Prognostic value of red blood cell distribution width for severe acute pancreatitis

BACKGROUND Severe acute pancreatitis(SAP)is a common condition in the intensive care unit(ICU)and has a high mortality.Early evaluation of the severity and prognosis is very important for SAP therapy.Recently,red blood cell distribution(RDW)was associated with mortality of sepsis patients and could be used as a predictor of prognosis.Similarly,RDW may be associated with the prognosis of SAP patients and be used as a prognostic indicator for SAP patients.AIM To investigate the prognostic value of RDW for SAP patients.METHODS We retrospectively enrolled SAP patients admitted to the ICU of the First Affiliated Hospital of China Medical University from June 2015 to June 2017.According to the prognosis at 90 d,SAP patients were divided into a survival group and a non-survival group.RDW was extracted from a routine blood test.Demographic parameters and RDW were recorded and compared between the two groups.The receiver operator characteristic(ROC)curve was constructed and Cox regression analysis was performed to investigate the prognostic value of RDW for SAP patients.RESULTS In this retrospective cohort study,42 SAP patients were enrolled,of whom 22 survived(survival group)and 20 died(non-survival group).The baseline parameters were comparable between the two groups.The coefficient of variation of RDW(RDW-CV),standard deviation of RDW(RDW-SD),Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment(SOFA)score were significantly higher in the non-survival group than in the survival group(P<0.05).The RDW-CV and RDW-SD were significantly correlated with the APACHE II score and SOFA score,respectively.The areas under the ROC curves(AUCs)of RDW-CV and RDW-SD were all greater than those of the APACHE II score and SOFA score,among which,the AUC of RDW-SD was the greatest.The results demonstrated that RDW had better prognostic value for predicting the mortality of SAP patients.When the RDW-SD was greater than 45.5,the sensitivity for predicting prognosis was 77.8%and the specificity was 70.8%.Both RDW-CV and RDW-SD could be used as independent risk factors to predict the mortality of SAP patients in multivariate logistic regression analysis and univariate Cox proportional hazards regression analysis,similar to the APACHE II and SOFA scores.CONCLUSION The RDW is greater in the non-surviving SAP patients than in the surviving patients.RDW is significantly correlated with the APACHE II and SOFA scores.RDW has better prognostic value for SAP patients than the APACHE II and SOFA scores and could easily be used by clinicians for the treatment of SAP patients.

Prediction of the severity of acute pancreatitis on admission by urinary trypsinogen activation peptide: A meta-analysis

AIM: To undertake a meta-analysis on the value of urinary trypsinogen activation peptide (uTAP) in predicting severity of acute pancreatitis on admission.METHODS: Major databases including Medline, Embase, Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials in the Cochrane Library were searched to identify all relevant studies from January 1990 to January 2013. Pooled sensitivity, specificity and the diagnostic odds ratios (DORs) with 95%CI were calculated for each study and were compared to other systems/biomarkers if mentioned within the same study. Summary receiver-operating curves were conducted and the area under the curve (AUC) was evaluated.RESULTS: In total, six studies of uTAP with a cut-off value of 35 nmol/L were included in this meta-analysis. Overall, the pooled sensitivity and specificity of uTAP for predicting severity of acute pancreatitis, at time of admission, was 71% and 75%, respectively (AUC = 0.83, DOR = 8.67, 95%CI: 3.70-20.33). When uTAP was compared with plasma C-reactive protein, the pooled sensitivity, specificity, AUC and DOR were 0.64 vs 0.67, 0.77 vs 0.75, 0.82 vs 0.79 and 6.27 vs 6.32, respectively. Similarly, the pooled sensitivity, specificity, AUC and DOR of uTAP vs Acute Physiology and Chronic Health Evaluation II within the first 48 h of admission were found to be 0.64 vs 0.69, 0.77 vs 0.61, 0.82 vs 0.73 and 6.27 vs 4.61, respectively.CONCLUSION: uTAP has the potential to act as a stratification marker on admission for differentiating disease severity of acute pancreatitis.

