护理风险管理在产科急危重症患者中的运用及对妊娠结局的影响评价

目的 探究护理风险管理在产科急危重症患者中的运用及对妊娠结局的影响。方法 选择医院 2021 年 7 月至 2022 年 6 月 产科收治的 120 例急危重症患者为研究对象。随机将患者分为对照组和研究组,每组各 60 例。对照组采用常规护理管理,研 究组采用护理风险管理。分析对比两组的护理满意度、不良妊娠结局、围生儿不良结局以及新生儿 apgar 评分。结果 研究组护 理满意度为 98.33%,显著高于对照组的 90.00%（P>0.05）。研究组不良妊娠结局发生率显著低于对照组（P<0.05）。研究组围 生儿不良结局发生率显著低于对照组（P<0.05）。研究组新生儿 apgar 评分显著高于对照组（P<0.05）。结论 对产科急危重症患 者实施护理风险管理,能提高护理满意度,改善不良妊娠结局和围生儿不良结局,提高新生儿 apgar 评分。     

SIRS评分在产科急危重症病人护理中的应用

[目的]评价全身炎症反应综合征(SIRS)评分在产科急危重症病人护理中的指导作用。[方法]按SIRS评分和病种基本接近原则,随机将入住我科急危病人120例分为两组,每组60例。Ⅰ组病人每天动态监测SIRS评分,评估病情,指导治疗和护理;Ⅱ组病人按医嘱护理级别、疾病种类行常规治疗及护理;观察两组病人痊愈率、转诊率、严重并发症确诊率、围生儿预后不良率及病人、家属、医生对护理工作的满意度。[结果]两组病人严重并发症发生情况、围生儿预后不良率及病人、家属和医生对护理满意度比较差异有统计学意义,Ⅰ组优于Ⅱ组。[结论]SIRS评分简单易懂、实用性强、可控性好,能够及时指导护理工作,降低母婴严重并发症发生率。     

护理风险管理在产科急危重症患者中的应用及对妊娠结局的影响

目的探讨护理风险管理在产科急危重症患者中的应用及对妊娠结局的影响。方法选择2018年1月1日至12月31日该院妇产科收治的急危重症患者400例,根据护理方法不同将患者分为两组,其中对照组(n=200)实施常规护理,观察组(n=200)实施护理风险管理。记录并比较两组患者护理期间的满意度及不良妊娠结局发生情况。结果观察组总满意度(99.00%)明显高于对照组总满意度(83.50%),差异有统计学意义(P0.05)。观察组先兆子痫、子痫、胎盘早剥、新生儿窒息等不良妊娠结局总发生率(14.50%)均低于对照组(43.00%),差异有统计学意义(P0.05)。结论护理风险管理在改善产科急危重症患者妊娠结局中有至关重要的作用,能明显提高产妇护理满意度,值得临床推广应用。     

严重创伤患者改良的全身炎症反应综合征评分与损伤严重度评分相关性分析

目的 探讨严重创伤患者改良的全身炎症反应综合征评分(R-SIRS)和损伤严重度评分(ISS)的相关性.方法 275例严重创伤患者于入院后进行R-SIRS评分及ISS评分,并对它们之间进行相关性分析.结果 R-SIRS与ISS具有明显的相关性.结论 全身失控性炎症免疫反应既是严重创伤的结果,又是病情加重的重要原因之一,R-SIRS评分有助于评估严重创伤患者的病情及预后.     

老年脑血管意外患者全身炎症反应综合征评分与医院感染及预后的相关性分析

目的评价老年脑血管意外患者全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)评分与发生医院感染及预后的相关性.方法本研究共收集187例神经内科的患者,对患者入院72 h内进行 SIRS评分,并对其发生医院感染与预后进行前瞻性统计.结果187例病例中,发生医院感染34例,医院感染发生率18%;死亡23例,死亡率12%;随着 SIRS评分增加,医院感染发生率、患者死亡率有增加的趋势(P<0.05).结论住院超过24 h且SIRS评分≥2分的老年脑血管意外患者应高度警惕医院感染发生的可能性,早期给予相应的干预措施,阻断由SIRS进一步进展到多器官功能衰竭的可能性.SIRS评分系统项目简单,方便操作,为指导临床预测患者的预后提供了又一重要方法,熟练掌握并应用于临床实践中将有助于对患者病情估计和有效诊治,具有良好的临床应用和科研价值.     

