AIM:To investigate effects of perirenal space blocking(PSB)on gastrointestinal function in patients with severe acute pancreatitis(SAP).METHODS:Forty patients with SAP were randomly allocated to receive PSB or no PSB(...AIM:To investigate effects of perirenal space blocking(PSB)on gastrointestinal function in patients with severe acute pancreatitis(SAP).METHODS:Forty patients with SAP were randomly allocated to receive PSB or no PSB(NPSB).All the SAP patients received specialized medical therapy(SMT).Patients in the PSB group received PSB+SMT when hospitalized and after diagnosis,whereas patients in the NPSB group only received SMT.A modifed gastrointestinal failure(GIF)scoring system was used to assess the gastrointestinal function in SAP patients after admission.Pain severity(visual analog scale,0 to100)was monitored every 24 h for 72 h.RESULTS:Modified GIF score decreased in both groups during the 10-d study period.The median score decrease was initially significantly greater in the PSB group than in the NPSB group after PSB was per-formed.During the 72-h study period,pain intensity decreased in both groups.The median pain decrease was significantly greater in the PSB group than in the NPSB group at single time points.Patients in the PSB group had significantly lower incidences of hospital mortality,multiple organ dysfunction syndrome,systemic inflammatory response syndrome,and pancreatic infection,and stayed in the intensive care unit for a shorter duration.However,no difference in terms of operation incidence was found between the two groups.CONCLUSION:PSB could ameliorate gastrointestinal dysfunction or failure during the early stage of SAP.Moreover,PSB administration could improve prognosis and decrease the mortality of SAP patients.展开更多
BACKGROUND： Postoperative liver failure remains a lifethreatening complication. Preoperative evaluation of liver function is essential in reducing the complications after hepatectomy. However, it is difficult to accu...BACKGROUND： Postoperative liver failure remains a lifethreatening complication. Preoperative evaluation of liver function is essential in reducing the complications after hepatectomy. However, it is difficult to accurately evaluate liver function before surgery because of the limitations of the liver function tests available. Recent advances in liver function tests improved the ability to assess liver function. The present review was to analyze these methods and their advantages.DATA SOURCES： MEDLINE was searched using the terms of ＂liver function test＂, ＂liver function evaluation＂ and ＂galactosyl serum albumin＂. Relevant articles published in English and Chinese from 1961 to 2014 were reviewed.RESULTS： Although serological tests are used frequently in practice, they reflect the degree of total liver damage or function, not the remnant of liver function. Child-Pugh score and model for end-stage liver disease（MELD） score assess whole liver function, and are particularly useful in determining whether patients with hepatocellular carcinoma and cirrhosis are candidates for resection or transplantation, but cannot determine the safe extent or removal. The indocyanine green and other metabolic quantitative liver function tests can evaluate functional hepatocytes, making them more accurate in predicting liver function. Computed tomography（CT）volumetry can provide anatomic information on the remnant liver volume but not on functional volume. 99mTc-galactosyl serum albumin scintigraphy, combined with single photon emission computed tomography, CT and three-dimensional reconstruction, may be a better quantitative measure of liver function, especially of remnant liver function.CONCLUSIONS： Tests used to evaluate liver functional reserve and to predict surgical risk have limitations. 99mTc-galactosylserum albumin scintigraphy, which can more accurately evaluate the whole and regional liver function, may be promising in predicting resection margins and risks of liver failure.展开更多
文摘AIM:To investigate effects of perirenal space blocking(PSB)on gastrointestinal function in patients with severe acute pancreatitis(SAP).METHODS:Forty patients with SAP were randomly allocated to receive PSB or no PSB(NPSB).All the SAP patients received specialized medical therapy(SMT).Patients in the PSB group received PSB+SMT when hospitalized and after diagnosis,whereas patients in the NPSB group only received SMT.A modifed gastrointestinal failure(GIF)scoring system was used to assess the gastrointestinal function in SAP patients after admission.Pain severity(visual analog scale,0 to100)was monitored every 24 h for 72 h.RESULTS:Modified GIF score decreased in both groups during the 10-d study period.The median score decrease was initially significantly greater in the PSB group than in the NPSB group after PSB was per-formed.During the 72-h study period,pain intensity decreased in both groups.The median pain decrease was significantly greater in the PSB group than in the NPSB group at single time points.Patients in the PSB group had significantly lower incidences of hospital mortality,multiple organ dysfunction syndrome,systemic inflammatory response syndrome,and pancreatic infection,and stayed in the intensive care unit for a shorter duration.However,no difference in terms of operation incidence was found between the two groups.CONCLUSION:PSB could ameliorate gastrointestinal dysfunction or failure during the early stage of SAP.Moreover,PSB administration could improve prognosis and decrease the mortality of SAP patients.
文摘BACKGROUND： Postoperative liver failure remains a lifethreatening complication. Preoperative evaluation of liver function is essential in reducing the complications after hepatectomy. However, it is difficult to accurately evaluate liver function before surgery because of the limitations of the liver function tests available. Recent advances in liver function tests improved the ability to assess liver function. The present review was to analyze these methods and their advantages.DATA SOURCES： MEDLINE was searched using the terms of ＂liver function test＂, ＂liver function evaluation＂ and ＂galactosyl serum albumin＂. Relevant articles published in English and Chinese from 1961 to 2014 were reviewed.RESULTS： Although serological tests are used frequently in practice, they reflect the degree of total liver damage or function, not the remnant of liver function. Child-Pugh score and model for end-stage liver disease（MELD） score assess whole liver function, and are particularly useful in determining whether patients with hepatocellular carcinoma and cirrhosis are candidates for resection or transplantation, but cannot determine the safe extent or removal. The indocyanine green and other metabolic quantitative liver function tests can evaluate functional hepatocytes, making them more accurate in predicting liver function. Computed tomography（CT）volumetry can provide anatomic information on the remnant liver volume but not on functional volume. 99mTc-galactosyl serum albumin scintigraphy, combined with single photon emission computed tomography, CT and three-dimensional reconstruction, may be a better quantitative measure of liver function, especially of remnant liver function.CONCLUSIONS： Tests used to evaluate liver functional reserve and to predict surgical risk have limitations. 99mTc-galactosylserum albumin scintigraphy, which can more accurately evaluate the whole and regional liver function, may be promising in predicting resection margins and risks of liver failure.
