急性ST段抬高心肌梗死合并肺动脉高压患者院内主要心脏不良事件分析

目的 探讨急性ST段抬高心肌梗死(ST-segment element myocardial infarction,STEMI)合并肺动脉高压患者院内主要心脏不良事件(major adverse cardiac events,MACE).方法 回顾性分析近两年就诊于河北医科大学第二医院的STEMI连续病例.详细记录两组患者基本临床资料、住院期间药物治疗和再灌注治疗情况.对所有入选病例在入院后24小时内进行二维超声心动图检查,测量心脏各腔室大小,评价心室功能.记录患者住院期间MACE的发生情况.应用多因素logistic回归分析肺动脉高压与STEMI患者院内MACE发生的相关性.过去两年累计入选STEMI患者227例.根据超声心动图估测肺动脉压力,将入选患者分为肺动脉压力正常组(肺动脉压力＜40 mmHg,1 mmHg=0.133 kPa,n=189例)和肺动脉高压组(肺动脉压力≥40 mmHg,n=38例).结果 与肺动脉压力正常组比较,肺动脉高压组年龄较大(62.8±10.5)岁vs(68.4±11.9)岁(P＜0.01),男性比例较少(85.7％vs 71.1％)(P＜0.05),吸烟者较多(41.8％ vs 60.5％)(P ＜0.05).两组在梗死部位、入院时Killip分级水平、GRACE评分和心肌型肌酸激酶同工酶(CK-MB)峰值水平方面均存在明显差异(P＜0.05).在治疗方面,肺动脉高压组使用正性肌力药物的比例高于肺动脉压力正常组(32.3％ vs 50.0％)(P＜0.05).与肺动脉压力正常组比较,肺动脉高压组射血分数较低(57.5％±6.3％ vs 52.1％±5.4％)(P＜0.01),室壁运动积分指数较高(1.45±0.22 vs1.83士0.34)(P＜0.01),舒张期E/e'比例较高(11士1.3 vs 16士2.4)(P＜0.01),三尖瓣反流速度较快(1.4士0.28m/s vs 2.9±0.37 m/s)(P＜0.01).肺动脉高压组住院期间MACE发生的比例较高(7.9％vs 21.1％)(P＜0.01).多因素logistic回归结果 提示,住院期间MACE发生的独立预测因素主要包括STEMI合并肺动脉高压(OR=66.64,95％CI=5.078～15.713,P＜0.01)、CK-MB峰值水平较高(OR=0.795,95％CI =-0.043～0.020,P＜0.01)以及脑钠素水平较高(OR=0.958,95％CI=0.106～0.177,P＜0.05).结论 合并肺动脉高压的STEMI患者院内MACE的发生率升高.     

产前血压与子痫前期患者产后蛋白尿相关性分析

目的 探讨子痫前期(preeclampsia,PE)患者产前血压与产后3个月蛋白尿的相关性.方法 回顾性分析2016年1月至2020年1月期间福建省立医院产科住院资料完整的218例剖宫产PE患者,电话随访产后3个月尿蛋白情况.分别根据产前收缩压(systolic blood pressure,SBP)和舒张压(diastolic blood pressure,DBP)三分位数将患者分为3个亚组:SBP组分为低SBP组(112～149mmHg,n=72)、中SBP组(150～167mmHg,n=73)、高SBP组(168～235mmHg,n=73);DBP组为:低DBP组(65～93mmHg,n=72)、中DBP组(94～104mmHg,n=73)、高DBP组(105～145mmHg,n=73),将各组间临床资料进行了比较,并用二元Logistic回归分析住院时血压、血脂等指标与产后蛋白尿之间的相关性.结果 产后3个月,203例患者进行了尿常规检测,其中49例(24.14％)尿蛋白定性试验阳性.二元Logistic回归分析示,SBP和总胆固醇水平是PE患者产后3个月蛋白尿阳性的独立危险因素,SBP的OR值为1.054(95％CI:1.023～1.087,P=0.001),总胆固醇的OR值为1.317(95％CI:1.080～1.607,P=0.007).SBP水平与产后3个月蛋白尿的发生风险相关,高SBP组产后尿蛋白发生风险是低SBP组的4.176倍(95％CI:1.101～15.795,P=0.001).结论 产前血压与PE患者产后3个月蛋白尿相关.其中产前高SBP是PE患者产后3个月蛋白尿的独立危险因素.     

