Risk factors related to hospital mortality in patients with isolated traumatic acute subdural haematoma: analysis of 308 patients undergone surgery

Background Acute subdural haematoma （ASDH） is a common traumatic brain injury with a relatively high mortality rate. However, few studies have examined the factors predicting the outcome of isolated traumatic ASDH. This clinical study examined the hospital mortality and analyzed the risk factors for mortality in patients treated surgically for isolated traumatic ASDH.
Methods We collected 308 consecutive patients who underwent neurosurgery for isolated traumatic ASDH between January 1999 and December 2007 and used multivariate Logistic regression analysis to evaluate the influence of 11 clinical variables on hospital mortality.
Results The overall hospital mortality was 21.75% （67/308）. Age （OR=1.807）, preoperative Glasgow Coma Score （OR=0.316）, brain herniation （OR=2.181） and the time from trauma to decompression （OR=1.815） were independent predictors of death, while no independent association was observed between hospital mortality and haematoma volume, midline shift, acute brain swelling or brain herniation duration, although these variables were correlated with hospital mortality in univariate analyses.
Conclusions This study identified the risk factors for hospital mortality in patients who underwent surgical treatment for isolated traumatic ASDH. An increased risk of death occurs in patients who are over 50 years of age and have lower preoperative Glasgow Coma Scores, the presence of brain herniation and a long interval between trauma and decompression. The findings should help clinicians determine management criteria and improve survival.     

Analysis of 287 patients with aortic dissection: General characteristics,outcomes and risk factors in a single center

The general characteristics,outcomes and risk factors of the patients with aortic dissection(AD) were evaluated in a single medical center.From January 2002 to December 2008,284 patients with AD were treated and followed-up at our institution,including 105 cases of type A AD and 179 cases of type B AD.The patients in each type were divided into three groups according to management:medical treatment group(A or B),open surgery group(A or B),and stent-graft group(A or B).The characteristics and follow-up outcomes were compared between the groups or subgroups.The results showed that there was significant difference in the prognosis for type A AD between medical treatment group and open surgery group,but there was no significant difference in the prognosis for type B AD between medical treatment group and stent-graft group.Independent risk factors of follow-up mortality for patients with type A AD included a history of atherosclerosis(HR,3.807;95% confidence interval [CI],1.489 to 7.611;P=0.003),in-hospital hypotension/shock(HR,4.687;95% CI,1.846 to 11.900;P=0.001),in-hospital myocardial ischemia or infarction(HR,3.734;95% CI,1.613 to 8.643;P=0.002),pleural effusion(HR,2.210;95% CI,1.080 to 4.521;P=0.030),branch vessel involvement(HR,2.747;95% CI,1.202 to 6.278;P=0.016) and surgical treatment(HR,0.177;95% CI,0.063 to 0.502;P=0.001).And there were insignificant independent predictors for mortality of the patients with type B AD.It was concluded that there were significant differences in characteristics and one year mortality between type A AD and type B AD,but after one year,there was no significant difference in the mortality and complications of them.There were several discordant risk factors of AD,such as female gender,age,thrombus,abrupt onset of pain that were considered as the risk factors in some papers.And there was no definite risk factor of mortality in this study in the patients with type B AD.     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

Clinical treatment and prognostic observation for different pathological infiltrations in 537 patients with unilateral retinoblastoma

Background The use of post-enucleation adjuvant therapy to decrease the extraocular relapse rate is frequently considered, but there is much controversy about the indications for adjuvant therapy. The aim of this retrospective study was to observe the treatment and prognosis for different degrees of invasion of eye tissue in retinoblastoma （RB） and identify the indications for post-enucleation adjuvant therapy. Methods We recruited 537 children who had been diagnosed with unilateral RB and had received enucleation from January 2006 to December 2012 in our hospital, and divided them into three groups according to their number of histopathologic risk factors： 0 factor, 1 factor, or 〉2 factors. Histopathologic high-risk factors included invasion of the optic nerve posterior to the ethmoid plate （including optic nerve stumps） and extensive invasions of the choroid, sclera, anterior chamber, iris, and ciliary body. Treatment was delivered accordingly, and the prognosis of different degrees of histopathologic invasion was observed. The subjects were followed up for 6 months to 7 years （average follow-up time： 35 months）. Statistical analysis was analyzed using X2 test. P 〈0.05 was considered significant. Results Of the 537 RB patients who received enucleation, 25 died （overall survival： 95.3%）. Of the 369 （68.7%） with no histopathologic risk factors, 1 died of recurrence, with a mortality rate of 0.3%, whereas of the 168 （31.3%） with histopathologic risk factors, 26 had recurrences and 24 died （mortality rate： 14.3%; P=0.000）. Of the 93 patients （17.3%）, each of whom had a single risk factor, nine had recurrences, 16 died （8.6%）. Of the 75 patients （14%） with two or more high-risk factors, 16 died （21.3%）. These differences were statistically significant between the three （P=0.000）. Conclusion Chemotherapy is recommended for patients with histopathologic risk factors, especially those with two or more histopathologic risk factors.     

