胃肠功能障碍和衰竭对老年危重病患者临床预后的影响

目的:分析胃肠功能障碍与衰竭对老年危重病患者临床康复情况及预后的影响,旨在为老年人的危重病临床护理与治疗提供参考.方法:将105例危重病患者分为胃肠功能障碍组和非胃肠功能障碍组,观察2组患者30d内多器官功能障碍综合征(MODS)的发生率、APACHEⅡ评分和病死率,胃肠功能障碍组存活患者和死亡患者GIDF评分.结果:胃肠功能障碍组30d内MODS发生率、病死率、APACHEⅡ评分均明显高于非胃肠功能障碍组.结论:胃肠功能障碍与衰竭可影响老年危重病患者的临床康复和存活情况,需提高临床重视程度.     

动态APACHEⅢ联合MODS评分在ICU临床研究中的应用

目的应用动态急性生理学及慢性健康状况评估Ⅲ（APACHEⅢ）评估重症监护病房（ICU）患者的病情及预后;同时对比动态APACHEⅢ评分,多器官功能障碍综合征（MODS）评分预测患者预后与实际预后的关系。方法收集整理286例危重症患者资料,分为存活组252例,死亡组34例,比较两组第1、3、5、7天应用APACHEⅢ系统评分,同时进行MODS评分及预后预测。结果第1、3、5、7天APACHEⅢ分值和预测病死率死亡组均高于存活组（P〈0.05或P〈0.01）,动态评分更有助预后判断;APACHEⅢ评分与MODS评分高低有一致性;MODS评分与死亡率有关。结论动态APACHEⅢ评分系统联合MODS评分系统可用于ICU病房患者病情及预后评估,是医疗质量及合理利用ICU资源的依据。     

原位肝移植合并重症脓毒症病人的临床研究

目的观察肝移植合并重症脓毒症病人的相关检验和临床指标，旨在总结原位肝移植合并重度脓毒症这一特殊感染人群的ICU治疗经验。方法回顾性分析入住外科ICU术后的56例符合重症脓毒症标准者病人，分成2组：非肝移植组（A组）和肝移植组（B组）。分别在第1天、第3天和第7天记录病人一般情况、血乳酸、器官衰竭个数、APACHEⅡ评分和MODS评分。观察住院28d的存活率和随访情况。结果非肝移植组合并重症脓毒症住院死亡率30％，而在肝移植组则为57．6％。肝移植组第l天血乳酸比非肝移植组明显升高，差异有统计学意义（P〈0．01），随之有所下降，但7d内仍然高于非肝移植组；肝移植组器官衰竭个数比非肝移植组明显增多，差异有统计学意义（P〈0．01）；2组观察期间APACHEⅡ动态评分差异无统计学意义（P〉0．05）；MODS动态评分在肝移植组比非肝移植组明显升高，差异有统计学意义（P〈0．01）。结论原位肝移植合并重症脓毒症住院28d死亡率约是非肝移植组的2倍，值得高度重视。原位肝移植合并重症脓毒症病人更容易合并有多器官功能衰竭且病情较难逆转。肝移植合并重症脓毒症病人判断病情和器官功衰竭程度的轻重，MODS评分优于APACHEⅡ评分。建议改进或者制定器官移植特有的评分标准并且应该加入血乳酸。     

ICU重症患者TNFα和CRP测定应用的探讨

目的通过定量测定ICU危重患者肿瘤坏死因子-α（TNF—α）和C-反应蛋白（CRP）的浓度,探讨两者的临床意义。方法将100例危重患者,根据APACHEⅡ评分系统分为A组（〈15分）25例,B组（15～25分）55例,C组（〉25分）20例,按病情分为MODS组38例,非MODS组62例。正常对照组为体检健康者50例。采集每组患者血标本,采用酶联免疫吸附法（ELISA）检测标本TNF—α、cTnI和CRP浓度。结果危重患者的TNF—α和CRP浓度均高于健康体检组（P〈0．01）;不同APACHEⅡ评分组之间TNF-α和CRP差异有统计学意义（P〈0．05或0．01）;MODS组患者的TNF-α和CRP值明显高于非MODS组（P〈0．01）。结论危重患者TNF-α、CRP和A—PACHEⅡ评分有较好的相关性,病情越重,两者的值越高。因此,可用于评价危重患者病情严重程度,对于预测预后有一定的临床意义。     

APACHEⅡ评分对急诊室无创通气治疗患者的预后评估价值

目的应用急性生理与慢性健康状况评分（APACHE）Ⅱ评分系统对急诊内使用无创通气治疗的患者进行病情顸后分析。方法回顾性分析2010年1月一2012年7月急诊室使用无创通气的急危重症患者的APACHEⅡ评分结果,根据患者的死亡和接受气管插管作为预后不良,成功脱机为预后良好,比较预后良好和预后不良患者临床特征、病因和APACHEⅡ分值间的差异,评价APACHEⅡ和预后的相关性。结果62例入选病例中男34例,女28例,根据BIPAP治疗后病情转归情况分为：预后良好组32例,预后不良组30例。预后不良组APACHEⅡ评分分值明显高于预后良好组（P〈0．01）,单因素回归分析发现APACHEⅡ分值与患者预后不良的发生率呈正相关（OR：1．112,P=0．029）,APACHEⅡ分值可预测患者预后不良,曲线下面积为0．658（P〈0．02）,Cutoff值为〉17,其诊断灵敏度为66．67（47．2～82．7）,特异度为59．38（40．6～76．3）。阳性预测值60．6（42．1—77．1）,阴性预测值65．5（45．7～82．1）。结论APACHEⅡ评分对急诊室内使用无创通气的不同病因的患者具有一定的预后预测作用。     

连续性血液净化救治心脏术后重症肾衰竭的疗效分析

目的探讨连续性血液净化（CBP）治疗心脏术后重症急性肾衰竭（ARF）的效果和时机选择。方法31例行CBP治疗的重症ARF患者分为生存组（A组）和死亡组（B纽）。观测两组治疗前后平均动脉压（MAP）、氧舍指数（PaO2／FiO2）、肾功能（Cr、BUN）、MODS评分和APACHEⅡ评分；比较2组CBP距ARF和尿量〈0．5ml／（Kg·h）时间。结果CBP前B组MODS评分、APACHEⅡ评分均明显高于A组；CBP后，仅A组MODS评分、APACHEⅡ评分下降；CBP后2组Cr、BUN降低，MAP、PaO2／FiO，升高；B组的CBP距ARF和尿量〈0．5ml／（Kg·h）时间长于A组（P均〈0．05）。结论CBP治疗心脏术后重症ARF是安全有效的，尽早行CBP有利于改善患者预后。     

医院获得性肺炎患者单核细胞人类白细胞抗原DR表达与预后

目的 探讨单核细胞人类白细胞抗原DR（HLA—DR）在转入重症监护病房（ICU）的医院获得性肺炎（HAP）患者中预测预后的价值。方法 对ICU内68例HAP患者根据预后分为死亡组和存活组，比较两组单核细胞HLA-DR、APACHE Ⅱ评分、皮质醇、T细胞亚群和NK细胞；采用Logistic回归模型对单核细胞HLA-DR、APACHE Ⅱ评分与28d住院病死率相关性进行分析。结果 死亡组单核细胞HLA-DR低于存活组（P〈0．05），而APACHE Ⅱ评分和皮质醇水平高于存活组（P〈0．01）；人ICU时单核细胞HLA-DR和APACHEⅡ评分与预后相关，单核细胞HLA-DR与28d住院病死率均和皮质醇水平呈负相关。结论 HAP患者的单核细胞HLA-DR表达水平与预后相关，将APACHE Ⅱ评分与单核细胞HLA-DR结合分析能提高预后预测的准确性。     

早期肠道复苏对危重症病人急性胃肠功能障碍的防治作用

目的研究早期肠道复苏法对危重症病人急性胃肠功能障碍的防治作用及护理效果。方法随机将入住ICU的107例危重症急性胃肠功能障碍患者分为研究组(早期肠道复苏组)、对照组两组。研究组为研究组(54例),对照组为常规治疗组(53例)。观察两组危重症病人胃肠功能障碍缓解时间、多器官功能障碍综合征(MODS)的发生率、住院费用及时间的差异。结果早期肠道复苏组病人的胃肠障碍缓解时间明显缩短,MODS的发生率及病死率明显降低,住院费用及时间均少于对照组。结论早期肠道复苏方法用于危重病人的急性胃肠功能障碍的防治及护理,安全、有效。     

急诊创伤患者血清中C-反应蛋白/脂联素水平与患者胃肠道功能、病情及预后的关系

目的探讨急诊创伤患者血清中C-反应蛋白/脂联素水平与患者胃肠功能、病情及预后的关系。方法选取2015年8月-2016年4月在本院诊断为急诊创伤的患者90例,检测患者血液中C-反应蛋白(CRP)和脂联素(APN)水平,采用胃肠功能评分评价患者胃肠功能、采用APACHEⅡ评分评价患者病情、分析CRP/脂联素与患者胃肠功能和病情的关系及预后的关系。结果本研究中共16例患者为预后不良,预后不良组患者血清CRP、CRP/APN水平高于预后良好组,而APN水平低于预后良好组,差异有统计学意义(P0.05)。CRP、CRP/APN水平与胃肠功能、血清DAO、D-乳糖、APACHEⅡ评分呈正相关,而APN与胃肠功能、血清DAO、D-乳糖、APACHEⅡ评分呈负相关(P0.05)。APN、CRP/APN、APACHEⅡ评分是患者死亡的独立风险因素(P0.05)。结论急诊创伤患者血清中CRP/ANP与患者预后密切相关。     

