Zhonghua wei zhong bing ji jiu yi xue最新文献

[Long-term clinical outcomes after percutaneous coronary intervention for ST-segment elevation myocardial infarction due to late and very late stent thrombosis]. [经皮冠状动脉介入治疗st段抬高型心肌梗死晚期和极晚期支架血栓形成的长期临床结果]。

Q3 Medicine

Zhonghua wei zhong bing ji jiu yi xue

Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20230925-00822

Xiaowei Li, Yixing Yang, Mingdong Gao, Changping Li, Xiaoyuan Wu, Yin Liu, Jing Gao

Objective: To explore the prognosis and influencing factors of ST-segment elevation myocardial infarction (STEMI) due to late stent thrombosis (LST) and very late stent thrombosis (VLST).Methods: Patients who underwent percutaneous coronary intervention (PCI) for STEMI caused by LST and VLST at Tianjin Chest Hospital from January 2016 to June 2021 were selected as the study subjects, and long-term follow-up was conducted. The baseline clinical features, laboratory examination indicators, echocardiography results, coronary angiography and intervention treatment characteristics, and antiplatelet treatment status of patients were collected. The study endpoint was major adverse cardiovascular event (MACE), including all-cause mortality, target vessel revascularization (TVR), myocardial infarction, and recurrent stent thrombosis (RST). Patients were divided into MACE group and non-MACE group based on the occurrence of MACE. Cox regression analysis was used to determine the univariate and multivariate predictive factors for MACE occurrence in STEMI patients caused by LST and VLST during long-term follow-up after PCI. Kaplan-Meier survival curves were plotted to analyze the cumulative survival rate without MACE during follow-up in subgroups of patients with different levels of fibrinogen (Fib) and initial number of stents. The incidence of MACE among patients receiving different drug-eluting stent (DES) treatments was compared.Results: A total of 418 patients diagnosed STEMI caused by LST and VLST through coronary angiography were enrolled, of which 115 had MACE and 303 did not. Among them, 404 cases (96.65%) completed follow-up, with a median follow-up time of 27.25 (18.00, 37.00) months. Cox regression analysis showed that Fib [hazard ratio (HR) = 2.840, 95% confidence interval (95%CI) was 1.329-6.066, P = 0.007], non-culprit vascular stenosis > 50% (HR = 5.974, 95%CI was 1.634-21.848, P = 0.007), initial stent quantity (HR = 3.314, 95%CI was 1.677-6.552, P = 0.001), B2/C lesions (HR = 5.463, 95%CI was 1.396-21.373, P = 0.015), and cardiogenic shock (HR = 4.141, 95%CI was 1.101-15.568, P = 0.035) were independently associated with the occurrence of MACE. The Kaplan-Meier survival curve showed that the higher the Fib level, the lower the cumulative survival rate without MACE (82.8%, 70.1%, 40.5%, P < 0.01); the more initial stents, the lower the cumulative survival rate without MACE (75.0%, 57.7%, 36.5%), with patients with initial stents ≥ 3 having the lowest cumulative survival rate without MACE (P < 0.001). A total of 210 patients (50.2%) received secondary stent treatment, and there was no significant difference in the incidence of MACE between patients receiving first and second generation DES treatment (27.3% vs. 24.7%, P > 0.05), but patients receiving first generation DES had a higher proportion of all-cause mortality (22.3% vs. 10.1%, P < 0.05). Compared with patients receivin

目的：探讨st段抬高型心肌梗死（STEMI）晚期支架血栓形成（LST）和极晚期支架血栓形成（VLST）的预后及影响因素。方法：选择2016年1月至2021年6月在天津市胸科医院行经皮冠状动脉介入治疗LST和VLST所致STEMI的患者作为研究对象，进行长期随访。收集患者的基线临床特征、实验室检查指标、超声心动图结果、冠状动脉造影及介入治疗特点、抗血小板治疗情况。研究终点为主要不良心血管事件（MACE），包括全因死亡率、靶血管重建术（TVR）、心肌梗死和复发性支架血栓形成（RST）。根据MACE发生情况将患者分为MACE组和非MACE组。采用Cox回归分析确定STEMI患者PCI术后长期随访中LST和VLST所致MACE发生的单因素和多因素预测因素。绘制Kaplan-Meier生存曲线，分析不同纤维蛋白原（Fib）水平和初始支架数量患者亚组随访期间无MACE的累积生存率。比较不同药物洗脱支架（DES）治疗组MACE的发生率。结果：共纳入418例经冠状动脉造影诊断为LST和VLST所致STEMI的患者，其中MACE 115例，无MACE 303例。其中404例（96.65%）完成随访，中位随访时间27.25（18.00,37.00）个月。Cox回归分析显示，Fib[危险比(HR) = 2.840, 95%可信区间（95% ci）为1.329 ~ 6.066,P = 0.007]、非罪魁祸首血管狭窄bbb50 % （HR = 5.974, 95% ci为1.634 ~ 21.848,P = 0.007）、初始支架数量（HR = 3.314, 95% ci为1.677 ~ 6.552,P = 0.001）、B2/C病变（HR = 5.463, 95% ci为1.396 ~ 21.373,P = 0.015）、心源性休克（HR = 4.141, 95% ci为1.101 ~ 15.568,P = 0.035）与MACE的发生独立相关。Kaplan-Meier生存曲线显示，Fib水平越高，无MACE的累计生存率越低（82.8%、70.1%、40.5%,P < 0.01）；初始支架越多，无MACE累积生存率越低（75.0%,57.7%,36.5%），其中初始支架≥3个的患者无MACE累积生存率最低（P < 0.001）。共有210例（50.2%）患者接受了二次支架治疗，第一代DES与第二代DES患者的MACE发生率无显著差异（27.3% vs. 24.7%, P < 0.05），但第一代DES患者的全因死亡率比例更高（22.3% vs. 10.1%, P < 0.05）。与小直径DES治疗组（< 2.75 mm）相比，大直径DES治疗组（≥2.75 mm） MACE发生率显著降低（20.5% vs. 35.9%, P < 0.05）。结论：由于LST和VLST导致的STEMI PCI术后长期临床结果不利，MACE发生率高。这种特殊类型STEMI的治疗仍然具有挑战性，重新植入第二代DES或更大直径DES（≥2.75 mm）可能是有益的。

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引用次数: 0

[Effect of extra corporeal reducing pre-load on pulmonary mechanical power in patients with acute respiratory distress syndrome]. [体外减重预负荷对急性呼吸窘迫综合征患者肺机械功率的影响]。

Q3 Medicine

Zhonghua wei zhong bing ji jiu yi xue

Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20240117-00054

Wenwen Zhang, Xin'gang Hu, Lixia Yue, Jie Zhang, Zhida Liu, Shuai Gao, Zhigang Zhao, Xinliang Liang

