目的探讨安宫牛黄丸辅助再灌注治疗重症急性缺血性卒中(AIS)的疗效。方法回顾性选取2021年5月至2023年5月绍兴市人民医院收治的60例再灌注治疗时间窗内重症AIS患者为研究对象,采用安宫牛黄丸辅助再灌注治疗30例,为观察组;采用单纯再灌...目的探讨安宫牛黄丸辅助再灌注治疗重症急性缺血性卒中(AIS)的疗效。方法回顾性选取2021年5月至2023年5月绍兴市人民医院收治的60例再灌注治疗时间窗内重症AIS患者为研究对象,采用安宫牛黄丸辅助再灌注治疗30例,为观察组;采用单纯再灌注治疗30例,为对照组。观察并比较两组患者治疗后病情及神经功能指标[包括美国国立卫生研究院卒中量表(NIHSS)、格拉斯哥昏迷量表(GCS)、改良Rankin量表(mRS)评分以及梗死后加重、梗死后出血、脑疝、神经功能恢复、治疗期间2周内死亡比例]、炎症指标[包括C反应蛋白(CRP)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、全身免疫炎症指数(SII)]等。结果观察组患者在90 d NIHSS评分,14、30 d GCS评分,90 d mRS评分以及神经功能恢复比例方面均优于对照组(均P<0.05)。两组患者治疗前后CRP、NLR、PLR、SII等炎症指标比较,差异均无统计学意义(均P>0.05)。结论安宫牛黄丸辅助再灌注治疗AIS有助于促进患者早期意识的恢复和远期神经功能缺损的改善,但对炎症指标影响不大。展开更多
Background Severity scoring systems are useful tools for measuring the severity of the disease and its outcome. This pilot study was to verify and compare the prognostic performance of the Simplified Acute Physiology ...Background Severity scoring systems are useful tools for measuring the severity of the disease and its outcome. This pilot study was to verify and compare the prognostic performance of the Simplified Acute Physiology Score II （SAPS II） and Glasgow Coma Scale （GCS） in neuro-intensive care unit （N-ICU） patients. Methods A total of 1684 patients consecutively admitted to the N-ICU at Xuanwu Hospital between January 1, 2005 and December 31, 2011 were enrolled in this study. The data-base included admission data, at 24-, 48-, and 72-hour SAPS II and GCS. Repeated measure data analysis of variance, Logistic regression analysis, the Hosmer-Lemeshow goodness-of-fit statistic, and the area under the receiver operating characteristic were used to evaluate the performance. Results There was a significant difference between the SAPS II or GCS score at four time points （F=16.110, P=0.000 or F=8.108, P=0.000）. The SAPS II scores or GCS score at four time points interacted with the outcomes with significant difference （F=116.771, P=0.000 or F=65.316, P=0.000）. Calibration of the SAPS II or GCS score at each time point on all patients was good. The percentage of a risk estimate prediction corresponding to observed mortality was also good. The 72-hour score have the greatest consistency. Discriminations of the SAPS II or GCS score at each time were all satisfactory. The 72-hour score had the greatest discriminative power. The cut-off value was 33 （sensitivity of 85.2% and specificity of 74.3%） and 6 （sensitivity of 70.6% and specificity of 65.0%）. The SAPS II at each time point on all patients showed better calibration, consistency and discrimination than GCS. The binary Logistic regression analysis identified physiological variables, GCS, age, and disease category as significant independent risk factors of death. After the two variables including underlying disease and type of admission were excluded, we built the