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脉络膜黑色素瘤伴脉络膜骨瘤存活15年一例

癫痫持续状态长期结局：一项关键评价

回顾性分析 37 项关于儿童和成人癫痫持续状态（Status epilepticus, SE）长期结果的研究，总结其研究设计、随访时间、结果评估、调查地区 （死亡率、SE 复发、继发性癫痫、认知结果、功能结果或生活质量）以及长期预后的预测因素。尽管既往研究设计存在异质性，儿童和成人在 SE 后长期不良结局的总体风险均很高。病因是影响结局的主要因素，年龄或 SE 持续时间的影响往往难以与潜在病因区分开来。治疗对 SE 远期疗效的影响尚不清楚。

Effect of Vitamin A Supplementation on Morbidity and Mortality in Children with Infectious Diseases

Objective　To evaluate the effect of vitamin A (Vit A) supplementation on the morbidity and mortality in children with infectious diseases. Methods　We searched Cochrane Library (Issue 1, 2004), MEDLINE (1966-2004.3) and The PedsCCM Evidence-Based Journal Club (1992-2002). Relevant systematic reviews and randomized controlled trials (RCTs) of Vit A supplementation on morbidity and mortality in children with infectious diseases were obtained. Results　We collected 107 studies and identified 13 systematic reviews or RCTs. The evidence showed that the effect of Vit A supplementation on morbidity and mortality was affected by the nutritional status of the children. Vit A supplementation given to Vit A deficient children could reduce the morbidity of diarrhea and mortality of measles. However, Vit A supplementation would increase the morbidity of diarrhoea and respiratory infections in children with sufficient nutrition. Conclusions　The nutritional status of children correlates with morbidity and mortality of some infectious diseases, and the nutritional status and serum Vit A level should be evaluated before Vit A supplementation applied.

Analysis of Postoperative Complications and Cause of Death for Carcinoma of Esophagus

Objective To analyse postoperative complications and cause of death for carcinoma of esophagus. Methods A retrospective study was undertaken for data of 2 085 patients with esophageal carcinoma from 1963 to 2003, the patients were divided into group A (332 cases,1963-1983), group B(727 cases,1984-1993) and group C (1 026 cases,1994-2003) by time. The postoperative complications and cause of death were analysed. Results Resectability rate, incidence rate of postoperative complications and hospital mortality were 90.84%(1 894/2 085), 11.61% (242/2 085) and 1.82% (38/2 085) respectively. Main complications were pulmonary complications (3.93%,82/2 085),anastomotic leak (3.12%,59/1 894), and cardiovascular disease (1.29%,27/2 085). Resectability rate of group B and group C were higher than that of group A, incidence rate of postoperative complications and hospital mortality of group B and group C were lower than that of group A. Resectability rate of group C were higher than that of group B, incidence rate of postoperative complications except pulmonary complications and hospital mortality of group C were lower than those of group B. Conclusions Pulmonary complications and anastomotic leak are main postoperative complications and cause of hospital death for carcinoma of esophagus, they are decreasing in recent years because of the progress of anesthetic,surgical technique and perioperative management.

Analysis on the Incidence and mortality of asthma in China based on the age-period-cohort model

Objective To analyze the incidence and mortality of asthma in China from 1990 to 2019, and to explore the influence of age, period and cohort on the incidence and mortality of asthma. Methods Using the Global Burden of Disease (GBD) 2019 database, the incidence and mortality of asthma in China from 1990 to 2019 were analyzed, and the time variation trend of age-standardized incidence and mortality was analyzed by using Joinpoint software, and the average annual variation percentage was calculated. The age-period-cohort model was constructed to analyze the influence of age, period and birth cohort on the incidence and mortality trend of asthma. Results In 2019, the incidence of asthma in China was 264.44/100 000, and the mortality rate was 1.74/100 000. The incidence rate of asthma in males (300.94/100 000) and mortality rate (1.99/100 000) were higher than those in females (226.51/100 000 and 1.49/100 000). From 1990 to 2019, the age-standardized incidence of asthma in China showed a downward trend, but the trend was not statistically significant (P>0. 05), and the age-standardized mortality showed a downward trend, with an average annual decrease of 4.90%, with a statistically significant trend (P<0.05). The results of age effect showed that the incidence of asthma in China showed a downward trend, and the death first showed a downward trend, and then increased in the age group of 55-59. The results of period effect show that the risk of asthma is decreasing, and then it is increasing from 2015 to 2019, and the risk of asthma mortality is decreasing. The results of cohort effect show that the later people are born, the lower the risk of asthma onset and death. The death of asthma is attributed to behavioral risk, high body mass index and tobacco, and the occupational risk tends to decrease. ConclusionsFrom 1990 to 2019, the incidence and mortality of asthma in China showed a decreasing trend, and the incidence and mortality of men were higher than that of women. The risk factors of behavioral risk, high body mass index and tobacco were still on the rise, so corresponding measures should be taken to carry out early screening, early detection, and early treatment for key populations.

