中性粒细胞与淋巴细胞比值和中性粒细胞胞外诱捕网与脓毒症肝损伤的临床研究

Objective To explore the clinical value of peripheral blood neutrophil-to-lymphocyte ratio (NLR) combined with neutrophil extracellular traps (NETs) in predicting liver injury in patients with sepsis. Methods A prospective observational study was conducted. The patients who met the diagnostic criteria for sepsis 3.0 admitted to the Department of Intensive Care Unit in Wuxi People's Hospital Affiliated to Nanjing Medical University from March 2019 to June 2020 were selected as the research objects. The basic informations of the patients were recorded. NLR based on blood routine at admission was calculated. PicoGreen fluorescence quantitative detection kit was used to detect the quantitative level of free DNA (cf-DNA/NETs) in the peripheral plasma of patients at admission. According to whether liver injury occurred, the patients were divided into the sepsis without liver injury group and sepsis with liver injury group. Binary Logistics regression analysis was used to predict the risk factors of sepsis with liver injury. The receiver operating characteristic (ROC) curve was drawn. The value of NLR, NETs, NLR combined with NETs in predicting liver injury in patients with sepsis was analyzed. Results A total of 122 patients with sepsis were enrolled, of which 45 patients suffered from septic liver injury, with an incidence rate of 36.89%. The NLR of the sepsis wth liver injury group was (21.63 ± 4.71), the NLR of the sepsis without injury injury group was (15.03 ± 4.71), and the NETs level of the sepsis with liver injury group was (505.86 ± 250.05) ug/L, the level of NETs in the sepsis without liver injury group was (179.27 ± 67.20) ug/L, and the differences between the two groups were statistically significant (all P<0.05). Binary logistic regression analysis found that NLR (Oi?=1.470, 95% CI: 1.121-1.926, P<0.05) and NETs (OR=1.O18, 95% CI: 1.005-1.030, P<0.05) at admission were the independent risk factors for liver injury in patients with sepsis. The best cut-off value of NLR was 16.68, and the best cut-off value of NETs was 317 ug/L. The sensitivity of combined application of NLR and NETs to predict liver injury in patients with sepsis was 77.78%, specificity was 98.70%, the area under the curve was 0.930, and the Youden Index was 0.765. Conclusions The peripheral blood NLR and NETs levels are independent risk factors for liver injury in patients with sepsis. The combined application of NLR and NETs has a certain predictive value for liver injury in patients with sepsis. Taking NLR of 16.68 and NETs of 317 ug/L as the cut-off values, they can be used as early warning indicators to predict liver injury in patients with sepsis. © 2021 Chinese Medical Association. All rights reserved.     

中性粒细胞/淋巴细胞比值与急性冠脉综合征相关性的研究进展

炎症反应在心血管疾病的发病机制中发挥着重要作用。近年来,中性粒细胞/淋巴细胞比值(NLR)作为一种新型的炎症标志物引起广泛关注。大量研究表明,NLR对急性冠脉综合征(ACS)的发生、发展及预后的预测具有重要临床价值。本文将系统总结近年来NLR在ACS中的研究进展。     

Cardiac disease and the patient with burns

Cardiac disease has many manifestations that may complicate burn care. A review of 2477 consecutive acute burn admissions was conducted to determine the types and incidence of cardiac complications in this patient population. Nearly one half of patients with a prior cardiac history manifested some form of cardiac dysfunction, most frequently arrhythmias. Eight percent had an in-hospital myocardial infarction. Only 6% of patients without a prior cardiac history manifested cardiac dysfunction. The in-hospital mortality rate after myocardial infarction for both groups was 3.5 to 4 times that of patients without burns. Except for patients with prosthetic valves, for whom anticoagulation and infection prophylaxis are required, burn care of the cardiac patient is expectant with selective use of invasive monitoring and therapy as determined by the patient's clinical course.     

