Abdominal compartment syndrome:Often overlooked conditions in medical intensive care units

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.

Clinical Effects of Intensive Insulin Therapy Treating Traumatic Shock Combined with Multiple Organ Dysfunction Syndrome

The therapeutic effects of intensive insulin therapy in treatment of traumatic shock combined with multiple organ dysfunction syndrome （MODS） were investigated. A total of 114 patients with traumatic shock combined with MODS were randomly divided into two groups： control group （n=56） treated with conventional therapy, and intensive insulin therapy group （n=58） treated with conventional therapy plus continuous insulin pumping to control the blood glucose level at range of 4.4-6.1 mmol/L. White blood cells （WBC） counts, prothrombin time （PT）, serum creatinine （SCr）, alanine aminotransferase （ALT）, serum albumin and PaO2 were measured before and at the day 1, 3, 5, 7 and 14 after treatment. The incidence of gastrointestinal dysfunction, the incidence of MODS, hospital stay and the mortality were also observed and compared. After intensive insulin therapy, the WBC counts, SCr, ALT and PT were significantly reduced （P0.05）, but the level of serum albumin was significantly increased （P0.05） at the day 3, 5, 7 and 14. In the meantime, the PaO2 was significantly elevated at the day 3, 5 and 7 （P0.01） after intensive insulin therapy. The incidence of gastrointestinal dysfunction, the incidence of MODS, the length of hospital stay and the mortality were markedly decreased （P0.01）. The results suggest early treatment with intensive insulin therapy is effective for traumatic shock combined with MODS and can decrease the length of hospital stay and the mortality.

Characteristics of postintensive care syndrome in survivors of pediatric critical illness: A systematic review

AIM To synthesize the available evidence focusing on morbidities in pediatric survivors of critical illness that fall within the defined construct of postintensive care syndrome(PICS) in adults, including physical, neurocognitive and psychological morbidities.METHODS A comprehensive search was conducted in MEDLINE, EMBASE, the Cochrane Library, Psyc INFO, and CINAHL using controlled vocabulary and key word terms to identify studies reporting characteristics of PICS in pediatric intensive care unit(PICU) patients. Two reviewers independently screened all titles and abstracts and performed data extraction. From the 3176 articles identified in the search, 252 abstracts were identified for full text review and nineteen were identified for inclusion in the review. All studies reporting characteristics of PICS in PICU patients were included in the final synthesis. RESULTS Nineteen studies meeting inclusion criteria published between 1995 and 2016 were identified and categorized into studies reporting morbidities in each of three categories-physical, neurocognitive and psychological. The majority of included articles reported prospective cohort studies, and there was significant variability in the outcome measures utilized. A synthesis of the studies indicate that morbidities encompassing PICS are well-described in children who have survived critical illness, often resolving over time. Risk factors for development of these morbidities include younger age, lower socioeconomic status, increased number of invasive procedures or interventions, type of illness, and increased benzodiazepine andnarcotic administration.CONCLUSION PICS-related morbidities impact a significant proportion of children discharged from PICUs. In order to further define PICS in children, more research is needed using standardized tools to better understand the scope and natural history of morbidities after hospital discharge. Improving our understanding of physical, neurocognitive, and psychological morbidities after critical illness in the pediatric population is imperative for designing interventions to improve long-term outcomes in PICU patients.

Anemia in patients with high-risk acute coronary syndromes admitted to Intensive Cardiac Care Units

