Examining the impact of early enteral nutritional support on postoperative recovery in patients undergoing surgical treatment for gastrointestinal neoplasms

BACKGROUND Patients with gastrointestinal tumors often suffer from poor nutritional status during treatment.Surgery is the main treatment for these patients,but the long postoperative recovery period is often accompanied by digestive and absorption dysfunction,leading to further deterioration of the nutritional status.Early enteral nutrition support is hypothesized to be helpful in improving this situation,but the exact effects have yet to be studied in depth.AIM To observe the effect of early enteral nutritional support on postoperative recovery in patients with surgically treated gastrointestinal tract tumors,with the expectation that by improving the nutritional status of patients,the recovery process would be accelerated and the incidence of complications would be reduced,thus improving the quality of life.METHODS A retrospective analysis of 121 patients with gastrointestinal tract tumors treated in our hospital from January 2020 to January 2023 was performed.Fifty-three of these patients received complete parenteral nutrition support as the control group for this study.The other 68 patients received early enteral nutritional support as the observation group of this study.The clinical indicators comparing the two groups included time to fever,time to recovery of postoperative bowel function,time to postoperative exhaustion,and length of hospital stay.The changes in immune function and nutritional indexes in the two groups were compared.Furthermore,we utilized the SF-36 scale to compare the changes in the quality of life between the two groups of patients.Finally,the occurrence of postoperative complications between the two patient groups was also compared.RESULTS The postoperative fever time,postoperative bowel function recovery time,postoperative exhaustion time,and hospitalization time were all higher in the control group than in the observation group(P<0.05).The levels of CD3+,CD4+,immunoglobulin(Ig)A,IgM,and IgG in the observation group were significantly higher than those in the control group at 1 d and 7 d postoperatively,while CD8+was lower than in the control group(P<0.05).Total protein,albumin,prealbumin,and transferrin levels were significantly higher in the observation group than in the control group at 7 d postoperatively(P<0.05).The SF-36 scores of patients in the observation group were significantly higher than those in the control group(P<0.0001).The overall incidence of adverse reactions after the intervention was significantly lower in the control group than in the observation group(P=0.021).CONCLUSION We found that patients with gastrointestinal tumors are nutritionally vulnerable,and early enteral nutrition support programs can improve the nutritional status of patients and speed up postoperative recovery.This program can not only improve the immune function of the patient and protect the intestinal function,but it can also help to improve the quality of life of the patient.However,this program will increase the incidence of complications in patients.Caution should be taken when adopting early enteral nutrition support measures for patients with gastric cancer.The patient's condition and physical condition should be comprehensively evaluated and closely monitored to prevent possible complications.

Nutritional status efficacy of early nutritional support in gastrointestinal care: A systematic review and meta-analysis

BACKGROUND Gastrointestinal surgery is a complicated process used to treat many gastrointestinal diseases,and it is associated with a large trauma:Most patients often have different degrees of malnutrition and immune dysfunction before surgery and are prone to various infectious complications during postoperative recovery,thus affecting the efficacy of surgical treatment.Therefore,early postoperative nutritional support can provide essential nutritional supply,restore the intestinal barrier and reduce complication occurrence.However,different studies have shown different conclusions.AIM To assess whether early postoperative nutritional support can improve the nutritional status of patients based on literature search and meta-analysis.METHODS Articles comparing the effect of early nutritional support and delayed nutritional support were retrieved from PubMed,EMBASE,Springer Link,Ovid,China National Knowledge Infrastructure,China Biology Medicine databases.Notably,only randomized controlled trial articles were retrieved from the databases(from establishment date to October 2022).The risk of bias of the included articles was determined using Cochrane Risk of Bias V2.0.The outcome indicators,such as albumin,prealbumin,and total protein,after statistical intervention were combined.RESULTS Fourteen literatures with 2145 adult patients undergoing gastrointestinal surgery(1138 patients(53.1%)receiving early postoperative nutritional support and 1007 patients(46.9%)receiving traditional nutritional support or delayed nutritional support)were included in this study.Seven of the 14 studies assessed early enteral nutrition while the other seven studies assessed early oral feeding.Furthermore,six literatures had"some risk of bias,"and eight literatures had"low risk".The overall quality of the included studies was good.Meta-analysis showed that patients receiving early nutritional support had slightly higher serum albumin levels,than patients receiving delayed nutritional support[MD(mean difference)=3.51,95%CI:-0.05 to 7.07,Z=1.93,P=0.05].Also,patients receiving early nutritional support had shorter hospital stay(MD=-2.29,95%CI:-2.89 to-1.69),Z=-7.46,P<0.0001)shorter first defecation time(MD=-1.00,95%CI:-1.37 to-0.64),Z=-5.42,P<0.0001),and fewer complications(Odd ratio=0.61,95%CI:0.50 to 0.76,Z=-4.52,P<0.0001)than patients receiving delayed nutritional support.CONCLUSION Early enteral nutritional support can slightly shorten the defecation time and overall hospital stay,reduce complication incidence,and accelerate the rehabilitation process of patients undergoing gastrointestinal surgery.

