重症监护患者的容量治疗

重症监护病房(ICU)的患者在血液动力学、器官血液灌注及免疫功能等方面可发生一系列的病理生理改变。此类患者,基础疾病的治疗当然是前提,但支持治疗,如充分的容量补充也很重要。目前对ICU患者用何种液体进行容量支持疗效最好还不清楚,尤其是在用胶体还是晶体上尚有争议。重症监护的医学新概念,如炎症、免疫和器官功能的作用等也给容量治疗这     

一个神经监护病室内的医源性肺炎

在监护室内院内感染的发病率较高,除了泌尿系统感染外,医源性肺炎是最常见的院内感染.常见的院内感染还有伤口感染及败血症.曾有学者报道医源性肺炎的发病率为7%～40% .医源性肺炎在监护室内已成为发病率及死亡率最高的原因,且给临床治疗带来了很大的额外经济负担,而成为一个严重问题.我们的研究目的是调查在神经监护室内医源性肺炎的发生率与发生的相关因素.     

外伤患者的急性呼吸窘迫综合征:ICU死亡率和预测因素

急性呼吸窘迫综合征(ARDS)是严重外伤患者的常见并发症。可影响预后,增加发病率、死亡率,延长住院时间。ARDS可能是全身炎症反应综合征(SIRS)的首发表现。[外伤性ARDS的病因包括多部损伤、大量输液、长骨骨折、胃内容物吸入、骨盆骨折、腹部外伤、颅脑损伤和败血症。]多系统器官衰竭(MSOF)的形成     

河南省食管癌死亡率预测

为了预测河南省食管癌在今后一定年限的死亡率，我们先后对几种回归方法进行了尝试，因数据少，所需因素多，建立的方程均不可靠，如何选择良好的预测模型，准确地做出预测，仍是有待解决的问题。本文采用了灰色数列预测方法GM（1，1）模型对食管癌死亡率进行预测，取得比较满意的结果，现报导如下。资料来源所用数据为1986年一1990年河南省食管癌死亡率资料，该资料来自河南省1／10人口抽样死因登记报告单位，并经计算机统计处理。其中对1986年至1990年河南省食管癌死亡率进行拟合，并对1991年一2000年河南省食管癌死亡率进行外推预测。建…     

武义县肺癌死亡率预测

武义县是浙江省疾病监测点之一。据1986年－1988年全死因回顾性调查资料，胃癌、肝癌、食管癌和肺癌是当地前4位恶性肿瘤死因，与1974年－1976年死因资料相比较，肺癌从第6位上升为第4倍，上升趋势明显。为探讨武义县肺癌死亡率上升趋势，笔者采用灰色数列预测方法GM（1，1）模型对肺癌死亡率进行了预测，现报告如下：资料与方法1990年至1995年的肺癌死亡率资料由武义县卫生防疫站提供，见表1。建立GM（1，1）模型，预报方程为。结果与分析一、原始数据拟会用预报方程得到相应的累加估计值y算原始数据的理论将肺癌死亡率理论值与实测值进…     

实体肿瘤重症患者抢救监护治疗进展与展望

近年来肿瘤发病率居高不下,肿瘤治疗手段层出不穷,肿瘤患者生存率有了显著提高,肿瘤救治理念也发生了显著改变。各种疗法在治疗和控制肿瘤的同时,亦会使患者产生重症状态,需要重症医学的医护人员进行救治。肿瘤患者产生重症状态多因疾病本身、围治疗期并发症以及伴随疾病及院内获得性疾病所致。新形势下救治肿瘤重症患者要考虑到代谢异常、凝血系统异常、免疫机制异常等特点,全面评估,发挥重症医学科救治平台作用,推广计划内转入ICU的救治理念,提高救治成功率和救治效率。将患者转出ICU后仍可继续按计划进行后续抗肿瘤治疗作为肿瘤重症患者ICU救治终点,构建肿瘤重症医学特色的学科和人才梯队,治疗好“肿瘤的重症和重症的肿瘤”是未来的发展方向。     

重症监护后的长期存活

简介：存活期的长短和生活质量对于经重症监护存活的患者,是重要的因素。我们决定观察在我们ICU病房内长期生存的患者,并将其与普通人群的存活率相比较。方法：1999年11月,通过挪威人口登记处对1987年在重症监护下存活的患者进行追踪。记录那些已死亡患者的死亡日期,并用Kaplan Meier生存计划来分析数据。此外,在年龄、性别相当的对照组中,对这一时期内的预期存活率,采用可行性生存统计方法(挪威统计法)进行了分析。结果：201例患者(占85.2％)生存于ICU。1999年11月时,123例患者仍存活,占全部患者的52％和存活者的61％。经相同的时期后,预期生存率为77％。离开ICU一年后,以前的ICU患者的生存率为0.79,而普通人群的生存率是0.82。结论：我们发现ICU存活者在离开ICU后的头12个月内的死亡率增加。此后的预期生存率与普通人群类似。     

