Zhonghua wei zhong bing ji jiu yi xue最新文献

ICU-acquired weakness (ICU-AW), as a common complication in the intensive care unit (ICU), has received increasing attention from clinicians due to its potential to cause severe functional impairments in survivors. Early research primarily focused on the definition, diagnosis, pathophysiology, and risk factors of ICU-AW, while systematic studies on stepwise interventions aligned with disease progression remain scarce. Current guidelines merely advocate for early mobilization, without specifying the timing or content of interventions. This paper reviews relevant domestic and international studies to summarize the time-window-based pathogenesis and intervention measures of ICU-AW, aiming to identify time-window-based prevention and control strategies for ICU-AW and optimize the implementation pathway based on the characteristics of ICU resource allocation in China.

Severe frostbite, due to its complex pathological mechanism and high risk of amputation, not only has a profound impact on the physiological functions and mental health of patients, but also poses severe challenges to clinical diagnosis, treatment and nursing. The American Burn Association clinical practice guidelines on the treatment of severe frostbite were released in April 2023. The guideline, based on the PICO principle (i.e. population, intervention, comparison, outcomes of clinics) and existing evidence, provides evidence-based recommendations for the treatment of severe frostbite in adult patients. These recommendations cover four themes, including rapid rewarming, imaging examination, thrombolytic therapy and the use of lloprost. To draw lessons from and promote the application of this guideline, this article focuses on its interpretation, aiming to provide reference and assistance for domestic medical staff to understand and apply this guideline.

Tracheal intubation is a key technology for establishing an artificial airway during the resuscitation of critically ill patients. Its success directly impacts patient life safety and prognosis. Identification of difficult airway and improper selection of laryngoscope blades are important factors leading to intubation failure and complications. To optimize this process, medical staff at Guangdong Provincial Hospital of Chinese Medicine have designed an auxiliary tool for airway assessment and laryngoscope blade selection, and have obtained a National Utility Model Patent of China (patent number: ZL 2021 2 1187307.9). The device is mainly composed of two right-angled handles and a ruler. The width of the handle is based on the "3-3-2" airway assessment rule (LEMON rule), corresponding to the patient's three-finger and two-finger widths, respectively, and is used to measure mouth opening (three-finger handle), chin-hyoid distance (three-finger handle), hyoid-thyroid notch distance (two-finger handle) to preliminarily identify difficult airways. The ruler is used to accurately measure the distance from the earlobe to the corner of the mouth, providing an objective basis for selecting the appropriate laryngoscope blade length. This tool is designed to be simple and is intended to shorten intubation time and indirectly improve first-time intubation success rate. To verify the clinical application effect of the auxiliary tool for airway assessment and laryngoscope blade selection, 80 patients who required emergency endotracheal intubation admitted to the department of emergency and intensive care unit of Guangdong Provincial Hospital of Chinese Medicine from January to December 2023 were enrolled, and the tool was used for pre-intubation assessment (observation group); and 80 patients who received routine emergency tracheal intubation in 2022 were used as the control (control group). The results showed that 6 cases (7.5%) in observation group had difficulty in identifying difficult airways before intubation using the tool, and all were successfully intubated using fiberoptic bronchoscopes. The success rate of one-time intubation for the remaining 74 patients was 98.6% (73/74). The success rate of one-time intubation in the observation group was significantly higher than that in the control group [91.3% (73/80) vs. 73.8% (59/80), χ² = 8.485, P = 0.004]. Although the incidence of complications such as tooth loss and oral bleeding in the observation group was lower than that in the control group, the differences were not statistically significant (tooth loss: 2.5% vs. 5.0%, χ ² = 0.692, P = 0.405; oral bleeding: 6.3% vs. 15.0%, χ ² = 3.224, P = 0.073). The results showed that the auxiliary tool can effectively identify difficult airways, guide the accurate selection of laryngoscope blades, and significantly improve the one-time endotracheal intubation success rate of critically ill patients.