Risk factors of mortality in road traffic injury patients with acute respiratory distress syndrome

Background Among the deaths due to trauma, about one half of the patients suffer from road traffic injury （RTI）. Most of RTI patients complicate acute respiratory distress syndrome （ARDS） and severe multiple injuries. ARDS is a major contributor to morbidity and mortality in trauma patients. Although many injuries and conditions are believed to be associated with ARDS independent risk factors in trauma patients, their relative importance in development of the syndrome are undefined. We hypothesize that not all of the traditional risk factors impacting mortality are independently associated with patients strictly identified by traffic injury. This study aimed to sieve distinctive risk factors in our RTI population, meanwhile, we also hypothesize that there may exist significantly different risk factors in these patients.
Methods This was a retrospective cohort study regarding RTI as a single cause for emergency intensive care unit （EICU） admission. Patients identified as severe RTI with post-traumatic ARDS were enrolled in a prospectively maintained database between May 2002 and April 2007 and observed. Twenty-three items of potential risk impacting mortality were calculated by univariate and multivariate Logistic analyses in order to find distinctive items in these severe RTI patients.
Results There were 247 RTI patients with post-traumatic ARDS admitted to EICU during the study period. The unadjusted odds ratio （OR） and 95% confidence intervals （CI） of mortality were associated with six risk factors out of 23： APACHE II score, duration of trauma factor, pulmonary contusion, aspiration of gastric contents, sepsis and duration of mechanical ventilation. The adjusted ORs with 95% Cl were denoted with respect to surviving beyond 96 hours EICU admission （APACHE II score, duration of trauma factor, aspiration of gastric contents）, APACHE II score beyond 20 EICU admission （duration of trauma factor, sepsis, duration of mechanical ventilation） and mechanical ventilation beyond 7 days EIC     

Epidemiology of methicillin-resistant Staphylococcus aureus infection and empirical antibiotic therapy for MRSA infection: multicenter investigation

Background The epidemiology of methicillin-resistant Staphylococcus aureus （MRSA） maybe changed by strict infection control measures,and the impact of empirical antibiotic therapy on the outcomes of MRSA infection was not clear.We aimed to investigate the present epidemiological status of MRSA infection and empirical antibiotic therapy for MRSA infection in university teaching hospitals in mainland China.Methods The present study was a multicenter prospective observational study conducted in five university teaching hospitals.Patients who were consecutively admitted to the intensive care unit and signed a consent form from March 3,2011 to May 31,2011 were included.Patients with age 〈18 years or with a length of hospital stay 〈48 hours were excluded from this study.The following variables were collected or recorded：demographic data,general status,APACHE Ⅱ score of the patient at the time of admission,infections,and the use of antibiotics during a stay.Primary outcomes and prognostic indicators included length of hospital stay and 28-day and 90-day mortality.The differences between the patients with appropriate empirical therapy and patients with inappropriate therapy were analyzed to detect the influences of antibiotic therapy on the prognosis of MRSA infection.Results A total of 682 cases were enrolled.Thirty （66.2%） of 88 MRSA cases were treated with effective antibiotics for MRSA infection; only 20% received appropriate empirical antibiotic treatment.The empirical therapy group compared with the target therapy group had a shorter length of stay,but there were no significant differences in mortality rates.There were no significant differences in the length of hospital stay,length of stay,and 28-day and 90-day mortality between MRSA-infected patients who received or not received effective antibiotics.Two hundred and eighteen cases received sensitive antibiotics for MRSA.Conclusions The MRSA infection rates are at relatively low levels in university teaching hospitals in China.The empirical use of sensitive antibiotics for MRSA infection was at relatively high rate,and there is a tendency of overusing in patients without MRSA infection.On the other hand,the rate of appropriate empirical antibiotic therapy for patients with MRSA infection is relatively low.     

