ABSTRACT
Objective To analyze the clinical features of neuropsychiatric systemic lupus erythematosus (NPSLE) with convulsion or coma as the main manifestation to facilitate the improvement of such patients' diagnosis. Methods Ninety-two patients with NPSLE confirmed in Peking Union Medical Hospital from January 2013 to December 2016 were collected, 27 NPSLE patients with convulsion or coma were in the study group, and the remaining 65 cases were in the control group. The following items in the two groups were compared in order to discover the differences in characteristics between the two groups: including sex, age, the first NPSLE episode or not, history of systemic lupus erythematosus (SLE), kidney, blood, heart, lung, skin mucous membrane, gastrointestinal involvement and co-infection, cerebrospinal fluid (CSF) pressure, cerebrospinal fluid cell count, cerebrospinal fluid/serum protein ratio, cerebrospinal fluid/serum glucose ratio, cerebrospinal fluid/serum chlorine ratio, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), complement 3 (C3), complement 4 (C4), magnetic resonance imaging (MRI) results, double strand deoxyribonucleic acid (ds-DNA) antibody, treatment status and hospitalization days. Results The number of CSF cells in the study group was significantly lower than that in the control group (×106/L: 91.84±25.37 vs. 279.52±101.12, P < 0.01). The skin mucosa involvement rate in the study group was significantly higher than that in the control group [14.81% (4/27) vs. 1.54% (1/65), P < 0.05]. Cerebrospinal fluid/serum protein ratio was higher in the study group than that in the control group (0.12±0.02 vs. 0.04±0.01, P < 0.05); the cerebrospinal fluid/serum glucose ratio was significantly lower than that in the control group (0.55±0.17 vs. 0.70±0.20, P < 0.01). The positive rate of MRI in the study group was higher than that in the control group [81.48% (22/27) vs. 55.38% (36/65), P < 0.05]; there were no significant differences between the two groups in other indexes (all P > 0.05). Conclusion Few cerebrospinal fluid cells increased involvement of skin mucosa, increased cerebrospinal fluid/serum protein ratio, decreased cerebrospinal fluid glucose/serum glucose ratio and increased MRI positive results were the clinical features of NPSLE patients with convulsion or coma as the clinical manifestation, early detection of this type of patients and early intervention can be beneficial to improve the prognosis.
ABSTRACT
Objective To analyze the clinical features of extubation failure in critically ill patients with tracheotomy in order to improve the success rate of tracheal extubation.Methods The clinical data of 52 critically ill patients with tracheotomy admitted to the Department of Emergency Internal Medicine of Chizhou People's Hospital of Anhui Province from January 2014 to January 2017 were retrospectively analyzed; there were 14 cases in failed extubation group (extubation failure: unable to plug the pipe, necessary to be cut or intubated again), and 38 cases were in successful extubation group (success criteria: after trying plugging the pipe for 24 - 48 hours, pulling out sleeving tube of tracheal incision, the incision healed well, within 3 months no dyspnea or pulmonary infection necessary to again performing tracheal intubation or incision). The differences in gender, age, within 3 days before plugging the pipe the consciousness, cough condition, the levels of serum albumin (Alb), serum potassium and serum sodium, brain natriuretic peptide (BNP), hemoglobin (Hb) were compared between the two groups, the clinical characteristics of extubation failure were analyzed, and the descriptions and their numbers for all diseases resulting in extubation failure were carried out.Results The number of conscious patients (24 cases vs. 4 cases), and the number of patients with good cough function (38 cases vs. 3 cases) were obviously more in successful extubation group than those in the failed extubation group, and the levels of serum Alb (g/L: 35.13±3.13 vs. 27.50±5.53), Hb (g/L: 112.18±13.62 vs. 94.14±17.03) in successful extubation group were significantly higher than those in failed extubation group (allP< 0.05). BNP was significantly lower in successful extubation group than that in failed extubation group (ng/L: 344.03±152.85 vs. 5887.80±2695.97,P < 0.05). The common diseases in extubation failure group were as follows: stroke in 7 cases, special severe craniocerebral injury 3 cases, respiratory failure 3 cases, after cardiac pulmonary resuscitation (CPR) operation 1 case.Conclusions The patients are fully assessed before extubation, countermeasures are taken as soon as possible in cases with coma, cough capability poor, hypoproteinemia, heart dysfunction and anemia in order to improve the successful rate of extubation.