高血压患者动态脉压与心律失常的相关性研究

目的:探讨原发性高血压(EH)患者动态脉压(PP)与心律失常的相关性.方法:随机选择EH患者106例,同时行动态血压(ABPM)与动态心电图检查,以PP＜60 mmHg(A组,n=52),PP≥60 mmHg(B组,n=54)分为两组,对其进行分析.结果:PP增加主要因收缩压(SBP)增加所致;随PP增加,SBP血压负荷增加,复杂性心律失常的发生率也明显增加.结论:EH患者PP与心律失常有关,临床治疗中要注意缩小PP,并将PP作为评价高血压危险度和降压效果的重要指标.     

休克指数对急性ST段抬高型心肌梗死患者院内死亡的预测价值

目的探讨休克指数(shock index, SI)在急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者院内死亡预测中的价值。方法 STEMI患者1 686例,均测量入院时收缩压、心率,计算SI,绘制ROC曲线评估SI预测STEMI院内死亡的效能;将1 686例患者根据SI最佳截断值分为低SI组(SI0.682)1218例和高SI组(SI≥0.682)468例,比较2组一般资料、临床特征、治疗及预后情况,广义混合效应模型回归分析SI与STEMI患者院内死亡的关系。结果 ROC曲线分析显示,SI以0.682为最佳截断值,预测STEMI患者院内死亡的AUC为0.729(95%CI:0.671～0.788,P0.001),灵敏度为67.7%,特异度为74.2%;高SI组中位年龄(66.43岁)较低SI组(63.30岁)大,女性(31.41%)及入院时前壁心肌梗死(65.17%)、合并心律失常(28.21%)、心功能Killip分级2～4级(49.57%)、心率100次/min(30.13%)、收缩压90 mm Hg(8.33%)、使用β受体阻滞剂治疗比率(63.68%)及院内病死率(13.25%)均高于低SI组(25.86%、53.12%、15.11%、31.69%、2.30%、0.99%、57.55%、2.71%),有高血压史(38.68%)、发病12 h内接受再灌注治疗(33.55%)及使用阿司匹林(95.51%)、氯吡格雷(89.10%)、血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂(43.59%)、替罗非班治疗比率(5.98%)低于低SI组(49.92%、40.80%、97.37%、92.36%、51.89%、9.20%)(P0.05);多因素广义混合效应模型回归分析结果显示,SI≥0.682(OR=4.02,95%CI:2.33～6.94,P0.001)是STEMI患者院内死亡的危险因素。结论 SI在预测STEMI患者院内死亡中具有较高的价值,SI≥0.682者院内死亡风险明显增高。     