Is the use of cardiopulmonary bypass for isolated coronary artery bypass an independent predictor of mortality and morbidity in patients with severe left ventricular dysfunction?

Background Patients presenting with severe left ventricular dysfunction （SLVD） undergoing conventional coronary artery bypass grafting （CCABG） are at an increased risk of perioperative mortality and morbidity. The aim of this study was to assess the risk factors responsible for mortality and morbidity among patients with SLVD by comparing CCABG and oft-pump coronary artery bypass surgery （OPCAB）.
Methods We retrospectively evaluated 186 consecutive patients with SLVD who underwent coronary artery bypass grafting （CABG）, including 102 by CCABG and 84 by OPCAB. Registry database, medical notes, and charts were studied for preoperative and postoperative data of the patients. Different variables and risk factors （preoperative, intraoperative, and postoperative） were evaluated and compared. The morbidity and mortality outcomes were compared in the two groups. The follow-up results and quality of life were assessed after surgery.
Results The two groups had similar percentage of patients with preoperative high-risk profiles and no significant differences were found between groups in baseline variables such as age or comorbidities. There was a significant difference in the number of grafts used between the two groups. CCABG patients received （3.6±0.5） grafts per patient, while OPCAB patients had （2.7±0.6） grafts （P 〈0.05）. Completeness of revascularization was also significantly different between the two groups （CCABG 91.1% vs OPCAB 73.8%, P 〈0.05）. The hospital mortality was similar in the two groups （4.8% in OPCAB vs 5.9% in CCABG）. The risk-adjusted mortality, according to the calculated propensity score, did not reach statistical significance in the two groups. In this study, OPCAB seemed to have a beneficial effect on reducing reoperation for bleeding, blood transfusion requirement, and the length of stay at ICU. But the incidence of perioperative myocardial infarction was more common in the off-pump group （P 〈0.05）. The degree of improvement in angina and qual     

Association between fifteen risk factors and progressing ischemic stroke in the Han population of northeast China

Background The mortality and disability associated with progressing ischemic stroke are much higher than general ischemic stroke. This study was conducted to determine the risk factors for progressing ischemic stroke in the Han population of northeast China. Methods A total of 2511 patients with ischemic stroke within 24 hours admitted to Department of Neurology, First Affiliated Hospital of Harbin Medical University were studied, from November 2007 to May 2009. All of the patients were classified into the progressing or non-progressing group according to the scores of the Scandinavian Neurological Stroke Scale. Fifteen putative risk factors were evaluated. The influence of risk factors for progressing ischemic stroke was analyzed with the simple Logistic analysis, the multiple Logistic analysis, and the stepwise Logistic regression model. All the statistical analysis was performed by SAS 9.1. Results Totally 359 （14.3%） patients met the criteria for progressing ischemic stroke. The Logistic analysis showed that age, family stroke history, smoking history, hypertension on admission, a drop in blood pressure after admission to the hospital, high serum glucose on admission, and fever were related to progressing ischemic stroke in the Han population of northeast China. Conclusion People of the ischemic stroke with these factors are more likely to develop progressing ischemic stroke.     

重症新生儿胎粪吸入综合征预后危险因素分析

  目的  探讨影响重症胎粪吸入综合征(meconium aspiration syndrome，MAS)患儿预后的危险因素，分析这些因素的预测价值，为提高MAS的临床救治水平提供帮助。   方法  回顾性分析蚌埠医学院第一附属医院2014年1月—2019年12月收治的77例行机械通气治疗的重症MAS患儿的临床资料，根据治疗结果分为通气成功组和通气失败组，对2组患儿一般资料、动脉血气分析及其并发症进行比较，再对有统计学意义的观察指标进行受试者特征(ROC)曲线及多因素逐步logistic回归分析。   结果  (1) 通气失败组胎儿宫内窘迫、持续性肺动脉高压(PPHN)及多器官功能障碍(MODS)发生率分别为66.7%、41.7%及66.7%，均高于通气成功组(41.5%、5.7%、22.6%)，通气失败组的Apgar评分、pH值、动脉血氧分压(PaO₂)及碱剩余(BE)均明显低于成功组，比较差异均有统计学意义(均P < 0.05)。(2)多因素logistic回归分析显示PaO₂、BE值、PPHN、MODS是影响机械通气治疗MAS预后的独立危险因素。(3)ROC曲线分析显示BE值为-8.5是预测MAS预后的最佳界值点，敏感性和特异性分别为94.3%和58.3%；PaO₂为40.5 mm Hg(1 mm Hg=0.133 kPa)是预测MAS预后的最佳界值点，敏感性和特异性分别为79.2%和58.3%。   结论  PaO₂、BE值及并发症PPHN、MODS是影响机械通气治疗重症MAS患儿预后的独立危险因素，PaO₂及BE值有助于早期预测重症MAS患儿的预后，早期及时对这些危险因素采取防治措施有助于降低重症MAS的病死率。      

