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find Keyword "重症监护室" 21 results
  • 重症监护室院内获得性血流感染123例临床分析

    目的了解重症监护室院内获得性血流感染(NBSI)的临床特点、病原菌分布及耐药性。 方法参照卫生部医院感染诊断标准,对复旦大学附属金山医院重症监护室2012年11月至2014年11月所有血培养阳性的患者病史进行回顾性调查研究,并对患者临床和病原学特征进行总结分析。 结果入选患者123例。基础疾病以肺部感染最多,共60例,占48.8%。机械通气者最多,共77例,占62.6%,其次为气管插管43例(35.0%)和留置深静脉导管38例(30.8%)。共发生NBSI 247例次,包括革兰阳性菌152株(61.5%),革兰阴性菌79株(32.0%),念珠菌16株(6.5%)。最常见的病原菌为表皮葡萄球菌80株(32.3%)、肺炎克雷伯菌33株(13.3%)。多数病原菌具有耐药性,革兰阳性菌仅对利奈唑胺无耐药率。 结论重症监护室NBSI的发生率较高,其致病菌以革兰阳性菌为主,大多具有耐药性,肺部感染最为常见,机械通气患者更易并发NBSI。加强深静脉导管的监控与管理有利于减少NBSI的发生。

    Release date:2016-10-21 01:38 Export PDF Favorites Scan
  • Predictive value of admission serum phosphate levels on short-term mortality in severe pneumonia patients admitted to ICU/RICU

    Objective To verify the association between admission serum phosphate level and short-term (<30 days) mortality of severe pneumonia patients admitted to intensive care unit (ICU) / respiratory intensive care unit (RICU). Methods Severe pneumonia patients admitted to the ICU/RICU of Quanzhou First Hospital Affiliated to Fujian Medical University from November 2019 to September 2021 were included in the study. Serum phosphate was demonstrated as an independent risk factor for short-term mortality of severe pneumonia patients admitted to ICU/RICU by logical analysis and receiver operator characteristic (ROC) curve. The patients were further categorized by serum phosphate concentration to explore the relationship between serum phosphate level and short-term mortality. Results Comparison of baseline indicators at admission between the survival group (n=54) and the non survival group (n=46) revealed that there was significant difference in serum phosphate level [0.9 (0.8, 1.2) mmol/L vs. 1.2 (0.9, 1.5) mmol/L, P<0.05]. Logical analysis showed serum phosphate was an independent risk factor for short-term mortality. ROC curve showed that the prediction ability of serum phosphate was close to pneumonia severity index (PSI). After combining serum phosphate with PSI score, CURB65 score, and sequential organ failure score, the predictive ability of these scores for short-term mortality was improved. Compared with the normophosphatemia group, hyperphosphatemia was found be with significantly higher short-term mortality (85.7% vs. 47.3%, P<0.05), which is absent in hypophosphatemia (25.8%). Conclusions Serum phosphate at admission has a good predictive value on short-term mortality in severe pneumonia patients admitted to the ICU/RICU. Hyperphosphatemia at admission is associated with a higher risk of short-term death.

    Release date:2023-10-18 09:49 Export PDF Favorites Scan
  • Meta-analysis of the morbidity of acquired swallowing disorders in intensive care unit patients

