Background Sepsis is a heterogeneous disease and identifying sepsis subphenotypes can help optimize sepsis management. Objective To identify sepsis subphenotypes and risk stratification using procalcitonin trajectories. Methods Retrospective analysis of 800 cases admitted to the General Hospital of Ningxia Medical University and 202 adult patients with sepsis (age >18 years) in Gansu Provincial Hospital from January 1, 2021 to August 1, 2023 was performed. 597 patients from the General Hospital of Ningxia Medical University were randomized into the development cohort (60%) , and another 202 and 203 from Gansu Provincial Hospital, totaling 405 patients, were included in the validation cohort (40%) . Firstly, the development cohort was divided into survival and death groups to analyze the prognostic value of procalcitonin measurements for sepsis at different times, and ROC curves were plotted to assess predictive efficacy. Then, Group-based trajectory modeling (GBTM) based on repeated measurements of procalcitonin was performed to identify sepsis subphenotypes, which were characterized based on trends in procalcitonin changes and clinical features, and survival analysis and risk stratification were performed, and, Finally, the predictive model was validated. Results In the development cohort, 512 patients survived and 85 died, and the overall 28-day mortality was 14.2%. In the validation cohort, 341 patients survived and 64 died, with an overall 28-day mortality of 16.3%. The death group had significantly higher PCT d3, PCT d5, and PCT d7 than the survival group (P<0.01) , and PCT d7 had the highest predictive efficacy with an area under the ROC curve of 0.833. The "Middle Start Rapid Rise" was characterized by respiratory dysfunction; the "Low Start Slow Decline" had the lowest comorbidity and critical care scores and was considered to be the baseline group; the "High Start Rapid Decline" was characterized by higher comorbidity and critical care scores; and the "High Start Slow Decline" was characterized by multiple organ dysfunction and had the highest value of critical care scores and was considered to be the most severe group on admission. Survival analyses of the four subphenotypes showed that "Middle Start Rapid Rise" had the highest mortality rate and was defined as the high-risk group, followed by "High Start Slow Decline" and was defined as the intermediate-risk group, "Low Start Slow Decline" and "High Start Rapid Decline" had the lowest mortality rate and were defined as the low-risk group. The relative distributions of calcitonin trajectories and comorbidities in the validation and development cohorts were generally consistent. Conclusion Procalcitonin trajectories can be used to identify sepsis subphenotypes, and the combination of procalcitonin values and trajectories can be used to achieve risk stratification for sepsis, providing a theoretical basis for clinicians to assess the prognosis of patients using procalcitonin trajectories.

目的 探讨不同手术时机对胸腰椎骨折伴完全性脊髓损伤疗效的影响.方法 48 例胸腰椎骨折伴完全性脊髓损伤患者,按照手术时机不同分为A组(29 例)和B组(19 例).A组患者伤后24 h内行急诊手术治疗,B组患者伤后 3～5 d行手术治疗.比较两组患者手术时间、术中出血量、术后神经功能恢复情况.结果 A组患者手术时间(191.6±35.1)min长于B组的(156.4±23.6)min,术中出血量(968.5±114.3)ml多于B组的(468.8±85.8)ml,差异均具有统计学意义(P<0.05).48例患者均得到随访,随访时间 13～23 个月,平均随访时间 18 个月.所有患者植骨均融合,内固定位置良好,无松动、断裂情况.末次随访时,A组有 4 例由术前的A级恢复为B级,好转率为 13.8%(4/29);B组有 2 例由术前的A级恢复为B级,好转率为10.5%(2/19).两组患者术后神经功能好转率比较差异无统计学意义(P>0.05).结论 对于胸腰椎骨折伴完全性脊髓损伤患者,早期手术会增加术中出血量,延长手术时间,增加手术风险,且对于术后神经功能恢复情况无显著效果,因此需先行对症支持治疗、处理基础疾病、改善一般情况后,再行手术治疗.

为了减少因盲插而造成子宫的机械损伤和穿孔,提高小鼠子宫灌注的准确率与成功率,连续5 d对雌性小鼠阴道上皮细胞进行H.E染色,确定发情周期,通过具有照明与摄像的仪器辅助引导子宫插管,评估各时期子宫颈口紧张度及子宫插管难度,然后在第5天筛选出子宫插管评价为困难的小鼠,通过可视化引导对其子宫灌注染液,最后处死小鼠,解剖小鼠腹腔,检查子宫染色情况.结果显示,发情期小鼠子宫颈口紧张比例低于其他情期小鼠(P＜0.05),发情间期小鼠子宫插管困难比例高于其他情期小鼠(P＜0.05);对第5天进行子宫灌注染液的小鼠解剖,显示子宫染色全部成功.可视化引导子宫灌注提供了可靠易行的子宫灌注方法,可减少因盲插或开腹方法所引入的人为因素及误差.

