降酸方联合非布司他治疗急性顽固性痛风性关节炎的临床观察

目的观察自拟降酸方联合非布司他治疗急性顽固性痛风性关节炎的临床疗效。方法选择2017年1月～2019年9月门诊收治的确诊为急性痛风性关节炎的患者100例,分为西药组和中西药组,西药组给予非布司他片,80 mg,每日1次口服,20 d为1个疗程。中西药组在西药组基础上给予降酸方,每日两次,20 d为1个疗程,早晚饭后半小时温服。比较两组治疗前和治疗20 d后血尿酸、C反应蛋白及疼痛评分,评估两组有效率。并比较中西药组治疗前和治疗3个月后的疼痛改善情况。结果治疗前两组UA、CRP和VAS比较,差异无统计学意义(P0.05)。治疗20 d后两组UA、CRP和VAS均低于治疗前,两组比较差异有统计学意义(P0.05)。中西药组愈显率为100%,明显好于西药组的14%(P0.05)。治疗前疼痛功能分级优0例,良4例,可38例,差8例。治疗3个月后优21例,良29例,可0例,差0例。治疗前CI(0.699,0.777),治疗后CI(0.224,0.300),值小的疗效好。结论自拟降酸方联合非布司他能显著降低血尿酸及C反应蛋白,并降低疼痛评分,明显优于单纯非布司他治疗,对于急性顽固性痛风性关节炎疗效显著,费用低廉,可以长期使用,值得临床推广。     

Prognostic Value of TIMI Score versus GRACE Score in ST-segment Elevation Myocardial Infarction

Background

The TIMI Score for ST-segment elevation myocardial infarction (STEMI) was created and validated specifically for this clinical scenario, while the GRACE score is generic to any type of acute coronary syndrome.

Objective

Between TIMI and GRACE scores, identify the one of better prognostic performance in patients with STEMI.

Methods

We included 152 individuals consecutively admitted for STEMI. The TIMI and GRACE scores were tested for their discriminatory ability (C-statistics) and calibration (Hosmer-Lemeshow) in relation to hospital death.

Results

The TIMI score showed equal distribution of patients in the ranges of low, intermediate and high risk (39 %, 27 % and 34 %, respectively), as opposed to the GRACE Score that showed predominant distribution at low risk (80 %, 13 % and 7%, respectively). Case-fatality was 11%. The C-statistics of the TIMI score was 0.87 (95%CI = 0.76 to 0.98), similar to GRACE (0.87, 95%CI = 0.75 to 0.99) - p = 0.71. The TIMI score showed satisfactory calibration represented by χ2 = 1.4 (p = 0.92), well above the calibration of the GRACE score, which showed χ2 = 14 (p = 0.08). This calibration is reflected in the expected incidence ranges for low, intermediate and high risk, according to the TIMI score (0 %, 4.9 % and 25 %, respectively), differently to GRACE (2.4%, 25% and 73%), which featured middle range incidence inappropriately.

Conclusion

Although the scores show similar discriminatory capacity for hospital death, the TIMI score had better calibration than GRACE. These findings need to be validated populations of different risk profiles.     

丁苯酞软胶囊治疗基底动脉尖综合征的疗效观察

目的 观察丁苯酞软胶囊治疗轻、中度基底动脉尖综合征的临床疗效.方法 将60例轻、中度基底尖动脉综合征患者随机分为治疗组和对照组,每组各30例.对照组予以常规治疗,治疗组在常规治疗基础上加用丁基苯酞软胶囊口服,疗程为14d.采用NIHSS评分与BI评分评价治疗前,治疗后第7天和第14天两组的神经功能与日常生活能力.结果 治疗后两组的NIHSS评分显著降低,BI评分显著增高(P＜0.05).治疗组在治疗后第7天和第14天的NIHSS评分明显低于治疗前及对照组,差异均具有统计学意义(P＜0.05);在治疗后第7天和第14天的BI评分则明显高于治疗前及对照组,差异均具有统计学意义(P＜0.05).结论 丁苯酞软胶囊治疗轻度中度基底动脉尖综合征具有较好的临床疗效.     

戒烟对老年中、重度慢性阻塞性肺疾病患者的康复效果研究

目的 探讨戒烟结合肺康复训练对老年中、重度慢性阻塞性肺疾病(COPD)的康复效果.方法 将60例有中-重度吸烟史的老年中、重度COPD住院患者分成戒烟治疗组(30例)和一般对照组(30例).治疗组除采用常规临床治疗和肺康复治疗外,还采用全面戒烟措施.对照组采用非戒烟治疗.治疗前、后两组均采用BODE评分评定患者康复情况.结果 治疗前两组的BODE评分 差异无统计学意义(P>0.05).治疗3个月后,康复治疗组的BODE评分明显降低.与自身治疗前及对照组比较,差异均有统计学意义(P<0.01).结论 采用强制戒烟措施结合呼吸康复训练,能显著降低老年中、重度COPD患者的BODE评分,改善COPD患者的呼吸困难症状,提高生存质量.     

Excellent Results and Minimal Complications of Total Hip Arthroplasty in Sickle Cell Hemoglobinopathy at Mid-Term Follow-Up Using Cementless Prosthetic Components

The purpose of this study was to compare the outcomes of cementless primary total hip arthroplasty (THA) in sickle cell patients compared to the remaining cohort of osteonecrosis patients who did not have this disease. Thirty-two sickle cell patients (42 hips) who had a mean age of 37 years and mean follow-up of 7.5 years (range, 5–11 years) were compared to 87 non-sickle cell osteonecrosis patients (102 hips) who had mean age of 43 years and mean follow-up of 7 years (range, 3–10.5 years). Outcomes evaluated included implant survivorship, Harris hip scores, complication rates, radiographic outcomes, and Short Form-(SF-36) health questionnaire. There were no significant differences in aseptic implant survivorship (95 vs. 97%), Harris hip scores (87 vs. 88 points), SF-36 score, or radiographic findings between the two patient cohorts. In light of these findings, we believe that the outcomes of THA improved in sickle cell patients with optimized medical management and the use of cementless prosthetic devices.     

