目的探讨电子序贯器官衰竭评分(simplified organ dysfunction criteria optimized for electronic health records,eSOFA)对急诊脓毒症患者28、90 d及1年预后的预测价值,并与序贯器官衰竭评分(sequential organ failure assessment,SO...目的探讨电子序贯器官衰竭评分(simplified organ dysfunction criteria optimized for electronic health records,eSOFA)对急诊脓毒症患者28、90 d及1年预后的预测价值,并与序贯器官衰竭评分(sequential organ failure assessment,SOFA)、急性生理学与慢性健康状况Ⅱ评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)进行比较。方法连续纳入2018年12月1日至2021年1月31日中国康复研究中心急诊重症监护室收治的脓毒症患者。分别绘制eSOFA、SOFA和APACHEⅡ评分对患者28、90 d及1年预后的受试者工作特征(receiver operating characteristic,ROC)曲线,计算相应的曲线下面积(area under curve,AUC),并进行比较。根据eSOFA评分的截断值将患者分为eSOFA评分≤2分和eSOFA评分>2分两组,比较两组的一般临床特点。结果本研究最终纳入197例脓毒症患者,年龄为84(74~88)岁,其中男119例。纳入患者28、90 d及1年的病死率分别为38.6%(76/197)、51.8%(102/197)及58.9%(116/197)。eSOFA、SOFA和APACHEⅡ评分对脓毒症患者28、90 d及1年预后均具有预测能力,但三者差异无统计学意义(P>0.05),eSOFA评分对脓毒症患者1年死亡预测模型的拟和优度差,对1年预后预测效果不佳(P=0.01)。与eSOFA评分≤2分组相比,eSOFA评分>2分组患者死亡风险高(P<0.05),SOFA评分[分:5(4,7)vs.9(7,12)]和APACHEⅡ评分[分:23(18,27)vs.28(23,35)]更差,且更多患者发生急性肾损伤(acute kidney injury,AKI)(61.8%vs.83.6%)及接受血管活性药物(10.3%vs.59.1%)和机械通气(19.1%vs.50.8%)治疗。结论eSOFA、SOFA和APACHEⅡ评分均能有效评估脓毒症患者的中短期预后,优化患者早期治疗策略,但eSOFA评分简便易计算,更适合应用于急诊科。展开更多
Data mining has the potential to provide information for improving clinical acupuncture strategies by uncovering hidden rules between acupuncture manipulation and therapeutic effects in a data set. In this study, we p...Data mining has the potential to provide information for improving clinical acupuncture strategies by uncovering hidden rules between acupuncture manipulation and therapeutic effects in a data set. In this study, we performed acupuncture on 30 patients with hemiplegia due to acute ischemic stroke. All participants were pre-screened to ensure that they exhibited immediate responses to acupuncture. We used a twirling reinforcing acupuncture manipulation at the specific lines between the bilateral Baihui(GV20) and Taiyang(EX-HN5). We collected neurologic deficit score, simplified Fugl-Meyer assessment score, muscle strength of the proximal and distal hemiplegic limbs, ratio of the maximal H-reflex to the maximal M-wave(Hmax/Mmax), muscle tension at baseline and immediately after treatment, and the syndromes of traditional Chinese medicine at baseline. We then conducted data mining using an association algorithm and an artificial neural network backpropagation algorithm. We found that the twirling reinforcing manipulation had no obvious therapeutic difference in traditional Chinese medicine syndromes of "Deficiency and Excess". The change in the muscle strength of the upper distal and lower proximal limbs was one of the main factors affecting the immediate change in Fugl-Meyer scores. Additionally, we found a positive correlation between the muscle tension change of the upper limb and Hmax/Mmax immediate change, and both positive and negative correlations existed between the muscle tension change of the lower limb and immediate Hmax/Mmax change. Additionally, when the difference value of muscle tension for the upper and lower limbs was 〉 0 or 〈 0, the difference value of Hmax/Mmax was correspondingly positive or negative, indicating the scalp acupuncture has a bidirectional effect on muscle tension in hemiplegic limbs. Therefore, acupuncture with twirling reinforcing manipulation has distinct effects on acute ischemic stroke patients with different symptoms or stages of disease. Improved muscle tension in the upper and lower limbs, reflected by the variation in the Hmax/Mmax ratio, is crucial for recovery of motor function from hemiplegia.展开更多
