Zhonghua wei zhong bing ji jiu yi xue最新文献

{"title":"[Long-term clinical outcomes after percutaneous coronary intervention for ST-segment elevation myocardial infarction due to late and very late stent thrombosis].","authors":"Xiaowei Li, Yixing Yang, Mingdong Gao, Changping Li, Xiaoyuan Wu, Yin Liu, Jing Gao","doi":"10.3760/cma.j.cn121430-20230925-00822","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20230925-00822","url":null,"abstract":"<p><strong>Objective: </strong>To explore the prognosis and influencing factors of ST-segment elevation myocardial infarction (STEMI) due to late stent thrombosis (LST) and very late stent thrombosis (VLST).</p><p><strong>Methods: </strong>Patients who underwent percutaneous coronary intervention (PCI) for STEMI caused by LST and VLST at Tianjin Chest Hospital from January 2016 to June 2021 were selected as the study subjects, and long-term follow-up was conducted. The baseline clinical features, laboratory examination indicators, echocardiography results, coronary angiography and intervention treatment characteristics, and antiplatelet treatment status of patients were collected. The study endpoint was major adverse cardiovascular event (MACE), including all-cause mortality, target vessel revascularization (TVR), myocardial infarction, and recurrent stent thrombosis (RST). Patients were divided into MACE group and non-MACE group based on the occurrence of MACE. Cox regression analysis was used to determine the univariate and multivariate predictive factors for MACE occurrence in STEMI patients caused by LST and VLST during long-term follow-up after PCI. Kaplan-Meier survival curves were plotted to analyze the cumulative survival rate without MACE during follow-up in subgroups of patients with different levels of fibrinogen (Fib) and initial number of stents. The incidence of MACE among patients receiving different drug-eluting stent (DES) treatments was compared.</p><p><strong>Results: </strong>A total of 418 patients diagnosed STEMI caused by LST and VLST through coronary angiography were enrolled, of which 115 had MACE and 303 did not. Among them, 404 cases (96.65%) completed follow-up, with a median follow-up time of 27.25 (18.00, 37.00) months. Cox regression analysis showed that Fib [hazard ratio (HR) = 2.840, 95% confidence interval (95%CI) was 1.329-6.066, P = 0.007], non-culprit vascular stenosis > 50% (HR = 5.974, 95%CI was 1.634-21.848, P = 0.007), initial stent quantity (HR = 3.314, 95%CI was 1.677-6.552, P = 0.001), B2/C lesions (HR = 5.463, 95%CI was 1.396-21.373, P = 0.015), and cardiogenic shock (HR = 4.141, 95%CI was 1.101-15.568, P = 0.035) were independently associated with the occurrence of MACE. The Kaplan-Meier survival curve showed that the higher the Fib level, the lower the cumulative survival rate without MACE (82.8%, 70.1%, 40.5%, P < 0.01); the more initial stents, the lower the cumulative survival rate without MACE (75.0%, 57.7%, 36.5%), with patients with initial stents ≥ 3 having the lowest cumulative survival rate without MACE (P < 0.001). A total of 210 patients (50.2%) received secondary stent treatment, and there was no significant difference in the incidence of MACE between patients receiving first and second generation DES treatment (27.3% vs. 24.7%, P > 0.05), but patients receiving first generation DES had a higher proportion of all-cause mortality (22.3% vs. 10.1%, P < 0.05). Compared with patients receivin","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1290-1295"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Construction of prognostic prediction model for patients with sepsis-induced acute kidney injury treated with continuous renal replacement therapy].","authors":"Yalin Li, Dongfeng Li, Jing Wang, Hao Li, Xiao Wang","doi":"10.3760/cma.j.cn121430-20240103-00010","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240103-00010","url":null,"abstract":"<p><strong>Objective: </strong>To explore the influencing factors of prognosis in patients with sepsis-induced acute kidney injury undergoing continuous renal replacement therapy (CRRT), and to construct a mortality risk prediction model.</p><p><strong>Methods: </strong>A retrospective research method was adopted, patients with sepsis-induced acute kidney injury who received CRRT at Fuyang People's Hospital from February 2021 to September 2023 were included in this study. Collect general information, comorbidities, vital signs, laboratory indicators, disease severity scores, treatment status, length of stay in the intensive care unit (ICU), and 28-day prognosis were collected within 24 hours of patient enrollment. The Cox regression model was used to identify the factors influencing prognosis in patients with sepsis-induced acute kidney injury, and a nomogram model was developed to predict mortality in these patients. Receiver operator characteristic curve (ROC curve), calibration curve, and Hosmer-Lemeshow test were used to validate the predictive performance of the nomogram model.