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。
ObjectiveBased on a large sample of data, study the factors affecting the survival and prognosis of patients with rectal cancer and construct a prediction model for the survival and prognosis.MethodsThe clinical data of 26 028 patients with rectal cancer were screened from the Surveillance, Epidemiology, and End Results (SEER) clinical database of the National Cancer Institute. Univariate and multivariate Cox proportional hazard regression analysis were used to screen related risk factors. Finally, the Nomogram prediction model was summarized and its accuracy was verified.ResultsResult of multivariate Cox proportional hazard regression analysis showed that the risk factors affecting the survival probability of rectal cancer included: age, gender, marital status, TMN staging, T staging, tumor size, degree of tissue differentiation, total number of lymph nodes removed, positive lymph node ratio, radiotherapy, and chemotherapy (P<0.05). Then we further built the Nomogram prediction model. The C index of the training cohort and the validation cohort were 0.764 and 0.770, respectively. The area under the ROC curve (0.777 and 0.762) for 3 years and 5 years, and the calibration curves of internal and external validation all indicated that the model could effectively predict the survival probability of rectal cancer.ConclusionThe constructed Nomogram model can predict the survival probability of rectal cancer, and has clinical guiding significance for the prognostic intervention of rectal cancer.
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.
Objective To investigate the prognostic factors of severe chronic obstructive pulmonary disease ( COPD) in elderly patients, and to guide the clinical assessment and appropriate interventions. Methods A prospective cohort study was carried out from May 1993 to December 2010. A total of 178 elderly patients with severe COPD were recruited for baseline survey, and followed up for the living conditions, whether used non-invasive ventilation, and causes of death. A survival analysis was performed on all patients stratified by lung function. The significant factors on survival rate were analyzed. Results In this cohort the survival rates were 49% and 12% in five and ten years, respectively. The important factors for prognosis were age [ relative risk( RR) = 1. 043, 95% confidence intervals( 95% CI = 1. 010-1. 050] , forced expired volume in one second ( FEV1 , RR = 0. 019, 95% CI = 0. 007-0. 052) , FEV1% pred ( RR = 1. 045, 95% CI = 1. 012-1. 079) , lung function grade ( RR = 2. 542, 95% CI = 1. 310-4. 931) , body mass index ( BMI, RR= 0. 945, 95% CI = 0. 895-0. 952) , and pulmonary heart disease ( RR = 1. 872, 95% CI = 1. 188- 2. 959) . In severe COPD, non-invasive ventilation ( NIV, RR = 1. 167, 95% CI = 0. 041-1. 674) , pulmonary heart disease ( RR = 3. 805, 95% CI = 1. 336-10. 836) , FEV1 ( RR = 0. 081, 95% CI = 1. 001-1. 168) , and arterial partial of oxygen ( PaO2 , RR=0. 956, 95% CI =0. 920-0. 993) were the independent predictors.The patients using NIV had longer survival than those without NIV. The 5 and 10 years survival rate in the patients with NIV were 78% and 50% , much higher than those without ventilation which were 30% and 25% , respectively. In extremely severe COPD, FEV1 ( RR=1. 059, 95% CI =1. 015-1. 105) , arterial partial of carbon dioxide ( PaCO2 , RR=1. 037, 95% CI = 1. 001-1. 074) , age ( RR= 1. 054, 95% CI = 1. 013-1. 096) and pulmonary heart disease ( RR = 1. 892, 95% CI = 1. 125-3. 181) were the independent predictors. Conclusions Age, BMI, FEV1 , PaO2 , PaCO2 , pulmonary heart disease, and NIV were prognostic factors in elderly patients with severe COPD. The prognostic factors between severe and extremely severe COPD were not identical. Patients with severe COPD should be given early intervention, including progressive nutritional support, and long-term home oxygen therapy combining with NIV.
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.
