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1.
目的探讨基于量化评估下的早期循序渐进康复训练对ICU机械通气患者预后的影响。方法选取2019年1月-2020年12月ICU机械通气患者96例,将2019年1月-12月48例患者设为对照组,将2020年1月-12月48例患者设为观察组。对照组行ICU常规护理,观察组在对照组的基础上实施基于量化评估下的早期循序渐进康复训练。比较两组干预前、干预后1个月神经肌肉功能、肌力、并发症发生及预后情况。结果观察组干预后神经肌肉功能总分及各维度评分、肌力评分显著高于对照组(P<0.05)。观察组机械通气时间、入住ICU时间、总住院时间显著短于对照组(P<0.05),观察组ICU获得性肌无力、呼吸机相关性肺炎、压疮发生率显著低于对照组(P<0.05)。结论基于量化评估下的早期循序渐进康复训练能有效改善机械通气患者神经肌肉功能,降低ICU获得性肌无力、呼吸机相关性肺炎及压疮发生率,有利于患者预后及康复。  相似文献   
2.
目的:观察压力支持通气模式(Pressure Support Ventilation,PSV)对重症监护患者睡眠质量的影响。方法:选取2017年1月至2017年8月德州市陵城区人民医院重症监护病房(ICU)收治的重症治疗患者60例作为研究对象,按照随机数字表法分为观察组和对照组,每组30例。对照组患者给予低剂量镇静加气管插管的方式进行干预,观察组患者给予压力支持通气模式进行干预,采用匹兹堡睡眠指数量表(Pittsburgh Sleep Quality Index,PSQI)比较2组患者干预前后的睡眠质量改善情况,采用抑郁自评量表(Self-rating Depression Scale,SDS)、焦虑自评量表(Self-rating Anxiety Scale,SAS)比较2组患者干预前后的焦虑以及抑郁状态改善情况。结果:干预后,观察组PSQI评分显著低于对照组,观察组SAS评分、SDS评分显著低于对照组,2组比较差异均有统计学意义(P<0.05)。结论:对重症监护患者采用压力支持通气模式有利于改善患者的睡眠质量。  相似文献   
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4.
ObjectivesInitial studies of individuals with coronavirus disease 2019 (COVID-19) revealed that obesity, diabetes and hypertension were associated with severe outcomes. Subsequently, some authors showed that the risk could vary according to age, gender, co-morbidities and medical history. In a nationwide retrospective cohort, we studied the association between these co-morbidities and patients' requirement for invasive mechanical ventilation (IMV) or their death.MethodsAll French adult inpatients with COVID-19 admitted during the first epidemic wave (February to September 2020) were included. When patients were diagnosed with obesity, diabetes or hypertension for the first time in 2020, these conditions were considered as incident co-morbidities, otherwise they were considered prevalent. We compared outcomes of IMV and in-hospital death according to obesity, diabetes and hypertension, taking age, gender and Charlson's co-morbidity index score (CCIS) into account.ResultsA total of 134 209 adult inpatients with COVID-19 were included, half of them had hypertension (n = 66 613, 49.6%), one in four were diabetic (n = 32 209, 24.0%), and one in four were obese (n = 32 070, 23.9%). Among this cohort, IMV was required for 13 596 inpatients, and 19 969 patients died. IMV and death were more frequent in male patients (adjusted oods ratio (aOR) 2.0, 95% CI 1.9–2.1 and aOR 1.5, 95% CI 1.4–1.5, respectively), IMV in patients with co-morbidities (aOR 2.1, 95% CI 2.0–2.2 for CCIS = 2 and aOR 3.0, 95% CI 2.8–3.1 for CCIS ≥5), and death in patients aged 80 or above (aOR 17.0, 95% CI 15.5–18.6). Adjusted on age, gender and CCIS, death was more frequent among inpatients with obesity (aOR 1.2, 95% CI 1.1–1.2) and diabetes (aOR 1.2, 95% CI 1.1–1.2). IMV was more frequently necessary for inpatients with obesity (aOR 1.9, 95% CI 1.8–2.0), diabetes (aOR 1.4, 95% CI 1.3–1.4) and hypertension (aOR 1.7, 95% CI 1.6–1.8). Comparatively, IMV was more often required for patients with the following incident co-morbidities: obesity (aOR 3.5, 95% CI 3.3–3.7), diabetes (aOR 2.0, 95% CI 1.8–2.1) and hypertension (aOR 2.5, 95% CI 2.4–2.6).ConclusionsAmong 134 209 inpatients with COVID-19, mortality was more frequent among patients with obesity and diabetes. IMV was more frequently necessary for inpatients with obesity, diabetes and hypertension. Patients for whom these were incident co-morbidities were particularly at risk. Specific medical monitoring and vaccination should be priorities for patients with these co-morbidities.  相似文献   
5.
