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Alanyl-glutamine Dipeptide for Severe Acute Pancreatitis: A Systematic Review

Objective　To systematically review the effectiveness and safety of alanyl-glutamine dipeptide for severe acute pancreatitis (SAP). Methods　Such databases as MEDLINE, EMbase, CENTRAL, VIP, WanFang Data, CBM and CNKI were electronically searched from inception to October, 2012 for randomized controlled trials on alanyl-glutamine dipeptide for SAP. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.2. Results　Five trials were included involving a total of 227 patients. The results of meta-analysis showed that: compared with the control group, the alanyl-glutamine dipeptide group had the lower incidence of SAP complications (RR=0.41, 95%CI 0.20 to 0.82), the lower incidence of infected pancreatic necrosis (RR=0.12, 95%CI 0.02 to 0.89), less time for alleviating bellyache (MD= –0.90, 95%CI –1.72 to –0.08). There was a tendency in decreasing SAP mortality (RR=0.15, 95%CI 0.02 to 1.19) and lessening the recovery time of blood amylase (SMD=0.37, 95%CI –0.04 to 0.79). Conclusion　Current evidence shows that, alanyl-glutamine dipeptide can lower the incidence of complications and the incidence of infected pancreatic necrosis, and shorten the time for alleviating bellyache in SAP patients. Due to the limited quality of the included studies, the above conclusion needs to be verified by more high quality studies.

Causes, Prevention and Nursing of the Complication in Critically Ill Neurosurgical Patients with Peripherally Inserted Central Catheter

目的　探讨神经外科危重患者经外周静脉置入中心静脉导管（PICC）的常见并发症发生原因，同时总结并发症有效预防措施及护理对策。 方法　纳入2009年9月－2012年9月期间行PICC的190例神经外科重症住院患者，统计并发症发生率，对其原因进行分析，并开展针对性预防和护理。 结果　本组患者PICC置管后有75例发生不同类型并发症，其中置管时并发症17例，包括导管异位8例，送管困难6例，穿刺失败3例，发生率为9%；导管留置期间并发症58例，包括穿刺点渗血、渗液16例，意外拔管12例，静脉炎10例，导管部分脱出9例，导管堵塞7例，导管相关性感染3例，导管相关性静脉血栓1例，发生率为30.5%。根据其发生的不同原因，采取积极的治疗和护理措施，并发症得以治愈，降低了并发症发生率。 结论　规范护理流程，加强临床培训，熟悉和掌握PICC并发症的预防和护理措施，可提高PICC置管、使用的安全性。

Influence of Intervention Integration on Intensiue Care Unit Ventilator Associated Pneumonia Incidence

目的　监测重症医学科（ICU）呼吸机相关性肺炎（VAP）的发病率，探讨实施干预组合措施对VAP发病率的影响。 方法　对2011年6月1日－2012年5月31日ICU使用呼吸机患者478例为监测对象并按时间先后分为两组，对照组按规范方法进行干预，试验组在规范干预基础上再采取组合干预措施，包括：每日评估患者、用一次性呼吸机螺纹管、用床角量角标识抬高床头、床尾设置黄色警示线、调查手卫生依从性等，统计分析两组VAP发病率。 结果　共监测ICU患者5 937个住院日，使用呼吸机1 510个机械通气日，呼吸机使用率25.43%，发生VAP 60例，VAP发病率为39.74例/1 000机械通气日，其中对照组发生VAP 21例，使用呼吸机343个机械通气日，VAP发病率为61.22例/1 000机械通气日；试验组发生VAP 39例，使用呼吸机1 167个机械通气日，VAP发病率为33.42例/1 000机械通气日，两组发病率差异有统计学意义（χ2=12.702，P=0.000）。 结论　实施干预组合措施可使VAP发病率显著下降，但仍高于国内外大型医院，基层医院还需不断努力控制好VAP的发病率。

重症药疹伴耐甲氧西林金黄色葡萄球菌感染护理一例

Somatostatin with Traditional Chinese Medicine for Acute Pancreatitis: A Systematic Review

