皮肌炎和多发性肌炎合并间质性肺炎死亡原因分析

目的分析皮肌炎和多发性肌炎合并间质性肺炎死亡患者的临床和实验室特征。方法对15例皮肌炎和多发性肌炎合并间质性肺炎死亡患者的临床表现、实验室检查及辅助检查等进行回顾性分析,并与23例生存者作比较。结果15例患者死亡年龄(50．1±12．0)岁,其中12例(80%)在起病半年内死亡；表现为急性或亚急性发病的间质性肺炎死亡率高,随着病程延长,肺部感染成为死亡主要原因。死亡组呼吸困难和肺部啰音出现比例、动脉氧分压降低例数与生存组比较差异有显著性。乳酸脱氢酶、谷丙转氨酶、谷草转氨酶升高明显,乳酸脱氢酶持续升高提示预后不良。肌酸磷酸激酶升高与抗Jo-1抗体阳性不是死亡的原因。结论皮肌炎和多发性肌炎早期合并间质性肺炎及随之的肺部感染是死亡的主要原因,早期关注肺部症状及积极治疗可能改善预后、降低病死率。     

老年肺部感染的特点及治疗策略（附76例临床分析）

分析76例老年肺部感染的临床表现,发现有明显的特征性.老年肺部感染在老年感染性疾病急诊患者中占首位(56.9%)且为主要死亡原因(74.5%).本文对我院干部病房近3年来60岁以上76例以肺部感染为主要诊断的住院患者在临床特点、早期诊断及治疗策略上分析如下.     

151例高龄脑卒中死亡原因分析

目的探讨高龄脑卒中患者发病急性期后的死亡原因。方法对我院收治的脑卒中串者急性期稳定后转入我院附属养老院进行跟踪观察,就其中死亡的151例患者资料进行分析结果肺部感染或肺部感染合并其他疾病为脑梗死急性期后主要死亡原因,本组92例,占60．92％;急性脑梗死患者发病后1年内死亡106例,占70．20％：结论对高龄脑卒中患者,应积极治疗,加强护理,减少肺部感染的发生,从而提高患者的生活质量。     

老年肺部感染的特点及治疗策略

在我院住院病例中，经过分析56例老年肺部感染的临床表现，发现有明显的特征性。老年肺部感染在老年感染性疾病急诊患者中首位且为主要死亡原因。本文对我院干部病房近8年来60以上56例肺部感染为主要诊断的住院患者在临床特点、早期诊断及治疗策略上分析如下：     

冠状动脉搭桥术后9例胸骨裂开的原因分析及护理

目的:探讨冠状动脉搭桥术后9例胸骨裂开的原因及护理方法。方法:对9例胸骨裂开病例进行回顾性分析。结果:9例患者诊断明确后送手术室行胸骨清创固定术,其中8例胸骨愈合良好,痊愈出院,占88.89%;1例因并发肺部感染、感染性休克导致多脏器衰竭而死亡,占11.11%。结论:冠状动脉搭桥术患者应重视术前合并症的处理,预防感染,术后从心理、功能锻炼、有效咳嗽、切口护理及营养支持等方面给予科学的指导,以促进胸骨切口愈合,缩短病程,使患者早日康复。     

重型颅脑外伤肺部并发症的预防及护理

因重型颅脑损伤患者免疫功能下降 ,咳嗽反射消失 ,呼吸道分泌物不易吸出 ,极易引起肺部并发症 ,如不早期预防 ,早期处理 ,将严重影响患者的康复。现将近年来我们对重型颅脑外伤患者肺部并发症的预防及护理体会报告如下。1　临床资料1 998年 1月至 1 2月我们共收治重型颅脑外伤 1 2 1例 ,其中气管切开 39例 ,并发肺部感染 1 7例 ,肺部并发症发生率 1 4 % ;治愈 90例 ,占 74 3% ;好转 1 8例 ,占 1 4 8% ;自动出院 4例 ,占 3 5 % ;死亡 9例 ,占 7 4 % ;其中并发肺部感染死亡 4例。2　原因分析(1 )颅脑损伤后咳嗽反射消失 ,呼吸道分泌物不…     

