序贯器官衰竭评分判断肝衰竭患者预后价值

目的通过序贯器官衰竭评分（SOFA）探讨肝衰竭并发多器官功能障碍综合征（MODS）患者预后的价值。方法对118例符合MODS诊断标准的肝衰竭患者进行SOFA评分,比较存活与死亡者临床特征的差异,评判其对肝衰竭合并MODS死亡的判断能力。结果死亡组与生存组患者呼吸系统SOFA得分分别为0.78±0.91和0.13±0.34（P〈0.01）,循环系统为0.55±0.85和0.0±0.0（P〈0.05）,肾脏得分1.43±1.12和0.38±0.81（P〈0.01）;死亡组与生存组患者SOFA总得分分别为10.93±2.21和8.31±1.20（P〈0.05）,受试者工作特征（ROC）曲线下面积为0.857（标准误0.040,渐进显著性水平P＜0.01）,渐进95%可信区间为0.778～0.936。当截断点为8分、9分和10分时,阳性预测值分别为89.2%、92.9%和96.0%,阴性预测值分别为57.1%、45.0%和30.2%。结论 MODS患者呼吸、循环和肾脏功能障碍是肝衰竭死亡的独立危险因素,SOFA评分对肝衰竭的预后具有良好的判断能力。     

Performance of quick sequential organ failure assessment (qSOFA) score for prognosis of heat-related hospitalized patients

BackgroundHeat-related illnesses pose significant threats to human health.Objectives(1) To evaluate the use of qSOFA score for prognosis of heat-related hospitalized patients; and (2) identify other predictors for patient prognosis.MethodsUsing 28-day mortality as the primary endpoint, a retrospective, observational study of patients hospitalized between June 2013 and September 2018 was conducted.ResultsThe qSOFA score from 84 patients was identified as an independent predictor of patient prognosis. The area under the receiver operating characteristic curves for qSOFA score was 0.702, and a sensitivity of 100.00% and a specificity of 47.06% were found for qSOFA score greater than or equal to 2. Other predictors included bilirubin, urea nitrogen, and troponin I levels.ConclusionsqSOFA score can be used as a parameter to distinguish patients with severe heat-related illness prior to further clinical analyses. In addition to that, multiple organ impairment should be considered when assessing patient prognosis.     

中性粒细胞与淋巴细胞比值联合序贯器官功能衰竭评分对老年脓毒症患者预后的预测作用

目的 探讨中性粒细胞与淋巴细胞比值(NLR)联合序贯器官功能衰竭评分(SOFA)对老年脓毒症患者预后的预测作用.方法 回顾性分析解放军第305医院2017年1月至2019年8月收治的124例老年脓毒症患者的临床资料,根据预后情况,分为存活组(58例)和死亡组(66例).比较2组患者性别、年龄、基础病、原发疾病及NLR、...     

脓毒症患者血浆抗凝血酶Ⅲ及D-二聚体与SOFA评分的相关性研究

目的 探讨脓毒症患者血浆抗凝血酶Ⅲ(AT-Ⅲ)活性、D-二聚体(D-dimer)与序贯器官衰竭评估(SOFA)评分的关系及其对病情严重程度的判断价值.方法 选取2006年1月至2007年1月在宁夏医学院附属医院ICU住院治疗的101例脓毒症患者,测定其明确诊断后24 h内的AT-Ⅲ活性和D-dimer质量浓度,同时记录呼吸、凝血、循环、中枢神经系统及肾脏、肝脏的SOFA评分.依据多器官功能障碍综合征(MODS)发生与否分为MODS组(46例)和非MODS组(55例);比较不同SOFA评分分段AT-Ⅲ活性和D-dimer质量浓度的差异,并进行相关性分析.结果 MODS组D-dimer质量浓度和SOFA评分均显著高于非MODS组(P＜0.05和P＜0.01),AT-Ⅲ活性显著低于非MODS组(P＜0.01);MODS组呼吸、循环、中枢神经系统凝血及肾脏的SOFA评分显著高于非MODS组(P均＜0.01);不同SOFA评分分段AT-Ⅲ活性和D-dimer质量浓度变化差异均有显著性意义(P＜0.01);AT-Ⅲ活性与SOFA评分呈明显负相关(r=-0.536,P＜0.01);D-dimer质量浓度与SOFA评分呈明显正相关(r=0.410,P＜0.01).结论 脓毒症患者存在明显的凝血功能障碍,血浆AT-Ⅲ活性和D-dimer测定及SOFA评分系统对于脓毒症患者病情严重程度的评估有良好的应用价值.     

