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Objective:To explore the prognostic risk factors of patients with multiple injuries and establish a nomogram prediction model.Methods:The clinical data of 291 patients with multiple injuries admitted to the Emergency Intensive Care Unit (EICU) of General Hospital of Ningxia Medical University were collected, including sex, age, open injury, norepinephrine use, mechanical ventilation, time to hospital after injury, distance to hospital, relative lymphocyte value, platelet count, lactic acid, injury severity score (ISS), acute physiology and chronic health evaluationⅡ (APACHE Ⅱ), Glasgow coma scale (GCS), number of blood transfusions, number of operations, and previous history of diabetes, hypertension and smoking within 24 h after admission. According to whether the condition worsened during the hospitalization of EICU, the patients were divided into the deterioration group and improvement group. SPSS26.0 software was used for statistical analysis of the data, univariate and multivariate analysis were used to screen the factors affecting the prognosis of patients with multiple injuries, receiver operating characteristic (ROC) curve and forest chart were drawn, and the influencing factors in binary Logistic regression model were used to make the nomogram.Results:Mechanical ventilation, norepinephrine use, age, relative lymphocyte value, lactic acid, APACHE-II score, GCS score, and number of operations were significant for predicting the prognosis of patients with multiple injuries ( P<0.05). The independent influencing factors obtained by binary Logistic regression model were age, lactic acid, APACHE-Ⅱ score and number of operations. ROC curve analysis showed that the area under the curve was the largest in multi-factor combined prediction, followed by APACHE-Ⅱ score. The diagnostic cut-off value of each index was as follows: age >58 years old, relative lymphocyte value≤ 8.62%, lactic acid >1.72, APACHE-Ⅱ score >16, GCS score≤ 6, and number of operations≤ 0. The R software was used to establish a nomogram of the influencing factors in the binary Logistic regression model, which had good predictive value. Conclusions:The nomogram constructed by age, relative lymphocyte value, lactic acid, APACHE-Ⅱ score, GCS score, number of operations, mechanical ventilation, and norepinephrine use has a good predictive value for the prognosis of patients with multiple injuries, and is worthy of promotion..
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Objective:To observe the relationship between inducible carbon monoxide synthase (iNOS) and delayed encephalopathy after acute carbon monoxide poisoning (DEACMP), and explore its mechanism of action in DEACMP.Methods:This study was designed as prospective cohort study. Patients with acute carbon monoxide poisoning who met the diagnostic criteria and were admitted to Emergency Intensive Care Unit(EICU) of our hospital from June 2019 to June 2021 were selected as subjects. Patients were divided into the DEACMP group and non-DEACMP group according to the occurrence of DEACMP. Serum samples were collected on the first 24 h after admission and on day 7 and 14 after admission, and the serum nitric oxide (NO), neuronal nitric oxide synthase (nNOS), inducible carbon monoxide synthase (iNOS), and endothelial nitric oxide synthase (eNOS) level were measured by enzyme-linked immunosorbent assay. The generalized estimating equation was used to estimate the difference of NO, nNOS, iNOS and eNOS between DEACMP and non-DEACMP patients.Results:A total of 78 patients with carbon monoxide poisoning were included in our study finally, including 49 (62.82%) males and 29 (37.18%) females, with an average age of (53.96±14.95) years, 20 (25.64%) patients with DEACMP, and 1 (1.28%) death. Univariate analysis showed that patients with DEACMP had an average increase of 3 h (95% CI: 1.00, 5.00) in carbon monoxide exposure time and a 5-point decrease in GCS score (95% CI: 1.00, 6.00) than the patients without DEACMP, and the proportion of patients with severe carbon monoxide poisoning in the DEACMP group was higher than that of the non-DEACMP group (90.00% vs. 32.76%). According to the analysis of generalized estimation equation, on day 7 and 14 after admission, Compared with non-DEACMP patients, neither by performing unadjusted nor adjusted analysis with the iNOS of DEACMP patients was significantly higher than that in non-DEACMP patients regardless of whether exposure time, GCS score, coma time or severity of carbon monoxide poisoning were adjusted or not ( P <0.01 or P <0.05). Except for the level of nNOS in the GEE model adjusted with carbon monoxide exposure time, the levels of NO, nNOS and eNOS showed no significant difference between DEACMP and non-DEACMP patients ( P >0.05). Conclusions:The expression of iNOS level is increased in DEACMP patients, and its continuous expression may be involved in the pathogenesis of DEACMP.
