呼吸监护病房老年患者高钠血症的临床分析

目的 探讨老年危重患者高钠血症与病情变化及预后的关系。方法 回顾2002年5月-2003年10月呼吸监护病房所有老年高钠血症患者临床资料．并用统计学方法对上述资料进行分析。结果 189例患者中高钠血症26例，发生率13．76％。高钠血症患者中死亡14例．病死率53．85％。在气管插管病例中高钠血症发生率为70．37％。发生高钠血症时急性生理学和慢性健康状况(APACHE)Ⅱ评分显著高于入监护室24小时的APACHEⅡ评分，同时肾功能也有一定影响，血肌酐值明显升高。高钠血症中死亡组与存活组比较，血钠水平有显著差异。结论 高钠血症是老年危重患者较常见的并发症，在气管插管患者发生率更高，且预后差。因此要重视老年危重患者高钠血症的发生。     

结核病危重患者的死亡预后因素初步分析

目的 探讨结核病危重患者死亡预后的影响因素.方法 对2008年6月至2010年2月浙江省中西医结合医院结核科ICU的62例成年结核病危重患者的临床资料进行回顾性分析,其中男48例,女14例,年龄20～91岁,平均(63±4)岁.以入住结核科ICU时间为研究起点,以转出结核科ICU或死亡时间为研究终点,将患者分为存活组(33例)和死亡组(29例),对年龄、性别、呼吸衰竭类型、有无机械通气、合并其他感染、耐多药结核病、抗结核治疗、急性病生理学和长期健康评价Ⅱ(APACHEⅡ)评分及肝损害等变量进行单因素分析.采用Cox回归分析患者死亡预后的独立危险因素,采用Kaplan-Meier生存分析法计算患者的累积生存率.结果 与结核病危重患者死亡预后有关的因素为:真菌感染,风险比(HR值)为3.44,95%CI为1.23～9.62;Ⅱ型呼吸衰竭,HR值为4.03,95%CI为1.56～10.38;肝损害,HR值为3.96,95%CI为1.30～12.10;APACHEⅡ评分＞25分,HR为4.91,95%CI为1.99～12.11.上述4项因素均可使结核病危重患者住院死亡的风险显著增高(x2值为5.53～11.88,均P＜0.05),住院累积生存率显著降低(x2值为4.43～22.68,均P＜0.05).结论 结核病危重患者的病死率高,合并真菌感染、Ⅱ型呼吸衰竭、肝损害和APACHEⅡ评分＞25分是患者死亡预后的危险因素.

Abstract：

Objective The purpose of this study was to investigate the prognostic factors associated with mortality in critically ill tuberculosis patients, and therefore to provide information for the early diagnosis and treatment of the disease. Methods The clinical daza of 62 patients with tuberculosis, who were admitted to the intensive care unit (ICU) of Integrated Chinese and Western Medicine Hospital of Zhejiang Province between June 2008 and Feb 2010, were analyzed retrospectively, with the admission date as a start point and the transferring out of ICU date or death date in the ICU as an end point. Forty-eight patients were males and 14 were females, and the patient' s age ranging from 20 to years (63 ± 4) years. In addition,these patients were divided into the survival (33 cases) and the death groups (29 cases). A total of 19 factors including age, sex, respiratory failure types, mechanical ventilation, infection, anti-tuberculous drug resistance, chemotherapy, clinical complications, critical illness score, liver damage, were analyzed for a single risk factor by the univariate model, and calculated for the independent death risk factors using the Cox logistic regression multivariate model. The cumulative survival rate based on the Kaplan-Meier survival model was calculated. Results The mortality was associated with 4 independent factors: fungal infection ( HR =3.44, 95% CI = 1.23 - 9. 62), type Ⅱ respiratory failure ( HR = 4. 03, 95% CI = 1.56 - 10. 38), liver damage (HR=3.96, 95% CI=1.30 -12. 10) and elevated APACHEⅡ score (＞25) (HR =4.91,95%CI = 1.99 - 12. 11 ). These factors significantly ( x2 =5. 53 - 11.88, all P ＜0. 05) increased the in-hospital mortality and decreased the hospital cumulative survival rate( x2 = 4. 43 -22. 68, all P ＜ 0. 05 ). Conclusion The high mortality of tuberculosis patients admitted to ICU was associated with fungal infection, type Ⅱ respiratory failure, liver damage, and elevated APACHE Ⅱ score ( ＞ 25).     

