Complex reimplantation of an inflatable penile prosthesis with scar tissue excision and distal corporal defect repair with Tutoplast®pericardium allograft

Background:Patients with inflatable penile prostheses(IPP)may experience erosions after years of use or after indwelling Foley catheter placement.IPP erosions should be managed as an infection with the entire IPP removed.Replacing IPPs in erosion patients can be challenging due to extensive scarring development.Using proper graft materials may be necessary to close and reinforce the corporal defect after difficult corporal dilation or significant scar removal for the long‐term success of IPP reimplantation.Case Presentation:Herein we report a patient with a history of IPP placement in 2007 for erectile dysfunction and Peyronie's disease,presenting in 2018 with dysuria and a feeling of IPP displacement following Foley catheter placement for coronary artery bypass graft surgery.The left cylinder of the IPP was observed by physical examination and a defect near the fossa navicularis was discovered during office cystoscopy.A complete explantation of IPP was then performed.Reimplantation of the IPP was performed in 2021 which required excision of corporal scar tissue and repair of a left distal corporal defect using a Tutoplast®pericardium allograft.The procedure was successful with proper IPP position and good function without any penile deformity.Conclusion:The use of graft materials in the management of corporeal defects should be considered in the setting of complex IPP revision.The Tutoplast®pericardium allograft reinforcement can provide long‐term durability,flexibility,and a lower risk of infection.

Outcomes of surgical correction of Peyronie’s disease with plaque excision and grafting: Comparison of testicular tunica vaginalis graft versus bovine pericardium graft

Objective:Peyronie’s disease(PD)is an abnormal wound healing in the penile tunica albuginea.After fibrotic plaque excision,different graft materials have been used to repair the defects,but the optimal graft remains unknown.This study aimed to compare the functional outcomes of testicular tunica vaginalis grafts and bovine pericardium grafts in patients with severe PD.Methods:A retrospective comparative study was conducted on 33 PD patients undergoing partial plaque excision and grafting from September 2015 to May 2021.The patients were divided into two groups depending on the type of graft used.For 15 patients in Group B,testicular tunica vaginalis grafts were used to repair the defect,while for 18 patients in Group A,bovine pericardium grafts were used.Data of the patient’s age,comorbidities,sexual function,penile curvature,postoperative complications,need for further treatment,change in penile length,and satisfaction were gathered and compared between the groups.Sexual function was evaluated using the 5-item version of the International Index of Erectile Function(IIEF-5),and a functional less than 20-degree penile curvature after surgery was considered a successful intervention.Results:There was no difference in age,comorbidities,degree of curvature,perioperative IIEF-5,operative time,plaque size,or complication rates.After surgery,a statistically significant improvement in curvature degree(p<0.05)and satisfactory penile appearance(p<0.05)were seen in both groups without any superiority between the two groups(p=0.423 and p=0.840,respectively).With a 30-month follow-up,the IIEF-5 was consistent in both groups,with no statistical significance between the groups(p=0.492).The main change in penile length during the operation was increased and still positive in the last follow-up in both groups without statistical significance(p=0.255 and p=0.101,respectively).Conclusion:Partial plaque excision and corporoplasty with both testicular tunica vaginalis or bovine pericardium grafts are equally effective in treating males with clinically significant PD.

Congenital Absence of Pericardium:The Largest Systematic Review in the Field on 247 Worldwide Cases(1977-Now)

Background:Congenital absence of pericardium(CAP),also known as pericardial agenesis,represents an uncommon cardiac abnormality and mostly incidental finding.It can be subdivided into complete and partial(left or right-sided)forms.Because of its infrequency,just case reports and a few case series have been released so far.This paper represents the largest systematic review in the field.Nine features(age at diagnosis,type,gender,clinical presentation,electrocardiography,imaging(ultrasounds,CT/MRI),concomitant cardiac defects,and outcome)were analysed.Methods:The electronic database PubMed was investigated from its establishment up to July 15th,2023.Just case reports and case series were included.Animal studies,papers that were not in English,Spanish,and Italian,and those manuscripts not reporting at least seven of the nine analysed features.were ruled out.The analysed data were reported mostly in terms of percentage.Results:One hundred eighty studies were included encompassing 247 patients.More than half of reviewed CAP cases were in males(63.2%).The mean age at diagnosis was 31.8±19.3 years;a range of 32 weeks of gestation-81 years).23.5%of the patients did not report any symptoms.The most common clinical presentations were chest pain(35.2%)and dyspnoea(29.2%).The most commonly seen ECG changes were right axis deviation(28.7%)and right bundle branch block(23.9%).CAP was suspected or diagnosed by echocardiography in 20.1%of cases.The diagnosis was made by CT and/or MRI in 61.9%of cases.CAP was left-sided in 71.2%,complete in 23.1%,and right-sided in 5.7%.A concomitant congenital heart defect was found in 22.7%,especially in the form of atrial septal defect(6.5%)and patency of ductus arteriosus(2.8%).The pericardial repair was required in 12.9% of the incomplete forms of the disease.Never did the complete form require surgical correction.The outcome appeared favourable in the vast majority of cases,with just 18 deaths(7.3%).Discussion:The main limitation of this systematic review is that it is based just on case reports and case series,due to the lack of large studies on CAP.However,it represents the largest analysis in the field.Due to the rarity of CAP establishing an International Registry is recommended.