慢性阻塞性肺疾病急性加重期多器官功能衰竭的危险因素分析

目的分析慢性阻塞性肺疾病急性加重期多器官功能衰竭的危险因素。方法选择2004年1月至2009年11月住院的114例慢性阻塞性肺疾病急性加重期患者,按是否并发多器官功能衰竭分为两组:观察组为41例慢性阻塞性肺疾病急性加重期继发多器官功能衰竭的患者,对照组为73例为未发生多器官功能衰竭的慢性阻塞性肺疾病急性加重期患者。观察和对照采用统一的调查表,对研究资料先进行单因素分析,然后进行多因素非条件Logistic回归模型分析。结果经分析筛选出慢性阻塞性肺疾病的病程(OR=12.480)、COPD的治疗时机(OR=1.324)、有创通气(OR=11.055)、肺炎(OR=8.667)、持续发热(OR=3.836)这5个因素为慢性阻塞性肺疾病急性加重期伴多器官功能衰竭的独立危险因素。结论慢性阻塞性肺疾病急性加重期伴多器官功能衰竭与病程、有创通气关系最为密切,持续发热也可促发MODS。     

COPD患者医院获得性肺炎临床分析

目的:分析我院住院慢性阻塞性肺疾病(COPD)患者医院获得性肺炎(HAP)特点,并分析有效临床处理方式。方法:回顾性分析2007年1月～2011年12月资料完整的496例COPD患者,全部COPD患者均进行痰细菌学检查,并对呼吸衰竭、年龄、咳嗽反射、心力衰竭、广谱抗菌素应用时间、气管插管/切开、机械通气和重症监护室(ICU)住院时间等9个候选因素进行二项Logistic回归分析。结果:COPD患者中HAP患病率21.98%(109/496),HAP病死率19.27%(21/109)。致病菌123株中以耐药肺炎克雷伯菌(21.14%)和铜绿假单胞菌(20.33%)最常见。结论:COPD患者HAP发生较高,主要致病菌是肺炎克雷伯菌和铜绿假单胞菌。HAP的发生与呼吸衰竭、年龄、应用广谱抗菌素、气管插管/切开、机械通气和ICU住院时间密切相关。选择合适的抗菌药物,加强ICU管理和早期防治是降低HAP发生的关键。     

多器官功能障碍综合征合并急性肾损伤的相关危险因素分析

目的：探讨多器官功能障碍综合征(MODS)合并急性肾损伤(AKI)的相关危险因素,为MODS治疗提供依据。方法对我院2011年1月至2015年6月间收治的241例MODS患者进行回顾性分析,其中合并AKI患者149例作为观察组,未合并AKI患者92例作为对照组,应用单因素和多因素Logistic回归分析分析MODS合并AKI的相关危险因素。结果241例MODS患者中合并AKI 149例,占61.83%。单因素分析显示,观察组患者的年龄、呼吸频率、血糖、血钠、心输出量、血肌酐峰值显著高于对照组,血压、中心静脉压、pH值、外周血管阻力显著低于对照组,肠内营养、血液净化、机械通气应用率显著低于对照组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄、收缩压、中心静脉压、血肌酐峰值、氧合指数是MODS合并AKI患者死亡的主要危险因素,而肠内营养、血液净化和机械通气是MODS合并AKI患者死亡的保护性因素(P<0.05)。结论年龄、收缩压、中心静脉压、血肌酐峰值、氧合指数、动脉血二氧化碳分压是MODS合并AKI的主要危险因素,而肠内营养、血液净化和机械通气可以有效降低AKI发生率,临床治疗应予以重视。     