改良早期预警评分在急危重症患者抢救中的应用

目的探讨改良早期预警评分在急危重症患者抢救中的应用及效果。方法采用改良早期预警评分表对急危重症患者病情进行评分,根据评分结果采用相应的处理流程。结果使用改良早期预警评分判断病情快捷准确,提高了医生对护理人员配合满意度及患者和家属对护理工作的满意度(P0.01)。结论对患者实施改良早期预警评分可以提高患者收治的准确性。     

全身炎症反应综合征评分系统的临床意义

准确预测严重创伤和各种危重患者的预后,对于所有临床医师及研究人员来说都是相当重要的问题。一些评分系统如急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)、APACHEⅢ及创伤     

预警评分在急危重症病人中的应用研究现状

对预警评分在急危重症病人中的研究现状进行分析,阐述不同预警评分的差异,为临床医护人员应用预警评分提供参考依据。     

17例脐带真结产科因素及妊娠结局的分析

脐带真结是导致胎儿官内窘迫的重要原因之一，发生率为0．4％～1．1％。脐带真结是由于胎儿运动时穿过脐带一圈形成，真结一旦拉紧导致脐血流完全关闭时，可使胎死宫内，死亡率极高。但是因为缺乏典型的临床特征和超声图像，产前难以诊断。筛查出脐带真结的高危孕妇，严密监测宫内情况，对降低围生儿死亡率有着极为深远的意义。     

全身炎症反应综合征评分对老年急性心肌梗死病人的预后预测

急性心肌梗死（acute myocardial infarction，AMI）是老年人多发的内科急症，随着现代医学发展，人类寿命的延长，其发病率明显增加，而且并发症多，病死率较高。我们使用全身炎症反应综合征（SIRS）评分法对96例老年AMI病人进行病情评估和预后预测，具有明显的临床意义及使用价值。     

全身炎症反应综合征评分在急性感染患者预后中的价值

目的：了解全身炎症反应综合征（SIRS）评分在急性感染患病情严重度，脏器功能衰竭、死亡率的关系，进一步观察SIRS评分对患预后的价值。方法：126例患分别予以SIRS评分，APACHEⅢ评分，MODS评分及死亡率统计，并行相关的统计学分析。结果，SIRS评分≥2组，APACHEⅢ评分，MODS病情严重度评分增高显，与SIRS评分＝0／1组比较P＜0．05，死亡组病人SIRS评分显增高（P＜0．01）。入院第一天，APACHEⅢ评分、MODS病情严重度评分与SIRS评分明显正相关（P＜0．001）。SIRS评分＝0／1组患无一例死亡；SIRS≥2时，死亡人数逐渐增高，以SIRS评分为4时最高。结论：SIRS评分与病情严重度密切相关，尤其SIRS评分≥2分与病情及死亡率关系更为密切，支持SIRS评分是一个简单、独立、有价值的预后评分标准。     

多发伤患者入院SIRS评分与预后的相关分析

目的探讨多发伤患者入院SIRS评分与其预后的相关性。方法对我院急诊创伤中心2000-01~2003-12间所收治的915例多发伤患者进行入院SIRS和ISS评分,分SIRS组与非SIRS组(SIRS分值为0,1)进行对比,同时根据年龄和ISS评分变量调整后通过Logistic和线形回归模型评价SIRS评分与多发伤患者死亡率、入ICU率、住院时间长短等预后的相关性。结果SIRS组患者与非SIRS组相比死亡率明显增加,SIRS分值是多发伤患者入ICU的独立预示因素。白细胞增多(>12×109/L)最能提示住院时间长短,体温(无论是高温还是低温)最能预示死亡率高低。结论入院SIRS评分操作简单,有独立预测多发伤患者预后的价值。     

Neutrophil elastase and systemic inflammatory response syndrome in the initiation and development of acute lung injury among critically ill patients.

