目的   通过机器学习方法构建脓毒症谵妄患者30 d死亡的预测模型，并识别关键预测因子。方法   采用基于医疗信息集成重症监护数据库（Medical Information Mart for Intensive Care IV）的回顾性队列研究方法，boruta筛选重要特征，并通过决策树，K近邻，LightGBM，随机森林，支持向量机，XGBoost构建模型进行分析，通过ROC曲线下面积进行评估，利用F1分数、召回率、精确率、特异度、灵敏度和阳性预测值比较模型表现。结果  XGBoost模型在训练集和验证集中的ROC曲线下面积分别为0.906和0.762，表明该模型具有良好的预测能力，入院年龄、红细胞分布宽度和白细胞计数是最重要的预测因子。结论   基于机器学习的脓毒症谵妄患者预后预测模型展现出良好的预测效能，为临床早期干预提供了重要参考依据。

       Objective  To construct a  30-day mortality  prediction model for  patients with  sepsis-associated  delirium using machine learning methods and identify key predictive factors．Methods  A  retrospective cohort study was conducted based on the Medical Information Mart for Intensive Care IV database．Important features were selected using the Boruta algorithm，and models including Decision Tree，K-Nearest Neighbors，LightGBM，Random Forest，Support Vector Machine，and XGBoost were constructed and analyzed．Model performance was evaluated using the area under the reciver operater characteristic（ROC）curve（AUC），along with F1 score，recall，precision，specificity，sensitivity，and positive predictive value．Results  The XGBoost model demonstrated strong predictive performance，with AUC values of 0.906 in the training set and 0.762 in the test set．Key predictors identified included admission age，red blood cell distribution width，and white blood cell count．Conclusions  The machine learning-based prediction model for sepsis-associated delirium prognosis exhibits robust predictive efficacy，providing a valuable tool for early clinical intervention．

脓毒症当前仍然是全球范围内重要的医疗卫生问题,其对世界公共卫生及患者安全带来重大威胁。脓毒症是指宿主对感染反应失调引起的危及生命的器官功能障碍, 其发病率和病死率均极高,是临床重症医学中的重大挑战。在脓毒症病情的进展过程中, 可出现组织灌注不足、血流动力学不稳定等变化, 从而导致多器官功能受损,而心脏是常见的被累及的重要靶器官之一, 这种由脓毒症所导致的不同程度的心肌损伤, 被称为“脓毒性心肌病”, 其发生和发展机制复杂多样, 涉及循环心肌抑制因素、心肌自身因素及自主神经失调等多个方面。文章综述了脓毒症患者发生心肌损伤的高危因素, 以期为临床治疗和预防提供参考。

Sepsis currently remains an important global healthcare issue, and a major threat to world public health and patient safety．Sepsis is a life-threatening organ dysfunction caused by dysregulation of the host response to infection, with extremely high morbidity and mortality,which is a major challenge in clinical critical care medicine．During the progression of sepsis, changes such as inadequate tissue perfusion and haemodynamic instability may occur, leading to impairment of multiple organ functions, while the heart is one of the commonly involved vital target organs, and the varying degree of myocardial damage caused by sepsis is known as “septic cardiomyopathy”．The mechanisms of its occurrence and development are complex and diverse, involving circulating myocardial inhibitory factors, myocardial auto-factors, and autonomic dysregulation．In this paper, we review the high-risk factors for myocardial injury in septic patients, providing a reference for clinical treatment and prevention.