肾移植术后肺部感染的诊治体会

目的:探讨肾移植术后患者肺部感染的发病特点、诊断及治疗。方法:对我院2002年4月至2005年11月收治的16例资料完整的肾移植术后肺部感染病人的临床资料进行回顾性分析。结果:发病时段在术后6个月内,混合感染多见,病情较重,呼吸衰竭发生率高(10例,占62.5%),机械通气是重要的抢救手段,治疗后临床治愈9例(占56.3%),死亡4例(其中1例自杀),自动出院3例。结论:肺部感染是肾移植术后一种常见并且严重的并发症,应高度重视和积极救治。早期诊断,及时予以抗细菌、抗病毒、抗真菌治疗,同时调整免疫抑制方案,提高机体免疫水平,积极应用呼吸支持,有利于提高治愈率。     

肝移植术后肺部感染的预防及护理

目的:探讨肝移植术后发生肺部感染的有效预防和护理方法。方法:回顾分析2003年11月~2006年1月在我院行肝移植术34例患者的病历资料,对11例术后肺部感染的原因进行分析,总结肺部感染的预防及护理措施。结果:34例肝移植患者中发生肺部感染11例,感染率32.4%,治愈10例,因肺部感染导致死亡1例。结论:长时间使用呼吸机、气管插管及气管切开为肺部感染的主要原因。加强术后病房管理,重视物理性预防及使用呼吸治疗装置的护理,严格遵守吸痰注意事项及无菌技术操作,能降低肝移植患者肺部感染的发生率。     

肝移植后早期深部真菌感染16例

为探索肝移植后早期深部真菌感染的早期诊断和治疗措施,收集了重庆医科大学附属第一医院重庆市器宵移植中心2001-10/2008-10的72例肝移植患者移植后并发早期深部真菌感染16例患者的临床资料,分别对其易感因素、病原学特点、诊断方法、治疗方案及预防措施进行回顾性病例分析.16例肝移植患者发生早期深部真菌感染23例次,死亡4例,感染发生率22.2%(16/72),死亡率25.0%(4/16).肺部感染15例次,肠道感染6例次,胆道感染1例次,颅内感染1例次.白色念珠菌感染占65.22%,非白色念珠菌感染占17.39%,曲霉菌感染占13.04%,隐球菌感染占4.35%.发病时间为移植后5～26 d.可见早期深部真菌感染是影响肝移植患者后生存率的重要原因之一.有效预防、早期诊断和积极治疗是提高深部真菌感染治愈率的关键.     

多发性骨髓瘤患者使用硼替佐米化疗期间发生肺部感染的临床危险因素分析

目的:探索以硼替佐米化疗的多发性骨髓瘤(MM)患者肺部感染的危险因素、病原菌株的分布及其耐药性。方法:选取2015年1月至2019年1月于甘肃省人民医院接受治疗的85例采用以硼替佐米为主化疗方案治疗的初治MM患者临床资料,依据是否发生肺部感染分为感染组和对照组,并对其发生肺部感染的危险因素、病原菌分类及耐药性进行回顾性分析。结果:85例MM患者肺部感染率55.29%。感染组中性粒细胞减少、贫血、ECOG评分≥2分比例显著高于对照组患者,数据对比具有统计学差异(P<0.05)。本研究累计检测出30株病原菌,革兰阴性菌60%,革兰阳性菌占33.33%,真菌占3.3%,结核菌占3.3%。铜绿假单胞菌、肺炎克雷伯菌、肺炎链球菌、金黄色葡萄球菌所占比例最高。MM患者合并肺部感染经过2周抗生素治疗,大部分患者预后较好,但肺部感染所致的死亡人数为3人,约占MM患者早期死亡人数的30%,其是MM患者早期重要的死亡原因。结论:中性粒细胞减少、贫血、ECOG评分≥2分是使用硼替佐米为主化疗方案的MM患者发生肺部感染的独立危险因素,同时肺部感染也是MM患者早期死亡主要原因。未获得培养结果及药敏结果前暂可经验性使用β内酰胺类和酶抑制剂复合制剂及碳青霉烯类抗生素控制感染。     

