【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.
ObjectiveTo investigate the health status of elderly peptic ulcer patients in Haikou city and its influencing factors. MethodsSeventy-eight elderly peptic ulcer patients treated in the Department of Gastroenterology, Haikou Hospital between February 2012 and December 2014 were chosen to be the observation group, and at the same time, another 78 healthy elderly people examined in the same hospital were designated as the control group. The general information and health status of the study subjects were investigated for correlation analysis. ResultsThe health status, physical function, body pain, life quality and mental health scores in the observation group were significantly lower than those in the control group (P<0.05). Univariate analysis showed that age, smoking, high-salt diet, body mass index (BMI) were significantly associated with the incidence of peptic ulcer (P<0.05). Multivariate logistic regression analysis showed that age, smoking, high-salt diet, BMI were all independent risk factors for peptic ulcer occurrence (P<0.05). ConclusionThe health status of elderly peptic ulcer patients in Haikou city is relatively low. Age, smoking, high-salt diet and BMI are the major independent risk factors for the occurrence of peptic ulcer. We need to actively strengthen symptomatic prevention and intervention.
Objective To investigate the impact of genetic factors on mental health status in child and adolescent twins. Methods A total of 102 pairs of twins aged 6 to 16 years were recruited with the support from educational committees and schools. After the guardians of these twins had signed an informed consent form, the Chinese version growth and the state of health evaluation (Development and Well-Bing Assessment, DAWBA) were completed by the parents of these twins to investigate their mental health status. Buccal mucosa samples were collected from all twins for DNA extraction and zygosity identification test. Result A total of 102 pairs of twins were recruited, among whom 93 pairs finished the investigation, including 50 monozygotic pairs and 43 dizygotic pairs. The results of emotional symptoms and behavior symptoms and the impact of symptoms from the DAWBA screening questionnaire showed that the intrapair correlation coeficien of the emotional disorder and the oppositional/conduct disorder and the impact in monozygotic twins were more remarkable than those in dizygotie twins, including separation anxiety (MZ group correlation coefficient (r) = 0.821, Plt;0.01; DZ group r=0.348, Plt;0.01), generalized anxiety (MZ group r=0.546, Plt;0.01; DZ group r=0.309, Plt;0.01), a special terror symptoms (MZ group r=0.849, Plt;0.01; DZ group r=0.726, Plt;0.01 ), and oppositional defiant / conduct disorder (MZ group r=0.237, Plt;0.01; DZ group r=0.163, Plt;0.01), attention deficit - hyperactivity disorder (MZ group r=0.640, Plt;0.01; DZ group r=0.198, Plt;0.01), autistic symptoms (MZ group r=0.680, Plt;0.01; DZ group r=0.372, Plt;0.01). Conclusion Genetic factors play an important role in mental health status of child twins.