目的 探讨俯卧位通气在脓毒症合并急性肺损伤患儿的应用效果。方法 选取泉州市儿童医院2020年9月—2023年9月收治的72例脓毒症合并急性肺损伤患儿,应用抽签法将其分为观察组与对照组,均为36例。对照组患儿实施常规仰卧位机械通气与对应护理,观察组患儿在常规护理基础上增加俯卧位通气与对应护理。对比两组患儿机械通气时间,干预前和干预3 d后气道平台压和心率水平,动脉血二氧化碳分压（PaCO₂）、动脉血氧分压（PaO₂）,并计算动脉血氧分压与吸入气中的氧浓度分数比值（PaO₂/FiO₂）,评价两组患儿预后及不良事件发生情况。结果 观察组机械通气时间明显低于对照组（P<0.05）,干预后两组患儿气道平台压、心率均降低,且观察组低于对照组（P<0.05）;干预后两组患儿PaO₂/FiO₂、PaO₂水平升高,观察组高于对照组,PaCO₂降低,观察组低于对照组（P<0.05）;干预后两组患儿全身性感染相关性器官功能衰竭评分（SOFA）、急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）评分均降低,观察组低于对照组（P<0.05）;两组患儿呼吸机管路折管、管路滑脱、压力性损伤等不良事件发生率对比差异无统计学意义（P>0.05）。结论 俯卧位通气在脓毒症合并急性肺损伤患儿的应用效果显著,可降低患儿气道平台压及心率,缩短机械通气时间,改善患儿通气功能,有助提升预后水平。

Objective To explore the application effect of prone position ventilation in children with sepsis complicated with acute lung injury．Methods From September 2020 to September 2023,72 children with sepsis and acute lung injury admitted to Quanzhou Children's Hospital were selected and divided into observation group and control group by drawing lots,both with 36 cases．The children in the control group received routine supine mechanical ventilation and corresponding nursing,and the children in the observation group added prone ventilation and corresponding nursing on the basis of routine nursing．By comparing the duration of mechanical ventilation,airway plateau pressure and heart rate level,PaCO₂,PaO₂,PaO₂/FiO₂,the prognosis and occurrence of adverse events in the two groups were evaluated．Results The mechanical ventilation time in the observation group was significantly shorter than that in the control group（P<0.05）．After intervention,the airway plateau pressure and heart rate levels of the two groups of children decreased,and the observation group was lower than the control group（P<0.05）．After the intervention,the levels of PaO₂/FiO₂ and PaO₂ in the two groups of children increased,with the observation group higher than the control group,while the level of PaCO₂ was lower,with the observation group lower than the control group（P<0.05）．After the intervention,the SOFA and APACHE II scores of the two groups of children decreased,and the observation group was lower than the control group（P<0.05）．There was no difference in the incidence of adverse events such as ventilator tube folding,tube slip and pressure injury between the two groups（P>0.05）．Conclusions The application of prone position ventilation in children with sepsis combined with acute lung injury has a significant effect,which can reduce airway plateau pressure,lower heart rate,shorten mechanical ventilation time,improve ventilation function,and assist in improving prognosis．

目的 探讨超声监测导向下早期肠内营养（EEN）在重症脓毒血症（SS）有创通气（IV）患者中的应用效果。方法 选取2021年2月—2023年11月连州市人民医院收入的115例SS-IV患者,依据随机数字表法分为对照组（n=57）、超声监测组（n=58）。所有患者均予重症监护病房（ICU）综合治疗,在此基础上对照组实施临床经验的传统肠内营养（EN）干预,超声监测组实施超声监测导向下EEN干预,均监测至治疗结束。统计两组IV时间、ICU停留时间、EN达标时间、EN不耐受发生率、相关并发症发生率,比较干预前、EN结束时营养状况[白蛋白（ALB）、总蛋白（TP）、前白蛋白（PA）]、序贯器官衰竭评分（SOFA）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。结果 对照组剔除放弃治疗1例,死亡2例,纳入54例;超声监测组剔除放弃治疗1例,死亡1例,纳入56例。超声监测组EN达标时间[（40.18±8.46）h]、IV时间[（7.12±1.44）d]、ICU停留时间[（9.21±1.63）d]短于对照组[（46.03±10.15）h、（8.02±1.62）d、（10.18±1.54）d]（t=3.288、3.082、3.206,均P<0.05）。EN结束时超声监测组SS-IV患者血清ALB[（32.05±3.13）g/L]、TP[（65.36±3.62）g/L]、PA[（0.24±0.06）g/L]高于对照组[（30.28±2.24）g/L、（63.28±4.24）g/L、（0.21±0.05）g/L]（t=3.400、2.770、2.843,均P<0.05）。EN结束时超声监测组APACHEⅡ评分[（15.85±1.93）分]、SOFA评分[（7.42±1.64）分]低于对照组[（17.02±2.04）分、（8.35±2.03）分]（t=3.091、2.648,均P<0.05）。超声监测组EN不耐受发生率[12.50%（7/56）]低于对照组[29.63%（16/54）],超声监测组相关并发症发生率[8.93%（5/56）]低于对照组[24.07%（13/54）]（χ²=4.878、4.608,均P<0.05）。结论 超声监测导向下EEN干预应用于SS-IV患者,可改善患者病情与营养状况,降低EN不耐受及相关并发症发生风险,缩短恢复时间。