</p><p><strong>Results: </strong>A total of 146 patients with sepsis-induced acute kidney injury were included, of which 98 survived and 48 died (with a mortality of 32.88%) after 28 days of treatment. The blood lactic acid, interleukin-6 (IL-6), serum cystatin C, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), and proportion of mechanical ventilation in the death group were significantly higher than those in the survival group. The ICU stay was significantly longer than that in the survival group, and the glomerular filtration rate was significantly lower than that in the survival group. Cox regression analysis showed that blood lactic acid [odds ratio (OR) = 2.992, 95% confidence interval (95%CI) was 1.023-8.754], IL-6 (OR = 3.522, 95%CI was 1.039-11.929), serum cystatin C (OR = 3.999, 95%CI was 1.367-11.699), mechanical ventilation (OR = 4.133, 95%CI was 1.413-12.092), APACHE II score (OR = 5.013, 95%CI was 1.713-14.667), SOFA score (OR = 3.404, 95%CI was 1.634-9.959) were risk factors for mortality in patients with sepsis-induced acute kidney injury (all P < 0.05), glomerular filtration rate (OR = 0.294, 95%CI was 0.101-0.860) was a protective factor for mortality in patients with sepsis-induced acute kidney injury (P < 0.05). The ROC curve showed that the column chart model has a sensitivity of 80.0% (95%CI was 69.1%-89.2%) and a specificity of 89.3% (95%CI was 83.1%-95.2%) in predicting 28-day mortality in patients with acute kidney injury caused by sepsis.</p><p><strong>Conclusions: </strong>Blood lactic acid, IL-6, mechanical ventilation, APACHEII score, SOFA score, glomerular filtration rate, and serum cystatin C are associated with the risk of death in patients with sepsis-induced acute kidney injury. The nomogram model could help early identification of mortality risk in these patients.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1268-1272"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Effect of extra corporeal reducing pre-load on pulmonary mechanical power in patients with acute respiratory distress syndrome].","authors":"Wenwen Zhang, Xin'gang Hu, Lixia Yue, Jie Zhang, Zhida Liu, Shuai Gao, Zhigang Zhao, Xinliang Liang","doi":"10.3760/cma.j.cn121430-20240117-00054","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240117-00054","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To explore the effects of veno-venous extra corporeal carbon dioxide removal (V-V ECCO&lt;sub&gt;2&lt;/sub&gt;R) on local mechanical power and gas distribution in the lungs of patients with mild to moderate acute respiratory distress syndrome (ARDS) receiving non-invasive ventilation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Retrospective research methods were conducted. Sixty patients with mild to moderate ARDS complicated with renal insufficiency who were transferred to the respiratory intensive care unit (RICU) through the 96195 platform critical care transport green channel from January 2018 to January 2020 at the collaborative hospitals of Henan Provincial People's Hospital were enrolled. According to different treatment methods, they were divided into a conventional treatment group and an ECCO&lt;sub&gt;2&lt;/sub&gt;R group, with 30 patients in each group. Both groups received standard treatments including primary disease treatment, airway management, and non-invasive ventilation. The conventional treatment group received bedside continuous renal replacement therapy (CRRT), and the ECCO&lt;sub&gt;2&lt;/sub&gt;R group received V-V ECCO&lt;sub&gt;2&lt;/sub&gt;R treatment. General information of patient such as gender, age, cause of disease, and acute physiology and chronic health evaluation II (APACHE II) were recorded; arterial blood gas analysis was performed before treatment and at 12 hours and 24 hours during treatment, recording arterial partial pressure of oxygen (PaO&lt;sub&gt;2&lt;/sub&gt;), arterial partial pressure of carbon dioxide (PaCO&lt;sub&gt;2&lt;/sub&gt;), and oxygenation index (PaO&lt;sub&gt;2&lt;/sub&gt;/FiO&lt;sub&gt;2&lt;/sub&gt;). Respiratory mechanics parameters [tidal volume, respiratory rate, maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP)] were recorded, and the rapid shallow breathing index (RSBI) was calculated; electrical impedance tomography (EIT) was used