内科重症监护病房的患者血液管理专家共识

分析内科重症监护病房(ICU)患者贫血、血小板减少及凝血功能障碍的病因。讨论内科ICU患者贫血、血小板减少及凝血功能障碍相应的防治原则,进一步形成符合内科ICU特点的患者血液管理(PBM)专家共识。从而提高内科ICU的PBM水平。     

Barlow综合征患者手术后的重症监护病房监护

目的探讨Badow综合征患者在行心脏手术后的重症监护病房监护要点。方法回顾性分析10例Baflow综合征患者在心脏外科手术后的重症监护病房监护情况,着重分析其监护和护理措施。结果术后重症监护病房监护时间为23．17±113．58h。1例患者肺不张,经抢救治愈,10例患者全部治愈出院。结论加强此类较少见疾病患者术后重症监护病房监护措施,可提高手术成功率,使患者安然渡过围术期。     

重症监护病房患者的个体化血糖管理

现在越来越多的证据提示重症监护病房(ICU)患者的血糖管理需要采取个体化血糖管理策略.针对ICU患者个体制定控糖目标时,除了需要考虑疾病种类之外,患者既往是否存在糖尿病病史也应当得到更多的关注.本文针对这一话题进行简要的文献复习和评论.     

急诊重症监护病房患者精神障碍的监测

目的:探讨急诊重症监护病房(emergency intensive care unit,EICU)患者精神障碍的临床特征。方法:收集2010年1月至2012年1月2年间,于北京安贞医院EICU住院患者的临床资料,进行总结分析。结果:患者住EICU出现精神障碍的年龄段集中在76～85岁,占57.1%(P<0.05),发生率7.5%(42/563),男女病死率相同11.9%(5/42)。患者基础病多为呼吸系统、心血管系统疾病、营养和代谢疾病,常合并呼吸衰竭、心力衰竭、电解质紊乱及肾功能不全等。EICU患者精神障碍的临床表现多为行为异常和定向力障碍。出现EICU精神障碍的患者精神症状大多持续1～10 d;由疾病因素为主导致精神障碍占61.9%(26/42),由非疾病因素为主导致的精神障碍占38.1%(16/42)。结论:EICU患者精神障碍的发生率以及病死率高。出现精神障碍多数与基础疾病有关。应重视病因治疗减少精神障碍持续时间。     

外科重症监护病房患者血清白蛋白与预后的关系研究

血清白蛋白是临床常用生化检查指标,在一定程度上可反映机体营养状况或慢性疾病严重程度[1]。急性生理学与慢性健康状况Ⅱ（APACHEⅡ）评分被国内外重症监护病房（intensivecareunit,ICU）广泛用于评估患者病情危重程度[1],因其简单可靠,目前已成为应用最为广泛的评分系统之一。     

重症监护病房患者的个体化血糖管理

现在越来越多的证据提示重症监护病房(ICU)患者的血糖管理需要采取个体化血糖管理策略.针对ICU患者个体制定控糖目标时,除了需要考虑疾病种类之外,患者既往是否存在糖尿病病史也应当得到更多的关注.本文针对这一话题进行简要的文献复习和评论.     

重症监护病房患者的个体化血糖管理

现在越来越多的证据提示重症监护病房(ICU)患者的血糖管理需要采取个体化血糖管理策略.针对ICU患者个体制定控糖目标时,除了需要考虑疾病种类之外,患者既往是否存在糖尿病病史也应当得到更多的关注.本文针对这一话题进行简要的文献复习和评论.     

重症监护医学的基本概念和加强监护病房的设置

危重症患者如出现重要脏器功能异常并影响到其功能时,则需要加强监护,通过监护可早期发现和及时处理包括急性呼吸衰竭在内的各种严重的器官功能异常。多器官功能障碍综合征（ＭＯＤＳ）为危重患者发生多器官功能异常,其特征为呼吸功能障碍合并其他肺外脏器的功能不全［...     