Objective To investigate the effect of ultrasound monitoring guided early enteral nutrition（EEN）in patients with severe sepsis（SS）and invasive mechanical ventilation（IV）．Methods A total of 115 SS-IV patients admitted to Lianzhou People's Hospital from February 2021 to November 2023 were randomly divided into control group（n=57）and ultrasound monitoring group（n=58）．All patients were given comprehensive treatment in intensive care unit（ICU）．On this basis,traditional enteral nutrition（EN）intervention with clinical experience was implemented in control group,and EEN intervention guided by ultrasonic monitoring was implemented in ultrasound monitoring group．All patients were monitored until the end of treatment．IV time,ICU stay time,EN compliance time,incidence of EN intolerance,and incidence of related complications were analyzed in the 2 groups．Nutritional status [albumin（ALB）,total protein（TP）,prealbumin（PA）],sequential organ failure assessment（SOFA）,acute physiology and chronic health evaluation Ⅱ（APACHEⅡ）were compared before intervention and at the end of EN．Results In control group,1 cases gave up,2 cases died,and 54 cases were included．In ultrasound monitoring group,1 case gave up,1 case died,and 56 cases were included．The EN compliance time [（40.18±8.46）h],IV time [（7.12±1.44）d] and ICU stay time [（9.21±1.63）d] of ultrasound monitoring group were shorter than those of control group [（46.03±10.15）h,（8.02±1.62）d,（10.18±1.54）d]（t=3.288,3.082,3.206,all P<0.05）．At the end of EN,serum ALB[（32.05±3.13）g/L],TP[（65.36±3.62）g/L],PA[（0.24±0.06）g/L] of SS-IV patients in ultrasound monitoring group were higher than those in control group [（30.28±2.24）g/L,（63.28±4.24）g/L,（0.21±0.05）g/L]（t=3.400,2.770,2.843,all P<0.05）．At the end of EN,APACHEⅡ scores [（15.85±1.93）points] and SOFA scores [（7.42±1.64）points] of ultrasound monitoring group were lower than those of control group [（17.02±2.04）points and（8.35±2.03）points]（t=3.091,2.648,all P<0.05）．The incidence of EN intolerance in ultrasound monitoring group [12.50%（7/56）] was lower than that in control group [29.63%（16/54）],and the incidence of related complications in ultrasound monitoring group [8.93%（5/56）] was lower than that in control group [24.07%（13/54）]（χ²=4.878,4.608,all P<0.05）．Conclusions EEN intervention guided by ultrasonic monitoring in SS-IV patients can improve the nutritional status of patients,reduce the risk of EN intolerance and related complications,shorten the recovery time,and reduce the progression of patients' disease．

目的 观察脓毒症患者血清胆碱酯酶(S-ChE)和T细胞程序性死亡分子-1(PD-1)以及炎症因子水平,并分析其与患者预后关系。方法 选取2018年8月—2021年5月在我院接受治疗的脓毒症患者为研究对象,同时选取同期在我院接受体检的健康人群为对照组。根据脓毒症患者的预后分为存活组和死亡组。比较脓毒症组和对照组、脓毒症存活组和死亡组患者S-ChE、PD-1水平和炎症因子水平的差异,并分析与患者预后的关系。结果 脓毒症患者的S-ChE水平低于对照组,PD-1水平高于对照组(P＜0.05)。脓毒症患者的CRP、PCT水平高于对照组,CD3⁺T、CD3⁺CD4⁺T和CD4⁺CD8⁺T水平低于对照组(P＜0.05)。死亡组患者的S-ChE水平低于存活组,PD-1水平高于存活组(P＜0.05)。死亡组患者的CRP、PCT水平高于存活组,CD3⁺T、CD3⁺CD4⁺T和CD4⁺CD8⁺T水平低于存活组(P＜0.05)。脓毒症患者S-ChE、PD-1水平呈负相关,(P＜0.05)。脓毒症患者的S-ChE与 CRP、PCT水平负相关,与CD3⁺T、CD3⁺CD4⁺T、CD4⁺CD8⁺T水平正相关(P＜0.05)。脓毒症患者的PD-1与 CRP、PCT水平正相关,与CD3⁺T、CD3⁺CD4⁺T、CD4⁺CD8⁺T水平负相关(P＜0.05)。S-ChE、PD-1预测脓毒症患者预后的AUC值为0.725(95%CI:0.605~0.825)、0.706(95%CI:0.585~0.809),P＜0.05。结论 脓毒症患者的S-ChE水平较低,PD-1水平较高,且与炎症因子水平和患者的预后相关。

