两个时期急性肾衰竭病人的临床和预后研究

目的探讨两个时期急性肾衰竭(ARF)病人的复杂性因素变化和预后的关系,以找出两个时期死亡率差别的原因.方法回顾性地分析1990年至1997年(A时期)的155例和2000年至2007-年(B时期)267例ARF病人的临床资料,比较其临床和预后变化.结果A、B两个时期病人的死亡率分别为47.7%和33-3%.B时期多脏器衰竭的发生率和器官衰竭数均明显低于A时期,B时期存在较多的慢性疾病状态,肾毒性物质和血透病人增多了,肺部疾病和手术在两个时期均占多数,多脏器衰竭、肺部疾病、肝病、手术后以及败血症对死亡率有明显影响.结论近些年,ARF病人总体年龄并无明显变化,但存在较多的慢性疾病状态,肾毒性物质和血透病人增多了,预后有明显改善.     

339例慢性肾衰竭的病因分析

目的分析慢性。肾衰竭的病因变化，及时的诊断和治疗慢性肾衰的原发病，避免或延缓其发展为慢性肾衰。方法对我院2005年10月～2008年11月339例住院患者慢性肾衰的病因进行分析，了解其病因特点。结果339例慢性肾衰患者中因糖尿病肾病引起者居首位，共114例（33．63％）；其次为慢性肾小球肾炎共81例（29．90％）；高血压肾病48例（14．16％）；慢性间质性肾炎42例（12．39％）；梗阻性肾病28例（8．26％）；多囊肾11例（3．24％）；其他痛风肾、过敏性紫癜肾炎、慢性肾盂肾炎等共15例（4．42％）。结论慢性肾衰竭病因的构成比例与现有的文献质料有差异，糖尿病肾病已成为慢性肾衰竭的首要原因，其次为慢性肾小球肾炎，高血压、梗阻性肾病明显上升，而慢性肾盂肾炎所占的比例在减少。     

妊娠合并急性胰腺炎13例分析

目的探讨妊娠期急性胰腺炎的病因、特点、对母儿危害以及早期诊断与治疗。方法回顾性分析我院收治的13例妊娠期急性胰腺炎的临床资料。结果除新生儿死亡2例外余全部治愈且预后良好。结论把握妊娠期急性胰腺炎的特点,早期诊断治疗,适时终止妊娠,可以提高治愈率,降低母婴死亡率。     

新生儿黄疸82例临床分析

本文通过对８２例黄疸患儿的病因、病程、治疗等临床资料的分析总结，旨在了解黄疸在我院住院病儿的发病情况、特点，结果发现新生儿黄疸发生率占总住院人数的３５％，以高胆红素血症为主（６６／８２），病因主要为Ｇ６ＰＤ缺陷症２４例，占２９．３％，感染（肺炎、败血症）１６例，占１９．５％，ＡＢＯ溶血１０例，占１２．２％以及窒息、缺氧、出血等非感染因素４例，占４．８％。经光疗以及药物退黄治疗、病因治疗，大部分痊愈，治愈率为９８．８％。     

重型肝炎肝移植术后急性肾功能衰竭的防治

目的总结重型肝炎肝移植术后急性肾功能衰竭（ARF）的防治经验。方法回顾性分析2002年9月至2004年10月上海交通大学医学院附属瑞金医院因重型肝炎行肝移植治疗的37例病人的临床资料。结果37例病人术后1年移植物存活率为83．8％，围手术期死亡6例（16.2％），术后并发ARF12例（32．4％），ARF组与非ARF组术前血总胆红素、肌酐、腹水量、凝血酶原时间比较，差异有显著性意义；[第一段]     

