Objective:To investigate the effect of early continuous renal replacement therapy (CRRT) within 24 h on in-hospital mortality in patients with sepsis.Methods:This study retrospectively analyzed the patients diagnosed as sepsis in the Emergency Intensive Care Unit of the First Affiliated Hospital of Wenzhou Medical University from January 2013 to December 2017. According to the prognosis, the patients were divided into the survival group and death group. The clinical baseline data of the two groups were compared, and multivariate logistic regression analysis was performed to screen out the risk factors of death in patients with sepsis and evaluate the effect of CRRT on mortality. According to whether CRRT was performed within 24 h after admission, the patients were divided into the CRRT group and non-CRRT group to compare fluid balance.Results:Among the 612 patients, 416 (67.9%) patients were male, the median age was 66 years; 362 patients survived and 250 patients died, with a mortality rate of 40.8%. Multivariate logistic regression analysis showed that the independent risk factors for death in patients with sepsis were: sex, simplified acute physiology score Ⅱ, sequential organ failure assessment, lactate, procalcitonin, and complicated with chronic obstructive pulmonary disease. Multivariate logistic regression analysis showed that patients received CRRT within 24 h had a higher risk of mortality ( OR=1.981 95% CI: 1.120-3.504, P=0.019). There was a statistically significant difference in fluid balance between the CRRT group and the non-CRRT group on the first day ( P<0.05), and there was no significant difference in total fluid balance in the first 3 days ( P>0.05). Conclusions:Early CRRT within 24 h cannot reduce the in-hospital mortality of patients with sepsis. The failure of CRRT which did not timely correct the volume overload state of patients with sepsis after fluid resuscitation may affect the outcome.

Objective:To explore the value of early dynamic changes of platelet count (PLT) in evaluating the prognosis of sepsis patients.Methods:A retrospective study was conducted to select sepsis patients admitted to the Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of Wenzhou Medical University from January 2013 to December 2017. The sepsis patients were divided into the survival group and death group according to the 28-day prognosis after EICU admission. The basic and clinical data of the two groups of patients were compared, and the risk factors for the 28-day prognosis of sepsis patients were screened, and the value of platelet change (ΔPLT) in the prognosis of sepsis was evaluated.Results:A total of 549 sepsis patients were included, 184 died within 28 days, and 365 survived, with a 28-day mortality rate of 33.5%. Compared with the survival group, the death group had a higher proportion of males, were older, and had more chronic diseases and tumors such as chronic obstructive pulmonary disease (COPD); simplified acute physiology score Ⅱ (SAPS-Ⅱ), sequential organ failure score (SOFA), procalcitonin, C-reactive protein, blood urea nitrogen, fibrinogen, and mean arterial pressure were lower, the PLT was lower on d1-5, the value of ΔPLT d2-5 were decreased more significantly, and the platelet to lymphocyte ratio (PLR) value was higher, and the difference was statistically significant ( P<0.05). However, there was no significant difference in mean platelet volume and platelet distribution width between the two groups (all P>0.05). Multivariate logistic regression analysis showed that COPD ( OR=4.167, 95% CI: 1.769-9.815, P<0.001), malignant tumor ( OR=1.815, 95% CI: 1.034-3.817, P=0.038), SAPS-Ⅱ score ( OR=1.071, 95% CI: 1.046-1.096, P<0.001), SOFA score ( OR=1.060, 95% CI: 1.001-1.021, P=0.041), and PLR value ( OR=1.001, 95% CI: 1.001-1.002, P<0.001) were independent risk factors affecting the 28-day prognosis of sepsis patients. PLT d1 ( OR=0.996, 95% CI: 0.995-0.998, P<0.001) was a protective factor for better prognosis in sepsis patients. The ROC curve analysis showed that the SAPS-Ⅱ score and SOFA score could predict the 28-day ICU prognosis of sepsis patients, and the SAPS-Ⅱ score had the largest area under the ROC curve (AUC=0.726). The AUC (0.678) of ΔPLT d4 was greater than those of the other days. When the optimal critical value was -26.5×10 9/L, the sensitivity was 57.8% and the specificity was 71.7%. Conclusions:The early dynamic changes of PLT are closely related to the prognosis of sepsis patients, which is worthy of clinical reference and promotion.

Objective:Focusing on the medical protection of marine sports events at the 19th Asian Games in Hangzhou. This paper analyzes the effect of the development and implementation of the medical protection program to provide a referable summary of experience for the medical protection of future large-scale international maritime events.Method:This paper retrospectively analyzed the medical protection of Ningbo Xiangshan Yafan Center during the preparation stage of the Asian Games Sailing Competition, and during the period from September 21 to September 27, 2023 when the Asian Games Sailing Competition is held. Analyze the organizational structure and scheme of medical support.Results:During this Asian Games sailing competition, there were a total of 14 paramedics, 4 rescue helicopter crews, 2 ambulances and 1 rescue helicopter in and around the competition venues. In the city, the designated hospital has set up a total of 12 working groups, 15 protection outpatient clinics and a number of various types of clinic areas. There are 129 medical and nursing staff directly participating in the medical protection work of the Asian Games. A total of 44 specialized beds were reserved in the designated hospitals. There were also a number of volunteers and logistic staff who relied on the support work. The top three major disease types were trauma with 66 cases (29.2%), upper respiratory tract infection with 34 cases (15.04%) and skin allergy with 19 cases (8.51%). The top two population groups consulted were staff with 95 visits (44.19%) and technical officers with 89 visits (41.40%).Conclusions:During the sailing competitions of the Asian Games, the medical care was smooth and orderly. Trauma, upper respiratory tract infections and skin allergies are the most prominent diseases. The number of medical consultations for staff and technical officials of the Asian Games Sailing Competition accounted for more than 80% of the total number of consultations for all personnel. They should be given priority care.