Objectives:This study aimed to study the characteristics of in-hospital deterioration in patients with congenital heart disease who required rapid response system activation and identify risk factors associated with 1...Objectives:This study aimed to study the characteristics of in-hospital deterioration in patients with congenital heart disease who required rapid response system activation and identify risk factors associated with 1-month mortality.Methods:We retrospectively analysed data from a Japanese rapid response system registry with 35 participating hospitals.We included consecutive patients with congenital heart disease who required rapid response system activation between January 2014 and March 2018.Logistic regression analyses were performed to examine the associations between 1-month mortality and other patient-specific variables.Results:Among 9,607 patients for whom the rapid response system was activated,only 82(0.9%)had congenital heart disease.Only few patients with congenital heart disease were being treated at the cardiology and cardiovascular surgery departments(12.3%and 9.9%,respectively).Moreover,the incidences of rapid-response events after intensive care unit discharge or surgery were low(6.8% and 12.2%,respectively).The most common reason for rapid response system activation was respiratory dysfunction(desaturation:35.4%,tachypnoea:25.6%,and new dyspnoea:19.5%).Rapid response system interventions and intensive care unit transfers were required for 65.9% and 20.7%of patients,respectively.The mortality rate was 1.2% at the end of the rapid response system intervention and 11.0% after 1 month.Moreover,decreased respiratory rate and decreased heart rate at rapid response system activation were associated with increased 1-month mortality.The adjusted odds ratio was 1.10(95% confidence interval 1.02–1.19)and 1.02(95% confidence interval,1.00–1.04) for respiratory rate and heart rate,respectively.Conclusions:Rapid response systems were rarely activated after cardiac surgery and intensive care unit discharge,which were situations with a high risk of sudden deterioration in patients with congenital heart disease.Therefore,encouraging the use of the rapid response system in these departments will enable intervention by a third,specialised team for in-hospital emergencies and help provide comprehensive medical care to patients.Furthermore,1-month mortality was associated with vital signs at rapid response system activation.These findings may guide treatment selection for patients with congenital heart disease showing deterioration.展开更多
目的探究急危重症剖宫产术产妇中,联合应用快速护理团队模式、护理行为感知模式的价值。方法选取河南省人民医院2021年12月至2023年12月期间收入的86例剖宫产产妇,所有产妇均存在急危重症。基于护理模式的差异性,将其分为研究组(n=43,...目的探究急危重症剖宫产术产妇中,联合应用快速护理团队模式、护理行为感知模式的价值。方法选取河南省人民医院2021年12月至2023年12月期间收入的86例剖宫产产妇,所有产妇均存在急危重症。基于护理模式的差异性,将其分为研究组(n=43,快速护理团队模式+护理行为感知模式)、对照组(n=43,快速护理团队模式),分析其在手术相关指标、产妇情况、新生儿情况差异。结果护理后,研究组手术室响应时间、手术时间、术中出血量、并发症发生率、产后大出血发生率均低于对照组,差异均有统计学意义(P<0.05),两组重症监护室抢救情况比较,差异无统计学意义(P>0.05)。护理前,两组产妇情绪评分以及应激反应指标(皮质醇、肾上腺素、去甲肾上腺素水平)比较,差异均无统计学意义(P>0.05),护理后,两组汉密尔顿焦虑量表(HAMA)评分均降低,应激反应指标均提高,研究组HAMA评分低于对照组,应激反应指标低于对照组,差异均有统计学意义(P<0.05)。护理后,两组新生儿1 min Apgar评分差异无统计学意义(P>0.05),研究组新生儿5 min Apgar评分、脐带血pH值高于对照组,研究组住院时间低于对照组,差异均有统计学意义(P<0.05)结论急危重症剖宫产术产妇中,联合应用快速护理团队模式、护理行为感知模式的价值较为理想,能够降低剖宫产手术时间以及术中出血量,使得术后并发症、产后大出血情况获得显著减少,同时进一步改善产妇焦虑情绪与应激情况,使新生儿5 min Apgar评分、脐带血pH值获得显著改善,促进其住院时间降低,具有临床应用意义。展开更多
