目的:探讨影响孕产妇入住重症监护室(intensive care unit,ICU)超过48 h的危险因素并寻找预测指标。方法:纳入重庆医科大学附属妇女儿童医院2023年1月至12月ICU中收治的危重孕妇或产后42 d内产妇,共纳入146例。根据孕产妇在ICU住院时间...
详细信息
目的:探讨影响孕产妇入住重症监护室(intensive care unit,ICU)超过48 h的危险因素并寻找预测指标。方法:纳入重庆医科大学附属妇女儿童医院2023年1月至12月ICU中收治的危重孕妇或产后42 d内产妇,共纳入146例。根据孕产妇在ICU住院时间将其分为≤48 h的短期组(n=60),>48 h的长期组(n=86)。记录并分析孕产妇一般资料、妊娠特征、ICU治疗手段、生命体征及实验室检查等资料。运用受试者工作特征(receiver operating characteristic,ROC)曲线分析上述指标对孕产妇入住ICU超过48 h的预测价值。结果:与短期组比较,长期组进行机械通气(P=0.001)、放射影像学检查(P=0.022)、降压(P=0.001)、利尿(P=0.001)、抗生素(P=0.006)等药物治疗,以及接受超过5 U输血(P=0.032)等治疗的比例明显升高。长期组孕产妇的孕检次数(P=0.003)明显少于短期组,入住ICU时体质指数(body mass index,BMI)值(P=0.012)明显高于短期组。长期组中合并妊娠期高血压疾病的孕产妇更多(P=0.016)。此外,长期组孕产妇血压水平明显高于短期组(P=0.001),白蛋白、谷丙转氨酶、直接胆红素、24 h尿蛋白与血清肌酐水平与短期组比较,差异有统计学意义(P<0.05)。ROC分析发现无论是收缩压[曲线下面积(area under the curve,AUC)=0.825]、舒张压(AUC=0.782),还是平均动脉压(AUC=0.811)对预测孕产妇ICU住院时间>48 h的评估价值均较高。孕检次数与妊娠期高血压疾病的孕产妇ICU住院时间进一步延长(P<0.05)。结论:妊娠期高血压疾病是延长孕产妇ICU住院时间的重要危险因素,可为孕产妇的重症监护与管理提供一定思路。
神经重症患者常面临急性脑损伤、颅内压升高及脑血流障碍等复杂病理生理问题,这些问题需要精准的监测手段以支持诊断和干预。传统神经监测方法以临床检查为主,但发现的变化往往是晚期体征,不足以发现和预防继发性脑损伤。近年来,多模态脑监测(MMM)技术的发展为神经重症监测提供了新的可能。MMM涵盖脑组织氧监测、脑血流监测、颅内压监测、脑电监测及脑代谢监测等多种手段,从多维度动态评估脑功能和病理状态。本文详细探讨了上述监测方法的原理、技术特点、临床应用及其在神经重症管理中的优势与局限性。没有一种单一的监测手段是适合所有患者,MMM是当前的趋势。随着该技术的进一步推广和应用,可为神经重症患者提供更为及时和个性化的治疗。Patients with severe neurological diseases in the neuroscience intensive care unit often face complex pathophysiological problems such as acute brain injury, increased intracranial pressure, and cerebral blood flow obstruction, which require precise monitoring techniques to support diagnosis and intervention. Traditional neurological monitoring methods are mainly based on clinical examination, but changes found during the examination are often late signs and insufficient to detect and prevent secondary brain injury. In recent years, the development of multimodal brain monitoring (MMM) technology has provided new possibilities for neurocritical care monitoring. MMM covers oxygen monitoring of brain tissue, cerebral blood flow monitoring, intracranial pressure monitoring, electroencephalography (EEG) monitoring, and cerebral metabolism monitoring, which evaluate brain function and pathological states from multiple dimensions and in a dynamic manner. This article discusses the principles, technical features, clinical applications, and advantages and limitations of the monitoring methods in detail. No single monitoring method is suitable for all patients, and MMM is the current trend. With the further promotion and application of this technology, it can provide more timely and personalized treatment for neurosurgical intensive care patients.
肺腺癌(LUAD)是非小细胞肺癌(NSCLC)的主要类型,其病理分级对于评估肿瘤侵袭性和预后至关重要。不同病理级别的LUAD在基因表达、TP53基因突变、转录因子FOSB、循环肿瘤细胞(CTC)以及外周血炎症因子等生物标志物表达上存在显著差异,可预测病理分级。因此,确定可靠的病理分级预测的生物标志物对治疗方案的选择至关重要。本文围绕LUAD病理分级预测相关的生物标志物进行综述,以期制定个体化治疗方案、改善预后。Lung adenocarcinoma (LUAD) is the predominant type of non-small cell lung cancer (NSCLC), and its pathological grading is crucial for assessing tumor aggressiveness and prognosis. LUADs of different pathological grades exhibit significant differences in the expression of biomarkers such as gene expression, TP53 gene mutations, transcription factor FOSB, circulating tumor cells (CTC), and peripheral blood inflammatory factors, which can predict pathological grading. Therefore, identifying reliable biomarkers for predicting pathological grading is essential for selecting appropriate treatment regimens. This review focuses on biomarkers related to LUAD pathological grading prediction, aiming to facilitate the development of individualized treatment plans and improve prognosis.
暂无评论