经鼻高流量氧疗治疗急性呼吸衰竭的随机对照试验

目的评价经鼻高流量氧疗治疗急性呼吸衰竭的临床效果。方法选择重症医学科收治的急性呼吸衰竭患者，用随机数字表法分为标准氧疗组、经鼻高流量氧疗组、无创通气组三组，分别给予面罩吸氧、经鼻高流量氧疗、无创正压机械通气治疗。观察患者 28 天气管插管率、90 天全因死亡率、治疗 48 h 后氧合状况。结果共纳入 116 例患者，其中经鼻高流量氧疗组 40 例，标准氧疗组 39 例，无创通气组 37 例。经鼻高流量氧疗组患者 28 天气管插管率明显低于标准氧疗组（22.5% 比 51.3%，OR=0.28，95%CI 0.10～0.73）和无创通气组（22.5% 比 48.6%，OR=0.31，95%CI 0.12～0.82）；三组 90 天全因死亡率差异无统计学意义（分别为 15.0%、25.6% 和 24.3%，P=0.456）。治疗 48 h 后，高流量氧疗组 PaO2 较标准氧疗组、无创通气组显著升高（P=0.006），高流量氧疗组比标准氧疗组提高 PaO2/FiO2 更有优势（OR=4.02，95%CI 1.64～9.85），但高流量氧疗与无创通气 PaO2/FiO2 差异无统计学意义（P>0.05），三组患者 PaCO2、pH、呼吸频率差异无统计学意义（P>0.05）。结论与标准氧疗、无创通气相比，经鼻高流量氧疗能显著降低急性呼吸衰竭患者 28 天气管插管率，且有降低患者 90 天全因死亡率的趋势。经鼻高流量氧疗提高患者氧合比标准氧疗更有优势，和无创通气效果相当。

Risk Factors for Mortality in the Arterial Switch Operation

Abstract： Objective To analyze risk factors for perioperative mortality in the arterial switch operation (ASO), in order to provide better operation and decrease the mortality rate. Methods We enrolled 208 ASO patients including 157 males and 51 females at Fu Wai Hospital between January 1, 2001 and December 31, 2007. The age ranged from 6 h to 17 years with the median age of 90 d and the weight ranged from 3 kg to 43 kg with the median weight of 5 kg. Among the patients, 127 had transposition of great artery (TGA) with ventricular septal defect (VSD), and 81 patients had TGA with intact ventricular septum (IVS) or with the diameter of VSD smaller than 5 mm. Coronary anatomy was normal (1LCX2R) in 151 patients and abnormal in the rest including 15 patients with single coronary artery, 6 with intramural and 36 with inverse coronary artery. Preoperative, perioperative and postoperative clinical data of all patients were collected to establish a database which was then analyzed by univariate analysis and multivariate logistic regression analysis to find out the risk factors formortality in ASO. Results There were 24 perioperative deaths (11.54%) in which 12 died of postoperative infection with multiple organ failure (MOF), 10 died of low cardiac output syndrome, 1 died of pulmonary hypertension, and 1 died of cerebral complications. Among them, 20 patients (18.30%) died in early years from 2001 to 2005, while only 4 (4.00%) died in the time period from 2006 to 2007, which was a significant decrease compared with the former period (Plt;0.05). The univariate analysis revealed that cardiopulmonary bypass (CPB) time was significantly longer in the death group than in the survival group（236±93 min vs. 198±50 min, P=0.002）, and occurrence of major coronary events (33.3% vs. 2.2%, P=0.000) and unusual coronary artery patterns（33.3% vs. 6.5%,P=0.000） were much more in the death group than in the survival group. Multivariate logistic regression analysis showed that early year of [CM(159mm]operation (OR=7.463, P=0.003), unusual coronary artery patterns (OR=6.303,P=0.005) and occurrence of majorcoronary events (OR=17.312, P=0.000) were independent predictors for perioperative mortality. Conclusion The ASO can be performed with low perioperative mortality in our hospital currently. Occurrence of major coronary events, unusual coronary artery patterns and year of surgery before 2006 are independent predictors for perioperative mortality.

