目的探讨成年无肝病重症患者入重症监护室(ICU)首次血氨水平与患者ICU死亡及医院死亡发生风险间的关系。方法采用回顾性队列研究,纳入eICU合作研究数据库(eICU Collaborative Research Database,eICU-CRD)中单次入院,首次入住ICU初始48 ...目的探讨成年无肝病重症患者入重症监护室(ICU)首次血氨水平与患者ICU死亡及医院死亡发生风险间的关系。方法采用回顾性队列研究,纳入eICU合作研究数据库(eICU Collaborative Research Database,eICU-CRD)中单次入院,首次入住ICU初始48 h内有血氨检测记录且入ICU未患有肝脏疾病的患者。提取患者的年龄、性别、种族、急性生理和慢性健康评分Ⅳ(APACHEⅣ评分)、肾脏替代治疗等治疗措施、基础患病情况及结局。采用单因素及多因素Logistic回归分析血氨水平与患者死亡风险之间的关系。采用交互作用分析初始血氨水平与患者死亡风险间的关系在不同APACHEⅣ评分、年龄、性别和种族患者中是否存在差异,同时进行亚组分析。结果共纳入1674名患者,多因素Logistic回归显示,初始血氨每增加10μg/dL,患者ICU死亡风险增高6.9%(OR=1.069,95%CI:1.036~1.104),患者医院死亡风险增高4.6%(OR=1.046,95%CI:1.017~1.076);初始血氨在49~82μg/dL组、≥82μg/dL组的患者ICU死亡风险和≥82μg/dL组患者医院死亡风险分别是<49μg/dL组患者的1.7倍(OR=1.700,95%CI:1.165~2.482)、2.862倍(OR=2.862,95%CI:1.792~4.570)、1.844倍(OR=1.844,95%CI:1.213~2.804)。初始血氨水平与ICU及医院死亡发生风险间的关系在不同APACHEⅣ评分、年龄、性别及种族患者中差异无统计学意义。结论在未患有肝脏疾病的重症患者中,入ICU后初始血氨水平升高与患者ICU及医院高死亡风险相关。展开更多
BACKGROUND:To evaluate the accuracy of National Early Warning Score(NEWS)in predicting clinical outcomes(28-day mortality,intensive care unit[ICU]admission,and mechanical ventilation use)for septic patients with commu...BACKGROUND:To evaluate the accuracy of National Early Warning Score(NEWS)in predicting clinical outcomes(28-day mortality,intensive care unit[ICU]admission,and mechanical ventilation use)for septic patients with community-acquired pneumonia(CAP)compared with other commonly used severity scores(CURB65,Pneumonia Severity Index[PSI],Sequential Organ Failure Assessment[SOFA],quick SOFA[qSOFA],and Mortality in Emergency Department Sepsis[MEDS])and admission lactate level.METHODS:Adult patients diagnosed with CAP admitted between January 2017 and May 2019 with admission SOFA≥2 from baseline were enrolled.Demographic characteristics were collected.The primary outcome was the 28-day mortality after admission,and the secondary outcome included ICU admission and mechanical ventilation use.Outcome prediction value of parameters above was compared using receiver operating characteristics(ROC)curves.Cox regression analyses were carried out to determine the risk factors for the 28-day mortality.Kaplan-Meier survival curves were plotted and compared using optimal cut-off values of qSOFA and NEWS.RESULTS:Among the 340 enrolled patients,90 patients were dead after a 28-day follow-up,62 patients were admitted to ICU,and 84 patients underwent mechanical ventilation.Among single predictors,NEWS achieved the largest area under the receiver operating characteristic(AUROC)curve in predicting the 28-day mortality(0.861),ICU admission(0.895),and use of mechanical ventilation(0.873).NEWS+lactate,similar to MEDS+lactate,outperformed other combinations of severity score and admission lactate in predicting the 28-day mortality(AUROC 0.866)and ICU admission(AUROC 0.905),while NEWS+lactate did not outperform other combinations in predicting mechanical