【摘要】　目的　评价生长抑素联合中药在治疗重症急性胰腺炎中的有效性。　方法　应用国际Cochrane协作网系统评价方法对生长抑素联合中药治疗重症急性胰腺炎的随机对照试验（RCT）进行系统评价。计算机检索MEDLINE（Ovid）、PubMed数据库、中文科技期全文数据库（VIP）、万方数据库、中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）。检索时间均为建库至2009年9月。文献检索语种为英语和中文。　结果　共纳入8个RCT，436例患者，所有纳入试验在治疗末均未进行随访。Meta分析结果显示，生长抑素联合中药治疗组（治疗组）的病死率（13/188，6.9%）明显低于单纯生长抑素治疗组（对照组）（24/174，13.7%），差异有统计学意义[Peto OR=0.46，95%CI（0.22，0.94），Plt;0.05]。治疗组平均住院日低于对照组[WMD=-7.01，95%CI（-7.89，-6.13），Plt;0.000 01]。治疗组腹痛缓解时间明显低于对照组，其差异有统计学意义[WMD=-0.77，95%CI（-0.82，-0.72），Plt;0.000 01]。治疗组与对照组治疗第7天APACHE Ⅱ评分均下降，治疗组下降幅度大于对照组，两组比较差异有统计学意义（Plt;0.05）。治疗组并发症发生率（26/91，28.6%）与对照组（35/88，39.8%）相比，其差异无统计学意义[Peto OR=0.61，95%CI（0.32，1.13），P=0.12]。　结论　生长抑素联合中药治疗在改善重症急性胰腺炎的病死率、平均住院时间、腹痛缓解时间、APACHE Ⅱ评分下降幅度优于单纯生长抑素治疗。

Effect of Total Enteral Nutrition Support on the Prognosis of Severe Acute Pancreatitis

【摘要】　目的　探讨比较全肠内营养支持和全肠外营养支持对急性重症胰腺炎（severe acute pamcreattis，SAP）预后的影响。　方法　将2003年1月-2008年12月收治的54例SAP患者于入院后第1周内随机分为两组:全肠内营养（A）组27例；全肠外营养（B）组27例。两组患者均静脉给予广谱抗生素预防感染。入院时CT扫描及C反应蛋白水平显示两组患者具有可比性。　结果　B组22例患者发生器官衰竭，明显高于A组（5例）。B组22例患者接受了手术治疗，A组手术患者6例（Plt;0.05）。A组患者胰腺坏死后感染发生率明显低于B组（Plt;0.05）。B组患者死亡率高于A组（Plt;0.05）。　结论　全肠内营养支持，不仅可以促进肠道功能的恢复和营养状况的维持，还可减少肠源性感染的发生率，对减少SAP的感染性并发症和病死率具有积极作用。【Abstract】　Objective　To evaluate the effects of total enteral nutrition and total parenteral nutrition on the prognosis on severe acute pancreatitis (SAP).　Methods　A total of 54 patients hospitalized from January 2003 to December 2008 were enrolled. In the first week of hospitalization, the patients were randomly divided into two groups: 27 patients in total parenteral nutrition group (group A) and 27 patients in total enteral nutrition group (group B). All patients were administered with sufficient prophylactic antibiotics. The results of CT scan and C-reactive protein levels were comparable between the two groups.　Results　Twenty-two patients had organ failure in group B, which was much higher than that in group A (five patieuts). The numbers of the patients undertwent surgical intervention in group A and B were 22 and 6 (Plt;0.05). The incidence of infection after pancreatic septic necroses in group A was obviously lower than that in group B (Plt;0.05). The mortality in group B was apparently higher than that in group A (Plt;0.05).　Conclusion　Total enteral nutrition support can not only promote the functional recovery of intestinal tract and sustain the nutrition of human body,but also decrease the incidence of enterogenic infection.

Effect of Early Application of Traditional Chinese Medicine in Treating Severe Acute Pancreatitis with Paralytic Intestinal Obstruction by Retention Enema Catharsis

目的：观察柴芩承气汤治疗重症急性胰腺炎(SAP)并发麻痹性肠梗阻 (Paralytic Intestinal Obstruction)的疗效。方法:依据纳入和排除标准,选取四川大学华西医院中西医结合科收治的SAP患者40例,按1∶1比例随机分成试验组(20例)和对照组(20例),试验组入院时即给予柴芩承气汤灌肠治疗,对照组使用安慰剂灌肠治疗;两组入院时基线资料差异无统计学意义(Pgt;005)，且两组均给予相同常规西医治疗。观察入院后其首次自行排便排气时间,入院时、入院后第3天、第7天APACHEⅡ评分及住院病程。结果:入院后首次自行排便排气时间试验组（302±154）天,低于对照组（453±241）天;入院后第3天APACHEⅡ评分试验组（925±184）分，低于对照组（1163±222）分;入院后第7天APACHEⅡ评分试验组（624±247）分，低于对照组（881±325）分。住院时间试验组（2453±426）天,低于对照组（3032±589）天。结论:早期应用柴芩承气汤灌肠治疗SAP并发麻痹性肠梗阻,可缩短麻痹性肠梗阻的持续时间及减轻其危害,减少住院病程。

