Apache Research Articles

Clinical Features and Prognostic Risk Factors of COVID-19 in Adults: a Retrospective Analysis of 93 Cases

Background: Since April 2020, the number of newly diagnosed cases and death cases of COVID-19 have decreased significantly in China but increased rapidly abroad Early diagnosis and treatment are of great concern to improving the prognosis of COVID-19 patients Objective: To investigate the clinical features and prognostic risk factors of adult patients with COVID-19, offering a reference for clinical diagnosis and treatment of this disease Methods: A retrospective design was used Participants were 93 adult cases of COVID-19 who were treated in Beijing Youan Hospital between January and February 2020 They were categorized into common, severe and critical types by the most serious conditions during hospitalization, in accordance with the Diagnosis and Treatment Protocol for COVID-19(Trial Version 7)issued by the National Health Commission of the People's Republic of China Indications such as general information, major clinical manifestations, baseline laboratory parameters, APACHE II and SOFA scores within 24 hours of admission, imaging findings, comorbidities and complications, treatments and outcomes were collected Results: There were 57 cases of common type(61 3%), 22 of severe type(23 7%)and 14 of critical type(15 0%) The male ratio was slighter higher in critical group, and female ratio was slighter higher in other groups, but sex composition showed no significant differences across the groups(P>0 05) The median age for common, severe and critical groups was 45 0, 62 0 and 81 0 years, respectively, showing significant differences(P0 05) Dyspnea occurred in all severe or critical cases, showing a higher incidence than common cases(100 0% vs 31 6%)(P<0 05) The incidence of lymphocytopenia in critical group was 100%, which was significantly higher than that in common group(49 1%)or severe group(59 1%)(P<0 05) Acute liver injury was the most common complication(58 1%)in all cases, but its incidence was obviously increased in severe group (77 3%) or critical group(92 9%), than that of common group(42 1%)(P<0 05) Chinese medicine therapy was used in 75 3% of all cases, but the severe cases had a higher rate of treating with Chinese medicine than critical cases(90 9% vs 50 0%, P<0 05) The rate of corticosteroid use in severe cases(63 6%)or critical cases(64 3%)was significantly increased than that of common cases(5 3%)(P<0 05) Six patients(6 5%)were treated with invasive ventilation, but only 1 of them(16 7%)was successfully extubated ultimately Nine patients(9 7%)died in hospital due to all causes Logistic regression analysis revealed that age ≥74 years〔OR(95%CI)=33 714(3 021, 376 211), P=0 004〕and baseline SOFA≥2 5〔OR(95%CI)=15 447(1 331, 179 260), P=0 029〕were independent risk factors for in-hospital death Conclusion: COVID-19 mainly manifests as respiratory infections Severe patients are apt to appear tissue injury and dysfunction of organs like liver, kidney and heart, etc The majority of patients have a favorable outcome Age and baseline SOFA score would help to label the prognosis of patients at an early stage Copyright © 2021 by the Chinese General Practice

The role of C-reactive protein testing in predicting the severity of acute pancreatitis

Background: Acute pancreatitis is a common gastrointestinal disease and timely severity stratification is crucial in reducing the mortality and morbidity of the patients. Many markers have been studied for their role as a single predictor of the severity of the disease. Our study is aimed to evaluate the performance of C-reactive protein (CRP) testing as a single biomarker in predicting the severity of acute pancreatitis. Methods: Retrospective observational study with data collection and content analysis design. Patients were divided according to the acute physiology and chronic health evaluation (APACHE II) score into two categories, mild and severe. CRP testing was obtained within 48 h of hospital admission. Results: Our results showed that out of 99 patients, 82 patients had a mild attack of acute pancreatitis, while 17 patients had a severe form of the disease. The mean CRP level of patients with severe acute pancreatitis was significantly higher than the mean CRP level of patients with the mild form of the disease. There was a fair agreement between CRP level and the APACHE II score. Conclusion: C-reactive protein (CRP) test obtained within 48 hours of hospital admission is a helpful tool in predicting the severity of acute pancreatitis.