Consideration of the Self-Care Supporting Program Including Simple Exercise for Patients with Early Stages of Secondary Lower-Limb Lymphedema

Aim: We devised a self-care supporting program targeting patients with early stages of secondary lower-limb lymphedema. The program incorporates “Simple exercises to replace lymphatic drainage” based on lymphatic flow. The purpose of this study was to consider the feasibility of continuing this program. Methods: The participants were patients in the early stages of secondary lower-limb lymphedema after gynecological cancer surgery and lymphedema therapists with more than five years of experience. Patients continued self-care at home after being briefed on the program, and they were analyzed on their self-care continuity status one month later based on a self-administered questionnaire survey and self-care notes. We interviewed the lymphedema therapists about this program to discuss the feasibility of continuing it and obtain feedback. Results: The patients who participated in the study were six women who underwent surgery with lymph node dissection for gynecological cancer. The therapists were five nurses and one occupational therapist. The patient understood the importance of all items in the self-care. “Observation,” “Touching,” and “Skin care” were relatively easy to continue. “Lymph drainage” and “Exercise” were continued with “Simple exercises to replace lymphatic drainage”. “Other exercises” were able to continue by adding distance and time to daily activities. Furthermore, “Measurement” and “Recording” became a burden and were difficult to continue. Nonetheless, this program was generally approved by the lymphedema therapists. They also pointed out the content and format of the self-care notes as improvements. Conclusions: We found that the self-care supporting program that incorporated “Simple exercises to replace lymphatic drainage” might be feasible to continue self-care for patients with early stages of secondary lower-limb lymphedema. Furthermore, we found that we needed to improve the “Measurement” and “Recording” sections of this program.

Continuous prediction method of earthquake early warning magnitude for high-speed railway based on support vector machine

Purpose–Using the strong motion data ofK-net in Japan,the continuous magnitude prediction method based on support vector machine(SVM)was studied.Design/methodology/approach–In the range of 0.5–10.0 s after the P-wave arrival,the prediction time window was established at an interval of 0.5 s.12 P-wave characteristic parameters were selected as the model input parameters to construct the earthquake early warning(EEW)magnitude prediction model(SVM-HRM)for high-speed railway based on SVM.Findings–The magnitude prediction results of the SVM-HRM model were compared with the traditional magnitude prediction model and the high-speed railway EEW current norm.Results show that at the 3.0 s time window,themagnitude prediction error of the SVM-HRMmodel is obviously smaller than that of the traditionalτc method and Pd method.The overestimation of small earthquakes is obviously improved,and the construction of the model is not affected by epicenter distance,so it has generalization performance.For earthquake events with themagnitude range of 3–5,the single station realization rate of the SVM-HRMmodel reaches 95%at 0.5 s after the arrival of P-wave,which is better than the first alarm realization rate norm required by“The TestMethod of EEW andMonitoring Systemfor High-Speed Railway.”For earthquake eventswithmagnitudes ranging from3 to 5,5 to 7 and 7 to 8,the single station realization rate of the SVM-HRM model is at 0.5 s,1.5 s and 0.5 s after the P-wave arrival,respectively,which is better than the realization rate norm of multiple stations.Originality/value–At the latest,1.5 s after the P-wave arrival,the SVM-HRM model can issue the first earthquake alarm that meets the norm of magnitude prediction realization rate,which meets the accuracy and continuity requirements of high-speed railway EEW magnitude prediction.

