Etiological characteristics of influenza-like illness in Jiangsu province from 2012 to 2016

Influenza-like illness(ILI)is an acute respiratory infection caused by various pathogens.However,the epidemiologic characteristics of ILI pathogens in Jiangsu province are unclear.To better understand the ILI etiology,the characteristics of the pathogens from nasopharyngeal swab samples of patients with ILI collected from 2012 to 2016 in 6 hospitals in Jiangsu province were studied.The pathogens,including influenza virus,respiratory syncytial virus(RSV),rhinovirus(HRV),adenovirus(ADV),herpes simplex virus(HSV),human coronavirus(hCoV),Streptococcus pneumoniae and Haemophilus influenzae,were detected by real-time PCR.At least one pathogen was identified in 1334 of the patients(40.23%).Among viruses,HRV,influenza A virus(Flu A),ADV and RSV were the most frequently detected.ADV was the only pathogen that was distributed evenly in different years and regions(P>0.05).The etiological distribution varied in different age groups.Streptococcus pneumoniae was the most common pathogen in co-infections with a co-detection rate of 64.57%(319/494).The spectrum of etiologies could help to estimate disease burden and provide guidance for vaccination.

Ascent schedules,acute altitude illness,and altitude acclimatization:Observations on the Yushu Earthquake

During the Yushu Earthquake on April 14,2010,a large number of rescuers from sea level or lowlands ascended to the quake areas very rapidly or rapidly less than 24 h. However,Yushu Earthquake is the highest quake in the world at altitudes between 3 750 m and 4 878 m where is a serious hypoxic environment. A high incidence of acute altitude illness was found in the unacclimatized rescuers;the mountain rescue operation changed as "rescue the rescuers". Lesson from the Yushu Earthquake is that the occurrence of acute altitude illness may be closely related to the ascent schedules. This prompted us to study the relationship between ascent rate and the incidence and severity of acute altitude illness;five different groups were compared. The first group was 42 sea level male young soldiers who ascended to quake area very rapidly within 8 h at 4 000 m;the second group was 48 sea level male young soldiers who ascended to 4 000 m rapidly less than 18 h;the third group was 66 acclimatized medical workers from 2 261 m who ascended to 4 000 m rapidly within 12 h;the fourth group was 56 Tibetan medical workers from 2 800 m who ascended to 4 000 m rapidly within 8 h;the fifth group was 50 male sea level workers who ascended to 4 000 m gradually over a period of 4 d. The results showed that the sea level rescuers ascended to 4 000 m very rapidly or rapidly had the highest incidence of acute mountain sickness (AMS) with the greatest AMS scores and the lowest arterial oxygen saturation (SaO2);the sea level workers ascended to 4 000 m gradually had moderate incidence of AMS with moderate AMS scores and SaO2 values;whereas the acclimatized and adapted rescuers had the lowest incidence of AMS,lowest AMS scores and higher SaO2;especially none AMS occurred in Tibetan rescuers. AMS score is inversely related to the ascent rate (r=-0.24,p< 0.001). Additionally,acute altitude illness is significantly influenced by altitude acclimatization. The ascent rate is inversely re- lated to the period of altitude acclimatization whereas the time of perfect recovered from AMS is positively correlated to the time taken to acclimatize. Generally,the best means of preventing acute altitude illness is slow and gradual ascent to high altitude,as this allows time for establishing altitude acclimatization and tolerance to the hypoxic environment. However,during an emergency circumstance,such as mountain rescue operation,the rescuers must rapidly ascend to high altitude,so a series of preventive strategies including pre-acclimatization,using some prophylactic drugs and oxygen supplementary are sorely necessary.