Objective To analyze the levels of serum cholinesterase (S-ChE), programmed death 1 (PD-1) and inflammatory factors in patients with sepsis, and analyze the relationship between them and the prognosis of patients. Methods Patients with sepsis treated in our hospital from August 2018 to May 2021 were selected as the research subjects, and healthy people who received physical examinations in our hospital during the same period were selected as the control subjects.The differences in the levels of S-ChE, PD-1 and inflammatory factors between the sepsis group and the control group, the sepsis survival group and the death group were compared, and their relationship with the prognosis of the patients were analyzed. Results The level of S-ChE in patients with sepsis was lower than that of the control group, and the level of PD-1 was higher than that of the control group (P<0.05).The CRP and PCT levels of sepsis patients were higher than those of the control subjects, and the levels of CD3⁺T, CD3⁺CD4⁺T and CD4⁺CD8⁺T were lower (P<0.05).The S-ChE level of the death group was lower than that of the survival group, and the PD-1 level was higher than that of the survival group (P<0.05).The levels of CRP and PCT in the death group were higher than those in the survival group, and the levels of CD3⁺T, CD3⁺CD4⁺T and CD4⁺CD8⁺T were lower than those in the survival group (P<0.05).The levels of S-ChE and PD-1 in sepsis patients were negatively correlated (P< 0.05).S-ChE level in patients with sepsis was negatively correlated with CRP and PCT levels, and positively correlated with CD3⁺T, CD3⁺CD4⁺T, and CD4⁺CD8⁺T levels (P<0.05).PD-1 level in patients with sepsis was positively correlated with CRP and PCT levels, and negatively correlated with CD3⁺T, CD3⁺CD4⁺T, and CD4⁺CD8⁺T levels (P<0.05).The AUC values of S-ChE and PD-1 predicting the prognosis of patients with sepsis were 0.725 (95% CI: 0.605~0.825), 0.706 (95% CI: 0.585~0.809), P＜0.05. Conclusions Patients with sepsis had lower level of S-ChE and higher level of PD-1, which were related to the levels of inflammatory factors and the prognosis of patients.

目的 分析新生儿无乳链球菌（B族链球菌,GBS）败血症的临床特点、围产期高危因素及预后,提高临床对GBS败血症的认识。方法 选择21例GBS败血症新生儿（收集病例时间为2018年2月—2021年11月）,采用回顾性调查法分析临床资料;对新生儿临床资料、实验室检查、影像学资料进行统计和对比,分析临床特征,同时比较患儿合并症情况及评估治疗预后结果等。结果 GBS败血症新生儿中早发型（90.48%）明显高于迟发型（9.52%）,P<0.05;GBS败血症新生儿主要症状表现为发热、发绀、气促、呻吟、抽搐等,以气促、呻吟为主;通过实验室检查,发现患儿普遍存在C反应蛋白、降钙素原、白细胞计数等指标异常情况;经头颅MRI检查提示蛛网膜下腔出血6例;X线提示新生儿吸入性综合征6例、双肺新生儿肺炎4例;部分患儿存在合并症,其中1例合并脑膜炎、3例合并蛛网膜下腔出血、4例合并黄疸、2例合并新生儿低血糖;所有患儿接受抗菌药物治疗,以青霉素、头孢他啶为主,平均住院时间（14.86±2.33）d,治愈19例（占比90.48%）、1例患儿好转后家属要求签字出院,1例家属要求转上级儿童医院。结论 新生儿无乳链球菌败血症有早发型和迟发型之分,两者的临床表现及特征有明显差异,该病病情较凶险,临床需高度重视本病的防治工作,早期诊断及时治疗干预,以提高新生儿预后。

