Search

Clinical value of peripheral blood vitamin D level in predicting the outcome of weaning from mechanical ventilation in critically ill patients

ObjectiveTo investigate the clinical value of peripheral blood vitamin D level in predicting the outcome of weaning from mechanical ventilation in critically ill patients.MethodsA total of 130 critically ill patients who undergoing mechanical ventilation for more than 48 hours in our hospital were recruited from June 2014 to June 2017. Serum 25(OH)D3 was detected on admission and before spontaneous breathing test (SBT) meanwhile general clinical data and laboratory examination indexes were recorded. The cases were divided into a successful weaning group and a failure weaning group according to the outcome of weaning from mechanical ventilation. Logistic regression equation was used to analyze the relationship between vitamin D level and failure weaning, and a receiver operating characteristic (ROC) curve was used to analyze the predictive value for failure weaning.ResultsThere were 46 patients with failure weaning among 130 patients (35.38%). Compared with the successful weaning group, the failure weaning group had significantly higher Acute Physiology and Chronic Health EvaluationⅡ score, longer duration in intensive care unit, higher respiratory rate, higher rapid shallow breathing index, higher C-reactive protein, higher N-terminal prohormone of brain natriuretic peptide, higher serum creatinine, and significantly lower albumin (all P<0.05). 25(OH)D3 level classifications on admission and before SBT in the failure weaning group were worse than those in the successful weaning group (P<0.05). 25(OH)D3 levels of the failure weaning group were lower than those of the successful weaning group [on admission: (18.16±4.33) ng/ml vs. (21.60±5.25) ng/ml, P<0.05; before SBT: (13.50±3.52) ng/mlvs. (18.61±4.30) ng/ml, P<0.05]. Multivariate logistic regression analysis showed that 25(OH)D3 levels on admission and before SBT were independent risk factors for failure weaning (OR values were 2.257 and 2.613, respectively, both P<0.05). ROC curve analysis showed that areas under ROC curve were 0.772 and 0.836, respectively, with sensitivities of 80.3% and 85.2%, specificities of 69.0% and 71.0%, respectively.Conclusions25(OH)D3 deficiency or insufficiency is common in critically ill patients. The lower the level of vitamin D, the higher the risk of failure weaning. So it may be an independent predictor of failure weaning.

Analysis of clinical characteristics of 49 patients with coronavirus disease 2019 in Jiangxi

ObjectiveTo analyze the clinical characteristics and epidemiological characteristics of patients with coronavirus disease 2019 treated early in Jiangxi province.MethodsFour-night patients with coronavirus disease 2019 treated in this hospital from January 21st to 27th, 2020 were included in this study. The epidemiological and clinical data of patients after admission were collected, and laboratory tests such as blood routine, urine routine, stool routine, liver and kidney function, electrolytes, myocardial enzymes, erythrocyte sedimentation (ESR), C-reactive protein (CRP), calcitonin, coagulation, T cell subset and Chest CT were reviewed. The clinical results of common and severe/critically ill patients were compared.ResultsOf the 49 patients, 40 were common and 9 were severe/critical. Fourty-six patients had a clear history of contact with Wuhan or other areas of Hubei. The sex ratio was 2.06∶1, and the average age was 42.9 years. The symptoms were mainly fever (78.7%), cough (38.8%), and fatigue (18.4%). 28.6% (14 cases) of patients had hypertension and diabetes. Serum lymphocyte count and calcium concentration of the patients were decreased, but lactate dehydrogenase, ESR, CRP and serum amyloid A were increased in these patients. T lymphocyte subsets (CD3+, CD4+, CD8+) decreased significantly in these patients. Forty-seven patients (95.9%) had single or scattered patchy ground glass density shadows on the chest CT. Compared with common patients, the patients with severe/critical patients were older (P=0.023), hospitalized later (P=0.002), and had higher comorbidities (P=0.017). ESR (P=0.001）, CRP (P=0.010) and the serum amyloid A (P=0.040) increased significantly, while CD3+ (P<0.001), CD4+ (P=0.012), CD8+ (P=0.006) decreased significantly in severe/critical patients.ConclusionsThe patients with coronavirus disease 2019 in Jiangxi province are commonly imported from Wuhan. Severe/critical patients are older, hospitalized later, and have more medical complications and more severe systemic inflammatory reactions than common patients.