Background Little information exists about the role of anemia in patients with acute coronary syndromes(ACS)admitted to Intensive Cardiac Care Units(ICCU).The aim of this study was to assess the prevalence of anemia and its impact on management and outcomes in this clinical setting.Methods All consecutive patients admitted to eight different ICCUs with diagnosis of non-ST segment elevation ACS(NSTEACS)were prospectively included.Anemia was defined as hemoglobin<130 g/L in men and<120 g/L in women.The association between anemia and mortality or readmission at six months was assessed by the Cox regression method.Results A total of 629 patients were included.Mean age was 66.6 years.A total of 197 patients(31.3%)had anemia.Coronary angiography was performed in most patients(96.2%).Patients with anemia were significantly older,with a higher prevalence of comorbidities,poorer left ventricle ejection fraction and higher GRACE score values.Patients with anemia underwent less often coronary angiography,but underwent more often intraaortic counterpulsation,non-invasive mechanical ventilation and renal replacement therapies.Both ICCU and hospital stay were significantly longer in patients with anemia.Both the incidence of mortality(HR=3.36,95%CI:1.43–7.85,P=0.001)and the incidence of mortality/readmission were significantly higher in patients with anemia(HR=2.80,95%CI:2.03–3.86,P=0.001).After adjusting for confounders,the association between anemia and mortality/readmission remained significant(P=0.031).Conclusions Almost one of three NSTEACS patients admitted to ICCU had anemia.Most patients underwent coronary angiography.Anemia was independently associated to poorer outcomes at 6 months.

Effects of the prone position on arterial blood gas analysis and respiratory parameters of acute respiratory distress syndrome patients:An observational retrospective study

Objective:To investigate the effect of the first prone position on arterial blood gas analysis and respiratory parameters of acute respiratory distress syndrome(ARDS)patients with and without COVID.Methods:This study was conducted retrospectively with 22 COVID-ARDS and 22 non-COVID ARDS patients,who were placed in a prone position for at least 16 hours on the first day at the intensive care unit admission,and arterial blood gas analysis was taken in the pre-prone,prone and post-prone periods.Results:PaO2 were significantly increased in the pre-prone vs.prone comparison in both groups,but the increase in the PaO2/FiO2 ratio was not significant.In comparing the pre-prone vs.post-prone PaO2/FiO2 ratios,there was a significant difference only in the non-COVID ARDS group.Conclusions:The improved oxygenation provided by prone positioning is more permanent with the“post-prone effect”in non-COVID ARDS patients.This can be attributed to the differences in the pathogenesis of the two ARDS types.

The Incidence of Respiratory Distress Syndrome among Preterm Infants Admitted to Neonatal Intensive Care Unit: A Retrospective Study

Background: Respiratory distress syndrome (RDS) or hyaline membrane disease (HMD) is the most common cause of neonatal morbidity and mortality in preterm infants. We aimed to determine the frequency of RDS among 3 groups of preterm infants and the value of some related factors. Methods: A cross-sectional, descriptive analytical investigation was carried out in the NICU ward of Akbarabadi Hospital (Tehran-Iran) during spring 2011. Newborns’ data were collected and assessed by using their hospital medical records. Seventy-three preterm infants with gestational age < 34 weeks were hospitalized in the NICU. All participants were divided into 3 groups: extremely preterm (<28 weeks), very preterm (28 to <32 weeks) and moderate preterm (32 to 34 weeks). Frequency of RDS and some related factors were compared among 3 groups. Results: RDS was observed in 65.6% of all participants;however frequency of RDS was not different between three groups. An inversely correlation was found between gestational age and mortality rate (p = 0.05). In regard to Betamethasone administration prior to birth, this interval was significantly longer in alive neonates in comparison to infants who died (p < 0.05). Conclusion: RDS was frequent in preterm neonates with gestational age < 32 weeks. Time of Betamethasone administration prior to birth can significantly influence on neonatal mortality rate.

