目的调查评价儿科住院患者的营养状况,了解其营养不良的患病率。方法上海交通大学医学院附属新华医院、附属上海儿童医学中心及附属儿童医院共2274例患儿入院时进行体格测量,以世界卫生组织儿童生长量表为参考标准,根据Z值评分法,分别...目的调查评价儿科住院患者的营养状况,了解其营养不良的患病率。方法上海交通大学医学院附属新华医院、附属上海儿童医学中心及附属儿童医院共2274例患儿入院时进行体格测量,以世界卫生组织儿童生长量表为参考标准,根据Z值评分法,分别计算年龄别身高Z值(height for age Z-score,HAZ)、年龄别体重Z值(weight for ageZ-score,WAZ)和身高别体重Z值(weightforheightZ-score,WHZ),评价住院儿科患者的营养状况。结果患儿营养不良的发生率分别为:生长迟缓(HAZ<-2)7.1%,低体重(WAZ<-2)5.5%,消瘦(WHZ<-2)5.2%;营养风险的发生率分别为:生长迟缓(-2≤HAZ<-1)13.5%,低体重(-2≤WAZ<-1)16.8%,消瘦(-2≤WHZ<-1)16.3%。先天性心脏病患儿生长迟缓、低体重和消瘦的发生率均较高;泌尿外科和骨科患儿生长迟缓的发生率较高。结论住院患儿具有较高的营养不良及营养风险发生率,有必要对全体儿科住院患者进行常规营养状况筛查。展开更多
目的比较分析急性生理学与慢性健康状况评分(APACHEⅡ)及临床肺部感染评分(CPIS)在慢性阻塞性肺病急性加重(AECOPD)患者治疗效果,住院时间及死亡风险中的预测指导作用。方法对78例AECOPD患者分别进行APACHEⅡ和CPIS评分,比较不同分组的...目的比较分析急性生理学与慢性健康状况评分(APACHEⅡ)及临床肺部感染评分(CPIS)在慢性阻塞性肺病急性加重(AECOPD)患者治疗效果,住院时间及死亡风险中的预测指导作用。方法对78例AECOPD患者分别进行APACHEⅡ和CPIS评分,比较不同分组的动脉血气结果、死亡率、死亡风险及住院时间进行分析。结果死亡组APACHEⅡ和CPIS评分均高于存活组。APACHEⅡ评分组<18和≥18,入院时和入院24 h PaCO2、PaO2差异无统计学意义;CPIS评分≥6组;CPIS评分<6和≥6分组住院时间分别为APACHEⅡ评分组入院时<18和≥18死亡率比较有统计学意义(χ2=6.96,P<0.05),A-PACHEⅡ评分组死亡分辨的ROC曲线下面积(0.789)略大于CPIS评分(0.719)。结论APACHEⅡ在判断死亡预后方面好于CPIS评分,而CPIS评分在预测患者24 h治疗效果及住院时间方面有一定优势。展开更多
AIM： To identify the risk factors in predicting the out- come of acute-on-chronic hepatitis B liver failure pa- tients. METHODS： We retrospectively divided 113 patients with acute-on-chronic liver failure-hepatitis ...AIM： To identify the risk factors in predicting the out- come of acute-on-chronic hepatitis B liver failure pa- tients. METHODS： We retrospectively divided 113 patients with acute-on-chronic liver failure-hepatitis B virus （ACLF-HBV） and without concurrent hepatitis C or D virus infection and hepatocellular carcinoma into two groups according to their outcomes after anti-HBV therapy. Their demographic, clinical, and biochemical data on the day of diagnosis and after the first week of treatment were analyzed using the Mann-Whitney U test, Fisher＇s exact test, and a multiple logistic regres- sion analysis. RESULTS： The study included 113 patients （87 men and 26 women） with a mean age of 49.84 years. Fifty- two patients survived, and 61 patients died. Liver failure （85.2%）, sepsis （34.4%）, and multiple organ failure （39.3%） were the main causes of death. Mul- tivariate analyses showed that Acute Physiology and Chronic Health Evaluation （APACHE） Ⅱ scores ≥ 12 [odds ratio （OR） = 7.160, 95% CI： 2.834-18.092, P 〈 0.001] and positive blood culture （OR = 13.520, 95% CI： 2.740-66.721, P = 0.001） on the day of diagnosis and model for end-stage liver disease （MELD） scores 28 （OR = 8.182, 95% CI： 1.884-35.527, P = 0.005） after the first week of treatment were independent predictors of mortality. CONCLUSION： APACHE II scores on the day of diag- nosis and MELD scores after the first week of anti-HBV therapy are feasible predictors of outcome in ACLF- HBV patients.展开更多
AIM： To analyze 67 cases of splenic abscess in a medica center of Taiwan during a period of 19 years. METHODS： From January 1986 to December 2004, a total of 67 patients with splenic abscess were enrolled for the re...AIM： To analyze 67 cases of splenic abscess in a medica center of Taiwan during a period of 19 years. METHODS： From January 1986 to December 2004, a total of 67 patients with splenic abscess were enrolled for the retrospective study. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, APACHE Ⅱ scores, and mortality rates were analyzed. RESULTS： There were 41 males and 26 females with the mean age of 54.14-14.1 years. Multiple splenic abscesses （MSA） account for 28.4% and solitary splenic abscess in 71.6% of the patients. Twenty-six of sixtyseven patients （35.8%） had extrasplenic abscesses, with leading site of liver （34.6%）, Microbiological cultures were positive in 58 patients （86.6%）, with 71.8% in blood culture and 93.5% in abscess culture. Gram negative bacillus （GNB） infection predominated （55.2%）, with leading pathogen of Klebslella pneumoniae （22.4%）, followed by gram positive coccus （GPC） infection （31%）. Splenectomy was performed in 26 patients （38.8%）, percutaneous drainage