First Indian Study on the use on the use of Indirect Calorimetry versus usual care in a tertiary care institute in India

Objective: To study the effect of Indirect calorimetry on the length of stay. The study comprises of the comparison between the use of indirect calorimetry versus usual care in critically ill mechanically ventilated patients with respect to the length of stay in the intensive care unit, and duration of time on ventilator. Patients were divided on basis of their nutrition risk to study the effect of Indirect calorimetry on the length of stay. Methods: This was a retrospective cohort study of 166 mechanical ventilated patients in S .L Raheja Hospital. Data was collected from 83 patients who were mechanically ventilated between January 2019 and November 2019 on whom indirect calorimetry was used to measure energy requirements. This cohort was compared to 83 patients between January 2018 and November 2918 where the energy requirements were calculated with the use of predictive equations. Both groups were matched for age, sex, comorbidities, Apache score and use of vasopressors. Results: Significant difference in the sicker group of patients was seen in the Length of stay in the intensive care unit. (9.23 +/- 8.14 vs 11.52 +/- 5.65, p value- 0.0034) Patients at risk for malnutrition demonstrated reduced length of time on ventilation as compared to those not at risk. (10.2 =/- 11.01 vs 13 +/-5.87,p value-0.0042) Conclusion: The use of indirect calorimetry may be associated with a lower length of icu stay among ventilated patients in a reasonably sick group of mixed surgical patients. KEY WORDS: indirect calorimetry; length of stay, mechanical ventilation

Analysis of 3 death cases of critical COVID-19 in Sichuan

Objective To analyze the clinical characteristics of critical COVID-19, and we improve the understanding of the diagnosis and treatment of severe cases. Methods Death cases with critical COVID-19 in Public Health Clinical Medical Center of Chengdu from January to May 2020 were collected, and their clinical data and imaging features were retrospectively analyzed. Results The three cases of severe type COVID-19 deaths, all have basic diseases, such as coronary heart disease, with or without lung diseases, renal disfunction , they all have symptoms of fever, cough, sputum. Athospital admission, APACHE II score and PSI rating were high-risk, laboratory examination results suggested lactate dehydrogenase, creatine kinase, troponin, brain natriuretic peptide, C-reactive protein and serum amyloid A were significantly increased, and T lymphocyte count droped apparently, chest imaging suggested pulmonary grinding glass patch shadow. After admission, the patients were given active antiviral, anti-bacterial, immunological and invasive mechanical ventilation support. All 3 patients had severe complications such as septic shock and multiple organ failure syndrome, and the average time from onset to death was 13.7 days. Conclusion Old-age people combined with heart disease and other basic diseases, and immunodeficiency are the high-risk groups of critical COVID-19. 摘要：目的 分析危重型新型冠状病毒肺炎死亡病例的临床特征, 提高对重症病例诊治的认识。 方法 收集 2020 年 1 月—5 月成都市公共卫生临床医疗中心接诊的危重型新型冠状病毒肺炎死亡病例资料, 回顾性分析其临床资 料和影像学特征。 结果 3 例危重型 COVID-19 死亡病例均有冠心病、伴或不伴肺部疾病、肾功能障碍等基础疾病, 均 有发热、咳嗽、咳痰症状, 入院 APACHE II 评分和 PSI 评分均为高危, 实验室检查结果提示肌酸激酶、肌钙蛋白、脑钠肽、C-反应蛋白及血清淀粉样蛋白 A 明显升高, 而 T 淋巴细胞计数明显下降, 胸部影像学提示双肺磨玻璃斑片影。入院后 给予积极的抗病毒、抗细菌、增强免疫治疗及有创机械通气呼吸支持。3 例患者均并发脓毒性休克及多器官功能衰竭 综合征等严重并发症, 起病到死亡的平均时间为 13.7 d。 结论 高龄、合并心脏病等基础疾病、免疫功能低下者是危重 型新型冠状病毒肺炎死亡的高危人群。

Distributed execution of bioinformatics tools on Apache Spark with ADAM and Cannoli

Distributed execution of bioinformatics tools on Apache Spark with ADAM and Cannoli

Effects of age on the use of lactate clearance rate to predict prognosis in septic shock patients