ventilation(AUROC 0.886).Admission lactate only improved the predicting performance of CURB65 and qSOFA in predicting the 28-day mortality and ICU admission.CONCLUSIONS:NEWS could be a valuable predictor in septic patients with CAP in emergency departments.Admission lactate did not predict well the outcomes or improve the severity scores.A qSOFA≥2 and a NEWS≥9 were strongly associated with the 28-day mortality,ICU admission,and mechanical ventilation of septic patients with CAP in the emergency departments.展开更多
目的探讨急诊重症监护室(emergency intensive care unit,EICU)血流感染患者临床结局的风险因子,为临床决策提供依据。方法回顾性收集2019年1月至2023年4月我院就诊的141例EICU血流感染患者的病历资料及血培养记录,采用Logistic回归分...目的探讨急诊重症监护室(emergency intensive care unit,EICU)血流感染患者临床结局的风险因子,为临床决策提供依据。方法回顾性收集2019年1月至2023年4月我院就诊的141例EICU血流感染患者的病历资料及血培养记录,采用Logistic回归分析患者死亡的危险因素,运用Cox回归分析上述因素与患者生存时间和临床结局的关系。结果在141例EICU血流感染患者中,两种及以上细菌混合血流感染[比值比(OR)=5.68,95%置信区间(CI):1.20~26.98,P<0.05]及多重耐药菌血流感染(OR=6.39,95%CI:2.78~14.67,P<0.01)与患者死亡具有显著相关性;是否根据药敏结果及时调整用药[风险比(HR)=0.47,95%CI:0.30~0.74]和多重耐药菌血流感染(HR=2.02,95%CI:1.28~3.20)是EICU血流感染患者死亡的风险因子(P<0.01)。结论尽早采集血培养,明确感染病原菌,精准用药控制感染,可以有效降低患者的死亡率。展开更多
目的分析急诊重症监护室(emergency intensive care unit,EICU)患者急性生理和慢性健康状况评分(APACHEⅡ评分)及促炎因子与临床结局之间的关系。方法随机收集2016—2017年EICU收治的103例住院患者,根据APACHEⅡ评分分为高危组和低危组...目的分析急诊重症监护室(emergency intensive care unit,EICU)患者急性生理和慢性健康状况评分(APACHEⅡ评分)及促炎因子与临床结局之间的关系。方法随机收集2016—2017年EICU收治的103例住院患者,根据APACHEⅡ评分分为高危组和低危组。分别检测记录并比较两组患者TNF-α、IL-6、IL-8及死亡率,并分析APACHEⅡ评分与其他各指标之间的相关性。结果高危组患者的TNF-α、IL-6、IL-8均显著高于低危组(P<0.05),且高危组死亡率与低危组比较,差异有统计学意义(P<0.05);APACHEⅡ评分与IL-6、IL-8、TNF-α、死亡率成正相关(P<0.05)。结论 APACHEⅡ评分结合IL-6、IL-8、TNF-α能够有效地判断EICU患者的疾病危重程度及预测患者的临床结局。展开更多
目的:探讨改进式标准化沟通模式(SBAR)床旁交班模式在急诊重症监护病房(emergency intensive care unit,EICU)中的应用效果。方法:2015年5~7月为现况组,实施传统交接班模式;2016年8~10月为改进组,实施改进式SBAR床旁交班模式,制定护护...目的:探讨改进式标准化沟通模式(SBAR)床旁交班模式在急诊重症监护病房(emergency intensive care unit,EICU)中的应用效果。方法:2015年5~7月为现况组,实施传统交接班模式;2016年8~10月为改进组,实施改进式SBAR床旁交班模式,制定护护床旁交班SBAR报告表,规范EICU护士床旁交接班程度。比较两组干预后交班错漏情况及改进前后护士交接班评估量表评分情况。结果:改进组干预后交班错漏情况明显少于现况组(P<0.05),改进后护士交接班评估量表中增进护士监控、合作、责任的评分高于改进前(P<0.05)。结论:运用改进式SBAR床旁交班模式后不仅规范了床旁交接流程,保证交接班信息的全面准确性,并且增进了护士行为监控和团队合作,帮助定位责任,值得长期推广,同时,也需要进行持续的监控与质量改进以促进护士床旁交接班质量的可持续性提高。展开更多
目的调查急诊护士转入重症监护病房(emergency intensive care unit,EICU)工作后的心理压力源,并提出相应的对策。方法采用质性研究中的现象学研究方法,对13名在EICU工作至少6个月的护士进行访谈,采用Colaizzi分析法分析资料。结果急诊...目的调查急诊护士转入重症监护病房(emergency intensive care unit,EICU)工作后的心理压力源,并提出相应的对策。方法采用质性研究中的现象学研究方法,对13名在EICU工作至少6个月的护士进行访谈,采用Colaizzi分析法分析资料。结果急诊护士转入EICU工作后的心理压力源主要来自于4个方面:护理技能、劳动强度增加、对患者沟通提出更高的要求、人员不足。结论护理管理者应积极采取措施减轻由急诊转入EICU护士的心理压力,从而提高护士的工作积极性,进而提高EICU的护理质量。展开更多