Femoral neck stress fracture and medial tibial stress syndrome following high intensity interval training: A case report and review of literature

BACKGROUND Femoral and tibial stress injuries are commonly found in long distance running athletes.Stress fractures have rarely been reported in athletes performing high intensity interval training(HIIT)exercise.The objective of this study was to report a case of a patient who presented with medial tibial stress syndrome and femoral neck stress fracture after performing HIIT exercises.CASE SUMMARY A 26 year old female presented with bilateral medial tibial pain.She had been performing HIIT exercise for 45 min,five times weekly,for a seven month period.Her tibial pain was gradual in onset,and was now severe and worse on exercise,despite six weeks of rest.Magnetic resonance imaging(MRI)revealed bilateral medial tibial stress syndrome.As she was taking norethisterone for birth control,a dual energy X-ray absorbitometry scan was performed which demonstrated normal bone mineral density of her lumbar spine and femoral neck.She was managed conservatively with analgesia and physiotherapy,but continued to exercise against medical advice.She presented again six months later with severe right hip pain.MRI of her right hip demonstrated an incomplete stress fracture of her subtrochanteric region.Her symptoms resolved with strict rest and physiotherapy.CONCLUSION HIIT may cause stress injury of the tibia and femur in young individuals.

Conventional insulin vs insulin infusion therapy in acute coronary syndrome diabetic patients

AIM:To evaluate the impact on glucose variability(GLUCV)of an nurse-implemented insulin infusion protocol when compared with a conventional insulin treatment during the day-to-day clinical activity.METHODS:We enrolled 44 type 2 diabetic patients(n=32 males;n=12 females)with acute coronary syndrome(ACS)and randomy assigned to standard a subcutaneous insulin treatment(n=23)or a nurse-implemented continuous intravenous insulin infusion protocol(n=21).We utilized some parameters of GLUCV representing well-known surrogate markers of prognosis,i.e.,glucose standard deviation(SD),the mean dailyδglucose(mean of daily difference between maximum and minimum glucose),and the coefficient of variation(CV)of glucose,expressed as percent glucose(SD)/glu-cose(mean).RESULTS:At the admission,first fasting blood glucose,pharmacological treatments(insulin and/or anti-diabetic drugs)prior to entering the study and basal glycated hemoglobin(HbA1c)were observed in the two groups treated with subcutaneous or intravenous insulin infusion,respectively.When compared with patients submitted to standard therapy,insulin-infused patients showed both increased first 24-h(median 6.9 mmol/L vs 5.7mmol/L P<0.045)and overall hospitalizationδglucose(median 10.9 mmol/L vs 9.3 mmol/L,P<0.028),with a tendency to a significant increase in first 24-h glycaemic CV(23.1%vs 19.6%,P<0.053).Severe hypoglycaemia was rare(14.3%),and it was observed only in 3 patients receiving insulin infusion therapy.HbA1c values measured during hospitalization and 3 mo after discharge did not differ in the two groups of treatment.CONCLUSION:Our pilot data suggest that no real benefit in terms of GLUCV is observed when routinely managing blood glucose by insulin infusion therapy in type 2 diabetic ACS hospitalized patients in respect to conventional insulin

Correlation between circulating endothelial cell level and acute respiratory distress syndrome in postoperative patients