血清半胱氨酸蛋白抑制剂C与急性肾衰竭预后关系的研究

目的：探讨急性肾衰竭（ARF）时血清半胱氨酸蛋白酶抑制剂C（Cys C）水平变化及其与预后的关系。 方法： 前瞻性收集本院重症监护室215例危重病人，每天采血检测血肌酐（Scr）和Cys C水平，应用Cockroft-Gault公式估算肾小球滤过率（GFR），ARF按ADQI的RIFLE标准进行分层诊断。 结果： 41例病人发生不同程度ARF, R标准7例、I标准13例，F、L和E标准共21例；死亡21例，存活20例；174例非ARF病人作为对照组。ARF病人血清Cys C水平明显高于对照组病人（P<0.01）; 在ARF的不同RIFLE分层标准中，血清Cys C与Scr、［Cys C］-1与GFR呈显著线性相关（P<0.01）；当以Scr升高≥150％作为ARF的诊断标准时，ROC分析显示血清Cys C在ARF的诊断上准确性高，曲线下面积为（AUC）：0.983（ 95％可信区间0.960-1.006 ）（P<0.01）。Logistic回归分析显示血清Cys C和Scr与ARF病人死亡率无关（P>0.05）；ROC分析表明Cys C和Scr不能预测ARF病人的死亡和存活情况（P>0.05）。 结论： 血Cys C在ARF时明显升高并与ARF的严重程度密切相关；Cys C可以作为ARF的检测手段之一，但与病人的预后无关不能作为病人预后的预测指标。     

28例妊娠期重型病毒性肝炎的临床研究

目的探讨妊娠期重型病毒性肝炎（以下简称妊娠重肝）的病原分型及临床特点。方法回顾性分析28例妊娠重肝患者的临床表现及实验室资料。结果本组病例病原感染率分别为：HAV3．57％，HBV64．29％，HCV7．14％，HDV3．57％，HEV25．00％，重叠感染率为28．57％；病死率为67．86％，妊娠并急性、亚急性及慢性重型肝炎的病死率分别为87．50％、80．00％、53．33％；早孕仅1例，存活；而中孕、晚孕并重型肝炎病死率分别为75．00％、68．42％；存活组和死亡组在凝血酶原时间、血清总胆固醇及肝脏萎缩的比较上有统计学差异（P〈0．05）；肝性脑病、感染、肝肾综合征、DIC、产后大出血发生率分别为78．57％、78．57％、50．00％、35．71％、25．00％；胎儿死亡率46．43％。结论本组妊娠重肝以HBV感染最常见，孕产妇及胎儿死亡率高；妊娠并重型肝炎转归与凝血酶原时间、血清总胆固醇、肝脏体积是否进行性缩小、伴并发症的数量有关．     

153例腹膜透析患者死亡及危险因素分析

目的分析腹膜透析患者死亡及其危险因素。方法对河北医科大学第三医院1997至2011年透龄6个月以上的153例CAPD患者进行回顾性分析，采用多变量Cox回归分析方法分析透析患者各临床指标对预后的影响。结果原发病病因中糖尿病肾病患者病死率最高（72．09％，31／43），其次为缺血性肾病（60．00％，6／10）；死因中主要为心力衰竭（28．99％，20／69），其次为脑血管意外（17．39％，12／69）。与存活组比较，死亡组血红蛋白（Hb）、血浆白蛋白（Alb）和总尿素清除指数（Kt/V）明显降低；年龄、脉压差、血磷及IyrH水平明显升高，差异均有统计学意义（均P〈0．05）。Cox回归分析结果显示患者年龄、总KdV、血磷、Hb、Alb水平对腹膜透析6个月以上死亡患者的相对危险度分别为1．188，0．798，2．308，2．102，O．898，均有统计学意义。结论透析初期患者年龄、Kt／V、血磷、Hb、Alb水平是CAPD死亡的独立危险因素。心脑血管疾病是CAPD患者的主要死因。     

极低出生体重儿死亡病例41例分析及预防

本文分析了近１０年来出生的死亡的４１例极低出生体重儿，结果显示：发病因素母体以妊高征为主（３１．７１％），其次是胎膜早破（１４．６３％）；胎儿因素以双胎为主（１９．５１％）。死亡原因前四位依次为：产时窒息（３１．７１％），呼吸窘迫综合征（１４．６３％）、败血症（１２．２０％），肺出血（９．７６％）。胎龄愈小、日龄愈小死亡率愈高（Ｐ＜０．０５），产重愈低、Ａｐｇａｒ评分愈低死亡率愈高。     