Predictors of the outcomes of acute-on-chronic hepatitis B liver failure

AIM： To identify the risk factors in predicting the out- come of acute-on-chronic hepatitis B liver failure pa- tients. METHODS： We retrospectively divided 113 patients with acute-on-chronic liver failure-hepatitis B virus （ACLF-HBV） and without concurrent hepatitis C or D virus infection and hepatocellular carcinoma into two groups according to their outcomes after anti-HBV therapy. Their demographic, clinical, and biochemical data on the day of diagnosis and after the first week of treatment were analyzed using the Mann-Whitney U test, Fisher＇s exact test, and a multiple logistic regres- sion analysis. RESULTS： The study included 113 patients （87 men and 26 women） with a mean age of 49.84 years. Fifty- two patients survived, and 61 patients died. Liver failure （85.2%）, sepsis （34.4%）, and multiple organ failure （39.3%） were the main causes of death. Mul- tivariate analyses showed that Acute Physiology and Chronic Health Evaluation （APACHE） Ⅱ scores ≥ 12 [odds ratio （OR） = 7.160, 95% CI： 2.834-18.092, P 〈 0.001] and positive blood culture （OR = 13.520, 95% CI： 2.740-66.721, P = 0.001） on the day of diagnosis and model for end-stage liver disease （MELD） scores 28 （OR = 8.182, 95% CI： 1.884-35.527, P = 0.005） after the first week of treatment were independent predictors of mortality. CONCLUSION： APACHE II scores on the day of diag- nosis and MELD scores after the first week of anti-HBV therapy are feasible predictors of outcome in ACLF- HBV patients.

Association between acute pancreatitis and peptic ulcer disease

AIM:To evaluate the relationship between peptic ulcer disease(PUD) and acute pancreatitis.METHODS:A cohort of 78 patients with acute pancreatitis were included in this study.The presence of PUD and the Helicobacter pylori(H.pylori) status were assessed by an endoscopic method.The severity of acute pancreatitis was assessed using Ranson's score,the Acute Physiology and Chronic Health Evaluation(APACHE) □ score,computed tomography severity indexand the clinical data during hospitalization,all of which were compared between the patients with and without PUD.The risk factors for PUD were also evaluated.RESULTS:Among 78 patients,41 patients(52.6%) with acute pancreatitis suffered from PUD,but only 13(31.7%) patients with PUD were infected by H.pylori.On univariate analysis,male gender,an etiology of alcohol-induced pancreatitis,a history of smoking or alcohol consumption,elevated triglyceride and C-reactive protein levels,and high APACHE □ score were signif icantly associated with PUD.However,on multivariate logistic regressionanalysis,the APACHE □ score(odds ratio:7.69;95% conf idence interval:1.78-33.33;P < 0.01) was found to be the only independent risk factor for PUD.CONCLUSION:Patients with acute pancreatitis are liable to suffer from PUD.PUD is associated with severeacute pancreatitis according to the APACHE □ score,and treatment for PUD should be considered for patients with severe acute pancreatitis.

Predictors of irreversible intestinal resection in patients with acute mesenteric venous thrombosis

BACKGROUND Acute mesenteric venous thrombosis(AMVT)can cause a poor prognosis.Prompt transcatheter thrombolysis(TT)can achieve early mesenteric revascularization.However,irreversible intestinal ischemia still occurs and the mechanism is still unclear.AIM To evaluate the clinical outcomes of and to identify predictive factors for irreversible intestinal ischemia requiring surgical resection in AMVT patients treated by TT.METHODS The records of consecutive patients with AMVT treated by TT from January 2010 to October 2017 were retrospectively analyzed.We compared patients who required resection of irreversible intestinal ischemia to patients who did not require.RESULTS Among 58 patients,prompt TT was carried out 28.5 h after admission.A total of 42(72.4%)patients underwent arteriovenous combined thrombolysis,and 16(27.6%)underwent arterial thrombolysis alone.The overall 30-d mortality rate was 8.6%.Irreversible intestinal ischemia was indicated in 32(55.2%)patients,who had a higher 30-d mortality and a longer in-hospital stay than patients without resection.The significant independent predictors of irreversible intestinal ischemia were Acute Physiology and Chronic Health Evaluation(APACHE)II score(odds ratio=2.368,95% confidence interval:1.047-5.357,P=0.038)and leukocytosis(odds ratio=2.058,95% confidence interval:1.085-3.903,P=0.027).Using the receiver operating characteristic curve,the cutoff values of the APACHE II score and leukocytosis for predicting the onset of irreversible intestinal ischemia were calculated to be 8.5 and 12×10^9/L,respectively.CONCLUSION Prompt TT could achieve a favorable outcome in AMVT patients.High APACHE II score and leukocytosis can significantly predict the occurrence of irreversible intestinal ischemia.Therefore,close monitoring of these factors may help with the early identification of patients with irreversible intestinal ischemia,in whom ultimately surgical resection is required,before the initiation of TT.

