Pub Date : 2024-11-01DOI: 10.3760/cma.j.cn121430-20240425-00379
Xurong Wang, Yidan Yang, Zhongyi Chen
The rates of recovery of spontaneous circulation, admission survival, and discharge survival of out-of-hospital cardiac arrest (OHCA) patients in China are much lower than the world and Asian averages, and the data on the survival of in-hospital cardiac arrest (IHCA) patients are also less favorable. The variable quality of cardiopulmonary resuscitation (CPR) and the low percentage of bystander CPR participation are the main reasons for these phenomena. Real-time feedback devices are an effective strategy to address these issues and have been recommended for use in several guidelines. However, the existing CPR feedback devices have the problems of being inconvenient to operate and expensive to popularize. Therefore, members of the CPR training team of Loudi Central Hospital designed a CPR real-time feedback APP device, which has been granted the right of National Invention Patent of China (patent number: ZL 2021 1 1118500.1). The device consists of a feedback device and a mobile device (there are two versions: healthcare professionals and non-healthcare professionals). The feedback device consists of a pressing plate and a soft rubber plate. The inner side of the soft rubber plate is covered with sensor monitoring points. On each sensor monitoring point, there are micro pressure sensors and micro acceleration sensors. When performing chest compressions, the sensors will transmit the relevant data to the cell phone feedback APP. By sampling and analyzing the data and building a three-dimensional dynamic model, the feedback APP accurately judges the effect of chest compressions based on factors such as the strength of the compressions, the frequency of the compressions and the depth of the compressions, corrects and provides voice guidance for the subsequent CPR process in real time, guides the rescuers to follow the standardized procedures for rescue, and improves the survival rate and neurological recovery of the CPR patients. The device improves CPR with exact effect, real-time accuracy, simple operation, easy to promote, and applicable to all populations. It has good clinical application and socialization popularization value, and can be equipped in medical institutions and public places.
{"title":"[Design and application of a real-time feedback APP device for cardiopulmonary resuscitation].","authors":"Xurong Wang, Yidan Yang, Zhongyi Chen","doi":"10.3760/cma.j.cn121430-20240425-00379","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240425-00379","url":null,"abstract":"<p><p>The rates of recovery of spontaneous circulation, admission survival, and discharge survival of out-of-hospital cardiac arrest (OHCA) patients in China are much lower than the world and Asian averages, and the data on the survival of in-hospital cardiac arrest (IHCA) patients are also less favorable. The variable quality of cardiopulmonary resuscitation (CPR) and the low percentage of bystander CPR participation are the main reasons for these phenomena. Real-time feedback devices are an effective strategy to address these issues and have been recommended for use in several guidelines. However, the existing CPR feedback devices have the problems of being inconvenient to operate and expensive to popularize. Therefore, members of the CPR training team of Loudi Central Hospital designed a CPR real-time feedback APP device, which has been granted the right of National Invention Patent of China (patent number: ZL 2021 1 1118500.1). The device consists of a feedback device and a mobile device (there are two versions: healthcare professionals and non-healthcare professionals). The feedback device consists of a pressing plate and a soft rubber plate. The inner side of the soft rubber plate is covered with sensor monitoring points. On each sensor monitoring point, there are micro pressure sensors and micro acceleration sensors. When performing chest compressions, the sensors will transmit the relevant data to the cell phone feedback APP. By sampling and analyzing the data and building a three-dimensional dynamic model, the feedback APP accurately judges the effect of chest compressions based on factors such as the strength of the compressions, the frequency of the compressions and the depth of the compressions, corrects and provides voice guidance for the subsequent CPR process in real time, guides the rescuers to follow the standardized procedures for rescue, and improves the survival rate and neurological recovery of the CPR patients. The device improves CPR with exact effect, real-time accuracy, simple operation, easy to promote, and applicable to all populations. It has good clinical application and socialization popularization value, and can be equipped in medical institutions and public places.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 11","pages":"1209-1212"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855600","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}
Pub Date : 2024-11-01DOI: 10.3760/cma.j.cn121430-20240304-00189
Jianhua Wu, Runling Guo, Yanhong Tian, Ying Wang
Objective: To explore the clinical application effects of early pulmonary rehabilitation training based on bundle airway management in patients with tracheostomy and non-mechanical ventilation.
Methods: Used convenience sampling, adult patients who underwent tracheostomy and non-mechanical ventilation admitted to Fenyang Hospital of Shanxi Province from January 2022 to May 2023 were enrolled. Patients were divided into control group and observation group based on their admission dates. The control group implemented bundle airway management based on the Airway care for patients with tracheostomy and non-mechanical ventilation. The observation group received additional pulmonary rehabilitation training implemented by a specialized respiratory rehabilitation team. The primary outcomes included hospital stay duration, improvement rate of muscle strength, diaphragmatic mobility, and successful extubation rate. Secondary outcomes included the incidence of pulmonary infection, improvement rate of self-care ability, and the duration of tracheal tube placement in extubated patients.
Results: A total of 41 patients were included in the control group and 39 patients in the observation group. There were no significantly differences in gender, age, first diagnosis of disease, and activities of daily living (ADL) score at admission between the two groups, indicating balanced baseline data and comparability. Compared with the control group, the observation group had a significantly shorter hospital stay (days: 38.33±17.58 vs. 51.34±27.06), a higher improvement rate of muscle strength (76.92% vs. 39.02%), greater diaphragmatic mobility (cm: 1.86±0.64 vs. 1.44±0.57), and a higher success rate of tracheostomy tube extubation (38.46% vs. 17.07%), the duration of tracheal tube placement in successfully extubated patients was significantly reduced (days: 33.26±17.87 vs. 50.60±21.98), with all differences being statistically significant (all P < 0.05). Although the improvement rate of ADL score (56.41% vs. 36.59%) and the incidence of pulmonary infection (5.13% vs. 7.32%) in the observation group were better than those in the control group, but there were no differences (both P > 0.05).
Conclusions: The addition of pulmonary rehabilitation training in bundle airway management can enhance exercise tolerance, improve respiratory function, promote sputum clearance, increase successful extubation rates, shorten hospital stays, and facilitate early recovery in patients with tracheostomy and non-mechanical ventilation.
