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Objective To analyze the comparation of national early warning score (NEWS), rapid emergency medicine score (REMS) and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score in predicting prognosis of critically ill patients in emergency department (ED). Methods A retrospective study was conducted. Critically ill patients, aged > 16 years, hospitalized > 24 hours, and admitted to the ED of Nanhua Hospital Affiliated to South China University from January 2016 to June 2017 were enrolled. NEWS, REMS and APACHE Ⅱ score were calculated based on the worst value of each index within 24 hours after emergency admission. The primary endpoint was 28-day mortality. The relationship between the three scoring systems and the prognosis of patients was analyzed. The predictive value of three scoring systems for the prognosis of critically ill patients in ED was analyzed by receiver operating characteristic curve (ROC). Results A total of 119 emergency severe patients were enrolled in the study, and the 28-day mortality was 21.0%. The scores of NEWS, REMS and APACHE Ⅱ in the death group were significantly higher than those in the survival group (NEWS score: 9.40±3.19 vs. 5.72±2.35, REMS score: 12.64±4.46 vs. 7.97±3.28, APACHE Ⅱscore: 26.64±6.92 vs. 16.19±5.48, all P < 0.01). With the increase of NEWS, REMS and APACHE Ⅱ score, the 28-day mortality of patients gradually increased [28-day mortality of NEWS < 5, 5-6, ≥ 7 was 3.03% (1/34), 13.33% (4/34), 64.25% (20/51); 28-day mortality of REMS < 12, 12-16, ≥ 17 was 10.99% (10/91), 50.00% (11/22), 66.67% (4/6); 28-day mortality of APACHE Ⅱ < 15, 15-24, ≥ 25 was 2.33% (1/43), 15.09% (8/59), 69.57% (16/23), respectively, all P < 0.01]. The ROC curve analysis showed that the areas under the ROC curve (AUC)of NEWS, REMS and APACHE Ⅱ score for predicting the prognosis of emergency critically ill patients were 0.830 [95% confidence interval (95%CI) = 0.737-0.923], 0.782 (95%CI = 0.671-0.892) and 0.878 (95%CI = 0.800-0.956), respectively (all P = 0.000), and the accuracy of prediction was 57.4%, 48.6%, 65.4%, respectively. Conclusions The scores of NEWS, REMS and APACHE Ⅱ were useful in predicting prognosis of critically ill patients, with the highest accuracy of APACHE Ⅱ forecast, followed by NEWS, and the lowest of REMS. After comprehensive consideration of cost-effectiveness, NEWS is more reliable in ED.
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Objective To explore the relationship between pathological changes of liver,serum ALT,expression of P-selectin in serum of mice and different dose of venom,the poisoning time induced by Agkistrodon Halys Pallas venom.Methods Using two -factor factorial design,72 male Kunming mice of clean grade were randomly ( random number) divided into 9 groups (n =8).As per the different doses of snake venom injected and different lengths of time after venom injected,the 9 groups were 0-dose (0.0 mg/kg) 3 hours after saline given group,0-dose 8 hours after saline given group,0-dose 24 hours after saline given group,low-dose (0.5 mg/kg) 3 hours after venom given group,low-dose 8 hours after venom given group,low-dose 24 hours after venom given,high-dose ( 1.0 mg/kg) 3 hours after venom given group,high-dose 8 hours after venom given group and high-dose 24 hours after venom given group.The pathological change of liver tissue was determined,and ALT and expression of P-selectin in serum were detected.Results In the venom given groups,the liver histopathologic scores,serum ALT value and expression of Pselectin in serum were significantly higher than those in control group ( P ＜ 0.05 ),and those in high-dose group were higher than those in low-dose group (P ＜ 0.05 ),and those in 8h groups were higher than those in 3h groups (P＜0.05),and those in 24 h groups were higher than those in 8 h groups (P ＜0.05).As the dose of venom increased and the length of time after venom given extended,the liver histopathologic scores,serum ALT and expression of P-selectin in serum were higher.A positive correlation between Pselectin expression and liver histopathologic scores was found after correlation analysis ( r =0.98,P ＜0.05 ).Conclusions Agkistrodon snake venom can cause acute liver injury with elevated ALT and Pselectin in mice.As higher dose of venom given and longer length of time after venom given extended,more serum ALT and P-selectin are produced.Between acute liver injury and high expression of P-selectin exists a correlation,suggesting overexpression of P-selectin is one of the mechanisms of acute liver injury induced by Agkistrodon Halys Pallas venom.
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Objective To explore the mechanism and therapeutic effects of wet dressing with 50％ magnesium sulfate ( MgSO4 ) as a part of comprehensive treatment for wound resulted from pit viper bites in children.Methods A total of 61 children with pit-viper-bitten wound enrolled from May 2009 through May 2011 were divided into two groups,namely the comprehensive treatment group (n =31 cases) and the conventional treatment group (n =30 eases). In the comprehensive treatment group,50％ magnesium sulfate wet dressing applied to the swelling parts of body in the early stage in addition to the conventional treatment and topically bandaged once a day keeping wet with spraying saline on the top of dressing.Before the treatment and on the 1st day,the 3rd day and the 5th day of treatment,the values of myocardial enzyme and the circumference of swelling parts were recorded,and the differences were analyzed by t- test.The differences in rate of wound healing in one week between two groups were analyzed by chi-square test.Results Before the treatment,there was no statistical difference in clinical features between the two groups with different modes of treatment for the viper-bitten children (P ＞ 0.05 ). During comprehensive treatment,the values of myocardial enzyme and the circumference of swelling parts decreased more markedly than those in conventional treatment group ( P ＜ 0.05 ).The rates of wound healing in one week of two groups were 80.5％ and 56.6％ respectively.Conclusions The comprehensive treatment with adjuvant of 50％ MgSO4 for the viper-bitten children can effectively reduce the tissue damage caused by venom,and the swelling as well,restoring function of body and shortening the time for wound healing and preventing complications.