Objective To explore the effects of age on the use of lactate clearance rate (LCR) to predict prognosis in septic shock patients. Methods Septic shock patients who were admitted into the intensive care unit (ICU) of the Affiliated Hospital of Xuzhou Medical University from January 2015 to August 2018, with complete clinical data, were selected for retrospective analysis. According to their ages, they were divided into a non-elderly group (aged 18-74 years) and an elderly group (≥75 years old). Moreover, according to the outcome of hospitalization, the patients were divided into a survival group and a death group. The level of arterial blood lactate (Lac) was measured when the patients were diagnosed with septic shock (0 h), and 12 h and 24 h after treatment, while the LCRs at 12 h and 24 h were calculated. The scores of Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and Sequential Organ Failure Assessment (SOFA), the length of hospitalization stay and outcomes were recorded. The differences of above indicators in each group were analyzed. Results A total of 483 septic shock patients were collected, in which 286 patients met inclusion criteria, including 111 cases in the elderly group and 175 in the non-elderly group. There were 61 cases (55.0%) of death in the elderly group and 55 cases (31.4%) of death in the non-elderly group. The COX regression analysis and survival time curve showed that age was an independent risk factor for the prognosis of septic shock patients. The risk of death in the elderly group was 1.95 times higher than that in the non-elderly group. Patients in the death group in different age ranges presented higher APACHE Ⅱ scores, SOFA scores, and blood Lac levels as well as lower 24 h LCR than those in the survival group (P 0.05). APACHE Ⅱ score, SOFA score and blood Lac level were positively related with hospitalization mortality, but negatively related with LCR. Conclusions Age, APACHE Ⅱ score, SOFA score, Lac level and LCR are related factors of hospitalization outcome, where age is an independent risk factor for the prognosis of septic shock patients. LCR cannot be used to accurately evaluate the prognosis of elderly patients with septic shock. Key words: Septic shock; Lactate clearance rate; Prognosis; Age

Effect of lncRNA MALAT1 expression on survival status of elderly patients with severe pneumonia.

The aim of this study was to explore the relationship between serum MALAT1 level and clinical features of elderly patients with severe pneumonia and its impact on patients' survival. A total of 150 elderly patients with severe pneumonia were enrolled in this study. According to patients' prognosis, enrolled subjects were divided into two groups, including death group (n=63) and survival group (n=87). The clinical data and indicators of subjects were collected, and χ2 and t-tests were used for statistical analysis. MALAT1 expression in the serum of all subjects was examined through the qPCR assay. Meanwhile, the predictive value of MALAT1 for patient death was assessed by the receiver operating characteristic curve (ROC). PT, APTT, DD, APACHE II scores, and MODS scores in death group were remarkably higher, while HB, HCT, TT, and PaO2/FiO2 were conversely lower than those in survival group (p<0.05). QRT-PCR results revealed significantly increased MALAT1 expression in death group when compared with survival group, especially in those patients with a history of smoking and COPD (p<0.05). In addition, ROC analysis confirmed the predictive value of MALAT1 for the prognosis of elderly patients with severe pneumonia. MALAT1 is highly expressed in the serum of elderly patients with severe pneumonia. Furthermore, it may serve as a marker for the prediction of survival of these patients.

Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome caused by novel 2009 influenza A (H1N1) virus

To summarize the clinical experiences and indications of extracorporeal membrane oxygenation (ECMO) for severe ARDS caused by novel 2009 influenza A (H1N1) virus. All ECMO cases with severe ARDS associated with novel 2009 influenza A (H1N1) virus were analyzed in 5 intensive care units (ICUs) from 5 different hospitals in Beijing and Tianjin. A physician experienced in ECMO handling collected the relevant data, including general conditions pre and post-EMCO, efficacy and complication parameters, ventilator settings of mechanical ventilation and clinical outcomes. The statistical software of SPSS (version 11.5) was used for data analysis. 18 cases of novel H1N1 influenza with severe ARDS received ECMO. There were 9 males and 9 females (all pregnant). The mean age was (33 ± 11) years old. Eight were complicated with pulmonary barotraumas (6 of pneumothorax). Prior to ECMO, the patients underwent noninvasive and invasive positive pressure ventilation for 1 day and 60 hours respectively. Physiological parameters 2-6 hours prior to ECMO use were: (53 ± 14) mm Hg of PaO2/FiO2, (17 ± 5) cm H2O of positive end expiratory pressure (PEEP), 3.80 ± 0.29 of Murray lung injury score, (7.38 ± 0.10) of arterial pH, (3.3 ± 2.3) mmol/L of serum lactate, 16 ± 8 of APACHE II score. All patients treated venous-venous ECMO (VV-ECMO) for a mean duration of 8 days (range: 2 - 168). Settings of mechanical ventilation (prior to ECMO vs 2 hours post-ECMO) were: peak airway pressure (31 ± 7) vs (25 ± 6) cm H2O, respiratory rate (15 ± 4) vs (22 ± 6) breaths/min, FiO2 0.8 - 1.0 vs 0.35 - 0.50, PEEP (16 ± 5) vs (12 ± 4) cm H2O. Arterial blood gas (pH, PaO2 and PaCO2) post-ECMO of 2 hours and 24-hour significantly improved (P < 0.05). Seven patients died during ECMO, 11 patients were successfully weaned from ECMO. And 8 of them survived and were discharged. One patient stayed in ICU and 2 died in ICU. As an effective measure of respiratory supports, ECMO may provide pulmonary rest and improve gas exchanges in severe ARDS induced by novel H1N1 Influenza.

