妊娠期急性脂肪肝(acute fatty liver of pregnancy,AFLP)是一种少见的危及生命的急症,是妊娠所特有的,通常发生在妊娠晚期或产后早期。不论分娩年龄或严重程度如何,及时分娩对于遏制病情至关重要。现将本院收治的2例AFLP并发多器官功...妊娠期急性脂肪肝(acute fatty liver of pregnancy,AFLP)是一种少见的危及生命的急症,是妊娠所特有的,通常发生在妊娠晚期或产后早期。不论分娩年龄或严重程度如何,及时分娩对于遏制病情至关重要。现将本院收治的2例AFLP并发多器官功能衰竭综合征(multiple organ dysfunction syndrome,MODS)的病例报道如下,以期提高对AFLP的识别和管理。展开更多
Background: Multiple organ dysfunction syndrome(MODS) is the sequential failure of several organ systems after a trigger event, like cardiogenic shock or decompensated heart failure. Mortality is high, up to 70% . Aut...Background: Multiple organ dysfunction syndrome(MODS) is the sequential failure of several organ systems after a trigger event, like cardiogenic shock or decompensated heart failure. Mortality is high, up to 70% . Autonomic dysfunction(AD)may substantially contribute to the development of MODS. In cardiology, it has recently been shown that nonlinear parameters could predict mortality.Our study aimed at 1. characterising the complex characteristics of AD of critically ill MODS patients by the nonlinear parameters of autonomic information flow(AIF), 2. comparing AIF with autonomic function of healthy controls, and 3. characterising the accuracy of this parameter in predicting mortality in MODS. Methods: We enrolled 43 score-defined MODS patients who were consecutively admitted to a twelve-bed medical intensive care unit in a university centre into this prospective outcome study. Additionally, we assigned 50 healthy controls to the study. AIF was assessed as a complexity function of AD using 24-h ECG. Measures of AIF were introduced according to the standard HRV concept. The patients were followed up for 28-day mortality. Results: MODS causes a disorganisation of short term AIF in favour of an enhanced(rigid) long term AIF. Concerning prognosis increased short term AIF was associated with survival. Short term AIF discriminated between MODS survivors and nonsurvivors at the level of APACHE II score. Conclusions: This is the first study providing evidence that complex AD of MODS patients is specifically assessed by AIF time scales and that AIF has significant prognostic impact.展开更多
目的基于入院时临床数据,分析恙虫病患者并发多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)相关危险因素,建立个体化预测恙虫病患者发生MODS风险的列线图模型。方法采用回顾性研究方法,分析住院治疗的恙虫病患者入...目的基于入院时临床数据,分析恙虫病患者并发多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)相关危险因素,建立个体化预测恙虫病患者发生MODS风险的列线图模型。方法采用回顾性研究方法,分析住院治疗的恙虫病患者入院时临床资料,将最终研究对象随机分为建模组(50%)与验证组(50%),建模组数据用于建立二元多因素logistic模型,用R软件绘制列线图,分析患者MODS发生因素。验证组数据用于验证模型。采用ROC曲线和校准图验证列线图模型的预测效能及准确度。结果瘀点或瘀斑(OR=0.001,95%CI:0.00~0.105)、Hb(OR=1.240,95%CI:1.075~1.683)、Plt(OR=1.146,95%CI:1.049~1.400)、ALB(OR=1.865,95%CI:1.317~4.265)、D-二聚体(OR=0.971,95%CI:0.937~0.987)和Pt(OR=0.507,95%CI:0.230~0.765)是患者发生MODS的独立危险因素(P<0.05)。建模组模型ROC曲线的AUC为0.924,验证组ROC曲线的AUC为0.911,两组ROC曲线比较差异无统计学意义(D=1.243,P=0.215)。校准图显示,两组预测模型校准曲线与标准曲线均接近,有统计学意义(P=0.746、0.870,均>0.10)。结论通过瘀点或瘀斑、Hb、Plt、ALB、D-二聚体和Pt独立危险因素,建立的预测恙虫病患者MODS发生风险的列线图模型,具有良好的诊断效能和准确度,对甄别该病患者中的MODS高风险人群,制定干预决策有指导意义。展开更多
文摘妊娠期急性脂肪肝(acute fatty liver of pregnancy,AFLP)是一种少见的危及生命的急症,是妊娠所特有的,通常发生在妊娠晚期或产后早期。不论分娩年龄或严重程度如何,及时分娩对于遏制病情至关重要。现将本院收治的2例AFLP并发多器官功能衰竭综合征(multiple organ dysfunction syndrome,MODS)的病例报道如下,以期提高对AFLP的识别和管理。
文摘Background: Multiple organ dysfunction syndrome(MODS) is the sequential failure of several organ systems after a trigger event, like cardiogenic shock or decompensated heart failure. Mortality is high, up to 70% . Autonomic dysfunction(AD)may substantially contribute to the development of MODS. In cardiology, it has recently been shown that nonlinear parameters could predict mortality.Our study aimed at 1. characterising the complex characteristics of AD of critically ill MODS patients by the nonlinear parameters of autonomic information flow(AIF), 2. comparing AIF with autonomic function of healthy controls, and 3. characterising the accuracy of this parameter in predicting mortality in MODS. Methods: We enrolled 43 score-defined MODS patients who were consecutively admitted to a twelve-bed medical intensive care unit in a university centre into this prospective outcome study. Additionally, we assigned 50 healthy controls to the study. AIF was assessed as a complexity function of AD using 24-h ECG. Measures of AIF were introduced according to the standard HRV concept. The patients were followed up for 28-day mortality. Results: MODS causes a disorganisation of short term AIF in favour of an enhanced(rigid) long term AIF. Concerning prognosis increased short term AIF was associated with survival. Short term AIF discriminated between MODS survivors and nonsurvivors at the level of APACHE II score. Conclusions: This is the first study providing evidence that complex AD of MODS patients is specifically assessed by AIF time scales and that AIF has significant prognostic impact.
文摘目的基于入院时临床数据,分析恙虫病患者并发多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)相关危险因素,建立个体化预测恙虫病患者发生MODS风险的列线图模型。方法采用回顾性研究方法,分析住院治疗的恙虫病患者入院时临床资料,将最终研究对象随机分为建模组(50%)与验证组(50%),建模组数据用于建立二元多因素logistic模型,用R软件绘制列线图,分析患者MODS发生因素。验证组数据用于验证模型。采用ROC曲线和校准图验证列线图模型的预测效能及准确度。结果瘀点或瘀斑(OR=0.001,95%CI:0.00~0.105)、Hb(OR=1.240,95%CI:1.075~1.683)、Plt(OR=1.146,95%CI:1.049~1.400)、ALB(OR=1.865,95%CI:1.317~4.265)、D-二聚体(OR=0.971,95%CI:0.937~0.987)和Pt(OR=0.507,95%CI:0.230~0.765)是患者发生MODS的独立危险因素(P<0.05)。建模组模型ROC曲线的AUC为0.924,验证组ROC曲线的AUC为0.911,两组ROC曲线比较差异无统计学意义(D=1.243,P=0.215)。校准图显示,两组预测模型校准曲线与标准曲线均接近,有统计学意义(P=0.746、0.870,均>0.10)。结论通过瘀点或瘀斑、Hb、Plt、ALB、D-二聚体和Pt独立危险因素,建立的预测恙虫病患者MODS发生风险的列线图模型,具有良好的诊断效能和准确度,对甄别该病患者中的MODS高风险人群,制定干预决策有指导意义。