Wound healing in the patient with burns

The burn wound presents many unique challenges to the nurse who promotes optimal wound healing. Nursing care includes meticulous attention to the prevention of infection, wound cleansing and debridement, and application of topical antibacterial agents. Preparation of graft recipient sites, care of graft and donor sites, and use of various biologic and synthetic wound coverings are required. An interdisciplinary approach that provides for adequate nutrition, fosters physical function, and supports psychologic adjustment to altered self-concept is required for holistic healing of the burn wound.     

中性粒细胞、血小板和淋巴细胞比值与银屑病、银屑病性关节炎的相关性分析

目的 探讨中性粒细胞、血小板和淋巴细胞比值(NLR)、血小板和淋巴细胞比值(PLR)与银屑病及银屑病性关节炎(PsA)的相关性.方法 选择75例银屑病患者(银屑病组)、28例PsA患者(PsA组)、50例健康体检者(健康组),分别检测三组的NLR、PLR、超敏C反应蛋白(hs-CRP)水平,根据银屑病皮损面积和严重程度...     

Severe itching in the patient with burns.

After discharge, the patient with burns is often plagued with persistent, unrelenting itching. The purpose of this study was to document the incidence and severity of itching in discharged patients with burns, to determine factors that may help in prediction of the problem, and to study the effectiveness of Benadryl (Parke-Davis, Morris Plains N.J.), Atarax (Roerig Div. of Pfizer Inc., New York, N.Y.) and Polyhist Forte (Mikart Inc., Atlanta, Ga.) in relieving the symptom. All adult patients who were discharged to our outpatient clinic were entered into this prospective study. Patients were started on one of the three agents, and agents were changed monthly in a randomized fashion. Severity of itching was determined by a visual linear analogue scale. The study population had a mean age of 35.9 +/- 12.8 years, and a mean burn size of 19.1% +/- 15.3% total body surface area. Eighty-seven percent of discharged patients complained of itching. The average severity of the problem was 7.6 +/- 1.9. A significant difference (p less than 0.05) among groups was found when the population was analyzed for size of burn and duration of time to wound closure. Symptoms varied with anatomic area burned. One hundred percent of patients with leg burns and 70% of those with arm burns complained of itching. Facial burns did not cause itching in any of the patients. The agents that were tested produced complete relief in only 20% of patients, partial relief in 60%, and no relief in 20%. There were no differences in response to the three agents tested. All three of the drugs that were tested had similar onset of action.(ABSTRACT TRUNCATED AT 250 WORDS)     

Helicopter transport of the patient with acute burns

Helicopter transportation of acutely injured or ill patients has become common practice at most major medical centers. However, its specific effectiveness in the transportation of acute-condition patients with burns has never been critically assessed. This study, for the period 1984 through 1988, evaluated the use of the helicopter for transportation of acute-condition patients with burns to a regional burn center for a rural area. It is concluded that helicopter transport within a 180-mile radius in a non-hospital-based system is not appreciably faster than is ambulance transport, and does not clinically benefit most burned patients. Consideration such as safety, cost, and working space are discussed. It is recommended that at least one of three criteria be met before helicopter transfer is considered for patients with burns: the surface area involved should be enough to require a formal fluid resuscitation, an inhalation injury should be present or suspected, or there should be a possible need for an escharotomy.     

压力治疗对烧伤后增生性瘢痕的远期影响

目的:研究长期的压力治疗对增生性瘢痕的影响。方法:选取2012年入住我院的深度烧伤后增生性瘢痕30例患者作为试验组,以压力衣或弹力绷带进行压力治疗,直至瘢痕成熟后2个月或试验持续24个月。在同期的门诊患者中,选取30例因各种原因无法进行压力治疗的深度烧伤后增生性瘢痕患者作为对照组。观察2组患者增生性瘢痕生长过程中,瘢痕生长速度(厚度)、羟脯氨酸、组胺、5-羟色胺等指标的表达差异。结果:1试验组瘢痕较对照组薄且生长周期相对较短,差异有显著性意义。2试验组患者的羟脯氨酸浓度水平低于对照组且降低的时间较早,差异有显著性意义。3组胺、5-羟色胺的浓度变化与瘢痕生长的相关程度不明显,差异无显著性意义。结论:压力治疗对增生性瘢痕有抑制的效果,长期坚持可促进增生性瘢痕的提前成熟。建议压力治疗应贯穿于瘢痕的整个生长过程。     

Inventory of potential reconstructive needs in the patient with burns

The rehabilitation and reconstruction of patients who survive large burns is an arduous task. To facilitate it we have devised an inventory form to accurately record the somatic abnormalities caused by burns and also the severity and location of burns. This form was used in the assessment of 25 pediatric patients with massive burns. It was found to be a very useful tool that allowed the identification of more specific functional and esthetic deformities than is possible with currently available forms. It also served as a template for the systematic planning of reconstructive procedures.     

