ObjectivesTo systematically review the efficacy of His-bundle pacing (HBP) and right ventricular pacing (RVP).MethodsPubMed, The Cochrane Library, Web of Science, EMbase, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on efficacy of HBP and RVP from inception to December, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 8 studies involving 1 130 patients were included. The results of meta-analysis showed that: HBP group was superior to RVP group in QRS duration (MD=–43.88, 95%CI –52.53 to –35.22, P<0.000 01), LVEF (MD=4.53, 95%CI 2.67 to 6.38, P<0.000 01), and NYHA (MD=–0.85, 95%CI –1.14 to –0.56, P<0.000 01). However, the operation time (MD=15.21, 95%CI 11.44 to 18.98, P<0.000 01) and fluoroscopy duration (MD=2.98, 95%CI 2.10 to 3.85, P<0.000 01) of HBP group were longer than that of RVP group.ConclusionsCurrent evidence shows that, compared with RVP, HBP is superior in maintaining of QRS duration, LVEF and NYHA; however, the operation time is longer. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.
方法 2008年9月-2009年11月，将20例颅脑外伤后颅内感染患者分为脑脊液外引流组和抗生素组各10例，外引流组进行持续腰池置管脑脊液外引流，定期取引流脑脊液进行常规和生化检查；抗生素组采用静脉抗生素治疗。对两组颅内感染情况进行对比分析。 结果 外引流组经持续腰池置管脑脊液外引流治疗后，颅内感染临床症状明显缓解，脑脊液有核细胞数和脑脊液微量蛋白含量显著降低、脑脊液葡萄糖和氯化物浓度升高（Plt;0.05）。治疗10 d后，外引流组体温、脑脊液有核细胞数、脑脊液微量蛋白含量、脑脊液葡萄糖和氯化物浓度的改善程度明显优于抗生素组（Plt;0.05）。 结论 持续腰池置管脑脊液外引流治疗颅内感染具有安全性高、操作简便、观察颅内感染情况方便的优点，可作为颅内感染可靠治疗手段。【Abstract】 Objective To observe the efficacy of continuous lumbar drainage of cerebrospinal fluid via a lumbar catheter in treating intracranial infection. Methods From September 2008 to November 2009, 20 patients with intracranial infection after head trauma were enrolled in this study. Ten of them, classified as the external drainage group, sustained continuous external lumbar drainage of cerebrospinal fluid. The cerebrospinal fluid was obtained regularly for routine and biochemical examination. The other 10 patients were categorized as the antibiotics group. They only accepted intravenous antibiotic therapy. Results For the patients in the external drainage goup, after continuous external lumbar drainage of cerebrospinal fluid, their clinical symptoms of intracranial infection were significantly alleviated and the number of nucleated cells and protein content in the cerebrospinal fluid decreased significantly, while the glucose and chloride concentrations increased significantly (Plt;0.05). After 10 days of treatment, the patients in the external drainage group were superior to those in the antibiotics group in improvement of the body temperature, the number of nucleated cells and protein content, glucose and chloride concentrations in the cerebrospinal fluid (Plt;0.05). Conclusion Continuous lumbar drainage of cerebrospinal fluid is simple and safe. It provides an easy way of monitoring the intracranial infection and can be a reliable treatment.
ObjectiveTo analyze risk factors of intraoperative massive hemorrhage in patients with pancreatitis-induced sinistral portal hypertension (SPH) and to explore its strategies of treatment.MethodsThe clinical data of patients with pancreatitis-induced SPH admitted to the West China Hospital of Sichuan University from January 2015 to March 2018 were retrospectively analyzed. The intraoperative massive hemorrhage was defined as the blood loss exceeding 30% blood volume. The factors closely associated with the intraoperative massive hemorrhage were analyzed by the forward logistic regression model.ResultsA total of 128 patients with pancreatitis-induced SPH were enrolled in this study, including 104 males and 24 females, with an average age of 47 years old and a median intraoperative bleeding volume of 482 mL. Among them, 93 patients with pancreatitis-induced SPH caused by the pancreatic pseudocyst after acute pancreatitis and 35 caused by the chronic pancreatitis. There were 36 patients with history of upper gastrointestinal bleeding and 46 patients with hypersplenism. Thirty-six patients suffered from the massive hemorrhage. Among them, 30 patients underwent the distal pancreatectomy concomitant with splenectomy, 1 patient underwent the duodenum- preserving resection of pancreatic head, and 5 patients underwent the pseudocyst drainage. The univariate analysis showed that the occurrence of intraoperative massive hemorrhage in the patients with pancreatitis-induced SPH was not associated with the gender, age, body mass index, albumin level, upper gastrointestinal bleeding, hypersplenism, type of pancreatitis, course of pancreatitis, number of attacks of pancreatitis, size of spleen, maximum diameter of lesions in the splenic vein obstruction site, or number of operation (P>0.05), which was associated with the diameter of varicose vein more than 5.0 mm (χ2=19.83, P<0.01), the intraperitoneal varices regions (χ2=13.67, P<0.01), the location of splenic vein obstruction (χ2=5.17, P=0.03), the operation time (t=–3.10, P<0.01), or the splenectomy (χ2=17.46, P<0.01). Further the logistic regression analysis showed that the varicose vein diameter more than 5.0 mm (OR=6.356, P=0.002) and splenectomy (OR=4.297, P=0.005) were the independent risk factors for the intraoperative massive hemorrhage in the patients with pancreatitis-induced SPH.ConclusionsSplenectomy and having a collateral vein more than 5.0 mm in diameter are independent risk factors for intraoperative massive blood loss in surgeries taken on patients with pancreatitis-induced SPH. Attention should be paid to dilation of gastric varices and choice of splenectomy.
Objective To observe and describe anatomical types of the pulmonary arteries to keep safety of lung resection. Methods Between November 25, 2005 and January 22, 2013, 194 patients who underwent right upper lobectomy/sleeve lobectomy or combined lung resection including right upper lobectomy were included in Peking University Cancer Hospital. There were 128 males with a median age of 59 (37-86) years and 66 females with a median age of 60 (42-77) years. We separated the pulmonary arteries and recorded the number and positions of them. Some patients were recorded photographically. Results There were 10 types of right upper lobe pulmonary artery branches in this study. Type 1: 1 apicoanterior segmental artery, 1 ascending segmental artery, 96 patients (49.5%); Type 2: 1 apicoanterior segmental artery, 2 ascending segmental arteries, 48 patients (24.7%); Type 3: 2 apicoanterior segmental arteries, 1 ascending segmental artery, 28 patients (14.4%); Type 4: 2 apicoanterior segmental arteries, 2 ascending segmental arteries, 9 patients (4.6%); Type 5: 1 apicoanterior segmental artery only, 6 patients (3.1%); Type 6: 1 apicoanterior segmental artery, 3 ascending segmental arteries, 3 patients (1.5%); Type 7: 4 apicoanterior segmental arteries, 1 ascending segmental artery, 1 patient (0.5%); Type 8: 3 apicoanterior segmental arteries, 1 ascending segmental artery, 1 patient (0.5%); Type 9: 2 apicoanterior segmental arteries, 1 patient (0.5%); Type 10: 3 apicoanterior segmental arteries, 2 ascending segmental arteries, 1 patient (0.5%). Conclusion The types of pulmonary artery branches are predictable in some way. It would be helpful to reduce the risk of pulmonary artery injury and improve the operation safety by following the rules. Variations of pulmonary artery should be noticed to avoid the major bleeding due to the pulmonary artery injury.