Mortality Risk Factors and Validation of Severity Scoring Systems in Critically Ill Patients with Acute Renal Failure

Background. Risk stratification and prediction of outcome in acute renal failure patients in the intensive care unit are important determinants for improvement of patient care and design of clinical trials. Methods. In order to identify mortality risks factors and validate general and specific predictive models for acute renal failure (ARF) patients in the intensive care unit (ICU), 324 patients were prospectively evaluated. Multivariate analysis by logistic regression was utilized for identification of mortality risk factors. Discrimination and calibration were used to evaluate the performance of the following models at referral to nephrologist and at initiation of renal replacement therapy: APACHE II, SAPS II, LODS, and ATN-ISI. Organ failure was assessed by SOFA and OSF. Results. The hospital mortality rate was 85%. The identified mortality risk factors were: age ≥ 65 yr, BUN ≥ 70 mg/dL, ARF of septic origin, and previous hypertension. Serum creatinine ≥ 3.5 mg/dL, systolic blood pressure ≥ 100 mm Hg, and normal consciousness were associated with mortality risk reduction. Performance of all prognostic models was disappointing with unsatisfactory calibration and underestimation of mortality on the day of referral to the nephrologist and at initiation of renal replacement therapy. Conclusions. Cross-validation of prognostic models for ARF resulted in poor performance of all studied scores. Therefore, a specific model is still warranted for the design of clinical trials, comparison of studies, and for prediction of outcome in ARF patients, especially in the ICU.     

Community-acquired pneumonia

Community-acquired pneumonia (CAP) is a common inflammatory process contained within the lungs in response to infection with non-hospital pathogens. Full resolution usually occurs with appropriate antimicrobial therapy. A significant proportion of patients develop severe CAP where there is failure to contain the local immune response. These patients can develop septic shock requiring admission to the intensive care unit. The CURB65 severity score is a rapid, objective way of predicting mortality and can be used to guide site of care decisions in conjunction with clinical assessment. Microbiological investigation of severe CAP permits pathogen-specific antibiotic therapy and provides epidemiological data. Complications include parapneumonic effusions and empyema. Outcome from severe CAP can be improved by prompt antibiotic therapy.     

Length of mechanical restraint following haloperidol injections versus oral atypical antipsychotics for the initial treatment of acute schizophrenia: A propensity-matched analysis from the Japanese diagnosis procedure combination database

Differences in effectiveness between haloperidol injection and oral atypical antipsychotics in the acute-phase treatment of schizophrenia are not well examined. We retrospectively investigated whether these treatment options affected the length of mechanical restraint. We used the Japanese Diagnosis Procedure Combination Database to identify schizophrenia patients who were involuntarily hospitalized and receiving mechanical restraint between July and December, 2006–2009. Data included patient demographics, use of antipsychotics, and number of days on which patients underwent mechanical restraint. Propensity score matching was performed to compare the number of days of mechanical restraint between the haloperidol injection group and the oral atypical antipsychotics group. We used survival analysis to examine whether the initial difference in treatment affected the number of days of mechanical restraint. Cox regression was performed to compare the concurrent effects of various factors. Among 1731 eligible patients, 574 were treated with haloperidol injections and 420 with atypical antipsychotics. Matching produced 274 patients in each group. Cox regression analysis showed that the initial therapeutic agents did not significantly affect the number of days of mechanical restraint. The results indicate that atypical antipsychotics were as effective as haloperidol injections in the acute-phase treatment of schizophrenia.     

血小板数量动态变化对脓毒症预后预测价值的初步探讨

摘要：目的　探讨血小板数量动态变化对脓毒症28 d病死率的预测价值。方法　回顾性研究2018年1月—2019年12月我院重症监护病房（ICU）连续收治的脓毒症患者,采集入ICU后14 d内血小板计数（PLT）动态数据。以第7天PLT较基线降低幅度大于20%为标准定义进行性血小板减少（PTCP）,绘制ROC曲线评价PTCP和序贯器官衰竭（SOFA）评分对脓毒症28 d病死率的预测价值。应用Logistic回归分析脓毒症28 d病死率的危险因素。采用Kaplan-Meier法对合并与未合并PTCP患者进行生存分析。结果　148例脓毒症患者纳入研究,死亡组30例,生存组118例,28 d病死率20.3%。与生存组相比,死亡组SOFA评分、高值D-二聚体（hD-dimer）占比、TCP、PTCP发生率显著升高（P＜0.01）。入院5 d后死亡组PLT呈进行性下降趋势,第7、10、14天生存组PLT高于死亡组,差异有统计学意义（P＜0.01）。PTCP、SOFA以及两者联合预测脓毒症死亡风险的ROC曲线下面积分别为0.683、0.691及0.778。Logistic回归显示,PTCP是脓毒症28 d死亡独立危险因素（P＜0.01）。Kaplan-Meier生存分析显示,合并PTCP时28 d生存率明显降低（P＜0.01）。结论　PTCP是脓毒症28 d死亡的独立危险因素;PTCP对脓毒症28 d病死率有一定预测价值,联合基线SOFA评分可提高预测效能。