Effect of electroacupuncture at pericardium meridian on D‑ser and NMDAR in acute phase of MCAO rats

Objective :To observe the effect of electroacupuncture at pericardium meridian on neurological deficit, D-serine ( D-Ser ) content and NMDAR expression in ischemic brain tissue of rats with middle cerebral artery occlusion ( MCAO ). Methods:A total of 36 SD rats were randomly divided into normal group, sham operation group, model group, EA pericardium meridian group, model+D-Ser group,and EA pericardium meridian+D-Ser group. The MCAO model was prepared by Zea Longa method. The model+D-Ser group and the EA pericardium meridian+D-Ser group were given exogenous D-Ser reagent(160 mg/kg i.p.) 30 minutes after the success of the insertion of the suture. EA pericardium meridian group and EA pericardium meridian+D-Ser group were treated with electroacupuncture for 30 min on the next day. The remaining groups were only bound for 30 min.Behavioral evaluation was performed at 6 h after successful modeling and 2 d after intervention, and then the rats were sacrificed. The content of D-Ser in ischemic brain tissue was measured by liquid chromatography tandem mass spectrometry, and the protein expression of NR1, NR2A and NR2B was detected by Western Blot. Results : Before treatment, compared with the normal group and the sham operation group, the behavioral scores of each group increased after modeling (P<0.05 );Compared with the model group, the behavioral scores of the model+D-Ser group and the EA pericardium meridian+D-Ser group were increased (P<0.05).After treatment, compared with the model group, there was no significant difference in the EA pericardium meridian group (P>0.05),The behavioral scores of the model+D-Ser group and the EA pericardium meridian+D-Ser group were still increased (P<0.05);Compared with the model+D-Ser group, the behavioral score of the EA pericardium meridian+D-Ser group was not statistically significant (P>0.05).Comparison before and after treatment in the group,except for the normal group and the sham operation group, the behavioral scores of each group were slightly increased, and the difference was not statistically significant (P>0.05).Compared with the model group, the content of D-Ser and the protein expression of NR1, NR2A and NR2B in the brain tissue of the model+D-Ser group were significantly increased (P<0.05);The protein expression of NR1, NR2A and NR2B decreased in EA pericardium meridian group (P<0.05);Compared with the model+ D-Ser group, the D-Ser content and the protein expression of NR1, NR2A and NR2B in the EA pericardium meridian+D-Ser group were decreased (P<0.05). Conclusion : EA at pericardium meridian points can reduce the D-Ser content in brain tissue of rats with acute MCAO, regulate the decrease of NR1, NR2A and NR2B protein expression, inhibit the NMDA receptor activity, and play a neuroprotective role.