Different phenotypes of monocytes in patients with newonset mild acute pancreatitis

AIM To evaluate the numbers of different subsets of monocytes and their associations with the values of clinical measures in mild acute pancreatitis(MAP) patients.METHODS The study included one group of 13 healthy controls and another group of 24 patients with new-onset MAP. The numbers of different subsets of monocytes were examined in these two groups of subjects by flow cytometry. The concentrations of plasma interleukin(IL)-10 and IL-12 were determined by cytometric bead array. The acute physiology and chronic health evaluation(APACHE) II scores of individual patients were evaluated, and the levels of plasma C-reactive protein(CRP) as well as the activities of amylase and lipase were measured. RESULTS In comparison with that in the controls, significantly increased numbers of CD14+CD163-, CD14+CD163-MAC387+ M1 monocytes, but significantly reduced numbers of CD14+CD163+IL-10+ M2 monocytes were detected in the MAP patients(P < 0.01 or P < 0.05). Furthermore, significantly higher levels of plasma IL-10 and IL-12 were observed in the MAP patients(P < 0.01 for all). More importantly, the levels of plasma CRP were positively correlated with the numbers of CD14+CD163-(R = 0.5009, P = 0.0127) and CD14+CD163-MAC387+(R = 0.5079, P = 0.0113) M1 monocytes and CD14+CD163+CD115+ M2 monocytes(R = 0.4565, P = 0.0249) in the patients. The APACHE II scores correlated with the numbers of CD14+CD163+CD115+(R = 0.4581, P = 0.0244) monocytes and the levels of plasma IL-10(R = 0.4178, P = 0.0422) in the MAP patients. However, there was no significant association among other measures tested in this population. CONCLUSION Increased numbers of CD14+CD163- and CD14+ CD163-MAC387+ monocytes may contribute to the pathogenesis of MAP, and increased numbers of CD14+CD163+CD115+ monocytes may be a biomarker for evaluating the severity of MAP.

Risk factors and their interactive effects on severe acute pancreatitis complicated with acute gastrointestinal injury

BACKGROUND There are many risk factors for severe acute pancreatitis(SAP)complicated with acute gastrointestinal injury(AGI),but few reports on the interaction between these risk factors.AIM To analyze the risk factors for SAP complicated with AGI and their interactive effects.METHODS We selected 168 SAP patients admitted to our hospital between December 2019 and June 2022.They were divided into AGI group and non-AGI group according to whether AGI was present.Demographic data and laboratory test data were compared between the two groups.The risk factors for SAP with concomitant AGI were analyzed using multifactorial logistic regression,and an analysis of the interaction of the risk factors was performed.RESULTS The percentage of patients with multiple organ dysfunction syndrome,acute physiological and chronic health scoring system II(APACHE II)score,white blood cell count and creatinine(CRE)level was higher in the AGI group than in the non-AGI group.There was a statistically significant difference between the two groups(P<0.05).Logistic regression analysis indicated that an APACHE II score>15 and CRE>100μmol/L were risk factors for SAP complicating AGI.The interaction index of APACHE II score and CRE level was 3.123.CONCLUSION An APACHE II score>15 and CRE level>100μmol/L are independent risk factors for SAP complicated with AGI,and there is a positive interaction between them.

