Clinical features and risk factors of severely and critically ill patients with COVID-19

BACKGROUND As of June 1,2020,over 370000 coronavirus disease 2019(COVID-19)deaths have been reported to the World Health Organization.However,the risk factors for patients with moderate-to-severe or severe-to-critical COVID-19 remain unclear.AIM To explore the characteristics and predictive markers of severely and critically ill patients with COVID-19.METHODS A retrospective study was conducted at the B11 Zhongfaxincheng campus and E1-3 Guanggu campus of Tongji Hospital affiliated with Huazhong University of Science and Technology in Wuhan.Patients with COVID-19 admitted from 1st February 2020 to 8th March 2020 were enrolled and categorized into 3 groups:The moderate group,severe group and critically ill group.Epidemiological data,demographic data,clinical symptoms and outcomes,complications,laboratory tests and radiographic examinations were collected retrospectively from the hospital information system and then compared between groups.RESULTS A total of 126 patients were enrolled.There were 59 in the moderate group,49 in the severe group,and 18 in the critically ill group.Multivariate logistic regression analysis showed that age[odd ratio(OR)=1.055,95%(confidence interval)CI:1.099-1.104],elevated neutrophil-to-lymphocyte ratios(OR=4.019,95%CI:1.045-15.467)and elevated high-sensitivity cardiac troponin I(OR=10.126,95%CI:1.088-94.247)were high-risk factors.CONCLUSION The following indicators can help clinicians identify patients with severe COVID-19 at an early stage:age,an elevated neutrophil-to-lymphocyte ratio and high sensitivity cardiac troponin I.

Prevalence of Various Cancer-Related Risk Factors among the Forcibly Displaced Myanmar National Community, the Rohingya, in Bangladesh: A Preliminary Assessment

Background: Large numbers of Forcibly Displaced Myanmar Nationals (FDMN), also called the Rohingya community, in Bangladesh face chronic life-threatening illnesses. Symptoms concerning for a cancer diagnosis are not easily evaluated and treated by healthcare systems available to this population. We conducted a rapid needs assessment of cancer screening and pain and palliative care with the goal of identifying the prevalence of cancer risk factors among the Rohingya who attended local health facilities. Methods: A cross-sectional study was conducted in the Kutupalong camp of Ukhiya, Cox’s Bazar among the Rohingya community. Data were?collected through purposive sampling. Face-to-face interviews were done using a structured questionnaire. Statistics were analyzed by using IBM SPSS 23.?Results: Out of 85 participants, 75 were female and 10 were male. 70 (82.4%) were uneducated (defined as lacking any formal institutional education), 10 (11.8%) people completed the primary level education and only 5 (5.9%) people received secondary level education. There were many participants with pulmonary disease with 35 (41.2%) people endorsing a history of asthma, bronchitis, and/or tuberculosis. There was a lack of female menstrual sanitation and hygiene with only 25 (29.4%) patients using sanitary napkins, that were donated by Non Government Organizations. Only 5.9% of the women had received any form of cervical cancer screening.?Conclusion: This study identifies risk factors associated with cancers and life-limiting diseases among the FDMN Rohingya refugees in Bangladesh. It is necessary to develop targeted education, cancer screening and cancer awareness programs for this population.

High-risk factors for delirium in severely ill patients and the application of emotional nursing combined with pain nursing

BACKGROUND Delirium is a neuropsychiatric syndrome characterized by acute disturbances of consciousness with rapid onset,rapid progression,obvious fluctuations,and preventable,reversible,and other characteristics.Patients with delirium in the intensive care unit(ICU)are often missed or misdiagnosed and do not receive adequate attention.AIM To analyze the risk factors for delirium in ICU patients and explore the applica-tion of emotional nursing with pain nursing in the management of delirium.METHODS General data of 301 critically ill patients were retrospectively collected,including histories(cardiovascular and cerebrovascular diseases,hypertension,smoking,alcoholism,and diabetes),age,sex,diagnosis,whether surgery was performed,and patient origin(emergency/clinic).Additionally,the duration of sedation,Richmond Agitation Sedation Scale score,combined emotional and pain care,ven-tilator use duration,vasoactive drug use,drainage tube retention,ICU stay du-ration,C-reactive protein,procalcitonin,white blood cell count,body tempe-rature,Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment score were recorded within 24 h after ICU admission.Patients were assessed for delirium according to confusion assessment method for the ICU,and univariate and multivariate logistic regre-ssion analyses were performed to identify the risk factors for delirium in the patients.RESULTS Univariate logistic regression analysis was performed on the 24 potential risk factors associated with delirium in ICU patients.The results showed that 16 risk factors were closely related to delirium,including combined emotional and pain care,history of diabetes,and patient origin.Multivariate logistic regression analysis revealed that no combined emotional and pain care,history of diabetes,emergency source,surgery,long stay in the ICU,smoking history,and high APACHE II score were independent risk factors for de-lirium in ICU patients.CONCLUSION Patients with diabetes and/or smoking history,postoperative patients,patients with a high APACHE II score,and those with emergency ICU admission need emotional and pain care,flexible visiting modes,and early intervention to reduce delirium incidence.

Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency

BACKGROUND:This study aimed to investigate the risk factors and outcome of critically ill cancer patients with postoperative acute respiratory insufficiency.METHODS:The data of 190 critically ill cancer patients with postoperative acute respiratory insufficiency were retrospectively reviewed.The data of 321 patients with no acute respiratory insufficiency as controls were also collected.Clinical variables of the first 24 hours after admission to intensive care unit were collected,including age,sex,comorbid disease,type of surgery,admission type,presence of shock,presence of acute kidney injury,presence of acute lung injury/acute respiratory distress syndrome,acute physiologic and chronic health evaluation(APACHE Ⅱ) score,sepsis-related organ failure assessment(SOFA),and PaO_2/FiO_2 ratio.Duration of mechanical ventilation,length of intensive care unit stay,intensive care unit death,length of hospitalization,hospital death and one-year survival were calculated.RESULTS:The incidence of acute respiratory insufficiency was 37.2%(190/321).Multivariate logistic analysis showed a history of chronic obstructive pulmonary diseases(P=0.001),surgeryrelated infection(P=0.004),hypo-volemic shock(P<0.001),and emergency surgery(P=0.018),were independent risk factors of postoperative acute respiratory insufficiency.Compared with the patients without acute respiratory insufficiency,the patients with acute respiratory insufficiency had a prolonged length of intensive care unit stay(P<0.001),a prolonged length of hospitalization(P=0.006),increased intensive care unit mortality(P=0.001),and hospital mortality(P<0.001).Septic shock was shown to be the only independent prognostic factor of intensive care unit death for the patients with acute respiratory insufficiency(P=0.029,RR:8.522,95%CI:1.243-58.437,B=2.143,SE=0.982,Wald=4.758).Compared with the patients without acute respiratory insufficiency,those with acute respiratory insufficiency had a shortened one-year survival rate(78.7%vs.97.1%,P<0.001).CONCLUSION:A history of chronic obstructive pulmonary diseases,surgery-related infection,hypovolemic shock and emergency surgery were risk factors of critically ill cancer patients with postoperative acute respiratory insufficiency.Septic shock was the only independent prognostic factor of intensive care unit death in patients with acute respiratory insufficiency.Compared with patients without acute respiratory insufficiency,those with acute respiratory insufficiency had adverse shortterm outcome and a decreased one-year survival rate.

Long-term results of extensive aortoiliac occlusive disease (EAIOD) treated by endovascular therapy and risk factors for loss of primary patency