    ObjevtiveThe morbidity of intensive care unit-acquired swallowing disorder (ICU-ASD) was clarified through meta-analysis by synthesizing previous evidence, in order to provide an evidence-based basis for early identification and intervention of ICU-ASD. Methods A computerized search of PubMed, Embase, Web of Science, The Cochrane Library, CHINAL, China Knowledge Network, Wanfang Data Knowledge Service Platform, and Chinese Science and Technology Journal Database was conducted to retrieve the relevant literature on the morbidity of ICU-ASD published in China and abroad from the database establiment to December 2022. Considering the quality of the included literature, the Chinese database excluded master's theses and non-core journals. Meta-analysis of morbidity was performed using Stata 12.0. Results A total of 19 papers, including 4291 patients, were included. Meta-analysis showed that the overall morbidity of ICU-ASD was 36% [95% confidential interval (CI) 26% - 46%; I2=97.62%, P<0.01]. Subgroup analyses showed that the morbidity of ICU-ASD in Asian, European, South American, and North American was 39% (95%CI 28% - 50%), 23% (95%CI 8% - 44%), 52% (95%CI 46% - 57%), and 39% (95%CI 20% - 61%), respectively; and that the morbidity of male and female ICU-ASD was 36% (95%CI 24% - 48%) and 33% (95%CI 22% - 45%), respectively; the morbidity of ICU-ASD was 41% (95%CI 30% - 52%) and 31% (95%CI 18% - 44%) in the patients with and without hypertension, respectively; the morbidity of ICU-ASD was 58% (95%CI 42% - 73%) and 51% (95%CI 36% - 66%) in the patients with and without respiratory disease respectively; the morbidity of ICU-ASD in the patients with and without diabetes mellitus was 37% (95%CI 24% - 51%) and 39% (95%CI 28% - 51%), respectively; the morbidity of ICU-ASD in the patients with and without renal disease was 40% (95%CI 23% - 59%) and 35% (95%CI 24% - 46%), respectively; the morbidity of ICU-ASD in the patients with intubation caliber ≤7.5 mm and >7.5 mm was 31% (95%CI 19% - 45%) and 37% (95%CI 22% - 54%), respectively; the morbidity of ICU-ASD in the patients with and without heart failure was 58% (95%CI 30% - 84%) and 36% (95%CI 23% - 51%), respectively; and the morbidity of ICU-ASD in patients with and without arrhythmia was 36% (95%CI 11% - 65%) and 31% (95%CI 21% - 42%), respectively; the morbidity of ICU-ASD in the patients with and without neurologic disease was 48% (95%CI 24% - 72%) and 34% (95%CI 15% - 57%), respectively. Begg's test P<0.05, Egger's test P<0.05, suggesting publication bias in the study, and the cut-and-patch method corrected for an overall incidence result of 27% (95%CI 18% - 36%). Conclusions Meta-analysis reveals an overall morbidity of 36% for ICU-ASD and 27% for the cut-and-patch correction. Subgroup analysis reveals that the morbidity of ICU-ASD is significantly higher in patients with hypertension, heart failure, and neurological disorders than in patients without these disorders. Current evidence suggests that the prevalence of ICU-ASD is high and needs to be taken seriously. Timely screening and assessment of swallowing disorders is recommended for intensive care unit patients, especially those with hypertension, heart failure, and neurological disorders.

    Release date:2023-10-18 09:49 Export PDF Favorites Scan
  • Changes of disease spectrum and main therapeutic interventions in respiratory intensive care unit

    ObjectiveTo analyze the trend of disease spectrum and main diagnosis and therapeutic technologies in respiratory intensive care unit (RICU) in recent years, and find out the trend of change of patient’s characteristics and commonly used interventions in order to provide evidence for planning discipline development and improving personnel training program.MethodsPatients information and main diagnosis and therapeutic technologies of 1503 inpatients in RICU of Shenzhen People's Hospital from January, 2017 to December, 2020 were collected. The changes of disease spectrum and diagnosis and treatment technologies in different years were compared and analyzed.ResultsAmong all the patients, 66.3% were directly admitted into RICU, 12.1% were transferred from respiratory department, and 21.6% were transferred from other departments. The proportion of patients with non-respiratory diseases as principal diagnosis had an increasing trend, from 18.8% in 2017 to 37.3% in 2020 (P<0.05). The diseases with most obvious increasing trend were sepsis, nervous system diseases, circulatory system diseases and extra-pulmonary malignancies (P<0.05). The use of respiratory related diagnosis and therapeutic technologies was gradually increasing, meanwhile, the use of non-traditional respiratory related technologies, especially continuous renal replacement therapy, was also increasing. There was no significant difference in fatality rate among different years (P>0.05).ConclusionsThe number of patients with extra-pulmonary diseases and the use of non-traditional respiratory related diagnosis and therapeutic technologies in RICU were increasing. The development of RICU and the allocation of technical personnel needed to be improved accordingly.