电针心经/心包经对阿尔茨海默病模型大鼠记忆能力及Aβ1-42蛋白表达的影响

目的:探讨电针心经/心包经对阿尔茨海默病大鼠学习记忆能力及心脏HO-1、Aβ1-42表达的影响。方法:选用SD大鼠35只,随机分为正常组、假手术组、模型组、心包经组、心经组,每组7只。分别对模型组、心包经组、心经组大鼠采用双侧海马内注射0.9%氯化钠溶液和Aβ1-42法建立AD模型。成模后对心包经组、心经组进行电针干预,正常组、假手术组、模型组捆绑处理,不进行电针刺激。治疗结束后运用Morris水迷宫检测大鼠学习记忆能力、HE染色法观察大鼠心肌组织病理改变、免疫组化法和免疫印迹法检测大鼠心肌HO-1和Aβ1-42蛋白表达情况。结果:假手术组各项指标与正常组比较,差异无统计学意义(均P>0.05)。与假手术组比较,模型组大鼠的逃避潜伏期明显延长,第二象限百分比、跨越平台次数减少,差异有统计学意义(均P<0.05)。心肌纤维排列紊乱,炎症反应明显,HO-1蛋白表达下调,而Aβ1-42蛋白表达增加,差异有统计学意义(均P<0.05)。与模型组比较,心经组、心包经组大鼠各项异常指标均得到改善,差异有统计学意义(均P<0.05)。与心经组比较,心包经组的逃避潜伏期缩短,第二象限百分比和跨越平台次数增加,差异有统计学意义(均P<0.05)。心经组HO-1与Aβ1-42蛋白表达与心包经组比较,差异无统计学意义(P>0.05)。结论:电针心经/心包经可改善阿尔茨海默病大鼠空间学习记忆能力,其作用机制可能与上调HO-1表达,减轻Aβ1-42神经毒性损伤有关。

产前超声诊断胎儿心包畸胎瘤1例

孕妇29岁,孕1产0,孕23周产前超声提示胎儿胸腔占位;既往无特殊病史及家族史。孕23周胎儿超声:于三血管气管切面探及大血管旁1.3cm×1.2cm略高回声包块,形态规则,向上延伸至主动脉与上腔静脉间隙内,四腔心切面及矢状切面见包块向下达右心房后方(图1A);CDFI于包块内未见明显血流信号,于室间隔膜周部探及宽2mm过隔血流束,心室水平见右向左分流(图1B)。超声诊断:心包畸胎瘤可能性大;可疑室间隔缺损。孕妇选择引产。胎儿标本心脏右后方见1.4cm×1.2cm×1.0cm包块,形态规整,边界清晰(图1C).

心外膜脂肪组织与心房颤动关系的研究进展

心房颤动(atrial fibrillation,AF)是一种常见的房性心律失常,AF导致的心功能损害和卒中是导致残疾及死亡的重要原因。心外膜脂肪组织(epicardial adipose tissue,EAT)是一种具有重要内分泌和炎症功能的生物活性器官,近年来研究表明,EAT与AF的发生和发展有着密切的关系。现就EAT与AF的关系的研究进展作一综述,旨在为AF的预防和治疗提供新思路。

基于古代文献浅析手少阴心经与手厥阴心包经的联系

有关“少阴经”与“厥阴经”的记载在长沙马王堆汉墓出土的《足臂十一脉灸经》与《阴阳十一脉灸经》便已有涉及。后期经过医家的不断完善,终于形成完整的经脉理论体系。通过古代文献《黄帝内经》《黄帝内经太素》《针灸甲乙经》《针灸大成》等对“手少阴心经”“手厥阴心包经”的记载,发现“手少阴心经”与“手厥阴心包经”在名称、循行、主治等方面关系紧密。因而通过厘清“手少阴心经”与“手厥阴心包经”两者间的关系,以期能够更好地指导临床。

内关穴醒脑开窍机制探析

内关为手厥阴心包经穴,有养血、调神、开窍之功,为醒脑开窍主穴。本文从内关与脑窍的联系、内关养血调神的角度探讨内关穴醒脑开窍的机制。内关通过心经连于目窍、舌窍,通过三焦经加强与耳窍的联系,与耳窍、目窍、舌窍的密切联系是其通脑窍的生理基础。内关属厥阴经穴,具备多血少气的特点;内关通于阴维脉,即阴维脉可通过内关调理津液、血液,故内关善滋阴养血。神的正常活动需以血液充盈为条件,故内关可通过调节阴血发挥养神、安神、调神的作用。现代临床中内关在心脑疾病中的应用也印证了如上机制。

Mechanisms on Correlation between the Pericardium Meridian and Heart Effects of Electroacupuncture at Neiguan and Other Acupo

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Does the Animal Origin Influence the Calcification of Xenograft Tissue Heart Valve Substitutes? Comparison between Bovine and Camel Pericardium in a Subcutaneous Rat Model

