BJ—MODS、APACHEII、SOFA、Marshall—MODS评分系统对MODS患者病情评估价值的比较

目的评价BJ—MODS、APACHEII、SOFA、Marshall—MODS四种评分系统对多器官功能障碍综合征（MODS）患者的病情评估及预后的价值。方法前瞻性、多中心搜集MODS患者191例,选取资料完整的MODS患者141例,分别进行BJ—MODS、APACHEII、SOFA、Marshall—MODS评分,比较存活组和死亡组之间各种评分以及同一组不同时间段的分值差异;以及四种评分不同分数段患者病死率。然后分别绘制患者入组第1天的BJ—MODS、APACHEII、SOFA、Marshall—MODS受试者工作特征曲线,计算ROC曲线下面积,评价各评分预测MODS患者预后的准确性。结果141例患者中,存活84例（59．6％）,死亡44例（32．2％）,放弃治疗12例（8．5％）,其他1例（0．7％）。总住院病死率为31．2％,ICU病死率为29．1％。存活纽和死亡组在入组第1天APAcHEⅡ评分,有统计学差异（P〈0．05）,而BJ—MODS、SOFA、Marshall—MODS评分均无统计学差异（P〉0．05）,入组第7天的BJ—MODS、APACHEII、SOFA、Mar-shall—MODS评分均有统计学差异（P〈0．05）。存活组和死亡组四种评分在两个时间段的差值,有统计学意义（P〈O．05）。BJ—MODS和Marshall—MODS评分随着病死率增加而增加,入组第7天差异有统计学意义（P〈0．001）;A-PAcHEⅡ和SOFA入组第1天评分随着病死率增加而有所下降,入组第7天差异有统计学意义（P〈0．001）。BJ—MODS评分入组第1天、入组第7天及第1天与第7天差值的曲线下面积分别为0．600、0．865、0．835,APACHEⅡ评分为0．618、0．869、0．821,SOFA评分为0．556、0．872、0．893,Marshall—MODS评分为0．551、0．870、0．871。BJ—MODS入组第1天评分随着器官障碍数目的增加而增加,有统计学差异（P〈0．05）,而BJ—MODS入组第7天、APACHElI、SO-FA、Marshall—MODS评分增加不明显。ICU病死率随着器官障碍数目的增加而增加,有统计学差异（P〈0．05）。结论APACHElI评分对MODS患者病情严重程度的顸后评估能力最好,BJ—MODS与SOFA、Marshall评分相当。     

三种评分系统对多器官功能障碍综合征患者的预后评估

目的　比较Marshall评分、SOFA评分与 95庐山标准对MODS患者的预后评估。方法　回顾性分析多器官功能障碍综合征 (MODS)患者住院资料。结果　根据本组资料三种评分系统的病情严重度分值将患者分成轻中重三组 ,分别计算各组MODS患者病死率 ,结果 ,三种评分的判断结果一致 ,即随着患者病情加重 (即各评分的分值升高 )而死亡率升高 ,轻症患者病死率为 14 6%～ 2 0 % ,重症患者为 72 7%～ 83 3 %。与存活组相比 ,死亡组的APACHEII分值、三种MODS评分的分值较高 ,发生功能障碍的器官数目较多 (P <0 0 5 )。APACHEII评分、SOFA评分、 95庐山标准、Marshall评分的ROC曲线下面积依次为 0 75 0 ( 0 0 63 )、 0 73 0 ( 0 0 67)、 0 70 1( 0 0 69)、 0 686( 0 0 73 )。结论　 95庐山标准、Marshall评分、SOFA评分三者都能对MODS的预后进行较为准确的评估。     

MODS评分和APACHE Ⅱ评分对多脏器功能障碍综合征患者预后评价的比较

目的：比较MODS评分（Marshall标准）和APACHEⅡ评分在评估多脏器功能障碍综合征患者的预后评价。方法：分析急诊科监护病房273例患者的住院资料,并进行MODS评分和APACHEⅡ评分,根据其当次入院后病死率,比较两种评分与患者预后的相关性,通过ROC曲线下面积比较两种评分的准确性。结果：MODS评分和APACHEⅡ评分分值越高,死亡危险率越高,各分组间病死率比较差异均有统计学意义（P〈0.01）;MODS评分、APACHEⅡ评分的ROC曲线下面积分别为0.765和0.802,MODS和APACHEⅡ评分比较ROC曲线下面积差异有统计学意义（P〈0.01）。结论：两种评分均能对多脏器功能障碍综合征患者的预后进行较为准确的评估,APACHEⅡ评分优于MODS评分。但从急诊科快速评估病情的角度考虑,MODS评分获得简便快捷,更符合急诊科的需求。     

