Kev sib raug zoo ntawm Braden Scale cov qhab nia thiab mob raum raug mob ntawm cov neeg mob uas mob Coronary Syndrome: Kev Tshawb Fawb Kev Tshawb Fawb Txog Kev Tshawb Fawb

TSAB NTAWV

1. Lub hom phiaj

Txhawm rau ntsuas qhov cuam tshuam ntawm cov kab mob hauv lub siab uas tau soj ntsuam los ntawm Braden Scale (BS) ntawm qhov mob raum raug mob (AKI) hauv cov neeg mob uas mob plawv mob plawv (ACS).

2. Tsim

Kev tshawb nrhiav kev sib koom ua ke ntawm ntau qhov chaw rov qab.

3. Kev teeb tsa

Cov chaw mob hauv siab los ntawm xya lub tsev kho mob tertiary hauv Suav teb.

4. Cov neeg koom nrog

Peb tau txheeb xyuas 3185 cov neeg mob nrog ACS los ntawm Kev Tshawb Fawb Txog Kev Tshawb Fawb Txog Kev Mob Chest Pain. Cov neeg mob tau muab faib ua peb pawg (B1, B2, thiab B3) raws li lawv cov qhab nia BS (tsawg dua lossis sib npaug ntawm 12 vs 13–14 vs Ntau dua lossis sib npaug rau 15, raws li) ntawm kev nkag.

5. Cov txiaj ntsig ntsuas

AKI tau txhais raws li cov txheej txheem ntawm xyoo 2012 Kab Mob Raum: Txhim Kho Cov txiaj ntsig thoob ntiaj teb. Multivariate logistic tsom xam tau siv los ntsuas kev sib raug zoo ntawm BS qhab nia thiab AKI.

6. Cov txiaj ntsig

Muaj 461 tus neeg mob (14.5 feem pua) nrog ACS uas muaj teeb meem ntawm AKI. Cov neeg mob uas tau qhab nia qis dua ntawm BS muaj qhov tshwm sim ntau dua ntawm AKI (p<0.001). Multivariate logistic regression analysis showed that adjusted ORs of the BS score for AKI were 2.242 (B1 vs B3: 95% CI: 1.643 to 3.060, p<0.001) and 1.566 (B2 vs B3: 95%CI: 1.186 to 2.069, p=0.002). The receiver operating characteristic curve analysis showed that the area under the curve of the BS score was 0.719 (95% CI: 0.702 to 0.736; p<0.001) for AKI.

7. Cov lus xaus

Qhov qhab nia BS yog tus kheej txuam nrog AKI. Tej zaum nws yuav yog ib qho cuab yeej siv tau los txheeb xyuas cov neeg uas yuav tau txais txiaj ntsig los ntawm kev kwv yees ntxiv thiab tiv thaiv AKI hauv cov neeg mob ACS.

Nyem qhov no kom tau txais txiaj ntsig ntawm Cistanche thiab yuav Cistanche cov khoom

Taw qhia

Acute coronary syndrome (ACS), qhov tshwm sim ntawm cov kab mob plawv ischemic, tseem yog qhov ua rau mob hnyav thiab tuag thoob ntiaj teb1 thiab yog lub luag haujlwm rau ntau tshaj 1 lab lub tsev kho mob hauv Tebchaws Meskas txhua xyoo.2 Txawm hais tias kev tuag ntawm cov neeg mob ACS tau poob qis hauv Xyoo tsis ntev los no, cov neeg tuag hauv tsev kho mob tseem nyob ntawm 2.5 feem pua ​​– 4.2 feem pua ​​.3–5 Kev txheeb xyuas cov neeg mob uas muaj kev pheej hmoo siab nrog ACS yog qhov tseem ceeb thiab pab txhawb kev txiav txim siab kho mob. 6

