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[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 Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20231211-01075
Xin Li, Xiao Tang, Lianzhen Qi, Ruili Chai
<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 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。
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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 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
<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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 cmH<sub>2</sub>O, 1 cmH<sub>2</sub>O ≈ 0.098 kPa) and high DP group (DP > 15 cmH<sub>2</sub>O) 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.</p><p><strong>Results: </strong>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 (cmH<sub>2</sub>O): 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。
{"title":"[Analysis of the correlation between driving pressure and prognosis in lung transplant recipients based on restricted cubic spline model].","authors":"Chenhao Xuan, Dapeng Wang, Shuyun Jiang, Song Wang, Zhiyu Li, Jingyu Chen, Hongyang Xu","doi":"10.3760/cma.j.cn121430-20240407-00311","DOIUrl":"10.3760/cma.j.cn121430-20240407-00311","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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 cmH&lt;sub&gt;2&lt;/sub&gt;O, 1 cmH&lt;sub&gt;2&lt;/sub&gt;O ≈ 0.098 kPa) and high DP group (DP &gt; 15 cmH&lt;sub&gt;2&lt;/sub&gt;O) 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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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 (cmH&lt;sub&gt;2&lt;/sub&gt;O): 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 &lt; 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 &lt; 0.05], and lower successful weaning rate of mechanical ventilation [81.8% (27/33) vs. 95.6% (65/68), P &lt; 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 &lt;","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1249-1255"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956015","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
[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 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
<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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。
{"title":"[Prevention and control status of central line-associated bloodstream infection in intensive care unit in Shandong province: a cross-sectional survey analysis].","authors":"Yang Shen, Zijian Tai, Xue Bai, Xuan Song, Man Chen, Qianqian Guo, Cheng Huan, Li Chen, Jicheng Zhang","doi":"10.3760/cma.j.cn121430-20240430-00397","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240430-00397","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1315-1320"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955911","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
[Research progress on prognostic prediction models for patients undergoing extracorporeal membrane oxygenation]. 体外膜氧合患者预后预测模型的研究进展
Q3 Medicine Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20240715-00598
Hanming Gao, Junyu Lu

Extracorporeal membrane oxygenation (ECMO), as a critical life support technology, has played a significant role in treating patients with refractory respiratory and circulatory failure. In recent years, with the advancements in medical technology, the scope of application of ECMO has been expanding, especially in the fields of acute respiratory distress syndrome, cardiogenic shock and other important roles. However, its high costs, complex operation, and associated risks of complications remain challenges in clinical practice. At present, an increasing number of studies have focused on developing and validating ECMO prognostic models. Developing precise prognostic prediction models is crucial for optimizing treatment decisions and improving patient survival rates. This article categorizes existing prognostic models for adult ECMO patients based on methodological classification, patient population, and theoretical framework. It highlights the limitations of current models in terms of sample size, multi-center validation, static data analysis, and model applicability. Moreover, it proposes future directions for model development, such as multi-center prospective studies, integration of machine learning and deep learning technologies, and increased focus on long-term outcomes, offering insights for researchers to improve model construction and explore new research directions.

体外膜氧合(Extracorporeal membrane oxygenation, ECMO)作为一项重要的生命支持技术,在治疗难治性呼吸和循环衰竭患者中发挥着重要作用。近年来,随着医疗技术的进步,ECMO的应用范围不断扩大,特别是在急性呼吸窘迫综合征、心源性休克等领域发挥了重要作用。然而,其成本高、操作复杂、并发症风险大,仍是临床实践中的挑战。目前,越来越多的研究集中于开发和验证ECMO预后模型。开发精确的预后预测模型对于优化治疗决策和提高患者存活率至关重要。本文根据方法分类、患者群体和理论框架对成人ECMO患者的现有预后模型进行了分类。它突出了当前模型在样本量、多中心验证、静态数据分析和模型适用性方面的局限性。提出了未来模型发展的方向,如多中心前瞻性研究、机器学习与深度学习技术的融合、对长期结果的关注等,为研究人员改进模型构建、探索新的研究方向提供了思路。
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引用次数: 0
[Research progress on the application of end-tidal carbon dioxide monitoring in prehospital emergency care]. [潮末二氧化碳监测在院前急救中的应用研究进展]。
Q3 Medicine Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20240709-00579
Jingtao Ma, Renbao Li, Qin Li, Wei Han

