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Cerebral autoregulation-directed optimal blood pressure management reduced the risk of delirium in patients with septic shock

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Journal of Intensive Medicine 2024年第3期4卷 376-383页

作者： qianyi peng Xia Liu Meilin Ai Li Huang Li Li Wei Liu Chunguang Zhao Chenghuan Hu Lina Zhang Department of Critical Care Medicine Xiangya HospitalCentral South UniversityChangshaHunanChina Hunan Provincial Clinical Research Center for Critical Care Medicine Xiangya HospitalCentral South UniversityChangshaHunanChina National Clinical Research Center for Geriatric Disorders Xiangya HospitalCentral South UniversityChangshaHunanChina

Background When resuscitating patients with septic shock,cerebrovascular reactivity parameters are calculated by monitoring regional cerebral oxygen saturation(rSO_(2))using near-infrared spectroscopy to determine the optimal blood ***,we aimed to analyze the impact of cerebral autoregulation-directed optimal blood pressure management on the incidence of delirium and the prognosis of patients with septic *** This prospective randomized controlled clinical study was conducted in the Xiangya Hospital of Central South University,***-one patients with septic shock(December 2020–May 2022)were enrolled and randomly allocated to the experimental(n=26)or control group(n=25).Using the ICM+software,we monitored the dynamic changes in rSO_(2) and mean arterial pressure(MAP)and calculated the cerebrovascular reactivity parameter tissue oxygen reactivity index to determine the optimal blood pressure to maintain normal cerebral autoregulation function during resuscitation in the experimental *** control group was treated according to the Surviving Sepsis Campaign *** in the incidence of delirium and 28-day mortality between the two groups were compared,and the risk factors were *** The 51 patients,including 39 male and 12 female,had a mean age of(57.0±14.9)*** incidence of delirium was 40.1%(23/51),and the 28-day mortality rate was 29.4%(15/51).The mean MAP during the first 24 h of intensive care unit(ICU)admission was higher([84.5±12.2]mmHg vs.[77.4±11.8]mmHg,P=0.040),and the incidence of delirium was lower(30.8%vs.60.0%,P=0.036)in the experimental group than in the control *** use of cerebral autoregulation-directed optimal blood pressure(odds ratio[OR]=0.090,95%confidence interval[CI]:0.009 to 0.923,P=0.043)and length of ICU stay(OR=1.473,95%CI:1.093 to 1.985,P=0.011)were risk factors for delirium during septic *** drug dose(OR=8.445,95%CI:1.26 to 56.576,P=0.028)and partial pressure of o

关键词： Septic shock Cerebral regional oxygen saturation Optimal blood pressure Delirium Mortality

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Erratum to “Relationship between PaO_(2)/FiO_(2) and delirium in intensive care:A cross-sectional study”[Journal of Intensive Medicine volume 3(2023)73–78.]

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Journal of Intensive Medicine 2024年第1期4卷 136-136页

作者： Fang Gong Yuhang Ai Lina Zhang qianyi peng Quan Zhou Chunmei Gui Department of Intensive Care Unit The First People’s Hospital of ChangdeChangdeHunan 415000China Department of Intensive Care Unit Xiangya HospitalCentral South UniversityChangshaHunan 410008China

The publisher regrets<“Relationship between PaO_(2)/FiO_(2) and delirium in intensive care:A cross-sectional study,”[1]published on pages 73-78,Issue 1,Volume 3 in Journal of Intensive Medicine(https://***/science/article/pii/S2667100x22000901)contains a mistake in Abstract and *** sentence in the Methods of Abstract and Statistical analysis“slightly low(200≥PaO_(2)/FiO_(2)<300 mmHg)”should be“slightly low(200≤PaO_(2)/FiO_(2)<300 mmHg)”.

