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《广州医药》编辑部

广州医药杂志服务号
论著

早产儿败血症的临床特征和不良结局影响因素分析

Analysis of clinical features and adverse outcome risk factors of sepsis in premature infants

:898-905
 
        目的   探讨出生胎龄<37周早产儿发生败血症时的临床特征及其不良结局的危险因素。方法   收集2020年1月—2023年12月安徽医科大学第一附属医院本部新生儿科收治出生胎龄<37周且发生败血症早产儿的临床资料;根据败血症发生时间分为早发型败血症(EOS)49例,晚发型败血症(LOS)150例;根据是否出现不良结局,分为结局不良组90例,结局良好组109例。分析EOS和LOS败血症的临床特征,并采用多因素Logistic回归分析早产儿败血症出现不良结局的危险因素。结果  早产儿败血症中EOS患儿出生胎龄更小,生后1 min Apgar评分更低,孕母羊水污染、胎膜早破≥18 h发生率较LOS更高(P<0.05);早产儿败血症临床表现无特异性,但LOS患儿休克发生率更高(P<0.05);早产儿易发生革兰阴性菌感染,合并先天性心脏病(OR=2.490,P<0.05)、出生胎龄<30周(OR=4.851,P<0.05)、出生体质量小于1 500 gOR=4.169,P<0.05)是早产儿败血症发生不良结局的危险因素。结论  早产儿败血症临床表现无特异性,更易发生革兰阴性菌感染,出生胎龄越小、体质量越低发生不良结局的风险更高。
       Objective  To analyze the clinical characteristics and  risk factors of adverse outcomes of  sepsis in premature infants with gestational age < 37 weeks.Methods  Clinical data of preterm infants < 37 weeksof gestational age admitted to the Department of Neonatology of the First Affiliated Hospital of Anhui Medical University from January 2020 to December 2023 were collected.According to the timing of sepsis,49 cases with early-onset sepsis(EOS)and 150 cases with late-onset sepsis(LOS)were diagnosed.According to the outcome,90 cases were divided into the adverse outcome group and 109 cases were good outcome group.The clinical characteristics of EOS and LOS were analyzed,and the risk factors of adverse outcomes were analyzed by multivariate logistic regression.Results The gestational age of EOS infants was smaller at birth,the 1 minute Apgar score was lower ,and the incidence of amniotic fluid contamination and premature rupture of membranes ≥18h were higher than those in LOS infants(P<0.05).The clinical manifestations of sepsis in premature infants were not specific,but the incidence of shock was higher in LOS children(P<0.05).Preterm infants were more likely to develop gram-negative bacterial infection,congenital heart disease(OR=2.490,P<0.05),gestational age <30 weeks(OR=4.851,P<0.05),and birth weight < 1500g(OR=4.169,P<0.05)were identified as significant risk factors for adverse sepsis outcomes in preterm infants.Conclusions The clinical manifestations of septicemia in preterm infants are non-specific,and they are more likely to suffer from gram-negative bacterial infection.The younger the gestational age and lower the birth weight of preterm infants,the higher the risk of adverse outcomes after sepsis.
论著

高原地区儿童阑尾炎术后早期炎性肠梗阻治疗分析

Treatment analysis of appendicitis early postoperative inflammatory small bowel obstruction in plateau area children