Background::Although endovascular therapy has been widely used for focal aortoiliac occlusive disease(AIOD),its performance for extensive AIOD(EAIOD)is not fully evaluated.We aimed to demonstrate the long-term results of EAIOD treated by endovascular therapy and to identify the potential risk factors for the loss of primary patency.Methods::Between January 2008 and June 2018,patients with a clinical diagnosis of the 2007 TransAtlantic Inter-Society Consensus II(TASC II)C and D AIOD lesions who underwent endovascular treatment in our institution were enrolled.Demographic,diagnosis,procedure characteristics,and follow-up information were reviewed.Univariate analysis was used to identify the correlation between the variables and the primary patency.A multivariate logistic regression model was used to identify the independent risk factors associated with primary patency.Five-and 10-year primary and secondary patency,as well as survival rates,were calculated by Kaplan-Meier analysis.Results::A total of 148 patients underwent endovascular treatment in our center.Of these,39.2%were classified as having TASC II C lesions and 60.8%as having TASC II D lesions.The technical success rate was 88.5%.The mean follow-up time was 79.2±29.2 months.Primary and secondary patency was 82.1%and 89.4%at 5 years,and 74.8%and 83.1%at 10 years,respectively.The 5-year survival rate was 84.2%.Compared with patients without loss of primary patency,patients with this condition showed significant differences in age,TASC II classification,infrainguinal lesions,critical limb ischemia(CLI),and smoking.Multivariate logistic regression analysis showed age<61 years(adjusted odds ratio[aOR]:6.47;95%CI:1.47-28.36;P=0.01),CLI(aOR:7.81;95%CI:1.92-31.89;P=0.04),and smoking(aOR:10.15;95%CI:2.79-36.90;P<0.01)were independent risk factors for the loss of primary patency.Conclusions::Endovascular therapy was an effective treatment for EAIOD with encouraging patency and survival rate.Age<61 years,CLI,and smoking were independent risk factors for the loss of primary patency.

Logistic Regression Analysis and Nursing Interventions for High-risk Factors for Pressure Sores in Patients in a Surgical Intensive Care Unit

Objective： To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions. Methods： A questionnaire regarding the factors for pressure sores in critically ill surgical patients was created using a case control study with reference to the pertinent literature. After being exam- ined and validated by experts, the questionnaire was used to collect data about critically ill surgical patients in a grade A tertiary hospital. Among the 47 patients enrolled into the study, the 14 who developed nosocomial pressure sores were allocated to the pressure sore group, and the remaining 33 patients who met the inclusion criteria and did not exhibit pressure sores were allocated to the control group. Univariate and multivariate logistic regression analyses were employed to examine the differences in 22 indicators between the two groups in an attempt to identify the risk factors for pressure sores. Results： According to the univariate analyses, the maximum value of lactic acid in the arterial blood, the number of days of norepinephrine use, the number of days of mechanical ventilation, the number of days of blood purification, and the number of days of bowel incontinence were statistically greater in the pressure sore group than in the control group （P〈0.05）. The multivariate logistic regression analysis revealed that the number of days of norepinephrine use and the level of lactic acid in the arterial blood were high risk-factors for pressure sores （P〈0.05）. Conclusions： The best method for preventing and control pressure sores in surgical critically ill patients is to strongly emphasize the duration of the critical status and to give special attention to patients in a continuous state of shock. The adoption of measures specific to high-risk patient groups and risk factors, including the active control of primary diseases and the application of decompression measures during the treatment of the patients, are helpful for improving the quality of care in the prevention and control of pressure sores in critically ill patients.

Prevalence of polymyxin-induced nephrotoxicity and its predictors in critically ill adult patients:A meta-analysis

BACKGROUND Polymyxin-induced nephrotoxicity is a major safety concern in clinical practice due to long-term adverse outcomes and high mortality.AIM To conducted a systematic review and meta-analysis of the prevalence and potential predictors of polymyxin-induced nephrotoxicity in adult intensive care unit(ICU)patients.METHODS PubMed,EMBASE,the Cochrane Library and Reference Citation Analysis database were searched for relevant studies from inception through May 30,2022.The pooled prevalence of polymyxin-induced nephrotoxicity and pooled risk ratios of associated factors were analysed using a random-effects or fixed-effects model by Stata SE ver.12.1.Additionally,subgroup analyses and meta-regression were conducted to assess heterogeneity.RESULTS A total of 89 studies involving 12234 critically ill adult patients were included in the meta-analysis.The overall pooled incidence of polymyxin-induced nephrotoxicity was 34.8%.The pooled prevalence of colistin-induced nephrotoxicity was not higher than that of polymyxin B(PMB)-induced nephrotoxicity.The subgroup analyses showed that nephrotoxicity was significantly associated with dosing interval,nephrotoxicity criteria,age,publication year,study quality and sample size,which were confirmed in the univariable meta-regression analysis.Nephrotoxicity was significantly increased when the total daily dose was divided into 2 doses but not 3 or 4 doses.Furthermore,older age,the presence of sepsis or septic shock,hypoalbuminemia,and concomitant vancomycin or vasopressor use were independent risk factors for polymyxin-induced nephrotoxicity,while an elevated baseline glomerular filtration rate was a protective factor against colistin-induced nephrotoxicity.CONCLUSION Our findings indicated that the incidence of polymyxin-induced nephrotoxicity among ICU patients was high.It emphasizes the importance of additional efforts to manage ICU patients receiving polymyxins to decrease the risk of adverse outcomes.

