Ann Surg:围手术期使用氢化可的松,能减少胰十二指肠切除术后并发症

2016-11-01 MedSci MedSci原创

本研究的目的是探讨,氢化可的松是否可以减少高危患者的胰十二指肠切除术后并发症(PPDC)。软胰腺是一个知名的PPDC的风险因素。此前,我们已经表明,胰腺横断线> 40%腺泡的患者最容易发展为PPDC。最近的研究表明,手术创伤导致残留胰腺的炎症,会促进PPDC的发生。在动力分析的基础上,随机对照试验(RCT)(NCT01460615),纳入155例(2012年2月至2015年3月)拟行胰十二指

本研究的目的是探讨,氢化可的松是否可以减少高危患者的胰十二指肠切除术后并发症(PPDC)。

软胰腺是一个知名的PPDC的风险因素。此前,我们已经表明,胰腺横断线> 40%腺泡的患者最容易发展为PPDC。最近的研究表明,手术创伤导致残留胰腺的炎症,会促进PPDC的发生。

在动力分析的基础上,随机对照试验(RCT)(NCT01460615),纳入155例(2012年2月至2015年3月)拟行胰十二指肠切除术的患者,随机分为静脉注射(i.v.)氢化可的松100 mg或安慰剂治疗 。所有患者均在麻醉诱导时接受第一次剂量。在手术过程中,由病理学家计算胰腺横断线冷冻标本的腺泡百分比。按计划,只有 > 40%腺泡的高危患者(n = 62)获得共8次随机化的氢化可的松/安慰剂治疗,每8小时1次。主要终点是尿胰蛋白酶原阳性天数和总体并发症(Clavien-Dindo III-IV)。对术后胰瘘(POPFs)、胰切除术后出血(PPH)和胃排空延迟(DGE)进行分级。

与安慰剂相比,氢化可的松治疗并没有改变胰蛋白酶的释放(阳性天数≥2天,46% vs 50%),但明显降低高危患者的总体并发症(18% vs 41%; P < 0.05; Clavien-Dindo III-IV)。此外,氢化可的松治疗组的POPF (11% vs 27%)、PPH (14% vs 24%)和DGE (29% vs 44%)也倾向于更低。90天死亡率为零。

本研究表明,氢化可的松治疗可显著降低高危患者的总体并发症。炎症可能是PPDC的重要介质。

原始出处:

Laaninen M1, Sand J, Nordback I, Vasama K, Laukkarinen J.Perioperative Hydrocortisone Reduces Major Complications After Pancreaticoduodenectomy: A Randomized Controlled Trial.Ann Surg. 2016 Nov;264(5):696-702.

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    2017-06-12 丁鹏鹏
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2016成人围手术期营养支持指南发布

自2006年中华医学会肠外肠内营养学分会制定《临床诊疗指南:肠外肠内营养学分册》至今已有10年,为了更好地规范我国的临床营养实践,我们按照当今国际上指南制定的标准流程,根据发表的文献,参考各国和国际性营养学会的相关指南,综合专家意见和临床经验进行回顾和分析,并广泛征求意见,多次组织讨论和修改,最终形成本指南。全文获取:下载地址:指南下载 (需要扣积分2分, 梅斯医学APP免积分

盘点:“输血”相关研究汇总

输血是指将血液通过静脉输注给病人的一种治疗方法,在临床上应用广泛。 小故事:最早的输血是在1667年,一个法国贵族将280ml的小牛血输给了一个精神失常的流浪汉,企图治疗他的精神问题。这位倒霉的患者在经历了严重的免疫反应、在鬼门关徘徊数次之后,居然奇迹般地活了下来,并且维持了一段时间的平静。 【1】围手术期输血不利于结肠癌术后的生存 研究纳入了24230例I至II