Mob raum raug mob (AKI) yog ib qho teeb meem ntawm ACS uas tej zaum yuav yog vim muaj qhov tsis zoo ntawm hemodynamic thiab kev siv cov tshuaj sib txawv.7 Raws li kev tshawb fawb dhau los, qhov tshwm sim ntawm AKI hauv cov neeg mob ACS yog li ntawm 6.3 feem pua ​​​​mus rau 36.6 feem pua, 8. thiab AKI muaj kev cuam tshuam tsis zoo rau cov neeg mob, suav nrog kev nyob hauv tsev kho mob ntev, qhov tshwm sim ntau dua ntawm cov xwm txheej hauv plawv thiab ob npaug-peb-peb tus neeg tuag.9-11 Muab qhov xwm txheej siab ntawm AKI thiab nws qhov cuam tshuam tsis zoo rau kev tshwm sim ntawm cov neeg mob ACS. , Nws yog ib qho tseem ceeb los txheeb xyuas cov neeg mob uas muaj kev pheej hmoo siab uas tuaj yeem tsim AKI kom cov neeg ua haujlwm kho mob tuaj yeem kwv yees thiab tiv thaiv qhov tshwm sim ntawm AKI hauv cov neeg mob ACS.

Frailty yog ib qho kev kho mob, uas ua rau poob ntawm lub cev rov qab, lub peev xwm cia, thiab kev ntxhov siab.12 tag nrho cov xwm txheej ntawm cov neeg mob tau tshaj tawm tias muaj feem cuam tshuam nrog rau lub raum ua haujlwm ruaj khov 13-15 thiab cuam tshuam nrog qhov tshwm sim ntawm AKI.16 yog li ntawd. , kev ntsuam xyuas ntxov thiab kev tshuaj xyuas ntawm qhov tsis txaus ntseeg yog qhov tseem ceeb rau kev ntsuam xyuas ntawm AKI.

Braden Scale (BS) yog siv dav hauv cov kev ntsuam xyuas kev saib xyuas neeg mob niaj hnub los kwv yees cov xwm txheej hauv lub siab hauv cov neeg mob.17 Vim tias BS tshuaj xyuas ntau yam uas tuaj yeem pab ntsuas qhov tsis zoo, xws li khoom noj khoom haus, kev paub, kev ua, thiab kev ua haujlwm, nws tau pom zoo. raws li ib tug frailty identification tool.18 Nyob rau hauv peb yav dhau los txoj kev tshawb no, cov qhab nia BS qis tau tshaj tawm tias muaj feem xyuam nrog kev tuag ntawm cov neeg mob uas mob myocardial mob19; Txawm li cas los xij, kev sib raug zoo ntawm BS cov qhab nia thiab AKI tseem tsis paub meej. Kev qhia meej txog kev sib raug zoo tuaj yeem pab cov kws saib xyuas neeg mob hauv cov kev pabcuam tu neeg mob txhua hnub txheeb xyuas cov neeg mob uas muaj kev pheej hmoo siab ntawm AKI, zam kev siv cov tshuaj nephrotoxic, txwv qhov sib txawv ntawm qhov nruab nrab, thiab ua kom muaj txiaj ntsig ntawm kev saib xyuas kev noj qab haus huv rau cov neeg mob uas muaj kev pheej hmoo siab nrog AKI.{{ 4}} Yog li, qhov kev tshawb fawb no tsom rau kev ntsuas kev sib raug zoo ntawm tus qhab nia BS thiab AKI hauv cov neeg mob ACS uas tau txais kev cuam tshuam thawj zaug percutaneous coronary intervention (PCI).

Cistanche ntxiv

Cov khoom siv thiab cov txheej txheem

1. Kawm tsim qauv

Nyob rau hauv qhov kev tshawb fawb ntau qhov kev rov qab los ntawm pawg neeg no, cov ntaub ntawv los ntawm Kev Tshawb Fawb Txog Kev Tshawb Fawb Txog Kev Mob Chest Pain (REACP) tau tshawb xyuas los soj ntsuam seb BS puas tuaj yeem kwv yees AKI hauv cov neeg mob ACS uas tau txais thawj PCI. Txoj kev tshawb fawb REACP tau tso npe rau cov neeg mob uas mob hauv siab mob ntawm lub hauv siab mob chaw los ntawm xya lub tsev kho mob qib siab hauv Suav teb thiab sau npe rau lawv ntawm www. chictr.org.cn (tus ID: ChiCTR1900024657).