老年危重症患者发生再喂养综合征的危险因素回归方程的构建及干预措施分析

目的构建老年危重症患者发生再喂养综合征(RFS)的危险因素回归方程,并分析相应的干预措施。方法回顾性分析2021年1月—2023年3月重症监护室(ICU)收治的154例老年危重症患者的临床资料,根据RFS发生情况分为RFS组51例和非RFS组103例。采用Logistic回归模型分析影响发生RFS的因素;采用受试者工作特征(ROC)曲线分析预测因子对RFS的预测价值;构建并验证相关Logistic回归方程,拟定相关护理干预内容。结果老年危重症患者发生RFS与急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、营养风险筛查2002(NRS2002)评分、有创机械通气、喂养前禁食时间、D-二聚体水平、营养摄入方式和喂养前血磷、血钾、血镁水平有相关性(P<0.05)。Logistic回归分析显示,APACHEⅡ评分、NRS2002评分、营养摄入方式和喂养前血磷、血钾水平均为影响老年危重症患者发生RFS的独立危险因素(P<0.05)。ROC曲线结果显示,APACHEⅡ评分、NRS2002评分、营养摄入方式和喂养前血磷、血钾水平和联合预测因子预测老年危重症患者发生RFS的曲线下面积(AUC)分别为0.754、0.723、0.707、0.783、0.774和0.859(P<0.05)。发生RFS的Logistic回归方程为L=0.085×APACHEⅡ评分-0.337×NRS 2002评分+0.537×营养摄入方式-0.776×喂养前血磷水平-0.207×喂养前血钾水平+0.942。该方程预测价值良好,可根据方程拟定针对性的护理干预措施。结论危险因素回归方程可用于老年危重症患者RFS发生风险的临床预测,临床可根据回归方程制订相关护理干预措施,预防RFS的发生。

经口气管插管患者口腔黏膜压力性损伤风险预测模型的构建及验证

目的构建并验证经口气管插管患者发生口腔黏膜压力性损伤的风险预测模型。方法纳入2022年12月至2023年7月浙江省某三级甲等医院ICU的400例经口气管插管患者为模型训练集,2023年8-10月的152例为模型外部验证集。采用logistic回归筛选口腔黏膜压力性损伤的预测变量。绘制受试者工作特征曲线下面积、校准曲线和临床决策曲线来评估预测模型的预测性能。采用Bootstrap法对模型进行内部验证。结果logistic回归结果显示,年龄、躁动-镇静程度量表评分、急性生理与慢性健康评分Ⅱ、血清白蛋白水平、气管插管操作者、气管导管固定方式和人工气道留置时间是口腔黏膜压力性损伤的影响因素(P<0.05)。训练集和验证集的受试者工作特征曲线下面积分别为0.913(95%CI:0.873~0.954)和0.956(95%CI:0.922~0.981);Hosmer-Lemeshow检验结果表明,模型预测值与实际值吻合较好,模型校准度较好(χ^(2)=1.702,P=0.427)。Bootstrap法重抽样结果显示,受试者工作特征曲线下面积为0.908(95%CI:0.852~1.105),灵敏度为94.9%,特异度为60.8%,准确率为83.7%。结论本研究构建的风险预测模型具有较好的区分度、校准度和临床应用价值,可为精准识别经口气管插管患者口腔黏膜压力性损伤高风险人群提供参考依据。