脑出血患者体温变化与预后的临床研究

目的探讨脑出血患者入院体温和入院后体温变化对机体神经系统预后的影响。方法 96例脑出血患者分别于入院第1、3、7、14天、1个月和3个月进行体温测量,并按入院时体温分为低体温组(T<36℃)、体温正常组(36～37℃)和体温升高组(T>37℃),以美国国立卫生研究院卒中量表(NIHSS)评分为标准判断机体神经系统的预后情况,观察脑出血患者体温的整体变化趋势以及NIHSS评分的变化趋势,分析低体温组、正常体温组与高体温组与NIHSS评分间的相关性。结果发现患者入院体温与入院后不同时间点的NIHSS评分密切相关(P<0.01),且呈正相关(P<0.01),体温越高患者神经功能缺损程度越严重。结论脑出血患者的体温变化与机体神经系统的预后密切相关,高体温患者常常指示预后不良,因而体温值有助于成为判定脑出血预后的有效指标而具有重要的临床意义。     

严重急性呼吸综合征老年患者的临床诊治及预后分析

为了解严重急性呼吸综合征 (SARS)老年患者的特点和治疗经验 ,我们对北京协和医院 2 0 0 3年 3～ 5月临床确诊的SARS老年患者的临床资料作一回顾性总结分析。对象与方法　根据中华人民共和国卫生部疾病控制司发布的《传染性非典型肺炎临床诊断标准 (试行 )》及《重症传染性非典型肺炎诊断标准》[1],选择北京协和医院 2 0 0 3年 3～ 5月诊治的临床资料完整的SARS老年患者 (≥ 60岁 ) 2 4例 ,对其流行病学及临床资料进行分析。并以同时期SARS非老年患者 53例为对照。结果采用SPSS 10 0软件进行统计 ,并作 χ2 检验及独立样本t检验 ,…     

Copeptin、APACHEEⅡ评分在危重患者预后评估中的价值

目的：探讨Copeptin水平联合急性生理和慢性健康状况评分(APACHEⅡ评分)评价危重患者预后的意义。     

270例高龄老年患者机械通气后短期预后及危险因素分析

目的：对行机械通气的老年患者进行随访观察,分析机械通气的短期预后及危险因素。方法选择2008年1月至2013年6月就诊于解放军总医院老年病房的270例机械通气患者为研究对象,根据机械通气后28d时和29d至3个月时患者的生存情况,将患者资料分成死亡组（n＝126）和存活组（n＝144）进行分析,采用单因素分析筛查出影响预后的因素,以有统计学意义的因素作为自变量进行多因素logistic回归分析,判断各因素对死亡风险的影响。结果270例老年机械通气患者,年龄（89.0±4.8）岁。肺炎（70.7%）为最常见病因,其次为急性左心衰（10.7%）和慢性阻塞性肺疾病急性加重（AECOPD,7.8%）等。28d内死亡86例（31.9%）,3个月内共死亡126例（46.7%）。多因素logistic回归分析显示低氧合指数（PO2/FiO2）、前白蛋白降低、血尿素氮（BUN）增高、血清肌酐（SCr）增高（〉165.2μmol/L）、使用呼气末正压（PEEP）是影响机械通气患者28d预后的危险因素（均P＜0.05）;慢性肾脏病（CKD）、C-反应蛋白（CRP）是影响机械通气患者29d至3个月时预后的危险因素（均P＜0.05）。结论肺炎、急性左心衰、AECOPD等是老年患者机械通气最常见的原因;CKD、低PO2/FiO2、前白蛋白降低、CRP、BUN增高、SCr增高（＞165.2μmol/L）及使用PEEP是影响机械通气患者预后的危险因素。     