重症监护病房患者院内深部真菌感染的诊断与治疗进展

重症监护病房（intensive care unit，ICU）患者出现医院获得性深部真感染的发生率明显上升，甚至超过了医院获得性革兰氏阳性球菌感染的发生率，且该类患者的病死率明显上升，是ICU患者的一个致病威胁，而且还造成巨大的经济负担。由于真菌感染症状的非特异性和临床表现的多变性，给诊断带来很大困难，何时开始抗真菌治疗亦存在很大分歧。因此，规范化治疗和抗真菌药物的临床合理应用更是目前抗感染领域的一个热点问题，现就ICU患者院内深部真菌感染的诊断与治疗进展作一综述如下。     

美国重症监护治疗病房见闻

1999年 11月～ 2 0 0 0年 11月 ,我到美国新奥尔良市的Ｔｕｌａｎｅ大学医学中心肺病理生理专业做访问学者 ,在完成规定的科研项目后 ,根据自己的专业特点 ,分别在ＵｎｉｖｅｒｓｉｔｙＨｏｓｐｉｔａｌ和ＣｈａｒｉｔｙＨｏｓｐｉｔａｌ的内科重症监护治疗病房 (ＭＩＣＵ)学习了 3个月 ,并到ＥａｓｔＪｅｆｆｅｒｓｏｎＧｅｎｅｒａｌＨｏｓｐｉｔａｌ (ＥＪＧＨ)的ＭＩＣＵ进行短期参观访问 ,对美国危重病医学的发展 ,尤其是ＩＣＵ内先进的医疗设施、诊疗技术及严格的病房管理制度留下了深刻的印象。一、美国危重病医学发展概况近年来美国…     

外科重症监护病房非心脏术后患者急性肺损伤/急性呼吸窘迫综合征特点及影响预后的多因素分析

目的回顾分析外科重症监护病房（SICU）非心脏术后住院患者的临床资料,以观察非心脏手术后患者急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）的发病情况及预后影响因素。方法2006年9月至2007年8月连续收入解放军总医院外科重症监护病房的105名非心脏手术术后患者纳入本研究。其中男62名,女43名;年龄（51.0±18.1）岁。沿用中华医学会重症医学分会（2006年）提出的ALI/ARDS诊断标准,所有观察病例按照入住SICU期间的最低氧合指数水平分为3组：氧合指数正常组,ALI组,ARDS组。分别比较各病例组年龄,体重,体重指数,ICU停留时间,以及患者住ICU期间以及转出ICU后30d内患者总死亡率,术中出血量与输液量。并应用Logistic回归分析以上各因素对ALI/ARDS患者总死亡率的影响。结果3组患者间年龄、体重和体重指数比较有显著性统计差异,发生ARDS组患者体重最重,体重指数最高。ARDS组在ICU停留时间明显高于其他2组。3组患者总死亡率无显著统计差异。各组患者中,术中出血量和液体入量无显著差异。Logistic回归分析显示,在发生ALI/ARDS的SICU患者中,年龄是影响患者预后的独立因素。高龄ALI/ARDS患者更容易发生死亡。结论老年、体重较重的患者更容易在术后发生ALI/ARDS,应加强此类高危患者的围术期管理,从而降低外科术后ALI/ARDS发病率,减少发病患者的死亡率。     

品管圈活动在糖尿病患者院外健康管理中的应用

目的探讨品管圈活动(QCC)在提高院外糖尿病患者血糖控制率中的效果。方法选取2011年8月~2013年12月在福建医科大学附属泉州第一医院门诊确诊糖尿病患者801例,成立品管圈小组,确立"提高糖尿病患者血糖控制率"为主题,通过问卷调查及电话回访,组内讨论确定血糖控制率低主要原因并制定对策,设定预期目标值,按品管圈程序开展实施,比较QCC前后糖尿病患者对服务质量满意度、治疗依从性、糖尿病认知率及血糖控制率情况。结果 QCC活动实施前,患者服务质量满意度,治疗依从性,DM认知率及血糖控制率分别为77.8%(623/801),70.2%(562/801),60.3%(483/801),64.4%(516/801),而纳入QCC活动后分别为93.9%%(752/801),94.9%%(760/801),85.0%(681/801),86.3%(691/801),各项指标均较活动前有明显提高,且实施前后间比较差异有显著统计学意义(P0.01)。结论 QCC应用于糖尿病院外健康管理工作中,对血糖控制率的整体提高有利,值得临床推广。     

A prediction model for 30-day deaths of cirrhotic patients in intensive care unit hospitalization