目的：探讨基于束状气道管理的早期肺康复训练在气管切开术非机械通气患者中的临床应用效果。方法：采用方便抽样的方法，选取2022年1月至2023年5月在山西省汾阳医院行气管切开术和非机械通气的成年患者。根据患者入院时间分为对照组和观察组。对照组在气管造口合并非机械通气患者气道护理的基础上实施束式气道管理。观察组接受由专业呼吸康复小组实施的额外肺康复训练。主要结果包括住院时间、肌力改善率、膈肌活动度和拔管成功率。次要结局包括拔管患者肺部感染发生率、自我护理能力改善率、气管插管放置时间。结果：对照组41例，观察组39例。两组患者入院时的性别、年龄、首次诊断疾病、日常生活活动（ADL）评分均无显著差异，表明基线数据平衡，具有可比性。与对照组比较，观察组患者住院时间明显缩短（38.33±17.58天vs. 51.34±27.06天），肌力改良率明显提高（76.92% vs. 39.02%），膈肌活动度明显提高（cm: 1.86±0.64天vs. 1.44±0.57天），气管造口拔管成功率明显提高（38.46% vs. 17.07%），拔管成功患者气管置管时间明显缩短（d: 17.07%）。（33.26±17.87∶50.60±21.98），差异均有统计学意义（P < 0.05）。观察组患者ADL评分改善率（56.41%比36.59%）和肺部感染发生率（5.13%比7.32%）均优于对照组，但差异无统计学意义（P < 0.05）。结论：在束状气道管理中加入肺康复训练可提高气管切开术合并非机械通气患者的运动耐量，改善呼吸功能，促进痰清，提高拔管成功率，缩短住院时间，促进患者早日康复。
{"title":"[Effect of pulmonary rehabilitation training in patients with tracheostomy and non-mechanical ventilation: a prospective cohort study].","authors":"Jianhua Wu, Runling Guo, Yanhong Tian, Ying Wang","doi":"10.3760/cma.j.cn121430-20240304-00189","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240304-00189","url":null,"abstract":"<p><strong>Objective: </strong>To explore the clinical application effects of early pulmonary rehabilitation training based on bundle airway management in patients with tracheostomy and non-mechanical ventilation.</p><p><strong>Methods: </strong>Used convenience sampling, adult patients who underwent tracheostomy and non-mechanical ventilation admitted to Fenyang Hospital of Shanxi Province from January 2022 to May 2023 were enrolled. Patients were divided into control group and observation group based on their admission dates. The control group implemented bundle airway management based on the Airway care for patients with tracheostomy and non-mechanical ventilation. The observation group received additional pulmonary rehabilitation training implemented by a specialized respiratory rehabilitation team. The primary outcomes included hospital stay duration, improvement rate of muscle strength, diaphragmatic mobility, and successful extubation rate. Secondary outcomes included the incidence of pulmonary infection, improvement rate of self-care ability, and the duration of tracheal tube placement in extubated patients.</p><p><strong>Results: </strong>A total of 41 patients were included in the control group and 39 patients in the observation group. There were no significantly differences in gender, age, first diagnosis of disease, and activities of daily living (ADL) score at admission between the two groups, indicating balanced baseline data and comparability. Compared with the control group, the observation group had a significantly shorter hospital stay (days: 38.33±17.58 vs. 51.34±27.06), a higher improvement rate of muscle strength (76.92% vs. 39.02%), greater diaphragmatic mobility (cm: 1.86±0.64 vs. 1.44±0.57), and a higher success rate of tracheostomy tube extubation (38.46% vs. 17.07%), the duration of tracheal tube placement in successfully extubated patients was significantly reduced (days: 33.26±17.87 vs. 50.60±21.98), with all differences being statistically significant (all P < 0.05). Although the improvement rate of ADL score (56.41% vs. 36.59%) and the incidence of pulmonary infection (5.13% vs. 7.32%) in the observation group were better than those in the control group, but there were no differences (both P > 0.05).</p><p><strong>Conclusions: </strong>The addition of pulmonary rehabilitation training in bundle airway management can enhance exercise tolerance, improve respiratory function, promote sputum clearance, increase successful extubation rates, shorten hospital stays, and facilitate early recovery in patients with tracheostomy and non-mechanical ventilation.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 11","pages":"1153-1156"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855605","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}
<p><strong>Objective: </strong>To investigate the protective effect and possible mechanism of sulforaphane (SFN) on acute liver injury in mice induced by diquat (DQ) poisoning.</p><p><strong>Methods: </strong>Forty-eight male C57BL/6 mice were divided into Control group, DQ model group (DQ group), SFN intervention group (DQ+SFN group), and SFN control group (SFN group) using a random number table method, with 12 mice in each group. Acute liver injury mice model was established by one-time intraperitoneal injection of 1 mL of 40 mg/kg DQ solution at once. SFN group was injected with 1 mL of ddH<sub>2</sub>O. After 4 hours of molding, 0.5 mL of 5 mg/kg SFN solution was injected into the peritoneal cavity of the DQ+SFN group and SFN group, once daily for 7 consecutive days. DQ group and Control group were injected with an equal amount of ddH<sub>2</sub>O. Then, the mice were euthanized to collect liver tissue and blood samples, and the levels of plasma biomarkers alanine aminotransferase (ALT) and aspartate aminotransferase (AST), as well as oxidative stress indicators such as superoxide dismutase (SOD), glutathione (GSH), and malondialdehyde (MDA) in liver tissue were measured. The changes of liver structure were observed under transmission electron microscopy. The apoptosis and reactive oxygen species (ROS) level in liver tissue were observed under fluorescence microscope. Western blotting was used to detect the protein expressions of nuclear factor E2-related factor 2 (Nrf2), hemeoxygenase-1 (HO-1), Kelch-like ECH-associated protein 1 (Keap1), and cleaved caspase-9 in liver tissue.</p><p><strong>Results: </strong>Compared with the Control group, the liver mitochondria in the DQ group showed severe swelling, partial dissolution of the matrix, and cristae rupture and loss; the levels of plasma AST and ALT significantly increased, the MDA content in the liver increased, the activities of SOD and GSH decreased, the level of ROS significantly increased, the number of apoptotic cells in the liver significantly increased, the protein expressions of Nrf2 and HO-1 significantly decreased, and the protein expressions of Keap1 and cleaved caspase-9 significantly increased. Compared with the DQ group, the mitochondrial damage in the DQ+SFN group was reduced, the levels of plasma AST and ALT were significantly reduced [ALT (U/L): 58.22±4.39 vs. 79.94±3.32, AST (U/L): 177.64±8.40 vs. 219.62±11.60, both P < 0.01], the liver MDA content decreased, and the activities of SOD and GSH increased [MDA (μmol/g: 5.63±0.18 vs. 5.96±0.29, SOD (kU/g): 102.05±4.01 vs. 84.34±5.34, GSH (mmol/g): 16.32±1.40 vs. 13.12±1.84, all P < 0.05], the production of ROS in liver tissue was significantly reduced [ROS (fluorescence intensity): 115.90±10.89 vs. 190.70±10.16, P < 0.05], and apoptotic cells were significantly reduced (cell apoptosis index: 4.39±1.00 vs. 10.71±0.56, P < 0.01), the protein expressions of Nrf2 and HO-1 were significantly increased, while the protein expressions
