胃肠功能状况与儿科危重症预后的相关性分析

[目的]研究胃肠功能状态对儿科危重病人预后的影响,为临床早期治疗提供依据.[方法]将本院ICU 2008~2009年收住院患者的临床资料进行回顾性研究,对出现胃肠功能障碍的及未出现胃肠功能障碍的危重症患者情况进行比较.同时对危重症中胃肠功能障碍的出现时间对预后的影响进行相关性分析.[结果]出现胃肠功能障碍患儿的休克及多脏器功能障碍综合征（MODS）发生率和病死率明显升高,与非胃肠功能障碍组比较差异有显著性（P〈0.05）.胃肠功能障碍出现的越早,患者发生休克,MODS的几率越大,同时亦可引起病死率增高.[结论]胃肠功能障碍出现越早,患者预后越差;同时胃肠功能状况对危重症预后的影响具有统计学意义.     

动态监测血乳酸对危重病人在预后中价值

目的:探讨危重病人血乳酸监测的临床价值。方法:结合APACHEⅡ评分,分析23例危重病人血乳酸动态变化。结果:23例危重病人3 d内死亡9例。生存组APACHEⅡ评分值为19.27分、12.34 mmol/L,死亡组A-PACHEⅡ评分值为29分、20.12 mmol/L,血乳酸与APACHEⅡ死亡组病人的血乳酸水平明显高于存活组。血乳酸与APACHEⅡ评分量呈正相关。结论:动态监测血乳酸水平量是判断危重病人预后的一个良好指标,血乳酸越高,且长时间不能恢复正常者,预后差。     

急腹症合并糖尿病术后胃肠功能不全的诊治体会

急腹症合并有糖尿病病人手术后胃肠功能不全在临床中较为常见,且易于为基层医生所忽视,所以延误诊断将影响治疗效果;在1993～2003年本科收治31例急腹症合并糖尿病病人中．有17例出现术后胃肠功能不全,其结果分析报道如下。     

降钙素原与内毒素在危重症患者脓毒症早期诊断及预后的价值研究

目的评价降钙素原(PCT)与内毒素(ET)检测在危重症患者脓毒症早期诊断及预后价值。方法前瞻性收集2015年2月至2016年10月该院重症医学科(ICU)收治疑似脓毒症患者为研究对象,有104例纳入此项研究。其中,全身炎症反应综合征31例(SIRS组),脓毒症30例(脓毒症组),严重脓毒症24例(严重脓毒症组),脓毒症休克19例(脓毒症休克组)。以脓毒症患者出院作为观察预后,共存活57例(存活组),死亡16例(死亡组)。检测所有患者入院时PCT、ET水平并收集相关临床资料,运用受试者工作特征曲线(ROC)评价各指标的效能。结果脓毒症组、严重脓毒症组、脓毒症休克组PCT水平、APACHE-Ⅱ评分、ET水平均明显高于SIRS组,且差异具有统计学意义(P0.05)。PCT水平和慢性健康状况评分Ⅱ(APACHE-Ⅱ评分)随着感染程度的严重而升高(P0.05),ROC曲线显示PCT诊断脓毒症的敏感性为82.2%,特异性为87.5%。PCT水平和APACHE-Ⅱ评分在死亡组水平更高,且差异有统计学意义(P0.05),而ET水平在两组间差异无统计学意义(P0.05),ROC曲线显示,PCT预测脓毒症患者死亡的曲线下面积(AUC)为0.867要显著高于APACHE-Ⅱ评分的0.762,且差异有统计学意义(P0.05)。结论相比APACHE-Ⅱ评分和ET,PCT检测更有助于临床医师早期诊断和治疗脓毒症患者。     

护理干预对老年危重患者鼻饲安全性的影响

目的：探讨护理干预对老年危重患者鼻饲安全性的影响。方法：将80例老年危重患者随机分为实验组（40例）和对照组（40例），实验组实施护理干预措施，对照组按常规鼻饲，分别统计两组患者置管情况及置管意外情况发生率。结果：两组患者置管情况比较，试验组患者一次置管成功率明显高于对照组（X^2=16．78，P〈0.01）；置管反应小（X^2=24．56，P〈0．01），置管过程远较对照组顺利；两组患者置管意外情况发生率，除脑血管意外发生率无显著差异外（X^2=2．12，P〉0．05），误入气管及呛咳方面两组比较有最著性差异（P〈0.05），血压升高、胃管盘曲口腔内、食物反流或窒息、鼻咽部损伤或炎症比较，两组有差异（P〈0.05，P〈0.01）。结论：老年危重患者置管时应严密观察病情，监测生命体征，尤其有心脏病史及置管过程中血压过高者应禁止强制性置管，以防意外发生。     