目的 探讨创伤救治体系管理模式的构建.方法 将2019年11月—2020年5月构建创伤救治体系管理模式前救治78例创伤患者设为对照组,将2020年6—12月构建创伤救治体系管理模式后救治的82例创伤患者设为观察组.对比两组创伤救治团队成员综合能力、创伤救护时效、生命支持完成情况及满意度.结果 与对照组相比,研究组学习能力、科研能力、工作态度、职业素质、专业实践能力、协调与应急能力、团队配合能力、综合处置能力更高,差异有统计学意义(P<0.05).与对照组相比,研究组创伤救治团队到达时间、早期治疗处理时间、挂号、分诊时间、血液相关指标送检时间、首次CT检查时间更短,差异有统计学意义(P<0.05).与对照组相比,研究组8 min高级生命救治完成率、手术到达时间完成率更高,差异有统计学意义(P<0.05).与对照组满意度评分(30.81±3.06)分相比,研究组满意度评分(35.21±3.01)分更高,差异有统计学意义(P<0.05).结论 创伤救治体系管理模式可提供创伤救治团队成员综合能力、创伤救护时效、生命支持完成情况及满意度,具有可靠性、实用性及科学性,对临床创伤救治具有重要意义.

目的 构建甘肃省创伤救治护理管理体系,以推进该省创伤护理的发展.方法 基于文献研究和专家访谈拟定指标初稿,采用Delphi法对21名创伤专家进行2轮咨询,确立甘肃省创伤救治护理管理体系.结果 2轮函询中专家的积极系数均为100％,权威系数分别为0.89、0.90,一、二、三级指标的肯德尔和谐系数分别为0.31、0.43、0.37,最终形成了包含5项一级指标(组织构架、人员管理、环境物品及流程管理、信息管理、质量控制)、20项二级指标、107项三级指标的甘肃省创伤救治护理管理体系.结论 构建的甘肃省创伤救治护理管理体系具有一定的科学性和可靠性,为甘肃省创伤救治护理管理工作提供了相应的救治机制和管理体系.

目的:评价传统治疗联合卡莫司汀片(1,3-Bis[2-Chloroethyl]-1-Nitroso-urea,BCNU)植入(GW组)对比不植入(对照组)在新诊断多形性胶质母细胞瘤患者中的治疗效果.方法:检索PubMed、EMbase、Cochrane library等数据库,参照Cochrane评价手册5.1.0和纽卡斯尔渥太华规模标准分别进行质量评价.结果:纳入4篇随机对照试验(randomized controlled trials,RCTs)和5篇队列研究,共1186例患者.对RCTs行Meta分析:GW组的中位生存期、颅内压升高发生率明显高于对照组,差异有统计学意义(P＜0.05);而脑脊液漏和抽搐发生率差异无统计学意义(P＞0.05).对队列研究Meta分析:GW组的中位生存期、术后1年生存率显著高于对照组,差异有统计学意义(P＜0.05).结论:传统治疗联合BCNU植入能显著增加新诊断多形性胶质母细胞瘤患者的中位生存期和术后1年生存率,而除了颅内压增高外不增加其他不良反应发生率.

Objective To systematically assess the efficacy of hypertonic saline (HS)versus mannitol for traumatic cerebral swelling.Methods Databases including CBM,CNKI,Wanfang,PubMed,EMBASE.com,Web of Science,and the Cochrane Library databases were searched from inception to January,2018.Literature selection,data extraction,and quality assessment were performed independently by two trained reviewers.STATA 12.0 software was used to analyze data.Results A total of 12 RCTs were included for systematic review and 8 for meta-analysis.The results of meta-analysis showed that there were no statistical significant differences in decreasing intracranial pressure [WMD =-0.41,95％ CI (-1.11,0.28),P =0.240] and shorting onset time of drug [SMD =0.11,95％ CI (-0.13,0.34),P =0.368].However,the difference was statistical significant in duration of drug [SMD =1.15,95％CI (0.55,1.75),P=0.000].Conclusion Compared with 20％ mannitol,the efficacy is similar for 3.0％ HS in decreasing intracranial pressure and shorting onset time of drug,and 3.0％ HS is better in duration of drug.More investigations are needed for other different density HS.