    Release date:2021-05-25 01:52 Export PDF Favorites Scan
  • The cognition of busyness and main busy scenes in intensive care unit nursing care: a qualitative study

    Objective To explore the nurses’ cognition of busyness in intensive care unit (ICU), summarize the main busy scenes, and provide strategies for solving problems of busyness. Methods Nurses in three ICU departments of Shanghai Oriental Hospital were selected by purpose sampling method from September 2020 to January 2021. Face-to-face semi-structured in-depth interviews were conducted with nurses. The interview data were analyzed and thematically refined using the method of Colaizzi data analysis. Results A total of 10 nurses were interviewed, including 8 general nurses and 2 head nurses, all of whom were women. The cognition of busyness covered three elements: explosively increased workload, time pressure, and overwhelming information from multiple sources. Busy scenes included four themes: large amount of patients, critical conditions of patients, unstable conditions of patients, and frequent service transfer among different medical divisions. Conclusions According to the three elements of nurses’ cognition of busyness and scenes of it, nursing managers can put forward corresponding solutions. This can retain or attract more nurses to work in ICU and provide better services for patients.

    Release date:2022-01-27 09:35 Export PDF Favorites Scan
  • 重症监护室侵入性操作的感染分析与护理干预

    【摘要】 目的 总结重症监护室(ICU)内各种侵入性操作与相关感染的关系及护理干预。 方法 对2008年7月-2009年6月ICU收治的患者进行回顾性调查,了解ICU内侵入性操作与相关感染发生情况。 结果 479例患者在ICU住院期间发生医院感染83例次,医院感染率17.33%,其中与侵入性相关感染74例次,占89.16%。各侵入性操作的医院感染发生率:气管插管/切开(未使用呼吸机)为14.81%;使用呼吸机为33.65%;留置导尿管为7.69%,留置胃管为7.14%;动静脉置管为0.94%。侵入性操作越多,感染率相应增高。 结论 对危重患者实施侵入性操作时,加强对呼吸系统、泌尿系统、血管内导管等相关感染的预防与控制,切断感染链是控制因侵入性操作而发生医院感染的有效方法。

    Release date:2016-09-08 09:52 Export PDF Favorites Scan
  • Risk factors for sleep disorders in ICU patients: a meta-analysis

    ObjectiveTo systematically review the risk factors associated with sleep disorders in ICU patients.MethodsWe searched The Cochrane Library, PubMed, EMbase, Web of Science, CNKI, Wanfang Data, VIP and CBM databases to collect cohort studies, case-control studies and cross-sectional studies on the risk factors associated with sleep disorders in ICU patients from inception to October, 2018. Two reviewers independently screened literature, extracted data and evaluated the bias risk of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 9 articles were included, with a total of 1 068 patients, including 12 risk factors. The results of meta-analysis showed that the combined effect of equipment noise (OR=0.42, 95%CI 0.26 to 0.68, P=0.000 4), patients’ talk (OR=0.53, 95%CI 0.42 to 0.66, P<0.000 01), patients’ noise (OR=0.39, 95%CI 0.21 to 0.74, P=0.004), light (OR=0.29, 95%CI 0.18 to 0.45, P<0.000 01), night treatment (OR=0.36, 95%CI 0.26 to 0.50, P<0.000 01), diseases and drug effects (OR=0.17,95%CI 0.08 to 0.36, P<0.000 01), pain (OR=0.37, 95%CI 0.17 to 0.82, P=0.01), comfort changes (OR=0.34,95%CI 0.17 to 0.67,P=0.002), anxiety (OR=0.31,95%CI 0.12 to 0.78, P=0.01), visit time (OR=0.72, 95%CI 0.53 to 0.98, P=0.04), economic burden (OR=0.63, 95%CI 0.48 to 0.82, P=0.000 5) were statistically significant risk factors for sleep disorders in ICU patients.ConclusionCurrent evidence shows that the risk factors for sleep disorders in ICU patients are environmental factors (talking voices of nurses, patient noise, and light), treatment factors (night treatment), disease factors (disease itself and drug effects, pain,) and psychological factors (visiting time, economic burden). Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusions.