危重病评分及急性肾损伤分期在行连续性肾脏替代治疗的急性肾损伤患者预后中的应用价值

目的 探讨急性生理学与慢性健康状况评分(acute physiology and chronic health evaluation,APACHE)Ⅱ、多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)评分、序贯性脏器衰竭评分(sequential organ failure assessment,SOFA)3种危重病评分系统和急性肾损伤(acute kidney injury,AKI)分期在行连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)的AKI患者中对预后的判断价值.方法 以2006年1月至2010年12月上海交通大学附属第六人民医院重症监护病房(intensive care unit,ICU)及急诊重症监护病房(emergency intensire care unit,EICU)行CRRT治疗的AKI患者为研究对象,在入ICU、开始CRRT时分别进行APACHE Ⅱ、MODS、SOFA评分和AKl分期,并用受试者工作特征(receiver operating characteristiC,ROC)曲线进行预后分析.结果 共收集患者117例,117例患者存活45例,死亡72例,总病死率为61.5%.剔除肾脏替代治疗作为AKI分期标准,有25例AKI 3期的患者在CRRT时分别纳入AKI 1期和2期.APACHE ⅡCRRT、MODSCRRT、SOFACRRT的ROC曲线下面积分别为0.901、0.851、0.885(P＜0.001),而AKICRRT的ROC曲线下面积为0.617(P=0.034).结论 APACHE Ⅱ、MODS及SOFA评分系统对行CRRT的AKI患者预后的判断价值较高,而AKI分期则意义不大.     

MODS病情严重度评分及预后王宝恩名医工作室学术园地评估系统对MODS患者预后预测价值的

目的 验证多器官功能障碍综合征病情严重度评分及预后评估系统（MODS评分系统）对MODS患者病情严重程度的辨别力及预后预测的准确性;同时与APACHEⅡ评分系统、Marshall评分系统相比较,判断三者在预测多器官功能障碍综合征患者预后方面的关联性及准确性.方法 前瞻性的收集MODS患者183例,利用MODS评分系统判断每例患者器官功能障碍种类及数目并计算出每例患者MODS评分及死亡概率;利用APACHEⅡ评分系统计算每例患者的APACHEⅡ评分和死亡危险性;利用Marshall评分系统计算每例患者的Marshall评分;比较死亡组患者与存活组患者MODS评分有无差异;应用接受者操作特征曲线下面积（AURCC）,判断该评分系统在预测患者转归方面的准确性,同时与APACHEⅡ评分系统、Marshall评分系统相比较,判断三者的关系.结果 ①183例患者病死率为58.4%.存活组MODS评分均值为6.05,标准差为2.87;死亡组MODS评分为10.12,标准差为3.60.两组比较差异有显著性（P〈0.05）.②在预测病死率方面：MODS评分系统死亡概率与APACHEⅡ评分系统死亡危险性的ROC曲线下面积分别为0.831±0.031、0.820±0.031;MODS评分、APACHEⅡ评分以及Marshall评分的ROC曲线下面积分别为0.805±0.032、0.809±0.032、0.649±0.041.结论 ①死亡组与存活组MODS评分差异有统计学意义,且随着MODS评分的增加,病死率增加,MODS评分系统能较好地反映患者病情严重程度.②MODS评分系统中死亡概率计算方程及APACHEⅡ评分系统中死亡危险性计算公式对MODS患者病死率的预测准确性较高,MODS评分系统预测病死率的准确性优于APACHEⅡ评分系统;MODS评分系统、APACHEⅡ评分系统、Marshall评分系统三者所计算出来的评分区分存活与死亡的辨别力较好,但前两者准确性更高.     

