基于Ryan评分评价烧伤严重程度与病原体感染创面-血液传播的关系

目的探讨基于Ryan评分评价烧伤严重程度与病原体感染创面-血液传播的关系,为烧伤患者合理系统性应用抗菌药提供依据。方法回顾性分析我院2014年4月～2018年4月收治的230例严重烧伤患者的临床资料,基于Ryan评分将所有患者分为四组(0组、1组、2组、3组)进行描述性统计分析,以烧伤严重程度与病原体感染的创面-血液传播关系因素为自变量,烧伤严重程度为因变量,分析评价Ryan评分对创面-血液传播的影响,并基于Ryan评分分析血培养阳性患者创面培养阳性率。结果四组患者的创面培养阳性率分别为15.7%、63.8%、82.5%及36.3%。严重烧伤患者创面培养菌群与血培养菌群一致,创面病原菌向血液传播与烧伤严重程度呈一定相关性(OR=0.124,95%CI=0.029～0.650),创面病原菌向血液传播为烧伤严重程度的相关因素。结论 Ryan评分可有效评价严重烧伤患者的烧伤严重程度与创面病原体向血液传播之间的关系。

Software improvement for evaluation of laryngopharyngeal pH testing(Restech)——a comparison between Data View 3 and 4

BACKGROUND When gastroesophageal reflux contents reach above the upper esophageal sphincter,patients may,in addition to typical reflux symptoms,present with atypical,extraesophageal symptoms related to laryngopharyngeal reflux(LPR).Surgical treatment of LPR has shown to lead to 70%symptom improvement,however no gold standard for the diagnosis of LPR exists.In 2007,the Restech Dx-pH was released as a valid method to measure acid exposure above the upper esophageal sphincter.Recently,a new software update was introduced for analysis of measured pH data and calculation of composite scores.The effect of the changes applied to the new software version have not yet been analyzed.AIM To compare results generated by Data View 3 to the most recently released Data View 4.METHODS All patients with gastroesophageal reflux disease symptoms were seen in a specialized surgical outpatient clinic for gastrointestinal function testing.Retrospective chart review was performed of all patients presenting with suspected gastroesophageal reflux disease and extraesophageal reflux symptoms,who underwent laryngopharyngeal pH monitoring using the Restech Dx-pH system(Respiratory Technology Corp.,Houston,TX,United States)and simultaneous esophageal pH monitoring.Data View 3 and Data View 4 were used to evaluate Restech studies obtained.Diary entries such as mealtimes,supine and upright periods,and symptoms were entered manually to ensure accuracy and precise conversion of data between both software versions.Paired t test was performed for statistical analysis of results.RESULTS A total of 174 patients(63.8%female)met inclusion criteria,all suffering from extraesophageal reflux symptoms as well as typical gastroesophageal reflux disease symptoms.Mean RYAN score upright was 48.77 in Data View 3 compared to 22.17 in Data View 4,showing a significant difference(~aP=0.0001).Similar results were shown for supine period(mean RYAN Score Data View 35.29 vs 1.42 in Data View 4,~cP=0.0001).For upright periods 80 patients showed a decrease of value of the RYAN score with a mean of-58.9(mean 51.1%decrease).For supine position 25 patients showed a decrease of value of the RYAN score with a mean of-15.13[range(-153.44)–(-0.01)],which equals a mean decrease of value of 44.5%.Ten patients showed no oropharyngeal acid exposure in Data View 3,but mild/moderate(n=7)or severe(n=3)acid exposure in Data View 4.Correlation with positive esophageal pH measurement was improved in all 10 patients.CONCLUSION Results of both software versions cannot be compared to each other.However,our data suggests that Data View 4 may be an improvement of the Restech pH measurement in the evaluation of LPR.

Ryan指数与反流症状指数量表、反流体征量表在咽喉反流性疾病诊断中的相关性分析

目的探讨Ryan指数与反流症状指数量表(RSI)、反流体征量表(RFS)在咽喉反流性疾病诊断中的相关性。方法回顾性分析以咽喉部不适症状就诊,病程1个月以上的行咽部pH检测的230例患者临床资料。所有患者均同时行电子喉镜检测,并行RSI、RFS评估。结果 Ryan指数阳性率为15.2%(35/230)。RSI、RFS、RSI或RFS及RSI且RFS阳性率分别为46.5%、28.7%、60.9%、13.9%。Ryan指数阳性组患者RFS评分高于Ryan指数阴性组患者,RSI评分与Ryan指数阴性组患者差异无统计学意义。RFS阳性,RSI或RFS,RSI且RFS阳性组Ryan指数阳性率高于RFS阴性,RSI或RFS,RSI且RFS阴性组。Ryan指数阳性与RSI、RFS、RSI或RFS及RSI且RFS阳性的一致性检验的kappa值分别为-0.06,0.394,0.116和0.172。以pH监测作为金标准时,RSI、RFS、RSI或RFS及RSI且RFS的敏感性分别为37.1%,74.3%,82.9%,28.6%;特异性分别为51.8%,79.5%,43.1%,88.2%;阳性预测值分别为12.1%,39.4%,20.7%,30.3%;阴性预测值分别为82.1%,94.5%,93.3%,87.3%。RSI与直立位及平卧位Ryan指数的相关系数分别为-0.056和-0.083;RFS与直立位及平卧位Ryan指数的相关系数分别为0.425和0.166。结论咽部pH检测是直接反映咽喉部反流的客观、无创的检测方法。RFS与Ryan指数有一定的正相关性,但量表与Ryan指数一致性差。尚需进一步研究更准确的、反映咽喉反流的量表及pH诊断指数。