C反应蛋白动态检测对严重多发伤并发MODS的临床意义

目的：探讨C反应蛋白（CRP）在评价严重多发伤并发多器官功能障碍综合征（MODS）中的价值。方法：将76例严重多发伤按相关标准分为MODS组（A）与非MODS组（B）。将两组伤后第1、7、14、21天各时相点测量的CRP值及CRP／LDL（炎症危险指数）的比值分别输入计算机作统计学处理，结果：A、B两组CRP动态值及CRP／LDL相比较，差异均有显著性，结论：动态监测CRP和CRP／LDL对临床监测严重多发伤后并发MODS的可能性有一定意义。     

急诊多发伤患者C反应蛋白变化的临床意义

选择2010年1月~2012年1月在我院治疗的急诊多发伤患者伴严重疼痛的患者20例为A组,急诊多发伤患者不伴严重疼痛的患者20例为B组,同时选择健康体检者20例作为对照组,检测三组外周血CRP水平。对三组血浆CRP进行检测,结果A组显著高于B组和对照组,差异均有统计学意义(P<0.05),B组和对照组比较差异也有统计学意义(P<0.01)。CRP作为一种急性时相蛋白,在急性多发伤的患者血浆中显著升高,而伴有严重疼痛的急性多发伤患者血浆中的CRP水平升高更为明显,说明CRP可以作为一种预测急性多发伤患者疼痛程度的客观检测指标之一。     

多发伤患者全身炎症反应综合征与多器官功能障碍综合征关系探讨

目的 探讨多发伤后全身炎症反应综合征（SIRS）和多器官功能障碍综合征（MODS）关系及防治策略。方法 回顾性分析652例多发伤患者入院时、入院3天后的临床资料。结果 多发伤患者入院时SIRS的发生率为39.3%,MODS的发生率为20.3%,病死率为10.9%;其中严重多发伤患者（106例）的SIRS发生率、MODS发生率和病死率是88.7%、34.9%和18.9%;3天后仍伴有SIRS的164例,其MODS的发生率和病死率是32.9%和17.7%,明显高于非SIRS组及入院时SIRS组（P〈0.05）;61例（9.4%）发生MODS的病死率为54.1%（33/61）。结论 积极治疗原发性损伤,防止创伤治疗过程中的第二次打击,阻断SIRS或脓毒血症向MODS发展进程,是改善多发伤预后的关键。     

蝮蛇伤患者血清酶学及C反应蛋白变化的临床研究

目的分析蝮蛇伤患者血清酶学及C反应蛋白(CRP)的变化对疾病的病情和预后估计的意义。方法按患者入院时中毒的程度分为轻型、重型、危重型,比较各型之间血清酶及CRP水平;根据SIRS诊断标准将患者分为SIRS组和非SIRS组,比较两组之间血清酶及CRP水平;根据MODS诊断标准将患者分为MODS组和非MODS组,比较两组之间血清酶及CRP水平。结果重型、危重型患者血清酶及CRP水平与轻型比较差异有统计学意义(P<0.05,P<0.01,P<0.001);SIRS组血清酶及CRP水平与非SIRS组比较差异有统计学意义(P<0.01,P<0.05);MODS组血清酶及CRP水平与非MODS组比较差异有统计学意义(P<0.05);SIRS组MODS的发生率明显高于非SIRS组(χ~2=19.73,P<0.001)。结论蝮蛇伤患者病情程度越重,其血清酶学及CRP水平升高越明显;蝮蛇伤患者并发SIRS时,血清CRP水平升高越明显,MODS发生率越高,病情越严重;蝮蛇伤患者血清酶学水平与SIRS、MODS的发生关系密切。     

严重多发伤后C-反应蛋白和血糖的变化及临床意义

目的 探讨严重多发伤患者血糖和C-反应蛋白（CRP）的变化及临床意义。方法 检测67例严重多发伤患者入院后第1、3、7天空腹血糖和CRP水平，并与同期68例轻度多发伤患者（对照组）进行比较。结果 重创组第1、3、7天的CRP和血糖水平均明显高于对照组（均为P〈0．05）；第1天创伤严重度评分与相应时相血糖水平正相关（P〈0．05），与相应时相CRP水平正相关（P〈0．05）。结论 严重多发伤后血糖和CRP水平的高低与创伤严重度呈正相关，持续增高提示预后不佳。     

多发伤患者心肌酶学检测意义探讨

目的:探讨肌酸激酶同工酶(CK-MB)和肌钙蛋白Ⅰ(cTnI)对多发伤病情和预后判断的临床价值.方法:回顾性分析2003年8月至2009年2月诊治的68例多发伤患者的临床资料,比较严重创伤组(ISS≥16分)和对照组(ISS<16分)间CK-MB、cTnI升高及多器官功能障碍综合征(MODS)的发生情况.结果:严重创伤组cTnI阳性率30.6%、MODS发生率22.2%均显著高于对照组的12.5%和3.1%,P<0.01.结论:对多发伤患者行cTnI检测有利于病情评估和预后判断,建议临床常规检测.     