Clinical effect of intra-abdominal pressure monitoring on jejunal nutrition in critically ill patients

Objective To investigate the clinical effect of intra-abdominal pressure monitoring on jejunal nutrition in critically ill patients. Methods From March 2017 to September 2018, 124 critically ill patients who needed early jejunal nutrition in ICU of our hospital were selected and randomly divided into observation group (63 cases) and control group (61 cases) according to the digital table.The observation group adjusted enteral nutrition according to IAP monitoring, while the control group was routinely observed and guided enteral nutrition.Intra-abdominal pressure was compared between the two groups.The changes of blood lactic acid, endotoxin and APACHE Ⅱ score were compared between the two groups. Results After treatment for 7 days and 14 days, the intra-abdominal pressure of the observation group[(14.28±2.36)mmHg, (12.08±1.78)mmHg] were lower than those of the control group [(16.05±2.55)mmHg and (15.21±2.11)mmHg] (t=4.013, 8.939, all P<0.05). After treatment for 14 days, the blood lactic acid, endotoxin, APACHE Ⅱ score in the observation group were (2.19±0.73)mmol/L, (0.71±0.21)U/L and (10.02±1.54), which were lower than those in the control group [(3.98±0.95)mmol/L, (0.92±0.23)U/L and (13.06±1.72)] (t=11.788, 5.313, 10.376, all P<0.05). The incidences of abdominal distension (9.52%) and gastric retention (7.94%) in the observation group were significantly lower than those in the control group (28.57%, 27.87%) (χ2=7.930, 8.437, all P<0.05). Conclusion Early jejunal nutrition under the monitoring of intra-abdominal pressure in critically ill patients can help to reduce intra-abdominal hypertension, promote the rehabilitation of patients, reduce the incidence of complications of jejunal nutrition and improve patients’ tolerance, which is worthy of clinical promotion. Key words: Enteral nutrition; Pressure; Abdominal cavity; Lactic acid; Endotoxins; APACHE Ⅱ score

The role of Th17 cells and cytokines in the diagnosis and treatment of acute pancreatitis

Objective To study the role of Th17 cells proportions and the cytokines levels in the diagnosis and treatment of acute pancreatitis (AP). Methods Patients with AP (n=82) treated in our hospital between August 2017 and August 2018 were divided into the mild AP group (MAP, n=36), the moderately severe AP group (MSAP, n=26) and the severe AP group (SAP, n=20). Twenty-five healthy subjects were chosen as the control group. The proportions of Th17 cells and the levels of cytokines including IL-17, IL-21, IL-22 and IL-23 in peripheral blood from the four groups were analyzed. The APACHE II and Ranson scores were used to evaluate the illness severity. Spearman correlation analysis was conducted to detect the correlation between the Th17 cells, cytokines, and inflammatory factor, APACHE II and Ranson scores. Results Compared with the control group, the proportion of Th17 cells and the levels of IL-17, IL-21, IL-22 and IL-23 in the peripheral blood of MAP, MSAP and SAP groups were significantly increased (SAP>MSAP>MAP, P<0.05). The levels of inflammatory cytokines IL-6, IL-8 and TNF-α, and the scores of APACHE II and Ranson in the SAP group were significantly higher than those in the MSAP group and MAP group (P<0.05). The proportion of Th17 cells and their cytokine levels were positively correlated with IL-6, IL-8, TNF-α, APACHE II and Ranson scores. The levels of Th17 cytokines returned to normal in AP patients after treatment. Conclusion Th17 cells and the cytokines have certain clinical significance in evaluating early inflammatory response, severity of illness, and therapeutic effect in AP patients. Key words: Pancreatitis, acute; Th17 cells; Cytokines; Inflammatory response; Disease assessment