or aspiration in 21 （31.3%）, and antibiotic therapy alone in 20 patients （29.9%）. Eventually, 12 of 67 patients expired （17.9 %）. By statistics, spleen infected with GNB was likely to develop multiple abscesses compared with infection with GPC （P=0.036）. Patients with GNB infection （P=0.009） and multiple abscesses （P=0.011） experienced a higher mortality rate than patients with GPC infection and solitary abscess. The mean APACHE Ⅱ score of 12 ex- pired patients （16.3±3.2） was significantly higher than that of the 55 survivals （7.2 ± 3.8） （P〈 0.001）. CONCLUSION： MSA, GNB infection, and high APACHE Ⅱ scores are poor prognostic factors. Early surgical intervention should be encouraged when these risk factors are present.展开更多
Objective Real-time ultrasound elastography(US-E) is a helpful tool in diagnosing thyroid nodules.This study aims to evaluate thyroid solid nodules,to establish the accuracy of US-E in providing information on the nat...Objective Real-time ultrasound elastography(US-E) is a helpful tool in diagnosing thyroid nodules.This study aims to evaluate thyroid solid nodules,to establish the accuracy of US-E in providing information on the nature of these nodules,and to assess the clinical value of elasticity scores(ES) and strain ratio(SR) in differentiating thyroid solid nodules and to explore its distribution characteristics using pathological analysis as reference. Methods Traditional ultrasonography and US-E were performed on 131 thyroid solid nodules(99 benign ones and 32 malignant ones) in 120 patients(78 females and 41 males).Three radiologists evaluated the nodules based on a four-degree elasticity scoring system.The nodules were classified according to the ES as soft(ES 1-2) or hard(ES 3-4).The SR was calculated online. Results The sensitivity and specificity of the ES for thyroid cancer diagnosis were 78%and 80%,respectively.SR values > 2.9 used as a standard to distinguish benign from malignant nodules had a sensitivity of 87%and a specificity of 92%.The SR of the benign lesions was 1.64±1.37,which was significantly different from that of malignant lesions,which was 4.96±2.13(P<0.01). Conclusions Both the ES and SR were higher in malignant nodules than those in benign ones.Real-time US-E was a useful index in the differential diagnosis of thyroid solid nodules.It can provide quantitative information on thyroid nodule characterization and improve diagnostic confidence.展开更多
文摘目的调查评价儿科住院患者的营养状况,了解其营养不良的患病率。方法上海交通大学医学院附属新华医院、附属上海儿童医学中心及附属儿童医院共2274例患儿入院时进行体格测量,以世界卫生组织儿童生长量表为参考标准,根据Z值评分法,分别计算年龄别身高Z值(height for age Z-score,HAZ)、年龄别体重Z值(weight for ageZ-score,WAZ)和身高别体重Z值(weightforheightZ-score,WHZ),评价住院儿科患者的营养状况。结果患儿营养不良的发生率分别为:生长迟缓(HAZ<-2)7.1%,低体重(WAZ<-2)5.5%,消瘦(WHZ<-2)5.2%;营养风险的发生率分别为:生长迟缓(-2≤HAZ<-1)13.5%,低体重(-2≤WAZ<-1)16.8%,消瘦(-2≤WHZ<-1)16.3%。先天性心脏病患儿生长迟缓、低体重和消瘦的发生率均较高;泌尿外科和骨科患儿生长迟缓的发生率较高。结论住院患儿具有较高的营养不良及营养风险发生率,有必要对全体儿科住院患者进行常规营养状况筛查。
文摘目的比较分析急性生理学与慢性健康状况评分(APACHEⅡ)及临床肺部感染评分(CPIS)在慢性阻塞性肺病急性加重(AECOPD)患者治疗效果,住院时间及死亡风险中的预测指导作用。方法对78例AECOPD患者分别进行APACHEⅡ和CPIS评分,比较不同分组的动脉血气结果、死亡率、死亡风险及住院时间进行分析。结果死亡组APACHEⅡ和CPIS评分均高于存活组。APACHEⅡ评分组<18和≥18,入院时和入院24 h PaCO2、PaO2差异无统计学意义;CPIS评分≥6组;CPIS评分<6和≥6分组住院时间分别为APACHEⅡ评分组入院时<18和≥18死亡率比较有统计学意义(χ2=6.96,P<0.05),A-PACHEⅡ评分组死亡分辨的ROC曲线下面积(0.789)略大于CPIS评分(0.719)。结论APACHEⅡ在判断死亡预后方面好于CPIS评分,而CPIS评分在预测患者24 h治疗效果及住院时间方面有一定优势。
基金Supported by Tri-Service General Hospital,No.TSGH-C101-137
文摘AIM： To identify the risk factors in predicting the out- come of acute-on-chronic hepatitis B liver failure pa- tients. METHODS： We retrospectively divided 113 patients with acute-on-chronic liver failure-hepatitis B virus （ACLF-HBV） and without concurrent hepatitis C or D virus infection and hepatocellular carcinoma into two groups according to their outcomes after anti-HBV therapy. Their demographic, clinical, and biochemical data on the day of diagnosis and after the first week of treatment were analyzed using the Mann-Whitney U test, Fisher＇s exact test, and a multiple logistic regres- sion analysis. RESULTS： The study included 113 patients （87 men and 26 