Abstract: Objective To determine the incidence, course, potential risk factors and outcomes of postoperative noninfectious fever in aortic surgical patients. Methods We reviewed 549 patients who received operation for aortic aneurysm or dissection in Beijing FuWai Cardiovascular Disease Hospital from January 2006 to January 2008. After excluding patients with a known source of infection during hospitalization, patients who had preoperative oral temperature greater than or equal to 38.0℃, patients who underwent emergency surgery, patients who died of other reasons other than feverrelated factors, and patients with incomplete data, we finally enrolled a total of 463 patients for final analysis. Depending on whether the patients developed a noninfectious fever after operation, we classified them into the febrile group (n=345, highest oral temperature ranging from 38.0-39.3℃) and the afebrile group (n=118, without postoperative fever). Univariate analysis was performed between these two groups of patients, with respect to demographics, operative data and postoperative conditions. Risk factors for postoperative fever were considered for the multivariate logistic regression model if they had a P value≤0.001 in the univariate analysis. Results After operation, 74.5%(345/463) of the patients had noninfectious fever. The minimum temperature of febrile patients on the operation day and the first postoperative day were both higher than afebrile patients（P=0.000，0.000）. The maximum temperature of febrile patients on the operation day, the first, second，third and fourth postoperative days were also higher than afebrile patients（P=0.000，0.000, 0.047, 0.018）. Univariate analysis demonstrated that weight (P=0.000), surgical type (P=0.000), minimum intraoperative bladder temperature (P=0.000), temperature upon ICU admission (P=0.000) and blood transfusion (P=0.000) were all risk factors for noninfectious postoperative fever. The multivariate logistic regression showed that surgical sites of thoracic and thoracoabdominal aorta (odds ratio: 4861; 95% confidence interval: 3.029，5.801; P=0.004), lower minimum intraoperative bladder temperature (odds ratio: 1.117; 95% confidence interval:1.013，1.244;P=0.040) and higher temperature on admission to the ICU (odds ratio: 2.570; 95% confidence interval:1.280，5.182;P=0.008) were significant predictors for postoperative noninfectious fever. Conclusion Noninfectious postoperative fever following aortic surgery is very common. Predictors of noninfectious postoperative fever following aortic surgery include surgical sites (thoracic or thoracoabdominal aorta), low intraoperative core temperature and temperature elevation in the immediate postoperative period.
【摘要】 目的 了解甲型H1N1流感发热病区门诊就诊高峰期患者焦虑状况及相关因素，采取针对性护理措施减轻患者焦虑情绪。 方法 2009年11月上旬-12月上旬采用一般资料调查和Zung′s焦虑自评量表（SAS）对219例患者进行调查分析。 结果 219例患者SAS平均分为（33.70±8.60）分，其中17例SAS总分≥50分，存在焦虑情绪，发生率7.76%。多元回归分析结果显示，在年龄、性别、城乡差异、发热程度等因素中，与焦虑症状有关的主要因素为年龄和发热程度。 结论 甲型H1N1流感发热病区门诊就诊高峰期患者焦虑情绪明显高于常模，应引起重视，在门诊工作中加强心理护理，减轻和尽力消除患者的焦虑情绪，以免对病情产生不利影响，不利于控制流感疫情。【Abstract】 Objective To investigate the anxiety status and related factors of H1N1 patients at influenza peak of fever clinics,and to take specific measures to reduce anxiety in patients. Methods The general information and Zung′s self rating anxiety scale (SAS) were taken to analyze 219 patients from early November to early December 2009. Results The average SAS score of the 219 patients was 33.70±8.60, in which there were 17 patients (7.76%) with total scores ≥ 50 and anxiety. Multiple regression analysis showed that the age and temperature were related factors among age, gender, urban-rural differences, and fever. Conclusion The survey suggests that the pafients at the H1N1 influenza peak of fever clinics are significantly more anxious than normal anxiety. Out-patient work should strengthen psychological care to reduce and try to eliminate the anxiety of patients, in order to avoid adverse impact which is not conducive to control influenza outbreaks.
