目的 研究高血压脑出血患者开始建立肠内营养的时间，以揭示其建立肠内营养的最佳时机。 方法 选取2010年7月－2011年9月收治的高血压脑出血患者69例，随机将其分为A、B、C组，A组23例在血流动力学稳定后24 h内采取鼻胃管方式开始建立肠内营养；B组23例在24～48 h内开始肠内营养支持；C组23例在48～72 h开始肠内营养支持，并分别于营养支持前1 d及营养支持后的14 d检测三组患者三头肌皮皱厚度、上臂肌围、血清白蛋白、血红蛋白水平等相关营养指标的波动情况；监测第3、14天各组患者腹泻、便秘、应激性溃疡、肺部感染等临床并发症的发生情况。 结果 相关营养指标监测结果研究发现：建立肠内营养支持14 d后，三组患者其三头肌皮皱厚度及上臂肌围在营养支持前后差异无统计学意义（P＞0.05）；A、B组患者其血清白蛋白及血红蛋白水平在营养支持后较前有增高表现，差异有统计学意义（P＜0.05），且B组患者其血清白蛋白及血红蛋白水平增高程度较A组更为显著；C组患者其血清白蛋白水平在营养支持后有增高表现，且差异有统计学意义（P＜0.05），但血红蛋白水平较前比较差异无统计学意义（P＞0.05）。相关临床并发症发生率的研究结果如下：给予肠内营养支持3 d后，A、C组患者分别与其余两组比较发现，其腹泻、胃潴留、应激性溃疡、肺部感染发生率较其余两组比较差异无统计学意义（P＞0.05）；B组患者与其余两组比较，其应激性溃疡发生率较其余两组减低，且差异有统计学意义（P＜0.05）；腹泻、胃潴留、肺部感染较其余两组比较无显著差异；但随着观察时间的不断延长，在肠内营养支持后的14 d，A组患者较其余两组比较，其腹泻、胃潴留、应激性溃疡发生率仍无显著差异，但其肺部感染的发生率较B组增高，而较C组减低，且差异有统计学意义（P＜0.05）；B组患者较其余两组比较，其腹泻、应激性溃疡、肺部感染的发生率较其余两组均减低，且差异有统计学意义（P＜0.05），并且其肺部感染发生率减低程度较A组明显，其胃潴留发生率与其余两组比较时差异无统计学意义（P＞0.05）；C组患者与其余两组比较，其应激性溃疡、肺部感染个例发生率较其余两组增高，但差异无统计学意义（P＞0.05）。 结论 高血压脑出血患者于血流动力学稳定后的24～48 h内给予建立肠内营养支持，可利于患者相关营养指标的恢复，减少相关临床并发症的发生，可能会在一定程度益于患者的预后。
【摘要】 目的 〖JP2〗研究质子泵抑制剂（PPI）是否为危重患者发生医院获得性肺炎的危险因素。 方法 收集2002年6月-2009年6月收治的198例重症患者资料，分为使用PPI组（96例）和未使用PPI组（102例）。采用logistic回归分析PPI使用情况和医院获得性肺炎的关系。 结果 使用PPI组肺炎的发生率较高（26.9%），尤其是PPI使用时间超过7 d者（37.5%）。在不同的多变量logistic回归模型中，分别用APACHE Ⅱ评分和入住重症监护室原因校正后，使用PPI以及使用天数均是医院获得性肺炎发生的危险因素（P=0.031，OR＝2.230，95%CI：1.957~2.947；P=0.002，OR＝1.824，95%CI：1.457~2.242）。 结论 长时间应用PPI可能是增加ICU患者发生医院获得性肺炎的一种风险因素。【Abstract】 Objective To identify whether proton pump inhibitors (PPI) is a risk factor of hospital-acquired pneumonia (HAP) in critical patients. Methods The clinical data of the critical patients admitted to ICU from June 2002 to June 2009 were retrospectively analyzed. A total of 198 patients were divided into two groups: 96 in PPI group and 102 in non-PPI group. The relationship between PPI and HAP was analyzed by logistic regression. Results The patients in PPI group had a higher risk of HAP (26.9%), especially who were treated with PPI more than 7 days (37.5%). Adjusted by APACHE Ⅱ score and reason for admission to ICU, PPI therapy and the using duration of PPI were both the risk factors of HAP in different multiple logistic models (P=0.031, OR=2.230, 95%CI: 1.957-2.947; P=0.002, OR=1.824, 95%CI: 1.457-2.242). Conclusion Long-term use of PPI is a risk factor of HAP.
