AIM: To study the safety of epidural anesthesia(EA),its effect on pancreatic perfusion and the outcome of patients with acute pancreatitis(AP).METHODS: From 2005 to August 2010,patients with predicted severe AP [Ranso...AIM: To study the safety of epidural anesthesia(EA),its effect on pancreatic perfusion and the outcome of patients with acute pancreatitis(AP).METHODS: From 2005 to August 2010,patients with predicted severe AP [Ranson score ≥ 2,C-reactive protein > 100 or necrosis on computed tomography(CT)] were prospectively randomized to either a group receiving EA or a control group treated by patientcontrolled intravenous analgesia. Pain management was evaluated in the two groups every eight hours using the visual analog pain scale(VAS). Parameters for clinical severity such as length of hospital stay,use of antibiotics,admission to the intensive care unit,radiological/clinical complications and the need for surgical necrosectomy including biochemical data were recorded. A CT scan using a perfusion protocol was performed on admission and at 72 h to evaluate pancreatic blood flow. A significant variation in blood flow was defined as a 20% difference in pancreatic perfusion between admission and 72 h and was measured in the head,body and tail of the pancreas.RESULTS: We enrolled 35 patients. Thirteen were randomized to the EA group and 22 to the control group. There were no differences in demographic characteristics between the two groups. The Balthazar radiological severity score on admission was higher in the EA group than in the control group(mean score 4.15 ± 2.54 vs 3.38 ± 1.75,respectively,P = 0.347) and the median Ranson scores were 3.4 and 2.7 respectively(P = NS). The median duration of EA was 5.7 d,and no complications of the epidural procedure were reported. An improvement in perfusion of the pancreas was observed in 13/30(43%) of measurements in the EA group vs 2/27(7%) in the control group(P = 0.0025). Necrosectomy was performed in 1/13 patients in the EA group vs 4/22 patients in the control group(P = 0.63). The VAS improved during the first ten days in the EA group compared to the control group(0.2 vs 2.33,P = 0.034 at 10 d). Length of stay and mortality were not statistically different between the 2 groups(26 d vs 30 d,P = 0.65,and 0% for both respectively).CONCLUSION: Our study demonstrates that EA increases arterial perfusion of the pancreas and improves the clinical outcome of patients with AP.展开更多
The Yalong River is an important river that runs across the abruptly changing terrain of the SE Tibetan Plateau. The terraces and Quaternary sediments in its valleys preserve the information of tectonic uplift, climat...The Yalong River is an important river that runs across the abruptly changing terrain of the SE Tibetan Plateau. The terraces and Quaternary sediments in its valleys preserve the information of tectonic uplift, climate changes, and landform evolution since the Middle Pleistocene. Based on geomorphological, sedimentological, and chronological investigations, 6-8 terraces are identified in the lower reaches of Yalong catchment and its tributary--the Anning River. The electron spin resonance （ESR） or optically stimulated luminescence （OSL） data on the alluvial sediments in the upper portion of terraces indicate that they formed in 1.10, 0.90, 0.72, 0.06-0.04, 0.03-0.02, and 0.01 Ma. Tectonic uplift and the climatic cycle controlled the formation of the Yalong River terraces. The former dominated the dissection depths and incision rates, whereas the latter controlled the transformation between accumulation, which developed during the glacial period, and incision, which developed during the glacial-interglacial transition. The Yalong downstream incised rapidly from 1.10 to 0.72 Ma and rapidly from 0.06 Ma until the present; the terraces developed during these two periods. The incision rates in space during the two periods indicate the uplifting extent of the Jinpingshan area, which decreases toward the east and the south. The results reveal two rapidly uplifting stages in the SE Tibetan Plateau, including an accelerated uplifting since 0.06 Ma. Since the Middle Pleistocene, the tectonic uplift of the SE and NE parts of the Tibetan Plateau is synchronous, according to the same development stages of the river terraces of the Yalong downstream and the Yellow River in the Lanzhou area of the NE Tibetan Plateau. The difference in the horizontal displacement between the Xianshuihe Fault and the Anninghe Fault bend resulted in the rapid uplift of the Jinpingshan area. The incision rate for the spatial distribution of the Yalong downstream is the geomorphologicai response of crustal shortening and uplift differences in the SE margin block of the Tibetan Plateau. The southeastward diffusion process of the Tibetan Plateau was recorded.展开更多