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Objective:To explore the evaluation value of sequential organ failure assessment (SOFA) score at different time points in the prognosis of patients with severe pneumonia combined with acute respiratory distress syndrome (ARDS).Methods:A retrospective cohort study method was conducted, including patients with severe pneumonia and ARDS admitted to the emergency intensive care unit (ICU) of General Hospital of Ningxia Medical University from January 2015 to December 2019. General clinical data such as gender, age, and the SOFA scores at 1, 2, 3, and 7 days after admission were recorded. According to the diagnostic test, the prognostic evaluation value of SOFA score in patients with severe pneumonia combined with ARDS at different time points and different ages was analyzed.Results:A total of 88 cases were included in this study, eventually, 42 cases were survived and 46 cases died, the mortality was 52.27%. The age of the death group was significantly older than the survival group (years old: 60.67±14.66 vs. 51.91±15.97), the SOFA score at each time point were significantly higher than those in the survival group (9.83±3.50 vs. 7.54±2.67, 9.98±3.75 vs. 7.48±2.92, 10.84±4.14 vs. 7.23±2.94, 11.71±4.03 vs. 6.51±3.22, respectively at 1, 2, 3, 7 days after admission, all P < 0.01). The receiver operator characteristic curve (ROC curve) showed that the SOFA score at 1, 2, 3, and 7 days after admission had a certain predictive value for the prognosis of patients with severe pneumonia combined with ARDS (all P < 0.01), and with the prolong of ICU stay, the area under ROC curve (AUC) of SOFA score had gradually increased. On the 7th day after admission, the SOFA score had the highest sensitivity in predicting severe pneumonia combined with ARDS patients, which was 92.86%, and the specificity was the highest on the 3rd day after admission, which was 88.10%. The AUC in day 7 was significantly higher than day 2 (0.85 vs. 0.72) , there was no statistically significant difference of AUC at other time points. After stratifying by age, the diagnostic of sensitivity, specificity, accuracy, and AUC of SOFA score for the prognosis had gradually increased, and the predictive value was better. However, only on day 3 after admission, the AUC of SOFA score was significantly higher than day 1 (0.80 vs. 0.77, P < 0.05), and there was no significant difference in AUC at other time points. In patients older than 60 years old, the AUC of the SOFA score predicting the prognosis of patients was relatively small on day 1 and day 2 (0.67, 0.68, respectively), the ability was poor. There was no statistically significant difference in the AUC of SOFA scores at each time point in evaluating the prognosis of patients. The trends over time of patients at different ages and time points showed that regardless of age, the SOFA scores of the patients in the death group showed an upward trend, while showed a downward trend in the survival group, the difference reached the largest on the 7th day after admission, and the death group was significantly higher than the survival group (age < 60 years old: 12.50 vs. 6.69; age≥60 years old: 11.58 vs. 6.21). Conclusion:The initial SOFA score has a certain value in the evaluation of prognosis of severe pneumonia patients combined with ARDS, but the effect is poor for elderly patients.
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Objective:To explore the effect of different hemoperfusion times on the recovery of serum cholinesterase (ChE) in patients with severe acute oral organophosphorus pesticide poisoning (AOPP).Methods:This was a retrospective case-control study. Patients with severe AOPP admitted to our hospital were identified between January 2010 and December 2019. The clinical information of patients with severe AOPP was collected between January 2010 and December 2019, the patient's ChE vitality levels were collected on admission, at 1, 3 and 5 days after admission, and the sex, age, oral poison volume, and related treatments were recorded as well. The relationship between ChE, different HP treatment times and patients without HP treatment was analyzed by generalized estimation equations and multiple comparisons afterward.Results:A total of 159 patients with severe AOPP were included in our study. Among them, 60 (37.74%) patients were male and 99 (62.26%) were female, with a median age of 33 years old (range 13-75 years old). The median oral dose of OPs was 75 mL (range 15-500 mL). Multivariate analysis results showed that in the unadjusted generalized estimation equation, compared with patients without HP treatment, the average ChE value of patients with single HP treatment was 745.6 U/L higher (95% CI: 467.09 - 1024.1; P<0.01), the average ChE value of patients with 2 times HP treatment was 565.81 U/L higher (95% CI: 384.25-747.36; P<0.01), and the average ChE value of patients with 3 times HP treatment was 43.86 U/L higher (95% CI: 420.71-1 067.01; P<0.01), the differences were all statistically significant. After adjusting the amount of oral OPs at admission, age and PSS score in the multiple generalized estimation equations, the results showed that whatever single HP treatment or multiple HP treatment, the recovery rate of ChE was significantly faster than those without HP treatment. And the multiple comparison results of multiple models showed that the difference between 3 times HP treatment and 1 to 2 times HP treatment was not statistically significant, and the average difference between 2 times HP treatment and single HP treatment was also not statistically significant. Conclusions:Hemoperfusion therapy can accelerate the recovery rate of ChE in AOPP patients; Whatever single HP treatment or multiple HP treatments, the recovery rate of ChE in AOPP patients has no significant difference.
