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1.
目的评估CHA2DS2-VASc评分对急性心肌梗死(AMI)患者院内结局事件的预测价值。方法回顾性分析冠心病医疗结果评价和临床转化研究(China PEACE)回顾性急性心肌梗死研究中23728例AMI患者的病历信息,按CHA2DS2-VASc评分分为低(0~3分)、中(4~6分)、高(7~9分)分值组。院内结局包括主要不良心血管事件、死亡、死亡或放弃治疗、再发心肌梗死、缺血性卒中等。采用多因素Cox回归分析CHA2DS2-VASc评分对AMI患者院内结局的影响。通过受试者工作特征(ROC)曲线,评估CHA2DS2-VASc评分对AMI患者院内死亡与死亡或放弃治疗的预测价值。结果入组患者年龄66(56,75岁)岁,女性占30.7%。CHA2DS2-VASc评分高分值组患者院内结局事件发生率更高,基础疾病更多(P值均<0.001);多因素logistic回归中,院内病死率(OR=6.13,95%CI 4.77~7.87,P<0.001)、院内死亡或放弃治疗率(OR=6.43,95%CI 5.16~8.00,P<0.001)、主要心血管事件发生率(OR=4.94,95%CI 4.06~6.01,P<0.001)明显高于其他两组。ROC曲线分析显示,无论院内病死率,还是死亡或放弃治疗率,CHA2DS2-VASc评分与简化版全球急性冠状动脉事件登记(global registry of acute coronary events,mini-GRACE)评分相比差异无统计学意义(ROC曲线下面积:0.699与0.696,P=0.752;0.708与0.713,P=0.489)。结论CHA2DS2-VASc评分是一种有效预测AMI患者院内风险的评估工具,该评分操作简单,预测价值与mini-GRACE评分相当。  相似文献   
2.
目的探讨Ranson评分在高脂血症性急性胰腺炎病情严重程度评估中的应用价值。方法回顾性选取2016年2月至2021年2月北京中医医院怀柔医院中重度高脂血症性急性胰腺炎患者100例,依据病情严重程度分为中度组(全身或局部并发症2d以上无持续性器官衰竭或短暂性器官衰竭2d内消退,n=40)、重度组(2d以上持续性器官衰竭可能对肾脏、心血管、呼吸等系统至少一个器官造成累及,n=60)两组。统计分析两组患者的临床资料、Ranson评分,并统计分析不同Ranson评分患者的多脏器功能衰竭综合征、感染、局部并发症发生情况、死亡情况。结果两组患者的性别构成比、年龄、血脂最高水平之间的差异均无统计学意义(P>0.05),重度组患者血糖>11mmol/L、血钙≤2mmol/L、LDH>350U/L、白细胞数计数>16×109/L、Hct降低>16×109/L、碱缺乏>6mmol/L、液体需要量>6L的患者比率、Ranson评分均高于中度组,差异均有统计学意义(P<0.05)。重度组患者的Ranson评分3~4分患者比率低于中度组,5~10分患者比率高于中度组,差异有统计学意义(P<0.05)。100例患者中,多脏器功能衰竭综合征59例,死亡30例,多脏器功能衰竭综合征发病率、病死率分别为29.00%、12.00%,其中Ranson评分3~4分、5~6分、7~8分、9~10分患者的多脏器功能衰竭综合征发病率、病死率均逐渐升高(P<0.05)。死亡患者的Ranson评分高于多脏器功能衰竭综合征、感染、局部并发症患者(P<0.05),多脏器功能衰竭综合征、感染患者的Ranson评分均高于局部并发症患者(P<0.05),但多脏器功能衰竭综合征、感染患者的Ranson评分之间的差异无统计学意义(P>0.05);Ranson评分与多脏器功能衰竭综合征发病率、感染率、病死率均呈正相关关系但无线性关系(r=0.875,P<0.05),与局部并发症发生率无相关性(r=0.190,P>0.05)。结论Ranson评分对高脂血症性急性胰腺炎病情严重程度的评估有较高应用价值。  相似文献   
3.
