血管活性药物评分联合APACHE II评分对血流感染后脓毒性休克患者预后的预测价值

目的:探讨血管活性药物评分(vasoactive inotropic score, VIS)联合急性生理与慢性健康评分(APACHE II)对血流感染后脓毒性休克患者结局的预测价值,为临床提供参考。方法:采用回顾性研究方法,通过收集2020年1月至2022年12月安徽医科大学附属合肥医院重症医学科收治的185例脓毒性休克患者的临床资料,根据28 d转归情况,分为存活组95例和死亡组90例,记录所有患者性别、年龄、相关血液检测指标、SOFA评分、24小时内急性生理与慢性健康评分(APACHE II)及24小时内最大血管活性药物评分(VISmax24)等信息,采用单因素分析筛选脓毒性休克患者的相关危险因素,多因素logistic回归分析影响脓毒性休克患者预后的独立危险因素,采用受试者工作特征(receiver op-erating characteristic, ROC)曲线下面积(area under curve, AUC)分析各指标的诊断价值。结果:单因素分析结果表明:死亡组的APACHE II评分(24.30 ± 5.157)、VISmax24 [100.0 (53.5, 121.0)]明显高于存活组(P max24联合APACHE II评分(AUC = 0.848, 95% CI: 0.792~0.905),较单一的APACHE II评分(AUC = 0.729, 95% CI: 0.655~0.802)、VISmax24 (AUC = 0.783, 95% CI: 0.709~0.856)、乳酸(AUC = 0.665, 95% CI: 0.587~0.743)、SOFA (AUC = 0.680, 95% CI: 0.602~0.758)预测价值更高。结论:VISmax24联合APACHE II评分能更有效预测血流感染后脓毒性休克患者的预后。

APACHE II評分在急危重症患者護理中的應用

目的探討APACHE II評分法(第二代急性生理學和慢性健康狀況評分)在ICU護理中的應用效果。方法採用APACHE II評分系統對ICU危重患者124例進行評分,針對記分的不同嚴重程度採用相應的護理對策。結果ICU死亡8例APACHE II評分由15~46分,1死亡手術病例發生幷發症和醫療護理糾紛。23例轉院不能預後評價APACHE II評分由5~36分。剩餘93例APACHE II評分由2~46分,病情好轉並穩定後轉專科病房治療。結論通過APACHE II對危重患者評分,護理管理者掌握了重症患者的病情及護理情况,爲重症護理提供了監控和指導依據;同時它又客觀科學地評價了科室護理工作量及患者的危重程度。

A comparison of APACHE II,BISAP,Ranson’s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification

Objective:Our aim was to prospectively compare the Accuracy of Acute Physiology and Chronic Health Evaluation(APACHE)II,Bedside Index of Severity in Acute Pancreatitis(BISAP),Ranson’s score and modified Computed Tomography Severity Index(CTSI)in predicting the severity of acute pancreatitis based on Atlanta 2012 definitions in a tertiary care hospital in northern India.Methods:Fifty patients with acute pancreatitis admitted to our hospital during the period of March 2015 to September 2016 were included in the study.APACHE II,BISAP and Ranson’s score were calculated for all the cases.Modified CTSI was also determined based on a pancreatic protocol contrast enhanced computerized tomography(CT).Optimal cut-offs for these scoring systems and the area under the curve(AUC)were evaluated based on the receiver operating characteristics(ROC)curve and these scoring systems were compared prospectively.Results:Of the 50 cases,14 were graded as severe acute pancreatitis.Pancreatic necrosis was present in 15 patients,while 14 developed persistent organ failure and 14 needed intensive care unit(ICU)admission.The AUC for modified CTSI was consistently the highest for predicting severe acute pancreatitis(0.919),pancreatic necrosis(0.993),organ failure(0.893)and ICU admission(0.993).APACHE II was the second most accurate in predicting severe acute pancreatitis(AUC 0.834)and organ failure(0.831).APACHE II had a high sensitivity for predicting pancreatic necrosis(93.33%),organ failure(92.86%)and ICU admission(92.31%),and also had a high negative predictive value for predicting pancreatic necrosis(96.15%),organ failure(96.15%)and ICU admission(95.83%).Conclusion:APACHE II is a useful prognostic scoring system for predicting the severity of acute pancreatitis and can be a crucial aid in determining the group of patients that have a high chance of need for tertiary care during the course of their illness and therefore need early resuscitation and prompt referral,especially in resource-limited developing countries.