Objective The purpose of this study is to evaluate the role of point-of-care ultrasound( POCUS) in assessm ent of patients with dyspnea in Rapid Response Team( RRT)consultation. 53 patients were included and their pre...Objective The purpose of this study is to evaluate the role of point-of-care ultrasound( POCUS) in assessm ent of patients with dyspnea in Rapid Response Team( RRT)consultation. 53 patients were included and their pre-POCUS, post-POCUS and final diagnoses were docum ented. Com pared with pre-POCUS diagnoses,the accuracy of postPOCUS diagnoses increased significantly from 37.7% up to 79.2%,P<0.01( final diagnoses as golden standard). When stratified by etiology, we can see that POCUS im proved the diagnostic sensitivity and specificity in m ost of the diseases. But still there were 11 patients in whom POCUS fail to diagnose. And in those POCUS-fail group the m ortality seem ed higher than in POCUS achieved group. In conclusion POCUS is a convenient and useful diagnostic tool which can im prove the diagnostic accuracy of patients with sudden onset of dyspnea in RRT consultation.展开更多
目的探讨快速反应团队在产科危急重症手术护理中的临床效果。方法选取赣州市人民医院2018年1月~2019年6月收治的156例需紧急剖宫产手术的孕妇作为研究对象,按照时间先后顺序分为对照组(2018年1~9月收治的82例)与实验组(2018年10月~2019...目的探讨快速反应团队在产科危急重症手术护理中的临床效果。方法选取赣州市人民医院2018年1月~2019年6月收治的156例需紧急剖宫产手术的孕妇作为研究对象,按照时间先后顺序分为对照组(2018年1~9月收治的82例)与实验组(2018年10月~2019年6月收治的74例)。对照组按紧急剖宫产护理常规进行手术护理配合,实验组在此基础上成立以麻醉科为首的快速反应团队,对紧急剖宫产手术进行全方位的医疗、护理配合。比较两组的相关时间、新生儿1 min Apgar评分和脐带动脉血pH值。结果实验组孕妇到达手术室的时间、手术室护理准备时间、麻醉完成时间、新生儿科医生到达时间、手术切皮到胎儿娩出时间、决定手术至胎儿娩出的时间(DDI)均短于对照组,1 min Apgar评分、脐带动脉血pH值高于对照组,差异有统计学意义(P<0.05)。结论成立产科快速反应团队进行急救模拟培训,优化急救配合流程,能够有效缩短产科危急重症手术DDI,提高抢救成功率,保障患者手术安全,有效改善新生儿的预后。展开更多
基金This work was supported by the Japan Society for the Promotion of Science KAKENHI(Grant Nos.JP24592755,JP18K16548)the Japanese Society of Intensive Care Medicine,and the Japanese Society of Emergency Medicine.
文摘Objectives:This study aimed to study the characteristics of in-hospital deterioration in patients with congenital heart disease who required rapid response system activation and identify risk factors associated with 1-month mortality.Methods:We retrospectively analysed data from a Japanese rapid response system registry with 35 participating hospitals.We included consecutive patients with congenital heart disease who required rapid response system activation between January 2014 and March 2018.Logistic regression analyses were performed to examine the associations between 1-month mortality and other patient-specific variables.Results:Among 9,607 patients for whom the rapid response system was activated,only 82(0.9%)had congenital heart disease.Only few patients with congenital heart disease were being treated at the cardiology and cardiovascular surgery departments(12.3%and 9.9%,respectively).Moreover,the incidences of rapid-response events after intensive care unit discharge or surgery were low(6.8% and 12.2%,respectively).The most common reason for rapid response system activation was respiratory dysfunction(desaturation:35.4%,tachypnoea:25.6%,and new dyspnoea:19.5%).Rapid response system interventions and intensive care unit transfers were required for 65.9% and 20.7%of patients,respectively.The mortality rate was 1.2% at the end of the rapid response system intervention and 11.0% after 1 month.Moreover,decreased respiratory rate and decreased heart rate at rapid response system activation were associated with increased 1-month mortality.The adjusted odds ratio was 1.10(95% confidence interval 1.02–1.19)and 1.02(95% confidence interval,1.00–1.04) for respiratory rate and heart rate,respectively.Conclusions:Rapid response systems were rarely activated after cardiac surgery and intensive care unit discharge,which were situations with a high risk of sudden deterioration in patients with congenital heart disease.Therefore,encouraging the use of the rapid response system in these departments will enable intervention by a third,specialised team for in-hospital emergencies and help provide comprehensive medical care to patients.Furthermore,1-month mortality was associated with vital signs at rapid response system activation.These findings may guide treatment selection for patients with congenital heart disease showing deterioration.