{"title":"[Sulforaphane alleviates acute liver injury induced by diquat in mice by activating Keap1/Nrf2 signaling pathway].","authors":"Jianhong Wang, Liang Peng, Liaozhang Wu, Shan Huang, Guoli He, Pei Shen, Jing Liang, Tingting Huang, Jiaming Huang, Hong Zhong, Manhong Zhou","doi":"10.3760/cma.j.cn121430-20230628-00474","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20230628-00474","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the protective effect and possible mechanism of sulforaphane (SFN) on acute liver injury in mice induced by diquat (DQ) poisoning.</p><p><strong>Methods: </strong>Forty-eight male C57BL/6 mice were divided into Control group, DQ model group (DQ group), SFN intervention group (DQ+SFN group), and SFN control group (SFN group) using a random number table method, with 12 mice in each group. Acute liver injury mice model was established by one-time intraperitoneal injection of 1 mL of 40 mg/kg DQ solution at once. SFN group was injected with 1 mL of ddH<sub>2</sub>O. After 4 hours of molding, 0.5 mL of 5 mg/kg SFN solution was injected into the peritoneal cavity of the DQ+SFN group and SFN group, once daily for 7 consecutive days. DQ group and Control group were injected with an equal amount of ddH<sub>2</sub>O. Then, the mice were euthanized to collect liver tissue and blood samples, and the levels of plasma biomarkers alanine aminotransferase (ALT) and aspartate aminotransferase (AST), as well as oxidative stress indicators such as superoxide dismutase (SOD), glutathione (GSH), and malondialdehyde (MDA) in liver tissue were measured. The changes of liver structure were observed under transmission electron microscopy. The apoptosis and reactive oxygen species (ROS) level in liver tissue were observed under fluorescence microscope. Western blotting was used to detect the protein expressions of nuclear factor E2-related factor 2 (Nrf2), hemeoxygenase-1 (HO-1), Kelch-like ECH-associated protein 1 (Keap1), and cleaved caspase-9 in liver tissue.</p><p><strong>Results: </strong>Compared with the Control group, the liver mitochondria in the DQ group showed severe swelling, partial dissolution of the matrix, and cristae rupture and loss; the levels of plasma AST and ALT significantly increased, the MDA content in the liver increased, the activities of SOD and GSH decreased, the level of ROS significantly increased, the number of apoptotic cells in the liver significantly increased, the protein expressions of Nrf2 and HO-1 significantly decreased, and the protein expressions of Keap1 and cleaved caspase-9 significantly increased. Compared with the DQ group, the mitochondrial damage in the DQ+SFN group was reduced, the levels of plasma AST and ALT were significantly reduced [ALT (U/L): 58.22±4.39 vs. 79.94±3.32, AST (U/L): 177.64±8.40 vs. 219.62±11.60, both P < 0.01], the liver MDA content decreased, and the activities of SOD and GSH increased [MDA (μmol/g: 5.63±0.18 vs. 5.96±0.29, SOD (kU/g): 102.05±4.01 vs. 84.34±5.34, GSH (mmol/g): 16.32±1.40 vs. 13.12±1.84, all P < 0.05], the production of ROS in liver tissue was significantly reduced [ROS (fluorescence intensity): 115.90±10.89 vs. 190.70±10.16, P < 0.05], and apoptotic cells were significantly reduced (cell apoptosis index: 4.39±1.00 vs. 10.71±0.56, P < 0.01), the protein expressions of Nrf2 and HO-1 were significantly increased, while the protein expressions ","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 11","pages":"1183-1189"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855705","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}
Pub Date : 2024-11-01DOI: 10.3760/cma.j.cn121430-20240326-00289
Shaodong Zhao, Hongjun Miao
Respiratory support is one of the key technologies for treating pediatric respiratory diseases. High-flow nasal cannula oxygen therapy (HFNC) represents a novel method of assisted respiratory support. The commonly used indicator for assessing HFNC efficacy in clinical practice is oxygenation index (PaO2/FiO2). However, this parameter has several limitations when evaluating the efficacy of HFNC in pediatrics. The ROX index, introduced in recent years, offers a more sensitive and specific assessment tool. This article reviews the application of the ROX index in assessing the efficacy of HFNC for pediatric respiratory failure, aiming to provide a more accurate assessment method.
{"title":"[Application progress of ROX index in evaluating the efficacy of pediatric high-flow nasal cannula oxygen therapy].","authors":"Shaodong Zhao, Hongjun Miao","doi":"10.3760/cma.j.cn121430-20240326-00289","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240326-00289","url":null,"abstract":"<p><p>Respiratory support is one of the key technologies for treating pediatric respiratory diseases. High-flow nasal cannula oxygen therapy (HFNC) represents a novel method of assisted respiratory support. The commonly used indicator for assessing HFNC efficacy in clinical practice is oxygenation index (PaO<sub>2</sub>/FiO<sub>2</sub>). However, this parameter has several limitations when evaluating the efficacy of HFNC in pediatrics. The ROX index, introduced in recent years, offers a more sensitive and specific assessment tool. This article reviews the application of the ROX index in assessing the efficacy of HFNC for pediatric respiratory failure, aiming to provide a more accurate assessment method.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 11","pages":"1230-1232"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855681","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}
Acute respiratory distress syndrome (ARDS) is a leading cause of high mortality in critically ill patients in intensive care units (ICU). Prone ventilation is one of the important treatment methods for ARDS, but due to the severity of the patients' conditions, their physical weakness, and poor cooperation, it is difficult for them to adjust to the prone position on their own. This requires a large number of medical staff to adjust the patient to a prone position and implement prone ventilation for than 12 hours daily to achieve therapeutic effects. Clinical implementation often faces challenges such as a shortage of staff, patient discomfort, difficulty in changing positions prolonged time leading to bedsores, and lack of auxiliary equipment. It is particularly challenging for ARDS patients, especially those in critical condition, to adjust their on their own. Therefore, healthcare workers from the department of emergency of Yingtan 184 Hospital designed a prone and side lying double-purpose inflatable mattress for ARDS, and obtained the National Utility Model Patent of China (patent number: ZL 2023 2 1249425.7). The prone and side lying dual-purpose inflatable mattress mainly consists of a main mattress, a forehead pad, a prone position pad, and bilateral side lying position pads. The prone position pad and the lateral position pad on both sides are relatively independent, and can be inflated separately through their inflation nozzles to meet the ventilation needs of ARDS patients in prone or lateral positions, making it easy to adjust the patient's position. This mattress is reasonably designed, simple in structure, easy to operate, comfortable, and practical. It has transformation, promotion, and application value.