Objective: To explore the effects of veno-venous extra corporeal carbon dioxide removal (V-V ECCO2R) on local mechanical power and gas distribution in the lungs of patients with mild to moderate acute respiratory distress syndrome (ARDS) receiving non-invasive ventilation.Methods: Retrospective research methods were conducted. Sixty patients with mild to moderate ARDS complicated with renal insufficiency who were transferred to the respiratory intensive care unit (RICU) through the 96195 platform critical care transport green channel from January 2018 to January 2020 at the collaborative hospitals of Henan Provincial People's Hospital were enrolled. According to different treatment methods, they were divided into a conventional treatment group and an ECCO2R group, with 30 patients in each group. Both groups received standard treatments including primary disease treatment, airway management, and non-invasive ventilation. The conventional treatment group received bedside continuous renal replacement therapy (CRRT), and the ECCO2R group received V-V ECCO2R treatment. General information of patient such as gender, age, cause of disease, and acute physiology and chronic health evaluation II (APACHE II) were recorded; arterial blood gas analysis was performed before treatment and at 12 hours and 24 hours during treatment, recording arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and oxygenation index (PaO2/FiO2). Respiratory mechanics parameters [tidal volume, respiratory rate, maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP)] were recorded, and the rapid shallow breathing index (RSBI) was calculated; electrical impedance tomography (EIT) was used to measure regional of interest (ROI) values in different lung areas at 12 hours and 24 hours of treatment, and the pulmonary mechanical energy was calculated.Results: The arterial blood gas analysis indicators, respiratory mechanics parameters, and pulmonary mechanical energy of patients in the conventional treatment group and ECCO2R group improved significantly after 24 hours of treatment compared to 12 hours of treatment (all P < 0.05). The levels of PaCO2, RSBI, total mechanical power, and non-dependent zone mechanical power in the ECCO2R group were significantly lower than those in the conventional treatment group at both 12 hours and 24 hours during the treatment [PaCO2 (mmHg, 1 mmHg ≈ 0.133 kPa): 44.03±2.96 vs. 49.96±2.50 at 12 hours, 41.65±3.21 vs. 48.53±2.33 at 24 hours; RSBI (times×min-1×L-1): 88.67±4.05 vs. 92.35±4.03 at 12 hours, 77.66±4.64 vs. 90.98±4.21 at 24 hours; total mechanical power (mJ): 10.40±1.15 vs. 12.93±1.68 at 12 hours, 11.13±1.18 vs. 14.05±1.69 at 24 hours; non-dependent zone mechanical powe

目的：探讨静脉-静脉体外二氧化碳去除术（V-V ECCO2R）对轻中度急性呼吸窘迫综合征（ARDS）无创通气患者局部机械动力和肺内气体分布的影响。方法：采用回顾性研究方法。选取2018年1月至2020年1月在河南省人民医院合作医院通过96195平台重症监护运输绿色通道转入呼吸重症监护室（RICU）的轻中度ARDS合并肾功能不全患者60例。根据治疗方法的不同分为常规治疗组和ECCO2R组，每组30例。两组均接受标准治疗，包括原发性疾病治疗、气道管理和无创通气。常规治疗组给予床边持续肾替代治疗（CRRT）， ECCO2R组给予V-V ECCO2R治疗。记录患者的一般信息，如性别、年龄、病因、急性生理和慢性健康评估II (APACHE II)；治疗前、治疗12 h、治疗24 h进行动脉血气分析，记录动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、氧合指数（PaO2/FiO2）。记录呼吸力学参数[潮气量、呼吸频率、最大吸气压力（MIP）、最大呼气压力（MEP）]，计算快速浅呼吸指数（RSBI）；采用电阻抗断层扫描（EIT）测量治疗12小时和24小时不同肺区感兴趣区域（ROI）值，计算肺机械能。结果：常规治疗组和ECCO2R组患者治疗24 h后动脉血气分析指标、呼吸力学参数、肺机械能较治疗12 h均有显著改善（P < 0.05）。ECCO2R组在治疗期间12 h和24 h的PaCO2、RSBI、总机械功率、非依赖区机械功率均显著低于常规治疗组[PaCO2 (mmHg, 1 mmHg≈0.133 kPa): 12 h时为44.03±2.96∶49.96±2.50,24 h时为41.65±3.21∶48.53±2.33；RSBI (times×min-1×L-1): 88.67±4.05 vs. 12小时92.35±4.03,77.66±4.64 vs. 24小时90.98±4.21；总机械功率（mJ）： 12小时10.40±1.15 vs. 12.93±1.68,24小时11.13±1.18 vs. 14.05±1.69；非依赖性区机械功率（mJ）： 12小时7.15±0.84 vs. 7.98±0.75,24小时7.77±0.93 vs. 9.13±1.10]，ECCO2R组在12小时和24小时MEP和MIP均显著高于常规治疗组[MEP (cmH2O, 1 cmH2O≈0.098 kPa): 12小时89.88±5.04 vs. 86.09±5.57,24小时96.57±2.59 vs. 88.66±2.98；MIP (cmH2O): 12 h时47.64±2.82 vs 41.93±2.44,24 h时60.11±6.53 vs 43.63±2.80，差异均有统计学意义（P < 0.05）。结论：V-V ECCO2R联合无创通气可有效降低轻中度ARDS患者非重力依赖区区域潮气量、机械功率和呼吸频率，改善呼吸窘迫和氧合状态。

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引用次数: 0

[Retrospective analysis of animal-related injuries in 1 266 patients based on the emergency department electronic medical record system]. [基于急诊科电子病历系统的1266例动物相关损伤回顾性分析]。

Q3 Medicine

Zhonghua wei zhong bing ji jiu yi xue

Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20231230-01131

Zheng Yang, Ji Wang, Chunyun Cai, Aihua Jiang

Objective: To analyze the characteristics of animal-related injuries and summarize the epidemiological features of the affected population using the hospital's emergency department electronic medical record system.Methods: A retrospective cross-sectional study was conducted, collecting data on animal-related injuries (dogs, cats, rodents, or other animals) as recorded in the outpatient registration system of the emergency department at Tongde Hospital of Zhejiang Province from October 8, 2022, to October 30, 2023. The study variables encompassed patient demographic characteristics (gender, age, occupation, residence, etc.), and injury characteristics (date and location of injury, type of animal inflicting the injury, level of exposure, wound site, number of wounds, vaccination history, etc.). Descriptive statistics and univariate analysis were performed on the collected data.Results: From October 8, 2022, to October 30, 2023, a total of 1 266 cases of animal bites were attended to in our hospital's emergency department. A distinct seasonal pattern was observed in the monthly distribution of animal bite patients, with a consistent presence throughout the year and notable fluctuations. There was a higher incidence during the summer and autumn (July to October), and a lower incidence during the winter and spring (December to the following March), marking a relatively quiescent period. The study included 680 female cases (53.7%) and 586 male cases (46.3%), with a median age of 27 years (range 11 months to 88 years). The majority of patients were clerks or workers (50.2%), followed by students (21.6%), laborers (8.5%), and retirees (3.6%). The majority of patients were local residents (90.6%), and the majority had no history of rabies vaccination (76.9%), with only 3 cases (0.2%) having pre-exposure immunization. Among the four types of animal bites, cat bites predominated (64.5%), followed by dog bites (28.7%), rodent bites (4.9%), and bites from other animals (1.9%). The time from injury to consultation was 0 (0-40) days. Most patients experienced a level III exposure (76.3%), with level II exposure being less common (23.2%), and level I exposure being the least frequent (0.5%). The upper limbs were the most common site of injury (72.1%), followed by the lower limbs (21.2%), and the trunk was the least affected (2.6%). The majority of patients had a single wound (75.8%), and the majority of injuries occurred at home (90.2%). The number of patients who self-cleaned their wounds was comparable to those who sought outpatient treatment. When stratified by age and gender, the age of 18 to 39 years group was identified as the high-incidence demographic for all four types of animal bites. In this age group, except for injuries caused by mice, injuries caused by other animals were more common in females than males.Conclusions: The proportion of injuries caused by cat