《Pancreatology》2022,22(5):665-670
Background and objectivesHyperlipasemia is highly prevalent among coronavirus disease 2019 (COVID-19) patients. The aim of this study was to assess the effect of lipase activity, measured at the time of admission, on the clinical course and mortality in COVID-19 patients.MethodsThe population of this study comprised 12,139 patients who were hospitalized due to COVID-19 between June 2020 and June 2021 in a pandemic hospital. Of these, 8819 patients were excluded from the study due to missing data, four patients were excluded due to a diagnosis of acute pancreatitis (according to the revised Atlanta criteria), and 72 patients were excluded due to alcohol use or having a history of chronic pancreatitis. The final study sample consisted of the remaining 3244 COVID-19 patients. Laboratory results, intensive care unit (ICU) follow-up periods, the need for mechanical ventilation, and mortality rates were compared between the normal lipase activity and high lipase activity groups.ResultsThere were 968 (29.8%) patients with high lipase activity at the time of admission. The rate of ICU admission was 36.1% vs. 9.9% (p < 0.001), mechanical ventilation requirement rates were 33.7% vs. 8.3% (p < 0.001), and mortality rates were as 24.6% vs. 6.4% (p < 0.001) in the high lipase activity group compared to the normal lipase activity group. Multivariate regression analysis revealed that high lipase activity was an independent factor in predicting mortality in hospitalized COVID-19 patients (odds ratio [OR]: 3.191, p < 0.001).ConclusionElevated lipase activity without acute pancreatitis at the time of admission in COVID-19 patients was determined as an independent predictor of poor prognosis.  相似文献   
6.
近年来,无创通气在儿童呼吸支持领域有了较快发展。无创通气无需气管插管,操作简便,对部分呼吸道疾病有较为满意的疗效。但是,无创通气不能完全替代有创机械通气。在有些疾病无创通气不仅有着较高的失败率,而且会因气管插管的延误导致病情恶化,增加患儿的病死率。在行无创通气之前需评估患儿是否适宜进行无创通气治疗。对于进行无创通气治疗的患儿需严密监护,动态观察生理指标和监测数据的变化,掌握好气管插管的时机,以免造成有创机械通气治疗的延误。  相似文献   
7.
石雯  周抒 《新医学》2022,53(9):649-654
目的 建立稳定的宫腔粘连(IUA)病理性再生动物实验模型。方法 将30只雌性SD大鼠随机分为实验组和对照组, 每组各15只。实验组通过自制2 mm直径刮匙分别对动情期大鼠的左、右侧子宫内膜进行轻度、重度机械损伤并设为轻度机械损伤组、重度机械损伤组;对照组大鼠开腹后不做子宫内膜损伤处理, 进行假手术对照。分别于术后0 h、24 h、72 h、5 d、7 d从每组随机选取3只大鼠取出双侧子宫行快速冰冻切片, 分别进行子宫内膜细胞中主要组织相容性复合体Ⅱ类分子(MHCⅡ)、5-溴脱氧尿苷(BrdU)免疫组织化学染色, 观察术后7 d不同大鼠内膜腺体情况以及术后不同时期不同机械损伤程度的大鼠子宫内膜组织炎性反应及子宫内膜组织增生修复变化。结果 轻度机械损伤组术后7 d可见少量红染含BrdU的细胞及蓝染的MHCⅡ细胞, 子宫内膜基本修复, 轻度炎症反应存在;重度机械损伤组术后7 d未见腺体或腺体数目极少, 未见明显红染含BrdU的细胞, 可见少许蓝染的MHCⅡ细胞、轻度炎症反应、内膜组织纤维化, 局部管腔闭合, 出现粘连。与对照组相比, 术后7 d大鼠子宫内膜腺体数目随着子宫内膜机械性受损伤程度增加而相应减少(P < 0.001)。结论 采用切开缝合子宫内膜机械损伤法可以成功建立大鼠IUA模型。大鼠子宫内膜轻度机械损伤后可以再生达到基本修复水平, 而重度机械损伤后子宫内膜组织无法达到基本修复, 且出现组织纤维化导致IUA。  相似文献   
8.