Designing a Teaching Website for Early Warning Technology Support Specialty Based on Information Architecture

With the advancement of education informatization,learning through the internet has become a very important approach.Existing teaching websites generally have problems such as low accuracy of information grouping and obvious disconnection between the navigation system and content.Based on information architecture,a teaching website for early warning technical support specialty is designed in this paper from four aspects:content organization,identification,navigation,and interaction.The unification of information processing and information requirements is achieved using this method,which improves the quality of professional course construction for early warning technology support specialty.

开挖顺序及内支撑早期刚度对软土基坑稳定性影响规律

深基坑开挖变形控制是软土基坑工程的难题,工程中常采用密集的混凝土内支撑来提高支撑刚度,然而实际工程中未能合理考虑软土深基坑的开挖顺序和混凝土内支撑早期刚度影响,往往导致基坑实际变形远大于设计值。结合珠三角水资源配置工程的软土深基坑,利用验证后的数值模拟方法研究了不同开挖顺序及混凝土内支撑早期刚度对基坑受力和变形特性的影响规律,得出了分层分区非对称开挖和对称开挖对地连墙水平位移和地表沉降的影响规律。结果表明:尽管非对称开挖会造成基坑两侧的地连墙位移和地表沉降差异,但是密集内支撑条件下非对称开挖比对称开挖对于基坑周围地表沉降和地连墙水平位移影响更小并能够大量节约工期;受混凝土内支撑早期刚度影响,施作内支撑后越早进入下一步开挖,地连墙水平位移和周围地表沉降越大;考虑内支撑早期刚度影响时基坑上部的内支撑轴力会增大,而下部的内支撑轴力会减小,早期刚度越小,这种趋势越明显;现场施工时难以实时动态监测混凝土的弹性模量,极易造成内支撑轴力的早期监测数据失真,甚至给工程带来错误决策。

胸腹腔镜食管癌根治术联合早期肠内营养支持治疗老年食管癌的临床观察

目的:研究胸腹腔镜根治术联合早期肠内营养支持治疗老年食管癌的效果。方法:研究对象选取2018年01月至2021年12月我院收治的96例老年食管癌患者,按照随机数字法分为观察组和对照组,每组各48例。对照组术后采取肠外营养支持治疗,观察组术后采取肠内营养支持治疗,比较两组患者术后住院时间、肛门排气时间、首次排便时间、下床活动时间、恢复饮食时,以及术前及术后7 d的营养相关状况指标白蛋白(ALB)、总蛋白(TP)、前白蛋白(PA)和体质量指数(BMI),免疫功能相关指标CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+),观察两组主要并发症的发生情况。结果:观察组住院时间、肛门排气时间、首次排便时间、恢复饮食时间均少于对照组(P<0.05);观察组术后7 d的ALB、TP、PA、BMI均高于对照组(P<0.05);观察组术后7 d的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均高于对照组(P<0.05);观察组吻合口瘘、肺部并发症及总并发症的发生率(P<0.05),均低于对照组。结论:早期肠内营养支持可以有效改善老年患者在胸腹腔镜联合食管癌根治术后营养状态,增强免疫功能,减少并发症,促进术后恢复,具有较大临床价值。

基于PS-InSAR技术的晋城矿区地表形变监测及地质灾害风险预警

地表形变是一种严重的地质灾害现象,不仅严重影响灾害区居民的日常生活,而且会造成巨大的社会经济危害,尤其在采煤区。针对传统地表沉陷监测方法费时费力、无法获取地表沉降面状信息、难以进行地表沉陷灾害评估的不足,基于高分辨率SAR卫星影像,利用永久散射体合成孔径雷达干涉测量(PS-InSAR)技术对山西省晋城市晋城矿区2018年1月至2018年12月期间地表沉陷进行监测,分析获取了该地区地表连续形变情况,并利用该技术获取的海量PS点建立支持向量机(SVM)地质灾害风险评估预警模型,对晋城矿区周边居民点地质灾害风险进行了识别和预测。结果表明:晋城矿区10个煤矿及其周边区域存在较大的地表形变;晋城矿区平均LOS向年平均地表形变速率范围为-37~30.3 mm/a;PS-InSAR技术在晋城矿区地表形变监测中具有可行性,且可以实现矿区地质灾害风险综合识别和预警。

