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find Keyword "脓毒症" 127 results
  • 早期乳酸清除率对重症感染患者预后的评估研究

    目的 分析早期乳酸清除率对重症感染患者预后的临床评估价值。方法 选取2009 年1 月至2011 年12 月收治的248 例重症感染患者为研究对象进行回顾性分析。根据患者转归分为生存组和死亡组, 比较两组一般资料、APACHEⅡ 评分、脓毒症休克发生率、初始血乳酸浓度和治疗 6 h的乳酸清除率差异。根据乳酸清除率水平分为高乳酸清除率组和低乳酸清除率组, 比较两组一般资料、APACHEⅡ评分、脓毒症休克发生率、初始血乳酸浓度和病死率的差异。结果 生存组和死亡组患者的一般资料、APACHEⅡ评分、初始血乳酸浓度间的差异均无统计学意义( P gt;0. 05) 。生存组乳酸清除率明显高于死亡组[ ( 32. 6 ±11. 3) % 比( 15. 2 ±10. 1) % , P = 0. 024] , 而脓毒症休克发生率明显低于死亡组( 30. 9% 比87. 5% , P = 0. 019) 。高乳酸清除率组的脓毒症休克发生率( 34. 6% 比 53. 7%) 及死亡率( 25. 5% 比61. 1% ) 明显低于低乳酸清除率组( P 均lt;0. 05) 。结论 早期乳酸清除率可用于早期评估重度感染患者的预后转归。

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  • 脓毒症休克患者免疫细胞变化与疾病演变及预后关系的研究

    目的 评价脓毒症休克患者外周血中性粒细胞、单核细胞、淋巴细胞计数与多器官功能衰竭及预后的关系。方法 记录患者被诊断为脓毒症休克后第1、3、5、7 d 中性粒细胞、单核细胞、淋巴细胞的变化, 同时进行脓毒症相关性器官衰竭评分( SOFA) 。根据院内预后分为存活组和死亡组。结果 100 例持续存在7 d 以上脓毒症休克的患者中, 50 例存活,50 例死亡。死亡组单核细胞计数、SOFA 评分在第5、7 d 明显升高, 并显著高于存活组的对应值( P lt;0. 05) 。死亡组淋巴细胞计数在第5、7 d 明显降低, 并低于存活组的对应值( P lt;0. 05) 。两组外周血中性粒细胞计数均未发生明显变化( P gt;0. 05) 。结论 脓毒症休克时, 单核细胞凋亡可能是机体的保护机制, 而淋巴细胞计数呈下降趋势预示患者预后不良。将SOFA 评分与淋巴细胞计数的变化相结合观察脓毒症休克的病情, 对患者的治疗及预后的评价有指导意义。

    Release date:2016-08-30 11:53 Export PDF Favorites Scan
  • Effects of Total Saponins of Panax Notoginseseng Injection on CoagulationFunction in Sepsis

    Objective To study the effects of total saponins of panax notoginseseng injection on the coagulation function in sepsis. Methods 50 sepsis patients with normal coagulation function were randomly divided into two groups. 25 patients in the control group received the routine treatment and the other 25 patients in the treatment group received total saponins of panax notoginseseng injection additionally. The levels of Plt, PT, TT, APTT, FIB and D-D were measured before the therapy and on 1st, 3rd and 7th day after the therapy. Results The levels of Plt, PT, TT, APTT, FIB and D-D before the therapy had no significant differences between the two groups ( P gt; 0. 05) . The levels of Plt and FIB had significant differences between the two groups on 7th day after therapy ( P lt;0. 01, P lt; 0. 05) . PT, TT, and APTT were prolonged in the controlled group gradually, butwere not prolonged or even shortened in the treatment group,which were significantly shorter in the treatment group on 7th day after therapy ( P lt; 0. 05) . D-D slightly elevated in the control group, but slightly elevated at first and dropped gradually in the treatment group, which was significantly lower in the treatment group on7th day after therapy. Conclusion Total saponins of panax notoginseseng injection has a protective effect on coagulation function in sepsis.

    Release date:2016-08-30 11:53 Export PDF Favorites Scan
  • Prediction of mortality in sepsis patients using simplified acute physiology score Ⅱ score combined with lactate clearance rates at different moments

