降钙素原联合APACHE Ⅱ评分对脓毒症病情及预后判断的指导价值

目的探讨血清降钙素原(PCT)检测联合APACHE Ⅱ评分对脓毒症病情及预后的价值。方法对长沙市第四医院重症医学科68例脓毒症患者按疾病的严重程度分为脓毒症组、严重脓毒症组、脓毒性休克组,分别检测各组血清PCT,并同时进行APACHE Ⅱ评分,对PCT与APACHE Ⅱ进行相关性分析。然后再根据患者转归不同分为生存组和死亡组,评价PCT、APACHE Ⅱ评分对脓毒症预后的判断的指导价值。结果脓毒症组PCT低于严重脓毒症组,严重脓毒症组PCT低于脓毒性休克组,其差异均具有统计学意义(P<0.05),死亡组PCT及APACHE Ⅱ评分明显高于生存组,差异具有统计学意义(P<0.05)。结论脓毒症患者PCT水平与APACHE Ⅱ评分具有相关性;检测PCT水平联合APACHE Ⅱ评分对脓毒症病情及预后判断具有指导价值。     

红细胞分布宽度在脓毒性休克患者中的变化研究

目的 观察红细胞分布宽度(RDW)在脓毒性休克患者中的变化情况及其临床应用价值。 方法 将研究对象分为脓毒性休克组(脓毒性休克组又分为死亡组和存活组)、脓毒症组和健康对照组,观察各组患者的RDW水平,同时与C反应蛋白(CRP)、降钙素原(PCT)、动脉血乳酸(Lac)、急性生理与慢性健康评分(APACHEⅡ)和序贯器官衰竭估计评分(SOFA)等进行相关性分析。 结果 脓毒性休克组、脓毒症组患者RDW明显高于健康对照组(P＜0.05)。与存活组相比,死亡组入院后1、3、5、7、10 d的RDW升高(P＜0.05)。入院第1个24 h脓毒性休克组RDW与CRP、PCT、APACHEⅡ评分和SOFA评分成正相关性(r=0.836,0.683,0.589,0.727,0.311,P＜0.05)。RDW与APACHEⅡ评分和SOFA评分联合可以提高脓毒性休克患者的死亡预测能力。 结论 RDW水平升高对脓毒症具有预示作用,同时对脓毒性休克患者不良预后具有判断作用。     

PCT、CRP水平及APACHEⅡ评分与ICU老年重症感染严重程度、预后的关系分析

目的 探究降钙素原(PCT)、C反应蛋白(CRP)水平及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分与重症加强护理病房(ICU)老年重症感染严重程度、预后的关系。方法 102例ICU老年脓毒症患者,均于入院24 h完成PCT、CRP检测及APACHEⅡ评估,根据病情严重程度分为单纯脓毒症组(45例)、重度脓毒症组(34例)、脓毒性休克组(23例);根据预后结局分为存活组(81例)和死亡组(21例)。比较单纯脓毒症组、重度脓毒症组、脓毒性休克组与存活组和死亡组PCT、CRP水平及APACHEⅡ评分,分析PCT、CRP水平及APACHEⅡ评分与重症感染严重程度、预后的相关性。结果 脓毒性休克组PCT(8.35±2.02)ng/ml、CRP(85.63±15.96)mg/L、APACHEⅡ评分(22.49±3.05)分和重度脓毒症组PCT(5.68±1.14)ng/ml、CRP(52.49±13.04)mg/L、APACHEⅡ评分(19.87±3.67)分均高于单纯脓毒症组的(3.61±0.92)ng/ml、(35.78±8.67)mg/L、(15.02±3.15)分,差异具有统...     