文摘目的探讨成年无肝病重症患者入重症监护室(ICU)首次血氨水平与患者ICU死亡及医院死亡发生风险间的关系。方法采用回顾性队列研究,纳入eICU合作研究数据库(eICU Collaborative Research Database,eICU-CRD)中单次入院,首次入住ICU初始48 h内有血氨检测记录且入ICU未患有肝脏疾病的患者。提取患者的年龄、性别、种族、急性生理和慢性健康评分Ⅳ(APACHEⅣ评分)、肾脏替代治疗等治疗措施、基础患病情况及结局。采用单因素及多因素Logistic回归分析血氨水平与患者死亡风险之间的关系。采用交互作用分析初始血氨水平与患者死亡风险间的关系在不同APACHEⅣ评分、年龄、性别和种族患者中是否存在差异,同时进行亚组分析。结果共纳入1674名患者,多因素Logistic回归显示,初始血氨每增加10μg/dL,患者ICU死亡风险增高6.9%(OR=1.069,95%CI:1.036~1.104),患者医院死亡风险增高4.6%(OR=1.046,95%CI:1.017~1.076);初始血氨在49~82μg/dL组、≥82μg/dL组的患者ICU死亡风险和≥82μg/dL组患者医院死亡风险分别是<49μg/dL组患者的1.7倍(OR=1.700,95%CI:1.165~2.482)、2.862倍(OR=2.862,95%CI:1.792~4.570)、1.844倍(OR=1.844,95%CI:1.213~2.804)。初始血氨水平与ICU及医院死亡发生风险间的关系在不同APACHEⅣ评分、年龄、性别及种族患者中差异无统计学意义。结论在未患有肝脏疾病的重症患者中,入ICU后初始血氨水平升高与患者ICU及医院高死亡风险相关。
基金Capital Clinical Characteristic Application Research of Beijing Municipal Science & Technology Commission (Z171100001017057).
文摘BACKGROUND:To evaluate the accuracy of National Early Warning Score(NEWS)in predicting clinical outcomes(28-day mortality,intensive care unit[ICU]admission,and mechanical ventilation use)for septic patients with community-acquired pneumonia(CAP)compared with other commonly used severity scores(CURB65,Pneumonia Severity Index[PSI],Sequential Organ Failure Assessment[SOFA],quick SOFA[qSOFA],and Mortality in Emergency Department Sepsis[MEDS])and admission lactate level.METHODS:Adult patients diagnosed with CAP admitted between January 2017 and May 2019 with admission SOFA≥2 from baseline were enrolled.Demographic characteristics were collected.The primary outcome was the 28-day mortality after admission,and the secondary outcome included ICU admission and mechanical ventilation use.Outcome prediction value of parameters above was compared using receiver operating characteristics(ROC)curves.Cox regression analyses were carried out to determine the risk factors for the 28-day mortality.Kaplan-Meier survival curves were plotted and compared using optimal cut-off values of qSOFA and NEWS.RESULTS:Among the 340 enrolled patients,90 patients were dead after a 28-day follow-up,62 patients were admitted to ICU,and 84 patients underwent mechanical ventilation.Among single predictors,NEWS achieved the largest area under the receiver operating characteristic(AUROC)curve in predicting the 28-day mortality(0.861),ICU admission(0.895),and use of mechanical ventilation(0.873).NEWS+lactate,similar to MEDS+lactate,outperformed other combinations of severity score and admission lactate in predicting the 28-day mortality(AUROC 0.866)and ICU admission(AUROC 0.905),while NEWS+lactate did not outperform other combinations in predicting mechanical ventilation(AUROC 0.886).Admission lactate only improved the predicting performance of CURB65 and qSOFA in predicting the 28-day mortality and ICU admission.CONCLUSIONS:NEWS could be a valuable predictor in septic patients with CAP in emergency departments.Admission lactate did not predict well the outcomes or improve the severity scores.A qSOFA≥2 and a NEWS≥9 were strongly associated with the 28-day mortality,ICU admission,and mechanical ventilation of septic patients with CAP in the emergency departments.