基于APACHEⅡ评分的老年重症病人能量代谢预测公式

目的:分析老年重症病人能量代谢同APACHE II评分间的联系,并计算与APACHE II评分相关的HB法应激系数,以减少HB法的误差。方法:观察对象为南华大学附属第二医院重症医学科2020年1月至2021年7月期间诊治的102名老年重症病人。比较HB法、IC法在对病人入住重症医学科后第一个24 h静息能量消耗数值方面的不同,以IC法为“金标准”,得出24 h每千克体质量的能量消耗;以APACHE II评分为依据,划分出不同危重程度的组别,并就两组24 h能量代谢与24 h每千克体质量能量消耗展开对比,经由Bland-Altman对HB法和IC法的一致性展开分析,经由t检验实施组间对比,经由Pearson分析关联性,借助线性回归对回归方程展开求解。结果:采取IC法与HB法测量的老年重症病人24 h静息能量代谢结果显示,偏倚均值是(454.6±253.0)kcal/d,可见偏倚明显。老年重症病人APACHEII≥20分组24 h能量代谢、24 h每千克体质量能量代谢较APACHEII<20分组显著增高(P<0.05)。APACHE II评分同应激系数存在正线性相关;经由一元回归对同APACHE II评分有关的HB法应激系数进行拟合,结果是“REE=(1.003+APACHE II×0.016)×HB”。结论:相比IC法测定的老年重症病人入住重症医学科的一个24 h的静息能量消耗,HB法所得值明显偏低,可以使用应激系数“Y=1.003+0.016×APACHE II”,来提升HB法对老年重症病人静息能量代谢测量的精准度。

Comparative research on the prognostic ability of improved early warning and APACHE Ⅱ evaluation for hospitalized patients in the emergency department

Objective： To compare the feasibility and applicability of predicting the prognosis of patients using the Early Warning Score（MEWS） system and the Acute Physiology and Chronic Health Evaluation（APACHE Ⅱ） system in the Emergency Department.Methods： Using a prospective study method, the APACHE Ⅱ and MEWS data for 640 patients hospitalized in the Emergency Internal Medicine Department were collected. The prognoses, two scores to predict the corresponding prediction index of sensitivity, specificity and positive predictive value for the prognosis,the negative predictive value and the ROC curve for predicting the prognosis were analyzed for all patients.Results： In the prediction of the risk of mortality, the MEWS system had a high resolution. The MEWS area under the ROC curve was 0.93. The area under the ROC curve for the APACHE score was 0.79, and the difference was statistically significant（Z =4.348, P 〈 0.01）.Conclusions： Both the MEWS and APACHE Ⅱ systems can be used to determine the severity of emergency patients and have a certain predictive value for the patient＇s mortality risk. However, the MEWS system is simple and quick to operate, making it a useful supplement for APACHE Ⅱ score.