    Release date:2019-07-18 10:28 Export PDF Favorites Scan
  • A Survey of Oral Care Practice in Intensive Care Units of Grade 3A Hospitals in China

    Objective To explore the type and frequency of oral care practice in intensive care units (ICUs) in Mainland China, and to provide evidence and suggestions for improving oral care practice. Methods Three survey methods, including mailing questionnaires to ICUs of Grade 3A hospitals, consulting experts in this field and visiting accessible ICUs, were used to survey current oral care practice in Mainland China. Results A total of 184 questionnaires were given to the subjects, of which 79 effective ones were collected, and the response rate was 42.93%. All 79 respondents considered oral care very unimportant, and 98.7% of the ICUs performed oral care in different ways. Currently, the cotton ball wipe-off method was the most frequently used for oral care (62.5%), with an average (9.1± 5.1) min per time, twice or three times daily. The mouthwashes often used were saline (76.1%), solutions containing sodium bicarbonate (22.8%), furacilin (13.9%), and hydrogen dioxide (13.9%). Conclusion The oral care practice for the critically-ill patients in ICUs of China is unsatisfactory, although it is perceived as an important item in nursing care. More evidence–based training should be given and it is necessary to establish a national oral care guideline for critically-ill patients.

    Release date:2016-09-07 11:23 Export PDF Favorites Scan
  • Progress of Ventilator Associated Pneumonia

    呼吸机相关肺炎( VAP) 是指应用机械通气治疗后48 h和停用机械通气拔除人工气道48 h 内发生的肺实质的感染性炎症。VAP 是机械通气治疗中常见的严重并发症。其发生率为9% ~70% [ 1] , 病死率高达20% ~71% [ 2, 3 ] 。依据其发生的时间可分为早发性VAP 和晚发性VAP。早发性VAP: 即气管插管或人工气道建立lt; 5 d 发生者, 约占VAP的1/2, 主要由插管时即定植于呼吸道内的病原体如肺炎链球菌、甲氧西林敏感金黄色葡萄球菌、流感嗜血杆菌等引起。晚发性VAP: 即气管插管或人工气道建立gt;5 d 发生者, 常由肠道革兰阴性细菌如肠杆菌科、不动杆菌属和假单胞菌属细菌所致。采取有效措施预防VAP 的发生, 对于降低病死率, 减少住院时间和医疗费用, 节约医疗资源具有重要的意义。按照随机对照临床试验中的预防措施可总分为非药物性措施与药物性措施。

    Release date:2016-08-30 11:52 Export PDF Favorites Scan
  • Bacterial detection of lower respiratory tract samples from patients in respiratory intensive care unit by loop-mediated isothermal amplification

    Objective To compare the bacterial spectrums of respiratory intensive care unit (RICU) patients derived from traditional bacterial culture and loop-mediated isothermal amplification (LAMP) assay. To analyze the relationship between clinical factors and clinical outcome of patients. Methods Data of patients in RICU with lower respiratory tract infection from October 2018 to December 2020 was collected. The bacterial spectrums obtained by traditional culture method and LAMP-based method were compared. Clinical factors were divided into two categories and taken into analysis of variance for assessing their relevance with clinical outcomes. Those with significances in analysis of variance were taken into binary logistic regression. Results A total of 117 patients were included. The ratio of patients with positive bacterial culture results was 39.13% (n=115), and that with positive LAMP assay results was 72.65% (n=117). The ratios of patients with at least two positive results for culture and LAMP were 8.70% (n=115) and 36.75% (n=117), respectively. According to chi-squared test, mechanical ventilation (χ2=5.260, P=0.022), and patients with two or more bacteria positive for LAMP assay (χ2=8.227, P=0.004) were related to higher risk of death. Mechanical ventilation and patients with two bacteria positive for LAMP assay were included in binary logistic regression. The odds ratio for death was 4.789 in patients with two or more bacteria positive by LAMP assay (95% confidence interval 1.198 - 19.144, P=0.027). Conclusions LAMP-based method is helpful in detecting more bacteria from respiratory tract specimens of RICU patients, which will be a contributor to precision medicine. Patients with at least two bacteria positive based on LAMP assay have higher risk of death.

    Release date:2022-04-22 10:34 Export PDF Favorites Scan
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