The aim of this study was to establish a prediction model for 30-day deaths of cirrhotic patients in intensive care unit.A case-control study involving 1840 patients was conducted in the Medical Information Mart of the Intensive Care Database III version 1.4. The logistic regression with L1 regularization was used to screen out the variables. The 30-day in-hospital death was used as the dependent variable and the selected variables were used as the independent variable to build a random forest model. The performance of the model was validated by the internal validation.The variables screened by logistic regression analysis were the age, heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, Oxygen saturation, white blood cells, platelets, red cell distribution width, glucose, blood urea nitrogen, bicarbonate, total bilirubin, hematocrit, alanine transaminase, aspartate transaminase, bilirubin, Simplified Acute Physiology Score II and Sequential Organ Failure Assessment. The areas under the curve of the random forest model based on these variables was 0.908, and the performance of this model were internally validated with an areas under the curve of 0.801. The random forest model displayed that Simplified Acute Physiology Score, Sequential Organ Failure Assessment, blood urea nitrogen, total bilirubin and bilirubin were more important predictors for the 30-day death of cirrhotic patients in intensive care unit.A prediction model for death of cirrhotic patients was developed based on a random forest analysis, providing a tool to evaluate the patients with a high risk of 30-day in-hospital deaths to help clinician make preventive intervention to decrease the mortality.     

The application of quality control circle to improve functional exercise execution rate of orthopaedic surgery patients: A SQUIRE-compliant quality-improving study

Since its application in medical institutions in China, quality control circle (QCC) has gained achievements in medical care and thus earned more attention from the administrative department of health. This paper focuses on the application of QCC (bone-strength test circle) as a new management concept and tool circle in improving the implementation rate of functional exercise in patients undergoing orthopedic surgery, which further effectively improve the accuracy and compliance of functional exercise in patients undergoing surgery, and further effectively promote the rehabilitation of patients.From July 2018 to November 2018, the management tools and statistical methods of QCC were used to compare the promotion effect of functional exercise execution rate of orthopedic surgery patients before and after QCC activities.The checklist investigated 6 key causes of functional exercise in patients undergoing orthopedic surgery, the operative rate of orthopaedic surgery in all aspects changed significantly. Among them, the factors of inadequate propaganda and education were compared before and after the improvement, which decreased by 71% after the improvement. The incorrect factors of exercise decreased by 69% after improvement, the effect was more obvious, the difference was statistically significant (P < .05). The improvement rate was 59.4%.Through this activity, functional exercise education process and functional exercise paths, and corresponding standards for various orthopedic diseases were established. At the same time, the measures such as health education for patients were strengthened, and the expected goals were effectively achieved.     

Interface design and human factors considerations for model-based tight glycemic control in critical care

Introduction

Tight glycemic control (TGC) has shown benefits but has been difficult to implement. Model-based methods and computerized protocols offer the opportunity to improve TGC quality and compliance. This research presents an interface design to maximize compliance, minimize real and perceived clinical effort, and minimize error based on simple human factors and end user input.

Method

The graphical user interface (GUI) design is presented by construction based on a series of simple, short design criteria based on fundamental human factors engineering and includes the use of user feedback and focus groups comprising nursing staff at Christchurch Hospital. The overall design maximizes ease of use and minimizes (unnecessary) interaction and use. It is coupled to a protocol that allows nurse staff to select measurement intervals and thus self-manage workload.

Results

The overall GUI design is presented and requires only one data entry point per intervention cycle. The design and main interface are heavily focused on the nurse end users who are the predominant users, while additional detailed and longitudinal data, which are of interest to doctors guiding overall patient care, are available via tabs. This dichotomy of needs and interests based on the end user''s immediate focus and goals shows how interfaces must adapt to offer different information to multiple types of users.

Conclusions

The interface is designed to minimize real and perceived clinical effort, and ongoing pilot trials have reported high levels of acceptance. The overall design principles, approach, and testing methods are based on fundamental human factors principles designed to reduce user effort and error and are readily generalizable.     