降钙素原和内毒素在脓毒症诊断中的意义

感染和脓毒症是目前ICU所面临的一个棘手难题，特别是由其诱发的脓毒性休克和多器官功能障碍综合征（MODS），已成为ICU危重患者主要死亡原因之一，因此，对感染和脓毒症及其并发症进行早期诊断和治疗显得尤为重要。目前已发现一些比脓毒症的临床症状和常规检测更有效的生物指标，其中一些指标在临床上已被证明有效。本文就降钙素原和内毒素在脓毒症中的诊断价值作一综述。     

免疫淋巴细胞对危重患者的预后预测

错误的诊断或延误诊断都将使患者失去最宝贵的抢救时机。怎样及早知道病情的恶化 ,及时采取有效措施 ,阻断病变的恶化 ,从而显著降低危重病的发生 ,降低死亡率 ,减少医疗纠纷的发生。我们试图寻找一个指标如 WBC>10× 10 9/L就有感染存在能对患者临界危重病的判断。淋巴细胞作为特异性免疫的主要细胞 ,可以判断患者的免疫系统功能状态 ,危及患者生命的两大并发症—感染和多器官衰竭的发生和发展均与免疫系统的变化有着值得重视的密切关系。本研究对 80例烧伤患者 T淋巴细胞亚群的测定 ,为临床治疗提供理论基础 ,现报告如下。1　对象和方法…     

ICU危重患者145例的鼻饲护理

目的：探讨危重患者鼻饲的护理。方法：2004-01/2006-10收治危重患者中经鼻胃管行肠内营养共145例,其中男87例,女58例,按照要求插入胃管,采取适当的体位、心理护理、误吸的预见性护理。结果：发生并发症者37例,经有效的护理后症状消失。结论：做好胃管及其预防并发症的护理,对于促进患者的康复具有积极的作用。     

周围静脉输注全营养混合液对外科危重病人的应用

目的 采用合理的营养支持,使病人能够耐受手术,降低危重病人的病死率。方法 在补充营养的基础上,调整营养液配方或营养素的比例,配制成全合一营养液,经周围静脉输注。结果 预防和纠正热量及蛋白质缺乏所致的营养不良,减少各种并发症,加速伤口愈合。结论 合理的营养支持是外科危重病人综合治疗的必要措施之一,全营养混合液可用于多种输液目的。     

降钙素原与内毒素联合检测在儿童脓毒症早期的诊断价值

目的探讨全血降钙素原与内毒素联合检测对儿童脓毒症早期的诊断价值。方法对2012年1月至2015年11月收治的329例脓毒症患儿行降钙素原与内毒素检测,分析不同检验方法早期诊断儿童脓毒症的正确率。结果 329例脓毒症患儿,82.07%的患儿降钙素原升高,45.59%的患儿内毒素升高,89.36%的患儿降钙素原与内毒素中至少有一项升高,两项联合检测的阳性率明显高于单一检查阳性率。其中205例血培养阴性或革兰阳性菌感染的脓毒症患儿的降钙素原、内毒素检验结果中,83.90%的患儿降钙素原升高,24.88%的患儿内毒素升高,86.83%的患儿降钙素原与内毒素中至少有一项升高,两项指标联合检测的阳性率明显高于单一内毒素检查阳性率,而与单一降钙素原检查阳性率相比差异无统计学意义(P0.05)。124例革兰阴性菌感染的脓毒症患儿中,79.03%的患儿降钙素原升高,79.84%的患儿内毒素升高,93.55%的患儿降钙素原与内毒素中至少有一项升高,两项指标联合检测的阳性率明显高于单项检查阳性率。结论脓毒症患儿,尤其是革兰阴性菌感染的脓毒症患儿,用降钙素原与内毒素联合检测灵敏度高,值得临床推广。     

Serum resistin levels in critically ill patients are associated with inflammation, organ dysfunction and metabolism and may predict survival of non-septic patients

Introduction  

Blood glucose levels and insulin resistance in critically ill patients on admission to intensive care units (ICUs) have been identified as factors influencing mortality. The pathogenesis of insulin resistance (IR) in critically ill patients is complex and not fully understood. Resistin is a hormone mainly derived from macrophages in humans and from adipose tissue in rodents, which regulates glucose metabolism and insulin sensitivity. In non-critically ill patients, resistin was found to be related to impaired glucose tolerance, insulin resistance, metabolic syndrome, obesity and type 2 diabetes. Therefore, resistin might represent a link between inflammation, acute phase response and insulin resistance in critically ill patients. We aimed to examine the correlation of serum resistin concentrations to parameters of inflammation, organ function, metabolism, disease severity and survival in critically ill patients.     

