Objective: This study aimed to analyze the relevant risk factors for nosocomial infection (NI) in patients who were admitted to an emergency department, explore the correlation between each influencing factor and the risk of NI, and evaluate the application value of immunological indicators on the patient prognosis, all of which can provide reference for clinical guidance. Methods: We prospectively enrolled 128 patients meeting the inclusion criteria who visited the emergency department of Dongzhimen Hospital, Beijing University of Chinese Medicine, from January 1 to December 31, 2019. Basic information and serum samples were collected from the patients, and flow cytometry was used. T lymphocyte subgroups, CD3+CD4+and CD3+CD8+, and natural killer (NK) cells were measured. Patients were divided into infection group and control group according to whether nosocomial infection occurred within 48 h of admission. Age, gender, type of disease, APACHE II score, Charlton score, T lymphocyte subtypes, and NK cell values were compared, and a logistic multivariate regression analysis was conducted. A multifactor regression analysis was performed on various risk factors. The nomogram website was used to draw a nomogram model of meaningful indicators, and the receiver-operating characteristic (ROC) curve was based on experimental results. Results: Logistics multivariate regression analysis showed the Charlton score and NK cell count were independent risk factors for nosocomial infection. Cell counts for subsets CD3+CD4+ and CD3+CD8+ were protective factors, and the OR value and 95% CI were 5.199 (1.933-13.983), 1.248 (1.055-1.475), 0.851 (0.790-0.916), and 0.832 (0.711-0.973), p < 0.05. respectively. Statistical significance was set at p < 0.05.The nomogram model suggested that the area under the curve for predicting the risk of nosocomial infection was 0.920 (0.872-0.967), p < 0.001. Conclusion: Patients with low CD3+CD4+ and CD3+CD8+ T lymphocyte or high NK cell count as well as high Charlton score are more likely to have nosocomial infection. Then, we speculate that the risk of nosocomial infection within 48 h is also high for patients with underlying diseases and immune function that is affected and suppressed on admission, regardless of whether infection occurs during hospitalization.

北京中医药大学东直门医院于2018年12月9日收治1例脓毒症患者.该患者为长期服用毒品者,即阿片类药物中毒者,患者近6个月来无明显诱因出现胸闷喘憋、汗出,不欲饮食,未予重视及诊治;近10?d来,胸闷喘憋、纳差加重,伴呼吸困难、周身乏力、头晕恶心,以"胸闷喘憋6个月,加重10?d"入院,诊断为阿片类药物中毒后脓毒症.入院4?h后患者出现心搏骤停,给予胸外按压、除颤、血管活性药物等措施后抢救成功.后姜良铎教授结合患者当前症状和体征,给予抗感染、化痰平喘、改善脑循环、清热解毒、回阳救逆、豁痰开窍治疗,并基于中医状态学说辨证论治,给予中药进行治疗.经治疗患者症状改善,取得一定的临床疗效,这为今后此类患者的救治提供了经验.