ObjectiveTo investigate the clinical characteristics and contribution factors in severe coronavirus disease 2019 (COVID-19).MethodsThe clinical symptoms, laboratory findings, radiologic data, treatment strategies, and outcomes of 110 COVID-19 patients were retrospectively analyzed in these hospitals from Jan 20, 2020 to Feb 28, 2020. All patients were confirmed by fluorescence reverse transcription polymerase chain reaction. They were classified into a non-severe group and a severe group based on their symptoms, laboratory and radiologic findings. All patients were given antivirus, oxygen therapy, and support treatments. The severe patients received high-flow oxygen therapy, non-invasive mechanical ventilation, invasive mechanical ventilation or extracorporeal membrane oxygenation. The outcomes of patients were followed up until March 15, 2020. Contribution factors of severe patients were summarized from these clinical data.ResultsThe median age was 50 years old, including 66 males (60.0%) and 44 females (40.0%). Among them, 45 cases (40.9%) had underlying diseases, and 108 cases (98.2%) had different degrees of fever. The common clinical manifestations were cough (80.0%, 88/110), expectoration (33.6%, 37/110), fatigue (50.0%, 55/110), and chest tightness (41.8%, 46/110). Based on classification criteria, 78 (70.9%) non-severe patients and 32 (29.1%) severe patients were identified. Significant difference of the following parameters was found between two groups (P<0.05): age was 47 (45, 50) years vs. 55 (50, 59) years (Z=–2.493); proportion of patients with underlying diseases was 27 (34.6%) vs. 18 (56.3%) (χ2=4.393); lymphocyte count was 1.2 (0.9, 1.5)×109/L vs. 0.6 (0.4, 0.7)×109/L (Z=–7.26); C reactive protein (CRP) was 16.2 (6.5, 24.0) mg/L vs. 45.3 (21.8, 69.4) mg/L (Z=–4.894); prothrombin time (PT) was 15 (12, 19) seconds vs. 18 (17, 19) seconds (Z=–2.532); D-dimer was 0.67 (0.51, 0.82) mg/L vs. 0.98 (0.80, 1.57) mg/L (Z=–5.06); erythrocyte sedimentation rate (ESR) was 38.0 (20.8, 59.3) mm/1 h vs. 75.5 (39.8, 96.8) mm/1 h (Z=–3.851); lactate dehydrogenase (LDH) was 218.0 (175.0, 252.3) U/L vs. 325.0 (276.5, 413.5) U/L (Z=–5.539); neutrophil count was 3.1 (2.1, 4.5)×109/L vs. 5.5 (3.7, 9.1)×109/L (Z=–4.077). Multivariable logistic analysis showed that there was positive correlation in elevated LDH, CRP, PT, and neutrophil count with the severity of the disease. Currently, 107 patients were discharged and 3 patients died. Total mortality was 2.7%.ConclusionsOld age, underlying diseases, low lymphocyte count, elevated CPR, high D-dimer and ESR are relevant to the severity of COVID-19. LDH, CPR, PT and neutrophil count are independent risk factors for the prognosis of COVID-19.
【摘要】 目的 探讨甲型H1N1流感重症与危重症的护理干预。 方法 回顾分析2009年10月-2010年2月收治的20例甲型H1N1流感重症与危重症患者的治疗方案及其护理干预措施。 结果 16例治愈出院， 4例死亡。其中7例需要呼吸机辅助通气。 结论 甲型H1N1流感重症与危重症需要综合治疗，同时，有效的护理干预也是提高甲型H1N1流感危重症患者治愈率和降低死亡率的关键。【Abstract】 Objective To evaluate the nursing intervention for patients with severe influenza A (H1N1). Methods The clinical data of 20 patients with severe influenza A (H1N1) from October 2009 to February 2010 were retrospectively analyzed. Results In 20 patients, 16 were cured and four died. A total of seven patients needed ventilation assisted with ventilators. ConclusionsThe patients with severe influenza A (H1N1) needs combined modality therapy. At the same time, active and effective nursing intervention is the key point of increasing the recovery rate and decreasing the mortality rate.