The Impact of Rate of Feeding Advancement after Early Initiation of Enteral Nutrition in Critically Ill, Underweight Patients: A Single-Center Retrospective Chart Review

Background: The optimal rate of feeding advancement after initiation of early enteral nutrition (EEN) for underweight, critically ill patients is unknown. Methods: We conducted a retrospective chart review in intensive care unit (ICU) patients with a body mass index (BMI) < 20.0 kg/m2. Patients were categorized into Group R, which reached the energy target within 3 days of EEN initiation, and Group S, which reached the energy target 4 or more days after EEN initiation. Results: A total of 65 patients with a median age of 73 years were included in the study. No significant differences were observed between the two groups for all-cause mortality, ICU-free days, or length of hospital stay. Ventilator-free days (VFDs) were significantly fewer in Group R than in Group S (18.0 [0.0 - 22.0] vs. 21.0 [16.3 - 24.8] days;P = 0.046). A significantly higher number of patients requiring mechanical ventilation (MV) at hospital discharge were observed in Group R than in Group S (29% vs. 8%;P = 0.030). Multivariable analyses with adjustment for confounders found that days required to reach target energy intake after EEN initiation were significantly and independently associated with the requirement for MV at hospital discharge, but not with VFDs. Conclusion: A slow rate of feeding advancement after initiation of EEN in critically ill patients having a BMI of <20.0 kg/m2 might be associated with a reduced requirement for MV at hospital discharge. These results require confirmation in a large multicenter trial of underweight, critically ill patients.

论大病保险回归基本医疗保险的历史必然性

2009年内生于新农合的高额费用保障政策,于2012年演变为与基本医保分离的城乡居民大病保险制度(下称大病保险)。尽管目标和资金来源与基本医保相同,却交由商业保险公司承办,并最终将大病保险定位于与职工相互保险相对应的补充层次,形成了“同一筹资两个制度层次”的结构。本文分析了将居民基本医保一分为二的大病保险在理论逻辑和实践中不可解的困境,指出大病保险在公平和效率两方面都会产生损失,与社会保险的价值观及大病保险制度安排的愿望相悖。本文指出“有限政府、有效市场”在医疗保险领域的局限性,认为现阶段内生于基本医保制度的高额费用保障政策是必要的,但基于公平统一、高效医保的要求,大病保险回归基本医保制度是理论逻辑和历史的必然。

危重患者标准化俯卧位通气安全实施流程构建及应用研究

目的:探究危重患者标准化俯卧位通气安全实施流程构建及应用研究。方法:根据治疗方法的不同将南昌大学第一附属医院2021年11月至2022年11月期间接收的重症医学科急性呼吸窘迫综合征患者100例分为对照组(常规俯卧位操作干预,n=50)和试验组(俯卧位通气标准化安全实施流程操作干预,n=50)。评估两组患者氧合指数、俯卧位维持时间、入住ICU时间、总住院时间、并发症发生率等指标的变化差异。结果:试验组患者氧合指数各指标水平均优于对照组(P<0.05);试验组患者俯卧位维持时间、入住ICU时间、总住院时间均明显短于对照组(P<0.05);相较于对照组(20.00%),试验组患者并发症发生率(6.00%)明显偏低(P<0.05)。结论:危重患者采用标准化俯卧位通气安全实施流程操作,可有效改善患者的氧合指数,减轻缺氧状态,缩短俯卧位维持时间、入住ICU时间、总住院时间,安全性相对较高,降低并发症发生率。