老年重症患者碳青霉烯耐药铜绿假单胞菌感染危险因素分析

目的探讨老年重症患者碳青霉烯耐药铜绿假单胞菌(carbapenem-resistant Pseudomonas aeruginosa,CRPA)感染的危险因素,建立预测模型并验证。方法收集2018年1月至2023年12月广东省第二中医院收治的148例CRPA感染的重症患者的人口学及临床资料,包括患者性别、年龄,是否合并呼吸衰竭、心功能不全、高血压、脑梗死等基础病,感染24 h内降钙素原、D二聚体、白细胞计数、血红蛋白、血小板计数、血尿素、血肌酐、血葡萄糖、丙氨酸氨基转移酶、总蛋白、总胆红素等实验室数据。根据患者年龄分为年轻组(44例)和老年组(104例)。年轻组年龄18~65(51.0±13.0)岁,老年组年龄≥65~103(79.8±8.0)岁。采用χ^(2)检验、t检验等方法进行单因素分析及多因素logistic回归分析确定感染预后的危险因素。使用LASSO回归筛选变量并构建列线图预测模型。模型评价使用受试者操作特征曲线下面积(area under curve,AUC)、标准曲线、决策曲线分析(decision curve analysis,DCA)。结果合并心功能不全、脑梗死,感染时血红蛋白、血小板计数降低、血尿素、血肌酐、血糖、降钙素原是老年重症患者CRPA感染的危险因素(均P<0.05);合并脑梗死(OR=5.537,95%CI 2.226~13.769)、血小板计数降低(OR=0.994,95%CI 0.991~0.998)是老年重症患者CRPA感染的独立危险因素。根据LASSO回归筛选脑梗死、血小板计数两个变量构建列线图预测模型,模型AUC为0.784;校准曲线显示呈45°角,具有较好的校准能力;临床决策曲线显示,模型在60%~90%治疗阈值概率范围内具有较高的净收益。结论构建模型的变量简单有效。构建的模型具有良好区分度及准确性,对老年重症患者CRPA感染具有良好的预测价值。在一定范围内对高危人群及时干预可获得良好的临床收益。

1990-2019年中国心血管疾病流行现状、疾病负担及发病预测分析

背景心血管疾病是严重危害人类健康的重大慢病,且仍是我国乃至全球一个亟待解决的公共卫生问题。目的探讨1990—2019年中国心血管疾病流行特征和疾病负担情况,预测2020—2050年中国心血管疾病发病情况,为心血管疾病相关防治策略的制订提供参考。方法检索2019年全球疾病负担研究(GBD 2019)数据库,提取1990—2019年中国及全球心血管疾病负担及危险因素的相关数据并进行分析,使用基于GBD 2019数据库可公开的发病率、患病率、死亡率以及对应的年龄标准化(简称标化)率来量化心血管疾病的疾病流行情况,使用伤残损失寿命年(YLD)、早死损失寿命年(YLL)、伤残调整寿命年(DALY)量化疾病负担情况,构建ARIMA模型预测2020—2050年中国心血管疾病的发病情况。结果1990—2019年中国心血管疾病的发病率、患病率及死亡率呈逐年上升趋势,其中发病率、患病率及死亡率分别增长了93.75%、99.75%、57.39%。女性的标化发病率、标化患病率均高于男性,标化死亡率低于男性(P<0.05)。从2019年数据上看,中国心血管疾病总体发病率随着年龄升高呈上升趋势,在95岁及以上年龄组达到最高值。男性和女性的发病率趋势与总体趋势相似,但略有差异。总体患病率随着年龄升高呈上升趋势,女性高于男性。在45岁以后心血管疾病的死亡率呈现上升趋势,男性的死亡率在各个年龄段均高于女性。1990—2019年男性YLL率、YLD率、DALY率增长了36.99%、102.42%、40.78%,女性增长了2.79%、107.13%、11.50%。从2019年数据来看,中国总人群心血管疾病的YLL率、YLD率、DALY率总体随着年龄的增加呈上升趋势,尚无拐点出现。男性YLL率、DALY率随人口老龄化进展逐渐升高并远高过女性,女性YLD率在55~59岁年龄组后逐渐升高并远高过男性。1990—2019年,全球心血管疾病的标化发病率、标化患病率及标化死亡率呈逐年下降趋势,而中国的标化发病率和标化患病率仍有所增加,标化死亡率虽有所降低,但仍高于全球范围。从全球整体水平上看,中国心血管疾病的标化YLL率、标化DALY率虽同全球一样呈下降趋势,但2000年以后中国心血管疾病的疾病负担高于全球整体水平,且标化YLD率逐年增加。与心血管疾病死亡相关的危险因素主要是吸烟、吸二手烟、饮酒、体力活动少、高空腹血糖、高收缩压、高BMI、高低密度脂蛋白胆固醇以及肾功能不全。从中国及全球相关数据来看,高收缩压(高血压)依然是造成心血管疾病死亡的首要危险因素,且死亡人数逐年增加。高低密度脂蛋白胆固醇(高脂血症)是全球及近年来中国心血管疾病死亡的第二因素。2020—2050年中国心血管疾病标化发病率仍呈上升趋势,预计到2050年心血管疾病的标化发病率将达到663.618/10万。结论1990—2019年我国心血管疾病的发病率、患病率及死亡率呈逐年上升趋势,因心血管疾病导致的疾病负担较重,在未来50年尚无拐点出现,疾病流行及负担情况均高于全球范围。预计到2050年心血管疾病的标化发病率将达到663.618/10万。