{"title":"[Design and application of a prone and side lying double-purpose inflatable mattress for acute respiratory distress syndrome].","authors":"Jian Guo, Shanyan Wu, Bohui Cha, Shuaicheng Wu, Qiaoqing Chen","doi":"10.3760/cma.j.cn121430-20240823-00718","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240823-00718","url":null,"abstract":"<p><p>Acute respiratory distress syndrome (ARDS) is a leading cause of high mortality in critically ill patients in intensive care units (ICU). Prone ventilation is one of the important treatment methods for ARDS, but due to the severity of the patients' conditions, their physical weakness, and poor cooperation, it is difficult for them to adjust to the prone position on their own. This requires a large number of medical staff to adjust the patient to a prone position and implement prone ventilation for than 12 hours daily to achieve therapeutic effects. Clinical implementation often faces challenges such as a shortage of staff, patient discomfort, difficulty in changing positions prolonged time leading to bedsores, and lack of auxiliary equipment. It is particularly challenging for ARDS patients, especially those in critical condition, to adjust their on their own. Therefore, healthcare workers from the department of emergency of Yingtan 184 Hospital designed a prone and side lying double-purpose inflatable mattress for ARDS, and obtained the National Utility Model Patent of China (patent number: ZL 2023 2 1249425.7). The prone and side lying dual-purpose inflatable mattress mainly consists of a main mattress, a forehead pad, a prone position pad, and bilateral side lying position pads. The prone position pad and the lateral position pad on both sides are relatively independent, and can be inflated separately through their inflation nozzles to meet the ventilation needs of ARDS patients in prone or lateral positions, making it easy to adjust the patient's position. This mattress is reasonably designed, simple in structure, easy to operate, comfortable, and practical. It has transformation, promotion, and application value.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 11","pages":"1213-1215"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855623","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}
Pub Date : 2024-11-01DOI: 10.3760/cma.j.cn121430-20231012-00865
Zhiyang Wang, Fang Huang, Shifeng Li, Xinyue Li, Yujie Liu, Bin Shao, Meili Liu, Yunnan Yao, Jun Wang
<p><strong>Objective: </strong>To develop and validate a predictive model of 28-day mortality in sepsis based on lactate dehydrogenase-to-albumin ratio (LAR).</p><p><strong>Methods: </strong>Sepsis patients diagnosed in the department of intensive care medicine of the First Affiliated Hospital of Soochow University from August 1, 2017 to September 1, 2022 were retrospective selected. Clinical data, laboratory indicators, disease severity scores [acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA)] were collected. Patients were divided into death group and survival group according to whether they died at 28 days, and the difference between the two groups was compared. The dataset was randomly divided into training set and validation set according to 7 : 3. Lasso regression method was used to screen the risk factors affecting the 28-day death of sepsis patients, and incorporating multivariate Logistic regression analysis (stepwise regression) were included, a prediction model was constructed based on the independent risk factors obtained, and a nomogram was drawn. The nomogram prediction model was established. Receiver operator characteristic curve (ROC curve) was drawn to analyze and evaluate the predictive efficacy of the model. Hosmer-Lemeshow test, calibration curve and decision curve analysis (DCA) were used to evaluate the accuracy and clinical practicability of the model, respectively.</p><p><strong>Results: </strong>A total of 394 patients with sepsis were included, with 248 survivors and 146 non-survivors at 28 days. Compared with the survival group, the age, proportion of chronic obstructive pneumonia, respiratory rate, lactic acid, red blood cell distribution width, prothrombin time, activated partial thromboplastin time, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, blood potassium, blood phosphorus, LAR, SOFA score, and APACHE II score in the death group were significantly increased, while oxygenation index, monocyte count, platelet count, fibrinogen, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and blood calcium were significantly reduced. In the training set, LAR, age, oxygenation index, blood urea nitrogen, lactic acid, total cholesterol, fibrinogen, blood potassium and blood phosphorus were screened by Lasso regression. Multivariate Logistic regression analysis finally included LAR [odds ratio (OR) = 1.029, 95% confidence interval (95%CI) was 1.014-1.047, P < 0.001], age (OR = 1.023, 95%CI was 1.005-1.043, P = 0.012), lactic acid (OR = 1.089, 95%CI was 1.003-1.186, P = 0.043), oxygenation index (OR = 0.996, 95%CI was 0.993-0.998, P = 0.002), total cholesterol (OR = 0.662, 95%CI was 0.496-0.865, P = 0.003) and blood potassium (OR = 1.852, 95%CI was 1.169-2.996, P = 0.010). A total of 6 predictor variables were used to establish a prediction model. ROC curve showed that the area under the curve (AUC)
{"title":"[Establishment and validation of a sepsis 28-day mortality prediction model based on the lactate dehydrogenase-to-albumin ratio in patients with sepsis].","authors":"Zhiyang Wang, Fang Huang, Shifeng Li, Xinyue Li, Yujie Liu, Bin Shao, Meili Liu, Yunnan Yao, Jun Wang","doi":"10.3760/cma.j.cn121430-20231012-00865","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20231012-00865","url":null,"abstract":"<p><strong>Objective: </strong>To develop and validate a predictive model of 28-day mortality in sepsis based on lactate dehydrogenase-to-albumin ratio (LAR).</p><p><strong>Methods: </strong>Sepsis patients diagnosed in the department of intensive care medicine of the First Affiliated Hospital of Soochow University from August 1, 2017 to September 1, 2022 were retrospective selected. Clinical data, laboratory indicators, disease severity scores [acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA)] were collected. Patients were divided into death group and survival group according to whether they died at 28 days, and the difference between the two groups was compared. The dataset was randomly divided into training set and validation set according to 7 : 3. Lasso regression method was used to screen the risk factors affecting the 28-day death of sepsis patients, and incorporating multivariate Logistic regression analysis (stepwise regression) were included, a prediction model was constructed based on the independent risk factors obtained, and a nomogram was drawn. The nomogram prediction model was established. Receiver operator characteristic curve (ROC curve) was drawn to analyze and evaluate the predictive efficacy of the model. Hosmer-Lemeshow test, calibration curve and decision curve analysis (DCA) were used to evaluate the accuracy and clinical practicability of the model, respectively.