有创动脉监测在危急重症患者手术麻醉诱导前的应用研究

目的:评估有创动脉监测技术在危急重症患者手术麻醉诱导前的应用效果。方法:选择2021年6月—2023年12月鹰潭市人民医院收治的84例危急重症患者作为研究对象。使用随机数字表法分为两组,各42例。所有患者均在本院接受手术治疗,对照组采取常规手术麻醉程序,而观察组则在手术麻醉诱导前采用有创动脉监测。比较两组麻醉前(T_(0))、麻醉诱导时(T_(1))、手术开始时(T_(2))、手术结束时(T_(3))及术后30 min(T_(4))的生命体征(心率、血压)、手术结果及并发症发生率。结果:T_(2)、T_(3)、T_(4),观察组心率均低于对照组,差异均有统计学意义(P<0.05)。T_(1)、T_(2)、T_(3),观察组收缩压均高于对照组,差异均有统计学意义(P<0.05)。T_(1)、T_(2)、T_(3)、T_(4),观察组舒张压均高于对照组,差异均有统计学意义(P<0.05)。观察组手术成功率高于对照组,死亡率及并发症发生率均低于对照组,差异均有统计学意义(P<0.05)。结论:危急重症患者手术麻醉诱导前应用有创动脉监测可以有效提升手术安全性和成功率,降低患者并发症发生率,对于提高手术质量和患者安全具有重要意义。

影响热射病患者90 d预后的危险因素分析

目的探讨热射病患者90 d预后的危险因素。方法回顾性分析2018年6月至2022年8月该院重症医学科收治的热射病患者89例,根据90 d死亡情况分为存活组(62例)和死亡组(27例),比较2组患者年龄、入院时体温及心率、降温时间、炎症及器官功能障碍的实验室数据、急性生理和慢性健康状况Ⅱ评分、序贯器官衰竭估计(SOFA)评分、格拉斯哥昏迷评分法评分等。结果89例患者中90 d内死亡27例(30.3%)。降温时间、入院时心率、SOFA评分是影响患者生存的独立危险因素(风险比=6.230、1.738、1.042,95%可信区间:2.561~14.521、1.026~2.114、1.011~1.427,P=0.004、0.002、0.023)。降温时间、入院时心率、SOFA评分联合预测热射病患者90 d病死率的受试者工作特征曲线下面积为0.993(95%可信区间:0.976~1.000,P<0.001),灵敏度为1.000,特异度为0.933。结论降温时间、入院时心率、SOFA评分是影响热射病患者90 d生存的因素,3个指标可联合使用预测患者90 d病死率和不良预后。

危重症病人谵妄预防护理质量敏感指标体系的构建与应用

目的:构建危重症病人谵妄预防护理质量敏感指标体系,通过临床应用评价其效果。方法:基于文献分析法、“结构-过程-结果”三维质量模式构建危重症病人谵妄预防护理质量敏感指标体系初稿,通过德尔菲法函询筛选、修订指标,最终确立危重症病人谵妄预防护理质量敏感指标体系。选取2021年7月—2022年3月、2022年4月—12月江西省安福县人民医院重症监护室(ICU)收治的危重症病人各60例,2022年4月起应用危重症病人谵妄预防护理质量敏感指标体系,此前均采取常规护理,将指标体系应用前作为对照组、指标体系应用后作为观察组,比较两组病人谵妄预防效果及护理满意度。结果:第1轮、第2轮函询问卷回收率均为100%,专家权威度系数分别为0.861和0.888,函询意见协调度肯德尔和谐系数(W值)分别为0.482(χ^(2)=27.396,P<0.001)、0.517(χ^(2)=36.803,P<0.001),构建的危重症病人谵妄预防护理质量敏感指标体系包含一级指标3个、二级指标8个、三级指标38个,指标变异系数为0.083~0.150。观察组病人谵妄发生率为3.33%,低于对照组的18.33%,谵妄持续时间为(47.29±13.50)h,短于对照组的(52.81±11.28)h(P<0.05);观察组病人护理满意度评价高于对照组(P<0.05)。结论:危重症病人谵妄预防护理质量敏感指标体系兼具科学性、可靠性,其在危重症病人谵妄预防护理中的应用能实现对护理质量的有效评价,可持续改进护理质量,有助于提高谵妄预防效果,并提升护理满意度。

