【摘要】 目的 探讨重型颅脑损伤的死亡原因。方法 对2002年1月—2010年1月收治的54例重型颅脑损伤死亡患者,其受伤原因、受伤至入科时间、损伤时间、临床表现、治疗情况等临床资料进行回顾性分析。结果 原发或继发性颅脑损伤严重、严重的合并伤和术后并发症是死亡的重要因素。结论 重型颅脑损伤患者死亡的原因是多方面的,对此类患者须采取综合救治措施,以降低其死亡率。
Objective To investigate the predictive value of extracorporeal membrane oxygenation (ECMO) pre-computer multiple scoring systems in the mortality of patients with cardiogenic shock. Methods A retrospective analysis was performed on 100 patients with cardiogenic shock due to various reasons who were treated with veno-arterial ECMO (VA-ECMO) from July 2020 to July 2022. The patients were followed up for 30 days and divided into a survival group (35 cases) and a death group (65 cases) according to whether they survived 30 days after withdrawal. General clinical data, blood biochemistry data within 24 hours before ECMO, ventilator parameters, past medical history and other data were collected, and sequential organ failure score (SOFA) before VA-ECMO, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), survival after veno-arterial ECMO (SAVE) score and modified SAVE score were calculated. Blood biochemical indicators and clinical scores related to patient prognosis were screened using two-independent sample t test or Man-Whitney U test. The predictive efficacy of each score on short-term prognosis (30-day post-discharge mortality) was evaluated by receiver operating characteristic curve and area under curve (AUC). Results There were significant differences in APACHEⅡ score, SAVE score and modified SAVE score between two groups (P<0.05). The AUC and its 95%CI of APACHEⅡ score was 0.696 (95%CI 0.592 - 0.801), of SAVE score was 0.617 (95%CI 0.498 - 0.736), and of post SAVE score was 0.664 (95%CI 0.545 - 0.782), respectively. All AUCs were relatively low (<0.75). Conclusion SOFA, APACHEⅡ, SAVE score and modified SAVE score have limited clinical value in the prognosis assessment of ECMO patients, and do not show obvious advantages.
【Abstract】ObjectiveTo compare the reliability of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and APACHE Ⅲ to estimate mortality of critical patients in abdominal surgery. MethodsTwo hundred and sixtyone critical patients in abdominal surgery were included in this study. The clinical data of the first day in ICU were collected and evaluated with both APACHE Ⅱand APACHE Ⅲ prognostic systems and statistical analysis were performed. Probability of survival (Ps) was compared with actual mortality. ResultsThe scores of APACHE Ⅱ and APACHE Ⅲ of death group were significantly higher than those of survival group respectively (P＜0.01). The actual mortality of patients whose Ps was no more than 0.5 was higher than that whose Ps was over 0.5 (P＜0.01). With two prognostic systems, the scores and mortality were the highest in pancreatitis patients and the lowest in patients with gastrointestinal malignant tumor. ConclusionAPACHE Ⅱ and APACHE Ⅲ prognostic systems can be effectively applied to the estimation of mortality of critical patients in abdominal surgery. For certain diagnostic categories, APACHE Ⅲ is better than APACHE Ⅱprognostic system.
Abstract: Objective To explore the inhospital mortalityrelated risk factors in the patients undergoing offpump coronary artery bypass grafting (OPCAB). Methods We retrospectively analyzed the clinical data of 215 patients undergoing OPCAB in our hospital from November 2007 to November 2008. There were 171 males and 44 females aged between 40 and 85 years old. Among them, there were 47 patients older than 70 years old. All of them were coronary artery disease (CAD) patients with triple vessel disease. We adopted univarialble analysis and logistic multivariable regression analysis to screen the risk factors for the mortality of OPCAB. Results Six patients died in hospital after OPCAB with a mortality rate of 2.79% (6/215). No renal dysfunction or respiratory failure occurred. The rate of reoperation for bleeding was 4.65% (10/215) and all the 10 patients having undergone reoperation were alive. A total of 209 patients were all alive after 1year follow-up. The results of logistic multivariable regression analysis showed that New York Heart Association (NYHA) Ⅲ and Ⅳ heart function (OR=42.116，95% CI 3.319 to 534.465，P=0.004) and mechanical ventilation duration (OR=1.007，95%CI 1.001 to 1.013，P=0.028) were independent risk factors for inhospital mortality of OPCAB. Conclusion OPCAB is an effective and safe treatment for CAD with triple vessel disease. NYHA Ⅲ and Ⅳ heart function and mechanical ventilation time after OPCAB are the risk factors for OPCAB inhospital mortality, yet, needs further study with large sample.