住院精神科患者死亡的相关因素分析及护理

目的 通过分析住院精神科患者的死亡资料,探讨死亡原因及相应护理对策,为精神科临床护理和医疗服务安全提供依据.方法 回顾性调查128例精神科住院死亡患者的病历,并对其进行统计学分析.结果 128例精神科住院死亡患者中,死亡原因以躯体疾病、意外事故和猝死为主,分别占50.8%、19.5%和19.5%;首次住院死亡91例占71.1%;住院10 d内死亡60例占469%;死亡多发生在夜间、午休和三餐时间.结论 躯体疾病、意外事故和猝死是精神科住院患者死亡的主要原因,护理人员应高度重视首次住院、住院10 d内的精神科患者,并加强特殊时间段护理.     

持续非卧床腹膜透析短期内退出的调查分析

目的　通过分析影响持续非卧床腹膜透析 (CAPD)患者一年内退出腹膜透析的因素 ,以期为此类易感人群制定合理的一体化治疗方案。方法　调查 2 0 0 0年 4月 1日至 2 0 0 3年 3月 31日在本腹透中心进行CAPD的终末期肾病患者的临床资料 ,包括性别、年龄、透析龄和糖尿病发病情况、退出腹膜透析的时间和原因、死亡病例的死因 ;采用体格损害指数、Charlson指数来评估患者合并症情况。结果　有 139例入选本研究 ,观察期间退出腹膜透析的有 5 0例 (35 .97% ) ,透析后一年内退出的有 4 0例 (占总退出例数 80 % ) ,其中死亡 32例 (2 3.0 2 % )、肾移植 4例、转血液透析 4例 ;在三月内退出腹膜透析的有2 2例 ,其中死亡 2 0例 ;在透析后一年内 32例死亡病例中 ,其中死于心肌梗死 6例 (19% )、充血性心力衰竭 7例 (2 3% )、中风 3例 (9% )、感染 5例 (16 % )、放弃治疗 3例 (9% )、多器官功能衰竭 1例 (3% )、呼吸衰竭 2例 (6 % )、恶性肿瘤 2例 (6 % )及其他不明原因 3例 (9% ) ;logistic回归分析提示Charlson指数、体格损伤指数、性别对CAPD患者一年内死亡退出的影响的相对危险度分别为 1.5 5 4、2 .12 5、2 .82 1,并均具有统计学意义 (P <0 .0 5 )。结论　心血管事件是CAPD患者在透析后一年内死亡的主要原因 ,合并     

肝移植术后晚期合并多器官功能衰竭主要死因分析

目的　探讨肝移植术后晚期导致患者死亡的主要原因 ,提出预防的方法。方法　回顾性分析1981年 2月— 1998年 4月在美国匹斯堡大学进行的生存期大于 1年的 2 94 0例肝移植长期随访结果 ,分析其主要死因与相关因素。结果　 1981— 1991年 10年肝移植术后病死率呈逐年降低趋势 ,从 2 0 .4 %降到 1.9% ;术后晚期 (存活期 >1年 )死亡者 817例 ,主要死因依次为恶性肿瘤 (复发 新生 ,2 0 .7% )、心血管并发症( 11.4 % )、各种感染 ( 11.3% )和呼吸系统并发症 ( 9.4 % )。随着免疫抑制剂使用情况的变化 ,1981— 1986年为环胞素 / Cy A,1986— 1990年为 OKT3/ Viaspan,1991— 1998年为 Tarolim us/ FK5 0 6 ,各期 1、5、10年病死率呈逐年下降趋势。术后 1、5、10、15和 18年病死率以 3～ 18岁年龄为低 ,19～ 6 0岁年龄组 10、15、18年病死率最高。病死率最高的肝移植指征为恶性肿瘤和暴发性肝功能衰竭 ,酒精性肝硬化术后随时间延长病死率逐年增加 ,13年最高 (达 76 .0 % )。结论　肝移植术后期主要死因为新生恶性肿瘤、心血管并发症、各种感染和呼吸系统并发症 ;尽早预防和及时治疗可提高肝移植长期生存率     

