ICU综合征多因素Logistic回归分析及风险模型的建立

目的 探讨ICU综合征发生的主要危险因素,建立Logistic风险模型,并评价其预测ICU综合征发生的灵敏度、特异度和准确度.方法 收集2007年6-9月入住ICU的危重症患者的数据,包括年龄:性别、文化程度、宗教信仰、家庭收入、医疗费报销情况、是否有家庭成员缺失、原发病、患病时间、性格类型、APACHE II评分等,采用SPSS 11.0统计软件包进行单因素分析,取其中有统计学意义的变量,做多因素Logistic回归分析.结果 年龄、性别、家庭收入、医疗费报销情况、是否有家庭成员缺失、是否经历同室患者死亡、住ICU时间、是否呼吸机治疗、睡眠情况、APACHE II评分、患病时间、性格类型等因素与ICU综合征发生有关.Logistic回归分析共有6个因素进入模型,按作用强弱依次为是否呼吸机治疗、住ICU时间、睡眠情况、性别、患病时间和曾经历同室患者死亡.此模型判断ICU综合征的准确度为82.37%,灵敏度为79.42%,特异度为85.13%.结论 曾使用呼吸机、住ICU时间、睡眠情况、性别、患病时间和曾经历同室患者死亡是ICU综合征发生的主要危险因素,所建立的风险模型能较好预测ICU综合征的发生.     

ICU综合征影响因素探讨

目的分析ICU综合征发生的主要影响因素,探讨预防ICU综合征的护理措施。方法收集2008年3月~9月入住我科ICU的重症患者相关资料,包括年龄、性别、文化程度、家庭收入、医疗费报销情况、入住ICU时间、是否经历同室患者死亡、呼吸机治疗等,分析各因素对发生ICU综合征的影响。结果年龄、家庭收入、医疗费报销情况、入住ICU时间、是否经历同室患者死亡及呼吸机治疗为影响ICU综合征发生的主要因素。结论针对影响ICU综合征发生的主要因素制定相应护理措施,可有效降低ICU综合征的发生率。     

ICU综合征多因素Logistic回归分析及风险模型的建立

目的探讨ICU综合征发生的主要危险因素,建立Logistic风险模型,并评价其预测ICU综合征发生的灵敏度、特异度和准确度。方法收集2007年6-9月入住ICU的危重症患者的数据,包括年龄、性别、文化程度、宗教信仰、家庭收入、医疗费报销情况、是否有家庭成员缺失、原发病、患病时间、性格类型、APACHE Ⅱ评分等,采用SPSS 11．0统计软件包进行单因素分析,取其中有统计学意义的变量,做多因素Logistic回归分析。结果年龄、性别、家庭收入、医疗费报销情况、是否有家庭成员缺失、是否经历同室患者死亡、住ICU时间、是否呼吸机治疗、睡眠情况、APACHE Ⅱ评分、患病时间、性格类型等因素与ICU综合征发生有关。Logistic回归分析共有6个因素进入模型,按作用强弱依次为是否呼吸机治疗、住ICU时间、睡眠情况、性别、患病时间和曾经历同室患者死亡。此模型判断ICU综合征的准确度为82．37％,灵敏度为79．42％,特异度为85．13％。结论曾使用呼吸机、住ICU时间、睡眠情况、性别、患病时间和曾经历同室患者死亡是ICU综合征发生的主要危险因素,所建立的风险模型能较好预测ICU综合征的发生。     

ICU手术患者认知闭合需要与ICU综合征的相关性及护理研究

目的 研究和分析ICU手术患者认知闭合需要与ICU综合征的相关性及护理.方法 选择2021年7月至2023年6月期间本院收治的80例ICU手术患者作为研究对象.采用中文版认知闭合需要量表对患者进行评估,并根据评估结果将其分为高认知闭合需要组(30例)、中等认知闭合需要组(28例)、低认知闭合需要组(22例).采用中文版ICU意识模糊评估表(CAM-ICU)评估患者是否发生ICU综合征.根据患者是否发生ICU综合征,将患者分为ICU综合征组(53例)与无ICU综合征组(27例).分析对比不同组患者ICU综合征发生率,采用Pearson相关分析认知闭合需要与ICU综合征的相关性.对比ICU综合征组与无ICU综合征组患者的一般资料,采用多因素Logistic回归分析法分析引发ICU综合征发生的影响因素.结果 高认知闭合需要组患者ICU综合征发生率显著高于中等认知闭合需要组;中等认知闭合需要组患者ICU综合征发生率显著高于低认知闭合需要组(P<0.05).Pearson相关分析显示,ICU手术患者认知闭合需要与ICU综合征呈正相关性.ICU综合征组与无ICU综合征组患者的性别无显著差异(P>0.05),ICU综合征组患者的青中年率、留置管道率、约束率均显著显著高于无ICU综合征组(P<0.05).Logistic回归分析显示,年龄、留置管道、约束均是引发患者发生ICU综合征的独立影响因素.结论 ICU手术患者认知闭合需要与ICU综合征呈正相关性,患者认知闭合需要水平越高,ICU综合征发生风险越高.     