Mechanical ventilation is an essential life-support therapy for critically ill patients. During ventilation, condensate water forms as a result of heating and humidification, posing risks such as ventilator-associated pneumonia (VAP), increased airway resistance, and even asphyxia. Clinicians often use inflated rubber or PVC gloves to secure the front end of the ventilator circuit. However, these methods are prone to loose tubing, instability, and water accumulation due to the tubing's low positioning. To address these issues, medical staff at the intensive care unit of the Affiliated Hospital of Hangzhou Normal University designed an inflatable ventilator tube fixation device, which has been granted a National Utility Model Patent of China (patent number: ZL 2022 2 1004655.2). The device comprises a support frame, mounting base, linkage structure, placement trough frame, and supporting balloon. The mounting base at the bottom of the support frame can be attached to a bed rail or guardrail, depending on patient needs. The support frame's height is adjustable via a sleeve and insertion rod, while the upper end connects to the linkage structure, allowing multi-angle adjustment and folding through the interlocking of slots and rods. The placement trough frame, welded from curved and circular rods, features a fixed cylinder at its central concavity that connects rotationally to a ring at the end of the linkage structure. The trough frame holds the supporting balloon, which is maintained in an inflated state with a draw rope and tensioner. The ring-shaped arc block and curved groove on the balloon's surface support and elevate the ventilator circuit, stabilizing the tubing and directing condensate toward a lower drainage position. This design is practical and user-friendly, ensuring secure fixation of the ventilator circuit during use. By maintaining elevation and preventing condensate accumulation and reflux, it effectively reduces ventilation-related complications, enhances medical safety, and lessens the workload of healthcare personnel, demonstrating strong potential for clinical adoption.

Objective: To identify independent predictors of in-hospital mortality in elderly patients with acute pancreatitis (AP) and to develop and validate a nomogram prediction model.

Methods: A retrospective cohort study was conducted, including patients aged ≥ 60 years admitted to the Affiliated Hospital of Zunyi Medical University with a diagnosis of AP from January 2015 to December 2024. Based on in-hospital outcomes, patients were divided into survival and death groups and were then randomly allocated to a training set and a validation set in a 7 : 3 ratio. Predictors were initially screened using Lasso regression and subsequently entered into multivariate Logistic regression analysis to identify independent risk factors for constructing the nomogram. Model discrimination, calibration, and clinical utility were evaluated using the receiver operator characteristic curve (ROC curve), calibration curve, and decision curve analysis (DCA), respectively.

Results: A total of 2 569 elderly AP patients were enrolled, with 2 323 survivors and 246 deaths in the hospital. The training set contained 1 801 patients (177 deaths, 9.8%), and the validation set contained 768 patients (69 deaths, 9.0%). Lasso regression identified five candidate variables including age, Ranson score, aspartate aminotransferase (AST), acute respiratory distress syndrome (ARDS), and use of vasoactive agents. Multivariate Logistic regression showed that age [odds ratio (OR) = 1.076, 95% confidence interval (95%CI) was 1.054-1.099, P < 0.001], Ranson score (OR = 1.318, 95%CI was 1.215-1.429, P < 0.001), AST (OR = 1.001, 95%CI was 1.000-1.001, P < 0.001), ARDS (OR = 3.782, 95%CI was 2.495-5.732, P < 0.001), and use of vasoactive agents (OR = 4.850, 95%CI was 3.192-7.370, P < 0.001) were independent predictors of in-hospital mortality. The nomogram prediction model was constructed based on the above five factors, ROC curve analysis shows that, the area under the curve (AUC) was 0.817 (95%CI was 0.784-0.851) in the training set and 0.823 (95%CI was 0.775-0.871) in the validation set, indicating good discriminative ability. Calibration plots demonstrated good agreement between predicted and observed probabilities, and DCA showed favorable net clinical benefit across a wide range of threshold probabilities.