Observation on the effect of sitting and standing buttonback rehabilitation in the early stage of severe pneumonia

Objective To explore the therapeutic effect of sitting and standing on the back stroke in the early stage of severe pneumonia. Methods A total of 62 patients with severe pneumonia admitted to the hospital from September 2016 to September 2018 were selected as the objects of observation. They were divided into two groups by digital random method, the control group (31 cases) received routine back-tapping early rehabilitation treatment, and the observation group (31 cases) received sit-and-stand back-tapping early rehabilitation treatment.The clinical index, index of time, acute physiology and chronic health evaluation (APACHE Ⅱ), dyspnea index score (mMRC), pap index score (Barthel) and security of the two groups were compared. Results Among the clinical indicators, there were no statistically significant differences between the two groups in terms of PaO2/FiO2, feeding quantity and acute aggravation(P>0.05). However, the amount of gastric retention in the observation group was significantly lower than that in the control group(t=6.611, P 0.05). However, in terms of time index, the length of hospitalization in the observation group was significantly lower than that in the control group, and the difference was statistically significant(t=2.039, P 0.05). Conclusions For severe pneumonia patients, early sitting, standing and backstroke rehabilitation can help reduce gastric retention, reduce disease risk, relieve dyspnea, reduce daily disability, and shorten hospital stay without increasing safety issues. Key words: Severe pneumonia; Sitting position; Early rehabilitation; Gastric retention

Changes of serum procalcitonin level in patients with severe trauma and its relationship with multiple organ failure

Objective To investigate the changes of serum procalcitonin (PCT) level in patients with severe trauma, and to analyze its relationship with multiple organ failure (MODS). Methods From October 2013 to October 2018, the serum PCT levels were measured in 40 patients with severe trauma complicated with MODS (MODS group: 40 cases) and 62 patients without MODS (non-MODS group: 62 cases) in Yuncheng Central Hospital.The relationship between PCT and severity of trauma score (ISS), sequential organ failure (SOFA), acute physiology and chronic health status score (APACHE Ⅱ) and prognosis was analyzed.The predictive value of PCT in the prognosis of patients with MODS and severe trauma combined with MODS was analyzed by ROC. Results The serum PCT levels of the MODS group were (8.25±2.35)μg/L, (7.26±2.49)μg/L, (3.62±1.75)μg/L on the 1st, 3rd and 7th day after admission, respectively, which were higher than those of the control group (t=7.561, 9.561, 8.251, all P<0.05). The serum PCT level in the MODS group increased with the increase of APACHE Ⅱ score and ISS score (F=12.108, 9.173, all P<0.05). The serum PCT level in the death group was higher than that in the survival group[(11.82±3.75)μg/L vs.(4.92±1.26)μg/L], and the difference was statistically significant (t=7.959, P<0.05). The area under MODS curve predicted by PCT for severe trauma patients was 0.848, with sensitivity and specificity of 80.00%(32/40), 82.50%(33/40), respectively.The area under MODS curve predicted by PCT was 0.747, with sensitivity and specificity of 77.50%(31/40), 72.50%(29/40), respectively. Conclusion The serum PCT level in patients with severe trauma complicated with MODS is significantly higher than that in patients without MODS, and its level is closely related to trauma, disease progression and prognosis.It is of great value to predict the occurrence and prognosis of MODS. Key words: Wounds and injuries; Procalcitonin; Multiple organ failure; Injury severity score; ROC curve; Prognosis; Diagnosis

Analysis of correlation between liver function and severity of acute pancreatitis