目的 探讨脑出血患者病死率与发病早期不同血压水平的关系。 方法 选择2006年2月－2012年6月在我院住院、符合入选标准及排除标准的患者120例, 经头颅CT证实为基底节区脑出血，血肿体积20～40 mL，收缩压＜200 mm Hg（1 mm Hg=0.133 kPa），舒张压＜110 mm Hg。 按照中国高血压分级标准（1级高血压：收缩压140～159 mm Hg或舒张压90～99 mm Hg；2级高血压：收缩压160～179 mm Hg或舒张压100～109 mm Hg；3级高血压：收缩压≥180 mm Hg或舒张压≥110 mm Hg）将患者分组，各组采用降颅内压、营养神经、维持水电解质平衡、对症治疗及康复治疗和康复护理等常规治疗，观察2周内各组病死率。 结果 1级高血压组与2级高血压组2周内病死率比较，差异无统计学意义（χ2=0.075，P=0.785）；1级高血压组与3级高血压组2周内病死率比较，差异有统计学意义（χ2=5.698，P=0.017）；2级高血压组与3级高血压组2周内病死率比较，差异有统计学意义（χ2=4.528，P=0.033）。 结论 对于早期血压较高的脑出血患者，进行积极的降压治疗，将血压控制在2级高血压水平，可以明显降低病死率。
ObjectiveTo investigate the associations of preoperative red cell distribution width (RDW) with mortality and morbidity in patients underwent liver transplantation. MethodsThis investigation was a retrospective study, the patients underwent liver transplantation met the inclusion criteria from June 2017 to May 2020 in the West China Hospital of Sichuan University were enrolled. The patients were divided into RDW≤14.5% group and RDW>14.5% group according to the normal RDW critical value (14.5%). The propensity score matching (PSM) was used to adjust the baseline characteristics. The primary outcome was 1-year mortality. The secondary outcomes included 1-year survival, 30-day mortality, incidence of early allograft dysfunction, acute kidney injury, renal replacement therapy, and pulmonary complications, as well as ICU stay and postoperative hospital stay. ResultsA total of 303 patients who met the analysis conditions were included. After PSM, 57 patients in each group were matched. There were no significant differences between the two groups in the baseline data such as the gender, age, body mass index (BMI), initial diagnosis, MELD score, Child-Pugh grade of the recipients, and the gender, age, and BMI of the donors (P>0.05). The 1-year [22.8% (13/57) versus 5.3% (3/57), χ2=7.27, P=0.007] and 30-day [15.8% (9/57) versus 3.5% (2/57), χ2=4.93, P=0.026] mortality of the patients with RDW >14.5% were higher than that of the patients with RDW ≤14.5% . The Kaplan-Meier survival curve showed that the 1-year survival of the patients with RDW ≤14.5% after liver transplantation was better than that of the patients with RDW >14.5% [hazard ratio=4.75, 95%CI (1.78, 12.67), P=0.007], but there were no significant differences between the two groups in the incidence of early graft dysfunction, acute renal injury, renal replacement therapy, and pulmonary complications, as well as postoperative hospital stay and ICU stay (P>0.05). ConclusionPreliminary results of this study indicate that preoperative RDW of patients underwent allogeneic liver transplantation is associated with1-year mortality, 30-day mortality, and 1-year survival.