The effects of cause of death classification on prognostic assessment of patients with pulmonary embolism

Summary. Background: Although previous studies have provided evidence that the majority of deaths following an acute pulmonary embolism (PE) directly relate to the PE, more recent registries and cohort studies suggest otherwise. Methods: We assessed the cause of death during the first 30 days after the diagnosis of acute symptomatic PE in a consecutive series of patients. We also assessed the prognostic characteristics of the simplified Pulmonary Embolism Severity Index (sPESI) and cardiac troponin I (cTnI) obtained at the time of PE diagnosis. Results: During the first 30 days after diagnosis, 127 of the 1291 patients died (9.8%; 95% confidence interval [CI], 8.2–11.5). Sixty patients (4.6%; 95% CI, 3.5–5.8) died from definite or possible PE, and 67 (5.2%; 95% CI, 4.0–6.4) died from other causes (cancer 25, infection 18, hemorrhage 7, heart failure 7, chronic obstructive pulmonary disease 5, renal failure 1, seizures 1, unknown 3). The sPESI predicted all‐cause (odds ratio [OR], 5.97; 95% CI, 1.74–20.54; P < 0.01) and PE‐associated mortality (OR, 8.79; 95% CI, 1.12–68.79; P = 0.04). cTnI only predicted PE‐associated mortality (adjusted OR, 2.39; 95% CI, 1.25–4.57; P < 0.01). For all‐cause mortality, the sPESI low‐risk strata had a negative predictive value of 98.8% (95% CI, 97.4–100) in comparison with 91.3% (95% CI, 88.9–93.6) for the cTnI. Conclusions: Within the first 30 days after the diagnosis of acute symptomatic PE, death due to PE and death due to other causes occur in a similar proportion of patients. As cTnI only predicted PE‐associated mortality, low‐risk sPESI had a higher negative predictive value for all‐cause mortality compared with cTnI.     

皮肌炎/多发性肌炎死亡危险因素分析

目的 回顾性总结皮肌炎（DM）或多发性肌炎（PM）患者的临床特征,分析DM/PM死亡的独立危险因素。方法 回顾性分析2016年1月~2019年9月在河北医科大学第二医院初次就诊并符合2004年国际肌病协作组建议的特发性炎症性肌病（IIM）分类诊断标准的212例DM/PM患者的临床资料, 根据半年内是否死亡分为研究组（死亡组）和对照组（非死亡组）,分析两组临床特点及实验室检查的差异,总结DM/PM死亡的独立危险因素。结果 两组间男性、白蛋白（ALB）<35 g/L、铁蛋白升高、抗MDA5抗体阳性、肺部感染、间质性肺疾病差异有统计学意义（P<0.05）;Logistic回归分析ALB<35 g/L、铁蛋白升高、抗MDA5抗体阳性、肺部感染、间质性肺疾病与DM/PM死亡密切相关（P<0.05）。结论 男性、ALB<35 g/L、铁蛋白升高、抗MDA5抗体阳性、肺部感染、间质性肺疾病为DM/PM死亡的独立危险因素,提示预后不良。     

Invasive mold infections in cancer patients: 5 years' experience withAspergillus,Mucor, Fusarium andAcremonium infections

