Incidence of immediate postextubation complications in critically Ill adult patients

BackgroundPostextubation complication rates vary among studies. It is necessary to standardize a method to identify postextubation complications and determine their potential association with extubation failure and reintubation in critically ill adult patients.ObjectivesTo describe immediate (up to 60 min) endotracheal postextubation complications in critically ill adult patients and determine whether these complications are associated with extubation failure.MethodsSecondary analysis of a Randomized Clinical Trial that included 240 critically ill adult patients, who were eligible for extubation. Overall complications include at least one major complication (upper airway obstruction, desaturation, vomiting, post-obstructive pulmonary edema) and/or minor complications (bronchospasm, severe cough, hypertension, tachycardia, tachypnea, poor respiratory mechanics).ResultsIncidence of overall, major and minor complications was 71.2%, 30.9% and 62.7%, respectively. Forty (16.9%) patients failed extubation, and thirty (12.7%) were reintubated. Of 168 patients who developed a postextubation complication, 137 (81.5%) were successfully extubated. Only major complications were significantly associated with reintubation after extubation failure (p<0.001).ConclusionWe have observed high incidence rates of overall, major and minor complications. The development of major complications was statistically significantly associated with extubation failure and reintubation. It is still unknown whether the identification and treatment of immediate postextubation complications have positive effects on patients' clinical course or whether the complications are a mere effect of the extubation procedure.     

Cardiac sarcoidosis as an incidental finding: A case report

BackgroundThis case illustrates the evaluation of a healthy young male with ECG anomalies in a perioperative electrocardiogram (ECG) that ended up with the diagnosis of a severe systemic disease.CaseA 28-year-old man was attended at the outpatient cardiology department to perform a preoperative ECG for lacrimal duct obstruction surgery, which showed Q and T negative waves in inferior leads. Echocardiogram and cardiac magnetic resonance (CMR) displayed left ventricular (LV) aneurysm at basal segments of the inferior, posterior, and lateral wall with myocardial thinning and dyskinesia. CMR and thoracic computed tomography (CT) showed bilateral nodular images in parotid glands, cervical, and thoracic lymphadenopathies. All those findings suggested the diagnosis of sarcoidosis, which was supported by Gallium-67 single-photon emission computed tomography (SPECT) results and finally confirmed by skin biopsy.ConclusionsThe present case highlights the complexity of sarcoidosis diagnosis. This young male was apparently asymptomatic; however, at presentation, he actually had three manifestations of active sarcoidosis: lacrimal duct obstruction, skin lesions, and cervical lymphadenopathies. It is essential to have a low threshold for sarcoidosis suspicion in the setting of unexplained systemic signs and symptoms.     

游离前列腺特异性抗原百分比和前列腺特异性抗原密度对前列腺癌的诊断价值

目的探讨游离前列腺特异性抗原(PSA)百分比(f/tPSA)和PSA密度(PSAD)在PSA灰区(PSA介于4～10 ng/ml)患者中前列腺癌诊断的价值。方法回顾性分析258例于PSA灰区行前列腺穿刺活检患者的临床资料,按病理结果分为前列腺癌组(PCa组)和前列腺增生组(PBH组),比较两组f/tPSA和PSAD的差异;通过受试者工作特征(ROC)曲线分析法,评价f/tPSA和PSAD在预测前列腺癌中的价值。结果 258例中,病理确诊为前列腺癌70例,占27.13%。两组的f/tPSA和PSAD差异有统计学意义[PCa组vsBPH组:0.11±0.06 vs 0.16±0.07,(0.27±0.11)ng.ml-1.cm-3vs(0.20±0.09)ng.ml-1.cm-3,P<0.01]。ROC分析提示f/tPSA和PSAD的曲线下面积(AUC)分别为0.684和0.708,优于tPSA的AUC 0.566。结论 f/tPSA和PSAD是PSA灰区前列腺癌诊断理想的辅助参数。     