目的：利用医院急诊科电子病案系统分析动物相关伤害的特点，总结感染人群的流行病学特征。方法：采用回顾性横断面研究方法，收集浙江省同德医院急诊科门诊登记系统记录的2022年10月8日至2023年10月30日的动物相关损伤（犬、猫、啮齿动物或其他动物）数据。研究变量包括患者人口统计学特征（性别、年龄、职业、居住地等）和损伤特征（损伤日期和地点、造成损伤的动物类型、暴露程度、伤口部位、伤口数量、疫苗接种史等）。对收集的数据进行描述性统计和单变量分析。结果：2022年10月8日至2023年10月30日，我院急诊科共收治动物咬伤病例1 266例。在动物咬伤患者的月度分布中观察到明显的季节性模式，全年一致存在，波动显著。夏季和秋季（7 - 10月）发病率较高，冬季和春季（12月至次年3月）发病率较低，处于相对平静期。其中女性680例（53.7%），男性586例（46.3%），中位年龄27岁（11个月~ 88岁）。以职员或工人为主（50.2%），其次为学生（21.6%）、劳工（8.5%）和退休人员（3.6%）。绝大多数患者为当地居民（90.6%），绝大多数患者无狂犬病疫苗接种史（76.9%），仅有3例（0.2%）进行了暴露前免疫接种。4种动物咬伤类型中，以猫咬伤为主（64.5%），其次是狗咬伤（28.7%）、啮齿动物咬伤（4.9%）和其他动物咬伤（1.9%）。从受伤到会诊时间为0（0 ~ 40）天。大多数患者经历III级暴露（76.3%），II级暴露较少（23.2%），I级暴露最不常见（0.5%）。上肢是最常见的损伤部位（72.1%），其次是下肢（21.2%），躯干最少（2.6%）。绝大多数患者为单伤（75.8%），绝大多数损伤发生在家中（90.2%）。自我清洗伤口的患者数量与寻求门诊治疗的患者数量相当。当按年龄和性别分层时，18至39岁年龄组被确定为所有四种动物咬伤的高发人群。在这个年龄组中，除了小鼠造成的损伤外，其他动物造成的损伤在雌性中比雄性更常见。结论：浙江省杭州市急诊科动物相关事件中猫致伤的比例明显较高。大多数患者缺乏狂犬病疫苗接种史和暴露前免疫史。夏季和秋季的病例发病率较高，高发期延长。利用急诊科动物损伤数据为动物咬伤监测提供了一种方便、可持续的方法，代表了一种综合监测数据的新途径，是对现有疾病控制监测系统的有益补充。

{"title":"[Retrospective analysis of animal-related injuries in 1 266 patients based on the emergency department electronic medical record system].","authors":"Zheng Yang, Ji Wang, Chunyun Cai, Aihua Jiang","doi":"10.3760/cma.j.cn121430-20231230-01131","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20231230-01131","url":null,"abstract":"Objective: To analyze the characteristics of animal-related injuries and summarize the epidemiological features of the affected population using the hospital's emergency department electronic medical record system.Methods: A retrospective cross-sectional study was conducted, collecting data on animal-related injuries (dogs, cats, rodents, or other animals) as recorded in the outpatient registration system of the emergency department at Tongde Hospital of Zhejiang Province from October 8, 2022, to October 30, 2023. The study variables encompassed patient demographic characteristics (gender, age, occupation, residence, etc.), and injury characteristics (date and location of injury, type of animal inflicting the injury, level of exposure, wound site, number of wounds, vaccination history, etc.). Descriptive statistics and univariate analysis were performed on the collected data.Results: From October 8, 2022, to October 30, 2023, a total of 1 266 cases of animal bites were attended to in our hospital's emergency department. A distinct seasonal pattern was observed in the monthly distribution of animal bite patients, with a consistent presence throughout the year and notable fluctuations. There was a higher incidence during the summer and autumn (July to October), and a lower incidence during the winter and spring (December to the following March), marking a relatively quiescent period. The study included 680 female cases (53.7%) and 586 male cases (46.3%), with a median age of 27 years (range 11 months to 88 years). The majority of patients were clerks or workers (50.2%), followed by students (21.6%), laborers (8.5%), and retirees (3.6%). The majority of patients were local residents (90.6%), and the majority had no history of rabies vaccination (76.9%), with only 3 cases (0.2%) having pre-exposure immunization. Among the four types of animal bites, cat bites predominated (64.5%), followed by dog bites (28.7%), rodent bites (4.9%), and bites from other animals (1.9%). The time from injury to consultation was 0 (0-40) days. Most patients experienced a level III exposure (76.3%), with level II exposure being less common (23.2%), and level I exposure being the least frequent (0.5%). The upper limbs were the most common site of injury (72.1%), followed by the lower limbs (21.2%), and the trunk was the least affected (2.6%). The majority of patients had a single wound (75.8%), and the majority of injuries occurred at home (90.2%). The number of patients who self-cleaned their wounds was comparable to those who sought outpatient treatment. When stratified by age and gender, the age of 18 to 39 years group was identified as the high-incidence demographic for all four types of animal bites. In this age group, except for injuries caused by mice, injuries caused by other animals were more common in females than males.Conclusions: The proportion of injuries caused by cat","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1311-1314"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Construction of prognostic prediction model for patients with sepsis-induced acute kidney injury treated with continuous renal replacement therapy]. [持续肾替代治疗对脓毒症急性肾损伤患者预后预测模型的构建]。

Q3 Medicine

Zhonghua wei zhong bing ji jiu yi xue

Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20240103-00010

Yalin Li, Dongfeng Li, Jing Wang, Hao Li, Xiao Wang

Objective: To explore the influencing factors of prognosis in patients with sepsis-induced acute kidney injury undergoing continuous renal replacement therapy (CRRT), and to construct a mortality risk prediction model.

Methods: A retrospective research method was adopted, patients with sepsis-induced acute kidney injury who received CRRT at Fuyang People's Hospital from February 2021 to September 2023 were included in this study. Collect general information, comorbidities, vital signs, laboratory indicators, disease severity scores, treatment status, length of stay in the intensive care unit (ICU), and 28-day prognosis were collected within 24 hours of patient enrollment. The Cox regression model was used to identify the factors influencing prognosis in patients with sepsis-induced acute kidney injury, and a nomogram model was developed to predict mortality in these patients. Receiver operator characteristic curve (ROC curve), calibration curve, and Hosmer-Lemeshow test were used to validate the predictive performance of the nomogram model.

Results: A total of 146 patients with sepsis-induced acute kidney injury were included, of which 98 survived and 48 died (with a mortality of 32.88%) after 28 days of treatment. The blood lactic acid, interleukin-6 (IL-6), serum cystatin C, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), and proportion of mechanical ventilation in the death group were significantly higher than those in the survival group. The ICU stay was significantly longer than that in the survival group, and the glomerular filtration rate was significantly lower than that in the survival group. Cox regression analysis showed that blood lactic acid [odds ratio (OR) = 2.992, 95% confidence interval (95%CI) was 1.023-8.754], IL-6 (OR = 3.522, 95%CI was 1.039-11.929), serum cystatin C (OR = 3.999, 95%CI was 1.367-11.699), mechanical ventilation (OR = 4.133, 95%CI was 1.413-12.092), APACHE II score (OR = 5.013, 95%CI was 1.713-14.667), SOFA score (OR = 3.404, 95%CI was 1.634-9.959) were risk factors for mortality in patients with sepsis-induced acute kidney injury (all P < 0.05), glomerular filtration rate (OR = 0.294, 95%CI was 0.101-0.860) was a protective factor for mortality in patients with sepsis-induced acute kidney injury (P < 0.05). The ROC curve showed that the column chart model has a sensitivity of 80.0% (95%CI was 69.1%-89.2%) and a specificity of 89.3% (95%CI was 83.1%-95.2%) in predicting 28-day mortality in patients with acute kidney injury caused by sepsis.

Conclusions: Blood lactic acid, IL-6, mechanical ventilation, APACHEII score, SOFA score, glomerular filtration rate, and serum cystatin C are associated with the risk of death in patients with sepsis-induced acute kidney injury. The nomogram model could help early identification of mortality risk in these patients.