Objective:To analyze the mechanism of Danpi-Chishao in treatment of sepsis based on network pharmacology.Methods:The corresponding targets of Danpi-Chishao and sepsis were carried out through TCMSP database, OMIM database and Genecards database. Cystoscope 3.8.2 software was used to construct the " Chinese medicine-active components-target-disease" network diagram. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were carried out by DAVID database. Weisheng cloud platform was used to draw bubble map.Results:A total of 36 effective components of Danpi-Chishao was obtained, mainly including quercetin, kaempferol, baicalin, β-sitosterol, stigmasterol, paeoniflorin and so on. There were 96 potential common key targets between Danpi-Chishao and sepsis, such as prostaglandin-endoperoxide synthase 2 (PTGS2), transcription factor p65 (RELA), phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit gamma (PIK3CG), B-cell lymphoma 2 (BCL-2)-associated X (BAX), BCL-2, Caspase-3 (CASP3) with a degree value>4.9. The result of protein-protein interaction (PPI) network analysis showed that there were 10 important target proteins, including alpha serine/threonine-protein kinase (AKT1), interleukin-6 (IL-6), tumor necrosis factor (TNF), interleukin-1β (IL-1β), vascular endothelial growth factor A (VEGFA), cellular tumor antigen p53 (TP53), matrix metalloproteinase-9 (MMP9), CASP3, PTGS2, C-C motif chemokine ligand 2 (CCL2). The pathways obtained by GO and KEGG enrichment analysis included atherosclerosis pathway, advanced glycation end products (AGE)-receptor for advanced glycation end products (RAGE) signal pathway, cancer pathway, tumor necrosis factor signal pathway, hypoxia-inducible factor (HIF) signal pathway, IL-17 signal pathway and other pathway.Conclusions:The mechanism of the intervention effect of Danpi-Chishao on sepsis may be that the active components such as quercetin, kaempferol, paeoniflorin act on target proteins such as PTGS2, RELA, PIK3CG, BAX, BCL2, CASP3, and through TNF-related signal pathway, HIF-1 signal pathway, IL-17 signal pathway, etc. Nonetheless, the conclusion needs further experimental verification.

Objective:To evaluate the value of age-adjusted Charlson comorbidity index (aCCI) in the clinical prognosis of sepsis and septic shock in the elderly, and to further explore the role of aCCI in evaluating the timing of Shenfu injection in elderly patients with septic shock.Methods:Clinical data of elderly patients with sepsis and septic shock in Dongzhimen Hospital of Beijing University of Chinese Medicine from January 1, 2019 to January 1, 2022 were retrospectively analyzed. With the median aCCI score of all samples as the cutoff value, the patients were divided into the low aCCI score group and high aCCI score group. The prognosis of elderly patients with septic shock and the application timing of Shenfu injection with aCCI score and sequential organ failure assessment (SOFA) were compared.Results:A total of 61 patients were included, including 31 patients in the high aCCI score group. The proportion of septic shock in elderly sepsis patients was lower in the low aCCI score group ( P < 0.05). The aCCI score (95% CI: 1.229-2.615; P< 0.01) was more valuable than SOFA score (95% CI: 1.035-1.607; P< 0.05) in predicting septic shock in elderly patients with sepsis. The 28-day survival rate in the low aCCI score group was higher than that in the high aCCI score group ( P < 0.05). Both the SOFA score (95% CI: 1.010-1.364) and the aCCI score (95% CI: 1.072-10.501) were independent factors affecting the 28-day survival rate. The use of Shenfu injection was associated with 28-day survival outcome in elderly patients with septic shock (95% CI: 0.012-0.788; P < 0.05). Conclusions:aCCI score is more effective than SOFA score in assessing the risk of shock in elderly patients with septic shock, and has a certain predictive value for the survival and prognosis of elderly patients with sepsis. Shenfu injection may be beneficial to the survival and prognosis of elderly patients with septic shock, but it needs to be further verified by large-scale prospective studies.

Objective:To compare the efficacy of conventional Western medicine alone and acupuncture combined with acupoint application in treating intestinal dysfunction secondary to mechanical ventilation in elderly patients with emergency sepsis.Methods:A retrospective analysis was performed on 111 elderly patients with mechanical ventilation for sepsis admitted to the emergency department of Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2019 to June 2021. They were divided into two groups according to the time of admission: Western medicine treatment group alone (patients from January 2019 to December 2019, n=47) and acupuncture combined with acupoint application group (patients from January 2020 to June 2021, n=64). Acupuncture combined with acupoint application group was treated with acupuncture combined with acupoint application on the basis of conventional Western medicine. The intestinal dysfunction score, abdominal circumference and mortality after 4 weeks were compared between the two groups. Results:The abdominal circumference and intestinal dysfunction score in acupuncture combined with acupoint application group were significantly lower than those before treatment [(100.56±9.34)cm vs (106.25±9.74)cm; (0.92±0.72)point vs (2.31±0.69)point, all P< 0.05], while there was no significant difference in the above indexes before and after treatment in the Western medicine treatment group (all P>0.05). The abdominal circumference, intestinal dysfunction score and mortality after 4 weeks in the acupuncture combined with acupoint application group were significantly lower than those in the Western medicine treatment group [(100.56±9.34)cm vs (108.09±10.52)cm; (0.92±0.72)point vs (2.43±0.62)point; (29.7%, 19/64) vs (48.9%, 23/47), all P<0.05]. Conclusions:The curative effect of acupuncture combined with acupoint application in the treatment of intestinal dysfunction secondary to mechanical ventilation in elderly patients with sepsis in emergency is better than that of routine treatment of Western medicine alone. The gastrointestinal function and prognosis of patients have been significantly improved, which is worthy of clinical promotion.