多发伤并发多器官功能障碍综合征的临床分析

目的调查分析多发伤患者并发多器官功能障碍综合征（MODS）的危险因素、发病率和病死率。方法回顾性分析2008年9月至2011年6月收住我院ICU的155例多发伤患者的临床资料。包括处理方法,损伤严重程度评分（ISS）分值与发生MODS的关系,发生MODS与未发生MODS病死率的比较。结果155例多发伤患者发生MODS29例（18．7％）。ISS〈16分、16～25分和≥25分的病例数分别为39、58和58例,其中发生MODS的病例分别为3、7和19例（x2=12．321,P=0．002）,≥25分的MODS发生率较高。发生MODS的29例多发伤患者死亡15例,未发生MODS126例患者死亡28例（x2=10．236,P=0．001）。结论多发伤后并发MODS是患者死亡的重要原因。积极治疗原发性损伤,防止创伤治疗过程中的第二次打击,早期支持保护重要脏器功能是改善多发伤预后的关键。     

多发伤全身性炎症反应综合征与多器官功能不全关系的研究

目的：研究多发伤患者发生ＳＩＲＳ和ＭＯＤＳ的情况以及两者之间的关系,从而为防治ＭＯＤＳ,降低多发伤患者死亡率提供理论依据。方法：选择１９９４年１０月至１９９７年１０月３年间急救医学中心必治的６０例多发伤者的临床资料,按照１９９１年８月,ＡＣＣＰ和ＳＣＣＭ会议的诊断标准,比较ＳＩＲＳ和ＭＯＤＳ的发病率。结果：６０例多发伤患者中,发生ＳＩＲＳ者５２例,发病率为８６．６７％,发生ＭＯＤＳ者６例,发病率为     

对西宁玉门地区严重多发伤伴颅脑伤患者诊断高原ARDS/MODS的验证

严重多发伤合并急性呼吸窘迫综合征／多器官功能障碍综合征（ARDS／MODS）已有较多报道，但以颅脑伤为主的多发伤合并ARDS／MODS在西宁玉门地区报道较少。我们调查了31例该地区严重创伤伴颅脑伤符合平原MODS诊断评分标准的病例资料，与兰州、西安地区同类病例进行比较，探讨不同海拔高度MODS诊断标准参数的差异。     

老年全身炎症反应综合征患者血清D-二聚体和C反应蛋白检测的意义

目的 研究D-二聚体、C反应蛋白（CRP）检测在老年全身炎症反应综合征（SIRS）向多器官功能障碍综合征（MODS）转化中的临床意义。方法 老年患者240例分为SIRS组和非SIRS组，SIRS组190例再分为MODS组与非MODS组，常规测定各组患者APACHEⅡ评分，分别用ELISA法测定血清D-二聚体水平，全自动生化分析仪免疫比浊法测定CRP水平。结果 发病后24h内SIRS组D-二聚体和CRP水平明显高于非SIRS组（P〈0．01）。MODS组患者血D-二聚体和CRP水平明显高于非MODS组（P〈0．05）。D-二聚体与预后呈负相关（r=-0．2879，P〈0．01）。结论 检测SIRS患者血清CRP和D-二聚体水平有助于早期诊断MODS并判断预后。     

严重创伤患者发生多器官功能障碍综合征的预防与护理

目的:预防和减少严重创伤患者发生多器官功能障碍综合征（MODS）,降低病死率。方法:根据诱发MODS的高危因素,对268例严重创伤患者采取了以下护理措施:①早期及时复苏;②早期防治感染;③及早发现各器官衰竭征象;④早期给予合理的营养支持;⑤心理支持;⑥避免医源性 MODS;⑦要有整体观念。结果:268例严重创伤患者中发生 MODS 118例（44.02％）,死亡68例（57.62％）,无因护理措施不当而导致的MODS以及MODS患者死亡。结论:正确的护理措施可有效降低严重创伤患者MODS的发生率和病死率。     

Plasma interleukin-8 as a potential predictor of mortality in adult patients with severe traumatic brain injury