2. Kawm cov pej xeem

Txij Lub Ib Hlis 2017 txog Lub Ob Hlis 2019, 14 460 cov neeg mob tau mus xyuas qhov chaw mob hauv siab, thiab 3337 tus neeg mob laus tau kuaj pom tias muaj ACS thiab tau txais thawj PCI. Ntawm cov neeg mob no, 122 tus neeg mob tsis muaj cov ntaub ntawv cuam tshuam thiab tsis tuaj yeem rov qab mus rau kev soj ntsuam, 150 tus neeg mob tau kho nrog thrombolysis thiab 218 tus neeg mob tawm hauv tsev kho mob hauv 24 teev. Thaum kawg, 2847 tus neeg mob tau raug xaiv thiab muab faib ua pawg B1, B2, thiab B3, raws li cov lej ntawm lawv cov qhab nia BS: Tsawg dua lossis sib npaug rau 12, 13–14, thiab Ntau dua lossis sib npaug rau 15 ntawm kev nkag, raws li (daim duab 1).

Daim duab 1 Kawm Flow chart. PCI, percutaneous coronary intervention.

3. Cov ntaub ntawv sau thiab txhais

Peb tau txais cov ntaub ntawv los ntawm cov ntaub ntawv ntawm REACP txoj kev tshawb fawb. Cov ntaub ntawv ntawm cov cim tseem ceeb, keeb kwm kev kho mob, coronary angiography, tshuaj, kev kuaj xyuas, thiab cov duab pom tau raug sau los ntawm cov kws kho mob. Bedside echocardiography tau ua los ntawm tus kws tshaj lij hauv 24 teev tom qab nkag, thiab sab laug ventricular ejection fraction (LVEF) tau suav nrog txoj kev biplane Simpson (Philips E33 Medical Systems, Bothell, Washington, USA). Ntiaj teb no Registry of Acute Coronary Events (GRACE) cov qhab nia thiab Gensini cov qhab nia raug xam raws li cov kev tshawb fawb yav dhau los.22–25 Mehran cov qhab nia muaj kev pheej hmoo suav nrog ntshav siab, siv cov twj tso kua mis intra-aortic, lub plawv tsis ua haujlwm, hnub nyoog, ntshav ntshav, ntshav qab zib mellitus, sib piv cov xov xwm ntim, thiab kwv yees glomerular filtration rate (eGFR).

Ntawm chav kho mob xwm txheej ceev, cov txheej txheem rau tus kws saib xyuas neeg mob yog siv BS ntawm txhua tus neeg mob thaum nkag nrog kev rov ntsuas dua txhua 24 teev. Rau lub subscales tsim BS, uas suav nrog kev xav, kev sib txuas lus, dej, kev ua ub no, khoom noj khoom haus thiab kev sib txhuam, thiab shear force. Txhua qhov subscale muaj 1-4 cov ntsiab lus, tsis suav nrog kev sib txhuam thiab lub zog shear uas muaj 1-3 ntsiab lus. Raws li cov qhab nia no, tag nrho cov ntsiab lus tuaj yeem nyob ntawm 6 txog 23.17 Raws li kev txhais lus tshawb fawb ntawm BS hauv xyoo 2005, txhawm rau txheeb xyuas tus neeg mob qhov kev pheej hmoo ntawm kev mob siab, cov qhab nia tau raws li hauv qab no: 15-23, mob me lossis tsis muaj kev pheej hmoo. ; 13–14, muaj kev pheej hmoo loj; thiab tsawg dua los yog sib npaug rau 12, muaj kev pheej hmoo siab.27

Staging of AKI was based on the criterion of Kidney Disease: Improving Global Outcomes.28 AKI stage 1 criteria are serum creatinine level >26.5 mmol/L (0.3 mg/dL) hauv 48 teev, nce hauv cov ntshav creatinine rau 1. tso zis<0.5 mL/kg/hour for 6–12 hours. The criteria for AKI stage 2 are increased serum creatinine to 2.0-fold–2.9-fold of the baseline value or urine output <0.5 mL/kg/hour for 12 hours. AKI stage 3 criteria are serum creatinine level >353.6 mmol / L (4.0 mg / dL), nce ntshav creatinine ntau dua 3.0-fold ntawm tus nqi hauv qab, tso zis tso zis<0.3 mL/kg/hour for 24 hours or anuria for 12 hours. The first serum creatinine value measured on admission is the baseline serum creatinine.