simplified SAPS II model. A correlation was suggested between the simplified SAPS II score at each time point and outcome, regardless of the diagnosis. Conclusions The GCS scoring system tends to be a little weaker in the predictive power than the SAPS II scoring system in this Chinese cohort of N-ICU patients. The advantage of SAPS II scoring system still exists that it dose not need to take into account the diagnosis or diseases categories, even in the special N-ICU. The simplified SAPS II scoring system is considered a new idea for the estimation of effectiveness.展开更多
目的评估早期肠内营养(EEN)对重症颅脑损伤患者炎症反应的影响。方法选取2012年7月到2014年7月我院外科ICU和神经外科收治的重症颅脑损伤患者140例,将患者随机分为研究组和对照组,对照组给予肠外营养(PN),研究组给予EEN,记录两组患者治...目的评估早期肠内营养(EEN)对重症颅脑损伤患者炎症反应的影响。方法选取2012年7月到2014年7月我院外科ICU和神经外科收治的重症颅脑损伤患者140例,将患者随机分为研究组和对照组,对照组给予肠外营养(PN),研究组给予EEN,记录两组患者治疗1、3、5、7、14 d血清C反应蛋白(CRP)水平和格拉斯哥昏迷评分(GCS);记录两组患者治疗7 d及14 d血清总蛋白、血清白蛋白、外周淋巴细胞计数。结果治疗后两组CRP均下降,治疗1 d两组CRP比较差异无统计学意义(P>0.05),研究组3、5、7、14 d CRP低于对照组,两组比较差异有统计学意义(P<0.05);两组1、3、5、7 d GCS比较差异无统计学意义(P>0.05),第14天研究组GCS评分高于对照组,两组比较差异有统计学意义(P<0.05)。两组治疗后第7天及第14天血清总蛋白、血清白蛋白、外周淋巴细胞计数均有上升,上述指标研究组高于对照组,两组比较差异有统计学差异(P<0.05)。结论 EEN与PN相比减轻了重症颅脑损伤患者的炎症反应,有助于患者从昏迷中恢复,改善了患者机体的内环境。展开更多
文摘目的探讨安宫牛黄丸辅助再灌注治疗重症急性缺血性卒中(AIS)的疗效。方法回顾性选取2021年5月至2023年5月绍兴市人民医院收治的60例再灌注治疗时间窗内重症AIS患者为研究对象,采用安宫牛黄丸辅助再灌注治疗30例,为观察组;采用单纯再灌注治疗30例,为对照组。观察并比较两组患者治疗后病情及神经功能指标[包括美国国立卫生研究院卒中量表(NIHSS)、格拉斯哥昏迷量表(GCS)、改良Rankin量表(mRS)评分以及梗死后加重、梗死后出血、脑疝、神经功能恢复、治疗期间2周内死亡比例]、炎症指标[包括C反应蛋白(CRP)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、全身免疫炎症指数(SII)]等。结果观察组患者在90 d NIHSS评分,14、30 d GCS评分,90 d mRS评分以及神经功能恢复比例方面均优于对照组(均P<0.05)。两组患者治疗前后CRP、NLR、PLR、SII等炎症指标比较,差异均无统计学意义(均P>0.05)。结论安宫牛黄丸辅助再灌注治疗AIS有助于促进患者早期意识的恢复和远期神经功能缺损的改善,但对炎症指标影响不大。
文摘目的分析创伤急诊失血性休克患者格拉斯哥昏迷评分(Glasgowcoma score,GCS)、血乳酸(lactic acid,Lac)与输血量的相关性及对患者预后的预测价值。方法回顾性收集2021年3月至2023年5月于金华市人民医院急诊医学中心诊治且完成随访的128例失血性休克患者的临床资料,按预后情况分为预后良好组(n=106)和预后不良组(n=22),比较两组患者的一般资料及GCS评分、Lac水平、输血量。采用Cox回归模型分析创伤急诊失血性休克患者预后情况的影响因素。建立受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析GCS评分、Lac水平、输血量对创伤急诊失血性休克患者预后的预测价值。结果128例患者中预后不良22例,占比17.19%。预后不良组患者的初始24h输血量及Lac、白细胞(whitebloodcell,WBC)水平高于预后良好组,入院GCS评分、血红蛋白(hemoglobin,Hb)水平低于预后良好组,差异有统计学意义(P<0.05)。Pearson相关分析显示初始24h输血量与入院GCS评分、入院Hb水平呈负相关(P<0.05),与入院Lac水平呈正相关(P<0.05)。初始24h输血量、入院GCS评分及入院Lac、Hb水平是影响创伤急诊失血性休克患者预后的独立危险因素(P<0.05)。初始24h输血量、入院GCS评分、入院Lac、入院Hb水平及联合检测的曲线下面积(area under the curve,AUC)分别为0.722、0.872、0.881、0.798、0.931,敏感度分别为68.2%、76.6%、85.7%、75.7%、88.8%,特异性分别为70.8%、81.0%、78.5%、81.0%、85.7%。成对Z检验显示,联合检测的AUC高于单个指标检测,且敏感度和特异性均为最优(P<0.05)。结论初始24h输血量、入院GCS评分及入院Lac、Hb水平均是影响创伤急诊失血性休克患者预后不良的独立危险因素,且4项指标联合检测的效能价值最高。