《Australian critical care》2022,35(4):480-487
Patient death in critical care is not uncommon. Rather, the provision of end-of-life care is a core feature of critical care nursing, yet not all nurses feel adequately prepared for their role in the provision of end-of-life care. For this reason, the Australian College of Critical Care Nurses (ACCCN) supported the development of a Position Statement to provide nurses with clear practice recommendations to guide the provision of end-of-life care, which reflect the most relevant evidence and information associated with end-of-life care for adult patients in Australian critical care settings. A systematic literature search was conducted between June and July, 2020 in CINAHL Complete, Medline, and EMBASE databases to locate research evidence related to key elements of end-of-life care in critical care. Preference was given to the most recent Australian or Australasian research evidence, where available. Once the practice recommendations were drafted in accordance with the research evidence, a clinical expert review panel was established. The panel comprised clinically active ACCCN members with at least 12 months of clinical experience. The clinical expert review panel participated in an eDelphi process to provide face validity for practice recommendations and a subsequent online meeting to suggest additional refinements and ensure the final practice recommendations were meaningful and practical for critical care nursing practice in Australia. ACCCN Board members also provided independent review of the Position Statement. This Position Statement is intended to provide practical guidance to critical care nurses in the provision of adult end-of-life care in Australian critical care settings.  相似文献   
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Abscopal effect is an interesting phenomenon in radiobiology that causes activation of immune system against cancer cells. Traditionally, this phenomenon was known as a suppressor of non-irradiated tumors or metastasis. However, it can be used as a stimulator of the immune system against primary tumor during radiotherapy. Immunotherapy, a novel tumor therapy modality, also triggers immune system against cancer. To date, some immunotherapy types have been developed. However, immune checkpoint blockade is a more common modality and some drugs have been approved by the FDA. Studies have shown that radiotherapy or immunotherapy administered alone have low efficiency for tumor control. However, their combination has a more potent anti-tumor immunity. For this aim, it is important to induce abscopal effect in primary tumors, and also use appropriate drugs to target the mechanisms involved in the exhaustion of cytotoxic CD8+T lymphocytes (CTLs) and natural killer (NK) cells. Among the different radiotherapy techniques, stereotactic body radiation therapy (SBRT) with some few fractionations is the best choice for inducing abscopal effect. On the other hand, programmed cell death 1 (PD-1) is known as one of the best targets for triggering anti-tumor immunity. This combination is known as the best choice among various strategies for radioimmunotherapy. However, there is the need for other strategies to improve the duration of immune system’s activity within tumor microenvironment (TME). In this review, we explain the cellular and molecular mechanisms behind abscopal effect by radiotherapy and evaluate the molecular targets which induce potent anti-tumor immunity.  相似文献   
7.
《Indian heart journal》2019,71(6):481-487
BackgroundFrontal QRS-T angle (FQRST) has previously been correlated with mortality in patients with stable coronary artery disease, but its role as survival predictor after ST-elevation myocardial infarction (STEMI) remains unknown.MethodsWe evaluated 267 consecutive patients with STEMI undergoing reperfusion or coronary artery bypass grafting. Data assessed included demographics, clinical presentation, electrocardiograms, medical therapy, and one-year mortality.ResultsOf 267 patients, 187 (70%) were males and most (49.4%) patients were Caucasian. All-cause mortality was significantly higher among patients with the highest (101–180°) FQRST [28% vs. 15%, p = 0.02]. Patients with FQRST 1–50° had higher survival (85.6%) compared with FQRST = 51–100° (72.3%) and FQRST = 101–180° (67.9%), [log rank, p = 0.01]. Adjusting for significant variables identified during univariate analysis, FQRST (OR = 2.04 [95% CI: 1.31–13.50]) remained an independent predictor of one-year mortality. FQRST-based risk score (1–50° = 0 points, 51–100° = 2 points, 101–180° = 5 points) had excellent discriminatory ability for one-year mortality when combined with Mayo Clinic Risk Score (C statistic = 0.875 [95%CI: 0.813–0.937]. A high (>4 points) FQRST risk score was associated with greater mortality (32% vs. 19%, p = 0.02) and longer length of stay (6 vs. 2 days, p < 0.001).ConclusionFQRST represents a novel independent predictor of one-year mortality in patients with STEMI undergoing reperfusion. A high FQRST-based risk score was associated with greater mortality and longer length of stay and, after combining with Mayo Clinic Risk Score, improved discriminatory ability for one-year mortality.  相似文献   
8.