目的探究简化急性生理评分Ⅱ(simplified acute physiological score-Ⅱ,SAPSⅡ)、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分及24 h乳酸清除率(24 h lactate clearance,LCR)对脓毒症患者预后的预测价值。方法回...目的探究简化急性生理评分Ⅱ(simplified acute physiological score-Ⅱ,SAPSⅡ)、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分及24 h乳酸清除率(24 h lactate clearance,LCR)对脓毒症患者预后的预测价值。方法回顾性研究,选取2023年1月—2024年1月郑州大学第一附属医院外科ICU诊治的96例脓毒症患者,依据预后情况将患者分为生存组71例及死亡组25例。比较两组患者实验室指标[血钙、降钙素原(procalcitonin,PCT)、乳酸脱氢酶(lactate dehydrogenase,LDH)]等水平,24 h LCR、SAPSⅡ评分及SOFA评分,logistic分析24 h LCR、SOFA评分及SAPSⅡ评分对患者预后独立危险因素,ROC曲线评估24 h LCR、SOFA评分及SAPSⅡ评分对患者预后的预测价值。结果生存组血钙指标(2.03±0.21)mmol/L高于死亡组(1.65±0.12)mmol/L,PCT、LDH指标分别是(3.25±0.16)μg/L及(4.93±1.26)mmol/L,均低于死亡组,差异有统计学意义(P<0.05);生存组24 h LCR(30.21±6.73)%高于死亡组(22.16±5.92)%,SAPSⅡ评分及SOFA评分分别是(37.29±7.15)分和(5.86±1.47)分,均低于死亡组,差异有统计学意义(P<0.05);logistic分析数据表明,24 h LCR、SOFA评分及SAPSⅡ评分是患者预后独立危险因素,(P<0.05);ROC曲线分析结果表明:24 h LCR预测患者预后曲线下面积为0.753,灵敏度为74.2%、特异度为73.4%;SOFA评分预测患者预后曲线下面积为0.775,灵敏度为82.9%、特异度为74.8%;SAPSⅡ评分预测患者预后曲线下面积为0.772,灵敏度为85.6%、特异度为72.5%;三者联合预测患者预后曲线下面积为0.802,灵敏度为86.4%、特异度为81.9%。结论SOFA及SAPSⅡ评分、24 h LCR联合血钙、PCT对患者预后有较高预测价值,可作为患者预后的预测指标。展开更多
文摘目的探讨电子序贯器官衰竭评分(simplified organ dysfunction criteria optimized for electronic health records,eSOFA)对急诊脓毒症患者28、90 d及1年预后的预测价值,并与序贯器官衰竭评分(sequential organ failure assessment,SOFA)、急性生理学与慢性健康状况Ⅱ评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)进行比较。方法连续纳入2018年12月1日至2021年1月31日中国康复研究中心急诊重症监护室收治的脓毒症患者。分别绘制eSOFA、SOFA和APACHEⅡ评分对患者28、90 d及1年预后的受试者工作特征(receiver operating characteristic,ROC)曲线,计算相应的曲线下面积(area under curve,AUC),并进行比较。根据eSOFA评分的截断值将患者分为eSOFA评分≤2分和eSOFA评分>2分两组,比较两组的一般临床特点。结果本研究最终纳入197例脓毒症患者,年龄为84(74~88)岁,其中男119例。纳入患者28、90 d及1年的病死率分别为38.6%(76/197)、51.8%(102/197)及58.9%(116/197)。eSOFA、SOFA和APACHEⅡ评分对脓毒症患者28、90 d及1年预后均具有预测能力,但三者差异无统计学意义(P>0.05),eSOFA评分对脓毒症患者1年死亡预测模型的拟和优度差,对1年预后预测效果不佳(P=0.01)。与eSOFA评分≤2分组相比,eSOFA评分>2分组患者死亡风险高(P<0.05),SOFA评分[分:5(4,7)vs.9(7,12)]和APACHEⅡ评分[分:23(18,27)vs.28(23,35)]更差,且更多患者发生急性肾损伤(acute kidney injury,AKI)(61.8%vs.83.6%)及接受血管活性药物(10.3%vs.59.1%)和机械通气(19.1%vs.50.8%)治疗。结论eSOFA、SOFA和APACHEⅡ评分均能有效评估脓毒症患者的中短期预后,优化患者早期治疗策略,但eSOFA评分简便易计算,更适合应用于急诊科。
基金supported by a grant from the Supporting Program of the"Eleventh Five-year Plan"for Science&Technology Research of China,Ministry of Science and Technology of China,No.2006BAI12B02a grant from the Scientific Research Fund for Talent Introduction in the Gansu University of Chinese Medicine of China,No.2012-11
文摘Data mining has the potential to provide information for improving clinical acupuncture strategies by uncovering hidden rules between acupuncture manipulation and therapeutic effects in a data set. In this study, we performed acupuncture on 30 patients with hemiplegia due to acute ischemic stroke. All participants were pre-screened to ensure that they exhibited immediate responses to acupuncture. We used a twirling reinforcing acupuncture manipulation at the specific lines between the bilateral Baihui(GV20) and Taiyang(EX-HN5). We collected neurologic deficit score, simplified Fugl-Meyer assessment score, muscle strength of the proximal and distal hemiplegic limbs, ratio of the maximal H-reflex to the maximal M-wave(Hmax/Mmax), muscle tension at baseline and immediately after treatment, and the syndromes of traditional Chinese medicine at baseline. We then conducted data mining using an association algorithm and an artificial neural network backpropagation algorithm. We found that the twirling reinforcing manipulation had no obvious therapeutic difference in traditional Chinese medicine syndromes of "Deficiency and Excess". The change in the muscle strength of the upper distal and lower proximal limbs was one of the main factors affecting the immediate change in Fugl-Meyer scores. Additionally, we found a positive correlation between the muscle tension change of the upper limb and Hmax/Mmax immediate change, and both positive and negative correlations existed between the muscle tension change of the lower limb and immediate Hmax/Mmax change. Additionally, when the difference value of muscle tension for the upper and lower limbs was 〉 0 or 〈 0, the difference value of Hmax/Mmax was correspondingly positive or negative, indicating the scalp acupuncture has a bidirectional effect on muscle tension in hemiplegic limbs. Therefore, acupuncture with twirling reinforcing manipulation has distinct effects on acute ischemic stroke patients with different symptoms or stages of disease. Improved muscle tension in the upper and lower limbs, reflected by the variation in the Hmax/Mmax ratio, is crucial for recovery of motor function from hemiplegia.