晚期血吸虫病患者血浆D-二聚体水平变化及诊断价值

目的 了解晚期血吸虫病患者体内血浆D-二聚体水平的变化。方法 对鄱阳湖区8个血吸虫病流行县的晚期血吸虫病患者以西门子公司产的配套血浆D-二聚体检测试剂作血浆D-二聚体水平检测。结果 共调查964例晚期血吸虫病患者,D-二聚体水平异常率达51.98%,最高值为5 960 μg/L;单纯性晚血和非单纯性晚血患者的血浆D-二聚体值分别为468.67±525.23和505.50±634.95,与健康人群比较差异有统计学意义(P_均<0.01),同时血浆D-二聚体水平与血吸虫病肝纤维程度呈弱正相关(r_单纯=0.067,r_非单纯=0.117,P_均<0.05);晚血患者的患病年数、腹水史和出血史影响血浆D-二聚体水平的变化。结论 晚期血吸虫病可造成血浆D-二聚体水平升高,血浆D-二聚体水平的变化可单独作为判断晚血患者病情指标。     

抗震作业时间地点与救灾人员心理状态的相关性

目的分析开展抗震救灾工作的时间和地点对救灾人员心理的影响,为针对性地开展心理干预提供依据。方法地震应急期,在灾区采用症状自评量表(SCL-90)对救灾人员进行测试,计算阳性项目数、总均分和各因子分,统计分析时间和地点因素对上述指标的影响。结果①按时间分组,10～12d组SCL-90指标显著高于其他两组(P<0.01),13～15d和16～18d两组间各指标差异无统计学意义(P>0.05)。②按救灾地点分组,汶川组总均分、各因子分高于其他组,差异具有统计学意义(P<0.01)。青川组除强迫、敌对、精神病性因子外,其余因子分高于彭州组,差异有统计学意义。③逐步回归分析,救灾地点和救灾时间对总均分的相关系数分别是12.25和-1.16。结论应急救灾人员的心理状态有明显的时间和地域特征,应根据该特征采取针对性的心理防护措施。     

老年糖尿病合并认知衰弱的研究进展

认知衰弱是一种动态的、可逆的病理性躯体衰老和神经退化过程,同时包含躯体衰弱和认知受损的综合状态。认知衰弱与老年糖尿病在发病特点、病理生理机制、疾病预后等多方面存在密切联系。笔者综合国内外相关文献,针对老年糖尿病合并认知衰弱群体,总结其综合评估﹑发病特点﹑有效干预这3个方面研究进展,为临床运用提供依据。目前没有统一的综合评估工具,建议针对评估场景和对象采用不同工具组合;营养干预、运动干预、血糖控制为目前有效干预方式,建议采取综合干预措施延缓疾病进展。     

中成药不良反应的诱发原因及热点问题分析

在我国,中成药的应用十分广泛.因其有存贮方便、随身携带、免煎煮、无异味和少刺激等优点,被广泛应用于疾病的预防与治疗。但随着应用的增多,近年来不断涌现的中成药不良反应/事件引起了国内外医药界的广泛重视。该文对近年来中成药不良反应的分类、常见的诱发因素等进行总结分析,并重点论述了中药注射剂合并用药、老年患者用药、补益药及包含有毒中药的中成药使用等热点问题,以提醒广大医护人员关注,尽可能降低其不良反应/事件的发生。     