食管切除术后的重症监护治疗

The aim of this article is to give a short review of problems associated with the intensive care treatment of patients after esophageal resection. Pulmonary dysfunction, supraventricular tachyarrhythmia, anastomotic leakage and mental disorders are the topics covered. Systemic inflammatory reaction and sepsis is the linking topic between these specific complications. Pulmonary dysfunction having an incidence of up to 40% is the most important complication. Low tidal volume ventilation, pain management including epidural analgesia and early tracheostomy are the mainstay of therapy. Supraventricular tachyarrhythmia is an early indicator of emerging complications. Its symptomatic treatment is standardized using electric cardioversion, beta-blockers and amiodarone. Anastomotic leakage must be suspect in any septic episode.Endoscopy and contrast studies allow for precise diagnosis. Interventional endoscopy is increasingly successful in the therapy of these leakages. Microbiological surveillance and specific antibiotic therapy ensure that a complication does not cause a septic cascade leading to multiorgan failure. The workload on ICU caused by a patient after esophageal resection still exceeds that of most other patients with gastrointestinal surgery.     

河北省磁县食管癌死亡率灰色预测研究

本文报告用灰色预测方法分别依14年和6年的已知食管癌死亡率的原始数据，对磁县1983-1990年的食管癌死亡率进行了预测，其两组魇始数据的预测结果均呈逐年下降趋势，并分别依14年和6年原始数据作累加徨成得出的预测公式进行了回代，结果回代所得值与实际原始数据相符，初步验证了灰铎预测对于食管癌死亡率的预测有一定实用意义。     

甘肃省胃癌死亡率变化及近期预测

[目的]了解甘肃省胃癌死亡率变化趋势,为制定甘肃省胃癌预防控制规划、防治策略提供依据。[方法]利用甘肃省1990～1992年、2004～2005年两次死因抽样调查资料,计算胃癌死亡率及其变化趋势;运用几何级数法计算胃癌死亡率的年平均增长值,利用恶性肿瘤死亡率的增减率,对甘肃省胃癌死亡率进行估计、预测。[结果]甘肃省胃癌死亡率呈下降趋势,粗死亡率和调整死亡率分别下降了7.02%和15.62%。城乡胃癌粗死亡率和调整死亡率均呈下降趋势,城市粗死亡率和调整死亡率分别下降了29.42%和44.58%,农村分别下降了7.34%和2.59%,2004～2005年城市胃癌死亡率比农村高出57.26%,城乡差距比1990～1992年缩小了一倍多;各年龄组胃癌死亡率男性均高于女性,70～岁组达到高峰;胃癌年均增减速度为-0.52%,虽呈下降趋势,但仍在恶性肿瘤死亡中排首位,预计到2010年甘肃省胃癌死亡率下降为60.10/10万。[结论]甘肃省胃癌死亡率虽呈下降趋势,但仍居恶性肿瘤死因顺位的首位,积极开展胃癌病因学研究,提出科学、有效的干预对策尤为重要。     

ICU中严重急性一氧化碳(CO)中毒患者生存的预测指标

简介：在法国，急性CO中毒仍是中毒引起死亡的首要原因。此项研究的目的是根据在这类患者收入ICU时所收集的主要临床和生理学资料，对与患者生存相关的预测因素进行评估。方法：我们复习了10年来34位患者的病历，他们都是因急性CO中毒而入院，并在ICU中接受了机械通气治疗。重度的CO中毒是指因呼吸、循环衰竭和/或神经系统衰竭而需要采取机械通气(MV)的病例。有91％的患者采用了高压氧疗法。所收集的资料包括患者的年龄、性别、CO的来源、住ICU期间临床和生理学的资料、采取的治疗措施及其疗效。采用Fisher精确检验，Kuskal-Wallis法，γ2检验以及ROC曲线进行统计学分析。结果：ICU内患者的死亡率为20％(7人)，神经学上完全康复的患者占88％。     

Predictive factors for severe toxicity of sunitinib in unselected patients with advanced renal cell cancer

Sunitinib has been registered for the treatment of advanced renal cell cancer (RCC). As patient inclusion was highly selective in previous studies, experience with sunitinib in general oncological practice remains to be reported. We determined the efficacy and safety of sunitinib in patients with advanced RCC included in an expanded access programme. ECOG performance status >1, histology other than clear cell and presence of brain metastases were no exclusion criteria. Eighty-two patients were treated: 23% reached a partial response, 50% had stable disease, 20% progressed and six patients were not evaluable. Median progression-free survival (PFS) was 9 months and median overall survival (OS) was 15 months. Importantly, 47 patients (57%) needed a dose reduction, 35 (43%) because of treatment-related adverse events, 10 (12%) because of continuous dosing, and two because of both. Stomatitis, fatigue, hand-foot syndrome and a combination of grade 1-2 adverse events were the most frequent reasons for dose reduction. In 40 patients (49%), there was severe toxicity, defined as dose reduction or permanent discontinuation, which was highly correlated with low body surface area, high age and female gender. On the basis of age and gender, a model was developed that could predict the probability of severe toxicity.     

