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Objective:To investigate the curative effects of early continuous blood purification therapy on moderate to severe acute pancreatitis.Methods:The clinical data of 94 patients with moderate to severe acute pancreatitis who received treatment in the First People's Hospital of Shangqiu, China between January 2018 and October 2019 were retrospectively analyzed. These patients were divided into a control group and an observation group ( n =47/group) according to different treatment methods. The control group was treated with conventional treatment, while the observation group was treated with continuous blood purification therapy based on conventional treatment. The time to abdominal pain and distension relief, the changes of vital signs such as respiration and heart rate, renal function, the levels of liver enzymes, C-reactive protein and interleukin-6, median remission time of systemic inflammatory response syndrome, the Acute Physiology, Age, Chronic Health Evaluation II score, modified Marshall score, and modified CT severity index (MCTSI) were compared between the two groups. Results:The time to abdominal pain relief [(2.28 ± 0.44) d] and the median remission time of systemic inflammatory syndrome [(5.27 ± 0.95) d] were significantly shorter than those in the control group [(6.23 ± 1.01) d and (11.30 ± 1.12) d, t = 34.213 and 28.308, both P < 0.05]. The levels of alanine aminotransferase, blood urea nitrogen, serum creatinine, C-reactive protein and interleukin-6 in the observation group were (28.22 ± 34.38) U/L, (5.73 ± 1.83) mmol/L, (70.26 ± 4.34) μmol/L, (102.66 ± 3.29) mg/L, (110.45 ± 5.50) pg/L respectively, which were significantly lower than those in the control group [(47.26 ± 56.61) U/L, (10.55 ± 3.09) mmol/L, (114.21 ± 6.87) μmol/L, (210.51 ± 10.11) mg/L, (281.77 ± 14.99) pg/L, t = 3.520, 23.724, 81.266, 96.618, 114.005, all P < 0.05]. The Acute Physiology, Age, Chronic Health Evaluation II score, modified Marshall score, and modified CT severity index in the observation group were (11.43 ± 0.66) points, (3.06 ± 0.29) points, (8.16 ± 0.27) points, which were significantly lower than (18.49 ± 1.77) points, (4.92 ± 0.37) points, (9.57 ± 0.35) points respectively in the control group ( t = 39.590, 76.458, 67.484, all P < 0.05). Conclusion:Continuous blood purification therapy can effectively remove metabolites and poisons from the body, shorten the duration of systemic inflammatory response syndrome, promote the recovery of body function, and thereby improve the prognosis of moderate to severe acute pancreatitis.
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Objective:To evaluate the prognostic value of combined detection of serum C-reactive protein(CRP), procalcitonin and lactic acid in elderly patients with community acquired pneumonia(CAP).Methods:Ninety-five elderly CAP patients in the emergency department of Shangqiu First People's Hospital were included as the case group, and 45 elderly healthy people in the emergency department of Shangqiu First People's Hospital were enrolled as the control group.Levels of blood lactic acid, procalcitonin and CRP were compared between the two groups.Meanwhile, blood levels of lactic acid, procalcitonin and CRP were compared between patients with different outcomes in the case group.The receiver operating characteristic(ROC)curve was used to evaluate the prognostic value of CRP, procalcitonin and blood lactic acid in elderly patients with CAP.Results:Compared with the control group, blood levels of lactic acid, procalcitonin and CRP were increased in the case group( t=20.77, 26.03 and 31.27, all P<0.01). During a 12-month follow-up, 13 cases(13.68%, 13/95)died and 82 cases(86.32%, 82/95)survived in the case group.Blood levels of lactic acid, procalcitonin and CRP were higher in the death group than in the survival group( t=25.56, 8.30 and 13.56, all P<0.01). ROC curve analysis showed that the sensitivity and specificity of serum lactic acid, procalcitonin and CRP in predicting the prognosis of elderly CAP patients were 76.92% and 73.17%, 84.62% and 78.05%, and 69.23% and 70.73%, respectively.The sensitivity and specificity of combined detection of the three indicators were 92.31% and 89.02%, respectively, higher than those of the individual indicators. Conclusions:Serum levels of lactic acid, procalcitonin and CRP are increased in elderly patients with CAP.Combined detection of the three indicators can improve the prognostic value and therefore has important clinical significance.
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Objective To summarize the international current status of anesthesia nursing research. Methods The nursing papers were searched across the databank of PubMed and Web of science between 1946 and 2017 and 2012 and 2017,respectively to look into the external characteristics of international anesthesia nursing publications. Using the methods of common words analysis, cluster analysis and citation analysis, we analyzed high frequency subjects and highly cited articles from 2012-2017, analyzing the highlights in the anesthesia nursing. Results 5,041 articles from 1946-2017 were included. The number of articles in anesthesia nursing field was relatively small in first 30 years,increasing year by year since 1970s and speeding up since 1990s.The average number of articles from 2012-2017 was all above 150.The 5,041 articles distributed in 1,260 journals.The top 10 journals accounted for 24.36% of the total number (1228/5041).The articles were mainly published in the developed countries in Europe and America.The hot spots in anesthesia nursing research included anesthesia management and pain management,professional skills of anesthesia nurses and medical team collaboration,intervention on psychological status and complications among perioperative patients. Conclusions The research of anesthesia nursing aboard has attracted more and more attention and formed several research highlights.Domestic research in the field is still at the early stage and in the future,domestic scholars can draw on foreign research highlights to carry out relevant research.
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Objective To investigate the clinical manifestations of aortic dissection (AD),the characteris-tics of early diagnosis and treatment,and the causes of misdiagnosis.Methods 40 cases of aortic dissection with clinical manifestations,auxiliary examination,clinical classification,emergency diagnosis and misdiagnosis were retro-spectively analyzed.Results Initial symptoms were severe chest pain and(or)low back pain in 25 patients;chest tightness,asthma,dyspnea in 4 cases(10.0%);Unexplained shock and collapse in 4 patients(10.0%);abdominal pain with abdominal discomfort in 4 cases(10.0%);1 case of limb numbness(2.5%);cough,fever and hemoptysis in 2 cases(5.0%).associated with blood pressure on both sides of the asymmetry,a difference of more than 10 mmHg in 10 cases(25.0%).Auxiliary examination:9 cases of abnormal ECG,3 cases(6.6%)of the patients with acute inferior myocardial infarction,emergency chest CT scan in 10 cases,10 cases of emergency nuclear magnetic reso-nance,CT angiography in 20 cases,9 cases of bedside ultrasound;Respectively:6 cases were misdiagnosed as acute coronary syndrome,1 case of cardiac insufficiency,2 cases of sever pneumonia,pancreatitis,cholecystitis,multiple organ dysfunction,1 case of renal failure,acute gastritis in 1 case;musdiagnosis time 1 day to 3 days.28 cases of covered stent in the treatment,the remaining 8 cases were transferred to surgical treatment and other conservative treatment,4 cases of death.Conclusion Aorta complicated and varied clinical manifestation,dangerous condition, improve the emergency physician of aortic dissection,open diagnostic thinking and timely diagnosis and differential diagnosis,according to the condition of reasonable selection of auxiliary examination,specific imaging examination is the key to reduce the misdiagnosis.