妊娠肝病围产儿死亡80例临床分析

目的：探讨妊娠肝病围产儿死亡的相关因素，对这一高危人群的围产期管理提出可行性建议和措施。方法：对1991年1月－2000年12月在我院诊断为妊娠肝病患者的围产儿死亡80例进行回顾性分析。结果：10年间我院肝病孕妇的围产儿死亡率为17．99‰，而且以死胎为主，占65．00％。围产儿死亡有性别差异，男性死亡率为21．64‰，显著高于女性死亡率10．11‰（P＜0．01）。前后5年比较围产儿死亡率无显著下降（P＞0．05），其中本市城区和郊区的围产儿死亡率有下降趋势，而外来人口围产儿死亡率有上升趋势。母体患重型病毒性肝炎、慢性乙型肝炎和妊娠急性脂肪肝（AFLP）者，围产儿死因主要为妊高征和胎儿及新生儿窒息。母体HBV携带者围产儿死因主要为脐带因素、胎膜早破和窒息。结论：妊娠肝病可使围产儿死亡率明显增加，其导致围产儿死亡的根本原因是重症肝病引起的妊高征和胎儿宫内缺氧。外来人口、男性胜儿等是围产儿死亡的高危因素。加强对肝病孕妇特别是外来人口的孕期管理，积极治疗肝病，必要时尽早终止妊娠，提高产时处理及新生儿复苏水平是降低妊娠肝病围产儿死亡率的关系。     

Acute renal failure mortality in hospitalized African Americans: age and gender considerations

The aging kidney is at risk for both toxic and hemodynamic-induced acute damage, resulting in a high incidence of acute renal failure (ARF) in elderly patients. The effect of age and or gender in ARF mortality in African Americans (AA) was studied in a 3-year, computer assisted retrospective review. In an inner city medical center, 100 patients classified as ARF at discharge or expiration were included in the study. Patients were classified into 3 age categories: <40, 40-64, and >64 years. The incidence of ARF was 35%, 28% and 37%, respectively. Patients >64 years of age were less likely to be dialyzed. Both pre- and postrenal causes of ARF were more common in patients >64 years of age than in younger patients. Hospital length of stay increased progressively with age. Mortality was lower in patients >64 years of age than in younger patients. The incidence of ARF was higher in male than female patients and the incidence of sepsis was higher in female than male patients. Dialytic need was greater in male patients, but mortality was higher in female than male patients. Multivariate logistic regression showed that in the presence of sepsis, oliguria and mechanical ventilatory support, the relative risk of mortality associated with advanced age was 16.5, the relative risk of mortality associated with female gender was 0.2. In summary, hospitalized elderly African-American patients have a high incidence of ARF, and patients less than 40 years of age are equally at risk. Although mortality was higher in female patients, gender and advanced age did not independently contribute to high mortality. Neither age nor gender considerations should supplant sound clinical judgment in the management of and decision making in elderly African-American patients with ARF.     

Pattern of in-hospital pediatric mortality over a 3-year period at University teaching hospitals in Iran

Introduction:

Causes of death are different and very important for policy makers in different regions. This study was designed to analyze the data for our in-patient children mortality.

Materials and Methods:

In this cross-sectional study from March 2011 to March 2013, all patients from 2 months to 18 years who died in pediatric intensive care unit, emergency room or medical pediatric wards in the teaching hospitals were studied.

Results:

From a total of 18,915 admissions during a 2-year-period, 256 deaths occurred with a mean age of 4.3 ± 5 years and mortality 1.35%. An underlying disease was present in 70.7% of the patients and in 88.5% of them the leading causes of death were related to the underlying diseases. The most common underlying diseases were congenital heart disease and cardiomyopathy in 50 (27.6%). The four main causes of deaths were sepsis (14.8%), pneumonia (14.5%), congestive heart failure (9.8%), and hepatic encephalopathy (9.8%).

Conclusion:

We may conclude that after sepsis and pneumonia, congestive heart failure, and hepatic encephalopathy are the leading causes of death. Most patients who died had underlying diseases including malignancies, heart and liver diseases as the most common causes.     

Laboratory tests in acute renal failure]

This review is focused on the roles of laboratory test in acute renal failure (ARF). The roles of the laboratory test changes along with the alterations in clinical features and with the advances of treatment. Recent acute renal failure is characterized by the following three features: most of the ARF develops in hospitals, the frequency of nonoliguric ARF is increasing, and the association of other organ failure such as heart failure, liver failure or respiratory failure, increases the mortality rate. Hemodialysis is instituted in the early phase of ARF to enable the supply of enough nutriments and drugs. These features of recent ARF increases the importance of the frequent analysis of plasma creatinine in patients, who are at risk for ARF, to diagnose ARF at the onset. After the development of ARF, laboratory tests for the evaluation of other organ function is repeated. The development of new drugs increases the incidence of interstitial nephritis, and the advances in the therapeutic approach on systemic diseases (such as SLE or PN), which frequently develop ARF, alter the prognosis of these diseases. Since the early diagnosis of these diseases is important, it is necessary to develop noninvasive and reliable tests for the diagnosis of these diseases.     

