【Abstract】ObjectiveTo compare the reliability of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and APACHE Ⅲ to estimate mortality of critical patients in abdominal surgery. MethodsTwo hundred and sixtyone critical patients in abdominal surgery were included in this study. The clinical data of the first day in ICU were collected and evaluated with both APACHE Ⅱand APACHE Ⅲ prognostic systems and statistical analysis were performed. Probability of survival (Ps) was compared with actual mortality. ResultsThe scores of APACHE Ⅱ and APACHE Ⅲ of death group were significantly higher than those of survival group respectively (P＜0.01). The actual mortality of patients whose Ps was no more than 0.5 was higher than that whose Ps was over 0.5 (P＜0.01). With two prognostic systems, the scores and mortality were the highest in pancreatitis patients and the lowest in patients with gastrointestinal malignant tumor. ConclusionAPACHE Ⅱ and APACHE Ⅲ prognostic systems can be effectively applied to the estimation of mortality of critical patients in abdominal surgery. For certain diagnostic categories, APACHE Ⅲ is better than APACHE Ⅱprognostic system.
Objective To study the mortality and prognostic factors of post-operative acute respiratory failure in cancer patients. Methods There were 1632 postoperative cancer patients from2004 to 2006 in the ICU of Cancer Hospital, in which 447 patients were complicated with acute respiratory failure ( intubation or tracheotomy and mechanical ventilation) . The clinical data was retrospectively analyzed. Stepwise logistic regression analysis was used to identify variables associated with mortality for acute respiratory failure. Results In 447 patients with acute respiratory failure ( male 260, female 187) , 106 cases died with a mortality of 6. 5% . Single factor analysis showed that acute morbodities ( shock, infection, organ failure) , intervention ( continuous renal replacement therapy, vasopressor drugs) , the 28-day ICU free days and APACHE scores ( ≥ 20) had significant differences between the survivor and non-survivor. Multiple logistic regression analysis showed that duration of operation( P = 0. 008, OR 1. 032, 95% CI 1. 008-1. 057) , APACHEⅡ≥20 scores( P =0. 000, OR12. 200, 95% CI 2. 896-51. 406) , organ function failure( P =0. 000, OR 13. 344,95% CI 3. 791-7. 395) were associated with mortality of acute respiratory failure. Conclusion Duration of operation, organ function failure, and APACHE Ⅱ scores were risk prognostic factors for postoperative cancer patients with acute respiratory failure.
Abstract： Objective To evaluate prediction validation of Sino System for Coronary Operative Risk Evaluation （SinoSCORE） on in-hospital mortality in adult heart surgery patients in West China Hospital.?Methods?We included clinical records of 2 088 consecutive adult patients undergoing heart surgery in West China Hospital from January 2010 to May 2012, who were also included in Chinese Adult Cardiac Surgical Registry.We compared the difference of preoperative risk factors for the patients between Chinese Adult Cardiac Surgical Registry and West China Hospital. SinoSCORE was used to predict in-hospital mortality of each patient and to evaluate the discrimination and calibration of SinoSCORE for the patients.?Results?Among the 2 088 patients in West China Hospital, there were 168 patients （8.05%） undergoing coronary artery bypass grafting （CABG）, 1 884 patients （90.23%） undergoing heart valve surgery, and 36 patients （1.72%） undergoing other surgical procedures. There was statistical difference in the risk factors including hyperlipemia, stroke, cardiovascular surgery history, and kidney disease between the two units.The observed in-hospital mortality was 2.25% （47/2 088）. The predicted in-hospital mortality calculated by SinoSCORE was 2.35% （49/2 088） with 95% confidence interval 2.18 to 2.47. SinoSCORE was able to predict in-hospital mortality of the patients with good discrimination （Hosmer Lemeshow test: χ2=3.164, P=0.582） and calibration （area under the receiver operating characteristic curve of 0.751 with 95% confidence interval 0.719 to 0.924）. Conclusion SinoSCORE is an accurate predictor in predicting in-hospital mortality in adult heart surgery patients who are mainly from southwest China