BACKGROUND Acute respiratory distress syndrome(ARDS)is injury of alveolar epithelial cells and capillary endothelial cells caused by various factors,including endogenous and exogenous lung factors,leading to diffuse pulmonary interstitial and alveolar edema,and acute respiratory failure.ARDS involves alveolar epithelial cells and pulmonary interstitial capillary endothelial cells.Circulating endothelial cells(CECs)are the only marker that directly reflects vascular endothelial injury in vivo.There have been few studies on the correlation between peripheral blood CECs and ARDS at home and abroad.The lungs are the organs with the highest capillary density and the most endothelial cells,thus,it is speculated that when ARDS occurs,CECs are stimulated and damaged,and released into the circulatory system.AIM To explore the correlation between CEC level and severity of ARDS in patients postoperatively.METHODS Blood samples were collected from all patients on day 2(d2)and day 5(d5)after surgery.The control group comprised 32 healthy volunteers.Number of CECs was measured by flow cytometry,and operation time was recorded.Changes in various indexes of patients were monitored,and diagnosis of ARDS was determined based on ARDS Berlin definition.We comprised d2 CECs in different groups,correlation between operation time and d2 CECs,ARDS of different severity by d2 CECs,and predictive value of d2 CECs for ARDS in postoperative patients.RESULTS The number of d2 CECs in the ARDS group was significantly higher than that in the healthy control group(P<0.001).The number of d2 CECs in the ARDS group was significantly higher than that in the non-ARDS group(P<0.001).The number of d2 CECs in the non-ARDS group was significantly higher than that in the healthy control group(P<0.001).Operation time was positively correlated with number of CECs on d2(rs=0.302,P=0.001).The number of d2 CECs in the deceased group was significantly higher than that in the improved group(P<0.001).There was no significant difference in number of d2 CECs between patients with mild and moderate ARDS.The number of d2 CECs in patients with severe ARDS was significantly higher than that in patients with mild and moderate ARDS(P=0.041,P=0.037).There was no significant difference in number of d5 and d2 CECs in the non-ARDS group after admission to intensive care.The number of d5 CECs was higher than the number of d2 CECs in the ARDS improved group(P<0.001).The number of d5 CECs was higher than the number of d2 CECs in the ARDS deceased group(P=0.002).If the number of CECs was>1351/mL,sensitivity and specificity of predicting ARDS were 80.8%and 78.1%,respectively.CONCLUSION Changes in number of CECs might predict occurrence and adverse outcome of ARDS after surgery,and higher numbers of CECs indicate worse prognosis of ARDS.

Phenobarbital Use as Adjunct to Benzodiazepines in the Treatment of Severe Alcohol Withdrawal Syndrome

Severe AWS （alcohol withdrawal syndrome） and AWD （alcohol withdrawal associated delirium） are common indications for intensive care unit admissions. Approximately 25% of patients with severe alcohol withdrawal require prolonged critical care hospital courses, often complicated by respiratory failure, need for mechanical ventilation due to administration of sedative continuous infusions and development of nosocomial infections. Although benzodiazepines are the mainstay of therapy for alcohol withdrawal, some patients exhibit benzodiazepine-refractory alcohol withdrawal. The use of phenobarbital as adjunct to benzodiazepines has been shown in studies to be effective in enhancing therapeutic responsiveness to benzodiazepines and reducing the need for mechanical ventilation. The objective of this study is to evaluate whether severe alcohol withdrawal treatment based on combining symptom-triggered benzodiazepine therapy with adjunctive phenobarbital will result in decreased mechanical ventilation rates, decreased use of continuous sedative infusions, decreased time to withdrawal symptom resolution and decreased length of stay in the intensive care unit. Chart reviews were utilized to determine total amount of benzodiazepine and phenobarbital use, need for mechanical ventilation, requirement of continuous lorazepam, dexmedetomidine or propofol infusions, average intensive care unit length of stay and incidence of adverse effects.

Alveolar Hemorrhage and Acute Respiratory Distress Syndrome Associated with Pulmonary Cement Following Percutaneous Vertebroplasty with Polymethylmethacrylate

We report a rare complication of diffuse alveolar hemorrhage and respiratory failure following percutaneous vertebroplasty in a patient who has evidence of cement leakage. Cement injection was done two days prior to presentation and covered 2 vertebral levels for osteoporosis induced fractures.

Advances in post intensive care unit care: A narrative review

As the treatment options,modalities and technology has grown,mortality in intensive care unit(ICU)has been on the decline.More and more patients are being discharged to wards and in the care of their loved ones after at times prolonged treatment,sometimes in isolation.These survivors have a lower life expectancy and a poorer quality of life.They can have substantial familial financial implications and an economic impact on the healthcare system in terms of increased and continued utilisation of services,the so-called post intensive care syndrome(PICS).But it is not only the patient who is the sufferer.The mental health of the loved ones and family members may also be affected,which is termed as PICS-family.In this review,we shall be reviewing the definition,epidemiology,clinical features,diagnosis and evaluation,treatment and follow up of PICS.We shall also focus on measures to prevent,rehabilitate and understand the ICU stay from patients’perspective on how to redesign the ICU,post ICU care needs for a better patient outcome.