    Objective To explore the predictive value of simplified acute physiological score Ⅱ (SAPS-Ⅱ) combined with lactate clearance rates (LCR) at different moments for mortality in sepsis patients. Methods A total of 188 patients with sepsis admitted in the hospital from April 2020 to February 2023 were selected, who were evaluated using the SAPS-Ⅱ scale. Spectrophotometry was used to detect blood lactate at baseline, after 6h, 12h, 24h, and 48h, then the LCR after 6h, 12h, 24h, and 48h were calculated. The patients were divided into a survival group (n=139) and a death group (n=37) based on 28 day outcome. Logistic regression analysis was used to explore the risk factors of sepsis death, and the efficacy of SAPS-Ⅱ scores combined with LCR at different moments in predicting patient death was analyzed using receiver operating characteristic (ROC) curve. Results Twelve patients fell off, and 37 died in the remaining 176 patients, the mortality rate was 21.02%. The age, temperature, random blood glucose, blood urea nitrogen, serum creatinine, and SAPS- Ⅱ scores in the death group were significantly higher than those in the survival group (P<0.05), while platelet count and LCR at all moments were significantly lower than those in the survival group (P<0.05). The LCR of the death group continued to decrease with time. The trend of changes in the survival group were opposite, and the differences in the two groups between each two moments were statistically significant (P<0.05). The SAPS-Ⅱ scores and LCR at all moments were risk factors for patient death (P<0.05). The SAPS-Ⅱ score and LCR at all moments had predictive value for patient death, and the area under ROC curve of the combined prediction was 0.921 (95%CI 0.825 - 1.000), which was higher than the individual prediction and LCR at each moment combined with SAPS II score prediction (P<0.05). Conclusion The SAPS-Ⅱ scores and LCR at different moments are all related to death of sepsis patients, and the combined prediction of death by the above indicators is highly effective.

    Release date:2023-12-07 04:39 Export PDF Favorites Scan
  • 炎性体复合物及其与脓毒症的关系研究进展

    自2002 年Martinon 等[ 1 ] 发现炎性体复合物( inflammasome) 以来, 人们对它们的结构和功能及其诱导机制的认识在不断完善。炎性体复合物通过控制半胱天冬氨酸酶1( caspase-1) 的活化进而调节着机体的炎症反应, 并在抗感染过程中发挥着积极的保护作用。脓毒症是感染引起的全身炎症反应,炎性体复合物可能参与了脓毒症炎症反应的启动和抗感染过程。研究发现炎性体复合物与脓毒症患者的生存率及病情严重程度密切相关, 炎性体复合物及caspase-1 的表达和活化受抑可能是造成脓毒症患者免疫麻痹的原因之一[ 2 , 3] , 这将为脓毒症的早期诊断和干预提供新的思路。现将炎性体复合物在启动炎症反应和抗感染方面的作用, 特别是与脓毒症的关系综述如下。

    Release date:2016-08-30 11:56 Export PDF Favorites Scan
  • Clinical Analysis of Xuebijing Injection in Treating Severe Burn Patients with Sepsis during Shock Stage

    目的:探讨应用血必净注射液对严重烧伤患者休克期并发脓毒症的治疗效果。方法:依据脓毒症感染诊断标准,对44例严重烧伤患者休克期并发脓毒症的患者,随机分为2组,对照组22例给予常规治疗,治疗组22例,加用血必净注射液,疗程7日。分别观察2组患者治疗前后体温(T)、心率(HR)、白细胞计数(WBC)、中性粒细胞率、血小板记数(PLT)及病死率。结果:血必净注射液治疗后,治疗组的HR、WBC、PLT与对照组比较有显曹改善(Plt;005);病死率较对照组显著降低(Plt;001)。结论:烧伤后早期应用血必净注射液是防治休克期烧伤脓毒症的重要措施,对烧伤脓毒症起到早期保护组织、防治MODS的作用。

    Release date:2016-09-08 09:56 Export PDF Favorites Scan
  • Evaluation of anticoagulant effect of nafamostat mesilate in continuous renal replacement therapy with oXiris filter for sepsis-related acute kidney injury

    Objective To evaluate the efficacy and safety of nafamostat mesylate as an in vitro anticoagulant in continuous renal replacement therapy (CRRT) using oXiris filters for patients with sepsis-associated acute kidney injury (SA-AKI). Methods SA-AKI patients at high risk of bleeding who received oXiris filter-CRRT at West China Hospital of Sichuan University between November 2021 and January 2023 were included in the study. Patients who received nafamostat mesylate as an anticoagulant were categorized into the nafamostat group, while patients who did not receive any anticoagulant during the same period were categorized into the control group. A comparative analysis was conducted between the two groups regarding general conditions, the lifespan of the first filter in CRRT, the number and percentage of cases with the first filter lasting 24, 48, and 72 h, activated clotting time (ACT) before and during treatment (both pre-filter and post-filter), laboratory test results before and after treatment, incidence of adverse reactions during treatment, and clinical outcomes of the patients. The mean ± standard deviation was used for normal distribution, and the median (lower quartile, upper quartile) was used for non-normal distribution. Results A total of 118 patients were included in the study, with 90 in the control group and 28 in the nafamostat group. There was no statistically significant difference in the general conditions or pre-treatment laboratory test indicators between the two groups (P>0.05). Kaplan-Meier survival analysis showed that the lifespan of the first filter was longer in the nafamostat group compared to the control group (hazard ratio=0.524, P=0.001). The percentage of patients whose first filter lasted 24 h was higher in the nafamostat group than that in the control group (60.7% vs. 25.7%, P=0.001); however, there was no statistically significant difference between the two groups for the first filter lasting 48 h or 72 h (P>0.05). During CRRT treatment, the mean post-filter ACT was longer in the nafamostat group than that in the control group [(216.7±43.2) vs. (181.6±35.5) s, P<0.001], and the mean post-filter ACT was longer than the pre-filter ACT in the nafamostat group [(216.7±43.2) vs. (183.3±37.7) s, P=0.005]. After the treatment, the international normalized ratio [1.5 (1.1, 1.8) vs. 1.7 (1.4, 2.4)], interleukin-6 levels [(235.5±80.9) vs. (500.5±112.7) pg/mL] were lower, and platelet count [48.0 (31.8, 73.0)×109/L vs. 29.0 (11.0, 61.8)×109/L] was higher in the nafamostat group compared to the control group (P<0.05). There was no statistically significant difference in other laboratory test indicators (P>0.05). The clinical outcomes of the patients did not show statistically significant difference between the two groups (P>0.05). Conclusion Nafamostat mesilate may be an effective and safe anticoagulant in SA-AKI patients at high risk of bleeding underwent oXiris filter-CRRT, and its in vitro anticoagulant effect is better than that without anticoagulant.