可视喉镜气管插管术在危重症患者院前急救中的应用效果

目的分析可视喉镜气管插管术在危重症患者院前急救中的效果。方法回顾性分析2021年5月—2023年5月徐州市中医院收治的96例危重症患者的临床资料,根据院前急救气管插管术的不同分为2组。其中行普通喉镜气管插管术的46例患者纳入对照组,行可视喉镜气管插管术的50例患者纳入观察组。对比2组的操作情况、血流动力学、并发症。结果观察组一次插管成功率为98.00%,高于对照组的82.61%(P<0.05)。观察组插管时间为(34.59±4.36)s、声门暴露时间为(4.71±0.54)s,短于对照组的(47.21±6.83)s、(7.59±1.69)s(P<0.05)。观察组插管次数为(1.58±0.36)次,少于对照组的(2.44±0.53)次(P<0.05)。观察组并发症发生率为4.35%,低于对照组的19.57%,差异有统计学意义(P<0.05)。插管前、插管后,2组心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)相比,差异无统计学意义(P>0.05);插管时,观察组HR为(77.05±6.89)次/min、MAP为(97.19±11.06)mmHg,低于对照组的(94.71±9.65)次/min、(112.57±13.67)mm Hg,差异有统计学意义(P<0.05)。结论可视喉镜气管插管术在危重症患者院前急救中效果显著,能够提升插管成功率,减少插管时间,对患者血流动力学影响较小,且并发症较少。

Epidemiology of influenza viruses from 2009-2013-A sentinel surveillance report from Union territory of Puducherry, India

Objective: To report the i ndings of inl uenza surveillance programme from Union territory of Puducherry and to document the clinical and epidemiological data of inl uenza viruses over a i ve year period from 2009-2013. Methods: Respiratory samples were collected from patients with influenza-like illness from 2009-2013 as part of routine diagnostic and surveillance activity. Detection of pandemic inl uenza A(H1N1) 2009, inl uenza A(H3N2) and inl uenza B was done using Real-time PCR. Results: Of the total 2 247 samples collected from patients with inl uenza-like illness during the study period 287(12.7%) and 92(4.0%) were positive for inl uenza A(H1N1) 2009 and inl uenza A(H3N2) respectively. A subset of 557 of these samples were also tested for inl uenza B and 24(4.3%) were positive. Signii cantly higher positivity rate for both viruses was observed in adults when compared with children. The peak positivity of influenza A(H1N1) 2009 was observed in 2009 followed by 2012, while that of inl uenza A(H3N2) was more uniformly distributed with the exception of 2012. Overall mortality rate due to influenza A(H1N1) 2009 was 7.6% while it was 1% for influenza A(H3N2). Each year influenza-like illness and influenza virus activity coincided with period of high rainfall and low temperature except in the first half of 2012. Conclusions: As the sole referral laboratory in this region, the data provides a comprehensive picture of inl uenza activity. This information will be useful in future planning of the vaccine schedule and inl uenza pandemic preparedness.

A-Smooth Regularization for Ill-Posed Equations with Perturbed Operators and Noisy Data

This paper concerns the A smooth regularization method for linear ill posed equations in the presence of perturbed operators and noisy data. The semi and full a posteriori Morozov discrepancy principles for choosing the regularization parameter are proposed, which lead to satisfactory results.

Effect of human rhinovirus infection in pediatric patients with influenza-like illness on the 2009 pandemic influenza A（H1N1） virus