中性粒细胞/淋巴细胞比值对呼吸机相关性肺炎病情严重程度及预后的评估价值

目的: 探讨中性粒细胞/淋巴细胞比值(NLR)对呼吸机相关性肺炎(VAP)病情严重程度及预后的评估价值。 方法: 回顾性分析2014年12月至2018年12月我院收治的210例VAP患者临床资料,根据患者入科24h内急性生理与慢性健康状况评分(APACHE II)情况,将其分为低危组(APACHE II评分< l0分,67例)、中危组(10≤APACHE II评分≤20分,70例)和高危组(APACHE II评分>20分,73例)。根据临床预后将其分为存活组(159例)和死亡组(51例)。记录不同组间患者一般临床资料,包括APACHE II评分、临床肺部感染严重程度评分(CPIS评分)、序贯器官衰竭评分(SOFA评分)、中性粒细胞计数(neutrophil, NEU)、淋巴细胞计数(lymphocyte, LYM)、NLR、降钙素原(procalcitonin, PCT)、高敏C反应蛋白(hypersensitive C reactive protein, hs-CRP)。采用Logistics回归、相关性分析及ROC曲线对不同组间相关数据进行统计分析。 结果: 不同严重程度组间NLR水平比较,差异有统计学意义(P<0.05),其中高危组最高,中危组次之,低危组最低。死亡组NLR水平显著高于存活患者,差异具有统计学意义(P<0.05)。多因素logistic回归分析显示,NLR、前白蛋白(PA)、APACHE II评分、CPIS评分及SOFA评分是VAP患者预后不佳的独立危险因素;相关性分析显示,死亡组患者NLR水平与APACHE II评分、CPIS评分及SOFA评分呈正相关(r1=0.842,P1<0.001;r2=0.805,P2<0.001;r3=0.901,P3<0.001),而与PA水平呈显著负相关(r= -7.047,P<0.001)。ROC曲线分析显示,NLR的曲线下面积(AUC)为0.833(95%CI:0.735~0.931),对预后不佳具有较高的预测价值,其阈值点为9.52,敏感性为81.58 %和特异性为74.16%。 结论: NLR水平对于评估VAP患者病情严重程度及预后,具有较高的预测价值,值得临床推广。

肾移植术后重症肺炎患者的预后危险因素

目的探讨肾移植术后重症肺炎患者的预后危险因素。方法收集2015年1月1日至2021年11月31日入住郑州大学第一附属医院重症监护病房的肾移植术后重症肺炎患者的病例资料,采用单因素分析、Logistic回归分析及ROC曲线等方法对其临床资料进行统计学分析。结果共有96例患者纳入研究,根据其出院转归分为存活组60例和死亡组36例。其中存活组男48例,女12例,年龄(37.1±13.77)岁;死亡组男31例,女5例,年龄(40.64±15.28)岁。两组研究对象之间,性别、年龄比较无统计学差异(P>0.05)。两组间降钙素原、D-二聚体、尿素、肌酐、肾小球滤过率、CD_(4)^(+)T淋巴细胞计数存在统计学意义(P均<0.05)。Logistic回归及ROC曲线提示APACHE II评分(AUC 0.733)、D-二聚体(AUC 0.702)、CD_(4)^(+)T淋巴细胞(AUC 0.638)对于肾移植后重症肺炎患者的预后均具有一定价值。结论应关注肾移植后重症肺炎患者的免疫状态改善和出凝血功能,尤其是APACHE II评分高的患者。

入院APACHE.II评分联合DIC评分对热射病患者死亡的预测价值

目的探讨热射病患者入院时APACHE.II评分联合DIC评分对死亡的预测价值。方法收集河北医科大学哈励逊国际和平医院自2013年6月至2017年9月收治的76例热射病患者为研究对象,根据预后将其分为死亡组与存活组。根据患者入院时临床资料及入院时检验结果分别计算APACHE.II评分及DIC评分,探讨2个指标联合对预后的价值。结果76例患者中,死亡23例(30.3%),存活53例(69.7%)。死亡组患者入院APACHE.II评分和DIC评分分别为26.26±6.48和4.00±1.38,明显高于存活组(APACHE.II评分为20.74±4.17,DIC评分为2.28±1.21),差异有统计学意义(P<0.01)。APACHE.II评分与DIC评分呈正相关关系(r=0.853,P<0.01),评分越高死亡率越高。logistic回归分析显示,两项指标能很好地预测死亡。APACHE.II评分预测死亡的敏感度和特异度为65.2%和81.1%,DIC评分预测死亡的敏感度和特异度为65.2%和84.9%,APACHE.II评分联合DIC评分预测死亡的敏感度和特异度为73.9%和92.5%。结论入院APACHE.II评分及DIC评分在热射病患者早期即明显升高,APACHE.II评分联合DIC评分对热射病患者死亡预测价值更高。