Twenty systemic mold infections due to hyphic fungi (molds) arising within the last 5 years in a 60-bed cancer department are analyzed. The most frequent risk factors were plants in ward (75%), prior therapy with broad spectrum antibiotics (70%), catheter insertion (70%), acute leukemia (65%) and neutropenia (60%). Before death, a definitive diagnosis was made in 40%, and a presumptive diagnosis in 60% of patients; post mortem the presumptive antemortem diagnosis was confirmed in all cases (100% of patients). Aspergillosis was the most common invasive fungal disease (55%), followed by mucormycosis (15%), fusariosis (15%), and acremoniosis (10%). Of 20 patients, 8 (40%) were cured or improved after antifungal therapy with amphotericin B, ambisome and/or itraconazole; 8/20 (40%) died of fungal infection and 4/20 (20%) of underlying disease with fungal infection. Even though the diagnosis was made and antifungal therapy started before death in 15/20 (75%), invasive mold infection had a 60% overall mortality in patients with malignant disease.     

Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study

Introduction

Sepsis is a leading cause of admission to non-cardiological intensive care units (ICUs) and the second leading cause of death among ICU patients. We present the first extensive dataset on the epidemiology of severe sepsis treated in ICUs in Spain.

Methods

We conducted a prospective, observational, multicentre cohort study, carried out over two 3-month periods in 2002. Our aims were to determine the incidence of severe sepsis among adults in ICUs in a specific area in Spain, to determine the early (48 h) ICU and hospital mortality rates, as well as factors associated with the risk of death.

Results

A total of 4,317 patients were admitted and 2,619 patients were eligible for the study; 311 (11.9%) of these presented at least 1 episode of severe sepsis, and 324 (12.4%) episodes of severe sepsis were recorded. The estimated accumulated incidence for the population was 25 cases of severe sepsis attended in ICUs per 100,000 inhabitants per year. The mean logistic organ dysfunction system (LODS) upon admission was 6.3; the mean sepsis-related organ failure assessment (SOFA) score on the first day was 9.6. Two or more organ failures were present at diagnosis in 78.1% of the patients. A microbiological diagnosis of the infection was reached in 209 episodes of sepsis (64.5%) and the most common clinical diagnosis was pneumonia (42.8%). A total of 169 patients (54.3%) died in hospital, 150 (48.2%) of these in the ICU. The mortality in the first 48 h was 14.8%. Factors associated with early death were haematological failure and liver failure at diagnosis, acquisition of the infection prior to ICU admission, and total LODS score on admission. Factors associated with death in the hospital were age, chronic alcohol abuse, increased McCabe score, higher LODS on admission, ΔSOFA 3-1 (defined as the difference in the total SOFA scores on day 3 and on day 1), and the difference of the area under the curve of the SOFA score throughout the first 15 days.

Conclusions

We found a high incidence of severe sepsis attended in the ICU and high ICU and hospital mortality rates. The high prevalence of multiple organ failure at diagnosis and the high mortality in the first 48 h suggests delays in diagnosis, in initial resuscitation, and/or in initiating appropriate antibiotic treatment.     

Characteristics of patients who die in hospital with no attempt at resuscitation

OBJECTIVE: To describe the characteristics, cause of hospitalisation and symptoms prior to death in patients dying in hospital without resuscitation being started and the extent to which these decisions were documented. MATERIALS AND METHODS: All patients who died at Sahlgrenska University Hospital in Goteborg, Sweden, in whom cardiopulmonary resuscitation (CPR) was not attempted during a period of one year. RESULTS: Among 674 patients, 71% suffered respiratory insufficiency, 43% were unconscious and 32% had congestive heart failure during the 24h before death. In the vast majority of patients, the diagnosis on admission to hospital was the same as the primary cause of death. The cause of death was life-threatening organ failure, including malignancy (44%), cerebral lesion (10%) and acute coronary syndrome (10%). The prior decision of 'do not attempt resuscitation' (DNAR) was documented in the medical notes in 82%. In the remaining 119 patients (18%), only 16 died unexpectedly. In all these 16 cases, it was regarded retrospectively as ethically justifiable not to start CPR. CONCLUSION: In patients who died at a Swedish University Hospital, we did not find a single case in which it was regarded as unethical not to start CPR. The patient group studied here had a poor prognosis due to a severe deterioration in their condition. To support this, we also found a high degree of documentation of DNAR. The low rate of CPR attempts after in-hospital cardiac arrest appears to be justified.     

