Résumé
Objective To explore the relationship between early changes of central venous-toarterial carbon dioxide difference (Pcv-aCO2) and the prognostic in patients with septic shock.Methods One hundred and three patients with septic shock were retrospectively analyzed.The patients were divided into death group (37 cases) and survival group (66 cases) according to prognosis.The patients were divided into four groups according to the changes of 0 and 6 h Pcv-aCO2:Pcv-aCO2 persistently high group (16 cases),Pcv-aCO2 increased group (19 cases),Pcv-aCO2 decreased group (22 cases),Pcv-aCO2 persistently normal group (46 cases).All the patients were treated with early goal-directed therapy (EGDT),and central venous oxygen saturation (ScvO2) ≥0.70 was the target.The acute physiology and chronic health evaluation (APACHE) Ⅲ score,sepsis related organ failure assessment (SOFA) and mortality were compared.Results There was no statistical difference in 0 h Pcv-aCO2 (P ＞ 0.05).The Pcv-aCO2 in 6,12 and 24 h in survival group was significantly lower than that in death group [(5.0 ± 1.8) mmHg (1 mmHg =0.133 kPa) vs.(6.8 ± 2.3) mmHg,(4.7 ± 2.3) mmHg vs.(7.2 ± 3.0) mmHg,(3.2 ± 1.5) mmHg vs.(7.5 ± 3.3) mmHg],and there was statistical difference (P ＜ 0.05 or ＜ 0.01).The APACHE Ⅲ score in survival group was significantly lower than that in death group [(51.6 ± 23.8) scores vs.(87.7 ± 35.9) scores],and there was statistical difference (P ＜ 0.05).The time of mechanical ventilation,APACHE Ⅲ score,SOFA,length of stay in hospital and mortality in Pcv-aCO2 persistently high group and Pcv-aCO2 increased group were significantly higher than those in Pcv-aCO2 decreased group and Pcv-aCO2 persistently normal group,and there were statistical differences (P ＜ 0.05 or ＜ 0.01).Conclusion The Pcv-aCO2 persistently high during the early resuscitation of septic shock is associated with multi-organ dysfunction and worse prognosis,and provides guidance for clinical treatment.
Résumé
ObjectiveTo observe the change of blood phosphorus and N-terminal pro-brain natriuretic peptide(NT-proBNP) in patients with severe acute organophosphorus pesticide poisoning (AOPP)and explore their clinical significance.MethodsSeventy-eight severe AOPP patients were selected and divided into dead group (54 cases) and survival group (24 cases).NT-proBNP and blood phosphorus were examined when the patients were just hospitalized,and after 1,2,4 d and when they were turn out from ICU or before the patients dead.ResultsComparing with survival group,blood phosphorus and NT-proBNP of dead group had no significant difference when the patients were just hospitalized(P＞ 0.05 ).After 1,2 and 4d NT-proBNP of dead group [ ( 1986.5 ± 24.9),(3568.2 ± 56.9),(7829.0 ± 64.3 ) ng/L ]was higher than that of survival group [ ( 1068.4 ± 20.2),(986.6 ± 16.4),(943.7 ± 14.6) ng/L,P ＜ 0.05 or ＜ 0.01 ],while blood phosphorus was significant lower than that in survival group [ ( 1.22 ± 0.13 ),(0.81 ± 0.10),(0.58 ±0.07 ) mmol/L vs.( 1.53 ± 0.16),( 1.48 ± 0.13 ),( 1.46 ± 0.14 ) mmol/L,P ＜ 0.05 or ＜ 0.01 ].NT-proBNP of dead group increased and blood phosphorusreduced gradually by time extending (P ＜ 0.05).NT-proBNP was lower when patients were turn out from ICU than that when the patients were just hospitalized [ (327.5 ±12.3) ng/L vs. (1023.3 ± 18.8) ng/L,P ＜ 0.05].Blood phosphorus had no difference at all time points in survival group (P ＞ 0.05 ).NT-proBNP was higher [ ( 31 486.5 ± 120.7) ng/L vs.(327.5 ± 12.3) ng/L,P ＜0.01 ]and blood phosphorus was lower [ (0.24 ± 0.03 ) mmol/L vs.( 1.57 ± 0.15 ) mmol/L,P ＜ 0.01 ]before death in dead group compared with those at the time turning out from ICU in survival group.Conclusions The value of NT-proBNP increased and blood phosphorus reduced gradually with disease progression.NT-proBNP and blood phosphorus were important factors reflecting the prognosis of blood AOPP patients.
Résumé
objective To evaluate the prognostic value of five scoring systems including acute physiology and chronic health evaluation Ⅱ score (APACHE Ⅱ ),Ranson score,sepsis-related organ failure assessment (SOFA),Balthazar CT severity index (CTSI) and modified early warning score (MEWS) in early prognosis of severe acute pancreatis.Methods One hundred and fifty-four patients with severe acute pancreatitis from January 2004 to January 2010 were studied retrospectively,and data pertinent to five scoring systems were recorded from day 1 to day 3 after admission in hospital All patients were divided into early non-survival group (43 cases) and early survival group ( 111 cases) by survival time after admission in hospital.Five scoring systems during first 3 days aftter admission and their prognostic value in early prognosis of severe acute pancreatitis was compared between two groups.Results Compared with that of early survival group,every day five scoring systems of early non-survival group were significantly higher in the first 3 days after admission (P ＜ 0.05 or ＜ 0.01 ).On day 1 after admission,APACHE Ⅱ was the most accurate predict of early mortality with area under curve (AUC) value of 0.879,closely followed by MEWS (AUC 0.858).On day 2 and 3 after admission,the MEWS was the most accurate predict of early mortality with AUC 0.900 and 0.942,respectively.Conclusion MEWS is more accurate predict of early mortality in severe acute pancreatitis among different scoring systems,worthy of generalization in clinic.