Modified shock index and mortality rate of emergency patients

BACKGROUND:This study aimed to determine whether modified shock index(MSI)is associated with mortality that is superior to heart rate,blood pressure,or the shock index(SI).in emergency patients.METHODS:A retrospective database review was performed on 22 161 patients who presented to Peking Union Medical College Hospital Emergency Department and received intravenous fluids from January 1 to December 31,2009.We gathered data of the patients on age,gender,vital signs,levels of consciousness,presenting complaints,and SI and MSI were calculated for all patients.RESULTS:Multivariate regression analysis was performed to determine the correlation between risk factors and outcome.There is a significant correlation between emergency patient mortality rate and patient's vital signs obtained at the triage desk(HR>120 beats/min,systolic BP<90 mmHg,diastolic BP<60 mmHg).MSI is a stronger predictor of emergency patient mortality compared to heart rate and blood pressure alone,whereas SI does not have a significant correlation with emergency patient mortality rate.CONCLUSION:MSI is a clinically significant predictor of mortality in emergency patients.It may be better than using heart rate and blood pressure alone.SI is not significantly correlated with the mortality rate of the emergency patient.

Diagnostic Performance of Serial bedside Capillary Lactate, Hemoglobin, and Shock Index for Severe Postpartum

Objective: To assess the diagnostic capacity of bedside capillary lactate (CLact), capillary Haemoglobin (CHb), and shock index (SI) for severe postpartum haemorrhage (SPPH > 2000 ml) at diagnosis, 15 minutes and 30 minutes later. Method: A cohort study was carried out in a reference hospital in San Luis Potosi, Mexico from February 2020 to March 2021, and included sixty women in vaginal labor or c-section who presented PPH (≥500 ml in labor or ≥1000 ml in c-section) measured by the gravimetric method. CLact, SI, and CHb concentrations were analyzed at diagnosis of PPH, 15 minutes, and 30 minutes. Patients who presented total blood loss of >2000 ml were considered SPPH. A T-test or Wilcox test was performed to compare the groups of non-severe and severe. Sensitivity, specificity, and performance were calculated by A Receiver Operating Curve. Results: A CLact measurement at 30 minutes was significantly different between the non-severe and severe groups (4.0 + 1.9 vs 4.8 + 1.15 P-value 0.001, with an optimal cut point of 4.3 mmol/dl at AUC 0.75, sensitivity 0.85, and specificity of 0.62. With a cut-point of 1.17, an AUC of 0.76, sensitivity of 0.43, and specificity of 0.98, SI at diagnosis was significantly different between the non-severe and severe groups (0.70 + 0.20 vs. 0.90 + 0.38 P-value 0.0228). Conclusion: SI is an early sign of SPPH;CLact can significantly identify SPPH after 30 minutes.

The role of shock index in predicting adverse events in elderly patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention

Background The prognostic value of shock index(SI)in elderly patients with ST-segment elevation myocardial infarction(STEMI)is unclear.This study was to explore the association of shock index with long-term mortality in elderly STEMI patients undergoing percutaneous coronary intervention(PCI).Methods A total of 731 elderly patients with STEMI undergoing PCI were included and divided into three groups according to the tertiles of shock index:<0.58(n=241),0.58-0.71(n=233)and≥0.71(n=257).Shock index is the ratio of heart rate to systolic blood pressure.Receiver operating characteristic(ROC)curves were conducted and the area under the curve(AUC)of SI for predicting in-hospital mortality was calculated.The association of shock index with in-hospital and one-year mortality was evaluated using multivariate regression analysis.Results In patients with shock index in the first to third tertiles,in-hospital death occurred in 2.5%,4.3%and 11.3%of patients,respectively.Inhospital major adverse clinical events(MACEs)occurred in 8.7%,10.3%and 21.4%of patients,respectively.ROC analysis showed that shock index>0.74 was the best threshold for predicting in-hospital death.Shock index>0.74 was independently associated with increased risk of in-hospital death[adjusted odds ratio(OR):3.68,95%confidence interval(CI):1.85-7.32,P<0.001].Kaplan-Meier survival curves showed that patients with shock index>0.74 had a worse prognosis than those with shock index≤0.74(Log-rank test:33.58,P<0.001).Conclusions In elderly patients with STEMI undergoing PCI,elevated shock index was independently associated with in-hospital and one-year mortality.