Burden trend analysis of disease attributable to high low density lipoprotein cholesterol in Chinese population from 1990 to 2019

ObjectiveTo analyze the variation trend of high low density lipoprotein cholesterol (LDL-C) attribution disease burden in China from 1990 to 2019. MethodsThe burden of disease indicators from Global Burden of Disease 2019 (GBD 2019), such as death attributable to high LDL-C, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lost to disability (YLDs) were extracted. The age was standardized using GBD 2019 global standard population, and the trend of rates with the annual percentage change (APC) was analyzed. ResultsFrom 1990 to 2019, the disease burden of high LDL-C increased with age in China. The mortality rate, DALYs rate and YLLs rate of males were higher than those of females, while the YLDs rate of males was lower than that of females. Joinpoint regression results showed that from 1990 to 2019, the high LDL-C attribution mortality rate (APC=3.4%, P<0.05), DALYs rate (APC=2.4%, P<0.05), YLLs rate (APC=2.4%, P<0.05), YLDs rate (APC = 2.9%, P<0.05), the standardized mortality rate (APC=0.8%, P<0.05) and the standardized YLDs rate (APC=0.7%, P<0.05) all increased in China. Regarding age, the mortality rate, DALYs rate and YLLs rate increased in the age group over 70 years old, while the YLDs rate increased significantly in the age group over 45 years old. ConclusionFrom 1990 to 2019, the burden of disease attributable to high LDL-C in China has become increasingly heavy, and the burden varies according to gender and age.

THE RELATIONSHIP BETWEEN THE COMPLICATIONS AND MORTALITY OF SEVERE ACUTE PANCREATITIS (REPORT OF 112 CASES)

目的了解重症急性胰腺炎（SAP）并发症与病死率的关系。方法对19年来我院肝胆外科收治的112例SAP患者进行回顾性总结分析。结果112例中，治愈92例（82.1%），死亡20例（17.9%），发生各种并发症73例（65.2%）。手术治疗73例（65.2%），治愈58例（79.5%），死亡15例（20.5%）。非手术治疗39例（34.8%），治愈34例（87.2%），死亡5例（12.8%）。手术治疗组和非手术治疗组间治愈率和死亡率差异无统计学意义（Pgt;0.05）。与病死率有关的并发症为休克、肺功能不全、胰性脑病和全身感染，其病死率分别为7.1%、6.3%、5.4%和3.6%。SAP并发症综合评分大于7分组和小于7分组比较，病死率差异有显著性意义（P＜0.01）。结论SAP患者是死于其并发症，而并发症中休克、肺功能不全、胰性脑病和全身感染是致死的最主要原因。

Investigation of Risk Factors Influencing the Mortality of the Arterial Switch Operation

Objective To analyze the outcome of arterial switch operation （ASO） for surgical repair of complete transposition of the great arteries （TGA）, and to investigate the risk factors influencing the mortality of ASO. Methods The clinical data of patients suffered from TGA and treated with ASO from the January 2003 to December 2004, and the clinical records in hospital including eehoeardiogram and operation record were collected. The clinical data were analyzed by chi-squared test and logistic muhivariable regression analysis, including the age undergone operation, body weight, diagnosis, anatomic type of coronary artery, cardiopulmonary bypass time, aortic crossclamping time, circulation arrest time, assisted respiration time after operation, the delayed closure of sternum and so on. The risk factors influencing the early mortality of the ASO were analyzed. Results Sixty seven patients were operated with ASO, five patients died during the peri-operative period. The outcome of univariate analysis indicated that risk factors influencing the mortality of ASO included： age（P=0. 004）, body weight （P=0. 042）, anatomic type of coronary artery （P= 0. 006） and extracorporeal circulation time （P= 0. 048）, the length of the CICU stay（P= 0. 004） and the hospital stay（P=0. 007） after operation in the TGA/VSD patients were longer than those in TGA/ IVS patients. The logistic muhivariable regression analysis indicated that the age at operation （P= 0. 012）, coronary arteries anomaly （P = 0.001 ）and the longer cardiopulmonary bypass time （P = 0. 002） were correlated with the increase of death rate. Conclusion It could be good results for TGA patients who was repaired with ASO. The age at operation, the coronary arteries anomaly and the longer cardiopulmonary bypass time are the risk factors influencing the mortality.