结束ICU治疗后危重患者的住院病死率及其流行病学因素

简介：确定结束ICU治疗后危重患者的住院病死率可能相关的流行病学因素对预防这类死亡有重要意义。这也是一项极有价值的质量评价工具。此项研究的目的就是力图确认这些与病例相关的因素。方法：我们回顾性分析了在1999年间有15张床位的内、外科ICU收住的889例患者。所有的病例都登记了如下资料：年龄、性别、住院经过、ICU住院时间、收入ICU前的住院时间，以及在结束ICU治疗后病情加重的情况(通过SAPⅡ和西班牙式APACHEⅢ评分法)、死亡的危险性(根据同一套预测系统以及MPM0、MPM24系统)、收住患者的类型(内科、外科择期手术或急诊手术患者)、患者是否为再次收入、收入ICU后所要达到的治疗目标、在ICU期间是否发生感染以及工作量(通过NEMS记录第一天和整个ICU住院期间)。收集住ICU期间和出院时的死亡率。结果：ICU住院期间的病死率为15.3％(136例)，而离开ICU后患者的死亡率则升高至19％(169例)，即33位患者在结束ICU治疗后在医院中死亡。仅收入ICU前的住院时间和离开ICU后的住院时间有显著的差异(两段时间均延长的患者在离开ICU后多死亡)。那些离开ICU后死亡的患者再次入院的机率较低，在我们研究中的33位患者无一人需行心包腔引流。其他的因素经分析也未显示出在整个研究样本中存在差异。结论：在此次研究中，我们未能确认任何特异性危险因素与离开ICU后患者的病死率相关，看来预防这样的死亡并不容易。     

Predictive factors of radiation-induced skin toxicity in breast cancer patients

Background  

To assess the factors affecting the incidence of radiation-induced dermatitis in breast cancer patients treated with adjuvant 3 D conformal radiotherapy by the analysis of dosimetry and topical treatments.     

Predictive factors for skin reactions in patients treated with thermoradiotherapy

In this study we performed univariate analyses to analyse the predictive factors for skin reactions, i.e. erythema, thermal blisters and ulceration, that occur during thermoradiotherapy. One hundred and twenty-six fields in 126 patients were treated with thermoradiotherapy using 915 MHz external microwave hyperthermia. Mean age of patients was 62 years. All but 11 lesions received previous therapy. Prior treatment included surgery (75%), chemotherapy (60%) and/or radiation therapy (51%). The mean previous radiation dose was 54 ± 2 Gy. The concurrent tumour radiation dose was 45 ± 1 Gy, in 16 fractions, over 35 elapsed days (dose per fraction of 1·6–4·8 Gy). The mean number of heat sessions administered was 5·5 ± 0·2 (range 1–14). In 83% of cases hyperthermia was administered biweekly. Forty-two patients were treated without any skin reaction (33%), erythema occurred in 59 fields (47%), transient thermal blisters occurred in 25 fields (20%) and ulceration occurred in 23 fields (18%). In 25 cases, two or more skin reactions (20%) were observed concurrently. Concurrent radiation dose correlated with skin reactions (p = 0·02). The incidence of skin reactions was inversely correlated with previous radiation therapy (p = 0·04) and previous radiation therapy dose (p = 0·04) possibly due to fibrosis. None of the tumour or skin thermal parameters correlated with the reaction rate.     

Relevance of Candida and other mycoses for morbidity and mortality in severe sepsis and septic shock due to peritonitis

This single‐centre retrospective cohort study evaluated the incidence and outcome of mycoses in critical ill patients (n = 283) with sepsis due to peritonitis. Overall mortality was 41.3%, and the 28‐day mortality was 29.3%. Fungal pathogens were found in 51.9%. The common first location was the respiratory tract (66.6%), followed by the abdominal site (19.7%). Candida colonisation was found in 64.6%, and invasive Candida infection in 34.0%. Identified fungi were Candida spp. in 98.6% and Aspergillus spp. in 6.1%. Patients with fungal pathogens showed a higher rate of postoperative peritonitis, APACHE II and tracheotomy. In comparison to patients without fungal pathogens, these patients showed a longer duration on mechanical ventilation, and a higher overall mortality. Patients with Candida‐positive swabs from abdominal sites had more fascia dehiscence and anastomosis leakage. Seventy‐two patients (48.9%) received antifungal therapy, 26 patients were treated empirically. Antifungal therapy was not associated with a decrease in mortality. Age and renal replacement therapy were associated with mortality. In conclusion, fungi are common pathogens in critically ill patients with peritonitis, and detection of fungi is associated with an increase in overall mortality. Particularly, Candida‐positive abdominal swabs are associated with an increase in morbidity. However, we were not able to demonstrate a survival benefit for antifungal therapy in peritonitis patients.