Background Some research groups have hypothesized that human rhinoviruses （HRVs） delayed the circulation of the 2009 pandemic influenza A（H1N1） virus （A（H1N1）pdm09） at the beginning of Autumn 2009 in France.This study aimed to evaluate the relationship between HRV and A（H1N1）pdm09 in pediatric patients with influenza-like illness in Beijing,China.Methods A systematic analysis to detect A（H1N1）pdm09 and seasonal influenza A virus （FLU A） was performed on 4 349 clinical samples from pediatric patients with influenza-like illness during the period June 1,2009 to February 28,2010,while a one-step real-time RT-PCR （rRT-PCR） assay was used to detect HRV in 1 146 clinical specimens selected from those 4 349 specimens.Results During the survey period,only one wave of A（H1N1）pdm09 was observed.The percentage of positive cases for A（H1N1）pdm09 increased sharply in September with a peak in November 2009 and then declined in February 2010.Data on the monthly distribution of HRVs indicated that more HRV-positive samples were detected in September （2.2％） and October （3.3％）,revealing that the peak of HRV infection in 2009 was similar to that of other years.Among the 1 146 specimens examined for HRVs,21 （1.8％） were HRV-positive,which was significantly lower than that reported previously in Beijing （15.4％ to 19.2％） （P ＜0.01）.Overall,6 samples were positive for both A（H1N1）pdm09 and HRV,which represented a positive relative frequency of 1.60％ and 2.08％ HRV,considering the A（H1N1）pdm09-positive and-negative specimens,respectively.The odds ratio was 0.87 （95％ CI 0.32; 2.44,P=0.80）.Conclusions HRVs and A （H1N1）pdm09 co-circulated in this Chinese population during September and October 2009,and the HRV epidemic in 2009 did not affect A（H1N1）pdm09 infection rates in Beijing,China as suggested by other studies.However,the presence of A（H1N1）pdm09 might explain the unexpected reduction in the percentage of HRV positive cases during the period studied.

REGULARIZATION METHODS FOR NONLINEAR ILL-POSED PROBLEMS WITH ACCRETIVE OPERATORS

This article is devoted to the regularization of nonlinear ill-posed problems with accretive operators in Banach spaces. The data involved are assumed to be known approximately. The authors concentrate their discussion on the convergence rates of regular solutions.

Implicit Iterative Method for Ill-Posed Equations with Perturbed Operators and Data

In this paper, the author applied an implicit iterative method to solve linear ill posed equations with both perturbed operators and perturbed data. After having carefully estimated some terms involved, a satisfactory order of convergence rate was derived.

Invasive Procedures and Length of Stay among Critically Ill Patients in ICU over Three Years: A Retrospective Study

Introduction: Intensive care unit (ICU) provides advanced specialized medical and nursing care for critically ill patients. Advanced monitoring techniques are needed to prevent physiologic deterioration, while the underlying disease treated and resolved. Frequents invasive procedure and treatment are used and affect the death rate and length of hospitalization. This study aimed to describe the variables associated with critically ill patients and describe the standard invasive procedures or treatments used among patients in ICU. Method: A retrospective comparative study which utilized the ICU electronic database. The data of 446 dead patients who have admitted to ICU between January 2014 and December 2016 as a case of sepsis, heart failure or COPD exacerbation were enrolled. Result: Almost of all patients had received intravenous fluid and vasoactive drugs. The mechanical ventilation support and insertion of the indwelling urethral catheter commonly used among patients with critical illnesses;78.3%, 41.3% respectively. One-third of all sepsis and heart failure patients were received CVC during ICU stay;patients with sepsis illness had less hospital length of stay than patients with heart failure and COPD (p Conclusion: We found a reduction in the death number among sepsis, heart failure and COPD patients with move forwards in years, the variety of death rate depends on the type of invasive procedure and treatment performed for each illness, mechanical ventilation support and insertion of indwelling urethral catheter commonly used among patients with critical illnesses.

Medication non-adherence in bipolar disorder: Review of rates, demographic and clinical predictors

