目的:分析长期机械通气患者脱机成败原因,提高脱机成功率。方法:针对本院2003年5月至2008年10月近6年ICU172例长期机械通气患者成败原因进行分析。结果:总脱机成功率90.69%。脱机失败率 9.31%。结论:长期机械通气患者多存在多种因素的共同参与,如营养不良、全身衰弱、呼吸功能不全、通气泵衰竭和心理因素等,增加了脱机的难度,进而出现撤机困难。
Aiming at the shortcomings in the theory and practice of integrated elderly care and medical services in China, using the methods of literature analysis and comparative analysis, we summarize four typical models of integrated elderly care and medical services, namely, the American commercial pension model, the British national tax financing system pension model, the Japanese national security transformation, and the German long-term care insurance system, and compare the four models systematically from the aspects of system overview, service principle, operation mode, financing supervision, etc. The enlightenment for the policy and practice development of integrated elderly care and medical services in China is obtained: firstly, the service concept should be innovated; secondly, it is important to improve the relevant legal protection and supporting measures; thirdly, the refinement of the integrated elderly care and medical service projects are supposed to be promoted; fourthly, a multi-party linkage mechanism ought to be establishd; and fifthly, community endowment model should be advocated.
ObjectiveBased on the latest version of the Database from Colorectal Cancer(DACCA), this study analyzed the long-term effect of neoadjuvant therapy combined with intersphincteric resection (ISR) in patients with rectal cancer. MethodsAccording to the established screening criteria, clinical data of 944 patients with rectal cancer admitted from January 2009 to December 2020 were collected from the DACCA updated on March 21, 2022, to explore the influencing factors for overall survival (OS) and disease specific survival (DSS) of rectal cancer treated with neoadjuvant therapy combined with ISR, by Cox proportional hazard regression model. Results① The 3-year OS and DSS survival rates of neoadjuvant therapy combined with ISR for rectal cancer were 89.2% and 90.4%, respectively, and the 5-year OS and DSS survival rates were 83.9% and 85.4%, respectively. ② For different ISR surgical methods and neoadjuvant therapy plans, there were no significant differences in OS and DSS (P>0.05), but there were significant differences in OS and DSS among different ypTNM stage groups (P<0.001), patients with ypTNM 0–Ⅱ had better OS and DSS. ③ BMI, ypTNM stage and R0 resection were influencing factors for OS and DSS (P<0.05). ④ The overall incidence of postoperative complications was low, including 6.4% (60/944) within 30 days, 7.5% (71/944) within half a year and 3.3% (31/944) over half a year after operation. ConclusionsIn the comprehensive treatment of patients with low/ultra-low rectal cancer, neoadjuvant therapy combined with ISR can achieve relatively stable and good long-term oncological efficacy, and the incidence of short-term postoperative complications is not high, which is one of the options.
ObjectiveTo systematically review the purchase willingness rate and influencing factors of long-term care insurance in Chinese population.MethodsCNKI, VIP, WanFang Data, EMbase and PubMed databases were electronically searched to collect cross-sectional studies on the purchase willingness rate of long-term care insurance in China from inception to March 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 16.0 software.ResultsA total of 66 cross-sectional studies involving 151 231 subjects were included. The results of the meta-analysis showed that the purchase willingness rate of long-term care insurance in China was 52.4% (95%CI 48.1% to 56.8%). Subgroup analysis showed that: among the sample characteristic factors, residents who were from the central region of China (56.4%), being studied after 2016 (53.3%), and residing in pilot regions (53.1%) had a higher willingness rate to purchase long-term care insurance. Among demographic factors, the research considered factors of residence and family size (56.2%) contributed to a higher willingness to purchase long-term care insurance, and residents with monthly income from 1 000 yuan to 5 000 yuan (55.4%) and who were unmarried (55.3%) had a higher willingness to purchase long-term care insurance. Among health and concept factors, the research considered factors of insurance and government trust (57.3%), factor of number of chronic diseases (55.0%), and factor of health risk cognition (52.4%) contributed to a higher willingness to purchase long-term care insurance. Among the factors of long-term care insurance system, factor of the government subsidy (60.6%), factor of long-term care insurance price (58.0%) and factor of payment methods (56.2%) contributed a higher willingness to purchase long-term care insurance.ConclusionsCurrent evidence shows that over half of residents are willing to purchase long-term care insurance. However, different factors still affect their purchase willingness. The influencing factors reflect numerous difficulties in the current long-term care insurance system, which requires attention and continuous improvement of policy formulators and related researchers.
