目的建立重症监护病房(intensive care unit,ICU)内接受过非同步心脏电复律的老年(≥65岁)患者发生院内死亡的预测模型,并评估其有效性。方法回顾性选取2022年6月至2024年8月解放军总医院第九医学中心及解放军总医院第一医学中心ICU收...目的建立重症监护病房(intensive care unit,ICU)内接受过非同步心脏电复律的老年(≥65岁)患者发生院内死亡的预测模型,并评估其有效性。方法回顾性选取2022年6月至2024年8月解放军总医院第九医学中心及解放军总医院第一医学中心ICU收治的老年患者276例,根据患者预后分为非院内死亡组111例及院内死亡组165例,收集患者临床资料,筛选影响院内死亡的预测因子,构建列线图预测模型,采用ROC曲线和决策曲线对预测模型进行评价。结果院内死亡组心率、血液透析、丙氨酸转氨酶、天冬氨酸转氨酶、乳酸脱氢酶、碱性磷酸酶、肌酐、血糖、乳酸水平、碱剩余负值、序贯性器官功能衰竭评估(sequential organ failure assessment,SOFA)评分、终末期肝病模型评分、心室颤动/扑动、无脉室速的诱因为器质性心脏病明显高于非院内死亡组,格拉斯哥昏迷量表评分明显低于非院内死亡组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,体温>37℃(OR=0.426,95%CI:0.198~0.915,P=0.029)、慢性阻塞性肺疾病(OR=2.333,95%CI:1.217~4.473,P=0.011)、格拉斯哥昏迷量表评分(OR=0.622,95%CI:0.410~0.944,P=0.026)、血红蛋白(OR=0.817,95%CI:0.715~0.934,P=0.003)、乳酸(OR=1.365,95%CI:1.174~1.587,P=0.000)、心率>100次/min(OR=2.757,95%CI:1.397~5.441,P=0.003)和SOFA评分(OR=1.112,95%CI:1.032~1.198,P=0.005)是院内死亡的影响因素。ROC曲线分析显示,列线图预测模型的曲线下面积为0.797,敏感性为76.97%,特异性为65.77%;重抽样校准曲线中模型的理想曲线与实际曲线匹配较好;临床决策曲线则显示出该模型具备良好的临床适用性。结论本研究筛选了ICU内接受非同步心脏电复律的老年患者发生院内死亡的危险因素,由此建立的列线图模型区分度和校准度高,拟合度好,临床适用性高。展开更多
Cardiac arrest remains a leading cause of death and permanent disability worldwide. Although many victims are initially resuscitated, they often succumb to the extensive ischemia-reperfusion injury inflicted on the in...Cardiac arrest remains a leading cause of death and permanent disability worldwide. Although many victims are initially resuscitated, they often succumb to the extensive ischemia-reperfusion injury inflicted on the internal organs, especially the brain. Cardiac arrest initiates a complex cellular injury cascade encompassing reactive oxygen and nitrogen species, Ca2+ overload, ATP depletion, pro- and anti-apoptotic proteins, mitochondrial dysfunction, and neuronal glutamate excitotoxity, which injures and kills cells, compromises function of internal organs and ignites a destructive systemic inflammatory response. The sheer complexity and scope of this cascade challenges the development of experimental models of and effective treatments for cardiac arrest. Many experimental animal preparations have been developed to decipher the mechanisms of damage to vital internal organs following cardiac arrest and cardiopulmonary resuscitation(CPR), and to develop treatments to interrupt the lethal injury cascades. Porcine models of cardiac arrest and resuscitation offer several important advantages over other species, and outcomes in this large animal are readily translated to the clinical setting. This review summarizes porcine cardiac arrest-CPR models reported in the literature, describes clinically relevant phenomena observed during cardiac arrest and resuscitation in pigs, and discusses numerous methodological considerations in modeling cardiac arrest/CPR. Collectively, published reports show the domestic pig to be a suitable large animal model of cardiac arrest which is responsive to CPR, defibrillatory countershocks and medications, and yields extensive information to foster advances in clinical treatment of cardiac arrest.展开更多
目的 了解美国军队野战输血医学发展的主要方向和最新动态。方法 通过www.clinicaltrials.gov网站首页,以“United States Department of Defense”“U.S.Army Medical Research and Development Command”“United States Naval Medica...目的 了解美国军队野战输血医学发展的主要方向和最新动态。方法 通过www.clinicaltrials.gov网站首页,以“United States Department of Defense”“U.S.Army Medical Research and Development Command”“United States Naval Medical Research Center”为检索词,检索自ClinicalTrials.gov成立(2002年)起至2021年5月1日野战输血医学相关临床试验项目的完整备案信息,通过研究进展状态、临床分期、任务分配、地域分布和主要研究内容及研究成果等,分析其主要特点。结果 共检索到临床试验项目931项,与野战输血医学密切相关的有16项;其中全血病原体处置占25%(4/16)、血小板输注占25%(4/16)、血浆输注占25%(4/16)、全血输注占18.75(3/16)和其他类型研究占6.25%(1/16)。美国军方注重在血液安全、血液贮存等方面的新技术突破,在抗休克输血输液治疗方面的效果评价,在全血早期输注治疗方面的应用探索和在血液保障技术产品研发方面的军地互动优势。结论 基于ClinicalTrials.gov对美国军方野战输血医学的分析,有利于快速了解美国军队野战输血医学的发展现状和趋势。展开更多
