危重病医学(Critical Care Medicine)是20世纪60年代末发展起来的一门新兴临床学科。近20年来，我国危重病医学从无到有、从小到大，呈现出蓬勃发展的态势，我国大型综合性医院都已经配备了一个或多个ICU(intensive care unit)，越来越...危重病医学(Critical Care Medicine)是20世纪60年代末发展起来的一门新兴临床学科。近20年来，我国危重病医学从无到有、从小到大，呈现出蓬勃发展的态势，我国大型综合性医院都已经配备了一个或多个ICU(intensive care unit)，越来越多的临床医师投身到了危重病医学领域。2003年在抗击SARS的战役中，这支崭新的队伍冲锋陷阵，发挥了不可替代的作用，得到了社会各界的广泛认可。然而，作为一门新兴学科，危重病医学在其发展过程中还很不完善，对于Icu的科室建设、人员培训及临床管理等方面，目前还没有达成广泛共识，也缺乏统一的规范。相对于我国而言，国外的危重病医学已有30余年的发展。展开更多
目的探讨电子序贯器官衰竭评分(simplified organ dysfunction criteria optimized for electronic health records,eSOFA)对急诊脓毒症患者28、90 d及1年预后的预测价值,并与序贯器官衰竭评分(sequential organ failure assessment,SO...目的探讨电子序贯器官衰竭评分(simplified organ dysfunction criteria optimized for electronic health records,eSOFA)对急诊脓毒症患者28、90 d及1年预后的预测价值,并与序贯器官衰竭评分(sequential organ failure assessment,SOFA)、急性生理学与慢性健康状况Ⅱ评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)进行比较。方法连续纳入2018年12月1日至2021年1月31日中国康复研究中心急诊重症监护室收治的脓毒症患者。分别绘制eSOFA、SOFA和APACHEⅡ评分对患者28、90 d及1年预后的受试者工作特征(receiver operating characteristic,ROC)曲线,计算相应的曲线下面积(area under curve,AUC),并进行比较。根据eSOFA评分的截断值将患者分为eSOFA评分≤2分和eSOFA评分>2分两组,比较两组的一般临床特点。结果本研究最终纳入197例脓毒症患者,年龄为84(74~88)岁,其中男119例。纳入患者28、90 d及1年的病死率分别为38.6%(76/197)、51.8%(102/197)及58.9%(116/197)。eSOFA、SOFA和APACHEⅡ评分对脓毒症患者28、90 d及1年预后均具有预测能力,但三者差异无统计学意义(P>0.05),eSOFA评分对脓毒症患者1年死亡预测模型的拟和优度差,对1年预后预测效果不佳(P=0.01)。与eSOFA评分≤2分组相比,eSOFA评分>2分组患者死亡风险高(P<0.05),SOFA评分[分:5(4,7)vs.9(7,12)]和APACHEⅡ评分[分:23(18,27)vs.28(23,35)]更差,且更多患者发生急性肾损伤(acute kidney injury,AKI)(61.8%vs.83.6%)及接受血管活性药物(10.3%vs.59.1%)和机械通气(19.1%vs.50.8%)治疗。结论eSOFA、SOFA和APACHEⅡ评分均能有效评估脓毒症患者的中短期预后,优化患者早期治疗策略,但eSOFA评分简便易计算,更适合应用于急诊科。展开更多
Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the c...Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the clinician, and this effort may serve to increase nationwide awareness and to improve the treatment result of ALI/ARDS. Methods The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations was derived from a 2001 publication sponsored by the International Sepsis Forum. A systematic review of the literature was undertook, and the reported results were graded into five levels to create recommendation grading from A to E, with a being the highest grade. Results It is essential to control the primary disease in ALI/ARDS. Role of noninvasive positive-pressure ventilation in ALI/ARDS is undefined. Noninvasive positive-pressure ventilation can not be considered in patients with coma, shock and damage of airway clearance. Limitation of end-inspiratory plateau pressure is important in the management of ARDS and may be facilitated by permissive hypercapnia. Recruitment maneuver should be considered to open collapsed lung and improve oxygenation. A minimum amount of positive end-expiratory pressure (PEEP) should be set to prevent atelectasis at end expiration in ARDS. If it is possible, setting the level of PEEP may be guided by measurement of static pulmonary pressure-volume curve . Unless contraindicated, patients with ARDS should be maintained semi-recumbent. Prone positioning should be considered in the patients with severest ARDS. Sedation protocols should be used. Paralysis is not recommended . The limited fluid management strategy is beneficial for ARDS. Corticosteroid is not recommended for ARDS. The role of other drugs is uncertain in ARDS. Conclusion Evidence-based recommendations can be made regarding many aspects of the acute management of ALI/ARDS that will hopefully translate into improved outcomes for the critically ill patient. The guidelines will be updated when some important new knowledge becomes available.展开更多