重型颅脑创伤患者The Reverse Shock Index Multiplied by GlasgowComa Scale Score (rSIG)与血清转运蛋白及预后的关系

目的探讨rSIG(the reverse shock index multiplied by glasgowcoma scale score)与血清转运蛋白(translocator protein,TSPO)在重型颅脑创伤患者中对预后的评估价值。方法将115例重型颅脑创伤患者分成存活组和死亡组,使用SPSS 20.0软件对组间生命体征、rSIG、TSPO等指标进行比较并分析rSIG与TSPO的关系。行受试者工作特征(receiver operating characteristic,ROC)曲线分析rSIG与TSPO及两者联合对重型颅脑创伤患者预后的预测价值。根据ROC曲线分析结果,以rSIG、TSPO的最佳截断值将患者分为rSIG≤14.8和rSIG > 14.8组,TSPO≤1.84 ng/mL组和TSPO > 1.84 ng/mL组,比较各组间病死率差异的统计学意义。结果纳入115例患者,存活组患者的rSIG显著大于死亡组,TSPO显著低于死亡组(10.5±4.4)vs(6.4±4.1),1.0(0.3, 1.9) ng/mL vs 3.4(2.0, 4.6) ng/mL, P<0.01。rSIG联合TSPO对重型颅脑创伤患者病死率的判断能力并不优于这两个指标单独对患者预后的预测能力。rSIG≤4.15组患者的TSPO及28 d病死率明显高于rSIG>4.15组患者。TSPO≤1.84 ng/mL组病例的rSIG明显大于TSPO > 1.84 ng/mL组病例;28 d病死率明显小于TSPO > 1.84 ng/mL病例。患者rSIG与TSPO呈负相关(r=-0.611,P<0.01)。结论 rSIG、TSPO对重型颅脑创伤患者的预后有较好的预测价值,在临床上具有一定指导意义。

Wearable Smart Sensor System for Medical Monitoring with an Assessment of the Level of Blood Loss and Pain Shock Because of Trauma or Injury

Blood loss in peacetime is mainly due to the normal menstrual cycle in women or diseases with surgical intervention. In wartime, blood loss in military personnel is a characteristic sign of a closed or open injury of the body during internal or external bleeding. Access to clinical care for wounded military personnel injured on the battlefield is limited and has long delays compared to patients in peacetime. Most of the deaths of wounded military personnel on the battlefield occur within the first hour after being wounded. The most common causes are delay in providing medical care, loss of time for diagnosis, delay in stabilization of pain shock and large blood loss. Some help in overcoming these problems is provided by the data in the individual capsule, which each soldier of the modern army possesses;however, data in an individual capsule is not sufficient to provide emergency medical care in field and hospital conditions. This paper considers a project for development of a smart real-time monitoring wearable system for blood loss and level of shock stress in wounded persons on the battlefield, which provides medical staff in field and hospital conditions with the necessary information to give timely medical care. Although the hospital will require additional information, the basic information about the victims will already be known before he enters the hospital. It is important to emphasize that the key term in this approach is monitoring. It is tracking, and not a one-time measurement of indicators, that is crucial in a valid definition of bleeding.

