Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 6 de 6
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
Infect Drug Resist ; 12: 815-824, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31114263

RESUMO

Background: Procalcitonin (PCT), an important biomarker, can be used for the guidance of antibiotic therapy in respiratory infection. However, it has been a problem that some patients might need antibiotic therapy restart because of infection recurrence after antibiotic discontinuation. To date, there are very few literature on the study of risk factors accounting for infection recurrence. Purpose of this clinical study: 1) To study on antibiotic discontinuation in ventilator-associated pneumonia (VAP) under the guidance of PCT; 2) To evaluate the possible risk factors leading to infection recurrence and antibiotic reuse. Methods: Antibiotic discontinuation was performed when patients met the following criteria: (i) serum PCT<0.5 µg/L, (ii) temperature<38.5℃ and (iii) leukocyte count<15×109/L. Next, the patients were divided into infection recurrence group (infection recurring within 7 days after antibiotic discontinuation) or infection controlled group (no infection recurring after antibiotic discontinuation). Possible risk factors accounting for infection recurrence were evaluated using logistic regression analysis. Results: Of the eligible 51 patients with VAP, 20 patients suffered infection recurrence. Clinical pulmonary infection score (CPIS) and characteristics of tracheal secretions were the independent risk factors (P=0.045 and P=0.041, respectively), accounting for infection recurrence. Simplified CPIS≥5 served a certain predictive value for infection recurrence in VAP when physicians considered antibiotic discontinuation (The area under the receiver operating characteristic curve 0.781, specificity 90.3%, sensitivity 55.0%, positive predictive value 78.6% and negative predictive value 75.7%). At the time of antibiotic discontinuation, differences between the two groups were not statistically significant in the proportion of patients with a tracheotomy and in the culture results of endotracheal aspirates (including semi-quantitative results and whether pathogens were multidrug-resistant [MDR] strains). Conclusion: Simplified CPIS and characteristics of tracheal secretions can be used to predict infection recurrence following PCT-guided antibiotic discontinuation in VAP. These findings are important because physicians may not need to put too much care on semi-quantitative culture results of endotracheal aspirates and whether pathogens are MDRstrains. Trial registration: The registration number of this clinical trial is: ChiCTR-OPC-17011228 (Trial registry name: Chinese Clinical Trial Registry; URL: http://www.chictr.org.cn).

2.
Heart Surg Forum ; 21(1): E054-E058, 2018 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-29485966

RESUMO

BACKGROUND: There are no previous studies dealing with paroxysmal atrial fibrillation (AF) and hypertension using electrocardiogram and tissue doppler imaging (TDI). The aim of this study was to investigate and identify the predictive indicators for paroxysmal AF in hypertensive patients using P wave dispersion (Pd) and TDI. METHODS: Patients with hypertension were enrolled. Patients with paroxysmal AF were classified as the PAF group, and patients without a history of paroxysmal AF were classified as the NAF group. The clinical data, P wave indicators and TDI indicators were collected and compared between the two groups. RESULTS: A total of 120 patients were enrolled into the study with 40 cases in the PAF group and 80 cases in the NAF group. Compared with NAF group, Pd, maximum P wave duration (Pmax), left ventricular end-diastolic dimension (LVEDd) and left atrial dimension (LAD) were significantly longer (P < .05) in the PAF group. PAL, PAI, PAR, LR, LI and IR were significantly longer (P < .05) in the PAF group than in the NAF group. As for ROC analysis, Pd and PAL had the greatest area under the curve. The best diagnostic value of Pd and PAL was 40ms and 78ms, respectively. The combination of Pd ≥40ms with Pmax ≥ 110ms showed higher specificity and positive predictive value but decreased sensitivity and negative predictive value for paroxysmal AF. CONCLUSIONS: The PAF group had significantly longer atrial electromechanical time and higher Pd compared with NAF group. The combination of Pd and TDI may be helpful to predict the onset of paroxysmal AF in patients with hypertension.


Assuntos
Fibrilação Atrial/diagnóstico , Ecocardiografia Doppler/métodos , Eletrocardiografia , Átrios do Coração/diagnóstico por imagem , Hipertensão/complicações , Taquicardia Paroxística/diagnóstico , Idoso , Fibrilação Atrial/etiologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Valor Preditivo dos Testes , Curva ROC , Taquicardia Paroxística/etiologia
3.
Med Sci Monit ; 22: 2670-8, 2016 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-27466863

RESUMO

BACKGROUND While mild and moderate sedation have been widely used to reduce sudden agitation in intracerebral hemorrhage (ICH) patients after surgery, agitation is still a frequent problem, which may cause postoperative blood pressure fluctuation. The present study aimed to evaluate the efficacy and safety of short-course deep sedation for the treatment of ICH after surgery. MATERIAL AND METHODS A total of 41 ICH patients who received surgery, including traditional craniotomy hematoma removal and decompressive craniectomy, were including in this non-randomized control study. Patients in the deep sedation group received continuous postoperative sedation with a target course for ≤12 hours and reached SAS scores of 1~2. Patients in the traditional sedition group received continuous light sedation and reached SAS scores of 3~4. Additional therapeutic interventions included antihypertensive treatment, mechanical ventilation, tracheotomy, and re-operation. RESULTS Patients in the deep sedation group had deeper sedation degree, and lower systolic blood pressure (SBP) and diastolic blood pressure (DBP). Residual hematoma after surgery in patients in the deep sedation group were smaller on the second, seventh, and fourteenth day after surgery (p=0.023, 0.003, 0.004, respectively). The 3-month mortality and quality of life of patients in the deep sedation group were lower and better than that of patients in the traditional sedation group, respectively (p=0.044, p<0.01). No significant difference in the incidence of ventilator-associated pneumonia (VAP) and ICU days were observed between the two groups. CONCLUSIONS Short-course deep sedation therapy in ICH patients after surgery is efficient in controlling postoperative blood pressure, reducing re-bleeding, and improving clinical prognosis.