Objective To explore the clinical value of liver function indicators in predicting the severity of disease in patients with acute pancreatitis (AP), and to provide a reference for clinical treatment. Methods A retrospective study was conducted and 142 patients with acute pancreatitis were included. The disease severity was evaluated according to the RANSON score and the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, and severe pancreatitis was used as the outcome index. Univariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed on single indicators that were statistically significant between mild and severe patients to determine the distinguishing value for disease severity. Results The RANSON score was graded: 43 cases of severe patients (RANSON≥3) and 99 cases of mild patients (RANSON<3); the difference in albumin (ALB) levels between the two groups was statistically significant (P<0.05). Univariate logistic regression analysis and ROC curve analysis were performed on ALB (OR=0.88, P<0.001). The area under the ROC curve and its 95% CI were 0.73 (0.63, 0.83). APACHE Ⅱ score classification: 94 cases of severe patients (APACHE Ⅱ score≥8) and 48 cases of mild patients (APACHE Ⅱ score<8). The difference in alanine aminotransferase (ALT) levels in the two groups were statistically significant (P<0.05). Univariate factor logistic regression analysis and ROC curve analysis were performed on ALT (OR=1.001, P=0.314). The area under the ROC curve and its 95% CI were 0.61 (0.50, 0.71). Conclusions ALB and ALT are valuable biomarkers for predicting the severity of AP. Key words: Liver function tests; Acute pancreatitis; Severity of illness

Alue of CRP, PCT and APACHEII for upper urinary calculi with urogenic sepsis

Objective To study the value of CRP, PCT and APACHE Ⅱ for upper urinary calculi with urogenic sepsis. Methods A retrospective analysis was made on clinical data of 71 cases of upper urinary calculi with urogenic sepsis from January 2015 to June 2018 in our hospital. All patients were divided into urogenic sepsis group and severe sepsis group. Gender, age, time of operation, CRP, PCT and APACHE Ⅱ values of the two groups were compared. Results The CRP values of the patients in the two groups was(45.92±12.31)mg/L and(61.31±18.82)mg/L, the PCT values of the patients in the two groups was(3.80±0.62)ng/mL and(5.55±1.47)ng/mL.There was significant difference in the APACHE Ⅱ score of the patients between the two groups(P<0.05). Conclusions The combined use of CRP, PCT and APACHE II score has a high value in evaluating the condition of patients with upper urinary calculi secondary to urogenic sepsis. Key words: Urinary Calculi; Sepsis; C-Reactive Protein; Calcitonin; Health Status Indicators

Establishment of a predictive model for outcomes in patients with severe acute pancreatitis by nucleated red blood cells combined with Ranson score and APACHE II score

Objective To explore a predictive model for outcomes of severe acute pancreatitis (SAP) patients. Methods A retrospective study was conducted of 102 SAP patients from January 1,2016 to April 30,2018 from Taizhou Hospital in this study. The participants were divided into survival group and death group according to the outcome of 90 days after admission,88 cases were in survival group including 57 males and 31 females, aged 55.5 (40.3-69.8) years; 14 cases were in death group including 5 males and 9 females, aged 63.0 (50.8-80.8) years. Clinical data and laboratory indicators were compared between the two groups. Statistical analyses were performed to compare categorical variables. Chi-square automatic interaction detector (CHAID) was used to construct the prediction model of SAP patients′ outcomes. The study cohort consisted of SAP patients from August 1st 2018 to July 1st 2019 were collected to validate the prediction model. Results (1)Statistical analyses were performed by chi square test and Mann-Whitney U test. There were statistically significant differences in the proportion of cardiovascular and cerebrovascular diseases, mechanical ventilation and septic shock, and also the Charlson complication index (CCI), the Ranson score and APACHEⅡscore(χ2=5.554, P=0.018; χ2=5.585,P=0.018;P=0.008;Z=-3.007,P=0.003;Z=-2.982, P=0.003; Z=-3.257, P=0.001), death group were higher than survival group. (2) The MPV, CRP, MCHC, pH, pCO2 and positive rates of NRBC were statistically different between survival group and death group(Z=-2.466,P=0.014;Z=-2.689,P=0.007;Z=-2.238,P=0.025;Z=-1.977,P=0.048;Z=-2.239, P=0.025;P=0.000).The NRBC-positive rate in the death group was higher than that in the survival group, while the other indexes were lower in the survival group.(3)The decision tree CHAID method obtains the prediction scheme: when it meets the Ranson score≤3, the SAP patients were judged to be alive; when it meets the Ranson score>3 and the NRBC in peripheral blood was negative, the SAP patients were judged to be alive; when it meets the Ranson score>3, the NRBC was positive and the APACHEⅡscore≤21, the SAP patients were judged to be alive; when it meets the Ranson score>3, NRBC was positive and APACHE Ⅱ>21, the SAP patients were adverse prognosis. (4) 50 SAP patients were collected in the validation group, with 43 actual survivors and 7 deaths. The accuracy rate of predicting the outcomes of SAP patients in validation group with the scheme was 94.0% (47/50). Conclusion The NRBC combined with Ranson score system and APACHE II score system can predict the outcomes of SAP patients. Key words: Acute disease; Pancreatitis; Erythroblasts; APACHE