文摘危重病医学(Critical Care Medicine)是20世纪60年代末发展起来的一门新兴临床学科。近20年来，我国危重病医学从无到有、从小到大，呈现出蓬勃发展的态势，我国大型综合性医院都已经配备了一个或多个ICU(intensive care unit)，越来越多的临床医师投身到了危重病医学领域。2003年在抗击SARS的战役中，这支崭新的队伍冲锋陷阵，发挥了不可替代的作用，得到了社会各界的广泛认可。然而，作为一门新兴学科，危重病医学在其发展过程中还很不完善，对于Icu的科室建设、人员培训及临床管理等方面，目前还没有达成广泛共识，也缺乏统一的规范。相对于我国而言，国外的危重病医学已有30余年的发展。
文摘目的探讨电子序贯器官衰竭评分(simplified organ dysfunction criteria optimized for electronic health records,eSOFA)对急诊脓毒症患者28、90 d及1年预后的预测价值,并与序贯器官衰竭评分(sequential organ failure assessment,SOFA)、急性生理学与慢性健康状况Ⅱ评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)进行比较。方法连续纳入2018年12月1日至2021年1月31日中国康复研究中心急诊重症监护室收治的脓毒症患者。分别绘制eSOFA、SOFA和APACHEⅡ评分对患者28、90 d及1年预后的受试者工作特征(receiver operating characteristic,ROC)曲线,计算相应的曲线下面积(area under curve,AUC),并进行比较。根据eSOFA评分的截断值将患者分为eSOFA评分≤2分和eSOFA评分>2分两组,比较两组的一般临床特点。结果本研究最终纳入197例脓毒症患者,年龄为84(74~88)岁,其中男119例。纳入患者28、90 d及1年的病死率分别为38.6%(76/197)、51.8%(102/197)及58.9%(116/197)。eSOFA、SOFA和APACHEⅡ评分对脓毒症患者28、90 d及1年预后均具有预测能力,但三者差异无统计学意义(P>0.05),eSOFA评分对脓毒症患者1年死亡预测模型的拟和优度差,对1年预后预测效果不佳(P=0.01)。与eSOFA评分≤2分组相比,eSOFA评分>2分组患者死亡风险高(P<0.05),SOFA评分[分:5(4,7)vs.9(7,12)]和APACHEⅡ评分[分:23(18,27)vs.28(23,35)]更差,且更多患者发生急性肾损伤(acute kidney injury,AKI)(61.8%vs.83.6%)及接受血管活性药物(10.3%vs.59.1%)和机械通气(19.1%vs.50.8%)治疗。结论eSOFA、SOFA和APACHEⅡ评分均能有效评估脓毒症患者的中短期预后,优化患者早期治疗策略,但eSOFA评分简便易计算,更适合应用于急诊科。
文摘Objective In 2006, Chinese critical care experts drafted management guidelines for diagnosis and therapy of acute lung injury (ALI) /acute respiratory distress syndrome (ARDS), that would be of practical use for the clinician, and this effort may serve to increase nationwide awareness and to improve the treatment result of ALI/ARDS. Methods The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations was derived from a 2001 publication sponsored by the International Sepsis Forum. A systematic review of the literature was undertook, and the reported results were graded into five levels to create recommendation grading from A to E, with a being the highest grade. Results It is essential to control the primary disease in ALI/ARDS. Role of noninvasive positive-pressure ventilation in ALI/ARDS is undefined. Noninvasive positive-pressure ventilation can not be considered in patients with coma, shock and damage of airway clearance. Limitation of end-inspiratory plateau pressure is important in the management of ARDS and may be facilitated by permissive hypercapnia. Recruitment maneuver should be considered to open collapsed lung and improve oxygenation. A minimum amount of positive end-expiratory pressure (PEEP) should be set to prevent atelectasis at end expiration in ARDS. If it is possible, setting the level of PEEP may be guided by measurement of static pulmonary pressure-volume curve . Unless contraindicated, patients with ARDS should be maintained semi-recumbent. Prone positioning should be considered in the patients with severest ARDS. Sedation protocols should be used. Paralysis is not recommended . The limited fluid management strategy is beneficial for ARDS. Corticosteroid is not recommended for ARDS. The role of other drugs is uncertain in ARDS. Conclusion Evidence-based recommendations can be made regarding many aspects of the acute management of ALI/ARDS that will hopefully translate into improved outcomes for the critically ill patient. The guidelines will be updated when some important new knowledge becomes available.