APACHEⅢ评分在ICU中的应用评价

目的 :应用急性生理学和慢性健康状况评分 (APACHE )评价重症监护病房 (ICU)患者的病情和预后 ,并与 APACHE 进行比较。方法 :对我院 2 0 0 0年 7月— 2 0 0 2年 1月 ICU中 87例危重患者的资料 (其中存活组 6 6例 ,死亡组 2 1例 )用《危重疾病评分系统》中 APACHE 和 APACHE 进行评分 ,并将 APACHE 中死亡概率 (Ps)与实际病死率进行对比。结果 :死亡组 APACHE 和 APACHE 分值均明显高于存活组(P均 <0 .0 1) ;APACHE 和 APACHE 分值与病死率呈正相关 ,APACHE >6 0分者病死率明显增加 ,Ps≤ 0 .5者实际病死率明显高于 Ps>0 .5者 (P<0 .0 1)。结论 :APACHE 分值配合 APACHE 的 Ps可较好地评价危重疾病的严重程度 。

APACHEⅡ/Ⅲ评分和SAPSⅡ评分预测肝衰竭预后的比较

目的比较APACHEⅡ/Ⅲ评分和SAPSⅡ评分系统评估我国肝衰竭患者预后的临床应用价值。方法收集200例肝衰竭患者入院24h内的相关资料,计算其APACHEⅡ/Ⅲ评分和SAPSⅡ评分,比较死亡组和生存组的差异;用ROC曲线分析比较这三个评分系统的预测能力。结果死亡组的APACHEⅡ/Ⅲ评分和SAPSⅡ评分分别是(15±7)分、(65±23)分和(33±11)分,均高于生存组[(8±4)分、(42±12)分和(26±5)分,P<0.01];APACHEⅡ/Ⅲ评分和SAPSⅡ评分的AUC分别为0.795、0.827和0.683,Youden指数分别是46.61%、56.86%和33.77%。结论SAPSⅡ评分判断肝衰竭预后能力很差,APACHEⅡ/Ⅲ评分在预测肝衰竭预后方面均有肯定的临床应用价值,且APACHEⅢ评分优于APACHEⅡ评分,对肝衰竭患者的病情评估和预后预测应以APACHEⅢ评分为首选。

内毒素血症与APACHE-Ⅲ评分及中西医结合治疗的关系

目的 :探讨内毒素血症与病情严重程度、药物疗效间的关系。方法 :按照随机对照的原则将15 3例急性感染患者分为单纯抗生素治疗组 (简称单纯治疗组 )及抗生素与中药联合治疗组 (简称联合治疗组 ) ,每组患者据APACHE Ⅲ评分又分为 3型 ,即A型 (APACHE Ⅲ评分≤ 2 0分 )、B型 (APACHE Ⅲ评分2 1～ 4 0分 )、C型 (APACHE Ⅲ评分 >4 0分 )。其中单纯治疗组 77例 ,男性 4 0例 ,女性 37例 ;年龄 18～ 76岁 ,平均 (46 5± 2 7 5 )岁 ;A型 4 1例 ,B型 2 8例 ,C型 8例 ;疗程 10～ 14天 ,平均 (11 5± 2 5 )天。联合治疗组 76例 ,男性 39例 ,女性 37例 ;年龄 18～ 70岁 ,平均 (44 5± 2 5 5 )岁 ;A型 37例 ,B型 30例 ,C型 9例 ;疗程 10～ 14天 ,平均 (10 5± 2 5 )天。采用鲎试剂法测定患者外周血内毒素含量 ,并进一步分析内毒素血症与APACHE Ⅲ评分的相关关系。结果 :急性重症感染患者APACHE Ⅲ评分 >2 0分者出现内毒素血症 (P <0 0 5 ) ,并与APACHE Ⅲ评分呈正相关 (r=0 718,P <0 0 5 ) ;中药加抗生素较单纯抗生素治疗能明显减轻内毒素血症 (P <0 0 5 ) ,改善预后。结论 :内毒素血症可作为预测病情严重度的一项参考指标 。