严重脓毒症中医证型与病情严重度及预后相关性的临床研究

目的探讨严重脓毒症中医证型与病情严重度及预后的相关性。方法对严重脓毒症患者进行中医辨证,记录患者一般情况、APACHE-II分值及转归,对其进行统计分析。结果在105例严重脓毒症患者中,原发病以呼吸道感染最多(77例,73.3%)。发生率较高的证型是热证(105例,100%)、腑气不通证(94例,89.5%)。多数患者非单一证型(101例,96.2%)。合并四种证型组的入院APACHE-II评分最高(27.75±7.436分,P=0.018)。合并四种证型组死亡率最高(21例,65.6%,P=0.012)。结论在严重脓毒症患者中,呼吸道感染最多见的,热证及腑气不通证是最常见的中医证型,合并的证型数越多,其入院时APACHE-II评分越高,病死率也越高。

Procalcitionin as a diagnostic marker to distinguish upper and lower gastrointestinal perforation

AIM To assess the accuracy of serum procalcitionin(PCT)as a diagnostic marker in verifying upper and lower gastrointestinal perforation(GIP).METHODS This retrospective study included 46 patients from the surgical intensive care unit(ICU)of the Second Affiliated Hospital of Harbin Medical University who were confirmed to have GIP between June 2013 and December 2016.Demographic and clinical patient data were recorded on admission to ICU.Patients were divided into upper(n=19)and lower(n=27)GIP groups according to the perforation site(above or below Treitz ligament).PCT and WBC count was obtained before laparotomy and then compared between groups.Meanwhile,the diagnostic accuracy of PCT was analyzed.RESULTS Patients with lower GIP exhibited significantly higher APACHE II score,SOFA score and serum PCT level than patients with upper GIP(P=0.017,0.004,and0.001,respectively).There was a significant positive correlation between serum PCT level and APACHE II score or SOFA score(r=0.715 and r=0.611,respectively),while there was a significant negative correlation between serum PCT level and prognosis(r=-0.414).WBC count was not significantly different between the two groups,and WBC count showed no significant correlation with serum PCT level,APACHE II score,SOFA score or prognosis.The area under the receiver operating characteristic curve of PCT level to distinguish upper or lower GIP was 0.778.Patients with a serum PCT level above 17.94 ng/d L had a high likelihood of lower GIP,with a sensitivity of 100%and a specificity of 42.1%.CONCLUSION Serum PCT level is a reliable and accurate diagnostic marker in identifying upper or lower GIP before laparotomy.

Prognostic indicators of patients with acute kidney injury in intensive care unit

BACKGROUND： Acute kidney injury （AKI） is associated with a high mortality. This study was undertaken to detect the factors associated with the prognosis of AKI.METHODS： We retrospectively reviewed 98 patients with AKI treated from March 2008 to August 2009 at this hospital. In these patients, 60 were male and 38 female. Their age ranged from 19 to 89 years （mean 52.4±16.1 years）. The excluded patients were those who died within 24 hours after admission to ICU or those who had a history of chronic kidney disease or incomplete data. After 60 days of treatment, the patients were divided into a survival group and a death group. Clinical data including gender, age, history of chronic diseases, the worst laboratory values within 24 hours after diagnosis （values of routine blood tests, blood gas analysis, liver and renal function, levels of serum cystatin C, and blood electrolytes） were analyzed. Acute physiology, chronic health evaluation （APACHE） II scores and 60-day mortality were calculated. Univariate analysis was performed to find variables relevant to prognosis, odds ratio （OR） and 95% confidence interval （CI）. Multiple-factor analysis with logistic regression analysis was made to analyze the correlation between risk factors and mortality.RESULTS： The 60-day mortality was 34.7% （34/98）. The APACHE II score of the death group was higher than that of the survival group （17.4±4.3 vs. 14.2±4.8, P〈0.05）. The mortality of the patients with a high level of cystatin C〉1.3 mg/L was higher than that of the patients with a low level of cystatin C （〈1.3 mg/L） （50% vs. 20%, P〈0.05）. The univariate analysis indicated that organ failures≥2, oliguria, APACHE II〉15 scores, cystatin C〉1.3 mg/L, cystatin C〉1.3 mg/L＋APACHE II〉15 scores were the risk factors of AKI. Logistic regression analysis, however, showed that organ failures≥2, oliguria, cystatin C〉1.3 mg/L ＋APACHE II〉15 scores were the independent risk factors of AKI.CONCLUSION： Cystatin C〉1.3 mg/L＋APACHE II〉15 scores is useful in predicting adverseclinical outcomes in patients with AKI.