B型利钠肽对非心源性危重患者的预后价值

目的 探讨B型利钠肽(BNP)浓度是否预测急诊非心源性危重患者的28 d病死率.方法 测量255例急诊室非心源性危重患者血中BNP浓度,并记录各项化验指标和临床生理指标.随访28 d患者是否存活,进一步分析人选时血BNP水平与28 d病死率的关系.结果 28 d共有71例死亡,死亡组患者的血BNP浓度中位数水平明显高于存活组(326.0 ng/L比50.9 ng/L,P<0.001),BNP水平预测28 d病死率的ROC曲线下面积为0.825,血BNP预测患者病死率的最佳界值点是114.0 ns/L,血BNP>114.0 ng/L(RR 7.268,95%CI 3.864～13.672)和急性生理学及慢性健康状况评分(APACHE)Ⅱ评分>20(RR 3.330,95%CI 1.815～6.109)是预测患者28 d病死率的独立危险因素.结论 血BNP水平是预测急诊非心源性危苇患者28 d病死率的独立指标,应用BNP预测危重患者病死率的能力优于急诊室常用的快速急性生理学评分与快速急诊医学评分系统,与经典的APACHE Ⅱ评分十分相近.     

B型利钠肽对非心源性危重患者的预后价值

Objective B-type natriuretic peptide(BNP) have been used widely in the diagnosis and prognosis of cardiogenic diseases, but the association between BNP concentrations and non-cardiogenic critical illness is unknown. Our study aims at investigating the role of natriuretic peptide testing for predicting 28-day mortality of non-cardiogenic critically ill patients in emergency department (ED). Methods A total of 255 non-cardiogenic critically ill patients treated in the emergency department were prospectively enrolled and a sample of blood was obtained for BNP measurement from each patient. A variety of clinical and laboratory variables were recorded. After 28 days, the vital status of each patient was ascertained and the association between BNP values at presentation and mortality was assessed. Results 71 patients died during the 28-day observation period. Median BNP concentrations at presentation among decedents were significantly higher than those of survivors (326. 0 ng/L versus 50. 9 ng/L,P <0. 001). The optimal BNP cut point for predicting 28-day mortality was 114. 0 ng/L. In a multivariate analysis (Cox-regression), a BNP concentration greater than 114. 0 ng/L(RR 7. 268, 95% CI 3. 864-13. 672) and an Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores greater than 20 (RR 3. 330, 95% CI 1. 815-6. 109)were the independent predictors of the 28-day mortality. BNP concentration alone had an area under the receiver operating characteristic curve (AUC) of 0. 825 for predicting mortality. Conclusions BNP concentrations at presentation are strong predictor of 28-day mortality in patients with non-cardiogenic critically ill patients in ED, which is better than Rapid Acute Physiology Score (RAPS) , Rapid Emergency Medicine Score (REMS) and APACHE Ⅱ score.     

B型利钠肽对非心源性危重患者的预后价值

Objective B-type natriuretic peptide(BNP) have been used widely in the diagnosis and prognosis of cardiogenic diseases, but the association between BNP concentrations and non-cardiogenic critical illness is unknown. Our study aims at investigating the role of natriuretic peptide testing for predicting 28-day mortality of non-cardiogenic critically ill patients in emergency department (ED). Methods A total of 255 non-cardiogenic critically ill patients treated in the emergency department were prospectively enrolled and a sample of blood was obtained for BNP measurement from each patient. A variety of clinical and laboratory variables were recorded. After 28 days, the vital status of each patient was ascertained and the association between BNP values at presentation and mortality was assessed. Results 71 patients died during the 28-day observation period. Median BNP concentrations at presentation among decedents were significantly higher than those of survivors (326. 0 ng/L versus 50. 9 ng/L,P <0. 001). The optimal BNP cut point for predicting 28-day mortality was 114. 0 ng/L. In a multivariate analysis (Cox-regression), a BNP concentration greater than 114. 0 ng/L(RR 7. 268, 95% CI 3. 864-13. 672) and an Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores greater than 20 (RR 3. 330, 95% CI 1. 815-6. 109)were the independent predictors of the 28-day mortality. BNP concentration alone had an area under the receiver operating characteristic curve (AUC) of 0. 825 for predicting mortality. Conclusions BNP concentrations at presentation are strong predictor of 28-day mortality in patients with non-cardiogenic critically ill patients in ED, which is better than Rapid Acute Physiology Score (RAPS) , Rapid Emergency Medicine Score (REMS) and APACHE Ⅱ score.     