患者女性，71岁，因"右侧肢体乏力伴言语不利4 d，咳嗽伴发热3 d"于2021年3月29日第一次入院。既往高血压，尿毒症透析2年。查体：神清，言语不利，双肺底湿啰音，右侧肢体肌力Ⅰ级且巴氏征阳性。白细胞10.72×10 9/L，C反应蛋白44.26 mg/L，降钙素原1.10 ng/mL，肌酐948.3 μmol/L，尿素28.22 mmol/L，癌胚抗原5.01 ng/mL。G、GM试验阴性，PPD阴性，结核杆菌特异性细胞免疫反应检测（TB-IGRA）阳性。外院CT见左侧额、顶、枕叶片状水肿（图1A），左肺空洞。入院连续3 d痰培养未见异常。支气管镜见左肺下叶开口黏膜充血。肺泡灌洗液培养出肺炎克雷伯菌，高通量测序示肺炎克雷伯菌（序列数9844）。经皮肺穿病理示纤维组织伴淋巴细胞浸润。头核磁示左枕叶及额颞叶异常信号。脑脊液培养5 d无细菌，高通量测序示肺炎克雷伯菌（序列数31）。诊断为肺脓肿、脑脓肿（肺炎克雷伯菌）。患者先后经头孢曲松钠美罗培南抗感染以及床旁血滤2周后未再发热自动离院。4月16日患者因"嗜睡伴发热1 d"返诊，体温峰值为38.5℃，查体躁动，失语，右侧肢体肌力0级。CT见大脑左半球大片低密度灶，其内团块样混杂密度，大脑镰下疝（图1B）；左肺空洞消失。继续给美罗培南抗感染及床旁血滤治疗。4月19日患者神志转清，无发热，可简单应答，增强核磁见左侧额顶叶多发脓肿，有窦道连通（图2A），家属拒绝进一步手术干预。保守治疗1个月余后言语基本流利，右侧肢力Ⅱ-Ⅲ级，复查头核磁脓肿减小，脑疝消失（图2B）。6月30日右侧肢体V级转入下级医院。2个月后随访，患者症状未再反复。

目的 研究人参、川芎有效成分对慢性间歇性低氧干预肥胖胰岛素抵抗诱导动脉粥样硬化过程中白色脂肪棕色化的调节作用机制.方法 使用ApoE-/-小鼠建立动物模型,给予振源胶囊(人参总皂苷)和磷酸川芎嗪片(川芎嗪)干预8周,记录小鼠体质量并监测血糖;使用比色法检测小鼠血清中总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白(low density lipoprotein cholesterol,LDL-C)水平;取小鼠腹腔脏器及腹主动脉周围的脂肪组织,采用Western blotting法检测脂肪组织中过氧化物酶体增殖物激活受体γ(peroxisome proliferator-activated receptor γ,PPARγ)、过氧化物酶体增生物激活受体γ辅激活子-1 α(peroxisome proliferator-activated receptor γ co-activator-1 α,PGC-1α)、解偶联蛋白1(uncoupling protein 1,UCP1)蛋白表达.结果 与空白对照组和常氧对照组相比,模型组小鼠体质量、血糖、LDL-C水平明显升高(P＜0.05、0.01);与模型组相比,人参-川芎有效成分高剂量组血糖、TG、LDL-C水平显著降低(P＜0.05、0.01),脂肪组织中PPARγ、PGC-1α以及UCP1蛋白表达水平明显升高(P＜0.05、0.01).结论 人参、川芎有效成分能够通过PPARγ/PGC-1α/UCP1信号通路促进白色脂肪棕色化,进而降低慢性间歇性低氧复合肥胖胰岛素抵抗诱导的动脉粥样硬化小鼠体质量、血糖、LDL-C、TG水平发挥抗动脉粥样硬化的作用.