Conclusions: The nomogram incorporating five independent predictors-age, Ranson score, AST, ARDS, and use of vasoactive agents-demonstrated good predictive performance for in-hospital mortality among elderly AP patients. This model provides a practical tool for individualized prognostic assessment and for informing clinical decision-making in this population.

The initial management of septic shock necessitates adequate fluid resuscitation to restore tissue perfusion. However, excessive or sustained fluid administration may precipitate fluid accumulation syndrome (FAS), significantly exacerbating the risk of organ dysfunction and mortality. Consequently, proactive prevention and management of FAS are paramount for optimizing patient outcomes. With the continuous optimization of fluid resuscitation strategies in the treatment of septic shock, de-resuscitation, as a key stage for preventing or correcting FAS, provides an important opportunity to improve patient prognosis. Recent studies have shown that during the later phase of septic shock resuscitation, active de-resuscitation combined with hemodynamic monitoring, adjustment of vasoactive drugs and other comprehensive intervention measures can help reduce fluid positive balance, lower the risk of organ dysfunction, shorten the length of intensive care unit (ICU) stay, and improve patient prognosis. Currently, the timing of de-resuscitation, volume assessment methods, the development of individualized treatment protocols, and the prevention and control of related complications have become the focus of research, while the search for reliable biomarkers to guide de-resuscitation strategies will become a future hot direction. In this article, we review the pathophysiology and clinical diagnosis of FAS, as well as the clinical strategies, controversies and challenges of de-resuscitation in septic shock, and explore the future research directions of de-resuscitation strategies, with the aim of providing theoretical basis and practical guidance for optimizing fluid management in patients with septic shock.

The persistent spread of multidrug-resistant bacteria (MDR) infections has become a major challenge in global public health, severely limiting treatment options with traditional antimicrobial drugs and leading to a significant increase in patient mortality. Antimicrobial peptides, as small-molecule effectors within the innate immune system, demonstrate significant potential in combating MDR infections due to their unique membrane-disrupting mechanisms, broad-spectrum antimicrobial activity, and low propensity to induce resistance. However, the monotherapy of antimicrobial peptides still faces challenges such as poor stability, rapid degradation in vivo, and potential resistance risks. To overcome these limitations, recent research has increasingly focused on combination strategies for antimicrobial peptides. By synergistically combining antimicrobial peptides with traditional antibiotics, other antimicrobial peptides, nanomaterials, or phage lysins, these approaches aim to enhance bactericidal effects and delay the development of resistance. This systematic review summarizes the latest research advances in antimicrobial peptides combination therapy for infection control, emphasizing synergistic mechanisms. Current challenges and future directions are discussed to provide a theoretical foundation and practical insights for developing novel anti-infective treatment regimens.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, characterized by high morbidity and mortality. Acute lung injury (ALI) is one of the earliest and most frequent complications of sepsis. Inflammatory response, oxidative stress, and ferroptosis are important pathogenic mechanisms in sepsis-induced ALI. Nuclear factor E2-related factor 2 (Nrf2), an essential antioxidant transcription factor, plays a pivotal role in alleviating lung injury by regulating multiple signaling pathways. This review systematically elaborates on the structure of Nrf2 and its protective role in sepsis-induced ALI, with a focus on how the Nrf2/heme oxygenase-1 (HO-1), Kelch-like ECH-associated protein 1 (Keap1)/Nrf2, silent information regulator 1 (Sirt1)/Nrf2, and phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt)/Nrf2 pathways collaboratively alleviate oxidative stress, suppress the release of inflammatory factors, and inhibit ferroptosis by regulating downstream target genes such as HO-1, glutathione peroxidase 4 (GPX4), and solute carrier family 7 member 11 (SLC7A11). Furthermore, the article summarizes the lung-protective effects demonstrated by various agents, including β-globin, curcumin, and hyperoside, through the specific activation of these pathways, providing a solid experimental basis for optimizing related treatment strategies and developing new drugs. This review aims to offer a deeper understanding of the biological significance of Nrf2 in sepsis-induced ALI and to provide theoretical support and research insights for future targeted clinical therapies.