to measure regional of interest (ROI) values in different lung areas at 12 hours and 24 hours of treatment, and the pulmonary mechanical energy was calculated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The arterial blood gas analysis indicators, respiratory mechanics parameters, and pulmonary mechanical energy of patients in the conventional treatment group and ECCO&lt;sub&gt;2&lt;/sub&gt;R group improved significantly after 24 hours of treatment compared to 12 hours of treatment (all P &lt; 0.05). The levels of PaCO&lt;sub&gt;2&lt;/sub&gt;, RSBI, total mechanical power, and non-dependent zone mechanical power in the ECCO&lt;sub&gt;2&lt;/sub&gt;R group were significantly lower than those in the conventional treatment group at both 12 hours and 24 hours during the treatment [PaCO&lt;sub&gt;2&lt;/sub&gt; (mmHg, 1 mmHg ≈ 0.133 kPa): 44.03±2.96 vs. 49.96±2.50 at 12 hours, 41.65±3.21 vs. 48.53±2.33 at 24 hours; RSBI (times×min&lt;sup&gt;-1&lt;/sup&gt;×L&lt;sup&gt;-1&lt;/sup&gt;): 88.67±4.05 vs. 92.35±4.03 at 12 hours, 77.66±4.64 vs. 90.98±4.21 at 24 hours; total mechanical power (mJ): 10.40±1.15 vs. 12.93±1.68 at 12 hours, 11.13±1.18 vs. 14.05±1.69 at 24 hours; non-dependent zone mechanical powe","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1244-1248"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Retrospective analysis of animal-related injuries in 1 266 patients based on the emergency department electronic medical record system].","authors":"Zheng Yang, Ji Wang, Chunyun Cai, Aihua Jiang","doi":"10.3760/cma.j.cn121430-20231230-01131","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20231230-01131","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To analyze the characteristics of animal-related injuries and summarize the epidemiological features of the affected population using the hospital's emergency department electronic medical record system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective cross-sectional study was conducted, collecting data on animal-related injuries (dogs, cats, rodents, or other animals) as recorded in the outpatient registration system of the emergency department at Tongde Hospital of Zhejiang Province from October 8, 2022, to October 30, 2023. The study variables encompassed patient demographic characteristics (gender, age, occupation, residence, etc.), and injury characteristics (date and location of injury, type of animal inflicting the injury, level of exposure, wound site, number of wounds, vaccination history, etc.). Descriptive statistics and univariate analysis were performed on the collected data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;From October 8, 2022, to October 30, 2023, a total of 1 266 cases of animal bites were attended to in our hospital's emergency department. A distinct seasonal pattern was observed in the monthly distribution of animal bite patients, with a consistent presence throughout the year and notable fluctuations. There was a higher incidence during the summer and autumn (July to October), and a lower incidence during the winter and spring (December to the following March), marking a relatively quiescent period. The study included 680 female cases (53.7%) and 586 male cases (46.3%), with a median age of 27 years (range 11 months to 88 years). The majority of patients were clerks or workers (50.2%), followed by students (21.6%), laborers (8.5%), and retirees (3.6%). The majority of patients were local residents (90.6%), and the majority had no history of rabies vaccination (76.9%), with only 3 cases (0.2%) having pre-exposure immunization. Among the four types of animal bites, cat bites predominated (64.5%), followed by dog bites (28.7%), rodent bites (4.9%), and bites from other animals (1.9%). The time from injury to consultation was 0 (0-40) days. Most patients experienced a level III exposure (76.3%), with level II exposure being less common (23.2%), and level I exposure being the least frequent (0.5%). The upper limbs were the most common site of injury (72.1%), followed by the lower limbs (21.2%), and the trunk was the least affected (2.6%). The majority of patients had a single wound (75.8%), and the majority of injuries occurred at home (90.2%). The number of patients who self-cleaned their wounds was comparable to those who sought outpatient treatment. When stratified by age and gender, the age of 18 to 39 years group was identified as the high-incidence demographic for all four types of animal bites. In this age group, except for injuries caused by mice, injuries caused by other animals were more common in females than males.