关键词： slightly sectional Medicine

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Relationship between PaO_(2)/FiO_(2) and delirium in intensive care:A cross-sectional study

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Journal of Intensive Medicine 2023年第1期3卷 73-78页

作者： Fang Gong Yuhang Ai Lina Zhang qianyi peng Quan Zhou Chunmei Gui Department of Intensive Care Unit The First People's Hospital of ChangdeChangdeHunan 415000China Department of Intensive Care Unit Xiangya HospitalCentral South UniversityChangshaHunan 410008China

Background::To investigate the relationship between partial pressure of oxygen(PaO_(2))/fraction of inspired oxygen(FiO_(2))and the probability of delirium in intensive care units(ICUs).Methods::The investigation was a cross-sectional study that involved the collection of data from patients admitted to the Xiang Ya Hospital Cardiothoracic Surgical Care Unit and Comprehensive Intensive Care Unit from 01 September 2016 to 10 December *** was diagnosed using the simplified version of the Chinese Confusion Assessment Method(CAM)for the *** and medical data were obtained within 24 h of each patient admitted in the *** PaO_(2)/FiO_(2) of each patient was recorded 24 h after admission in the *** patients were divided into three groups according to PaO_(2)/FiO_(2) data:normal(PaO_(2)/FiO_(2)≥300 mmHg),slightly low(200≥PaO_(2)/FiO_(2)<300 mmHg),and severely low(PaO_(2)/FiO_(2)<200 mmHg).Baseline characteristics were compared in the three *** of the unadjusted model,minimally adjusted model,and fully adjusted model are ***::A total of 403 participants were included in the study,of which 184(45.7%)developed ***(P<0.001),Sequential Organ Failure Assessment(SOFA)score(P<0.001),Acute Physiology and Chronic Health Evaluation(APACHE)II score(P<0.001),mechanical ventilation time(P<0.001),history of hypertension(P=0.040),heart disease(P=0.040),sedation(P=0.001),and PaO_(2)/FiO_(2)(P=0.006)were significantly associated with delirium in univariate *** regression analysis models were used to further analyze the associations between PaO_(2)/FiO_(2) and *** the crude model,for 1 standard deviation(SD)increase in PaO_(2)/FiO_(2),the odds ratio(OR)of delirium was 0.8(95%confidence interval[CI]:0.6-0.9),but there was no significant correlation in the fully adjusted *** was a non-linear relationship between the PaO_(2)/FiO_(2) and delirium in a generalized additive model.A two-piecewise linear re

关键词： Delirium Intensive care unit Partial pressure of oxygen(PaO_(2))/Fraction of inspired oxygen(FiO_(2)) Hypoxia Risk factor Non-linear relationship

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Epidemiology of acute kidney injury in intensive care septic patients based on the KDIGO guidelines

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Chinese Medical Journal 2014年第10期127卷 1820-1826页

作者： peng qianyi Zhang Lina Ai Yuhang Zhang Lemeng Department of Critical Care Medicine Xiangya Hospital Central South University Changsha Hunan 410008 China

Background Acute kidney injury （AKI） is a common complication of sepsis,which is associated with higher risks of adverse ***,kidney disease：improving global outcomes （KDIGO） recommended a new guideline forAKI,including a little modification on the AKI staging *** This retrospective study included 211 septic patients admitted to the intensive care unit （ICU） at Xiangya Hospital,Central South University from January 2008 to January *** was diagnosed and classified according to the KDIGO or acute kidney injury network （AKIN） *** between the AKI and non-AKI groups for baseline characteristics,laboratory examinations,etiology,outcomes,as well as the risk factors for AKI and 28-day mortality were *** reliability of the KDIGO criteria was also evaluated by comparing it with the AKIN *** The overall incidence of AKI in septic patients was 47.9％,and the 28-day mortality was 32.7％.The incidence of AKI was significantly higher in patients with more severe *** of hepatic and respiratory function were significantly worse in the AKI ***,a higher proportion of patients were infected with Enterobacter cloacae in the AKI *** independent risk factors for AKI were shock,the number of organ failures,blood urea nitrogen （BUN）levels,and the use of *** independent risk factors for mortality were BUN and creatine kinase-MB （CK-MB）*** the KDIGO criteria and the AKIN criteria were significantly associated with 28-day *** The incidence and 28-day mortality of AKI were very high in ICU septic *** attention should be paid to AKI-induced hepatic and respiratory dysfunction in clinical *** with an intra-abdominal source of infection were more likely to develop *** criteria are reliable in AKI staging.