新生儿危重病与胃肠功能障碍关系的探讨

目的探讨新生儿危重病与胃肠功能障碍的关系。方法评估 73例危重新生儿危重程度、多器官功能衰竭与胃肠功能障碍的关系。结果 73例危重新生儿中单项危重病 12例 ,多项危重病 6 1例 (其中危重 33例、极危重 2 8例 ) ;6 1例中 12例为单器官功能衰竭 ,余 4 9例为伴多器官功能衰竭。胃肠功能障碍发生率在危重病组与极危重病组分别为39.4 % (13/ 33)、71.4 % (2 0 / 2 8) ,两组比较具有显著性差异 (P <0 .0 5 )。单项危重病组与伴多器官功能衰竭组胃肠功能障碍发生率分别为 16 .7% (2 / 12 )、5 9.2 % (2 9/ 4 9) ,两组比较有非常显著性差异 (P <0 .0 1)。胃肠功能障碍的危重新生儿平均伴有器官衰竭的数目为 1.83个。结论新生儿病情越重 ,受损器官越多 ,胃肠功能障碍发生率越高 ,因此 ,要高度警惕 ,早期发现 ,早期治疗。     

Using extra systoles to predict fluid responsiveness in cardiothoracic critical care patients

Fluid responsiveness prediction is an unsettled matter for most critical care patients and new methods relying only on the continuous basic monitoring are desired. It was hypothesized that the post-ectopic beat, which is associated with increased preload, could be analyzed in relation to preceding sinus beats and that the change in cardiac performance (e.g. systolic blood pressure) at the post-ectopic beat could predict fluid responsiveness. Cardiothoracic critical care patients scheduled for a 500 ml volume expansion were observed. In the 30 min prior to volume expansion, the ECG was analyzed for occurrence of extra systoles preceded by at least 10 sinus beats. Classification variables, were defined as the change in a variable (e.g. systolic blood pressure or pre-ejection period) from the median of 10 preceding sinus beats to extra systolic post-ectopic beat. A stroke volume increase >15 % following volume expansion defined fluid responsiveness. Thirty patients were included. The change in systolic blood pressure predicted fluid responsiveness in 24 patients correctly with 83 % specificity and 75 % sensitivity (optimal threshold: 5 % systolic blood pressure increase), receiver operating characteristic (ROC) area: 0.81 (CI [0.64;0.98]). The change in pre-ejection period predicted fluid responsiveness in 22 patients correctly with 67 % specificity and 83 % sensitivity (optimal threshold: 19 ms pre-ejection period decrease), ROC area: 0.81 (CI [0.66;0.96]). Pulse pressure variation had ROC area of 0.57 (CI [0.39;0.75]). Based on standard critical care monitoring, analysis of the extra systolic post-ectopic beat predicts fluid responsiveness in cardiothoracic critical care patients with good accuracy.     

Brain dysfunction in patients with chronic critical illness

Critically ill patients frequently experience acute brain dysfunction in the form of coma or delirium, both of which are common during acute and chronic critical illness (CCI). These manifestations of brain dysfunction are associated with numerous adverse outcomes during acute critical illness, including prolonged hospitalization, increased healthcare costs, and increased mortality. The prognosis of CCI patients with coma or delirium has not yet been thoroughly studied, but preliminary studies suggest this population is at high risk for detrimental outcomes associated with acute brain dysfunction. Additionally, a high percentage of patients who survive acute or CCI suffer from long-term brain dysfunction, which manifests primarily as memory deficits and executive dysfunction and is predicted by brain dysfunction in the ICU. Interventions directed at reducing the burden of brain dysfunction during critical illness have shown promise in studies of patients with acute critical illness, but these therapies have yet to be studied during CCI. Thus, multicenter randomized trials are needed to determine which interventions are most effective for such patients. Until these data are available, management strategies that have been proven beneficial during acute critical illness-such as reduction of sedative exposure, especially to benzodiazepines, and early use of physical and occupational therapy-should be employed during the treatment of patients with CCI.     

Scoring systems used to predict mortality in patients with acute upper gastrointestinal bleeding in the ED

Objective

Acute upper gastrointestinal bleeding (UGIB) is a potentially life-threatening condition that requires rapid assessment in the emergency department (ED). We aimed to compare the performance of the AIMS65, Glasgow-Blatchford (Blatchford), preendoscopic Rockall (pre-Rockall), and preendoscopic Baylor bleeding (pre-Baylor) scores in predicting 30-day mortality in patients with acute UGIB in the ED setting.

Serum adipocyte fatty acid-binding protein levels in patients with critical illness are associated with insulin resistance and predict mortality

Introduction

Hyperglycemia and insulin resistance are commonplace in critical illness, especially in patients with sepsis. Recently, several hormones secreted by adipose tissue have been determined to be involved in overall insulin sensitivity in metabolic syndrome-related conditions, including adipocyte fatty-acid binding protein (A-FABP). However, little is known about their roles in critical illness. On the other hand, there is evidence that several adipose tissue gene expressions change in critically ill patients.