The sequential organ failure assessment score as a useful predictor for estimating the prognosis of systemic inflammatory response syndrome patients being treated with extracorporeal blood purification

Systemic inflammatory response syndrome (SIRS) is a major cause of morbidity and mortality in critically ill patients. Extracorporeal blood purification procedures are becoming important for treating these patients. However, the cost of these procedures is high. Therefore, a prognostic marker would be helpful. To establish the reliability of the Sequential Organ Failure Assessment (SOFA) score as a prognostic indicator, we evaluated daily changes in the SOFA score of 40 SIRS patients who needed blood purification procedures such as continuous renal replacement therapy (CRRT), endotoxin adsorption, bilirubin adsorption, and/or plasma exchange. Twenty patients survived and 20 died. Although the baseline scores of the two groups (survivors and non-survivors) did not differ, both the maximum value of the SOFA score and the DeltaSOFA score (the difference between the maximum SOFA and baseline SOFA scores) were significantly higher in the non-survivor group. The mortality rate among patients with a maximum SOFA score greater than or equal to 18 or a DeltaSOFA score greater than or equal to 3 was higher than for the rest of the patients. The changes in the SOFA score correlated well with the outcomes of the SIRS patients. The maximum SOFA score and the DeltaSOFA score are therefore likely to be useful prognostic markers.     

血清降钙素原与白蛋白比值联合序贯器官衰竭评估对脓毒症患者预后的预测价值

目的 探讨血清降钙素原与白蛋白比值(PCT/ALB)联合序贯器官衰竭评估(SOFA)对脓毒症患者预后的预测价值。方法 回顾性分析2019年1月至2020年1月山西医科大学附属白求恩医院急诊科收治的75例脓毒症患者的临床资料,按照28d预后将患者分为存活组(n=65)和死亡组(n=10)。监测患者入院当日的临床指标、并计算PCT/ALB以及SOFA。采用 SPSS 26.0 统计软件进行数据分析。采用t检验、χ²检验比较组间差异,Cox回归分析脓毒症患者死亡的相关因素,绘制受试者工作特征(ROC)曲线分析相关因素对患者预后的预测价值。结果 PCT、PCT/ALB、SOFA在死亡组中显著高于存活组,死亡组的ALB低于存活组,差异具有统计学意义(均P＜0.05)。PCT/ALB(HR=4.527,95% CI 1.321～15.512)、SOFA(HR=1.287,95%CI 1.081～1.534)是脓毒症患者28d死亡危险因素。PCT/ALB联合SOFA评分预测脓毒症患者预后的ROC曲线下面积为0.825,最佳截断点为1.824,灵敏度为80.0%,特异度为81.5%,优于单一指标的预测能力。结论 PCT、ALB、PCT/ALB、SOFA可评估脓毒症患者病情严重程度,其中PCT/ALB、SOFA与脓毒症患者28d死亡风险密切相关,PCT/ALB和SOFA联合预测脓毒症患者死亡风险价值优于单一指标的预测能力。     

改良序贯器官衰竭评分对肺炎克雷伯菌脓毒症预后的评估价值

目的:探讨改良序贯器官衰竭评分(improved sequential organ failure assessment,ISOFA)对肺炎克雷伯菌脓毒症预后的评估价值。方法:回顾性分析2018年1月1日至2019年6月30日吉林大学第一医院收治的379例肺炎克雷伯菌脓毒症患者的临床资料。按28 d预后情况分为存活组和死亡组,比较2组患者的年龄、性别、C反应蛋白、降钙素原、细菌耐药分级、发生脓毒症休克等指标。统计学分析采用独立样本t检验、曼-惠特尼U检验和χ²检验。logistic回归分析影响患者预后的危险因素;Spearman相关系数判定ISOFA与各评分系统包括查尔森评分(Charlson′s weighted index of comorbidities,WIC)、英国国家早期预警评分(national early warning system,NEWS)、急性生理学和慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、简化急性生理学评分Ⅱ(simplified acute physiology scoreⅡ,SAPSⅡ)、急性脓毒症病死率评分(mortality in emergency department sepsis score,MEDS)、序贯器官衰竭评分(sequential organ failure assessment,SOFA)、急性胃肠损伤分级(acute gastrointestinal injury,AGI)的相关性;采用受试者操作特征曲线下面积(area under receiver operating characteristic curve,AUROC)比较各评分系统对肺炎克雷伯菌脓毒症预后的评估价值。采用Kaplan-Meier生存曲线评价ISOFA风险分层在生存情况中的意义。结果:379例肺炎克雷伯菌脓毒症患者中,存活组278例,死亡组101例。2组患者的年龄、性别、发生脓毒症休克、细菌耐药分级、C反应蛋白、降钙素原,以及WIC、NEWS、APACHEⅡ、SAPSⅡ、MEDS、SOFA、AGI、ISOFA比较,差异均有统计学意义(t=-3.218,χ²=6.781、24.374、27.208,Z=-3.689、-5.022、-4.396、-4.697、-7.438、-6.348、-6.358、-8.676、-6.680、-11.658,均P<0.01)。单因素分析得到ISOFA的计算方法:ISOFA=SOFA+1.5×AGI。多因素logistic回归提示ISOFA、性别、SOFA、降钙素原、C反应蛋白、细菌耐药分级是影响预后的独立危险因素。ISOFA与WIC、NEWS、APACHEⅡ、SAPSⅡ、MEDS、SOFA的Spearman相关系数分别为0.327、0.371、0.614、0.564、0.578、0.847。WIC、NEWS、MEDS、SAPSⅡ、APACHEⅡ、SOFA、SOFA+AGI、ISOFA预测肺炎克雷伯菌脓毒症预后的AUROC及95%可信区间分别为0.646(0.584~0.708)、0.657(0.597~0.716)、0.712(0.654~0.771)、0.713(0.653~0.773)、0.749(0.693~0.806)、0.788(0.737~0.838)、0.872(0.826~0.917)、0.891(0.845~0.937),表明ISOFA预测效果最佳。Kaplan-Meier生存曲线提示,ISOFA低风险水平、中等风险水平、高风险水平间的生存情况差异均有统计学意义(均P<0.01)。结论:ISOFA对预测肺炎克雷伯菌脓毒症预后有重要的临床意义。     