危重症患者急性皮肤衰竭风险因素及预测工具的研究进展

急性皮肤衰竭是指由器官严重功能障碍(衰竭)或其他器官系统同时发生的灌注不足而导致的皮肤和皮下组织死亡事件,高发于危重症患者。作为一个新兴概念,我国在该领域的研究处于起步阶段,医护人员对其认识不足。因此,本文对危重症患者急性皮肤衰竭的危险因素及风险预测方法进行综述,以期为护理人员早期识别急性皮肤衰竭的高危患者并制订有效的预防和干预方案、降低急性皮肤衰竭的危害提供依据。

神经外科重症病人肠内营养并发腹压增高的危险因素

目的探讨神经外科重症病人肠内营养后发生腹压增高的危险因素。方法回顾性分析2022年6~12月神经外科监护室接受肠内营养治疗的123例神经外科重症病人的临床资料。肠内营养治疗后,在尿管末端连接压力传感器监测腹压,持续增高>12mmHg称为腹压增高。结果123例接受肠内营养的神经重症病人中,38例(30.89%)发生腹压增高。多因素logistic回归分析显示,镇静药物、喂养不耐受是神经外科重症病人肠内营养后发生腹压增高的独立危险因素(P<0.05),鼻肠管喂养、血清白蛋白正常是神经外科重症病人肠内营养后发生腹压增高的保护因素(P<0.05)。结论神经外科重症病人实施肠内营养过程中腹压增高发生率较高,镇静药物、鼻肠管喂养、血清白蛋白、喂养不耐受是神经外科重症病人肠内营养后发生腹压增高的影响因素,临床需参考这些因素制定预警方案,以改善病人的预后。

早期新生儿凝血功能异常达危急值的危险因素及与危重病例的相关性分析

目的探讨早期新生儿凝血功能异常达危急值的危险因素及其与危重病例的相关性。方法选取2019年5月至2021年9月濉溪县医院新生儿科收治的凝血功能异常达危急值的100例早期新生儿作为危急值组,并按1∶1比例随机选择同期住院凝血功能未达危急值的早期新生儿100例作为对照组。依据新生儿危重病例评分(neonatal critical illness scores,NCIS)评估病情危重程度,对其临床资料进行回顾性分析。对凝血功能异常达危急值的相关危险因素进行单因素和多因素Logistic回归分析。结果危急值组发生危重病例的比例高于对照组[60.0%(60/100)与27.0%(27/100),χ^(2)=22.154,P<0.001]。早期新生儿凝血功能异常达危急值与危重病例相关(Pearson列联系数C=0.316,P<0.001)。单因素分析结果显示,危急值组的胎儿窘迫、重度窒息、早期早产儿、中期早产儿、新生儿呼吸窘迫综合征、胎盘早剥、低体温、酸中毒的比例均高于对照组(P值均<0.05)。多因素Logistic回归分析结果显示,胎儿窘迫(OR=8.528,95%CI:1.728~42.085,P=0.009)、重度窒息(OR=10.129,95%CI:2.109~48.685,P=0.004)、早期早产儿(OR=15.689,95%CI:3.385~72.722,P<0.001)、中期早产儿(OR=10.186,95%CI:3.579~28.988,P<0.001)是早期新生儿凝血功能异常达危急值的独立危险因素。结论胎儿窘迫、重度窒息、早期早产儿、中期早产儿是早期新生儿凝血功能异常达危急值的独立危险因素。早期新生儿凝血功能异常达危急值与危重病例相关。

