Modified physiological and operative score for the enumeration of mortality and morbidity risk assessment model in general surgery

AIM: To establish a scoring system for predicting the incidence of postoperative complications and mortality in general surgery based on the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), and to evaluate its efficacy. METHODS: Eighty-four patients with postoperative complications or death and 172 patients without postoperative complications, who underwent surgery in our department during the previous 2 years, were retrospectively analyzed by logistic regression. Fifteen indexes were investigated including age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anesthesia. Modified POSSUM (M-POSSUM) was developed using significant risk factors with its efficacy evaluated. RESULTS: The significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intraoperative blood loss, and course of anesthesia. These factors were all included in the scoring system. There were significant differences in the scores between the patients with and without postoperative complications, between the patients died and survived with complications, and between the patients died and survived without complications. The receiver operating characteristic curves showed that the M-POSSUM could accurately predict postoperative complications and mortality.CONCLUSION: M-POSSUM correlates well with postoperative complications and mortality, and is more accurate than POSSUM.

The scoring system for patients with severe sepsis after orthotopic liver transplantation

BACKGROUND: Because of the complicated pathological features after liver transplantation, severe sepsis is difficult to treat and often leads to death. This study was undertaken to analyze the role of orthotopic liver transplantation (OLT) in patients with severe sepsis and to evaluate the effect of the scoring system. METHODS: Fifty-six patients conformed to the inclusion criteria. They were divided into two groups: non-OLT group (group A) and OLT group (group B). Besides the general data of the patients, the surveillance of blood lactate, the number of failed organs, acute physiology and chronic health evaluationⅡ(APACHEⅡ) and mutiple organ dysfunction score (MODS) were evaluated at the 1st, 3rd and 7th day after OLT. RESULTS: The mortality during hospitalization was 30% in the non-OLT group and 57.6% in the other group. The level of blood lactate at the 1st day of OLT increased more significantly in the OLT group than in the non-OLT group (P<0.01). It was decreased but higher than that in the non-OLT group in the seven days after OLT. The number of failed organs in the OLT group was greater than that in the non-OLT group (P<0.01). The continuous score of APACHEⅡwas not significantly different in the two groups. But the continuous MODS in the OLT group was higher than that in the non-OLT group (P<0.01), which was consistent with the number of failed organs. CONCLUSIONS: The persistently higher level of blood lactate during 7 days may be a dependent risk factor. Immunosuppression may be another risk factor for OLT patients. The mortality of OLT in patients with severe sepsis in 28 days is almost double that in non-OLT patients. The MODS score is better than the APACHEⅡscore in the assessment of organ failure in OLT patients with severe sepsis. The standard scoring system could be improved or a new scoring system that includes the blood lactate score should be established for liver transplantation.

Risk factors and their interactive effects on severe acute pancreatitis complicated with acute gastrointestinal injury

BACKGROUND There are many risk factors for severe acute pancreatitis(SAP)complicated with acute gastrointestinal injury(AGI),but few reports on the interaction between these risk factors.AIM To analyze the risk factors for SAP complicated with AGI and their interactive effects.METHODS We selected 168 SAP patients admitted to our hospital between December 2019 and June 2022.They were divided into AGI group and non-AGI group according to whether AGI was present.Demographic data and laboratory test data were compared between the two groups.The risk factors for SAP with concomitant AGI were analyzed using multifactorial logistic regression,and an analysis of the interaction of the risk factors was performed.RESULTS The percentage of patients with multiple organ dysfunction syndrome,acute physiological and chronic health scoring system II(APACHE II)score,white blood cell count and creatinine(CRE)level was higher in the AGI group than in the non-AGI group.There was a statistically significant difference between the two groups(P<0.05).Logistic regression analysis indicated that an APACHE II score>15 and CRE>100μmol/L were risk factors for SAP complicating AGI.The interaction index of APACHE II score and CRE level was 3.123.CONCLUSION An APACHE II score>15 and CRE level>100μmol/L are independent risk factors for SAP complicated with AGI,and there is a positive interaction between them.