Objective To compare the cl inical results between high-flexion and standard cruciate-stabling prostheses in total knee arthroplasty (TKA) by using the 36-item short form health survey (SF-36). Methods Between August 2007 and January 2009, 98 patients (106 knees) underwent TKA with standard cruciate-stabl ing prostheses (standard group), and 46 patients (50 knees) underwent TKA with high-flexion prostheses (high-flexion group). In standard group, there were30 males (32 knees) and 68 females (74 knees) with an age of (70.0 ± 3.5) years, including 78 cases (82 knees) of osteoarthritis (OA) and 20 cases (24 knees) of rheumatoid arthritis (RA) with a disease duration of (14.5 ± 3.3) years; the Hospital for Special Surgery Scoring System (HSS) and the range of motion (ROM) were 56.1 ± 21.6 and (89.0 ± 16.1)°, respectively. In high-flexion group, there were 8 males (10 knees) and 38 females (40 knees) with an age of (68.6 ± 8.9) years, including 44 cases (47 knees) of OA and 2 cases (3 knees) of RA with a disease duration of (13.9 ± 4.1) years; the HSS and ROM were 58.9 ± 25.3 and (91.0 ± 19.3)°, respectively. There was no significant difference in the general data (P gt; 0.05) between 2 groups, so the cl inical data of 2 groups had comparabil ity. Results In standard group, poor wound heal ing and persistent headache caused by cerebrospinal fluid leakage occurred in 1 case, respectively. In high-flexion group, transient common peroneal nerve palsy occurred in 1 case. There was significant difference (P lt; 0.05) in the hospital ization expense between standard group [ (39 000 ± 6 000)] and highflexion goup [ (52 000 ± 8 000)]. The follow-up time was 12-26 months (18 months on average) in standard group (91 cases, 98 knees) and 11-19 months (13 months on average) in high-flexion group (44 cases, 47 knees). The SF-36 showed significant difference in role-physical score (P lt; 0.05), but no significant difference in other 7 indices scores (P gt; 0.05). At the final follow-up, the ROM was (129.1 ± 19.2)° in high-flexion group and (123.6 ± 16.7)° in standard group; showing significant difference (P lt; 0.05). The HSS was 91.2 ± 17.6 in high-flexion group and 92.5 ± 14.5 in standard group; showing no significant difference (P gt; 0.05). Conclusion After TKA, the ROM in high-flexion group is superior to that in standard group, but there is no obvious advantages in terms of the HSS and SF- 36 outcomes.
目的:了解成都市集体儿童的健康状况及变化趋势,进一步做好托幼机构的卫生保健工作。方法:对1998-2007年成都市托幼机构集体儿童定期体检的资料进行分析、研究。结果:成都市集体儿童身高、体重达标率,身高、体重年增长合格率呈上升趋势;中、重度营养不良(体重低下、发育迟缓、消瘦)患病率逐年下降;单纯性肥胖发生率逐年升高;贫血的患病率呈下降趋势;视力不良患病率无明显下降;龋齿患病率呈下降趋势。结论:成都市集体儿童体格发育良好。儿童营养不良减少,肥胖明显增加,视力不良患病率无明显下降,今后托幼园所要将肥胖的预防和干预作为卫生保健工作的重点,并重视眼保健工作。
Objective To analyze the predictive value of von Willebrand factor (vWF) and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score on severity and prognosis of acute respiratory distress syndrome (ARDS). Methods The ARDS patients who were admitted between January 2010 and May 2012 were recruited in the study. APACHEⅡ score and plasma vWF were detected on the first day and the third day after diagnose of ARDS. The patients were divided intoasurvival group andadeath group according the prognosis. The predictive value of vWF and APACHEⅡ score on prognosis were analyzed by the receiver operating characteristic (ROC) curve. Lung injury score was calculated and its relationship with vWF and APACHEⅡ score were analyzed. Results One-hundred and twelve cases of ARDS were enrolled. There were no significant differences between the survival group and the death group in sex, age, respiration rate, blood pressure, white blood cells, procalcitonin or C-reactive protein (P > 0.05). On the first day after diagnosis of ARDS, the APACHEⅡ score and vWF level of the survival group were significantly lower than those in the death group (P < 0.05). On the third day, the APACHEⅡ score was increased but vWF level declined compared with those on the first day (P < 0.05). On the first day, lung injury score of the survival group was 1.7±0.4, significantly lower than that in the death group (2.5±0.6). On the third day, lung injury score in the survival group decreased, while lung injury score of the death group was significantly increased (P < 0.05). On the first day, vWF and APACHEⅡ score were positively correlated with lung injury score (r=0.75, P < 0.05; r=0.79, P < 0.05), respectively. On the first day, the area under the ROC curve of APACHEⅡ score and vWF were 0.87 and 0.91, respectively (P < 0.05). Conclusion APACHEⅡ score and vWF have high diagnostic value in evaluating the degree of lung injury and predicting the prognosis of patients with ARDS.