目的：探讨脓毒症致急性肾损伤患者接受持续肾替代治疗（CRRT）后预后的影响因素，并建立死亡风险预测模型。方法：采用回顾性研究方法，纳入阜阳市人民医院2021年2月至2023年9月接受CRRT治疗的败血症性急性肾损伤患者。收集患者入组后24小时内的一般信息、合并症、生命体征、实验室指标、疾病严重程度评分、治疗状况、重症监护病房（ICU）住院时间和28天预后。采用Cox回归模型确定脓毒症急性肾损伤患者预后的影响因素，并建立nomogram模型预测患者的死亡率。采用接收算子特征曲线（ROC曲线）、校正曲线和Hosmer-Lemeshow检验验证nomogram模型的预测效果。结果：共纳入146例败血症性急性肾损伤患者，治疗28 d后存活98例，死亡48例，死亡率32.88%。死亡组血乳酸、白细胞介素-6 （IL-6）、血清胱抑素C、急性生理与慢性健康评估ⅱ（APACHEⅱ）、序事性器官衰竭评估（SOFA）、机械通气比例均显著高于生存组。ICU住院时间明显长于生存组，肾小球滤过率明显低于生存组。Cox回归分析表明,血乳酸(比值比(或)= 2.992,95%置信区间1.023 - -8.754(95%置信区间)],il - 6 (OR = 3.522, 95% ci 1.039 - -11.929),血清半胱氨酸蛋白酶抑制物C (OR = 3.999, 95% ci 1.367 - -11.699),机械通气(OR = 4.133, 95% ci 1.413 - -12.092), APACHE II评分(OR = 5.013, 95% ci 1.713 - -14.667),沙发上得分(OR = 3.404, 95% ci 1.634 - -9.959)死亡率的危险因素在sepsis-induced急性肾损伤患者(P < 0.05),肾小球滤过率（OR = 0.294, 95%CI为0.101 ~ 0.860）是脓毒症致急性肾损伤患者死亡的保护因素（P < 0.05）。ROC曲线显示柱状图模型预测脓毒症急性肾损伤患者28天死亡率的敏感性为80.0% (95%CI为69.1% ~ 89.2%)，特异性为89.3% （95%CI为83.1% ~ 95.2%）。结论：血乳酸、IL-6、机械通气、APACHEII评分、SOFA评分、肾小球滤过率、血清胱抑素C与脓毒症所致急性肾损伤患者死亡风险相关。nomogram模型可以帮助早期识别这些患者的死亡风险。

{"title":"[Construction of prognostic prediction model for patients with sepsis-induced acute kidney injury treated with continuous renal replacement therapy].","authors":"Yalin Li, Dongfeng Li, Jing Wang, Hao Li, Xiao Wang","doi":"10.3760/cma.j.cn121430-20240103-00010","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240103-00010","url":null,"abstract":"Objective: To explore the influencing factors of prognosis in patients with sepsis-induced acute kidney injury undergoing continuous renal replacement therapy (CRRT), and to construct a mortality risk prediction model.Methods: A retrospective research method was adopted, patients with sepsis-induced acute kidney injury who received CRRT at Fuyang People's Hospital from February 2021 to September 2023 were included in this study. Collect general information, comorbidities, vital signs, laboratory indicators, disease severity scores, treatment status, length of stay in the intensive care unit (ICU), and 28-day prognosis were collected within 24 hours of patient enrollment. The Cox regression model was used to identify the factors influencing prognosis in patients with sepsis-induced acute kidney injury, and a nomogram model was developed to predict mortality in these patients. Receiver operator characteristic curve (ROC curve), calibration curve, and Hosmer-Lemeshow test were used to validate the predictive performance of the nomogram model.Results: A total of 146 patients with sepsis-induced acute kidney injury were included, of which 98 survived and 48 died (with a mortality of 32.88%) after 28 days of treatment. The blood lactic acid, interleukin-6 (IL-6), serum cystatin C, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), and proportion of mechanical ventilation in the death group were significantly higher than those in the survival group. The ICU stay was significantly longer than that in the survival group, and the glomerular filtration rate was significantly lower than that in the survival group. Cox regression analysis showed that blood lactic acid [odds ratio (OR) = 2.992, 95% confidence interval (95%CI) was 1.023-8.754], IL-6 (OR = 3.522, 95%CI was 1.039-11.929), serum cystatin C (OR = 3.999, 95%CI was 1.367-11.699), mechanical ventilation (OR = 4.133, 95%CI was 1.413-12.092), APACHE II score (OR = 5.013, 95%CI was 1.713-14.667), SOFA score (OR = 3.404, 95%CI was 1.634-9.959) were risk factors for mortality in patients with sepsis-induced acute kidney injury (all P < 0.05), glomerular filtration rate (OR = 0.294, 95%CI was 0.101-0.860) was a protective factor for mortality in patients with sepsis-induced acute kidney injury (P < 0.05). The ROC curve showed that the column chart model has a sensitivity of 80.0% (95%CI was 69.1%-89.2%) and a specificity of 89.3% (95%CI was 83.1%-95.2%) in predicting 28-day mortality in patients with acute kidney injury caused by sepsis.Conclusions: Blood lactic acid, IL-6, mechanical ventilation, APACHEII score, SOFA score, glomerular filtration rate, and serum cystatin C are associated with the risk of death in patients with sepsis-induced acute kidney injury. The nomogram model could help early identification of mortality risk in these patients.","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1268-1272"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Predictive value of plasma heparin-binding protein combined with albumin for 28-day mortality in patients with sepsis]. [血浆肝素结合蛋白联合白蛋白对败血症患者28天死亡率的预测价值]。

Q3 Medicine

Zhonghua wei zhong bing ji jiu yi xue

Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20240718-00614

Jiangping Liu, Yajun Li, Yawen Zheng, Cuijie Zhang, Lihua Huang, Xiaopeng Ning, Wenfei Wang, Qingli Dou

Objective: To evaluate the predictive value of plasma heparin-binding protein (HBP) combined with albumin (Alb) for predicting 28-day mortality in patients with sepsis.Methods: The clinical data of patients with sepsis admitted to the emergency intensive care unit (EICU) of the People's Hospital of Shenzhen Baoan District from March 2020 to March 2024 were retrospectively analyzed. The study began at the time of the first diagnosis of sepsis upon EICU admission and ended upon patient death or at 28 days. The gender, age, length of stay in EICU, underlying diseases, and infection sites were recorded. Within 24 hours of sepsis diagnosis, blood culture results, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), blood lactate acid (Lac), HBP, Alb, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation II (APACHE II), mortality in emergency department sepsis score (MEDS), modified early warning score (MEWS), number of organ failures, use of vasopressors, application of mechanical ventilation, renal replacement therapy, and 28-day prognosis were recorded, the differences in these indicators between two groups were compared. Univariate and multivariate Logistic regression analyses were used to analyze the risk factors of 28-day mortality in patients with sepsis. Receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated to evaluate the early predictive value of various risk factors for 28-day mortality in patients with sepsis.Results: A total of 300 patients with sepsis were included, with 16 excluded, resulting in 284 patients being analyzed. Among them, 191 survived and 93 died within 28 days. There were no statistically significant differences between the two groups in terms of gender, age, underlying diseases, infection sites, blood culture positivity rate, number of organ failures, and length of stay in EICU. Univariate analysis showed that the rate of vasopressor use, the rate of mechanical ventilation, HBP, PCT, CRP, Lac, SOFA score, APACHE II score, MEDS score, and MEWS score were significantly higher in the death group than those in the survival group, while Alb was significantly lower in the death group than that in the survival group. Multivariate Logistic regression analysis showed that HBP and Alb were independent risk factors for predicting 28-day mortality in patients with sepsis [odds ratio (OR) and 95% confidence interval (95%CI) were 1.093 (0.989-1.128) and 1.174 (1.095-1.259), both P < 0.05]. ROC curve analysis showed that both HBP and Alb had certain predictive value for 28-day mortality in patients with sepsis [AUC and 95%CI were 0.820 (0.717-0.923) and 0.786 (0.682-0.890), both P < 0.05]. When the critical value of HBP was 117.50 μg/L, the sensitivity was 85.90%, and the specificity was 70.50%. When the critical value of Alb was 28.30 g/L, the sens

