80岁以上超高龄多器官功能衰竭的CRRT疗效观察

观察CRRT治疗80岁以上超高龄多器官功能衰竭（multiple organ failure in the elderly,MOFE）。患者救治的临床疗效。2001年至2009年在本中心接受CRRT治疗的59例超高龄MOFE患者,年龄80—93岁,平均（82．5±3．28）岁。观察CRRT疗效及治疗过程中患者生命体征变化,监测其肝、肾功能。结果表明：59例超高龄MOFE患者以病情缓解,临床治愈标准,分为存活组和死亡组两组,出院44例占75％,院内死亡组15例占25％。Continuous blood Purification在超高龄MOFE的救治,可有效缓解患者病情,保护脏器功能,提高患者存活率,治疗过程患者耐受良好,血液动力学稳定,并发症少,疗效确切。     

糖尿病合并脑梗塞的临床特点及预后的关系探讨

目的 探讨糖尿病合并脑梗塞的临床特点以及预后关系,为临床中糖尿病合并脑梗塞的治疗提供科学的指导.方法 从我院2012年10月～2014年10月收治的糖尿病合并脑梗塞患者中选取80例并选择80例未患有糖尿病的脑梗塞患者,将两组患者进行临床特点的对比分析,并对其预后情况进行研究.结果 两组患者在临床特点、预后情况等方面具有明显的统计学意义上的差异(P＜0.05).结论 糖尿病合并脑梗塞在临床中是一种被公认为具有比单一脑梗塞更为严重危害性的疾病,糖尿病是一种能够引起心脑血管病变的重要危险因素,因此在进行脑梗塞的临床治疗中,必须要对患者的血糖情况进行重点监测,并根据血糖值实施必要的控制.     

影响高血压脑出血外科治疗预后的因素

目的 探讨影响高血压脑出血外科治疗预后的因素。方法 对132例高血压脑出血病人行手术治疗。结果 手术疗效满意。其中，恢复良好59例，中残24例，重残21例，植物生存3例。死亡25例，资料显示，年龄，意识障碍和脑疝程度，术前血压，出血部位和血肿量，血肿破入脑室诸因素与死亡率密切相关。结论 以上因素对高血压脑出血患者的预后均有明显的影响。     

院前急救护理对脑出血昏迷患者近期预后的影响

目的 探讨院前急救护理对脑出血昏迷患者近期预后的影响.方法 按就诊方式,将我院2008年1月～2010年4月收治的96例脑出血昏迷患者分为两组,由医院出诊接诊入院(即采取了院前急救护理措施)的患者为观察组,由家属自行送入医院(即未经院前急救护理)的患者为对照组,比较2组患者入院时脑疝和舌后坠的发生率、住院15天内的死亡率.结果 观察组患者入院时脑疝和舌后坠的发生率、住院15天内的死亡率均低于对照组(P=0.042).结论 对脑出血昏迷的患者进行院前急救护理能够减少脑出血昏迷患者脑疝及舌后坠等严重并发症的发生,降低患者近期死亡率,对改善脑出血昏迷患者的近期预后具有重要意义.     

脑出血患者高压氧治疗的临床应用研究

目的:研究高压氧在脑出血(Intracerebral hemorrhage,ICH)治疗中的作用.方法:将我院收治的80例ICH患者随机分为常规治疗组(常规组)40例和常规治疗+高压氧治疗组(联合组)40例,三个疗程后比较两组临床干预成功率、采用蒙特利尔认知评估量表(Montreal Cognitive Assessm...     

脑出血急性期血肿扩大24例临床分析

目的探讨脑出血急性期血肿扩大患者临床特点,为,临床诊治提供依据。方法对我院24例脑出血急性期血肿扩大患者临床资料进行回顾性分析。结果24例患者中高血压和长期饮酒患者所占比例较大,神经系统临床表现多样,出血部位壳核18例,丘脑5例,脑叶1例。4例患者于保守治疗过程中出现脑疝;3例患者因呼吸衰竭死亡;2例患者因出现梗阻性脑积水,行脑室腹腔引流术。其余存活患者均留有不同程度的后遗症。结论脑出血后血肿扩大发生率较高,应充分认识脑出血后继续出血的临床特点及相关因素,密切观察病情,采取积极治疗措施。     