AIM To conduct a systematic search for all studies examining rates and demographic and illness-related determinantsof medication non-adherence in bipolar disorder(BD).METHODS A comprehensive literature search was undertaken of six English-language databases to identify published articles on medication non-adherence in BD from inception till December 2016. Any article, either a review or an original-research article was examined for its relevance to the subject. All such articles were manually searched to locate any further articles containing relevant information. Studies were included only if they had adequately described the patient sample, assessment methods and statistical procedures, presented their results systematically and their conclusions were congruent with the results.RESULTS The initial search yielded 249 articles on the subject; of these 198 articles were included. Of the 162 originalresearch studies, 132 had provided information on rates of medication non-adherence in BD. There was a wide variation in rates ranging from universal adherence(100%) to almost universal non-adherence(96%); this discrepancy was more due to methodological differences than true variations in rates. Notwithstanding the significant discrepancies in methodology, based on these 132 studies mean rates of 41.5%-43% and median rates of 40%-41% were obtained for medication non-adherence in BD. Rates of adherence with mood stabilizers were significantly lower than those for antipsychotics, or for medications of all classes. None of the demographic attributes were unequivocally linked to medication non-adherence in BD. Similarly, medication-related variables such as type of medications, doses, treatment regimens and side effects did not demonstrate consistent associations with non-adherence. Among clinical characteristics the presence of comorbid substance use disorder and absence of insight were the only two factors clearly linked to non-adherence in BD.CONCLUSION Medication non-adherence is prevalent in about a thirdto half of patients with BD. Demographic, illness and treatment related factors do not predict non-adherence with certainty.

红细胞分布宽度-白蛋白比值与老年危重症患者病死率相关性研究

目的 研究红细胞分布宽度-白蛋白比值(red cell distribution width-albumin ratio,RAR)与老年危重症患者病死率的相关性。方法 采用回顾性队列研究设计,选择2007年—2020年重症监护室医学信息(Medical Information Mart for Intensive Care,MIMIC)数据库中所有符合纳入标准的患者作为研究对象,根据RAR三分位间距将其分成三组。比较分析三组一般资料,绘制Kaplan-Meier生存曲线评估不同RAR组患者28d病死率。采用Cox比例风险回归模型确定RAR与病死率的校正风险比。绘制限制性立方样条研究RAR作为连续变量对病死率的影响。亚组分析采用层次回归模型。结果 共12 293例患者纳入研究,其中RAR≤4.09组4 114例,4.09 5.31组4 086例。Kaplan-Meier生存曲线显示RAR>5.31组28d病死率最高(34.04%)。单因素Cox回归分析发现RAR与28d病死率相关(HR=1.24,95%CI:1.22~1.26,P<0.001)。Cox回归模型发现,调整潜在混杂因素后高RAR仍然是28d病死率的独立危险因素(HR=1.15,95%CI:1.13~1.18,P<0.001)。亚组分析显示RAR对28d病死率的影响效应在年龄、血小板、性别等亚组高(P<0.05)。限制性立方样条显示RAR与28d病死率基本呈线性正相关。结论 高RAR水平是老年危重症患者病死率的独立危险因素。

改良的国家早期预警评分对危重症病人预后评估的价值

目的 评估改良的国家早期预警评分(INEWS评分)在危重症病人预后中的价值。方法 选取2016年1月至2019年12月入住西安医学院第一附属医院呼吸与危重症医学科的危重症病人733例,收集病人入院24 h内的基本生命体征、相关生化指标、意识状态等进行INEWS评分、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ评分)、英国国家早期预警评分(NEWS评分)。依据病人出院结局分为存活组和死亡组,比较两组病人相关指标及评分差异,研究评分与病人死亡率之间的关系,绘制受试者操作特征曲线(ROC曲线),比较各评分ROC曲线下面积(AUC)、截断值(Cut-off值),比较两组病人INEWS评分的生存曲线,预测死亡率。结果 共纳入病人733例,男468例,女265例,存活组572例,死亡组161例,生存率78.04%,死亡率21.96%。死亡组病人的INEWS评分、APACHEⅡ评分、NEWS评分分别为18分(14,25)、10分(7,12)、11分(8,13),均高于存活组评分11分(8,16)、7分(5.25,9)、8分(6,10),差异有统计学意义(P<0.05)。INEWS评分、APACHEⅡ评分、NEWS评分的AUC分别为0.74,0.76,0.70,95%CI分别为(0.69,0.78)(0.72,0.81)、(0.65,0.75)。INEWS评分约登指数为10.5分(特异度85.3%,灵敏度50.3%)。生存分析表明,当约登指数≥10.5分时,ICU病人住院死亡率远高于INEWS<10.5分的病人,差异有统计学意义(P<0.001)。结论 INEWS评分可以用来预测危重症病人的预后。评分≥10.5分时,提示高的死亡率,INEWS评分可为医疗工作者提供更便捷ICU病人预后评估新指标。