降钙素原与C-反应蛋白对严重脓毒症和脓毒性休克患者严重程度的评估价值

目的探讨降钙素原(PCT)与C-反应蛋白(CRP)对重症监护病房(ICU)严重脓毒症和脓毒性休克患者严重程度的评估价值以及与急性生理学与慢性健康状况评分系统Ⅱ评分(APPACHEⅡ评分)及序贯器官衰竭评分(SOFA评分)的相关性。方法对2013年1月至2015年1月收住大同市第五人民医院重症医学科的104例脓毒症患者根据是否休克分为2组:脓毒性休克组(51例)和严重脓毒症组(53例)。2组患者在入住ICU后收集性别、年龄、既往史,急查血常规、即刻血糖、血气分析、肝肾功能,细菌培养,APPACHEⅡ评分及SOFA评分。入科24 h内抽血化验降钙素原、C-反应蛋白。观察2组患者PCT、CRP、SOFA评分、APACHEⅡ评分差异,脓毒症患者PCT、CRP与SOFA评分、APACHEⅡ评分的相关性,绘制受试者工作曲线(ROC),评价PCT、CRP、SOFA评分和APACHEⅡ评分对不同程度脓毒症的诊断价值。结果脓毒性休克组严重脓毒症PCT[(24.3±5.7)ng/ml和(4.2±2.6)ng/ml,P<0.01]、CRP[(97.1±10.8)mg/L和(64.2±11.3)mg/L,P<0.05)]、APACHEⅡ评分[(20.9±7.1)分和(16.3±5.7)分,P<0.01]、SOFA评分[(10.6±4.1)分和(5.4±3.0)分,P<0.05)]与严重服毒症组比较,脓毒性休克组各指标均明显升高。PCT、CRP与SOFA评分呈显著正相关(PCT:r=0.531,P<0.01。CRP:r=0.426,P<0.01),而二者与APACHEⅡ评分均无相关性(PCT:r=0.032,P>0.05;CRP:r=0.05,P>0.05)。PCT对评价脓毒症严重程度的ROC曲线下面积(AUC)明显大于CRP的AUC[0.787(95%可信区间0.679,0.894);0.671(95%可信区间0.546,0.796)]及APACHEⅡ评分的AUC[0.787(95%可信区间0.679,0.894);0.687(95%可信区间0.562,0.812)]。PCT对脓毒症严重程度评估的敏感度及特异性均高(截断值在0.795 ng/ml时,敏感度88.6%,特异度63.9%)。CRP的敏感度高但特异性低(截断值为35.00 mg/L时,敏感度88.6%,特异性41.7%)。SOFA评分的特异性高但敏感度低(截断值在9.00分时,敏感度65.7%,特异性91.7%)。APACHEⅡ评分敏感度高及特异性比PCT低(截断值为18.5分时,敏感度74.3%,特异度58.3%)。结论 PCT与CRP水平能很好地反映脓毒症患者的严重程度,且与SOFA评分有良好的相关性,PCT对脓毒症患者严重程度的评估,敏感性特异性均高。     

脓毒症患者血清降钙素原和N末端脑钠肽前体的变化及意义

目的通过检测脓毒症患者血清降钙素原(PCT)、N末端脑钠肽前体(NT-pro BNP)、心肌酶(CK、CK-MB)及肌钙蛋白I(c Tnl)的水平,探讨脓毒症患者病情严重程度与心肌损害的关系。方法选择2011年7月~2014年2月入住我院ICU确诊的脓毒症和脓毒性休克患者各30例,另选择门诊健康体检者30例作为对照组。统计入选者的性别、年龄及当天的APACHEⅡ评分。血清PCT水平的监测采用双抗体夹心免疫发光法,血清NT-pro BNP、心肌酶(CK、CK-MB)及c Tnl水平的监测采用酶联免疫吸附法(ELISA)。结果脓毒症休克组血清PCT水平较脓毒症组及健康对照组均明显升高(P<0.01);脓毒症组血清PCT水平较健康对照组明显升高(P<0.01);脓毒症休克组APACHEⅡ评分较脓毒症组明显升高(P<0.01)。脓毒症休克组血清NT-pro BNP及c Tnl水平较脓毒症组及健康对照组均明显升高(P<0.01);脓毒症组血清NTpro BNP及c Tnl水平较健康对照组明显升高(P<0.01);脓毒症休克组和脓毒症组血清CK及CK-MB较健康对照组升高(P<0.05);脓毒症休克组血清CK及CK-MB与脓毒症组比较差异无统计学意义(P>0.05)。APACHEⅡ评分与脓毒症患者血清PCT水平呈正相关(r=0.912,P<0.01);脓毒症患者血清c Tnl与血清PCT、APACHEⅡ评分均呈正相关(r=0.895,P<0.01;r=0.752,P<0.01);脓毒症患者血清NT-pro BNP与血清PCT、APACHEⅡ评分均呈正相关(r=0.716,P<0.01;r=0.708,P<0.01)。结论血清PCT水平及APACHEⅡ评分能较好地反映脓毒症患者病情的严重程度;血清c Tnl水平及NT-pro BNP水平升高说明脓毒症患者存在心肌损伤和心功能不全,且与脓毒症患者病情的严重程度相关。     

