Objective To explore the predictive value of soluble urokinase-type plasminogen activator receptor (suPAR) for severe acute pancreatitis (SAP). Methods A prospective cohort study was designed to enroll 103 patients with acute pancreatitis who were admitted to our department from March 1 to June 1, 2021, including 23 SAP and 80 non-severe acute pancreatitis (NSAP). Another 30 healthy subjects were recruited concurrently as control group. The plasma samples of all subjects were collected on the first day of admission to detect the level of suPAR using ELISA. General clinical data and the levels of procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein (CRP), D-dimer and serum calcium (Ca2+), as well as the results of blood routine and biochemical examinations of patients were all collected. Acute Physiology and Chronic Health Evaluation (APACHEⅡ) score and Ranson's score were subsequently calculated. For the control subjects, only their demographic characteristics (age and gender) were collected. Statistical analysis was adopted on the above data. Results The plasma suPAR level was significantly higher in the patients with NSAP and SAP than the control group (P < 0.05), and also notably higher in those of the SAP group than those out of the NSAP patients (P < 0.05). Pearson correlation analysis showed that plasma suPAR level was positively correlated with both APACHE Ⅱ score and Ranson's score (R=0.554, R=0.485, P < 0.05). Multivariate Logistic regression analysis indicated that suPAR, D-dimer and Ca2+ levels were independent predictors of SAP. ROC curve demonstrated that serum suPAR had a good predictive value for SAP (AUC=0.869). Conclusion The plasma level of suPAR is closely correlated with the severity of acute pancreatitis, and plays an important role in prediction of SAP.

目的:探讨血浆可溶性尿激酶型纤溶酶原激活物受体(suPAR)和损伤严重度评分(ISS)、新损伤严重度评分(NISS)、改良早期预警评分(MEWS)对急诊严重创伤患者病情危重程度的评估价值.方法:纳入2019年12月-2020年10月期间我院急救部抢救室接诊并收住院的严重创伤患者,入院后检测血浆suPAR并完善上述评分,根据入院24 h内的急性生理学和慢性健康状况评分(APACHE)Ⅱ及序贯器官衰竭评分(SOFA)将患者分为危重组和一般组,比较两组患者的一般情况、ISS、NISS、suPAR和MEWS,采用多因素Logistic回归分析患者病情危重的独立预测因子,绘制受试者工作特征(ROC)曲线明确各指标的评估价值.结果:共纳入101例严重创伤患者,其中危重组34例(33.7％),一般组67例(66.3％),危重组患者的血浆suPAR水平、ISS、NISS和MEWS 均显著高于一般组[(6.9±2.7)ng/mL vs.(5.0±2.0)ng/mL,P=0.000;29(26,34)分vs.25(20,29)分,P=0.004;34(34,41)分vs.33(27,34)分,P=0.001;4(3,5)分vs.2(1,3)分,P=0.000],一般情况的组间差异无统计学意义(P＞0.05);多因素Logistic回归分析显示入院时高MEWS、高血浆suPAR水平和高NISS是严重创伤患者病情危重的独立预测因子(OR=2.286,95％CI:1.501～3.482,P=0.000;OR=1.361,95％CI:1.062～1.744,P=0.015;OR=1.102,95％CI:1.014～1.198,P=0.022),ROC 曲线下面积(AUC)分别为0.829(95％CI:0.741～0.896,P＜0.001)、0.721(95％CI:0.623～0.806,P＜0.001)、0.700(95％CI:0.601～0.788,P＜0.001),取截断值＞3分、＞5.02 ng/mL、＞33分时对应的敏感度和特异度分别为70.59％和83.58％、76.47％和61.19％、82.35％和53.73％;suPAR联合MEWS时AUC 为0.857(95％CI:0.774～0.919,P＜0.001),敏感度为73.53％,特异度为86.57％;suPAR联合NISS时AUC 为0.819(95％CI:0.730～0.888,P＜0.001),敏感度为91.18％,特异度为65.67％.结论:单独应用MEWS、血浆suPAR和NISS均能进一步评估严重创伤患者的病情危重程度,suPAR联合MEWS后评估效能最佳,更适用于急诊.