高强度聚焦超声消融术联合桂枝茯苓丸治疗子宫肌瘤45例临床观察

目的:观察高强度聚焦超声消融术(HIFUA)联合桂枝茯苓丸治疗子宫肌瘤的临床疗效。方法:选取2020年1月—8月在江西省妇幼保健院住院治疗、年龄大于18岁、术前中医辨证属血瘀型的未绝经子宫肌瘤患者90例,随机分为观察组和对照组,各45例。观察组先行HIFUA治疗,术后口服桂枝茯苓丸3个月,对照组单纯采用HIFUA治疗。2组患者手术后1个月、3个月复查妇科B超,比较2组患者症状及生活质量改善情况。结果:(1)2组术后1个月、3个月子宫肌瘤缩小率比较,观察组均优于对照组,差异均有统计学意义(P<0.05);(2)2组术后1个月、3个月子宫肌瘤症状评分比较,观察组下降程度均优于对照组,健康相关生活质量问卷评分比较,观察组提高程度优于对照组,差异均有统计学意义(P<0.05)。结论:与单用HIFUA相比,HIFUA联合桂枝茯苓丸治疗子宫肌瘤的临床疗效更显著,肌瘤体积缩小率更大,症状及生活质量改善更明显,值得临床推广。

黄芪桂枝五物汤加减联合针刺治疗重症骨创伤患者ICU获得性衰弱的疗效

目的观察黄芪桂枝五物汤加减联合针刺治疗重症骨创伤患者重症监护病房(intensive care unit,ICU)获得性衰弱的效果。方法将66例重症骨创伤ICU获得性衰弱患者,按照随机数字表法分为对照组33例和观察组33例。对照组给予功能锻炼,观察组在此基础上联合黄芪桂枝五物汤加减联合针刺,连续治疗2周。比较两组的临床疗效、机械通气时间、ICU住院天数、日常生活活动能力Barthel指数(BI)评分、APACHEⅡ评分、肌力状态(MRC)评分。结果观察组的有效率90.91%(30/33),高于对照组的有效率69.70%(23/33)(P<0.05);观察组机械通气天数、住ICU时间明显短于对照组(P<0.05);治疗14d,观察组患者的BI等级优于对照组(P<0.05);治疗3d、治疗5d、治疗7d的观察组的APACHEⅡ评分明显低于对照组,肌力状态MRC评分明显高于对照组(P<0.05)。结论黄芪桂枝五物汤加减联合针刺治疗能明显缩短重症骨创伤ICU获得性衰弱患者的机械通气时间、ICU住院天数,提高日常活动能力,改善肢体肌力,更利于促进疾病康复。

超声龈下刮治联合黄连解毒汤加味含漱治疗慢性牙周炎临床研究

目的:观察超声龈下刮治联合黄连解毒汤加味含漱治疗慢性牙周炎热毒炽盛证的临床疗效。方法:选取104例慢性牙周炎热毒炽盛证患者,按随机数字表法分成对照组和观察组各52例。对照组剔除2例,最终纳入研究观察组52例、对照组50例。2组均进行龈上洁治、抛光,7 d后进行超声龈下刮治。对照组给予0.9%氯化钠溶液含漱,观察组给予黄连解毒汤加味含漱。比较2组临床疗效、牙周指数[牙周探诊深度(PD)、牙龈指数(GI)、牙龈出血指数(BI)、菌斑指数(PLI)]、龈沟液中炎症因子[白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)]水平及龈沟液中氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、一氧化氮(NO)]水平。结果:治疗1个月后,观察组临床疗效总有效率98.08%,高于对照组84.00%(P<0.05)。2组PD、GI、BI、PLI均较治疗前降低(P<0.05),观察组上述4项牙周指数均低于对照组(P<0.05)。2组龈沟液中IL-1β、TNF-α水平均较治疗前降低(P<0.05),观察组龈沟液中IL-1β、TNF-α水平均低于对照组(P<0.05)。2组龈沟液中MDA、NO水平均较治疗前降低(P<0.05),龈沟液中SOD、GSH-Px水平均较治疗前升高(P<0.05);观察组龈沟液中MDA、NO水平均低于对照组(P<0.05),龈沟液中SOD、GSH-Px水平均高于对照组(P<0.05)。结论:超声龈下刮治联合黄连解毒汤加味含漱治疗慢性牙周炎热毒炽盛证,可有效改善牙周症状,作用机制可能与抑制牙周组织炎症及改善牙周组织氧化应激反应有关。