青年脑出血患者的临床特点及发病危险因素分析

目的 探讨青年急性脑出血患者发病的临床特点、危险因素及预防措施。方法 回顾性分析2009年1月～2016年1月中国人民解放军第二五四医院神经内科收治的700例青年脑出血患者临床资料,分析其发病特点及可能的危险因素。结果 2009年～2016年共发生700例青年脑出血,在同期全部脑卒中中所占比例约在21.3%～35.6%。高血压合并动脉硬化仍然是脑出血的最主要病因,占42.7%（299例）。青年人群脑出血的发生与糖尿病史、心脏病史、吸烟史、口服抗凝药史相关（P＜0.05）,但仅有心脏病史、吸烟史、口服抗凝药史是独立性危险因素（P＜0.05）。结论 青年人群脑出血在临床已不是少见病,高血压合并动脉硬化仍然是最主要病因。心脏病史、吸烟史、口服抗凝药史是影响青年患者发生脑出血的最主要危险因素。     

脑出血患者合并肺炎的临床诊疗分析

肺炎是脑出血常见的临床并发症,现就我科收治的34例脑出血合并肺炎患者进行分析如下.     

Clinical characteristics and outcomes of community and hospital-acquired Acinetobacter baumannii bacteremia

PurposeWe aimed to characterize clinical manifestations of the patients with bacteremia due to community-acquired Acinetobacter baumannii and evaluate the outcomes of these patients.MethodsWe conducted a retrospective study to include adult patients with A. baumannii bacteremia and then classified them into two groups: community-acquired A. baumannii bacteremia and hospital-acquired A. baumannii bacteremia. Characteristics and outcomes between 2 groups were compared. The Galleria mellonella infection survival model was used to determine the virulence of A. baumannii in these 2 groups.ResultsThere were 63 patients with A. baumannii bacteremia: 21 patients with community-acquired (CA) bacteremia and 42 patients with hospital-acquired (HA) bacteremia. Three patients with CA bacteremia were excluded due to healthcare-associated risks of infection. The remaining 18 patients with CA bacteremia had carbapenem-susceptible A. baumannii (CA-CSAB). Among the 42 patients with HA bacteremia, 11 patients had carbapenem-susceptible A. baumannii (HA-CSAB) and 31 patients had carbapenem-resistant A. baumannii (HA-CRAB). The 30-day mortality rates of those with CA-CSAB did not differ from those with HA-CSAB bacteremia but were significantly lower than those with HA-CRAB (p = 0.003). The factors influencing 30-day mortality were infection with CRAB (p = 0.004), appropriate empirical antimicrobial therapy (p = 0.002), and higher Acute Physiology and Chronic Health Evaluation II score (p < 0.001). The G. mellonella assay showed no differences in survival rates among CA-CSAB, HA-CSAB, and HA-CRAB.ConclusionsPatients with bacteremia due to CA-CSAB and HA-CSAB had similar outcomes. Similar virulences of CA-CSAB and HA-CSAB were confirmed with the G. mellonella infection model.     

老年人肺部感染药物治疗临床分析

老年人肺部感染是一种常见病、多发病,严重危害人们健康。本文研究的目的探讨老年人肺部感染临床表现的特性,提高对老年人不典型肺部感染的认识。方法:对2008年1月-2009年12月住院的186例不典型老年肺部感染患者进行回顾性分析。分析总结了近2年我科老年肺部感染患者的临床特点及病原学特点,合理选择药物治疗的方法。     

Clinical characteristics of COVID-19 in young patients differ from middle-aged and elderly patients