Application and Nursing of Pulse Index Continuous Cardiac Output (PiCCO) Volume Monitoring in Early Fluid Resuscitation in Patients with Septic Shock

Background: Septic shock is a rapidly changing and fatal syndrome that can cause comprehensive deterioration of cardiopulmonary and renal function and multiple organ failure. At the same time, septic shock has the complex clinical manifestations and hemodynamics. PiCCO can accurately monitor blood flow, physical and volume indicators, and active and effective fluid resuscitation are important measures to reduce the fatality rate of septic shock and improve the prognosis of patients. Objectives: To explore the application and nursing of PiCCO in early fluid resuscitation in patients with septic shock. Methods: This was a retrospective observational study. The observation group and the control group each had 30 cases. The observation group used PiCCO to guide fluid resuscitation;the control group used conventional methods to guide fluid resuscitation. The changes in CVP, HR, MAP, and urine volume per hour were observed in the two groups. The changes of various indicators before and after fluid resuscitation, the length of stay in ICU and the mortality rate were compared between the two groups. All the outcomes were collected from the electronic medical case system after patients’ discharge from the hospital. Results: APACHE II, CVP, HR, MAP were compared between the observation group and the control group, and the differences were statistically significant (P < 0.05). The blood volume of patients in the observation group was significantly improved after fluid supplementation (P < 0.05). Compared with the control group, the length of stay in ICU in the observation group was significantly shorter, and the mortality rate was also significantly reduced (P < 0.05). Conclusion: PiCCO can be better used in early fluid resuscitation of patients with septic shock.

Application of pulse index continuous cardiac output system in elderly patients with acute myocardial infarction complicated by cardiogenic shock: A prospective randomized study

BACKGROUND Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) complicates management of the condition, and often leads to poor prognosis. Prompt and accurate monitoring of cardiovascular and accompanying hemodynamic changes is crucial in achieving adequate management of the condition. Advances in technology has availed procedures such as pulse index continuous cardiac output (PiCCO), which can offer precise monitoring of cardiovascular functions and hemodynamic parameters. In this study, PiCCO is evaluated for its potential utility in improving management and clinical outcomes among elderly patients with AMI complicated by CS. AIM To assess whether use of the PiCCO system can improve clinical outcomes in elderly patients with AMI complicated by CS.METHODS Patients from emergency intensive care units (EICU) or coronary care units (CCU) were randomized to receive PiCCO monitoring or not. The APACHE II score, SOFA score, hs-TnI, NT-proBNP, PaO2/FiO2 ratio and lactate levels on day 1, 3 and 7 after treatment were compared. The infusion and urine volume at 0-24 h, 24-48 h and 48-72 h were recorded, as were the cardiac index (CI), extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI) and global end diastolic volume index (GEDVI) at similar time intervals. RESULTS Sixty patients with AMI complicated by CS were included in the study. The PiCCO group had a significantly lower APACHE II score, SOFA score, hs-TnI and NT-proBNP levels on day 1, 3 and 7 after treatment. The infusion and urine volume during 0-24 h in the PiCCO group were significantly greater, and this group also showed significantly higher ADL scores. Furthermore, the PiCCO group spent lesser days on vasoactive agents, mechanical ventilation, and had a reduced length of stay in EICU/CCU. Additionally, the CI was significantly higher at 48 h and 72 h in the PiCCO group compared with that at 24 h, and the EVLWI, ITBVI and GEDVI were significantly decreased at 48 h and 72 h. CONCLUSION Applying the PiCCO system could improve the clinical outcomes of elderly patients with AMI complicated by CS.