文摘Background Severity scoring systems are useful tools for measuring the severity of the disease and its outcome. This pilot study was to verify and compare the prognostic performance of the Simplified Acute Physiology Score II （SAPS II） and Glasgow Coma Scale （GCS） in neuro-intensive care unit （N-ICU） patients. Methods A total of 1684 patients consecutively admitted to the N-ICU at Xuanwu Hospital between January 1, 2005 and December 31, 2011 were enrolled in this study. The data-base included admission data, at 24-, 48-, and 72-hour SAPS II and GCS. Repeated measure data analysis of variance, Logistic regression analysis, the Hosmer-Lemeshow goodness-of-fit statistic, and the area under the receiver operating characteristic were used to evaluate the performance. Results There was a significant difference between the SAPS II or GCS score at four time points （F=16.110, P=0.000 or F=8.108, P=0.000）. The SAPS II scores or GCS score at four time points interacted with the outcomes with significant difference （F=116.771, P=0.000 or F=65.316, P=0.000）. Calibration of the SAPS II or GCS score at each time point on all patients was good. The percentage of a risk estimate prediction corresponding to observed mortality was also good. The 72-hour score have the greatest consistency. Discriminations of the SAPS II or GCS score at each time were all satisfactory. The 72-hour score had the greatest discriminative power. The cut-off value was 33 （sensitivity of 85.2% and specificity of 74.3%） and 6 （sensitivity of 70.6% and specificity of 65.0%）. The SAPS II at each time point on all patients showed better calibration, consistency and discrimination than GCS. The binary Logistic regression analysis identified physiological variables, GCS, age, and disease category as significant independent risk factors of death. After the two variables including underlying disease and type of admission were excluded, we built the simplified SAPS II model. A correlation was suggested between the simplified SAPS II score at each time point and outcome, regardless of the diagnosis. Conclusions The GCS scoring system tends to be a little weaker in the predictive power than the SAPS II scoring system in this Chinese cohort of N-ICU patients. The advantage of SAPS II scoring system still exists that it dose not need to take into account the diagnosis or diseases categories, even in the special N-ICU. The simplified SAPS II scoring system is considered a new idea for the estimation of effectiveness.
文摘目的评估早期肠内营养(EEN)对重症颅脑损伤患者炎症反应的影响。方法选取2012年7月到2014年7月我院外科ICU和神经外科收治的重症颅脑损伤患者140例,将患者随机分为研究组和对照组,对照组给予肠外营养(PN),研究组给予EEN,记录两组患者治疗1、3、5、7、14 d血清C反应蛋白(CRP)水平和格拉斯哥昏迷评分(GCS);记录两组患者治疗7 d及14 d血清总蛋白、血清白蛋白、外周淋巴细胞计数。结果治疗后两组CRP均下降,治疗1 d两组CRP比较差异无统计学意义(P>0.05),研究组3、5、7、14 d CRP低于对照组,两组比较差异有统计学意义(P<0.05);两组1、3、5、7 d GCS比较差异无统计学意义(P>0.05),第14天研究组GCS评分高于对照组,两组比较差异有统计学意义(P<0.05)。两组治疗后第7天及第14天血清总蛋白、血清白蛋白、外周淋巴细胞计数均有上升,上述指标研究组高于对照组,两组比较差异有统计学差异(P<0.05)。结论 EEN与PN相比减轻了重症颅脑损伤患者的炎症反应,有助于患者从昏迷中恢复,改善了患者机体的内环境。