氨基末端B型钠尿肽前体及肌钙蛋白I对脓毒症预后的预测价值

目的 评价氨基末端B型钠尿肽前体（NT-pro-BNP）及肌钙蛋白I（cTnI）对脓毒症预后判断的作用.方法 人选住院的脓毒症患者66例,按病情严重程度,分为一般脓毒症组（24例）、严重脓毒症组（22例）及脓毒症休克组（20例）;根据患者的28天生存率,分为死亡组（20例）和存活组（46例）.在入院24小时内检测血清cTnI、NT-pro-BNP及降钙素原（PCT）水平,并进行急性生理和慢性健康状况评分Ⅱ（APACHEⅡ评分）,比较各组血清cTnI、NT-pro-BNP、PCT水平及APACHEⅡ评分,分析NT-pro-BNP、cTnI水平与PCT水平、APACHEⅡ评分的相关性.结果 脓毒症休克组的血清NT-pro-BNP、cTnI、PCT水平及APACHEⅡ评分明显高于严重脓毒症组及一般脓毒症组,差异具有统计学意义（P＜0.05）.严重脓毒症组的血清NT-pro-BNP、cTnI、PCT水平及APACHEⅡ评分高于一般脓毒症组,差异具有统计学意义（P＜0.05）.死亡组的血清cTnI、NT-pro-BNP、PCT水平及APACHEⅡ评分明显高于生存组（P＜0.05）.血清NT-pro-BNP、cTnI水平与PCT呈正相关（r分别=0.901,0.866,P＜0.05）,血清NT-pro-BNP、cTnI水平与APACHEⅡ评分呈正相关（r=0.602、0.521,P＜0.05）.结论 血清cTnI与NT-pro-BNP联合检测可以作为常规临床检测指标来判断脓毒症患者的预后.     

降钙素原检测对脓毒症病情及预后判断的指导价值(附46例分析)

目的探讨血清降钙素原(PCT)检测对脓毒症病情及预后判断的指导价值。方法 46例脓毒症患者按病情轻重分早期脓毒症组、严重脓毒症组和脓毒症休克组,分别比较组间血清PCT、C反应蛋白(CRP)、WBC和急性生理与慢性健康状况评分(APACHEⅡ),并行PCT与APACHEⅡ评分相关性分析;同时按PCT水平,分为PCT<5.0、5.0～<10.0、PCT≥10.0ng/mL 3组,比较各组的病死率、抗生素使用时间、住院时间和外周血培养结果。结果脓毒症休克组与其他两组比较,PCT、CRP、WBC和APACHEⅡ评分差异均有统计学意义(P<0.05);严重脓毒症组与早期脓毒症组比较,PCT、CRP、APACHEⅡ差异有统计学意义(P<0.05),WBC差异无统计学意义(P>0.05),PCT与APACHEⅡ评分之间呈显著正相关(r=0.68,P<0.05);随着PCT水平升高,脓毒症患者病死率呈增高趋势,抗生素使用时间及住院时间延长(P<0.05),同时血培养阳性率升高。结论血PCT对脓毒症病情判断及评估预后有一定指导意义。     

血浆N末端脑钠肽原在老年脓毒症患者预后评估中的应用

目的 探讨血浆N末端脑钠肽原(NT-proBNP)含量对老年严重脓毒症和脓毒性休克患者病情和预后的评估作用.方法 我院急诊监护室老年严重脓毒症和脓毒性休克患者96例,入院后给予NTproBNP、心脏超声等检查,比较死亡患者(31例)和存活患者(65例)NT-proBNP与急性生理和慢性健康评分(APACHE)Ⅱ评分的差别;比较严重脓毒症患者(62例)和脓毒性休克患者(34例)NT-proBNP、左心室射血分数(LVEF)和APACHEⅡ评分的区别.结果 死亡患者NT-proBNP和APACHEⅡ评分均大于存活患者[分别为(3763±1030) ng/L比(2944±1417) ng/L,(24 ±6)分比(19±8)分,P＜0.01];严重脓毒症患者NT-proBNP水平和APACHEⅡ评分小于脓毒性休克患者[分别为(2896±1325) ng/L比(3778±1426) ng/L,(20±6)分比(23±6)分],LVEF大于脓毒性休克患者[(46±10)％比(40±11)％,P＜0.01].结论 NTproBNP水平同APACHEⅡ评分一样对老年脓毒症患者有预后评估作用,NT-proBNP水平越高,预后越差.     