:893-897
 
      目的   回顾分析高原地区儿童阑尾炎术后早期炎性肠梗阻的临床特征,总结治疗经验。方法   回顾分析青海省妇女儿童医院2019—2023年收治的49例儿童阑尾炎术后早期炎性肠梗阻病例资料。结果   纳入研究的49例患儿,阑尾炎发病时间3~8 d,平均(5.38±1.25)d,术后出现肠梗阻时间3~11 d,平均时间(4.81±1.70)d,其中48例经过保守治疗后梗阻解除,恢复排气、排便,肠功能恢复时间4~13 d,平均(5.93±2.49)d,1例经积极保守治疗后病情进展,最终经手术治愈。49例患儿均顺利治愈出院,住院时间10~26 d,平均(15.69±3.79)d。术后随访1~2年,患儿饮食、排便均无异常。结论   高原地区儿童阑尾炎术后早期粘连性肠梗阻预防是关键,采取保守治疗同样可获得较高的治愈率,若保守治疗无效或病情进展应及时积极采取手术治疗。
       Objective  To review the clinical characteristics of early postoperative inflammatory small bowel obstruction(EPISBO) in children with appendicitis in plateau area and summarize the treatment experience.Methods  The data of 49 cases of appendicitis EPISBO in children admitted to Qinghai Women and Children’s Hospital from 2019 to 2023 were  retrospectively analyzed.Results  The onset time of appendicitis was 3-8 days,with an average of(5.38±1.25)days,and the time of intestinal obstruction was 3-11 days after surgery,with an average of(4.81±1.70)days.After conservative treatment,48 cases were relieved of obstruction,resumed exhaust and defecation,and intestinal function recovered in 4-13 day,average(5.93±2.49)d,1 case had progression after conservative treatment,and was cured by surgery.All the 49 children were successfully cured and discharged.The length of hospital stay was 10-26 days,with an average of(15.69±3.79)days.Postoperative follow-up of 1 to 2 years showed normal eating and bowel movements.Conclusions  The prevention of EPISBO in children with appendicitis in plateau area is the key.Conservative treatment can also achieve a higher cure rate.If conservative treatment is ineffective or the disease progresses,timely surgical treatment should be provided.

专家述评

运动因子对心血管系统保护作用的研究进展

The protective effects of exerkines on cardiovascular system

:870-879
 
       运动可以调节机体代谢,预防和治疗由糖脂代谢紊乱所引发的心血管疾病。运动因子是在运动过程中,由肌肉、脂肪以及肝脏等多个组织合成和分泌的一系列生物活性物质,包括蛋白质和多肽类分子、小分子代谢物以及核酸等。诸多研究证实,运动因子是运动调节机体代谢的重要因素之一,也是机体从运动中获益的关键分子机制。近年来,随着蛋白质组学、代谢组学以及高通量测序等相关技术的飞速发展,越来越多的运动因子被陆续发现和证实。这不仅拓宽了人们对机体从运动中获益相关机制的认知,还激发了人们对运动因子在健康领域应用前景的浓厚兴趣。文章系统地阐述了运动因子对机体心血管系统的影响,旨在揭示运动因子在促进心血管健康以及治疗心血管疾病等方面的积极效用。
       Exercise can prevent and treat cardiovascular diseases resulting from the metabolic disorders of glucose and lipid.Exerkines are defined as a series of bioactive substances in response to exercise including proteins,peptides,small molecular metabolites and nucleic acids.Multiple tissues can produce exerkines,such as skeletal muscle,adipose tissue,and liver.Many studies indicate that exerkines play essential roles in improving glucose and lipid metabolism,which are crucial to harness the health-related benefits mediated by exercise.In recent years,with the progression of proteomics,metabolomics and high-throughput sequencings,an increasing number of exerkines are discovered.These findings expand the research on beneficial effects of exercise and draw attention to the clinical implications of exerkines.This review aims to explore the influence of exerkines on cardiovascular system and reveal their potential roles in the prevention and treatment of cardiovascular disease.
医院管理

内部控制视角下优化公立医院采购与付款业务的策略研究

Strategies for optimizing procurement and payment operations in public hospitals from an internal control perspective

:855-860
 
        当前公立医院面临的内外部环境十分复杂,各种不确定因素影响公立医院健康运营。引入内部控制理念,建立健全采购与付款环节是必要的。文章对目前公立医院采购与付款业务管理中存在的问题进行分析,从改善内部环境建设、建立起有效的风险评估体系、加强采购与付款业务控制活动、巩固监督检查体系、加强信息沟通建设五个方面提出相应策略,优化公立医院采购与付款环节内部控制,从而减少风险带来的不确定性,保障医院运行的效率效益,助力医院高质量持续发展。
      Public hospitals are currently navigating a complex internal and external environment,where  various uncertainties can impact their effective operation.The introduction of internal control concepts and the establishment of  robust procurement and payment processes are essential.This paper analyzes the issues present in the management of procurement and payment operations within public hospitals.It proposes strategies across five key areas:enhancing the internal environment,establishing an effective risk assessment framework,strengthening control activities in procurement and payment processes,reinforcing the supervision and inspection system,and improving information communication.These  strategies aim to optimize internal controls,reduce uncertainty associated with risks,ensure operational efficiency,and support the sustainable,high-quality development of public hospitals.
医院管理