    Release date:2024-08-21 02:11 Export PDF Favorites Scan
  • 降钙素原与创伤的研究进展

    创伤是导致炎症反应的重要因素之一,炎症反应和感染是创伤后常见的病理生理过程,而由此所致的脓毒症或脓毒症休克是创伤后患者死亡的重要原因。感染的早期诊治与预后密切相关。临床上许多感染监测指标如体温、C反应蛋白、白细胞计数、白细胞介素6和肿瘤坏死因子α等诊断感染缺乏特异性,而血培养阳性率低、耗时长且较难区分细菌定植或感染,在临床应用受到很大的限制,使得临床医师对于创伤后感染的诊断更加困难。近年来降钙素原(PCT)是被认为是诊断细菌感染有效的生物学指标。诸多研究认为PCT可以作为诊断创伤后并发症的工具,其水平的高低与创伤的严重程度及预后相关。现就PCT与创伤的研究进展进行综述。

    Release date:2016-09-08 09:14 Export PDF Favorites Scan
  • Influence of Continuous Blood Purification on Severe Sepsis and CD4 + CD25 + Regulatory T Cells

    Objective To investigate the efficacy of continuous blood purification ( CBP) in the treatment of severe sepsis, and explore the related immune regulatory mechanisms. Methods Forty-eight patients with severe sepsis were randomly divided into a control group ( n =23) and a CBP group ( n =25) .CD4 + CD25 + regulatory T cells ( Treg% ) in peripheral blood and APACHEⅡ score were measured dynamically before treatment and 12, 24, 36, 48, 60, 72 hours after treatment. Meanwhile the length of ICUstay, duration of mechanical ventilation, and 28 day mortality were determined. Results Compared with the control group, the length of ICU stay, ventilator time, incidence of multiple organ failure, and mortality decreased significantly in the CBP group ( P lt; 0. 05) . And CBP also decreased Treg% and APACHEⅡ score significantly. There was a positive correlation between Treg% and APACHEⅡ score ( r =0. 804, P lt;0. 01) .Conclusion Early CBP treatment can reduce Treg%, improve cellular immunity and improve the prognosis of sepsis.

    Release date:2016-09-13 04:07 Export PDF Favorites Scan
  • Efficacy of Fish Oil Containing Lipid Emulsion in Sepsis: A Meta-Analysis

    ObjectiveTo evaluate the clinical efficacy of fish oil containing lipid emulsion (FO) in sepsis. MethodsRandomized controlled trials about fish oil containing lipid emulsion in sepsis,which were published from 1980,were searched from the following electronic databases:PubMed,Embase,Foreign Medical Journal Service,Cochrane Library,CNKI,Wanfang Database,and VIP Database. The articles screening,quality assessment and data extraction were conducted by two reviewers independently. The methodological quality of trials was assessed by Jadad's scale. All data was analyzed by Review Manager 5.2 software. ResultsFifteen studies involving 794 participants met the inclusion criteria. The meta-analysis results were as follows:compared with the control group,①FO could shorten the length of ICU stay[WMD=-5.59,95%CI(-7.65,-3.53)] and the length of hospital stay[WMD=-10.48,95%CI(-14.67,-6.29)],and also decrease the 28-day mortality[RR=0.69,95%CI(0.52,0.93)]. ②FO could reduce the concentration of TNF-α[WMD=31.78,95%CI(5.63,57.92)] and improve oxygenation index[WMD=41.95,95%CI(30.80,53.11)] in septic patients. ③There was no statistical significance in the decrease of C-reactive protein (CRP) between two groups(P>0.05). ConclusionThe administration of FO in septic patients can significantly shorten the length of ICU stay and hospital stay,decrease the 28-day mortality,reduce the concentration of TNF-α and improve oxygenation index. However,it shows no significant difference in the decrease of CRP compared with the administration of traditional lipid emulsion. All of the above results show that the septic patients can benefit from the administration of fish oil containing lipid emulsion.

    Release date:2016-08-30 11:31 Export PDF Favorites Scan
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