谷参肠安早期肠内营养治疗重症急性胰腺炎

目的:观察谷参肠安早期肠内营养治疗重症急性胰腺炎(Severe acute pancreatitis, SAP)的效果。方法:将50例SAP患者随机分为A组和B组(n=25)。A组采用常规治疗,B组采用常规治疗+谷参肠安治疗,比较两组血浆DAO, TNFα、IL10浓度,及APACHE Ⅱ评分。结果:两组入院后8日血浆DAO、TNFα取PACHE Ⅱ评分均较第1日显著降低,且第8日时两组差异显著(Plt;0.05),而血浆IL10浓度均较第1日显著上升,且第8日时两组差异显著(Plt;0.05)。结论:谷参肠安早期肠内营养对SAP有较好治疗作用。

Establishment of Acute Fulminant Hepatitis Mouse Model Induced by Lipopolysaccharide and D-galactosamine

目的：建立存活时间较长的急性重症肝炎小鼠模型。方法：将50只BALB/c小鼠平均分成5组，其中A、B、C、D 4组为实验组，E组为对照组；实验组分别给予D氨基半乳糖（D-GalN）和脂多糖（LPS），剂量分别为800 mg/kg和10 μg/kg、500 mg/kg和10 μg/kg、500 mg/kg和5 μg/kg、300 mg/kg和5 μg/kg，用生理盐水稀释至1 mL，行腹腔注射；对照组E腹腔注射生理盐水2 mL。以12 h死亡率、24 h死亡率及肝组织学改变为观察指标。结果：A、B、C、D及E组小鼠12 h死亡率分别为80%%、30%、10%、0和0；24 h死亡率分别为90%、60%、30%、0和0；A和B组小鼠肝组织学均呈急性重症肝炎表现，C组中有5只小鼠肝组织学符合重症肝炎的表现，而该组其余小鼠及D组所有肝组织学虽有炎症改变，但达不到重症肝炎的程度，E组肝组织学表现正常。结论：LPS 10 μg/kg联合D- GalN 500 mg/kg可成功建立12 h存活率较高的急性重症肝炎小鼠模型。

Establishment of Lung Injury Model Caused by Severe Acute Pancreatitis in Rats with Ligated Pancreatic Duct

Objective　To establish a stable and reliable lung injury model caused by severe acute pancreatitis（SAP）in rats， which is helpful to study the acute lung injury （ALI）and acute respiratory distress syndrome （ARDS） induced by SAP.Methods　Sixty Sprague-Dawley rats were randomized into ligature group （n=20）， traditional group （n=20），and sham operation group （n=20）. SAP model was established through retrograde injection of 5% taurocholic acid. After injection， the pancreatic duct of rats was ligated in ligature group， but not in traditional group. The lung damage and edema at 24 h after operaton and natural course of rats were observed.Results　The ALI model of rats induced by SAP was established successfully in ligature group. The rats died of acute respiratory failure within 48 h in ligature group， the mortality was significantly higher than that in traditional group （100% vs.20%），P＜0.05. Pleural effusion occurred in four rats in ligature group， while no pleural effusion was found in rats in other two groups. The volume of ascites of rats in ligature group was （21.15±5.33） ml， which was more than that in traditional group 〔（7.75±2.66） ml〕，P＜0.05， while no ascites was found in rats in sham operation group. The level of serum amylase of rats in ligature group was （2 470.70±399.73） U/L，which was significantly higher than that in traditional group 〔（1 528.40±289.54） U/L〕 and sham operation group 〔（831.10±93.26） U/L〕，P＜0.001. The level of serum albumin of rats in ligature group was （6.90±1.66）g/L， which was significantly lower than that in traditional group 〔（13.10±0.99） g/L〕 and sham operation group 〔（16.20±0.92） g/L〕，P＜0.001.The lung wet-to-dry weight ratio （W/D） of rats in ligature group was 6.50±0.23， which was greater than that in traditional group （4.92±0.18） and sham operation group （4.61±0.16）， P＜0.001. The score of lung histopathologic of rats in ligature group was 29.25±1.07， which was significantly higher than that in traditional group （12.65±1.98） and sham operation group （0），P＜0.001. The score of pancreas histopathologic of rats in ligature group was 15.95±0.15，which was significantly higher than that in traditional group （13.75±0.66） and sham operation group （0.13±0.29），P＜0.001. Under transmission electron microscope， basement membrane of pulmonary capillary of rats in ligation group was destructive， the nuclei was dissolved， endothelial pinocytotic vesicles was functional active， and tight junctions between capillary endothelial cells were blurred and even ruptured. Moreover， tight junctions between alveolar epithelial cells were destructive. Pathological changes of lung ultrastructure of rats in ligation group were more severe than that in traditional group， while no pathological change of lung ultrastructure was observed in rats in sham operation group. Conclusions　Injury process and pathogenesis of ALI or ARDS clinically caused by acute gallstone pancreatitis can be reproduced in this animal model， which is suitable to explore the related mechanisms of ALI caused by SAP and provides good animal model for the study of ALI caused by SAP.