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The proportion of injuries caused by cat","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1311-1314"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Predictive value of plasma heparin-binding protein combined with albumin for 28-day mortality in patients with sepsis].","authors":"Jiangping Liu, Yajun Li, Yawen Zheng, Cuijie Zhang, Lihua Huang, Xiaopeng Ning, Wenfei Wang, Qingli Dou","doi":"10.3760/cma.j.cn121430-20240718-00614","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240718-00614","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the predictive value of plasma heparin-binding protein (HBP) combined with albumin (Alb) for predicting 28-day mortality in patients with sepsis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The clinical data of patients with sepsis admitted to the emergency intensive care unit (EICU) of the People's Hospital of Shenzhen Baoan District from March 2020 to March 2024 were retrospectively analyzed. The study began at the time of the first diagnosis of sepsis upon EICU admission and ended upon patient death or at 28 days. The gender, age, length of stay in EICU, underlying diseases, and infection sites were recorded. Within 24 hours of sepsis diagnosis, blood culture results, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), blood lactate acid (Lac), HBP, Alb, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation II (APACHE II), mortality in emergency department sepsis score (MEDS), modified early warning score (MEWS), number of organ failures, use of vasopressors, application of mechanical ventilation, renal replacement therapy, and 28-day prognosis were recorded, the differences in these indicators between two groups were compared. Univariate and multivariate Logistic regression analyses were used to analyze the risk factors of 28-day mortality in patients with sepsis. Receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated to evaluate the early predictive value of various risk factors for 28-day mortality in patients with sepsis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 300 patients with sepsis were included, with 16 excluded, resulting in 284 patients being analyzed. Among them, 191 survived and 93 died within 28 days. There were no statistically significant differences between the two groups in terms of gender, age, underlying diseases, infection sites, blood culture positivity rate, number of organ failures, and length of stay in EICU. Univariate analysis showed that the rate of vasopressor use, the rate of mechanical ventilation, HBP, PCT, CRP, Lac, SOFA score, APACHE II score, MEDS score, and MEWS score were significantly higher in the death group than those in the survival group, while Alb was significantly lower in the death group than that in the survival group. Multivariate Logistic regression analysis showed that HBP and Alb were independent risk factors for predicting 28-day mortality in patients with sepsis [odds ratio (OR) and 95% confidence interval (95%CI) were 1.093 (0.989-1.128) and 1.174 (1.095-1.259), both P &lt; 0.05]. ROC curve analysis showed that both HBP and Alb had certain predictive value for 28-day mortality in patients with sepsis [AUC and 95%CI were 0.820 (0.717-0.923) and 0.786 (0.682-0.890), both P &lt; 0.05]. When the critical value of HBP was 117.50 μg/L, the sensitivity was 85.90%, and the specificity was 70.50%. When the critical value of Alb was 28.30 g/L, the sens","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1233-1237"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Efficiency analysis of hyperbaric oxygen therapy for paroxysmal sympathetic hyperactivity after brain injury: a multicenter retrospective cohort study].","authors":"Hongyu Wang, Changhe Li, Huimin Chen, Caihong Ren, Yajie Liu, Jiankai Gao, Hong Wang, Peiliang Li, Jinqiang Liu, Yujing Li, Sisen Zhang","doi":"10.3760/cma.j.cn121430-20231115-00980","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20231115-00980","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effect of hyperbaric oxygen (HBO) on paroxysmal sympathetic hyperexcitation (PSH) after brain injury.</p><p><strong>Methods: </strong>A multicenter retrospective study was conducted. Fifty-six patients with PSH who received HBO treatment from four hospitals in Henan Province from January 2021 to September 2023 were selected as the HBO group, and 36 patients with PSH who did not receive HBO treatment from Zhengzhou People's Hospital from May 2018 to December 2020 were selected as the control group. PSH assessment measure (PSH-AM) score [clinical feature scale (CFS) score+diagnostic likelihood tool (DLT) score] and Glasgow coma scale (GCS) were compared before and after HBO treatment, and between HBO group and control group to evaluate the effect of HBO treatment on prognosis of PSH patients.