OBJECTIVE To investigate the nerve injuries in diffuse brain injury patients complicated with pulmonary infections and observe the changes of levels of inflammatory factors so as to provide guidance for clinical treatment.METHODS A total of 66 patients with diffuse brain injury who were treated in hospitals from Jan 2014 to Jan 2016 were recruited as the study objects.The prevalence of clinical infections,levels of inflammatory factors,and distribution and drug susceptibility of pathogens causing the infections were statistically analyzed.RESULTS Of the 66 patients with diffuse brain injury,25 had the infections,with the infection rate 37.88％.There was no significant difference in the nerve injury indexes such as nerve filament acidic protein,creatine kinase isoenzymes,and myelin basic protein between the infection group and the non-infection group.The levels of C-reactive protein (CRP),interleukin 6 (IL-6),interleukin-8 (IL-8),tumor necrosis factor (TNF-α),and interleukin-1 (IL-1) of the patients with infection were respectively (40.87±k5.34)mg/L,(337.24±23.45)pg/ml,(540.83±46.93)pg/ml,(95.92±8.62)pg/ml,and (0.99±0.11)ng/L,significantly higher than (30.82t3.57)mg/L,(259.45± 16.83)pg/ml,(469.74±44.83)pg/ml,(84.44±7.45)pg/ml,and (0.31±0.01)ng/L of the patients without infection(P＜0.01).Totally 30 strains of pathogens were isolated from the 25 patients with the infections,including 21 strains of gram-negative bacteria,8 strains of gram-positive bacteria,and 1 strain of fungus.The gram-negative bacteria were highly susceptible to aztroenam and imipenem but were highly resistant to ampicillin,piperacillin,cefotaxime,and ceftriaxone.The gram-positive bacteria were highly resistant to penicillin and gentamicin but were highly susceptible to rifampicin.CONCLUSION The status of nerve injury does not differ significantly from the diffuse brain injury patients complicated with pulmonary infections to the patients without the infections,however,the levels of inflammatory factors are remarkably elevated.The gram-negative bacteria are dominant among the pathogens causing the infections.It is necessary for the hospital to take targeted treatment measures and reasonably use antibiotics based on the result of drug susceptibility testing.

目的 比较颅脑多排螺旋CT(MSCT)和CT脑灌注成像(CTPI)在外伤性弥漫脑肿胀(DBS)中的应用效果.方法 选取2015年1月～2016年10月收治的100例DBS患者作为研究对象,使用GE light speed 64排螺旋CT机扫描,在伤后2～6 h内行常规MSCT检查和CTPI检查,72 h内再次复查CTPI.比较MSCT与CTPI的DBS检出率,分析脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)和超清彩色图像与DBS预后的关系.结果 MSCT对DBS的检出率为88.0％,低于CTPI的96.0％(P＜0.01).治疗后,患者的CBF、CBV呈升高趋势,初次检查与复查CBF、CBV、MTT值比较,差异有统汁学意义(P＜0.01).结论 MSCT和CTPI在DBS中具有较好的应用效果,但CTPI能够有效评估患者的预后情况,通过超前彩色图像可直观观察和评价患者的病情变化,值得在临床中推广应用.

目的 探讨64排螺旋CT在创伤弥漫性脑肿胀患者非手术治疗中的应用价值.方法 对我院2013年6月～2015年5月收治的经非手术治疗单纯弥漫性性脑肿胀患者100例,在伤后2～6 h内行CT灌注(CTP)检查,7d后复查CTP,分析治疗前后感兴趣区域灌注参数的变化,6个月后随访,结合临床预后对数据进行统计、分析.结果 非手术治疗后,各感兴趣区域脑血流量(CBF)、脑血流容积(CBV)及平均通过时间(MTT)均较治疗前有所改善(P＜0.05),其中GOS评分＞3分者改善明显.结论 CTP可快速、准确地反映DBS患者脑血流动力学变化,为临床早期治疗、判断预后提供更可靠的依据.

