目的探讨改良早期预警评分(Modified Early Warning Score,MEWS)联合Braden评分对ICU老年患者压力性损伤的预测作用。方法收集某三级甲等医院201例ICU老年患者的一般资料、MEWS评分、Braden评分以及住院期间发生压力性损伤的资料。通过...目的探讨改良早期预警评分(Modified Early Warning Score,MEWS)联合Braden评分对ICU老年患者压力性损伤的预测作用。方法收集某三级甲等医院201例ICU老年患者的一般资料、MEWS评分、Braden评分以及住院期间发生压力性损伤的资料。通过受试者工作特征(receiver operating characteristic,ROC)曲线,评价MEWS评分、Braden评分及两者联合对老年患者压力性损伤的预测作用。结果MEWS评分联合Braden评分预测老年患者压力性损伤发生的ROC曲线下面积(area under the curve,AUC)为0.948[95%CI(0.891,0.982)],显著高于单独应用MEWS评分、Braden评分的0.834[95%CI(0.762,0.942)]、0.863[95%CI(0.783,0.939)](P<0.001);联合应用的灵敏度和特异度分别为92.6%和93.1%。结论MEWS评分联合Braden评分能够有效预测ICU老年患者压力性损伤的发生。展开更多
AIM:Considerable controversy surrounds the adoption of endoscopic sphincterotomy(ES)to facilitate the placement of 10F plastic stents(PS)and to reduce the risk of pancreatitis The aim of the study was to assess the po...AIM:Considerable controversy surrounds the adoption of endoscopic sphincterotomy(ES)to facilitate the placement of 10F plastic stents(PS)and to reduce the risk of pancreatitis The aim of the study was to assess the possible advantages of ES before PS placement. METHODS:From 3/1996 to 6/2001,172 consecutive patients, who underwent placement of a single 10F-polyethylene stent for inoperable malignant strictures of the common bile duct,were randomly assigned to 2 groups.In group A(96 patients),a ES was performed before PS placement In Group B,96 patients had PS directly.Early complications(within 30 d)and late effects(from 30 d to stent replacement)were assessed.Patency interval was defined as the period between PS placement and obstruction or death.The success of stent replacement in the 2 groups was evaluated. RESULTS:Stent insertion was successful in 95.8%(92/96) of the pts in group A and in 93.7%(90/96)of the patients in group B(P>0.05).Early complications were more frequent in patients who underwent ES(6.5% vs4.4%)but the data were not significant(P>0.05).In group A pancreatitis developed in two patients and bleeding in three;whereas pancreatitis occurred in 2 patients in group B.Complications were managed conservatively.No procedure related mortality occurred.All late complications were acute cholangitis due to stent occlusion.We performed a stent replacement in 87 patients that was successful in 84 cases without differences between groups. CONCLUSION:Sphincterotomy does not seem to be necessary for placement of 10F-PS in patients with malignant common bile duct obstruction.展开更多
文摘背景心脏康复作为冠心病患者康复的有效干预措施已达成共识,但国内外制定的心脏康复相关指南的质量尚不明确,相关的推荐意见有待整合。目的系统评价冠心病患者心脏康复的相关指南,为临床实践提供参考。方法于2022年6月,计算机检索the Cochrane Library、Web of Science、PubMed、中国知网、维普网及万方数据知识服务平台,以及国内外指南网和相关学会网,获取冠心病患者心脏康复相关指南,检索时限均为建库至2022-06-30。2名研究者按照纳入与排除标准独立筛选文献并提取资料。采用临床指南研究与评估系统Ⅱ(AGREEⅡ)对纳入指南进行质量评价,并汇总冠心病患者心脏康复的推荐意见。结果最终纳入10部指南,8部来源于国外,指南发布时间为2011—2020年。纳入指南AGREEⅡ各领域平均得分为:范围和目的71%、参与人员65%、严谨性58%、清晰性80%、应用性64%、独立性45%。4部指南推荐级别为A级,6部指南推荐级别为B级。主要推荐意见汇总为心脏康复的基本要求、健康教育、危险因素控制、心理支持、运动训练及促进患者参与心脏康复6个方面。结论纳入指南的质量处于中等至较高水平,在参与人员、严谨性、应用性、独立性领域仍需提高;各指南推荐意见趋于一致,但在促进患者参与心脏康复方面意见仍显不足;我国心脏康复指南质量水平与国外相比仍存差距,应构建适用于我国冠心病患者的高质量心脏康复循证指南。
文摘目的探讨改良早期预警评分(Modified Early Warning Score,MEWS)联合Braden评分对ICU老年患者压力性损伤的预测作用。方法收集某三级甲等医院201例ICU老年患者的一般资料、MEWS评分、Braden评分以及住院期间发生压力性损伤的资料。通过受试者工作特征(receiver operating characteristic,ROC)曲线,评价MEWS评分、Braden评分及两者联合对老年患者压力性损伤的预测作用。结果MEWS评分联合Braden评分预测老年患者压力性损伤发生的ROC曲线下面积(area under the curve,AUC)为0.948[95%CI(0.891,0.982)],显著高于单独应用MEWS评分、Braden评分的0.834[95%CI(0.762,0.942)]、0.863[95%CI(0.783,0.939)](P<0.001);联合应用的灵敏度和特异度分别为92.6%和93.1%。结论MEWS评分联合Braden评分能够有效预测ICU老年患者压力性损伤的发生。
文摘AIM:Considerable controversy surrounds the adoption of endoscopic sphincterotomy(ES)to facilitate the placement of 10F plastic stents(PS)and to reduce the risk of pancreatitis The aim of the study was to assess the possible advantages of ES before PS placement. METHODS:From 3/1996 to 6/2001,172 consecutive patients, who underwent placement of a single 10F-polyethylene stent for inoperable malignant strictures of the common bile duct,were randomly assigned to 2 groups.In group A(96 patients),a ES was performed before PS placement In Group B,96 patients had PS directly.Early complications(within 30 d)and late effects(from 30 d to stent replacement)were assessed.Patency interval was defined as the period between PS placement and obstruction or death.The success of stent replacement in the 2 groups was evaluated. RESULTS:Stent insertion was successful in 95.8%(92/96) of the pts in group A and in 93.7%(90/96)of the patients in group B(P>0.05).Early complications were more frequent in patients who underwent ES(6.5% vs4.4%)but the data were not significant(P>0.05).In group A pancreatitis developed in two patients and bleeding in three;whereas pancreatitis occurred in 2 patients in group B.Complications were managed conservatively.No procedure related mortality occurred.All late complications were acute cholangitis due to stent occlusion.We performed a stent replacement in 87 patients that was successful in 84 cases without differences between groups. CONCLUSION:Sphincterotomy does not seem to be necessary for placement of 10F-PS in patients with malignant common bile duct obstruction.
