Objective To analyze the risk factors of treatment failure by noninvasive positive pressure ventilation (NPPV) in patients with acute respiratory failure (ARF) due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and explore the best time that NPPV be replaced by invasive ventilation when NPPV failure occurs. Methods The data of patients with ARF due to AECOPD who were treated with NPPV from January 2013 to December 2015 were retrospectively collected. The patients were divided into two groups: the NPPV success group and the NPPV failure group (individuals who required endotracheal intubation or tracheotomy at any time). The Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score was analyzed; the Glasgow Coma Scale score, respiratory rate (RR), pH value, partial pressure of oxygen (PaO2), PaO2/fraction of inspired oxygen (FiO2) ratio, and partial pressure of carbon dioxide were also analyzed at admission, after 2 hours of NPPV, and after 24 hours of NPPV. Results A total of 185 patients with ARF due to AECOPD were included. NPPV failed in 35.1% of the patients (65/185). Multivariate analysis identified the following factors to be independently associated with NPPV failure: APACHEⅡscore≥30 [odds ratio (OR)=20.603, 95% confidence interval (CI) (5.309, 80.525), P<0.001], RR at admission≥35 per minute [OR=3.723, 95%CI (1.197, 11.037), P=0.020], pH value after 2 hours of NPPV<7.25 [OR=2.517, 95%CI (0.905, 7.028), P=0.070], PaO2 after 2 hours of NPPV<60 mm Hg (1 mm Hg=0.133 kPa) [OR=3.915, 95%CI (1.374, 11.508), P=0.010], and PaO2/FiO2 after 2 hours of NPPV<200 mm Hg [OR=4.024, 95%CI (1.542, 11.004), P=0.010]. Conclusion When patients with ARF due to AECOPD have a higher severity score, have a rapid RR at admission, or fail to improve in terms of pH and oxygenation after 2 hours of NPPV, the risk of NPPV failure is higher.
ObjectiveTo summarize the individualized selection of surgical treatment strategies and the key points of perioperative management for patients with heart valve disease complicated with severe chronic heart failure.MethodsThe clinical characteristics of 5 male patients with valvular heart disease complicated with severe chronic heart failure (CHF) were analyzed retrospectively from June 2017 to October 2018 in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, with an average age of 60.21 years.ResultsFive patients were given angiotensin receptor and neprilysin inhibitor (ARNI)-based anti-heart failure treatment after admission. The operation mode of these patients was decided to be valve replacement under cardiopulmonary bypass after individualized evaluation of patients’ improving symptoms. Three patients were treated with intra-aortic balloon pump (IABP) and continuous renal replacement therapy (CRRT) early after operation to assist patients in improving cardiac function. Five patients recovered oral anti-heart failure after awakening. All patients were discharged smoothly 2 weeks after operation.ConclusionIndividualized evaluation is needed for the choice of operation timing and mode, standardized preoperative treatment for heart failure, shortening the aortic blocking time during cardiopulmonary bypass, and early application of left ventricular adjuvant drugs or instruments are all important measures to help patients recover smoothly.
ObjectiveTo explore the relationship between blood glucose variability index and persistent organ failure (POF) in acute pancreatitis (AP). MethodsWe prospectively included those patients who were diagnosed with AP with hyperglycemia and were hospitalized in the West China Center of Excellence for Pancreatitis of West China Hospital of Sichuan University from July 2019 to November 2021. The patients were given blood glucose monitoring at least 4 times a day for at least 3 consecutive days. The predictive value of blood glucose variability index for POF in patients with AP was analyzed. ResultsA total of 559 patients with AP were included, including 95 cases of POF. Comparing with those without POF, patients with AP complicated by POF had higher levels of admission glucose (11.0 mmol/L vs. 9.6 mmol/L), minimum blood glucose (6.8 mmol/L vs. 5.8 mmol/L), mean blood glucose (9.6 mmol/L vs. 8.7 mmol/L), and lower level of coefficient of variation of blood glucose (16.6 % vs. 19.0 %), P<0.05. Logistic regression analyses after adjustment for confounding factors showed that the risk of POF increased with the increase of admission glucose [OR=1.11, 95%CI (1.04, 1.19), P=0.002], minimum blood glucose [OR=1.28, 95%CI (1.10, 1.48), P=0.001] and mean blood glucose [OR=1.18, 95%CI (1.04, 1.33), P=0.010]; with the higher level of coefficient of variation of blood glucose [OR=0.95, 95%CI (0.92, 0.99), P=0.021], the risk of POF decreased. The results of area under the curve (AUC) of the receiver operator curves showed that AG [AUC=0.787, 95%CI (0.735, 0.840)] had the highest accuracy in predicting POF, with sensitivities of 60.0% and specificities of 84.7%. ConclusionHigh admission glucose, minimum blood glucose, mean blood glucose, and low coefficient of variation of blood glucose were risk factors for the development of POF in patients with hyperglycemic AP on admission.