Intra-abdominal pressure monitoring in predicting outcome of patients with severe acute pancreatitis

BACKGROUND: Severe acute pancreatitis (SAP) is a serious disease with many complications, high mortality and poor prognosis. It is characterized by rapid deterioration and poses one of the most difficult challenges in clinical practice. Previous investigations suggest that SAP is one of the main causes of intra-abdominal pressure (IAP) increase. The aim of this study was to evaluate the utility of IAP-monitoring in predicting the severity and prognosis of SAP. METHODS: Eighty-nine patients with SAP who had been treated from February 2001 to December 2005 were studied. Since bladder pressure accurately reflects IAP, we measured it instead of IAP. Bladder pressure was measured at the time of admission and every 12 hours in the course of the disease, 9 consecutive times in all. The APACHE II scores of all patients were obtained within 24 hours after admission. According to a maximum bladder pressure <10 cmH(2)O, all patients were divided into two groups, mildly-elevated and severely-elevated. Mortality and mean APACHE II scores in the two groups were calculated. In addition, the mean bladder pressure and APACHE II scores in survivors were compared with those in deaths. RESULTS: Sixty-eight of the 89 patients were in the severely-elevated group. Mortality and mean APACHE II scores in this group were much higher than those in the mildly-elevated group (mortality, 39.71% vs. 9.52%; mean APACHE II score, 23.15 +/- 7.42 vs. 15.95 +/- 5.35, P<0.01). The mean bladder pressures and APACHE II scores in deaths were significantly greater than those in survivors (mean bladder pressure, 14.1 +/- 3.8 vs. 9.2 +/- 2.3 cmH(2)O, P<0.01; mean APACHE II score, 27.83 +/- 4.87 vs. 18.37 +/- 6.74, P<0.01). CONCLUSION: It is suggested that IAP may be used as a marker of the severity and prognosis of SAP.

Effects of high-volume hemofiltration on alveolar- arterial oxygen exchange in patients with refractory septic shock

BACKGROUND：High-volume hemofiltration （HVHF） is technically possible in severe acute pancreatitis （SAP） patients complicated with multiple organ dysfunction syndrome （MODS）. Continuous HVHF is expected to become a beneficial adjunct therapy for SAP complicated with MODS. In this study, we aimed to explore the effects of fluid resuscitation and HVHF on alveolar- arterial oxygen exchange, the Acute Physiology and Chronic Health Evaluation II （APACHE II） score in patients with refractory septic shock. METHODS：A total of 89 refractory septic shock patients, who were admitted to ICU, the Provincial Hospital affiliated to Shandong University from August 2006 to December 2009, were enrolled in this retrospective study. The patients were randomly divided into two groups： fluid resuscitation （group A, n=41）, and fluid resuscitation plus high-volume hemofiltration （group B, n=48）, The levels of O2 content of central venous blood （CcvO2）, arterial oxygen content （CaO2）, alveolar-arterial oxygen pressure difference P（A-a）DO2, ratio of arterial oxygen pressure/alveolar oxygen pressure （PaO2/ PAO2）, respiratory index （RI） and oxygenation index （OI） were determined. The oxygen exchange levels of the two groups were examined based on the arterial blood gas analysis at different times （0, 24, 72 hours and 7 days of treatment） in the two groups. The APACHE II score was calculated before and after 7-day treatment in the two groups. The levels of CcvO2, CaO2 on day 7 in group A were significantly lower than those in group B （CcvO2：0.60±0.24 vs, 0.72±0.28, P〈0.05; CaO2：0.84±0.43 vs. 0.94±0.46, P〈0.05）. The level of oxygen extraction rate （O2ER） in group A on the 7th day was significantly higher than that in group B （ 28.7±2.4 vs. 21.7±3.4, P〈0.01）. The levels of P（A-a）DO2 and RI in group B on the 7th day were significantly lower than those in group A. The levels of PaO2/PAO2 and OI in group B on 7th day were significantly higher than those in group A （P〈0.05 or P〈0.01）. The APACHE II score in the two groups reduced gradually after 7-day treatment, and the APACHE II score on the 7th day in group B was significantly lower than that in group A （8.2±3.8 vs. 17.2±6.8, P〈0.01）. HVHF combined with fluid resuscitation can improve alveolar- arterial-oxygen exchange, decrease the APACHE II score in patients with refractory septic shock, and thus it increases the survival rate of patients.