孕早期孕妇负性情绪水平、社会支持水平对睡眠质量的影响

目的探讨孕早期孕妇负性情绪水平、社会支持水平对睡眠质量的影响。方法选取269名正常产检的孕早期孕妇为研究对象,采用匹兹堡睡眠质量指数量表、抑郁自评量表、社会支持评估量表对研究对象进行线上问卷调查,采用Pearson相关分析法分析孕早期孕妇睡眠质量、抑郁情绪、社会支持水平之间的相关性,采用多元线性回归模型探讨孕早期孕妇睡眠质量的影响因素。结果孕早期孕妇睡眠质量与社会支持呈负相关、与抑郁情绪呈正相关;多元线性回归分析显示:社会支持(β=0241;95%CI0.027,0.146)和负性情绪(β=-0.285;95%CI-0.153,-0.040)是孕早期孕妇睡眠质量的影响因素。结论孕早期孕妇负性情绪、社会支持水平对睡眠质量有影响,提高孕妇的社会支持水平和情绪管理能力是改善孕早期睡眠质量的重要因素。

冲击地压煤层如何实现安全高效智能开采

冲击地压煤层如何实现安全高效智能开采是一项重大的产业技术难题,系统分析了我国冲击地压矿井分布特征、开采现状及冲击地压发展趋势,深入剖析了冲击地压矿井面临的主要开采难题。从区域地应力监测反演、矿井开拓布局优化、煤柱尺寸优化、井上下联合卸压、置换充填开采、高层位离层注浆等方面,全面阐述了冲击地压矿井全生命周期防控技术发展现状。针对巷道冲击地压防治难题,研发了冲击地压巷道全巷协同智能自适应抗冲击支护技术与装备,利用吸能防冲液压支架实现了正常状态对巷道围岩进行强支护、冲击过程迅速让位吸能的效果,结合支架智能运移装置、支架监测预警系统及全巷协同自适应抗冲击支护智能设计方法,构建了冲击地压巷道智能化吸能支护防控体系。分析了采煤工作面智能开采系统防冲原理,提出通过对围岩采动应力、覆岩断裂结构等进行监测分析,基于三维地质模型、大数据算法等对冲击地压发生位置、概率进行预测预警,并通过智能开采系统对液压支架的支护姿态与支护力、采煤机割煤速度等进行智能联动控制,实现采煤工作面智能开采与冲击地压智能防治。从采场应力与覆岩结构智能监测、冲击地压灾害数据库构建、冲击地压灾害分类预测预警等方面,分析了冲击地压智能防控技术的研发重点,提出了煤矿冲击地压监测预警系统组成及总体架构。从顶层设计、关键技术、智能精准解危与效果评价等方面提出了我国煤矿冲击地压煤层实现安全高效智能开采的技术路径与研发方向。

基于人工智能的临床决策支持系统早期临床评估的透明化报告

随着人工智能(AI)在医学领域的广泛应用,越来越多基于AI的临床决策支持系统应用于临床诊断与筛查等。早期临床评估对于评价基于AI临床决策支持系统的临床性能、安全性和人为因素具有重要意义,有利于为进一步的大规模临床试验奠定基础,但相关临床研究报告的透明度和完整性尚待提高。2022年5月,基于AI的临床决策支持系统早期临床评估报告指南(DECIDE-AI)正式在线发表。本文将结合DECIDE-AI中的AI相关报告项目及相关文献,探讨基于AI的临床决策支持系统早期临床评估的透明化报告,以期帮助我国系统开发者和研究者更好地理解与应用相关指南,提高基于AI的临床决策支持系统早期临床评估报告的透明度。