Objective To analyze the clinical characteristics,perinatal high-risk factors and prognosis of neonatal Streptococcus agalactiae（group B Streptococcus,GBS）sepsis,and to improve the clinical understanding of Streptococcus agalactiae sepsis．Methods Twenty-one newborns with GES sepsis were selected（the cases were collected from February 2018 to November 2021）,and the clinical data were analyzed by retrospective investigation．The clinical data,laboratory examination and imaging data of newborns were summarized and compared,and the clinical characteristics were analyzed．At the same time,the complications of children were compared and the prognosis of treatment was evaluated．Results In newborns with GBS sepsis,the early-onset rate（90.48%）was significantly higher than the late-onset（9.52%）,P < 0.05．The main symptoms of newborns with GBS sepsis were shortness of breath,moaning,fever,cyanosis,convulsions,etc．Through laboratory examination,it was found that there were common abnormalities in C-reactive protein,procalcitonin,leukocyte count and other indicators in children．Transcranial MRI results showed 6 cases with subarachnoid hemorrhage;X-ray showed 6 cases with neonatal aspiration syndrome and 4 cases with both lungs neonatal pneumonia．Some children had complications,including 1 case with meningitis,3 cases with subarachnoid hemorrhage,4 cases with jaundice,and 2 cases with neonatal hypoglycemia．All children were treated with antibiotics,mainly penicillin and ceftazidime．The average hospital stay was（14.86 ± 2.33）days,and 19 cases were cured（accounting for 90.48%）．One case of the child's family member asked to sign and leave the hospital after improvement,and one case of the family member asked to be transferred to a superior children's hospital．Conclusions Neonatal Streptococcus agalactiae sepsis can be divided into early-onset and late-onset type．There are significant differences in clinical manifestations and characteristics between them．The disease is dangerous,clinical attention should be paid to the prevention and treatment of the disease,early diagnosis and timely treatment and intervention,so as to improve the prognosis of newborns．

目的 探究血清降钙素原(PCT)联合阴离子隙(AG)检测在脓毒症患者预后中预测价值。方法 选取2019年1月—2021年1月于我院治疗117例毒症患者作为研究对象,根据入院治疗28 d的预后情况,分为存活组(78例)和死亡组(39例),对比2组患者一般资料,采用多因素分析其高危因素,应用ROC曲线确定曲线下面积,评估血清PCT联合AG检测对该类患者预后的预测价值。结果 2组患者一般资料对比,年龄、中性粒细胞计数、血清C反应蛋白(CRP)、PCT、AG、APACHEⅡ评分差异有统计学意义(P<0.05);年龄、CRP、PCT、AG水平是该类死亡的危险因素;ROC曲线分析结果显示,血清PCT曲线下面积为0.737,最佳截断值为9.595;AG曲线下面积为0.791,最佳截断值为21.695;血清PCT联合AG检测曲线下面积为0.933,最佳截断值为1.3442。结论 血清PCT联合AG检测对脓毒症患者预后具有较高的预测价值。

Objective To investigate the predictive value of serum procalcitonin (PCT) combined with anion gap (AG) detection on the prognosis of patients with sepsis. Methods One hundred and seventeen patients with sepsis treated in our hospital from January 2019 to January 2021 were selected as study subjects and divided into survival group (78 patients) and death group (39 patients) according to their prognosis at 28 d of admission. The general data of the two groups was compared, multi-factor Logistic analysis of high-risk factors of sepsis patients was performed, area under the ROC curve was applied to assess the predictive value of serum PCT combined AG detection on the prognosis of sepsis patients. Results After comparing the general data of the two groups, the differences in age, neutrophil count, C-reactive protein (CRP), PCT, AG and APACHE II scores were statistically significant (P<0.05); multi-factor Logistic regression analysis showed that age, CRP, PCT and AG levels were risk factors for death in sepsis patients; the results of ROC curve analysis showed that the area under the curve of serum PCT was 0.737, with an optimal cut-off value of 9.595; the area under the AG curve was 0.791, with an optimal cut-off value of 21.695;the area under the curve of serum PCT combined with AG was 0.933, and the optimal cut-off value was 1.3442. Conclusions Serum PCT combined with AG assay had a high predictive value for the prognosis of patients with sepsis.

