济宁地区21-三体综合征患儿致家庭负担情况调查

目的 调查济宁地区21-三体综合征患儿致家庭经济负担及精神负担情况。方法 2013年1-8月对济宁市78例21-三体综合征患儿的170名陪护人（试验组）及同期济宁市年龄与患儿相仿的、近期无任何重大疾病的100例健康儿童的190名陪护人（对照组）进行问卷调查。采用生活满意度评定量表（LSR）及生活满意度指数A（LSIA）评定两组陪护人生活满意度,采用症状自评量表（SCL-90）评定两组家庭负担情况。结果 试验组农村地区和城镇地区患儿治疗支出占家庭收入的68.56%、55.91%。试验组陪护人LSR、LSIA评分均低于对照组（P＜0.05）|试验组农村地区陪护人LSIA评分低于城镇地区,差异有统计学意义（P＜0.05）|试验组陪护人SCL-90中躯体化、人际关系、抑郁、焦虑及精神病性5个因子评分均低于对照组,差异均有统计学意义（P＜0.05）|试验组农村地区陪护人SCL-90中仅人际关系因子评分高于城镇地区,差异有统计学意义（P＜0.05）。结论 21-三体综合征患儿不仅会给家庭带来经济负担,更影响陪护人的生活质量及精神健康状况,应该引起足够的重视。     

Scrub typhus strikes back: Are we ready?

Scrub typhus has struck back, albeit with renewed vigour, impacting areas with previously known endemicity as also impressing newer expanses. It is not surprising, therefore, that Scrub typhus has emerged as a leading cause of public health concern globally as well as in India, but are we ready to take on the challenge?Over the last decade, there has been a global increase in the number of outbreaks of Scrub typhus, be it the military occupied areas or the civil population at large. The innumerable outbreaks of Scrub typhus, although disconcerting, have nonetheless contributed phenomenally towards better understanding of the dynamics of scrub typhus. There have been significant contributions to awareness of the disease amongst medical professionals, scrub typhus as a cause of Acute Undifferentiated Febrile Illness (AUFI) and newer clinical manifestation – Acute Encephalitis Syndrome (AES), availability and advances in diagnostics and management, man-vector-pathogen interactions, new records of Leptotrombidium species, newer vectors and Orientia species.Antigenic diversity and the varied clinical presentation of scrub typhus, absence of scrub typhus surveillance system and a lack of political will to recognize the disease as one of the important reemerging public health problem are areas seeking concerted deliberations and actions so that the challenges posed by scrub typhus can be addressed.     

Multisystem Inflammatory Syndrome after Breakthrough SARS-CoV-2 Infection in 2 Immunized Adolescents,United States

Eight weeks after having laboratory-confirmed SARS-CoV-2 breakthrough infections, 2 otherwise healthy, fully immunized adolescent patients in the United States who were experiencing related signs and symptoms were diagnosed with multisystem inflammatory syndrome in children. Our findings indicate that COVID-19 vaccination does not completely protect adolescents against multisystem inflammatory syndrome.     

消化性溃疡患者患病行为调查分析

目的了解消化性溃疡患者患病行为状况,以指导临床护理工作。方法选择消化性溃疡患者79例为溃疡组,选择健康体检人员89例为对照组。两组均使用《患病行为问卷》进行测评和比较分析。结果溃疡组患者中疑病指数（WI）〉6分占23％,患者一般疑病（GH）,疾病信念（DC）、疑病指数（WI）和疾病确信（DA）因子得分高于对照组,心理取向（P／S）得分低于对照组,差异均有统计学意义（P〈0．05）。情感压抑（AI）、否认心因（D）因子在不同职业消化性溃疡患者中得分差异有统计学意义,分别以农民、家庭妇女为最高;D因子得分各年龄段之间差异有统计学意义,以30～50岁患者得分最高。结论消化性溃疡患者“病感”明显,故治疗开始应尽快控制症状以诱导患者自觉接受正规的治疗方案,同时应加强心理护理和有效的护理沟通,提高患者满意度。     

Effect of midazolam on delirium in critically ill patients: a propensity score analysis

ObjectiveTo observe the association between exposure to midazolam within 24 hours prior to delirium assessment and the risk of delirium.MethodsWe performed a systematic cohort study with two sets of cohorts to estimate the relative risks of outcomes among patients administered midazolam within 24 hours prior to delirium assessment. Propensity score matching was performed to generate a balanced 1:1 matched cohort and identify potential prognostic factors. The outcomes included the odds of delirium, mortality, length of intensive care unit stay, length of hospitalization, and odds of being discharged home.ResultsA total of 78,364 patients were included in this study, of whom 22,159 (28.28%) had positive records. Propensity matching successfully balanced covariates for 9348 patients (4674 per group). Compared with no administration of midazolam, midazolam administration was associated with a significantly higher risk of delirium, higher mortality, and a longer intensive care unit stay. Patients treated with midazolam were relatively less likely to be discharged home. There was no significant difference in hospitalization duration.ConclusionsMidazolam may be an independent risk factor for delirium in critically ill patients.     