Objective:Animal models of sepsis are mainly established by cecal ligation and puncture which causes mixed bacterial infections in the abdominal cavity. However in internal clinic, sepsis is more common to be caused by respiratory bacterial infections. Therefore, it is necessary to establish animal models of sepsis caused by lung Infection.Methods:According to the concentration of Staphylococcus aureus (S. aureus) suspension and Pseudomonas aeruginosa (P. aeruginosa) suspension, Sprague Dawley (SD) rats were equally divided into 10 groups, including S-Cont group, S-0.75 group, S-1.5 group, S-3 group, S-6 group and P-Cont group, P-1 group, P-2 group, P-4 group, P-8 group. Rats in the control group were treated with normal saline nasal drip. Rats in each experimental group were infected by nasal dripping bacterial suspension with 0.75×10 8 CFU/ml, 1.5×10 8 CFU/ml, 3×10 8 CFU/ml, 6×10 8 CFU/ml of S. aureus suspension or 1×10 8 CFU/ml, 2×10 8 CFU/ml, 4×10 8 CFU/ml, 8×10 8CFU/ml P. aeruginosa suspension. Our study detected the body temperature (T), blood pressure (BP), heart rate (HR) of rats in each group before and after infection, as well as blood lactic acid (Lac) and procalcitonin (PCT) level after infection. The lung infections of rats in each group were observed by hematoxylin-eosin (HE) staining. Results:The blood pressure(BP) of S-1.5 group, S-3 group, S-6 group and P-8 group was lower than before infection (all P<0.05). The Lac and PCT of each S. aureus experimental group were higher than that of the S-Cont group (all P<0.01); and they showed an increasing trend with the increase of the bacterial suspension concentration ( P<0.05), except for the S-3 and S-6 group ( P>0.05). The Lac and PCT of each P. aeruginosa experimental group were higher than that of the P-Cont group (all P<0.01); and they showed an increasing trend with the increase of the bacterial suspension concentration (all P<0.05), except for the Lac in the P-4 group and P-8 group ( P>0.05). HE staining showed that different degrees of inflammatory infiltration can be seen in the lungs of the experimental rats in each group. Conclusions:Infection of rats by nasal dripping with 3×10 8 CFU/ml of S. aureus suspension or 4×10 8 CFU/ml of P. aeruginosa suspension could establish relatively stable rat sepsis model induced by lung bacterial infection, of which the former could also establish a relatively stable septic shock model.

Basic research for prevention and treatment of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues worldwide. In particular, multiple newly reported cases of autoimmune-related diseases after COVID-19 require further research on coronavirus-related immune injury. However, owing to the strong infectivity of SARS-CoV-2 and the high mortality rate, it is difficult to perform relevant research in humans. Here, we reviewed animal models, specifically mice with coronavirus-related immune disorders and immune damage, considering aspects of coronavirus replacement, viral modification, spike protein, and gene fragments. The evaluation of mouse models of coronavirus-related immune injury may help establish a standardised animal model that could be employed in various areas of research, such as disease occurrence and development processes, vaccine effectiveness assessment, and treatments for coronavirus-related immune disorders. COVID-19 is a complex disease and animal models cannot comprehensively summarise the disease process. The application of genetic technology may change this status.

