【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.
Objective To evaluate the effect of exogenous melatonin and its analogues on the prevention of delirium in critically ill patients by meta-analysis. Methods Randomized controlled trials of exogenous melatonin and its analogues in the prevention of delirium in critically ill patients were searched by computer from the Cochrane Library, PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Chongqing VIP, Wanfang, and SinoMed databases. The trial group was treated with melatonin or its analogues, while the control group was treated with placebo. The retrieval period was from the establishment of database to January 14th, 2021. Two researchers independently evaluated the literature quality, and meta-analysis was performed using RevMan 5.4 software. Results A total of 11 randomized controlled trials containing 1177 patients were enrolled, including 588 patients in the trial group and 589 patients in the control group. The results showed that exogenous melatonin and its analogues could reduce the occurrence of delirium in critically ill patients [odds ratio (OR)=0.45, 95% confidence interval (CI) (0.22, 0.91), P=0.03] and shorten the time of mechanical ventilation [standard mean difference (SMD)=−0.49, 95%CI (−0.94, −0.03), P=0.04], while might not affect the mortality rate [OR=0.73, 95%CI (0.46, 1.17), P=0.19] or length of intensive care unit stay [SMD=−0.05, 95%CI (−0.26, 0.15), P=0.61]. Conclusions The current evidence shows that exogenous melatonin and its analogues have some effect on reducing the occurrence of delirium and shortening the duration of mechanical ventilation in critically ill patients, and have no significant effect on reducing the mortality or length of intensive care unit stay. The above conclusions need to be confirmed by more high-quality studies.
Objective To explore the diagnosis and treatment of critically ill patients suffering from obstructive sleep apnea-hypopnea syndrome ( OSAHS) . Methods Critically ill patients with OSAHS admitted in intensive care unit from January 2003 to December 2007 were retrospectively analyzed. Results Seventy-nine critically ill patients were diagnosed as OSAHS. The initial diagnosis of OSAHS was made by history requiring, physical examination, and Epworth sleepiness score evaluation. The final diagnosis was comfirmed by polysomnography thereafter. Base on the treatment of primary critical diseases, the patients were given respiratory support either with continuous positive airway pressure ( CPAP) or with bi-level positive airway pressure ventilation ( BiPAP) . Two cases died and the remaining 77 patients were cured anddischarged. Conclusions Timely diagnosis of OSAHS is important to rescue the critically ill patients. Respiratory support combined with treatment of primary critical diseases can improve the outcomes of these patients.
目的 探讨危重症手足口病的集束化综合救护的护理方案。 方法 通过比较儿科使用集束化综合护理方案后1年（2009年5月－2010年4月）的26例危重症手足口病并发症的发生率，确定预防危重症手足口病的集束化综合护理方案的有效性。 结果 使用集束化综合护理方案后，26例患儿均治愈出院，其中仅3例有后遗症。 结论 集束化综合护理救治作为主动预防措施比传统的被动预防更有针对性和有效。
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.
Lung transplantation has been proved to be an effective treatment after more than forty years of fast development, while more than 4000 cases of lung transplantation performed globally each year. Recently, lung transplantation in China has been advanced rapidly, and the number of transplants has increased year by year. Respiratory and Critical Care Medicine team has been recognized to play a crucial role in lung transplantation. It has an irreplaceable role and status in promoting lung transplantation, improving the preoperative evaluation of lung transplantation and the maintenance of donors, and carrying out perioperative management, as well as long-term follow-up. Lung transplantation is a systematic project, requiring the perfect cooperation and collaboration of team members and contributing to recipients’ recovery.