Methods

A total of 120 patients (72 with sepsis, 48 without sepsis) were studied prospectively on admission to a medical ICU and compared with 45 healthy volunteers as controls. Various laboratory parameters and metabolic and inflammatory profiles were assessed within 48 hours after admission. Clinical data were collected from medical records.

Results

Compared with healthy controls, serum A-FABP concentrations were higher in all critically ill patients, and there was a trend of higher A-FABP in patients with sepsis. In multivariate correlation analysis in all critically ill patients, the serum A-FABP concentrations were independently related to serum creatinine, fasting plasma glucose, total cholesterol, TNF-alpha, albumin, and the Acute Physiology and Chronic Health Evaluation II scores. In survival analysis, higher A-FABP levels (> 40 ng/ml) were associated with an unfavorable overall survival outcome, especially in sepsis patients.

Conclusions

Critically ill patients have higher serum A-FABP concentrations. Moreover, A-FABP may potentially serve as a prognostic biomarker in critically ill patients with sepsis.     

Tei index in adult patients submitted to adriamycin chemotherapy: failure to predict early systolic dysfunction

Aims This study prospectively assessed whether Tei index is predictive of early systolic dysfunction in adults undergoing adriamycin treatment. Methods and results Left ventricular ejection fraction (LVEF) was obtained by radionuclide ventriculography at baseline and after treatment. Tei index was evaluated by echocardiography at baseline, at an intermediary cycle and at the end of chemotherapy. Fifty-five predominantly female patients (91%) with breast cancer (80%) and without known cardiac disease were evaluated. After treatment (adriamycin dose of 304 ± 47 mg/m²), systolic dysfunction (final LVEF < 50%) occurred in eight patients (14%). Baseline, intermediate or variation of Tei index were not accurate to predict early systolic dysfunction (“c” statistics ≤ 0.60). Baseline Tei index > 0.39, for example, had a sensitivity of 75%, specificity of 55%, positive predictive value of 22% and negative predictive value of 93%. Conclusion Tei index does not appear to be a useful tool for detection of early adriamycin cardiotoxicity in adults.     

Serum lactate level predict mortality in elderly patients with cirrhosis

BACKGROUND: Cirrhotic patients admitted to the intensive care unit (ICU) usually have multi-organ failure. Multiple organ failure entails a very poor outcome in all intensive care patients. Cirrhotic patients show high morbidity and mortality rates compared with other critically ill patients. Severity scores have been developed for cirrhotic patients admitted to ICU. The main aim of this study was to determine whether lactate level gives any predictive value for mortality in cirrhotic elderly patients admitted to the ICU. METHODS: In all the patients enrolled, a diagnosis of cirrhosis was confirmed either histologically or by resorting to clinical, laboratory, and ultrasonographic findings. During this period, patients with cirrhosis were admitted to the ICU with varying indications. Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD), Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores and lactate were compared between deceased and discharged patients. RESULTS: A total of 90 consenting patients were enrolled in this study. The mean age of all the patients was 69?±?5.919. We detected etiological factors for cirrhosis as HBV, HCV, alcohol, and cryptogenic cirrhosis. Hepatorenal syndrome and spontaneous bacterial peritonitis were significantly higher in patients who died than in those who were discharged from the ICU (p values were 0.01 and 0.028, respectively). Lactate level, CTP, APACHE II, MELD and SOFA scores were significantly higher in patients who died than in those who were discharged from the ICU (p values were 0.002, < 0.001,?相似文献   

Serum adiponectin upon admission to the intensive care unit may predict mortality in critically ill patients

Purpose

Adiponectin has been proposed as an important regulator of glucose metabolism influencing obesity and insulin resistance, which are important risk factors for the outcome of critically ill patients. Moreover, experimental models of inflammation suggest protective anti-inflammatory properties of adiponectin. We therefore investigated the potential pathogenic role and prognostic value of circulating adiponectin levels in critical illness.

Materials and methods

One hundred seventy critically ill patients (122 with sepsis and 48 without sepsis) were prospectively studied at admission to the medical intensive care unit (ICU) and compared with 60 healthy controls. Patients' survival was followed for approximately 3 years.

Results

Adiponectin serum concentrations did not differ between healthy controls and critically ill patients, neither in patients with nor in patients without sepsis. However, patients with decompensated liver cirrhosis had significantly elevated serum adiponectin levels. Likewise to non-critically ill subjects, ICU patients with preexisting diabetes or obesity displayed significantly reduced circulating adiponectin. Inflammatory cytokines did not correlate with serum adiponectin. Interestingly, low adiponectin levels at ICU admission were an independent positive predictor of short-term and overall survival.

Conclusions

Although serum concentrations did not differ in critically ill patients from controls, low adiponectin levels at admission to ICU have been identified as an independent predictor of survival.