目的探讨D-二聚体水平与多发伤患者发生多器官功能障碍(multiple organ dysfunction,MODS)的相关性,并分析其对MODS的预测价值。方法选取常州市肿瘤医院与合作医院(常州市第一人民医院)2017年5月30日一2019年5月30日收治150例多发伤患者的病例资料进行回顾性分析,收集患者入院24hD-二聚体水平(免疫比浊法检测)。根据患者在住院期间是否发生MODS将患者分为MODS组(45例)和非MODS组(105例)。分析D-二聚体水平与MODS的相关性,并观察其对MODS的预测价值。结果MODS组住院期间病死率、入院24h合并休克率、合并感染、损伤部位数目、损伤严重程度评分、D-二聚体水平高于非MODS组(P<0.05),住院时间长于非MODS组(P<0.05),血红蛋白、血小板计数低于非MODS组(P<0.05)。多因素分析结果显示,入院24h合并休克、合并感染、损伤严重程度评分、D-二聚体水平是多发伤患者发生MODS的独立影响因素(P<0.05)。ROC曲线分析结果显示,D-二聚体预测多发伤患者发生MODS的曲线下面积(AUC)为0.75,灵敏度及特异度分别为68.5%、75.3%。结论入院24 hD-二聚体水平升高的多发伤患者MODS发生率较高,且对MODS的发生具有较高预测价值。 相似文献
A retrospective analysis was conducted on 93 adult patients with cutaneous leukocytoclastic vasculitis from St. Vincent's Hospital Melbourne to determine the classification, aetiology, severity and prognosis of this population of patients. We developed a new classification system for the purposes of our study based on modifications to the Chapel Hill Consensus Conference definitions for vasculitic syndromes. The results of our study indicate that an obvious cause was not found in 44.1% of patients. Of the patients with secondary vasculitis, the commonest causes were drugs and infections, accounting for a total of 40.9% of patients. Extracutaneous involvement was found in 39.8% of patients. Patients with symptoms resolving in less than 3 months accounted for 59.1% of the population, whereas 24.8% of patients had either symptoms lasting three or more months or evidence of recurrent symptomatology. There were 6 deaths (6.91%) and the rest were lost to follow up. The majority of patients in this retrospective series were classified as having hypersensitivity vasculitis, which is a relatively benign disorder limited mostly to skin with a low incidence of extracutaneous involvement (15.8%). Nevertheless, evidence of systemic involvement or sepsis need to be excluded as this may have important implications for patient treatment and outcome. 相似文献
Cutaneous involvement may occur with virtually all syndromes of vasculitis. This can occur primarily as a dermatologic disorder or as a manifestation of a potentially life threatening systemic vasculitis. In this review article, classification, clinical manifestations, pathogenesis and therapy of cutaneous vasculitis will be discussed. Disorders which are primarily vascular in origin but lack a well defined inflammatory phase, referred to as ‘vasculopathies’ will also be discussed. 相似文献
Pakistan A 12-year-old boy from a village near Sukkur presented to the Civil Hospital, Karachi, Pakistan, in January 1992, with widespread black discoloration and ulcers of the lower extremities and focal areas of involvement of the upper extremities and face. The patient was previously healthy, when he suddenly developed low grade fever and severe pain on the left side of the chest for which he was given two unknown white tablets. His fever gradually became high, and next morning he was unable to walk and had erythematous patches on his lower extremities, nose, and posterolateral aspects of the upper extremities. He also developed watery diarrhea without blood or mucus and was incontinent. He was treated with a single dose of cotrimoxazole, furazolidone, and mefenamic acid. Oral rehydration salts were also given. His diarrhea improved, but the erythematous patches started to become black. Other symptoms included frequency and difficulty in passing urine, with only a few drops passed each time. He was hospitalized in Sukkur where oral antimicrobials (erythromycin, clindamycin) and parenteral steroids (dexamethasone, 4 mg, six hourly) were administered. The latter was gradually tapered over 15 days. The urinary symptoms improved after 1 day of hospitalization and treatment. Focal areas of the affected skin of the ears, face, and upper extremities became dry and sloughed off. The lesions were tender. There was no past history of sore throat, jaundice, joint pains, or blood transfusion. He had an episode of left-sided chest pain 1 year ago for which he was given medication. Five years ago he had a traumatic fracture of the lower leg. On examination, patchy but extensive black discoloration of the feet, lower legs, knees, and posterolateral aspects of the thighs was seen. Large ulcers were present on the buttocks and upper extremities. Ulcers were also seen on the nose, cheeks, lateral aspects of the pinna, upper arms, and elbows ( Figs 1 and 2 ). His temperature was 98.6 °F orally, pulse rate was 90/min (regular), respiratory rate was 20/min, and blood pressure was 90/50 mmHg. The patient was non-toxic, with no apparent systemic involvement on clinical examination. Figure 1 Open in figure viewer PowerPoint Patchy, extensive ulceration and black discoloration of the buttocks, posterolateral aspect of the thighs, knees, lower legs, and feet 相似文献
Takayasu arteritis (TA) is an inflammatory arteriopathy involving predominantly the aorta and its main branches. The disease evolves in two phases: a first, nonspecific inflammatory stage and a late 'pulseless' stage, in which complications related to arterial stenosis and aneurysm formation predominate. In both phases, skin manifestations, such as inflammatory nodules, erythema-nodosum- and pyoderma-gangrenosum-like ulcers, have been described. We report 2 patients with TA, who had cutaneous necrotizing vasculitis as presenting manifestation of the disease. A review of the literature revealed 8 similar cases. TA does not only involve large arteries, but also small blood vessels. The observation that in TA the inflammatory process of the large arteries affects regions of the walls supplied by the vasa vasorum, the anatomy of which bears resemblance to the cutaneous vessel system, suggests that primary involvement of small vessels contributes to the development of the clinicopathological features of TA. Knowledge of the skin manifestations associated with TA remains important for its diagnosis and prompt instauration of life-saving treatment. 相似文献