广州中医优势病种分值付费政策实施效果探析

Analysis on the effect of dominant diseases of traditional Chinese medicine under the DIP payment mode in Guangzhou

:849-854
 
       目的   分析广州市中医优势病种按病种分值付费政策实施效果,以期为完善广州市中医病种付费方式改革提供参考思路。方法   以广州市某三甲中医医院住院患者在政策实施前(n=6 057)及实施后(n=7 208)住院病历为研究样本,对医院次均住院医疗费用、中医综合治疗费占比、平均住院日进行两独立样本非参数检验等描述性统计分析。  政策实施后,住院人次增长19%,患者次均住院医疗费用下降7.02%(P<0.001),中医综合治疗费用占比提升0.8%P>0.05),医疗机构平均住院日缩短0.63 d(P<0.001),入组中医优势病种患者自费率较非入组的低,医疗机构总体病例组合指数下降,中医优势病种结算有盈余。结论  中医优势病种按病种分值付费政策有利于医保-患者-医院三方共赢;但中医优势病种入组率有待提高,建议加大对中医医疗机构的支持与助力;中医综合治疗费用占比提升不显著,建议完善中医治疗项目医疗服务价格动态调整机制;中医优势病种仅局限在住院,建议实现诊疗单元全覆盖。
       Objective  To discuss the correlation analysis of the hospitalization expenses of TCM dominant diseases under the DIP payment mode,and provide a reference for further promoting the reform of the payment mode of TCM dominant diseases in Guangzhou.Methods  The nonparametric test was used to analyze the number of inpatients,the average hospitalization cost,and the proportion of TCM comprehensive treatment on the data of inpatient records before and after the implementation of the TCM dominant diseases policy,the sample sizes were 6 057 and 7 028 respectively.Results  After the implementation of the TCM dominant diseases policy,there was a slight fluctuation in the number of inpatients from 6 057 to 7 208,the average hospitalization cost was decreased by 7.02%(P<0.001),the proportion of TCM comprehensive treatment costs had an increase of 0.8%(P0.05),the average length of hospital stay was shorten by 0.63 days(P<0.001),the self-expense  rate of the patients with the TCM dominant diseases of in the group was lower than that of the patients without the group,the total case mix index value of the hospital decreased,but there was a surplus on the group of TCM dominant diseases settlement.Conclusios  The policy is conducive to the tripartite win-win of medical insurance,patients and hospitals.However,the enrollment rate of TCM dominant diseases need to be improved,which is suggested to increase the support for TCM hospitals.The proportion of TCM comprehensive treatment has not increased significantly,so it is suggested to improve the dynamic adjustment mechanism of medical service price of TCM treatment items.The TCM dominant diseases are only limited to hospitalization,and it is recommended to achieve full coverage of diagnosis and treatment units.
护理研究

创伤骨科护理人员人文能力水平横断面调查研究

A cross-sectional research on the humanistic ability level of trauma orthopedic nurses

:843-848
 
       目的   通过横断面研究,统计郑州地区创伤骨科护理人员的人文关怀能力,分析影响其能力的相关因素。方法   采用便利抽样法,选取郑州地区医院150位创伤骨科护理人员作为调查对象。使用一般资料调查表、人文关怀能力量表对研究对象进行调查,分析郑州地区医院创伤骨科护理人员人文关怀能力。结果   共发放150份问卷,有效回收率100%。人文关怀能力量表总分为(191.22±16.15)分,三个维度均分由高到低分别为耐心(5.21±0.37)分、勇气(4.62±0.75)分、认知(4.19±0.24)。护士的人文关怀能力在年龄、工作年限、职称、用工性质、工作满意度等方面比较差异具有统计学意义(P<0.05)。结论   本研究所在地区护理人员人文关怀能力处于中等水平,但与西方国家相比,仍有较大差距,因此在今后的临床护理培训中,应制定针对性的提高策略。
      Objective  To study the level of humanistic care ability among trauma orthopedic nurses in Zhengzhou and analyze the influencing factors.Methods  A cross-sectional study was conducted using convenience sampling to select 150 trauma orthopedic nurses from hospitals in Zhengzhou.Data were collected using a general information questionnaire and the Humanistic Care Ability Scale.Results  A total of 150 valid questionnaires were collected,with a response rate of 100%.The total score of the Humanistic Care Ability Scale was(191.22±16.15),with the dimensions scores ranked as patienc(5.21±0.37),courage(4.62±0.75)and cognition(4.19±0.24).Significant differences in humanistic care ability were observed in terms of age,work experience,professional title,employment type,and job satisfaction(P<0.05).Conclusions  The humanistic care ability of trauma orthopedic nurses in Zhengzhou is at a moderate level,but there is still a gap compared to Western countries.Targeted training strategies and improving job satisfaction are recommended.
护理研究