</p><p><strong>Results: </strong>There were no statistically significant differences in age, gender, PSH etiology, GCS score, time from onset to occurrence of PSH, CFS score, CFS+DLT score and frequency of PSH episodes between the two groups, indicating comparability. The duration of HBO treatment ranged from 3 to 11 days for 56 patients receiving HBO treatment, and the duration of HBO treatment ranged from 3 to 5 courses. Compared with before treatment, after HBO treatment, PSH symptoms in HBO patients were significantly relieved (body temperature increase: 14.29% vs. 64.29%, heart rate increase: 25.00% vs. 98.21%, shortness of breath: 14.29% vs. 76.79%, blood pressure increase: 8.93% vs. 85.71%, sweating: 10.71% vs. 85.71%, muscle tone increased: 19.64% vs. 75.00%, all P < 0.05), CFS+DLT score decreased significantly (16.90±4.81 vs. 22.12±3.12, P < 0.01), GCS score improved (12.31±5.34 vs. 5.95±2.18, P < 0.01). After 30 days of hospitalization, compared with the control group, PSH symptoms in the HBO group were improved (body temperature increase: 14.29% vs. 19.44%, heart rate increase: 19.64% vs. 25.00%, shortness of breath: 10.71% vs. 27.78%, blood pressure increase: 7.14% vs. 22.22%, sweating: 8.93% vs. 25.00%, muscle tone increased: 19.64% vs. 38.89%, all P < 0.05 except body temperature increase), CFS+DLT score decreased (16.90±3.81 vs. 19.98±4.89, P < 0.05), GCS score increased (14.12±4.12 vs. 12.31±4.14, P < 0.01), the length of intensive care unit (ICU) stay was shortened (days: 18.01±5.67 vs. 24.93±8.33, P < 0.01).</p><p><strong>Conclusions: </strong>HBO treatment can significantly relieve the symptoms of patients with PSH after brain injury and provide a new idea for the treatment of PSH patients.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1285-1289"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Establishment of risk prediction model for pneumonia infection in elderly severe patients and analysis of prevention effect of 1M3S nursing plan under early warning mode].","authors":"Xin Li, Xiao Tang, Lianzhen Qi, Ruili Chai","doi":"10.3760/cma.j.cn121430-20231211-01075","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20231211-01075","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To construct a risk prediction model for elderly severe patients with pneumonia infection, and analyze the prevention effect of 1M3S nursing plan under early warning mode.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Firstly, 180 elderly severe patients admitted to the department of intensive care unit (ICU) of the Second Affiliated Hospital of Xingtai Medical College from September 2020 to September 2021 were enrolled. Their clinical data were collected and retrospectively analyzed, and they were divided into infected group and non-infected group according to whether they developed severe pneumonia. The risk factors affecting severe pneumonia in elderly severe patients were screened by univariate and multifactorial analysis methods, and the risk prediction model was constructed. The predictive efficiency of the model was analyzed by receiver operator characteristic curve (ROC curve). Then the risk prediction model was applied to prospectively include 60 high-risk elderly patients with severe pneumonia admitted from December 2021 to August 2022. The patients were randomly divided into study group and control group by envelope method, with 30 cases in each group. Both groups were given routine nursing. On this basis, the study group adopted 1M3S nursing scheme [standardized nursing management (1M), improving nursing skills (S1), optimizing nursing service (S2), ensuring nursing safety (S3)] in the early warning mode for intervention. Acute physiology and chronic health evaluation II (APACHE II) and Murray lung injury score were compared between the two groups before intervention and 7 days after intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 180 elderly severe patients, 34 cases were infected with pneumonia (18.89%). The proportion of patients with Glasgow coma scale (GCS) ≤ 8, duration of mechanical ventilation &gt; 7 days, use of antibiotics, poor oral hygiene, hospital stay &gt; 15 days and albumin ≤ 30 g/L in the infected group were significantly higher than those in the non-infected group. Multivariate Logistic regression analysis showed that duration of mechanical ventilation &gt; 7 days, use of antibiotics, GCS score≤ 8, hospital stay &gt; 15 days, albumin ≤ 30 g/L and poor oral hygiene were all independent risk factors for severe pneumonia in elderly severe patients. The odds ratio (OR) values were 3.180, 3.394, 1.108, 1.881, 1.517 and 2.512 (all P &lt; 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of the prediction model to predict severe pneumonia in elderly severe patients was 0.838, 95% confidence interval was 0.748-0.927, sensitivity and specificity were 81.25% and 72.57%, respectively, and the Youden index was 0.538. (2) There was no significantly difference in general data between the study group and the control group, which was comparable. After intervention, the APACHE II score and Murray lung injury score of the two groups were significantly decreased, and the APACHE II score and Murray lung inj","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1305-1310"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Progress in the immunometabolism in the regulation of macrophage function in sepsis].","authors":"Yingying Lu, Yan Bai, Fei Li, Zhuqing Rao","doi":"10.3760/cma.j.cn121430-20231216-01089","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20231216-01089","url":null,"abstract":"<p><p>Macrophages are widely distributed in peripheral blood, lungs, liver, brain, kidneys, skin, testes, vascular endothelial cells, and other parts of the body. As sentinel cells of innate immunity, they play an important role in the occurrence and development of sepsis. Recent research in immune metabolism has revealed the complicated relationship between specific metabolic pathways of macrophages and their phenotype and function in sepsis. During the pro-inflammatory phase of sepsis, macrophages are characterized by glycolysis, while in the immunosuppressive phase, they rely more on mitochondrial oxidative phosphorylation (OXPHOS). Hence, this review describes how macrophages metabolism related signaling pathways, molecules, enzymes and metabolic intermediates determine their phenotype and function to find critical targets which regulate the body immune status in sepsis.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1321-1324"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Analysis of the correlation between driving pressure and prognosis in lung transplant recipients based on restricted cubic spline model].","authors":"Chenhao Xuan, Dapeng Wang, Shuyun Jiang, Song Wang, Zhiyu Li, Jingyu Chen, Hongyang Xu","doi":"10.3760/cma.j.cn121430-20240407-00311","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240407-00311","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the correlation between postoperative driving pressure (DP) and the prognosis of lung transplantation, and to further evaluate the value of early DP monitoring in lung transplantation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A observational study was conducted. The patients after lung transplantation who admitted to the intensive care unit (ICU) of Wuxi People's Hospital from February 1, 2022 to February 1, 2023 were collected. They were divided into low DP group (DP≤15 cmH&lt;sub&gt;2&lt;/sub&gt;O, 1 cmH&lt;sub&gt;2&lt;/sub&gt;O ≈ 0.098 kPa) and high DP group (DP &gt; 15 cmH&lt;sub&gt;2&lt;/sub&gt;O) according to DP within 2 hours after operation. The clinical data including general information, primary disease, chronic diseases, cardiopulmonary function, laboratory indicators, intraoperative condition, postoperative lactic acid (Lac) and ventilator parameters were collected. Primary outcomes included 28-day and 90-day survival, and secondary outcomes included occurrence of primary graft dysfunction (PGD), duration of extracorporeal membrane oxygenation (ECMO), duration of mechanical ventilation, weaning of mechanical ventilation, and length of ICU stay. The general data and observations between the two groups were compared. Kaplan-Meier curve analysis was conducted to analyze the situation of mechanical ventilation and 90-day survival. Receiver operator characteristic curve (ROC curve) was used to evaluate the predictive ability of DP for failed weaning of mechanical ventilation and 90-day death. The dose-response relationship between DP and 90-day death risk was determined by restricted cubic spline model. Univariate analysis was performed using Cox proportional hazards model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 101 patients were enrolled, with 68 patients (67.3%) in the low DP group and 33 patients (32.7%) in the high DP group. No statistically significant difference in general information, chronic diseases, primary diseases, cardiopulmonary function, laboratory indicators, intraoperative conditions, and