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Objective To investigate the characteristics of cognitive impairment in critical patients, and to explore the role of early cognitive intervention training in improving cognitive impairment in critical patients. Methods A prospective cohort study was conducted. 133 patients in conscious and normal intelligence admitted to intensive care unit (ICU) of Hefei Second People's Hospital from January 2015 to June 2018 were enrolled. The patients were divided into control group (n = 66) and cognitive intervention group (n = 67) according to random number table based on chronological number for entry into the study. Cognitive function was assessed by Montreal cognitive assessment scale (MoCA scale) within 24 hours after ICU admission. The patients in the cognitive intervention group received a series of scientifically designed cognitive training sessions (playing electronic musical keyboard, learning simple Spanish, clock-drawing, psychological intervention) for 2 months, and follow-up was completed if the patient was discharged from ICU. While the patients in the control group did not undertake any cognitive training. After 2 months, the cognitive function of patients in both groups were assessed with MoCA scale. Subgroup analysis was conducted according to different age groups (20-40 years old, 41-60 years old, 61-80 years old) to explore the effect of cognitive intervention training in different age groups. According to the subjective evaluation of the patient's ability to live 2 months after cognitive intervention by the patient or his relatives, receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of the total score of MoCA for patients' ability to live after cognitive intervention. Results 133 critical patients were enrolled in the final analysis. There was no significant difference in gender, age, education, complications, ICU hospitalization, sedative or analgesic drug usage between the two groups, indicating that the data of the two groups were balanced and comparable. No significant difference in MoCA scale total score or sub-item cognitive domain score within 24 hours of ICU admission was found between the two groups. After 2 months of intervention, the incidence of cognitive impairment in the cognitive intervention group was significantly lower than that in the control group [38.8% (26/67) vs. 60.6% (40/66), χ2 = 6.321, P = 0.015]. The total score of MoCA scale and four sub-item cognitive domain scores including visual space and execution power, protection of memory, attention execution, and orientation in the cognitive intervention group were significant higher than those in the control group (MoCA scale total score: 26.73±1.92 vs. 24.95±2.26, visual space and executive power score: 4.39±0.70 vs. 3.95±0.88, protection of memory score: 8.91±1.03 vs. 8.24±1.37, attention execution score: 5.21±0.77 vs. 4.79±1.00, orientation score: 5.67±0.53 vs. 5.44±0.68, all P < 0.05), but no significant difference was found in verbal skills score (2.55±0.56 vs. 2.53±0.56, P > 0.05). Subgroup analysis showed that the total MoCA scale score of the younger sample (20-40 years old, n = 20) was recovered by 2.10±1.55 in the cognitive intervention group after 2 months of cognitive intervention, which was significantly higher than that in the control group (n = 21; 0.24±2.76, P < 0.05). In the middle-aged and the older population [aged 41-60 years old (n = 20) and 61-80 years old (n = 27)], the total MoCA scale scores were recovered slightly after cognitive intervention as compared with those in the younger sample (0.43±1.47, -1.91±2.20 vs. 2.10±1.55, both P < 0.05), which were significantly lower than those in the control group [aged 41-60 years old (n = 21) and 61-80 years old (n = 24), -0.78±1.38, -4.41±2.17,both P < 0.01]. It was suggested that cognitive intervention training played an active role in the recovery of cognitive function in young critical patients. It was shown by ROC curve analysis that the area under ROC curve (AUC) of MoCA scale total score for predicting daily life ability after cognitive intervention was 0.732 with 95% confidence interval (95%CI) of 0.646-0.819. When the best cut-off value was 24.5, the sensitivity was 89.3%, the specificity was 60.2%, the positive predictive value was 85.7%, and the negative predictive value was 80.8%. Conclusions Early cognitive intervention could efficiently abate the deterioration of cognitive function in critical patients in ICU and had significant effects on the visual space and executive power, protection of memory, attention execution and orientation. Cognitive intervention exerted significantly positive effects on the recovery of cognitive function in the younger sample population (aged 20-40 years old).
