ABSTRACT
Objective:Through retrospective analysis of the admission and treatment of patients in the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University over the past 5 years, it provides a basis for the construction of the subspecialty of intensive care medicine.Methods:Collect clinical data of patients admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from January 1, 2016 to December 31, 2020, including gender, age, first consultation department, intensive care unit (ICU) hospitalization time, ventilator use time, main diagnosis, acute physiology and chronic health evaluationⅡ(APACHEⅡ) when transferred into and out of ICU, treatment results, whether to give mechanical ventilation, whether to use a non-invasive ventilator to assist breathing, whether to die in 24 hours, rescue times and success rate, etc. Changes in the above indicators during the 5 years were analyzed.Results:In the past 5 years, our hospital has treated 2 668 patients in the comprehensive ICU with severe neurological, severe circulation, and severe trauma as the main treatment area, including 1 648 males and 1 020 females; aged 6 months to 94 years old, the average age (53.49±19.03) years old. Neurosurgery (907 cases) was the most frequently diagnosed department, the top 3 diseases were cerebral hemorrhage (539 cases), septic shock (214 cases), and hypovolemic shock (200 cases); ICU hospitalization time was 126 (52, 253) hours, ventilator time was 65 (17, 145) hours, APACHE Ⅱ scores were 23.29±8.12 and 12.99±6.37 when transferred into and out of ICU. The proportion of receiving mechanical ventilation was 92.94% (2 147/2 310), and 314 cases used non-invasive ventilators. 84 cases died within 24 hours (mortality was 3.15%). A total of 2 585 rescues were performed, and the rescue success rate was 92.84% (2 400/2 585). From 2016 to 2020, the 5-year cure rates were 65.92%, 65.83%, 61.53%, 65.64%, 69.06%, respectively, and the 5-year mortality were 13.13%, 14.29%, 18.89%, 16.69%, 13.38%, respectively.Conclusions:With the continuous expansion of critical care medicine, the establishment of classified subspecialties can focus on the admission of patients, so that treatment can be professionalized and standardized, improve the cure rate, and reduce mortality. At the same time, medical staff can focus on management and learning related expertise to master the disease, it is also more in-depth, which is helpful for doctors to improve themselves, and is conducive to the proficiency of related sub-specialties, and lays a good foundation for the development of the department.
ABSTRACT
Objective To analyze the pathogenic factors, clinical features and treatment measures of critically ill pregnant women so as to provide experience for improving the success rate of treatment. Methods The clinical data of 167 cases of critically ill pregnant women who admitted to intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University from January 2013 to December 2017 were collected, and the disease distribution of patients, the causes of postpartum hemorrhage, the treatment situation and the results. Patients were divided into obstetrical complications group, pregnancy complicated with basic diseases group and other complicated diseases group according to disease types, and the treatment status of each group was analyzed. Results Among 167 critically ill pregnant women, 118 cases (70.6%) were in the obstetric complications group, 26 cases (15.6%) were in the pregnancy complicated with basic diseases group, and 23 cases (13.8%) were in the other complicated diseases group. Nine cases died in 167 critically ill pregnant women, with a mortality rate of 5.4%. Postpartum hemorrhage was the major obstetric complication (35.3%), and the coagulation function of 59 patients with postpartum hemorrhage was significantly improved 48 hours after active hemostasis and reasonable blood transfusion [compared to entering the ICU, prothrombin time (PT, s): 14.49±4.66 vs. 23.39±8.11, activated partial thromboplastin time (APTT, s): 52.94±36.36 vs. 87.35±74.69, fibrinogen (Fib, g/L): 2.91±1.03 vs. 1.03±0.65, platelet count (PLT, ×109/L): 94.85±30.09 vs. 43.15±24.07, all P < 0.01]. Compared with pregnancy complicated basic diseases group and other complicated diseases group, the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores was reduced significantly in obstetrical complications group (10.41±4.85 vs. 16.46±13.87, 16.90±8.82, both P < 0.05), the length of ICU stay was significantly reduced (hours: 57.83±34.67 vs. 79.64±36.01, 278.30±83.72, both P < 0.05). Compared with other complicated diseases group, the mechanical ventilation time [hours :14 (6, 38) vs. 43 (12, 396)] and mortality (0.8% vs. 13.0%) were significantly decreased in obstetrical complications group (both P < 0.05). Conclusions Observe the changes of the condition closely, necessary hemodynamic treatment, respiratory support, and organ function support with critically ill pregnant women can improve the rescue success rate and prognosis.