Critically ill patients are commonly associated with systemic inflammatory response syndrome (SIRS) and are at a greater risk of developing acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Under these conditions, large amounts of various cytokines are produced, which either directly or indirectly induce tissue injury and finally organ dysfunctions, through the activation of neutrophils and as a result of release of cytotoxic molecules, especially neutrophil elastase (NE). In the present study, we determined plasma neutrophil elastase-alpha-1 antitrypsin complex (NE-AT) and elastase digests of cross-linked fibrin (e-XDP) in critically ill patients to elucidate the significance of NE in the initiation and progression of ALI and ARDS in the presence or absence of SIRS. We found significantly increased levels of plasma NE-AT in the patients with ARDS, especially when the definition of SIRS was met. Among ALI/ARDS groups, plasma NE-AT, but not e-XDP, correlated significantly with the decrease in PaO(2)/FIO(2) ratio and the duration of ALI/ARDS. Furthermore, NE-AT, but not e-XDP, significantly increased in subgroups whose PaO(2)/FIO(2) ratio decreased by more than 20%. Such correlations and differences between the subgroups were not observed in the non-ALI patients. From these results, we speculate that NE-AT, but not e-XDP, may be predictive of progressive lung injury in the early stage of ALI and ARDS.     

APACHE Ⅱ、SAPS Ⅱ及LODS 3种评分系统在单一重症监护室的应用比较

目的比较和评价急性生理学与慢性健康状况评分系统Ⅱ（APAcHEⅡ）、简明急性生理功能评分系统Ⅱ（SAPSⅡ）及Logistic器官功能障碍系统（LODS）3种评分系统对危重病患者院内病死率的预测能力。方法应用3种评分系统计算出病死概率并与实际病死率比较。通过受试者工作特征曲线（ROC）下的面积及分类表，判定3种评分系统的拟合优度；而各评分系统对分层精确度的预测则用校准曲线及Lemeshow—Hosmer妒统计来评估。结果APACHEⅡ评分系统的预测病死率与实际病死率基本相符，而其他两种评分系统的预测病死率偏低。APACHEⅡ、SAPSⅡ及LODS各评分系统的ROC曲线下面积分别为0．881、0．904和0．875；95％可信区间分别为0．858～0．904，0．884～0．924和0．851～0．898；而在诊断界点为50％时，APACHEⅡ、SAPSⅡ及LODS各评分系统的整体正确分类率分别为81．60％、82．Og％和79．26％。APACHEⅡ（X^2=9．69）及SAPSⅡ（X^2=13．50）评分系统对分层精确度的预测较好，LODS评分系统则较差（X^2=87．22）。结论3种评分系统预测危重病患者预后的鉴别能力均较好且接近一致，APACHEⅡ及SAPSⅡ评分系统的分层预测精确度明显好于LODS。     

Validation of the multiple organ dysfunction (MOD) score in critically ill medical and surgical patients

Objective To validate the Multiple Organ Dysfunction (MOD) score externally.Design Prospective observational cohort study.Setting Mixed medical/surgical ICU in a tertiary referral university hospital.Patients and participants Thousand eight hundred and nine patients admitted to ICU for more than 24 h over a 3-year period.Interventions None.Measurements and results The MOD score was calculated daily for all patients. The criterion validity of the individual organ scores, the maximal MOD score and the change in MOD score were assessed by examining the relationship between increasing scores and ICU mortality. Increased maximal MOD scores and each of the six individual organ scores, and change in MOD scores were associated with increased mortality.Conclusions Maximal and individual organ scores have criterion validity when tested in a different ICU from that in which the scores were derived, indicating that the scoring systems are reproducible. The association of change in MOD score with mortality indicates that the score is responsive. These data, combined with previous data establishing concept and content validity, indicate that the MOD score is a valid measure of multi-organ dysfunction.     