Effects of early rehabilitation therapy on patients with mechanical ventilation

BACKGROUND: For patients in intensive care unit(ICU), mechanical ventilation is an effective treatment to survive from acute illness and improve survival rates. However, long periods of bed rest and restricted physical activity can result in side effects. This study aimed to investigate the feasibility of early rehabilitation therapy in patients with mechanical ventilation.METHODS: A randomized controlled trial was carried out. Sixty patients, with tracheal intubation or tracheostomy more than 48 hours and less than 72 hours, were admitted to the ICU of the Affiliated Hospital of Medical College, Qingdao University, from May 2010 to May 2012. These patients were randomly divided into a rehabilitation group and a control group. In the rehabilitation group, rehabilitation therapy was performed twice daily, and the training time and intensity were adjusted according to the condition of the patients. Early rehabilitation therapy included heading up actively, transferring from the supine position to sitting position, sitting at the edge of the bed, sitting in chair, transferring from sitting to standing, and ambulating bedside. The patient's body mass index, days to first out of bed, duration of mechanical ventilation, length of ICU stay, APACHE II score, highest FiO2, lowest PaO2/FiO2 and hospital mortality of patients were all compared between the rehabilitation group and the control group. The differences between the two groups were compared using Student's t test.RESULTS: There was no significant difference in body mass index, APACHE II score, highest FiO2, lowest PaO2/FiO2 and hospital mortality between the rehabilitation group and the control group(P>0.05). Patients in the rehabilitation group had shorter days to first out of bed(3.8±1.2 d vs. 7.3±2.8 d; P=0.00), duration of mechanical ventilation(5.6±2.1 d vs. 12.7±4.1 d; P=0.005) and length of ICU stay(12.7±4.1 d vs. 15.2±4.5 d; P=0.01) compared with the control group.CONCLUSION: Early rehabilitation therapy was feasible and effective in improving the outcomes of patients with mechanical ventilation.

Significance of blood pressure variability in patients with sepsis

BACKGROUND: This study was undertaken to observe the characteristics of blood pressure variability(BPV) and sepsis and to investigate changes in blood pressure and its value on the severity of illness in patients with sepsis.METHODS: Blood parameters, APACHE II score, and 24-hour ambulatory BP were analyzed in 89 patients with sepsis.RESULTS: In patients with APACHE II score>19, the values of systolic blood pressure(SBPV), diasystolic blood pressure(DBPV), non-dipper percentage, cortisol(COR), lactate(LAC), platelet count(PLT) and glucose(GLU) were significantly higher than in those with APACHE II score ≤19(P<0.05), whereas the values of procalcitonin(PCT), white blood cell(WBC), creatinine(Cr), PaO2, C-reactive protein(CRP), adrenocorticotropic hormone(ACTH) and tumor necrosis factor α(TNF-α) were not statistically significant(P>0.05). Correlation analysis showed that APACHE II scores correlated significantly with SBPV and DBPV(P<0.01, r=0.732 and P<0.01, r=0.762). SBPV and DBPV were correlated with COR(P=0.018 and r=0.318; P=0.008 and r=0.353 respectively). However, SBPV and DBPV were not correlated with TNF-α, IL-10, and PCT(P>0.05). Logistic regression analysis of SBPV, DBPV, APACHE II score, and LAC was used to predict prognosis in terms of survival and non-survival rates. Receiver operating characteristics curve(ROC) showed that DBPV was a better predictor of survival rate with an AUC value of 0.890. However, AUC of SBPV, APACHE II score, and LAC was 0.746, 0.831 and 0.915, respectively.CONCLUSIONS: The values of SBPV, DBPV and non-dipper percentage are higher in patients with sepsis. DBPV and SBPV can be used to predict the survival rate of patients with sepsis.

