目的分析急诊骨盆骨折伴多发伤患者接诊途中死亡的危险因素。方法选取2016年6月至2017年12月医院急诊科收治的89例骨盆骨折伴多发伤患者为研究对象,根据患者接诊途中是否死亡,分为生存组(74例)与死亡组(15例)。收集患者的临床资料,比较...目的分析急诊骨盆骨折伴多发伤患者接诊途中死亡的危险因素。方法选取2016年6月至2017年12月医院急诊科收治的89例骨盆骨折伴多发伤患者为研究对象,根据患者接诊途中是否死亡,分为生存组(74例)与死亡组(15例)。收集患者的临床资料,比较快速急诊内科评分(REMS)与损伤严重程度(ISS)评分,并对影响急诊骨盆骨折伴多发伤患者接诊途中死亡的危险因素进行分析。结果死亡组患者入院前REMS、ISS评分均高于生存组(P<0.05)。死亡组15例患者中,死于失血性休克者8例,死于重度颅脑损伤者4例,死于肝脾破裂者3例。死亡组出血量>2 000 m L、合并失血性休克、合并多脏器损害、合并颅脑损伤、救护时间>1 h的占比均高于生存组(P<0.05);Logistic回归分析结果显示,上述因素均为急诊骨盆骨折伴多发伤患者接诊途中死亡的独立危险因素(P<0.05)。结论出血量、失血性休克、多脏器损害、颅脑损伤、救护时间均是导致急诊骨盆骨折伴多发伤患者接诊途中死亡的高危因素。针对具有上述因素的高危患者,在接诊途中实施快速、高效的救护处理是降低其死亡风险的关键。展开更多
Background: Klebsiellapneumoniae (KP) is a pathogen commonly causing nosocomial infection. Carbapenem-resistant KP (CRKP) is more resistant to multiple antimicrobial drugs than carbapenem-susceptible KP (CSKP) ...Background: Klebsiellapneumoniae (KP) is a pathogen commonly causing nosocomial infection. Carbapenem-resistant KP (CRKP) is more resistant to multiple antimicrobial drugs than carbapenem-susceptible KP (CSKP) isolates. The aim of the present study was to identify the risk factors for CRKP infection and the predictors of mortality among KP-infected adult patients. Methods: Patients with CRKP and CSKP infection were categorized as the case group and control group, respectively, and we conducted a 1:1 ratio case-control study on these groups. The CRKP isolates collected were tested tbr antimicrobial susceptibility and presence of KP carbapenemase (KPC) gene. Clinical data were collected to identity risk factors for CRKP infection and mortality of KP infection. Risk factors were analyzed under univariable and multivariable logistic regression model. Results: The independent risk factors for CRKP infection were admission to Intensive Care Unit (odds ratio [OR]: 15.486, 95% confidence interval [CI]: 3.175-75.541, P 〈 0.001); use of I3-1actams and [3-1actamase inhibitor combination (OR: 4.765, 95% CI: 1.508-15.055, P = 0.008): use of cephalosporins (OR: 8.033, 95% CI: 1.623-39.763, P = P= 0.019): and indwelling of urethral catheter (OR: 6.164, 95% CI: 1.847 0.011 ); fluoroquinolones (OR: 6.090, 95% CI: 1.343-27.613, -20.578, P = 0.003). However, older age (OR: 1.079, 95% CI: 1.005-1.158, P= 0.036), Charlson comorbidity index (OR: 4.690, 95% CI:2.094-10.504, P= 0.000), and aminoglycoside use (OR: 670.252, 95% CI: 6.577-68,307.730, P = 0.006) were identified as independent risk factors for patient deaths with KP infection. The mortality of CRKP group was higher than that of the CSKP group. KPC gene did not play a role in the CRKP group. CRKP mortality was high. Conclusion: Implementation of infection control measures and protection of the immunefunction are crucial.展开更多
文摘目的分析急诊骨盆骨折伴多发伤患者接诊途中死亡的危险因素。方法选取2016年6月至2017年12月医院急诊科收治的89例骨盆骨折伴多发伤患者为研究对象,根据患者接诊途中是否死亡,分为生存组(74例)与死亡组(15例)。收集患者的临床资料,比较快速急诊内科评分(REMS)与损伤严重程度(ISS)评分,并对影响急诊骨盆骨折伴多发伤患者接诊途中死亡的危险因素进行分析。结果死亡组患者入院前REMS、ISS评分均高于生存组(P<0.05)。死亡组15例患者中,死于失血性休克者8例,死于重度颅脑损伤者4例,死于肝脾破裂者3例。死亡组出血量>2 000 m L、合并失血性休克、合并多脏器损害、合并颅脑损伤、救护时间>1 h的占比均高于生存组(P<0.05);Logistic回归分析结果显示,上述因素均为急诊骨盆骨折伴多发伤患者接诊途中死亡的独立危险因素(P<0.05)。结论出血量、失血性休克、多脏器损害、颅脑损伤、救护时间均是导致急诊骨盆骨折伴多发伤患者接诊途中死亡的高危因素。针对具有上述因素的高危患者,在接诊途中实施快速、高效的救护处理是降低其死亡风险的关键。
基金This work was supported by the National Natural Science Foundation of China under Grant (No. 81201338).
文摘Background: Klebsiellapneumoniae (KP) is a pathogen commonly causing nosocomial infection. Carbapenem-resistant KP (CRKP) is more resistant to multiple antimicrobial drugs than carbapenem-susceptible KP (CSKP) isolates. The aim of the present study was to identify the risk factors for CRKP infection and the predictors of mortality among KP-infected adult patients. Methods: Patients with CRKP and CSKP infection were categorized as the case group and control group, respectively, and we conducted a 1:1 ratio case-control study on these groups. The CRKP isolates collected were tested tbr antimicrobial susceptibility and presence of KP carbapenemase (KPC) gene. Clinical data were collected to identity risk factors for CRKP infection and mortality of KP infection. Risk factors were analyzed under univariable and multivariable logistic regression model. Results: The independent risk factors for CRKP infection were admission to Intensive Care Unit (odds ratio [OR]: 15.486, 95% confidence interval [CI]: 3.175-75.541, P 〈 0.001); use of I3-1actams and [3-1actamase inhibitor combination (OR: 4.765, 95% CI: 1.508-15.055, P = 0.008): use of cephalosporins (OR: 8.033, 95% CI: 1.623-39.763, P = P= 0.019): and indwelling of urethral catheter (OR: 6.164, 95% CI: 1.847 0.011 ); fluoroquinolones (OR: 6.090, 95% CI: 1.343-27.613, -20.578, P = 0.003). However, older age (OR: 1.079, 95% CI: 1.005-1.158, P= 0.036), Charlson comorbidity index (OR: 4.690, 95% CI:2.094-10.504, P= 0.000), and aminoglycoside use (OR: 670.252, 95% CI: 6.577-68,307.730, P = 0.006) were identified as independent risk factors for patient deaths with KP infection. The mortality of CRKP group was higher than that of the CSKP group. KPC gene did not play a role in the CRKP group. CRKP mortality was high. Conclusion: Implementation of infection control measures and protection of the immunefunction are crucial.