不同评分系统对ICU中肺部感染患者预后评估的意义

目的 不同评分工具对ICU中肺部感染患者预后评估的意义.方法 本研究收集了2018-01-01-06-30于天津市第四中心医院综合ICU住院的所有肺部感染患者,计算CRB-65、CURB-65、快速SOFA评分(qSOFA)、序贯器官衰竭评估(SOFA)评分,采用受试者工作曲线(ROC曲线)及趋势2检验比较不同评分对I...     

急性生理评分与序贯器官衰竭评估评分预测高龄脓毒症患者预后的价值

目的比较急性生理评分(APS)与序贯器官衰竭评估评分(SOFA)对高龄脓毒症患者预后预测能力的差异。方法利用美国重症医学领域的公共数据库筛选出高龄(年龄≥80岁)脓毒症患者并分别计算APS与SOFA,以28 d内死亡为主要结局,使用多因素Cox回归分析各评分与预后的关联,同时绘制受试者工作特征(ROC)曲线并比较曲线下面积(AUC)的不同。结果最终共纳入2 936例高龄脓毒症患者,平均年龄为(85. 47±3. 09)岁,28 d内病死率为22. 89%。APS与SOFA均与28 d内死亡显著关联(风险比分别为1. 03与1. 17)。APS与SOFA预测28 d内死亡的ROC曲线下面积分别为0. 68和0. 63,差异有统计学意义(P 0. 01)。结论 APS与SOFA对于高龄脓毒症患者短期预后的预测有一定价值,而APS对28 d内死亡的预测价值优于SOFA。     

MODS评分与应激性溃疡的相关性研究

目的 预测多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)患者应激性溃疡的发生,为其预防治疗提供依据.方法 回顾性分析2008年8月至2012年8月入住南京军区南京总医院急诊重症监护病房(emergency intensive care unit,EICU)的符合MODS诊断标准的262例患者的临床资料.根据Marshall的MODS评分标准进行评分,依据应激性溃疡诊断标准判断应激性溃疡的发生,用秩相关分析MODS评分与应激性溃疡发生的相关性,应用受试者工作特征曲线(receiver operating characteristic curve,ROC)评价MODS评分对应激性溃疡的预测作用,计算Youden指数确定最佳临界值.结果 Spearman相关系数为0.693 (P ＜0.01),ROC下面积为0.793 (P ＜0.01),预测应激性溃疡的MODS评分最佳临界值为9分.结论 MODS评分能在一定程度上预测应激性溃疡的发生,MODS评分＞9分时应进行应激性溃疡的预防治疗.     

六种危重病评分方法对MODS患者预后判断的研究

目的 比较六种危重病评分方法及血清肿瘤坏死因子(TNF-α)、脂多糖(LPS)、单核细胞表面人白细胞抗原一DR(HLA-DR)对MODS患者预后评估的能力.方法 对53例MODS患者于入院第1、3、5天进行MODS、SOFA、ODIN、SAPSll、APACHEⅡ及APACHEm评分,并于人院第1天检测血清TNF-α、LPs及单核细胞表面HLA-DR水平.根据预后将患者分为存活组(34例)、死亡组(19例),比较两组患者各项指标的水平,并将各项指标对预后评估的ROC曲线进行分析.结果 死亡组患者入院第1、3、5天的六种危重病评分均高于存活组患者,各项评分与预后均有明显的相关性.根据ROC曲线分析,对预后评估能力较强的依次为第3天的APACHE Ⅱ评分、第5天的APACHEⅡ评分、第3天的APACHEⅢ评分、第1天的APACHE Ⅱ评分、第3天的SAPS Ⅱ评分、第5天的SAPSⅡ评分、第1天的ODIN评分、第5天的MODS评分.TNF-α及LPS水平与预后没有明显的相关性,HLA-DR及脏器功能不全数对预后具有评估能力,但低于APACHE评分.结论 APACHE评分方法评估MODS患者预后的能力优于其他评分系统,其中第3天的APACHE Ⅱ评分能力最强.     