目的：探讨血浆肝素结合蛋白（HBP）联合白蛋白（Alb）对脓毒症患者28天死亡率的预测价值。方法：回顾性分析深圳市宝安区人民医院急诊重症监护室（EICU） 2020年3月至2024年3月收治的脓毒症患者的临床资料。该研究从EICU入院时首次诊断败血症开始，并在患者死亡或28天结束。记录性别、年龄、在EICU的住院时间、基础疾病和感染部位。脓毒症诊断24小时内，血培养结果、白细胞计数（WBC）、c反应蛋白（CRP）、降钙素原（PCT）、血乳酸（Lac）、HBP、Alb、顺序器官衰竭评估（SOFA）、急性生理和慢性健康评估II （APACHE II）、急诊科脓毒症评分（MEDS）死亡率、改良早期预警评分（MEWS）、器官衰竭数量、血管升压药物的使用、机械通气的应用、肾脏替代治疗、记录28天预后，比较两组患者上述指标的差异。采用单因素和多因素Logistic回归分析脓毒症患者28天死亡率的危险因素。绘制受试者操作者特征曲线（Receiver operator characteristic curve， ROC曲线），计算ROC曲线下面积（area under ROC curve， AUC），评价各种危险因素对脓毒症患者28天死亡率的早期预测价值。结果：共纳入脓毒症患者300例，排除16例，共分析284例患者。其中191人存活，93人在28天内死亡。两组患者在性别、年龄、基础疾病、感染部位、血培养阳性率、器官衰竭次数、EICU住院时间等方面差异无统计学意义。单因素分析显示，死亡组血管加压剂使用率、机械通气率、HBP、PCT、CRP、Lac、SOFA评分、APACHE II评分、MEDS评分、MEWS评分显著高于生存组，Alb显著低于生存组。多因素Logistic回归分析显示，HBP和Alb是预测脓毒症患者28天死亡率的独立危险因素[比值比（OR）为1.093(0.989 ~ 1.128)，95%可信区间（95% ci）为1.174 (1.095 ~ 1.259)，P均< 0.05]。ROC曲线分析显示，HBP和Alb对脓毒症患者28天死亡率有一定的预测价值[AUC和95%CI分别为0.820（0.717-0.923）和0.786 (0.682-0.890)，P均< 0.05]。当HBP临界值为117.50 μg/L时，敏感性为85.90%，特异性为70.50%。当Alb临界值为28.30 g/L时，敏感性为69.30%，特异性为81.20%。两指标联合诊断时，AUC为0.881 (95%CI为0.817 ~ 0.945,P < 0.001)，敏感性为92.70%，特异性为76.80%。结论：HBP和Alb是预测脓毒症患者28天死亡率的独立危险因素。HBP和Alb对脓毒症患者28天死亡率的联合预测效率优于单一指标。

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引用次数: 0

[Efficiency analysis of hyperbaric oxygen therapy for paroxysmal sympathetic hyperactivity after brain injury: a multicenter retrospective cohort study]. 高压氧治疗脑损伤后阵发性交感神经亢进的疗效分析：一项多中心回顾性队列研究。

Q3 Medicine

Zhonghua wei zhong bing ji jiu yi xue

Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20231115-00980

Hongyu Wang, Changhe Li, Huimin Chen, Caihong Ren, Yajie Liu, Jiankai Gao, Hong Wang, Peiliang Li, Jinqiang Liu, Yujing Li, Sisen Zhang

Objective: To investigate the effect of hyperbaric oxygen (HBO) on paroxysmal sympathetic hyperexcitation (PSH) after brain injury.

Methods: A multicenter retrospective study was conducted. Fifty-six patients with PSH who received HBO treatment from four hospitals in Henan Province from January 2021 to September 2023 were selected as the HBO group, and 36 patients with PSH who did not receive HBO treatment from Zhengzhou People's Hospital from May 2018 to December 2020 were selected as the control group. PSH assessment measure (PSH-AM) score [clinical feature scale (CFS) score+diagnostic likelihood tool (DLT) score] and Glasgow coma scale (GCS) were compared before and after HBO treatment, and between HBO group and control group to evaluate the effect of HBO treatment on prognosis of PSH patients.

Results: There were no statistically significant differences in age, gender, PSH etiology, GCS score, time from onset to occurrence of PSH, CFS score, CFS+DLT score and frequency of PSH episodes between the two groups, indicating comparability. The duration of HBO treatment ranged from 3 to 11 days for 56 patients receiving HBO treatment, and the duration of HBO treatment ranged from 3 to 5 courses. Compared with before treatment, after HBO treatment, PSH symptoms in HBO patients were significantly relieved (body temperature increase: 14.29% vs. 64.29%, heart rate increase: 25.00% vs. 98.21%, shortness of breath: 14.29% vs. 76.79%, blood pressure increase: 8.93% vs. 85.71%, sweating: 10.71% vs. 85.71%, muscle tone increased: 19.64% vs. 75.00%, all P < 0.05), CFS+DLT score decreased significantly (16.90±4.81 vs. 22.12±3.12, P < 0.01), GCS score improved (12.31±5.34 vs. 5.95±2.18, P < 0.01). After 30 days of hospitalization, compared with the control group, PSH symptoms in the HBO group were improved (body temperature increase: 14.29% vs. 19.44%, heart rate increase: 19.64% vs. 25.00%, shortness of breath: 10.71% vs. 27.78%, blood pressure increase: 7.14% vs. 22.22%, sweating: 8.93% vs. 25.00%, muscle tone increased: 19.64% vs. 38.89%, all P < 0.05 except body temperature increase), CFS+DLT score decreased (16.90±3.81 vs. 19.98±4.89, P < 0.05), GCS score increased (14.12±4.12 vs. 12.31±4.14, P < 0.01), the length of intensive care unit (ICU) stay was shortened (days: 18.01±5.67 vs. 24.93±8.33, P < 0.01).

Conclusions: HBO treatment can significantly relieve the symptoms of patients with PSH after brain injury and provide a new idea for the treatment of PSH patients.

目的：探讨高压氧（HBO）对脑损伤后阵发性交感神经亢进（PSH）的影响。方法：采用多中心回顾性研究。选取2021年1月至2023年9月在河南省四家医院接受HBO治疗的PSH患者56例作为HBO组，2018年5月至2020年12月在郑州市人民医院未接受HBO治疗的PSH患者36例作为对照组。比较HBO治疗前后、HBO组与对照组之间PSH评估量表（PSH- am）评分[临床特征量表（CFS）评分+诊断似然工具（DLT）评分]和格拉斯哥昏迷量表（GCS），评价HBO治疗对PSH患者预后的影响。结果：两组患者在年龄、性别、PSH病因、GCS评分、PSH发病至发生时间、CFS评分、CFS+DLT评分、PSH发作次数等方面差异均无统计学意义，具有可比性。56例接受HBO治疗的患者，HBO治疗时间从3 ~ 11天不等，HBO治疗时间从3 ~ 5个疗程不等。与治疗前比较，HBO治疗后，HBO患者PSH症状明显缓解（体温升高：14.29% vs. 64.29%，心率升高：25.00% vs. 98.21%，呼吸急促：14.29% vs. 76.79%，血压升高：8.93% vs. 85.71%，出汗：10.71% vs. 85.71%，肌张力升高：19.64% vs. 75.00%，均P < 0.05）， CFS+DLT评分明显降低（16.90±4.81 vs. 22.12±3.12,P < 0.01）， GCS评分明显改善（12.31±5.34 vs. 5.95±2.18,P < 0.01）。住院30天后，与对照组相比，HBO组PSH症状得到改善(体温升高：14.29% vs. 19.44%，心率升高：19.64% vs. 25.00%，呼吸急促：10.71% vs. 27.78%，血压升高：7.14% vs. 22.22%，出汗：8.93% vs. 25.00%，肌张力增强：CFS+DLT评分降低（16.90±3.81比19.98±4.89,P < 0.05）， GCS评分升高（14.12±4.12比12.31±4.14,P < 0.01），重症监护病房（ICU）住院天数缩短（18.01±5.67比24.93±8.33,P < 0.01）。结论：HBO治疗可显著缓解脑损伤后PSH患者的症状，为PSH患者的治疗提供新的思路。