</p><p><strong>Results: </strong>A total of 394 patients with sepsis were included, with 248 survivors and 146 non-survivors at 28 days. Compared with the survival group, the age, proportion of chronic obstructive pneumonia, respiratory rate, lactic acid, red blood cell distribution width, prothrombin time, activated partial thromboplastin time, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, blood potassium, blood phosphorus, LAR, SOFA score, and APACHE II score in the death group were significantly increased, while oxygenation index, monocyte count, platelet count, fibrinogen, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and blood calcium were significantly reduced. In the training set, LAR, age, oxygenation index, blood urea nitrogen, lactic acid, total cholesterol, fibrinogen, blood potassium and blood phosphorus were screened by Lasso regression. Multivariate Logistic regression analysis finally included LAR [odds ratio (OR) = 1.029, 95% confidence interval (95%CI) was 1.014-1.047, P < 0.001], age (OR = 1.023, 95%CI was 1.005-1.043, P = 0.012), lactic acid (OR = 1.089, 95%CI was 1.003-1.186, P = 0.043), oxygenation index (OR = 0.996, 95%CI was 0.993-0.998, P = 0.002), total cholesterol (OR = 0.662, 95%CI was 0.496-0.865, P = 0.003) and blood potassium (OR = 1.852, 95%CI was 1.169-2.996, P = 0.010). A total of 6 predictor variables were used to establish a prediction model. ROC curve showed that the area under the curve (AUC) ","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 11","pages":"1140-1146"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855638","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}
<p><strong>Objective: </strong>To investigate and analysis of the occurrence and influencing factors of sarcopenia in elderly critically ill patients in the intensive care unit (ICU).</p><p><strong>Methods: </strong>A prospective cohort study was conducted. Elderly patients (aged ≥ 60 years) admitted to the ICU of Tianjin Medical University General Hospital from November 2023 to June 2024 were enrolled. Clinical records were collected, and conduct muscle mass and strength measurements, as well as upper arm circumference and calf circumference were measured. Appendicular skeletal muscle index (ASMI) of less than 7.0 kg/m<sup>2</sup> for males and less than 5.7 kg/m<sup>2</sup> for females was defined as reduced muscle mass, grip strength of less than 28 kg for males and less than 18 kg for females was defined as decreased muscle strength, patients meeting both low muscle mass and low muscle strength criteria were diagnosed with sarcopenia. According to the diagnostic criteria for sarcopenia, patients were divided into sarcopenia group and non-sarcopenia group. Multivariate Logistic regression analysis was applied to identify risk factors for sarcopenia in the elderly and to develop a predictive model for the occurrence of sarcopenia. The predictive value of various risk factors for sarcopenia in elderly critically ill patients was evaluated by receiver operator characteristic curve (ROC curve). The Kaplan-Meier curve for the length of ICU stay of two groups patients were drawn.</p><p><strong>Results: </strong>Finally, 540 elderly critically ill patients were included, including 43 patients with sarcopenia, and the incidence of sarcopenia was 8.0%. Univariate analysis showed that there were significantly differences in body mass index (BMI), number of hospitalizations in the past year, the length of ICU stay, ventilation mode, duration of mechanical ventilation, pre-admission exercise habits, nutritional support methods, upper arm circumference, calf circumference, and albumin infusion between the sarcopenia group and the non-sarcopenia group. Multivariate Logistic regression analysis showed that BMI [odds ratio (OR) = 0.79, 95% confidence interval (95%CI) was 0.67-0.93, P = 0.004], calf circumference (OR = 0.64, 95%CI was 0.54-0.76, P < 0.001), and duration of mechanical ventilation (OR = 1.06, 95%CI was 1.01-1.12, P = 0.034) were associated with an increased risk of sarcopenia in elderly critically ill patients. The ROC curve results showed that the area under the curve (AUC) and 95%CI of BMI, calf circumference, and duration of mechanical ventilation for predicting sarcopenia in elderly critically ill patients were 0.828 (0.767-0.888), 0.889 (0.844-0.933), and 0.397 (0.299-0.496), respectively, with cut-off values of 22.95 kg/m<sup>2</sup>, 28.25 cm, and 50.50 days, respectively. The Kaplan-Meier curve showed that the cumulative survival rate of patients with sarcopenia was significantly lower than that of the non-sarcopenia group (Log-Rank test
{"title":"[Analysis of the incidence and risk factors of sarcopenia in elderly intensive care unit patients: a prospective cohort study].","authors":"Yuehao Shen, Linlin Li, Haiying Liu, Yue Zhang, Dongxue Huang, Liuqing Duan, Lina Zhao, Keliang Xie","doi":"10.3760/cma.j.cn121430-20240819-00706","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240819-00706","url":null,"abstract":"<p><strong>Objective: </strong>To investigate and analysis of the occurrence and influencing factors of sarcopenia in elderly critically ill patients in the intensive care unit (ICU).</p><p><strong>Methods: </strong>A prospective cohort study was conducted. Elderly patients (aged ≥ 60 years) admitted to the ICU of Tianjin Medical University General Hospital from November 2023 to June 2024 were enrolled. Clinical records were collected, and conduct muscle mass and strength measurements, as well as upper arm circumference and calf circumference were measured. Appendicular skeletal muscle index (ASMI) of less than 7.0 kg/m<sup>2</sup> for males and less than 5.7 kg/m<sup>2</sup> for females was defined as reduced muscle mass, grip strength of less than 28 kg for males and less than 18 kg for females was defined as decreased muscle strength, patients meeting both low muscle mass and low muscle strength criteria were diagnosed with sarcopenia. According to the diagnostic criteria for sarcopenia, patients were divided into sarcopenia group and non-sarcopenia group. Multivariate Logistic regression analysis was applied to identify risk factors for sarcopenia in the elderly and to develop a predictive model for the occurrence of sarcopenia. The predictive value of various risk factors for sarcopenia in elderly critically ill patients was evaluated by receiver operator characteristic curve (ROC curve). The Kaplan-Meier curve for the length of ICU stay of two groups patients were drawn.</p><p><strong>Results: </strong>Finally, 540 elderly critically ill patients were included, including 43 patients with sarcopenia, and the incidence of sarcopenia was 8.0%. Univariate analysis showed that there were significantly differences in body mass index (BMI), number of hospitalizations in the past year, the length of ICU stay, ventilation mode, duration of mechanical ventilation, pre-admission exercise habits, nutritional support methods, upper arm circumference, calf circumference, and albumin infusion between the sarcopenia group and the non-sarcopenia group. Multivariate Logistic regression analysis showed that BMI [odds ratio (OR) = 0.79, 95% confidence interval (95%CI) was 0.67-0.93, P = 0.004], calf circumference (OR = 0.64, 95%CI was 0.54-0.76, P < 0.001), and duration of mechanical ventilation (OR = 1.06, 95%CI was 1.01-1.12, P = 0.034) were associated with an increased risk of sarcopenia in elderly critically ill patients. The ROC curve results showed that the area under the curve (AUC) and 95%CI of BMI, calf circumference, and duration of mechanical ventilation for predicting sarcopenia in elderly critically ill patients were 0.828 (0.767-0.888), 0.889 (0.844-0.933), and 0.397 (0.299-0.496), respectively, with cut-off values of 22.95 kg/m<sup>2</sup>, 28.25 cm, and 50.50 days, respectively. The Kaplan-Meier curve showed that the cumulative survival rate of patients with sarcopenia was significantly lower than that of the non-sarcopenia group (Log-Rank test","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 11","pages":"1196-1202"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855675","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}