Prehospital emergency care is the primary stage in the treatment of critically ill patients, where efficient and accurate monitoring methods are crucial for patient survival and prognosis. End-tidal carbon dioxide (EtCO2) monitoring is a real-time, non-invasive method that can sensitively capture the status of respiratory, circulatory, and metabolic functions, particularly in the urgent and complex pre-hospital environment, a immediate detection and non-invasive method, can sensitively capture the respiratory, circulatory, and metabolic status of patients. It provides valuable guidance for rapid decision-making and precise interventions. This is particularly valuable in the complex and urgent prehospital environment, providing critical data for rapid decision-making and precise intervention. This paper systematically reviews the advancements in the application of EtCO2 monitoring across various fields, including sepsis identification, trauma assessment, cardiac arrest, respiratory critical care, endotracheal intubation confirmation, and management of metabolic diseases, aiming to explore its application value and prospects in pre-hospital emergency care.

院前急救是危重患者治疗的初级阶段,有效、准确的监测方法对患者的生存和预后至关重要。潮末二氧化碳(EtCO2)监测是一种实时、无创的方法,可以灵敏地捕捉呼吸、循环和代谢功能的状态,特别是在紧急和复杂的院前环境中,一种即时检测和无创的方法,可以灵敏地捕捉患者的呼吸、循环和代谢状态。它为快速决策和精确干预提供了宝贵的指导。这在复杂和紧急的院前环境中特别有价值,为快速决策和精确干预提供关键数据。本文系统综述了EtCO2监测在脓毒症鉴定、创伤评估、心脏骤停、呼吸重症监护、气管插管确认、代谢性疾病管理等各领域的应用进展,探讨其在院前急救中的应用价值和前景。
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引用次数: 0
[Research progress on the early warning effectiveness of early warning score in patients with in-hospital cardiac arrest]. [预警评分对院内心脏骤停患者预警效果的研究进展]。
Q3 Medicine Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20231116-00983
Weidong Zhang, Wei Hu, Mengyuan Diao

In-hospital cardiac arrest (IHCA) is a critical medical issue threatening the survival and prognosis of hospitalized patients, characterized by high incidence, high mortality and poor prognosis. Early warning and intervention for IHCA are urgently needed. The early warning score (EWS) is developed as a point-of-care warning tool for early identification and intervention of hospitalized patients with deteriorating condition. In recent years, EWS has become one of the important methods for early warning of IHCA, especially EWS based on machine learning (ML) has shown great potential. This review mainly focuses on the traditional EWS and ML-based EWS, discusses the research status of EWS worldwide, and focuses on the research progress of EWS in early warning of IHCA.

院内心脏骤停(IHCA)是威胁住院患者生存和预后的重要医学问题,具有发病率高、死亡率高、预后差的特点。迫切需要对IHCA进行早期预警和干预。早期预警评分(EWS)是一种即时预警工具,用于对病情恶化的住院患者进行早期识别和干预。近年来,EWS已成为IHCA早期预警的重要方法之一,尤其是基于机器学习(ML)的EWS显示出巨大的潜力。本文主要综述了传统的EWS和基于ml的EWS,讨论了全球EWS的研究现状,重点介绍了EWS在IHCA预警中的研究进展。
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引用次数: 0
[Clinical efficacy of vitamin B1 in ICU-acquired weakness patients]. [维生素B1在icu获得性虚弱患者中的临床疗效]。
Q3 Medicine Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20240715-00596
Dandan Zhou, Jianhua Guo, Xuebin Wang

Objective: To observe the clinical efficacy of vitamin B1 in patients with ICU-acquired weakness (ICU-AW).

Methods: A retrospective analysis was conducted to select ICU-AW patients treated with vitamin B1 in the intensive care unit (ICU) of Shanghai East Hospital, Tongji University from July 2022 to December 2023. Propensity score matching was used to match the control group and observation group at a 1 : 1 ratio, considering differences in patient age, gender, and acute physiology and chronic health evaluation II (APACHE II). The control group received conventional treatment, while the observation group received vitamin B1 in addition to conventional treatment. Comparisons were made between the two groups in terms of basic information, APACHE II scores, Medical Research Council muscle strength score (MRC), interleukin-6 (IL-6), C-reactive protein (CRP), and serum creatinine (SCr) levels before and after treatment, mechanical ventilation time, and length of ICU stay were collected and compared between the two groups.