分析护理专业学生死亡态度的潜在类别及其影响因素

Latent categories and influencing factors analysis of nursing students’ attitudes towards death

:836-842
 
        目的   分析护生死亡态度的潜在类别及其影响因素,为开设符合我国国情的死亡教育课程提供参考。   采用便利抽样法,选取唐山市高校护生为调查对象。采用一般资料调查表、死亡态度描绘量表进行调查,基于潜在剖面分析护生死亡态度的类别及不同类别的影响因素。结果   共发放问卷520份,回收问卷516份,回收率为99.23%,剔除无效问卷11份,有效回收率为97.87%。护生死亡态度描绘量表得分为(96.91±13.20)分,经过剖面分析可划分为死亡态度积极-自然接受型(63.60%)和死亡态度消极-恐惧死亡型(36.40%)2个潜在类别。Logistic回归分析结果显示,陪伴临终亲友、未接触过死亡相关场所、半年内有亲友离世的护生属于死亡态度消极-恐惧死亡型的概率较大,自身性格偏外向、研究生学历的护生属于死亡态度积极-自然接受型的概率较大(均P<0.05)。结论   护生死亡态度存在明显的分类特征,可分为死亡态度积极-自然接受型和死亡态度消极-恐惧死亡型2个潜在类别;相关院校可针对不同类别特征的护生开设死亡教育相关课程,以期帮助护生更深刻地认识死亡,树立科学死亡观。
       Objective  To analyze the potential categories and influencing factors of nursing students’ death attitude,to provide reference for setting up death education courses in line with China’s situation.Methods  Convenient sampling method was used to select nursing students in Tangshan.General data questionnaire and death attitude description scale were used to investigate the categories of nursing students’ death attitude and their influencing factors based on latent profiles.Results  A total of 520 questionnaires were sent out and 516 were collected with a rate of 99.23%.Eleven invalid questionnaires were excluded with an effective rate of 97.87%.The score of the death attitude description scale of nursing students was(96.91±13.20),which could be divided into two potential categories:positive death attitude - natural acceptance type(51.49%)and negative death attitude - fear type(48.51%)after profile analysis.Logistic regression analysis showed that nursing students who accompanied their dying relatives and friends,had no visit to death-related places,and had relatives and friends who died within six months had a higher probability of negative death attitude - fear of death,while nursing students with extrovert personality and graduate degree had a higher probability of positive death attitude - natural acceptance(all P<0.05).Conclusions  There were obvious classification characteristics of nursing students’ attitude towards death,which can be divided into two latent categories:positive attitude towards death - natural acceptance type and negative attitude towards death - fear type.Relevant colleges and universities can set up death education courses for nursing students with different characteristics,in order to help nursing students have a deeper understanding of death and establish a scientific view of death.
论著

CT 增强碘对比剂急性不良反应发生及影响因素分析

Analysis of the occurrence and influencing factors of acute adverse reactions of enhanced CT iodine contrast agents