Visfatin levels in patients with severe pneumonia

BACKGROUND： As a cytokine highly expressed in internal organs, visfatin could be used as a biomarker of systemic inflammation response for chronic obstructive pulmonary diseases, but few studies have reported the use of visfatin in severe pneumonia. The present study was undertaken to determine the plasma levels of visfatin in patients with severe pneumonia. METHODS：A total of 70 patients, including 40 patients with severe pneumonia （group A） and 30 patients with non severe pneumonia （group B） who had been admitted to the ICU from June 2009 to June 2010, were enrolled in this prospective study. And another 30 healthy physical examinees served as healthy controls （group C）. Patients were excluded if they suffered from severe diseases of the heart, brain and kidney, cancers, autoimmune diseases, or received special treatment in the latest month. The plasma levels of visfatin, IL-6, IL-8 and TNF-α were measured by ELISA, while the level of CRP was determined by immuneturbidimetry, and the routine blood test was performed. Blood gas analysis and Acute Physiology and Chronic Health Evaluation II （APACHE II） were performed in patients with pneumonia. Comparisons between the groups were conducted by Student＇s t test, ANOVA or nonparametric test. Correlation analysis was carried out by Pearson＇s correlation test or Spearman＇s rank-order correlation test. RESULTS：The plasma level of visfatin in group A was significantly higher than that in groups B and C （P〈0.001）, and the level of visfatin in group B was significantly higher than that in group C （P〈0.001）. The plasma level of visfatin was positively correlated with CRP, TNF-α, APACHE II and PMN% in patients with severe pneumonia （rho=0.653, r=0.554, r=0.558, r=0.484, respectively, P〈0.05 for all）, while it was negatively correlated with PaO2 and PaO2/FiO2 （rho=-0.422, r=-0.543, respectively, P〈0.05 for all）. CONCLUSION：Visfatin may be involved in the systematic inflammation response in patients with severe pneumonia as a pro-inflammatory cytokine, and it is valuable in assessing the severity of pneumonia..

外周血CD4^(+)CXCR5^(+)Tfh水平对肺炎克雷伯菌感染者预后的影响

目的检测肺炎克雷伯菌感染者外周血CD4^(+)CXCR5^(+)滤泡辅助性T细胞(T follicular helper cell, Tfh)水平,探讨其对患者预后的影响。方法选取2017年7月-2019年5月于本院ICU住院治疗的147例患者为研究对象,根据患者入院后是否出现肺炎克雷伯菌感染,将其分为感染组(69例)和未感染组(78例)。采用流式细胞术检测147例患者外周血CD4^(+)CXCR5^(+)Tfh水平。采用单因素分析肺炎克雷伯菌感染的影响因素;采用单因素分析和多因素Logistic回归分析肺炎克雷伯菌感染者预后的影响因素。结果感染组的住院时间、入住ICU时间、入住ICU时APACHE II评分、机械通气时间及心血管疾病、多器官功能障碍综合征、接受手术、恶性肿瘤患者比例均高于未感染组,差异均有统计学意义(P均<0.05)。感染组外周血CD4^(+)CXCR5^(+)Tfh水平、死亡患者比例均高于未感染组(P均<0.05)。感染组中死亡患者外周血CD4^(+)CXCR5^(+)Tfh水平高于生存患者(P <0.05)。CD4^(+)CXCR5^(+)Tfh、碳青霉烯类耐药、入住ICU时APACHE II评分是影响肺炎克雷伯菌感染者死亡的独立危险因素(P均<0.05)。结论外周血CD4^(+)CXCR5^(+)Tfh水平在肺炎克雷伯菌感染者中显著升高,CD4^(+)CXCR5^(+)Tfh可能通过参与机体免疫应答影响感染者的预后。检测CD4^(+)CXCR5^(+)Tfh水平不仅对判断感染者的免疫状态有重要意义,也可为肺炎克雷伯菌感染者治疗提供依据。