危重症患者血糖动态水平监测及其对预后的影响

目的探讨危重症患者血糖动态水平监测及其对患者预后的影响。方法收集綦江县人民医院急诊ICU收治的危重症患者160例,以入院时空腹血糖升高的程度进行分组：A组（血糖≤6.1 mmol/L）21例,B组（血糖6.1~10mmol/L）68例,C组（血糖≥10 mmol/L）71例。应用美国强生one TouchR ultraTM微机血糖仪及试纸对所有患者进行血糖动态监测。观察三组患者入ICU时急性生理和慢性健康状况评分（APACHE Ⅲ评分）、住ICU天数、多器官功能衰竭综合征（MODS）发生率及住院死亡情况。同时根据患者预后,将160例病例分为生存组112例和死亡组48例,收集所有患者入ICU 1、6、12、24、48、72 h时的血糖动态监测结果。结果三组APACHE Ⅲ评分、住ICU天数比较差异均有统计学意义（P均〈0.01）。A组和B组MODS发生率均明显低于C组（P均〈0.01）,而A组MODS发生率略高于B组,但两组之间差异无统计学意义。A组和C组住院死亡率均明显高于B组（P均〈0.01）,而C组住院死亡率略高于A组,但两组之间差异无统计学意义。在入ICU 1、6、12、24、48、72 h每个时间点上,生存组的血糖水平呈持续下降,而死亡组血糖呈持续升高,明显高于生存组（P均〈0.01）。结论血糖动态变化与危重症患者的预后密切相关,可作为危重症患者的重要临床监测指标。     

Attitudinal and experiential correlates of anorgasmia

Twenty-four orgasmic and 10 anorgasmic women, ages 21–40, provided continuous self-report measures of sexual arousal while viewing explicit videotape segments depicting a variety of sexual activities. They also completed several questionnaires designed to assess sexual attitudes, knowledge, and guilt. As compared to the orgasmic women, the anorgasmic women reported (i) greater discomfort in communicating with a partner regarding only those sexual activities involving direct clitoral stimulation, (ii) more negative attitudes toward masturbation, (iii) greater endorsement of sex myths, and (iv) greater sex guilt. Contrary to expectations, the groups failed to differ significantly on either the frequency of use of any of the sexual activities depicted or on arousal to viewing these activities. The theoretical and clinical implications of these findings are explored.This research was supported in part by an NIH Biomedical Research Support Grant to the second author.     

Frequency of sexual problems and sexual dysfunction in middle-aged Danish men

The frequency of sexual dysfunction of a representative group of Danish middle-aged men was recorded, using a questionnaire and an interview that contained, respectively, 12 and 23 questions about sexual problems. The study sample consisted of 439 51-year-old men, all of whom received the questionnaire. Of these men, 100 were also interviewed. Interviewed men more frequently reported erectile dysfunction and previous contact with a therapist due to sexual problems at interview than in the questionnaire. Thus, 16 men (4% of the study population) who reported erectile dysfunction in the questionnaire constituted only a fraction of the true number. At interview nearly 40% of the men reported some kind of sexual dysfunction. There were, however, only 7% who found their problems abnormal for their age—and only 5% of the interviewed men intended to seek treatment for their problems.This project was supported by the Danish National Health Insurance Foundation (Journals H 11/118-86, H 11/80-87 and H 11/137-87) and utilized the statistical service of the Danish Medical Research Council.     

维生素B_6对脑瘫幼鼠认知障碍和步态异常的改善作用

目的:长期维生素B6(VB6)消化道给予脑瘫模型幼鼠,探讨其对认知功能障碍和步态异常的作用及可能机制。方法:14d龄Wistar大鼠54只随机分为脑瘫组(CM,n=18),VB6处理组(CM+VB6,n=18)和假手术组(CS,n=18)。采用改良的Philip方法,建立缺血缺氧脑瘫模型(右侧肢体偏瘫);应用Morris水迷宫试验(MWMT)检测各组大鼠认知功能的变化,观测其寻找水下平台的逃避潜伏期(EL)和游泳距离(SD);应用Footprintpatterntest(FPT)检测各组大鼠步态的变化,观测其左/右侧步长(LSL,RSL)、前肢间距离(FBW)、后肢间距离(HBW)和左/右侧前、后爪心间距离(DLFHFO,DRFHFO)。结果:MWMT:从D12起CM+VB6组EL、SD较CM组缩短(P<0.05)。从D19起CM+VB6组EL与CS组无差异(P>0.05),D20CM+VB6组SD与CS组无差异(P>0.05)。FPT:CM+VB6组与CM组比较,从D5起LSL、RSL增大(P<0.05),从D7起HBW、DRFHFO减小(P<0.05)。CM+VB6组和CS组比较,从D1起RSL、HBWD、RFHFO增大(P<0.05),从D5起LSL减小(P<0.05),D9FBW减小(P<0.05)。结论:VB6对脑瘫幼鼠认知功能障碍、步态异常有改善作用,改善效果随补充时间延长而增强。     

Psychosexual dysfunction in Indian male patients: Revisited after seven years

Short-term (1 year) outcome of 66 male patients with psychosexual dysfunction was studied in the context of patients' sociodemographic and clinical characteristics. A combination of erectile dysfunction and premature ejaculation was the most common diagnosis. Long-term (7 years) outcome of this cohort was evaluated in relation to short-term outcome. Improvement in the short-term indicated favorable long-term outcome. Initial dropout was associated with chronic and continuous sexual dysfunctioning.     

Aphasia and Sexuality

Changes in sexuality following stroke have attracted the interest of clinical researchers, but studies seldom include aphasic individuals, who comprise almost one third of the stroke population. Studies excluded those with moderate or severe aphasia because they cannot participate in interviews or complete questionnaires used in sexuality research. This pilot study investigated how stroke changed sexuality for aphasic people and their spouses. We sought their input as to when these issues should be addressed during the process of stroke recovery, and by whom. Interviews included a structured verbal questionnaire supported by gesture, written, and pictographic materials. Responses were qualitatively analyzed. We found that aphasia affects sexuality differently than for other stroke patients. They believe that improved communication skills would help their sex life. Aphasic individuals and their spouses are open to discussing sexuality with a physician and have specific medical, physical, and psychological issues they wish to address.     

Treatment of secondary orgasmic dysfunction: An outcome study

This study investigated the differential effectiveness of various treatment formats for 55 couples in which the woman reported secondary orgasmic dysfunction (defined as the inability of the woman to reach orgasm during intercourse, with or without clitoral stimulation, more than 50% of the time for the last 5 months). Couples received two 2-hr sessions of sexual reeducation and were then assigned into one of four treatment conditions (a communication skills format, a sexual skills format, one of two combination formats) or into one of two control conditions (an attention-comparison control condition which consisted of didactic presentations, or a waiting-list control condition). Treatment was conducted by one of two female clinical psychologists in groups of between four to six couples. No significant differences were found between the different treatment conditions at the posttest or at the 6-month follow-up. Statistical comparisons conducted between the combined treatment and combined control conditions showed that the couples who received treatment reported significantly less overall sexual dissatisfaction and significantly greater sexual harmony at the posttest; however, these differences became nonsignificant at the follow-up. In comparison with the women in the control conditions, a significantly greater number of women who received treatment reached or exceeded the project's 50% criterion for coital orgasmic functioning at the posttest; however, these differences became nonsignificant at the follow-up. Couples who reported less relationship adjustment prior to treatment showed greater overall gains in coital orgasmic frequency than couples who reported better relationship adjustment.This study is part of an investigation funded by NIMH Grant #MH32241.     

呼吸衰竭并发多脏器功能障碍的临床特点分析

目的通过呼吸衰竭并发多脏器功能障碍的临床特点分析,探讨防治该病的方法。方法回顾分析了９６例慢性阻塞性肺疾患（ＣＯＰＤ）所致呼吸衰竭并发多脏器功能障碍的患者。结果≤３个,４或５个,≥６个器官功能障碍患者的死亡率分别为２３％,５６％,８８％（Ｐ＜０．０１）。≤３个,４或５个,≥６个器官功能障碍患者的动脉血ｐＨ分别为７．３６５±０．０９４,７．３０９±０．０８２,７．２８７±０．０５７（Ｐ＜０．０１）。≤３个,４或５个,≥６个器官功能障碍患者的ＰａＯ２分别为５２．９３±１６．１８,３７．４３±９．３４,２７．１９±７．１４ｍｍＨｇ（Ｐ＜０．００１）。所有的患者均有感染。结论多脏器功能障碍是ＣＯＰＤ所致呼吸哀竭的主要死亡原因之一,而感染、酸血症和低氧血症是导致ＣＯＰＤ所致呼吸衰竭并发多脏器功能障碍的主要危险因素。