降钙素原、ISS评分和SOFA评分在外科创伤患者预后评估中的比较

目的:比较降钙素原(PCT)、ISS评分和SOFA评分对外科创伤患者的预后评估.方法:对首次入急诊抢救和重症监护病房的机械性创伤患者采集血标本,采用免疫发光法检测血浆PCT水平,同时对患者进行ISS评分和SOFA评分.用此三种方法预测患者的病死率.结果:ISS评分和SOFA评分均随着患者病情加重(即各评分的分值升高)而病死率升高,同时血浆PCT水平随着病情加重而升高(P=0.03).ISS评分、SOFA评分和PCT水平的ROC曲线下面积依次为0.691(0.062)、0.711(0.069)、0.692(0.072).结论:PCT、ISS评分和SOFA评分都能对外科创伤患者的预后进行较为准确的评估,PCT更具有较好的客观性和敏感度.     

MHD人群慢性肾脏病矿物质和骨异常单中心横断面研究

目的了解维持性血液透析（maintenance hemodialysis,MHD）患者的慢性肾脏病-矿物质和骨异常（CKD-MBD）的患病情况,并分析其相关危险因素。方法对2010年7月至2011年3月在四川省人民医院血液透析中心进行规律MHD的患者217例进行调查,收集患者的一般资料,测定血钙、血磷、血iPTH,行腹部侧位、骨盆正位、双手正位X线摄片,采用Kauppila评分进行血管钙化评分。分析CKDMBD各指标在血透患者中患病率、达标率以及相关危险因素。结果本次217例MHD患者中,高磷血症患病率为45.16%,低钙血症患病率为31.8%,高钙血症患病率为21.66%,高iPTH患病率为48.85%,低iPTH患病率为20.74%。X片显示有血管钙化的患者有154人（占70.97%）,有钙磷代谢异常、PTH、血管钙化1项或多项异常,符合KDIGO关于CKD-MBD诊断的患者比例高达96.31%。本组MHD患者血钙、血磷、PTH达标率分别为45.16%、44.7%、30.88%。血钙、磷、PTH均达标仅有20人（占9.22%）。血钙和血磷的达标率低于DOPP4。多因素Logistic回归分析显示高PTH的危险因素有高磷血症、低钙血症。低PTH的危险因素有年龄、透析龄和活性维生素D服用史。血管钙化的危险因素有高龄、高ALP、高磷血症和高CRP。结论 CKD-MBD在MHD患者中普遍存在,与DOPP4比较,存在CKD-MBD各项指标达标率较低。     

重症脑血管疾病的脑电图分级评价标准研究

目的比较不同脑电图(EEG)分级标准对脑血管疾病后脑功能损伤评价及预测预后的作用,旨在建立脑血管疾病的EEG评估标准。方法对40例大脑半球病变的急性脑血管疾病患者进行EEG检测,并根据3种不同分级标准(Lavizzari、Synek和Young标准)进行EEG分级分析。结果3种不同标准的EEG分级与预后均有显著相关性(P均<0.001),EEG级别越高,预后越差。经Logistic回归分析,Synek标准对生存和综合预测的准确率最高(分别为90.9%和89.2%),Young标准(分别为81.8%和83.8%)低于Synek标准,但高于Lavizzari标准(分别为75.0%和80.0%)。结论根据Synek标准进行的EEG分级能更好地反映急性脑血管疾病后脑功能损伤的程度以及准确预测预后。     

The prevention and treatment of glucocorticoid-induced osteoporosis in clinical practice

Glucocorticoids are associated with increased risk of bone loss and fracture. This study compared the prescribing of bone protective agents by rheumatologists in clinical practice with the standards recommended in the 1998 UK Consensus guidelines. All glucocorticoid users who attended rheumatology outpatients during a four-week period were eligible. Notes were audited according to a predefined proforma. Among the 1290 rheumatology outpatients seen in the study period, 189 (15%) were taking glucocorticoids. 63% of glucocorticoid patients were taking calcium and 46% vitamin D. In total, 124 (71%) of the 175 patients available for review were at high risk of osteoporotic fracture, of whom 76 (61%) were taking appropriate prophylaxis. In 26 (15%) patients, insufficient information was available to be able to quantify the risk of fracture. The study showed that the audit standard was not met in 39% of cases. A better strategy for the monitoring of clinical risk factors is therefore required.     