【摘要】 目的 调查成都市未成年犯管教所民警心理健康水平。 方法 2010年5月采用症状自评量表（symptom checklist 90，SCL-90）和健康调查简表（short form 36 health survey questionnaire，SF-36）调查成都市某未成年犯管教所153名民警的心理健康水平，并对比相应人群的常模分数。 结果 未成年犯管教所民警SCL-90阳性率57.5%，SCL-90总分及各因子分均高于1999年修正常模、1986年全国常模（Plt;0.05）。SCL-90的人际关系敏感因子分与北京监狱民警常模差异无统计学意义（Pgt;0.05），偏执因子分低于北京监狱民警常模（Plt;0.05），SCL-90总分及其余因子分均高于北京监狱民警常模（Plt;0.05）；SCL-90总分及各项因子分男性高于女性（Plt;0.05），直接监管犯人者高于内务、管理工作者（Plt;0.05）；年龄lt;35岁者的抑郁、偏执、精神病性因子分高于年龄gt;35岁者（Plt;0.05）。SF-36各因子分均低于1998年四川居民、2005年上海公安局民警（Plt;0.05）；SF-36各因子与SCL-90总分、各因子均呈负相关（Plt;0.05）。 结论 应重视并改善未成年犯管教所民警的心理健康水平。【Abstract】 Objective To investigate and analyze the mental health of policemen in juvenile reformatory and their relationships. Methods The mental health of 153 policemen working in a juvenile reformatory were assessed by using symptom checklist (SCL)-90 and short form 36 health survey questionnaire (SF-36) in May, 2010. The data was compared with norm and other relative data, such as SCL-90 China norm, norm revised in 1999, SCL-90 of judicial police in Beijing, etc. Results The positive rate of SCL-90 of policemen in reformatory was 57.5%. The total score and factor score of SCL-90 were significantly higher than that of the China norm revised in 1999. Furthermore, compared with the judicial policemen in Beijing, except for the interpersonal sensitivity and paranoid ideation, the total score and other factor scores were significantly higher. The SCL-90 total score and various factors of the males were significantly higher than that of the females. The score of the guards was higher than that of charging of quarters and management. In youth (less than 35 years old) depression, paranoid ideation, psychoticism factor scores were significantly higher than that in the middle-aged groups. SF-36 factor score of the reformatory police was significantly lower than that of Sichuan resident in 1998, and also the policemen in Shanghai Public Security Bureau in 2005. And SF-36 factor score of the reformatory policemen had a significant negative correlation with the total score and every factor score of SCL-90. Conclusion We should pay attention to the juvenile reformatory policemen’s mental health and and improve it.
ObjectiveTo analyze the roles of three scoring systems, i.e. Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ, Ranson’s criteria, and Sequential Organ Failure Assessment (SOFA), in predicting mortality in patients with severe acute pancreatitis (SAP) admitted to intensive care unit (ICU), and explore the independent risk factors for mortality in SAP patients.MethodsThe electronic medical records of SAP patients who admitted to ICU of West China Hospital, Sichuan University between July 2014 and July 2019 were retrospectively analyzed. Data of the first APACHE Ⅱ, Ranson’s criteria, SOFA score, duration of mechanical ventilation, the use of vasoactive drugs and renal replacement therapy, and outcomes were obtained. The receiver operator characteristic (ROC) curve was used to evaluate the value of APACHE Ⅱ score, Ranson’s criteria, and SOFA score in predicting the prognosis of SAP. Logistic regression models were created to analyze the independent effects of factors on mortality.ResultsA total of 290 SAP patients hospitalized in ICU were screened retrospectively, from whom 60 patients were excluded, and 230 patients including 162 males and 68 females aged (51.1±13.7) years were finally included. The ICU mortality of the 230 patients with SAP was 27.8% (64/230), with 166 patients in the survival group and 64 patients in the death group. The areas under ROC curves of