Predictors of mortality in patients with acute renal failure

Mortality associated with acute renal failure (ARF) remains high despite of developments in therapy strategies and definition of different prognostic factors. Therefore, this study focused on to define new prognostic factors and especially regional characteristics of the ARF patients. One hundred fifteen ARF patients, diagnosed from November 1998 to May 2003, were included to this prospective and observational study. Clinical features, laboratory parameters, Acute Physiology and Chronic Health Evaluation (APACHE) III scores and co-morbid conditions of the patients were examined. Clinical and laboratory data, and APACHE III scores were recorded at the first nephrology consult day. Thirty of the patients (26%) died. APACHE III scores, presence and the total number of co-morbid conditions and serum albumin levels at the time of first nephrology consultation were found as independent predictors of mortality. There was a negative correlation between APACHE III scores and serum albumin levels. Not only increased APACHE III score and presence of co-morbid conditions but also low serum albumin level was found as the predictors of mortality. However, only serum albumin level is seen as modifiable prognostic factor among these parameters. Therefore, further studies are necessary to determine the causes of hypoalbuminemia in patients with ARF and the effect of it's effective treatment on patients outcome.     

Acute acalculous cholecystitis in patients with surgical acute renal failure

Acute acalculous cholecystitis (AAC) developed in 11 (7.7%) of 143 patients with surgical acute renal failure (ARF) who had no prior biliary tract disease. The cause of this potentially fatal complication is multifactorial and include trauma, previous surgery, sepsis, intermittent positive pressure ventilation, total parenteral nutrition, multiple transfusions, hypotension, and opiate sedation. The diagnosis of AAC was based on clinical suspicion, ultrasound scanning, and laboratory tests (leukocyte count, liver enzymes, bilirubin and C-reactive protein). All our ARF patients with AAC were receiving antibiotics at the time of diagnosis. Five patients were treated conservatively and six underwent cholecystectomy. The mortality rate in our ARF patients with AAC was 45.5%, and was not significantly different from than in ARF patients without AAC. The diagnosis of AAC should be made early, and judicious management (conservative or surgical) decreases its role as a contributory factor to the mortality in ARF patients.     

急性DeBakey I型主动脉夹层手术的围麻醉期管理

目的回顾总结深低温停循环下DeBakeyI型主动脉夹层血管置换手术38例,探讨其围麻醉期管理方法。方法 38例急性DeBakeyI型主动脉夹层患者,全身麻醉深低温停循环（DHCA）下完成手术,术中实施多脏器保护。结果该组患者均顺利完成手术,麻醉诱导、维持平稳;平均体外循环时间（192.39±29.76）min,深低温停循环时间为（48.2±13.5）min,选择性脑灌注时间为（46.42±11.25）min;30例病人8～24h完全苏醒,顺利脱机拔管,8例出现短暂神经功能异常,通过术后脑保护措施,72h完全苏醒拔管,1例病人双下肢肌力减退,5d后完全恢复;肾功能衰竭6例;手术3d后死亡4例,2例死于肾功能衰竭,1例死于肺栓塞,1例死于呼吸功能衰竭,死亡率为10%;全部患者无麻醉死亡。结论充分的术前准备、术中麻醉管理、重要脏器的保护是提高主动脉弓动脉瘤血管置换手术成功率的关键。     

Long-term mortality in adult orthotopic heart transplant recipients

Heart transplantation is now regarded as the treatment of choice for end-stage heart failure. To improve long-term results of the heart transplantation, we analyzed causes of death relative to time after transplantation. A total of 201 consecutive patients, 154 (76.6%) males, aged ≥ 17 yr underwent heart transplantation between November 1992 and December 2008. Mean ages of recipients and donors were 42.8 ± 12.4 and 29.8 ± 9.6 yr, respectively. The bicaval anastomosis technique was used since 1999. Mean follow up duration was 6.5 ± 4.4 yr. Two patients (1%) died in-hospital due to sepsis caused by infection. Late death occurred in 39 patients (19.4%) with the most common cause being sepsis due to infection. The 1-, 5-, and 10-yr survival rates in these patients were 95.5% ± 1.5%, 86.9% ± 2.6%, and 73.5% ± 4.1%, respectively. The surgical results of heart transplantation in adults were excellent, with late mortality due primarily to infection, malignancy, and rejection. Cardiac deaths related to cardiac allograft vasculopathy were very rare.     