<p><strong>Objective: </strong>To comprehensively understand the basic situation of critical care medicine in Xinjiang Production and Construction Corps in order to promote the standardization, specialization, and systematization of quality control in critical care medicine.</p><p><strong>Methods: </strong>A survey was conducted from January 1, 2019, to December 31, 2021, using a questionnaire to investigate the human resources and basic allocation of comprehensive intensive care medicine departments in Xinjiang Production and Construction Corps division level hospitals and surrounding second-class hospitals. The survey content includes: basic situation of medical units, intensive care unit (ICU) basic information, ICU personnel situation, ICU equipment configuration situation, ICU performance situation, etc. The survey questionnaire was distributed in March 2022, with dedicated ICU attending physicians or above designated by each ICU as the contact person for the survey.</p><p><strong>Results: </strong>Sixteen questionnaires were distributed and returned, all of which were included from 16 comprehensive intensive care medicine departments in the Corps and surrounding areas, including 5 second class first class hospitals and 11 third class first class hospitals. There were 196 beds in 16 ICU units, and the ICU bed ratio (1.99% overall, 1.77% in third class first class hospitals) was lower than the 2%-8% stipulated in the Guidelines for the Construction and Management of Critical Care Medicine (Trial) issued by the National Health Commission. Only ICU beds in second class first class hospitals accounted for 2.65%, meeting this standard. The comprehensive ICU doctor-bed ratio in 16 hospitals was 0.55 : 1, third class first class hospitals was 0.60 : 1, and second class first class hospitals was 0.44 : 1, compared with 0.8 : 1 stipulated in the ministerial guidelines, there was a certain gap. Among the 108 doctors in 16 ICUs, only four have a master's degree or above. Associate senior and above professional and technical titles accounted for 27.78%, less than one third. Among the 334 nursing staff, there were no personnel with a master's degree or above, and only 10 personnel with associate senior or above professional and technical titles. From 2019 to 2021, there were 1 new master's degree personnel, 2 new senior professional and technical personnel, and 12 deputy senior professional and technical personnel. It indicating that the proportion of highly educated and experienced physicians and nurses were lower, team building lags behind, talent introduction were lower, and highly educated talents were scarce. The statistical analysis results of the absolute growth of core technology showed that the growth of core technology was slow, the progressiveness was insufficient, and the professional technical ability was insufficient.</p><p><strong>Conclusions: </strong>The construction of critical care majors and talent echelons in the Xinjiang Production
{"title":"[Survey on the current situation of human resources and basic configuration of the intensive care medicine in Xinjiang Production and Construction Corps from 2019 to 2021].","authors":"Xueting Li, Qi Zhang, Mengting Qin, Ling Huang, Hang Xu, Shan Ren","doi":"10.3760/cma.j.cn121430-20231029-00920","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20231029-00920","url":null,"abstract":"<p><strong>Objective: </strong>To comprehensively understand the basic situation of critical care medicine in Xinjiang Production and Construction Corps in order to promote the standardization, specialization, and systematization of quality control in critical care medicine.</p><p><strong>Methods: </strong>A survey was conducted from January 1, 2019, to December 31, 2021, using a questionnaire to investigate the human resources and basic allocation of comprehensive intensive care medicine departments in Xinjiang Production and Construction Corps division level hospitals and surrounding second-class hospitals. The survey content includes: basic situation of medical units, intensive care unit (ICU) basic information, ICU personnel situation, ICU equipment configuration situation, ICU performance situation, etc. The survey questionnaire was distributed in March 2022, with dedicated ICU attending physicians or above designated by each ICU as the contact person for the survey.</p><p><strong>Results: </strong>Sixteen questionnaires were distributed and returned, all of which were included from 16 comprehensive intensive care medicine departments in the Corps and surrounding areas, including 5 second class first class hospitals and 11 third class first class hospitals. There were 196 beds in 16 ICU units, and the ICU bed ratio (1.99% overall, 1.77% in third class first class hospitals) was lower than the 2%-8% stipulated in the Guidelines for the Construction and Management of Critical Care Medicine (Trial) issued by the National Health Commission. Only ICU beds in second class first class hospitals accounted for 2.65%, meeting this standard. The comprehensive ICU doctor-bed ratio in 16 hospitals was 0.55 : 1, third class first class hospitals was 0.60 : 1, and second class first class hospitals was 0.44 : 1, compared with 0.8 : 1 stipulated in the ministerial guidelines, there was a certain gap. Among the 108 doctors in 16 ICUs, only four have a master's degree or above. Associate senior and above professional and technical titles accounted for 27.78%, less than one third. Among the 334 nursing staff, there were no personnel with a master's degree or above, and only 10 personnel with associate senior or above professional and technical titles. From 2019 to 2021, there were 1 new master's degree personnel, 2 new senior professional and technical personnel, and 12 deputy senior professional and technical personnel. It indicating that the proportion of highly educated and experienced physicians and nurses were lower, team building lags behind, talent introduction were lower, and highly educated talents were scarce. The statistical analysis results of the absolute growth of core technology showed that the growth of core technology was slow, the progressiveness was insufficient, and the professional technical ability was insufficient.</p><p><strong>Conclusions: </strong>The construction of critical care majors and talent echelons in the Xinjiang Production ","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 11","pages":"1203-1208"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855706","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}
Pub Date : 2024-11-01DOI: 10.3760/cma.j.cn121430-20240813-00696
Yunfeng Fu, Zhongshu Liang, Wenchang Feng
Objective: To investigate the risk factors of death within 7 days in patients with acute myocardial infarction (AMI) complicated by ventricular septal rupture (VSR) based on echocardiography indicators, and to construct a nomogram model of ultrasound indicator risk to predict the risk of death in patients with post-infarction ventricular septal rupture (PIVSR).