创伤严重度评分和凝血功能指标在急诊外科患者病情及预后判断中的临床意义

目的探讨创伤严重度评分(ISS)和凝血功能指标在急诊外科患者病情及预后判断中的临床意义。方法选取2020年3月至2022年4月抚州市第一人民医院急诊科收治的60例创伤患者作为研究对象,按照ISS分为非危重症组(ISS≤16分,n=11)、危重症组(ISS 17~25分,n=28)、极危重症组(ISS>25分,n=21),均采取综合治疗方法治疗。比较3组凝血功能指标[D-二聚体(D-D)、纤维蛋白原(FIB)、部分活化凝血酶原时间(APTT)、凝血酶原时间(PT)、血小板计数(PLT)];根据患者入院28 d后的预后结局分为死亡组(n=12)与生存组(n=48),比较两组ISS及凝血功能指标水平;分析ISS、凝血功能指标及两者联合对预后预测的灵敏度、特异度。结果生存组PLT、FIB水平均高于死亡组,D-D水平及ISS均低于死亡组,PT、APTT均短于死亡组,差异有统计学意义(P<0.05)。非危重症组PLT、FIB水平均高于极危重症组,且FIB水平高于危重症组,差异有统计学意义(P<0.05);非危重症组D-D水平低于危重症组、极危重症组,且危重症组低于极危重症组,差异有统计学意义(P<0.05);非危重症组PT、APTT均短于危重症组、极危重症组,且危重症组短于极危重症组,差异有统计学意义(P<0.05)。ISS联合凝血指标预测患者预后的灵敏度、特异度均高于ISS、凝血指标单独检测,差异有统计学意义(P<0.05)。结论评估ISS、检测凝血功能指标有助于了解急诊外科患者病情,并对其预后进行准确判断,两者联合可明显提高预后预测价值。

APACHE Ⅲ、MODS和SOFA对心血管外科手术后患者预后的评估分析

目的:分析比较在心脏、大血管手术后应用急性生理学和慢性健康状况评分Ⅲ(APACHEⅢ)、MODS和SOFA对患者预后评估的临床意义。方法:对2009年1月～7月在我院行心脏大血管手术的80例患者,在心脏外科重症监护室(CSICU)期间每日应用APACHEⅢ、MODS和SOFA评分评估其预后,并做统计学分析。结果:三种评分在术后3天内无统计学差异,三种评分间相关性有显著统计学意义(P<0.001);ICU停留时间和术后医院停留时间与第一天评分间的相关性有显著统计学意义;术后第2天评分和ICU停留时间有显著统计学意义,A2与术后医院停留时间有显著相关性(P<0.001),而M2和S2无相关关系;术后第3天评分和ICU停留时间有显著统计学意义(P<0.001),术后停留时间仅与A3相关性有统计学意义(P=0.005),与M3 S3均无统计学相关。结论:对心脏、大血管手术后患者,三种评分对ICU停留时间有较好的提示;

APACHE Ⅱ及SOFA评分对危重症SFTS患者预测价值研究

目的:研究探讨急性生理和慢性健康评分系统(APACHEⅡ)、感染相关性器官功能衰竭(SOFA)评分对ICU发热伴血小板减少综合征(SFTS)患者预后预测的临床价值,以期进一步指导治疗。方法:选择2012年6月—2018年9月就诊于ICU的51例确诊SFTS的危重症患者,进行APACHEⅡ及SOFA评分。以生存组及死亡组作为预后指标,测试各评分的准确度。结果:51例患者SOFA评分预测住院病死率优于APACHEⅡ评分(P<0.05),死亡组多为高龄患者(P<0.01)。结论:SOFA评分对于危重型SFTS患者预后预测能力优于APACHEⅡ评分;高龄患者具有高病死率。