:829-835
 
       目的   探讨电子计算机断层扫描(CT)增强碘对比剂急性不良反应发生及影响因素分析。方法   选取天津市肿瘤医院空港医院2020年10月—2023年10月收治的100例行CT增强出现碘对比剂急性不良反应的患者进行回顾性分析,将其分为观察组,另选取同期在我院行CT增强检查未发生不良反应的100例患者作为对照组。分析观察组患者碘对比剂急性不良反应情况,对比两组患者临床资料及碘对比剂注射情况,以急性不良反应作为因变量(发生急性不良反应=1,未发生急性不良反应=0)纳入Logistic回归模型,分析CT增强碘对比剂急性不良反应发生的独立影响因素。结果  100例发生碘对比剂急性不良反应的患者中轻度65例(65.00%),中度34例(34.00%),重度1例(1.00%);观察组与对照组性别、年龄、体质指数(BMI)、高血压史、糖尿病史、心功能不全史、甲状腺功能亢进史、冠状动脉粥样硬化性心脏病史、碘对比剂使用史、食物过敏史对比差异无统计学意义(P>0.05),观察组与对照组哮喘史(9.00% vs 2.00%)、肾功能不全史(13.00% vs 3.00%)、碘对比剂不良反应发生史(21.00% vs  2.00%)、花粉过敏史(12.00% vs 4.00%)、药物过敏史(26.00% vs 7.00%)及其他过敏史(10.00% vs 2.00%),对比差异有统计学意义(χ 2 =4.710,P=0.030;χ  2 =6.790,P=0.009;χ 2 =17.740,P<0.001;χ 2 =4.350,P=0.037;χ 2 =13.100,P<0.001;χ 2 =5.670,P=0.017);观察组与对照组碘对比剂剂量对比差异无统计学意义(P>0.05),观察组与对照组碘对比剂注射速度(<3 mL/min为55.00% vs 69.00%;≥3 mL/min为45.00% vs 31.00%)、碘对比剂类型(碘克沙醇为34.00% vs 34.00%,碘佛醇为47.00% vs 30.00%,碘海醇为19.00% vs  36.00%)对比差异有统计学意义(χ 2 =4.160,P=0.041;χ 2 =9.010,P=0.011);肾功能不全史、碘对比剂不良反应发生史、药物过敏史、其他过敏史、碘对比剂注射速度为发生碘对比剂急性不良反应的影响因素(P<0.05)。结论  CT增强碘对比剂急性不良反应多以轻度为主,且以往合并肾功能不全、碘对比剂不良反应发生史、药物过敏史、其他过敏史、碘对比剂注射速度过高可能为碘对比剂不良反应发生的影响因素。
       Objective  To explore the occurrence and influencing factors of acute adverse reactions of iodine contrast agents in enhanced computed tomography(CT).Methods  A retrospective analysis was conducted on 100 patients admitted to our hospital from October 2020 to October 2023 who experienced acute adverse reactions to iodine contrast agents during CT enhancement.They were divided into an observation group and another 100 patients who underwent CT enhancement examination in our hospital during the same period without any adverse reactions were selected as the control group.The acute adverse  reactions of iodine contrast agent in the observation group of patients were analyzed,the clinical data and injection of iodine contrast agent between the two groups of patients were compared,and include acute adverse reactions as the dependent variable(occurrence of acute adverse reactions=1,absence of acute adverse reactions=0)was used in the Logistic regression model to analyze the independent influencing factors of acute adverse reactions of CT enhanced iodine contrast agent.Results  Among the 100 patients who experienced acute adverse reactions to iodine contrast agents,65 were mild reactions,accounting for 65.00%,34 cases had were moderate reactions,accounting for 34.00%,and one cases had severe reactions,accounting for 1.00%.There was no significant difference between the observation group and the control group in gender,age,body mass index(BMI),history of hypertension,diabetes,heart dysfunction,hyperthyroidism,coronary heart disease,use of iodine contrast agent,and food allergy(P>0.05).The history of asthma(9.00% vs 2.00%),renal insufficiency(13.00% vs 3.00%),adverse reactions of iodine contrast(21.00 % vs 2.00%),pollen allergy(12.00% vs  4.00%),drug allerg(26.00% vs  7.00%)and other allergies(10.00 % vs  2.00%)were significantly different(χ 2 =4.710,P=0.030;χ 2 =6.790,P=0.009;χ 2 =17.740,P<0.001;χ 2 =4.350,P=0.037;χ 2 =13.100,P<0.001;χ 2 =5.670,P=0.017).There was no significant difference in the dosage of iodine contrast agent between the observation group and the control group(P0.05).The injection rate of iodine contrast agent between the observation group and the control group(< 3 mL/min was 55.00% vs  69.00%;≥3 mL/min was 45.00% vs 31.00%),and the types of iodoxanol (iodoxanol[34.00% vs 34.00%],iodoxanol[47.00% vs 30.00%],iodohexanol[19.00% vs 36.00%]) were significantly different(χ 2 =4.160,P=0.041;χ 2  =9.010,P=0.011).History of renal insufficiency,adverse reactions to iodine contrast agents,drug allergies,other allergies,and injection speed of iodine contrast agents were independent risk factors for the occurrence of acute adverse reactions to iodine contrast agents(P<0.05).Conclusions  Acute adverse reactions to iodinated contrast agents in CT enhancement are mostly mild.Previous history of  renal insufficiency,history of adverse reactions to iodinated contrast agents,history of drug allergies,other allergic histories,and high injection speed of iodinated contrast agents may be influencing factors for the occurrence of adverse  reactions to iodinated contrast agents.
论著