Results: A total of 30 patients with ICU-AW were included, both 15 in each group. There were no significant differences in gender, age and APACHE II score between the two groups. There were no significant differences in APACHE II score, MRC score, IL-6, CRP, SCr levels, and the duration of ventilator-assisted ventilation and ICU stay between the two groups of patients before treatment. Both groups showed improvements in APACHE II scores and MRC scores after treatment, with the observation group showing significantly greater improvement compared to the control group (APACHE II score: 10.80±1.47 vs. 12.20±1.52, MRC score: 50.40±7.10 vs. 42.00±8.78, both P < 0.05). After treatment, both groups showed significant reductions in IL-6, CRP, and SCr levels, but there were no significant differences between the observation group and control group. The observation group had significantly shorter durations of mechanical ventilation (days: 7.67±1.54 vs. 9.67±2.44, P < 0.05) and ICU stay (days: 13.33±1.72 vs. 15.13±2.56, P < 0.05) compared to the control group.

Conclusions: The use of vitamin B1 during the treatment of ICU-AW significantly improves muscle strength and reduces the duration of mechanical ventilation and ICU stay.

目的:观察维生素B1治疗重症监护获得性虚弱(ICU-AW)的临床疗效。方法:回顾性分析2022年7月至2023年12月在同济大学上海东方医院重症监护病房(ICU)接受维生素B1治疗的ICU- aw患者。考虑患者年龄、性别、急性生理和慢性健康评估II (APACHE II)的差异,采用倾向评分匹配,以1:1的比例对对照组和观察组进行匹配。对照组给予常规治疗,观察组在常规治疗的基础上给予维生素B1治疗。比较两组患者的基本信息,收集两组患者治疗前后APACHEⅱ评分、医学研究理事会肌力评分(MRC)、白细胞介素-6 (IL-6)、c反应蛋白(CRP)、血清肌酐(SCr)水平、机械通气时间、ICU住院时间。结果:共纳入ICU-AW患者30例,每组15例。两组患者在性别、年龄和APACHE II评分上无显著差异。两组患者治疗前APACHEⅱ评分、MRC评分、IL-6、CRP、SCr水平、呼吸机辅助通气时间及ICU住院时间均无显著差异。两组治疗后APACHEⅱ评分和MRC评分均有改善,其中观察组改善明显高于对照组(APACHEⅱ评分:10.80±1.47比12.20±1.52,MRC评分:50.40±7.10比42.00±8.78,P均< 0.05)。治疗后,两组患者IL-6、CRP、SCr水平均显著降低,但观察组与对照组比较差异无统计学意义。观察组患者机械通气时间(7.67±1.54天比9.67±2.44天,P < 0.05)和ICU住院时间(13.33±1.72天比15.13±2.56天,P < 0.05)明显短于对照组。结论:在ICU- aw治疗过程中使用维生素B1可显著提高肌力,缩短机械通气时间和ICU住院时间。
{"title":"[Clinical efficacy of vitamin B1 in ICU-acquired weakness patients].","authors":"Dandan Zhou, Jianhua Guo, Xuebin Wang","doi":"10.3760/cma.j.cn121430-20240715-00596","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240715-00596","url":null,"abstract":"<p><strong>Objective: </strong>To observe the clinical efficacy of vitamin B1 in patients with ICU-acquired weakness (ICU-AW).</p><p><strong>Methods: </strong>A retrospective analysis was conducted to select ICU-AW patients treated with vitamin B1 in the intensive care unit (ICU) of Shanghai East Hospital, Tongji University from July 2022 to December 2023. Propensity score matching was used to match the control group and observation group at a 1 : 1 ratio, considering differences in patient age, gender, and acute physiology and chronic health evaluation II (APACHE II). The control group received conventional treatment, while the observation group received vitamin B1 in addition to conventional treatment. Comparisons were made between the two groups in terms of basic information, APACHE II scores, Medical Research Council muscle strength score (MRC), interleukin-6 (IL-6), C-reactive protein (CRP), and serum creatinine (SCr) levels before and after treatment, mechanical ventilation time, and length of ICU stay were collected and compared between the two groups.</p><p><strong>Results: </strong>A total of 30 patients with ICU-AW were included, both 15 in each group. There were no significant differences in gender, age and APACHE II score between the two groups. There were no significant differences in APACHE II score, MRC score, IL-6, CRP, SCr levels, and the duration of ventilator-assisted ventilation and ICU stay between the two groups of patients before treatment. Both groups showed improvements in APACHE II scores and MRC scores after treatment, with the observation group showing significantly greater improvement compared to the control group (APACHE II score: 10.80±1.47 vs. 12.20±1.52, MRC score: 50.40±7.10 vs. 42.00±8.78, both P < 0.05). After treatment, both groups showed significant reductions in IL-6, CRP, and SCr levels, but there were no significant differences between the observation group and control group. The observation group had significantly shorter durations of mechanical ventilation (days: 7.67±1.54 vs. 9.67±2.44, P < 0.05) and ICU stay (days: 13.33±1.72 vs. 15.13±2.56, P < 0.05) compared to the control group.</p><p><strong>Conclusions: </strong>The use of vitamin B1 during the treatment of ICU-AW significantly improves muscle strength and reduces the duration of mechanical ventilation and ICU stay.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1301-1304"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956018","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