成人维持性血液透析患者透析间期血压变异性独立影响因素探讨

目的探讨成人维持性血液透析(maintenance hemodialysis,MHD)患者透析间期血压变异性(blood pressure variability,BPV)独立影响因素。方法选择河北省邯郸市中心医院2015年1月～2019年9月收治成人MHD患者共505例,根据收缩压(systolic blood pressure,SBP)变异系数=SBP标准差/SBP平均值×100%,透析间期SBP变异系数四分位值(120,130,140,150)分为4组,患者入院SBP中位数148(128,170)mmHg,收缩压均数(mean systolic blood pressure,mSBP)中位数139(119,129,149,159)mmHg,其中SBP变异系数Q1(120～129mmHg)设为低变异系数组(n=127)、SBP变异系数Q2(130～139mmHg)设为中变异系数组(n=126)、SBP变异系数Q3(140～149mmHg)设为高变异系数组(n=126),SBP变异系数Q4(150～159mmHg)设为极高变异系数组(n=126)。采用Logistic回归模型分析透析间期SBP变异系数独立影响因素。结果中变异系数患者透析时间少于其他3组(t值分别为3.556,3.674,4.403;P值分别为0.024,0.028,0.018);低变异系数患者合并2型糖尿病比例多于其他3组(χ~2值分别为5.567,5.567,4.764;P值分别为0.027,0.031,0.020),超滤量高于其他3组(t值分别为3.653,3.528,4.039;P值分别为0.027,0.031,0.020);低变异系数患者透析间期体质量增加量少于其他3组(t值分别为3.525,3.611,3.334;P值分别为0.037,0.039,0.044)。高变异系数患者血钙水平高于其他3组(t值分别为3.346,3.211,3.509;P值分别为0.031,0.036,0.030)。极高变异系数患者服用钙离子通道阻滞剂比例低于低变异系数组和高变异系数组(χ~2值分别为5.534,6.588;P值分别为0.012,0.010)。Logistic回归分析显示,透析间期体质量增加量升高是透析间期SBP变异系数独立危险因素;超滤量升高和服用钙离子通道拮抗剂是透析间期SBP变异系数独立保护因素。结论体质量增加量、超滤量及是否服用钙离子通道拮抗剂与成人MHD患者透析间期BPV独立相关。     

超声诊断产褥期主动脉夹层一例

患者女性,37岁,自然受孕,既往孕0产0,无慢性高血压、糖尿病、心脑血管疾病史,否认心脑血管疾病家族史.孕21周自我监测血压并记录均为正常范围;孕25周外院动态血压监测提示收缩压(systolic blood pressure, SBP)为162 mmHg(1 mmHg=0.133 kPa),4次SBP≥140 mmH...     

积极降压对脑出血预后及早期血肿增长的作用

目的 比较脑出血急性期积极降压治疗与按指南要求控制血压对预后及早期血肿增长的影响.方法 采用前瞻性随机对照研究设计,收集2006年10月到2007年1月于南京市第一医院连续入院的脑出血患者共41例,随机(随机数字法)分为积极降压组(n=24)和指南降压组(n=17),分别予以早期积极降压治疗(入组后立即降压,目标收缩压≤140 mmHg)和按照美国心脏病学会2007年指南要求的降压治疗(收缩压≥180 mmHg才开始降压治疗),24 h后复查头颅CT测量血肿体积并随访患者至90 d,前瞻性比较两组90 d病亡/残疾率、近远期神经功能和24 h血肿增长情况.所得结果应用SPSS 10.0软件进行统计学处理,计量资料采用成组t检验,计数资料采用x2检验,P＜0.05为差异有统计学意义.结果 两组90 d病亡/残疾率、近远期神经功能比较差异无统计学意义(P＞0.05);24 h平均血肿增长率积极降压组为16.8%,指南降压组为36.1%,两组比较差异具有统计学意义(P=0.012);24 h平均血肿增加的绝对值两组比较差异无统计学意义(2.7 mL,5.1 mL,P=0.058);发生早期血肿扩大的比例两组分别为4.2%,47.1%,两组比较差异具有统计学意义(P=0.004).结论 脑出血早期将收缩压降到≤140 mmHg不改变脑出血预后及神经功能转归,但能显著减缓早期血肿增长.     