Hemostatic markers and the sepsis-related organ failure assessment score in patients with disseminated intravascular coagulation in an intensive care unit

We investigated the correlation between disseminated intravascular coagulation (DIC) score and hemostatic parameters and sepsis-related organ failure assessment (SOFA) score with clinical outcome of patients with DIC in an intensive care unit (ICU). The SOFA score was markedly elevated in patients with DIC relative to patients without DIC and significantly higher in non-survivors than in survivors. Abnormalities in almost all hemostatic parameters were significant in patients with DIC, but there was no significant difference in almost all hemostatic parameters between survivors and non-survivors. However, plasma antithrombin (AT) levels were significantly lower in non-survivors than in survivors. Soluble fibrin (SF) and tissue type plasminogen activator (tPA)-plasminogen activator inhibitor-I (PAI-I) complex correlated significantly with the SOFA score, whereas AT levels correlated significantly and negatively with the SOFA score. We conclude that the SOFA score is useful for predicting outcome in DIC patients in the ICU, and that hemostatic parameters, especially plasma AT levels, are also useful markers for organ failure and clinical outcome.     

快速序贯器官功能衰竭评分联合红细胞分布宽度对老年脓毒症患者预后的预测价值

目的研究快速序贯器官功能衰竭评分(qSOFA)联合红细胞分布宽度(RDW)对老年脓毒症患者预后的预测价值。方法选取2016年6月至2019年6月在河北北方学院附属第一医院急诊科收治的老年脓毒症患者124例进行回顾性研究。根据30d的预后情况分为存活组(78例)和死亡组(46例)。主要收集患者实验室检验数据、急性生理慢性健康评分(APACHEⅡ)和qSOFA评分。采用t检验、秩和检验及χ2检验比较组间差异;采用Cox回归模型分析预后影响因素;采用Kaplan-Meier曲线分析不同qSOFA、RDW患者预后的差异;采用ROC曲线分析qSOFA、RDW对老年脓毒症患者预后的预测价值。结果与存活组相比,死亡组患者的RDW、肌酐、降钙素原、APACHEⅡ评分、qSOFA评分明显增加(P<0.05);Cox回归分析显示,RDW、APACHEⅡ、qSOFA是脓毒症患者预后的影响因素(P<0.05);Kaplan-Meier曲线分析显示,不同qSOFA、RDW患者的预后情况差异有统计学意义(P<0.05);在logistic回归模型中生成qSOFA联合RDW预测老年脓毒症患者预后的新指标(-5.728+0.505×qSOFA+0.339×RDW),并进行ROC曲线分析,结果显示合成指标对老年脓毒症患者的预后具有预测价值,最佳截断点为-0.6144,其灵敏度和特异度分别为60.87%和79.49%,优于单一指标。结论qSOFA和RDW是老年脓毒症患者预后的影响因素,qSOFA联合RDW用于预测老年脓毒症患者预后具有更高的灵敏度和特异度。     