ObjectiveTo overview of systematic reviews (SRs) of Yiqi Fumai (YQFM) injection in the treatment of chronic heart failure (CHF). MethodsThe PubMed, Cochrane Library, EMbase, Web of Science, CNKI, CBM and WanFang Data databases were electronically searched to collect SRs of YQFM injection in the treatment of CHF from January 1, 2007 to October 31, 2022. Two reviewers independently screened literature, extracted data and assessed methodological quality, risk of bias, report quality and evidence quality by using AMSTAR-2, ROBIS scale, PRISMA, and GRADE system. ResultsA total of 7 SRs were included. The evaluation results showed that the quality of all SRs was low, a few SRs were assessed as having a low risk of bias, and all SRs were relatively completely reported. A total of 46 results were extracted from the included SRs, including 3 with moderate quality evidence, 12 with low quality evidence and 31 with very low quality evidence. ConclusionYQFM may be an effective and safe treatment, but current evidence quality is low.
Objective To investigate the 30-day mortality risk factors in elderly patients (≥70 years) with heart failure with reduced ejection fraction (HFrEF) after isolated coronary artery bypass grafting (CABG) and to construct a nomogram for predicting mortality risk. Methods A retrospective analysis of elderly HFrEF patients undergoing isolated CABG at Tianjin Chest Hospital from 2010 to 2024. Simple random sampling in R was used to divide the dataset into training and validation sets in a 7 : 3 ratio. The training set was further divided into survivors and non-survivors. Univariate logistic regression was performed to identify differences between groups, followed by multivariate logistic stepwise regression to select independent risk factors for death and to establish a death-risk nomogram, which underwent internal validation. The predictive value of the nomogram was assessed by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision-curve analyses for both the training and validation sets. ResultsA total of 656 patients were included. The training set consisted of 458 patients (survivors 418, deaths 40); the validation set consisted of 198 patients (survivors 180, deaths 18). In the training cohort, univariate analysis showed significant differences between survivors and deaths for creatinine (Cr) level, brain natriuretic peptide (BNP), maximum Cr, intra-aortic balloon pump (IABP) use, assisted ventilation, reintubation, hyperlactatemia, low cardiac output syndrome, and renal failure (P<0.05). After multivariable logistic regression with stepwise selection, five independent risk factors were identified: IABP use (OR=3.391, 95%CI 1.065–11.044, P=0.038), reintubation (OR=15.991, 95%CI 4.269–67.394, P<0.001), hyperlactatemia (OR=8.171, 95%CI 2.057–46.089, P=0.007), Cr (OR=4.330, 95%CI 0.997–6.022, P=0.024), and BNP (OR=1.603, 95%CI 1.000–2.000, P=0.010). Accordingly, a nomogram predicting mortality risk was constructed. The ROC and calibration analyses indicated good predictive value: training set AUC was 0.898 (95%CI 0.831–0.966); validation set AUC 0.912 (95%CI 0.805–1.000). Calibration and decision-curve analyses showed good agreement and clinical utility. Conclusion The nomogram incorporating IABP use, reintubation, hyperlactatemia, creatinine, and BNP provides good predictive value for 30-day mortality after CABG in elderly patients with HFrEF and demonstrates potential clinical utility.
In recent years, the potential benefits of acetazolamide in managing fluid overload in acute decompensated heart failure (ADHF) have attracted the attention of researchers. This article reviews the pharmacological mechanism of acetazolamide, how it improves patient symptoms and clinical prognosis in the treatment of heart failure, and the research progress in clinical application. The aim is to provide theoretical and research basis for clinicians to adjust and choose the comprehensive application plan of diuretics for ADHF, and to provide new ideas and directions for further research and development of new drugs targeting diuretic resistance in ADHF patients.
ObjectiveTo explore the role of nutritional support in adjuvant therapy for respiratory failure. MethodsWe took 72 patients with respiratory failure who were treated in our hospital from August 2011 to January 2013 as the research objects. They were divided into two groups:control group and trial group, with 36 patients in each group. The division of the groups was in accordance with the state food and drug administration clinical trial institution ethics committee standard operating procedures. In the control group, 36 patients were provided with regular treatments according to their condition, like maintaining the respiratory tract unobstructed, oxygen therapy, mechanical ventilation and anti-infection. In the trial group, we offered nutritional support in addition to the normal treatment. Consecutive 20 days was a course of treatment. After four courses, we inspected and put down two groups' respective clinical features, and made a contrast of their treatment conditions. We analyzed the treatments through observational indexes including assessment of eutrophication, treatment efficiency, pulmonary function and arterial blood gases. ResultsBoth groups had obvious therapeutic effects. The observational indexes in the trial group were better than those in the control group. The total effective rate was 91.7% in the trail group after treatment, significantly higher than that in the control group (66.7%) (χ2=8.692, P=0.003); the lung capacity, the ventilation flow ratio and arterial blood gas analysis values in the trial group was better than those in the control group. ConclusionThe effect of the nutritional support for the respiratory failure treatment is much better than the regular treatment. The total effective rate is improved while the death rate is lower than before and the patients recover quickly.
