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晚期泡型肝包虫病行肝移植术后肺、脑复发一例

Clinical features and treatment of patients with late-onset injuries in the 2008 Wenchuan earthquake

objective To analyze clinical features and treatment of patients with late-onset injuries in the 2008 Wenchuan earthquake．Methods Clinical data of three patients with late-onset injuries were analyzed retrospectively．Results The first patient was compromised with late-onset traumatic diaphragmatic hernia complicated with shock．The second and third patients were suffered from late—onset traumatic hepatic rupture．After prompt surgery operation，the first and second subjects survived．Unfortunately，the third patient died of severe abdominal infection despite successful operation .Conclusion Late-onset organ injuries must be recognized and treated promptl

静脉胰岛素泵联合持续血糖监测系统对肝移植术后患者血糖控制的有效性及安全性：附 1 例报道

目的 总结 1 例肝移植患者术后使用胰岛素泵联合持续血糖监测系统（CGMS）进行血糖控制的有效性及安全性。 方法 回顾性分析笔者所在医院科室于 2015 年 11 月收治的 1 例肝移植患者的临床资料，该患者术后使用胰岛素泵联合 CGMS 进行血糖控制。 结果 本例患者的血糖控制时间为 4 127 min。血糖控制参数：最大值 9.8 mmol/L，最小值 4.7 mmol/L（自觉无头晕、乏力等低血糖症状），平均 6.9 mmol/L，目标血糖达标时间为4 030 min，占 98%。血糖变异参数：标准差（SD ）为 1.1 mmol/L，血糖不稳定指数为 7.32（mmol/L）2/（h·d），平均血糖波动幅度为 0，平均日内血糖改变为 3.4 mmol/L。控制期间营养情况：肠内营养的碳水化合物用量为 115 g，全胃肠外营养的碳水化合物用量为 516 g，胰岛素用量为 139 U（用量均值为 2 U/h），平均采样时间为 109 min。肝移植术后 3 周患者痊愈出院，术后 1 个月随访无不适，复查糖化血红蛋白为 4.9%。 结论 胰岛素泵联合 CGMS 的血糖控制效果较好，但该结论仍需要大样本、多中心及前瞻性的随机对照试验给予证实。

机械敏感性 Piezo1 离子通道在急性呼吸窘迫综合征中的作用和机制研究

Retrospective analysis of death causes and relevant factors in victims of the 2008 W enchuan earthquake

Objective To analyze death causes and relevant factors in victims of Wenchuan earthquake．Methods Medical records of 27 dead patients admitted to W est China Hospital during the first 30 days after Wenchuan earthquake were analyzed retrospectively．Patient census data，diagnoses，dispositions，and prognoses were collected． Results A total of 2702 patients with earthquake related injuries were admitted to West China Hospital．The overall mortality rate was 1％(27／2702 patients)．The death were associated with age≥70．severe cerebral injuries and severe underlying illness．Mortality rate was highest in aged patients with comorbidities．Conclusions Insufficient pre-hospital treatment and inappropriate transfer procedure may contribute to the early death．Complicated with comorbidities is the leading cause of late death．Earlier involvement of intensivist in medical intervention in such a disaster is demanded．

Analysis of Tracheal Intubation in Intensive Care Unit

Objective To evaluate the clinical features and complications of bedside tracheal intubation in intensive care unit ( ICU) , and explore the suitable strategy of intubation. Methods In this retrospective study,42 patients who underwent bedside tracheal intubation in ICU during September 2008 and March 2009 were divided into a schedule group ( n =24) and an emergency group ( n =18) . The time to successful intubation, number of intubation attempts, and complications were recorded. The schedule group was defined as those with indications for intubation and fully prepared, while the emergency group was defined as those undergoing emergency intubations without full preparation due to rapid progression of disease and accidental extubation. Results The success rate for all patients was only 57. 1% on the first attempt ofintubation. The main complications during and after induction were hypotension ( 45. 2% ) and hypoxemia ( 50. 0% ) . Compared with the emergency group, the schedule group had fewer attempts to successful intubation ( 1. 71 ±1. 12 vs. 2. 67 ±1. 75) , higher success rate on the second attempt ( 87. 5% vs.61. 1%) , and lower ypoxemia incidence ( 29. 1% vs. 77. 8%, P lt; 0. 05) . Conclusions The tracheal intubation in ICU is a difficult and high risk procedure with obvious complications. Early recognition ofpatients with indications and well preparation are critical to successful bedside intubation.