Methods: The echocardiographic data of 40 patients with PIVSR admitted to the department of cardiology, Xiangya Third Hospital, Central South University from January 2014 to June 2024 were retrospectively analyzed. The patients were divided into death group and survival group based on their 7-day survival status. The risk factors affecting death within 7 days of PIVSR patients were analyzed by univariate and multivariate analyses, and the risk nomogram model of ultrasound indicators predicting death within 7 days of PIVSR patients was constructed by using R software. Calibration curve and receiver operator characteristic curve (ROC curve) were used to verify the prediction effect of the model.
Results: Among the 40 patients with PIVSR, 18 died at 7 days and 22 survived. Univariate analysis showed that, compared with the survival group, patients in the death group were older (years old: 73.7±6.8 vs. 68.1±7.7), had a larger diameter of VSR (mm: 10.4±4.2 vs. 7.7±3.0), and had a higher peak pressure difference (PPG) in the perforation area [mmHg (1 mmHg≈0.133 kPa): 49.0±11.6 vs. 37.0±16.1], left ventricular ejection fraction (LVEF) and stroke volume (SV) were significantly decreased [LVEF: 0.439±0.134 vs. 0.512±0.094, SV (mL): 46.1±15.6 vs. 62.0±14.3], and the differences were statistically significant (all P < 0.05). Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 1.212, 95% confidence interval (95%CI) was 1.034-1.420, P = 0.018] and perforation area PPG (OR = 1.248, 95%CI was 1.069-1.457, P = 0.005) were positively correlated with the occurrence of death events within 7 days in PIVSR patients, while SV was negatively correlated with the occurrence of death events within 7 days in PIVSR patients (OR = 0.851, 95%CI was 0.756-0.957, P = 0.007). The predicted value of the nomogram model for predicting the risk of death within 7 days in patients with PIVSR was basically consistent with the actual value, and the Hosmer-Lemeshow goodness of fit test χ 2 = 10.679, P = 0.220. The area under the curve (AUC) predicted by the model was 0.960, 95%CI was 0.913-0.998.
Conclusions: Age and echocardiographic indicators SV and perforation area PPG are risk factors for mortality within 7 days in PIVSR patients. The nomogram model of mortality risk within 7 days in PIVSR patients constructed using the above indicators has good discrimination and consistency.
{"title":"[Construction of a prediction model of ultrasound indicators for mortality risk within 7 days in patients with acute myocardial infarction and ventricular septal rupture].","authors":"Yunfeng Fu, Zhongshu Liang, Wenchang Feng","doi":"10.3760/cma.j.cn121430-20240813-00696","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240813-00696","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the risk factors of death within 7 days in patients with acute myocardial infarction (AMI) complicated by ventricular septal rupture (VSR) based on echocardiography indicators, and to construct a nomogram model of ultrasound indicator risk to predict the risk of death in patients with post-infarction ventricular septal rupture (PIVSR).</p><p><strong>Methods: </strong>The echocardiographic data of 40 patients with PIVSR admitted to the department of cardiology, Xiangya Third Hospital, Central South University from January 2014 to June 2024 were retrospectively analyzed. The patients were divided into death group and survival group based on their 7-day survival status. The risk factors affecting death within 7 days of PIVSR patients were analyzed by univariate and multivariate analyses, and the risk nomogram model of ultrasound indicators predicting death within 7 days of PIVSR patients was constructed by using R software. Calibration curve and receiver operator characteristic curve (ROC curve) were used to verify the prediction effect of the model.</p><p><strong>Results: </strong>Among the 40 patients with PIVSR, 18 died at 7 days and 22 survived. Univariate analysis showed that, compared with the survival group, patients in the death group were older (years old: 73.7±6.8 vs. 68.1±7.7), had a larger diameter of VSR (mm: 10.4±4.2 vs. 7.7±3.0), and had a higher peak pressure difference (PPG) in the perforation area [mmHg (1 mmHg≈0.133 kPa): 49.0±11.6 vs. 37.0±16.1], left ventricular ejection fraction (LVEF) and stroke volume (SV) were significantly decreased [LVEF: 0.439±0.134 vs. 0.512±0.094, SV (mL): 46.1±15.6 vs. 62.0±14.3], and the differences were statistically significant (all P < 0.05). Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 1.212, 95% confidence interval (95%CI) was 1.034-1.420, P = 0.018] and perforation area PPG (OR = 1.248, 95%CI was 1.069-1.457, P = 0.005) were positively correlated with the occurrence of death events within 7 days in PIVSR patients, while SV was negatively correlated with the occurrence of death events within 7 days in PIVSR patients (OR = 0.851, 95%CI was 0.756-0.957, P = 0.007). The predicted value of the nomogram model for predicting the risk of death within 7 days in patients with PIVSR was basically consistent with the actual value, and the Hosmer-Lemeshow goodness of fit test χ <sup>2</sup> = 10.679, P = 0.220. The area under the curve (AUC) predicted by the model was 0.960, 95%CI was 0.913-0.998.