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Objective To investigate the effect of real-time continuous monitoring system(RT-CGMS)on serum inflammatory factors and prognosis in patients with sepsis.Methods According to the prospective studies,patients were randomly divided into two groups Patients with sepsis were randomly divided into real-time continuous monitoring of blood glucose group and monitoring blood glucose meter group,of which the fasting serum tumor necrosis factor alpha(TNF-α) and interleukin-6(IL-6) and high sensitive C reactive protein (hs-CRP) were detected on the 1st,3rd,7th day.Meanwhile,insulin dosage,incidence of hypoglycemia and mortality rate of 28 days of patients in two groups were recorded,and the above indexes were analyzed.Results TNF-α,IL-6 and hs-CRP in the real-time continuous blood glucose monitoring group were (16.12±2.42)pg/ml、(112.37±17.39)pg/ml and(19.62±2.72)mg/L on the 7th day respectively,while TNF-α,IL-6 and hs-CRP in the blood glucose monitoring group were(23.46±3.12)pg/ml、(140.19±21.48)pg/ml and(25.42±2.54)mg/L on the 7th day,respectively.The decrease of TNF-α,IL-6 and hs-CRP in the continuous blood glucose monitoring group was more significant than that in the blood glucose monitoring group (P＜0.05).Insulin dosage in real-time continuous blood glucose monitoring group was (90.62±15.79)u,hypoglycemia rate was 5.4％,fatality rate was 10.81％ in 28 days of hospitalization,insulin dosage was (130.59±20.65)u,hypoglycemia rate was 22.85％,and fatality rate was 31.42％ in 28 days of hospitalization.There was significant difference between the two groups(P＜0.05).Conclusion For sepsis patients with stress hyperglycemia,a real-time continuous monitoring system combined with insulin therapy can improve the inflammatory response,and control blood glucose effectively as well as reduce mortality.
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Objective To investigate the risk factors for multiple organ dysfunction syndrome (MODS) in patients with type 2 diabetes mellitus (T2DM) complicated with infection.Methods The clinical data of 115 patients with T2DM complicated with infection in our hospital from Jan.2016 to Jan.2018 were retrospectively reviewed,including 60 patients with MODS(study group) and 55 patients without MODS(the control group).The related risk factors were analyzed by single factor and multi-factor logistic regression analysis.Results Single factor analysis showed that HbAlc[(5.47±0.86) vs (8.67±1.34)],hs-CRP[(8.31±2.18) vs (19.03±2.13)],PCT [(4.59±1.46) vs (13.42±2.67)],lac[(3.69±0.99) vs (6.58±1.18)],APACHE Ⅱ [(14.94±1.83) vs (24.98±3.19)],MBG[(9.81±0.62) vs (8.72±0.44)],SDBG[(3.43±0.20) vs (2.65±0.22)],MACE [(4.31±0.36) vs (2.93±0.19)],LAGE[(10.55±0.89) vs (6.49±0.19)],and MODD [(3.28±0.34) vs (2.05±0.25)] had statistical difference between the control group and the study group (P＜0.05).There was no significantly difference of blood glucose between the study group and the control group.Multi-factor logistic regression analysis showed that HbAlc,CRP,PCT,lac,APACHE Ⅱ],SDBG,LAGE,course of the disease were the main risk factors for MODS in patients with T2DM complicated with infection (P＜0.05).Conclusion HbAlc,CRP,PCT,lac,APACHE Ⅱ,SDBG,LAGE,and course of the disease were the main risk factors for MODS in patients with T2DM complicated with infection.
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One hundred patients with chronic renal failure(CRF) undergoing contrast diagnosis and/or interventional therapy were randomly divided into two groups: patients in hydration alone group( n = 49 )received intravenous infusion of 0.9% sodium chloride 12 h before injection of contrast media till 12 h after examination (hydration), patients in atorvastatin plus hydration group (n = 51 ) received atorvastatin 80mg/d 24 h before examintion for 3 d in addition to hydration.The serum creatinine concentrations were measured before and 48 h after injection of contrast media.In atorvastatin plus hydration group, the incidence rate of contrast-induced nephropathy (CIN) was 8% (4/51), which was significantly lower than that of hydration group (24%,12/49 )(P＜0.05).Short-term and large dose administration of atorvastatin plus hydration can decrease the incidence of CIN in patients with chronic renal failure undergoing contrast diagnosis and/or interventional thrapy.