白细胞计数对急诊冠状动脉介入治疗近期预后的影响

目的:探讨接受急诊冠状动脉介入治疗(PCI)的急性ST段抬高的心肌梗死(STEMI)患者,入院即刻白细胞计数(WBC)对院内心血管事件发生的影响。方法:行急诊PCI的STEMI患者179例,按急诊PCI前WBC水平分为2组:≤10×109/L为A组(n=69),>10×109/L为B组(n=110)。观察患者入院24 h内相关实验     

ST段抬高型心肌梗死直接经皮冠状动脉介入术治疗预后危险因素及危险分层

目的探讨行直接经皮冠状动脉介入术(primary percutaneous coronary intervention, pPCI)治疗的ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者院内主要心血管不良事件(major adverse cardiovascular events, MACEs)发生的危险因素并进行危险分层。方法行pPCI治疗的STEMI患者128例,依据术后10 d是否发生MACEs分为MACEs组62例,非MACEs组66例。记录患者一般资料,多因素logistic回归分析MACEs发生的危险因素,并根据OR值对危险因素进行危险分层。结果 MACEs组年龄、心率、ST段抬高总幅度、平均ST段抬高幅度,以及饮酒、下壁心肌梗死、Killip分级Ⅱ～Ⅲ级比率与非MACEs组比较差异均有统计学意义(P0.05),体质量、左室射血分数等与非MACEs组比较差异均无统计学意义(P0.05);年龄60岁(OR=4.45,95%CI:1.65～12.04,P=0.003),入院时心率≤67次/min(OR=3.47, 95%CI:1.25～9.63,P=0.017)、ST段抬高总幅度≥1.15 mV (OR=10.08,95%CI:2.64～38.53,P=0.001)、下壁心肌梗死(OR=7.78,95%CI:2.11～28.69,P=0.002)、Killip分级Ⅱ级(OR=4.21, 95%CI:2.96～6.32,P0.001)、Killip分级Ⅲ级(OR=8.38, 95%CI:4.56～13.53,P0.001)是院内发生MACEs的危险因素;危险分层结果显示,高风险组院内MACEs发生率(86.54%)高于低风险组(22.37%)(P0.05)。结论高龄(60岁)、入院时心率(≤67次/min)、Killip分级Ⅱ～Ⅲ级、下壁心肌梗死及ST段抬高总幅度≥1.15 mV是STEMI患者行pPCI治疗后发生院内MACEs的危险因素,根据危险因素对患者进行危险分层有助于识别危重患者、及时行pPCI治疗。     

胸痛中心网络建设对ST段抬高型心肌梗死再灌注时间的影响

目的:探讨胸痛中心网络建设对ST段抬高型心肌梗死(STEMI)再灌注时间的影响.方法:以2016年-2017年胸痛中心运行前2年收治的140例STEMI患者为对照组(C组),以2018年-2019年胸痛中心运行后2年收治的323例STEMI患者为研究组(R组),根据不同来院方式分为自行来院组(C1组,n=51;R1组,...     

The relationship between fibrinogen and in-hospital mortality in patients with type A acute aortic dissection

Background and purpose

Fibrinogen plays an important role in hemostasis and thrombosis and is proven to have prognostic significance in patients with cardiovascular disease. We examined the utility of fibrinogen as a prognostic indicator for patients with type A acute aortic dissection (AAD).

金山医院住院期间纯母乳喂养影响因素及护理对策

为了提高住院期间纯母乳喂养率,本文通过对2013年8月至2014年7月住院期间产妇母乳喂养情况资料进行分析,总结影响纯母乳喂养的因素,主要从以下四方面进行阐述：产妇方面、新生儿方面、医院方面、社会家庭方面,针对几方面影响因素探讨护理对策,以提高住院期间纯母乳喂养成功率。     

Does appropriate treatment of the primary underlying cause of PEA during resuscitation improve patients’ survival?

Aim of the study

We aimed to document how often patients received appropriate treatment of the primary cause underlying pulseless electrical activity (PEA) during cardiopulmonary resuscitation (CPR) and how it affected their outcome.