胶体金免疫法对手足口病分型检测的研究

目的 建立胶体金免疫法(CGIA)对手足口病(HFMD)分型的检测方法.方法 用双抗体夹心检测原理建立CGIA对HFMD分型检测方法,分别检测136例HFMD患儿和30例健康儿童粪便中柯萨奇病毒A16型(CA16)和肠病毒71型(EV71),以逆转录聚合酶链反应(RT-PCR)为金标准,评价CGIA检测性能.结果 CGIA 与RT-PCR检测136例HFMD患儿粪便EV71阳性率分别为27.2%和28.6%;CGIA与RT-PCR检测136例手足口病患儿粪便CA16阳性率分别为33.8%和35.3%;以RT-PCR为金标准,CGIA检测手足口病患儿粪便EV71的敏感性89.7%,特异性89.7%,阳性预测值94.5%,阴性预测值95.9%,准确度95.5%;CGIA检测手足口病患儿粪便CA16的敏感性85.4%,特异性94.3%,阳性预测值89.1%,阴性预测值92.2%,准确度91.1%.结论 CGIA法操作简单、方便、快速,特异性和敏感性好,为HFMD病原学早期分型诊断提供了一个有效的检测手段.     

规范护理行政管理的实践与体会

目的对护理单元进行规范化管理,提高护理工作质量。方法对33个护理单元进行规范化管理项目流程再造,制定并下发病区规范化行政管理标准,建设和观摩示范病区,对规范化管理成果进行验收。结果33个护理单元初查合格率为94．0％,复查合格率97．0％,差异有统计学意义（P〈0．01）。在护理质量方面,规范前合格率为消毒隔离管理93．6％,病房管理94．6％;复查合格率消毒隔离管理97．8％,病房管理98．9％,规范前后比较差异有统计学意义（P〈0．01）。结论规范护理管理,再造护理流程,制定全院达成共识的标准,严格按标准评价,提高了护理工作质量,对护理管理达到规范化、标准化、持续化有重要意义。     

Ergonomic sofa design to support kangaroo mother care in Indonesia

BackgroundThe chairs used by mothers performing Kangaroo mother care (KMC) in hospitals in Indonesia are not ergonomically designed, so they can cause an awkward posture and musculoskeletal disorders.ObjectiveThe purpose of this study was to create an ergonomic sofa design that would reduce musculoskeletal disorders among mothers who perform KMC in Indonesian hospitals.MethodsThe research method was based on the Nigel Cross concept and involved anthropometric measurement conducted with 69 postpartum mothers from four hospitals in Indonesia as a basis for designing an ergonomic sofa. The sofa design was assessed using virtual human modeling with the Siemens Jack software for posture and lower back analysis.ResultThe Rapid Upper Limb Assessment (RULA) value of 2 and low back analysis (LBA) of 363 N obtained with virtual human modeling showed that a mother who performed KMC with the ergonomic sofa was in a safe position with a low risk of experiencing lower back injuries. The resulting ergonomic sofa design had adjusted to the anthropometry of mothers in Indonesia. The mother's posture with a simulation using the ergonomic sofa design is easily maintained and acceptable and can be categorized as safe to the user.ConclusionThe ergonomic sofa design for KMC potentially improves posture and reduces the risk of musculoskeletal disorders. Further tests are needed, including prototype production and pilot testing, to determine its effectiveness.     

Comparison of different standards used in radioimmunoassay for atrial natriuretic factor (ANF).

Six different standards for determination of atrial natriuretic factor (ANF) in human plasma samples have been compared using our radio-immunoassay for ANF: International standard 85/669, National Biological Standard Boards, UK; Bachem standard, Torrance, USA; Bachem standard, Bubendorf, Switzerland; Bissendorf standard, Wedemark, Germany; Peninsula standard, Belmont, USA; UCB-Bioproducts standard, Brussels, Belgium. Standard curves obtained with different preparations were in parallel but showed considerable quantitative differences. Standard curves referring to the Bissendorf standard and the International standard, respectively, were almost identical. The dose required for 50% of binding inhibition (ID50s) determined with the Peninsula, UCB and Swiss Bachem standards were higher and ID50 for the American Bachem standard was much lower than ID50 for the International standard. In consequence, estimates of the ANF content in human plasma samples with different standard preparations as the reference showed a considerable variability. With the international standard as the gold reference (plasma ANF concentration 100%) the apparent plasma ANF concentrations measured with the other reference preparations varied from 42% to 178%.     