基金Supported by a research grant of the University Hospitals of Geneva(to Bühler L)
文摘AIM: To study the safety of epidural anesthesia(EA),its effect on pancreatic perfusion and the outcome of patients with acute pancreatitis(AP).METHODS: From 2005 to August 2010,patients with predicted severe AP [Ranson score ≥ 2,C-reactive protein > 100 or necrosis on computed tomography(CT)] were prospectively randomized to either a group receiving EA or a control group treated by patientcontrolled intravenous analgesia. Pain management was evaluated in the two groups every eight hours using the visual analog pain scale(VAS). Parameters for clinical severity such as length of hospital stay,use of antibiotics,admission to the intensive care unit,radiological/clinical complications and the need for surgical necrosectomy including biochemical data were recorded. A CT scan using a perfusion protocol was performed on admission and at 72 h to evaluate pancreatic blood flow. A significant variation in blood flow was defined as a 20% difference in pancreatic perfusion between admission and 72 h and was measured in the head,body and tail of the pancreas.RESULTS: We enrolled 35 patients. Thirteen were randomized to the EA group and 22 to the control group. There were no differences in demographic characteristics between the two groups. The Balthazar radiological severity score on admission was higher in the EA group than in the control group(mean score 4.15 ± 2.54 vs 3.38 ± 1.75,respectively,P = 0.347) and the median Ranson scores were 3.4 and 2.7 respectively(P = NS). The median duration of EA was 5.7 d,and no complications of the epidural procedure were reported. An improvement in perfusion of the pancreas was observed in 13/30(43%) of measurements in the EA group vs 2/27(7%) in the control group(P = 0.0025). Necrosectomy was performed in 1/13 patients in the EA group vs 4/22 patients in the control group(P = 0.63). The VAS improved during the first ten days in the EA group compared to the control group(0.2 vs 2.33,P = 0.034 at 10 d). Length of stay and mortality were not statistically different between the 2 groups(26 d vs 30 d,P = 0.65,and 0% for both respectively).CONCLUSION: Our study demonstrates that EA increases arterial perfusion of the pancreas and improves the clinical outcome of patients with AP.
基金supported by the Project of China Geological Survey (grant nos.1212011120071,201211077-3 and 1212011120182)
文摘The Yalong River is an important river that runs across the abruptly changing terrain of the SE Tibetan Plateau. The terraces and Quaternary sediments in its valleys preserve the information of tectonic uplift, climate changes, and landform evolution since the Middle Pleistocene. Based on geomorphological, sedimentological, and chronological investigations, 6-8 terraces are identified in the lower reaches of Yalong catchment and its tributary--the Anning River. The electron spin resonance （ESR） or optically stimulated luminescence （OSL） data on the alluvial sediments in the upper portion of terraces indicate that they formed in 1.10, 0.90, 0.72, 0.06-0.04, 0.03-0.02, and 0.01 Ma. Tectonic uplift and the climatic cycle controlled the formation of the Yalong River terraces. The former dominated the dissection depths and incision rates, whereas the latter controlled the transformation between accumulation, which developed during the glacial period, and incision, which developed during the glacial-interglacial transition. The Yalong downstream incised rapidly from 1.10 to 0.72 Ma and rapidly from 0.06 Ma until the present; the terraces developed during these two periods. The incision rates in space during the two periods indicate the uplifting extent of the Jinpingshan area, which decreases toward the east and the south. The results reveal two rapidly uplifting stages in the SE Tibetan Plateau, including an accelerated uplifting since 0.06 Ma. Since the Middle Pleistocene, the tectonic uplift of the SE and NE parts of the Tibetan Plateau is synchronous, according to the same development stages of the river terraces of the Yalong downstream and the Yellow River in the Lanzhou area of the NE Tibetan Plateau. The difference in the horizontal displacement between the Xianshuihe Fault and the Anninghe Fault bend resulted in the rapid uplift of the Jinpingshan area. The incision rate for the spatial distribution of the Yalong downstream is the geomorphologicai response of crustal shortening and uplift differences in the SE margin block of the Tibetan Plateau. The southeastward diffusion process of the Tibetan Plateau was recorded.