Intensive care unit-acquired weakness and mechanical ventilation:A reciprocal relationship

Intensive care unit-acquired weakness(ICU-AW;ICD-10 Code:G72.81)is a syndrome of generalized weakness described as clinically detectable weakness in critically ill patients with no other credible cause.The risk factors for ICU-AW include hyperglycemia,parenteral nutrition,vasoactive drugs,neuromuscular blocking agents,corticosteroids,sedatives,some antibiotics,immobilization,the disease severity,septicemia and systemic inflammatory response syndrome,multiorgan failure,prolonged mechanical ventilation(MV),high lactate levels,older age,female sex,and pre-existing systemic morbidities.There is a definite association between the duration of ICU stay and MV with ICU-AW.However,the interpretation that these are modifiable risk factors influencing ICU-AW,appears to be flawed,because the relationship between longer ICU stays and MV with ICU-AW is reciprocal and cannot yield clinically meaningful strategies for the prevention of ICU-AW.Prevention strategies must be based on other risk factors.Large multicentric randomized controlled trials as well as meta-analysis of such studies can be a more useful approach towards determining the influence of these risk factors on the occurrence of ICU-AW in different populations.

急诊危重患者院内转运过程中临床恶化的危险因素分析及护理

目的探讨急诊危重患者院内转运过程中临床恶化的危险因素及护理对策。方法采用回顾性研究方法,选取2023年3—12月急诊科收治且因诊断治疗需在院内转运的危重患者,收集转运前风险评分、患者临床资料、转运护士资质、准备时间、最终护理时间以及转运过程中表征临床恶化的国家早期预警评分系统(NEWS)评分。对危重患者院内转运过程中的危险因素进行多因素Logistic回归分析。结果839例急诊危重患者院内转运过程中临床恶化率为28.37%。多因素Logistic回归分析发现,21~25 min转运时间与临床恶化显著相关(β=0.133,P=0.027)。以下患者症状与临床恶化的可能性相关性较高:身体部位受伤/头部受伤/烧伤/中毒(β=0.670,P=0.030)、呼吸困难/痉挛(β=0.919,P<0.001)、休克/心律失常/胸痛/出血(β=1.134,P<0.001)、昏迷/意识改变/晕厥(β=1.343,P<0.001)和心脏骤停(β=2.251,P<0.001)。病情不稳定(β=1.689,P<0.001)、转移前风险评分为8分或更高(β=0.625,P<0.001)以及由非专职转运护士转运(β=0.495,P<0.008)的患者临床恶化率较高。结论急诊危重患者院内转运过程中临床恶化率较高。涉及循环、呼吸和神经系统的疾病,病情不稳定,转运前风险评分高,21~25 min转运时间以及由无急诊转运专职资质护士转运均与较高的临床恶化率相关。

重症患者ICU获得性代谢性碱中毒的危险因素分析及风险预测模型构建

目的观察重症医学科(ICU)患者在治疗期间发生代谢性碱中毒(代碱)的情况,探讨发生代碱的高危因素并建立风险预测模型。方法收集综合ICU入住院患者的一般临床资料(性别、年龄、基础疾病等),记录发生酸碱紊乱类型、发生代碱患者疾病分布,比较代碱组与非代碱组患者的一般临床资料、用药情况及实验室指标,单因素分析可能导致代碱的危险因素;将有统计学意义的危险因素纳入多因素logistic回归分析,根据OR值建立预测ICU发生代碱的模型,以ROC曲线来评价模型的预测效果。结果根据纳排标准最终纳入507例患者,其中发生代碱(代碱组)172例(33.93%)、未发生任何酸碱紊乱(非代碱组)100例(19.72%);发生代碱时间的中位数为3(2,4)d,代碱患者ICU住院期间病死率为8.1%,该组患者ICU住院时间和机械通气时间较非代碱组明显延长(P<0.05);多因素logistic回归分析显示,胃肠减压、利尿剂及碱性药的使用、高血Na(>143 mmol/L)为发生ICU获得性代碱的独立危险因素(P<0.05),其风险评分模型中对应的分值为4、3、2、1分;模型在ROC曲线下面积为0.799、灵敏度79.1%、特异度73.0%。结论胃肠减压、利尿剂、碱性药、高血Na(>143 mmol/L)是重症患者在ICU住院期间发生代碱的独立危险因素。