APACHEⅡ评分、血乳酸浓度、D-二聚体与重症感染患者预后的相关性分析

目的探讨急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分、血乳酸浓度、D-二聚体与重症感染患者预后的相关性。方法选取2021年1月至2022年12月安徽省第二人民医重症医学科收治的81例重症感染患者纳入观察组,根据28 d预后情况分为生存组49例和死亡组32例。观察死亡组、生存组临床特征及APACHEⅡ评分、血乳酸浓度、D-二聚体水平;Pearson相关性分析死亡组APACHEⅡ评分和血乳酸浓度、D-二聚体的关系;影响预后的危险因素采用多因素Logistic逐步回归分析;受试者工作曲线(ROC)分析APACHEⅡ评分、血乳酸浓度、D-二聚体对预后不良的预测价值。结果观察组APACHEⅡ评分、血乳酸浓度、D-二聚体水平高于对照组,差异有统计学意义(t=4.269,8.785,2.746,P<0.05);死亡组机械通气比例、SOFA评分、ICU住院时间和PCT水平高于生存组,差异有统计学意义(χ^(2)=4.847,4.940,t=8.256,12.474,P<0.05);死亡组APACHEⅡ评分、乳酸、D-二聚体水平高于生存组,差异有统计学意义(t=2.629,9.702,3.086,P<0.05);Pearson相关性,死亡组APACHEⅡ评分和血乳酸浓度、D-二聚体呈正相关(P<0.05);Logistic回归分析,机械通气、APACHE-II评分≥22.28分和血乳酸浓度≥3.58 mmol/L均为影响重症感染患者预后不良的独立危险因素(P<0.0.5);ROC分析,APACHEⅡ评分、血乳酸浓度、D-二聚体联合检测预测重症感染患者预后不良的AUC为0.921(P<0.05)。结论重症感染患者APACHEⅡ评分、血乳酸浓度、D-二聚体与其预后密切相关,其中APACHE-Ⅱ评分和血乳酸浓度均为影响重症感染患者预后的危险因素。

血清及支气管肺泡灌洗液中sTREM-1水平、APACHEⅡ评分及SOFA评分对重症肺炎患儿病情及预后评价

目的探讨血浆及支气管肺泡灌洗液中可溶性髓样细胞触发受体-1(s TREM-1)水平及急性生理学及慢性健康状况评分(APACHEⅡ)、序贯器官衰竭估计评分(SOFA)在小儿重症肺炎病情严重程度及预后判断中的意义。方法选取2017年8月至2019年10月收治的76例重症肺炎患儿为重症肺炎组,根据疾病转归情况分为无效组(n=34)和有效组(n=42);同时期在本院儿内科病房收治的普通肺炎患儿94例为普通肺炎组;以及同期门诊体检健康儿童100例为健康对照组。检测所有入组儿童血浆s TREM-1水平、APACHEⅡ评分及SOFA评分,并检测重症肺炎组患儿支气管肺泡灌洗液(BALF)s TREM-1水平,分析上述指标与儿童重症肺炎病情严重程度及预后的相关性。结果重症肺炎组血浆s TREM-1水平、APACHEⅡ评分及SOFA评分均明显高于普通肺炎组及健康对照组(P<0.05)。重症肺炎组患儿入院第7天时,无效组血浆s TREM-1、BALF s TREM-1水平及SOFA评分均上升,有效组上述各指标明显下降,且上述指标在两组间比较差异有统计学意义(P<0.05)。血浆s TREM-1、BALF s TREM-1、SOFA评分两两间均呈正相关(P<0.05),APACHEⅡ评分与血浆s TREM-1、BALF s TREM-1、SOFA评分均无相关性(P>0.05)。结论血浆、BALF s TREM-1水平及SOFA评分可作为评价儿童重症肺炎病情严重程度,提示病情预后的有效指标。

Prognostic value of red blood cell distribution width for severe acute pancreatitis