Because of complex pathophysiology and severe consequences, traumatic brain injuries (TBI) are an important medical problem. Pathophysiology of TBI includes local and systemic stress response, in which interleukin-8 (IL-8) is considered as a key mediator of neuroinflammation. However, prognostic relevance of IL-8 measurement in adult patients with severe TBI is not certain. Therefore, IL-8 was determined in blood samples from central venous and jugular bulb catheter and in cerebrospinal fluid of twenty patients with isolated TBI at admission to Intensive Care Unit. None of the patients had history of stroke, dementia, autoimmune diseases, acute infection or medication with anti-inflammatory drugs. Ten patients died due to traumatic brain injury, while the other ten recovered well. While there was no significant difference of IL-8 levels in cerebrospinal fluid between survivors and nonsurvivors, central venous plasma level of IL-8 was significantly lower in survivors (71.00 +/- 14.17 pg/ml), than in nonsurvivors (111.26 +/- 16.9 pg/ml). Receiver Operating Characteristic (ROC) analysis revealed significant prognostic value for IL-8 in the blood as well as for the age of patients, Glasgow Coma Scale (GCS) and Acute Physiologic and Chronic Health Evaluation (APACHE II). These findings suggest that the central venous plasma values of IL-8 at admission might be an early predictive marker in patients with severe TBI, comparative to standard clinical prognostic markers such as APACHE II and GCS.     

Vestibulo-ocular monitoring as a predictor of outcome after severe traumatic brain injury

Introduction  

Based on the knowledge that traumatic brainstem damage often leads to alteration in brainstem functions, including the vestibulo-ocular reflex, the present study is designed to determine whether prediction of outcome in the early phase after severe traumatic brain injury is possible by means of vestibulo-ocular monitoring.     

Low exogenous lactate clearance as an early predictor of mortality in normolactatemic critically ill septic patients

OBJECTIVE: To evaluate the prognostic value of lactate clearance and lactate production in severely ill septic patients with normal or mildly elevated blood lactate concentration.DESIGN Prospective, observational study. SETTING: Nineteen-bed mixed medicosurgical intensive care unit. PATIENTS: Fifty-six patients with severe sepsis and blood lactate concentration <3 mmol/L. MEASUREMENTS AND MAIN RESULTS: Lactate metabolism was evaluated in all patients. Lactate clearance was measured by modeling the change in arterial blood lactate over time induced by an infusion of 1 mmol/kg sodium lactate for 15 mins. Lactate production was calculated as the product of lactate clearance times the blood lactate concentration before the infusion. Outcome was taken to be mortality at 28 days after the beginning of the septic episode. A logistic regression model taking into account different risk factors was constructed. Among the 56 patients, 17 (30.3%) died before the 28th day. Basal blood lactate concentration was not different between survivors and nonsurvivors, whereas lactate clearance and production were higher in survivors (0.86 +/- 0.32 vs. 0.58 +/- 0.18 L/hr/kg, p < .005, and 1.19 +/- 0.63 vs. 0.89 +/- 0.24 mmol/hr/kg, p = .055, respectively). An increase in blood lactate 45 mins after the end of the lactate infusion (Deltalact-T60) > or = 0.6 mmol/L was predictive of 28-day mortality with 53% sensitivity and 90% specificity. Multivariate analysis showed that only three factors were independently and significantly correlated with 28-day mortality: presence of more than two organ failures (odds ratio, 27; p = .04), age >70 yrs (odds ratio, 5.7; p = .032), and Deltalact-T60 > or =0.6 mmol/L (odds ratio, 14.2; p = .042). CONCLUSION: Low lactate clearance in severely ill septic patients with normal or mildly elevated blood lactate is predictive of poor outcome independently of other known risk factors such as age and number of organ failures.     

重型闭合性颅脑损伤患者早期康复疗效观察

目的观察重症监护室中重型闭合性颅脑损伤患者早期康复的疗效。方法将118 例重型闭合性颅脑损伤患者分为治疗组和对照组各59例,对照组接受呼吸康复、压疮预防、泌尿系护理,治疗组在此基础上进行肢体神经功能康复、认知功能康复比较两组患者治疗前后的Glasgow昏迷量表(GCS)、Fugl Mayer量表评定(FMA)、日常生活活动能力(ADL)测评、残疾分级量表(DRS)测评和简易精神状态检查表(MMSE)评分。结果治疗组患者的GCS、FMA(上肢)、ADL和DRS评分较对照组有显著性差异( P <0.05),MMSE评分无显著性差异( P >0.05)。结论早期康复治疗可以改善重型闭合性颅脑损伤患者的神经功能,认知功能的改善短期内不明显。     

早期康复护理对重型颅脑损伤患者的影响

目的观察康复护理对重型颅脑损伤患者早期康复的影响。方法将142例重型颅脑损伤患者随机分为康复组72例和对照组70例,对照组行常规护理;康复组除行常规护理外,同时实施系统、规范的早期康复护理。比较两组Barthel指数评分及生活质量。结果康复组患者入院后30dBarthel指数评分和生活质量明显高于对照组(均P<0.01)。结论康复护理可降低颅脑损伤残疾率,提高患者生活质量。     