目的 慢性阻塞性肺病(COPD)为临床常见呼吸病之一,其急性加重(AECOPD)是导致患者死亡的关键原因之一,中西医对该病认知各有不同,中医药参与该病治疗有一定优势.本文拟通过中西医角度分析来为该病相关研究的深入发展提供理论参考.方法 本文从概念、病因病机、临床治疗等方面探讨中西医对AECOPD之认知,并综合实际临床经验,对中西医治疗AECOPD现存问题及如何更好发挥中西医之协同治疗作用,以提高临床疗效,降低病死率等问题进行讨论.结果 COPD在中医学范畴主要归为肺胀,古文中对于其发作特点有类似表述.AECOPD的西医病机包括炎症反应、氧化应激、免疫失调等,而中医病机主要在于肺脾肾亏虚,而痰浊、水饮和瘀血等病理产物积聚,影响肺之宣肃.AECOPD的西医治疗手段包括氧疗、扩张支气管、激素及抗感染等,而中医则需辨证论治,以痰热壅肺证和痰湿阻肺证为主;用治AECOPD的中成药及方剂可以通过减轻炎症、改善免疫、减少黏液分泌等机制发挥作用.结论 AECOPD治疗宜中西合用、标本兼顾、个体化治疗,但仍需更严谨和高质量的临床及基础研究提供依据.

目的:探究补肾益肺消癥方干预特发性肺间质纤维化(IPF)进展的可能机制,为"肺络微型癥疱"理论在中医药防治IPF奠定客观基础.方法:通过TGF-β1诱导MRC-5细胞转分化肺成纤维细胞,制备补肾益肺消癥方冻干粉,激光共聚焦显微镜观察MRC-5细胞线粒体自噬体数量及状况,通过Western Blot法检测NOX4、JNK、p62、Parkin、PINK1蛋白的表达.结果:模型组在TGF-β1刺激后较正常细胞组线粒体自噬现象明显增多,而西药对照组及中药低、中、高浓度组线粒体自噬现象较模型组减少.与正常组比较,模型组TGF-β1可显著激活JNK/p62/Parkin信号通路,各给药组NOX4、JNK、p62表达显著降低(P＜0.05),Parkin、PINK1表达显著升高(P＜0.05),但中药中浓度组对于降低JNK的表达明显优于其他给药组(P＜0.05).结论:补肾益肺消癥方治疗IPF的机制之一可能是通过抑制细胞线粒体自噬功能与调控JNK/p62/Parkin通路减缓肺组织的纤维化进程.

BACKGROUND To investigate effects of Maxingloushi decoction on lung inflammation and programmed death markers (programmed death-1 [PD-1], programmed death-ligand 1 [PD-L1]) in the lung tissue, peripheral blood, and bronchoalveolar lavage fluid (BLF) in a mouse model of chronic obstructive pulmonary disease (COPD). METHODS Thirty-six mature male BALB/C mice were randomly divided into normal group (group A, n=6), COPD model group (group B, n=10), Maxingloushi decoction + COPD group (group C, n=10), and PD-1 inhibitor + COPD group (group D, n=10). The COPD model was established by smoke inhalation combined with lipopolysaccharide (LPS). Levels of PD-1 and PD-L1 in plasma and BLF were measured by enzyme-linked immunosorbent assay (ELISA). Histopathological techniques were used to semi-quantitatively analyze the immuno-fluorescence optical density (IOD) value of the lung tissue. RESULTS In plasma and BLF, the expression of PD-1 in the group B was higher than that in the group A, and the expression of PD-L1 was lower than that in the group A. The expression of PD-1 and PD-L1 in the lung tissue was normalized in the group C in comparison with the group B (P<0.05) and the group D (P<0.05), and inflammatory cell infiltration in the lung tissue was also improved. CONCLUSIONS These findings reveal that COPD causes an immune imbalance in the peripheral blood and lung tissue, and that both Maxingloushi decoction and PD-1 inhibitor treatment can mitigate lung inflammation in COPD by reducing PD-1 expression and increasing PD-L1 expression. The treatment effect of Maxingloushi decoction may be superior to that of PD-1 inhibitor.