NLR与MSI对急性NSTEMI短期预后判断价值

目的本研究旨在探讨校正休克指数(MSI)和中性粒细胞/淋巴细胞比值(NLR)在判断急性非ST段抬高型心肌梗死(NSTEMI)患者短期内可能出现不良预后的预测能力。方法研究组选择2020年3月到2021年9月期间,首次就诊急诊科明确诊断为急性非ST段抬高型心肌梗死的276例患者。通过快速急诊绿道监测血压与心率,并于急诊科10 min内抽取血常规、床旁心脏彩超等相关化验检查,依据监测及化验结果,研究小组计算了校正休克指数(MSI)和中性粒细胞/淋巴细胞比值(NLR),然后根据统计结果将患者分为2组:NLR≥5.0组(n=75)与NLR﹤5.0组(n=201);(2)MSI≥1.2组(n=57)与MSI<1.2组(n=219)。比较2组一般资料情况,发生不良心血管事件的比例,采用受试者ROC曲线下面积来评估NLR值和MSI值对NSTEMI院内不良心血管事件的预测能力。结果连续入选的276例NSTEMI患者中,发生不良心血管事件52例,占18.8%,心源性休克患者15例,占5.4%,恶性心律失常患者24例,占8.7%,死亡13例,占4.7%。NLR≥5.0与MSI≥1.2值组的心功能、收缩压(SBP)、舒张压(DBP)及心率(HR)分别与NLR<5.0与MSI<1.2组比较,差异有统计学意义(P<0.05);NLR≥5.0与MSI≥1.2组MACE发生率分别高于NLR<5.0组与MSI<1.2组(P<0.05)。此外,NLR和MSI的ROC曲线下面积分别为0.734和0.703,提示NLR和MSI均具有评价急性非ST段抬高型心肌梗死患者短期不良心血管事件发生能力。结论MSI与NLR是评估NSTEMI短期不良预后的两个简单的重要的易获得指标。

产业集群对中国服装出口韧性的影响及空间溢出效应研究

在服装产业领域,产业集群现象尤为突出,已成为我国服装制造业发展的主要模式。随着全球化进程的不断深入,出口结构及其对产业韧性的影响成为研究的焦点。本文运用中国服装产品出口数据,从需求侧出发,深入探讨了服装产业集聚对出口韧性的影响机制。实证结果发现:产业集群与短期服装出口韧性负相关,且这一结果能够通过多种稳健性检验;进一步拓展空间杜宾模型发现,产业集群在区域经济发展中具有复杂的影响机制,产业集群虽然抑制了本土的短期服装出口韧性,但促进了周边地区的短期服装出口韧性。基于此,本文提出政府应实时调控,抵御外生冲击;通过建立区域内的风险共享机制,实现由竞争向协作和互惠的转变,以期持续推进区域经济一体化进程,构建区域风险共担机制,防范新时期外部冲击风险。

三项指标与老年急性STEMI患者介入术后无复流的相关性研究

目的 探讨入院休克指数(shock index, SI)、入院血糖(admission plasma glucose, APG)和同型半胱氨酸(homocysteine, HCY)与老年急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者行急诊经皮冠状动脉介入(percutaneous coronary intervention, PCI)术后无复流的相关性。方法 分析行急诊PCI术379例老年急性STEMI患者的临床资料,根据PCI术后TIMI血流分为无复流组(n=71)和正常血流组(n=308)。比较两组患者的临床资料、造影及介入情况。采用单因素及多因素Logistic回归模型分析老年急性STEMI患者行急诊PCI术后出现无复流的独立危险因素,利用受试者工作特征(receiver operator characteristic,ROC)曲线评估老年急性STEMI患者行急诊PCI术后发生无复流的预测效能。结果 与正常血流组比较,无复流组患者入院心率、SI高于正常血流组,收缩压、舒张压低于正常血流组,均P<0.01。白细胞计数(white blood cell,WBC)升高(P<0.05),中性粒细胞绝对值(neutrophil absolute count, NEUT)升高(P<0.05),红细胞计数(red bloodcell,RBC)降低(P<0.01),红细胞平均体积(meanredcellvolume,MCV)降低(P<0.01),血红蛋白(hemoglobin, HGB)降低(P<0.05),C反应蛋白(C-reactive protein, CRP)升高(P<0.05),APG升高(P<0.05),尿素(serum urea nitrogen, UREA)升高(P<0.05),HCY升高(P<0.01),D-二聚体(D-Dimer,D-D)升高(P<0.01)多因素Logistic回归分析表示SI、APG、HCY是老年急性STEMI患者急诊PCI术后发生无复流的独立危险因素。ROC曲线分析显示SI+APG+HCY对老年STEMI患者行PCI术后发生无复流的预测价值优于SI、APG、HCY、SI+APG、SI+HCY、APG+HCY,差异有统计学意义(P<0.01)。结论 SI、APG和HCY是老年急性STEMI患者行急诊PCI术后发生无复流的独立危险因素,且SI+APG+HCY对其有较好的预测价值。