早产儿缺氧缺血性脑病的MRI征像分析

目的:探讨分析早产儿缺氧缺血性脑病的MRI表现及其病理生理。方法:132例临床诊断为新生儿缺氧缺血性脑病的早产儿,常规行T1WI、T2WI、DWI、FLAIR扫描。结果:临床表现均考虑HIE,MRI表现皮层及皮层下出血、深部白质出血、脑室旁出血、脑室内出血、脑室旁软化灶。结论:MRI对早产儿HIE具有特征性表现,对早产儿HIE的早期诊断有重要意义。     

Effect of goal-directed fluid therapy on renal function in critically ill patients: a systematic review and meta-analysis

ObjectiveTo evaluate whether goal-directed fluid therapy (GDFT) reduces the risk of renal injury in critical illness.MethodsMEDLINE via PubMed, EMBASE, CENTRAL and CBM was searched from inception to 13 March 2022, for studies comparing the effect of GDFT with usual care on renal function in critically ill patients. GDFT was defined as a protocolized intervention based on hemodynamic and/or oxygen delivery parameters. A fixed or random effects model was applied to calculate the pooled odds ratio (OR) based on heterogeneity through the included studies.ResultsA total of 28 studies with 9,019 patients were included. The pooled data showed that compared with usual care, GDFT reduced the incidence of acute kidney injury (AKI) in critical illness (OR 0.62, 95% confidence interval (CI) 0.47 to 0.80, p< 0.001). Sensitivity analysis with only low risk of bias studies showed the same result. Subgroup analyses found that GDFT was associated with a lower AKI incidence in both postoperative and medical patients. The reduction was significant in GDFT aimed at dynamic indicators. However, no significant difference was found between groups in RRT support (OR 0.88, 95% CI 0.74 to 1.05, p= 0.17). GDFT tended to increase fluid administration within the first 6 h, decrease fluid administration after 24 h, and was associated with more vasopressor requirements.ConclusionsThis meta-analysis suggests that GDFT aimed at dynamic indicators may be an effective way to prevent AKI in critical illness. This may indicate a benefit from early adequate fluid resuscitation and the combined effect of vasopressors.     

Overt hypothyroidism with rhabdomyolysis and myopathy: a case report

Muscle involvement in adults with hypothyroidism is common. At least 79% of patients with hypothyroidism have muscle weakness, cramps, and myalgia complaints.1 The patients with hypothyroidism do have myopathy rather than functional muscle diseases.2 Nonspecific muscle stiffness related to myalgia may be associated with serum muscle enzyme elevations. Serum creatine kinase （CK） elevation can be observed in 57%-90% of patients with hypothyroidism. Skeletal muscle is affected more profoundly in cases of overt hypothyroidism,     

杂合式肾脏替代治疗在急危重患者中的应用

目的探讨杂合式肾脏替代治疗(hybrid renal replacement therapy,HRRT)在急危重患者治疗中的临床疗效。方法回顾性研究2005年1月至2010年1月于我院行HRRT治疗的117例急危重患者,观察这些患者行HRRT治疗后的病情和临床转归情况。结果经HRRT治疗后患者体温、心率和呼吸频率降低,各项生命体征趋于平稳。并发急性肾损伤的22例患者中16例患者尿量逐渐增多,肾功能部分或完全恢复。117例患者经HRRT治疗,10例患者死亡,治愈好转率为91.5%,死亡率为8.5%。结论杂合式肾脏替代治疗对于急危重患者来说是一种有效的治疗措施。     

吗啡联合咪达唑仑对急危重症患者ICU内镇痛镇静的效果探究

目的：评估在ICU内危急重症患者的镇痛镇静治疗中运用咪达唑仑+吗啡的效果及其有关情况。方法方便选择2015年5月一2016年5月因患有危急重症而进入该院ICU接受诊疗的73例患者,随机将其划分作对照、实验两组,对照组36例予以咪达唑仑+曲马多实施镇痛镇静性治疗,实验组37例予以咪达唑仑+吗啡实施镇痛镇静性治疗,经探究两种用药法的运用情况,比对两组镇静镇痛方面的疗效。结果实验组37例在用药治疗48 h后的VAS、Ra-masay评估分是(2.1±0.84）分、(5.2±0.29）分,优越于对照组36例的(3.9±1.28）分、(2.9±0.37）分,差异有统计学意义(P＜0.05）。另外,实验组病例持续通气时间、住院天数是(4.5±1.12）、(6.1±1.43）d,优越于对照组的(7.1±1.15）、(9.8±2.39）d,对比差异有统计学意义(P＜0.05）。结论在ICU危重症患者的镇痛、镇静治疗当中选用吗啡+咪达唑仑联治方法,既能获得较佳成效,又可减少人工通气及住院天数,值得进一步推荐及运用。