基于Logistic回归和支持向量机的早发性结直肠癌风险预测模型

目的:通过Logis tic回归和支持向量机(SVM)探究早发性结直肠癌(EOCRC)和晚发性结直肠癌(LOCRC)的危险因素,建立针对不同年龄段人群的风险预测模型并比较预测效果。方法:选择2012—2022年诊断为结直肠癌患者,记录人口学特征、临床表现、既往史、家族史、生活方式、体格检查、实验室检查及病理诊断,分别建立风险预测模型,比较两模型的ROC曲线下面积(AUROC)、准确率、精确率、召回率、F1分数。结果:综合两模型结果,EOCRC风险与出现消化道出血、腹胀腹痛、大便习惯改变等临床表现、体重减轻、肿瘤标志物升高具有较强的正相关性,与婚姻状况、阑尾切除史、糖尿病史、血脂异常病史、结直肠癌家族史也存在较弱的正相关;LOCRC风险与婚姻状况、出现临床表现、体重减轻、血脂异常、肿瘤标志物升高具有较强的正相关性,与年龄、吸烟、阑尾切除史、结直肠癌家族史也存在一定的正相关性。两模型的AUROC、准确率、F1分数相差不大,但Logistic回归模型的精确率更高而SVM模型的召回率更高。结论:EOCRC和LOCRC的危险因素不完全相同,婚姻状况、吸烟、血脂异常、肿瘤家族史在EOCRC中的贡献低于在LOCRC中的贡献。相较Logistic回归,SVM能发现更多的结直肠癌危险因素,能尽可能多的找出结直肠癌的可能患者。

基于时序网络仿真和贡献率的预警作战体系 任务支持能力评估

针对预警作战体系任务支持能力评估出现的网络化建模存在能力误差、任务能力缺乏动态特性以及评估结果与现实效果存在一定误差等问题,提出基于时序网络仿真和贡献率的作战体系任务支持能力评估方法。基于预警作战体系的静态网络模型,将其拓展到时序网络层面,并定义时序路径和时序效能环;根据任务层次分解将任务需求和能力进行匹配;建立时序网络和多Agent仿真的映射关系,构建贴近实际作战的仿真框架;利用贡献率的思想在蒙特卡洛仿真数据基础上分析预警作战体系的任务支持能力,将非对称高斯隶属函数表示的不确定指标和统计结果表示的精确指标用相似度权重进行集成,计算得到不同作战单元在体系中的任务支持能力。实验结果表明,所提方法有效可行,能够贴近装备实际能力,缩小与现实结果的评估误差,为体系能力评估和装备需求论证提供了技术支撑。

Coalbursts in China: Theory, practice and management

Coalburst is one of the most serious disasters that threaten the safe production of coal mines, and this disaster is particularly serious in China. This paper presents an overview of coalbursts in China since 1980s. From the "stress and energy" and "regional and local" perspectives, the achievements in the theory, practice and management of coalbursts in China are systematically summarized. A theoretical system of coalbursts has been formed to reveal the deformational behavior of coalbursts and explain the mechanism of coalbursts. The occurrence conditions of coalbursts are put forward and the critical stress is obtained. The stress index method for risk evaluation of coalbursts before mining is proposed, and the deformation localization prediction method of coalbursts is put forward. The relationship between energy release and absorption in the process of coalbursts is found, and the prevention and control methods of coalbursts, including the regional method, the local method and support, are presented. The safety evaluation index of coalburst prevention and control is put forward. The integrated prevention and control method for coal and gas outbursts is proposed. The prevention and control technology and equipment of coalbursts have also been developed. Amongst them, the distribution law of the critical stress in China coalburst mines is discovered. The technology and equipment for monitoring, prevention and control of coalbursts, as well as for integrated prevention and control of combined coalbursts and other disasters, have been developed. The energy-absorbing and coalburst-preventing support technology for roadways is invented, and key engineering parameters of coalburst prevention and control are pointed out. In China, coalburst prevention and control laws and standards have been developed. Technical standards for coalbursts are formulated, statute and regulations for coal mines are established, and regulatory documents are promoted.

