglobin, creatine kinase, IL-6 and TNF-α levels were measured in the multiple trauma patients (1st day, 3rd day, 7th day and 14th day) and the controls. Results Compared with the controls, the serum levels of myoglobin, creatine kinase, IL-6 and TNF-α in the patients with multiple trauma increased significantly from 1st to 14th day after injury (allP＜0.05). Serum myoglobin, creatine kinase, IL-6 and TNF-α levels on 3rd day after injury reached the peak, then decreased gradually in the mild, medium, and severe trauma groups, among which the changes of serum myoglobin, creatine kinase, IL-6 and TNF-α levels were significant on 3rd day compared with other timepoints (allP＜0.05). On 1st day after injury, serum levels ofmyoglobin, creatine kinase, IL-6 and TNF-α also differed significantly between the MODS group and non-MODS group (allP＜0.05). The AUCs of myoglobin, IL-6 and TNF-α for predicting MODS were 0.527-0.817, 0.641-0.890, and 0.197-0.544, respectively. Conclusions The dynamic changes of serum myoglobin, creatine kinase, IL-6 and TNF-α in patients with multiple trauma are correlated well with the injury severity and prognosis. Serum myoglobin, IL-6 and TNF-α levels may be good markers to predict secondary MODS in multiple trauma patients.
目的 探讨主要组织相容性复合体(MHC)Ⅱ类基因的反式转录因子（CⅡTA）在多器官功能障碍综合征（MODS）中对MHCⅡ类基因的调控机理。方法 18只雄性家猪随机分为实验组（n=9）和对照组(n=9)。实验组给予失血性休克、再灌注损伤、内毒素血症等复合干扰因素，建立二次打击猪MODS模型； 对照组仅进行麻醉和动静脉插管。7 d后处死存活动物。切取实验组造模成功动物和对照组动物的脾脏组织，用Trizol法提取总RNA。设计CⅡTA和猪MHCⅡ类基因(SLA-DQA)引物序列，逆转录构建cDNA，行实时荧光定量PCR检测。UVP计算机图像分析系统绘出标准曲线并得出2组CⅡTA mRNA和SLA-DQA mRNA的拷贝数。以Pearson法分析MODS动物CⅡTA mRNA和SLA-DQA mRNA表达的相关性。结果 实验组动物死亡7例，有8例发生MODS。对照组动物CⅡTA mRNA的拷贝数为（3.516±1.237）×103，实验组MODS动物为（0.367±0.088）×103，差异有统计学意义（P=0.000）； 对照组SLA-DQA mRNA拷贝数为（5.330±3.053）×103，实验组为（1.376±1.006）×103，差异亦有统计学意义(P=0.002)。MODS动物中CⅡTA mRNA和SLA-DQA mRNA的表达呈正相关(Pearson值为0.499，P=0.017)。结论 MODS模型复制满意。MHCⅡ类基因在MODS中表达下降与CⅡTA的调控有关。
目的 探讨5例特重型胰腺炎的特点及治疗方法。方法 我院2001年8月至2003年8月共收治特重型胰腺炎患者5例。其中入院后18 h内心跳、呼吸骤停3次的重症急性胰腺炎（SAP）1例，治疗以及时血液滤过和心、肺、脑复苏为重点； SAP并发胰性脑病2例，以大剂量维生素B1的补充，或足量补给浓缩红细胞为治疗重点； 并发多个器官功能障碍的暴发性胰腺炎（FAP）2例，治疗重点是血液滤过和防治多器官功能衰竭的级联放大反应，其中1例以高渗性糖昏迷为主要表现，治疗重点是内稳态的纠正，血液滤过，重要器官功能维护。结果 5例特重型胰腺炎患者均治愈，平均住院时间为32.2 d。结论 器官功能的复苏和维护、外科ICU监护、短时血液滤过、内稳态的纠正、中西药综合治疗及病因、对症的个体化治疗是特重型胰腺炎的重要治疗措施。
Objective To summarize and explore the clinical features, diagnosis and treatment of severe pulmonary tuberculosis (TB). Methods One death case of pulmonary TB in The First Affiliated Hospital of Soochow University was analyzed, related publications of case reports and articles relevant on the analysis and study of pulmonary tuberculosis deaths from Pubmed between January 2012 and March 2022 were also reviewed. Results A 25-year-old female patient was admitted for "intermittent cough with sputum for more than 1 year, aggravated with chest tightness and shortness of breath for 5 days". She had no underlying disease. Pulmonary TB was diagnosed by TB bacterium smear and next-generation sequencing of bronchoalveolar lavage fluid. The patient was in shock compensation period and developed acute respiratory distress syndrome immediately after admission. Through active anti-tuberculosis, invasive mechanical ventilation, intra-aortic balloon counterpulsation and continuous renal replacement therapy, the disease continued to deteriorate and she died on the third day after admission. A total of 269 pulmonary TB deaths were retrieved. An analysis of 244 patients' past medical history showed that human immunodeficiency virus co-infection was the most common among young people and chronic diseases were the most common among the elderly. All 269 patients died of septic shock, respiratory failure and multiple organ dysfunction syndrome (MODS), among which hyponatremia was also a significant complication. The shortest time from admission to death was 7 days, while the longest average time was only 35 days. Conclusions Pulmonary TB could develop into septic shock and MODS with poor prognosis and high mortality. Health education on TB should be strengthened.