接受手术治疗的脾破裂患者创伤性凝血病的危险因素分析

目的探讨接受手术治疗的脾破裂患者创伤性凝血病(TIC)的危险因素。方法回顾性分析2017年1月—2021年12月安徽医科大学第二附属医院急诊外科治疗因创伤致脾破裂行手术治疗患者84例,男性52例,女性32例;年龄18~82岁,平均50.1岁;道路交通伤37例,高处坠落伤21例,跌倒伤15例,殴打伤11例。根据是否合并TIC分为TIC组(30例)和非TIC组(54例)。对两组患者性别、年龄、受伤时间、休克指数、入院时首次体温、ISS、入院时首次血红蛋白、红细胞比容、血小板计数、CRP、肝功能(谷丙转氨酶)、营养状况(白蛋白)、pH值、剩余碱(BE)、乳酸、INR、D-二聚体、APTT、TT、血浆纤维蛋白原(FIB)、出血量行单因素分析,取其中有统计学意义的变量做多因素Logistic回归分析。判断影响接受手术治疗的脾破裂患者创伤性凝血病的的危险因素。结果两组患者年龄、血红蛋白、红细胞比容、D-二聚体、失血量、入院时首次体温、CRP、谷丙转氨酶、白蛋白比较差异无统计学意义(P>0.05);而休克指数、血小板计数、受伤时间、ISS、pH值、BE、乳酸、APTT、TT、FIB比较差异有统计学意义(P<0.05)。多因素回归分析发现休克指数(OR=2.355,95%CI 1.318~3.948,P<0.05)、血小板计数(OR=0.987,95%CI 0.970~1.004,P<0.05)、FIB(OR=0.599,95%CI 0.180~0.972,P<0.05)与创伤性凝血病显著相关。结论休克指数、血小板计数、FIB是接受手术治疗的脾破裂患者发生创伤性凝血病的独立危险因素。

血清脑钠肽、心肌肌钙蛋白T及休克指数与急性心肌梗死患者经皮冠脉介入术后主要不良心血管事件的相关性分析

目的 探讨血清脑钠肽(BNP)、心肌肌钙蛋白T(c Tn T)及休克指数(SI)与急性心肌梗死(AMI)患者经皮冠脉介入术(PCI)后主要不良心血管事件(MACE)的相关性。方法 回顾性分析2017年11月至2022年11月于徐州医科大学附属医院、江苏省滨海县人民医院进行PCI治疗的200例AMI患者的临床资料,将其分为MACE组(60例)与无MACE组(140例)。比较两组基线资料、血管狭窄程度(Gensini)评分、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及术前白蛋白、BNP、c Tn T、SI。采用logistic逐步回归分析MACE的危险因素,通过受试者工作特征(ROC)曲线分析各指标预测MACE的价值。结果 MACE组糖尿病患者占比及年龄、BNP、c Tn T、SI水平高于无MACE组(P<0.05)。logistic逐步回归分析结果显示,年龄(OR=2.145,95%CI=1.056~4.357)、BNP (OR=1.985,95%CI=1.156~3.408)、c Tn T (OR=1.997,95%CI=1.145~3.483)、SI(OR=1.897,95%CI=1.260~3.196)是AMI患者PCI治疗后MACE发生的危险因素(P<0.05)。ROC曲线分析结果显示,年龄、BNP、c Tn T、SI均可用于预测AMI患者PCI治疗后MACE的发生(P<0.05)。结论 年龄、BNP、c Tn T、SI可影响AMI患者PCI治疗后MACE的发生,可用于预测MACE的发生。