4. Xaus thiab ua raws

Cov pej xeem kawm tau txais qhov nruab nrab ntawm 11.9 lub hlis (5.0–20.4 lub hlis) ntawm kev soj ntsuam. Cov kws kho mob tau txais kev xam phaj cov neeg mob siv cov lus nug hauv xov tooj. Thawj qhov kawg yog AKI.

Cistanche extract thiab Cistanche hmoov

5. Kev txheeb cais

Cov categorical variables tau nthuav tawm raws li tus lej (feem pua) thiab muab piv los ntawm qhov kev xeem χ2. Cov kev hloov pauv tas mus li tau tshaj tawm raws li qhov nruab nrab (25th - 75th) lossis txhais tau tias ± SDs, raws li kev faib tawm tsis zoo thiab ib txwm muaj, thiab piv nrog kev sim Mann-Whitney U lossis kev tshuaj xyuas ntawm qhov sib txawv, raws li. Tus qauv logistic regression tau siv los ntsuas seb cov qhab nia BS puas cuam tshuam nrog AKI. Tag nrho cov kev hloov pauv tau suav nrog hauv tus qauv univariate, thiab cov kev hloov pauv tseem ceeb tau rov nkag mus rau hauv cov qauv sib txawv. Lub cheeb tsam nyob rau hauv tus neeg txais kev khiav hauj lwm yam ntxwv (ROC) nkhaus tau tsim los ntsuas lub peev xwm ntawm BS cov qhab nia los kwv yees AKI. Qhov sib npaug ntawm cov neeg muaj sia nyob ntawm peb pawg neeg mob (B1 vs B2 vs B3) nrog lossis tsis muaj AKI tau muab piv los ntawm Kaplan-Meier nkhaus. Txhawm rau tshawb nrhiav qhov cuam tshuam ncaj qha ntawm BS cov qhab nia ntawm txhua qhov kev tuag los ntawm kev bypath ntawm AKI, kev tsom xam txoj hauv kev tsim los ntawm cov qauv kev sib npaug sib npaug tau ua tiav.29 Cov txiaj ntsig ntawm txoj kev tsom xam tau soj ntsuam los ntawm tus qauv regression coefficients ( ) los piav qhia ncaj qha thiab indirect cuam tshuam rau tag nrho cov-ua rau tuag, thiab qhov kev faib ua feem ntawm cov mediating nyhuv yog xam los ntawm kev faib cov regression coefficient ntawm indirect txoj kev los ntawm tag nrho cov regression coefficient. Ib tug ob-tailed p-tus nqi ntawm<0.05 was considered significant. Data were analyzed using SPSS Statistics V.20.0 and R for Windows V.3.5.0.

6. Cov neeg mob thiab kev koom tes nrog pej xeem

Cov neeg mob tsis tau koom nrog hauv kev tsim lossis sau cov ntaub ntawv hauv txoj kev tshawb no.

Cov lus xaus

Qhov qhab nia BS ntawm kev nkag mus rau nws tus kheej cuam tshuam nrog AKI rau cov neeg mob ACS. BS tej zaum yuav yog ib qho cuab yeej muaj txiaj ntsig thiab yooj yim los txheeb xyuas qhov pheej hmoo ntawm AKI ntawm cov neeg mob ACS. Tsis tas li ntawd, ntau dua 30 feem pua ​​​​ntawm cov txiaj ntsig ntawm BS cov qhab nia ntawm kev tuag tau kho los ntawm AKI, uas qhia tias kev tsis txaus ntseeg thiab AKI yog ob lub hom phiaj tseem ceeb los txhim kho cov kev mob tshwm sim ntawm cov neeg mob ACS.

Standardized Cistanche

REFERENCES

1 Roth GA, Johnson C, Abajobir A, et al. Ntiaj teb no, lub regional, thiab lub teb chaws lub nra ntawm cov kab mob plawv rau 10 ua, 1990 txog 2015. J Am Coll Cardiol 2017; 70:1–25.