Multidimensional Evaluation of All-Cause Mortality Risk and Survival Analysis for Hospitalized Patients with COVID-19

Background: Coronavirus disease 2019 (COVID-19) has caused over 3.8 million deaths globally. Up to date, the number of death in 2021 is more than that in 2020 globally. Here, we aimed to compare clinical characteristics of deceased patients and recovered patients, and analyze the risk factors of death to help reduce mortality of COVID-19.Methods: In this retrospective study, a total of 2719 COVID-19 patients were enrolled, including 109 deceased patients and 2610 recovered patients. Medical records of all patients were collected between February 4, 2020, and April 7, 2020. Clinical characteristics, laboratory indices, treatments, and deep-learning system- assessed lung lesion volumes were analyzed. The effect of different medications on survival time of fatal cases was also investigated.Results: The deceased patients were older (73 years versus 60 years) and had a male predominance. Nausea (10.1% versus 4.1%) and dyspnea (54.1% versus 39.2%) were more common in deceased patients. The proportion of patients with comorbidities in deceased patients was significantly higher than those in recovered patients. The median times from hospital admission to outcome in deceased patients and recovered patients were 9 days and 13 days, respectively. Patients with severe or critical COVID-19 were more frequent in deceased group. Leukocytosis (11.35×10⁹/L versus 5.60×10⁹/L) and lymphocytopenia (0.52×10⁹/L versus 1.58×10⁹/L) were shown in patients who died. The level of prothrombin time, activated partial prothrombin time, D-dimer, aspartate aminotransferase, alanine aminotransferase, urea, creatinine, creatine kinase, glucose, brain natriuretic peptide, and inflammatory indicators were significantly higher in deceased patients than in recovered patients. The volumes of ground-glass, consolidation, total lesions and total lung in all patients were quantified. Complications were more common in deceased patients than in recovered patients; respiratory failure (57.8%), septic shock (36.7%), and acute respiratory distress syndrome (26.6%) were the most common complications in patients who died. Many treatments were more frequent in deceased patients, such as antibiotic therapy (88.1% versus 53.7%), glucocorticoid treatment (70.6% versus 11.0%), intravenous immunoglobin treatment (36.6% versus 4.9%), invasive mechanical ventilation (62.3% versus 3.8%). Antivirals, antibiotics, traditional Chinese medicines and glucocorticoid treatment may significantly increase the survival time of fatal cases. Quantitative computed tomography imaging results were correlated with biochemical markers.Conclusions: Most patients with fatal outcomes were more likely to have common comorbidities. The leading causes of death were respiratory failure and multiple organ dysfunction syndrome. Acute respiratory distress syndrome, respiratory failure and septic shock were the most common serious complications. Antivirals, antibiotics, traditional Chinese medicines, and glucocorticoid treatment may prolong the survival time of deceased patients with COVID-19.     

急诊患者连续性肾脏替代治疗的病因及疗效分析

目的了解急诊患者连续肾脏替代治疗(CRRT)的病因并分析其疗效。方法回顾分析北京大学第一医院急诊监护室2005年5月~2011年7月接受CRRT的217例患者,其中男性120例,女性97例(男女比例1.24∶1);年龄50~77岁,中位年龄68岁。分析病因,并比较患者治疗前后的急性生理学及慢性健康状况评价Ⅱ(APACHEⅡ)评分和感染相关器官功能衰竭评分(SOFA)及生命体征、生物化学指标的变化。结果 217例急诊患者病因中内科疾病占首位,187例;其次是外科和神经系统疾病,均是15例。在住院治疗期间,63例死亡,病死率29.0%。其中急性肾损伤(AKI)患者100例,肾功能恢复38例(38.0%);死亡36例(36.0%)。治疗后的生命体征较前平稳,生物化学指标较前好转,APACHEⅡ评分下降(P0.001),SOFA变化差异无统计学意义(P0.05)。结论 CRRT患者APACHEⅡ评分下降,病死率较低,但CRRT是否降低死亡率仍有待进一步研究证实。