B型利钠肽对非心源性危重患者的预后价值

Objective B-type natriuretic peptide(BNP) have been used widely in the diagnosis and prognosis of cardiogenic diseases, but the association between BNP concentrations and non-cardiogenic critical illness is unknown. Our study aims at investigating the role of natriuretic peptide testing for predicting 28-day mortality of non-cardiogenic critically ill patients in emergency department (ED). Methods A total of 255 non-cardiogenic critically ill patients treated in the emergency department were prospectively enrolled and a sample of blood was obtained for BNP measurement from each patient. A variety of clinical and laboratory variables were recorded. After 28 days, the vital status of each patient was ascertained and the association between BNP values at presentation and mortality was assessed. Results 71 patients died during the 28-day observation period. Median BNP concentrations at presentation among decedents were significantly higher than those of survivors (326. 0 ng/L versus 50. 9 ng/L,P <0. 001). The optimal BNP cut point for predicting 28-day mortality was 114. 0 ng/L. In a multivariate analysis (Cox-regression), a BNP concentration greater than 114. 0 ng/L(RR 7. 268, 95% CI 3. 864-13. 672) and an Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores greater than 20 (RR 3. 330, 95% CI 1. 815-6. 109)were the independent predictors of the 28-day mortality. BNP concentration alone had an area under the receiver operating characteristic curve (AUC) of 0. 825 for predicting mortality. Conclusions BNP concentrations at presentation are strong predictor of 28-day mortality in patients with non-cardiogenic critically ill patients in ED, which is better than Rapid Acute Physiology Score (RAPS) , Rapid Emergency Medicine Score (REMS) and APACHE Ⅱ score.     

B型利钠肽对非心源性危重患者的预后价值

Objective B-type natriuretic peptide(BNP) have been used widely in the diagnosis and prognosis of cardiogenic diseases, but the association between BNP concentrations and non-cardiogenic critical illness is unknown. Our study aims at investigating the role of natriuretic peptide testing for predicting 28-day mortality of non-cardiogenic critically ill patients in emergency department (ED). Methods A total of 255 non-cardiogenic critically ill patients treated in the emergency department were prospectively enrolled and a sample of blood was obtained for BNP measurement from each patient. A variety of clinical and laboratory variables were recorded. After 28 days, the vital status of each patient was ascertained and the association between BNP values at presentation and mortality was assessed. Results 71 patients died during the 28-day observation period. Median BNP concentrations at presentation among decedents were significantly higher than those of survivors (326. 0 ng/L versus 50. 9 ng/L,P <0. 001). The optimal BNP cut point for predicting 28-day mortality was 114. 0 ng/L. In a multivariate analysis (Cox-regression), a BNP concentration greater than 114. 0 ng/L(RR 7. 268, 95% CI 3. 864-13. 672) and an Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores greater than 20 (RR 3. 330, 95% CI 1. 815-6. 109)were the independent predictors of the 28-day mortality. BNP concentration alone had an area under the receiver operating characteristic curve (AUC) of 0. 825 for predicting mortality. Conclusions BNP concentrations at presentation are strong predictor of 28-day mortality in patients with non-cardiogenic critically ill patients in ED, which is better than Rapid Acute Physiology Score (RAPS) , Rapid Emergency Medicine Score (REMS) and APACHE Ⅱ score.     