急性骨髓炎患者血清红细胞沉降率、白细胞、降钙素原和白细胞介素-6水平变化及意义研究

目的:分析急性骨髓炎(AOL)患者血清红细胞沉降率(ESR)、白细胞(WBC)、降钙素原(PCT)和白细胞介素-6(IL-6)水平变化及意义。方法:选取AOL患者103例为AOL组,并依照临床严重程度分为轻度组(42例)、中度组(35例)及重度组(26例)。另选择未发生骨感染的骨折患者56例为非感染组。比较AOL组及各亚组与非感染组血清ESR、WBC、PCT及IL-6水平。分析AOL患者病情严重程度的影响因素。比较AOL不同预后患者的血清ESR、WBC、PCT及IL-6水平变化。分析血清ESR、WBC、PCT及IL-6水平单项及联合检测对AOL患者预后不良的预测价值。结果:AOL组血清ESR、WBC、PCT及IL-6水平显著高于非感染组(均P<0.05)。各亚组血清ESR、WBC、PCT及IL-6水平显著高于非感染组(均P<0.05)。多因素Logistic回归分析显示,血清ESR、WBC、PCT及IL-6水平是AOL患者病情严重程度的影响因素(均P<0.05)。103例患者中,预后良好81例,预后不良组22例,预后不良组血清ESR、WBC、PCT及IL-6水平显著高于预后良好组(均P<0.05)。受试者工作特征(ROC)曲线分析得出,血清ESR、WBC、PCT、IL-6水平单项及联合检测对AOL患者预后不良均具有一定的预测价值,且联合检测的预测价值更高。结论:血清ESR、WBC、PCT及IL-6参与AOL疾病的发生与发展,且水平随着疾病病情严重程度而变化,用于预测患者预后情况具有一定价值,而四项联合检测的预测价值更高。

基于血压及心率变异度预测重症患者院内死亡风险

目的 利用入住重症监护病房(intensive care unit, ICU)时的血压变异度(CV-MAP)及心率变异度(CV-HR)构建预测模型,预测ICU患者院内死亡的风险。方法 回顾性分析在美国重症监护医学信息数据库Ⅲ(medical information mart for intensive care, MIMICⅢ)中年龄≥18岁,且首次入住ICU患者的临床资料。通过多因素Logistic分析筛选危险因素并构建评分系统,采用受试者工作特征(receiver operator characteristic, ROC)曲线和校准曲线评估模型区分度和校准度,采用临床决策曲线评估模型实际应用价值。结果 共筛选符合标准的患者38 824例,院内死亡患者4075例(住院病死率为10.5%)。从危险因素中选择年龄、是否合并肝脏疾病、是否合并血液系统恶性肿瘤、是否合并转移癌、住院类型、24 h心率变异系数、24 h血压变异系数、是否使用血管活性药、是否接受镇痛治疗、是否接受镇静治疗、是否接受有创机械通气构建简化预测模型。模型预测院内死亡的ROC曲线下面积(AUC)为0.743(95%CI 0.735~0.750,P<0.001),Hosmer-Lemeshow检验χ^(2)=4.978,P=0.083。使用Bootstrap法进行1000次重复采样进行内部验证,校正曲线判断预测值与实际值一致性较好。决策曲线分析提示,在高阈值风险0.1~0.6时,预测模型具有较高的实用价值。结论 基于CV-MAP及CV-HR建立ICU患者院内死亡风险预测模型具有较好的临床预测价值,有助于识别高危患者。