Incidence,clinical course,and outcome in 217 patients with acute respiratory distress syndrome

OBJECTIVE: To assess prospectively acute respiratory distress syndrome incidence, etiologies, physiologic and clinical features, and mortality and its predictors in four intensive care units in Argentina. DESIGN: Prospective inception cohort. SETTING: Four general intensive care units in teaching hospitals. PATIENTS: All consecutive adult patients admitted between January 3, 1999, and January 6, 2000, that met the criteria of the American-European Consensus Conference for acute respiratory distress syndrome. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 235 patients developed acute respiratory distress syndrome, and 217 survived for >24 hrs; these were further analyzed. Main risk factors were: sepsis (44%, including 65 pneumonia cases), shock (15%), trauma (11%), gastric aspiration (10%), and other (34%). At admission, nonsurvivors had significantly higher Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment and McCabe scores, and lower oxygenation and pH. During the first week, Pao2/Fio2, Sequential Organ Failure Assessment, pH, base excess, and driving pressure consistently discriminated between survivors and nonsurvivors. Hospital mortality was 58%. One third of patients died early. Main causes of death were multiple organ dysfunction syndrome, sepsis, and septic shock; refractory hypoxemia was uncommon. Factors independently associated with mortality were organ dysfunctions on day 3, Pao2/Fio2 on day 3, and McCabe score. CONCLUSIONS: Acute respiratory distress syndrome was a frequent syndrome in this cohort. Sepsis was its leading cause, and pneumonia was the most common single diagnosis. Mortality was high but similar to most recent series that included serious comorbidities. Independent predictors of death 72 hrs after admission emphasize the importance of both extrapulmonary and pulmonary factors together with preexisting severe illnesses.     

肾移植受者死亡原因分析

目的 分析肾移植受者死亡原因,为提高肾移植受者长期生存率提供参考.方法 回顾性分析1990年1月至2010年12月间进行的2656例同种异体肾移植手术,共死亡285例,按肾移植时的年份分为1990~1995年(A)、1996~2000年(B)、2001~2005(C)、2006~2010年(D)4组,分析比较各组死亡率变化趋势.统计不同时间段死亡例数及各死亡原因构成比,并将其分为移植肾失功能死亡组(n=181)和移植肾带功能死亡组(n=104),对两组死亡原因进行比较分析.结果 4组肾移植受者死亡率分别为:A组28.21%;B组15.57%;C组8.14%、D组3.41%,B、C、D组与A组比较,差异有统计学意义(P<0.001).27.72%(79例)患者于肾移植术后3个月内死亡,该期死亡的主要原因是慢性充血性心力衰竭、感染;15.79%(45例)患者于术后3～5年死亡,死亡的原因主要为感染、慢性充血性心力衰竭.前3位死亡原因分别是,失功能组:慢性充血性心力衰竭(74例,40.88%)、肺部感染(26例,14.36%)、药物性肝衰竭(18例,9.94%);带功能组:肺部感染(46例,44.23%)、药物性肝衰竭(21例,20.19%)、心血管意外(2例,占1.92%).结论 肾移植受者死亡率随时间的发展呈明显下降趋势,患者死亡有两个高峰期:第一个是术后3个月,第二个是术后3～5年,感染是移植肾带功能组死亡的最主要原因,因心血管疾病死亡的风险在移植肾失功的受者中显著增加,加强对肺部感染及慢性充血性心力衰竭等并发症的防治十分关键.