ObjectiveTo compare the indirect calorimetry (IC) measured resting energy expenditure (MREE) with adjusted Harris-Benedict formula calculating resting energy expenditure (CREE) in the mechanically ventilated surgical critically ill patients and to evaluate the relationship between the resting energy expenditure (REE) with the severity of illness. MethodsTwenty-one patients undergonging mechanical ventilation for critical illness in the intensive care unit of general surgery between August 2008 and February 2010 were included in this study. Data during the study period of nutrition support were collected for computation of the severity of critical illness by acute physiology and chronic health evaluation Ⅱ scores (APACHE Ⅱ scores) and organ dysfunction scores (Marshall scores). MREE was measured by using IC of the MedGraphics CCM/D System within the first 7 d after nutrition therapy. CREE was calculated by using the HarrisBenedict formula adjusted with correction factors for illness at the same time. According to APACHE Ⅱ scores on admission, the enrolled patients were divided into two groups: APACHEⅡ score ≥20 scores group (n=8) and APACHE Ⅱ score lt;20 scores group (n=13), and the differences between MREE and CREE of patients in two groups were determined. ResultsThe reduction of variation tendency in CREE other than MREE in the enrolled patients within the first week of nutritional support was statistical significance (Plt;0.001). The CREE of patients 〔(1 984.49±461.83) kcal/d〕 was significantly higher than the MREE 〔(1 563.88±496.93) kcal/d〕 during the first week of nutritional support (Plt;0.001). The MREE on the 0, 1, 2, and 4 d after nutrition therapy were statistically significant lower than CREE at the same time interval in these patients (Plt;0.01), and the differences at the other time points were not significant (Pgt;0.05). There was a trend towards a reduction in APACHE Ⅱ and Marshall scores within the first week of nutrition therapy that reached statistical significance (Plt;0.001). During the first week of nutrition therapy, APACHEⅡ and Marshall scores of patients in ≥20 scores group were significantly higher than those in lt;20 scores group, respectively (Plt;0.05 or Plt;0.01), and the reductions of APACHE Ⅱ scores and Marshall scores were significant in patients of two groups (Plt;0.001). A significant positive correlation was found between CREE with APACHE Ⅱ scores (r=0.656, Plt;0.001) and Marshall scores (r=0.608，Plt;0.001) in patients within the first week after nutrition support. Although no statistically significant correlation was observed between MREE and APACHEⅡ scores (r=-0.045， P=0.563), a significant positive correlation was observed between MREE and Marshall scores (r=0.263, P=0.001) within the first week after nutrition therapy. There was no correlation between MREE and CREE (r=0.064, P=0.408) in patients at the same time interval. The reduction of MREE of patients in ≥20 scores group other than in lt;20 scores group was statistically significant within the first week after nutrition therapy (P=0.034). In addition, the MREE of patients in ≥20 scores group were not significantly different from those in lt;20 scores group (Pgt;0.05), and the mean CREE was not different in two groups patients within the first week of nutritional therapy 〔(1 999.55±372.73) kcal/d vs. (1 918.39±375.27) kcal/d, P=0.887〕. CREE was significantly higher than MREE of patients in ≥20 scores group within the first week except the 3 d and 5 d after nutrition therapy (Plt;0.05), while in lt;20 scores group CREE was significantly higher than MREE in patients only within the first 3 d after nutrition therapy (Plt;0.05 or Plt;0.01). MREE and CREE of patients in ≥20 scores group were not different from those in lt;20 scores group, respectively (Pgt;0.05).
Objective To establish and verify the early prediction model of critical illness patients with influenza. Methods Critical illness patients with influenza who diagnosed with influenza in the emergency departments from West China Hospital of Sichuan University, Shangjin Hospital of West China Hospital of Sichuan University, and Panzhihua Central Hospital between January 1, 2017 and June 30, 2020 were selected. According to K-fold cross validation method, 70% of patients were randomly assigned to the model group, and 30% of patients were assigned to the model verification group. The patients in the model group and the model verification group were divided into the critical illness group and the non-critical illness group, respectively. Based on the modified National Early Warning Score (MEWS) and the Simplified British Thoracic Society Score (confusion, uremia, respiratory, BP, age 65 years, CRB-65 score), a critical illness influenza early prediction model was constructed and its accuracy was evaluated. Results A total of 612 patients were included. Among them, there were 427 cases in the model group and 185 cases in the model verification group. In the model group, there were 304 cases of non-critical illness and 123 cases of critical illness. In the model verification group, there were 152 cases of non-critical illness and 33 cases of critical illness. The results of binary logistic regression analysis showed that age, hypertension, the number of days between the onset of symptoms and presentation at the emergency department, consciousness state, white blood cell count, and lymphocyte count, oxygen saturation of blood were the independent risk factors for critical illness influenza. Based on these 7 risk factors, an early prediction model for critical illness influenza was established. The correct percentages of the model for non-critical illness and critical illness patients were 95.4% and 77.2%, respectively, with an overall correct prediction percentage of 90.2%. The results of the receiver operator characteristic curve showed that the sensitivity and specificity of the early prediction model for critical illness influenza in predicting critical illness patients were 0.909, 0.921, and the area under the curve and its 95% confidence interval were 0.931 (0.860, 0.999). The sensitivity, specificity, and area under the curve (0.935, 0.865, 0.942) of the early prediction model for critical illness influenza were higher than those of MEWS (0.642, 0.595, 0.536) and CRB-65 (0.628, 0.862, 0.703). Conclusions The conclusion is that age, hypertension, the number of days between the onset of symptoms and presentation at the emergency department, consciousness, oxygen saturation, white blood cell count, and absolute lymphocyte count are independent risk factors for predicting severe influenza cases. The early prediction model for critical illness patients with influenza has high accuracy in predicting severe influenza cases, and its predictive value and accuracy are superior to those of the MEWS score and CRB-65 score.