Quality of nursing diagnosis and patient satisfaction. A study of the correlation

The research question was whether there exists a relationship between quality of nursing diagnoses in nursing documentations and patient's satisfaction with nursing diagnoses. The hypotheses stated that a positive relationship between nursing diagnosis and patient satisfaction exists; high quality of nursing diagnoses in the nursing documentation goes along with high patient satisfaction with nursing diagnoses. The sample consisted of 57 patients, their nursing documentations and nurses of three dermatological units of a university hospital in Switzerland. Nursing diagnosis was analysed from two points of view: the professional nursing focus and patients' focus. For this purpose, two measurement instruments have been developed. Three subconcepts of quality of nursing diagnoses and patient satisfaction were derived: interaction/personal dimension, patient participation and knowledge of nurses. Content validity of both instruments was established and the reliability coefficents of both instruments were rather high (.91 and .95). To test assessment objectivity, twelve raters analysed three nursing documentations. The tree Kappas were significant at a 5% level. The hypothesis was analysed by a correlational design. The main findings showed a significant relationship between quality of nursing diagnoses in documentations and patient satisfaction (tau = .18, p < or = .03). The evaluation of nursing diagnoses indicated effective communication between nurses and patients and that nurses assessed patients' situations appropriately. Patients satisfaction with nursing diagnoses was rather high. One of three subscales in both instruments yielded a significant correlation. The statistically significant, but low relationship suggests the need for further study.     

Treatment before transfer: the patient with burns

Objectives—To review pre-burns centre management, including assessment, resuscitation, and transfer.

Methods—A retrospective analysis of the notes of all the UK patients admitted to the Burns Centre in 1998, who had a body surface area burn of over 15% in adults (10% in children).

Results—There were 31 patients, 21 adults and 10 children, and the average burn size was 32% (12–96%). Fourteen were overestimated (average of 9%) and 13 underestimated by 7.5%. Twenty nine received intravenous fluids, 18 specified a formula, but it was only applied correctly in 10. The average time to the Burns Centre from the burn was 10 hours, and the time for resuscitation and transfer, eight hours. Documentation was generally poor.

Conclusion—There has previously been considerable variation in the standard of initial burn management and there have been problems with burn percentage assessment and resuscitation formula application. A new proforma has been introduced to tackle these issues.

     

中性粒细胞与淋巴细胞和血小板比值与老年脓毒症急性肾损伤的临床研究

目的:探讨中性粒细胞与淋巴细胞和血小板比值（neutrophil to lymphocyte and platelet ratio,NLPR）在老年脓毒症患者中对急性肾损伤（acute kidney injury,AKI）诊断和预后的临床价值。方法:回顾性分析武汉大学中南医院重症监护室（intensive care u...     

脑卒中患者整体功能与生存质量的相关性研究

目的:应用功能综合评定量表(FCA)和WHOQOL-BREF研究脑卒中偏瘫患者整体功能与生存质量之间的相关关系。方法:对50例脑卒中偏瘫患者在病程满6个月时进行FCA和WHOQOL-BREF量表评分,并将二者进行相关性分析。结果:FCA总分与WHOQOL-BREF各领域得分均显著相关(P<0.05或0.01),躯体功能得分与WHOQOL-BREF生理、心理和环境领域得分也显著相关(P<0.05或0.01),但认知功能得分则仅与社会关系领域得分相关,与其余二个领域得分无相关性。结论:脑卒中偏瘫患者整体功能与生存质量明显相关,躯体功能状况比认知功能能更显著地影响了患者的生存质量。