BACKGROUND Severe acute pancreatitis(SAP)is a common condition in the intensive care unit(ICU)and has a high mortality.Early evaluation of the severity and prognosis is very important for SAP therapy.Recently,red blood cell distribution(RDW)was associated with mortality of sepsis patients and could be used as a predictor of prognosis.Similarly,RDW may be associated with the prognosis of SAP patients and be used as a prognostic indicator for SAP patients.AIM To investigate the prognostic value of RDW for SAP patients.METHODS We retrospectively enrolled SAP patients admitted to the ICU of the First Affiliated Hospital of China Medical University from June 2015 to June 2017.According to the prognosis at 90 d,SAP patients were divided into a survival group and a non-survival group.RDW was extracted from a routine blood test.Demographic parameters and RDW were recorded and compared between the two groups.The receiver operator characteristic(ROC)curve was constructed and Cox regression analysis was performed to investigate the prognostic value of RDW for SAP patients.RESULTS In this retrospective cohort study,42 SAP patients were enrolled,of whom 22 survived(survival group)and 20 died(non-survival group).The baseline parameters were comparable between the two groups.The coefficient of variation of RDW(RDW-CV),standard deviation of RDW(RDW-SD),Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment(SOFA)score were significantly higher in the non-survival group than in the survival group(P<0.05).The RDW-CV and RDW-SD were significantly correlated with the APACHE II score and SOFA score,respectively.The areas under the ROC curves(AUCs)of RDW-CV and RDW-SD were all greater than those of the APACHE II score and SOFA score,among which,the AUC of RDW-SD was the greatest.The results demonstrated that RDW had better prognostic value for predicting the mortality of SAP patients.When the RDW-SD was greater than 45.5,the sensitivity for predicting prognosis was 77.8%and the specificity was 70.8%.Both RDW-CV and RDW-SD could be used as independent risk factors to predict the mortality of SAP patients in multivariate logistic regression analysis and univariate Cox proportional hazards regression analysis,similar to the APACHE II and SOFA scores.CONCLUSION The RDW is greater in the non-surviving SAP patients than in the surviving patients.RDW is significantly correlated with the APACHE II and SOFA scores.RDW has better prognostic value for SAP patients than the APACHE II and SOFA scores and could easily be used by clinicians for the treatment of SAP patients.

Mid-term Outcomes of Primary Constrained Condylar Knee Arthroplasty for Severe Knee Deformity

This study aimed to examine the clinical and radiographic outcomes of primary total knee arthroplasy（TKA） with use of Nex Gen#174; Legacy#174; Constrained Condylar Knee（CCK） prosthesis for severe knee deformity. Clinical data of 46 patients（48 knees in total, aged 61 years on average） with severe knee deformity who underwent TKA with Nex Gen#174; Legacy#174; CCK prosthesis between December 2007 and February 2012 were retrospectively analyzed. There were 34 knees with severe valgus with incompetent medial collateral ligament, 11 knees with severe flexion contracture with inability to achieve knee balancing in flexion and extension by posterior soft tissue release, 2 knees with Charcot arthritis with severe varus and bone loss, and 1 with traumatic osteoarthritis with severe varus and ligamentous instability. The mean duration of follow-up was 71 months（range 40–90 months）. The New Knee Society scoring（NKSS） system and the Hospital for Special Surgery（HSS） score were used to evaluate the functional and clinical outcomes. Visual Analogue Scale（VAS） was used for pain measurement and Knee Society criteria for evaluation of radiological images. The results showed that, in the total 48 knees, 1 case of loosening due to short-stem tibial component at 3 months post-operatively underwent revision. The 6-year prosthesis survival rate in this cohort was 97.9%. There was no component infection occurring within 6 years. Significant post-operative improvements were found in NKSS and HSS scores. Patient satisfaction was significantly increased. Pain score was decreased significantly. Total functional score was improved from 31.46±11.43 to 86.42±8.87, range of motion（ROM） from 42.42°±23.57° to 95.31°±23.45° and the flexion contracture from 5.31°±7.87° to 0.92°±1.80°. Preoperative radiographic study showed excessive valgus（≥7°） in 37 knees, and varus deformity in 3 knees. Post-operative femorotibial alignment was valgus 3.88°±1.76° in 48 knees. Antero/posterior（A/P） view of X-ray films showed 4 radiolucent lines（RLL） in 48 tibial components. It was concluded that TKA with CCK is effective for the treatment of the severe unstable knee that cannot be balanced by soft tissue.