IntroductionCoronavirus disease-2019 (COVID-19) has spread worldwide. The study aimed to understand the clinical characteristics of young COVID-19 patients.Material and methodsNinety patients with severe COVID-19 infection in western Chongqing were collected from 21 January to 14 March 2020. They were divided into 4 groups based on age: youth (< 39 years), middle-aged (39–48 years), middle-elderly aged (49–60 years), and elderly (> 60 years). The clinical symptoms, laboratory findings, imaging findings, and treatment effects were compared among the groups.ResultsThere were 22, 27, 19, and 22 cases in the youth, middle-aged, middle-elderly, and elderly groups, respectively. There were no significant differences with respect to gender or smoking status among the four groups. The clinical indicators of severe disease in the youth group were significantly different from the other three groups, and included the lymphocyte count (p < 0.001), C-reactive protein level (p = 0.03), interleukin-6 level (p = 0.01), chest computed tomography (CT) findings (p < 0.001), number of mild cases (p = 0.02), education level (p < 0.001), and CD4 + T lymphocyte level (p = 0.02) at the time of admission, and the pneumonia severity index (PSI) at the time of discharge (p < 0.001). The complications (p < 0.001) among the youth group were also significantly different from the other groups.ConclusionsYoung patients have milder clinical manifestations, which may be related to higher education level, higher awareness and higher acceptance of the prevention and control of the COVID-19 epidemic, as well as their good immune function.     

盐酸氟桂利嗪对实验性脑出血大鼠体感诱发电位的影响

目的:观察钙拮抗剂盐酸氟桂利嗪对脑出血后神经功能缺失的修复作用。方法:用66只成年健康Wistar大鼠,分为正常对照组(6只)、脑出血组(30只)和治疗组(30只)三个组,对后两组运用胶原酶法建立大鼠脑出血模型,其中出血组仅制模不作处理,治疗组于制模前一天及制模后五天,按1 mg／kg体重腹腔注射盐酸氟桂利嗪,每日一次。此两组均于制模后分别于0．5、6、24、72、120 h五个时点各6只鼠作体感诱发电位(SEP)测定P1-N1蜂峰值、P1波潜伏期值、N1潜伏期及神经功能评定后处死。结果:脑出血后SEP波幅降低和潜伏期延长。治疗组脑出血后6 h波幅开始明显降低及潜伏期明显延长,持续约3天左右后逐渐恢复,SEP的P1-N1峰峰波幅升高及P1、N1波潜伏期缩短,治疗组与出血组结果比较差异有显著意义(P<0．01)。结论:盐酸氟桂利嗪对脑出血动物神经功能缺失有明显的修复作用,即具有脑保护作用。     

Clinical outcomes and mortality in elderly peritoneal dialysis patients

OBJECTIVES:

To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis.

METHODS:

We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed.

RESULTS:

Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis were predictors of mortality. The mean technique survival duration was 61.7±5.2 months. The technique survival rates were 97.9%, 90.6%, 81.5% and 71% at 1, 2, 3 and 4 years, respectively. None of the factors analyzed were predictors of technique survival.

CONCLUSIONS:

Mortality was higher in elderly patients. Factors affecting mortality in elderly patients included advanced age, the presence of comorbid diseases, increased episodes of peritonitis, use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis.     

老老年急性心肌梗死患者介入治疗的疗效及近期安全性评价

目的评价老老年（≥80岁）急性心肌梗死（AMI）患者行急诊与择期经皮冠状动脉介入治疗术（PCI）的有效性和近期安全性。方法将120例老老年冠心病患者分为急性心肌梗死组（AMI组）和非心肌梗死组（对照组）,其中AMI组发病12h内行直接PCI的患者为AMI急诊组,其他AMI患者（AMI择期组）和对照组患者均行择期PCI,两组合称为非急诊组,对各组的临床资料及冠脉介入特点进行回顾性分析。结果 AMI急诊组PCI即刻成功率（72.2%）低于非急诊组（92.2%）,差异有统计学意义（P=0.036）。AMI急诊组并发症比非急诊组和AMI择期组高,差异有统计学意义（P〈0.001,P=0.039）,AMI组并发症及主要不良心脏事件发生率、院内死亡率均比对照组高（P〈0.05）。结论在老老年AMI患者中,急诊与择期PCI手术成功率均较高,虽然急诊PCI术发生并发症的风险较高,但两者在院内死亡率和主要不良心脏事件发生率方面差异无统计学意义。     

并存症对高龄髋部骨折患者手术预后的影响

目的探讨并存症对高龄髋部骨折患者手术预后的影响。方法选择在我院接受手术治疗并入住骨科重症监护病房的80岁以上髋部骨折患者117例,记录患者的年龄、性别、体质量、骨折类型、术前并存症的有无及种类数目和手术预后。按手术预后将患者分为康复组和术后院内死亡组。单因素分析明确术后院内死亡的潜在预测因素后,将这些因素进行多因素Logistic回归分析。结果术前无并存症者仅23例(19.7%),并存症1种者94例(80.3%),术后院内死亡10例(8.5%),术后院内死亡的预测因素为术前并存呼吸疾病和并存症3种或以上。结论根据术前并存症可预测高龄髋部骨折患者手术预后,术前应充分评估和准备。     