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Objective:To detect the expression of iNOS and nNOS in delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) and their correlation with hippocampal neuron degeneration and necrosis, and to explore iNOS and nNOS in DEACMP.Methods:Seventy-two adult male SD rats were selected and randomLy(random number) divided into the DEACMP group and normal group, with 36 rats in each group. The rats were given intraperitoneal injection of 99.99% CO gas without intervention. According to different time periods before and after dying and modeling, the two groups were divided into 6 subgroups: pre-modeling, 1 d modeling, 7 d modeling, 14 d modeling, 21 d modeling, and 28 d modeling. In 6 subgroups during the modeling time, HE staining was performed to observe neuron degeneration and necrosis in hippocampal CA3 area, and immunohistochemistry and Western blot were performed to detect the protein expression of iNOS and nNOS in hippocampus. Statistical analysis was performed using SPSS 21.0 software. The measurement data were expressed as Mean±SD, and normality test and variance analysis were performed on the experimental results of each group. The mean comparison between each group adopted the Student’s t test of two independent samples. Correlation analysis was conducted between the relative expression of iNOS and nNOS protein and the degenerative necrotic neurons, Pearson correlation analysis was used for normal distribution, and Spearman rank correlation analysis was used for non-normal distribution. A P<0.05 was considered as statistically significant. Results:There was no significant difference in the counts of hippocampal neuron degeneration and necrosis between the two groups before modeling, on 1 d, and 7 d modeling ( P>0.05), while there were significant differences between the two groups on 14 d, 21 d, and 28 d modeling ( P<0.05). There was no statistically significant difference in the expression of nNOS protein between the two groups of rats before modeling, on 21 d, and 28 d modeling ( P>0.05), while there were statistical differences between the 1 d modeling, 7 d modeling, and 14 d modeling ( P<0.05). There was no statistically significant difference in the expression of iNOS protein between the two groups of rats before and 1 day after modeling ( P>0.05), while there were statistically significant differences between the 7 d modeling, 14 d modeling, 21 d modeling and 28 d modeling ( P<0.05). Correlation analysis between the expression of iNOS protein and the count of degenerated and necrotic neurons showed a positive correlation ( P<0.05). There was no correlation between the expression of nNOS protein and the count of degenerated and necrotic neuron ( P>0.05). Conclusions:iNOS plays an important role in the pathogenesis of DEACMP; nNOS is not consistently highly expressed in the hippocampus of DEACMP, and has no correlation with neuronal degeneration and necrosis in the CA3 region of the hippocampus.
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Objective To evaluate the therapeutic effects of Shenfu injection (a Chinese herbal preparation of Aconitum and Ginseng) for the treatment of patients with post-resuscitation syndrome (PCAS) and to investigate its mechanism as well.Methods The data of 80 patients with restoration of spontaneous circulation (ROSC) after cardiac arrest were collected,and the patients were randomly divided into the experimental group and the control group.The patients in experimental group received Shenfu injection in addition to conventional treatment,and the patients in control group just had the conventional treatment.The cerebral performance classification (CPC) scores,Glasgow Coma Scales cores and sequential organ failure assessment (SOFA) scores before treatment and on the 3rd,7th,14th and 28th days after treatment in the patients of two groups were monitored and compared.The length of ventilation time,total expenses and mortality of the patients were calculated and compared between two groups.Results The data of 3 patients were excluded from those of total 80 patients,because the information of those patients was not complete.Finally,there were 37 cases in experimental group and 40 patients in control group.The CPC scores of smrvived cases in experimental group were lower than those in control group on the 3rd,7th,14th and 28th days after treatment (P ＜ 0.05).The Glasgow Coma Scale scores in experimental group were higher than those in control group on the 14th and 28th days after treatment (P ＜ 0.05).The SOFA scores in experimental group were lower than those in control group on the 3rd,7th and 14th days after treatment (P ＜ 0.05).There were no significant differences in length of ventilation time and total expenses between two groups on the 3rd,7th,14th and 28th days after treatment (P ＞ 0.05).The mortality of the experimental group was lower than that in control group at the 28 th day after treatment (P ＜ 0.05).Conclusions The Shenfu injection could improve the prognosis of patients with post cardiac arrest syndrome.