</p><p><strong>Conclusions: </strong>Age and echocardiographic indicators SV and perforation area PPG are risk factors for mortality within 7 days in PIVSR patients. The nomogram model of mortality risk within 7 days in PIVSR patients constructed using the above indicators has good discrimination and consistency.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 11","pages":"1169-1173"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855622","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}
Pub Date : 2024-11-01DOI: 10.3760/cma.j.cn121430-20231107-00950
Ruru Zhao, Yuanbo Liu, Yihong Huang, Hanming Gao, Debin Huang
<p><strong>Objective: </strong>To compare the application effects of three different extubation techniques in patients with mechanical ventilation in intensive care unit (ICU).</p><p><strong>Methods: </strong>A prospective randomized controlled study was conducted. Mechanical ventilation patients admitted to the critical care department of the First Affiliated Hospital of Guangxi Medical University from July to November 2023 were enrolled. According to the random number table generated by Excel, the patients were divided into negative pressure group, positive pressure group 1 and positive pressure group 2, with 45 cases in each group. On the basis of routine nursing, the negative pressure group used the negative pressure extubation technique to remove the tracheal catheter. In the positive pressure group, the pressure support (PS) and positive end-expiratory pressure (PEEP) of the positive pressure group 1 were 7 cmH<sub>2</sub>O (1 cmH<sub>2</sub>O≈0.098 kPa) and 5 cmH<sub>2</sub>O, and the PS and PEEP of the positive pressure group 2 were 15 cmH<sub>2</sub>O and 10 cmH<sub>2</sub>O. The main outcome measures were extubation related complications, including tachypnea, severe cough, sore throat, upper airway obstruction spasm, extubation failure, hypoxemia, and hypercapnia. The secondary outcome measures were the variation of heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and blood oxygen saturation before and 1, 15 and 30 minutes after extubation.</p><p><strong>Results: </strong>Finally, 42 patients were included in each group. There were no significant differences in gender, age, catheter retention days, duration of mechanical ventilation, acute physiology and chronic health evaluation II (APACHE II), catheter model and diagnosis among the three groups, which were comparable. There were statistically significant differences in the incidence of tachypnea, severe cough, sore throat, upper airway obstruction spasm, hypoxemia and hypercapnia among the three groups, while there was no statistically significant difference in the failure rate of extubation. The incidence of tachypnea, severe cough, sore throat, upper airway obstruction spasm, hypoxemia and hypercapnia after extubation in positive pressure group 1 and positive pressure group 2 were lower than those in negative pressure group (7.14%, 9.52% vs. 33.33%; 7.14%, 4.76% vs. 28.57%; 61.90%, 52.38% vs. 88.10%; 11.90%, 19.05% vs. 45.24%; 7.14%, 7.14% vs. 30.95%; 4.76%, 2.38% vs. 28.57%; all P < 0.05). There were no significant differences in extubation related complications between group 1 and group 2. There were significant differences in the time effect of heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and blood oxygen saturation 30 minutes after extubation among three groups (F values were 145.792, 49.749, 22.486, 23.622 and 242.664, respectively, all P < 0.01). The intergroup effect of blood oxygen saturation was s
目的：比较三种不同拔管技术在重症监护病房（ICU）机械通气患者中的应用效果。方法：采用前瞻性随机对照研究。选取广西医科大学第一附属医院2023年7月至11月重症监护室收治的机械通气患者。根据Excel生成的随机数字表将患者分为负压组、正压组1、正压组2，每组45例。负压组在常规护理的基础上，采用负压拔管技术拔除气管导管。正压组中，正压组1的压力支持（PS）和呼气末正压（PEEP）分别为7 cmH2O （1 cmH2O≈0.098 kPa）和5 cmH2O，正压组2的PS和PEEP分别为15 cmH2O和10 cmH2O。主要结局指标为拔管相关并发症，包括呼吸急促、严重咳嗽、喉咙痛、上气道梗阻痉挛、拔管失败、低氧血症和高碳酸血症。次要观察指标为拔管前、拔管后1分钟、15分钟和30分钟的心率、收缩压、舒张压、平均动脉压和血氧饱和度的变化。结果：每组42例。三组患者在性别、年龄、导管留置天数、机械通气时间、急性生理与慢性健康评估II （APACHE II）、导管型号、诊断等方面均无显著差异，具有可比性。三组患者呼吸急促、严重咳嗽、咽喉痛、上气道梗阻痉挛、低氧血症、高碳酸血症发生率比较，差异有统计学意义；拔管失败率比较，差异无统计学意义。正压组1、正压组2拔管后呼吸急促、严重咳嗽、咽喉痛、上气道梗阻痉挛、低氧血症、高碳酸血症发生率均低于负压组(7.14%、9.52% vs. 33.33%；7.14%, 4.76% vs. 28.57%；61.90%, 52.38% vs. 88.10%；11.90%, 19.05% vs. 45.24%；7.14%, 7.14% vs. 30.95%；4.76%, 2.38% vs. 28.57%；P < 0.05)。1组与2组拔管相关并发症无明显差异。三组患者拔管后30min心率、收缩压、舒张压、平均动脉压、血氧饱和度的时间效应差异有统计学意义（F值分别为145.792、49.749、22.486、23.622、242.664，P均< 0.01）。两组间血氧饱和度差异有统计学意义（F = 3.835, P = 0.024），拔管后1分钟、30分钟，正压组1、正压组2血氧饱和度高于负压组(拔管后1分钟：0.97±0.02、0.97±0.02∶0.95±0.02；拔管后30 min: 1.00±0.01,1.00±0.01 vs. 0.99±0.02，P均< 0.05)。心率与血氧饱和度的交互作用有统计学意义（F值分别为3.512、7.226，P均< 0.01）。结论：与负压拔管相比，正压拔管可有效减少ICU机械通气患者拔管相关并发症。有利于拔管后30分钟内维持稳定的血氧饱和度，具有较好的临床应用效果。建议使用低压拔管。
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