{"title":"[Efficiency analysis of hyperbaric oxygen therapy for paroxysmal sympathetic hyperactivity after brain injury: a multicenter retrospective cohort study].","authors":"Hongyu Wang, Changhe Li, Huimin Chen, Caihong Ren, Yajie Liu, Jiankai Gao, Hong Wang, Peiliang Li, Jinqiang Liu, Yujing Li, Sisen Zhang","doi":"10.3760/cma.j.cn121430-20231115-00980","DOIUrl":"10.3760/cma.j.cn121430-20231115-00980","url":null,"abstract":"Objective: To investigate the effect of hyperbaric oxygen (HBO) on paroxysmal sympathetic hyperexcitation (PSH) after brain injury.Methods: A multicenter retrospective study was conducted. Fifty-six patients with PSH who received HBO treatment from four hospitals in Henan Province from January 2021 to September 2023 were selected as the HBO group, and 36 patients with PSH who did not receive HBO treatment from Zhengzhou People's Hospital from May 2018 to December 2020 were selected as the control group. PSH assessment measure (PSH-AM) score [clinical feature scale (CFS) score+diagnostic likelihood tool (DLT) score] and Glasgow coma scale (GCS) were compared before and after HBO treatment, and between HBO group and control group to evaluate the effect of HBO treatment on prognosis of PSH patients.Results: There were no statistically significant differences in age, gender, PSH etiology, GCS score, time from onset to occurrence of PSH, CFS score, CFS+DLT score and frequency of PSH episodes between the two groups, indicating comparability. The duration of HBO treatment ranged from 3 to 11 days for 56 patients receiving HBO treatment, and the duration of HBO treatment ranged from 3 to 5 courses. Compared with before treatment, after HBO treatment, PSH symptoms in HBO patients were significantly relieved (body temperature increase: 14.29% vs. 64.29%, heart rate increase: 25.00% vs. 98.21%, shortness of breath: 14.29% vs. 76.79%, blood pressure increase: 8.93% vs. 85.71%, sweating: 10.71% vs. 85.71%, muscle tone increased: 19.64% vs. 75.00%, all P < 0.05), CFS+DLT score decreased significantly (16.90±4.81 vs. 22.12±3.12, P < 0.01), GCS score improved (12.31±5.34 vs. 5.95±2.18, P < 0.01). After 30 days of hospitalization, compared with the control group, PSH symptoms in the HBO group were improved (body temperature increase: 14.29% vs. 19.44%, heart rate increase: 19.64% vs. 25.00%, shortness of breath: 10.71% vs. 27.78%, blood pressure increase: 7.14% vs. 22.22%, sweating: 8.93% vs. 25.00%, muscle tone increased: 19.64% vs. 38.89%, all P < 0.05 except body temperature increase), CFS+DLT score decreased (16.90±3.81 vs. 19.98±4.89, P < 0.05), GCS score increased (14.12±4.12 vs. 12.31±4.14, P < 0.01), the length of intensive care unit (ICU) stay was shortened (days: 18.01±5.67 vs. 24.93±8.33, P < 0.01).Conclusions: HBO treatment can significantly relieve the symptoms of patients with PSH after brain injury and provide a new idea for the treatment of PSH patients.","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1285-1289"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Establishment of risk prediction model for pneumonia infection in elderly severe patients and analysis of prevention effect of 1M3S nursing plan under early warning mode]. [老年重症患者肺炎感染风险预测模型的建立及预警模式下1M3S护理方案的预防效果分析]。

Q3 Medicine

Zhonghua wei zhong bing ji jiu yi xue

Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20231211-01075

Xin Li, Xiao Tang, Lianzhen Qi, Ruili Chai

Objective: To construct a risk prediction model for elderly severe patients with pneumonia infection, and analyze the prevention effect of 1M3S nursing plan under early warning mode.Methods: Firstly, 180 elderly severe patients admitted to the department of intensive care unit (ICU) of the Second Affiliated Hospital of Xingtai Medical College from September 2020 to September 2021 were enrolled. Their clinical data were collected and retrospectively analyzed, and they were divided into infected group and non-infected group according to whether they developed severe pneumonia. The risk factors affecting severe pneumonia in elderly severe patients were screened by univariate and multifactorial analysis methods, and the risk prediction model was constructed. The predictive efficiency of the model was analyzed by receiver operator characteristic curve (ROC curve). Then the risk prediction model was applied to prospectively include 60 high-risk elderly patients with severe pneumonia admitted from December 2021 to August 2022. The patients were randomly divided into study group and control group by envelope method, with 30 cases in each group. Both groups were given routine nursing. On this basis, the study group adopted 1M3S nursing scheme [standardized nursing management (1M), improving nursing skills (S1), optimizing nursing service (S2), ensuring nursing safety (S3)] in the early warning mode for intervention. Acute physiology and chronic health evaluation II (APACHE II) and Murray lung injury score were compared between the two groups before intervention and 7 days after intervention.Results: Among 180 elderly severe patients, 34 cases were infected with pneumonia (18.89%). The proportion of patients with Glasgow coma scale (GCS) ≤ 8, duration of mechanical ventilation > 7 days, use of antibiotics, poor oral hygiene, hospital stay > 15 days and albumin ≤ 30 g/L in the infected group were significantly higher than those in the non-infected group. Multivariate Logistic regression analysis showed that duration of mechanical ventilation > 7 days, use of antibiotics, GCS score≤ 8, hospital stay > 15 days, albumin ≤ 30 g/L and poor oral hygiene were all independent risk factors for severe pneumonia in elderly severe patients. The odds ratio (OR) values were 3.180, 3.394, 1.108, 1.881, 1.517 and 2.512 (all P < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of the prediction model to predict severe pneumonia in elderly severe patients was 0.838, 95% confidence interval was 0.748-0.927, sensitivity and specificity were 81.25% and 72.57%, respectively, and the Youden index was 0.538. (2) There was no significantly difference in general data between the study group and the control group, which was comparable. After intervention, the APACHE II score and Murray lung injury score of the two groups were significantly decreased, and the APACHE II score and Murray lung inj