文摘目的探讨急诊重症监护室(emergency intensive care unit,EICU)血流感染患者临床结局的风险因子,为临床决策提供依据。方法回顾性收集2019年1月至2023年4月我院就诊的141例EICU血流感染患者的病历资料及血培养记录,采用Logistic回归分析患者死亡的危险因素,运用Cox回归分析上述因素与患者生存时间和临床结局的关系。结果在141例EICU血流感染患者中,两种及以上细菌混合血流感染[比值比(OR)=5.68,95%置信区间(CI):1.20~26.98,P<0.05]及多重耐药菌血流感染(OR=6.39,95%CI:2.78~14.67,P<0.01)与患者死亡具有显著相关性;是否根据药敏结果及时调整用药[风险比(HR)=0.47,95%CI:0.30~0.74]和多重耐药菌血流感染(HR=2.02,95%CI:1.28~3.20)是EICU血流感染患者死亡的风险因子(P<0.01)。结论尽早采集血培养,明确感染病原菌,精准用药控制感染,可以有效降低患者的死亡率。
文摘目的分析急诊重症监护室(emergency intensive care unit,EICU)患者急性生理和慢性健康状况评分(APACHEⅡ评分)及促炎因子与临床结局之间的关系。方法随机收集2016—2017年EICU收治的103例住院患者,根据APACHEⅡ评分分为高危组和低危组。分别检测记录并比较两组患者TNF-α、IL-6、IL-8及死亡率,并分析APACHEⅡ评分与其他各指标之间的相关性。结果高危组患者的TNF-α、IL-6、IL-8均显著高于低危组(P<0.05),且高危组死亡率与低危组比较,差异有统计学意义(P<0.05);APACHEⅡ评分与IL-6、IL-8、TNF-α、死亡率成正相关(P<0.05)。结论 APACHEⅡ评分结合IL-6、IL-8、TNF-α能够有效地判断EICU患者的疾病危重程度及预测患者的临床结局。
文摘目的:探讨改进式标准化沟通模式(SBAR)床旁交班模式在急诊重症监护病房(emergency intensive care unit,EICU)中的应用效果。方法:2015年5~7月为现况组,实施传统交接班模式;2016年8~10月为改进组,实施改进式SBAR床旁交班模式,制定护护床旁交班SBAR报告表,规范EICU护士床旁交接班程度。比较两组干预后交班错漏情况及改进前后护士交接班评估量表评分情况。结果:改进组干预后交班错漏情况明显少于现况组(P<0.05),改进后护士交接班评估量表中增进护士监控、合作、责任的评分高于改进前(P<0.05)。结论:运用改进式SBAR床旁交班模式后不仅规范了床旁交接流程,保证交接班信息的全面准确性,并且增进了护士行为监控和团队合作,帮助定位责任,值得长期推广,同时,也需要进行持续的监控与质量改进以促进护士床旁交接班质量的可持续性提高。
文摘目的调查急诊护士转入重症监护病房(emergency intensive care unit,EICU)工作后的心理压力源,并提出相应的对策。方法采用质性研究中的现象学研究方法,对13名在EICU工作至少6个月的护士进行访谈,采用Colaizzi分析法分析资料。结果急诊护士转入EICU工作后的心理压力源主要来自于4个方面:护理技能、劳动强度增加、对患者沟通提出更高的要求、人员不足。结论护理管理者应积极采取措施减轻由急诊转入EICU护士的心理压力,从而提高护士的工作积极性,进而提高EICU的护理质量。