women） with a mean age of 49.84 years. Fifty- two patients survived, and 61 patients died. Liver failure （85.2%）, sepsis （34.4%）, and multiple organ failure （39.3%） were the main causes of death. Mul- tivariate analyses showed that Acute Physiology and Chronic Health Evaluation （APACHE） Ⅱ scores ≥ 12 [odds ratio （OR） = 7.160, 95% CI： 2.834-18.092, P 〈 0.001] and positive blood culture （OR = 13.520, 95% CI： 2.740-66.721, P = 0.001） on the day of diagnosis and model for end-stage liver disease （MELD） scores 28 （OR = 8.182, 95% CI： 1.884-35.527, P = 0.005） after the first week of treatment were independent predictors of mortality. CONCLUSION： APACHE II scores on the day of diag- nosis and MELD scores after the first week of anti-HBV therapy are feasible predictors of outcome in ACLF- HBV patients.
文摘AIM： To analyze 67 cases of splenic abscess in a medica center of Taiwan during a period of 19 years. METHODS： From January 1986 to December 2004, a total of 67 patients with splenic abscess were enrolled for the retrospective study. The clinical characteristics, underlying diseases, organism spectra, therapeutic methods, APACHE Ⅱ scores, and mortality rates were analyzed. RESULTS： There were 41 males and 26 females with the mean age of 54.14-14.1 years. Multiple splenic abscesses （MSA） account for 28.4% and solitary splenic abscess in 71.6% of the patients. Twenty-six of sixtyseven patients （35.8%） had extrasplenic abscesses, with leading site of liver （34.6%）, Microbiological cultures were positive in 58 patients （86.6%）, with 71.8% in blood culture and 93.5% in abscess culture. Gram negative bacillus （GNB） infection predominated （55.2%）, with leading pathogen of Klebslella pneumoniae （22.4%）, followed by gram positive coccus （GPC） infection （31%）. Splenectomy was performed in 26 patients （38.8%）, percutaneous drainage or aspiration in 21 （31.3%）, and antibiotic therapy alone in 20 patients （29.9%）. Eventually, 12 of 67 patients expired （17.9 %）. By statistics, spleen infected with GNB was likely to develop multiple abscesses compared with infection with GPC （P=0.036）. Patients with GNB infection （P=0.009） and multiple abscesses （P=0.011） experienced a higher mortality rate than patients with GPC infection and solitary abscess. The mean APACHE Ⅱ score of 12 ex- pired patients （16.3±3.2） was significantly higher than that of the 55 survivals （7.2 ± 3.8） （P〈 0.001）. CONCLUSION： MSA, GNB infection, and high APACHE Ⅱ scores are poor prognostic factors. Early surgical intervention should be encouraged when these risk factors are present.
文摘Objective Real-time ultrasound elastography(US-E) is a helpful tool in diagnosing thyroid nodules.This study aims to evaluate thyroid solid nodules,to establish the accuracy of US-E in providing information on the nature of these nodules,and to assess the clinical value of elasticity scores(ES) and strain ratio(SR) in differentiating thyroid solid nodules and to explore its distribution characteristics using pathological analysis as reference. Methods Traditional ultrasonography and US-E were performed on 131 thyroid solid nodules(99 benign ones and 32 malignant ones) in 120 patients(78 females and 41 males).Three radiologists evaluated the nodules based on a four-degree elasticity scoring system.The nodules were classified according to the ES as soft(ES 1-2) or hard(ES 3-4).The SR was calculated online. Results The sensitivity and specificity of the ES for thyroid cancer diagnosis were 78%and 80%,respectively.SR values > 2.9 used as a standard to distinguish benign from malignant nodules had a sensitivity of 87%and a specificity of 92%.The SR of the benign lesions was 1.64±1.37,which was significantly different from that of malignant lesions,which was 4.96±2.13(P<0.01). Conclusions Both the ES and SR were higher in malignant nodules than those in benign ones.Real-time US-E was a useful index in the differential diagnosis of thyroid solid nodules.It can provide quantitative information on thyroid nodule characterization and improve diagnostic confidence.
