百日咳患儿免疫水平及其危重因素分析

目的系统分析百日咳患儿的免疫水平及其危重因素,以期为百日咳患儿的临床诊疗提供理论指导与参考借鉴。方法选取2019年9月至2021年3月收治于我院的百日咳患儿150例作为研究对象,按照病情严重程度进行分组,分为重症百日咳组(n=65)及普通型百日咳组(n=85)。通过系统对比两组患儿间免疫水平相关指标的差异,并探明上述指标与病情严重程度之间的相关性,进而为百日咳患儿的临床诊疗提高参考借鉴。结果①重症百日咳组IgA、IgG、IgM、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)显著低于普通型百日咳组,而CD_(8)^(+)、补体C_(3)及C_(4)水平均显著高于普通型百日咳组(P<0.05);②单因素分析表明,外周血白细胞、C反应蛋白、CD_(8)^(+)、补体C_(3)及C_(4)水平过高,IgA、IgG、IgM、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)水平过低以及血小板过少等均是诱发百日咳病情加重的独立危险因素(P<0.05);③Logistic多元回归分析表明,CD_(8)^(+)、补体C_(3)及C_(4)水平与百日咳病情严重程度呈显著正相关关系(OR=1.263,P=0.002;OR=1.482,P=0.001;OR=1.663,P=0.001);IgA、IgG以及CD_(4)^(+)与百日咳病情严重程度呈显著负相关关系(OR=-1.011,P=0.002;OR=-1.326,P=0.001;OR=-1.620,P=0.002)。结论百日咳患儿的免疫水平与健康对照存在显著差异,免疫相关指标的变化与病情严重程度息息相关。

肝炎后肝硬化危重因素探讨

本文对９６例肝炎后肝硬化住院患者进行了统计分析，Ｃｈｉｌｄ肝功能分级，探讨与死亡有关的危重因素。结果发现，上消化道出血，腹水及高胆红素血症、肝性脑病、肝肾综合征在死亡组的发生率明显高于生存组（Ｐ＜００５～０．００１）而血清转氨酶和自发性腹膜炎两组发生率相似（Ｐ＞００５），Ｃｈｉｌｄ肝功能分级基本上反映了病情的严重程度。

肝损伤后肝硬化危重因素分析

目的 :本文对 192例肝损伤后肝硬化住院患者进行了统计分析。方法 :child肝功能分级 ,分析与死亡有关的危重因素。结果 :发现上消化道出血 ,腹水及高胆红素血症、肝性脑病、肝肾综合征在死亡组的发生率明显高于生存组 (P <0 .0 5～ 0 .0 0 1)。结论 :血清转氨酸和自发性腹膜炎两组发生率相似 (P >0 .0 5 ) 。

Clinical outcomes in patients with ICU-related pancreatitis

AIM:To identify risk factors predictive of intensive care unit(ICU) mortality in patients with ventilator-related pancreatitis.The clinical outcomes of patients with ventilator-related pancreatitis were compared with those of patients with pancreatitis-related respiratory failure as well as controls.METHODS:One hundred and forty-eight patients with respiratory failure requiring mechanical ventilation and concomitant acute pancreatitis were identified from a prospectively collected dataset of 9108 consecutive patients admitted with respiratory failure over a period of five years.Sixty patients met the criteria for ventilator-related pancreatitis,and 88(control patients),for pancreatitis-related respiratory failure.RESULTS:Mortality rate in ventilator-related pancreatitis was comparable to that in ICU patients without pancreatitis by case-control methodology(P=0.544).Multivariate logistic regression analysis identified low PaO2/FiO2(OR:1.032,95% CI:1.006-1.059,P=0.016) as an independent risk factor for mortality in patients with ventilator-related pancreatitis.The mortality rate in patients with ventilator-related pancreatitis was lower than that in patients with acute pancreatitis-related respiratory failure(P<0.001).CONCLUSION:We found that low PaO2/FiO2 was an independent clinical parameter predictive of ICU mortality in patients with ventilator-related pancreatitis.

Noninfectious Fever Following Aortic Surgery:Incidence,Risk Factors,and Outcomes

Objective To determine the incidence, course, potential risk factors, and outcomes of noninfectious fever developed in patients after aortic surgery. Methods Patients who received operation for aortic aneurysm or dissection in our center from January 2006 to January 2008 were reviewed. Patients who met one of the following criteria were excluded： having a known source of infection during hospitalization; having a preoperative oral temperature greater than or equal to 38.0℃; undertaking emergency surgery; having incomplete data. Univariate analysis was performed in patients with noninfectious postoperative fever and those without, with respect to demographics, intraoperative data, etc. Risk factors for postoperative fever were considered for the muhivariate logistic regression model if they had a P value less than 0.10 in the univariate analysis. Results Totally 463 patients undergoing aortic surgery were enrolled for full review. Among them, 345 （74.5%） patients had noninfectious postoperative fever, the other 118 （25.5%） patients didn＇t develop postoperative fever. Univariate analysis demonstrated that several risk factors were associated with the development of noninfectious postoperative fever, including weight, surgical procedure, minimum intraoperative bladder temperature, temperature upon intensive care unit （ICU） admission, discharge, and during ICU stay, as well as blood transfusion. In a further multivariate analysis, surgical site of thoracic and thoracoabdominal aorta （odds ratio： 4.861; 95% confidence interval： 3.029-5.801; P=0.004）, lower minimum intraoperative bladder temperature （odds ratio： 1.117; 95% confidence interval： 1.01-1.24; P=0.04）, and higher temperature on admission to the ICU （odds ratio： 2.57; 95% confidence interval： 1.28-5.18; P=0.008） were found to be significant predictors for noninfectious postoperative fever. No difference was found between the febrile and afebrile patients with regard to postoperative hospitalization duration （P=0.558） or total medical costs （P=0.896）. Conclusion Noninfectious postoperative fever following aortic surgery is very common and closely related with perioperative interventions.