目的 探讨松龄血脉康对慢性间歇性低氧(CIH)介导的高血压及相关血管内皮损伤小鼠的干预效应和p38丝裂原活化蛋白激酶/核因子-κB9(p38 MAPK/NF-κB)信号通路的作用.方法 按照随机数字表法将小鼠分为6组:正常组、模型组、西药对照组和低、中、高3个剂量实验组,每组10只.给药后,正常组除外的5组均予低氧动物培养箱进行CIH处理15 d;正常组、模型组予生理盐水,西药对照组灌胃予氨氯地平0.74μg·kg-1·d-1,低、中、高3个剂量实验组分别灌胃予松龄血脉康5.85,11.70,23.40 mg·kg-1·d-1.检测小鼠血压,用实时荧光定量-PCR法和蛋白质印迹法检测p38MAPK/NF-κB信号通路相关基因及与蛋白表达水平.结果 正常组、模型组、西药对照组和高剂量实验组血压分别为(123.21±4.45),(143.51±3.06),(119.85±3.55),(126.71±4.65)mmHg;这4组的磷酸化P38丝裂原活化蛋白激酶(p-p38 MAPK)蛋白表达水平分别为0.41±0.12,1.35±0.24,0.74±0.28,0.53±0.14.这4组的NF-κB蛋白表达水平分别为0.32±0.15,1.00±0.18,0.58±0.13,0.43±0.13.这4组的细胞间黏附分子-1(ICAM-1)蛋白表达水平分别为0.43±0.09,1.47±0.30,1.05±0.41,0.74±0.20.基因结果的趋势与蛋白一致.模型组与正常组,上述指标的差异均有统计学意义(均P<0.05);西药对照组和高剂量实验组与模型组比较,上述指标的差异均有统计学意义(均P<0.05).结论 松龄血脉康能降低CIH条件下小鼠的血压水平,并改善炎症反应及血管内皮损伤,其机制可能与抑制CIH条件下p38 MAPK/NF-κB信号通路的上调作用有关.

目前中医院急诊临床医疗实际中"教"和"用"相互脱离,主要表现在中医药在急危重症患者临床实际中应用较少甚至缺失.笔者认为在中医急诊临床教学中,比起中医药(中医饮片、注射用中药以及针灸)在急诊的具体应用带教来说,更应该重视中西医基础病理病机的思维融通.本文总结了笔者在中医院急诊临床实习带教中典型的中西医思维融通案例,希望在今后的中医院急诊临床实习带教中有更多的老师(医师)能够重视这种思维融通并总结经验.

目的:比较肺部超声是否和床旁胸部X线检查具有老年社区获得性肺炎(CAP)同样的诊断效力;比较肺部分区逐肋探查法和改良BLUE方案两种肺部超声探查方法在诊断老年CAP时是否具有同样的诊断效力.方法:2018年12月-2020年11月期间在北京中医药大学东直门医院急诊科就诊、符合65岁及以上社区来源疑似CAP临床特点的患者入选本研究,分别进行床旁胸部X线检查、床旁肺部超声检查和胸部CT检查.以胸部CT为金标准,统计床旁胸部X线和肺部超声诊断的阳性和阴性例数.结果:基于多种征象联合诊断老年CAP,肺部超声敏感度低于床旁胸部X线检查(78.3％vs.85.0％),特异度高于床旁胸部X线检查(91.3％vs.71.7％),而整体诊断准确率高于床旁胸部X线检查(84.0％vs.79.2％);基于多种征象联合诊断老年CAP,肺部分区逐肋探查法其敏感度、特异度、诊断准确率(78.3％、91.3％、84.0％)均高于改良BLUE方案(61.7％、89.1％、73.6％).结论:肺部超声可作为相当于床旁胸部X线的一种有效诊断老年CAP的检查方法,达到急诊科医生早期、快速、准确诊断老年CAP的目的;改良BLUE方案不能够替代逐肋探查的超声检查方法诊断老年CAP.