[Quantitative analysis of chest CT in coronavirus infected patients and its correlation with clinical features]. 冠状病毒感染患者胸部CT定量分析及其与临床特征的相关性
Q3 Medicine Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20240422-00369
Yan Wang, Jiao Li, Yan Qu, Sumei Wang
<p><strong>Objective: </strong>To explore the quantitative analysis results of different patterns of chest computed tomography (CT) in patients with coronavirus infection and its relationship with viral load and pathophysiological status.</p><p><strong>Methods: </strong>A retrospective clinical cohort study was conducted. Patients with coronavirus infection admitted to Qingdao Municipal Hospital from June 9 to 15, 2023 (all patients underwent chest CT examination within 24 hours after diagnosis) were enrolled. The patients were divided into coronavirus infection non-pneumonia group and coronavirus infection associated pneumonia group according to CT findings. Relevant baseline data, such as demographic characteristics, chest CT characteristics, and laboratory indicators within 12 hours before and after CT examination were collected from each group. Spearman correlation test was used to quantitatively analyze the correlation between CT features and laboratory indicators. The receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of each laboratory index for pneumonia in patients infected with coronavirus. Multiple linear regression analysis was used to explore the relationship between different CT patterns such as ground-glass opacity (GGO) and consolidation and ventilatory oxygenation status.</p><p><strong>Results: </strong>A total of 171 patients were enrolled, including 44 patients in the coronavirus infection non-pneumonia group and 127 patients in the coronavirus infection associated pneumonia group (the incidence of pneumonia was 74.3%). Compared with patients with coronavirus infection alone, patients with coronavirus infection associated pneumonia had significantly lower lymphocyte count (LYM), oxygenation index (PaO<sub>2</sub>/FiO<sub>2</sub>), total lung capacity, GGO volume and GGO ratio, and significantly higher C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), D-dimer, fraction of inspired oxygen (FiO<sub>2</sub>) level, real volume variation and consolidation ratio, the differences were all statistically significant. There were no statistically significant differences in the nucleocapin protein (N) gene cycle threshold (Ct) value and open reading frame (ORF) gene Ct value between the two groups. ROC curve analysis showed that, after adjusting for age, gender, CRP level and other related factors, compared with N gene Ct value, ORF gene Ct value, N gene Ct value+LYM, ORF gene Ct value+LYM, the LYM had the most potential diagnosis power for coronavirus infection associated pneumonia. The area under the ROC curve (AUC) of LYM for predicting coronavirus infection was 0.703. When the cut-off value of LYM was 0.7×10<sup>9</sup>/L, the sensitivity was 55.5%, and the specificity was 79.5%, respectively. Multiple linear regression analysis showed that, when adjusted for consolidation ratio, age, gender, Hb and D-dimer levels, the GGO ratio in patients with coronavirus infection associated pneu
目的:探讨冠状病毒感染患者不同形态胸部CT定量分析结果及其与病毒载量和病理生理状态的关系。方法:回顾性临床队列研究。入选于2023年6月9日至15日在青岛市市立医院住院的冠状病毒感染患者(所有患者均在确诊后24小时内行胸部CT检查)。根据CT表现将患者分为冠状病毒感染非肺炎组和冠状病毒感染相关肺炎组。收集各组患者CT检查前后12小时内的人口学特征、胸部CT特征、实验室指标等相关基线数据。采用Spearman相关检验定量分析CT表现与实验室指标的相关性。绘制受试者操作者特征曲线(ROC曲线),评价各实验室指标对冠状病毒感染患者肺炎的预测价值。采用多元线性回归分析探讨不同CT表现如磨玻璃不透明(GGO)及实变与通气氧合状态的关系。结果:共纳入患者171例,其中冠状病毒感染非肺炎组44例,冠状病毒感染相关肺炎组127例,肺炎发生率为74.3%。与单纯冠状病毒感染患者相比,冠状病毒感染相关性肺炎患者淋巴细胞计数(LYM)、氧合指数(PaO2/FiO2)、总肺活量、GGO体积、GGO比值均显著降低,c -反应蛋白(CRP)、中性粒细胞/淋巴细胞比值(NLR)、d -二聚体、吸入氧分数(FiO2)水平、实际体积变化、实变比均显著升高,差异均有统计学意义。两组患者核衣壳蛋白(N)基因循环阈值(Ct)和开放阅读框(ORF)基因Ct值比较,差异均无统计学意义。ROC曲线分析显示,在调整年龄、性别、CRP水平等相关因素后,与N基因Ct值、ORF基因Ct值、N基因Ct值+LYM、ORF基因Ct值+LYM相比,LYM对冠状病毒感染相关性肺炎的潜在诊断能力最强。LYM预测冠状病毒感染的ROC曲线下面积(AUC)为0.703。当LYM的临界值为0.7×109/L时,敏感性为55.5%,特异性为79.5%。多元线性回归分析显示,在校正巩固比、年龄、性别、Hb和d -二聚体水平后,冠状病毒感染相关性肺炎患者GGO比与PaO2/FiO2相关(β = -2.18, P < 0.001)。在调整GGO比例、年龄、性别、Hb和d -二聚体水平后,冠状病毒感染相关性肺炎患者的实变比例与PaCO2相关(β = 0.36, P = 0.004)。调整GGO比例后,冠状病毒感染相关性肺炎患者的实变比例也与NLR相关(β = 0.79, P = 0.006)。结论:LYM可能是预测冠状病毒相关性肺炎的潜在标志物,其相关性似乎与病毒载量无关。此外,在影像学特征分析中,GGO与缺氧相关,实变与PaCO2水平和炎症相关。全肺实变比例的增加可能不利于肺通气。
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引用次数: 0
[Research progress on clinical evaluation index of brain function after cardiopulmonary resuscitation]. [心肺复苏后脑功能临床评价指标研究进展]。
Q3 Medicine Pub Date : 2024-12-01 DOI: 10.3760/cma.j.cn121430-20240318-00245
Xu Ma, Yun Wang, Tongjie Pan, Nan Gu, Kerong Hai