脓毒症急性肾损伤患者预后不良的影响因素

目的 探讨脓毒症急性肾损伤(AKIS)患者预后不良的相关危险因素。方法 选取2018年1月至2020年10月在我院收治的148例AKIS患者进行随访调查,依据住院期间28 d内是否发生死亡将其分为死亡组(n=67)、存活组(n=81);分析AKIS患者28 d内预后病死率,分别采用单因素比较法和多因素Logistic回归法,分别筛选如下因素:性别、年龄、BMI、心脑血管疾病、糖尿病、高血压、脓毒症严重程度、AKI分级、器官衰竭数量、机械通气、CRRT治疗、血管活性药物、低白蛋白血症、PCT、CRP、血乳酸、氧合指数、APACHEⅡ评分、SOFA评分等。结果148例AKIS患者28 d内病死率为45.27%(67/148);影响AKIS患者预后死亡的危险因素包括高龄(OR=2.550)、脓毒症休克(OR=5.349)、AKI分级(OR=4.406)、器官衰竭数量(OR=3.347)、机械通气(OR=3.983)、低白蛋白血症(OR=3.022)、PCT(OR=6.013)、APACHEⅡ评分(OR=2.770)等。结论 AKIS患者住院期间内具有很高的病死率,应根据筛选出的高危因素,进行早筛查、早预防、早治疗AKI,改善患者的预后,提高其生活质量。     

三种简易量表对慢性阻塞性肺疾病急性加重伴Ⅱ型呼吸衰竭患者病情的评估价值

目的探讨BAP-65、DECAF、CAPS三种量表对慢性阻塞性肺疾病（简称慢阻肺）急性加重伴Ⅱ型呼吸衰竭住院患者病情的评估价值。方法采集244例慢阻肺急性加重伴Ⅱ型呼吸衰竭患者入院时的基本资料及生理参数,进行回顾性分析,分别计算BAP-65、DECAF、CAPS评分,利用SPSS软件分析每种量表评估死亡率、机械通气率、机械通气组死亡率及有创通气率的ROC曲线下面积（AUROC）并比较。结果 BAP-65、DECAF、CAPS量表评估慢阻肺急性加重伴Ⅱ型呼吸衰竭住院患者死亡率的AUROC分别为0.731、0.765、0.711,评估机械通气的AUROC分别为0.638、0.702、0.617,评估机械通气组死亡率的AUROC分别为0.672、0.707、0.677,评估机械通气组采用有创通气方式的AUROC分别为0.745、0.732、0.627（BAP-65和CAPS评分比较,P〈0.05）。BAP-65或DECAF评分在4分以上的患者中,死亡率约为50%,需要机械通气支持的占95%以上。结论入院时BAP-65、DECAF、CAPS评分对于评估慢阻肺急性加重伴Ⅱ型呼吸衰竭患者的住院死亡率、机械通气率、机械通气患者的死亡率及有创通气率有一定价值,其中BAP-65、DECAF量表更加简洁实用。     

急性心肌梗死后合并多器官功能衰竭的老年患者预后相关因素分析

目的：探讨影响急性心肌梗死（AMI）后合并多器官功能衰竭（MODS）的老年患者预后相关因素。方法：回顾性分析84例AMI合并MODS患者病死率,根据患者预后分为存活组及死亡组,同时对预后相关情况、合并器官衰竭、治疗策略等30个因素进行组间比较,并将组间差别有统计学意义的因素进行多因素logistic回归分析。结果：患者病死率为56．0％。是否合并大面积前壁心肌梗死、是否合并陈旧性心肌梗死、是否合并肺部感染、是否出现心源性休克、是否使用IABP、Killip分级、是否使用机械通气及需要监护的时间等8个因素死亡组与存活组组间差异有统计学意义（均P〈0．05）。进一步多因素回归分析提示心源性休克、大面积前壁心肌梗死、肺部感染为AMI合并MODS的3个主要危险因素,OR分别为14．39、12．11及9．20。其中大面积前壁心肌梗死与心源性休克呈显著正相关（r=0．841,P〈0．01）。结论：急性心肌梗死合并多器官功能衰竭病死率高,尤其是出现大面积前壁心肌梗死、心源性休克等严重影响血流动力学及出现肺部感染等情况时,患者预后不良。如何防治血流动力学的急剧改变及肺部感染是改善老年AMI合并MODS患者预后的关键。     