ObjectiveTo investigate the relationship between admission serum potassium level and long-term prognosis in patients with unstable angina. MethodsWe studied the data of 1 412 patients with unstable angina who received coronary angiography examinations and completed the follow-up between July 2008 and September 2012. Serum potassium level within the first 24 hours after admission was collected. According to the serum potassium level, the patients were divided into three groups:those with a serum potassium level lower than 3.5 mmol/L, those with a level between 3.5 and 5.0 mmol/L and those with a level higher than 5.0 mmol/L. Then, we analyzed the relationship between admission serum potassium level and long-term prognosis in patients with unstable angina. ResultsThere was a U-shaped relationship between admission serum potassium level and long-term mortality that persisted after multivariable adjustment in patients with unstable angina. The all-cause mortality risk was the lowest in the group of patients with a potassium level of 3.5 to 5.0 mmol/L, whereas mortality was higher in patients with potassium level lower than 3.5 mmol/L and higher than 5.0 mmol/L [HR=1.89, 95%CI (1.13, 3.17), P=0.016; HR=1.64, 95%CI (0.40, 6.77), P=0.493]. Compared with patients with a serum potassium level between 3.5 and 5.0 mmol/L, the cardiovascular mortality risk was significantly higher in those patients with a potassium level lower than 3.5 mmol/L [HR=1.99, 95%CI (1.01, 3.94), P=0.048]. ConclusionThere is a U-shaped relationship between admission serum potassium level and long-term all-cause mortality rate, and the all-cause mortality rate and cardiovascular mortality risk was the lowest in patients with a potassium level between 3.5 and 5.0 mmol/L.
1术后生存41年，肝癌治疗史上的奇迹肝癌在我国是最常见的癌症之一，每年约10万人被夺去生命。此病进展迅速，预后很差，人们常将其称为“癌中之王”，或“不治之症”。 近年，肝癌研究不断取得突破进展，振奋人心。其中印象最深的是，复旦大学附属中山医院(原上海医科大学附属中山医院)在41年前为一肝癌患者成功施行了肝切除手术，至今已91岁高龄，仍健在。创造了肝癌外科治疗史上的奇迹。
Objective To explore the daytime variables which are predictive to nocturnal hyoxemia among COPD patients unqualified for long-term oxygen therapy ( LTOT) . Methods Forty-eight stable COPD patients with SaO2≥90% were enrolled in this study and regarded as patients unqualified for LTOT. All patients underwent lung function examination during daytime. Their nocturnal oxygen saturation was monitored with overnight pulse oximetry ( OPO) . ResultsDaytime oxygen saturation was positively correlated with nocturnal mean SaO2 ( r =0. 79, P lt;0. 0001) , and negatively correlated with time spend with saturation below 90% ( TB90) ( r = - 0. 75, P lt; 0. 0001) . No significant relationship was found between lung function parameters and nocturnal SaO2 . The patients with daytime oxygen saturation between 90% and 95% were more likely to have lower nocturnal oxygen saturation and longer TB90 ( P lt;0. 05) .Conclusions Daytime oxygen saturation may effectively predict the occurrence of nocturnal hyoxemia in stable COPD patients unqualified for LTOT. To reduce COPD complications and improve prognosis, we suggest a relative indication of LTOT for patients with daytime oxygen saturation between 90% and 95% and with nocturnal hyoxemia.