Lower body weight and female gender:Hyperphosphatemia risk factors after sodium phosphate preparations

Casals et al have reported an inverse correlation between serum phosphate and body weight after administration of sodium phosphate at a dose of 60 g. Our group has already described the relationship between body weight and hyperphosphatemia with these preparations, although our study was not quoted by Casals. We performed a pharmacokinetic study involving 13 volunteers who were divided into two groups on the basis of body weight： group I consisting of seven women with a median weight of 60 kg and group Ⅱ consisting of five men and one woman with a median weight of 119.2 kg. Group Ⅰdeveloped higher peak phosphate levels and maintained these levels above the subjects in Group Ⅱ for a prolonged time period despite adequate hydration being ensured with frequent monitoring of weight, fluid intake and total body weight. Our studydemonstrated that adequate hydration does not protect against the secondary effects of hyperphosphatemia. In the study by Casais et al, 66% of the study subjects were women, the correlation between serum phosphate and gender in their data also appears to be important. Women are at higher risk of acute phosphate nephropathy due to a diminished volume of distribution of the high dose of ingested phosphate. Decreased volume of distribution in women is due to diminished body weight. This is further compounded by decreased creatinine clearance in females.

Risk factors for prolonged intensive care unit stays in patients after cardiac surgery with cardiopulmonary bypass:A retrospective observational study

Objectives:Patients after cardiac surgery with cardiopulmonary bypass(CPB)require a stay in the ICU postoperatively.This study aimed to investigate the incidence of prolonged length of stay(LOS)in the ICU after cardiac surgery with CPB and identify associated risk factors.Methods:The current investigation was an observational,retrospective study that included 395 ICU patients who underwent cardiac surgery with CPB at a tertiary hospital in Guangzhou from June 2015 to June 2017.Data were obtained from the hospital database.Binary logistic regression modeling was used to analyze risk factors for prolonged ICU LOS.Results:Of 395 patients,137(34.7%)had a prolonged ICU LOS(>72.0 h),and the median ICU LOS was 50.9 h.Several variables were found associated with prolonged ICU LOS:duration of CPB,prolonged mechanical ventilation and non-invasive assisted ventilation use,PaO2/FiO2 ratios within 6 h after surgery,type of surgery,red blood cell infusion during surgery,postoperative atrial arrhythmia,postoperative ventricular arrhythmia(all P<0.05).Conclusions:These findings are clinically relevant for identifying patients with an estimated prolonged ICU LOS,enabling clinicians to facilitate earlier intervention to reduce the risk and prevent resulting delayed recovery.

Evaluation of the Appropriateness of Gastrointestinal Prophylaxis in the Critically III

The aim of this study was to determine the utilization of SRMD （stress related mucosal disease） prophylaxis in the ICU （intensive care unit） of a large teaching institution based on duration and defined adverse effects. Patients were reviewed for appropriateness of SRMD prophylactic therapy based on the presence of two independent risk factors （coagulopathy and mechanical ventilation greater than 48 hours） versus presence of any one risk factor from a list developed by the study investigator. Data was collected into spreadsheets and outcomes were analyzed using descriptive statistics. When evaluating patients based on the presence of any risk factor, 84 percent of patients had at least one risk factor present, while 16 percent did not have any. In patients who received famotidine, there was one occtLrrence of Clostridium difficile and 6 cases of electrolyte abnormalities. In patients who received a PPI, there was one documented case of HAP, two cases of ventilator-associated pneumonia, three cases of Clostridium difficile, and 14 patients who developed electrolyte abnormalities. Data does not show an association between acid suppression therapy and incidence of nosocomial infections. The number of patients whose therapy exceeded the appropriate stop-date compared with the number of patients in which SRMD prophylaxis was discontinued when risk factors diminished was greater when evaluating patients based upon the two independent risk factors.

Comparative analysis of characteristics and risk factors of traffic injury in aged people from urban and rural areas in Chongqing

：Objective：To study the epidemiologic characteristics of traffic injuries among people over 60 years old in the Nan＇ an district（urban）and Jiangjin district（rural）of Chongqing,and to discuss the corresponding strategies for its prevention and cure.Methods：Records of traffic injuries in people over 60 years old registered by the traffic police between 2000 and 2006 in Nan＇an district and Jiangjin district were collected in the Database of Road Traffic Accidents and Traffic Injuries.Epidemiologic characteristics of traffic injuries among the aged people were analyzed and compared.Results：Between the year 2000 and 2006,the average annual incidence of traffic injuries and mortality rate in the aged people in Nan＇ an district were 124.62/100 000 and 13.85/100 000 respectively,higher than that in Jiangjin district（27.49/100 000,7.13/100 000,P〈0.01）.However,the mortality rate for the aged people who were involved in traffic injuries in Jiangjin district was 20.60%,higher than that in Nan＇an district（10.00%,P〈0.01）.Head injury was the primary cause of death.Totally 76.58% of casualties were pedestrians.Over 90% of the traffic accidents occurred in the areas with no traffic signal or traffic control system.Conclusions：The traffic environment is unfavorable to the aged people.It is important to enhance traffic safety consciousness of drivers and the elderly and to strengthen traffic safety system and traffic law,so as to provide a safe road traffic environment for the aged people.