Objective: To validate the hypothesis that camel pericardium could be more protected than bovine pericardium against calcification process according to the huge difference in their respective lifestyle and lifetime. Methods: Glutaraldehyde (GA) fixed bovine and camel pericardium samples (BP and CP respectively) were both implanted in 30 New Zealand white rats (2 BP and 2 CP matched specimens in each animal) and explanted after 60 days. Unimplanted GA-fixed samples of both species served as control. Matched implanted samples and unimplanted samples were randomly submitted to elemental analysis by spectroscopy, phospholipid extraction, macroscopic and X-ray examination and histology. Results: At 60 days, calcium and phosphorus content were respectively 9.54% ± 3.1% and 4.79% ± 1.4% of tissue dry weight in BP, and 12.52% ± 2.7% and 6.14% ± 1.3% of tissue dry weight in CP (ns). In X-ray analysis, the calcification score was 1.28 ± 0.45 and 2.14 ± 0.98 in BP and CP samples respectively without significant difference (p < 0.08). In histology, calcifications were lower in BP than in CP: 1.37 ± 0.85 vs 2.28 ± 0.83 (ns);collagen fibers were better conserved in BP than in CP: 2.4 ± 0.48 vs 1.87 ± 0.78 (ns), and less disoriented: 25% vs 62% (ns). In unimplanted samples, there was a higher but not significant rate of extracted lipids in CP: 5.7 ± 1.8 vs 9.5 ± 3.8 nanomoles in PS fraction and 11.3 ± 3.7 vs 19 ± 7.7 nanomoles in total fatty acids, in BP and CP samples respectively. All results were in conjunction and demonstrated a higher but not significant rate of mineralization in camel pericardium after implantation, which could be related to a higher but not significant basic rate of phospholipid and fatty acids. Conclusion: This experiment study in a subcutaneous rat model has failed to valid our hypothesis. Because the differences observed between bovine and camel pericardium did not reach the significance, at the best, there is no difference between both species and at the worst, camel pericardium has a higher rate of the phosphatidylserine fraction of phospholipid, and is more sensitive and prompt to calcification.

Use of bovine pericardium graft for abdominal wall reconstruction in contaminated fields

AIM:To employ, in such conditions, a biological graft such as bovine pericardium that offers resistance to infection. METHODS:In our surgical department, from January 2006 to June 2010, 48 patients underwent abdominal wall reconstruction using acellular bovine pericardium; of these 34 patients had a contaminated wound due to diffuse peritonitis (complicated diverticulitis, bowel perforation, intestinal infarction, strangled hernia, etc. ) and 14 patients had hernia relapse on infected synthetic mesh. RESULTS: In our series, one patient died of multiorgan failure 3 d after surgery. After placement of the pericardium mesh four cases of hernia relapse occurred. CONCLUSION: Recurrence rate is similar to that of prosthetic mesh repair and the application of acellular bovine pericardium (Tutomesh , Tutogen Medical Gmbh Germany) is moreover a safe and feasible option thatcan be employed to manage complicated abdominal wall defects where prosthetic mesh is unsuitable.

Valve Repair Using Autologous Pericardium in Tricuspid Valve Endocarditis

Tricuspid valve endocarditis is a significant cause of valve-related morbidity and mortality. Prosthetic valve reconstruction can be costly and requires life-long anticoagulation. We present our experience with surgical management of an endocarditis damaged tricuspid valve leaflet in an intravenous drug user. We were able to excise the infected tissue and successfully repair the native valve using autologous pericardium, effectively eliminating the need for prostheses and associated complications. Our case report demonstrates that tricuspid valve reconstruction, using autologous pericar-dium, is a suitable option in patients with tricuspid endocarditis.

Primary synovial sarcoma of pericardium: A case report

Primary pericardial sarcomas are extremely rare. We report a case of 19 year old male who presented with cough, dyspnoea, and orthopnea. Investigations and exploratory thoracotomy revealed a large pericardial mass. Surgical debulking of the tumor was performed and the histopathological examination was compatible with synovial sarcoma. The tumor was unresectable due to its invasion and adhesion to mediastinal structures. Hence patient was started on palliative chemotherapy (adriamycin and ifosfamide based). Patient showed an initial symptomatic response but later on there was a clinical progres-sion and died within six months of his diagnosis.