ICU获得性衰弱发生影响因素分析及护理干预措施

目的分析重症监护室获得性衰弱(ICU-AW)发生的高危因素,总结护理干预措施。方法回顾性收集261例2023年1月—2023年12月医院ICU就诊的危重症患者的临床资料,根据患者是否并发ICU-AW可分为ICU-AW组(115例)和非ICU-AW组(146例)。根据患者临床资料将具有统计学意义的因素纳入多因素Logistic回归分析,以进一步分析危重症患者ICU-AW发生的危险因素。结果261例危重症患者中有115例发生ICU-AW,ICU-AW发生率为44.06%。多因素Logistic回归分析结果显示,入院时急性生理及慢性健康状况评分(APACHE II评分)、血乳酸水平高、ICU入住时间和机械通气时间长、诊断为多器官功能障碍、连续肾脏替代治疗、应用激素类药物均为危重症患者ICU-AW发生的独立危险因素(OR=3.086、4.297、1.958、3.180、3.736、3.658、4.031,P<0.05)。结论ICU患者ICU-AW发生率较高,且其危险因素包括入院时APACHE II评分、血乳酸水平高,ICU入住时间、机械通气时间长,多器官功能障碍、连续肾脏替代治疗、应用激素类药物等,临床可据此予以ICU患者针对性干预以降低ICU-AW发生率,进而改善患者预后。

危重症患者气管插管后低血压发生情况及其影响因素分析

目的分析急诊危重症患者紧急气管插管后低血压的发生情况及其危险因素。方法回顾性收集行气管插管的危重症患者病历资料,依据插管后血压情况分组,分析患者发生低血压的危险因素,并采用受试者工作特征(ROC)曲线分析模型预测价值。结果共收集102例患者,其中31例(30.39%)在气管插管后出现低血压(低血压组),71例(69.61%)血压正常(血压正常组);2组体质量、体重指数、收缩压、舒张压、血浆白蛋白水平比较,差异有统计学意义(均P<0.05)。Logistic回归分析结果显示,体质量、体重指数、插管前收缩压、插管前舒张压、血浆白蛋白为急诊危重症患者气管插管后低血压的危险因素,各变量预测急诊危重症患者气管插管后低血压的AUC值分别为0.762、0.739、0.717、0.758、0.834(均P<0.05)。结论急诊危重症患者紧急气管插管后低血压发生率较高,临床可通过患者的体重指数、插管前收缩压和舒张压、血浆白蛋白进行预估。

ICU重症患者动脉置管后非计划性拔管相关因素分析及预测模型

目的分析影响重症监护病房(ICU)重症患者动脉置管后非计划性拔管(UEX)的相关因素,并完成预测模型的构建与验证。方法回顾性选取2020年1月~2022年12月南京医科大学附属淮安第一医院收治的ICU重症患者104例,根据患者动脉置管后UEX事件发生与否将患者分为常规拔管组(n=80)和UEX组(n=24)。通过单因素分析获取影响患者动脉置管后UEX的可能相关因素,并通过二元logistic回归分析对相关因素进行独立危险因素的筛选。根据独立危险因素构建预测模型,并通过受试者工作特征(ROC)曲线及曲线下面积(AUC)进行验证。结果104例ICU重症患者中,共24例患者动脉置管后发生UEX,占23.08%(24/104)。单因素分析结果显示,两组患者的年龄、合并高血压情况、镇静药物使用情况、导管置管时间、静脉血栓发生情况比较,差异均有统计学意义(t=3.585、9.069、4.287、3.127、12.076,P<0.05)。多因素分析结果显示,年龄大(OR=1.038,95%CI=1.009~1.068,P=0.009)、导管留置时间长(OR=1.587,95%CI=1.122~2.244,P=0.009)和发生静脉血栓(OR=5.133,95%CI=1.404~18.767,P=0.013)均为ICU重症患者动脉置管后UEX的独立危险因素(P<0.05)。以独立危险因素构建预测模型,ROC的AUC为0.776。结论ICU重症患者年龄大、发生静脉血栓导管留置时间长均为ICU重症患者动脉置管后UEX的独立危险因素。