目的:分析输血反应类型,分布及概率。方法:回顾性分析我院2008年11月至2009年4月各类输血事件,收集输血不良反应回报单,进行统计分析。结果:在共计8996人次输血中,发生输血不良反应47人次,其中输注血浆引起的输血不良反应率为0.68％,输注红细胞悬液的不良反应率为0.30％,总的输血不良反应率0.98％,不同血液制品输血不良反应发生率具显著性差异(Plt;0.05)。其中主要表现为过敏反应,占63％,其次为发热反应.结论:如何提高临床科室科学合理用血水平的方法需进一步探讨。
Objective To highlight the characteristics of acute fibrinous and organizing pneumonia ( AFOP) . Methods The clinical, radiological and pathological data of two patients with AFOP were analyzed, and relevant literature was reviewed. Results Two male patients with the age of 48 years and 43 years presented with fever, cough, dyspnea and chest pain. The chest CT scan revealed multiple, bilateral, patchy consolidation distributing in peripheral areas in one case and consolidation in the middle lobe of the right lung and a little pleural effusion in another case. Two patients were diagnosed initially as community acquired pneumonia, but antibiotic treatment was ineffective. After the transbronchial lung biopsy and computed tomography guided percutaneous lung biopsy, pathological examination revealed there were numerous fibrin and organizing tissue in the alveoli without pulmonary hyaline membrane, which were consistent with AFOP. The patients showed significant clinical and radiological improvement after corticosteroid therapy. One patient was stable and the other one died of respiratory failure because of relapse during dose reduction of corticosteroids. Conclusions Patients of AFOP were misdiagnosed as pneumonia easily. Treatment with corticosteroids could be effective to some patients. If the antibiotic treatment was ineffective to the patient with fever and consolidation in the lungs, AFOP should be considered in the differential diagnosis.
ObjectiveTo explore the related factors for postoperative fever in patients with ovarian mature teratoma. MethodsA case-control study was conducted, and the subjects were patients with ovarian mature teratoma who had undergone surgical treatment in the hospital where the author works during September 2010 to August 2013. Eighty-eight cases diagnosed as ovarian mature teratoma with postoperative fever were included in the case group and 100 cases diagnosed as ovarian mature teratoma without postoperative fever were included in the control group. The medical records of the two groups were analyzed retrospectively. ResultsHospital stay of the case group and the control group was (5.68±1.53) and (3.28±1.18) days, respectively. The laparotomy ratio was 38.64% (34/88) and 20.00% (20/100); the tumor diameter was (6.65±3.07) cm and (5.33±1.87) cm, respectively. The difference in the above indicators between the two groups was significant (P<0.05). There was no significant difference in age, body mass index, body temperature before surgery, preoperative CA199, preoperative tumor torsion, preoperative antibiotics, tumor characteristics (bone, multi-room, bilateral), operative time, blood loss, pelvic adhesions, placing drainage tubes between the two groups (P>0.05). ConclusionPostoperative fever of ovarian mature teratoma is related to surgical approach and tumor size. Hospital stay is associated with postoperative fever. We should strengthen the gynecological examination. Early detection and reasonable choice of surgical procedures can reduce the incidence of postoperative fever, thus shorten the hospital stay and save medical resources.
ObjectiveTo investigate the diagnostic value of 18F-FDG PET/CT scan for fever of unknown origin. MethodsThe 18F-FDG PET/CT scan results and clinical data were analyzed retrospectively in 32 patients with fever of unknown origin examined between January 2011 and October 2013. Final diagnoses were determined with recognized diagnostic standard. Results18F-FDG PET/CT scan was able to detect the cause of fever precisely in 53.1% (n=17) of the patients and was helpful in 25 patients (78.1%). The final cause of fever was determined in 20 patients, including infection (40%), malignancy (10%), non-infectious inflammatory disease (40%) and miscellaneous causes (10%). True positive, false positive, true negative and false negative rate of the modality were 17.0%, 4.0%, 8.0% and 3.0%; and the sensitivity and specificity were 85.0% and 66.7%. Conclusion18F-FDG PET/CT scan plays an important role in the diagnosis of fever of unknown origin.
ObjectiveTo discuss clinical manifestation, laboratory examination, imaging and pathological features of intrahepatic cholangiocellular carcinoma(ICC) patients with fever as initial symptom accompanied with liver area pain, in order to improve the clinicians' acquaintance for ICC under similar circumstances. MethodThe case informations including medical history, clinical manifestation, laboratory examination, imaging finding, pathological examination, and treatment of 4 patients diagnosed with ICC by pathological biopsy from july 2013 to October 2014 in the First hospital of Lanzhou University were analyzed retrospectively. ResultsAll of four cases showed the fever as the initial symptom accompanied with the liver area pain. All of them had got chronic HBV infection. The WBC, neutrophil percentage, and procalcitonin were increased on admission in 3 cases. the levels of serum ALP and GGT were elevated in 3 patients. The AFP was obviously increased in 1 patient. The serum CA19-9 had moderately elevated in 2 patients. the ferroprotein was obviously increased in 2 patients. All the patients were confirmed under the abdominal CT scans and the liver pathological biopsy. ConclusionPatients with fever and liver area pain as intial symptoms, and with chronic hepatitis B and space-occupying lesions, who should be alert for ICC.