Aortic Neocuspidization with Autologous Pericardium: Initial Experience of Single Center

Background: Aortic neo-cuspidization (AVNeo) procedure has been adopted by limited centers with the publication of the mid-long term successful results. The aim of this study was to present initial experience of the AVNeo procedure of a single center. Methods: The medical records of 24 patients who underwent AVNeo with or without concomitant cardiac surgery between February 2019 and February 2021 at our tertiary hospital were scanned retrospectively. Results: The mean age of patients was aged 58.21 ± 13.14 years and 16 (66.7%) of them were men. 16 patients were operated on for aortic stenosis (66.67%). Morphology of the aortic valve was tricuspid in 21 (87.5%) and bicuspid in 3 (12.5%) of the patients. Additional cardicac surgery was performed in 13 (54.17%) patients. No patients needed reoperation for bleeding, pacemaker implantations, conversion to classical prosthetic aortic valve replacement, or infective endocarditis. Two patients died due to non-cardiac reasons. Preoperative peak and mean aortic valve pressures improved significantly at 1st and 6th months (Preop: 89.06 ± 21.88 mmHg and 56.38 ± 15.09 mmHg 1st month: 22.00 ± 3.93 mmHg and 8.73 ± 2.60 mmHg, 6th month: 18.13 ± 3.02 mmHg and 6.93 ± 1.83 mmHg). Conclusion: In conclusion, the AVNeo procedure is a feasible technique for aortic valve pathologies, with the advantages of avoiding anticoagulants and the applicability of concomitant surgical procedures. Although this procedure requires meticulous experience, results similar to the available published literature can be obtained and reproducible even during learning curve when technical steps are strictly followed.

Primary primitive neuroectodermal tumor in the pericardium-a focus on imaging findings:A case report

BACKGROUND Primitive neuroectodermal tumors(PNETs)are rare,sporadic malignant tumors of the peripheral nervous system,bone,or soft tissues.However,to the best of our knowledge,only three cases of PNET in the pericardium have been reported in the English literature,and their magnetic resonance imaging findings have not previously been described.CASE SUMMARY A 3-year-old boy was hospitalized with a 1-wk history of recurrent vomiting and weakness.Detailed history-taking revealed no evidence of heart disease.Computed tomography demonstrated a soft tissue mass in the left pericardial cavity with heterogeneous contrast enhancement.The border between the mass and the heart was poorly defined.Thoracotomy revealed a mass invading the left ventricle,with a high risk of bleeding.The mass was considered inoperable.A biopsy was performed,and the histological and immunohistochemical findings confirmed the diagnosis of primary PNET of the pericardium.The patient received four cycles of standard chemotherapy.Chest magnetic resonance imaging 3 mo after the initiation of chemotherapy revealed that the tumor in the pericardium still existed,but its volume had slightly decreased.The patient was lost to follow-up,and the final outcome was therefore unknown.CONCLUSION Medical imaging plays an important role in defining the pericardial origin of PNET and understanding its characteristics.Magnetic resonance imaging can provide more information on the tumor than computed tomography and may thus aid therapeutic planning.

Comparative Study of Bovine Pericardium and Gore-Tex in Tissual Interaction with Wistar Rats Diaphragm

Introduction: Simple suture isn’t always possible in large congenital diaphragmatic hernia (cdh) defects. Synthetic materials are used for correction such as Silastic&reg, Gore-Tex&reg (GT), Teflon&reg or biological, such as autologous muscle patches. It was shown that bovine pericardium (bp) was effective to correct those large defects with many positive outcomes when compared with syntactic materials. Aim: This study aims to establish an experimental model of correction for large diaphragmatic defect with PB and GT patches to compare histologically the tissue interaction between them and diaphragm in young Wistar rats. Materials & Methods: 15 wistar rats were divided in 3 groups: Rats that used BP was named G1;Rats that used GT was named G2;and rats with only scraping in the diphragm, named G3 (control). Animals were submited to a laparotomy and fixed pathces to diaphragms and harvested 3 weeks later. Area between normal diaphragm and patches were isolated and separated for histological analysis, such as lymphocytic infiltration (inflammation), neovascularization and fibrosis. Results: G1 presented inflammation between BP and Diaphragm In 5 Samples. G2 Presented Neovascularization In 5 Samples, But No inflammation. Fibrotic tissue overlapping GT patches occurred in 3 samples in G2. Comparing G1 with G2 there was a significant statistical difference concerning inflammation (P = 0.0079), in G1. Comparing neovascularization there is no significant statistical difference (P = 0.4444), despite a slight higher incidence in G2. Fibrosis in both groups presented no significant statistical difference (P = 0.4444), despite a slight higher incidence in G2. There were no alterations in G3. Discussion: Despite the statistical difference in the inflammatory process was more frequent in G1 (P = 0.0079), neovascularization and fibrosis were more frequent in G2. Conclusion: The proposed experimental model was satisfactory to reproduce suture of patches in the diaphragm. These results suggests that inflammation, neovascularization and fibrosis indeed contribute to a benign healing process that reacts differently in each group but can drive to a more lasting and permanent results when biological patch is considered. Statistical report suggests that this study should be continued with a larger sample of animals and a wider period of time before harvest.

