RESUMO
Objective:To explore the role of intra-abdominal pressure (IAP) monitoring in evaluating the efficacy of early enteral nutrition (EN) in patients with acute pancreatitis (AP).Methods:The clinical data were collected from the AP patients in department of criticle care medicine of Baoshan Branch of Huashan Hospital Affiliated to Fudan University from July 2020 to June 2021. The patients were divided into three groups according to their treatments: no gastrointestinal decompression with fasting group, gastrointestinal decompression with fasting group, gastrointestinal decompression with indwelling jejunal tube within 24 hours group. The data of white blood cell (WBC), procalcitonin (PCT), serum amylase (AMY) and IAP were analyzed before and after treatment, the initiation time oral feeding were also analyzed.Results:The decrease of WBC, PCT, AMY, and IAP in gastrointestinal decompression with indwelling jejunal tube within 24 hours group were significantly greater than those in the other groups [WBC (×10 9/L): -1.72±0.74 vs. -0.68±0.36, -1.23±86.97; PCT (μg/L): -3.14±5.19 vs. 0.06±0.48, -1.57±0.78; AMY (U): -148.43±75.89 vs. -74.85±78.84, -93.78±1.17; IAP (cmH 2O, 1 cmH 2O≈0.098 kPa): -4.82±1.66 vs. 0.36±1.32, -3.22±4.36, all P < 0.05]. There were no correlation between the changes of IAP and the changes of WBC, PCT or AMY in the non-gastrointestinal decompression with fasting group and the gastrointestinal decompression with indwelling jejunal tube within 24 hours group (all P > 0.05). The decreasing trend of IAP in patients with gastrointestinal decompression with fasting group was positively correlated with the change of AMY ( r = 0.65, P < 0.001). The initiation time of oral feeding in gastrointestinal decompression with indwelling jejunal tube within 24 hours group was significantly shorter than that in the other groups (hours: 89.538 vs. 111.273, 109.714), the difference was statistically significant ( P < 0.05). Conclusions:IAP monitoring, as an emergency means of monitoring the efficacy of early EN in AP patients, has the advantages of simplicity, efficiency and rationality, which has a more objective basis than the previous empirical treatment and open oral feeding.
RESUMO
Objective To investigate the guiding value of serum procalcitonin (PCT) level in antibiotic treatment of stroke-associated pneumonia (SAP) after spontaneous intracerebral hemorrhage. Methods A total of 120 patients with SAP after acute cerebral hemorrhage were enroled and were randomly divided into either a conventional treatment group ( n=59) or a PCT guided group ( n=61). In accordance w ith the guidelines for the use of antibiotics in China, the conventional treatment group w as treated w ith antibiotics and the course of antibiotics w as determined by the treating physician. The serum PCT of the PCT group w as monitored continuously after using antibiotics for 5 days. When PCT w as 2 w as poor outcome. They were folowed up for 6 months after discharge. A Kaplan-Meier survive curve was use to compare the survival rate of both groups. Results The course of antibiotics ( 8.95 ±2.73 d vs.13.26 ± 4.11 d;t=6.407, P<0.001) and the length of hospitalization ( 15.64 ±2.63 d vs.18.36 ±4.27 d; t=3.967, P<0.001) of the PCT group w ere significantly shorter than those of the conventional treatment group. There w ere no significant differences in the proportions of 30 d mortality ( 9.8%vs.10.1%; χ2 =0.003, P=0.951) and 90 d good outcome ( 60.6%vs.59.3%; χ2 =0.022, P=0.881) betw een the PCT guided group and the conventional treatment group. At the end of the 6-month folow-up period, a total of 13 patients (12.0%) died, including 6 in the conventional treatment group and 7 in the PCT group. The Kaplan-Meier analysis show ed that there w as no significant difference in the 6-month survival rate betw een the 2 groups (χ2 = 0.070, P= 0.791 ). Conclusions Monitoring the serum PCT level for guiding antibiotic treatment of SAP after spontaneous intracerebral hemorrhage is safe, and it may shorten the course of antibiotics and reduce the length of hospitalization.
RESUMO
Objective To evaluate the value of D-dimer in assessing severity and predicting longterm prognosis in patients with community acquired pneumonia (CAP).Methods From June 2009 to December 2010,a total of 189 patients with CAP were enrolled.After admission,D-dimer,procalcitonin (PCT) and C-reactive protein (CRP) were measured,and Pneumonia Severity Index (PSI) was calculated.They were assigned into two groups according to their D-dimer levels:high D-dimer levels group (D-dimer levels≥500 μg/L) and normal D-dimer levels group (D-dimer levels ＜ 500 μg/L).The followup time was one year.A Kaplan-Meier survive curve was constructed to assess the 1-year mortality,and multivariate logistic regression analysis were used to assess the value of D-dimer for predicting long-term prognosis.Results D-dimer levels increased with increasing PSI class [class Ⅰ-Ⅲ:378.37 μg/L (216.74,649.50) μg/L; class Ⅳ:673.41 μg/L (544.77,866.85) μg/L; class Ⅴ:831.58 μg/L (591.78,1066.39) μg/L,x2 =56.58,P ＜ 0.01].The Kaplan-Meier survival curve showed that 1-year mortality rate of high D-dimer levels group was higher than normal D-dimer levels group (log-rank test,x2 =52.51,P ＜ 0.01).The multivariate logistic regression analysis showed an independent relationship between higher D-dimer levels and long-term mortality (OR =2.05,95％ CI:1.48-2.61,P ＜ 0.01).Conclusion D-dimer is an independent predictor of severity and long-term prognosis in patients with CAP.