目的 探讨丙酸睾酮注射液联合乌司他丁对脓毒症患者免疫失衡的调节作用。方法 选取我院2019年10月—2020年1月收治的88例脓毒症患者,随机分成观察组和对照组各44例,对照组采用乌司他丁配合常规治疗,观察组在此基础上联合丙酸睾酮注射液对患者治疗,比较治疗1周2组临床疗效差异,观察治疗前及治疗1周,2组炎症因子水平[白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、白细胞介素-1β(IL-1β)]、睾酮(T)、白蛋白(Alb)水平及疾病危重程度(APACHEⅡ评分)、器官衰竭程度(SOFA评分)变化,分析治疗1周内2组患者药物不良反应发生情况差异。结果 治疗1周,观察组总有效率高于对照组(P＜0.05);2组患者IL-6、IL-1β水平及APACHEⅡ、SOFA评分均降低,且观察组较对照组更低(P＜0.05);2组患者IL-10、T、Alb水平均升高,且观察组较对照组更高(P＜0.05);2组药物不良反应总发生率比较无统计学意义(P>0.05)。结论 丙酸睾酮注射液联合乌司他丁治疗脓毒症可取得良好临床疗效,可有效改善病情及预后,对患者免疫失衡调节有积极意义。

Objective To investigate the regulatory effect of testosterone propionate injection combined with ulinastatin on immune imbalance in patients with sepsis.Methods A total of 88 patients with sepsis treated in our hospital from October 2019 to January 2020 were randomly divided into observation group and control group,with 44 cases each.The control group was treated with ulinastatin combined with routine treatment,while the observation group was treated with testosterone propionate injection additionally.The clinical efficacy difference between the two groups were compared after treating 1 week.The levels of inflammatory factors [interleukin-6 (IL-6),interleukin-10 (IL-10),interleukin-1 β (IL-1β)],testosterone (T),albumin (Alb),the severity of disease (APACHE II score) and the degree of organ failure (SOFA score) in the two groups were observed before and 1 week after treatment.The differences of adverse drug reactions between the two groups within 1 week of treatment were analyzed.Results The total effective rate of the observation group was higher than that of the control group (P＜0.05).IL-6 and IL-1β levels and APACHE II and SOFA scores decreased after treatment,while those of the observation group were lower than the control group (P＜0.05).The levels of IL-10,T and Alb in the two groups were increased,while those in the observation group were higher than the control group (P ＜ 0.05); the total incidence of adverse drug reactions in the two groups was not statistically significant (P>0.05).Conclusions Testosterone propionate injection combined with ulinastatin had good clinical efficacy in the treatment of sepsis,effectively improved the condition and prognosis,and had positive significance in the regulation of immune imbalance.

目的 探究序贯器官衰竭评分(sequential organ failure assessment,SOFA)联合可溶性程序性死亡因子-1(soluble programmed death-1,sPD-1)水平对脓毒症患者的预后影响。方法 选我院2019年3月—2021年3月期间86例脓毒症患者为研究对象,依据其预后情况(28 d转归)分为生存组(59例)、死亡组(27例),记录两组患者sPD-1、炎症细胞因子水平、SOFA评分及急性生理学与慢性健康状况评价系统Ⅱ(APACHEⅡ)评分情况,分析28 d死亡危险因素,并以ROC曲线分析SOFA+sPD-1对脓毒症患者预后评估价值。结果 死亡组年龄、C反应蛋白、降钙素原、sPD-1水平及SOFA、APACHEⅡ评分均较生存组高(P＜0.05);经Logistic回归分析,sPD-1、SOFA、APACHEⅡ为28 d死亡脓毒症患者独立预测因素(P＜0.05);联合预测后,SOFA+sPD-1的ROC曲线下面积最大,为0.862,敏感度、特异度分别为88.89%、88.14%。结论 在对脓毒症患者预后评估中,sPD-1、SOFA评分均为28 d病死独立预测因素,且SOFA+sPD-1对脓毒症患者转归预测能力更为理想。