早期降钙素原与N末端脑钠肽前体监测对ICU老年细菌性肺炎患者严重程度及预后的预测价值

目的探讨入住ICU的老年细菌性肺炎患者早期降钙素原(procalcitonin,PCT)、N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)水平与肺炎病情、预后的关系,为早期评估此类患者临床风险、预后提供依据。方法选取2019年11月至2021年12月安徽中医药大学第二附属医院ICU收治的72例老年细菌性肺炎患者为研究对象,按肺炎严重指数(pneumonia severity index,PSI)评分分为低危组(n=23)、中危组(n=32)及高危组(n=17),按治疗28d预后分为好转组(n=43)和无效组(n=29)。比较各组患者入科后首次血清PCT、NT-proBNP水平及急性生理与慢性健康状况Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分的差异;采用Spearman相关分析探讨PCT、NT-proBNP水平与PSI评分及APACHEⅡ评分的相关性;采用受试者工作特征曲线评估PCT、NT-proBNP及PSI评分对ICU老年肺炎患者临床预后的预测价值。结果高危组血清PCT、NT-proBNP水平及APACHEⅡ评分明显高于中危组及低危组,且中危组明显高于低危组,差异均有显著性(P<0.05)。无效组PCT、NT-proBNP水平及PSI评分、APACHEⅡ评分均高于好转组,差异有显著性(P<0.05)。PCT、NT-proBNP水平与PSI评分的相关系数r分别为0.636(P<0.05)及0.612(P<0.05),与APACHEⅡ评分的相关系数r分别为0.717(P<0.05)及0.662(P<0.05)。血清PCT、NT-proBNP水平及PSI评分预测ICU老年肺炎患者临床预后的曲线下面积分别为0.785、0.800、0.806。结论ICU老年肺炎患者早期的PCT、NT-proBNP水平与肺炎严重程度呈正相关,PCT、NT-proBNP水平越高,患者病情越重,且预后越差。

甘油三酯-葡萄糖指数与中度重症及重症急性胰腺炎并发急性肾损伤的相关性

目的探讨甘油三酯-葡萄糖指数(TyG指数)与中度重症及重症急性胰腺炎(MS-SAP)并发急性肾损伤(AKI)的关系。方法回顾性收集2018年1月-2022年7月扬州大学附属医院初诊为MS-SAP的161例患者的临床资料,根据AKI发生情况分为AKI组75例和无AKI组86例。比较2组患者的临床资料、实验室指标及TyG指数。采用Pearson相关性分析评价TyG指数与临床资料、实验室指标的相关性;采用Logistic回归分析探讨MS-SAP患者并发AKI的独立危险因素。结果AKI组与非AKI组的序贯器官衰竭评分(SOFA评分)、胰腺炎严重程度评分(Ranson评分)及急性生理学与慢性健康状况评价Ⅱ(APACHEⅡ)评分比较,差异有统计学意义(P<0.05)。与无AKI组相比,AKI组患者血清葡萄糖(GLU)、C反应蛋白(CRP)、甘油三酯(TG)、总胆固醇(TC)、血清肌酐(Scr)、TyG指数水平升高,高密度脂蛋白(HDL)和钙离子水平降低,差异有统计学意义(P<0.05)。Pearson相关性分析发现,TyG指数与合并糖尿病、SOFA评分、APACHEⅡ评分、TC、CRP、Scr呈正相关(P<0.05),与患者年龄、合并高血压、HDL、谷氨酸-丙酮酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)、镁离子、钙离子呈负相关(P<0.05)。Logistic回归分析显示,TyG指数、SOFA评分是MS-SAP患者并发AKI的独立影响因素(P<0.05)。结论MS-SAP并发AKI患者TyG指数水平明显升高。高水平TyG指数可能是MS-SAP患者并发AKI的影响因素之一,胰岛素抵抗是参与MS-SAP并发AKI的可能机制之一。