2 Eisen A, Giugliano RP, Braunwald E. Hloov tshiab ntawm tus mob coronary syndrome: kev tshuaj xyuas. JAMA Cardiol 2016; 1:718–30.

3 Virani SS, Alonso A, Benjamin EJ, et al. Mob plawv thiab mob stroke Statistics-2020 hloov tshiab: ib daim ntawv qhia los ntawm American koom haum plawv. Tshaj tawm 2020; 141: e139–596.

4 Malanchini G, Stefanini GG, Malanchini M, et al. Kev tuag ntau dua hauv tsev kho mob thaum lub asthiv nkag rau tus mob coronary syndrome: ib qho kev tshawb fawb loj ntawm Italian. J Cardiovasc Med 2019; 20:74–80.

5 Peng Y, Du X, Rogers KD, et al. Kev kwv yees kev tuag hauv tsev kho mob hauv cov neeg mob uas mob coronary syndrome hauv Suav teb. Am J Cardiol 2017; 120:1077–83.

6 Loudon BL, Gollop ND, Carter PR, et al. Kev cuam tshuam ntawm cov kab mob plawv thiab kab mob ntawm qhov ntev ntawm kev nyob thiab kev tuag hauv cov neeg mob uas mob coronary syndromes. Int J Cardiol 2016; 220:745–9.

7 Almendarez M, Gurm HS, Mariani J, et al. Cov txheej txheem txheej txheem los txo qhov tshwm sim ntawm qhov sib txawv ntawm lub raum raug mob thaum lub sij hawm percutaneous coronary intervention. JACC Cardiovasc Interv 2019; 12: 1877–88.

8 Xaiv JW, Blunt IRH, dua MP. Mob raum raug mob thiab tuag prognosis nyob rau hauv mob coronary syndrome cov neeg mob: ib tug meta-analysis. Nephrology 2018; 23:237–46.

9 Kaltsas E, Chalikias G, Tziakas D. Qhov tshwm sim thiab kev cuam tshuam ntawm lub raum raug mob hauv cov neeg mob myocardial infarction: cov tswv yim tiv thaiv tam sim no. Cardiovasc Drugs Ther 2018; 32:81–98.

10 Marenzi G, Cosentino N, Bartorelli AL. Mob raum raug mob nyob rau hauv cov neeg mob uas mob coronary syndromes. Heart 2015; 101:1778–85.

11 Marenzi G, Cabiati A, Bertoli SV, et al. Kev tshwm sim thiab qhov cuam tshuam ntawm mob raum raug mob hauv cov neeg mob pw hauv tsev kho mob nrog mob coronary syndromes. Am J Cardiol 2013; 111:816–22.

12 Ortiz-Soriano V, Neyra JA. Qhov cuam tshuam ntawm mob raum raug mob ntawm qhov tsis txaus ntseeg hauv cov neeg muaj mob hnyav - puas muaj pov thawj txaus? J Emerg Crit Care Med 2018;2. doi: 10.21037/jccm.2018.10.17. [Epub ua ntej luam tawm: 07 11 2018].

13 Guerville F, de Souto Barreto P, Taton B, et al. Kwv yees glomerular filtration rate poob qis thiab qhov teeb meem frailty hauv cov laus. Clin J Am Soc Nephrol 2019; 14:1597–604.

14 Morton S, Isted A, Avery P, thiab al. Puas yog kev tsis txaus ntseeg yog qhov kev kwv yees ntawm qhov tshwm sim hauv cov neeg laus laus uas muaj mob raum raug mob? Txoj kev tshawb fawb yav tom ntej. Am J Med 2018; 131:1251–6.

15 Baek SH, Lee SW, Kim SW, et al. Frailty raws li kev kwv yees ntawm mob raum raug mob hauv tsev kho mob cov neeg laus hauv tsev kho mob: ib qho chaw, kev tshawb fawb rov qab. PLoS One 2016; 11:e0156444.

16 Jiesisibieke ZL, Tung TH, Xu QY, et al. Lub koom haum ntawm mob raum raug mob nrog frailty nyob rau hauv cov neeg laus cov neeg laus: ib tug systematic tshuaj xyuas thiab meta-analysis. Ren Fail 2019; 41:1021–7.