postoperative Lac between the two groups was found. Compared with the low DP group, the patients in the high DP group had higher inspiratory pressure (Pinsp) and incidence of PGD with grade 3 at 24 hours after operation [Pinsp (cmH&lt;sub&gt;2&lt;/sub&gt;O): 21.0±0.6 vs. 20.0±0.7, PGD with grade 3 at 24 hours: 60.6% (20/33) vs. 39.7% (27/68), both P &lt; 0.05], longer duration of ECMO, duration of mechanical ventilation, and the length of ICU stay [duration of ECMO (hours): 37 (21, 109) vs. 22 (14, 43), duration of mechanical ventilation (days): 3.1 (1.8, 10.7) vs. 1.9 (1.1, 3.2), length of ICU stay (days): 6 (3, 13) vs. 4 (3, 5), all P &lt; 0.05], and lower successful weaning rate of mechanical ventilation [81.8% (27/33) vs. 95.6% (65/68), P &lt; 0.05). The 28-day and 90-day survival rates in the high DP group were significantly higher than those in the low DP group [28-day: 69.7% (23/33) vs. 86.8% (59/68), 90-day: 63.6% (21/33) vs. 83.8% (57/68), both P &lt;","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1249-1255"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Prevention and control status of central line-associated bloodstream infection in intensive care unit in Shandong province: a cross-sectional survey analysis].","authors":"Yang Shen, Zijian Tai, Xue Bai, Xuan Song, Man Chen, Qianqian Guo, Cheng Huan, Li Chen, Jicheng Zhang","doi":"10.3760/cma.j.cn121430-20240430-00397","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240430-00397","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To provide evidence for further reducing the incidence of central line-associated bloodstream infection (CLABSI) according to investigation of the prevention and control of CLABSI in intensive care unit (ICU) in Shandong Province.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The questionnaire was developed by experts from Shandong Critical Care Medical Quality Control Center, combining domestic and foreign guidelines, consensus and research. A convenient sampling method was used to recruit survey subjects online from October 11 to 31, 2023 in the province to investigate the management status of central venous catheter (CVC) in ICU units of secondary and above hospitals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 201 valid data were collected, involving 186 hospitals in the province, with a total of 201 ICU units, mainly comprehensive ICU (91%). The beds in ICU units were mainly single rooms (89%) and triple rooms (79%), and the ratio of doctors to total beds was 0.54 : 1. The training on the knowledge and operation of intravascular catheter-associated bloodstream infection in each ICU unit was mainly irregular (49%), and 96% of the catheter operators were authorized by the hospital. In terms of CVC selection, 89% of ICU units used dual-chamber CVC, and 86% of ICU units used catheters without antibiotic coating. When selecting the placement site, for conventional CVC catheterization, 65% preferred subclavian vein. Femoral vein was preferred in 87% of ICU units undergoing continuous renal replacement therapy. 95% of ICU units had established standardized operation procedure (SOP) for CVC placement. 86% of ICU units were capable of ultrasound positioning or guided puncture at the time of catheterization. During catheterization, 88% of ICU units met the sterile dress code. Before and after catheterzation, 81% and 77% of ICU units standardized hand hygiene. Only 31% of ICU units were covered from head to toe by aseptic wipes. For the choice of skin disinfectant, the majority of ICU units (72%) only used iodophor. After tube placement, 54% of ICU units chose sterile transparent dressing and 25% chose sterile gauze dressing. 98% of ICU units were sutured to secure the catheter. Regarding catheter replacement and removal, 45% of ICU units could not be removed or replaced within 2 days in emergency situations where the principle of sterility was not guaranteed. When CLABSI was suspected, 55% of ICU units were able to obtain the catheter tip, transcatheter blood culture, and contralateral peripheral vein blood culture at the same time. For CVC replacement frequency, most ICU units (75%) would not be replaced regularly, and some ICU units would be replaced regularly, but the frequency of replacement was different. For CLABSI prevention and control, 82% of ICU units developed a verification form or supervision form. When analyzing the sources of CLABSI data, most of them were filled in by themselves (60%). As for the frequency of data analy","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 12","pages":"1315-1320"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}