Objective To explore the effect of sequential organ failure assessment (SOFA) combined with soluble programmed death factor-1 (sPD-1) level on the prognosis of patients with sepsis. Methods A total of 86 patients with sepsis in our hospital from March 2019 to March 2021 were selected and divided into survival group (59 cases) and death group (27 cases) according to their prognosis (28-day outcome). The levels of sPD-1, inflammatory cytokines, SOFA and APACHEⅡ scores of two groups were recorded. The risk factors of 28-day mortality were analyzed. The prognostic values of SOFA+sPD-1 in patients with sepsis were analyzed by ROC curve. Results Age, C-reactive protein (CRP), procalcitonin (PCT) and sPD-1 levels and SOFA, APACHEⅡ scores of death group were higher than those of survival group (P＜0.05). By Logistic regression analysis, sPD-1 level, SOFA and APACHEⅡ scores were identified as independent predictors of 28-day death in patients with sepsis (P＜0.05). After combining prediction, the area under the ROC curve of SOFA+sPD-1 was the largest (0.862), and the sensitivity and specificity were 88.89% and 88.14% respectively. Conclusion In the prognosis evaluation of patients with sepsis, both sPD-1 level and SOFA score were independent predictors of 28-day mortality, and SOFA+sPD-1 was more effective in predicting the prognosis of patients with sepsis.

目的 探讨醒脑静联合连续肾脏替代疗法对脓毒症相关性脑病的疗效。方法 选取我院2014年6月—2016年6月收治的76例脓毒症相关性脑病患者作为研究对象,按照随机数字表法将其分成两组,每组38例。观察组给予醒脑静联合连续肾脏替代疗法治疗,对照组给予连续肾脏替代疗法治疗,比较两组患者的临床疗效,治疗前后格拉斯哥昏迷(Glasgow coma scale,GCS)评分、神经元特异性烯醇化酶(neuron-specifie enolase,NSE)含量、C-反应蛋白(C-reactive protein,CRP)含量及治疗后退热时间、恢复意识时间的长短。结果 观察组总有效率为89.47%,相对于对照组明显上升(P<0.05);观察组治疗后GCS评分较对照组明显升高,NSE含量、CRP含量较对照组明显降低,差异均有统计学意义(P<0.01);观察组治疗后的退热时间、恢复意识时间较对照组明显降低(P<0.01)。结论 醒脑静联合连续肾脏替代疗法对脓毒症相关性脑病的疗效显著,可有效缩短退热及恢复意识时间,降低患者痛苦,值得临床推广应用。

Objective To investigate the curative effect of Xingnaojing combined with continuous renal replacement therapy on sepsis associated encephalopathy. Methods 76 cases of sepsis associated encephalopathy in our hospital from June 2014 to June 2016 were selected as the research objects, and they were divided into two groups according to the random number table method, 38 cases in each group. The observation group were treated with Xingnaojing combined with continuous renal replacement therapy. The control group was given continuous renal replacement therapy. The clinical efficacy of two groups were compared before and after treatment about the Glasgow coma (Glasgow coma scale, GCS) score, neuron specific enolase (neuron-specifie enolase, NSE) content, C- reactive protein (C-reactive protein, CRP)content, and the length of the consciousness recovery time and pyretolysis time. Results In the observation group, the total effective rate was 89.47%. Compared with the control group. it increased significantly (P<0.05); After treatment the GCS score in the observation group was significantly higher than the control group, the content of NSE and CRP were significantly lower than the control group, the differences were statistically significant (P<0.01); In the observation group, after treatment the pyretolysis time, consciousness recovery time was significantly lower than the control group(P<0.01). Conclusion The curative effect of Xingnaojing combined with continuous renal replacement therapy on sepsis associated encephalopathy is significant and may effectively shorten the pyretolysis and the recovery of consciousness time, which is worthy of clinical application.