血浆降钙素原对脓毒性休克早期诊断及预后的意义

目的 通过对脓毒性休克患者的血浆降钙素原（PCT）定期检测，结合APACHEⅡ评分及SOFA评分评价PCT对脓毒性休克早期诊断以及预后的意义。方法 应用单克隆抗体透射比浊法分别对20例脓毒性休克患者及20例非脓毒性休克患者进行PCT检测和普通血细菌培养。部分脓毒性休克患者治疗1周后进行PCT复检。结果 ①脓毒性休克组PCT检测值明显高于非脓毒性休克组，有显著性差异，其灵敏度优于普通血培养。②脓毒性休克患者治疗前后PCT值随病情缓解而下降。PCT与APACHEⅡ评分及SOFA评分呈正相关。结论 PCT检测对脓毒性休克早期诊断及预后具有指导意义。     

降钙素原在脓毒症病情评估和预后判断中的应用价值

目的探讨降钙素原在脓毒症病情评估和预后判断中的应用价值。方法选取2009年8月~2014年6月本院重症监护病房收住的感染危重患者200例,其中脓毒症组140例,局部感染组60例,脓毒症患者根据病情轻重分为休克组和非休克组,根据预后分为生存组和死亡组,入科后进行APACHEⅡ评分,监测患者血清PCT水平及动态变化,并进行比较分析。结果脓毒症组和局部感染组首次PCT水平比较差异有统计学意义(P<0.01);非休克组和休克组首次PCT水平、APACHEⅡ评分比较差异有统计学意义(P<0.01)。生存组PCT水平呈下降趋势,死亡组PCT水平呈缓慢上升趋势,并维持较高水平。结论血清PCT水平对脓毒症的早期诊断、严重程度及预后评估具有较高的灵敏度和特异度,PCT水平的动态变化可作为评估病情、判断预后及调整治疗方案的依据,在脓毒症诊疗过程中有重要价值。     

颅脑损伤患者并发肺部感染的护理体会

目的：为了使并发肺部感染的病人更多、更好、更早的痊愈。方法：通过对32例颅脑外伤并发肺部感染病人的严密观察,采取更换体位、超声雾化、有效排痰训练等有效的护理措施干预,从而控制了肺部感染。结果：痊愈17例,占53.1%;显效12例,占37.5%,无效2例,占6.2%;死亡1例,占3.1%;实践证明,有效的护理干预对提高患者治疗成功率有着重要意义。     

卡马西平联用尼美舒利相关粒细胞缺乏症

1例78岁男性患者因带状疱疹神经痛、慢性阻塞性肺疾病合并感染,给予头孢唑肟钠（2.25 g静脉滴注,1次/d）、卡马西平（0.2 g口服,2次/d）、尼美舒利（100 mg口服,2次/d）、二羟丙茶碱（0.5 g静脉滴注,1次/d）、甲钴胺（0.5 mg口服,3次/d）、地塞米松（5 mg,静脉滴注1次）、盐酸哌替啶（25 mg,肌内注射1次）和盐酸布桂嗪（100 mg,肌内注射3次）等药物治疗。第7天,停用头孢唑肟钠,改为磷霉素钠（8 g静脉滴注,1次/d）。第11天,血常规检查示白细胞计数1.6×10^9/L,中性粒细胞0.03,中性粒细胞绝对值0.1×10^9/L,淋巴细胞绝对值0.9×10^9/L。立即停用所有药物,给予对症支持治疗。第15天,外周血白细胞计数0.9×10^9/L,中性粒细胞0.02,中性粒细胞绝对值0.1×10^9/L,淋巴细胞绝对值0.7×10^9/L。行骨髓穿刺检查,诊断为粒细胞缺乏症。第17天患者出现右肺气胸、肺不张。第20天出现急性呼吸衰竭、多脏器衰竭合并重症感染,经抢救无效死亡。     

Satisfaction with information and its relationship with adherence in patients with chronic pain