早期分阶段肺康复锻炼联合适应性支持通气对急性呼吸窘迫综合征患者肺功能及血气指标的影响

目的探讨早期分阶段肺康复锻炼联合适应性支持通气(ASV)对急性呼吸窘迫综合征(ARDS)患者肺功能及血气指标的影响。方法选取2021年1月至2023年2月我院收治的ARDS患者78例,按照随机数字表法分为对照组与观察组各39例,比较两组患者治疗前后的肺功能指标、血气指标、生活质量变化情况和呼吸机通气时间、住院时间、并发症发生情况。结果与治疗前相比,治疗后两组的深吸气量(IC)、第一秒用力呼气容积(FEV_(1))的值、FEV_(1)与用力肺活量的比值(FEV_(1)/FCV)、动脉血氧分压(PaO_(2))、血氧饱和度(SaO_(2))、PaO_(2)/FiO_(2)水平、生活质量评分显著升高,二氧化碳分压(PaCO_(2))水平显著降低(P<0.05),且观察组的IC、FVC、FEV_(1)/FVC、PaO_(2)、SaO_(2)、PaO_(2)/FiO_(2)水平、生活质量评分高于对照组,PaCO_(2)水平低于对照组(P<0.05);观察组呼吸机通气时间、住院时间显著低于对照组(P<0.05),患者并发症总发生率低于对照组(P<0.05)。结论早期分阶段肺康复锻炼联合ASV模式可以改善ARDS患者的肺功能和血气指标,降低并发症的发生率,缩短恢复时间,提高患者的生活质量。

高贝利特硫铝酸盐水泥在免拆钢筋桁架楼承板中的应用

装配式叠合楼板是由预制混凝土底板和现浇钢筋混凝土层叠合而成的装配整体式楼板。对比分析了装配式叠合楼板、钢质楼承板、纤维水泥板楼承板、细石混凝土免拆钢筋桁架楼承板的生产工艺与性能特点。重点分析了采用高贝利特硫铝酸盐水泥制作的细石混凝土免拆钢筋桁架楼承板的工艺特点及性能。高贝利特硫铝酸盐水泥细石混凝土底板吊装速度快、脱模时间短、低温免蒸养、免拆模;底板密度较小、收缩变形量小、抗压强度高、吸水率小、跨度大。

早强水泥基砂浆增强H型钢节点承压能力试验研究

装配式钢结构支护体系在基坑支护中被逐步推广。针对H型钢围檩的局部承压能力低的难题,使用早强水泥基砂浆填充承压节点区。试验研究表明,填充早强水泥基砂浆可以有效约束H型钢翼缘和腹板的屈曲及变形,增强H型钢承压节点的局部承载能力。

儿科患者病情恶化早期预警临床决策支持系统构建及应用评价

目的构建并评价儿科患者病情恶化早期风险评估及预警决策支持系统(intelligent risk assessment and early warning system,IRA-EWS)。方法以临床决策支持系统参考模型(clinical decision support system-reference model,CDSS-RM)为理论框架,以半结构式访谈提炼IRA-EWS功能清单,以专家论证会讨论完成系统设计。采用临床护理信息系统有效性评价量表进行IRA-EWS的应用评价。结果IRA-EWS包括以下功能:颜色预警,以红黄绿代表高中低程度的病情恶化预警级别;评估触发,基于结构化字段自动触发儿童早期预警评分(pediatric early warning score,PEWS)评估;决策支持,基于不同预警级别的护理计划予以决策支持;趋势展示,以可视化图表呈现单次住院周期内PEWS评分趋势;数据共享,医护实时共享中高风险预警。临床护士对IRA-EWS的使用体验平均得分为(97.46±0.90)分,得分最高的维度是“用户满意”,最低的是“系统质量”。结论基于CDSS-RM并评估临床护士需求,IRA-EWS的构建过程是科学的,护士对IRA-EWS有良好体验,后续还需对其是否可以改善患者结局作有效性评价。