重危患者APACHEⅢ评分与甲状腺激素水平的关系

目的 :探讨急性生理学与慢性健康状况评分 (APACHE )与甲状腺激素水平及疾病严重程度和预后的关系。方法 :对 4 3例 ICU患者的甲状腺激素〔总三碘甲状腺原氨酸 (TT3)、总甲状腺素 (TT4 )、游离三碘甲状腺原氨酸 (FT3)、游离甲状腺素 (FT4 )〕和促甲状腺激素 (TSH )水平与疾病严重程度及预后进行相关分析。疾病严重度采用入 ICU第 1个 2 4小时收集的 APACHE 评分 ,分为 4组 (轻度组 <6 0分 ,中度组 6 1～ 90分 ,重度组 91～ 12 0分 ,特重度组 >12 1分 ) ,同时取血查甲状腺激素。根据出院情况分为生存组与死亡组 ,比较 2组的甲状腺激素水平。结果 :APACHE 评分与 TT3、TT4 、TSH均呈负相关 (分别为 r1 =0 .6 0 7,P<0 .0 1;r2 =0 .4 34,P<0 .0 1;r3=0 .336 ,P<0 .0 5 )。TT3轻度组与中度、重度、特重度组及中度组与特重度组比较均有显著差异 (P均 <0 .0 5 ) ,TT4 轻度组与中度、重度、特重度组比较均有显著差异 (P均 <0 .0 5 )。死亡组 TT3、TT4 、TSH均较生存组降低 ,TT3、TSH下降幅度显著 (P均 <0 .0 1)。结论 :危重病患者病情越重 ,APACHE 评分越高 ,甲状腺激素水平下降幅度越大。TT3可作为评价 ICU患者预后的指标 ,APACHE 评分与甲状腺激素下降程度相关 ;两者结合用于临床 ,对危重病患者病情严重度判?

APACHEⅢ引入MODS评分对ICU患者病情评估价值的研究

目的 :评价急性生理学与慢性健康状况 (APACHE )评分引入多器官功能障碍综合征 (MODS)评分对 ICU患者病情评估的价值。方法 :对 70例 ICU患者在入住 ICU 2 4 h内分别进行 APACHE 评分和 MODS评分 ,以 ROC曲线下面积大小衡量各评分系统预测患者预后的能力 ,比较 APACHE 评分、MODS评分以及APACHE 与 MODS评分之和的 ROC曲线下面积。建立以患者预后为因变量 ,APACHE 评分、MODS评分以及 APACHE 与 MODS评分之和为自变量的判别方程 ,比较它们对患者预后判别的贡献率 (判别系数 )。结果 :APACHE 评分、MODS评分以及 APACHE 与 MODS评分之和的 ROC曲线下面积分别为 0 .76 5、0 .6 4 3和 0 .75 3;在判别方程中 ,它们的贡献率 (判别系数 )分别为 0 .998、0 .892和 0 .5 6 8。结论 :APACHE 对ICU患者预后的预测效果优于 MODS评分 ,APACHE 引入 MODS评分后并不能提高其预测效果。

苏丹红Ⅲ对泥鳅的急性毒性、遗传及生理毒性研究

以苏丹红Ⅲ为诱变剂,研究了其对泥鳅(Misgurnus anguillicandatus)的急性毒性效应,在此基础上研究了苏丹红Ⅲ在不同浓度和染毒时间对泥鳅红细胞微核率及其肝脏中谷草转氨酶(GOT)和谷丙转氨酶(GPT)活性的影响。试验表明,苏丹红Ⅲ对泥鳅的24 h半致死浓度为1.020 g/L,48 h半致死浓度为0.740 g/L,48 h安全浓度为0.117 g/L。染毒一段时间后,泥鳅红细胞的微核率与对照组比较均显著升高,达最高值后趋于平缓;随着苏丹红Ⅲ浓度的升高,泥鳅红细胞微核率与对照组相比出现极显著差异的时间相应提前。染毒后各组的谷草转氨酶和谷丙转氨酶活性呈下降趋势,达到峰值后趋于平缓;染毒时间越长,酶活下降的幅度越大。泥鳅红细胞的微核率及其肝脏中的GOT和GPT活性均与苏丹红Ⅲ有明显的剂量-时间效应,研究结果为进一步明确苏丹红Ⅲ的危害提供了试验数据。