血清炎性指标联合APACHEII评分对重症肺部感染患者生存预后的预测价值

目的分析研究血清炎性指标联合APACHEII评分对重症肺部感染患者生存预后的预测价值。方法选取2020年1月至2022年12月皖北煤电集团总医院重症医学二科收治的135例重症肺部感染患者作为研究对象,根据患者治疗后的临床结局分为生存组(n=119)与死亡组(n=16);通过单因素分析比较两组的年龄、性别、BMI指数、血清C反应蛋白(CRP)、降钙素原(PCT)、白细胞计数(WBC)、中性粒细胞计数(NEU)、白蛋白(ALB)、淋巴细胞计数(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))水平与APACHEⅡ评分;以患者在治疗期间出现死亡为预后不良,采用多因素Logistic回归分析重症肺部感染患者预后不良的影响因素,并采用ROC曲线分析血清CRP、PCT、WBC、NEU水平、APACHEⅡ评分对重症肺部感染患者预后不良的单一及联合预测价值。结果单因素分析结果显示,血清CRP、PCT、WBC、NEU、ALB、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平与APACHEⅡ评分均是重症肺部感染患者生存预后的影响因素(P<0.05);多因素Logistic回归分析显示,CRP水平升高(OR=1.889)、PCT水平升高(OR=2.188)、WBC水平升高(OR=2.125)、NEU水平升高(OR=1.790)、ALB水平降低(OR=1.904)、CD3^(+)水平降低(OR=2.115)、CD4^(+)水平降低(OR=1.872)、CD8^(+)水平降低(OR=2.173)、CD4^(+)/CD8^(+)水平降低(OR=1.978)和APACHEⅡ高评分(OR=2.201)均是重症肺部感染患者预后不良的独立危险因素(P<0.05);ROC曲线分析显示血清CRP、PCT、WBC、NEU水平、APACHEⅡ评分及联合检测的曲线下面积(AUC)分别为0.724、0.697、0.790、0.789、0.830、0.972,故联合检测优于单一检测(P<0.05)。结论血清炎性指标及APACHEⅡ评分与重症肺部感染患者生存预后相关,联合检测对重症肺部感染患者生存预后具有较好的预测价值。

早期急性胰腺炎严重程度的影响因素及其预测价值

目的探索急性胰腺炎早期严重程度的影响因素及预测价值。方法选取2021年6月至2022年12月于毕节市第一人民医院收治的270例急性胰腺炎患者为研究对象,按疾病严重程度分级分为轻度急性胰腺炎(MAP)(129例)、中重度急性胰腺炎(MSAP)(100例)和重度急性胰腺炎(SAP)(41例)三组,进行各组间临床资料和实验室指标比较,筛选出有统计学差异的指标,作为自变量,进行多因素logistic回归分析,分析急性胰腺炎严重程度的独立危险因素,并通过ROC曲线评估预测效能。结果临床资料中,三组患者的年龄、性别和病因比较,差异无统计学意义(P>0.05),MAP组、MSAP组和SAP组患者的住院天数中位数分别为8、8、12d,急性生理学及慢性健康状况评分系统(APACHEⅡ)评分中位数分别为3、6、14分,三组间的住院天数和APACHEⅡ评分比较,差异有统计学意义(P<0.05)。实验室指标中,三组间的钙(Ca)、纤维蛋白原(FIB)、纤维蛋白原/白蛋白比值(FAR)和Treg细胞百分比比较,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,Treg细胞百分比和APACHEⅡ评分是急性胰腺炎严重程度的独立危险因素(P<0.05)。ROC曲线分析结果显示,Treg细胞百分比和APACHEⅡ评分联合预测的下面积为0.912、灵敏度为85.4%、特异度为81.1%。结论外周血CD4^(+)CD25^(+)FOXP3^(+)Treg细胞联合APACHEⅡ评分能够明显提高急性胰腺炎早期严重程度的预测价值。