摘要:目的:观察伴有抑郁症状的心力衰竭患者加用黛力新干预的疗效。方法: 65例用Zung抑郁自评量表检测评测诊断为抑郁症并心力衰竭患者,将患者分为黛力新治疗组及对照组,治疗组在常规治疗基础上加用黛力新(2片/d),治疗1个月后再行Zung抑郁自评量表粗分及24项症状统计,同时观察治疗前后患者心功能改善情况。结果: 35例治疗组患者心功能的改善及Zung抑郁自评量表检测粗分及24项症状改善明显优于对照组。〖HTH〗结论〖HTSS〗: 黛力新使心衰患者的抑郁症状很快得到改善,并提高了心力衰竭的疗效。Abstract: Objective: To observe the curative efficacy of deanxit to the patients suffering by heart failure with depression. Methods: Sixtyfive patients who were diagnosed as depression by Zung Selfrating Depression Scale are into deanxit treatment group and control group,and treatment group receive the treatment with two pieces of deanxit everyday besides the conventional therapy.After a month,we count the Zung selfrating depression scale score and study the24 symptoms,at the same time,we observed the change of cardiac function in the patients. Results:The curative efficacy in the treatment group is better than those in the control group with improvement in cardiac function and Zung selfrating depression scale score and the alleviation for 24 symptoms. Conclusion:Deanxit can alleviate symptoms of depression in patients with heart failure soon and increase the efficacy of heart failure.
ObjectiveTo systematically review the efficacy of MitraClip therapy in heart failure patients with mitral insufficiency. MethodsDatabases including PubMed, The Cochrane Library (Issue 11, 2014), EMbase, CBM, CNKI, VIP and WanFang Data were searched from October 2005 to October 2015 to collect before-after controlled studies about the efficacy of MitraClip therapy in heart failure patients with mitral insufficiency. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 9 studies involving 782 patients were included. The results of meta-analysis showed that, compared with their conditions before treatment, patients after the MitraClip implantation had a declined NYHA class Ⅲ-Ⅳ ratio (RD=0.72, 95%CI 0.60 to 0.85, P<0.000 01), increased left ventricular ejection fraction (LVEF) (MD=-2.97，95%CI -5.06 to -0.89，P<0.005) and improved performance in 6 min walk-test (6-MWT) (MD=-88.73, 95%CI -157.16 to -20.31, P=0.01). ConclusionMitraClip therapy can, to a certain extent, improve the cardiac function of patients with heart failure and mitral insufficiency. However, further studies are needed to confirm its effects on improving the long-term survival of patients.
Objective To explore the prognostic value of early lactate clearance rate in patients with respiratory failure.Methods 117 patients with respiratory failure and elevated blood lactate, admitted into respiratory intensive care unit( RICU) between January 2010 and December 2011, were retrospectively analyzed. Arterial lactate and arterial blood gas were measured before and 12h, 24h, 48h, and 72h after treatment. Then12h lactate clearance rate was calculated. The acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) score was evaluated before and after 12h treatment. The mortality were compared between subgroups with different lactate normalization time( lt;24 h, 24 ～48 h, 48 ～72 h, and gt;72h, respectively) . The clinical data was compared between subgroups with different prognosis ( survival or non-survival ) and between subgroups with different lactate clearance rate( ≥10% as high lactate clearance rate, lt;10% as low lactate clearance rate) . Results The mortality of the patients with lactate normalization time in less 24 hours was significantly lower than that of the patients with lactate normalization time more than 72 hours ( 5. 3% vs. 89. 2% , P lt; 0. 001) . The 12 hour lactate clearance rate of the survival group was significantly higher than that of the non-survival group [ ( 43. 6 ±26. 8) % vs. ( 12. 3 ±39. 1) % , P lt;0. 01] . The mortality of the patients with high lactate clearance rate was significantly lower than that of the patients with lowlactate clearance rate( 25. 8% vs. 71. 4% , P lt;0. 01) . Conclusion Early lactate clearance rate can be used as a marker for prognosis of patients with respiratory failure.