实验室衰弱指数对老年CAP住院患者并发脓毒症及脓毒性休克风险的预测价值

目的 探讨实验室衰弱指数(FI-LAB)对老年社区获得性肺炎(CAP)住院患者发生脓毒症及脓毒性休克风险的预测价值。方法 回顾性纳入住院的老年CAP患者502例。选取40个入院后24 h内首次采集的常规实验室指标和生命体征指标构建FI-LAB,FI-LAB<0.35为非衰弱组,FI-LAB≥0.35为衰弱组。判定脓毒症和脓毒性休克的发生情况。采用修正Poisson回归构建预测模型并采用受试者工作特征(ROC)曲线分析预测价值。结果 多因素修正Poisson回归分析显示衰弱是老年CAP并发脓毒症和脓毒性休克的危险因素(P<0.001)。将FI-LAB乘以100后纳入多因素修正Poisson回归分析,发现FI-LAB每增加0.01,发生脓毒症及脓毒性休克的风险分别增高5.9%和6.2%(均P<0.001)。FI-LAB预测脓毒症及脓毒性休克的ROC曲线下面积分别为0.865和0.850,最佳截断值分别为0.28和0.42。结论 衰弱增加CAP并发脓毒症及脓毒性休克的风险。FI-LAB可预测CAP患者发生脓毒症和脓毒性休克的风险,早期发现高危人群。

急诊多发伤患者rSIG休克指数、初始血乳酸及D-二聚体变化分析

目的探讨并分析急诊多发伤患者rSIG休克指数、初始血乳酸及D二聚体(D-D)变化。方法选取本院2021年6月至2023年7月接诊的68例急诊多发伤患者的病历资料,根据治疗结局分为死亡组7例、存活组61例。根据损伤严重程度评分(ISS)对68例急诊多发伤患者进行划分,其中轻中度伤组55例(ISS评分≤25分)、重伤组13例(ISS评分>25分)。比较死亡组和存活组、轻中度伤组和重伤组急诊多发伤患者rSIG休克指数、初始血乳酸及D-D水平变化,采用Pearson相关分析法分析急诊多发伤rSIG休克指数、初始血乳酸及D-D水平与预后及损伤严重程度的相关性。结果死亡组患者的rSIG休克指数、初始血乳酸及D-D水平均明显高于存活组(P<0.05);重伤组患者的rSIG休克指数、初始血乳酸及D-D水平均明显高于轻中度伤组(P<0.05);经Pearson相关分析结果显示,急诊多发伤的rSIG休克指数、初始血乳酸及D二聚体水平与预后及损伤严重程度均呈正相关(P<0.05)。结论r SIG休克指数、初始血乳酸及D-D变化均与急性多发伤患者的死亡风险和不良预后密切相关。在急诊救治中,监测这些指标可以为医生提供重要的参考依据,有助于评估患者的病情和预后,从而制定更加合理的治疗方案。

反向休克指数和格拉斯哥昏迷量表评分的乘积指数联合血清纤维蛋白原和C反应蛋白水平对多发伤患者预后的预测价值

目的探究反向休克指数和格拉斯哥昏迷量表评分的乘积(rSIG)指数联合血清纤维蛋白原(FIB)、C反应蛋白(CRP)水平对多发伤患者预后的预测价值。方法选取2022年2月至2023年3月华北理工大学附属医院急诊科收治的多发伤患者140例,根据患者受伤28 d后的生存情况,分成存活组(120例)和死亡组(20例);另选取同期体检健康者100例作为对照。采用全自动凝血分析仪检测血清FIB水平,免疫散射比浊法检测CRP水平。采用Pearson法分析rSIG指数及血清FIB、CRP水平相关性。采用Cox回归方法分析多发伤患者死亡的影响因素。采用受试者工作特征曲线分析rSIG指数联合血清FIB、CRP水平对多发伤患者预后的预测价值。结果多发伤患者血清FIB水平低于健康体检者[(2.2±0.4)g/L比(2.9±0.5)g/L],CRP水平高于健康体检者[(36±8)mg/L比(7±3)mg/L],差异均有统计学意义(均P<0.001)。存活组患者血清FIB水平高于死亡组[(2.3±0.4)g/L比(1.6±0.4)g/L],CRP水平低于死亡组[(34±8)mg/L比(47±8)mg/L],rSIG指数高于死亡组,差异均有统计学意义(均P<0.05)。Pearson法分析结果显示,血清FIB与CRP水平呈负相关(r=-0.446,P<0.001),与rSIG指数呈正相关(r=0.473,P<0.001);血清CRP水平与rSIG指数呈负相关(r=-0.536,P<0.001)。Cox回归分析结果表明,FIB、CRP、rSIG指数均是多发伤患者死亡的影响因素(均P<0.05)。rSIG指数联合血清FIB、CRP水平预测多发伤患者预后的曲线下面积为0.972,明显高于单项检测(均P<0.05),联合检测敏感度为95.00%,特异度为88.33%。结论多发伤患者血清FIB水平下调,CRP水平上调,二者联合rSIG指数对多发伤患者预后具有一定预测价值。