基于Wave Intensity技术的高血压患者动脉弹性参数与血瘀证积分的相关性分析

目的探讨应用Wave Intensity(WI)技术检测高血压患者动脉弹性参数与血瘀证积分的相关性。方法用ALOKA Prosoundα10彩色多普勒超声仪检测119例高血压基础病患者,及62例健康对照者,获取颈总动脉β(僵硬度)、Ep(弹性模量)、AC(顺应性)、AI(增大指数)、PWVβ(β值推导的脉搏波传导速度)、PWV-WI(WI值推导的脉搏波传导速度)等数据,并评估血瘀证积分。结果高血压组β、Ep、AI、PWVβ、PWV-WI均值均高于对照组均值,而AC均值低于对照组均值,两组比较差异有统计学意义(P<0.05),而高血压血瘀证积分与β、Ep、PWVβ、PWV-WI值与呈正相关(分别为r=0.750,P<0.001;r=0.776,P<0.001;r=0.870,P<0.001;r=0.418,P<0.001),与AC呈负相关(r=-0.769,P<0.001),差异有统计学意义,血瘀证积分与AI无明显相关(r=0.023,P=0.800)。结论基于Wave Intensity技术检测的动脉弹性参数能较准确反映血瘀证程度,具有临床应用价值。

移动健康技术在ICU后综合征患者管理中的应用进展

ICU后综合征严重影响了患者的治疗依从性和生活质量,已引起广泛关注。文章对移动健康技术在ICU后综合征患者管理中的应用进行综述,介绍了移动健康的概念及移动健康技术在ICU后综合征患者管理中的应用形式,分析移动健康技术在ICU后综合征患者管理中的优势及不足,以期为国内开发高质量的移动健康技术提供参考。

ICU患者中心静脉导管拔除意外综合征风险的列线图预测模型构建与验证

目的探讨重症监护室(ICU)患者中心静脉导管(CVC)拔除意外综合征的影响因素,构建风险预测模型,并进行验证。方法回顾性收集2018年1月-2022年12月在我院ICU接受CVC置管3016例患者,根据是否发生CVC拔除意外综合征,分为发生组28例和未发生组2988例。比较2组一般资料,采用logistic回归分析其危险因素,探讨护理预防措施。结果ICU患者CVC拔除意外综合征发生率为0.93%,年龄≥65岁、置管时间≥7d、冠心病史、导管相关血流感染、空气栓塞是ICU患者发生CVC拔除意外综合征的危险因素。利用上述5个因素构建列线图模型,并对列线图模型进行内部验证,绘制校准曲线图显示校正曲线与理想曲线拟合良好,HosmerLemeshow拟合优度检验结果显示,χ^(2)=7.240,P=0.412,模型拟合优度良好。AUC=0.742,灵敏度为69.08%,特异度为79.32%,预测结果较好,DCA曲线和临床决策曲线均表明具有较好的临床实用性。结论年龄≥65岁、置管时间≥7d、冠心病史、导管相关血流感染和空气栓塞是ICU患者发生CVC拔除意外综合征的独立危险因素,基于此建立的列线图模型对于护理工作者早期干预,降低CVC拔除意外综合征的风险具有重要意义。