Clinical study on early application of continuous blood purification in the treatment of severe craniocerebral injury

Objective To study the clinical significance of early usage of continuous blood purification on the treatment of severe craniocerebral injury. Methods 85 Patients with severe brain injury admitted in our department were randomly divided into continuous blood purification treatment group (experiment group, 42 patients) and conventional treatment group (control group, 43 patients). patients in continuous blood purification treatment group were treated by continuous blood purification and traditional treatment from 1-7 days, traditional treatment group only were treated by the traditional treatment methods. To detect tumor necrosis factor (TNF)-α, neuron specific enolase (NSE) and pNF-H in 1 and 5 day. On the 28th day Apache Ⅱ score, ICU stay time and GCS score of two groups. To detect 6 months survival rate of two groups. Spss15.0 software was used for statistical analysis, The measurement data are subject to T test The survival rate and quality of life comparison between the two groups was compared by χ2 test, P<0.05 was considered statistically significant. Results Incidence of 5 days of TNF-α (4.85±0.45) ng/L (t=6.890, P 0.05). Conclusion Early continuous blood purification treatment improves the survival rate and quality of life of patients with severe brain injury which have higher clinical value. Key words: Continuous blood purification; Sever brain injury; Early treatment

Comparison of MPI and APACHE II in the Prognosis of Perforating Peritonitis

Comparison of MPI and APACHE II in the Prognosis of Perforating Peritonitis

Analysis of pathogens and risk factors of severe acute pancreatitis complicated with infection

Objective To investigate the characteristics of pathogens and risk factors of severe acute pancreatitis (SAP) complicated with infection, so as to provide reference for clinical diagnosis and treatment. Methods From February 2011 to January 2018, at the First Affiliated Hospital of Chongqing Medical University, 438 patients with SAP were selected. The samples including ascites, sputum and blood were collected and cultured. Distribution and drug resistance of pathogens were analyzed. Chi-square test and logistic regression analysis were used for analyzing the risk factors related to SAP complicated with infection. Results The total infection rate of SAP was 49.09% (215/438), of which the bacterial infection rate was 44.29% (194/438) and the fungal infection rate was 22.60% (99/438). A total of 625 pathogens were cultured, including 333 (53.28%) strains of Gram-negative bacteria, 171 (27.36%) strains of Gram-positive bacteria and 121 (19.36%) strains of fungi. Gram-negative bacteria were extremely resistant to β-lactams antibiotics, among them Acinetobacter baumannii was the highest (63.93% to 100.00%), and resistance rate to enzyme inhibitors was slightly lower (11.54% to 48.15%). The resistance rates of Gram-positive bacteria to penicillin and erythromycin were both high, which were 92.86% to 100.00% and 81.25% to 95.00%, respectively, and Gram-positive bacteria resistant to vancomycin, linezolid, and tigecycline were not found. The resistance rate of fungi was generally low (0 to 28.57%). The results of logistic regression analysis showed that multiple organ dysfunction syndrome (MODS) (odds ratio (OR)=2.031, 95% confidence interval (CI)1.230 to 3.356), acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score≥11 (OR=1.780, 95%CI 1.129 to 2.806), fasting time more than three weeks (OR=3.437, 95%CI 2.119 to 5.574), mechanical ventilation (OR=2.697, 95%CI 1.643 to 4.427) and surgery (OR=3.464, 95%CI 1.806 to 6.643) were the independent risk factors of SAP complicated with infection (all P<0.05). The results of stratified analysis indicated that MODS, fasting time more than three weeks, mechanical ventilation and surgery were the independent risk factors of more locus infection (all P<0.05). Conclusions The infection rate of SAP is high and the risk factors are complex. Early prevention, improvement of the pathogen detection and guiding the reasonable use of antibiotics are necessary. For patients with invasive procedures and treatment, aseptic awareness should be strengthen to prevent iatrogenic infection. Key words: Infection; Drug resistance; Risk factors; Severe acute pancreatitis