改良批质量抽样检验在地方性氟中毒轻病区复核判定质量控制中的应用

目的 探讨改良批质量抽样检验方法在地方性氟中毒（简称地氟病）轻病区复核判定质量控制中的应用。方法 2009年在四川省叙永县15个地氟病轻病区乡（镇）中单纯随机抽取6个,采用改良批质量抽样检验对22所村小学8～ 12岁儿童氟斑牙患病情况进行复核判定。结果 在6个乡（镇）97个轻病区村中,共核查22个村,占22.68％,复查氟斑牙儿童416人,检出氟斑牙儿童383人,氟斑牙儿童复核吻合率达92.07％;核查质量判定轻病区村达21个,占95.45％。结论 改良批质量抽样检验在地氟病轻病区复核判定质量控制中的应用,能提高质量控制工作效率,提高轻病区复核判定准确率,是地氟病轻病区判定质量控制的一种新颖方法。     

Glucose control in Mayo Clinic intensive care units

Background

Safe and effective glucose control in the intensive care unit (ICU) continues to be actively pursued. Large clinical trials have examined the safety and efficacy of insulin infusion protocols in medical and surgical ICUs. We report experiences of a single-center standardized nurse-driven insulin infusion protocol in three ICUs in an observational quality-improvement study.

Method

We analyzed the hourly point-of-care arterial blood glucose obtained during ICU insulin infusion protocol (protocol A) with a glucose target of 80–130 mg/dl in medical and surgical ICUs in February 2009. Following Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) study results, the protocol was amended (protocol B) to achieve target glucose of 110–150 mg/dl. The performance of protocol B was assessed in the ICUs in May 2010 and compared with protocol A with respect to glucose concentrations and rates of severe (<40 mg/dl) and moderate (40–60 mg/dl) hypoglycemia.

Results

With protocol A, in medical (n = 44) and surgical (n = 164) ICUs taken together, median glucose was 119 mg/dl, with severe and moderate hypoglycemia rates 1.4% (3/208) and 7.7% (16/208), respectively, which were significantly lower than those reported by the NICE-SUGAR and the Leuven studies. With protocol B, in medical (n = 44) and surgical (n = 167) ICUs taken together, median glucose was 132 mg/dl, with severe and moderate hypoglycemia of 0 % (0/211) and 0.5% (1/211), respectively.

Conclusion

The current ICU insulin infusion protocol (protocol B) reduces severe and moderate hypoglycemia without compromising glucose control when compared with protocol A. This could potentially impact patient-important outcomes.     

Risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures

BackgroundHealthcare Associated Infections constitute an important problem in Neonatal Units and invasive devices are frequently involved. However, studies on risk factors of newborns who undergo surgical procedures are scarce.ObjectiveTo identify risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures.MethodsThis case–control study was conducted from January 2008 to May 2011, in a referral center. Cases were of 21 newborns who underwent surgery and presented the first episode of laboratory-confirmed bloodstream infection. Control was 42 newborns who underwent surgical procedures without notification of laboratory-confirmed bloodstream infection in the study period. Information was obtained from the database of the Hospital Infection Control Committee Notification of infections and related clinical data of patients that routinely collected by trained professionals and follow the recommendations of Agência Nacional de Vigilância Sanitária and analyzed with Statistical Package for Social Sciences.ResultsDuring the study period, 1141 patients were admitted to Neonatal Unit and 582 Healthcare Associated Infections were reported (incidence-density of 25.75 Healthcare Associated Infections/patient-days). In the comparative analysis, a higher proportion of laboratory-confirmed bloodstream infection was observed in preterm infants undergoing surgery (p = 0.03) and use of non-invasive ventilation was a protective factor (p = 0.048). Statistically significant difference was also observed for mechanical ventilation duration (p = 0.004), duration of non-invasive ventilation (p = 0.04), and parenteral nutrition duration (p = 0.003). In multivariate analysis duration of parenteral nutrition remained significantly associated with laboratory-confirmed bloodstream infection (p = 0.041).ConclusionsShortening time on parenteral nutrition whenever possible and preference for non-invasive ventilation in neonates undergoing surgery should be considered in the assistance of these patients, with the goal of reducing Healthcare Associated Infections, especially laboratory-confirmed bloodstream infection.     

微量尿碘分析的质量控制

在尿碘分析中,因高铈接触比色法具较多优点而广泛应用。要获得精密、准确的分析结果,还需要统一分析方法,控制关键试剂和作好日常分析质量控制等工作。     

围术期急性血糖波动对患者冠状动脉旁路移植术后心房颤动发生率及重症监护病房住院时间的影响

目的 探讨围术期急性血糖波动幅度对患者冠状动脉旁路移植(coronary artery bypass grafting,CABG)术后心房颤动(postoperative atrial fibrillation,POAF)发生率及重症监护病房(intensive care unit,ICU)住院时间的影响.方法 前瞻性...