外周血淀粉酶、NLR、胆碱酯酶水平变化与有机磷农药中毒病情及预后的关系分析

目的分析外周血淀粉酶、中性粒细胞-淋巴细胞比值(NLR)、胆碱酯酶水平变化与有机磷农药中毒病情以及预后的关系。方法回顾性选取2019年7月至2020年8月阜阳市人民医院收治的103例有机磷农药中毒患者,根据中毒程度分为轻度组(n=47)、中度组(n=31)和重度组(n=25)。并根据患者出院时的生存情况分为存活组(n=83)和死亡组(n=20)。比较不同预后组患者一般资料[年龄、性别构成比、中毒至就诊时间、有机磷中毒种类、急性生理学和慢性健康状况评价(APACHEⅡ)评分、空腹血糖、动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))、乳酸、白细胞、血红蛋白、血尿素、血肌酐等]及淀粉酶、NLR、胆碱酯酶水平;采用Logistic回归分析分析影响有机磷农药中毒患者预后不良的因素,并分析各影响因素的预测价值;比较不同病情程度有机磷农药中毒患者的淀粉酶、胆碱酯酶、NLR水平。结果不同预后患者年龄、性别构成比、中毒至就诊时间、有机磷中毒种类、白细胞、血红蛋白、血尿素、血肌酐进行比较,差异均无统计学意义(P>0.05);存活组的APACHEⅡ评分、空腹血糖、PaCO_(2)、乳酸、NLR、淀粉酶水平均低于死亡组,PaO_(2)、胆碱酯酶水平均高于死亡组,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示:APACHEⅡ评分、淀粉酶、NLR、胆碱酯酶是有机磷农药中毒患者预后不良的独立危险因素(P<0.05)。APACHEⅡ评分、淀粉酶、NLR、胆碱酯酶联合预测有机磷农药中毒患者预后不良的受试者工作特征(ROC)曲线下面积是0.934,大于各指标单独预测(0.918、0.864、0.894、0.880)。重度组淀粉酶、NLR水平高于中度组、轻度组,而胆碱酯酶水平低于轻度组、中度组,差异均有统计学意义(P<0.05)。结论有机磷农药中毒严重程度与外周血淀粉酶、NLR、胆碱酯酶水平有关,APACHEⅡ评分、淀粉酶、NLR、胆碱酯酶是有机磷农药中毒预后的影响因素,其联合预测预后的价值较高,值得进一步研究。

扩大翼点入路联合逐步控制性减压手术对重型颅脑损伤患者NIHSS评分的影响

目的 分析扩大翼点入路联合逐步控制性减压手术对重型颅脑损伤患者NIHSS评分的影响。方法 选取2015年4月~2021年3月收治的140例重型颅脑损伤患者为研究对象,按照随机数字表法分为两组,每组各70例,对照组采用标准大骨瓣减压术联合传统快速减压术治疗,观察组采用扩大翼点入路联合逐步控制性减压手术治疗,对比两组术后7d NIHSS(美国国立卫生研究院卒中量表)评分和其他指标的差异。结果 与对照组对比,观察组术后24h、术后72h的颅内压更低,差异有统计学意义(P<0.05);与对照组对比,观察组术后7d时NIHSS评分更低,GCS评分更高,差异有统计学意义(P<0.05);术后6个月,与对照组对比,观察组治疗效果良好患者构成比更高,重度残疾、植物生存、死亡患者构成比更低,差异有统计学意义(P<0.05);与对照组对比,观察组术后大面积脑梗死、迟发颅内血肿、急性脑膨出等术后并发症发生率更低,差异有统计学意义(P<0.05)。结论 扩大翼点入路联合逐步控制性减压手术利于改善重型颅脑损伤患者预后,减轻神经功能缺损程度,降低颅内压,且安全性高。

睑板条悬吊联合异体巩膜兜带术治疗麻痹性睑外翻

目的:观察睑板条悬吊联合异体巩膜兜带术治疗麻痹性睑外翻的临床效果。方法:回顾性分析8例(8眼)麻痹性下睑外翻患者的临床资料,所有病例均行睑板条悬吊联合异体巩膜兜带术治疗。术后随访6~12个月,平均(10.15±1.76)个月。分别于术前、术后1天、随访终点应用睑外翻严重程度评分((Ectropion severity score,ESS))评价术前病情及术后疗效,并记录术后并发症发生情况。结果:术后8例(8眼)睑外翻均矫正,无复发。术前ESS评分为3.5~8分,中位数为7.5;术后1 d ESS评分1~3分,中位数为2;术后随访终点ESS为0~1,中位数为0;术前、术后比较差异均有统计学意义(P<0.05)。无感染及内植入物暴露、排斥、移位等并发症。结论:利用异体巩膜兜带术可加强睑板支撑,睑板条悬吊可矫正眼睑松弛,提升下垂的外眦角。睑板条悬吊联合异体巩膜兜带术治疗麻痹性睑外翻操作简便、易行,有效改善患者眼表状况及外观,且术后效果较为稳定,具有较高的临床价值。