Detection of reflux esophagitis on double-contrast esophagrams and endoscopy using the histologic findings as the gold standard

The purpose of our study was to determine the accuracy of double-contrast barium studies and endoscopy for detecting reflux esophagitis, using the endoscopic biopsy findings as the gold standard. A review of radiology, endoscopy, and pathology files showed 37 patients with reflux symptoms who underwent double-contrast barium studies and endoscopy with biopsy specimens from the esophagus. The radiographic images were reviewed in a blinded fashion and correlated with the endoscopic and histologic findings to determine the radiographic and endoscopic accuracies for detecting reflux esophagitis, using the endoscopic biopsy specimens as the gold standard. Double-contrast barium studies and endoscopy had low but comparable accuracies for detecting reflux esophagitis, with sensitivities of 35% and 39%, specificities of 79% and 71%, positive predictive values of 73% and 69%, and negative predictive values of 42% and 41%, respectively. When mucosa granularity was evaluated as an individual sign of esophagitis on double-contrast studies, this finding had a sensitivity of 35%, a specificity of 93%, a positive predictive value of 89%, and a negative predictive value of 46% for detecting reflux esophagitis. Our experience suggests that double-contrast barium studies and endoscopy have limited ability to detect reflux esophagitis, in particular mild esophagitis, when using the histologic findings as the gold standard. When radiographic abnormalities are detected, however, mucosal granularity is the single best sign of reflux esophagitis on double-contrast studies.     

肝硬化患者合并感染的回顾性研究

目的:探讨近年来复旦大学附属中山医院肝硬化患者感染状况、危险因素及预后。方法:对2002年1月-12月复旦大学附属中山医院收治的291例肝硬化患者进行回顾性调查分析。结果:291例肝硬化患者的感染率为21.65%(63/291例)。其中,院外感染率12.37%(36/291例),院内感染率8.59%(25/291例),院内外混合感染率0.69%(2/291例);感染部位分布;腹腔(自发性细菌性腹膜炎)33.80%(24/71例次),呼吸道28.17%(20/71例次),泌尿系16.90%(12/71例次),肠道5.63%(4/71例次),败血症5.63%(4/71例次),胆系4.24%(3/71例次),其他(皮肤、引流液等)5.63%(4/71例次);感染菌种分布;革兰阳性球菌36.84%(14/38株),革兰阴性杆菌31.58%(12/38株),真菌31.58%(12/38株)。291例肝硬化患者总病死率为7.90%(23/291例),感染组病死率22.22%(14/63例),明显高于非感染组病死率4.50%(9/228)。结论:肝硬化患者病情危重,易并发各种感染,其中老年患者、肝功能损害明显、严重并发症、合并多种器质性疾病、侵袭性医疗操作和广谱抗菌药的应用均可成为感染的诱发因素,增加病死率;且深部真菌医院内感染呈明显上升趋势,给肝硬化患者合并感染的防治增加了难度。     

Incidence and risk factors for hepatic sinusoidal obstruction syndrome after allogeneic hematopoietic stem cell transplantation: A retrospective multicenter study of Turkish hematology research and education group (ThREG)

Hepatic sinusoidal obstruction syndrome (HSOS) is a potentially life-threatening complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). We retrospectively evaluated the incidence, risk factors, treatment and survival for HSOS after allo-HSCT in Turkey. We also reported our experience of defibrotide (DF) for HSOS prophylaxis in high-risk (HR) patients. Across Turkey, 1153 patients from 10 centers were enrolled in the study. We evaluated the medical records of patients who were treated with allo-SCT between January 2012 and December 2015. The study included 1153 patients (687 males/466 females) with median age of 38 (15−71) years. The incidence of HSOS was 7.5 % (n = 86). The incidences of HSOS in the HR/DF+, HR/DF- and standard risk (SR) group were 8%, 66.7 % and 6.2 %, respectively. The rate of HSOS development was not statistically different between HR/DF + and SR group (p = 0.237). HSOS prophylaxis (defibrotide) was significantly decreased HSOS-related mortality (p = 0.004). The incidence of HSOS was found similar to literature in this large Turkish cohort. Defibrotide prophylaxis appears to be associated with low incidence of HSOS development and reduced HSOS-related mortality. Although these results are promising, future studies are needed to support the efficacy of defibrotide prophylaxis in patients with risk of HSOS.