B型利钠肽对非心源性危重患者的预后价值

Objective B-type natriuretic peptide(BNP) have been used widely in the diagnosis and prognosis of cardiogenic diseases, but the association between BNP concentrations and non-cardiogenic critical illness is unknown. Our study aims at investigating the role of natriuretic peptide testing for predicting 28-day mortality of non-cardiogenic critically ill patients in emergency department (ED). Methods A total of 255 non-cardiogenic critically ill patients treated in the emergency department were prospectively enrolled and a sample of blood was obtained for BNP measurement from each patient. A variety of clinical and laboratory variables were recorded. After 28 days, the vital status of each patient was ascertained and the association between BNP values at presentation and mortality was assessed. Results 71 patients died during the 28-day observation period. Median BNP concentrations at presentation among decedents were significantly higher than those of survivors (326. 0 ng/L versus 50. 9 ng/L,P <0. 001). The optimal BNP cut point for predicting 28-day mortality was 114. 0 ng/L. In a multivariate analysis (Cox-regression), a BNP concentration greater than 114. 0 ng/L(RR 7. 268, 95% CI 3. 864-13. 672) and an Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores greater than 20 (RR 3. 330, 95% CI 1. 815-6. 109)were the independent predictors of the 28-day mortality. BNP concentration alone had an area under the receiver operating characteristic curve (AUC) of 0. 825 for predicting mortality. Conclusions BNP concentrations at presentation are strong predictor of 28-day mortality in patients with non-cardiogenic critically ill patients in ED, which is better than Rapid Acute Physiology Score (RAPS) , Rapid Emergency Medicine Score (REMS) and APACHE Ⅱ score.     

B型利钠肽对非心源性危重患者的预后价值

Objective B-type natriuretic peptide(BNP) have been used widely in the diagnosis and prognosis of cardiogenic diseases, but the association between BNP concentrations and non-cardiogenic critical illness is unknown. Our study aims at investigating the role of natriuretic peptide testing for predicting 28-day mortality of non-cardiogenic critically ill patients in emergency department (ED). Methods A total of 255 non-cardiogenic critically ill patients treated in the emergency department were prospectively enrolled and a sample of blood was obtained for BNP measurement from each patient. A variety of clinical and laboratory variables were recorded. After 28 days, the vital status of each patient was ascertained and the association between BNP values at presentation and mortality was assessed. Results 71 patients died during the 28-day observation period. Median BNP concentrations at presentation among decedents were significantly higher than those of survivors (326. 0 ng/L versus 50. 9 ng/L,P <0. 001). The optimal BNP cut point for predicting 28-day mortality was 114. 0 ng/L. In a multivariate analysis (Cox-regression), a BNP concentration greater than 114. 0 ng/L(RR 7. 268, 95% CI 3. 864-13. 672) and an Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores greater than 20 (RR 3. 330, 95% CI 1. 815-6. 109)were the independent predictors of the 28-day mortality. BNP concentration alone had an area under the receiver operating characteristic curve (AUC) of 0. 825 for predicting mortality. Conclusions BNP concentrations at presentation are strong predictor of 28-day mortality in patients with non-cardiogenic critically ill patients in ED, which is better than Rapid Acute Physiology Score (RAPS) , Rapid Emergency Medicine Score (REMS) and APACHE Ⅱ score.     