ObjectiveTo analyze the effect of noninvasive positive pressure ventilation (NPPV) on the treatment of severe acute pancreatitis (SAP) combined with lung injury [acute lung injury (ALI)/acute respiratory distress syndrome (ARDS)] in emergency treatment. MethodsFifty-six patients with SAP combined with ALI/ARDS treated between January 2013 and March 2015 were included in our study. Twenty-eight patients who underwent NPPV were designated as the treatment group, while the other 28 patients who did not undergo NPPV were regarded as the control group. Then, we observed patients' blood gas indexes before and three days after treatment. The hospital stay and mortality rate of the two groups were also compared. ResultsBefore treatment, there were no significant differences between the two groups in terms of pH value and arterial partial pressure of oxygen (PaO2) (P>0.05). Three days after treatment, blood pH value of the treatment group and the control group was 7.41±0.07 and 7.34±0.04, respectively, with a significant difference (P＜0.05); the PaO2 value was respectively (60.60±5.11) and (48.40±3.57) mm Hg (1 mm Hg=0.133 kPa), also with a significant difference (P＜0.05). The hospital stay of the treatment group and the control group was (18.22±3.07) and (23.47±3.55) days with a significant difference (P＜0.05); and the six-month mortality was 17% and 32% in the two groups without any significant difference (P>0.05). ConclusionIt is effective to treat patients with severe acute pancreatitis combined with acute lung injury in emergency by noninvasive positive pressure ventilation.
ObjectiveTo assess the mortality, acute exacerbations, exercise capacity, symptoms and significant physiological parameters (lung function, respiratory muscle function and gas exchange) of patients with severe stable chronic obstructive pulmonary disease (COPD) with respiratory failure treated by noninvasive positive pressure ventilation (NPPV).MethodsA meta-analysis of randomized controlled trials was carried out by searching PubMed, Cochrane library, Embase, OVID, Chinese Biomedical Literature Database and the bibliographies of the retrieved articles up to February 2017. Studies of patients with severe stable COPD with respiratory failure receiving long-term noninvasive positive pressure ventilation and comparison with oxygen therapy were conducted, and at least one of the following parameters were reviewed: frequency of acute exacerbations, mortality, lung function, respiratory muscle function, gas exchange, 6-minute walk test.ResultsSix studies with 695 subjects met the inclusion criteria and were analyzed. The PaCO2 was significantly decreased in patients who received long-term NPPV. No significant difference was found between long-term NPPV and oxygen therapy in mortality, frequency of acute exacerbations, gas exchange, lung function, respiratory muscle function and exercise capacity. The subgroup analysis showed that NPPV improves survival of patients when it is targeted at greatly reducing hypercapnia.ConclusionCurrent evidence suggests that there is no significant improvement by application of NPPV on severe stable COPD with respiratory failure patients, but NPPV may reduce patients’ mortality with the aim of reducing hypercapnia.
ObjectiveTo summarize our clinical experience of surgical treatment for 51 patients with Stanford type A aortic dissection (AD). MethodsClinical data of 51 patients with Stanford type A AD who received surgical treatment in Shanghai Yuanda Heart Hospital between February 2009 and January 2013 were retrospectively analyzed. There were 29 males and 22 females with their age of 35-63 (47.2±11.1)years. The diagnosis of all the patients was confirmed by enhanced CT scan and Doppler echocardiography. Surgical procedures included Bentall procedure and Sun's procedure in 29 patients, Bentall procedure, mitral valve replacement and Sun's procedure in 2 patients, ascending aorta replacement and Sun's procedure in 17 patients, valsalva sinus plasty, ascending aorta replacement and Sun's procedure in 2 patients, ascending aorta replacement (stage 1), Sun's procedure (stage 2)and endovascular exclusion of the thoracic aorta (stage 3)in 1 patient. ResultsMean operation time was 320.6±77.3 minutes, cardiopulmonary bypass time was 190.4±63.4 minutes, aortic cross-clamp time was 123.2±45.1 minutes, duration of circulatory arrest with hypothermia was 28.2±11.1 minutes, and mean length of hospital stay was 13.4±4.2 days. Two patients (3.9%)died perioperatively including 1 patient with intraoperative bleeding and another patient with delayed bleeding after operation. Postoperative complications included bleeding, paraplegia, perivalvular leak and sternal dehiscence in 1 patient respectively, and endoleak in 2 patients. Forty-nine patients were followed up for 3-48 (25.3±10.5)months and no late death occurred. ConclusionSurgical treatment is effective for patients with Stanford type A AD.