关键词： acute kidney injury sepsis epidemiology risk factors KDIGO

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战略性人力资源管理在建筑企业的应用研究

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建筑经济 2023年第S1期44卷 419-422页

作者：彭谦益成都市建筑设计研究院有限公司四川成都610095

近年来,建筑企业市场竞争日趋激烈,行业生存压力较大,各企业为了进一步提升管理效能、提高发展质量,纷纷尝试在企业管理上进行革新。本文重点研究当前建筑企业管理革新的主流趋势——战略性人力资源管理,从建筑企业进行战略性人力资源... 详细信息

近年来,建筑企业市场竞争日趋激烈,行业生存压力较大,各企业为了进一步提升管理效能、提高发展质量,纷纷尝试在企业管理上进行革新。本文重点研究当前建筑企业管理革新的主流趋势——战略性人力资源管理,从建筑企业进行战略性人力资源管理转型的必要性入手,分析战略性人力资源管理如何作用于传统的人力资源六大板块,同时建筑企业在转型中普遍存在的困难和阻力,并基于此提出相应对策。

关键词：战略性人力资源管理人力资源三支柱建筑企业

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Differences in clinical characteristics between younger and older patients with COVID-19 and their relationship with the length of hospital stay

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Journal of Intensive Medicine 2021年第2期1卷 123-129页

作者： qianyi peng Xinhua Ma Zhiyong Liu Chunguang Zhao Lei Zhang Zhaoxin Qian Lina Zhang Department of Critical Care Medicine Xiangya HospitalCentral South UniversityChangshaHunan Province 410008China National Clinical Research Center for Geriatric Disorders ChangshaHunan Province 410008China Hunan Provincial Clinical Research Center for Critical Care Medicine ChangshaHunan Province 410008China Department of Emergency Xiangya HospitalCentral South UniversityChangshaHunan Province 410008China

Background:The coronavirus disease 2019(COVID-19)pandemic is currently threatening the health of individuals *** compared the clinical characteristics between younger patients(aged14 days)yielded an area under the ROC(AuROC)curve of *** and antibiotic treatments were administered to 97.6%and 39.0%of patients,*** antiviral drugs most commonly administered were traditional Chinese medicine(83.7%)and arbidol(75.6%).Conclusions:In this study,older patients and those with primary diseases were at a higher risk of worse clinical *** physicians who treat the

关键词： COVID-19 Age Primary diseases Risk factors Treatment

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围手术期可逆性后部脑病综合征:1例病例报道及文献回顾

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国际麻醉学与复苏杂志 2023年第4期44卷 399-404页

作者：邹宇彭倩宜肖娟中南大学湘雅医院麻醉科长沙410008 中南大学湘雅医院重症医学科长沙410008 绥宁县人民医院麻醉科绥宁422600

可逆性后部脑病综合征(posterior reversible encephalopathy syndrome,PRES)是一种临床上罕见的放射学综合征,其特征是头痛、癫痫发作、意识障碍和视觉变化。大量输血、应用免疫抑制药物、低颅内压、围手术期高血压和神经外科术后的患... 详细信息

可逆性后部脑病综合征(posterior reversible encephalopathy syndrome,PRES)是一种临床上罕见的放射学综合征,其特征是头痛、癫痫发作、意识障碍和视觉变化。大量输血、应用免疫抑制药物、低颅内压、围手术期高血压和神经外科术后的患者需警惕PRES的发生。此例PRES患者存在严重贫血,既往无高血压病史,术后出现癫痫发作和意识丧失,磁共振检查证实为PRES。通过文献检索,回顾分析了29例围手术期PRES患者,其中14例患者为女性,23例(79.3%)发生了术中或术后高血压,术后神经症状的平均发病时间为5.4 d。有效的围手术期血压管理、避免大量输血和早期诊断治疗有助于避免疾病发生、发展,促进患者早期康复,降低病死率和后遗症发生率。