Segurança na aplicação da eletroestimulação neuromuscular no doente crítico: estudo piloto

INTRODUÇÃO: A Neuromuscular Electrical Stimulation (NMES) é um importante aliado do paciente crítico, favorecendo contrações ativas mesmo em estado que requer imobilidade.OBJETIVO: Verificar a segurança da aplicação da NMES em Unidades de Terapia Intensiva (UTIs) de um hospital público da cidade de Salvador. MÉTODO: Trata-se de estudo piloto, de intervenção. Os dados foram coletados no período de fevereiro a junho de 2018, com amostra por conveniência em uma população de pacientes críticos intubados e em uso de vasopressores. Foi aplicada uma única sessão de 45 minutos de NMES em ambos os quadríceps (músculo reto femoral e vasto lateral), sendo coletados os seguintes dados hemodinâmicos 5 minutos antes da aplicação e logo após a terapêutica: frequência cardíaca, pressão arterial sistólica, diastólica e média; e frequência respiratória. Estes dados foram avaliados seguindo recomendações de segurança já descritas previamente. Para análise estatística, as variáveis foram descritas através de médias e desvio-padrão, mediana e intervalo interquartílico e percentuais obtidos nas variáveis do estudo. A distribuição dos dados foi avaliada pelo teste Shapiro-Wilk, e os testes Mann Whitney e T de student foram utilizados. RESULTADOS: A amostra foi composta por 8 pacientes sendo 1 excluído. Destes, 85,7% era do sexo feminino, sendo o diagnóstico clínico de Sepse evoluindo para choque em 85,7%, média da idade de 61±9,5 anos e APACHE II de 29±5,5. Não foram evidenciadas diferenças estatísticas em relação aos dados hemodinâmicos coletados pré e pós eletroestimulação. Estes dados são semelhantes aos resultados encontrados por outros autores em populações sem uso de vasopressores. CONCLUSÃO: É possível sugerir que a aplicação da NMES no doente crítico em uso de vasopressores é uma técnica segura e viável desde que respeitando os limites estabelecidos e parâmetros corretos baseados em evidências.

A comparative study on transnasal gastroscopy and conventional gastroscopy for percutaneous endoscopic pancreatic necrosectomy

Objective To compare the therapeutic value of transnasal gastroscopy and conventional gastroscopy for infective pancreatic necrosis(IPN) through percutaneous endoscopic necrosectomy(PEN). Methods A total of 24 IPN patients who received PEN for IPN from December 2015 to March 2019 were divided into the conventional gastroscopy group (n=15) and the transnasal gastroscopy group (n=9). The clinical therapeutic indicators such as vital signs, APACHE Ⅱ score changes, operation duration, difference in preoperative and postoperative volumes of peripancreatic necrosis and other indicators were compared between the two groups. Results There was no significant difference in the variation curve fitting of APACHE Ⅱ scores between the two groups (t=0.378, P=0.710). The operation time of the transnasal gastroscopy group was significantly shorter than that of the conventional gastroscopy group (119.7±47.4 min VS 172.8±56.2 min, P=0.018). Peripancreatic necrotic volume significantly decreased after operation in the transnasal gastroscopy group (404.03±170.73 mL VS 468.9±137.37 mL, P=0.002), and in the conventional gastroscopy group (499.44±227.17 mL VS 722.50±292.96 mL, P<0.001). There was no significant difference in the decrease extent in the conventional gastroscopy group and the transnasal gastroscopy group (223.06±212.92 mL VS 64.87±54.94 mL, P= 0.094). Conclusion On the condition of poor drainage of percutaneous catheter drainage, PEN can significantly reduce the range of necrotic lesions. Transnasal gastroscopy has the advantages in operation time in PEN and clearing deep abscess cavities over conventional gastroscopy. Key words: Pancreatitis; Percutaneous endoscopic necrosectomy; Infective pancreatic necrosis