ICU患者压疮发生危险因素分析

目的：探讨导致ICU患者压疮发生的危险因素。方法：采用自行设计的“ICU患者压疮风险因素调查表”记录735例ICU患者的患病情况、主要治疗情况等资料。结果：性别、糖尿病、脑卒中、入ICU时间、是否持续进行动脉血压监测、水肿、平均动脉压、乳酸Lac、心率、Apachell评分是ICU患者发生压疮的影响因素。结论：ICU患者压疮发生是多因素共同参与的病理生理过程,护理人员应充分认识各种危险因素对ICU患者发生压疮的影响,对存在或可能存在危险因素的ICU患者实施重点防护以减少压疮的发生。     

心脏术后患者发生ICU谵妄的相关因素分析

目的 分析心脏术后ICU谵妄发生的相关因素,提出合适的防治策略.方法 观察124例心脏术后的患者,记录性别、年龄、血型、呼吸机辅助时间及ICU时间；利用护士谵妄筛查量表(nursing delirium screening scale,Nu-DESC)评价是否发生ICU谵妄.利用SPSS软件进行统计分析.结果 124例心脏术后,顺利拔除气管插管的患者中,ICU谵妄的发生率为17％；ICU谵妄组与无ICU谵妄组的年龄、呼吸机辅助时间、入住ICU时间均有差异.不同血型的患者ICU谵妄的发生率显著不同,其中A型血的发生率明显高于B型血及O型血.Logistic回归进行单因素回归,发现年龄、呼吸机辅助时间、ICU时间、性别及血型均是ICU谵妄的相关因素.结论 年龄、呼吸机辅助时间、ICU时间、性别及血型均是ICU谵妄的影响因素.男性、高龄、较长的呼吸机辅助时间及ICU时间易导致ICU谵妄的发生.不同血型之间,ICU谵妄发生率明显不同,A型血较O型血、B型血更易发生ICU谵妄.     

脑卒中发病与性别的关系及康复护理对策

目的 探讨性别对脑卒中发病的影响,制订针对性的康复护理对策.方法 调查152例脑卒中患者,分析不同性别患者的患病情况及不同性别患者的认知障碍的发生情况.结果 脑卒中患者男性患病构成比明显高于女性,认知障碍发生率男性显著高于女性.结论 男性脑卒中患者患病率及认知障碍发生率高于女性,进行有针对性的康复护理是必要的.     

集束化护理策略对ICU患者ICU综合征的影响

目的探讨集束化护理策略对ICU患者ICU综合征的影响。方法将本院100例患者预防ICU综合征的患者设为观察组,实施集束化护理。将本院另外100例患者设为对照组,实施常规护理,比较2组的ICU综合征、谵妄、不良情绪的发生情况以及护理满意度。结果观察组ICU综合征的发生率低于对照组,谵妄值、焦虑值、抑郁值均低于对照组,ICU住院时间短于对照组,差异有统计学意义(P0.05)。观察组在病情保证、获取信息、被接纳等方面的满意度均高于对照组,差异有统计学意义(P0.05)。结论集束化管理能够显著降低ICU患者ICU综合征的发生率,缩短ICU住院时间,提高患者的护理满意度。     

急诊ICU后综合征患者疲乏影响因素分析及护理对策

目的 分析急诊ICU后综合征患者疲乏影响因素及护理对策。方法 采用整群抽样法,选取2019年5月-2022年5月我院收治的150例急诊ICU后综合征患者为研究对象,采用一般资料表进行基线资料收集,采用Piper疲乏修订量表(RPFS)进行疲乏现状调查和程度判定,采用单因素及多重线性回归分析明确影响因素,并提出相应护理对策。结果 150例急诊ICU后综合征患者中发生疲乏症状82例,占54.67%,平均得分为(5.78±2.59)分;未出现疲乏症状68例,占45.33%。多重线性回归分析结果显示,年龄≥60岁、机械通气时间≥3d、入住急诊ICU时间≥7d、有呼吸系统疾病史、APACHE II评分≥15分是急诊ICU后综合征患者疲乏的独立影响因素。结论 急诊ICU后综合征患者疲乏的影响因素较多,临床应充分重视高危患者,制定针对性护理对策,降低急诊ICU后综合征发生风险及疲乏程度,改善其治疗结局和预后。     

基层医院ICU综合征影响因素的探讨

目的探讨基层医院引起ICU综合征的影响因素。方法选择2011年3月~2013年4月120例入住ICU无精神障碍的患者作为研究对象,比较ICU综合征患者与无ICU综合征患者的影响因素。结果 120例患者中发生ICU综合征42例(35.00%);单因素t及χ2检验等11个因素在2组间差异均有统计学意义(P0.05),Logistic回归分析导致ICU综合征的独立影响因素包括:睡眠障碍(OR=4.97)、疾病及对ICU认知缺乏(OR=4.34)、护患关系一般(OR=3.56)、自费治疗(OR=2.89)。结论 ICU综合征发生率较高,影响因素复杂,应针对性实施护理预防措施,减少ICU综合征的发生。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.