高龄颅内主要供血动脉急性闭塞患者抽吸联合支架取栓后早期神经功能恶化相关因素

目的 分析高龄颅内主要供血动脉急性闭塞抽吸联合支架取栓后早期神经功能恶化(END)相关因素及预测模型构建。方法 选择2020年11月至2022年11月河北中石油中心医院神经内科收治的110例高龄(81.60±3.04)岁,颅内主要供血动脉急性闭塞患者,所有患者均采取抽吸联合支架取栓术治疗。根据术后END发生情况分组,将发生END患者纳入END组,将未发生END组患者纳入无END组。比较两组基线资料,采用Logistic回归分析各因素与高龄颅内主要供血动脉急性闭塞患者抽吸联合支架取栓后END发生的危险因素;绘制ROC曲线分析各因素联合预测高龄颅内主要供血动脉急性闭塞患者抽吸联合支架取栓后END发生的价值。结果 END组H型高血压、糖尿病患者占比高于无END组[35.71%(10/28)、32.14%(9/28) vs 15.85%(13/82)、13.42 (11/82)],WBC、CRP、脂蛋白相关磷脂酶A2 (lipoprotein-associated phospholipaseA2,Lp-PLA2)高于无END组[(11.19±1.27)×10^(9)个·L^(-1)、(16.36±1.25)mg·L^(-1)、(181.22±35.48)μg·L^(-1)vs(10.05±1.04)×10^(9)个·L^(-1)、(12.57±2.11) mg·L^(-1)、(107.52±28.31)μg·L^(-1)](P <0.05);二元Logistic回归分析结果显示,合并H型高血压、糖尿病及WBC、CRP、Lp-PLA2高表达是高龄颅内主要供血动脉急性闭塞患者抽吸联合支架取栓后END发生的危险因素(OR> 1,P <0.05);绘制ROC曲线发现,各因素联合预测高龄颅内主要供血动脉急性闭塞患者抽吸联合支架取栓后END发生的AUC:0.923、95%CI:0.860~0.987、P<0.05、特异度:0.854、灵敏度:0.929、约登指数:0.783,有一定预测价值。结论H型高血压、糖尿病与WBC、CRP、Lp-PLA2高表达是高龄颅内主要供血动脉急性闭塞患者抽吸联合支架取栓后END发生的危险因素,基于多因素构建的预测模型可有效预测END发生。

连续性血液净化结合早期营养支持治疗对重症脓毒血症患者营养状况与胃肠动力学指标的影响

目的:探究连续性血液净化结合不同营养支持方案对重症脓毒血症患者营养状况及胃肠动力学指标的影响。方法:选取河南宏力医院2021年1月至2022年10月94例重症脓毒血症患者,均接受连续性血液净化治疗,在此基础上,将其随机分为A组、B组,各47例,分别实施常规营养支持、早期营养支持,比较两组治疗前后营养水平[血清总蛋白(TP)、白蛋白(ALB)、血红蛋白(Hb)]、血清炎症反应指标[降钙素原(PCT)、高敏C反应蛋白(hs-CRP)、肿瘤细胞坏死因子(TNF-α)]、胃肠动力学指标[生长抑素(SS)、胃动素(MOT)、胃泌素(GAS)]、急性生理与慢性健康评价系统Ⅱ(APACHEⅡ)评分。结果:治疗前B组TP、ALB、Hb水平与A组相近(P>0.05);治疗后B组TP、ALB、Hb水平均较A组高(P<0.05);治疗前B组PCT、hs-CRP、TNF-α水平与A组相近(P>0.05);治疗后B组PCT、hs-CRP、TNF-α水平较A组低(P<0.05);治疗前B组SS、MOT、GAS水平与A组相近(P>0.05);治疗后B组GAS评分低于A组,SS、MOT水平高于A组(P<0.05);治疗前B组APACHEⅡ评分与A组相近(P>0.05);治疗后B组APACHEⅡ评分较A组高(P<0.05)。结论:对重症脓毒症患者连续性血液净化治疗中,实施早期营养支持,可改善其营养水平、胃肠道功能,降低血清炎症因子水平,改善其生理状态。