关键词：可逆性后部脑病综合征围手术期高血压输血

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重庆市商业地产周期波动的实证研究

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中国房地产 2017年第21期 20-29页

作者：彭谦益王林重庆大学建设管理与房地产学院重庆400045

房地产业是国民经济的支柱性产业,商业地产作为房地产业的重要组成部分,具有与宏观经济类似的周期性波动特征。在考虑重庆市目前的统计现状及指标数据可得性的基础上选取2003-2016年与商业地产周期相关的14个统计指标的年度数据,运用SPS... 详细信息

房地产业是国民经济的支柱性产业,商业地产作为房地产业的重要组成部分,具有与宏观经济类似的周期性波动特征。在考虑重庆市目前的统计现状及指标数据可得性的基础上选取2003-2016年与商业地产周期相关的14个统计指标的年度数据,运用SPSS16.0软件进行时序全局主成分分析,并绘制了重庆市商业地产周期波动的时序图。实证结果表明,在2003到2016年间,重庆市商业地产周期大致经历了3个完整的周期,周期平均长度为4个年度。在此基础上为宏观经济政策的制定和促进重庆市商业地产的健康良性发展提供建议。

关键词：商业地产时序全局主成分分析法 SPSS

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脑氧饱和度监测在脓毒症休克患者中的临床应用价值

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中南大学学报（医学版） 2021年第11期46卷 1212-1219页

作者：彭倩宜张丽娜艾美林黄立艾宇航中南大学湘雅医院重症医学科长沙410008 国家老年疾病临床医学研究中心(湘雅医院) 长沙410008 湖南省重症医学临床医学研究中心长沙410008

目的:脓毒症相关性脑病(sepsis associated encephalopathy,SAE)是脓毒症的一种常见神经并发症,谵妄是SAE的一种常见表现形式。SAE的病理生理学机制尚不明确,现有研究发现线粒体和内皮细胞功能障碍、神经递质异常、钙失调、脑微循环障... 详细信息

目的:脓毒症相关性脑病(sepsis associated encephalopathy,SAE)是脓毒症的一种常见神经并发症,谵妄是SAE的一种常见表现形式。SAE的病理生理学机制尚不明确,现有研究发现线粒体和内皮细胞功能障碍、神经递质异常、钙失调、脑微循环障碍和脑低灌注等可能参与其中。近红外光谱法(near-infrared spectroscopy,NIRS)是一种无创监测区域脑氧饱和度(regional cerebral oxygen saturation,rSO_(2))的方法,也是近年来研究的前沿热点。研究显示重症患者NIRS监测rSO_(2)异常与谵妄相关,且基于NIRS监测的治疗有助于改善患者的器官灌注和预后。本研究旨在通过NIRS监测脓毒症休克患者rSO_(2)的动态变化,并分析其与预后之间的关系。方法:收集2017年8月到2018年5月中南大学湘雅医院重症医学科收治的48例脓毒症休克患者资料,诊断依据欧美危重病医学会指定国际专家制订的脓毒症3.0标准。患者入重症监护室(intensive care unit,ICU)后在双侧前额放置NIRS监测探头对rSO_(2)进行连续动态监测至少6 h,记录rSO_(2)最高值(rSO_(2)max)和最低值(rSO_(2)min),计算rSO_(2)平均值和rSO_(2)变异度。收集患者的一般资料、入ICU 24 h内的实验室检查结果(血常规、肝肾功能、血气分析、感染指标、凝血功能)、评分结果[格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分、急性生理学与慢性健康状况评价II(Acute Physiology and Chronic Health Evaluation II,APACHE II)评分、序贯器官衰竭评价(Sequential Organ Failure Assessment,SOFA)评分等]。谵妄的评估采用ICU意识模糊评估法(Confusion Assessment Method for ICU,CAM-ICU)量表。记录患者机械通气(mechanical ventilation,MV)时间、ICU时间、住院时间和28 d病死率。首要结局指标为28 d病死率,次要结局指标为谵妄发生率、ICU时间和住院时间。分析存活与死亡患者、有谵妄与无谵妄患者之间实验室和临床指标的差异,评估谵妄的危险因素,评价rSO_(2)相关指标(rSO_(2)max、rSO_(2)min、rSO_(2)平均值和rSO_(2)变异度)用于预测28 d病死率和谵妄的能力及其界值。结果:脓毒症休克患者总的28 d病死率为47.92%(23/48),谵妄发生率为18.75%(9/48)。死亡患者的rSO_(2)min显著低于存活患者(P=0.042)。谵妄患者的rSO_(2)变异度显著高于无谵妄患者(P=0.006)。谵妄的独立危险因素是rSO_(2)max、直接胆红素(direct bilirubin,DBIL)水平和6 h集束化治疗是否达标。采用rSO_(2)相关指标预测脓毒症休克患者28 d是否死亡,rSO_(2)max、rSO_(2)min、rSO_(2)平均值和rSO_(2)变异度的受试者工作特征曲线下面积(area under the receiver operating characteristic curve,AUROC)分别为0.616、0.606、0.623和0.504;预测脓毒症休克患者是否发生谵妄,rSO_(2)max、rSO_(2)min、rSO_(2)平均值和rSO_(2)变异度的AUROC分别为0.682、0.617、0.580和0.501。rSO_(2)max预测谵妄的最佳界值是77.5%(敏感度为0.444,特异度为0.897),rSO_(2)min预测谵妄的最佳界值是65.5%(敏感度为0.556,特异度为0.744)。结论:rSO_(2)过低、过高或波动过大均与脓毒症休克不良预后和谵妄发生相关,需要引起临床重视。动态监测脓毒症休克患者的rSO_(2)并维持其平稳,可能对该类患者具有重要临床意义。