目的 综合分析MSCT联合CTPI在外伤性弥漫性脑肿胀患者中的应用及预后效果.方法 选取2012年8月～2016年8月在我院收治的100例外伤性弥漫性脑肿胀患者作为研究对象,按照入院顺序随机分为实验组与对照组,每组均为50例.对照组应用常规MSCT诊断方法,实验组应用MSCT联合CTPI诊断方法.采用SPSS20.0统计学软件分析两组患者在颅脑外伤中的检出率,并分析损伤区域的局部脑血流量(CBF)、局部脑血流容积(CBV)、平均通过时间(MTT)和超清彩色图像与外伤性弥漫性损伤预后的关系.结果 ①实验组检出率远远高于对照组(P＜0.05),两组患者的CBF、CBV、MTT数据比较差异有统计学意义(P＜0.05);②实验组GOS评分为(4.22±0.28)分,对照组GOS评分为(1.85±0.19)分,实验组患者预后效果显著优于对照组(P＜0.05).结论 MSCT联合CTPI在外伤性弥漫性脑肿胀患者中的应用及预后效果显著.

目的 探讨超薄多层螺旋CT和脑灌注成像在急性颅脑外伤(TBI)早期诊断中的临床应用价值.方法 收集2010年12月～2012年10月我院收治的200例急性颅脑外伤患者检查资料,均于伤后6h内行超薄多层螺旋CT(MSCT)和CT脑灌注成像(CTP)检查,全部病例于伤后2～3d动态复查MSCT明确诊断,将数据进行回顾性分析,采用卡方检验评价.结果 在MSCT与CTP这两种检测方法中,CTP在脑挫裂伤、硬膜下血肿和脑内血肿的诊断中优于超薄MSCT(P＜0.05),并且病灶周围低灌注区域大于超薄MSCT.结论 CTP对于急性颅脑外伤早期和微小损伤的诊断优于超薄MSCT,同时可以反映脑组织的灌注情况,具有可靠的临床价值.

BACKGROUND:Baloon kyphoplasty is effective in the treatment of osteoporotic vertebral compression fractures, but it is unclear that which one is proper, unilateral or bilateral approach, with better efficacy and fewer <br> complications. <br> OBJECTIVE:To assess the efficacy and safety of unilateralversus bilateral baloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures. <br> METHODS: We searched the electronic bibliographic databases including Cochrane Library, PubMed, EMBASE, ISI Web of Knowledge, CBMdisc and other databases to colect clinical trials concerning unilateral versus bilateral baloon kyphoplasty. Two estimators independently evaluated the quality of these included studies and analyzed data by Cochrane Colaboration’s RevMan 5.2 software. <br> RESULTS AND CONCLUSION:Fourteen trials involving 876 patients were included. There were 442 cases of unilateral approach and 434 of bilateral approach. The meta-analysis showed that there were no significant <br> differences in pain score by visual analog scale, vertebral height, and kyphotic angle; while the unilateral approach had less operating time, lower amount of cement injected and lower risk of cement leakage <br> than the bilateral approach [mean difference (MD)=-19.33, 95% confidence interval (CI) (-24.42,-14.24); <br> MD=-2.07, 95%CI (-2.42,-1.71); odds ratio=0.47, 95% CI (-24.42,-14.240)]. These findings indicate that the unilateral baloon kyphoplasty can reduce the leakage rate of bone cement.

目的 分析和对比多层螺旋CT(Multi-slice Spiral Computed Tomography,MSCT)与多层螺旋CT颅骨三维图像重建(Three dimensional reconstruction)在颅骨骨折中的影像表现,探讨多层螺旋CT颅骨三维图像重建在颅骨骨折中的临床应用价值.方法 收集2009年12月～2012年10月我院收治的300例急性颅脑外伤(traumatic brain injury TBI)检查资料,均于伤后6h内行多层螺旋CT及颅骨三维图像重建检查,检出颅骨骨折病例82例,将数据运用统计学方法分析,比较两种检查方法的差异.结果 多层螺旋CT颅骨三维图像重建在颅顶骨折(P =0.026)、颅底骨折(P=0.004)的检出率高于常规多层螺旋CT,具有统计学差异(P＜0.05),并且有较高的特异性及敏感性.结论 螺旋CT颅骨三维图像重建在颅骨骨折的诊断中优于MSCT,具有可靠的临床价值.