2024泰山科技论坛—“胸心海纳 精医天下”胸部疾病精准综合治疗纪要

危重患者困难气道管理策略

气道管理是危重患者救治过程中最重要的操作技术, 而危重患者进行气管插管操作时心肺功能和内环境往往处于失代偿状态, 对缺氧的耐受性明显降低, 易发生误吸及心搏骤停等严重并发症[ 1] 。因此, 完善对危重患者困难气道的管理策略, 掌握熟练的气道开放技术, 对于提高危重患者抢救成功率, 降低并发症发生率和死亡率具有重要意义。

The incidence and influencing factors of early enteral nutritional feeding interruptions in critically ill patients: a meta-analysis

ObjectiveTo systematically review the incidence and influencing factors of early enteral nutritional feeding interruptions in critically ill patients. MethodsThe PubMed, Web of Science, Embase, Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect observational studies on the early enteral nutritional feeding interruptions in critically ill patients from inception to January 2, 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 17.0 software. ResultsA total of 12 studies including 1 121 patients were included. Meta-analysis showed that the incidence of early enteral nutritional feeding interruptions in critically ill patients was 75.0% (95%CI 64.0% to 84.0%). Influenced by feeding intolerance, airway management, tube problems, radiological examination, and endoscopy, surgery and so on, interruptions of early enteral nutritional feeding frequently occur in critically ill patients. ConclusionCurrent evidence shows that early enteral feeding interruptions in critically ill patients are affected by many factors, and the incidence is high. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.

胸腔水封引流瓶用于危重症患者腹腔引流的效果观察

目的观察胸腔水封引流瓶用于重症监护病房（ICU）患者腹腔引流管引流的效果。 方法选取2014年1月－2015年1月收治的100例危重症患者，按照入住ICU的先后顺序依次分为对照组和试验组，每组各50例。对照组患者腹腔引流装置使用一次性普通引流袋，试验组患者腹腔引流装置使用一次性胸腔水封引流瓶。比较两组患者腹腔引流管的堵管发生率，以及护士每天护理腹腔引流管所花费的直接护理时间。 结果试验组患者腹腔引流管发生堵管的例数（1例，占2%）明显少于对照组（7例，占14%），差异有统计学意义（P＜0.05）；试验组管护士每天花费的直接护理腹腔引流管的时间明显短于对照组，差异有统计学意义（P＜0.05）。 结论胸腔水封引流瓶用于危重症患者腹腔引流管的引流能明显降低腹腔引流管的堵管发生率，显著减少护士的工作量，并能精确记录腹腔引流液的量，值得临床推广应用。

Early identification and contribution factor analysis of severe coronavirus disease 2019 in Xinyang city of Henan province

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.

危重患者院内转运实践及策略探讨

目的探讨综合性医院危重患者院内转运的重要性及转运中应注意的问题及转运策略。 方法总结分析2012年1月－2014年1月期间20 352例危重患者的急救及院内转运的实践及资料，探讨转运中的医疗人员组成、急救设备、转运流程、转运风险的评估、应对方案。 结果20 352例危重患者中，除136例因病情危重在抢救室抢救无效死亡，5 756例因抢救后病情相对平稳由抢救室转送急诊科留观室留观治疗或暂因患方及医院主客观原因不能转送专科住院治疗由抢救室转送急诊科监护室治疗，其余14 460例危重患者经抢救病情相对稳定后全部实现院内安全转送。 结论合理的救治医疗人员组成、积极对危重患者的救治、作好病情评估、把握好转运的时机是实现危重患者院内转运安全的保障。

25 例急诊心脏瓣膜置换术的临床分析

目的总结急诊心脏瓣膜置换治疗危重心脏瓣膜病患者的临床经验。方法回顾性分析 2008 年 4 月至 2018 年 4 月内科药物治疗无效的接受急诊手术治疗 25 例重症瓣膜病患者的临床资料（除外主动脉夹层、急诊搭桥同期行瓣膜手术及心脏肿物累及瓣膜手术的病例）。其中男 14 例、女 11 例，平均年龄（45.0±14.6）岁。均合并严重的心功能不全（Ⅳ级），8 例术前需要机械通气。感染性心内膜炎 11 例，均可见明显赘生物，其中 4 例合并瓣周脓肿；瓣膜重度狭窄 8 例，急性瓣膜重度关闭不全 6 例，包括急性腱索断裂 4 例、二尖瓣成形术后失败再次急诊行置换术 2 例。所有患者均在急诊、全身麻醉、体外循环下行瓣膜置换术。结果所有 25 例患者手术后住院期间死亡 6 例（24.0%），其中 5 例死于多脏器功能衰竭，1 例死于感染复发导致的败血症。另有 1 例术中出现Ⅲ度房室传导阻滞安装永久性起搏器；2 例术后早期出现脑出血，经积极治疗后康复，其余均顺利出院。随访 1～120 个月，随访率 100%（19/19），1 例术后 3 个月出现肺部感染死亡，其余患者的心功能均改善明显（Ⅰ级 3 例，Ⅱ级 15 例）。结论手术指征明确的重症瓣膜患者在内科药物治疗无效时应积极选择急诊手术治疗，不仅能够挽救患者的生命，还能提高患者远期生存质量。

Relationship Between Using Proton Pump Inhibitors and the Hospital-acquired Pneumonia in Critical Patients

【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.