《Jornal de pediatria》2021,97(5):525-530
ObjectiveTo determine the prevalence of life support limitation (LSL) in patients who died after at least 24 h of a pediatric intensive care unit (PICU) stay, parent participation and to describe how this type of care is delivered.MethodsRetrospective cohort study in a tertiary PICU at a university hospital in Brazil. All patients aged 1 month to 18 years who died were eligible for inclusion. The exclusion criteria were those brain death and death within 24 h of admission.Results53 patients were included in the study. The prevalence of a LSL report was 45.3%. Out of 24 patients with a report of LSL on their medical records only 1 did not have a do-not-resuscitate order. Half of the patients with a report of LSL had life support withdrawn. The length of their PICU stay, age, presence of parents at the time of death, and severity on admission, calculated by the Pediatric Index of Mortality 2, were higher in patients with a report of LSL. Compared with other historical cohorts, there was a clear increase in the prevalence of LSL and, most importantly, a change in how limitations are carried out, with a high prevalence of parental participation and an increase in withdrawal of life support.ConclusionsLSLs were associated with older and more severely ill patients, with a high prevalence of family participation in this process. The historical comparison showed an increase in LSL and in the withdrawal of life support.  相似文献   
9.
目的调查本科护理实习生的死亡态度现状,探讨其影响因素,以期为本科护理实习生死亡教育提供参考与借鉴。方法通过一般资料调查问卷和死亡态度量表(中文修订版)(DAP-R),对广东省八家三甲医院实习的133名护理实习生进行问卷调查,并对死亡态度影响因素的结果进行分析。结果133名护理实习生死亡态度总分(98.41±16.44)分,其中各维度得分从低到高顺序排列依次为:死亡逃避、趋近接受、逃离接受、自然接受、死亡恐惧。是否接受过相关死亡教育课程因素在多元线性回归分析结果具有统计学意义(P<0.05)。结论是否接受过相关死亡教育是影响护理实习生的死亡态度因素,在护理教育中应围绕“死亡教育”主题开展形式多元化的培训,培养护理实习生科学的死亡观,用理性的态度对待死亡,使其更好地为临床工作服务。  相似文献   
10.
目的:了解老年(年龄≥75岁)急诊心房颤动(房颤)患者的预后情况,分析不良预后的危险因素。方法:2009年至2011年在全国20家医院连续入选急诊就诊、年龄≥75岁房颤患者为本研究对象,收集患者基线资料和治疗情况,并进行1年随访,主要终点事件为全因死亡,次要终点事件为心血管死亡、卒中、大出血事件及主要不良事件。应用单因素和多因素Cox回归模型分析上述事件的独立危险因素。结果:共入选766例老年急诊房颤患者,年龄(80.76±4.66)岁,女性占56.9%。1年的全因病死率为24.3%,心血管病死率为12.8%,卒中发生率为10.6%,主要不良事件发生率33.6%,再入院率32%。多因素Cox回归模型分析显示年龄( HR1.073,95% CI 1.042~1.105)、心率( HR 1.008,95% CI 1.002~1.013)、痴呆/认知障碍史( HR 1.849,95% CI 1.016~3.365)、既往慢性阻塞性肺疾病史( HR 1.824,95% CI 1.303~2.551)为老年房颤患者1年死亡的独立危险因素。女性( HR 1.664,95% CI 1.036~2.675)、高血压病史( HR 2.035,95% CI 1.080~3.836)、痴呆/认知障碍史( HR 2.773,95% CI 1.220~6.302)、为老年房颤患者1年卒中的独立危险因素。 结论:老年急诊房颤患者的预后较差,年龄、心率、痴呆/认知障碍史、慢性阻塞性肺疾病史是老年急诊房颤患者1年全因死亡和主要不良事件的独立危险因素;女性、高血压病史、痴呆/认知障碍史为老年急诊房颤患者1年卒中的独立危险因素。  相似文献   
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