□ Due to the nature of chronic pain it would be expected that patients are highly adherent to their pain medication. However, results from this study have shown that 23 per cent of patients often or always avoid using their pain medication, 13.4 per cent often or always alter dosages, and 10.3 per cent often or always stop taking their medication for a while. This suggests intentional non‐adherence to pain medication □ Less than 50 per cent of respondents were satisfied with information provided on side effects, what to do if side effects occur, and possible interactions with other medication □ Patients' satisfaction with information about their medication was related to self‐reported adherence; greater satisfaction was associated with higher self‐reported adherence     

Genomic profiling associated with recurrence in patients with rectal cancer treated with chemoradiation

PURPOSE: Stage II and III adenocarcinoma of the rectum has an overall 5-year survival rate of approximately 50%, and tumor recurrence remains a major problem despite an improvement in local control through chemotherapy and radiation. The efficacy of chemoradiation therapy may be significantly compromised as a result of interindividual variations in clinical response and host toxicity. Therefore, it is imperative to identify those patients who will benefit from chemoradiation therapy and those who will develop recurrent disease. In this study, we tested whether a specific pattern of 21 polymorphisms in 18 genes involved in the critical pathways of cancer progression (i.e., drug metabolism, tumor microenvironment, cell cycle regulation, and DNA repair) will predict the risk of tumor recurrence in rectal cancer patients treated with chemoradiation. PATIENTS AND METHODS: A total of 90 patients with Stage II or III rectal cancer treated with chemoradiation were genotyped using polymerase chain reaction (PCR)-based techniques for 21 polymorphisms. RESULTS: A polymorphism in interleukin (IL)-8 was individually associated with risk of recurrence. Classification and regression tree analysis of all polymorphisms and clinical variables developed a risk tree including the following variables: node status, IL-8, intracellular adhesion molecule-1, transforming growth factor-beta, and fibroblast growth factor receptor 4. CONCLUSION: Genomic profiling may help to identify patients who are at high risk for developing tumor recurrence, and those who are more likely to benefit from chemoradiation therapy. A larger prospective study is needed to validate these preliminary data using germline polymorphisms on tumor recurrences in rectal cancer patients treated with chemoradiation.     

甘草酸单铵结合氦-氖激光治疗银屑病62例

目的用甘草酸单铵结合低能量氦-氖激光,观察治疗银屑病患者。方法62例寻常型银屑病患者,分为两组,A组用低能量氦-氖激光血管内照射,同时用甘草酸单铵静脉滴注,共36例;B组仅用甘草酸单铵,共26例。通过30d治疗。结果总有效率82.2%,其中A组有效率88.9%,B组73.1%(经Ridit检验,U＝2.76,P＜0.01),两组差异有极显著性意义。结论甘草酸单铵结合氦-氖激光治疗银屑病,比单用甘草酸单铵效果好。     

A fetus with meckel-gruber syndrome associated with isomerism

Abstract. Meckel-Gruber syndrome (MKS) is an autosomal recessive lethal malformation. As far as we know, the rate of incidence for the syndrome is 0.02 per 10,000 births. It is estimated that Meckel-Gruber syndrome accounts for 5% of all neural tube defects in Finland. Objective. The aim of this study is to present a case of a fetus with Meckel-Gruber syndrome associated with complete left isomerism. Method. The fetus was obtained after medical interruption of the pregnancy during the fifteenth gestational week. The mother was 36 years old and in a consanguineous marriage. The antenatal ultrasound examination revealed a polymalformative syndrome, leading to a postmortem examination. The fetopathological study of the fetus was conducted at the Centre for Maternity and Neonatology, Tunis, Tunisia, in 2008. Results. The female fetus had a significantly deformed ballooning abdomen, pes equinovarus, flexion of the wrist and a total posterior cleft palate. The central nervous system abnormalities were occipital encephalocele, cystic dilatation of the fourth ventricle, agenesis of corpus callosum and hydrocephalus. The study of the internal organs found dextrocardia, irregular lobulation of the lungs, left isomerism, and polysplenia. The microscopic examination revealed bilateral cystic dilation of the kidneys, fibrous proliferation of the liver and ectasic dilatation of the billiary ducts, representing a ductal plate malformation of the liver. Conclusion. The case is diagnosed with Meckel-Gruber syndrome associated with complete left isomerism, cleft palate and possibly Dandy-Walker syndrome.