Sepsis-associated encephalopathy (SAE) is a diffuse dysfunction of the nervous system resulting from sepsis originating outside the central nervous system. The elderly (≥65 years of age) are a particularly vulnerable population, and the emergency department is typically the first point of contact following onset of SAE. Clinical symptoms in elderly patients with SAE are often atypical, compounded by a high burden of underlying diseases and complications, which frequently leads to underdiagnosis or misdiagnosis. These patients are at increased risk of long-term or permanent central nervous system impairment, making rapid and accurate diagnosis and treatment especially critical. Currently, there are no standardized diagnostic or treatment guidelines tailored specifically to geriatric SAE. This expert consensus, grounded in evidence-based medicine and clinical experience, offers recommendations on the risk factors, clinical characteristics, diagnosis, and treatment of geriatric SAE. The goal is to standardize care, improve diagnostic accuracy, reduce mortality, and enhance patient outcomes.
Community-acquired pneumonia(CAP)in adults(≥18 years old)is the most common infectious disease encountered in emergency de-partments.Its clinical complexity and the need for prompt treatment decisions pose significant challenges for patient management.The physician-pharmacist collaborative management(PPCM)model,which optimizes drug therapy regimens through collaboration between physicians and clinical pharmacists,has demonstrated strong clinical value in practice.However,the lack of standardized national guide-lines for the application of the PPCM model in emergency departments in China has hampered its widespread adoption.This guideline is developed based on evidence-based medicine and clinical practice experience,with a focus on the application of the PPCM model in the management of CAP in emergency settings.It outlines the significance of the PPCM model,its applicable scenarios,the respective roles of emergency physicians and clinical pharmacists,and its practical implementation in the antimicrobial treatment of CAP patients.In addition,the guideline proposes standardized implementation processes and clinical pathways.By promoting the PPCM model,the expert panel aims to standardize the use of antimicrobial agents in the emergency treatment of CAP,reduce the risk of antimicrobial resistance,and improve patient outcomes.
目的:探讨肺部超声、中性粒细胞与淋巴细胞比值(NLR)、D-二聚体(D-D)及三者联合在医院获得性肺炎(HAP)的治疗效果和预后评价方面的应用价值.方法:回顾性选取2019年1月—2022年3月在北京华信医院重症医学科和急诊科接受治疗的268例HAP患者,按照疗效的区别进行分组,分为有效组与无效组,有效组216例,无效组52例.分别对2组患者的一般资料以及治疗开始前、治疗3 d后、治疗7 d后的D-D、外周血NLR与肺部超声评分(LUS)的变化进行比较;通过Pearson相关性分析对上述指标和临床肺部感染评分(CPIS)之间的关联性进行分析;通过logistic回归方程对影响疗效的有关因素进行分析;通过受试者工作特征(ROC)曲线与ROC曲线下面积(AUC)对以上3个指标及三者联合的疗效预测效能进行分析;通过Pearson相关性分析对上述指标和序贯器官衰竭估计评分(SOFA)之间的关联性进行分析;采用Kaplan-Meier曲线分析LUS、NLR、D-D高危组与低危组患者的生存率.结果:有效组治疗3 d及7 d后的LUS、NLR、D-D均低于无效组(P＜0.05);经Pearson线性相关性分析发现治疗7 d后的LUS、NLR及D-D均与CPIS呈正相关(P＜0.05),其中治疗7 d后的LUS与CPIS的相关性最强(r=0.532);logistic回归方程计算结果显示,治疗3 d与治疗7 d后的D-D、外周血NLR以及LUS都和HAP具备关联性(P＜0.05);ROC曲线分析,治疗7 d后LUS、NLR、D-D预测HAP治疗无效的AUC大于治疗3 d的AUC,治疗7 d后的LUS、NLR、D-D三者联合预测疗效的AUC最大,AUC=0.913;Pearson相关性分析显示治疗7 d后的LUS、NLR及D-D均与SOFA评分呈正相关(P＜0.05),其中治疗7 d后的LUS与SOFA评分的相关性最强(r=0.525).Kaplan-Meier曲线分析发现,治疗7 d后LUS、NLR、D-D高危与低危患者生存率比较,差异均有统计学意义(P＜0.05).结论:肺部超声联合NLR及D-D指标监测对评价HAP的疗效和预后具有临床价值,值得推广研究.
脓毒症是一种源于感染,以炎症反应和免疫功能紊乱为演变特征,表现为多脏器功能障碍且具有高度异质性的综合征.脓毒症生物标志物是指病原微生物侵入机体后,在生理、生化、免疫和遗传等方面表达出可测量的指标,用于定量评估机体防御反应状态和病理生理过程,并可用于早期筛查急诊脓毒症患者.新型生物标志物表现出良好的诊断潜力,可能是早期诊断脓毒症患者的突破点.不同类型生物标志物的动态监测和联合评估,可能是脓毒症患者早期筛查的重要举措;另外,生物标志物的床旁即时检验技术为急诊早期筛查脓毒症提供了一种快速、高效、便捷的检测方法.本文阐述了数种不同类型生物标志物早期筛查急诊脓毒症患者的研究现状,以期为构建急诊脓毒症患者早期筛查模型提供依据,从而能更早、更快、更准确地筛查急诊脓毒症患者.
创伤失血性休克是严重创伤后"可预防性死亡"的主要原因.目前我国创伤失血性休克诊疗的规范性仍有待提高,为此我们组织了国内多个学术组织的急诊专家,基于最新的临床与基础研究证据,权衡患者获益程度,编写了适用于院前急救、院内救治等创伤失血性休克不同阶段的专家共识,旨在为中国急诊医生规范救治创伤失血性休克提供系统、全面的参考依据.