Assuntos
Hemorragia Cerebral/terapia , Sedação Profunda/métodos , Adulto , Pressão Sanguínea/fisiologia , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/cirurgia , Craniotomia/efeitos adversos , Craniotomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Estudos Prospectivos , Qualidade de Vida , Respiração Artificial/métodos , Resultado do Tratamento
4.
PLoS One ; 9(7): e101447, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25000225

RESUMO

Antibiotic abuse can lead to antibiotic resistance, which is a severe problem in China. The purpose of this study is to evaluate the short-term effects of antimicrobial stewardship strategies, including formulary restriction, preauthorization, perioperative quinolone restriction, and control of total antibiotic consumption in the ICU at a tertiary hospital in China. After implementation of antimicrobial stewardship, the total antibiotic consumption in the ICU significantly decreased. The defined daily doses (DDDs) per 100 patient-days decreased from 197.65 to 143.41; however, the consumption of cephalosporins increased from 53.65 to 63.17 DDDs. Significant improvements in resistance to amikacin, gentamicin, ciprofloxacin, ofloxacin, ceftriaxone, ceftazidime, and piperacillin in Enterobacteriaceae and resistance to ceftazidime, imipenem, and meropenem in non-fermenting Gram-negative rods were observed. In addition, the initial use of no antibiotics or of a single antibiotic significantly increased (P<0.001) and the use of two antibiotics in combination significantly decreased (P<0.001). Our results demonstrate that implementation of antimicrobial stewardship in a short period in the ICU dramatically reduced antibiotic consumption and significantly improved antibiotic resistance, which leads to more reasonable antibiotic selections by ICU physicians.


Assuntos
Antibacterianos/uso terapêutico , Prescrição Inadequada/prevenção & controle , Prescrição Inadequada/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Centros de Atenção Terciária/estatística & dados numéricos , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
5.
Acta Cir Bras ; 27(10): 727-31, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23033135

RESUMO

PURPOSE: To compare curative effect of different treatments for hypertensive cerebral hemorrhage of 25 to 35 ml. METHODS: In this study, 595 cases were enrolled and grouped regarding treatments including conservative treatment, evacuation with microinvasive craniopuncture technique within 6h and 6-48 h after the attack. RESULTS: After follow up for three months after the attack, the assessment based on the Activity of Daily Living (ADL) indicated no significant difference among conservative treatment and surgical interventions (p>0.05). However, surgical interventions showed advantages of shorter hospitalization, quick removal of hematoma and obvious reduction of cost. CONCLUSION: The microinvasive craniopuncture technique to drain the hematoma within 6-48 h may be a good way in treating hypertensive hemorrhage of basal ganglia region.


Assuntos
Hemorragia dos Gânglios da Base/terapia , Gânglios da Base/cirurgia , Hemorragia Intracraniana Hipertensiva/terapia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Gânglios da Base/patologia , Hemorragia dos Gânglios da Base/patologia , Distribuição de Qui-Quadrado , Feminino , Hematoma/cirurgia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Punções/métodos , Fatores de Tempo , Resultado do Tratamento
6.
Acta cir. bras ; 27(10): 727-731, Oct. 2012. tab
Artigo em Inglês | LILACS | ID: lil-650563

RESUMO

PURPOSE: To compare curative effect of different treatments for hypertensive cerebral hemorrhage of 25 to 35ml. METHODS: In this study, 595 cases were enrolled and grouped regarding treatments including conservative treatment, evacuation with microinvasive craniopuncture technique within 6h and 6-48h after the attack. RESULTS: After follow up for three months after the attack, the assessment based on the Activity of Daily Living (ADL) indicated no significant difference among conservative treatment and surgical interventions (p>0.05). However, surgical interventions showed advantages of shorter hospitalization, quick removal of hematoma and obvious reduction of cost. CONCLUSION: The microinvasive craniopuncture technique to drain the hematoma within 6-48h may be a good way in treating hypertensive hemorrhage of basal ganglia region.


OBJETIVO: Comparar o efeito curativo de diferentes tratamentos da hemorragia hipertensiva cerebral de 25 a 35ml. MÉTODOS: Foram analisados 595 casos agrupados segundo tratamento conservador e evacuação com técnica de punção transcraniana dentro de 6h ou de 6 às 48h do início do quadro clínico. RESULTADOS: O seguimento após três meses e avaliado pelo Escore de Atividade de Vida Diário, indicou que não houve diferenças significantes entre os tratamentos conservador e cirúrgico (p>0.05) O tratamento cirúrgico mostrou vantagem com hospitalização mais curta e redução de custos. CONCLUSÃO: A técnica de punção transcraniana para drenagem de hematoma dos núcleos da base pode ser uma boa alternativa de tratamento.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia dos Gânglios da Base/terapia , Gânglios da Base/cirurgia , Hemorragia Intracraniana Hipertensiva/terapia , Procedimentos Neurocirúrgicos/métodos , Hemorragia dos Gânglios da Base/patologia , Gânglios da Base/patologia , Distribuição de Qui-Quadrado , Hematoma/cirurgia , Tempo de Internação , Punções/métodos , Fatores de Tempo , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA