床旁超声在急危重症中的临床价值

目的探讨床旁超声检查在急危重症诊断中的临床应用价值。方法回顾性分析我院近2年行床旁超声检查的496例患者资料,其中心血管急危重患者172例,腹部急危重患者324例。结果超声诊断与临床诊断相符470例,其中急性心肌梗死76例、主动脉夹层7例、肺栓塞5例、心包积液82例、内脏损伤162例、急性胰腺炎30例、异位妊娠54例、黄体破裂38例及前置胎盘16例,符合率94.8%。漏诊26例,占5.2%。结论床旁超声检查为急危重症患者迅速、方便地提供有价值的诊断信息,具有重要的临床应用价值。     

Understanding, recognizing, and managing chronic critical illness syndrome

Purpose: No evidence-based guidelines exist for the care of patients with chronic critical illness syndrome (CCIS), a growing population of patients being cared for by nurse practitioners (NPs). The purpose of this article is to provide NPs with a beginning physiological framework, allostasis, to guide their understanding and management of patients with CCIS.
Data sources: Scientific publications, related clinical guidelines.
Conclusions: Patients with CCIS are a distinct group of critically ill patients whose care needs are different from those of patients who are acutely critically ill. These patients demonstrate widespread tissue and organ damage. The widespread tissue and organ damage results in a syndrome of interrelated elements, which include neuroendocrine problems, severe malnutrition, wounds, infections, bone loss, polyneuropathy and myopathy, delirium and depression, and suffering.
Implications for practice: In caring for patients with CCIS, NPs need to focus on treating the elements of the syndrome as a cohort of interrelated elements and on re-establishing normalcy for the patient.     

测定血清肿瘤坏死因子在急性危重病中的临床意义

测定了54例急性危重病患者和21例正常人血清肿瘤坏死因子水平。结果表明:血清肿瘤坏死因子在急性心肌梗塞组(26.40±19.74U/ml)、脑卒中组(18.25±4.94U/ml)和心衰组(38.57±48.18U/mkl)均较正常对照组(15.80±1.70U/ml)升高(P<0.05)。在54例危重患者中有7例血清肿瘤坏死因子明显升高。作者认为危重病患者血清肿瘤坏死因子升高与病变的严重程度、有无并发症和感染有关。     

腹腔压力分级管理在慢重症患者肠内营养实施中的效果与评价

目的：分析腹腔压力分级管理在慢重症患者肠内营养(EN)实施中的效果。 方法：回顾分析2018年8月至2019年7月入住东部战区总医院普通外科7ICU的慢重症实施EN患者。 结果：研究共纳入100例符合纳排标准的慢重症患者,其中50(50%)例在EN期间实施腹腔压力分级管理(腹腔压力导向组/观察组),50(50%)例实施常规EN治疗(标准组/对照组)。腹腔压力导向组患者ICU住院时间较对照组患者明显缩短[(24.98 ± 5.24) d vs (27.48 ± 6.18) d,P = 0.031]。观察组患者在EN出现不耐受的总例次情况明显好于对照组(14次vs 42次,P < 0.05)。观察组患者的喂养中断情况和中断时间明显低于对照组患者(P < 0.05)。观察组患者营养指标(血清总蛋白、血红蛋白、体重指数)在实施腹腔压力分级管理14 d后明显好于对照组(P < 0.05),此外,观察组较对照组相比目标喂养量更易达标(92.98 ± 9.67 vs 83.06 ± 20.03 ,P < 0.01)。 结论： 慢重症患者EN期间通过腹腔压力分级管理可以改善预后,可用于CCI患者的治疗。     

简化新生儿危重病例评分法的临床应用评价

目的 通过与2001年发表的新生儿危重病例评分法(NCIS)进行比较,探讨简化新生儿危重病例评分法在临床应用的可行性.方法 这是一项前瞻、对照的临床研究.选取705例2007年1月1日至2009年12月31日首都儿科研究所重症监护病房(NICU)收治的外院转运新生儿,于入院当日、第3,7天及出院或死亡时进行新生儿危重病例评分.首次评分时,在10项评分指标中减去动脉血氧分压(PaO2)和pH,余8项指标;在其后3次评分时,再减去血钠、钾和肌酐或尿素氮,余5项指标,彤成新的简化评分法.分析简化新生儿危重病例评分与原评分方法对病情评估的符合率(>80%)及二者的相关性.结果 人院首次评分使用8项指标,与原病情评估一致的符合率为86.7%,第3,7天和末次评分使用5项指标,与原病情评估一致的符合率为86.6%-95.7%,简化前后有良好的相关性(P<0.01).简化后的首、末次评分,非危重、危重和极危重三组患儿的病死率差异有统计学意义(P<0.01),与NCIS的结果一致;简化前后相同病情程度患儿的病死率差异无统计学意义(P>0.05).结论 与NCIS相比,简化NCIS法对患儿病情的评估基本一致,可以较准确客观评价危重新生儿,是一种简便易行的临床评分方法.

Abstract：

Objective To discuss the clinical application of simplified neonatal critical illness score (sNCTS)in comparison with original neonatal critical illness score(oNCIS)published in 2001.Method A total of 705 neonates referred to neonate ICU(NICU)from 1 st January 2007 to 31th December 2009 were prospectively studied with control.The patients were scored by oNCIS on admission day,3rd,7th days after admission and on the day of discharge or dead.At the first scoring on admission,2 items of the PaO2 and pH were excluded from oNCIS's 10 items,and the remaining 8 items were used.Three items of plasma sodium,potassium and creatinine or BUN were scored out from 8 items and the still remained 5 items were used for the subsequent 3 scorings.The remaining 8 and 5 items were used as a simplified neonatal critical illness score.The simplified NCIS was evaluated by comparing the patients'condition that was assessed by the originat NCIS.The consistency rate between oNCIS and sNCIS should be over 80%.Results There were 8 items were used to evaluate the severity of disease on admission, and the consistence rate was 86.7%with the original NCIS.The 5 items selected from the original NCIS were used on the 3rd,the 7th days and the day of discharge or death.the consistence rate with original NCIS were 86.6%to 95.7%.A close correlation existed between the original NCIS and simplified NCIS(P<0.01).There were significant differences in mortality rates of the non-serious,serious and extremely serious groups between original NCIS and simplifled NCIS used for the first and the last seorings(P<0.01).Within a cohort of neonates with the same general condition,the assessments of mortality rates were not significantly different between these two methods (P>0.05).Conclusions Compared with the original NCIS.the simplified NCIS is consistent to a large extent in disease assessment,which is a concise way to evaluate the critical ill neonates objectively and can be easily applied to clinical practice.     

Alcoholism and critical illness: A review

Alcohol is the most commonly used and abused drug in the world, and alcohol use disorders pose a tremendous burden to healthcare systems around the world. The lifetime prevalence of alcohol abuse in the United States is estimated to be around 18%, and the economic consequences of these disorders are staggering. Studies on hospitalized patients demonstrate that about one in four patients admitted to critical care units will have alcohol-related issues, and unhealthy alcohol consumption is responsible for numerous clinical problems encountered in intensive care unit (ICU) settings. Patients with alcohol use disorders are not only predisposed to developing withdrawal syndromes and other conditions that often require intensive care, they also experience a considerably higher rate of complications, longer ICU and hospital length of stay, greater resource utilization, and significantly increased mortality compared to similar critically ill patients who do not abuse alcohol. Specific disorders seen in the critical care setting that are impacted by alcohol abuse include delirium, pneumonia, acute respiratory distress syndrome, sepsis, gastrointestinal hemorrhage, trauma, and burn injuries. Despite the substantial burden of alcohol-induced disease in these settings, critical care providers often fail to identify individuals with alcohol use disorders, which can have significant implications for this vulnerable population and delay important clinical interventions.     

Attitudes of midwives and maternal child health nurses towards suicide: A cross‐sectional study

Perinatal women are at risk of depression and/or suicidality. Suicide is the highest cause of indirect maternal deaths in the perinatal period. Midwives and maternal child health nurses (MCHN), as key clinicians, need to be able to detect these mental health issues. Little is known about these clinicians' attitudes to suicide. In this paper, we report on the results of a cross‐sectional study of midwives' and MCHN attitudes to suicide. A convenience sample of midwives (n = 95) and MCHN (n = 86) from south–eastern Victoria, Australia, was recruited into the study. Participants completed the Attitudes to Suicide Prevention Scale. The results showed that MCHN have more positive attitudes towards suicide prevention than midwives, and younger participants have more positive attitudes to suicide prevention compared to older participants. Midwives and MCHN could benefit from continuing professional education to build their knowledge and skills in assessing suicide risk for childbearing women and their families, increasing positive attitudes, improving detection, and mental health referrals.     

B型尿钠肽对危重病患者预后的诊断价值研究

目的探讨B型尿钠肽(BNP)水平判断危重病患者预后的诊断价值。方法选择本院重症监护室患者46例,按慢性健康状况评分Ⅱ(APACHEⅡ)随机分为A、B 2组,各23例,每组分别于入院第1天、第4天、第7天检测血浆BNP水平。结果 A组第1天、第4天、第7天血浆BNP水平明显低于B组(P<0.01);2组患者第4天和第7天血浆BNP水平均明显高于第1天,且第7天血浆BNP水平均明显高于第4天(P<0.01)。结论血浆BNP在诊断心力衰竭的同时,也可作为判断危重病患者预后的指标之一。     

急性危重病患者血乳酸(LACT)与血气检测的临床应用

目的 探讨急性危重病患者血清乳酸(LACT)和血气的临床应用.方法 对65例急性危重病患者和25例正常对照组同步测定乳酸(LACT)与血气指标.结果 急性危重病患者组血气指标与正常对照组差异无显著性(P＞0.05);但危重病患者组乳酸浓度和血糖浓度较正常对照组明显升高(P＜0.01).结论 急性危重病患者由于缺氧、高代谢、低灌注等原因,在未出现明显酸中毒之前即可有高乳酸血症存在,因此对危重病患者进行乳酸和血气检测有非常重要的临床意义.     

尿毒清在危重症合并肾功能不全患者中的治疗作用

目的:探讨中药尿毒清在治疗危重症合并肾功能不全患者中的疗效。方法:46例收住急诊重症监护室(E ICU)合并肾功能不全的危重症患者,在给予西医基础治疗基础上加用中药尿毒清,每日30 g口服或鼻饲,连续观察至给药后9 d。记录治疗后3、5、7和9 d血清尿素氮(BUN)、肌酐(C r)、pH值、阴离子间隙(AG)、红细胞计数(RBC)、血红蛋白(Hb)、急性生理学与慢性健康状况评分Ⅱ(APACHAⅡ)等相关指标,比较治疗前后患者上述指标的变化。结果:与治疗前比较,治疗后9 d患者肾功能明显改善,BUN、C r显著降低,RBC升高,AG明显下降(P均<0.05),pH值趋于正常,APACHAⅡ评分下降显著(P<0.05)。结论:尿毒清可改善危重症患者的肾功能,同时可纠正电解质紊乱及酸碱失衡,在危重症患者综合治疗中有一定的意义。     

Intellectual disability in Africa: implications for research and service development

Abstract

Although intellectual disability (ID) is probably the largest impairment grouping on the African continent, few indigenous research and evaluation studies have been undertaken. This article is an initial attempt to relate service delivery issues to an African research agenda. We critically analysed the available literature, drawing on academic publications and those of non-governmental agencies. In this process we identified several key issues for further investigation, namely: understanding ID in African contexts, access to education and health care, the provision of appropriate assistance and support, and income generation. We relate our analysis to the recommendations made in the World Report on Disability but with a specific focus on ID in Africa. The need for mainstreaming and prioritising ID in non-disability related and across impairment programmes is highlighted. We note the importance of families and emphasise the need to draw on informal and traditional forms of care and participation. The need for reliable research evidence to support practice is highlighted. We conclude with a call to action by and on behalf of individuals with ID to be included in the development priorities of the continent.

• Implications for Rehabilitation

• Service provision for people with intellectual disabilities in Africa is not always well served by insights obtained from western research agendas.

• Appropriate and effective rehabilitation requires an understanding of the context and the environment in which the disabled person operates.

• Indigenous research into the provision of support to families and the inclusion of persons with intellectual disability into mainstream programmes as well as disability specific provision is recommended.

     

Chronic pain in survivors of critical illness: a retrospective analysis of incidence and risk factors

Introduction

Chronic pain has been reported in survivors of critical illness for many years after discharge from hospital. This study investigates the incidence and site of chronic pain in survivors of critical illness between 6 months and 1 year after hospitalization, including ICU admission. A retrospective analysis of the risk factors for chronic pain in this patient group was also completed.

Methods

A questionnaire method was used to investigate the incidence of chronic pain and the specific body parts affected. A retrospective study and multivariable analysis were used to investigate the risk factors for chronic pain in this patient group. All survivors of a general intensive care unit (ICU) in South Wales in a 6-month period were included in this study.

Results

Chronic pain was reported in 44% of all respondents. The shoulder was the most commonly reported joint affected by pain (22%). Risk factors for chronic pain between 6 months and 1 year after ICU discharge were increasing patient age and severe sepsis.