连续静-静脉血液滤过治疗心脏术后肾功能衰竭临床研究

目的 观察连续静—静脉血液滤过（CVVH）治疗心脏术后肾功能衰竭的疗效。方法行股静脉或颈内静脉插管术,置入三腔血透管,选用BM25型（美国百特公司）血液滤过系统进行床旁CVVH。置换液以前稀释法输入,2000—4000ml／h,血流量150—300ml／min。治疗中采用低分子肝素持续抗凝。结果 人均CVVH时间为59．3h;血肌酐（Cr）和血尿素氮（BUN）下降明显（P〈0．05）;所有患者治疗中血流动力学稳定;没有发现出血或栓塞等并发症。26例患者中治愈18例;2例转为门诊间隙性透析,等待肾脏移植;死亡6例。结论CVVH是治疗心脏术后肾功能衰竭的安全、方便和有效的方法,能够降低死亡率。     

Echocardiographic assessment during exercise of heart failure patients with cardiac resynchronization therapy

This prospective echocardiographic study investigated the respective impacts of left ventricular (LV) pacing and simultaneous and sequential biventricular pacing (BVP) on ventricular dyssynchrony during exercise in 23 patients with compensated heart failure and ventricular conduction delays. During exercise, LV pacing and BVP significantly (p <0.05) improved mitral regurgitation and LV dyssynchrony compared with spontaneous activation. LV segmental electromechanical delays were significantly prolonged during LV pacing, leading to increased systolic time (p <0.05), decreased LV filling time (p <0.05), and decreased stroke volume (p <0.05) compared with BVP. After optimization of the interventricular delay with sequential BVP, additional benefit was obtained during exercise in terms of stroke volume and mitral regurgitation (p <0.05). The optimal interventricular delay was different at rest and during exercise in 57% of the patients. Changes from at rest to exercise in LV dyssynchrony were correlated with changes in stroke volume (r = -0.61, p <0.01) and changes in mitral regurgitation (r = 0.60, p <0.01).     

Easy prognostic assessment of concomitant organ failure in critically ill patients undergoing mechanical ventilation

BackgroundAcute respiratory distress syndrome (ARDS) is a life-threatening disease. We evaluated the prognostic utility of Model for End-stage Liver Disease excluding INR (MELD-XI) score for predicting mortality in a cohort of critically ill patients on mechanical ventilation.MethodsIn total, 11,091 mechanically ventilated patients were included in our post-hoc retrospective analysis, a subgroup of the VENTILA study (NCT02731898). Evaluation of associations with mortality was done by logistic and Cox regression analysis, an optimal cut-off was calculated using the Youden Index. We divided the cohort in two sub-groups based on their MELD-XI score at the optimal cut-off (12 score points).ResultsPeak-, plateau- and positive end-expiratory pressure were higher in patients with MELD-XI>12. Patients with MELD-XI>12 had higher driving pressures (14 ± 6 cmH2O versus 13 ± 6; p < 0.001). MELD-XI was associated with 28-day mortality after correction for relevant cofounders including SAPS II and ventilation pressures (HR 1.04 95%CI 1.03–1.05; p < 0.001. Patients with MELD-XI>12 evidenced both increased hospital (46% versus 27%; p < 0.001) and 28-day mortality (39% versus 22%).ConclusionsMELD-XI is independently associated with mortality and constitutes a useful and easily applicable tool for risk stratification in critically ill patients receiving mechanical ventilation.Trial registration: NCT02731898, registered 4 April 2016.     

Management of heart failure in cardiac surgical patients: amrinone and other pharmacologic agents

The pharmacologic treatment of heart failure and low cardiac output syndrome in the cardiac surgical patient continues to be a challenge in the nursing management of these patients. While the catecholamines have been of proven inotropic benefit over the years, their inherit risks of increased myocardial oxygen consumption, tachyphylaxis and poor tolerance in many patients have lead to the search for other medications to augment cardiac performance. Amrinone, the only drug available for use in the U.S. from the class of phosphodiesterase inhibitors, acts as both an inotrope and vasodilator to increase cardiac output without an increase in myocardial oxygen consumption. This paper reviews pharmacological management of heart failure in the cardiac surgical patient and nursing considerations specific to amrinone and combination inotropic therapy management.     

降钙素原与D-二聚体联合序贯器官衰竭评分对老年脓毒症患者病情及预后评估的价值

目的 探讨降钙素原(PCT)与D-二聚体(D-D)联合序贯器官衰竭评分(SOFA)对老年脓毒症患者病情判断和预后的评估价值.方法 回顾性分析2016年1月至2020年1月于上海市第五康复医院住院并诊断为脓毒症的117例老年患者(年龄≥60岁)的临床资料,记录患者入院24 h内PCT、D-D、SOFA评分及28 d预后....