【摘要】 目的 探讨甲型H1N1流感危重症患者的抢救疗效。 方法 2009年10月－2010年1月，对我院ICU收治5例甲型H1N1流感危重症患者采用集束化治疗方案进行救治，并就患者的器官功能变化进行评价。 结果 5例患者平均住院天数为（11.8±5.59）d，4 例存活，1例死亡。存活患者在治疗过程中急性生理和既往健康 （APACHE）Ⅱ、多器官功能障碍综合征评分（MODS）、全身性感染相关的器官衰竭评分 （SOFA）总体呈逐渐下降趋势。死亡者APACHEⅡ、SOFA评分均呈逐渐升高趋势。 结论 对甲型H1N1流感危重症患者采取集束化救治疗效良好。【Abstract】 Objective To explore the effect of bundle therapy on severe patients with influenza A (H1N1). Methods Bundle therapy were used in 5 severe patients with influenza A from October 2009 to January 2010. The patients’ organ dysfunction were observed for. Results The average in-hospital duration was (11.80±5.59) days. Four patients survived and one died with the survival ratio of 80%. Acute physiology and chronic health evaluation (APACHE) II score, Multiple organ dysfunction syndrome (MODS) score and sepsis-related organ failure assessment (SOFA) score gradually decreased in 4 survived patients, while gradually increased in the died patient. Conclusion Bundle therapy is effective on patients with severe influenza A.
Objective To evaluate the effect of exogenous melatonin and its analogues on the prevention of delirium in critically ill patients by meta-analysis. Methods Randomized controlled trials of exogenous melatonin and its analogues in the prevention of delirium in critically ill patients were searched by computer from the Cochrane Library, PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Chongqing VIP, Wanfang, and SinoMed databases. The trial group was treated with melatonin or its analogues, while the control group was treated with placebo. The retrieval period was from the establishment of database to January 14th, 2021. Two researchers independently evaluated the literature quality, and meta-analysis was performed using RevMan 5.4 software. Results A total of 11 randomized controlled trials containing 1177 patients were enrolled, including 588 patients in the trial group and 589 patients in the control group. The results showed that exogenous melatonin and its analogues could reduce the occurrence of delirium in critically ill patients [odds ratio (OR)=0.45, 95% confidence interval (CI) (0.22, 0.91), P=0.03] and shorten the time of mechanical ventilation [standard mean difference (SMD)=−0.49, 95%CI (−0.94, −0.03), P=0.04], while might not affect the mortality rate [OR=0.73, 95%CI (0.46, 1.17), P=0.19] or length of intensive care unit stay [SMD=−0.05, 95%CI (−0.26, 0.15), P=0.61]. Conclusions The current evidence shows that exogenous melatonin and its analogues have some effect on reducing the occurrence of delirium and shortening the duration of mechanical ventilation in critically ill patients, and have no significant effect on reducing the mortality or length of intensive care unit stay. The above conclusions need to be confirmed by more high-quality studies.
Objective To explore the diagnosis and treatment of critically ill patients suffering from obstructive sleep apnea-hypopnea syndrome ( OSAHS) . Methods Critically ill patients with OSAHS admitted in intensive care unit from January 2003 to December 2007 were retrospectively analyzed. Results Seventy-nine critically ill patients were diagnosed as OSAHS. The initial diagnosis of OSAHS was made by history requiring, physical examination, and Epworth sleepiness score evaluation. The final diagnosis was comfirmed by polysomnography thereafter. Base on the treatment of primary critical diseases, the patients were given respiratory support either with continuous positive airway pressure ( CPAP) or with bi-level positive airway pressure ventilation ( BiPAP) . Two cases died and the remaining 77 patients were cured anddischarged. Conclusions Timely diagnosis of OSAHS is important to rescue the critically ill patients. Respiratory support combined with treatment of primary critical diseases can improve the outcomes of these patients.