IntroductionThe risk of mortality in patients with COVID-19 was found to be significantly higher in patients who experienced thromboembolic events. Thus, several guidelines recommend using prophylactic anticoagulants in all COVID-19 hospitalized patients. However, there is uncertainty about the appropriate dosing regimen and safety of anticoagulation in critically ill patients with COVID-19. Thus, this study aims to compare the effectiveness and safety of standard versus escalated dose pharmacological venous thromboembolism (VTE) prophylaxis in critically ill patients with COVID-19.MethodsA two-center retrospective cohort study including critically ill patients aged ≥ 18-years with confirmed COVID-19 admitted to the intensive care unit (ICU) at two tertiary hospitals in Saudi Arabia from March 1st, 2020, until January 31st, 2021. Patients who received either Enoxaparin 40 mg daily or Unfractionated heparin 5000 Units three times daily were grouped under the “standard dose VTE prophylaxis and patients who received higher than the standard dose but not as treatment dose were grouped under ”escalated VTE prophylaxis dose“. The primary outcome was the occurance of thrombotic events, and the secondary outcomes were bleeding, mortality, and other ICU-related complications.ResultsA total of 758 patients were screened; 565 patients were included in the study. We matched 352 patients using propensity score matching (1:1). In patients who received escalated dose pharmacological VTE prophylaxis, any case of thrombosis and VTE were similar between the two groups (OR 1.22;95 %CI 0.52–2.86; P = 0.64 and OR 0.75; 95% CI 0.16–3.38; P = 0.70 respectively). However, the odds of minor bleeding was higher in patients who received escalated VTE prophylaxis dose (OR 3.39; 95% CI 1.08–10.61; P = 0.04). There was no difference in the 30-day mortality nor in-hospital mortality between the two groups (HR 1.17;95 %CI0.79–1.73; P = 0.43 and HR 1.08;95 %CI 0.76–1.53; P = 0.83, respectively).ConclusionEscalated-dose pharmacological VTE prophylaxis in critically ill patients with COVID-19 was not associated with thrombosis, or mortality benefits but led to an increased risk of minor bleeding. This study supports previous evidence regarding the optimal dosing VTE pharmacological prophylaxis regimen for critically ill patients with COVID-19.  相似文献   
9.
AIM: To investigate the ratio of spontaneous regression of retinopathy of prematurity (ROP) and to explore the possible relevant predictive factors. METHODS: A retrospective review of 405 infants who were diagnosed with ROP and mother during pregnancy were collected. Stage, zone, and duration of ROP were recorded. Statistical analysis was performed on 51 possible predictive factors. RESULTS: Totally 356 infants showed spontaneous regression. The incidence was 100%, 95.3%, and 22.7% in stage 1, 2, and 3, respectively. The 13.4% of the ROP with plus disease eventually resolved spontaneously. All affected eyes of aggressive posterior retinopathy of prematurity (AP-ROP) failed to spontaneously regress. The mean duration of ROP was 7.2wk in patients with spontaneous resolution of ROP. Days of mechanical ventilation (OR=0.981, 95%CI, 0.965-0.997, P=0.021), retinal hemorrhage (OR=0.173, 95%CI, 0.064-0.470, P=0.001), delivery pattern (OR=2.750, 95%CI, 1.132-6.681, P=0.025), maternal anemia in pregnancy (OR=0.142, 95%CI, 0.036-0.563, P=0.005), the stages (at initial diagnosis OR=0.183, 95%CI, 0.041-0.816, P=0.026; at final diagnosis OR=0.031, 95%CI, 0.006-0.167, P<0.001), and with plus disease or not (OR=0.005, 95%CI, 0.001-0.031, P<0.001) were independent predictive factors of the spontaneous regression of ROP. CONCLUSION: Most mild ROP can spontaneously resolve. Active treatment is still recommended for stage 3 ROP, zone I ROP, AP-ROP, and ROP with plus disease. Prolonged mechanical ventilation and concurrent retinal hemorrhage reduce the likelihood of spontaneous ROP resolution. The pattern of delivery and the mother’s anemia during pregnancy can also affect the prognosis of ROP.  相似文献   
10.
目的探索后循环急性缺血性脑卒中(PCS)患者经机械取栓并完全恢复前向血流后部分患者临床预后仍然不佳的影响因素。 方法连续纳入2017年1月至2020年9月于我院接受机械取栓治疗的PCS患者并进行回顾性分析。闭塞血管完全恢复前向血流定义为改良脑梗死溶栓血流分级(mTICI)达3级。90 d改良Rankin评分(mRS)> 2分则被定义为预后不良。将患者基线资料、治疗相关指标纳入多因素分析,并采用受试者工作特征曲线(ROC)来确定最佳界值。 结果共纳入39例经机械取栓治疗后完全恢复前向血流(mTICI 3级)的PCS患者。其中,预后不良患者共20例(51.3%)。采用逐步Logistic回归分析显示,入院时美国国立卫生研究院卒中量表(NIHSS)评分较高(OR = 1.21,95%CI = 1.037~1.414,P = 0.016)、后交通动脉(PcomA)未开放(OR = 0.052,95%CI = 0.005~0.557,P = 0.014)为90 d不良预后的独立预测因素。基于ROC曲线分析显示,入院时NIHSS评分曲线下面积为0.762,截断值为20分,敏感度为70.0%,特异度为84.2%。 结论入院时NIHSS评分高、后交通动脉未开放,是后循环急性缺血性脑卒中患者接受机械取栓治疗并完全恢复前向血流后临床预后仍不佳的相关因素。  相似文献   
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