文摘目的探究简化急性生理评分Ⅱ(simplified acute physiological score-Ⅱ,SAPSⅡ)、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分及24 h乳酸清除率(24 h lactate clearance,LCR)对脓毒症患者预后的预测价值。方法回顾性研究,选取2023年1月—2024年1月郑州大学第一附属医院外科ICU诊治的96例脓毒症患者,依据预后情况将患者分为生存组71例及死亡组25例。比较两组患者实验室指标[血钙、降钙素原(procalcitonin,PCT)、乳酸脱氢酶(lactate dehydrogenase,LDH)]等水平,24 h LCR、SAPSⅡ评分及SOFA评分,logistic分析24 h LCR、SOFA评分及SAPSⅡ评分对患者预后独立危险因素,ROC曲线评估24 h LCR、SOFA评分及SAPSⅡ评分对患者预后的预测价值。结果生存组血钙指标(2.03±0.21)mmol/L高于死亡组(1.65±0.12)mmol/L,PCT、LDH指标分别是(3.25±0.16)μg/L及(4.93±1.26)mmol/L,均低于死亡组,差异有统计学意义(P<0.05);生存组24 h LCR(30.21±6.73)%高于死亡组(22.16±5.92)%,SAPSⅡ评分及SOFA评分分别是(37.29±7.15)分和(5.86±1.47)分,均低于死亡组,差异有统计学意义(P<0.05);logistic分析数据表明,24 h LCR、SOFA评分及SAPSⅡ评分是患者预后独立危险因素,(P<0.05);ROC曲线分析结果表明:24 h LCR预测患者预后曲线下面积为0.753,灵敏度为74.2%、特异度为73.4%;SOFA评分预测患者预后曲线下面积为0.775,灵敏度为82.9%、特异度为74.8%;SAPSⅡ评分预测患者预后曲线下面积为0.772,灵敏度为85.6%、特异度为72.5%;三者联合预测患者预后曲线下面积为0.802,灵敏度为86.4%、特异度为81.9%。结论SOFA及SAPSⅡ评分、24 h LCR联合血钙、PCT对患者预后有较高预测价值,可作为患者预后的预测指标。
文摘目的 评价多种标志物及疾病严重程度评分对脓毒症患者预后的评估价值.方法 回顾性分析2015年1月至2016年12月入住贵州医科大学附属医院重症加强治疗病房(ICU)、符合Sepsis-3诊断标准的成人患者临床资料,根据预后将患者分为存活组和死亡组.建立受试者工作特征曲线(ROC),评估入ICU时血乳酸(Lac)、24 h乳酸清除率(LCR)、入ICU时血清降钙素原(PCT)、快速序贯器官衰竭评分(qSOFA)及24 h内序贯器官衰竭评分(SOFA)、简化急性生理学评分Ⅱ(SAPSⅡ)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分对患者预后的预测价值.结果 152例脓毒症患者中存活110例,死亡42例.与存活组比较,死亡组入ICU时Lac、PCT、SOFA评分、qSOFA评分、SAPSⅡ评分、APACHEⅡ评分明显升高,24 h LCR明显降低.ROC曲线分析显示,SAPSⅡ评分、24 h LCR、SOFA评分对脓毒症预后的预测价值较大,SAPSⅡ评分的ROC曲线下面积(AUC)为0.877(P=0.000),最佳阈值为41.50分时,敏感度为94.3%,特异度为68.5%;24 h LCR的AUC为0.869(P=0.000),最佳阈值为40.2%时,敏感度为92.1%,特异度为75.5%;SOFA评分的AUC为0.815(P=0.000),最佳阈值为7.60分时,敏感度为79.9%,特异度为78.5%.而PCT(AUC=0.759)、入ICU时Lac(AUC=0.725)、qSOFA(AUC=0.701)、APACHEⅡ评分(AUC=0.680)对脓毒症患者的预测价值一般(AUC 0.6~0.8).对于腹腔感染致脓毒症患者,预测预后最准确的指标为SOFA评分(AUC=0.889,P=0.000,最佳阈值为9.50分时,敏感度为81.2%,特异度为83.5%);对于肺部感染致脓毒症患者,预测预后最准确的指标为PCT(AUC=0.891,P=0.001,最佳阈值为3.95 mg/L时,敏感度为84.7%,特异度为94.1%).结论 SOFA评分及qSOFA评分不能代替传统评价指标评估脓毒症患者的预后.