Objective To investigate the clinical features of non-small cell lung cancer (NSCLC) patients with long-term survival and the related factors for treatment. Methods A retrospective analysis of clinical features, treatment factors, and survival was performed for 963 patients with pathologically confirmed stage Ⅳ NSCLC between January 2010 and December 2015 from Department of Thoracic Oncology, West China Hospital, Sichuan University. Results The median overall survival (OS) of the 963 patients was 20.8 months, and the 1-, 3-, 5-, and 7-year survival rates were 72.0%, 21.4%, 15.2%, and 4.8%, respectively. There were 81 patients in the long-term survival group (OS>60 months) and 882 in the non-long-term survival group (OS<60 months). Previous surgery, thoracic radiotherapy and epidermal growth factor receptor (EGFR) gene positive significantly increased the 5-year actual survival rate, reducing the risk of death by 62.0%, 58.8%, and 58.1%, respectively. Compared with the non-long-term survival group, more patients in the long-term survival group received two or more means of treatment including surgery, thoracic radiotherapy, and targeted therapy (28.4% vs. 11.6%, P<0.001) and more patients benefited from fourth- or further-line treatment (24.7%vs. 11.1%, P<0.001). Cox multivariate regression analysis indicated that performance status [hazard ratio (HR)=1.388, 95% confidence interval (CI) (1.199, 1.608), P<0.001] , N stage [HR=1.160, 95%CI (1.058, 1.272), P=0.002] , EGFR gene status [HR=0.588, 95%CI (0.469, 0.738), P<0.001] , previous surgery [HR=0.626, 95%CI (0.471, 0.832), P=0.001] , and thoracic radiotherapy [HR=0.592, 95%CI (0.480, 0.730), P<0.001] were independent prognostic factors of OS. Conclusions Good performance status, early N staging, EGFR mutation, previous surgery, and thoracic radiotherapy are important prognostic factors affecting the survival of advanced NSCLC patients. Long-term survival benefits from combined treatment and effective further-line therapies.
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.
ObjectiveTo evaluate the therapeutic effect of liver transplantation (LT) combined with adenovirus-mediated delivery of herpes simplex virus thymidine kinase / ganciclovir (ADV-TK/GCV) in treatment of patients with hepatocellular carcinoma (HCC), so as to benefit more patients with HCC beyond the Milan criteria. MethodsThe clinicopathologic data of patients with HCC underwent LT by the author team since 2007 were collected and analyzed. The patients were assigned into simple LT group and LT+ADV-TK/GCV group. The 5-year cumulative overall survival rate and relapse free survival rate of all LT patients and the patients with LT beyond the Milan criteria by simple LT and LT+ADV-TK/GCV therapy were compared. Meanwhile, Cox regression was used to analyze the risk factors affecting long-term overall survival rate and relapse free survival rate of all patients with HCC after LT. ResultsA total of 216 patients eligible for inclusion were collected in this study, including 134 patients in the simple LT group and 82 patients in the LT+ADV-TK/GCV group, 162 of whom beyond the Milan criteria, including 101 patients underwent the simple LT and 61 patients underwent the LT+ADV-TK/GCV. There were no statistical differences in the baseline data between the simple LT and LT+ADV-TK/GCV in all patients and patients beyond the Milan criteria (P>0.05). There were no statistical differences in 5-year overall survival rate and relapse free survival rate of all patients with HCC (P>0.05). The 5-year cumulative overall survival rate of the LT+ADV-TK/GCV group was better than that of the simple LT group in the patients beyond the Milan criteria (χ2=4.11, P=0.047), but it was not found that the 5-year cumulative relapse free survival rate had statistical difference (27-month survival time as the critical value, P=0.46, P=0.06). Cox regression multivariate analysis results showed that the larger cumulative tumor diameter, the preoperative elevated serum alpha fetoprotein (>400 μg/L), later TNM stage, and without combination of ADV-TK/GCV therapy increased the probability of shorter overall survival of patients after LT; and the patient’s older age, the larger cumulative tumor diameter, and later TNM stage increased the probability of shorter relapse free survival after LT, and it was not found that the combination of ADV-TK/GCV therapy had an impact on the relapse free survival. ConclusionLT combined with ADV-TK/GCV therapy can obviously improve overall survival among patients beyond the Milan criteria, more patients with advanced HCC will be candidates for LT combined with ADV-TK/GCV therapy.