休克指数与早期预警评分系统联合应用于急性消化道出血患者中的效果观察

目的分析休克指数(SI)与英国早期预警评分系统(NEWS)联合应用于急性消化道出血患者中的效果。方法采用随机抽样的方式在如皋市中医院2020年1月—2022年12月期间收治的急性消化道出血患者中抽取82例,分组对照组41例、观察组41例。给予对照组患者常规急诊护理,给予观察组患者SI联合NEWS的急诊护理措施。对比分析两组患者抢救时间、住院时间、血清学指标水平。结果观察组患者抢救时间以及住院时间均显著短于对照组,差异显著(P<0.05)。护理后,观察组血清学指标高于对照组,差异显著(P<0.05)。结论在急性消化道出血患者的就诊救治过程中联合应用SI与NEWS,可有效缩短患者抢救以及住院时间,同时利于患者血清学相关指标的恢复。

休克指数指导下的护理在外伤性肝脾破裂出血患者中的应用效果

目的:观察休克指数指导下的护理在外伤性肝脾破裂出血患者中的应用效果。方法:选取2020年9月至2022年9月该院收治的78例外伤性肝脾破裂出血患者进行前瞻性研究,按照随机数字表法将其分为观察组和对照组各39例。对照组实施常规护理,观察组在对照组基础上实施休克指数指导下的护理。比较两组护理前后负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)]评分、生命质量[生活质量综合评定问卷-74(GQOLI-74)]评分,以及并发症发生率和护理满意度评分。结果:护理后,观察组SAS、SDS评分均低于对照组,差异有统计学意义(P<0.05);护理后,观察组躯体功能、社会功能、心理功能、物质生活状态等GQOLI-74评分均高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为5.13%(2/39),低于对照组的20.51%(8/39),差异有统计学意义(P<0.05);观察组护理态度、需求满足、操作技能、健康指导等护理满意度评分均高于对照组,差异有统计学意义(P<0.05)。结论:休克指数指导下的护理应用于外伤性肝脾破裂出血患者可降低负性情绪评分和并发症发生率,提高生命质量和护理满意度评分,效果优于常规护理。

改良早期预警评分系统联合体温校正休克指数用于上消化道出血患者医院前急救病情评估的价值

目的分析改良早期预警评分系统(MEWS)联合体温校正休克指数(ASI)用于上消化道出血患者医院前急救病情评估的价值。方法选取2021年1月至2023年1月该院医院前急救的上消化道出血患者92例,根据患者不同失血量分为中重度组(失血量大于或等于500 mL,61例)和轻度组(失血量小于500 mL,31例)。比较2组患者MEWS、ASI评分,分析MEWS联合ASI用于上消化道出血患者医院前急救病情评估的价值。结果中重度组患者MEWS、ASI评分均明显高于轻度组,差异均有统计学意义(P<0.05);MEWS、ASI评分均与患者病情有关,差异均有统计学意义(优势比=2.470、2.605,P<0.05)。MEWS、ASI及联合用于上消化道出血患者医院前急救病情评估的受试者工作曲线下面积分别为0.847、0.714、0.870,均具有一定评估价值,且联合评估患者病情的价值更高。结论MEWS、ASI用于上消化道出血患者医院前急救病情评估均具有一定价值,且联合评估患者病情的价值更高。