在临床实践中,医生常会遇到运用片面的医学知识难以解释或处理的临床现象或问题,由此使我们联想到"中西医结合"方法,即采用中医学和西医学理论和方法各取其长、互补其短,从而解决实际问题.本文介绍3例胸腔积液和急性肾功能不全患者,因采用常规保守治疗方法(给予足量利尿剂)效果不佳,遂间断给予胸膜腔穿刺抽取胸水,引流胸水的同时可见尿量增加,水肿消退,呼吸困难等症状亦得到缓解.该文分别从中医和西医角度分析并阐述其机制,在寻找理论契合点的同时,提供中西医结合治疗的思路.

姜良铎教授认为外感咳喘存在单纯性的外感咳喘和内伤基础上的外感咳喘两种情况,临床诊治时不可混而同治.外感因素中寒邪居多,单纯性的外感咳喘治宜祛寒宣肺、解痉平喘,方用桂枝加厚朴杏子汤临证加减;内伤基础上的外感咳喘则病情复杂,脏腑相关、内外影响,姜老认为内伤基础上的外感咳喘诊治尤其注重肝肺关系.在外感咳喘的辨证上姜老注重"望咽喉"及判断"有无肺燥".现将其经验总结如下,并附典型病例说明.

目的 探讨中医医院急诊科防控急性呼吸道传染病(ARIs)的功能地位,进一步提高中医医院急诊科ARIs的防控能力.方法 结合中医医院急诊科特点,从严格遵守ARIs防控工作流程、划分不同风险等级工作区域、严控医护交叉感染、提供预防中药汤剂、重视心理调摄、根据实践反复优化流程、强化防疫理念等角度优化管理.结果 本院急诊科在ARIs防控实践过程中,除了严格遵照国家颁布的相关防控方案以及诊疗方案以外,还根据科室自身的特点,从空间、人员以及服务等方面制定出了更加适合本院和我科的疫情防控具体实施措施.结论 中医医院急诊科防控ARIs需结合科室自身特点,在实践过程中不断进行方案的完善与优化,希望笔者的经验能为其它中医医院急诊科制定适合自家医院的ARIs防控体系提供借鉴.

BACKGROUNDThe study aimed to evaluate the predictive role of interleukin-6 (IL-6) and chronic obstructive pulmonary disease (COPD) assessment test (CAT) score in mechanical ventilation (MV) in COPD patients at the acute exacerbation stage in the emergency department (ED).METHODSFor a one-year period, among adult patients in the ED who met the criteria of acute exacerbation of COPD, 158 who received MV within 48 hours after admission were compared to 294 who didn't require MV within the same period after admission. IL-6 level and CAT score were compared between the two groups. The predicted value of IL-6 and CAT score was assessed by logistic regression analysis and a receiver operating characteristic (ROC) curve.RESULTSThe IL-6 and CAT scores in the 158 MV patients were much higher than those without. IL-6 and CAT scores were independent predictors of MV within 48 hours using logistic regression analysis (IL-6: odds ratio [OR] 1.053, 95% confidence interval [CI] 1.039-1.067, P<0.001; CAT score: OR 1.122, 95% CI 1.086-1.159, P<0.001). The combination of IL-6 and CAT scores (area under ROC curve [AUC] 0.826, 95% CI 0.786-0.866, P<0.001) improved the accuracy of predicting MV within 48 hours when compared with IL-6 (AUC 0.752, 95% CI 0.703-0.800, P<0.001) and CAT scores alone (AUC 0.739, 95% CI 0.692-0.786, P<0.001). The sensitivity and specificity were 69.6%, 74.1%, 75.32% and 63.6%, respectively.CONCLUSIONThe combined of IL-6 and CAT scores is useful for evaluating the risk of COPD patients at acute exacerbation in ED, and can provide a predictive value for MV or not within 48 hours.