基于APS评分、FIB构建重症肺炎患儿预后列线图

目的:基于急性生理学评分(APS)、纤维蛋白原(FIB)构建重症肺炎(SP)患儿预后列线图。方法:分析153例SP患儿预后的危险因素;建立预后不良的列线图风险模型。结果:年龄、病程、致病菌种类、急性呼吸窘迫综合征(ARDS)、机械通气、APS、FIB均为SP患儿预后不良的危险因素(P<0.05)。列线图风险模型预测SP患儿预后的AUC为0.802(95%CI:0.730~0.862),表明该模型预测效能良好。结论:APS评分、FIB水平是SP患儿预后不良的危险因素,纳入APS评分、FIB水平的列线图风险模型对SP患儿预后具有较高的预测效能。

参附注射液治疗严重脓毒症临床疗效及对血清IL-6、IL-10水平的影响

目的观察参附注射液治疗严重脓毒症的临床疗效及其对血清IL-6和IL-10水平的影响。方法将68例严重脓毒症患者随机分为参附注射液加常规治疗组(简称参附组,36例)和常规治疗组(简称对照组,32例)。分别于治疗前及治疗后3、7天进行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和Marshall评分,评价其临床疗效并比较28天病死率,采用酶联免疫吸附法(ELISA)测定血清IL-6、IL-10水平;采用免疫投射比浊法测定C反应蛋白(C-reactive protein,CRP)。结果两组患者治疗前APACHEⅡ评分、Marshall评分、IL-6、IL-10及CRP水平比较,差异无统计学意义(P>0.05)。治疗后两组患者APACHEⅡ评分及Marshall评分均有下降(P<0.05),但参附组下降更明显(P<0.05)。参附组和对照组的病死率分别为25.0%(9/36)和37.5%(12/32),两组比较,差异无统计学意义(P>0.05)。治疗7天后两组血清IL-6及CRP水平均明显下降(P<0.05),但参附组下降幅度更大,与对照组比较,差异有统计学意义(P<0.05);而两组血清IL-10水平治疗前后无明显变化(P>0.05)。结论参附注射液能够降低血清促炎介质IL-6水平,调节严重脓毒症患者促炎/抗炎因子的平衡,从而起到改善临床疗效的作用。

APACHEⅢ引入MODS评分对ICU患者病情评估价值的研究

目的 :评价急性生理学与慢性健康状况 (APACHE )评分引入多器官功能障碍综合征 (MODS)评分对 ICU患者病情评估的价值。方法 :对 70例 ICU患者在入住 ICU 2 4 h内分别进行 APACHE 评分和 MODS评分 ,以 ROC曲线下面积大小衡量各评分系统预测患者预后的能力 ,比较 APACHE 评分、MODS评分以及APACHE 与 MODS评分之和的 ROC曲线下面积。建立以患者预后为因变量 ,APACHE 评分、MODS评分以及 APACHE 与 MODS评分之和为自变量的判别方程 ,比较它们对患者预后判别的贡献率 (判别系数 )。结果 :APACHE 评分、MODS评分以及 APACHE 与 MODS评分之和的 ROC曲线下面积分别为 0 .76 5、0 .6 4 3和 0 .75 3;在判别方程中 ,它们的贡献率 (判别系数 )分别为 0 .998、0 .892和 0 .5 6 8。结论 :APACHE 对ICU患者预后的预测效果优于 MODS评分 ,APACHE 引入 MODS评分后并不能提高其预测效果。