目的：构建老年重症肺炎感染患者风险预测模型，分析预警模式下1M3S护理方案的预防效果。方法：首先选取2020年9月至2021年9月邢台医学院第二附属医院重症监护病房（ICU）住院的老年重症患者180例。收集患者的临床资料并进行回顾性分析，根据是否发生重症肺炎分为感染组和非感染组。采用单因素和多因素分析方法筛选影响老年重症患者重症肺炎的危险因素，构建风险预测模型。采用受试者特征曲线（receiver operator characteristic curve， ROC）分析模型的预测效率。然后应用风险预测模型前瞻性纳入2021年12月至2022年8月收治的60例老年重症肺炎高危患者。采用包络法将患者随机分为研究组和对照组，每组各30例。两组均给予常规护理。在此基础上，研究组采用1M3S护理方案[规范护理管理（1M）、提高护理技能（S1）、优化护理服务（S2）、确保护理安全（S3）]进行预警模式干预。比较两组患者干预前和干预后7天的急性生理和慢性健康评估II （APACHE II）和Murray肺损伤评分。结果：180例老年重症患者中，34例感染肺炎，占18.89%。感染组格拉斯哥昏迷评分(GCS)≤8分、机械通气持续时间bbb70天、抗生素使用情况、口腔卫生不良、住院时间> 15天、白蛋白≤30 g/L的患者比例显著高于非感染组。多因素Logistic回归分析显示，机械通气时间bbb7 d、抗生素使用情况、GCS评分≤8分、住院时间> 15 d、白蛋白≤30 g/L、口腔卫生不良均为老年重症患者重症肺炎的独立危险因素。比值比（OR）分别为3.180、3.394、1.108、1.881、1.517和2.512 （P均< 0.05）。ROC曲线分析显示，该预测模型预测老年重症患者重症肺炎的ROC曲线下面积（AUC）为0.838,95%可信区间为0.748 ~ 0.927，敏感性和特异性分别为81.25%和72.57%，约登指数为0.538。(2)研究组与对照组一般资料无显著差异，具有可比性。干预后，两组患者的APACHEⅱ评分和Murray肺损伤评分均显著降低，研究组患者的APACHEⅱ评分和Murray肺损伤评分均显著低于对照组（APACHEⅱ评分：3.15±1.02比3.81±0.25，Murray肺损伤评分：5.01±1.12比6.55±0.21，P均< 0.01）。结论：影响老年重症肺炎患者发生发展的危险因素较多。基于机械通气持续时间bbb7天、住院时间> 15天、GCS评分≤8分、白蛋白≤30 g/L、口腔卫生不良和联合使用抗菌药物史的风险预测模型具有较高的预测效果。预警模式下1M3S护理方案的干预，可有效降低老年重症患者发生重症肺炎的风险，显著改善其病理生理状态。

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引用次数: 0

[Progress in the immunometabolism in the regulation of macrophage function in sepsis]. [免疫代谢在脓毒症巨噬细胞功能调节中的研究进展]。

Q3 Medicine

Zhonghua wei zhong bing ji jiu yi xue

Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20231216-01089

Yingying Lu, Yan Bai, Fei Li, Zhuqing Rao

Macrophages are widely distributed in peripheral blood, lungs, liver, brain, kidneys, skin, testes, vascular endothelial cells, and other parts of the body. As sentinel cells of innate immunity, they play an important role in the occurrence and development of sepsis. Recent research in immune metabolism has revealed the complicated relationship between specific metabolic pathways of macrophages and their phenotype and function in sepsis. During the pro-inflammatory phase of sepsis, macrophages are characterized by glycolysis, while in the immunosuppressive phase, they rely more on mitochondrial oxidative phosphorylation (OXPHOS). Hence, this review describes how macrophages metabolism related signaling pathways, molecules, enzymes and metabolic intermediates determine their phenotype and function to find critical targets which regulate the body immune status in sepsis.

巨噬细胞广泛分布于外周血、肺、肝、脑、肾、皮肤、睾丸、血管内皮细胞等身体部位。作为先天免疫的前哨细胞，它们在脓毒症的发生发展中起着重要作用。近年来免疫代谢研究揭示了脓毒症中巨噬细胞特异性代谢途径与其表型和功能之间的复杂关系。在脓毒症的促炎阶段，巨噬细胞以糖酵解为特征，而在免疫抑制阶段，它们更多地依赖线粒体氧化磷酸化（OXPHOS）。因此，本文综述了巨噬细胞代谢相关的信号通路、分子、酶和代谢中间体如何决定其表型和功能，以寻找脓毒症中调节机体免疫状态的关键靶点。

引用次数: 0

[Analysis of the correlation between driving pressure and prognosis in lung transplant recipients based on restricted cubic spline model]. [基于受限三次样条模型的肺移植受者驱动压与预后的相关性分析]。

Q3 Medicine

Zhonghua wei zhong bing ji jiu yi xue

Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20240407-00311

Chenhao Xuan, Dapeng Wang, Shuyun Jiang, Song Wang, Zhiyu Li, Jingyu Chen, Hongyang Xu

Objective: To investigate the correlation between postoperative driving pressure (DP) and the prognosis of lung transplantation, and to further evaluate the value of early DP monitoring in lung transplantation.Methods: A observational study was conducted. The patients after lung transplantation who admitted to the intensive care unit (ICU) of Wuxi People's Hospital from February 1, 2022 to February 1, 2023 were collected. They were divided into low DP group (DP≤15 cmH2O, 1 cmH2O ≈ 0.098 kPa) and high DP group (DP > 15 cmH2O) according to DP within 2 hours after operation. The clinical data including general information, primary disease, chronic diseases, cardiopulmonary function, laboratory indicators, intraoperative condition, postoperative lactic acid (Lac) and ventilator parameters were collected. Primary outcomes included 28-day and 90-day survival, and secondary outcomes included occurrence of primary graft dysfunction (PGD), duration of extracorporeal membrane oxygenation (ECMO), duration of mechanical ventilation, weaning of mechanical ventilation, and length of ICU stay. The general data and observations between the two groups were compared. Kaplan-Meier curve analysis was conducted to analyze the situation of mechanical ventilation and 90-day survival. Receiver operator characteristic curve (ROC curve) was used to evaluate the predictive ability of DP for failed weaning of mechanical ventilation and 90-day death. The dose-response relationship between DP and 90-day death risk was determined by restricted cubic spline model. Univariate analysis was performed using Cox proportional hazards model.Results: A total of 101 patients were enrolled, with 68 patients (67.3%) in the low DP group and 33 patients (32.7%) in the high DP group. No statistically significant difference in general information, chronic diseases, primary diseases, cardiopulmonary function, laboratory indicators, intraoperative conditions, and postoperative Lac between the two groups was found. Compared with the low DP group, the patients in the high DP group had higher inspiratory pressure (Pinsp) and incidence of PGD with grade 3 at 24 hours after operation [Pinsp (cmH2O): 21.0±0.6 vs. 20.0±0.7, PGD with grade 3 at 24 hours: 60.6% (20/33) vs. 39.7% (27/68), both P < 0.05], longer duration of ECMO, duration of mechanical ventilation, and the length of ICU stay [duration of ECMO (hours): 37 (21, 109) vs. 22 (14, 43), duration of mechanical ventilation (days): 3.1 (1.8, 10.7) vs. 1.9 (1.1, 3.2), length of ICU stay (days): 6 (3, 13) vs. 4 (3, 5), all P < 0.05], and lower successful weaning rate of mechanical ventilation [81.8% (27/33) vs. 95.6% (65/68), P < 0.05). The 28-day and 90-day survival rates in the high DP group were significantly higher than those in the low DP group [28-day: 69.7% (23/33) vs. 86.8% (59/68), 90-day: 63.6% (21/33) vs. 83.8% (57/68), both P <