Abstract： Objective To evaluate the incidence and prognosis of postoperative acute kidney injury （AKI） in patients after cardiovascular surgery， and analyse the value of AKI criteria and classification using the Acute Kidney Injury Network （AKIN） definition to predict their in-hospital mortality. Methods A total of 1 056 adult patients undergoing cardiovascular surgery in Renji Hospital of School of Medicine， Shanghai Jiaotong University from Jan. 2004 to Jun. 2007 were included in this study. AKI criteria and classification under AKIN definition were used to evaluate the incidence and in-hospital mortality of AKI patients. Univariate and multivariate analyses were used to evaluate preoperative， intraoperative， and postoperative risk factors related to AKI. Results Among the 1 056 patients， 328 patients（31.06%） had AKI. In-hospital mortality of AKI patients was significantly higher than that of non-AKI patients （11.59% vs. 0.69%， P＜0.05）. Multivariate logistic regression analysis suggested that advanced age （OR=1.40 per decade）， preoperative hyperuricemia（OR=1.97）， preoperative left ventricular failure （OR=2.53）， combined CABG and valvular surgery （OR=2.79）， prolonged operation time （OR=1.43 per hour）， postoperative hypovolemia （OR=11.08） were independent risk factors of AKI after cardiovascular surgery. The area under the ROC curve of AKIN classification to predict in-hospital mortality was 0.865 （95% CI 0.801-0.929）. Conclusion Higher AKIN classification is related to higher in-hospital mortality after cardiovascular surgery. Advanced age， preoperative hyperuricemia， preoperative left ventricular failure， combined CABG and valvular surgery， prolonged operation time， postoperative hypovolemia are independent risk factors of AKI after cardiovascular surgery. AKIN classification can effectively predict in-hospital mortality in patients after cardiovascular surgery， which provides evidence to take effective preventive and interventive measures for high-risk patients as early as possible.
Heart valve disease is one of the three most common cardiac diseases,and the patients undergoing valve surgery have been increasing every year. Due to the high mortality,increasing number of valve surgeries,and increasing economic burdens on public health, a lot of risk models for valve surgery have been developed by various countries based on their own clinical data all over the world,which aimed to regulate the preoperative risk assessment and decrease the perioperative mortality. Over the last 10 years, a number of excellent risk models for valve surgery have finally been developed including the Society of Thoracic Surgeons(STS), the Society of Thoracic Surgeons’ National Cardiac Database (STS NCD),New York Cardiac Surgery Reporting System(NYCSRS),the European System for Cardiac Operative Risk Evaluation(EuroSCORE),the Northern New England Cardiovascular Disease Study Group(NNECDSG),the Veterans Affairs Continuous Improvement in Cardiac Surgery Study(VACICSP),Database of the Society of Cardiothoracic Surgeons of Great Britain and Ireland(SCTS), and the North West Quality Improvement Programme in Cardiac Interventions(NWQIP). In this article, we reviewed these risk models which had been developed based on the multicenter database from 1999 to 2009, and summarized these risk models in terms of the year of publication, database, valve categories, and significant risk predictors.
Abstract: Objective To explore the inhospital mortalityrelated risk factors in the patients undergoing offpump coronary artery bypass grafting (OPCAB). Methods We retrospectively analyzed the clinical data of 215 patients undergoing OPCAB in our hospital from November 2007 to November 2008. There were 171 males and 44 females aged between 40 and 85 years old. Among them, there were 47 patients older than 70 years old. All of them were coronary artery disease (CAD) patients with triple vessel disease. We adopted univarialble analysis and logistic multivariable regression analysis to screen the risk factors for the mortality of OPCAB. Results Six patients died in hospital after OPCAB with a mortality rate of 2.79% (6/215). No renal dysfunction or respiratory failure occurred. The rate of reoperation for bleeding was 4.65% (10/215) and all the 10 patients having undergone reoperation were alive. A total of 209 patients were all alive after 1year follow-up. The results of logistic multivariable regression analysis showed that New York Heart Association (NYHA) Ⅲ and Ⅳ heart function (OR=42.116，95% CI 3.319 to 534.465，P=0.004) and mechanical ventilation duration (OR=1.007，95%CI 1.001 to 1.013，P=0.028) were independent risk factors for inhospital mortality of OPCAB. Conclusion OPCAB is an effective and safe treatment for CAD with triple vessel disease. NYHA Ⅲ and Ⅳ heart function and mechanical ventilation time after OPCAB are the risk factors for OPCAB inhospital mortality, yet, needs further study with large sample.