休克指数与血乳酸水平预测院前创伤性休克患者预后的对比分析

Comparative analysis of shock index and blood lactate level in predicting the prognosis of pre hospital traumatic shock patients

:824-828
 
       目的   探讨、对比休克指数(SI)与血乳酸水平预测院前创伤性休克患者预后中的应用。方法   于2020年12月—2023年12月收治80例创伤性休克患者,均接受SI、乳酸水平的监测。结合监测的结果进行分组:乳酸正常组:乳酸水平在2 mmol/L以下,升高组:2 mmol/L以上;SI正常组:SI在0.9以下,升高组:SI在0.9以上。观察、记录患者入院7 d后的序贯性器官功能衰竭评分(SOFA),对多器官功能障碍综合征(MODS)情况进行评估。同时观察、记录机械通气、血管活性药物的使用和住院等情况。结果   乳酸水平升高组60例,正常组20组;SI升高组58例,正常组22例,女性乳酸水平、SI,与男性比较差异无统计学意义(P>0.05)。是否发生多器官功能障碍者的年龄、性别、SI指数比较差异无统计学意义(P>0.05);格拉斯哥昏迷评分(GCS)评分[(4.22±1.53)分 vs (9.46±3.82)分,t=7.816,P<0.001]、住院时间[(23.34±5.71)d vs (12.26±2.11)d,t=11.830,P<0.001]、基础乳酸值[(4.75±2.36)mmol/L vs (2.04±1.11)mmol/L,t=6.721,P<0.001]与发生MODS在组间对比差异有统计学意义。SI升高组的容量复苏收缩压>80 mmHg(%)有27例,与乳酸水平升高组比较差异有统计学意义(P<0.05)(46.55% vs 18.18%,χ 2 =12.237,P0.001)。乳酸水平升高组中,11例患者接受机械通气,乳酸水平均升高(P0.05);9例患者使用血管活性药物,乳酸水平均升高,比较差异无统计学意义(P>0.05);38例住院患者,24例乳酸水平升高(P0.05)。13例患者接受机械通气,12例SI升高,比较差异无统计学意义(P>0.05);11例患者接受血管活性物治疗,8例SI升高,比较差异无统计学意义(P>0.05);39例患者住院,SI升高22例,比较差异有统计学意义(P<0.05)。结论   针对重症的创伤性休克患者,当血乳酸水平升高时会大大增加MODS发生的概率,乳酸水平在对重症创伤性休克患者预后进行预测时,应用价值更高。
       Objective  To explore and compare the application of shock index(SI)and  blood lactic acid level in predicting the prognosis of patients with pre-hospital traumatic shock.Methods  From December 2020 to December 2023,80 patients with traumatic shock were enrolled,and their SI and levels of lactic acid were monitored.Patients were grouped according to the monitoring results:normal group:lactic acid level below 2 mmol/L,increased group:above 2 mmol/L;normal group:SI below 0.9,and increased group:SI above 0.9.The sequential organ failure score(SOFA)was observed and recorded 7 days after hospitalization,and the situation of multiple organ dysfunction syndrome(MODS)was evaluated.At the same time,mechanical ventilation,the use of vasoactive substances and hospitalization were observed and recorded.Results  There were 60 cases in the group with increased lactic acid level and 20 cases in the normal group.There were 58 cases of increased SI and 22 cases of normal.The lactic acid level and SI index in women were higher than those in men,with no difference(P>0.05).There were no differences in age,sex,SI index and the incidence of MODS(P>0.05).GCS score(4.22±1.53 vs 9.46±3.82),hospitalization days(23.34±5.71 vs 12.26±2.11)d,basal lactate value(4.75±2.36 vs 2.04±1.11)mmol L-1 were significantly different from those of MODS(t=11.830,P<0.001;t=6.721,P<0.001,P<0.05).There were 27 cases with volume  resuscitation systolic blood pressure > 80 mmhg(%)in the group with increased SI,which was different from that of SI and lactic acid(46.55% vs18.18%,χ 2 =12.237,P<0.001;P<0.05).Lactic acid increased group:11 patients received mechanical ventilation,and the lactic acid levels of all 11 patients increased(P<0.05).Nine patients used vasoactive substances,and their lactic acid levels all increased,with no significant difference(P>0.05).Of the 38 inpatients,24 cases had elevated lactic acid levels(P<0.05).Thirteen patients received mechanical ventilation,and 12 patients had elevated SI,with no statistical significance(P>0.05).Eleven patients were treated with vasoactive agents,and 8 patients had increased SI,with no difference(P>0.05).Among the 39 patients hospitalized,22 cases had increased SI,and the difference was statistically significant(P<0.05).Conclusions  For patients with severe traumatic shock,when the blood lactic acid level increases,the probability of MODS will be greatly increased.Compared with SI index,lactic acid level has higher application value in predicting the prognosis of patients with severe traumatic shock.
论著