Circulating intercellular adhesion molecule-1 as an early predictor of hepatic failure in patients with septic shock

OBJECTIVE: To investigate whether endotoxin, interleukin-6, and circulating adhesion molecules, measured sequentially in blood, can predict mortality and organ dysfunction in sepsis. DESIGN: Inception cohort study with follow-up for 28 days. SETTING: Surgical intensive care unit at a university hospital. PATIENTS: A total of 14 consecutive patients were enrolled in the study within the first 24 hrs after onset of septic shock. Seven healthy subjects were studied as controls. INTERVENTIONS: Patients were analyzed for mortality and development of organ dysfunction. MEASUREMENTS AND MAIN RESULTS: At the end of the 28-day follow-up period, seven of the patients were still alive (survivors) but the other seven (nonsurvivors) had died. At the time of enrollment in the study (day 0), the Acute Physiology and Chronic Health Evaluation II score was 28.4 in survivors (n = 7) and 28.7 in nonsurvivors (n = 7). In contrast, circulating intercellular adhesion molecule-1 (ICAM-1) was significantly higher in nonsurvivors than in survivors. Circulating ICAM-1 predicted mortality in patients with septic shock with a sensitivity and a specificity of 71.4% each. Endotoxin, interleukin-6, circulating L-selectin, P-selectin, E-selectin, and platelet endothelial cell adhesion molecule-1, however, did not distinguish between survivors and nonsurvivors. In addition, circulating ICAM-1 at day 0 showed a significant correlation with the highest serum bilirubin observed during the entire study period (r2 = 0.963). CONCLUSIONS: Because only circulating ICAM-1 was higher in nonsurvivors than in survivors at day 0, circulating ICAM-1 may serve as an early prognostic marker for outcome in septic shock. In addition, measurement of circulating ICAM-1 facilitates identification of those patients with the highest risk of developing liver dysfunction.     

NLR and CRP to albumin ratio as a predictor of in-hospital mortality in the geriatric ED patients

IntroductionWe aimed to investigate the role of neutrophil to lymphocyte ratio (NLR) and the C-Reactive Protein/Albumin Ratio (CAR), which are obtained from the first laboratory values of the elderly patients at admission to the emergency department (ED), in predicting in-hospital mortality.MethodsThis retrospective observational study includes the patients aged 65 and above who applied to the emergency department for two months. The patients' neutrophil, lymphocyte, C-reactive protein (CRP), albumin, NLR and CAR values were recorded. Statistical analysis of NLR and CAR values was performed according to in-hospital mortality and ED outcome.Results784 patients were included in the statistical analysis of the study. Increased NLR (8.82 (4.16–16.63), 4.76 (2.62–8.56), p˂0.001) and increased CAR (21.39 (6.02–55.07), 4.82 (1.17–17.03), p < 0.001) values were found to be statistically significant in the group with mortality compared to the group without mortality. Increased NLR (AUC: 0.642) and increased CAR (AUC: 0.723) were a predictor of in-hospital mortality. It was found that in-hospital mortality risk in patients with concurrent high NLR and CAR values (CAR˃12.3, NLR˃7.1) was 9.87 times more than the patients with concurrent low NLR and CAR values (CAR<12.3, NLR < 7.1). NLR and CAR values of the patients hospitalized in intensive care and service (NLR 7.21 (4.07–13.36), 5.77 (3.45–11.22); CAR 12.65 (2.79–36.8), 9.56 (1.74–33.97)) were found to be statistically significantly higher than those who were discharged (NLR 3.64 (2.26–7.02); CAR 2.88 (0.9–10.59)).ConclusionAccording to our results, the concurrent high levels of NLR and CAR values were found to be more effective in predicting in-hospital mortality compared to a separate evaluation.     

早期环境干预对重型颅脑损伤病人功能恢复的影响

[目的]探讨早期环境干预对重型颅脑损伤病人功能恢复的影响.[方法]2010年11月-2011年5月收治的25例重型颅脑损伤病人作为实验组,采用早期环境干预;2010年1月-2010年10月收治的25例重型颅脑损伤病人作为对照组,采用常规治疗、护理和康复治疗,于康复介入时、出院时、出院1个月、出院3个月时采用功能综合评定量表(FCA)对病人进行综合功能评分.[结果]实验组与对照组比较,出院时、出院1个月、出院3个月时FCA评分比较差异均有统计学意义(P＜0.05或P＜0.01).[结论]早期环境护理对重型颅脑损伤病人运动、认知综合功能的恢复有良好的促进作用.