Methods

Data were collected between 2003 and 2010 in Finland and Sweden. All adult patients who underwent in-hospital cardiac arrest (IHCA) with PEA as the initial rhythm were included, if CPR was attempted. Patients were divided into two groups: those who received appropriate treatment of the primary cause during CPR (treatment of the primary cause group) and those who received conventional CPR (non-specific treatment group). Survival between groups was compared and a multivariable logistic regression analysis was performed to exclude the effect of possible confounders.

Results

Of 104 study patients, 19 (18%) received treatment of the primary cause and 85 (82%) received non-specific treatment. 30-Days survival of patients in treatment of primary cause group was superior compared to patients in the non-specific treatment group: 6 (32%) vs. 9 (11%) were alive 30 days after IHCA, p = 0.03. Multivariable analysis suggested that treatment of the primary cause improves the odds of survival 2.5-fold, but this was not statistically significant. Age was the only significant independent prognostic factor for 30-days survival.

Conclusion

During CPR, only a fifth of patients received appropriate treatment of the primary cause underlying PEA. Those patients were more likely to be alive 30 days after IHCA, but age turned out to be the only significant individual factor for better survival.     

住院患者健康教育评价标准的应用研究

目的：形成完善的住院患者健康教育评价标准,对健康教育活动起到系统的监测作用。方法选取2013年7—12月1297例住院患者作为研究对象,按照随机数字表法分为研究组540例和对照组757例。对照组采用常规健康教育,研究组采用健康教育评价标准确定后的健康教育。比较两组患者健康教育评价标准结果及患者满意度。结果入院时两组患者健康知识的知晓率比较差异无统计学意义(P>0.05),出院时研究组健康知识知晓率为93.1%,高于对照组的82.6%,差异有统计学意义(χ2=31.20,P<0.05)。出院时研究组患者满意度得分为(98.88±2.88)分,高于对照组的(95.95±6.63)分,差异有统计学意义(t=-9.26,P<0.01)。研究组患者在参与计划、寻求健康教育方式、控制疾病疼痛的方法、病情自我观察、生活自理能力、执行药物计划、选择食物、健康及功能锻炼的健康行为评价积极率分别为88.9%,92.7%,91.1%,85.1%,80.4%,83.3%,87.2%,81.1%,均优于对照组,差异有统计学意义(χ2值分别为141.6,176.8,178.3,59.3,36.5,64.6,91.4,30.2;P<0.01)。结论住院患者健康教育评价标准的形成对临床护理人员实施系统化、规范化的健康教育与提高健康教育评价有很大帮助。     

In-hospital use of automated external defibrillators does not improve survival

The use of automated external defibrillators (AEDs) following a cardiac arrest in the out-of-hospital setting has demonstrated increased survival rates, likely because up to 71% of out-of-hospital cardiac arrests are associated with rhythm disturbances that are able to be treated with defibrillation. ^{[1] , [2] and [3]} It is less clear whether the use of AEDs in the hospital setting would be effective because fewer patients (approximately 25%) have initial cardiac rhythms that respond to defibrillation⁴ and because survival may be compromised if the use of AEDs contributes to interruptions in the delivery of chest compressions.

Methods

The authors of this study⁵ used data from the National Registry of Cardiopulmonary Resuscitation (NRCPR) to evaluate the association between survival after an in-hospital cardiac arrest and use of an AED. Data was drawn from patients 18 years of age or older, who had an index pulseless, in-hospital cardiac arrest in clinical area where an AED was available for patient treatment. The sample comprised 11,695 patients from 204 hospitals. The primary outcome measure was survival to hospital discharge. The authors also reported secondary outcomes such as return of spontaneous circulation (ROSC) for at least 20 min during the acute resuscitation; survival at 24 h; and neurological status among those patients surviving to hospital discharge.