Oxidative stress in critically ill patients with systemic inflammatory response syndrome

OBJECTIVE: To evaluate whether critically ill patients with systemic inflammatory response syndrome, on admission to an intensive care unit, had more severe oxidative stress than those without this syndrome. DESIGN: A prospective, cohort study. SETTING: A mixed medical and surgical adult intensive care unit with 12 beds. PATIENTS: A total of 68 consecutive patients admitted to the intensive care unit. INTERVENTIONS: Venous blood samples were routinely obtained within 24 hrs of admission. MEASUREMENTS AND MAIN RESULTS: Patients' plasma total antioxidant capacity, the lipid peroxidation products malondialdehyde and 4-hydroxynonenal, reduced sulfhydryl groups, and nitrites/nitrates were measured by spectrophotometric technique at admission to the intensive care unit. Myeloperoxidase (enzyme-linked immunosorbent assay) and polymorphonuclear elastase (immuno-activation assay) were also measured on admission to the intensive care unit. The patients with criteria of systemic inflammatory response syndrome (n = 20) had higher Acute Physiology and Chronic health Evaluation III scores (determined by collecting the worst value within 24 hrs after admission to the intensive care unit) and plasma concentrations of lipid peroxidation products and nitrites/nitrates and lower plasma concentration of reduced sulfhydryl groups and plasma total antioxidant capacity than patients without the syndrome (n = 48). Moreover, the markers for leukocyte activation, myeloperoxidase and polymorphonuclear elastase, presented higher concentrations in the plasma of patients with systemic inflammatory response syndrome. CONCLUSIONS: Patients admitted to the intensive care unit with criteria of systemic inflammatory response syndrome had a more severe oxidative stress than patients without this syndrome.     

Endotoxin immunity and the developmentof the systemic inflammatory responsesyndrome in critically ill children

Background The systemic inflammatory response syndrome (SIRS) may be triggered by endotoxin. Humans have antibodies directed against the core of endotoxin (endotoxin core antibodies, EndoCAb) that appear to be protective following surgery and in sepsis. We hypothesised that children with elevated antibodies to endotoxin core would be less likely to develop SIRS in their initial period on intensive care. Because of the existing literature we defined two sub-groups according to the primary reason for ICU admission: infection and non-infection. Methods We recruited 139 consecutive patients admitted to a paediatric intensive care unit (PICU) with more than one organ failure for longer than 12 h as part of another study. Patients were classified on admission to PICU as having an infectious or a non-infections diagnosis. The occurrence of SIRS within 48 h of admission was recorded along with detailed clinical and demographic data, EndoCAb concentration and the potential confounding variables C-reactive protein and mannose-binding lectin. Results In the 71 patients admitted without infection (primarily post-operative and head injured) IgG EndoCAb was significantly lower in patients who developed SIRS than those who did not (72 vs. 131 MU/ml), independent of potential confounding variables. In patients with infection there was no significant difference in IgG EndoCAb between children developing SIRS and those who did not (111 vs. 80 MU/ml). Conclusion Head injured and post-operative patients admitted to PICU who develop early SIRS have significantly lower serum IgG EndoCAb levels than those who do not. M.W.T. and N.J.K. both act as scientific consultants for NatImmune, a Danish company exploring the therapeutic potential of MBL. M.G.M. is involved in the development of an anti-endotoxin vaccine This article refers to the editorial .     

Evaluation of oxygen consumption and resting energy expenditure in critically ill patients with systemic inflammatory response syndrome.