B型利钠肽对非心源性危重患者的预后价值

Objective B-type natriuretic peptide(BNP) have been used widely in the diagnosis and prognosis of cardiogenic diseases, but the association between BNP concentrations and non-cardiogenic critical illness is unknown. Our study aims at investigating the role of natriuretic peptide testing for predicting 28-day mortality of non-cardiogenic critically ill patients in emergency department (ED). Methods A total of 255 non-cardiogenic critically ill patients treated in the emergency department were prospectively enrolled and a sample of blood was obtained for BNP measurement from each patient. A variety of clinical and laboratory variables were recorded. After 28 days, the vital status of each patient was ascertained and the association between BNP values at presentation and mortality was assessed. Results 71 patients died during the 28-day observation period. Median BNP concentrations at presentation among decedents were significantly higher than those of survivors (326. 0 ng/L versus 50. 9 ng/L,P <0. 001). The optimal BNP cut point for predicting 28-day mortality was 114. 0 ng/L. In a multivariate analysis (Cox-regression), a BNP concentration greater than 114. 0 ng/L(RR 7. 268, 95% CI 3. 864-13. 672) and an Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores greater than 20 (RR 3. 330, 95% CI 1. 815-6. 109)were the independent predictors of the 28-day mortality. BNP concentration alone had an area under the receiver operating characteristic curve (AUC) of 0. 825 for predicting mortality. Conclusions BNP concentrations at presentation are strong predictor of 28-day mortality in patients with non-cardiogenic critically ill patients in ED, which is better than Rapid Acute Physiology Score (RAPS) , Rapid Emergency Medicine Score (REMS) and APACHE Ⅱ score.     

B型利钠肽对非心源性危重患者的预后价值

Objective B-type natriuretic peptide(BNP) have been used widely in the diagnosis and prognosis of cardiogenic diseases, but the association between BNP concentrations and non-cardiogenic critical illness is unknown. Our study aims at investigating the role of natriuretic peptide testing for predicting 28-day mortality of non-cardiogenic critically ill patients in emergency department (ED). Methods A total of 255 non-cardiogenic critically ill patients treated in the emergency department were prospectively enrolled and a sample of blood was obtained for BNP measurement from each patient. A variety of clinical and laboratory variables were recorded. After 28 days, the vital status of each patient was ascertained and the association between BNP values at presentation and mortality was assessed. Results 71 patients died during the 28-day observation period. Median BNP concentrations at presentation among decedents were significantly higher than those of survivors (326. 0 ng/L versus 50. 9 ng/L,P <0. 001). The optimal BNP cut point for predicting 28-day mortality was 114. 0 ng/L. In a multivariate analysis (Cox-regression), a BNP concentration greater than 114. 0 ng/L(RR 7. 268, 95% CI 3. 864-13. 672) and an Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores greater than 20 (RR 3. 330, 95% CI 1. 815-6. 109)were the independent predictors of the 28-day mortality. BNP concentration alone had an area under the receiver operating characteristic curve (AUC) of 0. 825 for predicting mortality. Conclusions BNP concentrations at presentation are strong predictor of 28-day mortality in patients with non-cardiogenic critically ill patients in ED, which is better than Rapid Acute Physiology Score (RAPS) , Rapid Emergency Medicine Score (REMS) and APACHE Ⅱ score.     

B型利钠肽对非心源性危重患者的预后价值

Objective B-type natriuretic peptide(BNP) have been used widely in the diagnosis and prognosis of cardiogenic diseases, but the association between BNP concentrations and non-cardiogenic critical illness is unknown. Our study aims at investigating the role of natriuretic peptide testing for predicting 28-day mortality of non-cardiogenic critically ill patients in emergency department (ED). Methods A total of 255 non-cardiogenic critically ill patients treated in the emergency department were prospectively enrolled and a sample of blood was obtained for BNP measurement from each patient. A variety of clinical and laboratory variables were recorded. After 28 days, the vital status of each patient was ascertained and the association between BNP values at presentation and mortality was assessed. Results 71 patients died during the 28-day observation period. Median BNP concentrations at presentation among decedents were significantly higher than those of survivors (326. 0 ng/L versus 50. 9 ng/L,P <0. 001). The optimal BNP cut point for predicting 28-day mortality was 114. 0 ng/L. In a multivariate analysis (Cox-regression), a BNP concentration greater than 114. 0 ng/L(RR 7. 268, 95% CI 3. 864-13. 672) and an Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores greater than 20 (RR 3. 330, 95% CI 1. 815-6. 109)were the independent predictors of the 28-day mortality. BNP concentration alone had an area under the receiver operating characteristic curve (AUC) of 0. 825 for predicting mortality. Conclusions BNP concentrations at presentation are strong predictor of 28-day mortality in patients with non-cardiogenic critically ill patients in ED, which is better than Rapid Acute Physiology Score (RAPS) , Rapid Emergency Medicine Score (REMS) and APACHE Ⅱ score.     