VALUE OF MRI IN DIAGNOSIS OF OBSTETRICAL BRACHIAL PLEXUS PALSY PRE-GANGLIONIC INJURY

Objective To evaluate the value of MRI in diagnosis of obstetrical brachial plexus palsy pre-gangl ionic injury. Methods From November 2006 to February 2008, 10 patients with obstetrical brachial plexus palsy were treated, 8 males and 2 females, aged from 2 months to 3 years (11.4 months on average). There were 7 cases of left side and 3 of right side.According to Tassin classification, 2 cases were type II, 6 type III and 2 type IV. All patients were performed MRI examinations before the operation, whose results were compared with those of exploration during the operation. Results MRI examinations showed 1 patient was normal and 9 patients had post-traumatic spinalmeningolcele. The 6 patients had displacement of spinal cord (4 towards the healthy side and 2 towards the sick side), 6 had deformity of spinal cord, and 2 had avulsed nerve root thickening. MRI detected 19 nerve roots were positive, 16 were true positive and 3 false positive in surgical exploration. MRI detected 6 nerve roots were negative, 4 were true negative and 2 false negative in surgical exploration. The sensitivity, specificity and accuracy of MRI in diagnosis of obstetrical brachial plexus palsy pre-gangl ionic injury were 84.2%, 80.0% and 83.3%, respectively. There were significant differences in the results by preoperative MRI examinations and by exploration during the operation (P lt; 0.05). Conclusion MRI can show pre-gangl ionic injury of brachial plexus of the patients with obstetrical brachial plexus palsy and can supply references for early diagnosis and operation time. MRI can be routinely conducted as a preoperative examination.

Application progress and prospect of critical care ultrasound in weaning process

Weaning difficulty is common in critically ill patients. Prolonged mechanical ventilation and weaning failure adversely affect the clinical outcome. How to better promote and achieve the early extubation is a very important subject. As a multi-dimensional monitoring method of important structure, function and morphology, critical care ultrasound which is helpful to improve our understanding and grasp of the core links in the respiratory circuit can comprehensively evaluate the state and reserve capacity of some important organs, such as the heart, lungs and diaphragm. It has great value in assessment of weaning and guided treatment. This paper will review the application of severe ultrasound in weaning.

新型冠状病毒性肺炎疫情时期器官移植调整策略及体会

目的探讨新型冠状病毒性肺炎（简称新冠肺炎）疫情时期器官捐献移植工作的调整策略，总结经验。方法解读新冠肺炎疫情期间器官移植工作指南和第一版专家共识后，四川大学华西医院器官移植中心制定了器官移植调整方法。结果于 2020 年 1 月 24 日至 2020 年 2 月 6 日进行公民逝世后器官捐献 4 例，均为男性，平均年龄 39.5 岁。捐献后共行器官移植手术 8 例，其中肝脏移植 4 例，肾脏移植 4 例。移植受体平均年龄 48 岁，男 6 例，女2 例。8 例移植手术顺利，7 例患者无输血。手术后患者恢复顺利，无外科并发症发生，无感染相关并发症发生。结论新冠肺炎疫情期间，通过调整方法和流程，可以安全开展器官移植工作和实现疫情防控。

Ex vivo liver resection followed by autotransplantation in the treatment of advanced hepatic alveolar echinococcosis: a report of 21 cases

Objective To summarize the methods, safety, and efficacy of the ex vivo liver resection followed by autotransplantation in the treatment of advanced hepatic alveolar echinococcosis (HAE). Method A retrospective analysis of clinical data and follow-up data in 21 cases who received ex vivo liver resection followed by autotransplantation in the treatment of HAE from February 2014 to December 2016 in West China Hospital was performed. Results All the patients successfully underwent ex vivo liver resection followed by autotransplantation and no death happened during operation. The median weight of remnant liver was 701.4 g (360–1 300 g), the average operation time were 13.6 h (9.4–19.5 h), the anhepatic phase time were 180–455 min with median of 314 min. The average of intraoperative blood loss were 2 379 mL (1 200–6 000 mL). The average of patients entered red blood cell suspension were 10.6 u (0–39.5 u), the average of fresh frozen plasma were 1 377 mL (0–6 050 mL) , of which 7 patients received autologous blood transfusion, with average of 1 578 mL (500–3 700 mL). The average of postoperative hospital stay were 23.5 days (4–51 days). Postoperative complications occurred in 12 patients during hospitalization, and 4 cases of postoperative complications were in grade Clavien-Dindo Ⅲ or above, 2 cases of grade Ⅴ (died). During the follow-up period, 19 patients were followed for a median of 16.2 months (3–38 months), no HAE recurrence or metastasis was found, only 1 patient were lost follow-up after surgery for 12 months. Massive ascites and hyponatremia were found in 1 patient who was diagnosis as left hepatic vein stenosis at the end of the 3 months after operation. The patient was cured after interventional treatment of hepatic vein stent implantation and angioplasty. Conclusions The ex vivo liver resection followed by autotransplantation provides radical treatment for patients with advanced HAE, but the surgery is difficult and has high risk of postoperative complications. The detailed preoperative evaluation, intraoperative pipeline reconstruction reasonably, and fine postoperative management can improve the patient’s survival, and reduce the rate of complications.