OBJECTIVE: To determine whether oxygen consumption VO2), CO2 production, and resting energy expenditure (REE) in critically ill patients differ in varying grades of systemic inflammatory response syndrome (SIRS). DESIGN: Prospective, clinical study. SETTING: Intensive care unit at a university hospital. PATIENTS: Twenty-six critically ill patients requiring mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 100 metabolic measurements were performed. The grade of SIRS and the Acute Physiology and Chronic Health Evaluation II score were evaluated at the time of the metabolic cart study. VO2 and REE differed among the groups inadequate for SIRS (non-SIRS), with SIRS without infection (nonseptic SIRS), and with SIRS with infection (septic SIRS) (125 +/- 37 mL/min/m2 and 855 +/- 204 kcal/day/m2, 135 +/- 33 mL/min/m2 and 948 +/- 214 kcal/day/m2, and 166 +/- 55 mL/min/m2 and 1149 +/- 339 kcal/day/m2, respectively; p < .005). Patients with septic SIRS had higher VO2 and REE than patients with non-SIRS and nonseptic SIRS. CONCLUSION: VO2 and REE differ among groups of patients with non-SIRS, nonseptic SIRS, and septic SIRS. Patients with septic SIRS have higher VO2 and REE than patients with non-SIRS or nonseptic SIRS. The present study shows that classifying patients into three grades (non-SIRS, nonseptic SIRS, and septic SIRS) is a valid predictor of metabolic stress in critically ill patients.     

Bias reduction in repeated-measures observational studies by the use of propensity score: The case of enteral sedation for critically ill patients

Purpose

Within the evidence-based medicine paradigm, randomized controlled trials represent the “gold standard” to produce reliable evidence. Indeed, planning and implementing randomized controlled trials in critical care medicine presents limitations because of intrinsic and structural problems. As a consequence, observational studies still occur frequently. In these cases, propensity score (PS) (probability of receiving a treatment conditional on observed covariates) is an increasingly used technique to adjust the results. Few studies addressed the specific issue of a PS correction of repeated-measures designs.

Materials and Methods

Three techniques for correcting the analysis of nonrandomized designs (matching, stratification, regression adjustment) are presented in a tutorial form and applied to a real case study: the comparison between intravenous and enteral sedative therapy in the intensive care unit setting.

Results

After showing the results before and after the use of PS, we suggest that such a tool allows to partially overcoming the bias associated with the observational nature of the study. It permits to correct the estimates for any observed covariate, while unobserved confounders cannot be controlled for.

Conclusions

Propensity score represents a useful additional tool to estimate the effects of treatments in nonrandomized studies. In the case study, an enteral sedation approach was equally effective to an intravenous regime, allowing for a lower level of sedation and spare of resources.     

Hypophosphatemia in critically ill patients

Purpose

The aim of this study was to assess the association of phosphate concentration with key clinical outcomes in a heterogeneous cohort of critically ill patients.

Materials and Methods

This was a retrospective observational study at a general intensive care unit (ICU) of an Australian university teaching hospital enrolling 2730 adult critically ill patients.

Results

We studied 10?504 phosphate measurements with a mean value of 1.17 mmol/L (measurements every 28.8 hours on average). Hyperphosphatemia (inorganic phosphate [iP] concentration > 1.4 mmol/L) occurred in 45% and hypophosphatemia (iP ≤ 0.6 mmol/L) in 20%. Among patients without any episodes of hyperphosphatemia, patients with at least 1 episode of hypophosphatemia had a higher ICU mortality than those without hypophosphatemia (P = .004). In addition, ICU nonsurvivors had lower minimum phosphate concentrations than did survivors (P = .009). Similar results were seen for hospital mortality. However, on multivariable logistic regression analysis, hypophosphatemia was not independently associated with ICU mortality (adjusted odds ratio, 0.86 [95% confidence interval, 0.66-1.10]; P = .24) and hospital mortality (odds ratio, 0.89 [0.73-1.07]; P = .21). Even when different cutoff points were used for hypophosphatemia (iP ≤ 0.5, 0.4, 0.3, or 0.2 mmol/L), hypophosphatemia was not an independent risk factor for ICU and hospital morality. In addition, timing of onset and duration of hypophosphatemia were not independent risk factor for ICU and hospital mortality.

Conclusions

Hypophosphatemia behaves like a general marker of illness severity and not as an independent predictor of ICU or in-hospital mortality in critically ill patients.