ObjectiveTo investigate the long-term retention rate of Oxcabazepine (OXC) in Chinese young children with symptomatic epilepsy and to evaluate the withdrawal causes of OXC. MethodsClinical features of 89 cases (male/female:48/41) from January.2009 to June.2015 were collected. Patients with symptomatic epilepsy who received mono-or adjunctive therapy with OXC. The initial dose was 10mg/kg/d twice a daily, 3~4weeks to increased to the target dose. OXC doses ranged between 12~53 mg/(kg·d) (mean dose:34.0±8.59 mg/(kg·d). An investigator recorded the antiepileptic drugs, seizure frequency, electroencephalogram and side effects for 3, 6, 12, 24 and 36months during follow-up. ResultsA total of 89 patients were enrolled in this investigation. patients with 50% reduction in seizure frequency in 6, 12, 24 and 36 months were 56.5%, 55.3%, 44.7%, 24.7%, and with seizure-free were 36.5%, 34.1%, 29.4%, 16.5%. In this research, 16(18.0%) patients experienced at least one side effect. The most common side effects observed were drowsiness 8 (42.1%), rash 3 (15.8%), and most were mild in severity. The retention rate of OXC in 3, 6, 12, 24, and 36months were 95.5%, 87.6%, 75.3%, 56.2%, 25.8%, respectively. The predominant causes of withdrawal were lack of efficacy 36(54.5%), end point 10(15.2%), adverse effects 8(12.1%), seizure-free 5(7.6%), follow-up loss 3(4.5%). COX analysis reveals that the age of onset was associated with treatment failure. ConclusionOur study demonstrates that OXC is safe and well tolerated in infants and very young children with symptomatic epilepsy, but the long-term retention rate is low. Whereas, for the purpose of better retention rate and therapeutic benefits, we should treat discretely depending on the complicated etiology and clinical features.
ObjectiveTo compare the efficacy and compliance of children children with refractory epilepsy receiving ketogenic diet (KD) in outpatient department with children receiving KD treatment in inpatient department. MethodsA retrospective study of 44 children with intractable epilepsy receiving the modified classical ketogenic diets in outpatient department from June 2014 to December 2015, who were followed-up during the third, sixth and twelfth month. Records of epileptic seizures and adverse reactions were used to evaluate the efficacy and retention rate of inpatient department KD treatment in children with refractory epilepsy, and compared with 104 children receiving KD treatment in inpatient department at the same period. ResultsThirty-four of the forty-four children comleted observation after 12-month follow-up, 15 cases had been seizure freedom, 22 cases had more than 50% reduction in seizure frequency, 12 patients had less than 50% reduction in seizure frequency.The total effective rate of the KD therapy in outpatient department was 64.7%, and the retention rate was 71%. 18 of of the 104 children with KD treatment in inpatient department at the same period comleted observation after 12-month follow-up, 3 cases had been seizure freedom, 5 cases had more than 50% reduction in seizure frequency, 13 cases had less than 50% reduction in seizure frequency.The total effective rate of the KD therapy in inpatient department was 27.8%, and the retention rate was 17.3%. ConclusionThe KD therapy in outpatient department is effective to children with intractable epilepsy, and there is a highly efficacy and compliance of children receiving KD in outpatient department comparing with children receiving KD in inpatient department. Therefore, it's optional to children with refractory epilepsy who can't received KD by inpatient department because of insufficient number of beds.
Objective To evaluate the effect of releasable sutures on shallow anterior chamber, filtering bleb and long-term intraocular pressure (IOP). Methods We searched MEDLINE (1971 to 2007), OVID (1971 to 2007) and National Science and Technology Library (1971 to 2007). Randomized controlled trials (RCTs) of the effect of releasable sutures on trabeculectomy were collected. Study selection and assessment, data collection and analyses were undertaken and cross-checked by two reviewers. Meta-analyses were performed with The Cochrane Collaboration’s RevMan 4.2.10 software. Results Six RCTs involving 341 eyes were included. Significant differences were observed in the reduction of postoperative shallow anterior chamber (RD –0.23, 95%CI –0.31 to –0.14, Plt;0.000 01) and functional filtering blebs (RD –0.15, 95%CI –0.27 to –0.02, P=0.02). But, no differences were observed for the control of long-term IOP (SMD –0.13, 95%CI –0.37 to 0.10, P=0.27). Conclusion The evidence currently available showed that releasable sutures could reduce the incidence of shallow anterior chamber and has no beneficial effect in controlling long-term IOP. The current evidence is insufficient to define the efficacy of maintaining functional filtering blebs. Further large-scale, high-quality randomized controlled trials are needed.