Results

Of the 11,695 patients with cardiac arrests, the majority (82.2%; n = 9616) were in a nonshockable rhythm, such as asystole or pulseless electrical activity (PEA). Only 17.8% (n = 2079) of patients in the study were in a shockable rhythm (ventricular fibrillation and pulseless ventricular tachycardia). AEDs were used on 4515 patients (38.6%). An overall survival to discharge rate of 18.1% (n = 2117) was reported. The use of an AED was associated with lower survival rates (16.3% vs 19.3%; adjusted rate ratio [RR], 0.85; 95% confidence interval [CI], 0.78–0.92; P < 0.001). AED use in those patients with asystole or PEA (unshockable rhythms) was associated with lower survival (10.4% vs 15.4%; adjusted RR, 0.74; 95% CI, 0.65–0.83; P < 0.001). Where shockable rhythms, such as ventricular tachycardia or ventricular fibrillation, were present, AED use did not increase survival (38.4% vs 39.8%; adjusted RR, 1.00; 95% CI, 0.88–1.13; P = 0.99). These trends were consistent for AED use in both monitored and nonmonitored hospital units (p > .10).For cardiac arrest due to asystole or PEA the use (or not) of an AED did not influence the rates of ROSC. For cardiac arrests due to ventricular fibrillation or pulseless ventricular tachycardia the rates of ROSC and survival at 24 h did not differ by AED use. AED use did not shorten the time to defibrillation and for those patients with ROSC, and was not associated with shorter CPR times or fewer administered defibrillations.Overall the authors concluded that the use of AEDs in hospitalised patients following cardiac arrest was not associated with improved survival.     

应激性高血糖对非糖尿病急性心肌梗死预后的影响

目的 急性心肌梗死(acute myocardial infarction,AMI)常见血糖升高,其增高的程度与疾病转归相关.现以空腹血糖定义非糖尿病AMI患者的应激性高血糖,研究应激性高血糖对非糖尿病的AMI院内预后的影响.方法 研究对象为南京解放军第81医院2000年1月至2010年5月收治入院的107例非糖尿病AMI患者.回顾性分析各组的院内死亡和院内并发症.排除标准:(1)年龄小于18岁;(2)有糖尿病史;(3)无糖尿病史但住院期间启动降糖治疗的患者;(4)非心血管病因的急性心肌梗死患者;(5)严重肝肾功能不全、严重肺部基础疾患、恶性肿瘤晚期患者;(6)近期使用过类同醇药物以及甲状腺机能亢进、库欣综合征等影响葡萄糖代谢疾病的患者.根据空腹血糖(fastingblood glucose,FBG)水平将其分为4组,分别是:<7.0 mmol/L,7.0～8.0 mmol/L,8.0～11.1 mmol/L,≥11.1 mmoL/L.采用Stata 9.2统计软件,分别进行成组t检验、方差分析、秩和检验及确切概率法分析.对有意义的变量进行多因素logistics回归分析.结果 发生应激性高血糖47例(43.9%).FBG≥7.0 mmol/L的患者即有应激性高血糖的患者较FBG<7.0 mmol/L患者的病死率显著增高,分别是27.66%和6.67%(P=0.006 3),OR=5.35(95%CI 1.61～17.75,P=0.006 1),肺部感染、充血性心力衰竭、严重心律失常和急性脑血管事件等院内并发症发生率也显著增高.经多因素Logistic回归分析显示FBG是AMI死亡的独立危险因素,OR=1.56(95%CI 1.09～2.23).结论 有应激性高血糖的非糖尿病AMI患者死亡风险增高、院内并发症显著增多.应激性高血糖可作为判定非糖尿病AMI预后的一个较好指标.