The ultimate goal of cardiac arrest-cardiopulmonary resuscitation (CA-CPR) is to reduce brain damage and promote neurological recovery. Although the return of spontaneous circulation (ROSC) has improved, the proportion of patients who survive to discharge is very low, so how to evaluate the recovery of brain function after resuscitation is particularly important in clinical work. From a clinical perspective, although early prognostic indicators are not perfect, identifying high-risk features may help clinicians determine the severity of brain injury caused by a patient's potential course of disease. This review, based on recent literature, selects several commonly used clinical brain function evaluation indicators to provide theoretical and practical support for assessing brain function recovery in patients after CPR.

心脏骤停-心肺复苏术(CA-CPR)的最终目的是减少脑损伤,促进神经系统恢复。虽然自发性循环恢复(ROSC)有所提高,但存活至出院的患者比例很低,因此如何评估复苏后脑功能的恢复情况在临床工作中显得尤为重要。从临床角度来看,尽管早期预后指标并不完善,但识别高危特征可能有助于临床医生确定患者潜在病程所引起的脑损伤的严重程度。本文在文献综述的基础上,选取临床常用的几种脑功能评价指标,为评估心肺复苏术后患者脑功能恢复情况提供理论和实践支持。
{"title":"[Research progress on clinical evaluation index of brain function after cardiopulmonary resuscitation].","authors":"Xu Ma, Yun Wang, Tongjie Pan, Nan Gu, Kerong Hai","doi":"10.3760/cma.j.cn121430-20240318-00245","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240318-00245","url":null,"abstract":"<p><p>The ultimate goal of cardiac arrest-cardiopulmonary resuscitation (CA-CPR) is to reduce brain damage and promote neurological recovery. Although the return of spontaneous circulation (ROSC) has improved, the proportion of patients who survive to discharge is very low, so how to evaluate the recovery of brain function after resuscitation is particularly important in clinical work. From a clinical perspective, although early prognostic indicators are not perfect, identifying high-risk features may help clinicians determine the severity of brain injury caused by a patient's potential course of disease. This review, based on recent literature, selects several commonly used clinical brain function evaluation indicators to provide theoretical and practical support for assessing brain function recovery in patients after CPR.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1329-1333"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956021","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}
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