目的 系统评价手术前握力锻炼对拟行动静脉内瘘(arteriovenous fistula,AVF)术的慢性肾脏病(chronic kidney disease,CKD)患者前臂血管内径的影响.方法 计算机检索中国生物医学文献数据库、中国知网期刊数据库、维普中文科技期刊数据库、万方期刊数据库、PubMed、Medline、Co-chrane library中已发表的相关文献,检索时限为建库至2021年2月26日.由2名研究员独立筛选文献、提取资料、文献质量评价并进行交叉核对,采用RevMan5.3软件进行Meta分析.结果 共纳入研究12篇,累计样本量343例.Meta分析结果显示:①锻炼后血管内径大于锻炼前血管内径(SMD=1.03,95％ CI:0.62～1.45,P＜0.01).②加压锻炼增加血管内径(SMD=1.31,95％ CI:0.26～2.36,P=0.01),非加压锻炼同样增加血管内经(SMD=0.92,95％ CI:0.49～1.34,P＜0.01).③不同锻炼时间节点血管内径与锻炼前血管内径比较:锻炼第2周(SMD=0.72,95％ CI:0.05～1.38,P=0.03)、第4周(SMD=1.60,95％CI:0.75～2.45,P＜0.01)、第6～8周(S5MD=1.47,95％ CI:0.77～2.18,P＜0.01)血管内径均大于锻炼前血管内径;④锻炼第8周血管内径与锻炼第4周血管内径比较差异无统计学意义(SMD=0.31,95％ CI:-0.43～1.05,P=0.41).结论 手术前握力锻炼可增加拟行AVF手术的CKD患者前臂血管内径,加压锻炼与非加压锻炼均有利于血管内径的增加,可将握力锻炼时间提前到手术前4周或8周.

Objective To investigate the predictive value of plasma soluble urokinase-type plasminogen activator receptor (suPAR) for post-severe traumatic multiple organ dysfunction syndrome (MODS). Methods A total of 108 patients suffering from severe trauma admitted to the Trauma Center of our hospital from December 2019 to December 2020 were enrolled. Venous blood samples were collected at admission and plasma suPAR concentration was measured by ELISA, and their demographic and clinical data were collected. The patients were divided into MODS group and non-MODS group according to the sequential organ failure assessment(SOFA) within 14 d after admission. The general data and variables such as suPAR, white blood cell (WBC) count, and injury severity score (ISS) were compared between the 2 groups. Logistic regression analysis was used to screen the independent predictors for post-traumatic MODS, and receiver operating characteristic (ROC) curve was adopted to evaluate the predictive value of the variables. Results Age, rate of comorbidity, ISS, suPAR at admission, rate of shock, rate of infection and rate of surgery were significantly higher in the MODS group than the non-MODS group [52.6±14.1 vs 46.1±14.1 years old, 29.4% vs 9.5%, 29 (25, 33) vs 26 (21, 30) points, 6.7±2.7 vs 5.0±2.1 ng/mL, 41.2% vs 17.6%, 61.8% vs 24.3%, 52.9% vs 32.4%, P < 0.05]. There were no significant differences in sex, injury cause, injury site, WBC count, and rate of blood purification between the 2 groups. Multivariate Logistic regression analysis showed that comorbidity, ISS, suPAR, and infection were independent predictors for post-traumatic MODS (P < 0.05). ROC curve analysis indicated that the area under the curve (AUC) of suPAR for predicting post-traumatic MODS was 0.704 (P < 0.05). When the cutoff value was 5.04 ng/mL, the sensitivity was 73.5% and the specificity was 62.2%. The AUC of ISS was 0.632 (P < 0.05), and the sensitivity was 73.5% and the specificity was 58.1% when the cutoff value was 26. Conclusion The plasma suPAR level at admission can predict the occurrence of post-traumatic MODS in patients with severe trauma. Early monitoring of suPAR has a certain value in evaluation of inflammation and immune activation in the body and in guidance of clinical evaluation and treatment.

目的:分析静脉输液非正常拔针的原因及护理措施.方法:对2013年7月-12月我科住院患者输液非正常拔针的原因进行分析.结论:在临床输液过程中,护理人员应加强巡视,重视患者健康教育,提高穿刺成功率,妥善固定,尽可能避免输液非正常拔针的发生.