神经危重症患者血乳酸水平与急性生理学与慢性健康状况评分Ⅱ相关性研究

目的 探讨神经危重症患者血乳酸水平的变化及其与急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)的关系及意义.方法 对59例神经危重症患者在入住ICU 24h内分别进行APACHEⅡ评分和血乳酸水平测定.依据APACHEⅡ评分将患者分为A组(11 ～20分)18例、B组(21～30分)29例、C组(＞30分)12例,按患者预后分为存活组43例、死亡组16例,比较各组血乳酸水平的差异.结果 A、B、C组血乳酸水平分别为(3.2±2.2)、(7.9±3.3)、(11.8±4.9) mmol/L,B、C组血乳酸水平显著高于A组(P＜0.01),C组血乳酸水平显著高于B组(P＜0.05).死亡组APACHEⅡ评分及血乳酸水平显著高于存活组(P＜0.01或＜0.05).APACHEⅡ评分与血乳酸水平呈显著正相关(r=0.623,P＜ 0.01).结论 随着APACHEⅡ评分增高,血乳酸水平也相应增高;血乳酸水平与神经危重症患者病情严重程度呈正相关,是预测神经危重症患者病情严重程度的早期、敏感、定量的指标.     

老年肺炎患者并发脓毒症的相关因素分析

目的 评价血乳酸在老年肺炎并发脓毒症中的作用及与疾病危险分级、预后的相关性.方法 选择75例老年肺炎及50例年轻肺炎患者,分为脓毒症组和非脓毒症组,脓毒症组分为MODS组和非MODS组,测定各组血乳酸、CRP、动脉血氧分压(PaO2)水平及不同APACHEⅡ评分组的乳酸值.结果 老年肺炎组脓毒症的发生率显著高于年轻肺炎组;脓毒症组和非脓毒症组血乳酸水平差异均有统计学意义,两组分别为(1.74±0.33)mmol/L和(1.35±0.66)mmol/L,P＜0.05;MODS组和非MODS组血乳酸水平亦差异有统计学意义,两组分别为(2.37±0.66)mmol/L和(1.28±0.32)mmol/L,P＜0.05;老年肺炎组血乳酸与CRP相关(r=0.279,P＜0.05;随APACHEⅡ评分上升,血乳酸进行性升高.结论 老年肺炎易并发脓毒症,血乳酸水平升高可预测肺炎严重程度、并发症的发生及预后.     

早期血乳酸清除率及急性生理学及慢性健康状况Ⅱ评分对急性肺损伤预后的评估意义

目的 探讨早期血乳酸清除率及急性生理学及慢性健康状况Ⅱ评分(APACHEⅡ)对急性肺损伤(ALI)预后的评估意义.方法 回顾性分析74例ALI患者的临床资料,比较存活组(60例)与死亡组(14例)患者的早期血乳酸清除率及APACHEⅡ,高血乳酸清除率(＞10％)组与低血乳酸清除率(≤10％)组患者病死率和多器官功能障碍综合征(MODS)发生率,APACHEⅡ≤10分(A组)、APACHE Ⅱ 11～20分(B组)、APACHE Ⅱ 21～30分(C组)、APACHE Ⅱ ＞30分(D组)患者早期血乳酸清除率、病死率及MODS发生率.结果 死亡组APACHE Ⅱ显著高于存活组[(22.5±5.3)分比(16.6±4.2)分](P＜0.05).死亡组早期血乳酸清除率显著低于存活组[(6.9±3.9)％比(15.8±5.1)％](P＜0.05).低血乳酸清除率组病死率和MODS发生率显著高于高血乳酸清除率组[36.4％(8/22)比11.5％(6/52)、59.1％(13/22)比36.5％ (19/52)](P＜ 0.05).A组和B组患者病死率、MODS发生率比较差异无统计学意义(P＞0.05);C组和D组患者病死率、MODS发生率显著高于B组,差异有统计学意义(P＜0.05);4组间早期血乳酸清除率两两比较差异均有统计学意义(P＜0.05).结论 早期血乳酸清除率和APACHE Ⅱ可作为反映ALI患者病情严重程度和预测转归的较好指标.     