目的：探讨肺移植术后驱动压力（DP）与预后的关系，进一步评价早期DP监测在肺移植中的价值。方法：采用观察性研究。收集2022年2月1日至2023年2月1日在无锡市人民医院重症监护病房（ICU）住院的肺移植术后患者。根据术后2 h内DP分为低DP组（DP≤15 cmH2O, 1 cmH2O≈0.098 kPa）和高DP组（DP > 15 cmH2O）。收集患者一般情况、原发疾病、慢性疾病、心肺功能、实验室指标、术中情况、术后乳酸（Lac）、呼吸机参数等临床资料。主要结局包括28天和90天的生存期，次要结局包括原发性移植物功能障碍（PGD）的发生、体外膜氧合（ECMO）持续时间、机械通气持续时间、机械通气脱机时间和ICU住院时间。比较两组一般资料及观察结果。采用Kaplan-Meier曲线分析机械通气情况及90天生存率。采用受试者操作特征曲线（Receiver operator characteristic curve， ROC）评价DP对机械通气脱机失败及90天死亡的预测能力。DP与90天死亡风险的剂量-反应关系采用限制三次样条模型确定。采用Cox比例风险模型进行单因素分析。结果：共纳入101例患者，其中低DP组68例（67.3%），高DP组33例（32.7%）。两组患者一般情况、慢性疾病、原发病、心肺功能、实验室指标、术中情况、术后Lac差异均无统计学意义。与低DP组相比,高DP组的患者有较高的吸气压力(Pinsp)和发病率PGD与三年级在术后24小时[Pinsp (cmH2O): 21.0±0.6和20.0±0.7,PGD在24小时内与三年级:60.6%(20/33)和39.7%(27/68),两个P < 0.05),长期的医学界,机械通气时间、ICU的长度保持(ECMO持续时间(小时):37(109)和22(43),机械通气时间(天):3.1（1.8, 10.7）比1.9 (1.1,3.2)，ICU住院天数（天）：6（3,13）比4(3,5)，均P < 0.05]，机械通气脱机成功率较低[81.8%（27/33）比95.6% (65/68),P < 0.05]。高DP组28天、90天生存率显著高于低DP组[28天：69.7%（23/33）比86.8%(59/68)，90天：63.6%（21/33）比83.8% (57/68)，P均< 0.05]。Kaplan-Meier曲线显示，低DP组患者较高DP组早断奶拔管，且累计脱机情况较好（Log-Rank检验：χ 2 = 14.054, P < 0.001），低DP组90天累计生存率显著高于高DP组（Log-Rank检验：χ 2 = 4.791, P = 0.029）。ROC曲线分析显示，预测90天死亡DP的ROC曲线下面积（AUC）为0.664[95%置信区间（95% ci）为0.540 ~ 0.787,P = 0.017]，预测机械通气脱机失败的AUC为0.794 （95% ci为0.667 ~ 0.921,P = 0.004）。限制三次样条模型分析结果显示，当DP < 18 cmH2O时，90天死亡风险继续增加；当DP≥18 cmH2O时，DP升高并没有继续增加90天死亡风险，呈现平台效应。单因素分析显示，DP是90天死亡的独立危险因素，DP每升高1 cmH2O，死亡风险增加9.3%[危险比(HR) = 1.093, 95%CI为1.007 ~ 1.186,P = 0.033]。结论：DP是肺移植术后死亡的独立危险因素，术后早期DP可作为肺移植术后机械通气脱机失败和90天死亡的预测因素。

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引用次数: 0

[Prevention and control status of central line-associated bloodstream infection in intensive care unit in Shandong province: a cross-sectional survey analysis]. [山东省重症监护病房中心线相关性血流感染防控现状：横断面调查分析]。

Q3 Medicine

Zhonghua wei zhong bing ji jiu yi xue

Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20240430-00397

Yang Shen, Zijian Tai, Xue Bai, Xuan Song, Man Chen, Qianqian Guo, Cheng Huan, Li Chen, Jicheng Zhang

Objective: To provide evidence for further reducing the incidence of central line-associated bloodstream infection (CLABSI) according to investigation of the prevention and control of CLABSI in intensive care unit (ICU) in Shandong Province.Methods: The questionnaire was developed by experts from Shandong Critical Care Medical Quality Control Center, combining domestic and foreign guidelines, consensus and research. A convenient sampling method was used to recruit survey subjects online from October 11 to 31, 2023 in the province to investigate the management status of central venous catheter (CVC) in ICU units of secondary and above hospitals.Results: A total of 201 valid data were collected, involving 186 hospitals in the province, with a total of 201 ICU units, mainly comprehensive ICU (91%). The beds in ICU units were mainly single rooms (89%) and triple rooms (79%), and the ratio of doctors to total beds was 0.54 : 1. The training on the knowledge and operation of intravascular catheter-associated bloodstream infection in each ICU unit was mainly irregular (49%), and 96% of the catheter operators were authorized by the hospital. In terms of CVC selection, 89% of ICU units used dual-chamber CVC, and 86% of ICU units used catheters without antibiotic coating. When selecting the placement site, for conventional CVC catheterization, 65% preferred subclavian vein. Femoral vein was preferred in 87% of ICU units undergoing continuous renal replacement therapy. 95% of ICU units had established standardized operation procedure (SOP) for CVC placement. 86% of ICU units were capable of ultrasound positioning or guided puncture at the time of catheterization. During catheterization, 88% of ICU units met the sterile dress code. Before and after catheterzation, 81% and 77% of ICU units standardized hand hygiene. Only 31% of ICU units were covered from head to toe by aseptic wipes. For the choice of skin disinfectant, the majority of ICU units (72%) only used iodophor. After tube placement, 54% of ICU units chose sterile transparent dressing and 25% chose sterile gauze dressing. 98% of ICU units were sutured to secure the catheter. Regarding catheter replacement and removal, 45% of ICU units could not be removed or replaced within 2 days in emergency situations where the principle of sterility was not guaranteed. When CLABSI was suspected, 55% of ICU units were able to obtain the catheter tip, transcatheter blood culture, and contralateral peripheral vein blood culture at the same time. For CVC replacement frequency, most ICU units (75%) would not be replaced regularly, and some ICU units would be replaced regularly, but the frequency of replacement was different. For CLABSI prevention and control, 82% of ICU units developed a verification form or supervision form. When analyzing the sources of CLABSI data, most of them were filled in by themselves (60%). As for the frequency of data analy

目的：通过对山东省重症监护病房（ICU）中心静脉相关感染（CLABSI）防控情况的调查，为进一步降低CLABSI的发生率提供依据。方法：由山东省重症监护医疗质量控制中心专家结合国内外指导意见、共识和研究成果编制问卷。采用方便抽样的方法，于2023年10月11日至31日在全省范围内在线招募调查对象，调查二级及以上医院ICU中心静脉导管（CVC）的管理现状。结果：共收集有效资料201份，涉及全省186家医院，共201个ICU单位，以综合ICU为主，占91%。ICU病房床位以单人间（89%）和三人间（79%）为主，医生与总床位之比为0.54:1。各ICU单元对血管内导管相关血流感染知识及操作的培训以不规范为主（49%），96%的导管操作人员为医院授权。在CVC的选择方面，89%的ICU单位使用双腔CVC， 86%的ICU单位使用无抗生素涂层的导管。在选择放置位置时，对于传统的CVC置管，65%的人首选锁骨下静脉。在接受持续肾替代治疗的ICU病房中，87%的患者首选股静脉。95%的ICU单位建立了CVC放置的标准化操作规程（SOP）。86%的ICU病房能够在置管时进行超声定位或引导穿刺。在置管期间，88%的ICU病房符合无菌着装规范。置管前后，81%和77%的ICU单位规范了手卫生。只有31%的ICU病房从头到脚用无菌湿巾覆盖。对于皮肤消毒剂的选择，大多数ICU（72%）仅使用碘伏。置管后，54%的ICU病房选择无菌透明敷料，25%选择无菌纱布敷料。98%的ICU病房被缝合以固定导管。在不能保证无菌原则的紧急情况下，45%的ICU病房不能在2天内拔除或更换导管。当怀疑CLABSI时，55%的ICU病房能够同时获得导管尖端、经导管血培养和对侧外周静脉血培养。对于CVC更换频率，大部分ICU（75%）不会定期更换，部分ICU会定期更换，但更换频率不同。在CLABSI防控方面，82%的ICU制定了核查表或监督表。在分析CLABSI数据的来源时，大部分是自己填写的（60%）。在数据分析频率方面，57%的人为1个月1次。结论：山东省所有ICU单位在操作人员授权、SOP的制定、验证表和监督表的制定与实施、超声引导穿刺、置管前后手卫生等方面均实现了规范化。但在血管内导管相关血流感染的知识和操作培训、最大无菌覆盖率、导管置换和拔除、CLABSI数据的报告来源等方面仍存在不足，需要在后续工作中加强。目前，CVC的选择、置管部位的选择、皮肤消毒剂的选择、置管后敷料的选择等仍需进一步研究。

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