口服铁剂对改善男性机采血小板固定献血者铁缺乏的效果

The effect of oral iron supplements on improving iron deficiency in male regular plateletpheresis donors

:815-818
 
       目的   探讨口服铁剂方法用于改善铁缺乏的男性机采血小板固定献血者铁营养状况效果,为采供血机构完善无偿献血者关爱策略提供数据支持。方法   选择2022年9月—2023年8月珠海市中心血站男性血小板固定献血者进行铁蛋白(FER)检测。以FER<30 ng/mL为铁缺乏的判定标准。将49名铁缺乏的男性机采血小板固定献血者随机分成干预组、对照组,分别进行口服铁剂干预,比较两组干预前后血红蛋白(Hb)、血清铁(SI)、FER的浓度变化情况。结果   共检测205名男性机采固定献血者,其中49名FER<30 ng/mL(铁缺乏组),占23.90%,其Hb、SI、FER均值低于FER≥30 ng/mL男性机采固定献血者(正常组)。49名铁缺乏的机采固定献血者口服铁剂干预后:干预组SI、FER浓度分别为(15.97±5.14)μmol/L、(30.55±14.42)ng/mL,高于对照组[(11.49±4.02)μmol/L、(12.77±5.86)ng/mL)],其差异有统计学意义(t=3.466,P<0.001;t=5.493,P<0.001)。干预组Hb为(143.42±10.85)g/L,高于对照组的(140.88±12.97)g/L,但差异无统计学意义(t=-0.726,P=0.471)。结论   针对铁蛋白低值的机采男性固定献血者,采取口服铁剂方法可以有效改善其铁缺乏状况。
       Objective  To explore the effect of oral iron  supplements on improving iron  deficiency in male  regular plateletpheresis donors.Methods  Male regular plateletpheresis donors from Zhuhai Blood Central Station were selected for ferritin(FER)detection.Using FER<30 ng/mL as the criterion for determining iron deficiency,49 donors were selected as the study subjects and divided into intervention group and control group,and the changes in hemoglobin(Hb),serum iron(SI),andFER concentrations were compared.Results  A total of 205 male regular plateletpheresis donors underwent FER detection,of which 49 donors had FER under 30 ng/mL(iron deficiency group),accounting for 23.90%.The mean Hb,SI,and FER levels in the iron deficiency group were significantly lower than those with FER≥30 ng/mL.After oral iron intervention,the SI and FER levels in the intervention group([15.97±5.14] μmol/L,[30.55±14.42] ng/mL)were significantly higher than those in the control group([11.49±4.02] μmol/L,[12.77±5.86] ng/mL),and the difference were statistically significant(t=3.466,P<0.001;t=5.493,P=0.000).The Hb values of the intervention group and the control group were(143.42±10.85)g/L and(140.88±12.97)g/L,respectively,with no statistically significant difference between the groups(t=-0.726,P=0.471).Conclusions  Oral iron supplementation can effectively improve iron deficiency in male regular plateletpheresis donors.
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