APACHE Ⅱ, Ranson’s criteria, APACHE Ⅱ combined with Ranson’s criteria, and SOFA score in predicting mortality in SAP patients admitted to ICU were 0.769, 0.741, 0.802, and 0.625, respectively. The result showed that APACHE Ⅱcombined with Ranson’s criteria was superior to any single scoring system in predicting ICU death of SAP patients. The result of logistic regression analysis showed that APACHE Ⅱ score [odds ratio (OR)=1.841, 95% confidence interval (CI) (1.022, 2.651), P=0.002], Ranson’s criteria [OR=1.542, 95%CI (1.152, 2.053), P=0.004], glycemic lability index [OR=1.321, 95%CI (1.021, 1.862), P=0.008], the use of vasoactive drugs [OR=15.572, 95%CI (6.073, 39.899), P<0.001], and renal replacement therapy [OR=4.463, 95%CI (1.901, 10.512), P=0.001] contributed independently to the risk of mortality.ConclusionsAPACHE Ⅱ combined with Ranson’s criteria is better than SOFA score in the prediction of mortality in SAP patients admitted to ICU. APACHE Ⅱ score, Ranson’s criteria, glycemic lability index, the use of vasoactive drugs and renal replacement therapy contribute independently to the risk of ICU mortality in patients with SAP.
Objective To evaluate the effects and the clinical significances of liquid resuscitation on blood gas analysis， acid-base balance， electrolytes， acute physiology and chronic health evaluationsⅡ（APACHEⅡ） score of patients with septic shock， and then to analyze the relations between serum chlorine （Cl－） level and APACHEⅡscore and the volume of liquid resuscitation. Methods According to the target of resuscitation （centre venous pressure 8-12mm Hg and mean arterial pressure≥65mm Hg）， 21 patients with septic shock received enough fluid for resuscitation during 24h . The results of blood gas analysis， acid-base balance， electrolytes， and APACHE Ⅱ score were compared between pre-resuscitation and 24h post-resuscitation by self-controlled prospective study. The relationships of the level of serum Cl－ and APACHEⅡ score with the volume of liquid used in resuscitation were analyzed . Results The mean resus-citation duration was （18.09±4.57） h， and the volume of liquid during 24 h resuscitation was 5 320-11 028mL with mean volume of （7 775±1 735） mL in 21 patients with septic shock. Serum sodium （Na＋， mmol/L） and Cl－（mmol/L）levels of post-resuscitation were significant higher than those of pre-resuscitation （Na＋：138.71±5.67 versus 135.62±7.23， P=0.024；Cl－：109.10±4.90 versus 101.67±8.59， P=0.000）. Compared with the levels of pre-resuscitation， the blood pH value， hematocrit （Hct，%）， anion gap （AG， mmol/L）， lactic acid （mmol/L）， and APACHE Ⅱscore significantly decreased （pH：7.31±0.05 versus 7.37±0.06， P=0.000；Hct：28.48±2.56 versus 32.76±9.19， P=0.049；AG：8.33±3.45 versus 14.17±8.83， P=0.004；lactic acid：1.66±0.89 versus 2.96±1.23， P=0.001；APACHEⅡ：10.90±3.73 versus 17.24±4.06， P=0.000） after 24h resuscitation. The correlation analysis showed that the level of serum Cl- was positively correlated with the volume of liquid used in resuscitation （r=0.717，P＜0.01）. However， there was no correlation between APACHEⅡscore and the volume of liquid used in resuscitation （P＞0.05）. Conclusions The target of liquid resuscitation in patients with septic shock should be cautiously determined， including control of the volume of crystal liquid for resuscitation， in order to avoid acid-base imbalance or hyperchloraemia. At the same time， the change in internal environment should be monitored. An optimistic fluid resuscitation to decrease APACHE Ⅱ score in patients with septic shock is unrelated to the volume of liquid resuscitation.