文摘目的建立重症监护病房(intensive care unit,ICU)内接受过非同步心脏电复律的老年(≥65岁)患者发生院内死亡的预测模型,并评估其有效性。方法回顾性选取2022年6月至2024年8月解放军总医院第九医学中心及解放军总医院第一医学中心ICU收治的老年患者276例,根据患者预后分为非院内死亡组111例及院内死亡组165例,收集患者临床资料,筛选影响院内死亡的预测因子,构建列线图预测模型,采用ROC曲线和决策曲线对预测模型进行评价。结果院内死亡组心率、血液透析、丙氨酸转氨酶、天冬氨酸转氨酶、乳酸脱氢酶、碱性磷酸酶、肌酐、血糖、乳酸水平、碱剩余负值、序贯性器官功能衰竭评估(sequential organ failure assessment,SOFA)评分、终末期肝病模型评分、心室颤动/扑动、无脉室速的诱因为器质性心脏病明显高于非院内死亡组,格拉斯哥昏迷量表评分明显低于非院内死亡组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,体温>37℃(OR=0.426,95%CI:0.198~0.915,P=0.029)、慢性阻塞性肺疾病(OR=2.333,95%CI:1.217~4.473,P=0.011)、格拉斯哥昏迷量表评分(OR=0.622,95%CI:0.410~0.944,P=0.026)、血红蛋白(OR=0.817,95%CI:0.715~0.934,P=0.003)、乳酸(OR=1.365,95%CI:1.174~1.587,P=0.000)、心率>100次/min(OR=2.757,95%CI:1.397~5.441,P=0.003)和SOFA评分(OR=1.112,95%CI:1.032~1.198,P=0.005)是院内死亡的影响因素。ROC曲线分析显示,列线图预测模型的曲线下面积为0.797,敏感性为76.97%,特异性为65.77%;重抽样校准曲线中模型的理想曲线与实际曲线匹配较好;临床决策曲线则显示出该模型具备良好的临床适用性。结论本研究筛选了ICU内接受非同步心脏电复律的老年患者发生院内死亡的危险因素,由此建立的列线图模型区分度和校准度高,拟合度好,临床适用性高。
基金Supported by Grants from The United States National Institute of Neurological Disorders and Stroke,No.R01 NS076975-03a predoctoral fellowship from the United States National Institute of Aging,Training in the Neurobiology of Aging,No.T31 AG020494a predoctoral fellowship from the University of North Texas Health Science Center’s Physician Scientist Program
文摘Cardiac arrest remains a leading cause of death and permanent disability worldwide. Although many victims are initially resuscitated, they often succumb to the extensive ischemia-reperfusion injury inflicted on the internal organs, especially the brain. Cardiac arrest initiates a complex cellular injury cascade encompassing reactive oxygen and nitrogen species, Ca2+ overload, ATP depletion, pro- and anti-apoptotic proteins, mitochondrial dysfunction, and neuronal glutamate excitotoxity, which injures and kills cells, compromises function of internal organs and ignites a destructive systemic inflammatory response. The sheer complexity and scope of this cascade challenges the development of experimental models of and effective treatments for cardiac arrest. Many experimental animal preparations have been developed to decipher the mechanisms of damage to vital internal organs following cardiac arrest and cardiopulmonary resuscitation(CPR), and to develop treatments to interrupt the lethal injury cascades. Porcine models of cardiac arrest and resuscitation offer several important advantages over other species, and outcomes in this large animal are readily translated to the clinical setting. This review summarizes porcine cardiac arrest-CPR models reported in the literature, describes clinically relevant phenomena observed during cardiac arrest and resuscitation in pigs, and discusses numerous methodological considerations in modeling cardiac arrest/CPR. Collectively, published reports show the domestic pig to be a suitable large animal model of cardiac arrest which is responsive to CPR, defibrillatory countershocks and medications, and yields extensive information to foster advances in clinical treatment of cardiac arrest.
文摘目的 了解美国军队野战输血医学发展的主要方向和最新动态。方法 通过www.clinicaltrials.gov网站首页,以“United States Department of Defense”“U.S.Army Medical Research and Development Command”“United States Naval Medical Research Center”为检索词,检索自ClinicalTrials.gov成立(2002年)起至2021年5月1日野战输血医学相关临床试验项目的完整备案信息,通过研究进展状态、临床分期、任务分配、地域分布和主要研究内容及研究成果等,分析其主要特点。结果 共检索到临床试验项目931项,与野战输血医学密切相关的有16项;其中全血病原体处置占25%(4/16)、血小板输注占25%(4/16)、血浆输注占25%(4/16)、全血输注占18.75(3/16)和其他类型研究占6.25%(1/16)。美国军方注重在血液安全、血液贮存等方面的新技术突破,在抗休克输血输液治疗方面的效果评价,在全血早期输注治疗方面的应用探索和在血液保障技术产品研发方面的军地互动优势。结论 基于ClinicalTrials.gov对美国军方野战输血医学的分析,有利于快速了解美国军队野战输血医学的发展现状和趋势。