Abstract：

Objective Hyperglycemia was common during acute myocardiai infarction (AMI). This study investigated the impact of stress hyperglycemia on in-hospital outcomes in patients without diabetes hospitalized with AMI. Methods The study included 107 patients with AMI without diabetes, who were admitted to 81 hospital of PLA of Nanjing, China from January 2000 to May 2010. The in-hospital mortality and in-hospital complications were analyzed retrospectively. The exclusion criteria were: (1 ) patients < 18 years old; (2) patients with history of diabetes; (3) patients who initiated anti-hyperglycemic therapy during their hospital stay though without previously diagnosed diabetes; (4) patients with non-cardiovascular causes for AMI; (5) patients with hepatic failure, kidney failure, serious lung illnesses and end stage of malignant tumour; (6) patients administrated with steroid treatment recently and those with some diseases which had dramatic effect on glucose metabolism such as hyperthyroidism and cushing syndrome. Patients were categorized according to FBG levels into4 mutually exclusive groups; <7.0 mmol/L, ≥7.0 but <8.0 mmol/L, 8.0 to< 11. 1 mmol/L and ≥11.1 mmol/L. The Statistical Package for Stata, version 9.2 was used for statistical analysis. According to corresponding data analysis of /-test, ANOVA, rank test and exact propability were used respectively. Univariate logistics regression analysis was conducted followed by multivariate logistics regression analysis on significant variables. Results The incidence rate of stress hyperglycemia in patients with AMI without diabetes was 43. 9% (n =47). In non-diabetic patients, the mortality of the group of FBG≥7. 0 mmol/L was significantly higher than the group of FBG < 7. 0 mmol/L, which are 27.66% and 6.67%(P=0.0063)respectively,OR=5.35(95%CI 1.61 - 17.75,P = 0.0061). In-hospital complications for example lung infection, congestive heart failure, serious arrhythmias and acute cerebrovas-cular events were increased significantly in AMI patients with stress hyperglycemia. Multivariate logistic regression analysis for mortality were performed adjusting for risk factors which demonstrated FBG was a independent risk factors of in-hospital death , OR = 1.56(95%CIl.09 -2.23). Conclusions In-hospital mortality and in-hospital complications were significantly increased in patients with AMI without diabetes which developed stress hyperglycemia. Stress hyperglycemia was of great prognostic value for short-outcomes of AMI.     

Outcome of cardiopulmonary resuscitation in hospitalized patients

Background: Information on who is likely to benefit from cardiopulmonary resuscitation (CPR) is essential for decision-making regarding resuscitative efforts. The purpose of the present study was to evaluate the results of CPR in hospitalized patients and to investigate the influence of clinical variables and their value as prognostic tools. Methods: We analysed prospectively collected data of 253 consecutive hospitalized patients in whom CPR was performed. Main outcome measures were: success of CPR, 24-h survival, discharge from hospital, mental status at the time of hospital discharge, diagnosis, age, adequacy of basic life support, duration of CPR, time of CPR. Results: The mean age was 69.5 years, with a range of 27 to 97 years. Distribution of sex was 145 men and 108 women. Of 253 CPR efforts, 141 (56%) were successful, and in 110 (43%), patients were alive after 24 h. Fifty patients (20%) were discharged alive. The mechanism of arrest with the best outcome was ventricular tachycardia or fibrillation. Advanced age and adequacy of basic life support by first-responders did not affect survival to discharge. Prolonged duration of the resuscitative effort was associated with a poor outcome. Among patients whose arrest lasted longer than 30 min, 89% died. Conclusion: 20% of patients who underwent in-hospital resuscitation were discharged alive. Need for prolonged resuscitation as well as certain mechanisms of arrest, such as progression of a shock state, were associated with a poor outcome. Patients who are likely to benefit from CPR performed for >30 min are rare. Therefore, a decision for prolonged CPR should be made only in reasonable cases.     