严重创伤患者发生重症监护后综合征危险因素的meta分析

目的系统评价严重创伤患者发重症监护后综合征(PICS)的危险因素。方法计算机检索PubMed、Medline、Web of Science、CochraneLibrary、中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库中关于严重创伤患者发生PICS危险因素的相关文献,检索时间限定为2010年1月至2024年4月。由2名研究者独立进行文献的筛选与数据提取,采用纽卡斯尔-渥太华量表(NOS)对纳入的队列研究和病例对照研究进行文献质量评价,横断面研究则参照美国卫生保健和质量机构(AHRQ)的标准进行文献质量评价,采用RevMan 5.4和Stata18.0软件进行meta分析。结果共纳入11篇文献,其中7篇为横断面研究,4篇为病例对照研究,文献质量均为中高等。meta分析结果显示,年龄≥60岁(OR=1.66,95%CI:1.43~1.91,P<0.001)、吸烟(OR=5.45,95%CI:1.61~18.47,P=0.006)、饮酒(OR=6.90,95%CI:2.14~22.26,P=0.001)、入住ICU时长≥7 d(OR=2.45,95%CI:1.18~5.11,P=0.020)、机械通气治疗(OR=1.96,95%CI:1.04~3.68,P=0.040)、睡眠障碍(OR=2.78,95%CI:1.35~5.73,P=0.005)、镇静药物使用(OR=2.88,95%CI:1.34~6.22,P=0.007)是严重创伤患者发生PICS的独立危险因素。敏感性和发表偏倚分析结果显示,除年龄≥60岁和入住ICU时长≥7 d因素外,其他因素均提示分析结果可靠,存在发表偏倚可能较小。结论严重创伤患者发生ICU后综合征的危险因素众多,临床实践中医护人员应重点关注其高危人群,并对这些风险因素进行及时的评估和干预,以降低重症创伤患者ICU后综合征的发生率,更好地促进患者健康转归。

强化降脂策略对多支血管病变急性冠状动脉综合征患者短期预后的影响

目的:探讨强化降脂策略对多支血管病变急性冠状动脉综合征(ACS)患者短期预后的影响。方法:回顾性纳入2019年8月至2020年11月期间在武汉大学中南医院心内科接受冠状动脉支架置入术的多支血管病变ACS患者136例,将其分为强化降脂组[3个月内将低密度脂蛋白胆固醇(LDL-C)控制<1.0mmol/L,且12个月内持续达标,n=69]和标准降脂组(12个月内将LDL-C逐渐控制<1.4 mmol/L,n=67)。观察两组患者出院后12个月内总胆固醇(TC)、甘油三酯(TG)、LDL-C、高密度脂蛋白胆固醇(HDL-C)、脂蛋白(a)[Lp(a)]水平的变化趋势,比较两组患者出院12个月时的主要不良心血管事件(MACE,包括心原性死亡、心肌梗死、靶血管血运重建和脑卒中)发生情况。结果:强化降脂组与标准降脂组患者入院时的基线资料相似,基线TC、TG、LDL-C、HDL-C水平差异均无统计学意义(P均>0.05)。出院3个月时,与入院时相比,强化降脂组患者的TC、TG、LDL-C、Lp(a)水平均明显降低(P均<0.05),HDL-C水平无明显变化(P>0.05);标准降脂组患者的TC、LDL-C水平均明显降低(P均<0.05),TG、HDL-C和Lp(a)水平均无明显变化(P均>0.05)。出院3、6、12个月时,强化降脂组患者的TC、LDL-C水平均明显低于标准降脂组(P均<0.01)。Kaplan-Meier生存曲线显示,出院12个月时,强化降脂组的MACE发生率明显低于标准降脂组(2.90%vs.14.93%,χ2=6.090,P=0.014)。多因素Cox回归分析显示,与标准降脂策略相比,强化降脂策略可显著降低多支血管病变ACS患者出院12个月时的MACE发生风险(HR=0.177,95%CI:0.037~0.838,P=0.029)。结论:在多支血管病变ACS患者中,与标准降脂策略相比,强化降脂策略很可能会降低短期MACE发生风险,未来需要开展大规模的前瞻性多中心研究来进一步验证。