Clinical features and treatment outcomes of upper gastrointestinal bleeding in patients with cirrhosis

With recent progress in treatment modalities, mortality from upper gastrointestinal (UGI) bleeding has decreased appreciably. The aim of this study was to establish how UGI bleeds are managed in Korean patients with cirrhosis and to evaluate treatment outcomes. A total of 479 episodes of acute UGI bleeding in 464 patients with cirrhosis were included during a six-month period at nine tertiary medical centers. Treatment outcomes were assessed by failure to control bleeding, rebleeding and mortality. The source of bleeding was esophagogastric varices in 77.7% of patients, nonvariceal lesions in 15.9%, and undefined in 6.5%. For control of bleeding, endoscopic and pharmacologic treatments were used in 74.7% and 81.9% of patients, respectively. Variceal ligation was a major technique for endoscopic treatment (90%), and terlipressin and somatostatin were the main pharmacologic agents used (96.4%). Initial hemostasis was achieved in 86.8% of cases, but rebleeding occurred in 3.8% and 16.8% of cases within five days and six weeks of hemorrhage, respectively. Five-day and six-week mortality were 11.3% and 25.9%, respectively. Survival of patients with variceal bleeding seems to be remarkably improved than previous reports, which may suggest the advances in hemostatic methods for control of variceal hemorrhage.     

Clinical characteristics of COVID-19 patients in three consecutive generations of spread in Zhejiang,China

ObjectivesThe aim was to determine the clinical characteristics of COVID-19 patients because the SARS-CoV-2 virus continues to circulate in the population.MethodsThis is a retrospective, multicentre, cohort study. Adult COVID-19 cases from four hospitals in Zhejiang were enrolled and clustered into three groups based on epidemiological history. First-generation patients had a travel history to Hubei within 14 days before disease onset; second-generation patients had a contact history with first-generation patients; third-generation patients had a contact history with second-generation patients. Demographic, clinical characteristics, clinical outcomes and duration of viral shedding were analysed.ResultsA total of 171 patients were enrolled, with 83, 44 and 44 patients in the first-, second-, and third-generation, respectively. Compared with the first and second generations, third-generation patients were older (61.3 vs. 48.3 and 44.0 years, p < 0.001) and had more coexisting conditions (56.8% vs. 36.1% and 27.3%, p 0.013). At 7 ± 1 days from illness onset, third-generation patients had lower lymphocyte (0.6 vs. 0.8 and 0.8 × 109/L, p 0.007), higher C-reactive protein (29.7 vs. 17.1 and 13.8 mg/L, p 0.018) and D-dimer (1066 vs. 412.5 and 549 μg/L, p 0.002) and more lesions involving the pulmonary lobes (lobes ≥5, 81.8% vs. 53.0% and 34.1%, p < 0.001). The proportions of third-generation patients developing severe illness (72.7% vs. 32.5% and 27.3%, p < 0.001), critical illness (38.6% vs. 10.8% and 6.8%, p < 0.001) and receiving endotracheal intubation (20.5% vs. 3.6% and 2.3%, p 0.002) were higher than in the other two groups.DiscussionThird-generation patients were older, had more underlying comorbidities and had a higher proportion of severe or critical illness than first- and second-generation patients.     

交通事故致多发性骨折的临床特点和治疗

目的探讨交通事故引起多发性骨折的临床特点和治疗.方法收集146例因交通事故所致的多发性骨折患者的临床资料,回顾性分析其临床特点和治疗方法.结果本研究中纳入146例患者,骨折类型以闭合性骨折和四肢骨折为主,并发症以休克为主.经抗休克、早期手术固定等治疗后,135例骨折愈合良好.治愈率达92.5%,骨折解剖复位达到87.3%.7例死亡,主要死因为失血性休克;5例骨折愈合不良.结论交通事故中的多发性骨折病情严重,需尽早明确诊断,以防误诊漏诊,积极抢救,以提高治愈率,减少并发症.