A canine model of aortic arch aneurysm created with autologous pericardium

Background:To establish a canine model of aortic arch aneurysm that is suitable for research on new devices and techniques applied to the aortic arch.Materials and methods:Fifteen mongrel dogs underwent surgery.The autologous pericardial patch was sewn on the aortotomy site in the anterior wall of the aortic arch.The animals were followed up for 3 months postoperatively.Computed tomography angiography was used to visualize and measure the aneurysm model.Hematoxylin and eosin staining was used to observe the histological characteristics of the aneurysm model.Changes in aneurysm diameter over time were analyzed using analysis of variance.Results:One dog died of hemorrhage during surgery.Fourteen dogs survived the surgical procedure.Two of them died on the first postoperative day because of ruptures at the suturing margin.The diameter of the aneurysm model was twice as large as that of the aortic arch.There was no significant change in the maximum diameter of the aneurysm model during the follow-up period.Conclusions:We established a controllable and stable aortic arch aneurysm model created with an autologous pericardium patch.The aneurysm model can be used to research endoleaks after thoracic endovascular aortic repair and new endovascular techniques can be applied to the aortic arch.

Rebar Impalement Injury Throughout Bilateral Hemithorax and Pericardium

Thoracic traumas have an important place among all injuries as they can cause significant mortality and morbidity. The thoracic injuries are the large part of trauma with head and extremity injuries. Thoracic traumas are divided into two groups, including penetrating and blunt. The primary causes for penetrating traumas are wounds caused by gunshot and sharp objects. The lungs are the most injured organ in penetrating thoracic traumas with many organ injuries accompanied. This case report is about a rebar impalement into bilateral hemitoraces and pericardium after falling down in spite of any injury is not occurred in heart, lung and great vessels. The fact that an injury to such an extent does not cause any intrathoracic catastrophic event is something that has not been reported in the past.

合并慢性阻塞性肺疾病对重症肺炎死亡率的影响以及重症肺炎中医证型分布特点分析

【目的】调查重症肺炎住院死亡率的相关危险因素及中医证型分布特点,分析合并慢性阻塞性肺疾病(COPD)对重症肺炎死亡率的影响。【方法】回顾性收集2018年1月1日~2020年12月31日在广州中医药大学第一附属医院呼吸与危重症医学科住院且第一诊断为重症肺炎的431例患者,根据存活情况将患者分为存活组370例和死亡组61例。通过采用单因素分析、多因素分析以及Cox回归分析确定危险因素,制作生存分析曲线,采用Log-rank检验分析曲线间差异是否有统计学意义,并应用phtest检验对95%置信区间(CI)的风险比(HR)进行检验。【结果】(1)中医证型分布方面,在431例重症肺炎患者中,邪陷正脱证64例,热闭心包证69例,痰热壅肺证74例,痰浊阻肺证80例,肺热腑实证69例,气阴两虚证75例。(2)单因素分析结果显示,相对于存活组,死亡组患者的年龄更大,体质量指数(BMI)更低,序贯器官衰竭估计(SOFA)评分、血清尿素氮与血清肌酐比值(BUN/Scr)、男性比例、合并充血性心力衰竭(CHF)和COPD比例以及辨证为邪陷正脱证、热闭心包证的比例更高,而辨证为气阴两虚证的比例更低,差异均有统计学意义(P<0.05或P<0.01)。(3)多因素分析结果显示,性别、合并COPD、SOFA评分、邪陷正脱证和热闭心包证是重症肺炎患者住院死亡率的危险因素,差异均有统计学意义(P<0.05或P<0.01)。(4)经模型1(混杂因素包括年龄、性别、BMI、合并CHF)和模型2(混杂因素包括年龄、性别、BMI、合并CHF、SOFA评分、BUN/Scr、邪陷正脱证、热闭心包证、气阴两虚证)校正后,合并COPD仍有较高的死亡风险,其HR(95%CI)分别为3.1(1.8-5.2)和2.1(1.0-1.2),差异均有统计学意义(P<0.01),且其风险系数并不随时间改变而变化。【结论】合并COPD是影响重症肺炎死亡率的独立危险因素,而辨证为邪陷正脱证、热闭心包证的重症肺炎患者也有着较高的死亡风险。