Objective Discussion of ultrathin multilayer spiral CT 3D image reconstruction,skull and brain perfusion imaging in acute brain injury to dynamic changes in the clinical value.Methods 2009December to 2011 October were collected in our hospital in 245 patients with acute traumatic brain injury patients check information,both in the 3-6 h after injury within conventional multislice spiral CT,thin multilayer spiral CT and three-dimensional image reconstruction of skull and brain CT perfusion imaging examination,all the cases in 2 to 7 days after injury dynamic review of conventional MSCT and ultrathin multilayer spiral CT,the data were retrospectively analyzed,using the chi-squared test evaluation.Results Super thin multilayer spiral CT in cerebral contusion and laceration,intracerebral hematoma in TBI with mixed diagnosis has statistics difference is better than the conventional MSCT.CTP in acute traumatic brain injury diagnosis was superior to conventional MSCT except diffuse axonal injury.CTP in cerebral contusion and laceration,subdural hematoma and intracerebral hematoma associated with intracerebral hematoma in the diagnosis with statistical difference,better than the ultrathin multilayer spiral CT (P ＜ 0.05).The 3D image reconstruction of skull fracture demonstrated great advantages in the treatment of skull fracture,which include cranial suture separation and basal skull fracture.Conclusion combined Super thin multilayer spiral CT 3D image reconstruction skull and brain CT perfusion imaging for acute craniocerebral injury early diagnosis and minimal injury diagnosis is superior to conventional multislice spiral CT,The rate of misdiagnosis can be decreased.which provide Reliable basis for early diagnosis and Prognosis of TBI.

目的研究盐酸洛哌丁胺在肠造口术后应用的临床疗效和使用价值。方法将2005年1月至2010年9月临床收治的54例因肠梗阻、腹部外伤、肠道肿瘤及部分因特异性感染而导致消化道穿孔等行肠造口患者,分为盐酸洛哌丁胺组(A组)和对照组(B组),分别采取一中心双盲法研究。结果 A组造瘘口肠排泄物明显减少,第4天肠排泄物量约为B组的50%,且短期内形成糊状;并发症发生率、平均住院日及住院费用均低于B组(P<0.05)。结论肠造口术后患者口服盐酸洛哌丁胺可减少排便体积及次数,增加大便稠硬度,且长期使用安全、有效,能降低患者并发症发生率和住院费用,缩短平均住院日,提高患者生活质量。

<正>近年来研究发现,危重症患者体内钙离子代谢紊乱与疾病的发生、严重程度和预后有密切联系。对老年危重症患者来说,及早作出正确的诊断及预后评估,对于指导治疗,争取抢救时机都是很必要的。1资料与方法1.1一般资料2005年1月至2010年1月我院收治的185例患者,其中普通患者80例,男47例,女33例,年龄30～80

在创伤急诊中,四肢血管损伤约占人体血管损伤的80%,而股动脉损伤则居四肢血管损伤的首位[1],特别是股静脉、股动脉损伤后出血凶猛,失血性休克发生率高常危及生命,如果不及时修复重建可能导致患肢丢失或永久性功能障碍,尤其近端股三角内股动脉、股静脉因其解剖的特殊性,损伤后止血、修复困难,后果更为凶险.

肝细胞癌 肝癌破裂出血可由肿瘤内少量出血发展为肝包膜下血肿,最终肝包膜破裂致腹腔内积血.由于包膜下血肿致肝包膜急性张力增高,临床可表现为突然发作的上腹痛、低血压及肝脏增大.59%～90%的患者可出现休克,60%～100%的患者出现腹部膨隆或腹膜炎表现,多数患者出现腹腔内积血,腹腔穿刺阳性率可达86%.

目的探讨普通外科手术切口愈合不良的相关因素、处理及预防措施。方法回顾性分析1830例普通外科手术患者的临床资料,统计分析切口愈合不良(切口感染、脂肪液化、裂开)发生率、影响因素、治疗及结果。结果1830例中切口愈合不良者57例,发生率3.1%(57/1830),57例中,脂肪液化占52.6%(30/57),切口惑字38.6%(22/57),裂开8.8%(5/57)。影响因素:年龄大、体质指数高、有基础疾病、急诊手术、备皮至手术时间长、夏季手术、切口长度、侵入性操作、手术时间长、非主刀医生缝合等。治疗后均预期愈合,术后随访无瘘道形成。结论普通外科手术切口愈合不良是多因素综合作用的结果,及时而恰当的治疗均能达愈合。