危重病患者动脉血乳酸水平与急性生理学及慢性健康状况评分和预后相关性研究

目的 探讨危重病患者动脉血乳酸水平与急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)之间的关系.方法 选择危重病患者71例,根据预后将患者分为死亡组16例和存活组55例,分析两组患者入院24 h内动脉血乳酸水平与APACHE Ⅱ及预后之间的关系.结果 随着APACHEⅡ的增加,动脉血乳酸水平和病死率均显著升高,APACHEⅡ>30分时,血乳酸水平已达(8.20±3.52)mmol/L,病死率则为64.7%(11/17),各分值之间比较差异均有统计学意义(P＜0.05).直线相关分析显示:动脉血乳酸水平与APACHEⅡ呈显著正相关(r=0.563,P<005).死亡组的APACHEⅡ和动脉血乳酸水平分别为(29.7±6.9)分和(7.6±4.1)mmol/L,均显著高于存活组的(18.3±7.0)分和(3.0±1.7)mmol/L,差异有统计学意义(P＜0.05).结论 危重病患者动脉血乳酸水平与 APACHEⅡ呈正相关关系,其水平对于判断危重病患者病情的严重程度和预后有重要临床意义.

Abstract：

Objective To investigate the correlation between arterial blood lactate levels and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) in critically ill patients.Methods Seventy-one patients with critical illness who treated in intensive care unit were included as research subjects and divided into death group with 16 cases and survival group with 55 cases according to the prognosis.The correlation between arterial blood lactate levels and APACHE Ⅱ was analyzed.Results With the increase of APACHE Ⅱ ,arterial blood lactate levels and mortality all increased significantly.The blood lactate levels reached (8.20±3.52) mmol/L and mortality was 64.7%(11/17) when APACHE Ⅱ >30 scores,and there were significant differences between different segment of APACHE Ⅱ (P <0.05).Linear correlation analysis showed:arterial blood lactate levels were positively correlated to APACHE Ⅱ significantly (r = 0.563,P <0.05).The APACHE Ⅱ and arterial blood lactate levels in the death group were (29.7 ± 6.9) scores and (7.6 ±4.1) mmol/L respectively,which were significantly higher than those in the survival group [(18.3 ± 7.0) scores and(3.0 ± 1.7) mmol/L].The differences between two groups were statistically significant (P＜0.05).Conclusion The arterial blood lactate levels of critically ill patients are positively related to APACHE Ⅱ ,and its level has an important clinical significance in judging the severity and the prognosis of the illness.     

血浆sFLT-1在重症肺炎中的预测价值及与APACHEⅡ评分的相关性分析

目的分析血浆sFLT-1在重症肺炎中的预测价值及与APACHE Ⅱ评分的相关性。方法选择2016年12月-2018年12月我院收治的重症肺炎患者90例,依据疾病类型分为重症肺炎组(A组,n=30)、重症肺炎合并感染性休克组(B组,n=30)和重症肺炎合并多器官功能障碍综合征组(C组,n=30),比较三组患者的血清CRP、PCT、WBC、sFLT-1水平、APACHE Ⅱ评分,分析存活与死亡患者的血清sFLT-1水平、APACHE Ⅱ评分及其相关性。结果 A组患者的血清CRP、PCT水平、APACHE Ⅱ评分均显著低于B组、C组(P0.05),血清sFLT-1水平均显著低于B组、C组(P0.05)。三组90例患者中,存活48例,死亡42例,存活率和死亡率分别为53.3%、46.7%,存活患者的血清sFLT-1水平、APACHE Ⅱ评分均显著低于死亡组(P0.05),血清sFLT-1水平与APACHE Ⅱ评分呈正相关(r=0.647,P0.05)。结论血浆sFLT-1在重症肺炎中的预测价值高,与APACHE Ⅱ评分呈正相关。     

B型钠尿肽前体联合急性生理和慢性健康状况评分Ⅱ在老年重症肺炎患者预后中的意义

目的探讨B型钠尿肽前体(NT-proBNP)水平联合急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)在预测老年重症肺炎患者预后中的意义。方法对2011年7月-2013年9月132例老年重症肺炎患者监测NTproBNP值,并进行APACHEⅡ评分,根据患者预后分为好转组和未愈组,分析NT-proBNP与APACHEⅡ评分在老年重症肺炎患者预后中的量化关系,并分析二者与危重患者ICU住院天数、机械通气时间、转归的关系。结果 132例患者死亡26例,病死率为19.7%;其中未愈组APACHEⅡ评分值和血清NT-proBNP浓度均明显高于好转组,差异有统计学意义(P<0.01);好转组患者的血清NT-proBNP浓度与患者ICU住院天数(r=0.7301)、机械通气时间(r=0.7932)呈正相关关系,不同住院天数组间比较差异有统计学意义;患者NT-proBNP水平与APACHEⅡ评分呈正相关。结论 NT-proBNP水平联合APACHEⅡ评分可协助预测老年重症肺炎患者ICU住院时长、机械通气时间、病死率等。     