关键词：区域脑氧饱和度近红外光谱法脓毒症休克谵妄病死率

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经颅多普勒超声在早期诊断脓毒症相关性脑病中的临床意义

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中华内科杂志 2019年第11期58卷 814-818页

作者：艾美林黄立冯清彭倩宜莫煜楠艾宇航张丽娜无中南大学湘雅医院重症医学科长沙410008 中国重症超声研究组

目的探索经颅多普勒超声(TCD)在早期诊断脓毒症相关性脑病(SAE)的临床意义。方法选2015年7月至2016年3月中南大学湘雅医院重症医学科的脓毒症患者,收集患者入ICU24 h内的一般临床资料,每日对患者进行2次谵妄评估,以ICU谵妄评估量表(CAM-... 详细信息

目的探索经颅多普勒超声(TCD)在早期诊断脓毒症相关性脑病(SAE)的临床意义。方法选2015年7月至2016年3月中南大学湘雅医院重症医学科的脓毒症患者,收集患者入ICU24 h内的一般临床资料,每日对患者进行2次谵妄评估,以ICU谵妄评估量表(CAM-ICU)作为临床诊断SAE金标准,将患者分为SAE组和脓毒症未合并脑病组。采用TCD监测2组患者大脑中动脉收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、平均血流速度(Vm)、搏动指数(PI)和阻力指数(RI)。分析上述各参数诊断SAE的界值、敏感度和特异度。结果43例脓毒症患者纳入本研究,其中SAE组12例,脓毒症未合并脑病组31例。SAE组患者Vm、Vd低于脓毒症未合并脑病组[Vm:(53.50±12.22)cm/s比(61.68±9.63)cm/s,P0.7,具有较高的准确性。Vd诊断SAE的界值为34.50 cm/s,敏感度为93.5%,特异度为58.3%;PI诊断SAE的界值为1.16,敏感度为58.3%,特异度为96.8%;RI诊断SAE的界值为0.65,敏感度为58.3%,特异度为96.8%。结论SAE的发病与脓毒症患者的脑灌注不足相关,TCD有利于SAE的早期诊断。

关键词：脓毒症脓毒症相关性脑病经颅多普勒超声脑血流诊断

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