17 Brown SJ. Braden nplai. Kev tshuaj xyuas ntawm cov ntaub ntawv tshawb fawb. Orthop Nurs 2004; 23:30–8.

18 Cohen RR, Lagoo-Deenadayalan SA, Heflin MT, et al. Tshawb nrhiav kev kwv yees ntawm cov teeb meem hauv cov neeg mob phais laus: qhov ntsuas qhov tsis txaus thiab qhov ntsuas Braden. J Am Geriatr Soc 2012; 60:1609–15.

19 Jia Y, Li H, Li Y, et al. Prognostic tus nqi ntawm Braden scale nyob rau hauv cov neeg mob uas mob myocardial infarction: los ntawm cov kev tshawb fawb retrospective multicenter rau kev ntsuam xyuas ntxov ntawm mob hauv siab mob. J Cardiovasc Nurs 2020;35:E53–61.

20 Kashani K, Rosner MH, Haase M, et al. Lub hom phiaj txhim kho kom zoo rau mob raum raug mob. Clin J Am Soc Nephrol 2019; 14:941–53. 21 Murphy F, Byrne G. Tus kws saib xyuas neeg mob lub luag haujlwm hauv kev tswj xyuas lub raum raug mob. Br J Nurs 2010; 19:146–52.

22 Granger CB, Goldberg RJ, Dabbous O, et al. Kev kwv yees ntawm lub tsev kho mob tuag hauv lub ntiaj teb kev sau npe ntawm cov xwm txheej mob coronary. Arch Intern Med 2003; 163:2345–53.

23 Gensini GG. Ib qho txiaj ntsig zoo dua rau kev txiav txim siab qhov hnyav ntawm cov kab mob plawv. Am J Cardiol 1983; 51:606.

24 Jia Y, Gao Y, Li D, et al. Geriatric noj zaub mov kev pheej hmoo index qhab nia kwv yees qhov tshwm sim ntawm kev kho mob hauv cov neeg mob uas mob ST-segment nce myocardial infarction. J Cardiovasc Nurs 2020; 35:E44–52.

25 Yu J, Li D, Jia Y, et al. Kev soj ntsuam kev pheej hmoo noj zaub mov 2002 tau cuam tshuam nrog mob raum raug mob thiab kev tuag hauv cov neeg mob uas mob plawv mob plawv: kev pom los ntawm REACP txoj kev tshawb fawb. Nutr Metab Cardiovasc Dis 2021; 31:1121–8.

26 Mehran R, Aymong ED, Nikolsky E, et al. Ib qho kev pheej hmoo yooj yim rau kev kwv yees ntawm qhov sib txawv ntawm qhov tshwm sim nephropathy tom qab percutaneous coronary cuam tshuam: kev txhim kho thiab pib siv tau. J Am Coll Cardiol 2004; 44:1393–9.

27 Braden BJ, Maklebust J, Maklebust J. Tiv thaiv qhov mob siab nrog Braden nplai: ib qho kev hloov tshiab ntawm cov cuab yeej siv yooj yim no uas ntsuas tus neeg mob qhov kev pheej hmoo. Am J Nurs 2005; 105:70–2.

28 Khwaja A. KDIGO cov txheej txheem kev kho mob rau mob raum raug mob. Nephron Clin Pract 2012; 120:c179–84.

29 Stein CM, Morris NJ, Nock NL. Kev tsim qauv vaj huam sib luag. Methods Mol Biol 2012; 850:495–512.

Zhou Li, 1,2 Bofu Liu, 1 Dongze Li, 1 Yu Jia, 1 Li Ye, 1 Xiaoyang Liao, 3 Zhi Zeng, 1 Zhi Wan 1

1 Department of Emergency Medicine, West China Tsev Kawm Ntawv Saib Xyuas Neeg Mob, West China Tsev Kho Mob, Sichuan University, Chengdu, Suav

2 Department of Cardiology, West China Tsev Kho Mob, Sichuan University, Chengdu, Suav

3 Department of General Practice thiab National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Suav