血小板、D-二聚体在感染性休克早期集束化治疗中的临床应用

目的探讨血小板、D-二聚体在感染性休克早期集束化治疗中的临床应用价值。方法随机选取成人综合ICU感染性休克患者60例，均予以早期集束化治疗。于集束化治疗前、治疗后6h，入ICU1、2、3、4、5d，分别检测血小板计数、D-二聚体浓度，并分别记录各时间点急性生理学和慢性健康状况评分系统II（APACHEII）评分。根据患者28d转归分为存活组与死亡组，比较两组不同时间点相关指标，并对本组内各时间点相关指标与集束化治疗前进行比较。分别将两组内血小板计数、D-二聚体浓度与APACHEII评分进行相关分析。结果存活组APACHEII评分、D-二聚体随着病情好转下降，死亡组则呈升高趋势；存活组血小板计数随着病情好转逐渐升高，而死亡组则逐渐下降。经Pearson相关分析，APACHEII评分与血小板计数呈负性相关（t=-0．862，P〈0．01），与D-二聚体浓度呈正相关（，=0．445，P〈0．01）。结论血小板计数、D-二聚体浓度可作为感染性休克治疗效果及预后的评价指标，与APACHEII评分结合，能更准确地评估感染性休克病情的严重程度及预后。

LRG1对成人ARDS的表达及临床意义

目的观察研究ARDS患者血清LRG1的变化水平及临床意义。方法选取2020年6月1日至2022年3月10日广西医科大学第一附属医院收治的20例成人ARDS患者作为观察组,并分3个亚组,其中轻度ARDS 8例,中度ARDS 6例,重度ARDS 6例;另选取同期正常对照组20例。比较ARDS与对照组及不同程度ARDS间血清LRG1水平差异。结果与对照组(412.55±179.44)μg/mL相比,患者组(615.16±106.44)μg/mL LRG1水平较对照组显著升高,P<0.05;ARDS三个亚组血清LRG1水平比较,轻度组(527.66±73.17)μg/mL、中度组(619.87±80.12)μg/mL、重度组(727.11±42.63)μg/mL三组组间比较有统计学意义(P<0.05),且随病情严重程度增加而升高;ARDS组患者血清LRG1水平越高,氧合指数越低(P<0.05),APACHE II评分越高(P<0.05)。结论ARDS患者的血清LRG1水平升高,与ARDS的严重程度相关,可作为ARDS病情严重程度的诊断指标。

COVID-19 presentation as acute pancreatitis:A case report

Rationale:The gastrointestinal manifestations of COVID-19 include anorexia,nausea,vomiting,abdominal pain,and diarrhea.However,pancreatitis as the presentation of COVID-19 is rarely reported.Patient’s Concern:A 63-year-old COVID-19 patient presented with complaints of abdominal pain and difficulty breathing for 5 d.Diagnosis:Contrast-enhanced computed tomography of the abdomen suggested acute interstitial pancreatitis without any biliary tract obstruction.Interventions:The patient was resuscitated with intravenous fluids based on dynamic parameters of fluid responsiveness.The patient was started on enteral feeding,analgesics,antibiotics,dexamethasone,low molecular weight heparin,and supportive therapy.Outcomes:The patient developed severe acute respiratory distress syndrome and died 6 days after admission.Lessons:Management of COVID-19 in the presence of pancreatitis is challenging.Adequate early fluid resuscitation is an important aspect of medical management for COVID-19 patients with pancreatitis and restrictive strategies must be followed.Increased liver enzymes and renal dysfunction in acute pancreatitis can also limit the use of specific therapies like remdesivir.Dexamethasone,even though it has shown a beneficial effect in treating COVID-19,can have an additive effect in causing hyperglycemia in these cases.Clinicians should be aware of this atypical presentation of COVID-19 with pancreatitis and adjust their management strategies,keeping in mind the considerations for both diseases.