文摘目的探究急危重症剖宫产术产妇中,联合应用快速护理团队模式、护理行为感知模式的价值。方法选取河南省人民医院2021年12月至2023年12月期间收入的86例剖宫产产妇,所有产妇均存在急危重症。基于护理模式的差异性,将其分为研究组(n=43,快速护理团队模式+护理行为感知模式)、对照组(n=43,快速护理团队模式),分析其在手术相关指标、产妇情况、新生儿情况差异。结果护理后,研究组手术室响应时间、手术时间、术中出血量、并发症发生率、产后大出血发生率均低于对照组,差异均有统计学意义(P<0.05),两组重症监护室抢救情况比较,差异无统计学意义(P>0.05)。护理前,两组产妇情绪评分以及应激反应指标(皮质醇、肾上腺素、去甲肾上腺素水平)比较,差异均无统计学意义(P>0.05),护理后,两组汉密尔顿焦虑量表(HAMA)评分均降低,应激反应指标均提高,研究组HAMA评分低于对照组,应激反应指标低于对照组,差异均有统计学意义(P<0.05)。护理后,两组新生儿1 min Apgar评分差异无统计学意义(P>0.05),研究组新生儿5 min Apgar评分、脐带血pH值高于对照组,研究组住院时间低于对照组,差异均有统计学意义(P<0.05)结论急危重症剖宫产术产妇中,联合应用快速护理团队模式、护理行为感知模式的价值较为理想,能够降低剖宫产手术时间以及术中出血量,使得术后并发症、产后大出血情况获得显著减少,同时进一步改善产妇焦虑情绪与应激情况,使新生儿5 min Apgar评分、脐带血pH值获得显著改善,促进其住院时间降低,具有临床应用意义。
文摘Objective The purpose of this study is to evaluate the role of point-of-care ultrasound( POCUS) in assessm ent of patients with dyspnea in Rapid Response Team( RRT)consultation. 53 patients were included and their pre-POCUS, post-POCUS and final diagnoses were docum ented. Com pared with pre-POCUS diagnoses,the accuracy of postPOCUS diagnoses increased significantly from 37.7% up to 79.2%,P<0.01( final diagnoses as golden standard). When stratified by etiology, we can see that POCUS im proved the diagnostic sensitivity and specificity in m ost of the diseases. But still there were 11 patients in whom POCUS fail to diagnose. And in those POCUS-fail group the m ortality seem ed higher than in POCUS achieved group. In conclusion POCUS is a convenient and useful diagnostic tool which can im prove the diagnostic accuracy of patients with sudden onset of dyspnea in RRT consultation.
文摘目的探讨快速反应团队在产科危急重症手术护理中的临床效果。方法选取赣州市人民医院2018年1月~2019年6月收治的156例需紧急剖宫产手术的孕妇作为研究对象,按照时间先后顺序分为对照组(2018年1~9月收治的82例)与实验组(2018年10月~2019年6月收治的74例)。对照组按紧急剖宫产护理常规进行手术护理配合,实验组在此基础上成立以麻醉科为首的快速反应团队,对紧急剖宫产手术进行全方位的医疗、护理配合。比较两组的相关时间、新生儿1 min Apgar评分和脐带动脉血pH值。结果实验组孕妇到达手术室的时间、手术室护理准备时间、麻醉完成时间、新生儿科医生到达时间、手术切皮到胎儿娩出时间、决定手术至胎儿娩出的时间(DDI)均短于对照组,1 min Apgar评分、脐带动脉血pH值高于对照组,差异有统计学意义(P<0.05)。结论成立产科快速反应团队进行急救模拟培训,优化急救配合流程,能够有效缩短产科危急重症手术DDI,提高抢救成功率,保障患者手术安全,有效改善新生儿的预后。