重症患者血清钠水平对预后的影响

目的 探讨重症患者高钠血症的发生情况及血钠水平对预后的影响。方法 选取2016年1月—2018年1月天津医科大学总医院老年ICU预计住院时间>48?h的成年患者280例,入ICU后24?h内取血标本送检,按血钠水平分为正常血钠组（血钠135～145?mmol/L）、低血钠组（血钠<135?mmol/L）和高血钠组（血钠>145?mmol/L）。记录患者的一般情况、疾病组成、实验室指标、机械通气时间、ICU住院时间、预后等,并计算入ICU后24?h内的急性生理学和慢性健康状况评价Ⅱ评分（APACHEⅡ评分）和序贯器官衰竭（SOFA）评分;比较高血钠组与非高血钠组住院时间、病死率等指标。采用Logistic回归分析筛选重症患者死亡的危险因素。结果 纳入的280例重症患者中,非高血钠组197例,高血钠组83例,分别占总例数的70.4%和29.6%。高血钠组中严重脓毒症21例（25.3%）、肾功能不全15例（18.1%）,与非高血纳组比较,差异有统计学意义（P?<0.05）。高血钠组与非高血钠组性别、年龄比较,差异无统计学意义（P?>0.05）,在APACHEⅡ、住院时间及病死率方面差异有统计学意义（P?<0.05）。多因素Logistic分析显示,APACHEⅡ评分和血钠水平为影响重症患者死亡的独立危险因素（P?<0.05）。结论 APACHEⅡ评分和血钠水平为影响ICU重症患者死亡的独立危险因素。     

多器官功能障碍综合征回顾性分析及预后相关因素

[目的]探讨多器官功能障碍综合征（MODS）的病因、临床生理特征、病死率以及死亡危险因素．[方法]回顾性分析2010年1月2011年12月间收治的符合MODS诊断标准的69例患者临床资料,均在诊断MODS当天进行急性生理与慢性健康状况评分（APACHEII）及多器官功能障碍评分（MODS）,其他指标包括年龄、性别、起病至确诊时间、既往慢性疾病史、RICU滞留时间、脏器损伤数目、血气分析指标（A—aDO2,RI）、乳酸（Lac）．[结果]69例MODS患者主要致病因素为中毒（46．74％）及重症感染（18．48％）．生存组与死亡组起病至确诊时间、RICU滞留时间、APACHEII评分及MODS评分上差异均具有统计学意义（P〈0．05）．死亡组的A-aDO2,RI,Lac值明显高于生存组（P〈O．05）．MODS患者的病死率与发病至确诊时间、脏器损害数目呈正相关（P〈0．05）．MODS患者最易受累器官为肺（81．16％）,其次为中枢神经系统（62．32％）及心脏（52．12％）,累及心脏病死率最高（58．33％）,死亡率高于中枢神经系统（48．84％）及肺（46．43％）．Logistic回9-5分析结果显示,脏器损害数目、Lac是影响MODS预后的独立危险因子．[结论]中毒为MODS患者的主要致病因素．MODS患者最易受累器官为肺,其次为中枢神经系统,累及心脏病死率最高,其次为中枢神经系统及肺．脏器损害数目、APACHEII评分、MODS评分、Lac、A—aDO2及RI可作为影响MODS预后的危险因素,其中脏器损害数目、Lac可作为影响MODS预后的独立危险因子．     

老年急性胰腺炎83例发病特点及预后分析

目的:探讨老年急性胰腺炎(AP)的发病特点及预后影响因素。方法:回顾性分析83例老年AP患者临床资料,随机选择同期入院20～50岁AP患者124例作为非老年对照组,比较两组间的病因、临床特点及并发症,对其预后影响因素进行分析。结果:老年AP症状不典型,常见病因为胆源性(75.9%);与非老年AP组相比,老年AP并发症较多,其中感染37.3%、多器官功能障碍(MODS)38.6%、休克30.1%,差异具有显著性。老年AP中21例死亡,病死率25.3%,常见死亡因素为器官功能障碍和感染。Logistic回归显示,感染、肺和肾功能障碍是影响老年AP预后的独立危险因素。结论:老年AP病因以胆源性多见,易并发感染、休克和多器官功能障碍;感染、肺和肾功能障碍是影响老年AP预后的独立危险因素。积极控制感染、防治多器官功能障碍对老年AP的治疗具有重要意义。