动态APACHEⅢ评分对老年急性胆管炎外科治疗的价值

目的:探讨急性生理、年龄及慢性健康评价系统(APACHE Ⅲ)在老年急性胆管炎外科治疗的应用和价值。方法:回顾分析1991～1996年资料齐全的98例患者,按Knaus法计算98例患者APACHE Ⅲ评分及病死率,并进行相关对比分析,所得结论指导1997～2001年69例患者的外科治疗。结果:APACHE Ⅲ评分值越高,病情越重,病死率越高,动态观察APACHE Ⅲ评分意义更大。50分以下,均非手术治疗获得成功;51～90分需急诊手术;91分以上宜先行PTCD、ENBD、或加EST取石术,如插管失败或引流效果欠佳,宜于急诊手术;引流效果好,需结合B超或CT所见决定手术时间。其一对胆管结石或胆道蛔虫伴胆道感染,宜引流48h后待APACHE Ⅲ评分下降至90分以下时予手术治疗;其二对恶性胆道梗阻、多次胆道手术史或伴严重内科合并病患者,宜引流3w后手术。结论:APACHE Ⅲ是一种合理、有效的病情评估系统,可指导老年急性胆管炎的外科治疗;据APACHE Ⅲ动态评分采取相应治疗方法,可提高治愈率。

急性生理学及慢性健康状况评价Ⅲ系统在监护病房中铜绿假单胞菌下呼吸道感染患者中的应用

目的 应用急性生理学及慢性健康状况评价Ⅲ (APACHEⅢ )系统评估监护病房 (ICU)中病人的下呼吸道感染的发生、疾病的危重程度 ,以及入住ICU的时间和预后。方法 对比观察入住ICU且合并下呼吸道铜绿假单胞菌 (PA)感染的 115例患者和对照组 116例ICU病人 ,按Knaus法进行APACHEⅢ评分 ,并进行临床对比。结果 两组患者共死亡 49例 ,APACHEⅢ分值为 (55 2 9±15 83 )分 ;存活 182例 ,APACHE分值为 (2 5 97± 14 3 9)分 ,两者差异显著 (t =12 3 9,P <0 0 1)。PA感染组和非PA感染组的APACHEⅢ评分、住院时间和死亡率差异显著。合并感染者较未合并感染者APACHEⅢ评分高 ,且随APACHEⅢ分值的升高 ,重症肺炎例数增多 ,住ICU时间延长 ,病死率升高。在PA感染组内 ,重症肺炎较非重症肺炎患者APACHEⅢ评分高 ,预后差。结论 在ICU病人尤其PA下呼吸道感染病人中 ,APACHEⅢ评分系统有助于预测患者的感染 ,评估病情的严重性、住ICU时间和预后。

急诊危重病患者血清硫化氢浓度与APACHEⅢ评分及预后关系的研究

目的探讨急诊监护室(EICU)危重病患者血清硫化氢(H2S)浓度改变与急性生理学及慢性健康状况评分Ⅲ(APACHEⅢ)及预后的关系。方法采用分光光度法检测72例入住EICU的危重病患者及12例健康体检者的血清H2S浓度,并对危重病患者进行APACHEⅢ评分;分析血清H2S浓度与APACHEⅢ评分及死亡率的关系。结果72例患者血清H2S浓度为(45.6±17.2)μmol/L,存活组血清H2S浓度(41.1±14.7)μmol/L,死亡组血清H2S浓度(62.8±15.5)μmol/L,两组比较差异有统计学意义(P<0.01);72例患者APACHEⅢ评分(43.6±26.0)分,存活组APACHEⅢ评分(37.7±22.2)分,死亡组APACHEⅢ评分(65.0±29.6)分,两组比较差异有统计学意义(P<0.01)。血清H2S浓度与APACHEⅢ评分呈正相关(r=0.7422,P<0.01),随各组血清H2S浓度增高,APACHEⅢ评分值亦增高(F=33.69,P<0.001),各组死亡率也随之增高(χ2=24.48,P<0.01)。结论急诊危重病患者血清H2S浓度较健康者明显增高,对判断病情及预后有一定的作用。