北京地区4960例慢性阻塞性肺病住院患者心血管疾病发生率的回顾性调查

目的 分析慢性阻塞性肺病(COPD)住院患者心血管疾病(CVD)及其相关疾病的发生率顺位、年龄及性别特征,探讨近10年COPD患者CVD发生率的演变趋势.方法 对2000年1月1日至2010年3月20日解放军总医院、北京协和医院及北京医院住院病案数据库进行回顾性调查.结果 (1)入选患者4960例,男性3570例,女性1390例,平均年龄(72.2±10.4)岁.(2)合并CVD的COPD患者共2562例,CVD总发生率为48.8%,标化率为26.4%.标化率排名前三位为肺源性心脏病和肺循环疾病(15.8%)、心力衰竭(13.6%)和缺血性心脏病(10.6%).(3)男性COPD患者心绞痛、肺源性心脏病和肺循环疾病、急性肾功能衰竭等发生率较高(P＜0.05),而女性病例急性心肌梗死、心律失常(房颤/房扑)、心力衰竭、肺栓塞、高血压病、糖尿病等发生率较高(P＜0.05).(4)近10年COPD患者的心律失常发生率有随年龄增加而升高趋势,缺血性心脏病和心力衰竭发生率则逐年下降;COPD患者中CVD的女性比例呈上升趋势.结论 COPD住院患者中有近50%存在CVD及相关合并症,且不同年龄和性别患者CVD合并症发生率的变化趋势各具特点.

Abstract：

Objective To retrospectively explore the prevalence of cardiovascular disease (CVD) in inpatients with chronic obstructive pulmonary disease(COPD)in Beijing.Methods The COPD patients who were discharged from the General Hospital of the Liberation Army,Peking Union medical college Hospital and Beijing Hospital between January 1st,2000 to March 20th,2010,were investigated.The prevalence of CVD were calculated.The tendency of the prevalence of CVD by age or discharge year and the difference of the prevalence of CVD between male and female were estimated by using chi-square analysis.Results There were 4960 COPD patients who were in accordance with the inclusion criteria with 3570 males and 1390 females.The mean age was 72.2±10.4 years.Of the COPD patients,48.8% were diagnosed as cardiovascular diseases.The age-adjusted over-all prevalence of CVD was 26.4%.Chronic pulmonary heart disease and other disease of pulmonary artery(15.8%)was the most frequent diseases,followed by heart failure(13.6%),ischemic heart disease (10.6%).In COPD patients,male was more likely to have angina,pulmonary heart disease and other disease of pulmonary artery and acute kidney failure (P＜0.05),while less likely to get arrhythmia (atrial fibrillation/atrial flutter),heart failure,pulmonary embolism,hypertension and diabetes mellitus (P＜0.05).The prevalence of arrhythmia increased with age,however,the ischemic heart disease and heart failure decreased.The proportion of CVD decreased in male patients while increased in females.Conclusion The overall prevalence of CVD comorbidities was 48.8% in 4960 patients with COPD who were older than 40 years in Beijing.There were differences among the groups of various age and sex in the distribution of CVD comorbidities frequencies year by year.     

急性高碳酸血症呼吸衰竭老年患者无创通气治疗失败风险评估模型研究

目的探究急性高碳酸血症呼吸衰竭(AHRF)老年患者无创通气(NIV)治疗失败的高危因素,构建失败风险评估模型。方法回顾性分析2015年8月至2017年8月在北京医院因AHRF行NIV治疗的100例老年住院患者资料,应用Cox比例风险模型探究AHRF老年患者NIV治疗失败的危险因素并建立风险评估模型;根据模型对患者进行危险度分层,比较不同危险分层患者NIV治疗失败率的差异,并通过构建受试者工作特征曲线(ROC),评价模型预测价值。结果NIV治疗前心率≥120次/min、胸部X线片示病变浸润≥3个象限、合并重症肺炎和简化急性生理学评分Ⅱ(SAPSⅡ)≥34分是AHRF老年患者NIV治疗失败的独立危险因素(P<0.05)。NIV治疗失败风险指数=0.808X 1(心率≥120次/min)+1.067X 2(胸部X线片示病变浸润≥3个象限)+1.79X 3(合并重症肺炎)+0.675X 4(SAPSⅡ≥34分)。随着风险模型评分的增加,AHRF老年患者NIV治疗失败率显著增加(P<0.001)。该模型ROC曲线下面积为0.882(95%CI:0.817~0.948,P<0.001)。结论NIV治疗前心率≥120次/min、胸部X线片示病变浸润≥3个象限、合并重症肺炎和SAPSⅡ≥34分是AHRF老年患者NIV治疗失败的独立危险因素,失败风险评估模型预测效能良好。