Conclusions

Chronic pain is a problem in survivors of critical illness, especially in the shoulder joint, and further studies are needed investigating therapeutic interventions that address this long-term problem.     

Estimating the risk reduction of isolation on COVID-19 nonhousehold transmission and severe/critical illness in nonimmune individuals: September to November 2021

There is growing scientific interest in immunity mandates/passports (IMP) for viral diseases in light of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. IMP isolate those who remain nonimmune from various settings to reduce nonhousehold transmissions from the nonimmune and reduce severe/critical illness among the nonimmune. A major limitation in the scientific literature is that there are currently no methods to quantify how many nonimmune individuals need to be isolated to achieve these purported benefits. This paper develops a procedure for estimating the benefits of IMP using a novel variant of the number needed to treat which we call the number needed to isolate (NNI). We use data from the SARS-CoV-2 pandemic to demonstrate the properties and utility of the NNI and to inform the debate about IMP. We focus on data from the European Union, United Kingdom, United States, Canada, Australia, and Israel during the fall 2021 when the Delta (B.1.617.2) variant predominated.     

Factors influencing the use and provision of respite care services for older families of people with a severe mental illness

Family carers of people with a severe mental illness play a vital, yet often unrecognized and undervalued role in Australian society. Respite care services can assist these family carers in their role; however, little is known about their access to these services. The paper addresses this knowledge gap. An exploratory field study was conducted throughout the eastern suburbs of Sydney, Australia, to identify and examine the factors influencing the use and provision of respite services for older carers of people with a mental illness. Semistructured, in-depth interviews, and structured self-completed questionnaires were conducted with older family carers, mental health care professionals, and respite care service providers. Additionally, relevant documents (local policies, strategic plans and reports on respite care) were reviewed. It was found that current respite services are problematic for older family carers of Australians with a mental illness, signalling the need for concerted efforts by carers, health professionals, and service providers to improve access. Changes to respite provision and utilization are recommended.     

低血脂水平与危重病预后的关系

目的:探讨低血脂水平与危重病预后的关系.方法:检测重症监护治疗病房(ICU)中341例危重患者入院24 h内血清甘油三酯(TG)和总胆固醇(TC)水平,其中266例同时测高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C),将各检测值以正常下限为界分为两组,＜正常下限为A组,≥正常下限为B组.同时用急性生理学与慢性健康状况评分系统Ⅱ、Ⅲ(APACHEⅡ、Ⅲ)对疾病的严重程度进行评估,比较两组患者的评估分值、存活概率(Ps)及患者实际病死率.结果:TG、TC、LDL-C A组的APACHEⅡ、Ⅲ评分和病死率均明显高于B组(P＜0.05或P＜0.01),Ps明显低于B组(P＜0.05或P＜0.01).HDL-CA组的APACHEⅢ评分明显高于B组(P＜0.05),而两组间APACHEⅡ评分、Ps和病死率的差异均无显著性(P均＞0.05).结论:在危重病应激期低TG、TC、LDL-C患者病死率及APACHEⅡ、Ⅲ均增高,Ps均降低,提示在危重病急性期低TG、低TC和低LDL-C可预测病情严重程度及预后.     

危重症早产儿医院感染相关危险因素的Meta分析

目的对国内外危重症早产儿医院感染的相关危险因素进行Meta分析,为危重症早产儿医院感染的预防控制提供支持和指导意见。方法检索中外文数据库Cochrane library、PubMed、Embase、万方数据库、维普数据库、中国知网(CNKI),同时筛检纳入文献的参考文献资料,查找有关于危重症早产儿发生医院感染危险因素的文献,筛选出符合评价标准的文献,使用Review Manager 5.3软件对纳入的文献进行Meta分析,并辅以发表偏倚的评估,对计算结果采用固定效应模型和随机效应模型比较,异质性较大的研究运用Stata软件做Meta回归分析。结果共纳入8项研究,评估相关危险因素OR及95%CI,分别为:体质量≤2 500g OR=2.71,95%CI(1.59~4.59);机械通气OR=2.66,95%CI(1.39~5.11);中心静脉留置OR=6.91,95%CI(3.87~12.35);全胃肠外营养OR=2.45,95%CI(1.06~5.68);胃管留置OR=3.22,95%CI(1.08~9.61);预防用抗菌药物OR=2.57,95%CI(0.84~7.80),中心静脉留置无明显统计学意义,其他各研究间差异存在统计学意义。结论 Meta分析表明低体质量、机械通气、胃管留置、全胃肠外营养、预防用抗菌药物使危重症早产儿更易发生医院感染。