B型利钠肽对非心源性危重患者的预后价值

Objective B-type natriuretic peptide(BNP) have been used widely in the diagnosis and prognosis of cardiogenic diseases, but the association between BNP concentrations and non-cardiogenic critical illness is unknown. Our study aims at investigating the role of natriuretic peptide testing for predicting 28-day mortality of non-cardiogenic critically ill patients in emergency department (ED). Methods A total of 255 non-cardiogenic critically ill patients treated in the emergency department were prospectively enrolled and a sample of blood was obtained for BNP measurement from each patient. A variety of clinical and laboratory variables were recorded. After 28 days, the vital status of each patient was ascertained and the association between BNP values at presentation and mortality was assessed. Results 71 patients died during the 28-day observation period. Median BNP concentrations at presentation among decedents were significantly higher than those of survivors (326. 0 ng/L versus 50. 9 ng/L,P <0. 001). The optimal BNP cut point for predicting 28-day mortality was 114. 0 ng/L. In a multivariate analysis (Cox-regression), a BNP concentration greater than 114. 0 ng/L(RR 7. 268, 95% CI 3. 864-13. 672) and an Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores greater than 20 (RR 3. 330, 95% CI 1. 815-6. 109)were the independent predictors of the 28-day mortality. BNP concentration alone had an area under the receiver operating characteristic curve (AUC) of 0. 825 for predicting mortality. Conclusions BNP concentrations at presentation are strong predictor of 28-day mortality in patients with non-cardiogenic critically ill patients in ED, which is better than Rapid Acute Physiology Score (RAPS) , Rapid Emergency Medicine Score (REMS) and APACHE Ⅱ score.     

体温对急性脑卒中患者死亡率的影响

目的　探讨体温对脑卒中患者预后的影响。方法　将 14 15例急性脑卒中患者分为两组 ,体温 >37.5℃者 32 4例为发热组 ,≤ 37.5℃者 10 91例为对照组。比较两组急性脑梗死和脑出血患者的死亡率。结果　发热组死亡率明显高于对照组 ,有显著性差异 (P <0 .0 5 )。结论　体温升高可加重脑组织损害 ,增加脑梗死及脑出血患者的死亡率     

老年肝硬化患者预后及影响因素分析

目的探讨我国老年人肝硬化的临床转归及用于评估预后的风险指标。方法选取172例老年肝硬化住院患者,通过电话和追踪等随访研究方法,分析肝硬化患者住院时临床及实验室相关指标对住院期间和中长期预后的影响。结果老年肝硬化患者住院期间3、6个月、1、3、5 a生存率分别为86.6%、85.3%、76.2%、73.1%、42.0%、21.8%,平均生存期为3.84 a。8个住院转归的独立影响因素为血清总胆红素（TBIL）、白蛋白（ALB）、凝血酶原时间（PT）、国际标准化比率（INR）、肌酐（Cr）、上消化道出血（UBIG）、肝肾综合征（HRS）、肝性脑病（HE）（P〈0.05）。5 a转归的独立影响因素为TBIL、ALB、PT、INR、Cr、尿素氮、低密度脂蛋白、腹水、HRS、HE（P〈0.05）。结论常用肝肾功能指标和主要并发症与老年人肝硬化患者住院转归和5 a转归显著相关,老年人肝硬化患者5 a预后较差。     

情绪变化对老年心绞痛患者预后的影响

随着人民生活水平的提高,冠心病的发病率逐年上升,尤其老年冠心病发病率近年来增长较为显著。据调查,城市老年人冠心病患病率为10.7％,居老年人心脏病患者患病率之首位,病死率高,直接影响老年人的生存和生活质量。为此,我们观察了我科自1989年1月至1999年10日住院老年冠心病心绞痛患者193例,并对其资料进行统计分析,发现情绪变化、体重、饮食习惯等对心绞痛预后有一定影响,尤其是情绪变化较为明显,现总结如下。