54例重症SARS患者APACHEⅢ评分分析

目的 :评估分析急性生理学和慢性健康状况评分 (APACHE )对严重急性呼吸综合征 (SARS)病情严重程度和预后的价值。方法 :收集整理 5 4例重症 SARS患者临床资料 (其中存活组 4 3例 ,死亡组 11例 ) ,采用 APACHE 评分评估重症 SARS的严重程度和预后。结果 :重症 SARS死亡组 APACHE 评分分值明显高于存活组 (P<0 .0 1) ;其中死亡组急性生理学评分 (APS)分值和年龄评分 (YS)分值均明显高于存活组 (P均<0 .0 1) ;老年重症患者病死率高 ;APACHE 分值与实际病死率呈正相关 ,APACHE 分值 >6 0分者病死率明显增加。结论 :重症 SARS患者 APACHE 评分分值与病情严重和预后有关。

APACHEⅢ评分与老年冠状动脉移植术后IABP辅助治疗的医院感染

目的分析冠状动脉移植术后主动脉内球囊反搏辅助的老年患者的医院感染情况与APACHEⅢ评分的相关性。方法回顾性收集、分析我院2006年4月至2009年2月冠状动脉移植术后IABP辅助治疗的老年(≥65岁)患者的医院感染资料,并进行APACHEⅢ评分系统评估。结果 111例患者,年龄69.9±3.8岁,男77例,女34例。医院感染29例,感染率26.1%。患者平均APACHEⅢ评分为60.8±14.0,高分组患者的医院感染率和住院死亡率均高于低分组。结论医院感染是老年冠状动脉移植术后IABP辅助患者的死亡危险因素之一,APACHEⅢ评分系统可作为预测医院感染发生的方法之一。

急性生理学与慢性健康状况评分Ⅲ评估老年慢性阻塞性肺疾病并机械通气患者预后的研究

目的研究急性生理学与慢性健康状况评分Ⅲ(APACHE)预测老年慢性阻塞性肺疾病(COPD)合并气管插管、呼吸机辅助通气患者预后的可行性及方法。方法系统性回顾北京友谊医院急诊科2000年1月—2005年3月收治的50例60岁以上老年COPD进行气管插管、呼吸机辅助通气患者的病历资料,根据APACHE评价系统编制相应的计算机软件,并对每一病例气管插管前后的病情进行评分。采用Logistic回归法建立预测死亡风险的数学模型。动态评估患者插管前后的APACHEⅢ分值,寻找对预后有统计意义的APACHE分值切分点(cutoff)。结果对患者气管插管前APACHEⅢ分值(Apa)进行Logistic回归,得到APACHEⅢ分值与死亡风险(概率,p)预测的数学模型为:p=Apaγ/(Dγ50+Apaγ),D50=73.4,γ=8;验证该模型准确率为80%。动态研究患者插管后1、3和7d病情变化,并依次进行APACHE评分。插管后3d,死亡风险有统计学意义的患者APACHE分值变化率的切分点为32.8%(P<0.01)。故认为气管插管后3d、APACHEⅢ分值下降超过插管前分值32.8%的患者存活可能性大;切分点结论对于死亡风险预测公式是个很好的补充,两个结论结合来预测患者预后准确率高。结论利用APACHEⅢ评分系统对老年COPD气管插管、呼吸机辅助通气的患者进行动态评价,对于患者的治疗及预后有一定的临床指导意义。

艾滋病并肺炎患者的急性生理学和慢性健康状况评分系统Ⅲ评分分析

目的评估分析急性生理学和慢性健康状况评分系统Ⅲ(APACHEⅢ)对判断艾滋病并肺炎患者病情的严重性和预后的价值.方法整理2003年1～12月住院艾滋病并肺炎患者74例的临床资料,采用APACHEⅢ评分评估艾滋病并肺炎患者病情的严重性和预后.结果74例患者中,死亡17例,存活57例,两者APACHEⅢ分值差异显著;APACHEⅢ分值越高,重症肺炎患者比例增高,治疗效果越差,死亡率增高;APACHEⅢ评分分值≥60者的死亡率明显增高;死亡与入院时APACHEⅢ分值相关(r=0.444,P=0.001),与死亡前的APACHEⅢ分值高度相关(r=0.965,P=0.001).结论APACHEⅢ评分有助于预测艾滋病并肺炎患者病情的严重性和预后.