他汀类药物对中国老年脓毒症患者住院期间病死率的影响

目的探讨他汀类药物对中国老年脓毒症患者住院病死率的影响。 方法对212例2009年3月至2012年3月在浙江大学医学院附属第一医院老年科住院的老年脓毒症患者进行研究。以出院为观察终点,将患者分为死亡组和存活组。采用多因素Logistic回归模型分析,以确定应用他汀类药物是否为住院期间病死率的的独立影响因素。 结果存活组使用他汀类药物的患者比例高于死亡组[13.9%（5/36）vs. 34.7%（61/176）,χ² = 6.014,P = 0.014],调整后的比值比（OR）有统计学意义（OR：0.17;95%CI：0.04 ~ 0.85;P = 0.03）。 结论他汀类药物的使用可能可以降低中国老年脓毒症患者住院期间的病死率。     

重症急性胰腺炎患者住院死亡因素的早期评估

目的 探讨早期评估重症急性胰腺炎(severe acute pancreatitis,SAP)患者住院期间死亡的相关因素,重点讨论血清胆固醇对SAP预后的影响.方法依据2003年中华医学会消化病学分会胰腺病学组制定的"中国急性胰腺炎诊治指南",回顾性分析南开医院1999年1月-2008年12月间诊断为SAP的住院患者338例,所有患者均在发病72 h内收住院,将患者按照死亡与否分为死亡组与存活组两组,且两组资料具有可比性,所有患者入院后24 h内均抽静脉血进行血常规、血生化及CT检查,并对这些因素进行单因素及Logistic多因素同归分析.结果 经Logistic回归分析,与血总胆固醇(Total cholesterol,TC)浓度≤3.67 mmol/L相比,TC浓度3.67～4.37 mmol/L,OR=0.664,P=0.412;TCA.37～5.23 mmol/L,OR=0.144,P=0.021;TC≥5.23 mmol/L时,OR=1.013,P=0.018,血CRP浓度随着血TC浓度的上升而下降.C-反应蛋白(C-reactive protein,CRP)≥170时,OR=7.074,P=0.031;血白蛋白(albumin,ALB)≤30时OR=7.224,P=0.029.结论ClIP,ALB,TC均可早期预测SAP患者住院病死率;血TC4.37～5.23 mmol/L为降低死亡优势的保护性因素,TC≤3.67 mmol/L或TC≥5.23 mmol/L为增加死亡优势的危险因素;高CRP血症、低ALB血症为增加死亡优势的危险因素,低ALB血症的危险性高于高CRP血症;血胆固醇适量增加可以对抗炎症反应,提高住院患者存活率,进而降低住院病死率.     

Outcome of cardiopulmonary resuscitation in a 2300-bed hospital in a developing country

OBJECTIVE: To evaluate the outcome and quality of in-hospital cardiopulmonary resuscitation (CPR), and factors affecting the outcome. SETTING: A 2300-bed university hospital in Thailand. METHOD: A 1-year prospective audit according to the Utstein style. RESULTS: A total of 639 cardiac arrests (370 male, 269 female, age 1 day-96 years, mean+/-S.D.=53.3+/-24.12 years) were included. Four hundred and thirty-three cardiac arrests (67.8%) occurred in non-monitored areas and 200 (31.3%) occurred in monitored areas. Five hundred and thirty-six cardiac arrests (84%) were witnessed. The majority of cardiac arrests occurred in medical patients (68.4%) and surgical patients (21.4%). The most common underlying causes of arrest were respiratory failure (24.7%) and septic shock (23.3%). Initial ECG rhythms were ventricular fibrillation 79 (12.4%), asystole 272 (42.6%) with pulseless electrical activity 225 (35.2%). Most patients received basic life support within 1 min (86.7%) and advanced life support (ALS) within 4 min (92.6%) but only 25% of patients received defibrillation within 3 min. Following resuscitation, 394 (61.7%) achieved restoration of spontaneous circulation and 44 patients (6.9%) survived to discharge. Only 162 post-arrest patients were treated in the critical care area. The initial survival rate was not associated with sex, age and time to ALS, but was significantly related to the monitored area. CONCLUSION: In our setting, survival to discharge is 6.9%. Initial survival rate was strongly associated with being in a monitored area. Defibrillators and the critical care areas were insufficient.