乳酸清除率联合急性生理功能和慢性健康状况评分Ⅱ评估脓毒症预后的临床分析

目的 探讨血乳酸清除率联合急性生理功能和慢性健康状况评分Ⅱ(APACHEⅡ)与脓毒症患者预后的关系及意义.方法 对65例脓毒症患者入院24h内的APACHEⅡ评分、12h后血乳酸清除率及患者预后情况进行分析.按照预后分为存活组和死亡组,高乳酸清除率组和低乳酸清除率组.结果 存活组与死亡组的年龄、性别构成比较差异无统计学意义,APACHEⅡ评分[分别为(14.53±3.58)、(19.37±3.24)分]、初始血乳酸浓度[分别为(6.48±2.37)、(10.37±3.13)mmol/L]、乳酸清除率[分别为(35.27±17.35)%、(15.32±10.21)%]差异均有统计学意义(P＜0.05).高乳酸清除率组的中心静脉压、平均动脉压、中心静脉血氧饱和度的改善明显优于低乳酸清除率组(P＜0.05),并且病死率也明显低于低乳酸清除率组(P＜0.01).结论 乳酸清除率联合APACHEⅡ评分可用于早期评估脓毒症患者的预后.     

脓毒症患者动脉血乳酸水平与APACHEⅡ评分相关性分析

目的探讨预测脓毒症患者病情及预后的简便易行且有临床实用价值的指标。方法对50例ICU病房的脓毒症患者入住时行APACHEⅡ评分及动脉血乳酸水平测定,比较不同APACHEⅡ评分分值组与动脉血乳酸水平的关系。结果APACHEⅡ评分21～30分组动脉血乳酸水平明显高于11～20分组（P〈0．05）;APACHEⅡ评分〉30分组动脉血乳酸水平明显高于21～30分组（P〈0．05）。动脉血乳酸水平与APACHEⅡ评分相关,死亡组动脉血乳酸水平明显高于存活组。结论随着APACHEⅡ评分增高,动脉血乳酸浓度也相应增高;动脉血乳酸浓度与危重病严重程度呈正相关,是危重病严重程度的早期、敏感的指标。     

危重病患者早期血浆N末端B型钠尿肽前体水平与疾病严重程度及炎性因子相关性研究

目的 探讨危重病患者早期血浆N末端B型钠尿肽前体(NT-proBNP)表达对炎性因子及预后的影响.方法 46例危重病患者治疗前检测血浆NT-proBNP、白细胞介素(IL)-6、IL-10,并行急性生理学和慢性健康状况(APACHE)Ⅱ评分,记录28 d存活情况,分为生存组和死亡组,每组23例.根据不同APACHEⅡ评分分为＜15分组(20例)、15～25分组(18例)、＞25分组(8例).结果 生存组血浆NT-proBNP、IL-6、APACHEⅡ评分均显著低于死亡组[(1073.30±677.38) ng/L比(1529.87±721.22) ng/L、(33.31±14.03) ng/L比(65.03±36.12) ng/L、(14.96±6.19)分比(19.21±7.16)分,P＜ 0.05].15～ 25分组血浆NT-proBNP、IL-6显著高于＜15分组[(1352.28±581.19) ng/L比(911.30±412.35) ng/L、(56.02±33.28) ng/L比(31.49 ±20.39) ng/L,P＜0.05],＞25分组血浆NT-proBNP[(2163.25±920.39) ng/L]显著高于15～25分组(P＜0.05).NT-proBNP与APACHEⅡ评分、IL-6呈正相关(r=0.6586,P＜0.01;r=0.3634,P＜ 0.05),与IL-10无相关性(r=0.0458,P＞0.05).结论 早期血浆NT-proBNP水平升高,可反映疾病严重程度及炎性状态,对判断预后有指导意义.     

APACHEⅡ评分系统对妇产科危重患者病情评估的价值

目的评价急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)评分系统在妇产科危重症患者病情评估中的适用性和可行性。方法对42例妇产科危重症患者进行APACHEⅡ评分,比较组间死亡率的差异。结果患者APACHEⅡ评分分值的增加,实际病死率逐渐增加,评分小于20分与评分大于20分组相比,χ2=5.64,P<0.05,差异有统计学意义;评分小于30分与大于30分组比较,χ2=4.47,P<0.05,差异亦具有统计学意义。结论 APACHEⅡ评分≥31分时,实际病死率显著增加,APACHEⅡ评分≤20分时,实际病死率低,无需入ICU治疗,因此可降低治疗费用,节约医疗资源。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.