休克指数评估联合危机管理模式在急诊外科中的护理质量分析

目的分析休克指数评估联合危机管理模式在急诊外科中的护理质量。方法选取2022年2月至2023年2月期间许昌龙湖医院急诊外科收治的100例患者与40例急诊外科中的护理人员,患者和护理人员均随机分为两组,对照组患者(50例)、研究组患者(50例);对照组护理人员(20例)、研究组护理人员(20例)。给予对照组危机管理模式,研究组在对照组基础上给予休克指数评估。对比两组患者确诊时间、急诊至手术时间、急诊室停留时间、焦虑自评表(SAS)、抑郁自评表(SDS)、生活质量、及满意度,对比两组护理人员护理质量操作水平。结果研究组患者确诊时间、急诊至手术时间及急诊室停留时间均低于对照组,差异有统计学意义(P<0.05)。护理后,研究组患者生理状态评分、社会功能评分、环境影响评分、身体疼痛评分、总体健康评分、社交功能评分、情感角色评分、心理健康评分均高于对照组,差异有统计学意义(P<0.05)。护理后,研究组患者焦虑、抑郁状态评分显著低于对照组,差异有统计学意义(P<0.05)。培训前,研究组护理人员的护理质量操作评分明显高于对照组,差异有统计学意义(P<0.05)。培训后,研究组患者对各方面护理满意度评分均高于对照组,差异有统计学意义(P<0.05)。结论在急诊外科中应用休克指数评估联合危机管理模式,可有效缩短患者的确诊时间,缓解焦虑、抑郁情绪,提升护理人员的护理质量操作水平。

枸橼酸对CRRT治疗脓毒症休克患者肾搏动指数及凝血功能水平的影响

目的:探究枸橼酸对连续性肾脏替代治疗(CRRT)对脓毒症休克患者肾搏动指数及凝血功能水平的影响。方法:选取2020年1月—2022年12月间就诊本院的90例脓毒症休克患者为受试对象,采用动态随机划分为对照组(n=45)与观察组(n=45)。两组患者均予以CRRT治疗,血流量速率设置为180 ml/min,透析液流速2000 ml/h。对照组予以肝素钠注射液抗凝(先取4 ml肝素钠注射液与250 ml氯化钠注射液配比混合静脉注射;后取16 ml肝素钠注射液与1000 ml氯化钠注射液配比混合静脉滴注)。观察组予以枸橼酸钠抗凝(每1000 ml输血量搭配10%葡萄糖酸钙10 ml进行中和静脉注射),两组均持续给药至CRRT治疗结束前1.5 h。比较两组患者治疗前及治疗7 d后肾动力学参数[肾搏动指数(RPI)、肾阻力指数(RRI)]、肾功能[血尿素氮(BUN)、血清肌酐(Scr)]、凝血功能[凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)]、肝功能[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBil)]变化;统计比较治疗7 d后滤器平均使用寿命、不良反应发生率。结果:治疗前两组患者各项指标比较均无统计学差异(P>0.05)。治疗7 d后,两组患者肾动力学参数(RPI、PPI)、肾功能指标(BUN、Scr)、肝功能指标(ALT、AST、TBil)水平均有下降,且观察组显著低于同时期对照组(P<0.05);凝血功能(PT、TT、APTT)均有升高,且观察组显著高于同时期对照组(P<0.05);观察组滤器使用寿命显著高于对照组,且不良反应发生率低于对照组(P<0.05)。结论:枸橼酸钠在CRRT治疗脓毒症休克患者时,不仅可以调节患者肾搏动指数和凝血状态,还能保护肝肾功能、延长滤器使用寿命,提高治疗安全性。