Objective To understand the epidemiological characteristics of lung cancer death in adults of Zhuhai in order to provide decision-making evidence for lung cancer control and prevention. Methods The data of Mortality Registration System from 2004 to 2005 in Zhuhai were applied to analyze the epidemiological features of lung cancer death in adults. Results From 2004 to 2005, the average mortality from lung cancer and the standardized rate in adults of Zhuhai were 25.3/lakh and 30.3/lakh, respectively. Lung cancer ranked the first on the list of death causes in all cases of cancer death. The standardized rate of the male and female population was 40.1/lakh and 19.2/lakh, respectively. The standardized rate of males was higher than that of females (u=7.23, Plt;0.01). The average mortality from lung cancer increased with age, especially in males over 60 years old. The standardized mortality from lung caner in Xiangzhou, Doumen and Jinwan was 30.5/lakh, 31.1/lakh and 27.3/lakh, respectively. No statistical significance was found in these areas. Conclusion Lung cancer is one of the major malignant tumors among Zhuhai people. Lung cancer mortality is increasing with population aging. Based on the main risk factors of lung cancer, effective preventive measures including tobacco control and environment improvement should be taken.
Objective We investigated the effect of supplementation with alanyl-glutamine dipeptide on insulin resistance and outcome in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure. Methods A prospective, randomized, open and controlled trial was conducted. Patients with COPD and respiratory failure were recruited between Jan 2005 to Feb 2006 and randomly assigned to a trial group (n=14) with glutamine dipeptide supplmented parenteral nutrition and a control group (n=16) with isocaloric, isonitrogenic parenteral nutrition. On the third day and fifth day of nutrition treatment, blood glucose was clamped at level of 4.4 to 6.1 mmol/L by intravenously bumped insulin. Blood gas, blood glucose level, insulin dosage were recorded everyday. The outcomes were mortality, length of stay (LOS) in hospital and in ICU, mechanical ventilation times and the costs of ICU and hospital.Results Thirty patients successfully completed the trial. There was no difference in blood gas between two groups, but PaO2 increased gradually. Compared with control group, blood glucose level had trend to decrease in trial group. The average insul in consumption decreased significantly in trial group on the fifth day. There was no statistical difference between two groups in mortality, length of stay in hospital and the costs of hospital. But compared with control group, length of stay in ICU and mechanical ventilation days had trend to decrease in trial group. Conclusion Alanyl-glutamine dipeptide do not improve pulmonary function of patients with COPD and respiratory failure. However, alanyl-glutamine dipeptide attenuated insul in resistance and stabilized blood glucose. This trial does not confirm alanyl-glutamine di peptide can improve outcome in critically ill patients with COPD and respiratory failure between two groups in mortality at the end of 30 days, length of stay in hospital and the costs of hospital. But the length of stay in ICU and the duration of mechanical ventilation does decrease, but not significantly, in the trial group.
目的 探讨脑出血患者病死率与发病早期不同血压水平的关系。 方法 选择2006年2月－2012年6月在我院住院、符合入选标准及排除标准的患者120例, 经头颅CT证实为基底节区脑出血，血肿体积20～40 mL，收缩压＜200 mm Hg（1 mm Hg=0.133 kPa），舒张压＜110 mm Hg。 按照中国高血压分级标准（1级高血压：收缩压140～159 mm Hg或舒张压90～99 mm Hg；2级高血压：收缩压160～179 mm Hg或舒张压100～109 mm Hg；3级高血压：收缩压≥180 mm Hg或舒张压≥110 mm Hg）将患者分组，各组采用降颅内压、营养神经、维持水电解质平衡、对症治疗及康复治疗和康复护理等常规治疗，观察2周内各组病死率。 结果 1级高血压组与2级高血压组2周内病死率比较，差异无统计学意义（χ2=0.075，P=0.785）；1级高血压组与3级高血压组2周内病死率比较，差异有统计学意义（χ2=5.698，P=0.017）；2级高血压组与3级高血压组2周内病死率比较，差异有统计学意义（χ2=4.528，P=0.033）。 结论 对于早期血压较高的脑出血患者，进行积极的降压治疗，将血压控制在2级高血压水平，可以明显降低病死率。